To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development.

Objective:To analyze the clinical features, treatment, and outcomes of fetal/neonatal atrial flutter (AFL) at the onset of the perinatal period to improve the management of this condition.Methods:This retrospective study analyzed the clinical data, treatment, and follow-up results of fetal/neonatal AFL cases transferred to Shanghai Children's Medical Center from November 2013 to August 2021. Clinical characteristics, cardioversion procedures, and outcomes were summarized. Descriptive method was used for statistical analysis.Results:A total of 21 fetuses/neonates presenting with AFL in the perinatal period were involved in this study, including 17 males and four females. Ten of them were born at full term, and 11 were preterms. All of the patients were delivered by cesarean section at 32 to 41 gestational weeks [ (36.6±1.9) weeks] with a birth weight of 2 130 to 4 450g [ (3 059±528) g]. Increased fetal heart rate was all detected after 32 weeks of gestation, and three of them were diagnosed with AFL by fetal echocardiography before being born. The heart rate remained elevated in all cases after birth. All were diagnosed as AFL based on an electrocardiogram on the day of birth, which showed a 2 to 6 over one ratio of atrioventricular conduction. Among the six cases of cardiac insufficiency and low blood pressure complicated by dyspnea and cyanosis, the symptoms were relieved in four cases after mask oxygenation and two cases after ventilation. Among the 21 cases, one was converted spontaneously to normal sinus rhythm and the other 20 recovered after medication or electrical cardioversion. Seven cases were initially treated by drug conversion with a success rate of 5/7 and hospitalized for 23 d (13-25 d). There was one with cardiac insufficiency before treatment and three newly developed cardiac insufficiency during treatment among the seven cases. Thirteen cases were offered electrical cardioversion initially, and the success rate of cardioversion was 12/13. There were five cases of cardiac insufficiency before treatment, while no new cases of cardiac insufficiency was reported during treatment. The duration of hospitalization was 11 d (9-14 d). Apart from one case, the rest 20 infants were followed up from one month to eight years old, and no recurrence was reported.Conclusions:For fetal/neonatal AFL with the onset during the perinatal period, the symptoms mainly manifest in late pregnancy. Its diagnosis depends on fetal echocardiography before birth or electrocardiogram after birth, and electrical cardioversion is a fast and effective measure. While the prognosis of perinatal-onset AFL is generally good.

Objective:To investigate the status of caregivers' benefit finding of senile dementia patients in Shiyan city, Hubei Province, and to analyze its influencing factors, so as to provide basis for carrying out targeted intervention measures.Methods:Totally 252 caregivers of senile dementia patients who visited Taihe Hospital, Shiyan People′s Hospital and Sinopharm Dongfeng General Hospital in Shiyan City, Hubei Province from July 2019 to July 2021 were selected as the research objects by convenience sampling method. The general Information Questionnaire, the Caregiver benefit finding questionnaire, the General self-efficacy Scale (GSES) and the Perceived Social Support Scale (PSSS) were used. The Pearson correlation analysis method was used for the correlation between caregivers' self-efficacy, social support and perceived benefit. Catreg was used to analyze the influencing factors of caregivers' benefit finding in senile dementia patients.Results:The total score of caregiver benefit questionnaire for 252 caregivers of senile dementia patients was (104.74 ± 14.82), the item "made me realize the significance of my health to my family and society" received the highest score (4.70 ± 0.55), while the item "made me quit bad habits" received the lowest score (3.22 ± 1.17). The GSES and PSSS scores of 252 caregivers of senile dementia patients were (24.74 ± 7.02) and (54.21 ± 13.32), which were positively correlated with the benefit finding ( r=0.565, 0.459, both P<0.01). The catreg analysis showed that the age of the caregiver, the average monthly income of the family, self-efficacy and social support were the influential factors of the perceived benefit level of the caregiver of senile dementia patients ( F values were 3.30-104.92, all P<0.05), which could explain 42.4% of the variance. Conclusions:The benefit finding of caregivers of senile dementia patients still needs to be improved. Medical staff should pay attention to the evaluation of benefit finding of caregivers of senile dementia patients, and provide personalized intervention measures to relieve caregivers' care pressure, maintain their physical and mental health, and improve the care quality of caregivers of senile dementia patients.

