Objective:To evaluate the influencing factors and predictive value of renal function recovery in elderly patients with heart failure(HF)and acute renal injury(AKI)after intermittent veno-venous hemofiltration(IVVH)using critical care ultrasound.Methods:The clinical data of elderly patients with heart failure(NYHF grade Ⅲ~Ⅳ)complicated with acute kidney injury(stage 2~stage 3)who underwent intravenous veno-venous hemofiltration(IVVH)in the critical care unit(CCU)of our hospital were retrospectively analyzed.The demographic information of the patients and the changes in clinical biochemical and critical care ultrasound monitoring parameters before and after 7 days of IVVH were recorded.Based on the recovery of renal function, the patients were divided into two groups: a renal function recovery group and a renal function non-recovery group.Logistic regression and Receiver Operating Characteristic Curve(ROC)curve analysis were performed to determine the predictive value of various influencing factors on the recovery of renal function in patients.Results:A total of 178 patients were enrolled in this study.After starting IVVH treatment, renal function recovered in 143 cases at 30 days, and in 138 cases at 90 days.However, renal function did not recover in 35 cases at 30 days, and in 40 cases at 90 days.The proportion of NYHF Ⅲ patients、the proportion of diabetic patients、the decrease of Beta 2-microglobulin(β2-MC)、the decrease of Cystain C(CysC)、the increase of venous transit time index(VTI)、the increase of Cardiac Output(CO)and the decrease in renal blood flow resistance index(RI)in the recovery groups at both 30 days and 90 days was significantly higher than that in the non-recovery group(all P<0.05).The total treatment time of IVVH in the recovery group was significantly shorter than that in the non-recovery group, with 30 days and 90 days( P<0.05).Logistic analysis revealed that the total treatment time of IVVH( OR=1.067, P<0.001), VTI( OR=0.652, P=0.024), CO( OR=0.037, P<0.001), and RI(OR<0.001, P=0.010)of the interlobar artery were identified as independent factors influencing the recovery of renal function in AKI patients at 30 days and 90 days after IVVH treatment.The ROC curve demonstrated the predictive value of various independent influencing factors for 30-day renal function recovery.The area under the curve(AUC)for VTI was 0.610(95% CI: 0.513-0.707), for CO it was 0.760(95% CI: 0.656-0.864), and for RI it was 0.694(95% CI: 0.589-0.799).Similarly, the ROC curve showed the predictive value of these factors for renal function recovery at 90 days.The AUC for VTI was 0.654(95% CI: 0.564-0.744), for CO it was 0.697(95% CI: 0.605-0.789), and for interlobar artery RI it was 0.605(95% CI: 0.495-0.715). Conclusions:The venous transit time index(VTI), cardiac output(CO), and renal interlobar artery RI, monitored by critical care ultrasound, are independent factors that can be used to evaluate the recovery of renal function in elderly patients with HF and AKI after IVVH treatment.Additionally, the changes in these parameters within 7 days after IVVH treatment have a high predictive value for the improvement of renal function in elderly patients after 30 days and 90 days.

Objective:To observe the clinical effect of tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive treatment of moderate to severe melasma.Methods:From December 2019 to September 2021, ninety-six female patients with melasma [age 24-59 years old, average age (37.8±6.0) years old] were admitted to the Plastic and Aesthetic Department of the First Affiliated Hospital of Henan University of Chinese Medicine. They were divided into the Q-switched laser group and the combined group by random number table method, with 48 cases respectively. The Q-switched laser group received Q-switched laser therapy, while the combined group received tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive therapy. The melasma area and severity index (MASI) scores were compared between the two groups before and after treatment. The clinical efficacy, adverse reactions and recurrence rates of the two groups were compared.Results:The MASI scores of the Q-switched laser group and the combined treatment group were (28.28±1.24) points and (28.52±4.25) points respectively before treatment, and (13.38±7.96) points and (9.11±5.48) points respectively after treatment. The MASI scores of the two groups were decreased after treatment, which of the combined group was lower than that of the Q-switched laser group ( t=3.06, P<0.05). The total clinical effective rate of the combination group (93.75%) was higher than that of the Q-switched laser group (79.17%) (χ 2=4.36, P<0.05). The incidence rate of hyperpigmentation (2.08%) and recurrence rate (2.08%) of the combination group were lower than those of the Q-switched laser group (14.58%, 16.67%) (χ 2=6.01, P<0.05). Conclusions:Tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive treatment can improve skin lesions and clinical efficacy in patients with moderate to severe melasma, and reduce pigmentation and recurrence.

