Objective To explore the value of applying multiple disciplinary team (MDT) in the clinical practice teaching of lymphoma. Methods 5-year program clinical medicine undergraduate students of 2012 were divided into experimental and control group randomly, with 30 cases in each group. The ex-perimental group received MDT in clinical teaching through MDT conference and cases analysis. The control group received conventional teaching mainly by smal class presentation and ward round . The effect of teaching was evaluated by examination and questionnaire. The data were analyzed through t-test and chi-square test by SPSS 20.0 software. Results The results showed the students' scores of the theory knowledge test of two groups were similar to each other, but the scores of discussional topic and clinical cases analysis were higher in experimental group than control group and statistically difference [(16.5 ±2.3)vs. (10.5 ±1.8);(37.5±2.5) vs.(27.5±1.8)], (P=0.000), and the final score of two groups showed statistically difference (93.5± 5.2 vs. 76.0 ±6.2) (P=0.000). Meanwhile, questionnaire survey of satisfaction showed that 27 students of experimental group (90.0%) were interested in this new teaching model, 29 students (96.7%) believed it im-proved understanding and memory to the process of lymphoma diagnosis and treatment, 25 students (83.3%) believed it could improved the ablility to diagnose and differential diagnose lymphoma and expanded their clinical view. 28 students (93.3%) had consolidated clinical thinking, and 26 students (86.7%) improved negotiation with patients. All issues were significantly better than control group (P<0.05). Conclusions The clinical teaching model innovation based on MDT could help medical students use the cross-discipinary interviewing and make optimal treatment plan for patients. It is conducive to the cultivation of their diagnosis, differential diagnosis and clinical thinking ability, which is worthy of promotion in hematological clinical teaching.

OBJECTIVE: To observe the CT three-dimensional imaging features of the frontal recess region with advanced three-dimensional reconstruction, and develop the real image of the important anatomical structures around the region to conduct surgery. METHOD: Thirty patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard three-dimensional reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely. RESULT: After the reconstruction, we get the three-dimensional model very close to the true state of the nasal cavity-sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In these patients, the height, width and depth of the agger nasi and frontal sinus were (9.45 ± 3.60)mm, (8.08 ± 3.37)mm, (26.98 ± 6.82)mm and (26.86 ± 9.45)mm, respectively. CONCLUSION This study tried to develop the standardized techniques and measurements from three-dimensional reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The project results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.
Ethmoid Sinus ; diagnostic imaging ; Frontal Sinus ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Nasal Cavity ; Paranasal Sinuses ; diagnostic imaging ; Tomography, Spiral Computed ; methods

OBJECTIVE: The purpose of the study was to observe the three-dimensional (3D) CT imaging features of the frontal recess region with 3D reconstruction, and obtain the real image of the important anatomical structures of the region to conduct surgery. METHOD: Five patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard 3D reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely. RESULT: After the reconstruction, we get the 3D model very close to the true state of the nasal cavity--sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In this patient, the height, width and depth of the agger nasi and frontal sinus were 12.3 mm, 12.1 mm, 38.5 mm, respectively. CONCLUSION This study tried to develop the standardized techniques and measurements from 3D reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.
Adolescent ; Adult ; Aged ; Female ; Frontal Sinus ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Tomography, Spiral Computed ; Young Adult

Objective To investigate the expression of thyroid cancer-1 (TC1) and β-catenin in cervical carcinoma and precancerous lesions and their significance. Methods Immunohistochemical methods were used to examine the expression of TC1 and β-catenin in80 cervical squamous cell carcinoma (CSCC) tissues, 40 high-grade squamous intraepithelial lesions (HSIL), 40 low-grade squamous intraepithelial lesions (LSIL), and 30 normal cervical tissues. Results Although TC1 expression in CSCC was significantly higher than that in LSIL (P = 0.002) and normal cervical tissues (P ＜ 0.001), it was similar to that in HSIL (P = 0.576). TC1 expression was positively correlated with poor differentiation (P = 0.005) and advanced FIGO stage (P = 0.004) in CSCC. β-catenin expression in CSCC was significantly higher than that in LSIL (P ＜ 0.001) and normal cervical tissues (P ＜ 0.001), but was similar to that in HSIL (P = 0.907). The abnormal β-catenin expression was also correlated with poor differentiation (P = 0.025) and advanced FIGO stage (P = 0.001) in CSCC. TC1 expression was positively correlated with the abnormal β-catenin expression in CSCC (r = 0.294, P = 0.008) and cervical squamous intraepithelial lesions (r = 0.549, P ＜ 0.001). Conclusion TC1 and β-catenin expression in CSCC and HSIL was significantly higher than that in LSIL and normal cervical tissues. TC1 expression correlated with the abnormal β-catenin expression, and with poor differentiation and advanced FIGO stage of CSCC.

