Objective:To detect the expression of tumor necrosis factor alpha in (TNF alpha) breast cacner and its relationship with imaging features.Methods:Using immunofluorescence and flow cytometry to detect the expression of TNF-α in MDA-MB-231 and MCF-7.Collect 82 patients with mammary gland disease,which was confirmed by pathological tissue,its pathological data,imaging data,and by immunohistochemistry to detect the expression of TNF-α in breast tissues,and analyze and the relationship between its expression and the pathological features and imaging characteristics.Results:TNF-α high expression in MDA-MB-231,the expression of TNF-oα in malignant breast tumor tissue significantly higher than that in benign tumor,the expression quantity associated with lymph node metastasis,TNM stages,strengthen uniform in MRI,the boundary and the shape of the X-ray Mammography (P=0.01),and color flow signal strength in ultrasound (P＜0.05).Conclusions:TNF alpha in breast tumor tissue was unusually high expression,and is closely related to some of the imaging features of breast tumor.

Objective To understand the general self-efficacy level of patients with tuberculosis(TB patients) and its influencing factors, provide evidence for improving the general self-efficacy of TB patients.Methods All TB inpatients in a comprehensive pulmonary hospital were conducted face-to-face survey through a general questionnaire and general self-efficacy scale, self-efficacy level of TB patients and its influencing factors were analyzed.Results Mean scale of general self-efficacy of 402 TB patients was (20.4±4.2), of which only 14 cases(3.5%)showed a high level self-efficacy.163(40.5%), 225(56.0%), and 14(3.5%)patients were with low(10~),medium(20~), and high(30~) self-efficacy scale.The general self-efficacy level of TB patients was influenced by the course of disease(P<0.001), residence(P=0.012), whether or not attended the lecture on tuberculosis education(P=0.034), whether or not conducted physical exercise(P=0.053,stepwise multiple linear regression analysis: P=0.017), working status(P=0.027), No.of hospitalization due to TB(P=0.002), family economic situation(P=0.027), and education level(P=0.020).Conclusion TB patients' self-efficacy level is low, and the general self-efficacy level and its influencing factors should be assessed by health care workers during the follow-up for patients, individualized nursing intervention for improving the TB patients' self-efficacy level should be developed.

cleaning and disinfection.Results All 28 surveyed medical institutions had separate endoscope disinfection rooms, 89.29% of which had integrated endoscopic cleaning station,17.86% had automatic endoscope washer/disinfector;100% used multi-enzymatic detergent,chose the right disinfectant,monitored disinfectant concentration every day, and implemented standard disinfection time.But only 39.29% changed multi-enzymatic detergent for each endo-scope,cleaning and disinfection personnel in 78.57% of medical institutions wore personal protective equipment correctly.77 digestive endoscopes were detected,the qualified rate was 88.31%.Conclusion Cleaning and disin-fection management of digestive endoscope in secondary and above medical institutions in Suzhou City is generally standardized,there are still some problems in the manipulation procedures,relevant national regulations should be strictly complied with,efficacy of cleaning and disinfection of digestive endoscope should be further improved.

