Objective:To explore the suitable prostate cancer screening mode under the medical community for primary hospitals.Methods:From April 2021 to April 2022, a total of 16007 male population ≥50 years from 9 branches of the medical community of the second hospital of Yinzhou participated in this study. They were divided into four groups according to age with group 1 of 50-59 years old, group 2 of 60-69 years old, group 3 of 70-79 years old, and group 4 of 80 years old and above. Serum tPSA was added to the routine physical examination, and the screening positive patients were referred to the referral hospital for further diagnosis and treatment under the mode of medical community. We proposed multi-parametric MRI (mpMRI) for those with serum PSA ≥4 ng/ml and suspicious lesions should be scored according to PI-RADS V2. The ultrasound-guided transperineal targeted prostate biopsy was performed for those with PI-RADS ≥3 and those with PI-RADS < 3 but tPSA ≥10 ng/ml. The tPSA follow-up examinations were performed every 6 months for tPSA < 10 ng/ml and PI-RADS < 3 points and once a year for tPSA < 4 ng/ml.Results:Among the 16 007 male population ≥50 years, 2 007(12.54%) were found serum PSA ≥4 ng/ml, and 634(31.59%)were referred to the referral hospital through the medical community system. Combining tPSA and mpMRI, 271 patients underwent ultrasound-guided transperineal targeted prostate biopsy. Among them, 162 were finally diagnosed with PCa, with a biopsy positive rate of 59.78%. The detection rate of PCa in all the subjects was 1.01%. According to the pathological grade, 5(3.08%) were in ISUP group 1, 95(58.64%) in ISUP group 2-3, and 62(38.27%) in ISUP group 4-5. There were 102(62.96%), 39(24.07%) and 21(12.96%) with localized, locally advanced or metastatic PCa, respectively. The levels of tPSA in the four groups were (1.13±1.44)ng/ml, (1.77±3.45)ng/ml, (3.27±17.58)ng/ml, and (4.26±11.48)ng/ml, respectively, with statistically significant differences ( P<0.01). The positive number of biopsy in each group was 1 case(0.06%), 56 cases(0.79%), 81 cases(1.36%) and 24 cases(1.82%) respectively, with statistically significant differences ( P<0.01). The number of ISUP 4-5 grades in each group was 0, 17(30.35%), 29(35.80%), and 16(66.67%) respectively, with statistically significant differences ( P<0.01). Conclusions:Based on the medical community system, according to the tPSA screening results of the primary hospitals, it is feasible and effective to refer suspicious patients to the referral hospitals for mpMRI examination, and screen prostate cancer by ultrasound-guided transperineal prostate fusion biopsy.

Objective:To investigate the clinical applicability of the four-grade grading(G4) advocated by the academy in recent years compared with the guideline-recommended three-grade grading(G3) in functional tricuspid regurgitation (FTR).Methods:A total of 137 consecutive patients were prospectively included from outpatient and inpatient clinics at Tangdu Hospital, Air Force Medical University from May to December 2023. All patients underwent echocardiography and were graded for regurgitation based on the 2017 American Society of Echocardiography Valve Evaluation Guidelines as the reference standard. The patients with regurgitation were grouped according to the G3 based on the guidelines and the G4 advocated by the academic community in recent years, respectively. The consistency of the regurgitation grading between multi-indicators and single-indicators was analyzed using the Kappa test for both G3 and G4. The quantitative regurgitation relevant parameters were analyzed using ROC curves to evaluate the diagnostic efficacies for G4, including the vena contracta width (VCW), the area of the color flow jet (A Jet), and the radius of the PISA (R PISA). Results:The results of consistency analysis showed that the consistency of regurgitation volume (RVol) was significantly higher in the G4 multi-indicators comprehensive assessment versus the single-indicators assessment compared with the G3, with a Kappa value of 0.84 vs. 0.30. The consistency of effective regurgitant orifice area (EROA) and VCW remained unchanged, with a Kappa value of 0.76 vs. 0.89, 0.51 vs. 0.66. ROC curve analysis showed that for the G4, the area under the curve (AUC) for moderate regurgitation were 0.854, 0.993, and 0.894, respectively, while for moderate-severe regurgitation, these values were 0.899, 0.979, and 0.917, respectively.Conclusions:For FTR, the G4 currently advocated by the academic community has better consistency between single-indicators and comprehensive indicators grading than the G3 based on the guideline, which is clinically applicable; A Jet, R PISA, and VCW can be supplemented to the G4, which helps to improve the quantitative assessment system.

