Objective:To investigate the expression level, development mechanism, role and clinical prognostic significance of tweety homolog 2 (TTYH2) in cutaneous melanoma (SKCM).Methods:The expression data and clinical information of 365 cutaneous melanoma patients were downloaded from the Cancer Genome Atlas (TCGA), and the expression data of 812 normal tissues were retrieved from the genotype and Genotype-Tissue Expression(GTEx) to analyze the expression level of TTYH2 in SKCM tissues and normal counterparts. Survival analysis and Cox proportional hazard regression analysis were used to evaluate the effect of TTYH2 expression on prognosis and survival in SKCM patients. Gene set enrichment analysis Kyoto Genome Encyclopedia (KEGG) and Gene Ontology (GO) were used to screen signaling pathways for significant TTYH2 enrichment. The interaction network analysis was carried out using STRING online platform to screen key protein network node genes. Secondly, CIBERSORT algorithm was used to analyze the expression of 22 immune cells in each sample, and Chi-square test was applied to analyze the difference of immune cells in the high-low expression group.Results:The expression of TTYH2 in SKCM patients was significantly higher than that in normal tissues. Survival analysis showed that SKCM patients with high TTYH2 expression group had a poor prognosis. High TTYH2 expression was an independent predictor of poor overall survival of SKCM ( HR=1.21, 95% CI 1.08-1.37, P=0.001). KEGG result showed that TTYH2 was mainly concentrated in cell synapses, ion channels, calcium signaling pathways and extracellular matrix receptor interaction pathways. GO analysis showed that the biological processes involved in TTYH2 may be closely related to the occurrence and development of tumors. TTYH2 interacts with chloride intracellular channel protein 5, chloride ion channel protein 2, glycine receptor family members and gamma-aminobutyric acid receptor family members, suggesting that TTYH2 may play an important role in the pathogenesis of SKCM. Immune cell infiltration analysis showed that the immune cell abundance of memory B cells, CD4 memory T cells and monocytes was significantly increased in the TTYH2 low expression group, while the immune abundance of follicular helper T cells and regulatory T cells was significantly decreased in the TTYH2 low expression group. Conclusion:TTYH2 expression may regulate the development of SKCM cells through various ways, affect the survival and prognosis of SKCM patients, and is a potential biological prognostic marker and therapeutic target of SKCM.

Objective:To investigate the expression level, development mechanism, role and clinical prognostic significance of tweety homolog 2 (TTYH2) in cutaneous melanoma (SKCM).Methods:The expression data and clinical information of 365 cutaneous melanoma patients were downloaded from the Cancer Genome Atlas (TCGA), and the expression data of 812 normal tissues were retrieved from the genotype and Genotype-Tissue Expression(GTEx) to analyze the expression level of TTYH2 in SKCM tissues and normal counterparts. Survival analysis and Cox proportional hazard regression analysis were used to evaluate the effect of TTYH2 expression on prognosis and survival in SKCM patients. Gene set enrichment analysis Kyoto Genome Encyclopedia (KEGG) and Gene Ontology (GO) were used to screen signaling pathways for significant TTYH2 enrichment. The interaction network analysis was carried out using STRING online platform to screen key protein network node genes. Secondly, CIBERSORT algorithm was used to analyze the expression of 22 immune cells in each sample, and Chi-square test was applied to analyze the difference of immune cells in the high-low expression group.Results:The expression of TTYH2 in SKCM patients was significantly higher than that in normal tissues. Survival analysis showed that SKCM patients with high TTYH2 expression group had a poor prognosis. High TTYH2 expression was an independent predictor of poor overall survival of SKCM ( HR=1.21, 95% CI 1.08-1.37, P=0.001). KEGG result showed that TTYH2 was mainly concentrated in cell synapses, ion channels, calcium signaling pathways and extracellular matrix receptor interaction pathways. GO analysis showed that the biological processes involved in TTYH2 may be closely related to the occurrence and development of tumors. TTYH2 interacts with chloride intracellular channel protein 5, chloride ion channel protein 2, glycine receptor family members and gamma-aminobutyric acid receptor family members, suggesting that TTYH2 may play an important role in the pathogenesis of SKCM. Immune cell infiltration analysis showed that the immune cell abundance of memory B cells, CD4 memory T cells and monocytes was significantly increased in the TTYH2 low expression group, while the immune abundance of follicular helper T cells and regulatory T cells was significantly decreased in the TTYH2 low expression group. Conclusion:TTYH2 expression may regulate the development of SKCM cells through various ways, affect the survival and prognosis of SKCM patients, and is a potential biological prognostic marker and therapeutic target of SKCM.

