Enhancing competency of clinical research nurses:A comprehensive training and evaluation framework

The Sun et al's training program for clinical research nurses(CRNs)in the World Journal of Clinical Cases is a comprehensive and scientific approach.It includes structured frameworks for CRN training,aiming to improve CRN competency.This program emphasizes practical abilities,updates training content,and improves evaluation methods.The cultivation of CRN talents focuses on enhancing the training system,establishing a multifaceted evaluation framework,and continuously refining the training programs.Regular feedback and evalua-tion are essential to improve CRNs'competency in practical settings.

Nomogram to predict severe retinopathy of prematurity in Southeast China

AIM:To define the predictive factors of severe retinopathy of prematurity(ROP)and develop a nomogram for predicting severe ROP in southeast China.METHODS:Totally 554 infants diagnosed with ROP hospitalized in the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University and hospitalized in Taizhou Women and Children’s Hospital were included.Clinical data and 43 candidate predictive factors of ROP infants were collected retrospectively.Logistic regression model was used to identify predictive factors of severe ROP and to propose a nomogram for individual risk prediction,which was compared with WINROP model and Digirop-Birth model.RESULTS:Infants from the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University(n=478)were randomly allocated into training(n=402)and internal validation group(n=76).Infants from Taizhou Women and Children’s Hospital were set as external validation group(n=76).Severe ROP were found in 52 of 402 infants,12 of 76 infants,and 7 of 76 infants in training group,internal validation group,and external validation group,respectively.Birth weight[odds ratio(OR),0.997;95%confidence interval(CI),0.996-0.999;P<0.001],multiple births(OR,1.885;95%CI,1.013-3.506;P=0.045),and non-invasive ventilation(OR,0.288;95%CI,0.146-0.570;P<0.001)were identified as predictive factors for the prediction of severe ROP,by univariate analysis and multivariate analysis.For predicting severe ROP based on the internal validation group,the areas under receiver operating characteristic curve(AUC)was 78.1(95%CI,64.2-92.0)for the nomogram,32.9(95%CI,15.3-50.5)for WINROP model,70.2(95%CI,55.8-84.6)for Digirop-Birth model.In external validation group,AUC of the nomogram was also higher than that of WINROP model and Digirop-Birth model(80.2 versus 51.1 and 63.4).The decision curve analysis of the nomogram demonstrated better clinical efficacy than that of WINROP model and Digirop-Birth model.The calibration curves demonstrated a good consistency between the actual severe ROP incidence and the predicted probability.CONCLUSION:Birth weight,multiple births,and noninvasive ventilation are independent predictors of severe ROP.The nomogram has a good ability to predict severe ROP and performed well on internal validation and external validation in southeast China.

Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer:Results from 24 hospitals in China

BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients with T1b GBC.METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China.The logrank test and Cox proportional hazards model were used to compare the overall survival(OS)of patients who underwent cholecystectomy(Ch)+RL and those who underwent Ch only.To investigate whether combined hepatectomy(Hep)improved OS in T1b patients,we studied patients who underwent Ch+RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTS Of the 121 patients(aged 61.9±10.1 years),77(63.6%)underwent Ch+RL,and 44(36.4%)underwent Ch only.Seven(9.1%)patients in the Ch+RL group had lymph node metastasis.The 5-year OS rate was significantly higher in the Ch+RL group than in the Ch group(76.3%vs 56.8%,P=0.036).Multivariate analysis showed that Ch+RL was significantly associated with improved OS(hazard ratio:0.51;95%confidence interval:0.26-0.99).Among the 77 patients who underwent Ch+RL,no survival improvement was found in patients who underwent combined Hep(5-year OS rate:79.5%for combined Hep and 76.1%for no Hep;P=0.50).CONCLUSION T1b GBC patients who underwent Ch+RL had a better prognosis than those who underwent Ch.Hep+Ch showed no improvement in prognosis in T1b GBC patients.Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines,RL was only performed in 63.6%of T1b GBC patients.Routine Ch+RL should be advised in T1b GBC.

