Objective:To evaluate the quality of the current foreign clinical practice guidelines (CPG) on obstetric venous thromboembolism (VTE), providing reference for standardizing the prevention and treatment of domestic VTE clinical practice.Methods:The GPGs for the management of obstetric VTE published abroad from inception to July 2020 were electronically searched. Two researchers independently evaluated the quality of the included guidelines in accordance with the internationally recognized guideline evaluation tool, AGREE Ⅱ.Results:A total of 12 guidelines, 2 recommendations and 1 consensus for obstetric VTE were included, covering 3 continents and 9 countries, and the published time span was 2009-2020. The standardized scores of the six domain (scope & purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence) included in the guidelines were: 99.44%, 62.78%, 70.35%, 95.74%, 68.80% and 76.94% respectively, and the scores in each domain were ≥ 50.00%, indicating that the included CPGs were of good quality. Except for the domain scope & purpose, the ranges of the other five domains were ≥ 50.00%, suggesting that the quality of the CPGs differed significantly. Among the 15 included CPGs, 4 CPGs were level A (recommended), 11 CPGs were level B (recommended after being revised), and there was no CPG in level C (not recommended). The difference in the recommended content of obstetric VTE management mainly focused on the risk assessment, drug type, dosage and period.Conclusions:The overall quality of the CPGs for obstetric VTE management is high, while the quality of the CPGs varies greatly. In addition, there are differences in the recommended content of obstetric VTE management. More high-quality researches are required to provide evidence-based support for the improvement of the CPGs.

Objective:To develop a mesenteric creeping fat index (MCFI) based on CT enterography (CTE) to characterize the degree of creeping fat wrapping around the inflamed gut in Crohn disease (CD), and to assess the relationship between MCFI and the inflammatory intestinal stricture.Methods:From December 2018 to July 2019, the patients with CD who underwent surgery in the First Affiliated Hospital of Sun Yat-Sen University were prospectively collected. The extent of perienteric mesenteric vessels wrapping around the gut was reconstructed to develop MCFI based on CTE images. The intestinal stricture index was obtained by calculating the ratio of the maximal upstream luminal diameter divided by the minimum luminal diameter apparent within the stricturing region. Using region-by-region correlation between CTE and surgical specimen, creeping fat score in intestinal specimen was obtained by assessing the extent of creeping fat wrapping around the resected bowel segment, and HE staining was performed on the bowel specimen corresponding to creeping fat to obtain the pathological inflammatory score. The Spearman correlation analysis was used to evaluate the correlation between MCFI, creeping fat score in intestinal specimen, and inflammatory score, intestinal stricture index. The ROC curve analysis was used to assess the accuracy of MCFI in distinguishing moderate-severe and mild inflammatory bowel walls.Results:Totally 30 CD patients were enrolled. The creeping fat score in intestinal specimen positively correlated with pathological inflammatory score ( r s=0.403, P=0.027) and with intestinal stricture index ( r s=0.642, P<0.001). MCFI positively correlated with creeping fat score in intestinal specimen ( r s=0.840, P<0.001), with pathological inflammatory score ( r s=0.497, P=0.005), and with intestinal stricture index ( r s=0.599, P<0.001). ROC analysis showed that the area under the curve of MCFI for differentiating moderate-severely from mildly inflammatory bowel walls was 0.718 (95%CI 0.522-0.913). Using MCFI≥4 as a cutoff value, the sensitivity and specificity were 81.8% and 47.4%, respectively. Conclusions:There was a correlation between creeping fat and inflammatory intestinal strictures in CD. MCFI can non-invasively depict the degree of creeping fat wrapping around the gut and assess the inflammatory intestinal stricture.

