Objective:To explore distribution characteristics of PD-1 on surface of peripheral blood T cells in non-small cell lung cancer(NSCLC)and its relationship with efficacy of interventional therapy.Methods:A total of 100 NSCLC patients who under-went interventional treatment in Rugao People's Hospital from February 2018 to October 2022 were selected as study subjects and set as case group,and 100 healthy individuals who underwent physical examinations at Rugao People's Hospital during same period as control group 1,another 100 patients with benign lung disease were set as control group 2.Hierarchical regression model was used to analyze relationship between surface PD-1 expression rate of peripheral blood T lymphocytes and clinical pathological characteristics.Generalized linear mixed model(GLMM)was constructed to determine relationship between PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Restricted cubic splines(RCS)was used to analyze dose-response relationship be-tween PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Cox regression analysis was used to identify risk factors.Results:Compared with control group,case group had higher expression rate of PD-1 on surface of CD4+T and CD8+T cells in peripheral blood(P<0.05).PD-1 expression rate of on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients were significantly correlated with TNM staging,lymph node metastasis and distant metastasis(P<0.05).Stratified regression model analysis showed that TNM staging,lymph node metastasis and distant metastasis had significant impact on PD-1+CD4+T and PD-1+CD8+T cells(P<0.05).Interventional therapy showed good clinical efficacy,with total effective rate of 76.00%.As therapeutic effect decreased,expression rate of PD-1 on surface of CD4+T and CD8+T lymphocytes in patients with different therapeutic effects showed an increasing trend before and after treatment(P<0.05).After adjusting for confounding factors(Model 2),PD-1+CD4+T value of 15.82～19.43,and≥19.44 clinical ineffectiveness risk were 1.164 and 1.330 times higher than those of control group(<12.20%),respectively(P<0.05);risk of clinical ineffectiveness with PD-1+CD8+T ranging from 17.06～20.69,and≥20.70 was 1.162 and 1.313 times higher than control group(<13.42%),respectively(P<0.05).RCS analysis showed a non-linear relationship between continuous changes in PD-1+CD4+T and PD-1+CD8+T and clinical failure risk(all P<0.001).Cox regression analysis showed that distant metastasis,PD-1+CD4+T and PD-1+CD8+T were all independent influencing factors for postoperative OS(P<0.05);TNM staging,distant metastasis and number of interventions were all independent influencing factors for postoperative PFS(P<0.05).Conclusion:PD-1 expression rate on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients is significantly correlated with TNM staging,lymph node metastasis,distant metastasis,clinical efficacy of interventional treatment and postoperative OS;PD-1+CD4+T and PD-1+CD8+T levels in TNM stages Ⅲ～Ⅳ are significantly higher than stage Ⅰ～Ⅱ patients.PD-1 expression rate can provide assistance for early diagnosis and auxiliary staging of NSCLC patients and guide clinical treatment.

Objective To explore the effect of Omaha system continuity nursing on the degree of pain and quality of life in patients undergoing arthroscopic rotator cuff repair.Methods A total of 110 patients who underwent arthroscopic rotator cuff repair at the First Affiliated Hospital of Wenzhou Medical University from September 2022 to May 2023 were selected.They were divided into intervention group and control group according to the random number table method,with 55 cases in each group.Patients in control group were given conventional continuous nursing,while patients in intervention group were given Omaha system continuity nursing.Both groups of patients were intervened for 6 months.The range of motion of shoulder joint,shoulder joint function,degree of pain and quality of life of two groups of patients before and after the intervention were compared.Results After the intervention,the range of motion of shoulder joint in intervention group was significantly greater than that in control group,University of California,Los Angeles shoulder joint score and the 8-item short form health survey were significantly higher than those in control group,and numerical rating scale score of pain was significantly lower than that in control group(P＜0.05).Conclusion Omaha system continuity nursing can improve shoulder joint mobility and function,alleriate pain,and improve quality of life for patients undergoing arthroscopic rotator cuff repair surgery.

