Objective To patient who suffer from middle and late period carcinoma of esophagus radiation therapy and chemotherapy. Observe the effects and the side effects of radiation therapy and chemotherapy.Methods Radiation therapy and chemotherapy 60 examples and radiation therapy 60 examples,radiation use usually divide,DT 40 Gy reduce area of radiation therapy,aroid medulla,add DT 20～30 Gy,its finished after 6～7 weeks.radiation therapy and chemotherapy after 1 and 4 week,DDP 20 mg/d is used.CF 0.1/d ivgtt CF ivgtt 1/2 is used use 5-fu 500 mg/d.iv five days in a routine,every day use radiation therapy and chemotherapy.Results Radiation therapy and chemotherapy 1,2,3 year alive rate are 67%,46%,34%,radiation therapy 1,2,3 year alive rate are 52%,38%,24%,pneumonia of radiation therapy is 14 examples and 12 examples,leukocyte in blood reaction is 26 examples and 17 examples,gastrointestinal effective is 25examples and 9 examples,death is 38 examples and 48 examples,treatment routine is better than compare routine (P＜0.05).Conclusion Radiation with PCF plan chemotherapy treat middle and late period carcinoma of esophagus have hish alive rate side effects and bad effects are low.

Objective To build predictive model of secondary mild cognitive impairment (MCI) in patients with painful diabetic neuropathy (PDN), and analyze its apply. Methods The patients with PDN were consecutively selected from March 2013 to March 2016. The relevant clinical data were recorded, and the patients were followed up for 1 year. According to the results of follow-up, secondary MCI risk indicators were predicted, and the time window of adverse outcomes event was validated. Results A total of 82 PDN patients completed the study, and secondary MCI occurred in 16 cases. Sixty-six cases had not secondary MCI. The Cox regression model multivariate analysis results showed that the independent influencing factors of secondary MCI was course of PDN, brief pain inventory (BPI) score and neuron-specific enolase (NSE) in patients with PDN (HR = 1.238, 1.336 and 1.450; P<0.05). The secondary time window of the MCI in PDN patients with the course of PDN ≥3.367 years, BPI score≥4.704 scores and NSE ≥ 7.420 μg/L was shorter, in whom BPI score and NSE had a higher evaluation ability. Conclusions The courses of PDN, BPI score and NSE are independent influencing factors of secondary MCI in PDN patients, and the BPI score≥4.704 scores and NSE≥7.420μg/L have a higher evaluation ability.

With advances in intensive care, more patients are surviving from critical illness, and post-intensive care syndrome (PICS) began to get people's attention. Early detection and intervention of PICS can improve the quality of life of intensive care unit (ICU) survivors and reduce the rate of re-hospitalization. However, effective, reliable, and easy-to-use assessment tools are the basis for early detection and evaluation of intervention outcomes. Thus, we introduce the evaluation tools for PICS from the perspective of universality or specificity, aim to provide reference for doctors or nurses to choose suitable assessment tools for PICS, and to provide reference for the development of localized assessment tools for PICS in China, so as to promote the related research of PICS.

ObjectiveTo investigate the efficacy and safety of sequential lenvatinib therapy after stereotactic body radiotherapy (SBRT) in the treatment of advanced primary liver cancer. MethodsA total of 18 patients with advanced primary liver cancer who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from October 2018 to May 2019 were enrolled, among whom there were 4 patients with BCLC stage B liver cancer and 14 patients with BCLC stage C liver cancer. The prescribed dose of planning target volume was 48-55 Gy (median 50 Gy) in 6-9 fractions, and the median of single dose was 6 (5-9) Gy per fraction. Oral administration of lenvatinib was given since 1 week after SBRT was finished, with a median medication time of 9.5 (3.6-25.8) months. Follow-up was performed once a month for the first 3 months after treatment and once every 3 months after 3 months of treatment. The Kaplan-Meier method was used to calculate overall survival (OS) rate, progression-free survival (PFS) rate, and local control (LC) rate, and the incidence rates of adverse reactions and complications were also observed. ResultsUp to the follow-up on November 30, 2020, a total of 8 patients died, among whom 3 died of liver failure, 3 died due to tumor progression, 1 died of perforation of gallbladder, and 1 died of gastrointestinal bleeding. At 3, 6, 9, 12, and 18 months of treatment, the OS rates were 100%, 94%, 83%, 72%, and 67%, respectively, the PFS rates were 100%, 67%, 50%, 22%, and 17%, respectively, and the LC rates were 100%, 94%, 94%, 94%, and 94%, respectively; the median OS time was ＞18 months, and the median PFS time was 9 months. Of all patients, 1 (6%) had a grade 3 adverse reaction during SBRT and 2 (11%) experienced a grade 3 adverse reaction during lenvatinib treatment, and no fatal adverse reaction was observed. ConclusionIt is preliminarily proved that sequential lenvatinib therapy after SBRT is an effective and safe treatment method for advanced primary liver cancer.

