The number of investigator initiated research (IIR) is increasing. But the recognition and management of IIR in China is still in its infancy, and there is a lack of specific and operable guidance for the implementation process. Based on our practical experiences, previous literature reports, and current policy regulations, the authors took prospective IIR as an example to summarize the implementation process of IIR into 14 steps, which are as the following: study initiation, ethical review, study registration, study filing, case report form design, database establishment, standard operating procedure making, investigator training, informed consent, data collection, data entry, data verification, data locking and data archiving.

Squamosa promoter binding protein-like (SPL) family is a group of important transcription factors involved in the regulation of plant growth and development and the response to environmental stress, but there are few studies in perennial fruit trees such as citrus. In this study, Ziyang Xiangcheng (Citrus junos Sib.ex Tanaka), an important rootstock of Citrus, was used as the material for analysis. Based on plantTFDB transcription factor database and sweet orange genome database, 15 SPL family members were genome-widely identified and cloned from Ziyang Xiangcheng, and named CjSPL1-CjSPL15. Sequence analysis showed that the open reading frame (ORF) length of CjSPLs ranged from 393 bp to 2 865 bp, encoding 130-954 amino acids. Phylogenetic tree divided 15 CjSPLs into 9 subfamilies. Gene structure and conserved domain analysis predicted 20 different conserved motifs and SBP basic domains. Analysis of cis-acting promoter elements predicted 20 different promoter elements, including those related to plant growth and development, abiotic stress and secondary metabolites. The expression patterns of CjSPLs under drought, salt and low temperature stresses were analyzed by real-time fluorescence quantitative PCR (qRT-PCR), and many CjSPLs were significantly up-regulated after stress treatment. This study provides a reference for further study on the function of SPL family transcription factors in citrus and other fruit trees.
Phylogeny ; Transcription Factors/metabolism* ; Gene Expression Regulation, Plant ; Plant Proteins/metabolism* ; Multigene Family ; Stress, Physiological

Telephone follow-up is one of the important ways to follow up patients. High-quality follow-up can benefit both doctors and patients. However, clinical research-related follow-up is often faced with problems such as time-consuming, laborious and poor patient compliance. The authors belong to a team that has been committed to the study of patient-reported outcomes for a long time. The team has carried out long-term follow-up of symptoms, daily function and postoperative complications of more than 1 000 patients after lung cancer surgery, and accumulated certain experience. In this paper, the experience of telephone follow-up was summarized and discussed with relevant literatures from the aspects of clarifying the purpose of clinical research follow-up, understanding the needs of patients in follow-up, and using follow-up skills.

Objective:To investigate the various factors that contribute to self-reported hypoglycemia in elderly patients with type 2 diabetes mellitus.Methods:This is a prospective cohort study that included 1, 010 elderly patients with type 2 diabetes mellitus who were hospitalized in Tianjin Medical University Chu Hsien-I Memorial Hospital from April to September 2019.Patients were selected using the convenient sampling method and were between the ages of 60-90(66.7±5.3)years with a disease course of 0.5-40.0 years.Baseline data was collected through questionnaires and patients were followed up for six months.The study observed self-reported hypoglycemia events and analyzed the influencing factors of self-reported hypoglycemia using logistic regression.Results:Out of the 1, 010 patients who participated in the study, 901(89.2%)completed it.Of those who completed the study, 321(35.6%)reported experiencing hypoglycemia.The median frequency of hypoglycemia was found to be 3(2, 4)times.Several factors were found to be influential in self-reported hypoglycemia in elderly patients with type 2 diabetes.These factors included waist circumference, HbA1c, thiazolidinediones combined with insulin therapy, frequency of hypoglycemia in the past year, blood glucose prevention education, and fear of hypoglycemia.All of these factors had a significant impact on self-reported hypoglycemia(all P<0.05). Conclusions:Medical professionals should prioritize patients who are undergoing thiazolidinediones combined with insulin therapy and frequently experience hypoglycemia.They should address the patients' fear of hypoglycemia and provide them with comprehensive education.

