Objective: To investigate the status of heat illness, knowledge awareness and adaptive behaviors of heat wave knowledge among food delivery riders, so as to provide a basis for optimizing heat wave response measures for food delivery riders. Methods: In November 2022, food delivery riders from a large food delivery platform in Ningbo City, Zhejiang Province were selected as survey subjects using a cluster sampling method. A self-designed electronic questionnaire was used to select demographic information, work status, lifestyle behaviors and disease history, heat illness status, knowledge awareness and adaptive behaviors of heatwave. Results: A total of 911 questionnaires were distributed, and 830 valid questionnaires were recovered, resulting in a valid response rate of 91.11%. Among the respondents, 796 (95.90%) were male, and 818 (98.55%) worked full-time. The mean age was (27.75±8.00) years. A total of 470 respondents (56.63%) had a work tenure of less than 1 year. The primary working hours were 8-<12 hours, with 504 people accounting for 60.72%. There were 108 cases of heatstroke, with an occurrence rate of 13.01%. And 286 people reported heat-related symptoms, with an occurrence rate of 34.46%. The overall awareness rate of heat wave knowledge was 73.22%, while the awareness rate of heat warning signal classification was relatively low at 9.04%. The heat wave cognition score was (5.86±1.31) points. There were statistically significant differences in heat wave cognition scores among food delivery riders of different ages, educational levels, family annual income, work tenures, and work durations (all P<0.05). Regarding positive adaptive behaviors, the number of riders paying attention to weather forecasts and actively learning about preventive measures was higher (734 people each, accounting for 88.43%). Regarding negative adaptive behaviors, the number of riders who often drank ice-cold beverages was higher (509 people, accounting for 61.33%). The heat wave adaptive behavior score was (6.88±1.77) points. There were statistically significant differences in adaptive behavior scores among riders with different educational levels, family annual income, work tenures, and smoking frequency (all P<0.05). Conclusions The occurrence rates of heatstroke and heat-related symptoms among food delivery riders are relatively high. The knowledge awareness and adaptive behaviors regarding heat wave are at a moderate level. It is suggested to strengthen health education, reinforce risk cognition of heat wave, and promote positive adaptive behaviors among food delivery riders.

ObjectiveTo investigate the effects of zinc finger E-box binding homeobox 1 （ZEB1） on the proliferation， migration， and invasion of lung adenocarcinoma H322 cells， as well as its underlying molecular mechanisms. MethodsThe gene expression characteristics of the transcription factor ZEB1 in lung adenocarcinoma were analyzed using data from the GEO and TCGA public databases. RT-qPCR and Western blot were employed to measure mRNA and protein expression levels of ZEB1 in lung adenocarcinoma cell lines （H322， A549， 95-D） and normal human bronchial epithelial cells （BEAS-2B）. Lentiviral transduction was utilized to establish stable ZEB1-overexpressing （Oe-ZEB1） and vector control （Oe-NC） H322 cell lines. Cell proliferation was assessed using CCK-8， colony formation， and EdU assays， while apoptosis was evaluated by Hoechst33258/PI double staining. Wound healing and Transwell assays were performed to examine cell migration and invasion capabilities. Cell cycle distribution was determined by flow cytometry， and Western blot was used to analyze protein expression changes in relevant signaling pathways. ResultsThe findings from GEO and TCGA indicated that ZEB1 expression in lung adenocarcinoma varied with tumor malignancy grade. RT-qPCR and Western blot analyses revealed significantly higher ZEB1 expression in lung adenocarcinoma cell lines compared to BEAS-2B cells （P0.05）. Results from the CCK-8， colony formation， EdU， wound healing， and Transwell assays demonstrated that， compared with the un-transfected control （Control） group， Oe-ZEB1 H322 cells exhibited enhanced proliferation， migration， and invasion capabilities （P0.05）. Hoechst33258/PI double staining and flow cytometry analyses showed that， relative to the Control group， apoptosis was reduced in Oe-ZEB1 H322 cells （P0.05）. Additionally， a decreased proportion of cells in the G₁ phase and an increased proportion in the S phase were observed in Oe-ZEB1 cells， indicating accelerated cell cycle progression. Western blot analysis further revealed that， compared with the Control group， Oe-ZEB1 H322 cells exhibited upregulated expression of N-cadherin， mutant p53 （mutp53）， and Cyclin D1 （P0.05）， while expression levels of E-cadherin， murine double minute 2 （MDM2）， and p21 were downregulated （P0.05）. ConclusionOverexpression of ZEB1 promotes the proliferation， migration， and invasion of lung adenocarcinoma H322 cells and may facilitate cell cycle progression by modulating the MDM2/mutp53/p21 signaling pathway， thereby promoting the transition of cells from the G₀/G₁ phase to the S phase.

