Objective:To review the clinical status based on the best evidence of drug administration in patients with dysphagia, systematically analyze the obstacle factors and promoting factors in the process of evidence transformation, and formulate reform strategies.Methods:Based on the evidence-based nursing research method and the guidance of the Ottawa Model of Research Use (OMRU), the review indicators were developed based on the best evidence. The current status of clinical practice behaviors of 223 patients and 75 nurses in the Neurology, Neurosurgery and Geriatric departments of the Affiliated Hospital of Jiangsu University were reviewed from July to December 2021.Based on the results of the review, qualitative interviews were conducted with 32 potential adopters, and content analysis was used to assess the barriers and contributing factors to the clinical translation of evidence in three aspects: evidence-based change, potential adopters and practice environment, so as to develop effective strategies.Results:Based on the 22 best evidence selected, the evidence-based team developed 25 review indicators to carry out clinical review, showing that the compliance rate of 16 indicators were less than 60%. By analyzing and summarizing the interview results of potential adopters, the main obstacles leading to the low compliance rate of nurses were analyzed as follows: evidence-based reform changed the traditional work mode, and the application of evidence was not convenient; at the level of potential adopters, nurses had poor knowledge and practice, heavy work burden, and low awareness of patients and caregivers; at the level of practice environment, there was lack of nursing norms and procedures for clinical transformation of evidence, and the channels of multi-disciplinary collaboration and communication were not smooth. The main promoting factors were the perfect supervision mechanism of evidence-based nursing projects, the evidence-based group had rich experience in evidence transformation, the management was willing to change, and the practitioners were good at innovation.Conclusions:There is still a large gap between the clinical practice and the best evidence of drug administration in patients with dysphagia. The promoting factors should be fully utilized to overcome the obstacles and implement improvements to promote the effective transformation of evidence into clinical practice.

Background:Following the short-term outbreak of coronavirus disease 2019(COVID-19)in December 2022 in China,clinical data on kidney transplant recipients(KTRs)with COVID-19 are lacking.Methods:We conducted a single-center retrospective study to describe the clinical features,complications,and mortality rates of hospitalized KTRs infected with COVID-19 between Dec.16,2022 and Jan.31,2023.The patients were followed up until Mar.31,2023.Results:A total of 324 KTRs with COVID-19 were included.The median age was 49 years.The median time between the onset of symptoms and admission was 13 d.Molnupiravir,azvudine,and nirmatrelvir/ritonavir were administered to 67(20.7%),11(3.4%),and 148(45.7%)patients,respectively.Twenty-nine(9.0%)patients were treated with more than one antiviral agent.Forty-eight(14.8%)patients were treated with tocilizumab and 53(16.4%)patients received baricitinib therapy.The acute kidney injury(AKI)occurred in 81(25.0%)patients and 39(12.0%)patients were admitted to intensive care units.Fungal infections were observed in 55(17.0%)patients.Fifty(15.4%)patients lost their graft.The 28-d mortality rate of patients was 9.0%and 42(13.0%)patients died by the end of follow-up.Multivariate Cox regression analysis identified that cerebrovascular disease,AKI incidence,interleukin(IL)-6 level of>6.8 pg/mL,daily dose of corticosteroids of>50 mg,and fungal infection were all associated with an increased risk of death for hospitalized patients.Conclusions:Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality.The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival,while higher doses of corticosteroids may increase the death risk.

Objective:To investigate the association between tumor necrosis factor-β (TNF-β) gene polymorphisms and genetic predisposition to gastric cancer, and to analyze the relationship between specific genotype of TNF-β and serum levels of TNF-β.Methods:Using case control study, we selected 153 patients with gastric cancer in Fudan University Shanghai Cancer Center between September 2021 and December 2022 as the gastric cancer group, and 150 healthy individuals were chosen as the healthy control group. In the previous study, 30 peripheral blood DNA samples of gastric cancer patients and healthy controls respectively were amplified by conventional PCR, which were sequenced to identify the genotype frequencies of TNF-β polymorphic loci (rs1041981, rs2229092, rs2229094 and rs78613290); consequently, Allele-Specific Quantitative PCR was used to further detect and analyze the genotype and genotype frequencies of TNF-β polymorphic loci; serum TNF-β levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA), and the relationship with specific genotypes of TNF-β was analyzed. Chi-square test and Fisher test were used to analyze the genotype distribution frequency of TNF-β polymorphic loci, and non-parametric statistics was used to analyze the differences in serum TNF-β expression levels.Results:The sequencing results showed that the genotype distribution of rs1041981 in gastric cancer group was CC 16.67% (5/30), CA 40.00% (12/30) and AA 43.33% (13/30). The genotype distribution in control group was CC 40.0% (12/30), CA 43.33% (13/30), AA 16.7% (5/30). The difference of genotype frequency between the two groups was statistically significant (χ 2=6.478, P=0.039). The genotypes of the polymorphic loci rs2229092 in both groups were AA, AG, and GG, with no statistically significant difference between the two groups (χ 2=1.888, P=0.612). The distribution frequencies of the genotypes of the polymorphic loci rs2229094 (TT and TC) and rs78613290 (GG and AG) showed no statistically significant differences between the two groups (both P>0.05). Further validation with an expanded clinical samples (153 cases in the gastric cancer group and 150 cases in the control group) found that the difference of rs1041981 genotype distribution between the gastric cancer group [CC 15.69%(24/153), CA 54.9%(84/153), AA 29.4%(45/153)] and the control group [CC 27.3%(41/150), CA 58.0%(87/150), AA 14.7%(22/150)] was significantly different (χ 2=12.366, P=0.002). Analysis of the influence of different allele frequencies on the risk of gastric cancer revealed that the odds ratio ( OR) of the A allele of rs1041981 for the risk of gastric cancer compared to the C allele was 1.701 (95% CI 1.235?2.355). Gene phenotype analysis combining the clinicopathological characteristics of gastric cancer patients found that the distribution frequency of the rs1041981 genotype was significantly different among groups of different genders, tumor invasion depths, and the lymph node metastasis, with statistically significant differences (All P>0.05). Additionally, gastric cancer patients with rs1041981 AA genotypes had higher serum TNF-β expression levels than those with CA and CC genotypes, (both P<0.05). Conclusions:The gene type frequency of the TNF-β gene polymorphic loci (rs1041981, C>A) exhibited significant differences between the gastric cancer group and the healthy control group. The presence of the A allele in rs1041981 site increased the susceptibility to gastric cancer, and patients with different gene types displayed vaning levels of serum TNF-β, among which AA genotype ranks the highest level.

