Objective To investigate the role of renin angiotensin system (RAS) in pathogenesis of nonalcoholic fatty liver disease (NAFLD).Methods Twenty-four Wistar rats were evenly divided into control group and model group.The rats of control group were fed with normal diet,and model group were with high-fat diet.Rats were killed at the eighth week and serum liver function,blood lipid,glucose and insulin were tested.The liver tissues were stained with HE and Picro acid-Sirius red for pathological observation.The liver tissue concentration of angiotensin Ⅱ was determined by ELISA method and the expression of TGF-β1 in liver tissue was examined by immunohistochemistry.Results After eight weeks high fat feeding,weight,liver index,liver function,blood lipids and serum insulin of model group were significantly higher than those of control group (weight:(463.50±22.72) g vs.(404.29±10.32) g; liver index:(3.75±0.21) g vs.(2.66±0.15) g; ALT:(79.8±8.6) U/L vs.(58.8±11.6) U/L; AST:(200.01±51.72) U/L vs.(150.30±37.27) U/L; total cholesterol:(3.67±0.48) mmol/L vs.(1.50±0.23) mmol/L; triglycerides:(2.06±0.40) mmol/L vs.(0.71±0.34) mmol/L; insulin:(17.37±2.89) pmol/L vs.(11.08±2.12) pmol/L),and all the differences were statistically significant (P＜0.01).The histopathological results of model group indicated liver steatosis,inflammatory reaction in part of lobule and portal area and significant fibrosis in part of liver tissue.The liver tissue angiotonin Ⅱ concentration of model group [(32.80 ± 2.81)pg/ml] was higher than that of control group [(22.83 ± 1.75) pg/ml,t =9.559,P＜0.01].The immunohistochemistry results showed that the expression of TGF-β1 of model group was obviously higher than that of control group (Z=-2.540,P =0.011 ).Spearman correlation analysis revealed that the increasing degree of angiotensin Ⅱ concentration was positively correlated with liver steatosis scores (r=0.644,P=0.002) and the expression of TGF-β1 (r=0.470,P=0.037).Conclusion The concentration of angiotensin Ⅱ and TGF-β1 increased in the livers of model rats,which indicated that RAS may participate in the pathogenesis and progress of NAFLD.

