Experience of medical transition from adolescents with congenital heart disease to adults:a meta-synthesis of qualitative research / 中华护理杂志

Objective To systematically evaluate qualitative studies on the experience of transition from adolescent to adult medical care for patients with congenital heart disease(CHD),and to provide a reference for exploring CHD transition management options and developing intervention strategies.Methods A computerized search of PubMed,Embase,Web of Science,Cochrane Library,EBSCO,CINAHL,China Knowledge Network,Wanfang database,Vipshop database,and China Biomedical Literature Database for qualitative studies on the transition experience of CHD patients from adolescence to adult medical care was conducted for the period from the establishment of the database to April 2023.The quality of the literature was evaluated using the Joanna Briggs Institute(JBI)Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research(2016),and the results were integrated using meta-integration methods.Results A total of 9 studies were included,and 49 research results were extracted,and 11 categories were summarized.The final synthesis included 4 integrated results:①Complex attitudes towards healthcare transition,with both attachment and expectation:attachment to paediatric healthcare providers,expectation of transition to adult healthcare providers.(2)Facing multiple healthcare transition challenges:lack of adequate preparation for healthcare transition,parents withdrawing from the role of disease manager,large differences in services between paediatric and adult healthcare providers.③Expect to receive multiple supports:expect to receive comprehensive health education from healthcare personnel,expect healthcare institutions to set up healthcare transition counselling clinics and achieve handover of illness,expect to receive companionship and support from parents,expect to receive understanding and help from peers.④ Per-ceived benefits of medical transition:increased ability to manage illness,role change and personal growth.Conclusion Adolescents with CHD have a complex experience of transitioning to adult healthcare,and healthcare professionals should be attentive to their feelings,encourage them to deal with challenges positively,and provide adequate information and joint parental and peer support to facilitate a smooth transition to adult healthcare for adolescents.

Quantitative analysis of macular capillaries in diabetic patients using optical coherence tomography angiography / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To quantify early changes of macular capillary parameters in type 2 diabetic patients using optical coherence tomography angiography(OCTA).METHODS: Retrospective case study. A total of 49 healthy subjects, 52 diabetic patients without retinopathy(noDR)patients, and 43 mild nonproliferative diabetic retinopathy(mNPDR)patients were recruited. Capillary perfusion density, vessel length density(VLD), and average vessel diameter(AVD)were calculated from macular OCTA images(3 mm×3 mm)of the superficial capillary plexus after segmenting large vessels and the deep capillary plexus. Parameters were compared among control subjects, noDR, and mNPDR patients. The area under the receiver operating characteristic curve estimated the abilities of these parameters to detect early changes of retinal microvascular networks.RESULTS: Significant differences were found in the VLD and AVD among the three groups(P<0.001). Compared with the control group, the noDR group had significantly higher AVD(P<0.05). VLD of both layers in patients of mNPDR group was significant decreased compared with that of noDR group(all P<0.01). Deep AVD had a higher area under the curve(AUC)of 0.796 than other parameters to discriminate the noDR group from the healthy group. Deep AVD had the highest AUC of 0.920, followed by that of the deep VLD(AUC=0.899)to discriminate the mNPDR group from the healthy group.CONCLUSIONS: NoDR patients had wider AVD than healthy individuals and longer VLD than mNPDR patients in both layers. When compared with healthy individuals, deep AVD had a stronger ability than other parameters to detect early retinal capillary impairments in noDR patients.

Safety and efficacy of transcatheter aortic valve replacement using the "All in One" single artery/vessel technique / 中华心血管病杂志

Objective: To explore the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the "All in One" single-artery/vessel technique. Methods: This is a retrospective study. A total of 30 consecutive patients underwent TAVR using the single artery/vascular technique in Beijing Anzhen Hospital from August to December 2021 were included. Baseline clinical data, operative situation, postoperative outcomes, and incidence of adverse events during hospitalization and at one month post TAVR were analyzed. Results: Mean age was (72.6±9.7) years, 16 were male patients, STS score was (4.73±3.12)%. Four patients were diagnosed as isolated aortic regurgitation (all with tricuspid aortic valves), and 26 patients were diagnosed as aortic stenosis (AS), 10 of whom with tricuspid aortic valves and 16 of whom with bicuspid aortic valves. The single-vessel technique was applied in 3 aortic stenosis cases; the single-artery technique was applied in 27 cases. Echocardiography was performed immediately after procedure and results showed no or trace perivalvular leak in 27 cases and small perivalvular leak in 3 cases; the mean aortic transvalvular gradient of 26 AS patients decreased from (50.4±16.0) mmHg (1 mmHg=0.133 kPa) to (9.4±3.2) mmHg (P<0.001). The procedure time was (64.8±18.9) min. There were no intraoperative death, valve displacement, conversion to surgery, coronary artery occlusion in all 30 patients. There were no major cardiac adverse events such as myocardial infarction or stroke occurred during hospitalization or at follow-up. One-month follow-up echocardiography indicated prosthesis works well. The symptoms were significantly alleviated, and the Kansas City Cardiomyopathy Score (KCCQ score) of all patients increased from 48.1±18.4 to 73.5±17.6 (P<0.001). Conclusions: TAVR using the single artery/vessel technique is safe and feasible. This technique is related to reduced access complications and worthy of wide application.

