Purpose/Significance To construct a risk prediction model for postoperative massive bleeding in nasopharyngeal carcino-ma after radiotherapy,and to evaluate its predictive performance.Method/Process Inpatients with major bleeding after radiotherapy for nasopharyngeal cancer in the First Affiliated Hospital of Zhengzhou University from 2016 to 2019 are selected as the study objects,and the same number of patients without major bleeding are randomly selected as the control group.The medical record index data of the two groups of patients are collected,and various machine learning algorithms are applied respectively and the optimal algorithm is selected to build the model.Result/Conclusion The model based on support vector machine(SVM)algorithm has a recall rate of 0.94,an F1 val-ue of 0.93,and a precision of 0.93,showing the best performance.It can be used to construct a prediction model for postoperative mas-sive bleeding in nasopharyngeal carcinoma,and provide more accurate personalized prediction for patients,which has good clinical appli-cation prospects.

Phenylalanine ammonia-lyase (PAL) is the key entry enzyme of plant phenylpropanoid pathway. It plays an important role in the biosynthesis of podophyllotoxin, an anti-tumor lignan that is currently produced from its main natural source Sinopodophyllum hexandrum (Royle) Ying. In this study, we cloned the gene ShPAL encoding phenylalanine ammonia-lyase by RT-PCR from the root of S. hexandrum ecotype inhabited in the Aba' district, Sichuan, based on its public SRA transcriptome data-package. Bioinformatics analyses showed that the ShPAL-encoded protein is composed of 711 amino acids, contains the conserved domains of PAL, and has the signature motif within the active center of aromatic ammonia-lyases. Moreover, ShPAL protein was predicted to have a secondary structure mainly composed of α-helix and random coil, a typical 'seahorse' shape monomer tertiary structure, and a homologous tetramer three-dimensional structure by Swiss-Modelling. The phylogenetic lineage analysis indicated ShPAL was of the highest sequence identity and the shortest evolutionary distance with the PAL of Epimedium sagittatum from the same Berberidaceae family. Subcellular localization experiments showed that ShPAL protein was mainly distributed in the cytoplasm, despite of a minority on the endoplasmic reticulum membrane. Furthermore, ShPAL protein was recombinantly expressed in Escherichia coli and purified by histidine-tag affinity chromatography. Its enzymatic activity was determined up to 20.91 U/mg, with the optimum temperature of 41 ℃ and pH of 9.0. In contrast, the enzyme activity of its F130H mutant decreased by about 23.6%, yet with the same trends of change with temperature and pH, confirming that phenylalanine at this position does affect the substrate specificity of PAL. Both the wild type and the mutant have relatively poor thermostability, but good pH-stability. These results may help to further investigate the regulatory role of PAL in the process of podophyllotoxin biosynthesis and advance the heterologous synthesis of podophyllotoxin to protect the germplasm resource of S. hexandrum. They also demonstrate that ShPAL has a potential application in biochemical industry and biomedicine.
Phenylalanine Ammonia-Lyase/metabolism* ; Podophyllotoxin ; Phylogeny ; Cloning, Molecular

Objective:To provide a reference for in-depth application and research in the field of coronary heart disease traditional Chinese medicine (TCM) nursing. Based on the CiteSpace software, the development trend and research hotspots of the literature are displayed and analyzed in this field.Methods:The China Knowledge Network (CNKI) database was used to retrieve the literature related to the research in this field published in the past 20 years from January 1st 2001 to October 5th 2021, and CiteSpace was used to visually analyze the number of articles, research institutions, authors and keywords, and to interpret its meaning in combination with the content of the atlas.Results:The amount of research literature in this field was generally on the rise, but the cooperation between various research institutions and authors needs to be strengthened. Research hotspots mainly focused on five areas: coronary heart disease-related symptom care, the application of characteristic TCM nursing techniques, the outcome indicators of the research, the TCM health management of patients with coronary heart disease, and the application model of TCM nursing.Conclusions:It is recommended to strengthen multidisciplinary and teamwork in this field, carry out high-quality randomized controlled studies, and focus on related research on multiple nursing models, evaluation tools, and symptom management.