PURPOSE: The aim of this study was to evaluate the effects of reflective trainings for nursing students on their critical thinking disposition. METHODS: A total of 157 senior undergraduate nursing students sampled from Hainan Medical University in China participated in this study in 2014. They were randomly divided into experimental and control groups. The experimental group students were provided the reflective training during their entire 12-month clinical internship, whereas students in the control group were requested to keep their reflective diaries but without a formal training. Before and after the intervention, nursing students' critical thinking disposition was rated using the Chinese version of Critical Thinking Disposition Inventory (CTDI-CV). RESULTS: Before the start of the intervention, the critical thinking disposition scores of the two groups had no significant differences. At the end of the intervention, it was found that the experimental students performed better in each subscale of CTDI-CV. These include the search for truth, open mind, analytical ability, systematic ability, critical thinking, self-confidence, curiosity, and cognitive maturity. By summing the scores of all categories, the results showed that the experimental group had a significantly higher total score than that of the control group (p ≤ .044). Evaluating the score difference in each function indicated that there was a range of improvements on the critical thinking disposition because of the reflective training intervention. CONCLUSION: Reflective training during the internship period improves nursing students' disposition of critical thinking and promotes their readiness for their clinical practices in the rapidly increasing demands of the healthcare field.
Asian Continental Ancestry Group ; China* ; Delivery of Health Care ; Education, Nursing ; Exploratory Behavior ; Humans ; Internship and Residency ; Nursing* ; Students, Nursing* ; Thinking*

OBJECTIVE:To evaluate the effects of PDCA cycle management on perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department. METHODS:In retrospective analysis,512 discharge medical records, 861 ones and 1 070 ones were selected from our hospital before PDCA cycle management(Jan.-Dec. 2013,before intervention group), after first cycle of PDCA cycle management (Jan.-Dec. 2014,first intervention group) and after second cycle of PDCA cycle management(Jan.-Dec. 2015,second intervention group),respectively. The perioperative prophylactic application of antibiotics was analyzed comparatively before and after continuous intervention. RESULTS:After 2 cycles of PDCA cycle management intervention, the constituent ratio of internal fixation in orthopedics department increased significantly;utilization ratio of antibiotics,the rate of rational type,medication ratio 0.5-1 h before surgery,the rate of rational treatment course,the proportion of antibiotics use in accordance with indications increased from 50.20%,98.08%,93.77%,6.61%,82.10% to 58.41%,100%,99.04%,52.00%, 99.04%,respectively. The number of antibiotics type decreased from 4 to 2;the proportion of cephazolin increased significantly while that of clindamycin decreased significantly compared to before intervention. Postoperative prophylactic medication course decreased from(4.63 ± 2.42)d to(1.61 ± 0.75)d;the proportion of patients with medication course <24 h or ranged 24-48 h increased significantly, while those with medication course>72 h decreased significantly, with statistical significance (P<0.05). CONCLUSIONS:PDCA cycle management improves the rational rate of perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department in our hospital. The prophylactic medication course of our hospital is not yet fully controlled within 24 h so it should be further intervened.

Objective To establish the animal model of chronic thromboembolic pulmonary hypertension(CTEPH) and to compare the accuracy of dual-energy CT (DECT) pulmonary angiography and histopathology for detecting CTEPH. Methods Eighteen canines were included in the study. All canines underwent paracentesis, embolization, CT scanning, pressure measurement and tranexamic acid feeding. The procedures were repeated every two weeks, until systolic/diastolic pressure in canines was≥30/15 mmHg or mean pulmonary artery pressure ≥ 20 mmHg.And then canines were sacrificed for histopathology examination. For CT pulmonary angiography (CTPA)in DE mode and DECT lung perfused blood volume (Lung PBV) images, the presence or absence of PE or perfusion defects were recorded on a per-canineand aper-lobe basis. With histopathological results as reference standard, the sensitivity, specificity of CTPA and lung PBV to detect PE were computed for two readers. The pairedχ2 test (McNemar test) was used to analyze the difference in diagnostic accuracy between CTPA and Lung PBV. Inter-reader agreement was also calculated with kappa test. Results CTEPH was demonstrated in 13 canines. On a per-canine basis, both readers found uneven and peripheral perfusion defects with DECT in 11 canines (84.6%, 11/13); while 5 canines (38.5%, 5/13) had cutoff or sudden stenosis of pulmonary arteries with CTPA;on a per-lobe basis,
both readers had sensitivities of 14.3%(5/35), 83.3%(30/36), specificities of 100.0%(30/30), 100.0%(29/29), accuracies of 53.8%(35/65), 90.8%(59/65)for CTPA and DECT, respectively. DECT had a higher sensitivity(χ2=-4.690,P<0.01)and accuracy(χ2=8.284,P<0.01) in detecting CTEPH. Excellent and moderate inter-reader agreements were observed with CTPA and DECT (Kappa=0.938, 0.572, both P<0.001). Conclusions It is feasible to make a CTEPH animal model with autologous thrombus. DECT shows a higher accuracy than CTPA to detect CTEPH in this canine model study.

