Objective:To investigate the clinicopathological characteristics, immunophenotypes, molecular features, and differential diagnosis of BAP1 mutated clear cell renal cell carcinoma (CCRCC) for better understanding this entity.Methods:Clinical data, histological morphology, immunophenotypes and molecular characteristics of 18 BAP1 mutated CCRCC cases diagnosed at the Department of Pathology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China from January 2020 to December 2022 were analyzed. The patients were followed up.Results:There were 17 males and 1 female patients, aged from 39 to 72 years, with an average age of 56.3 years. Sixteen patients with primary CCRCC were followed up for an average of 24 months, 7 patients had metastases occurred from 4 to 22 months postoperatively. Thirteen of the 16 patients were alive at the time of the last follow-up while 3 patients died 12, 15, and 20 months after the surgery, respectively. One patient underwent retroperitoneal mass resection, but had lung metastasis 32 months after surgery. One case received cervical tumor resection and died at 22 months after the surgery. Characteristic CCRCC regions were identified in 11 of the 18 cases. The tumor cells were arranged in papillary, alveolar, and large nest patterns. Abundant lymphoid tissue, necrosis, and psammoma bodies were seen. Tumor cells showed abundant eosinophilic cytoplasm, and sometimes exhibited rhabdoid differentiation. Round eosinophilic globules were located in the cytoplasm and extracellular matrix. There were 9 cases with WHO/International Society of Urological Pathology grade 3, and 9 cases with grade 4. PAX8 (18/18), carbonic anhydrase 9 (CA9, 16/18), CD10 (18/18), and vimentin (18/18) were positive in the vast majority of tumors.TFE3 was expressed in 5 cases, with strong expression in only 1 case. Eighteen cases were all positive for P504s. Twelve cases harbored a BAP1 mutation combined with von Hippel-Lindau (VHL) mutation, and 2 cases had mutations in BAP1, VHL and PBRM1 simultaneously. SETD2 mutation was not found in any of the cases.Conclusions:BAP1 mutated CCRCC contained papillary, alveolar, and large nest patterns, eosinophilic cytoplasm, high-grade nucleoli, and collagen globules, with P504s positivity. In practical work, when encountering CCRCC containing these features, pathologists should consider the possibility of BAP1 mutations and conduct related molecular tests.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Eyes are an important part of facial morphology. The study of eye morphology is of great value in exploring human growth and establishing eye database. Its shape and size are influenced by factors such as gender, age, and ethnic group. The related literature on eye morphology mainly includes the following aspects: gender, age, and ethnic differences of eye morphological variation; factors affecting eye shape variation; eyelid shape; eye symmetry research; eye morphology and epicanthus; measurement of eye shape related parameters; related application of eye morphology, etc. By sorting out and summarizing the research data and conclusion of related literature, this article briefly outlines the research on eye morphology and the measurement method of eye parameters, furthermore, it gives a brief review and outlook on the research of eye morphology in China.

Eyes are an important part of facial morphology. The study of eye morphology is of great value in exploring human growth and establishing eye database. Its shape and size are influenced by factors such as gender, age, and ethnic group. The related literature on eye morphology mainly includes the following aspects: gender, age, and ethnic differences of eye morphological variation; factors affecting eye shape variation; eyelid shape; eye symmetry research; eye morphology and epicanthus; measurement of eye shape related parameters; related application of eye morphology, etc. By sorting out and summarizing the research data and conclusion of related literature, this article briefly outlines the research on eye morphology and the measurement method of eye parameters, furthermore, it gives a brief review and outlook on the research of eye morphology in China.

This paper reviewed the present nursing manager succession planning at home and abroad, covering the succession standard of nursing managers, the content and form of pre-job training, and the evaluation tool of management ability. These efforts aim to provide references for the construction of nursing management talents teams in China.

