Objective The currently pertinent articles about the molecular mechanism of recurrence and metastasis of primary hepatocellular carcinoma (HCC) were reviewed. Methods Literatures that related to the molecular mechanism of the recurrence and metastasis of HCC were summarized retrospectively in this review. Results Several genes, such as the growth factors and the corresponding receptors, the adhesive molecule, and the extracellular matrix and many factors, such as the oxygen supply, tumor angiogenesis and the immune system, all took important roles in the process of recurrence and metastasis of HCC, which involves many steps. Conclusion The study of the recurrence and metastasis of HCC should be emphasized further since early intervening the genes that are related to the recurrence and metastasis may help prevent the recurrence and metastasis of HCC completely, decrease the death rate and improve patients’ life quality in the long term.

Objective To investigate the efficacy of surgical treatment for hepatolithiasis in patients of advanced age.Methods The clinical data of 196 patients of advanced age (≥80 years) and with hepatolithiasis who were admitted to the Kailuan General Hospital from January 2009 to October 2012 were retrospectively analyzed.All the 196 patients received surgical treatment.Patients were followed up via phone call or out-patient examination till May 2013.Results Fifty-eight patients received emergent operation within 24 hours after admission,and the other 138 patients received operation 7.4 days (range,1.0-18.0 days) after admission.Fifty patients received laparoscopic surgery,including 43 received cholecystectomy + choledocholithotomy + T tube drainage,7 received choledocholithotomy + T tube drainage.One hundred and forty-six patients received open surgery,including 78 received cholecystectomy + choledocholithotomy + T tube drainage,43 received choledocholithotomy + T tube drainage and 25 received choledocholithotomy + T tube drainage + partial hepatectomy.The operation time was (78 ± 16)minutes,and the volume of intraoperative bleeding ranged between 15 mL and 300 mL.One hundred and ninety-four patients were cured and 2 patients died.Thirty-seven patients had complications after operation,with the morbidity of 18.88％ (37/196).A total of 163 patients were followed up,with the follow-up rate of 83.16％ (163/196).The median time of follow-up was 26 months (range,7-52 months).Twelve patients had hepatolithiasis recurrence,and the recurrence rate was 7.36％ (12/163).Conclusion Surgical treatment for hepatolithiasis in patients of advanced age has the advantages of high cure rate,low incidence of complications and recurrence,and the clinical efficacy is satisfactory.

Objective To compare the efficacy of sedation with dexmedetomidine versus midazolam in mechanically ventilated patients.Methods Sixty patients aged 20-64 yr,with body mass index 21-25 kg/m2,APECHE Ⅱ score 10-25,requiring 24 h of nechanical ventilation in intensive care unit (ICU),were randomly divided into 2 groups (n=30 each): midazolam group (group M) and dexmedetomidine group (group D).A loading dose of midazolam 0.05 mg/kg was injected intravenously,followed by infusion at 0.03-0.20 mg· kg-1 · h-1 in group M.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously,followed by infusion at 0.2-0.7 μg· kg-1 · h-1 in group D.Ramsay sedation score was maintained at 2-4.The satisfaction of the doctors in ICU with the sedative efficacy,hypotension and bradycardia were recorded.Delirium was recorded starting from the begging of sedation to 2 h after the end of sedation.The emergence time and occurrence of falling asleep again within 2 h after waking were also recorded.Results Compared with M group,the satisfactory level of the doctors in ICU with the sedative efficacy was significantly increased,the emergence time was significantly shortened and the incidences of falling asleep again within 2 h after waking and delirium were significantly decreased (P ＜ 0.05 or 0.01),and no significant change was found in the incidence of hypotension and bradycardia in group D (P ＞ 0.05).Conclusion The efficacy of sedation with dexmedetomidine is better than that of midazolam in mechanically ventilated patients.

