AIMS:The C-reactive protein-triglyceride-glucose index (CTI) is a novel biomarker of insulin resistance and inflammation. This study aimed to investigate the association between baseline CTI and all-cause and cardiovascular (CVD) mortality in patients with diabetic foot (DF), providing a scientific basis for clarifying this relationship in clinical practice. METHODS:A total of 827 inpatients meeting inclusion criteria were enrolled from a tertiary hospital DF department in Tianjin (2020-2021), with median follow-up of 47 months. Outcomes included all-cause and CVD mortality. Multivariable Cox regression, restricted cubic splines (RCS), Kaplan-Meier analysis, and ROC curves were used to evaluate associations and predictive performance. RESULTS:During follow-up, 325 all-cause deaths occurred, including 158 CVD deaths. Fully adjusted models showed that high CTI was associated with 57% higher all-cause mortality (HR = 1.57, 95% CI:1.24-2.00) and 50% higher CVD mortality (HR = 1.50, 95% CI:1.06-2.11). RCS indicated nonlinear associations (P < 0.05), and ROC supported CTI's predictive accuracy for mortality. CONCLUSIONS:A higher CTI level was independently associated with an increased risk of all-cause and cardiovascular mortality in patients with diabetic foot. The CTI may serve as a promising and easily accessible risk stratification tool, though its clinical utility requires validation in prospective studies.

IntroductionDiabetic Foot (DF), as a serious complication of diabetes, is closely related to major adverse cardiovascular events (MACE) and mortality. However, research on predictive models for the MACE risk in DF patients is not sufficient. The purpose of this study is to construct a prognostic model for the MACE risk in patients with diabetic foot ulcers and provide a reference tool for clinical individualized management.MethodThis study retrospectively collected data of DF patients who were hospitalized and met the inclusion and exclusion criteria in a tertiary first-class comprehensive hospital mainly engaged in metabolic diseases in Tianjin from January 2018 to January 2020. The follow-up outcome was the occurrence of MACE within 5 years after discharge. Multiple imputation (MI) method was used to fill in the missing data. Based on the processed data, in terms of modeling methods, the top three frequently used methods were used. Logistic regression, random forest (RF) and support vector machine (SVM) were used respectively to analyze influencing factors. The performance of each model was compared by using confusion matrix, ROC curve and AUC value. The data set was divided into training set and test set according to the proportion of 80%/20%. Finally, the model effect was verified on the test set. The study finally included a total of 504 patients with DF. Among them, 147 cases (29.17%) experienced MACE events within five years. The AUC of the RF model in this study was 0.70, the AUC of the Logistic regression model was 0.62, and the AUC of the SVM model was 0.60.ConclusionAll three models established in this research have good clinical predictive ability. Among them, the clinical prediction model based on RF has the best effect and can effectively predict the risk of MACE in DF patients, helping clinical medical staff formulate personalized treatment plans.

Mitochondrial DNA (mtDNA) harboring the 1555 A > G variant is known to increase the risk of aminoglycoside-induced hearing impairment. In this study, a microfluidic chip-based method for colorimetric visualization and genotyping of loop-mediated isothermal amplification (LAMP) single nucleotide polymorphism (SNP) was proposed to detect mtDNA 1555 A > G. The mutation detection strategy depends on multiple mechanisms. Specific primers were manually designed to match the mutated region, with an additional mismatched nucleotide in the last position at the 3 ' end to increase the specificity. Meanwhile, to achieve specific dual verification, RNase HII was utilized for ribonucleotide cleavage. In addition, high-affinity locked nucleic acid (LNA)-oligonucleotide blocker probes capable of distinguishing single-nucleotide mismatches were utilized. Six LAMP primers were used to accelerate the reaction. The LAMP reaction and pH-based colorimetric detection were successfully performed using a polydimethylsiloxane (PDMS) genotyping chip within 20 min. The minimum limit of detection was 5.0 x 10(3) copies/mu L. The analytical sensitivity for nucleic acid detection in dried blood spot (DBS) samples was determined to be 1 ng/mu L. At the typical concentration range of DBS-derived DNA, the method demonstrated a detection limit for mutation abundance as low as 6.25 %. Clinical applicability was further assessed using DNA extracted from 113 neonatal DBS specimens, yielding complete concordance with results obtained by bidirectional Sanger sequencing. This strategy has tremendous potential for the determination of homozygotes and heterozygotes in target DNA sample, making it suitable as a portable and affordable point-of-care platform for rapid and accurate bedside SNP detection. The detection of mtDNA 1555 A > G has the potential to identify drug-induced deafness-related genes and reduce the burden on families and national healthcare systems via prevention.

