Objective:Understanding of the psychological experiences of young and middle-aged male patients with schizophrenia regarding protective restraints.Methods:This study was qualitative study. Using purposive sampling, middle-aged and young male schizophrenia patients who had undergone protective restraints in the Affiliated Brain Hospital, Guangzhou Medical University were selected as participants from September to December 2022. Data were collected through semi-structured interviews and analyzed using Colaizzi 7-step analysis method.Results:A total of 12 young and middle-aged male schizophrenic patients were interviewed, and four themes were summarized, including patients' attitudes toward protective restraints, patients' emotional experiences, patients' physical experiences, and patients' needs during protective restraints.Conclusions:Protective restraints provide patients with safety in the acute phase, as well as a variety of positive and negative psychological experiences. Psychiatric nurses should grasp the patient's condition, dynamically assess the risk level, adopt appropriate restraint devices, improve restraint care based on the patient's needs, and actively seek alternative measures to restrain simultaneously.

Objective:To understand the clinicopathological and molecular genetic characteristics of aggressive renal mucinous tubular and spindle cell carcinoma (MTSCC).Methods:The clinical features, histology, immunophenotype, molecular characteristics and prognosis of 4 cases of metastatic/recurrent renal MTSCC that were submitted to the Peking University Third Hospital (2 cases), Institute of Urology, Peking University (one case) and Zhejiang Provincial People′s Hospital (one case) from 2015 to 2020 were retrospectively reviewed and analyzed.Results:Among the four patients, two were male and two were female. The average age was 58 years, ranging from 28 to 77 years. Three patients underwent radical nephrectomy, while one underwent partial nephrectomy. The tumor size was 2-8 cm (mean, 5.6 cm). There were two cases classified as pT3a, one case as pT1b and one case as pT1a. Histologically, the tumors were mainly composed of tubules and spindle cell cords. For nuclear grade, three cases were G3 and one case was G2. Extracellular mucus was present in all four cases. Sarcomatoid features and tumor necrosis were observed in one and three cases, respectively. Immunohistochemistry showed that PAX8 (4/4), AMACR (4/4), CK7 (4/4), CKpan (3/3), vimentin (3/3) and CK8/18 (2/2) were positive in the tumor cells, but CAⅨ (1/4) or CD10 (2/3) were focally positive or negative. Fluorescence in situ hybridization showed that no trisomy of chromosomes 7 and l7 (2/2). Targeted next generation sequencing were performed in all four cases and showed that 3 cases had mutations in Hippo pathway involving MET (2/4), NF2 (1/4) and NTRK1 (1/4) genes. The other potentially pathogenic mutations involved KDM6A, SETD2 and PALB2. The follow-up period was 13 to 99 months. The time between diagnosis and metastasis/recurrence ranged from 6 to 58 months. Two patients died after lung metastasis occurred, one had multi-organ and multi-site lymph node metastases, and one achieved disease-free survival after resection of metastatic/recurrent foci.Conclusions:Renal MTSCC is a rare and distinct entity. The presence of high nuclear grade and pathological stage, high-grade morphology, lymphovascular invasion, and tumor necrosis suggests potential aggressive behaviors. It is thus recommended to report these histological features and conduct active follow-up and surveillance after surgery. The frequent mutations in MET, NF2 and NTRK1 suggest that dysregulation of Hippo pathway may be related to the development and progression of renal MTSCC.

Objective:Understanding of the psychological experiences of young and middle-aged male patients with schizophrenia regarding protective restraints.Methods:This study was qualitative study. Using purposive sampling, middle-aged and young male schizophrenia patients who had undergone protective restraints in the Affiliated Brain Hospital, Guangzhou Medical University were selected as participants from September to December 2022. Data were collected through semi-structured interviews and analyzed using Colaizzi 7-step analysis method.Results:A total of 12 young and middle-aged male schizophrenic patients were interviewed, and four themes were summarized, including patients' attitudes toward protective restraints, patients' emotional experiences, patients' physical experiences, and patients' needs during protective restraints.Conclusions:Protective restraints provide patients with safety in the acute phase, as well as a variety of positive and negative psychological experiences. Psychiatric nurses should grasp the patient's condition, dynamically assess the risk level, adopt appropriate restraint devices, improve restraint care based on the patient's needs, and actively seek alternative measures to restrain simultaneously.

