Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture (version 2023) / 中华创伤杂志

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Clinical value of a differentiation prediction model for invasive lung adenocarcinoma / 中华肿瘤杂志

Objective: To investigate the value of predicting the degree of differentiation of pulmonary invasive adenocarcinoma (IAC) based on CT image radiomics model and the expression difference of immunohistochemical factors between different degrees of differentiation of lesions. Methods: The clinicopathological data of patients with pulmonary IAC confirmed by surgical pathology in the Affiliated Huai'an First People's Hospital to Nanjing Medical University from December 2017 to September 2018 were collected. High-throughput feature acquisition was performed for all outlined regions of interest, and prediction models were constructed after dimensionality reduction by the minimum absolute shrinkage operator. Receiver operating characteristic curve was used to assess the predictive efficacy of clinical characteristic model, radiomics model and individualized prediction model combined with both to identify the degree of pulmonary IAC differentiation, and immunohistochemical expressions of Ki-67, NapsinA and TTF-1 were compared between groups with different degrees of IAC differentiation using rank sum test. Results: A total of 396 high-throughput features were extracted from all IAC lesions, and 10 features with high generalization ability and correlation with the degree of IAC differentiation were screened. The mean radiomics score of poorly differentiated IAC in the training group (1.206) was higher than that of patients with high and medium differentiation (0.969, P=0.001), and the mean radiomics score of poorly differentiated IAC in the test group (1.545) was higher than that of patients with high and medium differentiation (-0.815, P<0.001). The differences in gender (P<0.001), pleural stretch sign (P=0.005), and burr sign (P=0.033) were statistically significant between patients in the well and poorly differentiated IAC groups. Multifactorial logistic regression analysis showed that gender and pleural stretch sign were related to the degree of IAC differentiation (P<0.05). The clinical feature model consisted of age, gender, pleural stretch sign, burr sign, tumor vessel sign, and vacuolar sign, and the individualized prediction model consisted of gender, pleural stretch sign, and radiomic score, and was represented by a nomogram. The Akaike information standard values of the radiomics model, clinical feature model and individualized prediction model were 54.756, 82.214 and 53.282, respectively. The individualized prediction model was most effective in identifying the degree of differentiation of pulmonary IAC, and the area under the curves (AUC) of the individualized prediction model in the training group and the test group were 0.92 (95% CI: 0.86-0.99) and 0.88 (95% CI: 0.74-1.00, respectively). The AUCs of the radiomics group model for predicting the degree of differentiation of pulmonary IAC in the training group and the test group were 0.91 (95% CI: 0.83-0.98) and 0.87 (95% CI: 0.72-1.00), respectively. The AUCs of the clinical characteristics model for predicting the degree of differentiation of pulmonary IACs in the training and test groups were 0.75 (95% CI: 0.63-0.86) and 0.76 (95% CI: 0.59-0.94), respectively. The expression level of Ki-67 in poorly differentiated IAC was higher than that in well-differentiated IAC (P<0.001). The expression levels of NapsinA, TTF-1 in poorly differentiated IAC were higher than those in well-differentiated IAC (P<0.05). Conclusions: Individualized prediction model consisted of gender, pleural stretch sign and radiomics score can discriminate the differentiation degree of IAC with the best performance in comparison with clinical feature model and radiomics model. Ki-67, NapsinA and TTF-1 express differently in different degrees of differentiation of IAC.

