Background/Aims: Biliary tract cancer (BTC) frequently harbors KRAS mutations, which are associated with resistance to traditional treatment and a poor prognosis. Synthetic lethality (SL) strategy may provide other targets of KRAS. Therefore, we aim to identify and validate potential therapeutic targets of KRAS for the treatment of BTC via SL. Methods: The dependency (DepMap) projects were used to predict the synthetic lethal gene of KRAS. FDA-approved anticancer drug library was applied to screen potential drugs effective against KRAS-mutant BTC. Furthermore, the synthetic lethal effects or corresponding mechanisms of potential genes and drugs on BTC were investigated using KRAS-mutant and KRAS-wild type BTC cell lines, patient-derived xenografts (PDX), and KRAS oncogene-driven tumor models, as well as other KRAS-mutant cancer cell lines. Results: Initially, we discovered that the loss of GATA2 reduced the viability of KRAS-mutant but not KRAS-wild-type BTC. Subsequently, the drug library screened out disulfiram, which primarily exerts a synthetic lethal effect by inhibiting interleukin-1β (IL-1β) in KRAS-mutant BTC. Mechanistically, GATA2 specifically enhanced the transcription of IL-1β to promote NF-κB signaling in KRAS-mutant BTC. IL-1β inhibition phenocopied GATA2 deficiency, leading to reduced KRAS-mutant BTC viability. These synthetically lethal effects were confirmed using PDX, a KRAS oncogene-driven tumor model, as well as in other KRAS-mutant cancer cell lines. Conclusions In summary, these results indicate that inhibiting GATA2/IL1β could be a therapeutic strategy in KRAS-mutant BTC and potentially other cancers.

Objective:To explore the trajectory of postpartum post-traumatic stress disorder (PP-PTSD) in women of advanced maternal age and its influencing factors.Methods:From September 2021 to March 2023, convenience sampling was used to select women of advanced maternal age in the Department of Gynecology and Obstetrics at Taizhou Hospital of Zhejiang Province as participants. Parturients were surveyed at one week, one month, six months, and 12 months after delivering using General Information Questionnaire, Post-traumatic Stress Disorder Check-list-civilian Version, Social Capital Scale, and 10-item Connor-Davidson Resilience Scale. The latent growth mixture model was used to analyze the trajectory of PP-PTSD.Results:A total of 467 questionnaires were distributed, and 456 valid questionnaires were collected, with a valid rate of 97.64%. There were four types of PP-PTSD trajectories in women of advanced maternal age, namely non PP-PTSD type (71.27%, 325/456), early onset-gradual recovery type (12.06%, 55/456), early onset-prolonged type (9.21%, 42/456), and late onset-risk type (7.46%, 34/456). Univariate analysis showed that delivery mode, pregnancy complications, social capital, and psychological resilience were potential categories of influencing factors for the trajectory of PP-PTSD in women of advanced maternal age ( P<0.05) . Conclusions:There is population heterogeneity in the trajectory of PP-PTSD among women of advanced maternal age. It is recommended that medical and nursing staff dynamically monitor the PP-PTSD of women of advanced maternal age, identify their trajectory types early, and develop precise intervention measures based on classification.

Pin site infection is the most common complication during external skeletal fixation. Its incidence ranges from 12% to 69%. Domestic and international guidelines and consensus recommend that patients be cared for by dressing change at pin sites during external fixation. However, there have been no standardized procedures in clinic for dressing change at pin sites. Therefore, this tutorial intends to propose for domestic nursing colleagues standardized procedures for dressing change at pin sites during external skeletal fixation, based on the guidelines and consensus published, relevant literature and our own working experience.

Pin site infection is the most common complication during external skeletal fixation. Its incidence ranges from 12% to 69%. Domestic and international guidelines and consensus recommend that patients be cared for by dressing change at pin sites during external fixation. However, there have been no standardized procedures in clinic for dressing change at pin sites. Therefore, this tutorial intends to propose for domestic nursing colleagues standardized procedures for dressing change at pin sites during external skeletal fixation, based on the guidelines and consensus published, relevant literature and our own working experience.

