Objective To explore the interaction mechanisms among different dimensions of online learning competence in undergraduates,providing scientific evidence for optimizing software design and online education strategies.Methods A cross-sectional study was conducted with 347 undergraduates from Kunming Medical University via an online questionnaire in October 2024.Reliability testing and exploratory factor analysis were performed using SPSS 26.0,while structural equation modeling was constructed with Amos 24.0.Results Driving force directly and positively influenced regulatory force(β=0.778,P<0.001)and reciprocal force(β=0.302,P=0.003),but had no significant direct effect on adaptive force(β=0.131,P=0.182).Regulatory force and reciprocal force both exerted direct positive effects on adaptive force(β=0.262,P=0.022;β=0.410,P<0.001).The indirect effect of driving force on adaptive force accounted for 78.1%of the total effect(P=0.007),with regulatory force showing a significant mediating role(β=0.178,P=0.023),while reciprocal force alone did not(β=0.108,P=0.060).A chain mediating effect(driving force→regulatory force→reciprocal force→adaptive force)was confirmed(β=0.124,P=0.004).Conclusion Driving force serves as the core of online learning competence,and adaptive capacity is enhanced through regulatory and reciprocal forces.To promote knowledge internalization and adaptability,it is required to optimize feedback mechanisms and deepen interactive designs in online learning platforms.

Background Arsenic exposure is a common and important environmental and occupational hazardous factor in China, and arsenic-induced insulin resistance (IR) has attracted widespread attention as a negative health outcome to the population. Objective To explore part of the mechanism of hepatic IR induced by arsenic exposure based on the peroxisome proliferators-activated receptors γ (PPARγ)/ glucose transporter 4 (GLUT4) pathway, and to investigate potential effects of Ginkgo biloba extract (GBE) on hepatic IR induced by arsenic exposure and associated mechanism of action. Methods The target of drug action was predicted by network pharmacology and verified by in vivo and in vitro experiments. In vivo experiments: 48 SPF C57BL/6J male mice were divided into 4 groups, including control group, 50 mg·L⁻¹ NaAsO₂ model group (NaAsO₂), 50 mg·L⁻¹ NaAsO₂+10 mg·kg⁻¹ GBE intervene group (NaAsO₂+GBE), and 10 mg·kg⁻¹ GBE group (GBE), 12 mice in each group. The animals were given free access to purified water containing 50 mg·L⁻¹ NaAsO₂, or given intraperitoneal injection of normal saline containing 10 mg·kg⁻¹ GBE once per week. After 6 months of exposure, blood glucose detection, intraperitoneal glucose tolerance test (IPGTT), and insulin tolerance test (ITT) were performed. Serum and liver tissues were collected after the mice were neutralized, liver histopathological sections were obtained, serum insulin levels, liver tissue glycogen content, glucose content were detected by enzyme linked immunosorbent assay (ELISA), and the expression of PPARγ and GLUT4 proteins was detected by Western blot (WB). In vitro experiments: HepG2 cells were divided into 4 groups, including control group, 8 μmol·L⁻¹ NaAsO₂ group (NaAsO₂), 8 μmol·L⁻¹ NaAsO₂ + 200 mg·L⁻¹ GBE intervene group (NaAsO₂+GBE), and 200 mg·L⁻¹ GBE group (GBE). The levels of glycogen and glucose were detected by ELISA, and the expression of PPARγ and GLUT4 proteins was detected by WB. Results A strong binding effect between GBE and PPARγ was revealed by network pharmacology. In in vivo experiments, the NaAsO₂ group exhibited an elevated blood glucose compared to the control group, and the NaAsO₂+GBE group showed a decreased blood glucose compared to the NaAsO₂ group (P<0.01). The histopathological sections indicated severe liver structural damage in the arsenic exposure groups (NaAsO₂ group and NaAsO₂+GBE group), with varying staining intensity, partial liver cell necrosis, and diffuse red blood cell appearance. Both results of in vitro and in vivo experiments showed a decrease in glycogen synthesis and glucose uptake in the NaAsO₂ groups compared to the control groups, which was alleviated in the NaAsO₂+GBE group (P<0.01). The results of WB revealed inhibited PPARγ expression and reduced GLUT4 levels on the cell membrane, and all these changes were alleviated in the NaAsO₂+GBE group (P<0.01). Conclusion This study findings suggest that GBE antagonizes arsenic exposure-induced hepatic IR by regulating the PPARγ/GLUT4 pathway, indicating that GBE has a protective effect on arsenic exposure-induced hepatic IR, and PPARγ may be a potential therapeutic target for arsenic exposure-induced hepatic IR.

