Objective:To construct a leadership evaluation indicator system for managers in primary healthcare institutions.Methods:This study was a qualitative research. Based on the Chinese Academy of Sciences′ Five Forces Model of Leadership, the framework of the leadership evaluation indicator system for primary healthcare institution managers was initially constructed through literature review, expert interviews, surveys, and group discussions. From November 2020 to June 2021, 19 experts were invited to participate in two rounds of Delphi expert consultations. Based on the consultation results, the leadership evaluation indicator system for primary healthcare institution managers was developed, and the analytic hierarchy process (AHP) was used to determine the weight of each indicator.Results:Nineteen consulting experts were included in the study, 13 of whom were aged 40 years or older, and seven of whom had 20 years or more of professional experience. The response rates of the two rounds of Delphi expert consultation questionnaires were 18/19 and 19/19, respectively; the authority coefficients of the experts were 0.92 and 0.91, respectively. In the second round of consultation, the coordination coefficients of each level of indicators were 0.640, 0.557, and 0.512 ( P<0.05), respectively. The constructed leadership indicator system for managers of primary healthcare institutions included five primary indicators, 16 secondary indicators, and 44 tertiary indicators. The primary indicators, in order of their weight, were "influence"(0.299),"decisiveness"(0.245),"control"(0.156),"inspiration"(0.150), and "foresight"(0.150). Conclusions:This study is a preliminary construction of a leadership evaluation indicator system for managers of primary healthcare institutions, which can be a reference for the training and evaluation of relevant talents.

Objective    To study the hemocompatibility of bioprosthetic heart valve materials respectively based on glutaraldehyde and non-glutaraldehyde treatment. Methods    Fresh bovine pericardium was treated with glutaraldehyde or non-glutaraldehyde after adipose tissue was removed. To evaluate the hemocompatibility of the two bioprosthetic heart valve materials, hemolysis test, in vitro fibrinogen adsorption experiment, platelet adhesion experiment, thrombin-antithrombin complex (TAT) test, complement activation assay and ex vivo circulation experiment were performed. Results    The hemolysis test results demonstrated that both of the materials showed hemolytic rates lower than 5%. The results of TAT test and complement activation assay showed no statistical differences among the two materials and the blank control group. Compared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment showed significantly decreased fibrinogen adsorption, platelet adhesion and thrombosis. Conclusion    Compared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment show better hemocompatibility.

BACKGROUND: Immune-related adverse events (irAEs) are commonly occurred in patients treated with immune checkpoint inhibitors. However, evidence of irAEs derived from the Chinese population is relatively lacking. The aim of this study was to investigate the incidence and outcomes of irAEs in Chinese patients with lung cancer after receiving immune checkpoint inhibitors (ICIs). METHODS: Clinical and follow-up data from lung cancer patients who received at least one time of ICIs from January 2018 to September 2021 at Huadong Hospital, Fudan University were included. Statistical descriptions and Kaplan-Meier method were used to analyze the overall incidence of irAEs, as well as the incidence and outcomes of each type of irAEs. RESULTS: 135 patients were included in the study. 106 patients (78.5%) presented at least one type of irAEs, and the median time to first irAEs onset was 28 d. Most irAEs occurred at early time after treatment, and most irAEs were mild-moderate and reversible. 57 patients (42.2%) died at the study cutoff. The mortality rate of severe irAEs was 12.6% (n=17), and among them 7 patients (41.2%) died of pneumonitis. The median progression-free survival (PFS) and overall survival (OS) time of the total population was 505 d (95%CI: 352-658) and 625 d (95%CI: 491-759), respectively. Patients who presented any irAEs achieved a longer PFS than those who did not (median PFS: 533 d vs 179 d, P=0.037, HR=0.57), while patients who presented skin toxicities achieved a longer OS than patients who did not (median OS: 797 d vs 469 d, P=0.006, HR=0.70). CONCLUSIONS In real-world settings, irAEs in lung cancer patients were commonly observed, with pneumonitis as the most common fatal irAEs. In addition, patients who presented any irAEs may tend to achieve a longer PFS.
Humans ; Lung Neoplasms ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Immune Checkpoint Inhibitors/therapeutic use* ; Incidence ; Antineoplastic Agents, Immunological/therapeutic use* ; Drug-Related Side Effects and Adverse Reactions/drug therapy* ; Retrospective Studies

