Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Objective To investigate the regulatory effect of artemisinin derivative dihydroartemisinin(DHA)on anti-tumor immune function of CD8+T cells induced by non-small cell lung cancer(NSCLC)cells.Methods NSCLC A549 cells were divided into DMSO control group and DHA treatment group.A549 cells were treated with DMSO and DHA at different concentrations(25,50 and 100 μmol/L),and the optimal concentration of DHA was selected to treat A549 cells for 0,24,48 and 72 h according to half maximal inhibitory concentrate(IC50).CCK-8 method and colony formation test were used to detect the effect of DHA on the proliferation and colony formation ability of A549 cells.Peripheral blood mononuclear cells(PBMCs)of healthy individuals were isolated by density gradient centrifugation.After monocytes were removed by adhesion method,A549 cells pretreated with mitomycin C were co-cultured with PBMCs at 10:1 ratio.After 2 weeks,flow cytometry was used to detect the proportion of CD8+T cells and the expression levels of perforin and granzyme B.Results Compared with the control group,the proliferation inhibition rates of A549 cells increased after treatment with 25,50 and 100 μmol/L DHA for 24 h(P<0.01).The IC50 of DHA on A549 cells was46.26 μmol/L.According to IC50 concentration analysis,the inhibi-tion rates of A549 cells treated with 50 μmol/L DHA for 0,24,48 and 72h were 1.53%,53.50%,63.84%and 69.91%,and the cells inhibition rates of A548 cells increased compared with the previous observation time point,namely 0,24 and 48 h(P<0.01).The colony formation assay showed that the colony formation number of A549 cells in DHA treated group decreased compared with the control group(P<0.01).Flow cytometry results showed that compared with the control group,the proportion of CD8+T cells induced by A549 cells in the co-culture system and the proportion of CD8+T cells expressing perforin and granzyme B were higher in DHA pretreatment group(P<0.01).Conclusion DHA inhibits the growth of NSCLC cells and promotes anti-tumor immune response of CD8+T cells induced by NSCLC cells.

Objective To observe the feasibility of 5.0T MR for cardiac imaging.Methods Three patients with heart diseases and 17 healthy volunteers were prospectively enrolled.Cardiac MR(CMR)cine sequence and black blood sequence imaging were performed using 5.0T and 3.0T MR scanner,respectively.The image quality and artifacts degrees were compared between 5.0T and 3.0T CMR images,and the consistency of left ventricular parameters obtained using 5.0T and 3.0T scanners was analyzed.Results No significant difference of image quality nor artifacts degrees was found between 5.0T and 3.0T CMR images(all P＞0.05).The left ventricular end diastolic volume(EDV),end systolic volume(ESV),ejection fraction(EF),stroke volume(SV)and end diastolic mass(EDM)derived from cine images acquired at different fields were in a good agreement(all ICC＞0.75,all P＜0.001).Conclusion 5.0T MR could be used for cardiac imaging,with image quality of cine and black blood sequences comparable to that of 3.0T MR.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

[Objective]:To explore the effect evaluation of discharge preparation service on elderly patients with hip fractures.Methods:Totally 80 elderly patients with hip fractures admitted to Shanghai Sixth People′s Hospital from April 2019 to October 2019 were selected as the research objects, and they were divided into intervention group and control group according to admission time, 40 patients in each group. The control group was given routine nursing care, and the intervention group was given readiness service for hospital discharge.The application effect of the scheme was evaluated by the degree of readiness for discharge and the quality of discharge guidance, Barthel index score, Harris score and incidence of complications.Results:In the intervention group,the total score of readiness for hospital discharge of patients was 83.43±8.10,the total score of the quality of discharge guidance was 151.30±16.61,while those in the control group were 77.13 ± 9.30, 141.58 ± 18.34, the differences between the two groups were statistically significant( t=3.23, 2.49, both P<0.05).In terms of the follow-up after patients were discharged for 3 months, the Harris hip score and Barthel index scores for patients with hip fracture were 82.53 ± 7.83 and 88.13 ± 3.34,while those were 76.03 ± 12.15, 86.13 ± 2.65 in the control group,the differences between the two groups were statistically significant ( t=2.84, 2.97, both P<0.05). Conclusions:The discharge preparation service can effectively improve the readiness for hospital discharge and the quality of discharge guidance. It improves the hip joint function, the quality of life of patients, and the clinical outcome of patients effectively.

Objective:To study the application effect of objective structured clinical examination (OSCE)-based situational simulation case teaching on Nursing Fundamentals practical training. Methods:Using convenient sampling method, two undergraduate nursing classes of Batch 2018 in Hubei University of Chinese Medicine were chosen as the study objects. They were divided into observation group with 45 students and control group with 43 students through ball touching method. The control group used traditional teaching method, on this basis, the observation group used OSCE-based situational simulation case teaching. At the end of the semester, the results of theoretical assessment, operational skills assessment, humanistic care, health education achievements of the two groups of nursing students and students’ evaluation of the new teaching method in the observation group. SPSS 22.0 was used for t test. Results:The sores of theoretical assessment, operational skills and humanistic care assessment in the observation group were (81.01±8.53), (92.69±3.87) and (11.73±1.59), and the corresponding sores in control group were (76.94±9.74), (91.21±2.70) and (10.79±1.36). The nursing students in the observation group had significantly higher scores than the control group in above mentioned aspects ( P<0.05). In the observation group, 45 students (100.0%) believed that this teaching method could stimulate learning interest and comprehensively deal with clinical problems, 43 students (95.6%) thought that this teaching method could improve team cooperation ability, only one person (2.2%) did not agree that this teaching method could help to form critical thinking, and 42 students (93.3%) said that the teaching hours of this teaching method could be appropriately increased. Conclusion:The OSCE-based situational simulation case teaching may effectively improve the teaching quality of the nursing students and mobilize their learning activities.

