Objective To investigate the clinical significance and level changes of uric acid(UA)/albumin(ALB)ratio(UAR)in patients with chronic kidney disease(CKD)complicated with coronary heart disease(CHD).Methods A total of 175 patients with CKD were divided into the simple CKD group(control group,n=94)and the CKD complicated with CHD group(experimental group,n=81).The differences of blood routine,blood lipid,renal function and UAR were compared between the two groups.The influencing factors of CKD complicated with CHD were analyzed by binary Logistic regression.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index for CKD complicated with CHD.Results There were no significant differences in white blood cell count(WBC),monocytes(Mon),total cholesterol(TC),total triglyceride(TG),high-density lipoprotein(HDL-C)and low-density lipoprotein(LDL-C)between the two groups.The levels of neutrophils(Neu),red cell distribution width variation coefficient(RDW-CV),blood urea nitrogen(BUN),creatinine(Cr),UA and UAR levels were higher in the experimental group than those in the control group(R＜0.05).The levels of lymphocyte(Lym),red blood cell count(RBC),mean corpuscular hemoglobin concentration(MCHC),platelet(PLT),estimated glomerular filtration rate(eGFR)and albumin(Alb)were lower in the experimental group than those in the control group(R＜0.05).Logistic regression analysis showed that lower levels of RBC and MCHC,and higher levels of UAR were independent risk factors for CKD complicated with CHD.ROC curve showed that the area under the UAR curve was the largest in RBC,MCHC and UAR detection,which was 0.912(95%CI:0.870-0.953),the sensitivity was 90.10%,the specificity was 77.70%,the Yoden index was 0.678 and the cutoff value was 10.935.The AUC of combined detection of RBC,MCHC and UAR was 0.987(95%CI:0.974-0.999),the sensitivity was 93.80%and the specificity was 97.90%.Conclusion The increased serum UAR level in patients with CKD is a predictor of CHD.The combined detection of UAR,RBC and MCHC has higher prediction efficiency.

Objective:To search, evaluate and summarize the best evidence for oral fluid intake management in adult patients with urinary calculi, providing a decision-making basis for clinical nursing.Methods:Using keywords such as urolithiasis, urinary calculi, fluid intake, water intake, fluid, etc., a systematic search was conducted in relevant domestic and international databases, guideline websites, and professional association sites for evidence related to oral fluid intake management in adult urolithiasis patients. This included clinical decisions, best practices, guidelines, expert consensus, evidence summaries, systematic reviews, and recommended practices, covering the period from January 1, 2018 to June 1, 2023. Two researchers trained in evidence-based nursing independently evaluated the quality of the literature and extracted and integrated the evidence.Results:A total of 23 articles were included, comprising two clinical decisions, one best practice, four guidelines, 13 systematic reviews, and three recommended practices. Ultimately, 18 pieces of best evidence were summarized from six aspects: the importance of fluid intake, intake volume, timing of intake, the relationship between different types of fluids and the risk of urinary calculi, intake recommendations, monitoring methods, and precautions.Conclusions:This study summarizes the best evidence for oral fluid intake management in adult patients with urinary calculi, which can provide reference for clinical nursing. When applying this evidence, it is essential to fully consider clinical circumstances and patient characteristics to reduce the recurrence rate of urinary calculi.

Objective To analyze the application value of transvaginal ultrasonography(TVS)combined with contrast-enhanced ultrasound(CEUS)in the diagnosis of cesarean scar pregnancy(CSP).Methods Sixty patients with CSP confirmed by operation and pathology admitted to the First Hospital of Jiaxing from January 2022 to November 2023 were retrospectively analyzed.TVS and CEUS were examined before operation.The detection rate and type diagnosis of CSP were compared between TVS and CEUS alone and combined diagnosis.The receiver operating characteristic(ROC)curve was used to analyze the efficiency of TVS and CEUS in identifying gestational cesarean scar pregnancy(GCSP).Results Among the 60 patients with CSP,53 patients with GCSP and 7 patients with mass cesarean scar pregnancy(MCSP)were confirmed by surgery and pathology.The detection rate of CSP by TVS combined with CEUS(98.33％)was significantly higher than that by TVS or CEUS(P＜0.05),and the detection rate of CSP by CEUS was significantly higher than that by TVS(P＜0.05).The detection rate of GCSP by TVS combined with CEUS(100.00％)was significantly higher than that by TVS or CEUS(P＜0.05).The area under the curve(AUC)of TVS combined with CEUS for identifying GCSP was the largest,which was 0.857.The sensitivity was 100.00％,and the specificity was 71.40％.The detection rate of MCSP by TVS combined with CEUS was significantly higher than that by TVS(P＜0.05).Conclusion TVS combined with CEUS can effectively improve the clinical detection rate of CSP,which is conducive to the diagnosis of CSP classification,and has important application value.

