Objective To explore the correlation between gratitude and turnover intention of nursing staff.Methods A total of 660 clinical nurses from three general hospitals in Hangzhou city were subject to questionnaire survey for the correlation.Results The multidimensional gratitude totaled 128.33±32.67,at a medium or low level; their turnover intention totaled 14.59 ± 2.26,at a medium level.The multiple factor variance analysis showed statistically significant negative correlations between the three dimensions of gratitude(a sense of rich,simple thanks,and thanks to others)and turnover intention.Conclusion Related departments are recommended to pay close attention to nurses' gratitude and carry out gratitude education,so as to decrease their turnover intention,and keep the career stability of nurses.

OBJECTIVE To study the antibacterial activity of pazufloxacin in vitro against bacteria isolated from(patients) with respiratory and urinary tract infection,compared with levofloxacin,ciprofloxacin,cefuroxime and(cefotaxime) to provide guideline for clinical application.METHODS The infected bacteria were identified by the(fully) automatic VITEK system.The susceptibility test was determined by MIC method and K-B disk diffusion method respectively.RESULTS The sensitivity of most Gram-negative bacteria to pazufloxacin was basically the same to levofloxacin,cefotaxime, etc.However,the sensitivity of Pseudomonas and Acinetobacter to(pazufloxacin) was higher than to other four antibiotics;the sensitivity of Gram-positive cocci,particularly(Streptococcus) to(pazufloxacin) was obviously lower than cephalosporins and no better than other quinolones.(CONCLUSIONS) The antibacterial activity of pazufloxacin in vitro against the bacteria isolated from patients with(respiratory) and urinary tract infection is comparatively strong,especially in the urinary system.Pazufloxacin has an excellent broad-(spectrum) and strong antibacterial activity.However,the antibacterial activity against Gram-positive cocci is(expected) to promote.

Objective: Non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR)-activating mutations have higher response rate and more prolonged survival following treatment with single-agent EGFR tyrosine kinase inhibitor (EGFR-TKI) compared with patients with wild-type EGFR. However, all patients treated with reversible inhibitors develop acquired re-sistance over time. The mechanisms of resistance are complicated. The lack of established therapeutic options for patients after a failed EGFR-TKI treatment poses a great challenge to physicians in managing this group of lung cancer patients. This study evaluates the in-fluence of EGFR-TKI retreatment following chemotherapy after failure of initial EGFR-TKI within at least six months on NSCLC pa-tients. Methods:The data of 27 patients who experienced treatment failure from their initial use of EGFR-TKI within at least 6 months were analyzed. After chemotherapy, the patients were retreated with EGFR-TKI (gefitinib 250 mg qd or erlotinib 150 mg qd), and the tumor progression was observed. The patients were assessed for adverse events and response to therapy. Targeted tumor lesions were as-sessed with CT scan. Results:Of the 27 patients who received EGFR–TKI retreatment, 1 (3.7%) patient was observed in complete re-sponse (CR), 8 (29.6%) patients in partial response (PR), 14 (51.9%) patients in stable disease (SD), and 4 (14.8%) patients in progres-sive disease (PD). The disease control rate (DCR) was 85.2%(95%CI=62%-94%). The median progression-free survival (mPFS) was 6 months (95%CI=1-29). Of the 13 patients who received the same EGFR-TKI, 1 patient in CR, 3 patients in PR, 8 patients in SD, and 2 patients in PD were observed. The DCR was 84.6%, and the mPFS was 5 months. Of the 14 patients who received another EG-FR-TKI, 0 patient in CR, 6 patients in PR, 6 patients in SD, and 2 patients in PD were observed. The DCR was 85.7%, and the mPFS was 9.5 months. Significant difference was found between the 2 groups in progression-free survival but not in response rate or disease control rate. Conclusion:Retreatment of EGFR-TKIs can be considered an option after failure of chemotherapy for patients who were
previously controlled by EGFR-TKI treatment.

