Objective To investigate the value of hypocalcemia in early diagnosis of sepsis-induced coagulopathy(SIC).Methods Clinical data of 76 patients with sepsis in Department of Critical Care Medicine,the Affiliated Suzhou Hospital of Nanjing Medical University from April 2023 to April 2024 were retrospectively analyzed,patients were divided into SIC group(n=36)and non-SIC group(n=40),including age,sex,site of infection,underlying disease,sepsis-related organ failure assessment(SOFA)were collected.Arterial blood gas analysis,venous blood biochemistry,fibrinogen,inflammatory indicators procalcitonin(PCT),C-reactive protein(CRP),length of stay in Department of Critical Care Medicine,and mechanical ventilation time.Multivariate Logistic regression analysis and receiver operating characteristic(ROC)curve were used to evaluate the predictive value of serum calcium level in SIC.Results The age of patients in SIC group was significantly higher than that of non-SIC group(P＜0.05).The level of ionic calcium in SIC group was significantly lower than that in non-SIC group(P＜0.05).Inflammatory indicators PCT and CRP in SIC group were significantly higher than those in non-SIC group(P＜0.01).Multivariate logistic regression analysis showed that hypocalcemia was an independent risk factor for SIC(OR=3.431,95％CI:1.032-11.409).The area under ROC curve of the correlation between ionic calcium and SIC was 0.665(95％CI:0.543-0.788),and the best cut-off value was 1.03mmol/L.Conclusion Hypocalcemia is an independent risk factor for SIC.Active correction of early hypocalcemia is helpful to improve the clinical prognosis with SIC.

Objective To investigate the value of hypocalcemia in early diagnosis of sepsis-induced coagulopathy(SIC).Methods Clinical data of 76 patients with sepsis in Department of Critical Care Medicine,the Affiliated Suzhou Hospital of Nanjing Medical University from April 2023 to April 2024 were retrospectively analyzed,patients were divided into SIC group(n=36)and non-SIC group(n=40),including age,sex,site of infection,underlying disease,sepsis-related organ failure assessment(SOFA)were collected.Arterial blood gas analysis,venous blood biochemistry,fibrinogen,inflammatory indicators procalcitonin(PCT),C-reactive protein(CRP),length of stay in Department of Critical Care Medicine,and mechanical ventilation time.Multivariate Logistic regression analysis and receiver operating characteristic(ROC)curve were used to evaluate the predictive value of serum calcium level in SIC.Results The age of patients in SIC group was significantly higher than that of non-SIC group(P＜0.05).The level of ionic calcium in SIC group was significantly lower than that in non-SIC group(P＜0.05).Inflammatory indicators PCT and CRP in SIC group were significantly higher than those in non-SIC group(P＜0.01).Multivariate logistic regression analysis showed that hypocalcemia was an independent risk factor for SIC(OR=3.431,95％CI:1.032-11.409).The area under ROC curve of the correlation between ionic calcium and SIC was 0.665(95％CI:0.543-0.788),and the best cut-off value was 1.03mmol/L.Conclusion Hypocalcemia is an independent risk factor for SIC.Active correction of early hypocalcemia is helpful to improve the clinical prognosis with SIC.

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

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）］

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.

This article gives a review on the application status and clinical effect of behavioral activation （BA） therapy for patients with late-life depression， in which the theoretical content， research status and the characteristics of clinical application of BA therapy for patients with late-life depression were introduced， and the existing limitations and possible directions for future research were summarized， so as to provide references for the localization of BA therapy for patients with late-life depression.