Safety and efficacy of transcatheter aortic valve replacement using the "All in One" single artery/vessel technique / 中华心血管病杂志

Objective: To explore the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the "All in One" single-artery/vessel technique. Methods: This is a retrospective study. A total of 30 consecutive patients underwent TAVR using the single artery/vascular technique in Beijing Anzhen Hospital from August to December 2021 were included. Baseline clinical data, operative situation, postoperative outcomes, and incidence of adverse events during hospitalization and at one month post TAVR were analyzed. Results: Mean age was (72.6±9.7) years, 16 were male patients, STS score was (4.73±3.12)%. Four patients were diagnosed as isolated aortic regurgitation (all with tricuspid aortic valves), and 26 patients were diagnosed as aortic stenosis (AS), 10 of whom with tricuspid aortic valves and 16 of whom with bicuspid aortic valves. The single-vessel technique was applied in 3 aortic stenosis cases; the single-artery technique was applied in 27 cases. Echocardiography was performed immediately after procedure and results showed no or trace perivalvular leak in 27 cases and small perivalvular leak in 3 cases; the mean aortic transvalvular gradient of 26 AS patients decreased from (50.4±16.0) mmHg (1 mmHg=0.133 kPa) to (9.4±3.2) mmHg (P<0.001). The procedure time was (64.8±18.9) min. There were no intraoperative death, valve displacement, conversion to surgery, coronary artery occlusion in all 30 patients. There were no major cardiac adverse events such as myocardial infarction or stroke occurred during hospitalization or at follow-up. One-month follow-up echocardiography indicated prosthesis works well. The symptoms were significantly alleviated, and the Kansas City Cardiomyopathy Score (KCCQ score) of all patients increased from 48.1±18.4 to 73.5±17.6 (P<0.001). Conclusions: TAVR using the single artery/vessel technique is safe and feasible. This technique is related to reduced access complications and worthy of wide application.

Clinical characteristics of scabies: an analysis of 747 cases / 中华全科医师杂志

Objective:To analyze clinical characteristics of scabies.Methods:The clinical data of 747 patients with scabies who visited Department of Dermatology, Affiliated Hospital of Jining Medical College from January 2018 to December 2019 were retrospectively analyzed.Results:There were more males (73.09%, 546/747) than females (26.91%, 201/747); most of patients had a age of 13-24 year (55.96%, 418/747); students account for 50.33% (376/747) of all patients; there were more patients living in dormitory than those living at home (61.45% (459/747) vs. 38.55% (288/747)). The cases began to rise from October, reaching the peak in December and remaining at relatively high level in January and February, then decreasing to the lowest during March to September. The number of patients living in rural areas is higher than that in urban areas. Patients took average 30 (15, 90) days from onset of disease to seeing a doctor, and itching was the main complain for visiting. The locations of lesion were most common on the abdomen (63.19%, 472/747), fingertips and wrists (53.41%, 399/747), vulva (37.22%, 278/747), and extremities (30.25%, 226/747). The lesions were characterized by erythematous papules (71.62%, 535/747), nodules (47.12%, 352/747), papules (24.50%, 183/747), wheals (6.02%, 45/747), secondary infections (3.61%, 27/747), tunnels (3.08%, 23/747) and small pustules (2.14%, 16/747); the male scrotal nodules were common (48.17%, 263/546). More patients (471/747, 63.05%) first visited non-dermatology outpatient clinics, and less first visited dermatology outpatient clinics (276/747, 36.95%); the misdiagnosis rates were 55.41% (261/471) and 27.54% (76/276), respectively; 127 cases (17.00%) were misdiagnosed as eczema, 54 cases (7.23%) as allergic dermatitis, 41 cases (5.49%) as prurigo nodularis, and 35 cases (4.69%) as urticaria pulosa. Conclusions:There is a certain discrepancy in the incidence of scabies among different populations, regions and seasons, the lesions of scabies are polymorphic involving different parts of the body surface and it is easy to be misdiagnosed.

