Background Exposure to diisononyl phthalate (DINP), an endocrine disruptor associated with metabolic diseases and widely used in plastic products, has been linked to the development of several adverse health outcomes in the liver, including non-alcoholic fatty liver disease (NAFLD). Objective To investigate the effects and the possible molecular mechanisms of DINP exposure on lipid metabolism in human hepatocellular carcinoma cells (HepG2 cells). Methods First, HepG2 cells were treated with DINP at three time spots (24, 48, and 72 h) and eleven doses (0, 0.003, 0.01, 0.03, 0.1, 0.3, 1, 3, 10, 30, and 100 mmol·L⁻¹). Cell viability were detected using cell counting kit 8 (CCK8). Intracellular lipid deposition was determined by oil red O staining and lipid content detection, and triglyceride (TG) and cholesterol (TC) were further detected. Finally, the mRNA expression levels were detected by fluorescence quantitative PCR, including fatty acid synthesis related genes [acetyl-CoA carboxylase alpha (Accα), fatty acid synthase (Fasn), malonyl-CoA decarboxylase (Mlycd), and sterol regulatory element binding protein 1 (Srebp1)] and β-oxidation related genes [peroxisome proliferator activated receptor alpha (Pparα), AMP-activated protein kinase (Ampk), carnitine palmitoyltransferase 1A (Cpt-1a), transcription factor A, mitochondrial (Tfam), nuclear respiratory factor 1 (Nrf1), and peroxisome proliferator-activated receptor gamma and coactivator 1 alpha (Pgc1-α)]. Results Compared with the control group (0 mmol·L⁻¹), the no observed adverse effect levels (NOAEL) of HepG2 cell viability were 0.3, 0.1, and 0.1 mmol·L⁻¹ after 24, 48, and 72 h exposure to DINP, respectively, and the corresponding lowest observed adverse effect levels (LOAEL) were 1, 0.3, and 0.3 mmol·L⁻¹, respectively (P<0.05). After exposure to 30 mmol·L⁻¹ and 100 mmol·L⁻¹ DINP for 24 h, the intracellular lipid content, lipid deposition, TG, and TC levels were increased significantly compared with the control group (P<0.01). Compared with the control group, the mRNA expression levels of genes related to fatty acid synthesis, such as Mlycd, Srebp1, Fasn, and Accα, were down-regulated after the 100 mmol·L⁻¹ DINP exposure for 24 h, while the mRNA expression level of Mlycd was up-regulated in the 30 mmol·L⁻¹ group. The β-oxidation related genes such as Ampk, Pparα, and Tfam were up-regulated significantly after the 100 mmol·L⁻¹ DINP exposure, while Cpt-1a mRNA expression level was down-regulated (P<0.05). Conclusion Exposure to DINP at 30 mmol·L⁻¹ and 100 mmol·L⁻¹ can interfere with fatty acid synthesis and β-oxidation in lipid metabolism of HepG2 cells, resulting in lipid deposition.

