Roles of human periodontal ligament stem cells in osteogenesis and inflammation in periodontitis models: Effect of 1α,25-dihydroxyvitamin D3.

Periodontitis is a chronic inflammatory disease caused by Porphyromonas gingivalis and other bacteria, and human periodontal ligament stem cells (hPDLSCs) are a promising candidate for the treatment of periodontal supporting tissue defects. This study aimed to investigate the effect of 1α,25-dihydroxyvitamin D3 [1,25(OH)2VitD3] on osteogenic differentiation of hPDLSCs in an in vitro periodontitis model and whether it can improve inflammatory status. hPDLSCs were in vitro isolated and identified. After treatment with 1,25(OH)2VitD3 and ultrapure pure Porphyromonas gingivalis lipopolysaccharide (LPS-G), the viability of hPDLSCs was detected using Cell Counting Kit-8, the expressions of osteogenic markers and inflammatory genes using Western blotting and quantitative reverse transcription PCR (qRT-PCR), the levels of inflammatory factors in cells using enzyme linked immunosorbent assay (ELISA), and the fluorescence signal intensity of osteoblastic markers and inflammatory genes in cells using immunofluorescence assay. It was found that 1,25(OH)2VitD3 reversed the inhibition of hPDLSCs proliferation by LPS-G; LPS-G exhibited inhibitory effect on ALP, Runx2, and OPN expressions, and such inhibitory effect was significantly weakened when co-acting with 1,25(OH)2VitD3. Meanwhile, LPS-G upregulated the expressions of inflammatory genes IL-1ß and Casp1, whereas 1,25(OH)2VitD3 antagonized such an effect and improved the inflammatory status. In conclusion, 1,25(OH)2VitD3 can reverse the inhibitory effect of LPS-G on hPDLSCs proliferation and osteogenic differentiation and suppress LPS-G-induced upregulation of inflammatory gene expressions.

Safety, tolerability, and pharmacokinetics of fluoropezil (DC20), a novel acetylcholinesterase inhibitor: A phase I study in healthy young and elderly Chinese subjects.

The present study evaluated the safety, tolerability, and pharmacokinetics of fluoropezil (DC20), a novel acetylcholinesterase inhibitor under development for the treatment of Alzheimer's disease (AD) in otherwise healthy young and elderly Chinese subjects. The study of young subjects included the multiple ascending dose (MAD) arm (2 and 6 mg, N = 24) and the food effect arm (4 mg, N = 12) and was followed by the study of elderly subjects who were given (2 and 4 mg, N = 11). The noncompartmental analysis method was used to determine the pharmacokinetic parameters. The pharmacokinetics of fed versus fasted dose administration in the same subjects was assessed by 90% confidence interval. In the MAD arm, the accumulation ratios of DC20 in vivo were 2.29 and 2.15, respectively. In the food effect arm, compared with fasting administration, an area under the concentration-time curve from zero to t after a standard and high-fat diet orally administered slightly increased by about 19% and 29%, and the time to maximum concentration (Tmax ) was delayed by around 1 h. For elderly study subjects, Tmax was 1.5 and 1.25 h, and terminal half-life (t1/2 ) was 77.1 and 74.2 h, respectively. There were no serious adverse events (AEs), whereas gastrointestinal reactions were the most common AEs associated with the study drug. We predicted the safety risks of DC20 in the clinical treatment of AD, which were well-tolerated by the healthy young and elderly subjects. The elimination of DC20 from the body was slower in elderly subjects than in young subjects. This study was approved by the Center for Drug Evaluation, National Medical Products Administration (CTR20181428, CTR20190664, CTR20191878, and CTR20192724).

LC-MS/MS assay of fluoropezil and its two major metabolites in human plasma: an application to pharmacokinetic studies.

