ObjectiveTo investigate the association between endothelin receptor type A gene （EDNRA） and congenital bilateral absence of the vas deferens （CBAVD）. MethodsThis case-control study consisted of 124 subjects with CBAVD and 100 fertile controls.Two single nucleotide polymorphisms （SNPs： rs5335 and rs1801708） in the EDNRA gene were genotyped via PCR， PCR-RFLP analysis， and direct sequencing. ResultsNo significant differences existed between EDNRA polymorphisms and CBAVD phenotype （rs1801708： P=0.220 2， 0.163 2； rs5335： P=0.805 8， 0.818 6）. However， the rs1801708-rs5335 haplotype AG was notably associated with an increased risk of CBAVD （P=0.008 6， OR=2.178， 95% CI： 1.207-3.929）. A significantly protective effect of rs1801708-rs5335 haplotype GG on CBAVD （P=0.038 5， OR= 0.671， 95% CI： 0.460-0.980） was observed. After Bonferroni correction， the result for haplotype A-G remained significant （P =0.008 6<0.012 5）， while haplotype G-G was not significant. ConclusionThe rs1801708-rs5335 AG haplotype of EDNRA is a potential risk factor for CBAVD development in Han Chinese.

Objective:To explore the impact of National Metabolic Management Center (MMC) mode on the metabolic indexes in different age patients with type 2 diabetic mellitus (T2DM).Methods:A prospective study method was used. A total of 798 T2DM patients underwent the MMC mode management in Shanghai Punan Hospital of Pudong New District from May 2021 to August 2024 were selected. The patients followed the MMC one-stop diagnosis and treatment management service standards to enter the registration, treatment, examination and follow-up processes. The average follow-up time was 12.0 months. The glucose and lipid metabolism indexes, blood pressure and body mass index (BMI) before intervention and after receiving the intervention by MMC were measured. The glucose and lipid metabolism indexes included triacylglycerol, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin. The control rates of blood glucose, blood lipid, blood pressure and BMI were calculated after intervention.Results:The triacylglycerol, total cholesterol, LDL-C, fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin after intervention in patients with T2DM were significantly lower than those before intervention: (1.75 ± 1.63) mmol/L vs. (2.08 ± 1.74) mmol/L, (4.37 ± 1.11) mmol/L vs. (4.88 ± 1.24) mmol/L, (2.47 ± 0.92) mmol/L vs. (2.92 ± 0.98) mmol/L, (6.54 ± 1.71) mmol/L vs. (8.12 ± 3.05) mmol/L, (9.04 ± 3.49) mmol/L vs. (12.10 ± 5.28) mmol/L and (6.89 ± 1.23)% vs. (8.85 ± 2.31)%, the HDL-C after intervention was significantly higher than that before intervention: (1.21 ± 0.31) mmol/L vs. (1.13 ± 0.29) mmol/L, and there were statistical differences ( P<0.01). The control rates of blood lipid and blood glucose after intervention in patients with T2DM were significantly higher than those before intervention: 54.6% (436/798) vs. 37.3% (298/798) and 62.0% (495/798) vs. 26.1% (208/798), and there were statistical differences ( P<0.01); there were no statistical differences in the control rates of BMI and blood pressure before intervention and after intervention ( P>0.05). In T2DM patients with age <50 years and from 50 to 59 years, the triacylglycerol, total cholesterol, LDL-C, fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin after intervention were significantly lower than those before intervention, the HDL-C after intervention was significantly higher than that before intervention, and there were statistical differences ( P<0.05 or <0.01); the control rates of blood lipid and blood glucose after intervention were significantly higher than those before intervention, the patients with <50 years: 44.5% (114/256) vs. 27.7% (71/256) and 76.6% (196/256) vs. 28.9% (74/256), the patients with 50 to 59 years: 54.8% (86/157) vs. 28.0% (44/157) and 66.9% (105/157) vs. 24.8% (39/157), and there were statistical differences ( P<0.01); there were no statistical differences in the control rates of BMI and blood pressure between before intervention and after intervention ( P>0.05). In T2DM patients with age from 60 to 69 years, the triacylglycerol, total cholesterol, LDL-C, fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin after intervention were significantly lower than those before intervention, and there were statistical differences ( P<0.05 or <0.01); there was no statistical differences in HDL-C before intervention and after intervention ( P>0.05); the control rates of blood lipid and blood glucose after intervention were significantly higher than those before intervention: 59.0% (177/300) vs. 47.3% (142/300) and 53.3% (160/300) vs. 25.7% (77/300), and there were statistical differences ( P<0.01); there were no statistical differences in the control rates of BMI and blood pressure before intervention and after intervention ( P>0.05). In T2DM patients with aged ≥70 years, the total cholesterol, LDL-C, 2 h postprandial blood glucose and glycated hemoglobin after intervention were significantly lower than those before intervention, and there were statistical differences ( P<0.05 or <0.01); there were no statistical difference in triacylglycerol, HDL-C and fasting blood glucose between before intervention and after intervention ( P>0.05); the control rate of blood glucose after intervention was significantly higher than that before intervention: 48.2% (41/85) vs. 22.4% (19/85), and there was statistical difference ( P<0.01); there were no statistical differences in the control rates of BMI, blood pressure and blood lipid between before intervention and after intervention ( P>0.05). Conclusions:The intervention based on MMC mode management could effectively improve the glucose and lipid metabolism in patients with T2DM, especially for patients with aged <70 years. However, additional health guidance is needed for patients with aged ≥ 70 years to further enhance their health benefits.

