Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Objective:To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle.Methods:The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System.Results:Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases.Conclusions:According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.

Objective:To explore the clinical effects of the "Disease-Characteristics" project in improving the nursing quality of patients with diabetic retinopathy (DR) .Methods:Based on the content framework of "Disease-Characteristics", authoritative data of UpToTate and various guidelines were transformed into evidence for clinical application through the steps of evidence-based nursing, and a standardized "Disease-Characteristics" project for DR patients was constructed. Convenience sampling was adopted to select nurses who worked in the Shanghai Eye Hospital and the Ophthalmology Department of Shanghai First People's Hospital from January 1, 2018 to June 30, 2019 as research nurses. Convenience sampling was used to select 223 DR patients admitted to the two hospitals from October 30, 2018 to January 31, 2019 (before implementation) as the control group, and 261 patients with DR admitted from February 1, 2019 to April 30, 2019 (after implementation) as the observation group. We observed and compared indicators such as the correct rate of nurses' assessment of each key link of DR patients before and after implementation, the awareness rate of patients' DR-related knowledge, and the incidence of postoperative complications of patients.Results:After the implementation, the scores of the nurses in the assessment of each key link of DR patients increased from (90.36±1.16) to (96.72±1.13) , and the difference was statistically significant ( t=52.990, P<0.05) . The disease-related knowledge score of DR patients increased from (74.330±12.154) to (78.386±10.094) , and the difference was statistically significant ( t=4.010, P<0.05) . Postoperative complications such as persistent high intraocular pressure, vitreous rebleeding, inflammatory edema and diplopia were improved, and the differences were statistically significant ( χ2=7.131, 5.618, 5.788, 6.128; P<0.05) . Conclusions:The "Disease-Characteristics" project plan based on the best evidence has a certain significance for improving the nursing quality of DR and the prognosis of patients.

Targeted therapy and immunotherapy are important methods for the treatment of metastatic melanoma, but monitoring the patient′s disease progress and treatment response during the treatment is the key to accurate treatment and personalized treatment.Circulating tumor DNA (ctDNA) as a non-invasive " liquid biopsy" method, due to its high sensitivity and specificity for gene mutations, and the advantages of being qualitative, quantitative and traceable, which has shown great application value in monitoring metastatic melanoma progression, evaluating efficacy, and predicting prognosis during targeted therapy and immuno-therapy.

[ [Abstract] ] Objective: To identify the molecules related to the occurrence, development and prognosis of hepatocellular carcinoma (HCC) by constructing ceRNA regulatory network of HCC. Methods: Data of HCC transcription group were downloaded from TCGA database. We processed the original data into expression matrix of mRNA, lncRNA and miRNA via Perl language. DGEs of RNA and microRNA were extracted and analyzed from the“Edge”package of R language with the threshold of (|log FC|>2.0 and P<0.01). Through the database comparison, the relationship pairs of different lncRNAs-different miRNAs, different miRNAs-different mRNAs were obtained, and then imported them into the Cytoscape software to construct the ceRNA regulatory network diagram. The survival data of three DGEs were collected and analyzed by“survival”package and Kaplan Meier plotter analysis software. The survival curves were drawn and the genes were obtained by survival analysis. Results: The lncRNArelated ceRNA regulatory network of HCC was successfully constructed. Three regulatory pairs of lncRNA-miRNA-mRNA were obtained by analyzing the interaction and regulatory relationship between DGEs via ceRNA network. Among them, one regulatory pathway (CCDC26-hsa-mir-141-EPHA2) was in accordance with ceRNA theory. The prognostic analyses showed that the survival rate of patients with high expression of 14 mRNAs was lower than those with low expression, which could be used as biomarkers of adverse prognosis of HCC. The survival rate of patients with low expression of 1 lncRNA (TSPEAR-AS1) and 2 mRNA (CPEB3 and PROK2) was lower than those with high expression, which may be the protective gene of HCC. Conclusions:Through screening of HCC lncRNA related ceRNA regulatory network,14mRNAswithhighexpressionmaybetherelevant molecules related to poor prognosisofHCC,while1lncRNAand2 mRNAs with low expression may be the molecules related to good prognosis of HCC, providing reference for HCC treatment and prognosis evaluation.

Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma with a very high degree of malignancy. Currently, the standard treatment for SCLC is still chemoradiotherapy, and although SCLC is sensitive to chemotherapy in the early stage, recurrence and metastasis often occur due to drug resis-tance. In recent years, immunotherapy has made some progress in the study of SCLC. The immunodetection point programmed death-1 (PD-1) and its ligand (PD-L1) inhibitors, such as nivolumab, atezolizumab and pabolizumab, have shown good antitumor activity in clinical studies of SCLC, and PD-1/PD-L1 inhibitors combined with chemotherapy have shown better efficacy, providing a new strategy for the treatment of SCLC.

Objective To establish core competence evaluation index system for nurses specialized in cardiac intervention, and to provide an reference standard for the appointment, training and assessment of nurses specialized in cardiac intervention.Methods A total of 17 experts were consulted by a two-round Delphi survey. The weight of each index was determined by analytic hierarchy process.Results The enthusiasm of experts in both round was 100％. TheCr was 0.71-0.95; the coordination coefficients of the first-dimension, the second-dimension and the third-dimension were 0.334, 0.322, 0.285 (P<0.001). The core competence evaluation index system includes 5 first-level indicators, 18 second-level indicators, and 64 third-level indicators evaluation criterions.Conclusions This questionnaire has a high degree of enthusiasm and authority with a good coordination degree. The core competence evaluation index system can be the reference standard for appointment, training and assessment for nurses specialized in cardiac intervention.

This paper summarized the progress in studies on the core competence of nurses,the core competence assessment, training and management system of nurses specialized in intervention as well as the competence requirements and characteristics of nurses specialized in cardiac intervention,and points out the problems existing in core competence assessment indicators for nurses specialized in cardiac intervention in China,aiming to provide reference for China to build a better training and assessment system for nurses specialized in cardiac intervention.

Objective To study the characteristics of liver injury induced by simvastatin combined with HRZ (Isoniazid,Rifampicin and Pyrazinamide) in SD rats.Methods Fifty-four 8-week-old SD rats were randomly divided into 3 groups:group A (control),group B (HRZ) and group C (simvastatin combined to HRZ),half of each group were male.We calculated the accurate dose respectively before those rats were given intragastrical administration of corresponding drugs.Six rats were killed in each group on 10th,20th and 40th day,respectively.Before this,blood was fastened from femoral of every rat that would be killed to test liver function,liver tissue slices were made in order to observe the pathological characteristic.Results Alanine amiotransferase of group C elevated in line with time and reached statistic difference on 40th day,furthermore,it was significantly higher than group A (P＜0.05).Total bilirubin and direct Bilirubin of group C were significantly higher than those of group A from the beginning to the end (P＜0.05),however,they declined rapidly on 10th day,this trend also had statistic difference (P＜0.05) At the end of this experiment,hepatic cords was disordered slightly,but swelling liver cells and vacuolar degeneration were observed,the nuleus of cell condensed.Soakage of monocytes,neutrophils,and lymphocytes occurred in the portal and lobule regions,or even spotty necrosis occasionally.Conclusion Cholestasis occurs at the early stage when simvastatin is combined with HRZ in SD rats,however,it has a rapidly degressive trend.In contrast,Alanine amiotransferase elevates,furthermore,pathological injury or even spotty necrosis can emerge in liver tissue slices.

Objective To investigate the differences of all discomfort perceived by patients and with mechanical ventilation and nursing care .Methods A total number of 220 patients admitted to ICU accepted mechanical ventilation , and 68 nurses with over 1 year experience conducting ventilation were investigated on their perception with self-designed questionnaires .Results The total score of patients′comfort was (48.956 ± 7.136), of which physiological comfort was (27.816 ±4.158), psychological comfort (14.475 ±4.335), society comfort (8.141 ±3.895), while total patients′comfort score of nurses′perception was (59.110 ± 9.002), of which physiological comfort was (30.089 ±4.637), psychological comfort (11.032 ±4.076).The perception between nurses and patients had statistically differences (t=-8.512,-3.618,-6.708,-5.165, respectively;P<0.05).Conclusions The inconformity of perception between patients and nurses affects both evaluation of patients′discomfort and nursing care .Nurses should access discomfort of patients precisely in order to provide comfortable nursing .