Background: LC-MS/MS methods were developed for pharmacokinetic analysis and verified to measure fluoropezil, a new AchE inhibitor for Alzheimer's disease treatment, and its two primary metabolites (N-debenzyl fluoride fluoropezil [M1] and N-oxidized fluoropezil [M11]) in human plasma. Methods & results: Analytes were extracted from 50 µl plasma using protein precipitation and separated by HPLC using a bridged ethyl hybrid column and gradient elution procedure. Analytical detection was performed with a triple quadrupole mass spectrometer and electrospray ionization source in multiple reaction monitoring mode. The LC-MS/MS method was fully validated. The quantification linear ranges were 0.100-50.0 ng/ml (fluoropezil), 0.0500-25.0 ng/ml (M1) and 0.0500-25.0 ng/ml (M11). Conclusion: A sensitive, reliable LC-MS/MS method was established and used successfully to explore the pharmacokinetics of fluoropezil.

Research progress on medical interprofessional education / 中华医学教育探索杂志

Interprofessional education (IPE) is of great importance to the cultivation of medical students, which can improve their ability of team cooperation in medical work in the future and can also improve the treatment experience of patients. This paper focuses on the general situation of the development of medical IPE and organizational forms, capacity building framework, curriculum development, influencing factors, teaching evaluation, existing problems, and enlightenments on the development of medical IPE in China.

Value of aortic root CTA assessment in aortic valve surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the data of preoperative aortic root CT angiography (CTA), compare it with two-dimensional transthoracic echocardiography and investigate the correlation of the two measurements with the actual intraoperative measurement data. Methods    Clinical data of 53 patients with aortic valve diseases who underwent aortic valve repair in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 38 males and 15 females with an average age of 42.9±18.3 years ranging from 10 to 77 years. Preoperative two-dimensional transthoracic echocardiography (TTE) and aortic root CTA measurements were collected, including aortic valve annulus (AVA), aortic sinus (Sinus) and sino-tubular junction (STJ). In comparison with the intraoperative measurements during the aortic valve repair surgery, the consistency analysis was performed. Results    Both the preoperative echocardiography AVA measurements and the CT AVA measurements were positively correlated with the intraoperative AVA measurements (P<0.001). Compared with the echocardiography AVA data [correlation coefficient (ρ)=0.74, mean squared error (MSE)=12.78], the CT AVA data were more accurate and consistent with the intraoperative AVA measurements (ρ=0.95, MSE=2.72). CT AVA data had a higher correlation coefficient with the intraoperative measurements, compared to that of  the echocardiography AVA data (P<0.001). Conclusion    In comparison with two-dimensional transthoracic echocardiography, preoperative morphological evaluation of aortic root CTA is more consistent with the actual intraoperative measurements during aortic valve repair surgery.

Treatment of tibial plateau fractures involving external posterior condyle collapse with 3D printed osteotomy guide plate combined with "Jail" screw technique / 中华骨科杂志

Objective:To investigate the clinical efficacy of 3D printed osteotomy guide plate combined with "Jail" screw technique in the treatment of tibial plateau fractures involving external posterior condylar collapse.Methods:From January 2016 to January 2021, 41 patients (22 males and 19 females) with tibial plateau fractures involving external posterior condylar collapse were treated with 3D printed osteotomy guide plate combined with "Jail" screw technique and followed up. The age was 47.4±11.5 years (range, 22-69 years). According to Schatzker fracture type, 18 cases were type IV, 14 cases were type V and 9 cases were type VI. All fractures were closed, and 12 of them were complicated with lateral meniscus injury, but none of them were complicated with nerve and vascular injury. The time from injury to operation was 7.2±3.4 d (range, 4-17 d). All patients underwent 3D CT scanning and digital modeling before operation. According to the modeling results, a 1∶1 solid size fracture model was made by 3D printing, and the osteotomy guide plate and the "Jail" screw preset guide plate were designed. During the operation, the tibial lateral condyle osteotomy was performed with customized osteotomy guide plate. After reduction, the fixation of the fracture was performed with the preset guide plate using "Jail" screw. Postoperative fracture reduction was evaluated according to Rasmussen score, and knee function was evaluated by Hospital for Special Surgery (HSS) score.Results:All the 41 patients were followed up for 15.2±5.8 months (range, 6-26 months). Immediate postoperative radiographs showed good fracture reduction, and the average healing time was 14.1±1.2 weeks (range, 12-17 weeks). One year after operation, the Rasmussen score of knee joint was 17.4±1.6 points (range, 13-19 points), of which 31 cases were excellent, 8 cases were good, and 2 cases were fair, with an excellent/good rate of 95% (39/41). HSS scores was 87.3±5.6 points (range, 68-95 points), including 30 excellent cases, 10 good cases and 1 fair case, with an excellent/good rate of 98% (40/41). The range of motion of knee joint was 126.8°±3.8°. At the last follow-up, no serious complications such as common peroneal nerve injury, popliteal vascular injury, postoperative infection, or internal fixation failure occurred.Conclusion:3D printed osteotomy guide plate combined with "Jail" nail placement technique is an effective method for tibial plateau fractures involving external posterior condylar collapse, and the postoperative treatment results are satisfactory. The use of customized osteotomy guide plate is more accurate and less damaging. The use of "Jail" screw preset guide plate can ensure more accurate screw placement.

