Objective:To explore the talent cultivation model of nursing professional group under the 1+X certificate system, to build a talent cultivation system for nursing professional groups with "three progressions, four integrations, and five cocultivation"Methods:From 1 July 2021 to 31 December 2023, built a professional group course system of "mutual sharing of foundations, mutual generation of majors, mutual selection of positions, and progressive improvement of abilities". Aligned course content with X certificate content. Deepen the reform of the three education systems, create a "dual teacher" teaching team that combines full-time and part-time work, and build teaching resources that connect the cloud and the ground. The application effect of this model was evaluated in 2021 nursing majors in Cangzhou Medical College by cluster sampling.Results:There were 748 students majoring in nursing in class of 2021, 150 boys aged 19-22(20.00 ± 1.23), 598 girls, aged 19-21(19.00 ± 2.57). There were 118 students majoring in midwifery in class of 2021, all of them were girls, aged 18-20(18.00 ± 2.11). There were 128 students majoring in rehabilitation therapy technology in class of 2021, 66 boys aged 19-21(19.00 ± 2.11), 62 girls aged 19-21(19.00 ± 2.54). Nursing professional group completed the "Basic Nursing Technology Training Guidance", "Elderly Care" and other 5 self-compiled textbooks, 730 students had participated in the X certificate assessment, 729 students e passed the assessment, the passing rate was 99.9%.Conclusions:The talent cultivation model of "three progressions, four integrations, and five co cultivation" in the nursing professional group can cultivate students′ professional abilities, and cultivate a composite technical and skilled talent with multiple abilities and interconnections in one job.

BACKGROUND: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a severe congenital disorder characterized by vaginal hypoplasia caused by dysplasia of the Müllerian duct. Patients with MRKH syndrome often require nonsurgical or surgical treatment to achieve satisfactory vaginal length and sexual outcomes. The extracellular matrix has been successfully used for vaginal reconstruction. METHODS: In this study, we developed a new biological material derived from porcine vagina (acellular vaginal matrix, AVM) to reconstruct the vagina in Bama miniature pigs. The histological characteristics and efficacy of acellularization of AVM were evaluated, and AVM was subsequently transplanted into Bama miniature pigs to reconstruct the vaginas. RESULTS: Macroscopic analysis showed that the neovaginas functioned well in all Bama miniature pigs with AVM implants. Histological analysis and electrophysiological evidence indicated that morphological and functional recovery was restored in normal vaginal tissues. Scanning electron microscopy showed that the neovaginas had mucosal folds characteristics of normal vagina. No significant differences were observed in the expression of CK14, HSP47, and a-actin between the neovaginas and normal vaginal tissues. However, the expression of estrogen receptor (ER) was significantly lower in the neovaginas than in normal vaginal tissues. In addition, AVM promoted the expression of b-catenin, c-Myc, and cyclin D1. These results suggest that AVM might promotes vaginal regeneration by activating the b-catenin/cMyc/cyclin D1 pathway. CONCLUSION This study reveals that porcine-derived AVM has potential application for vaginal regeneration.

