Objective China is experiencing increasing disease burden and economic burden of acute myocardial infarction(AMI),while the healthcare resources are limited and unevenly distributed.Hospitalization duration is an important measure of health resource utilization index.This study aims to describe the time trend of Length of stay(LOS) for AMI inpatient care in eastern urban areas of China,and to identify potential hospital-level factors associated with the LOS,which is an important indicator of resource utilization.Methods The study randomly selected a representative sample of patients admitted for AMI in 2001,2006 and 2011,from urban hospitals in eastern China.After central data abstraction from medical records,patients' characteristics,treatments and outcomes were compared between 3 hospital groups that were divided according to their median of LOS.Results Five thousand and forty-seven AMI cases were included in the analyses.The average LOS were (15.3±10.2),(13.5±8.7) and (12.2±7.8) d in 2001,2006 and 2011 respectively,with a decreasing trend(F=10.93,P<0.001).After adjusted for patients' characteristics,there were no significant different in LOS between years.Patients' characteristics were similar between high-,middle-and low-LOS hospitals,however,in high-LOS hospitals,use rates of aspirin,clopidogrel and statins were even lower(P≤0.001).LOS were longer 1.9 d in the hospitals with relatively small AMI inpatient treatment volumes(30-80 annually,t=2.97,P<0.01).Conclusions The average LOS for AMI in eastern urban areas of China is much longer than in western countries.Conclusion between hospitals have highlighted the gaps in care quality and efficiency.Standardized clinical pathways and hierarchical medical system are essential strategies in the new healthcare reform.

Objective To evaluate the capability of Turbo inversion recovery magnitude (TIRM) magnetic resonance neurography (MRN) in the diagnosie of sacral plexus injury by comparing MRN findings with surgical results.Methods Ten patients with sacral plexus injury confirmed surgically underwent conventional T1WI,T2WI,TIRM and coronal TIRM MRN before operations from June,2011 to December,2012.The MRI data and surgical data were analyzed retrospectively to observe nerve injury.Results The coronal TIRM MRN images displayed 93 trunks of sacral plexus,of which 37 were confirmed injury by operation.The MRI findings were as follows:6 trunks involved continuous nerves,but with thickening and blurred margin,as well as abnormal high signal intensity;22 trunks were continuous,but with distortion,stiffness and adhesion accompanied by heterogeneous signal intensity and structural disorder;3 trunks showed complete loss of continuity,absence of normal signal,accompanied by retraction;and 3 trunks involved formation of traumatic neurofibroma.The coincidence of injured nerve trunks diagnosed by MRN with surgical findings amounts to 81.08％ (30/37).Conclusion MR with coronal TIRM imaging is effective in the diagnosis and depiction of sacral plexus injury,therefore it can be used as conventional sequence in sacral plexus examination to detect sacral plexus avulsion.

Objective:To summarize the self-management experience of patients with coronary heart disease, so as to provide a basis for medical and nursing staff to build and improve the self-management system of coronary heart disease.Methods:Qualitative studies on the self-management experience of patients with coronary heart disease were retrieved by computer in PubMed, Embase, Web of Science, CINAHL, Cochrane Library, Joanna Briggs Institute (JBI) , China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Database from database establishment to June 30, 2021. The articles were evaluated using the Quality Evaluation Standard for Qualitative Research (2016) of Australia JBI Evidence-based Health Care Center, and the results were summarized using the Meta-synthesis.Results:A total of20 articles were included, and 59 research results were extracted. A total of 12 new categories were formed by induction and combination, which were integrated into 3 integrated results, namely the driving factors of self-management, the blocking factors of self-management, the trajectory and path of self-management.Conclusions:Self-management of patients with coronary heart disease is a tortuous process influenced by multiple factors. Collaboration and support from families, healthcare systems, society, and governments are needed to promote patients' adherence to long-term self-management and improve their prognosis and quality of life.

