Objective:To investigate the correlation of the expression of Ephrin A receptor 2(EphA2)and its promoter region DNA hypomethylation with the occurrence of pyroptosis in invasive breast cancer. Methods:The expression level of pyroptosis-related protein EphA2 in normal breast tissue,paracancerous tissues and cancer tissues from 42 breast cancer patients was examined by Immunofluorescence staining and Western blotting.The expression level of pyroptosis related protein nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)was analyzed by immunofluorescence staining and Western blotting.The expression levels of apoptosis related proteins Caspase 1 and inflammatory cytokine interleukin-1β(IL-1 β)were studied by Western blotting.The DNA methylation level in the promoter region of EphA2 was investigated by nested methylation-specific PCR(nMS-PCR).The expression levels of DNA methyltransferase 1(DNMT1)and DNA methyltransferase 3a(DNMT3a)were examined by Western blotting.The correlation of the protein expression and methylation level of EphA2 in cancer tissues with the expression NLRP3,Caspase 1,IL-1 β,DNMT1 and DNMT3a was analyzed by Pearson correlation coefficient. Results:Compared with normal breast tissues and paracancerous tissues,the expression level of EphA2 protein was significantly increased(P＜0.01),while that of NLRP3,Caspasel and IL-1 βwas significantly decreased(P＜0.05)in breast cancer tissues.Meanwhile,compared with normal breast tissues and paracancerous tissues,the DNA methylation level of EphA2 promoter in breast cancer tissues was significantly decreased(P＜0.05),the expression level DNMT3a protein was significantly decreased(P＜0.01,P＜0.05),and the difference in the expression level of DNMT1 protein was not statistically significant.Pearson correlation analysis showed that the expression level of EphA2 protein is negatively correlated with that of NLRP3(r=-0.651 2,P＜0.05),Caspasel(r=-0.571 2,P＜0.05),IL-1β(r=-0.654 6,P＜0.05)or DNMT3a(r=-0.537 4,P＜0.05),while the methylation level of EphA2 was positively correlated with the protein expression level of NLRP3(r=0.634 1,P=0.026 8),Caspase1(r=0.672 8,P=0.01 6 5),IL-1 β(r=0.694 0,P=0.01 2 3)and DNMT3a(r=0.687 1,P=0.01 3 6). Conclusion:The expression of EphA2 protein is upregulated in breast cancer tissues is negatively correlated with pyroptosis.DNMT3a may be involved in the process of DNA hypomethylation in the promoter region of EphA2.

Objective:To explore the influencing factors of all-cause death in patients with acute myocardial infarction (AMI) and renal insufficiency(RI), and establish a clinical prediction tool.Methods:Collected 727 patients who were hospitalized in Beijing Anzhen Hospital from January 1st 2014 to April 31th 2019, and diagnosed as AMI with RI. Recorded the patients' baseline characteristics, past medical history, current complications, laboratory and auxiliary examination results, treatment methods (included target vessel reconstruction methods, medications, etc.), and follow-up patients for all-cause deaths. Firstly, multivariate Cox regression analysis was used to construct the model in the training set(485 cases). Secondly, the receiver operating characteristic curve ( ROC), calibration curve and clinical decision curve analysis (DCA) were drawn in the validation set(242 cases) to further verify the effect of the prediction model. Finally, a nomogram was developed based on the verified risk factors. Results:Multivariate Cox regression analysis found that there were nine predictors for the prognosis of all-cause death in patients with AMI & RI, the dangerous factors included women, comorbidities, high direct bilirubin, cardiogenic shock, respiratory failure, co-infection and hemofiltration; the protective factors included PCI and taking aspirin. Model evaluation results showed that the AUC of the validation set was 0.82; the calibration line was close to the ideal calibration line, and the slope≈1, the intercept≈0, and the fitting effect was good. Clinical decision-making when the all-cause mortality rate was 35%, the net benefit of active intervention patients based on the Cox model was 38%. A visual nomogram model was developed based on the prognostic risk factors that have been evaluated and predicted to be good. Conclusion:Women, with a history of comorbidities, direct high bilirubin, combined with cardiogenic shock, combined with respiratory failure, combined infection, hemofiltration, PCI and taking aspirin, these nine factors will affect all causes of AMI & RI. For the probability of death, the model developed in this research has high accuracy.

