Spondyloarthritis (SpA) is a group of chronic inflammatory diseases which predominantly involve spine and/or peripheral joints. SpA can be disabling and seriously affect the quality of life and function of patients. With the increasing clinical use of targeted drug therapy, precise and standardized use becomes the focus. China's first Consensus on Targeted Drug Therapy for Spondyloarthritis was developed by National Clinical Research Center for Dermatologic and Immunologic Diseases using international norms for consensus development. The consensus addresses 13 important clinical questions, ranging from principles, patient eligibility, pre-treatment screening, treatment initiation, drug selection and switch, co-medication, to adverse event monitoring of targeted drug therapy in SpA, and recommends treatment for specific patients, playing a key role in guiding clinical practices.

Objective:To analyze the surveillance data of population in rabies exposure and post-exposure prophylaxis (PEP) clinics in Shandong province from 2019 to 2023, explore risk factors for exposure, and provide a basis for further standardizing PEP.Methods:Based on surveillance data from the rabies exposure treatment clinic vaccination information system, population, and spatial administrative division data in Shandong province from 2019 to 2023, descriptive epidemiological methods were applied to analyze using SPSS 18.0.Results:The number of individuals receiving post-exposure treatment at PEP clinics in Shandong province from 2019 to 2023 was over 1 million annually and showed an increasing trend year by year, with the highest number of visits occurring from May to August each year. The number of female patients is increasing year by year. The 15-year-old and younger age group accounted for 31.69%-36.86% of clinic visits. Grade Ⅲ exposures accounted for 53.40%, and limbs accounted for approximately 89.81% of exposed areas. Approximately 1.94% is multi site exposure. The main injuring animals were dogs, followed by cats, and the proportion of cats is increasing year by year. The proportion of doctor′s office visitors who self-treated wounds increased from 32.32% to 45.46%, while the proportion of outpatient wound treatment decreased from 76.07% to 66.24%. The whole course vaccination rate after initial exposure is 63.79%. The whole course vaccination rate for the 15-29-year-old age group was lower than that for other age groups. The usage rate of passive immune preparations among grade Ⅲ exposed individuals is 35.66%. From 2019 to 2023, 8 cases of rabies were reported, none of whom received standard post-exposure treatment.Conclusions:The epidemic characteristics and exposure risk of people exposed to suspected rabies animals in Shandong province have changed. It is necessary to pay attention to the female population, the population with low vaccination rate between 15 to 29 years of age, cat bitten people, and carry out continuous monitoring on the exposed population, and timely adjust the prevention and control strategies.

Cervical cancer is a malignant tumor of the female reproductive system, which is closely related to persistent infection with high-risk human papillomavirus (HPV). Locally advanced cervical cancer (LACC) refers to cervical cancer of stage IB3 to IVA [International Federation of Gynecology and Obstetrics (FIGO) 2018 staging], characterized by tumor diameter greater than 4 cm or invasion of adjacent tissues. The standard treatment for LACC is concurrent chemoradiotherapy, with cisplatin as the preferred chemotherapeutic agent. However, there is still a clinical need for further improvement of the overall prognosis of LACC, and exploring effective adjuvant treatment strategies after concurrent chemoradiotherapy to increase the cure rate and quality of life of LACC patients is an important topic in clinical practice. This article reviews the types, indications, effects and existing problems of adjuvant treatment after concurrent chemoradiotherapy for LACC.

Objective To explore the health promotion behaviors among patients with pulmonary tuberculosis(TB),and to analyze its relationship with health locus of control,in order to provide scientific references for improving TB patients'health-promotion behaviors in clinical nursing care.Methods The interpretive sequence mixed method design was utilized.A convenient sampling was used to enroll 300 TB patients from 2 TB specialized tertiary hospitals in Xi'an as research subjects from January to April 2023.General information questionnaire,Health promoting lifestyle profile-Ⅱ,and Multidimensional health locus of control scale were used to collect data,and single-factor analysis and multiple linear regression analysis were conducted.Purposeful sampling was used to select 11 TB patients for a semi-structured interview,and the Colaizzi 7-step method was used to extract themes.Results In the quantitative study,the total score of health promoting behaviors in 294 TB patients was(110.26±15.74).Patients'intemal health locus of control,chance health locus of control,and occupational status significantly influenced their health-promotion behaviors(P＜0.05).In the qualitative study,4 themes were extracted,including awakening self-awareness of health,the desire to establish a normal life,the distress of multiple uncertainties,and the immediate effect of authoritative guidance.The qualitative and quantitative studies complemented each other and further verified the relationship between health promotion behaviors and health locus of control of TB patients.Conclusion The level of health-promotion behaviors in TB patients needs to be further improved.Nurses need to take systematic health education as an opportunity by the catalytic effect of individual health awareness,to improve their internal locus of control,reduce their opportunity control tendency due to multiple uncertainties,with the ultimate purpose of helping TB patients form and maintain health promotion behaviors.