Analysis of cognitive dysfunction and its influencing factors in elderly inpatients in Qinghai / 中华老年医学杂志

Objective:To evaluate the cognitive function of elderly inpatients in Qinghai and analyze the influencing factors in this prospective study.Methods:A total of 1077 elderly inpatients were enrolled for general information investigation, including the Mini Nutritional Assessment-Short form(MNA-SF), Geriatric Depression Scale 15(GDS-15), FRAIL Scale, activities of daily living(ADL), instrumental ability of daily living(IADL)and the Mini-Mental State Examination(MMSE).Results:The 1077 elderly inpatients being subjected in this study, included 470 in the cognitive impairment(CI)group and 607 in the normal group.The prevalence of CI in hospitalized elderly patients was 43.64%(470/1077). The results of univariate analysis showed that as compared with the normal group, the proportion of cognitive impairment was higher in female, elder patients, and boiling tea-drinker, otherwise the proportion of CI was lower in patients living with the spouse, normal sleep, often eating beef and mutton( P<0.01 or P<0.05); FRAIL Scale, ADL total score, and IADL total score were higher in the normal group than in the CI group( P<0.01); the elderly depression score and frailty score were higher in the CI group than in the normal group( P<0.01). The results of logistic regression analysis showed that the risk of CI was higher in female and people frequently drinking boiling tea than in male and people not frequently drinking boiling tea( OR=0.740, 1.211, both P<0.05), and that frequent consumption of beef and mutton, and reasonable levels of nutrition, ADL, and IADL were protective factors for CI in elderly hospitalized patients( OR=0.780, 0.938, 0.956, 0.895, all P<0.05). Conclusions:The incidence of cognitive impairment in hospitalized elderly patients in Qinghai is relatively high.Female and often drinking boiling tea may increase the risk of cognitive impairment.Regularly eating beef and mutton, reasonable levels of nutrition, maintaining good daily life ability can delay cognitive impairment.

Analysis of risk factors and construction of a prediction model for mild cognitive impairment in elderly inpatients in sub-plateau areas / 中华老年医学杂志

