Objective To investigate the level and influencing factors of caregivers′burden among primary caregivers of elderly stroke patients. Methods Totally 298 caregivers of elderly stroke patients were investigated with Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS) and Simplified Coping Style Questionnaire(SCSQ). The patients were investigated with Modified Barthel Index (MBI). Results The caregivers′burden was in the mild level with a total score of 35.21±11.45. The influencing factors were the number of days of care, daily caring hours, hospital anxiety and depression score, the coping style and the ability of patients to perform ADL. Conclusions The primary caregivers of stroke patients have mild burden. The nurses should be synchronized to assess the health of patients and primary caregivers at the same time, understand the caregivers′burden, and provide specific care advice, in order to reduce the burden of their carer, so as to improve the quality of patients′life.

PurposeTo evaluate the feasibility of a low-dose contrast medium protocol for 64-slice spiral CT angiography (CTA) of cerebral and carotid using a low-tube-voltage setting, and to compare the display effect of cerebral and carotid arteries by low-tube-voltage low-dose contrast medium and routine-tube-voltage routine-dose contrast medium scanning, and to assess the effect on radiation dose.Materials and MethodsEighty consecutive patients were prospectively selected to perform cerebral and carotid CTA inspection. The patients were randomly divided into control group and low dose group with 40 people in each group. The voltage in control group was 120 kV and the contrast agent was 80 ml; those in low dose group were 80 kV and 50 ml, respectively. The artery image quality was evaluated and venous interference was scored. The CT value, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and radiation dose in both groups were statistically analyzed.Results The consistency of uniform in artery image quality score and venous interference score was rather high according to the assessment of two physicians (Kappa=0.782 and 0.867). There was no statistical difference in artery image quality score, venous interference score, SNR and CNR between the two groups (Z=-0.864--0.032,P>0.05). The CT value in low dose group was higher than that in control group (differences with statistical significance,t=-8.789-1.715,P<0.05). The CT dose index of volume, dose-length product and effective dose in low dose group were all signiifcantly lower than those in control group (Z=-8.888,t=78.092 and 78.350, respectively,P<0.05).Conclusion The use of low tube voltage and low contrast dose in cerebral and carotid CTA examination can result in high quality images which meets the diagnostic needs and obviously reduce radiation dosage.

Objective To discuss the value of digital tomosynthesis for detection of pulmonary nodules. Methods Thirty patients suspected of having pulmonary nodules underwent chest radiography, digital tomosynthesis and CT examination. Above image data were transferred to postprocessing work station and were reviewed by 2 radiologists with 3 years of chest-radiology diagnosis experience in a double-blind method. The number, location and size of nodules were recorded. Then, 2 radiologists reviewed the all images once more, and discuss in consensus. The sensitivities of chest radiography and digital tomosynthesis for detection of pulmonary nodules were respectively calculated according to the CT results. Chi-square test was used for radiography, digital tomosynthesis and CT examination. Results Of 30 patients, 21 were detected having pulmonary nodules by X-ray radiography and 9 were negative, the total number of 40 nodules was detected, while 89 nodules in 26 patients were detected by digital tomosynthesis, and only 4 patients were negative. CT demonstrated 102 nodules in 27 patients, and 3 patients were negative. Taking CT as "gold standard", the sensitivities of X-ray radiography and digital tomosynthesis were 27.4%(28/102)and 87.2%(89/102), X~2=4.35, P<0.05, respectively. Conclusion Digital tomosynthesis has a high sensitivity for detection of pulmonary nodules compared with X-ray radiography, and could be an excellent and necessary supplementary technique of X-ray radiography.

Objective To explore the long-term outcomes and complications of patients with hematological malignancies (HM) after haploidentical donor transplantation (HDT) or siblingidentical donor transplantation (SDT).Methods From June,2011 to July,2016,89 patients with HM receiving allo-HSCT were retrospectively analyzed,including 57 patients undergoing HDT and 32 cases undergoing SDT.Results The median time to achieve neutrophil engraftment was 2 days shorter after HDT than SDT,whereas that of platelet engraftment was 3 days longer after HDT than SDT.The cumulative incidence for 3 to 4 grade acute graft-versus-host disease (GVHD) was not obviously different between HDT and SDT (8.77％ versus 12.5％ respectively;x2 =0.313,P =0.576).The cumulative incidence for chronic GVHD was not significantly different between HDT and SDT (45.6％ versus 37.5％;~ =0.551,P =0.458).Cytomegalovirus (CMV) reactivity was significantly higher in patients after HDT (77.19％) than those after SDT (21.88％) (x2 =25.633,P＜0.001).The occurrence of hemorrhagic cystitis was also obviously higher in patients after HDT (26.32％)than those after SDT (3.85％) (x2 =5.340,P =0.021).The 1-,2-,and 3-year relapse-free survival rate of patients receiving HDT and SDT was 63.9％,55.4％,44.3％ and 71.2％,58.3％,51.8％,respectively (P =0.541).The 1-,2-,and 3-year overall survival rate of patients receiving HDT and SDT was 75.3％,65.3％,52.3％ and 76.9％,62.9％,62.9％,respectively (P =0.777).Conclusion Considering similar incidence of severe GVHD and long-term outcomes,haploidentical donors should be recommended as a potential alternative donor source when an identical donor is lacking for patients with HM.

