Objective To explore the clinical effects of Tiaojing Zhuyun mixture combined with regulating menstration and promoting pregnancy by thirteen acupuncture in the treatment of Declining Ovarian Function(DOR)combined with follicular dysplasia infertility.Methods From January 1,2022 to January 1,2023,60 cases of infertility patients with DOR follicular dysplasia were treated in our hospital,and the above cases were randomly divided into experimental group:Tiaojing Zhuyun mixture+ regulating menstration and promoting pregnancy by thirteen acupuncture + Clomiphene group;Control group:Clomiphene group,30 cases each.The improvement of FSH,maximum follicle size and ovulation,uterine artery blood flow index,endometrial thickness and pregnancy were observed after treatment.Results The improvement of follicle stimulating hormone,maximum follicle size,endometrial thickness and uterine artery blood flow indexes in Tiaojing Zhuyun mixture+ regulating menstration and promoting pregnancy by thirteen acupuncture + Clomiphene group were better than clomiphene group.The difference between groups was statistically significant(P＜0.05).The ovulation rate was 66.7%and the pregnancy rate was 40%.The ovulation rate was 40%higher than the control group,and the pregnancy rate was 20%.The difference between groups was statistically significant(P＜0.05).Conclusion In the patients with DOR follicular dysplasia infertility,Tiaojing Zhuyun mixture combined with regulating menstration and promoting pregnancy by thirteen acupuncture can improve the level of follicle stimulating hormone,promote follicular maturation and ovula-tion,reduce the resistance of uterine artery blood flow,increase the thickness of endometrial,promote pregnancy,and have fewer adverse reactions.

Objective:To investigate the prognostic value of serum adenosylhomocysteinase (AHCY) in patients with hepatitis E virus acute liver failure (HEV-ALF).Methods:From 1 January 2017 to 31 December 2022, 100 patients each with HEV-ALF and acute hepatitis E (AHE) from the First Affiliated Hospital of Medical School of Zhejiang University and Affiliated Suzhou Hospital of Nanjing Medical University were included in this case-control study. The HEV-ALF group was 58.56±11.16 years old, including 71 men. The AHE group was 56.04±14.30 years old, including 61 men. All serum samples were obtained before the patient had an acute onset and were obtained without treatment. Firstly, the serum AHCY levels in patients with HEV-ALF and AHE were analyzed by ELISA. Secondly, the serum AHCY levels in HEV-ALF patients with different organ failure and disease condition were compared. According to the number of organ failure, 100 HEV-ALF patients were divided into organ failure number=2 group ( n=58), number=3 group ( n=24) and number>3 groups ( n=18). According to the disease condition, 100 patients were divided into improvement group ( n=49), disease fluctuation group ( n=37), and deterioration group ( n=14). Thirdly, the survival times between the high serum AHCY level group ( n=50) and the low serum AHCY level group ( n=50) were compared. Finally, the independent risk factors to predict mortality using the multivariate Logistic regression analysis, and evaluated the predictive and decision-making abilities of serum AHCY levels were explored using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results:Serum AHCY levels in HEV-ALF patients were significantly higher than those in AHE patients [326.92 (295.37-385.84) pg/ml vs. 222.88 (188.04-246.78) pg/ml, Z=-12.217, P<0.001]. Serum AHCY levels in group 2 were significantly lower than those in group 3 [303.44 (284.40-330.15) pg/ml vs. 335.36 (306.30-385.84) pg/ml, Z=-3.353, P=0.001]. Serum AHCY level in group 3 were significantly lowerthan those in group>3 [335.36 (306.30-385.84) pg/ml vs. 549.89 (423.35-660.22) pg/ml, P<0.001]. The serum AHCY levels in the fluctuation group were lower than those in the deterioration group [322.17 (283.92-423.74) pg/ml vs. 458.26 (374.66, 593.89) pg/ml, Z=-4.016, P=0.009]. The survival time of high serum AHCY level group was significantly lower than that of low serum AHCY level group [23.11 (20.25-25.96) days vs. 29.49 (28.79-30.20) days, Z=-2.596, P<0.001]. The multivariate Logistic regression analysis showed that the levels of serum AHCY and total bilirubin were independent risk factors to predict mortality in HEV-ALF patients [AHCY, OR (95% CI): 1.008 (1.002-1.015), P=0.008; total bilirubin, OR (95% CI): 1.011 (1.005-1.018), P=0.001]. Serum AHCY level predicting the area under the curve (AUC) of 30-day mortality in HEV-ALF patients was 0.912, with a sensitivity of 90.00% and a specificity of 93.75%. DCA results demonstrated that serum AHCY level had good decision-making power for predicting 30-day mortality in HEV-ALF patients. Conclusion:Serum AHCY has an important prognostic value for HEV-ALF patients. Higher serum AHCY levels indicate the worse prognosis of HEV-ALF patients.

