Objective:The aim is to construct an evaluation framework for clinical research benefits,and provide a reference for the formulate of evaluation standards for clinical research benefits.Methods:The Delphi method was used to carry out expert consultation,and the mean,score of importance,coefficient of variation and coordination,etc.of evaluation indicators were summarized and calculated,to screen evaluation indicators for clinical research benefits.Results:Twenty-three experts in this field were selected for correspondence,and their enthusiasm was 100%in both rounds,the authority coefficients were≥0.90,and Kendall's coefficients of concordance were<0.25(P<0.001).By referring to the mean and coefficient of variation of the indicators,as well as combining them with expert suggestions,an evaluation framework for clinical research benefits was ultimately formed with 2 primary indicators,5 secondary indicators,and 8 tertiary indicators.Conclusion:The evaluation framework for clinical research benefits constructed in this paper can comprehensively evaluate the research benefits,as well as provide a basis for reasonably determining the research risk-benefit ratio and developing quantitative evaluation tools for clinical research benefits.

Objective To observe the impact of age and menstrual status on semi-quantitative parameters of breast dynamic enhanced MRI(DCE-MRI)in healthy adult women.Methods A total of 283 adult females who underwent MR examinations due to suspected breast mass or breast discomfort but no breast tumor was detected after 1 year's clinical follow-up were retrospectively collected.Meanwhile,49 healthy adult female subjects in the menstrual period(menstruating subgroup)were prospectively recruited.All the above 332 subjects were divided into low age group(n=107),middle age group(n=114)and high age group(n=111)according to age,while into postmenopausal group(n=112)and premenopausal group(n=220,including 49 in menstruating subgroup,77 in proliferating subgroup and 94 in secreting subgroup).DCE-MRI semi-quantitative parameters,including maximum enhancement rate(ERmax)and maximum slope of increasing(Slopemax)were compared among different groups and subgroups,and the variations were observed.Results Significant differences of ERmax and Slopemax were found between high and low age groups(both P＜0.05),while no significant difference of ERmax and Slopemax was found between middle and low age group,nor between middle and high age group(all P＞0.05).Both ERmax and Slopemax in postmenopausal group were lower than those in premenopausal group(both P＜0.05),while no significant difference of DCE-MRI semi-quantitative parameters was found among different menstrual cycle subgroups(all P＞0.05).The coefficient of variance(CV)of normal breast ERmax in low,middle and high age groups was 56.20％,44.02％and 50.97％,respectively,of Slopemax was 54.74％,81.78％and 76.93％,respectively.CV of normal breast ERmax was 50.12％and 46.02％in postmenopausal and premenopausal groups,respectively,while CV of Slopemax was 72.84％and 62.04％,respectively.Among different subgroups,CV of ERmax and Slopemax in proliferative period were both the largest(61.39％,82.54％),which in menstrual period were both the smallest(33.99％,42.33％).Conclusion Semi-quantitative parameters of breast DCE-MRI were different among healthy women of different age and menstrual status,and the individual variations were large.

BACKGROUND: Tissue engineering is increasingly viewed as a promising avenue for functional cartilage reconstruction.However, chondrocyte dedifferentiation during in vitro culture remains an obstacle for clinical translation of tissue engineered cartilage. Re-differentiated induction have been employed to induce dedifferentiated chondrocytes back to their original phenotype. Regrettably, these strategies have been proven to be only moderately effective. METHODS: To explore underlying mechanism, RNA transcriptome sequencing was conducted on primary chondrocytes (P0), dedifferentiated chondrocytes (P5), and redifferentiated chondrocytes (redifferentiation-induction of P5, P5.R). Based on multiple bioinformatics analysis, LGR5 was identified as a target gene. Subsequently, stable cell lines with LGR5 knocking-down and overexpression were established using P0 chondrocytes. The phenotypic changes in P1 and P5 chondrocytes with either LGR5 knockdown or overexpression were assessed to ascertain the potential influence of LGR5 dysregulation on chondrocyte phenotypes. Regulatory mechanism was then investigated using bioinformatic analysis, protein–protein docking, immunofluorescence co-localization and immunoprecipitation. RESULTS: The current study found that dysregulation of LGR5 can significantly impact the dedifferentiated phenotypes of chondrocytes (P5). Upregulation of LGR5 appears to activate the PI3K/AKT signal via increasing the phosphorylation levels of AKT (p-AKT1). Moreover, the increase of p-AKT1 may stabilize b-catenin and enhance the intensity of Wnt/b-catenin signal, and help to restore the dedifferentated phenotype of chondrocytes. CONCLUSION LGR5 can modulate the phenotypes of chondrocytes in P5 passage through PI3K/AKT signaling pathway.

