Objective Through the cell block technique to detect the expression of P16 protein in the liquid-based cytology with atypical squamous cells of undetermined significance (ASCUS) and high degree of cervical intraepithelial lesions (HSIL),to explore the significance of P16 protein in ASCUS re-evaluate.Methods Collected in our hospital in 2012 cervix liquid based cytology specimens of 45 patients,including of 15 ASCUS,11 HSIL cases,low in 11 cases of epithelial lesions (LSIL) and 2 cases of squamous cell carcinoma,2 cases of atypical glandular cells,4 cases of normal cells as a control.Immunocytochemical analysis of P16 protein control analysis,cytology and histology results.Results The expressing of P16 protein in normal cells,ASCUS,LSIL,HSIL,squamous cell carcinoma,atypical glandular cells in the positive expression rates were 0,20％,27.2％,63.6％,100％,100％.Cytology and biopsy results,cytologic diagnosis of ASCUS 15 cases,biopsy:12 cases of cervicitis,CIN Ⅱ-Ⅲ in 3 cases; cytology the in LSIL11,biopsy:5 cases of cervicitis,CIN Ⅰ 6 cases ; the cytological diagnosis HSIL11 cases,biopsy:cervical four cases of intlammation,CIN Ⅱ-Ⅲ ; cytologic diagnosis of atypical glandular cells in 2 cases,biopsy:adenocarcinoma; cytologic diagnosis of squamous cell carcinoma in 2 cases,biopsy:squamous cell carcinoma.Conclusion Detection of P16 protein on the cell block can be used for ASCUS classification ASCUS reassessment.

Objective To establish acute hepatotoxic model induced by Amanita exitialis and to study the characteristics of acute toxic liver failure induced by mushrooms containing peptide toxins,in hope for providing some help to experimental research on poisoning induced by mushrooms containing peptide toxins.Methods UPLC-MS/MS (Ultra performance liquid chromatography-tandem mass spectrometry) method was used to detect peptide toxins in Amanita exitialis.To establish acute toxic liver hepatic failure model,the beagles were fed with 60 mg/kg of lyophilized powder of Amanita exitialis fungus which encapsulated in starch capsules.Toxic sighs were observed,coagulation function,hepatic and renal function,liver histopathological morphology,peptide toxin concentration in plasma and urine were detected during the experiment.Results Total peptide toxins in Amanita exitialis was (3 482.6 ± 124.94) mg/ kg.All the beagles had toxic signs including vomiting and diarrhea in 12-48 h after ingestion.On 24 h after ingestion,the beagles' ALT,AST,TBIL,ALP,PT and APTT levels increased obviously.On 36 h after ingestion,the beagles' ALT,AST,PT and APTT values reached their peaks (ALT:283.2 ± 112.9 Kallmann unit;AST:223.9 ±93.8 Kallmann units;PT:132.9 ± 152.6 s;APTT:131.4 ± 153.9 s).On 48 h after ingestion,the beagles' TBIL and ALP levels reached their peaks (TBIL:23.3 ± 14.6 mol/L;ALP:274.5 ± 115.5 U/L).The beagles' TBIL,TP and APTT returned to normal 1 week after ingestion,their ALT,AST and ALP levels returned to normal 3 weeks after ingestion.Three dogs died during 24-72 h after ingestion.Liver histopathological morphology study showed hemorrhagic necrosis of hepatocytes.Peptide toxins can be detected in plasma within 24 h after ingestion.Peptide toxins can be detected in urine within 96 h after ingestion.Conclusion Amanita peptide toxins can cause hemorrhagic necrosis of liver cells and lead to acute liver failure.This model is consistent with clinical pathophysiological process of acute toxic liver failure induced by mushrooms containing peptide toxins,and it can be applied to the study of diagnosis and treatment of poisoning induced by mushrooms containing peptide toxins.