Objective:To investigate the efficacy of Qingruxiao granules combined with tamoxifen in the treatment of breast hyperplasia and its effect on serum hypoxia-inducible factor-alpha (HIF-α), angiopoietin-2 (Ang-2) and prolactin (PRL) levels. Methods:Ninety-eight patients with breast hyperplasia admitted to Xi'an No.3 Hospital from June 2020 to January 2022 were retrospectively included in this study. They were divided into control and observation groups ( n = 49/group) according to different treatments. The control group was treated with tamoxifen alone. The observation group was treated with Qingruxiao granules combined with tamoxifen. Clinical efficacy, symptom score, ultrasound parameters (glandular layer thickness, longest diameter of mass, maximum diameter of hypoechoic area, inner diameter of lactating tube), endocrine hormone levels (estradiol, progesterone, and prolactin), HIF-α, and Ang-2 pre- and post-treatment, as well as the incidence of adverse reactions were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [93.88% (4/49) vs. 77.55%, χ2 = 5.33, P < 0.05). After treatment, breast mass score, breast pain, systemic accompanying symptom, and nipple discharge in the observation group were (1.34 ± 0.29) points, (1.02 ± 0.36) points, (0.68 ± 0.17) points, (0.97 ± 0.15) points, respectively, which were significantly lower than (1.57 ± 0.23) points, (1.45 ± 0.41) points, (0.95 ± 0.26) points, and (1.28 ± 0.26) points, respectively, in the control group ( t = 4.35, 5.52, 6.08, 7.23, all P < 0.001). The glandular layer thickness, the longest diameter of mass, the maximum diameter of hypoechoic area, and the inner diameter of lactating duct in the observation group were (9.45 ± 1.67) mm, (11.46 ± 3.68) mm, (14.37 ± 4.22) mm, and (1.23 ± 0.39) mm, respectively, which were significantly lower than (11.26 ± 2.51) mm, (16.33 ± 4.01) mm, (19.87 ± 5.01) mm, (1.54 ± 0.48) mm in the control group ( t = 4.20, 2.26, 5.88, 3.51, all P < 0.001). Serum estradiol and prolactin levels in the observation group were (122.35 ± 29.76) ng/L and (205.64 ± 36.42) IU/L, respectively, which were significantly lower than (139.76 ± 30.48) ng/L and (251.49 ± 41.87) IU/L in the control group ( t = 2.86, 5.78, both P < 0.05). Serum progesterone level in the observation group was (9.22 ± 1.57) μg/L, which was significantly higher than (7.18 ± 1.21) μg/L in the control group ( t = -7.20, P < 0.05). Serum HIF-α and Ang-2 levels in the observation group were (0.15 ± 0.05) ng/L and (0.98 ± 0.11) ng/L, respectively, which were significantly lower than (0.24 ± 0.07) ng/L and (1.49 ± 0.22) ng/L in the control group ( t = 7.32, 14.51, both P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Qingruxiao granules combined with tamoxifen can effectively improve clinical symptoms, reduce tumor size, regulate endocrine hormone levels, decrease the expression of angiogenic factors in patients with breast hyperplasia, and is highly safe.

Objective:To explore the mechanism of the extraction of Carthami flos in the treatment of chronic alcoholic liver injury based on metabolomics. Methods:The rats were randomly divided into normal group, model group, positive control group and low, medium and high dose groups of the extraction of Carthami flos, with 10 rats in each group. In addition to the normal group, the other groups were gavaged with 8 ml/kg of 56° Niulanshan Baijiu to prepare the rat model with chronic alcoholic liver injury. After the successful modeling, the positive control group was gavaged with 0.36 mg/kg of Hugan tablet, and the low, medium and high dose groups were gavaged with 0.476 7, 1.430 1 and 4.290 3 g/kg of the extraction of Carthami flos respectively, once a day for 21 days. The contents of GPT, GOT, TG and ALP2 in serum were detected by automatic biochemical analyzer, and the effects of the extraction of Carthami flos on chronic alcoholic liver injury in rats were analyzed by Ultra High Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS), cluster analysis, Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA). Results:The levels of GPT [(42.11±6.58)U/L, (42.38±6.58)U/L vs. (49.96±10.70)U/L] and GOT [(104.81±14.70)U/L, (102.91±23.65)U/L vs. (159.66±53.69)U/L] decreased ( P<0.05 or P<0.01), while the levels of TG [(0.85±0.29)U/L, (0.85±0.23)U/L vs.(0.62±0.21)U/L] and ALP2 [(104.53±13.53)U/L, (100.30±17.28)U/L vs.(77.13±12.54)U/L] increased ( P<0.05 or P<0.01); The results of cluster analysis, PCA and OPLS-DA showed that the model group and the high-dose group of the extraction of Carthami flos could be distinguished obviously. A total of 20 chemical markers were obtained in the serum of rats with chronic alcoholic liver injury treated with the extraction of Carthami flos. Among them, the extraction of Carthami flos can down regulate the level of serum linolenic acid triglyceride in rats with chronic alcoholic liver injury and up regulate triglyceride, palmitic acid, lysophosphatidylcholine, palmitoyl ethanolamide, epinephrine, sphingosine, lysophosphingomyelin α-Linolenic acid, docosahexaenoic acid and eicosapentaenoic acid are 10 endogenous metabolites. Conclusion:The treatment of chronic alcoholic liver injury with the extraction of Carthami flos may be related to the regulation of endogenous metabolites docosahexadilute acid, docosapentadilute acid α- Linolenic acid.