Diagnostic value of MRI in adnexal torsion / 实用放射学杂志

Objective To explore the diagnostic value of MRI in adnexal torsion.Methods A retrospective study was conducted on 32 patients with adnexal torsion confirmed by surgery and pathology.The MRI features were analyzed in combination with clinical data.Results Among the 32 cases of adnexal torsion,there were 12 cases of ovarian cyst,5 cases of cystic ovarian teratoma,4 cases of theca cell tumor,6 cases of ovarian cystadenoma,1 case of high-grade serous carcinoma,1 case of corpus luteum hematoma,1 case of simple ovarian torsion,1 case of ovarian goiter,1 case of fibrotheca cell tumor with serous cystadenoma;There were 13 cases on the left side and 19 cases on the right side;The torsion angle of adnexal was about 90 °-1 440 °.MRI showed that 13 of 32 patients were cystic masses and 19 were cystic solid masses;torsion pedicle can be seen near the mass,of which 13 cases showed"whirlpool sign",27 cases showed"T2WI dot low signal sign",10 cases showed"nodule sign",5 cases showed"triangle sign",and 9 cases had structural disorder around the mass.Enhancement showed no obvious enhancement in 12 cases,and mild enhancement in 20 cases.Thirty cases complicated with pelvic effusion;The uterus moved to the affected side in 9 cases,to the healthy side in 20 cases,and no obvious deviation in 3 cases.Conclusion The MRI imaging features of adnexal torsion are characteristic,which are cystic or cystic solid lesions.The torsion pedicle is characterized by"whirlpool sign"and"T2WI dot low signal sign",etc.The enhancement is mild or no enhancement.Combined with the clinical history,it is of great value for the preoperative diagnosis and treatment of adnexal torsion.

Association between clinical phenotypes of hypertrophic cardiomyopathy and Ca2+ gene variation gene variation / 中华心血管病杂志

Objective: To observe the association between clinical phenotypes of hypertrophic cardiomyopathy (HCM) patients and a rare calcium channel and regulatory gene variation (Ca2+ gene variation) and to compare clinical phenotypes of HCM patients with Ca2+ gene variation, a single sarcomere gene variation and without gene variation and to explore the influence of rare Ca2+ gene variation on the clinical phenotypes of HCM. Methods: Eight hundred forty-two non-related adult HCM patients diagnosed for the first time in Xijing Hospital from 2013 to 2019 were enrolled in this study. All patients underwent exon analyses of 96 hereditary cardiac disease-related genes. Patients with diabetes mellitus, coronary artery disease, post alcohol septal ablation or septal myectomy, and patients who carried sarcomere gene variation of uncertain significance or carried>1 sarcomere gene variation or carried>1 Ca2+ gene variation, with HCM pseudophenotype or carrier of ion channel gene variations other than Ca2+ based on the genetic test results were excluded. Patients were divided into gene negative group (no sarcomere or Ca2+ gene variants), sarcomere gene variation group (only 1 sarcomere gene variant) and Ca2+ gene variant group (only 1 Ca2+ gene variant). Baseline data, echocardiography and electrocardiogram data were collected for analysis. Results: A total of 346 patients were enrolled, including 170 patients without gene variation (gene negative group), 154 patients with a single sarcomere gene variation (sarcomere gene variation group) and 22 patients with a single rare Ca2+ gene variation (Ca2+ gene variation group). Compared with gene negative group, patients in Ca2+ gene variation group had higher blood pressure and higher percentage of family history of HCM and sudden cardiac death (P<0.05); echocardiographic results showed that patients in Ca2+ gene variation group had thicker ventricular septum ((23.5±5.8) mm vs. (22.3±5.7) mm, P<0.05); electrocardiographic results showed that patients in Ca2+ gene variation group had prolonged QT interval ((416.6±23.1) ms vs. (400.6±47.2) ms, P<0.05) and higher RV5+SV1 ((4.51±2.26) mv vs. (3.50±1.65) mv, P<0.05). Compared with sarcomere gene variation group, patients in Ca2+ gene variation group had later onset age and higher blood pressure (P<0.05); echocardiographic results showed that there was no significant difference in ventricular septal thickness between two groups; patients in Ca2+ gene variation group had lower percentage of left ventricular outflow tract pressure gradient>30 mmHg (1 mmHg=0.133 kPa, 22.8% vs. 48.1%, P<0.05) and the lower early diastolic peak velocity of the mitral valve inflow/early diastolic peak velocity of the mitral valve annulus (E/e') ratio ((13.0±2.5) vs. (15.9±4.2), P<0.05); patients in Ca2+ gene variation group had prolonged QT interval ((416.6±23.1) ms vs. (399.0±43.0) ms, P<0.05) and lower percentage of ST segment depression (9.1% vs. 40.3%, P<0.05). Conclusion: Compared with gene negative group, the clinical phenotype of HCM is more severe in patients with rare Ca2+ gene variation; compared with patients with sarcomere gene variation, the clinical phenotype of HCM is milder in patients with rare Ca2+ gene variation.

Feasibility study of using bridging temporary permanent pacemaker in patients with high-degree atrioventricular block after TAVR / 中华心血管病杂志

