Objective:To establish a decision tree model of pediatric complicated appendicitis (CA) based on Pediatric Appendicitis Score (PAS) combined with inflammatory indicators, and to evaluate its clinical application efficacy in pediatrics.Methods:The clinical data of 544 children diagnosed with appendicitis in Children′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was retrospectively analyzed. According to postoperative pathology, the children were divided into uncomplicated appendicitis group and CA group. The independent risk factors of CA were screened by univariate and multivariate logistic regression analysis, and these parameters were included to establish the decision tree model. The accuracy of the decision tree model was verified by receiver operating characteristic (ROC) curve.Results:Binary logistic regression analysis indicated that the PAS, C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were identified as independent risk factors for complicated appendicitis in children (all P<0.05). PAS, CRP and NLR were included as covariables to construct the decision tree model and binary logistic regression model for predicting CA. The decision tree demonstrated an overall accuracy of 79.2% with a sensitivity of 86.7% and specificity of 71.9%, and achieved an area under curve (AUC) of 0.821(95% CI: 0.786-0.857). The binary logistic regression model had a sensitivity of 79.6% and specificity of 69.1%, with an overall accuracy of 75.1% and achieved an AUC of 0.808(95% CI: 0.770-0.845). Conclusions:The decision tree model based on PAS score combined with CRP, NLR is a simple, intuitive and effective tool , which can provide pediatric emergency physicians a reliable basis for diagnosis of pediatric CA.

Objective:To apply the best evidence of hypoglycemia management for neonates delivered by mothers with gestational diabetes mellitus (GDM) in clinical practice and evaluate its curative effects.Methods:This study was a historical controlled study. The newborns delivered by GDM mothers who were admitted to the neonatal intensive care unit of a Class A hospital in Hefei from February to December 2019 were selected as the research objects by convenient sampling. Newborns delivered by GDM mothers admitted to the hospital during the application of evidence-based practice were the subjects of the pre-evidence study ( n=53) , and newborns delivered by GDM mothers admitted to the hospital after applying the evidence-based practice from September to December 2019 were used as evidence Post-application research subjects ( n=59) . Evidence-based nursing was used to obtain best evidence. Based on the evidence-based continuous quality improvement model as the theoretical framework, the evidence-based practice plan for neonatal hypoglycemia management of gestational diabetes mothers during delivery was constructed and applied. Before and after the application of evidence-based practice, 63 neonatal nurses and parents of neonates were surveyed with the self-made GDM Mothers' Newborn Hypoglycemia Management Questionnaire and the Chinese version of the Uncertainty of the Disease Parents Scale, respectively. And the changes in the incidence of hypoglycemia within 2 hours after birth was compared before and after the application of evidence-based practice. Results:A total of 7 pieces of evidence were used in the evidence-based practice. After the application of the evidence-based practice, the incidence of hypoglycemia in neonates delivered by mothers with gestational diabetes within 2 hours after birth decreased from 20.8% (11/53) to 3.4% (2/59) , and the difference was statistically significant (χ 2=8.206, P<0.05) . The score of the questionnaire on knowledge of hypoglycemia management of neonates delivered by mothers with gestational diabetes mellitus in 63 department nurses was increased from (7.00±1.43) to (7.84±1.18) , and the difference was statistically significant ( t=-12.253, P<0.05) . Before and after the application of evidence-based practice, scores of Mishel Uncertainty in Illness Scale for newborn parents were respectively 87.00 (65.00, 99.50) and 59.00 (43.00, 74.00) , and the difference was statistically significant ( U=728.500, P<0.01) . Conclusions:Evidence-based practice for blood glucose management of newborns delivered by gestational diabetic mothers can reduce the incidence of neonatal hypoglycemia and the uncertainty of their parents' diseases, improve nurses' neonatal hypoglycemia management level, and promote continuous improvement of nursing quality.

Objective To investigate the regulatory mechanism of Paraquat (PQ)-induced epithelial-mesenchymal transition (EMT) and the protective mechanism of N-acetyl-cysteine (NAC) in PQ-induced A549 cells by EMT markers (E-cadherin and α-smooth muscle actin).Methods EMT model was established by 30 μmol/L PQ-exposed A549 cells for 4 d.The application of 10 mmol/L NAC was incubated with A549 cells for 2 h in advance.Morphological changes of A549 cells were observed under light microscope.Western blot was used to detect the expression levels of TGF-β1,E-cadherin and α-smooth muscle actin.Results In PQ-induced EMT model,the PQ group showed typical morphological changes,and the cells changed from cobblestone-like epithelial appearance to spindle-shaped mesenchymal-like appearance compared to the control group.Westem blotting showed that the protein levels of TGF-β1 and α-smooth muscle actin in the PQ group were significantly increased and the protein levels of E-cadherin were decreased in the PQ group (all P＜0.05).NAC preincubation can effectively reverse the above changes caused by PQ exposure:the protein levels of E-cadherin and α-smooth muscle actin were significantly increased and decreased,respectively and morphological changes showed more cobblestonelike epithelial appearance.Conclusion Cell experiments showed that PQ exposure can cause EMT in epithelial cells,and NAC has a protective effect in this process.Thus,it may provide new ideas and strategies for the treatment of pulmonary fibrosis caused by PQ poisoning in clinical practice.