Objective To analyze the risk factors of preoperative lymph node staging (N-stage) deficiency in gastric cancer and establish a preoperative assessment model to assist in predicting preoperative N-stage. Methods A retrospective method was used to analyze the clinicopathological data of 268 patients with gastric cancer. The patients routinely underwent preoperative thin-section enhanced CT to assess preoperative N-stage. Results The risk factors for preoperative N-stage deficiency were analyzed in combination with postoperative pathological findings. Multifactorial logistic regression analysis was performed to determine influencing factors, and Kaplan-Meier analysis was used to plot the survival curves of preoperative N-stage accurate group and deficiency group. The nomogram plot and ROC curves of the prediction model were drawn using the R package. AUC, 95%CI, sensitivity, and specificity were calculated. Results Age, BMI, poor differentiation, and Lauren's classification as diffuse were independent risk factors for preoperative N-stage deficiency in gastric cancer (P < 0.05). Prognostic survival was significantly worse in the preoperative N stage-inadequate group than that in the accurate group (P=0.041). The AUC area was 0.935, with a sensitivity of 85.9% and specificity of 96.9%. Conclusion Young age, high BMI, poor differentiation, and Lauren's classification as diffuse are independent risk factors for preoperative N-stage deficiency. The established preoperative assessment model based on age, BMI, differentiation degree, and Lauren's classification in this study has relatively high credibility.

Patients with deep vein thrombosis require long-term anticoagulant therapy to prevent the spread or recurrence of the thrombus. Self-management can enhance patients' awareness of the disease and adherence to anticoagulant therapy, reducing the recurrence rate. This study reviews the current status, evaluation tools, intervention methods, and influencing factors of self-management in patients with deep vein thrombosis, providing reference for improving the home self-management ability of patients with deep vein thrombosis.

Background Exposure to uranium can result in multi-organ toxicity in humans. Some experimental studies have shown that uranium presents a damaging effect on liver, but no relevant population studies have been reported. Objective To investigate a potential association of plasma uranium exposure with liver injury. Methods The inhabitants of two representative areas of heavy metal pollution in northern and southern Hunan were selected as the research subjects. A total of 740 participants were recruited through 1∶1 paired case-control design based on a pre-determined diagnostic criterion for liver injury (defined as two or more anomalies among alanine aminotransferase, aspartate aminotransferase, and total bilirubin in the health examination) and the principle of case-control comparability. Information such as general demographic characteristics and medical history were collected through questionnaires and physical examination. Plasma uranium and liver function were determined by laboratory tests. Spearman correlation was applied to assess the association between plasma uranium concentration and liver injury indexes, and restricted cubic spline model was used to evaluate the dose-response relationship between plasma uranium concentration and liver injury. The participants were divided into four groups from Q1 to Q4 according to the quartile values of plasma uranium concentration of the control group after natural logarithmic transformation (with the Q1 group as the reference group), and the association between plasma uranium concentration and liver injury was evaluated by conditional logistic regression. Results The plasma uranium level in M (P₂₅, P₇₅) of the case group was 10.89 (6.78-18.53) ng·L⁻¹, higher than that in the control group, 9.26 (5.01-14.38) ng·L⁻¹ (P<0.001). The results of Spearman correlation analysis showed that alanine aminotransferase and aspartate aminotransferase were positively correlated with plasma uranium level (r_s=0.138, r_s=0.167; P<0.001). The restricted cubic spline model showed that the risk of liver injury increased with the increase of plasma uranium concentration (overall effect P<0.001). After adjusting for confounding factors such as gender, age, smoking, alcohol consumption, and prevalence of hypertension and hyperlipidemia, the results of conditional logistic regression analysis showed that the risks of liver injury in the Q2 group, the Q3 group, and the Q4 group were 2.043 (95%CI: 1.135-3.680), 2.246 (95%CI: 1.238-4.075), and 3.536 (95%CI: 1.955-6.397) times higher than that of the Q1 group respectively. Conclusion Plasma uranium exposure is associated with liver injury. This study is the first to provide population-level evidence of such an association.

