Objective To investigate the expression of human epidermal growth factor receptor 2(HER2),carbohydrate antigen 199(CA199)and microtubule-associated protein 1 light chain 3β(LC3B)in gastric canc-er tissues and their relationship with recurrence after radical gastrectomy.Methods A total of 95 patients with gastric cancer who underwent radical gastrectomy in the hospital from January 2021 to December 2022 were retrospectively selected.The expressions of HER2,CA199 and LC3B in gastric cancer tissues and adja-cent tissues were compared,and the clinicopathological characteristics were analyzed.According to the postop-erative recurrence of gastric cancer patients,they were divided into recurrence group(n=19)and non-recur-rence group(n=76).Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of recurrence in patients with gastric cancer after radical resection.Results The ex-pression levels of HER2,CA199 and LC3B in gastric cancer tissues were significantly higher than those in pa-racancerous tissues(P<0.05).The positive expression rates of HER2,CA199 and LC3B in gastric cancer tis-sues(38.95%,38.95%and 35.79%,respectively)were higher than those in adjacent tissues(9.47%,7.37%and 11.58%,respectively),and the differences were statistically significant(P<0.05).The positive expres-sion rate of HER2 in gastric cancer tissues was significantly different in patients with different TNM stage and lymph node metastasis(P<0.05).There were significant differences in the positive expression rates of CA199 and LC3B in gastric cancer patients with different tumor maximum diameter,TNM stage and lymph node metastasis(P<0.05).The maximum diameter of tumor≥5 cm,TNM stage Ⅲ/Ⅳ,lymph node metas-tasis,positive expression of HER2,positive expression of CA199 and positive expression of LC3B were inde-pendent risk factors for recurrence of gastric cancer patients after radical resection(P<0.05).Conclusion The gene expression and positive expression rates of HER2,CA199 and LC3B in gastric cancer tissues are high,which are related to the maximum tumor diameter,TNM stage and lymph node metastasis.The positive expression of HER2,CA199 and LC3B may increase the risk of recurrence of gastric cancer after radical gastrectomy.

This paper discussed the current education status on medical ethics and styles and the assessment condition in the examination of doctors' qualification， as well as the existing problems and potential solutions by reviewing domestic and foreign literature and summarizing the practice experience. Traditionally， medical ethics and styles have always been integrated into clinical medical practice in China. However， under the modern medical education system， it is challenged to integrate traditional education on medical ethics and styles with the rules of modern medical knowledge. By summarizing the education and assessment status of medical ethics and styles in the examination of doctors' qualification， it is found that the current examination is relatively poor in the evaluation content， and the way of evaluation is not diverse， with lack of curriculum of medical humanities. The solutions suggested are enriching relevant examination content， introducing more and comprehensive evaluation method， and establishing more medical humanities-related courses.

Objective:To discuss the effects of different doses of ganoderic acid A(GAA)on the biological activities,glycolysis,and the expression of rate-limiting enzymes of non-small cell lung cancer(NSCLC)PC9 cells,and to clarify the mechanism.Methods:The NSCLC PC9 cells were cultured in vitro and divided into blank control group,low dose(25 μmol·L-1)of GAA group,medium dose(50 μmol·L-1)of GAA group,and high dose(100 μmol·L-1)of GAA group.The methylthiazolydiphenyltetrazolium(MTT)assay was used to detect the survival rates of the PC9 cells in various groups;Transwell chamber assay was used to detect the number of migration cells of the PC9 cells in various groups;the glucose uptakes of the PC9 cells in various groups were detected by glucose assay kit;the levels of ATP in the PC9 cells in various groups were detected by ATP assay kit;the levels of lactic acid in the PC9 cells in various groups were detected by lactate assay kit;the expression levels of hexokinase 2(HK2)and pyruvate kinase M2(PKM2)mRNA in the PC9 cells in various groups were detected by real-time fluorescence quantitative PCR(RT-qPCR)method;the expression levels of HK2 and PKM2 proteins in the PC9 cells in various groups were detected by Western blotting method.Results:The MTT assay results showed that,at 24,48,and 72 h of culture,compared with blank control group,the survival rates of the cells in medium and high doses of GAA groups were significantly decreased(P<0.05).At 72 h of culture,compared with low dose of GAA group,the survival rate of the cells in high dose of GAA group was significantly decreased(P<0.05).The Transwell chamber assay results showed that compared with blank control group,the numbers of migration cells in medium and high doses of GAA groups were significantly decreased(P<0.05);compared with low doses of GAA group,the number of migration cells in high dose of GAA group was significantly decreased(P<0.05).Compared with blank control group,the glucose uptakes and levels of lactic acid in the cells in medium and high dose of GAA groups were significantly decreased(P<0.05),and the level of ATP in the cells in high dose of GAA group was significantly decreased(P<0.05).The RT-qPCR results showed that compared with blank control group,the expression levels of HK2 and PKM2 mRNA in the cells in medium and high doses of GAA groups were significantly decreased(P<0.05).The Western blotting results showed that compared with blank control group,the expression levels of HK2 and PKM2 proteins in the cells in medium and high doses of GAA groups were significantly decreased(P<0.05).Conclusion:Medium and high doses of GAA can inhibit the biological activities of proliferation and migration of the PC9 cells,reduce the glycolysis,and its mechanism may be related to the inhibition of the expressions of the key rate-limiting enzymes HK2 and PKM2.

