Objective The study aimed to investigate the predictive efficacy of contrast-enhanced ultrasound combined with telomerase reverse transcriptase(TERT)promoter mutation in constructing nomogram model for the prediction of concomitant cervical lymph node metastasis(CLNM)in papillary thyroid microcarcinoma(pTMC).Methods A total of 202 patients with pTMC who underwent partial or total thyroidectomy+lymph node dissection at our hospital from January 2021 to March 2024 were selected.Then,they were divided into the CLNM group(97 patients)and the non-CLNM group(105 patients)according to whether they had concomitant CLNM on postoperative pathological examination.General data and ultrasound(conventional ultrasound and contrast-enhanced ultrasound)characteristics were collected from all patients with pTMC,and Sanger sequencing was used to detect TERT promoter mutations.The influencing factors of pTMC complicated by CLNM were analyzed by single-factor and multifactorial unconditional logistic regression;the nomogram model of pTMC complicating CLNM with contrast-enhanced ultra-sound combined with TERT promoter mutation was constructed by RStudio 4.4.1 software,and the consistency and net benefit of the nomogram model were evaluated by using calibration curves,decision curves,and C-indexes,and the Hosmer-Lemeshow test for goodness of fit of the nomogram model;The predictive efficiency of the nomogram model constructed by combining contrast-enhanced ultrasound and TERT promoter mutation for pTMC complicated by CLNM was evaluated by plotting receiver operating characteristic(ROC)curves using MedCalc22.023 software.Results After postoperative pathological examination,the incidence of CLNM in 202 patients with pTMC was 48.02%(97/202).Univariate analysis showed that thyroglobulin antibodies,number of lesions,aspect ratio,micro-calcifications,enhancement time,enhancement mode,enhancement intensity,capsular continuity,and TERT promoter mutations were associated with pTMC complicating CLNM(P<0.05).Multifactorial unconditional logistic regression showed that multifocal tumours(OR=3.487,95%CI:1.641～7.406,P=0.001),microcalcifications(OR=4.484,95%CI:2.113～9.516,P<0.001),equal or high enhancement(OR=3.187,95%CI:1.460～6.957,P=0.004),disruption of peritoneal continuity(OR=2.201,95%CI:1.051～4.608,P=0.036),and TERT promoter mutation positivity(OR=4.460,95%CI:2.132～10.103,P<0.001)were the independent risk factors for pTMC complicating CLNM.A contrast-enhanced ultrasound combined TERT promoter mutation nomogram model was constructed based on independent risk factors for pTMC complicating CLNM[Logit(p)=-4.486+1.350×number of foci+1.399×microcalcifications+2.124×intensity of enhancement+1.524×capsular continuity+2.175×TERT promoter mutations].The C-index of this nomogram model was 0.899(95%CI:0.893～0.905),the calibra-tion curve alignment was close to the ideal curve,the decision curve was higher than the two extreme curves,and the Hosmer-Lemeshow test showed a P>0.05.The ROC curve analysis showed that the nomogram model constructed with contrast-enhanced ultrasound combined with TERT promoter mutations predicted CLNM in pTMC with an area under the curve of 0.899.This was significantly higher than the area under the curves for contrast-enhanced ultra-sound alone(0.857)and TERT promoter mutations alone(0.697)(P<0.05).Conclusion The contrast-enhanced ultrasound combined with TERT promoter mutations to construct a nomogram model has high predictive efficiency for pTMC complicating CLNM.