Objective To explore the role and mechanism of warm malate ringer's solution(MR)in resuscitation of the lethal triad caused by severe trauma.Methods A rat model of severe trauma was established in SPF-grade SD rats(half male and half female,weighing 200～220 g)using combined multiple injuries and hemorrhagic shock,and the rats were randomly divided into 8 groups(n=8):Sham group,only arterial and venous catheterization;Trauma(Tra)groups with different time points(10,30,60,90,120,180 min)and a Trauma group that were observed without any treatment for 180 min after model establishment.The changes of activated clotting time(ACT),reaction time(R),maximum amplitude(MA),and rate of blood clot formation(Angle)at different time points were detected by using thromboelastography,and tail bleeding,core body temperature and arterial blood gas parameters,were also observed and detected.The plasma von Willebrand Factor(vWF)level,mitochondrial respiratory control ratio in pulmonary venous endothelium,and expression levels of vascular endothelial cadherin(VE-Cadherin),peroxisome proliferator activating receptor gamma coactivator 1α(PGC1α),dynamin-related protein 1(Drp1),p-Drp1,and mitofusin 2(Mfn2)were detected to evaluate the vascular endothelial injury and mitochondrial dysfunction.Another group of SD rats were randomly divided into severe trauma group(no treatment for 180 min after injury),and MR solution at room temperature and at 37 ℃ groups.MR solution at room temperature or at 37 ℃ was given to the rats using a medical blood transfusion apparatus at 60 min post-trauma.Above indicators were observed and detected to investigate the resuscitation effect of the MR solution.Results Compared with the Sham group,the severely traumatic rats at 180 min after injury had significantly prolonged ACT and R values(P＜0.05),shortened MA and decreased Angle values(P＜0.05),extended tail bleeding time(P＜0.05),lower partial pressure of carbon dioxide(PCO2)and HCO3-and base excess(BE)levels(P＜0.05),and continuously increasing K+(P＜0.05)and decreasing Na+(P＜0.05)and Ca2+levels(P＜0.05).Additionally,plasma vWF level(P＜0.05)and protein levels of VE-cadherin,PGC1α and Mfn2 in pulmonary vein endothelium were significantly reduced(P＜0.05),the expression of p-Drp1 was enhanced and the mitochondrial respiration control rate was declined in the rats at 180 min after injury(P＜0.05).MR solution resuscitation shortened tail bleeding time(P＜0.05),increased core body temperature(P＜0.05),elevated plasma vWF level(P＜0.05),increased protein levels of VE-cadherin,PGC1α and Mfn2(P＜0.05),and decreased that of p-Drp1 protein expression(P＜0.05)when compared with the rats at 180 min after severe traumatic injury.The above effects were more significant in the rats infused with the solution at 37 ℃ than those at room temperature.Conclusion Warm MR solution significantly improves the lethal triad in rats after severe trauma,which may be associated with its improving mitochondrial function and attenuating vascular endothelial damage.

