OBJECTIVE To evaluate the safety， efficacy and economics of dapagliflozin in the treatment of type 2 diabetes mellitus （T2DM） combined with cardiovascular disease （CVD）， and provide an evidence-based basis for clinical treatment decisions. METHODS PubMed， the Cochrane Library， Embase， Web of Science， CNKI， Wanfang data， VIP， SinoMed and official websites of domestic and foreign health technology assessment （HTA） organizations were systematically searched. HTA reports， systematic evaluations/meta-analyses， and pharmacoeconomic studies of dapagliflozin in the treatment of T2DM combined with CVD were searched. After data extraction and quality assessment， the results of the included studies were analyzed descriptively. RESULTS A total of 13 papers were included， of which 10 were systematic evaluations/meta-analyses and 3 were pharmacoeconomic studies. In terms of efficacy， dapagliflozin significantly reduced patients’ glycosylated hemoglobin， body weight， body mass index and blood pressure levels compared with placebo， without increasing the risk of all-cause mortality； in terms of safety， dapagliflozin did not increase the risk of overall adverse events， major adverse cardiovascular events， cardiovascular death， hospitalization for heart failure， myocardial infarction， stroke， bone fracture and renal hypoplasia； in terms of economics， the UK and Chinese studies found an economic advantage for dapagliflozin， the Thai study did not. CONCLUSIONS Dagliflozin has better efficacy and safety in the treatment of T2DM combined with CVD， and its economic findings are still controversial in different countries， with economic advantages in the context of current Chinese healthcare policies and drug prices.

An improved U-shaped multi-lesion segmentation model,namely dense dilated attention pyramid UNet(DDAPNet),is proposed to overcome the difficulty in learning multi-scale features and address the issue of blurry boundaries in diabetic retinopathy(DR)segmentation task.DR images are treated with Patch processing to enhance the model's ability to capture local lesion features.After backbone feature extraction,a redesigned dense dilated attention pyramid module is introduced to expand the receptive field and address the issue of blurry lesion boundaries;and simultaneously,pyramid split attention module is used for feature enhancement;and then,the features output by the two modules are fused.Additionally,an improved residual attention module is embedded within skip connections to reduce interference from shallow redundant information.The joint validation on DDR dataset and real dataset from a specific hospital shows that compared with the original model,DDAPNet model improves the Dice similarity coefficient for segmentations of microaneurysms,hemorrhages,soft exudates and hard exudates by 4.31%,2.52%,3.39%and 4.29%,respectively,and increases mean intersection over union by 1.80%,2.24%,4.28%and 1.98%,respectively.The proposed model makes the segmentation of lesion edges smoother and more continuous,notably enhancing the segmentation performance for conditions like soft exudates in retinal lesions.

Background::Given that seizures may be triggered by vaccination, this study aimed to evaluate the risk and correlative factors of seizures in patients with epilepsy (PWE) after being vaccinated against coronavirus disease 2019 (COVID-19).Methods::This study retrospectively enrolled PWE who were vaccinated against COVID-19 in the epilepsy centers of 11 hospitals in China. We divided the PWE into two groups as follows: (1) patients who developed seizures within 14 days of vaccination were assigned to the SAV (with seizures after vaccination) group; (2) patients who were seizure-free within 14 days of vaccination were assigned to the SFAV (seizure-free after vaccination) group. To identify potential risk factors for seizure reccurence, the binary logistic regression analysis was performed. Besides, 67 PWE who had not been vaccinated were also included for elucidating the effects of vaccination on seizures recurrence, and binary logistic regression analysis was performed to determine whether vaccination would affect the recurrence rate of PWE who had drug reduction or withdrawal.Results::The study included a total of 407 patients; of which, 48 (11.8%) developed seizures within 14 days after vaccination (SAV group), whereas 359 (88.2%) remained seizure-free (SFAV group). The binary logistic regression analysis revealed that duration of seizure freedom ( P < 0.001) and withdrawal from anti-seizure medications (ASMs) or reduction in their dosage during the peri-vaccination period were significantly associated with the recurrence of seizures (odds ratio= 7.384, 95% confidence interval = 1.732–31.488, P = 0.007). In addition, 32 of 33 patients (97.0%) who were seizure-free for more than three months before vaccination and had a normal electroencephalogram before vaccination did not have any seizures within 14 days of vaccination. A total of 92 (22.6%) patients experienced non-epileptic adverse reactions after vaccination. Binary logistic regression analysis results showed that vaccine did not significantly affect the recurrence rate of PWE who had the behavior of ASMs dose reduction or withdrawal ( P = 0.143). Conclusions::PWE need protection from the COVID-19 vaccine. PWE who are seizure-free for >3 months before vaccination should be vaccinated. Whether the remaining PWE should be vaccinated depends on the local prevalence of COVID-19. Finally, PWE should avoid discontinuing ASMs or reducing their dosage during the peri-vaccination period.

