Objective To determine the biological traits and optimal condition for the induction and differentiation of endothelial progenitor cells from peripheral blood in healthy adults. Methods Mononuelear cells were isolated from peripheral blood of healthy adults by Ficoll-density eentrifugation. The isolated ceils were cultured in 1640 medium supplemented with VECF165 and bFGF. The EPC specific surface mark CD34 and KDR were assessed by fluorescence activated cell sorter(FACS)analysis: EPC were characterized as adherent cells double positive for DiL-acLDL uptake and lectin binding by direct fluorescent staining under a hser scanning confocal microscope. EPC migration were assayed by MTr assay. Result The number and migration ability of EPC were increased by VEGFl65 and bFGF. Conclusion Endothelial progenitors cells can be derived from mononuclear cells of peripheral blood at specific conditions.

Objective To study the effect of CT scanning condition on the target position coordinate with WIMRT radiotherapy planning system using the" Z" form localizing frame. Methods The whole Head Phantom containing three metal targets was scanned under the following conditions: localizing frame transver-sally tilting, CT gantry tilting and localizing frame axially tilting. Then the three target coordinates were com-puted respectively and compared with those under the standard condition. Results The height and width of coordinate under the localizing frame transversally tilting condition deviated from those under the standard scanning condition,which was in an angle dependent manner. On the other hand ,a tendency was shown that the greater the absolute height value of the targets coordinate, the greater the width value deviation. And so was the relation between the absolute width value of the coordinate and height value deviation. If CT gantry angle was not zero degree or localizing frame axis is not in the same line with the CT bed moving direction, the calculated longititude value of the targets coordinate was mainly affected. Conclusions CT scanning must be performed strictly under the standard localizing scanning condition by a proficient physicist.

The authors developed a standard of medical safety ( adverse) events standardization management, according to the principle of medical safety (adverse) event management, domestic and abroad research results and best practices for medical safety ( adverse) events management, as well as the present specifics and practice of hospital management in China. Such a standards is designed to standardize such key points of medical safety ( adverse) event management in China, namely the definition, classification, risk prevention, reports response and continuous improvement, which serves as an icebreaker for scientific management of medical safety (adverse) events.

Objective Toexploreasimpleandaccuratemethodfordeterminingthequantitativeevaluationandthevolumedegree divisionofpleuraleffusionbyMDCTtissuesegmentationtechnology.Methods Thevolumeofwaterinjectedintothreecontainersof differentshapeswasmeasuredby MDCTtissuesegmentationtechnique,andwerefurthercomparedwiththevolumeoftheactual waterinjection.Byusingthesamemethod,theliquidvolumeofpleuraleffusionbeforeandafterpumpingfrompatientswasmeasured andthedifferencebetweentheanteriorandtheposteriorwascalculated.Thenthedifferencebeforeandafterthepumpingwascomparedwiththe actualvolumeofclinicalfluidpumping.Atthesametime,thespecificmethodtodeterminethedegreedivisionofpleuraleffusionwas established.Results Forcontainersofdifferentshapes,theresultfromtheCTscanningliquidmeasurementwasthesameasactualwater injection,andhadahighcorrelation.Thedifferencebetweenbeforeandafterfluidextractionandclinicalactualfluidextractionwas linearcorrelated(positivecorrelation,r=0.986,P<0.001).Accordingtothemethodfordegreedivisionofadulthemothorax,MDCT tissuesegmentationtechnologydividedthevolumeofpleuraleffusionbeforethepumpingintosmall,mediumandlargeamounts.There were44caseswithsmallpleuraleffusion,11caseswithmoderatepleuraleffusionand7caseswithlargepleuraleffusion.Conclusion The volumeofpleuraleffusion measuredby MDCTtissuesegmentationtechnologycanreflecttheactualvolumeofpleuraleffusionin clinictoacertainextent,and MDCTtissuesegmentationtechnologycanbeusedtodividethevolumedegreeofpleuraleffusion.