Objective To analyze the long-term results of rituximab combined with whole brain radiotherapy and 3-dimentional conformal radiotherapy (3D-CRT) in treatment of patients with primary central nervous system lymphoma (PCNSL). Methods 23 postoperative patients younger than 60 years old were treated. Whole brain radiotherapy with dose of 32.4 Gy were performed and lesions were followed by 3D-CRT with dose of 18 Gy.A dose of rituximab (375 mg/m2) was infused on day 1 (once a week for six weeks).The overall survival was analyzed by using Kaplan-Meier.Results 19 patients(82.6 ％) was complete remission 3 patients (13.0 ％) was part remission,14 patients (60.9 ％) was progression-free survival was 26 months (17-34 months). The overall survival was 40 months (29-55 months). Toxicity was moderate without grade 3-4 neurotoxicity toxic events. Conclusions Radiotherapy (whole brain radiotherapy with sequential 3D-CRT)combined with rituximab seems to yield substantial long-term survival with moderate toxicity for the treatment of the younger patients with PCNSL.

Background Patients often suffer from a few complications of neurological and psychiatric problems after traumatic brain injury including damage of cognition, mental disorders and behavior problems. Damage of cognition is a common sequela in traumatic brain injury. Numerous researchers were focus on the cognition changes of patients with mild brain injury. But their conclusions are debatable. Executive function is one of the important components of cognition. In this study,we tried to find out the executive functional alterations of the patients with mild brain injury.Methods 159 patients with brain injury caused by transportation events and 68 normal controls were assessed executive function. The executive function tests included the block design in WAIS, the Stroop test, the verbal fluency and the modified version of Wisconsin card sorting test (M-WCST). These tests were applied to compare the scores of traumatic brain injury patients with various severities including mild, moderate, and severe and with different CT/MRI results.Results Patients with mild head injury got significantly lower scores on all tests than normal controls ( P＜0.01 ). But there was no significant difference between mild and moderate brain injury group. Except Stroop test and WCST categories, patients with mild brain injury got significantly lower scores on all other tests than those with severe brain injury ( P ＜0.05). In the brain injury cases with damage signs on CT/MRI, there was no significant difference on scores of all tests except block design tests among brain injury patients with various severities. Among the brain injury cases without any damage signs on CT/MRI, there was no significant difference on scores of all tests among brain injury patients with various severities. The correlation analysis showed that scores of block design and verbal fluency test were negatively related to the severity of brain injury( P＜0.05). The age and the education level of the patients had negative and positive correlation, respectively, to executive function.Conclusions The executive function of patients with mild brain injury was impaired when the medication was terminated. We should pay more attention to patients with mild brain injury by performing various tests for assessment of disability.

Functional vision is the visual ability of patients with visual disorders when they participate in or complete daily activities, through early evaluation and targeted treatment, the improvement of disease prognosis can be realized. In this paper, the concept of functional vision was introduced, the evaluation content, scoring method and application status of functional vision evaluation tools for patients with visual disorders were described, and the analysis and comparison of the characteristics and shortcomings of each evaluation tool were carried out.Thus providing appropriate functional vision evaluation tools for medical staff in China and providing reference for improving the quality of functional vision evaluation for patients with visual disorders.

Objective:To analyze the classification characteristics of nurses ′ perception of management care in tertiary Class A hospital in Tianjin and the differences in demographic characteristics among different categories, and provide reference for care managers to provide targeted care intervention. Methods:Totally 456 nurses from 6 tertiary Class A hospitals in Tianjin were selected by convenience sampling way from May to July 2020, and carried out surveys through the online questionnaire star platform. The content included general subject and the Chinese version of Caring Assessment Tool-administration Scale.Results:According to nurse management care perception totally 456 nurses were divided into 4 Latent groups: low decision-making respect and low care group (C1) 20.5% (94/456), moderate decision-making respect and high care group (C2) 35.6% (162/456), high decision-making respect and low care group (C3) 18.9% (85/456), high decision-making respect and high-care group (C4) 25.0% (115/456). Single factor analysis showed that there were statistically significant differences in the distribution difference of different categories of nurses in departments, working years, department atmosphere and family support ( χ2 values were 19.119-55.947, P<0.01). Multiple Logistic regression analysis showed that departments, working years, department atmosphere had an effect on the level of nurses management, care and perception ( P<0.05 or 0.01). Specifically, nurses in the internal medicine, obstetrics and gynecology and intensive care unit were more close to C2 group ( OR values were 2.435, 5.224, 22.291, P<0.05 or 0.01); nurses in the surgery were more close to C4 group ( OR values were 4.146, P<0.01); nurses with seniority of≤5 years were more close to C1 and C2 groups ( OR values were 0.326, 3.811, P<0.05 or 0.01); nurses with ordinary atmosphere were more close to C1 group ( OR value was 0.057, P<0.01). Conclusions:Nurses ′perception of management care is in the upper middle level, which can be divided into four potential categories. Nurses who are in the surgical department with high seniority or harmonious atmosphere or supportive families have good perception of management care; nurses who are in the department of internal medicine, obstetrics and gynecology, intensive care unit or a department with ordinary atmosphere or low seniority have an average level of management, care and perception, which need to be improved. Care managers could formulate targeted care management measures according to the characteristics of different categories of nurses.

