Objective To analyze the factors related to early allograft dysfunction(EAD)after liver transplantation and to construct a predictive model.Methods A total of 375 patients who underwent liver transplantation in our hospital from December 2008 to December 2021 were collected,including 90 patients with EAD and 266 patients without EAD.Thirty items of baseline data for the 2 groups were compared and analyzed.Aftergrouping in a ratio of 7∶3,univariate and multivariate logistic regression analyses were used in the training set to evaluate the factors related to EAD and construct a nomogram.Receiver operating characteristic(ROC)curve,decision curve analysis(DCA),sensitivity,specificity,positive predictive value,negative predictive value,Kappa value and other indicators were used to evaluate the model performance.Results The incidence of EAD after liver transplantation was 24%.Multivariate logistic regression analysis showed that preoperative tumor recurrence history(OR=3.15,95%CI:1.28～7.77,P=0.013)and operation time(OR=1.22,95%CI:1.04～1.42,P=0.015)were related to the occurrence of EAD after surgery.After predicting the outcome according to the cut-off point of 0.519 identified by the Youden index,the model performance in the both training set and validation set was acceptable.DCA suggested the model has good clinical applicability.Conclusion The risk factors for EAD after liver transplantation are preoperative tumor recurrence history and operation time,and the established model has predictive effect on prognosis.

Objective To explore the relationship between serum miRNA-21 and miR-27b levels and prognosis of patients with renal clear cell carcinoma.Methods A total of 118 patients with renal clear cell carcinoma admitted to the Qinghai University Hospital from February 2019 to April 2021 were selected as the study subjects,and another 118 healthy patients in the same period as the control group.Real time fluorescence quantitative polymerase chain reaction(PCR)was used to detect the expression of miR-21 and miR-27b in the serum of all subjects.The relative expression levels of serum miR-21 and miR-27b between the patients with renal clear cell carcinoma and healthy control patients were compared.The expression and correlation of serum miR-21 and miR-27b in the patients with renal clear cell carcinoma of different pathological stages and Fuhrman grading were analyzed.The relationship between the expression of serum miR-21 and miR-27b and the survival and prognosis of the patients was explored as well.Results The expression levels of serum miR-21 and miR-27b in the patients with renal clear cell carcinoma were higher than those in the healthy control group(P＜0.05).The serum miR-21 expression level in stage Ⅲ patients was higher than in stageⅠ(P＜0.05),while the serum miR-21 expression level in the stage Ⅳ patients was higher than that in stagesⅠ,Ⅱ,and Ⅲ(P＜0.05).The expression level of miR-27b in the serum of patients gradually increased across the four stages,with a significant difference(P＜0.05).The pathological staging was positively correlated with the expression of miR-21 and miR-27b(P＜0.001).The expression levels of miR-21 and miR-27b in serum of patients gradually increased across grades Ⅰ,Ⅱ and Ⅲ by Fuhrman grading,with significant difference(P＜0.05).Fuhrman grading was positively correlated with the serum miR-21 and miR-27b expression(P＜0.001).There was a statistically significant difference in the survival curve between the miR-21 high expression group and the low expression group(P＜0.05).There was a statistically significant difference in the survival curve between the high expression group and the low expression group of miR-27b(P＜0.05).Conclusion The expression levels of serum miR-21 and miR-27b in patients with renal clear cell carcinoma is indicative of the progression and prognosis of the patient's condition.

Objective In recent decades,China has implemented a series of policies to address air pollution.We aimed to assess the health effects of these policies on stroke burden attributable to ambient fine particulate matter(PM2.5). Methods Joinpoint regression was applied to explore the temporal tendency of stroke burden based on data from the Global Burden of Disease 2019 study. Results The age-standardized rates of disability-adjusted life year(DALY)for stroke attributable to ambient PM2.5 in China,increased dramatically during 1990-2012,subsequently decreased at an annual percentage change(APC)of-1.98[95%confidence interval(CI):-2.26,-1.71]during 2012-2019.For ischemic stroke(IS),the age-standardized DALY rates doubled from 1990 to 2014,and decreased at an APC of-0.83(95%CI:-1.33,-0.33)during 2014-2019.Intracerebral hemorrhage(ICH)showed a substantial increase in age-standardized DALY rates from 1990 to 2003,followed by declining trends,with APCs of-1.46(95%CI:-2.74,-0.16)during 2003-2007 and-3.33(95%CI:-3.61,-3.06)during 2011-2019,respectively.Conversely,the age-standardized DALY rates for subarachnoid hemorrhage(SAH)generally declined during 1990-2019. Conclusion Our results clarified the dynamic changes of the ambient PM2.5-attributable stroke burden in China during 1990-2019,highlighting the health effects of air quality improvement policies.

