1,25(OH) 2 vitamin D 3 is the most effective status of vitamin D in the body.It will play a biological active role when it combines with the receptor of vitamin D. It is common in the chronic kidney disease patients who are lack of vitamin D. The research finds that among the chronic kidney disease patients, in addition to the classic role of vitamin D in regulating calcium and phosphorus metabolism, it can also protect the kidney and delay the progress of chronic kidney disease by blocking the renin-angiotensin system, inhibiting inflammation, reducing podocyte damage and delaying renal fibrosis, etc.This article summarizes the protection mechanism of Vitamin D in the chronic kidney diseases.

Objective To assess the enhancement characteristic of breast lesions of contrast-enhanced ultrasound (CEUS) in comparison with contrast-enhanced magnetic resonance imaging (MRI).Methods Between August 2011 and March 2013,72 women with 72 lesions were enrolled.All patients underwent ultrasound,CEUS and MRI.The histopathologic results obtained from ultrasound-guided core biopsy or operation excisions were used as the reference standard.CEUS section evaluations were made similar with MRI regarding the size and shape of lesions.Different contrast enhancement patterns including homogeneous/heterogeneous,the tumor areas,the perfusion defect areas,and modality of time-intensity curve were evaluated.Pearson's correlation coefficient,Student's t-tests,and the concordance test were used for evaluation.Results Of the 72 lesions,pathologic examination revealed 56 (77.8％) malignant lesions and 16 (22.2％) benign lesions.The tumor areas measured by CEUS and MRI agreed well,with a correlation of r =0.894,P =0.000.The difference between the two measurements was not significant according to a paired t test (P =0.886).The concordance tests gave a value of the coefficient Kappa =-0.153 (P =0.061),indicating a low concordance between the results obtained with CEUS and those obtained with MRI regarding the enhanced uniformity.There were statistically significant differences in the perfusion defect areas as measured by CEUS and MRI (P =0.01).The CEUS estimates [(0.837 ± 0.827)cm2] were consistently higher than the MRI estimates [(0.576 ± 0.524)cm2].The time-intensity curve patterns between the two groups showed no correlation.Conclusions The enhancement patterns evaluated by CEUS and MRI partly agreed well.There was no direct association between the two methods regarding the enhancement patterns because of the different contrast agent.

Objective:This study aims to evaluate the sonographic features of phyllodes tumors of the breast (PTBs) and the cor-relation between sonographic and pathologic findings to improve the understanding of the disease. Methods:Sonographic findings of 85 PTBs from 83 patients were reviewed. The sonographic findings included the results of two-dimensional ultrasound and color Dop-pler flow imaging, elastographic features, and pathologic data. Results:Of the 85 lesions, 33 were the benign tumors, 28 were border-line, and 24 were malignant according to the pathologic diagnosis. Tumor morphology revealed that most masses were lobulated, with a clear-cut boundary, smooth verge, and inhomogeneous internal echo. Clear boundary was more common in the benign phyllodes tumors (χ2=12.721, P=0.002), and a cystic echo-free area was more commonly observed in these malignant tumors (χ2=9.677, P=0.046). LevelⅡandⅢsignals of the blood flow were observed in 75.3%of PTB cases. Of all lesions, only 26 were subjected to elasticity imaging, and the elastographic scores ranged from 2 to 3 in 88.5%of the cases (23/26). Conclusion:Conventional ultrasound and elastographic findings on PTBs exhibited definite characteristics. The border and cystic areas in the tumors can be used to differentiate between be-nign and malignant PTBs.