L-kynurenine (KYN), a key metabolite in the tryptophan degradation pathway, has been proposed as a novel potential biomarker for various diseases. However, existing methods for KYN detection mainly rely on highperformance liquid chromatography (HPLC), which is limited by complex operations and high cost. In this study, we developed molecularly imprinted polymers (MMIPs) through a facile and environmental-friendly synthetic route for the selective recognition and enrichment of KYN in urine samples. Coupled with a Nafion/RGO/SPCE-based electrochemical sensor, this strategy enabled the establishment of a cost-effective, sensitive, and specific method for urinary KYN determination without the need for HPLC separation. The sensor exhibited good linearity in the ranges from 0.50 to 20.0 mu M (R-2 = 0.9921) and 20.0 to 200.0 mu M (R-2 = 0.9946), with a limit of detection (LOD) of 0.16 mu M and a limit of quantification (LOQ) of 0.38 mu M. In urine samples, the method showed high recovery (99.0 % similar to 103.1 %) and low relative standard deviation (<7.99 %). Owing to its high selectivity, analytical performance, and potential for device miniaturization, this method provides a feasible approach for non-invasive early screening of urinary KYN in disease diagnosis, with promising applicability in point-of-care testing (POCT) and wearable devices.

Objective: Intrahepatic cholestasis of pregnancy (ICP) is associated with an elevated risk of adverse perinatal outcomes, including perinatal morbidity and mortality. The objectives of this study were to evaluate the bile acid (BA) metabolism profiles in the urine of patients with ICP and to investigate the association between specific BAs and maternal and neonatal outcomes in patients with ICP. Methods: A total of 127 Chinese women with ICP and 55 healthy pregnant women were enrolled in our retrospective study. Spot urine samples and clinical data were collected from pregnant women from January 2019 to December 2022 at the First Affiliated Hospital of Chongqing Medical University, Chongqing. Based on total bile acid (TBA) levels, the ICP group was subdivided into mild (10–40 μmol/L) and severe (≥40 μmol/L) ICP groups. Patients in the ICP group were further divided into two categories according to neonatal outcomes: an ICP with adverse pregnancy outcomes group and an ICP with non-adverse pregnancy outcomes group. Metabolites from maternal urine were collected and analyzed using ultra-high-performance liquid chromatography–triple quadrupole time-of-flight mass spectroscopy (UPLC-triple TOF-MS). Results: Significant differences were observed between the mild and severe ICP groups in the onset time of symptoms, gestational weeks at time of ICP diagnosis, the duration of using ursodeoxycholic acid (UDCA) drugs during pregnancy, gestational age at delivery, premature delivery, and cesarean delivery. The expression levels of the composition of different urinary bile acids including THCA, TCA, T-ω-MCA, TCA-3-S, TCDCA-3-S, TDCA-3-S, GCDCA-3-S, DCA-3-G and GDCA-3-G were remarkably higher in the ICP with adverse pregnancy outcomes group than those in the ICP with non-adverse pregnancy outcomes group and the control group. The single-parameter model used to predict adverse pregnancy outcomes in ICP had similar areas under the curve (AUCs) of the receiver operating characteristic (ROC), ranging from 0.755 to 0.869. However, an AUC of 0.886 and 95% CI were obtained by the index of combined urinary bile acids in multiple prediction models (95% CI 0.790 to 0.983, p < 0.05). TCA-3-S in the urinary bile acids had a strong positive correlation with the aspartate aminotransferase (AST) level (r = 0.617, p < 0.05). Furthermore, TCDCA-3-S and GCDCA-3-S in the urinary bile acids had a strong positive correlation with the alanine aminotransferase (ALT) level (r = 0.607, p < 0.05; r = 0.611, p < 0.05) and AST level (r = 0.629, p < 0.05; r = 0.619, p < 0.05). Conclusions: Maternal urinary bile acid profiles were prominent for the prognosis of maternal and neonatal outcomes of ICP. Elevated levels of TCA-3-S, TCDCA-3-S, and GCDCA-3-S in urine might be important predictors for indicating adverse pregnancy outcomes in ICP.

