Metastasis serves as an indicator of malignancy and is a biological characteristic of carcinomas. Epithelial-mesenchymal transition (EMT) plays a key role in the promotion of tumor invasion and metastasis and in the enhancement of tumor cell aggressiveness. Prostaglandin E synthase 3 (p23) is a cochaperone for heat shock protein 90 (HSP90). Our previous study showed that p23 is an HSP90-independent transcription factor in cancer-associated inflammation. The effect and mechanism of action of p23 on lung cancer metastasis are tested in this study. By utilizing cell models in vitro and mouse tail vein metastasis models in vivo, the results provide solid evidence that p23 is critical for promoting lung cancer metastases by regulating downstream CXCL1 expression. Rather than acting independently, p23 forms a complex with RNA-binding motif protein 14 (RBM14) to facilitate EMT progression in lung cancer. Therefore, our study provides evidence for the potential role of the RBM14-p23-CXCL1-EMT axis in the metastasis of lung cancer.

To summarize the emergency nursing experience of 1 patient with neck suicide complicated with airway obstruction and hemorrhagic shock.Nursing points:to ensure airway safety and establish artificial airway;to optimize airway management and implement early sedation and wake-up;to control injury bleeding and limited fluid resuscitation;to establish a micro blood station in the emergency department and start a high-dose blood transfusion procedure;to carry out the refined target body temperature management to reduce complications;to optimize speech communication strategies and implement early psychological care.After 7 days of careful treatment and nursing,the patient's condition improved and recovered.After 2 months of follow-up,the patient recovered well.

Objective:To evaluate the impact of roxadustat on thyroid function and to identify the associated factors in patients undergoing maintenance peritoneal dialysis (PD).Methods:This study was a single-center retrospective study. PD patients who received roxadustat or recombinant human erythropoietin (rHuEPO) treatment at Nanjing Drum Tower Hospital between January 2020 and June 2024 were included. The general and clinical information as well as laboratory indexes were collected. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were compared before and after treatment initiation. Hemoglobin (Hb) responses were also observed between the two groups. Logistic regression analysis was performed to explore the factors associated with thyroid function changes.Results:A total of 120 patients were enrolled, with an age of (55.17±16.42) years, including 66 males (55.0%). There were 81 patients received roxadustat (roxadustat group) and 39 patiens received rHuEPO (rHuEPO group). Compared to the rHuEPO group, the roxadustat group had a higher proportion of patients with diabetes ( χ 2= 4.172, P=0.041), a shorter PD vintage ( Z=-3.406, P=0.002), a lower serum level of total cholesterol ( Z=-2.082, P=0.037) and a lower level of fasting blood glucose ( Z=-2.589, P=0.010). Following treatment with roxadustat, the levels of FT4 ( Z=-5.349, P<0.01) and TSH ( Z=-3.720, P<0.01) decreased significantly. In contrast, no significant changes in FT4 or TSH levels were observed in the rHuEPO group (both P>0.05). For both roxadustat and rHuEPO groups, there were no significant changes in FT3 levels after treatment (both P>0.05). Multivariate analysis identified that higher baseline TSH (TSH≥2.27 μIU/ml, OR=1.581, 95% CI 1.196-2.089, P=0.001) and roxadustat exposure ( OR=3.432, 95% CI 1.410-8.355, P=0.007) as independent associated factors of subsequent TSH decline, and identified that higher baseline FT4 (FT4≥14.9 pmol/L, OR=1.390, 95% CI 1.162-1.662, P=0.001) and roxadustat exposure ( OR=5.798, 95% CI 2.225-15.113, P=0.001) as independent associated factors of subsequent FT4 decline. The degrees of hemoglobin changes after roxadustat or rHuEPO treatment did not differ significantly between roxadustat group and rHuEPO group ( t=-1.062, P=0.290). Of the 31 patients who underwent a second thyroid function test during roxadustat treatment, 24 continued with the original regimen, while 7 discontinued roxadustat. Among 24 patients who maintained roxadustat treatment, TSH ( Z=-0.400, P=0.689) and FT4 ( t=0.143, P=0.888) remained stable between the second and third tests. All 7 patients who discontinued roxadustat treatment showed TSH rebound and the changes of TSH levels were more significant than that in continuers ( Z=-2.505, P=0.012). FT4 recovery occurred in only 3 of them, with no significant difference in FT4 change between discontinuers and continuers ( Z=-0.685, P=0.493). Conclusions:Roxadustat commonly suppresses TSH and FT4, but not FT3, in PD patients. Baseline levels of TSH and FT4 are key associated factors of the inhibitory effect of roxadustat on thyroid function. This suppression does not intensify with prolonged exposure and is reversible after discontinuation, with TSH levels normalizing more quickly than FT4. Roxadustat-induced thyroid suppression does not compromise its efficacy in treating renal anemia.

