Feasibility Analysis of Constructing the Advance Medical Directive System for the Elderly in China / 中国医学伦理学

Advance medical directive has been implemented in many countries and regions, has also been widely concerned by medical and ethical circles in China, and has gradually entered the public consciousness. The phenomenon of loneliness, disability and dementia of the elderly is gradually increasing, which reflects the importance of advance medical directive in this large group. Therefore, this paper focused on the main body of medical decision-making patients, patients’ families and medical staff to describe the development status of medical decision-making in China, and analyze the reasons for obstacles in the promotion of advance medical directive in China from cultural, social and economic factors. By comparing the system, culture and medical insurance payment methods of the advance medical directive system in China and western countries, this paper explored the feasibility of constructing this system in China, and put forward that the construction of the advance medical directive system in China should be prepared in the cultural, economic and other aspects, so as to better improve the life quality of the elderly at the end of life in the future, and also provide some useful reference for its promotion in China’s medical practice.

Construction and verification of a quantitative index system to evaluate the medical and nursing care for the elderly service needs / 中南大学学报(医学版)

OBJECTIVES@#To construct a quantitative index system with the integrated medical and nursing care assessment for the elderly service needs, this system can assess the cost of medical and care services accurately and objectively, so as to provide scientific basis for the allocation of old-age service resources in China.@*METHODS@#Based on the survival needs of the Existence, Relation and Growth theory, an index system is constructed through literature analysis, group discussion, and expert correspondence. Analytic hierarchy process was used to determine the weights of indicators at all levels. The 3-grades service items corresponding to each index were quantified through the measurement of working hours, and the medical and nursing care needs of 624 disabled/demented elderly people over 60 years old in Changsha were investigated to evaluate their reliability and validity.@*RESULTS@#The authoritative coefficients of the 2 rounds of expert correspondence were 88.5% and 88.6%, respectively, and the opinion coordination coefficients were 0.159 and 0.167, respectively. The final quantitative evaluation index system included 4 first-level indicators, 17 second-level indicators, and 105 third-level indicators. The service time of doctor ranged from 6.01 to 22.64 min, the service time of nurses ranged from 0.77 to 24.79 min, and the service time of caregiver ranged from 0.12 to 51.88 min. The Cronbach's αcoefficient was 0.73, the split-half reliability was 0.74, the content validity was 0.93, and the calibration validity was 0.781.@*CONCLUSIONS@#The quantitative evaluation index system of medical and nursing service need for the elderly can be used to accurately evaluate the medical and nursing service need.

Research on the relationship between occupational cognition, coping style and transition shock of nursing interns / 中华医学教育探索杂志

Objective:To analyze the relationship between transition shock of nursing interns and occupational cognition and coping styles, and explore the factors affecting the status quo of nursing interns transformation, so as to provide guidance for the development of nursing students to respond to clinical transition shock.Methods:A cross-sectional survey of nursing students in Hunan Province was conducted among nursing interns from 18 colleges and universities in Hunan Province by using the General Demographic Data Questionnaire and the Transition Shock of Newly Graduated Nurses Scale, the Nurses' Professional Cognitive Survey Scale, and the Simplified Coping Style Questionnaire. The collected data were processed by SPSS 18.0 software, and multivariate linear regression analysis was performed to analyze the influencing factors of the shock.Results:The overall scores of nursing students transition shock were (64.49±16.33) points, while the transition shock was negatively correlated with occupational cognition ( r=-0.433, P<0.01) and positive response ( r=-0.263, P<0.01). And the occupational cognition, proposed academic qualification, reason for choosing nursing profession and positive response were the main factors affecting the transition shock of nursing students ( P=0.00, R2=0.21). Conclusion:The transition shock of nursing students is at the middle level, and has a strong negative correlation with the nursing students' occupational cognition and positive response. School teachers and clinical instructors should pay attention to the confusion, suspicion and unclear feelings and experiences caused by the transition shock of nursing students, helping nursing students to improve their occupational cognition, and learning how to positively respond to the transition shock problem, thereby improving the quality of clinical internship teaching and training of nursing students.

Expression and significance of immune checkpoint B7-homolog 4 in endometrial cancer / 中华妇产科杂志

