Objective:To analyze the risk factors for in-hospital malignant ventricular arrhythmia (MVA) in acute myocardial infarction (AMI) and to construct and validate a risk prediction model.Methods:This study was a retrospective cohort study. Patients aged≥18 years who were admitted to Qilu Hospital of Shandong University with a diagnosis of AMI and underwent coronary angiography (CAG) from May 2016 to March 2023 were selected, and the patients' clinical routine test indicators and CAG results were collected. Univariate and bidirectional stepwise logistic regression were used to screen out the risk factors for constructing the best prediction model. The prediction model was constructed by combining the results of multivariate logistic regression. The Hosmer-Lemeshow test and ROC curve, calibration curve, and decision curve were drawn to evaluate the model. The nomogram was drawn to visualize the model, and the Bootstrap self-sampling method was used for internal validation. The ROC curve was drawn to evaluate the predictive performance of each risk factor and prediction model. Finally, a multicollinearity test was performed.Results:Among the 4 205 patients finally included in the study, 115 patients (2.735%) developed MVA during hospitalization. The predictive factors screened out included age (X1), diastolic blood pressure (X2), respiratory rate (X3), blood glucose (X4), serum potassium (X5), logarithmic NT-proBNP (X6), myocardial infarction type (NSTEMI=X7, unclassified=X8), J wave (X9), Killip grade (Ⅱ=X10, Ⅲ=X11, Ⅳ=X12), and the regression equation was ln(p/1-p)=-4.699+0.029×X1-0.012×X2+0.059×X3+0.148×X4-1.175×X5+0.866×X6-1.427×X7-0.475×X8+0.758×X9+0.294×X10+0.902×X11+1.815×X12. The area under the ROC curve (AUC) of the model was 0.855 (95% CI: 0.816-0.894), and the Hosmer-Lemeshow test ( χ2=14.178, P=0.077) and the calibration curve showed that the predicted probability was consistent with the actual probability. The probability threshold of 0% to 65% had a better clinical net benefit. The area under the internal validation ROC curve (AUC) was 0.855, 95% CI: 0.813-0.891. The prediction performance of the nine variables was stronger than that of any single variable. There was no multicollinearity between the variables. Conclusions:Age, diastolic blood pressure, respiratory rate, blood glucose, serum potassium, NT-proBNP, type of AMI, J wave, and Killip class are forecasting indicator for in-hospital MVA in AMI. The risk prediction model based on the above factors has good predictive performance.

Objective To explore the feasibility and clinical value of endoscopic resection of duodenal papilla tumors with a maximum diameter greater than 3 cm. Methods A retrospective analysis was conducted on the clinical data of all 12 patients who underwent endoscopic resection of duodenal papilla tumors at the Endoscopy Center of Zhongshan Hospital (Xuhui Hospital), Fudan University and Rongcheng Hospital of Traditional Chinese Medicine from September 2017 to May 2023. The size of the tumors all exceeded 3 cm. Results All 12 patients successfully completed the operation, with a complete resection rate of 91.7% (11/12) and an en-bloc resection rate of 91.7% (11/12). One patient experienced delayed bleeding due to unclosed wound during operation and received endoscopic hemostasis; 11 cases underwent partial wound closure operation with pancreatic and biliary stent placement, without perforation or postoperative stenosis. Among them, 2 cases (18.2%) experienced delayed bleeding and received endoscopic hemostasis treatment. After operation, 1 case (8.3%) experienced nausea, vomiting, upper abdominal discomfort, and elevated blood amylase levels, who was later treated conservatively. During the mean follow-up period of 30.5 (1.0-69.0) months, 1 patient experienced recurrence and underwent surgical resection. Conclusions Endoscopic resection of duodenal papilla tumors can treat large diameter duodenal papilla tumors exceeding 3 cm, but postoperative complications may occur and require special attention. Postoperative placement of pancreatic and biliary stents and wound closure may reduce the incidence of complications.

