Objective To investigate the changes and clinical significance ot the expression ot microRNA in plasma and peripheral blood mononuclear cells in patients with schizophrenia.Methods 174 patients with schizophrenia in Danzhou People 's Hospital were selected as the case group and the other 80 healthy persons as control group The relative expression levels of 8 microRNA in two groups of plasma and pcripheral blood mononuclear cells were detected by real-time quantitative fluorescent PCR(MiR-195,MiR-346,MiR-181b,MiR-212,MiR-30e,MiR-432,MiR 7,MiR-34a),and the differences of microRNA in the plasma and peripheral blood mononuclear cells were compared between the two groups.ROC curve was used to analyze the sensitivity and specificity of microRNA as diagnostic criteria for schizophrenia and Logistic regression analysis of the relative risk of microRNA in schizophrenia.Results The expression levels of MiR-195,MiR-181b,MiR-132,MiR-30e,MiR-7 and in the patients of the case group(3.11±1.05,2.18±0.72,1.85±0.74 and 9.61±1.87) were significantly higher than those in the control group(4.48±1.07,2.92±0.86,3.53±1.07 and 11.96±2.73,P＜0.05 or P＜0.01).The expression levels of MiR-181b,MiR-212,MiR-30e and MiR-34a in peripheral blood mononuclear cells of patients in the case group (-4.20±1.16,0.27 ±0.55,-4.83± 1.05 and 2.64± 1.08) were significantly higher than those in control group (-3.56±0.81,0.91±0.68,-3.49±1.22 and 3.95±1.03,P＜0.05 or P＜0.01).Logistic regression analysis showed that plasma MiR-181b and MiR-30e were significantly relative risk (OR=2.357,95 ％ CI:1.361 ～ 4.093;OR=2.064,95 ％ CI:1.147～3.815),and peripheral blood mononuclear cells MiR-30e also had significant relative risk (OR=1.628,95 ％CI:0.914～2.926).ROC curve analysis showed that 95％CI and AUC in plasma and peripheral blood mononuclear cells of MiR-181b were 0.702 (0.784～0.632),0.658 (0.593 to 0.736),and plasma and peripheral blood mononuclear cell of MiR-30e were 0.775 (0.706～0.857),0.758 (0.686～0.839),respectively.Spearman correlation analysis showed that plasma MiR 181b and plasma MiR-30e were significantly correlated (r=0.547,P =0.043).Conclusion Abnormal expression of microRNA in patients with schizophrenia,and plasma and peripheral blood mononuclear cells MiR-181b and MiR-30e had good diagnostic value for schizophrenia patients.

Objective To improve the nursing skills of low age and service seniority nurses and meet the needs of clinical nurses,in order to serve patients better and improve the quality of cave.Methods According to knowledge tests 50 points for nurse job-related skill issued by Chinese Ministry of Health,our hospital selected 12 commonly used basic operation skills and designed comprehensive cases through integration and reformation.We trained and examined nurses with undergraduate degree came to our hospistal in 2008.Results After training,the score of clinical nursing skill reached 91.81,86 nurses reached the standard and the effective compliance rate was 95%.Conclusions It proved to be an effective method to improve the nursing skills of low-age and service seniority nurses by carrying out the comprehensive casestyle training methods.

Objective To analyze the clinical characteristics of two patients with 3β-hydroxysteroid dehydrogenase deficiency and to explore their molecular genetic defects.Methods The clinical features and laboratory data of two patients were collected.The exons of HSD3B2 gene were amplified by PCR and sequenced by Sanger sequencing.Results Patient 1, aged 5 yrs old, was raised as a girl with 46, XY karyotype, presented with hyperpigmentation, female infant vulva, clitoral hypertrophy, and bilateral cryptorchidism;Patient 2, aged 11 yrs old, was raised as a girl at birth but as a boy after 1 yr old for known 46, XY karyotype, presented with hyperpigmentation, micropenis and severe hypospadias.Both patients had markedly elevated adrenocorticotropin and decreased cortisol.Two homozygous missense mutations in HSD3B2 gene were identified:conversions of codon Pro155 toLeu(p.P155L)inpatient1,andcodonAla82toThr(p.A82T)inpatient2,bothofwhichwerereportedforthe first time in China.Conclusion The patients with 3β-hydroxysteroid dehydrogenase deficiency in 46,XY karyotype mainly present with male pseudohermaphroditism and adrenocortical deficiency, and the diagnosis should rely on the steroids detection and HSD3B2 gene screening.

Objective This paper aims to explore patient satisfaction with mobile medical payments in ethnic minority areas and its influencing factors.Methods From May to August 2023,565 ethnic minority patients from 6 villages in 4 ethnic minority autonomous counties in Dehong Prefecture and Pu'er City,Yunnan Province,were selected as research subjects,and 186 Han patients in Kunming were selected as controls.The general information questionnaire,the mobile medical payment will-ingness and attitude survey scale,and the medical cost mobile payment satisfaction survey scale were used to investigate their sat-isfaction with actual situation of medical mobile payment.Additionally,this paper discussed influencing factors affecting satisfac-tion.Results The ethnic minority patients exhibited a significantly lower level of satisfaction compared to the Han patients(39.65±10.43 vs.49.54±7.88,P＜0.05).ethnic minority patients scored significantly lower on the dimensions of satisfac-tion,such as perceived safety,ease of use and usefulness of mobile medical payment compared to the group of Han patients(all P＜0.05).Additionally,they ethnic minority patients showed significantly lower level of willingness and attitude to use mobile medical payment compared to the group of Han patients(P＜0.05).The main factors influencing the significant difference in satisfaction with mobile medical payment were ethnic group,number of hospital visits in previous year,first-time use of mobile medical payment,and educational background(P＜0.05).Conclusion Ethnic minority patients have a low perception of secur-ity,ease of use,and usefulness of mobile medical payments,as well as a low willingness and characteristics for mobile medical payment.Therefore it is necessary to further enhance their experience and satisfaction.In the development of mobile medical pay-ment services hospitals should fully consider the current situation of"illiteracy""semi-illiteracy"and"lack of resources"in re-mote ethnic areas.They should actively develop service platforms and applications suitable for mobile medical payment in ethnic minority areas to continuously enhance service efficiency and quality.

Objective:To explore the real experience of parents caring for children with Kawasaki disease complicated with giant coronary artery aneurysm at home,in order to provide reference for targeted interventions.Methods:With phenomenological approaches in qualitative study,semi-structured interviews were conducted among 10 parents whose children with Kawasaki disease complicated with giant coronary artery aneurysm, and Colaizzi 's 7-step analysis method was used to analyze the data and extract the theme.Results:The care experience of parents were classified into four themes:continued negative emotions;lacked of family care knowledge;bore a huge burden of care; eager for support strength.Conclusions:Parents of children with Kawasaki disease complicated with giant coronary artery aneurysm have many difficulties in disease management,family care and other aspects in the process of caring for children.They also bear a greater burden of psychological pressure.Medical workers should pay attention to parent′s psychological status and related problems,and provide effective intervention measures to promote the rehabilitation of children and improve the quality of life of the family.