The 500th case: pain in both hip joints, headache, and diplopia / 中华内科杂志

A male child, aged 5 years and 3 months, was admitted to the Oncology Department with a history of pain in both hip joints, headache, and diplopia lasting for 40 days. Physical examination did not reveal definitive signs or obvious abnormalities in the nervous system. Imaging studies showed only abnormalities in the craniocerebrum and spinal cord. Routine cerebrospinal fluid (CSF) analysis revealed elevation in the total number of white blood cells, mainly mononuclear cells. Biochemical analysis of CSF showed normal glucose and chloride levels, and increased protein concentrations. The possibility of central nervous system (CNS) infection was initially considered. Subsequently, antibacterial and antiviral therapy was administered; however, this treatment was ineffective. Further examination of CSF through immunophenotyping revealed mature B-cell lymphoma with CNS involvement; there were no neoplastic lesions detected elsewhere in the body. Thus, the patient was diagnosed with primary central nervous system lymphoma (PCNSL). Complete remission was achieved after chemotherapy with the CNCL-2017-mature B-cell lymphoma regimen. Thus far, all chemotherapy cycles have been completed, the patient remains in complete remission, and the follow-up is ongoing. Clinicians should pay close attention to PCNSL in children.

Effect of tonsillotomy on the inflammation and immune function in children with chronic tonsillitis / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the changes of inflammation and immune function in children with chronic tonsillitis after tonsillotomy. Methods:Prospectively collected 60 children with obstructive sleep apnea （OSA） diagnosed as chronic tonsillitis with adenoids and tonsillar hypertrophy from January to June 2021. Two groups were divided, the experimental group （n=30） underwent bilateral partial tonsillectomy + adenoidectomy by hypothermia plasma ablation, and the control group （n=30） underwent adenoidectomy by using the same hypothermia plasma ablation method. The number of tonsillitis attacks before surgery and within one year after surgery was recorded, and the serum immunoglobulin IgM, IgG, IgA, complement C3 and complement C4 levels before operation, one month and three months after operation were measured. Results:The number of tonsillitis attacks in the experimental group and the control group at one year after surgery was lower than that before surgery（P<0.05）; The number of inflammatory attacks in the experimental group was （0.50±0.63） times/year, which was lower than that of （1.33±0.80） times/year in the control group. There was no significant difference in the five immunization results of the two groups at one month and three months after operation compared with before operation, and there was also no significant difference between the experimental and the control groups. Conclusion:Partial tonsillectomy can be applied to children with chronic tonsillitis, which can effectively reduce the number of tonsillitis attacks and has no effect on the immune function of children.

Effects of perceived disease control and exercise self-efficacy on kinesiophobia in patients with heart failure: a longitudinal study / 中国实用护理杂志

Objective:To explore the status of kinesiophobia in patients with heart failure during discharge transition period, and analyze its changing trend and influencing factors.Methods:The189 patients with heart failure treated in Henan Provincial People′s Hospital from February 2020 to April 2021 were conveniently selected as the research objects. The general situation questionnaire, the Tampa Scale for Kinesiophobia Heart, the Self-efficacy for Exercise Scale and the Control Attitudes Scale-Revised were used to investigate the patients 2-3 days before leaving the hospital, 1 month and 4 months after discharge.Results:The score of patients′ kinesiophobia deteriorated slightly from 2-3 days before discharge (48.62 ± 11.26) to 1 month after discharge (49.03 ± 11.24), and decreased with the extension of the transition time to 4 months after discharge (47.86 ± 11.11). The overall trend of improvement was statistically significant ( F = 17.92, P<0.01). The score of perceived disease control also showed the same change pattern, 2-3 days before discharge (27.34 ± 7.40), 1 month after discharge (26.18 ± 7.39), 4 months after discharge (27.76 ± 7.38), the difference was statistically significant ( F = 38.41, P<0.01). The score of the exercise self-efficacy of 4 months after discharge (35.63 ± 11.51) was higher than (34.00 ± 11.88) of 2-3 days before discharge and (34.20 ± 11.69) of 1 month after discharge ( F = 12.33, P<0.01). The generalized estimation equation showed that exercise self-efficacy ( B = -0.255, P<0.01) and perceived disease control ( B = -0.439, P<0.01) were protective factors of kinesiophobia in patients with heart failure. Path analysis showed that perceived disease control could not only directly predict patients′ kinesiophobia ( β = -0.461, P<0.01), but also indirectly affect patients′ kinesiophobia by acting on exercise self-efficacy (mediating effect = -0.21, 95% CI -0.293 - -0.136). The mediating effect accounted for 31% of the total effect. Conclusions:The kinesiophobia, perceived disease control and exercise self-efficacy in patients with heart failure during discharge transition were dynamic. Perceived disease control could not only directly predict patients′ kinesiophobia, but also indirectly affect it by acting on exercise self-efficacy. Nursing staff can develop nursing interventions based on perceived disease control or exercise self-efficacy to reducethe level of kinesiophobia inheart failure patients.