Objective To evaluate effects and safety of gonadotrophin-releasing hormone agonist (GnRH-a) combined with transdermal estradiol and medroxyprogesterone acetate in the treatment of endometriosis. Methods From January I st, 2007 to July 31 st, 2007, 28 endometriosis patients underwent laparnscopic or transabdominal surgery in Obstetrics and Gynecology Hospital affiliated to Fudan University were randomly divided into group A and group B. 14 patients in group A received 3.6 mg goserelin once every 4 weeks, 12 weeks in all 14 patients in group B received goserelin and added 1/2 piece of half-hydrate estradiol every week and 6 mg oral medroxyprogesterone acetate per day, 12 weeks in all. Serum estradiol (E2 ), follicle stimulating hormone(FSH), bone gla protein levels, visual analogue scale (VAS) of pain, bone mineral density of lumbar spine, vaginal exfoliate cell spurs and the form of Kupperman were compared in patients before and after treatment. Results (1 ) After treatment, the level of FSH and E2levels were (5.0 ± 2. 6 ) U/L and (29 ± 17 ) pmol/L in group A and (3.0 ± 1.5 ) U/L, and (87 ± 53 ) pmol/L in group B, which were significantly lower than those before treatment [FSH (17. 0 ± 12. 2) U/L, and E2 (184 ± 194) pmol/L in group A and FSH :(15.3±13.6)U/L and E2: (281±242) pmol/L in group B, P ＜ 0. 01]. On the seventh day after three-month GnRH-a treatment, it was observed that the level of E2 was higher and FSH was lower in group B than the level of E2 and FSH of group A (P ＜ 0. 01 ). (2 ) After treatment, the basal vaginal exfoliate cell proportion in group A [(66. 2 ± 29. 0) %] was significantly lower than that in group B [(11.8 ± 28. 0) %, P ＜ 0. 01] ; while patients in group A owned a lower proportion of the middle [(29. 1 ± 23.1 ) %], superficial layers [(4. 0 ± 5.5 ) %] and esinophilic cells [(2. 3 ± 2. 6)%]than patients group B [middle layer: (73. 0 ± 25.2)% ; superficial layer: (15. 2 ± 10. 9)% ; esinophilic cells: (10. 8 ± 7.9 ) % ; P ＜ 0. 01]. (3) Before the treatment, patients' VAS scores of total, pelvic pain, dysmenorrheal and dyspareunia were 7.43±3. 20,2. 35 ± 1.82, 4. 93 ± 1.98 and 0. 14±0. 53 in group A and were 7.71±2. 02, 2. 57 ± 1.60, 4. 86 ± 1.56 and 0. 29 ± 1.07 in group B; after treatment, the scores above were changed to 0. 14±0. 36,0. 07±0. 27,0. 07±0. 27and 0 in group A and 0. 36±0. 50, 0. 29±0. 47, 0. 07±0. 27 and 0 in group B, which were all significantly lower than those before treatment separately (P ＜0. 01 ). When menstruation recovered, the scores were 0. 21±0. 43, 0. 07±0. 27, 0. 14 ± 0. 36, and 0 in group A and 0. 50±0. 65, 0. 29±0. 47, 0. 21±0. 43 and 0 in group B, which were also significantly lower than those before treatment (P ＜ 0.01 ), however, no statistical difference was found between groups at any time spot(P ＞ 0. 05). (4) In group A, the bone density after treatment [(0. 96 ± 0. 06 ) g/cm2] was lower than that before treatment [(0. 99 ± 0. 06 ) g/cm2, P ＜ 0.01 )]. In group B, the index was (0. 98 ± 0. 09) g/cm2, which was lower than that before treatment [(0. 99 ± 0. 10 ) g/cm2, P = 0. 201]. No statistical difference was found between groups(P ＞ 0. 05 ). The bone loss rate were (- 2. 77 ± 1.97 ) % in group A and (- 0. 93 ± 2. 86 ) % in group B (P = 0. 058 ). Before treatment, the bone gla protein was (13±3) μg/L in group A and (13±6) μg/L in group B. After treatment, the bone gla protein levels was (17±6)μg/L in group A, which was higher than that before treatment (P ＜ 0. 01 ), the level was (16±6)μg/L in group B, which was higher than that before treatment, however showed no statistical difference(P =0. 053). No difference was found in bone gla protein before and after treatment between two groups (P＞0. 05). (5) The form of Kupperman after treatment were 15±7 in group A and 11±6 in group B, which did not show significant difference (P ＞ 0. 05 ). The incidence of flash and sweat were 93% (13/14)in group A, which was significantly higher than that 57% (8/14) in group B(P ＜0.01 ). Conclusion The add-back therapy that consists of an estradiol patch and oral medroxyprogesterone acetate is effective and safe treatment for endometriosis.

Objective To Screen serum protein markers related to CRF and establish a diagnosis model,exploring and discussing its significance in serodiagnosis by comparing differences of serum protein spectrum expression between patients with chronic renal failure (CRF) and control group.Methods The trial included 62 CRF patients and 28 control ones.Serum samples were tested by surface enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS).The data were analyzed to screen serum proteomic biomarkers.By bioinformatics analysis,decision classification tree models were to be established and tested.Results A total of 19 effective protein peaks were significantly different between CRF and normal control (P＜0.001) at m/z range of 1 500 to 30 000,among which 18 showed low expression and 1 showed high expression in CRF.CRF and normal control were obviously different in the clustering;By bioinformatics analysis,a CRF-normal controls of the diagnostic decision tree model was developed,which was 87.8% in with prediction accuracy rate of 87.8% sensitivity of 87.1% and a specificity of 89.3%.Condusion Diagnostic decision tree model provides a more accurate prediction and solid experimental evidence for early clinical diagnosis.