OBJECTIVE: To examine the expressions of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in the kidney of rats with diabetic nephropathy before and after the treatment of Cordyceps sinensis, and to explore the mechanism of Cordyceps sinensis against hypoxia. METHODS: The diabetes model was produced by intraperitoneal injection of 60 mg/kg streptozotocin, then the rats whose 24 h urine protein level was above 30 mg/d were thought to have suffered diabetic nephropathy. Thirty rats were randomly divided into a diabetic nephropathy group (DN group, n=15) and a Cordyceps sinensis group (CS group, n=15), and another 15 normal rats served as a normal control group (NC group, n=15). The CS group were intragastrically administered Cordyceps sinensis extract liquid [5.0 g/(kg.d)], the other groups were intragastrically administered drinking water of equal volume. Five rats in each group were killed after 2, 4, and 6 weeks. The 24 h urine protein excretion, urine β-N-acetyl glucosaminidase (NAGase) and serum creatinine were measured; the renal pathological changes were evaluated by HE and Masson staining; the mRNA and protein expressions of HIF-1α and VEGF were dectected by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. RESULTS: Compared with the normal control group, the renal tubular vacuolar degeneration was obvious, and the glomerular mesangial matrix increased in the DN group. The 24 h urinary protein excretion, urine NAGase and serum creatinine also increased significantly (all P<0.05); the expressions of HIF-1α and VEGF in the renal tissue gradually increased with time, and the expression of HIF-1α was correlated with that of VEGF in the 2 groups (r=0.850, r=0.887, both P<0.05) . Compared with the DN group, the pathological changes were relieved, the 24 h urinary protein excretion, urine NAGase and serum creatinine level were decreased, and the expressions of HIF-1α and VEGF decreased in the CS group (all P<0.05), but they were still higher than those in the normal contral group (P<0.05). There was no significant difference in the mRNA and protein expression of HIF-1α between the 4th week and the 6th week after the treatment of CS (P>0.05). CONCLUSION The expressions of HIF-1α and VEGF increase in the kidney of rats with diabetic nephropathy, and the positive correlation suggests that there is chronic hypoxia in the renal tissue of diabetic nephropathy. Cordyceps sinensis may protect against chronic hypoxia injury in diabetic nephropathy by lowering the expressions of HIF-1α and VEGF.
Animals ; Cordyceps ; chemistry ; Diabetes Mellitus, Experimental ; complications ; metabolism ; Diabetic Nephropathies ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; metabolism ; Kidney ; metabolism ; Male ; Rats ; Rats, Wistar ; Vascular Endothelial Growth Factor A ; genetics ; metabolism

Objective:To investigate the independent risk factors of community-acquired pneumonia (CAP) complicated with acute respiratory distress syndrome (ARDS), and the accuracy and prevention value of ARDS prediction based on artificial neural network model in CAP patients.Methods:A case-control study was conducted. Clinical data of 414 patients with CAP who met the inclusion criteria and were admitted to the comprehensive intensive care unit and respiratory department of Changzhou Second People's Hospital Affiliated to Nanjing Medical University from February 2020 to February 2021 were analyzed. They were divided into two groups according to whether they had complicated with ARDS. The clinical data of the two groups were collected within 24 hours after admission, the influencing factors of ARDS were screened out by univariate analysis, and the artificial neural network model was constructed. Through the artificial neural network model, the importance of input layer independent variables (that was, the influence factors obtained from univariate analysis) on the output layer dependent variables (whether ARDS occurred) was drawn. The artificial neural network modeling data pairs were randomly divided into training group ( n = 290) and verification group ( n = 124) in a ratio of 7∶3. The overall prediction accuracy of the training group and the verification group was calculated respectively. At the same time, the receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated. Results:All 414 patients were enrolled in the analysis, including 82 patients with ARDS and 332 patients without ARDS. Univariate analysis showed that gender, age, heart rate (HR), maximum systolic blood pressure (MSBP), maximum respiratory rate (MRR), source of admission, C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), neutrophil count (NEUT), eosinophil count (EOS), fibrinogen equivalent unit (FEU), activated partial thromboplastin time (APTT), total bilirubin (TBil), albumin (ALB), lactate dehydrogenase (LDH), serum creatinine (SCr), hemoglobin (Hb) and blood glucose (GLU) were significantly different between the two groups, which might be the risk factors of CAP patients complicated with ARDS. Taking the above 19 risk factors as the input layer and whether ARDS occurred as the output layer, the artificial neural network model was constructed. Among the input layer independent variables, the top five indicators with the largest influence weight on the neural network model were LDH (100.0%), PCT (74.4%), FEU (61.5%), MRR (56.9%), and APTT (51.6%), indicating that that these five indicators had a greater impact on the occurrence of ARDS in patients with CAP. The overall prediction accuracy of the artificial neural network model in the training group was 94.1% (273/290), and that of the verification group was 89.5% (111/124). The AUC predicted by the aforementioned artificial neural network model for ARDS in CAP patients was 0.977 (95% confidence interval was 0.956-1.000).Conclusion:The prediction model of ARDS in CAP patients based on artificial neural network model has good prediction ability, which can be used to calculate the accuracy of ARDS in CAP patients, and specific preventive measures can be given.

