Objective To explore the correlation between the expression level of interferon gamma(IFN-γ)and the severity of patients with septic shock and its prognostic value.Methods The clinical data and serum of 96 septic shock patients admitted to the Department of Critical Care Medicine,the First Affiliated Hospital of Guangxi Medical University from March 2022 to August 2023 were collected,and divided into survival group and death group according to the 28-day outcome;collected at the same time Sera from 30 healthy people undergoing physi-cal examination during the same period served as the control group.The enzyme-linked immunosorbent(ELISA)method was used to detect the expression levels of IFN-γ in the three groups,and the expression levels of IFN-γ and various clinical data between the groups were analyzed.Results The serum IFN-γ expression level of patients with septic shock was lower than that of healthy people undergoing physical examination,212.80(151.11,255.79)ng/L compared with 343.37(314.5,427.95)ng/L,P<0.01.Among the 96 cases of septic shock,There were 54 cases in the survival group and 42 cases in the death group.The clinical data of the two groups were com-pared.The gender,smoking history,SBP,DBP,SI,Lac,IL-6,IFN-γ,PCT,SOFA score,and APACHEⅡscore of the two groups of patients were compared.The difference is statistically significant(P<0.01).Logistic regression analysis showed that decreased expression of Lac,IFN-γ,and APACHEⅡ score were independent risk factors for death in patients with septic shock.[Odds ratio(OR)and 95%confidence interval(95%CI)were 6.491(1.404～30.004)respectively.0.954(0.954～0.999),3.476(1.210～9.984),P<0.05].The Spearman correlation analysis of INF-γ,Lac and APACHEⅡ showed a negative correlation,and the correlation coefficients were-0.38 and-0.35 respectively.Drawing the ROC curves of Lac,IFN-γ,and APACHEII,the AUCs of the three were 0.847,0.869,and 0.833 respectively.The AUC of the three joint predictions was 0.978.The joint prediction value of the three was better than that of a single indicator,P<0.001.Conclusion The decrease in IFN-γ expression level and the severity of septic shock patients have good prognostic value.

Outpatient information management system is an important part of hospital information system,which plays an important role in hospital management,patient treatment,medical insurance reimbursement and settlement.This study integrated the application modes of big data,cloud computing,Internet of things and other cutting-edge technologies of artificial intelligence,focused on the intelligent decision support and whole-process simplified management of the diagnosis and treatment behavior of clinical TCM physicians,and developed a cloud intelligent TCM outpatient system for primary medical care.The system has intelligent medical functions such as intelligent prescription monitoring driven by the rule engine and intelligent recommendation of traditional Chinese medicine knowledge.It seamlessly connects with the intelligent four-diagnosis instrument for information collection and medical order input,and realizes the cloud storage,computing,distribution,management,service and outpatient process,multi-directional and convenient management mode.

Objective:To comprehensively understand the operational status and existing problems of the neurosurgery professional training bases for standardized residency training in Guangdong Province.Methods:According to the scoring rules of "Standardized Residency Training Evaluation Indicators—Surgery (Neurosurgery) Professional Base" formulated by the Post-Graduation Medical Education Neurosurgery Professional Committee of the Chinese Medical Doctor Association, 28 training bases were supervised and evaluated. The scoring results of the supervision of 28 neurosurgery training bases were collected, and the training bases were divided into two categories according to the traditional teaching history, 6 affiliated hospitals of traditional medical schools and 22 non-traditional affiliated/teaching hospitals. GraphPad 5.0 software was used for statistical analysis of the 14 core indicators, and t-test, variance analysis and Chi-square test were used for analysis. Results:The results showed that there was a statistically significant difference in the compliance rate of 14 core indicators between traditional teaching hospitals and non-traditional teaching hospitals ( P = 0.003), skill operation and type and number of surgeries ( P = 0.041) and student rotation plan ( P = 0.012). The differences were also statistically significant. Conclusion:This study reveals that the comprehensive management ability of training bases in traditional teaching hospitals is significantly better than that in non-traditional teaching hospitals. Additionally, it's suggested to strengthen the construction of professional bases, enhance the institutionalized management of bases, and thus realize the homogenization training of neurosurgery residents.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective:To explore the relationship between learning motivation and professional identity of nursing students.Methods:A total of 1 538 undergraduate and specialized nursing students from a medical college in Shandong Province were investigated with general information questionnaire, occupational identity scale and learning motivation scale.Results:The total score of professional identity and learning motivation of nursing students was 57.54±12.89 and 119.92 ±22.03 all of which were at the middle level. There was a positive correlation between the total score and each dimension ( r=0.225-0.614, P<0.01). Conclusions:Nursing students' professional identity is positively correlated with their learning motivation. The stronger their learning motivation is, the higher their level of professional identity is. It suggests that nursing education and managers should pay attention to improving their learning motivation and establish a stable professional concept.