As an innovative form of combining traditional aromatherapy with modern nasal medicine delivery technology， "olfactory administration of Chinese medicine" carries the theoretical essence of traditional Chinese medicine （TCM）， which is "moving and channeling Qi and fragrance， dredging and awakening the mind". Based on the systematic records of olfactory therapies in ancient books in emergency care， disorders of consciousness， lung system， and gynecological diseases， this paper examines the historical evolution of its clinical application， and elucidates the profound historical basis and theoretical feasibility of "olfactory administration of Chinese medicine" as a new form. Combined with the innovation and precise application of modern Chinese medicine olfactory agents in multi-system diseases such as nervous， respiratory， and cardiovascular diseases， this paper further analyzes the multi-dimensional mechanism of olfactory receptor pathway， olfactory brain pathway， nasal mucosal blood vessels， and lymphatic channels， and demonstrates its advantages of rapid onset， targeted brain entry， and systemic regulation. Under the background of continuous growth in the demand for external TCM treatment， continuous breakthroughs in the technology of nasal dosage forms， and increasingly accurate drug delivery paths， Chinese medicine olfactory agents have shown significant practical applicability and development potential. This study aims to provide theoretical support and practical direction for the system construction of this form.

Objective Exploring the clinical efficacy of using autologous rib cartilage grafting to reconstruct finger hemiarticular defects.Methods From August 2022 to February 2024,for 6 patients with hemiarticular surface defects in the metacarpophalangeal joints and interphalangeal joints of 8 fingers,costal cartilage was used for joint remodeling and transplantation to reconstruct the hemiarticular surface defects of the fingers.All 8 joint transplants in 6 patients were two-stage surgeries.In the first stage,antibiotic bone cement was used to fill the space-occupying lesions,and in the second stage,costal cartilage joint remodeling was performed to reconstruct the finger joint defects.Postoperative follow-up and assessment of fracture healing according to Paley fracture healing scoring criteria.Outpatient and WeChat follow-up,upper limb function is evaluated according to the upper limb functional assessment standards of the Chinese Medical Association Hand Surgery Society.Record VAS pain score.Results In this group,there were a total of 6 patients with 8 cases of hemiarticular defects.Among them,2 patients had two joint surgical sites,while the remaining 4 patients had a single joint surgical site.There were 2 cases of metacarpophalangeal joint head defects,2 cases of proximal articular surface defects,3 cases of proximal articular head defects,and 1 case of thumb proximal articular head defect.After surgery,8 out of 6 patients'hand wounds healed successfully.All patients were followed up for 6-12 months postoperatively,with an average of 9 months.The VAS pain score(affected finger)for the last follow-up was 0-2 points,with an average of 0.6 points.According to Paley's scoring criteria,all 6 patients had excellent fracture healing.According to the evaluation criteria for upper limb functional assessment of the Chinese Medical Association Hand Surgery Society,3 cases were rated as excellent,3 cases were rated as good,and 2 cases were rated as fair.Conclusion For patients with half joint defects on one side of the finger,rib rib cartilage was used for joint reconstruction,which significantly improved the joint shape and function at the defect site,and reduced joint pain scores.

Objective To understand the nursing practice of prone position ventilation for patients with moderate to severe acute respiratory distress syndrome(ARDS)in intensive care unit(ICU)in Shandong province,so as to provide basis for standardizing the nursing practice process of prone position ventilation and carrying out training for hospitals.Methods A self-made questionnaire was used,and convenience sampling was adopted.From September 15th to November 5th,2023,ICU nurses were selected from various hospital levels in Shandong province to investigate the obstructive factors of prone ventilation implementation,the weak links in nursing practice and status,and the occurrence of complications.Results A total of 1 188 questionnaires were collected,of which 991 were valid.92.8%(920/991)of nurses had performed prone position ventilation.The biggest obstacle to the implementation of prone position ventilation was the complexity of patient treatments and multiple devices involved[74.6%(686/920)].Regarding the status of training,90.5%(897/991)of nurses had received training on prone position ventilation and 77.0%(763/991)of nurses felt that training was needed.As for pre-operation assessment,more than 80.0%of nurses evaluated patients'vital signs,airway and secretions and so on,among which the evaluation awareness of analgesia was the worst[81.6%(751/920)].As for the main points of implementation,only 14.0%(129/920)of nurses chose the opposite side of the most important pipeline as the turning direction;48.6%(447/920)of nurses chose the anti-Trendelenburg position;36.3%(334/920)of nurses chose to ventilate≥12 hours.Facial edema[81.7%(752/920)],skin pressure injury[78.9%(726/920)]and eye complication[75.8%(697/920)]were the top 3 most frequent complications.Conclusions ICU nurses'prone position ventilation practices were generally line with the nursing team standard for prone position of adult mechanically ventilated patients and the best evidence recommendation,and needs to be further standardized in aspects of turning direction,position management,ventilation duration,and enteral nutrition management.It is recommended that nursing managers at all levels of hospitals further improve the quality of nursing practice of prone position ventilation according to relevant evidence-based evidence and the actual situation of hospitals.