Objective:To explore the effect and safety of flunarizine combined with carbamazepine in the treatment of migraine.Methods:From January 2018 to December 2018, 88 migraine patients treated in Yuyao People's Hospital were divided into control group ( n=44) and observation group ( n=44) according to different treatment methods.The control group was given flunarizine, and the observation group was treated with flunarizine combined with carbamazepine.The clinical efficacy and the incidence of adverse reactions were compared between the two groups through evaluation of the SF-36 scale score before and after treatment and the main cerebral arterial blood flow velocity. Results:The total effective rate in the observation group was significantly higher than that in the control group (90.91% vs.72.73%, χ 2=5.437, P<0.05), and the incidence of adverse reactions had no statistically significant difference between the two groups (15.91% vs.11.36%, P>0.05). The scores of the SF-36 scale in the observation group after treatment were significantly higher than those in the control group [PF: (86.15±8.24)points vs.(93.78±9.73)points; RP: (67.15±12.96)points vs.(87.93±13.78)points; BP: (59.59±15.75)points vs.(73.25±18.34)points; GH: (58.92±14.83)points vs.(69.12±17.93)points; VT: (64.98±15.45)points vs.(72.48±16.78)points; SF: (78.62±14.91)points vs.(87.26±15.72)points; RE: (60.25±18.45)points vs.(69.12±15.72)points; MH: (74.91±16.45)points vs.(87.12±17.93)points], the cerebral arterial blood flow velocity was significantly lower than the control group [ACA: (57.12±8.94)cm/s vs.(52.73±9.02)cm/s; MCA: (75.82±11.92)cm/s vs.(63.09±11.25)cm/s; PCA: (49.87±10.64)cm/s vs.(45.10±9.25)cm/s; VA: (46.20±4.02)cm/s vs.(44.12±4.03)cm/s; BA: (50.10±6.95)cm/s vs.(46.52±7.21)cm/s] (PF: t=3.969, RP: t=7.287; BP: t=3.748; GH: t=2.908; VT: t=2.181; SF: t=2.645; RE: t=2.427; MH: t=3.329; ACA: t=2.293; MCA: t=5.152; PCA: t=2.244; VA: t=2.424; BA: t=2.371, P<0.05). Conclusion:Flunarizine combined with carbamazepine can significantly improve the treatment effect of migraine, improve the quality of life and cerebral arterial blood flow velocity of patients, and has high safety.

Objective:To investigate the status and influencing factors of health-promoting lifestyle in young and middle-aged people with high normal blood pressure, so as to provide the basis for primary prevention about hypertension.Methods:From July to December 2020, a convenience sampling method was used to select 280 cases of young and middle-aged people with high normal blood pressure in the First Affiliated Hospital of Wenzhou Medical University were investigated by self-administered general information questionnaire,and Health Promotion Lifestyle Profile Ⅱ(HPLP-Ⅱ).Results:The HPLP-Ⅱ total score in the young and middle-aged with high normal blood pressure was 146.79 ± 29.57. Multiple linear regression analysis showed that different occupation,income, family history of hypertension and learning-willingness were the influencing factors of their health-promoting lifestyle( P<0.05). Conclusions:The health-promoting lifestyle among the young and middle-aged with high normal blood pressure is at a medium level, health care providers should strengthen guidance to improve their health-promoting lifestyle through health education and other ways for individuals without stable employment, poor income level, no family history of hypertension and lack in willingness to learn.

Mini clinical evaluation exercise ( mini-CEX ) is an educational and assessable tool to evaluate the clinical skills among resident doctors .An examiner directly examines an examinee and the evaluate the process including history collection , physical examination , and the communication skills with the patients , diagnosis and treatment .This evaluation method is widely used for its convenience , time saving, and high availability.It is also applied to student nurses assessment but arises some problems during the practice at present.The main problems include inappropriate application without items adjustment , absence of the marking criterion establishment , and the non-standard teacher training system .This paper is mainly focus on the analysis of the existing problems , in order to provide references for further investigation and application of mini-CEX in the nursing education field .

Objective To monitor the airbag pressure of artificial airway in mechanical ventilation patients, and to establish a mathematical model of airbag pressure decay, so as to explore the best interval of time for airbag pressure monitoring and provide a scientific basis to standardize the management of those patients.Methods Totals of 158 patients in respiratory intensive care unit ( RICU) with artificial airway were selected according to the upper limit of value, recommended by the guideline, the pressure of airbag was revised to 30 cmH2 O.The PORTEX pressure monitoring table was used and recorded every hour.Based on the recorded value, the mathematical model of airbag pressure decay was established using the curve fitting method, and then obtained the suitable interval of time for airbag pressure monitoring.Results Based on the recorded value and establishment of the mathematical model of airbag pressure decay, the optimum interval of time was 4.24 hours. If based on the lower limit of airbag pressure checked each hour, the optimum interval of time was 3.06 hours. Conclusions For the patients who have set up an artificial airway, the time for monitoring and correcting airbag pressure should be at least 4.24 hours.If based on a more safety point of view to prevent air leakage and the occurrence of complications, it should be at least 3.06 hours.