Objective To analyze the effect of dexmedetomidine(Dex)on biological behavior of A549 cells through expression of miR-1307.Methods Human lung cancer A549 cells were randomly divided into four groups after being cultured for 24 hours:Lung cancer A549 cell group,Dex 20μg/ml group,Dex 40μg/ml group and Dex 80μg/ml group;Each group has 6 parallel samples per hole.After each group of cell culture,we detected the cell proliferation by CCK-8 method,cell apoptosis by flow cytometry,mir-1307 expression by qRT-PCR,cell invasion and cell migration(Transwell)respectively Results Dex inhibits the viability of lung cancer A549 cells in a concentration-and time-dependent manner.Dex can promote the apoptosis of lung cancer A549 cells,and the apoptosis rate can be increased to 22.23%when the concentration of Dex reaches 80μg/ml,the apoptosis rate can rise to 22.23%.Dex inhibits the migration and invasion of lung cancer A549 cells in a concentration-dependent manner.In addition,the relative expression of miR-1307 in A549 cells after Dex treatment decreased significantly comparing to the control group,and the decline was more noteworthy with the increase of Dex concentration.Conclusion Dex can effectively inhibit the proliferation,invasion,metastasis,and apoptosis of humen A549 cells in a dose-dependent manner,and its efficacy may be related to its regulation of miR-1307 expression.

Objective To investigate the effect of different radiation doses on the accuracy of iodine quantification and CT value of virtual monochromatic image with a muti-spectral CT iodine phantom using second-generation dual-layer detector spectral CT(DLCT).Methods The second-generation DLCT scan abdominal phantom was used,which consisted of six different concentrations of iodine rods at 4,8 and 12 g/L.The scan parameters were set at 100,120 and 140 kVp tube voltages,and six radiation exposure sequences were scanned at each tube voltage:5,10,15,20,25 and 30 mGy.Measure the iodine concentration value and the CT value at the single level of 50,70 and 100 keV,and calculate the absolute error value of iodine concentration and CT value under different radiation exposure.SPSS 22.0 software single factor analysis of variance was used to compare the difference between the io-dine concentration and the absolute error of CT value under different Radiation exposure,and LSD method was used to compare the two groups.Results The absolute error of CT value of 4 g/L iodine rod with 10～30 mGy scanning at 100 keV energy level was significantly higher than that of 12 g/L and 8 g/L(P＜0.05),and the absolute error of iodine concentration measurement of other iodine rods with different concentrations at different Radiation exposure had no statistical difference.Conclusions The second-generation double-layer detector spectral CT has high meas-urement stability for iodine concentration quantification and CT value accuracy under conditions of radiation dose greater than 5 mGy.

Objective:To analyze the risk factors of short-term recurrence of hepatocellular carcinoma (HCC) treated by transcatheter arterial chemoembolization combined with radiofrequency ablation (TACE-RFA), and to predict the short-term recurrence rate by establishing a nomogram model.Methods:The clinical data of patients with hepatocellular carcinoma treated with TACE-RFA at the PLA General Hospital from January 2010 to December 2019 were retrospectively analyzed. Of 125 patients who were included, there were 103 males and 22 females, aged (56.6±8.9) years old. Based on whether tumors had recurred within 12 months after treatment, the patients were divided into two groups: the recurrent group ( n=86) and the non-recurrent group ( n=39). The baseline conditions, tumor characteristics and preoperative laboratory examination resultss were collected and the patients were followed-up by outpatient reexaminations. Multivariate logistic regression analysis was used to study the risk factors of short-term recurrence. C-index, correction model and ROC curve were used to evaluate the model. Results:Multivariate logistics regression analysis showed that the neutrophil to lymphocyte ratio (NLR) >1.25 ( OR=2.87, P=0.048), albumin-γ-glutamyltransferase ratio (AGR)≤0.3 ( OR=3.40, P=0.043), incomplete tumor encapsulation ( OR=3.81, P=0.007) and maximum tumor diameter ( OR=1.98, P=0.003) were independent risk factors for short-term recurrence after TACE-RFA. Applying the above factors to construct the nomograph, the C-index was 0.767, the area under the curve was 0.77 (95% CI: 0.67-0.85), and the calibration curve had a good consistency. Conclusion:NLR>1.25, AGR≤0.3, incomplete tumor encapsulation and tumor maximum diameter were risk factors of short-term recurrence after TACE-RFA in patients with HCC. The nomogram model based on the above factors was of good value in predicting short-term recurrence after TACE-RFA.