Efficacy of low-dose uric acid oxidase in the treatment of 106 pediatric patients with aggressive mature B-cell non-Hodgkin lymphoma and hyperuricemia / 中华实用儿科临床杂志

Objective:To investigate the efficacy of low-dose uric acid oxidase in treating children with aggressive mature B-cell non-Hodgkin lymphoma accompanied by hyperuricemia.Methods:Clinical data of children with primary aggressive mature B-cell non-Hodgkin lymphoma and hyperuricemia, who were treated in Beijing Children′s Hospital, Capital Medical University from January 2016 to June 2021 were retrospectively analyzed.The serum uric acid concentration was monitored in all pediatric patients from the day before chemotherapy to the seventh day of chemotherapy.Low-dose uric acid oxidase [0.05-0.10 mg/(kg·dose)] was intravenously injected into the patients when the serum uric acid level exceeded the upper limit of the normal range.The therapeutic effect and clinical medication experience of uric acid oxidase were summarized.The change of serum uric acid levels with time before and after the application of different doses of uric acid oxidase was analyzed by a repeated measures ANOVA. Results:A total of 106 children with primary aggressive mature B-cell non-Hodgkin lymphoma and hyperuricemia were enrolled in this study.There were 88 males and 18 females, with a median age of 6.5 (3.5, 10.0) years.The pathological subtypes comprised Burkitt′s lymphoma in 95 cases (89.6%), high-grade B-cell lymphoma in 7 cases (6.6%), and diffuse large B-cell lymphoma in 4 cases (3.8%). Additionally, 39 cases (36.8%) were in clinical stage Ⅲ and 67 cases (63.2%) were in stage Ⅳ.All cases had high tumor burden, including renal involvement in 52 cases (49.1%), tumor lysis syndrome in 42 cases (39.6%), and acute kidney injury in 27 cases (25.5%). Totally, one dose of uric acid oxidase was intravenously injected into 41 children (38.7%), 41 children (38.7%) were given 2 dosages, 20 children (18.9%) were given 3 dosages, and 4 children (3.8%) received 4 dosages.Moreover, 9 cases (8.5%) were supplemented with continuous renal replacement therapy.Serum uric acid concentrations before chemotherapy and 12 hours after injecting the first dose of uric acid oxidase were (741.4±312.9) μmol/L and (210.8±148.6) μmol/L, respectively.The difference was statistically significant ( t=5.288, P<0.001). The change of serum uric acid levels over time before and after the application of different doses of uric acid oxidase in children was compared, and no significant difference was found ( F=0.225, P=0.879). No delay in chemotherapy or death arising from tumor lysis syndrome and acute kidney injury occurred within 28 days after chemotherapy. Conclusions:Low-dose and on-demand application of uric acid oxidase can rapidly and effectively reduce serum uric acid levels in children with aggressive mature B-cell non-Hodgkin lymphoma in the early stage of chemotherapy.

Efficacy of low-dose uric acid oxidase in the treatment of 106 pediatric patients with aggressive mature B-cell non-Hodgkin lymphoma and hyperuricemia / 中华实用儿科临床杂志