Objective:To explore the long-term efficacy of laparoscopic fundoplication for proton pump inhibitor dependent gastroesophageal reflux disease (GERD).Method:Clinical data of proton pump inhibitor dependent GERD patients who underwent fundoplication at the Rocket Force Characteristic Medical Center from Jan to Jun 2012 were analyzed, including GERD symptom score, subjective symptom relief rate, PPI discontinuation rate and surgical satisfaction, as well as recurrence and complications.Result:A total of 160 GERD patients were included in this study, with 64% of patients having respiratory symptoms. Nissen and Toupet fundoplication were performed in 43 and 117 cases, respectively, with a follow-up time of (127±3) months. The postoperative GERD symptom scores of the patients were significantly lower than before treatment (all P<0.001); The subjective relief of overall symptoms in the digestive tract and airway problem was 90% (80%, 100%) and 100%, respectively. The PPI discontinuation rate was 86%, and the overall satisfaction rate of the treatment was 92%, and the satisfaction rate of patients with respiratory symptoms was 89%. 7% of patients experienced varying degrees of symptomatic recurrence, 4% of patients re-underwent endoscopic treatment and/or laparoscopic fundoplication due to symptom recurrence. The incidence of long-term postoperative dysphagia, bloating, belching, increased exhaust, abdominal pain, diarrhea, and constipation were 11.3%, 16.9%, 0, 1.3%, 0, 2.5%, and 5.6%, respectively. Conclusions:Laparoscopic fundoplication has good long-term efficacy in the treatment of GERD. A small number of patients may experience postoperative recurrence, as well as complications such as dysphagia and gas-bloat syndrome. Most recurrent patients can achieve good therapeutic effect by redoing endoscopic treatment or redoing surgery.

Objective:To analyze the new value of gastroscopy in the diagnosis of esophageal hiatal hernia(EHH).Methods:From March 7 to September 24 in 2019, 194 patients with gastroesophageal reflux disease who received endoscopy and high resolution esophageal manometry (HREM) at the Department of Gastroesophageal Surgery, the PLA Rocket Force Medical Center were selected. The transverse diameter of esophageal hiatus and the upward length of esophagogastric junction (EGJ) were measured under endoscopy, and the relevant data of reflux esophagitis (RE) and length and pressure of lower esophageal sphincter (LES) were collected. The value of traditional method under endoscopy and esophageal hiatus transverse diameter (EHTD) method under endoscopy in the diagnosis of EHH was compared. Independent sample- t test, rank sum test and chi-square test were used for statistical analysis. Results:The detection rate of EHH by EHTD method under endescopy was higher than that by traditional method under endoscopy and HREM method (60.8%, 118/194 vs. 14.9%, 29/194 and 37.1%, 72/194), and the detection rate of EHH by HREM method was higher than that by traditional method under endoscopy, and the differences were statistically significant ( χ2=86.75, 21.82, and 24.75; all P<0.001). The proportion of RE, the upward length of EGJ and the transverse diameter of esophageal hiatus of EHH patients diagnosed by traditional method under endoscopy and EHTD method under endoscopy were all higher than those of non-EHH patients (79.3%, 23/29 vs. 28.5%, 47/165; 49.2%, 58/118 vs. 15.8%, 12/76; 2.0 (2.0, 3.0) cm vs. 0.4(0, 0.7) cm, 0.7(0, 1.6) cm vs. 0(0, 0.6) cm; (2.60±0.71) cm vs. (1.88±0.44) cm, (2.30±0.45) cm vs. (1.51±0.29) cm); the minimum resting pressure of LES and resting pressure of LES were both lower than those of non-EHH patients(3.7(0.3, 12.1) mmHg (1 mmHg=0.133 kPa) vs. 9.1(3.3, 14.2) mmHg, 6.4(2.2, 12.5) mmHg vs. 10.8 (4.7, 15.5) mmHg; (9.70±7.92) mmHg vs. (14.92±10.30) mmHg, (11.36±7.79) mmHg vs. (18.44±11.78) mmHg); the length of intraperitoneal LES were shorter than that of non-EHH patients (0(0, 1.4) cm vs. 1.1(0, 1.7) cm, 0.3(0, 1.5) cm vs. 1.3(0.4, 1.8) cm); the length of LES of EHH patients diagnosed by EHTD method under endoscopy was shorter than that of non-EHH patients ((2.83±0.63) cm vs. (3.10±0.66) cm), and the differences were statistically significant ( χ2=26.53 and 22.31, Z=-8.26 and-5.04, t=5.26 and 13.67, Z=-2.14 and-2.71, t=-2.59 and-4.63, Z=-2.58 and-3.60, t=-2.96; all P<0.05). There were no significant differences in gender, LES length, intraperitoneal LES length, minimum resting pressure of LES, resting pressure of LES and residual pressure of LES between EHH patients diagnosed by EHTD method and traditional method under endoscopy (all P>0.05). Conclusions:Endoscopy plays a significant role in the diagnosis of EHH. EHTD method under endoscopy is more accurate in the diagnosis of sliding EHH, which is worthy of clinical reference.

