Objective To investigate the relationship between circadian sleep-wake biorhythm and prognosis in patients with middle cerebral artery acute ischemic stroke.Methods A total of 71 patients with acute ischemic stroke of middle cerebral artery were selected as the case group,and 67 patients without acute ischemic stroke and cerebrovascular stenosis were selected as the control group.According to the modified Rankin score at discharge,patients with acute ischemic stroke were subdivided into the good prognosis group(53 cases)and the poor prognosis group(18 cases).General clinical data of patients were collected,and differences of circadian rhythm,daytime sleep-wake rhythm,nighttime sleep-wake rhythm and circadian sleep-wake rhythm indexes were analyzed and compared between the two groups.Multivariate Logistic stepwise regression analysis was used to analyze prognostic factors of acute ischemic stroke in middle cerebral artery.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of relevant variables.Results Age,male ratio,hypertension,diabetes,hyperlipidemia,smoking and drinking history were significantly higher in the case group than those in the control group.Daytime stability(IS)in the case group was lower than that in the control group(P＜0.05).Daytime total sleep time,wake time after falling asleep,light sleep period,deep sleep period,non-rapid eye movement(NREM)sleep period,rapid eye movement(REM)sleep period and the proportion of deep sleep period,the proportion of REM sleep period were higher in the case group than those of the control group,while the REM sleep latency and the proportion of light sleep period were lower than those of the control group(P＜0.05).The total sleep time,wake time,light sleep period,NREM sleep period and REM sleep period were higher in the case group than those of control group,while the proportion of sleep latency and REM sleep period were lower than those of the control group(P＜0.05).The proportion of increased circadian sleep,increased daytime sleep and low sleep efficiency at night were higher in the case group than those of the control group(P＜0.05).Logistic stepwise regression analysis showed that daytime REM sleep was a prognistic factor in middle cerebral artery acute ischemic stroke.During daytime REM sleep,the area under ROC curve(AUC)was 0.705,the sensitivity was 0.811 and the specificity was 0.611.Conclusion After acute ischemic stroke of middle cerebral artery,the circadian sleep-wake rhythm is unbalanced,which is manifested as poor daytime stability,increased daytime sleep,increased circadian sleep and low sleep efficiency at night.Daytime REM sleep has predictive value for prognosis of acute ischemic stroke of middle cerebral artery.

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.

Background Individual monitoring of occupational external exposure is an essential part of the occupational health management of radiation workers, and is an important basis for the evaluation of individual absorbed dose and the diagnosis of occupational radiation diseases. Continuous participation of monitoring service providers in intercomparison is a fundamental quality assurance for routine monitoring, which can identify problems and improve them in time. Objective Taking the Laboratory of Radiation Protection in Shanghai Institute of Preventive Medicine as an example, to evaluate the performance of an individual occupational external dose monitoring system in the laboratory, identify influencing factors of the monitoring results, and provide a basis for improving the quality of daily monitoring by analyzing the process and results of a national intercomparison of individual dose monitoring. Methods According to the Testing criteria of personnel dosimetry performance for external exposure (GBZ 207-2016), and the relevant requirements of Class II (photon) inspection, a total of 20 groups of blind sample dosimeters were measured for four consecutive years from 2018 to 2021. The radiation energy source of each group was identified, and related personal dose equivalent H_p(10), the uncertainty of measurement results, and the deviation between the reported value and the reference value were calculated. The national intercomparison process and results of individual dose monitoring were also analyzed. Results The energy sources of the blind samples in the tested laboratory for four years were N100 or Cs-137. The reported dose values of the blind samples were 0.57-4.61 mSv, the combined uncertainties were 0.043-0.365 mSv, the expanded uncertainties (k=2) were 0.09-0.73 mSv, and the relative expanded uncertainties (k=2) were 13.8%-16.4%. The single-group performance ∣P_i∣ of 20 sets of blind samples in the four years was ≤0.10, the yearly comprehensive performance of 5 sets of blind samples was ≤0.10, and the yearly Q score of the test report was >15 points. The laboratory achieved excellent results in the national intercomparison of individual dose monitoring in four consecutive years, except the Q value not reaching full score. Conclusion The laboratory exhibits standardized data processing of individual dose monitoring, generates accurate and reliable results, and meets the requirements of relevant national standards; but it should continue to participate in the national intercomparison of individual dose monitoring, strengthen the angular response research of energy identified dosimeter, improve the monitoring ability of low-dose X-rays, analyze the key points of reducing the uncertainty of measurement results, and continuously improve the monitoring ability.

Objective:To explore the coping trajectory of primary caregivers in patients with permanent enterostomy, and to provide theoretical basis for clinical intervention.Methods:A semi-structured interview was conducted among 20 primary caregivers of patients with permanent enterostomy hospitalized in Qilu Hospital of Shandong University from May to July 2021. The data were analyzed by three-level coding and continuous comparison.Results:The coping trajectory of primary caregivers of permanent enterostomy patients experienced confusion and fatigue period, coping exploration period, acceptance and coexistence period, transformation and transcendence period.Conclusions:Medical staff should give corresponding health education and timely formulate effective intervention measures according to different stages. At the same time, we should effectively integrate external resources to promote the construction of "Hospital-Family-Community" tripartite care model to relieve the care pressure of caregivers.