Objective:To evaluate the usability of gamification coronary heart disease health management platform based on WeChat, so as to provide support for self-management of coronary heart disease patients.Methods:From November to December 2022, 10 patients with coronary heart disease who were treated at Dongzhimen Hospital of Beijing University of Chinese Medicine were selected using convenience sampling. The research subjects registered for the health management platform by scanning the QR code and underwent a 2-month trial experience. Two months later, researchers collected data from the platform and used a combination of questionnaire surveys and qualitative interviews to investigate the user's experience and feedback of the research subjects, in order to evaluate the usability of the platform.Results:Within two months, the health management platform had 226 visits, an average visit time of 26 minutes, and an availability questionnaire score of (71.8±2.8). The research subjects had an acceptable attitude towards the usability of this platform, had a good overall user experience, and had also provided improvement suggestions for the platform while they gained beneficial experiences.Conclusions:The gamification coronary heart disease health management platform based on WeChat has good usability, providing a feasible means for the health management of heart disease patients, and also providing reference for other chronic disease health management projects involving lifestyle changes and incentives.

Objective:To develop and evaluate the Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease.Methods:The item pool of the Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease was formed through literature review and expert consultation. Items were screened by combining frequency, correlation coefficient, Cronbach's α coefficient and factor analysis. Subjective and objective weighting was used to determine the weight of items, and diagnostic threshold was determined by receiver operator characteristic curve. Cronbach's α coefficient and factor analysis were used to test the reliability and validity of the scale.Results:The Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease had a total of 6 syndrome elements and 36 items. It included 3 items of blood stasis, 9 items of phlegm, 7 items of Qi stagnation, 5 items of Qi deficiency, 6 items of Yin deficiency, and 6 items of Yang deficiency, and the diagnostic thresholds were 1.000, 45.300, 36.400, 66.600, 33.900, and 30.500 respectively. The test-retest reliability coefficients of each dimension of the scale were all greater than 0.7, and the internal consistency reliability coefficients of each dimension were 0.540 to 0.848. In the factor analysis, each variable with a common factor load coefficient greater than 0.4 was extracted, and the results were completely consistent with the scale entry settings. The cumulative variance contribution rate was 53.822%.Conclusions:The reliability and validity of the Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease are good, and it has scientific research and clinical application value.

Objective:To investigate the repair method and curative effect of iatrogenic penis skin necrosis of varying degrees.Methods:From June 2016 to December 2018, a total of 20 patients with varying degrees of iatrogenic penis skin necrosis were treated in our center. According to the area of the necrotic skin of penis, different treatment methods were selected: 2 patients with change dressing; 9 patients with relaxation suture; 7 patients with scrotal skin flap based on one side anterior scrotal artery; 2 patients with penile embedded in scrotum and secondary repair.Results:All patients were cured, there was no infection and flap necrosis. All of the patients were satisfied with the appearance of the penis, the flaps of anterior scrotal artery flap and scrotal pedicle embedding the penis survived well and the penis erectile function was not affected during the follow-up for 6 to 12 months.Conclusions:For patients of varying degrees of iatrogenic penis skin necrosis, individualized treatment should be adopted, which can effectively repair the penile defects and achieve satisfactory effect.

Objective:To investigate the use intention of patients with coronary heart disease for mobile health and understand needs of patients for gamification design of mobile health platform, in order to improve the self-management level of patients with coronary heart disease by building a gamified mobile health platform.Methods:Using the convenient sampling method, a total of 181 hospitalized patients with coronary heart disease (CHD) in Department of Cardiology from July to September 2020 (3 hospitals in Beijing and 1 hospital in Heilongjiang Province) were selected as research objects. Questionnaire on the usage needs of mobile health platform for coronary heart disease was used to investigate them.Results:Only 8 of the 181 patients (4.42%) used cardiac mobile health, and 113 (62.43%) patients never used cardiac mobile health but would consider using it. But 60 (33.15%) patients never used cardiac mobile medical experience and said that they won' t use it in the future, and the reasons included operation, language, safety, need awareness and health concerns. Among 121 patients with coronary heart disease, the top three requirements for gamification design were human-computer interaction encouragement and company (32.23%) , completion of tasks to exchange for real prizes (30.58%) and health ranking (28.10%) .Conclusions:Based on needs of patients, an easy-to-use, scientific and readable gamified mobile health platform for coronary heart disease should be built, mobile health publicity should be increased, and the continuous use rate of the mobile health platform and the self-management of patients should be improved.

