Objective:To treat the Crohn's disease(CD)patients with ustekinumab(UST),to eva-luate their clinical and endoscopic remission,and to evaluate their transmural response(TR)and trans-mural healing(TH)condition using intestinal ultrasonography(IUS).Methods:Retrospective analysis was made on patients diagnosed with CD in Peking University People's Hospital from January 2020 to Au-gust 2022,who were treated with UST for remission induction and maintenance therapy.All the patients were evaluated on both week 8 and week 16/20 after treatment,including clinical,biochemical indica-tors,colonoscopy and IUS examination.Results:A total of 13 patients were enrolled in this study,inclu-ding 11 males and 2 females.The minimum age was 23 years,the maximum age was 73 years and the mean age was 36.92 years.All the patients were in the active stage of disease before treatment,and the average Best Crohn's disease activity index(Best CDAI)score was 270.12±105.55.In week 8,the Best CDAI score of the patients decreased from 270.12±105.55 to 133.16±48.66(t=4.977,P＜0.001).Eight patients achieved clinical remission while 5 patients remained in the active stage.Nine patients underwent colonoscopy evaluation.The average simple endoscopic score for Crohn's disease(SES-CD)score decreased from 10.71±7.14 before treatment to 6.00±7.81(t=2.483,P=0.048)in week 16/20.Four patients achieved endoscopic remission while 5 patients did not.In week 8,5 pa-tients achieved TR,2 patients achieved TH,the other 6 patients did not get TR or TH.In week 16/20,6 patients achieved TR,3 patients achieved TH while the other 4 patients did not get TR or TH.There was no significant statistical difference in the TR effect of UST between small intestine and colon lesions(Fisher test,P＞0.999).The rate of UST transmural response in the patients who had had previous bio-logical agent therapy was lower than those with no previous biological agent therapy,but there was no sig-nificant statistical difference(Fisher test,P=0.491).Conclusion:After treatment of UST,the clinical and endoscopic conditions of the CD patients had been improved,and some patients could achieve clini-cal remission and endoscopic remission.UST had good TR and TH effects on CD.TR might appear in week 8,and the TR effect increased in week 16/20.There was no significant statistical difference in the TR effect between small intestine and colon lesions.TR effect of UST was better in the patients who had no previous biological agent therapy than those who had had other biological agents,but the result had no significant statistical difference.

