Objective To explore the clinical efficacy of repeated transcranial magnetic stimulation(rTMS)and acupuncture therapy in the treatment of chronic insomnia disorder(CID)patients.Methods A total of 80 patients with CID,who were treated at Nanchang First Hospital from January 2022 to December 2023,were selected for the study.The patients were randomly divided into control group and treatment group,with 40 cases in each group.The control group patients were treated with dexmedetomidine,while the treatment group patients received rTMS and acupuncture therapy in addition to control group.The treatment course was 4 weeks,and the sleep quality,sleep related indicators,and psychological condition improvement of both groups of patients were observed before and after treatment.Results After treatment,the Pittsburgh sleep quality index scores of both groups of patients decreased(P＜0.05);The sleep latency and number of awakenings were lower than before treatment(P＜0.05),and the total sleep time,sleep efficiency,and proportion of rapid eye movement sleep were higher than before treatment,treatment group showed more significant improvement than control group(P＜0.05).After treatment,the Hamilton anxiety and depression scale scores of both groups of patients decreased compared to before treatment,but there was no statistically significant difference in control group before and after treatment(P＞0.05).However,there was a statistically significant difference in treatment group before and after treatment(P＜0.05).Conclusion The combination of rTMS and acupuncture treatment can significantly improve the sleep quality of CID patients,while also reducing the accompanying symptoms of anxiety and depression.

Objective To explore the efficacy and prognostic independent factors of modified island flap(OIF)and urethroplasty(tip)in the treatment of hypospadias in children.Methods The 164 children with hypospadias analyzed retrospectively were treated from February,2013 to February,2021.They were divided into two groups according to the operation method.82 patients in tip group were treated with tip and 82 patients in OIF group were treated with OIF.The treatment effects of the two groups were compared.Then they were divided into two groups according to the cure condition,namely,the good prognosis group(cured by operation,151 case)and the poor prognosis group(not cured by operation,13 case).Independent factors affecting the prognosis of children were analyzed by binary logistic regression.Results The cure rate of OIF group was 96.34％,which was higher than that of the tip group(87.8％),and the incidence of postoperative complications in OIF group was 7.32％,which was lower than that of the tip group(23.17％,P＜0.05).The operation time in tip group(95.95±12.35)min,which was shorter than that of the OIF group(P＜0.05).At the same time,the binary logistic regression analysis showed that the degree of hypospadias and the classification of barcat were the prognostic factors of children with hypospadias.The degree of penis bending,the width of penis head and the method of operation were suspicious factors.Conclusion OIF and tip have good effects in the treatment of hypospadias in children.OIF has a higher success rate,tip has a shorter operation time and fewer postoperative complications.However,the independent factors affecting the prognosis of children are preoperative hypospadias classification and barcat classification.This operation method is not an independent factor affecting the prognosis.

Taking medical statistics major in Binzhou Medical University as an example, based on the outcome-based education theory, in order to enhance the innovation ability of university students, we put forward the systematic second classroom training system, including improving the personnel training system, implementing education, experiment teaching reform, and practice teaching reform. It has achieved outstanding results in the discipline competition, improved social service ability and high degree of employer satisfaction. The systematic second-class talent training system based on the outcome-based education theory can provide reference for other medical colleges and related applied majors.

