Objective To enhance patients' abilities in self-management. Methods We used the nursing project method to analyze reasons and develop standard process of follow-up management and health education. A retro-spective analysis of 84 patients with stage 3 to 4 CKD was performed by nursing project method. This analysis compared the changes after the intervention program,including the ability of self-management,follow-up,medication and diet compliance,and the control rate of physiological indicators. Results By comparison with the intervention before and after,there were significant improvements in each dimension of self-management ability (P<0.001),follow-up, medication and diet compliance were significantly improved(P<0.05),and there were significant improvements in the control rate of systolic pressure and blood uric acid(P<0.001),the differences were statistically significant. Conclusion The application of nursing project can improve self-management ability,the compliance of follow-up,medication and diet as well as physiological indicators in patients with stage 3 to 4 CKD.

Magnetic resonance imaging (MRI) simulator (MRI-Sim) can provide superior images for radiotherapy.Due to the complexity of MRI technology and the safety problem caused by strong magnetic field, the acquisition and implementation of MRI simulation is more complicated than CT simulation.In order to ensure the introduction of MRI-Sim, this paper reviews the selection, installation, and acceptance test of MRI-Sim, including the selection of host and auxiliary equipment, installation site preparation, and safety precautions,as well as MRI-Sim acceptance test and commissioning.

Objective To investigate whether IL-24 can inhibit the growth of pancreatic cancer in immune-competent mice,which could be mediated by tumor-targeting oncolytic adenovirus (ZD55-IL-24).Methods Crystal violet staining assay was used to evaluate the anti-proliferative influence of ZD55-IL-24 on Panc02.The tumor growth curve,the tumor formation curve,TUNEL assay,cytotoxic T lymphocyte (CTL) killing assay and serum cytokines detection were used to assess anti-tumor efficacy of ZD55-IL-24 for pancreatic cancer in immune-competent mice.Results ZD55-IL-24 significantly inhibited the growth of pancreatic cancer cells in vitro.Lower tumor formation and slower tumor growth were identified in ZD55-IL-24 group,compared with ZD55-EGFP group or PBS group.ZD55-IL-24 induced pancreatic cancer cells'apoptosis,and mediated anti-cancer immunity by increasing killing responses of CTL to cancer cells and up-regulating serum γ-IFN and IL-6 levels.Conclusion ZD55-IL-24 can induce anti-tumor immunity and suppress pancreatic cancer growth in immune-competent mice.

Objective:To explore the effect of Internet nursing based on transtheoretical model (TTM) in dietary management of patients with chronic kidney disease (CKD).Methods:A total of 160 CKD patients in the Nephrology Clinic of Tianjin First Central Hospital were selected and divided into the control group and the observation group by convenience sampling and simple randomization, with 80 cases in each group. Quantitative diet management were given in the control group and Internet nursing intervention with TTM as the framework in the observation group for 6 months. The distribution of behavioral stages, dietary compliance and changes in clinical laboratory parameters before and after intervention were investigated in the two groups.Results:After intervention for 3 and 6 months, the distribution of behavioral phase in the observation group was better than that in the control group, and the difference was statistical significant ( χ2=28.48, 48.49, all P<0.01); the daily sodium intake in the observation group was (2.86 ± 0.64), (2.58 ± 0.56) g, and the daily protein intake was (0.81 ± 0.18), (0.76 ± 0.13) g/kg, respectively; the daily sodium intake and daily protein intake in the control group were (3.76 ± 1.42), (4.11 ± 1.49) g and (1.00 ± 0.19), (1.04 ± 0.21) g/kg, respectively, and the differences between the two groups had statistical significance ( t values were 26.74 -105.11, all P<0.01). After intervention for 3 and 6 months, systolic blood pressure was (126.41 ± 9.12) and (124.96 ± 8.58) mmHg (1 mmHg=0.133 kPa), serum creatinine was (177.01 ± 89.04) and (183.24 ± 101.48) μmol/L in the observation group, while systolic blood pressure was (133.16 ± 14.28) and (133.18 ± 12.34) mmHg, serum creatinine was (213.29 ± 108.02) and (222.61 ± 117.33) μmol/L in the control group, and serum potassium and serum phosphorus were (4.37 ± 0.38) and (1.10 ± 0.16) mmol/L after intervention for 6 months in the observation group, while (4.60 ± 0.43) and (1.21 ± 0.21) mmol/L in control group, and the differences between the two groups had statistical significances ( t values were 5.16-23.89, all P<0.01). Using repeated measures analysis of variance, there were significant differences in daily sodium and protein intake, time effect, effect and interaction effect of systolic blood pressure, serum creatinine, serum potassium and serum phosphorus ( Ftime values were 8.97-61.66, Finterblock values were 3.96-32.28, Finteraction values were 3.15- 36.35, all P<0.05), diastolic blood pressure time effect and interaction effect ( Ftime=8.08, Finteraction=3.64, all P<0.05), and blood uric acid time effect ( Ftime=10.50, P<0.01). Conclusions:The Internet care model framed by TTM is beneficial for improving dietary behavior, improving dietary compliance, and improving clinical laboratory parameters in CKD patients in the long term.

