Study on the application of sound thinking combined with Sandwich teaching method in oncology nursing teaching / 中华医学教育探索杂志

Objective:To explore the application of sound thinking combined with Sandwich teaching in oncology nursing practice teaching.Methods:A total of 68 nursing students who were interns in the Department of Oncology, The First Affiliated Hospital of Air Force Medical University from 2020 to 2021 were included in the study, and they were divided into a control group ( n=34) and an observation group ( n=34). The control group took routine teaching for interns, while the observation group took sound thinking combined with Sandwich teaching. The examination results, critical thinking abilities, and the evaluation of nursing teaching effectiveness of the two groups of nursing interns were evaluated. SPSS 22.0 was used for Chi-square test and t-test. Results:The examination scores of nursing students in the observation group were higher than those in the control group ( t=3.44, 2.87, 3.45, P<0.05). Compared with those before training, the scores of critical thinking ability of nursing interns in both groups increased after the training, and the observation group was better than the control group ( t=0.180, 3.64, 0.61, 2.92, 0.31, 2.74, 0.45, 2.65, 0.25, 3.58, 1.16, 2.85, 0.36, 3.20, 0.33, 2.38, P<0.05). The scores of autonomous learning ability, communication and collaboration ability, independent thinking ability, clinical reasoning ability, and problem-analyzing and -solving ability in the observation group were higher than those in the control group ( t=2.82, 3.46, 2.68, 3.29, 2.44, P<0.05). Conclusion:Combining sound thinking with Sandwich teaching in nursing clinical practice teaching in department of oncology can improve the examination scores of nursing students, improve their critical thinking abilities, and enable them to give a high evaluation of nursing teaching effectiveness.

Nusinersen treatment in patients with spinal muscular atrophy: A safety analysis of laboratory parameters / 西安交通大学学报(医学版)

【Objective】 To explore the changes of laboratory parameters and safety of nusinersen in the treatment of spinal muscular atrophy (SMA). 【Methods】 Retrospective analysis was made on the six SMA patients treated with nusinersen in the Department of Neurology at The First Affiliated Hospital of Xi’an Jiaotong University from December 2021 to December 2022. We summarized the patients’ clinical data, including genetic diagnosis results, disease classification, and clinical manifestations. Intrathecal injection of 5 mL/12 mg of nusinersen administered on the 1st, 14th, 28th, and 63rd days, followed by maintenance treatment every 4 months. After each administration, we compared and evaluated the patients’ cerebrospinal fluid, blood routine, liver function, kidney function, and coagulation function with baseline values. We regularly followed up the patients and recorded adverse reactions after administration to evaluate medication safety. 【Results】 A total of six patients were diagnosed with SMA, including four cases of SMA3 type and two cases of SMA4 type. The deletion of exon 7 of the survival motor neuron gene 1 (SMN1) in patients led to changes in motor neuron, most of which were caused by limb weakness; in severe cases, the patients were unable to stand. The baseline abnormal test indicators of patients included the increase of cerebrospinal fluid lactate dehydrogenase (CSF-LDH), the increase of creatine kinase (CK), and the decrease of creatinine (Cr). After four times of treatment, the patients’ CSF-WBC, CSF-Glu, CSF-Pro, CSF-LDH, WBC, PLT, RBC, ALT, AST, GGT, BUN, uric acid (UA), INR, aPTT, and D-dimer had no significant difference from the baseline (P>0 05). The patients had no other significant adverse reactions except headaches, dizziness, and back pain after puncture. 【Conclusion】 Nusinersen has good safety on SMA patients.

Current situation and influencing factors of humanistic care satisfaction of Chinese patients / 中华医院管理杂志

Objective:To investigate the current situation and influencing factors of patients′ satisfaction with nursing humanistic care, and to provide reference for improving the quality of such care provided by hospitals.Methods:From July to August 2022, outpatients and inpatients in 30 provinces were selected by multi-stage stratified sampling as the survey objects. A cross-sectional survey was conducted on an online platform, using the general information questionnaire and Chinese version of methodist health care system nurse caring instrument revised by the research group. The latter instrument consists of 12 dimensions. namely care coordination, competence, teaching/learning, emotional support, respect for individuality, physical comfort, availability, helping/trusting relationship, patient/family engagement, physical environment, spiritual environment and outcomes. Descriptive analysis was performed on the data collected by the questionnaires, and independent sample t-test and one-way ANOVA were used to analyze the influencing factors of patient satisfaction. Results:A total of 107 hospitals were selected for questionnaire survey, including 86 tertiary hospitals and 21 secondary hospitals, and 29 108 valid questionnaires were recovered. The patient satisfaction with nursing humanistic care scored (5.40±0.86); the top three dimensions were competence (5.50±0.89), emotional support (5.47±0.88) and helping/trusting relationship (5.46±0.86); the lowest scoring dimensions were teaching/learning (5.38±1.01), spiritual environment (5.36±1.04) and patient/family engagement (5.11±1.28). Differences with gender, age, marital status, child status, educational level, occupation, place of residence, economic region, per capita monthly income of the family, type of medical insurance, medical department visited and surgery or not presented significant differences on the patient satisfaction with nursing humanistic care scores ( P<0.05). Conclusions:The satisfaction of patients with hospital′s nursing humanistic care in China was at the middle to upper level. In the future, health education for patients should be strengthened, and a mode of family-engaged nursing humanistic care should be constructed in line with the Chinese cultural background. In the process of nursing services, the particularity of patient groups should be considered to better meet their needs.