Objective:To conduct a longitudinal study on different social support needs of patients with acute myocardial infarction (AMI) at different stages undergoing emergency PCI based on timing it right framework combined with multidimensional model of social support, so as to provide reference for the implementation of accurate nursing.Methods:Using the interpretative phenomenological research method, a total of 21 emergency PCI patients from Department of Cardiology in two ClassⅢ Grade A hospitals in Taiyuan were selected from December 2019 to July 2020 by the purposive sampling method. According to the course of the disease, 4 semi-structured interviews were conducted on the patients, combined with participatory observation. The interpretive phenomenological analysis method was used to analyze the data, and the social support multi-dimensional model was used to classify the results.Results:A total of 23 themes were extracted. The information support requirements of each phase were in order of diagnosis and risk, AMI and PCI related knowledge, medical notification rights, individualized paper discharge guidance, causes of discomfort and first aid knowledge (the latter two phases were the same) . The tool support requirements for each phase were emergency medical services, advanced stents and emergency PCI technology, green channels, economic support and mobile health care resources (the latter two phases were the same) . The emotional support needs of each stage included companionship and sense of security, acceptance and encouragement, psychological adjustment and construction (the same in the next phase) and strengthening independence. The social network support needs of each stage included the assistance of strangers to send to the hospital, the virtue and skill of medical staff, peer support, and reintegration into society (the latter three stages were the same) . The need for self-esteem support in each period was believing that they can survive, taking care of themselves as much as possible, keeping their illness confidential, receiving recognition for their recovery and giving back to others.Conclusions:The social support needs of emergency PCI patients change with the course of the disease. It is recommended that medical staff adopt a dynamic and continuous care concept, establish and improve a framework of social support needs that meets the local humanities, so as to facilitate education, evaluation and intervention.

Objective To explore the effect of nursing intervention based on the transtheoretical model and stages of change on breastfeeding knowledge, self-efficacy, and duration of breastfeeding in newly born pregnant women, aimed to provide reference for breastfeeding behavior health education model for pregnant women. Methods The 130 primiparas who came to the hospital graded a class- three of Shanxi Province for perinatal examination were selected as the research subjects from May to June in 2017 , they were divided into test group and control group by random digits table method. In the control group, the normal breastfeeding health guidance was carried out in the three stages of prenatal, hospitalized and after discharge. The test group divided the primipara from the beginning of pregnancy to 6th months postpartum period into 5 stages according to transtheoretical model and stages of change. The new strategy of breastfeeding should be formulated and implemented according to different stages and behavior changing processes. Results The total score of breastfeeding knowledge of primipara were (8.76±1.14), (8.92±1.21), (9.90±1.27), (9.94±1.29) points in control group before intervention, the 3rd day, the 42nd day and the 6th month after delivery, and they were (9.11 ± 1.42), (12.02 ± 1.64), (13.04 ± 1.67), (15.00±1.83) points respectively in test group, the differences were statistically significant(Ftime= 51.823, Fgroup=10.406, Finteractive=56.641, all P < 0.05). The total scores of breastfeeding self-efficacy of primipara were (84.62 ± 1.14), (88.96 ± 1.41), (86.65 ± 1.47), (84.31 ± 1.57) points respectively in control group before intervention, the 3rd day, the 42nd day and the 6th month after delivery, while in test group they were (84.98 ± 1.20), (104.02 ± 1.42), (111.00 ± 1.45), (120.04 ± 1.40) points, the differences were statistically significan (Ftime=12.592, Fgroup=229.674, Finteractive=79.955, all P<0.05). The pure breastfeeding rates of primipara were 60.0％(33/55) , 41.8％(23/55), 21.8％(12/55) in control group on the 3rd day, the 42nd day and the 6th month after delivery, they were 84.7％(50/59), 76.3％(45/59) , 49.2％(29/59) in the test group. The differences was statistically significant (χ2=8.804, 14.038, 9.235, all P <0.01). Conclusion Breastfeeding intervention based on the theory of behavioral staged transition can help primipara to improve breastfeeding knowledge and self-efficacy, and improve breastfeeding status.

