Objective To establish and evaluate the nomogram prediction model of the factors influencing the poor
prognosis of amputation patients with diabetes foot ulcer． Methods From August 2018 to June 2021，122 amputees with dia-
betes foot ulcer were selected from the Wound Center and Endocrine Department of Xinhua Hospital Affiliated to Shanghai
Jiaotong University School of Medicine． They were followed up for one year after surgery． According to whether there were ad-
verse events during the follow-up period，they were divided into a good prognosis group of 76 cases and a bad prognosis group
of 46 cases． Collect general data of patients and preoperative laboratory indicators; Single factor analysis and multivariate Cox
risk regression analysis were used to screen the influencing factors of poor prognosis of diabetes foot ulcer patients after amputa-
tion，Ｒ software was included in the influencing factors to establish a nomogram prediction model，and the ability of the nomo-
gram to predict the poor prognosis of diabetes foot ulcer patients after amputation was evaluated through the subject＇s work char-
acteristic curve ( ＲOC) and calibration curve． Ｒesults The proportion of family history of diabetes，neutrophil / lymphocyte
ratio ( NLＲ) ，C-reactive protein ( CＲP) ，D-dimer ( D-D) levels in poor prognosis group were higher than those in good prog-
nosis group ［χ2 ( t) / P = 5． 025 /0． 025，6． 803 / ＜ 0． 001，3． 229 /0． 002，6． 752 / ＜ 0． 001］，the level of albumin ( Alb) was
lower than that of the group with good prognosis ( t / P = 2． 564 /0． 012) ． Multivariate Cox risk regression analysis showed that
high NLＲ，CＲP and D-D were risk factors for poor prognosis of amputees with diabetes foot ulcer ［HＲ ( 95% CI) = 1． 520
( 1． 193 － 1． 935) ，1． 041 ( 1． 018 － 1． 066) ，3． 771 ( 2． 059 － 6． 908) ］，and high Alb was a protective factor ［HＲ ( 95%
CI) = 0． 934 ( 0． 888 － 0． 982) ］． The validation results of the nomograph prediction model based on the influence factors showChin J Diffic and Compl Cas，March 2023，Vol． 22，No． 3

that the area under the ＲOC curve is 0． 861 ( 95% CI 0． 786 － 0． 936) ，and the calibration curve is a straight line with a slope
of approximately 1． Conclusion The nomogram prediction model based on the influencing factors of poor prognosis of ampu-
tation patients with diabetes foot ulcer has good discrimination and consistency，and has certain guiding value for the formula-
tion of countermeasures for amputation patients with diabetes foot ulcer．

Objective To analyze serum albumin γ-Glutamyltransferase ( γ-GTP) ． The relationship between GTP
level and hyperuricemia ( HUA) in adult idiopathic membranous nephropathy ( IMN) ． Methods One hundred and thirty-six
patients with IMN admitted to the Department of Nephrology of the Affiliated Hospital of Hebei University from January 2020 to
December 2021 were selected，and the patients were divided into 36 patients in the HUA group and 100 patients in the non-
HUA group according to whether they had HUA． Collect relevant clinical data and detect serum albumin γ-GTP level，Pearson
method for analysis of serum albumin γ-Correlation between GTP level and uric acid ( UA) level，multi-factor logistic regres-
sion analysis of risk factors for the occurrence of UA in IMN patients，and the analysis of serum albumin γ-The value of GTP in
diagnosis of HUA in patients with IMN． Ｒesults Serum albumin in HUA group is lower than that in non-HUA group γ-The lev-
el of GTP was higher than that of non-HUA group ( t / P = 6． 591 / ＜ 0． 001，10． 147 / ＜ 0． 001) ． Pearson correlation analysis
