Objective To explore the professional identity of medical students with long education periods and its influencing factors.Methods Survey on professional identity was conducted through self-designed questionnaire among 665 medical students with long education periods of every grade.Single factor analysis of variance and t test were applied to do statistical analysis.Results There were significantly statistical differences in influencing factors of professional identity among every grade of long periodical medical students (P ＜ 0.05).There were significant statistical differences among influencing factors of sex,educational background of parents and residing(P ＜ 0.05).Conclusions Because of characteristics of medical education and psychological changes of students,professional identity of students shows a first decline and then an increase.Personal and environmental factors exert influences on professional identity at varying degrees.

[Objective]To investigate associations between the functional polymorphisms of signal transducer and activator of transcription 4 (STAT4) gene and preeclampsia.[Methods]PCR-restriction fragment length polymorphism was used to genotype rs10181656 and rs16833431 local polymorphism in 228 preeclampsia cases and 179 normal controls.[Results](1)The frequencies of rs10181656C/G were 35.96%,46.37%in genotype C/C,47.81%,44.69%in genotype C/G and 16.23%,8.94%in genotype G/G between preeclampsia patients and normal controls. They reached statistical difference (P = 0.031). There was different distribution in two alleles(C and G)between preeclampsia patients and normal controls(P=0.009).(2)There was no different distribution in 3 genotypes(C/C,C/T,T/T)and 2 alleles(C and T)of rs16833431 C/T between preeclampsia patients and normal controls(P =0.508,0.461).[Conclusions]Functional polymorphisms of the rs10181656 locus could associate with the preeclampsia. The polymor-phisms of the rs16833431 locus could not associate with the preeclampsia.

[Objective]Dysregulated long noncoding RNAs(lncRNAs)have been found involved in human diseases,including cancers. Long non-coding RNA growth arrest-specific 5(GAS5)was reported to be dysregulated in different types of cancers. Howev-er,the role of GAS5 in ovarian cancer remains elusive.[Methods]In the present study,the expression of GAS5 was detected in 108 ovarian cancer tissues and compared adjacent normal tissues by quantitative real-time PCR(qRT-PCR).[Results]The results showed that the expression levels of lncRNA GAS5 were significantly decreased in cancer tissues(P=0.0004),and it was negatively correlated with tumor size(<5 cm vs.>5 cm,P<0.0001),invasion depth(T1-T2 vs. T3-T4,P=0.0021),and tumor grade(Ⅰ~Ⅱgrades vsⅢ~Ⅳgrades,P=0.0086)in ovarian cancer patients. Kaplan-Meier analysis demonstrated that decreased lncRNA GAS5 expression contributed to poor disease-free survival and overall survival.[Conclusion]In conclusion ,our study suggested that decreased lncRNA GAS5 expression may beidentified as a potential poor prognostic biomarker in ovarian cancer.

Objective To express EV71 VP1 in prokaryotic expression system,initially evaluate the ability of blocking EV71 infection and the neutralizing activity of its polyclonal antibody.Methods Construct the prokaryotic expression plasmid pET30a (+)-VP1.Induced expression in Transetta (DE3) with IPTG and identified by Western blot.After purified with HisBind Protein Purification Kit,its ability of blocking EV71 infection and the neutralizing activity of its polyclonal antibody were analyzed.Results Plasmid PET-30a(+)-VPI was constructed successfully and the objective protein was expressed effectively.The ELISA titer of the polyclonal antibody was 1:3200 while neutralizing titer was 1:16 and the recombination protein lost the ability of blocking EV71 infection.Conclusion The recombination protein can stimulate mice to produce antibodies and the polyclonal antibody shew neutralizing activity but the recombination protein lost the binding activity to receptors probably due to the wrong advanced structure.