Objective:To investigate the effect and associated mechanism of tumor tissue-infiltrating NK cells after receiving radiotherapy for hepatocellular carcinoma (HCC).Methods:A HCC tumor-bearing mouse model was constructed using human hepatocellular carcinoma cell line (SK-Hep-1) and divided into four groups: control, radiotherapy, NK cell clearance, and NK clearance combined with radiotherapy. Tumor growth condition was simultaneously recorded. The NK cell ratio in peripheral blood and the NK cell intratumoral infiltration condition were detected by flow cytometry and immunohistochemistry. Lentiviral-constructed SK-Hep-1 cells was used to detect the effect of radiotherapy on the regulation of CXCL10 and NK cell chemotaxis following EZH2 overexpression. SK-Hep-1 cells were irradiated in vitro and in vivo. The expression levels of EZH2 and CXCL10 mRNA and protein in the two groups of cell lines and mouse tumor tissues were detected by reverse transcription polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA), western blotting (WB), and immunohistochemistry. The chemotaxis and blocking experiments were used to validate the chemotaxis effect of CXCL10 on NK cells. The independent sample t-test was used to compare the groups. P<0.05 was considered statistically significant. Results:The HCC tumor-bearing mouse model experiment showed that HCC tumor growth was most remarkable in the NK clearance combined with the radiotherapy group compared to the radiotherapy group ( P<0.05). Compared with the control group, the number of NK cells in the peripheral blood of nude mice in the radiotherapy group was significantly reduced, while the NK cell intratumoral infiltration was significantly increased ( P<0.05). Flow cytometry and immunohistochemistry showed invitro and invivo expressional alterations. The average expression levels of EZH2 mRNA and protein in hepatocellular carcinoma cell lines and tumor tissues were decreased in the radiotherapy group than the control group and mouse tumor tissues ( P<0.05), while the mRNA and protein expression levels of CXCL10 increased ( P<0.05). The cell supernatant following radiotherapy enhanced NK cell chemotaxis but inhibited CXCL10 neutralization. EZH2 overexpression validated that radiotherapy up-regulated CXCL10 mRNA and down-regulated protein expression levels in in vitro and in vivo experiments ( P<0.05). The chemotactic effect on NK cells was significantly weakened with EZH2 overexpression following radiotherapy. Conclusion:NK cells, as immune effector cells, are directly involved in radiotherapy- activated anti-HCC immunity. Importantly, radiotherapy inhibits EZH2 expression in hepatocellular carcinoma, thereby upregulating CXCL10 expression and enhancing intratumoral NK cell invasion.

Objective:To construct an evaluation index system for the core competence of emergency medical dispatchers, so as to provide a theoretical basis for the training, assessment and ability evaluation of emergency medical dispatchers.Methods:In September 2022, a research group was established to compile the first draft of the evaluation index system for the core competencies of emergency medical dispatchers through literature review, semi-structured interviews and group discussions. From October to November 2022, a total of 27 experts in related fields from nine provinces and municipalities directly under the Central Government in China were consulted by Delphi expert letters, items were screened and amended, and an evaluation index system for the core competence of emergency medical dispatchers was formed.Results:A total of two rounds of correspondence were conducted. The effective recovery rate of the questionnaire was 100%, and the authority coefficient of the experts was 0.856. Kendall's coordination coefficients were 0.402 and 0.414 ( P<0.01), respectively. Finally, a core competency evaluation index system for emergency medical dispatchers was constructed, which included seven primary indicators, 16 secondary indicators and 75 tertiary indicators. Conclusions:The core competence evaluation index system for emergency medical dispatchers is scientific, reliable and comprehensive, which can provide a theoretical basis for the training, assessment and ability evaluation of emergency medical dispatchers.

