Objective:To construct an evaluation index system for community hospice comfort care.Methods:This was a cross-sectional study. Two rounds of expert consultations were conducted using modified Delphi method from June to September 2023, 14 experts in the field of palliative care nursing were invited to participate in the consultations. Based on the consultation results, an evaluation index system for comfort care of community hospice was preliminarily developed.Results:All consultation experts were females, with an average age of (48±8) years; 9 held senior professonal titles, and 12 had more than 5 years of palliative care-related working experiencs. The positive coefficient of correspondence in two rounds of consultations was 100%, and the degree of authority was 0.841 and 0.834, respectively. The expert coordination coefficients for the importance of secondary indicators were 0.281 (χ 2=182.65) and 0.284 (χ 2=132.98), and the expert coordination coefficients for the operability of secondary indicators were 0.231 (χ 2=150.12) and 0.252 (χ 2=118.01), respectively. The constructed evaluation index system of hospice comfort care consisted of 5 primary indexes and 32 secondary indexes. The five primary indexes were environmental comfort, physiological comfort, psychological comfort, spiritual comfort and social comfort with a weight coefficient of 0.202 3, 0.205 3, 0.205 3, 0.199 4 and 0.187 7, respectively. Conclusion:An evaluation index system for comfort care in community hospice has been preliminarily developed in this study, after validation it would provide a reference for assessing the comfort needs of patients with palliative care.

Objective To investigate the application effect of a bedside ultrasound-guided intestinal cleaning program in patients with severe acute pancreatitis.Methods A total of 51 patients with severe acute pancreatitis admitted to the ICU of a tertiary A hospital in Shandong from March to September 2023 were selected by convenience sampling method,and they were divided into an experimental group and a control group according to random number table method.The experimental group was given the bedside ultrasound-guided intestinal cleaning program,and the control group was given the routine intestinal cleaning program.Acute gastrointestinal injury ultrasonography score,the incidence of grade Ⅲ acute gastrointestinal injury and intra-abdominal pressure were compared between the 2 groups before intervention,on the 3rd and 5th day.Results There was an interaction effect between time and group in the comparison of acute gastrointestinal injury ultrasonography scores in the 2 groups(F=7.478,P<0.001);simple effect analysis showed that acute gastrointestinal injury ultrasonography scores in the experimental group were lower than those in control group on the 3rd and 5th day,with statistically significant differences(P<0.05).The incidence of grade Ⅲ acute gastrointestinal injury in the experimental group(23%)was lower than that in the control group(60%),with statistically significant differences(P<0.05).The intra-abdominal pressure had an interaction effect between the 2 groups(F=47.128,P<0.001);simple effect analysis showed that the intra-abdominal pressure in the experimental group was lower than that in the control group on the 3rd and 5th day,with statistically significant differences(P<0.05).Conclusion The bedside ultrasound-guided intestinal cleaning program can improve acute gastrointestinal injury and reduce intra-abdominal hypertension in patients with severe acute pancreatitis.

Objective:To investigate the status quo of pain management for cancer patients in hospice care wards of community health service centers.Methods:The electronic medical records of 373 cancer patients admitted in hospice wards of Kangjian Community Health Center of Xuhui District and Jinshanwei Town Community Health Center of Jinshan District from January 2015 to July 2021 were collected. The characteristics of cancer pain, the use of analgesic drugs, the effects of analgesic drugs and its influencing factors were analyzed.Results:The incidence of cancer pain in 373 patients was 93.0% (347/373), and the proportion of moderate to severe cancer pain was 55.6% (193/347). Analgesics were used in 304 patients, among whom 233 (76.6%) patients used oral analgesics, 297 (97.7%) used on time, 97.6%(285/292) used sustained-release opioids, and 94 (30.9%) used combinedly. Breakout pain occurred in 100 cases (32.9%), all of which was controlled with immediate-release morphine. Cancer pain was not relieved in 132 cases (43.42%), and multivariate logistic regression analysis showed that the pain degree on admission (moderate: OR=3.69, 95 %CI:2.09-6.49; severe: OR=5.52, 95 %CI:2.43-12.53), the presence of burst pain ( OR=3.28, 95 %CI:1.77-6.06), the type of analgesics used (non-steroidal+weak opioids: OR=0.39, 95 %CI:0.20-0.76; nonsteroidal+strong opioids: OR=0.20, 95 %CI:0.08-0.51) and the adverse reactions ( OR=1.92, 95 %CI:1.03-3.60) were the influencing factors of pain relief in cancer pain patients (all P<0.05). Conclusion:The pain of cancer patients admitted to community palliative care wards cannot be ignored. Although most cancer pain patients use analgesic drugs in a standard way, there are still a high proportion of patients whose pain is not controlled. Various factors affect the effect of analgesic treatment.