Objective:To study the clinical characteristics of neonatal community-acquired Novel Coronavirus (COVID-19) Omicron variant infection.Methods:From March 30 to May 15, 2022, the epidemiological characteristics, clinical manifestations and outcomes of neonatal cases of community-acquired COVID-19 Omicron variant infection admitted to the isolation ward of our hospital were analyzed.Results:A total of 7 neonates infected with community-acquired COVID-19 Omicron variant were treated, including 3 males and 4 females. All of them were term infants with clear epidemiological exposure history. The infection was originated from caregivers of close contact (parents or babysitters). The main clinical symptoms was upper respiratory tract infection, including fever (6 cases), nasal congestion (6 cases), cough (5 cases), runny nose (2 cases), poor appetite (2 cases) and diarrhea (1 case). On admission, no abnormalities were found in blood routine examination and C-reactive protein (CRP). All but one case had normal serum amyloid A (SAA). No obvious abnormalities were found on chest X-ray. All patients were isolated in single-patient rooms after admission. They received standard symptomatic treatment and regular nucleic acid tests. The first negative nucleic acid results came on median 17 d(8~26 d) after the onset of the disease. The patients were discharged after two consecutive (24 h apart) nucleic acid tests with CT value ≥35 and continued health-monitor at home. On discharge, 5 patients had nasal congestion and 2 of them had cough. During the follow-up 4~6 weeks after discharge, all patients gradually recovered without positive nucleic acid results.Conclusions:All 7 neonates with community-acquired COVID-19 Omicron variant infection have epidemiological exposure history. The main clinical symptoms are long-lasting upper respiratory tract infections. It takes a relatively long time for the nucleic acid to turn negative, however, the overall short-term prognosis is good.

Objective:Hepatic amyloidosis is a metabolic disease with a low incidence rate. However, because of its insidious onset, the rate of misdiagnosis is high, and it usually progresses to a late stage when it is diagnosed. This article analyzes the clinical features of hepatic amyloidosis by combining clinical pathology in order to improve the clinical diagnosis rate.Methods:Clinical and pathological data of 11 cases of hepatic amyloidosis diagnosed at the China-Japan Friendship Hospital from 2003 to 2017 were summarized and analyzed retrospectively.Results:The clinical manifestations of 11 cases mainly included abdominal discomfort (4/11), hepatomegaly (7/11), splenomegaly (5/11), fatigue (6/11), etc. Biochemical test results showed that most patients' alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, total bilirubin, direct bilirubin, and total bile acids, accompanied by hypoalbuminemia were elevated, while some patients' 24-h urinary protein, creatinine, and blood urea nitrogen were elevated.Conclusion:All patients had slightly elevated aspartate transaminase levels (within 5 times the upper limit of normal), and 72% had slightly elevated alanine transaminase. Alkaline phosphatase and γ-glutamyl transferase levels were significantly raised in all cases, with the highest result for γ-glutamyl transferase being 51 times the upper limit of normal. Damage to the hepatocytes has an effect on the biliary system as well, leading to symptoms such as portal hypertension and hypoalbuminemia [(0.54~0.63) × upper limit of normal value, 9/11]. Amyloid deposits within the artery wall (54.5% of patients) and portal vein (36.4% of patients) were also indicative of vascular injury. A liver biopsy should be recommended for patients with unexplained elevated transaminases, bile duct enzymes, and portal hypertension in order to establish a definitive diagnosis.