Objective:To explore the changing track of cancer-related fatigue in patients with lung cancer during perioperative period and analyze its influencing factors.Methods:From December 2020 to May 2021, 162 eligible patients with lung cancer were selected in the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital by convenient sampling method. Mental resilience and social support were investigated before operation (T0);and cancer-related fatigue was investigated before operation (T0),3 days after operation (T1), 1 week after operation (T2), 2 weeks after operation (T3) and 1 month after operation (T4), and Latent Class Growth Model was used to identify the track categories. Logistic regression analysis was used to analyze the influencing factors.Results:Three cancer-related fatigue tracks were fitted in this study, which were no fatigue group (31.7%), increased fatigue group (36.0%) and sustained fatigue group (32.3%). Univariate analysis showed that smoking history ( χ2=14.83, P<0.05), BMI ( χ2=29.67, P<0.05), hemoglobin count ( F=4.57, P<0.05), mental resilience ( F=35.53, P<0.05), social support ( F=47.53, P<0.05) were related to the track category of cancer-related fatigue. Logistic regression analysis showed that smoking history, over weight/obesity, resilience and social support were the predictors of cancer-related fatigue locus ( P<0.05). Conclusions:Perioperative cancer-related fatigue of patients with lung cancer has different change trajectories, patients with higher BMI and lower resilience are more likely to have a tendency of persistent fatigue. Patients with smoking history and lower social support are more likely to have an upward trend of fatigue. For this kind of lung cancer patients, medical staff should take timely and effective intervention measures to improve their cancer-related fatigue.

OBJECTIVE：To provide reference for pharmaceutical enterprises to better fulfill their social responsibilities . METHODS：Taking the pharmaceutical enterprises listed in Shanghai and Shenzhen stock markets as the research objects ，the social responsibility texts and environmental protection texts of the included enterprises from 2017 to 2019 were classified and analyzed according to the three dimensions of time ，ownership and drug production type by using ROST Content Mining 6.0 software. The semantic network and node centrality were analyzed. RESULTS ：From the social responsibility texts of the included enterprises，it could be seen that from the perspective of time dimension ，the included enterprises paid more attention to “employees”，“social responsibility ”and“development”in 2017-2019，and the high-frequency words in the three years were relatively stable. From the perspective of ownership ，state-owned holding enterprises paid more attention to “development”and “targeted poverty reduction ”，while private holding enterprises paid more attention to “employees”，and collective holding enterprises paid more attention to “social responsibility ”. From the perspective of drug production type ，the word frequency of “targeted poverty reduction ”of TCM pharmaceutical enterprises was higher. From the environmental protection texts of the included enterprises，it could be seen that from the time dimension ，the included enterprises paid more and more attention to environmental protection in recent years ，and the description of environmental protection in the texts was more detailed. From the perspective of ownership，private holding enterprises paid more attention to environmental protection than collective holding enterprises and state-owned enterprises. From the perspective of drug production type ，due to the different types of drugs ，chemical drugs ，TCM， biological drugs and active pharmaceutical ingredients enterprises had their own characteristics in pollutants and their treatment processes. The results of semantic network and node centrality analysis showed that ，“development”，“protection” and “targeted poverty reduction ”were three high-frequency words with high centrality in the semantic analysis network of social responsibility text ，the middle centrality was 5.555，1.695，1.521 respectively；“emission”and“testing”were two key words with high centrality in the semantic analysis network of environmental protection texts ，the middle centrality was 3.856， 1.914 respectively，which further reflected that the included enterprises paid more attention to the above issues in terms of social responsibility performance and environmental protection. CONCLUSIONS ：The listed pharmaceutical enterprises have a broad consensus on social responsibility in China ，and have well fulfilled their social responsibility ，which is well combined with the current social hot spots. For environmental protection ，as a high pollution industry ，the pharmaceutical enterprises also performs the responsibility of environmental protection.