Application of dietary safety management based on swallowing function classification in elderly hip fractures / 中国实用护理杂志

Objective:To explore the effect of diet safety management based on swallowing function classification in perioperative period of elderly patients with hip fractures, so as to provide basis for improving perioperative food safety and shortening hospitalization time of patients with hip fracture.Methods:A total of 68 elderly patients with hip fractures in the First Medical Center of PLA General Hospital from December 2020 to August 2021 were selected and divided into experimental group and control group according to even and odd-number of admission number, each group contained 34 patients. The control group was given routine diet nursing and food safety education. The experimental group was given graded diet safety management according to the swallowing function evaluation results. The incidence of aspiration and length of hospital stay were compared between the two groups.Results:The incidence of chocking during hospitalization was 5.1% (78/1 517) in the control group and 1.2% (17/1 402) in the experimental group, and the difference was statistically significant ( χ2=35.73, P<0.01). The incidence of choking in the control group was 0.7% (11/1 517), and 0.4% (5/1 402) in the experimental group, and the difference was not statistically significant ( χ2=1.82, P>0.05). There was no significant difference in hospitalization time between the two groups, 10 (8,12) in the control group and 9 (8,11) in the experimental group ( Z=-1.33, P>0.05). Conclusions:The implementation of diet safety management based on swallowing function classification in elderly patients with hip fractures can reduce the incidence of coughing. Evaluation of swallowing function should be included in the evaluation of hip fractures in the elderly.

Domestic and international research progress of edible and medicinal Arecae Semen / 中国中药杂志

Arecae Semen, as the first place among "Four South Medicines" in China, has great dual-use value of medicine and food. The research of Arecae Semen was mainly focused on the active ingredients and efficacy value, and its potential safety hazards were also concerned. Until now, there is still a lack of clear boundaries between medicine and food, resulting in its safety cannot be guaranteed. Therefore, it is of great significance to establish clear boundaries of medicine and food use and health risk assessment. In this paper, the differences of pretreatment and application methods of Arecae Semen were analyzed, and the research progress of Arecae Semen in chemical composition identification and toxicology research and safety evaluation were reviewed emphatically. Finally, the differences of quality control and safety evaluation of Arecae Semen in pharmacopoeias or standards were analyzed at home and abroad. It was expected to provide reference value for quality control, safety evaluation and international standardization research of Arecae Semen.

Health risk assessment of exogenous harmful pollutants in Chinese medicine: a review / 中国中药杂志

In recent years, the quality and safety problems have been limiting the internationalization of Chinese medicine. The pollutants in Chinese medicine, particularly the exogenous harmful pollutants mainly including mycotoxins, pesticide residues, heavy metals, harmful elements, and sulfur dioxide, are of high risks for people. Therefore, the World Health Organization(WHO) and relevant national organizations have clearly defined the maximum residue limits(MRLs) of such pollutants. Chinese Pharmacopoeia(2020 edition, volume Ⅳ) also demonstrates the detection methods, MRLs and preliminary risk assessment methods for four typical exogenous harmful pollutants in Chinese medicine. Therefore, continuous optimization of the health risk assessment system can further help further raise the quality and safety of Chinese medicine. This paper reviews the research on the health risk assessment of four typical exogenous harmful pollutants in Chinese medicine and discusses the problems of and challenges for the assessment system, which is expected to lay a scientific basis for the establishment of the risk warning mode and response measures suitable for specific types of Chinese medicine.

CT radiomics model for differentiating malignant and benign thyroid nodules / 中华放射学杂志

Objective:To investigate the value of CT radiomics mode in differential diagnosis of benign and malignant thyroid nodules.Methods:The clinical and imaging data of 179 patients with thyroid nodules confirmed by pathology from May 2017 to August 2018 were retrospectively analyzed in the Affiliated Huaian First People′s Hospital of Nanjing Medical University. Among the patients, 89 cases were benign nodules and 90 cases were malignant nodules. All patients underwent unenhanced and enhanced CT scan before operation. The stratified random sampling method was used to divide patients into a training group (143 cases) and a testing group (36 cases) according to a ratio of 8∶2. The A.K software was used to extract 378 imaging omics features based on preoperative CT images, and then Spearman correlation analysis and least absolute shrinkage and selection operator regression analysis were used for feature selection and model construction. The receiver operating characteristic (ROC) curve was used to verify the model in the training group and the testing group, and the efficacy of imaging omics features to predict benign and malignant thyroid nodules was evaluated.Results:After feature screening, 16 radiomics features were used to construct an identification model between benign and malignant thyroid nodules. In the training group, the area under the ROC curve (AUC) was 0.92 [95% confidence interval (CI): 0.88-0.97], the sensitivity and specificity were 88.7%, 82.0%, and the diagnostic accuracy of the model was 91.1%. In the testing group, AUC was 0.90 (95 %CI: 0.81-0.98), sensitivity and specificity were 88.5%, 84.6%, and the diagnostic accuracy of the model was 88.2%. Conclusion:The CT radiomics mode has a good diagnostic performance in the identification of benign and malignant thyroid nodules.