Objective    To investigate the use of opioid analgesics during the postoperative hospitalization in patients undergoing lung resection and analyse its influencing factors. Methods    The clinical data of 450 patients undergoing lung resection in Sichuan Cancer Hospital among a multicenter symptom research database (CN-PRO-Lung 1) between November 2017 and January 2020 were analyzed. There were 248 males and 202 females with an average age of 54.7±10.3 years. Results    A total of 448 (99.6%) patients used opioid analgesics. The average daily morphine equivalent dose during the postoperative hospitalization was 48.9 mg. There were statistical differences in postoperative morphine equivalent dose across patients with different sex, age, highest level of education, Charlson Comorbidity Index score, surgical approach, surgical type, operative time, postoperative hospital stay and grade of postoperative complications (all P<0.05). Multivariate analysis showed that sex, surgical approach and postoperative hospital stay were independent influencing factors for morphine use during the postoperative hospitalization in patients undergoing lung resection (all P<0.05). Conclusion    In clinical practice, attention should be paid to postoperative pain for male patients, as well as to promote the application of minimally invasive surgery, and to shorten the length of postoperative hospital stay, in order to ultimately reduce the use of opioids.

Objective:To explore the mediating effect of nurses′ self-efficacy in palliative care between the past behavioral experience of end-of-life care and core competence, and provide theoretical reference for improving the core competence of clinical nurses in palliative care.Methods:579 clinical nurses from 2 tertiary general hospitals in Shandong Province were investigated by convenience sampling method using general information questionnaire, nurses′ self-efficacy questionnaire for palliative care and palliative care nurses′ core competency questionnaire. The data were analyzed by SPSS 25.0.Results:The total score of core competence of hospice care of 579 nurses was (71.41 ± 22.74), nurses′ self-efficacy of palliative care was positively correlated with their core competence ( r = 0.648, P<0.01), past behavior experience was positively correlated with self-efficacy ( r = 0.479, P<0.01), positively correlated with core competence ( r = 0.427, P<0.01). Nurses′ self-efficacy of palliative care played a partial mediating role between the pastbehavioral experience and core competence, which accounted for 64.67% of the total effect. Conclusions:The past behavioral experience of end-stage nursing can directly or indirectly affect the core competence of nurses in palliative care through self-efficacy. It can improve the core competence of palliative care by taking active measures to enrich the past behavioral experience of end-of-life care and improve self-efficacy.

Background Evidence on the association between greenness and adiposity in children and adolescents is inconsistent and mostly from developed countries. Relatively limited evidence is from China. Objective To assess the association between greenness and adiposity in children and adolescents based on satellite remote sensing data. Methods From 2016 to 2018, a cross-sectional study was conducted among 52316 children and adolescents aged 5-18 years in three cities in the Pearl River Delta region of China. Basic sociological and demographic characteristics of the population and adiposity levels were collected through questionnaires. Land Remote-Sensing Satellite (Landsat) data and moderate-resolution imaging spectroradiometer (MODIS) products were used to quantify the greenness around the schools and homes, including normalized difference vegetation index (NDVI), vegetation continuous field (VCF), soil-adjusted vegetation index (SAVI), and enhanced vegetation index (EVI) calculated within 500 m and 1000 m buffers centered around the participants' homes or schools. A restricted cubic spline function was used to assess the exposure-response relationship. After categorizing greenness levels into quartiles with the first quartile as the reference, two-level generalized linear models were applied to assess the change in body mass index z-scores (zBMI) and the risk of overweight of children and adolescents in higher quartiles relative to the lowest quartile. In addition, counterfactual framework modelling was applied to assess the potential mediation effects of PM_2.5 and NO₂, and physical activity levels on the associations between greenness and adiposity levels. Results Of the 52316 children included, 8406 (16.1%) were overweight. A non-linear negative association of the level of greenness around the homes or schools and zBMI was found, with a significant lower zBMI in children and adolescents when a certain level of greenness was reached. After adjusting for confounders, the participants in the highest quartile had a significantly lower level of zBMI and a significantly lower risk of overweight compared with those in the lowest quartile of NDVI_{500 m} and VCF_{500 m}. The estimate change (\begin{document}$b$\end{document}) for zBMI was −0.07 (95%CI: −0.10-−0.04) and the odds ratio (OR) for overweight was 0.92 (95%CI: 0.85-0.99) for the students in the highest NDVI_{500 m} quartile based on home address compared to those in the lowest quartile. Significant negative associations were also observed when 1000 m buffer, SAVI, and EVI were used. The mediation analysis showed that PM_2.5 and NO₂ partially mediated the negative association of NDVI_{500 m} with zBMI , and the proportions of mediation were 50% (95%CI: 20%-80%) and 90% (95%CI: 50%-160%), respectively while no significant mediation effect was observed for physical activity level. Conclusion Higher levels of greenness surrounding homes or schools may be associated with a reduced risk of overweight and decreased zBMI in children and adolescents, and such associations may be partially mediated by reducing air pollutant concentrations.