Objective:To understand the clinicopathological and molecular genetic characteristics of aggressive renal mucinous tubular and spindle cell carcinoma (MTSCC).Methods:The clinical features, histology, immunophenotype, molecular characteristics and prognosis of 4 cases of metastatic/recurrent renal MTSCC that were submitted to the Peking University Third Hospital (2 cases), Institute of Urology, Peking University (one case) and Zhejiang Provincial People′s Hospital (one case) from 2015 to 2020 were retrospectively reviewed and analyzed.Results:Among the four patients, two were male and two were female. The average age was 58 years, ranging from 28 to 77 years. Three patients underwent radical nephrectomy, while one underwent partial nephrectomy. The tumor size was 2-8 cm (mean, 5.6 cm). There were two cases classified as pT3a, one case as pT1b and one case as pT1a. Histologically, the tumors were mainly composed of tubules and spindle cell cords. For nuclear grade, three cases were G3 and one case was G2. Extracellular mucus was present in all four cases. Sarcomatoid features and tumor necrosis were observed in one and three cases, respectively. Immunohistochemistry showed that PAX8 (4/4), AMACR (4/4), CK7 (4/4), CKpan (3/3), vimentin (3/3) and CK8/18 (2/2) were positive in the tumor cells, but CAⅨ (1/4) or CD10 (2/3) were focally positive or negative. Fluorescence in situ hybridization showed that no trisomy of chromosomes 7 and l7 (2/2). Targeted next generation sequencing were performed in all four cases and showed that 3 cases had mutations in Hippo pathway involving MET (2/4), NF2 (1/4) and NTRK1 (1/4) genes. The other potentially pathogenic mutations involved KDM6A, SETD2 and PALB2. The follow-up period was 13 to 99 months. The time between diagnosis and metastasis/recurrence ranged from 6 to 58 months. Two patients died after lung metastasis occurred, one had multi-organ and multi-site lymph node metastases, and one achieved disease-free survival after resection of metastatic/recurrent foci.Conclusions:Renal MTSCC is a rare and distinct entity. The presence of high nuclear grade and pathological stage, high-grade morphology, lymphovascular invasion, and tumor necrosis suggests potential aggressive behaviors. It is thus recommended to report these histological features and conduct active follow-up and surveillance after surgery. The frequent mutations in MET, NF2 and NTRK1 suggest that dysregulation of Hippo pathway may be related to the development and progression of renal MTSCC.

BackgroundThe existing tools in China for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint do not sufficiently consider the specialty in psychiatric practice， and the scale items are somewhat cumbersome to use， which together restrict their further promotion and application. Accordingly， there is an urgent need for developing a more scientific assessment tool. ObjectiveTo construct a scale for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint and to verify its reliability and validity， so as to provide a generic tool for the assessment. MethodsBased on the theoretical framework of the knowledge-attitude-practice model， the preliminary scale was formed through systematic literature review， qualitative interview and Delphi method. From July to December 2021， a stratified sampling was utilized to select 729 psychiatric nurses from tertiary， secondary and primary （including unclassified medical institutions and grassroots hospitals） psychiatric hospitals in Guangdong Province. The formal scale was developed through item analysis， exploratory factor analysis and confirmatory factor analysis. The validity of the scale was evaluated by content validity and structure validity， and the reliability was verified by procedures including Cronbach's α coefficient， test-retest reliability， and split-half reliability. ResultsA total of 12 items of three dimensions （knowledge， attitude， practice） were included in the scale for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint. The scale-level content validity index （S-CVI） was 0.941， and the item-level content validity index （I-CVI） ranged from 0.812 to 1.000. Exploratory factor analysis extracted three common factors， and the cumulative variance contribution rate was 62.948%. The confirmatory factor yielded adequate fit. Cronbach's α coefficient was found to be 0.887 for the scale， 0.819 for knowledge dimension， 0.842 for attitude dimension， and 0.831 for practice dimension. The split-half reliability and test-retest reliability for the scale were 0.712 and 0.922， respectively. ConclusionThe scale shows satisfactory reliability and validity， which can be used to assess psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint. ［Funded by Guangdong Clinical Teaching Base Teaching Reform Research Project （number， 2021JD119）］

Humans ; Urinary Bladder Neoplasms/pathology* ; Carcinoma, Transitional Cell/pathology* ; Genetic Markers ; Biomarkers, Tumor/genetics* ; Urothelium/pathology*

Objective:To explore the real work experience and needs of nursing assistants of elderly patients with disability and mental disorders, and provide reference for relevant institutions to develop a reasonable support system and promote their physical and mental health.Methods:From October to November 2022, purposive sampling was used to select nursing assistants of elderly patients with disability and mental disorders from the Affiliated Brain Hospital of Guangzhou Medical University as the research subject. The phenomenological method was used to conduct in-depth interviews, recordings, and transcripts of 12 nursing assistants. The Colaizzi analysis program was used to analyze, organize, refine, and summarize.Results:A total of five themes were extracted, including multiple emotional experiences, lack of rest and relaxation, insufficient professional identity and external support, lack of care knowledge and skills, heavy workload and poor treatment.Conclusions:Accompanying management institutions and hospitals need to strengthen their attention to nursing assistants, reduce their physical and mental burden, attach importance to skill training, increase welfare benefits, enhance professional identity, and improve the quality of care.