Objective:To construct a management plan for postoperative paralytic ileus (PI) in spinal surgery patients and explore its effect.Methods:The management plan for PI in spinal surgery patients was constructed based on literature retrieval and expert consultation. From July 2020 to June 2021, 295 patients with spinal surgery of Spine Surgery Department in Yancheng Third People's Hospital were selected by convenience sampling. The patients from January to June 2021 were in the experimental group ( n=152) , and the patients from July to December 2020 were in the control group ( n=143) . The control group adopted routine nursing, while the experimental group received PI management plan of spinal surgery on the basis of routine nursing. We compared the abdominal distension grading, first exhaust time, defecation time, PI incidence, anal exhaust utilization rate, average hospitalization day and patient satisfaction between the two groups at 12, 24, 36, 48, 72 hours after surgery. Results:After intervention, there was no statistical difference in the level of abdominal distension between the two groups at 12, 24 and 36 hours ( P>0.05) . The level of abdominal distension in the experimental group at 48 hours and 72 hours were both lower than that in the control group, and the differences were statistically significant ( P<0.05) . The time of first exhaust and defecation of patients in the experimental group were shorter than that in the control group, and the differences were statistically significant ( P<0.01) . The incidence of PI in the experimental group was lower than that in the control group, with a statistically significant difference ( P<0.05) . The satisfaction of patients in the experimental group was higher than that in the control group, with a statistically significant difference ( P<0.05) . The utilization rate of anal exhaust in the experimental group was higher than that in the control group, with a statistically significant difference ( P<0.05) . There was no statistical difference in average hospitalization days between the two groups ( P>0.05) . Conclusions:PI management plan for patients with spinal surgery can reduce the first exhaust time, defecation time, PI incidence, and improve patient satisfaction, which can provide a basis for standardizing the management of PI for patients with spinal surgery.

Objective:To explore the current status and influencing factors of knowledge, attitude and practice of nurses in Thoracic Surgery Department on thoracic drainage tube nursing after pneumonectomy, aiming to provide a basis for the training of clinical thoracic surgery specialist nursing personnel.Methods:Using the convenient sampling method, a total of 319 nurses in Henan Province were selected as research objects from August 13 to November 13, 2020, and self-designed questionnaire on knowledge, attitude and practice of thoracic drainage tube nursing after pneumonectomy was used to investigate. A total of 319 questionnaires were issued and 300 valid questionnaires were returned, with an effective recovery rate of 94.04%.Results:The total score of knowledge, attitude and practice of 300 Thoracic Surgery Department nurses on thoracic drainage tube nursing after pneumonectomy and scores of knowledge, attitude and behavior dimensions were respectively (72.09±6.65) , (7.96±2.51) , (26.04±2.24) and (38.09±4.78) . The results of multiple linear regression analysis showed that main influencing factors of nursing knowledge of Thoracic Surgery Department nurses on thoracic drainage tube after pneumonectomy were education level, professional title and position ( P<0.05) . The influential factor of attitude was working years ( P<0.05) . The influencing factors of behavior were knowledge, attitude, position and whether participated a thoracic drainage training or not ( P<0.05) . The influencing factor of total score of knowledge, attitude and practice was professional title ( P<0.05) . Conclusions:Thoracic Surgery Department nurses have a positive attitude towards thoracic drainage tube nursing after pneumonectomy, but their knowledge and behavior level need to be improved. Nursing leaders should carry out thoracic drainage tube nursing training according to the different characteristics of nurses. At the same time, they need to encourage nurses to actively learn new knowledge and constantly update their own knowledge system, so as to change nursing behavior and improve the quality of thoracic surgery.

Objective To investigate the clinical application value of fluorescence polymerase chain reaction (PCR) .in the human leucocyte antigen-B27(HLA-B27) gene and gene typing detection of ankylosing spondy-litis (AS) patients .Methods A total of 43 clinical blood samples of AS and 56 samples of healthy controls were collected in Shenzhen Futian hospital for rheumatic diseases from January 2014 to March 2015 .HLA-B27 gene was detected by flow cytometry .HLA-B27 gene and gene typing was also detected by the fluorescence PCR method .Results Among 43 samples ,40 samples were HLA-B27 positive(93 .02%) by flow cytometry while 39 samples were HLA-B27 positive (90 .70%) by fluorescence PCR .The total coincidence rate was 97 .50% .Among 39 positive samples ,32 samples were HLA-B2704 positive (82 .05%) and 7 samples were HLA-B2705 positive (17 .95%) .Conclusion The fluorescence PCR is an accurate method to detect HLA-B27 gene and presents high consistency with flow cytometry .It can also detect the HLA-B27 gene typing .It may have great clinical application value and prospects .