Objective To systematically sort out the interventional studies on the application of auricular point sticking technique in patients with urinary calculi by means of evidence map analysis in order to understand the distribution of evidence in this field and the problems of the studies. Methods Chinese and English databases such as CNKI, Wanfang, VIP, China Biology Medicine (CBM) Database, PubMed, Cochrane Library, CINAHL complete, Web of Science, Elsevier Science Direct, Embase, etc. were systematically searched to screen for studies related to the application of auricular point sticking technique in patients with urinary calculi. The time frame of the review was from the database construction to June 2024, and the trend of publication, type of literature, sample size in the literature, interventions, distribution of acupuncture points, outcome indexes, and methodological quality of the literature were analyzed by using graphs and text. Results A total of 79 papers were included, including 65 randomized controlled studies, 5 quasi-experimental study, and 9 studies with unclear grouping basis. The overall trend of the number of publications was increasing, and the average sample size was 103.37 patients. The most frequently selected auricular acupuncture points were kidney, ureter, sympathetic point, Shenmen, and bladder, etc., and the endpoint indicators of greater concern were clinical efficacy, pain relief, and stone expulsion, etc. The methodological quality of the literature was not high. Conclusion Auricular point sticking technique has certain advantages in the treatment of urinary calculi, and the selection of acupoints and outcome indicators are diverse. However, most studies have shortcomings in scientific research design, personalized intervention measures, measurement and analysis of outcome indicators, etc. Therefore, more scientific and rigorous large-scale, multi-center randomized controlled studies are needed in the future to provide high-quality evidence-based basis for the application of auricular point sticking technique in patients with urinary calculi.

Objective To investigate the neuroprotective effect of methylene blue on diabetic retinopathy in rats. Methods Thirty SD rats were randomly divided into blank, control and experimental groups. The control and experimental groups were induced with diabetes by streptozotocin (STZ) intraperitoneal injection. After 6 weeks of successful modeling, the experimental group received intravitreal injection of methylene blue at a dose of [0.2 mg/(kg.d)], while the control group received an equal amount of dimethyl sulfoxide (DMSO) intravitreal injection, both continuously injected for 7 days. ELISA was used to detect the levels of retinal superoxide dismutase (SOD), 8-iso-prostaglandin F2alpha (iPF2α) and interleukin-1β (IL-1β) in rats. Western blot analysis was used to detect the expression of retinal extracellular signal-regulated kinase 1/2 phosphorylation (p-ERK1/2) and phosphorylated protein kinase B (p-AKT), and PAS staining was used to detect retinal morphological changes. Results Compared with the blank group rats, the retinal SOD activity in the control and experimental group rats was significantly reduced. iPF2α, IL-1β and p-ERK1/2 level increased, while p-AKT level decreased. Compared with the control group, the SOD activity of the experimental group rats increased. iPF2α and IL-1β level went down, while p-ERK1/2 and p-AKT level went up significantly. The overall thickness of the retinal layer and the number of retinal ganglion cells were significantly reduced. Conclusion Methylene blue improves diabetic retinopathy in rats by reducing retinal oxidative stress and enhancing ERK1/2 and AKT phosphorylation.
Rats ; Animals ; Diabetic Retinopathy/metabolism* ; Proto-Oncogene Proteins c-akt/metabolism* ; Mitogen-Activated Protein Kinase 3/metabolism* ; Interleukin-1beta/metabolism* ; Methylene Blue/pharmacology* ; Phosphorylation ; Rats, Sprague-Dawley ; MAP Kinase Signaling System ; Diabetes Mellitus, Experimental/drug therapy* ; Superoxide Dismutase/metabolism*

The development of information technology in the medical industry is accelerating the construction of 3-level rehabilitation networks centering on community-based rehabilitation, which is based on the Internet and in combination with the Internet of things(IOT). A municipal rehabilitation hospital cooperated with the health centers of sub-district communities in the city to build a remote rehabilitation network based on IOT technology, for rehabilitation training of community stroke patients. The two sides worked out a cooperation scheme on project management, designed and built a remote community rehabilitation management model. Under the remote monitoring and equipment data IOT, the medical team of the municipal rehabilitation hospital could formulate the therapeutic plan according to the immediately obtained relevant functional evaluation data, and the medical team of the community health service center was responsible for the implementation of the plan. Fifty-three patients in the experimental group received the training of remote lower limb intelligent feedback system based on IOT together with routine rehabilitation training. After 8 weeks of treatment, the functional evaluation data of the two groups were improved in varying degrees( P< 0.05), but the improvement of the experimental group was significantly better than that of the control group( P < 0.05). Remote rehabilitation under the construction path of remote rehabilitation network based on IOT technology could significantly promote the improvement of post-functional rehabilitation of community stroke patients. This study can provide reference for the construction of three-level remote rehabilitation networks based on IOT and the implementation of home-based remote rehabilitation therapy in the future.