Objective: To investigate clinical and histopathological features of subcutaneous sarcoidosis. Methods: A retrospective analysis was performed. Clinical and pathological data were collected from 8 patients diagnosed with subcutaneous sarcoidosis in Hospital for Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College between 2012 and 2018, and analyzed retrospectively. Results: Out of the 8 patients, 1 was male and 7 were female, with an average onset age of 50.5 years. The main skin manifestations were multiple painless skin-colored subcutaneous nodules, with no history of trauma or ulceration. Other skin lesions included erythema in 1 case and dark-purple plaques in 1 case. Lung involvement was detected in 6 cases, and no other systems were involved. Histopathological findings were mainly non-caseating granulomas in the subcutaneous tissue with negative acid-fast staining. Of the 8 patients, 7 received short-term oral glucocorticoid treatment and achieved remission or subsidence of lesions, 1 patient was lost to follow-up. Conclusions Subcutaneous sarcoidosis initially manifests as painless skin-colored subcutaneous nodules, which can be complicated by erythema, plaques and so on. Histopathological findings are characterized by non-caseating granulomas. Chronic and mild systemic involvement, especially lung involvement, is common in patients with subcutaneous sarcoidosis, and the prognosis is quite favorable.

Objective To study the mechanism of ferulic acid(FA)on hepatic fibrosis(HF)based on network pharmacology,and establish an in vitro model of rat hepatic stellate Cell-T6(HSC-T6)according to the results.Methods The potential targets of FA were screened through PubChem,swisstargetprediction and pharmmapper,and overlapped with the FA targets screened in disgenet,genecards and OMIM.Then,protein protein interaction(PPI)was analyzed by using string platform.Gene ontology(go)and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis were carried out for key targets by using R64 4.0.3,and the"component target disease"network diagram was constructed by Cytoscape 3.7.2 software.Based on this,the proliferation of HSC-T6 was detected by cell counting kit-8(CCK-8)method,and the grouping was determined:blank group and low-dose group(100 μg·mL-1 FA),medium dose group(200 μg·mL-1 FA),high dose group(400 μg·mL-1 FA)and positive control group(200 μg·mL-1 colchicine),the migration ability of HSC-T6 was detected by scratch test,and the content of HSC-T6 was detected by enzyme linked immunosorbent assay(ELISA)α-Alpha smooth muscle actin,α-Flow cytometry was used to detect the changes of HSC-T6 cycle,quantitative real time polymerase chain reaction(qRT-PCR)was used to detect the relative expression of JAK2 and STAT3 mRNA,and Western Blot was used to detect the molecular expression of JAK2 and STAT3 protein.Results 254 intersection targets of FA and HF were obtained.The core targets were signal transducer and activvator of Transcription(STAT3),albumin(ALB),protein kinase B(AKT1),tumor suppressor protein p53(TP53),epidermal growth factor receptor(EGFR)and caspase-3(CASP3).KEGG analysis showed that the action pathway of FA on HF mainly involved phosphatidylinositol 3 kinase protein kinase B(PI3K-Akt),vascular endothelial growth factor(VEGF),Janus kinase/signal transducer and activator of transcription(JAK/STAT)Tumor necrosis factor(TNF)and other pathways.The experimental results showed that in CCK-8 experiment,scratch experiment and ELISA experiment,compared with the blank group,the cell proliferation rate,migration ability and the expression of α-SMA protein decreased significantly(P<0.05).Compared with the blank group,the cycle arrest rate of low,medium and high dose groups and positive control group increased significantly(P<0.05).Compared with the blank group,the molecular weight and mRNA expression of JAK2 and STAT3 protein in low,medium and high dose groups and positive control group decreased gradually(P<0.05).Conclusion FA has the characteristics of multi-channel and multi-target.FA may inhibit the apoptosis of hepatic stellate cell(HSC)by down regulating JAK2 and STAT3 targets.