OBJECTIVETo study the expression of tumorigenesis-related stem cell markers Lgr5 and CD44 in different pathological types of intestinal polyps and their clinical significance in predicting tumorigenesis.

METHODSA total of 145 cases of colorectal polyps, adenomas and cancer tissues were obtained by colonoscopy biopsy. Immunohistochemistry was employed to detect the expression of Lgr5 and CD44 to analyze their relationship with the occurrence and prognosis of colon and rectal cancer.

RESULTSThe expression of CD44 in colon cancer tissue was 95.65%, significantly higher than that in normal mucosa (5%), inflammatory hyperplastic polyps (22.58%), tubular adenomatous polyps (55.26%) and villous polyps (75.76%) (P<0.05). The expression of Lgr5 in colorectal cancer was up to 95.65% while negative in normal colorectal tissue and was 16.12% in inflammatory hyperplastic tissues (P<0.05). The expression rate of Lgr5 was 86.84% in tubular adenoma and 93.94% in villous polyps, both comparable with that in colon cancer (P>0.05). Correlation analysis indicated that the expression of CD44 and Lgr5 were positively correlated with the progression of intestinal polyp tumorigenesis (rs=0.69377, P<0.0001; rs=0.81637, P<0.0001).

CONCLUSIONLgr5 and CD44 are highly expressed in colorectal cancer tissues in close correlation with the clinical and pathological features. The expression profiles of Lgr5 and CD44 represent a distinct feature to differentiate colorectal cancer from normal intestinal mucosa. Lgr5 is more closely correlated with tumor progression of polyps than CD44. This means detecting of the expression of Lgr 5 together with CD44 is important and necessary in clinical diagnosis of patients with early stage colorectal diseases such as polyps and their canceration.

Adult ; Aged ; Colorectal Neoplasms ; metabolism ; pathology ; Female ; Humans ; Hyaluronan Receptors ; metabolism ; Intestinal Polyps ; metabolism ; pathology ; Male ; Middle Aged ; Prognosis ; Receptors, G-Protein-Coupled ; metabolism ; Young Adult

ObjectiveTo evaluate the feasibility of gadolinium-enhanced dual energy CT pulmonary angiography (CTPA) in detecting pulmonary embolism (PE).MethodsIn vitro dual energy CT of phantoms of gadolinium and iodinated contrast agents with different diluted ratio was performed,and CT values were measured at different tube voltages.Ten rabbits which were grouped into 3 ml/kg and 5 ml/kg groups underwent dual energy CT scan.CT values of pulmonary artery trunk and the first branch of pulmonary artery were measured.Sponge gelatin were injected into the femoral vein of 6 rabbits to make PE model next day,then lungs were re-imaged with dual energy CT 2 h after embolization.Creatinine was repeatedly measured before and one day after injection of gadolinium via ear marginal vein or femoral vein sampling.One-way ANOVA test and independent student t test were used to analyze the difference of pulmonary artery enhancement between different groups.Results ( 1 ) Compared with iodinated contrast agent,CT value of gadolinium-based contrast agent at 80 kV was higher than those at 140 kV and averageweighted 120 kV.(2) At 140,80,and average weighted 120 kV,CT values of pulmonary artery trunk [CT values were (463.1 ± 118.0),(664.2 ± 188.0),(522.9 ± 137.7) HU] and of the first branch of pulmonary artery [ CT values were (445.1 ± 82.3 ),(606.7 ± 207.2),(493.4 ± 117.3 ) HU ] were higher than those at 3 ml/kg [ CT value of pulmonary artery trunk was ( 258.1 ± 55.1 ),( 384.0 ± 92.3 ),(295.4 ± 73.6) HU,CT value of the first branch of pulmonary artery (245.0 ± 73.2 ),( 309.1 ± 94.2),(263.8 ±78.5) HU;all P ＜0.05].CT values of pulmonary artery trunk and the first branch of pulmonary artery at 80 kV were higher than those at 140 kV and average-weighted 120 kV ( pulmonary artery trunk:F =6.004,P =0.005 ; the first branch of pulmonary artery: F =4.374,P =0.018).In 6 rabbits,CTPA showed the enhancement cut-off of bilateral pulmonary arteries,gadolinium mapping showed decreased perfusion in the corresponding lung lobes,manifested as blue on color-coded map,while normal lung was color coded as red or yellow.Creatinine was higher by 6.7％ and 20.6％ for group 3 ml/kg and 5 ml/kg.ConclusionsWith similar X-ray attenuation characteristics as iodine,gadolinium-based contrast agent can be used to pulmonary contrast-enhanced dual energy CT imaging,simultaneously providing both CTPA and gadolinium maps to detect PE.