ObjectiveTo investigate the protective mechanism of Qianyang Yuyin granules （QYYY） on aldosterone-induced podocyte injury. MethodA total of 30 C57BL/6J mice were randomly divided into five groups： control group， model group， QYYY low dose （QYYY-L） group， QYYY high dose （QYYY-H） group， and spironolactone （SPL） group， with six mice in each group. Except for the control group， mice were implanted with osmotic minipumps and injected continuously with aldosterone （300 μg·kg^-1·d^-1） to induce renal injury. The drug administration group was given low and high doses （2.6， 5.2 g·kg^-1·d^-1） of QYYY and SPL （18 mg·kg^-1·d^-1） for 28 days. The renal pathological changes of mice were observed by hematoxylin-eosin （HE） staining and Masson staining. The expression levels of Nephrin， Desmin， B-cell lymphoma-2 （Bcl-2）， Bcl-2-associated X （Bax）， cleaved Caspase-3， nuclear receptor subfamily 3 group C member 2 （NR3C2）， extracellular regulated protein kinases （ERK）， and phospho-ERK （p-ERK） in kidney tissue were detected by Western blot. The apoptosis levels of kidney tissue were detected by TdT-mediated dUTP nick and labeling （TUNEL） staining， and the superoxide dismutase （SOD） levels were detected. In vitro， the mice were divided into five groups： Control group， model group （aldosterone concentration of 200 nmol·L^-1）， QYYY-L group， QYYY medium dose （QYYY-M） group， and QYYY-H group （25， 50， and 100 mg·L^-1）. The effect of different concentrations of QYYY on the relative viability of aldosterone-induced podocytes was detected by cell proliferation and viability assay （CCK-8）. The expressions of Nephrin， Desmin， Bax， Bcl-2， cleaved Caspase-3， NR3C2， and p-ERK/ERK were detected by Western blot. AnnexinV-FITC/PI flow cytometry was used to detect the apoptosis levels of podocytes. Reactive oxygen species （ROS） in podocytes were observed by DCFH-DA. ResultCompared with the control group， the model group showed structural pathological changes and fibrotic conditions in the kidney， increased apoptosis levels （P<0.01）， and decreased SOD levels （P<0.01）. Aldosterone concentration at 200 nmol·L^-1 showed a significant decrease in podocyte activity （P<0.05）. Podocytes in the model group showed structural pathological changes， disordered arrangement of intercellular microfilaments， increased apoptosis levels （P<0.01）， and increased intracellular ROS levels （P<0.01）. The protein expressions of Nephrin， Bcl-2， and p-ERK/ERK in kidney tissue and podocytes were decreased （P<0.05， P<0.01）. The protein expressions of Desmin， Bax， cleaved Caspase-3， and NR3C2 were increased （P<0.05， P<0.01）. Compared with the model group， QYYY alleviated the structural damage and fibrosis of the kidney， decreased the apoptosis levels （P<0.05， P<0.01）， and enhanced the SOD content of the kidney （P<0.05， P<0.01）. QYYY improved the activity of podocytes （P<0.05， P<0.01）， restored the foot process structure of podocytes， and decreased apoptosis levels （P<0.01） and ROS levels of podocytes （P<0.01）. The protein expressions of Nephrin， Bcl-2， and p-ERK/ERK in kidney tissue and podocytes were increased （P<0.05， P<0.01）， and the protein expressions of Desmin， Bax， cleaved Caspase-3， and NR3C2 were down-regulated （P<0.05， P<0.01）. ConclusionQYYY improves aldosterone-induced podocyte injury by regulating the NR3C2/ROS/ERK pathway.

Objective:To study the risk factors of venous thromboembolism(VTE)and the predictive value of the improved VTE score model to identify the risk of VTE in gynecological surgery patients.Methods:From Janu-ary 1,2020 to December 31,2022,41 patients with VTE after gynecological surgery were selected as the VTE group,and a total of 164 patients with adjacent gynecological surgeries during the same period were selected as the non-VTE group with a ratio of 1 :4.Univariate and multivariate Logistic regression analysis were used to ana-lyze the risk factors of VTE after gynecological surgery,and a modified VTE risk factor rapid assessment model(referred to as the improved VTE score model)was constructed.The receiver operating characteristic(ROC)curve was used to study the predictive value for VTE for in gynecological surgery,and compared with the Caprini score model(Caprini table for short).Results:①Multivatiate Logistic regression analysis showed that there were independent risk factors for postoperative VTE in gynecology surgery(OR＞1,P＜0.05),including age≥60 years,BMI≥28 kg/m2,malignant tumors,surgery time＞3 hours,history of thrombosis,and the increased D-di-mer difference before and after surgery.②The Area under Curve(AUC)of ROC was 0.963 in the improved VTE score model with a Youden index 81.10％,sensitivity 87.80％and specificity 93.29％.The AUC of the Caprini score model was 0.888 with Youden index 63.41％,sensitivity 73.17％and specificity 90.24％.The improved VTE score model the Caprini score model identified 92.68％and 85.37％of VTE patients as high-risk or ex-tremely high-risk,respectively,but the difference was not statistically significant(P＜0.05).Conclusions:More attention should be paid to the six independent risk factors for postoperative VTE in gynecology surgery.The two score models showed a similar identified level.However,the improved VTE score model is more simple and easier to operate,has better practicality,and has certain clinical promotion value.

