Objective:To investigate the effect of the stress-induced protein sestrin 3(SESN3)on tumor proliferation and the sensitivity to endocrine therapy in hormone receptor-positive(HR+)breast cancer(BC)and its mechanism.Methods:The cancer genome atlas(TCGA)database was used to analyze the expression level of SESN3 in breast cancer tissue and paracancerous tissue.The clinical samples of breast cancer tissue and paracancerous tissue were collected,and immunohistochemistry(IHC)microarray was used to vali-date the expression of SESN3.Western blot was used to measure the protein expression level of SESN3 in BC cell lines with different pathological subtypes.HR+BC cell lines were used to establish the models of SESN3 overexpression and knockdown,and cell counting kit-8(CCK-8)assay and colony formation assay were used to assess the proliferative capacity of cells;Western blot was used to ana-lyze cell cycle alterations;a subcutaneous xenograft mouse model was used to validate the effect of SESN3 on proliferation in vivo.The bioinformatics analysis and Western blot were used to investigate the downstream mechanisms of SESN3 in regulating proliferation.Results:The analysis of TCGA database and clinical samples showed that the expression of the SESN3 gene in BC tissue was signifi-cantly lower than that in paracancerous tissue,and the patients with high SESN3 expression had a longer progression-free survival time.Compared with the other subtypes of BC cell lines,the HR+BC cells lines MCF-7 and T-47D had a relatively high expression level of SESN3.MCF-7 and T-47D cell lines were used to establish the cell models of knockdown(MCF-7KD and T-47DKD)and overexpres-sion(MCF-7OE and T-47DOE),and compared with the control group,MCF-7KD and T-47DKD cells showed increases in proliferative capacity and the proportion of cells arrested in the G2 and M phases.In vivo tumorigenesis experiments showed a significant increase in tumor growth in mice in the MCF-7KD group.The bioinfor-matics analyses showed a significant negative correlation between the mammalian Target of Rapamycin(mTOR)signaling pathway and SESN3 expression,and Western blot validation showed a significant increase in the expression of mTOR in MCF-7KD and T-47DKD cells,as well as reductions in the protein expression levels of autophagy-related genes.Subsequently,we further confirmed that the knockdown of MCF-7 and T-47D cells led to a decreased sensitivity to endocrine therapy.In addition,MCF-7、T-47D、MCF-7KD、and T-47DKD cell lines were treated with the mTOR inhibitor everolimus(EVE),and there was a significant reduction in proliferative capac-ity in the MCF-7KD group and the T-47DKD group;since the mTOR pathway reduced the sensitivity to endocrine therapy by reducing cell apopto-sis,there was a significant increase in the sensitivity to endocrine therapy with tamoxifen(TAM).Conclusion:The inte-grated database analysis,clinical sample validation,and in vivo/in vitro experimental models show that SESN3 inhibits the proliferation of HR+BC cells via the mTOR pathway and enhances the sensitivity to endocrine therapy.

Objective:To investigate factors influencing frequent episodes (≥ 4 episodes within 1 year) in children with moderate-to-severe atopic dermatitis (AD) in China.Methods:A national multicenter cross-sectional study was conducted. Patients under the age of 18 years diagnosed with moderate-to-severe AD were enrolled at dermatology clinics in 18 medical institutions across 12 provinces and municipalities in China between June 12 and August 8, 2023. At the time of the visit, their guardians completed a structured questionnaire covering demographic characteristics, clinical features of AD, personal and family history, factors associated with frequent episodes of moderate-to-severe AD, compliance with treatment, and disease awareness. Statistical analyses included t tests, one-way analysis of variance, rank-sum tests, and chi-square tests, with multiple-response analysis applied for multiple-choice questions. Results:A total of 965 valid questionnaires were collected, and 965 children with moderate-to-severe AD were included. Among them, there were 531 males and 434 females, 678 (70.3%) were aged 2 - < 12 years, 837 (86.7%) were from urban areas, the age at onset was 2.47 ± 3.03 years, and the median frequency of AD episodes in the past year was 4 times. These children were divided into 2 groups based on the median episode frequency: < 4-episode group (439 cases, 45.5%) and ≥ 4-episode group (526 cases, 54.5%). Compared with the < 4-episode group, children in the ≥ 4-episode group showed younger ages at onset (2.22 ± 2.98 years vs. 2.76 ± 3.06 years, P = 0.006) and higher proportions of patients with comorbid allergic diseases in both the children themselves (82.9% [436/526] vs. 69.7% [306/439], χ2 = 23.42, P < 0.001) and their relatives (66.0% [347/526] vs. 57.4% [252/439], χ2 = 7.46, P = 0.006). Children in the ≥ 4- episode group also had higher monthly usage of moisturizers (150 [30, 300] g vs. 60 [6, 200] g) and daily frequency of moisturizer use, greater disease awareness, but more severe fear of medication use (all P < 0.05). The region and the human development index level were both significantly associated with the episode frequency (both P < 0.001), with the highest proportion of children from South China in the ≥ 4- episode group (36.3%, 191/526). Children in the ≥ 4-episode group also had a longer duration of topical glucocorticoid use than those in the < 4-episode group ( Z = -2.21, P = 0.027). External triggers associated with AD episodes mainly included heat exposure (50.36%, 486/965), hot water bathing (40.73%, 393/965), seafood (23.52%, 227/965), and dust mites (33.37%, 322/965) . Conclusion:In children with moderate-to-severe AD in China, factors influencing frequent episodes may include residence in southern or economically developed regions, earlier age at onset, having a personal or family history of allergic diseases, and fear of medication use.

