Objective:To investigate and analyze the cognition onthe third-party mediation among medical staff in a tertiary general hospital of Nanjing,and thus to put forward rational suggestions.Method:A questionnaire survey was conducted among 200 doctors from a tertiary general hospital.Chi-square test and non-parametric test were used to analyze the data.Results:Totally 57.5％ of doctors thought the doctor-patient relationship was tense,78.5％ of doctors to some extent had understood the third-party mediation,91.5％ of doctors thoughtthe third-party mediation played a different role in dealing the medical disputes,71.0％ of doctors had heard of medical liability insurance,and 89.5％ of doctors thought it necessary to purchase the medical liability insurance.Conclusions:Doctors gradually accept the third-party mediation,but as a new thing,the main bodies at all levels should publicize the third-party mediation so as to give full play to the role of it.

Objective Currently,the sit-to-stand process is not well evaluated.The aim of the study is to evaluate quantitatively the reliability of posturographic parameters in the sit-to-stand process.Methods Seventy-four healthy participants were enrolled and required to finish 20-second sitting,standing and the sit-to-stand process.The computer calculated the posturographic parameters automatically.The test was repeated twice to assess the reliability at an interval of six days.Results During sitting and standing position,the intraclass correlation coefficients (ICCs) of all the parameters were above 0.50,indicating a good or fair reliability.During the standing stance and sitting phase of the sit-to-stand process,the ICCs of all the parameters were above 0.40 and 0.60 respectively,showing a good or fair reliability.Conclusions Sit-to-stand posturographic parameters are a new way to assess the position control ability among the healthy participants with a good reliability.Further study should be conducted among patients to result in better functional and effectiveness evaluation.

Objective To study CT-guided localization of additional pulmonary nodules with microcoils prior to video-assisted thoracoscopic surgery (VATS) resection in patients with suspected lung cancer.Methods Eleven patients suspected lung cancer underwent preoperative microcoils localization towards additional small pulmonary nodules.The head of microcoil was pinpointed adjacent to the target nodule while its end tail remained above the visceral pleura.VATS were performed within 24 hours, and comprehensive assessments were conducted according to surgical and pathological outcomes of primary and additional lesions, and suitable surgical processes were followed.Results All 11 localizing pulmonary nodules (4-15 mm in diameter) were successfully removed after VATS, 9 microcoils'' end tails of which were placed above visceral pleural surface.There were no serious complications related with localizing procedure.Other 16 lesions including 11 primary ones were resected.The surgical and pathological outcomes for lung lesions were utterly assessed.Conclusion Microcoil preoperative localization provides helpful orientation for complete resection and assessment of multiple pulmonary lesions in patients with suspected lung cancer.

Objective To study the clinical manifestations,endoscopic features,pathological features,treatment and prognosis of patients with duodenal neuroendocrine carcinoma (DNEC).Methods The clinical data of 9 patients with duodenal neuroendocrine carcinoma who were admitted to our hospital from December 2006 to December 2014 were retrospectively analyzed.Results There were 6 males and 3 females.The mean age was 61.5 years (range 48 ～75 years).The clinical manifestations were abdominal pain (n =7),jaundice (n =4),melena (n =1) and asymptomatic (n =1).The DNEC was usually solitary in the duodenum.The operations included duodenopancreatectomy (n =5),surgical resection (n =2),subtotal gastrectomy (n =1),and 1 patient was palliated by common bile duct stenting using an endoscopic retrograde cholangio-pancreatographic (ERCP) approach.The patients were followed up for 3 ～ 40 months after operation.For the 5 patients who underwent radical excision 4 were alive.One patient died from liver metastasis.For the 4 patients who underwent palliative therapy,one was alive,two died and one lost to follow-up.Conclusions The clinical manifestations of duodenal neuroendocrine carcinoma were non-specific.Endoscopic,pathologic and immumohisotochemical tests were important in the diagnosis.Surgical resection improved the prognosis of these patients.

Studies of cellular dynamic processes have shown that cells undergo state changes during dynamic processes, controlled mainly by the expression of genes within the cell. With the development of high-throughput sequencing technologies, the availability of large amounts of gene expression data enables the acquisition of true gene expression information of cells at the single-cell level. However, most existing research methods require the use of information beyond gene expression, thus introducing additional complexity and uncertainty. In addition, the prevalence of dropout events hampers the study of cellular dynamics. To this end, we propose an approach named gene interaction network entropy (GINE) to quantify the state of cell differentiation as a means of studying cellular dynamics. Specifically, by constructing a cell-specific network based on the association between genes through the stability of the network, and defining the GINE, the unstable gene expression data is converted into a relatively stable GINE. This method has no additional complexity or uncertainty, and at the same time circumvents the effects of dropout events to a certain extent, allowing for a more reliable characterization of biological processes such as cell fate. This method was applied to study two single-cell RNA-seq datasets, head and neck squamous cell carcinoma and chronic myeloid leukaemia. The GINE method not only effectively distinguishes malignant cells from benign cells and differentiates between different periods of differentiation, but also effectively reflects the disease efficacy process, demonstrating the potential of using GINE to study cellular dynamics. The method aims to explore the dynamic information at the level of single cell disorganization and thus to study the dynamics of biological system processes. The results of this study may provide scientific recommendations for research on cell differentiation, tracking cancer development, and the process of disease response to drugs.
Cell Differentiation/genetics* ; Entropy ; Gene Regulatory Networks ; High-Throughput Nucleotide Sequencing ; Single-Cell Analysis/methods*

