Objective To investigate the value of multi-slice spiral computed tomography (MSCT) features, along with the expression levels of epidermal growth factor receptor (EGFR) and insulin-like growth factor 1 receptor (IGF1R), in differential diagnosis of benign and malignant adrenal cortical tumors. Methods A total of 98 patients with adrenal cortical tumors admitted to Zibo Municipal Central Hospital from January 2020 to July 2024 were included in this study. All subjects underwent MSCT scans of the adrenal gland. The CT values of tumor parenchyma on plain scans and at arterial and venous phases were estimated. The surgical tumor specimens were collected for immunohistochemical staining and measurement of EGFR and IGF1R expression. The MSCT features and EGFR and IGF1R expression levels were compared among patients with different pathological types of adrenal cortical tumors. Results Of the 98 patients with adrenal cortical tumors, there were 18 cases with cortical carcinoma, 10 cases with metastatic tumors, 31 cases with pheochromocytoma, 25 cases with aldosterone-producing adenomas, and 14 cases with cortisol adenomas. The CT values of adrenal aldosterone-producing adenomas were significantly lower than other pathological types of adrenal cortical tumors on plain scans and at arterial and venous phases (P < 0.05). The CT values of metastatic tumors and cortical carcinoma were significantly lower than those of pheochromocytoma and cortisol adenomas at arterial and venous phases (P < 0.05). Specifically, at arterial and venous phases, the CT values of metastatic tumors were lower than those of cortical carcinoma, and the CT values of cortisol adenomas were lower than those of pheochromocytoma (P < 0.05). The positive expression levels of EGFR and IGF1R were higher in tumor specimens from patients with metastatic tumors and cortical carcinomas than from pheochromocytoma, aldosterone-producing adenomas, and cortisol adenomas (P < 0.05). There were no significant differences between patients with metastatic tumors and cortical carcinomas in terms of positive EGFR and IGF1R expression (P > 0.05). In addition, there were no significant differences in the proportions of positive EGFR and IGF1R expression among patients with malignant adrenal cortical tumors in terms of ages, genders, tumor sizes, and TNM stages (P > 0.05). Conclusion The CT values of MSCT scans at arterial and venous phases as well as EGFR and IGF1R expression levels correlate with the pathological types of adrenal cortical tumors.

Objective:To explore the factors leading to communication disorders in ICU patients during mechanical ventilation from the perspective of both patients and medical staff, and to use the theoretical framework of acceptability to identify the barriers that can be improved by intervention.Methods:Using the method of descriptive phenomenology from July to August 2022, 11 patients with mechanical ventilation and 8 medical staff in the comprehensive ICU of a Yuhuangding Hospital in Yantai were selected for interviews by the purpose sampling method, combined with participatory observation. The interviews of patients were conducted off ventilator. With Nvivo12.0 Plus software, the seven-step analysis method of Colaizzi phenomenology was adopted to summarize the theme and the theoretical framework of acceptability was used to identify the obstacle factors that could be improved by intervention.Results:The age of 11 patients was 18-46 years old, the duration of mechanical ventilation was 9.5-312.3 h. The age of 8 medical staff was 26-54 years old, the length of service in ICU was 2-30 years. A total of 14 themes were extracted. For patients: defensive mood, difficulty in presenting information, introverted personality, communication tools are hard to use, emergency treatment conflict, deny the ability to communicate, thought slowness. For medical staff: defensive mood, cognitive load, high time cost, lack of humane communication strategies, poor training, other priorities, loss of confidence in effective communication, awareness of the importance of communication was not enough.Conclusions:There are many factors that can be improved for patients with mechanical ventilation in ICU. It is suggested to speed up the research and development of high-tech and personalized alternative communication tools in China, reduce negative communication between doctors and patients and nurses and patients, and implement evidence-based multi-mode and progressive communication intervention strategies.