Objective:To investigate the risk factors for cerebral injury in survivors of twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser occlusion of chorioangiopagous vessels(FLOC) and to analyze the neurodevelopmental outcomes at 12 months of corrected age.Methods:A total of 136 cases of TTTS receiving FLOC in the Third Affiliated Hospital of Zhengzhou University from May 2018 to August 2021 were retrospectively selected as the FLOC group, and the survivors were followed up. Neurological development at 12 months of corrected age was assessed using the Griffiths mental development scales-Chinese (GDS-C) from five dimensions with locomotor, personal-social, hearing and language, hand-eye coordination and performance subscales. Eighty-eight fetuses of TTTS pregnancies receiving expectant treatment or amniotic fluid reduction were selected as the non-FLOC group. The perinatal mortality and the incidence of cerebral injury in the two groups were compared, as well as the incidence of cerebral injury between patients undergoing Solomon surgery and selective laser surgery in the FLOC group. Generalized estimating equations were used to analyze the risk factors for neonatal cerebral injury after FLOC and the factors influencing general developmental quotient score at the corrected age of 12 months. Chi-square test, t-test, and Mann-Whitney U test were used for statistical analysis. Results:(1) The perinatal mortality rate in the FLOC group was lower than that in the non-FLOC group [14.7% (20/136) vs 26.1% (23/88), χ 2=4.50, P=0.034]. There was no statistical significance in the incidence of neonatal cerebral injury between the two groups [18.7% (23/123) vs 21.8% (17/78), χ 2=0.29, P=0.592], but the incidence of severe cerebral injury in the FLOC group was lower than that in the non-FLOC group [6.5% (8/123) vs 15.4% (12/78), χ 2=4.20, P=0.040]. (2) In the FLOC group, there was no significant difference in the incidence of cerebral injury between donors and recipients, or between Solomon surgery and selective laser surgery [16.4% (10/61) vs 21.0% (13/62), χ 2=0.42; 20.0% (9/45) vs 17.9% (14/78), χ 2=0.08; both P>0.05]. (3) Multivariate analysis showed that neonatal asphyxia ( OR=7.04, 95% CI: 1.45-34.20, P=0.016) and higher preoperative TTTS stage ( OR=2.05, 95% CI: 1.10-3.82, P=0.023) were risk factors for neonatal cerebral injury. (4) Fifty-two cases were successfully followed up at the corrected age of 12 months, and the incidence of developmental delay in at least one dimension was 34.6% (18/52). Developmental delay was mainly manifested in locomotor skills and language, accounting for 26.9% (14/52) and 11.5% (6/52). No significant difference in Z value was found between recipients and donors in each dimension (all P>0.05). Solomon surgery, larger gestational age at operation and low birth weight were related to low general developmental quotient score (95% CI:－11.71 to－0.23，－1.99 to－0.47，0.00-0.01，respectively，all P<0.05). Conclusions:The occurrence of cerebral injury in TTTS survivors after FLOC is related to preoperative TTTS staging and intrapartum neonatal asphyxia. Neurodevelopment of survivors is related to birth weight and gestational age at surgery, and there is a higher incidence of mild developmental delay at corrected age of 12 months.

ObjectiveTo analyze the effects of respiratory control measures before and after COVID-19 epidemic on influenza virus. MethodsThe percentage of influenza-like cases， the positive rate of influenza virus and the change of influenza outbreaks before and after the COVID-19 pandemic were compared and analyzed by selecting the data of influenza surveillance sentinel-points in Shanghai. ResultsThe percentage of influenza-like illness after the outbreak of COVID-19 in 2020 was significantly higher than that during the same period between 2017 and 2019. The positive rate of influenza virus detection in 2020 was significantly lower than the average rate of influenza virus detection from 2017 to 2019 with significant statistical difference （χ ²=2 359.07， P<0.001）. The number of outbreaks in 2020 was significantly lower than that from 2017 to 2019. ConclusionDuring the respiratory season， personal protection and reduction of human aggregation can effectively reduce the infection of influenza and the incidence of influenza in the population.