Iodine accumulation represents a differentiation marker of thyroid cancer (TC) and a cornerstone of benefits from 131I therapy. However, dedifferentiation phenotypes occur in nearly 70% of recurrent or metastatic TCs driven by oncogenic mutations such as B-Raf proto-oncogene, serine/threonine kinase (BRAF), telomerase reverse transcriptase (TERT) promoters, and tumor proten p53 (TP53). Beyond genetic alterations, epigenetics, autophagy, tumor microenvironment and other pathways are also involved in the dedifferentiation of TC and the tolerance to 131I therapy. Targeting the above-mentioned pathways has potential to improve the malignant phenotype of TC and restore sensitivity to 131I therapy, which is of great clinical significance. Based on the relevant mechanisms of dedifferentiation, this paper elaborates on the progress of preclinical experiments and clinical studies related to differentiation therapies of TC.

Objective:To explore the significance of laboratory parameters in predicting the endoscopic manifestations of ulcerative colitis (UC) after treatment.Methods:From January 2015 to December 2020, the clinical data of 68 patients with UC hospitalized and treated in Peking University People′s Hospital were retrospectively and continuously collected. According to the degree of bleeding, vascular pattern, erosion and ulcer under endoscopy before and after treatment, they were divided into progressive group (post-treatment ulcerative colitis endoscopic index of severity (UCEIS) score higher than pre-treatment) and non-progressive group (post-treatment UCEIS score equal to or lower than pre-treatment). The baseline platelet count, platelet volume, platelet hematocrit, platelet distribution width, serum albumin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and related laboratory parameters were compared between the two groups. And analyzed the significance of related laboratory indexes in predicting the endoscopic manifestations of UC after treatment. Independent sample t test and receiver operating characteristic curve (ROC) analysis were used for statistical analysis. Results:According to the degree of bleeding under endoscopy before and after treatment, the patients were divided into progressive group (12 cases) and non-progressive group (56 cases). The baseline platelet count and platelet volume of the progressive group were higher than those of the non-progressive group ((375.58±154.30) ×10 9/L vs. (288.22±103.76) ×10 9/L, (9.29±1.13) fL vs.(8.52±1.29) fL), and the differences were statistically significant ( t=2.40 and 2.08, P=0.019 and 0.049). According to the degree of vascular texture under endoscopy before and after treatment, the baseline platelet volume and serum albumin level of the progressive group (9 cases) were higher than those of the non-progressive group (59 cases) ((9.58±1.18) fL vs. (8.54±1.26) fL, (41.49±5.08) g/L vs. (36.63±6.14) g/L), and the baseline CRP of the progressive group was lower than that of the non-progressive group (2.26 mg/L(0.95 mg/L) vs.8.64 mg/L (26.08 mg/L) ), and the differences were statistically significant ( t=2.32, 2.32, and z=-2.27, P=0.022, 0.047 and 0.045). According to the degree of erosion and ulcer under endoscopy before and after treatment, CRP and ESR of the progressive group (16 cases) were lower than those of the non-progressive group (52 cases) ((2.21 mg/L(5.26 mg/L) vs. 10.63 mg/L(29.97 mg/L), 14.50 mm/1 h (15.25 mm/1 h) vs.17.00 mm/1 h (11.00 mm/1 h)), and the differences were statisticaly significant ( z=-3.64 and -2.42, P=0.001 and 0.020). The cutoff value of baseline platelet count to assess the progression of bleeding under endoscopy after treatment was 336×10 9/L (sensitivity=0.636, specificity=0.852, area under the curve=0.698). The cutoff value of baseline CRP to assess the progression of erosion and ulcer under endoscopy after treatment was 3.44 mg/L (sensitivity=0.750, specificity=0.727, area under the curve=0.727). Conclusions:The baseline platelet volume, serum albumin and ESR are suggestive of endoscopic mucosal changes in patients with UC after treatment. The baseline platelet count and CRP can predict the efficacy in patients with UC.

