This article reviews the concept, importance, and assessment tools of nurse leadership. This article introduces the characteristics of each assessment tool and its application in different cultural backgrounds, so as to provide a reference for nurses to choose appropriate assessment tools, and to provide a basis for the development of assessment tools for nurse leadership in China.

Objective To research of acupuncture for the perioperative analgesia and immune function of the breast cancer patients.Methods A total of 40 breast cancer patients who were carried out the radical operation was randomly (random number table method) divided into acupuncture combined drugs group and control group in our hospital during from 2015.1 to 2016.12. The patients in acupuncture combined drugs group was carried out acupuncture combined TCI anesthesia,and the patients in control group was carried out TCI anesthesia. The analgesic effect was evaluated by Visual analogue scales(VAS) in 2h, 6h, 12h, 24h and 48h after operation. The percentage of peripheral blood subgroups of T-lymphocytes (CD3+, CD4+, CD8+), natural killer cell (CD16+CD56+) and the ratio of CD4+/CD8+ was detected in 30 min before anesthesia,2h after beginning of operation,1d , 2d and 5d after operation.Results he VAS scores at 2 h (2.30 ± 1.12vs. 3.75 ± 1.06,t=2.378), 6 h (2.64 ± 1.23vs. 5.56 ± 1.41,t=3.289) and 12 h (3.49 ± 1.46vs. 4.99 ± 1.27,t=2.040) after operation of acupuncture combined drugs group wwere significantly lower than those of control group (P<0.05). The CD3+ (52.35％ ± 4.20％vs. 48.01％ ± 4.42％,t=2.127), CD4+ (27.81％ ± 2.72％vs. 24.96％ ± 2.60％,t=2.250), CD4+/CD8+ (1.12 ± 0.15vs. 1.01 ± 0.13,t=2.136) in acupuncture combined drugs group were significantly higher than those of the control group in 1d after operation (P<0.05). The CD16+ CD56+ 2 h (14.79％ ± 2.04％vs. 13.58％ ± 1.50％,t=2.852), 1 d (14.43％ ± 2.27％vs. 13.11％ ± 1.82％,t=2.933) in acupuncture combined drugs group were significantly higher han those of control group in 2h after beginning of operation and 1d after operation (P<0.05).Conclusions The analgesic effect of acupuncture could be applied to radical operation of breast cancer under general anesthesia. This method could protect the subgroups of T-lymphocytes and natural killer cell, and improve the immune function of breast cancer patients.

C-C motif chemokine ligand 2(CCL2)and its receptor CCR2 are closely related to tumorigenesis and tumor progression.The CCL2/CCR2 signaling axis promotes tumor progression through multiple mechanisms:CCL2 binds to CCR2 on the surface of tumor cells,and thus promotes tumor growth/survival and metastasis;more importantly,CCL2 recruits a variety of immunosuppressive cells to aggregate in the tumor microenvironment,and inhibits the function and activity of immune cells,promoting tumor progression.The article reviews the CCL2/CCR2 signaling axis and its role in tumors and tumor microenvironment,with particular focus on the advances in clinical research on drugs targeting CCL2/CCR2 signaling axis,in order to gain an in-depth and overall understanding of the mechanism of action of CCL2/CCR2 axis in tumor progression and develop more effective anti-tumor immunotherapeutic agents.

