Objective To investigate the interference effects of orexin A on cell proliferation of the insulin?secreting beta?cell line(INS?1 cells) through the orexin receptor 1(OX1R)and the AKT/PKB signaling pathway. Methods INS?1 cells were exposed to different concentrations of orexin A in vitro,and treated with OX1R antagonist(SB334867),PI3K antagonist(wortmannin),or AKT antagonist(PF?04691502). The INS?1 cell proliferation and apoptosis,insulin secretion,OX1R protein activity and AKT phosphorylation level were determined. Results Orexin A(10-10 to 10-6 mol/L)stimulated the proliferation and activation of INS?1 cells,prevented apoptpsis,and increased insulin secretion. Additionally,AKT phosphorylation was stimulated by orexin A(10-10 to 10-6 mol/L). The OX1R antagonist SB334867(10-6 mol/L),the PI3K antagonist wortmannin (10-8 mol/L)and the AKT antagonist PF?04691502(10-6 mol/L)weakened the effects of orexin A. Conclusion Orexin A activated the AKT sig?naling pathway through the mediation of orexin A?OX1R,and promoted cell proliferation in INS?1 cells.

Objective To investigate the graduate students' mental pressure after the full im-plementation of the charging system and explore effective countermeasures of alleviating the psycho-logical pressure. Methods 413 full-time graduate students of Grade 2014 were randomly selected in a university of Shandong province. The graduate students' psychological pressure scale and self-designed questionnaire survey were used. The data were analyzed using SPSS 17.0 software, statistical descrip-tion of the survey data, independent sample t test, ANOVA. Results ①The psychological pressure of full-time graduate students at their own expense was in themedium pressure level; ②The economic pressure and academic pressure of the male graduate students were higher than those of the female graduate students (P=0.000,P=0.042), the rural economic pressures were greater than urban students graduate students graduate students (P=0.000); Professional graduate economic pressures were greater than academic graduate students (P=0.027);There is difference in the pressure of interpersonal commu-nication among different majors (P=0.016); ③78.75% (315/400) of the graduate students tuition fees, living expenses were mainly from their parents and the national and school awards; ④The percentage of those who completely agreed with the following view: full charge than at public expense is more advantageous to graduate education, comprehensive charge is advantageous to the education career development and comprehensive charge embodies the fairness of education was 84.75% (339/400), 71.25% (285/400) and 68.00% (272/400). Conclusion The full-time graduate students at their own expense have a more rational understanding of the charging policy; economic and academic pressures are the two outstanding pressure sources of the graduate students at the present stage. Graduate should improve their ability to cope with stress, and government and schools should take various measures to help students relieve stress.

Objective To evaluate the efficacy of different doses of dexmedetomidine for prevention of shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section.Methods A total of 120 patients,of ASA physical status Ⅱ or Ⅱ,aged 20-40 yr,with body mass index≤ 35 kg/m2,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were randomly divided into 4 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine 0.1,0.3 and 0.5 μg/kg groups (D1,D2 and D3 groups).Combined spinal-epidural anesthesia was performed at L3,4 interspace with isobaric 0.5％ bupivacaine 2 ml.In D1,D2 and D3 groups,dexmedetomidine 0.1,0.3 and 0.5 μg/kg (in 50 ml of normal saline) were infused intravenously,respectively.In group C,normal saline 50 ml was infused at a rate of 5 ml/min.The development of shivering,bradycardia,hypotension,nausea and vomiting was recorded during the period from the end of dexmedetomidine infusion to PACU discharge time.Results Compared with group C,the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D2 and D3 groups,and no significant change was found in the parameters mentioned above in group D1.Compared with group D2,the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D3 group.Conclusion Dexmedetomidine 0.3 and 0.5 μg/kg can prevent shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section,and 0.5 μg/kg provides better efficacy.

Objective To explore the feasibility of biplane-transesophageal echocardiography (Bip-TEE) in measuring the aortic annulus dimension (AAD).Methods Totally 24 patients underwent transcatheter aortic valve implantation (TAVI) were collected,and their AAD was measured by two-dimensional transthoracic echocardiography (2D-TTE),two-dimensional transesophageal echocardiography (2D-TEE),Bip-TEE and three-dimensional transesophageal echocardiography (3D-TEE) respectively.These four methods were compared with each other.The correlation between 3D-TEE measures and other three methods were analyzed.Results The AAD measured by 2D-TTE,2DTEE,Bip-TEE and 3D-TEE were (22.02±2.21)mm,(23.34±2.34)mm,(23.89±2.37)mm,(24.21±2.78)mm,respectively.The differences among 4 groups was significant (F=3.88,P=0.01).No statistically significant differences were found between Bip-TEE and 3D-TEE,2D-TEE and 3DTEE,Bip TEE and 2D-TEE (all P＞0.05).There were significant differences between 2D-TTE and 2D-TEE,2D-TTE and Bip-TEE,2D-TTE and 3D-TEE (all P＜0.05).The AAD measured by 3D-TEE were positively correlated with that of 2D-TTE,2D-TEE,Bip-TE (r=0.79,0.88,0.94,all P＜0.05).Conclusion Bip-TEE is a feasible method to measure the AAD rapidly and can provide reliable measurements for the prosthetic valve size in TAVI.

Objective To build prenatal health education programs for primiparities and their spouses based on the concept of flipped classroom.Methods Expert questionnaires for prenatal health education programs for primiparities and their spouses based on the concept of flipped classroom were prepared by searching for original literatures from international and domestic databases. The Delphi method was used to investigate a total of 50 obstetrics experts from 18 ClassⅢ hospitals from Shandong province for two rounds. Results The concentration degree of these experts' opinions was high with an authority coefficient of 0.956 and a familiarity coefficient of 0.958, the determination coefficient was 0.954; the coordination coefficients for primary, secondary and tertiary indicators were 0.617, 0.423 and 0.391, respectively. The final health education program included 2 primary indicators, 11 secondary indicators and 55 tertiary indicators. Conclusions The experts' opinions on the prenatal education program for primiparities and their spouses are consistent. The program is highly scientific and reliable, which provides reference for prenatal health education for primiparities and their spouses based on flipped classroom.