Objective:To investigate the efficacy of low-dose uric acid oxidase in treating children with aggressive mature B-cell non-Hodgkin lymphoma accompanied by hyperuricemia.Methods:Clinical data of children with primary aggressive mature B-cell non-Hodgkin lymphoma and hyperuricemia, who were treated in Beijing Children′s Hospital, Capital Medical University from January 2016 to June 2021 were retrospectively analyzed.The serum uric acid concentration was monitored in all pediatric patients from the day before chemotherapy to the seventh day of chemotherapy.Low-dose uric acid oxidase [0.05-0.10 mg/(kg·dose)] was intravenously injected into the patients when the serum uric acid level exceeded the upper limit of the normal range.The therapeutic effect and clinical medication experience of uric acid oxidase were summarized.The change of serum uric acid levels with time before and after the application of different doses of uric acid oxidase was analyzed by a repeated measures ANOVA. Results:A total of 106 children with primary aggressive mature B-cell non-Hodgkin lymphoma and hyperuricemia were enrolled in this study.There were 88 males and 18 females, with a median age of 6.5 (3.5, 10.0) years.The pathological subtypes comprised Burkitt′s lymphoma in 95 cases (89.6%), high-grade B-cell lymphoma in 7 cases (6.6%), and diffuse large B-cell lymphoma in 4 cases (3.8%). Additionally, 39 cases (36.8%) were in clinical stage Ⅲ and 67 cases (63.2%) were in stage Ⅳ.All cases had high tumor burden, including renal involvement in 52 cases (49.1%), tumor lysis syndrome in 42 cases (39.6%), and acute kidney injury in 27 cases (25.5%). Totally, one dose of uric acid oxidase was intravenously injected into 41 children (38.7%), 41 children (38.7%) were given 2 dosages, 20 children (18.9%) were given 3 dosages, and 4 children (3.8%) received 4 dosages.Moreover, 9 cases (8.5%) were supplemented with continuous renal replacement therapy.Serum uric acid concentrations before chemotherapy and 12 hours after injecting the first dose of uric acid oxidase were (741.4±312.9) μmol/L and (210.8±148.6) μmol/L, respectively.The difference was statistically significant ( t=5.288, P<0.001). The change of serum uric acid levels over time before and after the application of different doses of uric acid oxidase in children was compared, and no significant difference was found ( F=0.225, P=0.879). No delay in chemotherapy or death arising from tumor lysis syndrome and acute kidney injury occurred within 28 days after chemotherapy. Conclusions:Low-dose and on-demand application of uric acid oxidase can rapidly and effectively reduce serum uric acid levels in children with aggressive mature B-cell non-Hodgkin lymphoma in the early stage of chemotherapy.

Analysis on the characteristics of the NSFC distinguished young scholars in health science / 中华医学科研管理杂志

Objective:By summarizing and analyzing the data of the National Natural Science Foundation of China (NSFC) for distinguished young scholars in the department of health science, this paper provides support and reference for the organization and management of talent projects in related institutions to better serve the growth of young talents in medical field.Methods:Based on the data of distinguished young scholars projects approved from 2011 to 2020, this paper explored the characteristics of the projects in the department of health science. Information about the research field, institution distribution, age and gender of the principle investigator, and the situation of hosted projects were analyzed, main challenges were summarized to propose possible measurements for improvement.Results:The overall funding rate of distinguished young scholars projects in the department of health science is relatively low and more competitive. The growth of medical talents takes longer, more support and further attention is needed.Conclusions:The organization of the distinguished young scholars project in health science needs to respect the characteristics and development nature of medicine, at the same time, strengthen multi-dimensional configuration and management, and create a soft environment conducive to the growth of outstanding medical talents.

Analysis on influencing factors of perioperative nosocomial infection in elderly patients with hip fracture under the background of enhance recovery after surgery / 中国实用护理杂志

Objective:To analyze the influencing factors of perioperative nosocomial infection in elderly patients with hip fracture under the background of enhance recovery after surgery so as to provide guidance for prevention and control of the nosocomial infection.Methods:The clinical data were collected from 1 628 elderly patients with hip fracture who were hospitalized from January 2018 to August 2019,during the implementation of enhance recovery after surgery in Tianjin hospital. Medical records of the patients were reviewed and statistically analyzed through hospital medical record system, the incidence of perioperative nosocomial infection and the influencing factors for the infection were observed.Results:Of the 1 628 hospitalized patients with hip fracture, 102 had nosocomial infection, 125 case-times, with the infection rate 6.27%(102/1 628) and the case-times infection rate 7.68%(125/1 628). Lower respiratory tract, urinary tract and surgical site were the dominant infection sites, accounting for 72.80% (91/125), 11.20% (14/125) and 10.40% (13/125) respectively. Univariate analysis and multivariate logistic regression analysis indicated that bone traction( OR value was 2.152, 95% CI 1.130-4.097), surgery ( OR value was 0.268, 95% CI 0.133-0.537), hospitalization days≥15 d( OR value was 12.123, 95% CI 6.017-24.426), indwelling urinary catheter ( OR value was 7.566, 95% CI 4.093-13.986), cardiac insufficiency( OR value was 2.112, 95% CI 1.192-3.740), electrolyte disturbance( OR value was 2.383, 95% CI 1.396-4.067), lower extremity arteriosclerosis obliterans( OR value was 2.540, 95% CI 1.279-5.045) and senile dementia( OR value was 3.673, 95% CI 1.670-8.082) were the influencing factors for the perioperative nosocomial infection. Conclusions:The main influencing factors of nosocomial infection in elderly patients with hip fracture during the perioperative period were bone traction, operation, length of stay, indwelling urinary catheter and coexisting diseases. The risk of nosocomial infection can be reduced by applying the concept of enhance recovery after surgery in clinical orthopedics, comprehensively optimizing perioperative management and implementing effective prevention and control measures of nosocomial infection.

