Objective:To investigate the effect of microRNA-27b-3p (miR-27b-3p)/nuclear factor-E2-related factor 2 (Nrf2) on metabolic memory impairment of human retinal pigment epithelial (RPE) cells and to explore its regulatory mechanism.Methods:ARPE-19 cells were divided into normal control group, metabolic memory group, miR-27b-3p control group, miR-27b-3p inhibitor group, and liraglutide group.Cells in normal control group were cultured in 5.5 mmol/L normal glucose medium for 6 days.Cells in metabolic memory group were cultured in 30 mmol/L glucose for 3 days and changed to 5.5 mmol/L for 3 days.Cells in miR-27b-3p inhibitor group were added with puromycin after lentiviral transfection to select the successfully transfected cells, and were cultured in 30 mmol/L glucose for 3 days then 5.5 mmol/L glucose for 3 days.Cells in liraglutide group were cultured in 30 mmol/L glucose with liraglutide for 3 days then 5.5 mmol/L glucose for 3 days.The regulatory relationship between miR-27b-3p and Nrf2 was verified by lentiviral transfection.Expressions of miR-27b-3p, Nrf2, NAD(P)H dehydrogenase[quinone]1 (NQO1), heme oxygenase-1 (HO-1) mRNA and protein levels were analyzed by real-time quantitative PCR.Total and nuclear Nrf2 protein expressions were detected by Western blot.The cell proliferation rates of various groups were determined by cell counting kit-8 (CCK-8).The reactive oxygen species (ROS) level was detected by the DHE kit.Results:The miR-27b-3p mRNA relative expression of normal control group, metabolic memory group, miR-27b-3p control group, miR-27b-3p inhibitor group was 1.000±0.000, 1.881±0.034, 1.683±0.088 and 0.111±0.008, respectively, with a statistically significant difference ( F=850.815, P<0.001).The miR-27b-3p mRNA relative expression level was lower in normal control group than in metabolic memory group, lower in miR-27b-3p inhibitor group than in normal control group, and the differences were statistically significant (both at P<0.01).The expression levels of Nrf2 mRNA, total protein, and nuclear protein were decreased in metabolic memory group in comparison with normal control group and were significantly increased in miR-27b-3p inhibitor group in comparison with miR-27b-3p control group, showing statistically significant differences (all at P<0.01).The NQO1 and HO-1 mRNA expressions were decreased in metabolic memory group in comparison with normal control group, and were significantly higher in miR-27b-3p inhibitor group compared with miR-27b-3p control group, showing statistically significant differences (all at P<0.01).The fluorescence intensity of Nrf2, NQO1, and HO-1 was lower in metabolic memory group than in normal control group, and was higher in miR-27b-3p inhibitor group than in miR-27b-3p control group, showing statistically significant differences (all at P<0.01).Compared with metabolic memory group, the relative expression of miR-27b-3p mRNA declined in liraglutide group, with a statistically significant difference ( P<0.05).The relative expression levels of Nrf2 mRNA, NQO1 mRNA, HO-1 mRNA, total and nuclear Nrf2 protein of liraglutide group were enhanced in comparison with metabolic memory group, with statistically significant differences (all at P<0.05).The fluorescence intensity of Nrf2, NQO1, and HO-1 was enhanced in liraglutide group in comparison with metabolic memory group, and the differences were statistically significant (all at P<0.05).Compared with normal control group and liraglutide group, the cell proliferation viability was decreased in metabolic memory group, and the differences were statistically significant (both at P<0.01).The relative content of ROS was higher in metabolic memory group than in normal control group and liraglutide group, and the difference was significant (all at P<0.01). Conclusions:Liraglutide reverses the inhibition of metabolic memory on Nrf2, NQO1, and HO-1 by downregulating miR-27b-3p.

