新型冠状病毒(SARS-CoV-2)主要侵犯呼吸系统,随着临床数据积累,中枢神经系统受累的报道逐渐增多[1],在儿童和成人中类似.研究[2]发现,大部分感染SARS-CoV-2的儿童神经系统症状较轻,主要表现为头痛、头晕、嗅觉和味觉异常等.然而,也有一部分患儿出现了癫痫、昏迷和脑膜炎甚至坏死性脑病等严重神经系统症状[3].
Objective:To develop a standardized patient-based training plan for nursing interns to deal with hospital violence,which can be a guide for nursing interns in response to hospital violence and better handle such situations.Methods:Databases were searched to obtain full-text research on relevant topics,and evidence-based medicine methods were used to evaluate the evidence level and quality of the papers.With the best intervention evidence assessed and selected,a preliminary nursing intervention plan for hospital violence based on standardized patient simulations was constructed.This plan was further refined and the final training program was determined through two rounds of Delphi expert consultations.Results:A total of 17 articles were included in the study.A standardized patient-based training plan was constructed for student nurses to deal with hospital violence,including general knowledge of hospital violence,protective skills against hospital violence,and 44 specific indicators based on standardized patient simulations.The effective response rate for the two rounds of questionnaires was both 100%,and the expert authority coefficient(Cr)was 0.822 and 0.835,andKendall's W values was 0.247 and 0.308 respective,all of which showed statistical significance(P<0.01).Conclusion:The training plan for nursing interns to deal with hospital violence based on standardized patient simulations developed in this study has scientific validity and feasibility,which can provide a reference for clinical nursing education and training.
Objective:To search,evaluate and summarize the relevant evidence for self-management of patients with irritable bowel syndrome(IBS),so as to provide evidence-based information for clinical healthcare personnel to implement standardized patient self-management.Methods:Based on the"6S"evidence resource pyramid model,the top-down systematical search for evidence on self-management in patients with IBS was done in guideline websites,websites of professional societies,and comprehensive databases from January 2013 to December 2022;the types of literature included guidelines,clinical decisions,evidence summaries,expert consensus,and systematic reviews.Two researchers who were trained in evidence-based methodology independently evaluated the quality of the included literature,and the best evidence was extracted and summarized to form the best evidence.Results:A total of 18 literatures were included,including 8 guidelines,1 clinical decision,6 expert consensus,and 3 systematic reviews.Finally,a total of 27 pieces of best evidence were summarized,including 6 aspects of self-management,that is management support,knowledge learning,self-monitoring,diet management,exercise management,and psychological adjustment.Conclusion:The study summarized the best evidence for self-management in IBS patients,which can provide an evidence-based information for clinical healthcare professionals to more scientifically and effectively guide IBS patients in comprehensive self-management.
Objective:To investigate the relationship between mutations in the D-Loop region of spermatozoal mitochondrial DNA and asthenozoospermia.Methods:Semen samples from 134 asthenozoospermic patients(asthenospermia group)and 129 healthy men(control group)diagnosed and treated in Wenzhou Hospital of Traditional Chinese Medicine from July 2019 to March 2021 were collected,analyzed by the polymerase chain reaction(PCR)-sequencing method.The sequencing results of the D-Loop region of mtDNA were compared with the revised Cambridge Reference Sequence(rCRS).Mutations in the D-Loop region of mtDNA in spermatozoa from asthenozoospermic patients were analyzed using chi-square tests.Results:There were 62 mutations occurring in>5%of the frequencies in both groups,most of which were in the HV-1 and HV-2 regions,and the mutation type consisted mainly of alternate mutations.Analysis revealed a significant difference(P<0.05)between asthenozoospermia and controls in 11 mutations,which might increase or reduce the risk of asthenozoospermia.Conclusion:The high rate of mutations in the mtDNA D-Loop region of spermatozoa may play an important role in the development and progression of asthenozoospermia,which has implications for clinical screening and diagnosis of asthenozoospermia.
