Malignant mesenchymoma is composed by two or more unrelated mesenchymal elements ,it is rare in clinic.Both domestic and abroad have few case reports ,it tends to occur in older people and the incidence of mesenchymoma is higher in males than in females .The malignant tumor in young female genital is more rare . Malignant mesenchymoma often appears in limbs ,it is difficult to be diagnosed before surgical operation .It is con-firmed by pathological examination .The degree of this malignant is higher and the recurrence rate is high .There is no specificity in clinic .The imaging characteristics are so less that it can not be taken seriously .We report a case of malignant mesenchymoma in vulva which is confirmed by pathology .

The primary transitional cell carcinoma in nasal cavity is clinically manifested by progessively increasing nasal decongestion,bloody and purulent secretion intermittent appear ,headaches,hearing loss.The macroscopic character showed that a medium gray red ground tissue .The tumor cells were arranged in nested ,pa-pillary by microscopy,the nucleus was round or oval shape ,the tumor cells was infiltrating growth,basophilia or bright.Immunhistochenmical showed that P63,CK5/6,CK18,UroplakinIII,CerbB -2,CEA were positive,Ki67 positive index was about S -100,Cga,Syn,Calponinare all tested negative .Nasal primary transitional cell carcino-ma is uncommon clinically ,and it is easy to misdiagnosed .Its diagnosis and differential diagnosis mainly depends on pathological histoloy and immunohistochenmical examination .

Aim To explore the effect and mechanism of resveratrol (Res) on proliferation and differentiation of murine 3T3-L1 preadipocytes.Methods 3T3-L1 preadipocytes were cultured and treated with resveratrol in different dosages.Cell proliferation was analyzed by WST-1 method. Oil red O staining method and spectrophotography were applied to analyze the degree of differentiation. Real-time PCR was applied to detect the mRNA expression of adiponectin and leptin. Western blot was applied to detect the expression of silent information regulator 1 (Sirt1),peroxisome proliferator activated receptor γ (PPARγ) and CCTTA enhancer binding proteinα (C/EBPα).Results Res inhibited proliferation of murine 3T3-L1 preadipocytes in a time-dose dependent manner.The expression levels of adiponectin and leptin mRNA were decreased, and Res also inhibited 3T3-L1 preadipocytes to differentiate into mature adipocytes. Res increased the expression levels of Sirt1 and decreased the expression levels of PPARγ and C/EBPα.Conclusions Resveratrol can inhibit the proliferation and differentiation of 3T3-L1 preadipocytes.The underlying mechanisms may include enhancing expression of Sirt1 and inhibiting expression of PPARγ,C/EBPα which are related to cell differentiation.

Objective To investigate the effect of predeposit autotransfusion in operation of the patients with lumbar disc protrusion.Methods Fifty patients of transfusion with lumbar disc protrusion were assigned into two groups by stratified sampling randomly,30 patients whose blood were predeposited before operation in experimental group,and the other 20 patients whose blood were not predeposited before operation in control group.The blood loss,the blood requirements during operations,the hemotological routine indexes and the complications related to blood transfusion were compared respectively.Results The blood loss of experimental group [ (720 ± 665 ) ml ] perioperative period was lower than that of control group [ ( 1060 ± 558 ) ml ],but there was no significant difference between two groups (P ＞ 0.05 ).All the patients in experimental group went through perioperative period safely without allogenic blood transfusion.Hemoglobin,red blood cell and white blood cell were not significantly different between two groups before and after operation for 3,7 days (P＞ 0.05 ),the platelet count after operation for 7 days was significantly different between two groups (P ＜ 0.05).No complication was observed in experimental group but 1 case with complication was observed in control group.Conclusions Predeposit autotransfusion is an effective to avoid homologous blood transfusion and its complications for the patients with lumbar disc protrusion.Furthermore,the clinical effect is not significantly different between the predeposit autotransfusion patients and the allogenic blood transfusion patients.

