ObjectiveTo evaluate the impact of narrative medicine education on the narrative ability of resident physicians undergoing standardized residency training， and to explore its application value in clinical practice. MethodsA total of 23 obstetricians and gynecologists who participated in residency training at the Fourth Hospital of Hebei Medical University from October 2021 to June 2024 were randomly selected to receive a 3-month residency training program integrated with narrative medicine education， including narrative theory learning， text reading， reflective writing， and scenario-based case analysis. A questionnaire survey was conducted to analyze the personal situation of resident physicians， their narrative ability before and after receiving narrative medicine education， and their satisfaction with teaching. ResultsThe results of the questionnaire survey showed that resident physicians who had received narrative medicine education scored higher on the narrative ability assessment scale than before training， including improved narrative abilities in the dimensions of life and health narrative awareness， professional narrative thinking， professional development narrative behavior， peer communication narrative behavior， and doctor-patient interaction narrative behavior （P<0.05）. However， there were no statistically significant differences in the dimensions of life and health narrative behavior and family connection narrative behavior （P>0.05）. Meanwhile， resident physicians’ interest in active learning， clinical thinking ability， doctor-patient communication ability， and satisfaction with teaching methods have also been improved （P<0.05）. ConclusionNarrative medicine education can effectively enhance the narrative ability of resident physicians and make up for the current deficiencies in humanistic literacy and ethical education in current medical education. It is of great significance for improving doctor-patient relationships and the quality of medical services. Therefore， it is recommended to integrate narrative medicine education into the regular training curriculum for resident physicians.

Objective:To establish a derivative gas chromatography method for quantitative determination of hydra-zine hydrate in afatinib maleate.Methods:Acetone-glacial acetic acid solution and DB-225 capillary column(0.25 mm×30 m × 0.25 μm)and FID was used to separate andquantitative decermine hydrazine hydrate.Results:Excellent linearity showed within the range of 1.258-50.34 μg·mL-1(r＞0.999),detection limit was 0.001％,and the recovery rate was 91.7％-107.2％.Conclusion:The method shows low testing cost,satisfac-tory repeatability,simplicity and convenience,and is valid in derivative separation and analysis of hydrazine hydrate in afatinib maleate.

Objective To explore the effect of cardiac shock wave therapy(CSWT)on ST deviation of electrocardiogram and myocardial perfusion imaging in coronary artery disease(CAD)patients.Methods CAD patients who received CSWT in Cardiology Department of Beijing Hospital from December 2016 to August 2022 were enrolled.Three months of CSWT were conducted with a total of 9 times shock wave treatment.Clinical data,myocardial perfusion imaging data and stress electrocardiogram data were collected.Myocardial perfusion score,electrocardiographic data were compared before and after CSWT.Results A total of 55 patients were finally enrolled.There were 43 male and 12 female patients with an average age of(67.45±8.96)years old.ST deviation on 12 leads of electrocardiogram did not show significant difference before and after CSWT.Myocardial perfusion imaging showed global stress perfusion score(P=0.031)and reverse perfusion score(P=0.024).Global rest ischemia score reduced after CSWT(P=0.034).Target stress perfusion score(P=0.002),target reverse perfusion score(P=0.002),target reverse ischemic area(P=0.001)were improved after CSWT.Conclusions CSWT may not influence ST deviation of electrocardiogram,but may improve myocardial ischemia in CAD patients,

Objective To understand the distribution and changing resistance profiles of clinical isolates of Enterococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Enterococcus according to the unified protocol of CHINET program by automated systems,Kirby-Bauer method,or E-test strip.The results were interpreted according to the Clinical & Laboratory Standards Institute(CLSI)breakpoints in 2021.WHONET 5.6 software was used for statistical analysis.Results A total of 124 565 strains of Enterococcus were isolated during the 7-year period,mainly including Enterococcus faecalis(50.7％)and Enterococcus faecalis(41.5％).The strains were mainly isolated from urinary tract specimens(46.9％±2.6％),and primarily from the patients in the department of internal medicine,surgery and ICU.E.faecium and E.faecalis strains showed low level resistance rate to vancomycin,teicoplanin and linezolid(≤3.6％).The prevalence of vancomycin-resistant E.faecalis and E.faecium was 0.1％and 1.3％,respectively.The prevalence of linezolid-resistant E.faecalis increased from 0.7％in 2015 to 3.4％in 2021,while the prevalence of linezolid-resistant E.faecium was 0.3％.Conclusions The clinical isolates of Enterococcus were still highly susceptible to vancomycin,teicoplanin,and linezolid,evidenced by a low resistance rate.However,the prevalence of linezolid-resistant E.faecalis was increasing during the 7-year period.It is necessary to strengthen antimicrobial resistance surveillance to effectively identify the emergence of antibiotic-resistant bacteria and curb the spread of resistant pathogens.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

