This article reports the pharmacotherapy process of a clinical pharmacist participating in the treatment of acute liver injury caused by nintedanib in a patient with lung cancer complicated with interstitial pneumonia.Clinical pharmacist analyzed the rapid increase of liver enzymes in patients by excluding their past drug use history,stopping suspicious drugs and searching domestic and foreign literature,and determined that the association with nidanib was very likely according to RUCAM scale.The clinical pharmacies suggesteded stopping nintedanib and taking liver protection treatment actively.The clinician adopted the suggestion,and finally the patient's liver function improved after 20 days of treatment.Clinical pharmacists demonstrate their value by analyzing the causes and characteristics of liver injury in patients,assisting physicians in the timely identification and management of adverse reactions,and participating in clinical practice.This article can provide a reference for the diagnosis and treatment of similar cases of acute liver injury.

Objective:To investigate the effects of applying the "4C" teaching method combined with the Gibbs' reflective cycle to clinical nursing teaching in the department of urology.Methods:A total of 68 nursing students who practiced in the urology department of our hospital were divided using a lottery method into experimental group ( n=35, entering the second and third wards for internship) and control group ( n=33, entering the first and fourth wards). The experimental group was taught using the "4C" teaching method combined with the Gibbs' reflective cycle, including four teaching steps (connection, concept, concrete practice, and conclusion) and regular reflective discussions. The control group received traditional teaching, which covered entrance education, centralized theoretical training, skills demonstration, and exit assessment. At the end of internship, the two groups were compared in terms of self-directed learning ability, nursing competency, and theoretical and practical scores. SPSS 23.0 was used to perform the t test. Results:The self-directed learning scores of the experimental group and the control group were (227.37±12.91) and (207.09±16.27), respectively. The nursing competency scores were (156.66±12.49) and (138.06±17.23), respectively. The experimental group was significantly superior to the control group in self-directed learning ability ( t=5.71, P<0.001), nursing competency ( t=5.12, P<0.001), theoretical score ( t=3.03, P=0.004), and practical score ( t=4.88, P<0.001). Conclusions:The "4C" teaching method combined with the Gibbs' reflective cycle can effectively improve nursing students' self-directed learning ability and nursing competency, and help them better master knowledge and skills.

Objective:To explore the alterations in functional connectivity density (FCD) resulted from mild cognitive impairment (MCI) and their correlations with cognitive scores in various cognitive domains in patients with Parkinson's disease (PD).Methods:Forty-three PD patients admitted to Department of Neurology, Sixth Affiliated Hospital of Nantong University from January 2022 to April 2024 were selected and divided into PD-MCI group (MoCA scores<26) and PD with normal cognition (PD-NC) group (MoCA scores≥26) according to Montreal Cognitive Assessment (MoCA). Another 23 middle-aged and elderly healthy volunteers (HC group) matched with PD patients in age, gender and education level were recruited at the same period. Resting-state functional MRI (rs-fMRI) data were collected and whole brain FCD was calculated. Differences of clinical data, whole brain FCD, and FCD in brain regions with significantly different FCD among the 3 groups were compared. Efficiency of FCD in brain regions with significantly different FCD between PD-MCI group and PD-NC group in differentially diagnosing PD-MCI and PD-NC was analyzed by receiver operating characteristic (ROC) curve. Pearson correlation was used to the analyze the correlations of FCD in brain regions with significantly different FCD with MoCA score and cognitive scores in various cognitive domains.Results:Among the 43 patients, 23 were into the PD-MCI group and 20 into the PD-NC group. PD-MCI group had significantly lower scores in the visuospatial and executive function, abstraction, and delayed memory cognitive domains than PD-NC group ( P<0.05). Brain regions with significantly different FCD among the 3 groups were the right parahippocampal gyrus, left gyrus rectus, right rolandic operculum, left middle occipital gyrus, right precentral gyrus, left middle frontal gyrus, and left medial superior frontal gyrus. Compared with the HC group, the PD-MCI group and PD-NC group had significantly increased FCD at the right parahippocampal gyrus, left gyrus rectus and right rolandic operculum, statistically decreased FCD at the right precentral gyrus, left middle frontal gyrus, and left medial superior frontal gyrus ( P<0.05). Compared with the HC group, the PD-MCI group had significantly increased FCD at the left middle occipital gyrus ( P<0.05). Compared with the PD-NC group, the PD-MCI group had significantly decreased FCD at the right parahippocampal gyrus, and statistically increased FCD at the left middle occipital gyrus and left middle frontal gyrus ( P<0.05). Area under ROC curve (AUC) of FCD in brain regions with significantly different FCD in discriminating PD-MCI and PD-NC was 0.878, with sensitivity of 90.0% and specificity of 91.3%. FCD at right parahippocampal gyrus, left middle occipital gyrus and left middle frontal gyrus was negatively correlated with MoCA score ( P<0.05); FCD at right parahippocampal gyrus was positively correlated with cognitive scores in the visuospatial and executive function, and delayed memory domains ( P<0.05); FCD at left middle occipital gyrus was negatively correlated with cognitive scores in the executive function and visual-spatial skills, and abstraction domains ( P<0.05); FCD at the left medial frontal gyrus was negatively correlated with cognitive scores in the visuospatial and executive function, abstraction and delayed memory domains ( P<0.05). Conclusions:Abnormal FCD can be noted in some brain regions of PD patients, enjoying differences between PD-MCI patients and PD-NC patients. Combined FCD in brain regions with significantly different FCD has high value in differentially diagnosing PD-MCI and PD-NC, and FCD in brain regions with significantly different FCD is correlated with cognitive function changes in PD patients.

