Objective:To conduct reliability and validity test of Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire so as to evaluate whether they are applicable to the current situation of medical teamwork in China.Methods:From January to April 2019, the Chinese versions of TeamSTEPPS teamwork perceptions questionnaire and TeamSTEPPS teamwork attitudes questionnaire were used to evaluate 900 emergency department workers in 9 ClassⅢGrade A hospitals in Shanghai by cluster sampling, and reliability and validity of the questionnaires were analyzed and evaluated. In this study, a total of 900 questionnaires were issued, 870 were recovered and 861 were valid, with an effective recovery rate of 96%.Results:The exploratory factor analysis of the Chinese versions of Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire was carried out to extract the five dimensions of team structure, leadership, situation monitoring, mutual assistance and communication. The cumulative variance contribution rates were respectively 71.248% and 71.010%. In addition, a confirmatory factor analysis was performed on the questionnaires. The Chi-square degrees of freedom ratio (χ 2/ df) values were 2.870 and 2.214, normed fitting index ( NFI) values were 0.861 and 0.906, Tucker-Lewis index values were 0.896 and 0.940, incremental fit index ( IFI) values were 0.905 and 0.946, comparative fit index (CFI) values were 0.904 and 0.946, and root mean square error of approximation ( RMSEA) values were 0.066 and 0.053. The fitting values all reached the judgment standard, and the structural validity of the two questionnaires was good. The content validity indexes were good and they were respectively 0.94 and 0.95. The overall Cronbach's α coefficients of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire were respectively 0.949 and 0.938, the split-half reliability was respectively 0.848 and 0.959, and the test retest reliability were respectively 0.959 and 0.964. Conclusions:The Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire have good reliability and validity and high applicability, which can be used to measure the attitude and perceptions of medical teamwork in China.

Objective To study the clinical characteristics of neonatal Serratia marcescens sepsis.Method A retrospective review of perinatal factors,clinical manifestations,laboratory findings,treatment and prognosis of Serratia marcescens sepsis in our unit from January 2012 to November 2017.Result A total of 21 cases of serratia marcescens sepsis were identified (diagnosed),all except one were prematurely born.Infection occurred on different days after birth,2 within 3 days,1 within 3 ～ 7 days and 9 in the second week,and the remainder,after 14 days.The clinical manifestations of neonatal Serratia marcescens sepsis were uncharacteristic,mainly manifested as gray pallor,lethargy,and recurrent apnea.Some infants had complications such as pulmonary hemorrhage,septic shock,necrotizing enterocolitis and scleroderma.Most infants had low white blood cell count,thrombocytopenia and high C-reactive protein at the onset of illness.All Serratia marcescens cases were sensitive to piperacillin/tazobactam,ceftazidime and meropenen.In total,17 cases had lumbar puncture,5 of them diagnosed with meningitis,with elevation of cerebrospinal fluid white blood cell count and protein,and 3 infants complicated with brain abscess.The duration of antibiotic therapy were 14 days or more depending on the clinical conditions.The overall mortality was 14.3％.Conclusion Serratia marcescens is an important opportunistic pathogen.It might cause serious infections in the premature infants including sepsis,brain abscess and meningitis.Regular neuro-imagings might be necessary for all sepsis infants.The infected and colonized neonates might be the hidden source of Serratia marcescens.The surveillance protocols,eradication of colonization,and strict adherence to hand disinfection/washing might help to prevent dissemination of invasive bacteria among premature infants.

OBJECTIVETo investigate the correlation between transformation growth factor (TGF- B) polymorphisms and IgA nephropathy and the therapeutic effect of dendrobium on IgA nephropathy.

METHODSPolymerase chain reaction- restriction fragment length polymorphism (PCR- RFLP) and direct sequencing were used for analysis of 118 patients with IgA nephropathy from core families in Guangxi Zhuang Autonomous Region. The imbalanced transfer of TGF iso1-509 C/T in the affected offsprings was observed by transfer imbalance test and HRR analysis. The TGF-B genotype of the patients and the core family members were detected. The therapeutic effects of Dendrobium candidum combined with hormone and ACEI/ARB treatments were evaluated by observing the patient's urine protein (24 hUpr), serum albumin (ALB), creatinine (Scr) and urea nitrogen (BUN) levels.

