Objective:To discuss the clinical presentations,diagnosis,and treatment methods of the patients with Fournier's gangrene,and to enhance the clinicians'awareness of this condition.Methods:The clinical data including symptoms,signs,radiological findings,and surgical outcomes of one patient with Fournier's gangrene were collected.The relevant literatures were reviewed to summarize the clinical characteristics,diagnosis,and treatment methods for this condition.Results:The patient,a 42-year-old male,was admitted because of a history of infection around the perineum,scrotum,and perianal area for 13 d.His medical history included acute myeloid leukemia for 10 months,during which the patient underwent eight chemotherapy sessions in the local hospital.The abdominal CT scan results showed thickened,dense,and turbid soft tissue in the left inguinal area.The complete blood count reuslts showed the white blood cell count was 23.99×109 L-1.The cultures of wound secretions grew the Escherichia coli and Proteus mirabilis.The examination results showed there was necrosis of the scrotal skin and skin near the anus on the left buttock;the skin was blackened,hard,and demarcated from the surrounding normal skin with slight purulent exudation and no foul smell.The surrounding skin was significantly swollen and red;the rectal examination results showed no bleeding or fistulas.The patient underwent emergency debridement surgery on the admission day,followed by dressing changes,multiple applications of simplified negative pressure,perineal flap reconstruction,and skin grafting.The patient recovered well with normal function and had no complications.Conclusion:Fournier gangrene has acute onset and rapid progression,and the clinical manifestations are non-specific.The range of infection is not consistent with the progression of the disease.The diagnosis mainly depends on intraoperative exploration.Repeated radical surgery is the main treatment.The prognosis of this disease is good,and the recurrence rate is low,although long-term follow-up is still necessary after surgery.

Objective:To compare the comprehensive performance of three Varian on-board image (OBI) image systems (KV-CBCT, KV-planar and MV-EPID) and to explore the value of the combined application of these three systems in daily image-guided radiotherapy for nasopharyngeal cancer.Methods:KV-CBCT, KV-planar and MV-EPID scanning and registration were carried out in the left and right/abdominal and back/head and foot direction on human head and neck phantom. The set-up error, registration time, additional radiation dose and image quality of the three systems were compared by F-test.Results:KV-CBCT, kV-planar and MV-EPID were scanned for 55 times, respectively, and the set-up errors in the left and right/abdominal and back/head and foot direction of the three image-guided systems were (0.00±5.43)/(-0.02±5.49)/(0.02±5.58) mm, (0.04±5.49)/(0.02±5.56)/(0.02±5.54) mm, (0.02±5.22)/(0.11±5.34)/(-0.04±5.33) mm, respectively ( P=0.999, 1.000, 0.989). The average time consuming was (200±45) s, (120±36) s and (115±42) s; the additional radiation dose from low to high was kV-planar, KV-CBCT and MV-EPID; the image quality from low to high was MV-EPID, kV-planar and KV-CBCT. Conclusions:Three image-guided systems can meet the requirements of image-guided radiotherapy for nasopharyngeal cancer. Based on the overall performance of the three systems, 1 CBCT+ 4 kV planar per week is recommended and EPID should be used as a backup system in daily image-guided radiotherapy for nasopharyngeal cancer. This scheme makes full use of the high image quality of CBCT and the low radiation of kV planar to realize the regular detection of nasopharyngeal cancer volume change and the implementation of high-precision radiotherapy.

Objective:To investigate the current status of affective commitment and feedback-seeking behavior in junior nurses in three Class Ⅲ Grade A hospitals in Wenzhou and to explore the effect of affective commitment of junior nurses on feedback-seeking behavior.Methods:Methods Using the convenient sampling method, a total of 400 junior nurses in 3 ClassⅢ Grade A hospitals in Wenzhou in Zhejiang Province from October to December 2019 were selected as research objects. General data questionnaire, Affective Commitment Scale and Feedback-Seeking Behavior Scale were used to investigate the effect of affective commitment of junior nurses on feedback-seeking behavior. In this study, a total of 400 questionnaires were issued, and 372 valid questionnaires were collected, with an effective recovery rate of 93%.Results:The total score of Affective Commitment Scale for 372 junior nurses was (29.07±4.86) and that of Feedback-Seeking Behavior Scale was (40.47±6.47) . The results of univariate analysis showed that there were statistically significant differences in the feedback seeking behavior scores of junior nurses in terms of title, education background, department and employment mode ( P<0.05) . Pearson correlation analysis showed that the total score of Affective Commitment Scale for junior nurses was positively correlated with the total score of Feedback-Seeking Behavior Scale ( P<0.05) . Stratified regression analysis results showed that affective commitment had a predictive effect on feedback-seeking behavior of junior nurses ( P<0.05) . Conclusions:The affective commitment and feedback-seeking behavior of junior nurses are in the middle level and need to be further strengthened. Affective commitment positively affects feedback-seeking behavior, so nursing managers can improve the level of feedback-seeking behavior by strengthening the affective commitment level of junior nurses.

