Objective:To explore the application effect of the modified presentation assimilation discussion combined with heuristic clinical medicine teaching in training of extracorporeal membrane oxygenation specialist nurses.Methods:The convenient sampling method was used to select 62 nurses who participated in training of extracorporeal membrane oxygenation specialist nurses in the Second Affiliated Hospital of Zhengzhou University from January to June 2023 as the research objects. A total of 30 nurses who participated in the 25th training session from January to March 2023 were selected as the control group, and 32 nurses who participated in the 26th training session from April to June 2023 were selected as the observation group. The control group received conventional training method, while the observation group received modified presentation assimilation discussion combined with heuristic clinical medicine teaching. The theoretical knowledge and operational skills of nurses, core competence of extracorporeal membrane oxygenation specialist nurses and training satisfaction were compared between the two groups after training.Results:After training, the scores of theoretical knowledge and operational skills, core competence of extracorporeal membrane oxygenation specialist nurses and training satisfaction in observation group were higher than those in control group, and the differences were statistically significant ( P<0.05) . Conclusions:The modified presentation assimilation discussion combined with heuristic clinical medicine teaching can improve the theoretical knowledge and operational skills of extracorporeal membrane oxygenation specialist nurses, and the nurses' training satisfaction is higher.

Objective To perform genetic analysis in a family line of a pregnant couple with autosomal reces-sive non-syndromic deafness in order to identify its possible genetic etiology and provide prenatal diagnosis.Methods Whole-exome sequencing(WES)was used to analyze the genes of the proband,and Sanger sequencing was used to verify the suspected pathogenic loci.Prenatal genetic diagnosis was performed after amniotic fluid collection at 18 weeks of pregnancy.Results Autosomal recessive deafness type 3 related gene MYO15A c.10419_10423delCAGCT/c.10294_10308delCCTTGCATCCTTGCC compound heterozygous variant was found in the wife.A compound heterozygous variant of autosomal recessive deafness type 77-related gene LOXHD1:c.6388C＞T/ex-on 33-38 del.Maternal MYO15A c.10294_10308del CCTTGCATCCTTGCC heterozygous variant were detected in the husband and paternal LOXHD1 exon 33-38 del heterozygous variant were detected in the fetus.At the same time,the paternal CDH23 c.6693delT heterozygous mutation and the maternal PCDH15 c.5048_5051dupAGAA heterozygous mutation were detected in the fetus.These two heterozygous mutations lead to the possibility of the fe-tus suffering from ID/F Usher syndrome.Conclusion The deafness of the couple is caused by two different deaf gene mutations,and the probability of the fetus having the same deafness as the couple is very low.However,the fetus has a high possibility of having deafness caused by two gene mutations.Therefore,deafness caused by two gene mutations should be paid attention to in the prenatal diagnosis of families with both deaf parents.

OBJECTIVE To investigate the effect and potential mechanism of safflower polysaccharide on apoptosis and autophagy of human hepatocellular carcinoma cells. METHODS Human hepatocellular carcinoma HepG2， SMMC-7721 and Huh-7 cells were selected as subjects， and safflower polysaccharide was used as intervention drug to screen sensitive cells， intervention concentration and intervention time. The sensitive cells were selected as the object and intervened with different concentrations of safflower polysaccharide； the apoptosis， migration， clone formation， morphology and autophagy of human hepatocellular carcinoma cells were observed； the expressions of apoptosis， autophagy and phosphatidyl inositol-3-kinase （PI3K）/protein kinase B （Akt）/mammals rapamycin target protein （mTOR） signaling pathway related protein were detected. RESULTS safflower polysaccharide could inhibit the proliferation of 3 kinds of human hepatocellular carcinoma cells， and the half inhibition concentration of it to SMMC-7721 cells was significantly lower than to other two kinds of cells （P＜0.05）. After 48 h intervened with low， medium and high concentrations of safflower polysaccharide （20， 40， 80 μmol/L）， the apoptosis of SMMC-7721 cells was increased compared with the control group， and cell migration rates at 24 and 48 h （except for safflower polysaccharide low- dose group at 24 h） and clone formation rate at 24 h were significantly decreased compared with the control group （P＜0.05 or P＜ 0.01）. Compared with the control group， cell number in safflower polysaccharide groups was significantly decreased， and autophagy levels were improved to some extent； the relative expressions of cleaved caspase-3， caspase-9， Bax and beclin-1 protein and ratio of LC3Ⅱ/LC3Ⅰ were significantly increased， and the relative protein expressions of Bcl-2， p62， PI3K， mTOR and Akt were significantly decreased （P＜0.05 or P＜0.01）. CONCLUSIONS Safflower polysaccharide could effectively inhibit the proliferation and induce apoptosis and autophagy of human hepatocellular carcinoma SMMC-7721 cells， the mechanism of which may be related to the inhibition of PI3K/Akt/mTOR signaling pathway.