Objective:To investigate the prevalence of mild cognitive impairment(MCI)in elderly inpatients in high altitude areas, analyze the influencing factors, and then construct a risk factor model.Methods:A cross-sectional random sampling method was used to conduct a questionnaire survey among elderly patients over 65 years old hospitalized at Qinghai Provincial People's Hospital from October 2018 to February 2019.The survey contents included demographic data, lifestyles, physical activities and cognitive function.The occurrence of MCI was analyzed with descriptive epidemiological measures, a predictive model of influencing factors was established using Logistic regression analysis, and influencing factors were ranked.Results:There were a total of 1412 elderly people aged 65 and above, with 760 males, accounting for 53.8%.The ages of respondents ranged between 65-82 years, with an average age of(72.8±5.8)years.Of the subjects, 600 had MCI, with a prevalence of 42.4%.Male( OR=1.318, P=0.02), junior high school education or above( OR=0.521, P<0.001), bedriddenness( OR=2.658, P=0.002), lifestyle( OR=0.702, P=0.011), abnormal defecation( OR=1.625, P=0.005)and frailty( OR=1.536, P=0.002)were included into the predictive model of influencing factors.The area under the ROC curve in this study was 0.676(95% CI: 0.648-0.704), with sensitivity=0.553, specificity=0.741, and Youden index=0.274.When ordered by importance, the independent risk factors were frailty, male, abnormal defecation, bedriddenness, lifestyle, and education level. Conclusions:Male, frailty, abnormal defecation and long-term bedriddenness are risk factors for cognitive impairment in elderly people, whereas living with a partner and education above junior high school are protective factors.

Comparison of Gamma 3 U-blade system and Gamma 3 nails in treatment of elderly patients with osteoporotic unstable femoral intertrochanteric fracture / 中华创伤骨科杂志

Objective:To compare the short-term therapeutic effects of Gamma 3 U-Blade system and Gamma 3 nails in the treatment of elderly patients with osteoporotic unstable intertrochanteric fracture.Methods:The data of 70 elderly patients with osteoporotic unstable intertrochanteric fracture were retrospectively analyzed who had been admitted to the Department of Orthopedics, Wuhan Fourth Hospital from June 2018 to December 2020. They were divided into 2 groups according to their treatments. In the U-Blade group of 35 cases subjected to fixation with Gamma 3 U-Blade system, there were 14 males and 21 females with an age of (77.7 ± 4.8) years; in the Gamma 3 nail group of 35 cases subjected to fixation with Gamma 3 nails, there were 14 males and 21 females with an age of (79.3 ± 5.2) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, apex distance, fracture union time, postoperative complications, timed up and go (TUG) at postoperative 2 weeks, 3 months and 6 months, and hip function at postoperative 9 months.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference either in operation time, intraoperative blood loss or apex distance between the 2 groups ( P>0.05). The fracture union time [(12.0 ± 0.2) weeks] and Harris hip score at postoperative 9 months [90 (90, 91)] in the U-Blade group were insignificantly different from those in the Gamma 3 nail group [(12.0 ± 0.3) weeks and 91 (89, 91)] ( P>0.05). The rate of implant-related complications in the U-Blade group [0% (0/35)] was significantly lower than that in the Gamma 3 nail group [17.1% (6/35)] and the TUGs at postoperative 2 weeks and 3 months [(80.2 ± 3.6) s and 45 (43, 49) s] in the former were significantly shorter than those in the latter [(89.3 ± 4.2) s and 56 (54, 59) s] ( P<0.05). Conclusion:In the treatment of elderly patients with osteoporotic unstable intertrochanteric fracture, compared with traditional Gamma 3 nails, Gamma 3 U-Blade system can reduce implant-related complications and facilitate early recovery of walking ability.

Analysis of the dominant eye in the progress of myopia in adolescents / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the characteristics of the dominant eye in the progression of myopia in the proportion and gender distribution of the left eye and the right eye in the dominant eye, the difference in the degree and growth rate of myopia between the dominant eye and the non-dominant eye during the progression of myopia in adolescents.<p>METHODS: In this prospective study, we selected 235 cases of 7-17 years old adolescents with myopia who were treated in our hospital from February to May 2020. The ocular structure was examined to exclude various eye diseases, and the dominant eye(card hole method)was determined and cycloplegic optometry was performed. They were all corrected by wearing monofocal glasses, and the dominant eye(card hole method)and cycloplegic optometry were retested after 1a.<p>RESULTS: Among the subjects, 159 cases were right eyes, accounting for 67.7%, and 76 cases were left eyes, accounting for 32.3%; There was no significant difference in gender distribution between dominant eyes and non-dominant eyes(<i>P</i>>0.05); There was no significant difference in spherical equivalent degree between dominant and non-dominant eyes(<i>P</i>>0.05); There was no significant difference in the degree of myopia growth between dominant and non-dominant eyes(<i>P</i>>0.05); There was no significant difference in the increase of myopia and the increase of myopia between the two eyes whether the right eye was dominant or the left eye was non-dominant(<i>P</i>>0.05); There was a significant correlation between the degree of myopia growth in the dominant eye and in both eyes(<i>P</i><0.01).<p>CONCLUSION: In myopic adolescents, most of the dominant eyes were right eye, and there was no difference between dominant eye and gender; Dominant eyes showed no specificity in the degree and growth of myopia, the dominant eye type do not affect the degree of myopia growth and the degree of anisometropia, but the degree of dominant myopia growth may affect the degree of anisometropia in both eyes.