Objective:To investigate the reproducibility of volume and mass measurements assessed by commercially available pulmonary nodule segmentation software and to compare intraobserver and interobserver differences.Methods:From June 1,2016 to December 31,2019,image data of 163 SSNs found in 117 patients who underwent chest CT examination in Hebei Provincial People's Hospital were retrospectively collected.The two-dimensional(2D)volume,three-dimensional(3D)volume and mass of the enrolled SSNs were measured with volumetric software by two radiologists.Bland-Altman method was used to compare intraobserver and interobserver variability,and Wilcoxon method was used to compare the variance between the two.Results:A total of 163 SSNs were included.The intra-observer correlation coefficient of 3D mass and volume measurement variability was 0.999 and the interobserver correlation coefficient of 3D mass and volume measurement variability was 0.999.As for two-dimensional volume measurement,intraobserver and interobserver variability ranged from-25.1%to 24.6%and from-32.0%to 30.3%respectively,in contrast to the range from-16.7%to 13.7%and from-15.0%to 13.5%,respectively,for the three-dimensional volume measurement.As for the three-dimensional mass measurement,the intrao-bserver and interobserver variability ranged from-7.8%to 8.2%and from-11.0%to 9.7%,respectively.No significant difference was found for intra-observer and interobserver variability between 3D volume and mass measurements(P>0.05).Conclusion:The commercially available semi-automatic pulmonary nodule segmentation software has good repeatability in the quality measurement of SSNs,which can be used as a quantitative assessment method for the follow-up growth of SSNs.
Objective:To observe the short-wavelength fundus autofluorescence(SW-FAF)and near-infrared fundus autofluorescence(NIR-FAF)image characteristics of flat irregular pigment epithelial detachment(FIPED)in central serous chorioretinopathy(CSCR).Methods:A total of 38 eyes from 38 patients diagnosed with chronic or recurrent CSCR with FIPED at the Department of Retinal,Wenzhou Medical University Eye Hospital,between March 2020 and March 2021,were included for the retrospective study.SW-FAF,NIR-FAF,and other multimodal imaging examinations were performed using the Heidelberg Spectralis HRA+OCT system to analyze the FAF characteristics of FIPED.Results:Of 38 eyes with chronic or recurrent CSCR,20 eyes had vascularized FIPED and 18 eyes had non-vascularized FIPED.Vascularized FIPED showed punctate hypoautofluoresence(65%,13/20),mixed hypoautofluoresence(20%,4/20),and punctate mixed autofluorescence(15%,3/20)on SW-FAF.Non-vascularized FIPED exhibited punctate mixed autofluorescence(55.6%,10/18),punctate hypoautofluoresence(38.9%,7/18),and mixed hypoautofluoresence(5.6%,1/18)on SW-FAF.Vascularized FIPED showed fused with punctate hypoautofluoresence(80%,16/20)and patchy mixed autofluorescence(20%,4/20)on NIR-FAF.Non-vascularized FIPED demonstrated patchy mixed autofluorescence(83.3%,15/18)and patchy hypoautofluoresence(16.7%,3/18)on NIR-FAF.Conclusion:Vascularized and non-vascularized FIPED in patients with chronic or recurrent CSCR exhibit characteristic SW-FAF and NIR-FAF changes,which can guide treatment and follow-up.
虹膜囊肿分为原发性和继发性,是一种相对少见的疾病[1-2].原发性虹膜囊肿包括后色素上皮囊肿、虹膜间质囊肿和浮动囊肿[3].继发性虹膜囊肿多见于外伤或眼内手术术后植入[4].临床上根据囊肿的外形及其病理特点将植入性虹膜囊肿分为:浆液囊肿及珍珠样囊肿这两种类型[4].