Purpose To investigate the value of intratumoral and peritumoral radiomics features based on multi-parametric MRI for preoperative prediction of lymphovascular invasion(LVI)in clinical lymph node-negative(cN0)breast cancer.Materials and Methods This retrospective study included 280 patients with pathologically confirmed breast cancer who underwent preoperative MRI at Henan Provincial People's Hospital from January 2017 to May 2021.Patients were randomly divided into a training cohort and a testing cohort.After Z-score normalization,feature selection was performed using Select K Best and least absolute shrinkage and selection operator regression.Random forest algorithms were used to construct intratumoral,peritumoral,and combined intratumoral-peritumoral radiomics models for LVI prediction.Model performance and clinical utility were evaluated using the area under the receiver operating characteristic curve(AUC),calibration curves and decision curve analysis.Results High Ki-67 expression(≥20%),axillary lymph node metastasis and positive diffusion weighted imaging(DWI)margin sign were more common in the LVI-positive group(χ2=5.959,18.316,20.554,all P<0.05).In the testing cohort,the AUC values of the dynamic contrast-enhanced(DCE)-Intra and DCE-Com models for predicting LVI status were higher than those of the DWI sequence,whereas the AUC value of the DWI-Peri model was higher than that of the DCE sequence.The DWI-DCE-Com model achieved AUCs of 0.836 and 0.818 in the training and testing cohorts,respectively,which surpassed the predictive performance of single-sequence intratumoral-peritumoral radiomics models(DWI-Com,DCE-Com).Decision curve analysis showed that the DWI-DCE-Com model provided greater net clinical benefit across a reasonable range of threshold probabilities.Conclusion Radiomics models based on multiparametric MRI features from intratumoral and peritumoral regions can effectively predict LVI status in cN0 breast cancer,offering valuable support for preoperative individualized treatment decision-making.

Objective:To investigate whether killer immunoglobulin-like receptor(KIR)genotypes and haplotype are associated with the dry eye disease(DED)in a Chinese Han population.Methods:Polymerase chain reaction with sequence-specific primers(PCR-SSP)method was used to genotype KIR genes in 106 DED patients and 220 healthy controls.Results:A total of 23 KIR geno-types were found in DED patients and healthy controls,including 10 newly discovered KIR genotypes.The genotype G and haplotype 4 were associated with respectively increased risk of DED(P=0.025,P=0.004);while the haplotype 2 appeared to have an inverse asso-ciation with the disease(P=0.016).The frequency of KIR genotype B/B in DED patients was also significantly higher than that in con-trol group(P=0.027).KIR haplotype A and B had distinctive centromeric(Cen)and telomeric(Tel)gene-content motifs,and the Cen-B/B was associated with increased risk of DED(P=0.037).Conclusion:There may be an association between KIR genotype and hap-loid type with DED in Han population.

Objective To design and evaluate the clinical application efficacy of a novel bilateral-separation endotracheal tube fixation device and provide references for clinical practice.Methods Using convenient sampling,60 patients from the Neurological Intensive Care Unit of a tertiary-level hospital in Zhengzhou were selected from May to December 2024.Patients were randomly divided into an experimental group(n=30)and a control group(n=30).The experimental group utilized the novel bilateral-separation endotracheal tube fixation device,while the control group employed traditional bandage fixation methods.Differences in fixation time,tube displacement,and intubation duration were compared between the 2 groups.Results The experimental group demonstrated significantly shorter tube fixation times compared to the control group(P＜0.05).However,no statistically significant differences were observed between the groups regarding intubation duration and tube displacement(P＞0.05).Conclusion The novel bilateral-separation endotracheal tube fixation device can reduce tube fixation time for patients in neurological intensive care and enhance nurse satisfaction.Despite not showing advantages in preventing tube displacement,the device still presents promising potential for broad clinical application.

Objective:To analyze the changes of chronic disease treatment cost in Shanxi,to clarify priorities in chronic disease prevention and control,and provide recommendations for optimizing chronic disease prevention policies.Methods:"SHA 2011"accounting framework was used to measure the change of chronic disease treatment costs.Results:The proportion of chronic diseases in treatment cost remained at about 70%.The proportion of chronic disease treatment cost in general hospital is the highest.The proportion of chronic disease treatment expenses of 45-59 years old is second only to that of 60-74 years old.The proportion of treatment expenses for circulatory diseases should be kept above 25%;the main sources of financing is social medical insurance.Conclusion:The avoidable hospitalization cost of chronic diseases is high.The cost of chronic disease treatment is becoming younger.The health financing structure of chronic diseases tends to be reasonable.In order to further improve the prevention and control effect of chronic diseases and the efficiency of the use of chronic disease resources in Shanxi,it is necessary to improve the effectiveness of key policies,reduce the incidence of chronic diseases;improve the medical insurance reimbursement policy,optimize the use of inpatient services;strengthen the urban medical alliances,guide key groups to seek medical treatment reasonably;optimize the financial compensation and medical insurance payment policy,and improve the multi-channel financing mechanism