RESULTSIn the 118 patients with IgA nephropathy, we identified TGF-B 1 promoter -509C/T genotype CC in 32 (27.1%) cases, CT in 58 (49.2%) cases, and TT in 28 (23.7%) cases. In the core family of the patients, CC genotype was found in 33 (28.0%) cases, CT in 55 (46.6%) cases, and TT in 30 (28.0%) cases. The treatments significantly lowered 24 hUpr, Scr, and BUN levels ( > 0.05) in patients with CC genotype, significantly lowered 24 hUpr and BUN levels in patients with CT genotype ( < 0.05), and significantly lowered 24 hUpr and BUN level and increased ( < 0.05) ALB level ( < 0.01) in patients with TT genotype.

CONCLUSIONSThere is no significant correlation between TGF-B promoter - 509C/T polymorphism and IgA nephropathy. The patients with CC genotype are sensitive to the treatments with hormone and ACEI/ ARB and show a stronger response to combined treatments with dendrobium.

Objective To study the correlation between hyperhomocystinemia and the property of cerebral artery plaque,and the pathogenic mechanism of hyperhomocystinemia resulting in acute cerebral stroke.Methods 60 patients with acute ischemic stroke were chosen.30 patients with normal homocysteine were classified as control group.The other 30 patients with hyperhomocystinemia were classified as observation group.High resolution magnetic resonance imaging(HRMRI) and multi contrast plaque imaging technique were used to measure the cerebral artery plaque burden,the fat ratio of plaques,the hemorrhage within the plaque and fibrouscap rupture.The number of inflammatory cells in the plaque and the density of the new blood vessels were identified using the transfer constant of the contrast medium.Results In the observation group,4 cases with low-risk plaques (13.33％),10 cases with middle-risk plaques (33.33 ％) and 16 cases with high-risk plaques (53.33 ％).In the control group,13 cases with low-risk plaques (43.33％),6 cases with middle-risk plaques (20.00％),11 cases with high-risk plaques (36.67％).The number of intraplaque hemorrhage were 18 cases (60.00％) in the observation group,and 8 cases (26.67％) in the control group.The number of fibrouscap rupture were 21 cases (70.00％) in the observation group,and 13 cases (43.33％) in the control group.Risk stratification of vulnerable plaques in cerebral atherosclerosis (U =-2.032,P =0.042),intraplaque hemorrhage (x2 =6.79,P =0.009) and fibrouscap rupture (x2 =4.34,P =0.037) in the observation group was higher than that in the control group.The number of inflammatory cells in plaques and the density of the new blood vessels in the observation group was (0.188 ± 0.265)Ktrans/min,which in the control group was (0.118 ± 0.183)Ktrans/min.The number of inflammatory cells in the plaque and the density of the new blood vessels in the observation group was higher than that in the control group (t =11.831,P =0.000).Conclusion Hyperhomocystinemia causes intraplaque hemorrhage,fibrouscap rupture,inflammatory cell activity and neovascularization in plaques,accelerates cerebral atherosclerosis and increases the incidence of ischemic stroke events.