Objective:To explore the status and influencing factors of workplace bullying in Operating Room nurses.Methods:This study is a cross-sectional study. From April to May, 2022, a total of 158 Operating Room nurses from 4 ClassⅢ Grade A hospitals in Hangzhou were selected as research objects by the convenient cluster sampling method. The general information questionnaire, Negative Acts Questionnaire-Revised (NAQ-R) and PTSD Checklist-Civilian Version (PCL-C) were used to investigate Operating Room nurses. Binomial Logistic regression analysis was used to investigate the influencing factors of workplace bullying in Operating Room nurses. Pearson correlation analysis was used to investigate the association between workplace bullying and post-traumatic stress disorder. A total of 158 questionnaires were distributed in this study, and 154 valid questionnaires were received, with an effective recovery rate of 97.47%.Results:A total of 78.57% (121/154) of Operating Room nurses had experienced workplace bullying, 33.12% (51/154) had experienced moderate to severe workplace bullying, and 44.81% (69/154) had post-traumatic stress disorder. The NAQ-R score and PCL-C score of Operating Room nurses were (31.34±10.06) and (37.71±15.47) , respectively. Binomial Logistic regression analysis results showed that age and position were the influencing factors of workplace bullying in Operating Room nurses ( P<0.05) . Pearson correlation analysis results showed that workplace bullying was positively correlated with post-traumatic stress disorder ( r=0.657, P<0.01) . Conclusions:Workplace bullying is common in Operating Room nurses in ClassⅢ Grade A hospitals in Hangzhou. Younger nurses and nurses with position are more likely to suffer from workplace bullying, and workplace bullying is positively correlated with post-traumatic stress disorder. Operating Room managers should pay more attention to workplace bullying and develop targeted intervention measures to avoid workplace bullying.

Objective To investigate the expression of MPZL1 in gastric cancer tissues, its relation with the prognosis, and its effects on proliferation and colony formation of gastric cancer. Methods GEPIA and UALCAN databases were used to analyze the expression of MPZL1 in various malignant tumors. The KM Plotter database and UALCAN database were used to analyze the effect of MPZL1 on the overall survival of gastric cancer patients. The expression of MPZL1 protein and the changes of apoptosis-related proteins in gastric cancer cells were detected by Western blot, and the effects of MPZL1 expression on cell proliferation and colony formation were detected by CCK-8 and colony formation assay, respectively. Results MPZL1 was found to be highly expressed in various malignant tumors by GEPIA database. The results of UALCAN and KM Plotter databases analysis showed that MPZL1 was highly expressed in gastric cancer tissues, and might be correlated with the overall survival of gastric cancer patients. The results of CCK-8 and colony formation assay showed that the overexpression of MPZL1 promoted the proliferation and colony formation ability of gastric cancer cells (P < 0.05). Western blot results showed that compared with control group, the expression levels of pro-apoptotic proteins Bad and Caspase-7 in the overexpression group were significantly lower while those in knockdown group were higher. Conclusion MPZL is highly expressed in gastric cancer tissues and promotes the proliferation and colony formation of gastric cancer cells, which may be related to the inhibition of apoptosis.

Objective: To evaluate the epidemiologic characteristics of hand, foot and mouth disease in Zhejiang province between 2009 and 2017, so that scientific evidence could be provided for prevention and control of hand, foot and mouth disease. Methods: Spatial, temporal and population distribution of HFMD was analyzed. Real-time reverse transcription polymerase cain reaction was used to test Enterovirus A71 and Coxsackievirus A16 in samples. Results: Between 2009 and 2017, 1 108 093 HFMD cases were reported in Zhejiang with the prevalence of 226.24/100000; 2010, 2012, 2014 and 2016 had a higher prevalence than other years. Prevalence of HFMD peaked in April-July and September-October. Wenzhou, Taizhou and Ningbo had a higher prevalence than other cities. In total, 69.27% cases were children who were not enrolled in nursery school, and 65.67% were 1-3 years old. Pathogen surveillance showed that EV-A71 decreased in mild cases, whereas other enterovirus increased. However EV-A71 was still predominant in severe and fatal cases (56.0%). Conclusions Temporal and spatial distribution of HFMD is characteristic in Zhejiang province. EV-A71 predominated in severe cases and fatal cases, while other enterovirus (non-EV-A71, non CV-A16) were the main pathogen for mild cases.