Objective To comparatively observe the value of different machine learning(ML)models for predicting cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Totally 207 patients with pathologically diagnosed PTC were enrolled and divided into metastasis group(n=103)and non-metastasis group(n=104)according to lymph nodes pathology findings after surgical resection,also divided into training set(n=144)and validation set(n=63)with a ratio of 7∶3.Random forest(RF),decision tree(DT),K-nearest neighbor(KNN),logistic regression(LR)and support vector machine(SVM)models were constructed through combining clinical information and ultrasonic manifestations of lymph nodes.Receiver operating characteristic curves were drawn,and the areas under the curve(AUC)were calculated to evaluate the efficacy of these ML models for predicting PTC CLNM.Results Patients'age,transverse diameter/longitudinal diameter ratio of lymph node≥0.5,lymph nodes with cystic change,microcalcification,disappearance of lymphatic gate,hypoechoic mass and unclear border were all impact factors of PTC CLNM,among which microcalcification had the highest contribution to the models.In training set,AUC of DT and RF models were both 0.987,with accuracy reached 93.06%.In validation set,AUC of DT and RF models was 0.817 and 0.895,respectively,all higher than those of other models.The accuracy,specificity and positive predictive value of RF model in validation set was 84.13%,93.10%and 92.86%,respectively,and RF model was the best one among all 5 ML models.Conclusion Among different ML models,RF model was the best one for predicting PTC CLNM.

Objective To investigate the correlation between cognitive function and medication compliance in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM who were admitted to the Department of Endocrinology,Drum Tower Hospital,Nanjing University School of Medicine from July 2023 to December 2023 were selected.The clinical data and laboratory results of the patients were collected.The medication compliance of the patients was evaluated by Adherence to Refills and Medications Scales(ARMS).And the overall cognitive function and independent cognitive domain tests were performed.According to the diagnostic criteria of mild cognitive impairment(MCI),patients were divided into normal cognitive group and MCI group.Linear regression analysis was used to evaluate the correlation between cognitive function and medication compliance in T2DM patients.Multivariate logistic regression analysis was used to explore the relationship between cognitive dysfunction and poor medication compliance in T2DM patients.Results A total of 216 patients with T2DM were enrolled,including 113 patients with normal cognitive function and 103 patients with MCI.The ARMS score(16.4±4.1 vs.15.1±2.8)and the rate of poor medication compliance(54.4%vs.31.0%)in the MCI group were higher than those in the normal cognitive group(all P<0.05).After adjusting for gender,age,years of education and glycosylated hemoglobin,ARMS scores were significantly negatively correlated with immediate memory,attention and delayed memory scores(all P<0.05).Multivariate logistic regression analysis showed that patients with MCI had a higher risk of poor medication adherence[OR=2.645,95%CI=(1.414,4.946),P<0.001].Conclusions Poor cognitive function,especially memory and concentration,is associated with reduced medication compliance in patients with T2DM.Patients with memory and attention problems should be given appropriate medication advice to improve their compliance in clinical practice.

