Objective To investigate the prognostic value of thrombin-antithrombin III complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor complex(t-PAIC)in patients with myelodysplastic syndrome(MDS).Methods Selected 88 primary MDS patients diagnosed at the 521 Hospital of Ordnance Industry from January 2018 to January 2021.Plasma levels of TAT,PIC,TM,t-PAIC,fibrin degradation products(FDP)and D-dimer(D-D)were measured.A multivariate approach was used to analyze the association between overall survival(OS)and the levels of each coagulation marker.Coagulation markers significantly associated with OS were used to construct a coagulation prognostic scoring system.Based on the median coagulation marker score,MDS patients were divided into high and low score groups.Kaplan-Meier analysis was used to plot survival curves.Results TAT(OR=1.667),PIC(OR=0.734),TM(OR=1.294)and t-PAIC(OR=1.523)were independent factors influencing OS in MDS patients(Wald χ2=0.671～10.751,all P<0.05).The β-values were integrated as statistical weights to construct a coagulation marker score,calculated as follows:[TAT]×0.502-[PIC]×1.013+[TM]×0.181+[t-PAIC]×0.381.The OS(median 14.6 months)and leukemia free survival(LFS)(median 10.3 months)of patients in the high coagulation marker score group were significantly lower than those in the low score group(33.6 months,35.2 months)(Log rank=20.57,26.84,all P<0.001).Subgroup analysis indicated that in both the low-risk IPSS-R subgroup(very low,low,and intermediate risk)and the high-risk IPSS-R subgroup(high and very high risk),the OS(Log rank=9.12,4.30)and LFS(Log rank=4.54,8.51)of the high coagulation marker score group were lower than those of the low score group(all P<0.05).Bivariate analysis showed a moderate correlation between the coagulation marker score and Revise International Prognostic Scoring System(IPSS-R)(PCC=0.536,P<0.001).Multivariate analysis indicated that IPSS-R and high coagulation marker scores were independent risk factors for OS and LFS in MDS patients(P<0.05).Conclusion The coagulation marker score,based on TAT,PIC,TM and t-PAIC,can serve as an independent prognostic factor for OS and LFS in MDS patients.

Objective To investigate the prognostic value of thrombin-antithrombin III complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor complex(t-PAIC)in patients with myelodysplastic syndrome(MDS).Methods Selected 88 primary MDS patients diagnosed at the 521 Hospital of Ordnance Industry from January 2018 to January 2021.Plasma levels of TAT,PIC,TM,t-PAIC,fibrin degradation products(FDP)and D-dimer(D-D)were measured.A multivariate approach was used to analyze the association between overall survival(OS)and the levels of each coagulation marker.Coagulation markers significantly associated with OS were used to construct a coagulation prognostic scoring system.Based on the median coagulation marker score,MDS patients were divided into high and low score groups.Kaplan-Meier analysis was used to plot survival curves.Results TAT(OR=1.667),PIC(OR=0.734),TM(OR=1.294)and t-PAIC(OR=1.523)were independent factors influencing OS in MDS patients(Wald χ2=0.671～10.751,all P<0.05).The β-values were integrated as statistical weights to construct a coagulation marker score,calculated as follows:[TAT]×0.502-[PIC]×1.013+[TM]×0.181+[t-PAIC]×0.381.The OS(median 14.6 months)and leukemia free survival(LFS)(median 10.3 months)of patients in the high coagulation marker score group were significantly lower than those in the low score group(33.6 months,35.2 months)(Log rank=20.57,26.84,all P<0.001).Subgroup analysis indicated that in both the low-risk IPSS-R subgroup(very low,low,and intermediate risk)and the high-risk IPSS-R subgroup(high and very high risk),the OS(Log rank=9.12,4.30)and LFS(Log rank=4.54,8.51)of the high coagulation marker score group were lower than those of the low score group(all P<0.05).Bivariate analysis showed a moderate correlation between the coagulation marker score and Revise International Prognostic Scoring System(IPSS-R)(PCC=0.536,P<0.001).Multivariate analysis indicated that IPSS-R and high coagulation marker scores were independent risk factors for OS and LFS in MDS patients(P<0.05).Conclusion The coagulation marker score,based on TAT,PIC,TM and t-PAIC,can serve as an independent prognostic factor for OS and LFS in MDS patients.

