Objective To systematically characterizes the temporal changes in urokinase-type plasminogen activator(uPA)over the course of neoplastic progression using a mouse oral squamous cell carcinoma(OSCC)model induced by 4-nitroquinoline-1-oxide(4-NQO).Methods A total of 65 wild-type C57BL/6 mice of 5 weeks old were randomly assigned to two groups,a 4-NQO group(n=50),which received daily administration of 100 μg/mL 4-NQO in drinking water,and a control group(n=15),which received sterile water.At 12,16,20,22,and 24 weeks,10 mice from the 4-NQO group and 3 from the control group were randomly selected,weighed,and sacrificed.Tongue tissues were collected for hematoxylin-eosin(HE)staining to preliminarily assess OSCC development,and for immunofluorescence staining and quantitative real-time PCR to evaluate dynamic uPA expression in tongue tissues during OSCC progression.Results After 16 weeks of exposure,4-NQO-treated mice exhibited significantly lower body mass compared with that of the controls(P<0.05)and the weight loss became increasingly more pronounced over time.Histopathological changes in tongue tissues progressed in a clearly time-dependent manner—hyperplasia and mild dysplasia emerged at week 12,while moderate-to-severe dysplasia and carcinoma were observed by week 22,yielding a tumorigenic rate of 25%,which escalated to 70%by week 24.Immunofluorescence and qPCR analyses demonstrated a pronounced,progressive up-regulation of uPA expression in lesional tissues as OSCC progressed(P<0.000 1).Conclusion This study not only confirmed the uniqueness of the 4-NQO model in OSCC research,but also revealed the changes in uPA during tumor invasion.These findings provide a theoretical foundation for the development of early diagnosis and precision treatment strategies,holding significant potential clinical value and research importance for improving patient prognosis.

The syndrome/pattern of defensive qi deficiency is a common basic syndrome of traditional Chinese medicine in clinical practice. However,there is a lack of standardized and operable diagnostic specifications in practical applications. Based on the previous literature,this study proposed the idea of starting from the elements of the syndrome,qualitative diagnostic criteria for the syndrome/pattern of defensive qi deficiency oriented to the entire region of the disease were constructed based on the two dimensions of " deficient defensive qi failing to consolidate the exterior" and " qi deficiency" and constructing a set of quantitative evaluation criteria as the supporting content for the diagnostic items. The core members of the research group attempted to formulate the draft standard,then reached a consensus through the Delphi method expert questionnaire consultation and the Nominal group technique,and finally evaluated the reliability and validity of the standard through clinical verification to provide ideas for the standardization and normalization of research on syndromes.

Purpose/Significance To understand the behavioral characteristics of patients with eye diseases,and to optimize the smart medical service strategies for eye diseases.Method/Process Guided by Anderson's medical service utilization model,the elec-tronic medical records(EMR)data of 17 602 patients in a hospital are collected,and chi-square test and pedigree clustering method are used to explore the behavioral characteristics of patients with eye diseases from four dimensions.The satisfaction of 702 patients with eye diseases on smart medical services is investigated,and the main influencing factors are analyzed by ordinal logistic regression.Re-sult/Conclusion According to the demographic characteristics of patients with eye diseases,registration methods,common ophthalmic diseases and incidence data,settlement methods,etc.,suggestions and strategies for smart medical services for eye diseases are put for-ward from four aspects:resource layout,technical compatibility,service mode and optimized settlement.

Objective To observe the clinical efficacy of autologous hair follicle stem cell transplantation for hair restoration in patients with alopecia. Methods Ten patients with alopecia, including five with androgenic alopecia and five with seborrheic alopecia, were selected from November 2022 to May 2023. They were treated with autologous hair follicle stem cell transplantation. Data before treatment were used as the control group, and data after treatment were used as the study group. Follow-up was conducted for 3 to 8 months. The FPF scoring system was designed to collect data and evaluate the treatment effect. Results Nine patients had an improvement score of ≥7 points, and one patient had an improvement score of 2 points, with a treatment excellence rate of 90% (9/10). Compared with the total score of (2.81±0.92) points in the control group, the total score of the study group was (9.00±2.21) points, and the difference was statistically significant (P < 0.001). Conclusion Autologous hair follicle stem cell transplantation for hair restoration is safe and effective, and has a broad range of indications.