Consideration on promoting medical science popularization in the new era: Based on the practice of Peking University Health Science Center / 中华医学科研管理杂志

Objective:Taking medical science popularization as an strategic point, it is imperative to constantly strengthen the thinking and exploration to make further contributions to the " Healthy China Initiative" and " Science and Technology Strategy" .Methods:Taking into consideration of the characteristics of medical popularization in the new era, this study summarizes the current situation of medical science popularization in Peking University Health Science Center, proposes further construction plans.Results:Medical science popularization and scientific innovation are both important work at Peking University Health Science Center. The medical science popularization is well developed by the combination of a series of working strategies, including construction of comprehensive platforms that cover the scientific research, academic exchanges, publicity and rewards.Conclusions:Scientific and technological innovation and scientific popularization are the two wings to achieve innovative development. It is necessary to further strengthen the deep integration of medical science popularization and scientific research work, improve the evaluation and assessment system, and promote the development of medical science popularization work to a higher level.

Exploration of the ethical review criteria and management of COVID-19 Emergency Research / 中华医学科研管理杂志

Objective@#Conduct comprehensive analysis of the regulatory requirement of ethical review regarding to the response of public health emergency, illustrate particular ethical review and ethical administration strategies for COVID-19 Emergency Research.@*Methods@#Theoretical discussion, case study and interpretation of international guidelines were adopted to explore challenges and possible best practices for ethical review of such research.@*Results@#The ethical review of COVID-19 emergency research should comply with regulatory requirement in general, combined with contextual background.@*Conclusions@#The ethical review approval criteria of COVID-19 emergency research should take into full consideration of its urgency to make sure efficient and high quality initial review, meanwhile, more attention should be paid on continuing ethical review and ethical consultation during the whole life-circle of COVID-19 Emergency Research.

Association between metal cobalt exposure and the risk of congenital heart defect occurrence in offspring: a multi-hospital case-control study

BACKGROUND@#Many studies have investigated heavy metal exposure could increase the occurrence of congenital heart defects (CHDs). However, there are limited data regarding the relationship between cobalt exposure and CHD occurrence in offspring. The aim of this study was to analyze the association between cobalt exposure in mothers and the risk of CHDs in offspring.@*MATERIALS AND METHODS@#In order to explore the association between cobalt exposure and occurrence of congenital heart defect (CHD), a case-control study with 490 controls and 399 cases with CHDs in China were developed. The concentrations of cobalt in hair of pregnant woman and fetal placental tissue were measured and processed by a logistic regression analysis to explore the relationship between cobalt exposure and risk of CHDs.@*RESULTS@#The median concentration of hair cobalt in the control and case group was 0.023 ng/mg and 0.033 ng/mg (aOR, 1.837; 95% CI, 1.468-2.299; P < 0.001), respectively. And the median (5-95% range) fetal placental cobalt concentrations were 19.350 ng/g and 42.500 ng/g (aOR, 2.924; 95% CI, 2.211-3.868; P < 0.001) in the control and case groups, respectively. Significant differences in the middle level of cobalt in hair were found in the different CHD subtypes, including septal defects, conotruncal defects, right ventricular outflow tract obstruction, and left ventricular outflow tract obstruction (P < 0.001). Dramatically, different cobalt concentrations in fetal placental tissue were found in all subtypes of cases with CHDs (P < 0.01).@*CONCLUSIONS@#The finding suggested that the occurrence of CHDs may be associated with cobalt exposure.

Exploration of the ethical review criteria and management of COVID-19 Emergency Research / 中华医学科研管理杂志

Objective:Conduct comprehensive analysis of the regulatory requirement of ethical review regarding to the response of public health emergency, illustrate particular ethical review and ethical administration strategies for COVID-19 Emergency Research.Methods:Theoretical discussion, case study and interpretation of international guidelines were adopted to explore challenges and possible best practices for ethical review of such research.Results:The ethical review of COVID-19 emergency research should comply with regulatory requirement in general, combined with contextual background.Conclusions:The ethical review approval criteria of COVID-19 emergency research should take into full consideration of its urgency to make sure efficient and high quality initial review, meanwhile, more attention should be paid on continuing ethical review and ethical consultation during the whole life-circle of COVID-19 Emergency Research.