Application of Bayesian network and regression method in treatment cost prediction.

Charging according to disease is an important way to effectively promote the reform of medical insurance mechanism, reasonably allocate medical resources and reduce the burden of patients, and it is also an important direction of medical development at home and abroad. The cost forecast of single disease can not only find the potential influence and driving factors, but also estimate the active cost, and tell the management and reasonable allocation of medical resources. In this paper, a method of Bayesian network combined with regression analysis is proposed to predict the cost of treatment based on the patient's electronic medical record when the amount of data is small. Firstly, a set of text-based medical record data conversion method is established, and in the clustering method, the missing value interpolation is carried out by weighted method according to the distance, which completes the data preparation and processing for the realization of data prediction. Then, aiming at the problem of low prediction accuracy of traditional regression model, this paper establishes a prediction model combined with local weight regression method after Bayesian network interpretation and classification of patients' treatment process. Finally, the model is verified with the medical record data provided by the hospital, and the results show that the model has higher prediction accuracy.

Diversity of porcine reproductive and respiratory syndrome virus in Shandong, China.

Porcine reproductive and respiratory syndrome virus (PRRSV) is one of the most economically significant pathogens in swine industry of China. To study infection and genetic variation of PRRSV, 637 tissue samples were collected from diseased pigs in Shandong, and then subjected to detection of PRRSV. The nsp2 and ORF5 genes were sequenced for investigation of variations and phylogenetic analysis. The results showed that positive rate of PRRSV was 9.58% in the collected samples. Phylogenetic analysis of GP5 showed that these strains were clustered into two lineages (1 and 8) indicating different genotypes of PRRSV were circulating in Shandong province. Meanwhile, sequence analysis Of nsp2 showed that the PRRSV strains with 30 amino acids deletions were dominant. Moreover, novel pattern of recombination/deletion and insertion in nsp2 was observed in these strains, indicating that novel PRRSV strains with different patterns of deletions or insertions in nsp2 are emerging in China. All the results suggested that continuous surveillance of PRRSV in China is warranted. Keywords: PRRSV; GP5; nsp2; genetic analysis; Shandong.

Nonalcoholic fatty pancreas disease: An emerging clinical challenge.

Nonalcoholic fatty pancreas disease (NAFPD) is an emerging disease that has gained an increasing amount of attention in recent years. It describes fat accumulation in the pancreas with insignificant alcohol consumption, but the pathogenesis is largely unknown. A wide range of terms have been used to describe the phenomenon of pancreatic fat accumulation, but NAFPD remains an under-recognized and non-independent disorder. Obesity, age, sex, race, and unhealthy lifestyle are established independent risk factors for NAFPD, which is strongly associated with metabolic syndrome, type 2 diabetes, pancreatitis, pancreatic fistula, pancreatic cancer, and nonalcoholic fatty liver disease. At present, imaging techniques are common diagnostic aids, but uniform criteria and consensus are lacking. Therapeutically, healthy diet, weight loss, and exercise are the mainstays to reduce pancreatic fat accumulation. It can be seen that there is a limited understanding of NAFPD at this stage and further exploration is needed. Previous studies have revealed that NAFPD may directly affect diagnosis and clinical decision-making. Therefore, exploring the pathophysiological mechanism and clinical associations of NAFPD is a major challenge for researchers and clinicians.

