Creatinine, uric acid, hypoxanthine and xanthine are important diagnostic biomarkers in human urine for gouty arthritis or renal disease diacrisis. A simple method for simultaneous determination of these biomarkers in urine based on reversed-phase high-performance liquid chromatography (RP-HPLC) with ultraviolet (UV) detector was proposed. After pretreatment by dilution, centrifugation and filtration, the biomarkers in urine samples were separated by ODS-BP column by elution with methanol/50 mM NaH2PO4 buffer solution at pH 5.26 (5:95). Good linearity between peak areas and concentrations of standards was obtained for the biomarkers with correlation coefficients in the range of 0.9957-0.9993. The proposed analytical method has satisfactory repeatability (the recovery of data in a range of creatinine, uric acid, hypoxanthine and xanthine was 93.49-97.90%, 95.38-96.45%, 112.46-115.78%and 90.82-97.13%with standard deviation of o5%, respectively) and the limits of detection (LODs, S/N Z 3) for creatinine, uric acid, hypoxanthine, and xanthine were 0.010, 0.025, 0.050 and 0.025 mg/L, respectively. The established method was proved to be simple, accurate, sensitive and reliable for the quantitation of gouty arthritis' biomarkers in human urine samples. The ratio of creatinine to uric acid was found to be a possible factor for assessment of gouty arthritis.

We analyzed genetic evolution characteristics of avian influenza A (H7N9) virus isolated in Zhaoqing,China,2014-2016.Nucleic acid were extracted and sequenced from 17 samples of H7N9 positive cases in Zhaoqing.Genetic characteristics of homology and important amino acid sites were analyzed by using BioEdit5.0 and MEGA6.0.The evolutionary trees were constructed by Neighbor-Joining and the referenced sequences were downloaded from GenBank,Eight nucleic acid fragments from 7 strains of H7N9 viruses were successfully generated.The highest homology was found in HA gene with A/chicken/Dongguan/695/2014(H7N9),and NA gene with A/chicken/Dongguan/1075/2014(H7N9).The internal genes were high homology with avian H7N9 and H9N2 virus from Dongguan and Shenzhen in Guangdong,China.The HA and NA genes were directly evolved in the Pearl River Delta evolution branch with the H7N9 sequences from the cities of Dongguan,Guangzhou and Shenzhen,while the sequences from the provinces of Anhui,Zhejiang,and Jiangsu were in the Yangtze River Delta evolution branch.There were 2 alkaline amino acids in cleavage site of HA,2 mutations (G186V and Q226L) in the crucial sites related with the receptor of HA protein,1 mutation (E627K) in PB2 protein,and 1 drug resistance mutation (S31N) in M2 protein.And no evidence of neuraminidase resistance in NA protein was found.In conclusion,the H7N9 virus for human infection in Zhaoqing may originate from avian H7N9 and H9N2 viruses,which circulated in the Pearl River Delta region of Guangdong from 2013 to 2014.The mutations of G186V,Q226L and E627 K might be related with high susceptibility to human beings.

Objective: To establish a TaqMan-MGB probe-based real-time fluorescence RT-PCR assay for avian influenza H5N6 virus used in rapid diagnosis for suspected cases and surveillance for outer environment of live poultry markets. Methods: Based on the conservative sequences of avian influenza H5N6 virus for HA and NA gene published on GenBank, specific primers and TaqMan-MGB probes were designed to develop and optimize for the dual real-time RT-PCR assay. Specificity, sensitivity, repeatability and comparison tests were carried out. Results: This dual real-time RT-PCR detection can be completed within 80 minutes. There was no cross-reaction with other subtypes of influenza virus and common respiratory pathogens. The minimum detection limit could be up to 10 copies/reaction. The correlation coefficient of standard curve for the gene of H5 and N6 were 0.999 and 0.993, and the coefficients of variation for cycle threshold were range from 0.151%-0.549%and 0.213%-0.575%, respectively. The positive and negative coincidence rates of the validation test were 100%. Conclusions This TaqMan-MGB probe-based dual real-time RT-PCR for avian influenza H5N6 virus was rapid, specific and sensitive. It will have a good use in early emergency detection of suspected cases and continuous monitoring of external environment in live poultry trade market.

