Objective To compare the accuracy of bedside lung ultrasound in emergency(BLUE)and combined cardiac-lung and additional ultrasound(CLAUS)for diagnosing the causes of acute dyspnea.Methods Totally 1 016 patients with acute dyspnea were retrospectively enrolled and divided into cardiogenic pulmonary edema group(n=268),pneumonia group(n=574),pneumothorax group(n=33),pulmonary embolism group(n=67)and CAD(chronic obstructive pulmonary disease/asthma/diaphragmatic dysfunction)group(n=74)according to the causes of acute dyspnea.The findings of CLAUS protocol were compared among groups,and the accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea were also compared.Results CLAUS showed that B-B and B-C were the most common modes in cardiogenic pulmonary edema group,while A-B/A-C/B-A/B-B/B-C/C-C modes were common in pneumonia group,and A-A mode was the most common in pneumothorax group,pulmonary embolism group and CAD group.Significant differences of the manifestations of pulmonary ultrasound,pleural feature of anterior chest wall,left/right cardiac insufficiency and abnormal inferior vena cava diameter were found among groups(all P＜0.05).The accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea was 86.91%(883/1 016)and 94.49%(960/1 016),respectively,the latter was higher than the former(χ2=34.587,P＜0.05).Conclusion CLAUS protocol could be used to effectively diagnose the causes of acute dyspnea,with higher accuracy than BLUE protocol.

Vascular cognitive impairment(VCI)is a group of syndromes ranging from mild cognitive impairment to dementia caused by cerebrovascular disease,due to the lack of sensitivity and specific biomarkers,it is difficult to identify and diagnose early.Abnormal connectivity is observed in brain regions of patients with vascular cognitive disorders,locates mainly in the default mode network(DMN),and changes in their abnormal functional connectivity correlated with the degree of patients' cognitive impairment.Resting-state functional magnetic resonance imaging(rs-fMRI)is a commonly used method to detect the internal activity of the brain at resting state.The use of various rs-fMRI to study abnormal changes in the DMN in patients with VCI is useful to further investigate the pathogenesis of VCI and provide an objective basis for imaging.This article mainly reviews the application of rs-fMRI in the DMN in patients with VCI,bringing new perspectives for the correct diagnosis and assessment of VCI.

Objective:To study the life characteristics and related risk factors of patients with depression in Shandong Province.Methods:Based on the 2015 mental epidemiological survey database in Shandong Province,a total of 832 patients with depression,807 high-risk individuals with depression,and 819 low-risk individuals were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)and the Structured Clinical Interview for DSM-Ⅳ-TR Axis I Disorders,Research Version(SCID-I/P).In 2020,SCID-I/P was used for re diagnosis,and the General Health Questionnaire(GHQ-12),Simple Quality of Life question-naire,Pittsburgh sleep quality index(PSQI),Childhood Trauma Questionnaire(CTQ),Social Support Rating Scale(SSRS),Global Pain Scale(GPS),Montreal Cognitive Assessment(MoCA),Simplified Coping Style Question-naire(SCSQ)were used for evaluation.Compare changes in the quality of life of depression patients and construct a risk factor model.Results:Patients with depression had lower scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those in the high-and low-risk groups,those in remission of depression had higher scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those in non-re-mission,and those with new-onset disorder in the high-and low-risk groups had lower scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those with no-onset disorder(Ps＜0.001).Depres-sion diagnosis and PSQI scale scores at baseline negatively predicted at retest after 5 years(β=-0.06,-0.15),while coping style tendencies at baseline positively predicted(β=0.06).The simple quality of life questionnaire at baseline negatively predicted depression diagnosis at retest after 5 years,GHQ-12 scores at retest after 5 years,and PSQI scale scores at retest after 5 years(β=-0.11,-0.17,-0.09),while the simple quality of life question-naire at baseline positively predicted coping style tendencies at retest after 5 years(β=0.13).Depression diagnosis at retest after 5 years,GHQ-12 scores at retest after 5 years,PSQI scale scores at retest after 5 years,coping style tendencies at retest after 5 years,SSRS scale scores,CTQ scale scores,GPS scale scores,and the simple quality of life questionnaire at baseline all influenced the simple quality of life questionnaire at retest after 5 years through ei-ther direct or indirect pathways.Conclusion:It suggest that the quality of life is lower in patients with depression than in the general population.Depression diagnosis,sleep,mental health,pain,social support,childhood trauma and coping are direct and indirect risk factors affecting life.

