Objective To explore the problems and solving countermeasures in application of nursing vertical management,and provide references for nursing post management reform.Methods Through purposive sampling method,nursing administers,clinical nurses,heads of clinical departments and performance directors from five hospitals were interviewed by semi-structured interview method.Data were analyzed using 7-step Colaizzi's phenomenological analysis method.Results Four themes were formed about the problems in application of nursing vertical management,including:affecting department management and doctor-nurse collaboration,insufficient scientificity and fairness of performance evaluation,significant issues regarding post setting of senior nurses,competence and sense of belonging of temporarily deployed nurses.Four themes were formed about the solving countermeasures in application of nursing vertical management,including:improving participation of clinical departments in nursing management,making performance system to public and asking advices of nurses,providing career development for senior nurses,and conducting standardized training and establishing reserve nurses tank.Conclusion The main problems in application of nursing vertical management consisted of affecting department management and doctor-nurse collaboration,insufficient scientificity and fairness of performance evaluation,post setting of senior nurses,and competence and sense of belonging of temporarily deployed nurses.We suggested to better apply nursing vertical management by improving participation of clinical department in nursing management,making performance system to public and asking advices of nurses,providing career development for senior nurses,and conducting standardized training and establishing reserve nurses tank.

Objective To study the effects of Cad-Ⅱgene on osteogenic differentiation of human mesenchymal stem cells in vitro. Methods The human marrow mesenchymal stem cells (hBMSCs) were isolated and cultured in vitro before they were divided into 2 groups. In the transfeetion group, the hBMSCs were transfeeted with Cad- Ⅱgene;in the simple osteogenic inducement group, they were cultured in the condition medium. Then the expressions of Cad- Ⅱ protein were determined and the alkaline phosphatase (ALP) activities and the expressions of ostcocalein were measured at 3, 7, 14 and 21 days for comparison between the 2 groups. Results The ALP activity and positive expression of osteoealcin were regulated significantly higher in the transfeetion group than in the simple osteogenic inducement group at different times (P <0.05). The mineralized nodes began to appear at 14 days in the 2 groups and increased with time. Conclusion Cad-Ⅱgene transfeetion can promote differentiation of hBMSCs into the osteoblasts.

The aim of this study was to investigate the effect of Compound Yihe Tea on improving insulin resistance in obesity mice. Thirty-two male C57BL/6J mice were randomly divided into 4 groups: the normal fat diet group(NFD group), high fat diet group(HFD group), Compound Yihe Tea low dosage group［20 mg/(kg ·d), YH-L group］ and high dosage group［40 mg/(kg ·d), YH-H group］. NFD group was given standard feed, and the remaining mice were administered with high fat diet. After 6 weeks, YH-H and YH-L groups were given Compound Yihe Tea for 6 weeks. Blood glucose was measured at week 11 and serum levels of total cholesterol(TC), serum triglyceride(TG), low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)were measured at week 12. Liver tissues were prepared for oil red O and HE staining. Immunohistochemical analysis was used to test the protein expression of GLUT4 in liver. Protein expressions of PI3K, Akt and GLUT4 in epididymis white adipose tissue(WAT)were tested by Western blot. The results showed that Compound Yihe Tea could effectively reduce body weights and the serum levels of TC, TG and LDL-C. Furthermore Compound Yihe Tea could improve the histopathological changes of liver, up-regulate the protein expression of PI3K, Akt and GLUT4 in epididymis WAT and the protein expression of GLUT4 in liver. Compound Yihe Tea can reduce the fat accumulation in liver tissue, improve the indexes of blood glucose and lipid levels, and improve insulin resistance via PI3K-AKT-GLUT4 pathway.