The gene TNFAIP3 acts as a negative regulator of the NF-κB signaling pathway. TNFAIP3 encodes the A20 protein，which exerts a potent anti-inflammatory effect and plays a pivotal role in the regulation of inflammation and immunity. In recent years，TNFAIP3 has garnered significant attention as a susceptibility gene for numerous autoimmune diseases，including but not limited to systemic lupus erythematosus，rheumatoid arthritis，psoriasis. Additionally，high-penetrance heterozygous mutations in TNFAIP3 cause a haploinsufficiency of A20（HA20）. HA20 is a monogenic autoinflammatory disease. But some individuals of HA20 exhibit clinical features of autoimmune diseases，including varying degrees of autoantibody positivity，lupus-like phenotypes，and autoimmune thyroid disease.This article focuses on the single nucleotide polymorphism of TNFAIP3 and related autoimmune diseases，to underscore the crucial role of TNFAIP3 in the pathogenesis of autoimmune diseases，and to provide new research directions and potential drug targets for these conditions.

This study was aimed to observe the effects on glucolipid metabolism of aqueous extract of traditional South African herb Sutherlandia. Intraperitoneal injection of streptozotocin (STZ) combined with high fat feed method was used in the establishment of type 2 diabetes rat model. Then, rats were randomly divided into the normal group, model group, pioglitazone group, and the Sutherlandia group. Observation was made on changes of body weight, oral glucose tolerance test (OGTT), blood triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C). Western blot method was used to detect IRS-1 expression of skeletal muscle in rats of each group. The results showed that compared with the normal group, body weight in the model group was decreased, and indicators of OGTT, TG, TC, LDL-C were significantly increased (P< 0.05). Symptoms such as increased drink-ing, eating and urine were obvious; and the IRS-1 expression was obviously decreased (P< 0.05). After treatment, compared with the model group, there was no significant body weight increase in the Sutherlandia group or the pi-oglitazone group. Indicators of blood glucose, TG, TC in the Sutherlandia group and the pioglitazone group were ob-viously decreased with no statistical difference (P< 0.05 or P< 0.01). In the Sutherlandia group and the pioglitazone group, IRS-1 expression of skeletal muscle in rats was obviously increased with no statistical difference (P< 0.05). It was concluded that type 2 diabetes rats induced by intraperitoneal injection of STZ combined with high fat feed method can induce glucolipid metabolism disorders. Traditional South African herb Sutherlandia can obviously reduce the blood sugar level, improve blood lipid metabolism, and improve the level of insulin. Sutherlandia can improve the IRS-1 expression of skeletal muscle in rats, relief the insulin resistance, and lower blood sugar. However, the effect of its exact ways required further in-depth study.

Objective: To understand the level of radius speed of sound (SOS) in female college students and explore the effect of dietary on their bone health,so as to provide a reference for effective prevention fracture and osteoporosis among college students. Methods: A total of 363 female college students were selected by multistage stratified random sampling method. Dietary intake was assessed with a self-administered food frequency questionnaire, principal component analysis was used to derive dietary patterns. Speed of sound was measured by ultrasonic bone densitometer. Results: In all, the mean SOS of female college students was(4 138.0±114.3)m/s, 26.7% of female college students had low bone mass. Three dietary patterns were identified by factor analysis, explaining 55.4% of the diet variation: "snack" "plant" "high protein and high fat" patterns, respectively. Multiple linear regression analysis showed that with the increase of age, the level of SOS in radius increased significantly; and snacks consumption was negatively associated with the level of SOS(β=13.23, -0.47, P<0.05). Conclusion University stage is still the critical period of bone mass accumulation for female, snacks consumption may have a negative impact on bone health, so it is necessary to carry out nutrition education to help improve health awareness, promote health eating, and lead health lives to prevent osteoporosis.

