Objective To observe the value of spectral CT parameters for evaluating T staging of advanced gastric cancer(AGC).Methods Totally 155 AGC patients were collected and divided into T2 stage(n=40)and T3/4a stage(n=115)according to postoperative pathology.CT values,water concentration(WC)and iodine concentration(IC)of AGC lesions on 40-140 keV arteriovenous phase single energy level images were measured,and the standardized IC(nIC)and spectral curve slopes k1 and k2 were calculated.Clinical variables and spectral quantitative parameters were compared between groups,and receiver operating characteristic curve was plotted,the area under the curve(AUC)was calculated to evaluate the value of each parameter and model for identifying T2 and T3/4a stage AGC.Results Tumor thickness,proportion of low differentiation degree,CT100kev,CT140kev,and WC values in T3/4a group were all significantly higher than those in T2 group(all P＜0.05).CT140keV of AGC lesions on venous phase images presented the highest discrimination efficacy among single parameters,with AUC of 0.782.AUC of clinical-arterial phase-venous phase model was 0.848,higher than that of clinical model and arterial phase model alone(both P＜0.05)but not significantly different compared with AUC of venous phase model(P＞0.05).Conclusion Spectral CT quantitative parameters,especially venous phase parameters could be used to effectively identify T stage of AGC.Multi-parameter combined models had higher diagnostic value.

Objective To investigate the influencing factors and pathways of fluid management adherence and interdialytic weight control in hemodialysis patients based on the health belief model.Methods Using convenience sampling,433 patients receiving hemodialysis were included from 4 hospitals in Guangdong province.The demographic and clinical data questionnaire,Health Belief Scale of Fluid Restriction,and Fluid Intake Adherence Scale were used.The relative-interdialytic weight gain(R-1DWG)was calculated.Results The mean score of patients'fluid management adherence was 3.08±0.97,indicating a moderate level,with 35.57％of patients exceeding the required R-IDWG standard.Regarding health beliefs,perceived benefits(β=0.161)and self-efficacy(β=0.685)of fluid restriction directly affected fluid adherence;perceived threats of poor fluid restriction indirectly affected fluid management adherence through perceptions of benefits and self-efficacy(β=0.235);perceived barriers were indirectly and negatively associated with fluid management adherence through self-efficacy(β=-0.246).Higher fluid management adherence was associated with better control of R-IDWG(β=-0.361).Regarding the coordinating factors,age,educational level,hemodialysis vintage and diabetes were influential factors of fluid management adherence(|β|:0.050-0.162)and R-IDWG control(|β |:0.049-0.309).The coefficients(β)of each path were statistically significant(P＜0.05).Conclusion Healthcare providers should comprehensively assess patients'health beliefs,focus on patients with lower educational levels and diabetes,and identify weakness in their fluid management to achieve the required R-IDWG standard.

Objective To explore the related genes that play a key regulatory role in cisplatin resistance in lung adenocarcinoma. Methods Bioinformatics methods were used to download the differentially-expressed genes between cisplatin sensitive group and drug resistant group in patients with lung adenocarcinoma in TCGA database and GDSC database. GO function analysis and KEGG pathway enrichment analysis were carried out to analyze the differentially-expressed genes. The protein-protein interaction network was constructed and hierarchical cluster analysis was carried out to screen the key genes. The key genes were verified at the cell level by real-time fluorescence quantitative PCR and ELISA. Then the expression of the selected key gene in A549/DDP cells was silenced by siRNA and its sensitivity to cisplatin was detected. Results We screened out 178 differentially-expressed genes. After cluster analysis, CXCL9, CXCL10, NKX2-1 and SFTPA1 were regarded as the key genes of cisplatin resistance in lung adenocarcinoma. CXCL10 was temporarily selected for subsequent verification and function experiment. The mRNA expression of CXCL10 in A549/DDP cells was significantly higher than that in A549 cells (P < 0.001), and the expression of CXCL10 protein in the supernatant of A549/DDP cells was higher than that in A549 cells, which were consistent with the prediction of bioinformatics. The sensitivity of A549/DDP cells to DDP increased after silencing CXCL10 expression. Conclusions CXCL10 is a key gene to regulate cisplatin resistance in lung adenocarcinoma. Downregulating the expression of CXCL10 can become a potential target for reversing cisplatin resistance in lung adenocarcinoma.

