Objective To investigate the changes of serum metabolites in patients with occupational chronic lead poisoning using non-targeted metabolomics, and to screen differential metabolic pathways. Methods A total of 14 patients with occupational chronic lead poisoning were selected as the poisoning group, and 14 healthy people without occupational hazard exposure history were selected as the control group using the judgment sampling method. Serum of the individuals from the two groups was collected. Non-targeted metabolomics technology based on ultra high performance liquid chromatography-tandem mass spectrometry was used to detect serum metabolite levels in the two groups. Differential metabolites (DMs) were screened by the principal component analysis, partial least squares discriminant analysis and orthogonal partial least squares discriminant analysis, and related metabolic pathways were explored. Results The blood lead level in the poisoning group was higher than that in the control group (median: 359.59 vs 5.04 μg/L, P<0.01). There were significant differences in serum metabolites between the poisoning group and control group. After the combination of results from the positive and negative ion patterns, a total of 89 DMs were screened in serum of patients in the poisoning group, including 50 upregulated and 39 downregulated metabolites compared with the control group. The serum DMs of poisoning group were mainly enriched in arginine biosynthesis, ABC transporter, purine metabolism, choline metabolism in malignant tumor, glycerophospholipid metabolism and ether lipid metabolism compared with the control group (all P<0.05). Conclusion Abnormal changes of serum metabolic profile occurred in patients with occupational chronic lead poisoning. The metabolic pathways such as arginine biosynthesis, ABC transporter, purine metabolism, choline metabolism, glycerophospholipid metabolism and ether lipid metabolism may be involved in the occurrence and development of lead poisoning.

Objective To explore the mediating role of sleep quality on the impact of occupational stress on depressive symptom among secondary industry occupational population. Methods A total of 895 secondary industry workers in Wuxi City were selected as the study subjects using the stratified random sampling method. The Core Occupational Stress Scale (COSS), Patient Health Questionnaire-9 items (PHQ-9) and Self-Filled Sleep Questionnaire (SSQ) were used to investigate their occupational stress, depressive symptom and sleep quality. Depressive symptom, occupational stress and sleep quality were respectively regarded as dependent variable, independent variable and mediating variable. Process program was used to construct a mediation model, and Bootstrap method was used to test its mediating effect. Results The median score and 25th, 75th percentile for occupational stress, depressive symptom and sleep quality was 43.0 (43.0, 48.0), 6.0 (3.0, 8.0) and 3.0 (1.0, 3.0) points. The detection rates of occupational stress, depressive symptom, sleep disorder were 28.7%, 63.0% and 38.8%, respectively. Spearman correlation analysis result showed that occupational stress was positively correlated with both depressive symptom and sleep quality (Spearman correlation coefficients of 0.46 and 0.49, all P<0.01). Bootstrap test result showed that occupational stress had positive effect on both depressive symptom and sleep quality (partial regression coefficients of 0.25 and 0.09, all P<0.01). Sleep quality partially mediated the impact of occupational stress on depressive symptom with the mediation effect value of 0.05 (95% confidence interval of 0.03-0.06), accounting for 20.0% of the total effect. Conclusion Both depression symptom and sleep quality are positively correlated with occupational stress in secondary industry occupational population. Sleep quality of this population partially mediate the impact of occupational stress on depressive symptom.

Objective:To explore the association of cerebral venous outflow assessed by CT angiography (CTA) with first pass effect (FPE) in patients with acute anterior circulation large vessel occlusion accepted mechanical thrombectomy (MT).Methods:A retrospective analysis was performed; patients with acute anterior circulation large vessel occlusion accepted MT and CTA in Department of Neurology, Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2021 were consecutively enrolled. Cerebral venous outflow in baseline CTA was evaluated using Cortical Vein Opacification Score (COVES). Patients were categorized into either FPE or non-FPE groups based on recanalization of occluded vessels after initial MT. General information, clinical features, radiological data, and surgery-related data between the 2 groups of patients were collected and compared. Significant variables ( P<0.1) from univariate analysis were included into a multivariable Logistic regression model to explore the relation between COVES and FPE. Predictive value of COVES in FPE was assessed using receiver operating characteristic (ROC) curve. Results:Out of the 143 patients enrolled in this study, 52 were into the FPE group and 91 were into the non-FPE group. Compared with the non-FPE group, the FPE group had higher COVES scores, higher proportion of patients with good cerebral venous drainage (COVES≥3), smaller core infarct volume, and shorter time from femoral artery puncture to vessel recanalization, with significant differences ( P<0.05). Multivariable Logistic regression analysis revealed that COVES was still corelated with FPE after adjusting covariates such as baseline NIHSS scores, core infarct volume, and time from femoral artery puncture to vessel recanalization ( OR=0.730, 95% CI: 0.567-0.940, P=0.015). ROC curve demonstrated that the combined model of COVES with aforementioned factors (COVES scores+baseline NIHSS scores+core infarct volume+time from femoral artery puncture to vessel recanalization) had an area under the curve of 0.757 (95% CI: 0.672-0.841, P<0.001), with sensitivity of 61.5% and specificity of 78.0%. Conclusion:Favorable cerebral venous drainage is an independent predictor for successful FPE in patients with acute anterior circulation large vessel occlusion accepted MT.

