OsMADS5 interacts with OsSPL14/17 to inhibit rice root elongation by restricting cell proliferation of root meristem under ammonium supply.

Nitrogen (N) is a vital major nutrient for rice (Oryza sativa). Rice responds to different applications of N by altering its root morphology, including root elongation. Although ammonium ( NH 4 + ) is the primary source of N for rice, NH 4 + is toxic to rice roots and inhibits root elongation. However, the precise molecular mechanism that NH 4 + -inhibited root elongation of rice is not well understood. Here, we identified a rice T-DNA insert mutant of OsMADS5 with a longer seminal root (SR) under sufficient N conditions. Reverse-transcription quantitative PCR analysis revealed that the expression level of OsMADS5 was increased under NH 4 + compared with NO 3 - supply. Under NH 4 + conditions, knocking out OsMADS5 (cas9) produced a longer SR, phenocopying osmads5, while there was no significant difference in SR length between wild-type and cas9 under NO 3 - supply. Moreover, OsMADS5-overexpression plants displayed the opposite SR phenotype. Further study demonstrated that enhancement of OsMADS5 by NH 4 + supply inhibited rice SR elongation, likely by reducing root meristem activity of root tip, with the involvement of OsCYCB1;1. We also found that OsMADS5 interacted with OsSPL14 and OsSPL17 (OsSPL14/17) to repress their transcriptional activation by attenuating DNA binding ability. Moreover, loss of OsSPL14/17 function in osmads5 eliminated its stimulative effect on SR elongation under NH 4 + conditions, implying OsSPL14/17 may function downstream of OsMADS5 to mediate rice SR elongation under NH 4 + supply. Overall, our results indicate the existence of a novel modulatory pathway in which enhancement of OsMADS5 by NH 4 + supply represses the transcriptional activities of OsSPL14/17 to restrict SR elongation of rice.

Development and validation of a nomogram for predicting cognitive frailty in patients on maintenance haemodialysis.

AIMS: This study aimed to construct a nomogram for predicting the risk of cognitive frailty in patients on maintenance haemodialysis. DESIGN: An explorative cross-sectional design was adopted. METHODS: From April 2022 to July 2022, 496 participants were recruited from five haemodialysis centres in Qingdao, Shandong Province, China. Participants with cognitive frailty were screened by Frailty Phenotype scale and Mini-Mental State Examination. Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression were utilized to determine predictors. The predictive performance of the nomogram was validated by calibration and discrimination. Decision curve analysis was used to assess clinical utility. Internal validation was implemented using 1000 bootstrap samples to mitigate overfitting. RESULTS: The prevalence of cognitive frailty was 17.5% (n = 87). Six risk predictors, namely health empowerment, alexithymia, age, educational level, marital status and dialysis vintage, were screened and used to develop a nomogram model. The nomogram had satisfactory discrimination and calibration, and decision curve analysis revealed considerable clinical utility. CONCLUSIONS: A nomogram incorporated with the six risk predictors was developed, and it exhibited excellent prediction performance. The nomogram may strengthen the effective screening of patients at high risk of cognitive frailty. IMPACT: This study established a tool for healthcare staff to predict cognitive frailty probability and identify risk factors in patients on maintenance haemodialysis. The nomogram can meet the needs of personalized care and precision medicine simultaneously. PATIENT OR PUBLIC CONTRIBUTION: Data were collected from patients on maintenance haemodialysis by using questionnaire survey. REPORTING METHOD: STROBE checklist was used.

Risk Perception Scale of Disease Aggravation for older patients with non-communicable diseases: Instrument development and cross-sectional validation study.