Objective:To investigate and elucidate the impact of a collaborative multidisciplinary care model on acute ischemic stroke caregivers.Methods:Using the random number table method,a total of 119 pairs of patients with acute ischemic stroke and their caregivers who were hospitalized in Lishui Central Hospital from December 2019 to May 2023 were selected and divided as the multidisciplinary collaborative care group(n=62)by an evidence-based multidisciplinary collaborative nursing model and the control group(n=57)by a conventional nursing care model.At the time of 3 months after discharge,the Zarit caregiver burden interview(ZBI),self-rating depression scale(SDS),and the Mos 36-item short form health survey(SF-36)were used to evaluate,with analysis made,the impact of two different nursing modes on the care burden,depression level and life quality of caregivers.Results:The scores of Zarit caregiver burden scale and self-rating depression scale of both groups of caregivers decreased three months after discharge(P<0.001).The scores of Zarit caregiver burden scale in the multidisciplinary collaborative care group were significantly lower than those of the caregivers in the control group(P<0.001),and the proportion of caregivers with moderate or greater care burden was lower(χ2=16.384,P<0.001).The self-rating depression scale scores of the caregivers in the multidisciplinary collaborative care group were significantly lower than those of the caregivers in the control group(P<0.001),and the proportion of caregivers classified as depressed was significantly lower(χ2=4.449,P=0.035).The life quality scores of caregivers in both groups improved,and the total physical and mental health scores of caregivers in the multidisciplinary collaborative care group were significantly higher than those in the control group(all P<0.001).Conclusion:The evidence-based multidisciplinary collaborative nursing model is helpful for the acute ischemic stroke caregivers by reducing their care burden,making them psychologically stronger and enhancing their quality of life,therefore,it merits clinical implementation and promotion.
In response to the continuous increase in the number of basic medical teachers with non-clinical medical background in medical colleges,this paper proposes a series of effective ways to systematically reshape the medical knowledge of basic medical teachers with non-clinical medical background based on an analysis of the current professional background of basic medical teachers in Wenzhou Medical University,so as to improve the post competency by avoiding the disconnection between basic medical education and clinical practice.The effective ways Include the formulation of teacher training program with clear training objectives;the implementation of the tutor training system to improve professional quality in the form of"mentoring";the customization of the curriculum with core medical course for the systematic learning of medical knowledge;the determination of the core knowledge points of the course for sake of early integration with the clinical practice.
Fibroblast growth factor 21(FGF21)is an atypical member of the fibroblast growth factor(FGF)superfamily and is secreted into blood to act mainly in target tissues,including brain,liver,adipose tissue,skeletal muscle and pancreas islet via a heterodimeric receptor complex comprising fibroblast growth factor receptor(FGFR1)and coreceptor β-Klotho.Previous studies suggest that FGF21 can decrease blood glucose levels and body weight.Targeting FGF21 has emerged as an option for nonalcoholic steatohepatitis(NASH)therapy.The current clinical trials indicate that FGF21 has the potential for the treatment of nonalcoholic steatohepatitis.However,the effect of FGF21 analog on liver histology,clinical outcome and safety needs to be further verified with a larger number of patients.This review summarizes the mechanism and recent development of FGF21 functions in metabolic diseases and related clinical drug research advances,which might provide a suitable reference for clinical management.
Objective:To analyze the coagulation index and genotype of two patient with hereditary coagulation Factor V(FV)deficiency by compound heterozygous mutations and their family members,and to explore their molecular pathogenesis.Methods:The blood coagulation indexes such as Plasma FV activity(FV:C)and FV antigen(FV:Ag)in the peripheral blood of each family member were measured by the one-stage clotting method.All exons and their flanking regions of the F5 gene were amplified by PCR and then sequenced.The impact of mutations on protein function was analyzed by Bioinformatics software.The spatial structure changes of FV proteins were analyzed by PyMOL software before and after mutations.The function of the mutant protein was analyzed by the Calibrated automated thrombogram.Results:Phenotypic testing showed that both probands had a decrease in FV:C and FV:Ag simultaneously,manifesting as type I of the FV deficiency.Genetic analysis showed that the proband A had c.332G>T heterozygous missense mutation(p.Ser111Ile)in exon 3 and c.6665A>G heterozygous polymorphism(p.Arg2222Gly)in exon 25;the proband B had c.286G>C heterozygous missense mutation(p.Asp96His)in exon 3 and c.2393-2393delC heterozygous deletion mutation(p.Pro798Leufs*13)in exon 13.Bioinformatics analysis showed the p.Ser111Ile mutation and the p.Pro798Leufs*13 mutation were pathogenic mutations.Protein model analysis showed that p.Ser111Ile mutation could affect the structure of hydrogen bonds between amino acids.The truncated protein were produced by a p.Pro798Leufs*13 mutation.The thrombin generation test showed that the clotting function of proband A and B had been affected.Conclusion:These four mutations may be responsible for the reduction of FV level in two families.Moreover,the p.Ser111Ile mutation is a rarely reported.
