Objective To analyze the clinical characteristics and prognostic factors of patients with malignant melanoma liver metastasis. Methods The clinical data of patients with melanoma liver metastasis before first-line systemic therapy were retrospectively collected. Kaplan–Meier survival analysis was conducted to evaluate the association of clinical characteristics with overall survival (OS) and progression-free survival (PFS). Prognostic factors associated with PFS and OS were determined through Cox regression analysis. Results A total of 80 patients were included in this study. Six of these patients did not receive systemic or local antitumor therapy after the diagnosis of liver metastasis. Their median survival time after the diagnosis of liver metastasis was 2.3 months. The median OS of the remaining 74 patients was 12.83 months. Cox regression analysis determined that in the patients receiving systemic or local antitumor therapy, age and local treatment were independent prognostic factors for OS; gender and serum NSE levels were independent prognostic factors for systemic PFS and intrahepatic PFS. First-line treatment including immune checkpoint inhibitors (ICIs) may have survival benefits for patients but the difference was not statistically significant (HR=0.716, P=0.255). Among gene mutations, NRAS mutations had the highest rates (11.25%) and were associated with poor prognosis. In addition, BRAF and CKIT mutations were detected in eight (10%) and four (5%) patients, respectively. Conclusion Patients who are younger and receive local treatment have a relatively better prognosis. The first-line ICI therapy may have survival benefits for patients.

Cholesterol,as an important component of cell membranes,plays a multifaceted role in mediating tumor immunomodulation and drug intervention.In case of cholesterol metabolic imbalance,the accumulation of cholesterol metabolic intermediates,the changes in concentrations,and the regulation of related signaling pathways can affect tumor immunity by promoting inflammation and inhibiting immune cell function.Preclinical and clinical studies have shown that controlling cholesterol metabolism can inhibit tumor growth,re-shape body immune regulation,and enhance antitumor immunity.A deep understanding of the association between immune cells and cholesterol metabolic pathways in the tumor microenvironment can help to develop novel drugs targeting cholesterol metabolism.This article reviews the multifaceted role of cholesterol and its derived metabolites in the tumor microenvironment by regulating various types of immune cells such as myeloid-derived suppressor cells,tumor-associated macrophages,dendritic cells,and T-lymphocytes,as well as the characteristics of tumor immunomodulation mediated by cholesterol metabolism and the advances in pharmaceutical re-search on improving the immune function of the body by intervening against cholesterol,in order to further provide new ideas and a thera-peutic basis for cholesterol modulation and intervention in tumor im-munotherapy.

Objective: To investigate the association between consumption of milk tea beverages and other sugary beverages with insomnia symptoms among college students, so as to the provide reference for promoting sleep quality among college students. Methods: From September to November 2023, a convenience sampling method was used to select 15 440 college students from seven universities in Shanghai, Jiangxi Province, Hubei Province, and Shanxi Province. A self developed questionnaire and the Insomnia Severity Index were used to assess milk tea beverage consumption, other sugary beverages and insomnia symptoms. Univariate analysis of insomnia symptoms among college students was performed using Chi square tests and Cochran-Armitage trend χ 2 tests. Multivariate Logistic regression analysis was conducted for the association between milk tea and other sugary beverage consumption with insomnia symptoms. Results: The detection rates of insomnia symptoms among college students was 40.83%. The frequency of consumption of different milk tea and various sugary drinks (juice, tea, milk, sodas,yogurt, functional drinks, coffee) per week was related to the detection trend rate of insomnia symptoms of college students ( χ 2 trend =38.38, 47.66, 74.16, 32.44, 65.78 , 38.71, 35.94, 91.59, P < 0.01 ). Multivariate analysis indicated that compared to individuals with no milk tea consumption, college students engaging in milk tea consumption had a significantly increased risk of insomnia symptoms ( OR =1.24, P <0.05). Students consuming milk tea at low to moderate frequencies (1-3, 4-5 times per week) showed a higher risk of insomnia symptoms compared to those with no consumption ( OR =1.20, 1.54, P <0.05). Furthermore, higher levels of milk tea consumption were significantly associated with insomnia symptoms (1 501-2 999 mL, OR =1.22; ≥3 000 mL, OR =1.36), and the consumption of other sugary beverages were also associated with insomnia symptoms of college students ( OR =1.10-1.55) ( P <0.05). Conclusions There is a relationship between consumption of milk tea beverage other sugary beverages with insomnia symptoms among college students. Colleges should regularly conduct dietary health education seminars to improve sleep quality among college students.

