Objective To investigate the application of CUSUM (cumulative sum control chart) curve in cardiac clinical teaching of resident surgeon education.Methods We chose a surgeon of 10years work experience of attending the preparation operation of internal mammary artery as control reference (standard group,28 patients) and a resident engaged in professional clinical cardiac work no more than 5 years as group 1,a professional training physician engaged in cardiac surgery clinical work more than 5 years as group 2 and took 40 patients' data respectively from the two groups' preparation of internal mammary artery operation.And then we recorded the postoperative mammary artery flow,internal mammary artery preparation time and adverse events data and made statistics analysis with SPSS 19.0,and CUSUM curve with Matlab R2012b polynomial curve.Results When the density of operate interval and the operate numbers came to about 25 cases,the polynomial eurve's slope rate went up to 0,regardless the surgeons' experience,CUSUM value was accumulated from 66 to 76,and overcame the learning curve successfully.However,when the density of operate interval did no reach the standard,the surgeon's CUSUM ploynomial cmwe slope rate never reached to 0,and can't overcome the learning curve.Conclusion CUSUM curve gives a clear quantitative indicator to the cultivation of clinical physician,and makes teaching teachers can understand the young physicians' learning process,so as to change the teaching plan,help young physicians cross the learning curve as soon as possible.

Objective To establish a quick method to probe the environmental estrogen-like compounds via fluorescent imaging analysis in high content analysis (HCA) technology.Methods HCA assays were performed to quantitatively in-vestigate the effect of collected environmental pollutants , including bisphenol A , nonylphenol , 1,2-phenylenediamine , 4-aminophenol, resorcinol, 3-aminophenol, 1,4-phenylenediamine and 2,5-diaminotoluene on nuclear granules formation ( Foci-formation) of estrogen receptor α( ERα)-EGFR( enhanced green fluorescent protein ) fusion-protein, which was se-lected as a research model in this study .The results were confirmed by the ERαtranscriptional activity by luciferase as-says.Results Compounds 1,2-phenylenediamine, 4-aminophenol, resorcinol, 3-aminophenol, 1,4-phenylenediamine and 2,5-diaminotoluene sulfate could not induce the ERα-EGFR nuclear granule formation.17-β-Estradiol, bisphenol A, or nonylphenol enhanced ERα-EGFR nuclear granule formation in a dose-dependent manner .The EC50 value was (4.17 ± 0.41) nmol/L, (1.48 ±1.79) μmol/L,or (3.70 ±0.78) μmol/L, respectively.The minimum detectable concentration was 1 nmol/L (17-β-estradiol)and 300 nmol/L (bisphenol A, nonylphenol).In luciferase tests, 17-β-estradiol, bisphe-nol A, or nonylphenol increased ERαtranscriptional activity in a dose-dependent manner ,and the EC50 value was (4.46 ±0.56) nmol/L, (2.31 ±0.21) μmol/L, or (6.60 ±0.94) μmol/L, respectively.The minimum detectable concentration was 3 nmol/L (17-β-estradiol), 300 nmol/L (bisphenol A),and 1 μmol/L (nonylphenol).Conclusion As an efficient method for ERαagonist identification , HCA assays based on the cell image phenotypes analysis can be used in quick recog -nition of environmental compounds with ER agonist-like activity.In all experimental compounds , only bisphenol A and non-ylphenol have a clear ER agonist-like activity .

Objective To determine the diagnostic value of 8-hour pH monitoring in gastroesophageal refulux disease(GERD)and compare its sentivity and specificity with that of 24-hour monitoring.Methods Patients had been given esophageal manometry and ambulatory 24-hour pH monitoring.The 8-hour datas were analyzed from the standard ambulatory 24-hour pH recording.GERD was confirmed if DeMeester Score was no less than 14.72 according to the routine pH monitoring,then DeMeester score was reanalyzed according to 8-hour period,the same dignosis cirteria was used for 8-hour pH monitoring.Results Totally 221 patients met the entrance criterion.The 8-hour test had a sensitivity of 93.5% when compared to the 24-hour test and a specificity of 95.9%.Kappa test and Mc-nemar test verified the two monitor periods were with considerable consistency.The Pearson coefficient correlation was 0.929 with P value less than 0.001.Conclusion The 8-hour analysis is as sensitive and specific as the routine test for demonstrating GERD.By using this method,patients may suffer less discomfort and appear enhanced compliance.

