High myopia combined with glaucoma(HMG), as a refractory subtype of glaucoma, poses significant challenges due to overlapping structural alterations of both conditions,leading to difficulties in differential diagnosis and a notably high missed diagnosis rate. Optical coherence tomography(OCT)revealed that rapid thinning of the temporal retinal nerve fiber layer is a key biomarker for the early diagnosis of HMG, and reference values for physiological thinning have been established. In addition, artificial intelligence(AI)-assisted diagnostic systems have demonstrated considerable potential in scenarios such as fundus image analysis and data interpretation. Global collaborative initiatives on HMG are currently constructing multicenter databases to support the training and validation of AI models.In terms of treatment, the strategy for intraocular pressure control needs to be further optimized,including setting lower target intraocular pressure, paying attention to medication specificity, while emphasizing neuroprotection and lifestyle interventions. Innovative treatments, including stem cell therapy, have progressed to phase II clinical trials, with some patients exhibiting measurable improvements in visual acuity. Furthermore, individualized management based on disease stratificationis is still required. Future developments are expected to focus on precision medicine, early screening programs, and interdisciplinary collaboration, with the goal of improving visual outcomes in patients with HMG.

Stiff person syndrome (SPS) is a rare neuro-immune disorder characterized by exaggerated startle responses and muscle spasms in response to minor stimuli. SPS is often misdiagnosed as panic disorder or agoraphobia. This paper reported a case of a patient with SPS presenting symptoms similar to panic attack. The patient had been misdiagnosed as dystonia, anxiety disorder and panic attack. The patient was finally correctly diagnosed through multiple disciplinary team discussions. This study integrates a comprehensive understanding of symptomatology and patient-reported experiences with targeted neurological evaluations and supplementary diagnostic tools to improve the accuracy of etiological diagnoses. This study aims to enhance the ability of psychiatrists to recognize somatic diseases presenting with psychiatric symptoms and to improve clinical diagnostic and treatment levels.

Stiff person syndrome (SPS) is a rare neuro-immune disorder characterized by exaggerated startle responses and muscle spasms in response to minor stimuli. SPS is often misdiagnosed as panic disorder or agoraphobia. This paper reported a case of a patient with SPS presenting symptoms similar to panic attack. The patient had been misdiagnosed as dystonia, anxiety disorder and panic attack. The patient was finally correctly diagnosed through multiple disciplinary team discussions. This study integrates a comprehensive understanding of symptomatology and patient-reported experiences with targeted neurological evaluations and supplementary diagnostic tools to improve the accuracy of etiological diagnoses. This study aims to enhance the ability of psychiatrists to recognize somatic diseases presenting with psychiatric symptoms and to improve clinical diagnostic and treatment levels.

ObjectiveTo improve the response capabilities to disasters and prevent major epidemics， it is of practical use to study the capability evaluation system of the national emergency medical rescue team that combines theoretical training and practical exercises， to enhance the overall quality of the teams. MethodsFirst， a capability assessment system for the national emergency medical rescue team was constructed based on the INSARAG External Classification （IEC） standards of the national emergency medical rescue team. Then， based on the outcome based education （OBE） concept， we conducted innovative research on the curriculum design and exercise programs for team building and member training. Finally， an empirical analysis was conducted on the effectiveness of the evaluation system and training exercises based on the statistical analysis of the comprehensive quality evaluation of the Shanghai national emergency medical rescue team from 2020 to 2023， as well as the empirical analysis of the rescue exercise on the Cruise of spectrum. ResultsBased on the linear regression analysis of each core competency indicators， the five core competencies in the evaluation system， including rescue skills， medical and health knowledge， disaster coping ability， team cooperation ability， and mental resilience training， were positively correlated with the cumulative number of trainings （r=0.71， r=0.76， r=0.81， r=0.84， r=0.96，all P<0.05）， indicating that the training was effective and the course design was reasonable. Empirical cases showed that the three-dimensional rescue drill model had remarkable results in the actual combat application and ability improvement of team members. ConclusionThe training courses and drills designed based on the three-level assessment system are effective in improving the comprehensive capabilities of the national emergency medical rescue team.

