Objective:Induced pluripotent stem cells (iPSCs) cell lines were established using peripheral blood mononuclear cells (PBMCs) from a patient suffering from neonatal respiratory distress syndrome (NRDS) who carried Adenosine triphosphate-binding cassette transporter A3 ( ABCA3) compound heterozygous mutations. Methods:Cell experimental research.Peripheral venous blood was collected and PBMCs were isolated and cultured in vitro. PBMCs were transfected with non-integrated Sendai vector carrying reprogramming factors.The chromosome karyotypes of the established iPSCs were analyzed.Immunofluorescence and flow cytometry were used to detect pluripotency markers of stem cells and verify their differentiation potential.Sanger sequencing was performed to analyze gene mutations.In addition, short tandem repeat (STR) analysis was performed, polymerase chain reaction(PCR) and agarose gel electrophoresis were used to detect virus residual. Results:Karyotype analysis of established iPSCs cell lines showed normal diploid 46, XY karyotype.Immunofluorescence showed positive staining of stem cell pluripotency markers OCT4, SSEA4, Nanog and Sox2.Flow cytometry was used to detected stem cell pluripotency markers and showed expression of TRA-1-60, SSEA-4 and OCT4.After differentiation into all three germ layers, immunofluorescence was performed to detect ectoderm (Pax-6), mesoderm (Brachyury) and endoderm alpha-fetoprotein markers, and the results showed positive staining, which confirmed that the iPSCs had the potential to differentiate.Sanger sequencing showed c. 3997_3998del and c. 3137C>T compound heterozygous mutations.STR analysis showed they originate from PBMCs, and no Sendai virus residual was detected by PCR and agarose gel electrophoresis.Conclusions:In this study, PBMCs from patient carrying ABCA3 compound heterozygous mutations was used to establish iPSCs cell lines.The research lays a foundation for the study of pathogenesis, therapeutic drug screening and cell therapy of NRDS caused by ABCA3 gene mutations.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the risk factors of infection of Pseudomonas aeruginosa combined with Elizabethkingia anophelis in patients with cerebral hemorrhage and the antimicrobial treatment plan.Methods Clinical pharmacists participated in the treatment of pulmonary infection caused by Pseudomonas aeruginosa combined with Elizabethkingia anophelis in a patient with cerebral hemorrhage.The risk factors of Elizabethkingia anophelis infection and antimicrobial treatment plan were analyzed by referring to literature and combining the patient's condition,medical history,drug use history and related examination results.Results Based on the infection site,the characteristics of mixed bacterial infection,and the metabolic/pharmacodynamic characteristics of antimicrobial agents,clinical pharmacists made drug recommendations for clinicians in the adjustment of anti-infection protocols,and patients'systemic infections were effectively controlled.Conclusion Elizabethkingia anophelis is a conditional pathogen with low virulence and is not easy to infect healthy people.When the patient's immunity is low,it is easy to transform into pathogenic bacteria,which should be paid attention to.

ATP-binding cassette transporter A3(ABCA3) gene mutation is one of the important causes of severe respiratory distress syndrome and interstitial lung disease in children and adults.Clinical phenotypes vary dramatically among patients with ABCA3 mutations.So far, the genotype-phenotype correlation is not entirely clear.The association between the possible factors that influence the phenotypes, such as the environment, infection and diseases remains to be studied.There is no specific treatment for the diseases caused by the mutations.Present models for studying ABCA3 mutations in vitro are still to be improved.This article focuses on reviewing the structure, genetics and the research progress of treatment of ABCA3 gene mutation related pediatric diseases, in order to provide experience and ideas for further researches and treatment of the diseases caused by ABCA3 gene mutation.