Objective To comparatively observe the value of different machine learning(ML)models for predicting cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Totally 207 patients with pathologically diagnosed PTC were enrolled and divided into metastasis group(n=103)and non-metastasis group(n=104)according to lymph nodes pathology findings after surgical resection,also divided into training set(n=144)and validation set(n=63)with a ratio of 7∶3.Random forest(RF),decision tree(DT),K-nearest neighbor(KNN),logistic regression(LR)and support vector machine(SVM)models were constructed through combining clinical information and ultrasonic manifestations of lymph nodes.Receiver operating characteristic curves were drawn,and the areas under the curve(AUC)were calculated to evaluate the efficacy of these ML models for predicting PTC CLNM.Results Patients'age,transverse diameter/longitudinal diameter ratio of lymph node≥0.5,lymph nodes with cystic change,microcalcification,disappearance of lymphatic gate,hypoechoic mass and unclear border were all impact factors of PTC CLNM,among which microcalcification had the highest contribution to the models.In training set,AUC of DT and RF models were both 0.987,with accuracy reached 93.06%.In validation set,AUC of DT and RF models was 0.817 and 0.895,respectively,all higher than those of other models.The accuracy,specificity and positive predictive value of RF model in validation set was 84.13%,93.10%and 92.86%,respectively,and RF model was the best one among all 5 ML models.Conclusion Among different ML models,RF model was the best one for predicting PTC CLNM.

Objective Exploring the clinical efficacy of using autologous rib cartilage grafting to reconstruct finger hemiarticular defects.Methods From August 2022 to February 2024,for 6 patients with hemiarticular surface defects in the metacarpophalangeal joints and interphalangeal joints of 8 fingers,costal cartilage was used for joint remodeling and transplantation to reconstruct the hemiarticular surface defects of the fingers.All 8 joint transplants in 6 patients were two-stage surgeries.In the first stage,antibiotic bone cement was used to fill the space-occupying lesions,and in the second stage,costal cartilage joint remodeling was performed to reconstruct the finger joint defects.Postoperative follow-up and assessment of fracture healing according to Paley fracture healing scoring criteria.Outpatient and WeChat follow-up,upper limb function is evaluated according to the upper limb functional assessment standards of the Chinese Medical Association Hand Surgery Society.Record VAS pain score.Results In this group,there were a total of 6 patients with 8 cases of hemiarticular defects.Among them,2 patients had two joint surgical sites,while the remaining 4 patients had a single joint surgical site.There were 2 cases of metacarpophalangeal joint head defects,2 cases of proximal articular surface defects,3 cases of proximal articular head defects,and 1 case of thumb proximal articular head defect.After surgery,8 out of 6 patients'hand wounds healed successfully.All patients were followed up for 6-12 months postoperatively,with an average of 9 months.The VAS pain score(affected finger)for the last follow-up was 0-2 points,with an average of 0.6 points.According to Paley's scoring criteria,all 6 patients had excellent fracture healing.According to the evaluation criteria for upper limb functional assessment of the Chinese Medical Association Hand Surgery Society,3 cases were rated as excellent,3 cases were rated as good,and 2 cases were rated as fair.Conclusion For patients with half joint defects on one side of the finger,rib rib cartilage was used for joint reconstruction,which significantly improved the joint shape and function at the defect site,and reduced joint pain scores.

Objective To investigate the correlation between cognitive function and medication compliance in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM who were admitted to the Department of Endocrinology,Drum Tower Hospital,Nanjing University School of Medicine from July 2023 to December 2023 were selected.The clinical data and laboratory results of the patients were collected.The medication compliance of the patients was evaluated by Adherence to Refills and Medications Scales(ARMS).And the overall cognitive function and independent cognitive domain tests were performed.According to the diagnostic criteria of mild cognitive impairment(MCI),patients were divided into normal cognitive group and MCI group.Linear regression analysis was used to evaluate the correlation between cognitive function and medication compliance in T2DM patients.Multivariate logistic regression analysis was used to explore the relationship between cognitive dysfunction and poor medication compliance in T2DM patients.Results A total of 216 patients with T2DM were enrolled,including 113 patients with normal cognitive function and 103 patients with MCI.The ARMS score(16.4±4.1 vs.15.1±2.8)and the rate of poor medication compliance(54.4%vs.31.0%)in the MCI group were higher than those in the normal cognitive group(all P<0.05).After adjusting for gender,age,years of education and glycosylated hemoglobin,ARMS scores were significantly negatively correlated with immediate memory,attention and delayed memory scores(all P<0.05).Multivariate logistic regression analysis showed that patients with MCI had a higher risk of poor medication adherence[OR=2.645,95%CI=(1.414,4.946),P<0.001].Conclusions Poor cognitive function,especially memory and concentration,is associated with reduced medication compliance in patients with T2DM.Patients with memory and attention problems should be given appropriate medication advice to improve their compliance in clinical practice.