A single nucleotide variant in mitochondrial DNA (mtDNA) 1555A>G is associated with drug-induced hearing loss. For the 1555A>G mutation site, 1555A wild-type and 1555G mutant-type plasmids were constructed, respectively. In this study, a PCR method based on the TaqMan amplification refractory mutation system was proposed to detect mtDNA 1555A>G. A common upstream primer, a common TaqMan probe, and two downstream allele-specific primers with mismatched bases were designed. One-step amplification and detection of the wild-type and mutant type at the 1555 site were realized for the deafness-related gene through two reactions. Based on this detection method, the minimum detection limit of the wild-type and mutant type detection systems for plasmids was 50 copies/μL. The minimum sensitivity for the detection of nucleic acids in real dried blood spot (DBS) samples was 0.1 ng/μL. In the normal DBS DNA sample, the detection limit of the mutation abundance reached 0.78%. The specificity of the detection method was 100%, and the coefficient of variation was less than 3.36%. This approach was validated using clinical DNA extracted from 113 DBS samples of newborns. Additionally, it showed 100% agreement with bi-directional Sanger sequencing. It can be used as an optional method for the clinical detection of deafness-related genes.

In human and rodents, some individuals may remain lean even when they are challenged with high calorie intake. Here, we used C57BL/6J mice to establish animal models of high-fat diet (HFD) induced obesity sensitive (DIO) mice and obesity resistant (DIR) mice. In DIR mice, improved metabolic profile through brown adipose tissue (BAT) activation was observed, while plasma unconjugated bile acids (BAs) were decreased together with increased intestine tauro-conjugated BAs (e.g., T-β-MCA). The composition of the gut flora also differs greatly between DIR and DOR. Using fecal microbiota transplants from DIR mice, HFD fed recipient mice exhibited a trend toward reduced adiposity and improved glucose tolerance, showing increased serum tauro-conjugated BAs levels. STC-1 cell experiments confirmed T-β-MCA could activate FXR/TGR5 pathway and induce the production of GLP-1, inhibiting genes that regulate the ceramide synthesis. Our results indicated that the DIR mice exhibited higher energy expenditure by activating BAT thermogenesis, which may be related to altered gut microbiota-bile acids-glucagon like peptide-1 axis.

Capsaicinoids, mostly from chili peppers, are widely used in daily life. Capsaicinoids are considered to be markers for the identification of illegal cooking oil (ICO), which is a serious threat to public health. The identification of capsaicinoids can help reveal food-related fraud, thereby safeguarding consumers’ health. Here, a novel and ultrasensitive method was established with a signal amplification strategy for the detection of capsaicinoids. AuNPs@Fe3O4 nanocomposites were functionalized with 4-aminothiophenol (4-atp). After diazotization, 4-atp on AuNPs@Fe3O4 reacted with capsaicinoids and formed capsaicinoids-azo-atp-AuNPs@Fe3O4. Ultimately, capsaicinoids-azo-atp-AuNPs@Fe3O4 was dropped onto the surface of a screen-printed carbon electrode (SPCE) and detected via the differential pulse voltammetry (DPV) method. AuNPs@Fe3O4 nanocomposites increased the specific surface area of the electrode. Moreover, the diazotization–coupling reaction enriched the analytes on the electrode surface. Liquid–liquid extraction was used for sample pretreatment. Under a pH value of 9.0 and concentration of 0.20 mol/L for the supporting electrolyte, the linearity of capsaicinoids in ICO is from 0.10 to 10.00 ng/mL, and the limit of detection (S/N = 3) is 0.05 ng/mL. This method is ultra-sensitive, reliable, and cost-effective for the detection of capsaicinoids. Herein, this method provides a promising tool for the identification of ICO.

