Stressors can be classified as controllable and uncontrollable events.Self-choice behavior plays an important role in the "problem-solution" process of coping when individual faces controllable stressors.As to the uncontrollable stressors there are 2 different coping modes: transformation and compensation coping.This paper reviews the research achievements in the relationship between stress and self-choice behavior.

The paper probed into the building and application of the evaluation system for the target responsibility system centering on nursing units, in line with recent development hospital practices. It discussed the design of the target-based quantitative assessment standards for nursing units, and the methods of target-based evaluation for nursing units, which are used in the target responsibility evaluation of 21 nursing units of the hospital. Results of the practice prove that such responsibility system raises the nursing quality and efficiency, improves nurses' incentives and cooperativeness, as well as elevates the safety and creativity of nursing and its management efficiency.

Objective To understand the difference between psychological characteristics and stress response as a result of military stress and to evaluate the rate of stress response among individuals with different psychological characteristics.Methods The State-Trait Anxiety Inventory,blood pressure,breath,pulse wave,and serum levels of lactate acid and cortisol were measured at 8 to 9 am for 372 servicemen following 15 days'training.ResultsIn 97 subjects ,the value of special characteristic anxiety Was 2-standard deviation higher than normal model(i.e.high special characteristic anxiety).and low special characteristic anxiety was found in 79.The condition anxiety of 2 standard deviation higher than normal model wag found in 172 participants.A total of 132 subjects showed significant changes in condition anxiety,serum cortisol and lactic acid,and systolic blood pressure(P＜0.01).Sixty-one or 71 subjects with high or low special characteristic anxiety experienced condition anxiety,changed serum cortisol and lactic acid,and systolic blood pressure,respectively.Conclusion Psychological characteristics may be considered as a predicting factor of stress response.

Objective To evaluate the effect of fenretinide (4-HPR)-loaded liposomes (4-HPR-L) on the proliferation,apoptosis and migration of A375 and B16F10 melanoma cells.Methods A film-ultrasonic dispersion method was used to prepare 4-HPR-L.In vitro cultured A375 cells,as well as B16F10 melanoma cells,were divided into the following groups:blank control group treated with fresh culture medium alone,4-HPR groups treated with 4-HPR at concentrations of 0.1,1,15,30,50 and 70 mg/L separately,and 4-HPR-L groups treated with 4-HPR-L at concentrations of 0.1,1,15,30,50 and 70 mg/L separately.Cell counting kit-8 (CCK8) assay was conducted to detect cell proliferation,Hoechst33258 staining and flow cytometry to detect cell apoptosis,wound healing assay to evaluate cell migration ability,and laser scanning confocal microscopy to observe endocytic uptake of the liposomes.Statistical analysis was done by one-way analysis of variance (ANOVA) for intergroup comparison,and a two-sample t-test for comparisons between 2 groups with SPSS 20.0 software.Results Both 4-HPR and 4-HPR-L showed inhibitory effects on the proliferation of A375 and B16F10 melanoma cells.After 48-hour treatment,the survival rates of A375 cells in the 0.1-,1-,15-,30-,50-and 70-mg/L 4-HPR groups were (94.3 ± 1.4)％,(91.7 ± 2.5)％,(84.4 ± 2.5％),(78.8 ± 2.1)％,(59.0 ± 1.1)％ and (42.8 ± 2.0)％ respectively,and those in the 0.1-,1-,15-,30-,50-and 70-mg/L 4-HPR-L groups were (86.0 ± 0.2)％,(76.5 ± 0.6)％,(60.9 ± 1.5)％,(49.0 ± 0.5)％,(32.9 ± 0.2)％ and (18.9 ± 0.5)％ respectively.After 48-hour treatment,the survival rates of B16F10 cells in 0.1-,1-,15-,30-,50-and 70-mg/L 4-HPR groups were (95.4 ± 1.9)％,(90.5 ± 2.6)％,(77.0 ± 0.8％),(64.4 ± 3.5)％,(59.1 ± 2.9)％ and (49.9 ± 1.9)％ respectively,and those in the 0.1-,1-,15-,30-,50-and 70-mg/L 4-HPR-L groups were (88.4 ± 2.0)％,(80.9 ± 3.4)％,(60.9 ± 2.2)％,(51.5 ± 2.9)％,(41.1 ± 1.2)％ and (33.5 ± 2.4)％ respectively.The survival rates of A375 and B16F10 cells were significantly higher in the 0.1-,1-,15-,30-,50-and 70-mg/L 4-HPR groups than in the 4-HPR-L groups at the same concentrations (A375 cells:t =8.019,8.298,11.455,19.978,33.672,16.314 respectively,all P ＜ 0.01;B16F10 cells:t =3.573,3.153,9.953,4.019,8.097,7.53 respectively,all P ＜ 0.05).Hoechst33258 staining showed that the morphology of the melanoma cells in the control group and 4-HPR groups did not change obviously,but the cells.in the 4-HPR-L groups became smaller,with the cytoplasm concentrated,nuclei dissociated into fragments,and apoptotic bodies formed.Flow cytometry showed that the apoptosis rates of A375 and B16F10 cells were significantly higher in the 4-HPR-L groups than in the 4-HPR groups (all P ＜ 0.01).Cell wound healing assay showed that the inhibitory effect of 4-HPR-L on the migration of cells was stronger than that of 4-HPR,and 4-HPR-L could markedly decrease the degree of wound healing.Laser scanning confocal microscopy showed that C6 liposomes could be rapidly and successfully internalized into both A375 and B16F10 cells.Conclusion The 4-HPR-L can be internalized into A375 and B16F10 cells better than 4-HPR,effectively inhibit the proliferation and migration of A375 and B16F10 cells,and induce the apoptosis of these cells.

