ObjectiveTo investigate the expression of serum Aldo-keto reductase family 1 member B10 （AKR1B10） in patients with hepatocellular carcinoma （HCC） in northern China， and to provide a new and valuable biomarker for the clinical diagnosis of HCC. MethodsThis study was conducted among 102 patients with HCC， 119 patients with benign liver disease， and 132 patients with other malignant tumors who attended The Affiliated Hospital of Chengde Medical University and 148 healthy individuals who underwent physical examination from May 2020 to May 2024. ELISA and chemiluminescence were used to measure the serum levels of AKR1B10 and alpha-fetoprotein （AFP）. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between three groups and further comparison between two groups； the chi-square test was used for comparison of categorical data between groups. The area under the ROC curve （AUC） was used to assess diagnostic efficiency. ResultsThe expression level of AKR1B10 was 3 053.79 （1 475.67‍ ‍—‍ ‍4 605.86） pg/mL in the HCC group， 1 324.42 （659.68‍ ‍—‍ ‍2 023.88） pg/mL in the benign liver disease group， 660.68 （377.56‍ ‍—‍ ‍2 087.77） pg/mL in the other malignant tumor group， and 318.30 （82.73‍ ‍—‍ ‍478.82） pg/mL in the healthy group， with a significant difference between the four groups （H=240.86， P<0.001）， and further comparison between two groups showed that the HCC group had a significantly higher level than the other three groups （all P<0.001）. The ROC curve analysis of the HCC group and the other three groups showed that serum AKR1B10 had an optimal cut-off value of 1 584.97 pg/mL in the diagnosis of HCC， with an AUC of 0.86 （95% confidence interval ［CI］： 0.82‍ ‍—‍ ‍0.90）， a sensitivity of 74.3%， and a specificity of 85.2%. Compared with each indicator alone， a combination of AKR1B10 and AFP could improve the sensitivity （81.8%） and specificity （91.4%） of HCC diagnosis. AKR1B10 had an AUC of 0.84 （95%CI： 0.78‍ ‍—‍ ‍0.90） in the diagnosis of patients with early- or middle-stage HCC， with a sensitivity of 76.2% and a specificity of 81.2%. AKR1B10 had an AUC of 0.85 （95%CI： 0.77‍ ‍—‍ ‍0.92） in the diagnosis of patients with AFP-negative HCC， with a sensitivity of 81.6% and a specificity of 79.9%. ConclusionAKR1B10 is a promising serological marker for the diagnosis of HCC， and a combination of AKR1B10 and AFP can improve the detection rate of HCC patients in northern China， especially those with early- or middle-stage HCC and AFP-negative HCC.

Objective:To construct a quality assessment tool for teaching plans designed for clinical scenario-based simulation, test its reliability and validity, and provide an effective tool for accurately and objectively evaluating the simulation instructors' capabilities in clinical scenario-based simulation teaching designs and the quality of teaching plans.Methods:Through literature review and two rounds of expert consultation using the Delphi method, an initial draft of the assessment tool was formed. Subsequently, an empirical study was conducted with 85 clinical scenario-based simulation teaching plans collected nationwide to test the reliability and validity of the assessment tool.Results:The quality assessment tool for teaching plans designed for clinical scenario-based simulation consists of 5 primary items and 17 secondary items. The Cronbach's α coefficient of the scale was 0.872. The inter-rater reliability, measured by the intraclass correlation coefficient, was 0.838. The scale level content validity index was 0.949. The results of confirmatory factor analysis showed χ2/d f of 2.385, a root mean square error of approximation of 0.090, and a comparative fit index of 0.861, indicating an acceptable model fit. Conclusions:The quality assessment tool for teaching plans designed for clinical scenario-based simulation demonstrates high reliability and validity and can be used as a tool for evaluating the simulation instructors' capabilities in clinical scenario-based simulation teaching designs and the quality of teaching plans.

Objective:To explore the construction of an assessment tool for the implementation of scenario-based simulation courses, and provide a reference for the standardized implementation of scenario-based simulation courses and the key direction of teacher training.Methods:Based on the elements of the implementation of scenario-based simulation courses, the Scenario-Based Simulation Course Implementation Quality Scale was developed through expert interviews and expert panel meetings. This scale was used to rate the implementation of scenario-based simulation courses by 12 teaching teams in Shanghai, China. The evaluation scores were collected and analyzed using R language.Results:The reliability of the evaluation scale was assessed using Cronbach's α (0.893) and inter-rater consistency was assessed using the intraclass correlation coefficient (0.226). Among the 12 teaching teams, the lowest score rate was 67.07% for "debriefing". A correlation analysis between scenario-based simulation teaching design and course implementation showed a Pearson correlation coefficient r of -0.08 ( P=0.809), which indicated no significant correlation between them. Conclusions:The assessment of the implementation of scenario-based simulation courses should include all aspects of course implementation. The rater's understanding of scenario-based simulation courses can affect the results. Debriefing remains a challenge in implementing scenario-based simulation courses. A comprehensive assessment of the teaching ability of simulation teaching teams should include both teaching design and course implementation.

