Objective To compare the image quality and patient radiation dose of coronary computed tomography angiography (CCTA) received by prospectively-gated step-and-shoot (SAS) technique with those obtained by retrospectively-gated spiral (RGS) technique on a 256-slice CT scanner. Methods A total of 200 patients were enrolled in this study. One hundred patients underwent CCTA with SAS mode were subdivided into two groups: ( 1 ) 50 patients with an average heart rate (HR) ≤70 bpm were scanned with a data acquisition time window centered at the 75％ of the R-R cycle ( group A) and (2) 50 patients with HR ＞ 70 bpm were scanned with the data acquisition time window centered at the 45％ of the R-R cycle, including a phase tolerance of ±％ (group B). Other 100 patients underwent CCTA with RGS mode and ECG-based tube current modulation were also subdivided into two groups: (3) 50 patients with HR ≤70 bpm were scanned with cardiac dose right set to phase of 75％ (group C) and (4) 50 patients with HR ＞ 70 bpm were scanned with cardiac ose Rdight set to phases of 45％ and 75％ (group D). All patients were grouped in randomized order. The image quality of CCTA were evaluated using a rank scale from 1 to 4 ( 1 : excellent ; 4 : non-assessable ) .Radiation dose of the four groups received was also estimated. The image quality between groups was compared by Mann-Whitney U test.The radiation dose between groups was compared by t test. For the 100 patients received by prospective ECG-gated CCTA, the receiver operating characteristic curve (ROC) was used to analyze the CCTA image quality and average heart rate to determine the uppercutoff of HR for obtaining diagnostic coronary images with SAS mode. A spearman correlation analysis was also performed to analyze the correlation of HR and image quality in patients underwent CCTA with SAS mode.Results Of 2338 coronary artery segments, excellent or good image quality( score of 1 or 2) was achieved in 96. 5％ (585 of 606) in group A, 77.7％ (445 of 573 ) in B,96. 1％ (548 of 570) in C, and 85. 7％ (505/589) in D, with no significant difference for A vs C(Z ＝- 1. 351 ,P ＞0. 05) and with significant differenceS for B vs D (Z＝ -2. 236,P ＜0. 05). Linear correlation analysis indicated a significant degradation of image quality with the increase of heart rate using SAS mode (Spearman correlation, r ＝ 0. 577, P ＜0. 01 ). ROC analysis established an upper HR threshold of 78 bpm for obtaining diagnostic image quality using SAS mode( AUC ＝ 0. 827, P ＜ 0. 05 ). The average radiation dose in group A [ ( 2. 6 ± 0. 5 ) mSv]reduced 75 ％ comparing with that in group C [ ( 10. 6 ± 2. 3 ) mSy], and the average radiation dose in group B [ ( 4.0 ± 0. 7 ) mSy]reduced 69％ comparing with that in group D [ ( 13.0 ± 1. 4) mSv]. ConclusionUsing SAS mode to perform low-dose CCTA with 256-slice helical CT could keep the image quality and reduce radiation dose significantly. Our preliminary experience suggests a good promise of this technique which could be applied to a wider group of patients such as with higher heart rates.

Objective To investigate the core competency of grass-roots nurses in Jiangsu Province,and to provide references for training grass-roots nurses.Methods The Competency Inventory for Registered Nurse(CIRN)was used to investigate 593 grass-roots nurses in Jiangsu Province.Results The overall score of importance judgement for core competency was 4.45±0.73.The overall execution frequency was 4.26±0.69.There were significant differences in the importance judgment of clinical care,interpersonal relationship,leadership,and professional development among nurses with different job titles(P＜0.05).There were significant differences in the execution frequency of clinical care,interpersonal relationship,ethical/legal practice,critical thinking and scientific research among nurses with different job titles (P＜0.05).There were certain differences in the importance judgment and the execution frequency for core competency among nurses with different job titles and nurses from different institutions.Conclusion The score for grass-roots nurses' core competency in Jiangsu Province was not high and unbalanced.There were differences between the importance judgment and the execution frequency.Hospital managers should take appropriate measures to address existing problems and improve the grass-roots nursers' core competency according to different characteristics.

Objective To investigate the detection rate of motoric cognitive risk syndrome (MCR)and explore the possible risk factors.Methods A total of 429 elderly patients from geriatric department of Zhejiang Hospital from October 2014 to September 2018 were recruited in the crosssectional study.General information and functional assessment including fall history,self-reported visual impairment and hearing impairment,depressive symptom,cognitive function and gait speed were collected.Patients with MCR were screened out according to the MCR diagnostic criteria.Multiple logistic regression analysis was used to analyze the associated risk factors.Results Seventeen patients(4.0％)met the MCR diagnostic criteria.The proportions of obesity,polypharmacy,cerebral vascular diseases,self-reported hearing impairment,depressive symptoms and slow gait were higher in MCR patients than in non-MCR patients(P＜0.05).Compared with non-MCR patients,MCR patients had lower mini mental state examination (MMSE) scores (P ＜ 0.01).After adjusting for associated confounding factors,multiple logistic regression analysis showed obesity (OR =3.74,95 ％ CI:1.14-12.23,P ＜ 0.05) and depressive symptoms (OR =5.79,95％ CI:1.76-19.06,P ＜ 0.01) were risk factors for MCR.Conclusions MCR is not uncommon in elderly patients.Obesity and depressive symptoms are closely associated with an increased risk of MCR.