Objective:To investigate the association between the local renin-angiotensin system (RAS) in human follicular fluid (hFF) and age, ovarian function, in vitro fertilization (IVF) laboratory outcome. Methods:A non-intervention observational study was designed. hFF and medical case history without personal identity of patients who received IVF simply because of male factor infertility in Reproductive Medicine Center, the First Affiliated Hospital of Soochow University during January 2021 and February 2022 were collected. The renin, angiotensin converting enzyme (ACE), ACE2, angiotensin (Ang)Ⅱ and Ang 1-7 levels were detected by enzyme-linked immunosorbent assay kit. The correlation between age and RAS in hFF was analyzed by simple linear regression, and multivariate linear regression was used to further analyze the correlation between the RAS and IVF laboratory outcome.Results:1) A total of 139 samples of analysable hFF were obtained. 2) There was a linear negative correlation between age and renin (Pearson's r=-0.313 3, P<0.001), angiotensin converting enzyme (ACE; Pearson's r=-0.183 6, P=0.031), angiotensinⅡ (AngⅡ; Pearson's r=-0.218 6, P=0.010), ACE/ACE2 (Pearson's r=-0.319 2, P<0.001), AngⅡ/Ang1-7 (Pearson's r=-0.224 3, P=0.008), while the linear relationship with ACE2 and Ang1-7 was not significant (all P>0.05). 3) Basal follicle-stimulating hormone was positively correlated with age ( β=0.636, P<0.001), ACE2 ( β=0.267, P=0.026) and AngⅡ ( β=0.268, P=0.001), while negatively correlated with ACE ( β=-0.320, P<0.001) and Ang1-7 ( β=-0.217, P=0.014). Basal luteinizing hormone was positively correlated with AngⅡ ( β=0.330, P=0.003), while negative correlated with Ang1-7 ( β=-0.395, P=0.002). Antral follicle count was positively correlated with Ang1-7 ( β=0.153, P=0.049), while negatively correlated with age ( β=-0.869, P<0.001) and ACE2 ( β=-0.082, P=0.004). Basal anti-Müllerian hormone was only negatively correlated with age ( β=-0.349, P<0.001). There was no correlation between RAS and basal estradiol, progesterone, prolactin, testosterone (all P>0.05). 4) Oocyte retrieval count was positively correlated with renin ( β=0.146, P=0.014), AngⅡ ( β=0.113, P=0.034) and Ang1-7 ( β=0.185, P=0.002), while negatively correlated with age ( β=-0.717, P<0.001); MⅡ oocyte maturation rate was positively correlated with AngⅡ ( β=0.207, P=0.019) and Ang1-7 ( β=0.217, P=0.026), while negatively correlated with age ( β=-0.518, P<0.001). There was no correlation between RAS and the rates of two pronuclei embryos, transplantable embryos, high-quality embryos (all P>0.05). Conclusion:The local RAS in ovarian follicles is affected by age and correlated with ovarian function and IVF laboratory outcome.

Objective:To investigate the association between the local renin-angiotensin system (RAS) in human follicular fluid (hFF) and age, ovarian function, in vitro fertilization (IVF) laboratory outcome. Methods:A non-intervention observational study was designed. hFF and medical case history without personal identity of patients who received IVF simply because of male factor infertility in Reproductive Medicine Center, the First Affiliated Hospital of Soochow University during January 2021 and February 2022 were collected. The renin, angiotensin converting enzyme (ACE), ACE2, angiotensin (Ang)Ⅱ and Ang 1-7 levels were detected by enzyme-linked immunosorbent assay kit. The correlation between age and RAS in hFF was analyzed by simple linear regression, and multivariate linear regression was used to further analyze the correlation between the RAS and IVF laboratory outcome.Results:1) A total of 139 samples of analysable hFF were obtained. 2) There was a linear negative correlation between age and renin (Pearson's r=-0.313 3, P<0.001), angiotensin converting enzyme (ACE; Pearson's r=-0.183 6, P=0.031), angiotensinⅡ (AngⅡ; Pearson's r=-0.218 6, P=0.010), ACE/ACE2 (Pearson's r=-0.319 2, P<0.001), AngⅡ/Ang1-7 (Pearson's r=-0.224 3, P=0.008), while the linear relationship with ACE2 and Ang1-7 was not significant (all P>0.05). 3) Basal follicle-stimulating hormone was positively correlated with age ( β=0.636, P<0.001), ACE2 ( β=0.267, P=0.026) and AngⅡ ( β=0.268, P=0.001), while negatively correlated with ACE ( β=-0.320, P<0.001) and Ang1-7 ( β=-0.217, P=0.014). Basal luteinizing hormone was positively correlated with AngⅡ ( β=0.330, P=0.003), while negative correlated with Ang1-7 ( β=-0.395, P=0.002). Antral follicle count was positively correlated with Ang1-7 ( β=0.153, P=0.049), while negatively correlated with age ( β=-0.869, P<0.001) and ACE2 ( β=-0.082, P=0.004). Basal anti-Müllerian hormone was only negatively correlated with age ( β=-0.349, P<0.001). There was no correlation between RAS and basal estradiol, progesterone, prolactin, testosterone (all P>0.05). 4) Oocyte retrieval count was positively correlated with renin ( β=0.146, P=0.014), AngⅡ ( β=0.113, P=0.034) and Ang1-7 ( β=0.185, P=0.002), while negatively correlated with age ( β=-0.717, P<0.001); MⅡ oocyte maturation rate was positively correlated with AngⅡ ( β=0.207, P=0.019) and Ang1-7 ( β=0.217, P=0.026), while negatively correlated with age ( β=-0.518, P<0.001). There was no correlation between RAS and the rates of two pronuclei embryos, transplantable embryos, high-quality embryos (all P>0.05). Conclusion:The local RAS in ovarian follicles is affected by age and correlated with ovarian function and IVF laboratory outcome.