The clinical manifestations of subacute combined degeneration of spinal cord (SCD) in children are complex and vary greatly. Due to the fact that some patients with SCD may be complicated with autoimmune diseases, the high early misdiagnosis and missed diagnosis rates are observed. One case of 13-year old female with severe anemia, multiple joint swelling and pain in left limbs and paralysis of bilateral lower limbs with the extremely low level of serum vitamin B12 and poly-glandular involvement as well as a variety of positive auto-antibodies (anti-intrinsic factor antibody, anti-parietal cell antibody, thyroid peroxidase antibody, thyroid globulin antibody and perinuclear anti-neutrophil cytoplasmic antibody) was retrospectively analyzed. The patient was diagnosed as SCD with autoimmune disease (undifferentiated connective tissue disease and autoimmune polyglandular syndrome). The patient′s condition gradually alleviated after high-dose intravenous methylprednisolone, immunoglobulin, naproxen (then changed to hydroxychloroquine 1 month later), vitamin B12 and levothyroxine sodium tablets supplementation, blood transfusion and rehabilitation. SCD with autoimmune diseases is rare in children, and the clinical manifestations vary greatly. Early recognition and early treatment can improve the prognosis of SCD. The clinical data of this child were retrospectively analyzed, so as to improve the understanding of the disease by clinicians.

OBJECTIVE: To explore the genetic etiology of a child with D bifunctional protein deficiency (DBPD) born to a consanguineous pedigree. METHODS: A child with DBPD who was admitted to the First Affiliated Hospital of Hainan Medical College on January 6, 2022 due to hypotonia and global developmental delay was selected as the study subject. Clinical data of her pedigree members were collected. Peripheral blood samples of the child, her parents and elder sisters were collected and subjected to whole exome sequencing. Candidate variant was validated by Sanger sequencing and bioinformatic analysis. RESULTS: The child, a 2-year-and-9-month-old female, had featured hypotonia, growth retardation, unstable head lift, and sensorineural deafness. Serum long-chain fatty acids were elevated, and auditory brainstem evoked potentials had failed to elicit V waves in both ears with 90 dBnHL stimulation. Brain MRI revealed thinning of corpus callosum and white matter hypoplasia. The child's parents were secondary cousins. Their elder daughter had a normal phenotype and no clinical symptoms related to DBPD. Elder son had frequent convulsions, hypotonia and feeding difficulties after birth, and had died one and a half month later. Genetic testing revealed that the child had harbored homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene, for which both of her parents and elder sisters were carriers. Based on the guidelines from the American College of Medical Genetics and Genomics, the c.483G>T (p.Gln161His) was rated as a pathogenic variant (PM1+PM2_Supporting+PP1+PP3+PP4). CONCLUSION The homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene caused by the consanguineous marriage probably underlay the DBPD in this child.
Female ; Humans ; Pedigree ; Muscle Hypotonia ; Hearing Loss, Sensorineural ; Protein Deficiency ; Mutation

Objective:To translate the Intermittent Catheterization Difficulty Questionnaire (ICDQ) into Chinese, and to test its reliability and validity in neurogenic bladder patients.Methods:After translation, back-translation, cross-cultural debugging, expert consultation and pre-investigation, a Chinese version of ICDQ was formed. A total of 248 patients with neurogenic bladder clean intermittent self-catheterization who were treated and followed up in the First Hospital of Shanxi Medical University in October 2022 were selected as research objects by the convenient sampling method, and the Chinese version of ICDQ was used for investigation. The critical ratio method was used for project analysis. Content validity and structure validity were used to test the validity of the questionnaire. Cronbach's α coefficient, split half reliability coefficient and retest reliability coefficient were used to test the reliability of the questionnaire. A total of 248 questionnaires were sent out in this study, and 238 were effectively collected, with a recovery rate of 95.97% (238/248) .Results:The Cronbach's α coefficient of the Chinese version of ICDQ was 0.857, the split half coefficient was 0.711, and the retest reliability coefficient was 0.954. The content validity index of the Chinese version of ICDQ item level was 0.860 to 1.000, and the content validity index of the scale level was 0.930. Seven common factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 77.38%. The results of confirmatory factor analysis showed RMSEA < 0.080, GFI, AGFI, TLI, CFI > 0.800. Conclusions:Through confirmatory factor analysis, the Chinese version of ICDQ shows that the model fitting indicators of the scale meet the corresponding requirements, indicating that the scale has high structural validity and overall model fitting. It can be used as an evaluation tool for intermittent self catheterization difficulties in patients with neurogenic bladder.