Objective To explore the dynamics of carers'caregiving dilemmas during different stages of disease progression in patients with diabetic foot ulcers,and to provide a basis for giving precise intervention strategies.Methods Based on the theory of Timing It Right,the phenomenological study was adopted.A purposive sampling method was used to select carers of patients with diabetic foot ulcers who were hospitalised in the Wound Repair Unit of a tertiary hospital in Beijing from March 2023 to February 2024 to conduct semi-structured interviews,and the data were analysed using the Colaizzi 7-step analysis method.Results Combined with the theory of Timing It Right,5 stages of diabetic foot ulcer development were formed,and 5 themes were extracted(①diagnostic period:mixed emotions,facing the dilemma of being unable to do anything;②therapeutic period:lack of knowledge of the disease,and the difficulties of bedside care;③recovery period:contradictions of the desire for rapid healing and the lack of caregiving ability;④transition period:poor patient adherence,and the hope for professional support;⑤adaptation period:the accumulation of negative emotions,and the persistence of caregiving difficulties),and 12 sub-themes.Conclusion At different stages of disease development in patients with diabetic foot ulcers,the caregiving dilemma of caregivers changes dynamically,and healthcare professionals should provide professional,personalised,and high-quality professional support according to their caregiving experience and needs at different stages to improve their quality of care and promote patients'recovery.

Objective To investigate the relationship between the expression of serum microRNA-326(miR-326)and microRNA-623(miR-623)in non-small cell lung cancer(NSCLC)patients and their clinical pathological characteristics and prognosis.Methods A total of 114 NSCLC patients diagnosed in our hospital from March 2019 to June 2020 were collected as study subjects as case group,123 healthy individuals who underwent physical examination were as the control group.According to the 3-year prognosis,patients were separated into a survival group of 71 cases and a death group of 43 cases.Patient related clinical data were collected,real-time fluorescence quantitative PCR method was applied to detect the expression levels of miR-326 and miR-623 in various serum samples;Kaplan-Meier method was applied to analyze the relationship between the expression levels of serum miR-326 and miR-623 in NSCLC patients and their 3-year prognosis;Cox proportional risk regression model was applied to analyze the influencing factors of 3-year prognosis in NSCLC patients.Results The expression levels of serum miR-326 in the case group and control group were 0.64±0.15 and 1.02±0.23,respectively,and the expression levels of miR-623 were 0.56±0.10 and 0.98±0.15,respectively.The difference between the two groups was statistically significant(P＜0.05).The proportions of patients with low expression of miR-326 and miR-623 in low differentiation,TNM stage Ⅲ+Ⅳ,and lymph node metastasis were higher than those in high differentiation,TNM stage Ⅰ and Ⅱ,and no lymph node metastasis(P＜0.05).The 3-year survival rates of patients with low expression of miR-326(20/55,36.36％)and miR-623(27/61,44.26％)in the serum of NSCLC patients were lower than those of patients with high expression of miR-326(51/59,86.44％)and miR-623(44/53,83.02％)(Log Rank x2=32.060,22.812,P＜0.05).Serum miR-326[(0.55±0.09)vs.(0.69±0.11)]and miR-623 levels[(0.48±0.08)vs.(0.61±0.10)]of patients in the death group were significantly lower than those in the survival group(P＜0.05).The area under the curve(AUC)for poor prognosis of serum miR-326 and miR-623 alone and in combination in patients diagnosed with NSCLC were 0.828(95％CI:0.754 to 0.901),0.763(95％CI:0.671 to 0.855),and 0.903(95％CI:0.849 to 0.958),respectively.The proportions of patients with TNM stage Ⅲ+Ⅳ,lymph node metastasis,low expression of miR-326 and low expression of miR-623in the death group were higher than those in the survival group(P＜0.05).MiR-326 and miR-623 were protective factors affecting 3-year mortality in NSCLC patients,while TNM staging and lymph node metastasis were independent risk factors affecting 3-year mortality in NSCLC patients(P＜0.05).Conclusion The low expression of miR-326 and miR-623 may be involved in the occurrence and development of lung cancer,which is closely related to the clinical pathological characteristics and poor prognosis of patients.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Abstract: Objective To compare the differences in the expression of interleukin-8 (IL-8) and signal transducer and activator of transcription 3 (STAT3) among three groups of individuals: patients with multi-drug resistant tuberculosis (MDR-TB), patients with drug-susceptible tuberculosis (DSP-TB), and healthy controls. By analyzing the differences between these groups, the study seeks to provide a reference basis for clinical auxiliary diagnosis of new type tuberculosis. Methods The differences in mRNA expression profiles of chip from peripheral blood mononuclear cells (PBMCs) among three groups were analyzed. MDR-TB and DSP-TB patients were selected as study subjects, with healthy individuals serving as a control group, and the serum IL-8 concentration of each group was measured using an ELISA assay to compare differences between groups. Additionally, PBMCs from all groups were isolated and total RNA was extracted for analysis of IL-8 and STAT3 mRNA expression using quantitative real-time PCR(Q-PCR). Differences in STAT3 protein expression among the groups were also compared by Western blot assay. Results The serum IL-8 concentration in the MDR-TB and DSP-TB groups was significantly higher than that in the healthy control group, with a statistically significant difference (P<0.05). The relative expression level of IL-8 mRNA in PBMCs of the MDR-TB group and DSP-TB group was also significantly higher than that of the healthy control group, with a statistical significance (P<0.05). Both Q-PCR and Western Blot results revealed that the expression of STAT3 in the healthy, DSP-TB and MDR-TB groups sequentially increased, presenting statistically significant differences between the groups (P<0.05), consistent with the mRNA chip results. Conclusions The expression of IL-8 in active tuberculosis patients (ATB) is significantly increased, which can be used as a marker to distinguish ATB from healthy populations. The changes of STAT3 concentration not only serve as a reference for the diagnosis of ATB but can also distinguish between DSP-TB and MDR-TB populations. The combined detection of IL-8 and STAT3 holds promise as a clinical auxiliary diagnostic basis for different tuberculosis patients.