Objective:Analysis of hepatitis B surface antigen negative donations, initial detection of reactivity followed by subsequent differential tests or repeat the infection status of non-discriminated reactive (NDR) unresponsive blood donors to explore whether different nucleic acid detection systems have differences in the detection of HBsAg -/NDR. Methods:The test result and reactivity rates of blood donor samples received from January 2020 to August 2022 were compared, and some samples were repeated for both nucleic acid testing systems, and the characteristics of the HBsAg -/HBV DNA + blood donors were analyzed. Results:Through the analysis of nucleic acid result from January 2020 to August 2022, repeated nucleic acid detection can improve the detection of HBsAg -/NDR blood donors, and the detection rate is offset in different cycle threshold valve ( Ct value) intervals or different sample absorbance to cut-off absorbance ratio ( S/ CO value) interval. Also grouping of Ct values or S/ CO values revealed that there was variability in detection rates between intervals in the two nucleic acid detection systems (PCR: X2=108.23, P<0.001, TMA: X2=40.95, P<0.001), mainly concentrated in Ct values less than 38.5 or S/ CO values between 10 and 15. And analysis of selected HBsAg -/HBV DNA + blood donor populations revealed that repeat nucleic acid testing was found for donors of different age ( X2=9.38, P=0.025), number of blood donations ( X2=22.52, P<0.001), occupation ( X2=24.92, P=0.002) and education level ( X2=10.37, P=0.016) significant differences, while there was no statistically significant difference for blood donors by gender ( X2=9.38, P>0.05), with far more males (67.50%) than females. Conclusions:For blood donors with a Ct value of less than 38.5, or an S/ CO value between 10 and 15, or a blood donor at the age of 41 to 50 years, another detection technology can be combined to improve the detection rate, reduce the potential risk of virus transmission of HBsAg -/NDR blood donors, and ensure the safety of clinical blood.

Objective:To analyze the situation of hepatitis B enzyme immunoassay-positive but nucleic acid negative infection (HBsAg ELISA(+ )/HBV-DNA(-)) among unpaid blood donors in Zhejiang Blood Center, and to explore the causes of inconsistency between enzyme immunoassay and nucleic acid result.Methods:A single nucleic acid test was performed on blood donors whose routine blood screening result were HBsAg-ELISA(+ )/HBV-DNA(-), and the test result of such blood donors were analyzed.Results:A total of 205 HBsAg-ELISA(+ )/HBV-DNA(-) samples were screened from 114017 blood donors from May to November, 2022. The proportion of male blood donors (0.14%) were significantly lower than that of the female blood donors (0.24%)( χ2= 14.761, P<0.005); the proportion of the first blood donor (0.32%) was significantly higher than that of the second blood donor (0.09%) ( χ2 = 78.781, P<0.005); the difference between different education levels is statistically significant ( χ2 =47.753, P<0.005). After single-person nucleic acid re-detection, the re-detection rate of nucleic acid in ELISA double-reagent positive samples was higher than that in single-reagent positive samples ( χ2=94.378, P<0.005); there was no significant difference between ELISA reagent 1 and reagent 2 in the detection rate of nucleic acid ( χ2 =0.163, P>0.005). There was no significant difference in the positive rate of secondary nucleic acid detection between the two nucleic acid detection systems ( χ2=0.626, P>0.005). Serological supplementary test showed that 11 HBV-DNA(+ ) samples showed two serological combination patterns after chemiluminescence detection, namely HBsAg(+ )/HBeAb(+ ) and HBeAb(+ ), most of which were HBsAg(+ )/HBeAb (+ ), a total of 10 cases, accounting for 90.91%, and only one case was HBeAb (+ ), accounting for 9.09%. The quantitative result of HBsAg showed that most of them were at low HBsAg level. Conclusions:After re-detection by single nucleic acid detection method, HBsAg-ELISA(+ )/HBV-DNA(-) samples of blood donors do have a certain proportion of HBV-DNA(+ ), but most of the samples were still HBV-DNA (-), additional experiments on HBV serological markers and HBV-DNA are needed to determine their true infection status and clarify the reasons for the inconsistency between enzyme immunoassay and nucleic acid test result. In addition, nucleic acid and HBsAg detection reagents with high sensitivity and specificity should be selected as far as possible in blood donor screening to ensure the accuracy of result.

With the rapid development of computing methods and computing power, the ability of artificial intelligence in problem modelling and analysis has been improved rapidly. Artificial intelligence has been gradually introduced into the field of medical care and nursing, and played an important role in assisting medical care and nursing. This paper mainly discusses the progress of artificial intelligence technology in nursing, and analyzes the existing problems and challenges, in order to provide new ideas for artificial intelligence in supporting the development of nursing more effectively.

