Objective To investigate the effect of applying core competence training for grading nursing in ICU.Methods The nurses in ICU were divided into high qualification nurses group and low qualification nurses group according to professional ability;make clear the post responsibility, clinical educational training and management were performed according to grades.The nursing department and head nurse evaluated the training;the scores were analyzed and fed back.Results After applying core competence training for grading nursing the satisfaction of patients and nurses and the operational standard-reaching rate were significantly higher (p<0.05).Conclusion The core competence training for grading nursing could give full play to nurses at all levels, provide basis and ladder of sustainable development for nurse's career, deserve the clinical expansion.

Objective To establish a zebrafish model of thrombosis induced by three kinds of inducers and observe the anti?thrombotic effect of a Chinese traditional medicine, Guanxinning tablet ( GXN) . Methods The zebrafish models of thrombosis was induced by using 1?5μmol/L phenyl hydrazine, 80μmol/L arachidonic acid and 5 mg/L ponatinib, re?spectively, and were treated with various concentration of GXN, clopidogrel or asprin. The thrombus in the tail vein was observed under microscope, Erythrocytes in the zebrafish heart were stained with o?dianisidine and the erythrocyte staining intensity was assessed with a NIS?Elements DTM image analyzer, and the anti?thrombolic effect of GXN was calculated. Results Venous thrombus was significantly increased and the staining intensities of erythrocytes in the heart were signifi?cantly decreased after induction by phenyl hydrazine, arachidonic acid or Ponatinib ( P <0?001 ) , respectively. At the same time, GXN showed an incresing anti?thrombolic effect in the zebrafish models (P<0?001) in a dose?effect manner, with a IC50 of GXN of 44?32 mg/L,138?5 mg/L and 459?5 mg/L, respectively. Conclusions The zebrafish models of thrombosis are successfully established by phenyl hydrazine, arachidonic acid or Ponatinib, respectively, by different for?mation mechanisms. GXN has been shown to have an anti?thrombosis effect, probably, by multiple target effects.

Objective To explore the efficacy of cold packs combined with ice compress in treatment of pain after erbium fractional photothermal therapy on acne scars. Methods Eighty cases which were confirmed to the criteria were randomized into two groups:treatment group and control group. The treatment group (n=40) treated with cold packs combined with cold icy compress immediately after the surgery for 30~40 mins. The control group (n=40) was given icy compress therapy immediately after the surgery for 30~40 mins. The therapy continued for three days after the surgery on the two groups. The self-feeling symptom and pain relieving time were compared between the two groups. Result The time for pain relief in the wounds and the time for scabbing were both significantly shorter than those in the control group (P<0.01). Conclusion The cold packs combined with ice compress therapy can relieve the pains effectively and it can shorten the recovery time after fractional photothermal therapy.

Total hysterectomy is a treatment for cervical intraepithelial neoplasia Ⅲ (CINⅢ), and its recurrence rate is very small. In recent years, with the development of colposcopy and the increase of postoperative follow-up rate, the detection rate of vaginal intraepithelial neoplasia (VAIN) and vaginal cancer after CINⅢ hysterectomy has increased significantly. In recent years, a number of studies have found that persistent human papillomavirus (HPV) infection is the most important factor leading to the recurrence of vaginal stump after CINⅢ level hysterectomy, so eliminating HPV infection can improve the patient's performance. The prognosis of persistent HPV infection is affected by many factors. The author reviewed the factors related to the clearance of HPV after CINⅢ hysterectomy. The purpose of this study is to provide a theoretical basis for improving the prognosis of patients and delaying the recurrence time after CINⅢ hysterectomy.