Objective To develop a method for determination of 13 kinds of bile acid in healthy people and patients with pri-mary liver cancer by HPLC-MS.Methods Acetonitrile was used to precipitate protein in plasma samples .The separation was per-formed on a SHISEIDO MG C18 reverse phase column (3.0 mm ×100 mm,3μm).The mobile phase were acetonitrile and water (con-taining 0.1%formic acid and 0.5%ammonia), gradient elution.The flow rate was 0.4 ml/min, the temperature of column was 25℃and the injection volume was 5 μl.Electrospray ion source (ESI) and selected ion mode (SIM) were applied for quantitative analysis under negative ion mode .Results The calibration curves of 13 kinds of bile acids were linear in the range of 3.3-4 400 ng/ml, intra-day and inter-day precision results were all less than 7%, the average recovery were 82.67%-109.75%.The result showed that the content of conjugated bile acid increased in the plasma of patients with primary liver cancer compared with the healthy control group , especially in TUDCA, TCDCA, TCA, GCA and GCDCA.Conclusion The LC -MS method was sensitive and selective which could be suitable for determination of bile acid in healthy people and patients with primary liver cancer .The study laid a foundation for the me-tabolism of bile acid in vivo and the clinical diagnosis and treatment of patients with hepatocellular carcinoma .

Objective To investigate the status of nurses′ psychological capital and analyze its influencing factors, to provide theoretical basis for improving nurses′ psychological capital for clinical nursing managers. Methods A total of 1 095 nurses in a Beijing tertiary hospital were investigated by a self-designed questionnaire about general information and psychological capital questionnaire ( PCQ ) of Chinese version. Variance analysis and multiple linear regression were used to explore the influencing factors of nurses′psychological capital.Results The mean score of psychological capital was (4.15±0.68), and the scores of dimensions from high to low were:self-efficacy (4.26±0.92), hope (4.21±0.89), toughness (4.20±0.70) and optimism (3.93±0.61). Multiple regression analysis indicated that the score of psychological capital in nurses with different titles, authorized strength, working time, departments and ages were significantly different ( F=8. 688,7.028,2.709,3. 986,3.852;P<0.01).Conclusions Theoverall nurses′ psychological capital is in the middle-high level. Nursing managers should pay more attention to the special groups, and take measures to improve their psychological capital.

Objective To explore the application and effect of "disease-characteristics nursing quality improvement" program in the nursing of patients with pancreatic cancer.Methods By convenience sampling method,13 patients with pancreatic cancer admitted to the department of general surgery of Peking University First Hospital from January to December 2011 were selected as the control group and treated by conventional nursing;while 40 patients with pancreatic cancer admitted from January to December 2015 were selected as the observation group,and treated with "disease-characterisitics nursing quality improvement"program for pancreatic cancer patients that on the basis of patient-centered and evidence-based nursing. Nursing brands of "SAFE plan" for drainage tube nursing and "360 security nutrition guard" for jejunostomy tube nursing were conducted,with the quality supervised by one nurse specialized in pancreatic cancer. The average hospitalized days and postoperative hospitalized days were compared between two groups;the nurses′ scores of specialized technique before and after the implementation of plan were also compared between two groups.Results After the implementation of "disease-characteristics nursing quality improvement",both the average hospitalized days and the postoperative hospitalized days were decreased(t=2.083,2.111;P<0.05). Nurses′ operational capacity of pumping nutrient solution through jejunostomy tube was improved(t=9.051,P<0.01).Conclusions "Disease-characteristics nursing quality improvement" for patients with pancreatic cancer is beneficial to shorten patients′ hospitalized days and improve specialized operational capability of nurses,so it worth promoting in clinic.

