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Objective:To construct a self-examination index system for hospital legal practice, and provide effective reference for the self-examination work of hospital practice in accordance with the law.Methods:From May 2021 to September 2022, a multi-dimensional and multi-level indicator system was initially constructed through literature review and expert interviews; Delphi expert consultation method was used to carry out a three-round questionnaire survey, experts were invited to assess the importance of indicators, and the weight values of indicators were processed by using analytic hierarchy process-fuzzy comprehensive evaluation method.Results:The Cs value of consulting experts′ familiarity with the survey content was 0.84, Ca value of judgment basis was 0.78, Cr value of authoritative evaluation was 0.81, and Kendall W value was 0.630. The index system of hospital self-examination included 5 first-level indexes, 19 second-level indexes, and 30 third-level indicators. The 5 first-level indicators included institutional practice, personnel practice, disinfection and prevention of infectious disease, online diagnosis and treatment, and anti-fraud insurance, with weights of 0.235, 0.186, 0.188, 0.185, and 0.206 respectively. Among the second-level indicators, the weights of rational use of medical insurance fund, internet hospital and internet diagnosis and treatment, organization qualification and practice behavior were the highest, with values of 0.206, 0.185, 0.122 and 0.113 respectively. Among the third-level indicators, the internet hospital physician qualification, whether the hospital had obtained the license to practice, cracking down on fraudulent insurance practices, real-name medical treatment, and reasonable and standardized use of health insurance costs had the highest weight, which were 0.185, 0.122, 0.076, 0.065, and 0.065, respectively. Conclusions:The self-examination index system of medical institutions is scientific, which could help the medical institutions to practice self-examination and ensure medical quality and safety.
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As a front-line department for the prevention and control of respiratory infectious diseases, the construction and management of fever clinics have also been adjusted with the changes of the epidemic situation in different periods. In this context, the scope of diagnosis and treatment of fever clinics should be expanded again, not limited to the detection and screening of infectious diseases, but should focus on early treatment and prevention of severe diseases. Management measures should also be further optimized with the expansion of patient types. Face of this situation, we need to actively explore the integration of epidemic prevention and control into the normalized diagnosis and treatment environment, and at the same time maintain the ability to respond to the outbreak of the epidemic. As a hospital of traditional Chinese medicine, it is also important to play and develop the characteristics of traditional Chinese medicine in the construction of fever clinic.
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Objective:To analyze the clinicopathological features, gene mutation characteristics, and prognostic related factors of patients with primary gastrointestinal stromal tumor (GIST) of small intestine.Methods:From January 1, 2011 to December 30, 2019, surgical resected and pathological diagnosed small intestinal GIST without preoperative adjuvant therapy, at Tianjin Medical University Cancer Institute & Hospital were retrospectively collected. The mutational status of KIT exons 9, 11, 13, and 17 and platelet-derived growth factor receptor alpha ( PDGFRA) exons 12 and 18 were detected by polymerase chain reaction and Sanger direct sequencing. Clinicopathological features and gene mutation characteristics were analyzed. Pearson chi-square test and Bonferroni continuous correction test were used to compare the categorical variables among groups. Kaplan-Meier method and log-rank test were used for univariate survival analysis. The multivariate Cox proportional hazards regression model was used for multivariate survival analysis. Results:The proportions of patients with maximum tumor diameter> 10.0 cm and high-risk GIST located in the jejunum and ileum were higher than those of patients with primary GIST located in the duodenum (18.7%, 28/150 vs. 6.4%, 5/78; 56.7%, 85/150 vs. 43.6%, 34/78), and the differences were statistically significant ( χ2=14.67 and 12.46, P=0.002 and 0.006). The results of gene detection of 58 cases of small intestinal GIST indicated that the percentage of KIT gene mutant and wild type accounted for 84.5% (49/58) and 15.5% (9/58), among which 34 cases (69.4%), 12 cases (24.5%), 2 cases (4.1%) and 1 case (2.0%) were KIT gene exons 11, 9, 13 and 17 mutations, respectively, and none of the case with PDGFRA mutation. The 3-, 5-, and 10-year progression-free survival rates of the patients with small intestinal GIST were 88.1%, 85.0%, and 68.3%, respectively, and the 3-, 5-, and 10-year overall