Study on the Application Effect of Humanoid Figure Teaching Method in the Improvement of Job Competence and Humanistic Care Ability of Newly Recruited Nurses / 中国医学伦理学

To explore the effects of the humanoid figure teaching method on the improvement of humanistic care and job competence of newly recruited nurses. A total of 72 newly recruited nurses in our hospital were selected as the research objects. The research objects were divided into control group and observation group, with 36 in each group. The control group was taught by traditional nursing methods, and the observation group was taught by the humanoid figure teaching method. The clinical teaching effect, core competence and humanistic care ability were compared between the two groups of newly recruited nurses. The results showed that the newly recruited nurses in the observation group had higher academic performance, nursing ward round scores, teaching satisfaction and patient family satisfaction than the control group (P<0.05). The newly recruited nurses in the observation group were better than the newly recruited nurses in the control group in terms of core competence and humanistic care ability (P<0.05). Therefore, the humanoid figure teaching method can effectively improve the clinical teaching effect of nursing work, enhance the clinical competence and humanistic care ability of newly recruited nurses, which is conducive to the development of clinical teaching and work. The humanoid figure teaching method guides newly recruited nurses from the perspective of "whole person", infiltrate the medical humanistic spirit into clinical nursing work, and provide patients with personalized services with in-depth and humanistic care.

Influencing factors for the recurrence of diabetic foot ulcers: A meta-analysis.

This study aims to systematically review and identify the related influencing factors for the recurrence of diabetic foot ulcers (DFUs)in diabetic patients. We searched PUBMED, EMBASE, Web of Science, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang and VIP databases to identify eligible studies published before March 31, 2022 to collect case-control studies or cohort studies on the related influencing factors for the recurrence of DFUs. Two reviewers independently screened the literature, and extracted data. Also, they assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale. A meta-analysis was performed using RevMan5.4.1 software. 20 studies were included; 4238 patients were enrolled, in which 1567 were in the DFU recurrence group and 2671 were in the non-recurrent DFU group. Risk factors for the recurrence of DFUs included diabetic peripheral neuropathy (odds ratio [OR] = 4.05, 95% CI, 2.50-6.58, P < 0.00001), peripheral vascular disease (OR = 3.94, 95% CI, 2.65-5.84, P < 0.00001), poor blood glucose control (OR = 3.27, 95% confidence interval [CI], 2.79-3.84, P < 0.00001), plantar ulcer (OR = 3.66, 95% CI, 2.06-6.50, P < 0.00001), osteomyelitis (OR = 7.17, 95% CI, 2.29-22.47, P = 0.0007), smoking (OR = 1.98, 95% CI, 1.65-2.38, P < 0.00001), history of amputation (OR = 11.96, 95%CI, 4.60-31.14, P < 00001), multidrug-resistant bacterial infection (OR = 3.61, 95%CI, 3.13-4.17, P < 0.00001), callus (OR = 5.70, 95%CI, 1.36-23.89, P = 0.02), previous diabetic foot ulcer (OR = 4.10, 95% CI, 2.58-6.50, P < 0.00001), duration of previous diabetic foot ulcer >60d (OR = 1.02, 95% CI, 1.00-1.03, P = 0.004), history of vascular intervention (OR = 3.20, 95% CI, 2.13-4.81, P < 0.00001) and Wagner grade III/IV (OR = 4.40, 95% CI, 2.21-8.78, P < 0.0001). However, no significant differences were found in age, duration of diabetes, body mass index, total cholesterol or foot deformity. Recurrence of diabetic foot ulcers is affected by a variety of factors. Thus, we should focus on high-risk groups and take targeted interventions as soon as possible to reduce the recurrence rate of DFUs, because of the limited quality and quantity of the included studies, more rigorous studies with adequate sample sizes are needed to verify the conclusion.

Developing an implementation protocol of clinical decision-support system about pediatric parenteral nutrition administration based on Guideline Implementation with Decision Support Checklist / 中国实用护理杂志

Objective:To develop an implementation protocol of clinical decision-support system about pediatric parenteral nutrition administration based on Guideline Implementation with Decision Support Checklist.Methods:From November to December 2021, using 4 dimensions and 16 items of Guideline Implementation with Decision Support Checklist, an multidisciplinary expert consultation was conducted, based on the previous clinical decision-support system and implementation protocol draft, to identify qualitative suggestions and quantitative assessment, and form the final protocol.Results:According to the Guideline Implementation with Decision Support Checklist, experts evaluated the implementation protocol draft, ranked the scores of 4 dimensions, system, content, context, and implementation, successively. Based on 12 updated suggestions, the final protocol included 4 dimensions and 12 interventions, including CDS updates, preparation before launching, experimental application and promotion, and systematic monitoring.Conclusions:The development of Guideline Implementation with Decision Support Checklist-based implementation protocol of clinical decision-support system about pediatric parenteral nutrition administration facilitated the thorough and structured consideration and agreement of multidisciplinary team, thus to optimize protocol and provide foundation for clinical practice.