Objective To analyze the value of Wilms tumor 1(WT1)gene combined with mul-tiparameter flow cytometry for minimal residual disease(FCM-MRD)in evaluating prognosis of chil-dren with acute myeloid leukemia(AML).Methods The clinical data and general information of 76 children with AML were retrospectively analyzed.Before treatment,WT1 gene expression was detec-ted by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)in all the children,and MRD was detected by FCM.All the children were followed up for a year,and they were divided into good prognosis group(n=40)and poor prognosis group(n=36)according to prognosis condition.The changes of WT1 gene and MRD before treatment and 3,9 and 12 months after treatment were observed in both groups;the changes of WT1 gene and MRD before and after treatment were com-pared in the children with different therapeutic plans;the relationships of clinicopathological features with WT1 gene expression and positive rate of FMM-MRD were analyzed in AML children.Spearman correlation coefficient was used to analyze the relationships of WT1 gene expression and positive rate of FCM-MRD with the prognosis of AML children;the Kaplan-Meier survival curve was drawn to an-alyze the effects of WT1 gene expression and positive rate of FMM-MRD on the recurrence of AML-children and their correlations;the receiver operating characteristic(ROC)curve was drawn to ana-lyze the efficiencies of single detection with WT1 gene and FMM-MRD and combined detection in predicting prognosis of AML children;the relationships of WT1 gen and MRD with FLT3 ITD/TKD mutation were analyzed in AML children.Results The WT1 expression levels and positive rates of FCM-MRD at 9 and 12 months after treatment in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);the WT1 gene expression level and positive rate of FCM-MRD in children with DAH chemotherapy regimen were lower than those in children with DAE chemotherapy regimen,while the rate of good prognosis was higher than thatin children with DAE chemotherapy regimen,but there were no significant differences between children with different chemotherapy regimens(P＞0.05);the WT1 gene expression and the positive rate of FCM-MRD were significantly correlated with white blood cell count,FAB typing,bone marrow primitive cells,and cytogenetic grouping in AML children(P＜0.05).Spearman correlation coefficient analysis showed the WT1 gene expression and positive rate of FCM-MRD were significantly negatively correla-ted with prognosis of AML children(P＜0.05);the Kaplan-Meier survival curve validation showed that overall survival(OS)and progression free survival(PFS)in children with high expression of WT1 were significantly lower than those in children with low expression of WT1(x2=4.215,9.530;P=0.040,0.002),and OS and PFS in children with positive FCM-MRD were also signifi-cantly lower than those in children with negative FCM-MRD(x2=5.144,6.381;P=0.023,0.012);the Spearman correlation coefficient analysis showed that the WT1 gene expression was sig-nificantly negatively correlated with OS and PFS in AML children(P＜0.05);the ROC curve showed that the area under the curve of WT1 combined with FCM-MRD was significantly higher than that of single indicator detection,with a sensitivity of 88.89％and a specificity of 87.50％;the Spearman correlation analysis showed that there were no significant correlations of WT1 gene expres-sion and positive rate of FCM-MRD with FLT3 ITD/TKD mutation(P＞0.05).Conclusion The expression level of WT1 and the positive rate of FCM-MRD show specific changes in AML children with different prognosis,and are strongly correlated with the prognosis of AML children.Combined detection of the two indicators can effectively predict the prognosis of AML children.