showed that there was a negative correlation between serum albumin and UA level in HUA group ( r / P = － 0． 737 / ＜ 0． 001) ，γ-
GTP level was positively correlated with UA level ( r / P = 0． 774 / ＜ 0． 001) ． Multivariate logistic regression analysis showed that
high serum creatinine，hypertension γ-High GTP is a risk factor for the occurrence of UA in IMN patients ［OＲ ( 95% CI) = 2．
064 ( 1． 136 － 3． 754) ，1． 514 ( 1． 087 － 2． 109) ，1． 349 ( 1． 102 － 1． 650) ］，and high serum albumin is a protective factor ［OＲ
( 95% CI) = 0． 674 ( 0． 481 － 0． 944) ］． ＲOC curve analysis showed that serum albumin γ-The area under the curve of HUA in
IMN patients diagnosed by GTP and their combination was 0． 785，0． 768 and 0． 908，and their combined diagnostic efficacy was
higher than that of single index ( Z / P = 2． 814 /0． 012，3． 715 / ＜ 0． 001) ． Conclusion The serum albumin level of patients withChin J Diffic and Compl Cas，March 2023，Vol． 22，No． 3
IMN and HUA decreased，γ-The level of GTP increased，which was related to the increase of uric acid level and the occurrence
of HUA．

Objective To explore the correlation between the expression levels of serum microＲNA-21 ( miＲ-21) and
miＲ-155 in patients with ulcerative colitis ( UC) and Clostridium difficile infection ( CDI) ． Methods One hundred and twen-
ty-four patients with UC admitted to the First Affiliated Hospital of Tsinghua University from February 2021 to August 2022
were selected as the study subjects． According to whether the UC patients were infected with Clostridium difficile，they were
divided into non-CDI group ( 58 cases) and combined CDI group ( 66 cases) ． At the same time，55 healthy persons were se-
lected as the healthy control group． Collect clinical data of all subjects; Hemoglobin ( Hb) ，albumin ( Alb) ，white blood cell
count ( WBC) ，neutrophil ratio ( NEUT) ，C-reactive protein ( CＲP) ，erythrocyte sedimentation rate ( ESＲ) and other bio-Chin J Diffic and Compl Cas，March 2023，Vol． 22，No． 3

chemical indicators were detected; The expression levels of miＲ-21 and miＲ-155 in serum were detected by real-time fluores-
cence quantitative PCＲ; Pearson＇s method was used to analyze the correlation between the expression levels of serum miＲ-21
and miＲ-155 and biochemical indicators in patients with UC complicated with CDI． Multifactor logistic regression analysis was
used to analyze the factors affecting the occurrence of UC complicated with CDI． The diagnostic value of serum miＲ-21 and
miＲ-155 in patients with UC complicated with CDI was evaluated by the working characteristic curve ( ＲOC) of subjects． Ｒe-
sults Comparison of Hb and Alb levels，combined CDI group ＜ non-CDI group ＜ healthy control group ( F / P = 55． 339 / ＜
0． 001，433． 328 / ＜ 0． 001) ，and comparison of NEUT and CＲP levels，combined CDI group ＞ non-CDI group ＞ healthy con-
trol group ( F / P = 64． 375 / ＜ 0． 001，532． 313 / ＜ 0． 001) ． The levels of WBC and CＲP in CDI group were higher than those
in non-CDI group and healthy control group ( P ＜ 0． 05) ． Compared with the expression level of miＲ-21 and miＲ-155 in ser-
um，the expression level of combined CDI group ＞ non-CDI group ＜ healthy control group ( F / P = 207． 397 / ＜ 0． 001，339．
643 / ＜ 0． 001) ． In patients with UC complicated with CDI，serum miＲ-21 was positively correlated with the expression level
of miＲ-155 ( r / P = 0． 449 / ＜ 0． 001) ，and serum miＲ-21 and miＲ-155 were positively correlated with WBC，NEUT，CＲP
and ESＲ ( miＲ-21: r / P = 0． 257 /0． 037，0． 490 / ＜ 0． 001，0． 405 /0． 001，0． 287 /0． 020; miＲ-155: r / P = 0． 313 /0． 011，0．