Objective To explore the changes in serum energy metabolites in patients with peripheral T-cell lymphoma,and investigate serum biomarkers for monitoring peripheral T-cell lymphoma from the perspective of energy metabolism.Methods Multiple/selected reaction monitoring(MRM/SRM)was used to detect the energy-related metabolites in the sera of 16 patients with newly diagnosed peripheral T-cell lymphoma admitted in the Hematology Medical Center of the Second Affiliated Hospital of Army Medical University from November 2020 to December 2021,as well as 10 recruited healthy volunteers.The corresponding clinical data including medical history,laboratory results and image data were collected and retrospectively analyzed.Results Significant differences were seen in the contents and expression profiles of serum energy metabolism-related products between the patients and the healthy volunteers.The patients had significantly reduced serum contents of cyclic AMP,succinate,citrate and cis-aconitate(P＜0.05),and elevated D-glucose 6-phosphate content(P＜0.05).The serum contents of citrate and succinate were negatively correlated with the risk stratification(low-,moderate-and high-risk)and clinical stage of the disease(P＜0.05).Meanwhile,there was a negative correlation between the contents of L-malic acid and citrate and the mid-term efficacy evaluation results,such as complete/partial response(CR/PR)or stable disease(SD)(P＜0.05).For patients with extranodal NK/T cell lymphoma(n=10),there were also significant reductions in the contents of cyclic AMP,succinate,citrate,isocitrate and cis-aconitate in the sera of patients compared with healthy volunteers(P＜0.05),and the contents of citrate and succinate were negatively correlated with the clinical stage(P＜0.05)and were rather correlated with mid-term efficacy evaluation results(CR/PR or SD)(P＜0.05).For patients with angioimmunoblastic T-cell lymphoma(n=6),the serum contents of cyclic AMP,citrate and succinate were significantly lower,while the content of D-glucose 6-phosphate was higher when compared with the healthy volunteers(P＜0.05),and the content of succinate was negatively correlated with both clinical stage and risk grade of the patients(P＜0.05).Conclusion There are 5 serum differential metabolites identified between patients with peripheral T-cell lymphoma and healthy controls,and succinate and citrate are expected to be serum biomarkers of peripheral T-cell lymphoma.