Objective To study the expression of silent information regulator (SIRT) in brains of rats with chronic fluorosis and reveal the correlation between SIRT1 and the ability of learning and memory of rats.Methods Sixty SD rats were selected and their body weight was (100 ± 20) g,according to the body mass of the rats,random number table method was used to divide rats into control group,low and high fluoride groups,experimental period was 3 and 6 months (ten rats in each experimental period,half males and half females).In control group,the rats were fed with drinking water containing no more than 0.5 mg/L fluoride;the rats in low and high fluoride groups were fed drinking water containing 5.0 and 50.0 mg/L fluoride,respectively.All of rats were fed the same standard food containing no more than 0.6 mg/kg fluoride.Three degree method was used to check the formation of dental fluorosis.Rat urinary fluoride was determined via the fluoride electrode method;Morris water maze method was used to detect the ability of learning and memory of rats (the escape latency time,the number of crossing the platform and stay time in platform quadrant);the protein and mRNA expression levels of SIRT1 were detected by Western blotting and Real-time PCR,respectively.Results In the experimental period of 3 and 6 months,no dental fluorosis was observed of rats in control group,but there were different degrees of dental fluorosis in low and high fluoride groups,especially in high fluoride group.The urinary fluorine contents [(1.60 ± 0.09),(1.91 ± 0.16) mg/L;(1.94 ± 0.19),(2.31 ± 0.18) mg/L] of rats fed with low and high fluoride for 3 or 6 months were significantly higher than those in control group [(1.08 ± 0.15),(1.09 ± 0.17) mg/L,P ＜ 0.05].The escape latency time [(18.36 ± 2.80) s] of rats in the high fluoride group at the end of 3 months was higher than that of control group [(6.68 ± 3.01) s,P ＜ 0.05],the number of stay time in platform quadrant [(12.91 ± 3.25) s] was lower than that of control group [(19.97 ± 3.30) s,P ＜ 0.05].The escape latency time [(15.46 ± 4.56),(28.16 ± 4.00) s] of rats in low and high fluoride groups at the end of 6 months were all higher than that of control group [(6.62 ± 2.31) s,P ＜ 0.05];the number of crossing the platform and stay time in platform quadrant [(2.25 ± 1.71) times,(12.73 ± 3.55) s;(1.40 ± 1.15) times,(9.26 ± 1.72) s] of these rats were significantly lower than those of the control group [(4.00 ± 1.58) times,(19.53 ± 4.36) s,P ＜ 0.05].The expression levels of protein [(73.84 ± 9.68)％,(73.23 ± 4.51)％;(53.30 ± 17.63)％,(54.69 ± 18.71)％] and mRNA [(70.33 ± 4.89)％,(66.27 ± 3.38)％;(37.72 ± 4.89)％,(44.15 ± 1.74)％] of SIRT1 in the hippocampus and cortex of rats fed with high fluoride for 3 or 6 months were significantly lower than those in control group [(100.00 ± 13.51)％,(100.00 ± 13.60)％;(100.00 ± 15.37)％,(100.00 ± 12.19)％;(100.00 ± 2.65)％,(100.00 ± 4.34)％;(100.00 ± 3.40)％,(100.00 ± 4.52)％,P ＜ 0.05].Whereas,the decreased expression levels of protein [(77.65 ± 14.51)％,(71.51 ± 8.27)％] and mRNA [(57.78 ± 1.96)％,(63.76 ± 2.16)％] of SIRT1 in the hippocampus and cortex of rats in the low fluoride group were only observed at the end of 6 month of experiment (P ＜ 0.05).The expression of protein of SIRT1 in the hippocampus and cortex of rats in 3 or 6 months was negatively correlated with the escape latency time of rats (r=-0.598 5,-0.493 2;-0.782 6,-0.777 3,P＜ 0.05),and it was positively correlated with the number of crossing the platform (r =0.547 7,0.523 3;0.720 5,0.715 4,P ＜ 0.05).Conclusion The decrease of the ability of learning and memory in rats with chronic fluorosis may be related to the decreased expression of SIRT1 influenced by chronic fluorosis.