Objective:To explore the diagnostic efficacy of nomogram based on multi-parameter MRI for assessment of bowel fibrosis in patients with Crohn disease（CD).Methods:The clinical and imaging data of CD patients diagnosed by surgical histopathology in the First Affiliated Hospital of Sun Yat-sen University from June 2015 to March 2018 were prospectively collected. All the patients underwent conventional MRI and diffusion kurtosis imaging（DKI) within 2 weeks before surgery. Patients who underwent surgery between June 2015 and September 2017 were included in the model building group, and those who underwent surgery between October 2017 and March 2018 were included in the model validation group. We measured the apparent diffusion coefficient（ADC) from monoexponential model of diffusion-weighted imaging（DWI), apparent diffusional kurtosis（K app), and apparent diffusion for non-Gaussian distribution（D app) from non-Gaussian DKI model, and observed T 2WI signal intensity and enhancement pattern of the same segment. One to three intestinal specimens per patient were stained with Masson′s trichrome for the histological grading of fibrosis. Correlations between qualitative/quantitative MRI indexes and histological grades were evaluated using the Spearman rank test. Multivariate logistic regression analysis was performed to identify independent factors to be included into the nomogram for predicting the degree of bowel fibrosis and its diagnostic performance was assessed by internal and external validation. Results:A total of 40 CD patients were included, including 31 in the model construction group and 9 in the model verification group. A total of 81 intestinal specimens from 31 patients were graded as none-to-mild bowel fibrosis（ n=32) and moderate-to-severe bowel fibrosis（ n=49) according to a scoring system of fibrosis. In the training cohort, the K app value of moderate-to-severely fibrotic bowel walls was significantly higher than that of none-to-mildly fibrotic bowel walls, and the D appand ADC values of moderate-to-severely fibrotic bowel walls were significantly lower than those of none-to-mildly fibrotic bowel walls（ Z=-5.999, -4.521 and -3.893; P<0.001). There was no significant difference in T 2WI signal intensity or enhancement pattern between these two groups（χ2=1.571 and 0.103; P>0.05). Moderate and mild correlations of histological fibrosis grades with K appand D app( r=0.721 and -0.483; P<0.001), and a mild correlation with ADC（ r=-0.445, P<0.001) were found. Independent factors derived from multivariate logistic regression analysis to predict the degree of bowel fibrosis were K app and D app. Internal and external validation revealed good performance of the nomogram with concordance index of 0.901（95% confidence interval, 0.824-0.978) and 1.000, respectively, for differentiating none-to-mild from moderate-to-severe fibrosis. Conclusion:The DKI-based nomogram can be used to evaluate the bowel fibrosis in CD patients and provides a visual and simple prediction method for clinic.

Objective:To investigate the correlation between serum bilirubin level and the risk of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus of different sexes.Methods:A total of 1 304 patients with type 2 diabetes mellitus were included in this study. The clinical data were collected and fundus examination was performed. According to the results of fundus examination, the patients were divided into DR group and Non-DR (NDR) group. The correlation between the levels of serum total bilirubin, direct bilirubin, indirect bilirubin, and the occurrence of DR was analyzed.Results:The levels of total bilirubin, direct bilirubin, and indirect bilirubin in DR group were significantly lower than those in NDR group. Univariate analysis showed that the levels of total bilirubin and indirect bilirubin were negatively correlated with the occurrence of DR ( P<0.01). There was no significant correlation between the level of direct bilirubin and the occurrence of DR. Smooth curve fitting showed that there was a U-shaped relationship between the levels of total bilirubin and indirect bilirubin and the risk of DR in women, while a negative correlation between total bilirubin, indirect bilirubin and the risk of DR in men. The results of multiple regression analysis showed that in men total bilirubin increased by 1 μmol/L, the risk of DR decreased by 8% ( OR=0.92, 95% CI 0.88-0.98, P<0.01). Indirect bilirubin increased by 1 μmol/L, and the risk of DR decreased by 9% ( OR=0.91, 95% CI 0.84-0.96, P<0.01). In women, when total bilirubin<12.8 μmol/L, for every 1 μmol/L increase in total bilirubin, the risk of DR decreased by 17%( OR=0.83, 95% CI 0.72-0.95, P<0.01); When total bilirubin≥12.8 umol/L, for every 1 μmol/L increase in total bilirubin, the risk of DR increased by 10%( OR=1.10, 95% CI 1.01-1.20, P<0.05); When indirect bilirubin<9.8 μmol/L, for every 1 μmol/L increase in indirect bilirubin, the risk of DR decreased by 20%( OR=0.80, 95% CI 0.68-0.94, P<0.01); When indirect bilirubin≥9.8 μmol/L, for every 1 μmol/L increase in indirect bilirubin, the risk of DR increased by 13%( OR=1.13, 95% CI 1.01-1.25, P<0.05). Conclusion:This study shows that there is a U-shaped relationship between the levels of total bilirubin and indirect bilirubin and the risk of DR in female patients with type 2 diabetes mellitus, and there is a negative correlation between total bilirubin, indirect bilirubin and the risk of DR in male patients. However, there was no significant correlation between direct bilirubin and DR risk.

