Nuclear factor-erythroid 2 related factor 2 (Nrf2) is an ubiquitous and important transcription factor. It regulates antioxidant response elements (AREs)-mediated expression of antioxidant enzyme and cytoprotective proteins. A large body of research showed that Nrf2-Keap1 (Kelch-like ECH-associated protein 1, Keap 1)-ARE signaling pathway is involved in the endogenous antioxidant defense mechanisms. Nrf2 increases the expression of a number of cytoprotective genes, protects cells and tissues from the injury of a variety of toxicants and carcinogens. As a result, Nrf2 enhances the expression of glutathione and antioxidants such as superoxide dismutase and glutathione S-transferase, and subsequently scavenging free radicals. Air pollution especially from PM2.5 particles, is associated with an increasing morbidity of inflammatory pulmonary diseases and their deterioration. More and more studies demonstrated that Nrf2 was a novel signaling molecule in the modulation of inflammatory responses in these inflammatory respiratory diseases, such as asthma, acute lung injury (ALI) and COPD. Therefore, Nrf2 targeting might be a therapeutic target, which will provide clinical benefit by reducing both oxidative stress and inflammation in asthma, acute lung injury (ALI) and COPD. This review focused on the relationship between Nrf2 and inflammatory respiratory diseases and oxidative stress.

Objective To study the scale and structure of health professional education in China's colleges and universities and their changes from 1998 to 2012. Method Descriptive analyses of national data were conducted, mainly including calculation of absolute numbers, average rates of change per year, and percentages. Results The number of colleges and universities involved in health professional education increased from 189 in 1998 to 590 in 2012.The number of health professional students who were enrolled by, studied in and graduated from these colleges and universities respec-tively reached 587 thousand, 2 104 thousand, and 508 thousand in 2012, with annual growth rates of about 15 percent. The proportion of diploma graduates rose from 42.9 percent in 1998 to 54.0 percent in 2012, which was bigger than those of students at other education levels. In 2012, health professional educational institutions per 10 million popu-lation in western China was less than eastern and middle China by 1.1 and 0.9, respectively. Health profes-sional graduates per 10 thousand population in western China was less than eastern and middle China by 3.3 and 1.6, respectively. Public institutions and their students respectively accounted for 78.1 percent and 85.1 percent though private institutions and their students increased more quickly than public ones. Student-faculty ratio rose from 7.1∶1 in 1998 to 20.0∶1 in 2012. Conclusion The scale of health profes-sional education has been expanding at a decreasing growth rate in China. The disciplinary composition of health professional students has some-what improved and private schools increased at a quicker rate than public ones. However, the gap in scale of education between western China and middle/eastern China has been widening. Education re-sources per student cannot keep pace with the expansion of students, which has affected education of health professionals in many aspects.

The aim of this study is to investigate the anti-inflammatory effect of the adenosine derivative N6-(3-hydroxylaniline) adenosine (WS070117M1) on cigarette smoke plus LPS (lipopolysaccharide)-induced chronic obstructive pulmonary disease (COPD) in mice and its mechanism. COPD model was established by exposing male BALB/c mice to cigarette smoke and challenged with LPS inhalation. Supernatants of bronchoalveolar lavage fluid (BALF) were harvested and IL-1β, IL-6, IL-8 and TGF-β1 levels were measured by ELISA (enzyme-linked immunesorbent assay). The number of total white blood cells and neutrophils in bronchoalveolar lavage fluid was counted separately. Lung tissue was stained with Mayer 's hematoxylin and eosin for histopathologic examination. pAMPKa protein expression and distribution of lung tissue were analyzed by immunohistochemistry method. In vitro, levels of AMPKα phosphorylation in phorbol-12- myristate-13-acetate (PMA) differentiated THP-1 cells was detected by immunohistochemistry, IL-8 level in supernatants of cigarette smoke condensate stimulating PMA differentiated THP-1 cells was measured by ELISA. The results showed that WS070117M1 treatment significantly activated AMPKa in the lung tissue. It also resulted in down regulation of IL-1β, IL-6, IL-8 and TGF-β1 levels in bronchoalveolar lavage fluid and IL-8 level in cigarette smoke condensate stimulating PMA differentiated THP-1 cells. In addition, WS070117M1 could inhibit the recruitment of total white blood cells and neutrophils. These results suggest that WS070117M1 may alleviate the airway inflammation by activating AMPK in the lung tissue.