Objective:To explore the current situation of attitudes toward seeking professional psychological help among parents of premature infants, and to analyze its influencing factors.Methods:From January to September 2019, this study selected 121 parents of premature infants at two ClassⅢ Grade A hospitals of Zhejiang Province as subjects by convenience sampling. Those parents were investigated with the General Information Questionnaire, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF) , Simplified Coping Style Questionnaire (SCSQ) and the General Self-Efficacy Scale (GSES) . A total of 121 questionnaires were sent out and 112 valid questionnaires were collected with 92.6% for the valid recovery rate.Results:Among 112 parents of premature infants, the total score of ATSPPH-SF was (18.11±3.76) . There were statistical differences in the total score of ATSPPH-SF among parents with different body weight of premature infants, parents' genders, places of residence and family monthly income ( P<0.05) . Among parents of premature infants, the total score of ATSPPH-SF had a positive correlation with positive coping style ( r=0.337, P<0.05) , and had negative correlations with scores of negative coping style and self-efficacy ( r=-0.319, -0.296, P<0.05) . Multiple linear regression analysis showed that the influencing factors of attitudes toward seeking professional psychological help among parents of premature infants included the body weight of premature infants, family monthly income, positive coping style and self-efficacy with statistical differences ( P<0.05) . Conclusions:Nursing managers should pay attention to the attitudes toward seeking professional psychological help among parents of premature infants, especially in those with low levels of body weight of premature infants, family monthly income and self-efficacy. Nursing managers also should help them to establish the positive coping style so as to improve parents' acceptance of seeking professional psychological help.

Objective To explore the effect of disease management programs (DMPs) on prevention of recurrence of ischemic stroke (IS).Methods This study was a prospective follow-up study which included 182 subjects with IS between January 2012 and December 2013. These subjects were divided into study group (n=88) and control group (n=94) randomly. The patients of study group received six months of DMPs and the pa-tients of control group received conventional health education at discharge.Results The follow-up was carried out 33 months (6-45 months) averagely in two groups. 5 cases recurred IS in the study group, with the time to recurrence of 20 (10-35) months, and 3-year recurrence-free survival rate was 92.8%; 14 cases recurred IS in the control group, with the time to recurrence of 13 (4-28) months, and 3-year recurrence-free survival rate was 84.3%. Recurrence-free survival rate in study group was significantly increased than the control group(χ2=4.371, P<0.05).Conclusions Disease management programs can significantly reduce the recurrence of ischemic stroke, which is worthy of applying in clinical work further.

Objective To investigate the application value of case-based learning (CBL) combined with teaching rounds in the standardized training of residents in department of hematology. Methods A total of 124 residents who received standardized training in department of hematology from August 2015 to July 2018 were selected and randomly divided into experimental group and control group. The residents in the experimental group received the teaching method of CBL combined with teaching rounds, while those in the control group received traditional teaching rounds. The two groups were compared in terms of department examination scores and teaching quality. Results Compared with the control group, the experimental group had significantly higher scores of the department examinations of hematological theoretical knowledge and case analysis (P<0.05). The residents in the experimental group thought that the new teaching method of CBL combined with teaching rounds could stimulate their interest in learning hematological diseases, improve self-study abilities , help them to combine theoretical knowledge with clinical practice , enhance their knowledge of hematological diseases, and cultivate their clinical thinking ability. Conclusion CBL combined with teaching rounds has achieved good results in standardized training of residents in department of hematology, and thus it holds promise for application in standardized training of other specialties in internal medicine.

Objective To establish a predictive model using multiple layer perceptron (MLP) for short-term outcome after subacute ischemic stroke.Methods From January, 2019 to September, 2021, 60 readmission-inpatients in Department of Rehabilitation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were collected the clinical features of first admission (less than 30 days after attack), and the outcomes were assessed with modified Rankin Scale (MRS) three months after the first admission. The risk factors were screened with single factor analysis, and the short-term outcome predictive models were established with multi-factor Logistic regression and MLP. The predictive accuracy of both models was calculated, and the predictive effects were compared with Receiver Operating Characteristic (ROC) curve.Results For multi-factor Logistic regression, the predictive accuracy was 73.3%, and the area under ROC curve was 0.851. For MLP, the predictive accuracy was 88.9%, and the area under the ROC curve was 0.930.Conclusion The prediction of short-term outcome after subacute ischemic stroke can be done with MLP model.