Objective To explore the role of CD4~+CD25~+CD127~(lo) regulatory T cells (Tregs) and inter-leukin (IL)-6, transforming growth factor beta (TGF-β), IL-17 in the pathogenesis of lupus nephritis (LN) by detecting the levels of IL-10, IL-6, TGF-β, IL-17, CD4~+CD25~+CD127~(lo) Tregs in the peripheral blood of patients with active and inactive LN. Methods Three-colour flow cytometry was used to quantitatively measure proportions of Treg cells, the levels of TGF-β, IL-17 were detected by ELISA, and the levels of IL-10, IL-6 in the peripheral blood were detected by Cytometric Bead Array System. Results ① Compared with the inactive LN and the normal controls (P<0.01), the level of CD4~+CD25~+CD127~(lo) Tregs from patients with active LN was lower(P<0.01). When compared with the normal controls, the level of CD4~+CD25~+CD127~(lo) Tregs from LN inactive patients had no significant difference (P>0.05). ② Compared with patients with inactive LN, the levels of IL-10, IL-6 was higher (P<0.01) in patients with active LN. ③ Compared with the patients with inactive LN and the normal controls, the levels of TGF-β, IL-17 was not significantly different (P>0.05). ④ The level of CD4~+CD25~+CD127~(lo) T cell was correlated negatively with the levels of IL-10, IL-6 and SLEDAI (P<0.05), and was not correlated with C3 and C4. ⑤ SLEDAI was correlated positively with the levels of IL-10 and IL-6 (P<0.01). SLEDAI and the level of IL-10 were correlated negatively with C3 and C4 (P<0.01 for both). ⑥ The level of CD4~+CD25~+CD127~(lo) Tregs from LN was not correlated with TGF-β and IL-17. ⑦ TGF-β was correlated positively with the level of IL-17. Conclusion ① The level changes of Tregs and IL-10, IL-6, TGF-β in the peripheral blood of LN can be used as the indicators for the activity status of lupus nephritis. ② Tregs and IL-10, IL-6 in the peripheral blood of LN patients is negatively correlated. ③ The glucocorticoid hormone is helpful to elevate the level of Tregs but decrease IL-17. T cell level can vary in different body status, different microenvironmental and immune status.

OBJECTIVETo study the distribution of abdominal and pelvic lymph nodes involved in non-Hodgkin lymphoma in Chinese patients.

METHODSCT images of 241 non-Hodgkin lymphoma patients with abdominal and pelvic lymph nodes involved were reviewed. Of them, 96 patients whose clinical and image data fulfilled the requirements of the analysis were included: 1. Positive abdominal and/or pelvic nodular lesion in untreated patients examined by CT (n = 74). 2. New lesions in abdominal or pelvic lymph nodes who never had any nodular lesion by previous abdominal and/or pelvic CT (n = 14). 3. Treated patients who did not have abdominal and/or pelvic CT before, showed regression of initial disease for at lease 6 months after chemotherapy and patients showing abdominal and/or pelvic nodal lesions (n = 8) were assessed. In accordance with Clinical Schema for the Lymphoid System, these patients were divided into 3 histology subtypes: indolent (IL; n = 31), aggressive (AL; n = 61) and very aggressive (VAL; n = 2) lymphoma. The remaining 2 cases were unclassified (UCL). Both abdominal and pelvic CT scans were undertaken in 46 patients, abdominal CT only in 47 patients and pelvic CT only in 3 patients. Enhanced CT with i.v. contrast was obtained in 80 patients. The anatomic sites involved were designated as retroperitoneal (i.e. paraaortic), mesenteric, abdominal (i.e. celiac, paracardiac, gastrohepatic, and hepatic hilar, etc), retrocrural, subdiaphragmatic, common iliac, internal iliac, external iliac, and inguinal nodes, respectively.

RESULTSThe lesions were located in the retroperitoneum, with an incidence of 83% for both IL and AL. These were predominantly seen superior and inferior to the renal hila, with incidences of 72.0% (18/25) in IL and 67.3% (33/49) in AL. Pelvic lymph nodes came the next, with incidences of 41.9% (126/301 sites of IL and AL), 57.5% (50/87 sites) in IL and 35.5% (76/214 sites) in AL. Mesenteric lymph nodes stood third with incidences of 37.1% (33/89 IL and AL), 43.3% (13/30) in IL and 33.9% (20/59) in AL. There was only one statistically significant evidence that the external iliac lymph nodes were much more commonly seen in IL than in AL (P < 0.05).

CONCLUSIONIn Chinese patients, retroperitoneal, iliac, and mesenteric nodes are the most commonly involved lymph nodes in NHL. The involved retroperitoneal lymph nodes are predominantly located superior and inferior to the renal hila. The anatomic distribution of abdominal and pelvic lymph nodes in NHL of Chinese patients is different from that of the western countries.