Objective To observe the clinical effect of ultrasound-guided quadratus lumborum block combined with enhanced recovery after surgery (ERAS) for the laparoscopic appendectomy in children. Methods A total of 154 children undergoing laparoscopic appendectomy, 114 males and 40 females, aged 3-10 years, ASA physical status Ⅰ or Ⅱ, were divided into the ERAS group (group E) and control group (group C), n = 77 each group. Patients in group E received ultrasound-guided deep injection of 0.2％ ropivacaine 0.75 ml/kg into quadratus lumbar muscle. According to the guidelines for rapid rehabilitation fasting for 4 h and abstaining from drinking for 2 h, functional beverages were given 30 min before operation and parental escort during induction of anesthesia while given general anesthesia with laryngeal mask, that is, propofol 2-6 mg·kg-1·h-1 was continuously pumped with 2％-6％ sevoflurane. Patients in group C were given traditional anesthesia, strict fasting for 6 h and no drinking for 4 h, as while as induction with midazolam, propofol, atracurium and sufentanil and tracheal intubation. The VAS scores at 2, 3, 6 and 12 h post-operation were recorded. The awakening time, anal exhaust time, ambulation time, hospitalization days, the patient's satisfaction rates were recorded. The cases of nausea, vomiting, regurgitation and aspiration were recorded. Results The VAS scores at 2, 3, 6 and 12 h post-operation in group E were significantly lower than that in group C (P ＜ 0.05). All the postoperative rehabilitation indicators in group E were superior to group C, including the awakening time, anal exhaust time, ambulation time, hospitalization days and patient's satisfaction (P ＜ 0.05). Complication incidences in group E were significantly declined compared with group C (P ＜ 0.05). Conclusion For children undergoing laparoscopic appendectomy, ultrasound-guided quadratus lumborum block combined with the ERAS strategy could result in less postoperative complications, reduced postoperative pain, rapid rehabilitation, shortened hospitalization time and increased patients' satisfaction.

Objective To investigate the value of critical scoring system in the treatment of multiple organ dysfunction after exposure to poisoning by analyzing 3 cases of industrial organic fluorine gas poisoning.Methods Clinical data of symptoms,signs,treatments,outcome and the changes in the scores as APACHE Ⅱ,SOFA,MODS were collected,the differences among the patients were compared and the relevance was analyzed.Results The first APACHE Ⅱ was 19-26.Scores of case 1 in the three scoring systems constantly increased and different components were found,with the suggestion of sequential organ dysfunction.Other two patients' scores decreased and survived without complications.Conclusiorn Multiple critical scoring systems can be used to evaluate the outcome of multiple organ dysfunction due to organic fluorine gas poisoning.System evaluation and individualized treatment are both important.More studies can help to set up a special critical scoring system.

Aim To explore the effect of miRNA-143 ( miR-1 4 3 ) on homocysteine ( Hcy ) induced-vascular smooth muscle cells ( VSMCs ) proliferation and the mechanism .Methods VSMCs were cultured and in-cubated with Hcy by using primary cultured method . Then, cells were treated with different concentrations of Hcy and folate .VSMCs proliferation was determined with MTT assay , miR-143 was measured by qRT-PCR, and methylation of miR-143 was determined with meth-ylated PCR.Results After cells were treated with dif-ferent concentrations of Hcy , the proliferation of VSMCs was significantly increased , mRNA expression of miR-143 was decreased and methylation of miR-143 was increased .The proliferation of VSMCs was signifi-cantly decreased when transfected VSMCs with miR-143 precursor , and cell proliferation was increased by using miR-143 inhibitor transfection .Conclusion Hy-pomethylation of miR-143 may inhibit VSMCs prolifera-tion.