Emergence of the colistin resistance gene,mcr-1,has attracted worldwide attention.Despite the prevalence of mcr-1-positive Escherichia coli(MCRPEC)strains in human carriage showing a significant decrease between 2016 and 2019,genetic differences in MCRPEC strains remain largely unknown.We therefore conducted a comparative genomic study on MCRPEC strains from fecal samples of healthy human subjects in 2016 and 2019.We identified three major differences in MCRPEC strains between these two time points.First,the insertion sequenceISApll1 was often deleted and the percentage of mcr-1-carrying IncI2 plasmids was increased in MCRPEC strains in 2019.Second,the antibiotic resistance genes(ARGs),aac(3)-Ⅳa and blaCTX-M-1,emerged and coexisted with mcr-1 in 2019.Third,MCRPEC strains in 2019 contained more viru-lence genes,resulting in an increased proportion of extraintestinal pathogenic E.coli(ExPEC)strains(36.1％)in MCRPEC strains in 2019 compared to that in 2016(10.5％),implying that these strains could occupy intestinal ecological niches by competing with other commensal bacteria.Our results suggest that despite the significant reduction in the prevalence of MCRPEC strains in humans from 2016 to 2019,MCRPEC exhibits increased resistance to other clinically important ARGs and contains more virulence genes,which may pose a potential public health threat.

Objective:To explore the definition and implications of occupational attractiveness among long-term caregivers.Methods:The Walker and Avant concept analysis method was used to define the concept of occupational attractiveness among long-term caregivers.Results:Attributes of occupational attractiveness of long-term caregivers were: (ⅰ) a strength or ability; (ⅱ) mutual attraction between long-term care occupations and incumbents and potential job seekers; (ⅲ) to attract potential job seekers and satisfying their willingness to work; (ⅳ) to retain and motivate in-service long-term care personnel, and enabling them to develop the professional identity and career development.Conclusions:This concept is defined from the perspective of nursing practice in the elderly care service industry in China and combined with the characteristics of long-term caregivers at this stage. It provides clear conceptual support for further relevant research, and provides certain theoretical and practical guidance for the long-term care work of elderly care institutions, communities and families in China.

Objective:To investigate the accuracy and feasibility of 3D-printing individualized template-guided and CT-guided 192Ir interstitial brachytherapy in the central recurrent gynecologic tumors by comparing pre-plan and intraoperative physical dosimetric parameters. Methods:This study involved 38 patients with central recurrent gynecologic tumors who underwent 3D printing individual template (3D-PIT)-assisted and CT-guided 192Ir interstitial brachytherapy in the Department of Radiation Oncology of the Peking University Third Hospital from Jan 2018 to Dec 2019.The prescription doses for the target tumor areas were 10-36 Gy to be delivered at 5-6 Gy/fraction for 2-6 fractions.The pre-plan and intraoperative dosimetric parameters were compared, including the minimum prescription doses delivered to 90% and 100% of target volume( D90, D100)and the mean percentage of volume receiving 100% of the prescription doses ( V100). Meanwhile, the doses delivered to 2 cm 3 ( D2 cm 3) of organs at risk (bladders, rectums, and colons) were analyzed.The quality parameters of the brachytherapy were studied, including conformity index (CI), homogeneity index (HI), and external index (EI) of the target volume.Perioperative complications were also observed. Results:A total of 194 treatments were included.During the treatment, 5-13 (median 6) needles were inserted, with a prescription dose of 5-6 Gy per fraction.There were no statistical differences between pre-plan and intraoperative D90, D100, V100, CI, HI, and EI as well as the D2 cm 3 of bladders and colons at risk ( P>0.05). In contrast, for the D2 cm 3 of rectums, the intraoperative dose was slightly higher than the pre-plan dose, showing a statistical difference ( t=-0.335, P=0.027). Conclusions:The 3D-PIT-assisted and CT-guided 192Ir interstitial brachytherapy at a high dose rate is accurate and feasible in the treatment of recurrent gynecologic tumors, meeting the pre-plan dose requirement.