Protective Effect of Glycyrrhizae Radix et Rhizoma-Granati Pericarpium Formula on Ultraviolet-induced Skin Damage / 中国实验方剂学杂志

Objective:To explore the potential synergistic protective mechanism of Glycyrrhizae Radix et Rhizoma-Granati Pericarpium formula compound by using the methods and tools of network pharmacology，and provide a basis for the modernization of traditional Chinese medicine（TCM） compounds and the discovery of new drugs. Method:Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） was used to obtain the active components of Glycyrrhizae Radix et Rhizoma-Granati Pericarpium formula and their corresponding targets. The obtained targets were input to the UniProt database to inquire the gene names corresponding to the targets. By searching the CTD database，Genecards database and OMIM database of disease-related websites，the anti-sunburn targets were obtained. The interaction of the active targets was analyzed with online STRING database to screen the predicted core targets. The gene ontolog（GO） gene function enrichment analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis of the predictive targets were performed by using DAVID database. Cytoscape 3.6.1 software was used to make "drug-component-target" network diagram，"protein-protein interaction" network diagram and "component-target-pathway" network diagram. Online website Draw Venn Diagram was used to show the relationship between disease targets and drug predicted targets. R Studio software was used to draw the functional enrichment analysis diagram of GO gene and KEGG pathway. Molecular docking between the active ingredients and the core targets was performed using GOLD software. Result:The 16 active compounds were collected，such as liquiritin，glycyrrhizin，kaempferol and quercetin. The active components mainly acted on 5 core targets：protein kinase B1（AKT1），interleukin（IL）-6，vascular endothelial growth factor（VEGFA），tumor necrosis factor（TNF） and tumor suppressor gene （TP53） and played a role in anti-sunburn effect primarily through these pathways such as hepatitis B，pathways in cancer，toxoplasmosis，chagas disease（American trypanosomiasis），and TNF signaling pathway. Conclusion:Based on the method of network pharmacology，the present study has preliminarily explored the anti-sunburn targets and pathways of Glycyrrhizae Radix et Rhizoma-Granati Pericarpium formula，and further verified the characteristics of multi-component and multi-target treatment of diseases in TCM，so as to provide certain scientific ideas for the modernization research of Chinese herbal compound prescriptions.

Anti-inflammatory Mechanism of Epimedii Folium in Treatment of Depression Based on Network Pharmacology and Molecular Docking / 中国实验方剂学杂志

Objective:To predict the anti-inflammatory targets and relevant signaling pathways of Epimedii Folium in the treatment of depression by network pharmacology，in order to explore the potential mechanism of its anti-depression effect. Method:The active constituents of Epimedii Folium were collected and screened out through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） database. PharmMapper server and TCMSP database were used to predict and screen out protein targets. OMIM database，CTD database and GeneCards database were used to screen out relevant targets and anti-inflammatory targets of depression. Enrichment analysis of the gene ontology （GO） function and Kyoto Encyclopedia of genes and genomes（KEGG） signaling pathway for the key anti-inflammatory targets of Epimedii Folium were carried out by DAVID database. Cytoscape 3.6.0 was used to construct the network diagram of "active component-action target-signal pathway" of Epimedii Folium and analyze the topological structure of the network. GOLD molecular docking software was used to verify the results of active components and key anti-inflammatory targets. Result:A total of 12 active components，30 targets and 5 key anti-inflammatory targets of Epimedii Folium were screened out， 65 biological processes，4 cell components and 1 molecular function were enriched with GO function， and 41 KEGG pathways were enriched and analyzed，including 9 inflammation-related signaling pathways. Molecular docking verified that icariin and key anti-inflammatory targets could form the optimal binding structure. Conclusion:The study preliminarily reveals the molecular mechanism of Epimedii Folium on depression through its anti-inflammatory target and its relevant signaling pathway network，so as to provide a basis for further study on the antidepressant effect of Epimedii Folium.

