ObjectiveTaking the rat model of spleen-stomach damp-heat syndrome（SSDHS） as the research object， this study aimed to investigate the potential biomarkers of SSDHS and the related metabolic pathways based on urine metabolomics， and tried to reveal the essence of SSDHS at the level of endogenous small molecular metabolites. MethodSixteen SD rats were randomly divided into normal and model groups. The normal group was fed normal chow and the model group was fed with 200 g·L^-1 honey water daily， and lard and Chinese Baijiu alternately on alternate days for 17 days. The SSDHS model rats were exposed to external dampness-heat environment with temperature at 30-34 ℃， relative humidity of 95% for 2 h at the same time every day from the 10^th day for 7 d. Then， the model was evaluated by observing the general conditions of the rats， measuring the contents of motilin（MTL） and gastrin（GT） in plasma by enzyme-linked immunosorbent assay（ELISA）， and examining the histopathology of gastronitestinal tissues. In additon， the urine metabolomics analysis was performed by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS）， and the detection conditions was as follows：ACQUITY™ UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm）， mobile phase of 0.1% formic acid aqueous solution（A）-0.1% formic acid acetonitrile solution（B） for gradient elution （0-3 min， 1%-18%B； 3-8 min， 18%-40%B； 8-10 min， 40%-100%B）， the flow rate of 0.4 mL·min^-1， electrospray ionization（ESI） in positive and negative ion modes， scanning range of m/z 50-1 000. The univariate and multivariate statistical analysis were constructed for screening inter-group differential ions， the element composition was calculated according to the precise relative molecular weight， and ion information was matched with databases such as Human Metabolome Database（HMDB） to identify biomarkers. Kyoto Encyclopedia of Genes and Genomes（KEGG） database was used to obtain the biological information of metabolites， and their associated metabolic pathways were analyzed by MetaboAnalyst 5.0. ResultCompared with the normal group， the rectal temperature of the model group increased significantly（P<0.01）， the levels of plasma MTL and GT decreased significantly（P<0.05， P<0.01）， and pathological changes such as bleeding， congestion and inflammatory infiltration in the gastric and colonic tissues. A total of 25 differential metabolites such as L-histidine， citric acid and isocitric acid were found to be the potential biomarker of SSDHS by urine metabolomics， 13 of which were phase Ⅱ metabolites of endogenous substances（glucuronic acid conjugates， sulfuric acid conjugates and acetyl conjugates）， involving the metabolic pathways of histidine metabolism， tricarboxylic acid cycle， glyoxylate and dicarboxylate metabolism. ConclusionSSDHS primarily causes disorders of histidine metabolism， tricarboxylic acid cycle， glyoxylate and dicarboxylate metabolism， as well as the imbalance of the activation/inactivation of endogenous metabolites， which may involve the immune response， material and energy metabolism， inflammatory response and intestinal flora， and may provide a basis for the establishment and application of SSDHS model.

Objective:To preliminarily study the feasibility, safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with selective portal vein embolization (SPVE) before surgical resection in the treatment of large liver cancer.Methods:A retrospective study was conducted on the clinical data of 17 patients with large liver cancer treated with TACE combined with SPVE from January 2016 to December 2019 at the Department of Hepatobiliary Surgery, the Sixth Medical Center of PLA General Hospital. The study included 15 males and 2 females, aged (59.17±10.30) years. The levels of alanine aminotransferase, tumor changes and patient survival were analyzed before operation, after TACE, and after SPVE.Results:Among the 17 patients, the levels of alanine aminotransferase on the 1st and 3rd day after SPVE was significantly higher than those after TACE [191.4 (30.5-1966.4) IU/L vs 125.3 (35.7-846.2) IU/L on the first day, and 298.5 (24.6-1334.2) IU/L vs 208.6 (21.6-775.6) IU/L on the 3rd day], all P<0.05. One month after the two combined embolism, among the 6 patients with a tumor diameter of 5-10 cm, 2 patients (33.3%) had complete remission, 3 patients (50.0%) had partial remission, and 1 patients (16.6%) had stable disease. For the tumor’s longest diameter, among the 11 patients with tumors >10 cm, 1 patient had complete remission (9.1%), 4 patients had partial remission (36.4%), 5 patients had stable diseases (45.5%), and 1 patient had disease progression (9.1%). Eventually, 11 patients underwent surgical exploration. The median residual liver volume before treatment was 329.5 (284.9-365.7) ml, and after the combined procedure 415.6 (354.7-718.8) ml. The median hyperplasia ratio was 28.1% (14.1%-51.3%). Eight patients finally underwent surgical resection. There was no death in the perioperative periods. The median tumor-free survival time was 17 (7-42) months, and the median survival time was 27 (7-42) months. Conclusion:For patients with large liver cancer with insufficient remnant liver volume, preoperative TACE+ SPVE has certain value in controlling tumor progression, promoting remnant liver hyperplasia, increasing surgical resection rate and improving prognosis.