To compare the performance of ArcCheck and film verification for volumetric intensity modulated arc therapy (VMAT) in the treatment of nasopharyngeal carcinoma, and to study the feasibility of ArcCheck in VMAT dosimetric verification. Five patients of nasopharyngeal carcinoma treated with VMAT were enrolled in this study. Dose verification was carried out by ArcCheck and film respectively. The result showed that there were no significant differences between ArcCheck and film verification. ArcCheck software can obtain three dimensional dose distribution directly with simple operation. It is convenient for ArcCheck to be used for VMAT dosimetric verification.
Carcinoma ; Humans ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Software

Objective To investigate the clinical pathologic features of a distinct variant of focal cortical dysplasia (FCD) characterized by neuronal loss of layer four.Methods Between 2005 and 2017,approximately 3 000 surgeries were performed for the treatment of intractable epilepsy at Xuanwu Hospital,Capital Medical University and Yuquan Hospital,Tsinghua University.Retrospective analysis of clinic-pathological data of patients with epilepsy surgery was made and histological manifestations of neuronal loss of cortical layer four were included in this study.Results In this cohort,25 patients (22 males and three females) were identified with early onset pharmaco-resistant epilepsy and regionally circumscribed neuronal loss of cortical layer four in surgical specimens from the occipital lobe.Histologically,except for neuronal loss in cortical layer four in all cases,glial scar lesions were found in some patients.Thus the histology of those cases can be subdivided into two groups:group A (13 cases):neuronal loss of cortical layer four without glial scar lesions;and group B (12 cases):neuronal loss of cortical layer four with glial scar lesions.Due to the prominent horizontal disorganization of cortical layering and lack of any other microscopically visible principle lesion,group A should be classified hitherto as FCD International League Against Epilepsy (ILAE) type Ⅰ b,however,group B with scar lesions and cortical dysplasia around the main leision,should be classified as FCD ILAE type Ⅲd.This retrospective analysis of clinical histories revealed a perinatal distress in 20 patients (80％),suggesting an acquired pathomechanism.Magnetic resonance imaging revealed abnormal signals in the occipital lobe in all patients,and signal changes suggestive of encephalomalacia were found in 18 patients.Surgical treatment achieved favorable seizure control (Engel class Ⅰ and Ⅱ) in 18 patients (75％ among 24 available follow up).Comparion of the two groups with age at epilepsy onset (group A:5.00±2.76,group B:5.01±3.78),the proportion of perinatal distress (group A:11/13,group B:9/12) and the follow-up results (favorable seizure control of the two groups was 9/13,9/11 respectively) showed that there was no statistically significant difference between the two groups.Conculsion Neuronal loss of cortical layer four in the occipital lobe should be classified as a distinct variant of FCD ILAE type Ⅲd.

Distant metastasis is one of the main obstacles to cancer treatment.Overexpression of S1PR1 in malignant tumors enhances cell invasion and migration activity,mediates EMT and induces lymphangiogenesis and angiogenesis via activation of its downstream signaling pathways,eventually results in the occurrence of tumor metastasis.S1PR1 is also closely related to generation of acquired radiotherapy resistance.This article discusses the roles of S1PR1 in tumor metastasis and radiotherapy resistance.

Objective:To observe the expression of vascular endothelial growth factor (VEGF) and aquaporin 4 (AQP4) in the inner limiting membrane (ILM) of diabetic retinopathy (DR) with macular edema, and analyze the correlation between VEGF and AQP4 expression.Methods:A cross-sectional study. From September 2019 to September 2020, 38 eyes of 38 patients with DR and idiopathic macular hole (iMH) who underwent vitrectomy (PPV) combined with ILM stripping at the Hangzhou campus of The Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. Among them, there were 25 males and 13 females who aged 37-76 years old, average age was 59±10 years old; All eye included 15 right eyes and 23 left eyes. iMH and DR included 9 eyes in 9 cases and 29 eyes in 29 cases, respectively, and they were divided into iMH group and DR group. The DR group was divided into DME group and no DME group according to whether it was accompanied by diabetic macular edema (DME), with 14 eyes and 15 eyes respectively. After the stripped ILM tissue was fixed, immunofluorescence analysis was performed to obtain a picture of the fluorescence mode of AQP4 and VEGF, and the fluorescence intensity value of VEGF and AQP4 was measured by Image J software. The differences of VEGF and AQP4 immunofluorescence values in the specimens between groups were compared by one-way analysis of variance. The correlation between the fluorescence intensity of AQP4 and the fluorescence intensity of VEGF was analyzed by Pearson correlation analysis.Results:The average fluorescence intensity valuesof VEGF and AQP4 in ILM specimens of DME group, no DME group and iMH group were 38.96±7.53, 28.25±3.12, 30.07±4.84 and 49.07±8.73, 37.96±6.45, 38.08±5.04, respectively. The average fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DME group was significantly higher than that of the no DME group and iMH group, and the difference was statistically significant ( F=13.977, 9.454; P<0.05). The average fluorescence intensity values of VEGF and AQP4 on IML specimens in the DR group were 33.80±7.91, 43.76±9.44, respectively. The results of Pearson correlation analysis showed that the fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DR group was significantly positively correlated ( r=0.597, P=0.003). Conclusions:The expressions of VEGF and AQP4 in ILM of eyes with DR and DME are significantly increased compared with those without DME. The expression of VEGF and AQP4 in ILM of eyes with DR is positively correlated.