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in reproductive-aged women. The occurrence of PCOS was reported to be associated with the alteration of gut microbiota. Microbiota-derived indoles may possibly play a key role in glycemic control. The purpose of this work is to reveal the alteration of plasma indoles in PCOS patients and to investigate the correlation between indoles levels and glucose metabolism. Sixty-five patients with PCOS and twenty-eight age-matched women were enrolled in this work. The concentrations of plasma indoles, including indoxyl sulfate (IS), indole-3-acetic acid (IAA), indole-3-propionate (IPA), indole (IND), and 3-methylindole (3-MI), were measured by HPLC with the fluorescence detection. The plasma levels of IS, IAA, and IND were significantly elevated in patients with PCOS compared to those in the control group ( p < 0.05). Furthermore, the plasma levels of IS, IAA, and IND were positively correlated with fasting glucose, fasting insulin, and the homeostatic model of insulin resistance index (HOMA-IR) ( p < 0.05). Besides, the 3-MI level in the plasma was positively correlated with the fasting glucose level, whereas plasma levels of IS, IAA, IND, and 3-MI were negatively correlated with glucagon-like peptide 1 ( p < 0.05). Moreover, IS and IND were considered to be risk factors for PCOS after age, BMI, T, LH, and HOMA-IR adjustment. The area under the receiver-operating characteristic curve of the combined index of five indoles was 0.867 for PCOS diagnosis. Additionally, plasma indoles altered in PCOS, which was closely associated with the glucose metabolism.

Abstract To explore the serum levels of IL-39, CXCL14, and IL-19 in patients with tuberculosis (TB) along with their clinical significances and their concentration changes in macrophages after Bacille Calmette-Guérin vaccine (BCG) or Mycobacterium tuberculosis (M. tb) H37Rv stimulation in vitro. The serum levels of IL-39, CXCL14, and IL-19 of 38 TB patients, and 20 healthy staff members were measured by enzyme-linked immunosorbent assay. Moreover, the levels of IL-19, CXCL14, and IL-39 in cultured THP-1 macrophages were detected at 12, 24, and 48 h after stimulation with BCG or M. tb H37Rv strains. It was found the serum level of IL-39 was significantly reduced and CXCL14 was remarkably elevated in TB patients. In vitro, at 48 h after stimulation, IL-39 level of cultured THP-1 macrophages in the H37Rv group was significantly lower than that in the BCG and control groups, and the CXCL14 level of cultured THP-1 macrophages in the H37Rv stimulation group was remarkably higher than that in the control group. Therefore, IL-39 and CXCL14 may be involved the pathogenesis of TB, and serum IL-39 and CXCL14 could potentially serve as a new biomarker of TB.

Some florfenicol (FF) metabolites have a strong binding affinity towards biomolecules in the edible tissues of some food animals. These bound FF residues cannot be extracted directly from edible tissues with organic solvents and are present in higher concentrations even than solvent extractable residues. In this study, an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was established to detect the total residues of FF in eggs, by quantifying the metabolite florfenicol amine (FFA). The sample was hydrolyzed at 95-100 degrees C for 4 hours to release sample-matrix bound residues and convert them all into FFA. The hydrolyzed sample was washed with ethyl acetate to remove interfering substances, extracted with ethyl acetate under alkaline conditions, purified by solid phase extraction and quantified by UPLC-MS/MS. The recoveries of FFA in eggs ranged from 91.2 to 102.4%, with an RSD <= 10.9%. The LOD and LOQ were 0.5 and 1.0 mu g/kg, respectively. This method can be applied to the quantification of total FF residues in eggs.

Objective: To explore the clinical features, fetal outcomes and serum bile acids (BAs) metabolism in asymptomatic hypercholanemia of pregnancy (AHP), as well as the comparison with those in intrahepatic cholestasis of pregnancy (ICP) and normal pregnancies. Methods: A study containing 676 pregnant women was performed to investigate the clinical informations, routine biochemical features and obstetric outcomes of AHP by the comparison with ICP and normal pregnancies. Within the study subjects, 203 pregnant women received prospective determination for 55 serum individual BAs based on a validated UPLC-QTOF-MS/MS method. The differences in clinical features and serum BAs metabolism among the three groups were then investigated. Results: The risk of adverse fetal outcomes in AHP (28.3%) was significantly higher than that in normal pregnancies (8.9%, p < 0.001), but lower than that in ICP group (52.1%, p < 0.001). Multivariate statistics analysis indicated a distinctive serum BAs metabolic profiling among the three groups (PLS-DA, (RY)-Y-2 = 0.580, Q(2) = 0.537). Levels of serum BAs especially for deoxycholic acid species were found remarkably elevated in AHP as compared to those in ICP. Conclusions: AHP group had distinguished clinical features and serum BAs metabolism as compared to ICP group and normal pregnancies.

