Objective To settle the "bottleneck" disputes existed in the key aspect of emergency treatment care of emergency department, long delayed time of medical workers or patients, perplexity of first-aid personnel, less standard in medical records. Methods Comparison experiment was carried out with the traditional model of emergency care in contrast with the new model, besides the service attitude was improved,the awareness of responsibility was strengthened and the first-aid technique was increased. Number of nursing errors and disputes, hospitalization time, satisfaction degree of patients and record trace-ability were observed. Results The nursing errors and disputes reduced by 46%, hospitalization time re-duced by an average of (7.2±0.2) minutes, satisfaction degree of patients increased by 10.99%, leaving 1673 record traceability of care. Conclusions The application of new management processes of nursing interface in emergency department can settle the "bottleneck" disputes of key interface, make the green passage of emergency patients more convenient and is conducive to safe care, less mortality, high work effi-ciency, which proves to be a reference for fellows.

Objective To study the mechanism of bromocriptine (BRC) inducing autophagy-dependent cell death in pituitary adenomas and to explore its significance.Methods Thirty pituitary adenomas excised in our hospital from June 2013 to December 2015 were collected;the expressions of LC3 and Bcl-2 in these pituitary adenomas and normal brain tissues were examined by immunohistochemical staining.The rat hypophysoma MMQ cells were conventionally cultured in vitro;after 24 h of treatment with 60 μmol/L BRC,cytometry was performed to detect the variation of these cell cycle;the protein expressions of microtubule-associated protein light chain 3-Ⅰ (LC3-Ⅰ) and light chain 3-1Ⅱ (LC3-1Ⅱ) and the ratio of Bcl-2/Bax were measured by Western blotting after 24 h of treatment with various concentrations BRC (0,30 and 60 μ moi/L) for the MMQ cells.Results The LC3 protein expression rate in the pituitary adenomas was 80％ (24/30) and that in the normal brain tissues was 0％ (0/30);Bcl-2 protein expression rate in the pituitary adenomas was 83.33％ (25/30) and that in the normal brain tissues was 0％ (0/30).The high expression rates of LC3 and Bcl-2 in pituitary adenomas were significantly higher than those of the normal brain tissues (P＜0.05).Patients with increased prolactin after BRC treatment had significantly higher expression rates of LC3 and Bcl-2 than those with decreased prolactin after BRC treatment (P＜0.05).After treatment with 60 μmol/L BRC for 24 h,the number of MMQ cells in G0-G1 phase was significantly larger than controls (P＜0.05).After 24 h of induction with various concentrations BRC,Western blotting showed that the conversion ratio of LC3-Ⅰ to LC3-Ⅱ in MMQ cells was significantly increased following the increase of BRC concentration (P＜0.05);the ratio of Bcl-2 and Bax showed no significant difference among the 0,30 and 60 μ mol/L BRC treatment groups (P＞0.05).Conclusion The death manner of BRC-treated pituitary adenoma cells is mainly autophagic cell death rather than apoptosis.

Objective To explore the expression levels of chemokine (C-C motif) ligand 18 (CCL18) in human glioma tissues and its effects on the invasion,migration and proliferation ofglioma cells.Methods (1) Sixty samples were harvested from the glioma which was excised surgically and confirmed pathologically from the patients at the Department of Neurosurgery,Affiliated Hospital to Binzhou Medical College from January 2012 to December 2017.Of the samples,by the WHO grading,26 belonged to grade Ⅱ,18 to grade Ⅲ and 16 to grade Ⅳ.Ten samples of normal brain tissue were harvested as controls from the contemporary patients who underwent intracranial decompression and excision due to brain injury.CCL18 mRNA expression was determined by real-time RT-PCR and CCL18 protein expression in tumor cells by immunochemically histological staining.(2) U251 glioma cells cultured in vitro were incubated with CCL18 serum-free culture media (0 ng/mL,5 ng/mL and 10 ng/mL) for 24 h before they were subjected to Transwell,scarification and CCK-8 assays to measure cellular invasion,migration and proliferation.Results (1) The expression of CCL18 mRNA was significantly increased in the order from normal brain,glioma of grade Ⅱ,glioma of grade Ⅲ to glioma of grade Ⅳ (P＜0.05);the expression of CCL18 protein was significantly increased in the order from glioma of grade Ⅱ,glioma of grade Ⅲ to glioma of grade Ⅳ (P＜0.05).(2) The 24 h Transwell assay for invasion showed that the number of transmembrane cells was significantly increased in the order from 0 ng/mL group to 5 ng/mL group to 10 ng/mL group (43.5±8.3,202.0±18.5 and 279.7±18.6 cells) (P＜0.05).The widths of scratch (pixels) in the scarification assay for migration were 498.4±75.3,381.3±21.4 and 347.7±14.2 at 12 h,and 299.5±15.3,284.6±7.8 and 237.3±20.6 at 24 h,respectively,showing significant differences between the groups of 0 ng/mL,5 ng/mL and 10 ng/mL recombinant CCL18 (P＜0.05).The cell growth in CCK-8 assay for proliferation was 1.000±0.019,1.260±0.094 and 2.070±0.138 fold at 24 h,respectively,also showing significant differences between the groups of 0 ng/mL,5 ng/mL and 10 ng/mL recombinant CCL18 (P＜0.05).Conclusions Expression of CCL18 in glioma is associated with the malignancy of the tumor.As CCL 18 promotes invasion,migration and proliferation of glioma cells,it may be a potential biomarker for detecting and grading human glioma.