Objective:To explore the application of failure mode and effects analysis (FMEA) in low-energy X-ray intraoperative radiotherapy (IORT), analyze its potential risks in IORT, and preliminarily explore the feasibility of FMEA in optimizing IORT management and reducing the occurrence of potential risks.Methods:An FMEA working group was established by the IORT team (1 radiologist, 1 radiology physicist, 2 surgeons, and 2 nurses) to apply the FMEA methodology to conduct a systematic risk assessment. The process modules were established, the potential failure modes and causes for each module were analyzed, the severity (SR), frequency of occurrence (OR) and likelihood of detection (DR) of failure modes were scored and the risk priority number (RPN) was calculated: RPN= SR × OR × DR. The possible errors and potential clinical impact of each part of the radiotherapy process were prospectively analyzed and understood, the causes and current measures were analyzed for each failure mode and preventive measures were proposed and risk management measures were taken accordingly.Results:The IORT process was divided into 8 modules with 14 failure modes. The highest OR value was unsatisfactory target area confirmation (7 points), the highest SR value was equipment failure to discharge the beam (10 points), the highest DR value was wrong key entry after dose calculation (7 points), the highest RPN values were unsatisfactory target area confirmation (210 points) and ineffective protection of endangered organs (180 points). Weaknesses were corrected according to priorities, workflows were optimized and more effective management methods were developed.Conclusion:FMEA is an effective method of IORT management and contributes to reducing the occurrence of potential risks.

Objective To analyze the expression levels and clinical significance of N-myc down-stream-regulated gene 3(NDRG3)and semaphoring 3A(SEMA3A)in elderly patients with acute ischemic stroke(AIS).Methods A total of 100 elderly AIS patients admitted to Department of Geriatrics of Liaocheng People's Hospital from September 2020 to September 2022 were included as the study group.According to their NIHSS score at admission,they were divided into mild(34 cases),moderate(31 cases)and severe(35 cases)subgroups.All patients were followed up for 3 months after discharge.And they were assigned into good prognosis group(69 cases)and poor prognosis group(31 cases)based on the modified Rankin scale score.Another 100 healthy individ-uals who underwent physical examination in our hospital during the same period were recruited as the control group.Western blotting was used to detect the protein expression of NDRG3 and SEMA3A in peripheral blood mononuclear cells(PBMC).ELISA was applied to measure the con-tents of VEGF,TGF-1,TNF-α,and IL-17 in peripheral blood samples.Spearman rank correlation analysis was performed to analyze the correlation of NDRG3 and SEMA3A levels with NIHSS score,and ROC curve was plotted to analyze the values of NDRG3 and SEMA3A in predicting poor prognosis in elderly AIS patients.Results The expression levels of NDRG3 and SEMA3A in PBMC were obviously higher in the study group than the control group(1.11±0.16 vs 0.76± 0.13,0.78±0.13 vs 0.42±0.09,P＜0.01).The levels in the mild,moderate and severe subgroups were significantly higher than that of the control group(P＜0.01).The poor prognosis group had statistically higher expression levels of NDRG3 and SEMA3A than the good prognosis group(P＜0.01).Spearman rank correlation analysis showed that the NIHSS score was positively corre-lated with the expression levels of NDRG3 and SEMA3A in elderly AIS patients(r=0.597,P＜0.01;r=0.618,P＜0.01),while the NDRG3 level was positively correlated with that of SEMA3 A(r=0.477,P＜0.01).ROC curve analysis indicated that the AUC value of combined NDRG3 and SEMA3A levels was superior to that of NDRG3 and SEMA3A alone in predicting of poor progno-sis(0.962 vs 0.861,0.880,P＜0.01).Conclusion The levels of NDRG3 and SEMA3A proteins are up-regulated in elderly AIS patients,and are closely associated with the severity and prognosis of the disease.