Objective:To explore distribution characteristics of PD-1 on surface of peripheral blood T cells in non-small cell lung cancer(NSCLC)and its relationship with efficacy of interventional therapy.Methods:A total of 100 NSCLC patients who under-went interventional treatment in Rugao People's Hospital from February 2018 to October 2022 were selected as study subjects and set as case group,and 100 healthy individuals who underwent physical examinations at Rugao People's Hospital during same period as control group 1,another 100 patients with benign lung disease were set as control group 2.Hierarchical regression model was used to analyze relationship between surface PD-1 expression rate of peripheral blood T lymphocytes and clinical pathological characteristics.Generalized linear mixed model(GLMM)was constructed to determine relationship between PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Restricted cubic splines(RCS)was used to analyze dose-response relationship be-tween PD-1 expression rate on peripheral blood T cell surface and risk of clinical ineffectiveness.Cox regression analysis was used to identify risk factors.Results:Compared with control group,case group had higher expression rate of PD-1 on surface of CD4+T and CD8+T cells in peripheral blood(P<0.05).PD-1 expression rate of on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients were significantly correlated with TNM staging,lymph node metastasis and distant metastasis(P<0.05).Stratified regression model analysis showed that TNM staging,lymph node metastasis and distant metastasis had significant impact on PD-1+CD4+T and PD-1+CD8+T cells(P<0.05).Interventional therapy showed good clinical efficacy,with total effective rate of 76.00%.As therapeutic effect decreased,expression rate of PD-1 on surface of CD4+T and CD8+T lymphocytes in patients with different therapeutic effects showed an increasing trend before and after treatment(P<0.05).After adjusting for confounding factors(Model 2),PD-1+CD4+T value of 15.82～19.43,and≥19.44 clinical ineffectiveness risk were 1.164 and 1.330 times higher than those of control group(<12.20%),respectively(P<0.05);risk of clinical ineffectiveness with PD-1+CD8+T ranging from 17.06～20.69,and≥20.70 was 1.162 and 1.313 times higher than control group(<13.42%),respectively(P<0.05).RCS analysis showed a non-linear relationship between continuous changes in PD-1+CD4+T and PD-1+CD8+T and clinical failure risk(all P<0.001).Cox regression analysis showed that distant metastasis,PD-1+CD4+T and PD-1+CD8+T were all independent influencing factors for postoperative OS(P<0.05);TNM staging,distant metastasis and number of interventions were all independent influencing factors for postoperative PFS(P<0.05).Conclusion:PD-1 expression rate on surface of CD4+T and CD8+T cells in peripheral blood of NSCLC patients is significantly correlated with TNM staging,lymph node metastasis,distant metastasis,clinical efficacy of interventional treatment and postoperative OS;PD-1+CD4+T and PD-1+CD8+T levels in TNM stages Ⅲ～Ⅳ are significantly higher than stage Ⅰ～Ⅱ patients.PD-1 expression rate can provide assistance for early diagnosis and auxiliary staging of NSCLC patients and guide clinical treatment.

Objective To explore the effect of Omaha system continuity nursing on the degree of pain and quality of life in patients undergoing arthroscopic rotator cuff repair.Methods A total of 110 patients who underwent arthroscopic rotator cuff repair at the First Affiliated Hospital of Wenzhou Medical University from September 2022 to May 2023 were selected.They were divided into intervention group and control group according to the random number table method,with 55 cases in each group.Patients in control group were given conventional continuous nursing,while patients in intervention group were given Omaha system continuity nursing.Both groups of patients were intervened for 6 months.The range of motion of shoulder joint,shoulder joint function,degree of pain and quality of life of two groups of patients before and after the intervention were compared.Results After the intervention,the range of motion of shoulder joint in intervention group was significantly greater than that in control group,University of California,Los Angeles shoulder joint score and the 8-item short form health survey were significantly higher than those in control group,and numerical rating scale score of pain was significantly lower than that in control group(P＜0.05).Conclusion Omaha system continuity nursing can improve shoulder joint mobility and function,alleriate pain,and improve quality of life for patients undergoing arthroscopic rotator cuff repair surgery.

Objective To investigate the effect and mechanism of osteopontin(OPN)in hepatoma cell migration through galectin-3 binding protein(LGALS3BP).Methods Human hepatoma cell lines SMMC-7721,SMMC-P(stably transfected with empty eukaryotic expression vectors),and SMMC-OPN(stably transfected with the OPN gene)were cultured.mRNA expression levels of OPN and LGALS3BP were measured by RT-qPCR.Western blot assays were used to analyze the relative protein expression of OPN and LGALS3BP and PI3K/AKT pathway.Wound healing assays were performed to explore the cell migration ability.After transfection with LGALS3BP-targeting small interfering RNA(si-LGALS3BP)or negative control small RNA(si-NC)into SMMC-OPN cells,cell migration and relative expression of PI3K/AKT pathway-related proteins were assessed.Results Compared with SMMC-7721 and SMMC-P,the migratory ability of SMMC-OPN cells was significantly reinforced,and expression of LGALS3BP was obviously upregulated at both mRNA and protein levels.Moreover,relative expression of p-PI3K/PI3K and p-AKT/AKT proteins was significantly increased.Wound healing assays showed that the si-LGALS3BP obviously suppressed the migratory ability of SMMC-OPN cells.Furthermore,relative expression of p-PI3K/PI3K and p-AKT/AKT proteins in SMMC-OPN cells was significantly decreased after transfection of si-LGALS3BP.Conclusions OPN activates the PI3K/AKT pathway by upregulating LGALS3BP expression to promote hepatoma cell migration.