COVID-19 is a new type of respiratory infectious disease. Currently, the epidemic is spreading across China and in some countries outside China. However, healthcare workers on the clinical frontline is not fully aware of this new type of disease. Therefore, practical and feasible training programs shall be developed by combining effective training forms and complete curriculum based on the actual situation to train medical personnel at all levels. The authors work together with expert teams combating the epidemic in Beijing and even the whole country to formulate this expert consensus, with a view to providing a practical solution for the development of operating room-related training during epidemic prevention and control, so that scientific and reasonable curriculum settings can be made available and training can proceed orderly.

Objective:To investigate clinical and histopathological features of mucinous nevi.Methods:Clinical and pathological data were collected from 10 patients with clinically and histopathologically confirmed mucinous nevi in Hospital of Dermatology, Chinese Academy of Medical Sciences from January 2014 to December 2019, and retrospectively analyzed.Results:All cases developed mucinous nevi in childhood, with an average age of onset being 6.5 years. Of the 10 patients, 7 had lesions on the trunk, among whom 4 had lesions on the back; the remaining 2 had lesions on the limbs, and 1 had generalized lesions on the trunk and limbs. The skin lesions were locally arranged in lines, bands or clusters, and skin-colored, reddish or yellow in color, with the texture varying from soft to hard. Histopathological examination showed that 10 patients presented with disordered arrangement of collagen fiber bundles in the dermis and mucin deposition at varying locations and to different degrees among them, 6 with thickened and red-stained collagen fibers in the deposition area, and the remaining 4 with sparse and decreased collagen; focal liquefaction degeneration of the basal layer was observed in 2 cases, and different amounts of mature adipose tissue in the dermis were seen in 3 cases.Conclusions:Mucinous nevus pathologically manifests as mucin deposition of varying degrees among disorderedly arrangd collagen fiber bundles in the dermis, which is similar to some other diseases, and is easily misdiagnosed. Close combination of clinical and pathological features facilitates confirmed diagnosis.

Connective tissue nevi (CTN) , a kind of benign skin hamartomas, can be classified into 3 types according to the excessive components predominating in skin lesions, including collagen type, elastin type and proteoglycan type, and each type of CTN includes various inherited and acquired diseases. Therefore, genetic, clinical, and histopathological features should be considered for the confirmation of diagnosis of CTN and its subtypes. According to the latest Chinese and international literature, this review elaborates clinical classification and histopathological characteristics of CTN, aiming to further strengthen the understanding of this disease.

Objective:This investigation aims to assess the impact of CSF3R mutations and the presence of measurable residual disease (MRD) on the prognosis of patients with CEBPA double mutations who have acute myeloid leukemia (AML) .Methods:The prognostic significance of these two factors was examined in the present study, which included 66 patients with complete genetic mutations and sequential MRD information.Results:Following the second course of chemotherapy, the MRD status and CSF3R mutations of these patients were linked to their long-term prognosis. CSF3R mutated patients showed inferior relapse-free survival (RFS) (5-year RFS: 15.2% vs 38.7% , P=0.006) and overall survival (OS) (5-year OS: 18.2% vs 60.6% , P=0.038) compared with those with wild-type CSF3R. After the second course of chemotherapy, patients with negative MRD had an RFS of 64 months and an OS of not reaching, which was significantly longer than that of patients with positive MRD (15 and 48 months, and the P value were 0.004 and 0.050, respectively) . CSF3R mutations ( HR=0.317, 95% CI 0.129-0.779, P=0.012) , WT1 mutations ( HR=0.304, 95% CI 0.115-0.804, P=0.016) , and NRAS mutations ( HR=0.153, 95% CI 0.061-0.385, P<0.001) were all independently associated with a poor prognosis for RFS, and CSF3R mutations and positive MRD tended to be independently associated with a poor prognosis for OS, according to the results of a Cox proportional-hazards model analysis ( P values were 0.071 and 0.088, respectively) . The patients were divided into three groups based on their CSF3R mutation status and MRD status following treatment: wide-type CSF3R and negative MRD, mutated CSF3R or positive MRD, and mutated CSF3R and positive MRD, which showed significantly different RFS ( P<0.001) and OS ( P=0.006) . Conclusion:Both CSF3R mutations and positive MRD were associated with poor outcome in AML patients with CEBPA double mutations. An integrity model based on these two factors may be beneficial for accurately evaluating the prognosis of these patients.