Objective  To establish a model that can predict the occurrence of acute kidney disease (AKD) in liver cirrhotic patients and evaluate its performance.  Methods  Liver cirrhotic patients who hospitalized in the department of gastroenterology of the First Hospital of Lanzhou University from January 2017 to January 2022 were retrospectively included. They were divided into AKD and non-AKD groups according to whether they were combined with AKD during hospitalization, and were randomized into training and validation sets in a 7∶3 ratio. The clinical data of patients in the two groups were collected, and LASSO regression and multifactorial Logistic regression were used to screen the influencing factors for the occurrence of AKD in patients with liver cirrhosis and to establish a prediction model. The model was then evaluated by using the receiver operating characteristic curve, the calibration curve and the clinical decision curve.  Results  A total of 796 cases of liver cirrhotic patients who met the inclusion and exclusion criteria were enrolled. Among them, 103 cases were in the AKD group and 693 cases were in the non-AKD group; 561 cases were in the training set and 235 cases were in the validation set. The results of LASSO regression and multifactorial Logistic regression showed that a history of diabetes (OR=2.922, 95% CI: 1.290-6.564, P=0.009), hepatic encephalopathy (OR=6.210, 95% CI: 2.278-17.479, P < 0.001), gastrointestinal bleeding (OR=2.501, 95% CI: 1.236-5.073, P=0.011), ascites (OR=3.219, 95% CI: 1.664-6.539, P < 0.001), male (OR=0.477, 95% CI: 0.254-0.879, P=0.019), hemoglobin (OR=0.987, 95% CI: 0.975-0.999, P=0.044), albumin (OR=0.952, 95% CI: 0.911-0.991, P=0.023), and prothrombin time (OR=0.865, 95% CI: 0.779-0.920, P < 0.001) were the independent influences on the occurrence of AKD in liver cirrhotic patients, and were used to construct a prediction model. The area under the curve of the model in the training set and validation set for predicting the occurrence of AKD in liver cirrhotic patients was 0.895 (95% CI: 0.865-0.925) and 0.869 (95% CI: 0.807-0.930), respectively. The calibration curves showed that the model had good fit and consistency and the clinical decision curves showed that the use of the model for predicting the risk of AKD could benefit liver cirrhotic patients overall.  Conclusions  A prediction model for the occurrence of AKD in liver cirrhotic patients was established based on eight influencing factors, including gender, history of diabetes, and hepatic encephalopathy. It was validated to have good discrimination, calibration, and clinical utility, and is expected to assist in the clinical early screening and identification of liver cirrhosis-associated AKD.

Objective To compare the effects of different doses of vitamin D supplementation on vita-min D deficiency and insufficiency in premature infants.Methods A total of 126 premature infants hospital-ized in the pediatrics department of this hospital from March 25,2021 to December 30,2022 were selected as the study subjects and began to supplement different doses of vitamin D on 3 d after birth under the intestinal tract tolerance.They were divided into 500,900 and 2 100 IU/d groups according to vitamin D supplementary dose.The differences in vitamin D levels at beginning and after supplementation were compared among the groups.Results Among 126 premature infants,there were 52 cases of vitamin D deficiency and 74 cases of vi-tamin D insufficiency.Compared with vitamin D insufficiency,the proportion of vitamin D supplementation in the mothers of the premature infants with vitamin D deficiency was lower(P＜0.05).The serum calcium,phosphorus,alkaline phosphatase and 25-hydroxyvitamin D levels after birth had no statistical difference a-mong 3 groups(P＞0.05).The 25-hydroxyvitamin D level after supplementation had statistical difference a-mong 3 groups(P＜0.05),moreover the 500 IU/d group was lower than the 2 100 IU/d group(P＜0.05).The longest duration of vitamin D supplementation in the 2 100 IU/d group was 90 d,its highest 25-hydroxyvitamin D level after supplementation was 48.3 ng/mL,no vitamin D poisoning condition appeared,there were still 40 cases(85.1％)of vitamin D deficiency and insufficiency after supplementation in the 900 IU/d group,and 17 cases(25.8％)in the 2 100 IU/d group.Conclusion Giving vitamin D 2 100 IU/d in pre-term infants is recommended after birth to prevent the vitamin D deficiency.