Objective To study the expression of epidermal growth factor receptor 1 (EGFR) protein in breast cancer and its correlation to molecular subtyping and hormone receptor status.Methods 467 cases of breast cancer were included.According to ER,PR,HER2,and Ki-67 status,the cases were categorized into 4 molecular subtypes,including 185 cases of luminal A,109 cases of luminal B,76 cases of HER2-enriched,and 70 cases of triple-negative breast cancer (TNBC).According to ER and PR status,the cases were divided into 4 subtypes,including 240 cases of ER+/PR+,50 cases of ER+/PR-,4 cases of ER-/PR+,and 173 cases of ER-/PR-.Results EGFR protein expression rates in Luminal A,Luminal B,HER2-enriched and TNBC were 16.8％(31/185),54.1％(59/109),97.4％(74/76),78.6％(55/70),respectively.The EGFR expression in HER2-enriched was significantly higher than those in TNBC,Luminal B and Luminal A(P＜0.01),and EGFR expression in TNBC was significantly higher than those in Luminal B and Luminal A (P＜0.01),furthermore,EGFR expression in Luminal B was significantly higher than that in Luminal A (P＜0.01).EGFR protein expression rates in ER+/PR+ subtype,ER+/PR-subtype,ER-/PR+ subtype and ER-/PR-subtype were 25.4％ (61/240),52.0％ (26/50),75.0％ (3/4),88.4％(153/173),respectively.The EGFR expression in ER-/PR-subtype was significantly higher than in ER+/PR+ subtype and ER+/PR-subtype (P＜0.01),and EGFR expression in ER+/PR-subtype was significantly higher than that in ER+/PR+ subtype (P＜0.01).EGFR protein expression rate was higher in ER-/PR-subtype than in ER-/PR+ subtype,and EGFR protein expression rate was higher in ER-/PR+ subtype than that in ER+/PR+ subtype and ER+/PR-subtype,but all of the difference were not statistically significant (P＞0.05).Conclusion EGFR protein expression is closely related to breast cancer molecular subtyping and negative hormone receptor expression,which is a potential biomarker of anti-breast cancer therapy.

Objective To observe the application of multiple fluorescent PCR (Polymerase Chain Reaction) in the diagnosis and clinical detection of bloodstream infection. Methods 256 blood cultures were collected by the Laboratory Department of Yinzhou People′s Hospital from January 2018 to May 2018, and were detected by multiplex fluorescent PCR. The results of the PCR were compared with the traditional blood culture bacteria identification instrument (traditional blood culture method). The number of positive and negative samples and the number of corresponding samples of the two methods were counted. Then, they analyzed the specificity and sensitivity of multiplex fluorescence PCR in the diagnosis of bloodstream flow infections. Results A total of 18 pathogenic microbes are detected through blood culture and PCR. Multiple fluorescent PCR detects 142 positive samples and 114 negative samples. Among them, 132 samples also show positive through blood culture, and 111 samples show negative. The consistency rate between multiple PCR and traditional blood cultures is 91.8％ (235/256). The negative prediction rate of PCR is 97.4％ (111/114), sensitivity rate 97.8％ (132/135), specificity rate 91.7％ (111/121). 10 samples show positive through multiple fluorescence PCR but negative for blood culture, 3 samples show positive through blood culture but negative for PCR. Besides, there are 3 types of pathogens that exceed the detection range of PCR. Conclusions Multiplex PCR method can detect 17 pathogens in blood culture specimens of patients, which can not only optimize the traditional blood culture process, but also greatly shorten the reporting time and improve the detection rate of blood culture methods. Especially for patients treated with antibiotics, it can reduce missed detection and improve the diagnostic rate of bloodstream infections.

