Objective:To explore the effect of comfort nursing intervention in hospice care for advanced cancer patients at home, and to provide reference for hospice care for advanced cancer patients at home.Methods:A randomized controlled trial was conducted. A total of 105 patients with advanced cancer who were treated in the Cancer Hospital Affiliated to Harbin Medical University from January to February 2023 were selected as the research objects. According to the random number table, they were divided into control group of 53 cases and intervention group of 52 cases. The control group received routine nursing methods, while the intervention group received comfort nursing interventions on this basis. The intervention lasted for 4 weeks. The changes in palliative care outcomes, quality of life and death anxiety were compared between the two groups before and after intervention.Results:Totally 105 cases were included, 53 cases in the control group and 52 cases in the intervention group. In the control group, there were 25 males, 28 females, aged (58.96 ± 10.71) years old; in the intervention group, there were 22 males, 30 females, aged (59.82 ± 10.53) years old. Before intervention, there was no statistically significant difference in palliative care outcomes, quality of life and cancer death anxiety scores between the two groups of patients (all P>0.05). After intervention, the total score of palliative care outcomes in the intervention group was (13.34 ± 5.88) points, significantly lower than (16.15 ± 5.72) points in the control group, with a statistically significant difference ( t = 2.48, P<0.05). The overall health status score of quality of life was (68.55 ± 9.34) points in the intervention group, higher than (63.01 ± 9.28) points in the control group ( t = 3.05, P<0.05). The total score of cancer death anxiety was (8.85 ± 2.72) points, significantly lower than (10.59 ± 3.14) points of the control group, with a statistically significant difference ( t = 3.04, P<0.05). Conclusions:The application of comfort nursing mode in home based hospice care can improve the quality of hospice care for advanced cancer patients, reduce their level of death anxiety, and is of great significance for improving the quality of life of advanced cancer patients.

Objective To investigate the therapeutic mechanism of Gandou Bushen Decoction(GDBSD)for improving reproductive disorders in male mouse models of Wilson disease(WD).Methods Sixty male homozygous TX mice were randomized equally into 4 groups and treated with daily gavage of saline(WD model group),penicillamine(0.09 g/kg),or GDBSD(0.2 mL/10 g),or with intraperitoneal injection of U0126(20 mg/kg)in addition to GDBSD gavage,with 15 male DL mice as control.After 4 weeks of treatment,copper content in testicular tissue of the mice was detected,and histopathology of the testes and epididymis was examined using HE staining and electron microscopy.TUNEL staining was used to identify apoptotic cells in the testes.The protein expressions of Bcl-2,Cytc,caspase-3,ERK,and p-ERK in the testicular tissue were evaluated with Western blotting,and BrdU-positive cells were detected with immunohistochemical labeling.Sperm density,viability,malformation rate and fertility levels of male mice were studied.Results Treatment with penicillamine and GDBSD obviously improved pathological changes of the testis,increased sperm density and motility,lowered sperm abnormality rate,fertility levels and increased testicular JOHNSEN score of TK mice,but the therapeutic effect of GDBSD was blocked by U0126.GDBSD treatment significantly lowered Cytc and caspase-3 expressions and increased Bcl-2 expression in the testicular tissue of TX mice(P<0.05),while U0126 treatment significantly lowered testicular Bcl-2 expression level.No significant differences were found in total protein expression levels of ERK1/2 among the 5 groups,but p-ERK protein expression was significantly reduced in WD and U0126 groups and increased in penicillamine and GDBSD groups.Conclusion GDBSD can improve spermatogenesis and enhance fertility of male TX mice with WD possibly by activating the ERK signaling pathway to enhance proliferation and reduce apoptosis of the spermatogenic cells.