To evaluate the association between serum anti-tissue transglutaminase antibody (anti-tTG) titers and the severity of histological damage to the duodenal mucosa and to predict a possible anti-tTG cutoff value for diagnosing celiac disease (CD) and villous atrophy in the domestic population. Clinical and pathological data from 76 adult CD patients with positive anti-tTG titers and duodenal biopsy results who were treated at the People′s Hospital of Xinjiang Uygur Autonomous Region from July 2017 to January 2022 were retrospectively analyzed. The correlation between anti-tTG titers and the severity of duodenal mucosal damage was statistically assessed to predict the optimal anti-tTG titer cut-off value for diagnosing CD and villous atrophy. Of the 76 patients, 10 had underlying CD, and of the 66 patients with duodenal histopathology, four were Marsh Ⅰ, six were Marsh Ⅱ, and 56 were Marsh Ⅲa-c grade. In adults with CD, anti-tTG titers were shown to be associated with the severity of histological damage to the duodenal mucosa. When the anti-tTG level was ≥5 times the upper limit of normal (ULN), the sensitivity and specificity for diagnosing CD were 83.9% and 92.9%, respectively. When the anti-tTG titer was ≥8 times the ULN, the sensitivity and specificity for diagnosing villous atrophy were 67.9% and 90.0%, respectively. Anti-tTG levels had a strong predictive value for diagnosing CD in adults when titers exceeded 10 times the ULN. Thus, the anti-tTG cut-off value can be combined with clinical judgment to diagnose CD, limiting the use of invasive endoscopy.

