Objective To investigate the expression of serum exosomal long non-coding RNA X chromo-some inactivation specific transcript(LncRNA XIST)and microRNA(miR)-130a-3p in gestational diabetes mellitus(GDM)patients and its relationship with pregnancy outcome.Methods A total of 149 GDM patients(GDM group)and 149 healthy pregnant women(control group)admitted to the hospital from January 2021 to January 2024 were selected.Serum exosomal LncRNA XIST,miR-130a-3p and glucose and lipid metabolism indexes of the two groups were detected and compared.The correlation of LncRNA XIST and miR-130a-3p levels with glycolipid metabolism indexes was analyzed by Pearson method.Univariate and multivariate Logis-tic regression models were used to analyze the influencing factors of pregnancy outcomes in GDM patients.Re-ceiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of serum exosomal Ln-cRNA XIST and miR-130a-3p levels alone and in combination for pregnancy outcomes in GDM patients.Results Serum exosomal LncRNA XIST levels,fasting insulin(FINS),fasting blood glucose(FBG),insulin resistance index(HOMA-IR),2-hour postprandial glucose(2 hPG),total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)levels in GDM group were higher than those in control group(P＜0.05),and the levels of miR-130a-3p and high density lipoprotein cholesterol(HDL-C)were lower than those in the control group(P＜0.05).LncRNA XIST was positively correlated with FINS,FBG,HOMA-IR,2 hPG,TC,TG and LDL-C,and negatively correlated with HDL-C(P＜0.05).miR-130a-3p was negatively correlated with FINS,FBG,HOMA-IR,2 hPG,TC,TG and LDL-C,and positively correlated with HDL-C(P＜0.05).Among the 149 GDM patients,43 cases showed adverse pregnancy outcome,accounting for 28.86％.The increase level of FBG,the increase level of LncRNA XIST and the increase of HOMA-IR were risk factors for adverse pregnancy outcome in GDM patients,while the increase of miR-130a-3p was a protec-tive factor.The ROC curve analysis showed that the predictive efficacy of combined detection was superior to that of single indicator detection.Conclusion The serum exosomal LncRNA XIST of GDM patients is highly expressed,and miR-130a-3p is lowly expressed,and the combined detection of the above indexes has a high predictive value for pregnancy outcome.

Objective:To investigate the use of folded flap for repair of laryngeal and hypopharyngeal defect and the clinical efficacies of laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer.Methods:A retrospective analysis was performed for 10 cases of piriform sinus cancer that were treated in the Second Norman Bethune Hospital of Jilin University from January 2020 to April 2023 and all patients were males, aged 42-68 years. The first choice of treatment for all patients was surgery. After function neck dissection and tracheotomy, partial laryngectomy and hypopharyngectomy were carried out. The folded island flaps were prepared and used for the repairs of laryngeal and hypopharyngeal defects and the reconstructions laryngeal and hypopharyngeal functions. The patients were followed up.Results:The laryngeal and pharyngeal cavities were reconstructed well in 10 patients, and all the flaps survived, with no case of pharyngeal fistula. All patients were able to eat normally through the mouth at 2 weeks after surgery without obvious choking, and 4 patients completed the swallowing function evaluation without aspiration or only a small amount of aspiration. All the 10 patients underwent postoperative radiotherapy. The postoperative follow-up time was 5.4-41.4 months, and there was no case with tumor recurrence or death. Laryngoscopy showed that 8 patients had a spacious new laryngeal orifice, which met the conditions for extubation, of whom 7 patients had their tracheal tubes removed and 1 patient was still under observation, and that 2 patients had a slightly narrowed new laryngeal orifice due to a thick skin flap, with further follow-up observation. All patients retained their phonatory functions after surgery.Conclusion:Folded island flap can be used for the function reconstructions of the larynx and hypopharynx after surgery of pyriform sinus cancer.