Rapid detection of trace Hg~(2+) in animal matrix by specific DNA electrochemical sensor / 中国中药杂志

A highly specific electrochemical biosensor based on T-Hg~(2+)-T structure for fast screening trace Hg~(2+) in complex animal drug matrix was constructed by cyclic voltammetry(CV) and differential pulse voltammetry(DPV). In the presence of Hg~(2+), it can be specifically binded to the T base of DNA sequence on the surface of modified gold electrode, which changes the conformation of DNA molecule and the electrochemical signal. The concentration ratio of EDC/NHS, the concentration ratio of FC-DNA and the reaction time of the biosensor were optimized by the index of sensitivity and reproducibility in CV. The results showed that the stability of the biosensor was good within 3 days(RSD≤1.3%), the difference between batches was low(RSD=4.7%), and the specificity of the biosensor was high in the presence of interfering ions(As~(3+), Cd~(2+), Cu~(2+), Pb~(2+), Zn~(2+) and Fe~(3+)). DPV results showed that the peak current signal value has a linear relationship with the lgC_((Hg)) over a concentration range from 0.1 nmol·L~(-1) to 1.0 μmol·L~(-1) with a detection limit of 0.066 nmol·L~(-1). Finally, the recovery rate tested in the matrix of animal medicine was satisfactory as 99.17%-101.3%, which can meet the needs of the determination of trace Hg~(2+) in the matrix of Bombyx Batryticatus, and provide a new idea for the rapid screening of trace heavy metals in the matrix of other types of complex traditional Chinese medicine.

Application of molecular tracing technique in one analysis of AIDS infection source / 中华实验和临床病毒学杂志

Objective@#To determine the HIV infection of a 13-year-old leukemia patient Wei using molecular tracing technique.@*Methods@#Three blood samples were collected from the persons who were associated with HIV positive blood donation member Lang. The viral load was tested and pol gene was sequenced and analyzed. At the same time using HyPhy2.2.4 and Cytoscape 3.6.1 to establish the molecular network with these 3 samples sequences and other HIV subtypes sequences obtained from Luzhou.@*Results@#The HIV-1 viral load test result of the three patients were: Lang 933 CPS /ml (treated, blood donor), Wei (blood recipitent) 89 813 CPS /ml, Deng (blood recipitent) 85 158 CPS /ml. The subtype of HIV-1 of these three samples were all recombinant HIV CRF01_AE, and the pol gene similarity was 98.8% (Lang and Wei), 99.7% (Lang and Deng), and 99.1% (Wei and Deng), respectively. The gene sequences of the three samples were linked into clusters (the gene distance was less than 0.004).@*Conclusions@#The patient Wei with leukemia was infected with HIV-1 due to blood transfusion during the seroconversion period, and the three patients were more likely to be infected with the same HIV-1 strain. It is necessary to popularize the use of high-sensitivity nucleic acid detection method in blood collection and supply institutions, which can effectively improve the safety of blood use.