AIM: The present study aimed to develop the Risk Perception Scale of Disease Aggravation for older patients with non-communicable diseases and evaluate its psychometric properties. DESIGN: Instrument development and cross-sectional validation study were conducted. METHODS: This study contained four phases. In phase I, a systematic literature review was conducted to identify the conception of disease aggravation and risk perception. In phase II, a draft scale was formulated from face-to-face semi-structured in-depth interviews by Colaizzi's seven-step qualitative analysis method and group discussions among the researchers. In phase III, domains and items of the scale were revised in accordance with the suggestions from Delphi consultation and patient feedback. In phase IV, psychometric properties were evaluated. FINDINGS: Exploratory and confirmatory factor analyses determined four structural factors. Convergent and discriminant validities were acceptable because the average variance extracted coefficients ranged from .622 to .725, and the square roots of the average variance extracted coefficients for the four domains were larger than those of bivariate correlations between domains. The scale also exhibited excellent internal consistency and test-retest reliability (Cronbach's alpha coefficient = .973, intraclass correlation coefficient = .840). CONCLUSIONS: Risk Perception Scale of Disease Aggravation is a new instrument that measures the risk perception of disease aggravation for older patients with non-communicable diseases, including possible reason, serious outcome, behaviour control and affection experience. The scale contains 40 items that are scored on a 5-point Likert scale, and it has acceptable validity and reliability. IMPACT: The scale is applied to identify different levels of risk perception of disease aggravation for older patients with non-communicable diseases. Clinical nurses can provide targeted interventions to improve older patients' risk perception of disease aggravation based on levels of risk perception during hospitalization and the period before discharge. PATIENT OR PUBLIC CONTRIBUTION: Experts provided suggestions for revising the scale dimensions and items. Older patients participated in the scale revision process to improve the wording of the scale.

Comparison of anesthetic effects of different doses of alfentanil combined with ciprofol in elderly patients undergoing ERCP: a randomized controlled trial.

BACKGROUND AND OBJECTS: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are often old and poor in physical fitness. The purpose of this study was to investigate the anesthetic effect of different doses of alfentanil combined with ciprofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS: In this clinical trial, 137 patients, who were candidates for ERCP were randomly divided into three groups. Group A were given 0.15 µg/kg/min of alfentanil in maintenance stage, Group B were given 0.25 µg/kg/min and Group C were given 0.35 µg/kg/min. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) of the patients at each time point including the entry into the operation room (T0), at the beginning of surgery(T1), 10 min after surgery(T2), 20 min after surgery(T3), 30 min after surgery(T4),endoscopy withdrawal (T5) were recorded. Adverse events(including respiratory depression, body movement and hypoxemia),the dosage of ciprofol, the time of operation time and awakening were recorded. RESULTS: Compared with Group A, MAP and HR in Group B and Group C was decreased during T1-T5 (P < 0.05). Compared with group B, MAP and HR in group C was decreased during T1-T5 (P < 0.05). Compared with Group A and Group C,the number of adverse reactions of Group B was decreased(P < 0.05). There was no statistical difference in surgical time among the three groups(P > 0.05),but a statistically significant difference in recovery time (P < 0.05). CONCLUSION: The adverse events of alfentanil 0.25µg/kg/min combined with ciprofol were low, and the anesthetic effect was the best.

[Expression and significance of jumonji domain-containing protein 2B and hypoxia inducible factor-1α in non-Hodgkin lymphoma tissues in children]. / 含jumonji结构域的蛋白2Bå’Œç¼ºæ°§è¯±å¯¼å› å­1α在儿童非霍奇金淋巴瘤组织中的表达及意义.

OBJECTIVES: To investigate the expression and significance of jumonji domain-containing protein 2B (JMJD2B) and hypoxia-inducible factor-1α (HIF-1α) in non-Hodgkin's lymphoma (NHL) tissues in children. METHODS: Immunohistochemistry was used to detect the expression of JMJD2B and HIF-1α in lymph node tissue specimens from 46 children with NHL (observation group) and 24 children with reactive hyperplasia (control group). The relationship between JMJD2B and HIF-1α expression with clinicopathological characteristics and prognosis in children with NHL, as well as the correlation between JMJD2B and HIF-1α expression in NHL tissues, were analyzed. RESULTS: The positive expression rates of JMJD2B (87% vs 21%) and HIF-1α (83% vs 42%) in the observation group were higher than those in the control group (P<0.05). The expression of JMJD2B and HIF-1α was correlated with serum lactate dehydrogenase levels and the risk of international prognostic index in children with NHL (P<0.05). The expression of JMJD2B was positively correlated with the HIF-1α expression in children with NHL (rs=0.333, P=0.024). CONCLUSIONS: JMJD2B and HIF-1α are upregulated in children with NHL, and they may play a synergistic role in the development of pediatric NHL. JMJD2B can serve as a novel indicator for auxiliary diagnosis, evaluation of the severity, treatment guidance, and prognosis assessment in pediatric NHL.