Objective:To determine the expression and diagnostic value of peripheral blood lymphocytes and functional activation status in non-Hodgkin lymphoma with hemophagocytic lymphohistiocytosis (NHL-HLH) .Methods:We retrospectively analyzed clinical data from 30 newly diagnosed NHL-HLH patients admitted to Jiangsu Province Hospital from September 2022 to September 2023. We assessed peripheral blood lymphocytes and activation status by flow cytometry. Forty newly diagnosed patients with NHL who received treatment at our hospital during the same period and had lymphocyte and functional activation indexes were selected as the control group. The differences in relative and absolute lymphocyte counts and functional activation indexes between the two groups were compared. The optimal cutoff values for continuous variables were calculated from the receiver operating characteristic curve and logistic regression analysis was used to evaluate the risk factors in NHL patients with HLH.Results:A total of 30 NHL-HLH patients were evaluated, including 12 T-cell lymphoma and 18 B-cell lymphoma patients. Forty individuals were in the control group, which included 19 T-cell lymphoma and 21 B-cell lymphoma patients. The absolute counts of CD3 + T, CD4 + T, CD8 + T, and NK cells, along with the relative count of NK cells, were significantly lower in the HLH group compared with that in the control group (all P values<0.01) . The expression of CD38 and HLA-DR on CD8 + T-cell activated subgroups was significantly higher in the NHL-HLH group compared with that in the control group (CD8 +CD38 +/CD8 + T expression median: 57.4% vs 21.5%, P<0.001; CD8 +CD38 +/CD8 + T expression median: 49.7% vs 33.5%, P=0.028, respectively) . In addition, CD28 expression on CD4 + and CD8 + T cells was significantly higher in NHL-HLH patients ( P<0.01) . ROC curve and multivariate logistic regression analyses revealed that absolute NK cell count ≤72.0 cells/μl, CD4 +CD28 +/CD4 + T >94.2%, and CD8 +CD28 +/CD8 + T >38.4% were risk factors for predicting the occurrence of NHL-HLH patients. The sensitivity and specificity of the regression model were 86.7% and 86.1%, respectively, with an area under the curve of 0.94 ( P<0.001) . Conclusions:In NHL patients with HLH, there was a significant reduction in the absolute number of peripheral blood lymphocyte subpopulations, whereas T-cell function was notably activated. Specifically, absolute counts of NK cells ≤72.0 cells/μl, CD4 +CD28 +/CD4 + T >94.2%, and CD8 +CD28 +/CD8 + T >38.4% were identified as risk factors for predicting the development of NHL-HLH patients. This will assist in early clinical diagnosis and treatment.

Objective To investigate the international occupational classification of rehabilitation-therapy professionals,and analyze the core competencies,to improve the occupational system of rehabilitation-therapy professionals in China. Methods According to Standard Country or Area Codes for Statistical Use that prepared by the Statistics Division of the United Nations and Human Development Index of each country or area,the occupational classification of rehabil-itation-therapy professionals in the International Labour Organization(ILO)and 17 typical countries or areas was compared,and rehabilitation competency framework(RCF)was used to analyze the core competencies. Results The occupational classification or similar documents of ILO and 15 countries or areas were obtained.Except China categorizing rehabilitation-therapy professionals as technicians,all the documents set detailed occupations of rehabilitation-therapy professionals such as physical therapist and speech therapist as formal full-time occupa-tion;and ILO and 14 countries or areas defined these detailed occupations as professional occupation.The core competencies of technicians only involved a very small number of competencies and activities in RCF,while the core competencies of detailed occupations of rehabilitation-therapy professionals covered the vast majority of competencies and activities in RCF.There were differences in RCF competencies and activities involved in the core competencies of detailed occupations of rehabilitation-therapy professionals. Conclusion The core competencies are different between rehabilitation-therapy professionals and technicians,and among different detailed occupations of rehabilitation-therapy professionals.It is important for China to establish the detailed occupations of rehabilitation-therapy professionals as formal full-time occupation.The education re-lated to therapy and rehabilitation in China is gradually aligning with international standards,legislation on occu-pational qualification admission for rehabilitation-therapy professionals should be carried out,and make the reha-bilitation-therapy professionals to be professional occupation.

Objective To investigate the therapeutic mechanism of Gandou Bushen Decoction(GDBSD)for improving reproductive disorders in male mouse models of Wilson disease(WD).Methods Sixty male homozygous TX mice were randomized equally into 4 groups and treated with daily gavage of saline(WD model group),penicillamine(0.09 g/kg),or GDBSD(0.2 mL/10 g),or with intraperitoneal injection of U0126(20 mg/kg)in addition to GDBSD gavage,with 15 male DL mice as control.After 4 weeks of treatment,copper content in testicular tissue of the mice was detected,and histopathology of the testes and epididymis was examined using HE staining and electron microscopy.TUNEL staining was used to identify apoptotic cells in the testes.The protein expressions of Bcl-2,Cytc,caspase-3,ERK,and p-ERK in the testicular tissue were evaluated with Western blotting,and BrdU-positive cells were detected with immunohistochemical labeling.Sperm density,viability,malformation rate and fertility levels of male mice were studied.Results Treatment with penicillamine and GDBSD obviously improved pathological changes of the testis,increased sperm density and motility,lowered sperm abnormality rate,fertility levels and increased testicular JOHNSEN score of TK mice,but the therapeutic effect of GDBSD was blocked by U0126.GDBSD treatment significantly lowered Cytc and caspase-3 expressions and increased Bcl-2 expression in the testicular tissue of TX mice(P<0.05),while U0126 treatment significantly lowered testicular Bcl-2 expression level.No significant differences were found in total protein expression levels of ERK1/2 among the 5 groups,but p-ERK protein expression was significantly reduced in WD and U0126 groups and increased in penicillamine and GDBSD groups.Conclusion GDBSD can improve spermatogenesis and enhance fertility of male TX mice with WD possibly by activating the ERK signaling pathway to enhance proliferation and reduce apoptosis of the spermatogenic cells.

