Mitogen activated protein kinase(MAPK)is one of the four biggest signal transduction systems which contain four subtribes named p38,ERK5/BMK1,ERK and JNK/SAPK respectively.Previous studies have shown that MAPK pathway is involved in growth,cell differentiation,perishing,the synchronization of cell function and so on.ERK/MAPK,one of the members of MAPK family,and Sma-and MAD-related(Smad)play important roles in the proliferation of fibroblast,modulating inflammation mediator production as well as transferring factors activity in the process of pulmonary fibrosis(PF).This review focuses on relationship between Smads and ERK in the pathogenesis and progression of PF.

Objective: To educate the high-quality nurses with ability and to improve their capability in holistic nursing.Methods: Interlocution of nursing case is applied to theory teaching.Clinic probation and simulative act are applied to practical teaching.Results:Situational teaching method is welcome among the experimental students whose grade is higher than that of the students of contrast class.Conclusion: It is propitious to education in synthesis ability of students to use situational teaching method based on the holistic nursing.

Aim To observe the effects of cytokine signaling inhibition protein-3(SOCS3) on the liver fibrosis progression and reverse.Methods C57BL/6 mouse model was established by subcutaneous injection of carbon tetrachloride(CCl4).After a successful model of fibrosis, one-month normal diet was given to induce the reverse fibrosis model, while normal mice of the same gender and weight were as control group.Mice were sacrificed at 1, 2, 3, 4, 5, 6, 7, 8 weeks, respectively, then the liver tissue was harvested for the observation of its injury by hematoxylin and eosin(HE) staining.Then Masson staining was applied for the detection of changes in collagen, and the immunohistochemistry(IHC) for the observation of type Ⅰ Collagen(Colla-1), alpha smooth muscle actin(α-SMA), transforming growth factor beta 1(TGF-β1) and SOCS3 protein expression.In vitro formation of fibrosis was induced by TGF-β1 stimulating HSC-T6 cell lines, which was then reversed by MDI medium, with co-incubation of HSC-T6 cells with plasmid in the process of the reverse.Western blot was employed to detect SOCS3, Colla-1, α-SMA, TGF-β1 expression.Results The expression of SOCS3 and TGF-β1 increased in mouse model of fibrosis with the worsening fibrosis process and decreased in the reverse process.Over-expression SOCS3 in the reverse process reduced the development of liver fibrosis;meanwhile, the expression of TGF-β1 was also reduced accordingly.Conclusion SOCS3 may influence the development of the liver fibrosis and its reverse via regulating the expression of TGF-β1.

Objective To analyze satisfaction of the clinical practice content of nursing postgraduates with different characteristic, and to provide transformative suggestions for the construction of clinical practice scheme of nursing postgraduates. Methods Using judgment sampling and snowball sampling, the questionnaire survey was conducted among 101 nursing postgraduates, and comparing satisfaction of clinical practice content of postgraduates with different age, work experience and teaching mode. SPSS 17.0 software package was used for data description and t test. Results The total satisfaction of clinical practice content of nursing postgraduates was low, and different postgraduates′satisfaction was different. On practical operation opportunity,> 30 years old of postgraduates′satisfaction was (3.95±0.87), which was higher than those 20~30 years old, (3.35±0.90), and the difference was statistically significant, t=2.748, P<0.01. On clinical practice assessment methods and frequency, the satisfaction of postgraduates with a fixed teacher was higher than those without a fixed teacher (3.40±0.74) vs. (2.83±0.87), and the difference was statistically significant, t=3.310, P<0.01. Conclusions At present, the clinical practice content of nursing postgraduates is in shortage, and need to be further improved.