Objective:To investigate the correlation between impulse oscillometry system examination indicators and conventional pulmonary ventilation function.Methods:The pulmonary ventilation function data of 10 883 patients from January 1, 2020 to December 31, 2022 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were included. The one-second rate [ratio of forced expiratory volume in the first second (FEV 1) to forced vital capacity (FVC)] measured as a percentage of the predicted value was ≥92% for the control group ( n=3 478) and <92% for the pulmonary obstruction group ( n=7 405). The obstruction group was subdivided into five groups according to the degree of pulmonary dysfunction: mild group ( n=3 938),moderate group ( n=1 142),oderate-severe group ( n=917),severe group ( n=737),and extremely severe group ( n=671). Conventional pulmonary ventilatory function FVC, FEV 1, one-second rate, and forced expired flow at 50% of FVC (MEF50%), forced expired flow at 75% FVC (MEF25%), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), and pulsed oscillation pulmonary function test were detected in both groups of patients. Impedance at 5 Hz (Z5) means total respiratory resistance, resistance at 5 Hz (R5) means total airway resistance, reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways, and resistance at 20 Hz (R20) represents resistance of the central airways. R5-R20 reflects resistance in the small airways. Additionally, peripheral resistance (Rp), respiratory resonance frequency (Frex), and area under the reactance curve (Ax) were also measured. Correlation between the indicators of the two groups and the sensitivity and specificity of the impulse oscillometry system parameters for the diagnosis of obstructive pulmonary ventilation dysfunction were analyzed. Results:Pulmonary function force expiratory volume in the first second as a percentage of predicted value (FEV 1%Pre) [80.10 (54.95,97.10)%],one-second rate [62.43(48.67, 67.02)%],MEF50% [1.33 (0.62,1.97)L/s],MEF25% [0.28 (0.17,0.41)L/s], MMEF [0.85 (0.43,1.29)L/s],and PEF [5.64 (3.73,7.50)]L/s in the obstruction group were significantly lower than those in the control group ( P<0.05). The differences within the subgroups of the obstruction group were also significant ( P<0.05). Pulsed oscillation Z5 [0.42 (0.33,0.55)kPa·L -1·s -1],Rp [0.25 (0.20,0.45)kPa·L -1·s -1], R5 [0.39 (0.31,0.49)kPa·L -1·s -1], R20 [0.28 (0.24,0.34)kPa·L -1·s -1], R5-R20 [0.09 (0.05,0.17)kPa·L -1·s -1],Frex [16.32 (13.07,20.84)Hz], and Ax [0.67 (0.28,1.64)] indices in the obstruction group were significantly higher than those in the control group. X5 [-0.14 (-0.23, -0.10)kPa·L -1·s -1] was significantly lower than that in the control group ( P<0.05). Z5, Rp, X5, R5, R5-R20, Frex, and Ax were statistically significant between different degrees of obstruction in the obstruction group ( P<0.05). The impulse oscillometry system parameters Z5, Rp, R5, R20, R5-20, Frex, and Ax were negatively correlated with the indices of conventional pulmonary ventilation ( r=-0.21-0.68, P<0.05), and the parameter X5 was positively correlated with the indices of conventional pulmonary ventilation ( r=0.41-0.68, P<0.05). The pulsed oscillation pulmonary function test parameters X5 (58.60%-95.68%) and Ax (57.08%-98.06%) presented the best sensitivity; X5 (86.29%-98.82%), Frex (86.69%-94.71%), and Ax (88.10%-98.53%) displayed the best specificity; and R20 presented the worst sensitivity and specificity. The sensitivity and specificity were slightly better in female patients than in male patients. Conclusion:The technical parameters of the impulse oscillometry system showed significant correlation with relevant indices of conventional pulmonary ventilation function detection. These well reflect the changes of different degrees of pulmonary ventilation function and have greater significance for reference in evaluating the degree of pulmonary function impairment.