Objective:To evaluate the effectiveness of Orem self-care model for elderly patients with hip fracture.Methods:The databases including Medline, Embase, Web of Science, Cochrane Library Database, Wanfang, CNKI, VIP, and CMB were searched from inception to September 2020. All randomized controlled trials (RCTs) of the Orem self-care model applied in elderly patients with hip fracture were included. Two investigators independently screened research, extracted data and assessed the quality of literature based on standard methods. RevMan 5.3 software was performed to conduct the Meta-analysis.Results:A total of 11 RCTs were included, involving 1 088 patients. Compared with conventional nursing model, self-care model could effectively reduce the incidence of complications during hospitalization ( RR=0.26, 95% CI 0.18-0.39, P<0.001) and improve the Harris scores ( MD=13.33, 95% CI 11.09-15.57, P<0.001) of elderly patients with hip fracture. However, the impacts of self-care model on alleviating postoperative pain was still uncertain. Additionally, the self-care model could shorten hospital stay, but the combined effect size was unavailable due to the high heterogeneity between related studies. Conclusions:In comparison with conventional nursing model, the Orem self-care model was more beneficial to shorten the hospitalization stay, reduce the incidence of postoperative complications and promote hip joint function of elderly patients with hip fractures. To confirm the effectiveness of self-care models in pain management for elderly patients with hip fractures, multicenter RCTs with high quality and large samples are needed.

Objective: To discuss the imagingcharacteristics of S₂AI screw trajectory in ADS patients. Methods: Forty patients with degenerative scoliosis were scanned with Simens Sliding 40-slice spiral CT scanner. Three-dimensional scanning and reconstruction were performed in these patients with the scanning range including thoracolumbar spine, lumbar spine, lumbosacral region, pelvis and bilateral hip joints. The base of the lateral sacral crest on the midline between the lower edge of S₁ dorsal foramina and the upper edge of S₂ dorsal foramina was the starting point. The placement plane of S2AI screw trajectory was determined from the starting point to the lower margin of anterior inferior iliac spine. A 10mm diameter screw was the design template. A circle with a diameter of 5 mm as the center of the lowest point of the ilium inner cortex was made, and a tangent line from the starting point to the outer diameter of the circle (the inner part of the ilium) was selected as the axis of the screw trajectory. The lateral angle and the length of the axis of the screw trajectory and iliac width were measured in transverse plane. The caudal angle, the distance from the axis of the screw trajectory to iliosciatic notch, and the caudal angle, the distance from the axis of the screw trajectory to the upper edge of the acetabulum were measured in sagittal plane. These parameters were recorded and analyzed. Results: The trajectory length of S₂AI screw in ADS patients was 12.00±0.99 cm, the lateral angle was 41.24°±3.92°, the caudal angle was 27.73°±6.45°, and the distance from the axis of the screw trajectory to iliosciatic notch was 1.05±0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12±1.65 cm. The trajectory length, lateral angle, caudal angle, distance from the axis of the screw trajectory to iliosciatic notch, distance from the axis of the screw trajectory to the upper edge of the acetabulum and iliac width of S2AI screw was respectively 12.40±0.83 cm, 39.47°±1.76°, 28.00°±6.39°, 1.08±0.32 cm, 1.76±0.34 cm, 2.26±0.25 cm in male patients, and was respectively 11.75±1.01 cm, 42.30°±4.48°, 27.56°±6.61°, 1.21±1.00 cm, 1.90±0.32 cm, 2.04±0.18 cm in female patients. The screw length and lateral angle had statistically difference between male and female patients(P<0.05). Compared with non-ADS patients in previous studies, female patients with ADS had significant differences in increased lateral angle and decreased caudal angle of S₂AI screw. Conclusion There is ideal trajectory of S₂AI screws in ADS patients. There was no significant difference of the length of S₂AI screws between ADS patients and non-ADS population. Different direction was noticed in the placement of S₂AI screws, especially in female patients. Increased lateral angle and decreased caudal angle would be obtained in the procedure of placing S₂AI screws in female ADS patients during operation.