Objective:To construct back propagation (BP) neural network model to predict the dose required for 131I therapy for hyperthyroidism and to calculate the personalized dose plan for patients. Methods:A complete set of data of patients treated for hyperthyroidism radioaiodine was collected from the nuclear medicine departments of several medical colleges in Shanghai, including history, examination result, treatment course, etc. As a result, a prediction model was established. The predicated result for BP neural network, radial basis function (RBF) neural network and Support Vector Machine (SVM) were compared by means of small sample data. The optimal model was selected to predict administrated dose and to finally test the accuracy of the model.Results:The average errors in BP neural network, RBF neural network and SVM model based on small samples were 5.53%, 7.09% and 9.64%, respectively. After comparison, BP neural network was selected to build the prediction model. 30 cases of data were selected by random sampling to verify the BP neural network. The mean error, mean square error, minimum error and maximum error of the prediction result were 7.22%, 0.053, 0.57% and 13.78%, respectively.Conclusions:In this study, a neural network prediction method was proposed to provide a more accurate dose for patients in need of radioiodine therap for hyperthyroidism, and to reduce the possibility of radiation damage or the unsatisfactory therapeutic effect caused by insufficient dose. It has clinical practical significance in providing the reference for clinicians to evaluate the administrated dose.

Humans ; COVID-19 ; Consensus ; SARS-CoV-2 ; China

Objective:To investigate the clinicpathological, immunohistochemical and molecular genetic features of malignant mixed mesodermal tumor (MMMT) in the female reproductive system.Methods:To analyze its histopathological characteristics, we performed a retrospective review of the MMMT cases diagnosed at PLA General Hospital, Beijing, China during 2005-2019 using its surgical and pathological databases. EnVision immunohistochemical staining was used to detect the expression of ER, PR, p16, p53 and MMR proteins.Results:Fifty cases were conformed to the diagnosis, including 29 cases originated in the uterus, 16 cases in ovary, 4 cases of synchronous occurrence in uterus and ovary, 1 case in cervix. The tumor was histologically composed of two components, namely carcinoma and sarcoma ones, with clear borderline or blend mutually. The proportion of cancer component in the whole tumor ranged from 5%-90%. The proportion of carcinoma was more than 50% in 76% of the cases, and less than 50% in 24% of cases, including 2 cases with<10% of carcinoma. In the cases of primary uterine MMMT, the main carcinoma type was high grade endometrioid carcinoma (55%, 16/29). In ovarian MMMT, the main carcinoma type was serous carcinoma (12/16), while that of cervical MMMT was squamous cell carcinoma. The others were clear cell carcinoma or the undifferentiated carcinoma. There was one carcinoma type in most cases, only 7 cases had two carcinoma types. Homologous sarcomas, including stromal sarcoma, leiomyosarcoma and high-grade spindle cell sarcomas, were more commonly found in uterine MMMT (72.4%, 21/29). While heterogenic sarcomas, including chondrosarcoma, osteosarcoma and rhabdomyosarcoma, were more commonly noted in ovarian MMMT (12/16) than MMMT of other sites. There were 10 cases that consisted of two types of sarcomas. The synchronous MMMT of uterus and ovary had similar morphology and the types of carcinoma and sarcoma. The tumor cells that spread or metastasized to lymph node, omentum, intestinal wall or skin were all carcinoma cells, and were morphologically consistent with the original tumors. Immunohistochemically, ER and PR were both negative (23/25 in uterine, 8/10 in ovarian tumors). p16 was strongly positive (11/11 in uterine tumors, and 6/6 in ovarian tumors), with similar expression patterns in the carcinoma and sarcoma components. p53 showed mutant-type staining (64%, 21/33) and expressed synchronously in carcinoma and sarcoma components. p53 mutation was found in 35% cases of endometrial carcinoma and 46.7% cases of non-endometrial carcinoma. p53 mutation was also found in only 31.8% cases of heterogenic sarcomas, but in 50% of non-heterogenic sarcomas. Twenty-eight cases (28/33, 85%) presented intact mismatch repair proteins, while 5 cases (5/33, 15%) presented deficient mismatch repair proteins.Conclusions:MMMT in female reproductive system is a rare high-grade biphasic tumor with complex and diverse morphology. The immunohistochemical features are characterized by negative ER/PR and strongly positive p16, mostly mutant p53 and proficient mismatch repair proteins. The patients with a high FIGO stage have worse prognosis.