Objective To investigate the influencing factors for the prognosis of adult patients with chronic drug-induced liver injury (DILI). Methods A total of 255 patients who were diagnosed with chronic DILI by liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2018 were enrolled, and according to the liver function after 2 years, they were divided into non-recovery group and recovery group. The two groups were analyzed in terms of the clinical data including age, sex, body mass index, types of drugs used, type of DILI injury, severity of DILI injury, underlying diseases, laboratory markers, liver histology, and 2-year prognosis. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for the prognosis of chronic DILI. Results After 2 years of follow-up, 195 patients (76.5%) achieved the recovery of liver function, while 60 patients (23.5%) did not achieve such recovery. There were significant differences between the two groups in the type of DILI injury ( P =0.028), the proportion of patients with diabetes ( P =0.048), and the degree of liver fibrosis ( P < 0.001), and compared with the recovery group, the non-recovery group had significantly higher levels of baseline white blood cell count, platelet count (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase, and total bile acid and a significantly lower level of cholinesterase (ChE) (all P < 0.05). The baseline characteristics were included in the univariate logistic regression analysis, and the results showed that PLT, ALT, AST, ChE, and fibrosis degree were significantly associated with the prognosis of chronic DILI (all P < 0.05). The multivariate logistic regression analysis of the above variables showed that PLT < 100×10 9 /L (odds ratio [ OR ]=3.592, 95% confidence interval [ CI ]: 1.128-11.438, P =0.003) and ALT > 2×upper limit of normal (ULN) ( OR =3.080, 95% CI : 1.331-7.127, P =0.009) were independent risk factors for the prognosis of chronic DILI. Conclusion When patients meet the diagnostic criteria for chronic DILI, the independent risk factors PLT < 100×10 9 /L and ALT > 2×ULN may be used to screen out the patients who are more likely to have poor prognosis.

OBJECTIVE：To optim ize the ultrafiltration technology of enzymatic hydrolysate from Eucommia ulmoides peel. METHODS：The single factor test was adopted to investigate the effects of molecular weight of ultrafiltration membrane ，liquid temperature，operating pressure ，operating frequency ，membrane filtration time ，liquid concentration and pH on transfer rates of aucubin，geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel. Setting the molecular cut off of fixed ultrafiltration membrane of 100 000，liquid concentration of 7 g/L，and pH value of 7，the ultrafiltration technology was optimized by Box-Behnken design response-surface methodology and validated with liquid temperature ，operating pressure，operating frequency and membrane passing time as factors ，using comprehensive scores calculated from transfer rates of aucubin，geniposide and chlorogenic acid as well as solid removal rate as indexes. RESULTS ：The optimal ultrafiltration technology of enzymatic hydrolysate from E. ulmoides peel was as follows as liquid temperature of 35 ℃，operating pressure of 0.5 MPa，operating frequency of 35 Hz and membrane passing time of 42 min. Results of validation tests showed that the comprehensive scores of the transfer rates of aucubin ，geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel was 78.06％（RSD＝1.43％，n＝3），and its relative error with the predicted value （77.18％） was 1.14％. CONCLUSIONS ：The optimized ultrafiltration technology is stable and reliable ，and can be used for the ultrafiltration purification of enzymatic hydrolysate from E. ulmoides peel.

Clinical and laboratory data of 5 cases of fulmiant type 1 diabetes mellitus (FTlDM) hospitalized in our department of endocrinology and metabolism from February 2014 to December 2016 were collected analyzed.All these patients characterized by acute onset and severe ketoacidosis,with course of 1-3 d.At admission,the blood glucose level was 31.8 ～ 58.9 mmol/L,HbA1c 6.0％ ～ 7.5％,F-CP 0.01～0.05 nmol/L and 2 hC-P 0.02～0.05 nmol/L The pancreatic βcell function had no significant improvement after 1year.FTlDM patients have clinical features of abrupt onset,often with severe metabolic disorders,poor prognosis and seriously damaged islet β cell function.

Objective To investigate the relationship between leptin level of IGR patients and intima-media thickness (IMT) of carotid arterial. Methods One hundred and eighteen IGR patents were enrolled into the following three groups according to the result of oral glucose tolerance test (OGTT): 38 cases of the purely impaired fasting glucose (IFG) group, 42 cases of the purely impaired glucose tolerance (IGT) group and 42 cases of the IFG combining with IGT (IFG + IGT) group. Thirty-eight cases with normol glucose tolerance (NGR) were enrolled in the NGR group. The blood fat, fasting blood-glucose (FBG), fasting insulin (insulin), fasting C peptide , 2 h-postprandial blood glucose , 2 h-insulin , 2 h-C peptide , glycosylated hemoglobin (HbA1C), C-reactive protein (CRP), body mass index (BMI), leptin and IMT were determined in patients of the three groups and the healthy controls. The multiple linear regression was used to analyze the relationship between leptin level and IMT , and person correlation was further used to analyze the affinity degree between leptin level and IMT. Results Compared with the NGT group, the inter-group comparison showed that leptin level was significantly increased in the IFG, IGT and (IFG + IGT) groups (P < 0.05, respectively). Compared with the IFG and IGT groups, IMT and the leptin level were increased in the (IFG + IGT) group (P < 0.05, respectively). The multiple linear regression analysis showed that leptin level was correlated with the increase of IMT in the (IFG + IGT) group (P < 0.05), but not in the IFT group and the IGT group. Conclusion The leptin level in the IGR group and the IMT in the IFG + IGT ) group were significantly increased , the leptin level was closely associated with IMT.

