Aim To investigate whether elevated monocyte to lymphocyte ratio(MLR)is associated with the in-hospital mortality risk in elderly patients with acute myocardial infarction(AMI).Methods The medical history of 1 550 elderly patients with AMI hospitalized in the Department of Cardiology of the Second Affiliated Hospital of Dalian Medical University from December 2015 to December 2021 was retrospectively collected,including 132 patients who died during hospitalization.It mainly includes gender,age,height,body weight,blood routine,lipid related indicators,fast-ing blood glucose(FBG),myocardial enzyme,type of myocardial infarction,estimated glomerular filtration rate(eGFR),in-hospital outcomes,prevalence of heart failure,diabetes,hypertension,and use of statins and antiplatelets during hospi-talization.According to ROC curve analysis,patients with MLR＞0.342 were defined as high MLR group(n=699),whereas patients with MLR≤0.342 were defined as low MLR group(n=851).Results The age,white blood cell count,monocyte count,MLR,cardiac troponin I(cTnI),FBG,eGFR＜60 mL/(min·1.73 m2),male patients,heart failure,and proportion of all-cause deaths occurred during hospitalisation were higher in the high MLR group than those in the low MLR group(P＜0.05),body mass index(BMI),lymphocyte count,low density lipoprotein cholesterol(LDLC),eGFR＞60 mL/(min·1.73 m2),hypertension,and use of antiplatelet agents were lower in the high MLR group compared to the low MLR group(P＜0.05).Multivariate Logistic regression results showed that high MLR was independently asso-ciated with the in-hospital mortality risk in elderly AMI patients(OR=1.812,95％CI:1.106～2.969,P=0.018).The results of ROC curve analysis showed that the predictive ability of MLR combined with cTnI or FBG would be significantly improved,and the area under ROC curve was 0.789 and 0.739,respectively.Restrictive cubic spline(RCS)analysis results indicated a linear dose-response relationship between MLR and in-hospital outcomes in elderly AMI patients.Conclusion Elevated MLR is independently associated with the in-hospital mortality risk in elderly AMI patients,and cli-nicians can consider using MLR indicators in daily diagnosis for risk stratification and related treatment of such patients to improve their short-term prognosis.

Objective:To investigate the situation of nursing handover among psychiatric nurses, and explore the association between perceived organizational support, self-efficacy and quality of nursing handover.Methods:A total of 186 clinical nurses in Shandong Mental Health Center were enrolled by convenience sampling method. They were assessed with handover evaluation scale, perceived organizational support scale and general self-efficacy scale for the evaluation of nursing handover, perceived organizational support and self-efficacy.Results:The average score of quality of nursing handover was 5.85±1.14, and bi-variate correlations were found between perceived organizational support, self-efficacy and quality of nursing handover. Self-efficacy could mediate the relationship between organizational support and nursing handover, and the value of mediating effect was 13.4%.Conclusions:Self-efficacy might mediate the relationship between perceived organizational support and nursing handover among psychiatric nurses.

Mental health is key to public health, as building and developing a mental health service system is legally required in the Mental Health Law of China. The authors probed deep, by means of questionnaire, field survey and group interview, into the characteristics and setbacks of the resources available, organizational framework and operations of the system in China. As found in the study, given a framework in place, this system is plagued by insufficient human resources, weak infrastructure, unreasonable input and compensation mechanism, as well as poor management at community level. These problems are common nationwide. On this basis and with reference to experiences of developed countries, policy proposals are raised in terms of integrated system building, capacity building and assurance mechanism, for framework building and supportive policies of other cities in China.