Objective To explore the effect of ligustrazine on the learning and memory function of rats with aluminum-induced cognitive impairment and its mechanism.Methods Sixty male Wistar rats were divided into a blank control group,a model group,a low-dose ligustrazine group,a high-dose ligustrazine group,and a piracetam group using a random number table method,with 12 rats in each group.The rats in the blank control group were not subjected to any treatment;the rats in the model group,low-dose ligustrazine group,high-dose ligustrazine group,and piracetam group were first prepared with aluminum toxicity models by daily gavage of 100 mg·kg-1 AlCl3 solution.After successful modeling,the rats in the piracetam group were intragastrically administered with piracetam at a dose of 400 mg·kg-1,while rats in the low-dose and high-dose ligustrazine groups were intragastrically administered with 100 and 200 mg·kg-1 ligustrazine,respectively;the rats in the blank control group and the model group were intragastrically administered with the same volume of physiological saline.All rats in the five groups received intragas tric administration once a day for 30 consecutive days.After 30 days of intervention,the Morris water maze test was used to evaluate the learning and memory function of rats in the five groups.After completing the water maze experiment,rats in the five groups were anesthetized with 200 g·L-1 chloral hydrate,and their brain tissues were quickly removed after decapitation.Immunohistochemical staining was used to observe the expression of calcium voltage-gated channel subunit alpha 1E(CACNA1E),calmodulin(CALM),and brain-derived neurotrophic factor(BDNF)in the hippocampal CA1 region of rats in the five groups;Western blot was used to detect the relative expression levels of CACNA1E,CALM,and BDNF proteins in the hippocampal CA1 region of rats in the five groups;and real-time fluorescence quantitative polymerase chain reaction was used to detect the relative expression levels of CACNA1E,CALM,and BDNF mRNA in the hippocampal CA1 region of rats in the five groups.Results On the 1st day of the Morris water maze test,the latent periods of rats in the model group,piracetam group,low-dose ligustrazine group,and high-dose ligustrazine group were significantly higher than those in the blank control group(P＜0.05);there was no statistically significant difference in the latent periods of rats among the piracetam group,low-dose ligustrazine group,high-dose ligustrazine group,and model group(P＞0.05).On the 3rd day of the Morris water maze test,the latent periods of rats in the model group,piracetam group,low-dose ligustrazine group,and high-dose ligustrazine group were significantly higher than those in the blank control group(P＜0.05);the latent periods of rats in the piracetam group and high-dose ligustrazine group were significantly lower than those in the model group and low-dose ligustrazine group(P＜0.05);there was no statistically significant difference in the latent periods of rats between the low-dose ligustrazine group and the model group(P＞0.05).On the 5th day of the Morris water maze test,the latent periods of rats in the model group,piracetam group,low-dose ligustrazine group,and high-dose ligustrazine group were significantly higher than those in the blank control group(P＜0.05);the latent periods of rats in the piracetam group and high-dose ligustrazine group were significantly lower than those in the model group and low-dose ligustrazine group(P＜0.05);there was no statistically significant difference in the latent periods of rats between the low-dose ligustrazine group and the model group(P＞0.05).On the 3rd and 5th days of the Morris water maze test,there was no statistically significant difference in the latent periods of rats between the piracetam group and the high-dose ligustrazine group(P＞0.05).The times of rats crossing platform in the model group,piracetam group,low-dose ligustrazine group,and high-dose ligustrazine group were significantly lower than those in the blank control group,and the times of rats crossing platform in the piracetam group and high-dose ligustrazine group were significantly higher than those in the model group and low-dose ligustrazine group(P＜0.05);there was no statistically significant difference in the times of rats crossing platform between the low-dose ligustrazine group and the model group(P＞0.05);there was no statistically significant difference in the times of rats crossing platform between the piracetam group and the high-dose ligustrazine group(P＞0.05).Under the microscope,brown CACNA1E,CALM,and BDNF positive cells could be observed in the hippocampal CA1 region.The expressions of CACNA1E,CALM,and BDNF proteins in the hippocampal CA1 region of rats in the model group,piracetam group,low-dose ligustrazine group,and high-dose ligustrazine group were significantly lower than those in the blank control group,and the expressions of CACNA1E,CALM,and BDNF proteins in the hippocampal CAl region of rats in the piracetam group and high-dose ligustrazine group were significantly higher than those in the model group and low-dose ligustrazine group(P＜0.05);there was no statistically significant difference in the expressions of CACNA1E,CALM,and BDNF proteins in the hippocampal CAI region of rats between the low-dose ligustrazine group and the model group(P＞0.05);there was no statistically significant difference in the expressions of CACNA1E,CALM,and BDNF proteins in the hippocampal CA1 region of rats between the piracetam group and the high-dose ligustrazine group(P＞0.05).The relative expression levels of CACNA1E,CALM,and BDNF proteins and mRNAs in the hippocampal CA1 region of rats in the model group,piracetam group,low-dose ligustrazine group,and high-dose ligustrazine group were significantly lower than those in the blank control group(P＜0.05);the relative expression levels of CACNA1E,CALM,and BDNF proteins and mRNAs in the hippocampal CA1 region of rats in the piracetam group and high-dose ligustrazine group were significantly higher than those in the model group and low-dose ligustrazine group(P＜0.05);there was no statistically significant difference in the relative expression levels of CACNA1E,CALM,and BDNF proteins and mRNAs in the hippocampal CA1 region of rats between the low-dose ligustrazine group and the model group(P＞0.05);there was no statistically significant difference in the relative expression levels of CACNA1E,CALM,and BDNF proteins and mRNAs in the hippocampal CA1 region of rats between the piracetam group and the high-dose ligustrazine group(P＞0.05).Conclusion Ligustrazine has significant protective effects on aluminum-induced cognitive impairment in rats and can greatly enhance the learning and memory function of rats.The mechanism may be related to the up-regulation of CANA1E,CALM and BDNF expression in the brain induced by ligustrazine.

Objective:At present,the doctor-patient relationship is tense.The prevalence of negative emotions,such as depression and anxiety,among healthcare workers is increasing every year.Negative attitudes of medical workers toward mental problems may aggravate the doctor-patient conflict and psychological problems of medical workers.This study aims to explore the complex network relationships between outpatient medical workers'attitudes toward mental problems,doctor-patient relationships,and their depression/anxiety levels. Methods:A total of 578 outpatient medical staff from the Second Xiangya Hospital of Central South University(167 males,411 females)completed questionnaires on their attitudes toward mental problems,doctor-patient relationships,and depression/anxiety symptoms.Network analysis was conducted separately to construct the"attitude towards mental problems-doctor-patient relationship network"and"depression-anxiety related network". Results:The edge between"M15(insulting words)"and"D8(waste time)"showed the strongest strength in the"attitude towards mental problems-doctor-patient relationship network",and"M15(insulting words)"had the highest bridge strength in the network.For the analysis of emotional variables,"P1(anhedonia)"showed the most obvious association with"D10(communication difficulties)"in the doctor-patient relationship and"M2(poor quality of life)"in the psychiatric attitudes,and"P1(anhedonia)"was the key bridge symptom in the network. Conclusion:The"insulting words"may be an intervention target for medical workers'attitudes toward mental problems.The"anhedonia"in depression is the potential symptom that needs to be treated.Intervention targeting these variables may be beneficial to improve the mental health level of medical workers and the doctor-patient relationship.