Myxococcus xanthus is a Gram-negative soil bacterium capable of performing sophisticated cellular behaviors and growing one of the most intricate bacterial single-species biofilms in nature. During the process of biofilm formation, social behaviors of M. xanthus cells dominate key steps of the biofilm establishment, e.g., cellular motility on solid surface, predatory behavior by the grouped cells, kin recognition in the community, fruiting body development, myxospore differentiation, and programmed cell death. This review introduces the recent research progress about the M. xanthus biofilms.

Objectives To generate an orthotopic left lung transplantation model in mice, and to observe the early changes of respiratory system resistance andγδT lymphocytes infiltrated in grafts? Methods The research time was from March 2014 to May 2015? The male C57BL/6 mice ( n=35) and BALB/c mice (syngenic group,n=10) were randomly divided into five groups. Control group (n=5): wild C57BL/6 mice; syngenic transplant group ( n=10 ): C57BL/6→C57BL/6; allogenic transplant group ( allogenic group,n=10): BALB/c→C57BL/6; each transplant group was randomly divided into 3?day and 7?day subgroups ( n=5 )? Respiratory system resistance and histological features of grafts were assessed, and differences in graft infiltrating γδT lymphocytes and mRNA expression of interleukin ( IL )?17A were quantified on 3 and 7 days after transplantation? Multiple comparisons were performed using one?way analysis of variance and least significant difference analysis? Results ( 1 ) The respiratory system resistance of syngenic group and allogenic group were (2?61±0?59) cmH2O·s/ml and (2?84±0?31) cmH2O·s/ml 3 days post?operation, both of them increased compared to control group (1?39±0?17) cmH2O·s/ml (1 cmH2O=0?098 kPa) (P=0?001, 0?000). The respiratory system resistance of allogenic group were (4?33±0?67) cmH2 O·s/ml 7 days post?operation, which was significantly higher than that of syngenic 7?day subgroup (1?87±0?27) cmH2O·s/ml and control group (1?39±0?17) cmH2O·s/ml (P=0?000, 0?000)?(2) The isografts of syngenic group showed a relatively normal histological appearance with minimal infiltration of inflammatory cells, and the allografts of allogenic group infiltrated apparently by inflammatory cells, especially 7?day subgroup showed acute cellular rejection? ( 3) The percentage of γδT lymphocytes infiltrated in isografts and allografts were 3?90%± 0?86% and 4?40%± 0?57%, respectively, which were significantly increased compared to that of control lungs 2?00%±0?23% 3 days post?operation(P=0?000, 0?000);The percentage ofγδT lymphocytes infiltrated in 7 days allografts was 5?40%±0?98% , which was higher compared to that of 7 days isografts 2?60%± 0?54% and control lungs 2?00%± 0?23% ( P=0?000, 0?000)? (4) IL?17A mRNA expression levels were 3?37±0?55 and 5?23±1?50 in isografts and 6?77± 0?93 and 27?32±4?20 in allografts, on postoperative day 3 and 7 respectively? All of them were significantly upregulated compared to that of control lungs 0?99±0?08 (P=0?000, 0?000), and allografts exhibited significantly greater IL?17A transcript levels compared to isografts on postoperative day 3 and 7 ( P=0?000, 0?000) . Conclusion The rise of respiratory system resistance of lung grafts after transplantation may relate to the increased IL?17A?producing γδT lymphocytes infiltrated in the grafts.