The Efficacy and Safety of Daratumumab-Based Regimen in Treatment of Multiple Myeloma Patients with Renal Impairment / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safety of daratumumab in treatment of multiple myeloma (MM) patients with renal impairment (RI).@*METHODS@#The clinical data of 15 MM patients with RI who received daratumumab-based regimen from January 2021 to March 2022 in three centers were retrospectively analyzed. Patients were treated with daratumumab or daratumumab combined with dexamethasone or daratumumab combined with bortezomib and dexamethasone and the curative effect and survival were analyzed.@*RESULTS@#The median age of 15 patients was 64 (ranged 54-82) years old. Six patients were IgG-MM, 2 were IgA-MM,1 was IgD-MM and 6 were light chain MM. Median estinated glomerular filtration rate (eGFR) was 22.48 ml/(min·1.73 M2). Overall response rate of 11 patients with MM was 91% (≥MR), including 1 case of stringent complete response (sCR), 2 cases of very good partial response (VGPR), 3 cases of partial response (PR) and 4 cases of minor response (MR). The rate of renal response was 60%(9/15), including 4 cases of complete response (CR), 1 case of PR and 4 cases of MR. A median time of optimal renal response was 21 (ranged 7-56) days. With a median follow-up of 3 months, the median progression-free survival and overall survival of all patients were not reached. After treatment with daratumumab-based regimen, grade 1-2 neutropenia was the most common hematological adverse reaction. Non-hematological adverse reactions were mainly infusion-related adverse reactions and infections.@*CONCLUSION@#Daratumumab-based regimens have good short-term efficacy and safety in the treatment of multiple myeloma patients with renal impairment.

Effects of Decitabine Combined with Anlotinib on Proliferation and Apoptosis of Multiple Myeloma Cells / 中国实验血液学杂志

OBJECTIVE@#To investigate the biological effects and its relative mechanism of decitabine combined with anlotinib on multiple myeloma cells.@*METHODS@#The human MM cell lines and primary cells were treated with different concentrations of decitabine, anlotinib, and decitabine+anlotinib, respectively. The cell viability was detected and combination effect was calculated by CCK-8 assay. The apoptosis rate was measured by flow cytometry and the level of c-Myc protein was determined by Western blot.@*RESULTS@#Both decitabine and anlotinib could effectively inhibit the proliferation and induce the apoptosis of MM cell lines NCI-H929 and RPMI-8226. The effect of combined treatment on the inhibition of cell proliferation and induction of apoptosis was stronger than that of single-drug treatment. The combination of the two drugs also showed strong cytotoxicity in primary MM cells. Decitabine and anlotinib could down-regulate the level of c-Myc protein in MM cells and the c-Myc level in the combination group was the lowest.@*CONCLUSION@#Decitabine combined with anlotinib can effectively inhibit the proliferation and induce apoptosis of MM cells, which provides a certain experimental basis for the treatment of human MM.

Analysis of prognostic factors of extranodal NK/T-cell lymphoma treated with pegaspargase/L-asparaginase: a multicenter retrospective study / 中华血液学杂志

