Objective:To explore the predictive value of ultrasonic shear wave elastography (SWE) parameters and pathological characteristics on the status of human epidermal growth factor receptor 2 (HER2), which is difficult to be determined by immunohistochemistry (IHC) in breast cancer, and to construct a nomogram model.Methods:A retrospective case-control study was conducted. One hundred and fifteen cases of breast cancer diagnosed and treated in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from September 2018 to April 2022 were selected, and their HER2 was evaluated as IHC 2+; the HER2 expression status was determined by fluorescence in situ hybridization (FISH) detection, including 23 HER2 positive cases and 92 HER2 negative cases. The ultrasound SWE parameters [including maximum shear wave velocity (V max), mean shear wave velocity (V mean), median shear wave velocity (V median), minimum shear wave velocity (V min)] and clinicopathological characteristics between HER2 positive and negative groups were compared. The variables with statistically significant differences ( P < 0.05) between groups were included in a multivariate logistic regression model, the independent risk factors for HER2 positivity were screened, and a nomogram model was constructed based on these independent risk factors. With the FISH test results as the gold standard, the efficacy of nomogram in judging HER2 positivity in breast cancer which was difficult to be identified by IHC was evaluated with the receiver operating characteristic (ROC) curve; the accuracy and clinical net benefit of the nomogram model were evaluated using calibration curve and decision curve analysis (DCA), respectively. Results:The patients were all female, aged (56±13) years, ranging from 30 to 88 years old. V max [ M ( Q1, Q3)] [8.54 (7.38, 9.47) m/s vs. 6.46 (5.07, 8.42) m/s], V mean [(5.41±0.78) m/s vs. (4.53±1.22) m/s], V median [5.06 (4.48, 5.52) m/s vs. 4.35 (3.42, 4.96) m/s], V min [3.35 (2.68, 3.88) m/s vs. 2.59 (2.11, 3.34) m/s], the proportion of patients with axillary lymph node metastasis [56.5% (13/23) vs. 22.8% (21/92)], and the Ki-67 positivity index [35% (30%, 55%) vs. 25% (15%, 35%)] in the HER2 positive group were higher than those in the HER2 negative group, and the differences were statistically significant (all P < 0.05); There was no statistically significant difference in age, lesion location, pathological type, vascular invasion, nerve invasion and long diameter, short diameter, echo, regular shape, clear boundary, posterior echo, calcification, blood flow grading, Breast Imaging Report and Data System (BI-RADS) classification detected by ultrasound between the two groups (all P > 0.05). Multivariate logistic regression analysis showed that increased ultrasound V max ( OR = 1.786, 95% CI: 1.283-2.485, P = 0.001) and axillary lymph node metastasis ( OR = 4.185, 95% CI: 1.327-13.197, P = 0.015) and elevated Ki-67 positivity index ( OR = 1.042, 95% CI: 1.014-1.071, P = 0.003) were independent risk factors for HER2 positivity. ROC curve analysis showed that the area under the curve (AUC) of HER2 positive breast cancer which was difficult to be determined by IHC was 0.816 (95% CI: 0.732-0.883), that was higher than 0.712 (95% CI: 0.620-0.794) of V max, 0.601 (95% CI: 0.504-0.692) of axillary lymph node metastasis and 0.706 (95% CI: 0.613-0.788) of Ki-67 positivity index based on the nomogram constructed by the above independent risk factors, with statistically significant differences (all P < 0.05). The calibration curve showed that the predicted probability of the nomogram model was close to the actual probability, and DCA indicated that the clinical net benefit of the model was good. Conclusions:The nomogram constructed based on ultrasonic SWE parameter V max, axillary lymph node metastasis and Ki-67 positivity index has a good predictive effect on HER2 status of breast cancer which is difficult to be determined by IHC.