Objective:To discover the clinical features of nocturnal enuresis (NE) in adults and to detect factors that correlated with the symptom severity.Methods:This cross-sectional study recruited NE subjects from September 2017 through December 2020. All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer. Followed by documentation of history and medical records, three-day bladder diary was adopted to assess their voiding pattern, and urodynamic parameters were obtained to evaluate lower urinary tract function.Results:A total of 106 NE patients (43 male and 63 female) were identified. There is no statistical difference regarding the average age (men: 57.8±15.6 vs. women: 56.1±14.0, P>0.05) and BMI (men: 23.9±3.4 vs. women: 23.3±4.3, P>0.05) between men and women. Comorbidities are extremely common in NE patients (n=85, 80.2%), with the incidence rate higher in men compared to women [88.4% (38/43)vs. 74.6% (47/63), P<0.05]. Hypertension (n=58, 54.7%), hyperlipemia (n=41, 38.7%), diabetes mellitus (n=38, 35.8%), coronary heart disease (n=22, 20.8%) were the most frequently reported conditions. On bladder diaries, subjects were frequently manifested nocturnal polyuria (NP, 47/106, 44.3%), reduced nocturnal bladder capacity (NBC, 74/106, 69.8%), or combination of both(33/106, 31.3%). Urodynamic studies suggested that the incidence of reduce bladder compliance, detrusor overactivity (DO), stress incontinence, bladder outlet obstruction(BOO), detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106), 39.6%(42/106), 17.9%(19/106), 9.4%(10/106), 25.5%(27/106)and 15.1%(16/106), respectively. Women were more likely to suffer from stress urinary incontinence [2.3%(1/43) men vs. 28.6% (18/63) women, P<0.01], while men were prone to have bladder outlet obstruction [ 23.3%(10/43) men vs. 0 women, P<0.01]. Correlation analysis demonstrated that obesity( r=0.63, P<0.01), systemic comorbidities( r=0.40, P<0.01), presence of NP( r=0.50, P<0.01) and NP+ NBC( r=0.47, P<0.01), post-void residual( r=0.53, P<0.01), reduced compliance( r=0.21, P=0.04), DU( r=0.28, P<0.01), stress incontinence( r=0.42, P<0.01)and DHIC ( r=0.35, P<0.01)are positively correlated with NE severity. Whereas, reduced Q max( r=-0.35, P<0.01), low capacity( r=0.21, P=0.03), and reduced bladder sensation( r=-0.21, P=0.03) correlate negatively with NE severity. Conclusions:The presence of NE is not only a sign of bladder dysfunction, but also an implication of obesity, systematic chronic diseases, urine production malfunctioning. Therefore, a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully, so that, an integrated and personalized treatment can be carried out.

Objective To construct an optimal prediction model for lymph node metastasis(LNM)in early gastric cancer(EGC)using machine learning techniques and assess its predictive performance.Methods Clinical data of 433 EGC patients undergoing radical surgery in our hospital from January 2015 to December 2022 were collected.They were divided into a training set and a validation set in a 7:3 ratio.LASSO regression was used to screen variables and multivariate logistic regression analysis was employed to identify independent risk factors for LNM in the EGC patients.Ten machine learning models were constructed using categorical boosting(Catboost),light gradient boosting machine(LightGBM),extreme gradient boosting machine(XGboost),random forest(RF),gradient boosting machine(GBM),neural networks(NNET),support vector machine(SVM),K nearest(KNN),Naive Bayes(NB)and Logistic regression.The predictive power of the above models was evaluated and compared in terms of accuracy,precision,recall,F1 score value,sensitivity,specificity,positive predictive rate,negative predictive rate,Kappa value,area value under the receiver operating characteristic curve(AUC),calibration curve,decision curve,and precision-recall curve.Finally,SHAP(SHapley Additive exPlanations)was applied to explain the contribution of each variable in the best model for the prediction outcomes.Results Depth of tumor invasion,lymphovascular invasion and smoking history were independent risk factors for LNM in the EGC patients.Catboost model obtained the best predictive performance,and had 5 performance indicators outperforming the other models in the training set,that is,an AUC value of 0.904(95％CI 0.868～0.940),a F1-score of 0.633,a Brier score of 0.100,a negative predictive rate of 0.975,and a Kappa value of 0.520.Finally,calculating the SHAP values of Catboost revealed that the depth of tumor invasion and lymphovascular invasion were two key characteristic variables for predicting LNM.Conclusion The depth of tumor invasion of submucosal and lymphovascular invasion and smoking history are independent risk factors for LNM in early gastric cancer.ML can be used to predict LNM risk,the Catboost model has the best predictive performance and can provide guidance for clinical diagnosis and treatment decisions.

Objective:To retrieve, evaluate and summarize relevant evidence of parastomal hernia prevention and management, so as to provide a reference for clinical nursing.Methods:We used computer systems to search and screen the related guidelines, evidence summary, recommended practices, expert consensus and systematic reviews on the prevention and management of parastomal hernia in the official websites of ostomy-related associations, guide networks, and databases. The research time limit was from the establishment of the database to July 2, 2020. Two systematically trained researchers evaluated the quality of the articles, and extracted data and evidence from the articles that met the quality standards.Results:A total of 9 articles were included, involving 6 guidelines, 1 recommended practice and 2 systematic reviews. A total of 15 best pieces of evidence were summarized, including 5 aspects, namely diagnostic standards, classification, risk factors, prevention and management.Conclusions:If medical personnel can accurately identify the risk factors of parastomal hernia, and carry out early prevention and management, it can reduce the incidence of parastomal hernia and/or alleviate the discomfort caused by parastomal hernia, thereby improving the patient's quality of life. It is suggested that clinical nursing staff can transform in a targeted manner according to specific clinical situations to improve the quality of clinical nursing.

