BACKGROUND:Our previous studies have shown that a soft substrate has a significant effect on morphology and cytoskeleton of rat bone marrow mesenchymal stem cel.
OBJECTIVE:To explore the effect of polyacrylamide gels as soft substrates with different elastic moduli on the chondrogenic differentiation of human synovial-derived mesenchymal stem cels.
METHODS:The synovium was harvested from patients with osteoarthritis under sterile conditions, and primary human synovial-derived mesenchymal stem cels were separated using limiting dilution assay. The flow cytometry and multi-directional differentiation experiments were used to identify the cel surface markers and function of the human synovial-derived mesenchymal stem cels, respectively. The polyacrylamide gels with the elastic modulus of 0.4, 6, 30 kPa, which were made using various amounts of acrylamide and bis-acrylamide, were used to culture human synovial-derived mesenchymal stem cels under induction with transforming growth factor-β1 for 7 and 14 days. RT-PCR was used to test the expression of chondrogenic genes, type II colagen gene and cartilage acidic protein 1. The 6-wel cel culture plates served as controls.
RESULTS AND CONCLUSION: The human synovial-derived mesenchymal stem cels showed different cel morphology in the different elastic modulus of polyacrylamide gels. The expression of type II colagen gene and cartilage acidic protein 1 were affected by the different elastic modulus of polyacrylamide gels and culture time, and there was an interaction between these two factors. At 7 days of induction, the expression of cartilage acidic protein 1 gene on 6 kPa polyacrylamide gels was the highest (F=44.350,P=0.000); meanwhile, the expression of type II colagen gene on 0.4 kPa polyacrylamide gels was the highest (F=6.384,P=0.005). These findings indicate that polyacrylamide gels with lower elastic modulus are superior to routine culture plates to promote the chondrogenic differentiation of human synovial-derived mesenchymal stem cels.

Objective To investigate the accuracy and safety of using normal saline as a medium to guide the catheter lumen to assist the localization of the catheter tip. Methods This study included the patients with hematological malignancies in our fully implantable venous port. We enrolled 105 patients from January 2014 to December 2015 as control group, and 220 patients from January 2016 to June 2017 as the experimental group. The control group used the traditional fully implantable venous port after the chest X slice to determine the location of the catheter tip. The experimental group used the intracavitary electrocardiogram location technology to assist the complete implantable venous port catheter tip positioning catheter, then chest X film. Results No catheterization occurred in all the patients. The rate of catheter placement was 100％. In the experimental group, 179 patients (81.36％) had the best placement of catheter tip (i.e., superior vena cava right atrium junction, CAJ), and 35 patients (52.38％) in the control group had the best placement of catheter tip. The proportion of the catheter tip located in the best position (the superior vena cava auricular commissure and CAJ) in the experimental group was higher than that in the control group (χ2=29.615, P < 0.05). Conclusions By the injection of saline guided endocardial mapping real-time monitoring of totally implantable venous transfusion port catheter tip position, can guide the surgeon to grasp the real-time operational direction of totally implantable venous transfusion port catheter tip, accurately positioning the catheter tip position, improve the surgical success rate, worthy of clinical use.

Objective Based on the three-dimensional quality structure model,to construct the nursing quality evaluation index system for acute leukemia,in order to provide references for clinical evaluation of quality of nursing care for acute leukemia.Methods Based on the theory of Donabedian's structure-process-outcome quality structure model,through literature search,semi-structured interview,expert meeting,expert consultation and analytic hierarchy process,the quality evaluation index system and index weight for acute leukemia were determined.Results After two rounds of expert consultation,questionnaire response rates were 94.74％,100％;expert authority coefficients were 0.848,0.854;Kendall coordination coefficients were 0.273,0.420,and P values were all less than 0.01.The final index system consisted of 3 first-level indicators,8 second-level indicators,and 24 third-level indicators (3 structure indicators,7 process indicators,14 outcome indicators).Each of third-level indicators contained index names,calculation methods,and data collection methods.Conclusion The process of construction of nursing quality evaluation index system for acute leukemia is scientific,the contents are reasonable,which can reflect nursing characteristics of acute leukemia.

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.

Objective:To explore the diagnostic value of contrast-enhanced mammography (CEM) and MRI in differentiating benign and malignant breast lesions based on the 2013 breast imaging reporting and data system (BI-RADS) lexicon and the supplement on CEM.Methods:The clinical and imaging data of 83 patients with breast lesions from March 2019 to April 2022 in the Third Affiliated Hospital of Soochow University were retrospectively analyzed. Totally 100 breast lesions from 83 female patients aged 28 to 78 (49±14) years, were divided into benign lesions (50 lesions) and malignant lesions (50 lesions) according to the pathological results. The t-test, χ 2 test and Fisher′s exact test were used to compare the differences of clinical and imaging features between benign and malignant lesions, and these imaging features which had statistical differences were established CEM and MRI models by multivariate logistic regression analysis respectively. The receiver operating characteristic curves and the area under the curve (AUC) were used to assess the diagnostic efficacy of two models in differentiating benign and malignant breast lesions. Using the DeLong test compared the AUC. Results:Multivariate logistic regression analysis showed that associated features (OR=9.075,95%CI 1.430-57.570, P=0.019), lesion conspicuity (OR=6.180,95%CI 2.608-14.646, P<0.001), mass margin (OR=2.193,95%CI 1.405-3.422, P=0.001) and calcification distribution (OR=2.147,95%CI 1.157-3.986, P=0.015) were independent predictors of differentiating benign and malignant breast lesions in CEM, and then the predictive model of CEM was constructed. Time-signal intensity curve (OR=9.230, 95%CI 3.178-26.805, P<0.001), associated features (OR=5.289,95%CI 1.343-20.831, P=0.017) and mass margin (OR=2.192,95%CI 1.336-3.597, P=0.002) were independent predictors of differentiating benign and malignant breast lesions in MRI, and the predictive model of MRI was constructed. The AUC of CEM and MRI models for differentiating benign and malignant breast lesions were 0.947 and 0.930 respectively, and two models were no significant difference ( Z=0.68, P=0.494). Conclusion:The diagnostic efficacy of CEM and MRI in differentiating benign and malignant breast lesions is comparable based on the 2013 BI-RADS lexicon and the supplement on CEM.