Objective:To explore the impact of applying micro-video tracing training model to emerging infectious diseases (EIDs) knowledge training on the autonomous learning ability and learning outcomes among emergency department nurses.Methods:In this study, the training content was developed from the perspective of the historical development of EIDs. The training program was constructed in the form of a micro-video classification module and periodic WeChat group push-based autonomous learning. Convenience sampling was used to select 85 emergency nurses ( n=85) from a grade A tertiary general hospital in Shanghai for micro-video tracing training. The nurses were provided with EIDs knowledge training using a module consisting of 11 episodes, each of which included 5 sessions, i.e., enlightening thinking, micro-video learning, key point consolidation, key point analysis, and extension and expansion. After the intervention, the nurses were compared for their autonomous learning ability and their knowledge, belief, and action levels of EIDs, and their degree of satisfaction with the training model was evaluated. SPSS 20.0 and GraphPad Prism 9.3.0 were used for non-parametric Wilcoxon paired tests of quartiles ( Q25, M, and Q75). Results:After the training, the emergency department nurses had significantly higher scores in overall autonomous learning ability ( Z=-4.69, P<0.001) and in each dimension: concept of self-motivation ( Z=-4.48, P<0.001), task analysis ( Z=-4.06, P<0.001), self-monitoring and regulation ( Z=-4.50, P<0.001), and self-evaluation ( Z=-4.82, P<0.001); they had significantly higher scores in overall knowledge, belief, and action levels of EIDs ( Z=-4.65, P<0.001) and in each dimension: knowledge ( Z=-4.04, P<0.001), belief ( Z=-3.24, P=0.001), and action ( Z=-4.05, P<0.001). Emergency department nurses had a high degree of satisfaction with the training model (degree of satisfaction for each item >90%). Conclusions:The micro-video tracing training model can effectively improve the autonomous learning ability of emergency department nurses and their knowledge, belief, and action levels of EIDs, with a high degree of satisfaction among the nurses, making it promising for wide use.

Objective To construct a nomogram model to predict the risk of pressure injuries(PI)in mechanically ventilated patients in the intensive care unit(ICU).Methods Clinical data of mechanically ventilated patients in the ICU of Zhongshan Hospital,Fudan University from January 1,2020 to March 15,2023 were retrospectively collected as the training set,and data from ICU of the same hospital from October 1,2023 to December 11,2023 were collected as the external validation set.Risk variables for PI were selected using LASSO regression and Cox proportional hazards model,and a nomogram model was constructed.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the model.Calibration curve and decision curve analysis(DCA)were used to assess the model's calibration and clinical applicability.The external validation was performed using the validation set data.Results A total of 580 mechanically ventilated patients were included in the training set,with 84 cases(14.5％)of PI.LASSO regression and Cox proportional hazards model selected 10 variables to construct the nomogram model.The ROC curve showed an AUC of 0.830 for predicting PI in mechanically ventilated patients.Calibration curve and DCA indicated good calibration and predictive performance of the model.The external validation set included 100 patients,with 12 cases of PI,and the AUC was 0.870.Calibration curve and DCA showed good model performance.Conclusions The nomogram model based on LASSO-Cox regression has good predictive performance and can be used to screen high-risk population for PI in mechanically ventilated patients.

Objective: To examine mental health problems among adolescents in Taiyuan City and its relationship to chronotype, so as to give a scientific basis for supporting mental health of middle school students. Methods: From October to November 2021, a total of 2 621 pupils were enrolled from three junior high schools and two senior high schools in Taiyuan by using a multi stage stratified cluster random sampling method to investigate demographic characteristics, mental health status, and chronotype. Chi squared test, Spearman correlation analysis and Logistic regression were used to analyze the relationship between sleep patterns and mental health problems in middle school students. Results: The proportion of morning, intermediate and evening types of middle school students sleep were 17.9%, 65.6%, and 16.4%, respectively. The overall detection rate of mental health problems was 13.8 %, which was statistically significant among middle school students in different grades, self perceived family economic status, the number of friends and sleep patterns ( χ 2=42.69, 29.15, 46.02, 93.99, P <0.05). After adjusting for grade, self perceived family economic status and the number of friends, Logistic regression analysis revealed that mental health problems were positively associated with evening type ( OR =2.84) and negatively associated with morning type ( OR =0.61)( P ＜0.05). Conclusion Chronotype is associated with mental health problems among middle school students, with a higher risk for evening type and a lower risk for morning type. Mental health of middle school students can be enhanced by changing their chronotype.