Comprehensive characterization of genomic and radiologic features reveals distinct driver patterns of RTK/RAS pathway in ground-glass opacity pulmonary nodules.

Ground-glass opacity (GGO)-associated pulmonary nodules have been known as a radiologic feature of early-stage lung cancers and exhibit an indolent biological behavior. However, the correlation between driver genes and radiologic features as well as the immune microenvironment remains poorly understood. We performed a custom 1021-gene panel sequencing of 334 resected pulmonary nodules presenting as GGO from 262 Chinese patients. A total of 130 multiple pulmonary nodules were sampled from 58 patients. Clinical-pathologic and radiologic parameters of these pulmonary nodules were collected. Immunohistochemistry (IHC) and multiplex immunofluorescent staining (mIF) were applied to analyze proliferation and immune cell markers of GGO-associated pulmonary nodules. Compared with pure GGO nodules, mixed GGO nodules were enriched for invasive adenocarcinoma (IAC) (182/216 vs 73/118, P < .001). Eighty-eight percent (294/334) of GGO-associated nodules carried at least one mutation in EGFR/ERBB2/BRAF/KRAS/MAP2K1 of the RTK/RAS signaling pathway, and the alterations in these driver genes were mutually exclusive. The analysis of multifocal pulmonary nodules from the same patient revealed evidence of functional convergence on RTK/RAS pathways. Nodules with ERBB2/BRAF/MAP2K1 mutations tended to be more indolent than those with EGFR and KRAS mutations. IHC and mIF staining showed that KRAS-mutant GGO nodules displayed higher infiltration of CD4+ T cell and CD8+ T cell as well as stronger proliferation and immune inhibitory signals. Our study demonstrates a driver landscape of radiologically detectable GGO-associated pulmonary nodules in Chinese patients and supports that different driver patterns in RTK/RAS pathway are corresponding to different radiologic features.

Utility of cell-free DNA from bronchial washing fluid in diagnosis and genomic determination for radiology-suspected pulmonary nodules.

BACKGROUND: Bronchial washing fluid (BWF) is a less-invasive specimen. Due to the limited sensitivity of BWF cellular component diagnosis, the aim of this study was to explore the potential role of BWF supernatant as a source of liquid biopsy of lung cancer. METHODS: This prospective study enrolled 76 suspected and 5 progressed lung cancer patients. Transbronchial biopsy tissues, BWF supernatant (BWF_Sup) and BWF precipitant (BWF_Pre) were tested by a targeted panel of 1021 genes. RESULTS: BWF_Sup cell-free DNA (cfDNA) was superior to tissue biopsy and BWF_Pre in determining mutational allele frequency, tumour mutational burden, and chromosomal instability. Moreover, BWF_Sup and BWF_Pre achieved comparable efficacy to tissue samples in differentiating malignant and benign patients, but only BWF_Sup persisted differentiated performance after excluding 55 malignancies pathologically diagnosed by bronchoscopic biopsy. Among 67 malignant patients, 82.1% and 71.6% of tumour-derived mutations (TDMs) were detected in BWF_Sup and BWF_Pre, respectively, and the detectability of TDMs in BWF_Sup was independent of the cytological examination of BWF. BWF_Sup outperformed BWF_Pre in providing more subclonal information and thus might yield advantage in tracking drug-resistant markers. CONCLUSIONS: BWF_Sup cfDNA is a reliable medium for lung cancer diagnosis and genomic profiles and may provide important information for subsequent therapeutic regimens.

Influencing factors of treatment and prognosis perceptions among advanced cancer patients: a cross-sectional study.