Objective:To investigate the expression of microRNA-152-3p(miR-152-3p)in colon cancer(CC)and its effect of targeting Krüppel-like factor 4(KLF4)on proliferation,migration and invasion of CC cells.Methods:The targeting relationship between miR-152-3p and KLF4 was predicted by starBase and TCGA database analysis,as well as the difference in their respective expression in normal and CC tissues.Dual luciferase and RIP experiments verified the targeting relationship between miR-152-3p and KLF4.The mRNA expression of miR-152-3p and KLF4 in CC cell lines was measured by RT-qPCR;the protein expression of KLF4 in CC cell lines was measured by Western blot;the proliferation ability of cells was examined by MTT;the migration ability of cells was examined by scratch healing assay;the invasion ability of cells was examined by Transwell assay;the cell cycle distribution and apoptosis percentage of cells were examined by cell cycle assay and apoptosis assay.Results:miR-152-3p was highly expressed in CC tissues and cell lines(P<0.001),while KLF4 was lowly expressed(P<0.01).miR-152-3p was able to target and downregulate KLF4 expression(P<0.01).miR-152-3p overexpression increased the proliferation,migration and invasion ability of CC cell lines,as well as cell cycle distribution in S and G2/M phases,and inhibited their apoptosis;KLF4 overexpression decreased the proliferation,migration and invasion ability of CC cell lines,contributing to cell cycle retention in G0/G1 phase,and accelerated apoptosis(P<0.05).The up-regulation of KLF4 expression inhibited the promotion of miR-152-3p on the proliferation,migration and invasion of CC cells(P<0.05),increased the proportion of cells in G0/G1 phase(P<0.05),and promoted apoptosis(P<0.05).Conclusion:miR-152-3p promotes proliferation,migration and invasion of CC cells by targeting down-regulation of KLF4 expression.
Objective:To explore the differentiation factors related to the synchronous multiple colorectal carcinoma(SMCRC)and single colorectal carcinoma(CRC),and to construct a nomogram prediction model.Methods:The clinical data of 42 patients with SMCRC and 120 patients with single CRC who underwent surgery in Ningbo Medical Center Lihuili Hospital from January 2016 to December 2021 were retrospectively collected.Univariate analysis and multivariate Logistic regression were used to analyze the differentiation factors related to the SMCRC and single CRC,based on which a nomogram prediction model was constructed.The predictive efficiency of the model was analyzed by ROC curve and calibration curve.Results:Univariate analysis showed that sex,adenomatous polyp,hypertension,serum carcinoembryonic antigen level,albumin content,and hemoglobin content were statistically difference between the two groups(P<0.05).Multivariate Logistic regression analysis showed that male(OR=3.108,95%CI=1.113-8.682),adenomatous polyp(OR=2.941,95%CI=1.036-8.346),hypertension(OR=3.202,95%CI=1.128-9.088),and hemoglobin≤120 g/L(OR=3.868,95%CI=1.095-13.671)were independent predictors for distinguishing the occurrence of SMCRC from single CRC(P<0.05).The area under the ROC curve was 0.743(95%CI=0.630-0.856).The sensitivity was 75%and the specificity was 68%.The calibration curve showed that the three curves fit well,indicating that the model had good consistency and accuracy.Conclusion:In this study,the identification factors related to SMCRC and single CRC has been analyzed and a nomogram prediction model constructed to accurately assess the risk of SMCRC,which provides a basis for early clinical identification of SMCRC.
China has stepped into the"14th Five-Year Plan"period of high-quality development.By April 2023,nearly 490 biopharmaceutical enterprises have been listed in China's A-share market,with a total market value of approximately 7.29 trillion yuan.Considered as an emerging industry of strategic significance in the 14th Five-Year Plan,biopharmaceutical industry is expected to become an important support for the public healthcare in the future.At present,Zhejiang Province,compared with other regions in China,has stronger pharmaceutical innovation capacity.However,some deficiencies were found in the aspects of collaborative development and model innovation.This research,combining the practical and empirical research paradigm proceeded from the reality,will share literature analysis,theoretical analysis and empirical analysis,by which we mean to provide suggestions for building a modern pharmaceutical collaborative innovation system that would be able to realize self-generating and virtuous cycle development,with a view to promoting the coordinated development of biopharmaceutical industry-university-research.