A 64-year-old male patient with gastric adenocarcinoma received chemotherapy with oxaliplatin (250 mg intravenous infusion on day 1) and tegafur gimeracil oteracil potassium (60 mg orally twice daily on day 1 to day 14, 21 days as a cycle). One month later, he was given nivolumab immunotherapy (240 mg intravenous infusion on day 1, 14 days as a cycle). On the 2nd day of the 4th cycle of nivolumab treatment (the 44th day after the first dose), the patient developed diarrhea with watery stools, 3 to 4 times a day, accompanied by mild abdominal pain; 3 days later, the diarrhea worsened, showing dark red bloody stools, covered with pus moss, up to 10 times a day, accompanied by obvious abdominal pain. According to colonoscopy and histological examination results, ulcerative colitis (initial onset, total colon, active stage, and severe) was diagnosed, which was considered as a grade 3 immune-related colitis induced by nivolumab. After suspension of chemotherapy and immunotherapy, and administration of glucocorticoids and octreotide, the patient′s abdominal pain and diarrhea were gradually improved. On the 45th day of nivolumab withdrawal, the patient received chemotherapy with oxaliplatin and tegafur gimeracil oteracil potassium again, and colitis did not recur.

A 64-year-old male patient with gastric adenocarcinoma received chemotherapy with oxaliplatin (250 mg intravenous infusion on day 1) and tegafur gimeracil oteracil potassium (60 mg orally twice daily on day 1 to day 14, 21 days as a cycle). One month later, he was given nivolumab immunotherapy (240 mg intravenous infusion on day 1, 14 days as a cycle). On the 2nd day of the 4th cycle of nivolumab treatment (the 44th day after the first dose), the patient developed diarrhea with watery stools, 3 to 4 times a day, accompanied by mild abdominal pain; 3 days later, the diarrhea worsened, showing dark red bloody stools, covered with pus moss, up to 10 times a day, accompanied by obvious abdominal pain. According to colonoscopy and histological examination results, ulcerative colitis (initial onset, total colon, active stage, and severe) was diagnosed, which was considered as a grade 3 immune-related colitis induced by nivolumab. After suspension of chemotherapy and immunotherapy, and administration of glucocorticoids and octreotide, the patient′s abdominal pain and diarrhea were gradually improved. On the 45th day of nivolumab withdrawal, the patient received chemotherapy with oxaliplatin and tegafur gimeracil oteracil potassium again, and colitis did not recur.

Objective:To explore effects of the total number of night shifts on BMI of medical workers in recent 5 years.Methods:This study was a cross-sectional study. Using the convenient sampling method, data of medical workers in Affiliated Hospital of Jining Medical University were collected from January 2016 to December 2020. The medical examination data of medical workers were obtained from the electronic information system of medical examination center, and the number of night shift and basic information of medical workers are extracted from the human resource management department. The covariates in this study included categorical variables and continuous variables. Categorical variables included gender, job title and job type. Continuous variables included age, working years, systolic blood pressure, diastolic blood pressure, white blood cells, red blood cells, hemoglobin, average hemoglobin volume, platelets, ALT, total bilirubin, total protein, albumin, urea, creatinine, uric acid, triacylglycerol, Total cholesterol, HDL-C, LDL-C and glucose. The relationship between the number of night shift and BMI was processed by generalized addition model and smoothing curve fitting.Results:Finally, a total of 908 medical workers were selected for data analysis. The average number of night shifts for 908 medical workers in 5 years was (339.0±30.8) , and the average BMI was (22.88±2.08) kg/m 2. After adjusting for confounding factors, the number of night shift showed a non-linear relationship with BMI, and the number of inflection points was 634. On the left of the inflection point, there was no significant relationship between the number of night shifts and BMI ( P=0.829) . The relationship between the two on the right side of the inflection point was significant, the effect size and 95% confidence interval were 0.02 and 0.01-0.03, respectively. Conclusions:BMI value of medical workers increases significantly with the increase of night shift number when the number of night shift is more than 634 in recent 5 years. Hospital managers can calculate and plan the number of night shifts per year to reduce the effect of night shifts on the health of medical workers.