Objective: To evaluate the sensitivity and specificity of immunohistochemistry (IHC) in the classification of cardiac amyloidosis on endomyocardial biopsy (EMB) and heart allograft. Methods: Twenty cardiac tissues from 19 patients at Fuwai Hospital from January, 1990 to April, 2017 with histopathologic features of amyloidosis and Congo red staining positivity were included. IHC was performed with monoclonal antibodies against AA amyloid and polyclonal antibodies against transthyretin (ATTR), λ-light chain (AL-λ), κ-light chain (AL-κ), ApoAⅠ, ApoAⅡ, ApoA Ⅳ and β₂-microglobin. The extent of interstitial staining was evaluated by light microscopy, and three patterns were recognized; these included diffuse pericellular pattern, discrete pericellular pattern, and nodular pattern. Two patterns of vascular deposition were also noted, including arterial pattern and venous pattern. Endocardial involvement was also assessed and recorded. Results: Nineteen cases were divided into three groups according to the pattern of proteins expression in specimens. The first group (5 cases) only showed single protein expression on EMB. The second group (6 cases) showed more than one protein expression, but one of them was intensely stained or any staining of any protein together with ApoA Ⅳ co-staining. The third group (8 cases) also showed more than one protein expression and all of them had intense staining. Amyloid deposits were successfully subtyped as AL-λ, ATTR, AL-κ and ApoAⅠby IHC in the former two groups with the sensitivity of 11/19. In the third group, amyloid deposits could not be subtyped by immunohistochemistry due to their poor specificity. The pericellular pattern tended to favor AL over ATTR amyloidosis and vascular deposition tended to favor ATTR. Conclusions Amyloid deposits can be reliably subtyped in diagnostic cardiac specimens using IHC. The co-deposition of chaperon proteins, the distribution of amyloid proteins and clinical features are also auxiliary to subtype cardiac amyloidosis.

Objective To explore the relationship among psychological resilience, self-efficacy and core competence in psychiatric nurses. Methods Totally 237 psychiatric nurses in a psychiatric hospital in Shandong province were recruited and assessed with general information questionnaire, Connor-Davidson Resilience Scale, General Self-Efficacy Scale and Competency Inventory for Registered Nurse. Results The total core competence of psychiatric nurses was (2.59 ± 0.66) points, at a moderate level. Psychological resilience were positively corrected with self- efficacy (r=0.454,P=0.000) and core competence (r=0.647, P=0.000), self-efficacy were positively corrected with core competence (r=0.487, P=0.000). Psychological resilience partially mediate the relationship between self- efficacy and core competence, It′s mediating effect was 44.8%. Conclusions Psychological resilience plays an important role to core competence in psychiatric nurses.Nursing managers should carry out related training, improve the psychological resilience and self-efficacy of psychiatric nurses, and comprehensively improve the level of core competencies.

Objective To investigate the present status and influencing factors of psychological distress among psychiatric nurses, and provide theoretical basis for intervention measures. Methods Totally, 812 psychiatric nurses in six psychiatric hospitals of Shandong province were selected to complete the Kessler Psychological Distress Scale (K10), Perceived Organizational Support(POS), Simplified Coping Style Questionnaire(SCSQ) and Emotion regulation questionnaire(ERQ). Results The mean scores of psychological distress among psychiatric nurse was (21.29±8.11) points,70.3%of psychiatric nurses had psychological distress. There were significant differences in psychological distress among psychiatric nurses with different age (F=6.886,P=0.001), working years (F=4.403,P=0.004), professional title (F=6.597,P=0.000) and experience of nurse-patient conflict (F=7.228,P=0.000).Psychological distress was negatively related to cognitive reappraisal(r =- 0.093), positive coping style (r =- 0.163) and perceived organizational support(r =- 0.379), while psychological distress was positively related to expressive suppression(r=0.160) and negative coping style(r=0.258)(all P<0.01). Regression analysis revealed that the factors impacting psychological distress were positive coping style, perceived organizational support, expressive suppression, negative coping style and nurse-patient conflict (R2=0.224,F=46.611,P=0.000). Conclusions Psychiatric nursing managers should pay attention to the cultivation of emotional management ability of nurses and the ability to deal with conflict,encouraging them apply positive thinking cognition and positive coping style to deal with negative events in the work,creating a supportive work environment in order to improve the level of mental health.