Objective: To analyze the effects of 12week highintensity fitness exercise on body composition,lipid metabolism and gut microbiota in obese adolescents, so as to provide references for improving the health levels of obese adolescents. Methods: From January to June 2023, 20 obese adolescents from Huaifeng Vocational and Technical School in Huaian City were recruited for the study. Participants were assigned to an exercise group (n=10) and a control group (n=10) for a 12week exercise intervention by random number table method, and both groups had the same diet during the intervention period. The exercise group engaged in three exercises every week, mainly consisting of moderate to highintensity aerobic exercise combined with highintensity intervals. In the first week, there was a 30 minutes of aerobic exercise, followed by 10 minutes of highintensity interval training in the total intervention time each week, and the rest of the time was aerobic exercise with a total intervention time of 60 minutes to maintain; the control group did not receive specific interventions. Body composition was measured using bioelectrical impedance analysis, and lipid levels were determined using an automatic biochemical analyzer. The expression levels of serum inflammatory factors were measured at baseline and after 12 weeks of intervention, and gut microbiota was analyzed using 16S rRNA gene sequencing. Statistical analysis was performed using t test and Chisquare test. Results: After 12 weeks of intervention, the levels of triglycerides (TG), and lowdensity lipoprotein cholesterol (LDL-C) in obese adolescents in the exercise group decreased from (1.7±0.6, 3.5±0.8) mmol/L to (0.9±0.3, 2.6±0.4) mmol/L, while highdensity lipoprotein cholesterol (HDL-C) increased from (1.1±0.2) mmol/L to (1.4±0.2) mmol/L; and serum interleukin-1 receptor antagonist(IL-1Rn) decreased from (8.4±1.6) to (4.5±0.4) ng/mL in the exercise group (t=7.34,2.49,-3.05,2.56, P<0.05). The α-diversity results showed that the Chao index (268.00±22.67) and Ace index (243.98±38.64) in the exercise group were higher than those in the control group (184.52±19.28, 171.43±23.33), and the differences were statistically significant (t=2.48, 2.53, P<0.05). The Shannon index (5.36±1.41) in the exercise group was higher than that in the control group (4.73±1.12), and the Simpson index (0.78±0.10) was lower than that in the control group (0.89±0.10), but the differences were not statistically significant (t=1.83, -2.10, P>0.05). The β-diversity results showed that the intergroup differences in gut microbiota structure between the exercise group and the control group were greater than the intragroup differences, and the differences in gut microbiota structure between the exercise group and the control group were statistically significant (R2=0.083，P<0.05). After intervention, there were significant differences in the relative abundances at the levels of phylum, class, genus, and species in gut microbiota among obese adolescents between the exercise group and the control group (P<0.05). Conclusion The 12week highintensity fitness exercise can alleviate obesity symptoms in obese adolescents through the gut microbiota-lipid metabolism pathway and improve mild chronic inflammatory status.

BACKGROUNDGensing Rg3 is an active component from ginseng. The aim of this study is to observe the clinical anticancer effect of Rg3 in combination with chemotherapy regimen NP (vinorelbine+cisplatin) in advanced non-small cell lung cancer (NSCLC).

METHODSStage III-IV NSCLC patients confirmed by pathology or cytology all received vinorelbine plus cisplatin for at least two cycles, and were randomized into two groups: patients in arm A also received placebo twice a day, while patients in arm B received two tablets of Rg3 twice a day for at least two months. The endpoints of the study were the efficacy, survival and tolerance of patients.

RESULTSFrom July 2000 to May 2002, 115 patients were enrolled into the trial. The patients' characteristics were well balanced in the two groups. Sex of patients: male, 79; female 36. Types of pathology: adenocarcinoma, 71; squamous cell carcinoma, 29; adenosquamous carcinoma, 8; others, 7. TNM stage: stage III, 45; stage IV, 70. Prior chemotherapy: with, 17; without, 98. Prior radiotherapy: with, 15; without, 100. Prior surgical treatment: with, 23; without, 92. Nine patients discontinued from the trial due to severe adverse effects (5) and other reasons (4), so there were 106 patients evaluable for clinical efficacy. The response rate was 14.5% (8/55) in arm A, and 33.3% (17/51) in arm B (P=0.011). The survival time in arm A was 9.7 months (mean) and 8.0 months (median), and 15.3 months (mean) and 10.0 months (median) in arm B (P=0.0088).

CONCLUSIONSPreliminary results show improvements in response rate and survival time (median and mean) in Rg3 arm compared with placebo arm. It is worthy to confirm the results in further clinical trials.