The central nervous system is susceptible to the modulation of various neurophysiological processes by the cytochrome P450 enzyme(CYP),which plays a crucial role in the metabolism of neurosteroids.The antiepileptic drug phenytoin(PHT)has been observed to induce neuronal side effects in patients,which could be attributed to its induction of CYP expression and testosterone(TES)metabolism in the hip-pocampus.While pregnane X receptor(PXR)is widely known for its regulatory function of CYPs in the liver,we have discovered that the treatment of mice with pregnenolone 16α-carbonitrile(PCN),a PXR agonist,has differential effects on CYP expression in the liver and hippocampus.Specifically,the PCN treatment resulted in the induction of cytochrome P450,family 3,subfamily a,polypeptide 11(CYP3A11),and CYP2B10 expression in the liver,while suppressing their expression in the hippocampus.Func-tionally,the PCN treatment protected mice from PHT-induced hippocampal nerve injury,which was accompanied by the inhibition of TES metabolism in the hippocampus.Mechanistically,we found that the inhibition of hippocampal CYP expression and attenuation of PHT-induced neurotoxicity by PCN were glucocorticoid receptor dependent,rather than PXR independent,as demonstrated by genetic and pharmacological models.In conclusion,our study provides evidence that PCN can negatively regulate hippocampal CYP expression and attenuate PHT-induced hippocampal neurotoxicity independently of PXR.Our findings suggest that glucocorticoids may be a potential therapeutic strategy for managing the neuronal side effects of PHT.

Objective:To understand the awareness of smoking hazards and intention of smoking concession in residents aged 18-65 years in Beijing, and provide scientific evidence for the development and improvement of tobacco control policies and measures.Methods:Data were collected from the 2017 Beijing Non-communicable and Chronic Disease surveillance. A multi-stage stratified cluster sampling method was used to take samples from 165 communities in 16 districts of Beijing. Logistic regression was used to analyze the influencing factors.Results:Among 11 594 participants, 49.93% had no intention of smoking concession. The percentage of refusing smoking concession was higher in men (50.39%) than in women (43.01%), the difference was significant ( χ2=14.211, P=0.002), and higher in suburban residents (56.78%) than in urban residents (45.30%), the difference was significant ( χ2=51.977, P<0.001). For the smoking cessation motivation, "illness" was the reason for more former smokers (29.88%) compared with current smokers (11.50%), the difference was significant ( χ2=85.865, P<0.001). The awareness rates of smoking hazards was higher in women (34.97%) than in men (32.63%), the difference was significant ( Z=5.612, P<0.001), higher in suburban residents (35.44%) than in urban residents (33.03%), the difference was significant ( Z=-3.734, P<0.001), and higher in never smokers (35.15%) than in smokers (30.06%), the difference was significant ( χ2=62.277, P=0.005). Multiple logistic regression analysis results showed people with general awareness ( OR=0.61, 95 %CI: 0.39-0.94) and poor awareness ( OR=0.67, 95 %CI: 0.50-0.90) of smoking hazards were less likely to quit smoking and people with general awareness ( OR=0.64, 95 %CI: 0.53-0.76) and poor awareness ( OR=0.87, 95 %CI: 0.78-0.98) of smoking hazards were more likely to smoke. Conclusions:Smokers aged 18-65 in Beijing had low willingness for smoking cessation. Health problem was main consideration for smoking cessation. Never-smokers had better awareness of smoking hazards than smokers, and the awareness of smoking hazards was an influencing factor of smoking status.

Objective: To investigate the changes and clinical significance of quantitative parameters of dynamic contrast-enhanced MRI in normal uterus of women during different menstrual states. Methods: Totally 46 women with different menstrual states who underwent dynamic contrast-enhanced MRI were divided into premenopausal phase (proliferative phase [n=16], secretory phase [n=16]) and postmenopausal phase (n=14) according to different menstrual states. The quantitative parameters (Ktrans, Kep and Ve) of endometrium, junctional zone and myometrium were measured. One-way ANOVA or rank sum test was used to compare the quantitative parameters with different uterus structures and menstrual states. Results: The Ktrans value and Kep value of endometrium between the same menstrual states were statistically significant (all P<0.05). There were significant differences of Ktrans, Kep, in secretory phase, proliferative phase and postmenopausal phase, Kep in secretory phase and proliferative phase (P<0.05). There was statistically significant difference of Ve in junctional zone between proliferative phase and postmenopausal phase (P<0.05). There were significant differences in Ktrans, Kep and Ve among endometrium, junctional zone and myometrium under the same menstrual state (all P<0.05). The Ktrans was statistically significant during the secretory phase (all P<0.05). There was no significant difference in Kep between the junctional zone and the myometrium except postmenopausal phase, and the Kep were statistically significant between the structures in different menstrual states (P<0.05). Conclusion: The changes of Ktrans, Kep and Ve in different menstrual states should be considered when using the quantitative parameters of dynamic enhanced MRI to evaluate uterine diseases.

Dyskinesia is one kind of motor complications caused by prolonged administration of levodopa to patients affected by Parkinson's disease. The mechanisms of dyskinesia in Parkinson's disease are still unknown. Recent research suggests the prevalence of dyskinesia mainly depends on genetic factors, levodopa therapy,clinical subtype, body weight and gender. Accumulating evidence indicates that assessment scales, functional magnetic resonance imaging and biomarkers could improve the clinical diagnosis and assessment of dyskinesia. In addition, a number of clinical trials of dyskinesia have indicated that new drugs such as an extended-release formulation of adamantine, and physical therapy such as repetitive transcranial magnetic stimulation are beneficial to the treatment of dyskinesia.

