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Objective:To assess the imaging characteristics of muscle FDG metabolism, tumor incidence, and pulmonary interstitial changes in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody positivity in 18F-FDG PET/CT imaging, and the value of 18F-FDG PET/CT in differentiating anti-MDA5 antibody positive dermatomyositis. Methods:From June 2016 to July 2019, the PET/CT images of 75 patients with dermatomyositis (21 males, 54 females, age (52.3±14.3) years; 34 anti-MDA5 antibody positive and 41 anti-MDA5 antibody negative) and 30 healthy controls (10 males, 20 females; age (53.5±11.8) years) were retrospectively analyzed in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. The SUV max of muscle was measured and the mean of SUV max (mSUV max) was calculated. Statistics of patients with dermatomyositis complicated with neoplastic lesions and the SUV max of pneumonia lesions in patients with dermatomyositis complicated with interstitial pneumonia was determined. Independent sample t test, one-way analysis of variance, Student-Newman-Keuls (SNK) test and χ2 test were used to analyze data. The ROC curve analysis was used to analyze the diagnostic efficacy of mSUV max for the differential diagnosis of anti-MDA5 antibody positive dermatomyositis. Results:The muscle mSUV max of the control group, anti-MDA5 antibody positive and negative groups were 0.39±0.05, 0.66±0.21 and 0.87±0.29 ( F=39.93, P<0.001), respectively. The muscle mSUV max of dermatomyositis patients was increased compared with healthy controls ( q values: 6.76, 12.63, both P<0.001), and the muscle mSUV max of anti-MDA5 antibody negative was higher than positive ( q=5.79, P<0.001). The AUC was 0.74, and the cut-off value of muscle mSUV max was 0.75 with the accuracy of 74.7%(56/75). Of 41 patients with negative anti-MDA5 antibody, there were 6 (14.6%) had malignant tumor, while there was no malignant tumor in patients with positive anti-MDA5 antibody (0/34; χ2=5.41, P=0.020). There were 11 patients (26.8%, 11/41) with anti-MDA5 antibody negative dermatomyositis complicated with interstitial pneumonia and 33 patients (97.1%, 33/34) with anti-MDA5 antibody positive dermatomyositis complicated with interstitial pneumonia ( χ2=37.81, P<0.001). FDG metabolism in anti-MDA5 antibody positive patients was higher than that in anti-MDA5 antibody negative patients (lesion SUV max: 3.65±1.83 and 2.38±1.27; t=2.13, P=0.039). Conclusions:The muscle FDG metabolism of anti-MDA5 antibody positive dermatomyositis patients is higher than that of healthy controls, but lower than that of anti-MDA5 antibody negative patients. The incidence of neoplastic lesions in patients with positive anti-MDA5 antibody is lower than that in patients with negative anti-MDA5 antibody. The proportion and severity of interstitial pneumonia are higher in patients with positive anti-MDA5 antibody than in those with negative anti-MDA5 antibody. 18F-FDG PET/CT has certain value on identifying anti-MDA5 antibody positive dermatomyositis.
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Objective:To analyze the incidence, biochemical and molecular characteristics, and gene mutation spectrum of neonatal methylmalonic acidemia (MMA) in Shaanxi province.Methods:This study involved 146 152 newborns undergoing neonatal screening for methylmalonic acidemia by tandem mass spectrometry in Northwest Women's and Children's Hospital from January 2014 and December 2019. Clinical manifestations and follow-up data of newborns diagnosed with MMA and their acylcarnitine profiles and gene mutations were analyzed. According to whether they had elevated homocysteine or not, these patients were divided into two groups, the complicated group and the isolated MMA group. The control neonates were those excluded from having methylmalonic acid by re-examination. Kruskal-Wallis and Mann-Whitney U test was conducted for statistical analysis. Results:(1) Twenty-one cases of MMA were confirmed with an incidence of 1/6 960, including 11 cases (52.4%) of isolated MMA (isolated MMA group) and 10 (47.6%) complicated by elevated homocysteine (complicated group). Eight patients in the isolated group had symptoms within one month after birth, mainly feeding difficulties, vomiting, drowsiness, poor response and infection, and five died. Patients in the complicated group were all diagnosed before developing typical clinical symptoms, and no developmental abnormalities were reported during follow-up. (2) Blood propionyl carnitine and its ratios to acetylcarnitine and free carnitine in the isolated MMA and complicated groups were higher than those in the control group [ M (min-max), 9.26 (3.70-37.78) μmol/L and 7.27 μmol/L (3.58-13.62 μmol/L) vs 4.51 μmol/L (1.48-8.69 μmol/L), H=23.239; 1.12 (0.32-2.43) and 0.74 (0.36-1.90) vs 0.25 (0.09-0.45), H=47.061; 0.94 (0.12-1.92) and 0.56 (0.18-1.03) vs 0.17 (0.06-0.38), H=36.868; all P<0.001]. The blood methionine level in the complicated group was significantly lower than that in the isolated MMA group [7.64 μmol/L (3.40-19.25 μmol/L) vs 24.22 μmol/L (10.73-56.55 μmol/L), U=3.000, P<0.001]. (3) All 21 patients carried complex heterozygous mutations or homozygous mutations in pathogenic genes, including 15 distinct MMUT mutations and 13 distinct MMACHC mutations. In the isolated MMA group, the most common mutation was c.323G>A (p.Arg108His) in the MMUT gene with a positive rate of 13.6%, and an unreported mutation, c.1676+11A>G, with unidentified clinical significance, was also found. The most common mutations in the complicated group were c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in the MMACHC gene, and the positive rates were both 20.0%. Moreover, two unreported variants, c.430-2A>C and c.648_650delAGA (p.216_217delSEinsS), were detected and suspected to be pathogenic. Conclusions:MMA is not uncommon in Shaanxi province. Children with isolated MMA tend to be more severe clinically. The identification of hotspot mutations, including c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in MMACHC gene and c.323G>A (p.Arg108His) in MMUT gene, provides a foundation for further genetic screening, counseling, and prenatal diagnosis, and is conducive to reduce the mortality and disability rate of neonatal MMA.
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OBJECTIVE@#To explore the relationship between materialistic values and depression in medical students.@*METHODS@#A random sample of 1158 college students from a medical university in Guangdong Province was investigated using the materialism tendency scale (MTS), the simplified version of purpose in life test (PIL-SF) and the patient health questionnaire (PHQ-9).@*RESULTS@#The survey showed that 17.33% of the students had obvious depressive symptoms. A negative correlation was found between the materialistic values and the meaning in life (=-0.229, < 0.01) in these students; materialistic values were positively correlated with depression (=0.246, < 0.01), and the meaning in life was negatively correlated with depression (=-0.476, < 0.01). Meaning in life mediated the relationship between materialistic values and depression, which accounted for 41.2% of the total effects.@*CONCLUSIONS@#Meaning in life partially mediates the relationship between materialistic values and depression.
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Humans , Depression , Students, Medical , Surveys and QuestionnairesABSTRACT
Objective To explore the relationship between achievement motivation,procrastination and positive mental health of college students.Methods A total of 348 students completed a survey that in-cluded Achievement Motivation Scale(AMS),General Procrastination Scale(GPS)and Mental Health Con-tinuum Short Form(MHC-SF).Results (1)The average scores of achievement motivation,procrastination and positive mental health in college students were 3.61±12.05,56.48±10.62 and 3.46±0.82 respectively. The proportion of flourishing student was accounted for 53.16%,44.83% for the moderately mentally healthy and 2.01% for the languishing.(2)College students' achievement motivation was positively correlated with positive mental health(r=0.399,P<0.01),achievement motivation was negatively correlated with procrasti-nation(r=-0.388,P<0.01)and procrastination was negatively correlated with positive mental health(r=-0.267,P<0.01).(3)Procrastination had a partial mediating effect between achievement motivation and positive mental health,and the proportion of mediating effect in total effect was 12.75%.In three dimensions of positive mental health,procrastination also had partial mediating effect between achievement motivation and psychological well-being and emotional well-being respectively,the proportion of mediating effect in total effect were 15.71% and 20.63% respectively.But the mediating effect between achievement motivation and social well-being was not significant.Conclusion College students with higher achievement motivation have higher positive mental health,but the procrastination has indirect negative effect between the two variables,which leads to the negative effect of emotional and psychological well-being in the positive mental health condition.
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Objective To investigate and analyse the status and influential factors of palliative care knowledge of nursing undergraduates,then provide theoretical basis for palliative care education. Methods Using random sampling method, 400 nursing undergraduates were investigated by Palliative Care Quiz for Nursing (PCQN) and palliative care attitude questionnaire. Results 366 nursing undergraduates completed the survey whose scores were 8.363 ± 4.240, and 66.9%(244/366) of them had never heard of palliative care. Choosed right rate of PCQN was 41.13% (150/366). The scores of palliative care philosophy and principles 0.298±0.248, pain and symptom control and psychological scores 0.436 ± 0.235 and social and spiritual support scores 0.499 ± 0.318 had significant difference (F=38.866, P=0.000). The scores of palliative care attitude questionnaire were 36.756 ± 3.183, and the average score of all items were over 3. The palliative care attitude scores had significant difference in different grade (F=2.737, P=0.043). Conclusions Nursing undergraduates hold positive attitudes of palliative care, but the cognition degree were at a low level. To promote the development of palliative care, it should be strengthened publicity, education and training in this area. It is necessary to carry out palliative care education in nursing undergraduate students.