Objective To investigate the association of Tim-1 protein expression and its gene polymorphism with nutritional parameters in patients with systemic lupus erythematosus (SLE).Methods Peripheral blood samples were collected from 126 patients with SLE.Serum Tim-1 protein levels were detected by ELISA,and the Tim-1 gene-416G＞C,-1454G＞A polymorphism was detected by PCR-RFLP.Prealbumin,ceruloplasmin,and retinol conjugated protein levels were determined by immunoturbidimetry.Ferritin and 1,25-dihydroxy vitamin D3 levels were detected by electrochemiluminescence.Results Concentrations of serum Tim-1 protein,prealbumin,ceruloplasmin,retinol binding protein,ferritin,and 1,25-dihydroxy vitamin D3 were 249.7±30.2 pg/mL,226±42 μg/mL,363±95 μg/mL,29.4± 13.2 μg/mL,355± 164 ng/mL,and 26.4-± 11.5 ng/mL,respectively.In the-416G＞C site,GG,GC,and CC genotypes accounted for 11.9％,57.1％,and 31.0％,respectively.In the-1454G＞A site,GG,GA,and AA genotypes accounted for 67.5％,26.2％,and 6.3％,respectively.The Tim-1 protein concentration did not differ significantly between the different genotypes of the-416G＞C site (F=0.575,P=0.564) or-1454G＞A site (F=1.255,P=0.289).Tim-1 level was significandy negatively correlated with prealbumin (r =-0.176,P =0.033),and positively correlated with ceruloplasmin (r =0.205,P =0.014) and 1,25-dihydroxy vitamin D3 (r=0.166,P=0.042).The serum prealbumin level decreased significantly (P=0.027) in patients harboring the GG genotype in the-1454G＞A site,whereas the serum 1,25-dihydroxy vitamin D3 level decreased significandy (P =0.024) in patients with the AA genotype in the-1454G＞A site.Conclusion Serum Tim-1 protein level and the-1454G＞A polymorphism of Tim-1 gene are associated with the nutritional function of patients with SLE.

Objective To investigate the efficacy of Saxagliptin on the glucose and lipids metabolism and adipokines levels in diet-induced insulin resistance rat,and to explore the regulatory mechanism of saxagliptin in insulin resistance.Methods 36 4-week-old male Wistar rats were randomly divided into two groups:control group (n=12) and high-glucose and fat diet group(HF,n =24).The HF rats were randomly divided into two subgroups:HF group and saxagliptin group,and continued the treatment for 8 weeks.Levels of blood glucose,insulin,triglyceride (TG),total cholesterol (TC),TNF-α and adiponectin were determined.Results After four months,serum levels of fasting glucose,insulin,TG,TC were significantly increased in HF group as compared with control group [(7.07±1.61) mmol/L vs.(5.10±0.44) mmol/L,(23.70±7.37) mU/L vs.(19.35 ± 6.38) mU/L],[(3.21± 1.44) mmol/L vs.(0.83 ± 0.39) mmol/L,(3.04 ± 1.62) mmol/L vs.(1.14±0.24) mmol/L,all P＜0.05],and were all decreased after the treatment of saxagliptin.The glucose infusion rate was lower in HF group than in control group and was higher in saxagliptin group than in HF group [(18.80±1.57) mg · kg-1 · min-1 vs.(24.31±2.65) mg · kg 1 · min 1,(21.45 ±1.80) mg· kg-1 · min-1 vs.(18.80±1.57) mg· kg 1 · min-1,P＜0.01 or 0.05].Compared with the control group,serum THF-α was higher and adiponectin level was lower in HF group [(1.38 ±0.18) μg/L vs.(2.33±0.21)μg/L,(2.65±0.29) mg/L vs.(1.38±0.20)mg/L,both P＜0.01].Saxagliptin can significantly increase the serum level of adiponectin and decrease the level of TNF-α in HF group (P＜0.01 or 0.05).Conclusions Saxagliptin treatment can improve high-fat dietinduced insulin resistance,decrease blood lipids levels and regulate the levels of adipokines in HF rats.

Objective To investigate the changing and correlation between PaCO2 and PETCO2 during laparoscopic colorectal surgery. Methods Thirty ASA Ⅰ-Ⅱ patients scheduled for laparoscopic colorectal surgery were accepted general anesthesia and trachea cannula. Hemodynamic measurements, respiratory parameters and artery blood gas analysis were drawn at 5 min after intubating, 5 min, 30 min and 60 min after pneumoperitoneum, before the side-incisions were opened and the end of operations. Results The operation time was (216.1±39.1) min, pneumoperitoneum time was (117.3±11.5) min. Comparing to the data after pneumoperitoneum, there were differences among the parameters of circulating dynamics, but the values were acceptable, pH was decreasing with time, except 5 min after pneumoperitoneum, it was significantly decreased 30 min after pneumoperitoneum until the end of operations, compared with pre-intlation value (P<0.01), pH withdrawn a little at the end of the operations. The PETCO2 and PaCO2 at different times after pneumoperitaneum were significantly higher compared with pre-inflation value (P<0.05 or<0.01). They were increasing with the time of pneumoperitoneum, and withdrawn a little at the end of the operations. There was a good correlation between PETCO2 and PaCO2, although the correlation was worst after deflation. Conclusions The circulation dynamics are stable, the correlation of PETCO2 and PaCO2 is good during the laparoscopic colorectal surgery, PaCO2 may exceed the normal value after long-term of penumoperitoneum. It is necessary to monitor the blood gas analysis during such surgeries.