Objective:To develop the Peristome Skin Injury Risk Assessment Scale and to verify its reliability, validity and predictive performance in patients with colorectal cancer stoma.Methods:The initial assessment scale was developed through literature review and Delphi expert consultation. From February 2020 to April 2021, convenient sampling was used to select 290 cases of colorectal cancer stoma patients who were reexamined in the Oncology Surgery of the First Affiliated Hospital of Xi'an Jiaotong University as the research object. Item analysis, validity analysis, reliability analysis, receiver operating characteristic curve (ROC) were used to test the reliability, validity and predictive performance of the scale.Results:Exploratory factor analysis extracted a total of 4 common factors, namely general condition, stoma condition, postoperative condition, education and self-care condition, a total of 17 items, and the cumulative variance contribution rate was 85.144%. The scale-level content validity index was 0.941, and the item-level content validity index was 0.857 to 1.000. The Cronbach's α coefficient of the total scale was 0.824, the split-half reliability coefficient was 0.837, and the test-retest reliability coefficient was 0.819. There was a statistically significant difference in the scores of the Peristome Skin Injury Risk Assessment Scale in patients with colorectal cancer stoma between the injury group and the non-injury group ( P<0.05) . The area under the ROC curve was 0.838 (95% confidence interval: 0.785-0.891) . When the cut-off score was 39.5, the sensitivity of the scale was 0.849, the specificity was 0.759, the Youden index was 0.608, and the predictive performance was the best. Conclusions:The Peristome Skin Injury Risk Assessment Scale has good reliability and validity, and has high predictive performance, which is suitable for the assessment of the risk of peristome skin injury in patients with colorectal cancer in China.

Objective:To investigate the possible causative factors of central core disease(CCD), the clinical features of a neonatal case with CCD and five patients in the pedigree line were analyzed for RYR1 gene variant.Methods:Medical and family history inquiries and detailed clinical examinations were performed in the proband . High-throughput sequencing technology was applied to analyze the gene variant of the proband , and Sanger sequencing was applied to verify the pedigree distribution of the variant.Results:The whole exon sequencing results showed that the proband has a missense variant of c. 14591 A>C (p.Tyr4864Ser) in the RYR1 gene which was unreported previously; Sanger sequencing results showed that the father, grandfather, the eldest aunt and second aunt of the proband all carried the same variant. The c. 14591 A>C variant of RYR1 gene was predicted to be a likely pathogenic (PM2+ PM5+ PP1+ PP3) according to the American College of Medical Genetics and Genomics standards and guidelines. Conclusions:The RYR1 gene c. 14591 A >C (p.Tyr4864Ser) variant may be the genetic cause of the pedigree and genetic testing helps to clarify the diagnosis. Identification of this variant has enriched the variant spectrum of the RYR1 gene.

Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.

Objective:To analyze the distribution and drug resistance of wound pathogenic microorganisms in outpatients of wound healing center so as to provide a basis for the standardized construction of wound healing centers.Methods:A retrospective case series study was used to analyzed the data of 365 outpatients treated at Ruijin Hospital, Shanghai Jiaotong University School of Medicine from December 2017 to October 2019. There were 220 males and 145 females, aged (58.8±18.9)years (range, 18-98 years). The patients included 92 first-visit patients and 273 re-visit patients. The culture results (positive rate of pathogenic microorganisms, bacterial species, bacterial distribution) and drug sensitivity results of the wound secretions were compared and analyzed.Results:(1) Among 365 samples of wound secretions, 198 patients were positive for pathogenic microorganisms with a positive rate of 54.3%. A total of 107 strains (51.0%) of Gram-positive bacteria were detected, mainly Staphylococcus aureus (70 strains, 33.3%); 95 strains (45.2%) of Gram-negative bacteria were detected, mainly Escherichia coli (20 strains, 9.5%), followed by Pseudomonas aeruginosa (17 strains, 8.1%); 8 strains (3.8%) of fungi were detected. (2) A total of 26 (28.3%) first-visit patients were positive for pathogenic microorganisms, and 172 (63.0%) re-visit patients were positive for pathogenic microorganisms. The rate of positive microorganism detection had significant differences between first-visit and re-visit patients ( P<0.05). (3) A total of 29 strains were detected in first-visit patients, including 16 strains (55.2%) of Gram-positive bacteria, 11 strains (37.9%) of Gram-negative bacteria and 2 strains (6.9%) of fungi. A total of 181 strains were detected in re-visit patients, including 91 strains (50.3%) of Gram-positive bacteria, 84 strains (46.4%) of Gram-negative bacteria and 6 strains (3.3%) of fungi. The microbial distribution was significantly different between first-visit and re-visit patients ( P<0.05). (4) Compared with first-visit patients, the resistance of Staphylococcus aureus isolated from the re-visit patients to spenicillin, oxacillin, ciprofloxacin, tetracycline, clindamycin, moxifloxacin, erythromycin, and levofloxacin were increased variably. No vancomycin-resistant Staphylococcus aureus was detected, indicating that the staphylococcus aureus presented in the wound was highly sensitive to vancomycin. Conclusions:Staphylococcus aureus is the most common microorganism in wound secretions in outpatients of wound healing center. The rate of positive pathogenic microorganisms in wound secretions of re-visit patients is significantly higher than that of first-visit patients, and the distribution of pathogenic microorganisms of first-visited and revisited patients differs significantly. The Staphylococcus aureus detected in re-visit patients has a higher resistance to common antibiotics compared with first-visit patients. It is suggested that timely detection of pathogenic microorganisms in outpatients and effective control and supervision of outpatient infections are important contents that cannot be ignored in the construction of wound healing center.

