Purpose: Myofibroblastic cancer-associated fibroblasts (myCAFs) are important components of the tumor microenvironment closely associated with tumor stromal remodeling and immunosuppression. This study aimed to explore myCAFs marker gene biomarkers for clinical diagnosis and therapy for patients with bladder cancer (BC). Materials and Methods: BC single-cell RNA sequencing (scRNA-seq) data were obtained from the National Center for Biotechnology Information Sequence Read Archive. Transcriptome and clinical data were downloaded from The Cancer Genome Atlas and the Gene Expression Omnibus databases. Subsequently, univariate Cox and LASSO (Least Absolute Shrinkage and Selection Operator regression) regression analyses were performed to construct a prognostic signature. Immune cell activity was estimated using single-sample gene set enrichment analysis whilst the TIDE (tumor immune dysfunction and exclusion) method was employed to assess patient response to immunotherapy. The chemotherapy response of patients with BC was evaluated using genomics of drug sensitivity in cancer. Furthermore, Immunohistochemistry was used to verify the correlation between MAP1B expression and immunotherapy efficacy. The scRNA-seq data were analyzed to identify myCAFs marker genes. Results: Combined with bulk RNA-sequencing data, we constructed a two-gene (COL6A1 and MAP1B) risk signature. In patients with BC, the signature demonstrated outstanding prognostic value, immune infiltration, and immunotherapy response. This signature served as a crucial guide for the selection of anti-tumor chemotherapy medications. Additionally, immunohistochemistry confirmed that MAP1B expression was significantly correlated with immunotherapy efficacy. Conclusions Our findings revealed a typical prognostic signature based on myCAF marker genes, which offers patients with BC a novel treatment target alongside theoretical justification.

Objective:To understand the status quo of nurses' knowledge, attitude and behavior towards secondary prevention of coronary heart disease (CHD) , so as to provide basis for the standardization of secondary prevention management of CHD.Methods:From July to August 2020, a total of 1 087 nurses in the Cardiovascular Department of 20 comprehensive hospitals (12 ClassⅢ hospitals and 8 ClassⅡ hospitals) and 1 ClassⅢ Grade A Cardiovascular Hospital in 11 cities of Shanxi Province were selected as the research subjects by convenience sampling method. The self-designed questionnaire (including general information, knowledge dimension, attitude dimension and behavior dimension) was used to investigate them.Results:The scores of secondary prevention knowledge, attitude and behavior of 1 087 nurses in Cardiovascular Department were (24.17±5.37) , (53.85±7.97) and (51.23±10.07) , respectively. Multiple linear regression analysis showed that department, whether to have learned relevant guidelines / consensus in the past 12 months, cardiovascular working years, whether to have carried out cardiac rehabilitation in hospital and department, hospital level, whether to have participated in cardiac rehabilitation training were the influencing factors of cardiovascular nurses' knowledge, attitude and practice of secondary prevention management ( P<0.05) . Correlation analysis showed that there were positive correlations among the scores of knowledge, attitude and behavior of secondary prevention of coronary heart disease in nurses of Cardiovascular Department ( P<0.01) . Conclusions:Cardiology nurses need to improve their knowledge and behaviors in the management of secondary prevention of coronary heart disease, while the nursing attitudes are positive. Nursing administrators and educators should strengthen the training and learning of nurses on secondary prevention knowledge of patients with coronary heart disease, so as to effectively improve the compliance of patients with secondary prevention of coronary heart disease self-management.

Objective To introduce the application of grafting mechanism on a classⅢ grade A hospital's nursing counterpart support to county-level hospitals in Shanxi Province, and to summarize its effects and existing problems, so as to promote nursing counterpart support work and provide reference for the increase of the efficiency of counterpart support. Methods From 2014 to 2016, grafting mechanism was carried out in 23 county-level hospitals nursing counterpart supported by a classⅢ grade A hospital of Shanxi Province through 4 segments: field investigation, content selection, cultural integration and guided implementation. The evaluation of various mechanisms before and after grafting and the nurse satisfaction, patient satisfaction, high quality nursing service, as well as key discipline construction were statistically analyzed in 23 count-level hospitals. Results 100% of the 23 county-level hospitals applied grafting mechanism. A total of 20 nursing mechanism were grafted, focusing on 7 personnel systems, 3 performance management systems and 10 nursing quality management systems. The evaluation level of various mechanisms was significantly improved in the county-level hospitals after mechanism grafting. Nurse satisfaction increased from (87.6±15.2) to (89.7±16.8);patient satisfaction increased from (92.3±17.5) to (94.1±18.1); and high quality nursing service score increased from (73.5±12.9) to (75.8±14.0), and the differences were statistically significant (t=5.725, 4.042, 6.493;P< 0.01). A total of 5 of the county-level hospitals were approved provincial key discipline construction projects. Conclusions The mechanism of grafting plays a significant role in nursing counterpart support activities. Its theories and practice are worth of promoting.