Objective:To explore the effect of Jian-Pi-Zhi-Dong decoction on autonomous activity and dopamine (dopamine, DA) synaptic vesicle protein expression in the striatum of Tourette syndrome (TS) model rats.Methods:The 4-week-old male SD rats were used to establish the TS model by intraperitoneal injection of N-aminodipropionate. Thirty successfully modeled rats were randomly divided into model group, Chinese medicine group, and tiberide group according to random number table method, with 10 rats in each group. And another 10 rats with matched body mass were selected as the control group. Rats in Chinese medicine group were given Jian-Pi-Zhi-Dong decoction solution (1.6 g/100 g) and the rats in tiapride group were given sulfate tiapride suspension (2.1 mg/100 g), while rats in control group and model group were given an equal volume of 0.9% sodium chloride solution, once a day for 4 weeks.The number of autonomous activities in rats was determined by autonomous activity programmer. ELISA was used to detect the level of DA in the striatum of rats and the expression of dopamine transporter (DAT).Vesicular monoamine transporter-2 (VMAT2) and α-synuclein (α-syn) were measured by Western blot.SPSS 25.0 software was used for data analysis. Multiple group comparisons were performed using one-way ANOVA, non-parametric test and repeated measures ANOVA.Results:Comparing the number of autonomous activities among the 4 groups, the interaction effect between time and group was significant ( F=184.354, P<0.001). At the 1-4 weeks of gavaging, the numbers of autonomic activities in the model group were more than those in the control group (all P<0.05).While the numbers of autonomic activities in Chinese medicine group and tiapride group were less than those in the model group (all P<0.05). Moreover, the numbers of autonomic activities in Chinese medicine group and tiapride group from 1 to 4 weeks were less than those after model making (all P<0.05). The Western blot results showed significant differences in the relative expression of α-syn ( H=29.098), DAT ( F=54.632) and VMAT2 ( H=18.982) among the 4 groups (all P<0.001). The expression levels of α-syn protein in Chinese medicine group and tiapride group were both lower than that in the model group (0.39(0.36, 0.51), 0.39(0.36, 0.50), 0.62(0.50, 0.70)) (both P<0.05). The expression level of DAT protein in Chinese medicine group was higher than that in the model group and lower than that in tiapride group ((0.37±0.06), (0.26±0.07), (0.49±0.09)) (both P<0.05). And the expression level of VMAT2 protein in Chinese medicine group had no significant difference compared with that in the model group ( P>0.05).The ELISA results showed significant differences in DA content of striatum among the 4 groups ( F=75.370, P<0.001). The level of DA in the model group was higher than that in the control group ((7.65±0.72) ng/L, (3.71±0.59) ng/L, P<0.05). The levels of DA in Chinese medicine group ((3.92±0.81) ng/L) and tiapride group ((4.40±0.53) ng/L) were lower than that in the model group (both P<0.05), and the difference between Chinese medicine group and tiapride group was not significant ( P>0.05). Conclusion:Jian-Pi-Zhi-Dong decoction can relieve the tic symptoms of the model rats with TS, and its mechanism may be related to inhibiting the excessive release of α-syn, improving the expression of DAT and VMAT2, improving the DA synaptic vesicle circulation, and reducing the DA content in the synaptic space of the brain.

