Objective:To explore the relationship between post-traumatic growth and stress perception as well as the chain-mediated roles of psychological resilience and navigating social support in patients with primary liver cancer(PLC), in order to provide theoretical ideas for the nursing and intervention of PLC patients.Methods:Convenience sampling was used to select PLC patients admitted to the First Affiliated Hospital, Third Affiliated Hospital, and Fourth Affiliated Hospital of Xinjiang Medical University from October 2023 to May 2024 as the research subjects. A cross-sectional survey was conducted using Posttraumatic Growth Inventory, the Chinese Perceived Stress Scale, Perceived Social Support Scale, and the Connor-Davidson Resilience Scale.Results:A total of 236 PLC patients were ultimately included, including 189 males and 47 females. Age distribution was as follows: 18-40 years years (7 cases), 41-60 years (128 cases), and ≥61 years (101 cases). Posttraumatic growth showed a significant negative correlation with perceived stress ( r=-0.512, P<0.01), while demonstrating positive correlations with psychological resilience and perceived social support ( r=0.605, 0.515, both P<0.01). Psychological resilience and perceived social support had mediating and chain mediating effects between perceived stress and posttraumatic growth, with mediating effects of -0.176 and -0.069, accounting for 29.24% and 11.46% of the total effect, respectively. The chain mediating effect value was 0.073, accounting for 12.13% of the total effect. Conclusions:The pathway of stress perception on post-traumatic growth in patients with PLC is indirect, and stress perception can contribute to the growth of post-traumatic growth in patients through psychological resilience, and navigating social support.

Objective:To explore the relationship between post-traumatic growth and stress perception as well as the chain-mediated roles of psychological resilience and navigating social support in patients with primary liver cancer(PLC), in order to provide theoretical ideas for the nursing and intervention of PLC patients.Methods:Convenience sampling was used to select PLC patients admitted to the First Affiliated Hospital, Third Affiliated Hospital, and Fourth Affiliated Hospital of Xinjiang Medical University from October 2023 to May 2024 as the research subjects. A cross-sectional survey was conducted using Posttraumatic Growth Inventory, the Chinese Perceived Stress Scale, Perceived Social Support Scale, and the Connor-Davidson Resilience Scale.Results:A total of 236 PLC patients were ultimately included, including 189 males and 47 females. Age distribution was as follows: 18-40 years years (7 cases), 41-60 years (128 cases), and ≥61 years (101 cases). Posttraumatic growth showed a significant negative correlation with perceived stress ( r=-0.512, P<0.01), while demonstrating positive correlations with psychological resilience and perceived social support ( r=0.605, 0.515, both P<0.01). Psychological resilience and perceived social support had mediating and chain mediating effects between perceived stress and posttraumatic growth, with mediating effects of -0.176 and -0.069, accounting for 29.24% and 11.46% of the total effect, respectively. The chain mediating effect value was 0.073, accounting for 12.13% of the total effect. Conclusions:The pathway of stress perception on post-traumatic growth in patients with PLC is indirect, and stress perception can contribute to the growth of post-traumatic growth in patients through psychological resilience, and navigating social support.

Background::Growth differentiation factor-15 (GDF-15) is a stress response protein and is related to cardiovascular diseases (CVD). This study aimed to investigate the association between GDF-15 and pre-eclampsia (PE).Method::The study involved 299 pregnant women, out of which 236 had normal pregnancies, while 63 participants had PE. Maternal serum levels of GDF-15 were measured by using enzyme-linked immunosorbent assay kits and then translated into multiple of median (MOM) to avoid the influence of gestational week at blood sampling. Logistic models were performed to estimate the association between GDF-15 MOM and PE, presenting as odd ratios (ORs) and 95% confidence intervals (CIs).Results::MOM of GDF-15 in PE participants was higher compared with controls (1.588 vs. 1.000, p < 0.001). In the logistic model, pregnant women with higher MOM of GDF-15 (>1) had a 4.74-fold (95% CI= 2.23-10.08, p < 0.001) increased risk of PE, adjusted by age, preconceptional body mass index, gravidity, and parity. Conclusions::These results demonstrated that higher levels of serum GDF-15 were associated with PE. GDF-15 may serve as a biomarker for diagnosing PE.