Nursing skill competitions are the wind vane for clinical nursing development, and the teaching concepts, proposition forms, and evaluation systems demonstrated by competitions have a strong reference value for nursing teaching. This article introduces the knowledge selection and integration from nursing-related courses according to the problems and objectives to be solved by drawing on the STEM education concept in comprehensive nursing practical training in the context of integration of competition and education. Realistic problem scenarios can be created with clinical cases as the carrier or main line, and then the Tanner clinical judgment model is used to guide students to conduct a comprehensive analysis of cases, thereby helping students to develop clinical thinking ability and comprehensive practical skills, so as to bridge the gap between the contents learned at school and nursing work in clinical practice and help nursing students adapt to clinical practice as soon as possible.

Objective:To investigate the efficacy and safety of intravenous thrombolysis and antiplatelet therapy in patients with stroke warning syndrome (SWS), as well as influencing factors of the outcome in patients with SWS.Method:Patients with SWS admitted to the 521 st Hospital of Ordnance Group from June 1, 2018 to December 31, 2023 were retrospectively included. Some patients were treated with ateplase intravenous thrombolysis, followed by oral antiplatelet therapy; some patients only received antiplatelet therapy. The main outcome measure was the modified Rankin Scale score at 90 days after onset, with a score of 0-2 defined as good outcome. Results:A total of 35 patients with SWS were included, including 26 males (74.3%) with an age of 58.29±11.06 years. Nineteen patients (54.3%) received intravenous thrombolysis, and 27 (77.1%) had good outcome at 90 days. There was no statistically significant difference in demographic, baseline data, and good outcome between the intravenous thrombolysis group and the antiplatelet therapy group. One patient had new stroke and one had transient ischemic attack in the intravenous thrombolysis group. There were statistically significant differences in ABCD2 score, systolic blood pressure, low-density lipoprotein cholesterol, fasting blood glucose, highest National Institutes of Health Stroke Scale (NIHSS) score at onset, and symptom duration between the good outcome group and the poor outcome group (all P<0.05). Conclusions:The efficacy of intravenous thrombolysis is similar to that of antiplatelet drugs alone in treating SWS. ABCD2 score, systolic blood pressure, low-density lipoprotein cholesterol, fasting blood glucose, highest NIHSS score at onset, and duration of symptoms may be influencing factors for the outcome of patients with SWS.