This paper analyzes the laws, regulations and concre measures of Traditional Chinese Medicine (TCM) in Canada, so as to provide reference for TCM products to enter Canada, and for the establishment of TCM regulation system and the improvement of its detailed rules in China. The regulation of TCM in Canadian, on the one hand, supervision is to provide guidance for the protection of consumers' rights and interests, including the guidance of rational drug use and rational purchase for consumers; on the other hand, it is to supervise enterprises, including the safety, effectiveness and quality certification of TCM products, labeling and packaging requirements, as well as the site certification of product manufacturing, packaging, labeling and import. The Ministry of health of Canada takes evidence as the core of evaluation, and ensures the safe and effective use of TCM products in Canada through product and site licensing evaluation. In the supervision of TCM, relevant departments in China should further strengthen the protection of consumers' drug rights and interests, strengthen the construction of TCM registration evidence system, and pay attention to the risk management of drug production quality.

Objective:To investigate the characteristics and management of the emergency patients with orthopaedic trauma during COVID-19 epidemic.Methods:A retrospective analysis was performed of the 32 emergency inpatients at Department of Orthopedics, Nanfang Hospital from January 20 to February 26, 2020. They were 23 males and 9 females, aged from 4 to 66 years (mean, 35 years). The causes for their injury included traffic accident in 14 cases, sharp cutting (e.g. by a kitchen knife) in 6 cases, heavy object crushing in one, machine crushing in one, fall in 2, and machine twisting in one. High energy injury occurred in 13 cases and low-energy injury in 9 cases. The injury involved the upper limb in 7 cases and the lower limb in 15 cases. Grade Ⅱ protection was adopted during the diagnosis and treatment for the one emergency patient who had not undergone nucleic acid screening for 2019-nCoV while grade Ⅰ protection for the other 21 patients. 2019-nCoV infection was recorded in the patients and medical staff as well. The measures and experience were reviewed in the management of orthopaedic emergencies during the COVID-19 epidemic.Results:During the diagnosis and treatment of 22 emergency patients with orthopaedic trauma, none of the medical staff or patients was infected with COVID-19. As the one emergency patient was treated as a suspected case and protected by grade Ⅱ measures, COVID-19 infection was ruled out after surgery.Conclusions:During the COVID-19 epidemic, front-line medical staff dealing with traumatic emergencies faced a higher risk of infection. The emergency orthopaedic traumas were mainly caused by a traffic accident or a machine, and those in the elderly patients by a sharp cutting or a fall. The incidence of COVID-19 infection could be reduced by COVID-19 screening before admission, appropriate anesthesia and surgical methods, protection of perioperative medical staff, postoperative wards care and psychological counseling.

Objective: To explore the effect of different midwifery methods on the pelvic floor function of parturients and nursing experience. Methods: From January 2018 to December 2018, 200 cases of vaginal delivery in Enze Obstetrics and Gynecology Hospital of Taizhou Hospital were selected as study objects.According to the random number table method, they were divided into non-invasive midwifery group and traditional midwifery group, with 100 cases in each group.The non-invasive midwifery group adopted non-invasive midwifery, while the traditional midwifery group adopted traditional midwifery.The pelvic floor muscle strength, pelvic floor muscle dysfunction and postpartum hemorrhage were observed in the two groups. Results: There was no statistically significant difference in pelvic floor muscle strength between the two groups in grade 0, grade Ⅰ, grade Ⅱ, grade Ⅲ and grade Ⅳ(all P>0.05). The pelvic floor muscle strength of the observation group in grade Ⅴ (45.00%) was higher than that of the control group (31.00%), the difference was statistically significant (χ²=4.160, P<0.05). The incidence of sexual dysfunction (15.00%) and stress urinary incontinence (28.00%) in the observation group were significantly lower than those in the control group (41.00%, 54.00%) (χ²=16.766, 13.973, all P<0.05). The amount of bleeding 2 hours after delivery in the observation group [(245.93±19.89)mL] was less than that in the control group [(297.42±24.21)mL] (t=16.433, P<0.05). Conclusion Non-invasive midwifery has little effect on the pelvic floor function of parturients, and the incidence rate of sexual dysfunction and stress urinary incontinence is low, and the amount of bleeding is small, which is worthy of clinical reference.