Prevalence and risk factors of tessellated fundus in Tianjin Medical University students / 中华眼底病杂志

Objective:To investigate the prevalence and risk factors of tessellation fundus (TF) among Tianjin Medical University students with different refractive statuses.Methods:A cross-sectional study. From September to December 2019, 346 students from Tianjin Medical University were randomly selected and underwent slit-lamp examination, non-cycloplegic auto-refraction, subjective refraction, best-corrected visual acuity, ocular biometric measurement, and non-dilation fundus photography. The differences in the prevalence of TF in basic characteristics and ocular biometric parameters were compared. Based on the equivalent spherical (SE), refractive status was divided into the non-myopia group (SE>-0.50 D) and the myopia group (SE≤-0.50 D). The myopia group was further divided into mild myopia group (-3.00 D<SE≤-0.50 D), moderate myopia group (-6.00 D<SE≤-3.00 D), and high myopia group (SE≤-6.00 D). According to the axis length (AL), the subjects were divided into AL<24 mm group, 24-26 mm group, and >26 mm group. The logistic regression was used to analyze the risk factors affecting TF. Trend tests were performed for each risk factor and TF.Results:Of the 346 subjects, 324 (93.6%, 324/346) were myopia, of whom 73 (21.1%, 73/346), 167 (48.3%, 167/346), and 84 (24.3%, 84/346) were mild myopia, moderate myopia, and high myopia, respectively; 22 (6.4%, 22/346) were non-myopia. There were 294 (85.0%, 294/346) students with TF in the macula, including 9 (40.91%, 9/22), 58 (79.45%, 58/73), 145 (86.83%, 145/167), and 82 (97.62%, 82/84) in non-myopia, low myopia, moderate myopia, and high myopia group, respectively; 52 (15.0%, 52/346) students were without TF in the macula. There were statistically significant gender differences ( χ2=4.47), SE ( t=6.29), AL ( t=-8.29), anterior chamber depth ( Z=-2.62), lens thickness ( Z=-2.23), and average corneal radius ( Z=-3.58) between students with and without TF in the macula ( P<0.05). Spherical equivalent and axial length were independent risk factors for TF and its severity ( P≤0.001). With an increasing degree of myopia, and increasing axial length, the risk of TF increased ( P for trend<0.001). Conclusions:The prevalence of TF is 85.0% among Tianjin Medical University students. TF is detected in the fundus of no myopia, mild myopia, moderate myopia and high myopia. The degree of myopia is higher, the AL is longer, the possibility of TF is higher.

Nuclear factor-Y mediates pancreatic β-cell compensation by repressing reactive oxygen species-induced apoptosis under metabolic stress / 中华医学杂志(英文版)

BACKGROUND@#Pancreatic β-cells elevate insulin production and secretion through a compensatory mechanism to override insulin resistance under metabolic stress conditions. Deficits in β-cell compensatory capacity result in hyperglycemia and type 2 diabetes (T2D). However, the mechanism in the regulation of β-cell compensative capacity remains elusive. Nuclear factor-Y (NF-Y) is critical for pancreatic islets' homeostasis under physiological conditions, but its role in β-cell compensatory response to insulin resistance in obesity is unclear.@*METHODS@#In this study, using obese ( ob/ob ) mice with an absence of NF-Y subunit A (NF-YA) in β-cells ( ob , Nf-ya βKO) as well as rat insulinoma cell line (INS1)-based models, we determined whether NF-Y-mediated apoptosis makes an essential contribution to β-cell compensation upon metabolic stress.@*RESULTS@#Obese animals had markedly augmented NF-Y expression in pancreatic islets. Deletion of β-cell Nf-ya in obese mice worsened glucose intolerance and resulted in β-cell dysfunction, which was attributable to augmented β-cell apoptosis and reactive oxygen species (ROS). Furthermore, primary pancreatic islets from Nf-ya βKO mice were sensitive to palmitate-induced β-cell apoptosis due to mitochondrial impairment and the attenuated antioxidant response, which resulted in the aggravation of phosphorylated c-Jun N-terminal kinase (JNK) and cleaved caspase-3. These detrimental effects were completely relieved by ROS scavenger. Ultimately, forced overexpression of NF-Y in INS1 β-cell line could rescue palmitate-induced β-cell apoptosis, dysfunction, and mitochondrial impairment.@*CONCLUSION@#Pancreatic NF-Y might be an essential regulator of β-cell compensation under metabolic stress.