Objective To investigate the effects of transient receptor potential cation channel 6 (TRPC6) on the expression of nephrin, desmin and caspase 9 and on the apoptosis of podocytes in a mouse model of podocyte injury induced by TGF-β1.Methods Conditionally immortalized mouse podocytes were cultured in vitro and divided into four groups: control, TGF-β1 treatment, TGF-β1+PGPU6/GFP/Neo-TRPC6-mus-581 (TRPC6 knockdown) and TGF-β1+PGPU6/GFP/Neo-NC (negative control).Real-time RT-PCR and Western blot analysis were performed to detect the expression of nephrin, desmin and caspase 9 at mRNA and protein levels, respectively.Flow cytometry was used to analyze the apoptotic rate of podocytes.DAPI fluorescent staining was used to observe the morphological changes of apoptotic podocytes.Results Green fluorescent protein (GFP)-expressing podocytes at 48 hours after transfection were significantly more than those at 24 hours after transfection.The level of TRPC6 in mouse podocytes transfected with PGPU6/GFP/Neo-TRPC6-mus-581 was significantly decreased as compared with that of the control group (P<0.05).No significant difference in the expression of TRPC6 was observed between the negative control group and the control group.Compared with the control group, the TGF-β1 treatment group showed increased expression of desmin and caspase 9 at both mRNA and protein levels (P<0.01), but decreased expression of nephrin at mRNA and protein levels at 48 hours after TGF-β1 intervention (P<0.05).The up-regulated desmin and caspase 9 and the down-regulated nephrin induced by TGF-β1 could be inhibited by the means of TRPC6 knockdown.The apoptosis rate of podocytes in TGF-β1 treatment group was (14.0±2.1)%, while that in TRPC6 knockdown was (10.90±0.56)% (P<0.05).The apoptosis rate of podocytes in negative control group was higher than that in TGF-β1 treatment group (P>0.05).More apoptotic cells with typical morphological features of apoptosis were observed after exposure to TGF-β1 for 48 hours.Conclusion TGF-β1 could induce the apoptosis of podocytes, inhibit the expression of nephrin and enhance the expression of caspase 9 and desmin, the possible mechanisms of which may be related to TRPC6 signal pathway.These changes in TGF-β1-treated podocytes could be alleviated by inhibiting the expression of TRPC6, which might have a protective effect on podocyte injury.

Objective To investigate the changes of soluble CD105,transforming growth factor-beta1(TGF-β1) and vascular endothelial growth factor(VEGF) in esophageal cancer(EC) patients,analyzing its clinical significance.Methods Collecting 56 cases of gastric cancer(observation group) and 49 cases of healthy people(control group)from Nov.2014 to Jan.2016 as the research objects.The levels of soluble CD105,TGF-β1 and VEGF were detected in EC patients pre-and post-operation and healthy subjects.The data of soluble CD105,TGF-β1 and VEGF were analyzed in the two groups.Results The pre-operation levels of soluble CD105,TGF-β1 and VEGF in EC patients were significantly higher than those in the control group,the difference was statistically significant(P<0.05).The pre-operation levels of soluble CD105,TGF-β1 and VEGF in EC patients were significantly higher than post-operation levels,the difference was statistically significant(P<0.05).The post-operation levels of soluble CD105,TGF-β1 and VEGF in EC patients were not statistically different with control group(P>0.05).Conclusion The levels of soluble CD105,TGF-β1 and VEGF could be abnormal in patients with EC,which might be the index for monitoring the clinical disease condition and judging the prognosis of the EC.

Objective To explore the correlation between breast ultrasound data classification system (BI-RADS) and estrogen receptor (ER),progesterone receptor (PR),proto-oncogene (Cerb-2).Methods The IDC ultrasound imaging of 320 patients diagnosed as breast cancer by surgery and postoperative pathology wasanalyzed,including the size of the lump,edge burr,aspect ratio,the presence of microcalcification,mass internal blood flow of posterior acoustic attenuation,mass,elasticity ratings and mass BI-RADS classification,and the expressions of ER,PR and CerB-2 were detected by immunohistochemical method.Results The positive rates of PR and ER in the mass with burr edge were significantly higher than those in the mass without burr edge,the positive rate of Cerb2 in mass with slight calcifications was significantly higher than that in mass without slight calcifications,and the positive rate of Cerb-2 in mass with flow grade Ⅱ ～Ⅲ was significantly higher than that in mass with flow grade 0 ～ I.The expressions of BI-RADS in mass with positive ER,PR and CerbB2 were significantly higher than those in mass with negative ER,PR and CerbB-2 (P ＜ 0.05).Conclusion There are correlations between molecular biology of breast cancer and edge burr,microcalcification and rich blood flow.