OBJECTIVE The objective of this study is to discuss when to dissect the lymph nodes behind the right recurrent laryngeal nerve (LN-prRLN) from the standpoint of the right cervical level Ⅵ-1 (superficial layer to the recurrent laryngeal nerve) lymph nodes in papillary thyroid carcinoma (PTC) patients.METHODS The clinical data of 306 bilateral or right PTC patients from the Hangzhou First People's Hospital who underwent dissection of level Ⅵ-1 lymph nodes and LN-prRLN between March 2014 and September 2015 were analyzed. We measured the number of level Ⅵ-1 metastatic lymph nodes and size of level Ⅵ-1 lymph nodes metastasis loci to predict the metastasis of LN-prRLN.RESULTS The number of level Ⅵ-1 metastatic lymph nodes and size of level Ⅵ-1 lymph nodes metastasis loci were risk factors of LN-prRLN metastasis(P<0.05). When the number of the level Ⅵ-1 metastatic lymph nodes was greater than 1.5, the AUC was 0.813 (the sensitivity was 78.43%, the specificity was 76.65%). The ROC showed that when the size of level Ⅵ-1 lymph nodes metastasis loci were more than 0.45 cm, the AUC was 0.726 (sensitivity was 90.20%, specificity was 48.90%).CONCLUSION In bilateral or right PTC patients with metastasis of level Ⅵ-1 lymph nodes, especially when the number of level Ⅵ-1 metastatic lymph nodes was greater than 2cm and the metastasis loci were more than 0.45 cm, we should dissect the LN-prRLN.

Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury.Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked.The animal model of iatrogenic splenic injury was established by general anesthesia.Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding.The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 rmin if still bleeding.Then hemostatic effect after removing blocking and oppression was observed.Control group was only treated with gelatin sponge compression to stop bleeding.Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group,and before compression and relieving the compression for 2 hours in control group.IL-1 (interleukin),SOD (superoxide disproportionation enzyme),MPO (myeloperoxidase),MDA (malondialdehyde) and caspase-3 (aspartame acid cysteine protease) were detected.Results The control group still had bleeding,while the experimental group had successfully stopped bleeding.Serum markers before and after occlusion in the experinental group were IL-1 (124.4 ± 106.8 vs.121.2 ± 105.1),SOD (4.7 ± 2.7 vs.5.2 ± 1.8) and MDA (8.8 ±6.5 vs10.8 ±7.5).There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 (121.2 ± 105.1 vs.162.8 ± 73.8),SOD (5.2 ± 1.8 vs.4.7 ± 2.8) and MDA (10.8 ±7.5 vs.9.6 ±6.6) (P＞0.05).Histological indicators before and after occlusion in the experimental group included MPO (0.62 ±0.23 vs.0.68 ±0.21) and Caspase-3 (0.90 ±0.29 vs.0.86 ± 0.26),and there was no statistical difference on MPO (0.68 ±0.21 vs.0.86 ±0.23 after two sets of experiments) and Caspase-3 level (0.86 ± 0.26 vs.1.21 ± 0.18) (P ＞ 0.05) in two groups after occlusion/ oppression.Conclusion The therapeutic effect of intermittent splenic artery occlusion combined with gelatin sponge compression hemostasis is safe and effective and without obvious ischemia reperfusion injury.

AIM:To explore the improving effect of osteocalcin on obesity-related insulin resistance and in-flammation in the adipose tissue of obese mice .METHODS:The C57BL/6 mice were fed with high-fat diet for 12 weeks to obtain obese mice.Osteocalcin (30 ng/kg or 3 ng/kg) and saline solution (control) were intraperitoneally injected for other 4 weeks.The fat mass, body weight, serum triglycerides and serum free fatty acid were analyzed .Intraperitoneal glu-cose tolerance test and insulin tolerance test were carried out .Macrophage infiltration degree in the adipose tissue was ob-served by immunohistochemical staining .The mRNA expression of monocyte chemotactic protein-1 ( MCP-1 ) and CD68 was detected by real-time fluorescence quantitative PCR .RESULTS:Osteocalcin (30 ng/kg or 3 ng/kg) treatment for 4 weeks significantly reduced the body weight , fat mass and insulin level , and improved abnormal glucose tolerance and insu-lin resistance in the obese mice .Moreover, the macrophage infiltration decreased , and the mRNA expression of MCP-1 and CD68 was down-regulated in the adipose tissue of obese mice treated with osteocalcin at 30 ng/kg.CONCLUSION:Os-teocalcin at 30 ng/kg significantly reduces body weight and fat mass , and attenuates the severity of insulin resistance through down-regulating the mRNA expression of MCP-1 and CD68 and inbihiting macrophage infiltration in the adipose tis-sue of obese mice induced by high-fat diet.