Abdomen ; Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Child ; China ; epidemiology ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Lymphoma, Non-Hodgkin ; epidemiology ; pathology ; Male ; Middle Aged ; Pelvis

Objective To assess the efficacy and safety of mifepristone combined with oral or vaginal misoprostol for termination of pregnancy between 8 and 16 weeks of gestation. Methods This was a randomized, multi-center, open clinical trial. A total of 625 women at 8-16 weeks of gestation were randomized to receive 200 mg oral mifepristone followed by either oral misoprostol 400 μg every 3 hours or vaginal misoprostol 400μg every 6 hours for a maximum of 4 doses 36-48 hours later. There were 417 women in oral group with 198 at 8-9 weeks and 219 at 10-16 weeks, while 208 women in vaginal group with 99 at 8-9 weeks and 109 at 10-16 weeks. The outcome measures were the success abortion rate, induction to abortion interval, the amount of bleeding, reoccurrence of menstruation and adverse events. Results Abortion rate was significantly higher in vaginal group [98.1% (202/206)] than that in oral group [94.0%(390/415), P=0.023]; concerning termination of pregnancy at 8-9 weeks and 10-16 weeks respectively, there were no significant differences between oral and vaginal groups (P=0.156, P=0.073). The induction to abortion interval was no significant difference in oral and vaginal group in different gestational weeks ( P=0.238, P=0.273). The average induction to abortion interval was (4.1 ± 6.6) hours and (6.0 ± 4.5) hours respectively in terminating 8-9 weeks and 10-16 weeks of gestation. Concerning the amount of bleeding within 2 hours of placenta expulsion, there was significant difference between oral group [(63±46) ml] and vaginal group [(55 ± 45) ml] in terminating 8-9 weeks of gestation (P=0.047), while there was no significant difference between groups in terminating 10-16 weeks of gestation [oral group (76 ± 52) ml versus vaginal group (76 ± 61) ml, P=0.507]. The reoccurrence of menstruation was about 37 days in both oral and vaginal groups. Two cases of incomplete abortion were serious adverse events (SAE) relating to treatment. The common adverse events (AE) of nausea and vomiting were significantly higher in oral group [57.2% (239/417), 36.3% (151/417)] than those in vaginal group [45.4% (94/208), 26.1% (54/208); P=0.005, 0.011]. Conclusion Oral or vaginal misoprostol combined with mifepristone, is effective and safe for termination of pregnancy between 8 and 16 weeks of gestation.

Objective: To investigate the relationship between gastrointestinal disorders (GID) and core symptoms or behavioral problems among the children with autism spectrum disorder (ASD) . Method: Totally 328 children with ASD and 202 normal controls were enrolled in this cross-sectional study from August 2013 to October 2016. The information about the gastrointestinal disorders, behavioral and emotional problems was collected by using questionnaires. Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC) were used to assess the core symptoms of the children with ASD. Neurodevelopmental status was evaluated with Gesell Developmental Scale (GDS). These variables were analyzed by using student's t-test and chi-square test. Result: The prevalence of GID was significantly higher in the children with ASD than in the normally developing children (49.4% (162/328) vs.25.7% (52/202), χ²=29.039, P=0.000), especially the symptoms of constipation (33.2% (109/328) vs. 13.9% (28/202)), diarrhea (9.5%(31/328) vs. 1.5% (3/202)), nausea and vomiting (9.5% (31/328) vs. 3.5% (7/202)), and foul defecation (16.5% (54/328) vs. 5.0% (10/202)) (all P<0.05). Among the ASD children, the prevalence of GID was similar between male and female (46.7% (133/285) vs. 46.5%(20/43), χ²=0.006, P=0.938), as well as among all age groups (χ²=1.907, P=0.862). There was no significant difference in scores of GDS in the ASD children with or without GID (all P>0.05). Compared with ASD children without GID (n=166), the ASD children with GID (n=162) got higher scores in the "Body and Object Use" of ABC scale ( (16.4±9.3) vs. (12.3±6.7) scores, t=2.258, P=0.028), and had more emotional problems (63.6% (103/162) vs. 49.4% (82/166), χ²=6.707, P=0.010). Moreover, the score of behavior problems questionnaire was higher in the ASD children with GID ( (35.3±16.8) vs. (16.1±13.6) scores, t=5.748, P=0.000). Conclusion Children with ASD have higher risk of GID than the normal developing children. While the stereotyped behaviors, problem behaviors and emotional problems are severer in the ASD children with GID. Hence, it is important to provide comprehensive treatment and management for these groups of children.