Objective To explore the application effect of promoting excellence and reflective learning in the full-process situational simulation training of team collaboration in the emergency departments,and to provide a reference for cultivating clinical nursing talents.Methods Stratified random sampling combined with sequential substitution method was adopted to conduct situational simulation training for 56 nurses in the emergency department from October to December 2024.The method of promoting excellence and reflective learning was used for guiding feedback,including 5 steps:pre-feedback,response,description,analysis,and summary.The clinical reasoning and reflection ability,clinical practice ability and teamwork ability of nurses were compared before and after the training.Results After the training,nurses improved in all dimensions of clinical reasoning and self-assessment ability of reflection(P＜0.001).The theoretical examination and team operation assessment scores of nurses were improved compared with those before the training(P＜0.001).The leadership,teamwork ability,overall evaluation and total score of nurses were all improved compared with those before the training(P＜0.05).Conclusion The use of promoting excellence and reflective learning for training in the scenario simulation of team collaboration in the emergency departments is helpful to improve nurses' clinical reasoning and reflection ability,clinical practice ability and teamwork ability

Objective To construct a regional collaborative cloud-based treatment model treatment model for patients with severe road traffic injuries,and to preliminarily evaluate the differences in nursing timeliness indicators and outcomes.Methods The regional collaborative cloud-based treatment platform includes 4 ports,including public security traffic police,pre-hospital emergency center,regional trauma center triage,and regional trauma center resuscitation unit.This forms a standardized real-time interactive treatment process between regional medical services and police for patients with severe road traffic injuries.Using a concurrent control study design,241 patients with severe road traffic injuries admitted to the emergency department of a regional trauma center in Zhejiang Province from May 2022 to May 2024 were selected as the study subjects.Among them,120 patients treated with the regional real-time collaborative cloud-based treatment model were designated as an experimental group,while 121 patients treated with the original trauma care process were designated as a control group.The differences in timeliness indicators and outcomes between the 2 groups were compared.Results The study included 241 patients with severe trauma.After the application of the regional collaborative cloud-based treatment model,the time from the scene of the accident to the hospital,the proportion of information early waming,completion time of pre-examination and triage,waiting time of the trauma team,the time of the first CT,the length of multidisciplinary consultation,and the time for completing hospitalization procedures in the experimental group were shorter than those in the control group(P＜0.05),the proportion of information early waming in the experimental group was 100％(120/120),and the proportion of information early waming in the control group was 52.1％(63/121).The difference between the two groups was statistically significant(P＜0.001).The survival rate of the experimental group was 90.8％(109/120),and that of the control group was 86.0％(104/121).There was no significant difference between the two groups(x2=1.399,P=0.237).Conclusion The regional collaborative cloud-based treatment model improves the timeliness and standardization of the treatment of patients with severe road traffic injury,which has certain reference significance and promotion value.