OBJECTIVE： To study the development status of TCM enterprises of Nantong city and provide suggestions， and to promote the sustainable development of TCM enterprises of Nantong city. METHODS： Taking Nantong city as an example， questionnaires were issued to 15 TCM enterprises in Nantong （including 4 TCM decoction piece enterprises， 11 TCM pharmaceutical preparation enterprises）. The statistical analysis was carried out in respects of scale structure， development （including economic development and staff） and development potential （by enterprise R&D funds and R&D personnel input intensity） of enterprises during 2013-2017. RESULTS & CONCLUSIONS： In terms of the scale and structure of the enterprise， there were no large-scale enterprises in Nantong city， only 3 medium-sized enterprises， 12 small enterprises； the overall scale of enterprises was small； the overall concentration of TCM enterprises was not high， in which the market structure of TCM decoction piece enterprises was oligopolistic， and the structure of preparation enterprises was competitive. The concentration of TCM decoction enterprises was higher than that of TCM preparation enterprises. In terms of economic development， the annual average GDP and profit growth rate are 14.98％ and 19.09％ from 2014 to 2017； the economic development situation was good， but the brand variety advantage was not developed fully. In terms of staff， employee’s education level was mainly college degree （34.01％） and the staff category was mainly salesperson （32.73％）. In terms of the company’s development potential， enterprise R&D funds and R&D personnel input intensity were in low levels （average 2.96％， 11.32％ in 5 years）， the number of patents （16 in 2013 vs. 17 in 2017） and innovative products （7 in 2013 vs. 12 in 2017） increases slowly， and only one had opened up overseas markets. In response to the issues， TCM enterprises of Nantong city or other areas should merge and reorganize appropriately to expand the scale of the industry and improve the market concentration； increase research funds and talented personnel investment， insist the protection and in novation of TCM. In addition， build a big data “healthy cloud” platform to break the traditional industrial chain； at the same time， seize the “Belt and Road” policy finance and taxation opportunities to promote overseas and develop markets to promote the sustainable development of TCM enterprise.

Objective To study the cell morphology and differentiation efficiency when rabbit bone marrow mesenchymal stem cells (BMSCs) were induced osteogenic differentiation as culturing by autologous platelet-rich plasma (PRP) instead of serum,and to explore a new method of inducing BMSCs osteogenic differentiation.Methods The PRP was prepared by arterial blood of rabbit.Punctured and The bone marrow was sampled from rabbit's iliac bone,and BMSCs were collected,which divided into PRP group,fetal calf serum (FBS) group and serum-free control group,and cultured in 10％ autologous PRP,10％ FBS and serum-free respectively,combined with DMEM-F12 medium.The second generation cells were divided into experimental and control groups.The experimental groups' medium was added dexamethasone,β-sodium glycerophosphate and ascorbic acid,and the control groups went on.The cell morphological difference of each group was Observed between anterior and after inducing differentiation,and compared between each group.Results BMSCs of PRP and FBS groups grew quickly,presented like fusiform form before induction,and increasd in volume,became a triangle,polygonal and round form gradually after osteogenic induction.Cells of PRP and FBS groups aggregated spontaneously and multilayered,and formed calcium nodules and bone-like structure after induced 7 days averagely,which could be stained red by alizarin red S;cells of serum-free groups were induced 14 days averagely,only three samples showed osteogenesis performance.Cells of PRP and FBS groups differentiation efficiency was superior to serum-free groups when inducd 20 days,the difference was statistically significant (P＜0.05),and the difference between efficiency of PRP and FBS groups was not significant (P＞0.05).Conclusions Autologous PRP could be used to proliferate and induce osteogenic differentiation of BMSCs instead of serum.

ObjectiveTo investigate the effects of oxidized low density lipoprotein (oxLDL) on autophagy and its effect on Akt/mTOR/p70S6K signaling pathway in human umbilical vein endothelial cells (HUVECs).MethodsThe cultured HUVECs were divided into either an oxLDL or a control group, and treated with 100 μg/ml oxLDL and equal volume phosphate buffer solution respectively.The cells were collected after 6 h and 12 h.Transmission electron microscopy was used to observe the autophagosome.Real-time fluorescence quantitative polymerase chain reaction was used to detect expression levels of microtubule associated protein 1 light chain 3 (LC3) and p62 mRNA.Western blot was used to detect the expression levels of LC3, p62, P-Akt/Akt, P-mTOR/mTOR, and p-p70S6K/p70S6K.Results Compared with the control group, the number of intracellular autophagosome increased obviously (P<0.05), LC3 mRNA and protein expression levels increased significantly (all P<0.05), and p62 mRNA and protein expression levels decreased significantly (all P<0.05) in the oxLDL group.In addition, the phosphorylated protein expression levels of Akt, mTOR and p70S6K in the oxLDL group were significantly decreased than those in the control group (all P<0.01).However, total protein levels of Akt, mTOR, and p70S6K were not significantly different between the oxLDL group and the control group.Conclusion oxLDL may induce the autophagy of HUVECs via inhibiting the Akt/mTOR/p70S6K signaling pathway.