Objective To investigate the clinicopathological characteristics and significance of solid, endometrioid and transitional (SET) ovarian high-grade serous carcinoma (HGSC). Methods A total of 408 cases of ovarian HGSC admitted to Peking University People's Hospital from January 2011 to September 2016 were collected. (1) According to the proportion of tumors with SET form in all tumors, they were divided into three groups: HGSC-classic group (<25%), HGSC-SET Ⅰ (25%-50%) and HGSC-SETⅡ (>50%) group. The clinical and pathological characteristics of three groups of ovarian HGSC patients were compared respectively. (2) According to the growth pattern, that was, the proportion of pushing/expanding invasive tumors in the whole pelvic disseminated tumors of pelvic disseminated tumors, the three groups were divided into four subgroups: group A (0-25%), group B (26%-50%), group C (51%-75%) and group D (>75%). Differences in progression-free survival (PFS) among the four subgroups in each group were compared respectively. Results The median age of 408 cases with ovarian HGSC was 63.3 years (47-78 years), including 152 cases premenopausal and 256 cases postmenopausal. Among 408 cases of ovarian HGSC, 290 cases were in HGSC-classic group, 91 cases in HGSC-SETⅠand 27 cases in HGSC-SET Ⅱ group. (1) There were significant differences in age, proportion of menopausal patients, tumor necrosis (including map necrosis or acne necrosis), response rate to primary chemotherapy, 5-year mortality rate and PFS between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P<0.05). There was no significant difference among the above indexes between HGSC-SETⅠand HGSC-SETⅡ(P>0.05). In HGSC-classic group, HGSC-SET Ⅰ and HGSC-SET Ⅱ, the proportion of family members or patients with history of epithelial ovarian cancer or breast cancer increased in turn, and the detection rate of serous tutal intraepithelial carcinoma (STIC) in fallopian tube tissue decreased in turn. There were significant differences between the two groups (P<0.05). (2) In HGSC-classic group, there were 147 cases in group A, 124 cases in group B and 19 cases in group C (0 case in group D), with median PFS of 17.4, 17.7 and 16.5 months respectively (P<0.05); 10, 6, 29 and 46 cases in group A, B, C and D in HGSC-SETⅠ, with median PFS of 9.6, 12.7, 30.1 months and 39.0 months respectively, which there were significant difference among group A and C and D (all P＜0.05); among group B, C and D group in HGSC-SET Ⅱ, there were respectively 3, 12 and 12 cases (0 case in group A), and the median PFS was 13.5, 34.2 and 47.8 months (P＜0.05). PFS was positively correlated with the increase of push/expansive infiltration ratio. Conclusions The detection rate of STIC in ovarian HGSC patients with SET is higher, the effect of primary chemotherapy is better, and PFS is prolonged. PFS was significantly prolonged in patients with pelvic disseminated tumors of HGSC-SET, the infiltration of which were predominated by pushing or expanding boarder.

Objective To investigate the prevalence and related factors of musculoskeletal diseases in nurses by means of qualitative and quantitative research, and to have a discussion on the inner experiences of nurses. Methods 1 012 clinical nurses, from one hospital during March 2019 to May 2019, were selected as research objects by convenience sampling method. The Nordic musculoskeletal disease questionnaire was used for investigation,and SPSS 21.0 was used for statistical analysis. In the qualitative study,5 ICU nurses were selected by objective sampling method. Data were collected by semi-structured interview method,and analyzed by content analysis method. Results The annual prevalence rate of musculoskeletal diseases in clinical nurses was mainly in the neck (53.2%, 538/1 012), followed by the waist and back (48.5%, 491/1 012), hip and leg (45.2%, 457/1 012). Logistic regression analysis of neck related factors showed that BMI (P=0.039), repeated operation for one minute (P=0.007), and staff shortage in the Department (P=0.027) were the influencing factors of musculoskeletal diseases. Qualitative research extracted the following two themes:negative psychological experience of nurses under high workload and positive psychological experience of nurses. Conclusion The prevalence of neck is the highest among those of other musculoskeletal diseases in clinical nurses, which is related to many related factors. In the professional environment of nurses, nurses have high self-protection willingness and ability. It is suggested to strengthen support from hospital, family and other aspects, reduce the prevalence rate, and improve the quality of work and family life of nurses.

