Purpose:The aim of this study was to evaluate the changes of NK and T lymphocyte with gastric cancer and before and after operation.Methods:T lympho cyte subsets and NK cell activity of 36 cases of gastric cancer and 30 cases of normal subjects were measured by monoclonal anti human T lymphocyte antibody and MTT assay before and after operation.Results:It was found that before operation the CD3(+),CD4(+) cell and ratio of CD4(+)/CD8(+) were significantly decreased and CD8(+) cell was increased and NK activity decreased with gastric cancer as compared to control group ( P

Acute mesenteric ischemia (AMI) is a lifethreatening disease,with high mortality rate and is easily misdiagnosed.Rapid and acute detection of the AMI and its primary diseases by multi-slice computed tomography (MSCT) and computed tomography angiography (CTA) is of great significance.The clinical data of 31 patients with AMI who were admitted to the Xidian Group Hospital from January 2005 to June 2013 were retrospectively analyzed.Stenosis or occlusion of the mesenteric blood vessels,diminished or absent enhancement of the bowel wall are the direct signs of CT,thickening of the bowel wall is the most typical indirect sign of CT.Dilatation or collapse of the bowel lumen and swelling of the mesenterium are the common CT signs.Pneumatosis intestinalis and gas in the portomesenteric vein are reliable CT signs of the Intestinal Infarction.Artery and venous embolism,atherosclerosis,vasculitis,aortitis,strangulated intestinal obstruction and superior mesenteric artery dissection are the possible causes of AMI.

Objective:To study the expressione of autophagy-related protein Beclin-1 and LC3 in cortex and hippocampus of rats after cerebral ischemia reperfusion injury and the efficacy of Edaravone.Methods:Sprague Dawley rats were randomly divided into sham group,model group and Edaravone group.The cerebral ischemia reperfusion model was induced via Zea Longa with blocking the middle cerebral artery of 2 h and reperfusing of 24 h.Animals assigned to sham group were only separated left common carotid artery.Edaravone was injected intraperitoneally at a dose of 1 0 mg/kg at 15 min before reperfusion.The condition of nerve injury of rats was conducted by Neurobehavioral score.The degree of brain injury and success of model were determined based on 2,3,5-triphenyltetrazolium chloride(TTC)staining.The changes of neuron stained by hematoxylin and eosin (HE) in cortex and hippocampus were observed.The expression of Beclin-1 and LC3 was measured by immunohistochemistry.Results:After cerebral ischemia reperfusion the neurobehavioral score of edaravone group was(2.00± 0.67),which was obcviously less than(2.50± 0.53) of model group(P＜0.05).The infraction focus and the neuron injury in cortex and hippocampus neurons were also observed in model group,and the edaravone group reduced above expression.The positive rate of Beclin-1 of each group in cortex were (1 1.08± 0.85)％,(33.42± 1.57)％ and (25.61± 1.39)％,there was significant difference between model group with sham group and edaravone group (P＜0.05).The positive rate of Beclin-1 of each group in hippocampus were (10.34± 0.21)％,(31.82± 1.73)％ and (22.74± 1.26)％,there was significant difference between model group with sham group and edaravone group(P ＜ 0.05).The positive rate of LC3 of each group in cortex were (15.33± 0.47)％,(39.72± 1.73)％ and (28.53± 1.61)％,there was significant difference between model group with sham group and edaravone group(P＜0.05).The positive rate of LC3 of each group in hippocampus were (13.74± 0.37)％,(32.53± 1.43)％ and(25.38± 1.23)％,there was significant difference between model group with sham group and edaravone group (P＜0.05).Conclusion:The expression of Beclin-1 and LC3 was increased after cerebral ischemia reperfusion.Edaravone may reduce autophagy and brain injury through downregulation the expression of Beclin-1 and LC3.