Objective:Discussion MKK4 protein expression in nasopharyngeal carcinoma and -1044 A/T polymorphism correlation.Methods:90 patients with nasopharyngeal carcinoma , MKK4 protein expression was determined by immunohistochemical staining,polymerase chain reaction-restriction fragment length polymorphism ( PCR-RFLP ) to detect the gene -1044A/T sites monocytes nucleotide polymorphism.Results:MKK4 protein expression in nasopharyngeal carcinoma (-) was 24.4%(22/90),(+) was 15.6%(14/90),(++) was 34.4%(31/90),(+++) was 25.6% (23/90).Low expression (-/+) patients with a total of 36 cases,-1044AA genotype accounted for 22 cases (61.11%),AT genotype accounted for 12 cases (33.33%),TT genotype accounted for two cases (5.56%),AT+TT gene type accounted for 14 cases (38.89%).The patients with high MKK4 expression of 54 cases,of which accounted for 38 cases of AA genotype (70.37%),AT genotype accounted with 15 cases (27.78%),TT genotype accounted for one case (1.85%),AT +TT genotype accounted for 16 cases (29.63%).Low expression and high expression of T gene mutation occurs no significant ( Z=0.323 , P=0.747 ) .Conclusion: MKK4 protein expression correlated with -1044 A/T gene promoter polymorphisms was no significant correlation .

OBJECTIVE: To investigate the association between-1304T/G polymorphism in the promoter of MKK4 gene and the susceptibility in sporadic nasopharyngeal carcinoma. METHOD: MKK4-1304T/G genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 90 NPC cases and 30 healthy controls. RESULT: The number of nasopharyngeal carcinoma patients carrying with TG+GG genotype was much higher than those of controls (82.2% vs 66.7%, χ² =10.076, P < 0.05). Analysis showed that compared with the-1304TT genotype, -1304TG heterozygous reduced risk of nasopharyngeal carcinoma 0.56 fold (95% CI = 0.164-1.178, P < 0.01) and-1304GG lower 0.58 fold (95% CI = 0.126-1.381, P < 0.01), TG+ GG genotype variation risk of nasopharyngeal carcinoma decreased 0.72 fold (95% CI = 0.105-0.753, P < 0.01). CONCLUSION MKK4 gene-1304TG genotype can reduce risk of nasopharyngeal carcinoma, and it may be an independent protection factor in sporadic nasopharyngeal carcinoma.
Carcinoma ; Genetic Predisposition to Disease ; Genotype ; Heterozygote ; Humans ; MAP Kinase Kinase 4 ; genetics ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; genetics ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Promoter Regions, Genetic