Objective To evaluate the inhibitory effect of fenretinide-loaded liposomes(4-HPR-L) on subcutaneous transplanted malignant melanomas in nude mice.Methods A film-ultrasonic dispersion method was used to prepare 4-HPR-L.BALB/c nude mice were subcutaneously inoculated with A375 melanoma cells in the right axillary fossae to establish malignant melanoma-bearing nude mouse models.Ten nude mouse models were randomly and equally divided into 2 groups to be injected with near-infrared fluorescent cell membrane label (DiR) solution or DiR liposomes (DiR-L)at the same concentration in the caudal vein,and a live imaging system was used to observe the distribution of DiR or DiR-L in nude mice at 6,12,24 hours after the injection.Another 30 nude mice were randomly and equally divided into 3 groups to be injected with 5％ (mass fraction) glucose solution at a single-dose of 0.2 ml (control group),25 mg/kg 4-HPR solution (4-HPR group)and 25 mg/kg 4-HPR-L solution (4-HPR-L group) respectively on days 8,10,12,14,16,18,20 and 22 after the inoculation with A375 cells.The mouse body weight and tumor volume were dynamically monitored in the above groups after the injection,and the survival situation was observed.The nude mice were sacrificed on day 2 after the final injection,and the heart,liver,spleen,lung,kidney and tumor tissues were resected.These tissues were subjected to hematoxylin-eosin staining and immunohistochemical staining to observe the metastasis of melanoma in mice,and terminal deoxyribonucleotidyl transferase-mediated nick end labelling was performed to detect the apoptosis in tumor cells.One-way analysis of variance and independent-sample t test were used to analyze measurement data.Results The live imaging system showed that DiR-L could be retained in melanoma for a long time,and strong fluorescence of DiR-L could be still observed in the tumors at 24 hours after injections.Quantitative fluorescence analysis revealed that the fluorescence intensity of DiR-L (22.85 ± 1.66) was significantly higher than that of DiR in tumor tissues (8.45 ± 0.97,t =12.957,P ＜ 0.01).Compared with the control group and 4-HPR group,the resected tumor weight on day 2 after the final injection was significantly decreased in the 4-HPR-L group (F =27.055,t =4.768,6.640,respectively,both P ＜ 0.05).Hematoxylineosin staining showed that liver metastasis occurred in 2 nude mice in the 4-HPR-L group,but in all the nude mice in the control group and 4-HPR group.All the nude mice in the 4-HPR-L group died within 76 days after inoculation,and the mice in the control group and 4-HPR group all died within 56 and 59 days respectively after inoculation.There were significant differences in the apoptotic index among the control group (12.14‰ ± 1.33‰),4-HPR group (67.17‰± 15.18‰) and 4-HPR-L group (152.73‰ ± 11.27‰;F =167.588,P ＜ 0.05),and the apoptotic index was significantly higher in the 4-HPR-L group than in the control group and 4-HPR group (t =18.162,11.075 respectively,both P ＜ 0.05).Conclusion 4-HPR-L can effectively inhibit the growth of subcutaneous melanoma in nude mice and metastasis of melanoma cells,and prolong the survival duration of nude mice.