Objective: To determine the feasibility of using temporary permanent pacemaker (TPPM) in patients with high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR) as bridging strategy to reduce avoidable permanent pacemaker implantation. Methods: This is a prospective observational study. Consecutive patients undergoing TAVR at Beijing Anzhen Hospital and the First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were screened. Patients with high-degree AVB and TPPM were included. Patients were followed up for 4 weeks with pacemaker interrogation at every week. The endpoint was the success rate of TPPM removal and free from permanent pacemaker at 1 month after TPPM. The criteria of removing TPPM was no indication of permanent pacing and no pacing signal in 12 lead electrocardiogram (EGG) and 24 hours dynamic EGG, meanwhile the last pacemaker interrogation indicated that ventricular pacing rate was 0. Routinely follow-up ECG was extended to 6 months after removal of TPPM. Results: Ten patients met the inclusion criteria for TPPM, aged (77.0±11.1) years, wirh 7 females. There were 7 patients with third-degree AVB, 1 patient with second-degree AVB, 2 patients with first degree AVB with PR interval>240 ms and LBBB with QRS duration>150 ms. TPPM were applied on the 10 patients for (35±7) days. Among 8 patients with high-degree AVB, 3 recovered to sinus rhythm, and 3 recovered to sinus rhythm with bundle branch block. The other 2 patients with persistent third-degree AVB received permanent pacemaker implantation. For the 2 patients with first-degree AVB and LBBB, PR interval shortened to within 200 ms. TPPM was successfully removed in 8 patients (8/10) at 1 month without permanent pacemaker implantation, of which 2 patients recovered within 24 hours after TAVR and 6 patients recovered 24 hours later after TAVR. No aggravation of conduction block or permanent pacemaker indication were observed in 8 patients during follow-up at 6 months. No procedure-related adverse events occurred in all patients. Conclusion: TPPM is reliable and safe to provide certain buffer time to distinguish whether a permanent pacemaker is necessary in patients with high-degree conduction block after TAVR.

Effects of adjuvant trastuzumab on long-term survival of T1N0M0 stage human epidermal growth factor receptor 2 positive breast cancer: a real-world study / 中华肿瘤杂志

Objective: To investigate the prognosis impact of adjuvant trastuzumab treatment on human epidermal growth factor receptor 2 (HER-2) positive early breast cancer patients. Methods: A retrospective study was conducted, HER-2-positive T1N0M0 stage breast cancer patients who underwent surgery in the Affiliated Tumor Hospital of Xinjiang Medical University from January 2010 to December 2019 were divided into treatment group and control group according to whether they were treated with trastuzumab or not. Propensity score matching (PSM) was used to balance the confounding bias caused by differences in baseline characteristics between the two groups. Cox proportional hazards model was used to analyze the risk factors affecting disease-free survival (DFS). The Kaplan-Meier method was used to estimate the 3- and 5-year DFS and overall survival (OS) rates of the two groups before and after PSM. Results: There were 291 patients with HER-2 positive T1N0M0 stage breast cancer, including 21 cases in T1a (7.2%), 61 cases in T1b (21.0%), and 209 cases in T1c (71.8%). Before PSM, there were 132 cases in the treatment group and 159 cases in the control group, the 5-year DFS rate was 88.5%, and the 5-year OS rate was 91.5%. After PSM, there were 103 cases in the treatment group and 103 cases in the control group, the 5-year DFS rate was 86.0%, and the 5-year OS rate was 88.5%. Before PSM, there were significant differences in tumor size, histological grade, vascular invasion, Ki-67 index, postoperative chemotherapy or not and radiotherapy between the treatment group and the control group (P<0.05). After PSM, there were no significant difference in clinicopathological features between the treatment group and the control group (P>0.05). Multivariate analysis showed that histological grade (HR=2.927, 95 CI: 1.476, 5.805; P=0.002), vascular invasion (HR=3.410, 95 CI: 1.170, 9.940; P=0.025), menstrual status (HR=3.692, 95 CI: 1.021, 13.344, P=0.046), and chemotherapy (HR=0.238, 95 CI: 0.079, 0.720; P=0.011) were independent factors affecting DFS. After PSM, the 5-year DFS rate of the treatment group was 89.2%, while that of the control group was 83.5%(P=0.237). The 5-year OS rate of the treatment group was 96.1%, while that of the control group was 84.7%(P=0.036). Conclusion: Postoperative targeted therapy with trastuzumab can reduce the risk of recurrence and metastasis in patients with HER-2-positive T1N0M0 stage breast cancer.

Temporal dynamics of microglia-astrocyte interaction in neuroprotective glial scar formation after intracerebral hemorrhage / 药物分析学报

The role of glial scar after intracerebral hemorrhage(ICH)remains unclear.This study aimed to inves-tigate whether microglia-astrocyte interaction affects glial scar formation and explore the specific function of glial scar.We used a pharmacologic approach to induce microglial depletion during different ICH stages and examine how ablating microglia affects astrocytic scar formation.Spatial transcriptomics(ST)analysis was performed to explore the potential ligand-receptor pair in the modulation of microglia-astrocyte interaction and to verify the functional changes of astrocytic scars at different periods.During the early stage,sustained microglial depletion induced disorganized astrocytic scar,enhanced neutrophil infiltration,and impaired tissue repair.ST analysis indicated that microglia-derived insulin like growth factor 1(IGF1)modulated astrocytic scar formation via mechanistic target of rapamycin(mTOR)signaling activation.Moreover,repopulating microglia(RM)more strongly activated mTOR signaling,facilitating a more protective scar formation.The combination of IGF1 and osteopontin(OPN)was necessary and sufficient for RM function,rather than IGF1 or OPN alone.At the chronic stage of ICH,the overall net effect of astrocytic scar changed from protective to destructive and delayed microglial depletion could partly reverse this.The vital insight gleaned from our data is that sustained microglial depletion may not be a reasonable treatment strategy for early-stage ICH.Inversely,early-stage IGF1/OPN treatment combined with late-stage PLX3397 treatment is a promising therapeutic strategy.This prompts us to consider the complex temporal dynamics and overall net effect of microglia and astrocytes,and develop elaborate treatment strategies at precise time points after ICH.

