Hospital discharge readiness and its influencing factors and nursing strategies in patients with chronic diseases with multiple diseases / 中国实用护理杂志

Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.

Expression and Clinical Significance of KIF11,β-catenin and GSK-3β in Cervical Cancer / 医学研究杂志

Objective To investigate the expression of kinesin family member 11(KIF11),β-catenin and glycogen synthase ki-nase-3β(GSK-3β)in cervical cancer and its clinical significance.Methods The expression of KIF11,β-catenin and GSK-3β in 102 cases of cervical cancer,52 cases of high-grade squamous intraepithelial lesion(HSIL)and 46 cases of low-grade squamous intra-epithelial lesion(LSIL)and 40 cases of chronic cervicitis were detected by immunohistochemistry,to analyze the relationship between the expression of the three indicators and the clinicopathological characteristics of cervical cancer patients,and to analyze the correlation be-tween the three indicators.COX proportional hazards model was used to analyze the prognostic factors of cervical cancer patients.Results With the progression of cervical lesions,the positive rates of KIF1 1 and β-catenin increased gradually,while the positive rates of GSK-3β decreased gradually(P＜0.05).The positive expressions of KIF11,β-catenin and GSK-3β in cervical cancer tissues were significantly different in International Federation of Gynecology and Obstetrics(FIGO)stage,differentiation degree and lymph node metastasis(P＜0.05),but there was no significant difference among different ages and pathological types(P＞0.05).The expression level of KIF11 was positively correlated with β-catenin(r=0.461,P＜0.05),and the expression level of β-catenin was negatively correlated with GSK-3β(r=-0.692,P＜0.05).The expression level of KIF11 was negatively correlated with GSK-3β(r=-0.336,P＜0.05).The average survival time of patients with positive expression of KIF11 and β-catenin was shorter than that of pa-tients with negative expression,and the average survival time of patients with positive expression of GSK-3 β was longer than that of pa-tients with negative expression of GSK-3β.COX regression analysis showed that FIGO stage,lymph node metastasis,KIF11 and β-catenin were independent risk factors for the prognosis of cervical cancer patients,and GSK-3β was an independent protective factor.Conclusion KIF11,β-catenin and GSK-3β are abnormally expressed in the tissues of cervical cancer patients.KIF11 may be in-volved in the regulation of Wnt/β-catenin pathway in the development of cervical cancer.The combined detection of KIF11 may provide a new reference for the diagnosis and prognosis of cervical cancer.

Impact of the interval period after prostate systematic biopsy on MRI interpretation for prostate cancer / 中华放射学杂志

Objective:To investigate the impact of the interval period between biopsy and MR examination on tumor detection and extraprostatic extension (EPE) assessment for prostate cancer (PCa) using multi-parametric MRI (mpMRI).Methods:The study was cross-sectional and retrospectively included 130 patients with PCa who underwent RP and preoperative systematic biopsies followed by mpMRI between January 2021 and December 2022 in the First Medical Center of Chinese PLA General Hospital. Patients were divided into 3 groups according to interval following biopsy (group A,<3 weeks, 31 cases; group B, 3-6 weeks, 67 cases; group C,>6 weeks, 32 cases). The percentages of hemorrhage volume in the total prostate were drawn on T 1WI and calculated. The junior, senior and expert radiologists independently localized the index lesions and calculated the accuracy for tumor detection, in addition to assessing the probabilities of EPE according to EPE grade. The correlation between the hemorrhage extent and interval was analyzed using the Spearman correlation coefficient. The accuracy for tumor detection was compared using χ2 test among groups. The diagnostic performance of the radiologists for EPE prediction was assessed using the receiver operating characteristic curve, and the differences between the corresponding area under the curve (AUC) were compared using the DeLong test. Results:The percentage of hemorrhage was correlated with the interval between biopsy and MR examination ( r=-0.325, P<0.001). The detection accuracy of junior radiologist was 83.9% (26/31), 76.1% (51/67), and 78.1% (25/32) in group A, B and C, respectively; no differences were observed in the detection accuracy among three groups ( χ2=0.76, P=0.685). The detection accuracy of senior radiologist was 83.9% (26/31), 80.6% (54/67), and 71.9% (23/32) in 3 groups with no differences ( χ2=1.53, P=0.464). The detection accuracy of expert radiologist was 80.6% (25/31), 77.6% (52/67), and 93.8% (30/32) with no differences ( χ2=3.95, P=0.139). The AUC (95% CI) for predicting EPE were 0.830 (0.652-0.940), 0.704 (0.580-0.809), 0.800 (0.621-0.920) in the group A, B and C for junior radiologist; 0.876 (0.708-0.966), 0.768 (0.659-0.863), 0.896 (0.736-0.975) for senior radiologist; and 0.866 (0.695-0.961), 0.813 (0.699-0.895), 0.852 (0.682-0.952) for expert radiologist, respectively. No differences were observed among the subgroups in each radiologist ( P>0.05). Conclusion:The interval period does not significantly affect the detection accuracy and EPE assessment of PCa using mpMRI. There is probably no necessity for prolonged intervals following systematic biopsy to preserve the clarity of MRI interpretation for PCa.

