AIM: To investigate the effect of diltiazem on mean pulmonary arterial pressure(mPAP) and nitric oxide synthase(NOS) in arterioles in chronic hypoxic hypercapnic rats. METHODS: Twenty-four rats were randomly divided into three groups: control group(A),hypoxic hypercapnic group(B), hypoxic hypercapnia+ diltiazem group (C), constitutive endothelial NOS(ceNOS) were observed in arterioles of rats using the technique of immunohistochemistry,ceNOS mRNA were observed by the technique of in situ hybridization . RESULTS: (1)mPAP was significantly higher in rats of B group than that of A and C group( P 0 05),but mCAP was lower in rats of C group than that in B group.(2)Light microscopy showed WA/TA (vessel wall area/total area) was significantly lower in rats of C group than that of B group ( P

Objective To investigate the association between the minisatellite polymorphism in the first exon of PLA2G4C gene and schizophrenia, and to reveal the important role of DNA sequence polymorphism in the pathogenesis of schizophrenia.Methods The minisatellite polymorphisms in the first exon of PLA2G4C gene in 91 patients with schizophrenia (case group)and 81 healthy persons (control group)were detected with PCR-sequencing analysis.The chi-square (χ2 )goodness-of-fit test was used to analyze the distribution of the PLA2G4C minisatellite polymorphism in various groups and to explore the association between the minisatellite polymorphism in the first exon of PLA2G4C gene and schizophrenia. Results There were minisatellite polymorphisms in PLA2G4C gene.Three kinds of polymorphisms 1×27 bp,2×27 bp and 3×27 bp were found by sequencing.The distribution of allelic frequencies at PLA2G4C polymorphism showed no statistical significance between case group and control group (P>0.05 ). No statistically significant difference was found in 3-homozygous haplotypes in PLA2G4C gene between case group and control group (P>0.05).At the same time,there was no statistically significant difference between 3-heterozygous haplotypes in PLA2G4C gene between case group and control group (P>0.05).Conclusion The minisatellite polymorphisms in the first exon of PLA2G4C gene are found,but the minisatellite polymorphism in the first exon of PLA2G4C gene may be not associated with the occurrence of schizophrenia.

Objective:To explore the prognostic biomarkers of glioblastoma (GBM) in the tumor microenvironment (TME) and its function.Methods:A total of 169 GBM samples of 161 GBM patients were collected from the Cancer Genome Atlas (TCGA) database. ESTIMATE algorithm in R4.1.0 software was used to calculate the proportion of immune components and stromal components in TME, which were expressed as immune score and stromal score, respectively. According to the median value of the two scores, 169 GBM samples were divided into the high score group and the low score group, respectively, 84 each in each group (those whose scores were equal to the median were not involved in the grouping). The differentially expressed genes (DEG) [false discovery rate (FDR) < 0.05] between the high score group and the low score group of the two scores were obtained by using limma package, and the co-up-regulated and co-down-regulated DEG of the two scores were obtained by using Venn program. Based on the STRING database, the protein interaction (PPI) network of co-up-regulated and down-regulated DEG of immune score and stromal score was constructed, and the top 30 genes with connectivity were selected. Univariate Cox proportional hazard model analysis of overall survival (OS) of 161 GBM patients in the TCGA database was performed on co-up-regulated and down-regulated DEG between immune score and stromal score by using R4.1.0 software to obtain the DEG affecting OS. The intersection of the DEG obtained from PPI analysis and Cox analysis was taken as the prognostic core genes. According to the median expression value of prognostic core genes in GBM samples from the TCGA database, 161 patients were divided into prognostic core genes high expression group and low expression group (patients whose scores were equal to the median were not involved in the grouping), with 80 cases in each group. Kaplan-Meier survival analysis of OS was performed by using R4.1.0 software. GSEA 4.2.1 software was used to perform gene set enrichment analysis (GSEA) on all genes with transcriptome data of GBM patients in the two groups of the TCGA databases, and the main enriched functions of the two groups of genes were obtained. The CIBERSORT algorithm was used to test the accuracy of the proportion of tumor infiltrating immune cell (TIC) subsets in 169 GBM samples from the TCGA database, and 57 GBM samples were finally obtained. Immune cells with differential expression levels and immune cells related to the expression of prognostic core genes among the samples with different expression levels of prognostic core genes were analyzed; Venn program was used to obtain the intersection of immune cells with differential levels and related immune cells, and differentially expressed TIC related to expressions of prognostic core genes in GBM were obtained.Results:Based on the immune score and stromal score of GBM samples in the TCGA database, a total of 693 co-up-regulated and co-down-regulated DEG of both scores were screened out. After the intersection of 78 DEG related to OS obtained by univariate Cox regression analysis and 30 DEG obtained by PPI network results, CC motif chemokine receptor 2 (CCR2) was identified as the prognostic core gene ( HR = 1.294, 95% CI 1.060-1.579, P = 0.011). GBM patients with CCR2 high expression had worse OS compared with those with CCR2 low expression ( P = 0.009). GSEA analysis showed that genes in the CCR2 high expression group were mainly enriched in immune-related pathways, while genes in the CCR2 low expression group were mainly enriched in metabolism-related pathways. Among 57 screened GBM samples, there were differences in the levels of 3 immune cells between the CCR2 high expression group and the CCR2 low expression group ( P < 0.05). CCR2 expression was correlated with the levels of 9 immune cells (all P < 0.05). Venn program analysis showed that differentially expressed 3 TIC in GBM related to CCR2 gene expression were obtained; among them, M2 macrophages were positively correlated with CCR2 expression, while T follicular helper cell and activated NK cells were negatively correlated with CCR2 expression. Conclusions:CCR2 may be the core gene related to the prognosis in the TME of GBM. As reference, the level of CCR2 can help to predict the status of TME and prognosis in GBM patients, which is expected to provide a new direction for the treatment of GBM.