Objective:To determine the relationship between trimester-specific gestational weight gain and pregnancy outcome among women with twin pregnancies.Methods:A retrospective cohort study was conducted among Chinese women with twin pregnancies delivered from January 2013 to October 2015 in the International Peace Maternity & Child Health Hospital of China Welfare Institute.Gestational weight gain was compared between women with different progestational BMI.After the adjustment for age and progestational BMI,binary Logistic regression analysis was conducted to explore the relationship between gestational weight gain rate and gestational complications,premature birth,premature rupture of membrane and neonatal birth weight.Results:①A total of 472 subjects met the inclusion criteria.Rate of gestational weight gain were(0.41 ±0.15),(0.64 ±0.30) and (0.49 ±0.15) kg/week in Early,Mid-and Late-,and Whole of pregnancy respectively.②With regards to trimester-specific gestational weight gain,statistically significant associations were found between rate of weight gain and gestational hypertension and preterm birth (P ＜ 0.05).Those with faster gestational weight gain had higher rate of premature rupture of fetal membrane(P ＜ 0.05).And those with lower gestational weight gain had lower neonatal birth weight(P＜0.05).③After adjusting maternal age,progestational BMI and gestational age at delivery,the sum of twins' birth weight increased 25.21g,30.89g and 21.46g respectively when the maternal body weight increased 1kg during the whole pregnancy,in Early and Mid-pregnancy (P ＜ 0.001),and during in Late-pregnancy(P =0.001).Conclusions:Gestational weight gain among women with twin pregnancy are closely related with adverse pregnancy outcomes.The gestational weight gain rate in different gestation are of some predictive value for pregnancy outcomes.More research with long follow-up are needed to determine proper gestational weight gain for twin pregnancy suitable for Chinese women.

Objective To analyze of the relationship between level of anxiety and depression before surgery and anus exhausting time for patients after gynecological abdominal surgery.Methods A descriptive study was conducted with a survey of 100 cases of patients with gynecological abdominal surgery where the level of anxiety and depression before surgery and post-anus exhausting time were analyzed to explore the correlation between them.Results In the 88 valid questionnaires,the incidences of stress and anxiety before surgery were respectively 38.64％(34/84) and 19.32％(17/88) and the average anus exhausting time after surgery was (44.55 ± 13.90) hours;the anus exhausting time of anxious patients was significantly longer than that of non-anxious patients [(48.35±12.84) hours vs.(42.50±14.13) hours,t=-2.12,P＜0.05] and bivariate Logistic regression analysis suggested that preoperative level of anxiety had a significant effect on anus exhausting time after surgery.Conclusions Stress,anxiety and other negative emotions can affect anus exhausting time after surgery and level of anxiety could be used as one predictor of the delay of anus exhausting time after surgery.

Objective:To study the clinical effect and safety of aerosol inhalation of recombinant human interferon α-2b( P. puti-da) in the children with viral upper respiratory tract infection ( VURI) . Methods: Totally 100 children diagnosed as viral upper re-spiratory tract infection were randomly divided into the observation group and the control group with 50 cases in each. The two groups of children were both given symptomatic and supportive treatment, and the observation group was given IFN-α2b (P. putida) 150 000 IU·kg-1 ·d-1 in 2-4 ml 0. 9% sodium chloride injection with aerosol inhalation, qd, 5-10 min each time, and the control group was given ribavirin 10-15 mg·kg-1 ·d-1 in 5% glucose injection 150 ml, ivd, and a course of treatment was continuous 5 d. The fever, cold symptoms ( catarrh, cough, malaise) and clinical efficiency of the two groups were compared. Results:The defervescence effect of the observation group was significantly higher than that of the control group after the treatment(P<0. 05). The effect in the children with mild and moderate cough in the observation group was better than that in the control group, and the changes were statistically sig-nificant difference(P<0. 01). The heat range, cough fading time, catarrh symptom and systemic symptom disappearance time in the observation group were significantly better than those in the control group(P<0. 05). The clinical efficient rate of the observation group was 96. 0%, which was significantly higher than that (84. 0%) in the control group(P<0. 05) . Conclusion: Combined with the conventional therapy, aerosol inhalation of IFN-α2b can be effectively and safely used for treating viral upper respiratory tract infec-tion in children, which is worthy of popularized use in clinics.