Objective To investigate the pathological changes and related factors leading to failure of bioprosthetic valves.Methods The surgical explanted bioprosthetic valves in Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2006 to December 2014 were retrospectively reviewed.Calcification,cusp tears,pannus and infectious endocarditis of bioprosthetic valves were evaluated by gross examination,X ray photography and histopathological analysis.Meanwhile,the age and the site at implantation,and the tissue type of bioprosthetic valves,the implantation duration were obtained by chart review and used to be analyzed with the modes of valve failure.U test,x2 test and Fisher exact test were used to analyze the data.Results Total 48 bioprostbetic valves were collected from 40 cases with 26 females.Their age at the time of implantation was 12 to 71 years (median 58 years).The tissue types of bioprosthesis included 24 bovine pericardial valves and 24 porcine aortic valves respectively.The implantation sites included mitral in 29 valves,aortic in 14 valves and tricuspid in 5 valves.The implantation duration ranged from 5 days to 27 years (mean (111 ± 77) months).The study showed that the commonest mode of valve failure was structural valve deterioration (32 valves,66.7％).The fewer modes of valve failure were infectious endocarditis (9 valves,18.7％) and non-structural valve deterioration (7 valves,14.6％).No thrombosis was found in this series.The degree of calcification was correlated positively with implantation duration (r =0.52,P =0.000).The implantation duration of bovine pericardial valves was longer than that of porcine aortic valves ((146 ± 74) months vs.(77 ± 68) months,Z =-3.24,P =0.001).Porcine aortic valves had a higher incidence of cusp tears than bovine pericardial valves (66.7％ vs.16.7％,x2 =12.34,P =0.000) despite they had a relatively lower incidence of calcification (41.7％ vs.75.0％,x2 =5.37,P =0.019).For the age at the time of implantation,the patients ≤ 60 years old had more calcification of bioprosthetic valves compared with those ＞ 60 years old (45.1％ vs.2/17,x2 =5.51,P =0.019) whereas the patients ≤60 years old had fewer cusp tears (12.9％ vs.58.8％,P =0.002).Infectious endocarditis was found more frequently in the valves failure within 5 years than those failure after 5 years (6/14 vs.8.8％,P =0.006).Conclusions Structural valve deterioration is the principle cause of bioprosthetic valve failure while infectious endocarditis mainly involves the valves failure in early and middle terms after surgery.The mode of valve failure in the patients ≤60 years old is different from that in the patients ＞ 60 years old at the time of implantation.More calcification would occur in bioprosthetic valve in the younger patients.

Objective To investigate the pathological changes and related factors leading to failure of bioprosthetic valves.Methods The surgical explanted bioprosthetic valves in Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2006 to December 2014 were retrospectively reviewed.Calcification,cusp tears,pannus and infectious endocarditis of bioprosthetic valves were evaluated by gross examination,X ray photography and histopathological analysis.Meanwhile,the age and the site at implantation,and the tissue type of bioprosthetic valves,the implantation duration were obtained by chart review and used to be analyzed with the modes of valve failure.U test,x2 test and Fisher exact test were used to analyze the data.Results Total 48 bioprostbetic valves were collected from 40 cases with 26 females.Their age at the time of implantation was 12 to 71 years (median 58 years).The tissue types of bioprosthesis included 24 bovine pericardial valves and 24 porcine aortic valves respectively.The implantation sites included mitral in 29 valves,aortic in 14 valves and tricuspid in 5 valves.The implantation duration ranged from 5 days to 27 years (mean (111 ± 77) months).The study showed that the commonest mode of valve failure was structural valve deterioration (32 valves,66.7％).The fewer modes of valve failure were infectious endocarditis (9 valves,18.7％) and non-structural valve deterioration (7 valves,14.6％).No thrombosis was found in this series.The degree of calcification was correlated positively with implantation duration (r =0.52,P =0.000).The implantation duration of bovine pericardial valves was longer than that of porcine aortic valves ((146 ± 74) months vs.(77 ± 68) months,Z =-3.24,P =0.001).Porcine aortic valves had a higher incidence of cusp tears than bovine pericardial valves (66.7％ vs.16.7％,x2 =12.34,P =0.000) despite they had a relatively lower incidence of calcification (41.7％ vs.75.0％,x2 =5.37,P =0.019).For the age at the time of implantation,the patients ≤ 60 years old had more calcification of bioprosthetic valves compared with those ＞ 60 years old (45.1％ vs.2/17,x2 =5.51,P =0.019) whereas the patients ≤60 years old had fewer cusp tears (12.9％ vs.58.8％,P =0.002).Infectious endocarditis was found more frequently in the valves failure within 5 years than those failure after 5 years (6/14 vs.8.8％,P =0.006).Conclusions Structural valve deterioration is the principle cause of bioprosthetic valve failure while infectious endocarditis mainly involves the valves failure in early and middle terms after surgery.The mode of valve failure in the patients ≤60 years old is different from that in the patients ＞ 60 years old at the time of implantation.More calcification would occur in bioprosthetic valve in the younger patients.