OBJECTIVE: To analyze the clinical phenotype and genetic etiology for a child featuring congenital hypothyroidism (CH). METHODS: Whole exome sequencing (WES), copy number variation (CNV) sequencing and chromosomal microarray analysis (CMA) were carried out for a newborn infant who had presented at Linyi People's Hospital for CH. Clinical data of the child was analyzed, in addition with a literature review. RESULTS: The main characteristics of the newborn infant had included peculiar face, vulvar edema, hypotonia, psychomotor retardation, recurrent respiratory tract infection with laryngeal wheezing and feeding difficulties. Laboratory test indicated hypothyroidism. WES suggested a CNV deletion on chromosome 14q12q13. CMA further confirmed a 4.12 Mb deletion at chromosome 14q12q13.3 (32649595_36769800), which has encompassed 22 genes including NKX2-1, the pathogenic gene for CH. The same deletion was found in neither of her parents. CONCLUSION Through the analysis of clinical phenotype and genetic variant, the child was diagnosed with 14q12q13.3 microdeletion syndrome.
Female ; Humans ; Congenital Hypothyroidism/genetics* ; DNA Copy Number Variations ; Phenotype ; Syndrome ; Microarray Analysis

Objective:To investigate the factors affecting the accuracy of electronic portal imaging device (EPID)-based in vivo dose verification in radiotherapy for patients with lung and esophageal cancers, and to recommend the workflow and specifications for the application of the in vivo dose verification. Methods:This study randomly selected 32 patients who received radiotherapy for esophageal and lung cancers at the Department of Radiation Oncology, Jinhua Municipal Central Hospital from May to August 2022, including 14 lung cancer cases and 18 esophageal cancer cases. Using a uRT-linac 506c linear accelerator, these patients were treated according to the dynamic intensity-modulated radiotherapy (dIMRT) and EPID-based In vivo dose verification ( In vivo EPID) plans developed with the uRT-TPOIS planning system. The In vivo dose verification performed during the treatment included 238 fractions of In vivo EPID and 80 fractions of image-guided radiotherapy (IGRT) for the lung cancer cases, as well as 414 fractions of In vivo EPID and 105 fractions of IGRT for the esophageal cancer cases. The 2D γ passing rate for each irradiation field was obtained according to the set threshold value. Furthermore, fractioned irradiation fields with γ-passing rates below the threshold value were analyzed, and primary factors decreasing the γ-passing rate were further analyzed by combining the online CT images and 3D reconstruction-derived dose. Results:For lung and esophageal cancers, the mean γ-passing rates were 95.1% ± 5.7% and 96.5% ± 4.5%, respectively at 3 mm/5%; 91.5% ± 8.4% and 92.2% ± 4.9%, respectively at 3 mm/3%, and 79.1% ± 14.7% and 83.7% ± 8.2%, respectively at 2 mm/2%, indicating no statistically significant differences between two cancers ( P > 0.05). The average γ passing rate for beam orientations near 0°/180° (Group A) was higher than those near 90°/270° (Group B) 3 mm/5%: Z = -25.4, P < 0.05; 3 mm/3%: Z = -26.8, P < 0.05). The IGRT correction of setup errors significantly improved the γ passing rates (96.3% ± 5.1% and 96.4% ± 4.9%, respectively at 3 mm/5%, Z = -5.50, P < 0.05; 92.3% ± 8.0% and 91.3% ± 7.7%, respectively at 3 mm/3%, Z = -9.54, P < 0.05). The results of In vivo dose verification were affected by changes in the volumes and motion of tumors and normal tissues, radiotherapy positioning, and adequacy of pre-treatment preparation. Conclusions:EPID-based In vivo dose verification during radiotherapy can avoid incorrect irradiation. However, it is necessary to standardize the workflow of the EPID-based In vivo dose verification to avoid the decrease in the γ passing rate caused by artificial factors.