Objective:To explore the psychological experience of ICU nurses caring for young patients with suicide attempts in a general hospital, and to lay a foundation for the study of psychological adjustment and intervention for ICU nurses.Methods:Twelve ICU nurses who had experience of caring for suicide attempted- young patients from Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University were selected by using descriptive qualitative research method and the maximum difference method of the purposive sampling during October to December in 2023, and semi-structured in-depth personal interviews were conducted. Traditional content analysis method was used to sort out and analyze the data and extract the themes.Results:A total of 12 nurses completed the interview, 5 males, 7 females, aged 23-38(29.33 ± 4.14) years, three themes and seven sub-themes were extracted: psychological characteristics of care (avoidance of active communication, fear of care, empathy); the support required for nursing care (support from colleagues; support from nursing managers); self-growth after caregiving (self-growth in terms of life and death, and self-growth in terms of children′s education).Conclusions:ICU nurses have a certain degree of psychological pressure when taking care of young patients with suicide attempts, which will produce empathy for patients and affect their self-values. At the same time, they need support from colleagues and nursing managers. Therefore, general hospitals should pay attention to the psychological state of ICU nurses, carry out the targeted communication training and mental health support for ICU nurses, and help them gain positive nursing career growth and values.

Objective:To investigate whether killer immunoglobulin-like receptor(KIR)genotypes and haplotype are associated with the dry eye disease(DED)in a Chinese Han population.Methods:Polymerase chain reaction with sequence-specific primers(PCR-SSP)method was used to genotype KIR genes in 106 DED patients and 220 healthy controls.Results:A total of 23 KIR geno-types were found in DED patients and healthy controls,including 10 newly discovered KIR genotypes.The genotype G and haplotype 4 were associated with respectively increased risk of DED(P=0.025,P=0.004);while the haplotype 2 appeared to have an inverse asso-ciation with the disease(P=0.016).The frequency of KIR genotype B/B in DED patients was also significantly higher than that in con-trol group(P=0.027).KIR haplotype A and B had distinctive centromeric(Cen)and telomeric(Tel)gene-content motifs,and the Cen-B/B was associated with increased risk of DED(P=0.037).Conclusion:There may be an association between KIR genotype and hap-loid type with DED in Han population.

Objective:To investigate the relationship among social support, anxiety and cancer pain behavior in patients undergoing radiotherapy for advanced colorectal cancer, and to explore the mediating role of social support between anxiety and cancer pain behavior.Methods:A sample of 100 patients with advanced colorectal cancer admitted to the Oncology Radiotherapy Department of the Affiliated Hospital of Jiangnan University was recruited from March 2021 to March 2023. The hospital anxiety and depression scale (HADS), perceived social support scale (PSSS) and visual analogue scale (VAS) were utilized to assess patients' anxiety levels, individually perceived levels of social support and cancer pain intensity.The SPSS 25.0 software and AMOS 26.0 software were used for data analysis.Pearson correlation analysis was conducted to examine the relationships between these variables, and the Bootstrap method was employed to investigate the mediating role of social support in the relationship between anxiety and cancer pain behavior.Results:The patients' HADS anxiety score was (10.63±2.56), VAS pain score was (5.31±1.92), and PSSS social support score was (56.19±6.28). Pearson correlation analysis showed that anxiety was positively correlated with cancer pain behavior ( r=0.785, P<0.001), and social support was significantly correlated with both anxiety ( r=0.671) and cancer pain behavior ( r=0.672) (both P<0.001). Structural equation modeling indicated that social support partially mediated the relationship between anxiety and cancer pain behavior, with an indirect effect value of 0.177 (95% CI=0.033-0.287), accounting for 22.55%(0.177/0.785) of the total effect and the direct effect value was 0.608 (95% CI=0.287-0.642), accounting for 77.45%(0.608/0.785) of the total effect. Conclusion:Social support plays a mediating role in the effect of anxiety on cancer pain behavior in patients with advanced colorectal cancer undergoing radiotherapy. Enhancing social support can effectively alleviate anxiety in patients with advanced colorectal cancer undergoing radiotherapy, thereby alleviating cancer pain behavior, providing a theoretical basis for clinical comprehensive interventions.