Fournier gangrene is a relatively rare clinical critical disease, and its clinical symptoms are not specific and easily unrecognized by some clinicians. It has the features of acute onset, quick development, severe illness, and often accompanied by infection shock which is seriously life-threatening. It is difficult in treatment with high medical costs and long length of hospitalization, which increases pain for patients and relatives and brings heavy economic and psychological burden on patients, society, and medical workers. By reviewing the literature home and abroad and combined with clinical practice, I summarize the researches on concept, epidemiology, clinical manifestation, diagnosis and treatment of Fournier gangrene, in order to provide reference for vast number of clinical workers.

Objective To develop a remote diabetic retinopathy (DR) screening system and to evaluate the effectiveness of the screening system in community.Methods A cross-sectional study was carried out under the informed consent of subjects in Peking University People's Hospital and Beijing Xicheng District Desheng Community Health Service Center from June 2015 to December 2016.A remote DR screening system was established in Peking University People's Hospital and Beijing Xicheng District Desheng Community Health Service Center during June 2015 to December 2016.Based on non-mydriatic digital eye fundus camera photography and the internet transmission technology,anterior ocular segment and fundus images of 2 473 eyes from 1 355 community subjects with type 2 diabetes mellitus were transmitted from Beijing Xicheng District Desheng Community Health Service Center to the reading center of Peking University People's Hospital,and the results were provided to the subjects after analysis,including visual examination,diagnosis and follow-up rate of the subjects,the agreement between remote screening system and conventional screening method was analyzed and compared.Results The visual acuities of the 2 473 eyes of 1 355 subjects were obtained by trained community physician,and the visual acuity was ≤0.05 in 103 eyes (4.2％),＞0.05-0.3 in 780 eyes (31.5％),＞0.3 in 1 590 eyes (64.3％).A good consistency was found in the diagnosis and grading of DR (Kappa value =0.895) and in diagnosis of macular disorder (Kappa value =0.763)between the remote screening system and conventional screening method.In addition,the diagnosis results of retinal photocoagulation were consistent between the two methods (Kappa value =1.000).The mean duration of the remote screening system for one subject was 10 minutes,which was shorter than 23 minutes of conventional screening method.The follow-up rate of remote screening system was 75.2％.Conclusions There is a high consistency in the DR diagnosis and evaluation between the remote non-mydriatic screening system and conventional screening method.The screening program with follow-up requests has a satisfying follow-up rate,which could meet the demand of DR screening.

Objective To investigate the relationships among current alexithymia, social relational quality and quality of life in breast cancer patients receiving chemotherapy. Methods By convenient sampling method, from April 2015 to September 2016, totally 151 patients were invited to complete demographic questionnaire, Toronto alexithymia scale, social relational quality scale and functional assessment of cancer therapy-breast. The Pearson correlation method was used to analyze the relationship among current alexithymia, social relational quality and quality of life. Results All of the patients got the average score (59.11±15.75) on Toronto alexithymia scale, which was moderate level. The total scores of social relational quality and life quality were (53.45±5.13) and (93.84±15.17). There was a negative relationship between alexithymia with social relational quality (r=-0.441) and quality of life (r=-0.597) (P<0.05). Conclusions Breast cancer patients has serious alexithymia after the operation. Nurses can carry out activities which gives patients more opportunities to express emotion, encourage patients to face difficulties and challenges, communicate with others actively, and get more support from others and encourage family members participate in the patient care process to reduce alexithymia and improve quality of life.