Background:Previous study has found that harmine inhibited the proliferation of gastric cancer cells by down-regulating cyclooxygenase-2(COX-2)expression. However,its molecular mechanism is not fully clear. Aims:To investigate the effect of harmine on proliferation and apoptosis of gastric cancer cells,and explore the role of PTEN/Akt/MDM2 signaling pathway in this process. Methods:Human gastric adenocarcinoma cell line SGC-7901 and MKN-45 were treated with harmine at different concentrations(2,4,8,16,32 μg/mL)for 24,48,and 72 hours. The cell proliferation and apoptosis were detected by MTT assay and Hoechst staining,respectively. The expressions of PTEN,COX-2, phosphorylated Akt(p-Akt)and p-MDM2 were measured by Western blotting. Results:Harmine dose- and time-dependently inhibited proliferation and induced apoptosis of SGC-7901 and MKN-45 cells. Also,harmine dose-dependently increased PTEN expression,and inhibited p-Akt,p-MDM2 and COX-2 expressions in SGC-7901 and MKN-45 cells. Conclusions:Harmine may inhibit proliferation and induce apoptosis of gastric cancer cells via down-regulating COX-2 expression through PTEN/Akt/MDM2 signaling pathway.

Objective To explore the relationship between the serum neuropeptide Y (NPY) levels and the pathogenesis,therapeutic intervention of schizophrenia. Methods One hundard twenty-five patients with schizophrenia (case group) with no medication for at least 4-week and 136 healthy controls (control group) were evaluated by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Positive and Negative Syndrome Scala (PANSS). Simultaneously blood tests were performed to detect serum NPY levels. In the case group, PANSS was evaluated and blood collected again after 4 weeks of treatment with olanzapine. Result At the baseline,the serum NPY concentration was significantly lower in the case group than in control group (t=-5.79, P<0.01). The scores of RBANS and its factors were significantly lower in the case group than in control group (all P<0.01). The concentration was positively correlated with the score of the attention factor for RBANS scale (r=0.20, P=0.04). After treatment with olanzapine for 4 weeks,the serum NPY level in the case group was significantly increased (t=-2.23,P=0.03).The scores of PANSS total scale and subscale were significantly decreased(all P<0.01).There was no significant correlation between alterations of the serum level of NPY and PANSS total or subscale scores from baseline to 4-week (all P>0.05). Conclusion The present study has revealed a significant decrease in serum NPY levels in patients with schizophrenia which can be attenuated by treatment of Olanzapine.The action of Olanzapine may be related to the mechanism of action of Olanzapine.However,there is no correlation between alterations of the serum level of NPY and the improvement in the patientˊs clinical symptoms.

Objective To compare the efficacy of continuous lumbar plexus block (LPB) with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement.Methods Sixty elderly patients of both sexes,aged 65-85 yr,weighing 50-71 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective total hip replacement,were divided into 2 groups (n =30 each) using a random number table:0.5 μg/ml dexmedetomidine+0.1％ ropivacaine group (group D1) and 1.0 μg/ml dexmedetomidine + 0.1％ ropivacaine group (group D2).Lumbar-sacral plexus block combined with general anesthesia was used.At the end of operation,LPB pump was started and set up to deliver a 4 ml bolus dose with a 30 min lockout interval and background infusion at a rate of 8 ml/h.The analgesia solution contained 0.5 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D1 and 1.0 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D2.Postoperative analgesia lasted for 48 h,and the visual analogue scale score was maintained ≤ 3.Patientcontrolled intravenous analgesia (PCIA) pump was connected when break-through pain happened.PCIA solution contained morphine 50 mg diluted to 50 ml in 0.9％ sodium chloride.PCIA pump was set up to deliver a 1 ml bolus dose with a 5 min lockout interval and no background infusion.When the visual analogue scale score ＞3,the patient-controlled LPB pump was used first,and 15 min later if analgesia was still ineffective,PCIA pump was applied.The number of patients in whom analgesia was effective and occurrence of adverse reactions were recorded.Results Compared with group D1,the rate of effective analgesia was significantly increased,and the incidence of nausea,vomiting and pruritus was decreased in group D2 (P＜ 0.05).No bradycardia,hypotension,over-sedation,respiratory depression,urinary retention or local skin infection was found in the two groups.Conclusion Continuous LPB with 1.0 μg/ml dexmedetomidine added to 0.1％ ropivacaine provides better efficacy for postoperative analgesia in elderly patients undergoing hip replacement.