Objective　To explore the effects of dynamic neuromuscular stabilization techniques on the exercise capacity,balance function and walking function of Parkinson’s patients.Methods　A total of 46 Parkinson’s disease patients were selected and divided into control group (n=23) and study group (n=23) using a random number table method.The control group was given conventional drugs and rehabilitation training,30 min/time,1 d/time,5 d/week;the study group was treated with dynamic neuromuscular stabilization technology on the basis of the control group,30 min/time,1 d/time,5 d/week.Before treatment,4 weeks after treatment,and 8 weeks after treatment,the third part of the Unified Parkinson’s Comprehensive Rating Scale (UPDRS-Ⅲ),the peak torque of the back muscles (PT),and the forward and backward movement distance of the trunk pressure center (AP-SD),timed up-walking test (TUGT) were evaluated.Results　Before treatment,there was no significant difference in UPDRS-Ⅲ,PT,AP-SD and TUGT between the two groups (P>0.05).The UPDRS-Ⅲ,PT,AP-SD,and TUGT groups of the two groups improved after 4 weeks of treatment and 8 weeks of treatment compared with those before treatment,and the experimental group had UPDRS-Ⅲ ［(18.76±3.59) points］ at 8 weeks of treatment,PT ［(128.09±23.74)N·m］,AP-SD［(60.68±18.63) mm］,TUGT［(22.71±3.43) S］ improved significantly (P<0.05).Conclusion　DNS can effectively improve the motor dysfunction of Parkinson’s patients,improve the patient’s back muscle strength,balance function and walking ability.

Objective:To investigate the significance of plasma pentraxin 3 (PTX3) in patients with secondary hemophagocytic lymphohistiocytosis (sHLH).Methods:Plasma PTX3 levels were tested by ELISA in 48 newly diagnosed sHLH patients, 18 healthy volunteers and 9 lymphoma controls in the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2019. Clinical parameters were collected, and the correlations with PTX3 levels were analyzed.Results:PTX3 level in newly diagnosed group was significantly higher than that of healthy control group [16.29(1.17-66.00) vs. 0.76(0.01-7.86) μg/L, P<0.01]. Patients with lymphoma-associated HLH(LHLH) had higher plasma level of PTX3 than Fhose with infection-associated HLH (IHLH) [24.29(3.36-66.00) vs. 9.56(1.17-36.50)μg/L, P<0.05]. Plasma PTX3 levels in 48 sHLH patients were positively correlated with serum ferritin ( P<0.05). Receiver operating characteristic (ROC) curve for plasma PTX3 levels of sHLH and healthy controls produced a cutoff value at 3.9 μg/L, with its 86.7% sensitivity and 94.4% specificity. And ROC analysis showed that PTX3 17.5 μg/L was the critical value for diagnosis of LHLH from non-LHLH group, that the sensitivity and specificity were 63.0% and 76.2% respectively. The 1-year overall survival (OS) rate in patients with PTX3≥17.5 μg/L was significantly lower in those with PTX3<17.5 μg/L (18.5% vs. 75.8%, P<0.01). Conclusion:These results indicate the potential of PTX3 as a biomarker for diagnosis and prognosis in patients with sHLH.