Objective To analyze the value of Wilms tumor 1(WT1)gene combined with mul-tiparameter flow cytometry for minimal residual disease(FCM-MRD)in evaluating prognosis of chil-dren with acute myeloid leukemia(AML).Methods The clinical data and general information of 76 children with AML were retrospectively analyzed.Before treatment,WT1 gene expression was detec-ted by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)in all the children,and MRD was detected by FCM.All the children were followed up for a year,and they were divided into good prognosis group(n=40)and poor prognosis group(n=36)according to prognosis condition.The changes of WT1 gene and MRD before treatment and 3,9 and 12 months after treatment were observed in both groups;the changes of WT1 gene and MRD before and after treatment were com-pared in the children with different therapeutic plans;the relationships of clinicopathological features with WT1 gene expression and positive rate of FMM-MRD were analyzed in AML children.Spearman correlation coefficient was used to analyze the relationships of WT1 gene expression and positive rate of FCM-MRD with the prognosis of AML children;the Kaplan-Meier survival curve was drawn to an-alyze the effects of WT1 gene expression and positive rate of FMM-MRD on the recurrence of AML-children and their correlations;the receiver operating characteristic(ROC)curve was drawn to ana-lyze the efficiencies of single detection with WT1 gene and FMM-MRD and combined detection in predicting prognosis of AML children;the relationships of WT1 gen and MRD with FLT3 ITD/TKD mutation were analyzed in AML children.Results The WT1 expression levels and positive rates of FCM-MRD at 9 and 12 months after treatment in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);the WT1 gene expression level and positive rate of FCM-MRD in children with DAH chemotherapy regimen were lower than those in children with DAE chemotherapy regimen,while the rate of good prognosis was higher than thatin children with DAE chemotherapy regimen,but there were no significant differences between children with different chemotherapy regimens(P＞0.05);the WT1 gene expression and the positive rate of FCM-MRD were significantly correlated with white blood cell count,FAB typing,bone marrow primitive cells,and cytogenetic grouping in AML children(P＜0.05).Spearman correlation coefficient analysis showed the WT1 gene expression and positive rate of FCM-MRD were significantly negatively correla-ted with prognosis of AML children(P＜0.05);the Kaplan-Meier survival curve validation showed that overall survival(OS)and progression free survival(PFS)in children with high expression of WT1 were significantly lower than those in children with low expression of WT1(x2=4.215,9.530;P=0.040,0.002),and OS and PFS in children with positive FCM-MRD were also signifi-cantly lower than those in children with negative FCM-MRD(x2=5.144,6.381;P=0.023,0.012);the Spearman correlation coefficient analysis showed that the WT1 gene expression was sig-nificantly negatively correlated with OS and PFS in AML children(P＜0.05);the ROC curve showed that the area under the curve of WT1 combined with FCM-MRD was significantly higher than that of single indicator detection,with a sensitivity of 88.89％and a specificity of 87.50％;the Spearman correlation analysis showed that there were no significant correlations of WT1 gene expres-sion and positive rate of FCM-MRD with FLT3 ITD/TKD mutation(P＞0.05).Conclusion The expression level of WT1 and the positive rate of FCM-MRD show specific changes in AML children with different prognosis,and are strongly correlated with the prognosis of AML children.Combined detection of the two indicators can effectively predict the prognosis of AML children.