Objective To explore the relationship between visuospatial abilities of the students ma-jor in air traffic management and their performances,and then provide theories of their vocational classified. Methods 104 healthy male college students were tested by the cognitive laterality battery (CLB),which included visuospatial tests and verbal-sequential tests.At the same time,their performances assessed by air traffic management stimulators.Results Subjects with higher scores achieved by operating on air traffic management stimulators have higher visuospatial abilities,which was confirmed by the visual spatial scores (A) ((0.183±0.094) vs (0.060±0.338), t=41.57, P=0.000) and cognitive laterality quotient (CLQ) ((0.087±0.108) vs (-0.096±0.101), t=43.14, P=0.000)).However,compared with others in lower scores group,their scores on the phonological tests (P) reduced ((0.096±0.081) vs (0.157±0.092), t=6.81, P=0.012) ) .Moreover,there were the significant positive correlation between their performance on air traffic management stimulators and A ( r=0.749, P<0.01) ,CLQ ( r=0.663, P<0.01) ,cognitive performance quotient (CPQ) ( r=0.394, P<0.01).Conclusion For air traffic management occupation,the higher visual spatial abilities were the base of having the higher performance.Thus the visuospatial abilities may be as a good index of selecting and vocational classified for air traffic management students.

Objective:To observe the efficacy, median progression-free survival (PFS) and adverse reaction induced by rh-endostatin injection (Endostar) plus platin-based chemotherapy for advanced non-small cell lung cancer (NSCLC).Methods:Fifty five histologically or cytologically confirmed advanced NSCLC patients received Endostar combined with platin-based chemotherapy for more than 2 cycles. The evaluated parameters included PFS, response rate (RR), clinical benefit rate (CBR) and adverse reaction. Results:Of the 51 patients who can be evaluated for response, 15 (29.4%) achieved partial response (PR), 27 (52.9%) had stable disease (SD), 9 (17.6%) had progressive disease(PD), no patient had complete response(CR). The overall RR was 29.4% (15/51) and CBR was 82.4% (42/51). The median PFS was 6.3 months. There were no significant differences in the short-term efficacy and PFS between the patients who had different pathological features (P=0.037), those had naive or relapsed diseases (P=0.101), or those received different chemotherapeutic regimens (P=0.232). The total white cells and platelets decreased by 72.7% and 54.5%, respectively. The frequency of grade Ⅲ or Ⅳ neutropenia and thrombocytopenia were 36.4% (20 caces) and 21.8% (12 cases), respectively. Four patients stopped the therapy for adverse reaction. One died of gastrointestinal hemorrhage; one had uncontrolled grade Ⅲ hypertension; one had superventricular arrhythmia; one had grade Ⅳ hepatic dysfunction. Conclusion:The combination of Endostar and platin-based chemotherapy increased the CBR and prolonged the PFS of the patients with advanced NSCLC. The toxicities were tolerable.

Objective To summarize clinical experience of application of muliplefoliated flap combined with tendon graft from dorsal foot for repairing soft tissue defects of multi-fingers. Methods Based on the results of microdissection researches, muliplefoliated flap including medial foot flap, the first metatarsal dorsal flap, lateral foot flap, extensor pollicis brevis of toe and extensor proprius of the fifth toe pedicled by anterior tibial vessels and dorsal pedis vessels as trunk, anterior medial malleolus vessels, the first metatarsal vessels and anterior lateral malleolus vessels as branches respective was designed for repairing soft tissue and tendon defects of multi-fingers. Results In all 12 cases, total survival of flap was 11 cases , 1 case had partial necrosis of distal flap and it was healed by dress changing. Conclusion Transplantation of muliplefoliated flap combined with tendon graft from dorsal foot is a good method to repair soft tissue and tendon defects of multi-fingers.

Objective:To analyze employment status and its tendency of eight-year program clinical medical graduates and explore its implications to talent cultivation using employment data from a university in Beijing.Methods:Descriptive analysis was used in this study. Indicators that were analyzed included quantity of employment, employment rate, employment region and specialty.Results:Between 2009 and 2021, a total of 2 281 eight-year clinical medical students graduated in the university. Among them, 2 188 (96.0%) of them were employed in the year of graduation. On average, 90.8% (2 034/2 241) of them were employed by medical institutions although the percentage decreased over years. A majority of them chose to work in economically developed provinces of eastern China. Those chose to work in Beijing accounted for 78.7% (1 723/2 188), the highest percentage among all provinces. The top two specialties of choice were surgery and internal medicine, which respectively accounted for 33.0% (753/2 281) and 24.4% (557/2 281). Only a few of them chose to study some specialties that were challenged by a serious shortage of physicians, including pediatrics, mental diseases and mental health.Conclusion:Although the employment status of eight-year clinical medical graduates are good, it is still necessary to pay attention to the new tendency of employment, and further improve training scheme. Meanwhile, more guidance on choice of secondary specialties are needed to build a competent talent team for specialty development. Finally, education of curriculum iedology and politics should be strengthened to encourage them to work in specialties and remote provinces that face a serious shortage of physicians.