Objective To investigate two-dimensional color Doppler commissure real-time shear wave elastrography (SWE) examination and its application value in the diagnosis of breast diseases.Methods One hundred and thirty patients (158 breast lesions) confirmed with breast disease were chosen from September 2013 to September 2014,and all patients underwent two-dimensional color Doppler ultrasound and SWE examination.The receiver operating characteristic (ROC) curve was examined to obtain maximum elasticity modulus value,average elastic modulus value and the corresponding critical value for the diagnosis of benign and malignant breast lesions.According to the results of pathological examination,sensitivity,specificity and accuracy of two-dimensional ultrasound and SWE for the diagnosis of breast lesions were evaluated and compared.Results Of all 158 breast lesions in 130 patients,90 were malignant lesions and 68 were benign lesions.The sensitivities of two-dimensional ultrasound and SWE in diagnosis of breast cancer were 89.7％ and 89.5％,the specificities were 85.6％ and 95.3％ and the accuracy were 87.3％ and 91.4％,respectively.The sensitivity,specificity and accuracy in the diagnosis of breast cancer by combination of two-dimensional ultrasound and SWE were 98.5％,93.3％,95.6％,respectively.Conclusions Although two-dimensional color Doppler ultrasound is a commonly used method in the diagnosis of breast lesions,it has certain limitation.The specificity of diagnosis can be improved by SWE,which is a useful complement to traditional two-dimensional ultrasound technology.Combination of the two methods can significantly increase the sensitivity and accuracy of the diagnosis and provide a reliable basis for the differential diagnosis,reduce the rate of misdiagnosis,missed diagnosis and unnecessary biopsy,which has important clinical application value.

Objective To explore students nurses′acceptance of case-based group assessment. Method A total of 100 student nurses participated in the survey by a self-designed questionnaire to evaluate the perception and acceptance of the student nurses. Results The score on the acceptance of case-based group assessment was (2.44 ± 0.46). The items with higher acceptance included teamwork spirit, clinical reasoning and decision-making ability, and the items with lower acceptance were improving of nurse-patient communication and the nursing skills. Conclusions The student nurses have a good acceptance of the case-based group assessment and think this assessment method can contribute to development of teamwork spirit and competency of clinical reasoning and decision-making. On the other hand, they suggest we should strengthen the ability in nurse-patient communication and optimize the links in ability assessment.

Objective To systematically review the clinical effectiveness of Chinese medicine in treating nasopharyngeal carcinoma patients with radioactive xerostomia. Methods The randomized or semi-randomized controlled trials of the Chinese medicine for nasopharyngeal carcinoam patients with radioactive xerostomia were screened out by online retrieving and manual retrieving of domestic and oversea databases such as Cochrane Library, JBI Library, PubMed, OVID, EMBase, Web of Science, CNKI, Wanfang Database, VIP Database, CBM Database. The data extract and quality assessment were performed by two reviewers independently. Meta-analysis was conducted for the included trials. Results Eight trials were included. The results of Meta-analysis showed that Chinese medicine can effectively delay the progress of oral mucous membrane ulcer in nasopharyngeal carcinoma patients after radiotherapy, and decrease the incidence of grade 3-4 oral mucous membrane ulcer ( Z=4.86, P<0.00001) . Conclusion Chinese medicine has certain effect in treating nasopharyngeal carcinoma patients with radioactive xerostomia.

Objective? To evaluate the effects of competency-based training model in training for new nurses. Methods? Randomized controlled trials and quasi experiments on application of competency-based training model in training for new nurses were retrieved in PubMed, EMBASE, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), China Scientific Journal Database, Wanfang Data and VIP by computer. Meta-analysis was carried out with the RevMan 5.3 after literature screening, data extraction and quality assessment of literature. Results? A total of 6 literatures were included. Meta-analysis showed that competency-based training model could improve the knowledge comprehensive capacity [MD=4.91, 95%CI(3.84, 5.99), P＜ 0.001], good personal qualities [MD=0.28,95%CI(0.22,0.35),P＜0.001], interpersonal communication skills [MD=2.31, 95%CI(0.84, 3.78), P=0.002], clinical nursing ability [MD=0.33, 95%CI(0.08, 0.58), P=0.040], construction and development ability of specialty [MD=0.23, 95%CI(0.19, 0.27), P＜ 0.001], critical thinking and innovation ability [MD=1.37, 95%CI(0.17, 2.57), P=0.020]. Conclusions? Competency-based training model in training can effectively improve new nurses' knowledge comprehensive capacity, good personal qualities, interpersonal communication skills, clinical nursing ability, construction and development ability of specialty, critical thinking and innovation ability, and improve their competency. The multicenter, high quality and large-sample study on effects of competency-based training model in training for nurses should be carried out since number of the included literatures involving evaluation indexes of this study was few and heterogeneity occurred in some evaluation indexes.