The aim of the present study is to explore the association between abdominal obesity and chronic kidney disease (CKD) through a systematic review of published studies. Databases including Wanfang data, CNKI, VIP, CBM, Cochrane Library, PubMed, Web of science and Embase were searched up to July 2021 to collect longitudinal studies published in Chinese and English on the association between abdominal obesity and CKD. In order to avoid omission, reference lists of related articles were also checked manually. After literature selection, data were extracted and study quality was evaluated by the Newcastle-Ottawa scale. Statistical analysis of this study was conducted using Stata 11.0 software. Finally, five studies were included in this study. The results showed that abdominal obesity defined by waist circumference was not associated with CKD (OR=1.17,95% CI:0.93-1.48). According to the results of subgroup analyses, whether adjusted body mass index might be part of the reason of heterogeneity. Based on results of this study, the association between abdominal obesity defined by waist hip ratio and CKD, as well as the association between abdominal obesity and CKD in different genders, remains unknown. In conclusion, abdominal obesity might not be associated with incident CKD. However, more studies are needed in the future to explore this association.

We studied the patients diagnosed with X-linked hypophosphatemicrickets(XLH) and treated with burosumab in Peking Union Medical College Hospital from January 2021 to December 2022. In addition, we described the clinical characteristics of the patients, the changes of clinical indexes before and after burosumab treatment, and the adverse drug reactions during treatment. We also evaluated the efficacy and safety of burosumab for XLH. The results showed that three children XLH patients and one adult XLH patients received burosumab treatment. After treatment, the serum phosphorus level of all patients increased; the serum phosphorus of 3 children patients increased above the lower limit of the reference value range; the serum alkaline phosphatase(ALP) of all patients was lower than that of before treatment; the serum ALP of one adult patient was close to the normal range after 2.5 years of treatment. One child patient showed small crystals in kidney through ultrasound 48 weeks after treatment; one child and one adult showed increased serum parathyroid hormone(PTH)level before treatment and serum PTH continued increasing after treatment. Finally, it may be concluded that burosumab increased serum phosphorus levels in XLH patients, kept the level relatively stable, and reduced serum ALP levels. No serious adverse reactions occurred during treatment, in order to provide reference for the use of burosumab in patients with XLH.

ObjectiveTo evaluate the clinical efficacy and safety of Tripterygium wilfordii polyglycoside tablets （TWP） in the treatment of rheumatoid arthritis （RA） in the real world. MethodDiagnosis and treatment data of patients with RA in Chinese medicine rheumatology registration research information platform information database （CERTAIN） from January 1，2019 to January， 2024 were collected. According to the inclusion and exclusion criteria， data were screened. The included data were divided into an exposure group and a control group according to the use of TWP or not. Propensity score matching （PSM） was used in both groups to keep the baseline balanced and comparable. The disease activity score （DAS28-ESR） of 28 joints based on the erythrocyte sedimentation rate （ESR）before and after treatment was compared between the two groups， as well as health assessment questionnaire （HAQ），visual analogue scale （VAS），tender joint count （TJC），swollen joint count （SJC）， patient's global assessment （PGA），evaluator's global assessment （EGA），laboratory indexes， clinical curative effect， and adverse reactions. ResultA total of 3 978 patients were included，including 929 in the exposure group and 3 049 in the control group. Before PSM，there were significant differences in demographic information，DAS28-ESR score，PGA，EGA，HAQ，VAS scores，SJC， and TJC between the two groups （P<0.05）. After successful PSM matching，922 patients in the exposure group and 922 patients in the control group were included. There was no significant difference in demographic information and DAS28-ESR between the two groups before treatment，and the differences in other indexes between the two groups decreased to varying degrees. After treatment，the DAS28-ESR，PGA，EGA，HAQ，SJC，TJC，VAS scores， ESR，and IgG immune index of the two groups were significantly lower （P<0.01）. Compared with those in the control group after treatment，the DAS28-ESR，PGA，EGA，HAQ，VAS scores， and ESR in the exposure group after treatment decreased more significantly （P<0.05，P<0.01）. There was no significant difference in TJC in the exposure group after treatment. However， TJC in the exposure group was significantly higher than that in the control group before treatment （P<0.05）. In terms of TJC reduction，the exposure group performed better than the control group. There was no significant difference in SJC and IgG between the exposure group and the control group after treatment. After treatment，the clinical symptoms of poor appetite，insomnia and many dreams，upset，fatigue，and fear of wind and cold in the two groups were improved. Except that the proportion of women in the exposure group was higher than that in the control group （P<0.01），there was no significant difference in the incidence of other adverse reactions between the two groups after treatment. ConclusionTWP to treat RA can effectively reduce DAS28-ESR，PGA，EGA，HAQ，TJC，and VAS scores and improve the general symptoms. Except for the women at childbearing age with fertility requirements that TWP is not applicable，it shows good security.