Analysis of ADR reports caused by cefotaxime sodium in Shandong province and effects of skin test on serious ADR / 中国药房

OBJECTIVE To analyze the clinical manifestations and characteristics of adverse drug reactions （ADR） caused by cefotaxime sodium in Shandong province， and to explore the effects of skin test before medication of cefotaxime sodium on serious ADR， so as to provide reference for safe drug use in clinic. METHODS The relevant data of cefotaxime sodium-induced ADR reported by Shandong Province ADR Monitoring Center during December 2019 to December 2021 were collected from National ADR Monitoring System. The ADR classification， age， gender， ADR occurrence time， route of administration， history of allergy， primary diseases， ADR systems/organs involved， clinical manifestations， outcome， skin test or not before medication were statistically analyzed. RESULTS A total of 1 057 ADR reports caused by cefotaxime sodium were included. Among them， there were 867 patients （82.02%） with general ADR and 190 patients （17.98%） with serious ADR. The majority were ＜11 years old （40.30%）. The main route of administration was intravenous drip （96.69%）. A total of 1 033 patients （97.73%） developed ADR 30 min to 24 h after medication. A total of 814 patients （77.01%） had no history of allergy. The primary diseases were respiratory system infection （56.58%）. Main systems/organs involved in ADR were skin and its appendants， digestive system and respiratory system， and its clinical manifestations were rash， pruritus， nausea， vomiting， chest tightness， etc. After withdrawal or symptomatic treatment， 1 050 patients （99.34%） were cured or improved. Before the use of cefotaxime sodium， 850 patients underwent skin test （151 patients occurred serious ADR）； there was no statistical significance in the incidence of serious renzhen202102@163.com ADR， compared with the incidence of serious ADR in 207 patients without skin test （39 patients occurred serious ADR）（P＝0.718）. CONCLUSIONS ADR caused by cefotaxime sodium is mainly seen in patients ＜11 years old， mostly occurring 30 min to 24 h after intravenous drip； skin test before medication of cefotaxime sodium cannot reduce the risk of serious ADR. Before using cefotaxime sodium in clinical practice， patients should be asked about their allergy and medication history in detail. During use， it is important to focus on the patient’s condition within 24 h after medication to prevent serious ADR and ensure the safety of clinical medication.

Meta-analysis of repeated low-level red light therapy for retarding myopia progression in children / 中华实验眼科杂志

Objective:To systematically evaluate the effect of repeated low-level red light (RLRL) therapy on controlling the progression of myopia in children.Methods:Medline, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov and the CNKI, VIP, Wanfang database, and Chinese Clinical Trial Registry (www.chictr.org.cn) were searched from their establishment to September 2022 to obtain the randomized controlled trial (RCT) about RLRL controlling myopia progression in children.Grey literature was also searched.Inclusion and exclusion criteria were developed according to the PICOS principle.Two researchers screened the literature independently, extracted data, and assessed the risk of bias in the included studies using the Cochrane collaboration tool for assessing risk of bias.The data were imported into RevMan 5.4 software for meta-analysis.Mean and standard deviation of data were used to obtain mean differences and 95% confidence intervals of included studies.Changes in spherical equivalent (SE) and axial length (AL) were compared between before and after the intervention in RLRL and single-vision spectacle (experimental group) and single-vision spectacle (control group). The GRADE system was used to grade the quality of evidence for the outcome indicators.Results:A total of 157 studies were obtained.After the screening, 7 RCT studies including 1 038 study subjects met the inclusion criteria.Meta-analysis results showed that retarded SE progression was retarded and AL elongation was reduced significantly after different follow-up durations (1, 3, 6, 12 and 24 months) in experimental group compared with control group.As the follow-up duration extended from 1 month to 24 months, the retard of SE progression increased from 0.14 to 0.93 D, and the reduction of AL increased from 0.07 to 0.48 mm.Both 635 and 650 nm red light significantly retarded SE progression and reduced AL elongation.The two outcome indicators, SE change and AL change were moderate-strength evidence by GRADE.Conclusions:The current moderate-strength evidence shows that RLRL can better retard myopia progression in children than single-vision spectacle glasses.

Analysis of potential categories and influencing factors of prostate cancer patients' participation in shared decision making / 中国实用护理杂志

Objective:To explore the potential categories of prostate cancer patients′ participation in shared decision making, and analyze the characteristics and influencing factors of different categories of prostate cancer patients′ participation, so as to provide theoretical support for improving prostate cancer patients′ participation in shared decision making.Methods:This was a cross-sectional study. A total of 292 patients with a first diagnosis of prostate cancer without metastasis from three tertiary grade A hospitals in Zhengzhou were selected from October 2019 to October 2020 (Henan Provincial People′s Hospital, the First Affiliated Hospital of Zhengzhou University, the First Affiliated Hospital of Henan University of Chinese Medicine). The general data questionnaire, the Decisional Engagement Scale, Perceived Social Support Scale and Disease Uncertainty Scale were used. Latent class analysis was used to classify prostate cancer patients according to shared decision making participation, and Logistic regression was used to analyze the influencing factors of the potential category.Results:The total scores of the Decisional Engagement Scale, Perceived Social Support Scale and Disease Uncertainty Scale in prostate cancer patients were (67.28 ± 20.77), (62.34 ± 15.39), (95.06 ± 8.05) points, respectively. The shared decision making participation of prostate cancer patients was divided into three potential categories: high participation group 76.4%(223/292), moderate participation group 12.7%(37/292), and low participation group 11.0%(32/292). Taking high participation group as reference, age( OR=1.088, 95% CI 1.161-1.231, P<0.05) and illness uncertainty( OR=1.480, 95% CI 1.414-1.919, P<0.05) were the risk factors for the low participation group; perceived social support was the protective factor ( OR=0.857, 95% CI 0.775-0.946, P<0.05). Illness uncertainty was the risk factor( OR=1.525, 95% CI 1.316-1.767, P<0.05), and perceived social support was the protective factor ( OR=0.829, 95% CI 0.838-0.949, P<0.05) for the moderate participation group. Conclusions:There were obvious classification characteristics of shared decision making participation for prostate cancer patients. Age, perceived social support and illness uncertainty were the influencing factors of it. Interventions should be taken according to the characteristics of each category, to improve the level of shared decision making of prostate cancer patients.

Effect of aerobic exercise on microcirculation in sedentary college students / Efeito do exercício aeróbico sobre a microcirculação em estudantes universitários sedentários / Efecto del ejercicio aeróbico sobre la microcirculación en estudiantes universitarios sedentarios

ABSTRACT Introduction Due to economic development and technological progress, more attention has been given to intellectual education in detriment of physical conditioning, a phenomenon that has corroborated to raise obesity to a contemporary concern in public health. In this sense, studies that can provide reference to guide the scientific sport intervention behavior of college students are the focus of the current research. Objective Explore the effect of different doses of aerobic exercise on microcirculation function in sedentary college students. Methods 69 students from Minzu University were recruited and randomly divided into exercise groups A, B and control. The exercise group received 12 weeks of aerobic exercise intervention. Among them, group A practiced 1-2 times per week, group B practiced ≥ 3 times per week. The control group did not practice any sport. Results After testing, microvascular reactivity showed an interaction to group and time (p<0.01). Among them, exercise group B was higher than control group and exercise group A (p<0.01), with no significant differences between exercise group A and control group (p>0.05). Conclusion Aerobic exercise affects body microvascular response and endogenous NO level. Aerobic exercise lasting 12 weeks with frequency equal to or greater than three times per week can improve the microvascular response of sedentary college students by promoting endogenous NO production. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Com o desenvolvimento econômico e o progresso tecnológico, mais atenção foi dada à educação intelectual em detrimento do condicionamento físico, fenômeno que corroborou para elevar a obesidade a uma preocupação contemporânea na saúde pública. Nesse sentido, estudos que possam fornecer referência para orientar o comportamento de intervenção esportiva científica de estudantes universitários são o foco da pesquisa atual. Objetivo Explorar o efeito de diferentes doses de exercício aeróbico sobre a função da microcirculação em estudantes universitários sedentários. Métodos Foram recrutados 69 estudantes da Universidade de Minzu, divididos aleatoriamente em grupos de exercícios A, B e controle. O grupo de exercícios recebeu 12 semanas de intervenção de exercícios aeróbicos. Entre eles, o grupo A praticou 1-2 vezes por semana, o grupo B praticou ≥ 3 vezes por semana. O grupo controle não praticou nenhum esporte. Resultados após o teste, a reatividade microvascular mostrou uma interação ao grupo e ao tempo (p<0,01). Entre eles, o grupo de exercícios B foi superior que o grupo controle e o grupo de exercícios A (p<0,01), sem diferenças significativas entre o grupo de exercícios A e o grupo controle (p>0,05). Conclusão O exercício aeróbico afeta a resposta microvascular corporal e o nível endógeno de NO. O exercício aeróbico com duração de 12 semanas com frequência igual ou superior de três vezes por semana pode melhorar a resposta microvascular de estudantes universitários sedentários, promovendo a produção de endógenos NO. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Con el desarrollo económico y el progreso tecnológico, se prestó más atención a la educación intelectual en detrimento del acondicionamiento físico, fenómeno que corroboró elevar la obesidad a una preocupación contemporánea en la salud pública. En este sentido, los estudios que pueden servir de referencia para orientar el comportamiento científico de intervención deportiva de los estudiantes universitarios son el centro de la investigación actual. Objetivo Explorar el efecto de diferentes dosis de ejercicio aeróbico sobre la función microcirculatoria en estudiantes universitarios sedentarios. Métodos Se reclutaron 69 estudiantes de la Universidad de Minzu y se dividieron aleatoriamente en los grupos de ejercicio A, B y control. El grupo de ejercicio recibió 12 semanas de intervención de ejercicio aeróbico. Entre ellos, el grupo A practicaba 1-2 veces por semana, el grupo B practicaba ≥ 3 veces por semana. El grupo de control no practicó ningún deporte. Resultados Tras las pruebas, la reactividad microvascular mostró una interacción con el grupo y el tiempo (p<0,01). Entre ellos, el grupo de ejercicio B fue superior al grupo de control y al grupo de ejercicio A (p<0,01), sin diferencias significativas entre el grupo de ejercicio A y el grupo de control (p>0,05). Conclusión El ejercicio aeróbico afecta a la respuesta microvascular corporal y al nivel de endógeno NO. El ejercicio aeróbico de 12 semanas de duración con una frecuencia igual o superior a tres veces por semana puede mejorar la respuesta microvascular de los estudiantes universitarios sedentarios al promover la producción endógena de NO. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Progress of bone metastasis of hepatocellular carcinoma / 肿瘤研究与临床

Hepatocellular carcinoma (HCC) is a malignant tumor with a high incidence in China. Bone is a common extra hepatic metastasis site of HCC. Bone metastasis of HCC not only has a serious impact on the quality of life of patients, but also shortens their survival time. However, the pathogenesis of bone metastasis of HCC remains unclear. This review summarizes the clinical features, pathogenesis, prognostic factors, diagnosis and treatment progress and other aspects of bone metastasis of HCC, in order to provide new ideas for the clinical diagnosis and treatment.

Effect of exercise therapy on exercise capacity and quality of life of maintenance hemodialysis patients / 中国实用护理杂志

Objective:To explore the effect of exercise therapy on the exercise capacity and quality of life of maintenance hemodialysis patients.Methods:A total of 90 patients who underwent regular dialysis in Henan Provincial People′s Hospital, People′s Hospital of Zhengzhou University from April to December, 2020 were selected as the research objects by convienient sampling method. They were divided into experimental group and control group by random number table method, with 45 cases in each group. The control group was given routine nursing, and the experimental group took exercise therapy on the basis of routine nursing. The intervention lasted for 12 weeks. The changes in the exercise capacity and quality of life of the two groups before and after the intervention were observed.Results:Finally, 43 patients were included in the control group and 41 patients in the experimental group. There was no significant difference in the exercise capacity and quality of life before the intervention between the two groups( P>0.05). After the intervention, the maximum oxygen uptake, anaerobic threshold, 6MWT distance were (15.22 ± 3.08) ml·kg -1·min -1, (620.70 ± 53.56) ml·kg -1·min -1, (475.36 ± 50.51) m in the experimental group, and (12.22 ± 2.46) ml·kg -1·min -1, (590.18 ± 52.07) ml·kg -1·min -1, (444.50 ± 46.09) m in the control group, the differences were statistically significant between the two groups( t=3.32, 2.68, 296, all P<0.05). After the intervention, the scores of physiological function, physiological intelligence, physical pain, overall health, vitality, social function, emotional function and mental health dimensions of the quality of life were (84.32 ± 18.53), (84.61 ± 25.80), (76.40 ± 18.15), (59.02 ± 15.38), (52.22 ± 13.68), (69.56 ± 17.29), (94.24 ± 29.47), (73.44 ± 12.86) points in the experimental group, and (76.25 ± 17.35) (66.37 ± 27.63), (65.68 ± 17.54), (47.26 ± 15.45), (44.86 ± 13.14), (61.82 ± 16.51), (76.30 ± 26.14), (64.17 ± 13.36) points in the control group, the differences were statistically significant between the two groups( t values were 2.08-3.54, all P<0.05). Conclusions:Exercise therapy during dialysis can enhance exercise capacity and improve quality of life in maintenance hemodialysis patients.

Construction and clinical effects of endocrinology nursing subspecialty group / 中国实用护理杂志

Objective:To construct endocrinology nursing subspecialty model and explore its clinical effect.Methods:In December 2018, the organization structure of endocrinology nursing subspecialty was constructed in the Drum Tower Hospital Affiliated of Nanjing University Medical School and applied in clinic. In this model, the data of 2018 were taken as the data before application and the data of 2020 were taken as the data after application. The comprehensive ability of nurses, nurse satisfaction, related nursing workload and scientific research ability of nurses were compared before and after the application of the model.Results:After the application of subspecialty nursing mode, nurses′ comprehensive ability score was (92.00 ± 2.36) points. Compared with (84.25 ± 3.24) points before implementation, the difference was statistically significant ( t=-9.46, P<0.01); nurses′ satisfaction evaluations including specialty development (7.92 ± 1.41), self-quality improvement (8.00 ± 1.69), work pressure (6.42 ± 2.67), salary and welfare (3.96 ± 0.85), compared with (5.79 ± 2.31), (6.17 ± 2.82), (8.33 ± 1.50), (2.88 ± 1.59) before implementation, the difference was statistically significant ( t values were -3.86--2.73, all P<0.05). The annual workload of related nursing increased and the scientific research ability of nurses was improved. Conclusions:The application of endocrinology nursing subspecialty mode is beneficial to improve nurses′ comprehensive ability of clinical work, improve the level of specialized nursing, improve the quality of nursing service and promote the improvement of economic benefits, which is worthy of clinical promotion.