Cortical hierarchy disorganization in major depressive disorder and its association with suicidality.

Objectives: To explore the suicide risk-specific disruption of cortical hierarchy in major depressive disorder (MDD) patients with diverse suicide risks. Methods: Ninety-two MDD patients with diverse suicide risks and 38 matched controls underwent resting-state functional MRI. Connectome gradient analysis and stepwise functional connectivity (SFC) analysis were used to characterize the suicide risk-specific alterations of cortical hierarchy in MDD patients. Results: Relative to controls, patients with suicide attempts (SA) had a prominent compression from the sensorimotor system; patients with suicide ideations (SI) had a prominent compression from the higher-level systems; non-suicide patients had a compression from both the sensorimotor system and higher-level systems, although it was less prominent relative to SA and SI patients. SFC analysis further validated this depolarization phenomenon. Conclusion: This study revealed MDD patients had suicide risk-specific disruptions of cortical hierarchy, which advance our understanding of the neuromechanisms of suicidality in MDD patients.

Behavioral and pathological characterization of YG8R transgenic mouse models of Friedreich ataxia / 中风与神经疾病杂志

@#Objective This study aimed to compare the motor behavior and pathological changes of YG8R transgenic mouse models of Friedreich ataxia (FRDA). Methods The movement behavior changes between YG8R mice and littermate wild-type (WT) mice were evaluated by the accelerated rotarod test,open field test,grip strength test and gait analysis. Real-time fluorescence-based quantitative PCR (qRT-PCR) was used to detect the Frataxin mRNA in the dorsal root ganglia (DRG) and cerebellum. Immunohistochemical staining was used to evaluate neuronal death in the mouse spinal cord tissue. Results Compared with WT mice,the time-to-fall off on an accelerating rotarod,movement distance,and grip strength of YG8R mice were significantly decreased (P<0.05) from 4 to 6 months. Compared to WT mice,YG8R mice had significantly decreased left and right hindlimb step lengths (P<0.05),increased forelimb and hindlimb step widths (P<0.01),decreased right hind limb swing time (P<0.01),and increased the touchdown time of the left and right hind limbs (P<0.05). The number of neurons in the spinal cord of YG8R mice was significantly decreased (P<0.01). The qRT-PCR results showed that frataxin mRNA levels in the spinal cord and DRG of YG8R mice were significantly decreased compared with the WT group (P<0.0001). Conclusion This study further provides detailed motor characteristics and pathological changes of the YG8R transgenic mouse models of FRDA based on GAA repeat expansion,which will be helpful for follow-up studies on the disease mechanism and treatment of FRDA.

Value of quantitative parameters of enhanced MRI in predicting collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus / 中华放射学杂志

