Background and purpose:Δ133p53 can promote tumor cell growth, but the exact mechanism is not clear. This study was aimed to observe the expression and signiifcant of the p53 isoformsΔ133p53 and p53 gene downstream molecules MDM2 and cyclin G1 genes by 5-FU-MKN45 gastric cancer cell line model. Methods:Af-ter using different concentrations of 5-FU (50μg/mL, 100μg/mL) to human gastric cancer cell line MKN45, inhibition rate should be detected by MTT assay, the changes ofΔ133p53 mRNA, MDM2 mRNA and cyclin G1 mRNA express-ing were detected by reverse transcription-polymerase chain reaction (RT-PCR). Differences between these groups were analyzed by ANOVA, comparisons within groups were analyzed by t-test, bivariate correlation was analyzed by Pearson linear correlation. Results:MTT results showed that with the increased concentration of 5-FU and the extension of time, the cell inhibition rates increased gradually. The inhibition rates of 50μg/mL 5-FU were 41.10%, 54.79%and 68.48%, for culturing 24, 48 and 72 hours. There were statistically signiifcant differences between the groups(F=45.52, P=0.00). The inhibition rates of 100μg/mL 5-FU were 69.53%, 78.21%and 86.92%, for culturing 24, 48 and 72 hours. There were statistically signiifcant differences between the groups(F=85.58,P=0.00). The inhibition rates of 50 and 100μg/mL were 41.10%and 69.53%, for culturing 24 hours. There were statistically signiifcant differences between the groups(F=51.29, P=0.00). The inhibition rates of 50 and 100μg/mL were 54.79%and 78.21%, for culturing 48 hours. There were statistically signiifcant differences between the groups(F=51.29, P=0.00). The inhibition rates of 50 and 100μg/mL were 68.48%and 86.82%, for culturing 72 hours. There were statistically signiifcant differences between the groups(104.91, P=0.00). RT-PCR results showed that with the increase of the concentration of 5-FU, theΔ133p53 mRNA, MDM2 mRNA and cyclin G1 mRNA expression gradually declined in gastric cancer cell line MKN45 cells, and there were statistically signiifcant differences between the groups(F=738.532, 1 396.607, 2 785.56,P=0.00). Cor-relation analysis showed that the expressions ofΔ133p53 mRNA and MDM2 mRNA in gastric cancer were positively correlated (r=0.871, P=0.01), while the expression of cyclin G1 mRNA and p53 mRNA had no obvious relevance (P=0.13). Conclusion:In the 5-FU-MKN45 gastric cancer cell line model, anti-tumor pathway ofΔ133p53 isomers is related with MDM2 but was not related with cyclin G1.

Objective To investigate the learning outcome of clinical scenarios discussion im-plemented in teaching medical students before clinical probation. Methods Using standardized pa-tients (SP) to simulate the clinical common difficult situation, all eight year program clinical medicine students (84) of Grade 2008 who were about to enter the clinical probation were given clinical commu-nication education guidance. Through five classification variables questionnaire and return visit, the teaching effect was evaluate. Epidata 3.0 was used to input data, and the SPSS 15.0 was used to make descriptive analysis of the questionnaire and proportion comparison. Results We found 35.4%(29) and 63.4%(52) of subjects liked and approval this training, respectively;90.2%(74) of the subjects thought the diffi-culty of this train was moderate; 77.3% (65) of subjects believed that it was necessary to set the clinical scenarios discussion before clinical probation. Conclusions The implementation of clinical scenarios discussion before clinical probation was effective on inducing the medical students to pay attention to the doctor-patient communication, and deep thinking about the communication notice mat-ters and cop-ing styles in clinical environment.