Objective:To investigate the clinicopathological features and prognosis of IgA nephropathy (IgAN) patients with gross hematuria.Methods:The clinical and pathological data of 490 primary IgAN patients admitted in the Affiliated Hospital of Qingdao University from January 2010 to June 2019 were analyzed. Patients were divided into gross hematuria group and non-gross hematuria group. The clinical and pathological features and prognosis were compared between the two groups. All patients were diagnosed by kidney biopsy, and followed up until June 30, 2020. Kaplan-Meier survival curve was used to examine the renal survival,and Cox regression model was used to analyze the risk factors affecting renal survival in two groups.Results:Among 490 patients there were 111 patients (22.7%) in the gross hematuria group and 379 patients (77.3%) in the non-gross hematuria group. Age, hypertension, 24-h urine protein, serum creatinine, blood uric acid, blood triglycerides, total blood cholesterol level, mesangial cell hyperplasia (M1), the proportion of renal tubular atrophy or renal interstitial fibrosis (T1/2) in gross hematuria group were lower than those in non-gross hematuria group ( P<0.05), while the estimated glomerular filtration rate (eGFR) in gross hematuria group was higher than those in non-gross hematuria group ( P<0.05). Four hundred and twenty six patients (86.9%) were followed up for at least 6 months, including 93 patients in gross hematuria group and 333 patients in non-gross hematuria group. There was no statistically significant difference in treatment method between the two groups ( P>0.05). The incidence of end-point events in non-gross hematuria group was higher than that in gross hematuria group [18.6%(62/333) vs. 6.5%(6/93), χ2=8.023, P<0.05]. Kaplan-Meier survival analysis showed that the cumulative renal survival rate of the gross hematuria group was higher than that of the non gross hematuria group (χ2=11.44, P<0.001). Multivariate Cox regression analysis showed that urine protein>1 g/24 h, eGFR<60 ml·min -1·(1.73 m 2) -1, hypertension, hyperuricemia and the elevated serum IgA/C3 were risk factors for renal survival [ HR(95% CI)=3.457(1.137-10.514),2.736(1.073-6.977),2.720(1.144-6.465),2.789(1.102-7.060),1.070(1.009-1.135), all P<0.05]. Conclusions:IgAN patients with gross hematuria has less severe kidney damage and higher cumulative renal survival rate than non-gross hematuria patients. Urinary protein>1.0 g/d, hypertension, hyperuricemia and the elevated serum IgA/C3 are risk factors for adverse end-point events, to which timely attention and corresponding treatment should be given.

Objective:To understand the current situation of physicians′ competency in China and statistically analyze its influencing factors, hence providing referential evidences for promoting their competency.Methods:The evaluation scale for Chinese physicians′ competency was developed by referring to sophisticated overseas evaluation frameworks. Based on the electronic platform of the medical alliance, stratified sampling was conducted at 39 hospitals in 13 provinces, from which 2 156 physicians were surveyed, and statistical analysis was made on the current situation and influential factor of their competency in 6 dimensions(medical knowledge, diagnosis and treatment, scientific research and teaching, interpersonal communication, spirit of professionalism, population health)Results:The score range in multiple dimensions of physicians′ competency was between 2.85 and 3.89(5 in total), among which spirit of professionalism dimension scores the highest, and teaching and research dimension scores the lowest. Logistic regression analysis shows that their competency level in 6 dimensions is correlated to a range of factors, including gender, degree, title, supervisor qualifications, standardized training program of specialist physicians, and affiliation or not to teaching hospitals( P<0.05). Conclusions:Their overall competency is expected to be elevated. To name a few, they are lack of teaching and research abilities, and need to conduct clinical-oriented scientific research; they are expected to enrich knowledge structure, and need to embrace a wider concept of health; they need to improve their non-technical service abilities, and should further emphasize their humanistic quality; physicians′ practice competency depends upon their extent of medical education, and ensuring the quality of standardized training becomes the key measure.

Objective:To assess the interobserver and inter-modalities agreement with two non-invasive diagnostic modalities of hepatocellular carcinoma in high-risk patients: contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) and magnetic resonance imaging liver imaging reporting and data system (MRI LI-RADS).Methods:From August 2017 to August 2019, the CEUS and MRI data of patients at high risk for HCC from the Second Affiliated Hospital of Zhejiang University School of Medicine were analyzed retrospectively. A total of 217 lesions in 173 patients were classified according to CEUS LI-RADS v. 2017 or MRI LI-RADS v. 2018, by 4 blinded independent observers with more than 10 years of experience of CEUS or MRI. Interobserver and inter-modalities agreement was assessed with Cohen′s kappa.Results:The interobserver agreement was moderate and comparable for CEUS/MRI LI-RADS category (κ=0.606/0.603), the inter-modalities agreement was moderate for CEUS and MRI LI-RADS category (κ=0.564), LI-RADS 3, M, 4 and 5 by two imaging methods showed that the Kappa values were 0.739, 0.551, 0.734 and 0.592, respectively.Conclusions:The total inter-modalities agreement between CEUS and MRI LI-RADS categories is moderate, while the agreements of LI-RADS 3, 4 are strong, and LI-RADS M, 5 are moderate.