Prognostic factors analysis of Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction after radical resection with different surgical approaches / 中华消化外科杂志

Objective:To investigate the prognostic factors of Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical resection with different surgical approaches.Methods:The retrospective case-control study was conducted. The clinicopathological data of 442 patients who were admitted to Tianjin Medical University Cancer Institute and Hospital from February 2003 to July 2011 were collected. There were 362 males and 80 females, aged from 21 to 85 years, with a median age of 64 years. Patients underwent radical resection of AEG. Observation indicators: (1) surgical situations; (2) follow-up; (3) progrostic factors analysis of AEG after radical resection; (4) survival of patients after radical resection of AEG via abdominal approach; (5) survival of patients after radical resection of AEG via thoracoabdominal approach; (6) survival of patients after radical resection of Siewert type Ⅱ type AEG; (7) survival of patients after radical resection of Siewert type Ⅲ AEG. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to June 2018. Measurement data with skewed distribution were described as M (range). Count data were expressed as absolute numbers or percentages. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-rank test was used for survival analysis. Univariate analysis was conducted using the Kaplan-Meier method. Multivariate analysis was conducted using the COX proportional hazard model. Results:(1) Surgical situations: 442 patients underwent radical resection of AEG, including 204 via abdominal approach and 238 via thoracoabdominal approach. There were 391 patients with D 2 lymphadenectomy and 51 with D 2+ lymphadenectomy. (2) Follow-up: 442 patients were followed up for 8-162 months, with a median follow-up time of 37 months. All the 442 patients survived for 2-156 months, with a median survival time of 31 months. The 1-, 3-, 5-year overall survival rates were 79.2%, 42.0%, 30.0%, respectively. (3) Prognostic factors analysis of AEG after radical resection: results of univariate analysis showed that tumor diameter, Lauren type, pathological T staging, pathological N staging, pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration were related factors for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG ( χ2=4.028, 4.885, 19.435, 17.014, 34.449, 9.707, 11.866, P<0.05). Results of multivariate analysis showed that pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration were independent influencing fators for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG ( hazard ratio=1.255, 0.486, 1.454, 95% confidence interval: 1.024-1.539, 0.325-0.728, 1.096-1.928, P<0.05). (4) Survival of patients after radical resection of AEG via abdominal approach: of the 204 patients undergoing radical resection of AEG via abdominal approach, the 1-, 3-, 5-year survival rates were 83.6%, 50.4%, 37.8% for 121 patients with Siewert type Ⅱ AEG, respectively, versus 72.0%, 39.3%, 31.8% for 83 patients with Siewert type Ⅲ AEG, showing no significant difference in the survival between the two groups ( χ2=1.854, P>0.05). (5) Survival of patients after radical resection of AEG via thoracoabdominal approach: of the 238 patients undergoing radical resection of AEG via thoracoabdominal approach, the 1-, 3-, 5-year survival rates were 79.6%, 38.8%, 23.8% for 183 patients with Siewert type Ⅱ AEG, respectively, versus 79.1%, 37.6%, 29.3% for 55 patients with Siewert type Ⅲ AEG, showing no significant difference in the survival between the two groups ( χ2=0.215, P>0.05). (6) Survival of patients after radical resection of Siewert type Ⅱ AEG: of the 304 patients with Siewert typeⅡAEG, the postoperative 1-, 3-, 5-year survival rates were 83.6%, 50.4%, 37.8% for 121 patients undergoing radical resection of AEG via abdominal approach, respectively, versus 79.6%, 38.8%, 23.8% for 183 patients undergoing radical resection of AEG via thoracoabdominal approach, showing no significant difference in the survival between the two groups ( χ2=2.406, P>0.05). (7) Survival of patients after radical resection of Siewert type Ⅲ AEG: of the 138 patients with Siewert type Ⅲ AEG, the postoperative 1-, 3-, 5-year survival rates were 72.0%, 39.3%, 31.8% for 83 patients undergoing radical resection of AEG via abdominal approach, respectively, versus 79.1%, 37.6%, 29.3% for 55 patients undergoing radical resection of AEG via thoracoabdominal approach, showing no significant difference in the survival between the two groups ( χ2=0.640, P>0.05). Conclusions:Pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration are independent fators for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG. Siewert types and surgical approach are not related factors for prognosis of patients after radical resection of AEG. There is no significant difference in the survival between patients with different Siewert types of AEG undergoing radical resection via different surgical approaches.

