Objective:To explore the changes of serum histone deacetylase 2 (HDAC2), lonely G protein-coupled receptor ligand (Apelin) and B-type brain natriuretic peptide (BNP) in patients with chronic obstructive pulmonary disease (COPD) and the predictive value for prognosis.Methods:A retrospective selection was made of 100 COPD patients (COPD group) admitted to the Fourth People's Hospital of Langfang from May 2022 to May 2023 and 50 healthy individuals who underwent physical examinations during the same period (healthy control group) as the research subjects. The levels of serum HDAC2, Apelin and BNP in the two groups were compared. The levels of HDAC2, Apelin and BNP in COPD patients with different clinical characteristics were compared. The correlation among serum HDAC2, Apelin and BNP in COPD patients were analyzed by Spearman test. The predictive value of serum HDAC2, Apelin and BNP for the prognosis of patients with COPD was analyzed by the receiver operating characteristic (ROC) curve.Results:The level of HDAC2 in the COPD group was lower than that in the healthy control group, the levels of Apelin and BNP were higher than those in the healthy control group: (2.38 ± 0.56) U/L vs. (7.51 ± 1.33) U/L, (491.62 ± 53.82) ng/L vs. (337.19 ± 46.52) ng/L, (211.05 ± 23.46) ng/L vs. (37.52 ± 4.32) ng/L, there were statistical differences ( P<0.05). COPD patients with different clinical characteristics, including those in acute exacerbation and stable stages, mild, moderate and severe cases, COPD patients with pulmonary function grades Ⅱ, Ⅲ and Ⅳ, COPD patients with and without pulmonary hypertension, and patients with poor prognosis and good prognosis, there were statistically significant differences in the levels of HDAC2, Apelin and BNP ( P<0.05). The Spearman test results indicated that in COPD patients, serum HDAC2 was negatively correlated with Apelin ( r = - 0.469, P = 0.001), HDAC2 was negatively correlated with BNP ( r = - 0.435, P = 0.001), and Apelin was positively correlated with BNP ( r = 0.418, P = 0.001). The results of ROC curve analysis indicated that the combined detection of HDAC2, Apelin and BNP had the highest area under the curve for predicting the prognosis of COPD patients (0.954), with a sensitivity of 81.66%. Conclusions:COPD patients have lower HDAC2 and higher Apelin and BNP levels. The three indicators are correlated to a certain extent, and their levels are closely related to the clinical characteristics of patients. The combined detection of the three indicators can be used as important predictive indicators for the prognosis of COPD patients.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective:To explore the changes of serum histone deacetylase 2 (HDAC2), lonely G protein-coupled receptor ligand (Apelin) and B-type brain natriuretic peptide (BNP) in patients with chronic obstructive pulmonary disease (COPD) and the predictive value for prognosis.Methods:A retrospective selection was made of 100 COPD patients (COPD group) admitted to the Fourth People's Hospital of Langfang from May 2022 to May 2023 and 50 healthy individuals who underwent physical examinations during the same period (healthy control group) as the research subjects. The levels of serum HDAC2, Apelin and BNP in the two groups were compared. The levels of HDAC2, Apelin and BNP in COPD patients with different clinical characteristics were compared. The correlation among serum HDAC2, Apelin and BNP in COPD patients were analyzed by Spearman test. The predictive value of serum HDAC2, Apelin and BNP for the prognosis of patients with COPD was analyzed by the receiver operating characteristic (ROC) curve.Results:The level of HDAC2 in the COPD group was lower than that in the healthy control group, the levels of Apelin and BNP were higher than those in the healthy control group: (2.38 ± 0.56) U/L vs. (7.51 ± 1.33) U/L, (491.62 ± 53.82) ng/L vs. (337.19 ± 46.52) ng/L, (211.05 ± 23.46) ng/L vs. (37.52 ± 4.32) ng/L, there were statistical differences ( P<0.05). COPD patients with different clinical characteristics, including those in acute exacerbation and stable stages, mild, moderate and severe cases, COPD patients with pulmonary function grades Ⅱ, Ⅲ and Ⅳ, COPD patients with and without pulmonary hypertension, and patients with poor prognosis and good prognosis, there were statistically significant differences in the levels of HDAC2, Apelin and BNP ( P<0.05). The Spearman test results indicated that in COPD patients, serum HDAC2 was negatively correlated with Apelin ( r = - 0.469, P = 0.001), HDAC2 was negatively correlated with BNP ( r = - 0.435, P = 0.001), and Apelin was positively correlated with BNP ( r = 0.418, P = 0.001). The results of ROC curve analysis indicated that the combined detection of HDAC2, Apelin and BNP had the highest area under the curve for predicting the prognosis of COPD patients (0.954), with a sensitivity of 81.66%. Conclusions:COPD patients have lower HDAC2 and higher Apelin and BNP levels. The three indicators are correlated to a certain extent, and their levels are closely related to the clinical characteristics of patients. The combined detection of the three indicators can be used as important predictive indicators for the prognosis of COPD patients.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective:To construct a targeted and accurate evaluation system for facial and cervical wounds and scars of burn patients.Methods:The method combining literature analysis and survey research was adopted, and the basic principles of item system construction were followed. From June to August 2020, based on the aesthetic standards of facial and cervical plastic surgery, the topographic map assessment system for facial and cervical wounds and scars of burn patients was preliminarily formed, focusing on the assessment of wounds and scars in the necks and faces of patients after burns. In September 2020, 38 experts in the relevant fields were consulted in advance and the questionnaire was revised according to the experts' opinions. From December 2020 to March 2021, the Delphi method was applied to conduct inquiry by correspondence with 35 experts in relevant fields from Guangzhou, Shenzhen, Shanghai, Beijing, and other cities, who met the inclusion criteria, and the items were screened and established. The effective recovery rate of inquiry questionnaire was calculated to determine the level of enthusiasm of experts, the average authority coefficient of all items was calculated to determine the level of expert authority, the average importance expert score, the average coefficient of variation, and the average full score rate of all the third-level items were calculated to determine the concentration of expert opinions, the average coefficients of variation and Kendall's harmony coefficients of the importance, sensitivity, and operability expert scores of all the third-level items were calculated to determine the degree of coordination of expert opinions. The Kendall's harmony coefficients for the importance, sensitivity, and operability expert scores of all the third-level items were statistically analyzed with chi-square test.Results:Among the 35 experts consulted by Delphi method, mainly were male, aged (48±10) years, with 8-38 years of working experience, mainly with associate senior titles and above, all with a bachelor's degree or above education background, and of whom 11 were burn experts, 7 were wound repair experts, 4 were plastic surgery experts, and 13 were rehabilitation medicine experts. Finally, a topographic map assessment system for facial and cervical wounds and scars of burn patients was formed, including 4 first-level items, 21 second-level items, 40 third-level items, and 1 mask. The effective recovery rate of inquiry questionnaire was 100% (35/35). The average authority coefficient of all items was 0.89. The average importance expert score was 4.67, the average coefficient of variation of importance expert score was 0.01, and the average full score rate of all the third-level items was 86.3%. The average coefficients of variation of the importance, sensitivity, and operability expert scores of all the third-level items were 0.01, 0.01, and 0.02, respectively. The Kendall's harmony coefficients for the importance, sensitivity, and operability expert scores of all the third-level items were statistically significant (with χ2 values of 1 201.53, 745.67, and 707.07, respectively , P<0.05). Conclusions:The established topographic map assessment system for facial and cervical wounds and scars of burn patients has high scientificity and reliability, which can be used for the evaluation of facial and neck wounds or scars in burn patients.

Objective:To apply self-directed learning-oriented multi-channel teaching to clinical digestive system integration course and explore its teaching effect.Methods:Seventy undergraduates of Batch 2015 majoring in clinical medicine in a medical college of Shandong Province were selected as subjects. In the clinical digestive system integration course, we designed and implemented multi-channel teaching methods including problem-based learning (PBL), integrated teaching of theory and practice, standardized patient teaching, group focus teaching and moral education. The scores of students' practice examination under the two teaching methods were compared, and the self-assessment of students' autonomous learning ability before and after the intervention was compared. SPSS 20.0 was used for t test. Results:The average total score of practical assessment in the intervention group was (86.10±6.01), which was higher than that (81.84±7.08) of the Batch 2014 students ( P<0.05). The total score of students' self-assessment of autonomous learning ability was (145.41±9.42) before the intervention. By comparison, the total score was (152.94±10.18) after the intervention. Except for the dimension of "self-innovation", the scores of self-directed learning ability in general and other dimensions were significantly different before and after the intervention ( P<0.05). Conclusion:Self-directed learning-oriented multi-channel teaching is a suitable teaching method for the integration curriculum of clinical digestive system.

OBJECTIVES: To explore the correlation between cytosine-phosphoric-guanylic (CpG) site of Septin 9 gene and colorectal cancer, and to develop a real-time PCR detection system in plasma in patients with colorectal cancer. METHODS: The methylation of training samples was detected by high-throughput sequencing technology, and the sites highly consistent with the clinical information of colorectal cancer were identified. Then the detection system of real-time PCR was designed to analyze the consistency of plasma and tissue based on methylationa sensitive enzyme digestion. Finally, 100 clinical trials were conducted to evaluate the performance of the detection system with the methylation sensitive enzyme digestion-real-time PCR. RESULTS: The highly consistent sites, which were selected by high-throughput sequencing from 71 training set samples, was the 38th CpG. Based on the detection region, the screened methylation sensitive enzymes were CONCLUSIONS The 38th CpG site of Septin 9 detected by the detection system of methylation sensitive enzyme digestion-real-time PCR can highly predict the occurrence of colorectal cancer with great clinical application value.
Colorectal Neoplasms/genetics* ; CpG Islands/genetics* ; DNA ; DNA Methylation ; Humans ; Plasma/metabolism* ; Septins/metabolism*

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

To investigate the expression, clinical significance, and biological function of the long non-coding RNA (lncRNA) ADAMTS9-AS2 in colorectal cancer (CRC).
 Methods: Gene microarray analysis was performed to explore the expression of ADAMTS9-AS2 in CRC. Real-time PCR was used to verify its expression in 20-paired CRC tissues and adjacent non-tumor tissues. We further explored the relationship between ADAMTS9-AS2 expression and clinicopathological features, and its prognostic role in relapse-free survival (RFS) among early stage CRC patients using Kaplan-Meier and Cox regression analyses. In vitro assays, cell counting kit-8 assay, colony formation assay, and Transwell assay were used to evaluate the biological function of ADAMTS9-AS2 in CRC.
 Results: ADAMTS9-AS2 was down-regulated in CRC patients according to the gene microarray analysis, which was confirmed in CRC tissues and cells. High expression of ADAMTS9-AS2 was associated with a higher 5-year RFS rate (83.8% vs 73.5%, P=0.041) and it was an independent prognostic factor for RFS [hazard ratio (HR)=0.528; 95% CI 0.299 to 0.932; P=0.028] at the early stage of CRC. ADAMTS9-AS2 overexpression in CRC cells inhibited cell proliferation, migration, and invasion, while suppression of ADAMTS9-AS2 showed opposite effects.
 Conclusion: ADAMTS9-AS2 is a valuable prognostic factor for CRC and may function as a tumor suppressor in CRC via inhibiting cell proliferation and metastasis.
ADAMTS9 Protein ; genetics ; Cell Movement ; Cell Proliferation ; Colorectal Neoplasms ; genetics ; Gene Expression Regulation, Neoplastic ; Humans ; Neoplasm Recurrence, Local ; RNA, Long Noncoding

Objective To compare the rates and pathological features of diabetic keratopathy in mice induced by single high dose or multiple low dose streptozotocin (STZ) injections.Methods Eighty male C57BL/6 mice (6-8 weeks old) were randomly divided into 4 groups with each group contain 20 mice:normal control group,multiple low dose 1 month group and multiple low dose 3 months group (injected with 60 mg/kg STZ for 5 consecutive times),single high dose 1 month group (injected with 150 mg/kg STZ).The survival rate,model success rate,body weight,glycosylated hemoglobin (HbA1c) content were compared among different modeling group.The percentages of residual epithelial defect area were examined by fluorescein sodium staining after removal of central corneal epithelium.The expression of p-Akt,Sirt1 and Ki67 were evaluated by immunofluorescent staining.The corneal sensitivity were compared among different groups before corneal epithelial curettage,3,7,10 and 14 days after corneal epithelial curettage.The corneal subbasal nerve density at 14 days after corneal epithelial curettage were compared among different groups.This study complied with the declaration of ARVO Results The success rate of diabetic modeling in multiple low dose 1 month group,multiple low dose 3 months group and single high dose 1 month group was 90％,80％ and 70％,respectively.The HbA1c levels in the diabetic modeling groups were significantly higher than that in the normal control group (all at P＜0.05).The percentage of residual epithelial defect area 24 and 48 hours after corneal epithelial curettage in the multiple low dose 3 months group and single high dosc 1 month group were significantly higher than those in the normal control group (all at P＜0.05).The fluorescence intensity of p-Akt,Sirt1 and Ki67 in the multiple low dose 3 months group and single high dose 1 month group were stronger than those in the normal control group.There were no significant differences on corneal sensitivity and corneal nerve density between normal control and multiple low dose 3 months group before and 14 days after the corneal epithelial removal (all at P＞0.05).However,the corneal sensitivity and corneal nerve density were dramatically decreased in the multiple low dose 3 months group and single high dose 1 month group before and 14 days after the corneal epithelial removal,and there were significant differences compared with normal control group (all at P＜0.05).Conclusions The injection of 60 mg/kg STZ can not induce the features of diabetic keratopathy in mice within 1 month.However,the mice of both 1 month after 150 mg/kg STZ injection and 3 months after 60 mg/kg STZ injection appear the typical epithelial and nerve features of diabetic keratopathy,therefore can be the ideal animal models for research.