OBJECTIVE: To explore the clinical characteristics, genetic basis and clinical treatment of seven neonates with congenital nephrogenic diabetes insipidus (NDI). METHODS: Clinical data of the patients were collected. High-throughput sequencing was carried out to detect potential variants. Sanger sequencing was used to verify the results. RESULTS: The patients were all males, with the age of onset being 10 to 21 days. All patients were admitted to the hospital for intermittent fever as the first symptom during the neonatal period. Additional symptoms had included polydipsia and polyuria. After the treatment, 5 patients had recovered, the remainders still had NDI symptoms and developmental retardation. Five children were found to harbor pathogenic variants of the AVPR2/AQP2 gene, which included one in-frame mutation of c.645_646insGCACCTACCCTGGGTATCGCC, two missense mutations of c.541C>T and c.419C>A, and two hemizygous deletions of the AVPR2/AQP2 gene. Among these, two were unreported previously. Cases 6 and 7 were a pair of twins. Both had carried homozygous missense variants of c.538G>A of the AVPR2/AQP2 gene, which was known to be pathogenic. CONCLUSION AVPR2/AQP2 is the main pathogenic gene for congenital NDI, for which two novel pathogenic variants have been discovered in this study. Above results have provided a basis for clinical diagnosis and genetic counseling for the affected pedigrees.
Aquaporin 2/genetics* ; Child ; Diabetes Insipidus, Nephrogenic/genetics* ; Diabetes Mellitus ; Humans ; Infant, Newborn ; Male ; Molecular Biology ; Mutation ; Pedigree ; Receptors, Vasopressin/genetics*

The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient′s medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.

Objective To explore the subjective sleep quality and mental resilience in colorectal cancer patients during the treatment period. Methods A total of 72 colorectal cancer patients undergoing chemotherapy from May to September 2016 in First Affiliated Hospital of Xi'an Jiaotong University were selected by convenience sampling method. Pittsburgh sleep quality index (PSQI) and Conner-Davidson Resilience Scale (CD-RISC) were applied to investigate patients' sleep quality and mental resilience before discharge, and at the 1st month, 3rd month and 6th month of the chemotherapy. Single factor repeated measurement analysis of variance was applied to compare the difference between sleep quality score and mental resilience score, and Pearson correlation coefficient was used to analyze the correlation between them. Results The PSQI scores at the 4 follow-up time points were (9.43±4.26), (9.02±3.68), (7.58±4.01) and (6.16±3.22), and the difference was statistically significant (F=9.861,P<0.05). The CD-RISC scores at the 4 follow-up time points were (60.13±15.80), (66.56±16.17), (69.82±17.46) and (73.03±17.85), and the difference was statistically significant (F=7.681,P<0.05). The difference of PSQI scores of patients in different age groups was statistically significant (F=2.792,P< 0.05), and the differences of CD-RISC in patients with different education degree and in different cancer stages were statistically significant (F=3.321,3.534;P<0.05). There were a negative correlations between sleep quality and mental resilience at the each time point (r=-0.32--0.53;P<0.05). The CD-RISC score of the patients with early stage sleep disturbances was lower than that of non-sleep disturbances patients at each time point (P< 0.05). Conclusions Health professionals should pay close attention to the sleep status of colorectal cancer patients at the early stage of treatment, and take appropriate interventions to improve the quality of life and resilience development.