This study conducted in-depth interviews to analyze the use of textbooks and learning patterns among medical students from various countries and regions and then proposed loose-leaf digital textbooks as a novel pattern of textbooks. Loose-leaf digital textbooks can meet the requirements of both systematic theoretical education in domestic curricula and the self-directed learning approach in foreign education systems. Compared with traditional textbooks, such digital textbooks have the advantages of flexibility, timeliness, and strong interactivity, thereby enhancing learning efficiency and teaching effectiveness among students. The study further explored the modular design and application strategies for loose-leaf digital textbooks and suggested to achieve personalized education through the integration of digital technologies and improve the adaptability and international competitiveness of textbooks. This study provides innovative ideas for teaching reform in Sino-foreign cooperative education programs of clinical medicine.

Objective:To investigate factors influencing frequent episodes (≥ 4 episodes within 1 year) in children with moderate-to-severe atopic dermatitis (AD) in China.Methods:A national multicenter cross-sectional study was conducted. Patients under the age of 18 years diagnosed with moderate-to-severe AD were enrolled at dermatology clinics in 18 medical institutions across 12 provinces and municipalities in China between June 12 and August 8, 2023. At the time of the visit, their guardians completed a structured questionnaire covering demographic characteristics, clinical features of AD, personal and family history, factors associated with frequent episodes of moderate-to-severe AD, compliance with treatment, and disease awareness. Statistical analyses included t tests, one-way analysis of variance, rank-sum tests, and chi-square tests, with multiple-response analysis applied for multiple-choice questions. Results:A total of 965 valid questionnaires were collected, and 965 children with moderate-to-severe AD were included. Among them, there were 531 males and 434 females, 678 (70.3%) were aged 2 - < 12 years, 837 (86.7%) were from urban areas, the age at onset was 2.47 ± 3.03 years, and the median frequency of AD episodes in the past year was 4 times. These children were divided into 2 groups based on the median episode frequency: < 4-episode group (439 cases, 45.5%) and ≥ 4-episode group (526 cases, 54.5%). Compared with the < 4-episode group, children in the ≥ 4-episode group showed younger ages at onset (2.22 ± 2.98 years vs. 2.76 ± 3.06 years, P = 0.006) and higher proportions of patients with comorbid allergic diseases in both the children themselves (82.9% [436/526] vs. 69.7% [306/439], χ2 = 23.42, P < 0.001) and their relatives (66.0% [347/526] vs. 57.4% [252/439], χ2 = 7.46, P = 0.006). Children in the ≥ 4- episode group also had higher monthly usage of moisturizers (150 [30, 300] g vs. 60 [6, 200] g) and daily frequency of moisturizer use, greater disease awareness, but more severe fear of medication use (all P < 0.05). The region and the human development index level were both significantly associated with the episode frequency (both P < 0.001), with the highest proportion of children from South China in the ≥ 4- episode group (36.3%, 191/526). Children in the ≥ 4-episode group also had a longer duration of topical glucocorticoid use than those in the < 4-episode group ( Z = -2.21, P = 0.027). External triggers associated with AD episodes mainly included heat exposure (50.36%, 486/965), hot water bathing (40.73%, 393/965), seafood (23.52%, 227/965), and dust mites (33.37%, 322/965) . Conclusion:In children with moderate-to-severe AD in China, factors influencing frequent episodes may include residence in southern or economically developed regions, earlier age at onset, having a personal or family history of allergic diseases, and fear of medication use.

This study conducted in-depth interviews to analyze the use of textbooks and learning patterns among medical students from various countries and regions and then proposed loose-leaf digital textbooks as a novel pattern of textbooks. Loose-leaf digital textbooks can meet the requirements of both systematic theoretical education in domestic curricula and the self-directed learning approach in foreign education systems. Compared with traditional textbooks, such digital textbooks have the advantages of flexibility, timeliness, and strong interactivity, thereby enhancing learning efficiency and teaching effectiveness among students. The study further explored the modular design and application strategies for loose-leaf digital textbooks and suggested to achieve personalized education through the integration of digital technologies and improve the adaptability and international competitiveness of textbooks. This study provides innovative ideas for teaching reform in Sino-foreign cooperative education programs of clinical medicine.