Objective To investigate the effects of the thickness of the chest wall compensation film and the patient's body characteristics on the setup errors and radiation dose of breast cancer patients receiving intensity-modulated radiotherapy following surgery.Methods A total of 103 patients with breast cancer who were treated in the Tumor Radiotherapy Center of Fuyang Cancer Hospital from January 2021 to June 2023 were selected for a prospective study.All patients received cone-beam CT scan.The effects of body mass index(BMI),tumor location,chest circumference,and the affected breast volume on the setup errors were analyzed;and the effects of different compensation film thicknesses on the radiation doses to the planning target volume(PTV),lung,heart,and spinal cord were explored.Results The left-right setup errors didn't differ significantly in breast cancer patients with different BMI and affected sides(P>0.05);but the patients with chest circumference≥89.0 cm and affected breast volume≥650 cm3 had greater left-right setup errors than the other patients(chest circumference<89.0 cm and affected breast volume<650 cm3)(P<0.05).The difference in the superior-inferior setup errors was trivial in breast cancer patients with different affected sides(P>0.05),but the superior-inferior setup errors were greater in patients with BMI≥23.1 kg/m2,chest circumference≥89.0 cm,and breast volume on the affected side≥650 cm3 than the others(BMI<23.1 kg/m2,chest circumference<89.0 cm,and breast volume on the affected side<650 cm3)(P<0.05).There was no significant difference in the anterior-posterior setup errors in breast cancer patients with different BMI,chest circumferences,breast volumes,and affected sides(P>0.05).For left-sided breast cancer,the measured values of D95%and D5%of PTV,V20%of left lung,V30%and Dmean of heart,Dmax of spinal cord,MU,and HI in patients with 0.5 and 1.0 cm compensation films were close(P>0.05);while lower CI was found in patients with 0.5 cm compensation film than those with 1.0 cm compensation film(P<0.05).For right-sided breast cancer,the measured values of D95%and D5%of PTV,V20%of right lung,Dmax of spinal cord,MU,CI,and HI didn't differ significantly between patients using 0.5 and 1.0 cm compensation films(P>0.05).Conclusion The BMI,chest circumference,and breast volume on the affected side in breast cancer patients undergoing intensity-modulated radiotherapy are all associated with the setup errors.Both 0.5 and 1.0 cm chest wall compensation films can be used for postoperative radiotherapy,which has little effect on the dosimetry and accelerator MU.

Objective To explore the correlation of serum level of reduced NOX2 with cerebral blood supply and prognosis in elderly patients with TBI.Methods A total of 86 elderly TBI pa-tients admitted to our department from January 2019 to December 2022 were recruited and served as the TBI group,and another 80 age-and gender-matched elderly individuals who took physical examinees in our hospital during the same period were enrolled and served as the control group.According to the GCS score at admission,the TBI group was divided into mild,moderate and se-vere subgroups(22,35 and 29 cases).The patients were also assigned into good prognosis sub-group(54 cases)and poor prognosis subgroup(32 cases)based on GOS score in 6 months after treatment.The dynamic changes in serum NOX2 level and cerebral blood flow indicators among different groups and subgroups were compared,and their correlation with the prognostic GOS score was analyzed.Results The average blood flow Vm,rCBF,and rCBV of TBI patients at 1,3,5,7,and 10 d after injury were significantly reduced,and the serum NOX2 level was obviously in-creased when compared to the control group(P＜0.01).Statistical difference was seen in serum NOX2 level among the patients with different degrees of TBI at 1,3,5,7 and 10 d after injury(P＜0.05,P＜0.01).The serum NOX2 level at 1,3,5,7,10 and 14 d after injury in the TBI group was negatively correlated with GCS score(r=-0.413,-0.427,-0.515,-0.592,-0.566,-0.338;P＜0.01),and the Vm CBV,and rCBF values at 1,3,5,7,and 10 d after injury were posi-tively correlated with GCS score(r=0.392,0.379,0.407,0.418,0.420,P＜0.01;r=0.404,0.414,0.429,0.419,0.428,P＜0.01;r=0.412,0.427,0.432,0.428,0.393,P＜0.01).The serum NOX2 level at 1,3,5,7 and 10 d after injury in the TBI group was negatively correlated with Vm,rCBV and rCBF values(P＜0.01).The serum NOX2 level of the patients in the poor prognosis subgroup were significantly higher than those in the good prognosis subgroup at 1,3,5,7,10,and 14 d after injury,while,the rCBV and rCBF values were obviously lower than those in the good prognosis subgroup(P＜0.05,P＜0.01).The serum NOX2 level in the TBI patients at 1,3,5,7,10,and 14 d after injury were negatively,while Vm,rCBV and rCBF values were positively correlated with GOS scores at 6 months after treatment(P＜0.01).Conclusion Elevated serum NOX2 level is closely correlated with insufficient cerebral blood supply and poor prognosis in elderly TBI pa-tients.Dynamic monitoring of serum NOX2 level and changes in cerebral blood flow indicators are of great clinical significance in evaluation of TBI prognosis.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore the risk factors of perioperative outcomes of lung transplantation and establish a predictive model for delayed extubation after lung transplantation.Methods:From January 1, 2020 to December 31, 2022, 104 lung transplantation recipients were retrospectively collected to identify the risk factors of early post-operative outcome.According to the timing of extubation post-lung transplantation, they were assigned into two groups of normal(77 cases)and delayed(27 cases). Baseline profiles, type of primary diagnosis, cold ischemic duration and lung transplantation approach were compared between two groups.The factors with significant difference were examined by univariate and multivariate Logistic regression.Furthermore, multivariate logistic model was visualized by a nomogram.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA) were performed for evaluating the model's predictive performance and its value for clinical utilization.Results:The postoperative mortality rate was 9.6%.Delayed extubation was a strong predictor for postoperative mortality.Cold ischemic time outperformed others variates in terms of delayed extubation prediction.AUC of cold ischemic time and multivariate logistic model was 0.75(95% CI: 0.69-0.81)and 0.87(95% CI: 0.82-0.91). Conclusions:Delayed postoperative extubation is a key predictor of early post-lung transplantation mortality.The established predictive model may effectively identify high-risk patients for preventive intervention and survival improvement post-lung transplantation.