Objective To investigate the application value of tenofovir alafenamide fumarate (TAF) in elderly patients with chronic hepatitis B (CHB) and its influence on bones and kidneys. Methods A total of 36 CHB patients, aged ≥60 years, who received TAF antiviral therapy in Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qingdao Sixth People's Hospital, Chengyang People's Hospital, and Jimo People's Hospital from June 2021 to October 2022 were enrolled in this study, and all patients received TAF (25 mg/d) antiviral therapy. Related data were collected at baseline and weeks 24 and 48 of treatment, including virological indicators, biochemical parameters, urinary protein electrophoresis indices, transient elastography (FibroScan), and bone mineral density. Virological indicators included high-sensitivity HBV DNA quantification; biochemical parameters included total bilirubin, direct bilirubin (DBil), indirect bilirubin (IBil), alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bile acid (TBA), glucose, blood urea nitrogen, creatinine, estimated glomerular filtration rate, and cystatin C (Cys C); urinary protein electrophoresis indices included urinary β2 microglobulin (β2-MG), urinary retinol (URBP), and urinary α1 microspherin (α1-MG). The paired t -test was used for comparison of normally distributed continuous data before and after treatment, and the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment; the chi-square test or the Fisher's exact test was used for comparison of categorical data. Results A total of 36 CHB patients completed 24 weeks of follow-up. The complete virological response rate after 24 weeks of treatment was higher than that at baseline [83.3% (30/36) vs 77.8% (28/36), χ 2 =0.36, P =0.55], and there were significant reductions in DBil ( t =-2.42, P =0.02) and Cys C ( t =-4.34, P < 0.001) from baseline to week 24. A total of 18 CHB patients completed 48 weeks of follow-up. The complete virological response rate after 48 weeks of treatment was higher than that at baseline (94.4% vs 77.8%, χ 2 =2.22, P =0.34), and there were significant increases in IBil ( t =2.43, P =0.03), TBA ( Z =-2.24, P =0.03), and bone mineral density T score of lumbar vertebra ( t =2.92, P = 0.01) and femoral neck ( t =2.42, P =0.03) and a significant reduction in liver stiffness measurement ( t =-2.31, P =0.03). There were no significant changes in β2-MG, URBP, and α1-MG after treatment (all P > 0.05). Conclusion TAF has a good antiviral effect in CHB patients aged ≥60 years and can help more CHB patients achieve complete virological response, without causing damage to the kidney, and it can also improve bone mineral density and liver fibrosis degree.

Objective:To analyze the epidemiological characteristics of all the patients with intertrochanteric fracture admitted to the Third Hospital of Heibei Medical University in the past 10 years.Methods:Data of patients with intertrochanteric fracture admitted to our hospital from January 1, 2010 to December 31, 2019 were retrospectively analyzed. According to the year of admission, all the patients were divided into two groups: the first five years (group A) and the last five years (group B). Gender, age, injury cause, Evans classification, complicated diseases, length of hospital stay and whether surgical treatment or not were compared.Results:A total of 6,125 patients with intertrochanteric fracture were included in the study, including 2,664 males and 3,461 females with a male to female ratio of 0.77∶1. The peak age was 70-79 for males and 80-89 for females. There were 2,314 cases in group A (male to female ratio was 0.91∶1) and 3,811 cases in group B (0.70∶1), showing significant differences between the 2 groups in the male to female ratio ( χ2=25.265, P< 0.05). The peak age ranged from 70 to 80 years (31.9%,739/2,314) in group A and from 80 to 90 years (34.5%, 1,313/3,811) in group B. There were significant differences between the 2 groups in the sex ratios of age groups from 70 to 79 years ( χ2=0.024, P< 0.05). In all the 6,152 patients with a definite injury cause, the fall and indoor activity accounted for the highest proportion (83.9%, 5,140/6,125), and the proportion of group A was 75.4% (1,745/2,314) while the proportion of group B was 89.1%(3,395/3,811) showing a significant differences between the 2 groups in injury cause ( χ2=14.363, P< 0.05). Based on X-ray films or computer tomography (CT) of 3,560 patients, the Evans type II and III were the most common types. Type II accounted for the highest proportion in group A (38.1%, 239/628) while type III did in group B (39.5%, 1,159/2,932) . There were significant differences between the 2 groups in the proportion of Evans classification ( χ2=183.569, P< 0.05). Of all the 6,125 fracture cases, 4,846 fracture patients (79.1%) were complicated with medical diseases. There was a statistically significant difference between the 2 group of the patients who were complicated with medical diseases ( χ2=8.916, P< 0.05). A total of 5,148 patients were treated by operation and 1,925 patients were in group A while the other 3,259 cases were in group B. In group A, the median hospitalization was 14 days and the quartile interval was 8 days. In group B, the median hospitalization and the quartile interval was 12 days and 8 days respectively. There were significant differences between the 2 groups in length of hospital stay for patients treated by surgery ( Z=-9.909, P<0.001). Conclusion:The intertrochanteric fractures admitted to the Third Hospital of Heibei Medical University in the past 10 years were more common in females than in males. Fall and indoor activity was the most common injury cause. Evans types II and III prevailed. The fractures showed an aging trend by comparing the former 5 years and latter 5 years. The number of intertrochanteric fracture patients complicated with medical diseases increased significantly, but the total days of hospitalization was on the decline.