Medicated diet has a long history in China. It is a special dietary form under the guidance of basic theo-ries of traditional Chinese medicine (TCM). This article discussed the characteristics, hot spots and methodological development of current study on medicated diet. It also discussed on current misunderstandings on the study of med-icated diet, such as lack of the guidance of systematic theory, not well-formed system, lack of professional personnel and their limitations, in order to promote the subject development of medicated diet.

To explore the relativity between alexithymia and cognitive function in somatoform disorder patients.A total of 40 patients aged 18-65 years fulfilling the criteria of ICD-10 for somatoform disorders were recruited as research group.And 40 normal healthy subjects were selected as control group.Toronto alexithymia scale-20 (TAS-20) was employed to examine the alexithymia.And cognitive abilities screening instrument (CASI) was used to measure their cognitive ability.The 9-factor scores and total score of CASI test in patients with somatoforill disorder were significantly lower than those in the normal controls (P ＜ 0.05 or ＜ 0.01).The 3-factor scores and total score of TAS-20 test in patients withsomatoforill disorder were significantly higher than those in the normal controls (P ＜ 0.05 or ＜ 0.01).In research group,CASI scores were negatively correlated with the TAS-20 scores (P ＜0.05 or 0.01).

OBJECTIVE:To outline the development of phytomedicine in Germany to offer a reference for traditional Chinese medicine.METHODS:From the aspects of research,production and market to make an exposition of phytomedicine's develop?ment in Germany.RESULTS:There existed a gap between Germany and China in technology and standards in production of botanicals.CONCLUSION:We should use the experience of Germany in developing botanicals to draw up international quality standard of traditional Chinese medicine.

Objective: To construct a prediction model for sleep disorders in shift workers of a chemical fiber enterprise, so as to provide the basis for early identification and prevention of sleep disorders in shift workers. Methods: Shift workers were sampled from a chemical fiber enterprise in Tongxiang City, Zhejiang Province using a cluster sampling method from August 2022 to July 2024. Demographic information, length of service and average weekly working hours were collected through questionnaire surveys. Depressive symptoms, anxiety symptoms and sleep disorders were evaluated using the Pittsburgh Sleep Quality Index, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire, respectively. The shift workers were randomly divided into a training set and a validation set at a ratio of 7∶3. Predictive factors were selected using a multivariable logistic regression model based on the training set, and a nomograph model for prediction of sleep disorders in shift workers was established. The predictive values of the model were evaluated using the receiver operating characteristic (ROC) curve and calibration curve based on the training set and validation set. Results: Totally 673 shift workers were included, with a median age of 32 (interquartile range, 12) years. There were 493 males, accounting for 73.25%. There were 471 (69.99%) workers in the training set and 202 (30.01%) workers in the validation set. There were 274 workers with sleep disorders, accounting for 40.71%. The equation for the prediction model was ln[p/(1-p)]=-8.391+1.906×average weekly working hours+1.822×depressive symptoms+1.667×anxiety symptoms. The area under the ROC curve was 0.769 (95%CI: 0.661-0.835) for the training set and 0.655 (95%CI: 0.593-0.737) for the validation set, and Hosmer-Lemeshow test showed a good fitting effect (both P>0.05). Conclusion The nomograph model constructed by average weekly working hours, depressive symptoms and anxiety symptoms can be used to predict the risk of sleep disorders in shift workers of a chemical fiber enterprise.