Executive impairment is common after stroke, which causes in disabilities for controling thinking, emotion and behavior. The etiology is uncertain. There is no specific assessment tool for it. The psychological assessment is the main approach to screen and diagnose executive impairment, including screening and specific examination. There are still some advantages and disadvantages. The strategy for rehabilitation includes recovery, compulsory and adaptive treatment. Medication is the main treatment, but still unsatisfactory. Cognitive training, computer-assisted cognitive rehabilitation and transcranial direct current stimulation and so on are applied. Imaging and physiological electrical techniques are needed.

Objective:To observe the effect of 3 Hz and 10 Hz repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function and activities of daily living in patients with ischemic stroke. Methods:From June, 2016 to September, 2017, 60 inpatients with ischemic stroke were randomly divided into sham rTMS group (n = 19), 3 Hz-rTMS group (n = 21) and 10 Hz-rTMS group (n = 20). All the patients received routine training and their own rTMS for two weeks. Their rest motor threshold (RMT) was measured, and they were assessed with modified Ashworth Scale (MAS), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment, and at six weeks follow-up. Results:There were 48 patients completing the trial, while five in 3 Hz-rTMS group, five in 10 Hz-rTMS group and two in the sham rTMS group dropped. The RMT increased in 3 Hz and 10 Hz rTMS groups (t > 2.390, P < 0.05) after treatment, but there was no significantly difference among the three groups (F = 0.164, P > 0.05). The MAS scores of elbow and wrist decreased gradually over time in 3 Hz and 10 Hz rTMS groups (P < 0.05), and the MAS scores of elbow was less in 3 Hz and 10 Hz rTMS groups than in the sham rTMS group at follow-up (P < 0.05). The interaction of time and group was significant on the FMA-UE scores (F = 14.243, P < 0.001), and the FMA-UE scores improved more in 3 Hz and 10 Hz rTMS groups than in the sham rTMS group at different stages (P < 0.01). The interaction of time and group was not significant in MBI score (F = 1.481, P > 0.05), and there was no significant difference among the three groups at any time (F < 2.925, P > 0.05). Conclusion:Both 3 Hz and 10 Hz rTMS can promote the recovery of upper limb motor function in ischemic stroke patients safely and effectively, and 10 Hz rTMS is recommended as less time is needed.

Objective To evaluate the anti-diabetic effect and mechanism of a novel G protein coupled receptor 40 (GPR40) agonist SZZ15 -11. Methods Transactivation assay based on luciferase reporter gene was performed to explore the agonist activity of the compounds to GPR40. The primary mouse islets were used to evaluate the insulinotropic ability of the compounds. After oral administration of the tested compounds once,the plasma concentrations of glucose,insulin and glucagon like peptide 1 (GLP-1) were determined in normal mice followed oral glucose loading. The effect of the compounds on gastric emptying was also evaluated in normal mice given orally once. In spontaneous type 2 diabetic KKAy mice orally administrated compound for one month,the plasma glucose concentration were measured. Results The compound SZZ15 -11 activated GPR40 with EC50 of 1. 2 μmol·L-1. It significantly promoted glucose-stimulated insulin secretion (GSIS) in mouse primary islets by 61. 1％ (P < 0. 05) under high glucose conditions (16. 8 mmol·L-1). Oral administration of SZZ15-11 (50 mg·kg-1) once decreased the plasma concentrations of glucose in normal ICR mice followed oral glucose loading,reduced the area under the curve (AUC) by 13. 1％ (P < 0. 05) ,and increased insulin secretion after oral glucose load by 46. 6％ (P < 0. 05). SZZ15-11 also obviously delayed the gastric emptying rate in normal mice at a dose of 50 mg·kg-1,which reduced the area of the serum acetaminophen concentration-time curve (P <0. 05). At two doses of 50 and 100 mg·kg-1,plasma GLP -1 levels in normal mice after oral glucose load was increased (P <0. 05). In the type 2 diabetic KKAy mice administrated with SZZ15 -11 at the dose of 50 and 100 mg·kg-1 for 4 weeks,the fasting blood glucose was decreased significantly decreased (P < 0. 01 and P < 0. 05). Conclusion The novel GPR40 agonist SZZ15 -11 promoted glucose-dependent insulin and GLP-1 secretion,thus ameliorated glucose metabolism in type 2 diabetic mice. It will be a potential anti-diabetic compound candidate which is worth of further exploration.