Objective:To search, evaluate and summarize the evidence related to the maintenance of peripheral arterial duct flushing systems in children for clinical reference.Methods:Up To Date, BMJ, Nathional Institute for Health and Care Excellence(NICE), Chinese Medlive, Cochrane Library, Joanna Briggs Institute(JBI), CINAHL, METSTR, PubMed, Wanfang, CNKI, VIP were used to collect secondary evidence resources about management and maintenance of peripheral arterial duct flushing systems in children. After the quality evaluation of each type of literature, the evidence was extracted and summarized.Results:A total of 9 articles were included in the research. The 22 pieces of best evidence were obtained from 7 aspects, including basic requirements of children′s peripheral arterial duct flushing systems, arterial flushing method, flushing rate of injection pump system, flushing pressure of pressurized bag pump system, arterial flushing fluid, replacement and maintenance of children′s arterial catheter flushing system, and continuous improvement of arterial catheter maintenance.Conclusions:The best evidence for the establishment and maintenance of pediatric peripheral arterial duct flushing systems provides a basis for clinical decision, but practice testing is still needed.

Objective:To explore the expression of fructose bisphosphate aldolase A (ALDOA) in the bone marrow of patients with acute myeloid leukemia (AML) and the correlation with clinical features and prognosis.Methods:The bone marrow samples of 90 newly diagnosed AML (non-acute promyelocytic leukemia) patients and 18 allogeneic hematopoietic stem cell transplantation donors who were treated from January 2013 to December 2015 in the First Affiliated Hospital of Zhengzhou University and the Children's Hospital Affiliated to Zhengzhou University were collected. The relative expression level of ALDOA mRNA in bone marrow samples was detected by using real-time quantitative polymerase chain reaction (qRT-PCR). Clinical data of these patients were retrospectively analyzed, and the patients were divided into continuous complete remission (CR) group and refractory recurrent (RR) group according to the clinical response and follow-up results. The differences of the relative expression level of ALDOA mRNA between AML group and the normal control group, CR group and RR group were analyzed. Univariate and multivariate Cox regression risk model were used for analysis of factors influencing prognosis of AML patients.Results:The relative expression level of ALDOA mRNA in AML group was higher than that in normal control group [(5.71±0.44) vs. (1.10±0.08), t = 4.74, P<0.001]. The relative expression level of ALDOA mRNA in the RR group was higher than that in the CR group [(6.69±0.67) vs. (4.30±0.36) , t = 2.79, P < 0.001]. In addition, there were statistically significant differences in the proportion of patients with ALDOA mRNA high expression and those with ALDOA mRNA low expression stratified by the number of white blood cell, the proportion of bone marrow blasts and whether complete remission could be achieved or not after 1 course of induction therapy (all P < 0.05). Overall survival in patients with ALDOA high expression was worse than that in patients with ALDOA low expression ( χ2 = 5.59, P = 0.018). Multivariate analysis showed that white blood cell count, prognosis stratification, whether complete remission could be achieved or not after 1 course of induction therapy and ALDOA expression were the independent prognostic factors for the death of AML patients (all P < 0.05). Conclusions:ALDOA may play an important role in the development and progression of AML, and the expression level of ALDOA in the bone marrow can be used as an index for the prognosis assessment of AML patients and may be a potential therapeutic target for AML.

Objective:To compare fibrosis-driving cells in patients with primary myelofibrosis (PMF) and patients with myelodysplastic syndromes (MDS) with myelofibrosis (MF) (MDS-MF) .Methods:Bone marrow biopsy sections of patients with newly diagnosed PMF and MDS (10 each randomly selected for MF-0/1, MF-2, and MF-3) were stained with specific immunofluorescence antibodies to label Gli1, LeptinR, alpha smooth muscle actin (α-SMA) , CD45, and ProcollagenⅠ. Images captured by confocal microscopy were analyzed by Fiji-ImageJ to calculate the cell counts of Gli1 +, LeptinR + cells, and fibrosis-driving cells including α-SMA +, α-SMA +/Gli1 +, α-SMA +/LeptinR +, and ProcollagenⅠ +/CD45 + cells. Results:Patients with PMF and MDS with MF-2/3 had higher LeptinR +, α-SMA +, α-SMA +/Gli1 +, and Procollagen Ⅰ +/CD45 + cell counts compared with those with MF-0/1 (all P values<0.05) . However, patients with PMF with MF-2/3 presented with higher Gli1 + and α-SMA +/LeptinR + cell counts than those with MF-0/1 ( P=0.001 and 0.006) , whereas these cells were similar between patients with MDS with MF-0/1 and MF-2/3 ( P=0.169 and 0.067) . In patients with MF-0/1, all fibrosis-driving cells did not differ between PMF and MDS (all P>0.05) . However, in patients with MF-2/3, Procollagen Ⅰ +/CD45 + cell counts were higher in patients with PMF compared with those with MDS ( P=0.007) , while other fibrosis-driving cell counts were similar between these two groups (all P>0.05) . MF grade and fibrosis-driving cell counts were not correlated with overall survival in patients with either PMF or MDS. Conclusion:α-SMA + cells in patients with PMF originated from both Gli1 + and LeptinR + cells, whereas α-SMA + cells in patients with MDS-MF only originated from Gli1 + cells; patients with PMF had higher ProcollagenⅠ +/CD45 + cell counts than those with MDS-MF.