Objective: To explore the prognostic factors of extracellular NK/T cell lymphoma (ENKTL) treated with pegaspargase/L-asparaginase. Methods: The clinical data of 656 ENKTL patients diagnosed at 11 medical centers in the Huaihai Lymphoma Working Group from March 2014 to April 2021 were retrospectively analyzed. The patients were randomly divided into two groups: a training set (460 cases) and a validation set (196 cases) at 7∶3, and the prognostic factors of the patients were analyzed. A prognostic scoring system was established, and the predictive performance of different models was compared. Results: Patients' median age was 46 (34, 57) years, with 456 males (69.5% ) and 561 nasal involvement (85.5% ). 203 patients (30.9% ) received a chemotherapy regimen based on L-asparaginase combined with anthracyclines, and the 5-year overall survival rate of patients treated with P-GEMOX regimen (pegaspargase+gemcitabine+oxaliplatin) was better than those treated with SMILE regimen (methotrexate+dexamethasone+cyclophosphamide+L-asparaginase+etoposide) (85.9% vs 63.8% ; P=0.004). The results of multivariate analysis showed that gender, CA stage, the Eastern Cooperative Oncology Group performance status (ECOG PS) score, HGB, and EB virus DNA were independent influencing factors for the prognosis of ENKTL patients (P<0.05). In this study, the predictive performance of the prognostic factors is superior to the international prognostic index, Korean prognostic index, and prognostic index of natural killer lymphoma. Conclusion: Gender, CA stage, ECOG PS score, HGB, and EB virus DNA are prognostic factors for ENKTL patients treated with pegaspargase/L-asparaginase.

Implementation study of Evidence-based Nursing Practice Guideline for Enteral Nutrition of Infants with Congenital Heart Disease application / 中国实用护理杂志

Objective:To evaluate the effectiveness of Evidence-based Nursing Practice Guideline for Enteral Nutrition of Infants with Congenital Heart Disease application on improving the nutritional status of infants with congenital heart disease (CHD) in the target population, and to explore the effective strategies of evidence implementation in the process of dissemination, implementation and integration into clinical practice. Methods:This was an implementation study. Promoting Action on Research Implementation in Health Services Integrated Framework (i-PARIHS) was used as a theoretical model. Infants with CHD who received cardiac surgery from the heart ICU of Children ′s Hospital of Fudan University from January 2019 to February 2020 were selected as the study subjects. January to June 2019 and September to February 2020 were the pre and post implementation phase respectively. For medical staff, communication strategy, implementation process strategy, integration strategy and capacity-building strategy were used to advance the implementation process. According to the implementation strategy of children, the 26 best practice recommendations in the guide were translated into operable nursing processes and enteral nutrition programs, which were implemented in four stages: admission to the hospital, pre operation, post operation cardiac care room, post operation ward recovery, and pre discharge. Implementation Results Variable Assessment Form was used to evaluate effectiveness of the implementation strategies; hospitalization weight and upper arm circumference, serum albumin and pre-albumin before discharge were used to evaluate effectiveness of the interventions. Results:Scores of eight aspects of Implementation Results Variable Assessment reached more than 75% of the total score. Pre-albumin of post-implementation was (166.53 ± 42.57) g/L, which was statistically significantly higher than (148.41 ± 30.66) g/L before discharge ( t=-3.21, P<0.01); the weight loss of pre-implementation was 0.00 (0.41) kg, while the weight change of post-implementation was -0.10 (0.40) kg, the difference was statistically significant ( Z=-2.90, P<0.01). Conclusions:The strategies of diffusing, implementing, integrating the CHD enteral nutrition protocol based on guide could improve the implementation results and the nutrition status of infants with CHD.

Progress on standardized nutrition therapy for head and neck cancer during the peri-radiotherapeutic period / 中华放射肿瘤学杂志

Malnutrition is a common complication of cancer patients, and solving nutrition problems is still one of the challenging tasks in clinical practice. The incidence of malnutrition in head and neck cancer patients during the peri-radiotherapeutic period is high, which is not only related to disease-mediated metabolic disorders, complications and psychological factors, but also associated with the toxic and side effects induced by radiotherapy. Malnutrition will reduce the tolerance, accuracy, and therapeutic effects of radiotherapy, which in turn lowers the quality of life and even adversely affects the prognosis of disease. Medical nutrition therapy can improve the nutritional status of the body, ensure smooth progress of radiotherapy, and improve the efficacy of comprehensive cancer treatment. It is necessary and urgent to deliver standardized nutrition therapy and management of head and neck cancer patients during the peri-radiotherapeutic period. Nutritional risk screening, nutritional assessment, and acute radiation injury assessment are required to develop an individualized nutrition treatment plan and make dynamic adjustment. In this article, relevant literature of nutrition therapy for head and neck radiotherapy at home and abroad was summarized, and the standardized nutrition therapy for head and neck cancer patients during the peri-radiotherapeutic period was reviewed.