Objective:To investigate the expression of B7 homolog 4 (B7-H4) and its clinical significance in endometrial cancer.Methods:A total of 833 patients with endometrial cancer admitted to Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from 2009 to 2019, were enrolled. The expression of B7-H4, mismatch repair (MMR), p53, programmed cell death ligand 1 (PD-L1) protein, and CD 8+ T lymphocyte density in endometrial cancer tissues were detected by the EnVision two-step method of immunohistochemical staining. First-generation sequencing (Sanger method) was used to determine molecular subtyping of endometrial cancer. The χ2 test was used to compare the differences in positive expression rate of B7-H4 protein in endometrial cancer tissues with different clinicopathological features and molecular subtyping, PD-L1 protein expression, and CD 8+ T lymphocyte density. Survival analyses [including recurrence-free survival (RFS) and disease-specific survival (DSS)] were performed for 664 patients with follow-up time≥3 months, with a median follow-up time of 31 months (range: 4-121 months), and the Cox proportional hazards regression model was used to analyze the relevant factors affecting the prognosis of patients with endometrial cancer. Results:(1) The median age of 833 patients was 58 years (range: 25-88 years); pathological type: 595 with endometrioid carcinoma, 238 with non-endometrioid carcinoma; surgical-pathological staging: 542 cases at stage Ⅰ, 38 cases at stage Ⅱ, 173 cases at stage Ⅲ, and 45 cases at stage Ⅳ. Molecular subtyping was performed in 590 patients, including 50 with POLE mutation, 163 with mismatch repair defect (MMR-d) type, 246 with nospecific molecular change (NSMP) type, and 131 with p53 mutation subtype. (2) B7-H4 protein was expressed with brownish-yellow stainind in the cell membrane and cytoplasm of endometrial carcinoma, and the positivity rate of B7-H4 protein was 71.5% (596/833). The positivity rates of B7-H4 protein among patients with different age, surgical-pathological stage, tumor grade, pathological type, depth of muscular invasion, presence or absence of lymphovascular space invasion, and molecular subtype were significantly different (all P<0.05). The positivity rates of B7-H4 protein among patients with different PD-L1 protein expression and CD 8+ T lymphocyte density were not significantly different ( P>0.05). The 5-year RFS (83.9%) and DSS (87.3%) of B7-H4 protein-positive patients had an increasing trend compared with the 5-year RFS (77.2%) and DSS (78.1%) of B7-H4 protein-negative patients, but there were not statistically significant differences ( P=0.053, P=0.083). (3) Univariate analysis showed that the 5-year RFS and DSS of patients with different age, tumor grade, surgical-pathological stage, pathological type, depth of muscular invasion, lymphovascular space invasion, and molecular subtype were significantly different (all P<0.01). There were no significant differences in 5-year RFS ( P=0.184, P=0.113) and DSS ( P=0.549, P=0.247) among patients with different CD 8+ T lymphocyte density and PD-L1 protein expression. Further analysis according to molecular subtype, the results of CD 8+ T lymphocyte density and PD-L1 protein expression showed that the 5-year RFS and DSS of B7-H4 protein-positive patients were higher than those of B7-H4 protein-negative patients with NSMP subtype, low density of CD 8+ T lymphocyte and PD-L1 protein-negative endometrial carcinoma (all P<0.05), however, there was no significant difference in 5-year DSS between B7-H4 protein-positive patients and B7-H4 protein-negative patients with PD-L1 protein-negative endometrial cancer ( P=0.060). Multivariate analysis showed that positive expression of B7-H4 protein was an independent factor for 5-year RFS ( HR=0.27, 95% CI: 0.09-0.78, P=0.016) and DSS ( HR=0.16, 95% CI: 0.05-0.58, P=0.005) in patients with NSMP subtype endometrial carcinoma. In patients with low-density CD 8+ T lymphocytes endometrial cancer, positive expression of B7-H4 protein was an independent factor for 5-year RFS ( HR=0.45, 95% CI: 0.26-0.80, P=0.006), but it was not an independent factor for 5-year DSS. In patients with PD-L1 protein-negative endometrial cancer, B7-H4 protein was not an independent factor for 5-year RFS. Conclusion:B7-H4 protein expressed highly in endometrial carcinoma tissues, and its high expression is closely related to clinicopathological features, molecular subtype of p53 mutant and NSMP, and the favorable prognosis of patients with low density of CD 8+ T lymphocyte immunophenotype endometrial carcinoma.

Construction and verification of an intelligent measurement model for diabetic foot ulcer / 中南大学学报(医学版)

OBJECTIVES@#The measurement of diabetic foot ulcers is important for the success in diabetic foot ulcer management. At present, it lacks the accurate and convenient measurement tools in clinical. In recent years, artificial intelligence technology has demonstrated the potential application value in the field of image segmentation and recognition. This study aims to construct an intelligent measurement model of diabetic foot ulcers based on the deep learning method, and to conduct preliminary verification.@*METHODS@#The data of 1 042 diabetic foot ulcers clinical samples were collected. The ulcers and color areas were manually labeled, of which 782 were used as the training data set and 260 as the test data set. The Mask RCNN ulcer tissue color semantic segmentation and RetinaNet scale digital scale target detection were used to build a model. The training data set was input into the model and iterated. The test data set was used to verify the intelligent measurement model.@*RESULTS@#This study established an intelligent measurement model of diabetic foot ulcers based on deep learning. The mean average precision@.5 intersection over union (mAP@.5IOU) of the color region segmentation in the training set and the test set were 87.9% and 63.9%, respectively; the mAP@.5IOU of the ruler scale digital detection in the training set and the test set were 96.5% and 83.4%, respectively. Compared with the manual measurement result of the test sample, the average error of the intelligent measurement result was about 3 mm.@*CONCLUSIONS@#The intelligent measurement model has good accuracy and robustness in measuring the diabetic foot ulcers. Future research can further optimize the model with larger-scale data samples.