Objective To analyze the effects of different supplements on anemia related indexes in rural children. Methods A stratified method was adopted, and six villages (towns) in and around Qinghai Province were selected as intervention sits for the present study. A total of 304 children from 2 to 6 years old at each intervention site meeting the inclusion criteria were screened and divided into three groups (A, B, and C), who were intervened for 3 months. Serum vitamin A, vitamin D and hemoglobin levels were measured before and after the intervention. Results The hemoglobin level of 304 children before intervention was (118.65±16.07) g /L, and the prevalence of anemia was 9.54%. The vitamin A value, vitamin D value and hemoglobin value were increased after three months of the intervention. The changes of vitamin A value, vitamin D value and hemoglobin value in rural children in group C were significantly higher than those in groups A and B. The increase in vitamin A value in rural children aged 3 years was significantly higher than that in other age groups, and the increase in hemoglobin in rural children of 1 year old was significantly higher than that in other age groups. The increase in vitamin A value of rural children of other ethnic groups (mainly Tibetans) was significantly higher than that of Han and Hui nationalities, and the increase of hemoglobin value in Hui rural children was significantly higher than that in Han and other ethnic groups. Conclusion Vitamin A combined with iron dextran tablets was effective in preventing anemia in rural children.

Objective The aim of this study was to evaluate the relationship between hemoglobin ( Hb ) levels and diabetic retinopathy( DR) risk in Chinese patients with type 2 diabetes mellitus( T2DM) . Methods A total of 629 patients who were hospitalized and diagnosed as T2DM were enrolled in the study. The clinical data were collected;All participants underwent an ophthalmic examination, including fundus photographs. They were divided into DR and non-diabetic retinopathy( NDR) groups based on the results of fundus examination. Anemia was defined according to Chinese anemia criteria. The analyses were performed to evaluate the relationships between Hb levels and DR risks. Results The patients with DR had lower hemoglobin levels and a higher prevalence of anemia compared to those without DR. A univariate analysis displayed a significant negative correlation between Hb levels and the rates of DR( P<0.01) . In multivariate linear regression, a 29％ decrease in DR risk was found with a 1 g/dl increase in Hb level(OR=0.713, 95％CI 0.598-0.850, P<0.01). Presence of anemia increased the risk of DR with OR=4.123(95％CI 1.793-9.478, P<0.01) times compared to those who did not have anemia. Conclusion The study indicates a negatire relationship letween Hb levels and DR risk, and a higher Hb levels may reduce the development of DR in T2DM.

OBJECTIVETo evaluate the diagnostic value of 3.0T high-resolution MRI in mesorectal lymph node metastasis of rectal cancer.