Precore/basal core promoter mutants quantification throughout phases of hepatitis B virus infection by Simpleprobe

AIM:To investigate precore/basal core promoter(PC/BCP) mutants throughout hepatitis B virus(HBV) infection and to determine their relationship to hepatitis B early antigen(HBeA g) titers.METHODS:We enrolled 191 patients in various stages of HBV infection at the Huashan Hospital and the Taizhou Municipal Hospital from 2010 to 2012.None of the patients received antiviral therapy.HBV DNA from serum,was quantified by real-time PCR.The HBV genotype was determined by direct sequencing of the S gene.We used the Simpleprobe ultrasensitivequantitative method to detect PC/BCP mutants in each patient.We compared the strain number,percentage,and the changes in PC/BCP mutants in different phases,and analyzed the relationship between PC/BCP mutants and HBe Ag by multiple linear regression and logistic regression.RESULTS:Patients with HBV infection(n = 191) were assigned to groups by phase:Immune tolerance(IT) = 55,Immune clearance(IC) = 67,Low-replicative(LR) = 49,and HBeA g-negative hepatitis(ENH) = 20.Of the patients(male,112; female,79) enrolled,122 were HBe Ag-positive and 69 were HBe Ag-negative.The median age was 33 years(range:18-78 years).PC and BCP mutation detection rates were 84.82%(162/191) and 96.86%(185/191),respectively.In five HBe Ag-negative cases,we detected double mutation G1896A/G1899 A.The logarithm value of PC mutant quantities(log10 PC) significantly differed in IT,IC,and LR phases,as well as in the ENH phase(F = 49.350,P < 0.001).The logarithm value of BCP mutant quantities(log10 BCP) also differed during the four phases(F = 25.530,P < 0.001).Log10 PC and log10 BCP values were high in the IT and IC phases,decreased in the LR phase,and increased in the ENH phase,although the absolute value at this point remained lower than that in the IT and IC phases.PC mutant quantity per total viral load(PC%) and BCP mutant quantity per total viral load(BCP%) differed between phases(F = 20.040,P < 0.001; F = 10.830,P < 0.001),with PC% and BCP% gradually increasing in successive phases.HBeA g titers negatively correlated with PC%(Spearman's rho =-0.354,P < 0.001) and BCP%(Spearman's rho =-0.395,P < 0.001).The negative correlation between PC% and HBeA g status was significant(B =-5.281,P = 0.001),but there was no such correlation between BCP% and HBeA g status(B =-0.523,P = 0.552).CONCLUSION:PC/BCP mutants become predominant in a dynamic and continuous process.Log10 PC,log10 BCP,PC% and BCP% might be combined to evaluate disease progression.PC% determines HBeA g status.

Urinary and sexual function changes in benign prostatic hyperplasia patients before and after transurethral columnar balloon dilatation of the prostate

BACKGROUND Transurethral columnar balloon dilatation of the prostate(TUCBDP) is a new surgical treatment, but its efficacy remains controversial because of limited clinical application.AIM To investigate the clinical effect of TUCBDP for benign prostatic hyperplasia(BPH).METHODS Overall, 140 patients with BPH who underwent surgical treatment were included in the study. A random number table was used to divide the participants into study and control groups(n = 70 per group). The study group underwent TUCBDP. The prostate resection surgical time, intraoperative blood loss, bladder irrigation time, catheter indwelling time, length of hospital stay, International Prostate Symptom Score(IPSS), maximum urine flow rate(Qmax), residual urine volume(RUV), changes in the International Erectile Function Score(ⅡEF-5) score, serum prostate-specific antigen(PSA), quality of life(QOL) score, and surgical complications were compared in both groups.RESULTS The operation time, intraoperative blood loss volume, bladder flushing time, urinary catheter indwelling time, and length of hospital stay were significantly lower in the study group than in the control group(P < 0.05). There were no significant differences in the IPSS, Qmax, and RUV measurements between the study and control groups(P > 0.05). However, at 3 mo post-surgery, the IPSS and RUV measurements were both lower(P < 0.05) and Qmax values were higher(P < 0.05) compared to the pre-surgery results in both groups. The ⅡEF-5 scores before and 3 mo after surgery were not significantly different between the study and control groups(P > 0.05). At 1 mo after surgery, the ⅡEF-5 score was higher in the study group than in the control group(P < 0.05). The serum PSA levels and QOL scores before treatment and at 1 and 3 mo after treatment were not significantly different between the study and control groups(P > 0.05). However, lower serum PSA levels and QOL scores were observed after 1 and 3 mo of treatment compared to pre-treatment levels in the study group(P < 0.05). The surgical complication rate of the study group(4.29%) was lower than that of the control group(12.86%;P < 0.05).CONCLUSION TUCBDP for BPH and transurethral resection of the prostate can achieve better results, but the former method is associated with less surgical trauma.