OBJECTIVETo explore the role of eukaryotic translation elongation factor 1A1 (eEF1A1) in regulating the invasion and metastasis of hepatocellular carcinoma (HCC) cells and the possible mechanism.

METHODSqRT-PCR and Western blotting were used to detect the mRNA and protein expression of eEF1A1 and NOB1 in different HCC cell lines and normal liver cells. The invasion and migration abilities of HCC cells with eEF1A1 knockdown or overexpression were examined using Transwell chamber assay and RTCA assay, and the changes in NOB1 mRNA and protein expressions in the cells were detected. The effects of increasing NOB1 expression in HCCLM3-sheEF1A1 cells and decreasing NOB1 expression in eEF1A1-overexpressing MHCC97h cells on eEF1A1 expression and cell invasion and migration abilities were analyzed using Western blotting, Transwell chamber assay and RTCA assay.

RESULTSThe expressions of eEF1A1 and NOB1 were significantly increased in positive correlation in HCC cells as compared with normal hepatocytes. Knockdown of eEF1A1 significantly decreased the invasion and migration of HCC cells and reduced the mRNA and protein expression of NOB1 ( < 0.01). Overexpression of eEF1A1 significantly enhanced invasion and migration of HCC cells and increased NOB1 mRNA and protein expressions ( < 0.01). Increasing NOB1 expression in HCCLM3-sheEF1A1 cells led to the restoration of NOB1 expression and cell invasion and migration abilities ( < 0.01), whereas decreasing NOB1 in MHCC97h-eEF1A1 cells resulted in inhibition of NOB1 expression and cell invasion and migration ( < 0.01).

CONCLUSIONSeEF1A1 positively regulates the expression of NOB1 to promote the invasion and migration of HCC cells .

Objective To systematically evaluate the effect of different administration methods of hydrocortisone on blood glucose in patients with septic shock. Methods The Cochrane Library, PubMed, Web of Science, Embase, CNKI, CBM, Wanfang, and VIP databases were searched from foundation to December 31st, 2017 for the randomized controlled trials (RCTs) about hydrocortisone on blood glucose of different drug-deliver ways in patients with septic shock. In addition, the citation retrievals were performed by the literature references. Then the quality evaluation and data extraction was conducted by two researchers independently according to the Cochrane systematic review methods. RevMan 5.3 software was utilized to perform meta-analysis on the influences of the two different administration methods of the continuously pumping hydrocortisone group (experimental group) vs. the intermittently dripping hydrocortisone group (control group) on the mean blood glucose (MBG), largest amplitude of glycemic excursion (LAGE), glucose variability (GV), hyperglycemia time window in patients with septic shock. Results 1 203 relevant articles were preliminarily searched. Then the duplications were removed, reviews, and non-RCTs and articles evidently not accordant with the inclusion criteria were excluded by titles and abstracts. Eventually a total of 5 well-designed RCTs (404 cases) were incorporated, including 201 cases in the experimental group and 203 cases in the control group. The results of meta-analysis showed that compared with the control group, MBG was significantly decreased in the experimental group [mean difference (MD) = -0.99, 95% confidence interval (95%CI) = -1.53 to -0.45, P < 0.05], LAGE was decreased (MD = -5.66, 95%CI =-6.92 to -4.41, P < 0.05), GV was reduced (MD = -0.67, 95%CI = -0.82 to -0.53, P < 0.05), and hyperglycemia time window was shortened (MD = -7.68, 95%CI = -9.03 to -6.33, P < 0.05). The funnel chart revealed that there was publication bias in the MBG, hyperglycemia time window of the articles, and the publication bias was lower in the LAGE and GV. Conclusion Compared with intermittent administration method, the continuous pumping hydrocortisone method can stabilize the blood glucose of septic shock patients, shorten the duration of hyperglycemia and reduce the peak value of blood glucose.