ObjectiveTo understand the level of medical narrative competence among hospice care practitioners in Shanxi Province， explore its influencing factors， and provide references for carrying out targeted training and improving the medical narrative competence of the medical and nursing staff. MethodsUsing convenience sampling， a total of 102 medical and nursing staff from hospitals providing hospice care in Shanxi Province were recruited as the research subjects. Questionnaire surveys were conducted with the Self-Designed General Information Questionnaire and the Self-Rating Scale for Medical Narrative Competence as the research tools. Univariate analysis and multiple linear regression analysis were adopted to explore the level of medical narrative competence and its influencing factors among hospice care practitioners in Shanxi Province. ResultsThe total score of medical narrative competence among hospice care practitioners in Shanxi Province was （158.19±19.69）. The mean scores of all dimensions were ranked from the lowest to the highest as attention and listening， understanding and response， and reflection and representation. Univariate analysis demonstrated that working years in hospice care， daily communication frequency with patients， weekly communication duration， degree of colleague care， professional recognition， job satisfaction， and familiarity with narrative medicine constituted the influencing factors for the level of medical narrative competence among hospice care practitioners （all P<0.05）. Multiple linear regression analysis showed that working years in hospice care， degree of colleague care， and familiarity with narrative medicine had statistically significant effects on the medical narrative competence of hospice care practitioners （all P<0.05）. ConclusionAdministrators of hospice care should prioritize medical and nursing staff who lack familiarity with narrative medicine， have low degrees of colleague care， experience short working years， and possess low professional recognition and job satisfaction with hospice care work. Targeted training should be strengthened for these individuals to improve their medical narrative competence level， thereby enhancing the quality of hospice care services.

Tenascin-C (TNC), an extracellular matrix glycoprotein, is lowly expressed in normal adult tissues while significantly upregulated under pathological conditions such as injury, inflammation, or tumors. Recent studies have shown that TNC plays an important role in Alzheimer's disease (AD) development: it is not only closely related to the formation of β-amyloid (Aβ) plaque, but also involved in neuroinflammation regulation and Aβ clearance process. This article reviews the effect of TNC on AD pathology in aspects of neuroinflammation, synaptic function, autophagy and Aβ load, aiming to provide theoretical basis for TNC-targeted AD treatment and drug development.

Tenascin-C (TNC), an extracellular matrix glycoprotein, is lowly expressed in normal adult tissues while significantly upregulated under pathological conditions such as injury, inflammation, or tumors. Recent studies have shown that TNC plays an important role in Alzheimer's disease (AD) development: it is not only closely related to the formation of β-amyloid (Aβ) plaque, but also involved in neuroinflammation regulation and Aβ clearance process. This article reviews the effect of TNC on AD pathology in aspects of neuroinflammation, synaptic function, autophagy and Aβ load, aiming to provide theoretical basis for TNC-targeted AD treatment and drug development.

Objective:To analyze the clinical characteristics and all-cause mortality influencing factors of patients with Keshan disease.Methods:Clinical data of patients with Keshan disease from Keshan disease areas in Sichuan Province and Yunnan Province were collected and retrospectively analyzed for clinical characteristics and survival status during regular follow-up. According to the survival status of patients, the survey subjects were divided into a survival group and a death group. All-cause mortality (referring to the death caused by various reasons throughout the follow-up period) was used as the study endpoint. Kaplan-Meier (K-M) survival curve analysis and log-rank χ 2 test were performed, univariate and multivariate Cox regression analysis were used for all-cause mortality factor analysis. Results:A total of 176 patients with Keshan disease were collected, including 92 cases in Sichuan Province and 84 cases in Yunnan Province. Among all the patients, there were 105 males, accounting for 59.66%, and 71 females, accounting for 40.34%. The age was (53.89 ± 13.19) years old. Thirty-five cases died from all causes, with a mortality rate of 19.89%. There were significant differences in age ( t = 2.09, P = 0.038), New York Heart Association (NYHA) cardiac function grading (χ 2 = 14.62, P < 0.001) and ventricular premature contraction (χ 2 = 6.82, P = 0.009) between the survival group and the death group. K-M survival curve analysis showed that patients with Keshan disease complicated by premature ventricular contraction and high NYHA cardiac function grading (Ⅲ and Ⅳ) had higher all-cause mortality (log-rank χ 2 = 8.72, 22.49, P < 0.05). Univariate Cox regression analysis showed that NYHA cardiac function grading and ventricular premature contraction ( HR = 3.09, 2.71, P < 0.05) were predictive influencing factors for all-cause mortality in patients with Keshan disease. Multivariate Cox regression analysis showed that NYHA cardiac function grading ( HR = 6.57, P = 0.002) and ventricular premature contraction ( HR = 2.98, P = 0.050) were independent factors for all-cause mortality in patients with Keshan disease. Conclusions:Among 176 patients with Keshan disease, the number of patients with poor cardiac function (NYHA cardiac function grading Ⅲ and Ⅳ) and arrhythmia is high. NYHA cardiac function grading and ventricular premature contractions are independent influencing factors for all-cause mortality in patients with Keshan disease.

Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.

Post-stroke cognitive impairment (PSCI) is a series of syndromes caused by stroke, involving impairment of one or more cognitive functions, such as attention, language function, executive function, visuospatial cognition, episodic memory and working memory, etc. The traditional treatment methods of PSCI include drug therapy and cognitive training. The treatment modalities are limited and the maintenance effect is not good. Therefore, an auxiliary treatment method is urgently needed to improve its therapeutic effect. Transcranial direct current stimulation (tDCS) is a safe and mature non-invasive brain stimulation technique, which generates weak direct current (1-2 mA) through electrodes placed on the scalp to change the resting membrane potential of neurons, regulate the excitability of the cerebral cortex, so as to achieve the purpose of treatment. This article reviews the effect of tDCS on PSCI, and hopes to provide reference and guidance for its rehabilitation treatment.