Objective To explore the effects of endotoxin/lipopolysaccharide (LPS) on early apoptosis of human neutrophil through PIM3.Methods Venous blood samples were collected from a healthy adult volunteer to isolate neutrophils.The neutrophils were divided into control group,LPS group,and LPS + PIM447 group according to the random number table.No treatment was given to the cells in control group.The cells in LPS group underwent LPS stimulation (1 μL,1 μg/mL).The cells in LPS + PIM447 group underwent PIM447 (1 μL,final amount-of-substance concentration of 5 μmol/L) intervention 30 min before having the same LPS stimulation as that in LPS group.After conventional culture for 1 h,the early cell apoptosis rate was determined with flow cytometer;the generation level of reactive oxygen species (ROS) was assessed with dihydrogenrhodamine 123 fluorescent probe staining method;and the level of PIM3 was detected by Western blotting.After conventional culture for 2 h,the cell chemotaxis distance was measured by agarose chemotaxis cell model.The sample numbers of each group in the 4 experiments were all 5.Data were processed with one-way analysis of variance and Student-Newman-Keuls test.Results (1) The early apoptosis rate of cells in LPS group [(0.891 ± 0.012) ％] was close to that in control group [(1.351 ± 0.183)％,P ＞0.05)].The early apoptosis rate of cells in LPS+PIM447 group [(82.057±0.121)％]was higher than that in LPS group (P ＜ 0.01).(2) The cell chemotaxis distance of cells in LPS group [(984 ±5) μm] was significantly shorter than that in control group [(2 241 ±7) μm,P ＜0.01].The cell chemotaxis distance of cells in LPS + PIM447 group [(1 785 ± 1 1) μm] was significantly longer than that in LPS group (P ＜ 0.05).(3) The generation level of ROS in cells of LPS group was significantly higher than that in control group (P ＜ 0.05).The generation level of ROS in cells of LPS + PIM447 group was significantly lower than that in LPS group (P ＜ 0.05).(4) The expression level of PIM3 in cells of LPS group (1.297 ±0.015) was significantly higher than that in control group (0.789 ±0.021,P ＜0.05).The expression level of PIM3 in cells of LPS + PIM447 group (0.731 ± 0.011) was significantly lower than that in LPS group (P ＜0.05).Conclusions LPS stimulation can reduce the early apoptosis of human neutrophils.Pre-intervention with PIM447 can significantly increase the early apoptosis of neutrophils after LPS stimulation,recover the chemotaxis,and inhibit the production of ROS.The mechanism may be related to LPS promoting the expression of PIM3.

Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.

Objective:To analyze the medication rules in the ancient book Pu Ji Fang for the external treatment of acne based on data mining method. Methods:By screening out the methods of treating acne externally in Pu Ji Fang and establishing a standardized medical record database, this paper adopted the web version of Ancient and Modern Medical Record Cloud Platform to calculate the frequency, properties, flavors, and meridians of those medicines, and conduct cluster analysis by using IBM SPSS Modeler 18.0 software to analyze the association rules. Results:A total of 87 prescriptions were selected, including 164 kinds of Chinese materia medica, among which. Radix Angelicae, Ligusticum Wallichii, Rhizoma Typhoni and lead powder are frequently appeared. The properties of those medicines are mainly warm, cold and mild; the flavors of those medicines are mainly spicy, acrid, sweet and bitter, and the meridians mainly belongs to lung, spleen, stomach and liver meridians. The medical pair and group with the strongest associationion are Ligusticum Wallichii- Radix Angelicae and Rhizoma Typhonii- Radix Angelicae- Ligusticum Wallichii. Those freuently appeared medicines could be grouped into three categories. The paste dosage that was frequently appeared has strong correlation with tallow, mercury and lead powder, while the powder dosage that was frequenctly appeared has strong correlation with Angelica Dahurica, Radix Saponicae, Gleditsia sinensis, Radices Ligustici Sinensis and Ligusticum Wallichii. Conclusions:The application of data mining method could preliminarily reveal the medication rules of Pu Ji Fang for the external treatment of acne. The main treatment method is XinSanFaYue. The three categories of Chinese materia medica are used to treat the syndrome of asthenic habitus attacked by exogenous pathogenic factors, exterior attacked by wind heat and hot blood stasis respectively, showing the rules of treating acne externally before Ming Dynasty and providing references for the clinical treatment of acne.

Osteonecrosis of the femoral head (ONFH) is one of the common and difficult-to-treat orthopedic diseases caused by a variety of factors that lead to abnormal blood flow to the femoral head, which in turn leads to deformation and collapse of the femoral head and eventually results in severe hip joint dysfunction. The key to the treatment is early diagnosis and correct treatment according to the stage classification and active prevention of further aggravation of ONFH aiming to delay or avoid hip replacement surgery in young and middle-aged patients. At present, there are various non-surgical and surgical hip-preserving modalities for early ONFH, designed to slow down the progression of the disease, prevent the femoral head from collapsing and stop the mild collapse. In recent years, with the emergence and development of bone reconstruction biomaterials, artificial bone reconstruction after scraping of ONFH lesions has shown great potential in the treatment of early ONFH. The authors review the research progress in hip-preserving modalities for early ONFH in young and middle-aged patients from non-surgical and surgical perspectives, hoping to provide a reference for clinical treatment of early ONFH.