Objective:To understand the cognition, willingness to test and influencing factors of hepatitis C (HCV) based on social software for men who have sex with men (MSM).Methods:An online questionnaire was used to investigate the target population of Blued platform users, including general demographic characteristics, sexual behavior, drug abuse behavior, cognition of hepatitis C prevention and treatment, past hepatitis C testing status and future testing willingness. There were 14 questions in the cognition part, and answering 10 or more questions were defined as "knowing" . Cognition rate, willingness to test and related influencing factors of hepatitis C were analyzed in different characteristics population. Data were analyzed by univariate and multivariate logistic regression.Results:A total of 1800 valid questionnaires were completed, of which 58.9% (1 061/1 800) had heard of hepatitis C, and the overall cognition rate of hepatitis C was 33.5% (603/1 800). The cognition rate of hepatitis C among those aged 30 years old, monthly income among RMB 5 000~10 000, high school education or above, and previous HIV testing [42.5% (371/873), 36.7% (191/520), 35.1% (584/1 663) and 37.4% (544/1453)] was considerably higher than those of the corresponding low-age, low-income, low-educated, not having HIV testing and not insisting on condom use, and the differences were statistically significant ( P < 0.05). The proportion of respondents who were willing to undergo hepatitis C testing in the next 3 months was 82.5% (851/1 031). The proportion of respondents who were tested for HIV in the past, had anal sex in the past 6 months and had high-risk behaviors [85.2% (766/899), 86.1% (609/707) and 86.6% (610/704)] was considerably higher than those who had not been tested for HIV, had no anal sex and had no high-risk behaviors in the past 6 months, and the differences were statistically significant ( P < 0.05). Conclusion:The survey respondents have a low cognition rate of hepatitis C, but have a higher willingness to test. Targeted publicity and education should be strengthened for this population, and convenient conditions should be provided to promote regular testing.

Objective To investigate the clinical implications of serum tenascin-C (TNC) levels for lung injury and the prognosis in acute paraquat (PQ) poisoning patients.Methods Clinical data of acute PQ poisoning patients hospitalized in Emergency Department of First Hospital of China Medical University from January 1 to December 31,2017 were prospectively collected.Patients' serum samples were obtained on admission and serum TNC levels were quantified by a commercially available enzymelinked immunosorbent assays (ELISA) kit.Patients were followed up to 28 d after poisoning and divided into the survival and non-survival groups.The differences of clinical data together with serum TNC level between the two groups were analyzed by univariable analysis.The correlation between serum TNC level and liver function,renal function and artery blood gas results was analyzed.Logistic regression analysis was used for assessing the independent risk factors of death.ROC curves of related parameters were plotted and the area under the curve (AUC) was calculated.Results Eighty-two patients were enrolled in this study:35 patients in the non-survival group and 47 patients in the survival group.There was no significant difference of data on admission between the two groups,including pH,PaO2,Cr,BUN,ALT,TBil,AMS,TNC,lung CT positive rate.But PaCO2,Lac,urine paraquat concentration and serum TNC level on admission were significantly different between the survival and non-survival groups.Furthermore,serum TNC level was correlated significantly with the worst PaO2 value,pH,and lung CT positive rate within 72 h from admission,especially the worst PaO2 value (r=-0.801,P＜0.01).Logistic regression analysis showed that the serum TNC level on admission was an independent risk factor for the prognosis of acute PQ poisoning patients.The AUC was 0.895 and the cutoff value was 41.9 ng/mL.Conclusion The early serum TNC level in acute PQ poisoning patients can predict the degree of lung injury and evaluate the prognosis.

Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography ( ERCP ) for the diagnosis and treatment of children with pancreaticobiliary diseases. Methods Clinical data of 115 children with pancreaticobiliary diseases who underwent ERCP between July 2006 and June 2016 at Hangzhou First People' s Hospital were reviewed. Anesthesia types, therapeutic methods,success rate and postoperative complications were summarized. Results A total of 221 ERCP procedures were performed on 115 patients. Eighty one cases were diagnosed as common bile duct stones, 22 bile duct cysts, 3 biliary ascariasis, 66 chronic pancreatitis, 45 pancreas divisum, and 43 acute pancreatitis. Thirty-one procedures were performed under general anesthesia. Dissection of pancreatic duct and biliary duct, calculus removal, insertion of pancreatic duct and biliary duct, and draining in pancreatic duct or biliary duct were performed. The success rate of the ERCP procedure was 98. 6％ ( 218/221) with complication rate of 7. 2％( 16/221 ) . In terms of postoperative complications, post-ERCP pancreatitisoccurred in 7 ( 3. 2％) cases, bleeding in 5 ( 2. 3％) , and postoperative cholangitis in 4 ( 1. 8％) . All the complications were cured after treatment. Conclusion Congenital anatomic anomalies are common in children with pancreaticobiliary diseases. Early diagnosis and treatment of ERCP by an experienced endoscopist for children with pancreaticobiliary diseases is effective and safe.