Objective To detect the expression of peroxisome proliferator-activated receptor γ (PPARγ) in the brains of rats with chronic fluorosis and elucidate the relationship between PPARγand oxidative stress in chronic fluorosis.Methods According to body weight (100-120 g),sixty healthy SD rats were divided into control group (less than 0.5 mg/L fluoride in drinking water),low fluoride group (5.0 mg/L fluoride in drinking water,prepared by NaF),and high fluoride group (50.0 mg/L fluoride in drinking water) via the random number table method,20 rats in each group (half male and half female).The experiment periods were 3 and 6 months,respectively.Then 24-hour urine samples of rats were collected from each group,all rats were put to death and brain tissues were taken.The fluoride contents in urine and brain tissue were measured with fluoride-ion selective electrode;the levels of PPARγ protein and mRNA in the cortex and hippocampus were determined by Western blotting and Real-time fluorescence quantitative PCR,respectively;and the activities of superoxide dismutase (SOD) and level of malondialdehyde (MDA) in serum were detected by xanthine oxidase method and thiobarbituric acid method;the correlation between PPARγ protein expression and oxidative stress was analyzed.Results After 3 and 6 months of treatment,the contents of fluoride in urine and brain in low fluoride group [(1.57 ± 0.18) mg/L,(3.43 ± 0.70) μg/g;(1.79 ± 0.17) mg/L,(7.40 ± 1.21) μg/g] were higher than those of control group [(1.11 ± 0.17) mg/L,(2.39 ± 0.50) μg/g;(1.02 ± 0.15) mg/L,(2.87 ± 0.82) μg/g,P ＜ 0.05],and the values in high fluoride group [(1.91 ± 0.23) mg/L,(6.70 ± 0.87) μg/g;(2.44 ± 0.51) mg/L,(12.10 ± 1.30) μg/g] were significantly higher than those in low fluoride group (P ＜ 0.05).In high fluoride group after 3 months of treatment,the expression of PPARγprotein [(79.00 ± 3.46)％,(80.35 ± 2.50)％] and mRNA [(79.11 ± 11.18)％,(82.10 ± 9.94)％] in hippocampus and cortex of rat brains were significantly lower than those of low fluoride group [(104.01 ± 5.77)％,(101.17 ± 6.35)％;(112.88 ± 22.15)％,(101.14 ± 8.60)％,P＜ 0.05];the expression of PPARγprotein [(64.32 ± 10.43)％,(60.20 ± 10.92)％] and mRNA [(41.03 ± 9.93)％,(52.25 ± 11.48)％] in the same brain regions of the rats after 6 months of treatment in high fluoride group were significantly lower than those of control group [(99.99 ± 11.19)％,(100.00 ± 11.30)％;(100.00 ± 10.00)％,(100.00 ± 9.00)％] and low fluoride group [(73.88 ± 3.36)％,(81.50 ± 14.90)％;(76.02 ± 8.65)％,(73.36 ± 7.43)％,P ＜ 0.05].The activities of SOD in serum in low and high fluoride groups after 6 month treatment [(37.94 ± 1.92),(35.54 ± 2.53) U/ml] were significantly lower than that of control group [(41.24 ± 0.66) U/ml,P ＜ 0.05],and the value in high fluoride group was lower than that in low fluoride group (P ＜ 0.05);serum MDA contents in high fluoride group after 3 and 6 month treatment [(8.29 ± 1.49),(11.63 ± 1.04) nmol/mg pr] were higher than those in low fluoride group [(6.39 ± 0.69),(7.50 ± 1.64) nmol/mg pr] and control group [(5.02 ± 0.71),(5.87 ± 1.03) nmol/mg pr,P ＜ 0.05].The correlation analysis results showed the levels of PPARγprotein in hippocampus and cortex of rats were negatively correlated with fluoride contents in brain tissues (3 month:r=-0.769,-0.793;6 month:r =-0.832,-0.870;P ＜ 0.05),positively correlated with SOD activities (3 month:r =0.550,0.826;6 month:r =0.822,0.896;P ＜ 0.05) and negatively correlated with MDA contents (3 month:r =-0.703,-0.609,6 month:r =-0.792,-0.657;P ＜ 0.05) in serum.Conclusions Declined expression of PPARγat protein and mRNA levels has been detected in brains of rats with chronic fluorosis,which might be related to the increase of oxidative stress.PPARγ may be involved in the occurrence of chronic fluorosis.