METHODSThe images and postoperative pathological data of patients with pathologically diagnosed rectal cancer who underwent prospective 3.0T two dimensional high-resolution MRI rectal examinations and surgery within two weeks after MRI examination at the First Affiliated Hospital, Sun Yat-sen University from November 2015 to November 2016 were retrospectively collected. Patients who received preoperative neoadjuvant therapy and those who did not undergo operation after MRI examination were excluded. The MRI sequences included high-resolution sagittal, coronal and oblique axial T2 weighted image (T2WI) (repetition time/echo time, 3000-4000 ms/77-87 ms; slice thickness/gap, 3 mm/0 mm; field of view, 18-22 cm). Two abdominal MRI radiologists independently assessed the morphology, margin, signal of all visible mesorectal nodes, measured their minor axes (three times for each radiologist) and gave estimation of the malignancy. The criteria of metastatic nodes on high-resolution MRI T2WI were nodes with irregular shape, ill-defined border and/or heterogeneous signal. The results of MRI diagnosis were compared with postoperative pathology. The sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of mesorectal nodes and nodes with different short-axis diameter ranges were calculated to evaluate the diagnostic efficiency of high-resolution MRI. Kappa statistics was used to evaluate the agreement for per node and for per patient between high-resolution MRI and pathological results. A Kappa value of 0-0.20 indicated poor agreement; 0.21-0.40 fair agreement; 0.41-0.60 moderate agreement; 0.61-0.80 good agreement; and 0.81-1.00 excellent agreement.

RESULTSA total of 81 patients were enrolled in the retrospective cohort study, including 50 males and 31 females with age of (59.3±11.1) years. Histopathology showed 1 case of well differentiated adenocarcinoma, 63 of moderately differentiated adenocarcinoma, 9 of moderately to poorly differentiated adenocarcinoma, 2 of poorly differentiated adenocarcinoma, 3 of mucinous adenocarcinoma and 3 of tubulovillous adenocarcinoma. Histopathological staging showed 2 cases in T1 stage, 20 in T2 stage, 45 in T3 stage and 14 in T4 stage; 34 in N0 stage, 40 in N1 stage and 7 in N2 stage; 76 in M0 stage and 5 in M1 stage. A total of 377 nodes were included in the node-by-node evaluation, of which 168 (44.6%) nodes were metastatic from 58.0% (47/81) patients. The median short-axis diameter was 5.4(2.4-18.6) mm in metastatic nodes, which was significantly larger than 3.8 (2.0-8.7) mm in non-metastatic nodes[Z=10.586, P=0.000]. The sensitivity, specificity, accuracy, PPV and NPV were 74.4% (125/168), 94.7% (198/209), 85.7% (323/377), 91.9% (125/136) and 82.2% (198/241), respectively. The Kappa values between high-resolution MRI and histopathological diagnosis for node-by-node and patient-by-patient were 0.71 and 0.70 respectively, indicating good agreements. Fourteen nodes >10 mm were all metastatic. The results of high-resolution MRI for nodal status were consistent with the results of histopathological diagnosis, and the sensitivity, accuracy and PPV were all 100.0%. Among 124 nodes with short-axis diameter of 5-10 mm, 95 (76.6%) were metastatic, and the sensitivity, specificity, accuracy, PPV and NPV were 78.9% (75/95), 86.2% (25/29), 80.6% (100/124), 94.9% (75/79) and 55.6% (25/45), respectively. The agreement was fair (Kappa value 0.55) between high-resolution MRI and histopathological diagnosis. Among 239 nodes with short-axis diameter ≤5 mm, 59(24.7%) were metastatic, and the sensitivity, specificity, accuracy, PPV and NPV were 61.0% (36/59), 96.1%(173/180), 87.4%(209/239), 83.7%(36/43) and 88.3%(173/196), respectively. The agreement was good (Kappa value 0.63) between high-resolution MRI and histopathological diagnosis.

CONCLUSIONRectal high-resolution MRI has good diagnostic value for estimating metastatic mesorectal nodes by evaluating the morphology, margin and signal of nodes.

Aged ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Prospective Studies ; Rectal Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Sensitivity and Specificity

Objective To analyze the current research status and problem of ICU visiting before patient transfer in.To supply the reference for the future research in the field. Methods China National Knowledge Infrastructure,Wanfang database and VIP database were searched for literatures on the field. Note Express and Excel 2007 were used to statistical analysis the tendency of the literature publication trend, distribution,region, article type and research topic. Results Totally 86 articles were retrieved. The first was published in 2004,the related articles increased gradually yearly.18 articles were published in core journals and 16 kinds of nursing journals.There were 6 funds-supported articles,3 degree papers. The top three provinces where the first author came from were Jiangsu,Hubei and Shanghai.The primary study types(74.42%) were experimental study and quasi-experimental study. The primary study topic (90.7%)were intervention comparing and problem resolving. Conclusions Research on ICU pre-visiting is focused by the domestic researchers.However,the object of the pre-visiting,visiting content and form should be improved. The tool of visiting should be structured. The research method and topic should be increased.