Objective:To explore the effect of instant blood glucose monitoring system (FGM) in perioperative blood glucose management in patients with hip fracture complicated with diabetes mellitus, and to provide guidance for perioperative blood glucose management.Methods:A total of 100 patients with hip fracture complicated with diabetes mellitus treated in the Department of Orthopaedics, Gongli Hospital, Pudong New Area, Shanghai from July 2018 to July 2020 were selected as subjects.The patients were divided into experimental group and control group by random digits table method with 50 cases in each group. The patients in both groups adopted the mode of multidisciplinary cooperation.The experimental group was used to monitor blood glucose based on FGM, and traditional blood glucose monitoring was used in the control group. The waiting time before operation, the pain caused by blood glucose acupuncture, the satisfaction of patients and medical staff, the blood glucose level at different time points and the incidence of adverse reactions were compared between the two groups.Results:The waiting time before operation, the proportion of patients with moderate and severe pain after acupuncture and the incidence of hyperglycemia in the experimental group were (2.58 ± 1.30) d, 2% (1/50) and 30% (15/50), respectively, the control group were (3.67 ± 1.59) d, 22% (11/50) and 50% (25/50), respectively. The differences were statistically significant( t value was -2.087, χ2 values were 9.470, 4.170, P<0.05). The satisfaction of patients and medical staff in the experimental group were (46.43 ± 1.87), (46.58 ± 2.10) points, respectively, the control group were (40.67 ± 3.24), (43.84 ± 2.92) points, respectively.The differences were statistically significant( t values were 8.441, 8.087, P<0.05). There was no significant difference in fasting blood glucose, 2-hour postprandial blood glucose and pre-bedtime blood glucose between the two groups( P>0.05). Conclusions:The application of FGM can realize the continuous blood glucose monitoring and management of patients,making the blood glucose reach the standard more quickly and smoothly, meanwhile it may effectively shorten the waiting time before operation and reduce the acupuncture pain of blood glucose monitoring and recognize patients with concealed abnormal blood glucose. The application can improve the satisfaction of patients and medical staff, and promote the rapid recovery of patients as well.

Objective:To evaluate the clinical application of virtual and simulation techniques to aid pre-operative design for precise screw placement into the sustentaculum tali in the treatment of intra-articular calcaneal fractures.Methods:From January 2016 to January 2019, 68 patients were treated at Department of Orthopaedics, Suqian Hospital Affiliated to Xuzhou Medical University for intra-articular calcaneal fractures of Sanders types Ⅱ-Ⅳ. According to different designs of screw placement into the sustentaculum tali, they were assigned into a control group (38 cases and 42 feet) and an observation group (30 cases and 33 feet). There were 24 males and 14 females with an age of 39.3 years±8.8 years in the control group. There were 17 males and 13 females with an age of 42.0 years ± 7.6 years in the observation group. The control group was given a routine placement design based on the X-ray and MSCT scanning images of the injured feet. In the observation group, a Mimics model was first constructed using the X-ray and MSCT scanning images of the normal or less injured feet for further virtual screw placement into the sustentaculum tali on a 3D printed model. The disparity was investigated between the parameters designed and the actual values in both groups. The 2 groups were compared in terms of average placements, screw distribution, placement accuracy, placement time and Maryland scores of foot function one year after operation.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The design parameters and actual values in the control group were respectively as follows: 17.7°±3.2° versus 15.1°±5.9° in upward oblique angle, 20.3°±2.1° versus 16.2°±6.8° in backward oblique angle, and 47.9 mm ± 3.8 mm versus 45.4 mm ± 4.2 mm in length of screw path, showing significant differences ( P< 0.05). The design parameters and actual values in the observation group were as follows: 16.5°±3.5° versus 17.1°±3.9° in upward oblique angle, 20.9°±4.3° and 19.6°±3.8° in backward oblique angle, and 48.1 mm ± 3.1 mm versus 47.3 mm ± 3.8 mm in length of screw path, showing insignificant differences ( P>0.05). The average screw placements into the sustenta culum tali in the observation group (1.6±0.5) were significantly more than those in the control group (1.2±0.4). Compared with the control group, the observation group had a higher rate of placement of 2 screws[60.6 % (20/23) versus 16.7% (7/42)], higher accuracy of placement [94.3% (50/53) versus 77.6% (38/49)], less placement time for each screw (9.6 mm±3.9 min versus 13.2 mm±4.7 mm), less placement time for each foot (15.6 mm±4.8 min versus 20.5 mm±3.8 mm), and higher Maryland scores at one year after operation (94.2±6.5 versus 89.7±6.9). All the above comparisons were statistically significant ( P<0.05). Conclusions:Application of virtual and simulation techniques to aid pre-operative design for precise screw placement into the sustentaculum tali can improve the outcomes of intra-articular calcaneal fractures, because it increases the number of screws placed, enhances quality of screw placement, shortens operation time, and thus facilitates functional recovery of the injured foot.