Effects of Da Ding Feng Zhu Decoction in 30 Cases of Liver Fibrosis

To study the clinical effects of Da Ding Feng Zhu (大定风珠) Decoction on liver fibrosis. 56 patients withliver fibrosis due to chronic hepatitis B were randomly divided into a treatment group (30 cases treatedwith Da Ding Feng Zhu Decoction) and a control group (26 cases treated with colchicine). The serumlevels of hyaluronic acid (HA), procollagen Ⅲ (PC-Ⅲ), Ⅳ collagen (Ⅳ-C) and Laminin (LN) of thepatients were determined, compared and analyzed before treatment and after 3-month treatment in the twogroups. The results showed that in the treatment group, the levels of HA, PC-Ⅲ, Ⅳ-C and LN after3-month treatment were significantly lowered as compared to that before treatment (P＜0.01). In thecontrol group, only the HA level was obviously lowered (P＜0.05). There was an significant difference(P＜0.05) in PC-Ⅲ and Ⅳ-C and a very significant difference (P＜0.01) in HA after treatment between thetwo groups. It is therefore concluded that Da Ding Feng Zhu Decoction can lower serum indexes of liverfibrosis.

Left abdominal wall proliferative myositis resection and patch repair:A case report

BACKGROUND Proliferative myositis is a rare benign tumor that is typically self-limiting and does not become malignant.It can be cured by simple resection without reported recurrence.Due to its rapid growth,hard structure and ill-defined borders,it can however be mistaken for malignant tumors such as sarcomas.CASE SUMMARY We investigate the case of a 64-year-old male with proliferative myositis of the abdominal wall,who was preoperatively administered a needle aspiration biopsy and given a simple excision and patch repair.We then compared it with other similar cases to determine the effectiveness of this treatment method.CONCLUSION Resection with follow-up observation has shown to be an effective treatment method for proliferative myositis.To avoid unnecessarily extended or destructive resection,a thorough and conclusive diagnosis is crucial,which requires adequate imaging and pathological knowledge.

The Significance of PSA Modified Parameters (F/T)/PSAD for Diagnosing Prostatic Cancer in the Grey Zone of 4～10 ng/ml

OBJECTIVE To investigate the diagnostic value of modified prostate specific antigen(PSA)parameters in the diagnosis of prostate cancer(PCA) when the serum PSAis in a grey zone of 4~10 ng/ml. METHODS The results of serum PSA determinations of the patients receiving a transrectal ultrasound-guided multiphase prostatic biopsy,were retrospectively analyzed.In the 88 patients with a serum PSA value of 4-10 ng/ml,the final diagnosis of PCA was made in 21,and that of benign prostate hyperplasia(BPH)in 67 patients.The percentage of the free-serum PSA([FPSA]/total-serum PSA[TPSA],F/T),PSA density(PSAD)and the sensitivity and specificity of the new PSA modified parameter(F/T)/PSAD in diagnosing PCA,within a set threshold value,was compared. RESULTS In the 88 patients with serum PSA in the grey zone of 4.0-10.0 ng/ml,there was no significant difference in comparing the TPSA between the 21 PCA patients and 67 BPH patients(P>0.05).However, there was a significant difference in the value of modified PSA parameters, such as F/T,PSAD and(F/T)/PSAD,between the PCA and the BPH groups (P<0.001).As the cut off point-value of the F/T,PSAD and(F/T)/PSAD was set at 0.16,0.15 and 0.8,the diagnostic sensitivity for PCA was 66.7%, 76.2%and 85.7%,and the specificity was 41.8%,43.3%and 68.7%,respectively.There was no significant difference in the sensitivity comparing the modified parameters for diagnosing PCA(P>0.05),whereas an overt predominance was present in the specificity of(F/T)/PSAD for PCAdiagnosis (P<0.05). CONCLUSION In the serum PSA grey zone of 4-10 ng/ml,a modified PSA parameter can improve the PCA diagnostic accuracy rate.With a considerably high sensitivity,application of the(F/T)/PSAD may effectively enhance the diagnostic specificity,which is superior to the F/T and PSAD, and can be expected to be one of the new indices derived from the PSA.

Comment“Asymptomatic small intestinal ulcerative lesions:Obesity and Helicobacter pylori are likely to be risk factors”

There are many causes of anemia.It is unreasonable to simply associate anemia with asymptomatic ulcers in the small intestine.

Comments on“Effect of type 2 diabetes mellitus in the prognosis of acute-on-chronic liver failure patients in China”

A study addressing the influence of type 2 diabetes on the prognosis of acute-onchronic liver failure patients was reviewed.Some statistical deficiencies were found in the reviewed article,and the sample size was too small to support the study.In addition,age should have been considered as one of the prognostic factors.

Application of proteome technology in screening biomarkers associated with gastric cancer

Objective: To initially explore the application of proteome technologies in study of serum, to establish two-dimen-sional gel electrophoresis (2-DE) profiles of human gastric cancer serum and paired normal serum, and to screen and identify differentially expressed proteins in poorly-differentiated gastric cancer serum and paired normal serum, in which try to find out significant biomarker candidates for gastric cancer. Methods: 2-DE was adopted to separate the total proteins of poorly-differentiated gastric cancer serum and paired normal serum. After staining and analyzing by ImageMaster 2D Elite software, the differentially expressed proteins were identified by matrix-assisted laser desorption/ionization-time of flight- mass spectrometry (MALDI-TOF-MS). Results: 2-DE serum profiles with high resolution were obtained. Five protein spots were found as differentially-expressed proteins and identified as Serpin B6 (Placental thrombin inhibitor) Cytoplasmic antiproteinase (CAP) (Protease inhibitor6) (PI-6), Septin-1 (LARP) (Serologically defined breast cancer antigen NY-BR-24), Kallikrein-6 precursor (Protease M) (Neurosin) (Zyme) (SP59), Hemoglobin beta chain, Hemoglobin beta chain and Beta-defensin 108 precursor (Beta-defensin 8) (DEFB-8). Conclusion: The differential proteins were demonstrated to present in poorly-differentiated gastric cancer serum and paired normal serum. The molecular biomarkers associated with poorly differentiated gastric cancer could be possibly identified by the high throughput screening proteome technology.

Staphylococcus aureus bloodstream infection in a Chinese tertiary-care hospital:A single-center retrospective study

To the Editor:Despite major advances in medical care,the incidence and mortality of bloodstream infection(BSI)remain high,which is still a global public health challenge.BSI can be caused by various microorganisms,and the most common organisms are Escherichia coli,Klebsiella pneumoniae,and Staphylococcus aureus(S.aureus),according to the China Antimicrobial Surveillance Network(CHINET).[1]S.aureus is the third most common cause of BSI,which is associated with shortterm mortality rates of 15–30%,long-term excess mortality,and increased healthcare costs.At present,there are many studies on Gram-negative bacteremia but relatively few on S.aureus bloodstream infection(SA-BSI),especially in China.With the occurrence of new treatments and clinical conditions,such as aging and extensive antibiotic resistance,it is necessary to reanalyze the clinical characteristics and prognosis of SA-BSI.

推拿结合远道取穴针刺治疗青少年假性近视(英文)

目的:观察推拿结合远道取穴针刺治疗青少年假性近视的临床疗效。方法:将64名青少年假性近视患者按随机数字表随机分为治疗组和对照组,每组32例(64只眼)。治疗组采用推拿结合远道取穴针刺治疗,对照组采用单纯推拿治疗,推拿手法、推拿部位及治疗时间均与治疗组相同。每日治疗1次,连续10次为1疗程,休息2 d后继续下一个疗程,共治疗3个疗程。两组患者均在接受3疗程治疗后进行标准对数视力表检测裸眼远视力和散瞳后检影验光近视屈光度检测,观察其近期疗效。结果:治疗3个疗程后,两组患者视力均较治疗前有改善;治疗组总有效率为92.2%,对照组为82.8%,两组总有效率差异有统计学意义(P<0.05),提示治疗组疗效优于对照组。结论:推拿结合远道取穴针刺治疗青少年假性近视疗效显著,而且没有针刺眼周穴位带来的恐惧,易于被青少年接受,值得在临床上推广应用。

腹针配合八脉交会穴治疗慢性咽炎（英文）

目的:探讨腹针配合八脉交会穴治疗慢性咽炎的有效性。方法:选择符合纳入标准的慢性咽炎患者30例,给予腹针配合针刺八脉交会穴中的列缺、照海治疗。每日治疗1次,10次为1疗程,治疗1疗程后观察疗效。结果:经过1疗程治疗,30例患者中治愈21例,显效5例,有效2例,无效2例,总有效率为93.3%。结论:腹针配合八脉交会穴治疗慢性咽炎疗效可靠,值得临床推广应用。

Advances in endocrine and targeted therapy for hormone-receptorpositive,human epidermal growth factor receptor 2-negative advanced breast cancer

Nearly 70%of breast cancer(BC)is hormone-receptor(HR)-positive,human epidermal growth factor receptor 2(HER2)-negative,and endocrine therapy is the mainstay of treatment for this subtype.However,intrinsic or acquired endocrine resistance can occur during the endocrine treatment.Based on insights of endocrine resistance mechanisms,a number of targeted therapies have been and continue to be developed.With regard to HR-positive,HER2-negative advanced BC,aromatase inhibitor(AI)is superior to tamoxifen,and fulvestrant is a better option for patients previously exposed to endocrine therapy.Targeted drugs,such as cyclindependent kinases(CDK)4/6 inhibitors,mammalian target of rapamycin(mTOR)inhibitors,phosphoinositide-3-kinase(PI3K)inhibitors,and histone deacetylase(HDAC)inhibitors,play a significant role in the present and show a promising future.With the application of CDK4/6 inhibitors becoming common,mechanisms of acquired resistance to them should also be taken into consideration.

针刺配合推拿治疗失眠症临床观察(英文)

目的:观察针刺配合推拿治疗失眠症的临床疗效。方法:使用随机数字表,将符合纳入标准的100例患者随机分为治疗组(51例)和对照组(49例)。治疗组予以针刺百会、风池、完骨、神庭、安眠、内关等穴位及推拿治疗;对照组患者仅接受针刺治疗。两组均每天治疗1次,10次为1个疗程,治疗3个疗程后进行疗效观察和比较。结果:治疗组51例中46例完成3个疗程治疗,其中治愈17例,显效18例,有效7例,无效4例,总有效率为91.3%。对照组49例中46例完成3个疗程治疗,其中治愈8例,显效12例,有效14例,无效12例,总有效率为73.9%。治疗组总有效率明显高于对照组(P<0.05)。结论:针刺配合推拿治疗失眠可以镇静安神,激发经气,疗效优于单纯针刺治疗。

成年大鼠睾丸经EDs处理后再生睾丸间质细胞基因图谱的改变

成年睾丸间质细胞（ALC）是睾丸中产生雄激素的唯一内分泌细胞，只占有睾丸细胞的1％-5％。大鼠睾丸中的睾丸间质细胞被EDs去除后能够再生。本研究中，我们主要研究了大鼠睾丸经EDS处理后睾丸间质细胞再生及基因的变化图谱。EDS处理后7、21、35、90天后分析血清中睾酮、睾丸基因图谱和一些类固醇生成相关的蛋白变化情况。EDS处理后第7天睾丸中睾酮水平几乎检测不到，然后开始恢复。处理后7天，81个基因下调2倍或者更多，其中48个基因检测不到，包括类固醇合成通路中的蛋白Star、Scarbl、Cypllal、Cypl7al、Hsd3bl、CyplblICyp2al。这些基因在21天开始表达增多，到90天已经完全恢复到正常水平。89个基因上调2倍或者更高，nPkib。这些上调的基因到90天恢复正常；其中Cyp2al直到35天才开始恢复，表明这个基因只在成年睾丸间质细胞中表达，不在前体细胞中表达。qPCR，Westernblot、半定量免疫组织染色检测了随机抽取的基因和蛋白确认其变化情况。

Effect of Candida albicans on Intestinal Ischemia-reperfusion Injury in Rats

Background： Inflammation is supposed to play a key role in the pathophysiological processes of intestinal ischemia-reperlhsion injury （IIRI）, and Candida albicans in human gut commonly elevates inflammatory cytokines in intestinal mucosa. This study aimed to explore the effect of C. albicans on IIRI. Methods： Fifty female Wistar rats were divided into five groups according to the status of C. a/bicans infection and IIRI operation： group blank and sham; group blank and IIRI; group cetbperazone plus IIR1; group C. albicans plus cetbperazone and IIRI （CCI）; and group C. albicans plus cefbperazone and sham. The levels of inflammatory factors tumor necrosis factor （TNF）-a, interleukin （IL）-6, IL- 1 β, and diamine oxidase （DAO） measured by enzyme-linked immunosorbent assay were used to evaluate the inflammation reactivity as well as the integrity of small intestine. Histological scores were used to assess the mucosal damage, and the C. albicans blood translocation was detected to judge the permeability of intestinal mucosal barrier. Results： The levels of inflammatory factors TNF-a, IL-6, and IL-1β in serum and intestine were higher in rats undergone both C. albicans infection and IIRI operation compared with rats in other groups. The levels of DAO （serum： 44.13 ± 4.30 pg/ml, intestine： 346.21 ± 37.03 pg/g） and Chiu scores （3.41 ± 1.09） which reflected intestinal mucosal disruption were highest in group CCI after the operation. The number ofC. albicans translocated into blood was most in group CCI （[33.80 ± 6.60] x 10-2 colony forming unit （CFU）/ml）. Conclusion： Intestinal C. albicans infection worsened the llRl-induced disruption of intestinal mucosal barrier and facilitated the subsequent C. alhicans translocation and dissemination.