Objective To investigate the current status of job satisfaction,stressful events and self-efficacy among nurses in cancer hospital,and explore correlation among job satisfaction,stressful events and self-efficacy.Methods Totally 260 nurses from Zhejiang Cancer Hospital were inquired by Minnesota satisfaction questionnaire,inventory of stressful events,and general self-efficacy scale.Descriptive analysis and Pearson correlation analysis were adopted to analyze the data.Results A total of 260 questionnaires were given out,while 246 valid questionnaires returned,and the effective rate was 94.6％.The total average scores of job satisfaction,stressful events and self-efficacy were (3.41 ± 0.45),(117.72 ± 18.92) and (2.50 ± 0.44).There was a significant negative correlation between overall satisfaction and stressful event (r =-0.458,P＜0.001).However,satisfaction were positively correlated with self-efficacy (r =0.257,P =0.020).Conclusions Job satisfaction among nurses of cancer hospital is higher than data of previous studies,but the overall self-efficacy is still low,and most of them is in the middle-high stressful events.Managers can improve nurses' job satisfaction by reducing occupational stress and increasing self-efficacy.That might reduce dimission rate,and maintain the stability of care team.

Objective To explore the effect of specific nursing on quality of life of the parents of children with mental retardation (MR). Methods 160 parents of children with MR and 160 parents of normal children were evaluated with WHO Quality Of Life-BREF (WHO-QOL-BREF). The children with MR were divided into observation group (n=80) and control group (n=80). The control group received the traditional nursing care, and the observation group accepted specific nursing care. The scores of WHOQOLBREF were compared. Results The score of WHOQOL-BREF was lower in the MR group than in the normal group (P<0.01). The score decreased with the aggravation of MR (P<0.001). The score of WHOQOL-BREF was higher in the observation group than in the control group (P<0.01). Conclusion Specific nursing should be given to the parents of children with MR, which can promote their quality of life.

The application of micro-lectures in higher medical education is still in a stage of exploration.The au-thors applied the micro-lectures with the traditional teaching method in the teaching of physiology, and conducted a questionnaire survey about it.In this article, the authors summarized the developing process, the students’attitude and the video production of micro-lectures, and compared the micro-lecture with traditional teaching method and MOOCS.At last, they gave some suggestions about application of micro-lectures in higher medical college.

Objective To discuss the correlation between C-peptide level and autonomic neuropathy in diabetic foot in patients with type 2 diabetes mellitus (T2DM). Methods The levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2 h-PG) and fasting C-peptide (FC-P) were detected in 124 T2DM patients. The Neuropad was used to test functions of sudomotor nerves in foot. Patients were divided into two groups:diabetic autonomic neuropathy (DAN) group and non-autonomic neuropathy group (NDAN) according to the results of functions of sudomotor nerves in foot. Values of gender, age, body mass index (BMI), blood pressure, FBG, 2 h-PG and FC-P were compared between the two groups. The Pearson correlation analysis was carried out between the indexes mentioned above and the time for completing color change of Neuro-pad. Results There were no significant differences in gender, age, FBG and 2 h-PG between two groups (P>0.05). The FC-P level was (1.07 ± 0.75)nmol/L in DAN group, which was significantly lower than that in NDAN group (1.43 ± 1.00) nmol/L (P > 0.05). The time for completing color change of Neuropad was negatively correlated with C-peptide. Conclu-sion The autonomic nerve functions in diabetic foot is closely related with C-peptide. It is inferred that C-peptide may have protective effect on autonomic nerves in diabetic foot.

Objective To investigate the clinical efficacy of fire needling in treating endometriosis.Method Fifty-eight endometriosis patients were randomly allocated to treatment and control groups. The treatment group received fire needling at specific points. The treatment was given at one week before menstruation until the end of it, twice a week, three months as a course. The control group took gestrinone 2.5 mg from the first day of menstruation, twice a week, for three consecutive months. The therapeutic effects were evaluated in both groups at three months after the end of treatment.Result The cure rate and the efficacy rate were significantly higher in the treatment group than in the control group (P＜0.05). The pregnancy rate was also higher in the treatment group than in the control group (P＜0.05).Conclusion Fire needling treatment for endometriosis has the advantages of good therapeutic effect, high cure rate and no influence on pregnancy.