Objective To study X-ray and clinical diagnosis of multiple myeloma(M M).Methods X-ray findings in 16 cases with M M were retrospectively analyzed.Results The main manifestations on X-ray were:normal in 3;osteoporosis in 8;osteolytic destrucion in 12;osteosclerosis in 1 and mass of soft tissue in 6.Conclusion The diagnosis of M M is mainly depended on clinical and X-ray findings,puncture of bone marrow is of diagnostic value,the differential diagnosis is still necessary.

ve method of limb salvage.

Objective To explore the outcome of the tibial bone-skin flap grafts in the management of severe traumatic osteomyelitis complicated with bone and skin defect in leg.Methods Twenty-seven cases of the traumatic osteomyelitis complicated with bone and skin defect in leg were treated with vascularized tibial bone-skin flap grafe from August, 2007 to November, 2013.Reconstruction of limb tibia continuity and cover the wound.Results The tibial bone-skin flaps were completely survived in 26 of the 27 cases except 1 ease which was repaired by adjacent flap because of the disorder blood circulation.The followed-up showed that all flaps had good blood circulation.The infection was controlled completely.The leg function and contour were satisfactory.Conclusion The tibial boneskin flap has the advantages of abundant blood supply, full bone-skin flap supply, shortens hospitalization and suitable for treatment of traumatic osteomyelitis complicated with bone and skin defect in leg.

Objective To verify and valuate the performance of small dense low-density lipoprotein cholesterol (sdLDL-C) detection by the direct clearance method and evaluate its preliminary clinical application in acute coronary syndrome (ACS).Methods Case control study:The performance (accuracy,precision,linearity) of sdLDL-C was assessed by direct clearance method.In 143 cases of ACS patients selected from Cardiology Department and Emergency Department of Shangdong Provincial Hospital from April to October in 2016,with 100 cases male,female 43 cases,including acute myocardial infarction (AMI)group of 59 cases,unstable angina pectoris (UAP) group of 84 cases;83 cases of healthy volunteers as a control group selected from health physical examination center of Shandong Provincial Hospital,with 59cases male,female 24 cases.Levels of sdLDL-C,total cholesterol (TCH),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C),apolipoprotein A (ApoA I),apolipoprotein B (ApoB),lipoprotein (a) (Lpa) and high sensitive C-reactive protein (Hs-CRP) were detected separately by automatic biochemical analyzer.Non high density lipoprotein cholesterol (non-HDL-C) equals TCH minus HDL-C.x2 test,t test,one-way ANOVA,Pearson correlation and multiple linear regression analysis were used as statistical methods.Results The within-lot or between-lot variation was 2.85％ and 3.36％.Methodological comparison:regression equation Y =0.984X + 0.018,r2 =0.966,t =-0.191,P =0.850.There was a good linear correlation (Y =1.026X + 0.007,r2 =0.999) between theoretical values and actual detection results in range of 0.15-2.65 mmol/L.SdLDL-C concentrations were positive correlated with TCH,non-HDL,LDL-C,TG,ApoB (r =0.758,0.848,0.839,0.514,0.885,respectively,P ＜0.01),and negative correlated with HDL-C (r =-0.224,P =0.001),but no correlation with APOA I,Lpa and Hs-CRP(r =-0.021,0.050,0.003,respectively,P ＞ 0.05).Multiple linear regression analysis showed that the factors influencing sdLDL-C level were HDL-C,ApoB,LDL-C and TG.The levels of sdLDL-C,TG in the ACS group were significantly higher than those in the control group (t =3.415,4.660,respectively,P ＜ 0.01),but no difference between the two groups in the levels of TCH,non-HDL-C and LDL-C (t=-1.831,-0.452,-1.398,respectively,P ＞0.05).Comparing AMI group with control group,sdLDL-C,TG and Hs-CRP were significantly higher than the control group (P =0.000,0.000,0.000,respectively),but TCH,LDL-C and non-HDL were similar between the two groups (P =0.800,0.320,0.120,respectively);Comparing UAP group with control group,TG and Hs-CRP were higher than control group (P =0.001,0.047,respectively),TCH and LDL-C were significantly lower than the control group (P =0.003,0.008,respectively),but sdLDL-C had no difference (P =0.305);Comparing AMI group with UAP group,sdLDL-C,TCH,LDL-C and Hs-CRP were significantly higher than UAP group (P =0.000,0.003,0.001,0.000,respectively),and TG were no statistical significance (P =0.473).Conclusions Direct clearance method can meet the requirement of sdLDL-C detection.sdLDL-C level can assess the metabolism of blood lipids and be used as an independent risk factor and predictive index of ACS,superior to LDL-C.