Objectives To generate an orthotopic left lung transplantation model in mice, and to observe the early changes of respiratory system resistance andγδT lymphocytes infiltrated in grafts? Methods The research time was from March 2014 to May 2015? The male C57BL/6 mice ( n=35) and BALB/c mice (syngenic group,n=10) were randomly divided into five groups. Control group (n=5): wild C57BL/6 mice; syngenic transplant group ( n=10 ): C57BL/6→C57BL/6; allogenic transplant group ( allogenic group,n=10): BALB/c→C57BL/6; each transplant group was randomly divided into 3?day and 7?day subgroups ( n=5 )? Respiratory system resistance and histological features of grafts were assessed, and differences in graft infiltrating γδT lymphocytes and mRNA expression of interleukin ( IL )?17A were quantified on 3 and 7 days after transplantation? Multiple comparisons were performed using one?way analysis of variance and least significant difference analysis? Results ( 1 ) The respiratory system resistance of syngenic group and allogenic group were (2?61±0?59) cmH2O·s/ml and (2?84±0?31) cmH2O·s/ml 3 days post?operation, both of them increased compared to control group (1?39±0?17) cmH2O·s/ml (1 cmH2O=0?098 kPa) (P=0?001, 0?000). The respiratory system resistance of allogenic group were (4?33±0?67) cmH2 O·s/ml 7 days post?operation, which was significantly higher than that of syngenic 7?day subgroup (1?87±0?27) cmH2O·s/ml and control group (1?39±0?17) cmH2O·s/ml (P=0?000, 0?000)?(2) The isografts of syngenic group showed a relatively normal histological appearance with minimal infiltration of inflammatory cells, and the allografts of allogenic group infiltrated apparently by inflammatory cells, especially 7?day subgroup showed acute cellular rejection? ( 3) The percentage of γδT lymphocytes infiltrated in isografts and allografts were 3?90%± 0?86% and 4?40%± 0?57%, respectively, which were significantly increased compared to that of control lungs 2?00%±0?23% 3 days post?operation(P=0?000, 0?000);The percentage ofγδT lymphocytes infiltrated in 7 days allografts was 5?40%±0?98% , which was higher compared to that of 7 days isografts 2?60%± 0?54% and control lungs 2?00%± 0?23% ( P=0?000, 0?000)? (4) IL?17A mRNA expression levels were 3?37±0?55 and 5?23±1?50 in isografts and 6?77± 0?93 and 27?32±4?20 in allografts, on postoperative day 3 and 7 respectively? All of them were significantly upregulated compared to that of control lungs 0?99±0?08 (P=0?000, 0?000), and allografts exhibited significantly greater IL?17A transcript levels compared to isografts on postoperative day 3 and 7 ( P=0?000, 0?000) . Conclusion The rise of respiratory system resistance of lung grafts after transplantation may relate to the increased IL?17A?producing γδT lymphocytes infiltrated in the grafts.

Objective:To investigate the CT value added value of the mean of critical value in the diagnosis of giant cell tumor clinical sensitivity.Methods: Aretrospective analysis, selected from March 2013 to November 2014, the clinical data of 120 patients with bone tumors treated, they can be divided into two groups at random, control group and the observer, 60 cases in each group, observer for patients with giant cell tumor of bone, the control for the patients with giant cell tumor of bone. Each patient chose three ROI, the added value of the mean values of enhanced CT and CT values mean as observed values, under the experience of observation analysis of patients with giant cell tumor of the added value of CT values mean critical value and its sensitivity in the clinical diagnosis of giant cell tumor of bone.Results: The observation group of patients after CT enhanced scan display area average CT value of HU(108±39)HU was significantly higher than the control group(82±78)HU CT value(t=3.348, P<0.05), statistically significant difference; Through the ROC curve analysis, found that when the added value of CT values mean acuity 96.5 as critical, sensitivity and specificity of diagnosis of giant cell tumors of bone are 90.9% and 90.9% respectively; When the CT value added value of the mean acuity 41.5 HU as the critical point, the sensitivity and specificity of diagnosis of giant cell tumor bone were 98.9%, 48.1% respectively.Conclusion: The bone giant cell average CT value added value of diagnosis of critical value of 96.5HU 41.5HU, and high sensitivity, but the specificity is low, the added value of CT values help determine the existence of the giant cell tumors of bone.