BACKGROUND: T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domains (TIGIT), an inhibitory receptor expressed on T cells, plays a dysfunctional role in antiviral infection and antitumor activity. However, it is unknown whether TIGIT expression on T cells influences the immunological effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivated vaccines. METHODS: Forty-five people living with HIV (PLWH) on antiretroviral therapy (ART) for more than two years and 31 healthy controls (HCs), all received a third dose of a SARS-CoV-2 inactivated vaccine, were enrolled in this study. The amounts, activation, proportion of cell subsets, and magnitude of the SARS-CoV-2-specific immune response of TIGIT + CD4 + and TIGIT + CD8 + T cells were investigated before the third dose but 6 months after the second vaccine dose (0W), 4 weeks (4W) and 12 weeks (12W) after the third dose. RESULTS: Compared to that in HCs, the frequency of TIGIT + CD8 + T cells in the peripheral blood of PLWH increased at 12W after the third dose of the inactivated vaccine, and the immune activation of TIGIT + CD8 + T cells also increased. A decrease in the ratio of both T naïve (T N ) and central memory (T CM ) cells among TIGIT + CD8 + T cells and an increase in the ratio of the effector memory (T EM ) subpopulation were observed at 12W in PLWH. Interestingly, particularly at 12W, a higher proportion of TIGIT + CD8 + T cells expressing CD137 and CD69 simultaneously was observed in HCs than in PLWH based on the activation-induced marker assay. Compared with 0W, SARS-CoV-2-specific TIGIT + CD8 + T-cell responses in PLWH were not enhanced at 12W but were enhanced in HCs. Additionally, at all time points, the SARS-CoV-2-specific responses of TIGIT + CD8 + T cells in PLWH were significantly weaker than those of TIGIT - CD8 + T cells. However, in HCs, the difference in the SARS-CoV-2-specific responses induced between TIGIT + CD8 + T cells and TIGIT - CD8 + T cells was insignificant at 4W and 12W, except at 0W. CONCLUSIONS TIGIT expression on CD8 + T cells may hinder the T-cell immune response to a booster dose of an inactivated SARS-CoV-2 vaccine, suggesting weakened resistance to SARS-CoV-2 infection, especially in PLWH. Furthermore, TIGIT may be used as a potential target to increase the production of SARS-CoV-2-specific CD8 + T cells, thereby enhancing the effectiveness of vaccination.
Humans ; Antibodies, Viral ; CD8-Positive T-Lymphocytes ; COVID-19/complications* ; COVID-19 Vaccines/immunology* ; HIV Infections/complications* ; Receptors, Immunologic ; SARS-CoV-2

To explore the pharmacogenomic markers that affect the platinum-based chemotherapy response in non-small-cell lung carcinoma (NSCLC), we performed a two-cohort of genome-wide association studies (GWAS), including 34 for WES-based and 433 for microarray-based analyses, as well as two independent validation cohorts. After integrating the results of two studies, the genetic variations related to the platinum-based chemotherapy response were further determined by fine-mapping in 838 samples, and their potential functional impact were investigated by eQTL analysis and in vitro cell experiments. We found that a total of 68 variations were significant at P < 1 × 10^-3 in cohort 1 discovery stage, of which 3 SNPs were verified in 262 independent samples. A total of 541 SNPs were significant at P < 1 × 10^-4 in cohort 2 discovery stage, of which 8 SNPs were verified in 347 independent samples. Comparing the validated SNPs in two GWAS, ADCY1 gene was verified in both independent studies. The results of fine-mapping showed that the G allele carriers of ADCY1 rs2280496 and C allele carriers of rs189178649 were more likely to be resistant to platinum-based chemotherapy. In conclusion, our study found that rs2280496 and rs189178649 in ADCY1 gene were associated the sensitivity of platinum-based chemotherapy in NSCLC patients.

Corona virus disease 2019 （COVID-19） has led to more than 500 million cases， including 6.19 million deaths. Mutated strains of SARS-CoV-2 （alpha， beta， gamma， delta and omicron） have successively emerged. Currently the omicron variant is gradually replacing the delta variant， driving a surge of cases in most countries including China， posing a great challenge to the prevention and treatment of COVID-19. In the face of the severe pandemic situation， a large number of non-medical volunteers are fighting on the front lines of the war against the pandemic and are vulnerable to exposure due to lack of professional knowledge. This paper introduces the routine skills training of volunteers and emergency response， aiming to provide behavioral guidance for non-medical volunteers in designated isolation facilities.

OBJECTIVE: To investigate the effect of calmodulin (CaM) and its mutants on binding to voltage-gated Na channel isoleucine-glutamine domain (Na1.2 IQ). METHODS: The cDNA of Na1.2 IQ was constructed by PCR technique, CaM mutants CaM, CaM and CaM were constructed with Quickchange site-directed mutagenesis kit (QIAGEN). The binding of Na1.2 IQ to CaM and CaM mutants under calcium and calcium free conditions were detected by pull-down assay. RESULTS: Na1.2 IQ and CaM were bound to each other at different calcium concentrations, while GST alone did not bind to CaM. The binding affinity of CaM and Na1.2 IQ at [Ca]-free was greater than that at 100 nmol/L [Ca] ( < 0.05). In the absence of calcium, the binding amount of CaM wild-type to Na1.2 IQ was greater than that of its mutant, and the binding affinity of CaM to Na1.2 IQ was the weakest among the three mutants ( < 0.05). CONCLUSIONS The binding ability of CaM and CaM mutants to Na1.2 IQ is Ca-dependent. This study has revealed a new mechanism of Na1.2 regulated by CaM, which would be useful for the study of ion channel related diseases.
Calcium ; metabolism ; Calmodulin ; genetics ; metabolism ; Mutation ; NAV1.2 Voltage-Gated Sodium Channel ; metabolism ; Protein Binding ; genetics