526 / ＜ 0． 001，0． 492 / ＜ 0． 001，0． 310 /0． 011) Alb was negatively correlated ( miＲ-21: r / P = － 0． 451 / ＜ 0． 001，－ 0． 417 /
＜ 0． 001． miＲ-155: r / P = － 0． 436 / ＜ 0． 001，－ 0． 397 / ＜ 0． 001) ． High Hb and high Alb are protective factors for UC com-
bined with CDI ［OＲ ( 95% CI) = 0． 527 ( 0． 349 － 0． 767) ，0． 624 ( 0． 440 － 0． 885) ］，and high NEUT，CＲP，miＲ-21 and
miＲ-155 are risk factors for UC combined with CDI ［OＲ ( 95% CI) = 2． 042 ( 1． 207 － 3． 455) ，4． 620 ( 1． 086 － 19． 659) ，
3． 457 ( 1． 625 － 7． 352) ，4． 527 ( 1． 791 － 11． 440) ］． The area under curve ( AUC) of serum miＲ-21，miＲ-155 and their
combined diagnosis of UC with CDI were 0． 915，0． 878 and 0． 950，respectively; The AUC of the combined diagnosis was
higher than that of the single index diagnosis ( Z / P = 2． 565 /0． 010，3． 338 /0． 001) ． Conclusion The expression of miＲ-21
and miＲ-155 in the serum of patients with UC complicated with CDI are both increased，which are risk factors for the occur-
rence of UC complicated with CDI． Combined detection can be used to diagnose the occurrence of UC complicated with CDI．

Objective To analyze the diversity of intestinal flora in patients with ulcerative colitis complicated with
clostridium difficile infection and its influence on glucose and lipid metabolism． Methods From January 2018 to December
2021，84 patients with ulcerative colitis complicated with clostridium difficile infection were selected as the infection group，
and 91 patients with active ulcerative colitis ( non-infected group) and 104 patients with non-ulcerative colitis ( control group)
were selected for the same period． The clinical data，glycolipid metabolism index ( total cholesterol ( TC) ，triacylglycerol
( TG) Low density lipoprotein cholesterol ( LDL-C) ，high density lipoprotein cholesterol ( HDL-C) ，fasting blood glucose
( FPG) ，intestinal microflora diversity ( Chao1 index，Ace index，Simpson index，Shannon index) and distribution differ-
ences． Spearman method was used to analyze the correlation between metabolic indicators and the diversity of different micro-
flora． Ｒesults Compared with the serum TC and TG levels，the infected group was lower than the non-infected group and
lower than the control group ( F / P = 20． 051 / ＜ 0． 001，26． 321 / ＜ 0． 001) ． Compared with the Chao1 index，Ace index and
Shannon index，the infected group was lower than the non-infected group than the control group ( F / P = 176． 245 / ＜ 0． 001，
254． 463 / ＜ 0． 001，247． 447 / ＜ 0． 001) ，while the Simpson index was higher than the non-infected group than the control
group ( F / P = 105． 363 / ＜ 0． 001) ． Compared with the control group，the abundance of Shigella and Escherichia in the non- Chin J Diffic and Compl Cas，March 2023，Vol． 22，No． 3
infected group was higher，and bifidobacteria，lactobacillus，Bacteroides and Eubacterium were decreased ( LDA ＞ 2log10，P
＜ 0． 05) ． Compared with non-infected group，Bacteroides，Proteus，Clostridium and Bacillus increased in the infected group，
while the abundance of Bacteroides and Citrobacter decreased ( LDA ＞ 2log10，P ＜ 0． 05) ． The correlation analysis showed that
the Chao 1 index，Ace index and Shannon index of patients with ulcerative colitis complicated with clostridium difficile infec-
tion were positively correlated with the levels of TC and TG ( TC: r / P = 0． 614 / ＜ 0． 001，0． 584 / ＜ 0． 001，0． 592 / ＜ 0． 001;
TG: r / P = 0． 604 / ＜ 0． 001，0． 587 / ＜ 0． 001，0． 591 / ＜ 0． 001) ，while Simpson index is negatively correlated with TC and TG
levels( r / P = － 0． 601 / ＜ 0． 001，－ 0． 593 / ＜ 0． 001) ． Conclusions The intestinal flora of patients with ulcerative colitis
