Objective:To explore the relationship between the longitudinal change trajectory of white blood cell (WBC) and new-onset type 2 diabetes mellitus(T2DM).Methods:It was a prospective cohort study. A total of 2 792 people who underwent health examinations at the Health Management Center of the Affiliated Hospital of Qingdao University from January 2019 to December 2023 for five consecutive years and met the research standards were selected as the study subjects. Group-based trajectory modeling (GBTM) was established. The target population was divided into three groups based on the longitudinal change trajectory of WBC: low-stable group, medium-stable group and high-stable group. The cumulative incidence of T2DM in the three groups were analyzed. Multivariate Cox proportional risk regression models were used to analyze the correlation between different WBC trajectory groups and the risk of T2DM in total population, males and females. A restricted cubic spline regression (RCS) model was used to analyze the dose-response relationship between baseline WBC and risk of T2DM.Results:The cumulative incidence rate of T2DM in low-stable group, medium-stable group and high-stable group increased gradually, which was 2.5%, 5.3% and 6.9%, respectively ( χ2=19.024, P<0.001). After adjusting for multiple confounding factors in the Cox proportional hazards regression model, no significant difference in the incidence risk of T2DM among the three WBC trajectory groups in males; While the hazard ratios in the high-stable and medium-stable group in women was 2.852(95% CI: 1.067-7.628) and 2.588 (95% CI: 1.133-5.912), respectively, when compared with that in the low-stable group (both P<0.05). RCS curve analysis showed a linear relationship between WBC and the risk of T2DM in female ( Pnon-linear=0.956), when the WBC count was>5.53×10 9/L, the risk of T2DM increased with the rise of WBC. Conclusion:Higher WBC trajectory is positively correlated with the risk of new-onset T2DM in female health examination population.

The well-known insulin-like growth factor 1 (IGF1)/IGF-1 receptor (IGF-1R) signaling pathway is overexpressed in many tumors, and is thus an attractive target for cancer treatment. However, results have often been disappointing due to crosstalk with other signals. Here, we report that IGF-1R signaling stimulates the growth of hepatocellular carcinoma (HCC) cells through the translocation of IGF-1R into the ER to enhance sarco-endoplasmic reticulum calcium ATPase 2 (SERCA2) activity. In response to ligand binding, IGF-1Rβ is translocated into the ER by β-arrestin2 (β-arr2). Mass spectrometry analysis identified SERCA2 as a target of ER IGF-1Rβ. SERCA2 activity is heavily dependent on the increase in ER IGF-1Rβ levels. ER IGF-1Rβ phosphorylates SERCA2 on Tyr⁹⁹⁰ to enhance its activity. Mutation of SERCA2-Tyr⁹⁹⁰ disrupted the interaction of ER IGF-1Rβ with SERCA2, and therefore ER IGF-1Rβ failed to promote SERCA2 activity. The enhancement of SERCA2 activity triggered Ca²⁺_ER perturbation, leading to an increase in autophagy. Thapsigargin blocked the interaction between SERCA2 and ER IGF-1Rβ and therefore SERCA2 activity, resulting in inhibition of HCC growth. In conclusion, the translocation of IGF-1R into the ER triggers Ca²⁺_ER perturbation by enhancing SERCA2 activity through phosphorylating Tyr⁹⁹⁰ in HCC.