Single center experience of transcatheter aortic valve replacement with a simplified operative protocol / 中华心血管病杂志

Objective: To summarize the single center experience of transcatheter aortic valve replacement (TAVR) with a simplified operative protocol. Methods: Consecutive patients who underwent transfemoral TAVR (TF-TAVR) from July 2020 to December 2020 in Fuwai Hospital were retrospectively analyzed. We compared the baseline characteristic, procedure information, 30-day follow-up outcomes of the patients who underwent TF-TAVR without the simplified operative protocol (routine group) or with the simplified operative protocol (simplified protocol group). Results: 93 patients were collected, 42 patients belonging to routine group, 51 patients belonging to simplified protocol group. In simplified protocol group, there were 51 patients planned to use ultrasound-guided femoral access puncture, procedure was successful in all 51 patients (100%). There were 49 patients planned to use the radial artery as the secondary access, procedure was successful in 45 patients (92%). There were 48 patients planned to use the strategy of avoidance of urinary catheter, this strategy was achieved in 35 patients (73%). There were 12 patients planned to use the left ventricular guidewire to pace, procedure was successful in 11 patients (92%). There were no differences in baseline characteristics, major clinical endpoints and 30-day follow-up outcomes between the two groups. Meanwhile, the procedure time ((62.5±17.9)min vs. (78.3±16.7)min, P<0.001), operation room time ((133.7±25.1)min vs. (159.2±42.6)min, P<0.001), X-ray exposure time ((17.2±6.5)min vs. (20.2±7.7)min, P=0.027) were significantly shorten in simplified protocol group compared with the routine group. Conclusion: Our study results indicate that the simplified operative protocol of TF-TAVR is as effective and safe as the routine operative protocol, meanwhile using the simplified operative protocol can significantly increase the operative efficiency of TF-TAVR.

Association of single nucleotide polymorphisms in microRNAs with the risk of chronic spontaneous urticaria / 中华皮肤科杂志

Objective:To investigate the association between single nucleotide polymorphisms (SNPs) in microRNAs (miRNAs) and the risk of chronic spontaneous urticaria (CSU) .Methods:A case-control study was conducted. A total of 98 patients with CSU (CSU group) were collected from Department of Dermatology, Affiliated Hospital of Jining Medical University from January to June in 2019, and 148 health checkup examinees (control group) were collected at the same time, all of whom were of Han nationality from Shandong province. Genomic DNA was extracted from venous blood samples, and polymorphic sites rs2431697 (miRNA-146a) , rs57095329 (miRNA-146a) , rs3746444 (miRNA-499) , rs11614913 (miRNA-196a2) and rs895819 (miRNA-27a) were analyzed for SNP genotyping by multiplex PCR amplification and single-base extension. Chi-square test was used to analyze differences in the distribution of alleles, genotypes and genetic models between the two groups, and unconditional logistic regression to analyze the relationship between gene SNPs and the risk of CSU.Results:All samples were successfully genotyped by analysis of the 5 polymorphic sites. The alleles of the miRNA-196a2 SNP rs11614913 were T/C, and the absolute frequency of T allele was 110 (56.1%) in the CSU group and 131 (44.3%) in the control group; there was a significant difference in the T/C allele frequency distribution between the two groups ( χ2 = 6.64, P = 0.010) , and the T allele might be a risk factor for CSU ( OR=1.61, 95% CI: 1.12-2.32) . In addition, the absolute frequencies of CC, CT and TT genotypes of rs11614913 were 16 (16.3%) , 54 (55.1%) , 28 (28.6%) in the CSU group, and 48 (32.4%) , 69 (46.6%) , 31 (20.9%) in the control group respectively, and there was a significant difference in the genotype distribution between the two groups ( χ2 = 8.16, P = 0.017) ; the distribution of the dominant genetic model (TT + CT vs. CC) also significantly differed between the two groups ( χ2 = 7.95, P = 0.005) , which might increase the risk of CSU ( OR=2.46, 95% CI: 1.30-4.65) . Conclusion:The miRNA-196a2 SNPs may be associated with the risk of CSU in the Han population in Shandong, China, and the rs11614913 polymorphism may increase the risk of CSU.