OBJECTIVE:To systematically review the pregnancy safety of selective 5-serotonin reuptake inhibitor (SSRI) for depression in women underwent in vitro fertilization (IVF) combined with embryo transfer,and to provide evidence-based refer-ence. METHODS:Retrieved from PubMed,EMBase,Cochrane Library,Medline,CBM,CJFD,VIP and Wanfang database,tri-als about SSRI (trial group) vs. no medicine or placebo alone (control group) for depression in women underwent IVF combined embryo transfer were collected. Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation. RESULTS:A total of 4 studies were included,involving 2122 patients. Results of Meta-analysis showed there was no statistical significance in miscarriage rate [RR=0.90,95%CI(0.61,1.35),P=0.62],pregnancy rate [RR=1.03,95%CI (0.73,1.45),P=0.87] or live birth rate [RR=1.03,95%CI(0.65,1.63),P=0.91] between 2 groups. CONCLUSIONS:For depres-sion in women underwent IVF combined with embryo transfer,SSRI do not increase miscarriage rate,decrease pregnancy rate and live birth rate and have no significant effect on the results of IVF combined with embryo transfer.

BACKGROUND: With the increasing number of patients undergoing knee arthroplasty in China, the complications caused by the mismatch of prosthesis with anatomical parameters arouse extensive attentions.OBJECTIVE: To measure the anatomical parameters of the knee joints in healthy Zhuang ethnic group from Guangxi Zhuang Autonomous Region, China, using three-dimensional (3D) reconstruction technology, thus providing reference for the design and placement of the hip prosthesis.METHODS: Sixty-eight individuals, including 30 females and 38 males, were selected from 217 healthy people undergoing CT examination. All data were imported into Mimics 15.0 software used for 3D reconstruction, and then the knee parameters were then measured and analyzed.RESULTS AND CONCLUSION: There was no significant difference in the parameters of the bilateral femur and tibia (P > 0.05). The femoral parameters had significant differences between genders (P < 0.05). The width of tibial platform, sagittal length of lateral tibial platform, distance between medial tibial plateau and fibular head, and posterior slope of tibial plateau showed no significant differences between genders (P > 0.05), while there were significant differences in the width of medial/lateral tibial platform, and sagittal length of medial tibial platform between genders (P < 0.05). The sagittal length of medial femoral condyle was negatively correlated with age, and all femoral parameters were positively correlated with height; while only the width of medial and lateral tibial platform were positively correlated with height. To conclude, 3D reconstruction technology is available for research on the morphology of the knee joint in the Zhuang ethnic group from Guangxi Zhuang Autonomous Region, which provides references for prosthesis design and research appropriate for the Zhuang ethnic group.

Objective To investigate whether sex,age-of-onset,education and asymmetry affect non-motor symptoms (NMS)in Parkinson disease,and to analyze the relationship between motor symptoms and NMS in Parkinson's disease.Methods The detailed clinical information of 157 patients with idiopathic Parkinson's disease(PD)was recorded and followed up.The data was calculated with SPSS statistic software.Sex had an impact on sleeping disorder (P＜ 0.05).Sleep disorder in female was more prominent.Cognitive disorder was affected by age-of-onset and education duration.The pain and sensory disorder were affected by age-of-onset (P ＜ 0.05).Differences in the effects of asymmetry on NMS were not statistically significant (P＞ 0.05).The higher the scores of postural instability and gait difficulty (PIGD)were,the lower the Mini-Mental State Examination (MMSE)score was(β=-1.837,P =0.004).The higher the tremor score was,the higher the Hamilton Depression Scale(HAMD) score was(β=3.460,P =0.001).The higher the rigidity akinesia score was,the higher the autonomic dysfunction score was(β=0.104,P=0.006).Conclusions The non-motor symptoms of Parkinson's disease are affected by the age,sex and cultural level.Symmetryor-not does not affect Parkinson's disease.Non-motor symptoms and motor symptoms are closely linked.The encountered posture and gait abnormalities of patients should trigger physician alerts to focus on patients' cognitive function.The encountered tremor of patients should trigger physician alerts to focus on their emotional changes.Facing to the patient with rigidity and less moving,physician should alert to the occurrence of autonomic symptoms.