Objective: To observe the refractive status of preschool children, and to explore the prevalence and development trend of ametropia in preschool children, so as to provide support for controlling adolescent ametropia and improving children s health care service. Methods: This cross sectional survey was conducted among 27 561 preschool children (55 122 eyes) aged 3-6 years old in the High tech Zone of Suzhou from September to December 2020. The refractive status was screened by the US Weilun binocular optometry. Results: The total detection rate of ametropia was 9.5%, including 8.6% of astigmatism, 1.3% of hyperopia and 0.5% of myopia. The detection rates of myopia (1.1%) and hyperopia (2.2%) were the highest in the 6-year-old group, and the older the age was, the lower the spherical diopter was, and the higher the cylindrical diopter was. The abnormal rate of colposcopy in girls ( 1.3% ) was higher than that in boys (0.9%), and the abnormal rate of total anisometropia in women (2.3%) was also higher than that in men (1.9%). The main astigmatism was mixed astigmatism (49.1%) and compound hyperopia astigmatism (39.2%); The older the age, the lower the detection rate of compound hyperopia astigmatism. And it is dominated by regular astigmatism( 97.5% ); The higher the age, the higher the detection rate of astigmatism with the rule, while the lower the detection rates of astigmatism against the rule and oblique axis astigmatism. Conclusion The detection rate of myopia and hyperopia increased significantly at the age of 6, and anisometropia and axial astigmatism also reached the highest at the age of 6. Local health care departments should pay attention to children s astigmatism, especially astigmatism with the rule.

Objective: To investigate the influencing factors of preschoolers hyperopia reserve, and to provide a scientific basis for preschoolers to prevent myopia. Methods: Visual screening and a questionnaire survey were conducted on 5 087 4-year old children in Suzhou High-tech Zone from September to December in 2020. The influencing factors of children s hyperopia reserve were analyzed by univariate analysis and Logistic regression model. Results: A total of 997(19.6%) children had hyperopia reserve deficiency. Logistic regression showed that the negative factors associated with hyperopia reserve included being girl( OR=0.81, 95%CI =0.70-0.93), no food allergy( OR=0.78, 95%CI =0.63-0.96); and the positive factors included father myopia( OR=1.20, 95%CI =1.03-1.39), mother myopia( OR=1.17, 95%CI =1.01-1.36), exposure of night lights(for less than 1 hour: OR=1.53, 95%CI =1.21-1.92; for 1 to 3 hours: OR=1.48, 95%CI =1.09-2.00), insufficient vegetable intake( OR=1.26, 95%CI =1.07- 1.46 )( P <0.05). Conclusion Parental myopia, nighttime sleep environment and dietary factors have potential associations with hyperopia reserve deficiency among children. Corresponding measures should be actively taken to improve the preschoolers hyperopia reserve.