The purpose of this study was to understand the prevalence of Neoehrlichia mikurensis in rodents in Yunnan commensal rodent plague foci.Lianghe Country,Mangshi City,and Mile City in Yunnan Province were chosen as sampling sites,where rodents were captured with dead-traps.The N.mikurensis groEL gene in rodent spleen samples was detected with nested PCR,and the positive products were sequenced with Sanger bidirectional assays.The infection rate of N.mikurensis a-mong plague foci,habitats,species,and sexes was compared with Chi-square tests or Fisher's exact probability method.Of 656 rodent spleen samples,12 N.mikurensis positive samples were detected in R.tanezumi,R.sladeni,N.confucianus,and B.bowersi.The positivity rate was 1.83％.No significant difference in the N.mikurensis positivity rate was observed a-mong plague foci,habitats,species,and sexes(P＞0.05).Genetic evolution analysis of the groEL gene indicated that the se-quence similarity of nucleic acid sequences in 12 positive samples was 99.5％-100％,and the nucleic acid sequences of N.mikurensis were in the same branch,belonging to cluster Ⅳ.Thus,four species of rodents were found to have low frequency infection with N.mikurensis in Yunnan commensal rodent plague foci.

Endoplasmic reticulum stress(ERS)is a protective cellular response that occurs when cells face hypoxia or nutrient deprivation.It alleviates protein accumulation in the endoplasmic reticulum(ER)by the unfolded protein response.Unfolded or misfolded proteins that are not efficiently cleared by the unfolded protein response pathway are degraded by endoplasmic reticulum-phagy(ER-phagy),which is trigged by ERS to restore ER morphology.ER-phagy is mediated by ER-phagy receptors.In mammali-an and yeast cells,various ER-phagy receptors exist that promote ER fragment formation,capture autoph-agic cargos and deliver them to autolysosomes for degradation.Each ER-phagy receptor has unique struc-tural features that determine its mode of cargo capture.Additionally,ERS regulates ER-phagy by media-ting the expression and phosphorylation of ER-phagy receptors.Research has shown that ERS-induced ER-phagy plays a crucial role in the pathogenesis of various human diseases.Therefore,elucidating the specific mechanisms underlying ERS-induced ER-phagy provides a theoretical basis for the prevention and treatment of ER-phagy-related diseases.Herein,we review the molecular mechanisms of ERS-induced ER-phagy mediated by ER-phagy receptors in mammals(FAM134B,RTN3L,SEC62,CCPG1)and yeasts(Atg39,Atg40,Erp1),as well as the connection between ERS-induced ER-phagy and human diseases such as neurodegenerative disorders and cancer,aiming to provide new strategies for the preven-tion and treatment of ER-phagy-related diseases.