Objective To access the value of MRI in differential diagnosis between intrahepatic cholangiocarcinoma and atypical hepatic abscess. Methods Retrospectively collecting and analyzing the clinical and MRI imaging data of 19 patients with intrahepatic cholangiocarcinoma (ICC) and 17 patients with atypical hepatic abscess, confirmed by reexamination after anti‐inflammation therapy, surgery or puncture etiology, from June 2011 to July 2018 in Central Hospital of Lishui City.They were divided into ICC and abscess groups.All patients underwent routine liver plain MRI, DWI and contrast‐enhanced MR scan. The MRI features of the two groups (including morphology, boundary, cystic change and necrosis, pseudocapsule, hemorrhage, lipid composition, the signature of lesion in different phases of MRI and surrounding tissue) were studied. Fisher exact test and t test were used. Result This study showed that there was statistical difference between the two groups in the following aspects, the presence of cystic degeneration, the degree of annular enhancement in arterial phase, the homogeneous enhancement in portal venous phase and balanced phase and the central filling enhancement sign (P<0.05).The results showed that necrotic cystic lesion was more common in the abscess group (15/17 cases) than in the ICC group (0/19 cases);in the cases with annular enhancement in arterial phase,the degree of enhancement in the ICC group (13/16 cases) was higher than that in the abscess group (2/9 cases); the enhancement of the central parenchyma of lesion on out‐of‐phase images (1/19 cases) was slower in the ICC group than that in the abscess group (14/17 cases);and the ICC group was likely to present as central filling enhancement compared to the abscess group. Conclusion The presence of cystic lesions in DWI, the enhancement degree of marginal parenchyma, the enhancement speed of central parenchyma and the whole enhancement pattern are essential signs for differentiating intrahepatic cholangiocarcinoma and atypical hepatic abscess. 图1 女,53岁,右肝脓肿.病灶最大径4.0 cm,病灶中的小囊变区在DWI上呈高信号(↑) 图2 女,39岁,右肝脓肿.病灶最大径3.1 cm,病灶中的小囊变区在DWI上呈高信号(↑) 图3 女,66岁,右肝肝内胆管细胞癌(ICC).病灶最大径5.3 cm,横轴面T2WI病灶整体呈不均匀高信号,内见相对更高信号的富黏液区(↑) 图4 男,45岁,右肝ICC.病灶最大径5.8 cm,横轴面T2WI病灶整体呈高低混杂信号,内见散在片状低信号的凝固性坏死区(↑) 图5 与图1为同一患者.横轴面T2WI病灶实质部分呈均匀高信号,小囊变区呈明显高信号(↑) 图6 与图2为同一患者.横轴面T2WI病灶实质部分呈等信号,小囊变区呈明显高信号(↑)图7 与图3为同一患者.增强扫描动脉期横轴面示病灶边缘轻度不规则环形强化 图8 与图4为同一患者.增强扫描动脉期横轴面示病灶强化环有多处中断征象(↑) 图9,10 男,45岁,右肝ICC.病灶最大径5.8 cm,增强扫描动脉期横轴面(图9)示病灶边缘局部显著环形强化,局部强化环明显中断(↑).平衡期横轴面像(图10)示病灶中央有填充强化 图11 与图3,7为同一患者.平衡期横轴面示病灶内富黏液区出现轻微中央填充强化(↑) 图12 与图4、8为同一患者.平衡期横轴面像示病灶中央有填充强化 图13,14 男,59岁,右肝脓肿.病灶最大径4.3 cm,动脉期横轴面像(图13)示脓壁散在强化,周围见片状异常灌注.平衡期横轴面像(图14)示脓壁均匀强化,其内囊变区无强化 图15 与图2,6为同一患者.平衡期横轴面像示脓壁均匀强化呈相对等信号,其内囊变区无强化(↑) 图16 与图1,5为同一患者.平衡期横轴面像示脓壁均匀强化呈相对等信号,其内囊变区无强化(↑)

Objective: To evaluate the impacts of an on-pump beating-heart versus an off-pump coronary artery bypass grafting (CABG) technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (EF) of 35% or less. Methods: A total of 216 consecutive patients with an echocardiographic estimated EF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study and were divided into either an OBCAB group (patients who received on-pump beating-heart CABG surgery, n=88) or an OPCAB group (patients who received off-pump CABG surgery, n=128). The early clinical outcomes were investigated and compared. The outcomes were compared between groups by t-test, χ² test or Fisher′s exact test, when appropriate. Results: No significant differences emerged between the two groups in baseline characteristics of the entire cohort except for more patients with diabetes and a larger left ventricular endo-diastolic diameter in the OBCAB group. Patients in the OBCAB group compared to the OPCAB group had a similar in-hospital mortality (3.4% vs. 4.7%, P= 0.741). Mean EF, as measured preoperatively and early postoperatively (before discharge), significantly improved from (31.0±2.8)% to (35.6±2.9)% (t=10.61, P=0.000) in the OBCAB group and from (31.0±2.9)% to (34.8±3.3)% (t=9.68, P=0.000) in the OPCAB group, respectively. The improvement of mean LVEF in the OBCAB group was significantly higher than that in the OPCAB group ((4.7±0.2)% vs. (3.6±0.3)%, t=29.53, P=0.000). Patients in the OBCAB group compared to the OPCAB group had a significant higher early postoperative EF ((35.6±2.9)% vs.(34.8±3.3)%, t=1.892, P=0.034) but shared a similar baseline EF ((31.0±2.8)% vs. (31.0±2.9)%, t=0.012, P=0.930). Patients in the OBCAB group compared to the OPCAB group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7±0.8 vs. 2.8±0.6, t=9.442, P=0.000; (715±187) ml vs. (520±148) ml, t=8.544, P=0.000, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Conclusion The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated EF of 35% or less.