Objective To investigate the association between the functional polymorphisms of Foxp3 gene and unexplained recurrent spontaneous abortion (URSA).Methods PCR-restriction fragment length polymorphism (rs3761548,rs2294021 ) and PCR with sequence-specific primers (rs2232365,rs5902434) were used to detect four polymorphisms of Foxp3 in 146 URSA cases and 112 normal controls.Results ( 1 ) The frequencies of rs3761548A/C were 10.3％,22.3％ in genotype C/C,38.4％,40.2％ in genotype A/C and 51.4％,37.5％ in genotype A/A between URSA patients and normal controls; the frequencies of rs2232365A/G were 5.5％,15.2％ in genotype A/A,47.9％,50.0％ in genotype A/G,46.6％,34.8％ in genotype G/G between URSA patients and normal controls; they all reached statistical difference ( P＜0.05 ).The carriers of rs3761548A allele and rs2232365G allele increased the risk of URSA (OR=1.73,1.61 ; all P ＜ 0.05 ).(2) There was no difference in the genotypic distribution of rs5902434del/ArTTpolymorphism between cases and controls ( P =0.10),but the frequency of del allele in URSA was statistically increased than that of controls (71.2％,62.5％ ; OR =1.49,P =0.04 ).(3) There was no different distribution in 3 genotypes (C/C,T/C,T/T) and 2 alleles (T and C) of rs2294021T/C between URSA patients and normal controls (P =0.18 and 0.08 ).(4) Estimated haplotype frequency distribution of rs5902434del/ATT,rs3761548A/C and rs22323565A/G showed haplotype del-A-G conferring the susceptibility to URSA ( OR =2.51,P ＜ 0.01 ) but haplotype del-C-G and ATT-A-A could provide protection on URSA ( OR =0.18,0.22 ; all P ＜ 0.01 ).Conclusion Functional polymorphisms of Foxp3 gene could probably confer the susceptibility to URSA,by altering Foxp3 function and (or) its expression.

[Objective] To investigate associations between the functional polymorphisms of signal transducer and activator of transcription 4 (STAT4) gene and unexplained recurrent spontaneous abortion (URSA) and between STAT4 protein expression and the genotypes of rs 10181656 locus.[Methods] PCR-restriction fragment length polymorphism was used to genotype rs 1 0181656 locus polymorphism in 332 URSA cases and 260 normal controls,in 86 URSA cases and 77 normal controls of which immunohistochemical technique was used to detect STAT4 protein expression.[Results] The frequencies of rs10181656 C/G were 36.45 ％,46.54％ in genotype C/C,46.99％,45.38％ in genotype C/G and 16.57％,8.08％ in genotype G/G between URSA patients and normal controls.They reached statistical difference (P ＜ 0.05).The carriers of rs 10181656 G allele increased the risk of URSA (OR =1.50,P ＜ 0.05).STAT4 protein expression in decidual tissues:①There was statistical difference in the STAT4 protein expression in decidual tissues between cases and controls (P ＜ 0.05).In URSA patients there was statistical difference in the STAT4 protein expression among genotype CC,CG and GG of rs10181656 locus (P ＜ 0.05).So was in normal controls (P ＜ 0.05).In genotype CC there was no difference in the STAT4 protein expression between cases and controls (P ＞ 0.05).Neither was In genotype CG and GG respectively (P all ＞ 0.05).[Conclusion] Functional polymorphisms of the rs10181656 locus could probably associate with the susceptibility of URSA via STAT4 protein expression increased by genotype G/G in maternal decidual tissue.

Objective:To investigate the relationship between the expression level of thymocyte selection-associated high mobility group box protein ( TOX) gene and the radiosensitivity of lower-grade glioma (LGG) patients. Methods:Using bioinformatics research methods, 474 LGG patients from The Cancer Genome Atlas (TCGA) database were selected as the test set (TCGA-474 set), and two different genetic data sets ( n=412 and n=171) from the Chinese Glioma Genome Atlas (CGGA) database were selected as the validation set (CGGA-412 set and CGGA-171 set). Patients were stratified based on whether received radiotherapy, and divided into the high and low TOX expression group according to the expression level of TOX gene in LGG. Survival curves of all patients were plotted. The overall survival (OS) and progression-free survival (PFS) of patients in the high and low TOX expression groups were compared and analyzed using log-rank test. Results:Multivariate analysis of OS in the TCGA-474 set showed that high expression of TOX was a protective factor for OS ( HR=0.061, 95% CI: 0.005-0.791, P=0.044). After stratification analysis based on radiotherapy and adjustment for confounding factors, the HR (95% CI) of patients with high TOX expression in the TCGA-474, CGGA-412, and CGGA-171 sets were 0.405 (0.261-0.629), 0.581 (0.418-0.806), and 0.464 (0.269-0.800), respectively, with P values of <0.001, 0.001, and 0.008, respectively. Among patients receiving radiotherapy in the TCGA-474 set, the OS and PFS of patients with high TOX expression were significantly longer than those in the low TOX expression group, and the differences were statistically significant (both P<0.001). The OS benefit of patients with high expression of TOX was significantly prolonged in both the CGGA-412 and CGGA-171 sets compared to those with low TOX expression, and the differences were statistically significant (both P<0.001). Conclusion:The high expression of TOX may be related to the radiosensitivity of LGG, which may be a gene marker of the radiosensitivity of LGG.