Robot-assisted training can improve the bladder and intestinal functions of paraplegic patients / 中华物理医学与康复杂志

Objective To explore the clinical effect of training assisted by a lower limb rehabilitation robot on the bladder and intestinal function of paraplegic spinal cord injury survivors. Methods Thirty-eight paraplegic patients with spinal cord injury were divided according to their admission order into an experimental group ( n=19) and a control group (n=19). Both groups were given conventional rehabilitation training, while the experimental group was additionally provided with robot-assisted lower limb training in three stages:adaptation, training and con-solidation. It lasted 30 minutes daily, 5 days per week for 12 weeks. Before and after the training, an urodynamics examination system was used to evaluate the maximum urine flow, bladder capacity, residual urine volume, bladder pressure and detrusor pressure. Colon transit time, mean rectal pressure and intestinal function were measured using the colon transit test, a mean rectal pressure test, and the Functional Independence Measure ( FIM) scale respective-ly. Results The average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance, average rectal pressure and intestinal FIM score of the robot training group after training were all significantly better than before the training, as were the average residual urine volume and colon transit time. After the training, the average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance and average rectal pressure of the robot training group were all significantly higher than those of the control group, while the average residual urine volume and colon transit time were significantly smaller. Then, 32％ of the patients in the experimental group achieved no less than 6 points for their average FIM score, significantly higher than in the control group. Conclusion Robot-assisted lower limb training combined with comprehensive rehabilitation training can effectively improve the bladder and intestinal function of paraplegic patients after a spinal cord injury.

The application of checklist for nursing handover in emergency department / 中国实用护理杂志

Objective@#To explore the effects of checklist for nursing handover in emergency department.@*Methods@#A total of 48 emergency department nurses were recruited by convenient sampling method. We implemented nursing bedside handover checklist four months, the quality of the nursing handover and nurses′ mastery of the patients′ condition and the patients′ satisfaction were compared before and after the implementation.@*Results@#After four-month intervention, the score of the nursing handover quality increased from 60.39±3.22 to 67.73±3.09, the difference was statistically significant (t=-14.377, P<0.01). The score of the nurses′ mastery of the patients′ condition increased from 23.89±2.34 to 27.08±1.82, and there was significant difference (t=-7.287, P<0.01). Patients′ satisfaction improved from 91.163% (111/121) to 96.67% (116/120), the difference was statistically significant (χ2=10.66, P<0.05).@*Conclusions@#Implementation of nursing bedside-handover checklist in emergency department can reduce individual cognitive defects, decrease the information missing of the nursing handover,improve the quality of nursing work and ensure the safety of patients.

Clinical characteristics of 46 pediatric diffuse large B-cell lymphoma and treatment outcome / 中华儿科杂志

Objective@#To summarize the clinical data of diffuse large B-cell lymphoma (DLBCL) in children and to evaluate the efficacy of Beijing Children′s Hospital B cell lymphoma protocol in the treatment of pediatric DLBCL.@*Methods@#The data (clinical, pathology, lab and image data) of 46 pediatric DLBCL admitted to the treatment group of Beijing Children′s Hospital from January 2005 to June 2017 were collected and analyzed retrospectively. According to the risk factors of staging, existence of poor prognosis genes and giant tumors, stratified treatment was carried out according to the international standard modified LMB89 regimen with high dose and short course. The Kaplan-Meier method was used to calculate the event free survival (EFS) and the overall survival (OS).@*Results@#(1) Among the 46 cases, there were 33 males and 13 females. The median age was 8.0 years. The time from the initial symptom onset to the diagnosis was more than 15 days in 45 children. Fourteen cases had B group symptoms (fever, night sweat, and weight lost), 25 cases had extranodal disease, 39 cases were stage Ⅲ and Ⅳ, 12 cases had bone marrow involvement, 3 cases had jawbone involvement. Thirty cases were group B and 16 cases were group C in the treatment group. (2) Initial symptoms: 6 cases had cervical mass, 20 cases had abdominal mass, 10 had abdominal pain with acute abdomen, 8 cases had fever, 2 cases had snore or upper respiratory tract obstruction. (3) Pathology result: 40 cases were germinal center B cell DLBCL, 6 cases were non germinal center B cell DLBCL, no case had the MYC gene rupture, double hit lymphoma and triple hit lymphoma. (4) Complication and evaluation: the tumor lysis syndrome was seen in 3 cases initially, severe infection and delayed treatment was seen in 1 case, no treatment related death. The first evaluation showed all cases were sensitive to chemotherapy (shrink>25%), the second evaluation showed 1 case had residual disease, the others were complete remission. (5) Treatment and outcome: the 5 year-EFS was the same with 5 year-OS, both were (97.8±2.2) %. Two cases relapsed after treatment off, early relapse was seen in 1 case, and died because of abandoning treatment. Late relapse was seen in 1 case and got a complete remission after Rituximab+group C protocol treatment.@*Conclusions@#Pediatric DLBCL was common in school aged boys, most cases were at middle and late stage at the time of diagnosis. DLBCL had a good prognosis after the treatment with Beijing Children′s Hospital′s B cell lymphoma protocol, but late relapse could be seen.