Objective:To explore the chain mediating role of positive coping and organizational climate in the relationship between charismatic leadership and clinical nurses' organizational silence behavior.Methods:This study was a cross-sectional research. A convenience sampling method was used to select 236 clinical nurses from the First Affiliated Hospital of Zhengzhou University from April to May 2024. The Conger-Kanungo Charismatic Leadership Scale, Simplified Coping Style Questionnaire (positive coping), Organizational Climate Scale, Nurse Organizational Silence Evaluation Questionnaire were administered to the nurses. Harman's single-factor test was used to examine common method bias, while Spearman's correlation analysis was employed to analyze the relationships among charismatic leadership, positive coping, organizational climate, and organizational silence behavior. The chain mediating effect of positive coping and organizational climate between charismatic leadership and organizational silence behavior was tested using Model 6 in SPSS PROCESS macro.Results:A total of 248 questionnaires were retrieved, with 236 valid responses, yielding an effective response rate of 95.16%. The common method bias test revealed that 7 factors with eigenvalues greater than 1 were extracted, with the first factor explaining 26.19% of the variance, which was below the critical value of 40%. Correlation analysis showed that charismatic leadership, positive coping, and organizational climate were positively correlated with each other ( P<0.05), and organizational silence behavior was negatively correlated with charismatic leadership, positive coping, and organizational climate ( P<0.05). The mediating effect analysis showed that charismatic leadership could directly affect nurses' organizational silence behavior ( β=-0.138, P<0.01), and could also affect nurses' organizational silence behavior through three mediating paths: charismatic leadership→positive coping→nurses' organizational silence behavior, with an effect value of -0.205, accounting for 46.91% (-0.205/ -0.437) of the total effect; charismatic leadership→organizational climate→nurses' organizational silence behavior, with an effect value of -0.073, accounting for 16.70% (-0.073/-0.437) of the total effect; charismatic leadership→positive coping→organizational climate→nurses' organizational silence behavior, with an effect value of -0.021, accounting for 4.81% (-0.021/-0.437) of the total effect. The total mediating effect was -0.299, accounting for 68.42% (-0.299/-0.437) of the total effect. Conclusions:Charismatic leadership not only directly influences nurses' organizational silence behavior but also has an indirect impact through the mediating effects of positive coping and organizational climate.

Objective:To explore the chain mediating role of positive coping and organizational climate in the relationship between charismatic leadership and clinical nurses' organizational silence behavior.Methods:This study was a cross-sectional research. A convenience sampling method was used to select 236 clinical nurses from the First Affiliated Hospital of Zhengzhou University from April to May 2024. The Conger-Kanungo Charismatic Leadership Scale, Simplified Coping Style Questionnaire (positive coping), Organizational Climate Scale, Nurse Organizational Silence Evaluation Questionnaire were administered to the nurses. Harman's single-factor test was used to examine common method bias, while Spearman's correlation analysis was employed to analyze the relationships among charismatic leadership, positive coping, organizational climate, and organizational silence behavior. The chain mediating effect of positive coping and organizational climate between charismatic leadership and organizational silence behavior was tested using Model 6 in SPSS PROCESS macro.Results:A total of 248 questionnaires were retrieved, with 236 valid responses, yielding an effective response rate of 95.16%. The common method bias test revealed that 7 factors with eigenvalues greater than 1 were extracted, with the first factor explaining 26.19% of the variance, which was below the critical value of 40%. Correlation analysis showed that charismatic leadership, positive coping, and organizational climate were positively correlated with each other ( P<0.05), and organizational silence behavior was negatively correlated with charismatic leadership, positive coping, and organizational climate ( P<0.05). The mediating effect analysis showed that charismatic leadership could directly affect nurses' organizational silence behavior ( β=-0.138, P<0.01), and could also affect nurses' organizational silence behavior through three mediating paths: charismatic leadership→positive coping→nurses' organizational silence behavior, with an effect value of -0.205, accounting for 46.91% (-0.205/ -0.437) of the total effect; charismatic leadership→organizational climate→nurses' organizational silence behavior, with an effect value of -0.073, accounting for 16.70% (-0.073/-0.437) of the total effect; charismatic leadership→positive coping→organizational climate→nurses' organizational silence behavior, with an effect value of -0.021, accounting for 4.81% (-0.021/-0.437) of the total effect. The total mediating effect was -0.299, accounting for 68.42% (-0.299/-0.437) of the total effect. Conclusions:Charismatic leadership not only directly influences nurses' organizational silence behavior but also has an indirect impact through the mediating effects of positive coping and organizational climate.