Objective:To evaluate the effectiveness of low-dose of prophylactic indomethacin in reducing the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in elderly patients.Methods:From July 2021 to October 2022, patients undergoing ERCP in Zhongshan Hospital, Fudan University and Shanghai Xuhui District Central Hospital were enrolled prospectively and assigned to either the low-dose (50 mg) indomethacin group or the conventional-dose (100 mg) group using the DAS electronic central randomization system. Data from elderly patients aged≥60 were collected and compared for the incidence of PEP and other adverse reactions.Results:A total of 418 elderly patients (Zhongshan Hospital, Fudan University, n=122; Shanghai Xuhui Distric Central Hospital, n=296) were ultimately included in the study, with 201 in the low-dose group and 217 in the conventional-dose group. There was no significant difference in the incidence of PEP between the low-dose group and the conventional-dose group [5.97% (12/201) VS 7.37% (16/217), χ2=0.33, P=0.566]. There was also no significant difference in drug-related adverse events between the two groups [4.98% (10/201) VS 4.15% (9/217), χ2=0.16, P=0.685]. Further subgroup analysis revealed that among elderly patients aged 60-<70, there were 13 patients diagnosed as having PEP. The incidence of PEP between the low-dose group and the conventional-dose group was not statistically significant [6.19% (6/97) VS 6.60% (7/106), χ2=0.01, P=0.903], and the occurrence of drug-related adverse events between the two groups was not statistically significant [6.19% (6/97) VS 2.83% (3/106), P=0.315]. Among elderly patients aged≥70, there were 15 patients diagnosed as having PEP. The incidence of PEP between the low-dose group and the conventional-dose group was not statistically significant [5.77% (6/104) VS 8.11% (9/111), χ2=0.45, P=0.501], and the occurrence of drug-related adverse events between the two groups was not statistically significant [3.85% (4/104) VS 5.41% (6/111), P=0.749]. Conclusion:The prophylactic use of 50 mg indomethacin showed similar efficacy in reducing the incidence of PEP in elderly patients compared with 100 mg indomethacin. Therefore, elderly patients can use 50 mg indomethacin prophylactically to reduce the incidence of PEP.

Objective:To explore the effectiveness of SECI (socialization, externalization, combination, and internalization) model in clinical practice training of hematology nurses.Methods:A total of 86 students from the clinical practice training course for hematology nurses from October 2022 to September 2023 were selected as the research subjects. The 43 trainees who received practical training from October 1, 2022 to March 31, 2023 were included in the traditional group, and the 43 trainees who received practical training from April 1, 2023 to September 30, 2023 were included in the observation group. The traditional group received traditional teaching, while the observation group received SECI teaching. After the training, basic assessment and satisfaction evaluation were conducted, and a long-term evaluation was conducted at 6 months after the training. The t test and chi-square test were performed using SPSS 25.0. Results:The observation group had higher scores in case reports [(92.03±2.21) vs. (88.14±2.36)], theoretical assessments [(95.61±3.79) vs. (86.58±3.75)], and operational assessments [(96.24±1.45) vs. (90.13±1.41)] compared with the traditional group (all P<0.05). The observation group had higher scores for teaching plans, teaching methods, teaching effectiveness, teaching atmosphere, internship content, and overall satisfaction with practical training than the traditional group ( P<0.05). The long-term evaluation showed that the theoretical and operational assessment scores of the observation group were higher than those of the traditional group at 6 months after training (both P<0.05). Conclusions:The application of SECI teaching in the clinical practice training of hematology nurses has shown good results, which can help nurses better grasp clinical theoretical knowledge and significantly improve their practical operation ability and training satisfaction.