Purpose: Effective predictors of the response to neoadjuvant chemotherapy (NAC) are still insufficient. This study aimed to investigate the predictive value of serum lipid profiles for the response to NAC in breast cancer patients. Methods: A total of 533 breast cancer patients who had received NAC were retrospectively studied. The pretreatment of serum lipids, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and lipoprotein-α, and clinicopathological characteristics were collected to assess their predictive roles. Results: Breast cancer patients had significantly lower TC, TG, HDL-C, and LDL-C levels than normal individuals. Among these indicators, TG and LDL-C levels and HDL-C level increased and decreased significantly after NAC, respectively. In estrogen receptor (ER)-positive patients, increased LDL-C level was associated with better outcomes. Moreover, the receiver operating characteristic curve analyses suggested that TG and HDL-C levels at diagnosis can be used as predictors of the response to NAC only in the ER-positive subgroup.According to univariate analyses, patients with low TG level (< 1.155 mmol/L) or high HDL-C level (≥ 1.305 mmol/L) in the ER-positive subgroup had more favorable clinical responses than the other patients in the subgroup. Furthermore, according to multivariate analyses, a high HDL-C level (≥ 1.305 mmol/L, p = 0.007) was an independent predictor of NAC efficacy. Conclusion High HDL-C level (≥ 1.305 mmol/L) before NAC and increased LDL-C level after NAC were associated with the better treatment response in ER-positive breast cancer patients.These results are potentially considered beneficial in establishing treatment decisions.

Objective To discuss the effects of simulation -based team training on early adaptation and stress in patients with permanent intestinal stoma.Methods 164 patients with permanent intestinal stoma were divided into control group(82 cases)and intervention group(82 cases).In control group,routine peri -operational health education was adopted,while in intervention group,health education based simulation -based team training was adopted. Then,the intervention effects of ostomy adjustment inventory and stress distress were evaluated.Results After the intervention,there was significant difference between two groups at the level of ostomy adjustment inventory and stress distress(all P <0.05).Conclusion The simulation -based team training could increase the level of ostomy adjust-ment inventory,but reduce the level of stress distress.

Objective To discuss the effects of 6Emodel on stress distress in patients with colorectal cancer after permanent intestinal stoma and to provide reference for the implementation of psychological intervention. Methods A total of 168 patients with permanent intestinal stoma were divided into control group(85 cases)and intervention group(83 cases).In the control group,routine nursing was adopted,while in intervention group,nursing based 6Emodel (including experience,environment,event,engaging,effect,expand)was adopted.The time of intervention was 1 year,and the psychological distress scale for cancer patients was tested.Results After interven-tion,the psychological distress of the intervention group was (39.62 ±14.62)points,which was lower than (46.21 ± 13.68)points of the control group,the difference was statistically significant between the two groups(t =3.057,P =0.002).Conclusion The 6Emodel can reduce the level of psychological distress of colorectal cancer after per-manent intestinal stoma,and has positive effects on the early distress following stoma.The intervention can be one of the effective ways to implement psychological intervention for patients with stoma.

Objective To investigate the expression patterns and significance of aquaporin 5 (AQP‐5) and multidrug‐resistance associated genes in human colon cancer with different differentiation degree and their correlation .Methods The expression of aqua‐porin 5 and resistance genes P‐gp ,GST‐π,TopoⅡ ,and TS in human 45 cases colon cancer tissues with different differentiation de‐gree and 36 cases of adjacent mucosa tissues as well as 58 cases of normal colonic epithelium were detected by quantitative RT‐PCR ,Western blot and immunohistochemistry .Results Immunohistochemistry results showed that AQP‐5 distributed mainly in the cell membrane and the cytoplasm .Fluorescence quantitative RT‐PCR and Western blot showed that AQP‐5 expression could not be detected in adjacent mucosa tissues and normal colonic epithelium tissues .The AQP‐5 expression level was higher in colon cancer tissues compared with adjacent mucosa tissues and normal colonic epithelium tissues (P<0 .05) ,and the expression intensity was correlated with the differentiation degree of colon cancer tissues (P<0 .05) .The results of immunohistochemistry indicated that P‐gp distributed mainly in the cell membrane and the cytoplasm ,GST‐πmainly distributed in the nuclei and cytoplasm ,Topo Ⅱ main‐ly distributed in the nucleus ,and TS distributed mainly in the cytoplasm .Fluorescence quantitative RT‐PCR and Western blot re‐sults showed that the expression levels of all resistance genes detected were higher in colon cancer tissues compared with adjacent mucosa tissues and normal colonic epithelium tissues (P<0 .05) .Furthermore ,P‐gp ,GST‐π,and Topo Ⅱ expression were negative‐ly correlated with the differentiation degree of colon cancer tissues ,the more poor differentiation level of tissue ,the higher expres‐sion level of P‐gp ,GST‐π ,Topo Ⅱ .However ,the expression level of TS did not change significantly in different differentiation de‐gree colon cancer tissues (P>0 .05) .Positive correlation was found between the expression of AQP‐5 and P‐gp ,GST‐π,Topo Ⅱ(P<0 .05) .Negative correlation was found between the expression of AQP‐5 and TS (P>0 .05) .Conclusion The AQP‐5 and re‐sistance gene expression were increased in colon cancer tissues .The AQP‐5 expression level was higher in colon cancer compared with adjacent control or normal tissues ,which may promote the transfer and progress of colon cancer .

10.3969/j.issn.1007-3969.2013.04.007