Objective:To explore the predictive value of ultrasonic shear wave elastography (SWE) parameters and pathological characteristics on the status of human epidermal growth factor receptor 2 (HER2), which is difficult to be determined by immunohistochemistry (IHC) in breast cancer, and to construct a nomogram model.Methods:A retrospective case-control study was conducted. One hundred and fifteen cases of breast cancer diagnosed and treated in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from September 2018 to April 2022 were selected, and their HER2 was evaluated as IHC 2+; the HER2 expression status was determined by fluorescence in situ hybridization (FISH) detection, including 23 HER2 positive cases and 92 HER2 negative cases. The ultrasound SWE parameters [including maximum shear wave velocity (V max), mean shear wave velocity (V mean), median shear wave velocity (V median), minimum shear wave velocity (V min)] and clinicopathological characteristics between HER2 positive and negative groups were compared. The variables with statistically significant differences ( P < 0.05) between groups were included in a multivariate logistic regression model, the independent risk factors for HER2 positivity were screened, and a nomogram model was constructed based on these independent risk factors. With the FISH test results as the gold standard, the efficacy of nomogram in judging HER2 positivity in breast cancer which was difficult to be identified by IHC was evaluated with the receiver operating characteristic (ROC) curve; the accuracy and clinical net benefit of the nomogram model were evaluated using calibration curve and decision curve analysis (DCA), respectively. Results:The patients were all female, aged (56±13) years, ranging from 30 to 88 years old. V max [ M ( Q1, Q3)] [8.54 (7.38, 9.47) m/s vs. 6.46 (5.07, 8.42) m/s], V mean [(5.41±0.78) m/s vs. (4.53±1.22) m/s], V median [5.06 (4.48, 5.52) m/s vs. 4.35 (3.42, 4.96) m/s], V min [3.35 (2.68, 3.88) m/s vs. 2.59 (2.11, 3.34) m/s], the proportion of patients with axillary lymph node metastasis [56.5% (13/23) vs. 22.8% (21/92)], and the Ki-67 positivity index [35% (30%, 55%) vs. 25% (15%, 35%)] in the HER2 positive group were higher than those in the HER2 negative group, and the differences were statistically significant (all P < 0.05); There was no statistically significant difference in age, lesion location, pathological type, vascular invasion, nerve invasion and long diameter, short diameter, echo, regular shape, clear boundary, posterior echo, calcification, blood flow grading, Breast Imaging Report and Data System (BI-RADS) classification detected by ultrasound between the two groups (all P > 0.05). Multivariate logistic regression analysis showed that increased ultrasound V max ( OR = 1.786, 95% CI: 1.283-2.485, P = 0.001) and axillary lymph node metastasis ( OR = 4.185, 95% CI: 1.327-13.197, P = 0.015) and elevated Ki-67 positivity index ( OR = 1.042, 95% CI: 1.014-1.071, P = 0.003) were independent risk factors for HER2 positivity. ROC curve analysis showed that the area under the curve (AUC) of HER2 positive breast cancer which was difficult to be determined by IHC was 0.816 (95% CI: 0.732-0.883), that was higher than 0.712 (95% CI: 0.620-0.794) of V max, 0.601 (95% CI: 0.504-0.692) of axillary lymph node metastasis and 0.706 (95% CI: 0.613-0.788) of Ki-67 positivity index based on the nomogram constructed by the above independent risk factors, with statistically significant differences (all P < 0.05). The calibration curve showed that the predicted probability of the nomogram model was close to the actual probability, and DCA indicated that the clinical net benefit of the model was good. Conclusions:The nomogram constructed based on ultrasonic SWE parameter V max, axillary lymph node metastasis and Ki-67 positivity index has a good predictive effect on HER2 status of breast cancer which is difficult to be determined by IHC.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