Objective To establish an immortalized tree shrew corneal stromal cells(CSCs)line and to study its response to virus infection.Methods Primary tree shrew CSCs were isolated and cultured by the tissue block adhesion method.CSCs were then transfected with a lentivirus carrying the SV40T gene and monoclonal cells were selected for passage culture.The characteristics of the CSCs were investigated by morphological observation and compared with 40 generations until the 50 generations or more,immunofluorescence identification of vimentin and SV40T genes,karyotype examination,and cell proliferation curve.The CSCs were infected with herpes simplex virus-1(HSV-1)(McKrae strain),Zika virus(ZIKV,GZ01 strain),Dengue virus typeⅡ,and H1N1(PR8).Results The immortalized tree shrew CSCs after＞50 passages appeared spindle-shaped with good cell morphology and structure compared with 40 generations.Positive immunofluorescence expression of vimentin and SV40T genes.The cell growth curve showed that the cells were in logarithmic-phase growth on days 4～5 and grew vigorously.The number of chromosomes in the primary cells was stable at 62,while immortalized CSCs had 64 chromosomes at P21 and P56.The virus titer results showed that the immortalized tree shrew CSCs were sensitive to HSV-1(McKrae strain),ZIKV(GZ01 strain),Dengue virus typeⅡ,and H1N1(PR8),with virus titers of 1.32×105,5.62×106,2.69×107,and 7.76×104 CCID50/mL,respectively.Conclusions The immortalized tree shrew CSCs were established successfully,suggesting that this cell line is suitable for studies of the mechanisms of HSV,ZIKV,Dengue virus,and influenza A virus infection in relation to corneal diseases and antiviral drugs.

ObjectiveTo compare the brain imaging characteristics in patients with knee osteoarthritis (KOA) and low back pain (LBP) based on amplitude of low frequency fluctuation (ALFF) of functional magnetic resonance imaging. MethodsFrom August, 2015 to September, 2021, 16 KOA patients and 16 healthy subjects (controls 1) with similar age and gender were recruited from the communities of Fuzhou, Fujian. Other 27 patients with LBP and 32 healthy subjects (controls 2) with similar age and gender were obtained from the Openpain database. The ALFF were analyzed. KOA patients were assessed the pain with Brief Pain Inventory (BPI), and LBP patients were assessed with Visual Analogue Scale (VAS). The correlation between ALFF and pain scores was analyzed. ResultsCompared with their own controls, the ALFF decreased in the left anterior insula for both KOA and LBP patients. The ALFF decreased in the hippocampus and posterior cingulate cortex in KOA patients, while increased in LBP patients. ALFF in the left precuneus, left middle cingulate cortex and right periaqueductal gray matter decreased in KOA patients, and ALFF increased in the right precentral/postcentral gyrus. ALFF of bilateral anterior cingulate cortex, bilateral orbital anterior frontal cortex, left dorsolateral prefrontal cortex and right medial prefrontal cortex decreased in LBP patients, and ALFF increased in the right parahippocampal gyrus and right amygdala. ALFF of the left middle cingulate cortex negatively correlated with BPI score in KOA patients (r = -0.73, P = 0.003), and ALFF of the right hippocampus/amygdala positively correlated with VAS score in LBP patients (r = 0.73, P = 0.003). ConclusionThere are common and specific brain imaging features in different types of chronic pain. The alteration in the left anterior insula, hippocampus and posterior cingulate gyrus may be the common mechanism for KOA and LBP.

Objective:To systematically evaluate the effect of couple-centered psychological intervention on breast cancer patients.Methods:Randomized controlled trials published in PubMed, Embase, Web of Science, Scopus, CINAHL, Cochrane Library, JBI, CNKI, Wanfang, Vip and CBM database on the effect of psychological intervention on breast cancer patients with husband and wife as the center were searched by computer. The retrieval time was from the establishment of the database to September 2020. Two reviewer independently conducted literature screening, data extraction and literature quality evaluation according to the inclusion and exclusion criteria, and Meta analysis was carried out using RevMan 5.3 software.Results:A total of 879 patients were included in 11 articles. Meta analysis results showed that the couple-centered psychological intervention not only improved the quality of life, but also improved the anxiety of breast cancer patients ( SMD=1.54, 95% CI 0.22-2.86, P=0.02) and depression ( SMD=1.22, 95% CI 0.12-2.33, P=0.03). Conclusions:After psychological intervention, the anxiety and depression of breast cancer patients were improved and the quality of life was also improved. Due to the inconsistency in the mode, frequency and evaluation index of psychological intervention, more large samples and high-quality studies are needed to further verify the effect of couple-centered psychological intervention on breast cancer patients and spouses centered on husband and wife.