Objective:To understand the status quo of nurses' professional mission and explore the influencing factors of nurses' professional mission.Methods:From November to December, 2018, 316 nurses from three tertiary hospitals in Tianjin were selected as the research objects. The occupational mission scale was used to investigate the sense of professional mission, the nursing work environment scale was used for the nursing work environment survey, and the work family conflict scale was used for the work family conflict investigation. Pearson correlation analysis was used to analyze the correlation among nurses' sense of professional mission, nursing work environment and work family conflict; multiple linear regression analysis was used to analyze the influencing factors of nurses' sense of professional mission.Results:The score of professional mission of nurses was (2.90±0.56) . Average monthly income, nursing work environment and work family conflict were the influencing factors of nurses' professional mission ( P<0.05) . The results of hierarchical regression showed that the higher the average monthly income ( β=0.252) , the higher the sense of professional mission of nurses ( R2=0.064) ; after controlling general data, the two dimensions of nursing work environment: Nurses' participation in hospital affairs ( β=0.263) , high-quality nursing service foundation ( β=0.368) , and work family conflict ( β=-0.145) could explain 43.1% of the total variation of professional mission. Conclusion:The sense of professional mission of nurses is above the middle level. Nursing managers should start with the influencing factors such as average monthly income, nursing working environment and work family conflict, so as to stimulate or improve nurses' sense of professional mission.

Objective:To understand the status quo of nurses' professional mission and explore the influencing factors of nurses' professional mission.Methods:From November to December, 2018, 316 nurses from three tertiary hospitals in Tianjin were selected as the research objects. The occupational mission scale was used to investigate the sense of professional mission, the nursing work environment scale was used for the nursing work environment survey, and the work family conflict scale was used for the work family conflict investigation. Pearson correlation analysis was used to analyze the correlation among nurses' sense of professional mission, nursing work environment and work family conflict; multiple linear regression analysis was used to analyze the influencing factors of nurses' sense of professional mission.Results:The score of professional mission of nurses was (2.90±0.56) . Average monthly income, nursing work environment and work family conflict were the influencing factors of nurses' professional mission ( P<0.05) . The results of hierarchical regression showed that the higher the average monthly income ( β=0.252) , the higher the sense of professional mission of nurses ( R2=0.064) ; after controlling general data, the two dimensions of nursing work environment: Nurses' participation in hospital affairs ( β=0.263) , high-quality nursing service foundation ( β=0.368) , and work family conflict ( β=-0.145) could explain 43.1% of the total variation of professional mission. Conclusion:The sense of professional mission of nurses is above the middle level. Nursing managers should start with the influencing factors such as average monthly income, nursing working environment and work family conflict, so as to stimulate or improve nurses' sense of professional mission.

Objective:To explore the prenatal ultrasound phenotype and genetic basis of two fetuses with Wolf-Hirschhorn syndrome (WHS).Methods:A retrospective analysis was conducted on the ultrasound imaging data of two fetuses suspected for WHS at the Prenatal Diagnostic Center of Qingyuan People′s Hospital in July 2017 and August 2019, respectively. Amniotic fluid samples of the two fetuses were subjected to chromosomal karyotyping and chromosomal microarray analysis (CMA). This study was approved by Medical Ethics Committee of the Qingyuan People′s Hospital (Ethics No. IRB-2022-064).Results:Prenatal ultrasound examination of the two fetuses had consistently revealed WHS-associated traits including intrauterine growth restriction (IUGR), craniofacial abnormalities and cardiovascular anomalies. Karyotyping analysis suggested that both fetuses had harbored cryptic chromosomal translocations involving partial deletion of 4p. And parental verification revealed that it was de novo for fetus 1 and paternal for fetus 2. CMA has confirmed that fetus 1 had an approximately 8.7 Mb deletion at 4p16.3p16.1 and a 6.8 Mb duplication at 8p23.1p23.1, whilst fetus 2 had a 20.05 Mb deletion at 4p16.3p15.31 and a 7.66 Mb duplication at 9p24.3p24.1. The karyotype of fetus 1 was determined as 46, XN, der(4)t(4; 8)(p16.1; p23.1)dn.arr[hg19]4p16.3p16.1(68345_8721580)×1, 8p23.3p23.1(158048_6933745)×3, and that of fetus 2 was determined as 46, XN, der(4)t(4; 9)(p15.3; p24)dpat.arr[hg19]4p16.3p15.31(68345_20116061)×1, 9p24.3p24.1(208454_7868292)×3. Conclusion:The 4p deletion is probably the main cause for the WHS phenotype in both fetuses. WHS should be suspected when IUGR, renal anomalies, craniofacial and cardiovascular abnormalities are detected upon prenatal ultrasound screening.