Objective To systematically review the influencing factors of non-specific low-back pain among nurses in China. Methods The formal and published articles were retrieved based on the search terms of nurses, low-back pain and factors in Chinese National Knowledge Infrastructure (CNKI), WanFang data, VIP, China Biology Medicine Database, PubMed, Web of Science and Cochrane Library, and with the methods of "snowball" and manual searching from 31st January 2004 to 30th April 2019. RevMan 5.3 was used to meta-analysis for included articles. Results This systematic review and Meta-analysis totally included 11 articles involving 11 097 nurses, and extracted 7 influencing factors of low-back pain with OR value ＞1. There were three factors related to low-back pain including advanced working ages (OR=2.09, 95% CI: 1.55-2.82), being married (OR=1.67, 95% CI: 1.11-2.50) and being on night shift in turn (OR=1.29, 95% CI: 1.14-1.46). There still lacked strong evidences in whether ages, positional titles, education levels and departments influenced low-back pain of nurses. Conclusions Main influencing factors of non-specific low-back pain among nurses in China are advanced working ages, being married and being on night shift in turn. There are no statistical differences in the influences of ages, positional titles, education levels and departments on low-back pain of nurses. Intervention should be conducted from aspects of nurses and hospital management.

Objective:To evaluate the MAPO index of work-related musculoskeletal disorders (WMSDs) among ward nurses who manually handled patients, and to explore the influencing factors of WMSDs in the workplace.Methods:From March to May 2019, convenience sampling method was used to select 317 nurses from 26 wards of a ClassⅢ Grade A hospital. The General Information Questionnaire, MAPO index assessment, and the meter ruler were used to comprehensively evaluate the situation of WMSDs in the workplace of nurses who manually handled patients inwards with the method of on-site investigation and measurement. According to the score of the MAPO index, there were 3 risk levels of wards, namely red light, yellow light, and green light. The yellow light meant that it was necessary to implement the medium-term and long-term intervention plan, and the red light meant that the short-term intervention plan must be implemented. Multivariate Logistic regression was used to analyze the influencing factors of WMSDs in nurses who manually handled patients in the ward.Results:A total of 317 questionnaires were distributed and 265 valid questionnaires were returned with an effective response rate of 83.6%. In the 265 ward nurses, there were 76.2% (202/265) of nurses with WMSDs. There were 13 (50.0%, 13/26) wards with red lights, including 158 (59.6%, 158/265) nurses, and 6 (23.1%, 6/26) wards with yellow lights, including 92 (34.7%, 92/265) nurses, and 7 (26.9%, 7/26) wards with green lights, including 15 (5.7%, 15/265) nurses. Multivariate Logistic regression analysis showed that MAPO index and the ward score were the influencing factors for the occurrence of WMSDs among ward nurses with statistical differences ( OR=1.056, 1.571; P<0.05) . Conclusions:The risk of WMSDs in the workplace of ward nurses is high. It is recommended starting with the types of beds, bed spacing, auxiliary equipment, nursing human resource allocation, and occupational protection training to reduce the occurrence of WMSDs in nurses.

Objective:To explore the effects of Baduanjin combined with resistance exercise in rural elderly.Methods:From May to September 2020, totally 80 aged people from 2 villages in Hebei province were selected by convenient sampling. Patients from one village were randomly included into an intervention group ( n=40) , and patients from the other village were included into a control group ( n=40) . Patients in the control group took daily activities and exercise, and received only health education, while patients in the intervention group practiced Baduanjin combined with resistance exercise in addition to daily activities. The Chinese version of Fried Frailty Phenotype Assessment Components, Time Up and Go Test (TUGT) , Five-Times Sit-to-Stand Test (FTSST) , and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the frailty, balance ability, lower limb muscle strength, and sleep quality of the two groups of rural elderly before and after the intervention. In this study, totally 80 questionnaires were distributed, and 78 valid questionnaires were recovered, accounting for an effective recovery rate of 97.5%. Results:The Chinese version of Fried Frailty Phenotype Assessment Components and PSQI scores of the rural elderly in the intervention group after the intervention were lower than those in the control group and before the intervention, and the differences were statistically significant ( P<0.05) . The TUGT and FTSST time of the rural elderly in the intervention group after the intervention were shorter than those in the control group and before the intervention, and the differences were statistically significant ( P<0.01) . Conclusions:Baduanjin combined with resistance exercise can delay the debilitating state of rural elderly, improve their lower limb muscle strength, balance ability and sleep quality, and enrich their exercise methods.