Objective:To investigate the prognosis of intensive care unit(ICU)patients with carbapenem-resistant Klebsiella pneumoniae(CR-KP)infection.Methods:Clinical data of 86 elderly patients with KP infection admitted to our hospital from August 2017 to July 2019 were retrospectively analyzed.All patients were identified by the VITEK system and were tested by using the Kirby-Bauer paper diffusion method for drug susceptibility.Based on the existence of CR-KP, patients were divided into the non-resistance group(n=40)and the resistance group(n=46). The number of ventilator days, ICU days and clinical prognosis were compared between the two groups.Results:Specimens from sputum had the highest rate of KP isolation(46/86, 53.49%), followed by specimens from drainage fluid(16/86, 18.60%), blood(12/86, 13.95%), puncture wound fluid(3/86, 3.50%)and the tip of deep vein catheters(9/86, 10.46%). KP had high drug resistance to meropenem, and the drug-resistance rate was 53.49%(46/86). Compared with the non-resistance group, ventilator days and ICU days increased in the drug-resistance group[(60.75±72.86)d vs.(26.11±41.10)d, (73.41±63.32)d vs.(38.96±50.75)d, t=2.660 and 2.756, P=0.003 and 0.004]. The clinical effectiveness rate was higher in the non-resistance group than in the drug-resistance group(57.50% or 23/40 vs.23.91 % or 11/46, χ2=10.097, P=0.001). Conclusions:ICU patients with CR-KP have a higher number of ventilator days and longer ICU stays than those without CR-KP.In clinical practice, it is necessary to strictly follow the indications for antibiotic use, regularly perform bacterial identification and drug susceptibility tests, and diagnose KP infection as early as possible, in order to provide evidence for clinical diagnosis and treatment.

Objective: To explore the mechanism of miR-19a-3p regulating cell adhesion molecule 2 (CADM2) to inhibit the proliferation and metastasis of renal carcinoma cells via the AKT signaling pathway. Methods: A total of 42 patients with renal cancer admitted to Department of Nephrology, the First Affiliated Hospital of Suzhou University from April 2012 to November 2017 were enrolled to collect samples of surgically resected renal carcinoma tissues and paracancerous tissues. Expression of miR-19a-3p was detected in renal carcinoma tissues and 4 types of renal carcinoma cell lines such as 786-O by quantitative Real-time polymerase chain reaction (qPCR). The effects of miR-19a-3p knockdown on proliferation, invasion and epithelial mesenchymal transition (EMT) of renal carcinoma 786-O cells were evaluated by CCK-8 assay, Transwell assay and immunofluorescence, respectively. Subsequently, dual luciferase reporter assay was used to verify whether CADM2 was a target gene of miR-19a-3p. Furthermore, Wb was applied to detect the regulatory effect of miR-19a-3p onAKT signaling pathway through CADM2. Results: miR-19a-3p expression was significantly up-regulated in renal carcinoma tissues and cell lines (all P<0.01). Knockdown of miR-19a-3p could inhibit proliferation, invasion and EMT process of 786-O cells; furthermore, the results indicated that CADM2 was a direct target of miR-19a-3p and its expression was down-regulated (P <0.05 or P<0.01). Additionally, knockdown of miR-19a-3p obviously suppressed proliferation, migration and EMT process of 786-O cells via up-regulating CADM2 and blocking AKT pathway (all P<0.05 or P<0.01), thus alleviating the occurrence and development of renal carcinoma. Conclusion: The study demonstrates that miR-19a-3p has a high expression level in renal carcinoma tissues; knockdown of miR-19a-3p could significantly inhibit the proliferation, migration and EMT process of renal carcinoma tissues, and its mechanism may be associated with miR-19a-3p/CADM2/AKT axis.