Objective:To investigate the application effects of free transplantation of autologous omentum in treating maxillofacial infection complicated with complex sinus tract.Methods:The retrospective observational study method was used. Four patients with maxillofacial infection complicated with complex sinus tract were admitted to Department of Burns and Plastic Surgery of the Second Affiliated Hospital of Air Force Medical University from July 2017 to the December 2019, including 3 males and 1 female aged 36-60 years. Preoperative facial computed tomography (CT) was performed on patients for calculating the volume of sinus tract. During the operation, the sinus tract was thoroughly debrided, and the volume of the tissue defect was about 5 cm×3 cm×2 cm-10 cm×5 cm×3 cm after debridement. The tissue defect area was filled with omentum of 100-300 mL which was cut under laparoscopy. The artery and vein on the right side of the omentum were reserved as the vascular pedicle of the donor area, which were anastomosed with the facial artery and external jugular vein of the recipient area. The survival of omentum, and the occurrences of reinfection and complication were observed after operation, respectively. On the 10th day and in 1 month after the operation, the blood supply of omentum was examined by colored Doppler ultrasound and CT angiography, and the filling of tissue defect area was examined by head and face CT. During follow-up after the operation, the recoveries of face appearance and function and scar hyperplasia in the donor area.Results:The transplanted omentums in 4 patients survived after the operation with no reinfection and complication. On the 10th day and in 1 month after the operation, the transplanted omentums had good blood supply, and the filled area with omentum was in good shape, without formation of dead cavity. During follow-up of 6-10 months after surgery, the appearance and function of face recovered well, and there was no obvious scar hyperplasia in the donor area.Conclusions:After free transplantation of omentum in treating maxillofacial infection with complex sinus tract, the patients have good facial appearance and function, and the application of laparoscopy results in little damage to the patients and quick postoperative recovery.

Evidence indicates that metabolic reprogramming characterized by the changes in cellular metabolic patterns contributes to the pathogenesis of pulmonary fibrosis(PF).It is considered as a promising ther-apeutic target anti-PF.The well-documented against PF properties of Tanshinone ⅡA(Tan ⅡA)have been primarily attributed to its antioxidant and anti-inflammatory potency.Emerging evidence suggests that TanⅡA may target energy metabolism pathways,including glycolysis and tricarboxylic acid(TCA)cycle.However,the detailed and advanced mechanisms underlying the anti-PF activities remain obscure.In this study,we applied[U-13C]-glucose metabolic flux analysis(MFA)to examine metabolism flux disruption and modulation nodes of Tan ⅡA in PF.We identified that Tan ⅡA inhibited the glycolysis and TCA flux,thereby suppressing the production of transforming growth factor-β1(TGF-β1)-dependent extracellular matrix and the differentiation and proliferation of myofibroblasts in vitro.We further revealed that Tan ⅡA inhibited the expression of key metabolic enzyme hexokinase 2(HK2)by inhibiting phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR)/hypoxia-inducible factor 1α(HIF-1α)pathway activities,which decreased the accumulation of abnormal metabolites.Notably,we demonstrated that Tan ⅡA inhibited ATP citrate lyase(ACLY)activity,which reduced the collagen synthesis pathway caused by cytosol citrate consumption.Further,these results were validated in a mouse model of bleomycin-induced PF.This study was novel in exploring the mechanism of the occurrence and develop-ment of Tan ⅡA in treating PF using 13C-MFA technology.It provided a novel understanding of the mechanism of Tan ⅡA against PF from the perspective of metabolic reprogramming.