BACKGROUND:With the promotion of 3D printing technology, 3D printing scaffolds for bone tissue engineering have become the new ideas for jaw bone repair. OBJECTIVE:To compare the physical and biological properties of sheep vertebral bone meal/polyvinyl alcohol (PVA) scaffold, nano-hydroxyapatite (nHA)/PVA scaffold, and sheep vertebral bone meal/PVA nonporous bone plate. METHODS:3D printing technology was used to print sheep vertebral bone meal/PVA scaffold, nHA/PVA scaffold, and sheep vertebral bone meal/PVA nonporous bone plate. Porosity, morphology, water absorption rate and mechanical properties of different scaffolds were detected. Three kinds of scaffolds were al used to culture bone marrow mesenchymal stem cel s, and cel proliferation ability was detected using cel counting kit-8 at 1, 4, 7 days of culture. RESULTS AND CONCLUSION:Under scanning electron microscope, the sheep vertebral bone meal/PVA scaffold and nHA/PVA scaffold exhibited regular and interconnected pores with good continuity and clear network structure;the sheep vertebral bone meal/PVA nonporous bone plate had no obvious pores;however, it had dense and evenly distributed micropores with different sizes on its surface. The porosity of nHA/PVA scaffold was lower than that of the sheep vertebral bone meal/PVA scaffold (P<0.05). The water absorption rate was highest for the nHA/PVA scaffold fol owed by the sheep vertebral bone meal/PVA scaffold and the sheep vertebral bone meal/PVA nonporous bone plate (P<0.05). In contrast, the scaffold toughness was highest for the sheep vertebral bone meal/PVA nonporous bone plate, fol owed by the sheep vertebral bone meal/PVA scaffold and nHA/PVA scaffold. In addition, the cel proliferation activity of cel s cultured on the sheep vertebral bone meal/PVA scaffold was significantly higher than that cultured on the other two kinds of scaffolds. Taken together, the 3D printing sheep vertebral bone/PVA scaffold has good physical and chemical performance.

ObjectiveTo investigate the clinical effect of infusion of albumin versus artificial colloidal fluid after ascites drainage in patients with liver cirrhosis and ascites. MethodsCochrane Library (from 1993 to February 2018) PubMed (from 1966 to February 2018), Embase (from 1990 to February 2018), Chinese Scientific Journal Full-Text Database (from 1994 to February 2018), CBM (from 1978 to February 2018), China Science and Technology Journal Database (from 1989 to February 2018), Chinese Medical Association Digital Periodical Database (from 1997 to February 2018), and related periodicals and conference proceedings were searched for randomized controlled trials (RCTs) on infusion of albumin and artificial colloidal fluid after ascites drainage in patients with liver cirrhosis and ascites. The modified JADAD method and Cochrane systematic review were used for data extraction and literature quality assessment, and a statistical analysis was performed. RevMan 53 was used for the Meta-analysis. ResultsA total of 7 RCTs with 696 patients were included, with 299 patients in the human serum albumin group and 397 in the artificial colloidal fluid group. The human serum albumin group had a significantly lower incidence rate of hyponatremia than the artificial colloidal fluid group (11.04% vs 20.4%, risk ratio ［RR］=0.58, 95% confidence interval ［CI］: 0.40-0.84, P=0.004). There were no significant differences between the two groups in the incidence rates of kidney injury (702% vs 7.81%, RR=0.93, 95%CI: 0.53-1.65, P=0.82), hepatic encephalopathy (6.77% vs 7.45%, RR=0.87, 95%CI: 0.48-1.55, P=0.63), gastrointestinal bleeding (3.91% vs 3.65%, RR=0.97, 95%CI: 0.43-2.22, P=0.95), abdominal infection (522% vs 4.56%, RR=1.07, 95%CI: 052-2.18, P=0.86), and hospital death (12.78% vs 14.59%, RR=0.70, 95%CI: 047-1.02, P=0.06). ConclusionHuman albumin has an advantage over artificial colloidal fluid in reducing hyponatremia after ascites drainage in patients with cirrhotic ascites.