Objective To investigate the effects of hyperbaric Oxygen (HBO)exposure on Caspase-3 and Bcl-2 mRNA ex-pressions in both internal carotid artery (ICA)and basal artery (BA)in rabbits.Methods Twenty-four healthy adult New Zealand rabbits were randomly divided into 2 groups:HBO group and the control group,with each group consisted of 12 animals.The rab-bits in the HBO group were exposed to HBO at 2.2 ATA for 60 minutes each day for 3 successive days.The rabbits in the control group were normally fed without any treatment.Real-time PCR was used to detect Caspase-3 and Bcl-2 mRNA expressions in both ICA and BA in 2 groups.Results HBO significantly decreased the Caspase-3 mRNA expression [(0.038 ±0.006 )vs .(1.000 ± 0.225)]and increased the Bcl-2 mRNA expression [(1.877 ±0.1 69)vs .(1.000 ±0.364)].In ICA,HBO similarly decreased the Caspase-3 mRNA expression [(0.41 9±0.091)vs .(1.000 ±0.1 75)]and increased the Bcl-2 mRNA expression [(1.269 ±0.270) vs .(1.000±0.1 1 7)]in BA.All the differences mentioned above were of statistical significance (P <0.01).Conclusion HBO ex-erts an inhibition effect on apoptosis in cerebral vascular endothelial cells.The mechanism may be related to inhibiting the expres-sion of Caspase-3 mRNA and promoting the expression of Bcl-2 mRNA.

ObjectiveTo explore clinical,histopathological and genetic features in a case of fatal familial insomnia (FFI) and related literatures were reviewed. Methods The clinical features in one patient with FFI were analyzed,and the dead patient was examined at autopsy and histopathological studies were performed on the brain tissues; and the blood samples from the patient and some of her familial members were collected for the sequencing of prion protein gene (PRNP). Results The main clinical features included intractable insomnia,psychiatric symptoms and abnormal night sleep behavior,unsteady gait,difficulty swallowing,sudden death,and positive family history. The pathological studies showed multiple neuronal loss and gliosis of brain tissues from the proband,predominated in thalamus; and analysis of PRNP revealed gene D178N mutation,and linkage with 129 methionine (Met) allele in the proband and a relative.ConclusionsFFI patients may manifest as sudden death,and may have prominent psychiatric symptoms; the corresponding gene mutation could occur in the asymptomatic carriers; the data of autopsy and brain tissue pathology is helpful for further understanding of this disease.

Objective To explore the current status and influencing factors of procrastination behavior of nursing interns , and help nursing educators find effective solutions to improve procrastination behaviors of nursing interns.Methods Totally 235 nursing interns of one hospital from October 2015 to February 2016 were investigated by general procrastination scale, time management disposition scale, self-control scale and Chinese frost multidimensional perfectionism scale.The situation of their procrastination behavior was analyzed, and the influencing factors were analyzed by Pearson correlation analysis and multiple stepwise regression analysis.Results The average score of each item of general procrastination scale was (2.140± 0.494).There were 91.49%of students who showed different level of procrastination behavior .There was a negative relation among time management disposition , self-control and procrastination behavior ( r=-0.173--0.416, P<0.01) .There was no correlation between total score of perfectionism and procrastination behavior (r=0.098,P>0.05).There was a negative correlation between adaptive perfectionism and procrastination behavior (r=-0.243, P<0.01), and there was a positive correlation between maladaptive perfectionism and procrastination behavior (r=0.233, P<0.01).The influencing factors of procrastination behavior contained self-control scores, time monitoring, maladaptive perfectionism and adaptive perfectionism . Conclusions It can reduce the procrastination behavior of nursing interns by improving ability of time monitoring, self-control, and shaping the accurate recognition .