Objective To explore the application effect of modified installing method of high flexion rotating platform prosthesis trial model in double compartment knee arthroplasty.Methods A total of 20 patients(26 knees)with severe knee osteoarthritis admitted to Hebi People's Hospital from January 2021 to April 2022 and required double compartment knee arthroplasty were selected as the research subjects.Patients were divided into the control group(10 knees)and the observation group(16 knees)based on the installing method of high flexion rotating platform prosthesis trial model.The patients in the control group used the conventional installing method of high flexion rotating platform prosthesis test model(placing the tibial side test model,the femoral side test model and finally the pad test model),while patients in the observation group used the modified installing method of high flexion rotating platform prosthesis test model(matching the femoral test model,pad and tibial test model when the patient flexed 60° to 90°,and placing them together into the knee joint osteotomy groove).The intraoperative bleeding volume and surgical time of patients in the two groups were recorded.Before surgery,2 weeks after surgery and 18 months after surgery,the knee joint function of patients was evaluated by the American hospital for special surgery(HSS)scoring system,and the range of motion(ROM)of knee joint of patients was measured by protractor.Results The intraopera-tive bleeding volume of patients in the observation group was significantly less than that in the control group,and the surgical time was significantly shorter than that in the control group(P＜0.05).There was no statistically significant difference in preoperative HSS score and ROM of knee joint of patients between the two groups(P＞0.05).At 2 weeks and 18 months after surgery,the HSS score and ROM of knee joint of patients in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Compared with the conventional installing method of high flexion rotating platform prosthesis trial method,the modified installing method of high flexion rotating platform prosthesis trial model in double compart-ment knee arthroplasty for patients with severe knee osteoarthritis can effectively improve surgical efficiency,reduce intraopera-tive bleeding,improve knee function and increase ROM of knee joint.

OBJECTIVES: Firefighters are prone to suffer from psychological trauma and post-traumatic stress disorder (PTSD) in the workplace, and have a poor prognosis after PTSD. Reliable models for predicting PTSD allow for effective identification and intervention for patients with early PTSD. By collecting the psychological traits, psychological states and work situations of firefighters, this study aims to develop a machine learning algorithm with the aim of effectively and accurately identifying the onset of PTSD in firefighters, as well as detecting some important predictors of PTSD onset. METHODS: This study conducted a cross-sectional survey through convenient sampling of firefighters from 20 fire brigades in Changsha, which were evenly distributed across 6 districts and Changsha County, with a total of 628 firefighters. We used the synthetic minority oversampling technique (SMOTE) to process data sets and used grid search to finish the parameter tuning. The predictive capability of several commonly used machine learning models was compared by 5-fold cross-validation and using the area under the receiver operating characteristic curve (ROC-AUC), accuracy, precision, recall, and F1 score. RESULTS: The random forest model achieved good performance in predicting PTSD with an average AUC score at 0.790. The mean accuracy of the model was 90.1%, with an F1 score of 0.945. The three most important predictors were perseverance, forced thinking, and reflective deep thinking, with weights of 0.165, 0.158, and 0.152, respectively. The next most important predictors were employment time, psychological power, and optimism. CONCLUSIONS PTSD onset prediction model for Changsha firefighters constructed by random forest has strong predictive ability, and both psychological characteristics and work situation can be used as predictors of PTSD onset risk for firefighters. In the next step of the study, validation using other large datasets is needed to ensure that the predictive models can be used in clinical setting.
Humans ; Stress Disorders, Post-Traumatic/diagnosis* ; Firefighters/psychology* ; Cross-Sectional Studies ; Algorithms ; Machine Learning

【Objective】 To determine the reference range of thromboelastogram(TEG) and establish a TEG feature for local population by measuring TEG parameters in healthy adults in Shenzhen comparing the difference between gender and age, and analyzing the reference data provided by reagent manufacturer. 【Methods】 A total of 916 healthy adults, aged between 19 to 59, who did their regular health checks in our hospital from September 2020 to August 2021 were selected. The TEG(from Lepu Medical Technology Co., Ltd.) was performed, and the clot reaction time(R), clot formation time(K), coagulation angle(α-Angle), maximum amplitude(MA), coagulation index(CI), fibrinolysis index LY30 and the estimated percent lysis (EPL) were analyzed. 【Results】 The reference ranges of TEG parameters, including R, K, α-Angle, MA, CI, LY30 and EPL, of 916 healthy adults from Shenzhen were 3.25~8.19 min, 0.66~3.18min, 47.70~76.56deg, 50.05~72.91mm, -4.3~3.4, 0~2.2% and 0~3%, respectively. The value of α-Angle, CI, K, LY30, MA and R didn’t all meet the given range provided by the manufacturer; some were exceeding and some inferior to. A total of 227 out of 916 individuals presented abnormal results, relative to the references, in at least one parameter, and 78 were diagnosed of abnormal coagulation based on the given reference range, with a specificity of 75.2%. 【Conclusion】 The reference range of TEG parameters of Shenzhen locals is significantly different from that provided by manufacturers. And it is imperative for local TEG laboratories to establish their own reference ranges according to age and gender groups based on local population characteristics.

