Objective: To understand classroom environmental conditions and their association with spinal curvature abnormalities among students of primary and secondary schools in Guizhou Province, so as to provide a basis for formulating school health policies and scientific prevention and control measures for abnormal spinal curvature in students. Methods: Using a stratified random sampling method, 471 schools (2 811 classrooms) were selected annually across the province from 2022 to 2024 in order to monitor and evaluate classroom environment according to national standards. Spinal examinations were conducted for 196 606 (2022), 194 876 (2023), and 195 048 (2024) students, and χ 2 test was used to analyze the correlation of desk and chair compliance with student spinal curvature abnormalities. Results: The qualified rates of classroom blackboard illuminance uniformity ( 85.41 %) and the blackboard size (82.24%) were the highest in primary and secondary schools in Guizhou Province, while the average blackboard surface illumination qualified rate (20.10%) was the lowest. The average desk illumination (50.11%-58.63%), desk illumination uniformity (61.92%-72.27%) and qualified noise rate (50.04%-51.94%) increased significantly in 3 years; in addition, the compliance rate of desks and chairs decreased from 25.00% to 13.52%, and the differences were all statistically significant ( χ 2=42.48, 80.93, 46.09, 129.72, all P <0.05). Middle school classrooms outperformed primary schools in terms of per capita area, average blackboard illuminance, blackboard illuminance uniformity, average desktop illuminance, desktop illuminance uniformity, and noise compliance ( χ 2=311.55, 12.41, 20.64, 40.76, 10.25, 52.47), but had lower compliance for blackboard size and reflectance ( χ 2=537.29, 7.59) (all P <0.01). Urban schools had higher compliance than suburban schools for per capita area, average blackboard illuminance, average desktop illuminance, and desktop illuminance uniformity ( χ 2=73.71, 17.68, 29.30 , 36.03), but lower compliance for desk-chair suitability, blackboard size, and blackboard reflectance ( χ 2=4.72, 26.02, 5.43 ) (all P <0.05). The spinal curvature abnormality detection rate was 0.83%. A significant association was found between abnormality detection and desk-chair non compliance ( χ 2=223.85, P <0.01). Conclusions Classroom environment hygiene in Guizhou schools is suboptimal. Strengthening school environmental hygiene infrastructure and greater attention to its impact on student s health are essential.

Objective: To understand the epidemiological characteristics of abnormalities spinal curvature among children and adolescents in Karst landform in Guizhou Province, so as to provide a scientific basis for targeted comprehensive intervention. Methods: From September to December 2023, 194 875 children and adolescents aged 6-18 were selected from all countieldistricts of 9 cities (prefectures) in Guizhou Province by stratified random cluster sampling method according to the proportion of Karst landform area in Guizhou Province for carrying out spinal curvature abnormality screening, and a questionnaire survey was conducted on 139 449 students in the fourth grade and above of primary school. Binary Logistic regression was used for multivariate analysis. Results: The detection rate of abnormal spinal curvature among children and adolescents aged 6-18 in Guizhou Province was 1.13%. The detection rates of abnormal spinal curvature in areas with a high proportion of Karst landform, areas with a low proportion of Karst landform, intercalation areas, and nonKarst landform areas were 1.10%, 2.00%, 0.90%, and 0.60%, respectively. Among them, the detection rates of abnormal spinal curvature in female students (2.40%, 1.60%, 0.90%) in areas with a low proportion of Karst landform, intercalation areas and nonKarst landform were higher than those in male students (1.60%, 0.10%, 0.30) (χ2=12.66, 112.69, 30.22, all P<0.05). The detection rates of abnormal spinal curvature among senior high school students (2.00%, 4.30%, 1.40%, 1.30%) in different Karst landform distributions were successively higher than those among junior high school students (1.40%, 3.20%, 1.00%, 0.60%) and primary school students (0.70%, 0.80%, 0.60%, 0.30%) (χ2=306.11, 175.80, 14.24, 39.57, all P<0.05). The results of multivariate Logistic regression analysis showed that the detection rates of abnormal spinal curvature in both highproportion and lowproportion Karst landform areas were higher than those in nonKarst landform areas [OR(95%CI)=1.84(1.05-2.25), 1.60(1.23-2.09), both P<0.05]. Conclusion The detection rate of abnormal spinal curvature in children and adolescents aged 6-18 in Guizhou Province is related to the distribution of Karst landform, so it is necessary to strengthen screening and appropriate comprehensive interventions.

