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Objective:The clinical features, laboratory indices, and imaging data of patients with Pneumocystis jirovecii pneumonia (PJP) were described and analyzed, aiming to provide helpful information for the diagnosis and treatment of PJP. Methods:A retrospective study were conducted with data from 154 PJP patients who visited China-Japan Friendship Hospital from May 2017 to August 2020. Their clinical characteristics, laboratory and imaging data, and clinical outcomes were collected for analysis. The patients were further divided into the death group (51 cases) and the survival group(103 cases). The differences between the groups were compared by using t-test, nonparametric test, and chi-square test. Results:Of the 154 PJP patients, there were 89 males and 65 females, with a mean age of (53.7±14.8) years. Among them, 85.7% (132/154) were on immunosuppressive/glucocorticoids agents within the past month. Besides, 27.9% (43/154) and 33.1% (51/154) had kidney diseases and connective tissue diseases, respectively. The major clinical manifestations in these patients involved fever 82.9% (126/154), cough 59.7% (92/154), and dyspnea 52.6% (81/154). For the laboratory data, the lactate dehydrogenase (LDH) was 561.0 (434.3, 749.0) IU/L and the value increased in 91.3% (95/104) of the patients. The CD4+T-cell lymphocytes in 88.0% (95/108) and 57.4% (62/108) of patients were lower than 400/μl and 200/μl, respectively. Furthermore, (1, 3)-β-D glucan (BG) increased in 74.4% (67/90) of PJP patients (≥100.0 ng/L). For the imaging results, chest computed tomography (CT) showed diffuse ground-glass shadows/grid shadows in 90% (117/130) patients. Compared with the survival group, higher LDH [690.5 (528.8, 932.3) IU/L vs 502.5 (381.8, 657.0) IU/L, Z=-3.375, P=0.001], white blood cell count (WBC) [9.8 (5.8, 12.6) ×10 9/L vs 7.3 (5.0, 10.1) ×10 9/L, Z=-2.392, P=0.017], and age [(69.8±14.5) years vs (50.6±14.0) years, t=-3.756, P=0.001] were found in the death group. Lower lymphocyte ratio [5.3 (3.2, 9.3) % vs 9.6 (5.6, 17.2) %, Z=?3.262, P=0.001] and oxygen partial pressure (PaO 2) levels [(73.2±20.5) mmHg vs (64.8±17.7) mmHg (1 mmHg=0.133 kPa), t=2.345, P=0.021] were also observed in the death group. Furthermore, in the death group, the bacterial and fungal infection rate was higher than the rates in the survival group [55.1% (27/51) vs 21.5% (22/103), χ 2=15.372, P=0.001]. Conclusions:Long-term use of immunosuppressive agents or glucocorticoids predispose to PJP. CD4+T-lymphocytes, LDH, and BG might be used as important auxiliary examinations for PJP patients. Age, LDH, WBC, lymphocyte ratio, PaO 2 and possible combinations with bacterial or fungal infections are more closely related to the prognostic of PJP patients.
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Objective:To comparatively analyze the changes regulation of death attitude and death education needs for undergraduate nursing students in different grades.Methods:From March to June in 2019, 766 undergraduate nursing students from Batch 2015 to Batch 2018 of a medical college were collected in cluster sampling. The investigation was conducted by using the scale of Death Attitude Profile-revised in Chinese version and the scale of death education needs. SPSS 22.0 was used for statistical analysis, LSD test for measurement data, and chi-square test for counting data.Results:There were increasing trends of scores from freshman to junior in dimensions of fear of death, approach-oriented death acceptance and escape-oriented death acceptance ( P < 0.05), and the scores decreased in senior, but without statistical difference compared with junior ( P > 0.05). In neutral death acceptance dimension, the score decreased significantly in the second year ( P = 0.001), and then returned back to the original level in the fourth year. No significantly statistical difference was found in scores of different grades in death escape dimension ( P = 0.038). The score of death education need in the fourth year was the highest ( P < 0.05) and was positively correlated with the score of neutral death acceptance dimension ( P = 0.007). Conclusion:With the increase of school year, nursing students' positive attitude for death demonstrates positive trend, while the level of negative attitude of death are becoming balanced. The fourth year is suggested to be the right time to conduct death education immediately.