Objective:To explore the effect of responsibility management combined with nursing intervention based on Rosenthal effect on the quality of life and adverse reactions of patients with multiple myeloma.Methods:Using convenience sampling method, 75 patients with multiple myeloma admitted to the Hematology Department of Henan Provincial People's Hospital from March 2016 to July 2018 were selected as the control group conducting responsibility management. A total of 75 patients with multiple myeloma admitted from December 2018 to March 2021 were selected as the observation group, and the nursing intervention based on Rosenthal effect was applied on the basis of the control group. The quality of life of the two groups of patients before and after the intervention was compared, and the incidence of adverse reactions during the admission of the patients was counted.Results:Before the nursing intervention, there was no statistically significant difference in the scores of various indicators of the quality of life between the two groups of patients ( P>0.05) . After the nursing intervention, three functional indicators of physical function, cognitive function, emotional function, as well as scores of the fatigue, nausea and vomiting, loss of appetite, insomnia symptoms and general health of patients in the observation group were better than those in control group, and the differences were statistically significant ( P<0.05) . The incidence of adverse reactions in the observation group was 9.3% (7/75) , which was lower than 24.0% (18/75) in the control group, and the difference between the two groups was statistically significant ( P<0.05) . Conclusions:Responsibility management combined with nursing intervention based on Rosenthal effect can improve the quality of life of patients with multiple myeloma and reduce the incidence of adverse reactions, which is worthy of clinical application.

Objective: To evaluate the histocompatibility and clearance of chlorpyrifos and its metabolite of activated charcoal and adsorption resin by in vitro study. Methods: Venous blood from volunteers were incubation with activated charcoal or adsorbent resins, cytometry parameters and plasma components were detected for evaluation the histocompatibility of adsorbents. Venous blood from volunteers mixed with chlorpyrifos and its metabolite were incubation with activated charcoal or adsorbent resins, plasma concentration of chlorpyrifos and its metabolite were detected for evaluation the efficacy of adsorbents. Results: Incubation tests show that the absorbents reduce the blood platelet (F=3.671, P<0.05) , serum glucose (F=10.564, P<0.05) , albumin (F=5.239, P<0.05) , uric acid (F=7.175, P<0.05) , creatinine (F=23.673, P<0.05) , T3 (F=11.161, P<0.05) and free T3 (F=10.256, P<0.05) . However, other cytometry parameters and plasma components were not influenced. Both activated charcoal and adsorbent resins could reduce the plasma concentration of chlorpyrifos (F=798.110, P<0.01) and its metabolite (F=1495.212, P<0.05) . Conclusion In vitro test show that both activated charcoal and adsorbent resins could clear chlorpyrifos and its metabolite, however, could not influence main cytometry parameters and plasma components, the histocompatibility of adsorbents are satisfactory.

Objective To investigate the current situation of caregiver burden of relative caregivers of multiple myeloma patients, and to analyze its influencing factors. Methods Cross-section investigation method was used in the study. A total of 125 multiple myeloma patients and their relative caregivers, who accepted treatment in the hematology department of He'nan Provincial People's Hospital from December 2015 to March 2017 were selected by convenience sampling method. The general situation investigation questionnaire, Zarit Caregiver Burden Inventory (ZBI), Barthel Index (BI), Social Support Rating Scale (SSRS) and Connor-Davidson Resilience Scale (CD-RISC) were adopted in the investigation. PASW 18.0 software was adopted for statistical analysis of the data. Results The ZBI score of the relative caregivers of multiple myeloma patients was (57.01±15.36), and 86.4% of the caregivers' scored at a moderate level and over. The differences of ZBI scores of the caregivers with different educational background, family average monthly income, caring time and the different numbers of complications in patients were statistically significant (t/F/H=3.924,9.656,8.062,20.608;P< 0.05). The average score of BI in multiple myeloma patients was (53.56±8.30), with moderate dysfunction, which was negatively correlated with the total score of ZBI and the scores of its all dimensions (P< 0.01). The average score of SSRS in the caregivers was (48.18± 8.53), with a high level of social support, and the average score of CD-RISC was (64.50±9.41), the two of which were both negatively correlated with the total score of ZBI and the scores of its all dimensions (P<0.05). As indicated by the results of multiple linear regression analysis, the complication number and self-care ability of the patients as well as the average monthly family income, caregiving time, social support and mental elasticity of the relative caregivers could be included in the regression equation, which explained 40.1% of the variance. Conclusions The caregiver burden of patients with multiple myeloma is relatively heavy. The complication number and self-care ability of the patients as well as the average monthly family income, caregiving time, social support and mental elasticity of the relative caregivers are the influencing factors of caregiver burden.