Objective:To explore the value of quantitative parameters of enhanced MRI in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus.Methods:Sixty-seven patients with renal cell carcinoma and inferior vena cava tumor thrombus who underwent radical resection and inferior vena cava venography in First Medical Center, PLA General Hospital from May 2006 to January 2021 were included retrospectively. According to the results of inferior vena cava venography, the patients were divided into two groups: the well-established collateral circulation group ( n=41) and the poor-established collateral circulation group ( n=26). Quantitative parameters were measured on preoperative enhanced MRI images, including tumor size, the maximum diameter of bilateral lumbar veins, the length of tumor thrombus, and the long and short diameters of tumor thrombus. Student′s t test or Mann-Whitney U test was used for comparison between the two groups. The independent risk factors related to the establishment of collateral circulation were obtained by binary logistic regression analysis and the model was established. The receiver operating characteristic curve was employed to evaluate MRI quantitative parameters and the logistic model, and the area under the curve (AUC) was compared by the DeLong test. Results:Between the well-established collateral circulation group and the poor-established collateral circulation group, the maximum diameter of the right lumbar vein, the maximum diameter of the left lumbar vein, the length of the tumor thrombus, the long diameter of the tumor thrombus, and the short diameter of the tumor thrombus were different significantly ( P<0.05). There was no significant difference in the tumor size between the two groups ( t=0.30, P=0.766). The AUC of the maximum diameters of the right lumbar veins and left lumbar veins, length of tumor thrombus, long and short diameters of tumor thrombus in predicting the collateral circulation were 0.917 (95%CI 0.824-0.971), 0.869 (95%CI 0.764-0.939), 0.756 (95%CI 0.636-0.853), 0.886 (95%CI 0.785-0.951), and 0.906 (95%CI 0.809-0.963). The AUC of the maximum diameter of the right lumbar vein and the short diameter of the tumor thrombus were larger than those of the length of the tumor thrombus, and the differences were statistically significant ( Z=2.25, 2.04, P=0.025, 0.041), but the AUC between other parameters had no significant difference ( P>0.05). The maximum diameter of the right lumbar vein (OR 24.210, 95%CI 2.845-205.998), the maximum diameter of the left lumbar vein (OR 20.973, 95%CI 2.359-186.490), and the length of the tumor thrombus (OR 23.006, 95%CI 2.952-179.309) were independent risk factors for predicting the establishment of inferior vena cava collateral circulation. The AUC of logistic model was 0.969 (95%CI 0.931-1.000). Conclusion:Quantitative parameters of tumor thrombus and lumbar vein based on enhanced MRI have a good ability in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus. The maximum diameter of bilateral lumbar veins and the length of the tumor thrombus were independent risk factors for inferior vena cava collateral circulation.

Interobserver agreement and diagnostic performance assessment of clear cell likelihood score using T 2WI with fat suppression technique / 中华放射学杂志

Objectives:To investigate the effect of fat suppression (FS) T 2WI on the interobserver agreement and diagnostic performance of clear cell likelihood score version 2.0 (ccLS v2.0) for clear cell renal cell carcinoma (ccRCC). Methods:In this retrospective study, the MR images of 111 patients with pathologically confirmed small renal masses (SRM) from January to December 2021 were analyzed in the First Medical Centre, Chinese PLA General Hospital. Of the 111 SRM, 82 cases were ccRCC and 29 cases were non-ccRCC. Two radiologists independently assessed ccLS scores based on T 2WI signal intensity (hypointense, isointense, hyperintense) and other MRI features (ccLS-T 2WI). After a one-month interval, the ccLS scores were independently evaluated utilizing the frequency-selective saturation FS-T 2WI and other MRI features (ccLS-FS-T 2WI). Fisher′s exact test was used to compare the difference in SRM signal intensity on T 2WI and FS-T 2WI. The weighted Kappa test was performed to assess the interobserver agreement of the two radiologists, and differences in the weighted Kappa coefficients were compared using the Gwet consistency coefficient. Receiver operating characteristic curves were drawn to evaluate the diagnostic performance of ccLS-T 2WI and ccLS-FS-T 2WI in diagnosing ccRCC, and the area under the curve (AUC) was compared utilizing the DeLong test. Results:The signal intensity of 111 SRM on T 2WI and FS-T 2WI had statistically significant difference (χ 2=126.33, P<0.001), consistent in 88 cases (79.3%) and varied in 23 cases (20.7%). The weighted Kappa coefficient of ccLS-T 2WI was 0.57 (95%CI 0.45-0.69) between the two radiologists, and the weighted Kappa coefficient of ccLS-FS-T 2WI was 0.55 (95%CI 0.42-0.67), and the difference was not statistically significant ( t=-0.65, P=0.520). The AUC of ccLS-T 2WI for ccRCC diagnosis was 0.92 (95%CI 0.86-0.97), while the AUC of ccLS-FS-T 2WI for ccRCC diagnosis was 0.91 (95%CI 0.85-0.96), and the difference was not statistically significant ( Z=1.50, P=0.133). Conclusions:The interobserver agreement and diagnostic performance of ccLS v2.0 based on T 2WI and FS-T 2WI sequences for ccRCC are comparable, and FS-T 2WI is applicable for the clinical application of ccLS v2.0.