survival rates were 96.6%, 94.5%, and 86.1%, respectively. The results of univariate survival analysis showed that the progression-free survival rate and overall survival rate of patients with very low-risk and low-risk GIST were higher than those of patients with intermediate-risk and high-risk GIST (100.0%, 49/49 vs. 72.3%, 81/112; 100.0%, 49/49 vs. 89.3%, 100/112, respectively), and the differences were statistically significant ( χ2=14.07 and 4.92, P<0.001、=0.027). The results of univariate survival analysis of patients with intermediate-risk and high-risk GIST showed that the epithelioid cell type, mitotic index >5/5 mm 2, Ki-67 proliferation index >5%, and without postoperative adjuvant therapy were all related with progression-free survival time, and the differences were statistically significant ( χ2=8.39, 5.53, 13.73 and 15.44, P=0.004、0.019、<0.001、<0.001). Without postoperative adjuvant therapy was related with poor overall survival time ( χ2=7.06, P=0.008). The results of univariate analysis in patients with intermediate-risk and high-risk GIST and without postoperative adjuvant therapy showed that the epithelioid cell type, high-risk, mitotic index >5/5 mm 2 and Ki-67 proliferation index >10% were all related with progression-free survival time, and the differences were statistically significant ( χ2=10.08, 6.51, 10.37 and 15.72, P=0.001、0.011、0.001、<0.001). The results of multivariate analysis indicated that Ki-67 proliferation index >5% ( HR=5.018, 95% confidence interval(95% CI) 1.745 to 14.430, P=0.003) and without postoperative adjuvant treatment ( HR=0.145, 95% CI 0.051 to 0.414, P<0.001) were independent risk factors of postoperative tumor progression in patients with small intestinal intermediate-risk and high-risk GIST. Ki-67 proliferation index>10% ( HR=8.381, 95% CI 1.364 to 51.487, P=0.022) was an independent risk factor of postoperative tumor progression in patients with small intestinal intermediate-risk and high-risk GIST and without postoperative adjuvant treatment. Conclusions:The most common mutation in small intestinal primary GIST is KIT mutation, followed by wild type, no case of PDGFRA gene mutation has been found. High Ki-67 proliferation index can predict poor prognosis of patients with moderate-risk and high-risk small intestinal primary GIST. Postoperative adjuvant therapy can significantly improve the prognosis of patients with small intestinal intermediate-risk and high-risk primary GIST.
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Objective:To study the effect of early nursing intervention to prevent lymphedema of upper limb after breast cancer surgery and its effect on postoperative quality of life.Methods:Between July 2018 and March 2020, one hundred and seventeen cases of breast cancer, all female, admitted to department of thyroid and breast surgery, the affiliated Zhongshan hospital of Dalian University, were underwent modified radical mastectomy with axillary lymph node dissection. Fifty-eight cases were included in the control group whereas fifty-nine cases were in the intervention group. The control group received conventional nursing, the intervention group added early care intervention measures on the basis of conventional nursing. Follow-ups were carried out monthly in a period of 9 months post-surgery. The incidence and grade of lymphedema were compared between the two groups.Results:The incidences of lymphedema at 1,3,9 months after surgery were 8.5% (5/59), 8.5% (5/59), 10.2% (6/59) in the intervention group, which were lower than 31.0% (18/58), 36.2% (21/58), 43.1% (25/58) in the control group. Statistics showed significant difference between the two groups ( χ2 value was 9.425, 13.041, 16.289, P<0.05). The incidence of mild, moderate, and severe lymphedema were statistically different between the two groups ( χ2 value was 10.350, 12.078, 17.422, P<0.05). Follow-up for the quality of life was assessed using a 5-dimension evaluation method, including physical status, social/family status, emotional status, functional status and additional attention. One month follow-up showed 20.36±1.80, 20.03±1.68, 34.63±3.52, 15.86±1.96, 19.81±1.04 in the intervention group, all higher than the control group 17.03±1.36, 17.10±1.46, 19.38±1.51, 10.91±1.22, 18.36±1.21. Three-month follow-up showed 23.56±2.72, 23.73±2.20, 39.93±4.17, 20.31±3.04, 26.37±2.23 in the intervention group, higher than those of the control group 20.90±2.14, 19.12±2.63, 25.79±3.59, 13.97±2.67, 21.02±2.50. Nine month follow-up showed 27.44±2.01, 25.80±1.85, 40.88±3.72, 21.02±2.78, 27.02±2.45 in the intervention group, which were high than the control group 19.93±1.66, 20.67±1.46, 19.38±2.29, 16.33±2.65, 22.29±2.52. The difference between the two groups were statistically significant ( t value was 8.691-34.383, P<0.05). Conclusions:Early nursing intervention could prevent lymphedema of upper limb after breast cancer surgery, delay the progress of lymphedema, reduce the incidence and grade of lymphedema, and promote the rehabilitation of patients' affected limbs, improve quality of Life of patients, which is worthy of clinical application.