Objective To explore the effect of modified Seldinger technology in PICC intubation for chemotherapy . Methods Forty patients with chemotherapy during January to December 2014 were assigned as the control group, where the traditional PICC intubation was used, and another forty patients during January to December 2014 as the observation group, where modified Seldinger technology was used. The two groups were compared in terms of post-intubation comfort, puncture success rate, bleeding rate and complications. Results The post-intubation comfort degree of the observational group was significantly higher than that of the control group (P<0.05). The total puncture success rate and one-time success rate were both statistically significantly higher than those of the control group, and the rates of obstruction and infection were significantly lower than those of the control one (P<0.05). Conclusion Modified Seldinger technology used for intubation for chemotherapy can help improve comfort degree and safety and reduce the rate of complications.

Objective To study the effect of DNA methylation regulation on the toxic effect of paraquat on the sensitized V79 cells t pretreated with 5-aza-2'-deoxycytidine.Methods V79 cells were treated by 5-aza-2'-deoxycytidine (5-Aza-2'-dc) for 12h,which is a DNA methylation inhibitor,and then treated with paraquat for 12h.The morphological changes of V79 cells were observed by microscopy and the cell viability was determined by MTT assay and trypan blue staining method.Results Microscopic examination showed that the combination of 5-Aza-2'-dc and paraquat had stronger effect in inhibiting the growth of V79 cells(the cells became smaller and poorer adhensive ability) than single 5-Aza-2'-dc or paraquat.MTT assay showed that cell viability in the combination group (54.47 ± 3.04) ％ was significantly lower than the 5-Aza-2'-dc group (95.52 ± 0.90) ％ and paraquat group (89.68 ± 4.26) ％ (P＜0.05).Trypan blue staining assay showed that the death rate of ceils in the combination group (53.58 ± 1.57) ％ was significantly higher than the 5-Aza-2'-dc group (7.44 ± 2.31) ％ and paraquat group (12.90 ± 1.21) ％ (P＜0.05) Conclusion 5-Aza-2'-dc promotes V79 cells damage caused by paraquat.

Objective To study the reactive oxygen level and the expression of anti-apoptotic protein Bcl-2 and pro-apoptotic protein Bax after treatment of DNA methyltransferase inhibitor 5-aza-2'-deoxycytidine (5-Aza-2'-dc) and paraquat in V79 cells.Methods Cultured V79 cells were divided into 5-Aza-2'-dc treatment group (group A),paraquat treatment group (group B),5-Aza-2'-dc and paraquat treatment group (group C,V79 cells were pretreated with 5-Aza-2'-dc for 12h followed by exposure to paraquat for 12h) and control group (group D).Reactive oxygen level in V79 cells was measured by DCFH-DA flow cytometry and expression of Bcl-2 and Bax was detected by Western blot.Results Reactive oxygen levels and expression levels of Bcl-2 and Bax in V79 cells were significantly different (P＜0.05) in 5-Aza-2'-dc and paraquat treatment group (group C),compared with 5-Aza-2'-dc treatment group (group A),paraquat treatment group (group B) and control group (group D).Expression levels of Bcl-2 and the ratio of Bcl-2 and Bax were lower while reactive oxygen levels and expression levels of Bax were higher in group C than in groups A,B and D.Conclusion 5-Aza-2'-dc regulates DNA methylation by the imbalancing the reactive oxygen metabolism and apoptosis,thus up-regulating the toxic effect of paraquat on V79 cells.