Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.

Objective:To analyze the role of the Hippo signaling pathway in epithelial-mesenchymal transition (EMT) of triple-negative breast cancer (TNBC) cells.Methods:70 patients with TNBC admitted to the Yan ′an People′s Hospital from April 2021 to September 2023 were selected. Before treatment, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression levels of Hippo signaling pathway-related indicators (Yap, ta Z, mst 1) in peripheral blood, and the patients were treated with the TP regimen for 21 days. After the treatment, puncture biopsy was performed on the tumor tissues of the patients. They were divided into the transformation group and the non-transformation group based on whether EMT occurred. The influencing factors of EMT in tumor cells of TNBC patients were analyzed, and the value of the Hippo signaling pathway in predicting EMT in tumor cells of TNBC patients was analyzed.Results:After treatment, 18 cases (25.71%) of 70 patients with TNBC developed EMT. The proportion of tumor node metastasis (TNM) stage Ⅳ in the transformation group was (13/18), the level of Yap mRNA was (4.82±0.63), the level of taZ mRNA was (2.93±0.41), and the mst 1 mRNA level (3.09±0.51) and the long diameter of the tumor [(5.95±0.77)cm] were both higher than those in the non-transformation group [44.23%(23/52), (3.84±0.59), (2.34±0.39), (2.45±0.47), (4.14±0.63)cm] (all P<0.05). Binary logistic regression analysis revealed TNM stage Ⅳ [ OR=4.768, 95% CI(1.630, 13.951)], Yap mRNA [ OR=5.675, 95% CI(1.940, 16.602)], and taZ mRNA [ OR=5.124 95% CI(1.751, 14.992)], mst 1 mRNA [ OR=5.557, 95% CI(1.899, 16.257)], tumor long diameter [ OR=3.850, 95% CI(1.316, 11.263)] was an influencing factor for the occurrence of EMT in tumor cells of TNBC patients (all P<0.05). After analysis by the receiver operating characteristic (ROC) curve, the combined sensitivity of TNM stage Ⅳ, Yap mRNA, taZ mRNA, mst 1 mRNA, and tumor long diameter in predicting EMT in tumor cells of TNBC patients was 66.67%, 72.22%, 77.78%, 72.22%, 77.78%, and 88.89%, respectively. The specificities were 69.23%, 71.15%, 76.92%, 73.08%, 75.00% and 92.31% respectively. The combined prediction of TNM stage Ⅳ, Yap mRNA, taZ mRNA, mst 1 mRNA, and tumor long diameter in tumor cells of TNBC patients had a relatively high value (all P<0.05). Conclusions:The combined detection of TNM stage Ⅳ, Yap mRNA, taZ mRNA, mst 1 mRNA, and tumor long diameter can better predict the occurrence of EMT in tumor cells of patients with TNBC.