Objective To investigate the effect of prunella vulgaris extract on inflammation,macrophage phenotype,and phagocytic ability in septic mice,and analyze whether Toll like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway involved in its mechanism.Methods C57BL/6 mice were divided into the control group,the model group and the prunella vulgaris extract low(25 mg/kg),medium(50 mg/kg)and high(100 mg/kg)dose groups.Except for the control group,all other groups of mice were injected intraperitoneally with lipopolysaccharide(LPS)to prepare sepsis model.Each group was given corresponding medication by gavage.After 24 hours of administration,serum tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,high mobility group protein B1(HMGB1),IL-10 levels,the proportion of M1 type(CD11b+F4/80+)and M2 type(CD206+F4/80+)macrophages in peritoneal macrophages,the phagocytotic capacity of macrophages,the expression of inducible nitric oxide synthase(iNOS)messenger RNA(mRNA)and arginase 1(Arg1)mRNA in peritoneal macrophages and expression levels of TLR4,NF-κB p65 and their phosphorylated proteins in macrophages were detected.Results Compared with the control group,serum TNF-α,IL-1β,HMGB1,proportion of M1 type macrophages in abdominal cavity,mean fluorescence intensity and phagocytotic capacity of macrophages,iNOS mRNA,TLR4,phosphorylated NF-κB p65(p-NF-κB p65)/NF-κB p65 protein expression were increased in the model group(P＜0.05).IL-10,proportion of M2 type macrophages and Arg1 mRNA expression were decreased(P＜0.05).Compared with the model group,serum TNF-α,IL-1β,HMGB1,proportion of M1 type macrophages in abdominal cavity,iNOS mRNA,TLR4,p-NF-κB p65/NF-κB p65 protein expression were decreased successively in the prunella vulgaris extract low,medium and high dose groups(P＜0.05).IL-10,proportion of M2 macrophages,mean fluorescence intensity and phagocytotic capacity of macrophages and Arg1 mRNA expression were increased successively(P＜0.05).Conclusion By inhibiting TLR4/NF-κB pathway,prunella vulgaris extract may inhibit the polarization of peritoneal macrophages into M1 type and promote their polarization to M2 type,enhance macrophage phagocytic ability and alleviate LPS induced inflammatory response in septic mice.

Background::Growth differentiation factor-15 (GDF-15) is a stress response protein and is related to cardiovascular diseases (CVD). This study aimed to investigate the association between GDF-15 and pre-eclampsia (PE).Method::The study involved 299 pregnant women, out of which 236 had normal pregnancies, while 63 participants had PE. Maternal serum levels of GDF-15 were measured by using enzyme-linked immunosorbent assay kits and then translated into multiple of median (MOM) to avoid the influence of gestational week at blood sampling. Logistic models were performed to estimate the association between GDF-15 MOM and PE, presenting as odd ratios (ORs) and 95% confidence intervals (CIs).Results::MOM of GDF-15 in PE participants was higher compared with controls (1.588 vs. 1.000, p < 0.001). In the logistic model, pregnant women with higher MOM of GDF-15 (>1) had a 4.74-fold (95% CI= 2.23-10.08, p < 0.001) increased risk of PE, adjusted by age, preconceptional body mass index, gravidity, and parity. Conclusions::These results demonstrated that higher levels of serum GDF-15 were associated with PE. GDF-15 may serve as a biomarker for diagnosing PE.

Objective:To compare the consistency of preoperative frailty assessment in elderly colorectal cancer patients using Frailty Phenotype (FP), FRAIL Scale (FS), Clinical Frailty Scale (CFS), and Edmonton Frailty Scale (EFS), and their predictive performance in predicting the postoperative complication, so as to provide reference for nurses to choose appropriate frailty assessment tools.Methods:From December 2020 to October 2021, 207 elderly patients who underwent radical surgery for colorectal cancer at the General Surgery of the First Affiliated Hospital of Soochow University were selected as the study subject by convenience sampling. FP, FS, CFS, and EFS were used to assess patients' frailty. Taking postoperative complications as the outcome indicator, the predictive performance of four frailty assessment tools was compared using the receiver operating characteristic (ROC) curve and Bayes discriminant analysis.Results:The frailty detection rates of FP, FS, CFS, and EFS in 207 elderly colorectal cancer patients were 19.8% (41/207), 11.6% (24/207), 22.2% (46/207), and 10.1% (21/207), respectively. The areas under the ROC curves of FP, FS, CFS, and EFS were 0.714, 0.643, 0.737, and 0.665, respectively, with statistically significant differences (all P<0.01). Pairwise comparison found that there were statistically significant differences in the area under the ROC curve between FP and FS, FS and CFS, CFS and EFS ( P<0.05). The cross validation accuracy of FP, FS, CFS and EFS in predicting the postoperative complication in elderly colorectal cancer patients was 78.7%, 68.6%, 76.3%, and 75.8%, respectively. Conclusions:FP and CFS have moderate predictive performance for postoperative complications in elderly colorectal cancer patients, and there is no difference in predictive performance between the two. Both CFS and FP can be used for the assessment of preoperative frailty in elderly colorectal cancer patients, but considering clinical applicability, CFS is recommended.

Using novel virtual reality (VR) technology to carry out the construction of clinical medical examination question bank, while deepening the reform of clinical medical course examination, it continues to innovate the medical professional evaluation system and improve the flexibility, diversity and scientificity of clinical medicine in teaching and assessment. It is of great and far-reaching significance to improve the teaching level and the quality of medical education in medical colleges and universities. This paper analyzes and discusses the necessity and feasibility of building a clinical medical examination question bank, and the advantages and prospects of integrating VR technology to carry out the construction of clinical medical examination question bank. At the same time, the exploration and practice of the examination question bank construction based on VR technology disscussed in detail would provide innovative thinking and reference for the clinical medical teaching and evaluation, medical personnel training and other aspects in China.