Objective To investigate the effect and mechanism of Taxilli Herba decoction in preventing miscarriage in rats with threatened abortion.Methods Seventy-two SPF-grade SD rats were co-housed at a male-to-female ratio of 2∶1.Forty-eight pregnant rats were subsequently divided into a normal group,a threatened abortion model group,a positive control group,as well as Taxilli Herba decoction low/medium/high dose groups(n=8 rats per group).Rats in the positive control group received 3.02 mg/kg dydrogesterone intragastrically,and rats in the low-,medium-,and high-dose Taxilli Herba decoction groups received 2.5,5,and 10 g/kg Taxilli Herba decoction intragastrically,respectively.The normal and model groups received intragastric distilled water once a day for 10 consecutive days.On day 10 after administration of the corresponding treatment,rats in all groups except the normal group received intragastric administration of 3.75 mg/kg mifepristone suspension.The effects of Taxilli Herba on the vaginal bleeding rate and abortion rate were observed.Serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estrogen(E),progesterone(P),vascular endothelial growth factor(VEGF),testosterone(T),and aromatase and E and P levels in the ovary in pregnant rats were detected by enzyme-linked immunosorbent assay.Expression levels of E receptor(ER),P receptor(PR),VEGF receptor 2(VEGFR2),and platelet endothelial cell adhesion molecule-1(CD31)in the uterine decidua in pregnant rats were detected by immunofluorescence staining,and semi-quantitative analysis was performed.Results Mifepristone significantly increased the vaginal bleeding rate and abortion rate in pregnant rats,but these were effectively reduced by treatment with Taxilli Herba water decoction.Taxilli Herba water decoction also increased serum E,P,and VEGF,and ovary levels of E and P(P＜0.05).The treatment also decreased serum LH,maintained the secretion of FSH,and enhanced ER,PR,VEGFR2,and CD31 expression in decidual tissue.Conclusions Taxilli Herba demonstrated effective miscarriage-prevention effects in a rat model of threatened abortion.Its mechanism of action involves regulating the normal physiological function of the hypothalamic-pituitary-gonadal axis upstream of the uterus,and enhancing the expression of the downstream P/PR/VEGF/VEGFR2 and E/ER/VEGF/VEGFR2 pathways.

Objective:To summarize the clinical data of single-center juvenile dermatomyositis（JDM）complicated with interstitial lung disease（ILD），and provide experience for pediatricians.Methods:Data of 61 children with JDM who were admitted to Children's Hospital affiliated to Xi'an Jiaotong University from January 2016 to May 2023 were collected. General data，clinical symptoms，chest high-resolution CT，laboratory examination and myositis antibody spectrum of the children were recorded.Results:Among the 61 children with JDM，there were 30 cases（13 males and 17 females）without ILD. The age of onset was 5.96（3.50，8.92）years and the course of disease was（11.79±20.00）months. There were 31 cases with ILD（14 males and 17 females），the age of onset was 7.42（4.50，10.08）years，and the duration of ILD was（5.47±8.09）months. There was statistical difference in the course of disease between the two groups（ P<0.05），but no statistical difference in gender and age between the two groups（ P>0.05）. Among 61 children with JDM，there were statistical differences in fever between the two groups（ P<0.05），but no statistical differences in heliotrope discoloration，gottron’s papules，calcinosis and myasthenia between the two groups（ P>0.05）. AST and FER showed statistical difference between the two groups（ P<0.05），while CK，LDH，CK-MB，ESR，C3 and C4 showed no statistical difference（ P>0.05）. All 61 cases of children were tested for myositis antibody spectrum，and there was statistical difference in anti-MDA5 antibody between the two groups（ P<0.05），but no statistical difference in the rest（ P>0.05）. There were statistical differences between the two groups in the treatment of methotrexate，hydroxychloroquine and cyclophosphamide（ P<0.05）. A total of 11 cases（36.67%）in the without ILD group were treated with biologics（8 adalimumab，2 infliximab and 1 tofacitinib），and 23 cases（74.19%）in the ILD group were treated with biologics（11 adalimumab，9 tofaciib，2 infliximab and 1 tocilizumab）. All 61 cases with JDM were followed up. Among the 30 children without ILD，1 case was lost to follow-up 2 months after treatment，and the rest were treated effectively without death. Among the 31 children with ILD，3 cases died of severe pulmonary infection with multidrug-resistant bacteria during treatment，of which 1 case was positive for anti-MDA5 antibody and 2 cases were negative for myositis specific antibody. Conclusion:JDM is more likely to be complicated with ILD，fever is more likely to occur in ILD group，and children with positive anti-MDA5 antibody are more likely to occur ILD. Biologic agents such as adalimumab and tofacitinib are effective in combination therapy. In the course of treatment，multi-drug resistant bacteria infection should be guarded against to reduce mortality.