Objective To investigate the relationship between pentraxin 3(PTX3)and first-pass effect of mechanical thrombectomy in patients with large vessel occlusion acute ischemic stroke(AIS).Methods A total of 136 AIS patients with large vessel occlusion treated in Liaocheng People's Hospital from January to August 2023 were selected,and they were divided into first pass group(n=41)and non-first pass group(n=95)according to whether they achieved first-pass effect of mechanical thrombectomy.The clinical data of all patients were collected and the serum PTX3 levels were detected.All patients were followed up for 3 months,and the prognosis was evaluated according to the modified Rankin score.Multivariate Logistic regression was used to analyze the influencing factors of first-pass effect in AIS patients with large vessel occlusion.ROC analysis was used to analyze the predictive value of serum PTX3 for first-pass effect in AIS patients with large vessel occlusion.Results The rate of good prognosis in the first pass group was higher than that in the non-first pass group(56.10％vs 36.84％),and the difference was significant(x2=4.341,P=0.037).Compared with the non-first pass group,the age(59.38±5.12 years),the proportion of hypertension(43.90％),the National Institutes of Health Stroke Scale(NIHSS)score at admission(13.58±4.16 score)in the first pass group and serum PTX3 level(1.21±0.32 ng/L)in the first pass group were lower than those in the failed group(63.45±7.61 years,65.26％,15.75±5.13 score,1.71±0.41 ng/L),and the differences were significant(t/x2=3.129,5.395,2.389,6.944,all P＜0.05).Multivariate Logistic regression analysis showed that younger age[OR(95％CI):0.859(0.752～0.982)],no hypertension[OR(95％CI):0.672(0.480～0.942)],decreased NIHSS score at admission[OR(95％CI):0.867(0.781～0.962)]and decreased serum PTX3 levels[OR(95％CI):0.558(0.326～0.954)]were the influencing factors of the first-pass effect of mechanical thrombectomy in AIS patients with large vessel occlusion(Waldx2=4.997,5.238,7.280,4.543,all P＜0.05).After 3 months of follow-up,the serum PTX3 level of the good prognosis group was lower than that of the poor prognosis group(1.28±0.39 ng/L vs 1.65±0.43 ng/L),and the difference was significant(t=5.111,P＜0.001).ROC analysis showed that serum PTX3 had a high predictive value for first-pass effect and poor prognosis in AIS patients with large vessel occlusion,with the areas under the curve(95％CI)of 0.785(0.703～0.866)and 0.734(0.651～0.806),respectively,and their optimal cut-off values were 1.38 ng/L and 1.56 ng/L,respectively.Conclusion The first-pass effect of mechanical thrombectomy in AIS patients with large vessel occlusion is beneficial to the short-term prognosis.The expression of serum PTX3 is closely related to the first-pass effect in AIS patients with large vessel occlusion,and this index could have a high predictive value for whether the patients can achieve the first-pass effect.