Objective: To compare the in vitro osteogenic ability of brown adipose stem cells (BADSC) and white adipose stem cells (WADSC), and to provide evidence for further research and clinical application of adipose-derived stem cells. Methods: The brown fat under the scapula of SD rats and the white adipose tissue in the groin were isolated and obtained BADSC and WADSC. The morphology of the cells was observed by an inverted phase contrast microscope, and the cell count was used to detect the proliferative ability. After osteogenic induction, alkaline phosphatase (ALP) staining and alizarin red staining were performed. The expression of the osteogenic marker gene [Runt-related transcription factor-2 (RUNX2), osteocalcin] was detected by quantitative real-time PCR (qPCR). Results: Both BADSC and WADSC were osteogenic. The ALP activity of BADSC was significantly greater than that of WADSC at each time point after osteogenic induction. After 5 weeks of osteogenic induction, BADSC formed a larger area of calcium nodules (accumulated optical density was 92 558±1 507), which was significantly greater than WADSC (accumulated optical density was 52 319±1 786) (t=29.81, P<0.05). The expression of BADSC osteogenic marker genes (RUNX2 and osteocalcin) was significantly higher than that of WADSC (P<0.05). Conclusions Both BADSC and WADSC have the potential for osteogenic differentiation, but BADSC has better osteogenic differentiation ability than WADSC.

ObjectiveTo discuss the values of fiber bronchoscopy with three-way laryngeal mask airway continuous ventilation in 1-6 month old infants with oxygen-dependent respiratory diseases.MethodsFrom January 2010 to May 2011, 29 cases of 1-6 month old infants with oxygen-dependent respiratory diseases who underwent conventional ifber bronchoscope and 148 cases of 1-6 month old infants with oxygen-dependent respiratory diseases who underwent ifber bronchoscopy with three-way laryngeal mask airway continuous ventilation were enrolled in control and treatment groups respectively. The success rate of ifber bronchoscope and the incidence rate of complications were compared between two groups.ResultsIn the treatment group, the success rate of ifber bronchoscope was 89.2% which was signiifcantly higher than 58.6% in the control group and the rate of laryngeal edema was 9.1% which was signiifcantly lower than 35.3% in the control group. The rates of endotracheal intu-bation ventilation and postoperative hemorrhage were lower than those in the control group, but the difference was not statistical ly signiifcant.ConclusionFiber bronchoscopy with three-way laryngeal mask airway continuous ventilation is superior to the traditional ifber bronchoscope in 1-6 month old infants with oxygen dependent respiratory system diseases.

Objective To explore the preventive effect of Fluconazole on invasive fungous infections in premature infants.Methods Two hundred and thirty-four cases of preterm infants hospitalized in Jiangmen Central Hospital from Feb.2008 to Oct.2013 were analyzed by retrospective study.The subjects were divided into 3 groups based on whether Fluconazole was used and it was used orally or intravenously for the prevention of invasive fungous infections in premature infants.The Fluconazole prophylaxis was not given to group A,whereas oral Fluconazole prophylaxis [6 mg/(kg · times),every other day] and intravenous Fluconazole prophylaxis [3 mg/ (kg · times),once every 3 days] were applied in group B and group C.The incidence of invasive fungous infections and the clinical effects of Fluconazole on the 3 groups were evaluated and compared.Results The number of cases analyzed in the study were 53,115 and 66 cases in group A,group B and group C,respectively.There were no significant differences between the 3 groups in terms of gender,gestational age,birth weights,length of hospitalization,intravenous nutrition,and number of peripherally inserted central catheter,antibiotics and invasive mechanical ventilation use days (all P ＞ 0.05).The incidences of invasive fungal infections were 11.32％ (6/53 cases),6.96％ (8/115 cases) and 0 in group A,group B and group C,respectively.The prophylaxis effects between the 3 groups were significantly different (x2 =7.078,P =0.029).Group A and group B were not significantly different (x2 =0.905,P =0.342),but group C was better than group A and group B,and the differences were significant (P =0.007,0.028).Conclusions Prevention of invasive fungous infections by intravenous Fluconazole has good curative effects,and which can be used as the first choice.