Objective:To investigate the effects of moxibustion,filiform needle acupuncture,and electroacupuncture on synovial hypoxia and expression of synovial fibrosis markers[transforming growth factor(TGF)-β and collagen alpha-1(Ⅰ)chain(COL1A1)]in knee osteoarthritis(KOA)rats.Methods:Fifty Sprague-Dawley rats were randomly divided into a normal group,a model group,a moxibustion group,an acupuncture group,and an electroacupuncture group,with 10 rats in each group.Except for the normal group,rats in the other four groups were injected with sodium iodoacetate into the right knee joint cavity to establish KOA models.The right Futu(ST32)and Zusanli(ST36)were selected in the moxibustion,acupuncture,and electroacupuncture groups to perform the mild moxibustion with moxa sticks,filiform needle acupuncture,or electroacupuncture,respectively.Each intervention lasted 15 min,once every other day,and continued for 4 weeks,with a total of 14 interventions.The Lequesne score was used to evaluate the degree of knee dysfunction before and after intervention,and the rat's right knee joint diameter was measured to evaluate the degree of knee swelling.Morphological changes of the right knee joint synovial tissue were observed using hematoxylin-eosin staining.Hypoxia probe immunofluorescence staining was used to observe the degree of synovial hypoxia in rats.Western blotting was used to detect the protein expression levels of hypoxia-inducible factor(HIF)-1α,TGF-β,and COL1A1 in the synovial tissue of the right knee joints.Results:Before intervention,the Lequesne score and the right knee joint diameter in the other four groups increased significantly compared to the normal group(P<0.01).After intervention,the Lequesne score and the right knee joint diameter increased significantly in the model group compared to the normal group(P<0.01)together with worsened cartilage deformation and osteophytes,inflammatory cell infiltration and fibrosis in synovial tissue,and hypoxia degree,and the expression levels of HIF-1α,TGF-β,and COL1A1 proteins in the knee joint synovial tissue of rats increased(P<0.01).The Lequesne score and the right knee joint diameter decreased significantly(P<0.01 or P<0.05),the cartilage morphology was normal without obvious osteophytes,and the hypoxia degree reduced in the three intervention groups compared to the model group.Among them,the moxibustion group had the most notable improvement in hypoxia,synovial tissue fibrosis,angiogenesis,and inflammatory cell infiltration.The expression levels of HIF-1α,TGF-β,and COL1A1 proteins decreased in the moxibustion and electroacupuncture groups(P<0.01),and the expression levels of HIF-1α and TGF-β proteins were decreased in the acupuncture group(P<0.01).Conclusion:Moxibustion,filiform needle acupuncture,and electroacupuncture improve knee joint function and reduce knee joint swelling in KOA rats.The mechanism may be to improve synovial fibrosis of the knee joint by regulating HIF-1α;moxibustion has the best effect on improving hypoxia among the three interventions,but the effect of filiform needle acupuncture on COL1A1 is not significant.

OBJECTIVE To explore the effect of the comprehensive unit-based safety program(CUSP)collaborative action strategy on reducing the incidence of catheter-associated urinary tract infection(CAUTI)in elderly patients.METHODS From Jun.to Nov.2024,the Seventh Medical Center of the PLA General Hospital implemented the CUSP collaborative action strategy for intervention.Comparisons were made between pre-intervention(from Dec.2023 to May 2024)and post-intervention(from Jun.to Nov.2024)regarding nurses' know ledge-attitude-practice(KAP)scores on CAUTI prevention,implementation rates of key nursing measures for elderly CAUTI prevention and CAUTI incidence rates among elderly patients.RESULTS The pre-intervention KAP score of nurses from geriatric de-partment on CAUTI prevention was(83.44±6.67),significantly lower than the post-intervention score(108.19±16.27)(P＜0.001).The implementation rates of 10 key nursing measures for elderly CAUTI prevention improved(P＜0.05).The incidence rate of CAUTI was 2.88‰(16/5 546)among 5 546 catheter days before the intervention,and the incidence rate of CAUTI was 0.73‰(4/5 496)among 5 496 catheter days after the intervention(P=0.008).CONCLUSIONS The CUSP collaborative action strategy effectively enhances the KAP levels of nurses from geriatric department on CAUTI prevention,improves the implementation rates of key nursing measures,and reduces CAUTI incidence rates among elderly patients.