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Objective To explore the value of applyingcomprehensive design experiment evalua-tionin the evaluation of nursing experimental teaching. Methods In the nursing profession, and after the acute and severe cases were collected, comprehensive design experiment evaluation was carried out by using the first-aid and severe training programs, according to the patients needs. Then the simulation effect of students was evaluated by multi-subjects Afterwards, a questionnaire survey was conducted among 143 participants on clinical competency and experimental assessment. The data were analyzed through ratio. Result 121 nursing students' (84.6%) clinical competence was improved. 143 nursing students (100%) thought that the test was of great significance to achieve education target. 138 nursing students (96.6%) thought that general design and arrangement of satisfaction were high. 141 nursing students (98.7%) were satisfied with the multi-subject evaluation. 106 nursing students (74.1%) were willing to conduct self evaluation and give evaluation of others. Conclusion Comprehensive designing experiments evaluationcan significantly improve the critical clinical competence of nursing students, and can help the professional education target implementation. The operation mode is recognized by the students. The evaluation of the multi-subject evaluation is highly respected, but it needs to develop the students' ability of objective evalua-tion.
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Objective:To study the inhibitory effect of γδT cells on the proliferation of ovarian cancer SKOV3 cells,and to clarify its possible mechanism of inducing apoptosis. Methods:The human ovarian cancer SKOV3 cells cultured in vitro were used as control group,and theγδT and SKOV3 cells were co-cultured for 72 h as γδT cells treatment group.Laser scanning confocal microscope was used to obeserve the morphological changes of nucleus SKOV3 cells,and the inhibitory rate of proliferation of SKOV3 cells in two groups were detected by MTT method;Transwell Chambers was used to detect the cell migration ability,then the apoptotic rates of SKOV3 cells were tested by flow cytometry (FCM).Results:The apoptotic morphology of nucleus of SKOV3 cells in γδT cells treatment group were found under microscope,such as nuclear shrinkage.The MTT resultes displayed that the inhibitory rate of proliferation of SKOV3 cells in γδT cells treatment group was higher than that in control group (P <0.05).The Transwell Chambers results showed that the number of transmembrane cells in γδT cells treatment group was lower than that in control group,and the migration rate was decreased compared with control group (P <0.05).The FCM results showed that the apoptotic rate of SKOV3 cells in γδT cells treatment group was higher than that in control group (P < 0.05 ).Conclusion:γδT cells can inhibit the proliferation and the migration abilities of ovarian cancer SKOV3 cells,and promote the apoptosis.
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Objective To com pare and explore the application value of diatom nitric acid digestion method and plankton 16S rDNA PCR method for drow ning identification. Methods Forty drow ning cases from 2010 to 2011 were collected from Department of Forensic Medicine of Wenzhou Medical University. Sam ples including lung, kidney, liver and field water fromeach case were tested with diatom nitric acid digestion method and plankton 16S rDNAPCR method, respectively. The Diatom nitric acid digestion method and plankton 16S rDNAPCR method required 20 gand 2g of each organ,and 15 mL and 1.5 mL of field water, respectively. The inspection time and detection rate were com pared between the two methods. Results Diatom nitric acid digestion method m ainly detected two species of diatom s, Centriae and Pennatae, while plankton 16S rDNA PCR method am plified a length of 162 bp band. The average inspection time of each case of the Diatom nitric acid digestion method was (95.30±2.78) min less than (325.33±14.18)min of plankton 16S rDNA PCR method (P<0.05).The detection rates of two methods for field water and lung were both 100% . For liver and kidney, the detection rate of plankton 16S rDNA PCR method was both 80% , higher than 40% and 30% of diatom nitric acid digestion method (P<0.05), respectively. Conclusion The laboratory testing method needs to be appropriately selected according to the specific circum stances in the forensic appraisal of drow ning. Com pared with diatom nitric acid digestion method, plankton 16S rDNA PCR method has practice values with such advantages as less quantity of sam ples, huge inform ation and high specificity.
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Basic knowledge of forensic science is theoretical and abstract,therefore,confir-matory experiment teaching is often adopted in the experiment teaching. International education has become an important topic in medical colleges and universities. Forensic medicine is a compulsory subject for medical international students. This article discussed the exploration and practice in teach-ing forensic medicine for international students at Wenzhou Medical University,which included faculty constructing and training,encouraging whole English teaching by young teachers,applying heuristic interactive teaching and case teaching,establishing strict attendance and appraisal system and con-ducting comprehensive evaluation on medical teaching quality and teaching management.