Objective:To establish an early prediction model for bloodstream infection in patients with extremely severe burns based on the screened independent risk factors of the infection, and to analyze its predictive value.Methods:A retrospective case-control study was conducted. From January 1, 2010 to December 31, 2019, 307 patients with extremely severe burns were admitted to the Department of Burns and Plastic Surgery of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medcine, including 251 males and 56 females, aged from 33 to 55 years. According to the occurrence of bloodstream infection, the patients were divided into non-bloodstream infection group (221 cases) and bloodstream infection group (86 cases). The gender, age, body mass index, outcome, length of hospital stay of patients were compared between the two groups, and the detection of bacteria in blood microbial culture of patients was analyzed in bloodstream infection group. The included 307 patients were divided into modeling group (219 cases) and validation group (88 cases) according to the random number table with a ratio of about 7∶3. The gender, age, body mass index, total burn area, full-thickness burn area, combination of inhalation injury, implementation of mechanical ventilation, days of mechanical ventilation, days of intensive care unit (ICU) stay, outcome, length of hospital stay, complication of bloodstream infection of patients were compared between the two groups. According to the occurrence of bloodstream infection, the patients in modeling group were divided into bloodstream infection subgroup (154 cases) and non-bloodstream infection subgroup (165 cases). The total burn area, full-thickness burn area, combination of inhalation injury, implementation of mechanical ventilation, days of mechanical ventilation, and days of ICU stay of patients were compared between the two subgroups. The above-mentioned data between two groups were statistically analyzed with one-way analysis of independent sample t test, chi-square test, and Mann-Whitney U test to screen out the factors with statistically significant differences in the subgroup univariate analysis of modeling group. The factors were used as variables, and binary multivariate logistic regression analysis was performed to screen out the independent risk factors of bloodstream infection in patients with extremely severe burns, based on which the prediction model for bloodstream infection in patients with extremely severe burns of modeling group was established. The receiver operating characteristic (ROC) curve of the prediction model predicting the risk of bloodstream infection of patients in modeling group was drawn, and the area under the ROC curve was calculated. The sensitivity, specificity, and the best prediction probability were calculated according to the Youden index. According to the occurrence of bloodstream infection, the patients in validation group were divided into bloodstream infection subgroup (21 cases) and non-bloodstream infection subgroup (67 cases). The prediction probability >the best prediction probability of model was used as the judgment standard of bloodstream infection. The prediction model was used to predict the occurrence of bloodstream infection of patients in the two subgroups of validation group, and the incidence, specificity, and sensitivity for predicting bloodstream infection were calculated. In addition, the ROC curve of the prediction model predicting the risk of bloodstream infection of patients in validation group was drawn, and the area under the ROC curve was calculated. Results:Compared with those of non-bloodstream infection group, the mortality of patients in bloodstream infection group was significantly higher ( χ2=8.485, P<0.01), the length of hospital stay was significantly increased ( Z=-3.003, P<0.01), but there was no significant change in gender, age, or body mass index ( P>0.05). In patients of bloodstream infection group, 110 strains of bacteria were detected in blood microbial culture, among which Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii were the top three bacteria, accounting for 35.45% (39/110), 26.36% (29/110), and 13.64% (15/110), respectively. Gender, age, body mass index, total burn area, full-thickness burn area, proportion of combination of inhalation injury, proportion of implementation of mechanical ventilation, days of mechanical ventilation, days of ICU stay, outcome, length of hospital stay, and proportion of complication of bloodstream infection of patients were similar between modeling group and validation group ( P>0.05). Compared with those of non-bloodstream infection subgroup in modeling group, the total burn area, full-thickness burn area, proportion of combination of inhalation injury, proportion of implementation of mechanical ventilation, days of mechanical ventilation, and days of ICU stay of patients in bloodstream infection subgroup were significantly increased ( Z=-4.429, t=-4.045, χ2=7.845, 8.845, Z=-3.904, -4.134, P<0.01). Binary multivariate logistic regression analysis showed that total burn area, days of ICU stay, and combination of inhalation injury were the independent risk factors for bloodstream infection of patients in modeling group (odds ratio=1.031, 1.018, 2.871, 95% confidence interval=1.004-1.059, 1.006-1.030, 1.345-6.128, P<0.05 or P<0.01). In modeling group, the area under the ROC curve was 0.773 (95% confidence interval=0.708-0.838); the sensitivity was 64.6%, the specificity was 77.9%, and the best prediction probability was 0.335 when the Youden index was 0.425. The bloodstream infection incidence of patients predicted by the prediction model in validation group was 27.27% (24/88), with specificity of 82.09% (55/67) and sensitivity of 57.14% (12/21). The area under the ROC curve in validation group was 0.759 (95% confidence interval=0.637-0.882). Conclusions:The total burn area, days of ICU stay, and combination of inhalation injury are the risk factors of bloodstream infection in patients with extremely severe burns. The early prediction model for bloodstream infection risk in patients with extremely severe burns based on these factors has certain predictive value for burn centers with relatively stable treatment methods and bacterial epidemiology.

Objective To analyze the main factors affecting early using enteral nutrition and the effect of enteral nutrition within 72 h after burning on outcomes by presenting a retrospective cohort study of 11 years of hospitalization data,to provide evidence for enteral nutrition regimens for severe burn patients.Methods A retrospective study analyzed adult extensive burn patients between January 2009 and December 2020.Patients enrolled in this study who admitted to the burn department within 24 h after burning and with a burned area of more than 30%.Univariate and multiple regression were used to analyze the main factors affecting early using enteral nutrition in patients with severe burn.Non parametric Mann-Whitney U test was used to compare the main influencing factors of enteral nutrition implementation within or after 72 h,as well as the impact on the treatment outcomes such as 28-day survival rate and in hospital survival rate.Results The univariate analysis found that total burn area,full-thickness burn area,burn type,and inhalation injury were the main factors of the time to initation of enteral nutrition in patients with severe burn(P<0.05).Incorporating the above single factors into multiple regression analysis,we found that the main factors affecting enteral nutrition using in patients with severe burn were full-thickness burn area(P=0.017)and inhalation injury(P=0.001).To analysis whether enteral nutrition was started within 72 h after burning,we found that inhalation injury and larger area of full-thickness burn area in patients was the main factors for initiating enteral nutrition.After matching injury situation with pre-injury situation,we found that using enteral nutrition within or after 72 h after injury were no significant differences in the survival rate,28-day survival rate,and positive blood culture rate(P>0.05),but was associated with the lower incidence of bacteria positive in intravenous catheters(P=0.001)and the lower rate of parenteral nutrition treatment used within 7 d after burning(P= 0.001).Conclusions The main factor for influencing early implement enteral nutrition in patients with severe burn were large area of full-thickness burn and inhalation injury.Enteral nutrition using within 72 h after burning reduces the incidence of catheter infection and the use of parenteral nutrition,thereby reducing the risk of treatment in patients with severe burn.

