Objective To investigate the effects of carcinoembryonic antigen (CEA), carbohy-drate antigen (CA19-9), carbohy-drate antigen (CA125), human epididymis protein 4 (HE4) And the combined detection of ovarian cancer risk prediction model (ROMA) in the diagnosis and significance of endometrial cancer.Methods From May 2014 to May 2010, 80 patients with endometrial cancer were treated.According to its clinical pathology is divided into observation 1 group and observation 2 group.Serum samples were collected and serum CEA, CA19-9, CA125 and HE4 levels were analyzed statistically and the ROMA values were calculated according to menopausal status.Results Compared with the control group, the levels of CEA, CA19-9, CA125 and HE4 in the serum of observation group patients with endometrial carcinoma were significantly higher than those in the control group, the ROMA value of the menopausal state was significantly higher, the difference was statistically significant (P＜0.05).And with the progression of endometrial cancer staging, compared with the observation 1 group, the levels of CA19-9, CA125 and HE4 in the serum of the observation 2 group were significantly higher, the ROMA values of the menopausal states were significantly increased, the difference was statistically significant (P＜0.05).The combined detection rate of CEA, CA19-9, CA125, HE4 and ROMA in serum of patients with endometrial carcinoma was significantly higher than that of each index (P＜0.05).Conclusion The abnormally elevated levels of CEA, CA19-9, CA125, HE4, and ROMA in the serum of patients have important significance and role in the clinical diagnosis of endometrial cancer and its clinical staging.

Objective To investigate the effects of moderate-to-vigorous intensity physical activity (MVPA) in early pregnancy on the onset of gestational diabetes mellitus (GDM) in Sichuan Province. Methods A case-control study was performed on 1 508 gravidas at 8-14 gestational weeks in Sichuan Provincial Hospital for Women and Children from February to July, 2017. Baseline information during early pregnancy was collected through questionnaires. Information on time and intensity of physical activity were collected through pregnancy physical activity questionnaire. The time spent in MVPA was calculated and was categorized as active ( ≥ 3.5 h/week) or inactive MVPA (<3.5 h/week). Based on self-reported pre-pregnancy weights collected by questionnaire as well as the measured heights, body mass index (BMI) before pregnancy was calculated. After a 75 g oral glucose tolerance test (OGTT) at 24-28 gestational weeks, all subjects were divided into GDM (n=561) or non-GDM group (n=947), according to the GDM diagnostic criteria of the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China (2014). Mann-Whitney U test and Chi-square test were used for statistical analysis. Multivariate unconditional logistic regression model was used to analyze the association between the time of MVPA in early pregnancy and GDM incidence. ResuLts The median time spent in MVPA [M(P25-P75)] in early pregnancy was 3.00 (0.50-3.12) h/week, and 345 gravidas (22.9%) were classified as active in MVPA. After the control of confounding factors such as age, gravidity and parity history, and pre-pregnancy BMI, the multivariate unconditional logistic regression analysis showed that compared with the inactive group, the risk of GDM of active MVPA gravidas was reduced by 26.1% (OR=0.739, 95%CI: 0.553-0.989, P=0.042). Among primigravidas and primiparae, the risk of GDM in active MVPA gravidas was decreased by 47.6% and 44.3% than the inactive ones, respectively (primigravidas: OR=0.524, 95%CI: 0.297-0.925, P=0.026; primiparae: OR=0.557, 95%CI: 0.357-0.868, P=0.010). ConcLusions Insufficient physical activity in early pregnancy is common in gravidas in Sichuan, China. The risk of GDM could be reduced if the frequency of MVPA during early pregnancy is no less than 3.5 h/week, especially in primigravidas and primiparae.

Objective To investigate the clinical characteristics of paraneoplastic syndrome with prominent osteoarticular involvement. Methods The clinical materials of 20 patients with paraneoplastic syndrome with prominent osteoarticular involvement were collected. The characteristics of clinical manifest-ations, laboratory tests and imagines were analyzed. Results Among the 20 patients, 16 were male and 4 were female, with a mean age of 44.5 years and a median course of 6 months. Ten cases were associated with hematological tumor and 10 cases were associated with solid tumor. Eleven cases presented as peripheral arthritis (7 cases of polyarthritis, 4 cases of oligoarthritis/monoarthritis), 5 cases presented with hypertrophic osteoarthropathy (HOA) and 4 cases presented with tumor-induced osteomalacia (TIO). Three cases were acute lymphocytic leukemia, 2 cases were multiple myeloma, 1 case was lymphoma, and 1 case was bone tumor in polyarthritis. Four oligoarthritis cases were all associated with acute lymphocytic leukemia. All 5 cases of HOA were associated with lung cancer. All 4 cases of TIO were associated with tumor of mesenchymal tissue. Extra-articular manifestations presented in 14 cases and inflammatory markers increased in 15 cases. anti-cyclic cirullinated peptide (anti-CCP) antibodies was low titer positive in only 1 case and other parameters including rheumatoid factor (RF), anti-CCP antibodies, antinuclear antibodies spectrum (ANAs) and human leukocyte antigen (HLA)-B27 were negative. Multiple bone imaging abnormalities appeared in 15 cases. Conclusion Osteoarticular manifestations may be the first symptom of malignancy and difficult to diagnose. It is necessary to be highly aware of potential malignancy.