Objective:To compare the prevalence and progression of subclinical atherosclerosis (SA) in populations with different cardiovascular disease (CVD) risks in China, and clarify the relationship between CVD risk stratification and SA.Methods:All participants were from Beijing Community-Based Cohort of Atherosclerosis. A total of 1 462 participants underwent carotid ultrasound and coronary computed tomography scan during 2008-2009 and 2013-2014. After excluding 191 participants with history of CVD and incomplete baseline data, 1 271 participants were included in final analysis. The 10-year CVD risk for participants were calculated based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) equation, and risk stratification was performed. The prevalence and progression of SA was determined by carotid intima-media thickness (cIMT), carotid plaque score and coronary artery calcification (CAC) score.Results:In the participants included in this study, 536 (42.2%), 418 (32.9%) and 317 (24.9%) were classified to have low, intermediate and high 10-year risk, respectively. With the rising level of 10-year risk, the proportion of patients with SA and SA progression increased. In low, intermediate and high CVD risk groups, the proportions of participants with CAC were 16.4%, 36.4% and 52.0% (trend P<0.001); and 15.4%, 36.4% and 53.6% had progression of CAC during follow-up, respectively (trend P<0.001); compared with low-risk group, RRs for CAC progression of intermediate and high-risk groups were 2.316 (95% CI: 1.714-3.129) and 3.322 (95% CI: 2.472-4.463), respectively (trend P<0.001). The trend of relationship between CVD risk stratification and cIMT and carotid plaque progression were consistent with CAC. Conclusions:This current study shows CVD risk stratification is closely related to the prevalence and progression of atherosclerosis in Chinese population. However, many people with low CVD risk have atherosclerotic change in their carotid and coronary artery.

ObjectiveTo explore the effect of mentality-controlling on local microcirculation of acupuncture at Hegu （LI 4）. MethodsForty healthy subjects were randomly divided into simple acupuncture group and mentality-controlling acupuncture group， with 20 cases in each group. The simple acupuncture group was acupunctured at Hegu （LI 4） on the right hand of the patient. In mentality-controlling acupuncture group， an audio clip was played to guide the participants to control their mentality when needle retention for 5 min after performing acupuncture twirling mani-pulation. The microcirculatory blood perfusion units （MBPU） was captured and compared between groups of participants using laser speckle contrast imaging （LSCI） for 5 mins in each of the four stages， state before acupuncture （R1）， after needle insertion （A1）， after needle twirling （A2） and after needle withdrawal （R2）. The participants' feelings such as relaxation， concentration， drowsiness， energy flow at acupoints were compared between groups， and the adverse reactions were recorded. ResultsThe MBPU values of R1， A1， A2 and R2 stages in mentality-controlling acupuncture group were 67.92±18.40 PU， 168.13±46.03 PU， 144.19±44.40 PU， 159.73±65.21 PU， respectively. The simple acupuncture group were 79.85 （66.80， 99.40）PU， 193.31 （173.15， 224.80）PU， 147.68 （128.12， 198.30）PU， 158.09 （126.05， 207.59）PU respectively. There was a statistically significant difference in MBPU between groups of the four stages （P＜0.01）. Among them， the MBPU in the A1 stage of both groups was significantly larger than that in the R1 stage， the MBPU in the A2 stage significantly smaller than that in the A1 stage， and the MBPU in the R2 stage was significantly larger than that in the R1 stage （P＜0.01）. MBPU in the R2 stage of the mentality-controlling acupuncture group was larger than that in the A2 stage （P＜0.05）. The difference of MBPU between A2 and A1 in mentality-controlling acupuncture group was significantly smaller than that in the simple acupuncture group， and the difference was statistically significant （t = 3.79， P＜0.01）. In mentality-controlling acupuncture group， 18 participants felt relaxed （90%）， 15 concentrated （75%）， 3 felt sleepy （15%）， and 14 felt energy flow at acupoints （70%）； while in the simple acupuncture group， 13 participants felt relaxed and sleepy （65%）， 6 concentrated and 6 felt energy flow at acupoints （30%）. The number of participants with concentration and energy flow at acupoints in mentality-controlling acupuncture group was higher than that in the simple acupuncture group， and the number felt sleepy was lower than that in the simple acupuncture group （P＜0.05）. No needle fainting， needle site infection， local haematoma and any other adverse reactions were found in both groups. ConclusionAcupuncture could affect the changes of local microcirculation， and controlling mentality during acupuncture can slow the rate of MBPU reduction and enhance the post-acupuncture effect with a favourable safety profile.

