HBV DNA integration （iDNA） is the core barrier that must be overcome to achieve functional cure for chronic hepatitis B （CHB） and to prevent the occurrence of hepatocellular carcinoma （HCC）. During reverse transcription， 5%　—　10% of viral genomes are converted into double-stranded linear DNA that is randomly inserted into host chromosomes， generating stable iDNA and continuously producing HBsAg， thereby driving B- and T-cell immune exhaustion and locking the host in an immune-tolerant state. The process of iDNA runs throughout the entire natural history of HBV infection， and the viral enhancers it carries can promote clonal hyperplasia of indeterminate potential， accumulate pre-neoplastic mutations， and ultimately lead to HCC. Although long-term nucleos（t）ide analog or interferon therapy can suppress viral replication and reduce the formation of new integrations， existing therapies still fail to eliminate existing iDNA. Therefore， there is an urgent need for innovative strategies that can precisely target integration breakpoints， epigenetically silence iDNA， or eradicate integrated clones， so as to significantly increase the functional cure rate of CHB and fundamentally reduce the risk of HCC.

Objective:To investigate the effect of intensive lipid-lowering therapy on carotid artery intima-media thickness and plaque area in patients with acute cerebral infarction.Methods:Eighty-two patients with acute cerebral infarction who received treatment at the Changzhi Mental Health Center from July 2021 to July 2022 were included in this study. Using a randomized controlled trial design, the patients were randomly divided into an intensive treatment group ( n = 41) and a conventional treatment group ( n = 41) using the random number table method. All patients had surpassed the recommended time window for thrombolysis and were given conventional treatments, including antiplatelet aggregation and neuroprotection. The conventional treatment group received conventional lipid-lowering therapy, while the intensive treatment group underwent intensive lipid-lowering therapy. All treatments lasted 6 months. The levels of blood lipids (low-density lipoprotein cholesterol and total cholesterol), inflammatory factors (C-reactive protein and interleukin-6), and atherosclerosis indicators (carotid artery intima-media thickness and plaque area) were measured and compared between the two groups before and after treatment. Adverse reactions occurring during the treatment period, including myalgia, nausea, vomiting, and abnormal liver function were also recorded. Results:Before treatment, there were no significant differences in blood lipids, inflammatory factors or atherosclerosis indicators between the conventional treatment and intensive treatment groups (all P > 0.05). After treatment, the levels of low-density lipoprotein cholesterol and total cholesterol in the intensive treatment group were significantly lower than those in the conventional treatment group [(3.44 ± 0.42) mmol/L vs. (4.81 ± 0.53) mmol/L, (3.46 ± 0.35) mmol/L vs. (2.41 ± 0.27) mmol/L, t = 12.97, 15.21, both P < 0.05]. After treatment, serum levels of interleukin-6 and C-reactive protein in the intensive treatment group were significantly lower than those in the conventional treatment group [(4.79 ± 0.53) mg/L vs. (6.97 ± 0.81) mg/L, (38.45 ± 4.14) pg/L vs. (49.66 ± 5.07) pg/L, t = 14.42, 10.97, both P < 0.05]. Carotid artery intima-media thickness and plaque area in the intensive treatment group were significantly smaller than those in the conventional treatment group [(0.98 ± 0.10) mm vs. (1.17 ± 0.12) mm, (13.04 ± 1.37) mm 2vs. (17.96 ± 1.89 mm 2, t = 7.79, 13.50, both P < 0.001). There was no significant difference in the overall incidence of adverse reactions during treatment between the intensive treatment and conventional treatment groups ( P > 0.05). Conclusion:Intensive lipid-lowering therapy is highly effective in patients with acute cerebral infarction. It can reduce inflammatory reactions, delay the progression of atherosclerosis, and provide a safety profile similar to that of conventional lipid-lowering therapy.