Safety evaluation of heavy metals contaminated Astragalus membranaceus using health risk assessment model / 中国中药杂志

To evaluate the safety of heavy metals contaminated Astragalus membranaceus,an appropriate protocol was established to study the heavy metals pollution level by health risk assessment. This study provided a detailed procedure to assess the medicinal herbs in quality control and safety evaluation,and expected to create awareness among the public on the safety of consuming of A. membranaceus or any other kinds of medicinal herbs. The heavy metals content of Cu,As,Cd,Pb and Hg in a total of 45 batches of A. membranaceus were carefully analyzed with a developed inductively coupled plasma mass spectrometry( ICP-MS). Besides,the heavy metal contamination level was further evaluated through 4 main assessment parameters,including maximum residue limit( MRL) set by International Standard Organization,estimated daily intake( EDI) set by IUPAC,target hazard quotients( THQ) and Total THQ set by USEPA and total THQs in raw herbs of A. membranaceus. In addition,the recommended MRLs of 5 main heavy metals aimed to A. membranaceus were calculated based on the regulated consumption quantity. The result showed that,under the ISO international standard of Chinese medicine-Chinese herbal medicine heavy metals,the unqualified rate was 8. 89% for A. membranaceus,which including 4 batches of A. membranaceus exceeded the MRL of As. Here,the standard THQ value of A. membranaceus was firstly proposed as 0. 02 and 0. 011 25 for adults and children,respectively,which were calculated with the recommended consumption quantity of 30 g and 9 g for adults and children. Furthermore,the values of THQ for As and total THQs in adults and children were exceeded the standard THQ in A. membranaceus,and the recommended MRLs of Pb,Cd,Hg and Cu in above medicinal materials that calculated based on health risk assessment model were higher than the regulated MRLs that set by ISO and Chinese Pharmacopeia. The research showed that the contents of heavy metals in A. membranaceus were not in the safe range and the certain non-carcinogenic risks to human body cannot be neglected. Based on above investigation result,it is easily known that the common evaluation method for raw herbs based on the comparison of MRL of heavy metals was not precise enough,and the international model of health risk assessment should be built for each medicinal herb. Above all,this study provided a more realistic research approach for safety evaluation of any other kinds of heavy metals contaminated medicinal herbs,including the establishment of heavy metals standard limit in a specified medicinal herb under recommended consumption quantity,and it is expected to create awareness among the public on the safety of consuming any other medicinal herbs.

Correlation of serum C-telopeptide cross-linked collagen type Ⅰ with bone mineraI density in a rat modeI of disuse osteoporosis / 中国组织工程研究

BACKGROUND: C-telopeptide and N-telopeptide cross-linked collagen type Ⅰ (CTx and NTx, respectively) are specific biochemical bone markers that can reflect bone formation and resorption. OBJECTIVE: To analyze the association of CTx with disuse osteoporosis. METHODS: Male Sprague-Dawley rats, weighing 180-220 g, were randomly divided into control and disuse osteoporosis groups. Right hind limbs of the rats in the disuse osteoporosis group were immobilitzed for 4 weeks by ankle-tail fixation to establish the rat model of disuse osteoporosis. Peritoneal venous blood was collected before and after modeling, and the femur was then removed to measure the serum CTx level and bone mineral density of the bilateral femurs. RESULTS AND CONCLUSION: The serum CTx level did not differ significantly between groups before modeling (P > 0.05). At 4 weeks after modeling, the serum CTx level in the disuse osteoporosis group was significantly higher than that in the control group and at baseline (P <0.01). The serum CTx level showed no significant change in the control group before and after modeling (P > 0.05). The increment of serum CTx in the disuse osteoporosis group exhibited a negative correlation with the bone mineral density of the bilateral femurs (r=0.426, P < 0.01). The bone mineral density of the right femur in the disuse osteoporosis group was significantly lower than that of the left one in the disuse osteoporosis group and the right one in the control group (P < 0.01), and there was no significant difference in the bone mineral density between left and right femurs in the control group (P > 0.05). These results imply that the model of disuse osteoporosis by ankle-tail fixation is established successfully. Disuse osteoporosis can promote the production of CTx further reducing bone mineral density; CTx is positively correlated with the degree of bone loss, so it can be used for therapeutic assessment and diagnosis of osteoporosis.