Objective:To explore the association between cognitive function and the level of gamma-amino-butyric acid(GABA)in anterior cingulate cortex(ACC)before and after treatment in patients with major depres-sion disorder.Methods:Totally 31 medication-naive patients with major depression disorder meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)and 33 normal controls were col-lected.Each eligible patient received treatment with selective serotonin reuptake inhibitor agents for 8 weeks.The MATRICS Consensus Cognitive Battery(MCCB)was used to evaluate the cognitive function.By means of 1H magnetic resonance spectroscopy,anterior cingulate cortex GABA concentrations were measured.Results:At base-line,the concentration of ACC GABA relative to water(GABA+/W)was lower in the patient group than in the control group(P＜0.05)and increased after treatment(P＜0.05).ACC GABA+/W was negatively associated with verbal learning and visual memory score in patient group at baseline(correlation coefficient and P value were r=-0.40,P＜0.05;r=-0.42,P＜0.05,respectively).The ACC GABA+/W difference resulted of treatment in patient group was positively associated with the difference of working memory score and the difference of reasoning and problem-solving score(correlation coefficient and P value were r=0.58,P＜0.05;r=0.66,P＜0.05,respec-tively).Conclusion:The cognitive dysfunction of patients with major depression disorder may not be related to the degree of depression and anxiety.And improvement of cognitive function may be associated with increase of ACC GABA concentrations.

Neoadjuvant chemoradiotherapy (NCRT) is the standard therapeutic strategy for locally advanced rectal cancer (LARC). Due to the different responses of patients to NCRT, the clinical prognosis of patients varies greatly. Therefore, it is important to establish sensitive biomarkers to predict the response of patients to treatments before NCRT. Immune cells in the tumor microenvironment (TME) were closely related to the efficacy of NCRT in patients with LARC. This paper reviewed the research progress on the relationships of cytotoxic T cells, programmed death-ligand 1 (PD-L1), tumor-associated macrophages (TAMs), regulatory T cells (Treg) and neutrophil to lymphocyte ratio (NLR) with chemoradiotherapy sensitivity in rectal cancer, illustrated the potential and limitations of these immune cells in predicting chemoradiotherapy response in rectal cancer, and provided a feasible direction for future researches.

Objective:To observe the lipid-lowering effect of atorvastatin on patients with acute cerebral infarction with different ATP-binding cassette subfamily B member 1(ABCB1) genotypes, and thus to provide clinical research evidence for individual application of atorvastatin in patients with acute cerebral infarction.Methods:From March 2021 to December 2021, 131 patients with acute cerebral infarction admitted to the Department of Neurology of Xuchang Central Hospital were included. The ABCB1 G2677T gene polymorphism rs2032582 of patients was detected by fluorescence staining in situ hybridization.Based on the detection results, patients were divided into GG group, GT group and TT group.All patients were given atorvastatin (20 mg/d) for lipid-lowering treatment.The levels of low density lipoprotein cholesterol(HDL-C), high density lipoprotein cholesterol(HDL-C), total cholesterol(TC)and triglyceride(TG) in serum of patients in the three groups before and 2 months after treatment were recorded and analyzed.The adverse drug reactions in the three groups were recorded. When the serum LDL-C level was less than 1.8 mmol/L, it was considered that the lipid-lowering treatment was effective.The binary Logistic regression analysis was used to explore the influencing factors of atorvastatin lipid lowering therapy.The software of SPSS 25.0 was used for statistical analysis.Results:There were 50 (38.17%), 49 (37.40%) and 32 (24.43%) patients in GG group, GT group and TT group, respectively. The serum TC levels of patients in GG group, GT group and TT group after treatment were (3.47±0.70) mmol/L, (3.59±1.09) mmol/L and (3.48±1.02) mmol/L, respectively, which were lower than those before treatment ((4.27± 0.99) mmol/L, (4.02±0.98) mmol/L and (4.03±1.31) mmol/L), all of which were statistically significant ( t=7.652, 3.092, 5.593, all P<0.01). The serum LDL-C levels in GG group, GT group and TT group after treatment were (1.89±0.53) mmol/L, (2.07±0.92) mmol/L and (1.96±0.79) mmol/L, respectively, which were lower than those before treatment ((2.87±0.92) mmol/L, (2.56±0.89) mmol/L and (2.55±1.11) mmol/L) ( t=9.896, 4.055, 5.980, all P<0.001). The differences of serum LDL-C level before and after treatment in GG group, GT group and TT group were (-0.97±0.69) mmol/L, (-0.50±0.86) mmol/L and (-0.59±0.56) mmol/L, respectively. The difference of serum LDL-C level before and after treatment in the three groups was statistically significant ( F=5.614, P=0.005). The difference of TC, TG and HDL-C before and after treatment was not statistically significant( F=2.783, 0.490, 1.677, all P>0.05). The binary Logistic regression analysis showed that ABCB1 G2677T gene type and staying up late were independent influencing factors for atorvastatin lipid-lowering therapy. The probability of effective lipid-lowering in GT patients with ABCB1 G2677T gene was 27.9% of that in GG patients ( OR=0.279, 95% CI: 0.110-0.709, P=0.007), and the probability of TT type patients was 33.8% of GG type patients ( OR=0.338, 95% CI: 0.121-0.943, P=0.038). The probability of effective lipid-lowering in patients who had the habit of staying up late was 26.4% of the patients who did not stay up late ( OR=0.264, 95% CI: 0.118-0.591, P=0.001). There was no significant difference in the total incidence of adverse drug reactions among the three groups( χ2=0.868, P=0.648). Conclusion:The lipid-lowering effect in patients with GG type of ABCB1 G2677T is better than that of GT type and TT type when atorvastatin is used to treat patients with acute cerebral infarction.