发生于肺部的孤立性纤维瘤(solitary fibrous tumor,SFT)大多与胸膜关系密切,局限于肺叶内者非常少见.笔者报道1例局限于肺内的SFT影像表现.患者为35岁女性,体检意外发现左肺上叶肿块,病灶形态较为光整,密度均匀,增强扫描呈轻度持续性强化,周围可见"贴边血管征".患者接受胸腔镜下左肺上叶切除术,病理为SFT.
目的:探讨老年早期结直肠癌和高级别上皮内瘤变(HGIN)患者接受内镜黏膜下剥离术(ESD)治疗的安全性和有效性.方法:收集2021年1月至2021年12月在温州医科大学附属第一医院接受ESD治疗的157例早期大肠癌和HGIN患者.根据年龄分为老年组(≥ 60岁,91例)和中青年组(18～59岁,66例).比较老年组和中青年组患者的一般情况、病灶特点、手术情况、术后并发症等.结果:成功完成ESD术者156例,切除失败1例,后转外科.老年组病灶最大径为[2.5(1.7,3.5)cm],中青年组病灶最大径平均为[2.0(1.5,2.6)cm],差异有统计学意义(P＜0.05).老年组病变特别好发于直肠,与中青年组比较差异有统计学意义(P＜0.05).老年组术后并发症发生率高于中青年组,差异有统计学意义(P＜0.05).两组整块切除率、完整切除率、复发率差异无统计学意义(P＞0.05).结论:对于老年患者早期结直肠癌和HGIN的治疗,ESD是安全有效的方法;老年患者病灶较大,术后并发症较多,需多加重视.
目的:探讨胸部CT扫描下胸椎截面的骨骼肌指数(SMI)诊断肌肉减少症(肌少症)的可行性,并与常规诊断肌少症的腹部CT下第三腰椎截面(L3)的SMI进行比较,分析这些指标对于胃癌患者术后生存的影响.方法:选取2014年7月至2019年3月在温州医科大学附属第一医院接受胃癌根治术的1 096例胃癌患者.在横断面CT图像上测量第十二胸椎(T12)和L3水平的骨骼肌面积(SMA),计算两个水平所对应的SMI和T12水平诊断肌少症所对应的骨骼肌截断值.分析两个水平的CT图像参数的相关性和两个水平下诊断的肌少症对于胃癌术后生存的预测价值.结果:男性胃癌患者诊断肌少症的T12水平SMI(SMI-T12)的截断值为29.2 cm2/m2,女性为25.3 cm2/m2.男性截断值对应的灵敏度、特异度、曲线下面积分别为79.3％、77.0％和0.858,女性为71.0％、61.8％和0.737.所有胃癌患者中,T12水平下诊断为肌少症[肌少症-T12(+)]有167例(15.2％),L3水平下诊断为肌少症[肌少症-L3(+)]有154例(14.1％),两者检出率差异无统计学意义(P=0.188).COX回归分析结果表明,肌少症-T12(+)是影响总生存时间的独立危险因素(HR=1.502,95％CI=1.159～1.948,P=0.002).多元线性回归分析结果表明,肌少症-T12(+)和肌少症-L3(+)都与术后住院时间延长显著相关(P=0.002,P-0.020).结论:T12截面下的SMI可用于肌少症的诊断,其诊断的肌少症是胃癌患者术后生存的独立危险因素.