Objective:To investigate the efficacy and feasibility of urethroplasty using inner prepuce graft combined with Orandi flap for the treatment of the obliterated penile urethral atresic stricture.Methods:From January 2016 to September 2019, the clinical data of 18 obliterated penile urethral stricture cases were analyzed retrospectively. All the patients were treated using inner prepuce flap combined with Orandi Flap. The average age of the patients was 62.1 years old (range 20-81 years old). Ten cases had suprapubic cystostomy before operation. The maximum flow rate was 1.6-6.2 ml/s, with an average of 4.2ml/s. The intubation general anesthesia and lithotomy position was used. The foreskin of penis was incised longitudinally. The urethra was exposed and the segment of stricture was opened longitudinally. The range of stricture length was measured with soft ruler, ranging from 2.0 to 7.5 cm, with an average of 5.0cm. After the fibrotic tissue was completely removed, the dorsal inner prepuce was incised with needed length and width for harvesting a free skin flap in order to transplant and reconstruct the dorsal urethral. The Orandi flap was used to cover the ventral urethra, and a F14-16 silicone catheter was retained. The length range of the inner prepuce graft was 2.0-7.5 cm, with an average of 5.1cm; the width was 1.2-1.8 cm, with an average of 1.4cm. The length of Orandi flap was 2.2-7.7 cm, with an average of 6.0cm; the width was 1.0-1.5 cm, with an average of 1.3 cm. The catheter was removed 3-4 weeks after operation. The patients were then followed up after 3, 6 and 12 months postoperatively and then with annual assessments for the symptoms, urinary flow rate, and urethrography or soft urethroscopy when necessary.Results:All of the 18 operations were completed successfully. The patients were followed up for 6-36 months, with an average of 22 months. There were 5 patients with terminal dripping, 4 patients with recurrent urinary tract infection within half a year after operation, and antibiotic treatment being effective. The quality of life scores at 3 months and 6 months after operation were 0.8 (0-2) and 0.6 (0-1), respectively, which were statistically significant compared with before operation ( P<0.001). Conclusions:The use of free inner prepuce flap combined with Orandi flap is an effective treatment for the obliterated penile urethral atresic stricture, especially for the patients who are unwilling or unsuitable to harvest the oral mucosa. It has the advantages of convenient harvesting and less complications.

Objective:To investigate the clinical characteristics, treatment and prognosis of children with acquired thrombotic thrombocytopenic purpura (TTP).Methods:The clinical manifestations, laboratory examination, treatment and prognosis of 5 children with acquired TTP hospitalized in Beijing Children′s Hospital, Capital Medical University from January 2016 to July 2019 were analyzed retrospectively.Results:There were 5 children with acquired TTP including 2 males and 3 females, with the onset age of 8.9(0.8-14.5) years, while 11 children with TTP in the same period. Thrombocytopenia and microangiopathic hemolytic anemia were found in all 5 patients. Only one patient had typical pentalogy of TTP, 3 patients had nervous system symptoms and 3 patients had fever, while renal impairment was relatively rare (1 case). Laboratory examination showed severe thrombocytopenia (7(4-14) ×10 9/L) and low level of hemoglobin (70(58-100)g/L) in all 5 children. Blood biochemical examination showed that total bilirubin (mainly indirect bilirubin) increased in 3 patients, lactate dehydrogenase increased in 5 patients, and urea nitrogen increased in 1 patient. Bone marrow smear showed megakaryocyte did not decrease. Plasma ADAMTS13 activity was 0 in all 5 patients while ADAMTS13 inhibitor was positive in 4 patients and negative in 1 patient. All 5 children received glucocorticoid therapy, rituximab was added in the early stage of the disease, and 3 children received plasma exchange. The time of platelet recovery to normal was 19 (9-29) days. One child had TTP recurrence after 9 months of treatment. The condition was stable after being treated with glucocorticoid and rituximab again. This case was finally diagnosed as systemic lupus erythematosus after more than 3 years followed up. By December 1, 2020, the follow-up time was 24(16-57) months.The clinical symptoms of all patients disappeared and the platelet level was stable at 159(125-269) ×10 9/L. Conclusions:Childhood acquired TTP is relatively rare, which can occur in all age groups. The clinical manifestations are mainly thrombocytopenia and microangiopathic hemolytic anemia, the plasma ADAMTS 13 activity and inhibitor test are helpful for the diagnosis of acquired TTP. Plasma exchange and rituximab are effective treatment. This disease requires long-term follow-up.