OBJECTIVETo identify the causative mutations in two Chinese Han families featuring triphalangeal thumbs (TPT) and preaxial polydactyly (PPD).

METHODSBlood samples were collected from 9 members (2 affected) from family 1 and 14 members (7 affected) from family 2. After genomic DNA was extracted, the ZPA regulatory sequence (ZRS) region was analyzed with real-time quantitative PCR (qPCR) and Sanger sequencing. For family 1, haplotypes compassing the ZRS were also analyzed with short tandem repeats (STR) and single nucleotide changes.

RESULTSNo copy number mutation around the ZRS region was found in both families. Two heterogeneous mutations in the ZRS (406A>G and 105C>G) were found to co-segregate with the TPT/PPD malformation in family 1 and 2, respectively. Neither mutation was detected in 200 healthy individuals. Haplotype analysis and Sanger sequencing of family 1 indicated that the first TPT/PPD patient in the family was both germline and somatic mosaic for the 406A>G mutation.

CONCLUSIONTwo pathogenic ZRS mutations, 105C>G and 406A>G, have been identified in two Chinese Han families with TPT/PPD, among which the 406A>G mutation was de novo.

Asian Continental Ancestry Group ; genetics ; Female ; Hand Deformities, Congenital ; genetics ; Haplotypes ; Humans ; Male ; Mutation ; Polydactyly ; genetics ; Regulatory Sequences, Nucleic Acid ; Thumb ; abnormalities

Objective:To develop a Core Competency Scale for Ophthalmic Specialist Nurses and test its reliability and validity.Methods:This study was a questionnaire development study. This study transformed the core competency evaluation indicators for ophthalmic specialist nurses constructed through literature review, semi-structured interviews, expert consultations, and other methods to form the initial draft of the Core Competency Scale for Ophthalmic Specialist Nurses. From October 2022 to March 2023, a survey was conducted on 364 ophthalmic specialist nurses in China using purposive and snowball sampling. Item analysis, exploratory factor analysis, and reliability testing were performed on the scale.Results:The final Core Competency Scale for Ophthalmic Specialist Nurses included six dimensions of ophthalmic specialized knowledge, ophthalmic specialized skills, essential nursing practice ability, communication and education ability, scientific research ability, and professional competence, totaling 30 items. Exploratory factor analysis extracted six common factors, with a cumulative variance contribution rate of 73.077%. The total Cronbach's α coefficient of the scale was 0.955, the half reliability coefficient was 0.796, and the retest reliability coefficient was 0.973.Conclusions:The Core Competency Scale for Ophthalmic Specialist Nurses has good reliability and validity, which can be used to evaluate the core competency of ophthalmic specialist nurses.

Objective: To observe the survival and side effects of stereotactic body radiotherapy (SBRT) in large hepatocellular carcinoma (HCC) patients. Methods: Twenty-eight large HCC patients undergoing SBRT in 302 Military Hospital from November 1, 2011 to January 31, 2014 were observed. The prescribed dose was 39-61 Gy/3-9f. Among them, 20 patients simultaneously received transcatheter arterial embolization. The overall survival (OS), progression-free survival (PFS) and local control (LC) rates were calculated by using Kaplan-Meier method. The influencing factors of OS were analyzed by Cox regression model. The influencing factors of radiation-induced liver disease (RILD) were identified by using Logistic regression analysis. Results: The 1-, 2-, 3-and 5-year OS rates were 75%, 57%, 54% and 22%, respectively. The 1-, 2-, 3-and 5-year PFS rates were 59%, 47%, 36% and 18%, respectively. The 1-, 2-, 3-and 5-year LC rates were 92%, 86%, 86% and 86%, respectively. Four patients suffered from RILD and none died from RILD. Child-Pugh classification was the influencing factor of OS and RILD. Conclusion It is preliminarily believed that SBRT is an alternative and safe treatment for patients with large HCC.