Objective To observe the effect of Tanggankang on the expression of CREB in diabetic-fatty liver rats;To investigate the mechanism of Tanggankang. Methods STZ and feeding high fat forage induced diabetic rats were randomly divided into model group, Huganning group, Tanggankang high dose group, Tanggankang medium dose group, Tanggankang low dose group, 10 rats in each group, with 10 normal rats as control. After 12 weeks of drug intervention, rats were killed, the livers were removed, and the expression of CREB was detected by Western blot. Results Compared with normal group, the level of CREB of model group was significantly decreased (P<0.01). Compared with model group, Tanggankang low, medium and high dose group significantly decreased the level of CREB (P<0.01). Conclusion Tanggankang may play an active role in glucose and lipid metabolism by affecting the expression of CREB.

Objective:To observe the effect of Tangshenning on renal function and LOX-1 mRNA expression in the kidney of early diabetic nephropathy rats model. Methods:Early diabetic nephropathy rats model was made with high fat diet, STZ and unilateral ne-phregtomy. After the 12-week drug intervention, the rats were sacrificed, the kidneys were removed and the mRNA expressions of LOX-1 in the kidney were observed by the method of RT-PCR. Results:Early diabetic nephropathy rats model was successfully made by the triple-modeling method. The mRNA expression of LOX-1 in the kidney was significantly increased, and Tangshenning could low-er the expression of LOX-1 in the kidney in a dose-dependent manner. Conclusion:The abnormal expression of LOX-1 could be one of the mechanisms for diabetic nephropathy. Tangshening has good kidney protective effect through decreasing LOX-1 abnormal expression in the kidneys, which deserves further research.

Objective To summarize the experience of diagnosis and treatment of occult spontaneous pneumothorax in young adults.Methods To review and summarize the imaging data and treatment process of 22 cases of occult spontaneous pneumothorax.Results Surgical treatment was performed in 22 patients.Among them,VATS operation in 18 cases,VATMoperation in 4 cases.Operation difficulty was severe adhesion free existed in the apex of lung and pleural top.22 patients with the successful completion of the operation,no major bleeding during the operation,no open chest surgery.1 -3 years follow -up without recurrence.Conclusion Surgical treatment is the first choice for occult spontaneous pneumothorax in young adults.Often due to severe adhesion of the chest,surgery is difficult,the surgeon should be fully prepared before surgery.Patients with good prognosis,due to the difficulty of early diagnosis,clinicians should pay attention to.

Objective To explore the application of a three-dimensional simulation system in extended liver resections.Methods A three-dimensional surgical simulation system was used for preoperative assessment and for computer simulation to estimate the resected liver volume,the residual liver volume,and the surgical resection margins.The software virtual liver resection was used to choose the most optimal surgical option.The actual resection,the postoperative liver volume and the actual surgical resection margins were compared.Results 1 patient was diagnosed by ultrasound to develop ascites on post-operative day 2.Another patient was diagnosed by transthoracic ultrasound to have moderate pleural effusion on postoperative day 1.Postoperative liver failure developed in 1 patient.There was no patient who developed bile leakage.The average length of stay was 6 ～ 85 days (average 22 d).There was no recurrence within 1 month after surgery and there was no postoperative deaths.Condusions The three-dimensional surgery simulation system was effective.It gave an accurate evaluation and simulation of the liver surgery.In extended liver resection,it gave good guidance and help.

Betacellulin (BTC) is one of "islets regeneration factors" which received more and more attention these years. BTCe is the C-terminal 50-residue region of mature BTC protein and can bind with erbB-1?erbB-4 receptor. It has the same mitogenic activity on cells as the whole section. BTC and BTCe can improve the level of glucose-stimulated insulin secretion (GSIS) during islets culture in vitro though they had no effect on the acute insulin secretion. BTCe also effectively ameliorated the hyperglycemia of STZ-induced diabetic rats by a single plasmid injection into muscle of rats. It is supposed that BTCe promote the proliferation of PDX-1 positive cells or repair some signal transduction pathway. Perhaps the latter is more important.

