Objective:To construct a comprehensive and targeted risk assessment index system for central venous catheter (CVC) dysfunction in patients undergoing continuous renal replacement therapy (CRRT) .Methods:The risk assessment indicators for CVC dysfunction in CRRT patients were determined based on literature review and Delphi expert consultation. From July to September 2023, 19 experts in hemodialysis were selected for expert consultation. Based on expert opinions and screening criteria, corresponding indicators were added, deleted, or modified. After the second round of consultation, the expert opinions tended to be consistent.Results:A total of 17 experts completed two rounds of consultation. In the two rounds of consultation, the effective response rates of the questionnaires were 89.5% (17/19) and 100.0% (19/19), respectively, and the expert authority coefficients were 0.87 and 0.88, respectively. The Kendall harmony coefficients were 0.131 and 0.138 ( P<0.05). The final risk assessment index system included seven primary indicators and 44 secondary indicators. Conclusions:The risk assessment index system for CVC dysfunction in CRRT patients constructed is scientific, reliable, and practical, which can provide reference for clinical medical and nursing staff to improve catheter risk management in CRRT patients.

Objective:To construct a set of quality evaluation index system of "Internet + nursing" with clear evaluation criteria with the service objects as the evaluation subject and Service Quality model as the theoretical framework, and to provide an objective basis for the quality evaluation of "Internet + nursing".Methods:CNKI, Wanfang databases, VIP, PubMed, and Web of Science were searched from establishment to November 2021. The article determined the quality evaluation items of "Internet + nursing" based on the perspective of service objects by means of literature analysis, field research and Delphi expert inquiries. Analytic hierarchy process was used to confirm the weight of each indicator.Results:In this study, 22 experts were consulted for 2 rounds.The effective recovery rate of the two rounds of questionnaires were 100%. The judgment basis coefficient was 0.936, familiarity coefficient was 0.945 and authority coefficient was 0.941; in the first round, the Kendall harmony coefficients assigned to the importance of the first and second level indicators were 0.187 and 0.122, and the Kendall harmony coefficients assigned to the feasibility were 0.183 and 0.125; in the second round, the Kendall harmony coefficients assigned to the importance of the first and second level indicators were 0.241 and 0.190, and the Kendall harmony coefficients assigned to the feasibility were 0.218 and 0.166 (both P<0.01). The final evaluation index system for the "Internet + nursing" based on the perspective of service objects included 7 first-class indicators and 33 second-class indicators. Conclusions:The "Internet + nursing" quality evaluation index system constructed in this study based on the perspective of service objects is scientific, reliable and practical, which can be used as an evaluation tool for the current "Internet + nursing" quality evaluation and strategy optimization.

Objective:To understand the work experience and service quality of "Internet plus Nursing Service" led by tertiary hospitals to lay the foundation for building an "Internet plus Nursing Service" quality control index system suitable for China's national conditions.Methods:Using field research method, combining purposive sampling with open sampling, from September 2021 to February 2022, the 11 "Internet plus Nursing Service" visiting nurses from 10 residential areas in Shibei District, Shinan District, Laoshan District, Chengyang District and Jimo District of Qingdao were observed for 5 months.Results:The work experience of "Internet plus Nursing Service" visiting nurses: meeting the rigid needs of society and patients, and nurses′ professional value and satisfaction were multiplied; there were still shortcomings in the regulatory mechanism, and information technology construction needed to be continuously strengthened; there were still hidden dangers in patient safety and nurse professional safety issues. Six key factors influencing the quality of Internet plus nursing service were analyzed: non-standard preparation of articles before visiting, non-standard dress for door-to-door service, inadequate preparation for pre operation evaluation, lack of empathy during operation, weak awareness of infection prevention outside the hospital, and failure to carry out health education based on patients′ conditions after operation.Conclusions:The Internet plus nursing service model is dominated by the tertiary hospitals in Qingdao, which has realized two-way referral between the community and the superior hospitals, and has effectively improved the quality of extended care. The acceptance and satisfaction of patients and their families are high, and nurses′work enthusiasm and professional value have increased significantly. It is still necessary to establish and improve theInternet plus nursing service work standards to achieve the homogenization and diversification of nursing services, promote the comprehensive quality of community medical staff.