A thermosensitive hydrogel system consisting of PLGA-PEG-PLGA hydrogel and Pseudomonas aeruginosa DNA vaccine was constructed and the immune efficacy of the system was evaluated. The PLGA-PEG-PLGA thermosensitive hydrogel containing Pseudomonas aeruginosa DNA vaccine was prepared by a simple physical mixing method. The gelation temperature, cytotoxicity, and release curve in vitro were tested.The degradability of hydrogel in vivo was evaluated. The mice were divided into control group (PBS), hydrogel group (Hydrogel), in vivo-jetPEI/plasmid DNA group (in vivo-jetPEI/pDNA), and hydrogel + in vivo-jetPEI/plasmid group (Gel+in vivo-jetPEI/pDNA). Mice were immunized three times with a ten-day interval. Two weeks after the last immunization, the mice were sacrificed. The proliferation of splenic lymphocytes, serum specific IgG antibodies and IFN-γ in supernatant of splenic lymphocytes were detected. The gelation temperature of PLGA-PEG-PLGA hydrogel was (32 ± 0.5) ℃. There was no obvious toxicity to cells in vitro, and about 80% of plasmid DNA was released after 7 days in vitro. PLGA-PEG-PLGA hydrogel was biodegradable, and degraded almost completely after 15 days in vivo. The spleen lymphocytes proliferated; the levels of specific IgG antibodies and IFN-γ of in vivo-jetPEI/pDNA and Gel+in vivo-jetPEI/pDNA groups increased. The hydrogel could enhance the immune response induced by DNA vaccine.Results suggest that the thermosensitive hydrogel system consisting of PLGA-PEG-PLGA hydrogel and Pseudomonas aeruginosa DNA vaccine is a promising new strategy for the development of PA vaccine.

Patient safety management is one of the key of nursing management, and checklist plays an active role in patient safety management. In this paper, the definition and origin of the checklist, creating methods and principles, as well as the research status at home and abroad were summarized to provide references for clinical nursing staff to compile and apply the checklist.

The incidence of rectal cancer has been increasing in recent years .It leads to more attention of scholars at home and abroad ,which the efficacy of rectal cancer has been improved by using neoadjuvant therapy all over the world .It is included preoperative radiotherapy ,preoperative chemotherapy and preoperative chemora-diotherapy .Preoperative radiotherapy ,which can be divided into short radiotherapy and conventional radiotherapy , are evaluated by comparison of T drop rate ,sphincter preservation rate ,complete remission rate and other indica-tors of clinical effect .Although the experience of pure preoperative chemotherapy is not rich enough ,it still has an advantage in lowering the tumour stage and other aspects .Currently, preoperative chemoradiotherapy is a good choice for rectal cancer ,because it could make an obvious advantage in the treatment ,at the same time ,three-di-mensional radiotherapy can make target more evenly distributed and focus treatment more precise .However,neo-adjuvant therapy has insufficient support in clinical in our country.So it needs to get more information for clinical effectiveness of applying preoperative chemoradiotherapy .This study is to summarize the new adjuvant treatment of rectal cancer .