Objective:To investigate the clinical effect of focused ultrasound ablation surgery (FUAS) combined with suction curettage for mass-type cesarean scar pregnancy (CSP) and to analyze the influencing factors of vaginal bleeding and readmission.Methods:From January 2014 to December 2020, 88 patients with mass-type CSP were treated by FUAS combined with suction curettage in the Third Xiangya Hospital of Central South University. The clinical results and the influencing factors of bleeding and readmission for mass-type CSP were analyzed.Results:All the patients underwent one time FUAS treatment successfully. Immediately after FUAS treatment, color Doppler ultrasound showed obvious necrosis and no perfusion area in all lesions, and the blood flow in the mass-type CSP tissue significantly decreased. The median volume of blood loss in the procedure was 20 ml (range: 5-950 ml). Thirteen patients (15%, 13/88) had vaginal bleeding≥200 ml, and 15 patients (17%, 15/88) were hospitalized again. The average time for menstruation recovery was (28±8) days (range: 18-66 days). The average time needed for serum human chorionic gonadotropin-beta subunit to return to normal levels was (22±6) days (range: 7-59 days). The risk of large vaginal bleeding of patients were related to the blood supply of the mass ( OR=5.280, 95% CI: 1.335-20.858, P=0.018) and the largest diameter of the mass ( OR=1.060, 95% CI: 1.010-1.120, P=0.030). The risk of readmission were related to the largest diameter of the mass ( OR=1.055, 95% CI: 1.005-1.108, P=0.030) and the depth of the uterus cavity ( OR=1.583, 95% CI: 1.015-2.471, P=0.043). No serious complications such as intestinal and nerve injury occurred during and after FUAS treatment. Conclusions:FUAS combined with suction curettage is safe and effective in treating patients with mass-type CSP through this preliminary study. The volume of vaginal bleeding are associated with the blood supply of the mass and the largest diameter of the mass, the risk of readmission are related to the largest diameter of the mass and the depth of the uterus cavity.

Objective:To construct an evaluation index system for quality of use of insulin pumps in hospitals, in order to provide a reference for evaluating quality of use of insulin pumps in hospitals in clinical work.Methods:Based on the three-dimensional quality evaluation model of "structure-process-result", the first draft was determined through literature review and group discussion from January to February 2022. Using the Delphi expert correspondence method, 26 experts from 13 provinces/municipalities in China were consulted in two rounds to determine the quality evaluation index system for the use of insulin pumps in the hospital.Results:The recovery rate of the two rounds of expert questionnaire was 100%, and the expert authority coefficient was 0.971. The mean value of the second round of index importance assignment was 4.500-5.000 and the coefficient of variation was 0-0.22. The final construction of quality evaluation index system of insulin pump use in the hospital included 3 first-level indicators, 15 second-level indicators and 37 third-level indicators.Conclusions:The constructed quality evaluation index system of insulin pump use in the hospital is scientific, reasonable and practical, which has guiding significance for evaluating the quality of insulin pump use in the hospital.

Objective:To explore the influence of family caregiver empowerment intervention model on discharge preparation and quality of life of patients with lung cancer undergoing chemotherapy.Methods:From January 2019 to January 2020, 84 lung cancer patients who received chemotherapy in the Department of Respiratory Medicine in the First Affiliated Hospital of Zhengzhou University were selected, each patient chose one family primary caregiver. It was divided into the control group and the intervention group by the draw method with 42 cases in each group. The control group received routine nursing intervention of internal medicine chemotherapy, and the intervention group received empowerment intervention of main family caregivers on the basis of the control group. The effect of family caregiver empowerment intervention mode were investigated by observing the discharge readiness and quality of life of lung cancer patients.Results:There was no significant difference in the preparation for discharge and quality of life between the two groups before intervention ( P>0.05); after three cycles intervention, the total scores of discharge readiness and quality of life in the intervention group were (76.30±2.80), (94.05±3.70), which were significantly better than those in the control group(73.02±3.73), (87.44±4.18), and the differences were statistically significant ( t values were -4.464, -7.527, P<0.01). Conclusions:Empowerment intervention model of family caregivers can improve the discharge readiness and quality of life of lung cancer patients undergoing chemotherapy.