Objective: To explore the diagnosis, treatment and prognosis of primary prostatic signet ring cell carcinoma (SRCC), so as to provide reference for the clinical diagnosis and treatment. Methods: A retrospective analysis was conducted on the clinical data of 6 patients with primary prostatic SRCC treated in Nanjing Drum Tower Hospital during Nov.2020 and Sep.2024.The clinical manifestations, imaging features, treatment methods, histological characteristics and prognosis were summarized. Results: The average age of the patients was (72.00±4.28) years.Varying degrees of dysuria occurred in 4 patients. All patients underwent multi-parametric magnetic resonance imaging (mpMRI) examination before surgery, and the results indicated typical prostate cancer.Preoperative biopsies showed high-grade (Gleason 8-10) prostate acinar adenocarcinoma.Postoperative pathological diagnoses were mixed types of prostate acinar adenocarcinoma and SRCC, and no metastasis was found in the pelvic lymph nodes.All patients were followed up for 1 to 46 months after surgery and are currently alive.Robot-assisted laparoscopic radical prostatectomy only was performed in 3 cases; apalutamide and leuprolide/triptorelin was administered after surgery in 2 cases; bicalutamide + goserelin was administered after surgery in 1 case, who developed bladder metastasis of prostate cancer 24 months later, and the serum prostate-specific antigen (PSA) concentration decreased to a safe level (<0.2 ng/mL) after the use of darolutamide with radiotherapy.No recurrence or metastasis was found in the remaining patients. Conclusion: Primary prostatic SRCC is a rare and highly aggressive malignant tumor of the prostate.The diagnosis depends on pathological examinations due to lack of specific imaging features and clinical manifestations.The prognosis is poor, and there is currently no standardized treatment.The combined use of surgery, hormonotherapy and radiotherapy can help improve the survival rate of patients.

Objective To investigate the correlation of human epididymis protein 4(HE4)with proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods A total of 147 T2DM patients from January 2020 to July 2023 in Jiujiang NO.l People's Hospital were enrolled in observation group.According to the severity of proteinuria,observation group was divided into three groups:Normal albuminuria group(101 cases),microalbuminuria group(25 cases),and massive albuminuria group(21 cases).50 healthy examinees with gender and age matching during the same period were selected as control group.HE4 levels and clinical indicators in each group were compared and analyzed.Correlation between HE4 and proteinuria was analyzed by using univariate and multivariate linear regression.Results The correlation network diagram reveals that HE4 functions was a pivotal node linking serum albumin,urinary microalbumin,urinary microalbumin-to-creatinine ratio(UACR),and renal function biomarkers.Compared to control group,HE4 levels significantly elevated in observation group(P＜0.01).Both univariate and multivariate linear regression analysis demonstrate a positive correlation between HE4 and UACR.Logistic regression analysis shew that after adjusting for confounding factors including age,gender,estimated glomerular filtration rate(eGFR),albumin(ALB),blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),lactate dehydrogenase(LDH)etc.elevated HE4 levels was a risk factor for proteinuria(OR=1.110,95％CI:1.005-1.226).Conclusion Elevated HE4 levels in patients with T2DM is positivly correlated with UACR.Increase its level increases the risk of proteinuria in T2DM patients.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

ObjectiveTo explore the histological characteristics of the kidney in Mongolian gerbils of different ages. MethodsTen Mongolian gerbils of 2, 6, and 12 months old (half male and half female) were selected. After euthanasia, the kidneys were taken and paraffin sections were made. After HE, MASSON and PAS staining, the structural differences of different parts of the kidney tissue in gerbils of different ages were observed by digital scanning, and the relevant data of the kidney tissue were measured by image analysis software. ResultsThe number of proximal convoluted tubules was more than that of distal convoluted tubules in the renal cortex and outer medulla of gerbils. With age, the glomerular density decreased, the glomerular diameter increased, the basement membrane of renal tubules thickened, and the fibrous components between renal tubules increased. ConclusionThe histological structure of Mongolian gerbil's kidney varies with age, which may be related to glomerulosclerosis and parenchymal cell reduction. The specific mechanism needs further study.