Objective:To measure and analyze the distribution characteristics of the micro-hardness of the middle-upper thoracic vertebrae (T 1-T 10) in the human body. Methods:T 1-T 10 vertebrae from three fresh cadavers were divided into vertebral body area and attachment area. 3 mm specimens were cut by a high-precision slow saw and 11 regions were selected and measured on each vertebrae by a Vickers microhardness tester (cortical bone: 1-9, cancellous bone: 10-11). The micro-hardness distribution of T 1-T 10 vertebrae was recorded and analyzed. Results:A total of 330 measurement areas from 30 vertebrae were measured, and 1 650 hardness values were collected. The average hardness values of the overall cortical bone of the middle-upper thoracic vertebrae of the 3 cadavers were 30.55±5.44 HV, 29.94±4.86 HV, and 29.55±4.36 HV, respectively. The difference among the groups was statistically significant ( F=4.680, P=0.009). The average hardness values of the overall cancellous bone were 27.93±5.61 HV, 28.21±4.96 HV, 27.98±3.94 HV, respectively. There was no significant difference among the groups ( F=0.091, P=0.913). There were statistically significant differences between the hardness values in the attachment area and vertebral body area of each cadaver ( t=7.467, 4.750, 6.621, P<0.001); the hardness of the cancellous bone in the attachment area of each cadaver was higher than that of the cancellous bone in the vertebral body ( t=1.785, 3.159, 3.103, P=0.077, 0.002, 0.003). The distribution of microhardness in 11 measurement areas of 3 cadavers were similar: the hardness of the cortical bone of pedicle, lamina and inferior endplate cortex (1, 2, 7) were higher; the hardness of the cortical bone of upper endplate and peripheral cortex (6, 8, 9) were lower. The distribution patterns of the microhardness in different vertebral segments of the 3 cadavers were similar: The hardness values gradually increased from T 1 to T 10. The vertebra with the largest hardness of the cortical bone was T 8; and the vertebra with the largest hardness of the cancellous bone were T 7, T 7 and T 6, respectively. Conclusion:The hardness of the upper endplate and peripheral cortex was low, which could disperse the load to protect the fragile cancellous bone. The hardness of the pedicle was the highest. The hardness of the cortical bone was higher than that of the cancellous bone, and the values of different segments gradually increased from top to bottom, which may be related to the physiological and anatomical morphology, and the gradual increase of the load of muscle force and body weight.

Objective:The entire genome sequences of 25 novel coronaviruses in Jiangsu province were analyzed and their evolutionary characteristics were studied.Methods:High-throughput sequencing was used to sequence the throat swab samples from confirmed cases. Single nucleotide polymorphisms were analyzed using CLC Genomics Workbench 12.0 software. Evolution characteristics were analyzed by MEGA 5.1.Results:A total of 52 single-base substitution mutations were detected in 25 strains. Phylogenetic analysis showed 25 stains were clustered into two clades. Viruses in clade 1 contain 8 682 and 28 144 CT SNP links. While viruses in clade 2 contain mutations in those two bases, i. e., 8 682 (ORF1ab: C8 517T, synonymous mutation) and 28 144 (ORF8: T251C, L84S). Among clade 2, five stains subclustered into one group based on SNP links in 24 034 (S: C2 472T, synonymous mutation), 26 729 (M: T207C, synonymous mutation), and 28 077 (ORF8: G184C, V62 L). There were no significant differences in the distribution of different clades/subclusters in the population and the disease types.Conclusions:We have found some SNPs occurred in new coronaviruses. The effects of different SNPs on virus transmission and pathogenicity need to be further studied.

Objective To explore the effects of six sigma management model in orthopedic robotic surgery training for new nurses of Operating Room. Methods This study selected 20 nurses with entry of 2016 of Operating Room at Henan Provincial People's Hospital in control group,20 nurses with entry of 2017 in experimental group. Control group carried out the orthopedic robotic surgery training with the routine method, while experimental group implemented the training based on the six sigma management model. Examination for new nurses of two groups was carried out with the same examination forms and contents. The investigation adopted the surgeon satisfaction questionnaire and the training satisfaction questionnaire. Results After orthopedic robotic surgery training based on the six sigma management model,the scores of theory knowledge, operational skills and clinical practice of experimental group were(94.72±3.63),(96.95±2.32)and (95.96±2.15)higher than those[(86.41±4.44),(90.15±4.61)and(88.72±4.28)]of control group with statistical differences(P<0.01). After training,surgeon satisfaction with experimental group and control group was(95.56±2.26)and(88.32±4.83)respectively with a statistical difference(P < 0.01). In experimental group,new nurses' satisfaction with training arrangement,training mode,examination,acceptance and total score of satisfaction were(24.08±1.03),(23.78±0.77),(23.95±0.83),(23.71±0.73)and(95.45±1.64) respectively better than those[(21.15±1.14),(21.31±1.21),(21.08±1.04),(20.65±1.23)and(84.22±2.16)] in control group with statistical differences(P< 0.01). Conclusions Six sigma management model can help new nurses of Operating Room to grasp the robotic surgery-related knowledge,increase operation cooperation ability,satisfaction of surgeon and new nurses so as to improve the effects of orthopedic robotic surgery training.