Abstract: To investigate the factors affecting lean non-alcoholic fatty liver disease (NAFLD), so as to provide the reference for the prevention and treatment of lean NAFLD. Methods: Individuals who underwent physical examination at Huzhou Central Hospital from January 1, 2023 to March 31, 2024 and had a body mass index (BMI) <23 kg/m2 was selected. Demographic information, lifestyle behaviors, dietary habits and physical examination data were collected through questionnaire surveys. Lean NAFLD was assessed using abdominal ultrasonography combined with BMI. Factors affecting lean NAFLD were analyzed by using a multivariable logistic regression model. Results: A total of 627 individuals were surveyed, with a mean BMI of (20.83±2.01) kg/m2. There were 349 males (55.66%) and 278 females (44.34%). Lean NAFLD was detected in 74 cases, with a detection rate of 11.80%. Multivariable logistic regression analysis identified BMI (OR=1.830, 95%CI: 1.165-2.869), gender (male, OR=2.615, 95%CI: 1.402-4.875), triglycerides (OR=3.062, 95%CI: 1.613-5.812), alanine aminotransferase (OR=1.587, 95%CI: 1.106-2.277), vegetable and fruit intake (150-300 g/d, OR=0.416, 95%CI: 0.230-0.752; >300 g/d, OR=0.303, 95%CI: 0.141-0.649), dairy product intake (≥300 mL/d, OR=0.369, 95%CI: 0.195-0.701) and sugared beverage intake (1-250 mL/d, OR=1.601, 95%CI: 1.071-2.393; >250 mL/d, OR=2.438, 95%CI: 1.363-4.354) as factors affecting lean NAFLD. Conclusion The risk of lean NAFLD is associated with BMI, gender, triglyceride, alanine aminotransferase, and the vegetable and fruit, dairy product and sugared beverage intake.

Objective:This study aims to investigate the correlation and significance between the expression of P53 and epitheli-al-mesenchymal transition (EMT) in breast cancer. Methods:The expression patterns of P53, Twist, Snail, E-cadherin, N-cadherin, Vi-mentin, and Fibronectin protein were detected via immunohistochemistry in 63 cases with breast carcinoma. The correlation of P53 pro-tein with clinicopathologic features and survival of breast carcinoma, as well as the relationship between the expression of P53 and EMT, was analyzed. Results:The expression rates of P53, Twist, Snail, and EMT are 44.4%(28/63), 54.0%(34/63), 68.3%(43/63), and 41.3%(26/63), respectively. The P53 protein expression is correlated with tumor grade (P<0.05) but not with other clinicopatholog-ic features (P>0.05). The expression of P53 is also correlated with the expression of Twist and Snail, which are associated with EMT (P<0.05). Multivariate survival analysis reveals that lymph node metastasis, P53, and EMT are independent prognostic factors. Conclu-sion:The expression of P53 is correlated with tumor grade and EMT in breast cancer, which can be used as an independent prognostic factor. Therefore, P53 may be an effective target for breast cancer therapy.

Objective:To propose a method to evaluate the total body water (TBW) of patients on hemodialysis with urea kinetic model (UKM), and compare it with body surface bio-impedance spectrum (BIS) analysis. Methods:We enrolled 24 adult patients with end stage renal disease (ESRD) without hyper-catabolism in our dialysis center. All of them had been on hemodialysis for more than 3 months. TBW was measured with BIS analysis immediately before and after dialysis session, and one hour after hemodialysis session. Spent dialysate was collected; blood samples were taken before and one hour after hemodialysis session, TBW before hemodialysis session were calculated by UKM. Results:Patients were 6 men and 18 women, the average age was (51.2?13.5) years and the average time on dialysis was (33.2?36.7) months. Causes of ESRD included chronic glomerulonephritis (8 patients), diabetic nephropathy (1 patients), hypertensive renal damage (1 patients), interstitial nephritis(two patients), chronic pyelonephritis (two patients). The average ultrafiltration volume was (2.7?1.0) L (0.5-4.4 L) . Plasma urea concentrations were (23.06?5.76) mmol/L and (8.15?2.06) mmol/L before and one hour after hemodialysis session, respectively. There was no significant difference between TBW measured immediately after and one hour after hemodialysis session with BIS analysis [(29.9?8.8) L and (29.8?8.6) L, respectively; average difference was (0.1?0.9)L, P=0.70]. These two measurements correlated very well (Pearson r=0.99, P