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Objective@#To investigate the strong expression (S+) of P53 and BCL2 proteins in MYC/BCL2 double-expression DLBCL (DEL) and whether they can be used for the prognostic evaluation and stratified diagnosis of DELs.@*Methods@#Tissue microarray were made by filed FFPE blocks of 174 DLBCL cases. The translocation of MYC, BCL2 and BCL6 genes were detected by FISH, and the proteins were detected by IHC. Data of clinicopathologic features and follow up of patients were collected and OS (overall survival) and PFS (progression free survival) were analyzed by statistics.@*Results@#Eight double-hit lymphomas (DHLs) were identified in all cases, and 45 DELs were selected from 166 remaining cases, which have no significant difference in OS and PFS compared with non-DEL cases (P=0.668 and P=0.790) . Of 42 DEL-cases with follow up data, 24 cases with P53+ or/and BCL2 (S+) are significantly shorter OS and PFS than others (P=0.003 and P=0.000) , in which the cases with P53+/BCL2 (S+) co-expression were the worst prognosis, and P53/BCL2 co-weaker positive DEL cases even have superior OS and PFS than those non-DELs. Although statistics showed that the cases of P53+ or/and BCL2 (S+) have a lower OS and PFS in total cases (P=0.063 and P=0.024) , it is not the case when the DEL-cases take out from total cases, that is the cases with P53+ or/and BCL2 (S+) are as similar OS and PFS as others in non-DEL group (P=0.590 and P=0.550) .@*Conclusion@#The strong expression of P53 and BCL2 proteins can be used as indicators of stratified diagnosis and poor prognosis of DEL.
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Objective: To explore the clinicopathological characteristics and prognostic factors of gastric neuroendocrine neoplasm (NEN). Methods: Clinicopathological parameters and follow-up data collected from 117 patients with gastric NEN at Tianjin Medical University Cancer Institute and Hospital from March 2011 to December 2017 were reviewed, classified, and graded according to World Health Or-ganization (WHO) 2010 classification. Clinicopathological characteristics of different types and grades of gastric NEN were compared and survival analysis was performed. Results: Among the 117 cases confirmed as gastric NEN, this entire cohort comprised 13 cases (11.1%) of neuroendocrine tumor (NET) G1, 6 cases (5.1%) of NET G2, 57 cases (48.7%) of neuroendocrine carcinoma (NEC), and 41 cases (35.1%) of mixed adenoneuroendocrine carcinoma (MANEC). Gastric NET G1 and G2 typically consisted of multiple small tumors with shallow invasion and infrequent lymphatic and distant metastases at early stages at the time of diagnosis. The treatment of patients with gastric NET included endoscopic submucosal dissection and radical surgical resection. Precursor neuroendocrine lesions were detected in most cases. The patients with gastric NET G1 and G2 had a good prognosis. Gastric NEC and MANEC mostly consisted of single large tumors with deep infiltration, and common lymphatic and distant metastases at advanced stages when the diagnoses were confirmed. All the patients with gastric NEC and MANEC underwent surgical resection, and most received adjuvant therapy. Histopathological changes of gastric NEC were characterized by large cells and poorly differentiated tumors, while gastric MANEC had various forms of neuroendocrine and adenocarcinoma components. The prognosis of patients with gastric NEC and MANEC was poor for both; however, the predictors of progression-free survival and overall survival were different between gastric NEC and MANEC. Conclusions: Gastric NEN are a group of heterogeneous tumors with different clinicopathological features and prognosis. More multicenter studies with large sample sizes are still needed to improve the classification of gastric NEN and explore the prognostic factors.