Objective To evaluate the correlations between CT features and histopathologic subtypes of lung adenocarcinomas presenting as pure ground-glass nodules (pGGN) of 1 cm or less in maximal diameter. Methods CT appearances, pathology and clinical data of 95 patients (97 lesions) who underwent curative resection of lung adenocarcinomas presenting as pGGN≤1 cm in diameter from March 2011 to February 2015 were retrospectively analyzed. Of the 97 lung adenocarcinomas, there were 19 atypical adenomatous hyperplasia (AAH) (19.6%), 31 adenocarcinoma in situ (AIS) (31.9%), 19 minimally invasive adenocarcinoma (MIA) (19.6%) and 28 invasive pulmonary adenocarcinoma (IPA) (28.9%). Fifty (51.5%) were preinvasive (AAH+AIS) and 47 (48.5%) were invasive (MIA+IPA). Lesion size and density were compared among pathologic subtypes using analysis of variance (ANOVA). Lesion size were compared between preinvasive and invasive lesions using 2?independent samples t?test. Lesion location, presence of bubble?like sign, air bronchogram, vessel changes, margin, and tumor?lung interface were compared among histopathologic subtypes using chi?square test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off point of size in discriminating preinvasive lesions from invasive lesions. Results Of the 97 lesions, there were no statistically significant differences among histopathologic subtypes in terms of lesion density, presence of bubble?like sign, air?bronchogram, and margin (P>0.05). Mean size of AAH, AIS, MIA and IPA was (0.72 ± 0.19), (0.82 ± 0.14), (0.84 ± 0.11) and (0.85 ± 0.16) cm respectively. There were statistically significant differences among histopathologic subtypes in terms of lesion size (F=3.16, P=0.028). The vessel changes occurred in 2 of AAH, 11 of AIS, 10 of MIA and 17 of IPA. There were statistically significant differences among histopathologic subtypes in terms of vessel changes (χ2=13.22, P=0.004). Lesions with clear tumor?lung interface were in 10 of AAH, 24 of AIS, 17 of MIA, and 26 of IPA. There were statistically significant differences among histopathologic subtypes in terms of tumor?lung interface (χ2=12.67, P=0.005). The optimal cutoff value of lesion size for differentiating preinvasive lesions from invasive lesions was 0.82 cm (sensitivity, 61.7%;specificity, 62.0%). Conclusion Lesion size, vessel changes, and lung?tumor interface may indicate the invasiveness of lung adenocarcinoma presenting as pGGNs of≤1 cm in diameter.

Objective To observe the electronic physiological mechanism of Low Resistance Thought Induction Psychotherapy (TIP) on depression.Methods 48 patients with depression were randomly divided into TIP group and Citalopram group.The observation period was 6 months.The Hamilton Rating Scale for Depression(HAMD) was used to evaluate the efficacy,and Polysomnogram(PSG)was used to evaluate the electronic physiological mechanism.Results TIP had efficacy on reducing numbers of wake [before treatment (3.92±3.24),after treatment (2.38± 1.21),P＜0.05]、REM time [before treatment (86.75 ±28.29),after treatment (63.19±28.11),P＜0.01]、REM％ [before treatment (23.89±6.84),after treatment (16.16±6.36),P＜0.01].Citalopram had efficacy on increasing Sleep time [before treatment (350.52±50.71),after treatment (388.58±43.89),P＜0.01]、number of REM [before treatment (3.71±2.87),after treatment (5.17±5.58),P＜0.05]、S3+4 [before treatment (35.79±32.76),after treatment (56.77±34.21),P ＜0.05]、S3 +4％ [before treatment (10.13 ± 9.20),after treatment (14.53 ± 8.66),P＜0.05]、REM time [before treatment (66.39±29.22),after treatment(78.61 ±30.19),P＜0.05].TIP had superior to Citaloprarn on regulating numbers of wake and REM time.Conclusions Electronic physiological mechanism of TIP treating depression is to regulat numbers of wake,REM time,REM％.