Objective To determine the protein expression level of p-STAT1 and STAT1 in thyroid cancer and its correlation with clinical pathological parameters,especially with lymph node metastasis and relapse-free survival.Methods p-STAT1 and STAT1 protein were measured by immunohistochemical staining in 80 cases of primary thyroid carcinoma and matched normal controls.All samples were selected from the pathological storage in the Jiangdong 22nd Zone,of Zhuji People's Hospital.The correlation between p-STAT1,STAT1 and patients clinical pathological parameters was analyzed.74 out of 80 patients were followed up over 3 years to analyze the potential relationship between expression of p-STAT1 and STAT1 and relapse-free survival.Results The positive expression of p-STAT1 and STAT1 was 28.8％ and 90.0％ in thyroid cancer tissue versus 85.0％ and 50.0％ in normal thyroid tissue.The difference was statistically significant(P ＜ 0.05).The positve expression of p-STAT1 in stage Ⅲ and Ⅳ thyroid cancers was significantly lower than in stage Ⅰ and stage Ⅱ thyroid cancer(P ＜ 0.05).There was negative correlation between the expression of p-STAT1 and tumor stage and lymph node metastasis,while the expression of STAT1 was irrelevant.Furthermore,the relapse-free survival was 100％ in p-STAT1 positive patients,and 92.65％ in STAT1 positive group.Conclusion p-STAT1 protein level,negatively correlating with tumor stage and lymph node metastasis,down regulates in primary thyroid cancers,and may be a novel biomarker for thyroid cancer metatstasis.

Objective To develop a new type of oxygen mask, which has adjustable vent and can be removable. Methods An adjustable and removable vent below the mask was added to the conventional mask, so the problem of taking off the mask for interrupted oxygen inhalation was solved. The change of the passage of the oxygen import and export could add comfort, keep away from the operation area of the neck,chest area, etc. The new mask had a filmy hole in each side which was for gastrointestinal drainage tubes,which increased tighmess. Results The new mask improved the effect of oxygen inhalation, added comfort to patients and was convenient for medical operation. Conclusions The mask is innovative and can be widely used in clinic.

Objective:To investigate the serum levels of soluble Fas (sFas) and soluble FasL (sFasL) in elderly patients with skin cancer and its clinical significance.Methods:Eighty-two elderly skin cancer patients who underwent surgical treatment in Zhuji People′s Hospital and Zhejiang Provincial People′s Hospital from January 2014 to December 2017 were selected as the skin cancer group, and 82 healthy elderly patients were selected as the control group. The serum sFas and sFasL levels were determined by double anti sandwich enzyme linked immunosorbent assay (ELISA).Results:The serum levels of sFas and sFasL in the skin cancer group were higher than those in the control group [(21.06 ± 3.23) μg/L vs. (5.64 ± 1.18) μg/L, (14.52 ± 3.42) μg/L vs.(3.27 ± 0.96) μg/L], there were significant differences ( t=40.606, 28.679, P<0.05). The serum sFas and sFasL levels were closely related to pathological grade and lymph node metastasis. The serum levels of sFas and sFasL in patients with pathological grade Ⅲ-Ⅳ were higher than those at grade Ⅰ-Ⅱ [(23.57 ± 3.16) μg/L vs. (16.35 ± 3.62) μg/L, (17.16 ± 3.29) μg/L vs. (12.15 ± 3.58) μg/L], there were significant differences ( t=8.931, 6.173, P<0.05). The serum levels of sFas and sFasL in patients with lymph node metastasis were higher than those without lymph node metastasis [(24.09 ± 3.46) μg/L vs. (14.37 ± 3.19) μg/L, (18.17 ± 3.64) μg/L vs. (11.02 ± 3.27) μg/L], there were significant differences ( t=13.124, 9.306, P<0.05). The serum sFas and sFasL levels were not associated with age, gender, location and type ( P>0.05). The serum sFas and sFasL levels after treatment were lower in patients with skin cancer than before treatment [(7.94 ± 1.21) μg/L vs. (21.06 ± 3.23) μg/L, (5.38 ± 1.02) μg/L vs. (14.52 ± 3.42) μg/L], there were significant differences ( t=34.445, 23.191, P<0.05). Conclusions:Serum sFas and sFasL levels are elevated in elderly skin cancer patients. The serum sFas and sFasL levels are closely related to pathological grade and lymph node metastasis in elderly skin cancer patients, and the clinical efficacy can be evaluated.

Objective:Iron accumulation is related to the occurrence of postmenopausal osteoporosis. Meanwhile, autophagy abnormality of bone marrow hematopoietic cells is observed in hip osteoporotic fracture. This study is performed to investigate correlation between iron accumulation induced bone loss and hematopoietic autophagy dysfunction to explore the new risk factor of osteoporosis.Methods:Male iron accumulation mice model was established by intraperitoneally injecting ferric ammonium citrate. Serum ferritin and osteogenic indicator P1NP were tested by ELISA. Bone mineral density was measured by micro-CT. Femur and tibia bone marrows were collected for hematopoietic stem and progenitor cells proportion and cell apoptosis analysis. Autolysosome formation was measured by image flow cytometry. We used conditional mouse model Atg7 flox/flox; Vav-Cre(Atg7 -/-) in which Atg7 had been genetically deleted in the hematopoietic system. Bone marrow hematopoietic stem and progenitor cells were collected for RNA sequence. micro-CT scan was conducted for Atg7 -/- femur. Results:Ferritin level of iron accumulation mice was significantly higher than control group( P<0.05). Iron accumulation inhibited P1NP and induced decreased bone mineral density( P<0.05). Iron accumulation bone marrow displayed enhanced hematopoietic stem and progenitor cells proportion( P<0.05), with more cell apoptosis( P<0.05). Hematopoietic autophagy was deteriorated in iron accumulation bone marrow. Transcriptomic profiling showed up-regulation of iron activity in Atg7 -/- mice, with increased iron homeostasis and iron membrane transporter genes, including Lcn2, Tfr2, Slc40a1(Fpn1), Steap3, and Cpox. micro-CT revealed severe bone loss and decreased bone mineral density in Atg7 -/- mice( P<0.05). Conclusion:Iron accumulation induced bone loss is related to inhibition of hematopoietic cells. Hematopoietic autophagy dysfunction is associated with bone loss.