Objective The study aimed to investigate the predictive efficacy of contrast-enhanced ultrasound combined with telomerase reverse transcriptase(TERT)promoter mutation in constructing nomogram model for the prediction of concomitant cervical lymph node metastasis(CLNM)in papillary thyroid microcarcinoma(pTMC).Methods A total of 202 patients with pTMC who underwent partial or total thyroidectomy+lymph node dissection at our hospital from January 2021 to March 2024 were selected.Then,they were divided into the CLNM group(97 patients)and the non-CLNM group(105 patients)according to whether they had concomitant CLNM on postoperative pathological examination.General data and ultrasound(conventional ultrasound and contrast-enhanced ultrasound)characteristics were collected from all patients with pTMC,and Sanger sequencing was used to detect TERT promoter mutations.The influencing factors of pTMC complicated by CLNM were analyzed by single-factor and multifactorial unconditional logistic regression;the nomogram model of pTMC complicating CLNM with contrast-enhanced ultra-sound combined with TERT promoter mutation was constructed by RStudio 4.4.1 software,and the consistency and net benefit of the nomogram model were evaluated by using calibration curves,decision curves,and C-indexes,and the Hosmer-Lemeshow test for goodness of fit of the nomogram model;The predictive efficiency of the nomogram model constructed by combining contrast-enhanced ultrasound and TERT promoter mutation for pTMC complicated by CLNM was evaluated by plotting receiver operating characteristic(ROC)curves using MedCalc22.023 software.Results After postoperative pathological examination,the incidence of CLNM in 202 patients with pTMC was 48.02%(97/202).Univariate analysis showed that thyroglobulin antibodies,number of lesions,aspect ratio,micro-calcifications,enhancement time,enhancement mode,enhancement intensity,capsular continuity,and TERT promoter mutations were associated with pTMC complicating CLNM(P<0.05).Multifactorial unconditional logistic regression showed that multifocal tumours(OR=3.487,95%CI:1.641～7.406,P=0.001),microcalcifications(OR=4.484,95%CI:2.113～9.516,P<0.001),equal or high enhancement(OR=3.187,95%CI:1.460～6.957,P=0.004),disruption of peritoneal continuity(OR=2.201,95%CI:1.051～4.608,P=0.036),and TERT promoter mutation positivity(OR=4.460,95%CI:2.132～10.103,P<0.001)were the independent risk factors for pTMC complicating CLNM.A contrast-enhanced ultrasound combined TERT promoter mutation nomogram model was constructed based on independent risk factors for pTMC complicating CLNM[Logit(p)=-4.486+1.350×number of foci+1.399×microcalcifications+2.124×intensity of enhancement+1.524×capsular continuity+2.175×TERT promoter mutations].The C-index of this nomogram model was 0.899(95%CI:0.893～0.905),the calibra-tion curve alignment was close to the ideal curve,the decision curve was higher than the two extreme curves,and the Hosmer-Lemeshow test showed a P>0.05.The ROC curve analysis showed that the nomogram model constructed with contrast-enhanced ultrasound combined with TERT promoter mutations predicted CLNM in pTMC with an area under the curve of 0.899.This was significantly higher than the area under the curves for contrast-enhanced ultra-sound alone(0.857)and TERT promoter mutations alone(0.697)(P<0.05).Conclusion The contrast-enhanced ultrasound combined with TERT promoter mutations to construct a nomogram model has high predictive efficiency for pTMC complicating CLNM.

Objective:To identify the clinical characteristics and adverse events of patients with giant cell arteritis (GCA).Methods:Patients who were hospitalized and diagnosed with GCA in Zhongshan Hospital, Fudan University, from December 2009 to November 2020 were enrolled into a retrospective study analysis. Baseline data and follow-up data were collected. Adverse events were defined as one of the following events: relapses, ischemic complications and death. Patients with adverse events were analyzed in clinical features and risk factors by univariate and multivariate analysis. Associations with adverse events were assessed using ROC curve and survival curves.Results:A total of 69 patients with GCA were included in this study, with the male: female ratio of 1∶1.03. Fatigue and headache were common symptoms. Finally, 61 patients were followed up at the end of May in 2021. Over the mean follow-up time of (35±20) months, adverse events occurred in 16 cases (26.2%). Patients with adverse events had significantly lower levels of platelet and globulin at baseline than those without adverse events [(325±142)×10 9/L vs (238±112)×10 9/L, t=2.22, P=0.030]; [(31±6) g/L vs (26±6) g/L, t=2.74, P=0.008]. Red cell volume distribution width-coefficient of variation (RDW-CV) was considered an independent risk factor for adverse events [ OR (95% CI)=0.32 (0.14,0.74), P=0.008]. Further, patients especially with RDW-CV<14.75% were prone to have adverse events, which occurred in 2.6%, 20.5%, 25.6%, 33.3%, 41.00% in 1, 2, 3, 5, 10 years. Its risk increased significantly after 2 years ( P=0.042, P=0.021, P=0.002, P=0.001). The incidence of adverse events was much higher in patients with RDW-CV<14.75%(95% CI=0.002). Conclusion:Adverse events are common in patients with GCA. RDW-CV is an independent risk factor for having adverse events. Low level of RDW-CV predicts an increased risk of adverse events by the following years.