Objective To investigate the relationship between serum periostin (POSTN) level and bone mineral density in patients undergoing maintenance hemodialysis (MHD). Methods Ninety-five patients who had received MHD treatment for more than 3 months in the Hemodialysis Center of Qingdao Municipal Hospital from October 2022 to October 2023 were enrolled as experimental group. Meanwhile, 50 healthy individuals undergoing health examinations in the Physical Examination Center of the same hospital during the same period were selected as the control group. Clinical data such as gender and age were collected for both groups. Fasting venous blood samples were collected before dialysis to measure parathyroid hormone (PTH), alkaline phosphatase (ALP), urea nitrogen, serum creatinine, serum calcium, serum phosphorus, and other indicators. Serum POSTN levels in MHD patients and healthy individuals were determined using enzyme-linked immunosorbent assay (ELISA). The correlation between serum POSTN levels and bone mineral density in MHD patients was explored. Univariate and multivariate binary Logistic regression analyses were performed to identify risk factors for low bone mineral density in MHD patients and assess the clinical value of serum POSTN level in predicting low bone mineral density in these patients. Results The serum POSTN level in the experimental group were significantly higher than those in the control group (P < 0.05). These patients were divided into two groups based on T-values: normal bone mass group(47 cases, T value >-1.0) and low bone mineral density (48 cases, T value≤-1.0). The low bone mineral density group had significantly higher serum POSTN levels, dialysis vintage, PTH, ALP, serum phosphorus, β₂-microglobulin levels, and a higher proportion of females compared to the normal bone mass group (P < 0.05). Pearson correlation analysis revealed negative correlations of bone mineral density T values with serum POSTN, dialysis vintage, C-reactive protein, PTH, ALP, serum phosphorus, and β₂-microglobulin in MHD patients (r=-0.695, -0.688, -0.246, -0.528, -0.216, -0.309, -0.293; P < 0.05). Multivariate binary Logistic regression analysis showed that after adjusting for confounding factors such as dialysis vintage, PTH, and ALP, high serum POSTN level was an independent risk factor for low bone mineral density in MHD patients. The receiver operating characteristic (ROC) curve indicated that the area under the curve (AUC) for serum POSTN level in predicting low bone mineral density in MHD patients was 0.901, with a cut-off value of 29.66 ng/L. Conclusion MHD patients have higher serum POSTN levels than healthy individuals, and this marker is associated with low bone mineral density in MHD patients.

Objective: To explore the correction factors of lung cancer caused by radon exposure in a uranium mine, and estimate the excess relative risk (ERR) coefficient of lung cancer caused by radon in the uranium miners. Methods: Male miners who worked in a uranium mine more than one year in Hunan Province from 1958 to 2018 were selected. This study preliminarily estimated the ERR coefficient of lung cancer caused by radon in the miners with different corrections using the Possion regression model. Results: This study cohort included 4 851 uranium miners, with 187 miners died with lung cancer from 1958 to 2018, and cumulative follow-up of 207 251 person-year. The ERR coefficient of lung cancer caused by radon without correction factors was estimated to be 0.21%/WLM (95%CI: 0.04%/WLM-0.27%/WLM). In the final model, the exponential correction factors of radon-induced lung cancer were time since exposure and exposure rate. In this model, if time since exposure was 45 years and the average exposure rate was 0.14 WL, the estimated ERR coefficient was 1.73%/WLM (95%CI: 0.36%/WLM-3.11%/WLM). The ERR decreases by about 60.00% for every 10 years since exposure, and increases by about 30.00% for every one WL increase exposure rate. Conclusion: The correction factors of lung cancer caused by radon in uranium miners in this mine were the time since exposure and exposure rate. It was preliminarily estimated that the ERR coefficient of lung cancer caused by radon in the occupational radon exposed population in this uranium mine was 1.73%/WLM (95%CI: 0.36%/WLM-3.11%/WLM).