Microbiota-derived indoles were closely associated with psychological disorders like depression. We aimed to develop an HPLC method with fluorescence detection (FLD) for simultaneous determination of plasma indoles, including indoxyl sulfate (3-INDS), indole-3-acetic acid (IAA), indole-3-propionate (IPA), indole (IND) and 3-methylindole (3-MI). Diethyl ether and ethyl acetate were selected as the mixed extractant for the sample preparation. The separation was carried out on a Shim-Pack VP-ODS column (150 x 4.6 mm, 4.6 mu m) with the mobile phase composed of 10 mmol/L sodium dihydrogen phosphate/methanol (40:60, v/v). The excitation and emission wavelengths were set at 280 and 355 nm, respectively. The linearities in plasma were obtained in the range of 1.56-400.0 mu mol/L for 3-INDS, 0.312-10.0 mu mol/L for IAA, 0.125-6.00 mu mol/L for IPA, 6.25-400.0 nmol/L for IND, and 1.56-400.0 nmol/L for 3-MI, respectively. The coefficients of variation (CVs) for each analyte of the intra-day and inter-day precisions were within 4.0 and 5.2%, respectively. The recoveries were in the range of 90.1-109.3%. This sensitive and accurate method was applied to analyze plasma indoles for the diagnostic of depression in the patients with polycystic ovary syndrome (PCOS).

随着整合医学与精准医学的飞速发展,传统的专科化医学教育模式展现出较大的局限性.临床实践教学是临床医学教育的中心环节,各大型医院在目前"专科化"的基础上,在经皮肺穿刺活检术的临床实践教学中需要充分重视整合医学的观念与改革措施,逐步将整合医学融入临床教学实践中,构建与时俱进的教学模式,让学生深刻认识到医学领域的整体性、多学科之间的交叉性和融合性.同时从多角度理解人体及疾病的本质与内在联系.教学过程中在以教师讲授基础上,还需加强学生的实践锻炼,培养学生建立以患者为整体、为核心,临床与实际操作结合的思维体系,最终构建整合医学下经皮肺穿刺活检术临床教学模式,提高教学效果,达到培养目标.

A novel dual-template magnetic molecularly imprinted polymer (MMIP) was synthesized to extract normetanephrine (NMN), metanephrine (MN) and 3-methoxytyramine (3-MT) from spot urine samples. As the adsorbent of dispersive solid-phase extraction (d-SPE), the MMIP was prepared using dopamine and MN as dual templates, methacrylic acid as the functional monomer, ethylene glycol dimethacrylate as the crosslinking reagent and magnetic nanoparticles as the magnetic core. NMN, MN, 3-MT and creatinine (Cr) in spot urine samples were selectively enriched by d-SPE and detected by HPLC-fluorescence detection/ultraviolet detection. The peak area (A) ratios of NMN, MN and 3-MT to Cr were used for the diagnosis of pheochromocytomas and paragangliomas (PPGLs). The results showed that the adsorption efficiencies of MMIP for target analytes were all higher than 89.0%, and the coefficient variation precisions of intra-assay and inter-assay for the analytes were within 4.9% and 6.3%, respectively. The recoveries of the analytes were from 93.2% to 112.8%. The MMIP was still functional within 14 days and could be reused at least seven times. The d-SPE and recommended solid-phase extraction (SPE) were both used to pretreat spot urine samples from 18 PPGLs patients and 22 healthy controls. The correlation coefficients of ANMN/ACr and AMN/ACr between d-SPE and SPE were both higher than 0.95. In addition, the areas under the receiver operator curves for spot urine ANMN/ACr, AMN/ACr and plasma free NMN and MN were 0.975, 0.773 and 0.990, 0.821, respectively, indicating the two methods had the similar performances. The d-SPE method took only 20 min, which was effective in clinical application.