Diagnostic value of magnetic resonance imaging in cesarean scar pregnancy / 第二军医大学学报

Objective To analyze the magnetic resonance imaging (MRI) features of caesarean scar pregnancy (CSP), and to evaluate the diagnosis value of MRI in CSP. Methods The MRI data of 38 patients with clinically and pathologically confirmed CSP were retrospectively analyzed. These patients aged 19 to 50 years old, with one to two previous cesarean sections. The interval between this pregnancy and the last cesarean section was 2 to 11 years, the menopause time was 32 to 90 days, the urine human chorionic gonadotrophin (HCG) were all positive, and the blood β-HCG was 159.7-210 800.0 U/L. Twenty-nine cases were treated due to a small amount of vaginal bleeding after menopause, and nine cases due to abdominal pain. Results On the sagittal T2-weighted image, 38 cases of gestational sacs were clearly showed, of which 28 cases had round or oval morphology, with low signal on T1 and high signal on T2; 10 cases of gestational sacs showed irregular mixed cystic solidity with slightly low signal on T1 and slightly high signal on T2, and the contents were significantly strengthened after the enhancement. In all cases, the cyst wall was intact and located at the scar of the cesarean section of the anterior inferior wall of the uterus. In two cases of MRI grade 0, the gestational sac was located on the scar surface and grew into the uterine cavity without involving the myometrium; in 13 cases of grade 1, the gestational sac slightly invaded the myometrium, but mainly grew in the uterine cavity, with a clear boundary between the gestational sac and the myometrium; in 14 cases of grade 2, the gestational sac was small and completely implanted into the myometrium, the endometrial junction was continuously interrupted, the anterior-inferior wall of the uterus was thin, in the shape of “W” or “U”, without invading the serosa; in nine cases of grade 3, the gestational sac was large, completely implanted into the myometrium and protruded out of the uterine contour, compressing the bladder. Fifteen patients of MRI grade 0 and 1 were mainly treated with methotrexate, mifepristone or misoprostol, and/or ultrasound-guided curettage; 23 patients of grade 2 and 3 were mainly treated with curettage, excision of scar lesions and scar repair. Conclusion The typical MRI features of CSP can guide the clinical treatment decision-making, especially for the choice of operation mode.

The application of Kirkpatrick Model in the evaluation of standardized training effect of new nurses / 中国实用护理杂志

Objective:To evaluate the effect of standardized training for new nurses in the first year based on Kirkpatrick model as a theoretical framework.Methods:A cross-sectional study was conducted. New nurses' satisfaction with training, theoretical and operational assessment, job performance, core competence, turnover rate and other indicators were used, to evaluate the effect of standardized training for 62 new nurses in the first year.Results:At the reaction level, the overall satisfaction score of new nurses was 4.66±0.47; at the learning level, the theoretical assessment score was 95.32±2.38, the operational assessment score was 97.53±1.07, and the performance score was 97.12±1.64; at the behavioral level 88.45±9.75; and at the result level, there were no complaints and errors among new nurses, and the turnover rate was 1.6% (1/62). The theoretical and operational assessment scores were positively correlated with work performance, with r value of 0.424 and 0.399, respectively, and P = 0.001. The theoretical assessment scores were negatively correlated with the behavioral level, with the r value of -0.264 and P= 0.038. There were no correlation with the operational assessment scores and the behavioral level, with the r value of 0.147 and P value of 0.253. Conclusions:Kirkpatrick model validates the standardized training program for new nurses effectively, and provides scientific basis for improving the training program for new nurses. The results level of the training needs to be evaluated in the long term.