The purpose of education is to cultivate talents who can master the ability of self-learning lifelong. With the rapid development of multimedia technology, the knowledge carrier represented by micro curriculum plays a very important role in improving students' self-learning ability. In traditional Chinese medicine college, due to the short of time, weak learning foundation, the ability of self-learning is hard to improve in the modern medical courses such as biochemistry. This is not conducive to the cultivation of modern talents of Chinese medicine. In this paper, we chose the biochemistry teaching in TCM college as an example, and discuss how we can make the application of micro courses reasonably in the teaching process. This study was regarded as a starting to improve the students' self-learning ability effectively.

Objective To analyze the clinical features and risk factors of death in pediatric trauma,in order to provide preventing strategies and reduce mortality.Methods A retrospective study of 7936 traumatic children admitted to the emergency department of our hospital from April 2014 to March 2016 was conducted.We retrospectively summarized the clinical features and Logistic regression analysis was used to analyze the risk factors of death in children with trauma.Results Compared to females,male patients contributed higher percentages(1.73∶1).There were more migrant children(5535 cases) than local ones(2 401 cases)(χ2=14.314,P＜0.05).Children in infancy stage(2 024 cases)and toddler period(3 097 cases) were more than in the other periods.Limb[41.9%(3 324/7 936)] and skin injuries[38.5%(3 058 324/7 936)] were the most common.Children trauma causes varied with age,fall,tumble and traffic accidents were common causes of children trauma.Pediatric trauma score of surviving group(n=1933),death group(n=5),general ward group(n=1852) and ICU group(n=86) were 8.53± 2.17,3.17± 1.29,9.72± 1.25,5.23± 1.84,respectively.Shock decompensation,mechanical ventilation,Glasgow coma scale ≤7 and pediatric trauma score＜8 were the risk factors which caused the death of trauma.Conclusion Parents should improve the security sense,strengthen the care of children and obey the traffic rules to reduce the rate of children trauma.Clinicians should pay attention to shock decompensation,mechanical ventilation,Glasgow coma scale and pediatric trauma score in order to identify critically ill patients in early stage and improve the success rate of rescue.

Objective To explore the effect of situation-background-assessment-recommendation (SBAR) communication mode in handover of postoperative patients from operating room (OR) to intensive care unit(ICU).Methods From March 2015 to June 2015, 32 postoperative patients form OR to ICU were recruited in compared group where traditional handover was used. Forty-four patients were then recruited in intervention group since October 2015 to June 2016 where SBAR handover mode was implemented. In intervention group, SBAR handover mode and SBAR handover sheet was build based on previous research as well as training was done for handover nurses. The quality of handover prior to and after the implementation of SBAR handover mode was compared. The degree of recalled information of handover and the proportion of incident reports due to communication errors, as well as the duration of handover were calculated.Results The quality of handover improved from (64.20±2.09) to (71.13±3.10) after the implementation of SBAR handover mode(t=10.15, P<0.01). The degree of recalled information of handover increased from 88.25% to 94.55% for handover nurses (χ2=6.73,P<0.01)while the duration of handover shorted from (18.97±2.12)min to (13.34±2.47)min (t=10.41, P<0.01).Conclusions SBAR handover mode is able to improve the quality and timeliness of handover which can further ensure the accuracy and integrity of handover information and worth popularizing.

Objective To explore the application of SBAR communication culture in emergency department,so as to promote the effective communication between doctors and nurses and ensure the safety of patients.Methods From July 2015 to June 2016,by setting up an emergency SBAR studio, training, implementation and monitoring of the SBAR communication model for medical staff were carried out, and compared the effect of SBAR communication mode before and after the implementation of the medical cooperative attitude scale,the safety attitude scale and the self-made communication satisfaction scale, and counted the incidence of adverse events caused by communication barriers.Results After the SBAR communication mode,the attitude of nursing cooperation (52.06±4.52) score, and the satisfaction of medical staff (65.62±3.84) were significantly improved compared with before (t=10.905, 6.676;P<0.05),due to communication barriers caused by adverse events and hidden trouble from the previous 50% to decline after the development of the 14.29% (χ2=4.453,P<0.05).Conclusions SBAR communication mode improves the standardization, accuracy and effectiveness of information in emergency medical communication, and has a significant effect on improving the team cooperation and promoting the safety of patients.