Objective:To analyze the role of the Hippo signaling pathway in epithelial-mesenchymal transition (EMT) of triple-negative breast cancer (TNBC) cells.Methods:70 patients with TNBC admitted to the Yan ′an People′s Hospital from April 2021 to September 2023 were selected. Before treatment, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression levels of Hippo signaling pathway-related indicators (Yap, ta Z, mst 1) in peripheral blood, and the patients were treated with the TP regimen for 21 days. After the treatment, puncture biopsy was performed on the tumor tissues of the patients. They were divided into the transformation group and the non-transformation group based on whether EMT occurred. The influencing factors of EMT in tumor cells of TNBC patients were analyzed, and the value of the Hippo signaling pathway in predicting EMT in tumor cells of TNBC patients was analyzed.Results:After treatment, 18 cases (25.71%) of 70 patients with TNBC developed EMT. The proportion of tumor node metastasis (TNM) stage Ⅳ in the transformation group was (13/18), the level of Yap mRNA was (4.82±0.63), the level of taZ mRNA was (2.93±0.41), and the mst 1 mRNA level (3.09±0.51) and the long diameter of the tumor [(5.95±0.77)cm] were both higher than those in the non-transformation group [44.23%(23/52), (3.84±0.59), (2.34±0.39), (2.45±0.47), (4.14±0.63)cm] (all P<0.05). Binary logistic regression analysis revealed TNM stage Ⅳ [ OR=4.768, 95% CI(1.630, 13.951)], Yap mRNA [ OR=5.675, 95% CI(1.940, 16.602)], and taZ mRNA [ OR=5.124 95% CI(1.751, 14.992)], mst 1 mRNA [ OR=5.557, 95% CI(1.899, 16.257)], tumor long diameter [ OR=3.850, 95% CI(1.316, 11.263)] was an influencing factor for the occurrence of EMT in tumor cells of TNBC patients (all P<0.05). After analysis by the receiver operating characteristic (ROC) curve, the combined sensitivity of TNM stage Ⅳ, Yap mRNA, taZ mRNA, mst 1 mRNA, and tumor long diameter in predicting EMT in tumor cells of TNBC patients was 66.67%, 72.22%, 77.78%, 72.22%, 77.78%, and 88.89%, respectively. The specificities were 69.23%, 71.15%, 76.92%, 73.08%, 75.00% and 92.31% respectively. The combined prediction of TNM stage Ⅳ, Yap mRNA, taZ mRNA, mst 1 mRNA, and tumor long diameter in tumor cells of TNBC patients had a relatively high value (all P<0.05). Conclusions:The combined detection of TNM stage Ⅳ, Yap mRNA, taZ mRNA, mst 1 mRNA, and tumor long diameter can better predict the occurrence of EMT in tumor cells of patients with TNBC.

Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.

Objective:To investigate the effect of high-dose vitamin D combined with insulin on serum homocysteine (HCY), glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus.Methods:From June 2020 to May 2023, 120 patients with gestational diabetes mellitus in Yan'an People's Hospital were selected as the research object, and they were randomly divided into observation group and control group with 60 cases in each group. The control group was treated with insulin aspart, while the observation group was treated with insulin aspart and large dose of vitamin D. The levels of serum HCY, glucose metabolism, serum 25-hydroxyvitamin D3 and blood lipid metabolism were compared between the two groups before and after treatment. The pregnancy outcomes of the two groups were compared and analyzed through follow-up.Independent sample t-test is used for comparison between two groups of econometric data that conform to normal distribution, while paired t-test is used for comparison within groups. The comparison between the groups was performed by χ2 test. Results:After treatment, fasting blood glucose ((4.67±0.52) mmol/L vs (5.46±0.68) mmol/L), 2-hour postprandial blood glucose ((6.67±0.56) mmol/L vs (8.42±0.78) mmol/L) and homeostasis model insulin resistance index (2.45±0.45 vs 3.87±0.34) in the observation group were significantly lower than those in the control group, and homeostasis model assessment of islets in pre diabetes patients β cell function index (HOMA-β) in the observation group was significantly higher than that in the control group (87.15±10.45 vs 75.92±10.06). The differences were statistically significant (t values were 7.15, 14.12, 19.50, and 6.00; all P<0.001). After treatment, the serum HCY level ((8.72±1.27) μmol/L vs (10.18±1.65) μmol/L), in the observation group was lower than that in the control group and the serum 25-OH-D3 level ((15.05±2.41) μg/L vs (11.25±2.37) μg/L) in the observation group was higher than that in the control group. The differences were statistically significant ( t=5.43, 8.71, P<0.001). After treatment, the serum triglyceride, total cholesterol and low density lipoprotein cholesterol (LDL-C) in the observation group were compared with those in the control group. LDL-C levels were lower than those in the control group ((2.15±0.15) mmol/L vs (3.23±0.18) mmol/L, (5.23±0.14) mmol/L vs (6.34±0.17) mmol/L, (1.53±0.21) mmol/L and (2.21±0.22) mmol/L), serum high density lipoprotein cholesterol (HDL-C), HDL-C levels were significantly higher than those in the control group ((1.18±0.11) mmol/L vs (0.98±0.12) mmol/L), and the differences were statistically significant (t-values were 35.70, 39.04, 17.32, and 9.52, respectively, all P<0.001). The incidence of adverse pregnancy outcome in the observation group was lower than that in the control group (10% (6/60) vs 40% (24/60)), and the difference was statistically significant ( χ2=14.28, P<0.001). Conclusion:High-dose vitamin D combined with insulin therapy can not only effectively improve glucose and lipid metabolism, but also reduce the HCY level and improve the adverse pregnancy outcome in patients with gestational diabetes mellitus.