OBJECTIVE: To explore the genetic basis of a Chinese pedigree affected with Dyggve-Melchior-Clausen syndrome. METHODS: Whole exome sequencing and Sanger sequencing were carried out to detect potential pathogenic variants associated with the syndrome. The function of candidate variant was verified by Western blotting. RESULTS: A novel homozygous variant, c.1222delG of the DYM gene was detected in the two affected siblings, for which both parents were heterozygous carriers. The variant has caused replacement of Asp by Met at amino acid 408 and generate a premature stop codon p.Asp408Metfs*10. Western blotting confirmed that the variant can result in degradation of the mutant DYM protein, suggesting that it is a loss of function variant. CONCLUSION The homozygous c.1222delG frameshift variant of the DYM probably underlay the Dyggve-Melchior-Clausen syndrome in the two affected siblings. Above findings has enabled clinical diagnosis and genetic counseling for the family.
China ; Dwarfism/genetics* ; Humans ; Intellectual Disability ; Osteochondrodysplasias/genetics* ; Pedigree

Objective:To evaluate the effect of prolonged graft cold ischemia time(CIT)on outcomes of lung transplantation(LTx).Methods:Clinical data are retrospectively reviewed for 111 patients undergoing LTx at Affiliated Shanghai Pulmonary Hospital of Tongji University between January 2019 and January 2022. They are divided into two groups of prolonged CIT(8~12 h, 41 cases)and control(<8 h, 70 cases)according to CIT. Kaplan-Meier method is employed for estimating 1-year cumulative survival rate and multivariable Cox proportional hazard regression model for identifying independent risk factors of 1-year mortality.Results:No significant inter-group difference existed in the incidence of primary graft dysfunction grade Ⅲ within the first 72 h post-LTx(21.2% vs. 16.3%). The 30-day(90.2% vs. 94.3%)and 90-day(82.9% vs. 82.9%)survival rates are comparable between two groups. Similarly 1-year cumulative survival is also comparable between two groups (74.6% vs. 60.4%, Log-rank P=0.279). Multivariate Cox regression analysis indicated that prolonged CIT was not associated with an elevated risk of 1-year mortality( HR 0.691; 95% CI: 0.317~1.506). However, an absence of ECMO support during surgery( HR 3.562; 95% CI: 1.061~11.959)and postoperative mechanical ventilation for >3 days(HR 2.892; 95% CI: 1.387~6.031)elevate 1-year risk of mortality. Conclusions:Prolongation of CIT to 8~12 h has no adverse effect on the prognosis of recipients. Given a great scarcity of donor lungs and a growing number of LTx candidates, it is reasonable to accept prolonged CIT donor lungs for clinical LTx.

Objective:To explore the effect of health education management based on "People-Environment-Occupation" (PEO) model in epilepsy patients and their families.Methods:From October 2018 to December 2019, 84 pairs of epilepsy patients and their families admitted to the Department of Neurology, Xuanwu Hospital of Capital Medical University were selected by convenience sampling as the research object. According to the admission time, the patients admitted from October 2018 to March 2019 were set as the control group, with a total of 42 pairs. A total of 42 pairs from April to December 2019 were set up as the observation group. The control group was given routine in-hospital health education, group occupational therapy and regular follow-up after discharge. On the basis of the above, the observation group carried out health education management based on PEO model for their families. The scores of Hamilton Anxiety Scale (HAMA) , Hamilton Depression Scale (HAMD) , Quality of Life in Epilepsy-31 (QOLIE-31) were compared between the two groups before intervention and 2, 6, and 10 weeks after discharge, and the scores of Epilepsy Knowledge Questionnaire before intervention and 10 weeks after discharge were compared.Results:The HAMA scores of the observation group were lower than those of the control group, and the QOLIE-31 score was higher than that of the control group, the differences were all statistically significant ( P<0.05) . Ten weeks after discharge, the epilepsy knowledge scores and total scores of the observation group, such as disease and medication knowledge, safety and first aid, psychological nursing, life coping and social participation, were higher than those in the control group (all P<0.01) . Conclusions:Health education management based on PEO model can improve the disease knowledge of epilepsy patients and their families, patients' anxiety and depression, and their quality of life.

The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplanta-tion, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.