Since the National Health Commission launched the pilot work of " Internet+ nursing service" in 2019, medical institutions at all levels in China keep innovating their nursing service models to provide targeted high-quality care for discharged patients or special groups suffering from diseases and poor mobility. In April 2021, a tertiary hospital in Qingdao carried out the " Internet+ " whole course management practice with specialized nurses as the main service subjects, which center on discharged patients as the main service objects. By estabusing a management team and the construction of " Internet+ " information exchange platform, the hospital implemented the whole course of disease management process including patients′ pre-hospital management, in-hospital estimate, and post-hospital follow-up rehabilitation, to provide specialized nursing services such as PICC dressing change care, stoma care, and mother and infant care for patients at home. By February 2022, the " Internet+ " whole course management service had expanded to 50 kilometers away from hospital, with a total of 1 181 specialized nursing services. This management highlighted the characteristics of specialized nursing services in tertiary hospitals, accurately matched the needs of patients, reflected the concept of holistic care, and provided references for the rapid promotion of the development of " Internet+ nursing service" in China.

BACKGROUND: Lung cancer is one of the common malignant tumors that impair human health. With the development of epigenetics, the researchers found that enhancer of Zeste homolog 2 (EZH2) is highly expressed in lung cancer tissue and its expression is closely related to the prognosis. EZH2 inhibitor can also enhance the sensitivity of tumor cells to a variety of anti-tumor drugs. The purpose of this study is to investigate the effect of combination of EZH2 inhibitor and gefitinib on the proliferation, apoptosis and migration of Gefitinib-resistant lung cancer cells. METHODS: PC9 and PC9/AB2 cells were used for this study. CCK-8 and EdU experiment were used to detect combined treatment on cell viability and proliferation activity; Wound healing assay and Transwell chamber experiment were used to determine the effects of combination therapy on cell migration ability; Flow cytometry was used to detect the effect of combination therapy on EZH2 and apoptosis; Western blot was used to observe the effect of combination therapy on epidermal growth factor receptor (EGFR) signaling pathway-related proteins expression. RESULTS: In gefitinib-resistant cell line PC9/AB2, gefitinib combined with EZH2 inhibitor GSK343 can significantly inhibit cell viability, reduce cell migration and increase cell apoptosis. At the same time, combination therapy can significantly inhibit the expression of EZH2 and phosphorylation EGFR proteins. CONCLUSIONS The combination of EZH2 inhibitor GSK343 and gefitinib sensitize PC9/AB2 cell to gefitinib response. This study also suggests that synergistic therapy plays a role in the reversal of EGFR-tyrosine kinase inhibitor (EGFR-TKIs) resistance in lung cancer.
Antineoplastic Agents ; pharmacology ; Cell Line, Tumor ; Cell Movement ; drug effects ; Cell Proliferation ; drug effects ; Cell Survival ; drug effects ; Drug Resistance, Neoplasm ; drug effects ; Drug Synergism ; Enhancer of Zeste Homolog 2 Protein ; antagonists & inhibitors ; ErbB Receptors ; antagonists & inhibitors ; Gefitinib ; pharmacology ; Humans ; Lung Neoplasms ; pathology ; Protein Kinase Inhibitors ; pharmacology