Mixed epithelial and stromal tumor family of the kidney: clinical and MRI features / 中华放射学杂志

Objective:To investigate the clinical and MRI features of the mixed epithelial and stromal tumor family (MESTF) of the kidney.Methods:From January 2009 to September 2021, 42 patients with pathologically-proven MESTF from the First Medical Center of Chinese PLA General Hospital were collected in this retrospective study. Clinical information, MRI features, and pathological results were documented. According to the Bosniak classification (BC) version 2019, all MESTFs were divided into cystic MESTFs (36 cases) and solid-cystic MESTFs (6 cases). The R.E.N.A.L. nephrometry score (RNS), lesion size, laterality, location, margin, shape, growth pattern, presence of protruding into renal sinus, hemorrhage, and enhancement pattern were evaluated and documented. Based on BC versions 2005 and 2019, all the cystic MESTFs were assessed and divided into low (Ⅰ, Ⅱ, ⅡF) and high (Ⅲ, Ⅳ) grades. The independent sample t test or Mann-Whitney U test were performed to compare age, RNS, and lesion size between cystic MESTFs and solid-cystic MESTFs. Pearson χ 2 test, continuity-adjusted χ 2 test or Fisher exact probability test were utilized to evaluated the differences of clinical and MRI features and the distribution of low or high grades in two versions of BC. Results:Forty-two MESTFs were unilateral and solitary masses, 25 males and 17 females, with a mean age of (41±13) years old. Compared to solid-cystic MESTFs, cystic MESTFs were prone to demonstrate endophytic growth pattern (χ 2=17.77, P<0.001), and no significant differences in other clinical and MRI features were observed between cystic and solid-cystic MESTFs (all P>0.05). There were 7 low-grade and 29 high-grade tumors in the BC version 2005, respectively. Meanwhile, 24 low-grade and 12 high-grade tumors in the BC version 2019, respectively. The distribution of low or high-grade tumors in the two versions of BC had a statistically significant difference (χ 2=16.37, P<0.001). Conclusion:MESTFs demonstrated middle-age onset and no gender predilection. Cystic MESTFs are more likely to exhibit endophytic growth pattern with low-grade classification in BC system version 2019.

Protective effect of heme chloride on hypoxia-induced tissue injury in mice / 中南大学学报(医学版)

Objective:Heme chloride(Hemin)is an in vitro purified form of natural heme and an important raw material for anti-anemia and antitumor drugs.This study aims to analyze the protective effect of Hemin on tissue damage in low-pressure oxygen chamber simulated plateau hypoxic mice,and explore its role in anti-plateau hypoxia. Methods:Thirty male BALB/c mice were randomly divided into a blank group,a positive drug group(acetazolomide,200 mg/kg),a Hemin low-dose group(15 mg/kg),a Hemin medium-dose group(30 mg/kg),and a Hemin high-dose group(60 mg/kg)with intraperitoneal injection.The anti-hypoxic activity of Hemin was explored by atmospheric closed hypoxia experiment and the optimal dose was screened.Thirty-six male BALB/c mice were randomly divided into a blank group,a hypoxia group,a positive drug group,and a Hemin high-dose group.The plasma inflammatory factor levels and oxidative stress indicators malondialdehyde(MDA),glutataione(GSH),and superoxide dismutase(SOD)levels of myocardium,brain,lung,and liver tissues were measured in different groups with hypoxia for 24 h.The degree of histopathological damage of mice was observed with HE staining.The degree of protection of Hemin against tissue hypoxia injury was detected with the hypoxia probe piperidazole. Results:Compared with the blank group,the survival time of mice in the positive drug group,the Hemin medium-dose group,and high-dose group was significantly extended(all P<0.05),with the highest prolongation rate in the Hemin high-dose group.Compared with the hypoxia group,mice in the Hemin high-dose group showed a significant increase in SOD level and GSH content of brain tissue,and a significant decrease in MDA content of lung tissue(all P<0.05).The results of HE staining and hypoxia probe showed that Hemin had a significant protective effect on the damage of liver,heart,brain and lung tissues of mice with hypoxia,and the most obvious effect on that of the brain tissue. Conclusion:Hemin has an effect of improvement on oxidative stress and inflammatory response caused by hypoxia,and has obvious protective effect on tissue damage caused by hypoxia.