Single-cell RNA sequencing (scRNA-seq) is used for transcriptome profiling at the individual cell level, which is capable of screening in differentially gene expression that results from genetic mutation. Islet-based developmental atlas and heterogeneity characterization are currently the main applications of scRNA-seq in diabetes. scRNA-seq also can be used to mark and purify the functional β cells from resident adult stem cells in the pancreatic islets, which is expected to improve the outcome of islet β cells transplantation in type 1 diabetic patients. In addition, the technique can aid in learning diabetic β cell dedifferentiation and immunomodulatory functions. Although the study of scRNA-seq in diabetic retinopathy, nephropathy, atherosclerosis, and peripheral neuropathy is still at a nascent stage, scRNA-seq has great potential in a wide range of biomedical and clinical applications.

OBJECTIVES: Nasopharyngeal carcinoma (NPC) is a highly invasive epithelial malignant tumor with unique geographical and ethnic distribution characteristics. NPC is mostly found in south China and Southeast Asia, and its treatment mainly depends on radiotherapy and chemotherapy. However, NPC is usually found in the late stage, and local recurrence and distant metastasis are common, leading to poor prognosis. The receptor tyrosine kinase AXL is up-regulated in various tumors and it is involved in tumor proliferation, migration, invasion, and other processes, which are associated with poor prognosis of tumors. This study aims to detect the expression of AXL in NPC cell lines and tissues, and to investigate its biological function of AXL and the underlying molecular mechanisms in regulation of NPC. METHODS: The expression levels of AXL in normal nasopharyngeal epithelial tissues and NPC tissues were analyzed by GSE68799, GSE12452, and GSE53819 data sets based on Gene Expression Omnibus (GEO) database. The Cancer Genome Atlas (TCGA) database was used to analyze the relationship between AXL and prognosis of head and neck squamous cell carcinoma (HNSC). The indicators of prognosis included overall survival (OS), disease-free interval (DFI), disease-specific survival (DSS), and progression-free interval (PFI). Western blotting assay was used to detect the AXL protein expression levels in normal nasopharyngeal epithelial cell line and NPC cell lines. Immunohistochemical method was used to detect AXL expression levels in normal nasopharyngeal epithelial tissues and NPC tissues. Cell lines with stable AXL knockdown were established by infecting 5-8F and Fadu cells with lentivirus interference vector, and cell lines with stable AXL overexpression were established by infecting C666-1 and HK-1 cells with lentivirus expression vector. Real-time PCR and Western blotting were used to detect the efficiency of knockdown and overexpression in stable cell lines. The effects of AXL knockdown or overexpression on proliferation, migration, and invasion of NPC cells were detected by CCK-8, plate colony formation, and Transwell assays, and the effect of AXL knockdown on tumor growth in nude mice was detected by subcutaneous tumor formation assay. The sequence of AXL upstream 2.0 kb promoter region was obtained by UCSC online database. The PROMO online database was used to predict AXL transcription factors with 0% fault tolerance, and the JASPAR online database was used to predict the binding sites of ETS1 to AXL. Real-time PCR and Western blotting were used to detect the effect of ETS1 on AXL protein and mRNA expression. The AXL upstream 2.0 kb promoter region was divided into 8 fragments, each of which was 250 bp in length. Primers were designed for 8 fragments. The binding of ETS1 to AXL promoter region was detected by chromatin immuno-precipitation (ChIP) assay to determine the direct regulatory relationship between ETS1 and AXL. Rescue assay was used to determine whether ETS1 affected the proliferation, migration, and invasion of NPC cells through AXL. RESULTS: Bioinformatics analysis showed that AXL was highly expressed in NPC tissues (P<0.05), and AXL expression was positively correlated with OS, DFI, DSS, and PFI in HNSC patients. Western blotting and immunohistochemical results showed that AXL was highly expressed in NPC cell lines and tissues compared with the normal nasopharyngeal epithelial cell line and tissues. Real-time PCR and Western blotting results showed that knockdown and overexpression efficiency in the stable cell lines met the requirements of subsequent experiments. The results of CCK-8, plate colony formation, Transwell assays and subcutaneous tumor formation in nude mice showed that down-regulation of AXL significantly inhibited the proliferation, migration, invasion of NPC cells and tumor growth (all P<0.05), and the up-regulation of AXL significantly promoted the proliferation, migration, and invasion of NPC cells (all P<0.05).As predicted by PROMO and JASPAR online databases, ETS1 was a transcription factor of AXL and had multiple binding sites in the AXL promoter region. Real-time PCR and Western blotting results showed that knockdown or overexpression of ETS1 down-regulated or up-regulated AXL protein and mRNA expression levels. ChIP assay result showed that ETS1 bound to AXL promoter region and directly regulate AXL expression. Rescue assay showed that AXL rescued the effects of ETS1 on proliferation, migration and invasion of NPC cells (P<0.05). CONCLUSIONS AXL is highly expressed in NPC cell lines and tissues, which can promote the malignant progression of NPC, and its expression is regulated by transcription factor ETS1.
Animals ; Cell Line, Tumor ; Cell Movement/genetics* ; Cell Proliferation/genetics* ; Gene Expression Regulation, Neoplastic ; Mice ; Mice, Nude ; Nasopharyngeal Carcinoma/genetics* ; Nasopharyngeal Neoplasms/metabolism* ; RNA, Messenger/genetics* ; Sincalide/metabolism* ; Transcription Factors/genetics*