Objective To explore the effects of comprehensive nursing intervention on fiber gastroscopy for senile patients.Methods Totally 100 senile patients who received fiber gastroscopy in the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University from September 2014 to October 2015 were selected by convenient sampling, and randomly and equally divided into an observation group and a control group. Patients in the control group received routine nursing, while patients in the observation group received comprehensive nursing intervention on the basis of routine nursing. The blood pressure, heart rate and coordination during fiber gastroscopy were compared between the patients in the two groups before and after fiber gastroscopy; and the Self-Anxiety Scale (SAS) and Self-Depression Scale (SDS) were used to rate the emotion of the patients after hospitalization and before fiber gastroscopy.Results The differences in heart rate, systolic pressure and diastolic pressure before and after fiber gastroscopy in the patients in the observation group were smaller than that of the patients in the control group (t=43.732, 42.744, 61.492;P<0.01). Totally 45 patients in the observation group could keep quiet during fiber gastroscopy, higher than the number in the control group (χ2=17.533,P<0.01); 5 patients in the observation group showed fear during fiber gastroscopy, lower than the number in the control group (χ2=17.533,P<0.01); and the number of patients in the observation group who showed nausea, vomiting and cough was lower than that in the control group (P<0.01). The SDS and SAS scores of the patients in the observation group before fiber gastroscopy were (41.14±2.14) and (41.12±3.47), both lower than those of the patients in the control group (t=13.471, 8.843;P<0.01).Conclusions Comprehensive nursing intervention for senile patients can eliminate the fear, improve the adaptability, and mitigate the psychological and physical stress reaction in the patients.

Objective To construct a cardiovascular surgery nursing service action plan system based on patient's demand so as to provide a reference for nurse specialisms of cardiovascular surgery to provide good service for patients.Methods From January 2017 to June 2017, patients of cardiovascular surgery of a ClassⅢ Grade A hospital were investigated with the self-designed patients' demand for nursing service questionnaire according to literature analysis and interview results of patients. Weights of the primary index and secondary index were calculated by analytic hierarchy process so as to construct a cardiovascular surgery nursing service action plan system based on patient's demand.Results The cardiovascular surgery nursing service action plan system based on patient's demand included 5 primary indexes and 78 secondary indexes. The Cronbach's α of patients' demand for nursing service questionnaire was 0.974 with a good internal consistency. Kaiser-Meyer-Olkin (KMO) was 0.843, andP value of Bartlett sphericity test was less than 0.001 with a good construct validity. The normalized weight coefficients of 5 primary indexes (physiological needs, safety needs, belongingness and love needs, self-esteem needs and self-actualization needs) were 0.2205, 0.4798, 0.0771, 0.1339 and 0.0887 respectively with 0.0488 for the consistency ratio (CR). TheCR of 21 secondary indexes of physiological needs, 19 secondary indexes of safety needs, 11 secondary indexes of belongingness and love needs, 20 secondary indexes of self-esteem needs and 7 secondary indexes of self-actualization needs was 0.0488, 0.0508, 0.0823, 0.0877 and 0.0746 respectively. TheCR was all less than 0.1 showed a satisfactory consistency in the results of hierarchy sequencing.Conclusions The construction of cardiovascular surgerynursing service action plan system based on patient's demand with the strict scientific method improves patient satisfaction. It is worth to be a reference for nursing peers and managers of cardiovascular surgery.

Objective: To explore correlation between QRS complex duration and left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (CLBBB).Methods: A total of 213 patients, who were diagnosed as left bundle branch block by ECG in our hospital from Feb 2012 to Jun 2013, were selected.According to QRS complex duration, patients were divided into CLBBB group (n=182) and incomplete left bundle branch block (ICLBBB) group (n=31).Linear correlation analysis was used to analyze the correlation between QRS complex duration and LVEF, and receiver operating characteristic curve (ROC) was used to analyze optimal cutoff point of QRS complex duration for predicting LVEF<50%.Results: Compared with ICLBBB group, there was significant rise in QRS complex duration [(104.61±8.85) ms vs.(149.36±17.25) ms] and significant reduction in LVEF [(54.26±4.96)% vs.(45.22±12.57)%] in CLBBB group, P<0.01 both.Linear correlation analysis indicated that QRS complex duration was significant inversely correlated with LVEF (r=-0.55, P=0.001) in CLBBB patients.ROC analysis indicated that optimal cutoff point of QRS complex duration for predicting LVEF<50% was 151ms, the area under the curve was 0.79 (P=0.001),its sensitivity was 68.1% and specificity was 83.5%.Conclusion: QRS complex duration is significant inversely correlated with LVEF in CLBBB patients, which can be used as a simple index predicting reduced LVEF.