The role of intravoxel incoherent motion diffusion-weighted imaging in distinguishing diabetic nephropathy from non-diabetic renal disease in diabetic patients / 中华内科杂志

Objective:To investigate the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM).Methods:A diagnostic test. In this prospective study, patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled. IVIM-DWI parameters including perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured in the renal cortex, medulla, and parenchyma. Patients were divided into the DN group and NDRD group based on the renal biopsy results. IVIM-DWI parameters, clinical information, and diabetes-related biochemical indicators between the two groups were compared using Student′s t-test or Mann-Whitney U test. The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman′s correlation analyzes. The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic (ROC) curves. Results:A total of 27 DN patients and 23 NDRD patients were included in this study. The DN group comprised 19 male and 8 female patients, with an average age of 52±9 years. The NDRD group comprised 16 male and 7 female patients, with an average age of 49±10 years. The DN group had a higher D* value in the renal cortex and a lower f value in the renal medulla than the NDRD group (9.84×10 -3 mm 2/s vs. 7.35×10 -3 mm 2/s, Z=-3.65; 41.01% vs. 46.74%, Z=-2.29; all P<0.05). The renal medulla D* value was negatively correlated with DN grades, interstitial lesion score, and interstitial fibrosis and tubular atrophy (IFTA) score ( r=-0.571, -0.409, -0.409; all P<0.05) while the renal cortex f value was positively correlated with vascular sclerosis score ( r=0.413, P=0.032). The renal cortex D* value had the highest area under the curve (AUC) for discriminating between the DN and NDRD groups (AUC=0.802, sensitivity 91.3%, specificity 55.6%). Conclusion:IVIM-derived renal cortex D* value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.

Practice and exploration of " medical insurance home payment" of " Internet plus nursing service" in Ningbo / 中华医院管理杂志

In December 2021, in order to effectively solve the economic burden and payment difficulties of the elderly or disabled elderly and tumor patients in the promotion of " Internet plus nursing services", Ningbo included three home medical care services, namely, peripherally inserted central maintenance, urinary catheter care and nasogastric tube care with large patient needs and high frequency, into medical insurance, and could be paid at home(hereinafter referred to as: " medical insurance home payment" ). The author introduced the relevant concepts and service processes of " medical insurance home payment", and summarized the effects, problems and further improvement measures. After the implementation of the policy, the number of three nursing services included in " medical insurance home payment" reached 7 953 in 2022, with an increase of 105.29% over the same period in 2021, no adverse events occurred, and patient satisfaction was high. Ningbo " medical insurance home payment" could reduce the economic burden of patients and provide a reference for the medical insurance payment and service charges of " Internet plus nursing services" in China.

Effect of Jianpi Yishen Huazhuo Prescription on Ovarian Function in Rats with Polycystic Ovary Syndrome Based on NLRP3 Inflammatory Pathway / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Jianpi Yishen Huazhuo prescription in the improvement of ovarian function in polycystic ovary syndrome （PCOS）. MethodSeventy female SD rats in SPF grade were randomly divided into 6 groups， 15 in the blank group and 15 in the model group， 10 in the metformin group （0.1 g·kg-1·d-1）， and 10 in the low （1.275 g·kg-1·d-1）， medium （2.55 g·kg-1·d-1）， and high-dose （5.10 g·kg-1·d-1） Jianpi Yishen Huazhuo prescription groups. The blank group was given normal saline （10 mL·kg-1·d-1） by gavage and ordinary feed， and the other groups were given letrozole （1 mg·kg-1·d-1） by gavage combined with high-fat feed for 21 days to induce the model of PCOS. After modeling， the blank group and model group were given equal volume normal saline by gavage， and each drug group was given the corresponding dose of the drug by gavage for 30 days. The changes in body mass and fasting blood glucose （FPG） of rats before and after modeling were compared. Hematoxylin eosin （HE） staining was used to observe the morphological change in the ovaries of rats in each group. The serum levels of follicle stimulating hormone （FSH）， luteinizing hormone （LH）， testosterone （T）， anti-Mullerian hormone （AMH）， and estradiol （E2） were measured by enzyme-linked immunosorbent assay （ELISA）， and the LH/FSH ratio was calculated. Immunohistochemical staining （IHC） and Western blot were used to detect the protein expression levels of nucleoside binding oligomerization domain protein like receptor 3 （NALP3）， apoptosis-associated speck-like protein （ASC）， cysteine protease-1 （Caspase-1）， nuclear transcription factor-κB （NF-κB）， interleukin-1β （IL-1β）， interleukin-18 （IL-18）， and interleukin-6 （IL-6） in the rat ovaries. ResultAs compared with the blank group， large follicles with polycystic expansion were found in the ovaries of the model group， no dominant follicles were found， the granular layer of follicles decreased and arranged loosely， and the number of corpus luteum decreased significantly. Serum T， LH， AMH and LH/FSH increased in the model group （P<0.05， P<0.01）， while FSH and E2 decreased （P<0.05， P<0.01）. The relative protein expression levels of NALP3， ASC， Caspase-1， NF-κB， IL-1β， IL-18， and IL-6 increased （P<0.05， P<0.01） in the ovaries of the model group. Compared with the model group， the low， medium， and high-dose Jianpi Yishen Huazhuo prescription groups and the metformin group showed growing follicles and corpus luteum at all levels， the number of cystic expanding follicles decreased， the thickness of follicular granular layer increased， the number of follicular fluid increased， mature follicles were visible， and the local morphology of oocytes was complete. Serum T， LH， AMH， and LH/FSH in these groups decreased （P<0.05， P<0.01）， while E2 and FSH increased （P<0.05）. The relative protein expressions of NALP3， ASC， Caspase-1， NF-κB， IL-1β， IL-18， and IL-6 in the ovaries of these groups decreased （P<0.05， P<0.01）. There was no significant difference among the treatment groups. ConclusionBy inhibiting the activation of NLRP3 inflammasome， Jianpi Yishen Huazhuo prescription reduces the release of NALP3， ASC， Caspase-1， NF-κB， IL-18， IL-1β， and IL-6 inflammatory factors in ovarian tissues， regulates endocrine level， and effectively reduces PCOS inflammatory statu， so as to play a role in improving ovarian function.