PURPOSE: The present study aimed to investigate the status and significantly influencing factors of treatment and prognosis perceptions among advanced cancer patients based on patient-reported outcome. METHODS: A cross-sectional study was conducted at two tertiary A general hospitals. From June to September 2019, 300 patients were invited and 292 of them participated in this study. Except for 9 invalid questionnaires, 283 pen-paper questionnaires including sociodemographic and clinical characteristics, Chinese Version of Prognosis and Treatment Perception Questionnaire, Herth Hope Index, and Hospital Anxiety and Depression Scale were well completed. Descriptive analysis, Pearson's correlation test, logistic regression analysis, and multiple linear regression analysis were applied for analysis. RESULTS: One hundred seventy-five (61.8%) advanced cancer patients reported inaccurate treatment perception. Prognosis perception scored 87.9 ± 13.72 indicating a middle level of prognosis perception. Fourteen (4.9%), 138 (48.8%), and 131 (46.3%) patients presented low, middle, and high prognosis perception levels, respectively. In patients, without spouse and religion beliefs, received chemoradiotherapy, diagnosed as cancer equal to or less than 1 year, and higher hope level were inaccurate treatment perception's risk factors. Younger age, longer diagnosis time, higher educational level, less support for medical expenses payment, receiving chemoradiotherapy, and lower hope level but more anxiety and depression symptoms were positive predictors of prognosis perception. CONCLUSIONS: A majority of advanced cancer patients in this study reported inaccurate treatment and middle level of prognosis perception influencing by objective and subjective factors. Clinical interventions could be developed referring these impacting factors originating from patient-reported outcome.

MicroRNA as an early diagnostic biomarker for contrast-induced acute kidney injury.

Contrast-induced acute kidney injury (CI-AKI) is a common clinical complication and an important cause of increased mortality, prolonged hospitalization, and increased medical costs. For taking effective interventions in CI-AKI, early diagnosis and active prevention are of key importance. Currently, early CI-AKI detection depends on serum creatinine (Scr) levels, which lags behind the actual time of renal injury and seriously affects early diagnosis and interventions. MicroRNA (miRNA) has been found to be a useful biomarker in early CI-AKI diagnosis. Several studies have reported on tissue and time-specific miRNAs in AKI as effective diagnostic biomarkers and potential therapeutic targets, but there are only a few studies on miRNA in CI-AKI. However, these studies are preliminary exploratory investigations on changes in miRNA expression in CI-AKI, and whether these specific miRNAs can be used as biomarkers for early CI-AKI diagnosis and as clinical therapeutic targets requires systematic and in-depth studies. Therefore, more sensitive and specific miRNAs of CI-AKI could be discovered, providing newer options and development directions for early diagnosis and intervention in clinical CI-AKI practice. This review evaluates the research progress on specific miRNAs in the early diagnosis of CI-AKI with an aim of providing basic data for the clinical application of these molecular markers in CI-AKI.

Social support and sleep quality in patients with stroke: The mediating roles of depression and anxiety symptoms.

BACKGROUND: Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living and social participation, but the relationship between social support and sleep quality remains unknown. AIMS: This study aimed to assess the incidence of poor sleep quality, clarify the relationship between social support and sleep quality amongst stroke patients and determine whether anxiety and depression symptoms mediate this relationship. METHODS: We conducted a quantitative, cross-sectional study involving 238 patients with stroke (median age of 61 [range 29-87] years, 68.1% male) recruited from a comprehensive tertiary care hospital between September 2019 and January 2020. A self-administered, structured questionnaire was used for the survey. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 4 (parallel mediation) of the SPSS PROCESS macro. RESULTS: Results showed that the incidence of poor sleep quality amongst stroke patients was 65%. Mediation analysis showed that social support exerted significant direct effects on sleep quality, and anxiety and depression symptoms mediated the relationship between social support and sleep quality. CONCLUSION: Measures should be taken to enhance social support to improve the sleep quality of stroke patients.

Serial circulating tumor DNA identification associated with the efficacy and prognosis of neoadjuvant chemotherapy in breast cancer.

BACKGROUND: Circulating tumor DNA (ctDNA) provides a promising noninvasive alternative to evaluate the efficacy of neoadjuvant chemotherapy (NCT) in breast cancer. METHODS: Herein, we collected 63 tissue (aspiration biopsies and resected tissues) and 206 blood samples (baseline, during chemotherapy (Chemo), after chemotherapy (Post-Chemo), after operation (Post-Op), during follow-up) from 32 patients, and preformed targeted deep sequencing with a customed 1021-gene panel. RESULTS: As the results, TP53 (43.8%) and PIK3CA (40.6%) were the most common mutant genes in the primary tumors. At least one tumor-derived mutation was detected in the following number of blood samples: 21, baseline; 3, Chemo; 9, Post-Chemo; and 5, Post-Op. Four patients with pathologic complete response had no tissue mutation in Chemo and Post-Chemo blood. Compared to patients with mutation-positive Chemo or Post-Chemo blood, the counterparts showed a superior primary tumor decrease (median, 86.5% versus 54.6%) and lymph involvement (median, 1 versus 3.5). All five patients with mutation-positive Post-Op developed distant metastases during follow-up, and the sensitivity of detecting clinically relapsed patients was 71.4% (5/7). The median DFS was 9.8 months for patients with mutation-positive Post-Op but not reached for the others (HR 23.53; 95% CI, 1.904-290.9; p < 0.0001). CONCLUSIONS: Our study shows that sequential monitoring of blood ctDNA was an effective method for evaluating NCT efficacy and patient recurrence. Integrating ctDNA profiling into the management of LABC patients might improve clinical outcome. TRIAL REGISTRATION: This prospective study recruited LABC patients at Peking Union Medical College Hospital (ClinicalTrials.gov Identifier: NCT02797652).