BACKGROUND:The greatest risk of osteoporosis in total knee arthroplastyisperioperative and long-term periprosthetic fractures. However, limited by the traditional concept of osteoarthritis patientswhousualy not associated with osteoporosis, domestic clinical trials have not given enough attention to the osteoporosis before total knee arthroplasty.
OBJECTIVE:To analyze the osteoporosis and its relative factors in osteoarthritis patients before total knee arthroplasty.
METHODS:Data of 81 cases (81 knees) of knee osteoarthritiswhounderwenttotal knee arthroplasty in the Department of Joint Surgery of Tianjin People’s Hospital from January 2012 to November 2014 were retrospectively analyzed. They received lumbar spine and hip bone mineral density examination before surgery. The correlation of bone mineral density with age, body mass index, knee motion range,and knee deformity was analyzed before surgery. The independent risk factors for osteoporosis before replacement were analyzed.
RESULTS AND CONCLUSION:(1) Of 81 patients, there were normal bone mineral density in 25 cases (31%), osteopenia in 35 cases (43%),andosteoporosis in 21 cases (26%). Al 10 males had no osteoporosis and 21 in 71 female cases suffered osteoporosis (30%). Theincidence of osteoporosis in females was significantly higher than in male patients (P=0.046). (2) There was a linear correlation of bone mineral density with age and body mass index (correlation coefficientr=-0.230, 0.225). (3) The age of≥65 years and body mass index≥25 kg/m2were independent risk factors of osteoporosis before replacement (P< 0.05). (4) Patients with knee osteoarthritis had higher incidence of osteopenia and osteoporosis before total knee arthroplasty. The degree of osteoporosis was negatively correlated with age, but positively correlated with body mass index. The age of≥65 years and body mass index < 25 kg/m2were independent risk factors for preoperative osteoporosis. Thus, bone mineral density examination is essential for those patients before total knee arthroplasty.

The expansion movement of the market and the reverse movement that it has encountered to control its expansion constituted the " double movement" written by the British scholar Karl Polan.In traditional China,because the market was strictly embedded in the social,political,economic and ethical structure,there was no so-called " double movement",and the trust between doctors and patients was naturally established and historical-ly continued.Since the reform and opening up,with the gradual introduction of market mechanism in the reform of medical system,the market was increasingly " un-embedded" and expanded rapidly.At the same time,the socie-ty represented by the patients and their families gradually began to wake up and took action against market expan-sion,forming a more typical trend of " double movement" and triggering a more obvious crisis of doctor-patient trust.From the perspective of "double movement",to rebuild doctor-patient trust in the new period must re-em-bed the market into the society and strictly regulate some spontaneous social reverse movements.

Facing the problems of inconsistent standards and lack of standardized management procedures in the management of hospital diagnosis and surgical operation master data, the hospital redefined the metadata and data model by analyzing the data characteristics and the requirements of different application scenarios, cleaned and transformed the existing data to form a standardized unified standard for distribution, and established a complete data lifecycle management process.Finally, the consistency, integrity and controllability of diagnosis and operation data in each system could be realized, and the management level of diagnosis and operation master data could be effectively improved.

Objective To investigate the changes of serum Copeptin and matrix metalloproteinase-9 (MMP-9) in children with chronic heart failure (CHF) and its clinical significance. Methods A total of 186 children with CHF were selected for CHF group, including 78 cases of cardiac function grade Ⅱ, 65 cases of grade Ⅲ, and 43 cases of grade Ⅳ. There were 57 cases of dilated cardiomyopathy, 68 cases of congenital heart disease and 61 cases of other diseases. Another 85 healthy children from health checkup were chosen as controls. The levels of serum Copeptin and MMP-9 were determined by enzyme linked immunosorbent assay (ELISA), and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was measured by bidirectional lateral flow immunoassay. The left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular ejection fraction (LVEF), and left ventricular short fraction shortening (LVFS) were measured by echocardiography. ROC curve was used to analyze the diagnostic value of serum Copeptin and MMP-9 in CHF. The correlation of serum Copeptin and MMP-9 with the cardiac function indices were examined by Pearson correlation analysis. Results The levels of serum copeptin, MMP-9, and NT-proBNP in different cardiac function groups (Ⅱ, Ⅲ, Ⅳ) increased gradually with the aggravation of the cardiac function damage and were higher than those in control group, and the differences were statistically significant (P<0.05). Compared with the control group and cardiac function grade Ⅱ group, the levels of LVESD and LVEDD were increased and the levels of LVEF and LVFS were decreased in the grade Ⅲ and Ⅳ groups. Compared with the grade Ⅲ group, the levels of LVESD and LVEDD were increased and the levels of LVEF and LVFS were decreased in the grade Ⅳ groups. There were significant differences (P<0.05). The ROC curve showed that the area under the curve (AUC) and 95％ CI of serum Copeptin, MMP-9, NT-proBNP and combinations of these three biomarkers in the diagnosis of CHF were 0.845 (0.781～0.914), 0.806 (0.736～0.883), 0.894 (0.828～0.962) and 0.925 (0.846～0.983) respectively, and the optimal thresholds were 12.5 pmol/L, 175.3 μg/L and 2037.0ng/L. The level of serum Copeptin was positively correlated with MMP-9 (r=0.807, P<0.001). Conclusion Serum Copeptin and MMP-9 may be involved in the ventricular remodeling in CHF children and they are expected to be a good indicator for the diagnosis of CHF and cardiac function.