Efficacy of adrenocorticotropic hormone in treating primary nephrotic syndrome in children with dual resistance to glucocorticoids and calcineurin inhibitors / 中华肾脏病杂志

Objective:To investigate the efficacy and safety of adrenocorticotropic hormone (ACTH) in treating primary nephrotic syndrome in children with dual resistance to glucocorticoids and calcineurin inhibitors (CNIs).Methods:Clinical data of 6 children with primary nephrotic syndrome treated with ACTH in the Children's Hospital of Zhejiang University School of Medicine from January 1, 2015 to December 31, 2019 were retrospectively collected. All the enrolled patients were children with primary nephrotic syndrome with dual resistance to glucocorticoids and CNIs. All the 6 children were given 0.4-1.0 IU·kg -1·d -1 ACTH (total ≤25 IU)+5% glucose 500 ml intravenous infusion for 8 h during the hormone reduction process, with a course of treatment for 5 days, once a month, and continuous treatment for 3-6 months. Clinical data such as 24 h urinary protein quantification, serum albumin, serum cholesterol, estimated glomerular filtration rate (eGFR) level and glucocorticoid dosage were collected at equal time points at 6 months before treatment, at the beginning of treatment, at the end of treatment and at 6 months of follow-up after treatment of ACTH to evaluate the efficacy and adverse reactions. Results:The onset age of 6 children was (4.89±1.77) years, and the age of the first treatment with ACTH was (9.49±3.06) years. All the 6 children completed 3 to 6 months of ACTH treatment, with 2 cases of complete remission, 2 cases of partial remission and 2 cases of no remission. At the end of ACTH treatment, 24 h urinary protein was significantly decreased ( P=0.026), serum albumin level was significantly increased ( P=0.003), and glucocorticoid dosage was significantly decreased ( P<0.001) than before treatment. At 6 months after the end of ACTH treatment, there was no statistical significance in 24 h urinary protein, serum albumin and hormone dosage compared with the end of ACTH treatment (all P>0.05), and the blood cholesterol level continued to decrease ( P=0.039). There was no significant change in eGFR during observation period ( P>0.05). In the process of ACTH infusion, all the 6 children showed transient decrease in urine output, rash in 2 cases, and elevated blood glucose in 1 case, which could be spontaneously relieved after drug withdrawal. There were no serious cardiovascular events, renal impairment, infection and other adverse reactions. Conclusions:ACTH has a good effect on children with primary nephrotic syndrome who are dual resistant to glucocorticoids and CNIs. ACTH can reduce proteinuria, decrease the dosage of glucocorticoids, improve the clinical remission rate, and has good security.