BACKGROUND: MiR-148b-3p is an important microRNA that has been reported to be significantly related to various types of cancer, but its role in lung adenocarcinoma remains elusive. The purpose of this study is to detect the expression level of miR-148b-3p in lung adenocarcinoma specimens, and to analyze its correlation with the clinicopathological features as well as the prognosis of patients with lung adenocarcinoma. METHODS: A total of 123 tumor specimens from lung adenocarcinoma patients who underwent surgical resection in our department from January 2011 to December 2012 were collected. The expression of miR-148b-3p was detected by quantitative real-time PCR (qRT-PCR), and its correlation with clinicopathological features of patients with lung adenocarcinoma was analyzed. Multivariate Cox proportional hazard models were used to analyze independent predictors of overall survival in patients with lung adenocarcinoma. The overall survival (OS) of patients in miR-148b-3p high expression group and miR-148b-3p low expression group were estimated by means of the Kaplan-Meier method and were compared using the Log-rank test method. RESULTS: Of the 123 patients with lung adenocarcinoma, 71 were in miR-148b-3p high expression group and 52 in low expression group. MiR-148b-3p was significantly associated with tumor grade (P=0.001) and tumor size (P=0.007), but not with age, gender, smoking history, history of alcohol, tumor thrombus, pleural invasion, node status or metastasis status. Multivariate Cox proportional hazard model analysis showed that tumor size (P=0.032), node status (P=0.005) and miR-148b-3p expression level (P=0.047) were significant independent predictors of overall survival of patients with lung adenocarcinoma. Kaplan-Meier survival analysis showed that the overall survival of patients with high expression of miR-148b-3p was significantly better than that of patients with low expression (P=0.010). CONCLUSIONS MiR-148b-3p was significantly associated with tumor grade and tumor size in lung adenocarcinoma, and served as an independent predictor of overall survival of patients with lung adenocarcinoma. The overall survival of patients with high expression level of miR-148b-3p was significantly better than that of patients with low expression.
Adenocarcinoma of Lung ; diagnosis ; genetics ; pathology ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Kaplan-Meier Estimate ; Male ; MicroRNAs ; genetics ; Middle Aged ; Neoplasm Grading ; Prognosis ; Tumor Burden

Objective To investigate the microsurgical effect of spinal cord Intramedullary cavernous hemangioma.Methods The clinical data of 23 patients with spinal cord Intramedullary cavernous henangioma from January,2003 to March,2017 were analyzed retrospectively.McCormick clinical neurological function classification method and MRI examination were used to analyze the changes of neurological function and imaging changes beforeand-after operation.MRI and assess nerve function were reviewed 6-12 months after discharge.Results Twentytwo cases were totally resected,and subtotal excised in 1 case.The symptoms improved and even disappeared completely in 17 cases.There was no obvious improvement in 4 cases,2 cases were worse and no death cases.Twentyone cases were followed-up.The follow-up time was 3 months-9 years,and no tumor recurrence was found.Among the 14 cases of clinical neurological function Ⅰ-Ⅱ,10 cases recovered rapidly and most of the symptoms improved or even disappeared.Three cases had no obvious change.The other 1 case aggravated symptoms;Six cases of Ⅲ-Ⅳ patients in 7 cases of postoperative recovery,and 1 case of no change.According to preoperative neurological function grade Ⅰ-Ⅱ and Ⅲ-Ⅳ,the treatment effect of patients was compared,the difference was significant (x2=5.25,P＜0.05).Conclusion Microsurgical resection of spinal cord Intramedullary cavernous hemangioma is safe and effective.The preoperative nerve function,the relationship between the tumor and the spinal cord,and the surgical skill and the degree of resection are the important factors that affect the prognosis.