Objective:To analyze the research status and comment of radiation-induced heart injury based on relevant literature analysis in China.Methods:A literature database was established with studies published from 1983 to 2021 as the data source from "China National Knowledge Infrastructure (CNKI) database", "Wanfang Database", "VIP Chinese Science and Technology Journal Database" and "China Biology Medicine Disc". The publication date, type and journal distribution of studied related to radiation-induced heart injury were quantitatively analyzed.Results:A total of 300 literatures were included. The chronological distribution of literatures: from 1983 to 2021, the number of literatures related to radiation-induced heart injury was gradually increased, and the overall trend was on the rise. The top three publication journals were Chinese Journal of Radiation Oncology, Chinese Journal of Radiation Medicineand Protection, and Chinese Journal of Cancer Prevention and Treatment. Literature type distribution: clinical research accounted for 48.50%, 25.58% for review, and 17.61% for animal experiment, respectively. The distribution of clinical research types: lung cancer, esophageal cancer and breast cancer were the most, followed by thymoma and lymphoma. In animal experiments, rat was the most frequently studied animal model, and the maximum radiation dose was 20 Gy. Conclusions:The number of studies related to radiation-induced heart injury is gradually increasing in China. The quantity of clinical studies is higher than that of animal experiments, most clinical studies focus on chest tumors, but there is great potential in animal experimental research. We still need to explore the pathogenesis of radiation-induced heart injury and develop drug prevention and intervention strategies.

Pelvic insufficiency fracture (PIF) is a late complication which is not fully understood after radiotherapy and chemotherapy for cervical cancer and is easily misdiagnosed as bone metastasis. Previous clinical trials focused on the incidence, time and location of PIF, while the analysis of potential risk factors mainly emphasized the clinical characteristics of patients. There were few studies analyzing the correlation between treatment factors and the incidence. The damage of pelvis bone, especially the sacrum, after radiotherapy is mainly related to irradiation mode and dose. In this article, the radiotherapy technology, the formulation of bone-conserving radiotherapy plan, the dose-volume parameters of external irradiation and intracavitary brachytherapy, and the correlation between chemotherapy and this disease were reviewed. In the future, according to the advantages of precision radiotherapy technology, it is necessary to optimize the bone preservation plan, reduce the irradiation range and dose of sacrum and pelvis, and then reduce the incidence of PIF, which needs further clinical trials and practice to verify.

Radiotherapy is one of the main treatment for esophageal cancer. With the development of radiotherapy techniques, prognostic outcomes of esophageal cancer have been gradually improved and radiation-induced heart disease (RIHD) has captivated increasing attention. Radiation-induced heart complications mainly encompass pericardial disease, cardiomyopathy, coronary artery atherosclerosis, valvular heart disease, and arrhythmias, etc. The use of modern radiotherapy techniques is expected to mitigate heart injury and reduce the risk of RIHD. Research progress on the incidence and risk factors of RIHD in esophageal cancer were described as follows.

Objective:To investigate the symptom clusters and influencing factors among breast cancer patients receiving aromatase inhibitor treatment and to provide a theoretical basis for the symptom clusters management.Methods:From April 2020 to January 2021, 253 breast cancer patients were recruited in Peking University Cancer Hospital by convenient sampling method. All the patients were cross-sectional investigated by the demographic and clinical characteristics questionnaire, the M.D. Anderson Symptom Inventory, the Hospital Anxiety and Depression Scale. The principal component analysis was used to extract the symptom clusters and the multiple linear regression was used to analyze the risk factors.Results:During the period of breast cancer patients receiving aromatase inhibitor treatment, three symptom clusters were identified: sick symptom cluster, treatment related-psychological symptom cluster, digestive symptoms cluster. The prevalence of the three symptom clusters was 49.4%(125/253), 45.1%(114/253), 22.5%(57/253), respectively. The median severity of the three symptom clusters was 2.80, 2.00, 0.67, respectively. Multiple linear regression analysis showed that anxiety and education level were the influencing factors of sick symptom cluster ( β=0.25, -0.25, all P<0.05), anxiety, depression and educational level were the influencing factors of treatment related-psychological symptom cluster ( β = 0.34, 0.20, -0.16, all P<0.05), anxiety, depression and chemotherapy history were the influencing factors of digestive symptom cluster ( β= 0.17, 0.18, -0.13, all P<0.05). Conclusions:Breast cancer patients with aromatase inhibitor treatment are affected by symptom clusters. In order to relieve the symptom clusters, we need pay attention to the mentation, the education level and prerious treatment of the patients.