OBJECTIVES: To investigate the role of DTX2 in regulating biological behaviors of oxaliplatin-resistant colorectal cancer cells (CRC/OXA cells). METHODS: CCK8 assay was used to determine the inhibition rate of oxaliplatin-treated CRC cells. A CRC/OXA cell line was constructed, in which DTX2 expression level was detected. The cells were transfected with a DTX2-shRNA plasmid or co-transfected with DTX2-shRNA and pcDNA-Notch2, and the changes in cell proliferation, migration and invasion ability were evaluated using plate cloning assay, scratch assay and Transwell invasion assay. The expression levels of Notch2, NICD and epithelial-mesenchymal transition (EMT) proteins of the transfected cells were detected with Western blotting. In a nude mouse model bearing SW620/OXA cell xenografts, the effects of DTX2 knockdown and Notch2 overexpression in the implanted cells on tumor growth and protein expressions were tested. RESULTS: The IC₅₀ of oxaliplatin was 6.00 μmol/L in SW620 cells and 8.00 μmol/L in LoVo cells. CRC/OXA cells showed a significantly increased expression of DTX2. DTX2 knockdown in CRC/OXA cells significantly inhibited cell proliferation, migration and invasion, and these effects were reversed by co-transfection of the cells with pcDNA-Notch2. DTX2 knockdown significantly reduced the expression levels of Notch2, NICD and vimentin proteins and increased E-cadherin expression in CRC/OXA cells, and co-transfection with pcDNA-Notch2 potently attenuated the changes in these proteins. In the tumor-bearing mice, DTX2 overexpression obviously promoted the growth of SW620/OXA cell xenograft, enhanced the protein expressions of Notch2, NICD and vimentin, and lowered the expression of E-cadherin. CONCLUSIONS High expression of DTX2 promotes proliferation, migration, invasion and EMT of CRC/OXA cells through the Notch2 signaling pathway, suggesting the potential of DTX2 as a target to improve the efficacy of oxaliplatin.
Epithelial-Mesenchymal Transition ; Humans ; Cell Proliferation ; Oxaliplatin ; Colorectal Neoplasms/metabolism* ; Animals ; Drug Resistance, Neoplasm ; Receptor, Notch2/metabolism* ; Cell Line, Tumor ; Mice, Nude ; Cell Movement ; Organoplatinum Compounds/pharmacology* ; Neoplasm Invasiveness ; Mice

Objective:To investigate the impact of the deep-learning-based CT fractional flow reserve (CT-FFR) on clinical decision-making and long-term prognosis in patients with obstructive coronary heart disease.Methods:In this single-center retrospective cohort study, consecutive patients with obstructive coronary heart disease (with at least one stenosis≥50%) on their first coronary computed tomography angiography (CCTA) in Beijing Anzhen Hospital from February 2017 to July 2018 were included. Baseline clinical and CT characteristics were collected. Deep-learning-based CT-FFR and Leiden CCTA risk score were calculated. All patients enrolled were followed up for at least 5 years. The study endpoint was major adverse cardiovascular events (MACE), defined as the composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and unplanned revascularization. Receiver operating characteristic (ROC) curves were drawn to define the optimal cut-off point of the Leiden score in predicting the 5-year MACE, and survival analysis and Cox regression were performed to explore the related factors of MACE.Results:A total of 622 patients, aged 61 (54, 66) years, with 407 (65.4%) males were included. Diagnostic coronary angiography was performed in 78 patients after their baseline CCTA, with 34 (43.6%) patients had CT-FFR>0.80. During a follow-up time of 2 181 (2 093, 2 355) days, 155 patients (24.9%) suffered from MACE. ROC derived optimal cut-off point of Leiden score for predicting MACE was 15.48. Survival analysis found that male patients, Leiden risk score>15 and CT-FFR≤0.80 had worse prognosis. Multivariate Cox regression analysis identified CT-FFR≤0.80 as an robust and independent predictor of MACE ( HR=4.98, 95% CI 3.15-7.86, P<0.001). Conclusion:Deep-learning-based CT-FFR aids in clinical decision-making and the evaluation of long-term prognosis in patients with obstructive coronary heart disease.