Objective:To analyze the clinical characteristics and neurophysiological features of patients with neuralgic amyotrophy (NA) and explore their neurological function status.Methods:Clinical data and neurophysiological findings of 90 patients diagnosed with NA at Beijing Tsinghua Changgung Hospital from September 2016 to January 2024 were collected and their clinical phenotypes and neurophysiological characteristics were systematically summarized and analyzed.Results:Among the 90 patients, males accounted for 60.0% (54 cases) and females accounted for 40.0% (36 cases). The duration of the disease was 12 (3, 36) months (ranged from 1 week to 5 years). The onset age of the patients was 58 (30, 70) (21-87) years. Unilateral involvement was noted in 94.4% (85/90) of patients, exhibiting a left-to-right ratio of 1∶1.3, while only 5.6% (5/90) had bilateral involvement. The majority of patients demonstrated a monophasic clinical course with a recurrence rate of just 2.2% (2/90). The primary clinical manifestations included upper limb pain in 70.0% (63/90) of patients, which progressed to muscle weakness and atrophy within 1 day to 1 month, whereas 30.0% (27/90) of patients without significant pain symptoms. Lesions predominantly affected the upper trunk of the brachial plexus, which accounted for 64.4% (58/90) of patients. Distal nerve injuries in the upper limb were observed in 14.4% (13/90) of patients, with 6.7% (6/90) demonstrating isolated anterior interosseous nerve involvement and another 6.7% (6/90) exhibiting isolated posterior interosseous nerve involvement; 1 case had concurrent anterior and posterior interosseous nerve damage. Additionally, 1 case presented with bilateral phrenic nerve involvement, and another patient had isolated posterior tibial nerve injury. Electrophysiological evaluations of patients with NA revealed that axonal damage to motor nerve fibers was a hallmark feature of the condition. Among patients undergoing motor nerve conduction studies, 68.8% (55/80) exhibited decreased compound muscle action potential amplitude, and 31.3% (25/80) had prolonged latency. Sensory nerve conduction was normal in 60.0% (48/80) of patients, while abnormalities included prolonged latency in 15.0% (12/80), reduced amplitude in 12.5% (10/80), slowed conduction velocity in 8.8% (7/80), and absent waveforms in 3.8% (3/80) of patients. The rates of abnormal nerve conduction findings in motor nerves were the highest in the suprascapular nerve (70.6%, 36/51), followed by the axillary nerve (58.3%, 35/60), musculocutaneous nerve (50.7%, 35/69), long thoracic nerve (6/17), and both anterior and posterior interosseous nerves (7.5%, 6/80 each). In sensory nerves, abnormalities were predominantly noted in the lateral antebrachial cutaneous nerve (30.0%, 12/40). Needle electromyography demonstrated neurogenic damage, most frequently affecting the infraspinatus muscle (69.2%, 18/26), biceps brachii (68.1%, 49/72), and deltoid muscle (65.3%, 47/72). The positive rate of magnetic resonance neurography (MRN) for NA was 62.1% (41/66), among which 63.4% (26/41) showed localized swelling of the brachial plexus, 51.2% (21/41) exhibited T 2 hyperintensity, and 4.9% (2/41) demonstrated denervated changes in the muscles. The positive rate of ultrasound for NA was 71.1% (59/83), with 91.5% (54/59) showing nerve swelling and 8.5% (5/59) exhibiting hourglass constriction .Conclusions:NA is a peripheral neuropathy characterized by spontaneous pain, limb weakness, and (or) muscle atrophy primarily. Its clinical phenotype predominantly involves damage to the upper trunk of the brachial plexus, which can also manifest as isolated mononeuropathy. Neurophysiological findings most commonly reveal the neurogenic damage to the muscles innervated by the upper trunk of the brachial plexus, mainly characterized by the axonal damage to the motor nerves, and pure motor nerve damage may also be observed. MRN and neuroultrasound can assist in qualitative diagnosis.

Objective:To assess the clinical efficacy and safety of image-guided γ-ray stereotactic body radiation therapy(IG γ-SBRT)in treating advanced pancreatic cancer.Methods:A total of fifty-six patients with advanced pancreatic cancer admitted to Senior Department of Oncology Medicine of the Fifth Medical Center of Chinese PLA General Hospital(Department of Oncology of the Sixth Medical Center)from February 2017 to September 2020 were selected.All patients were treated with IG γ-SBRT,and the 50%-60%of isodose curve covered the planned target volume(PTV).The peripheral dose of each time was 3.0-4.5 Gy,and there were 10-11 times of treatment.The therapeutic effect was observed and was evaluated by follow-up.The visual analog scale(VAS)score was adopted to assess the situation of the pain of patients before and 3 months after treatment,and the adverse reaction of them.Results:In the 56 patients,52 cases occurred epigastric pain with VAS ranging from 3 to 10 points,among which 32 patients accompanied by symptoms such as lower back pain and abdominal distension.After 3 months of treatment,the results of reexamination and follow-up indicated that there were 48 patients whose VAS scores decreased 3 scores and above 3 scores on the basis of original scores,and the efficiency of treating pain was 92.3%.In addition,the VAS scores of 3 patients decreased 1-2 scores on the basis of original scores,which ratio was 5.85%of the total number of people.All 56 patients were reexamined at the 3rd month after treatment,and 13 cases of them obtained complete response(CR),and 37 cases obtained partial response(PR),and 1 case obtained progressive disease(PD),and 5 cases obtained stable disease(SD),and the objectively response rate(ORR)was 89.3%,and the locally control rate was 98.2%.In addition,median progression-free survival(PFS)was 6.5 months,and 1-year survival rate was 62.5%(35/56),and 2-year survival rate was 23.2%(13/56).The adverse reactions of 56 patients were the adverse reactions of digestive system and blood system,among which 47 patients occurred upper digestive tract reaction,and the incidence of adverse reactions was 83.9%(47/56).A total of 43 patients occurred myelosuppression,and the incidence of myelosuppression was 76.8%(43/56).Conclusion:IG γ-SBRT can effectively relieve the symptoms of metastatic pancreatic cancer,and improve the effectiveness of treatment,the local control rate and survival rate.The tolerance of adverse reaction of that is favorable,and the safety of that is higher.