The supporting of national natural science foundation of China in international research projects cooperation :Taking Peking University Health Science Center as an example / 中华医学科研管理杂志

Objective To explore ways to promote international research cooperation ,enhance research innovation and interna-tional impact of Peking University Health Science Center (PKUHSC) ,we analyzed the international (regional) cooperation and ex-change program of National Natural Science Foundation of China (NSFC) .Methods Taking the major international (regional) joint research projects as an example ,we analyzed the current situation of international research collaboration of PKUHSC and proposed pos-sible suggestions .Results PKU HSC is active in international research cooperation and gained advantage in undertaking major interna-tional (regional) joint research projects .To further enhance our international competitiveness ,the international research cooperation projects need to be further optimized .Conclusions It is necessary to further explore the international cooperation mode of "project-tal-ent-base",and enhance international level of scientific and technological innovation .

Clinical value of standardized procedures of fine lymph node sorting from gastric can-cer samples after curative resection: a study of 727 cases / 中国肿瘤临床

Objective: To evaluate the potential clinical value of standardized procedures of fine lymph node sorting from gastric can-cer samples after curative resection. Methods: Between January 2016 and December 2017, 727 gastric cancer patients who under- went R0 resection in the Tianjin Medical University Cancer Institute and Hospital were retrospectively included and assigned to either the fine lymph node sorting group or regional lymph node sorting group in accordance with the lymph node sorting methods from the tumor samples of all patients. Both the numbers of examined lymph nodes and metastatic lymph nodes were compared between the two groups. Additionally, correlation analyses were performed between the numbers of examined lymph nodes and metastatic lymph nodes in the two groups. Results: There was no significant difference in sex, age, or tumor size between the two groups (P>0.05), indi-cating that there was comparability between the two groups. The number of examined lymph nodes in the fine lymph node sorting group was significantly higher than that in the regional lymph node sorting group (P<0.001). Furthermore, the number of examined lymph nodes in the fine lymph node sorting group was much higher than that in the regional lymph node sorting group with the same pT, pN, or pTNM stage (P<0.001). The number of metastatic lymph nodes in the fine lymph node sorting group was significantly higher than that in the regional lymph node sorting group (P<0.001). There was a significant positive correlation between the numbers of ex-amined lymph nodes and metastatic lymph nodes in both groups (fine lymph node sorting group r=0.181, P=0.023; regional lymph node sorting group r=0.227, P<0.001). Additionally, the correlation coefficient between the numbers of examined lymph nodes and metastatic lymph nodes in the fine lymph node sorting group was weaker than that in the regional lymph node sorting group. Conclu-sions: The standard procedures of fine lymph node sorting from tumor samples of gastric cancer may increase the number of exam-ined lymph nodes, accurately provide the postoperative pN stage, reduce the stage migration, and should be applied in clinical stan-dardization.

Relationship between PDE4C gene methylation in peripheral blood leukocytes, interaction of environmental factors and pathogenesis of breast cancer / 实用肿瘤学杂志

Objective The objective of this study was to investigate the relationship between the methylation of phosphodies-terase 4C(PDE4C)gene in peripheral blood leukocytes,and its interaction with environmental factors and the pathogenesis of breast cancer. Methods A case-control study was conducted to select 402 cases of breast cancer and 470 cancer-free controls from Octo-ber 2010 to December 2014. The specific DNA methylation-modified quantitative PCR method was used to detect the methylation of PDE4C gene. The use of crossover analysis and multivariate logistic regression was used to analyze the relationship between the level of gene methylation and its interaction with environmental factors and the pathogenesis of breast cancer. Results PDE4C methylation was not found to be significantly associated with the onset of breast cancer. High-frequency/high-intake of whole grains,vegetables, onion-based plants,poultry,milk,and regular exercise could reduce the risk of breast cancer;high-frequency/high-intake of pork, irregular menstrual cycle,and a high psychological stress index could increase the risk of breast cancer. PDE4C hypermethylation had a significant combining effect with edible onion-producing plants greater than 3 times/week,with an OR of 0. 373(95% CI:0. 208~0. 668,P=0. 001). Conclusion Hypermethylation of PDE4C is not an independent risk factor for breast cancer,and its combination with environmental factors affects the risk of breast cancer.