Objective: To analyze the current situation, influencing factors and mechanism of knowledge-attitude-practice(KAP) regarding acquired immune deficiency syndrome(AIDS)/sexually transmitted diseases(STDs) among migrant workers in Chengdu's main urban area, so as to provide a basis for the development of effective prevention and control policies for this group. Methods: Convenience sampling and systematic sampling were used to collect demographic information and data on knowledge, attitudes, and sexual behavior characteristics of AIDS/STDs of the participants. The collected data were organized and statistically analyzed by EpiData 3.1 and SPSS 26.0 software. Additionally, a KAP path analysis model was constructed by using AMOS 24.0 software. Results: A total of 257 valid questionnaires were obtained. The AIDS awareness rate was 55.6%, with a mean scores of(5.59±1.61). The awareness rate of STDs was 37.4%, with a mean scores of(9.05±3.00). Discrimination attitudes towards AIDS and STDs were reported by 58 participants(22.6%) and 44 participants(17.1%) respectively. The prevalence of high-risk sexual behavior was 3.50%. Men(OR=0.500, 95%CI: 0.279-0.897) acted as deterrents to knowledge of AIDS. On the other hand, childlessness facilitated discrimination against AIDS(OR=2.748, 95%CI: 1.385-5.451) and STDs(OR=2.287, 95%CI: 1.084-4.825). There was lower likelihood of engaging in high-risk sexual behavior among migrant workers in Chengdu's main urban area who were older(OR=0.854, 95%CI: 0.785-0.929). The occurrence of high-risk sexual behaviors was influenced both directly and indirectly by attitudes towards AIDS and related knowledge. There was a positive correlation between knowledge about AIDS and STDs and attitudes towards them(r=0.15,0.24, bothP<0.05), as well as between attitudes towards AIDS and attitudes towards STDs(r=0.57,P<0.05). That is, the higher the scores of knowledge, the less likely one was to hold discrimination attitudes. Therefore, increasing the rate of knowledge awareness could reduce discrimination towards AIDS/STDs and the occurrence of high-risk sexual behaviors. Conclusion The level of AIDS/STDs knowledge among the migrant workers in Chengdu′s main urban area is concerning. Innovative interventions should be intensified in key areas and populations.

Objective:To explore the latent categories of outpatient nurses' conflict management styles and analyze their influencing factors.Methods:A total of 408 outpatient nurses from six hospitals of Jiangsu Province were selected as study participants by convenience sampling. Data were collected using a general information questionnaire, the Rahim Organizational Conflict Inventory Scale, the Nurse Burnout Scale, the Caring Ability Inventory Scale and the Wong and Law Emotional Intelligence Scale. Latent profile analysis was used to classify the conflict management styles of outpatient nurses, and logistic regression analysis was applied to identify the influencing factors of different categories.Results:A total of 408 questionnaires were distributed, and 372 valid responses were received, with an effective response rate of 91.18%. Outpatient nurses' conflict management styles were divided into two categories: the "Integration-Concession Group" and the "Dominance-Avoidance Group." Logistic regression analysis showed that being an only child, receiving interpersonal communication training, nurse burnout, humanistic care ability, and emotional intelligence were significant influencing factors of the latent categories of conflict management styles ( P<0.05) . Conclusions:There is heterogeneity in outpatient nurses' conflict management styles. It is recommended that nursing administrators adopt a comprehensive approach, conduct thorough assessments of nurses' general conditions and personality traits, guide nurses toward adopting positive conflict management methods, and enhance their abilities in problem-solving and conflict resolution. This can improve interpersonal relationships and work efficiency in medical settings, stabilize the outpatient nursing workforce, and improve the overall quality of nursing services.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the efficacy and safety of plasma exchange(PE) in the treatment of autoimmune hemolytic anemia in children.Methods:The data from 8 hospitals in China during November 2014 to April 2017 were collected, and the clinical characteristics of PE in children with AHA were analyzed retrospectively.Results:A total of 21 children with AHA were included in the study, including 17 cases from PICU and 4 cases from pediatric kidney ward, with 11 boys and 10 girls, and the median age was 3.64(0.25, 11.10)years old, and median hospital stay was 12(4, 45)days.There were 15 cases(71.4%) with infection, 2 cases(9.5%)with autoimmune diseases, 4 cases(19.0%) with unknown.Consciousness disturbance occurred in 4 patients before replacement and recovered to normal after PE.The volume of blood decreased in two cases(9.5%) and completely relieved.There were 20 cases of anemia (95.2%), 15 cases were normal after PE, and 5 cases were improved.Jaundice occurred in 18 cases (85.7%), 12 cases were normal after PE, 6 cases were improved.Hepatosplenomegaly was found in 11 cases, 10 cases were normal after PE, 1 case was improved.After PE, the hemoglobin and red blood cell count increased, while the total bilirubin, indirect bilirubin, urea nitrogen and lactate dehydrogenase decreased, there were significant differences between pre-and post-replacement ( P<0.05). Only 1 case had allergic reaction, which was improved after symptomatic treatment, and PE was continued.After PE, 2 cases (9.5%) had complete remission, 16 cases (76.2%) had partial remission and 3 cases (14.3%) had been discharged. Conclusion:PE therapy can obviously improve the clinical symptoms and laboratory indexes of children with AHA who have failed to respond to conservative treatment.It can be used as a treatment measure for children with severe AHA and has a good safety.