【Objective】 To evaluate and analyze the impact of COVID-19 epidemic on inventory of red blood cells (RBCs)in local and municipal blood stations in China, and to provide reference for the management of public health emergencies. 【Methods】 Relevant data from 2018 to 2021 were collected, and the differences in the volume of qualified RBCs, the usage efficiency of inventory RBCs, the average daily distribution of RBCs,the blood distribution rate of RBCs prepared by 400 mL whole blood, the difference in the average storage days of RBCs at the time of distribution, the average daily inventory of RBCs and the time of the average daily inventory of RBCs to maintain the distribution in 24 local and municipal blood stations in China during the COVID-19 epidemic and non-epidemic periods were retrospectively analyzed. 【Results】 Compared with non-epidemic periods, the volume of qualified RBCs [(117 525.979 ±52 203.175)U] and the average daily distribution of RBCs [( 156. 468 ± 70. 186) U ] increased significantly, but the usage efficiency of inventory RBCs decreased(97.24%±0.51%) significantly (P<0.05).There was no significant difference in the blood distribution rate of RBCs prepared by 400 mL whole blood(73.88%±20.30%), the average storage days of RBCs distribution(13.040 ±3.486), the average daily stock quantity of RBCs[(2 280.542 ±1 446.538) U ] and the time of the average daily inventory of RBCs to maintain the distribution[(15.062 ±7.453) d] (P>0.5). 【Conclusion】 During the COVID-19 epidemic, the inventory management of RBCs operated well, the overall inventory remained relatively stable, the stock composition and storage period showed no significant change.

Objective:To test the reliability and validity of a multi-dimensional, quantitative video evaluation system (the Multi-dimensional system) for evaluating hand dysfunction among stroke survivors so as to provide an objective basis for its clinical application.Methods:Sixty stroke survivors with single dysfunctional hand were evaluated using the Multi-dimensional system and also using the Fugl-Meyer Upper Extremity Assessment (FMA-UE) and the Action Research Arm Test (ARAT) and in terms of their active range of hand motion (AROM-H). The Multi-dimensional system′s internal consistency, composite reliability, split-half reliability, parallel-forms reliability as well as intra- and inter-observer reliability were quantified. Its validity was tested in terms of content validity, structural validity, convergent validity and criterion validity.Results:The system′s Cronbach′s α was determined to be 0.86. Its one-dimension composite reliability was 0.939, its split-half reliability coefficient was 0.88 and its parallel-forms reliability was 0.922. The inter-evaluator reliability was between 0.965 and 0.998 [95%CI= (0.919, 0.999)], and the single evaluator ICC value was 0.973 to 0.998 [95%CI= (0.937, 0.999)]. The validity test produced a content validity index of 1, and the Pearson correlation coefficients between each sub-item and the total score were all greater than 0.60. The KMO value for structural validity was 0.882, and there was a common factor in the component matrix which reflected 60.9% of the information in the original variables. The system′s convergent validity AVE was 0.609 with Pearson correlation coefficients between the multidimensional system and the FMA-UE and ARAT both > 0.70.Conclusion:The multi-dimensional quantitative video evaluation system has good reliability and validity in the evaluation of stroke survivors with hand dysfunction.

Objective:To investigate the effect of anterior or posterior debridement on infections of the lumbar vertebral fusion with cage and pedical screw system.Methods:A total of 10 cases (3 males and 7 females, age 49.80±13.29 years) with infections in the lumbar fusion device were admitted from January 2013 to December 2019. The cases were diagnosed with deep infections after the preview surgery at 10.80±13.24 months, including 10 cases with 12 cages infections and 8 cases with screw system infections. 7 cases were done with debridement and removal of the cages via the anterior approach. And another 3 cases underwent posterior debridement and removal of lumbar fusion cages. The changes in laboratory examination such as WBC count, ESR, CRP, visual analogue scale (VAS) and Oswestry Disability Index (ODI) score were compared preoperatively, 2 months and 6 months postoperatively.Results:No patients were lost in the follow-up. The average follow-up time periods is 16.30±5.10 months (range 9-24 months). There was no significant difference in WBC count between 2 and 6 months after surgery compared with preoperation ( F=0.855, P=0.436). The ESR, CRP, VAS and ODI scores decreased in 2 months and 6 months after sugery, which has significant differences compared preoperation ( P<0.05). The abnormal signals in the lambar vertebral showed a gradual fading trend in the postoperative MRI. The completely fading time was 5.00±1.33 months (range 3-7 months). One-stage bone grafting was performed in 6 cases with 8 spaces via anterior approach, 5 cases with 7 spaces showed the intervertebral fusion after postoperative with 6.80±2.28 months (range 4-10 months), 1 case wirh 1 space was not fused. One-stage bone grafting was performed in 2 cases via posterior approach: 1 case was fused after postoperative and the other patient was not, which due to bone graft area infection. Postoperative bone graft displacement occurred with 1 case and 1 case with L 5 nerve root pulling injury during the operation. Conclusion:The fusion cage can be removed by debridement via posterior approach, but it is difficult to done the completely debridement, which the main reason is the obstruction of the posterior nerve and bone structure. Posterior approach also have risks of infection recurrence and nerve root injury. Cage removal via anterior approach was relatively easy and debridement was thoroughly, which has the risk of injury of important adjacent vessels.