Objective:To compare the abilities of different neural networks to generate pseudo-computed tomography (CT) images from magnetic resonance imaging (MRI) images and to explore the feasibility of pseudo-CT for clinical radiotherapy planning.Methods:A total of 29 brain cancer patients with planning CT and diagnostic MRI were selected. 23 of these patients were used for training neural networks and 6 for testing pseudo-CT images. Cycle-consistent generative adversarial network (cycleGAN), contrastive learning for unpaired image-to-image translation (CUT), and improved network denseCUT proposed in this study were applied to generate pseudo-CT images from MRI images. The pseudo-CT images were imported into a clinical treatment planning system to verify the feasibility of applying this method to radiotherapy planning.Results:The comparison between the generated pseudo-CT images and real CT images showed that the mean absolute errors were (72.0±6.9), (72.5±8.0), and (64.6±7.3) HU for the cycleGAN, CUT, and denseCUT, respectively. Meanwhile, the structure similarity indices were 0.91±0.01, 0.91±0.01, and 0.93±0.01, respectively. The peak signal-to-noise ratios were (28.5±0.7), (28.5±0.7), and (29.5±0.7) dB, respectively. The 2%/2 mm γ passing rates were 98.05%, 97.92%, and 98.31% for the cycleGAN, CUT, and denseCUT, respectively.Conclusions:DenseCUT can generate more accurate pseudo-CT images and the pseudo-CT can meet the demand for the dose calculation of IMRT plan.

ObjectiveTo determine the prevalence of ticks parasitic on domestic animals in Yiwu City of Zhejiang Province. MethodsWe monitored， identified and analyzed ticks parasitic on domestic animals in Yiwu in 2021. ResultsA total of 452 domestic animals were monitored， of which 306 were infected with ticks， suggesting a prevalence of 67.70%. A total of 2，603 ticks were captured， and the tick index was determined to be 5.76. The ticks were identified to belong to one family， four genera， and 10 species. Haemaphysalis longicornis was the dominant tick （59.16%）， followed by Rhipicephalus haemaphysaloides （26.32%） and Rhipicephalus microplus （6.45%）. Prevalence of ticks， tick index， and number of tick species were listed for domestic animals as follows： goats （74.37%， 7.45， 7 species）， yellow cattle （62.50%， 4.14，6 species）， and dogs （54.62%， 2.59， 8 species）. Moreover， goat was the main domestic animal infected with more than two tick species （25.99%）； H.longicornis （91.26%） was the species with most repated infections. The dominant species of ticks were H.longicornis （65.15%） and R.haemaphysaloides （29.42%） in goats， R.microplus （67.67%） and R.haemaphysaloides （20.69%） in yellow cattle， and H.longicornis （57.14%） and Haemaphysalis porcupines （21.10%） in dogs. However， seasonal fluctuation in tick index differed among goats， yellow cattle and dogs. The fluctuation in tick index in goats and dogs was consistent with that of H.longicornis， with a major peak in March and the minor peaks in September and October. The fluctuation in tick index in yellow cattle was consistent with that of R.microplus， with two peaks in April and August-September. In addition， larval ticks， nymphal ticks and adult ticks were caught in this study， among which nymphal ticks were most common. We found that single domestic animals were infected with ticks of the same species and different stages， which was more common in goats and those animals infected with H.longicornis. ConclusionTicks parasitic on domestic animals are common in Yiwu. Multiple species of ticks have been identified， with H.longicornis as the dominant species. It warrants further monitoring and countermeasures.