Objective To investigate the diagnostic effect of diffusion tensor imaging (DTI) on spinal neurotype brucellosis spondylitis (BS).The characteristics of apparent diffusion coefficient (ADC) value and fractional anisotropy (FA) value of spinal neurotype BS in different disease stages were quantitatively analyzed to evaluate the different forms of spinal neurofibrillary tract injury.Methods A prospective design was used to collect data of BS patients with spinal neurological symptoms from June 2015 to July 2017 in the First Affiliated Hospital of Hebei North University as the brucellosis group (n =39),including 23 males and 16 females,aged (20.8 ± 15.3) years old.Healthy subjects were selected as the control group (n =30),including 20 males and 10 females,aged (25.2 ± 4.0) years old.The brucellosis group was divided into acute stage (＜ 3 months),subacute stage (3-6 months) and chronic stage (＞ 6 months),with 12,10 and 17 cases,respectively.Routine spinal scans and DTI scans were performed using a 3.0T superconducting magnetic resonance imaging (MRI) scanner,DTI used Fiber Trak package to measure ADC value and FA value and perform quantitative analysis [receiver operating characteristic (ROC) curve],and reconstructed the changed form of the spinal neurotype BS nerve fiber bundle.Results A total of 39 patients' data were collected in the brucellosis group.Among them,5 patients showed segmental thickening of spinal nerves on conventional MRI,high signal on T2 weighted imaging (T2WI) and short time inversion recovery (STIR),and color code changes on DTI scan FA imaging.Routine MRI of 34 patients showed spinal cord compression,spinal cord morphological changes or cauda equina nerve aggregation and displacement,while DTI scan FA imaging showed spinal cord or cauda equina nerve morphological changes,but no color code changes.The ADC values of patients in the acute and subacute stages were higher than that of the control group [(1.41 ± 0.05),(1.31 ± 0.05),(1.23 ± 0.05) × 10-3 mm2/s,P ＜ 0.05],and the FA values were lower than that of the control group (0.40 ± 0.04,0.68 ± 0.08,0.76 ± 0.05,P ＜ 0.05).There were no statistically significant differences in ADC and FA values between patients with chronic spinal neurotype BS [(1.25 ± 0.04) × 10-3 mm2/s,0.72 ± 0.04] and the control group (P ＞ 0.05).ROC curve analysis showed that the area under curve (AUC),specificity,sensitivity and accuracy of ADC were 0.912,0.942,0.930 and 0.924,respectively.The AUC,specificity,sensitivity and accuracy of FA were 0.901,0.937,0.928 and 0.943,respectively.The change forms of spinal neurotype BS were:① color code change;② loss/fracture;③ displacement and pressure;④ rarity.Conclusion DTI plays a diagnostic role in spinal neurotype BS,and can quantitatively analyze the characteristics of changes in ADC value and FA value in different periods,and can clearly display the forms of changes in spinal neurofiber,providing a reliable basis for the diagnosis of spinal neurotype BS.

Objective To explore the differential diagnosis of breast ductal carcinoma in situ (DCIS)and breast ductal carcinoma in situ with microinvasion (DCIS-Mi)by ADCMin ,ADCDR and DCE-MRI,and to analyze the correlation between DCIS-Mi and biological factors. Methods Preoperative breast MRI examinations were performed in 41 patients with DCIS-Mi and 3 7 patients with DCIS.DCIS-Mi and DCIS patients were compared in terms of ADCMin ,ADCMax ,ADCDR ,early enhancement rate (EER)and the morphological characteristics of DCE-MRI.The optimal diagnostic variables were determined by binary Logistic regression,the threshold value of the optimal diagnostic variables was ensured by ROC,and the correlation between DCIS-Mi and biological factors was analyzed by Spearman.Results ADCMin of DCIS-Mi patients was lower than that of DCIS (t＝6.294,P＝0.033),and ADCDR was higher than that of DCIS (t＝9.246,P＝0.020).70.7 3% DCIS-Mi showed non-tumor-like enhancement,inclined to segmental distribution,and internal heterogeneous or cluster ring enhancement;29.27% manifested tumor-like enhancement,internal heterogeneous or ring enhancement,and unclear margin.64.86% DCIS showed non-tumor-like enhancement,inclined to linear distribution,internal homogeneous/heterogeneous enhancement;35.14% expressed tumor-like enhancement,internal homogeneous enhancement,and clear margin.The accuracy,sensitivity and specificity of ADCMin , ADCDR ,tumor or non-tumor internal enhancement features in the diagnosis of DCIS-Mi were higher (84.0%,9 5.3%,9 2.4%;89.3%, 9 5.3%,9 2.4%;85.1%,9 2.5%,9 3.8%;87.4%,9 6.8%,84.7%, respectively).ADCMin and ADCDR threshold value were 1.1 1× 10－3 mm2/s and 0.35×10－3 mm2/s,respectively.ADCMin of patients with DCIS-Mi was positive correlation with ER(－)and PR(－), and negative correlation with HER-2(+)(P＜0.05).ADCDR ,non-tumor distribution,and non-tumor internal enhancement characteristics,the tumor edge and internal enhancement characteristics were negative correlation with ER(－)and PR(－),and positive correlation with HER-2 (+)(P＜0.05).Conclusion ADCMin ,ADCDR and DCE-MRI can be used for the differential diagnosis of DCIS-Mi and DCIS, and provided evidence for clinical treatment plan.