Objective To observe the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on hand function in patients after stroke. Methods From June,2016 to September,2017,30 stroke patients were randomly divided into control group(n=30)and experimental group(n=30).Both groups received routine training after sham rTMS or 3 Hz rTMS.Fugl-Meyer Assessment(FMA),modified Ashworth Scale(MAS)and modified Barthel Index(MBI)were used to evaluate the hand function and the activities of daily living before and after treatment. Results Finally 27 patients completed the experiment.After treatment, the FMA score increased in both groups (Z>2.070, P<0.05), and the difference value was higher in the experimental group than in the control group (Z=-2.296,P<0.05);the MAS score improved in the experimental group(Z=-2.456,P<0.05),no difference was found in the control group(Z=-0.816,P>0.05),and the difference value was higher in the experimental group than in the control group(Z=-2.792,P<0.01);the MBI score improved in both groups(t>3.085,P<0.01),howev-er,no difference was found in the MBI score and the difference value between two groups(t<0.246,P>0.05). Conclusion High-frequency rTMS could promote the hand function in patients after stroke.

OBJECTIVETo investigate the main inhalant allergens and their distribution patterns in children with allergic diseases from Xi'an and the surrounding area and to provide evidence for the prevention and treatment of allergic diseases in children.

METHODSSkin prick test was performed using liquid with 13 standardized allergens (ALK-ABELL, Denmark) on 3085 children from Xi'an and the surrounding area who were treated for allergic diseases between July 2006 and July 2011, to detect inhalant allergens.

RESULTSOf the 3085 patients, 1368 (44.34%) had positive SPT results, with the most prevalent inhalant allergen being Dermatophagoides pteronyssinus (804 cases, 26.06%), followed by Dermatophagoides farinae (793 cases, 25.71%), Blomia tropicalis (440 cases, 14.26%), mugwort (282 cases, 9.14%), and cat hair (204 cases, 6.61%). The positive rates were 28.66% in the <4 years group, 41.85% in the 4-6 years group, and 58.61% in the 7-15 years group (P<0.01). Males had a significantly higher SPT positive rate than females (47.78% vs 38.50%；P<0.05). The SPT positive rate was highest in children with allergic rhinitis (72.41%), followed by bronchial asthma (62-25%), allergic dermatosis (45.83%), and allergic purpura (36.28%).

CONCLUSIONSIn children from Xi'an and the surrounding area, the main inhalant allergens for allergic diseases include Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, mugwort and cat hair. The SPT positive rate increases with age. Male children have a higher SPT positive rate than female children. The SPT positive rate is highest in children with allergic rhinitis.

Adolescent ; Allergens ; immunology ; Child ; Child, Preschool ; Female ; Humans ; Hypersensitivity ; diagnosis ; Infant ; Male ; Skin Tests

Objective To explone the rehabilitation nursing intervention of hospital-community integration on the social function of patients with schizophrenia. Methods 240 schizophrenia patients were randomly divided into observation group ( 120 cases) and control group ( 120 cases). Both groups received routine treatment and care. Other than this, observation group received early intervention and rehabilitation care. Social Disability Screening Scale (SDSS) and the Morning Side rehabilitation status scale (MRSS) were used. Recurrence rate and medication compliance of two groups after 1 year were compared. Results Better improvement of the social function and medication compliance, as well as lower recurrence rate was found in the observation group. There was significant difference between the two groups ( P ＜ 0.01 or P ＜ 0.05 ).Conclusions The rehabilitation nursing intervention of hospital-community integration can improve the social function of schizophrenia patients and contributes to their quality of life.