Objective To explore the effect and possible pharmacological mechanism of Bufei Tongbi Decoction in the treatment of systemic lupus erythematosus interstitial lung disease (SLE-ILD).Methods The effective components and related targets of Bufei Tongbi Decoction were obtained using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and Uniprot database. Key genes for SLE-ILD were screened based on DrugBank,DisGeNET,GeneCards,PharmGKB,OMIM,and GEO databases. Using Cytoscape software,a drug active ingredient-target-disease relationship network diagram was constructed to obtain the effective active ingredients and possible mechanisms of action of Bufei Tongbi Decoction in the treatment of SLE-ILD. Gene ontology (GO) function enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were used to reveal related target genes and pathway functions. Taking C57BL/6 mice as normal group,MRL/lpr mice were injected with bleomycin 5mg/kg in the nasal cavity. According to the random number table method,the mice were divided into model group,Bufei Tongbi Decoction low-dose group (10.4 g/(kg·d)),Bufei Tongbi Decoction medium-dose group (20.8 g/(kg·d)),Bufei Tongbi Decoction high-dose group (41.6 g/(kg·d)) and prednisone group (3 mg/(kg·d)). The intervention lasted for 28 days. Hematein eosin and Masson staining were used to observe the pathological changes of mouse lung tissue,the expressions of transforming growth factor-β1 (TGF-β1) and collagen type Ⅲ (Col-Ⅲ) in lung tissue were detected by immunohistochemistry,and the expressions of interleukin-1β(IL-1β),interleukin-10 (IL-10) and interleukin-17 (IL-17) in serum were detected by ELISA. The mRNA expressions of matrix metallopeptidase 1(MMP-1),hypoxia inducible factor-1α(HIF-1α),retinoid-related orphan receptor γt (RORγt ) and forkhead box P3 (FOXP3) in lung tissue were analyzed by RT-PCR,the protein expressions of HIF-1α and MMP-1 in lung tissue were detected by Western blotting,and the expressions of T helper 17 cells (Th17) and regulatory T cells (Treg cells) in blood were detected by cytometry.Results A total of 163 effective ingredients,259 targets,1729 SLE-ILD disease targets,958 SLE-ILD differential genes and 40 drug-disease interaction targets were obtained by screening. GO functional enrichment and KEGG pathway enrichment showed that IL-17 signaling pathway activated by IL-1β and MMP-1,and Th17 cell differentiation activated by IL-1β and HIF-1α were the main pathways. Animal experiments showed that Bufei Tongbi Decoction could effectively improve the degree of lung interstitial lesion and reduce the expressions of TGF-β1 and Col-Ⅲ in SLE-ILD mice (P<0.01). The expressions of IL-1β,HIF-1α and IL-17 were decreased (P<0.01). Medium and high doses of Bufei Tongbi Decoction decreased the expressions of MMP-1 and RORγt mRNA (P<0.01),and increased the expressions of IL-10 and FOXP3 mRNA (P<0.01). Bufei Tongbi Decoction could reduce the proportion of Th17 cells,increase the proportion of Treg cells,downregulate the balance of Th17/Treg (P<0.05),and improve the immune disorder. Conclusion Bufei Tongbi Decoction has the characteristics of multi-target and multi-pathway in treating SLE-ILD,and its mechanism may be related to the regulation of Th17/Treg cell balance.

Objective:To explore the MRI features of fetal coronal cleft vertebrae, and to compare the efficacy of MRI and ultrasound in the diagnosis of fetal coronal cleft vertebrae, and to analyze the outcome of fetal coronal cleft vertebrae.Methods:From September 2019 to June 2021, 40 fetuses suspected of fetal vertebral deformities by ultrasound were retrospectively collected in Shandong Provincial Hospital Affiliated to Shandong University, who were diagnosed as coronal cleft vertebrae after MRI examination. Five cases of induced labor and 14 cases lost to follow-up were excluded, and 21 fetuses who underwent MRI after delivery were finally included. The gestational weeks were 25-34 (29.1±2.6) weeks, and there were 19 males and 2 females. Fetal spine MRI includes susceptibility weighted imaging (SWI) and T 2-true fast imaging with steady-state (True-FISP). The MRI features and outcome of fetal coronal cleft vertebrae were explored. The image quality scores of SWI, T 2-True-FISP and ultrasound were compared with Friedman test and Wilcoxon signed-rank test. The diagnostic accuracy of fetal coronal cleft vertebrae of SWI, T 2-True-FISP and ultrasound was calculated. Cochran test was used to compare the efficiency of 3 kinds of images, and the modified McNemar test was used for pairwise comparison between groups. Results:There were 10 cases of single and 11 cases of multiple fetal coronal cleft vertebrae, 16 cases of simple lumbar vertebrae, 2 cases of simple thoracic vertebrae, and 3 cases of thoracolumbar vertebrae. The common SWI features of 21 cases show longitudinal strip or dot high signal on the sagittal plane, and transverse fissure like high signal on axial plane. Anterior part of vertebral body was larger than posterior part in 19 cases of them. The image quality scores of SWI, T 2-True-FISP and ultrasound were 4 (3, 4), 2 (2, 2), 2 (2, 2), and the difference was statistically significant in general (χ2=34.24, P<0.001). Pairwise comparison showed that the image quality of SWI was better than those of T 2-True-FISP and ultrasound ( Z=-4.04, P<0.001; Z=-4.11, P<0.001), and there was no statistically significant difference between T 2-True-FISP and ultrasound ( Z=-0.58, P=0.388). The diagnostic accuracy of SWI, T 2-True-FISP and ultrasound was 100% (21/21), 66.7% (14/21), 47.6% (10/21). The diagnostic accuracy of SWI was better than those of T 2-True-FISP and ultrasound (χ2=5.14, P=0.008; χ2=9.09, P<0.001), and there was no statistically significant difference between T 2-True-FISP and ultrasound (χ2=0.75, P=0.194). MRI showed that coronal cleft vertebrae disappeared in all 21 fetuses after birth, including 1 case of syringomyelia and 1 case of fatty filum terminal. Conclusions:MRI, especially SWI, plays an important role in the diagnosis of fetal coronal cleft vertebrae. Fetal coronal cleft vertebrae disappeared in the follow-up after birth, which proved to be a normal physiological variation from the radiographic perspective.