Objective? To explore the status quo of thirst distress in patients with heart failure and its influencing factors and to provide a basis for developing intervention measures. Methods? Totally 445 patients with heart failure were selected from 3 ClassⅢ Grade A hospitals in Jiangsu and He′nan Provinces by convenient sampling, and investigated with the general information questionnaire, Thirst Distress Scale-Heart Failure (TDS-HF), Minnesota Heart Failure Quality of Life Scale (MLHFQ) and 24-hour Input and Output Record between August and December 2018. The influencing factors to thirst distress in patients with heart failure were also analyzed. Results? A total of 445 questionnaires were sent out, and 401 questionnaires were effectively recovered. The TDS-HF and MLHFQ scores of the patients with chronic heart disease were (21.98±9.70) and (57.77±28.34), and there was a positive correlation between the two (P=0.003). Univariate analysis revealed that there was a statistically significant difference in TED-HF scores between the patients with different body surface area, BMI,drinking alcohol or not,7 d fluid intake, 7 d fluid output, 7 d input-output difference, proportion of morning input, proportion of afternoon input, proportion of night input, cardiac function, left ventricular ejection fraction (LVEF), NT-proBNP, estimated plasma volume status (ePVS), with or without edema and estimated glomerular filtration rate (eGFR) (P＜0.05). Multiple linear regression analysis was conducted taking TDS-HF scores as dependent variables and the statistically significant variables found in univariate analysis as independent variables. The results showed that patients′ BMI, body surface area, 7 d fluid intake, 7 d input-output difference, proportion of morning input, proportion of afternoon input, cardiac function, ePVS, edema grading and eGFR were the main influencing factors to thirst distress in patients with heart failure (P＜ 0.05). Conclusions? The thirst distress is severe in patients with heart failure, which is affected by limited water, individual variation between patients and disease conditions. It is necessary for medical and nursing workers develop targeted intervention measures, reduce thirst distress while achieving the best outcomes, and improve the patients′ quality of life.

Objective:To explore research trends in the field of heart failure nursing.Methods:Web of Science database was searched and there trieval year was set to January 2000 to October 2020. CiteSpace software was used to visualize and quantitatively analyze the retrieval results.Results:A total of 2 352 articles were included. The number of articles published on heart failure nursing showed a continuous rise, and the highest number of articles issued was in 2018.The Journal with the highest number of publications was Journal of Clinical Nursing, the author with the highest number of publications was Tiny Jaarsm, the country with the highest number of publications was the United States, and the influential institution was University of Pennsylvania.Research hotspots mainly focused on management, outcome, mortality, quality of life, readmission, risk, hospitalization, survival, depression and palliative care. Conclusions:Visualization analysis shows the research trend in the field of heart failure nursing research, transitional nursing and community nursing are still the focus of future research.The visual analysis shows the research trend in the field of heart failure nursing, and transitional nursing and community nursing are still the research hotspots in the future.

Objective:To explore the research hotspots and status of nursing human resource management.Methods:Using the Web of Science core database as the data source, CiteSpace 5.8. R1 visual analysis software was used to analyze the country/institutional distribution, journal distribution, author collaboration, references, and keyword co-occurrence (clustering) of nursing human resource management research published from January 1, 2000 to June 5, 2021. The relevant results are summarized and discussed.Results:A total of 2 537 articles were included. The annual distribution of published articles showed a continuous upward trend in general, and the most articles was in 2020 (271 articles) , and the country with the most articles was the United States. The institution with the most publications and influence was the University of Sao Paulo, and Lancet was the most co-cited journal, followed by the Journal of Advanced Nursing and the International Journal of Nursing Studies. High-frequency keywords mainly included job satisfaction, education/training, stress, mortality, satisfaction, challenge, attitude, patient safety, leadership and intervention. Conclusions:This study visually presents the general situation of foreign nursing human resource management research, and forms a general understanding of the research hotspots, which provides a reference for future research.

Objective:To deeply understand the real experience of young and middle-aged lymphoma patients returning to society.Methods:From August to September 2021, 17 young and middle-aged lymphoma patients admitted to the Department of Hematology of the First Affiliated Hospital with Nanjing Medical University were selected as the research object by objective sampling. Phenomenological research method was using to conduct face-to-face in-depth interviews. Colaizzi 7-step analysis method was used to summarize, analyze and refine the theme.Results:A total of 3 first-level themes and 10 second-level themes were extracted. Among them, the willingness to return to society included firm willingness of social return and negative attitude of social return. The scope of social return included returning to work, interpersonal communication, family responsibilities, leisure and entertainment and lifestyle. The influencing mechanism of social return was composed of disease and treatment factors, mental factors, external support and economic capacity.Conclusions:The experience of young and middle-aged lymphoma patients returning to society is a dynamic change process in many aspects. In the future, it is necessary to further explore the status quo of social return of such groups and explore the influencing factors and change tracks of heterogeneity.