Objective To explore the clinical efficacy of Chaiqi Ningshen Anmian Decoction(CNAD)combined with wrist ankle acupuncture(WAA)in treating chronic insomnia(CI)patients with heart and spleen deficiency.Methods CI patients diagnosed and treated at the Beijing Huairou Hospital of Traditional Chinese Medicine from April 2022 to April 2023 were selected,and patients were randomly divided into the Eszolam(ET)group and the combination group(CNAD combined with WAA)according to the random number table method,with 50 cases in each group.The primary outcome was clinical efficacy[evaluated by the Traditional Chinese Medicine Syndrome Integral(TCMSI)].Secondary outcomes included changes in cognitive function[assessed by the Montreal Cognitive Assessment(MoCA)],anxiety level[assessed by the Hamilton Anxiety Scale(HAMA)],sleep quality[assessed by the Pittsburgh Sleep Quality Index(PSQI)],glycated serum albumin(GA),serotonin(5-HT),interleukin-1 β(IL-1β),and C-reactive protein(CRP)before and after treatment in both groups.Results Before treatment,there was no significant differences in total TCMSI between the two groups(P＞0.05).After treatment,the total TCMSI of the combination group was significantly lower than that of the ET group(P＜0.05),and the treatment effectiveness rate was significantly higher in the combination group(P＜0.05).Before treatment,there were no significant differences in MoCA score,HAMA score,PSQI score,serum GA level,serum 5-HT level,serum IL-1 level and serum CRP level between the groups(P＞0.05).After treatment,the MoCA score,serum GA level,and serum 5-HT level in the combination group were significantly higher than those in the ET group(P＜0.05),while the HAMA score,PSQI score,serum IL-1β level,and serum CRP level were significantly lower in the combination group(P＜0.05).Conclusion Compared with ET,CNAD combined with WAA significantly improves insomnia symptoms in CI patients with heart and spleen deficiency,enhances cognitive function and sleep quality,and reduces anxiety levels.This may be related to the upregulation of serum 5-HT,IL-1 β and the inhibition of the inflammatory response.

Objective:Hepatic amyloidosis is a metabolic disease with a low incidence rate. However, because of its insidious onset, the rate of misdiagnosis is high, and it usually progresses to a late stage when it is diagnosed. This article analyzes the clinical features of hepatic amyloidosis by combining clinical pathology in order to improve the clinical diagnosis rate.Methods:Clinical and pathological data of 11 cases of hepatic amyloidosis diagnosed at the China-Japan Friendship Hospital from 2003 to 2017 were summarized and analyzed retrospectively.Results:The clinical manifestations of 11 cases mainly included abdominal discomfort (4/11), hepatomegaly (7/11), splenomegaly (5/11), fatigue (6/11), etc. Biochemical test results showed that most patients' alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, total bilirubin, direct bilirubin, and total bile acids, accompanied by hypoalbuminemia were elevated, while some patients' 24-h urinary protein, creatinine, and blood urea nitrogen were elevated.Conclusion:All patients had slightly elevated aspartate transaminase levels (within 5 times the upper limit of normal), and 72% had slightly elevated alanine transaminase. Alkaline phosphatase and γ-glutamyl transferase levels were significantly raised in all cases, with the highest result for γ-glutamyl transferase being 51 times the upper limit of normal. Damage to the hepatocytes has an effect on the biliary system as well, leading to symptoms such as portal hypertension and hypoalbuminemia [(0.54~0.63) × upper limit of normal value, 9/11]. Amyloid deposits within the artery wall (54.5% of patients) and portal vein (36.4% of patients) were also indicative of vascular injury. A liver biopsy should be recommended for patients with unexplained elevated transaminases, bile duct enzymes, and portal hypertension in order to establish a definitive diagnosis.