Objective: To investigate the prognostic value of dynamic monitoring of RUNX1-RUNX1T1 transcript in pediatric patients with t (8;21) acute myeloid leukemia (AML) . Methods: The clinical features and RUNX1-RUNX1T1 transcript levels of 55 pediatric t (8;21) AML patients, newly diagnosed from Jan. 2010 to Apr. 2016, were analyzed retrospectively. The relationship between the minimal residual disease (MRD) and prognosis was analysed by dynamic monitoring of RUNX1-RUNX1T1 transcript levels using real-time quantitative PCR (RQ-PCR) technology. Results: The RUNX1-RUNX1T1 transcript levels in bone marrow cells at diagnosis was not related to relapse. After one course of induction therapy, patients with a more than 2 Log reduction of RUNX1-RUNX1T1 transcript levels (>2 Log) had lower 5 years cumulative incidence of relapse (CIR) [ (24.3±8.4) % vs (52.6±9.7) %, χ²=9.046, P=0.003], relapse-free survival (RFS) [ (71.6±12.7) % vs (48.1±13.2) %, χ²=5.814, P=0.016], and better overall survival (OS) [ (76.9±12.5) % vs (48.9±14.7) %, χ²=6.346, P=0.012], compared to patients with a less than 2 Log reduction (a<2 Log) . Multivariate Cox survival analysis suggested that a>2 Log reduction in RUNX1-RUNX1T1 transcript levels after a course of induction therapy was an independent prognostic factor for RFS (HR=0.263, 95%CI 0.081-0.851, P=0.026) and OS (HR=0.214, 95% CI 0.057-0.808, P=0.023) . During consolidation therapy and follow-up period, molecular relapse of 16 cases and hematologic relapse of 13 cases were identified by continuous dynamic monitoring of RUNX1-RUNX1T1 transcript levels, with a median interval of 4.0 (1.5-5.8) months from the molecular relapse to hematologic relapse. 2 cases of molecular relapse who received timely allogeneic hematopoietic stem cell transplantation did not experience hematologic relapse. Conclusion Dynamic monitoring RUNX1-RUNX1T1 transcript levels by RQ-PCR technique can subdivide patients into relatively low and high risk group, early screen patients at high risk of relapse and provide a scientific basis for precision stratification and risk-adapted therapy for pediatric t (8;21) AML children.

Objective To investigate the serum asymmetric dimethylarginine (ADMA)expression in patients with acute cerebral infarction. Methods A total of 100 patients with acute cerebral infarction admitted to the Department of Neurology,the First Affiliated Hospital of Xi′an Medical College from March 2013 to August 2015 were enrolled retrospectively. According to the National Institutes of Health Stroke Scale (NIHSS)scores,they were divided into three groups:mild infarction (n =21;<4),moderate infarction (n =49;4 -15),and severe cerebral infarction (n = 30;> 15);100 healthy subjects without cerebrovascular disease in the same period were used as a control group. Enzyme linked immunosorbent assay was used to detect the plasma ADMA concentration,and the levels of plasma ADMA among the groups were compared. Results The concentrations of plasma ADMA of the mild,moderate,severe cerebral infarction,and the control groups were 0. 80 ± 0. 16,1. 14 ± 0. 28,1. 33 ± 0. 33,and 0. 52 ± 0. 16 μmol/ L,respectively. There were significant differences among the groups (F = 2. 32,P < 0. 05). Multivariate logistic regression analysis suggested that ADMA was an independent risk factor for cerebral infarction (OR,1. 140,95% CI 1. 078 -1. 212,P = 0. 045). Conclusions The expression levels of plasma ADMA increased gradually in patients with mild,moderate,and severe cerebral infarction. The higher the ADMA levels,the severe the neurological deficit would be. ADMA might be an independent risk factor for cerebral infarction.

Objective To develop ELISA kit stabilizer for each component ,with which the shelf life of kit could meet the com-mercial need .Methods A series of stabilizers for microplate ,enzyme-labeled antibody and standards were prepared by the means of experience and orthogonal approach ,through controlled trials ,screening out the best stabilizer formulations .Results A kind of coa-ted stabilizer (mass fraction :bovine serum albumin 0 .5% ,gelatin 0 .25% ,trehalose 5% ,PEG4000 0 .1% ) and a kind of enzyme la-beled antibody stabilizer (mass fraction :Bovine serum albumin 1% ,peptone 1% ,sucrose 10% ,trehalose 5% ,PEG4000 0 .25% ) were screened out .Conclusion The ELISA kits can be stable at 4 ℃ for 1 year after treated with the obtained stabilizers .

Angiotensin (Ang Ⅱ),a main effector peptide of the renin-angiotensin system (RAS),mediates a hormonal action in the maintenance of blood pressure and electrolyte levels,and thus fluid homeostasis.Recent studies have implicated that it correlates with tumor growth,angiogenesis,metastasis and it has drawn more and more attention.Many studies show that Ang Ⅱ-AT1R/AT2R play crucial roles in tumor growth,metastasis,invasion and tumor angiogenesis,which are formed new targets for treating malignant tumors.