Combining biofeedback based on virtual reality technology with transcranial magnetic stimulation aids the recovery of dysphagic stroke survivors / 中华物理医学与康复杂志

Objective:To observe the effect of combining biofeedback therapy (BFT) based on virtual reality technology with repeated transcranial magnetic stimulation (rTMS) on dysphagia among stroke survivors.Methods:Eighty patients were randomly divided into a control group, an rTMS group, a BFT group and a combined treatment group, each of 20. In addition to routine dysphagia rehabilitation, the rTMS and BFT groups were given those treatments, while the combined treatment group was given both for 4 weeks. Swallowing function was evaluated before and after the treatment using the standardized swallowing assessment (SSA) and the functional oral intake scale (FOIS). Videofluoroscopy was used to quantify the subjects′ oral and pharyngeal phases and their aspiration status.Results:Significant improvement was observed in the average FOIS and SSA scores, as well as in the average oral and pharyngeal phases and in aspiration. The combined treatment group′s results were significantly better in all those aspects than those of the other 3 groups.Conclusion:The combined application of biofeedback therapy based on virtual reality technology and repeated transcranial magnetic stimulation can improve the swallowing function of stroke survivors with dysphagia. It is worthy of clinical promotion.

Association of Next Generation Sequencing Based Genotypic Profiling with MICM Characteristics in NPM1 Mutated Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To explain the clinicobiological heterogeneity of NPM1 mutated (NPM1mut) acute myeloid leukemia (AML) by analyzing the association between next-generation sequencing (NGS) profiles and MICM characteristics in patients with this AML subtype.@*METHODS@#Data of 238 NPM1mut patients with available NGS information on 112 genes related to blood disease was collected, and χ2 test and nonparametric test were used to analyze the distribution association between NGS-detecting mutations and conventional MICM parameters.@*RESULTS@#In entire NPM1mut cohort, totaling 240 NPM1 mutation events were identified, of whom 10 (10/240, 4.2%) were missense mutations, which did not involve any W288 or W290 locus and were found exclusively in NPM1mut/FLT3-ITD- group. All but one of these missense mutations (9/10, 90%) were accompanied by AML subtype-defining recurrent cytogenetic or molecular abnormalities, of which 7 cases were in the low risk and 2 in the high risk. NPM1mut occurred solely as an insertion/deletion (indel) type in the NPM1mut/FLT3-ITD+ group. The incidence of favorable plus unfavorable karyotypes in NPM1mut/FLT3-ITD- group was higher than in NPM1mut/FLT3-ITD+ group (6.4% vs. 0, P=0.031). The positive rates of CD34 and CD7 in NPM1mut/FLT3-ITD+ group were significantly higher than in NPM1mut/FLT3-ITD- group (CD34: 47.9% vs. 20.6%, P<0.001; CD7: 61.5% vs. 29.9%, P<0.001). Logistic analysis showed that FLT3-ITD independently predicted for CD34+ and CD7+ [odds ratio (OR)=5.29, 95%CI: 2.64-10.60, P<0.001; OR=3.47, 95%CI: 1.79-6.73, P<0.001; respectively]. Ras-pathway mutations independently predicted for HLA-DR+ (OR=4.05, 95%CI: 1.70-9.63, P=0.002), and KRAS mutation for MPO- (OR=0.18, 95%CI: 0.05-0.62, P=0.007). TET2/IDH1 mutations independently predicted for CD34- and CD7- (OR=0.26, 95%CI: 0.11-0.62, P=0.002; OR=0.30, 95%CI: 0.14-0.62, P=0.001; respectively), and MPO+ (OR=3.52, 95%CI: 1.48-8.38, P=0.004). DNMT3A-R882 independently predicted for CD7+ and HLA-DR+ (OR=3.59, 95%CI: 1.80-7.16, P<0.001; OR=13.41, 95%CI: 4.56-39.45, P<0.001; respectively), and DNMT3A mutation for MPO-(OR=0.35, 95%CI: 1.48-8.38, P=0.004).@*CONCLUSION@#Co-existing FLT3-ITD in NPM1mut AML independently predicts for CD34+ and CD7+, co-existing Ras-pathway mutation for HLA-DR+ and MPO-, co-existing TET2/IDH1 mutation for CD34-, CD7-, and MPO+, and co-existing DNMT3A mutation for HLA-DR+, CD7+, and MPO-, thereby providing a new mechanism explanation for the immunophenotypic heterogeneity of these AML patients.