Objective:To summarize the best evidence for the prevention and management of oral mucosal pressure injury (OMPI) in severe neurological patients with tracheal intubation.Methods:The clinical decisions, guidelines, expert consensus, evidence summary, systematic reviews, and clinical practice regarding the prevention and management of OMPI in severe neurological patients with tracheal intubation were searched in domestic and foreign databases, guideline websites, and professional association websites. The search period was from database establishment to May 30, 2023. Four researchers who undergone systematic evidence-based training conducted literature quality evaluation and evidence extraction.Results:A total of 15 articles were included, including three evidence summaries, three systematic reviews, two guidelines, three clinical practices, three expert consensus, and one clinical decision. A total of 27 pieces of best evidence were summarized from six aspects of risk assessment, oral mucosal assessment, oral nursing, tracheal intubation management, nutritional support, and organizational training.Conclusions:The best evidence for the prevention and management of OMPI in severe neurological patients with tracheal intubation summarized provides evidence-based evidence for medical and nursing staff to prevent and manage OMPI in severe neurological patients with tracheal intubation.

Objective:To investigate the past continuing medical education (CME) in pediatrics for general practitioners in community health centers in Longhua District, Shenzhen, so as to explore the willingness, needs and suggestions of general practitioners for CME in pediatrics.Methods:A mixed methods research were used in this study. Firstly, the purpose sampling method was used to select general practitioners in community health centers in Longhua District, Shenzhen for personal in-depth interviews. The interview contents were recorded and transcribed. The interview contents were coded by NVivo software. Theme frame analysis method was used for data sorting and theme extraction. Based on the results of qualitative interviews, the questionnaire was developed and distributed through the electronic questionnaire platform, and relevant questionnaire data were analyzed by Excel.Results:The results of qualitative research showed that after personal in-depth interviews with 10 general practitioners, the information reached saturation. Through repeated reading, induction and analysis of the interview data, four themes were extracted: ① previous pediatric training opportunities and satisfaction; ② willingness to participate in pediatric training; ③ the demand of training content, form and duration; ④ measures to encourage participation in training. In terms of quantitative research results, a total of 223 electronic questionnaires were collected, among which there were 219 valid questionnaires. Besides, 150 (68.5%) general practitioners said that they had no or only a few training opportunities in pediatrics CME in the past. There were some problems in the past CME training, such as unsystematic training (39 practitioners, 66.1%), narrow course coverage (30 practitioners, 50.8%), the content divorced from clinical practice (29 practitioners, 49.2%), monotonous teaching method (27 practitioners, 45.8%), etc. And 210 (95.9%) general practitioners were willing to participate in pediatric training, and 161 (73.5%) hoped that the form of training would be a combination of online and offline. In terms of pediatrics specialty content training needs, the general practitioners had higher demand for respiratory (188 practitioners, 85.8%), digestive (160 practitioners, 73.1%), infectious (145 practitioners, 66.2%) and dermatology (136 practitioners, 62.1%) specialty.Conclusion:There are still some problems in pediatrics CME, such as few training opportunities, unsystematic training, etc. In the future, we need to formulate systematic training plans and incentive measures according to the needs of general practitioners, to strengthen the pediatric professional training for general practitioners and improve their ability to receive children, in order to promote the implementation of hierarchical medical system for children.

Objective:To investigate the status quo and related issues of reception of pediatric patients by general practitioners in community health centers in Longhua District of Shenzhen through qualitative and quantitative studies.Methods:In qualitative study, 10 general practitioners (GPs) from community health centers in Longhua District of Shenzhen were selected by the purpose sampling method for personal in-depth interviews. The interview contents were recorded and transcribed, then coded by Nvivo software. Theme frame analysis method was used for data sorting and theme extraction. Based on the results of qualitative interviews, the questionnaire was developed and distributed through the electronic questionnaire platform. The contents of the questionnaire included general information, the situation of pediatric patient reception in community health centers, the willingness and ability of GPs to receive children, the existing problems and the measures to promote receiving pediatric patients in community health centers.Results:The results of personal in-depth interviews with 10 GPs showed that the obtained information reached saturation. Through repeated reading, induction and analysis of the interview data, four themes were extracted: ① GPs in community health centers received a large number of pediatric outpatients with common diseases; ② GPs in community health centers are willing to receive child patients, but they were lack of ability; ③ there were many problems of pediatric patients reception in community health centers; ④ training and incentive policies would help to promote child patient reception in community health centers. A total of 223 electronic questionnaires were collected, 219 of which were valid for analysis. All the community health centers in Longhua District received pediatric patients, the number accounted for 20%-60% of the total outpatients; 84.5%(185/219)of the responders were willing to receive child patients, 65.8% (144/219)of them assumed that the consulting ability was average. The main problems for GPs to receive pediatric patients were "insufficient training" (76.7%,168/219) and "lack of consulting ability" (55.3%,121/219). The important measures to promote GPs to receive child patients were to improve their own clinical competence (94.1%,206/219), to have clinical faculty with pediatric background mentoring at the community health center (74.9%,164/219), to improve the supporting facilities (42.9%,94/219) and continuous professional support (38.8%,85/219).Conclusion:The status quo of pediatric patient reception in the community of Shenzhen Longhua District is generally satisfactory. The main problems in this aspect are insufficient training for general practitioners and lack of clinical competence, which should be strengthened and improved in the future.