ObjectiveTo evaluate the image quality of displaying the pulmonary artery and pulmonary emboli at different tube voltages and find the optimal tube voltage.MethodsSixty-six patients underwent contrast-enhanced dual energy CT pulmonary angiography (CTPA) from August 2007 to February 2010.Data obtained with 80 kVp,weighted average 120 kVp,and 140 kVp were divided into group Ⅰ,Ⅱ,and Ⅲ respectively.CT value of pulmonary artery ( grade 1—4),emboli,and muscles were measured.Corresponding signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated.One-way ANOVA analysis and Friedman test were used to analyze statistical significance among these values.Image quality of CTPA from these three groups was assessed.The inter-reader agreement of image quality was performed by kappa test.ResultsCT value of branch 1 to 4 of ptlmonary artery was (446 ± 140) HU,(433±130) HU,(411 ±138) HU,and (392±127) HU in group Ⅰ,(303±91) HU,(290±85) HU,(276±86) HU,and (263 ±85) HU in group Ⅱ,and (244 ±70) HU,(230 ±63) HU,(216 ±72) HU,and (205 ±68) HU in group Ⅲ.There was significant difference for CT values (P ＜0.01) among three groups.CT value of pulmonary artery in 80 kVp images was higher than 140 kyp and 120 Kvp.On quantitative analysis of 37 patients,CNR value of pulmonary clots was 8.3 ± 3.3,8.0 ± 2.9,and 5.6 ± 2.2 in group Ⅰ,Ⅱ,and ⅢⅢ,respectively.CNR values of pulmonary clots in 80 kVp images and 120 kVp images were higher than that in 140 kVp (P ＜0.01 ).There was no statistical difference for image quality of CTPA among the three groups ( P ＞ 0.05 ).Agreement of image quality of CTPA derived from 80 kVp (kappa value =0.789,P ＜0.01 ) was superior to that of 120 kVp (kappa value =0.652,P ＜0.01 ) and 140 kVp ( kappa value = 0.509,P ＜ 0.01 ).Conclusions CT value of pulmonary artery in 80 kVp images was higher than that of weighted average 120 kVp and 140 kVp,and the image quality and CNR was comparable with that of weighted average 120 kVp images.This tube voltage ( 80 kVp) is optimal for CT pulmonary angiography in the evaluation of patients with suspected pulmonary embolism.

Objective To preliminarily investigate the effect of PBL applied in teaching of Obstetrics and Gynecology. Methods Ninety eight students were randomly divided into PBL pedagogy group and traditional pedagogy group in clinical practice teaching of dysfunctional uterine bleeding. Exam scores were assessed and opinion survey was summarized. Results The exam score was 80.7 ± 5.6 of PBL pedagogy group and 76.3 ± 4.9 of the other group respectively. There was significant difference between the scores of the two groups (P <0.05). Most students consider that PBL pedagogy was of benefit to students' ability. Conclusion PBL pedagogy has more advantages in training of clinical thinking than traditional teaching method.

Objective To evaluate monoenergetic imaging of dual energy CT in the visualization of metal fixation of factures. Methods In total, 29 patients with factures underwent 36 metal fixations,including 11 external fixations implanting in tibiofibula (n = 11 ) and 25 internal fixations (cervical spine,n=10; lumbar spine, n=4; tibiofibula, n=8; radial bone, n=3). They were recruited into this study.After dual energy CT scan, monoenergetic software was used to post-process with the following 6 photon energies: 40, 70, 100, 130, 160, 190 keV. Two radiologists evaluated and rated the reformatted images with 6 different photon energies and average weighted 120 kV images according to the following 4-score scale. Score 1: nonassessable, with marked artifact; score 2: assessable, moderate artifact; score 3: good,mild artifact, good visualization of bony structures; score 4: excellent, no artifact. Kruskal-Wallis was used to perform statistical analysis of image quality for total fixations, external and internal fixations with various selective kev settings and average weighted 120 kV. Results For total fixations, monoenergetic imaging of dual energy CT has 25 fixations with score 3 and 4, but 120 kV has only 4 fixations with score 3 and 4.Monoenergetic imaging of dual energy CT improved image quality of fractures with metal fixation compared to average weighted 120 kV images ( F = 116. 487, P ＜0. 01 ). Images of 130 kev had the best image quality for external metal fixation (9 fixations with score 3 and 4, F = 60. 902, P ＜ 0. 01), while 70 kev was best for internal metal fixation ( F = 122. 149, P ＜ 0. 01). Conclusions Monoenergetic imaging of dual energy CT improves image quality of fractures with metal fixation. Reformatted images at 70 keV and 130 keV havethe optimal image quality for internal and external metal fixation, respectively.