Effects of risk grading nursing on the prevention of postoperative deep vein thrombosis and quality of life in patients undergoing knee arthroscopic surgery / 中国实用护理杂志

Objective:To explore the effects of risk grading nursing on the prevention of postoperative deep vein thrombosis (DVT) and quality of life in patients undergoing knee arthroscopic surgery.Methods:A total of 1 140 patients undergoing knee arthroscopic surgery in Beijing Jishuitan Hospital were selected. The 529 cases with routine nursing from January to December 2018 were selected as the control group, while another 611 cases with risk grading nursing from January to December 2019 were selected as the observation group. The incidence of DVT, limbs swelling, quality of life and nursing satisfaction were compared between the two groups.Results:The incidence of DVT and the positive rates of Homan sign and Neuhof sign were 2.78% (17/611), 3.93% (24/611), 4.91% (30/611) in the observation group, and 5.10% (27/529), 10.02% (53/529), 11.72% (62/529) in the control group, the differences were statistically significant ( χ2=4.12, 16.70, 17.72, all P<0.05). The peripheral diameter and body surface temperature at 5 cm above the ankle, 10 cm below the patella and 15 cm above the patella were (21.30 ± 1.72) cm, (34.89 ± 2.75) cm, (46.69 ± 4.58) cm, (33.14 ± 1.40) ℃, (34.45 ± 1.52) ℃, (35.22 ± 1.36) ℃ in the observation group, and (22.88 ± 1.43) cm, (35.91 ± 1.81) cm, (49.18 ± 4.23) cm, (34.39 ± 1.22) ℃ (35.88 ± 1.49) ℃, (35.97 ± 1.31) ℃ in the control group, the differences were statistically significant ( t values were -16.74--7.25, all P<0.05). The scores of general health, physiological function, physiological function, mental health, social function, emotional function, body pain and body vitality were (75.84 ± 5.33), (79.78 ± 5.71), (76.71 ± 4.14), (84.91 ± 4.15), (75.53 ± 4.19), (78.80 ± 6.76), (74.85 ± 3.49), (78.61 ± 3.52) points in the observation group, and (71.39 ± 4.28), (75.44 ± 6.26), (73.05 ± 4.09), (80.15 ± 6.87), (71.66 ± 4.18), (74.89 ± 6.23), (71.14 ± 5.20), (74.66 ± 5.14) points in the control group, the differences were statistically significant ( t values were 10.10-15.57, all P<0.05). The satisfaction scores of nursing communication, safety, nursing technology, nursing, guidance and physical environment were (4.54 ± 0.42), (4.75 ± 0.46), (4.54 ± 0.52), (4.60 ± 0.48), (4.60 ± 0.53), (4.30 ± 0.64) points in the observation group, and (3.93 ± 0.34), (3.98 ± 0.37), (3.96 ± 0.41), (3.93 ± 0.38), (3.85 ± 0.36) (3.74 ± 0.38) points in the control group, the differences were statistically significant ( t values were 17.62-30.82, all P<0.05). Conclusions:Risk grading nursing is beneficial to alleviate postoperative limb swelling in patients after knee arthroscopic surgery, reduce incidence of DVT, improve quality of life and nursing satisfaction.

LncRNA AFAP1-AS1/miR-27b-3p/VEGF-C axis modulates stemness characteristics in cervical cancer cells / 中华医学杂志(英文版)

BACKGROUND@#Long non-coding RNA (lncRNA) actin filament-associated protein 1 antisense RNA 1 (AFAP1-AS1) functions as a competing endogenous RNA to regulate target genes expression by sponging microRNAs (miRs) to play cancer-promoting roles in cancer stem cells. However, the regulatory mechanism of AFAP1-AS1 in cervical cancer (CC) stem cells is unknown. The present study aimed to provide a new therapeutic target for the clinical treatment of CC.@*METHODS@#Hyaluronic acid receptor cluster of differentiation 44 variant exon 6 (CD44v6)(+) CC cells were isolated by flow cytometry (FCM). Small interfering RNAs of AFAP1-AS1 (siAFAP1-AS1) were transfected into the (CD44v6)(+) cells. The levels of AFAP1-AS1 were measured by quantitative real-time PCR (qRT-PCR). Sphere formation assay, cell cycle analysis, and Western blotting were used to detect the effect of siAFAP1-AS1. RNA pull-down and luciferase reporter assay were used to verify the relationship between miR-27b-3p and AFAP1-AS1 or vascular endothelial growth factor (VEGF)-C.@*RESULTS@#CD44v6(+) CC cells had remarkable stemness and a high level of AFAP1-AS1. However, AFAP1-AS1 knockdown with siAFAP1-AS1 suppressed the cell cycle transition of G(1)/S phase and inhibited self-renewal of CD44v6(+) CC cells, the levels of the stemness markers octamer-binding transcription factor 4 (OCT4), osteopontin (OPN), and cluster of differentiation 133 (CD133), and the epithelial-mesenchymal transition (EMT)-related proteins Twist1, matrix metalloprotease (MMP)-9, and VEGF-C. In the mechanism study, miR-27b-3p/VEGF-C signaling was demonstrated to be a key downstream of AFAP1-AS1 in the CD44v6(+) CC cells.@*CONCLUSIONS@#LncRNA AFAP1-AS1 knockdown inhibits the CC cell stemness by upregulating miR-27b-3p to suppress VEGF-C.