Objective The objective of this study was to investigate the effects and mechanisms of plant-derived oleuropein on GDM mice.Methods Oleuropein was administered to GDM mice at the dose of 10 mg·kg-1·d-1.Body weight and blood glucose were recorded.The levels of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein-1(MCP-1)were measured by ELISA and RT-qPCR to assess the inflammation level in GDM mice,the activation of Adenosine 5′-monophosphate-activated protein kinase signaling pathway was measured by Western blot.Gestational outcome was analyzed through comparing litter size and birth weight.Results Oleuropein attenuated the elevated body weight of GDM mice and efficiently reduced blood glucose,and restored insulin sensitivity.Oleuropein treatment also reduced oxidative stress and inflammation levels,activated AMPK signaling pathways in the liver tissues of GDM mice,and significantly improved gestational outcome in mice.Conclusion Oleuropein is effective in alleviating symptoms of GDM and improving gestational outcome in the mouse model.This effect is achieved by attenuating oxidative stress and inflammation,which is mediated by the AMPK signaling pathway.

By consulting ancient materia medica， medical books， prescription books and modern literature， this paper systematically combed and reviewed the name， origin， scientific name evolution， producting area， quality evaluation， medicinal parts， harvesting and processing and traditional efficacy of Lasiosphaera Calvatia. The results show that Mabo was first recorded in Mingyi Bielu. Since then， all dynasties have taken Mabo as a legitimate name. Before the Song dynasty， only Calvatia lilacina was used as the original plant of Lasiosphaera Calvatia， which was expanded after the Song dynasty with the appearance of C. gigantea， Lasiosphaera fenzlii， Bovistella radicata and other varieties. Until modern times， there was an addition of Lycoperdon perlatum， L. pyriforme and other original plants of Lasiosphaera Calvatia. Since 1975， the original plant of Lasiosphaera Calvatia in various regulations and academic monographs has been basically uniform for C. lilacina， Lasiosphaera fenzlii and C. gigantea. Resource of the medicinal fungus was widely distributed in China and was mainly wild. From ancient times to the present， the medicinal parts of Lasiosphaera Calvatia are all fruiting body， which is harvested in summer and autumn， and its processing method was to take powder in ancient times， but to cut blocks in modern times. In recent times， its quality has been summarized as large， thin-skinned， intact， full， loose-bubbled and elastic. The medicinal efficacy has been developed from very good for all scores， and after the Ming and Qing dynasties， it is consistent with the 2020 edition of Chinese Pharmacopoeia， with the efficacy of clearing the lung， promoting pharynx， relieving fever and hemostasis， mainly treating cough aphonia， throat obstruction and pharyngeal pain， vomiting blood， epistaxis， hemoptysis， and external treating sores and bleeding from cuts and wounds. Based on the results of herbal textual research， it is suggested that C. lilacina is the first choice for the origin of Lasiosphaera Calvatia involved in famous classical formulas， and it is processed into block or powder for medicine.

Objective:To investigate the clinicopathologic features and differential diagnosis of ureteral fibroepithelial polyps.Methods:The clinicopathologic features and prognosis of ureteral fibroepithelial polyps with complete data retrieved from the pathology database of the Institute of Urology, Peking University from January 2013 to December 2021 were collected and analyzed. All HE staining sections were reviewed by a senior urologic pathologist. Immunohistochemical analysis was done in some cases for differential diagnosis. The clinical, imaging and outcome data were collected, and discussed together with relevant literature.Results:There were 45 patients with complete clinicopathologic data, including 34 males and 11 females (male: female=3.1∶1.0), with a median age of 36 (range 13-80) years. Preoperative diagnosis included polyp in 23 cases, tumor in 19 cases and calculi in 3 cases. The main clinical symptoms were hematuria (13 cases), low back and abdominal pain (9 cases) and no symptoms (9 cases). There were 29 cases of multiple polyps, 16 cases of single polyp; 32 cases were on the left side, 13 cases were on the right side; 29 cases of upper polyps, 9 cases of middle polyps, and 6 cases of lower polyps. Twenty-seven patients had no related urologic history, 10 patients had history of urolithiasis, and the rest had history of stents, strictures or tumors. Local ureteral resection and anastomosis were the most common treatment (20 cases), followed by ureteroscopic polypectomy (12 cases). The patients were followed up from the pathological diagnosis to the cut-off time: 4 cases were lost to follow-up, and the remaining 34 cases were followed up for 3 to 85 (mean 60 months). One case had polyp recurrence after 3 months, and the other case had polyp recurrence after 2 years. Fibroepithelial polyps had a variety of gross manifestations, ranging from elongated polyps or small papillary and polypoid to large papillary masses. Microscopically, they were divided into type 1, type 2 and type 3, and the type 3 was the most common type (28 cases). In this study, there were 41 cases of simple fibroepithelial polyp, 2 cases of malignant transformation of polyps into urothelial carcinoma, one case of polyps with urothelial carcinoma, and one case of polyp with surface urothelial carcinoma in situ; the stroma showed myofibroblastic proliferation.Conclusions:The clinical manifestations and morphologic characteristics of ureteral fibroepithelial polyps are diverse. The three microscopic types are easily confused with many benign and malignant ureteral diseases, such as inflammatory polyps, adenocystitis, papilloma, etc. Awareness of the key differentiation points and judicious use of immunohistochemistry will be helpful for the diagnosis and differential diagnosis.