Objective:To evaluate the value of blood urea nitrogen (BUN)/creatinine (Cr) ratio for guiding the access route of double balloon enteroscopy (DBE) for small intestinal bleeding.Methods:The clinical information was collected from 105 patients who underwent DBE for suspected small intestinal bleeding at Air Force Medical Center from January 2015 to October 2019. Patients were divided into the elevated BUN/Cr group ( n=52) and the normal BUN/Cr group ( n=53), with a cut-off value of 81. Comparison was made for the detection rate of lesions between the oral route and anal route separately in the two groups using Chi-square test. Results:Among the 105 patients with suspected small intestinal bleeding, definite causes of bleeding were identified in 79 patients by DBE, and the overall lesion detection rate was 75.24% (79/105). In the elevated BUN/Cr group, the overall lesion detection rate was 76.92% (40/52), among which 79.49% (31/39) was through oral and 47.37% (9/19) through anal enteroscopy. In the normal BUN/Cr group, the overall lesion detection rate was 73.58% (39/53), and 63.64% (21/33) was transoral and 51.43% (18/35) transanal. The lesion detection rate of transoral enteroscopy in the elevated group was significantly higher than that in the normal group ( χ2=6.576, P=0.010). There was no significant difference in the lesion detection rate of transanal enteroscopy between the two groups ( χ2=2.230, P=0.135). Conclusion:For patients with active small intestinal bleeding (active bleeding within 48 hours), the BUN/Cr ratio higher than 81 may indicate that DBE should be performed firstly via oral route.

Objective:To investigate the efficacy of double balloon enteroscopy (DBE) in the treatment of bleeding from small intestinal vascular lesion and risk factors of bleeding recurrence .Methods:From April 2013 to May 2020, at Air Force Medical Center, the clinical data of 65 patients with confirmed or suspected bleeding from small intestinal vascular lesion were retrospectively analyzed. The patients were divided into DBE treatment group (patients of Yano classification 1a and 1b received argon plasma coagulation, and patients of Yano classification 2 and 3 accepted combination of titanium clip and submucosal injection of lauromacrogol sclerosing agent) and non-DBE treatment group (traditional treatments such as stopping anticoagulant or antiplatelet drugs, blood transfusion, and iron supplementation). The bleeding recurrence of patients with single small intestinal vascular lesion between DBE treatment group and non-DBE treatment group, and patients with single or mulitiple vascular lesion of DBE treatment group were compared. Univariate analysis was used to analyze the clinical data of patients with or without recurrent bleeding. Multivariate logistic regression model was used to analyze the independent risk factors and protective factors of recurrent bleeding in small intestinal vascular lesion. Independent sample t test, chi-square test and Fisher exact probability method were used for statistical analysis. Results:Forty-four (25 of single vascular lesion and 19 of multiple vascular lesion) patients were diagnosed with small intestinal vascular lesions and received DBE treatment (DBE treatment group). Twenty-one patients with single vascular lesion accepted traditional treatment (non-DBE treatment group). The recurrent rate of bleeding in patients with single vascular lesion of DBE treatment group was lower than that in patients with single vascular lesion of non-DBE treatment group and patients with multiple vascular lesion of DBE treatment group (24.0%, 6/25 vs. 71.4%, 15/21 and 12/19), and the differences were statistically significant ( χ2=10.348 and 6.848, P=0.001 and 0.009). The results of univariate analysis showed that the proportion of blood transfusion, hypertension, complicated with valvular heart disease and DBE treatment in patients with rebleeding or not rebleeding from small intestinal vascular lesion was different with statistically significant (69.7%(23/33) vs. 37.5%(12/32), 51.5%(17/33) vs. 18.8%(6/32), 42.4%(14/33) vs. 12.5%(4/32) and 54.5%(18/33) vs. 81.2%(26/32), χ2=6.777, 7.628, 7.265, and 5.298, all P<0.05). The results of multivariate logistic regression analysis indicated that blood transfusion during the course of disease (odds ratien ( OR)=3.736, 95% confidence interval ( CI) 1.082 to 12.898, P=0.037) and complication with valvular heart disease ( OR=4.916, 95% CI 1.107 to 21.829, P=0.036) were independent risk factors of bleeding recurrence in patients with small intestinal vascular lesions. DBE treatment was the protective factor of bleeding recurrence in patients with small intestinal vascular lesion ( OR=0.214, 95% CI 0.057 to 0.808, P=0.023). Conclusions:DBE is effective in the treatment of small intestinal vascular lesion bleeding, especially for single vascular lesion. Blood transfusion during disease course and complication with valvular heart disease are independent risk factors for bleeding recurrence in patients with small intestinal vascular lesion.

This article described the background,concept,characteristic and objective of the research-based nursing,systematically introducing the main measures including management mechanism, nursing service,nursing staff training,and nursing scientific development.Other areas covered include innovation management mechanism,updating service philosophy,improving nursing staff training,and constructing scientific research platform.