Objective:To examine the expression of transmembrane emp24 domain-containing protein 4(TMED4) in liver tissue of patients with hepatocellular carcinoma, and to investigate the effects of TMED4 gene on the proliferation and migration of hepatocellular carcinoma cells and related molecular mechanisms. Methods:The expression of TMED4 at protein level in liver cancer tissue and paracancerous tissue of patients with hepatocellular carcinoma were detected by Western blotting and immunohistochemical stainning, and the correlation between its expression and clinicopathological features was analyzed. The effects of TMED4 overexpression or knockdown on proliferation, migration and healing ability of hepatocellular carcinoma cells in vitro and in vivo were determined by cell proliferation test, Transwell test, wound healing test and subcutaneous tumor formation in nude mice. The molecular mechanism of TMED4 in regulating the biological behavior of hepatocellular carcinoma cells was preliminarily explored by pathway analysis. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:The results of Western blotting showed that the expression of TMED4 at protein level in hepatocellular carcinoma tissue was lower than that in paracancerous tissue(0.52±0.29 vs. 0.83±0.22), and the difference was statistically significant( t=2.54, P=0.022). The results of immunohistochemical examination indicated that the expression of TMED4 at protein level in liver cancer tissue was lower than that in paracancerous tissue(5.46±3.37 vs. 7.58±3.08), and the difference was statistically significant( t=3.49, P<0.001). The expression of TMED4 at protein level was significantly correlated with vascular invasion and Barcelona clinic liver cancer stage( χ2=6.83 and 4.20, P=0.009 and 0.040). The results of cell proliferation assay showed that the absorbance value of SMMC-7721 cells in TMED4 overexpression group was lower than that in control group(1.38±0.05 vs. 2.37±0.08), while the optical density value of HepG2 in TMED4 knockdown group was higher than that in control group(0.76±0.04 vs. 0.54±0.01), and the differences were statistically significant( t=18.23 and 8.85, both P<0.001). The results of Transwell test showed that the number of migrated SMMC-7721 cells in TMED4 overexpression group was less than that in control group(286.30±13.01 vs. 439.70±12.34), while the number of migrated HepG2 cells in TMED4 knockdown group was higher than that in control group(249.00±6.00 vs. 160.00±6.56), and the differences were statistically significant( t=14.81 and 17.34, both P<0.001). The wound healing test showed that the healing rate of SMMC-7721 cells in TMED4 overexpression group was lower than that in control group((0.21±0.01)% vs.(0.45±0.01)%), the healing rate of HepG2 cells in TMED4 knockdown group was higher than that in control group((0.46±0.01)% vs.(0.20±0.01)%), and the differences were statistically significant( t=200.10 and 30.46, both P<0.001). The results of subcutaneous tumor formation assay in nude mice showed that the growth rate of cells in TMED4 overexpression group was slower than that in control group. After cell inoculation for 6 weeks, the subcutaneous tumor volume of mice in TMED4 overexpression group was smaller than that in control group(27.36 mm 3(138.70 mm 3) vs. 1 741.62 mm 3(1 783.39 mm 3)), the tumor weight was lower than that in control group(0.06 g(0.14 g) vs. 1.46 g(1.09 g)), and the differences were statistically significant(both Z=-2.31, both P<0.001). The results of Western blotting showed that the expression of Snail at protein level in SMMC-7721 cells of the TMED4 overexpression group was lower than that of the control group(0.32±0.01 vs. 0.90±0.03), the protein level of Snail in HepG2 cells of TMED4 knockdown group was higher than that of control group(1.03±0.01 vs. 0.97±0.01), and the differences were statistically significant( t=28.49 and 12.31, both P<0.001). The results of real time fluorescent quantitative polymerase chain reaction showed that the expression of Snail at mRNA level in SMMC-7721 cells of TMED4 overexpression group was lower than that of control group(0.13±0.05 vs. 1.00±0.15), the expression of Snail at mRNA level in HepG2 cells of TMED4 knockdown group was higher than that of control group(1.25±0.32 vs. 0.21±0.14), and the differences were statistically significant( t=9.62 and 5.10, P<0.001 and P=0.007). Conclusion:TMED4 may affect the proliferation and migration of hepatocarcinoma cells by regulating the expression of Snail, and which is expected to become a potentially therapeutic target for hepatocellular carcinoma.