Objective:To search, evaluate and summarize the evidence of the safety and application of closed tracheal suction systems and to provide reference for clinical nursing work.Methods:BMJ Best Practice, UpToDate, Joanna Briggs Institute Evidence-based Health Care Center, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, American Assocition for Respiratory Care, Society of Critical Care Medicine, Medlive, Cochrane Library, PubMed, Embase, CINAHL, CNKI, Wanfang Database, China Biology Medicine disc were searched for related guidelines, system reviews, expert consensus, best practices, etc. The retrieval time was from the database construction to February 28, 2021. Two researchers independently evaluated the quality of the included literature and extracted and summarized the evidence of the literature that met the quality standards.Results:A total of 20 literatures were included, including 3 clinical decisions, 2 guidelines, 11 systematic reviews and 4 expert consensuses. A total of 27 pieces of best evidence were compiled from five aspects, including indications for use, clinical effects, safety, methods of use and replacement.Conclusions:This study summarizes the best evidence on the clinical application of closed sputum suction devices in adults. When applying the evidence, clinical nurses need to select the best evidence in combination with the clinical environment to standardize the clinical application of closed tracheal suction systems.

Objective:To develop an online continuing education course of pediatrics for primary physicians using the ADDIE model and to evaluate its application effect.Methods:Experts in fields of general practice and pediatrics were invited to develop an online continuing education course of pediatrics for general practitioners using ADDIE model from June to July 2020. From August 2020 to September 2020 the course was conducted with 12 live sessions on the open platform. In September 2020, 16 primary pediatricians and 15 general practitioners who completed whole courses were invited to attend focus group interviews. The interview contents were recorded, transcribed, and coded using Nvivo software; the subject frame analysis method was used to sort the data and refine the theme.Results:Information was saturated by focus group interviews with 14 general practitioners and 14 pediatricians. Finally, three themes were extracted from the interview results:(1)The advantages of this course were practicality, comprehensiveness and online teaching; (2) The course improved the diagnosis and treatment ability of participants, increased self-confidence of doctors and satisfaction of patients, and also promoted academic exchanges among colleagues; (3) For future improvement of the course, the clinical knowledge points, practical procedures, new thinking of diagnosis and treatment, progress in guidelines, and knowledge depth should be added; and the use of case teaching and combination of online with offline, and extending teaching time should be considered.Conclusion:An online continuing education course of pediatrics for primary physicians has been developed based on the ADDIE model, which received favorable feedback from the primary pediatricians and general practitioners who attended the course.

Objective:To introduce the usefulness and advantages of needle-type choledochotomy in laparoscopic common bile duct exploration.Methods:A retrospective analysis for the data of 1 107 patients who successfully implemented laparoscopic common bile duct exploration in Subei People′s Hospital of Jiangsu Province from January 1, 2013 to December 31, 2020 were applied. All cases were divided into the study group 662 cases with needle-type choledochotomy) and the control group (445 cases with non-needle-type choledochotomy) according to the manipulation of common bile duct incision. The time-cost, incidences of bleeding and bile leakage, as well as the recurrence rate of bile duct stone and the incidence of bile duct stenosis were observed and compared between the two groups. Normally distributed data were expressed as mean±standard deviation ( Mean± SD) and compared by t test while count data were expressed as frequency or percentage and compared by chi-square test or Fisher′s exact test. Results:The bile duct incision time and bleeding rate were (14.45±2.46) s and 25.1% in the study group, (104.48±15.32) s and 68.1% in the control group, respectively. The differences between the two groups were statistically significant ( P<0.001). The incidence of stone recurrence, biliary leakage, and bile duct stricture were 3.0%, 3.6% and 0.3% in the study group, 4.9%, 5.6% and 0.4% in the control group, respectively. There were no statistically significant differences between the two groups ( P>0.05). Conclusion:Needle-type bile duct incision can be used as a routine manipulation in laparoscopic common bile duct exploration for its time-saving, less bleeding, safe and easy to handling.