Objective: To explore the effects of the intervention based on the theoretical framework of Health Belief Model on improving sharp injury protection behavior compliance of medical staffs, in order to provide some references for energetically developing blood-borne occupational exposure protection intervention in the region. Methods: According to the inclusion criteria, 178 medical staffs were selected, implemented intervention of the theory of health belief model. Methods included diversity training, experiencing operation, filed observation and supervision and so on, strengthened intervention after 1 month, evaluated the intervention effect after 3 months, used questionnaires and field observation to evaluate the effect before and after the intervention. Results: the scores of security behavior compliance were higher before intervention and there was significant difference (P<0.05) . Observed that, after the intervention the incidence of unsafe behavior in medical personnel dropped from 29.1% to 13.2%, the difference was statistically significant (P<0.05) . Conclusion The intervenion of the theory of health belief model can strengthen sharp injury protection belief of medical personnels, improve behavior compliance, reduces the occurrence of sharp injury.

This nursing interactive system, based on hospital information system, minimizes manual repetitions of nurses and their cross-space communication problems. It provides an accurate and intuitive information display and communication channel for clinical nursing care, which can also provide a preliminary evaluation of its application effects. On such basis, the authors propose that building such a system is a necessity in nursing informationization, as it elevates nursing efficiency, scientific management and patient safety.

OBJECTIVETo study the role of Th17/Treg imbalance in the immune pathogenesis and therapeutic significance in childhood aplastic anemia (AA).

METHODWe analyzed data from 43 children (male: female = 14: 29) with AA, all the cases were at the age of 2 to 14 years at diagnosis, and were hospitalized at our department of pediatrics between January 2012 and October 2013 in the Second Hospital of Anhui Medical University. All these patients were divided into 2 groups, severe AA (SAA) group (n = 25, male: female = 8: 17, 2-14 years old) and non-severe AA (NSAA) group (n = 18, male: female = 6: 12, 2-14 years old), depending on the severity at first diagnosis. As to the treatment, we analyzed data at 3 phases of treatment, diagnosis (n = 43, male: female = 14: 29, 2-14 years old), transfusion-indenpendence (n = 8, male: female = 5: 3, 2-11 years old), complete response (n = 6, male: female = 3: 3, 2-11 years old); at the same time, AA children who did not respond to the treatments were considered as failed treatment control (transfusion-indenpendence with failed treatment group, n = 5, male: female = 1: 4, 3-8 years old; complete response failed treatment group, n = 4, male: female = 2: 2, 4-11 years old). The ratio of Treg and Th17 cells in CD4(+) T cells were tested by flow cytometry. The levels of IL-6 and IL-17 in plasma were determined by ELISA. During the same period, 25 age-matched healthy children (male: female = 12: 13, 3-14 years old) were recruited as normal control, 9 cases (male: female = 5: 3, 2-11 years old) of AA children induced by chemotherapy as diagnosis control group. Differences in variables were analyzed using ANOVA and t-tests or the Kruskal-Wallis and Mann-Whitney U-tests, as appropriate. Correlation analysis was evaluated by the Spearman rank correlation test.