UBE2C affects breast cancer proliferation through the AKT/mTOR signaling pathway / 中华医学杂志(英文版)

BACKGROUND@#Ubiquitin-conjugating enzyme E2C (UBE2C) has been shown to be associated with the occurrence of various cancers and involved in many tumorigenic processes. This study aimed to investigate the specific molecular mechanism through which UBE2C affects breast cancer (BC) proliferation.@*METHODS@#BC-related datasets were screened according to filter criteria in the Gene Expression Omnibus (GEO) database and The Cancer Genome Atlas (TCGA) database. Then differentially expressed genes (DEGs) were identified using Venn diagram analysis. By using DEGs, we conducted the following analyses including Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), protein-protein interaction (PPI), and survival analysis, and then validated the function of the hub gene UBE2C using quantitative reverse transcription-polymerase chain reaction (RT-qPCR), cell counting kit-8 (CCK-8) assay, transwell assay, and Western blot assay.@*RESULTS@#In total, 151 DEGs were identified from the GEO and TCGA databases. The results of GO analysis demonstrated that the DEGs were significantly enriched with mitotic nuclear division, lipid droplet, and organic acid-binding. KEGG analysis showed that the peroxisome proliferators-activated receptor (PPAR) signaling pathway, regulation of lipolysis in adipocytes, and proximal tubule bicarbonate reclamation were significantly enriched in the signal transduction pathway category. The top three hub genes that resulted from the PPI network were FOXM1, UBE2C, and CDKN3. The results of survival analysis showed a close relationship between UBE2C and BC. The results of CCK-8 and transwell assays suggested that the proliferation and invasion of UBE2C knockdown cells were significantly inhibited (P < 0.050). The results of Western blot assay showed that the level of phosphorylated phosphatase and tensin homology deleted on chromosome 10 (p-PTEN) was obviously increased (P < 0.050), whereas the levels of phosphorylated protein kinase B (p-AKT), phosphorylated mammalian target of rapamycin (p-mTOR), and hypoxia-inducible factor-1 alpha (HIF-1α) were dramatically decreased (P < 0.050) in the UBE2C knockdown cell.@*CONCLUSION@#UBE2C can promote BC proliferation by activating the AKT/mTOR signaling pathway.

Influencing factors of preoperative pulmonary function in elderly patients undergoing rotator cuff surgery / 北京大学学报(医学版)

OBJECTIVE@#To analyze the preoperative pulmonary function in rotator cuff injury patients and the possible influencing factors.@*METHODS@#All the rotator cuff surgery patients who underwent pre-operative pulmonary function examination in Peking University Third Hospital from Jan. 2020 to Jun. 2020 were retrospectively reviewed. Their perioperative medical records and main parameters of pulmonary function were collected from database management system, and their gender, age, body mass index (BMI), smoking history, time from injury, visual analogue scale (VAS) and other factors impacting on preoperative pulmonary function were studied.@*RESULTS@#Twenty-nine patients with rotator cuff injury were included, among whom 1 patient was reported to have restrictive ventilation dysfunction and 2 patients to have obstructive ventilation dysfunction. All the three patients denied the history of respiratory diseases, and had no respiratory symptoms. In all enrolled patients, the mean forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) was 79.2%±5.9%, and the mean VAS pain score was 3.66±1.26. In addition, the dynamic pulmonary functions (FVC, FEV1) were reduced in more than half of the elderly, and the total lung capacity (TLC) was lower than the estimated value in 2/3 of the elderly. There were significant differences in three main indexes of pulmonary functions between genders, and the percentage of the estimated TLC between normal BMI group (18 kg/m2 < BMI < 24 kg/m2) and overweight/obesity group (BMI≥24 kg/m2) was significantly different. Based on the injury time longer than 1 year or not, the results indicated that FVC and TLC were significantly different between the two groups.@*CONCLUSION@#In addition to gender and age, time from injury and severity of pain, as well as overweight/obesity, may influence pulmonary function outcomes in the elderly rotator cuff patients. Targeted intervention can be carried out on these factors before surgery. Preoperative lung function test can be used as one of the basic evaluation indexes for respiratory training and rehabilitation of patients.

Correlations of miR-432 expression with cell proliferation and migration and tripartite motif containing protein 38 expression in isocitrate dehydrogenase wild-type glioma, and overall survival of these patients / 中华神经医学杂志