Objective:To establish the post competency evaluation index system for extracorporeal membrane oxygenation (ECMO) nurses.Methods:Based on semi-structured interviews, a preliminary post competency evaluation index system for ECMO nurses was developed. From May to June 2022, the Delphi method was used to conduct two rounds of consultation with 19 experts in critical illness field from 15 ClassⅢGrade A hospitals in 6 provinces and municipalities across the country to determine the evaluation index system. The analytic hierarchy process was used to determine the weights and consistency coefficients of indexes at all levels. The positivity of experts was expressed by the effective response rate of the questionnaire, the coordination degree of expert opinions was expressed by Kendall's W and coefficient of variation, the authority of experts was expressed by the authority coefficient of experts, and the concentration of expert opinion was expressed by the mean importance assignment and the perfect score rate. Results:In two rounds of expert consultations, the effective response rates of the questionnaires well all 100.00% (19/19), with expert authority coefficients of 0.834 and 0.879. The Kendall's W for the overall indicator in the second round of expert correspondence was 0.281 ( P<0.01), and the coefficient of variation of the indicators at all levels was 0.05 to 0.17. In the second round of consultation, the mean importance scores assigned to indicators at all levels was 4.05 to 4.95, with a perfect score of 21.05% to 94.74%. The final constructed post competency evaluation index system for ECMO nurses included 4 first-level indicators, 28 second-level indicators, and 59 third-level indicators. Conclusions:The post competency evaluation index system for ECMO nurses is scientific, reliable, and reasonable, which can provide reference for optimizing the ECMO nurse training system and improving evaluation standards.

Extracorporeal membrane oxygenation is an extracorporeal life support technique used to rescue patients with respiratory and (or) heart failure. Infection is one of the most serious complications of extracorporeal membrane oxygenation, which can affect patients' clinical outcomes. This article reviews the definition, diagnosis, incidence, site of infection, pathogenic bacteria, risk factors, prevention and treatment measures of extracorporeal membrane oxygenation associated nosocomial infection, so as to provide reference for the prevention and treatment of extracorporeal membrane oxygenation associated nosocomial infection.

This paper reviews the research status of the training and certification of extracorporeal membrane oxygenation nurses at home and abroad and their job competencies, and analyzes its limitations, so as to provide a reference for the training of extracorporeal membrane oxygenation nurses in my country.

Mammalian carboxylesterases (CEs) are key enzymes from the serine hydrolase superfamily. In the human body, two predominant carboxylesterases (CES1 and CES2) have been identified and extensively studied over the past decade. These two enzymes play crucial roles in the metabolism of a wide variety of endogenous esters, ester-containing drugs and environmental toxicants. The key roles of CES in both human health and xenobiotic metabolism arouse great interest in the discovery of potent CES modulators to regulate endobiotic metabolism or to improve the efficacy of ester drugs. This review covers the structural and catalytic features of CES, tissue distributions, biological functions, genetic polymorphisms, substrate specificities and inhibitor properties of CES1 and CES2, as well as the significance and recent progress on the discovery of CES modulators. The information presented here will help pharmacologists explore the relevance of CES to human diseases or to assign the contribution of certain CES in xenobiotic metabolism. It will also facilitate medicinal chemistry efforts to design prodrugs activated by a given CES isoform, or to develop potent and selective modulators of CES for potential biomedical applications.

Objective To perform a questionnaire survey on patients with cerebrovascular disease, so as to find problems in the fall-preventing education and provide scientific evidence for health education improvement. Methods From October 2015 to December 2016, a self-designed "Let's mitigate falling danger"questionnaire was applied to investigate a total of 193 patients with cerebrovascular disease from geriatric department, neurology department and neurosurgical department, and analyzed the resules. Results The average score of the 193 patients was (25.05±4.63). The three items with lowest score were "Using fall-leading drugs" (1.30±0.86), "Getting-up behavior" (1.32±0.88) and "Feeling embarrassed seeking help"(1.35±0.64) in the questionnaire. Besides, the fall-preventing score were different in patients with different gender, education level, diagnosis, history of fall and whether received fall-preventing education or not, and the differences were statistical significant (t=2.013, 11.638, 10.750, 5.238, 2.147;P< 0.05). Generalized linear regression analysis showed that receiving fall health education, gender, education level and disease type were the influencing factors of fall prevention cognition in patients with cerebrovascular disease (P< 0.05). Conclusions Cerebrovascular patients are lack of awareness of fall risks in hospital. The nursing management should take risk control on these patients. The responsible nurse should choose personalized education mode and content according to relevant awareness deficits.