Objective:To study the genetic variation and distribution characteristics of thalassemia in people of childbearing age in Hubei Province, and to provide clinical basis for the local government decision-making departments to formulate and promote appropriate policies for prevention and control of thalassemia.Methods:Venous blood samples were collected from 44 849 people of childbearing age in hospitals in Hubei Province from May 13, 2019 to August 17, 2021. PCR-flow fluorescence hybridization and PCR+diversion hybridization were used to screen thalassemia genes. Spouses of those who tested positive were also tested for thalassemia genes. When both spouses carried the same type of thalassemia gene, the amniotic fluid of pregnant women was extracted for prenatal diagnosis and followed up.Results:Among the 44 849 people of childbearing age, 2 286 cases were diagnosed as thalassemia gene carriers through genetic testing, and the total detection rate was 5.10% (2 286/44 849). Among them, 1 488 cases were diagnosed as α-thalassemia, and the detection rate was 3.32% (1 488/44 849); 767 cases were diagnosed as β-thalassemia, and the detection rate was 1.71% (767/44 849); 31 cases were diagnosed as α-thalassemia combined with β-thalassemia, and the detection rate was 0.07% (31/44 849). The top three genotypes of α-thalassemia were -α 3.7/αα, -- SEA/αα, and -α 4.2/αα, accounting for 58.06% (864/1 488), 26.14% (389/1 488), and8.74% (130/1 488), respectively. The top three genotypes of β-thalassemia were β IVS-Ⅱ-654/β N, β CD41-42/β N, and β CD17/β N, accounting for 41.72% (320/767), 21.25% (163/767), and 16.04% (123/767), respectively. The main genotypes of α-thalassemia combined with β-thalassemia were -α 3.7/αα complex β IVS-Ⅱ-654/β N and -α 3.7/αα complex β CD41-42/β N, accounting for 29.03% (9/31) and 16.13% (5/31), respectively. A total of 59 people of childbearing age were conducted prenatal diagnosis, among fetus, there were 4 cases of severe thalassemia (2 cases of severe α-thalassemia, 2 cases of severe β-thalassemia), 5 cases of intermediate α-thalassemia, 5 cases of intermediate or severe β-thalassemia, 19 cases of mild thalassemia (8 cases of mild α-thalassemia, 11 cases of mild β-thalassemia), 13 cases of stationary α-thalassemia, and 1 case of stationary α-thalassemia combined with mild β-thalassemia, there were 12 cases without α-thalassemia or β-thalassemia genes. After follow-up, 4 cases of severe thalassemia, 2 cases of intermediate α-thalassemia, and 5 cases of intermediate or severe β-thalassemia were terminated pregnancy by the joint decision of both parents. Conclusions:In Hubei Province, the detection rate of thalassemia is high, and α-thalassemia is the main mutation type. The combination of thalassemia gene screening and prenatal diagnosis is of great significance in reducing the birth rate of children with thalassemia.

Objective:To summarize the survival rate, complications, and outcomes of 32 periviable extremely preterm infants (PEPIs) born at ≤23 gestational weeks.Methods:This was a retrospective observational study involving PEPIs born at the Shenzhen Maternity & Child Healthcare Hospital from January 1, 2015, to December 31, 2021. Clinical data of all subjects were collected and analyzed. The survival rates of PEPIs born from 2015 to 2019 and 2020 to 2021 were compared. Chi-square (or Fisher's exact) test was used for statistical analysis. Results:(1) During the study period, 32 PEPIs were admitted, accounting for 0.024% (32/132 534) of all newborns born in the same hospital during the study period. The median gestational age of the 32 PEPIs was 23 weeks (21 +4-23 +6 weeks), and the birth weight was 480 g (350-720 g). (2) The survival rate of PEPIs born between 2020 and 2021 was 10/19, which appears to be a trend higher than that between 2015 and 2019 (3/13, χ2=2.79, P=0.095), while the rate of withdrawal of treatment was 8/13 and 3/19, respectively, with a statistically significant difference ( χ2=7.16, P=0.007). (3) Thirteen of the 32 PEPIs survived on discharge, including four born at 22 weeks and nine at 23 weeks. The birth weights of these surviving infants were 300-<400 g in one case, 400-<500 g in five cases, 500-<600 g in four cases, 600-<700 g in one case, and ≥700 g in two cases. (4) The most common complication was moderate and severe bronchopulmonary dysplasia (10/13), followed by retinopathy of prematurity requiring surgical intervention (5/13), patent ductus arteriosus requiring ligation (4/13), late-onset sepsis (2/13), necrotizing enterocolitis (stage Ⅱa or above) (2/13) and grade Ⅲ-Ⅳ intraventricular hemorrhage or periventricular leukomalacia (2/13). The median duration of follow-up was ten months (6-69 months), and motor retardation occurred in three infants. Conclusions:The overall survival rate of PEPIs in our hospital is relatively high, with a lower incidence of complications during hospitalization and relatively better outcome. However, further studies are required for the long-term prognosis in this group of infants.