Objective To explore the feasibility and clinical application value of total laparoscopic radical resection of Ⅳ-type hilar choangiocarcinoma. Methods Clinical data of 2 patients receiving total laparoscopic radical resection of Ⅳ-type hilar choangiocarcinoma in Hunan Provincial People's Hospital from April 2015 to December 2015 were analyzed retrospectively. The informed consents of both patients were obtained and the local ethical committee approval was received. Case 1, male, 73 years old, hospitalized for icteric skin and sclera for more than 1 month. Case 2, female, 62 years old, hospitalized for icteric skin and sclera for more than 2 months. The admitting diagnosis were both Ⅳ-type hilar choangiocarcinoma. The bilateral hepatic ducts and left portal vein were invaded by tumor in the 2 cases. Before the operation, the patients received symptomatic and supportive treatments for liver protection, jaundice alleviation etc., and then received total laparoscopic radical resection of hilar choangiocarcinoma. The lymph nodes were resected from far to near, the common bile duct was dissected and cut off, the left and caudate lobe was resected, hilar bile duct plasty and Roux-en-Y bilioenterostomy were performed. Results Operations were performed successfully in both patients and the digestive tract was reconstructed. The operative duration were 430, 410 min respectively, the intraoperative blood loss was 800, 600 ml respectively. No perioperative complication was observed.Two patients received abdominal enhanced CT examination 1 year after operation, no tumor recurrence or metastasis was observed. Conclusion Total laparoscopic radical resection of hilar choangiocarcinoma is safe and feasible, in which hemihepatectomy or extended hemihepatectomy including caudate lobe, lymphadenectomy, bile duct plasty and biliary-enteric reconstruction can be performed.

Objective To explore repressive effects of transthyretitin (TTR) on the growth of human retinal endothelial cells (hREC) under high glucose and hypoxia environment. Methods hRECs were divided into 8 groups, including normal glucose group (5.5 mmol/L glucose), hypoxia group, high glucose group (25.0 mmol/L glucose), high glucose and hypoxia group, normal glucose group+TTR, normal glucose and hypoxia group+TTR, high glucose group+TTR, high glucose and hypoxia group+TTR. Flow cytometry was used to analyze cellular apoptosis. The expression level of Akt, p-Akt, eNOS, Bcl-2 and Bax protein were measured by Western blot. Results Hypoxia could induce apoptosis as the apoptosis rate of normal and hypoxia group was higher than normal group (χ2=25.360, P<0.05), high glucose and hypoxia group was higher that high glucose group (χ2=17.400, P<0.05). The cell apoptosis rate of high glucose and hypoxia group+TTR were increased significantly as compared with high glucose and hypoxia group (χ2=9.900, P<0.05). There was no statistically significant difference on the cell apoptosis rate between normal group and high glucose group, normal group+TTR and normal group, high glucose group+TTR and high glucose group, normal and hypoxia group+TTR and normal and hypoxia group (P>0.05). Western blot showed that the expression of Akt did not change significantly in all eight groups(F=2.450, P>0.05). Compared to normal group, the expression of p-Akt, eNOS, Bcl-2 in normal and hypoxia group were decreased (t=9.406, 5.306, 4.819), and the expression of Bax (t=-4.503) was increased (P<0.05). Compared to high glucose group, same trend was found in high glucose and hypoxia group (t=8.877, 7.723, 6.500, -14.646; P<0.05). The expression of p-Akt in normal and hypoxia group+TTR was higher than normal and hypoxia group (t=-5.024, P<0.05) ,but there was no difference on the expression of eNOS, Bcl-2, Bax between these two groups (t=-2.235, -2.656, -0.272;P>0.05). Compared to high glucose and hypoxia group, the expression of p-Akt and Bcl-2 in high glucose and hypoxia group+TTR were decreased (t=4.355, 4.308; P<0.05), the expression of Bax was increased (t=-4.311, P<0.05), and there was no difference on the expression of eNOS between these two groups (t=-1.590, P>0.05). There was no statistically significant difference in the expression of p-Akt, eNOS, Bcl-2, Bax between high glucose group and normal group (t=-3.407, -4.228, -4.302, -2.076; P>0.05), normal group+TTR and normal group (t=-4.245, -4.298, -2.816, -1.326; P>0.05), high glucose group+TTR and high glucose group (t=4.016, -0.784, 0.707, -0.328; P>0.05). Conclusion Under high glucose and hypoxia, transthyretitin suppress the growth of hREC through Akt/Bcl-2/Bax, but not Akt/eNOS signaling pathway.