Objective:To explore the recurrence and death outcomes of the patients with diabetic foot for 5 year follow-up after ulcer healing, and analyze the risk factors.Methods:A prospective cohort study was conducted in 317 patients with diabetic foot and ulcer healing who were hospitalized in the Department of Diabetic Foot Disease of Tianjin Medical University Chu Hsien-I Memorial Hospital from January 2013 to December 2014. The ulcer recurrence and death of patients after 5 years of continuous follow-up were recorded, and binary logistic regression and Cox proportional hazard regression models were used to analyze risk factors, respectively.Results:Follow-up was completed in 292 of 317 patients (follow-up rate of 92.1%). The 5-year cumulative recurrence rate in follow-up patients was 71.2% (208/292), the recurrence rate of the same site was 29.8% (62/208), multiple recurrence rate was 41.3% (86/208), the highest recurrence rate was 32.7% in the forefoot area (68/208), and the ulcer recurrence rate of the 122 patients with osteomyelitis was 73.8% (90/122). The cumulative five-year mortality rate was 39.7% (116/292). The mortality rate of patients with recurrence was higher than that of patients without recurrence [44.2% (92/208) vs 28.6% (24/84), P<0.05]. Multivariate analysis showed that age, osteomyelitis, foot care behavior, caregiver reaction, glycated hemoglobin A 1c, limb extremity arterial disease (LEAD) stage, and end-stage renal disease were independent influencing factors for ulcer recurrence in patients with diabetic foot ( P<0.05). Bathel index, caregiver reaction, glycated hemoglobin A 1c, LEAD stage, end-stage renal disease, and cardiac events were independent influencing factors of death ( P<0.05). Conclusions:The risk factors of ulcer recurrence are mainly age, osteomyelitis and foot care behavior. The risk factors for death are Bathel index and cardiac events. Moreover, caregiver reaction, glycated hemoglobin A 1c, LEAD stage Ⅳ, kidney disease stage 5 are the risk factors of both ulcer recurrence and death.

目的 建立检测随机尿游离型甲氧基去甲肾上腺素(NMN)、甲氧基肾上腺素(MN)的高效液相色谱-电化学(HPLC-ED)方法,并探讨其临床应用价值.方法 完善样本处理流程及色谱条件,建立检测随机尿游离型NMN、MN的HPLC-ED法.采用HPLC-ED法检测35例嗜铬细胞瘤患者(嗜铬细胞瘤组)、70例原发性高血压患者(高血压组)、78例非嗜铬细胞瘤肾上腺占位患者(肾上腺占位组)和44名体检健康者(正常对照组)的随机尿和血浆游离型NMN、MN浓度,同时检测肌酐(Cr),计算尿NMN/Cr比值和尿MN/Cr比值.采用受试者工作特征(ROC)曲线评估各项指标诊断嗜铬细胞瘤的效能.结果 HPLC-ED法检测随机尿游离型NMN、MN的线性范围均为25～2500μg/L,检测限[信噪比(RSN)=3]分别为5.9和11.3μg/L,平均回收率为92.8％～103.4％.NMN高、低浓度的批内变异系数(CV)分别为3.7％、2.2％,批间CV分别为5.6％、3.3％;MN高、低浓度批内CV分别为4.3％、2.7％,批间CV分别为5.1％、3.4％.嗜铬细胞瘤组随机尿游离型NMN、MN浓度和尿NMN/Cr比值、尿MN/Cr比值明显高于高血压组、肾上腺占位组及正常对照组(P<0.001),高血压组、肾上腺占位组及正常对照组之间差异均无统计学意义(P>0.05).ROC曲线分析结果显示,随机尿游离型NMN、随机尿游离型MN、尿NMN/Cr比值、尿MN/Cr比值、血浆游离型NMN、血浆游离型MN诊断嗜铬细胞瘤的曲线下面积(AUC)分别为0.91、0.88、0.96、0.94、0.93和0.88.嗜铬细胞瘤患者术后1周尿MN/Cr比值均降为正常,但有2例患者术后血浆MN浓度高于术前,有1例患者血浆NMN浓度高于术前.结论 建立了检测随机尿游离型NMN、MN浓度的HPLC-ED方法.尿NMN/Cr比值和尿MN/Cr比值诊断嗜铬细胞瘤的效能均优于血浆游离型NMN、MN,且在嗜铬细胞瘤的术后评估中也有较好的价值.