Objective To explore the correlation between breast ultrasound data classification system (BI-RADS) and estrogen receptor (ER),progesterone receptor (PR),proto-oncogene (Cerb-2).Methods The IDC ultrasound imaging of 320 patients diagnosed as breast cancer by surgery and postoperative pathology wasanalyzed,including the size of the lump,edge burr,aspect ratio,the presence of microcalcification,mass internal blood flow of posterior acoustic attenuation,mass,elasticity ratings and mass BI-RADS classification,and the expressions of ER,PR and CerB-2 were detected by immunohistochemical method.Results The positive rates of PR and ER in the mass with burr edge were significantly higher than those in the mass without burr edge,the positive rate of Cerb2 in mass with slight calcifications was significantly higher than that in mass without slight calcifications,and the positive rate of Cerb-2 in mass with flow grade Ⅱ ～Ⅲ was significantly higher than that in mass with flow grade 0 ～ I.The expressions of BI-RADS in mass with positive ER,PR and CerbB2 were significantly higher than those in mass with negative ER,PR and CerbB-2 (P ＜ 0.05).Conclusion There are correlations between molecular biology of breast cancer and edge burr,microcalcification and rich blood flow.

Objective To evaluate the effectiveness and safety of ultrasound-enhanced thrombolysis for acute ischemic stroke.Methods Fifty stroke patients with acute middle cerebral artery occlusion were randomly divided into either a ultrasound-enhanced thrombolysis group (recombinant tissue-plasminogen activator [rtPA] +2 MHz ultrasound monitoring for 2 h) or a standard thrombolysis group (rtPA alone).The demographic characteristics,vascular risk factors,blood pressure before treatment,thrombolysis in brain ischemia (TIBI) grade before thrombosis,and vascular occlusion site of the patients were collected.The primary outcome endpoint was the good outcome rate (defined as the modified Rankin Scale score 0-1) at 3 months.The secondary outcome endpoints were complete recanalization at 2 h after thrombolysis,sustained complete recanalization,symptomatic intracerebral hemorrhage,and mortalitY.Results The good outcome rate of the ultrasound-enhanced thrombolysis group at 3 months after treatment was significantly higher than that of the standard thrombolysis group (64％ vs.36％;P=0.011).The sustained complete recanalization rate (40％ vs.8％;P =0.018) and complete recanalization rate (48％ vs.12％;P =0.012) of the ultrasound-enhanced thrombolysis group were significantly higher than those of the standard thrombolysis group,but there were no significant differences in the reocclusion rate (8％ vs.12％;P =0.637),incidence of symptomatic intracerebral hemorrhage (4％ vs.4％;P=1.000),and mortality (4％ vs.4％;P=1.000) compared with the standard thrombolysis group.Conclusions Ultrasoundenhanced thrombolysis can improve the sustained complete recanalization rate,complete recanalization rate,and good outcome rate after using rtPA within 2 h,and it does not increase the risks of symptomatic cerebral hemorrhage and death.It is a safe and effective adjunctive thrombolytic therapy.

Objective To explore the different effects on the bleeding after the surgery of minimally invasive intracranial haematoma with drainage method.Methods The cases with minimally haematoma invasive operation were divided into A and B group.Group A simply used the liquefaction agent for blood clots( urokinase mixed with hyaluronidase),without washing step,and Group B used saline water to wash repeatedly and then use liquefaction agent to divert.Results The hematoma clearance rate of A group equal to that of B Group,while the rate of re-bleeding was ( 3.8 ％ ) obviously lower than than of B Group ( 22.7％ ) ( x2 =4.594,P ＜ 0.05 ).Condusion For many cases who have experienced the minimally invasive intracranial operation,the simple use of liquefaction agent can divert haematoma,and the risky rate of re-bleeding was obviously lowered.