Objective To investigate the application value of deep learning optical coherence tomography ( OCT) on wet age-related macular degeneration ( wAMD) assisted diagnosis. Methods Weakly supervised deep learning algorithms was applied on the premise that only disease or not can be provided as a marker. The OCT image automatically assisted in the diagnosis of diseased areas of wAMD,and thermograms were applied to provide a basis for doctors to detect disease areas. Based on the deep learning of weak supervision,a new network algorithm structure was proposed for detecting disease area in ophthalmic OCT images. At the same time, thermograms were adopted to improve the accuracy of the lesion map,which is the location of the lesion area. This study followed the Declaration of Helsinki. This study protocol was approved by Ethic Committee of Ningbo Eye Hospital ( No. 2018-YJ05 ) . Written informed consent was obtained from each subject before entering study cohort. Results Resnet-based deep learning algorithm gave a diagnostic accuracy rate of 94. 9％ for the disease, which was much higher than that of AlexNet 85. 3％,VGG 88. 7％, and Google-Net 89. 2％. The thermograms with different colors provided a more convenient auxiliary diagnosis basis for doctors. Conclusions Compared with the original classification network,which needs disease area markers as empirical knowledge, deep learning algorithm model not only provides better results in the classification of retinal diseases,but also marks potential disease areas. The lesion area provides a basis for judging the area of the lesion for the diagnosis of wAMD.

Adolescent ; Adult ; Brain ; abnormalities ; pathology ; physiopathology ; Child ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Nerve Net ; pathology ; physiopathology ; Schizophrenia ; etiology ; physiopathology ; Schizophrenic Psychology

Objective: To observe the efficacy and safety of intensive cladribine-based conditioning regimen for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with major thalassemia. Methods: Retrospective analysis was performed for the clinical data of 12 children with major thalassemia undergoing allo-HSCT from March 2017 to July 2018. All of them were diagnosed definitely and the median age at transplantation was 5 years (range: 2-13 years), including HSCT from HLA-matched unrelated donor (n=8), HLA8/10-matched unrelated donor (n=1), HLA-matched sibing donor (n=2) and haploidentical donor (n=1). They received a new intensive conditioning regimen of cyclophosphamide (CTX), cladribine, busulfan (Bu) and antithymocytic globulin. The median doses of mononuclear cell (MNC) and CD34 positive cell were 10.97×10⁸/kg (range: 5.72-12.49×10⁸/kg) and 12.2×10⁶/kg (range: 6.7-22×10⁶/kg). Graft-versus-host disease (GVHD) was prevented by cyclosporine A (CSA), methotrexate (MTX) and mycophenolate mofetil (MMF). Results: Engraftment succeeded (n=11) and failed (n=1). The median time of neutrophil and platelet engraftment was 11 days (range: 8-17 days) and 13 days (range: 8-37 days) respectively. There were grade II acute GVHD (n=6) and grade IV intestinal acute GVHD (n=1) at 35 days post-transplantation. The latter one finally died of severe infection at 70 days post-transplantation. Two recipients of DLI developed limited chronic GVHD. Three cases (25%) developed cytomegaloviremia. None suffered from severe transplantation-related complications, such as cytomegalovirus diseases, hepatic veno-occlusive disease (HVOD), hemorrhagic cystitis or septicemia, etc. The median follow-up time was 15(8-18) months. Among 11 survivors, ten became transfusion-independent. Conclusions Cladribine-based conditioning regimen is both safe and effective for allo-HSCT in children with major thalassemia. However, vigorous immunosuppression may increase the risks of infection and viral activation after transplantation.

Objective To investigate the effect of calcitriol on osteogenic differentiation of mesenchymal stem cells (MSCs) induced by bone morphogenetic protein 9 (BMP9). Methods The experiment was divided into four groups: control group, calcitriol group, BMP9 group and BMP9+calcitriol group. Quantitative PNPP method was used to detect alkaline phosphatase (ALP) activity. RT-PCR and Western blotting method analyzed expression of osteocalcin（OCN）and osteopontin (OPN). Alizarin red staining assessed the formation of mineralized nodules. In addition, the changes of cell morphology and elastic modulus during osteogenic differentiation were studied by atomic force microscope. ResultsCompared with control group, calcitriol alone had no significant effect on the osteogenic differentiation of MSCs, but calcitriol could enhanced expression of osteogenic markers and formation of mineralized nodules induced by BMP9. However, neither calcitriol nor BMP9 could affect elastic modulus of cells. The combined treatment of BMP9 and calcitol could enhance phosphorylation of AKT and β-catenin which were both important for osteogenesis. The pretreated PI3K inhibitor could inhibit phosphorylation of AKT and β-catenin as well as ALP activity in BMP9+calcitriol group. In addition, calcitriol did not affect the BMP/Smad signaling pathway induced by BMP9. Conclusions Calcitriol synergies with BMP9 could promote MSCs osteogenesis by activating the PI3K/AKT signaling pathway. The study about effects and mechanisms of different regulatory factors on osteogenic differentiation of MSCs is of great significance for the treatment of osteoporosis and the development of bone tissue engineering.