In December, the outbreak of a novel coronavirus (2019-nCoV) in Wuhan, China, has attracted extensive global attention. On January 20, 2020,the Chinese health authorities upgraded the coronavirus to a Class B infectious disease in the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases, and considered it as Class A infectious diseases in disease control and prevention. On January 22, 2020, the 2019-nCoV nucleic acid detection test was listed as the diagnostic criteria in the "guidelines for diagnosis and treatment of pneumonia due to 2019-nCoV (Trial Version 2)" . Therefore, standardizing the operation process of the 2019-nCoV nucleic acid detection in clinical laboratories has become a top priority. It is of paramount importance to establish standard protocols for detection of the 2019-nCoV nucleic acids in clinical laboratories to improve the reliability of the results and ensure the biosafety of laboratory personnel.

OBJECTIVE: To explore the influencing factors and correlation of job burnout and organizational support in medical staffs. METHODS: The cluster random sampling method was used to select 1 231 medical staffs as the study subjects from 7 municipal hospitals in Zhengzhou City,Henan Province. Maslach Burnout Inventory-General Survey and Organizational Support Scale were used for questionnaire survey. The correlation between job burnout and organizational support was analyzed by canonical correlation analysis. RESULTS: The score of job burnout was( 36. 0 ± 14. 1),and the median score of organizational support was 72. 0, showing a negative correlation( Spearman correlation coefficient was-0. 333,P < 0. 01). There is canonical correlation between job burnout and organizational support( F = 1. 94,P <0. 01). CONCLUSION: The present situation of job burnout among medical staffs is serious. Job burnout of medical staffs can be reduced by improving their sense of organizational support.

Objective: To analyze the research status, hotspots and frontier progress of hypertension in children in English and Chinese literature, so as to provide reference for the early prevention of hypertension in children. Methods: The Web of Science core collection database and CNKI database were searched to collect the literature related to the study of hypertension in children from 2000 to 2021, and the CiteSpace 5.8.R3 and VOSviewer 1.6.18 visualization tools were used to analyze the literature characteristics including publications, authors, regions, institutional cooperation, research hotspots and frontiers. Results: A total of 22 687 English studies and 4 440 Chinese studies were finally included. According to the analysis results, the number of articles published on hypertension in children was on the rise. The published English articles were mainly University of Toronto and University of Colorado. The main publishing institution of Chinese articles was the First Affiliated Hospital of Peking University. The United States and China took the lead in the number of core journals published in the field of hypertension in children, the United States ranked first in terms of the influence of publications. Keyword co occurrence analysis showed that the high frequency keywords in the English literature included prevalence, risk, obesity, risk factor, body mass index, insulin resistance, overweight, metabolic syndrome, cardiovascular disease and mortality. Chinese high frequency keywords in the literature include obesity, risk factors, adiposis, influencing factors, overweight, prevalence, diabetes, treatment, health education and body mass index. The analysis of keywords showed that 25 burst terms were obtained separately in English and Chinese literature. Conclusion In recent years, the research interest on hypertension in children continues to grow and keeps updated, with the research scope expanding significantly, regarding obesity, diabetes and cardiovascular diseases.