Objective To assess the effect of fenretinide (4-HPR) on proliferation,apoptosis and migration of B16F10 and A375 melanoma cells,and to evaluate the effect of liposomes and RGD peptidemodified liposomes on its uptake and therapeutic effects.Methods A film-hydration method was used to prepare 4-HPR liposomes (4-HPRL),which were modified with RGD peptide to prepare RGD-4-HPRL,and the concentration,particle size,electric potential,drug loading capacity and encapsulation efficiency were measured for 4-HPRL and RGD-4-HPRL.In vitro cultured B16F10 and A375 cells were divided into several groups:4-HPR group,4-HPRL group and RGD-4-HPRL group treated with Dulbecco's minimum essential medium (DMEM) containing 4-HPR bulk drug,4-HPRL and RGD-4-HPRL respectively at the same concentration of 4-HPR,and control group treated with culture solution at the same volume.After different durations of treatment,cell counting kit-8 (CCK8) assay was performed to evaluate cellular proliferative activity,annexin V/propidium iodide staining to detect apoptosis,and scratch wound healing assay to evaluate the effect of drug treatment on cell migration ability.Then,4-HPR was replaced by coumarin 6 (C6) to prepare C6 liposomes (C6L) and RGD-C6L,and flow cytometry was conducted to evaluate C6 uptake by B16F10 cells.Statistical analysis was carried out with SPSS22.0 software by one-way analysis of variance (ANOVA) for the comparison among several groups and t test for the comparison between two groups.Results The concentration of 4-HPR in the prepared 4-HPRL solution was over 1 300 mg/L.The encapsulation efficiency and drug loading capacity of 4-HPRL were (95.51 ± 1.22)％ and (7.27 ± 0.11)％ respectively,and those of RGD-4-HPRL were (95.82 ± 0.81)％ and (7.14 ± 0.13)％ respectively.The particle size distribution of 4-HPRL and RGD-4-HPRL was uniform,and their average particle size was below 100 nm.CCK8 assay showed that 4-HPR could markedly inhibit the proliferative activities of B16F10 and A375 cells.The cell proliferation inhibition rate of 4-HPRL was higher than that of 4-HPR at the same concentration of 4-HPR (P ＜ 0.01),and the inhibition rate of RGD-4-HPRL was higher than that of 4-HPRL (P ＜ 0.01 or P ＜ 0.05) and 4-HPR (P ＜ 0.01).As annexin V/propidium iodide apoptosis assay showed,when the concentration of 4-HPR was 10 mg/L,the total apoptosis rates of B16F10 cells in the control group,4-HPR group,4-HPRL group and RGD-HPRL group were (4.44 ± 0.35)％,(28.33 ± 0.66)％,(46.43 ± 0.77)％ and (51.33 ± 0.37)％ respectively.When the concentration of 4-HPR was 20 mg/L,the total apoptosis rates of A375 cells in the above 4 groups were (4.97 ± 0.62)％,(16.68 ± 3.81)％,(32.62 ± 1.24)％ and (44.85 ± 4.92)％ respectively.The apoptosis rates of B16F10 and A375 cells were significantly higher in the 4-HPRL group than in the 4-HPR group (both P ＜ 0.01),and higher in the RGD-4-HPRL group than in the 4-HPRL group (both P ＜ 0.01) and 4-HPR group (both P ＜0.01).Scratch wound healing assay showed that 4-HPR could inhibit scratch healing and migration of B16F10 and A375 cells,and the inhibitory effects of 4-HPRL and RGD-4-HPRL were distinctly superior to those of 4-HPR bulk drug.C6 uptake assay revealed that the fluorescence intensity of C6 in B16F10 cells in the control group,C6 group,C6L group and RGD-C6L group were 2.15 ± 0.28,8.56 ± 0.36,20.48 ± 0.13 and 22.55 ± 0.07 respectively,and there were significant differences between the 4 groups (F =67 194.186,P ＜ 0.01).Additionally,the fluorescence intensity of C6 was significantly higher in the C6L group and RGD-C6L group than in the C6 group (both P ＜ 0.01),and higher in the RGD-C6L group than in the C6L Group (P ＜ 0.01).Conclusions 4-HPR can inhibit the proliferation and migration of A375 and B16F10 cells,and induce their apoptosis.Liposomes and RGD-targeted liposomes can markedly enhance the effect of 4-HPR on melanoma cells.