The sensitivity of cardiac troponin testing for diagnosing acute myocardial infarction(AMI)varies over time from chest pain onset.This study aimed to determine the diagnostic performance of point-of-care testing cardiac troponin T(POCT-cTnT)at different time intervals post-symptom onset to refine rapid rule-out approaches for AMI.Methods This retrospective study included 6,024 patients presenting with chest pain from January 2018 to December 2022.POCT-cTnT and central lab cTnI levels were measured on admission.Receiver operating charac-teristics analysis stratified by time windows assessed the accuracy of POCT-cTnT for diagnosing AMI.Results The overall AUC of POCT-cTnT for diagnosing AMI was 0.826(95%CI:0.816～0.836),with a sensitivity of 72.81%and a specificity of 86.26%.According to the time intervals of chest pain onset(＜3 hours,3～6 hours,6～12 hours,12～24 hours,24～72 hours,and≥72 hours),the AUC values for groups after 6～12 hours were 0.918,0.928,0.920 and 0.908,respectively,with no statistically significant difference(P＞0.05),but all were higher than the groups within 6 hours(P＜0.001).According to the time of chest pain onset,the AUC for the≥8h group was 0.921,with a negative predictive value(NPV)of 98.1%and a negative likelihood ratio(-LR)of 0.11.Its AUC was higher than those of the≥3 h,≥2 h,≥1 h,and overall groups(P＜0.05),but there was no statistically significant differ-ence compared with the groups after≥4 h(P＞0.05).Conclusions Chest pain onset time has a certain impact on the performance of a single POCT-cTnT test for diagnosing AMI.The duration from chest pain onset to hospital admission combined with POCT-cTnT test may improve the reliability in diagnosing AMI.Specifically,a single POCT-cTnT test at four hours after chest pain onset,especially eight hours after chest pain onset,can diagnose or exclude AMI.

Objective To study the the expression of cytokeratin 5/6(CK5/6)and cell proliferation an-tigen(Ki-67)in apocrine triple-negative breast carcinoma(ATNBC)and their relationship with clinicopatho-logical features and prognosis.Methods Twenty-one patients with pathologically diagnosed invasive apocrine breast cancer and negative estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor-2(Her-2)in this hospital were selected as the ATNBC group,Twenty-two cases in non-ATNBC(NATNBC)were randomly selected as negative control(NATNBC group).The clinical pathological data and follow-up data of all patients were collected,and the expressions of CK5/6 and Ki-67,as well as their relation-ship with clinicopathological characteristics was analyzed.The prognosis in the patients with ATNBC was ana-lyzed.Results There were statistically significant differences in age(P＜0.001),age distribution(P=0.001),histological grading(P＜0.001),and distant metastasis(P=0.020)between the ATNBC group and the NATNBC group(P=0.020).There were 7 cases(33.33％)of CK5/6 positive expression in the ATNBC group and 17 cases(80.95％)in NATNBC group.There was statistically significant difference in the positive expression rate of CK5/6 between the ATNBC group and NATNBC group(P＜0.05).There were 3 cases(14.29％)of Ki-67 high proliferation in the ATNBC group and 17 cases(77.27％)in the NATNBC group.The high proliferation rates of Ki-67 had statistically significant difference between the ATNBC group and NATNBC group(P＜0.05).The positive expression rate of CK5/6 was correlated with the tumor sites and lymph node metastasis in ATNBC patients(P＜0.05).The high proliferation rate of Ki-67 was correlated with nerve invasion in ATNBC patients(P＜0.05).The survival analysis showed that there was statistically significant difference in the 5 years disease-free survival(DFS)rate between the ATNBC group and NATNBC group(P＜0.05).Conclusion ATNBC has its unique clinicopathological features,CK5/6 is less expressed in ATN-BC,the high proliferation of Ki-67 is also less,and the prognosis of ATNBC is better than that of NATNBC.