ObjectiveTo investigate the efficacy of invasive-noninvasive sequential mechanical ventilation (MV) in senile patients with severe community-acquired pneumonia (CAP).Methods A prospective study was conducted. The patients with severe CAP aged≥ 75 years admitted to Department of Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from November 2012 to July 2014, with refusal to have tracheostomy, were enrolled. All patients meeting the diagnostic criteria of CAP and severe CAP were first admitted into the Department of Emergency, and they were found to need MV without absolute contraindication for noninvasive ventilation (NIV) in RICU. The patients were mechanically ventilated via endotracheal intubation (ETI), and they were randomly divided into invasive-noninvasive sequential MV group (sequential MV group) and conventional MV group. NIV was initiated immediately when patients matched the conditions for early extubation in the sequential MV group. Oxygen therapy (5 L/min) via a Venturi mask was provided when the indications of conventional extubation were met. The baseline data and clinical characteristics were recorded, the risk factors of death were analyzed by logistic regression analysis, and 60-day survival rate was analyzed by Kaplan-Meier curve. Results Ninety-one senile patients with severe CAP were enrolled, among them 28 patients died within 60 days, with a mortality rate of 30.77%. No significant difference in 60-day mortality was found between sequential MV group (n = 44) and conventional MV group [n = 47, 25.0% (11/44) vs. 36.2% (17/47),χ2 = 1.331,P = 0.249]. In the sequential MV group, the incidence of ventilator-associated pneumonia (VAP) was significantly decreased [27.3%(12/44) vs. 55.3% (26/47),χ2 = 7.350,P = 0.007], and the rate of ETI≥2 times was increased [59.1% (26/44) vs. 29.8% (14/47),χ2 = 5.095,P = 0.024] as compared with conventional MV group. Compared with survival group, the patients in non-survival group showed a higher incidence of cerebrovascular disease (60.7% vs. 25.4%,P = 0.002), higher acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (26.46±2.59 vs. 24.41±2.47,P = 0.001), British Thoracic Society confusion, uremia, respiratory rate, blood pressure,≥75 years (CURB-75 score, 4.00±0.47 vs. 3.68±0.53,P = 0.013), a longer total duration of MV (days: 21.18±10.02 vs. 14.56±7.62,P = 0.002), and a higher ratio of ETI≥ 2 times (53.6% vs. 33.3%,P< 0.001). It was revealed by multivariate logistic regression analysis that ETI≥ 2 times and comorbidity of cerebrovascular infarction were independent predictors of a worse outcome in the senile patients [odds ratio (OR) = 9.677, 95% confidence interval (95%CI) = 3.075 - 30.457,P< 0.001;OR = 5.386, 95%CI = 1.781 - 6.284,P = 0.003]. It was showed by Kaplan-Meir survival analysis that ETI times and concurrent cerebrovascular infarction imparted significant effects on the 60-day survival rate (χ2 = 40.805,P= 0.000;χ2 = 4.425, P = 0.035).ConclusionInvasive-noninvasive sequential MV may not improve the outcome of senile patients with severe CAP, and ETI≥ 2 times and concurrent cerebrovascular disorders drastically lowered the survival rate.

〔Abstract〕 Taking Beijing University of Chinese Medicine as an example , the paper analyzes problems existing in teaching computer basic courses .It proposes to combine the teaching concept of flipped classroom with the case -based teaching method , reform the teach-ing contents, methods, processes and modes of computer basic courses in medical colleges and cultivate students ′abilities to analyze and solve problems , and analyzes the feasibility .

Objective To study the clinical value of esophageal stent placement with radiation therapy for the middle-late pa-tients with esophageal cancer.Methods To perform esophageal stent placement and radiation therapy for the middle-late 35 pa-tients,and to perform radiation therapy for the middle-late 37 patients,then observe the clinical curative effects.Results The treat-ment group were significantly alleviated with dysphagia symptom after operation,which 32 cases sticked the entire radiation,ac-counting for 91.4%,no one can′t complete the treatment because of nutritional status reason.Survival time of one month after ra-diotherapy was up to 100.0%,and survival time of six months was 85.7% (30/35).But the contrast group with dysphagia symp-tom were aggravated or no relief,and needed parenteral nutrition.There were 23 cases to complete the entire radiation,accounting for 62.2%,and 5 cases happened esophageal tracheal fistula.Survival time of one month after radiotherapy was 83.8%(31/37),and survival time of six months was 62.2% (23/37).Two groups of cases in radiotherapy resistance difference was statistically signifi-cant,one month and six months of survival time were statistically significant (all P <0.05 ).Conclusion Esophageal stent place-ment with radiotherapy is more efficient than only radiation therapy to the middle-late patients with esophageal cancer.