Objective:To construct an inter-hospital standardized transport scheme for patients supported by extracorporeal membrane oxygenation (ECMO) combined with modified early warning score (MEWS) and the transport checklist based on the theory of process reengineering.Methods:Through literature review, according to the actual situation of the Second Affiliated Hospital of Zhengzhou University, the MEWS scores and transport verification sheets were effectively combined to construct the inter-hospital standardized transport scheme for patients supported by extracorporeal membrane oxygenation. And according to the inter-hospital standardized transport scheme, the medical staff in the transport team were trained and assessed for ECMO patient transport knowledge. Using the convenient sampling method, a total of 223 ECMO patients admitted to the Second Affiliated Hospital of Zhengzhou University from January to December 2019 who were transported by conventional transport were selected as the control group. A total of 222 ECMO patients who were transported by the ECMO interhospital standardized transport scheme from January to December 2020 were selected as the observation group. This study Compared the incidence of adverse transport events in the two groups of and the transport knowledge of medical staff in the transport group before and after training.Results:The score of transport knowledge of ECMO patients of medical staff after training were higher than those before training, and the difference was statistically significant ( P<0.01) . The incidence of transport adverse events in the observation group was lower than that in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The standardized inter-hospital transport scheme for ECMO patients can form an efficient and safe standardized transport process, reduce the incidence of adverse transport events and improve the transport safety of ECMO patients.

Objective To analyze the efficacy and safety of PD-1 inhibitor combined with anlotinib on advanced neuroendocrine carcinoma. Methods We collected the data of patients with advanced neuroendocrine carcinoma who had failed the first-line standard chemotherapy and treated with PD-1 inhibitor combined with anlotinib from the First Affiliated Hospital of Zhengzhou University. Results A total of 45 patients, including 24 males and 21 females, were included. The median age was 57 years old. The primary tumor sites were lung (23 cases, 51.1%), esophagus (8 cases, 17.8%), pancreas (7 cases, 15.6%) and rectum (7 cases, 15.6%). Eighteen cases (40%) had failed the first- and second-line treatments, and 27 cases (60%) had failed the third-line and above treatments. All patients received 2-15 cycles of treatment, 3 cases died due to disease progression, overall objective response rate was 11.1%, disease control rate was 53.5%, median progression-free survival was 5.8 months, and 10-month progression-free survival rate was 25.5%. Adverse events were mainly grade 1-2 myelosuppression and digestive tract reactions. Conclusion PD-1 combined with anlotinib show better efficacy and good tolerance on advanced neuroendocrine carcinoma. It can be used as a choice after the failure of standard first-line treatment of advanced neuroendocrine carcinoma.

Objective To investigate the prevalence of hypertension in high temperature,noise operators and related factors.Methods A total of 1 263 workers from a steel enterprise were selected,among them,583 operators contacting with high temperature and noise served as the group A,267 operators only contacting with noise as the group B,249 operators only contacting with high temperature as the group C and 164 operators without contacting with high temperature and noise as group D.The prevalence of hypertension and related factors were analyzed.Results In the analysis of hypertension prevalence rate,the group D (12.8％) ＜ group C (25.7％)＜ group B (34.6％)＜group A(43.9％).In the analysis of blood pressure(systolic pressure/diastolic pressure),the group D[(115.8± 11.5)/(73.6±5.4) mm Hg]＜ group C[(124.1±10.7)/(81.9±7.3) mm Hg]＜ group B[(132.9±11.3)/(86.7±5.2) rnm Hg]＜ group A [(143.7 ± 12.8)/(92.4 ± 6.5) mm Hg].The onset age of hypertension in the group A was earlier than that in the group B,C,D (P＜0.05).The lower educational level,the more working years,the bigger body mass index(BMI),themore smoking and drinking were,the higher the hypertension prevalence rate was.Hypertension had significantly negative correlation with the educational level and significantly positive correlation with age,working years,BMI,smoking and drinking (P＜ 0.05).Conclusion The prevalence of hypertension in high temperature and noise operators is related to personal constitution and living habits.