Objective:To investigate and analyze the psychological stress status and influencing factors of medical staff in comprehensive grade A hospitals.Methods:This was a cross-sectional survey using a convenient sampling method. A questionnaire survey was conducted among 2 048 staff members of the Affiliated Hospital of Qingdao University from February 25 to June 16, 2022. The questionnaires included the Self-rating Stress Questionnaire (SSQ-53), the Self-rating Anxiety Scale, and the Self-rating Depression Scale. A total of 2 048 questionnaires were distributed and 2 048 were collected. Among them, 2 006 (97.95%) were valid questionnaires, and 2 006 medical staff were ultimately included in the analysis. According to the results of the scale, they were divided into the increased psychological stress group and the non increased psychological stress group. Descriptive analysis, independent sample t-test/chi-square test, correlation analysis, and other methods were used to analyze the psychological stress status of medical staff and the distribution of related factors, and multivariate logistic regression was used to analyze their influencing factors. Results:A total of 310 (15.5%) out of 2 006 study subjects showed increased psychological stress. Women had a statistically significant increase in physical (14.7% vs 8.0%, χ2=12.40, P<0.001) and emotional dimensions (18.2% vs 13.5%, χ2=5.04, P=0.025) of stress compared to men. The level of psychological stress was positively correlated with anxiety and depression ( r=0.810, 0.749, respectively, P<0.001). Univariate analysis showed that those who were women ( χ2=6.76, P=0.009), with low education backgrounds ( Z=-2.50, P=0.012), nurses ( χ2=15.72, P<0.001), or working in emergency departments ( χ2=13.64, P=0.009) had a higher rate of increased psychological stress, while the serum calcium level in the increased psychological stress group was lower than that in the non increased psychological stress group ( t=2.82, P=0.005). Multivariate analysis showed that low educational backgrounds ( OR=2.238, 95% CI: 1.090-4.597, P=0.028) and working in emergency department ( OR=1.589, 95% CI: 1.012-2.493, P=0.044) were independent risk factors for increased psychological stress of medical staff. Working in administrative and logistics departments ( OR=0.466, 95% CI: 0.229-0.950, P=0.036) and serum calcium level ( OR=0.213, 95% CI: 0.059-0.760, P=0.017) were negatively correlated with increased psychological stress. Conclusions:In comprehensive grade A hospitals, medical staff working in the emergency department or with lower educational backgrounds face greater psychological stress. Serum calcium level is negatively correlated with increased psychological stress, but the causal relationship needs further study.

Objective: To explore the facilitators and barriers of the implementation of evidence based mental health practice, in order to provide practical experience for promoting the development of evidence based mental health services in primary schools in China. Methods: Semi structured interviews were conducted with 4 education bureau managers, 8 school administrators, 7 classroom teachers, and 7 treatment providers after providing evidence based practice in 10 primary schools in Henan Province, China. Data was analyzed using thematic analysis. Results: Evidence based practice in primary schools faced multiple factors at the macro level, school level, and individual level. A total of 8 facilitators and 9 barriers were extracted. Among these factors, some factors were particularly striking. These included the "exclusion" of teacher title evaluation system, time conflict between practice and school schedule, stigmatization of mental health and mismatch between perceived effectiveness of services and expectations. Conclusion Evidence based mental health practice is feasible in Chinese schools. The implementation process needs to take full account of macro, school and individual multi level factors to move evidence based mental health services from theory and data to practice in China.

Objective:To compare the ability of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and triglyceride-glucose index (TyG) in identifying nonalcoholic fatty liver disease (NAFLD).Methods:A total of 11 524 eligible subjects who underwent physical examination in the Affiliated Hospital of Qingdao University from January to December in 2018 were selected in this research. The correlation between TG/HDL-C, TyG and NAFLD was analyzed by using binary logistic regression. The receiver operating characteristic (ROC) curves of TyG and TG/HDL-C were drawn for identifying NAFLD in male and female, and their diagnostic value for NAFLD was compared.Results:The prevalence of NAFLD increased with TG/HDL-C and TyG. After adjusting for confounding factors, when compared with that in the first quartile group of TG/HDL-C, the odds ratios (OR) and 95% confidence intervals ( CI) of NAFLD risk in the second, third and fourth quartile groups of TG/HDL-C was 2.380 (2.039-2.779), 3.902 (3.342-4.555) and 7.903 (6.745-9.259), respectively. Compared with that in the first quartile group of TyG, the OR (95% CI) of NAFLD risk in the second, third and fourth quartile groups of TyG was 2.243 (1.923-2.617), 3.918 (3.363-4.565) and 9.002 (7.676-10.559), respectively. The area under the curve (AUC) of TG/HDL-C and TyG in identifying NAFLD in male was 0.746 and 0.744, respectively, and there was no significant difference between the two indexes ( P=0.509 1). The AUCs of TG/HDL-C and TyG in identifying NAFLD in female was 0.785 and 0.799, respectively, and the difference was statistically significant ( P<0.001). The cut-off point of TG/HDL-C for identifying NAFLD in male was 1.02, and the cut-off point of TyG for identifying NAFLD in female was 8.55. Conclusions:TG/HDL-C and TyG are closely related to NAFLD in adults. There is no difference between TG/HDL-C and TyG in evaluating NAFLD in male, while TyG is better than TG/HDL-C in evaluating NAFLD in female.