Objective Triple-negative breast cancer(TNBC)poses a significant challenge for treatment efficacy.CD8+T cells,which are pivotal immune cells,can be effectively analyzed for differential gene expression across diverse cell populations owing to rapid advancements in sequencing technology.By leveraging these genes,our objective was to develop a prognostic model that accurately predicts the prognosis of patients with TNBC and their responsiveness to immunotherapy. Methods Sample information and clinical data of TNBC were sourced from The Cancer Genome Atlas and METABRIC databases.In the initial stage,we identified 67 differentially expressed genes associated with immune response in CD8+T cells.Subsequently,we narrowed our focus to three key genes,namely CXCL13,GBP2,and GZMB,which were used to construct a prognostic model.The accuracy of the model was assessed using the validation set data and receiver operating characteristic(ROC)curves.Furthermore,we employed various methods,including Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway,immune infiltration,and correlation analyses with CD274(PD-L1)to explore the model's predictive efficacy in immunotherapeutic responses.Additionally,we investigated the potential underlying biological pathways that contribute to divergent treatment responses. Results We successfully developed a model capable of predicting the prognosis of patients with TNBC.The areas under the curve(AUC)values for the 1-,3-,and 5-year survival predictions were 0.618,0.652,and 0.826,respectively.Employing this risk model,we stratified the samples into high-and low-risk groups.Through KEGG enrichment analysis,we observed that the high-risk group predominantly exhibited enrichment in metabolism-related pathways such as drug and chlorophyll metabolism,whereas the low-risk group demonstrated significant enrichment in cytokine pathways.Furthermore,immune landscape analysis revealed noteworthy variations between(PD-L1)expression and risk scores, Conclusion Our study demonstrates the potential of CXCL13,GBP2,and GZMB as prognostic indicators of clinical outcomes and immunotherapy responses in patients with TNBC.These findings provide valuable insights and novel avenues for developing immunotherapeutic approaches targeting TNBC.

Objective:To investigate the relationship between six common cytogenetic abnormalities and bone marrow pathomorphology in multiple myeloma (MM).Methods:Bone marrow biopsy was performed on 151 newly-diagnosed MM patients. Meanwhile, myeloma cells were enriched by CD138 immunomagnetic beads, and then lq+, 13q-, 17p-, t(4;14), t (11;14), t (14;16) and other common genetic abnormalities were detected using interphase fluorescence in situ hybridization (FISH). The relationship between different genetic abnormalities and biopsy morphology was compared.Results:Of the 151 patients, 15 had extramedullary infiltration (9.9%). The rate of cytogenetic abnormalities was 76.2% (115/151), of which 1q+ accounted for 49.7% (75/151), 13q-39.1% (59/151), 17p-8.6% (13/151), t(4;14) 21.2% (32/151), t(11;14) 19.2% (29/151), and t(14;16) 2.0% (3/151). The proliferation patterns of MM plasma cells were nodular (48.3%, 73/151), interstitial (33.8%, 51/151) and diffuse (17.9%, 27/151). The morphology of plasma cells was mainly mature type (58.3%, 88/151), followed by juvenile type (20.5%, 31/151), intermediate type (15.9%, 24/151) and plasmacyte type (5.3%, 8/151). According to the mSMART risk stratification system, the proliferation pattern of myeloma cells in the high-risk group was mainly diffuse type, and the morphology was mainly immature and plasmacyte type. In the middle-risk group, mature type myeloma cells were mainly nodular proliferating. In the low-risk and negative group, mature type myeloma cells were mainly interstitial proliferating. There was no difference in the probability of different proliferation modes of intermediate type plasma cells in each group.Conclusions:The proliferation pattern and morphology of plasma cells in bone marrow biopsy combined with cytogenetic markers can more accurately predict the severity and prognosis of MM.