complicated with clostridium difficile infection has changed，and the diversity of flora is related to the lipid metabolism of pa-
tients．

Objective To analyze the relationship between the levels of serum Toll-like receptor 2 ( TLＲ-2) ，mono-
cyte chemoattractant protein-1 ( MCP-1) ，interleukin-6 ( IL-6) and infection in patients with open fracture after operation．
Methods Select 248 patients with open fractures who were diagnosed and treated in the Orthopedics Department of Hanchuan
People＇s Hospital of Hubei Province from October 2017 to July 2021 as the research object，and divide them into non-infection
group ( 170 cases) and infection group ( 78 cases) according to whether they have infection after operation． The levels of TLＲ-
2，MCP-1 and IL-6 in serum of the two groups at different time after operation were compared． Spearman correlation analysis
was used to analyze the correlation between the levels of TLＲ-2，MCP-1 and IL-6 in serum after operation and the degree of in-
fection． Multivariate logistic regression analysis was used to analyze the risk factors of postoperative infection in patients with
open fracture，and the subject work characteristic curve ( ＲOC) was drawn to predict the diagnostic value of various indicators Chin J Diffic and Compl Cas，March 2023，Vol． 22，No． 3
for postoperative infection in patients with open fracture． Ｒesults The proportion of operation time ≥ 3 hours，hospital stay
≥ 4 weeks，wound depth ≥ 2 cm，surgical site of lower limb，waist and hip，type II and type III surgical incision in the in-
fection group was higher than that in the non-infection group ( t / P = 5． 994 /0． 014，33． 188 / ＜ 0． 001，82． 687 / ＜ 0． 001，6．
491 /0． 011，15． 169 / ＜ 0． 001) ． The levels of TLＲ-2，MCP-1 and IL-6 in the infected group were higher than those in the
control group on the 3rd，5th and 7th day after operation ( P ＜ 0． 001) ，and the levels of TLＲ-2，MCP-1 and IL-6 in the in-
fected group increased gradually on the 3rd day after operation，reached the highest level on the 5th day after operation，and
then decreased; Spearman correlation analysis showed that the serum levels of TLＲ-2，MCP-1 and IL-6 were positively correla-
ted with the severity of the disease ( r / P = 0． 627 / ＜ 0． 001，0． 631 / ＜ 0． 001，0． 612 / ＜ 0． 001) ． Logistic regression analysis
showed that the operation time ≥ 3 hours，hospital stay ≥ 4 weeks，wound depth ≥ 2 cm，the operation site of lower limb，
waist and hip，surgical incision II and III，and the high serum TLＲ-2，MCP-1 and IL-6 on the fifth day after operation were
independent risk factors for postoperative infection in patients with open fracture ［OＲ ( 95% CI) = 19． 920 ( 8． 745 －
45． 374) ，17． 415 ( 7． 693 － 39． 441) ，37． 885 ( 15． 874 － 90． 415) ，27． 833 ( 12． 883 － 60． 132) 41． 390 ( 19． 374 － 88．
426) ，38． 755( 15． 273 － 98． 341) ，39． 103( 14． 941 － 102． 341) ，47． 743 ( 17． 826 － 127． 869) ］． The ＲOC curve showed
that the level of serum TLＲ-2，MCP-1，IL-6 and the area under the curve ( AUC) of the three combined to predict the diag-
nostic value of postoperative infection in patients with open fractures were 0． 839，0． 831，0． 828，and 0． 925，respectively．
The combined predictive efficiency of the three was higher than that of their individual prediction ( Z / P = 2． 493 /0． 017，2．
741 /0． 012，3． 000 /0． 007) ． Conclusion The serum levels of TLＲ-2，MCP-1 and IL-6 were significantly increased in pa-
tients with postoperative infection of open fractures． Clinical detection of their levels is helpful for early diagnosis and disease
judgment of postoperative infection．