RESULT(1) The ratio of Th17 cells in newly diagnosed AA patients were higher than that of normal group or diagnosis control group [1.63% (1.27%, 2.48%) vs. 0.4% (0.35%, 0.51%) or 0.50% (0.45%, 0.75%), both P < 0.01] while the ratio of Treg cells was lower [4.24% (3.10%, 5.29%) vs. 7.03% (6.56%, 7.48%) or 7.50% (6.60%, 8.30%), both P < 0.01] and the proportion of Th17/Treg were significantly higher [0.53(0.34, 0.69) vs. 0.06 (0.05, 0.07) or 0.09 (0.08,0.11), both P < 0.01]. (2) The levels of IL-6 and IL-17 in newly diagnosed AA patients were higher than in normal group [ (223 ± 92) vs. (116 ± 18) ng/L, (26.2 ± 12.0) ng/L vs. (10.6 ± 2.1) ng/L, P both < 0.01]. There was a positive correlation between Th17 cells and some Th17 cells related cytokines such as IL-17 and IL-6 (r = 0.62, 0.64, P both < 0.01). (3) The ratio of Th17, Th17/Treg, and the levels of IL-6 and IL-17 in children with SAA were also higher than in normal group [1.80% (1.25%, 2.61%) vs. 0.40% (0.35%, 0.51%), 0.57% (5.10%,0.82%) vs. 0.06% (0.05%, 0.07%), (225 ± 108) vs. (116 ± 18) ng/L, (25.9 ± 12.6) vs. (10.6 ± 2.1)ng/L, all P < 0.01]. NSAA also higher than normal group. The ratio of Treg in children with SAA and NSAA was less than that in normal group (P all < 0.01). However, the ratio of Th17, Treg, Th17/Treg, and the levels of IL-6 and IL-17 had no significant difference between SAA and NSAA (all P > 0.05). (4) In different stages of treatment, such as diagnosis, transfusion-indenpendence, complete response, there were significant differences in the ratio of Th17 and Th17/Treg (both P < 0.05) but not in Treg (P > 0.05).

CONCLUSIONThe imbalance of Th17/Treg cells and abnormally increased cytokines related to Th17 cells exist in peripheral blood of AA children, but did not significantly affect the severity of AA in preliminary diagnosis. After treatment with immunosuppression, AA was gradually relieved as the imbalance of Th17/Treg was corrected.

Adolescent ; Anemia, Aplastic ; immunology ; therapy ; Blood Transfusion ; Child ; Child, Preschool ; Cytokines ; Female ; Flow Cytometry ; Humans ; Interleukin-17 ; Interleukin-6 ; Male ; T-Lymphocytes, Regulatory ; immunology ; Th17 Cells ; immunology

ObjectiveTo study the dynamic express of CD57 on T cell of PBMC and clinical significance in acute HIV infection.MethodsSeventeen patients with acute HIV infection were enrolled study randomly diagnosed from 2006.11 to 2009.12 and 15 healthy donors as control group.The PBMCs from 1th,3th and 6th during acute infection were collected.The proportion of CD3+CD57+T lymphocytes,CD3+ CD8+CD57 +T lymphocytes and CD3 + CD4 + CD57 + T lymphocytes were evaluated by flow cytometric analysis with three or double color staining.The relationship between the proportion of CD57+ T phenotypes and virus load and CD4+T cells count was analyzed.ResultsThe proportion of CD57+T lymphocytes in PMBC in 1th,3th and 6th during acute HIV acute was 15.24％ ±1.49％,13.51％ ±2.45％ and 14.65％ ±1.83％,respectively,and was higher than normal control group and the difference was significantly(P＜0.0001 ).The proportion of CD8+ CD57+T lymphocytes was 7.79％ ±2.10％ and 9.88％ ±2.36％ in 1th and 3th month during acute infection,respectively.The proportion of CD8+ CD57+T lymphocytes in 1th and 3th month during acute infection were positive relationship with virus load in corresponding time,and R2 was 0.3700 and 0.3768,and P value was 0.0096 and 0.0088,respectively.The proportion of CD8+CD57+T lymphocytes in the 1th and 3th month during acute infection was negative relationship with CD4+T lymphocytes count.The R2 was 0.3768 and 0.4235,and P value was 0.0215 and 0.0017,respectively.In 6 rapid progressors and 11 no rapid progressors on the 1th month after HIV infection,CD8+ CD57+T lymphocytes percentage was 11.20％±2.21％ and 6.16％ ±1.09％,respectively,and CD4+CD57+T lymphocytes percentage 2.79％ ±0.31％and 1.40％ ±0.30％,respectively.Both CD8+CD57+T and CD4+CD57+T in rapid progressors were higher than no rapid progressors,and P value was 0.0338 and 0.0106,respectively.ConclusionCD57+ T lymphocytes percentage in peripheral blood increase in acute HIV infection patients,in which the increasing CD8+CD57+T lymphocyte may mirror the dynamic of HIV replication and CD4+T cell count.The CD57 high express on T lymphocyte on the early HIV acute infection predicts rapid progression.