Objective:To construct an Omaha system-based remote intervention program for clinical nurses' neck, shoulder and low back pain and evaluate its effect.Methods:From July to October 2020, 94 nurses with neck, shoulder and low back pain in a Class Ⅲ hospital were randomly selected by ward. Using the envelope method, nurses were randomly divided into the intervention group and the control group, with 47 cases in each group, among them, the intervention group dropped 1 and the remaining 46 persons, the control group dropped 4 and the remaining 43 persons. The intervention group conducted a remote intervention program (using Omaha system as the theoretical framework, and using literature review, semi-structured interviews and expert consultation to construct a remote intervention program for clinical nurses' neck, shoulder and low back pain) . The control group used conventional guidance. The General Information Questionnaire, Exercise Compliance Questionnaire, Knowledge-Behavior-Symptoms (K-B-S) and Visual Analog Scale (VAS) were used to evaluate the intervention effect.Results:The exercise compliance of nurses in the intervention group was 78.26% (36/46) and that in the control group was 39.53% (17/43) , the difference was statistically significant ( P<0.01) . After 6 weeks of intervention, the nurses' cognitive and behavior scores in the intervention group were higher than those in the control group, and the difference was statistically significant ( P<0.05) . There was no statistically significant difference in the symptom score between the two groups ( P>0.05) . The VAS score and frequency of neck, shoulder and low back pain were lower than those of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:Based on Omaha system, the remote intervention program for the clinical nurses' neck, shoulder and low back pain is safe, scientific and theoretical. It can improve cognition and behavior of neck, shoulder and low back pain nurses, reduce the intensity and frequency of pain, and the nurses have good compliance.

Objective:To construct a training program for the life care and caring abilities of home caregivers for the aged with cognitive impairment, so as to provide a basis for conducting training.Methods:From April to May 2021, a preliminary training program was developed through literature review and group discussion. From June to July 2021, purposive sampling was used to select 12 experts from Beijing city, Hebei and Hunan provinces to conduct two rounds of Delphi expert consultation, and finally a training program for life care and caring abilities of home caregivers for the aged with cognitive impairment was constructed.Results:The effective recovery rate of the questionnaire from two rounds of expert consultation was 100.00% (12/12). The authority coefficient of 12 experts was 0.891. The Kendall's W of the first, second, and third level indicators in the second round of consultation were 0.417, 0.205 and 0.200 respectively ( P<0.05). After the second round of consultation, the average value of each item's importance assignment was > 3.500, and the coefficient of variation was < 0.250. The final training program for the life care and caring abilities of home caregivers for the aged with cognitive impairment included 4 training modules, 11 training items, and 35 training content. Training forms included PPT teaching, video learning, case analysis, role playing, operational demonstrations, practical exercises, caregiver self-sharing, and other forms. Conclusions:The training program for life care and caring abilities of home caregivers for the aged with cognitive impairment has good scientific and practical significance, and can provide a basis for the training of home caregivers for the aged with cognitive impairment.

Background/Aims: Ubiquitination is widely involved in the progression of hepatocellular carcinoma (HCC) by regulating various cellular processes. However, systematic strategies for screening core ubiquitin-related genes, clarifying their functions and mechanisms, and ultimately developing potential therapeutics for patients with HCC are still lacking. Methods: Cox and LASSO regression analyses were performed to construct a ubiquitin-related gene prediction model for HCC. Loss- and gain-of-function studies, transcriptomic and metabolomics analysis were used to explore the function and mechanism of UBE2S on HCC cell glycolysis and growth. Results: Based on 1,423 ubiquitin-related genes, a four-gene signature was successfully constructed to evaluate the prognosis of patients with HCC. UBE2S was identified in this signature with the potential to predict the survival of patients with HCC. E2F2 transcriptionally upregulated UBE2S expression by directly binding to its promoter. UBE2S positively regulated glycolysis in a HIF-1α-dependent manner, thus promoting the proliferation of HCC cells. Mechanistically, UBE2S enhanced K11-linkage polyubiquitination at lysine residues 171 and 196 of VHL independent of E3 ligase, thereby indirectly stabilizing HIF-1α protein levels by mediating the degradation of VHL by the proteasome. In particular, the combination of cephalomannine, a small molecule compound that inhibits the expression of UBE2S, and PX-478, an inhibitor of HIF-1α, significantly improved the anti-tumor efficacy. Conclusions UBE2S is identified as a key biomarker in HCC among the thousands of ubiquitin-related genes and promotes glycolysis by E3 enzyme-independent ubiquitination, thus serving as a therapeutic target for the treatment of HCC.