Objective:To investigate the correlation between peripheral blood lymphocyte immunophenotyping,cytokine levels before and after immune and anti-angiogenesis combined therapy,and treatment efficacy as well as prognosis in patients with advanced mucosal melanoma.Methods:A total of 28 patients with advanced mucosal melanoma admitted to the Drum Tower Hospital of Nanjing University School of Medicine from April 2019 to June 2022 were included in this analysis.All patients received combined treatment of camrelizumab(PD-1 inhibitor)and apatinib(anti-angiogenic drug).Peripheral blood samples were collected before treatment and after two cycles of treatment for lymphocyte immunophenotyping and cytokine level testing.The correlation between these immune markers and treatment efficacy as well as patient prognosis was evaluated.Results:After two cycles of treatment with camrelizumab and apatinib in patients with mucosal melanoma,the proportion of PD-1 positive cytotoxic T lymphocytes(CD3+CD8+CD279+cells)in peripheral blood was significantly reduced(P<0.001),while the proportion of NK cells(CD3-CD16+CD56+cells)was significantly increased(P=0.0054).Pre-treatment peripheral blood IFN-γ levels were found to be associated with overall survival(OS)(P=0.013).Patients with low IFN-γ levels had a median OS of 329 days,while the median OS for patients with high IFN-γ levels was not reached.Higher baseline IFN-γ levels were associated with a greater benefit in progression-free survival(PFS).Conclusion:The proportion of PD-1-positive T lymphocytes,NK cells and IFN-γ levels in peripheral blood may have predictive value for the efficacy and prognosis of advanced mucosal melanoma patients undergoing immunotherapy and anti-angiogenesis combined therapy.Future large-sample studies are needed to better characterize the clinical potential of these markers.

Uveal melanoma originates from the uveal tract and has a significant tendency to liver metastasis.Once metastasis occurs,the prognosis is poor.The current treatment options for uveal melanoma are liver-directed therapies including liver partial resection,ablation,isolated hepatic perfusion and percutaneous hepatic perfusion,hepatic artery infusion chemotherapy,transcatheter arterial chemoembolization,immune embolization,and radioembolization,and systemic treatment for metastatic uveal melanoma.This review discusses the pathogenesis of liver metastasis in uveal melanoma and reviews the current treatment options for uveal melanoma.

Uveal melanoma originates from the uveal tract and has a significant tendency to liver metastasis.Once metastasis occurs,the prognosis is poor.The current treatment options for uveal melanoma are liver-directed therapies including liver partial resection,ablation,isolated hepatic perfusion and percutaneous hepatic perfusion,hepatic artery infusion chemotherapy,transcatheter arterial chemoembolization,immune embolization,and radioembolization,and systemic treatment for metastatic uveal melanoma.This review discusses the pathogenesis of liver metastasis in uveal melanoma and reviews the current treatment options for uveal melanoma.

Objective:To explore the application effect of situation comedy teaching combined with peer teaching in clinical practice teaching of undergraduate nursing students.Methods:A total of 96 undergraduate nursing students who practiced in a first-class hospital at grade 3 in 2019 were randomly divided into the observation group and the control group, with 48 nursing students in each group. The control group adopted clinical teaching mode, including group theory teaching and group operation demonstration. On the basis of this, the observation group additionally adopted the clinical teaching mode of situation comedy teaching combined with peer teaching. The differences between the two groups in the assessment of nursing knowledge and skills assessment, independent learning ability and teaching satisfaction were observed. SPSS 20.0 software was used for t-test. Results:After the implementation of clinical teaching, the scores of nursing comprehensive ability of nursing students in the observation group (87.71 ± 5.11) were higher than those in the control group (78.47±6.24) ( P < 0.05). The independent learning ability of nursing students in the observation group (98.80±10.61) was significantly higher than that in the control group (74.47±9.83), and the difference was statistically significant ( P < 0.05). The score of teaching satisfaction in the observation group (2.83±7.07) was significantly higher than that in the control group (50.17±6.75), and the difference was statistically significant ( P < 0.05). Conclusion:The application of situation domedy teaching combined with peer teaching in the clinical teaching of undergraduate nursing students can improve their independent learning ability and clinical practice ability. Meanwhile, the process of teachers and students participating in situational experience and peer analysis and discussion can increase the teacher-student interaction, and improve the satisfaction of nursing students with clinical teaching.