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Objective To explore the community elderly depression effect on quality of life and provide the basis for the elderly mental health intervention. Methods Adopting stratified random sampling method, using the SF-12,CES-D and psychological capital questiennaire of elder to survey among 500 community elderly people and established the structural equation model. Results The age, degree of education, income situation, depression and the old psychological capital of the community elderly can be used to predict the quality of life, can explain 88.6%variance of life quality(P<0.05);depression on quality of life has a direct effect of-0.21(P < 0.05); depression through psychological capital indirect effect on quality of life for-0.64(P<0.05). Conclusions The elderly depression through psychological capital intermediary effect on the quality of life.
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Objective To evaluate the diagnostic performance of Xpert MTB/RIF for the diagnosis of tuberculous meningitis (TBM).Methods This was a prospective, single center clinical trial.A total of 116 consecutive patients with suspected meningitis who were admitted to Xijing Hospital from October 2013 to June 2015 were recruited.Mycobacterium tuberculosis ( MTB) and rifampicin ( RIF) resistance mutations in 1 ml cerebrospinal fluid ( CSF) were detected with Xpert MTB/RIF and the remaining sample was tested by Ziehl-Neelsen staining , MGIT960 liquid culture and other laboratory tests .And the enrolled patients were grouped according to the 2010 South African expert consensus .The diagnostic performance of Xpert MTB/RIF was evaluated by comparing against clinical score >5 points and MGIT960 liquid culture as reference standards respectively .The comparison was performed using a χ2 test or Fisher′s exact test for categorical variables and a nonparametric rank sum test for continuous variables .Results Among the enrolled 116 subjects, 23 subjects were diagnosed as definite-TBM by MGIT960 liquid culture, 16 subjects were classified as probable TBM , 27 subjects were classified as possible TBM , and 50 subjects were classified as non-TBM.When clinical score >5 points was used as a reference standard , the sensitivity of Xpert MTB/RIF (39.4%) was comparable with that of MGIT960 liquid culture (34.8%) (χ2 =0.292, P=0.589), and significantly better than that of Ziehl-Neelsen staining (9.9%) (χ2 =16.500, 12.771, P<0.001). No significant differences were found among the specificities of Xpert MTB /RIF, MGIT960 liquid culture and Ziehl-Neelsen staining ( 98.0%, 100.0% vs 98.0%, χ2 =1.014, P=0.602 ) .When tested against MGIT960 liquid culture as a reference standard , the sensitivity of Xpert MTB/RIF was 91.3%. Conclusions Xpert MTB/RIF is a rapid and specific method to detect MTB and RIF resistance in CSF .It exhibits a good rule in value for the diagnosis of TBM and a comparable sensitivity with MGIT 960 liquid culture, thus it can be used as the initial method for the diagnosis of tuberculous meningitis .
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Objective To explore the occupational stressors and the coping strategies in the newly-employed nurses and to explore their relationships. Method The survey was done among 193 registered nurses with less than 3 years working experience using the occupational stressor scale for Chinese nurses, the simplified coping strategies questionnaire and a self-designed general demography form. Results The total score on occupational stressors was 2.27 ± 0.56, which was at a common level. Postive and negative coping style were 1.88 ± 0.44 and 1.04 ± 0.51. The stressors together with the dimensions were positively correlated with negative coping strategies (P<0.05). Conclusion Nursing administration should improve work environment, provide enough manpower for patient care, carry out training system to focus on education for newly employed nurses, and provide advice and help for them when they need.
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Objective To evaluate the clinical application of disk diffusion method(ROSCO company of Denmark) for testing the susceptibility of candida species isolated from patients with cancer with the using broth microdilution method ((NCCLS) M27-A of America Committee for clinical laboratory standards) as the gold standard in order to find the better method for clinical laboratory.Methods Antifungal susceptibility (5-flucytosine,amphotericin B,fluconazole and itraconazole) of 78 strains of Candida species were tested both by ROSCO disk diffusion method and ATB FUNGUR2 broth microdilution method.The microdilution method NCCLS as the gold standard.The sensitivity,specificity,positive and negative predictive values of two methods was calculated.Results The Kappa value was reached to 0.89 in term of disk diffusion method for detecting susceptibility of candida to 5-flucytosine,amphotericin B,fluconazole and itraconazole,suggesting that no serious errors was seen in terms of sensitive and resistant another method.Of 78 strains of candida,they had the high susceptibility to 5-flucytosine,amphotericin B,which were 88.20％ and 89.17 ％.The lower susceptibility of 78 strains of candida was fluconazole and itraconazole (56.34％ and 52.12％).Candida glabrata and candida krusei were proved to suspect to four kinds of antifungal agents(90.95％,85.71％).And the lowest positivity was 67.50％ and 41.67％ regarding of candida glabrata and candida krusei.Conclusion The higher consistency was seen in terms of detecting candida susceptibility to antibiotics by disk diffusion method and microdilution method,suggesting disk diffusion method can replace microdilution method.In bur hospital,candida species are susceptibility to amphotericin B at the highest sensitivity and courtyard albicans at lower sensitivity.Antifungal agents works to candida albicans and lower inhibition rate to candida kruse.