Objective To explore more suitable calculation method of the insulin dosage in insulin hypoglycemia-growth hormone stimulation test(insulin tolerance test, ITT). Methods Fifty-six subjects suspected of growth hormone deficiency were divided into primary and secondary onset groups. All the patients took oral glucose tolerance test and ITT. Homeostasis model of assessment for insulin resistance index ( HOMA-IR) and insulin sensitivity index ( ISI), area under insulin curve ( AUCINS ) and the area under glucose curve ( AUCPG ) were calculated. The insulin dosages during ITT between two groups were compared and the main factors influencing the insulin dosage were analyzed. Results There was no difference in the insulin dosage during ITT between primary and secondary groups. The actual dosage of insulin in this cohort study revealed a significant difference from the initial insulin dosage recommended by the guideline. Multiple linear regression analysis found that AUCINS and body mass index were the independent factors affecting the insulin dosage. Then the optimized coefficient of ITT ( γ) were found. Conclusion The insulin dosage used in our study was inconsistent with the guidelines-recommended ones. In order to make ITT more efficient and safer, a more optimized calculation method to improve the successful rate of insulin-induced hypoglycemia in ITT is proposed.

To improve the recognition and treatment of the combination of classical congenital adrenal hyperplasia (CAH) and Turner's syndrome. A case of 21-hydroxylase deficiency (21-OHD) in 45,X[3] / 46,XX [47] was reported,and the related literatures were reviewed. A 29-year-old woman with 45,X[3] / 46,XX[47] was referred with clitorimegaly and primary amenorrhea. Her height was 150 cm with a weight of 56 kg. Physical examination revealed a Tanner stage Ⅵ for both breast development and pubic hair development. She showed a little signs of Turner' s syndrome, such as cubitus valgus. Lab findings: sex hormones are significantly increased, including progesterone, testosterone, dehydroepiandrosterone, 17 hydroxyprogesterone, dihydrotestosterone, and androstendione. Enhanced CT scan showed bilateral adrenal hyperplasia. Gynecological ultrasound showed that the size of the uterus and ovary were near normal and the endometrium was not clear. By gene mutation screening, two mutation sites were found in CYP21A2 gene, such as IVS2-13C/ A→G and p. Ile173Asn( c. 518T→A). Taken together, the patient was diagnosed as a combination of 21-OHD and Turner syndrome. A total of ten patients associated with CAH in Turner's syndrome have been reported so far. The findings showed that routine karyotyping during investigations of patients presenting with ambiguous genitalia or with a diagnosis of CAH may reveal the concomitant presence of Turner's syndrome. We should make a definite diagnosis and give early treatment as soon as possible.

Based on the analysis of blended learning characteristics, a blended learning pro-cess model including preliminary analysis, learning activities design, blended evaluation was con-structed. Then, a blended learning case study was carried out by taking the Fourth Military Medical University Information Security course as an example. The implement methods of setting learning goal, selecting learning content, constructing learning environment, organizing learning activities and course evaluation, were described in detail. Lastly, from the effectiveness questionnaire, it could be shown that blended learning motivated the learners' enthusiasm significantly. In order to improve the learning performance, we proposed that blended learning activities must be flexible and adaptive,and integrate face-to-face learning with online learning effectively.

ObjectiveTo compare the sensitivity and specificity of a new index of insulin resistance (IR) derived from plasma triglyceride and glucose with homeostasis model assessment for insulin resistance index ( HOMA-IR) and insulin sensitivity index from frequent sampling intravenous glucose tolerance test (FSIGT-ISI).Methods A total of 1024 subjects (240 normal control,335 with obesity,312 impaired glucose regulation,and 137 type 2 diabetes mellitus) were included in the present study.Standard oral glucose tolerance test,insulin release test,lipid profiles,and other biochemical markers were measured. Among them 540 subjects were selected to undertake FSIGT.TyG index is derived from plasma triglyceride and fasting glucose.TyG2 index is derived from plasma triglyceride and postprandial 2 plasma glucose.ResultsPearson correlation coefficient between TyG and HOMA-IR or FSIGT-ISI was 0.427 ( P＜0.01 ) and -0.100 ( P=0.024 ),respectively,and that between TyG2 and HOMA-IR or FSIGT-ISI was 0.455 ( P＜0.01 ) and - 0.162 ( P＜0.01 ),respectively.The sensitivity and specificity of TyG index for diagnosis of IR was 68.5％ and 63.5％ compared with HOMA-IR,and 68.5％ and49.5％ compared with FSIGT-ISI.For TyG2 index,the slightly higher sensitivity ( 81.7％ with HOMA-IR,75.7％ with FSIGT-ISI),but lower specificity (51.5％ with HOMA-IR,48.2％ with FSIGT-ISI) were found.ConclusionsBothTyGandTyG2 indices could be used as a surrogate for assessing IR in Chinese subjects.However,considering its moderately high sensitivity but low specificity,these two indices are limited in the use of large-scale epidemiological screening.