Objective:To explore the effect of cognitive-behavioral therapy on fear of hypoglycemia and self-management behavior of patients with steroid diabetes mellitus.Methods:A total of 76 patients with steroid diabetes mellitus from August 2018 to October 2019 in the First Affilated Hospital of Nanjing Medical University were selected and divided into experimental group and control group according to the admission time, and each group contained 38 cases. The control group recieved routine therapy and nursing care, on the basis of this, the experimental group was given cognitive-behavioral therapy for 8 weeks. Before and after 8 weeks of intervention, the effects were assessed by Chinese version Hypoglycemia Fear Surgey-Worry Scale(CHFSⅡ-WS) and Sumary of Diabetes Self Care Activities (SDSCA), respectively.Results:There was no significant difference in the score of CHFS Ⅱ-WS, SDSCA before intervention between the two groups( P>0.05). After 8 weeks of intervention, the scores of worry & fear and total CHFS Ⅱ-WS scores were (6.61±1.66), (8.75±1.73) points in the experimental group and (7.60±1.44), (9.69±1.77) points in the control group, the differences were statistically significant ( t values were 2.678, 2.247, P<0.05); in addition, the scores of diet, exercise, blood sugar testing, medications in SDSCA were (20.36±1.91), (11.86±2.27), (7.19±1.56), (6.86±0.99) points in the experimental group, and (18.51±1.50), (9.89±2.29), (5.71±1.45), (5.31±1.18) points in the control group, the differences were statistically significant ( t values were 3.644-5.983, P<0.05). Conclusions:Cognitive-behavioral therapy can effectively alliviate fear of hypoglycemia and promote self-management behavior of steroid diabetes mellitus patients.

Objective:To deeply understand the real experience of young and middle-aged lymphoma patients returning to society.Methods:From August to September 2021, 17 young and middle-aged lymphoma patients admitted to the Department of Hematology of the First Affiliated Hospital with Nanjing Medical University were selected as the research object by objective sampling. Phenomenological research method was using to conduct face-to-face in-depth interviews. Colaizzi 7-step analysis method was used to summarize, analyze and refine the theme.Results:A total of 3 first-level themes and 10 second-level themes were extracted. Among them, the willingness to return to society included firm willingness of social return and negative attitude of social return. The scope of social return included returning to work, interpersonal communication, family responsibilities, leisure and entertainment and lifestyle. The influencing mechanism of social return was composed of disease and treatment factors, mental factors, external support and economic capacity.Conclusions:The experience of young and middle-aged lymphoma patients returning to society is a dynamic change process in many aspects. In the future, it is necessary to further explore the status quo of social return of such groups and explore the influencing factors and change tracks of heterogeneity.

Objective:To construct a nursing quality evaluation index system for knee ligament injury to provide a basis for standardizing the nursing practice and improving the nursing quality of knee ligament injury.Methods:Based on the three-dimensional quality structure model of "structure-process-outcome" proposed by Donabedian, the quality evaluation index system for knee ligament injury specialties was constructed through literature review, brainstorming, and Delphi expert consultation from April to June 2023.Results:Sixteen experts were included in the inquiry. The effective recovery rate of the two rounds of expert correspondence questionnaires was 16/16, the expert authority coefficient was 0.95, and the Kendell harmony coefficients of the expert correspondence were 0.116 and 0.122, respectively (both P<0.05). The final constructed knee ligament injury specialty care quality evaluation index system contained 3 primary indicators (structural quality, process quality and outcome quality), 16 secondary indicators, and 69 tertiary indicators.Conclusions:The specialized nursing quality evaluation index system for knee ligament injury constructed in this study is scientific and reliable, which can provide a basis for the evaluation and assessment of the nursing quality of knee ligament injury specialties and promote the continuous improvement of their nursing quality.

Objective To investigate the expression discordances of estrogen receptor ( ER), progesterone receptor (PR), human epidermal growth factor receptor2 ( HER?2) and Ki?67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and／or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER?2 and Ki?67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER?2 and Ki?67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER?2 and Ki?67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P＜0.001). The disease?free survival (DFS) of patients with ER, PR positive, HER?2 negative and low expression of Ki?67 in metastatic lesion was much longer ( P＜0.05). Conclusions The expressions of ER, PR, HER?2 and Ki?67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.