The aim of this study is to evaluate the effectiveness of a smart non-invasive blood glucose monitor prototype during pregnancy through clinical validation.The monitor utilizes near-infrared spectroscopy combined with AI big data analysis of photoelectric volumetric pulse wave data to achieve non-invasive monitoring of blood glucose in women during pregnancy.The research team developed a monitor that employs a sensing chip,effectively overcoming the problems of weak signals and individual differences in non-invasive blood glucose monitoring.The user experience is enhanced by visualizing the test results on the accompanying cell phone APP(application)of the smart non-invasive pregnancy blood glucose monitor.Clinical validation revealed that the non-invasive monitoring data for pregnant women aged 20～30 years significantly differed from those obtained via traditional blood glucose measurement methods,whereas no significant difference(P<0.05)was observed for pregnant women aged 31～42 years.The study concluded that further calibration of the monitor and an expansion of the sample size are necessary to enhance consistency with invasive glucose monitoring results.

Objective:To explore the application of positive psychological intervention methods in young stroke patients and verify the effect on post-traumatic growth and subjective well-being of patients.Methods:Using the convenient sampling method, a total of 114 young stroke patients who were hospitalized in Department of Neurology in a ClassⅢ Grade A hospital from October 2018 to February 2020 were selected as the research objects. According to the random number table method, they were divided into the control group (57 cases) and the experimental group (57 cases) . The control group implemented routine psychological nursing, while the experimental group implemented active psychological intervention on the basis of the control group. Posttraumatic Growth Inventory (PTGI) and General Well-Being Schedule (GWB) were used to evaluate patients the two groups.Results:After intervention, the total score of PTGI, the total score of GWB and scores of all dimensions of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Positive psychological intervention can improve post-traumatic growth and subjective well-being of young stroke patients.

Objective:To construct the access standard of nursing service project according to the feasibility, operational risk and difficulty of "Internet+ nursing service" home-based nursing project operation, so as to provides references for establishing the management method of "Internet+ nursing service".Methods:From March to August 2021, nursing service projects in the existing "Internet+ nursing service" platform were collected, and relevant literature and policies were referred to build an "Internet+ nursing service" project pool, including 64 nursing service items. The convenient sampling method was adopted to select 19 hospital nursing managers, community nursing managers, clinical nursing and nursing education experts in the field of "Internet+ nursing service" in Beijing from November 2021 to January 2022. Delphi method was adopted to conduct expert letter inquiry, and to evaluate the feasibility of home operation, difficulty score, risk score and access suggestions of nursing service projects.Results:The results showed that 61 nursing service items had the feasibility of home nursing operation. The nursing operations of intravenous injection, intravenous infusion and indwelling needle infusion were not suitable for home operation. Among them, the operators of the five items such as transfusion port maintenance, wound dressing change, peritoneal dialysis, ostomy nursing and disease rehabilitation guidance should be competent only after they passed the training and assessment of specialized nurses and had the operation experience of the project due to the difficulty of operation or the medium and high level of risk. Hair care and warm water bath were of low difficulty and low risk to be operated at home and they could be completed by trained caregivers or nursing workers. Operators of 54 items such as oral care, perineal scrubbing, rapid blood glucose monitoring, etc., should have nurse practicing certificate, nurse or above title, and have more than 5 years of related work experience.Conclusions:The access standard of "Internet+ nursing service" project established in this study is highly scientific and reliable, which can provide useful reference for establishing the access management method of "Internet+ nursing service".