Objective To improve the cellular uptake efficiency and the therapeutic effect through the structural modification of paclitaxel(PTX)and the preparation of corresponding liposomes.Methods The prodrug of paclitaxel,PTX-PA,was prepared by esterification reaction,and the quantitative detection method of PTX-PA was established.Next,the optimal formulation and preparation of PTX-PA/Lip was obtained through single factor screening based on their appearance,particle size,and encapsulation efficiency.Results The PTX-PA was successfully synthesized,and the established HPLC quantitative analysis method for PTX-PA met the methodological requirements.After the optimal preparation and formulation research through single factor screening,the particle size of optimized PTX-PA/Lip was(62.75±1.81)nm with a PDI of(0.076±0.02),while the drug encapsulation rate reached more than 90%.Conclusion This research successfully prepared palmitic acid modified paclitaxel liposomes based on nanotechnology,enhancing the drug delivery efficiency of paclitaxel and laying the foundation for the pharmacodynamics research of PTX-PA.

Objective To investigate the expression levels of plasma circular RNA PTP4A2(circPTP4A2)and circTLK2 in elderly patients with acute ischemic stroke(AIS)and their predic-tive value for neurological functional outcomes.Methods A total of 122 elderly AIS patients admitted to our department from May 2021 to December 2022 were prospectively recruited,and according to their modified Rankin Scale(mRS)score at 3 months after stroke onset,they were divided into a good outcome group(mRS score≤2,81 cases)and a poor outcome group(mRS score:3-6,41 cases).Their baseline data,and plasma circPTP4A2 and circTLK2 levels were compared between the two groups.Multivariate logistic regression analysis was employed to iden-tify prognostic factors for poor outcomes in the elderly AIS patients.ROC curve analysis was ap-plied to evaluate the prognostic value of circPTP4A2 and circTLK2 for adverse outcomes in the patients.Pearson correlation analysis was performed to assess the relationship of plasma levels of circPTP4A2 and circTLK2 with NIHSS score,as well as mRS score.Results The plasma expres-sion levels of circPTP4A2 and circTLK2 were significantly higher in the poor outcome group than the good outcome group[2.08(0.87,2.77)vs 0.93(0.63,1.20),1.71(0.92,2.80)vs 0.75(0.49,1.09),P＜0.01].Multifactor logistic regression analysis showed that plasma circPTP4A2 and circTLK2 were independent predictive factors for poor functional outcomes in elderly AIS patients(P＜0.01,P＜0.05).ROC curve analysis demonstrated that the AUC value of combined circPTP4A2 and circTLK2 in predicting poor outcome in elderly AIS patients was 0.787(95％CI:0.691-0.883).Pearson correlation analysis revealed that the expression levels of circPTP4A2 and cir-cTLK2 in elderly AIS patients were mildly positively correlated with baseline NIHSS scores(r=0.463,r=0.456;P＜0.01)and moderately positively correlated with mRS scores at 3 months after stroke onset(r=0.682,r=0.604;P＜0.01).Conclusion Plasma circPTP4A2 and circTLK2 may be potential biomarkers for predicting neurological functional outcomes in elderly AIS patients.

Twenty general practice residents who received training in Tongren Hospital from 2018 to 2020 were enrolled. The residents undertook rotation in chronic disease care clinic of the general medicine department, and a multi-disciplinary integrated teaching mode was applied. The theoretical knowledge test, skill assessment and self-evaluation were performed before and after rotation. The 360-degree evaluation was carried out when leaving the department (study group), the results were compared with that of internal medicine (control group) in the same period. The teaching effect was comprehensively evaluated. The scores of theoretical knowledge and skill assessment after rotation were significantly higher than those before rotation ( P<0.01). The self-evaluated ability was significantly higher than that at admission, especially in general practice thinking (7.85±0.88), doctor-patient communication (7.95±0.69), health education (7.80±0.70) and disease management (8.20±0.62) ( P<0.01). The 360-degree evaluation showed that the study group was better than the control group in interpersonal communication skills [(4.75±0.44) vs. (4.41±0.50)], system-based work ability[(4.75±0.44) vs. (4.31±0.47)], practice-based learning and improvement [(4.80±0.41) vs. (4.33±0.48)], patient care [(4.75±0.44) vs. (4.28±0.46)] and training mode satisfaction [(4.85±0.37) vs. (4.38±0.49)] (all P<0.05). The study indicates that the multi-disciplinary integrated teaching mode applied for rotation in the chronic disease care clinic of the general medicine department can improve the teaching effect and raise the teaching quality for general practice residency training.