Objective:To analyze the risk factors of acute kidney injury (AKI) in hip fracture patients with serious underlying diseases and establish a prediction nomogram.Methods:Clinical information of hip fracture patients admitted to the intensive care unit (ICU) of Beth Israel Deaconess Medical Center (BIDMC) was analyzed using the Medical Information Mart for Intensive Care (MIMIC)-IV. Patient comorbidities, disease scores, vital signs and laboratory tests, surgical modalities, invasive procedures, and drug use were recorded. According to the diagnostic criteria of AKI in the Kidney Disease Improving Global Outcome (KDIGO) guideline, the enrolled patients were randomly divided into training set and validation set. Based on logistic regression analysis, least absolute shrinkage and selection operator (LASSO) logistic regression algorithm was used to analyze the risk factors of AKI after admission, and the corresponding prediction model was calculated.Results:A total of 474 patients were enrolled, including 331 in the training set and 143 in the validation set. According to the diagnostic criteria of AKI of KDIGO guidelines, the patients were divided into AKI group (159 cases) and non-AKI group (172 cases). Univariate analysis showed that age ( t=2.61, P=0.009), coronary heart disease (χ 2=2.08, P=0.038), heart failure (χ 2=2.60, P=0.009), hemoglobin ( t=1.89, P=0.059), platelets ( t=1.81, P=0.070), urea nitrogen ( t=2.83, P=0.005), blood creatinine ( t=3.65, P<0.001), blood sodium ( t=2.55, P=0.011), blood glucose ( t=2.52, P=0.012), anion gap ( t=3.44, P=0.001), diastolic blood pressure ( t=2.72, P=0.007), mean arterial pressure ( t=2.16, P=0.031), SOFA score ( t=3.69, P<0.001), simplified acute physiological function score II (SAPSII) score ( t=2.95, P=0.003), as well as furosemide (χ 2=2.03, P=0.042), vancomycin (χ 2=1.70, P=0.089), vasoactive medications (χ 2=3.74, P<0.001) and use of invasive mechanical ventilation (χ 2=4.81, P<0.001) were risk factors associated with the development of AKI in hip fracture patients. Multivariate logistic regression analysis showed that age ( OR=1.03, P<0.001), coronary heart disease ( OR=2.05, P=0.069), hemoglobin ( OR=0.88, P=0.050), blood creatinine ( OR=1.37, P=0.009), blood sodium ( OR=1.07, P=0.026), anion gap ( OR=1.09, P=0.028) and vasoactive medications ( OR=3.83, P=0.018) and the use of invasive mechanical ventilation ( OR=6.56, P<0.001) were independent predictors of the development of AKI in hip fracture patients with serious underlying diseases. The area under the curve of the nomogram prediction model constructed by the above 8 predictors was 0.789, and the calibration curve of the nomogram was close to the ideal diagonal. Decision curve analysis showed that the net benefit of the model was significant. Conclusion:The incidence of AKI is high in hip fracture patients with serious underlying diseases. Age, coronary heart disease, hemoglobin, serum creatinine, serum sodium, anion gap, vasoactive drugs, and invasive mechanical ventilation can predict the occurrence of AKI to a certain extent. Combined with the risk factors, the construction of the corresponding prediction model can predict and manage the diagnosis and treatment of AKI in patients with hip fracture complicated with severe underlying diseases.

Objective:To carry out evidence-based nursing for standardized management of stress hyperglycemia in perioperative period of gastrointestinal tumor patients, and to formulate indicators, analyze obstacles and promoting factors, formulate action strategies.Methods:Guided by the Johns Hopkins evidence-based nursing model, evidence were searched, evaluated and summarized. Clinical indicators and review methods were formulated to carry out quality review. From November 2021 to April 2022, the medical staff and patients in the gastrointestinal surgery department of the First Affiliated Hospital of Anhui Medical University who met the inclusion criteria were conducted, and the incidence of compliance rate was calculated. Based on the results of the baseline review, the obstacles and contributing factors were analyzed.Results:A total of 26 pieces of best evidence were included and 14 indicators were formulated for 48 medical staff and 45 patients to clinical review, among which the compliance rate of 7 indicators was less than 60%. The main obstacle factors were lack of procedures and instruments for management of perioperative stress hyperglycemia in gastrointestinal tumor patients, lack of knowledge of medical staff, etc. The main promoting factors were organizational support, good atmosphere of medical team cooperation, strong willingness to change, etc.Conclusions:There is a big gap between the clinical practice and the best evidence of perioperative stress hyperglycemia management in patients with gastrointestinal tumor. Action strategies should be put forward for obstacles and promoting factors to promote evidence transformation.