Objective To investigate the role of enteral nutrition (EN) support in the treatment of patients with chronic heart failure. Methods Ninety patients with chronic heart failure (conform to the New York Heart Association (NYHA) cardiac function class Ⅲ-Ⅳ) admitted to Intensive Care Unit (ICU), Cardiology Care Unit (CCU) and Emergency ICU (EICU) of Taizhou First People's Hospital from January 2015 to September 2017 were enrolled, and according to different nutritional methods, they were divided into a control group (rational autonomous diet group) and an observation group (Ruineng enteral nutritional emulsion for EN group), each group 45 cases. Based on the calculation (Harris-Benedict) of individual total energy consumption the control group had a reasonable autonomous diet and Ruineng EN emulsion for EN group. The chang of various nutrition indexes [including body mass index (BMI), serum total protein (TP), albumin (Alb), hemoglobin (Hb), vitamin B12, folic acid, serum iron], inflammatory factors [tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)], and the level of cardiac function index (LVEF) before and after treatment were observed. Results ① Before treatment, vitamin B12 in the observation group was significantly higher than that in the control group (ng/L: 153.3±54.6 vs. 113.4±80.2, P < 0.05), there were no statistical significant differences in other indicators between the two groups (all P > 0.05). ② After treatment, compared with those before treatment, the nutritional indicators and LVEF of both groups were higher, and inflammatory factors were lower, there were statistical significant differences in the other indicators before and after treatment except Hb and IL-6 in the control group and serum iron in the observation group [the control group: BMI (kg/m2) was 20.9±1.8 vs. 19.9±1.2, TP (g/L) was 66.0±2.4 vs. 63.7±1.6, Alb (g/L) was 34.4±3.5 vs. 31.1±2.3, vitamin B12 (ng/L) was 149.5±79.2 vs. 113.4±80.2, folic acid (nmol/L) was 10.0±1.7 vs. 4.6±3.2, serum iron (μmol/L) was 16.5±13.7 vs. 10.4±7.5, TNF-α (ng/L) was 23.8±10.0 vs. 28.3±8.6, LVEF was 0.35±0.14 vs 0.32±0.04; observation group: BMI (kg/m2) was 21.5±1.4 vs. 20.2±1.4, TP (g/L) was 66.5±2.8 vs. 64.3±2.2, Alb (g/L) was 35.8±3.1 vs. 33.3±1.9, Hb (g/L) was 121.4±13.8 vs. 112.9±12.0, vitamin B12 (ng/L) was 201.1±98.6 vs. 153.3±54.6, folic acid (nmol/L) was 15.7±14.4 vs. 8.8±2.8, TNF-α (ng/L) was 20.5±6.3 vs. 25.8±3.0, IL-6 (ng/L) was 209.4±6.5 vs. 220.9±16.9, LVEF was 0.38±0.07 vs. 0.33±0.02, all P < 0.05]. ③ Before and after treatment, the changes of BMI, Hb, vitamin B12, folic acid and IL-6 in the observation group were more significant than those in the control group [BMI (kg/m2): 1.4±0.9 vs. 1.1±0.3, Hb (g/L): 8.6±1.2 vs. 2.7±0.9, vitamin B12 (ng/L): 47.1±1.0 vs. 36.2±0.9, folic acid (nmol/L): 6.8±1.8 vs. 5.5±1.8, IL-6 (ng/L):-10.8±2.3 vs. -1.6±1.0, all P < 0.05]. After treatment, the degree of increase of serum iron in the control group was more significant than that in the observation group (μmol/L: 6.2±0.8 vs. 1.4±0.9, P <0.05), there were no significant differences in the degrees of improvement in TP, Alb and TNF-α between the two groups (all P > 0.05). ④ The difference value of each indicator before and after treatment of the two groups of patients with cardiac grade Ⅲ was more significant than that in the patients with cardiac grade Ⅳ, among the indicators in the control group, Hb, serum iron and IL-6 showed statistical significant differences [Hb (g/L): 3.05±0.42 vs. 2.47±0.84, serum iron (μmol/L): 6.81±0.91 vs. 5.95±1.82, IL-6 (ng/L): -3.87±0.45 vs. -0.53±0.28, all P < 0.05], while in the observation group of patients with cardiac grade Ⅲ and Ⅳ, Alb, Hb, serum iron, IL-6 appeared statistical significant differences [Alb (g/L): 3.41±0.38 vs. 2.27±0.91, Hb (g/L): 9.83±1.44 vs. 8.10±0.98, serum iron (μmol/L): 2.23±0.34 vs. 1.04±0.88, IL-6 (ng/L):-14.11±0.42 vs. -9.45±1.01, all P < 0.05]. Conclusion In the treatment of patients with chronic cardiac failure, simultaneously EN support is given energetically, that can improve the nutrition status of organism, reduce inflammatory reaction and enhance cardiac function; the therapeutic effect of Ruineng EN support is remarkably better than that of the autonomous diet support.

