Objective To investigate the effect of multidisciplinary physician/nurse collaboration care mode in diagnosis and treatment of elderly patients with intertrochanteric fracture.Methods Clinical data of 433 elderly patients with intertrochanteric fracture treated from August 2011 to September 2013 were studied retrospectively.Among them,136 were diagnosed and treated using conventional methods (control group) and 297 using the multidisciplinary physician/nurse collaboration approach (collaboration group).Hospital stay,surgery rate,time from hospitalization and operation,and complications were compared between the two groups.Results Length of hospital stay [(14.8 ± 5.9) d] in collaboration group was not statistically different from that in control group [(16.0 ± 4.7) d,t =0.433,P ＞ 0.05],but surgery rate was improved (72.8％ vs 83.9％,x2 =7.212,P ＜ 0.05),time from hospitalization and operation shortened [(5.6 ± 2.9) d vs (6.9 ± 3.4) d,t =3.096,P ＜ 0.05],and perioperative complication rate reduced in collaboration group compared to control group (all P ＜ 0.05).Conclusion Multidisciplinary physician/nurse collaboration mode is a novel method for diagnosis and treatment of intertrochanteric fracture in the elderly and is associated with improved surgery rate,reduced perioperative complications and early functional recovery.

Objective To provide a scientific basis for the formulation of effective incentive measures for rural health workers,by analyzing the factors influencing their work enthusiasm and constructing an incentive mechanism framework.Methods A field questionnaire survey and personal in-depth interview were conducted on 803 health technicians from 45 township health centers in Shandong,Anhui and Shanxi provinces.The study covered economic,management,education and career supports aspects,and the data were analyzed in descriptive,multi-level model and correlation analyses.Results The work enthusiasm scoring of rural health workers was 89.83 + 9.54.Workload,doctor-patient relationship,work competence and income index were the four influencing factors,with the differences showing statistical significance(P ＜0.05).The income index (income expectancy/real income affects work) influences the enthusiasm negatively,while the rest of the factors were positive.Work enthusiasm was positively correlated with three dimensions of job performance.The satisfaction of interpersonal relationship,workload and competence were positively correlated with work enthusiasm.The correlation indexes are respectively 0.35,0.33 and 0.21 (P ＜ 0.01).Conclusions To motivate primary health institutions and their health workers,the authorities should focus on the economic factors,and take into account non-economic ones,while improving the performance-based wage system and creating a fair workplace culture.

Objective To investigate the long-term outcome of radical prostatectomy (RP) in the patients with incidental prostate cancer (IPCa) detected by surgery of benign prostatic hyperplasia (BPH) and to evaluate the risk factors for residual tumour after BPH surgery and biochemical recurrence in patients with IPCa treated with RP.Methods We retrospectively analyzed the clinical and follow-up data of 45 patients with IPCa detected by surgery of BPH and undergoing RP from January 2004 to October 2016.The age,PSA before and after BPH surgery,prostate volume,T stage and Gleason score after the BPH surgery,T stage at RP (pT0,pT2,pT3),Gleason score at RP and status of biochemical recurrence were recorded.Multivariate logistic regression analysis addressed the association between the factors and the presence of residual cancer after the surgery for BPH.Cox regression was used to analyzed the relationship between the factors and the rate of biochemical recurrence after RP.Results Among 45 IPCa patients,21 patients were stage T1a and 24 were stage T1b.After RP,7 (15.6％) patients had no residual tumor (pT0).PSA before BPH surgery (RR =2.58,95％ CI 1.27-5.42,P =0.04),PSA after BPH surgery (RR =4.26,95％ CI 2.57-7.64,P =0.01) and Gleason score after BPH surgery (RR =3.98,95％ CI 1.85-5.77,P =0.02) were significant associated factors with the residual cancer after BPH surgery.With a mean follow-up of 54 months(ranging 5-144 months),the 5-and 10-years.biochemical recurrence-free survival rates were 95.6％ and 86.7％,respectively.PSA after surgery for BPH (RR =4.79,95％ CI 2.57-7.64,P =0.02) and Gleason score after RP(RR =2.01,95％ CI 1.74-5.21,P =0.04) were the only independent risk factors for biochemical recurrence.Stage (T1a-T1b) did not predict residual cancer or the rate of biochemical recurrence (P ＞ 0.05).Conclusions RP in the patients with IPCa detected by BPH surgery had a good outcome of long-term oncological control.PSA before and after BPH surgery and Gleason score at BPH surgery were the significant associated factors of residual cancer after BPH surgery.PSA after BPH surgery and Gleason score at RP were the only independent risk factors for biochemical recurrence.