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 investigate the efficacy and prognosis of rituximab (RTX) in the treatment of M-type phospholipase A2 receptor (PLA2R)-associated idiopathic membranous nephropathy (IMN).Methods:It was a retrospective cohort study. The clinical data of PLA2R-associated IMN patients who received RTX treatment in the Shenzhen Second People's Hospital from September 2018 to March 2023 were collected. According to remission status of proteinuria, the patients were divided into proteinuria remission group (24-hour urinary protein quantity < 3.5 g) and non-proteinuria remission group (24-hour urinary protein quantity ≥ 3.5 g), and the clinical data between the two groups were compared. According to baseline 24-hour urinary protein quantity and estimated glomerular filtration rate (eGFR), the patients were divided into high-risk disease progression group [24-hour urinary protein quantity ≥ 8 g or eGFR < 60 ml·min -1·(1.73 m 2) -1] and non-high-risk disease progression group [24-hour urinary protein quantity < 8 g or eGFR ≥ 60 ml·min -1·(1.73 m 2) -1]. Kaplan-Meier survival curve was utilized to compare the differences of proteinuria remission rates and renal composite endpoint event survival rates between the two groups. Multivariate Cox regression analysis was utilized to identify the influencing factors of proteinuria remission and renal composite endpoint event. Results:This study included 46 PLA2R-associated IMN patients, with 31 males (67.4%). The baseline eGFR was (78.4±34.1) ml·min -1·(1.73 m 2) -1. The 24-hour urinary protein quantity was 8.33 (6.04, 12.85) g. After 14.95 (7.44, 22.15) months of follow-up, 29 patients (63.0%) achieved proteinuria remission, with remission time of 6.0 (5.0, 9.0) months. Six (20.7%) patients relapsed, with relapsed time of 17.25 (11.75, 18.28) months. CD20 in the proteinuria remission group was lower than that in the non-proteinuria remission group ( Z=2.270, P=0.023). Eleven (23.9%) patients experienced renal composite endpoint events wtih occurrence time of 16.07 (7.87, 29.63) months. Kaplan-Meier survival curve analysis indicated that there was no statistically significant difference in proteinuria remission rates (log-rank χ2=0.26, P=0.612) and renal composite endpoint event survival rates (log-rank χ2=0.25, P=0.619) between baseline 24-hour urinary protein quantity ≥ 8 g and < 8 g groups. There was no statistically significant difference in proteinuria remission rates after RTX treatment (log-rank χ2=0.77, P=0.381) and renal composite endpoint event survival rates (log-rank χ2=1.41, P=0.236) between eGFR ≥ 60 ml·min -1·(1.73 m 2) -1 and < 60 ml·min -1·(1.73 m 2) -1 groups. Multivariate Cox regression analysis showed that hypertension history ( HR=0.16, 95% CI 0.05-0.55), immunosuppressive therapy history ( HR=0.08, 95% CI 0.01-0.50), baseline eGFR < 60 ml·min -1·(1.73 m 2) -1 ( HR=0.21, 95% CI 0.05-0.92), baseline PLA2R antibody titer ≥ 100 RU/ml ( HR=0.20, 95% CI 0.06-0.69), long time between treatment and first diagnosis ( HR=1.33, 95% CI 1.12-1.57), high baseline triglyceride ( HR=1.46, 95% CI 1.02-2.08), and baseline 24-hour urinary protein quantity ≥ 8 g ( HR=8.54, 95% CI 2.08-35.12) were independent influencing factors of proteinuria remission after RTX treatment. The baseline PLA2R antibody titer ≥ 100 RU/ml was an independent influencing factor of reaching the renal composite endpoint event ( HR=7.31, 95% CI 1.23-43.62). Conclusions:The proteinuria remission rate after RTX treatment of PLA2R-associated IMN is 63.0% and the recurrence rate is 20.7%. The incidence rate of renal composite endpoint event is 23.9%. The hypertension history, immunosuppressant medication history, baseline eGFR < 60 ml·min -1·(1.73 m 2) -1, baseline PLA2R antibody titer ≥ 100 RU/ml, long time between treatment and first diagnosis, high baseline triglyceride, and baseline 24-hour urinary protein quantity ≥ 8 g are independent influencing factors of proteinuria remission, and baseline PLA2R antibody titer ≥ 100 RU/ml is an independent risk factor of renal poor prognosis in PLA2R-associated IMN patients.

Objective:To investigate the types, incidences, and clinical characteristics of shock in polytrauma patients at different stages after polytrauma.Methods:A retrospective study was conducted on polytrauma patients admitted to multiple trauma centers from June 2020 to December 2021. The inclusion criteria were patients >18 years old and treated due to polytrauma. Exclusion criteria included an admission time of more than 48 h after trauma, a history of malignancy, or metabolic, consumptive, and immunological diseases. The early stage was defined as the period of ≤48 h after polytrauma, and the middle stage was defined as the period between 48 h and 14 days. The patient’s medical history, clinical manifestations, laboratory tests, imaging examination, injury severity score (ISS), and Glasgow coma scale (GCS) were collected. The types, incidences, and clinical characteristics of shock in different stages after polytrauma were analyzed, according to the diagnostic criteria of each type of shock. The differences between the groups were compared by Student’s t test, χ2 test or Mann-Whitney U test. Results:The incidence of the early and middle stage shock after polytrauma were 73.1% and 36.4%, respectively, with statistically significant difference between stages ( P<0.01). There were significant differences in the incidence of hypovolemic shock (83.6% vs. 28.4%), distributed shock (13.7% vs. 80.9%) and cardiogenic shock (3.5% vs. 6.6%) between stages (all P<0.05). The incidence of obstructive shock (8.4% vs. 9.7%, P>0.05) was similar between stages. The incidence of undifferentiated shock was 1.6% and 1.2%, respectively. There were 9.5% patients with multifactorial shock in the early stage and 14.4% in the middle stage. Totally 7 combinations of multifactorial shock were found in different stages after polytrauma. In the early stage, the combination of HS and DS accounted the highest ratio (42.3%) and followed by HS and OS for 28.8%. In the middle stage, the combination of HS and DS was the most common (48.6%) and followed by DS and OS (24.3%). Conclusions:The incidence of shock in polytrauma patients is high. Different types of shock can occur simultaneously or sequentially. Therefore a comprehensive resuscitation strategy is significant to improve the success rate of treatment.