Taking the occurrence and development of general consent as the research object, this paper compared the differences between the ethical characteristics of broad consent and informed consent of specific research through the analysis of the content revision process of broad consent in the U.S. Broad Rules, and tried to explore the feasibility of implementing broad consent in Chinese medical institutions.

Objective: To investigate the self-reported prevalence, clinical characteristics, complications of allergic rhinitis (AR) and the sensitization of outdoor air pollen allergens in children in the Inner mongolia grassland region. Methods: A multistage, stratified and random clustered sampling with a face-to-face interview survey study in children from 0 to 17 years old was performed together with 10 common allergen skin prick tests (SPT) and measurements of the daily pollen count in 6 regions in the Inner mongolia grassland region from May to August of 2015. SAS 9.4 software was used for data analysis. Results: A total of 2 443 subjects completed the study. The self-reported prevalence of AR was 26.6%. The prevalence of boys was higher than that of girls (28.8% vs 24.3%, χ²=6.157, P<0.05). Subjects from urban areas showed higher prevalence than rural areas (34.7% vs 18.8%, χ²=79.107, P<0.05). There was significant regional difference in the prevalence of AR among the six areas investigated (χ²=221.416, P<0.05). The main clinical symptoms of AR were sneezing (88.2%) and nasal congestion (78.6%). Among combined diseases, asthma accounted for 16.5% (107/650), rhinoconjunctivitis accounted for 47.9% (311/650). The peak season of AR was April and July, with the top SPT positive allergens of Artemisia species and chenopodium in this area. Conclusions The prevalence AR in children in the Inner mongolia grassland region is extremely high. Sneezing is the main clinical symptom. Rhinoconjunctivitis is the most common combined disease. High summer and autumn pollen exposure is the main cause of AR.

Objective To investigate the cognition of medical staff on the control and treatment of venous thromboembolism ( VTE) at the municipal general hospitals in Beijing, for due countermeasures. Methods Customized questionnaires were used to survey the medical staff at 7 general hospitals in Beijing. The data so acquired were divided into approval items and disapproval items to calculate the ratio of approval items, while the comparison between those of different specialties and academic titles was subject to logistic regression analysis. Results 2 496 valid questionnaires were recovered, and the results showed that over 95% of them recognized the necessity of the VTE control and treatment work in the hospital, yet they need to improve their professional knowledge in this regard. There were differences in the cognition level among different specialties, and the higher the professional title, the better the recognition. Top three concerns for VTE work were increased workload, increased hospitalization expenses and extended hospital stay in turn. Top three difficulties in the work were patient′s compliance, coordination of auxiliary departments, and doctors′ cognition and involvement. Conclusions Cognition of VTE needs to be enhanced, and it is imperative to improve the VTE control and treatment system, carrying out the work in a scientific, standardized and economic manner.

Objective: To investigate the clinical and immunological laboratory features, mutations in SH2D1A gene and SAP protein expression in four children of two families with X-linked lymphoproliferative disease type 1(XLP-1). Method: Four patients (Family A including Patient 1 and Patient 2, Family B including Patient 3 and Patient 4) and their maternal relatives were enrolled in this study. The clinical manifestation, EBV infection status and chest CT scan were analyzed. The absolute and relative numbers of lymphocyte subsets, T lymphocyte proliferative response, SAP protein expression were assessed by flow cytometry. Quantification of signal joint TCR rearrangementexcision circle (sjTRECs), CDR3 spectratyping of TCRvβ and gene mutation of SH2D1A were detected by PCR based on genomic DNA or cDNA. Result: Four male patients from two families were diagnosed with XLP-1. The ages of disease onset were more than 1 year, more than 1 year, more than 1 month and 6 months. The ages at diagnosis were nine years and ten months, sixteen years and eight months, fourteen years and ten months, four years and nine months. All patients had recurrent infections and EBV infection. Patients 1, 2, and 3 had agammaglobulinemia and Patient 4 had hypogammaglobulinemia. Chest CT scan showed all patients had atelectasis and pneumonia, and Patient 3 had bronchiectasis. Patient 3 was diagnosised as Burkitt lymphoma. For immunological function, all patients exhibited reduced CD4/CD8 ratios, increased numbers of exhausted T lymphocyte, decreased number of NK cell. The numbers of total B lymphocyte and naïve B lymphocyte were normal, but the number of memory B lymphocyte declined in all cases. Four patients′ copy numbers of sjTRECs were low and CDR3 spectratypings of TCRvβ showed mildly skewed. But their T lymphocyte proliferative response was normal. SAP protein expression in four cases were measured by flow cytometry. Two patients from Family A were absent and two patients from Family B showed decreased values. SH2D1A gene sequence analysis showed that the patients of Family A harbored a nonsense mutation (c.163 C>T; p.R55X) in exon 2. Their mother and two sisters were carriers. A missense mutation of SH2D1A gene (c.278 G>A; p.G93D) in exon 3 was found in the patients of Family B. The mother was carrier. Four patients remain survived, Patient 3 gave up treatment, other three patients received IVIG therapy. Conclusion Four patients with XLP-1 from two families characterized by agammaglobulinemia have an extreme vulnerability to Epstein-Barr virus (EBV) infection. The functions of T cell, B cell and NK cell are impaired at different stages. The detection of SAP protein and SH2D1A gene are the key methods for diagnosis of XLP-1.