Relationships among psychological stress, achievement motivation and psychological capital in college students / 中国学校卫生

Objective@#This study explored the relationships among psychological stress, achievement motivation and psychological capital in college students to provide a reference for improving the level of psychological capital in college students.@*Methods@#A multi stage stratified cluster sampling method was used to select 9 940 college students from ten universities in Anhui Province. The achievement motivation scale (AMS), psychological stress scale (SRQ-20) and psychological capital scale (PPQ) were applied. The moderating effect of the questionnaire was analyzed with χ 2 tests, Spearman rank correlation and stratified regression.@*Results@#Statistical differences were found in psychological stress according to major, whether students leader, family economic status and whether students had left behind experience ( χ 2=15.50, 10.25, 28.61, 25.55, P <0.05). The rank correlation results indicated that psychological stress was negatively correlated with the pursuit of success ( r =-0.27) and four dimensions of self efficacy,optimism,hope and resilence in psychological capital ( r =-0.43, -0.41,-0.36,-0.45)( P <0.05), and was positively correlated with the avoidance of failure ( r =0.25, P <0.05). The stratified regression model indicated that psychological stress in the dimensions of college students achievement motivation (pursuit of success: β =0.02, Δ R 2=0.01, P <0.01; failure avoidance: β = 0.03 , Δ R 2=0.01, P <0.01) played a moderating role in the relationship between psychological capital and psychological capital.@*Conclusion@#Being female, senior students, low household economic status, and left behind experience are associated with more psychological stress among college students. Psychological stress is correlated with achievement motivation and psychological capital, and has a moderating effect on the relationship between achievement motivation and psychological capital.

Practice on fine management to shorten outpatient waiting time / 中华医院管理杂志

To solve the problems of long waiting time for outpatients, difficulty on implementation of one patient one room initiative, backward appointment method on examination, and imperfect instruction and guidance, a series of fine management measures have been taken place in a tertiary hospital which included dividing the patient waiting queue reasonably, establishing the patient secondary consultation system, improving the outpatient order of two-way management between doctors and patients, establishing one key appointment system for examinations, building hospital intelligent navigation system, and implementing outpatient payment and self-service drug delivery.The results showed, the waiting time of outpatients was significantly shortened ( P<0.001), and the satisfaction of patients in waiting time, hospital guidance and appointment registration was significantly improved ( P<0.05). Fine management mode combining online and offline can effectively increase the efficiency of outpatient service, improve clinical experience, and facilitate the high-quality development of medical services.

Detection of p16/Ki-67 in women with abnormal cytological results and its diagnostic value for cervical intraepithelial neoplasia II+ grade / 国际生物医学工程杂志

Objective:To explore the detection capability of p16/Ki-67 double staining technique in women with various abnormal thinprep cytologic test (TCT) results and its diagnostic value for cervical intraepithelial neoplasia Ⅱ+ grade (CIN2+).Methods:A total of 225 women with abnormal TCT results, i.e. the atypical squamous cells of undetermined significance(ASC-US), in the Tianjin Central Hospital of Gynecology Obstetrics, Nankai University Affiliated Maternity Hospital from December 2018 to December 2019 were enrolled. p16/Ki-67 double staining were detected and compared with the high risk human papillomavirus (HR-HPV) and pathological results.Results:The positive rates of p16/Ki-67 double staining increased with cytologic and pathologic categories. For diagnosis of CIN2+, p16/Ki-67double staining (90.1%) was less sensitive than HR-HPV testing (98.2%)( P<0.05), but the specificity of p16/Ki-67 double staining (58.8%) was significantly higher than HR-HPV(21.6%) ( P<0.001). Conclusions:Compared with HR-HPV, p16/Ki-67 double staining has better effect on diagnosing CIN2+. p16/Ki-67 double staining can be considered as triaging method for management of ASC-US and LSIL patients, significantly reduce the colposcopy referral rate (nearly 50%), which has high clinical application value.

Effect of sequel reperfusion coronary intervention on heart rate variability of patients with acute ST-segment elevation myocardial infarction / 中国基层医药

Objective:To explore the effect of sequel reperfusion percutaneous coronary intervention (PCI) therapy on heart rate variability (HRV) during myocardial reperfusion in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:With a randomly case controlled study method, 180 patients with STEMI in Yidu Central Hospital Affiliated to Weifang Medical College were selected as study objects, and they were randomly divided into two groups: sequel recanalization PCI(sPCI) group(observation group) and conventional primary PCI(pPCI) group(control group), with 90 cases in each grouop.The rate of SDNN<70 mm of the two groups and other indicators of HRV were observed at 14 d after successful PCI.Results:There was statistically significant difference between the two groups in MBG3(77.78% vs.63.33%, χ 2=4.51, P=0.03). There was statistically significant difference between the two groups in the incidence of SDNN<70 mm at 14 d after PCI(10.00% vs.23.33%, χ 2=5.69, P=0.02). If sequel recanalization PCI was served as a variable for predicting SDNN<70 mm, the results of Logistic regression analysis showed that odds ratio ( OR) value was 0.36, 95% confidence interval ( CI) was 0.16-0.85, P=0.02.The other factors that affected the incidence rate of SDNN<70 mm were the level of MBG3( OR=0.45, 95% CI: 0.16~0.95, P=0.03), time-to-reperfusion( OR=2.65, 95% CI: 1.06~5.98, P=0.04), blood sugar level of admission ( OR=1.96, 95% CI: 1.04~7.71, P=0.04), TnI value( OR=2.06, 95% CI: 1.03~5.68, P=0.04), heart function( OR=2.18, 95% CI: 1.08~6.89, P=0.04). Conclusion:The sequel recanalization PCI may be better than conventional PCI for the patients with STEMI in obtaining myocardial blush grades.Meanwhile, it can increase the indicators of HRV and decrease the incidence rate of SDNN<70 mm.