Objective     To observe and describe anatomical types of the pulmonary arteries to keep safety of lung resection. Methods     Between November 25, 2005 and January 22, 2013, 194 patients who underwent right upper lobectomy/sleeve lobectomy or combined lung resection including right upper lobectomy were included in Peking University Cancer Hospital. There were 128 males with a median age of 59 (37-86) years and 66 females with a median age of 60 (42-77) years. We separated the pulmonary arteries and recorded the number and positions of them. Some patients were recorded photographically. Results     There were 10 types of right upper lobe pulmonary artery branches in this study. Type 1: 1 apicoanterior segmental artery, 1 ascending segmental artery, 96 patients (49.5%); Type 2: 1 apicoanterior segmental artery, 2 ascending segmental arteries, 48 patients (24.7%); Type 3: 2 apicoanterior segmental arteries, 1 ascending segmental artery, 28 patients (14.4%); Type 4: 2 apicoanterior segmental arteries, 2 ascending segmental arteries, 9 patients (4.6%); Type 5: 1 apicoanterior segmental artery only, 6 patients (3.1%); Type 6: 1 apicoanterior segmental artery, 3 ascending segmental arteries, 3 patients (1.5%); Type 7: 4 apicoanterior segmental arteries, 1 ascending segmental artery, 1 patient (0.5%); Type 8: 3 apicoanterior segmental arteries, 1 ascending segmental artery, 1 patient (0.5%); Type 9: 2 apicoanterior segmental arteries, 1 patient (0.5%); Type 10: 3 apicoanterior segmental arteries, 2 ascending segmental arteries, 1 patient (0.5%). Conclusion     The types of pulmonary artery branches are predictable in some way. It would be helpful to reduce the risk of pulmonary artery injury and improve the operation safety by following   the rules. Variations of pulmonary artery should be noticed to avoid the major bleeding due to the pulmonary artery injury.

Our previous works disclosed the contributing role of macrophage migration inhibitory factor (MIF) and dopaminergic inhibition by lysine dimethyltransferase G9a/Glp complex in peripheral nerve injury-induced hypersensitivity. We herein propose that the proinflammatory cytokine MIF participates in the regulation of neuropathic hypersensitivity by interacting with and suppressing the descending dopaminergic system. The lumbar spinal cord (L-SC) and ventral tegmental area (VTA) are two major locations with significant upregulation of MIF after chronic constriction injury (CCI) of the sciatic nerve, and they display time-dependent changes, along with a behavioral trajectory. Correspondingly, dopamine (DA) content shows the reverse characteristic change to MIF with a time-dependent curve in post-surgical behavior. The levels of both MIF and DA are reversed by the MIF tautomerase inhibitor ISO-1, and a negative relationship exists between MIF and DA. The reversed role of ISO-1 also affects tyrosine hydroxylase expression. Furthermore, CCI induces Th promoter CpG site methylation in the L-SC and VTA areas, and this effect could be abated by ISO-1 administration. G9a/SUV39H1 and H3K9me2/H3K9me3 enrichment within the Th promoter region following CCI in the L-SC and VTA was also decreased by ISO-1. In cultured dopaminergic neurons, rMIF enhanced the recruitment of G9a and SUV39H1, followed by an increase in H3K9me2/H3K9me3. These molecular changes correspondingly exhibited alterations in Th promoter CpG site methylation and pain behaviors. In summary, MIF functions as a braking factor in curbing dopaminergic descending inhibition in peripheral nerve injury-induced hypersensitivity by mediating Th gene methylation through G9a/SUV39H1-associated H3K9 methylation.

Objective To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016.Methods Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation.Results A total of 1183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1124 patients were enrolled. The proportion of men was 36.48% (410/1124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: MoranI = 0.427,Z = 2.646,P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the high-high concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing.Conclusion The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.