Objective:A meta-analysis was conducted to investigate the risk factors of interstitial lung disease in patients with RA to provide a reliable reference for clinical practice.Methods:Publications of the China Knowledge Network, Vipshop, Wanfang, China Biomedical Literature Database, EMbase, PubMed, and Cochrane Library databases were searched to obtain literature on cohort studies and case-control studies for risk factors for RA complicated with interstitial lung disease from the time of database creation until December 31, 2022. Literature screening, information extraction, and final quality evaluation were performed independently by two investigators. The extracted data were analyzed using RevMan 5.3 software.Results:A total of 31 studies with a total of 26 747 patients were included in this study, of which 4 799 patients(17.94%) were patients with RA complicated with interstitial lung disease. A total of 12 risk factors were obtained included: advanced age [ OR (95% CI) =1.07(1.04, 1.09), P<0.001], high age at onset [ OR (95% CI) =2.11(1.17, 3.82), P=0.010], male [ OR (95% CI) =1.95(1.34, 2.84), P<0.001], long duration of disease [ OR (95% CI) =1.10(1.08, 1.13), P<0.001], smoking [ OR (95% CI) =2.47(1.57, 4.04), P<0.001], high disease activity [ OR (95% CI) =(1.21, 2.54), P=0.003), cough [ OR (95% CI) =6.10 (2.40, 15.52), P<0.001], decreased pulmonary carbon monoxide diffusing capacity [ OR (95% CI) =0.93(0.89, 0.96), P<0.001], and high titer anti-CCP antibody [ OR (95% CI) =1.14(1.03, 1.26), P=0.010], high titer RF [ OR (95% CI) =2.37(1.70, 3.29), P<0.001], high level of immunoglobulin A [ OR (95% CI) =1.26 (1.09, 1.46), P=0.002] and high level of glycoprotein antigen 125 [ OR (95% CI) =3.66 (1.81, 7.41), P<0.001]. Conclusion:The existing evidence have shown that advanced age, high age at onset, male, long disease duration, smoking, high disease activity, cough, decreased pulmonary carbon monoxide diffusing capacity, high titer anti-CCP antibody and RF, high level of immunoglobulin A and high level of glycoprotein antigen 125 are the main risk factors for interstitial lung disease in patients with rheumatoid arthritis. However, the evidence of Raynaud's phenomenon and tumor marker CA153 as risk factors for RA complicated with interstitial lung disease is not strong, and further high-quality prospective cohort studies are needed.

Objective:To construct the "Internet +" nurse core competency evaluation index system.Methods:Combined with the policy analysis and literature research, a preliminary item pool was formed. The semi-structured interview was conducted to form a preliminary "Internet+" nurse core competency evaluation index system. From June to August 2021, the Delphi method was used to conduct three rounds of consultation with 19 experts, and finally determine the contents of the index system. The weights of indicators at all levels were calculated in combination with analytic hierarchy process.Results:Among three rounds of expert consultation, the questionnaire recovery rates were 100%, 100%, and 94.7% respectively, and the expert authority coefficients were 0.862, 0.857, and 0.841, and the Kendall coefficients were 0.228, 0.296, and 0.295 with statistical differences ( P<0.001) . The finally established "Internet +" nurse core competency evaluation index system included 4 first-level indicators, 16 second-level indicators and 59 third-level indicators of professional knowledge, professional skills, comprehensive ability and personal characteristics. Conclusions:The constructed "Internet +" nurse core competency evaluation index system is reliable, scientific and practical, and can be used as a basis for evaluating "Internet +" nurses' service capabilities.

Objective:To explore the influencing factors of Internet + nursing service quality.Methods:Using a convenience sampling method, 290 nursing staff who had implemented Internet+ nursing services in Beijing and Tianjin were selected for a questionnaire survey from January to February 2022, and structural equation model was used to analyze the influencing factors and the path of action of service quality.Results:The structural equations constructed fit well, with gender, degree of service difficulty and degree of service motivation being direct influences on the quality of Internet+ nursing services, with degree of service difficulty also having an indirect effect on service quality through degree of service motivation.Conclusions:The quality of Internet+ nursing services is influenced by multiple factors and pathways. The relevant authorities can conduct a comprehensive assessment of the factors and pathways and manage them in a targeted manner to improve the quality of services.