OBJECTIVETo highlight current knowledge about M-type phospholipase A2 receptor (PLA2R) which is the first human autoantigen discovered in adult idiopathic membranous nephropathy.

DATA SOURCESRelevant articles published in English from 2000 to present were selected from PubMed. Searches were made using the terms "idiopathic membranous nephropathy, M-type PLA2R and podocyte."

STUDY SELECTIONArticles studying the role of M-type PLA2R in idiopathic membranous nephropathy were reviewed. Articles focusing on the discovery, detection and clinical observation of anti-PLA2R antibodies were selected.

RESULTSM-type PLA2R is a member of the mannose receptor family of proteins, locating on normal human glomeruli as a transmembrane receptor. The anti-PLA2R in serum samples from MN were primarily IgG4 subclass. Technologies applied to detect anti-PLA2R autoantibody are mainly WB, IIFT, ELISA and so on. Studies from domestic and overseas have identified a strongly relationship between circulating anti-PLA2R levels and disease activity.

CONCLUSIONRecent discoveries corresponding to PLA2R facilitate a better understanding on IMN pathogenesis and may provide a new tool to its diagnosis, differential diagnosis, risk evaluation, response monitoring and patient-specific treatment.

Animals ; Autoantigens ; metabolism ; Glomerulonephritis, Membranous ; immunology ; metabolism ; Humans ; Podocytes ; metabolism ; Receptors, Phospholipase A2 ; metabolism

BACKGROUNDThe various risk factors for retinal hard exudates are still poorly understood in type 2 diabetic patients. The aim of this study was to determine the association between urinary albumin excretion rate (UAER) and hard exudates in macular region in north Chinese patients.

METHODSA total of 272 patients (272 eyes) were enrolled for this study, including 154 subjects from group 1 (mild hard exudates), 91 subjects from group 2 (moderate hard exudates) and 27 subjects from group 3 (severe hard exudates) confirmed using colour fundus photography, optical coherence tomography (OCT) as well as slit-lamp biomicroscopy with 78 diopter (D) lens. Each participant underwent a comprehensive assessment that included biochemical, clinical characteristics test and detailed ophthalmic evaluation. One-way analysis of variance (ANOVA) test and chi-square test were performed to analyze the fasting blood glucose (FBG), glycated hemoglobin (HbA1c), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), full blood counts, urinary albumin excretion rate (UAER), blood creatinine (CREA), duration of diabetes, body mass index (BMI), systolic blood pressures (SBP) and diastolic blood pressures (DBP) between groups. Ordinal logistic regression analysis was further performed in order to eliminating the possible confounding factors.

RESULTSThree groups were matched in terms of age and gender. Risk factors which showed significant difference between groups include FBG (P < 0.001), HbA1c (P < 0.001), LDL (P < 0.001), UAER (P < 0.001), duration of diabetes (P = 0.001), TC (P = 0.005), SBP (P = 0.026), CREA (P = 0.004) and haemoglobin (Hb) (P = 0.012). There was no significant difference between groups for the TG, HDL, DBP, platelet, total white blood cells and BMI. Using ordinal Logistic regression analyses, of all the variables, HbA1c, LDL and UAER which were independent risk factor for hard exudates showed a significantly odds ratio of 1.25, 3.07, and 1.39, respectively. There were also significant differences in UAER level between patients with mild, moderate, severe hard exudates groups (P < 0.001).

CONCLUSIONSUAER was an independent risk factor associated with retinal hard exudates in macular region in type 2 diabetic patients. This study highlights the need for close monitoring and fundus examination for hard exudates in patients with elevated UAER to prevent irreversible visual loss.

Aged ; Albuminuria ; physiopathology ; Diabetes Mellitus, Type 2 ; physiopathology ; urine ; Female ; Humans ; Macular Edema ; physiopathology ; urine ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

The iterative reconstruction algorithm in the main function is to improve the subjective and objective image quality in CT, compared with the traditional algorithm, can significantly reduce the signal-to-noise ratio, contrast to noise ratio, make the CT image quality is good, and more recently, studies have found that the application of the algorithm or can reduce the use of radiation dose, so use foreground is very good, the technology based on this the paper focus on the development of technology, neusoft medical iteration, and the second generation iteration technology in general, the application of CT examination and evaluation are analyzed.