Nurse's professional identity is a positive evaluation of nursing profession by the nurses themselves,which directly affects the outcome of patients and nurses.Nursing practice environment can not only affect the formation of nurses' professional identity,but also affect the safety of patients and the development of hospitals through the influence of nurses.The research on professional identity and positive working environment of nurses in China started late and is still in the exploratory stage.This study analyzed the overview,research progress and relationship of nurses' professional identity and practice environment,and provided reference for nurses' professional identity training and the construction of positive nursing practice environment in China.

Objective To study the changes of gonadotropin releasing hormone agonist (GnRH-a) in pinopodes during luteal phase and to explore the possible mechanism of GnRH-a in luteal phase support of assisted reproductive technology (ART).Methods Totally 40 primary infertility women who were treated with ART due to male factors were enrolled,according to the order of the group they were randomly divided into experimental group and control group.On the 7th day after ovulation,the experimental group received a subcutaneous injection of 0.1 mg of GnRH-a,while the control group received a subcutaneous injection of placebo only (0.9％ salinc 2 ml),3 days later they came to the clinic again.Serum estradiol and progesterone levels were measured before and after treatment in each group.Pinopodes were collected for electron microscopic examination.Levels of ER and PR were detected by western blot.Results (1) There was no significant difference between the experimental group and the control group in the estrogen level before and after the treatment (all P＞0.05).The level of progesterone in the experimental group after treatment [(66.8± 14.9) nmol/L] was significantly higher than that before treatment(P＜0.05);also significantly higher than the same period of the control group (P＜0.05).(2) There was no significant difference in the expression of ER protein in the experimental group before and after treatment (P＞0.05).The expression of PR in the experimental group after treatment was significantly lower than that before treatment (P＜0.05);also lower than the same period of the control group (P＜0.05).(3) Expression amount of pinopodes in the experimental group after treatment was significantly higher than that before treatment [65％ (13/20) versus 25％ (5/20),P＜ 0.05],and the development trend was more mature [the percentage of maturation:75％ (15/20) versus 35％ (7/ 20),P＜0.05].Expression amount of pinopodes after treatment and the percentage of maturation in the experimental group were significantly higher than those in the same period of control group (P＜0.05).Conclusion GnRH-a in luteal phase support may play a role through the corpus luteum,which may promote the secretion of progesterone,downregulation of PR expression,promote the growth of pinopodes,and improve the endometrial receptivity.