ObjectiveTo observe the primary tumor of tree shrews and to provide a basis for studying the pathogenesis and prevention of trichoepithelioma. MethodsA tumor was discovered in the chest and abdomen of a tree shrew during natural cultivation. The tree shrew was anesthetized, and the tumor was surgically removed. Hematoxylin and eosin (HE) staining and immunohistochemical staining were performed on the tumor tissue after paraffin section, and the tumor cells were isolated and cultured by passage. The isolated tumor cells were subcutaneously injected into healthy tree shrews and nude mice. The tumorigenesis of tumor cells in vivo was observed once a day, with nude mice continuously observed for 2 months and tree shrews observed for more than 6 months. ResultsHE staining showed that the basal cells in the dermis were arranged as a whole, like a string of petals, forming nests and stripe-like structures with clear boundaries. The observation results after magnification revealed that the tumor cells were arranged in a pallisade-like and basal pattern, with deep nuclear staining and minimal cytoplasmic. Immunohistochemical staining showed the high expression of CK protein and low proportion expression of ki-67 protein in tumor cells, as well as the high expression of vimentin and low expressions of Bcl2 and CD10 in tumor cell mesenchyme. The isolated tumor cells grew well in DMEM medium containing 10% fetal bovine serum and could be cultured by passage, but no tumor formation was observed in healthy tree shrews and nude mice inoculated with tumor cells. ConclusionCombined with the location of the tumor, overall morphology, HE staining, and immunohistochemical results, the thoracoabdominal mass of the tree shrew was diagnosed as a trichoepithelioma.

Objective:To explore the perivenous blocking management strategy for portal vein-superior mesenteric vein (PSMV) resection and reconstruction and its effect on postoperative complications in patients undergoing pancreaticoduodenectomy (PD).Methods:The data of 137 patients with pancreatic cancer treated with PD in Beijing Chaoyang Hospital Affiliated to Capital Medical University, Chaoyang Central Hospital, the Second Hospital of Chaoyang, Rizhao Central Hospital, the Second People's Hospital of Binzhou from January 2010 to December 2020 were collected. There were 83 males and 54 females with an average age of 61.8 years. There were 42 patients in the reconstruction group and 95 patients in the control group. The main intraoperative indexes and postoperative complications were compared between the two groups with the aim to review our experience in PSMV resection and reconstruction by using the perivenous blocking management strategy.Results:PD was successfully completed in 137 patients in the reconstruction group, the PSMV blocking time was 15-120 min, with a median of 30 min. The operation time 380 (330, 465) min, intraoperative blood loss 725 (500, 1000) ml, and postoperative hospital stay 21.0 (16.0, 28.0) d in the reconstruction group were significantly higher than those of control group [305 (280, 340) min, 400 (300, 500) ml and 18.0 (14.0, 24.5) d] (all P<0.05). The reoperation rate and perioperative mortality were 4.8% (2/42) and 2.4% (1/42) in the reconstruction group, while 2.1% (2/95) and 1.0% (1/95) in the control group, respectively. There was no significant difference between the two groups (both P>0.05). The incidence of pancreatic fistula, peritoneal effusion and infection, pulmonary infection of the reconstruction group was significantly higher than those of the control group ( P<0.05). There was no significant difference in the incidence of postoperative bleeding, delayed gastric emptying, biliary fistula, incision infection, reoperation between the two groups ( P>0.05). Conclusions:PSMV resection and reconstruction significantly increased the incidences of complication after PD, including pancreatic fistula, peritoneal effusion/infection and pulmonary infection. The perivenous blocking management strategy significantly promoted smooth postoperative recovery and effectively reduced morbidity rates of postoperative bleeding and mortality after PSMV resection and reconstruction in PD.

Objective:To evaluate the application of multiparametric MRI (mpMRI)-transrectal ultrasound (TRUS) fusion guided biopsy in the diagnosis of clinical significant prostate cancer (PCa).Methods:A prospective analysis was performed in 168 patients with suspected PCa from September 2015 to June 2017 in the First Affiliated Hospital of Soochow University. Suspicious areas on mpMRl were defined and graded using prostate imaging reporting and data system version 2 (PI-RADS V2) score. All the patients had the TRUS-guided systematic biopsy, 108 patients with PI-RAD V2 scores ≥ 3 had additional MRI-TRUS targeted biopsies. Taking pathologic results as golden standard, the detection rates were compared between the 2 methods using χ 2 test. Results:Initially, all of the 168 patients underwent TRUS biopsy. PCa was detected in 86 (101 niduses) of 168 patients (51.19%, 86/168), 82 (91 niduses) (48.81%, 82/168) were not prostate cancer. Seventy eight (46.43%, 78/168) cases of PCa were detected by TRUS biopsy, and 63 (58.33%, 63/168) cases of PCa were detected by MRI-TRUS fusion guided biopsy, the difference was statistically significant between TRUS biopsy and MRI-TRUS fusion guided biopsy (χ 2=3.73, P=0.035). The 168 patients were biopsied with a total of 2 300 cores, including TRUS biopsy 2 016 cores and MRI-TRUS fusion targeted biopsy 284 cores. Additionally, the detection rate for per cores for MRI-TRUS fusion targeted biopsy (51.76%, 147/284) was significantly higher than that for TRUS biopsy cores (19.64%, 396/2 016) (χ 2=142.38, P<0.05). Among patients with a positive biopsy for PCa, the biopsy cores for conventional TRUS biopsy was 1 032 comparing to 214 cores for MRI-TRUS biopsy. The suspicious MRI-TRUS fusion targeted biopsy (68.69%, 147/214) detected more PCa compared with TRUS biopsy (38.37%, 396/1 032) (χ 2=66.27, P<0.05). Among patients with a positive biopsy for PCa, MRI-TRUS fusion targeted biopsy [69.74% (106/152)] detected more significant cancer cores than TRUS biopsy [54.50% (351/644) ] (χ 2=11.67, P<0.05). Conclusion:MRI-TRUS fusion biopsy combined with PI-RADS V2 increases positive rate markedly and improves the detection rate of clinical significant PCa.