Objective To investigate the status and molecular epidemiology of hepatitis D virus (HDV) infection in the gathering area of Mongolian population in Inner Mongolia Autonomous Region of China. Methods A total of 230 patients with positive hepatitis B surface antigen (HBsAg) who attended Inner Mongolia International Mongolian Hospital from April 2019 to October 2020 were enrolled, and according to related information, they were divided into hepatitis B+liver cirrhosis group( n =18) and hepatitis B group( n =212). According to HBsAg quantification with a cut-off value of 250 IU/mL, the patients were divided into HBsAg < 250 IU/mL group( n =104) and HBsAg ≥250 IU/mL group( n =126). ELISA was used to detect HDV antibody, and quantitative real-time PCR was used to measure HDV RNA in patients with positive HDV antibody. Genotyping was performed for HDV RNA-positive samples. The chi-square test was used for comparison of categorical data between two groups. Results The positive rate of HDV antibody was 16.09%, and among the patients with positive HDV antibody, the positive rate of HDV RNA was 91.89%. Among the 18 patients with hepatitis B and liver cirrhosis, the positive rate of HDV antibody was 44.44%, and among the patients with positive HDV antibody, the positive rate of HDV RNA was 100%. There were 104 patients with HBsAg < 250 IU/mL, among whom only 3 patients (2.88%) were positive for hepatitis D antibody, and there were 126 patients with HBsAg ≥250 IU/mL, with a positive rate of HDV antibody of 26.98%. Genotype 1 was observed in all the samples that could be genotyped. Conclusion There is a relatively high infection rate of HDV in Inner Mongolia Autonomous Region, especially in patients with HBsAg ≥250 IU/mL or those with liver cirrhosis. It is necessary to strengthen the detection of hepatitis D in HBsAg-positive patients and perform early diagnosis and treatment to prevent the further progression of hepatitis.

Objective:To explore the effects of concept map combined with team-based learning (TBL) teaching method on the examination results, critical thinking ability and teaching satisfaction of nursing interns.Methods:A total of 67 nursing interns in Guangyuan Central Hospital from March to October 2019 were selected and randomly divided into study group and control group. TBL teaching method was used in the control group, and concept map combined with TBL teaching method was used in the study group. The assessment results, critical thinking ability and teaching satisfaction of the two groups were compared. SPSS 22.0 was used for chi-square test and t test. Results:The theoretical knowledge and final examination scores of the study group were higher than those of the control group ( P<0.05); after teaching, the scores of curiosity, truth seeking, systematic ability and self-confidence and total scores of the study group were higher than those before teaching and those of the control group ( P<0.05); the satisfaction scores on having great value to clinical practice, improving learning initiative, helping to understand teaching content, cultivating cooperative learning ability and stimulating learning competitiveness in the study group were higher than those in the control group ( P<0.05). Conclusion:Concept map combined with TBL teaching method is beneficial for nursing interns to master learning knowledge, improve critical thinking ability and increase teaching satisfaction.

Hepatocellular carcinoma (HCC) often has an insidious onset, and most patients are in the advanced stage and have lost the best opportunity for treatment at the time of diagnosis, resulting in a poor prognosis. As a multifunctional transcription factor, Yin Yang 1 (YY1) regulates the transcription of a variety of important genes and plays a key role in various tumors. Previous studies have shown that YY1 affects many biological behaviors such as proliferation, apoptosis, migration, and angiogenesis and is closely associated with drug resistance and poor prognosis of HCC. This article reviews the research advances in the role of YY1 in the development and progression of HCC, so as to provide a theoretical basis for the treatment of HCC.

Objective:To analyze the clinical and radiological features of patients with hypoplasia of the internal carotid artery.Methods:Four patients with hypoplasia of the internal carotid artery (including 3 patients with congenital absence of the internal carotid artery), admitted to our hospital from January 2010 to December 2021, were chosen in our study. The clinical data and imaging features of these patients were retrospectively analyzed.Results:The age of these patients ranged from 31 to 73 years, and two patients were female. Clinically,2 patients presented with dizziness, 1 patient presented with limb weakness, and 1 patient was asymptomatic. In 3 patients with congenital absence of the internal carotid artery, DSA results showed that the internal carotid artery was not developed, and CT bone window showed that the internal carotid artery canal was absent; 1 patient with hypoplasia of the internal carotid artery showed thin imaging in DSA results. One patient was combined with anterior communicating artery aneurysm and left internal carotid artery aneurysm. One patient was with vertebral arterial dolichoectasia. The collateral circulation compensation: type A was noted in 3 patients and type C was noted in 1 patient.Conclusion:The patients with hypoplasia of the internal carotid artery are usually asymptomatic, and patients with congenital absence of the internal carotid artery can have ischemic symptom; these patients can be complicated with vascular abnormalities such as aneurysm and vascular thickening.

Objective:To analyze the clinical and radiological features of patients with hypoplasia of the internal carotid artery.Methods:Four patients with hypoplasia of the internal carotid artery (including 3 patients with congenital absence of the internal carotid artery), admitted to our hospital from January 2010 to December 2021, were chosen in our study. The clinical data and imaging features of these patients were retrospectively analyzed.Results:The age of these patients ranged from 31 to 73 years, and two patients were female. Clinically,2 patients presented with dizziness, 1 patient presented with limb weakness, and 1 patient was asymptomatic. In 3 patients with congenital absence of the internal carotid artery, DSA results showed that the internal carotid artery was not developed, and CT bone window showed that the internal carotid artery canal was absent; 1 patient with hypoplasia of the internal carotid artery showed thin imaging in DSA results. One patient was combined with anterior communicating artery aneurysm and left internal carotid artery aneurysm. One patient was with vertebral arterial dolichoectasia. The collateral circulation compensation: type A was noted in 3 patients and type C was noted in 1 patient.Conclusion:The patients with hypoplasia of the internal carotid artery are usually asymptomatic, and patients with congenital absence of the internal carotid artery can have ischemic symptom; these patients can be complicated with vascular abnormalities such as aneurysm and vascular thickening.