OBJECTIVE: To explore the genetic basis for an infant with permanent neonatal diabetes mellitus (PNDM). METHODS: Clinical data of the child was collected. Targeted capture-next generation sequencing was carried out to identify the potential variants. Candidate variant was verified by Sanger sequencing of her family members. RESULTS: The child was a 4-month-and-26-day female featuring onset of ketoacidosis accompanied with fasting blood glucose of 24.4 mmol/L, positive urine glucose, decreased serum C-peptide, HbA1c of 9.58%, and negative diabetes autoantibody. Genetic testing revealed that she has carried a heterozygous c.314T>G (p.L105R) variant of the INS gene. Sanger sequencing verified that neither of her parents has carried the same variant, which was also unreported in the literature. The variant was classified as likely pathogenic based on the ACMG guidelines. CONCLUSION The c.314T>G (P.L105R) variant of the INS gene probably underlay the genetic etiology in this child. Genetic testing should be conducted for children with suspected PNDM for early diagnosis and appropriate treatment.
Humans ; Infant ; Child ; Infant, Newborn ; Female ; Mutation ; Insulin/genetics* ; Diabetes Mellitus/genetics* ; Genetic Testing

Objective:To provide molecular evidence for clinical diagnosis and genetic counseling by analyzing the clinical characteristics and identifying the pathogenic genes in a SPONASTRIME-type spondyloepimetaphyseal dysplasia(SEMDSP)family.Methods:Clinical data of the family members was collected and analyzed. Case 2 was identified as the proband for whole-exome sequencing and variant analysis. Suspected variants were validated across family numbers using Sanger sequencing.Results:The two affected individuals in this family, a brother and a sister, both presented as short stature. The initial diagnosis for the sister(case 1)was made at the age of 4 years and 2 months(height: 88.6 cm), and for the brother(case 2)at 4 years and 4 months(height: 81.6 cm). Both individuals exhibited distinctive facial features, including frontal bossing, midface hypoplasia with depressed nasal bridge, upturned nostrils, ocular hypertelorism, and epicanthus, thick hair, short lingual frenulum, stubby fingers and palms, and absence of scoliosis. The parents displayed normal phenotypes. Laboratory tests indicated growth hormone deficiency in both affected individuals. Imaging studies revealed significant bone age delay in case 2, while case 1 showed longitudinal striations at the distal radius but with bone age matching their actual age(5 years and 11 months). Despite receiving recombinant human growth hormone treatment, both patients had inadequate responses. Genetic testing identified compound heterozygous mutations in the TONSL gene shared by the two siblings. These mutations included a paternally inherited c. 1291-14_1291-11delCCTC and a maternally inherited c. 1909_1920delACGCTGCAGCAG. Notably, SEMDSP families have not been reported in China, and the c. 1909_1920delACGCTGCAGCAG mutation is a novel variant.Conclusion:Two patients were diagnosed as spondyloepimetaphyseal dysplasia, SPONASTRIME type, and the compound heterozygous variant was the genetic cause of this family.

Starvation therapy is an emerging oncological treatment that targets the abnormally elevated nutrient uptake and metabolic pathways to inhibit and kill tumors. In addition to glucose, the targets of starvation therapy also include other nutrients in tumor cells.However, concerns like ineffective targeting and drug tolerance probably have an impact on their clinical translation.Nanomaterial-assisted starvation treatment has been developing quickly in recent years to address these concerns.In this review, several exemplary nanomedicines for starvation therapy and combined starvation therapy with other therapies were offered.They target nutrients other than glucose metabolism, including lactic acid, amino acids, and lipids, using nanomaterials to improve the efficacy of starvation therapy.This review provides reference for further development of nanomedicines with starvation treatment effect.

Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.