Objective:To construct an estimating equation to accurately reflect the aging phenomenon of the glomerular filtration rate(GFR).Methods:Healthy subjects receiving physical examinations at the First Affiliated Hospital of Nanjing Medical University between January 2017 and April 2018 were included in the study, and the aging phenomenon of renal function indicators such as serum creatinine(Scr)was used as the reference standard to evaluate the accuracy of four Scr-based GFR equations during GFR aging, including the full age spectrum(FAS)equation, the Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI)equation, the Osaka equation and the Xiangya equation.Results:Of 37 636 individuals receiving physical examinations, 6 534 met the criteria specified in this study.Scr, serum urea nitrogen, serum uric acid, and serum albumin showed a significant aging phenomenon( H=191.640, 196.693, 83.271, 414.585, P<0.001 for all).The GFR estimated by the four equations all decreased with aging, but the starting point and rate of decline were significantly different.The GFR aging phenomenon estimated by the FAS equation was closer to the trend of renal function indicators. Conclusions:The FAS equation may be more applicable to healthy people to understand the aging phenomenon of GFR.

【Objective】 To establish and evaluate a fluorescent antibody to membrane antigen (FAMA) method for detecting antibodies against varicella-zoster virus (VZV) based on Vero E6 cells. 【Methods】 Based on the adapted VZV-Oka-E6 strain that VZV-Oka live attenuated varicella vaccine strain grew in Vero E6 cells, Vero E6 cells were infected with VZV-Oka-E6 of three different doses (10^4.65, 10^4.95 and 10^5.25 TCID50), and the cytopathic effect was observed under a microscope to determine the optimal infection dose of VZV-Oka-E6 strain. Then the detectable sensitivity of the infected cell antigen slides prepared after fixing the infected cells with different fixatives was compared to determine the optimal fixative. As a result, the FAMA method based on Vero E6 cells for the determination of neutralizing anti-VZV has been developed. The established FAMA assay was used to detect the international standard for varicella zoster immunoglobulin with different titers to determine the sensitivity of the assay. The specificity of the assay was evaluated by detecting specific antibodies against human herpes simplex virus (HSV) type 1 and type 2. The neutralizing anti-VZV antibodies of the international standard for varicella zoster immunoglobulin were detected using VZV-infected cell antigen slides prepared in the same batch and four different batches, respectively, to determine the intra-assay repeatability and inter-assay repeatability. The international standard for varicella zoster immunoglobulin with three known titers was detected to evaluate the relative accuracy of this assay. The anti-VZV titers in 20 apheresis plasma samples were determined with the newly established FAMA test and ELISA test, respectively, and the detection results of the two methods were compared using Spearman’s correlation test. 【Results】 The optimal infection dose of the VZV-Oka-E6 strain in FAMA assay was determined to be 10^5.25 TCID50, and acetone precooled at -20℃ was used as the fixative. The FAMA test has a high sensitivity with a detecting limit of 31.25 mIU/mL for neutralizing anti-VZV titers. The negative result was observed when detecting herpes simplex virus (HSV) type 1 and 2 specific antibodies. The international standard for varicella zoster immunoglobulin was detected by VZV infected cell antigen slides prepared in the same batch and 4 different batches, with the coefficient of variation being 29.95% and 26.71%, respectively. The detection value of the international standard for varicella zoster immunoglobulin with three different titer levels was consistent with their theoretical value. The correlation coefficient of the detection results of 20 apheresis plasma samples by the FAMA test and ELISA test was 0.268. 【Conclusion】 The VZV FAMA assay has good sensitivity, specificity, repeatability, and relative accuracy in detecting neutralizing anti-VZV titers. It can be applied for detecting neutralizing anti-VZV titers in apheresis plasma samples as well as the varicella-zoster immunoglobulin (VZIG) preparations.