Objective:To investigate the clinical effect of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar.Methods:From September 2015 to May 2019, a total of 11 patients who had facial depressed scar were treated with minimally invasive scar release combined with autologous microfat graft in Huaihe Hospital of Henan University. Needle scar separator or 10 ml syringe needle was inserted under skin to release scar adhesion thoroughly. Microfat was harvested from the abdomen, which was separated and purified, and then evenly transplanted into the stripped space (0.5 cm wider than the edge of scar) under the scar with a 1 ml syringe. The severity of scar was evaluated pre-operation, 3-month post-operation and 6-month post-operation, using Vancouver Scar Scale score and Stony Brook Scar Evaluation Scale score to evaluate the efficacy. Using Visual Analogue Scale score to evaluate patient satisfaction. Analyses were performed using SPSS Statistics 25.0, and measurement data were expressed as Mean±SD if they conformed to normality and homogeneity of variance. One-way ANOVA was used for multi-time point data, and the Bonferroni test was performed for pairwise comparison. P<0.05 was considered a statistically significant difference. Results:The depression of scars disappeared immediately after treatment. 6 months after treatment, the surface of the scars was flat, the color and elasticity were close to adjacent normal skin, and the texture of the scars was soft. All patients were followed up for 6 months without recurrence, and 11 patients were satisfied. In Vancouver Scar Scale score, the pre-operation score was 7.27±1.10, the 3-month post-operation score was 2.64±0.81 and the 6-month post-operation score was 0.91±0.54, showing a significant difference ( F=467.98, P<0.001). Pairwise comparison result show that comparing the pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P<0.001). In Stony Brook Scar Evaluation Scale score, the pre-operation score was (2.00±0.89), the 3-month post-operation score was 4.45±0.69 and the 6-month post-operation score was 4.45±0.69, showing a significant difference ( F=67.00, P<0.001). Pairwise comparison result show that comparing pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P=0.006). The 6-month post-operation Visual Analogue Scale score was 95.0±6.74. Conclusions:Minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar can avoid the post-surgery scar formation and adhesion, and improve the color and texture of the facial hypertrophic scar. This method can be carried out under local anesthesia, with simple procedure and exact effect.

Objective:To investigate the clinical effect of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar.Methods:From September 2015 to May 2019, a total of 11 patients who had facial depressed scar were treated with minimally invasive scar release combined with autologous microfat graft in Huaihe Hospital of Henan University. Needle scar separator or 10 ml syringe needle was inserted under skin to release scar adhesion thoroughly. Microfat was harvested from the abdomen, which was separated and purified, and then evenly transplanted into the stripped space (0.5 cm wider than the edge of scar) under the scar with a 1 ml syringe. The severity of scar was evaluated pre-operation, 3-month post-operation and 6-month post-operation, using Vancouver Scar Scale score and Stony Brook Scar Evaluation Scale score to evaluate the efficacy. Using Visual Analogue Scale score to evaluate patient satisfaction. Analyses were performed using SPSS Statistics 25.0, and measurement data were expressed as Mean±SD if they conformed to normality and homogeneity of variance. One-way ANOVA was used for multi-time point data, and the Bonferroni test was performed for pairwise comparison. P<0.05 was considered a statistically significant difference. Results:The depression of scars disappeared immediately after treatment. 6 months after treatment, the surface of the scars was flat, the color and elasticity were close to adjacent normal skin, and the texture of the scars was soft. All patients were followed up for 6 months without recurrence, and 11 patients were satisfied. In Vancouver Scar Scale score, the pre-operation score was 7.27±1.10, the 3-month post-operation score was 2.64±0.81 and the 6-month post-operation score was 0.91±0.54, showing a significant difference ( F=467.98, P<0.001). Pairwise comparison result show that comparing the pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P<0.001). In Stony Brook Scar Evaluation Scale score, the pre-operation score was (2.00±0.89), the 3-month post-operation score was 4.45±0.69 and the 6-month post-operation score was 4.45±0.69, showing a significant difference ( F=67.00, P<0.001). Pairwise comparison result show that comparing pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P=0.006). The 6-month post-operation Visual Analogue Scale score was 95.0±6.74. Conclusions:Minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar can avoid the post-surgery scar formation and adhesion, and improve the color and texture of the facial hypertrophic scar. This method can be carried out under local anesthesia, with simple procedure and exact effect.