Objective:To investigate the application value of contrast-enhanced ultrasound (CEUS) before and after microwave ablation of thyroid nodules.Methods:Fifty-six patients (79 thyroid nodules) who received microwave ablation of thyroid nodules in Huaian Medical District, General Hospital of Eastern Theater Command from March 2016 to October 2019 were included in this study. CEUS was performed before microwave ablation to accurately assess the size, number and blood supply of thyroid nodules as well as the position of the feeding vessels. CEUS was performed immediately after microwave ablation to determine whether the lesion area was thoroughly ablated and to measure the volume of thyroid nodules. At 1, 3, 6 and 12 months after surgery, the level of thyroid hormone was measured and the absorption of thyroid nodules was evaluated.Results:Preoperative CEUS showed that among the 79 thyroid nodules, 42 were solid nodules that had different degrees of enhancement, including 33 annular homogeneously highly enhanced nodules and 9 heterogeneously highly enhanced nodules; 24 were cystic mixed solid nodules that had solid components, including 16 homogeneously highly enhanced nodules and 8 nodules with only local high enhancement in the solid component; 13 were cystic nodules, including 9 nodules with septa and 3 nodules with contrast medium on the diaphragm. Contrast medium was still visible around three nodules immediately after microwave ablation. Ablation continued in three nodules until there was no contrast medium. The incidence of complications during and after treatment was 0%. The average volume of the thyroid nodules before treatment was (7.52 ± 6.74) cm3. At 1, 3, 6 and 12 months after surgery, the average volume of the thyroid nodules was (6.06 ± 5.19) cm3, (3.06 ± 2.85) cm3, (1.32 ± 1.23) cm3 and (0.59 ± 0.52) cm 3, respectively. There was significant difference in volume of thyroid nodules between before and after microwave ablation ( F = 96.32, P < 0.001). Conclusion:Preoperative CEUS can determine the distribution of the blood supply of thyroid nodules and the course of the feeding vessels, identify the needle-entering position for microwave ablation and the primary ablation area, improve the accuracy of treatment, and reduce the occurrence of complications such as bleeding. Postoperative CEUS can determine whether lesion area is thoroughly ablated, reduce residual lesions and excessive ablation.

Objective? To investigate the hope level of elderly patients undergoing total knee arthroplasty (THA) and analyze its influencing factors, so as to provide evidence for improving the hope level and quality of life of patients after THA. Methods? A cluster random sampling method was used to select 308 patients with bilateral THA for the first time who were admitted to two ClassⅢ Grade A general hospitals in Harbin from January 2017 to July 2018. Questionnaire surveys were conducted using Herth Hope Scale, the Second Edition of Beck Depression Scale and Social Support Scale. Results? The total score of hope level in elderly THA patients was (29.96±8.72). Among them, 76.62% (236/308) had moderate to high level of hope and the total score of depression was (19.20±11.75) which was at a moderate level. There were significant differences in the hope level of patients with different gender, place of residence, educational level, marital status and family per capita monthly income (P＜ 0.05). The results of multiple stepwise regression analysis showed that age, sex, family income per capita, depression, negative coping style, subjective support and objective support were the influencing factors of elderly THA patients' hope level (P ＜ 0.05). Conclusions? The THA patients' hope are at a medium level. Medical staff should pay attention to the relevant factors affecting the level of hope, adopt targeted nursing intervention measures, give psychological guidance to patients, provide social support, and further improve the level of hope of the THA patients.

Objective:To investigate the iodine nutrition status of children aged 8 to 10 years old in Nanchang City.Methods:From March 2020 to September 2022, 9 counties (districts, administration bureau) in Nanchang City were selected as monitoring points. Each monitoring point was divided into 5 sampling areas according to the east, west, south, north, and middle directions. One township was selected from each area, and 40 non-boarding children aged 8 to 10 years old (age balanced, half male and half female) from one primary school were selected as survey subjects. Edible salt samples from children's homes, as well as a random urine sample were collected to detect salt iodine and urinary iodine level. The thyroid volume of children was also measured.Results:From 2020 to 2022, a total of 5 400 edible salt samples from children's homes were tested, with a median salt iodine level of 24.13 mg/kg. Among them, there were 5 172 qualified iodized salt samples, 168 unqualified iodized salt samples, and 60 non-iodized salt samples. The coverage rate of iodized salt was 98.89% (5 340/5 400), the qualified rate of iodized salt was 96.85% (5 172/5 340), and the consumption rate of qualified iodized salt was 95.78% (5 172/5 400). A total of 5 400 children's urine samples were tested, with a median urinary iodine level of 210.90 μg/L. A total of 2 662 children were examined for thyroid, of which 4 had thyroid enlargement, with an enlargement rate of 0.15% (4/2 662).Conclusion:The overall iodine nutrition of children aged 8 to 10 years old in Nanchang City is at a super appropriate level, and the thyroid enlargement rate meets the national standard (< 5%).