Objective:To construct an evaluation index system for the elderly stressors, so as to provide a basis for comprehensive and effective stressor assessments for the elderly.Methods:With the bio-psycho-social medicine model as the theoretical guide, the first draft of the evaluation index system for the elderly stressors was drawn up through the literature analysis and the semi-structured interview. The Delphi method was used to conduct two rounds of expert consultations to 13 experts. The analytic hierarchy process was used to determine all levels of indicators and their weights.Results:In two rounds of expert consultations, the expert positive coefficients were 86.67% and 100.00% respectively, and the authority coefficients were both 0.889, and the Kendall coordination coefficients were 0.339 and 0.361 respectively ( P<0.05) . The evaluation index system for the elderly stressors included 4 first-level indicators, 12 second-level indicators and 65 third-level indicators. Conclusions:The evaluation index system for the elderly stressors based on the Delphi method is scientific and practical, and can provide a unified standard for the evaluation of the elderly stressors.

Objective To establish a Real-time quantitative PCR method (qPCR) for the detection of diatom UPA barcoding genes and evaluate its application in the drowning diagnosis. Methods The homologous sequences of diatoms UPA gene was obtained by Blast from GeneBank, based on which the universal primers for diatoms were designed. DNA were extracted from 2 common human symbiotic bacteria (Escherichia coli, Bifidobacterium longum), 3 species of planktonic bacteria, 15 species of planktonic algae, tissue samples (lung, liver and kidney) from human cadavers (28 drowning victims, 1 victims by non-drowning in the water, 3 victims deaths on land) in 32 cases. The specificity, sensitivity and repeatability of the designed primers were tested. The positive rates of diatoms detection in the drowning cases were calculated. The results of the real-time quantitative method were evaluated comparatively by Microwave Digestion-Vacuum Filtration-Automated Scanning Electron Microscopy (MD-VF-Auto SEM) and PCR-Capillary Electrophoresis (PCR-CE). Results The results showed that the primers UPA99 had strong specificity for the diatomaceae (Synedra radians, Navicula sp., Melosira varians, Cyclotella sp. and Nitzschia sp.) DNA. The melting curve of the amplified product was smooth; the peak was narrow; the melting temperature was (87±1)℃. The sensitivity of qPCR method was 1.56×10-5ng/μL with the detection range of 1.56×102ng/mL~1.56×10-5ng/μL, in contrast with the PCR-CE method (1.56×10-3ng/μL). This real-time PCR method showed high repeatability and stability with the coefficient of variation less than 2%. The detection rate of lung, liver and kidney was 89.3%, 71.4% and 64.3% respectively. Conclusion The established qPCR method, based on the universal primers designed for diatom UPA gene, has high specificity, high sensitivity and good repeatability. With a promising prospect for application, qPCR is suitable for drowning diagnosis.

Objective: To investigate the effect of transcatheter arterial chemoembolization(TACE) combined with three dimensional conformal radiotherapy(3-DCRT) and hyperthermia on inoperable primary hepatic carcinoma. Methods: This study retrospectively analyzed 96 patients with hepatic carcinoma in the Third Hospital of Chengde between 2014 and 2017 who received TACE or combined therapy (TACE combined with 3-DCRT and hyperthermia). Kaplan-Meier curve was used to compare the overall survival(OS) of the two groups. Results: There were 50 cases in the combined therapy group, 46 cases in the TACE group.The effective rate of the combined therapy group was 76.1%, and that of TACE group was 45.6%, the difference was statistically significant(P=0.028). The overall 6-, 12- and 18-month survival rates of the combined therapy group were 98.0%, 89.9% and 63.1%, respectively, which in the TACE group were 91.3%, 67.3% and 46.8%, respectively, the difference between the two groups was significant(χ²=7.836, P=0.005). The incidence of adverse effect of the combined therapy group was low, only 2 patients(4.0%) developed radiation-induced liver disease(RILD), and the liver function recovered to the normal level after 8 weeks. Conclusion TACE combined with 3-DCRT and hyperthermia is more effective than TACE alone for inoperable primary hepatic carcinoma, and with a low incidence of adverse effect.