Objective:To explore the relations of psychological stress reactions to workplace violence and so-cial acknowledgement among emergency nurses.Methods:Totally 444 emergency nurses from 8 tertiary hospitals and 1 second A hospital in Beijing were selected.Psychological stressful reactions were measured with the Impact of Event Scale-Revised (IES-R).The social acknowledgment from general society and family to victims was assessed with the Social Acknowledgment Questionnaire (SAQ).Results:Among the 444 samples,96.8% sustained verbal assaults,43.2% underwent physical assaults,32.0% encountered threats,and 4.3% suffered sexual assaults.The results of ANOVA analysis indicated that nurses who suffered 3 types of violence had higher scores of IES-R than the ones who endured one type of violence and 2 types of violence[(22.0 ±16.1)vs.(15.4 ±15.6),(18.1 ± 16.1),Ps <0.01)].Similarly,those nurses who suffered 4 types of violence had higher scores of IES-R than the ones who enduredone type of violence and 2 types of violence [(33.4 ±17.1)vs.(15.4 ±15.6),(18.1 ±16.1), Ps <0.01].Regressive analysis showed that family disapproval,general disapproval,and violence types predicted psychological stress reactions,(β=0.13 -0.40,P <0.05,adjust R2 =0.27).Conclusion:It suggests that violence types,social disapproval and family disapproval may play vital roles in predicting the degree of posttraumatic dis-tress in emergency nurses after suffering from hospital violence.

Objective:To detect the expression of microRNA-218 (miR-218) in human acute lymphocyte leukemia (ALL) T lymphocytes ( CCRF-CEM) ,explore its effects on the biological features of CCRF-CEM cells and the expression of its target gene c-kit, so as to provide new insights for leukemia treatment.Methods: Using the quantitative real-time polymerase chain reaction ( qRT-PCR) ,we detected the expression of miR-218 in the normal peripheral blood T lymphocytes and CCRF-CEM cells.Forty-eight hours after the miR-218 mimic was transfected into the CCRF-CEM cells,the expression of miR-218 in the CCRF-CEM cells was detected by qRT-PCR.The effect of miR-218 on the CCRF-CEM cell viability was detected using MTT.The effect of miR-218 on the proliferation and apoptosis of CCRF-CEM cell was analyzed using flow cytometry.c-kit gene was identified to be a target gene of miR-218 by luciferase reporter enzyme system,and the effect of miR-218 on the expression of KIT protein in cells were determined using Western blot.Results:As shown by qRT-PCR,compared with that in the normal peripheral blood T lymphocytes,the expressions of miR-218 in ALL T lymphocytes cell lines were significantly decreased ( P<0.01 ) .Compared with the control group, the expression of miR-218 increase significantly in CCRF-CEM cells transfected with miR-218 mimic for 48 hours ( P<0.01).MTT showed that the cell viability decreased significantly after the over-expression of miR-218 in the CCRF-CEM cells ( P<0.05 ) .Flow cytometry showed that the S-phase fraction significantly declined after the over-expression of miR-218 ( P<0.01 ) , and meanwhile the apoptosis of cells also significantly increased (P<0.01).Luciferase reporter gene assay showed that,compared with the control group,the relative luciferase activity significantly declined in the miR-218 mimic transfection group (P<0.01).Compared with the control group,the expression of KIT protein in the CCRF-CEM cells transfected with miR-218 mimic for 48 hours significantly decreased ( P<0.01).Conclusion:The expression of miR-218 decreases in ALL T lymphocytes cell lines.MiR-218 can negatively regulate the expression of KIT protein,inhibit the proliferation and increase the apoptosis of CCRF-CEM cells.Treatment based on the enhanced expression of miR-218 may be a promising strategy for leukemia.