Background:A rating scale that takes into account heart rate, acidosis, consciousness, oxygenation, and respiratory rate (the HACOR score) has been used to predict noninvasive ventilation (NIV) failure in patients with chronic obstructive pulmonary disease (COPD). However, the HACOR score has not been used to predict NIV failure in non-COPD patients with acute-on-chronic respiratory failure. Methods:This study was performed in the respiratory intensive care unit of a teaching hospital. Data had been collected prospectively between June 2011 and January 2019. We enrolled non-COPD patients who received NIV due to acute-on-chronic respiratory failure, pH < 7.35, and PaCO2 >45 mmHg. NIV failure was defined as requiring intubation or dying during NIV. The HACOR score was determined at initiation and after 1-2, 12, and 24 h of NIV. Scores can range from 0 to 27, with higher scores indicating a higher risk of NIV failure. Results:A total of 148 patients were enrolled in the study, 52 with sleep apnea-hypopnea syndrome, 34 with chronic thoracic sequelae, 31 with bronchiectasis, 14 with chest wall deformity, 5 with obesity-hypoventilation syndrome, and 12 with other conditions. Of the patients, 19 (13%) experienced NIV failure. From initiation to 24 h of NIV, the HACOR scores of patients who experienced NIV failure were much higher than those of patients who received successful NIV. The area under the receiver operating characteristic curve was 0.69, 0.91, 0.91, and 0.94 when the HACOR score was tested at initiation and after 1-2, 12, and 24 h of NIV, respectively. To obtain the best sensitivity and specificity, the cutoff value at initiation was 7 with a sensitivity of 68% and a specificity of 61%. After 1-2 h of NIV, it was 5 with a sensitivity of 90% and a specificity of 85%. After 12 h of NIV, it was 4 with a sensitivity of 82% and a specificity of 91%. After 24 h of NIV, it was 2 with a sensitivity of 100% and a specificity of 76%. Conclusions:The HACOR score has high sensitivity and specificity for predicting NIV failure among non-COPD patients who receive NIV due to acute-on-chronic respiratory failure with respiratory acidosis.

Objective:To explore the effect of posture management combined with incentive nursing in patients with esophageal cancer surgery.Methods:From February 2019 to February 2021, convenience sampling was used to select 90 patients with esophageal cancer who received radical surgery for esophageal cancer in a ClassⅢ Grade A hospital in Nanjing as the research object. According to the random number table method, the patients were divided into the observation group and the control group with 45 cases each. The control group conducted conventional nursing, and the observation group carried out incentive nursing combined posture management. The quality of life, sleep quality, hope level, postoperative recovery and nursing satisfaction of the two groups of patients before and after the intervention were compared.Results:After the intervention, the total score of the Quality of Life Index (QL-Index) , total score and dimension scores of Herth Hope Index (HHI) , and the score of nursing satisfaction in the observation group were all higher than those in the control group, and the differences were statistically significant ( P<0.05) . After the intervention, the total score of the Pittsburgh Sleep Quality Index (PSQI) of the observation group was lower than that of the control group, and the differences were statistically significant ( P<0.05) . After the intervention, the hospital stay, first exhaust time, and first defecation time of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Posture management combined with incentive nursing is applied to patients with esophageal cancer surgery, which can effectively improve the patient's quality of life, sleep quality, level of hope and nursing satisfaction, and promote the patient's postoperative recovery.

Introduction: Breast cancer (BC) has become the most commonly diagnosed cancer worldwide. It is very critical for the differential diagnosis between BC and benign breast diseases (BBD). The characteristics of serum bile acids (BAs) profiling in patients with BBD and BC was elucidated so that potential biomarkers could be find out for the differential diagnosis of BC and BBD. Methods: A pseudo-targeted approach was used to perform BAs metabolomics analysis in serum of 29 patients with BBD and 47 patients with BC by ultra-high performance liquid chromatography/hybrid quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS). Partial least squares-discriminant analysis (PLS-DA) was used to establish a differential diagnostic model for BC, and the receiver operating characteristic (ROC) curve and logistic regression analysis were used to screen out bile acids as biomarkers for the differential diagnosis of BC and BBD. Results: The serum BAs profile in BC group was quite different from that in BBD group. Compared with the BBD group, BC group had higher level of chenodeoxycholic acid (CDCA), while they had lower levels of dihydroxy tauro-conjugated BA (Tdi-1) and sulfated dihydroxy glyco-conjugated BA (Gdi-S-1). The sensitivity and specificity of PLS-DA model for patients classification were 100% and 92.3%, respectively. The combined biomarker, CDCA and Tdi-1, had high efficacy for the differential diagnosis (area under the curve was 0.954, 95% CI: 0.8801.000) of BC. Besides, the performance was superior to traditional biomarkers in the differential diagnosis of BC with or without comorbidities. Conclusion: The profile of serum BAs in women with BC was quite different from that in patients with BBD. Serum BAs profiling analysis could be used as an effective tool for the differential diagnosis of BC and BBD.