ObjectiveTo develop a two-dimensional high-performance liquid chromatography （2D-HPLC） for simultaneous determination of the contents of four kinds of Uncaria alkaloids： rhynchophylline， isorhynchophylline， corynoxeine and isocorynoxeine. MethodsThe 2D-HPLC apparatus was comprised of a first chromatographic column in version Aston SC2 （3.5 mm×25 mm， 5 μm）， an intermediate column in version Aston SH C₁₈ （3.5 mm×10 mm， 5 μm）， and an analytical column in version Aston SCB （4.6 mm×125 mm， 5 μm）. The mobile phase of the first and second liquid chromatography system were CAA-1 and mixed mobile phase （V _{BPI-1 basic mobile phase} ∶ V _{MPI-1 mobile phase} ∶ V _{OPI-1 organic mobile phase} = 45∶14∶41）. The chromatographic parameters included a flow rate of 1.0 mL/min， a column temperature of 40℃， a wavelength of 254 nm， an injection volume of 500 μL and a detection time of 9.5 min. ResultsThe linear ranges of rhynchophylline， isorhynchophylline， corynoxeine and isocorynoxeine were 9.77~10 000.00 ng/mL （r=0.999 6）， 10.74~11 000.00 ng/mL （r=0.999 7）， 10.74~11 000.00 ng/mL （r=0.999 7）， 10.74~11 000.00 ng/mL（r=0.999 6）， respectively. The relative standard deviation （RSD） of precision， stability and repeatability were all less than 5.00%. The accuracy was 95.20%~104.01%， and the recovery rate was 93.63%~101.38%. ConclusionThe 2D-HPLC developed for simultaneous determination of four kinds of alkaloids in Uncaria is simple and accurate， which can be used as a new method for quality control of Uncaria.

ObjectiveTo determine the contents of four kinds of indole alkaloids （rhynchophylline， isorhynchophylline， corynoxeine， isocorynoxeine） in Uncaria by high-performance liquid chromatography-mass spectrometry-automatic internal standard （HPLC-MS-AIS）. MethodsChromatographic separation was performed using C₁₈ column （3.0 mm×50 mm， 3.3 μm）， and the mobile phase， comprising 0.1% formic acid aqueous solution-acetonitrile （82∶18， V/V）， was eluted at a flow rate of 0.5 mL/min and column temperature of 30℃. Mass spectrometric detection was performed using an electrospray ionization source and positive multiple-reaction monitoring mode at a voltage capillary of 4 000 V. The mass-to-charge ratio （m/z） transition was 385.25/160.10 for rhynchophylline， 385.30/160.10 for isorhynchophylline， 383.25/160.15 for corynoxeine and 383.25/160.15 for isocorynoxeine， respectively. The injection volume was kept constant at 2 μL. ResultsThe linear concentration ranges of rhynchophylline， isorhynchophylline， corynoxeine and isocorynoxeine were 2.30~600.00 ng/mL （r=0.999 3）， 2.30~600.00 ng/mL （r=0.999 2）， 2.47~650.00 ng/mL （r=0.999 4） and 2.47~650.00 ng/mL （r=0.999 2）， respectively. The relative standard deviation （RSD） of precision and stability were all lower than 5.00%， the accuracy ranged from 92.40% to 104.10%， and the average recovery was 95.90%~104.60%. ConclusionHPLC-MS-AIS method is simple and accurate for the determination of four kinds of alkaloids in Uncaria， and can be used as a new method for quality control of Uncaria.