Objective:To explore the responsibilities of respiratory nurses in the management of chronic obstructive pulmonary disease (COPD) patient and the difficulties in disease management, so as to provide reference basis for formulating COPD management training strategies for respiratory nurses.Methods:Using phenomenological methodology, 14 nurses from the Department of Respiratory and Critical Care Medicine in the General Hospital of Ningxia Medical University and the First People′s Hospital of Yinchuan were interviewed in a personal semi-structured way from May to August 2021, and the data were sorted and analyzed according to Colaizzi 7-step analysis method.Results:Nurses′understanding of the responsibilities of COPD patient management could be summarized into five themes: dynamic monitoring and management of patients′ health, nursing decision-making of sudden changes in patients′ condition, implementation of patients′ out of hospital follow-up, promotion of improvement of patients′ self-management behavior, and cooperation among multidisciplinary team members. The difficult experience of nurses in the management of COPD patients abstracted five themes: lack of professional knowledge of COPD management, lack of clinical nursing decision-making authority, lack of human and financial support for follow-up, lack of communication skills with patients, and lack of multidisciplinary team formation in the hospital.Conclusions:Respiratory nurses have a clear understanding of the responsibilities of COPD patient management, but there are multiple difficulties in performing their responsibilities. We should pay attention to the responsibility positioning and difficulty support of nurses′ COPD management, and formulate targeted training strategies to promote the improvement of COPD nursing quality.

Objective To establish a method for uranium aerosol sample collection, dry ashing treatment, and laboratory laser-fluorescence measurement in the workplace of uranium processing and fuel fabrication facilities. Methods Through optimization experiments, the effects of sampling flow, sample pH value, and test temperature on uranium aerosol concentration results were studied, and the detection limit, precision, and recovery rate of the method were tested. Results Under the optimal test conditions, the detection limit of the method was 0.025 ng/mL; the minimum detectable concentration of 1 m³ of aerosol samples was 1.25 × 10⁻³ μg/m³; the relative standard deviation (RSD) of the measurement results was less than 5%; the recovery rate was between 96% and 104%. Conclusion The detection limit, precision, and accuracy of the method meet the testing requirements for uranium aerosol samples in the workplace of uranium processing and fuel fabrication facilities.

With the rapid development of the nuclear industry, the uranium-exposed population is rapidly expanding. Kidney injury is a major health concern for uranium-exposed population because uranium is initially retained in the kidneys and induces chemical toxicity. However, the commonly used clinical markers of kidney injury usually show significant changes in the late stages of such damage, making it difficult to monitor the occupational health of uranium-exposed population. In recent years, a number of biomarkers that can reflect early kidney injury caused by uranium have been identified and investigated by enzyme-linked immunosorbent assay and protein blotting. This article will review the studies in this area, with the aim of providing a basis for the diagnosis and understanding the development and prognosis of uranium-induced kidney injury.