A status survey on clinical teaching towards postgraduates of master of nursing specialist in China / 中国实用护理杂志

Objective:To investigate the current status of clinical teaching towards postgraduates of master of nursing specialist(MNS) in China.Methods:Objective sampling was used to invest 390 MNS clinical nursing teachers in 36 hospitals across the country. The survey included the admission and evaluation criteria of teachers, the MNS postgraduates′ clinical teaching plan and implementation, and the assessment of MNS postgraduate ′s clinical practice ability, etc. Results:Among the criteria for clinical teachers for MNS postgraduates, 79.49% of departments required bachelor ′s degree or above, and 67.18% of departments requested medium-grade professional title or above; 47.44% of the departments demanded that clinical teachers had the research experience, 58.21% departments asked for the experience of articles publication. The main method of selecting clinical teaching teachers was examination (50%), while 31.28% departments had no definite criteria. The evaluation indicators of clinical teachers mainly depended on the results of students ′ clinical practice capability assessment (81.79%) and students ′ satisfaction (80%). Only 49.23% of the study objects knew the training objectives of MNS. The pivotal abilities of MNS graduate students were the ability of clinical nursing practice (91.79%) and clinical research (82.82%). The MNS postgraduate teaching plan of each department was mainly derived from the requirements of tutors and colleges (87.69%). The mode of clinical teaching was that one student was guided by a fixed clinical teacher (87.18%). Clinical practice assessment methods of MNS mainly included theoretical knowledge assessment (88.46%) and the performance of section lectures (82.56%). The assessment personnel were mainly clinical teachers (95.40%) and head nurses (83.51%). The self-assessment of clinical teachers was rated at the medium level about their performance on the postgraduate MNS students ′ clinical teaching. Conclusions:The homogenization and standardization of the construction of MNS clinical teaching base needs to be improved in China. In the field of defining the criteria of clinical teaching teachers, strengthening the construction of clinical faculty, perfecting the clinical teaching plan and evaluation system according to the cultivation objectives and specialist characteristics, and elevating the comprehensive medical education combined with clinical education and college education, further exploration is indispensable.

Cavity Formation is a Prognostic Indicator for Pathologic Stage I Invasive Lung Adenocarcinoma of ≥3 cm in Size.

BACKGROUND We investigated the correlation between cavity formation, prognosis, and tumor stage for pathologic stage I invasive lung adenocarcinomas (IADCs) ≤3 cm in size. MATERIAL AND METHODS 2106 candidates with pathologic stage I IADC were identified from Shanghai Chest Hospital between 2009 and 2014. There were 227 patients who were diagnosed as having cavity formation and another 1879 patients who were not (the non-cavitary lung cancer group). Kaplan-Meier analysis curves were conducted to compare the overall survival (OS) and relapse-free survival (RFS) between these 2 groups. Cox proportional hazards regression was performed to discover the independent risk factors of OS and RFS. Receiver operating characteristic (ROC) curve was done to determine the cutoff value of cavity size for predicting prognosis. Furthermore, subgroup analysis was stratified by the size of tumor and the 8th classification of T category. RESULTS Compared with non-cavitary lung cancer group, patients with cavity formation were found to have a higher prevalence of male patients (P=0.015), older age patients (P=0.039), larger size tumors (P=0.004), and worse cancer relapse (P<0.001). Survival analysis found that patients with cavitary IADC had significantly shorter RFS than those with non-cavitary IADC (P=0.001). Further, subgroup analysis confirmed a significantly worse RFS in cavitary IADC group both in stage T1a (P=0.002) and T1b (P<0.001), but not for stage T1c (P=0.962) and T2a (P=0.364). Moreover, cavity formation was still less of a significant predictor of RFS in multivariable analysis (hazard ratio [HR] 1.810, 95% confidence level [CI] 1.229-2.665, P=0.003). The ROC curve showed that the best cutoff value of maximum diameter of the cavity for judging RFS was 5 mm (sensitivity: 0.500; specificity: 0.783). At the same time, multiple cavities were more likely to lead to recurrence (sensitivity: 0.605; specificity: 0.439). CONCLUSIONS Cavitary adenocarcinoma was a worse prognostic indicator compared with non-cavitary adenocarcinoma, especially for cavity >5 mm and multiple cavities. Thus, for stage T1a and T1b, cavitary and non-cavitary IADC should be considered separately.