Objective To explore whether CCL18 is involved in regulating the expression of miRNAs in breast cancer.Methods The expression profile of miRNAs in the breast cancer cell following CCL18 treatment was determined by miRNAs microarray analysis.Then we performed QRT-PCR and Luciferase Reporter Assay to validate the results from the miRNAs microassay.We used transient transfection to change the expression of miR98 and c-myc in breast cancer cells.We then used QRT-PCR and Western blot to analyze the mechanism by which CCL18 downregulates the expression of miR98 in breast cancer cells.Results miRNAs microarray analysis showed that cells treated with CCL18 differentially expressed 20 miRNAs genes compared with those in the control group. Our QRT-PCR and Luciferase Reporter Assay confirmed the result.The mRNA and protein expressions of C-myc and lin28 were increased after CCL18 stimulation in breast cancer cells.Transfection with c-myc siRNAs rescued the increase of lin28 and loss of miR98 expression caused by CCL18 stimulation.Our results also showed that CCL18 could upregulate the expression of N-Ras at post-transcription level.Conclusion CCL18 downregulates the expression of miR98 via N-Ras/c-myc/lin28 pathway.The downregulated miR98 increases the expression of N-Ras after transfection,which further activates c-myc/lin28 pathway and forms a positive feedback loop.

Objective:To establish the post-discharge disease management program for patients with chronic heart failure,and observe the effects of disease management on prognosis.Methods:Totally 207 patients with chronic heart failure,who were ad-mitted to hospital due to acute exacerbation,were enrolled.After discharge these patients were randomly divided into the study group (103 cases)and the control group (104 cases).Disease management program was implemented in the study group,and only routine outpatient follow-up was implemented in the control group.The clinical follow-up results one year after discharge were compared between the two groups.Results:Excluding the patients lost during follow-up,totally 1 88 patients completed the data collection,among which 98 cases were from the study group and 90 cases were from the control group.There was no significant difference regarding the baseline of clinical characteristics between the two groups (P >0.05 ).Follow-up results showed that compared with that in the control group,within the six months after discharged,the readmission rate,the multi-ple readmission rate,and the readmission or death joint events rate in the study group decreased significantly (P <0.05).The percentage of cardiac function NYHA class I to II and the left ventricular ejection fraction in the study group were higher than that in the control group (P <0.05),and the left ventricular end-diastolic diameter was in contrast (P <0.05).The score of Minnesota Living with Heart Failure Questionnaire in the study group was superior to that in the control group (P <0.05 ). Conclusions:The implementation of post-discharge disease management for the patients with chronic heart failure can signifi-cantly reduce the risk of the readmission,the multiple readmission,and the readmission or death joint events within the six months after discharge,and improve the patients’cardiac function and quality of life.

Objective To investigate the effects of sphingosine kinase 1 (SphK1 ) inhibitor N, N-dimethylsphingosine (DMS)combined with 5-fluorouracil (5-FU)on the proliferation and apoptosis of gastric cancer MGC-803 cells and to explore the possible mechanisms involved.Methods MGC-803 cells were cultured in vitro.The effects of DMS and 5-FU on cell proliferation,apoptosis,and cell cycle distribution of MGC-803 cells were detected by MTT assay and flow cytometer (FCM),respectively.The expressions of SphK1 ,TS,DPD,NF-κB p65 and Bcl-2 proteins were detected by Western blot.Results Different concentrations of DMS or 5-FU alone or in combination could obviously inhibit the proliferation of MGC-803 cells in a dose-dependent and time-dependent manners (P<0.05 ).And the proliferation inhibition rate of MGC-803 cells in the combination group was significantly higher than that in the single drug groups (P<0.05).Treatment of MGC-803 cells with DMS did not affect the cell cycle distribution (P>0.05).As compared with the cells without drug treatment,DMS or 5-FU alone could obviously increase the apoptosis rate of MGC-803 cells (P<0.05);the apoptosis rate in the combination group was significantly higher than that in the single-drug groups (P<0.05).The expression levels of SphK1,NF-κB p65 and bcl-2 proteins were down-regulated with the treatment of DMS alone or in combination,whereas those of TS and DPD were not affected.Conclusion DMS can inhibit the proliferation and induce apoptosis of gastric cancer MGC-803 cells in vitro.It shows a good synergetic effect in combination with 5-FU,probably by down-regulating the expressions of SphK1,NF-κB p65 and Bcl-2 proteins.

10.3969/j.issn.2095-4344.2013.25.008