Objective: Through research on the geriatric nursing related literature in Chinese journals and medical care and elderly care combination related keywords from 1979 to 2017, this study provides the development trend of geriatric nursing research. Methods: Searching articles in Wanfang, CNKI, VIP database, selecting the keywords and published time of the paper. Employing descriptive statistics to describe literatures information such as publication time, quantity of keywords, word frequency of keywords, heat degree of keywords, character of keywords and so on. Results: Totally 134 791 articles were got and 58 031 articles were included in the analysis. The amount of literature growth was slow before 2005, The cumulative amount of literature in 1979-2005 was only 12.75% of the total amount of literature. After 2005, the amount of literature increased rapidly year by year. The number of literature published in 2017 has exceeded 12%. The amount of the geriatric nursing related literature was proportional to the number of people aged 65 and over in China. In the research of geriatric nursing, the content related to medical care and elderly care combination was quite dispersed, and it did not involve research at the level of Medical Association. The medical care and elderly care combination and Medical Association were new areas in the research of geriatric nursing. Conclusion The amount of the geriatric nursing related literature from 1979 to 2017 was proportional to the number of people aged 65 and over in China. There are few researches on how to carry out geriatric nursing under the policy of medical care and elderly care combination and Medical Association, which should be the focus of future research and exploration to actively respond to the challenge of aging population.

Objective: To explore the effect of 4R crisis management theory on reducing urinary tract infections in Department of Urology severe craniocerebral injury. Methods: A randomized controlled clinical trial was conducted. From January 2018 to January 2019, 92 patients with indwelling urinary catheter were selected as the study subjects in the Department of Urology, Jiangsu People's Hospital. The control group was given routine nursing of indwelling catheter, while the observation group was given nursing of indwelling catheter with 4R crisis management theory on the basis of the control group. The incidence of catheter-associated urinary tract infections (CAUTI), the occurrence time of CAUTI, the days of indwelling catheter, the days of hospitalization and the urine culture bacteria were observed. Results: The incidence of CAUTI, occurrence time and days of indwelling catheter in the observation group were 8.70% (4/46), (12.417 ± 3.542) d, 5 (3, 12), while those in the control group were 30.43% (14/46), (9.762 ± 2.874) d, 9 (4, 21). There were significant differences in CAUTI incidence, occurrence time and days of indwelling catheter between the two groups (χ²=7.168, t=5.838, Z=5.192, P < 0.01 or 0.05); there was no significant difference in hospitalization days between the two groups (P > 0.05). Seven pathogenic bacteria were detected in urine culture of control group and three pathogenic bacteria were detected in observation group. The number of pathogenic bacteria in observation group was less than that in control group. Conlousion 4R crisis management theory can effectively reduce the incidence of CAUTI, delay the occurrence of CAUTI, shorten the days of indwelling catheter, and reduce the pathogenic bacteria in urine culture, which is worthy of clinical application.

Objective: To understand the medical expenditure and related household economic burden of pulmonary tuberculosis (TB) patients receiving full course treatment in designated TB hospitals in China and identify the related factors. Method: A cross-sectional study was conducted in 535 consecutive TB patients receiving TB treatment from April 2017 to June 2017 in 5 designated TB hospitals in eastern and western China selected through stratified cluster sampling. A questionnaire was used to collect the information about patients’ social economic characteristics and TB diagnosis and treatment expenditure. Results: The average total medical expenditure for TB treatment was 12 635.5 yuan (RMB), in which the direct medical expenditure accounted for 65.3% of the total. Nearly half of the total medical expenditure occurred in pre-treatment period. The expenditure in pre- treatment period was higher in the patients with low education level, newly treated patients, and initial sputum negative patients. The median (quartile) for the ratio of total medical expenditure to annual household income was 22%(10%-57%). Ordinal logistic regression analysis showed that low-level education background, lower household income, hospitalization and suffering from other chronic disease might increase the ratio of medical expenditure to annual household income. Conclusions Medical expenditure for full course TB treatment is still high in patients in designated TB hospitals. It is suggested to strengthen the capability building of timely found and referral of TB patients in non- designated hospitals and improve fee reduction and exemption policy for some patients.