Objective:To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods:Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups: the interstitial cystitis(IC)group(n=28), the neurogenic bladder(NB)group(n=36), the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14). Different sets of evaluation parameters were used for different diseases.Patients’ baseline data and data in stage I(test phase)and stage Ⅱ(permanent SNM)were recorded, statistically analyzed and compared.Results:Ninety-one people underwent SNM treatment.Of them, 53 patients received permanent implants(stage Ⅱ), and the total conversion rate of stage I to stage Ⅱ was 58.2%(53/91). Patients receiving permanent implants(stage Ⅱ)had a preoperative period ranging from 3 months to 30 years, and were followed up for 2 to 58 months after treatment, with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 35.4%, 31.6%, 33.7%, 32.6%, 49.2%, 43.2% and 13.2%, respectively.The improvement rates in stage Ⅱ for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 43.2%, 40.0%, 37.8%, 50.5%, 70.5%, 70.4% and 43.2%, respectively.Three adverse events occurred, including 1 case of recurrent symptoms, 1 case of moderate infection, and 1 case of electrical lead dislocation.Conclusions:Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve stimulation.

Objective:To discuss the effect of adipose-derived stem cell-derived exosomes(ADSC-Exos)on the migration ability of the macrophages RAW264.7,and to clarify its role in promoting function of the macrophages.Methods:The adipose tissue adjacent to epididymis of the SD rats was isolated to perform primary culture of the adipose-derived stem cells(ADSCs).The adipogenic and osteogenic differentiation induction was conducted,and the multidirectional differentiation potential of the ADSCs was detected by oil Red O and Alizarin red staining.Western blotting and immunofluorescence methods were used to detect the positive expressions of the ADSCs markers CD29 and CD44;the ADSC-Exos were extracted by Exos isolation kit,and the morphology,size,and distribution of particle size of the ADSC-Exos were examined by transmission electron microscope and nanoparticle tracking analyzer;the expression levels of exosome-specific markers CD9 and TSG101 proteins in the ADSC-Exos were detected by Western blotting method;the uptake of ADSC-Exos by the macrophages was observed by tracing method.The macrophages RAW264.7 were divided into control group,10 mg·L-1 ADSC-Exos group,20 mg·L-1 ADSC-Exos group,and 40 mg·L-1 ADSC-Exos group.The activities of the macrophages in various groups were detected by 5-ethynyl-2'-deoxyuridine(EdU)staining;the number of migration macrophages in various groups was detected by Transwell chamber assay;the adhesion of macrophages in various groups was observed by fluorescence microscope.Results:After 24 h of primary culture,the ADSCs adhered to the wall and exhibited scattered,elongated shapes;after 7 d of culture,the adherent cells showed a comb-like,vortex-like orderly arrangement,resembling fibroblasts;after 10 passages,the irregular morphology of the ADSCs and decreased proliferation rate were found.The isolated ADSCs showed potential for the osteogenic and adipogenic differentiation,and the expressions of CD29 and CD44 proteins were positive.The transmission electron microscope observation resuls showed that the ADSC-Exos appeared disc-shaped,and the main peak of particle size distribution was around 132 nm.The CD9 and TSG101 proteins were positively expressed in the ADSC-Exos,indicating successful extraction.The fluorescence microscope results showed red fluorescence signals around the nuclei of the RAW264.7 cells,indicating the uptake of ADSC-Exos by the macrophages.Compared with control group,the rates of EdU positive cells in 10,20,and 40 mg·L-1 ADSC-Exos groups were significantly increased(P<0.05);compared with 10 mg·L-1 ADSC-Exos group,the rate of EdU positive cells in 20 mg·L-1 ADSC-Exos group was significantly increased(P<0.05).Compared with control group,the numbers of migration cells in 10,20,and 40 mg·L-1 ADSC-Exos groups were significantly increased(P<0.05);compared with 10 mg·L-1 ADSC-Exos group,the numbers of migration cells in 20 and 40 mg·L-1 ADSC-Exos groups were significantly increased(P<0.05).Compared with control group,the numbers of the adherent macrophages in 10,20,and 40 mg·L-1 ADSC-Exos groups were significantly increased(P<0.05);compared with 10 mg·L-1 ADSC-Exos group,the number of adherent macrophages in 20 mg·L-1 ADSC-Exos group was significantly increased(P<0.05).Conclusion:The ADSC-Exos can be internalized by the macrophages and they can enhance the migration ability of the macrophages by affecting the cell adhesion.

Objective:To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment.Methods:Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively.Results:A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0-Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately-poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation ( P<0.001), and moderately and moderately-poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3-25 months, and no signs of local recurrence or metastasis were found. Conclusion:Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short-term efficacy.