Objective:To compare the curative efficacy in the treatment of humeral surgical neck fractures between open reduction and locking plating versus closed reduction and interlocking intramedullary nailing.Methods:From July 2018 to July 2020, 60 patients with humeral surgical neck fracture were treated at Department of Orthorpaedic Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine. They were 24 males and 36 females, aged from 40 to 70 years and injured at the left side in 35 cases and at the right side in 25 ones. Of them, 30 underwent open reduction and locking plating (open group) and the other 30 closed reduction and interlocking intramedullary nailing (closed group). The 2 groups were compared in terms of operation time, intraoperative blood loss, surgical incision length, fracture healing time, Neer shoulder function scoring 3 months after surgery, and postoperative complications.Results:There were no statistically significant differences between the open and closed groups in preoperative general data, showing they were comparable ( P>0.05). The length of surgical incision [(5.2±1.1) cm], operation time [(34.3±12.7) min], intraoperative blood loss [(52.5±7.3) mL] and fracture healing time [(9.2±1.5) weeks] in the closed group were significantly better than those in the open group [(11.1±2.5) cm, (69.4±21.4) min, (123.5±5.2) mL and (14.2±3.4) weeks)] ( P<0.05). The excellent and good rate by Neer shoulder function scoring at 3 months after operation in the closed group (93.3%, 28/30) was significantly higher than that in the open group (66.7%, 20/30) ( P<0.05). There were no postoperative complications in either group. Conclusion:In the treatment of humeral surgical neck fractures, the curative efficacy of closed reduction and interlocking intramedullary nailing is better than that of open reduction and locking plating.

Objective:To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section.Methods:A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results:(1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years ( OR=1.5, 95% CI: 1.1-1.9), prenatal hemoglobin level <110 g/L ( OR=1.7, 95% CI: 1.3-2.2), history of uterine surgery ( OR=1.8, 95% CI: 1.3-2.6), placenta previa ( OR=1.9, 95% CI: 1.1-3.1), placenta accreta ( OR=2.6, 95% CI: 1.8-3.9), blood pool in the placenta ( OR=1.6, 95% CI: 1.1-2.3), abnormal posterior placenta muscle wall ( OR=1.8, 95% CI: 1.2-2.6), placenta projecting to the anterior uterine wall ( OR=3.0, 95% CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion:IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.

Objective:To develop the risk assessment scale for deep vein thrombosis (DVT) in Intensive Care Unit (ICU) patients so as to provide a theoretical basis for clinical nurses to assess the risk of DVT in ICU patients.Methods:We drew up the initial entry pool of the scale, and revised the scale through expert letter inquiries. The diagnostic threshold was used to determine with the receiver operating characteristic (ROC) cure, and percentiles were used to determine risk levels. The reliability was analyzed using inter-rater reliability, internal consistency reliability and split-half reliability. The validity was analyzed with the content validity, structure validity and standard correlation validity.Results:The scale included 37 items. The optimal diagnostic threshold of the scale was 10, and the area under the ROC cure was 0.837 with a statistical difference ( P<0.001) . The risk levels of the scale were as follows, 10 to 11 were divided into low risk, 12 to 16 were divided into medium risk, and ≥17 was divided into high risk. The correlation coefficient of the inter-rater reliability of the scale was 0.967 with a statistical difference ( P<0.001) , and the Cronbach's α coefficient and the split-half reliability coefficient of the scale were 0.804 and 0.742 respectively. The content validity of the scale was 0.97, and the standard correlation validity was 0.665 with a statistical difference ( P<0.001) , and the Kaiser-Meyer-Olkin ( KMO) value was 0.533 with no statistical difference ( P>0.500) , and the χ 2 value of the Bartlett sphericity test was 1 849.43 also with a statistical difference ( P<0.001) . The cumulative contribution rate was 65.39%. Conclusions:This study initially developed a risk assessment scale for DVT in ICU patients, which provides a scientific and effective assessment tool for the development of DVT prevention and treatment in ICU patients.