Objective To explore the clinical effect of "disease-characteristics nursing quality improvement" program(DNQIP)in improving the nursing quality of rectal cancer patients.Methods On basis of patient-centered and evidence-based practice,Department of General Surgery of Peking University First Hospital searched for the optimal nursing practice,created the characteristic management of rectal cancer and implemented the DNQIP program. We explored and compared the differences of patients in patient satisfaction, nurses' satisfaction,disease management index before(2012)and after(2015)the implementation of DNQIP. Results Compared with the indicatiors before the implementation,DNQIP effectively improved patient satisfaction(χ2=18.990,P<0.001),nurses' satisfaction(χ2=9.463,P=0.002),increased the number of stoma positioning(χ2=17.053,P<0.001),decreased the incidence rate of the stoma complications(χ2=5.291, P=0.021),increased outpatient follow-up number(χ2=10.459,P=0.001)and effectively shorten the average length of stay(ALOS)(t=128.34,P<0.001).Conclusions DNQIP is an effective method to improve the nursing quality of patients with rectal cancer.

Objective:To assess the changes of left ventricular systolic function and global myocardial work in heart failure with preserved ejection fraction (HFpEF) patients by speckle tracking layer-specific strain combined with myocardial work technique and explore the diagnostic value of each parameter for HFpEF.Methods:From December 2019 to December 2020, 38 HFpEF patients (HFpEF group) and 38 healthy individuals with age- and sex-matched (control group) were enrolled consecutively in the Fourth Affiliated Hospital of Harbin Medical University. Conventional ultrasound parameters were collected. Layer-specific strain and myocardial work techniques were used to obtain the global longitudinal strain (GLS) of the left ventricular endocardium, mid-myocardium, and epicardium (GLSendo, GLSmid, GLSepi), global myocardial work index (GWI), global myocardial work efficiency (GWE), global constructive work (GCW), and global wasted work (GWW). The absolute difference of GLS(ΔGLS) between endocardium and epicardium were calculate.All parameters were analyzed statistically. ROC curves were plotted to compare the effectiveness of layer-specific strain and myocardial work parameters in predicting left ventricular systolic function impairment in HFpEF patients.Results:①Left atrial diameter, interventricular septum at end-diastole, left ventricular posterior wall at end-diastole, relative wall thickness, left ventricular mass index, and average early diastolic peak velocity (E)/early diastolic tissue velocity (e′) in HFpEF group were significantly higher compared with control subjects, while late diastolic peak velocity (A), E/A, and e′ were significantly lower (all P<0.05); E, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, fraction shortening, and left ventricular ejection fraction were not different between HFpEF and control groups (all P>0.05). ②The global longitudinal strain of the left ventricule was highest in the endocardium and lowest in the epicardium. ③Compared with control subjects, HFpEF patients demonstrated significantly decreased GLSendo, GLSmid, GLSepi, ΔGLS, GWI, GWE, GCW and increased GWW (all P<0.01). ④The ROC results showed that the area under the curve of ΔGLS and GWE for predicting left ventricular contractile function impairment in HFpEF group, was 0.884 and 0.882, respectively; The cutoff values were -5.8% and 95%; The sensitivity were 84.2% and 71.1%, and the specificity was 84.2% and 89.5%, respectively. ⑤The ROC curve of combining the two technologies showed that the maximum area under the curve of the ΔGLS in tandem with GWE was 0.944, the sensitivity was 81.6%, and the specificity was 97.4%. Conclusions:Both speckle tracking layer-specific strain and myocardial work techniques can sensitively detect left ventricular myocardial function impairment in HFpEF patients at an early stage. ΔGLS and GWE are more reliable indexes for predicting left ventricular systolic function damage in HFpEF patients. Combining the two techniques can improve the diagnostic performance in HFpEF patients.

Clonal hematopoiesis with indeterminant potential(CHIP)is defined as the proportion of detectable clonal hematopoietic cells in peripheral blood exceeding 2% and without confirmed hematologic malignancy.CHIP could increase the risk of malignant diseases through changes in DNA damage response, transcriptional programming and epigenetic modification.The incidence of malignant tumors in the blood system is significantly higher in the CHIP patients than healthy person.In addition, CHIP represents a negative factor associated with aging.Recent studies have found that the incidences of infections, anemia, heart failure, thrombotic events, and tumors of the blood system in CHIP carriers were significantly increased.Starting with the epigenetic modifications, phenotypic changes and inflammatory mechanisms of CHIP-related gene mutations, this paper discussed the mechanisms of CHIP-related diseases and possible intervention aimed at aging.