Objective:To explore the correlation between abdominal aortic calcification and serum cell division cycle 42 (CDC-42) in maintenance hemodialysis (MHD) patients, and to explore the influencing factors of them.Methods:A cross-sectional study was conducted in the Blood Purification Center of Qingdao Municipal Hospital,112 patients who underwent MHD for more than 6 months from October 2019 to March 2021 were selected. The abdominal aortic calcification score (ACCs) was calculated by reference to the abdominal lateral X flat tablets. According to AACS, 50 cases were divided into no and mild calcification group (0≤AACS<5 points) and 62 cases were divided into moderate and severe calcification group (AACS≥5 points). The level of serum CDC-42 was detected by enzyme linked immunosorbent assay (ELISA). Taking the median serum CDC-42 level as the boundary, 56 cases were divided into low CDC-42 group and high CDC-42 group. Spearman correlation analysis was used to analyze the correlation between indicators. The risk factors of elevated CDC-42 and abdominal aortic calcification in MHD patients were explored by multivariate logistic regression analysis, and the variables were included by entry method.Results:In 112 patients, 91 cases (81.25%, 91/112) had abdominal aortic calcification, and the median serum CDC-42 level was 466.56 (335.56,623.57) ng/L. CDC-42, AACs, age, dialysis age, diabetic nephropathy, glycosylated hemoglobin, alkaline phosphatase, parathormone and calcium in the no and mild calcification groups were 347.77 (291.20, 419.53) ng/L, 1.00 (0.00, 3.00) points, (57.18±6.25) years, 31.50 (15.00, 49.25) months, 34.00%(17/50), (6.63±0.97)%, 116.22 (87.32, 152.13) U/L, 258.57 (143.40, 433.31) ng/L, (2.18±0.26) mmol/L, and in the moderate to severe calcification group were 602.69 (489.61, 762.73) ng/L, 10.00 (7.00, 16.25) points, (60.81±7.12) years, 49.00 (18.00, 67.00) months, 53.23%(33/62), (7.07±1.20)%, 144.34 (99.71, 201.76) U/L, 336.57 (230.63, 506.00) ng/L,(2.28±0.26) mmol/L, with statistically significant differences between the two groups(The statistical values were 6.99, 9.11, 2.83, 2.45, 4.14, 2.08, 2.04, 2.16 and 1.99, respectively, all P<0.05). CDC-42, AACs, glycosylated hemoglobin and parathormone in the low CDC-42 group were 336.50 (295.10, 395.25) ng/L, 2.00 (0.00, 4.00) points, (6.62±1.06) %, 250.60 (140.20, 462.02) ng/L,and in the high CDC-42 group were 622.92 (558.11, 836.65) ng/L, 10.00 (6.25, 15.75) points, (7.13±1.13) %, 347.21 (240.40,501.20) ng/L, with statistically significant differences between the two groups (The statistical values are 6.51, 5.21, 2.43 and 2.54, respectively,all P<0.05). Abdominal aortic calcification has positive correlations with CDC-42 ( r s=0.704, P<0.001), age ( r s=0.308, P=0.001), dialysis years ( r s=0.198, P=0.036), glycosylated hemoglobin ( r s=0.358, P<0.001), alkaline phosphatase ( r s=0.187, P=0.048), parathormone ( r s=0.437, P<0.001), serum calciu m( r s=0.323, P=0.001) and serum phospho-rus ( r s=0.251, P=0.007), and negative correlation with serum albumin( r s=-0.276, P=0.003). This study has confirmed that high serum CDC-42 ( OR=1.010, 95%CI:1.004-1.016, P=0.001) and senior dialysis age ( OR=1.033, 95%CI:1.006-1.061, P=0.018) were independent risk factors for moderate to severe abdominal aortic calcification.Serum CDC-42 levels has positive correlation with AACs ( r s=0.704, P<0.001), age ( r s=0.240, P=0.011), dialysis age ( r s=0.191, P=0.044), glycosylated hemoglobin ( r s=0.350, P<0.001), parathormone ( r s=0.380, P<0.001) and serum calcium ( r s=0.235, P=0.013). This study learned that,high AACs ( OR=1.185, 95%CI:1.037-1.354, P=0.013) and high parathormone ( OR=1.005, 95%CI:1.001-1.009, P=0.009) were independent risk factors for high CDC-42. The area under the receiver operating characteristic curve (ROC-AUC) of serum CDC-42 in predicting moderate and severe abdominal aortic calcification in MHD patients was 0.885. When the cut-off point was 466.56 ng/L, the predictive sensitivity and specificity were 79% and 86% respectively. Conclusion:The degree of abdominal aortic calcification in MHD patients was positively correlated with the level of serum CDC-42. High serum CDC-42 and high dialysis age were independent risk factors for abdominal aortic calcification in MHD patients. High AACS and high parathyroid hormone were independent risk factors for the increase of serum CDC-42 in MHD patients .