Objective To compare the node strength in white matter networks between depressive disorder and bipolar depression patients,analyze structural connectivity impairments across brain regions,and assess their diagnostic utility.Methods This longitudinal study initially enrolled 91 patients with a baseline diagnosis of depressive episode.All subjects underwent diffusion tensor imaging at recruitment and white matter structural weighted networks were constructed using deterministic fiber tracking.After≥9 years of naturalistic follow-up,23 patients who maintained a diagnosis of major depressive disorder(MDD group)and 18 patients who maintained a diagnosis of bipolar disorder(BD group),while 30 demographically matched healthy controls(HC group)were included for comparison.The differences in nodal connection strength within the brain white matter networks among the three groups were compared.Furthermore,the receiver operator characteristic(ROC)curve was utilized to evaluate the diagnostic value of the differential brain regions in distinguishing between MDD and BD.Results In the left anterior cingulate gyrus,the node strength was lower in the BD than in the MDD group(3.89±0.76 vs.4.74±0.60).However,the node strength in the right caudate nucleus(4.94±1.26 vs.3.46±0.99)and right globus pallidus(1.98±0.67 vs.1.25±0.29)was higher in the BD than in the MDD group(P<0.01,FWE-corrected).The combined connectivity strengths of three brain regions—the left anterior cingulate gyrus,right caudate nucleus and right globus pallidus—were used to differentiate between MDD and BD,and an ROC curve was plotted,with an area under the curve(AUC)of 0.95(95%CI:0.91～0.99;P<0.001).The sensitivity and the specificity were 0.89 and 0.87,respectively.Conclusion The differences in node strength between patient groups may serve as a potential neuroimaging biomarker.Integration of node connectivity strengths from these differential brain regions can achieve superior discrimination accuracy.

Objective:To investigate the hospitalization utilization of pneumoconiosis patients and its influencing factors in a northwestern city, and to provide theoretical basis for formulating service policies for pneumoconiosis patients.Methods:From March to October 2021. Existing living pneumoconiosis patients in kashgar were selected as the research objects. The "Survey Questionnaire on Medical Behaviors and Influencing Factors of Pneumoconiosis Patients" developed by the National Institute of Occupational Health and Poison Control of China Centers for Disease Control and Prevention was used to collect pneumoconiosis patients infomations from March to October 2021. This study investigated the demographic characteristics of pneumoconiosis patients, the types and stages of pneumoconiosis, as well as hospitalization in the past year, reasons for hospitalization, treatment measures, reasons for discharge. Additionally, it examined factors influencing medical behaviors, including medical insurance reimbursement, work-related injury insurance, and compensation situations.Logistics regression was used to analyze the influencing factors of hospitalization utilization.Results:The average age of the pneumoconiosis patients was elder with the age of 64.8. 86.7% (156/178) of them were retired, 75.8% (135/178) of them relied primarily on pensions for their income. The main types of pneumoconiosis were silicosis and coal workers' pneumoconiosis with the proportion of 57.3% (102/178) and 24.2% (43/178). 67.4% of them were stage I. The hospitalization rate in the year prior to the survey was 37.1%. The factors that promoted hospitalization were pension as the main source of income, pneumoconiosis in stage II, silicosis as the pneumoconiosis type, suffering joint pain, with two OR more other lung diseases (tuberculosis, cor pulmonale, COPD, pulmonary infection, bulla or pneumothorax, lung cancer, or mesothelioma) ( P<0.05) . Conclusion:The hospitalization rate of pneumoconiosis patients in the previous year was low. It is mainly influenced by the patient's economic income, the duration of pneumoconiosis, and the presence of comorbidities.

Objective To evaluate the feasibility of multi spiral computed tomography(MSCT)for etiological analysis of patients with pelvic venous congestion syndrome(PVCS).Methods The clinical and imaging data of 134 patients diagnosed with PVCS were analyzed retrospectively.The anatomical etiology of PVCS was analyzed,and the clinical and imaging differences between the two groups with and without vascular variation were compared.Results Among the 134 patients,69 had vascular variation,which included 37 distal hypoplasia of left renal vein(LRV),22 nutcracker phenomenon,6 ovarian vein(OV)variation,2 LRV variation,2 portal hyper-tension,2 pelvic arteriovenous fistula,1 left iliac vein compression syndrome,1 left renal malrotation and 1 left renal arteriovenous fistula.The remaining 65 cases showed no vascular variation.There were statistically significant differences in the left ovarian vein(LOV)diameter and reflux degree between the two groups(t=2.544,P=0.012;χ2=21.797,P<0.001).Patients with vascular varia-tion had wider diameter of LOV and higher degree of reflux.There were no statistically significant differences between the two groups regarding age,symptom,times of pregnancy and delivery and body mass index(BMI)values(P>0.05).Conclusion MSCT can provide important reference value for etiological analysis of PVCS,which is helpful for precise treatment.