Urbanization has increased the population density and exposure to environmental risk factors, accelerated changes of people's lifestyles and aggravated population health disparities. A general population cohort in eastern China, Shanghai Suburban Adult Cohort and Biobank (SSACB), was established to understand the incidence and prevalence of chronic and non-communicable diseases, and identify environmental, lifestyle, and genetic risk factors in adults (aged 20-74 years old) living in the suburban of Shanghai, where urbanization process is rapid, and provide evidence for the precise prevention and control of chronic diseases. The cohort study was launched by School of Public Health,Fudan University depended on "Discipline Construction Project Shanghai Peak for Public Health and Preventive Medicine". Four districts in Shanghai, i.e. Songjiang, Jiading, Minhang and Xuhui, were selected. A total of 69 116 permanent residents aged 20-74 years were recruited. Epidemiological investigation, physical examination and laboratory tests were conducted to collect the basic information of the study subjects. Blood and urine samples were collected from them to establish a biobank. An information platform was established, from which the baseline data of the study subjects in electronic medical record system, chronic disease management system, cancer registry, infectious disease reporting system, and death registry can be shared. This paper introduces the design concept, process and future plan of SSACB.

Objective: In this study, black tea and Citrus maxima (BT-CM), yellow tea and C. maxima (YT-CM), green tea and C. maxima (GT-CM) as subjects, the active ingredient content and antioxidant activity of three tea and C. maxima (T-CM) were analyzed. The effects of three T-CMs on apoptosis of liver cells in vitro and its mechanism were further explored. Methods: National standard method and HPLC were used for active ingredient analysis. MTT, cell flow cytometry and Western blot were used to analyze the effects of three T-CMs on cell proliferation, apoptosis, and its underlying molecular mechanism. Results: The content of tea polyphenols, free amino acids, ratio of polyphenols and amino acids, ester catechins, non-ester catechins and caffeine in YT-CM and GT-CM was significantly higher than that of BT-CM. The in vitro antioxidant capacity of YT-CM and GT-CM was also significantly stronger than that of BT-CM. Three T-CMs had the effects of inhibiting proliferation, arresting cell cycle and inducing apoptosis in HepG2 and Bel7402 cells, especially YT-CM and GT-CM. Western blot analysis showed three T-CMs activated PI3K/AKT/mTOR signaling pathway and regulated the expression levels of apoptosis-related proteins Bax, Bcl-2 and Caspase-3/9. YT-CM and GT-CM had better ability to change the signal pathway than BT-CM. Conclusion: In short, T-CMs, which combined different degrees of fermentation tea with C. maxima, were rich in nutrients and biologically active substances. T-CMs, especially YT-CM and GT-CM, are healthy drinks that help to prevent and treat liver cancer.

Objective:To summarize our experience in 13 cases of intestinal autotransplantation (IATx) after resection of lesions involving the roots of mesenteric vessels.Methods:The clinical data of 13 patients undergoing IATx in Xijing hospital were retrospectively analyzed. The etiology, surgical procedure and complications were analyzed. The patients were followed up by telephone and regular evaluations.Results:All 13 cases of IATx were successfully completed. For 12 patients who were diagnosed with tumors involving the mesenteric roots, the tumors were removed for cure intent avoiding massive intestinal resection. Pancreaticoduodenectomy was carried out simultaneously in 11 cases. The postoperative complication rate was 85% (11/13). The autograft was resected in 1 patient on the 1st postoperative day due to necrosis from mesenteric thrombosis, leading to short bowel syndrome. One-year survival was 69% (9/13). Among 4 deaths, 1 patient died of liver metastasis, and another died of liver and lung metastases. Five patients were alive 2 years postoperatively.Conclusion:IATx while-technically challenging, avoiding short small bowel syndrome in properly selected patients after resection of lesions especially benign ones involving the roots of mesenteric vessels that were traditionally considered to be "unresectable".