Objective:To explore the effects of apigenin on apoptosis and hypoxia inducible factor-1α (HIF-1α)/nuclear factor κB (NF-κB) signaling pathway in renal cancer A498 cells.Methods:Human renal cell carcinoma A498 cells were cultured in vitro and divided into different concentrations of apigenin (10, 20, 40 μmol/L) groups, apigenin (40 μmol/L)+ HIF-1α agonist dimethylenediaminoacetic acid (DMOG) group, HIF-1α inhibitor rifiximab (YC-1) group, and control group. Cell proliferation was detected using cell counting kit-8 (CCK-8) assay and plate clone formation assay, apoptosis was detected using Hoechst 33258 staining and flow cytometry, and expression of apoptotic proteins and HIF-1/NF-B pathway proteins was detected using Western blot assay.Results:Celery extract significantly inhibited the proliferation of A498 cells, and the inhibitory effect was concentration dependent ( P<0.001). Compared with the control group, the apoptosis rates of A498 cells in the 10, 20, and 40 μmol/L apigenin groups and YC-1 groups were significantly increased [(4.35±1.04)% vs (10.06±1.13)%, (18.52±2.58)%, (32.17±2.63)%, (26.94±2.41)%], as well as the expression levels of B lymphocyte tumor 2 related protein (Bax) and Cleaved Caspase-3 protein, while the expression levels of B lymphocyte tumor 2 (Bcl-2) were significantly reduced (all P<0.001). Compared with the control group, the HIF-1α protein expression levels (0.85±0.08 vs 0.63±0.06, 0.31±0.03, 0.16±0.02) and p-NF-κB p65/NF-κB p65 ratio (0.82±0.08 vs 0.51±0.05, 0.30±0.03, 0.13±0.01) of A498 cells in the 10, 20, and 40 μmol/L apigenin groups were significantly reduced (all P<0.001). Compared with the apigenin group, the apoptosis rate of A498 cells in the apigenin+ DMOG group was significantly reduced [(32.17±2.63)% vs (14.85±1.62)%], and the expression levels of Bax and Cleared Caspase-3 proteins were significantly reduced, while the expression levels of Bcl-2 proteins were significantly increased (all P<0.001). Conclusions:Apigenin may promote apoptosis in renal cancer A498 cells by inhibiting the activation of the HIF-1α/NF-κB signaling pathway.

Objective:To investigate the effect of astragaloside IV (AS-IV) regulating the signal axis of stromal cell-derived factor-1α (SDF-1α)/CXC chemokine receptor 4 (CXCR4) on the mobilization of bone marrow endothelial progenitor cells (EPCs) to peripheral blood in diabetes skin ulcer (DSU) rats.Methods:Twenty four SPF grade male Sprague Dawley (SD) rats were selected to make the model of type 2 diabetes rats by intraperitoneal injection of 30 mg/kg 1% (plastid ratio) streptozotocin, and then round full-thickness skin with a diameter of 2 cm was cut on both sides of the waist and back to make the skin ulcer model of diabetes rats. After that, they were randomly divided into AS-IV group (50 mg/kg AS-IV), blocker group (50 mg/kg AS-IV+ 5 mg/kg AMD3100) and model group. At the same time, a blank group ( n=8) was set up, The drug was administered via intraperitoneal injection, and the model group and blank group were treated with 0.9% NaCl of equal volume. On the 10th day, peripheral blood, femoral bone marrow, and wound neovascularization tissues of rats were collected. The number of EPCs in peripheral blood of each group of rats was measured by flow cytometry, and the protein expression of SDF-1α and CXCR4 in peripheral blood, femoral bone marrow, and wound neovascularization tissues of rats was detected by enzyme-linked immunosorbent assay (ELISA); At the same time, the wound healing rates of each group were tested. Results:On the 10th and 21st day after modeling, the wound healing rate of each group of rats was compared. The blank group healed the fastest, while the model group healed the slowest. The AS-IV group had better healing than the model group and the blocker group, and the difference was statistically significant (all P<0.05). On the 10th day after modeling, the positive rates of peripheral blood EPCs in the white group, AS-IV group, and blocker group were significantly higher than those in the model group (all P<0.05), while the positive rates of peripheral blood EPCs in the blocker group were significantly lower than those in the AS-IV group (all P<0.05). On the 10th day after modeling, the protein expression of SDF-1α and CXCR4 in the wound, serum, and bone marrow of the model group was the lowest, while the protein expression in the blank group was the highest (all P<0.05). The protein expression of SDF-1α and CXCR4 in the wound, serum, bone marrow of the AS-IV group was significantly higher than that of the blocker group and model group, and the difference was statistically significant (all P<0.05). Conclusions:Astragaloside IV can promote the mobilization and migration of endothelial progenitor cells from bone marrow to peripheral blood in diabetes ulcer rats by regulating SDF-1α/CXCR4 signal axis, and can participate in angiogenesis of diabetes ulcer wounds as seed cells to promote the healing of diabetes skin ulcers.