EGFR Mutation Status and PD-L1 Expression in Patients ≤40 Years Old with NSCLC / 肿瘤防治研究

Objective To retrospectively analyze the clinical data of 47 young NSCLC patients mutation style of EGFR and PD-L1 expression in tumor cells, to understand their clinicopathological and molecular characteristics. Methods We enrolled 47 young (≤40 years old) patients confirmed as NSCLC who underwent surgical resection, and 94 old patients (≥60 years old) were matched as 1:2 by R language. EGFR mutation status was detected by ARMS-PCR, and the expression of PD-L1 was detected by immunohistochemistry. Results The median age of 47 young patients with NSCLC was 37 years old. The disease was more common in women and the majority type was adenocarcinoma. In youth group, the 19del and 20ins were more frequent, but the exon 21 L858R point mutation proportion was higher in elder group. The expression of PD-L1 was significantly increased in the solid predominant histological subtype. The PD-L1 expression in 19del patients was higher than that in the patients with L858R mutation in youth group. Conclusion The majority of young NSCLC patients are female, nonsmokers and suffered from adenocarcinoma cancer. The proportion of EGFR alteration in 19del and 20ins in youth group is higher than that in elder group. The positive rate of PD-L1 expression in solid predominant histological subtype is higher than that with other subtypes. The expression of PD-L1 in young patients with EGFR 19del is higher than that with L858R.

Mediating effect of serum BDNF level on association of occupational PAHs exposure with cognitive impairment in coke oven workers / 环境与职业医学

Background Long-term occupational polycyclic aromatic hydrocarbons (PAHs) exposure is an important risk factor for cognitive impairment. At the same time, it can also cause a decrease of brain-derived neurotrophic factor (BDNF). However, it is not clear whether BDNF plays a key role in the cognitive impairment of workers caused by occupational PAHs exposure. Objective To analyze the correlation between the levels of PAHs in the plasma of coke oven workers and cognitive impairment, and to explore the possible mediating effect of plasma BDNF level on the relationship between PAHs and cognitive impairment. Methods A cross-sectional survey was carried out to select 138 pairs of workers from a coking plant (exposure group) and an energy plant (control group) in a large enterprise in Taiyuan, and the matching variables included age, education level and smoking status. The basic data of the workers were collected by questionnaire. The cognitive function of the workers was assessed by the Montreal Cognitive Assessment (MoCA) scale. Fasting elbow venous blood was collected, the plasma concentrations of 16 PAHs were determined by high performance gas chromatography-mass spectrometry (GC-MS), and the plasma concentration of BDNF was detected by enzyme-linked immunosorbent assay (ELISA). Multiple linear regression model was used to analyze the relationship between 12 PAHs levels in plasma and MoCA scores, and Bootstrap method was used to analyze the mediating effect of BDNF in the relationship between these two indicators. Results The average (\begin{document}$\bar x \pm s $\end{document}) age of workers in the two groups was (48.46±5.04) years, the length of service was (21.45±9.78) years, and 58.7% of the participants reported their education level at secondary vocational school, high school, and above. The median level (25th and 75th percentiles) [M(P25, P75)] of plasma Σ12PAHs concentration of workers in the exposure group [20.937 (9.454, 38.387) μg·L−1] was significantly higher than that of the control group [9.997 (4.952, 23.770)μg·L−1] and the MoCA score (22.82±2.38) of the exposure group was significantly lower than that of the control group (24.60±5.67) (P<0.05). The plasma BDNF showed no significant difference between the exposure group [(29.99±9.80) μg·L−1] and the control group [(31.48±9.09) μg·L−1](P>0.05). Taking plasma PAHs as independent variable and MoCA score as dependent variable, after adjusting selected covariates, the results of multiple linear regression model showed that the MoCA score changed by −0.020 (95%CI: −0.035 - −0.005) for every 1 μg·L−1 increase of plasma Σ12PAHs. Low (<P33), medium ( P33~P66) and high (>P66) dummy variables were set according to the intertertile boundaries (8.31, 23.76) μg·L−1 of the plasma level of Σ12PAH of the workers. The change of MoCA score in the high concentration group versus the low concentration group was −1.167 (95%CI: −1.866 - −0.467). The MoCA score changed by 0.066 (95%CI: 0.012 - 0.119) for each 1 μg·L−1 increase in plasma BDNF level. The results of dichotomous logistic regression analysis showed that the risk of cognitive impairment in the high concentration group was 2.635 (95% CI: 1.085 - 6.398) times higher than that in the low concentration group. The results of mediating effect analysis showed that plasma BDNF level was an intermediate variable between PAHs and cognitive impairment, and 45.50% of PAHs-induced cognitive impairment risk was mediated by reduced BDNF level. Conclusion The level of plasma PAHs in coke oven workers is negatively correlated with MoCA score, and PAHs may mediate cognitive impairment by reducing plasma BDNF level.