Objective: To verify the applicability of the theory of planned behavior(TPB) in the physical exercise behaviors of rural adolescents in Sichuan Province, and to explore the possible influencing factors of physical exercise behaviors, and to provide a theoretical basis for further effective intervention measures. Methods: A total of 2 302 students were selected from grade seven and grade ten of two rural middle schools in Zizhong, Sichuan Province. The survey was conducted with a structured questionnaire. Using TPB as the research framework and basis, the structural equation model was constructed for analysis. Results: Lack of physical exercise was 1 527(66.3%).Physical exercise behavior was statistically different among schools, grades(t=-7.40，-2.90，10.90,P<0.05)， and genders. Based on TPB, the structural equation model was established and corrected to obtain the revised model, and the fitting index GFI=0.93, CFI=0.94, NFI=0.94, TLI=0.93, IFI=0.94,RMSEA=0.07, indicating the model fitted good. Exercise intention directly affected exercise behaviors. The standardized effect was 0.45(95%CI=0.39-0.52). Subjective norms and perceived power were the main two mediators of the relationship between value evaluation and exercise intention. The standardized effect values were 0.66(95%CI=0.57-0.73), 0.23(95%CI=0.16-0.93)(P<0.01). Conclusion There is serious lack of physical exercise in rural adolescents in Sichuan Province. TPB has a good applicability for physical exercise in rural adolescents in Sichuan Province. Subjective norm is the most important factors to promote exercise intentions.

Objective:To compare the efficacy and safety of standard treatment with or without adjuvant chemotherapy in patients with highly malignant non-metastatic prostate cancer.Methods:In this prospective non-randomized controlled study, consecutive non-metastatic prostate cancer patients with pathologically proven Gleason score of 9-10 or Gleason score of 5 admitted to Peking University First Hospital were enrolled. Four to six cycles of chemotherapy using docetaxel ± carboplatin regimen were added or not after standard radical therapy. The primary end point was 5-year event-free survival (EFS), and the secondary end points were distant metastasis-free survival (MFS), overall survival (OS), and treatment-related adverse events. The survival curve was drawn by Kaplan-Meier method. The differences between two groups were analyzed by log-rank test.Results:A total of 176 patients were consecutively enrolled from November 2019 to January 2022 of which 138 patients received only standard radical therapy (control group), and 38 patients received adjuvant chemotherapy after standard radical therapy (chemotherapy group). The median follow-up time was 13.4 (2.0-34.0) months. All patients survived. The 30-month EFS rates in the chemotherapy and control groups were 100% and 85.6%, respectively ( P=0.064). There were no events in the chemotherapy group, while there were 12 cases of events in the control group, including 6 cases of biochemical recurrence and 6 cases of imaging progression. The 30-month MFS rates in two groups were 100% and 91.9%, respectively ( P=0.205). After the 1 vs. 2 propensity score matching, the EFS and MFS rates in two groups were 100% vs. 85.7% ( P=0.056), and 100% vs. 92.2% ( P=0.209), respectively. The incidence rates of grade 2 and above urinary toxicity in the chemotherapy and control groups were 2.6% and 7.2% ( P=0.354), respectively. The incidence rates of grade 2 and above rectal toxicity were 5.3% and 5.1% ( P=0.711), respectively. Grade 3 and above chemotherapy-related toxicity in the chemotherapy group were leukopenia (31.6%), thrombocytopenia (2.6%) and alopecia (13.2%). Conclusion:The addition of adjuvant chemotherapy after standard radical therapy tends to improve the overall EFS of patients with highly malignant prostate cancer, and the adverse effects are tolerable, which should be confirmed by long-term follow-up results.