Objective:To investigate the correlation between the annual professional proficiency test results and the theoretical examination score of completion assessment in standardized residency training, as well as the value of the annual professional proficiency test results in predicting whether a resident passes the theoretical examination of completion assessment.Methods:The residents who participated in the annual professional proficiency test of residency training in Affiliated Hospital 2 of Nantong University in 2019-2021 and the completion assessment of residency training in 2020-2022 were selected as subjects, and related data were collected, including sex, education background, personnel type, training specialty, the results of annual professional proficiency test, and the theoretical examination score of completion assessment. According to whether the resident passed the theoretical examination of completion assessment, they were divided into passed group and failed group. SPSS 19.0 was used to perform the chi-square test, the independent samples t-test, and the binary logistic regression analysis; the Pearson correlation coefficient was used for correlation analysis; the sensitivity analysis was represented by ROC curve. Results:Compared with the residents who passed the theoretical examination of completion assessment, the residents who did not pass the examination had a significant reduction in the proportion of the residents from our hospital and a significant increase in the proportion of the residents commissioned by foreign institutions ( χ 2=7.00, P=0.008). The passed group had a significantly higher national percentile of annual professional proficiency test score than the failed group (43.46%±26.61% vs. 23.40%±18.71%, t=6.02, P<0.001). The national percentile of annual professional proficiency test score was positively correlated with the theoretical examination score of completion assessment ( r=0.43, P<0.05). The source of residents commissioned by foreign institutions and the low percentile of annual professional proficiency test score were independent risk factors for failing the theoretical examination of completion assessment ( P=0.020 and P<0.001). The national percentile of annual professional proficiency test score had an area under the ROC curve of 0.73 (95% CI: 0.65-0.80) in predicting the outcome of theoretical examination and had a certain predictive value with a cut-off value of 15.1%. Conclusions:In addition to strengthening homogenization and professional base management for residency training, it is necessary to make full use of the results of annual professional proficiency test in standardized residency training and timely check the professional knowledge of the residents whose a national percentile of <15.1%, so as to effectively improve the pass rate of theoretical examination and the quality of training.

This study aimed to investigate the effects of PmrB△Leu172 on polymyxin B resistance in Pseudomonas aeruginosa. Pseudomonas aeruginosa PmrB△Leu172 strain was constructed by homologous recombination technology, and the minimum inhibitory concentration of polymyxin B against wild type and mutant strains were determined by the broth microdilution technique. The effect of PmrB△Leu172 mutation on gene transcription level was determined by RNA sequencing. Reverse transcription quantitative PCR was used to verify the effect of PmrB△Leu172 mutation on the transcription level of PmrB-regulated genes in P. aeruginosa. The results showed that the minimum inhibitory concentration and minimum bactericidal concentration of mutant strain were 4 and 2 times higher than that of wild-type, respectively, and the transcription level of PmrB-regulated genes was also up-regulated. The results suggested that PmrB△Leu172 mutation of P. aeruginosa can enhance the regulation of PmrA-PmrB two-componentsystem, which leads to the resistance of P. aeruginosa to polymyxin B.