Objective:To investigate the effect of early enteral nutrition combined with Bacillus in the treatment of patients with digestive tract perforation.Methods:59 patients with emergency digestive tract perforation were randomly divided into experimental group (EN plus Bacillus,n =31) and control group (TPN,n =28).The patients in the experimental group were given enteral nutrition plus Bacillus after first days (＜ 24 h),and the control group was treated with parenteral nutrition support on the first day after surgery.The average hospitalization time,length of ICU stay,incidence of complications,and serum C-reactive protein in the two groups were analyzed.Results:The average length of hospitalization time,ICU stay,recovery of bowel function and eating time were significantly shorter in the experimental group than in the control group(P ＜ 0.05).There was no significant difference in nutrition index between the two groups during the perioperative period (P ＞ 0.05).The C-reactive protein in the experimental group was significantly lower than that in the control group fourth days after operation (P ＜ 0.05).The incidence of postoperative wound infection in the experimental group was significantly lower than that of the control group (P ＜ 0.05).There was no significant difference in the incidence of other complications.Conclusion:Early administration of enteral nutrition combined with Bacillus can significantly shorten the intestinal function recovery time,decreasethe average hospitalization days,reduce the postoperative wound infection rate and thus improve the outcome of patients with digestive tract perforation.

Objective To explore nursing requirement and its influencing factors for patients staying at home.Methods We utilized self-designed questionnaire to investigate general information and nursing requirement among 500 patients,who had different nursing care needs at home in Taiyuan city,and describe patients' need by constituent ratio,mean standard deviation and percentage.The patient's personal data used descriptive analysis,two sample t test,single factor variance analysis,while the influence factors of patient care needs at home applied multiple linear regression analysis.Results The total score nursing requirement of patient at home were (2.25 ± 1.63),and the requirement intensity in proper sequence as:health guidance (2.82 ± 1.34),psychological nursing (2.57 ± 1.68),primary nursing (2.39 ± 1.16),life care (.1.70 ± 1.31),specific nursing (1.65 ± 1.07).Multiple linear regression analysis showed that gender was the influence factors of primary nursing needs,the influencing factors of per capita income impacted the needs of health guidance,and age was the influencing factor of psychological nursing demand.Conclusions Home care is the development direction of future nursing,which should be guided by the requirement.We should base on multi-dimension to develop suitable home care according to national situation and meet the diversified demand.

Objective To study the willingness to home care needs of patients, in order to provide a basis for the further development of home care. Methods The self-designed questionnaire was used in the study. By using the convenience sampling method,500 patients with home care in 10 communities in Taiyuan city were surveyed. Results A total of 390 cases (78. 0%) had the demand of home care. The top 3 demands were that 208 cases ( 53. 3%) needed the disease prevention knowledge instruction, 205 cases ( 52. 6%) needed the measurement of blood pressure, and 202 cases (51. 8%) needed to set up the health records and the regular physical examination. 226 patients ( 57. 9%) required the home care services provided by hospital nurses. There was significant difference in the choices of home care providers in patients with different disease (χ2 =6. 786,P<0. 05). 221 cases (56. 7%) hoped that the cost of home care could be charged according to the service items. 234 cases (60. 0%)hoped that the home care costs could be covered by the health insurance. Conclusions Home care service is the development direction of future nursing. It should be responded to an appeal by the policy and become demand-oriented. We should set up home care service system, to meet people′s diversified needs.

Objective To summarize the working effect of nursing counterpart support in one first class, grade three hospital from 2011 to 2013, and provide a reference and evidence for the further strategy made. Methods With the help of National Health Planning Commission and Ministry of Finance which provide an arena for developing audit and acceptance of 2010 national key clinical specialized subject construction, 23 primary hospitals were selected to investigate nursing counterpart support from 2011 to 2013 by questionnaire including three aspects: quality of care, talent team building and specialized development and 13 clauses. Results Nursing counterpart support acquired a breakthrough at aspects of quality of care, talent team building and specialized development including specialized nurses 88, technical backbone 36 people, learning to serve 51 people. The satisfaction of patients in support primary hospital was ( 98. 17 ± 1. 23 ) score, night-shift allowance (26. 84 ± 17. 33), implementation of post management hospital 52. 2%, the rate of ward acquired quality accounting for 81. 4%, rate of beds/nurses (2. 51 ± 0. 72), and averagely nurse′s satisfaction (95. 27 ± 3. 47). Conclusions Counterpart support had a positive effect on promoting the development of primary hospitals.