【Objective】 To retrospectively analyze the irregular antibodies in 6 blood group systems other than the Rh blood group system in 53 pregnant women and analyze its correlation with the occurrence of hemolytic disease of the newborn(HDN). 【Methods】 19 473 pregnant women were screened for irregular antibodies by microgel detection technology combined with anti-human globulin (IgG+ C3d), and the positive samples screened out were further confirmed to understand the types and titers of irregular antibodies. Irregular antibody type determination experiment: IgG type irregular antibody titer was determined after mercaptoethanol (2-Me) inactivated the serum of the irregular antibody positive specimen, and then IgG and IgM type were determined by comparing the titer levels of irregular antibody. Three hemolysis tests and total bilirubin tests were performed on umbilical cord blood during delivery to analyze the level of jaundice and the occurrence of HDN. 【Results】 53 cases of irregular antibodies other than the Rh blood group system were detected in 19 473 pregnant women, with a positive rate of 0.27%, mainly MNS and Lewis blood group system.The incidence of HDN was 39.6% (21/53). There were 27 cases of IgM, 7 IgG, and 19 IgM + IgG. Comparison of total bilirubin detection between the low titer group (≤8) and the high titer group (>8) : the latter was significantly higher than the former (P<0.05); IgG antibody subtypes: IgG1 of the latter significantly increased (P<0.05), and so was IgG3 in former (P<0.05). There was a significant positive correlation between IgG1, IgG3 and total bilirubin. The area under the curve of IgG1+ IgG3 for HDN diagnosis, the sensitivity and specificity were 0.953, 0.900, and 0.967, respectively. 【Conclusion】 Other than Rh blood group system, irregular antibodies are mainly distributed in MNS and Lewis blood group system. The incidence of HDN is higher in Kell, Duffy and Kidd blood group systems after producing irregular antibodies. Non-antibody types are mostly IgM type or IgM + IgG mixed, and the incidence of HDN is not high; Patients with poor maternal history, either high or low titer, can be classified into IgG1 and IgG3 in early stages, and those with Abnormal results should be included into the perinatal management of high-risk women with regular checking.

Objective:To explore the application value in cerebral blood perfusion status of dynamic susceptibility contrast enhanced perfusion weighted imaging (DSC-PWI) in ischemic cerebrovascular disease (ICVD).Methods:Retrospective analysis of 31 cases ICVD head magnetic resonance imaging (MRI), diffusion weighted imaging (DWI), magnetic resonance angiography (MRA) and DSC-PWI image in clinical diagnosis, and selectively analyze parameters including relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT) and time to peak (TTP) for generalize its characteristics.Results:31 cases of ICVD, 16 cases hypoperfusion, rCBF decreased significantly, rCBV decreased, MTT and TTP prolonged, include 7 cases of large vessel disease and 5 cases of small vessel disease. The collateral circulation formed 9 cases, including 3 cases with good compensation, rCBF normal, rCBV normal, MTT and TTP prolonged, 6 cases with bad compensation, rCBF decreased, rCBV normal or increased, MTT and TTP prolonged. The blood reperfusion in 3 cases, rCBF normal or slightly increased, rCBV increased, MTT shortened or normal, and TTP shortened. The excessive perfusion in 3 cases, rCBF significantly increased and rCBV significantly increased, with MTT and TTP shortened.Conclusions:DSC-PWI can reliably reflect the perfusion state and collateral circulation compensation of ICVD, so as to guide the selection of clinical treatment program and significantly improve the prognosis of patients.