An unusual cause of ascites: Castleman disease.

BACKGROUND: Castleman disease (CD) is a group of rare lymphoproliferative diseases with common lymph node histological features that can easily be misdiagnosed as infections, multiple autoimmune diseases, and malignant tumors. CASE PRESENTATION: Here we report a rare case of a Chinese male with refractory ascites for two years and was eventually diagnosed as CD. CONCLUSIONS: The challenges in diagnosis of CD arise from the large differential, clinical heterogeneity and our limited understanding of pathology. In case of rare ascites, CD needs to be considered.

Circ_0038467 regulates lipopolysaccharide-mediated cell proliferation, apoptosis, and inflammatory response by miR-195-5p/TLR4 axis through NF-κB pathway in MRC-5 cells.

Infantile pneumonia (IP) is an acute lower respiratory infection and brings a heavy burden to children health. Circular RNAs (circRNAs) participate in the regulation of pneumonia process. In this research, the effects of circ_0038467 in regulating lipopolysaccharide (LPS)-induced cell injury and underlying mechanism were revealed. Results showed that circ_0038467 expression and TLR4 protein level were upregulated, while miR-195-5p expression was downregulated in LPS-induced MRC-5 cells. Circ_0038467 silencing restored LPS-mediated inhibition on cell proliferation and promotion on apoptosis and inflammatory response. Additionally, circ_0038467 acted as a sponge of miR-195-5p, which was further revealed to target TLR4. MiR-195-5p inhibitor reversed circ_0038467 silencing-mediated influences under LPS treatment. Furthermore, LPS-activated NF-κB pathway was partly blocked by circ_0038467 silencing, which was restrained by TLR4 overexpression. Circ_0038467 silencing protected MRC-5 cells from LPS-induced injury by miR-195-5p/TLR4 axis through NF-κB pathway, providing a theoretical basis for circRNA-directed IP therapy.

Applications of System Dynamics Models in Chronic Disease Prevention: A Systematic Review.

INTRODUCTION: Chronic disease is a serious health problem worldwide. Given that health care resources are limited, a comprehensive, effective, and affordable way is needed to provide insights to prevent chronic diseases. System dynamics models provide a comprehensive and systematic method that can predict results over time. These models can simulate and predict appropriate prevention measures for chronic diseases to determine the best practice. METHODS: Two researchers (Y.W., B.H.) independently searched databases (PubMed, Web of Science, Scopus, and Embase) for full-text articles published from January 2000 through February 2021. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020-compliant search was carried out to review system dynamics models of chronic disease prevention. A total of 34 articles were included in our study. RESULTS: We divided the prevention measures of system dynamics models into 2 main categories: upstream prevention and downstream prevention. Upstream prevention measures include lifestyle (eg, tobacco control, balanced diet, mental health, moderate exercise), obesity prevention, and social factors. Downstream prevention measures include clinical treatment of chronic diseases. Results showed that effective upstream prevention measures could reduce the prevalence of chronic diseases, and downstream prevention measures could reduce the incidence of complications, improve quality of life, prolong life, save medical costs, and reduce mortality. CONCLUSION: To our knowledge, our systematic review is the first to evaluate the application of system dynamics models in preventing chronic diseases. Such models can provide effective simulations. Hence, we can use system dynamics models to design and implement effective prevention measures for people with chronic diseases.

Relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease: A cross-sectional study.