Analysis of 130 cases of pediatric primary nephrotic syndrome without routine hormone therapy immediately after diagnosis / 中华肾脏病杂志

Objective:To investigate the causes and outcomes in the children who did not immediately receive glucocorticoids therapy after initial diagnosis of primary nephrotic syndrome (PNS).Methods:The clinical data of PNS patients not immediately receiving glucocorticoids therapy after initial diagnosis at the Department of Nephrology, the Children's Hospital, Zhejiang University School of Medicine from January 1, 2005 to December 31, 2014 were retrospectively analyzed.Results:A total of 1 431 cases were initially diagnosed with PNS, including 1 061 males and 370 females. Among them, 130 cases did not receive conventional glucocorticoids treatment immediately, accounting for 9.1%. Of whom, 75 cases were found showing spontaneous remission after symptomatic treatment; 23 cases were directly treated with adrenocorticotropic hormone (ACTH), one case with mycophenolate mofetil (MMF), and 31 cases not given glucocorticoids or immunosuppressants because of parental refusal. Among 75 cases with spontaneous remission, 16 cases were found in sustained remission; 39 cases were treated with glucocorticoids and 6 cases with ACTH at relapse; 14 cases were lost. Among 29 cases using ACTH, 7 cases were found in sustained remission. Among the 31 cases who refused glucocorticoids or immunosuppressants therapy, one died. The case treated with MMF, later were given with halved hormone because of no-effective response.Conclusions:Spontaneous remission is found in a small proportion of PNS patients at first-onset, but most subsequently relapse. Hormone therapy should be routinely given unless remission has occurred before application. Some children's parents refuse hormone therapy, and need further communication. Some cases initially treated with ACTH are found in sustained remission, which should be further observed and studied to clear the efficacy and safety of ACTH.

Establishment of a model for ward categorizing and grading and its application in nursing management / 中华医院管理杂志

In order to identify 35 key work items indicating the workload, difficulty of nursing technology and nursing risk of different wards scientifically, a mathematical model of classification of wards was established by literature review, conference discussions, expert consultation, brainstorming, and field measurement, and information technology as well. On such basis, scores of the wards were calculated, and the total scoring of each ward was ranked from high to low into three categories and six grades. Each grade of wards was assigned with different performance distribution weights. Such a mathematical model for ward categorizing and grading based on HIS system and key item and weights, can monitor ward nursing in real time, and provide nursing administrators at all levels with clinical risk early warning by means of vertical and horizontal comparisons. These administrators can take precautions in time in terms of human resources and materials. Ward categorizing and grading as an indicator for performance distribution ensures the rationality of such distribution, enhances nursing motivation and stabilizes front-line nursing teams in the end.

Progress of anti-angiogenesis targeted therapy of advanced osteosarcoma / 肿瘤研究与临床

Osteosarcoma is a malignant tumor of mesenchymal origin and occurs mostly in young people, which is characterized with high malignancy, poor prognosis, easy recurrence and metastasis, as well as a great difficulty in treatment. Osteosarcoma is rich in blood supply, and its growth, invasion and metastasis highly depend on the tumor new angiogenesis. The process of angiogenesis is mainly initiated by various pro-angiogenic factors secreted by tumor cells, and the anti-angiogenic targeted therapy has been taken based on the targets spot and signal pathways of various angiogenic factors, which can effectively suppress the various biological behaviors of the osteosarcoma and improve the survival rate. However, a series of problems, such as drug resistance, side effects, different evaluation criteria, and difficulties in selecting effective treatment strategies also exist in the process of anti-angiogenesis therapy, and thus, further studies are needed. This paper mainly reviews the clinical trials of anti-angiogenic drugs, main barriers in usage, as well as the feasible treatment strategies in clinical practice.