Objective:To explore the effect of type D personality and perceived control on experiential avoidance in patients with coronary heart disease (CHD) , so as to provide a basis for reducing their experiential avoidance.Methods:From December 2018 to August 2019, a total of 365 patients with CHD who were admitted and treated in a ClassⅢ Grade A hospital in Anhui Province were selected as research objects by convenient sampling method. Type D Personality Scale-14 (DS-14) , Control Attitudes Scale-Revised (CAS-R) , Acceptance and Action Questionnaire 2nd Edition (AAQ-Ⅱ) were used to investigate those patients.Results:Among the 365 patients with coronary heart disease, 128 were type D personality, accounting for 35.1%. The score of CAS-R was (25.18±5.73) and that of AAQ-Ⅱ was (21.61±5.99) . Multiple linear regression showed that the negative emotions and social inhibition of type D personality, perceived control and residences had predictive effects on experiential avoidance in patients with CHD, and the joint explanation variation was 47.0%.Conclusions:The experiential avoidance of patients with CHD needs to be improved. Clinical nurses should actively assess whether patients with CHD have type D personality and help patients improve their perceived control so as to reduce their experiential avoidance.

Objective: To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer. Methods: A total of 55 patients who were undergoing preoperative muti-parameters MRI of T₂WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI-transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo-diffusivity (D^*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t-test was used to compare the differences in lesion parameters between prostate cancer and BPH, low-risk (BPH+Gleason score 6 points) and medium-high-risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis. Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low-risk or high-risk. Results: 27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia (BPH) in PZ were included, meanwhile, the cases of GS ≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa-BHP group and high-low risk group in TZ (P<0.05), D^* and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were -0.585 and -0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS ≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05). Conclusions IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid-higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.

Objective To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer. Methods A total of 55 patients who were undergoing preoperative muti?parameters MRI of T2WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI?transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo?diffusivity (D*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t?test was used to compare the differences in lesion parameters between prostate cancer and BPH, low?risk (BPH+Gleason score 6 points) and medium?high?risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis.Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low?risk or high?risk. Results 27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia(BPH) in PZ were included, meanwhile, the cases of GS≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa?BHP group and high?low risk group in TZ (P<0.05), D*and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were－0.585 and－0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05). Conclusions IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid?higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.

Objective To explore the clinical features,the risk factors of mortality and drug resistance of the isolates in patients with group B streptococcus (GBS) meningitis.Methods A retrospective analysis was performed in 96 children with GBS meningitis (46 males and 50 females) at Beijing Children's Hospital Affiliated to Capital Medical University from January 2013 to October 2017.The clinical characteristics,prognosis and drug resistance were reviewed and analyzed.According to the onset time,the patients were divided into early onset disease (EOD,0-6 days),late onset disease (LOD,7-89 days) and very late onset disease (VLOD,90 days-16 years),the clinical features were compared.According to the results of cranial imaging examination,the patients were divided into two groups:those with neurological complications and those without neurological complications.The influencing factors of neurological complications were analyzed.According to the outcome of 28 days after discharge,patients were divided into death group and survival group.The risk factors of mortality were analyzed by multivariate Logistic regression analysis.Non-numeric variables were analyzed with x2 test or Fisher's exact test.Numeric variable between groups were compared with nonparametric test.Results A total of 96 patients were enrolled,including 18 (19％) EOD,71 (74％) LOD and 7 (7％) VLOD cases.The median age of EOD cases was 2 days,with a range from 0 to 6 days.The median age of LOD cases was 31 days,with a range from 7 to 81 days.The median age of VLOD cases was 153 days,with a range from 95 to 214 days.Before the onset of the disease,the mother had mastitis in 6 cases and premature rupture of membranes in 6 cases.The common clinical manifestations of patients were fever (95％,91/96),anorexia (65％,62/96),seizure (56％,54/96),and consciousness changes (36％,35/96).The differences were statistically significant in gender (13/18 vs.28/71 vs.5/7,x2=7.705,P=0.024),the number of cases who was admitted to intensive care unit (ICU) (5/18 vs.31/71 vs.0,x2=6.065,P=0.042) and peripheral blood leukocyte (12(4,18)× 109/L vs.6(3,11)×109/L vs.13(6,17)× 109/L,H=9.885,P=0.007) in EOD group,LOD group and VLOD group.Cranial imaging was performed in 94 patients,60 patients (64％) developed neurological complications,including subdural effusion (31/94,33％),followed by intracranial hemorrhage (26/94,28％),cerebral softening (19/94,20％),cerebral atrophy (15/94,16％),ependinitis (8/94,9％) and hydrocephalus (4/94,4％).By univariate x2 test analysis,seizure (63％ (38/60) vs.41％ (14/34),x2=4.310,P=0.038) was a risk factor of neurological complications.Within 28 days after discharge,88 patients survived and 8 patients died,with a fatality rate of 8％.The independent risk factors for the death were septic shock (OR:9.548,95％ CI 1.439-63.356,P=0.019) and respiratory failure (OR:7.053,95％ CI 1.160-42.888,P=0.034).All of isolates were susceptible to penicillin (68/68),ceftriaxone (47/47),cefepime (50/50),vancomycin (60/60) and linezolid (54/54),while the rates of resistance to tetracycline,levofloxacin,clindamycin and erythromycin were 5/12,17/45,38/46 and 32/37,respectively.Conclusions The main type of GBS meningitis is late onset cases.The incidence of neurological complications was high.The independent risk factors for death were septic shock and respiratory failure.The strains were severely resistant to clindamycin and erythromycin.

Objective To investigatethe current condition and correlation of metacognitive abilities and professional values in undergraduate nursing students, and analyze the influence of metacognitive ability on professional values. Methods Totally 310 undergraduate nursing students from a medical university during October to December 2017 were selected by convenience sampling method. All the students were investigated with general information questionnaire, Metacognitive Ability Scale and College Students' Occupational Values Scale. Pearson correlation analysis was used to analyze the correlation between metacognitive ability and professional values of undergraduate nursing students, and stratified regression analysis was used to analyze the influencing factors of professional values of undergraduate nursing students. A total of 310 questionnaires were distributed and 300 valid questionnaires were collected. Results The total score of metacognitive ability in undergraduate nursing students was (74.97±10.20), and the total score of professional values in undergraduate nursing students was (123.32±14.51). Undergraduate nursing students' metacognitive ability dimensions were positively correlated with professional values (P＜ 0.01). The metacognitive ability of undergraduate nursing students has a significant predictive effect on their occupational values (P＜ 0.01). Conclusions The metacognitive ability and professional values of undergraduate nursing students need to be improved, and their metacognitive ability can significantly affect their professional values. Nursing educators can promote the improvement of their professional values through cultivating the metacognitive ability of undergraduate nursing students.

Heterotopic pancreas is usually defined as a presence of pancreatic tissue without any anatomical or vascular continuity,and is one of the congenital and rare diseases.The clinical manifestations are easily confused with other gastrointestinal diseases,and conventional endoscopic examination cannot provide a clear preoperative diagnosis,therefore heterotopic pancreas is often misdiagnosed.It is very important to distinguish heterotopic pancreas and other digestive diseases.In this article,the clinical characteristics,differential diagnosis and treatment method of one patient with heterotopic pancreas who was admitted to the Affiliated Hospital of Chengde Medical College in March 2014 were analyzed.

Objective To investigate the role of NMDA receptors in central medial thalamus (CMT) in the unconscious?ness induced by general anesthesia. Methods A total of 60 rat models for microinfusion were assigned into 4 groups (n=15 for each group). After induction with propofol, 10 mmol/L (NMDA10 group), 20 mmol/L (NMDA 20 group) and 40 mmol/L (NMDA40 group) of NMDA and normal saline (group C) with equal volume were microinfused into CMT. The incidence of purposeful movement and recovery time of righting reflex were observed in each group respectively. Infusion sites were local?ized by histological method. Results When the microinfusion site localized within CMT, comparing with group C, the recov?ery time of righting reflex reduced notably in three NMDA groups (P<0.05). The recovery time was significantly shorter in NMDA20 group and NMDA40 group than that of NMDA10 group. The incidence of purposeful movement during propofol an?esthesia was higher in NMDA20 group and NMDA40 group than that of group C (P<0.05). When the microinfusion site lo?calized out of CMT, the recovery time of righting reflex was remarkably longer than that within CMT in three NMDA groups (P<0.05), and there was no significant difference in the incidence of purposeful movement and recovery time between four group (P>0.05). Conclusion Microinfusion of NMDA agonist into CMT reverses propofol anesthesia, indicating that NMDA receptor in CMT may contribute to the propofol-induced unconsciousness.