Objective To evaluate the efficacy and adverse events of adjuvant targeted therapy for non-distant metastatic renal cell carcinoma (ndmRCC).Methods A comprehensive literature search was conducted in PubMed,SpringerLink,Web of Science,and the Cochrane Library.All clinical randomized controlled trials on adjuvant targeting therapy for ndmRCC were retrieved.Literature screening,data extraction and literature quality evaluation were conducted by three researchers independently,and metaanalysis was performed using Review Manager Version 5.3.Outcomes we were interested in included progression-free survival (PFS),overall survival (OS),and adverse events.Results A total of 4 RCTs with 5 studies and 4 944 ndmRCC patients were selected for meta-analysis.Targeted adjuvant therapy improved the PFS of ndmRCC patients.The hazard ratio (HR) was 0.92(95％ CI0.85-1.00,P =0.05) between the targeted therapy group and the placebo group.With the extension of follow-up,this effect was more significant,and the HR was 0.89 (95％ CI0.81-0.97,P =0.01).However,targeted adjuvant therapy did not extend the OS of ndmRCC patients,and the HR was 0.92(95％ CI0.81-1.05,P =0.22).Compared with the placebo,targeted adjuvant therapy increased the incidence of adverse events and the number of patients who had to discontinue because of adverse events was also increased.The odds ratios were 6.03 (95％ CI5.30-6.86,P ＜ 0.001) and 7.65 (95 ％ CI6.31-9.26,P ＜ 0.001),respectively.Conclusions Targeted adjuvant therapy can improve the PFS of ndmRCC patients after surgery,but it cannot improve the OS.At the same time,it increases the incidence of adverse events.

Objective: To investigate the independent predictors of inguinal lymph node metastasis (LLM) in patients with penile squamous cell carcinoma (SCCP), and to establish a nomogram for predicting individual LLM risk. Methods: The data of patients with SCCP diagnosed at the department of urology, Xijing Hospital from July 2009 to June 2019 were analyzed retrospectively. A total of 101 patients were included in this study, with age of 55 (26-84) years. There were 25 (24.8%) and 76 (75.2%) patients with and without palpable inguinal lymph node enlargement, respectively. There were 47 cases (46.5%), 40 cases (39.6%) and 14 cases (13.9%) in T₁, T₂ and T₃ stages, respectively; there were 67 cases (66.3%), 21 cases (20.8%) and 13 cases (12.9%) in Broder 1, 2 and 3, respectively. The average value (or median) of fibrinogen was 2.84 (1.72-5.00)g/L; alkaline phosphatase was 80(32±214)U, hemoglobin was 147(81-180)g, platelet count was (193.74±65.68×10⁹/L, absolute value of neutrophils, monocytes and lymphocytes were 3.98(1.19-11.85)×10⁹/L, 0.44(0.17-1.90)×10⁹/L and 1.68(0.58-4.13)×10⁹/L, respectively. The average (or median) value of PLR, NLR and LMR were 113.38(18.80-418.42), 2.42(0.59-10.22) and 3.84 (1.08-9.89), respectively. There were 26 cases (25.7%) with LLM and 75 cases (74.3%) without LLM. The independent predictors of LLM were identified by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram by integrating all independent predictors, and the bootstrap method was used to internally validated our nomogram, where the value of AUC (area under the ROC curve) was calculated and the calibration plot was drawn. Results: Clinical inguinal lymph node status (P<0.006), T stage (P<0.021), Broder grade (P<0.017) and absolute neutrophil value (P<0.043) were independent predictors of LLM. The accuracy of our nomogram was 0.875 (AUC=0.875, 95%CI 0.859-0.891); Moreover, the risk of LLM predicted by nomogram was in good consistency with the actual LLM rate, and the errors of the nomogram-predicted LLM risks were all within 10%. Conclusions Clinical inguinal lymph node status, T stage, broder grade and absolute value of neutrophils were identified as independent predictors of LLM in patients with SCCP on the basis of single center data. A generic nomogram predicting LLM risk for Chinese patients was developed, which would be helpful to screen SCCP patients who need prophylactic inguinal lymph node dissection.

Curriculum for undergraduate medical education in the United Kingdom consists of two parts, namely pre-clinical and clinical courses. Medical undergraduate students are encouraged to study for a second degree and individualized education is emphasized. Various methods are employed in teaching highly integrated courses, mainly according to human organs and systems or physiological functions. Drawing lessons from relevant experiences of the United Kingdom, China should further strengthen the formulation and supervision of standards and guidelines for undergraduate medical education, and actively promote the reform of teaching models in order to facilitate the connection and integration between basic medical education and clinical practice. It's also suggested that priorities be given to the cultivation of compound medical talents and individualized education for medical students. Finally, educational system should be further improved in order to enhance the effects of clinical practice.