To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.
Breast Neoplasms/surgery* ; Female ; Humans ; Mastectomy, Segmental ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective To compare the clinical outcomes of low-dose rabbit antithymocyte globulin (rATG ) vs basiliximab as induction therapy in recipients of ABO-incompatible kidney transplantation (ABOi-KT) .Methods Retrospective analysis was conducted for e the clinical data of 40 ABOi-KT recipients between March 2017 and March 2019 .17 recipients of them received induction therapy with basiliximab (basiliximab group) while another 23 recipients received low-dose rATG (rATG group ,rATG 25 mg/d × 3 d) .During a median follow-up period of 282 days , the data of serum creatinine and eGFR at 1 week and 1 month ,graft survival rate and complication rate of two groups were compared .Results No significant difference existed in age ,gender ,dialytic modality/ duration , blood groups of recipients , HLA mis-match , blood group antibody titers , dose of rituximab ,blood groups of donors or donor age ( P > 0 .05 ) . The times of double filtration plasmapheresis in Basiliximab group were more (P< 0 .05) .No significant difference existed in serum creatinine and eGFR at 1 week or 1 month ( P > 0 .05 ) . No significant difference existed in graft survival rate . No significant difference existed in rate of acute rejection ,parvovirus B19 infection , urinary tract infection or hematoma .Conclusions Low-dose of rATG is as effective as basiliximab for ABOi-KT recipients .And rATG does not increase the rate of infection .

Objective To investigate the long-term effect of free flap in repairing hemifacial atrophy.Methods From April,1991 to April,2015,19 cases (5 males and 14 females) aged between 18 and 51 years (mean,26 years) with hemifacial atrophy were treated by free flap.Hemifacial atrophy affected the left side in 8 patients,and the right side in the remaining 11.Fifteen cases only had a hemifacial soft tissue deficit,the other 4 cases were associated with ipsilateral zygoma dysplasia,in which 1 had ipsilateral scar contracture.The latissimus dorsi muscle flap were applied in 12 cases (2 of which anastomose thoracodorsal nerve with the cervical branch of the facial nerve),the scapular flap in 2 cases,the tensor fascia latae dermal flap with dermal fat flap in 3 cases,and with iliac groin composite tissue flap and ilium groin dermal composite tissue flap in 1 case respectively.Among them,14 flaps had their blood vessels anastomosed to the superficial temporal artery and vein,and 5 to the facial artery and vein.All operations were successfuly accomplished and followed-up for 2-21 years.Results All patients had ideal clinical outcomes with significant improvement in facial symmetry and skin color,and no dysfunction happened.Conclusion The long-term effect of surgical management with free flap in repairing hemifacial atrophy is satisfactory.It is an effective method of clinical treatment.

Objective To summarize our experiences in the diagnosis and prognosis of different subtypes of primary thyroid lymphoma (PTL). Methods The clinical data of 27 PTL patients who were treated in our hospital from January 1998 to December 2014 were retrospectively analyzed. The pathological types of these patients included B cell lymphoma unclassifiable (BCLU) (n=5),mucosa-associated lymphiod tissue lymphoma (MALT) (n=9),diffuse large B cell lymphoma (DLBCL) (n=12),and T cell lymphoma (n=1). Results Of all these 27 cases,the most common clinical symptom was painless swelling of the neck (n=21,77.8%). Of 7 patients who had received preoperative fine needle biopsy,lymphoma was suspected in 2 cases (28.6%). Among these 7 cases,the positive rate of suspicious lymphoma was 66.7% in 3 DLBCL patients,0 in 3 MALT patients,and 0 in 1 BCLU paitent. Also,25 patients underwent intraoperative frozen pathological examination,which revealed lymphoma or suspicious lymphoma in 16 cases (64.0%); in these patients,the positive rate was 66.7% for BCLU,77.8% for MALT,58.3% for DLBCL,and 0 for T-cell lymphomas. The overall survival was (89.3±12.4) months,and the overall 5-year survival rate was 61.6%. The estimated survival in symptomatic group was 31.6 months,which was significantly shorter than that in asymptomatic group (97.9 months) (P=0.032). Other factors including age,sex,tumor size,tumor stage,international prognostic index,tracheal compression,lactate dehydrogenase,residual tumor,and pathological type showed no significant effect on survival(all P>0.05). Conclusions DLBCL has the highest fine needle biopsy positive rate,MALT has the highest frozen pathological positive rate,and intraoperative frozen pathology has more malignant results than the preoperative fine needle biopsy in the diagnosis. The accompanying lymphoma symptoms may be an adverse prognostic factor.