Objective:To prepare the whole bladder acellular matrix (BAM) using the self-designed perfusion decellularization system, and evaluate the feasibility of constructing the tissue engineering bladder with the adipose-derived stem cells (ADSCs).Methods:This study was conducted from October 2020 to April 2021. The self-designed perfusion decellularization system was used, and four different decellularization protocols (group A, group B, group C and group D) were formulated, according to the flow direction of the perfusate and the action time of different decellularization solutions. Among them, the urethral orifice of the bladder tissue was used as the outflow tract of the perfusion fluid in groups A and B. The top of the bladder was cut off and used as the outflow tract of the perfusion fluid in groups C and D. In groups A and C, 1% Triton X-100 was treated for 6 h, and 1% sodium dodecyl sulfate (SDS) was treated for 2 h. In groups B and D, 1% Triton X-100 was treated for 7 h, and 1% sodium dodecyl sulfate (SDS) was treated for 1 h. In addition, the tissue in the normal bladder group was directly obtained from the natural bladder tissue, which did not require perfusion, cryopreservation and thawing. The fast and efficient decellularization protocol was screened out through HE, DAPI, Masson trichrome and Alcian Blue staining and quantitative analyses to prepare the whole bladder scaffold. The prepared BAM was used as the scaffold material, and the ADSCs were used as the seeding cells to construct the tissue engineering bladder. HE and DAPI staining were used to observe the distribution of ADSCs on the BAM.Results:HE and DAPI staining showed that there was no obvious nuclear residue in the group C. Masson trichrome and Alcian Blue staining showed that the collagen structure and glycosaminoglycan were well preserved in the group C. There was no significant difference in bladder wall thickness between the group C and the normal bladder group [(975.44±158.62)μm vs.(1 064.49±168.52)μm, P > 0.05]. The DNA content in the group C [(43.59 ±4.59) ng/mg] was lower than that in the normal bladder group, group A, group B and group D [(532.50±26.69), (135.17±6.99), (182.49±13.69) and(84.00±4.38)ng/mg], and the difference was statistically significant ( P<0.05). The collagen content [(10.98 ± 0.29)μg/mg] and glycosaminoglycan content [(2.30±0.18)μg/mg] in group C were not significantly different with those in the normal bladder group [(11.69±0.49) and (2.36±0.09)μg/mg, P>0.05]. Scanning electron microscopy showed that a large number of pore structures could be observed on the surface of the prepared BAM in groups A-D and were facilitated to cell adhesion. The isolated and cultured ADSCs were identified by flow cytometry to confirm the positive expression of CD90 and CD29, and the negative expression of CD45 and CD106. Live/dead staining and CCK-8 detection confirmed that the prepared BAM in the group C had no cytotoxicity. HE and DAPI staining showed that a large number of ADSCs were distributed on the surface and inside of the tissue engineering bladder. Conclusions:The whole bladder shape BAM prepared by the self-designed perfusion decellularization system could be used as the scaffold material for bladder tissue engineering, and the constructed tissue engineering bladder could be used for bladder repair and reconstruction.

BACKGROUNDS: At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios. METHODS: We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC. The pregnancy outcomes between the two groups were compared. Primary outcomes were successful vaginal delivery rates. Secondary outcomes were maternal and neonatal adverse events. Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups. RESULTS: The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group (64.1% [66/103] vs. 59.6%, [84/141] P = 0.475), even after adjustment for potential confounding factors (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.57-2.00, P = 0.835). The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group (1.9% [2/103] vs. 7.8%, [11/141] P < 0.001), but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group (12.6% [13/103] vs. 0.7%, [1/141] P < 0.001). Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone (aOR: 6.71, 95% CI: 1.96-22.95). There were three factors related to vaginal delivery failure after induction with SBC, namely gestational age (aOR: 1.51, 95% CI: 1.07-2.14), body mass index (BMI) >30 kg/m2 (aOR: 2.98, 95% CI: 1.10-8.02), and fetal weight >3500 g (aOR: 2.49, 95% CI: 1.12-5.50). CONCLUSIONS Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC, with their advantages and disadvantages. In women with nuchal cord, the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor. BMI >30 kg/m2, large gestational age, and estimated fetal weight >3500 g are risk factors for vaginal delivery failure after induction with SBC.
Administration, Intravaginal ; Catheters ; Dinoprostone/therapeutic use* ; Female ; Fetal Weight ; Humans ; Infant, Newborn ; Labor, Induced/methods* ; Nuchal Cord ; Oligohydramnios ; Oxytocics ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies