Objective To investigate the expression and significance of RANK/RANKL/OPG signaling path-way in gerbil external auditory canal cholesteatoma(EACC).Methods Twenty-five mongolian long-clawed gerbils were divided into an experimental group(n=15)and a control group(n=10),and an EACC model was constructed by external auditory canal ligation method in the experimental group.Three months later,the external auditory ca-nal tissues of the control group and the experimental group(10 ears)were collected,and RT-qPCR and Western blot were performed to detect the expression levels of receptor activator of NF-κB(RANK),receptor activator of NF-κB ligand(RANKL),osteoprotegerin(OPG)mRNA and protein in the signaling pathway.Results Two ger-bils in the experimental group died during the modeling process,and cholesteatoma of the external auditory canal was formed in 10 ears 3 months after the operation,with a modeling success rate of 76.9％(10/13).Compared with the normal control group,there was no statistically significant difference in the expression of RANK mRNA in gerbil external auditory canal tissues(P=0.08).The expression of RANK protein was upregulated,the expression of RANKL mRNA and protein was upregulated,while the expression of OPG mRNA and protein was downregulat-ed,the ratio of RANKL/OPG was upregulated,with a statistically significant difference between the two groups(P＜0.01).Conclusion The RANK/RANKL/OPG signaling system may play an important role in the formation of gerbil EACC and bone destruction.

Objective To analyze the feasibility of probiotics in delaying the progression of early Alzheimer's disease(AD)based on the changes of brain-gut-microbiota axis factors.Methods A total of 100 patients with early AD who visited Shaoxing 7th People's Hospital from December 2023 to December 2024 were selected and divided into control group(40 cases)and study group(60 cases)based on different treatment methods.The control group was treated with donepezil hydrochloride,while study group was treated with donepezil hydrochloride combined with probiotic preparations.The cognitive function,daily living ability,intestinal flora,and relative expression levels of brain-gut-microbiota axis factors,interleukin(IL)-6,tumor necrosis factor-α(TNF-α),5-hydroxytryptamine(5-HT),γ-aminobutyric acid(GABA),and lipopolysaccharide(LPS)/Toll-like receptor 4(TLR4)/nuclear factor-KB(NF-κB)axis factors were compared before and after treatment in both groups.The clinical efficacy and prognosis monitoring results were also compared.Results The total effective rate and the proportion of patients with a clinical dementia rating score of 0 in study group were higher than those in control group(P＜0.05).The cognitive function and daily living ability scores in study group were higher than those in control group(P＜0.05).The copy numbers of lactobacillus and bifidobacterium in study group were higher than those in control group,while the copy numbers of enterococcus and escherichia coli were lower(P＜0.05).The relative expression levels of amyloid-β protein 1-42,IL-6,TNF-α,TLR4,and NF-κB in study group were lower than those in control group,and the levels of 5-HT and GABA were higher(P＜0.05).Conclusion Probiotics can delay the progression of early AD patients and improve clinical efficacy.It is speculated that the mechanism of action may be related to regulating the brain-gut-microbiota axis-mediated LPS/TLR4/NF-κB pathway to restore the intestinal microecology and alleviate neurological inflammation.

Objective To investigate the expression and significance of RANK/RANKL/OPG signaling path-way in gerbil external auditory canal cholesteatoma(EACC).Methods Twenty-five mongolian long-clawed gerbils were divided into an experimental group(n=15)and a control group(n=10),and an EACC model was constructed by external auditory canal ligation method in the experimental group.Three months later,the external auditory ca-nal tissues of the control group and the experimental group(10 ears)were collected,and RT-qPCR and Western blot were performed to detect the expression levels of receptor activator of NF-κB(RANK),receptor activator of NF-κB ligand(RANKL),osteoprotegerin(OPG)mRNA and protein in the signaling pathway.Results Two ger-bils in the experimental group died during the modeling process,and cholesteatoma of the external auditory canal was formed in 10 ears 3 months after the operation,with a modeling success rate of 76.9％(10/13).Compared with the normal control group,there was no statistically significant difference in the expression of RANK mRNA in gerbil external auditory canal tissues(P=0.08).The expression of RANK protein was upregulated,the expression of RANKL mRNA and protein was upregulated,while the expression of OPG mRNA and protein was downregulat-ed,the ratio of RANKL/OPG was upregulated,with a statistically significant difference between the two groups(P＜0.01).Conclusion The RANK/RANKL/OPG signaling system may play an important role in the formation of gerbil EACC and bone destruction.

Objective To analyze the feasibility of probiotics in delaying the progression of early Alzheimer's disease(AD)based on the changes of brain-gut-microbiota axis factors.Methods A total of 100 patients with early AD who visited Shaoxing 7th People's Hospital from December 2023 to December 2024 were selected and divided into control group(40 cases)and study group(60 cases)based on different treatment methods.The control group was treated with donepezil hydrochloride,while study group was treated with donepezil hydrochloride combined with probiotic preparations.The cognitive function,daily living ability,intestinal flora,and relative expression levels of brain-gut-microbiota axis factors,interleukin(IL)-6,tumor necrosis factor-α(TNF-α),5-hydroxytryptamine(5-HT),γ-aminobutyric acid(GABA),and lipopolysaccharide(LPS)/Toll-like receptor 4(TLR4)/nuclear factor-KB(NF-κB)axis factors were compared before and after treatment in both groups.The clinical efficacy and prognosis monitoring results were also compared.Results The total effective rate and the proportion of patients with a clinical dementia rating score of 0 in study group were higher than those in control group(P＜0.05).The cognitive function and daily living ability scores in study group were higher than those in control group(P＜0.05).The copy numbers of lactobacillus and bifidobacterium in study group were higher than those in control group,while the copy numbers of enterococcus and escherichia coli were lower(P＜0.05).The relative expression levels of amyloid-β protein 1-42,IL-6,TNF-α,TLR4,and NF-κB in study group were lower than those in control group,and the levels of 5-HT and GABA were higher(P＜0.05).Conclusion Probiotics can delay the progression of early AD patients and improve clinical efficacy.It is speculated that the mechanism of action may be related to regulating the brain-gut-microbiota axis-mediated LPS/TLR4/NF-κB pathway to restore the intestinal microecology and alleviate neurological inflammation.

Purpose To investigate the clinicopathological characteristics and genetic variations of stage Ⅰ lung adenocarci-noma with high-grade components,according to the new grading system of the WHO classification of thoracic tumors(2021).Methods A retrospective analysis was conducted on the clini-cal data of 785 patients with stage Ⅰ lung adenocarcinoma.HE,EnVision immunohistochemistry and Victoria blue staining were used,common genetic variation(EGFR/KRAS/ALK/ROS1/RET)were detected by PCR method.The correlation between different high-grade components and clinical pathological charac-teristics as well as genetic variations in stage Ⅰ lung adenocarci-noma were analyzed.Results A total of 785 cases of stage Ⅰlung adenocarcinoma were enrolled,including 332 cases with high-grade components and 453 cases without high-grade compo-nents.Among the adenocarcinomas with high-grade components,there were 7 cases of grade 1,150 cases of grade 2,and 175 ca-ses of grade 3.The positive rates of tumor cells spreading through airspace(STAS),vascular invasion,and pleural inva-sion in grade 2 adenocarcinoma with two high-grade components(61.5％,21.2％,26.9％)were significantly higher than that of the adenocarcinomas with only one high-grade component(20.4％,7.1％,5.1％),but there was no significant differ-ence in grade 3 adenocarcinoma.The positive rate(39.0％)of STAS in the micropapillary group with one high-grade component in grade 2 adenocarcinoma was significantly higher than that in the complex glandular group(9.3％)and the solid group(0),while there was no significant difference between the latter two groups.Among the three groups there were no statistically signif-icant differences in grade 3 adenocarcinoma.In 167 cases of ad-enocarcinoma with two or more high-grade components,there were 74 cases(44.3％)of complex glands combined with mi-cropapillary components,67 cases(40.1％)of complex glands combined with solid components,8 cases(4.8％)of micropap-illary combined with solid components,and 18 cases(10.8％)of three types of components.The positive rates of pleural inva-sion and KRAS gene mutation or fusion gene(ALK/ROS1/RET)in the group of complex glands combined with solid(49.3％,28.3％)were significantly higher as compared to those in the group of complex glands combined with micropapil-lary(27.0％,8.6％).The positive rate of psammoma bodies in the group with high-grade components(24.7％)was significant-ly higher than that in those without high-grade components(3.5％,P＜0.001),and the positive rate of psammoma bodies in group of gene mutation(EGFR/KRAS)(40.4％)was higher than that in the no-gene mutation group(26.7％,P＜0.05).Conclusion The clinicopathological features of different high-grade components in stage Ⅰ lung adenocarcinoma are not identi-cal,suggesting that their invasiveness may have different biologi-cal backgrounds.Characteristic morphological observations are helpful.

Objective: To investigate an occupational hazardous gas poisoning incident caused by gas leakage in the process of hazardous waste treatment. Methods: An investigation was conducted on a case of occupational acute hazardous gas poisoning caused by waste treatment gas leakage in Shandong province in December 2017. Meanwhile, the clinical data of 5 cases of poisoning patients were analyzed, and the accident related poison test report and other relevant data were analyzed. Results: The incident was caused by the toxic waste did not do labeling work, the workers' protection measures were not in place, the illegal operation and the blind rescue, resulting in a total of 5 people died on the spot, 12 people were hospitalized with poisoning. Among them, 5 patients admitted to our hospital showed varying degrees of damage to the nervous system and respiratory system. After active treatment, they all got better and were discharged. Conclusion The poisoning is mainly caused by hydrogen sulfide dichloromethane hydrogen cyanide gas leakage serious production liability accident, clinical main performance for the nervous system circulatory system respiratory system and other system damage.

Objective: To report a case of rat poison with multiple hemorrhage after trauma. Methods: The clinical data of a case of rodenticide poisoning with hemorrhage as the first symptom admitted to a third-class a hospital in July 2018 were analyzed and summarized. Results: This patient is a rodent drug poisoning patient with hemorrhage as the first symptom.The disease was diagnosed as bromohamelin and bromadiolone poisoning through the analysis of poison detection because the rodent drug was taken in the market and the history of taking poison was concealed. The patient was given active comprehensive treatment of vitamin K1 and other drugs for clinical cure. Conclusion For patients with clinically unexplained hemorrhage, the possibility of rodenticide poisoning should be considered and the toxicant detection should be improved actively.

Objective: To investigate a poisonous mushroom poisoning incident and analyze its clinical data. Methods: Investigate a poisonous mushroom poisoning incident in a place in Shandong in July 2018, at the same time, the clinical data of 2 cases of mushroom poisoning were analyzed and summarized. Results: The incident was caused by a poisoning incident caused by residents eating poisonous mushrooms. The poisonous mushroom in this incident was identified as a scaled white goose cream. Two patients with poisoning developed gastrointestinal symptoms such as nausea and vomiting, abdominal pain and diarrhea, and liver damage occurred later. After active rescue and treatment, one patient was discharged from hospital, and the other patient developed acute pulmonary embolism during the treatment. He was discharged after interventional thrombolysis and follow-up treatment. Conclusion After investigation, the incident was caused by the ingestion of poisonous mushrooms mainly based on the scalloped white goose cream. After active treatment, they were cured and discharged.

Objective To improve the nurses' compliance of elevating the head-of-bed of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation, who had no contraindications of head-of-bed elevation by the installation of angle measuring device and reminding device for head-of-bed elevation, so as to reduce the incidence of ventilator-associated pneumonia (VAP). Methods A total of 575 and 473 cases of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation were selected respectively rom the patients who were hospitalized in Tengzhou Central People's Hospital in Shandong Province in the year of 2014 and 2016. In 2014, before intervention, the implementation of cluster nursing and the general monitoring data of VAP were comprehensively grasped. In 2015, a total of 26 beds in ICU were installed with angle measuring device and reminding device for head-of-bed elevation. In 2016, after intervention, the implementation of cluster nursing and the general information level of the monitoring data of VAP were collected. SPSS 17.0 software was applied for data statistical analysis before and after intervention. Results The nurse compliance of head-of-bed elevation for mechanical ventilation patients was improved after intervention (χ2=1 691.675, P<0.001), as well as the incidence of VAP significantly decreased (χ2=9.248, P=0.002). The incidence of VAP millennium catheterization decreased, but the difference was not statistically significant (χ2=2.694, P=0.058). Conclusions The installation of bed angle measuring device and reminding device can effectively improve nurse compliance of head-of-bed elevation in patients with mechanical ventilation and reduce the incidence of VAP.

Objective To explore the effect of hospital-community-family integrated care on the physical and mental function of discharged stroke patients. Methods Sixty stroke patients discharged from the third people′s hospital of Bengbu were recruited from January 1, 2014 to April 30, 2015. The patients were divided into intervention group and control group by random number table, and 30 patients in each group. Rehabilitated nursing intervention including feeding, language, physical and psychological and psychological trainings were conducted in intervention group, while participants in control group only received routing nursing service. Then, the Barthel index scores, Fugl-Meyer motor function scores and Hanmilton Depression Scale (HAMD) scores were assessed in both two groups pre-intervention and six months after intervention. Results Intervened before and 6 months after the intervention group of patients with Barthel index score respectively (44.17 ± 11.21) points, (72.47 ± 15.36) points, Fugl-Meyer motor function scores were respectively (43.47±16.22) points, (62.39 ±15.41) points, HAMD scores were (26.81 ± 8.24) points, (17.42 ± 6.29). The difference was statistically significant (t=8.16, 4.64, 4.97, P <0.01). In contrast, the control group of patients with Barthel index score changes showed statistical significance (t=1.94, P=0.03), HAMD score also had differences (t=1.86, P=0.04) and the change was far less than the intervention group. Between the two groups after the intervention compared with Barthel index score, Fugl-Meyer motor function score and HAMD also had statistical significance (t=5.81, 3.55, 2.35, P = 0.00). Conclusions The rehabilitated nursing intervention has evident effects onliving environment,daily life, physical and mental function in discharged stroke patients, and the intervention approaches we used have certain clinical practice value.