Objective:To assess the left ventricular myocardial function in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF) after percutaneous coronary intervention(PCI) by noninvasive myocardial work technology, and to explore the evolution of left ventricular myocardial function recovery.Methods:A total of 92 NSTE-ACS patients from July to December 2019 in Beijing Chao Yang Hospital with normal wall motion and LVEF (>55%) after PCI were recruited. Echocardiography was performed 1 day before PCI, 1 day, 2 weeks, 1 month, and 3 months after PCI. Global longitudinal strain (GLS) was analyzed, and Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global myocardial work efficiency (GWE) among groups were compared and their correlations with strain parameters were explored.Results:GWI, GCW, GWE were improved ( P<0.05) at 1 day after PCI, GLS improved ( P<0.05) and GWW decreased ( P<0.05) at 2 weeks, LVEF improved ( P<0.05) at 1 month. Baseline GWI and GCW had a moderately negative correlation with GLS ( r=-0.67, -0.66; both P<0.05); GWW had a moderately positive correlation with mechanical dispersion(MD) and postsystolic shortening index(PSI) ( rs=0.45, 0.50; both P<0.05); GWE had a moderately negative correlation with GLS, MD and PSI ( rs=-0.47, -0.55, -0.56; all P<0.05). Conclusions:Left ventricular myocardial function gradually improves in NSTE-ACS patients with normal wall motion and LVEF after PCI. Myocardial work parameters changes are more sensitive than GLS and LVEF, and can assess early left ventricular myocardial function changes after PCI.

Background China's manufacturing industry is still labor-intensive, and assembly employees in manufacturing industry are facing a great risk of work-related musculoskeletal disorders (WMSDs). Objective To investigate and analyze the prevalence and distribution of WMSDs among assembly workers in manufacturing enterprises and explore the relationship between WMSDs and ergonomic exposure factors such as posture load and mental load. Methods From July to September 2017, by convenient sampling, a cross-sectional survey was conducted to select 670 workers engaged in electronic accessories assembly and railway vehicle manufacturing in three manufacturing enterprises in two cities in northern China as the research participants. The posture load assessment was based on the Chinese Musculoskeletal Questionnaire independently developed by our research group. The mental load assessment was based on a revised Chinese version of the Subjective Workload Assessment Technique. An unconditional logistic regression model was used to explore the relationship between ergonomic exposure and WMSDs. Results The overall prevalence rate of WMSDs was 39.6% (265/670) with 43.8% in males and 25.2% in females; the highest prevalence rate was 47.7% in the group aged 40 years and over. The prevalence rate of WMSDs in the electronic accessories assembly workers was 16.9%, that in the railway vehicle manufacturing workers was 57.3%, and the difference was statistically significant (\begin{document}$ {\chi ^2} $\end{document}=112.63, P<0.001). The mental load score [median (first quartile, third quartile)] was 55.6 (51.9, 83.3) points, and the posture load score was 27.1 (16.0, 41.5) points. The results of unconditional logistic regression model showed that women (OR=3.152, 95%CI: 1.458-6.813), drinkers (OR=1.934, 95%CI: 1.124-3.326), and railway vehicle manufacturing worker (OR=3.416, 95%CI: 1.756-6.644) had a higher risk of reporting WMSDs; The higher the mental load (OR=1.019, 95%CI: 1.007-1.031) and posture load (OR=1.034, 95%CI: 1.019-1.050), the higher the risk of reporting WMSDs. The hierarchical analysis results showed that the risk of reporting WMSDs was higher among the electronic accessories assembly workers who were older (compared with those aged <30 years, OR_30-39=2.526 and OR_≥40=12.263, respectively) and with higher posture load (OR=1.025, 95%CI: 1.002-1.049), as well as among the railway vehicle manufacturing workers who were drinking (OR=2.035, 95%CI: 1.155-3.583), obese (OR=3.094, 95%CI: 1.185-8.078), with higher mental load (OR=1.013, 95%CI: 1.001-1.025) and posture load (OR=1.033, 95%CI: 1.018-1.049). Conclusion There is a significant correlation between reporting WMSDs and ergonomic exposures such as posture load and mental load, and drinking is also a risk factor of WMSDs. The risk of reporting WMSDs in female workers in assembly manufacturing industry is higher than that in male workers. The overall prevalence rate of WMSDs in railway vehicle manufacturing workers is higher than that in electronic accessories assembly workers.