Objective To investigate the fall-related knowledge and behaviors and ways after injury by chief caregivers of inpatients with neurological disease.Method We designed a questionnaire of fall-related knowledge,behaviors and ways after injury and used it among 208 chief caregivers of inpatients with neurological disease.Results On fall-related knowledge,the three items with the lowest scores about fall-related knowledge included fall-related medicine,postural hypotension and abnormal excretion.Of fall-prevented behaviour score,the lowest 3 items were three steps for getting up,placing things correctly and using wheelchair protection derive.Of the inquiry and fall measures score,the lowest 3 item were helping the patient up,observation and prevention after fall.There were significant differences in the total scores on education,time for taking care of the patients,history of fall and health education on fall (P＜0.05).The scores of those with education of senior middle school,college or above were significantly higher than those with education of junior middle school or lower (P＜0.001).The following time for taking care of the patients were compared with statistics significant:＜1month and 3～6 month,＜1month and ＞6 months,1～3 months and 3～6 months (P＜0.001).Conclusion The caregivers of the patients with neurological disease are short of knowledge in fall-related knowledge,normal behaviors and should carry out individualized health education to them.

Objective To investigate the expressions of aquaporin 4 (AQP4) in the bacterial meningitis in rats and to explore the molecular mechanism for brain edema caused by bacterial meningitis.Methods Totally 40 of 3-week-old-Sprague-Dawley healthy rats,body weight 60-80 g,male or female,were divided into a normal control group(n =10),and infection groups:24 hours after injection(n =10),48 hours after injection(n =10),and 5 days after injection(n =10).The expressions of AQP4 in the brain were detected by immunohistochemistry and Western blot methods respectively after 24 hours,48 hours,5 days of inoculation.Results Mortality rate:no rats in the control group and the infection group after 24 hours were dead.Two rats in the infection group after 48 hours and 4 rats in the infection group after 5 days were dead because of serious sickness,with the mortality rates 20％ and 40％,respectively.AQP4 expression was slightly positive under light microscope,and the positive cells mainly surrounded glial cells and blood vessels,while neurons were not dyed.Immunohistochemical staining showed that AQP4 expression in the model group increased with the severity of edema;compared with the control group,the AQP4 expression in the brain tissues increased in different periods after rats were infected,and the differences between groups were statistically significant (F--91.84,P ＜ 0.01).Western blot analysis showed that after the brain received streptococcus pneumoniae injection,expression of AQP4 began to increase in 24 hours after streptococcal injection,and reached to the peak in 48 hours,but decreased in 5 days,but the expression still remained higher than that of the normal control group.Each group had statistically significant difference(F =14.23,P ＜ 0.01).Conclusions Expression of AQP4 in the models with bacterial meningitis may increase initially and decrease later.It suggests that AQP4 plays a protective role during the development of infectious brain edema.

Phospho-histone H2AX(γH2AX) has been widely used in vitro genotoxicity evaluation of ionizing radiation, carcinogenic substances and cigarette smoke as an important biomarker of DNA double stranded breaks ( DSBs) . The study developed an enzyme-linked immunesorbent assay for detection of the content ofγH2AX in cells to evaluate the genotoxicity of cigarette smoke. The study exposed CHO cells with cigarette smoke total particulate matter ( TPM) and cigarette smoke condensate ( CSC) of different dose, dose-effect relationship between smoke exposure and DNA damage and the poisonous difference of cigarette smoke components has been investigated by detecting the content change ofγH2 AX in cells under different exposure time and dose. In addition, reactive oxygen species ( ROS) in cells were also detected to study the mechanism of cigarette smoke exposure induced DSBs. The experiment result showed that the required time for the level ofγH2AX in cells grew to the peak prolonged with increased exposure dose. Once the level of γH2AX in cells grew to the peak value, then it decreased slowly; the level of γH2AX in cells rised with increasing dose of cigarette smoke;The effect of TPM on the content change of γH2AX was more than CSC; Moreover, smoke exposure could induce concentration increase of ROS in cells, and a good correlation of content change of ROS and γH2AX in cells were found, free radicals in cigarette smoke may be one major cause of DSBs.