Objective:To investigate the expression of IGF1R-Ras and RAGE-HMGB1 signaling pathways in colorectal cancer patients with type 2 diabetes mellitus and their significance.Methods:The resected cancer tissues were obtained from 59 patients with colorectal cancer (CRC), including 29 patients with type 2 diabetes mellitus (CRC/DM group) and 30 with CRC alone (CRC group). The expressions of IGF1R, Ras, RAGE and HMGB1 in cancer tissues were detected by immunohistochemistry. The differences between the two groups were compared and the relationship between the expression and clinicopathological characteristics was analyzed.Results:In CRC/DM group, the positive rates of IGF1R and Ras were both 65.5% (19/29), and 51.7% (15/29) patients had IGF1R+ Ras+ immunophenotype, which were significantly higher than those in CRC group [33.3% (10/30), 36.7% (11/30) and 20.0% (6/30); P=0.013, 0.027 and 0.011, respectively]. The expression of IGF1R and Ras in CRC / DM group was positively correlated ( r=0.479, P=0.017). The positive rate of RAGE expression in CRC group and CRC/DM group was 70.0% (21/30) and 72.4% (21/29) respectively, and the positive rate of HMGB1 expression was 46.7% (14/30) and 58.6% (17/29) respectively, neither was observed with significant difference ( P=0.358 and 0.838). However, the proportion of patients with RAGE+ HMGB1+ immunophenotype in CRC/DM group [55.2% (16/29)] was higher than that in CRC Group [26.7% (8/30)] which was statistically significant ( P=0.026), and the expression of both proteins was positively correlated in CRC/DM group ( r=0.578, P=0.003). The clinicopathological analysis showed that in both groups the expression of IGF1R, Ras, RAGE and HMGB1 had no correlation with the sex, age, differentiation degree, tumor length, T stage and lymph node metastasis ( P>0.05). Conclusion:Both IGF1R-Ras and RAGE-HMGB1 pathways may be involved in the oncogenesis of colorectal cancer in patients with type 2 diabetes.

Objective:To investigate the expression of IGF1R-Ras and RAGE-HMGB1 signaling pathways in colorectal cancer patients with type 2 diabetes mellitus and their significance.Methods:The resected cancer tissues were obtained from 59 patients with colorectal cancer (CRC), including 29 patients with type 2 diabetes mellitus (CRC/DM group) and 30 with CRC alone (CRC group). The expressions of IGF1R, Ras, RAGE and HMGB1 in cancer tissues were detected by immunohistochemistry. The differences between the two groups were compared and the relationship between the expression and clinicopathological characteristics was analyzed.Results:In CRC/DM group, the positive rates of IGF1R and Ras were both 65.5% (19/29), and 51.7% (15/29) patients had IGF1R+ Ras+ immunophenotype, which were significantly higher than those in CRC group [33.3% (10/30), 36.7% (11/30) and 20.0% (6/30); P=0.013, 0.027 and 0.011, respectively]. The expression of IGF1R and Ras in CRC / DM group was positively correlated ( r=0.479, P=0.017). The positive rate of RAGE expression in CRC group and CRC/DM group was 70.0% (21/30) and 72.4% (21/29) respectively, and the positive rate of HMGB1 expression was 46.7% (14/30) and 58.6% (17/29) respectively, neither was observed with significant difference ( P=0.358 and 0.838). However, the proportion of patients with RAGE+ HMGB1+ immunophenotype in CRC/DM group [55.2% (16/29)] was higher than that in CRC Group [26.7% (8/30)] which was statistically significant ( P=0.026), and the expression of both proteins was positively correlated in CRC/DM group ( r=0.578, P=0.003). The clinicopathological analysis showed that in both groups the expression of IGF1R, Ras, RAGE and HMGB1 had no correlation with the sex, age, differentiation degree, tumor length, T stage and lymph node metastasis ( P>0.05). Conclusion:Both IGF1R-Ras and RAGE-HMGB1 pathways may be involved in the oncogenesis of colorectal cancer in patients with type 2 diabetes.