Objective:To survey the teaching ability of general practitioners(GPs) in community health centers of Shanghai, and its influencing factors.Methods:A questionnaire survey on the teaching ability of general practice trainers was conducted from January to February 2017. The participants of the survey were GPs with teaching experiences from community health centers in Shanghai selected by a stratified and proportional cluster sampling method. The questionnaire included two aspects: the general information and teaching ability of the participants. The influencing factors of teaching ability were analyzed by univariate and multivariate regression analysis.Results:A total of 1 138 GPs from 116 selected community health centers participated in the questionnaire survey, among whom 63.6% (724/1 138) worked in community teaching bases and 78.5% (893/1 138) had received training for trainers. The total score of teaching ability was 38.00 (30.00, 40.00). The score of the item"interesting in teaching"was (3.46±0.80), 75%—80% of the other questions answered "yes". The score of"application of multi-teaching methods"was (3.78±0.72). Multivariate analyses showed that working for 5—9 and 10—19 years [ OR=7.14 (2.47—11.81), P=0.003; OR=5.32 (1.30—9.33), P=0.009], working in community teaching bases [ OR=13.23 (9.88—16.57), P<0.001] and receiving training for trainers [ OR=17.76 (13.80—21.71), P<0.001] were influencing factors of teaching ability. Conclusion:The main problems related to teaching ability in community GPs are lack of teaching interest and the poor application of multi-teaching methods, the relevant training is necessary for them in the future.

ObjectiveTo observe the effect of wrist-hand orthosis combined with modified constraint-induced movement therapy (mCIMT) on upper limb and hand function in patients with stroke. MethodsFrom February, 2022 to December, 2023, 32 patients after stroke in Huashan Hospital, Fudan University were randomly assigned to control group (n = 16) and experimental group (n = 16). Both groups underwent routine rehabilitation, and wore constraint glove almost four hours a day. The experimenal group wore dynamic wrist-hand orthosis four hours everyday, additionally; five days every week, for three weeks. They were evaluated with Wolf Motor Function Test (WMFT), Action Reach Arm Test (ARAT), the strength of gripping, Amount of Use (AOU) and Quality of Movement (QOM) of Motor Activity Log (MAL), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before and after treatment, while root mean square ratio of affected/healthy extensor muscle of wrist was measured with surface electromyography ResultsAfter treatment, the scores of WMFT, ARAT, MAL-QOM, HAMA and the root mean square ratio of affected/healthy extensor muscle of wrist improved in both groups (|t| > 2.179, P < 0.05), and the improvement of WMFT score and the strength of gripping was greater in the experimental group than in the control group (|t| > 2.343, P < 0.05); the strength of gripping, the scores of MAL-AOU and HAMD improved in the experimental group (|t| > 2.819, P < 0.05). ConclusionmCIMT assisted with dynamic wrist-hand orthosis could improve upper limb and hand function in stroke patients.

Objective In the recovery process of stroke patients, the ability of maintaining standing and sitting position might have a great effect on the improvement of activity of daily living. There are few the methods which evaluate quantitatively and effectively the ability of position control ability in clinical practice. The aim of the study is to quantitatively evaluate the reliability of posturographic parameters based on the center of pelvis in different standing positions and walking activity.Methods From May to June, 2018, Seventy-nine healthy participants were enrolled. They were evaluated with iReGo, a walking assisstant robot, in three conditions: normal standing position, left/right standing position and walking 10 meters at an appropriate speed. The computer calculated the posturographic parameters automatically. The participants completed their second test one day after the first one.Results During normal standing position, the intra-class correlation coefficients (ICC) of average sway in coronal plane, average sway in sagittal plane, path length, and covered area were more than 0.70. During left standing position, ICC of all the above parameters were more than 0.70. During right standing position, ICC of all the above parameters were more than 0.49. When walking 10 meters at an appropriate speed, ICC of path length and covered area were more than 0.75. Comparing different standing positions, the normal standing position was more stable than the left/right standing position, and there was no difference between the left and the right standing positions.Conclusion Posturographic parameters based on the center of pelvis might be a reliable way to assess the position control ability in different standing positions and walking process.

Objective: To explore and analyze the possible mechanism of liver injury in patients with coronavirus disease 2019 (novel coronavirus pneumonia, NCP). Methods: The correlation between ALT, AST and other liver enzyme changes condition and NCP patients’ disease status reported in the literature was comprehensively analyzed. ACE2 expression in liver tissue for novel coronavirus was analyzed based on single cell sequencing (GSE115469) data. RNA-Seq method was used to analyze Ace2 expression and transcription factors related to its expression in liver tissues at various time-points after hepatectomy in mouse model of acute liver injury with partial hepatectomy. t-test or Spearman rank correlation analysis was used for statistical analysis. Results: ALT and AST were abnormally elevated in some patients with novel coronavirus infection, and the rate and extent of ALT and AST elevation in severe NCP patients were higher than those in non-severe patients. Liver tissue results of single cell sequencing and immunohistochemistry showed that ACE2 was only expressed in bile duct epithelial cells of normal liver tissues, and very low in hepatocytes. In a mouse model of acute liver injury with partial hepatectomy, Ace2 expression was down-regulated on the first day, but it was elevated up to twice of the normal level on the third day, and returned to normal level on seventh day when the liver recovered and hepatocyte proliferation stopped. Whether this phenomenon suggests that the bile duct epithelial cells with positive expression of Ace2 participate in the process of liver regeneration after partial hepatectomy deserves further study. In RNA-Seq data, 77 transcription factors were positively correlated with the expression of ACE2 (r > 0.2, FDR < 0.05), which were mainly enriched in the development, differentiation, morphogenesis and cell proliferation of glandular epithelial cells. Conclusion We assumed that in addition to the over activated inflammatory response in patients with NCP, the up-regulation of ACE2 expression in liver tissue caused by compensatory proliferation of hepatocytes derived from bile duct epithelial cells may also be the possible mechanism of liver tissue injury caused by 2019 novel coronavirus infection.