Purpose To discuss the value of phase III CT angiography (CTA) and ultrasound in evaluating the preoperative vascular anatomical variation and the lumen patency of the patients with liver transplantation. Materials and Methods The clinical and imaging data of 126 patients with liver transplantation in the First Affiliated Hospital of Zhengzhou University were collected. CT scan in arterial phase, portal venous phase, venous phase and CTAreconstruction and ultrasound examination were performed before surgery. CTA images included volume rendering (VR), maximum intensity projection (MIP), curve plane reformation (CPR), and multi-plane reformation (MPR). The anatomical variations and lumen patency of the hepatic artery, the portal vein system, the hepatic vein and the inferior vena cava were observed. The accuracy of CTA and ultrasound of the evaluation of blood vessels in patients with liver transplantation was compared with the criteria of intraoperative exploration and postoperative pathological results. Results Among 126 patients with liver transplantation, all the hepatic artery lumen was unobstructed, with 98 cases of normal anatomical structure and 28 cases (22.2％) of anatomical variation, including Michel type II 7.1％ (9/126), type III 6.3％ (8/126), type IV 3.2％ (4/126), type V 2.4％ (3/126), type VI 0.8％ (1/126); 2.4％(3/126) of Michel classification was not included. The diagnostic accuracy of CTA for arterial anatomical variations was 100.0％, and the patency diagnosis of the lumen was consistent with the operation, and the anatomical variation cannot be evaluated. In 126 patients, there were 94 cases of portal vein patency, and 32 cases of portal vein embolus, including 21 cases with thrombus and 11 cases with tumor embolus. The diagnostic accuracy of CTA and ultrasound for portal vein embolus was 93.7％ and 96.0％, respectively; and there was no statistical significance (P>0.05). The diagnostic accuracy of them for thrombosis was 96.0％ and 91.3％, respectively; and there was statistical significance (P<0.05). The diagnostic accuracy of them for the tumor thrombus was 97.6％ and 92.1％, respectively; and there was statistical significance (P<0.05), CTA could show the collateral circulation around the portal vein. The diagnostic accuracy of CTA and ultrasound for venous patency was both 99.3％. The diagnostic accuracy of CTA and ultrasound for the anatomy of hepatic venous trunk was 99.2％ and 95.2％, respectively; and there was no statistical significance (P>0.05). Conclusion CTA can accurately evaluate the hepatic artery variation of liver transplantation. It has a high accuracy rate for the qualitative diagnosis of portal vein emboli, and can display collateral circulation. Its overall preoperative diagnostic value is better than that of ultrasound.

Objective To investigate the levels and significance of Th17 cells and regulatory T cells (Treg) in peripheral blood of children with allergic rhinitis during pollen and non-pollen seasons.Methods Thirteen children with hay fever, 10 children with house dust mite(HDM)-allergic asthma and 10 healthy children were recruited into this study.Percentages of Th17 and Treg cells were detected by flow cytometry.Levels of IL-17, IL-10 and TGF-β in cell culture supernatants were measured by ELISA.Results (1) The percentages of Th17 cells in children with allergic rhinitis [(3.4±2.4)%] were significantly higher than those in HDM-allergic asthmatics [(2.1±1.6)%] and those in healthy children [(0.5±0.3)%] during pollen season (both P<0.05).The levels of Treg cells in allergic rhinitis group [(2.1±1.3)%] and in HDM-allergic asthma group [(3.6±1.9)%] were significantly lower than those in healthy control group [(5.5±2.8)%] (both P<0.05).The levels of Th17 cells [(3.0±1.9)% vs (3.4±2.4)%, P<0.05] and ratios of Th17/Treg cells [(1.4±1.0)% vs (1.7±1.5)%, P<0.05] in children with allergic rhinitis were significantly decreased during non-pollen season as compared with those during pollen season, but the levels of Treg cells were up-regulated [(2.4±1.6)% vs (2.1±1.3)%, P<0.05].(2) Correlation analysis revealed that the ratios of Th17/Treg cells were positively correlated with the concentrations of FeNO (fractional concentration of exhaled NO) (r=0.321, P<0.05) and the counts of circulating eosinophils (r=0.198, P<0.05) in children with allergic rhinitis during pollen season.Conclusion The imbalanced Th17 and Treg cells in children with allergic rhinitis during pollen season might play a vital role in the regulation of allergic airway inflammation.

Malignant pleural mesothelioma (MPM) is a malignant tumor with strong invasiveness, low survival rate and lack of effective treatment options. As the only first-line treatment plan for the advanced MPM, combination of pemetrexed and cisplatin chemotherapy have been existing since the last 20 years. Immunotherapy has long been considered as a potential treatment plan for MPM, mainly including immune checkpoint inhibitors (ICIs), immunotoxin therapy, anti-cancer vaccine and adoptive T-cell therapy. This review focuses on summarizing the current research status of immune checkpoint inhibitors in MPM, discusses the effect of tumor heterogeneity on ICIs treatment, and describes that the biomarker-oriented immunotherapy is a new vision for the realization of individualized treatment of MPM.
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OBJECTIVE:To provide reference for evaluating the new round of essential medicine bidding and purchase policy in China,ensuring the stability of essential medicine supply and improving national essential medicine system.METHODS:Based on the theoretical analysis,taking Shanghai and Yunan province as sample,the questionnaire was designed to investigate the difficulty to implement essential drug purchase policy in essential medicine supply system,and the bidding situation evaluation of production enterprises by both sides of local drug bidding among staff in production enterprises,circulation enterprises,primary health care institutions and other institutions.The types of influential factors for the implementation of essential medicine purchase policy were determined finally.Factor analysis method was used to screen the key influential factors.RESULTS & CONCLUSIONS:Four common factors had a great influence on the implementation of essential medicine policy in China.The impact of the large to small is the rationality of the tender procurement program,the standardization of pharmaceutical production,the stability of demand for drug use and macroeconomic policy regulation and protection.It is suggested to further improve the drug recruitment system,select the products that have quality assurance and production specifications,and fully meet the diverse needs of the market,while provide relatively stable usage information for manufacturers.If necessary,"drug purchase with target quantity" of Shanghai model can be forced to carry out by policy so as to ensure that the interests of all parties in the pharmaceutical supply chain are treated fairly.