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Objective To investigate the estimated values of sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) for diagnosis and prognosis in patients with sepsis according to the new diagnostic criteria in Sepsis 3.0.Methods A retrospective study was conducted.All the clinical data were collected from patients with definite diagnosis of infection and they were admitted into the Intensive Care Unit (ICU) of Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from July 2014 to June 2016.The patients' gender,age,infectious location,respiratory rate (RR),oxygenation index (PaO2/FiO2),Glasgow coma scale (GCS),total bilirubin (TBil),platelet count (PLT),serum creatinine (SCr),serum lactate level,etc.general data on admission were collected to carry out SOFA and qSOFA scorings.And then the septic patients in accord with the diagnostic criteria of Sepsis 3.0 were screened out.According to outcome after admission,the septic patients were divided into survival group and death group,and the differences in diagnosis and in estimation value of prognosis between SOFA scoring and qSOFA scoring were assessed as SOFA group and qSOFA group.Results From 545 septic patients enrolled,189 septic patients consistent with the diagnostic criteria of Sepsis 3.0 were selected.In SOFA scoring group,the morbidity of septic patients was 34.68％,while in qSOFA scoring group,it was 15.96％,the difference between the two groups being statistically significant (P ＜0.01).The mortality was significantly lower in SOFA scoring group than that in qSOFA scoring group [28.04％ (53/189)vs.42.53％ (38/87),P ＜ 0.05].The mortality of qSOFA scoring group was about 1.52 times that of SOFA scoring group.On the aspect of scoring,in patients with SOFA scoring the score of death group was significantly higher than that in survival group (8.74 ± 0.417 vs.7.10 ± 0.235,P ＜ 0.01);in the patients with qSOFA scoring,the score in death group compared with that in survival group showed uo statistical significant difference (2.32 ± 0.48 vs.2.16 ± 0.37,P ＞ 0.05).On the aspect of laboratory indexes,the levels of GCS score in death group was significantly lower than that in the survival group (8.15 ± 0.67 vs.12.48 ± 0.36),blood lactate level in death group was significantly higher than that in the survival group (mmol/L:8.55 ± 4.66 vs.2.31 ± 0.16,P ＜ 0.01);the PaO2/FiO2,TBil,PLT and SCr showed no significant differences between the two groups (all P ＞ 0.05).Conclusions The new diagnostic criteria (Sepsis 3.0) can be used for diagnosis of sepsis in ICU.Compared with qSOFA scoring,the SOFA scoring is more suitable to be used for diagnosis and predicting prognosis of septic patients in ICU;SOFA scoring,GCS scoring and serum lactate level can be applied to estimate outcome of septic patients.
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Induced pluripotent stem cell (iPS cell) opened a new way to stem cell research,iPS cells can differentiate into hepatocytes in vitro gradually,this breakthrough makes the iPS cells have become a promising clinical application source.During the process of iPS cells to hepatocytes,a variety of cytokines regulate gene expression by coordinating various liver cell growth signal to promote iPS cells into hepatocytes differentiation and maturation.This article summarizes the relevant cytokines and their role in iPS cells in hepatocytes differentiation.
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Objective:To analyze the clinico-pathological characteristics, pathological diagnosis, and treatment of rhabdoid tu-mor. Methods:The medical records of four rhabdoid tumor patients that were admitted to the Tianjin Medical University Cancer Insti-tute and Hospital since 2000 were analyzed based on existing literature. Results:In one of the four cases, the tumor originated from the kidney, whereas in the other three, the tumor occurred from extra-renal soft tissues. Histologic analysis revealed that the tumor cells were loosely arranged with diffuse growth, vesicular nuclei, dyed cytoplasm, visible eosinophilic inclusions, and more nuclear fission. The results of immunohistochemical staining showed that the vimentin and epithelial membrane antigen were positive, whereas CK, CD99, CD34, and S-100 were positive at different degrees. MyoD1, Desmin, and INI-1 were negative. Conclusion:Rhabdoid tumor is rare and highly aggressive. It occurs mainly in the kidney and can also be found in other systems. The unique pathological form and im-munohistochemical staining observed on the tumor can be used as reference for diagnosis.
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Moyamoya disease (MMD) is a chronic and progressive occlusive cerebrovascular disease.Presently,its etiology and pathogenesis remain unclear,of which the genetic factors play a key role in the etiology of MMD.This article reviews the progress in research on genetics of MMD.
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Vasculogenic mimicry (VM) is a pattern of neoplasm cells,which achieve their blood supplements through deformation and simulating capillary channels.Cumulative studies show that the formation of VM in glioma have a close relation with the glioma stem cells.In addition,some molecules such as microRNA,epithelial cell kinase-A2,vascular endothelial cadherin,transforming growth factor-Jβ,vascular endothelial growth factor receptor-2 and galectin-1 play important roles in the forming process of vasculogenic mimicry.Recently,it is found that VM is associated with the poor prognosis of patients with glioma and anti angiogenesis drug efficacy.So the research on VM about the discovery,formation mechanism,prognostic impact and the clinical significance will provide an opportunity for diagnosis and therapy of glioma in early stage.
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Objective To investigate the expectation values of dental esthetics during the orthodontic treatment in adolescents with malocclusion.Methods 14～18 year-old adolescents with malocclusion were randomly divided into the treatment group (30 cases) and the control group (21 group) for a prospective study with a period of 1.5 years (0,0.5,1.0,1.5 year respectively),esthetics components of index of orthodontic treatment need (IOTN-AC) and self-made sheet for expectation values of dental esthetics were used to evaluate the values during the follow-up.Results During the follow-up,the IOTN-AC values in the treatment group were decreasing,conversely,the values in the control group were increasing,the expectation values of dental esthetics were increasing in both of the two groups,the differences above were significantly.Conclusions Expectation values of dental esthetics were higher during the follow-up in both of the treatment and untreatment cases,so the dentists and the nurses should encourage the consolidation therapy in treatment cases,and persuade the untreatment cases for orthodontic therapy in order to improve their psychological needs.