Objective:To compare the prognostic value of four prognostic models in predicting time to first treatment (TTFT) in patients with Binet A Chinese chronic lymphocytic leukemia (CLL) .Methods:This retrospective analysis included one hundred and ten patients with Binet A CLL, initially diagnosed in the First Affiliated Hospital of Nanjing Medical University (Pukou CLL center) from June 2009 to January 2020. Risk stratification was conducted according to IPS-E, CLL-IPI, CLL1-PM, and Barcelona-Brno prognostic models.Results:Among 110 patients with Binet A CLL patients, the median age was 58 (25-84) years. The median follow-up time was 35 (4-189) months, and 57 (51.8%) patients met the indication for treatment due to symptomatic disease progression during follow-up. Log-rank analysis of nine variables was conducted involving age, Rai stage, absolute lymphocyte count (ALC) , lymph node size, lymphocyte doubling time (LDT) , β 2-Microglobulin, IGHV status, TP53, and Del (11q) . Additionally, Rai Ⅰ-Ⅲ, ALC>15×10 9/L, palpable lymph node size ≥1cm, β 2-Microglobulin>3.5 mg/L, unmutated IGHV, TP53 mutation or deletion, and 11q deletion were independent risk factors of TTFT. Predictive value of each model was assessed by Harrel C-index and Akaike information criterion (AIC) with CLL1-PM (C-index=0.736, AIC=777) , followed by CLL-IPI (C-index=0.722, AIC=933) , IPS-E (C-index=0.683, AIC=1004) , and Barcelona-Brno prognostic model (C-index=0.663, AIC=986) . Conclusion:All four prognostic models effectively predicted TTFT. IPS-E might be an ideal model to guide clinical surveillance because of its easy accessibility and low expenses in routine clinical practice. Therefore, for patients receiving fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS) examination at diagnosis, CLL-IPI or CLL1-PM could be applied to evaluate their prognosis more comprehensively.

Objective:To investigate the clinical, genetic, and clonality related aspects of individuals with Richter transformation (RT) .Methods:From January 2019 to December 2021, 18 RT patients with diagnoses at the First Affiliated Hospital of Nanjing Medical University (Pukou CLL center) were retrospectively examined. The immunoglobin heavy variable (IGHV) gene usage and IGHV-D-J rearrangement pattern of diagnosed CLL/SLL and transformed diffuse large B-cell lymphoma (DLBCL) were compared to determine the clonality relatedness. To investigate the risk factors of RT, Clinical and laboratory data from patients with newly diagnosed CLL/SLL and transformed DLBCL were gathered.Results:The median age of RT was 56.5 (41-75) years old. 17 patients transformed to DLBCL and 1 transformed to Hodgkin lymphoma (HL) . Of 17 individuals who had DLBCL transformation, 15 had CLL/SLL-related clonality and 2 had unrelated clonality. Next-generation sequencing (NGS) analysis of 11 paired initially diagnosed treatment-naive CLL/SLL and RT DLBCL found that EGR2、TP53 and NOTCH1 were among the most frequently mutated genes both in treatment-naive CLL/SLL and in RT DLBCL. In several cases, specific mutations were gained or lost throughout RT, indicating clonal evolution. Among 10 patients before exposure to BTK inhibitors before RT, four patients acquired BTK mutation. The aforementioned mutations should be considered high-risk variables for transformation; in addition, TP53 and EGR2 mutations could be linked to a poor prognosis following RT in patients receiving a cocktail of new medicines.Conclusion:Most RT DLBCL patients in our center are clonality related (15/17, 88.2% ) and we recommend all qualified centers to evaluate clonality relatedness of RT DLBCL patients. There was some variability in the mutational landscape between DLBCL that had undergone a transformation and initially diagnosed, treatment-naive CLL/SLL. The underlying molecular mechanism of RT needs more research.