Objective To investigate the role of microRNA-192 (miR-192) in the regulation of epithelial mesenchymal transition induced by advanced glycation end products (AGEs) in human peritoneal mesothelial cells.Methods The human peritoneal mesothelial cells,the human peritoneal mesothelial cells transfected by miR-192 inhibitor and the human peritoneal mesothelial cells transfected by miR-192 inhibitor negative control were cultured for 72 hours in culture medium containing AGEs (80mM);M199 medium and medium with M199 medium containing 80mM BSA as negative control,the expression of miR-192 and mRNA was detected by real-time quantitative PCR,and the expression of miR-192 and mRNA was detected by Western blotting.Results AGEs significantly upregulated the expression of miR-192,Collagen Ⅰ mRNA,α-smooth muscle actin (α-SMA) mRNA and protein(P ＜ 0.05),while significantly downregulated the E-cadherin mRNA and protein expression(P ＜ 0.05).Compared with human peritoneal mesothelial cells transfected by miR-192 inhibitor,the expression of miR-192 and Collagen Ⅰ mRNA and α-SMA mRNA and protein was decreased (P ＜0.05),while E-cadherin mRNA and protein expression was significantly increased (P ＜ 0.05).Conclusion AGEs may induce EMT of human peritoneal mesothelial cells by upregulation of miR-192 expression.MiR-192 inhibitor may prevent AGEs-inducing EMT of human peritoneal mesothelial cells by down-regulation of miR-1 9 2 expression,and may play an important regulatory role in EMT of human peritoneal mesothelial cells induced by AGEs.

Objective To investigate the role of microRNA-192 (miR-192) in the regulation of epithelial mesenchymal transition induced by advanced glycation end products (AGEs) in human peritoneal mesothelial cells.Methods The human peritoneal mesothelial cells,the human peritoneal mesothelial cells transfected by miR-192 inhibitor and the human peritoneal mesothelial cells transfected by miR-192 inhibitor negative control were cultured for 72 hours in culture medium containing AGEs (80mM);M199 medium and medium with M199 medium containing 80mM BSA as negative control,the expression of miR-192 and mRNA was detected by real-time quantitative PCR,and the expression of miR-192 and mRNA was detected by Western blotting.Results AGEs significantly upregulated the expression of miR-192,Collagen Ⅰ mRNA,α-smooth muscle actin (α-SMA) mRNA and protein(P ＜ 0.05),while significantly downregulated the E-cadherin mRNA and protein expression(P ＜ 0.05).Compared with human peritoneal mesothelial cells transfected by miR-192 inhibitor,the expression of miR-192 and Collagen Ⅰ mRNA and α-SMA mRNA and protein was decreased (P ＜0.05),while E-cadherin mRNA and protein expression was significantly increased (P ＜ 0.05).Conclusion AGEs may induce EMT of human peritoneal mesothelial cells by upregulation of miR-192 expression.MiR-192 inhibitor may prevent AGEs-inducing EMT of human peritoneal mesothelial cells by down-regulation of miR-1 9 2 expression,and may play an important regulatory role in EMT of human peritoneal mesothelial cells induced by AGEs.

Objective:To explore the influencing factors of clinical nurses in general hospitals to carry out hospice care under hospice shared care model, and further improve the quality of hospice care in general hospitals under this mode.Methods:Using the descriptive phenomenological research method, 13 clinical nurses from Sir Run Run Shaw Hospital Affiliated to Medical School of Zhejiang University were selected by purposive sampling from June to September 2023. Semi-structured interviews were conducted based on the capacity opportunity-motivation-behavior model, and Colaizzi′s 7-step analysis method was used to summarize and refine the theme.Results:There were 3 males and 10 females, aged 24-38 years old. Three themes and 11 sub-themes were extracted in this study: ability factors (theoretical knowledge cannot meet clinical needs, lack of clinical practice ability, insufficient self emotional regulation ability), motivation factors (willingness to carry out hospice shared care model, sense of professional benefit, professional identity, perception of care pressure, hospice care self-efficacy), opportunity factors (the influence of Confucian culture, systematic construction of hospice shared care model in hospitals, and multiple external support).Conclusions:Nurses' hospice care under hospice shared care model is affected by internal and external factors. Nurses can learn through multiple channels, find positive work experience, and use multi-dimensional support system to provide high-quality hospice care services for patients.