Correlation between imaging characteristics and histopathology in the ovarian thecoma-fibroma / 中国医师进修杂志

Objective To explore the imaging characteristics of the ovarian thecoma-fibroma.Methods The clinical imaging characteristics of 25 patients with thecoma-fibroma were retrospectively analyzed. Results A total of 27 lesions were seen in 25 patients, and the maximum diameter of the tumors was 1.2 - 15.0 cm, with an average diameter of 6.9 cm. The tumors whose maximum diameter larger than 6 cm were mainly as cysticsolid. Twenty-six lesions were well-defined margin, and 14 lesions were round and oval masses, 9 lesions were lobulated masses, 3 lesions were irregular masses, and 1 lesion presented with unclear boundary. A total of 10 lesions in 9 cases were performed with CT scan, and the density was similar to uterine muscle density. In MRI scan of a total of 17 lesions of 16 cases, all lesions showed hypointensity on T1WI. On T2WI, 8 lesions showed slightly hyperintensity, 7 lesions appeared slight hypointensity, and 2 lesions appeared significantly hypointense. Eight lesions showed slit hyperintensity. Enhancement scanning was performed in seven cases. Five cases showed mild to moderate enhancement, 1 case was enhanced obviously, and 1 case was not strengthened. Conclusions The imaging findings of the ovarian thecoma-fibroma have somewhat features and can indirectly reflect pathology of tumor. Combined with the clinical data, imaging characteristics are is helpful to the diagnosis and differential diagnosis of the disease.

Analysis on Policies of Quality Safety Control of Chinese Materia Medica in Circulation / 中国中医药信息杂志

The circulation process of Chinese materia medica involves a series of links from planting to marketing. Unqualified problems of Chinese materia medica are common in each link of the process of circulation, which seriously harm public health and the further development of Chinese materia medica market. Therefore, the relevant government departments have paid high attention to quality safety of Chinese materia medica and issued many policies. This article sorted out the policies of quality safety control of Chinese materia medica in circulation, analysed the existing problems, and proposed the corresponding suggestions, with a purpose to provide valuable references for government departments to further improve the quality of Chinese materia medica.

QS mini-incision knee replacement accompanied by early rehabilitation in 16 cases / 中国组织工程研究

OBJECTIVE:To analysis outcomes of patients with knee osteoarthritis treated by mini-incision knee replacement accompanied by early rehabilitation. METHODS:Outcomes of 28 knee osteoarthritis patients (46 knees) who were treated by joint replacement from 2005 June to August were retrospectively analyzed. Sixteen patients were served as experimental group,including 4 males and 12 females,aged 59-77 (65.3?5.3) years,and the course of disease was 10-15 (13.4?4.3) years. These patients were received mini-incision knee replacement,accompanied by specified early rehabilitation procedure. Early rehabilitation procedure comprised psychological treatment,training before knee replacement,muscle strength training after knee replacement,and correction of poor gait,joint position sense training and exercise for coordination after knee replacement,early quadriceps femoral muscle active extension knee exercises especially emphasized. Another 12 patients were served as control group,including 5 males and 7 females,aged 60-75 (67.5?4.7) years,with course of disease 8-18 (12.8?4.9) years,they were received normal knee replacement. Pain severity,joint motion ranges and functional situations were evaluated. RESULTS:Twenty-eight patients stayed in hospital for (13.2?2.7) days (ranging from 10 days to 16 days). All the patients were followed up 9 to 12 months. There were no significantly differences in pain severity,joint motion ranges and functional scores on admission between two groups. Pain,joint motion and joint functions were improved greatly after knee replacement. The joint motion ranges and functional scores were higher on discharge and the last follow-up in the experimental group than that of the control group. CONCLUSION:The program that consists of Mini-incision knee replacement,which protected quadricep muscle intactness and diminished surgical injury,accompanied by psychological treatment,preoperational preparation,postoperational training,correction of gait,training in articular position sensation and all the body coordination,can improve the outcomes of the knee osteoarthritis patients with knee replacement.