To investigate the effect of electroacupuncture on motor function in hemiplegic patients with spasticity after stroke. Methods 80 patients with Hemiplegia spasticity after stroke were selected and randomly divided into treatment group （n=40） and control group （n=40）. All the patients used the same rehabilitation training. The treatment group used Hemiplegia side electroacupuncture therapy. The control group used traditional acupuncture therapy. Before treatment and 8 weeks after treatment，the degree of spasticity was evaluated with the improved Ashworth scale，the simplified FuglMeyer motor function scale （FMA） and the modified Barthel index （MBI） were used to assess motor function and activities of daily living （ADL）. Results Before treatment there were no significant difference between the two groups （P>0.05）. After 8 weeks of treatment，the FMA，MBI and mproved Ashworth scale of patients in each group were significantly improved （P<0.01）and （P<0.05）respectively. The improved Ashworth scale，FMA and MBI in the treatment group were better than those in the Control Group （P<0.05）. Conclusion Electroacupuncture therapy combined with rehabilitation training on Hemiplegic side is helpful to relieve spasticity and improve the motor function and daily living ability of the patients. The effect is better than traditional acupuncture treament bombined with rehabilitation training.

OBJECTIVE：To esta blish a UPLC fingerprint of Pyrrosia petiolosa from southwest China ，and to determine the contents of 4 kinds of phenolic acids （neochlorogenic acid ，caffeic acid ，chlorogenic acid and cryptochlorogenic acid ）. METHODS：The determination was performed on Waters Cortecs T 3 C18 column（100 mm×2.1 mm，1.6 μm）with mobile phase consisted of methanol- 0.1％ phosphoric acid （gradient elution ）at the flow rate of 0.35 mL/min. The detection wavelength was set at 326 nm. The column temperature was 30 ℃，and injection volume was 1 μL. UPLC method was used to establish the UPLC fingerprint of P. petiolosa in combination with the Similarity Evaluation System of TCM Chromatographic Fingerprints （2012 edition）. Cluster analysis and principle component analysis （PCA）were performed by using SPSS 20.0 software. The contents of 4 kinds of phenolic acids in 20 batches of P. petiolosa were determined by external standard method. RESULTS ：There were 9 common peaks for the UPLC fingerprint of P. petiolosa . Peaks 1，3，4，5 and 9 were identified as neochlorogenic acid ，caffeic acid，chlorogenic acid ，cryptochlorogenic acid and isochlorogenic acid C ，respectively. RSDs of the relative retention time of each peak in different batches of P. petiolosa were 0-0.68％，and the RSDs of the relative peak area were 0-62.35％. The similarities between the fingerprint of 20 batches of medicinal materials and the control chromatogram were not less than 0.990. The result of cluster analysis showed that P. petiolosa from different regions could be sorted into three species. Results of PCA showed the differences among P. petiolosa from different regions. The linear range of neochlorogenic acid ，caffeic acid ，chlorogenic acid and cryptochlorogenic acid were 0.61-61.41，0.18-17.60，2.00-200.11，0.62-61.51 μ g/mL （R2＞0.999 9）. RSDs of precision ， reproducibility and stability tests were all lower than 2.00％. The recoveries were 96.23％-98.17％（RSD＝0.96％-2.28％， n＝6）. Among 20 batches of samples ，the contents of above 4 kinds of phenolic acids were 0.385 3-1.891 9，0.018 0-0.129 5，2.569 5-10.676 0，0.563.5-1.860 5 mg/g. CONCLUSIONS ： The established UPL C fingerprint could reflect the main chemical constituents of P. pedunculata . Phenolic acids could be used as the main evaluation indexes for the quality of P. petiolosa . The quality order of P. petiolosa from southwest China was Chongqing product＞Sichuan product ＞Guizhou product.