Objective:To investigate the expressions and significance of cyclin D2 and bcl-2 in diffuse large B-cell lymphoma (DLBCL) and their clinical significances.Methods:The tissues of 87 DLBCL patients undergoing resection and 23 patients with lymphoid tissue reactive hyperplasia (RLH) in the First Central Hospital of Baoding from January 2015 to March 2020 were collected. Immunohistochemistry method was used to detect the expressions of cyclin D2 and bcl-2 in tissues of DLBCL and RLH, and the relationship between the expressions of cyclin D2 and bcl-2 as well as the association with the clinicopathological features of DLBCL patients.Results:The positive rates of cyclin D2 protein in DLBCL and RLH were 33.3% (29/87) and 2.0% (1/23), the positive rates of bcl-2 protein in DLBCL and RLH were 60.9% (54/87) and 7.0% (3/23); the positive rates of cyclin D2 and bcl-2 in DLBCL were higher than those in RLH, and the differences were statistically significant( χ2=7.566, P=0.006; χ2=17.512, P < 0.01). The expressions of cyclin D2 and bcl-2 proteins were related to the Ann Arbor staging and immunophenotype of DLBCL patients (all P < 0.05), while not related to age, gender, cancer location, tissue type (all P > 0.05). There was a positive correlation between the expressions of cyclin D2 and bcl-2 protein in DLBCL ( r=1.000, P < 0.01). Conclusions:cyclin D2 and bcl-2 may be related to the development and progression of DLBCL, and both may have some synergies.

Objective:To understand the attitudes and behaviors status of injury prevention among urban residents' injury prevention in Changsha City and to provide evidence for urban residents' injury prevention.Methods:A stratified random sampling was conducted to extract 504 residents from 8 communities in 2 urban districts of Changsha City. The questionnaires were distributed on-site, and 420 valid questionnaires were got.Results:The attitudes and behavioral scores of urban residents' injury prevention were 43.35±14.29 and 38.92±3.75, while the agreement rate regarding injury prevention attitudes was 76.63% and the compliance rate of injury prevention behaviors was 43.10%. The scores of injury prevention behaviors among urban residents with different ages, family annual income, exercise frequency, and frequency of injuries were different ( F values were 2.815, 4.740, 4.153, P<0.05). There were differences in the scores of injury prevention attitudes among the residents of different ages, education background, and frequency of injuries ( F values were 3.030-8.162, P<0.01 or 0.05). Conclusion:The residents ′ attitude towards injury prevention was positive and the compliance rate of injury prevention behavior among urban residents in Changsha is low. Both injury prevention attitudes and behaviors differed in the residents with different backgrounds.

Objective:To explore the continuous nursing needs at discharge among geriatric hip fracture patients with hip arthroplasty.Methods:From January to March 2019, this study selected 15 geriatric hip fracture patients with hip arthroplasty by purposive sampling. Semi-structured interview was carried out for those patients at discharge. Colaizzi 7-step analysis was used to data analysis to understand the needs.Results:By analyzing, marshaling and extracting, there were three themes concerned by postoperative patients. Those themes included the needs for health education, improving unhealthy psychology and health services.Conclusions:Hip fracture patients with hip arthroplasty have many burdens and needs for physiology, psychology and society. Nurses should pay more attention to those patients, and provide targeted intervention as well as thorough health education for discharged patients to improve their self-care abilities.

Objective:To investigate knowledge, attitude and practice status of transitional care in orthopedic nurses in Shanghai and their advice on transitional care for hip fractures.Methods:From January to March 2019, the questionnaire star was used to send "nurse transitional care knowledge attitude practice scale" and "self-made opinion questionnaire on postoperative transitional care for patients with hip fractures" to orthopedic nurses in 18 public secondary and tertiary hospitals in Shanghai by link through WeChat platform to conduct a questionnaire survey. A total of 423 valid questionnaires were collected.Results:The total scores of knowledge, attitude and practice dimensions of transitional care in orthopedic nurses were respectively (39.60±8.72) , (60.43±9.52) and (29.03±8.43) , which were at the medium level. Position and education background were the influencing factors of the total score of knowledge, attitude and practice of transitional care in orthopedic nurses ( P<0.05) . Hospital level, professional title, educational background and position were the influencing factors of knowledge score of transitional care in orthopedic nurses ( P<0.05) . Position, education background and hospital level were the influencing factors of the attitude score of transitional care in orthopedic nurses ( P<0.05) . Professional title was the influencing factor of the practice score of transitional care in orthopedic nurses ( P<0.05) . Orthopedic nurses believed that the best way to realize transitional care needs was WeChat official account, the most important dimension was rehabilitation exercise, the best practitioner was the rehabilitation therapist and the most appropriate frequency was once every two weeks. Conclusions:The level of knowledge, attitude and practice of transitional care in clinical nurses in Shanghai needs to be further improved. To carry out transitional care for hip fractures, it is necessary to strengthen information exchange between medical institutions, establish and improve the nurses' transitional care training system, establish a new transitional care service system based on information technology and centered on patients and promote the orderly development of transitional care work.