With the development of assisted reproductive technology (ART), more and more infertile couples have their own children. According to incomplete statistics, as of 2010, about 5 million babies worldwide were born after treatment with ART. It is not clear whether and how ART affects the sex of offspring at birth. And with the increase of the number of ART newborns, it may have a profound impact on the demographics in the future. At present, the known factors that may affect the sex ratio of newborns with ART include parental age, type of infertility, embryo transfer stage (cleavage stage/blastocyst stage), embryo transfer type (fresh embryo/frozen embryo), etc. This paper aims to review the factors that may affect the sex ratio of newborns with ART at present.

With the development of assisted reproductive technology (ART), more and more infertile couples have their own children. According to incomplete statistics, as of 2010, about 5 million babies worldwide were born after treatment with ART. It is not clear whether and how ART affects the sex of offspring at birth. And with the increase of the number of ART newborns, it may have a profound impact on the demographics in the future. At present, the known factors that may affect the sex ratio of newborns with ART include parental age, type of infertility, embryo transfer stage (cleavage stage/blastocyst stage), embryo transfer type (fresh embryo/frozen embryo), etc. This paper aims to review the factors that may affect the sex ratio of newborns with ART at present.

Objective To explore the effect of smoking on endothelium-dependent vascular relaxing function and endogenous apelin-13 level.Methods Forty healthy volunteers,including 20 smokers and 20 non-smokers were randomly selected and participated in the study from December 2014 to April 2015.During the study period the smokers were asked to quit smoking for one month and the non-smoking group was given short-term smoking intervention.The changes of vascular endothelial function and plasma apelin13 levels were compared between the smoking group and non-smoking group,and before and after intervention.Results Flow-mediated dilatation (FMD) in smoking group was significantly lower than that in non-smoking group [(5.34 ± 1.83) ％ vs.(8.12 ± 2.62) ％,t =-3.75,P ＜ 0.01].FMD in smoking group was significantly increased after 1 month of quitting smoking [(5.34 ± 1.83) ％ vs.(9.05 ± 2.18) ％,t =-6.66,P ＜ 0.01],FMD in non smoking group was slightly decreased [(8.12 ± 2.62) ％ vs.(7.78 ± 1.96) ％,t =0.90,P =0.38] after short-term smoking.The level of plasma apelin-13 in smoking group was significantly lower than that of non smoking group [(44.22 ± 16.58) pg/ml vs.(70.12 ± 24.35) pg/ml,t =-3.79,P ＜ 0.01].The level of plasma apelin-13 in smoking group was significantly increased after 1 month of smoking cessation intervention [(44.22 ± 16.58) pg/ml vs.(65.32 ± 17.13) pg/ml,t =-4.26,P ＜0.01].In non smoking group,the level of plasma apelin-13 was significantly decreased after short-term smoking [(70.12 ± 24.35) pg/ml vs.(45.83 ± 15.66) pg/ml,t =4.93,P ＜ 0.01].Conclusion Cigarette smoking leads to endothelial dysfunction.Short term occlusion of tobacco may significantly improve endothelial function and increase plasma apelin-13 level,suggesting that apelin-13 may be involved in the occurrence and development of endothelial dysfunction induced by cigarette smoking.

Objective To analyze of the efficacy of minimally invasive surgery combined with medication in the treatment of ureteral calculi.Methods From June 2013 to June 2015,124 patients with ureteral calculi which confirmed by X-ray in our hospital were collected as subjects.According to the treatment method,they were divided into control group and observation group,patients in the control group were treated with simple medication,while the observation group were treated with minimally invasive surgery combined with drug therapy.The effects of treatment and the levels of MCP-1,TFF1 and HMGB1 in urine between two groups were compared.Results The stone expulsion rate and the net rate of the observation group was higher than those of the control group,the differences were significant(P<0.05).The stone expulsion time of observation group was shorter than that of the control group,the formation rate of the observation group was lower than that of the control group,the differences were significant(P<0.05).Adverse reactions occurred in 11 cases of the observation group,in 29 cases of the control group,the incidence of adverse reactions in the observation group was lower than that in the control group,the difference was significant(P<0.05).After the treatment,17 cases of adverse drug reactions occurred in the observation group,which was more than 5 cases of adverse drug reactions in the control group,the difference was significant(P<0.05).After treatment,the levels of MCP-1 and HMGB1 in urine of two groups were decreased compared with those before treatment,the level of TFF1 was increased,the differences were significant(P<0.05);while the levels of MCP-1 and HMGB1 of the observation group after treatment were lower than those of the control group,the level of TFF1 was higher than that of the control group,the difference was significant(P<0.05).The effective rate of the observation group was 88.71％,which higher than 69.35％ of the control group,the difference was significant(P<0.05).Conclusion On the basis of medication,combined with extracorporeal shock wave lithotripsy for ureteral calculi can not only improve the therapeutic effect,but also reduce the risk of adverse reactions.