Objective To construction of discharge readiness assessment index for patients with percutaneous transhepatic biliary drainage.Methods Based on the framework of the Meleis's transitions theory,the relevant literature was consulted,the semi-structured interview and group discussion were implemented,and the framework of the assessment index system for discharge readiness of patients with percutaneous transhepatic biliary drainage was initially constructed.Then,two rounds of Delphi expert consultations were conducted.The weight of each indicator was set by Analytic Hierarchy Process.Results The effective recovery of 2 rounds of expert consultations were both 100％.The authority coefficients were 0.964 and 0.972,The Kendall harmony coefficients were 0.240 and 0.228(P＜0.001).The final discharge readiness assessment index system for patients with percutaneous transhepatic biliary drainage was established,including 4 first-level indicators and 35 second-level indicators.Conclusion The discharge readiness assessment index system for patients with percutaneous transhepatic biliary drainage was scientific and reliable,which can provide references for the evaluation of discharge readiness for patients with percutaneous transhepatic biliary drainage.

Objective:To investigate the effects of Bruner's constructivist theory on the critical thinking and practice performance of nursing students interning in internal medicine.Methods:One hundred and fifty-three undergraduate nursing students practicing in the department of internal medicine of a Beijing grade A tertiary hospital were selected by convenience sampling and divided into control group ( n=76) and experimental group ( n=77) according to the order of rotation time. The experimental group received teaching based on Bruner's constructivist theory, while the control group was given traditional teaching. SPSS 24.0 was used to perform the t test. Results:Compared with the control group, the experimental group showed a significantly higher critical thinking score [(306.13±33.00) vs. (325.03±32.09)], a significantly higher exit theory assessment score [(94.74±3.24) vs. (96.94±1.79)], a significantly higher exit skills assessment score [(86.68±11.95) vs. (90.23±9.17)], and a significantly higher degree of satisfaction with teaching [(180.08±13.35) vs. (187.91±14.50); all P<0.05]. Conclusions:Bruner's constructivist theory can help nurse students improve their critical thinking, theoretical and practical performance, and satisfaction with teaching, which enhances the effects of internal medicine nursing teaching.

Objective:To systematically review the prediction models of postoperative mortality risk in elderly patients with hip fracture.Methods:China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine disc, PubMed, Embase, Cochrane Library and Web of Science were systematically searched for studies on mortality risk prediction models after hip fracture surgery in the elderly. The search period was from establishment of the databases to February 28, 2023. Two researchers independently screened the literature, extracted the data, and used the predictive model risk bias tool to evaluate the quality of studies. R4.1.1 software was used to perform meta-analysis of the data.Results:A total of 15 studies were included, of which five were for model development and ten were for model development and internal validation. The performance of the prediction models in the 15 studies was generally good ( AUC: 0.640-0.967), but all of them had bias risks, mainly due to the small sample size, unreported processing methods for missing data values, data complexity, the inappropriate screening method of predictor variables and the lack of consideration of model fitting. Meta-analysis showed that age increase [ OR=1.06, 95% CI (1.04, 1.08), P<0.01], male [ OR=1.92, 95% CI (1.48, 2.48), P<0.01] and reduced hemoglobin [ OR=1.53, 95% CI (1.35, 1.74), P<0.01] were independent risk factors for postoperative death in elderly patients with hip fracture. Conclusions:The prediction model of mortality risk after hip fracture surgery in elderly patients still has shortcomings. In the future, it is necessary to optimize the existing model and verify the model internally and externally. Medical staff should focus on elderly, male, postoperative patients with low hemoglobin and formulate targeted intervention strategies in advance.