Objective To assess the feasibility of utilizing the ExacTracDynamic surface monitoring system(ETD)for setup and body surface monitoring in patients with thoracic tumors undergoing intensity-modulated radio-therapy(IMRT).Methods Patients receiving IMRT for thoracic tumors were included in this study.The enrolled patients were alternatively assigned to either conventional cross curve positioning(control group)or surface monitoring system-assisted positioning(experimental group).ETD X-ray images were utilized for calibration purposes prior to radiotherapy,enabling the determination of setup errors.A region of interest(ROI)was delineated on the body surface above the sternum,and real-time body surface monitoring was performed based on this ROI during radiotherapy.Post-radiotherapy X-ray images were obtained to verify patient position.Data regarding left-right(X),head-foot(Y),abdomen-back(Z),pitch,roll,and yaw directions were recorded and analyzed.Results A total of 60 patients were enrolled,with 754 fractions of radiotherapy in the control group and 718 fractions in the experimental group.The setup errors in the X and Z directions were significantly smaller in the experimental group compared to the control group(P<0.05).Moreover,there was a significant reduction in the number of setup errors≤0.50 cm for X,Y,and Z directions,as well as≤1.00° for Roll angle in the experimental group compared to the control group(P<0.05).Additionally,differences were observed between surface monitoring and X-ray image verification regarding position deviation along Y and Z directions(P<0.05),although these deviations remained within submillimeter levels on average.Conclusion Surface monitoring system-assisted positioning can enhance radiotherapy setup accuracy among thoracic tumor patients,particularly along X and Z directions.Furthermore,when setting ROI above sternum on body surface area,surface monitoring provides better reflection of target area's position deviation.

This paper reviewed the concept of organizational silence, elaborated on the content, evaluation methods, reliability, validity, characteristics, and other aspects of nurse organizational silence assessment tools, and compares the basic characteristics, content, and application of each tool. The aim was to provide reference for selection of appropriate assessment tools to identify nurse organizational silence, as well as for the development of comprehensive assessment tools and the early formulation of management strategies.

Objective:To explore the application effect of case-based learning (CBL), teaching mode combined with 3D printing in clinical teaching of sacral tumors.Methods:A total of 108 undergraduate interns and standardized residency training students who studied in our hospital from 2017 to 2018 were divided into the CBL teaching group ( n = 53) and the CBL combined with 3D printing teaching group ( n = 55) according to their study time. The combined teaching group used computer tomography (CT) data to reconstruct and print out a 3D model of sacral tumors based on CBL, and performed preoperative teaching on the invasion of the surrounding tissues of the tumor. The scores of the students in the two groups were evaluated respectively, and the students were surveyed by self-identification questionnaire (learning interest, self-learning ability, teamwork ability, comprehensive analysis ability and clinical thinking ability). The t-test (one-sided) was used for comparison between groups using stata 14.0. Results:The score of CBL teaching group (75.90±6.70) was lower than that of CBL combined with 3D printing teaching group (83.60±7.40). In terms of critical thinking ability evaluation, self-learning ability, learning interest, comprehensive analysis ability and clinical thinking ability, the CBL combined 3D printing teaching group was superior to the CBL teaching group, and the difference was statistically significant ( P<0.001). In terms of teamwork ability, there was no statistical difference between the two groups. Conclusion:The CBL teaching mode combined with 3D printing can improve academic performance, students' learning interest and clinical thinking ability of sacral tumors in the teaching of undergraduate interns and standardized residency training students.

【Objective:】 To compare and analyze the trends and hotspots in the field of medical ethics at home and abroad, and explore their teaching enlightenment for medical ethics in China. 【Methods:】 The relevant papers indexed in CNKI and Web of Science database from December 31, 2011 to December 31, 2022 were retrieved with "medical ethics" as the key word. The bibliometric method was used to compare and analyze the research trends, keyword co-occurrence, and changes of research hotspots of medical ethics at home and abroad. 【Results:】 A total of 1,187 Chinese and English papers were included. Medical ethics education and bioethics were the common research topics both domestically and internationally. The research topics in China focused on ethical teaching and the ethical principles in clinical practice, and the research hotspots in the past two years were curriculum ideological and political education, teaching practice, etc. Foreign research focused on ethical issues in clinical practice, and in the past two years, the hotspots were clinical trial ethics, informed consent, and so on. 【Conclusion:】 Medical ethics research at home and abroad has different emphasis, with domestic research being theoretical oriented and foreign research being practical oriented. By deepening the content of courses, improving the sustainable education system, and strengthening interdisciplinary cooperation, the development of ethical education in China can be promoted. This paper can provide reference for improving the education system of medical ethics in China and pointing out the direction of further research on medical ethics.