With the continuous improvement of treatment ability in intensive care unit (ICU), many critically ill and complex patients have survived due to the development of technology. However, most of them suffer from the psychological and physiological problems of post-intensive care syndrome (PICS). Therefore, the early identification and prevention of PICS is particularly critical. We should understand the pathophysiological mechanism of PICS, strictly implement ABCDEFG bundle management measures [including airway management (A), breath (B), reasonable analgesia and sedation treatment (C), prevention of delirium (D), early rehabilitation (E), family engagement (F), good communication (G)] during ICU hospitalization, and pay attention to reasonable nutritional support, optimizing blood glucose management, providing positive psychological intervention and support to patients through family members' encouragement and accompanying, ICU diary and other forms, following up the health status of patients transferred out/discharged from ICU, providing multi-disciplinary and professional continuing medical services, finding the entry point and timing of traditional Chinese medicine intervention, and giving full play to the advantages of integrated traditional Chinese and Western medicine treatment, which can improve the quality of life of patients. This article reviews the pathophysiological mechanism, risk factors, prevention and management measures, traditional Chinese medicine syndrome differentiation and treatment of PICS, in order to improve the early identification, diagnosis and treatment of critical patients with PICS, and improve the prognosis of patients.

Objective:To evaluate the global and segmental myocardial work in patients with cardiac amyloidosis (CA) by left ventricular pressure-strain loop (PSL) noninvasively.Methods:Eighteen patients with CA in Beijing Chao-Yang Hospital from March 2018 to December 2020 were included as CA group, 20 healthy subjects were selected as control group. The global longitudinal strain (GLS) and mechanical dispersion (MD) of left ventricle were analyzed by two-dimensional speckle tracking imaging. The left ventricular PSL was used to assess global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). The mean value of left ventricular basal, mid and apical myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated and compared between the two groups.Results:①Compared with the control group, GLS was decreased and MD was increased in CA group (all P<0.05). ②GWI, GCW, GWW and GWE were decreased in CA group compared with the control group (all P<0.05). ③In CA group, the MWI, CW and WE of the basal, mid and apical segments were lower than those of control group (all P<0.05), WW of the basal and mid segments were lower than those of apical segment(all P<0.05). The impairment of MWI, WW and WE in basal and mid segment were more significant than those of apical segment (all P<0.05). ④GWI, GCW and GWE were positively correlated with GLS ( r=0.854, 0.816, 0.748; all P<0.001) and LVEF ( r=0.674, 0.634, 0.650; all P<0.01), and negatively correlated with MD ( r=-0.657, -0.672, -0.710, all P<0.01). GWI and GCW were negatively correlated with E/e′ ( r=-0.493, -0.539; all P<0.05). Conclusions:The global, basal, mid and apical left ventricular myocardial work indices are decreased in CA patients. MWI, CW and WE show an apical sparing pattern. Quantitative assessment of myocardial work by PSL may provide more valuable information for CA patients.