Objectives:This study aims to investigate the association between cumulative fasting blood glucose(FBG)and presence of coronary artery calcification(CAC). Methods:A total of 1 113 participants were recruited from the Beijing Community-based Cohort of Atherosclerosis.Anthropometric measurements and laboratory examinations including FBG were performed in 1998,2008-2009 and 2013-2014 respectively,and coronary CT scan was performed in 2013-2014.Participants were classified into 4 groups according to the level of cumulative FBG(10-year weighted cumulative value of at least 2 FBGs):<50.0 mmol/L group(n=495),50.0-55.9 mmol/L group(n=345),56.0-69.9 mmol/L group(n=176),and≥70.0 mmol/L group(n=97).CAC score>0 was defined as presence of CAC.Multivariable logistic regression model was applied to analyze the impact of cumulative FBG exposure on the risk of CAC,and subgroup analyses were conducted according to factors such as sex and age. Results:The mean age of enrolled participants was(59.7±6.4)years,523(47.0%)were male and 478(42.9%)had CAC.The proportion of subjects with CAC increased with the increment of cumulative FBG.Compared with the<50.0 mmol/L group,the multivariable-adjusted OR(95%CI)for CAC in the 50.0-55.9 mmol/L group,56.0-69.9 mmol/L group,and≥70.0 mmol/L group were 1.43(1.04-1.98),1.92(1.24-2.99)and 2.79(1.35-5.77),respectively(Ptrend<0.05).The risk for CAC increased by 34%per 10 mmol/L increase in cumulative FBG,with OR(95%CI)of 1.34(1.12-1.59).There was no statistically significant difference in the risk of CAC presence for each 10 mmol/L increase in cumulative FBG level between the subgroups(all P≥0.05). Conclusions:Elevated cumulative FBG is a risk factor for the prevalence of CAC,indicating the importance of maintaining healthy FBG in preventing the occurrence of CAC.

Objective:To explore the application effect of adjustable body position protection belt in patients undergoing not painless colonoscopy.Methods:A randomized and controlled trial was used, a total of 180 patients who planned to undergo not painless colonoscopy in the Endoscopy center, the First Hospital of Jiaxing from January to October 2022 were selected as the research objects. They were divided into the experimental group and the control group by the random number table method, with 90 cases in each group. The control group adopted the traditional method of colonoscopy body position placement, and on this basis, the experimental group used the adjustable body position protection belt to assist the patient body position placement. The maintenance rate of body position in colonoscopy, the cecal intubation time, the degree of intraoperative pain and the acceptance rate of re-examinationunder the same operating doctor and nurse were compared between the two groups.Results:The maintenance rate of body position in colonoscopy was 97.78%(88/90) in the experimental group and 58.89%(53/90) in the control group, the difference was statistically significant ( χ2 = 37.84, P<0.05). The cecal intubation time was (7.84 ± 4.39) min in the experimental group and (10.13 ± 5.85) min in the control group, the difference was statistically significant ( t = 2.98, P<0.05). The intraoperative pain score was 2.96 ± 1.39 in the experimental group and 4.28 ± 1.42 in the control group, the difference was statistically significant ( t = 6.31, P<0.05). The acceptance rate for re-colonoscopy was 88.89%(80/90) in the experimental group and 72.22%(65/90) in the control group, the difference was statistically significant ( χ2 = 7.98, P<0.05). Conclusions:Use of adjustable body position protection belt to assist body position placement before the patients undergoing not painless colonoscopy, it can improve the maintenance rate of body position during not painless colonoscopy, shorten the time of cecal intubation, reduce the intraoperative pain degree, and patients also have a higher willingness to undergo colonoscopy again.