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Objective To observe the clinical effects of the method of reinforcing qi,nourish ing yin and promoting blood circulation to remove blood stasis in the treatment of restenosis after percutaneous coronary intervention.Methods 60 coronary heart disease patients who had accepted PCI treatment and occurred restenosis were randomly recruited into a control group and a treatment group,30 eases in each group.The control group received conventional therapy.The treatment group was treated with conventional therapy combined with TCM of reinforcing qi,nourishing yin and promoting blood circulation to remove blood stasis.Both groups were treated for 6 months.The clinical symptoms,coronary angiography or coronary artery CTA,blood lipids were observed.Results The total effective rate was 93.33％ and 66.67％ in the treatment group and the control group respectively,showing statistical difference (x2=8.787,P＜0.05).The patients' clinical symptoms in the treatment group were improved,such as chest pain,chest tightness,shortness of breath,fatigue,dry mouth [The scores were respectively(1.07± 1.01)、(1.33±1.21)、(1.47±1.17)、(1.53±1.14)、(1.53± 1.01),(P＜0.05) ].The treatment group demonstrated a significantly better therapeutic results than the control group [Thescoreswererespectively(2.07±1.53)、(2.27±1.46)、(3.73±1.46)、(3.73±1.87)、(3.13±1.63),(P＜0.05) ].The results of coronary angiography or coronary artery CTA showed that the narrow degree in the treatment group was no more aggravating and it had no new restenosis.After the treatment,the level of CHOL、TG、HDL-C、LDL-C in the treatment group was improved [They were respectively (4.55±0.44)mmol/L、(1.81±0.56)mmol/L、(1.26±0.38)mmol/L、(2.25±0.49)mmol/L,(P＜0.05) ].The improvement in CHOL、TG、LDL-C of the treatment group was better than that of the control group [They were respectively (4.86±0.63)mmol/L、(2.29±1.06)mmol/L,(2.60±0.73)mmol/L,(P＜0.05)].Conclusion The method of reinforcing qi,nourishing yin and promoting blood circulation to remove blood stasis could improve the patients clinical symptoms and blood lipids,and therefore spreventing restenosis.
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The expression of human epidermal growth factor receptor 2 (HER2), serine-threonine kinase (Akt), 4E-binding protein (4EBP1), phophorylated ribosomal protein S6 kinasel (p70S6Kl) and ribosomal protein S6 ( S6) were detected with immunohistochemistry in 48 cases of human breast cancer. Tumors high-expressing HER2 showed higher Akt expression as compared to tumors with negative HER2 (P < 0. 01). Levels of Akt were correlated with the downstream molecules 4EBP1 ( P < 0. 01) and p70S6K ( P < 0. 05 ). 4EBP1 was mainly expressed in poorly differentiated tumors (P <0. 01) and correlated with tumor size ( P < 0. 05) , lymph node metastasis ( P < 0. 01) and locoregional recurrences ( P < 0. 01). Results suggest that 4EBPl may be the main factor in PI-phosphoinositide-3-kinase (PI3K)-Akt-mammalian targot of rapanycin signal transduction pathways, which is associated with grade of malignancy and prognosis of breast cancer.
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Objective To dieuss clinical manifestations of the organs damage out of lung caused by my-coplasma pneumonia(MP) infection in children. Methods Clinical date of 383 children with mycoplasma pneumonia infection were retrospectively reviewed. Results Among 383 cases, a total of 81 cases(21.25 %) were accompanied by organs damage out of lung. Conclusion The organs damage out of lung were observed in many system, the rate of organs damage out of respiratory tract is high in children. Mistake may occur easily in diagnosis if the symptoms out of lung appear first.
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After intracerebral ventricular administration of adrenomedullin (AM) in normal saline (NS) or 30% glucose to rats, the effects on blood glucose and glucose regulatory hormones were studied and compared. 1) Am in NS increased significantly the concentration of plasma insulin and C peptide, and decreased the concentration of glucagon and blood glucose. 2) As compared with 30% glucose alone, AM in 30% glucose raised significantly the plasma insulin and C peptide and decreased significantly the glucagon concentration, but the blood glucose level remained unchanged. The results showed that the AM plays a role in the regulation of pancreatic hormone secretion by central nerve system.