Multiple rib fracture is a common chest injury that can cause severe pain and seriously affect life quality of the patients. The traditional pulmonary function test can only assess changes in total lung volume and ventilation of the multiple rib fracture, but fails to reveal regional ventilation status in rib fracture area and ventilation differences within the whole lung. Instead, pulmonary electrical impedance tomography (EIT), as a novel bedside technique for ventilation monitoring, has advantages of non-invasiveness, non-use of radiative rays and dynamic visualization of regional ventilation, enabling to quantify ventilation defects and heterogeneity in space and time. Starting with the assessment of ventilation changes and research status of ventilation function in multiple rib fracture and the characteristics of EIT, the authors review the research progress in the evaluation of ventilation function following multiple rib fracture based on EIT, with the aim to provide new insight into the research on ventilation changes after multiple rib fracture.

Objective:To explore whether the 15-minute retention rate (R15) of indocyanine green (ICG) in the indocyanine green excretion test and the effective hepatic blood flow (EHBF) can predict the occurrence of mild hepatic encephalopathy (MHE).Methods:Using the convenience sampling method, we collected clinic data from 153 patients diagnosed with liver cirrhosis or liver failure from June 2019 to December 2019 in the Third Affiliated Hospital of Sun Yet-sen University in Guangzhou. We screened the MHE patients with the number connect test-A and the digital symbol test, and analyzed the clinical data. By taking different values for R15 and EHBF as cut-off points, the significance of the two factors in predicting MHE is explored respectively.Results:The incidence of MHE was 38.56% (59/153). Single factor analysis showed that the difference of Child-Pugh grade between the MHE group and the non-MHE group was statistically significant ( χ2 value was 7.606, P<0.05), while the differences between cirrhosis and liver failure diagnosis, fasting blood glucose, and serum creatinine were not statistically significant ( P>0.05). When most points between 0.11 and 0.61 were selected as normal and abnormal cut-off points of R15, R15 had statistical significance ( P<0.05) and when R15 selected 0.18, it was most significant (Fisher exact test P=0.00024). When most points between 0.08 and 0.76 were selected as normal abnormal cut-off points of EHBF, EHBF had statistical significance ( P<0.05) and when EHBF selected 0.25, it was most significant (Fisher exact test P=0.00022). Through Logistic stepwise regression analysis, the risk factors for MHE were R15 and EHBF. The ROC curve was used to illustrate the predictive effects of two factors on MHE. Conclusions:The incidence of MHE in patients with cirrhosis or liver failure is high. When R15≥0.18 or EHBF≤0.25 L/min, R15 and EHBF in indocyanine green excretion test can better predict the occurrence of MHE than Child-Pugh classification, and can be help to evaluate and manage patients in time.

Objective:To explore the suitability of using Rasch analysis to transform scores on the Activities and Participation component of the ICF Rehabilitation Set.Methods:Between January and May 2017, five hundred and fifteen post-acute rehabilitation patients were recruited in 13 research centers through quota sampling. Specially-trained health professionals used the Activities and Participation component of the ICF Rehabilitation Set to collect data. Rasch analysis was performed using RUMM 2030 software to test for goodness of fit, threshold estimates, and local dependency.Results:Of the five hundred and fifteen participants, 279 (54.2%) had a neurological condition, 119 (23.1%) a cardiopulmonary condition, 49 (10.0%) a musculoskeletal condition, and 68 (13.2%) some other condition. After Rasch analysis, the Activities and Participant component of the ICF Rehabilitation Set was divided into two domains: Activities, and Participation with 9 categories under activities and five under participation.Conclusions:After rescoring the response options, deleting four poorly-fitting categories and generating one testlet, it was found that the activities and participation component the ICF Rehabilitation Set can be divided into two outcome measures to be applied in clinical practice.