The Effects of Decitabine Combined with All-Trans Retinoic Acid on the Number of Immune Cells in Myeloid Neoplasms / 中国实验血液学杂志

OBJECTIVE@#To investigate the effects of decitabine (DEC) combined with all-trans retinoic acid (ATRA) on the number of immune cells, efficacy and adverse reactions in the treatment of myeloid neoplasms patients.@*METHODS@#Eighty-four patients with myeloid tumors, including AML, MDS-EB-1 or MDS-EB-2 treated by the regimen containing decitabine in our hospital from January 2009 to October 2019 were enrolled and retrospectively analyzed, among the patients, 21 patients treated with DEC alone, 24 patients treated with DEC combined with ATRA (DEC/ATRA) and 39 patients treated with DEC combined with G-CSF priming regimen (DEC/priming). The changes of peripheral blood immune cell levels before and after treatment of the patients between the three groups were compared, and the differences in clinical efficacy and adverse reactions of the patients between the three groups were also compared.@*RESULTS@#There was no statistical differences in the number of immune cells among the patients in the three groups before treatment (P>0.05). NK cell levels decreased significantly in the patients in DEC and DEC/ATRA group after treatment (P<0.05); After treatment, the levels of CD8+ and CD3+T cells in the patients treated by DEC /priming regimen significantly increased (P<0.05), while the levels of CD3-HLA-DR+ B cells significantly decreased (P<0.05). The overall response rate (ORR) of the patients in DEC/ATRA group (75%) and DEC/priming group (74.36%) was significantly higher than 42.86% in DEC monotherapy group, and the differences showed statistically significant (P<0.05), while the ORR between the patients in DEC/ATRA and DEC/priming group showed no statistic differences (P>0.05). There were no statistical differences in overall survival (OS) and incidence of bleeding between the patients in the three groups (P>0.05). The incidences of grade 3 to 4 bone marrow suppression and the infection rate of the patients in DEC monotherapy and DEC/ATRA group were significantly lower than that in DEC/priming regimen group after treatment (all P<0.05), however, there was no statistical difference between DEC monotherapy and the DEC/ATRA group.@*CONCLUSION@#The efficacy of DEC/ATRA on myeloid neoplasms is comparable to that of DEC/priming regimen, and the anti-myeloid tumor effect of DEC/ATRA regimen may be related to the regulation of NK cells and T cells.

Change in Japanese children's 24-hour movement guidelines and mental health during the COVID-19 pandemic.

Specialized guidelines are required for the health behaviors of vulnerable populations such as children. This is especially true during the COVID-19 pandemic, wherein major lifestyle changes have occurred, especially among young children. The present study aims to use longitudinal data to understand changes in the physical activity, screen time, sleep, and mental health of preschoolers in Japan during the COVID-19 pandemic, compared to pre-pandemic period. Subjective and objective measures were used to assess the variables of interest longitudinally. It was found that physical activity, adherence to WHO-recommended screen time, and prosocial behaviors decreased significantly. On the other hand, sedentary time and hyperactivity increased. Our results are consistent with findings from other countries. The implications with respect to outdoor playtime, screen-time in the context of online learning during the pandemic, and the effects of parents' mental health on preschool-aged children are discussed.

Effects of preemptive nasogastric tube placement on improving nutrition and feeding status of infants with congenital heart disease / 中国实用护理杂志

Objective:To evaluate the effectiveness and safety of preemptive nasogastric tube placement for improving nutritional status and clinical outcomes in hospitalized infants with congenital heart disease.Methods:Children from 0 to 12 months with congenital heart disease hospitalized in cardiovascular center of Children's Hospital of Fudan University from February to July 2018 were selected as control group through continuous sampling. Children hospitalized were selected from September 2018 to February 2019 as intervention group. The control group followed the current feeding method, the intervention group used preemptive nasogastric tube placement. The nutritional indicators, feeding indicators and clinical outcomes of the two groups were compared to evaluate the intervention effect.Results:The serum albumin and prealbumin of the children in the intervention group were (36.81±4.59) g/L and (162.74±48.17) g/L, which were higher than those in the control group (34.80±5.21) g/L and (142.98± 33.96) g/L, the difference between the two groups was statistically significant ( t values were -2.721, -3.169, both P<0.05); the daily enteral intake, calorie intake and single enteral calorie intake of children in the intervention group were (124.93±27.97) ml·kg -1·d -1, (376.48±88.53) kj·kg -1·d -1, (48.39±9.13) kj·kg -1·time -1, higher than the control group (114.74±30.63) ml·kg -1·d -1, (330.01±90.75) kj·kg -1·d -1, (44.24±13.31) kj·kg -1·time -1, the difference between the two groups was statistically significant ( t values were -2.511, -3.750, -2.382, all P<0.05). the incidence of feeding difficulties in the intervention group was 4.95% (5/101) lower than 14.68% (16/109) of the control group, the difference between the two groups was statistically significant ( χ2 value was 5.513, P<0.05); the proportion of children in the intervention group reaching the target feeding amount when discharged from the hospital was 97.03% (98/101), higher than 84.40% (92/109) of the control group, the difference between the two groups was statistically significant ( χ2 value was 9.699, P<0.05). Conclusions:Preemptive nasogastric tube placement is safety and effectively for patients with congenital heart disease in clinical infants. but it still needs a large sample for a long time to confirm its effectiveness.