We introduce the background of Shanghai medical purchasing service and supervision platform (later we call it "open platform") and the effect of its implementation. We also analyze the problems occurred by medical institutions in the management of supplies, explore how to use open platform to strengthen the management of medical supplies, further optimize the structure of supplies, standardize the clinical reasonable use and charges, and ensure the quality, safety and traceability of supplies.
China ; Equipment and Supplies

OBJECTIVE： To observe the protective effect of atorvastatin-induced increase of EPC-MVs on myocardial cells in ST-segment elevation myocardial infarction （STEMI） patients， and to investigate its potential mechanism. METHODS： Totally 168 STEMI patients was collected from our hospital during Feb. 2015-Feb. 2018， and then divided into group A （88 cases） and group B （94 cases） according to the dose of atorvastatin. All patients received percutaneous coronary intervention， and then given Bivaleridine for injection， Clopidogrel bisulfate tablets and Atorvastatin calcium tablets. Group A was given Atorvastatin calcium tablets 20 mg， once a day. Group B was given Atorvastatin calcium tablets 20 mg， twice a day. A treatment course lasted for 30 d， and two groups were treated for 3 courses at least. The levels of blood lipid （TC， LDL-C， HDL-C） （before treatment and 30th， 60th， 90th day after treatment） and the number of EPCs positive cells （30th， 60th day after treatment） were observed in 2 groups. The expression of miRNA of EPC-MVs （60th day after treatment） was detected， and the expression difference of miRNA were validated. Target gene and KEGG pathway enrichment of miRNA with most significant expression difference were analyzed， and the effects of it on the proliferation of cardiac HCM-a cells were evaluated. The occurrence of ADR was recorded in 2 groups. RESULTS： Totally 8 patients withdrew from the study in group A， and 6 patients in group B. There was no statistical significance in the levels of TC， LDL-C and HDL-C or the number of EPCs positive cells in peripheral blood between 2 groups before treatment or 30th day after treatment （P＞0.05）. After treatment， the level of HDL-C in 2 group （60th and 90th day after treatment） and the number of EPCs positive cells in peripheral blood in group B （60th day after treatment） were increased significantly， and group B was significantly higher or more than group A at the same time point （P＜0.05）. Microarray analysis showed that compared with group A， 16 miRNAs expressed more than 1.5 times differentially in EPC-MVs of group B， 7 of which were up-regulated and 9 down-regulated. Top five differentially expressed genes were hsa-miR-126 （up-regulated）， hsa-miR-1275 （up-regulated）， hsa-miR-7704 （down-regulated）， hsa-miR-105-5p （down-regulated）， and hsa-miR-3180 （down-regulated）. Fluorescence quantitative polymerase chain reaction results showed that compared with group A， relative expression of hsa-miR-126 and hsa-miR-1275 in group B were increased significantly； and relative expression of hsa-miR-7704， hsa-miR-105-5p and hsa-miR-3108 were decreased significantly （P＜0.05）. The expression difference of hsa-miR-126 was the most significant， and its target genes included Ang-1， PDGF， p38 MAPK， Smad2/3， HIF-1， TGF-β， etc. The signaling pathways involved in regulation mainly included angiogenesis signaling pathway， chronic myelogenous leukemia related pathway， renal epithelial cell carcinoma related pathway and so on. CCK-8 test showed that the optical density （OD） of cells in hsa-miR-126 specific interfering substance group was decreased significantly， and the OD value of cells in simulated substance group was increased significantly， compared with blank group （P＜0.05）. There was no statistical significance in the incidence of ADR as diarrhea， nausea and vomiting， rash， etc. （P＞0.05）. CONCLUSIONS： Different doses of atorvastatin can regulate the level of HDL-C， and large dose of atorvastatin can increase the number of EPCs significantly， but dose not influence the safety of drug use. This effect may be associated with up-regulating the expression of hsa-miR-126 in EPC-MVs so as to promoting the proliferation of myocardial cells.