Objective:To explore the effect of continuous nursing model based on family unit in long-term warfarin anticoagulation in elderly patients with mechanical heart valve replacement (MHVR) .Methods:From July 2018 to March 2021, 87 elderly patients who underwent MHVR in Wuxi Second People's Hospital and received long-term warfarin anticoagulation after surgery were selected by convenience sampling as the research subject. The patients were divided into the observation group ( n=46) and the control group ( n=41) by random number table method. The control group adopted the routine nursing model, and the observation group adopted the family unit-based continuous nursing model on this basis. The two groups of patients were compared in terms of 3 indicators, namely treatment compliance, treatment effectiveness, and treatment safety. Results:In terms of treatment compliance, the compliance rates of smoking and drinking cessation, diet control, compliance with medicines and regular review of patients in the observation group were better than those in the control group, and the differences were statistically significant ( P<0.05) . In terms of treatment effectiveness, the international normalized ratio (INR) compliance rate and the quality of life score of the observation group were higher than that of the control group with statistical differences ( P<0.05) . In terms of treatment safety, there was no significant difference in the incidence of bleeding events and thrombosis events between the two groups ( P>0.05) . Conclusions:The continuous nursing model based on family unit is effective and safe, and can improve the compliance of elderly patients with MHVR taking warfarin after surgery, and improve the INR compliance rate and quality of life of elderly patients.

Objective:To investigate the occurrence and clinical characteristics of extremely severe tirofiban-induced thrombocytopenia (TIT).Methods:Patients who used tirofiban during hospitalization in Linyi people′s Hospital from March 2015 to September 2021 was screened through the hospital information system. The medical records of patients with extremely severe TIT after medication were collected and analyzed retrospectively. The patient data extracted from the medical records included gender, age, medication indication, comorbidities, tirofiban application, combined drugs, platelet count (PLT) before and after tirofiban use, thrombocytopenia onset time from the application of tirofiban, the time to minimum value of PLT from medication, and the clinical manifestations, intervention, and prognosis of TIT, etc.Results:A total of 10 354 inpatients who used tirofiban during the set period were entered, of which 20 (0.19%) had extremely severe TIT. Among the 20 patients, 16 were male and 4 were female, aged 39-84 years with an average age of 66 years, 12 of which were ≥65 years. The medication indications of tirofiban were acute myocardial infarction in 8 patients, cerebral infarction in 5 patients, unstable angina pectoris in 4 patients, and post-operation of coronary artery bypass grafting, transient ischemic attacks, and post-operation of coronary- stent implantation in 1 patient respectively. The comorbidities included hypertension in 13 patients, diabetes mellitus in 4 patients, cerebral infarction in 3 patients, and New York Heart Association (NYHA) greater than or equal to class Ⅲ heart failure in 3 patients. Tirofiban was administered by continuous intravenous pumping for 1-48 hours. The combined drugs included aspirin enteric-coated tablets, clopidogrel tablets, ticagrelor tablets, heparin, low molecular weight heparin, alteplase, and plasmin. Five patients had symptoms of chills and shivers within 1-6 hours after treatment, 7 had oral mucosal bleeding, epistaxis, gingival bleeding, skin ecchymosis, ecchymosis on venipuncture sites, tarry stool, or bloody stool within 1-7 days after treatment, and 10 had no clinical symptoms. The median time from tirofiban application to the onset of PLT decrease and to the minimum value of PLT [(1-18)×10 9/L] were 12 (6, 20) and 18 (12, 22) hours, respectively, and the 2 kinds of time above were consistent in 13 patients. Tirofiban was discontinued in all patients after the diagnosis of extremely severe TIT, and treatments with glucocorticoids, human immunoglobulin, and platelet infusion were given. PLT recovered to (100-258)×10 9/L after 3-17 days (median time 4 days) of treatments in 18 patients. The other 2 patients developed tarry stool and bloody stool 2 and 1 days after the diagnosis of TIT, respectively, followed by respiratory and cardiac arrest, and died. Conclusions:Extremely severe TIT has low incidence but urgent onset, which can lead to fatal bleeding events, and some patients may have no clinical symptoms. The prognosis is generally good after tirofiban withdrawal and receiving glucocorticoids and symptomatic treatments. However, it should be alert to the adverse consequences caused by secondary bleeding events.