Objective:To study the effect of cyclin Y (CCNY) on the lesion degree of patients with liver cancer and its correlation with preoperative and postoperative liver injury.Methods:The clinical data of 60 patients with liver cancer (liver cancer group) and 69 patients with liver cirrhosis (liver cirrhosis group) in Hangzhou Hospital of Zhejiang Medical and Health Group from January 2015 to October 2017 were retrospectively analyzed. In liver cirrhosis group, Child-Pugh liver function grade A was in 33 cases (liver cirrhosis grade A group), grade B was in 21 cases (liver cirrhosis grade B group), grade C was in 15 cases (liver cirrhosis grade C group). The serum total bilirubin (TBIL), alanine aminotransferase (ALT), albumin, cholinesterase, γ-glutamyl transpeptidase (GGT) and total bile acid were detected by automatic biochemical analyzer. The serum CCNY was detected by WB method, and compared with 40 healthy subjects (healthy control group).Results:Compared with those in healthy control group, the albumin and cholinesterase in liver cirrhosis grade A, B and C groups were significantly decreased, the ALT, TBIL, GGT, total bile acid and CCNY were significantly increased, , and the changes were more obvious with the severity of liver disease, and there were statistical differences ( P<0.05). Pearson correlation analysis result showed that the CCNY was positive correlation with TBIL, ALT, total bile acid and GGT in patients with liver cancer ( r = 0.544, 0.612, 0.553 and 0.539; P<0.05), and CCNY was negative correlation with albumin and cholinesterase ( r = - 0.478 and - 0.620, P<0.05). In patients with liver cancer, before operation and 1, 2 and 7 d after operation, the CCNY was 3.01 ± 1.10, 7.24 ± 2.57, 6.29 ± 1.78 and 4.01 ± 1.52, ALT was (98.74 ± 16.79), (430.55 ± 197.62), (255.73 ± 26.77) and (121.89 ± 20.42) U/L, respectively; the CCNY and ALT 1 and 2 d after operation were significantly higher than those before operation, those 2 d after operation were significantly lower than those 1 d after operation, those 7 d after operation were significantly lower than those 2 d after operation, and there were statistical differences ( P<0.05); there were no statistical difference between 7 d after operation and before operation ( P>0.05). The expression of CCNY before operation and 1 d, 2 d, 7 d after operation was positive correlation with ALT in patients with liver cancer ( r = 0.669, 0.821, 0.663 and 0.642; P<0.01). Conclusions:The more severe the degree of liver lesions in patients with liver cancer, the higher the serum CCNY, and the higher the expression of CCNY, the more severe the degree of liver injury in patients with liver cancer due to surgery, which is positively correlated with liver injury indexes.

Objective:To investigate the effect of baicalein in improving non-alcoholic fatty liver disease caused by high fat-induced oxidative damage in mice.Methods:Male C57BL/6J mice weighing 18-20 g were randomly divided into 4 groups: normal control group (C, 10% fat for energy), high-fat group (H, 60% fat for energy), high-fat + scutellaria baicalein group (H+B, baicalein: 400 mg·kg -1·bw -1), and baicalein control group (B, baicalein: 400 mg·kg -1·bw -1). After 12 weeks, mice were sacrificed, and the tissue samples were collected. Liver pathological changes were observed by hematoxylin and eosin staining. Mitochondrial morphology was examined by ultramicropathology. Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH) and mitochondrial membrane potential (MMP) changing levels in the liver were determined by kit. Sestrin2 and protein carbonylation (PCOS) levels were detected by Western blotting. Small interfering RNA (siRNA) was used to knock-down the Sestrin2 protein expression in HepG2 cells. Intramyocellular lipid changes in HepG2 cells was detected by fluorescent dye BODIPY493/503. One way ANOVA was used LSD pairwise comparison method was used to test the statistical difference. Results:Compared with the normal control group, high-fat fed caused significant fatty degeneration, decreased GSH and SOD levels ( P ??< 0.05), increased MDA and protein carbonylation levels, and increased Sestrin2 expression ( P < 0.05) in mice. Mitochondrial shape changes, swelling, lack of cristae, and MMP was down-regulated by 33.3% ( t = 13.456, P ??< 0.001). Baicalein intervention had effectively inhibited hepatic steatosis and oxidative damage caused by high-fat fed, and further up-regulated Sestrin2 expression, MMP ( t = 10.104, P ??< 0.001), and significantly alleviated liver damage in mice. Sestrin2 expression knock-down had further increased the intracellular lipid deposition and PCOs expression ( P ??< 0.05), and reduced baicalein ability to antagonize lipid deposition and antioxidant capacity in Hep2 cells. Conclusion:Baicalein alleviate non-alcoholic fatty liver by regulating Sestrin2 expression and high-fat fed-induced liver oxidative damage.