Objective:To analyze the predictive value of echocardiography combined with diaphragmatic ultrasound on the outcome of removing machine for patients who underwent cardiac valve replacement for mechanical ventilation.Methods:Retrospectively,a total of 57 patients who adopt mechanical ventilation after underwent cardiac valve replacement in the First People's Hospital of Yibin from January 2022 to March 2023 were selected as the study subjects.According to the results of removing machine,the patients were divided into failed group(11 cases)and successful group(46 cases).All patients underwent echocardiography combined with diaphragmatic ultrasound examination.The indicators of echocardiography,included left ventricular ejection fractions(LVEF),right ventricular fractional area change(RVFAC)and systolic myocardial velocity(Sa),between different groups were compared.The early diastolic mitral annular tissue velocity(e')was recorded to calculate the ratio of early diastolic transmitral flow velocity(E)to e'(E/e'),and the indicators of echocardiography and diaphragmatic ultrasound.Logistic regression analysis was performed to analyze the factors affecting the failure of removing machine.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive values of echocardiography and diaphragmatic ultrasound indicators for the failure of removing machine in mechanical ventilation.Results:The differences of the differences of LVEF,RVFAC and Sa between failed group and successful group were no significant(P>0.05).The E/e'value of the successful group was 10.06±1.30,which was significantly lower than 12.69±2.96 of the failed group,and the difference was statistically significant(t=2.084,P＜0.05).The diaphragm thickening fraction(DTF)and diaphragm excursion(DE)values of the successful group were respectively 41.34±10.74 and 13.04±1.18,which were significantly higher than 19.67±5.37 and 11.27±0.94 of the failed group,respectively,and the differences between the two groups were statistically significant(t=2.148,2.776,P＜0.05).The results of logistic regression analysis showed that low expression of DTF and DE,as well as high expression of E/e',were all influence factors for the failure of removing machine for patients adopted mechanical ventilation after underwent cardiac valve replacement.The ROC results showed that the best cut-off value of the prediction model was 0.0893,and the area under curve(AUC)values were 0.713(95%CI:0.646～0.758),0.710(95%CI:0.651～0.779),0.752(95%CI:0.657～0.805)and 0.886(95%CI:0.782～0.991).Conclusion:The combination of echocardiography and diaphragm ultrasound has better prediction for the outcome of removing machine,which high higher clinical application value.

Objective:To construct the evaluation index system of the core competence of neonatal specialist nurses, so as to provide reference for clinical training of neonatal specialist nurses.Methods:From January 2020, through literature review, theoretical analysis, interview, Delphi method and superiority chart, the evaluation index and weight of core competence of neonatal specialist nurses were determined.Results:Totally 28 experts in China were invited for 3 rounds of consultation. The effective recovery rate of the questionnaires was 93.33%(28/30) in the first round. The effective recovery rate of the questionnaires was 100.00%(28/28) in the second and third rounds. The authority coefficient of the experts was 0.85 in the third round. The Kendall′s coefficients of concordance of the first-level indexes, second-level indexes and third-level indexes were 0.150, 0.221 and 0.161, respectively. The final evaluation index system of the core competence of neonatal specialist nurses included 5 first-level indicators, 17 second-level indicators and 58 third-level indicators.Conclusions:The evaluation index system of the core competence of neonatal specialist nurses constructed in this study has certain scientific, reliable and clinical application value, which is conducive to the training of newborn specialized nurses in China.

Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.

ObjectiveTo analyze the factors influencing meropenem-related liver injury （MRLI） and to explore their clinical predictive value. MethodsA retrospective case-control study was conducted， and the Chinese Hospital Pharmacovigilance System （CHPS） was used to establish a retrieval scheme. A total of 1 625 hospitalized cases using meropenem from January 2018 to December 2022 were collected. Patients were divided into case group （n=62） and control group （n=1 563） based on the presence or absence of liver injury. Clinical data and laboratory indicators from both groups were collected and analyzed. The t-test was used for comparison of normally distributed continuous data between the two groups， while the Mann-Whitney U test was used for comparison of continuous data not conforming to a normal distribution. The chi-square test was used for comparison of categorical data between the two groups. A multivariate Logistic regression analysis was performed to identify the influencing factors for MRLI. A Logistic regression equation was established， and the predictive value of these factors was assessed using the receiver operating characteristic （ROC） curve. ResultsThe results of univariate analysis indicated that the rates of male patients， hypoproteinemia， shock， intensive care unit （ICU） admissions， sepsis， and liver， gallbladder， and cardiovascular diseases， the levels of alanine aminotransferase （ALT）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， aspartate aminotransferase （AST）， creatinine （CREA）， and procalcitonin （PCT）， and the number of hospitalization days were significantly higher in the case group than in the control group （P<0.05）， and that the platelet levels in the case group were significantly lower than those in the control group （P<0.05）. The multivariate Logistic regression analysis showed that male sex （odds ratio ［OR］=2.080， 95% confidence interval ［CI］： 1.050 — 4.123， P=0.036）， admission to the ICU （OR=8.207， 95%CI： 4.094‍ ‍—‍ ‍16.453， P<0.001）， comorbidity with gallbladder disease （OR=8.240， 95%CI： 3.605‍ ‍—‍ ‍18.832， P<0.001）， ALP （OR=1.012， 95%CI： 1.004‍ ‍—‍ ‍1.019， P=0.004）， GGT （OR=1.010， 95%CI： 1.005‍ ‍—‍ ‍1.015， P<0.001）， and PLT （OR=0.997， 95%CI： 0.994‍ ‍—‍ ‍0.999， P=0.020） were the influential factors for MRLI. The areas under the ROC curve of ALP， GGT， and PLT were 0.589， 0.637， and 0.595， respectively， and the AUC of them combined was 0.837. ConclusionMale sex， ICU admission， comorbidity with gallbladder disease， increased ALP， increased GGT， and decreased PLT were influencing factors for MRLI， and a combination of factors has a better predictive value for the occurrence of MRLI.