Objective To investigate the levels of serum AFP and CEA in healthy physical examination people and their sexual difference.Methods (1 )Healthy physical examination people were divided into the group A(510 males)and group B(477 fe-males);(2)these two groups were subdivided into the group A1 (<40 years old),A2 (40 - <50 years old),A3 (50 - <60 years old),A4(60-<70 years old)and A5 (70 -87 years old),and group B1 (<40 years old),B2(40 -<50 years old),B3 (50 -<60 years old),B4(60-<70 years old)and B5(70-87 years old).The serum AFP and CEA in 987 healthy physical examination peo-ple were measured by the electrochemiluminesence immunoassay,and then the detection results were compared among various groups.Results (1)The detection results of serum AFP and CEA had statistically significant differences between the group A and B (P <0.01);(2)there was no statistical differences among the group A and among the group B.Conclusion The serum AFP and CEA levels in healthy physical examination people in the local area have difference between males and females,which in males are significantly higher than those in females,indicating that the reference range of AFP and CEA should be repectively established ac-cording to different sexes;while the serum AFP and CEA levels have no differences among various age groups in males and fe-males.

Objective The Ethical Decision-Making Confidence Scale(EDMC)was translated into Chinese,and its reliability and validity were tested.Methods The English version of EDMC was translated into Chinese and back-translated according to the Brislin model.After being reviewed by the original authors,cultural adjustments were made,and a pretest was conducted to finalize the Chinese version of the scale.To test the reliability and validity of the scale,228 nurse leaders were investigated using a convenience sampling method in a tertiary hospital in Zhejiang from April to May 2023.Additionally,20 nurse leaders were selected to provide test-retest data 2 weeks after the survey.Results The Chinese version of EDMC contained 2 dimensions,namely skill-related confidence(9 items)and behavior-related confidence(6 items).The I-CVI ranged from 0.833 to 1.000,and the S-CVI/Ave was 0.967.Exploratory factor analysis extracted 2 common factors with factor loadings ranging from 0.546 to 0.828 for each item,contributing to a cumulative variance rate of 65.449％.The Cronbach's α coefficient of the overall scale was 0.947,and the Cronbach's α coefficient for each dimension ranged from 0.911 to 0.919.The split-half reliability of the total scale was 0.882,and the test-retest reliability was 0.752.Conclusion The Chinese version of EDMC demonstrated good reliability and validity,making it suitable for a comprehensive evaluation of the ethical decision-making confidence of nurse leaders.It can provide corresponding bases for medical administrators to make educational plans and targeted intervention strategies.

Objective:To explore more clinical characteristics and outcomes of children with severe pneumonia induced by adenovirus type 7(Adv-7).Methods:Seventy children with severe pneumonia induced by Adv-7 admitted to the pediatric intensive care unit of Guangzhou Women and Children′s Medical Center from January 2016 to October 2019 were enrolled.The clinical features, treatments and outcomes of these children were recorded.Results:(1)There were 43 males(61.4%)and 27 females(38.6%). Thirty(42.9%)patients were 0-12 months old, 28(40.0%)patients were 13-36 months old, and 12(17.1%)patients were over 36 months old.(2)The average onset time of severe pneumonia induced by Adv-7 was(11.87±7.10)days before being admitted to PICU.The average sequential organ failure assessment score was 6.80±3.13.The average Murray lung injury score was 2.49±1.15.The average P/F value was(150.57±86.25)mmHg(1 mmHg=0.133 kPa). Sixty-four cases(91.4%)were involved in two or more area of lung on X-rays.All cases were diagnosed with sepsis.(3)Laboratory examination: white blood cell count was(7.6±5.5) ×10 9/L, platelet count was(238.8±164.2)×10 9/L, and C-reactive protein was(39.4±37.2)mg/L.(4)Treatments: intravenous gamma globulin was used in 65 cases(92.9%). Intravenous glucocorticoid was used in 45 cases(64.3%). Fiberoptic bronchoscopy was performed in 43 cases(61.4%). Blood purification treatment was performed in 21 cases(30%). Sixty-three patients(90.0%)were treated with non-invasive or invasive ventilator, high frequency ventilator-assisted ventilation was used in 20 cases(28.6%). Surfactant was used in six cases(8.6%). Extracorporeal membrane oxygenation was used in 19 cases(27.1%). (5)The average treatment time for ventilation was(13.10±11.58)days.The average time for temperature recover was(4.69±4.01)days in PICU.The average PICU stay time was(15.76±12.20)days.The average length of stay was(27.04±13.10)days.There were 16 patients died and the mortality was 22.9%. Conclusion:The children with severe pneumonia induced by Adv-7 were critical and had significant lung injuries.Suffering from active clinical treatment such as extracorporeal membrane oxygenation, some of these patients still had poor prognosis.

OBJECTI VE To explore the effects of total flavonoids of Bidens polisa L.（TFB）on insulin resistance （IR）of HepG2 cells. METHODS B. polisa L. was refluxed and extracted with 80％ ethanol to obtain TFB. Palmitic acid was used to induce IR mode of HepG 2 cells in vitro . The effects of low-concentration ，medium-concentration and high-concentration （20，40， 80 mg/L） of TFB on the consumption of glucose were investigated. Using metformin as positive control ，the effects of low-concentration，medium-concentration and high-concentration （20，40，80 mg/L）of TFB on the protein expression of insulin receptor substrate- 1（IRS-1），c-Jun N-terminal kinase （JNK）and protein kinase C （PKC）were investigated. Molecular docking technology was used to explore the interaction between eight main active components of TFB such as quercetin ，quercitrin and IRS-1，JNK and PKC proteins. RESULTS The glucose consumption of TFB low-concentration ，medium-concentration and high-concentration groups were increased significantly （P＜0.05 or P＜0.01）. Compared with normal group ，the expression of IRS-1 and JNK protein in the model group decreased significantly ，and the expression of PKC protein increased significantly （P＜ 0.01）. Compared with model group ，the protein expression of IRS- 1 and JNK could up-regulated while the protein expression of PKC down-regulated in TFB low-concentration ，medium-concentration and high-concentration groups and metformin positive control group （P＜0.05 or P＜0.01）. The score of molecular docking energy between maritimetin in TFB and IRS- 1 protein was －7.9 kcal/mol（1 kcal＝4.816 kJ）. The scores of molecular docking energy of maritimetin ，rutin and JNK protein were －9.3 kcal/mol. The score of molecular docking energy between quercitrin and PKC protein was －4.9 kcal/mol. Interactions between components and proteins included forming hydrogen bonds ，hydrophobic bonds and so on. CONCLUSIONS TFB can significantly improve IR of HepG 2 cells，the mechanism of which may be related to the regulation of protein expression of IRS ，JNK and PKC. Maritimetin，rutin and quercitrin may be potential active ingredients for improving IR.