Objective:To summarize the evidence on nutritional management for elderly cancer patients domestically and internationally.Methods:Literature on nutritional management of elderly cancer patients was systematically searched on databases and websites such as British Medical Journal (BMJ) Best Practice, UpToDate, Guidelines International Network, Agency for Healthcare Research and Quality, Cochrane Library, Web of Science, Embase, PubMed, China National Knowledge Infrastructure, WanFang Data, National Comprehensive Cancer Network and American Cancer Society. The search period was from January 2018 to February 2023. Three researchers evaluated the quality of the included literature, while two researchers extracted and summarized evidence.Results:A total of 10 articles were included, including two clinical decisions, four guidelines, one expert consensus, one evidence summary, and two systematic reviews. A total of 32 pieces of evidence were summarized from three aspects, consisting of nutritional risk screening and assessment, nutritional education or counseling, and nutritional intervention.Conclusions:This study summarizes the best evidence for nutritional management in elderly cancer patients. It is recommended that medical and nursing staff apply evidence based on clinical situations and patient preferences.

Objective To investigate the protective effect and mechanism of J147 on the injury of human neuroblastoma cells(SH-SY5Y)induced by high glucose(HG).Methods We established HG-induced SH-SY5Y cell injury model.Then SH-SY5Y cells were divided into blank control(Con)group HG group,HG+J147 0.5 μmol/L(HG+J147 0.5)group,HG+J147 1 μmol/L(HG+J147 1)group,HG+J147 2 μmol/L(HG+J147 2)group,HG+PI3K/AKT inhibitor LY294002(LY)10 μmol/L(HG+LY)group,HG+ERK1/2 inhibitor U0126(U0)5 μmol/L(HG+U0)group,HG+J147 2 μmol/L+LY 10 μmol/L(HG+J147 2+LY)group,HG+J147 2 μmol/L+U0 5 μmol/L(HG+J147 2+U0)group.Cell viability was detected by MTS cell proliferation and toxicity detection kit;LDH activity was tested by lactate dehydrogenase kit;morphological changes of SH-SY5Y cells were evaluated by microscope;cell apoptosis was detected by flow cytometry;and apoptosis-related proteins(Bcl-2,Bax)and signaling pathway-related proteins(p-AKT,AKT,p-ERK1/2,ERK1/2,p-CREB,CREB,BDNF)were detected by Western blot.Results Compared with Con group,the cell viability,Bcl-2/Bax ratio,p-AKT/AKT,p-ERK/ERK,p-CREB/CREB and BDNF protein expressions decreased(P<0.01),while LDH activity and apoptosis rate increased in HG group(P<0.01).Compared with HG group,the cell viability,Bcl-2/Bax ratio,p-AKT/AKT,p-ERK/ERK,p-CREB/CREB and BDNF protein expressions increased(P<0.01),while LDH activity and apoptosis rate decreased in HG+J147 2 group(P<0.01).Compared with HG+J147 2 group,the cell viability,Bcl-2/Bax ratio,p-AKT/AKT and BDNF protein expression decreased(P<0.05 or P<0.01),while LDH activity and apoptosis rate increased(P<0.05 or P<0.01),the expression of p-ERK/ERK protein in HG+J147 2+LY group decreased(P<0.05),and the expression of p-CREB/CREB protein in HG+J147 2+U0 group decreased in HG+J147 2+LY and HG+J147 2+U0 groups(P<0.05).Conclusions J147 can alleviate HG-induced SH-SY5Y cell damage,and the mechanism may be related to the activation of PI3K/AKT and ERK1/2 signaling and the reduction of apoptosis.