Background and purpose:Promoter methylation ofPCDH10, a gene encoding protocadherin 10, has been found to be correlated to poor prognosis in gastric cancer (GC) patients. However, the relationship between the expression of PCDH10 and prognosis in GC remained unknown. This study aimed to explore the relationship be-tween the expression of PCDH10 and clinicopathological features and prognosis of GC, and to identify biomarker for predictions of recurrence and survival of GC.Methods:mRNA expressions of PCDH10 in 115 pairs of GC tissues and adjacent normal tissues were detected by real-time lfuorescence quantitative polymerase chain reaction (RTFQ-PCR). The correlation between PCDH10 expression level and clinicopathological features and prognosis of GC was analyzed. Prediction models for 5-year recurrence and 5-year survival were established using logistic regression method.Results:Progression-free survival (PFS) and overall survival (OS) were signiifcantly prolonged in patients with PCDH10 low expression compared to patients without PCDH10 low expression (P=0.046 andP=0.033 respectively). PCDH10 low expression signiifcantly correlated with less lymph node metastasis (P=0.001) and earlier TNM staging (P=0.001), and was more common in female than in male (P=0.040). The mRNA expression of PCDH10 did not correlate with age, Lauren classiifcation, T stage, neural invasion or vascular invasion. Univariate Cox analysis showed Lauren classiifca-tion, T stage, N stage, M stage and PCDH10 expression signiifcantly correlated with PFS and OS. Logistic regression models for the prediction of 5-year recurrence or 5-year survival based on clinicopathological features included Lauren classiifcation, T stage, N stage and M stage as variables. Logistic regression models for the prediction of 5-year recur-rence or 5-year survival based on PCDH10 expression included Lauren classiifcation, T stage, M stage and PCDH10 expression level but not N stage as variables. The models based on PCDH10 expression had the same effciencies as models based on clinical parameters in predicting 5-year recurrence or 5-year survival for GC patients.Conclusion:PCDH10 low expression correlated with better prognosis, less lymph node metastasis and earlier TNM stage in GC patients. Low expression of PCDH10 may be a biomarker of better survival for GC patients. Logistic regression model based on PCDH10 mRNA expression may serve as a prediction model when patients have unknown lymph node metas-tasis status.

Objective The aim of this study is to analyze the prevalence of myositis-specific autoantibodies (MSAs) and to elucidate their associations with clinical features in Chinese dermatomyositis (DM) patients. Methods Four hundreds and twenty-seven DM patients were enrolled in this retrospective study. Clinical features and sera were collected. Twelve subtypes of MSAs were detected by commercial test kits. The correlations between MSAs and clinical phenotypes in DM patients were calculated by t test, Mann-Whitney U test or χ2 test. In order to clarify whether MSAs subsets would be independent factors of certain clinical feature or not, separate models were established to test the correlation via the Logistic regression analysis. Results The positivity of MSAs was 69.8% in 427 patients with DM. Anti-ARS, anti-MDA5 and anti-TIF1-γ antibodies were the three most common MSAs in the DM patients with positivity of 19.9%, 17.6%and 17.1% respectively. Different kinds of rash associated with MSAs subtypes by χ2 test. Certain MSAs subtype might be an independent factor for clinical features via logistic regression analysis. Interstitial lung disease (ILD) was observed more frequently in patients carrying anti-MDA5 [OR=5.266, 95%CI (2.522, 10.996), P<0.01] and anti-Jo-1 [OR=6.232, 95%CI (1.674, 23.199), P=0.006]. On the contrary, anti-Mi2 [OR=0.208, 95%CI (0.074, 0.580, P=0.003] and anti-TIF1-γ [OR=0.189, 95%CI (0.096, 0.370), P<0.01] were protective factors against developing ILD. Anti-TIF1-γ was an independent risk factor for cancer-associated myositis [OR=5.907, 95%CI (2.868, 12.168), P<0.01]. Anti-TIF1-γ[OR=2.789, 95%CI (1.594, 4.880) P<0.01], anti-NXP2 [OR=2.983, 95%CI (1.274, 6.982), P=0.012] and anti-SAE1 [OR=4.815, 95%CI (1.082, 21.424), P=0.039] could worsen dysphagic tendencies. In contrast, anti-MDA5 [OR=0.349, 95%CI (0.169, 0.720), P=0.004] might decrease the prevalence of this manifestation. Conclusion Patients with DM have a high frequency of MSAs. Some subtypes of MSAs are correlated with and may be independent factors of different clinical phenotypes. These indicated that MSAs can be useful biomarkers in monitoring the extramuscular features in DM patients.