Objective To explore the expression of Fascin-1 and EGFR in triple-negative breast cancer (TNBC) and non-triple-negative breast cancer (non-TNBC) and its correlation.Methods According to ER,PR,and HER2 status,breast cancer were categorized into 2 subtypes:70 cases of TNBC and 370 cases of non-TNBC.The immunohistochemical technique,EnVision method,was used to evaluate the expression of Fascin-1 and EGFR in breast cancer.Results Expression rate of Fascin-1 and EGFR protein in TNBC was 88.6％(62/70)and 78.6％(55/70),while it was 19.2％(71/370)and 44.3％(164/370)in non-TNBC,respectively.Fascin-1 expression rate was significantly higher in EGFR positive non-TNBC cases (34.8％,57/164) than in EGFR negative cases (6.8％,14/206)(x2=46.032,P=0.000).The positive rate of Fascin-1 protein in EGFR-positive TNBC cases (92.7％,51/55) was higher than that in EGFR negative cases (73.3％,11/15),and the difference had no statistically significance (x2=2.673,P=0.102).Conclusions EGFR signal pathway may positively regulate Fascin-1 expression in non-TNBC.The relationship between EGFR and Fascin-1 in TNBC is needed for further study.

Medical ethics has a long history and rich connotations.It has developed from the simple "medical morality" of ancient times to the modem medical ethics.The basic principles of medical ethics include autonomy,non-maleficence,beneficence,justice,and so on.Researchers often conduct clinical researches in the balance between achievements and ethical norms.Clinical researchers of surgery should have a deep understanding of medical ethical principles and strictly abide by medical ethics.Ethics committee should strictly perform their duties and play the role of inspection and supervision.Modem medical knowledges should be popularized throughout the society to make clinical research correctly understood.Adhering principles of ethics first,people orientation and cooperation practice,with patients' benefit as evaluation criteria,balance of surgical "Dao" and "Shu" can be achieved.

OBJECTIVE： To establish the quality standard for Bushen quyu granules. METHODS： TLC was used for qualitative identification of Rosa laevigata， Cuscuta chinensis， processed Fallopia multiflora and Lithospermum erythrorhizon in Bushen quyu granules. And then， the content of total polysaccharides in Bushen quyu granules was determined by UV spectrophotometry. HPLC method was used for the content determination of rutin， quercetin and hyperin in Bushen quyu granules. The determination was performed on BDS C18 column with mobile phase consisted of acetonitrile-0.08％ phosphoric acid solution （gradient elution） at the flow rate of 1 mL/min. The column temperature was 30 ℃， and detection wavelength was set at 370 nm. The sample size was 10 μL. RESULTS： TLC test sample chromatogram of 4 medicinal materials showed the same spot or fluorescence at the corresponding position with the reference substance and control medicinal materials. The linear range of glucose， rutin， quercetin and hyperin were 0.003-0.018 mg/mL， 0.225-7.20 μg/mL， 0.07-2.24 μg/mL and 1.25-39.88 μg/mL（r＝0.999 5 or 0.999 9， n＝6）. RSDs of precision， stability and reproducibility tests were all less than 3％ （n＝6）. Average recoveries were 102.2％， 101.2％， 100.9％， 101.0％ （RSD＝1.28％， 2.93％， 2.41％， 1.59％， n＝6）. Average contents were 0.46 g/g， 5.48        μg/g， 8.18 μg/g and 102.88 μg/g（n＝3）. CONCLUSIONS： Established quality standard of Bushen quyu granules is accurate and reliable， and can provide scientific reference for quality control of Bushen quyu granules.