Objective:To investigate the differences in estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 expressions between metastatic sites and primary sites in metastatic triple-negative breast cancer (TNBC) patients and to analyze their effects on the prognosis of patients.Methods:A retrospective cohort study was conducted. The clinicopathological data of 108 patients diagnosed with metastatic TNBC in Lianyungang Hospital Affiliated to Xuzhou Medical University from September 2018 to September 2023 were collected. Local metastatic sites included ipsilateral axillary lymph nodes and chest wall, while distant metastatic sites encompassed contralateral axillary lymph nodes and chest wall, bilateral supraclavicular lymph nodes, cervical lymph nodes, bone and viscera. The metastatic sites were identified as metastatic TNBC by using immunohistochemistry (IHC) and/or fluorescence in situ hybridization. The heterogeneity in ER, PR, HER2, and Ki-67 expression between primary sites and metastatic sites in all patients and those with local and distant metastases was analyzed, and the heterogeneity was defined as the inconsistency in the expression of markers including loss and gain expressions between primary sites and metastatic sites. The Kaplan-Meier method was used to analyze disease-free survival (DFS), and log-rank test was used for comparison among groups.Results:All patients were female, with an average age of (55±10) years; 51 cases had local metastases, and 57 cases had distant metastases. In metastatic sites, no ER and PR positivity were observed; in primary sites, 28.7% (31/108) of patients were ER positive and 21.3% (23/108) of patients were PR positive, and there were statistically significant differences in the proportion of patients with ER or PR positive between primary sites and metastatic sites (all P < 0.001). There were no statistically significant differences in the proportions of patients with different expression status including HER2 [positive: 0 (0/108) vs. 4.6%(5/108), low expression: 50.0% (54/108) vs. 45.4% (49/108), negative: 50.0% (54/108) vs. 50.0% (54/108)], Ki-67 [high expression: 86.1% (93/108) vs. 91.7% (99/108)] between metastatic sites and primary sites (all P > 0.05). The proportions of patients with inconsistent ER and PR expression between metastatic sites and primary sites were 28.7% (31/108) and 21.3% (23/108), respectively, all due to the expression loss in metastatic sites; the proportions of patients with inconsistent HER2 and Ki-67 expression between metastatic sites and primary sites were 42.6% (46/108) and 11.1% (12/108), respectively, with HER2 and Ki-67 expression loss of metastatic sites accounting for 22.2% (24/108) and 8.3% (9/108), respectively and expression gain accounting for 20.4% (22/108) and 2.8% (3/108), respectively. The proportions of patients with inconsistent ER [45.6% (26/57) vs. 9.8% (5/51)], PR [36.8% (21/57) vs. 3.9% (2/51)] and Ki-67 [17.5% (10/57) vs. 3.9% (2/51)] expression in distant metastatic sites and primary sites were higher than those with local metastatic sites and primary sites, and the differences were statistically significant (all P < 0.05). The proportions of patients with inconsistent HER2 between distant metastatic sites and primary sites and those with inconsistent HER2 between local metastatic sites and primary sites were 47.4% (27/57), 37.3% (19/51), respectively, and the difference was not statistically significant ( P = 0.300). Patients with inconsistent ER and Ki-67 expressions had better DFS than those with consistent expressions, with median DFS time of 30 months (95% CI: 22-40 months) vs. 22 months (95% CI: 22-24 months) for ER and 28 months (95% CI: 20-61 months) vs. 22 months (95% CI: 22-24 months) for Ki-67, and the differences were statistically significant (all P < 0.05). There were no significant differences in DFS between metastatic sites and primary sites with consistent expressions of PR and HER2 or not (all P > 0.05). Conclusions:There are differences in ER and PR expressions between primary sites and metastatic sites of metastatic TNBC patients, while the expressions of HER2 and Ki-67 seem to be no differences. The inconsistency of ER, PR and Ki-67 expressions with primary sites in distant metastatic sites are more common compared with in local metastatic sites. The differences in hormone receptor expression between primary sites and metastatic sites may impact patients' DFS.