Objective To establish virtual three-dimensional models of interventional devices and individualized surgical area structure in transjugular intrahepatic portosystemic shunt(TIPS)treatment,and to explore the value of virtual models for preoperative simulation in TIPS treatment.Methods Thin slice scan data of 8 patients with supine upper abdomen were obtained,three dimensional structures of bone,liver,portal vein,inferior vena cava and hepatic vein in CT scan area were reconstructed in Mimics software.According to the size of interventional instruments,a virtual RUPS-100 puncture kit and an VIATORR stent were established in 3D MAX software. Computer simulations were performed to evaluate the route from the hepatic vein puncture portal vein using the RUPS-100 puncture kit and VIATORR stent release position.Results ①The establishment of individual three-dimensional model of patients was helpful for doctors to understand the spatial relation of hepatic vein and portal vein.②Through simulation,the puncture parameters of multi angle and multi position are obtained,which was helpful for the doctor to adjust the puncture direction according to the puncture point.③The position of the bare segment of the VIATORR stent in the portal vein was obtained by simulation,which was helpful for evaluating the length of the stent.④The preoperative simulation results included the simulation parameters for each patient puncture into left portal vein,right portal vein and portal vein bifurcation.In the actual operation,we punctured into the portal vein bifurcation in 4 cases,into the right branch in 2 cases and into the left in 2 cases.⑤Preoperative simulations were performed using 8 mm×6 cm×2 cm size VIATORR stent.Howere,the actual operation of the first case was lack of experience,and the stent position was lower,then we released a bare stent at the proximal end of the VIATORR stent.The rest of the cases were the same as the simulation results.Conclusion According to the three-dimensional model of the individual structure of the patient,the preoperative simulations have high fidelity.The simulation results of the parameters of the puncture and the release position of the stent could guide the actual operation more accurately.It is of practical value to improve the success rate of operation and to train residents.

Objective To investigate the possibility of the involvement of RhoA/mDia1 pathway to cause the expression of phosphorylate ezrin-radixin-moesin (p-ERM) in rat pulmonary micro-vascular endothelial cell (PMVEC) after the stimulation of lipopolysaccharide (LPS).Methods The specimens of lung tissue were taken from healthy male SPF grade SD rat with 100-120 g body weight which was purchased from the laboratory animal center of Anhui province.After culture,the PMVECs were randomly divided into dose-dependent groups (0,0.1,1,10 μg/mL LPS added in PMVECs and cultured for30 min,n =8 in each),time-dependent groups (10 μg/mL LPS added to PMVECs cultured for 0,15,30,60,120 min,n =8 in each) and intervention group (n =8).In the intervention group,PMVECs were cultured with 1 μg/mL C3 transferase in serum free media for 240 min,followed by treatment with 10 μg/mL LPS for 30 min.Meanwhile,two control groups in serum-free DMEM medium were made by adding 10.μg/mL LPS to PMVECs and 1 μg/mL C3 transferase to PMVECs respectively cultured for 30 min (n =8 in each).Western blot was used to detect the level of p-ERM,ERM and mDia1.Data were analyzed with SPSS 16.0 software,while one way analysis of variance (ANOVA) was used to compare multiple sets of variables,the intergroup comparisons were analyzed by the least-significant-difference (LSD) tests,with P ＜0.05 for the statistically significant difference.Results ERM,p-ERM and mDia1 were presented in rat PMVEC.Stimulation with LPS up-regulated p-ERM,mDia1 in a dose-dependent manner:LPS [0 μg/mL LPS group:(0.520±0.101),0.1 μg/mL LPS group:(0.657 ±0.092),1 μg/mL LPS group:(0.891 ±0.167),10 μg/mL LPS group:(1.227 ±0.106);0 μg/mL group vs.0.1 μg/mL group,P ＞0.05;the rest P ＜0.01];and mDia1 [0 μg/mL LPS group:(0.200 ±0.102),0.1 μg/mL LPS group:(0.430 ±0.121),1 μg/mL LPS group:(0.603 ±0.154),10 μg/mL LPS group:(0.887 ±0.204);0.1 μg/mL group vs.1 μg/mL group,P ＞ 0.05;the rest P ＜ 0.05].In time-dependent group,the level of p-ERM protein increased at 15 min (0.670 ±0.149),peaked at 30 min (1.175 ±0.103),then decreased,at 60 min (0.959 ±0.189),90 min (0.842 ±0.129),but kept at higher level at 120 min (0.767 ±0.097) than that in control group (0.471 ±0.157,15 min group vs.120 min group,60 min group vs.90 min group and 90 min group vs.120 min group,P ＞ 0.05;the rest P ＜ 0.05);and the level of mDia1 increased at 15 min (0.779 ±0.035),peaked at 30 min (0.889 ±0.036) then decreased at 60 min (0.648 ±0.019),90 min (0.582 ±0.068),but kept at higher level at 120 min (0.526 ±0.059) than that in control group (0.284±0.118,all P ＜ 0.01).C3 transferase caused a marked attenuation of LPS induced p-ERM expression [control group:(0.339 ± 0.069);C3 + LPS group:(0.438 ± 0.07);C3 control group:(0.352 ± 0.071);LPS control group:(0.634 ± 0.191),C3 + LPS group vs.LPS control group,P =0.01],as the same in mDia1 [control group:(0.449 ±0.122);C3 + LPS group:(0.380 ±0.148);C3 control group:(0.404 ±0.164);LPS control group:(0.622 ±0.174),C3 + LPS group vs.LPS control group,P ＜ 0.01].Conclusions LPS could up-regulated the expression of p-ERM protein,and inhibition of RhoA/mDia1 signal pathway by C3 transferase could down-regulated the p-ERM levels.