The application of checklist for nursing handover in emergency department / 中国实用护理杂志

Objective To explore the effects of checklist for nursing handover in emergency department. Methods A total of 48 emergency department nurses were recruited by convenient sampling method. We implemented nursing bedside handover checklist four months, the quality of the nursing handover and nurses′ mastery of the patients′ condition and the patients′ satisfaction were compared before and after the implementation. Results After four-month intervention, the score of the nursing handover quality increased from 60.39 ± 3.22 to 67.73 ± 3.09, the difference was statistically significant (t=-14.377, P＜0.01). The score of the nurses′mastery of the patients′condition increased from 23.89 ± 2.34 to 27.08 ± 1.82, and there was significant difference(t=-7.287, P＜0.01). Patients′ satisfaction improved from 91.163% (111/121) to 96.67% (116/120), the difference was statistically significant (χ2=10.66, P＜0.05). Conclusions Implementation of nursing bedside-handover checklist in emergency department can reduce individual cognitive defects, decrease the information missing of the nursing handover,improve the quality of nursing work and ensure the safety of patients.

Analysis of risk factor of perioperative complications in patients with radical gastrectomy for gastric cancer and its influence on prognosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the risk factor of perioperative complication in gastric cancer patients with radical therapy and its influence on prognosis.</p><p><b>METHODS</b>Clinical, pathological and follow-up data of 1 148 gastric cancer patients undergoing radical gastrectomy at Tianjin Medical University Affiliated Tumor Hospital between January 2009 and August 2011 were retrospectively collected. Pearson 2 test and Logistic regression analysis were used to analyze the risk factor of perioperative complication. Cox regression analysis was used to evaluate the influence of perioperative complications on the prognosis in patients after radical gastrectomy. Kaplan-Meier survival curve was applied to calculate the survival.</p><p><b>RESULTS</b>Of 1 148 patients, 851 were male, 297 were female, age ranged from 19 to 89 (average 59.9) years. Perioperative complication occurred in 312 cases (27.2%), including 140 cases of pulmonary infection and 53 cases of abdominal infection. Multivariate Logistic regression analysis showed that ≥65 years old (OR:0.736, 95%CI: 0.558 to 0.971, P=0.030), serum albumin less than 35 g/L(OR:2.626, 95%CI: 1.479 to 4.665, P=0.001), Borrmann type IIII((OR: 0.748, 95%CI: 0.610 to 0.917, P=0.005), tumor site at upper 1/3 of stomach (OR:1.326, 95%CI:1.167 to 1.506, P=0.000), combined organ resection(OR:0.624, 95%CI:0.428 to 0.909, P=0.014) were independent risk factors of perioperative complication. Tumor site at upper 1/3 of stomach (OR:1.649, 95%CI: 1.368 to 1.988, P=0.000), ≥65 years old (OR:0.548, 95%CI:0.379 to 0.792, P=0.001), without intraoperative chemotherapy (OR:1.671, 95%CI:1.146 to 2.437, P=0.008) were independent risk factors of perioperative pulmonary infection; Borrmann type IIII((OR:0.576, 95%CI:0.369 to 0.900, P=0.015), with intraoperative chemotherapy (OR:0.431, 95%CI:0.230 to 0.810, P=0.009), intraoperative blood loss ≥400 ml(OR:0.411, 95%CI:0.176 to 0.959, P=0.040) and combined organ resection (OR:0.412, 95%CI:0.215 to 0.789, P=0.008) were independent risk factors of perioperative intraperitoneal infection. Cox regression analysis revealed that without intraoperative chemotherapy, proximal subtotal or total gastrectomy, TNM stage III(, N3 stage lymph node metastasis, positive soft tissue outside lymph node, combined organ resection and organ failure were independent risk factors affecting the prognosis of gastric cancer patients after radical resection (all P<0.05), however the perioperative complication was not independent risk factor affecting the prognosis (P=0.259). The median survival time was 35 months, and 5-year survival rate was around 38.7%. The median survival time of gastric cancer patients with operative complications and without complications were 28.0 and 36.5 months, and the 5-year survival rates were 37.2% and 39.3%, whose difference was not statistically significant (P=0.259).</p><p><b>CONCLUSION</b>There is a higher risk of perioperative complication in those gastric cancer patients with old age, preoperative low serum albumin level, tumor site at upper 1/3 of stomach, Borrmann type IIII(, intraoperative combined organ resection, while the perioperative complication has no significant effects on the long-term survival.</p>