Objective To determine the value of accommodation quotient (AQ) on dysphagia evaluation in the elderly. Methods 40 old cases with dysphagia were assessed with AQ, Kubota Water Swallow Test (WST) and Swallowing Evaluation (SE) before and after 3 weeks of treatment. The patients were divided into 2 groups based on the first AQ assessment: mild group (AQ=1.5~2.5) and serious group (AQ< 1.5). Results There was not significant difference in scores of WST between both groups (P>0.05) but SE (P<0.05). The AQ before treatment moderately correlated with the scores of WST and SE before treatment and improvement (P<0.001), and SE after treatment (P<0.001), but did not correlate with the score of WST after treatment (P>0.05). Conclusion The AQ may indicate the function of swallowing in the elderly, and predict the outcome of dysphagia.

Objective To explore the relationship between the somatosensory evoked potential (SEP) diversification during operation and the short term outcome of ossification of posterior longitudinal ligament (OPLL) of cervical spine. Methods 70 OPLL inpatients from February 2008 to February 2011were included in this study. All patients received anterior cervical operation. According to the diversification of the SEP during surgery, the patients were divided into 2 groups. The preoperative and postoperative JOA scores of the OPLL patients were collected. Results There were 35 patients in the SEP no change group and 30 in SEP improved group. There was no difference in the preoperative JOA scores between them (P>0.05), but was significantly different in the postoperative JOA scores (P>0.05). Conclusion There is some relationship between the SEP diversification during operation and the short term outcome of OPLL of cervical spine.

Objective The stress reaction in double-balloon enteroscopy was investigated,the influencing factors and intervention countermeasures were studied.Methods Cardiovascular effects and physiological reactions of 60 double-balloon enteroscopy patients were surveyed.The patients were divided into 2 groups according to the cardiovascular effects to underwent single factor analysis of related factors.Results The incidence of physiological reactions was 68.3%,the incidence of cardiovascular reactions was 56.7%.Evident difference existed in blood pressure,heart rate and blood oxygen saturation rate before,during and after examination.The grouping analysis showed cardiovascular effects were influenced by many kinds of factors.Conclusions Different degrees of the stress reactions in double-balloon enteroscopy might appear.The influencing factors included the enteroscopy mode and time,gender,age,mood,and physician operation experience.The stress reactions might be reduced by taking the corresponding intervention measures according to the influencing factors.

ObjectiveTo examine the test-retest reliability and measurement error in using a Jamar dynamometer to determine grip strength for elder men. Methods40 elder men with a mean age of 82 years old volunteered to participate in this study. The grip strength was administered twice using a Jamar dynamometer by specially trained testers; subjects were re-tested at the same time of day a week later by the same testers. ResultsThe infraclass correlation coefficient（ICC） was 0.99. The standard error of measurement (SEM and SEM%) were 1.18～1.69 and 4.11%～6.41%. The smallest real difference (SRD and SRD%) were 3.27～4.68 and 11.39%～17.75%. The Bland-Altman analysis revealed no systematic errors between test and retest. ConclusionThe Jamar dynamometer is reliable and with acceptable measurement errors to determine grip strength for elder men.

ObjectiveTo investigate the age-related changes in grip strength of the elderly men and compare with the norms of overseas. Methods112 subjects were divided into six groups: 65～69 years old, 70～74 years old, 75～79 years old, 80～84 years old, 85～89 years old, and 90～95 years old. The grip strength was measured with Jamar dynamometer. ResultsThe grip strength of both sides were significantly moderate negative correlated to age (r=-0.681 and -0.68, P<0.001) and stepwise regression analysis showed the age was important clinical factor to consider in determining grip strength in the elderly men （R2=0.468, F=47.951, P＜0.001). The grip strength was declined significantly during the 75～79 and 85～89 years old. ConclusionGrip strength had declined in the elderly men and these losses were significantly related to age. The highest loss in men was in the age over 75. The norms of grip strength overseas were not applicable to Chinese older adults.