Objective A comparison of two method of establishing pressure ulcer rat models to determine which is the most suitable for experimental use.Methods 18 male SD rats were randomly divided into control(n=6),model A(n=6)and model B(n=6)groups.In the control group,iodophor treatment was given after hair removal at the simulated modeling site.In model group A,longitudinal compression was performed by simple deep-tissue foreign body implantation.In model group B,transverse compression was performed via the magnet compression method.The times required to complete the process and for each stage of pressure ulcer model establishment in each group were recorded.The general condition of the rats was observed,and the modeling rate,mortality rate,and infection rate were compared.Results By naked eye,we observed that the model A and model B groups gradually developed redness and swelling,ulceration,bleeding,exudation,and necrosis.Comparison of the whole time to produce pressure uler between model A and model B groups:the difference between the two groups was statitically significant(P＜0.05).Comparison of the time to produce pressure injury between Model A and Model B:The difference between the two groups at stage Ⅰ was not statistically significant(P＞0.05);the difference between the two groups at stage Ⅱ was statistically significant(P＜0 05);the difference between the two groups at stage Ⅲ was statistically significant(P＜0 05);the difference between the two groups at stage Ⅳ was statistically significant(P＜0 05).The mental and sports scores of the rats in the control group were significantly different from those in the model A and model B groups(P＜0.05).The general state of rats in the model group A was significantly different from that in the model B group,and coat color was dimer and activity decreased in the model group A.The modelling rate of rats in both model A and model B groups was 100％.The mortality and infection rates of the model group A were higher than those of the model group B,which were 33.34％and 16.70％,respectively.Conclusions Successful preparation of a four-stage model of pressure ulers in both modalities.The two method have both commonalities and distinct characteristics.The magnet compression method required less time,the rats were generally in good condition,and the mortality and infection rates were low;thus it is suitable for short-term intervention research.The simple deep-tissue foreign body implantation method took longer,required rats to have a certain level of tolerance,had high infection and mortality rates,and is more suitable for use for long-term observations of pressure ulcers.

Objective:To investigate the toxic effect of chlorambucil combined with ibrutinib on mantle cell lymphoma(MCL)cell line Jeko-1 and its related mechanism.Methods:The MCL cell line Jeko-1 was incubated with different concentrations of chlorambucil or ibrutinib or the combination of the two drugs,respectively.CCK-8 assay was used to detect the proliferation of the cells,and Western blot was used to measure the protein expression levels of BCL-2,caspase-3,PI3K,AKT and P-AKT.Results:After Jeko-1 cells were treated with chlorambucil(3.125,6.25,12.5,25,50 μmol/L)and ibrutinib(3.125,6.25,12.5,25,50 μmol/L)alone for 24,48,72h respectively,the cell proliferation was inhibited in a time-and dose-dependent manner.Moreover,the two drugs were applied in combination at low doses(single drug inhibition rate＜50％),and the results showed that the combination of two drugs had a more significant inhibitory effect(all P＜0.05).Compared with the control group,the apoptosis rate of the single drug group of chlorambucil(3.125,6.25,12.5,25,50 μmol/L)and ibutinib(3.125,6.25,12.5,25,50 μmol/L)was increased in a dose-dependent manner.The combination of the two drugs at low concentrations(3.125,6.25,12.5 μmol/L)could significantly increase the apoptosis rate compared with the corresponding concentration of single drug groups(all P＜0.05).Compared with control group,the protein expression levels of caspase-3 in Jeko-l cells were upregulated,while the protein expression levels of BCL-2,PI3K,and p-AKT/AKT were downregulated after treatment with chlorambucil or ibrutinib alone.The combination of the two drugs could produce a synergistic effect on the expressions of the above-mentioned proteins,and the differences between the combination group and the single drug groups were statistically significant(all P＜0.05).Conclusion:Chlorambucil and ibrutinib can promote the apoptosis of MCL cell line Jeko-1,and combined application of the two drugs shows a synergistic effect,the mechanism may be associated with the AKT-related signaling pathways.

Objective:To clarify the specificity of patient blood type and blood type antibody through patient blood type serological tests and molecular biology results,and to search for matching blood for patients.Methods:Blood type serological methods were used for the identification of red blood cell ABO,RhD,and p blood type.Salt water method,microcolumn gel method and IAT method were used for irregular antibody screening and antibody specificity identification.Forward and reverse sanger sequencing was used to amplify specifically the third exon(CDS sequence)of the A4GALT gene,identify the mutation site and genotype of the gene.Results:The patient's serological blood type was positive for type B and D,indicating a p phenotype.At the same time,anti-Tja was detected in the serum,and further sequencing of the A4GALT gene exon was performed,the homozygous mutation with G＞C occurred at base 559,and the genotype ISBT was named A4GALT*01N.10.Molecular biology verification confirmed it to be p blood group.Serological methods confirm that the patient's serum contains anti-Tja.Conclusion:The joint identification of the rare blood type—p blood type by serological and molecular biological methods is of great significance for safe clinical blood transfusion.