Targeting "undruggable" c-Myc protein by synthetic lethality / 医学前沿

Synthetic lethal screening, which exploits the combination of mutations that result in cell death, is a promising method for identifying novel drug targets. This method provides a new avenue for targeting "undruggable" proteins, such as c-Myc. Here, we revisit current methods used to target c-Myc and discuss the important functional nodes related to c-Myc in non-oncogene addicted network, whose inhibition may cause a catastrophe for tumor cell destiny but not for normal cells. We further discuss strategies to identify these functional nodes in the context of synthetic lethality. We review the progress and shortcomings of this research field and look forward to opportunities offered by synthetic lethal screening to treat tumors potently.

Comparing the clinical characteristics and prognosis of seropositive and seronegative rheumatoid arthritis patients in China: a real-world study / 中华风湿病学杂志

Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.

The relationship between three-dimensional right ventricular longitudinal deformation and myocardial fibrosis in patients with end-stage heart failure / 中华超声影像学杂志

Objective:To investigate the values of right ventricular free wall longitudinal strain (RVFWLS) by three-dimensional speckle tracking echocardiography (3D-STE) in predicting the degree of RV myocardial fibrosis (MF) in patients with end-stage heart failure (HF).Methods:A total of 102 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2018 to December 2019. Echocardiographic examinations were performed in these patients before heart transplantation. The conventional RV function parameters were obtained, including fractional area change, tricuspid annular plane systolic excursion(TAPSE), myocardial performance index, tricuspid lateral annular systolic velocity(Tricuspid s′). Two-dimensional (2D) RVFWLS was calculated by two-dimensional speckle tracking echocardiography (2D-STE). Right ventricular (RV) end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV stroke volume (RVSV), RV ejection fraction (RVEF) and 3D-RVFWLS were measured by 3D-STE. The degree of MF was quantified using Masson′s trichrome stain in RV myocardial samples after heart transplantation. Patients were divided into mild, moderate, and severe groups according to the degree of MF on histology, then echocardiographic parameters were compared among the 3 groups. Pearson correlation analysis and the multiple linear regression analysis between echocardiographic parameters and RV MF were analyzed.Results:Compared with patients with mild and moderate MF, 3D-RVFWLS, 2D-RVFWLS and conventional parameters of RV function were significantly decreased in patients with severe MF.RV MF strongly correlated with 3D-RVFWLS ( r=-0.71, P<0.01), modestly correlated with 2D-RVFWLS ( r=-0.53, P<0.01), and weakly correlated with RVFAC, TAPSE, RVEF, Tricuspid s′, RVSV ( r=-0.47, -0.44, -0.35, -0.29, -0.38; all P<0.01). 3D-RVFWLS correlated best with the degree of MF compared with 2D-RVFWLS and conventional RV function parameters ( r=-0.71 vs r=-0.29~-0.53, all P<0.05). A stepwise multivariate analysis showed that 3D-RVFWLS was independently associated with RV MF (β=1.554, P<0.01, adjusted R2=0.539). Conclusions:3D-RVFWLS can provide an important imaging reference for detecting the degree of RV MF in patients with end-stage HF.