Premature infants are multisystem immature and more prone to extravasation injury of intravenous drugs than mature neonates. Extravasation injury will not only increase the pain of children, prolong hospital stay, increase medical expenses, but also cause limb dysfunction in children, and even leave them disabled. In view of the lack of professional guidelines and consensus on the treatment of extravasation injury in premature infants by intravenous treatment, clinical nurses have certain difficulties in the prevention and treatment of extravasation injury in premature infants. This article reviews the evaluation of risk factors, assessment and management for extravasation injury in premature infants, aiming to provide a practical basis for clinical practice and provide a reference for further development of prevention and treatment strategies.

Objective:To construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes and evaluate its reliability and validity so as to provide a scientific assessment scale for clinical practice.Methods:The literature review, group discussion, expert consultation method and questionnaire survey method were used to construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes. Based on the theory of knowledge, attitude and practice, the initial scale was developed through literature review. The Delphi method was used to conduct two rounds expert consultation to develop the pre-test scale. From August to October 2020, a total of 230 pre-discharge patients from China-Japan Union Hospital of Jilin University were selected as the research subjects. The reliability and validity of the scale were tested.Results:The formal scale included 32 items and 4 dimensions. The scale-level content validity index was 0.79-1.00, unanimity scale-level content validity index ( S- CVI/ UA) was 0.81, and average scale-level content validity ( S- CVI/ Ave) was 0.95. The Cronbach's α coefficient of the scale was 0.955, and the half-reliability was 0.846. Conclusions:The Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes has good reliability and validity, which can provide a scientific and effective assessment tool for clinical practice.

Objective:To design a new medication guidance tool for clinical intravenous therapy and nursing safety which covers all-dimensional information of intravenous therapy and nursing needs, and observe its application effects.Methods:(1) The treatment plans of common and frequently-occurring diseases in the priority departments of Class Ⅲ general hospitals in Jilin Province from January 2016 to December 2017 were retrospectively investigated and summarized to determine the index framework of intravenous therapy guidance tools. (2) The status quo survey, expert meeting and literature search were used to determine the content of the guidance tool and the drug information. (3) The expert consensus was used to determine the presentation of the guidance tool. (4) Totally 127 nurses in the departments were selected by convenient sampling for a non-contemporaneous controlled trial to compare the effects of the guidance tool after one month of application and nursing staff's level of knowledge about the risk of intravenous therapy.Results:(1) A guidance tool with 8 specialties, 73 treatment plans, and 326 commonly used drug information presented with specialties as an index and visualized signs was designed and developed, which covers relevant information such as requirements for infusion device materials, selection of infusion device, and requirements for inter-group tube flushing and sealing. (2) From May to June 2019, the nurses were tested before and after use, who were required to complete the specialist drug knowledge questionnaire within the specified time. The accuracy of the three dimensions of the physical and chemical properties of drugs, pharmacological effects, and safe use was 89.76%, 90.55%, and 95.27%, respectively, which were higher than that before use, and the difference was statistically significant ( P<0.05) . Conclusions:Based on the needs of clinical intravenous therapy and nursing safety medication, the novel guidance tool for intravenous therapy and safe medication nursing is designed and completed, which can effectively improve the nurses' ability to safely use intravenous medications and work efficiency and is worth promoting in clinical practice.