Objective To investigate the citizen's attitude towards the cognition of brain death and the legislation of brain death criteria. Methods A questionnaire survey was performed in 1 500 outpatients or accompanying personnel by the convenient sampling method. The questionnaire data were independently recorded by two professionals using the Epidata 3.02 software. The factors influencing the citizen's support of the legislation of brain death were analyzed by univariate and multivariate Logistic regression models. Results Among 1 433 eligible respondents, 84.65% (1 213/1 433) of them knew brain death, and 24.32% (295/1 213) considered brain death as a reasonable criterion for death. The proportion of respondents who supported and opposed the legislation of brain death was 49.79% (604/1 213) and 17.31% (210/1 213).Male [odds ratio (OR)=1.3, 95% confidence interval (CI) 1.0-1.6], those with junior college degree or above at educational level (OR=1.5, 95%CI 1.1-1.9), those whose relatives and friends were engaged in organ donation (OR=3.3, 95%CI 1.1-10.3), those who participated in public welfare activities of organ donation (OR=3.1, 95%CI 1.6-6.0) and those who regarded brain death as a reasonable criterion for death (OR=2.0, 95%CI 1.5-2.6) were more inclined to support the legislation of brain death, which were the independent influencing factors of the legislation of brain death (all P < 0.05). Conclusions Citizens have relatively low cognition and support of the legislation of brain death criteria. Relevant propaganda on brain death should be widely carried out to strengthen the citizen basis for the legislation.

Objective To investigate the correlation between tumor perfusion parameters and tumor volume and Child-Pugh classification in CT of hepatocellular carcinoma (HCC).Methods Fifty-six patients with hepatocellular carcinoma were selected to perform CT perfusion imaging.The parameters of the total tumor perfusion such as hepatic artery perfusion (HAP),portal vein perfusion (PVP)and hepatic perfusion index (HAPI)were calculated according to the degree of hepatic encephalopathy,albumin,bilirubin, clotting time,ascites for liver Child-Pugh classification.The relationship between the tumor or peritumoral perfusion parameters with tumor volume and Child-Pugh classification were analyzed.Results (1)There was no correlation between tumor or peritumoral perfusion with the tumor volume.(2)The difference of HAP,PVP and HAPI between the different Child-Pugh classification groups was statistically significant (P<0.000 1).(3)With the reduction of Child-Pugh classification,the tumor body HAP and HAPI values gradually decreased, while the PVP value increased gradually.Conclusion There is no correlation between the tumor volume of hepatocellular carcinoma with total tumor perfusion parameters.The differences in perfusion measurements between different Child-Pugh classification can intuitively and quantitatively reflect the reserve function of the liver.

Objective According to the analysis on nonconformities which were found from on-site assessmentin medical laboratory ISO15189accreditationcarried on byChina National Accreditation Service for Conformity Assessment(CNAS) during years 2004to 2013,to study current status of quality management in domestic medical laboratory.Methods By means of retrospective analysis, nonconformities found in 171 times of on-site audit of 133 clinical laboratories in ISO15189 accreditation during 2004 to 2013 were collected and then classified according to requirements of ISO 15189.Results Among 1 501 nonconformities involved in 171 times of on-site audit, management and technical requirements accounted for 28.5%(428) and 71.5% ( 1073 ) respectively.The mainly clauses of nonconformity were 4.3 ( 26.2%) and 4.6 (12.6%) in management requirements and 5.3 ( 25.2%), 5.4 ( 13.1%), 5.5 ( 16.0%) and 5.6 (20.2%)in technical requirements.The mainly subclauses of technical requirements were 5.3.2, 5.3.7, 5.4.3, 5.4.9, 5.5.2, 5.5.3, 5.6.1, 5.8.3 and 5.8.10.Conclusion The weakness for the medical laboratory quality management is mainly process control(5.4, 5.5 ,5.6), laboratory equipments (5.3), document control (4.3) and external services and supplies (4.6), which werethe main directions need to be improved in current medical laboratory quality management.