Objective To explore the effect of virtual laboratory (VL) + flipped classroom in teaching of virus infection diagnosis.Methods 40 students of Class One from clinical medical undergraduates of Grade 2014 were randomly taken as the experimental group,with 40 students of Class Two as the control group.The experiment group adopted flipped classroom teaching by virtual lab platform and classroom activities,while the control group adopted traditional classroom teaching such as watching video and lecturing.Finally post-test scores were compared by the independent samples t-test of SPSS 18.0 statistical software between the two groups.The teaching effects were evaluated through questionnaires survey in experimental group.Results The scores (82.73 ± 2.62) of comprehensive assessments were superior to the control scores (57.94 ± 4.65).Difference between the two groups was statistically significant (t=29.380,P=0.000).Students' satisfaction concerning the teaching methods and effects of the flipped classroom in experimental group was up to 85％.Conclusion Flipped classroom based on internet virtual lab platform in teaching of virus infection diagnosis can enhance the teaching quality and improve students' learning enthusiasm and thinking ability.

Objective To propose an improved discrete wavelet transform (DWT ) and to apply it in multimodal medical im‐age fusion .Methods Firstly ,the source medical images were initially transformed into the high frequency and low frequency images by DWT ;then the high frequency part adopted the big direction absolute values ,which effectively preserved the detailed informa‐tion of image ,while the low frequency part used the fusion rule of local energy ratio for preserving the most of image information ;finally ,the discrete wavelet reverse transform was used for reconstructing the fusion sub‐images into fusion image .Results By comparing the fusion images by 3 groups of medical images ,this proposed algorithm was superior to other existing algorithms in the aspects of subjective visual effect and objective evaluation indicators .Conclusion The proposed algorithm of medical image fusion is rapid and accurate ,has excellent performance in the noise environment and clinical examples ,can obtain the high quality fusion im‐age and has higher clinical application value .

The experiment contents were integrated into three parts such as basic skills and verification experiment, systematic experiment and designing experiment. Basic skills and confirmato-ry experiments were performed alone with theory teaching by combination of modern teaching methods and traditional teaching methods, which consisted of “speaking”(experimental principles, methods and main technical points using multimedia), “looking”(demonstrating related operation on teaching website), teachers' demonstration, students' doing experiment independently and summarizing. In this part, the experimental operation skills such as the sterile operation technology, staining technology, microscopy technology and pure culture were emphasized. Systemic experiments would be carried out after completion of the most theory, the experiment time could be adjusted according to the experiment content, and the PBL teaching method was taken in this stage. After the theory teaching of Medical Microbiology was finished, students voluntarily participated in design experiments in the last stage, which were the fusion of scientific research subject and the experimental teaching. From the preview experiment, experiment operation, experiment report, to the final test, the multi-dimensional evalua-tion was implemented throughout the course of experiment teaching.