Expert consensus on early childhood caries management / 国际口腔科学杂志·英文版

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

Progress on low protein diet for patients with chronic kidney disease / 中华全科医师杂志

Nutrition therapy is considered as the basis for prevention and management of chronic kidney disease (CKD), throughout the three-tier prevention strategies of CKD. The primary objective is to delay the disease progression, correct metabolic disorders, and improve the outcomes of CKD. Low protein diet has been recognized as an important therapeutic measure in CKD, but the quantity, quality and source of protein are always the points of contention. Recently, both domestic and foreign guidelines have been updated on the amount of protein intake. In addition to quantity, attention has been paid to the type and diversity of proteins. With the rise of plant-based food consumption and the concept of vegetarian diet, the scientific community began to review the benefits of plant protein again, and a plant-based diet is recommend extensively. Whether the plant-based dietary pattern is also suitable for CKD patients who need a low-protein diet, and whether it could meet the nutritional needs of CKD patients are hot topics, this article reviews the recent progress of these research hotspots.

Early- and mid-term clinical outcomes of patellofemoral arthroplasty / 中华骨科杂志

Objective:To investigate the early- and mid-term clinical, functional and radiographic outcomes of patellofemoral arthroplasty (PFA).Methods:A retrospective analysis was conducted in 64 patients (80 knees) who suffered from severe patellofemoral osteoarthritis (PFOA) and underwent PFA from January 2013 to December 2020. These patients were aged 60.50±8.82 (range from 27 to 82) years, including 9 males (12 knees) and 55 females (68 knees). All enrolled individuals presented typical PFOA. Unilateral PFA was performed in 48 cases, bilateral PFA in 16 cases, including one-stage PFA in 9 cases and two-stage PFA in 7 cases. The visual analogue scale (VAS), Hospital for Special Surgery (HSS) knee score and Oxford knee score (OKS) of patients with more than 5 years' follow-up were assessed to evaluate the clinical effects of PFA at the time before surgery, 1 year and 5 years after surgery. In addition, the patellar tilt angle (PTA) and hip-knee-ankle (HKA) angle were measured and analyzed to evaluate the improvement of patellar tracking and progression of tibiofemoral osteoarthritis, based on axial X-ray imaging (skyline view) of knee and the full length standing X-ray imaging of the lower limbs at before surgery and 5 years after surgery. Meanwhile, the complications of all patients that related to the operation were recorded.Results:A total of 64 patients were followed up for 4.31±1.79 (range, 1.5 to 8.2) years. Twenty-five patients (32 knees) who followed up more than 5 years were analyzed. The VAS, HSS and OKS improved from 5.91±0.82, 68.06±6.03 and 21.22±3.46 preoperatively to 0.88±1.01, 90.09±3.30 and 39.06±3.37 at 1 year after surgery, and to 0.41±0.76, 94.53±2.99 and 42.13±3.17 at 5 years after surgery, respectively ( F=89.38, 81.47, 56.73, P<0.001). Additionally, comparing to the preoperative radiological data, the patellar tract was improved with the PTA decreased from 8.21°±3.14° preoperatively to 3.58°±4.48°at 5 years after surgery ( t=4.96, P<0.001). The HKA angle changed from 179.01°±1.43° preoperatively to 178.77°±1.67° at 5 years follow up ( t=1.71, P=0.096). There was no case of prosthesis loosening or wear and no case of obvious progression of tibiofemoral osteoarthritis that needed revision in all patients. Conclusion:Satisfied early- and mid-term clinical outcomes could be achieved by PFA in treating severe PFOA patients. PFA could relieve pain and improve function of knee joint.