This report summarizes the emergency care and nursing interventions for a Parkinson's disease patient with severe hypothermia complicated by ventricular arrhythmia.Key nursing points included continuous core temperature monitoring with goal-directed,phased,progressive rewarming;proactive identification and rapid response to arrhythmias;precise fluid management and skin protection to dynamically optimize blood perfusion and pressure redistribution;vigilant prevention and early intervention of hypothermia-related complications.With multidisciplinary treatment and meticulous nursing care,the patient was successfully discharged after 17 days of hospitalization with a favorable recovery.At the three-month follow-up after discharge,the patient had recovered well with no recurrence of similar episodes.

Objective To investigate the effect of KH-type splicing regulatory protein(KHSRP)on the malignant biological behavior of lung adenocarcinoma(LUAD)by targeting the Janus kinase 1(JAK1)/signal transducer and activator of transcription 3(STAT3)signaling axis.Methods Clinical data were collected for 64 patients with LUAD,diagnosed at Huaihe Hospital from January 2017 to December 2018.Expression levels of KHSRP were detected in LUAD tissues and adjacent tissues by immunohistochemical staining.KHSRP gene expression was also detected in LUAD cell lines(SPC-A1,H1975,CL1-5,PC-9,Calu-3,H446)and normal human bronchial epithelial cells using quantitative reverse transcription-polymerase chain reaction.KHSRP expression in SPC-A1,H1975,PC-9,and Calu-3 cells was manipulated by lentivirus transfection.The effects of KHSRP on the proliferation,migration,and invasion of LUAD cells were detected by Cell Counting Kit-8 and Transwell assays.The effects of KHSRP overexpression and knockdown were also investigated in a mouse xenograft tumor model,and JAK/STAT signaling pathway proteins were detected by Western blot.Rescue experiments were conducted to verify if KHSRP promoted the malignant progression of LUAD cells by regulating the JAK1/STAT3 signaling pathway.Results KHSRP expression was significantly higher in LUAD tissues compared with adjacent tissues(P＜0.05).Overexpression of KHSRP significantly promoted the proliferation,migration,and invasion of LUAD cells in vitro(P＜0.05).KHSRP also promoted LUAD cell xenograft tumor growth and lung nodule metastasis in nude mice in vivo(P＜0.01).KHSRP knockdown significantly decreased the levels of JAK1,phospho-JAK1,and STAT3 in the JAK/STAT signaling pathway,while the situation was reversed following KHSRP overexpression(P＜0.05).Rescue experiments showed that KHSRP reversed the inhibitory effect of knockdown(P＜0.05).Conclusions KHSRP targets the JAK1/STAT3 signaling pathway and acts as an oncogene in LUAD.

Objective:To establish a nomogram model to predict the level of psychological distress in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods:A total of 100 AMI patients underwent PCI were selected,a predictive model based on the influencing factors was established,receiver operating characteristic(ROC)curve was used to analyze the predictive value of the nomogram prediction model for psychological distress after PCI.Results:Among 100 AMI patients,35 cases(35.00％)had total Hospital Anxiety and Depression Scale(HADS)score ≥15 score.The level of psychological distress in AMI patients after PCI was correlated with family monthly income,scores on general self-efficacy scale(GSES)score,age,Killip grade,Social support rating Scale(SSRS)score,gender,and number of complications(P＜0.05).Older age,female and more comorbidities were independent risk factors for higher level of psychological distress in AMI patients after PCI(P＜0.05),while high GSES score and SSRS score were protective factors(P＜0.05).The C index of the nomogram prediction model=0.853.The calibration curve shows that the predicted probability fits the actual observed probability well.The area under the curve(AUC)of the nomogram prediction model was 0.924,the specificity was 84.26％,and the sensitivity was 87.17％.Conclusion:Older age,female and more comorbidities are risk factors for higher psychological distress AMI patients after PCI,high SSRS score and GSES score are protective factors.The nomogram prediction model based on the above risk factors can effectively predict the level of psychological distress.