Clinical image identification of basal cell carcinoma and pigmented nevi based on convolutional neural network / 中南大学学报(医学版)

To construct an intelligent assistant diagnosis model based on the clinical images of basal cell carcinoma (BCC) and pigmented nevi in Chinese by using the advanced convolutional neural network (CNN).
 Methods: Based on the Xiangya Medical Big Data Platform, we constructed a large-scale clinical image dataset of skin diseases according to Chinese ethnicity and the Xiangya Skin Disease Dataset. We evaluated the performance of 5 mainstream CNN models (ResNet50, InceptionV3, InceptionResNetV2, DenseNet121, and Xception) on a subset of BCC and pigmented nevi of this dataset. We also analyzed the basis of the diagnosis results in the form of heatmaps. We compared the optimal CNN classification model with 30 professional dermatologists.
 Results: The Xiangya Skin Disease Dataset contains 150 223 clinical images with lesion annotations, covering 543 skin diseases, and each image in the dataset contains support for pathological gold standards and the patient's overall medical history. On the test set of 349 BCC and 497 pigmented nevi, the optimal CNN model was Xception, and its classification accuracy can reach 93.5%, of which the area under curve (AUC) values were 0.974 and 0.969, respectively. The results of the heatmap showed that the CNN model can indeed learn the characteristics associated with disease identification. The ability of the Xception model to identify clinical images of BCC and Nevi was basically comparable to that of professional dermatologists.
 Conclusion: This study is the first assistant diagnosis study for skin tumor based on Chinese ethnic clinical dataset. It proves that CNN model has the ability to distinguish between Chinese ethnicity's BCC and Nevi, and lays a solid foundation for the following application of artificial intelligence in the diagnosis and treatment for skin tumors.

Preparation of Magnetic Imprinted Polymer by Surface Grafting and Its Recognition Performance for Dibutyl Phthalate / 分析化学

The magnetic molecularly imprinted polymers (MMIPs), based on the surface of magnetic nanoparticles being modified by surface grafting, have been successfully synthesized, with dibutyl phthalate (DBP) as template molecule, ethylene glycol dimethacrylate (EGDMA) as cross-linking agent and azobisisobutyronitrile (AIBN) as initiator. Scanning electron microscopy (SEM), transmission electron microscope (TEM), and elemental analysis were employed to characterize the MMIPs. The structure and magnetic properties of the MMIPs were investigated by means of X-ray diffraction and vibrating sample magnetometer. The BET surface area shows that MMIPs is 380 m2/g and MNIPs is 324 m2/g. A series of static adsorption experiments were conducted to analyze its adsorption performance, which followed pseudo-second-order model by the kinetic analysis with correlation coefficient (R2) 0.9797, and Sips equation with correlation coefficient (R2) 0.999 by the isothermal analysis. The imprinting factors of diallyl phthalate (DAP), DBP and di-2-ethylhexyl phthalate (DEHP) were 1.53, 2.21 and 1.39 respectively, showing that MMIPs had better recognition performance for DBP. The experiment of regeneration recycles with five times showed the regeneration ability of DBP was only reduced by 12.3％.

Research on direct forming of comminuted fracture surgery orienting model by selective laser melting / 生物医学工程学杂志

In order to simplify the distal femoral comminuted fracture surgery and improve the accuracy of the parts to be reset, a kind of surgery orienting model for the surgery operation was designed according to the scanning data of computer tomography and the three-dimensional reconstruction image. With the use of DiMetal-280 selective laser melting rapid prototyping system, the surgery orienting model of 316L stainless steel was made through orthogonal experiment for processing parameter optimization. The technology of direct manufacturing of surgery orienting model by selective laser melting was noted to have obvious superiority with high speed, precise profile and good accuracy in size when compared with the conventional one. The model was applied in a real surgical operation for thighbone replacement; it worked well. The successful development of the model provides a new method for the automatic manufacture of customized surgery model, thus building a foundation for more clinical applications in the future.

Influence of Psychological Intervention on Therapeutic Effect of Massage Therapy for Fibromyalgia Syndrome / 广州中医药大学学报

Objective To observe the influence of psychological intervention on therapeutic effect of massage therapy for fibromyalgia syndrome(FMS).Methods Sixty-eight FMS patients were equally randomized into the treatment group and the control group.The two groups were given massage therapy and oral use of amitriptyline tablets,and the treatment group received psychological intervention additionally.The therapeutic effect was evaluated with Visual Analogic Scale(VAS) and Hamilton Depression Scale(HAMD).Results After treatment,9 were clinically cured,12 markedly effective,10 effective,2 ineffective and the total effective rate was 93.9% in the treatment group;in the control group,3 were clinically cured,8 markedly effective,13 effective,8 ineffective and the total effective rate was 75.0%;the difference between the two groups was significant(P