Objective:To establish an early prediction model with multiple indicators to predict the risk of severe acute pancreatitis (SAP) in hyperlipidemic acute pancreatitis (HLAP).Methods:The clinical data of 92 patients with HLAP admitted to the Emergency Department of our hospital from March 2018 to February 2020 were analyzed retrospectively. Among them, 29 cases deteriorated to SAP and 63 cases did not. Univariate analysis was used to screen predictive indicators related to hyperlipidemic severe acute pancreatitis (HL-SAP), and logistic regression analysis was used to screen independent predictive indicators related to HL-SAP. Then a prediction model was established. The area under (AUC) the receiver operating curve (ROC) was used to evaluate the predictive ability of each predictive indicator and the model for HL-SAP. Bootstrap resampling technology was used to validate the predictive ability of the model.Results:Univariate analysis showed that procalcitonin, D-dimer, C-reactive protein, albumin, cholesterol and CT grade had influence on the progression of HLAP to SAP ( P<0.05). Logistic regression analysis showed that D-dimer ( OR=2.112, 95% CI: 1.022-4.366; P<0.05), CT grade ( OR=5.818, 95% CI: 2.481-13.643; P<0.01) and cholesterol ( OR=1.146, 95% CI: 1.004-1.308; P<0.05) were independent risk factor of HL-SAP. The AUC of D-dimer, CT grade, cholesterol and the model were 0.802, 0.875, 0.665 and 0.927, respectively. Internal validation of the predictive ability of the model showed that the C-index was 0.927. Conclusions:In the early phase, application of the prediction model that composes D-dimer, CT grade and cholesterol has a good predictive effect on HL-SAP.

Objective: To investigate the dynamic change of paraquant-induced kidney injury in rats and the protective effect of edaravone. Methods: Eighty SD rats were randomly divided into 4 groups: the normal control group, paraquat poisoning group, edaravone treatment group and edaravone control group. The normal control group of 8 rats were given 1 ml of 0.9% sodium chloride through the abdominal cavity, and the same amount of fluid into the abdominal cavity after 30 minutes. The paraquat poisoning group of 24 rats were given 1 ml of paraquat solution (20 mg/kg) through the abdominal cavity to build poisoning models, and the same amount of 0.9% sodium chloride was injected into the abdominal cavity after 30 minutes. The edaravone treatment group of 24 rats were given edaravone (5 mg/kg) through the abdominal cavity after 30 minutes when the poisoning models were set up. The edaravone control group of 24 rats were given 1 ml of 0.9% sodium chloride through the abdominal cavity, and edaravone (5 mg/kg) was injected into the abdominal cavity after 30 minutes. In addition to the normal control group, the other groups processed 1 times a day to mantain 7 d. On 1, 3, 7, 21 d several rats in each group were excuted and the kidney tissue and serum samples were collected, then each pathological changes of the kidney were observed with light microscopy. Serum creatinine, KIM-1, NGAL were measured by ELISA, the expression of HSP70 protein in kidney were observed with immunohistochemical staining. Results: The pathological examination reveald that the damage of kidney tissue in the paraquat group was the most serious on 3 d, and the damage was consistently alleviated in edaravone treatment group at the same time, renal fibrosisn was unseen in each group until 21 d. Compared with normal control group, there was no statistically significant in edaravone control group (P>0.05) . The KIM-1 in blood and kidney in paraquat poisoning group were markedly increased in 1 d (P<0.05) . The NGAL in blood and creatinine were markedly increased in d7 (P<0.05) . The NGAL in kidney increased over time, but had no statistically difference with the control group (P>0.05) .Compared with paraquat poisoning group, the serum creatinine, KIM-1 in blood and kidney, the KIM-1 in kidney had decreased significantly in edaravone treatment group (P<0.05) . The NGAL in kidney has no statistically significant compared with the poisoning group (P>0.05) . HSP70 expression of kidney tissue in edaravone treatment group had significantly increased in d3 compared with the paraquat poisoning group (P<0.05) . Conclusion Edaravone can prompt a significant rise of HSP70 in kidney tissue, reduce KIM-1 and NGAL levels, and play a protective role in kidney injury of acute paraquat poisoning.