Application of chromosomal microarray analysis in prenatal diagnosis of pregnant women with advanced age / 中华医学遗传学杂志

OBJECTIVE@#To assess the value of chromosomal microarray analysis (CMA) for the detection of fetal anomalies among pregnant women with advanced age.@*METHODS@#CMA results of 562 cases, in addition with the outcome of pregnancy and neonatal follow-up were reviewed.@*RESULTS@#Among the 562 amniotic fluid samples, 73 cases (12.99%) of fetal chromosomal abnormalities were detected, which included 21 cases (3.73%) of chromosomal aneuploidies and 52 cases (9.25%) of copy number variations (CNVs). The latters included 27 cases of pathological CNVs (4.80%), 4 cases of possible pathogenic CNVs (0.71%) and 42 cases of variants with unknown clinical significance (7.47%). Compared with those under 35, the detection rate of fetal chromosomal aneuploidies for women with advanced age was higher under the indications of voluntary test, abnormal ultrasonic structures, abnormal ultrasonic soft index and risks indicated by non-invasive prenatal testing (NIPT). No significant difference was found in the detection rate of CNVs between those ≥35 and 0.05). 552 cases (98.22%) of pregnant women have completed the followed up. Among 31 women with pathological and possible pathogenic fetal CNVs detected by CMA, 25 had terminated the pregnancy, 6 (19.35%) have delivered without obvious abnormality. 41 pregnant women with fetal CNVs of unknown clinical significance have completed the follow up, among whom 3 had terminated the pregnancy, 1 newborn was found with malformation after birth, which yielded an abnormal pregnancy rate of 9.76%. 480 pregnant women with negative CMA results have completed the follow up, among whom 5 (1.04%) had abnormal pregnancy or delivered a child with birth defect.@*CONCLUSION@#There is a certain difference between the outcome of pregnancy predicted by CMA testing and the actual outcome. The pregnancies with fetal CNVs with unknown clinical significance detected by CMA have a high adverse rate, which should attract clinical attention. CMA testing should be recommended for pregnant women with advanced age regardless of whether they have other symptoms. CMA combined with other detection methods is the trend for prenatal diagnosis.

Landscapes and dynamic diversifications of B-cell receptor repertoires in COVID-19 patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the pandemic of coronavirus disease 2019 (COVID-19). Great international efforts have been put into the development of prophylactic vaccines and neutralizing antibodies. However, the knowledge about the B cell immune response induced by the SARS-CoV-2 virus is still limited. Here, we report a comprehensive characterization of the dynamics of immunoglobin heavy chain (IGH) repertoire in COVID-19 patients. By using next-generation sequencing technology, we examined the temporal changes in the landscape of the patients immunological status, and found dramatic changes in the IGH within the patients immune system after the onset of COVID-19 symptoms. Although different patients have distinct immune responses to SARS-CoV-2 infection, by employing clonotype overlap, lineage expansion and clonotype network analyses, we observed a higher clonotype overlap and substantial lineage expansion of B cell clones during 2-3 weeks of illness, which is of great importance to B-cell immune responses. Meanwhile, for preferences of V gene usage during SARS-CoV-2 infection, IGHV3-74 and IGHV4-34 and IGHV4-39 in COVID-19 patients were more abundant than that of healthy controls. Overall, we present an immunological resource for SARS-CoV-2 that could promote both therapeutic development as well as mechanistic research.

Characterization of the SARS-CoV-2 Spike in an Early Prefusion Conformation

Pandemic coronavirus disease 2019 (COVID-19) is caused by the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for which there are no efficacious vaccines or therapeutics that are urgently needed. We expressed three versions of spike (S) proteins--receptor binding domain (RBD), S1 subunit and S ectodomain--in insect cells. RBD appears monomer in solutions, whereas S1 and S associate into homotrimer with substantial glycosylation. The three proteins confer excellent antigenicity with six convalescent COVID-19 patient sera. Cryo-electron microscopy (cryo-EM) analyses indicate that the SARS-CoV-2 S trimer dominate in a unique conformation distinguished from the classic prefusion conformation of coronaviruses by the upper S1 region at lower position ~15 [A] proximal to viral membrane. Such conformation is proposed as an early prefusion state for the SARS-CoV-2 spike that may broaden the knowledge of coronavirus and facilitate vaccine development.

Construction of breast milk closed-loop management system for neonatal ward based on information technology / 中华医院管理杂志

Many hospitals in China have realized the information management of breast milk bank, but the systematic management of breast milk feeding is one of the weak links in the work of neonatal ward. Relying on information technology, Children′s Hospital of Fudan University implanting the functions of precise calculation, record, reminder and warning of clinical decision support into the breast-milk management system, realized the whole flow of breast milk closed-loop management monitoring and recording, standardized the breast-feeding and execution process, realized the process management and fine management of breast-feeding, and provided reference for the information management of breast-feeding.