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Objective To study on virulence characteristics and multilocus sequence type of Vibrio parahaemolyticus isolated from clinic in Beijing Tongren hospital.Methods Total 152 strains of Vibrio parahaemolyticus isolates were collected from diarrheal patients of outpatients in Beijing Tongren Hospital,Capital Medical University from 2009 to 2011.PCR was used to detect hemolysin gene thermo stable direct themolysin gene (tdh),TDH-related hemolysin gene (trh),type Ⅲ secretion system 2 (T3SS2α,T3SS2β)and systematic functional gene (toxRS/new,orf8) for pandemic 03∶ K6 clone and its derivatives.The genetic features of these strains were determined by multilocus sequence typing (MLST).Results 96％ (146/152) VP harbored tdh gene,2％ (3/152) VP harbored trh gene and 100％ (152/152) VP harbored T3SS2 gene.In this study there were 107 pandemic strains (both tdh and toxRS/new positive and trh negative),38 pathogenic strains (tdh positive and/or trh positive) and 6 nonpathogenic strains (both tdh and trh negative).All nonpathogenic strains harbored systematic functional gene (toxRS/new,orf8).Only one pathogenic strains harbored orf8 gene.One clone harbored all virulence gene.In this study there were 16 sequence types,and ST3 is the pandemic sequence type,including 113 strains,and four new sequence types were found.Conclusions In this study more than 90％ Vibrio haemolyticus harbored tdh gene and ST3 was the pandemic sequence type in Beijing.One can get bacterial pathogenic charateristic and population genetics information by virulence gene testing and MLST.
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Objective: To determine the rate of lymph node metastases in women with endometrial carci-noma and to compare the pattern of lymphatic spread of endometrial carcinoma with that of cervical carcino-ma. Methods: We retrospectively analyzed the lymphatic spread in 104 patients with endometrial carcinoma and 253 patients with cervical carcinoma. All of the patients underwent a complete pelvic and para-aortic lymphadenectomy from caudal to the median circumflex to the level of renal vessels. Results: The incidence of lymphatic metastases in the endometrial carcinoma group was higher than that in the cervical carcinoma group (22.1% vs 16.2 %). The pathologic grade (G_1: 12.1%; G_2: 21.4%; G_3: 34.5%) and depth of myometrial in-vasion (≤1/2: 11.9%; >1/2: 29%) were correlated with lymph node metastasis. The rates of para-aortic node involvement, pelvic lymph node involvement and involvement of both were 4.3%, 34.8% and 60.9% in the en-dometrial carcinoma group and 0%, 68.3% and 31.7% in the cervical carcinoma group. The rates of obturator node involvement were 73.9% and 70.7%, respectively; the rates of suprainguinal node involvement were 8.7% and 7.3%, respectively. Compared with cervical carcinoma, endometrial carcinoma showed higher rate of para-aortic and sacral node involvement (65.2% vs 31.7%, and 21.7% vs 17.1%) and lower rate of extamal iliac node involvement (17.4% vs 41.5%). Conclusion: Compared with cervical carcinoma, endometrial carcino-ma has a distinct lymphatic spread pattern and can directly metastasize to both pelvic lymph nodes and pa-ra-aortic lymph nodes with pelvic lymph node metastases being dominant. Positive lymph nodes are common-ly seen in cases of all pathological grades.
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Objective To investigate the expressions and significance of PAX-5, OCT-2 and BOB.1 in Hodgkin lymphoma (HL). Methods Immunohistochemical method was used to detect the expressions of CD30, CD15, PAX-5, OCT-2, BOB.1, CD20 and CD3 in 44 samples of formalin-fixed, paraffin-embedded tissues of HL. The histological classification was carried out according to the WHO classification for tumors of hematopoietic and lymphoid tissues (2001). Results In all 44 cases, 3 (6.8) were nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) and 41 (93.2) were classical Hodgkin lymphoma (CHL). In Hodgkin and Reed Sternberg cells, CD30 were expressed in 36 samples (81.8), CD15 in 27 (61.4), CD20 in 14 (31.8), PAX-5 in 43 (97.7), OCT-2 in 14 (31.8), and BOB.1 in 7 (15.9). All samples of NLPHL expressed OCT-2 and BOB.1, while in the samples of CHL, 30 samples (73.2) expressed both OCT-2 and BOB.1, 7 (17.1) expressed only OCT-2, 1 (2.4) expressed only BOB.1 and all were negative for CD30. Conclusion Hodgkin lymphoma is a rare neoplasm with uncertain cause and difficult to diagnose. The detection of PAX-5, OCT-2 , BOB.1 in combination with CD30, CD15 will conduce to the diagnosis and differential diagnosis of Hodgkin lymphoma.