At present,case management is widely used in the management of chronic diseases and special diseases,but the case management of the special group of high-risk infant needs to be further discussed. This paper summarizes the definition of high-risk infants, the necessity of developing case management, the present situation of implementation of case management of high-risk infants at home and abroad, and probes into the challenges faced when developing case management of high-risk infants in China,in order to promote the application of case management.

Objective:To investigate the status and feasibility of evidence-based nursing practice of pain assessment in pediatric nurses and to analyze its influencing factors.Methods:The convenient sampling method was adopted to select pediatric nurses who met the inclusion and exclusion criteria in Children's Hospital of Shanghai Jiao Tong University from August to December 2018 as the research objects. The Questionnaire on Status of Evidence-Based Nursing Practice of Pain Assessment in Nurses was used to investigate and the influencing factors were analyzed. A total of 300 questionnaires were issued and 265 valid questionnaires were collected, with an effective recovery rate of 88.33%.Results:The evidence-based nursing practice score of pain assessment of 265 pediatric nurses was (114.22±19.81) . The highest score was the dimension of pain screening, and the lowest score was the dimension of communication with patients and their families in pain assessment. Univariate analysis showed that there were statistically significant differences in the total scores of pain assessment evidence-based nursing practice among pediatric nurses in their departments and their doctors' support for pain treatment, whether pain was listed as the fifth vital sign, and whether pain care system was established ( P<0.05) . Multiple linear regression analysis showed that doctors' support for pain treatment, whether the department listed pain as the fifth vital sign and whether the pain care system was established were the influencing factors for pain assessment evidence-based nursing practice of pediatric nurses ( P<0.05) . Conclusions:At present, pediatric nurses in Children's Hospital of Shanghai Jiao Tong University, have a relatively high level of evidence-based nursing practice in pain assessment. However, it is necessary to strengthen communication with patients and their families, establish relevant systems within the department, enhance medical cooperation and promote knowledge transformation of evidence-based nursing for pediatric pain assessment.

Objective: To investigate the correlations between parameters of histograms of the apparent diffusion coefficient (ADC) with multi-b-value diffusion-weighted imaging (DWI) at 3.0T MRI and prognostic factors and molecular subtypes of breast cancer, to evaluate the diagnostic performance of ADC histograms at different b values. Methods: A total of 114 patients (116 lesions) with inva-sive ductal carcinomas confirmed by surgical pathology who underwent breast magnetic resonance imaging from March 2015 to Janu-ary 2016 in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. The histograms of ADC with b val-ues of 0, 500, 800, 1000, and 1,500 s/mm2 were generated using Image J software. Various parameters were calculated: for example, the minimum, mean, mode, skewness, and kurtosis. Different groups were based on the molecular subtypes, tumor size (T1 vs . T2-3), histologic grade (high vs. low), and lymph node status (positive vs. negative) that were recorded. Mann-Whitney U tests were used to compare the differences in ADC histogram parameters between two different groups. Receiver operating characteristic curves (ROC) were constructed. Results: The skewness was lower in Luminal tumors than that in non-Luminal tumors with b values of 500, 800, 1, 000, and 1,500s/mm2 (P<0.05). The ADCmin was higher in human epidermal growth factor receptor-2 (HER-2) over-expression than in non-HER-2 over-expression (P<0.05). The kurtosis was lower in stage T1 tumors than stage T2-3 tumors (P<0.05), and kurtosis was cor-related with tumor size (P<0.05). ADCmode and ADCmean were different between different histological subtypes with a b value of 500 s/mm2 (P<0.05). Under different b values, there were no significant differences in terms of areas under the curve for each histogram pa-rameter, which had statistically significant differences (P>0.05). Conclusions: Multi-b-value DWI ADC histogram analysis, as a quantita- tive method to characterize tumor heterogeneity, can reflect the biological behavior and prognosis of breast cancer to some extent, and the diagnostic performance of ADC histograms showed no significant differences in differentiating molecular types and prognostic factors of breast cancer at different b values.