Objective To analyze the hope level and correlative factors in hospitalized pneumoconiosis patients, and to provide suggestions of clinical nursing interventions. Methods The study assessed the hope level and social support of 103 hospitalized pneumoconiosis patients via Henh hope level scale ( Chinese version) and the social support revalued scale ( SSRS) . Results The average score of the hope level of 103 cases was (20. 79 ± 6. 32);45 cases (43. 7%) were at low level, 39 cases (37. 9%) were at average level, and 19 cases were at advanced level. The scores of social support, objective support, subjective support and the using-support degrees were significantly lower than the domestic normative scores (P<0. 01). Patient′s educational level, marital status, family income and social support had positive correlation to the hope levels. However, the disease stage, illness duration, hospitalization time and complications had negative correlation to the hope levels. Conclusions The average score of the hope level is at a low level and correlative to the patient′s educational level, marital status, family income, disease stage, illness duration, hospitalization time and complications.

Aging and age-related ailments have emerged as critical challenges and great burdens within the global contemporary society.Addressing these concerns is an imperative task,with the aims of postponing the aging process and finding effective treatments for age-related degenerative diseases.Recent investigations have highlighted the significant roles of nicotinamide adenine dinucleotide(NAD+)in the realm of anti-aging.It has been empirically evidenced that supplementation with nicotinamide mononucleotide(NMN)can elevate NAD+levels in the body,thereby ameliorating certain age-related degenerative diseases.The principal anti-aging mechanisms of NMN essentially lie in its impact on cellular energy metabolism,inhibition of cell apoptosis,modulation of immune function,and preservation of genomic stability,which collectively contribute to the deferral of the aging process.This paper critically reviews and evaluates existing research on the anti-aging mechanisms of NMN,elucidates the inherent limitations of current research,and proposes novel avenues for anti-aging investigations.

Objective:To assess the feasibility and efficacy of hypofractionated radiotherapy with simultaneous integrated boost (HFRT-SIB) for patients with non-osteogenic spinal metastases who were not suitable for stereotactic body radiotherapy (SBRT).Methods:A totoal of 26 spinal metastatic lesions in 24 patients with non-osteogenic spinal metastases admitted to Beijing Luhe Hospital affiliated to Capital Medical University from March 2020 to April 2023 were retrospectively analyzed. In our institution, a higher-dose fractionated regimen for spinal metastases was introduced, at a dose of 3 Gy/f ×10 times (5 times a week, once a day) to the clinical target volume (CTV), and simultaneous integrated boost (SIB) of 4 Gy/f ×10 times (5 times a week, once a day) to the gross tumor volume (GTV). The primary endpoint was the overall relief (OR) rates of pain at 12 and 24 weeks post-radiotherapy, while secondary endpoints included the pain response time and duration of pain relief, the incidence of adverse events post-radiotherapy, and the 1-year overall survival (OS) rate. The differences before and after treatment were analyzed by Wilcoxon signed-rank test. OS was assessed using Kaplan-Meier method.Results:The median follow-up was 11.7 (8.0, 17.0) months. At 12 weeks post-radiotherapy, 92% (22/24) of patients achieved OR, and 81% (17/21) obtained OR at 24 weeks post-radiotherapy. The median pain response time was 4 (3, 5) d. At the last follow-up, 42% (10/24) of patients maintained pain relief for over 1 year, with a median duration of pain relief up to 11.0 (6.0, 16.9) months. The 1-year OS rate was 66.3%, and no patients experienced grade 3 or higher acute or chronic adverse events.Conclusion:HFRT-SIB can effectively alleviate pain, and achieve sustained pain control, and does not lead to severe adverse effects in patients with non-osteogenic spinal metastases.

Objective:To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods:Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern, central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire. Information on occurrence of unintended pregnancy within 2 years after delivery, postpartum contraceptive use, sexual resumption, breastfeeding, and women′s socio-demographic characteristics, and so on, were collected. Life-table analysis, cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results:A total of 18 045 postpartum women were investigated. The cumulative 1- and 2-year unintended pregnancy rates after delivery were 5.3% (95% CI: 4.5%－6.1%) and 13.1% (95% CI: 11.3%－14.8%), respectively. Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women, ethnic minorities, women with abortion history, and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation (all P<0.01). The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth (all P>0.05). Conclusions:In China, the risk of unintended pregnancy within 2 years after delivery is relatively high. Service institutions and service providers should improve the quality of postpartum family planning services, promote the use of high effect contraceptive methods, and educate women to use a method at the time of their sexual resumption or even before.

Betacoronavirus ; isolation & purification ; pathogenicity ; Bile Acids and Salts ; metabolism ; Bile Ducts, Intrahepatic ; pathology ; virology ; Cell Culture Techniques ; Coronavirus Infections ; complications ; pathology ; Cytokine Release Syndrome ; etiology ; physiopathology ; Cytopathogenic Effect, Viral ; Epithelial Cells ; enzymology ; pathology ; virology ; Humans ; Hyperbilirubinemia ; etiology ; Liver ; pathology ; Organoids ; pathology ; virology ; Pandemics ; Peptidyl-Dipeptidase A ; analysis ; Pneumonia, Viral ; complications ; pathology ; Receptors, Virus ; analysis ; Serine Endopeptidases ; analysis ; Viral Load