Expression of CD44 in Tumor Tissue and Serum of Small Cell Lung Cancer and Its Clinical Prognostic Significance / 中国肺癌杂志

BACKGROUND@#Small cell lung cancer (SCLC) is a highly aggressive malignancy characterized by rapid growth, early metastasis and acquired therapeutic resistance, and the prognosis is extremely poor. Studies have proved that the stem cell marker CD44 is correlated with tumor recurrence and treatment resistance, however, there are limited reports yet concerning on the CD44 expression and its clinical prognostic significance in SCLC patients. The purpose of this study is to investigate the expression of CD44 in tumor tissues as well as serum of SCLC patients and explore its correlation with the clinical characteristics, therapeutic effect and prognosis.@*METHODS@#The tumor tissues and serum samples of 47 newly diagnosed SCLC patients were collected. Immunohistochemistry and enzyme-linked immunosorbent assay were applied to detect CD44. The relationship between CD44 level and the clinical characteristics as well as prognosis of the patients was analyzed.@*RESULTS@#The stem cell marker CD44 was detectable both in serum sample and tumor tissue of SCLC patients. The positive rate of CD44 in tumor tissue was significantly higher in patients with performance status (PS) 2 than that of patients with PS 0-1 (85.71% vs 30%, P=0.017). Patients were divided in to different groups according to the treatment efficacy. The CD44 immunohistochemical score and serum level in the disease progression group were significantly higher than those in the disease control group, and the differences were statistically significant (P=0.006, P=0.034), Univariate analysis depicted that the progression-free survival (PFS) of CD44 positive patients was significantly shorter than that of CD44 negative patients (5.23 mon vs 9.03 mon, P=0.036).@*CONCLUSIONS@#The positive expression of CD44 in tumor tissues of pre-treatment SCLC patients is correlated with poor PFS. The clinical significance of CD44 is worthy to be further studied.

The study of the risk factors and pathogenesis of idiopathic epimacular membrane / 中华眼底病杂志

Idiopathic macular membrane (iERM) is a fibrocellular membrane that forms on the inner surface of the retina. In its early stages, symptoms of iERM are usually not apparent. However, advanced iERM can cause different degrees of visual impairment and effect the quality of life of patients. Current studies suggest that iERM may be associated with posterior vitreous detachment (PVD), age, sex, race and/or ethnicity, poor lifestyle, refractive error, diabetes, hypercholesterolemia, and cardiovascular disease. The most well-established risk factors for iERM are age and PVD. The pathogenesis of iERM is extremely complex. Various cell types, such as Müller cells, Hyalocytes and myofibroblasts, nerve growth factor, interleukin-6, transforming growth factor β, vascular endothelial growth factor and other cytokines and growth factors, as well as a variety of genes and proteins are directly or indirectly involved in the formation of iERM, however, their exact role remains a mystery. In the future, further studies at the molecular level and gene level are needed to provide greater help for the clinical diagnosis and treatment of iERM.

Study on the application of exercise stress echocardiography combined with layer-sepcific strain in patients with essential hypertension / 中华超声影像学杂志

Objective:To evaluate the diagnostic value of exercise stress echocardiography combined with left ventricular two-dimensional speckle tracking layer-specific strain technique in evaluating subclinical myocardial damage and reserve function in patients with hypertension.Methods:A total of 51 healthy subjects(control group) and 55 hypertensive patients (hypertension group) were enrolled in the treadmill exercise stress test in Sichuan Provincial People′s Hospital from October 2018 to January 2020. According to the European Guidelines for the Prevention and Treatment of Hypertension, the inclusion criteria for patients with hypertension were: blood pressure≥140/90 mmHg or who explicitly took antihypertensive drugs, and related cardiovascular diseases were excluded. The conventional parameters of resting and peak exercise, including left ventricular mass index, left ventricular end-diastolic volume index and left ventricular ejection fraction et al, were analyzed by speckle tracking software in two groups. According to the standard images in the resting and peak exercise, the endocardium /mid-myocardium /epicardium of left ventricular (three-, two-, four-chamber and global) longitudinal strain and circumferential strain (papillary muscle level) were compared respectively in two groups. The characteristics of strain differences and the systolic function reserve between the resting and peak exercise were evaluated.Results:There were significant differences in conventional ultrasound parameters between resting and peak exercise period in hypertension group, except E/A and e/a ratio (all P<0.05), and E/e value increased significantly(12.1±0.38) during peak exercise, indicating impaired diastolic reserve function. The longitudinal and circumferential layer-specific strain values from endocardial to epicardial were gradually decreased in both two groups. Compared with the control group, the resting longitudinal and circumferential endocardial strain values in hypertensive group were decreased, and the differences were more obvious at peak status, for instance global longitudinal endocardium strain at rest[control group (24.4±1.5)%, hypertension group (20.4±2.3)%], peak status[control group (30.8±2.8)%, hypertension group (22.8±2.9)%]( P<0.05). There were no significant differences of the partial layer-specific strain values between the peak exercise and resting status in hypertension group, while peak layer-specific strain of the control group were all significantly increased, suggesting that the left ventricular systolic reserve function of hypertension patients was lower than that of the control group. Conclusions:Left ventricular layer-specific strain can effectively evaluate the myocardial function in patients with hypertension, especially the endocardial strain can be used as an indicator parameter, and the peak exercise stress state is more sensitive. The systolic and diastolic reserve function of the left ventricle in patients with hypertension at the peak period are reduced to different degrees. Exercise stress echocardiography combined with left ventricular layer-specific strain technique can be used as a new method for detection of myocardial function impairment in patients with hypertension.