Objective:To study the correlations of micro RNA (miR)-432 expression with cell proliferation and migration, and tripartite motif containing protein 38 ( TRIM38) gene expression in isocitrate dehydrogenase ( IDH) wild-type glioma, and overall survival (OS) of these patients. Methods:(1) The miRNA expression microarray data of 198 glioma patients (81 with IDH mutant, 106 with IDH wild type and 11 with unknown type) and 5 nontumorous brain tissues (controls) were downloaded from China Glioma Genome Atlas (CGGA); expression differences of miR-432 between IDH mutant and IDH wild type glioma subgroups and normal controls were compared. According to the median value of miR-432 expression in IDH wild-type glioma samples, these patients were divided into miR-432 high expression group ( n=51) and miR-432 low expression group ( n=53), Kaplan-Meier survival analysis was used to compare the OS, univariate and multivariate Cox regression analyses were used to determine the factors influencing OS, and Pearson correlation was used to analyze the relation between miR-432 expression and TRIM38 gene expression. (2) Human glioma cell line U251 was routinely cultured and divided into nonsense sequence control group and miR-432 mimics group; CCK-8 assay was used to detect the cell viability on the 1 st-5 th d of cultivation; Transwell assay was used to detect the cell migration; quantitative reverse transcription PCR (RT-qPCR) was used to detect the TRIM38 mRNA expression. (3) According to the binding sites between miR-432 and TRIM38 gene predicted by miRNA target gene prediction database, the wild-type TRIM38 3'-terminal untranslated region (3'-UTR) and mutant TRIM38 3'-UTR sequences were designed; U251 cells were divided into miR-432 nonsense sequence+wild-type TRIM38 3'-UTR group, miR-432 mimics+wild-type TRIM38 3'-UTR group, miR-432 nonsense sequence+mutant TRIM38 3'-UTR group, and miR-432 mimics+mutant TRIM38 3'-UTR group; the luciferase activity in these 4 groups was detected by microplate assay. Results:(1) The miR-432 expression in IDH wild-type glioma was significantly decreased as compared with that in the IDH mutant one ( P<0.05). The OS of patients in the miR-432 low-expression group was significantly shorter as compared with that in the miR-432 high-expression group ( P<0.05). Age, glioma grading, and miR-432 expression were significantly correlated with OS of IDH wild-type glioma patients ( P<0.05), but miR-432 expression level was not an independent influencing factor for OS ( P>0.05). The miR-432 and TRIM38 mRNA expressions in IDH wild-type glioma samples were negatively correlated ( r=-0.255, P=0.018). (2) As compared with nonsense sequence control group, miR-432 mimics group had significantly lower cell activity on the 2 rd-5 th d of cultivation, significantly smaller number of migrated cells, and statistically decreased TRIM38 mRNA expression ( P<0.05). (3) The luciferase activity of cells in the miR-432 mimics+wild-type TRIM38 3'-UTR group was significantly lower than that in the miR-432 nonsense+wild-type TRIM38 3'-UTR group ( P<0.05). Conclusion:The miR-432 expression is low in IDH wild-type glioma tissues, and it is associated with poor prognosis of these patients; miR-432 overexpression can inhibit the proliferation and migration of glioma cells, which may be related to its specific binding of TRIM38 gene and interference the expression of this gene.

Clinical analysis of 20 pediatric patients with kerion / 中华全科医师杂志

Twenty pediatric patients with kerion were treated in Department of Dermatology, Affiliated Hospital of Jining Medical University from January 2014 to June 2020. The general information, clinical manifestations, laboratory test results, treatment and prognosis were retrospectively analyzed. There were 13 males and 7 females aged from 2 to 10 years. Thirteen patients had a history of contact with animals, 4 had contact with parents with tinea. All patients had alopecia, 6 cases presented with inflammatory mass, 14 presented with abscessus; some patients had regional lymphadenopathy and febrile. Four cases were misdiagnosed as abscesses caused by bacterial infection and underwent incision leading to deep ulcers. A total of 13 fungal strains were isolated, including 4 strains of Microsporum gypseum, 3 strains of Trichophyton rubrum, 2 strains of Microsporum canis, the others were Trichophyton tonsurans and Trichophyton mentagrophytes and Fusarium. All patients were treated with fluconazole, concomitantly with topical antifungals and He-Ne laser, 19 of whom were cured. It is suggested that kerion characterized by inflammatory lesions is likely to be misdiagnosed. Fungal examination can confirm the diagnosis of kerion, and fluconazole is effective for treatment.

Precision diagnosis of a full-term pregnancy with hydatidiform mole based on postnatal short tandem repeat DNA genotyping: a case report / 中华围产医学杂志

We describe a case of spontaneous conception following ovarian stimulation, in which a singleton pregnancy was revealed by ultrasound at 17 gestational weeks, with a multi-cystic "honeycomb" pattern in part of the placenta. With close monitoring, the patient delivered a healthy male neonate through cesarean section at 38 gestational weeks. The clinical findings, combined with ultrasound, laboratory, pathological, and immunohistochemistry examination, and short tandem repeat genotyping, confirmed a twin pregnancy consisting of a complete mole and coexisting fetus. No obvious abnormalities were found in the mother or the boy during a four-and-a-half-year's follow-up.

Advances in innate immune evasion strategies of enterovirus 71 / 中华微生物学和免疫学杂志

Enterovirus 71 (EV71) is one of the main pathogens causing hand, foot and mouth disease (HFMD), which seriously threatens the health of infants and young children and causes major infectious diseases in the Asia-Pacific region. The host′s innate immune response is the most effective way to fight against viral infections. However, EV71 has evolved a series of strategies, escaping from innate immune surveillance and destroying its antiviral function in the process of gaming with the host. This article mainly focuses on the research progress of EV71′s innate immune escape mechanism, and provides help for the development of anti-EV71 infection drugs.