AIM: This study aimed to investigate the relationships among hope, meaning in life, and post-traumatic growth (PTG) in patients with chronic obstructive pulmonary disease. DESIGN: A cross-sectional study design. METHODS: Between October 2018-September 2019, 221 chronic obstructive pulmonary disease patient completed the questionnaires including sociodemographic information, Chinese Version of Herth Hope Index, Meaning in Life Questionnaire, and Post-traumatic Growth Inventory. Descriptive analysis, Spearman's correlation analysis, the Kruskal-Wallis H test, the Mann-Whitney U test, and the ridge regression analysis were used for analysis. RESULTS: Spearman's correlation analysis showed that hope and meaning in life were positively interrelated with PTG (r = 0.20-0.45, r = 0.36-0.54, p < 0.01). Ridge regression analysis results showed that hope, meaning in life, time since diagnosis, habitation, medical insurance, and monthly income could explain 47.30% of the variance in PTG (F = 33.863, p < 0.001). CONCLUSION: Chinese patients with chronic obstructive pulmonary disease experienced a slightly positive change in meaning in life and a moderate degree of hope and PTG. Results suggested that hope and meaning in life were positively connected with PTG. Therefore, enhancing hope and meaning in life might be crucial for patients with chronic obstructive pulmonary disease to promote PTG. IMPACT: The findings added better understanding of relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease which can help nurse give interventions in the early stage of disease diagnosis.

Relationship between illness perception, fear of progression and quality of life in interstitial lung disease patients: A cross-sectional study.

AIMS AND OBJECTIVES: This study aimed to investigate whether fear of progression mediates the association between illness perception and quality of life among interstitial lung disease patients. BACKGROUND: So far, the physiological treatment of interstitial lung disease is limited. In addition to immunosuppressants such as glucocorticoids, two anti-fibrosis drugs (pirfenidone and nintedanib) have shown moderately beneficial effects on slowing the progression of interstitial lung disease fibrosis. However, none of these drugs has shown reliable or strong beneficial effects on improving quality of life. Psychological care and mental health support strategies focusing on improving patients' quality of life are particularly important. DESIGN: A cross-sectional study. METHODS: A convenience sample of patients suffering from interstitial lung disease were enrolled from August to December 2019. Data including sociodemographic and clinical characteristics, illness perception, fear of progression and quality of life were collected. The descriptive analysis and Pearson correlations were analysed by SPSS 26.0 (IBM Corp.). PROCESS v3.4 (by Andrew F. Hayes) macro was applied to analyse the mediating effects. We used the STROBE checklist to report the results. RESULTS: Both illness perception and fear of progression were correlated with quality of life. Fear of progression mediated the association between illness perception and quality of life. The indirect effect was 0.121, and the proportion of intermediary effect in the main effect was 26.36%. CONCLUSION: Interstitial lung disease patients experience relatively poor quality of life and fear of progression exerts a mediating role between illness perception and quality of life. RELEVANCE TO CLINICAL PRACTICE: This study alerts medical staff to pay attention to negative illness perception and excessive fear, which is helpful to formulate effective interventions to manage interstitial lung disease patients' quality of life.

Nurses' behaviours towards physical restraint use in the ICU: A descriptive qualitative study.

AIMS AND OBJECTIVES: The study aims to explore and describe nurses' behaviours towards physical restraint (PR) use in intensive care units (ICUs) and identify key characteristics of these experiences. BACKGROUND: Patients within the ICU are always vulnerable, which requires a thoughtful deliberation when employing PR in ethically laden situations. Considering that the qualitative study on nurses' behaviours towards PR use in ICUs is limited, a deep understanding of how nurses reason and restrict patients is necessary before developing a minimizing programme in hospitals. METHODS: A descriptive qualitative study was conducted in this paper. Data were collected by 24 semistructured, in-depth and individual interviews about PR, where 24 nurses were drawn from six ICUs of four hospital settings from a comprehensive tertiary care hospital in Qingdao. The QSR NVivo 11.0 software program was used to manage the interview data, and data analysis was guided by the Qualitative Analysis Guide of Leuven. The checklist of Consolidated Criteria for Reporting Qualitative Studies was followed as a guideline in reporting the study. RESULTS: Regarding PR, nurses' behaviours start with a hazard perception, followed by hesitation about whether to restrict the patient. They would usually decide to apply PR when they think that no other choice to control the situation is available. Then, they would reflect on and rationalize their behaviours. Nurses, intensivists, patients and their families participate in and affect this process directly or indirectly. CONCLUSIONS: Nurses' behaviours towards PR use comprise a series of complex processes centred on safety. Nurses' decision making should be performed with the participation of intensivists, patients and family caregivers.