Objective To explore the clinical features of hemophagocytic syndrome in children and the signifi﹣cance of gene detection. Methods TWenty－tWo pediatric patients diagnosed as hemophagocytic syndrome since 2004 clinical and laboratory criteria Were enrolled in Children＇s Hospital Affiliated to Zhengzhou University from January 2014 to January 2016. The clinical data of patients Were analyzed,and the genes associated With hemophagocytic syn﹣drome Were detected. The clinical biochemical indicators Were compared betWeen mutation group and non －mutation group. Results TWenty－tWo cases of patients(3 months to 12 years)Were enrolled,including 10 males and 12 fe﹣males,and the proportion of children over 5 years old accounted for the highest proportion,accounting for 50%,and all of them had fever,liver,spleen and lymph node enlargement. The main test results Were as folloWs:peripheral blood cells decreased in 6 cases( 27. 27%),hemophagocytic phenomena presented in bone marroW smears in 12 cases (54. 55%),abnormal liver function in 18 cases(81. 82%),and loW serum albumin in 22 cases(100. 00%). High serum ferritin levels Were detected in 20 cases(90. 91%);the detection of natural killer(NK)cell activity shoWed nor﹣mal activity( active ＞ 15%) in 7 cases( 31. 82%),and decreased activity( activity ≤ 15%) in 15 cases (68. 18%). The genes associated With hemophagocytic syndrome Were detected in 22 cases of patients,and 12 of them Were associated With mutations related to hemophagocytic syndrome,accounting for 54. 55%. LYST,ITK and UNC13D gene Were common. There Was no statistical difference in Which ages of onset,symptoms of the nervous system,and labo﹣ratory data of leukocyte count,red blood cell count,hemoglobin,platelet count,NK cell activities,prognosis,hemophago﹣cytic phenomena shoWed in bone marroW smears,alanine aminotransferase,albumin,triglyceride,ferritin and fibrinogen betWeen mutation group and non－mutation group(all P＞0. 05). Conclusions Pediatric hemophagocytic syndrome is mostly accompanied by fever,liver,spleen and lymph node enlargement,and most of them are accompanied by gene mu﹣tations. LYST,ITK and UNC13D gene are commonly seen. But there is no significant correlation betWeen gene mutation and general condition,biochemical index and severity of the disease.

Objective To investigate the status quo of the cerebral injury in patients with acute stress disorder (ASD) and the impact of family function,mental toughness,and the characteristics of brain lesions on it.Methods A total of 349 patients were enrolled from North China University of Science and Technology affiliated hospital neurology department and neurosurgery department from May 2016 to November 2016 and they were tested with Stanford Acute Stress Reaction Questionnaire (SASRQ),the family function assessment scale (APGAR),Chinese version of mental toughness scale (CD-RISC).Results 349 cases of patients with SASRQ score (57.21±44.97),8 to 39 160 people (45.8％),40 to 56 85 people (24.4％),57 to 150 104 people (29.8％).The results showed that whether the hemiplegia (β=-0.030),family function (β=-0.032),mental toughness (β=0.886),disturbing degree (β=0.052),bad days (β=0.060)were picked in the regression equation (P＜0.05).Conclusion There were obvious acute stress symptoms in patients with brain injury.The individuals who have family dysfunction,the worse the psychological resilience and the higher the disturbance degree of the patients with hemiplegia,may be likely to get acute stress disorder.