Objective To investigate the correlation between intervertebral disc injury and postoperative kyphosis after percutaneous kyphoplasty (PKP) in patients with single-level osteoporotic thoracolumbar fracture.Methods The data of 63 patients were retrospectively analyzed who had been treated at Department of Orthopaedics,Puai Hospital for single-level osteoporotic thoracolumbar fractures from August 2012 to August 2015.They were all treated with posterior balloon dilatation PKP.According to the preoperative MRI data,they were divided into an observation group (29 patients with intervertebral disc injury) and a control group (34 patients without intervertebral disc injury).The wedged angles (WA) and cobb angles of the injured vertebrae were compared between the 2 groups at postoperative 1,6 and 12 months.The changes in WA and cobb angles were observed in the same group at postoperative 1,6 and 12 months.The cob angles in the patients with different Sander classifications of intervertebral disc injury in the observation group were observed at postoperative 1,6 and 12 months.The correlation between intervertebral disc injury and postoperative kyphosis after PKP was statistically analyzed.Results The 2 groups were comparable as there were no significant differences between them in preoperative general data (P ＞ 0.05).All the patients were followed up for an average of 19.3 months (from 12 to 30 months).The WAs at postoperative 1,6 and 12 months in the observation group (4.9° ± 2.5°,5.8° ± 2.4° and 6.2° ± 2.4°) were insignificantly larger than those in the control group (4.7° ± 2.4°,5.2° ± 2.4° and 5.8° ± 2.4°) (P ＞ 0.05).The cobb angles at postoperative 6 and 12 months in the observation group (14.4° ± 3.6° and 15.8° ± 3.5°) were significantly larger than those in the control group (10.1 ° ± 3.7° and 10.7° ± 3.8°) (P ＜ 0.05),and also significantly larger than that at postoperative one month in the same group (10.6° ± 3.2°) (P ＜ 0.05).The cobb angles at postoperative1,6 and 12 months in the control group showed a tendency of insignificant increase (P ＞ 0.05).At postoperative 1,6 and 12 months in the observation group,the cobb angles for patients with Sander types Ⅱ & Ⅲ were significantly larger than for patients with Sander type Ⅰ (P ＜ 0.05).Conclusion After PKP for patients with single-level osteoporotic thoracolumbar fracture,kyphosis of different severities may occur after operation;intervertebral disc injury is an important factor which aggravates postoperative kyphosis.

Objective To investigate the relationship between the expression of 06-methyl guanine DNA methyltransferase (MGMT),X-ray repair cross complementation gene 1 (XRCC1) and the incidence of glioma.Methods From February 2015 to September 2017,53 glioma patients (glioma group) in our hospital were enrolled in the study.50 patients with hypertensive intracerebral hemorrhage were selected as control A group,and 106 healthy volunteers as control B group.Immunohistochemical staining was used to detect the expression of MGMT and XRCC1 in brain tissue of glioma group and control A group,and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) were used to detect the polymorphism of MGMT and XRCC1 gene in glioma group and control B group.Results The positive expression rates of MGMT and XRCC1 in the tissues of brain glioma were 47.17％ and 39.62％,respectively,which were significantly higher than those in the control A group (P ＜ 0.05).There was no significant difference in the positive expression rate of MGMT and XRCC1 in patients with grade Ⅰ,,Ⅲ and Ⅳ (P ＞ 0.05);There was no correlation between the expression of MGMT and XRCC1 in glioma tissues (rs =0.162,P ＞ 0.05);The proportion of XRCC1 genotype AG + GG in brain glioma group was 58.49％,which was significantly higher than that of control B group (P ＜ 0.05);The proportion of MGMT genotype LP + PP in brain glioma group was 28.30％,which was significantly higher than that of control B group (P ＜ 0.05).Conclusions MGMT and XRCC1 are increased significantly in glioma brain tissues,but not correlatedwith pathological grades;The polymorphism of MGMT and XRCC1 genes may be related to the susceptibilityof gliomas.