Lupus enteritis masquerading as Crohn's disease.

BACKGROUND: Systemic lupus erythematosus is an autoimmune disease which can affect multiple organs, resulting in significant mortality and morbidity. Lupus enteritis is one of the rare complications of SLE, defined as vasculitis of the intestinal tract, with supportive biopsy findings and/or image. However, lupus enteritis is seldom confirmed on histology or image and the changes of intestinal mucosa are nonspecific. Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract which affects any part of the gastrointestinal tract. The diagnosis of CD is confirmed by clinical evaluation and a combination of endoscopic, histology, radiology, and/or biochemical investigations. CASE PRESENTATION: Here we report a rare case of a 71-years-old Chinese male has been diagnosed with lupus enteritis which similar to CD in the aspects of endoscopic, histology, and radiology. So far, there are no relevant cases reported. CONCLUSIONS: The endoscopic appearance of lupus enteritis is nonspecific, on the basis of our case, the features of lupus enteritis can be described as spacious, clean and no moss ulcers which discontinuous involved all gastrointestinal tract.

Modeling and optimizing the chromatic holographic waveguide display system.

A ray-tracing model is developed based on coupled wave theory for a volume holographic grating, which is the most important element of the holographic waveguide display but not accessibly integrated in current optical design software. The model fully and faithfully represents the angular selectivity, wavelength selectivity, polarization, and other properties for the in-coupling, out-coupling, and expansion gratings. It is especially important that the model is compatible with the current optical design software. In this paper, combining with other mature optical simulation functions of Zemax, integrated models are built for typical holographic waveguide display configurations, including image source, collimation element, gratings, waveguide plates, and approximate eye. It could provide the retina image at different viewing positions, based on which the main performance characteristics of a holographic waveguide display, such as field of view, color uniformity, eye box, and light efficiency, could be easily derived. Consequently, it provides a valuable guiding approach for the design and optimization of holographic waveguide displays.

[ZO-1 gene methylation status and its clinical significance in children with non-Hodgkin lymphoma].

OBJECTIVE: To investigate the methylation status of zonula occludens-1 (ZO-1) gene promoter and its clinical significance in children with stage IV non-Hodgkin lymphoma (NHL) and to provide a basis for further etiological study and early diagnosis of this disease. METHODS: Fifty-five children with a confirmed diagnosis of stage IV NHL (40 cases of T-NHL and 15 cases of B-NHL) were selected as the case group, and 20 children with diseases other than hematologic malignancies were selected as the control group. Bone marrow samples were collected from these subjects. Methylation-specific PCR (MS-PCR) was applied to evaluate the methylation status of ZO-1 gene promoter, and the integrated optical density (IOD) was determined. RT-PCR was used to measure the mRNA expression of ZO-1. RESULTS: MS-PCR showed that the methylated bands of ZO-1 gene promoter were found in 39 (70.9%) of 55 patients in the case group before treatment, while no ZO-1 gene promoter methylation was detected in the control group. With close tracking of 47 cases in the study group, consisting of 32 cases of T-NHL and 15 cases of B-NHL, the rates of ZO-1 gene promoter methylation prior to treatment were 72% and 67%, respectively, (P>0.572). The cases of T-NHL and B-NHL showed no significant changes in methylation rate in the early and middle phases of chemotherapy (P>0.05), but they showed significant changes in methylation rate in the late phase of chemotherapy (P<0.05). RT-PCR showed that the NHL cases carrying methylated ZO-1 gene had no mRNA expression of ZO-1, while all children in the control group had mRNA expression of ZO-1. There was no linear relationship between the total number of peripheral blood leukocytes and ZO-1 gene IOD (r=0.093, P=0.575); a positive correlation was found between the number of malignant cells in bone marrow and ZO-1 gene IOD (r=0.669, P<0.001). CONCLUSIONS: ZO-1 gene shows a hypermethylation status in children with NHL, and the methylation level is positively correlated with the number of malignant cells in bone marrow. ZO-1 may be used as a novel molecular marker in early diagnosis, outcome assessment, prognostic evaluation, and detection of minimal residual disease.