Objective:To investigate the occurrence and clinical characteristics of extremely severe tirofiban-induced thrombocytopenia (TIT).Methods:Patients who used tirofiban during hospitalization in Linyi people′s Hospital from March 2015 to September 2021 was screened through the hospital information system. The medical records of patients with extremely severe TIT after medication were collected and analyzed retrospectively. The patient data extracted from the medical records included gender, age, medication indication, comorbidities, tirofiban application, combined drugs, platelet count (PLT) before and after tirofiban use, thrombocytopenia onset time from the application of tirofiban, the time to minimum value of PLT from medication, and the clinical manifestations, intervention, and prognosis of TIT, etc.Results:A total of 10 354 inpatients who used tirofiban during the set period were entered, of which 20 (0.19%) had extremely severe TIT. Among the 20 patients, 16 were male and 4 were female, aged 39-84 years with an average age of 66 years, 12 of which were ≥65 years. The medication indications of tirofiban were acute myocardial infarction in 8 patients, cerebral infarction in 5 patients, unstable angina pectoris in 4 patients, and post-operation of coronary artery bypass grafting, transient ischemic attacks, and post-operation of coronary- stent implantation in 1 patient respectively. The comorbidities included hypertension in 13 patients, diabetes mellitus in 4 patients, cerebral infarction in 3 patients, and New York Heart Association (NYHA) greater than or equal to class Ⅲ heart failure in 3 patients. Tirofiban was administered by continuous intravenous pumping for 1-48 hours. The combined drugs included aspirin enteric-coated tablets, clopidogrel tablets, ticagrelor tablets, heparin, low molecular weight heparin, alteplase, and plasmin. Five patients had symptoms of chills and shivers within 1-6 hours after treatment, 7 had oral mucosal bleeding, epistaxis, gingival bleeding, skin ecchymosis, ecchymosis on venipuncture sites, tarry stool, or bloody stool within 1-7 days after treatment, and 10 had no clinical symptoms. The median time from tirofiban application to the onset of PLT decrease and to the minimum value of PLT [(1-18)×10 9/L] were 12 (6, 20) and 18 (12, 22) hours, respectively, and the 2 kinds of time above were consistent in 13 patients. Tirofiban was discontinued in all patients after the diagnosis of extremely severe TIT, and treatments with glucocorticoids, human immunoglobulin, and platelet infusion were given. PLT recovered to (100-258)×10 9/L after 3-17 days (median time 4 days) of treatments in 18 patients. The other 2 patients developed tarry stool and bloody stool 2 and 1 days after the diagnosis of TIT, respectively, followed by respiratory and cardiac arrest, and died. Conclusions:Extremely severe TIT has low incidence but urgent onset, which can lead to fatal bleeding events, and some patients may have no clinical symptoms. The prognosis is generally good after tirofiban withdrawal and receiving glucocorticoids and symptomatic treatments. However, it should be alert to the adverse consequences caused by secondary bleeding events.

Objective To investigate the effects of "one to one" tutorial system of two-way selection model in the standardized training of new nurses.Methods Using purposive sampling, a total of 25 new nurses recruited in July 2014 were selected as the control group,and they received traditional teaching mode. Another 25 new nurses recruited in July 2015 were selected as the observation group,and they received "one to one" tutorial system of two-way selection model. The theoretical and operating scores,general self-efficacy and career self-efficacy of nurses were compared between two groups after one year's training.Results The sores of basic theory,basic operation,professional theory and bedside practice in the observation group were (89.99±5.76), (90.08±2.56),(88.39±6.71) and (92.74±4.30),which were significantly higher than (85.61±6.27),(87.99±3.27),(84.30±5.74) and (89.22±3.55) in the control group (t=2.105,2.296,2.591,2.543;P<0.05). There was no significant difference between two groups in the scores of general self-efficacy,educational requirements and job duties before the training (P>0.05). After one year's training,the scores of general self-efficacy,educational requirements and job duties in the observation group were (31.48±3.12),(15.24±2.16) and (15.64±2.48),which were significantly higher than (26.96±3.54),(11.66±2.54) and (12.40±2.50) in the control group (t=3.901,4.177 and 4.825;P<0.01).Conclusions "One to one" tutorial system of two-way selection model in the standardized training of new nurses could make new nurses change from students to qualified nurses faster and it is worth to be expanded.

Objective To explore the application value of the situation-background-assessment-recommendation(SBAR) communication mode in the patients with acute myocardial infarction (AMI).Methods Ninety-four cases of AMI patients who were hospitalized in the department of cardiology in Wuxi No.2 People's Hospital of Nanjing Medical University were included and were randomly divided into the conventional group and the SBAR group. There were 47 cases in each group. The patients in the conventional group were given the routine care; the patient in the SBAR group was given the SBAR communication mode. The nursing satisfaction and the incidence of adverse events in the 2 groups were compared.Results The nursing satisfaction in the SBAR group was 95.74%, which was significantly higher compared to the conventional group (70.21%,P<0.05). The total incidence of adverse events in the SBAR group was 4.25%; in the conventional group the incidence was 25.53%. The difference between the 2 group was significant (χ2=6.42,P<0.05).Conclusions The SBAR communication model can effectively improve the quality of the nurses' disease observation and the nursing satisfaction and reduce the incidence of clinical adverse events, which was worth clinical promotion.