Objective To observe the intervention effect of immune-enhancing enteral nutrition (EN) emulsion on immune function of critically ill patients with mechanical ventilation (MV). Methods One hundred and twenty critically ill patients with MV admitted to the Department of Emergency Intensive Care Unit (EICU) of Taizhou First People's Hospital from July 2015 to June 2017 were enrolled, and they were divided into immune-enhancing EN group and standard EN group by random numbers generated by a computer. Ultimately, 76 cases were enrolled in the study, among them, 36 cases were in the immune-enhancing nutrition group and 40 cases were in the standard nutrition group. The differences of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), the sequential organ function evaluation (SOFA) score on 1, 3, 7 days and immunity indexes (secretory immuno-globulins IgA, IgG, IgM), lymphocyte subpopulation (CD4 and CD8), duration of MV and the length of ICU stay on the 1, 7 days after EN were compared. Results Comparisons between the immune-enhancing EN group and standard EN group showed: APACHE Ⅱ score had no statistically significant difference between the two groups at each time point, SOFA score on 7 days after EN treatment was significantly decreased in the immune-enhancing EN group (2.56±1.38 vs. 3.68±2.96, P < 0.05); IgA, IgG, IgM were obviously higher in the immune-enhancing EN group than those in standard EN group on 7 days after treatment [IgA (mg/L): 2 967.6±635.6 vs. 2 525.0±592.7, IgG (mg/L): 14 982.5±2 899.7 vs. 12 996.4±2 875.9, IgM (mg/L): 1 206.8±233.3 vs. 1 093.2±165.1, all P < 0.05], CD4 (0.45±0.06 vs 0.37± 0.10) and CD8 (0.20±0.03 vs. 0.18±0.04) were significantly higher than those in standard EN group (both P < 0.05). The MV time (hours): 122.33±63.91 vs. 155.69±77.06) and ICU stay time (hours): 197.57±70.60 vs. 239.61±84.83) of the immuno-enhancing EN group were markedly shorter than those of the standard EN group (both P < 0.05). Conclusion Compared with standard EN, the immune-enhancing EN emulsion can improve the immune function of critically ill patients with MV, and shorten the duration of MV support and the length of ICU stay.

Objective: To understand the sedentary behavior level of children and adolescents with intellectual disabilities in Jinan City, and to provide a reference basis for developing health behavior intervention strategies. Methods: By used the method of cluster random sampling,the Children s Leisure Activities Study Survey was used to investigate the sedentary behavior level of 285 children and adolescents with intellectual disabilities aged 6-18 years from 7 special education schools in Jinan City. Results: The sedentary behavior time during the whole week among children and adolescents with intellectual disabilities in Jinan City was 394.46 min/d, including 378.00 min/d on weekdays(Monday to Friday) and 388.80 min/d on weekends (Saturday and Sunday), the difference was statistically significant ( Z =-2.19, P <0.05). 80.4%(229) of children and adolescents with intellectual disabilities had sedentary behavior time of more than 2 h/d. The sedentary behavior time per day during the whole week among children and adolescents with intellectual disabilities was negatively correlated with the amount of time spent in moderate vigorous physical activity among them ( r =-0.16, P <0.05). Conclusion Excessive sedentary behavior has become a growing public health concern among children and adolescents with intellectual disabilities,which warrants targeted healthy behavior intervention.

Objective To compare the clinical efficacy of invisible appliance and fixed appliance in the treatment of skeletal class I malocclusion.Methods A prospective cohort study with a minimum sample size of no less than 19 subjects in each group was used,and 46 adult patients with bone type I were eventually enrolled.According to the type of appliance,they were divided into the invisible appliance group(group A)with 25 patients and the fixed appliance group(group B)with 21 patients.Data were analyzed before orthodontic treatment(T0)after(T1)between invisible and traditional fixed orthodontics.Results The static occlusion index and PAR score were improved after treatment,and the differences were statistically significant(P<0.01).The occlusal dynamic parameters including OT,OFAT,OFPT,AOF and DT were significantly improved after treatment(P<0.01).There were significant differences in AOF,forward and lateral DT between the two groups(P<0.01),the invisible group was better than the fixed group.Conclusion Both the dynamic and static occlusal changes can be greatly improved with invisible and fixed appliance in the treatment of patients with class I malocclusion.Invisible appliance is better than fixed appliance in balancing occlusion,eliminating and reducing occlusal interference.