Objective: To study the application of multiple row spiral CT (MSCT) in the diagnosis of inferior vena cava lesions in Budd Chiari syndrome (BCS) and its clinical value. Methods: Eighty patients with BCS admitted to the Central Hospital of Shan County from May 2017 to May 2018 were divided into two groups by digital grouping method, with 40 cases in each group.The control group was diagnosed by ultrasound, and the study group was diagnosed by multi-slice CT.The pathological changes, tissue contrast of inferior vena cava and hepatic vein and the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of inferior vena cava obstruction were compared between the two groups. Results: The pathological diagnosis rate in the study group was significantly higher than that in the control group(χ²=4.562, 4.695, 4.125, 5.124, all P<0.05). The contrast of inferior vena cava and hepatic vein tissues in the study group was significantly higher than that in the control group (t=12.897, 13.214, all P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of the diagnosis of inferior vena cava occlusion in the study group were higher than those in the control group (the control group: 91.2%, 98.6%, 97.3%, 80.3%, the study group: 100.0%, 99.5%, 98.2%, 100.0%, χ²=11.897, 10.214, 11.235, 13.564, all P<0.05). Conclusion The application of MSCT in the diagnosis of BCS-inferior vena cava lesions, can display the lesions comprehensively and intuitive guidance in the treatment of inferior vena cava lesions, has high diagnostic value, it is worthy of popularization and application in clinic.

Objective? To study and design an early warning and pre-control scheme for the risk of intravenous catheter blockage and observe the application effect in the clinical practice. Methods? This study was divided into three stages: the first stage established the risk early warning plan of intravenous indwelling catheter occlusion through literature review, expert consultation, analytic hierarchy process and retrospective research; the second stage summarized the best evidence of intravenous indwelling catheter occlusion intervention through literature retrieval and literature quality evaluation, and established the risk through expert consultation. In the third stage, by convenience sampling we selected the inpatients from some departments of a Class Ⅲ Grade A hospital in Jilin Province to carry out non-synchronous control experiment. A total of 236 inpatients who used intravenous indwelling catheter from May to June of 2018 were taken as the observation group, and 218 inpatients from May to June of 2017 were taken as the control group. The occurrence of intravenous indwelling catheter occlusion and indwelling time of intravenous indwelling catheter were compared between the two groups. Results? A pre-warning evaluation scheme consisting of two first-level indicators, eight second-level indicators and 17 third-level indicators was formed, and three early-warning levels, low-risk, medium-risk and high-risk, were determined. A pre-control scheme was formed for different early-warning levels. The non-synchronous control experiment showed that the incidence of intravenous indwelling catheter occlusion in the observation group was higher than that in the control group, the difference between the two groups was statistically significant (P＜ 0.05); the indwelling time of intravenous indwelling catheter in the observation group was longer than that in the control group, and the difference between the two groups was statistically significant (P＜0.05). Conclusions? The use of risk early warning theory, the forming of a comprehensive risk factor assessment program, and the use of forward-looking nursing thinking in the implementation of targeted pre-control program, can help to improve nurses' ability to identify and control the risk of intravenous indwelling catheter occlusion, reduce the incidence of indwelling catheter occlusion, and effectively prolong the indwelling time.

A 7-year-old female patient presented with frontal bossing and exophthalmos complicated by skin pigmentation all over the body for 7 years.Pigmentation was seen on the flexor aspects of the bilateral elbows 1 week after birth,and skin pigmentation gradually appeared at multiple body sites 1 year later.She had suffered from lacrimal duct obstruction since childhood,and repeated dredging of the duct was ineffective.Parents of the child were healthy and non-consanguineous marriage,and had no family history of the same disease.Physical examination showed square-shaped skull,frontal bossing,maxillary hypoplasia,mandibular prognathism,exophthalmos,ocular hypertelorism,depressed nasal bridge,dental malocclusion,and irregular dentition.Skin examination showed dark brown skin all over the body,coarse skin on the neck,axillary and inguinal regions,papillomatous cutaneous thickening,with velvet-like appearance.The patient was diagnosed with Crouzon syndrome complicated by acanthosis nigricans (CAN).Polymerase chain reaction (PCR)and DNA sequencing were performed to detect mutations in the FGFR3 gene in the patient with CAN,her parents and 100 unrelated healthy controls.A heterozygous missense mutation (C.1172 C ＞ A) was identified in the FGFR3 gene in the proband,but not in her parents or the 100 unrelated healthy controls.The missense mutation in the FGFR3 gene may be a causative mutation leading to the clinical manifestations of the patient.

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.