目的:探讨胃癌细胞中靶向复制蛋白A1(RPA1)基因的miRNA对肿瘤恶性生物学行为的影响及其机制.方法:采用生物信息学分析法比较癌与癌旁组织中RPA1基因的表达及其与胃癌患者预后的相关性;采用RNA pulldown法在胃癌细胞(SGC-7901)中检测靶向RPA1基因3'UTR区的miRNA;构建miR-145高表达的胃癌SGC-7901细胞,采用MTT法检测细胞增殖情况,采用流式细胞术分析细胞周期时相;采用双荧光素酶实验验证miR-145与RPA1的靶向关系,Western blot法进一步证实miR-145和RPA1的靶向关系.结果:相比于癌旁组织,RPA1基因在胃癌组织中表达显著上调(P＜0.05),并且RPA1基因在胃癌组织中的高表达与患者更差的预后相关.RNA pulldown回收并检测胃癌细胞SGC-7901中靶向RPA1基因3'UTR区的miRNA,结果发现miR-145和RPA1基因3'UTR区的结合最高.荧光素酶报告基因实验结果显示,miR-145组荧光素酶活性相比于对照miRNA组显著降低(P＜0.05);Western blot检测结果显示,与转染对照miRNA组比较,miR-145组RPA1表达显著下降(P＜0.05).MTT结果显示miR-145组胃癌细胞增殖能力较对照miRNA组低(P＜0.05);流式细胞术检测结果显示miR-45组胃癌细胞G2/M期阻滞增加(P＜0.05).结论:miR-145高表达可显著抑制胃癌细胞的增殖,这一作用可能与下调RPA1表达,阻滞细胞周期有关.
目的:研究中线蛋白2(MID2)在胃癌中的表达水平及对胃癌患者预后的影响,探讨MID2表达对胃癌细胞生物学表型的影响.方法:收集2014年1月至2016年12月温州医科大学附属第一医院胃癌根治术后患者组织标本420例,联合TCGA数据库评估MID2在胃癌组织中的表达情况及对胃癌患者预后的影响.构建靶向MID2基因的过表达质粒和小干扰RNA(siRNA),转染胃癌细胞后通过CCK-8实验评估胃癌细胞的增殖能力,Transwell实验评估胃癌细胞的迁移与侵袭能力.结果:MID2表达水平在胃癌组织中上调(P＜0.05);MID2高表达预示着胃癌患者较短的总体生存期(P=0.002)、无病生存期(P=0.002)、无进展生存期(P=0.003).上调MID2的表达可以显著促进胃癌细胞BGC-823和SGC-7901的增殖和迁移、侵袭能力(P＜0.05);敲低MID2能够显著抑制胃癌细胞MGC-803的增殖和迁移、侵袭能力(P＜0.05).结论:MID2在胃癌组织中表达上调,MID2高表达与胃癌患者较差的预后相关,上调MID2的表达可以显著促进胃癌细胞恶性表型.
目的:研究甲基转移酶样因子3(METTL3)在结肠癌患者中的表达特征及其与临床预后相关性,并探讨METTL3表达对结肠癌细胞不同生物学表型的影响.方法:综合分析癌症基因组图谱计划(TCGA)数据库和4个不同来源的基因表达数据库(GE0)数据集中1 278例结肠癌组织和41例癌旁组织中METTL3基因的表达差异;使用Kaplan-Meier曲线分析METTL3表达高低对患者预后的影响.回顾性收集2014-2018年温州医科大学附属第一医院行根治性手术的481例结肠癌组织和59例癌旁组织,使用免疫组化法检测METTL3蛋白的表达差异.采用小干扰RNA(siRNA)分别敲低结肠癌细胞系DLD-1和HCT-116中METTL3的表达水平;采用CCK-8法和Transwell法检测METTL3表达对结肠癌细胞系不同恶性表型的影响.结果:在TCGA数据库和本中心结肠癌组织标本中,METTL3在肠癌组织中的表达均升高(P＜0.001).生存分析结果显示,METTL3高表达与结肠癌患者较短的总生存期(Log-rank P=0.028)和无病生存期(Log-rank P=0.035)相关.单因素和多因素Cox分析结果显示,METTL3可以作为结肠癌患者预后的独立危险因素(HR=1.335,95％CI=1.032～1.738,P=0.030).同时,敲低METTL3的表达可以显著抑制结肠癌细胞DLD-1和HCT-116的增殖(P＜0.01)和迁移侵袭能力(P＜0.01).结论:METTL3在结肠癌组织中表达上调,并可以作为结肠癌患者不良预后的独立因素.敲低METTL3表达可以抑制结肠癌细胞恶性表型.METTL3可能作为致癌基因参与结肠癌恶性进展.