Objective To investigate the expression level of human epididymis protein 4 ( HE4 ) in se-rous ovarian cancer tissues and its relationship with clinicopathological features .Methods The expression level of HE4 in 140 serous ovarian cancer patients and its relationship with clinicopathological features were detected by immunohistochemistry.To compare the correlation between HE4 and CA125, the histological expressionOf CA125 was also detected by IHC .Results the positive expression rate of HE 4 and CA125 in moderately and poorly differentiated serous ovarian cancer tissues were respectively 89.76%and 81.89%;the positive expression rate in well differentiated group were respectively 46.61% and 15.38%,in the advanced stages were 92.44%and 83.19%,in the early stages were 47.62%and 33.33%.the positive expression rate of lymphatic metastasis were 95.65%and 84.35%,without lymphatic metastasis were 40.00%and 36.00%,the positive expression rate of peritoneal implantation were 90.00% and 87.27%, without peritoneal implantation were 70.00% and 33.33%;the positive expression rate of ascites were 89.76% and 79.53%,without ascites were 46.15% and 38.46%.Besides,the positive expression rates of HE4 and CA125 were 86%and 76%,the differences were sta-tistically significant.Both the positive expression in ovarian cancer are correlated positively (P<0.05).The ex-pression of HE4 and CA125 has nothing with the occurrence of pausimenia and the number of parity in patients with ovarian cancer(P>0.05).Conclusion The expression of HE4 in serous ovarian cancer is related with FI-GO stages,the degree of tumor differentiation ,lymph node metastasis and ascites .

Objective To investigate the present situation and to analyze related factors of nursing practice environment among 22 public hospitals in Shanghai area.Methods We investigated 1 600 nurses from the 22 hospitals with general information questionnaire and the Chinese version of Practice Environment Scale,and also analyzed related factors by single and multiple factor analysis.Results 1 582questionnaires were taken back.49％ were dissatisfied with their working environment,and 28.1％ were evaluated to have nice practice conditions.Nurse concerned with workforce management and adequate resources were widespread.Logistic analysis indicated that hospital's level,the nurse's age,educational background and seniority were main factors influencing nurses' satisfaction.Nurse work in tertiary hospitals reported lower satisfaction.Conclusions More attention should be paid on improving nursing practice environment.

Objective To explore the risk factors of heart failure among continuous ambulatory peritoneal dialysis (CAPD) patients.Methods General information, scale of volume management of CAPD , New York Heart Association ( NYHA) classification and biochemical data were used to analyze independent risk factors of heart failure among CAPD patients .The relationship between level of volume management and incidence of heart failure was also discussed in different nutritional status .Results A total of 114 questionnaires were handed out and 114 were recovered , with the rate of 100%.Level of volume management , serum pre-albumin, blood urea nitrogen were independent risk factors for heart failure among CAPD patients (r=-1.290,-0.006,0.085, respectively;P<0.05).With a normal level of serum pre-albumin, higher volume management score were associated with lower incidence of heart failure (χ2 =10.542,P<0.05).No differences were found between volume management scores and incidence of heart failure among those with higher or lower serum pre -albumin levels.Conclusions Improvement of the level of volume management and dialysis adequacy as well as attention to assess nutritional status of CAPD patients can provide references for preventing heart failure .

Objective To explore factors affecting long-term compliance to weight management (WM) of patients with congestive heart failure (CHF)and to provide evidence for improving patients' compliance.Methods In-depth semi-structured interviews based on reinforcement theory were conducted among 18 CHF patients who received WM intervention over 6 months.The data were analyzed by Colaizzi analysis program.Results Three themes were found:precipitating factors such as the correct perception of disease and self-efficacy,the factors of positive reinforcement such as early gains from WM,readmission,follow-up,family and social support,as well as the factors of negative reinforcement such as gaining nothing during long period,physical and mental disorders.These above factors made long-term compliance to WM of 50％ of the participants dynamic and fluctuant.Conclusions Medical staff should identify patients'compliance at different stages in time during follow-up,analyze the factors that affect their compliance,and then grasp the optimal timing of intervention to perform targeted,multiform and multiple health education to improve compliance.

Objective To explore the impact of intervention of weight management (WM)on readmission rate of patients with congestive heart failure(CHF).Methods sixty-six CHF patients were divided into the control group(34 cases)and the intervention group(32 cases).The patients in the intervention group received the weight management intervention for 6 months after discharge,while the control group was carried on the conventional education and follow-up.The ability of WM and readmission rate of patients due to onset of CHF were compared between the two groups.Results Six months after the intervention,significant differences were found on the scores of weight monitoring,WM related-knowledge,belief and practice in the intervention group,but only WM related-practice was improved in the control group.The readmission rote due to onset of CHF was reduced in the intervention group.Conclusions WM intervention could significantly improve the ability of WM and reduce readmission rate due to CHF onset of CHF patients.