Objective:To provide reference for the development of a more intelligent and systematic nursing clinical decision support system based on the concept of precision nursing and data sharing, the nursing plan module of clinical decision support system.Methods:An evidence-based knowledge base was constructed based on the nursing process and the standardized nursing terminologies; the nursing plan module was designed according to clinical needs, and the logical reasoning rules were formulated from the generation, sequencing and stopping of nursing problems, objectives, measures and activities, and finally the nursing plan module of clinical decision support system was formed.Results:The nursing plan module of clinical decision support system included the basic information of patients, positive evaluation items and weight values, nursing problems, objectives, measures and activities, etc. the module could automatically deduce the nursing plan according to the patient's individual characteristic index (positive evaluation item), and sort the nursing problems and corresponding measures and activities according to the generation time, weight value and correlation degree. It could automatically distinguish nursing problems, goals, measures and the time of activity stop, and realize intelligent decision-making.Conclusion:The interface of nursing plan module of this system is clear and logical reasoning rules are rigorous. It breaks through the bottleneck of nursing decision-making based on personal professional knowledge and experience in clinical situation for a long time, which can ensure the homogeneity of nursing plan and improve the correctness of decision-making.

Objective:To design and develop an unplanned extubation clinical decision support system, aiming to provide a reference for nurses' clinical decision-making.Methods:Through literature review and expert consultation, the knowledge base of the clinical decision support system for unplanned extubation was constructed, and the system function and interface were designed.Results:The authoritative coefficients of the two rounds of expert consultation were 0.853 and 0.867, respectively, and the Kendall ′s W were 0.458 and 0.492, respectively. The final built knowledge base included catheter evaluation module, unplanned extubation evaluation module, and knowledge reasoning rule module. At present, the knowledge base had sorted out 48 first-level items, 9 second-level items, 72 third-level items in the catheter evaluation module, and 5 first-level items, 12 second-level items, and 73 third-level items in the unplanned extubation evaluation module. Entry, 40 knowledge reasoning rules. Conclusions:The clinical decision-making system for unplanned extubation has changed the implementation of unplanned extubation risk early warning, optimized the management process, and realized the interaction of the hospital system. It can conduct dynamic unplanned extubation risk assessment based on individualization and assist nurses Make clinical decisions and promote the safety of nursing management.

The clinical data of a newborn with Kleefstra syndrome combined with SLC2A1 gene mutation in the Department of Newborn Infants, Children′s Hospital of Nanjing Medical University were retrospectively analyzed.The laboratory examination, genetic characteristics, diagnosis and treatment progress were analyzed.This is the first report of a newborn with Kleefstra syndrome combined with SLC2A1 gene mutation, presenting with an early-onset epilepsy.Gene analysis is the most reliable method to make a definitive diagnosis.

Antibody drug conjugations (ADCs) are a new class of drugs with both targeted specificity and high activity of chemotherapy drugs, which has gradually become a novel generation of therapeutic models with great clinical application prospects. In recent years, ADCs composed of monoclonal antibodies against different tumor cell surface antigens and small molecule potent cytotoxic drugs have shown superior therapeutic effects on recurrent / metastatic breast cancer. This article reviews the clinical application and research progress of ADCs with different molecular targets in the field of breast cancer.

The prevalence of osteoporosis， osteoarthritis， gouty arthritis， rheumatoid arthritis， and intervertebral disc degeneration is increasing year by year with the growing number of elderly people， and the common clinical manifestations of these diseases include severe pain in different areas， which seriously affects the daily life of the patients. Therefore， how to relieve the pain and reduce the prevalence of bone and joint diseases and improve the quality of life of the patients is a hot spot in the medical field. Studies have confirmed that NOD-like receptor family， pyrin domain-containing protein 3 （NLRP3） inflammasomes， as pattern recognition receptors， are involved in the inflammation， chondrocyte proliferation， osteoblast and osteoclast differentiation， intervertebral disc cell inflammation and scorching， extracellular matrix degradation and apoptosis， mitochondrial dysfunction， endoplasmic reticulum stress， and reactive oxygen species damage， demonstrating close link with the development of bone and joint diseases. Chinese medicine has a long history and demonstrates remarkable therapeutic effects in the treatment of bone and joint diseases. It can mitigate the pathological changes of bone and joint diseases by inhibiting NLRP3 inflammasomes to alleviate the pain， playing a role in preventing and treating these diseases. Therefore， this paper briefly describes the relationship between NLRP3 inflammasomes and the development of bone and joint diseases by reviewing the latest research progress at home and abroad. We summarize the latest studies about the active components， extracts， and compound prescriptions of Chinese medicines in the treatment of bone and joint diseases via regulating NLRP3 inflammasomes. This review is expected to offer new insights into the in-depth research on the pathogenesis and drug treatment of bone and joint diseases and provide a basis for the clinical application of Chinese medicine in the prevention and treatment of such diseases.