Objective:To construct the core competency framework and content for cardiac rehabilitation specialist nurses so as to provide a basis for training, use and assessment for cardiac rehabilitation specialist nurses.Methods:From December 2018 to December 2019, this study initially formed the core competency framework and content for cardiac rehabilitation specialist nurses by literature review and expert interview. Delphi method was used to 17 experts and two rounds of consultations. Items were screened and revised, and item weight was determined by combining with Precedence chart.Results:Among two rounds of expert consultation, the core competency framework and content for cardiac rehabilitation specialist nurses included 5 first-level items, 27 second-level items and 107 third-level items. The valid response rates of two rounds of expert consultation were 100% and 94.12%, and authoritative coefficients were 0.894 and 0.900 respectively. In the second round of expert consultation, Kendall harmonious coefficients of the first-level, second-level and third-level items were 0.342, 0.244 and 0.212 respectively ( P<0.01) . Conclusions:There are high levels of expert activity, authority as well as coordination. The core competency framework and content for cardiac rehabilitation specialist nurses can provide a basis for training, use and assessment for cardiac rehabilitation specialist nurses.

Objective To investigate the effect of hemin on neuronal necroptosis and its mechanism in mice after intracerebral hemorrhage.Methods (1) Experiment one: 24 C57BL/6 mice were divided into sham-operated group, saline control group, 5 mmol/L hemin group, and 10 mmol/L hemin group (n=6); mice in the latter two groups were injected 20μL 5 mmol/L or 10 mmol/L heme solution into the corpus striatum to prepare cerebral hemorrhage models, and the normal saline group was injected 20μL normal saline; Western blotting was used to detect the protein expressions of heme oxygenase-1 (HO-1), receptor-interacting protein (RIP)1, RIP3, and mixed lineage kinase domain like protein (MLKL). Three C57BL/6 mice were injected 20μL 10 mmol/L heme solution into the corpus striatum to prepare cerebral hemorrhage models; 24 h after that, double-labelling immunofluorescence was used to detect the expressions of Caspases-3 and neuron-specific nuclear protein (NeuN) in the hippocampus tissues. (2) Experiment two: the primary cultured hippocampal neurons were stimulated with 0, 10, 20, 40 and 80μmol/L heme for 6 h and 40μmol/L heme for 0, 1, 2, 4 and 6 h, respectively; lactic dehydrogenase (LDH) method was used to determine the neuron damage. After the primary cultured hippocampal neurons being stimulated with 40μmol/L heme for 0, 1, 2, 4 and 6 h, respectively, the protein expressions of interleukin-1 receptor (IL-1R)1, RIP1, RIP3, MLKL and caspase-3 in the neurons were detected by Western blotting, and the level of inflammatory factor interleukin-1β(IL-1β) was detected by ELISA. After primary cultured hippocampal neurons being stimulated with 0, 40μmol/L heme for 6 h, the expressions of NeuN and Caspase-3 in the neurons were detected by double-labelling immunofluorescence. (3) Experiment three: the primary cultured hippocampal neurons were pre-incubated with 0, 0.5, 1.0, and 1.5μg/mL IL-1R antagonist for one h, and then, stimulated with 40μmol/L heme for 6 h; the toxic injury of neurons was detected by LDH method, and the protein expressions of IL-1R1, RIP1, RIP3 and MLKL in neurons were detected by Western blotting.Results (1) As compared with those in the sham-operated group and saline control group, protein expressions of HO-1, RIP1, RIP3 and MLKL in the 5 mmol/L heme group and 10 mmol/L heme group were significantly increased (P<0.05); at 24 h after 10 mmol/L heme injection, Caspase-3 expression was found in frozen sections of hippocampal tissues of mice, but no co-localization of Caspase-3 and NeuN was found. (2) As compared with those in the 0μmol/L heme group, LDH release rates in the heme groups of different concentrations were significantly increased and concentration-dependent (P<0.05); as compared with the heme group of 0 h stimulation, the heme groups of different times of stimulation had significantly increased release rates of LDH in time dependent manner (P<0.05). As compared with the heme group of 0 h stimulation, the heme groups of different times of stimulation had significantly increased IL-1R1, RIP1, RIP3, and MLKL protein expressions (P<0.05); Caspase-3 showed no obvious changes. As compared with the heme group of 0 h stimulation, the heme groups of different times of stimulation had significantly increased IL-1βlevels in time dependent manner (P<0.05). No obvious Caspase-3 expression was noted in the heme group of 6 h stimulation. (3) As compared with the 40μmol/L heme group, pre-incubation groups of 0.5, 1.0, and 1.5μg/mL IL-1R antagonist had significantly reduced LDH release rates and protein expressions of IL-1R1, RIP1, RIP3 and MLKL (P<0.05).Conclusion sHemin could induce neuron cell death directly via a necroptosis pathway rather than Caspase3-mediated apoptosis. The cytotoxicity of hemin could be alleviated by blocking IL-1R.