Objective The aims of this study were to construct short hairpin RNA(shRNA)lentiviral vector in breast cancer T47D cells,to carry out RNA interference on lysine acetyltransferase 6B(KAT6B/MORF)gene,to down-regulate its expression and to explore its function.Methods Two pairs of single-stranded short hairpin RNA(shRNA5 and shRNA8)and the corresponding control sequences(Scramble5 and Scramble8)were synthesized based on the CDS of KAT6B gene.Polymerase chain reaction(PCR) was used to amplify double-stranded and ligated with the entry vector(pENTR/pSM2(CMV)GFP),which were subjected to a doub-le digestion(EcoRl and Xhol)linearization and homologous recombination with the entry vector(pENTR/pSM2(CMV)GFP)to obtain an entry clone containing the desired fragment.The target fragment was recombined onto the target vector(pLenti x1 puro DEST)via the LR cloning reaction of the Gateway system.The lentiviral packaging plasmids were co-transfected into HEK-293T cells with two pairs of target plasmids. The supernatant of HEK -293T cells was collected and transformed into T47D cells. The expression of KAT6B protein was detected in T47D cells by Western blot.Results The single colony obtained from the transformation was identi-fied by sequencing,which was consistent with the target sequence,indicating that the lentiviral vector had been successfully construc-ted.The expression of KAT6B protein was significantly lower in the shRNA KAT6B group than that in the control group,which indica-ted that the constructed gene silencing vector could play a role in the KAT6B gene in T47D cells.Conclusion The shRNA lentiviral gene silencing vectors of KAT6B were constructed and identified in T47D cells,which indicated that the foundation for further study

Objective:To study characteristics of changes in the demand for emergency medical services during epidemic prevention and control "10 new measures" in Zhejiang province.Methods:The data of 26 emergency centers connected to the provincial integration platform of Zhejiang Province (hereinafter referred to as "provincial platform" ) were retrospectively analyzed, and the data were collected from one week before the implementation of "10 new measures" to the sixth week after implementation (December 1, 2022 to January 18, 2023). The collected information included: the number of 120 calls and ambulance services, the types of disease, age composition of patients, performance of emergency medical services.Results:From the second week of the implementation of "10 new measures" (December 15 to 21, 2022), the number of 120 calls and ambulance services were increased rapidly, and the peak occurred in the third week of implementation (December 21 to 28, 2022). Among the types of diseases, the number and proportion of patients with abnormal symptoms and respiratory diseases increased significantly, reaching the highest peak in the third week (December 21 to 28, 2022) and the fourth week (December 29, 2022 to January 4, 2023) of implementation, respectively. After the second week of implementation, the number of elderly patients aged 71 to 100 increased significantly, reaching a peak in the fourth week (December 29, 2022 to January 4, 2023), accounting for 60.76% of the total. During the epidemic period, the quality control indicators such as emergency dispatch time, ambulance dispatch time and medical treatment all fluctuated, but the changes were not significant.Conclusions:During the implementation of epidemic prevention and control "10 new measures", there were obvious characteristic changes in the demand for pre-hospital emergency in Zhejiang Province, but the quality of pre-hospital emergency medical was basically stable.