Objective To explore the impact of nursing work environment on the occurrence of nosocomial infections in ICU. Methods The sample consisted of 1890 nurses who provided direct care for patients in ICUs of level 2 and level 3 hospitals in mainland China. The nursing work environment of ICU was measured with a Chinese translation version of the Practice Environment Scale of Nursing Work Index (PES-NWI). Nurses were asked to estimate how frequently nosocomial infections occurred including surgical site infection, urinary tract infection, central line infection, and ventilator associated pneumonia. Results The composite score of PES-NWI of ICU nurse was 3.35(2.77, 3.81)points. The percentage of nurses who reported the 4 kinds of nosocomial infections in ICU"had happen"were 60.4%(surgical site infection,1122/1858),68.0%(urinary tract infection,1265/1859),52.9%(central line infection, 981/1856), and 66.0%(ventilator associated pneumonia, 1229/1861). Nurses who graded higher in PES-NWI would be less likely to report the 4 kinds of nosocomial infections had happen,OR:0.591(surgical site infection), 0.664(urinary tract infection), 0.573(central line infection), 0.567(ventilator associated pneumonia), all P<0.01. Conclusions A better nursing work environment is significantly related to lower occurrence of nosocomial infections in ICU.

Objective To observe the clinical characteristics of non-viral liver diseases which were examined by ultrasound guided liver biopsy in order to explore the significance of liver biopsy.Methods From January 2006 to December 2015,patients with non-viral liver diseases who received liver biopsy were retrospectively enrolled.Etiology,pathological diagnosis and clinical diagnosis of the patients were analyzed;the differences in disease types between male and female,among different age (less than 60 years and over 60 years)were compared;and the consistency of two pathologists in the pathological diagnosis was analyzed.Chi-square test was performed for statistical analysis.Results Among 182 patients,there were 73 (40.1％) males and 109 (59.9％) females.The most common etiology were autoimmune liver disease (68 cases,37.4％),non-alcoholic fatty liver disease (NAFLD) (40 cases,22.0％) and drug-induced liver injury (DILI) (29 cases,15.9％).The differences in etiology between male and female,between age less than 60 years and over 60 years were statistically significant (X2 =7.31 and 5.87,both P ＜ 0.05).The consistency of two pathologists in the diagnosis of NAFLD,alcoholic liver disease,hereditary metabolic disease and neoplastic disease was good (Kappa=0.85,0.88,0.75 and 1.00).The consistency rates of two pathologists in the diagnosis of autoimmune disease,NAFLD and DILI were 52.9％ (36/68),75.0％ (30/40) and 48.3％ (14/29),respectively.The consistency rate was highest in NAFLD,and the difference was statistically significant (X2 =7.68,P=0.023).However,there was no significant difference in consistency rates of two pathologists in the diagnosis of autoimmune liver disease and DILI (X2 =0.12,P=0.859).The consistency rates between pathological diagnosis and clinical diagnosis in autoimmune liver disease,NAFLD and DILI were 60.3％ (41/68),85.0％ (34/40) and 55.2％ (16/29),respectively,and the difference was statistically significant (X2 =8.98,P=0.011).The consistency rate in NAFLD was highest.However,there was no significant difference in consistency rates between pathological diagnosis and clinical diagnosis in autoimmune liver disease and DILI (X2 =0.22,P=0.639).Conclusions The liver biopsy may guide the clinical diagnosis of NAFLD.However,to improve the diagnostic rates of autoimmune liver disease and DILI,biopsy results,history and laboratory results should be combined.