Depression is a kind of severe psychiatric disorders whose risk prediction, classification, diagnosis, and prognosis lack sufficient objective basis. Metabolomics is an emerging discipline that is developed recently after genomics and proteomics, which provides new ways for examining the etiology, diagnosis, mechanism, and prognosis, and screening potential biomarkers in depression. Blood samples are easy to obtain and have less trauma, which contains almost all small molecular products in the body. This paper reviews the recent researches of blood endogenous small molecule substance metabolism in depression, in order to provide more theoretical basis and exploration direction for further study of metabolomics of depression.

Objective:To investigate the correlation between CD133 expression and clinicopathological features in triple negative breast cancer (TNBC) patients, and the impact of CD133 on prognosis in these patients.Methods:Data of 70 patients who received surgical treatment in our center from Jan. 2008 to Dec. 2012 were collected. Immunohistochemistry was used to examine the expression of CD133. Patients were divided into two groups according to CD133 expression. Univariate analysis, Cox and Logistic regression multivariate analysis were used in order to investigate the correlation between CD133 expression and clinicopathological features. Kaplan-Meier curve and Log-rank analysis were used to evaluate DFS (disease-free survival) and OS (overall survival) .Results:CD133 was expressed in cytomembrane and cytoplasm with expression rate of 95.71% (67/70) . Of which, 64.29% (45/70) of patients were low CD133 expression and 35.71% (25/70) were high expression. High CD133 expression was significantly correlated with younger age (≤50) ( P=0.007) and larger tumor size (>2 cm) ( P=0.020) . Tumor size ( P=0.035) , axillary status ( P=0.001) , Ki67 ( P=0.005) and CD133 expression ( P=0.014) were independent predictors of recurrence and metastasis in TNBC patients. Axillary status was independent predictor of death event ( P=0.008) . Increased CD133 was associated with poor prognosis. Compared with high expression, patients with low CD133 expression had better DFS ( P=0.002) and OS ( P=0.088) , while OS did not reach significant difference. Conclusion:CD133 expression was correlated with age and tumor size in TNBC patients. High expression was associated with recurrence, metastasis and poor prognosis. Thus, CD133 may be a potential biomarker in predicting prognosis in TNBC.

Objective:To improve the standardized training effects of the first year graduate new nurses by the mini clinical evaluation exercise (Mini-CEX) .Methods:By cluster sampling, a total of 91 new nurses hired in 2017 of Xinqiao Hospital Affiliated to Army Medical University were in control group; and 120 new nurses hired in 2018 were in experimental group. Control group carried out routine training method. On the basis of that, experimental group implemented the Mini-CEX based clinical nursing core competence training and operational skill training once a month after changing routine teaching rounds and operational training, lasting 12 times. The scores of Mini-CEX for the first and twelfth time of experimental group were compared by paired sample t-test, the theoretical achievements and skill performances of new nurses between two groups were compared by independent sample t-test. Results:The scores of Mini-CEX of clinical nursing core competence training and operational skill training in experimental group for the twelfth time were (6.27±0.46) and (6.73±1.10) respectively, higher than those for the first time with statistical differences ( t=-8.48, -7.64; P<0.01) . Among new nurses in standardized training of the first year, the theoretical achievements and skill performances of department in experimental group were (87.70±11.32) and (92.90±8.22) , those of hospital were (85.50±11.83) and (89.67±8.99) respectively, higher than those in control group with statistical differences ( t=-2.71, -2.09, -2.24, -3.22; P<0.05) . Conclusions:Mini-CEX has significant effects in training for the first year among new nurses .