Objective To investigate the impact of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack(TIA).Methods A total of 366 patients with acute mild ischemic stroke or moderate-high risk TIA who carried CYP2C19 loss-of-function alleles were included in the study.Baseline data were collected at admission,and clinical outcomes were collected within 3 months post-onset(primary outcomes:stroke recurrences within 3 months post-onset;secondary outcomes:composite outcome of stroke recurrence or death within 3 months post-onset,vascular events,and quality of life within 3 months).Kaplan-Meier method was used to plot the cumulative incidence curve of outcomes.Multivariate Cox proportional hazards mod-el and multivariate Logistic regression model were used to evaluate the relationship between over-weight and clinical outcomes within 3 months post-onset in patientswith ischemic stroke or TIA.The integrated discrimination improvement index(IDI)and net reclassification improvement index(NRI)were calculated to assess the predictive value of adding body mass index(BMI,whether o-verweight or not)based on traditional models for predicting the prognosis of acute ischemic stroke or TIA.Results After 3 months of follow-up,28 patients had stroke recurrence,1 patient died,and 31 patients had vascular events.The Kaplan-Meier cumulative incidence curve showed that the cu-mulative incidences of stroke recurrence,stroke recurrence or death,and vascular events after 3 months of onset were lower in overweight patients compared with non-overweight patients(Log-rank P＜0.05).Multivariate analysis showed that compared with non-overweight patients,overweight pa-tients had significantly reduced risks of stroke recurrence within 3 months(HR=0.24;95％CI,0.08 to 0.71),composite outcome of stroke recurrence or death(HR=0.24;95％CI,0.08 to 0.69),and vascular events(HR=0.22;95％CI,0.07 to 0.63),and significantly improved qual-ity of life within 3 months(OR=0.39;95％CI,0.20 to 0.76).The IDI and NRI calculations showed that compared with traditional models,the new model adding BMI(whether overweight)had significantly improved predictive ability for the prognosis of acute ischemic stroke or TIA.Conclu-sion Overweight may be a protective factor for the prognosis of TIA patients with acute mild ische-mic stroke or moderate-high risk who carry CYP2C19 loss-of-function alleles.Compared with non-o-verweight patients,overweight patients have reduced risks of stroke recurrence,composite outcome of stroke recurrence or death,and vascular events within 3 months post-onset,and improved quality of life within 3 months post-onset.

Objective To investigate the impact of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack(TIA).Methods A total of 366 patients with acute mild ischemic stroke or moderate-high risk TIA who carried CYP2C19 loss-of-function alleles were included in the study.Baseline data were collected at admission,and clinical outcomes were collected within 3 months post-onset(primary outcomes:stroke recurrences within 3 months post-onset;secondary outcomes:composite outcome of stroke recurrence or death within 3 months post-onset,vascular events,and quality of life within 3 months).Kaplan-Meier method was used to plot the cumulative incidence curve of outcomes.Multivariate Cox proportional hazards mod-el and multivariate Logistic regression model were used to evaluate the relationship between over-weight and clinical outcomes within 3 months post-onset in patientswith ischemic stroke or TIA.The integrated discrimination improvement index(IDI)and net reclassification improvement index(NRI)were calculated to assess the predictive value of adding body mass index(BMI,whether o-verweight or not)based on traditional models for predicting the prognosis of acute ischemic stroke or TIA.Results After 3 months of follow-up,28 patients had stroke recurrence,1 patient died,and 31 patients had vascular events.The Kaplan-Meier cumulative incidence curve showed that the cu-mulative incidences of stroke recurrence,stroke recurrence or death,and vascular events after 3 months of onset were lower in overweight patients compared with non-overweight patients(Log-rank P＜0.05).Multivariate analysis showed that compared with non-overweight patients,overweight pa-tients had significantly reduced risks of stroke recurrence within 3 months(HR=0.24;95％CI,0.08 to 0.71),composite outcome of stroke recurrence or death(HR=0.24;95％CI,0.08 to 0.69),and vascular events(HR=0.22;95％CI,0.07 to 0.63),and significantly improved qual-ity of life within 3 months(OR=0.39;95％CI,0.20 to 0.76).The IDI and NRI calculations showed that compared with traditional models,the new model adding BMI(whether overweight)had significantly improved predictive ability for the prognosis of acute ischemic stroke or TIA.Conclu-sion Overweight may be a protective factor for the prognosis of TIA patients with acute mild ische-mic stroke or moderate-high risk who carry CYP2C19 loss-of-function alleles.Compared with non-o-verweight patients,overweight patients have reduced risks of stroke recurrence,composite outcome of stroke recurrence or death,and vascular events within 3 months post-onset,and improved quality of life within 3 months post-onset.