Objective To explore the sensitivity and specificity of conventional eytogeneties(CC),nested-reverse transcriptase polymerase chain reaction(nested-RT-PCR) and dual-color and dual-fusion fluorescence in situ hybridization(D-FISH) technique in monitoring the tumor load of chronic myeloid leukemia (CML) during treatment.Methods CC,nested-RT-PCR and interphase D-FISH were simultaneously carried out to detect the tumor load of 5 CML patients during treatment with interferon-Mpha(IFN-α).Results 24 specimens from 5 CML patients before and after IFN-α therapy were investigated and the results showed that 23 specimens were Ph+ with different positive ratios by CC.All specimens were bcl-abl mRNA (+) by RTPCR.The Ph-ber-abl+ specimen from case 2 after 75 months of post-treatment showed 4.5%bcr-abl+ cells by FISH.2 specimens from case 1 at 22 mortths,26 mortths of post-treatment.2 specimens from cage 5 after 12 months,16 menths of post-treatment and 2 specimens from case 4 after 6 menths,10 menths post-treatment with same Ph+ ratio respectively were investigated by FISH and showed 47.5% and 39.5%,74.0%and 60.5%,99.0% and 99.5% bcr-abl+ cells,respectively.Conclusion CC can be used as a basic tool to monitor the change of tumor load in CML during treatment. When CC can't evaluate precisely dynamic changes of tumor load and when tumor load in patient with treatment were too low to detect Ph bv CC while bcr-abl mRNA was still positive by RT-PCR,FISH Call be used to detect precisely tumor load and monitor dynamic change of the disease.More sensitive RT-PCR was used to monitor tumor load when it was negative to bcr-abl by FISH during treatment.

Aim To investigate the relationship between neuronal nicotinic acetylcholine receptor and the amnesia and hypnosis induced by enflurane in mice.Methods Animal models were established by Intraperitoneal injecting of enflurane(2.2 ml?kg-1 and 0.4 ml?kg-1).Artificial cerebrospinal fluid or different dose of nicotine were intracerebroventricular injected,then sleeping time in the analeptic test was recorded;and the step down latency and error times in the step down test;step through latency and error times in the step through test.For the independent activity test,recorded the independent activity times of mice treated with enflurane(0.4 ml?kg-1) in 5 min.Results Compared with control group,intracerebroventricular nicotine decreased sleeping time in the analeptic test,increased step down latency and step through latency in both step down test and step through test.Furthermore,the error times were decreased in both tests.All the outcomes were significant and the influence was dose-dependent.There was no significant difference for the independent activity times of mice treated with 0.4 ml?kg-1 enflurane by ip injection.Conclusion All the evidence suggested that neuronal nicotinic receptor is one of important targets for the hypnotic and amnestic effect of enflurane in mice.

0.05). Intrathecal administration of D-serine (0.025, 0.05, 0.1 ng), antagonized analgesia induced by isoflurane in tail-immersiontest and the early phase of formalin test (P0.05). Intrathecal administration of D-serine (0.05 ng) antagonized and the isoflurane′s suppression to the expression of Fos-protein in the spinal cord in mice(P