Objective To explore the values of peripheral blood inflammatory parameters in predicting the efficacy of immunotherapy and prognosis after immunotherapy in patients with proficient mismatch repair(pMMR)metastatic colorectal cancer(mCRC).Methods The clinical data of 44 inoperable pMMR mCRC patients who received immunotherapy in Zhongshan Hospital(Xiamen Branch),Fudan University from February 2019 to February 2024 were analyzed retrospectively.The pre-treatment peripheral blood inflammatory parameters such as neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),pan-immune-inflammation value(PIV)and systemic immune-inflammation index(SⅡ)were collected.The receiver operating characteristic(ROC)curves were drawn to evaluate the predictive value of inflammatory parameters on the efficacy of immunotherapy.The effects of inflammatory parameters on the prognosis after immunotherapy were evaluated according to the optimal cutoff value obtained by ROC curves.Univariate and multivariate Cox proportional hazard models were used to analyze the risk factors affecting the prognosis of patients with pMMR mCRC.Results NLR,PLR,PIV and SⅡ had some predictive values on the efficacy of immunotherapy in inoperable pMMR mCRC patients,and SⅡ was superior to NLR,PLR and PIV.Compared with NLR≥3.36 group,PLR ≥223.54 group and SⅡ≥769.29 group,the disease control rate(DCR)after immunotherapy was higher in the NLR＜3.36 group,PLR＜223.54 group and SⅡ＜769.29 group(P＜0.01);the progression-free survival(PFS)was longer in the NLR＜3.36 group and SⅡ＜769.29 group(P＜0.05),and the overall survival(OS)was longer in the NLR＜3.36 group,PLR＜223.54 group and SⅡ＜769.29 group(P＜0.05).The univariate analysis showed that Eastern Cooperative Oncology Group Performance Status(ECOG PS)score,NLR and SⅡ were risk factors for the PFS of patients after immunotherapy;the liver metastasis,bone metastasis,NLR,PLR and SⅡ were risk factors for the OS of patients after immunotherapy(P＜0.05).The multivariate Cox proportional risk model analysis showed that SⅡ≥769.29 was an independent risk factor for the prognosis of pMMR mCRC patients after immunotherapy(P＜0.001).Conclusions Peripheral blood NLR,PLR,PIV and SⅡ could predict the efficacy of immunotherapy in pMMR mCRC patients and SⅡ is superior to NLR,PLR and PIV,and SⅡ≥ 769.29 has independent predictive value for poor prognosis in pMMR mCRC patients receiving immunotherapy.

Objective To investigate the effects of exogenous Apelin-13 on the expression of glucose and fatty acid metabolism related genes in the liver and skeletal muscle of diabetic rats.Methods Forty male Wister rats were randomly divided into a control group (n=8) and an experimental group (n=32).In the experimental group,a rat model of type 2 diabetes mellitus was established by a high glucose and high-fat diet and intraperitoneal injection of streptozotocin (STZ).The diabetic rats were randomized into a diabetic model group and an Apelin-13 treatment group with 14 rats in each group.Rats in the Apelin-13 treatment group were intraperitoneally injected with 0.1 μmol· kg· d-1 Apelin-13 for 10 weeks,while the control group and the diabetic model group were injected with an equal volume of 0.9％ NaCl solution for 10 weeks.At the end of the 10 week treatment,fasting blood glucose values in each group were measured.Levels of mRNA expression of glucose-6-phosphate (G-6-P),phosphoenolpyruvate carboxykinase (PEPCK),peroxisome proliferatoractivated receptor alpha (PPAR-α),acy1 CoA synthetase long-chain family member1 (ACSL1),and carnitine palmitoyltransferase1 (CPT1) in the liver and levels of mRNA expression of PPAR-α and glucose transporter type 4 (GLUT4) in skeletal muscle were detected by real-time fluorescence quantitative polymerase chain reaction (PCR).Results Levels of mRNA expression of liver PPAR-α,liver ACSL1,liver CPT1,and GLUT4 in skeletal muscle were lower in the diabetic model group (0.309±0.073,0.508±0.056,0.389±0.118 and 0.289±0.066,respectively) than in the control group (0.971±0.028,0.990±0.015,0.987±0.015 and 0.994±0.009,respectively) (all P＜0.05);In the Apelin 13 treatment group,their mRNA expression levels (0.663±0.085,0.802±0.079,0.752 ±0.097 and 0.509±0.119,respectively) were higher than in the diabetic model group,but lower than in the control group (all P＜0.05).Liver G-6 P and PEPCK mRNA levels in the diabetic model group (1.727±0.05 and 1.309±0.130) were higher than in the control group (1.002±0.005 and 0.993± 0.010) (both P＜0.05),but lower than in the Apelin13 treatment group (2.586±0.208 and 1.842± 0.234) (both P＜0.05).Skeletal muscle PPAR-α mRNA levels in the diabetic model group (0.477± 0.118) and the Apelin-13 treatment group (0.566±0.0780) were lower than in the control group (0.993±0.013) (both P＜0.05),but showed no significant difference between the two experimental groups (P ＞ 0.05).Conclusions Apelin-13 increases the expression of the PPAR,ACSL1,and CPT1 genes in the liver and,to a certain extent,improves fatty acid oxidation metabolism in the liver in type 2 diabetic rats.It also increases the expression of the G-6-P and PEPCK genes,promotes gluconeogenesis in the liver,and may be related to the development of type 2 diabetes.In skeletal muscle,Apelin 13 increases GLUT4 gene expression,moderately improves skeletal muscle metabolism and may play a role in the regulation of oxidative stress.

Aim To provide references for clinical trials dose and rational drug use by evaluating mitochondrial toxicity of bentysrepinine on HepG2 cells.Methods Mitochondrial toxicity of bentysrepinine on HepG2 cells was cmomprehensively evaluated by measuring proliferation inhibition rate, lactic acid content in culture supernatant, reactive oxygen species(ROS) content, mitochondrial membrane potential (MMP) variation and the activity of mitochondrial respiratory chain complex enzymes Ⅰ to Ⅳ.Results The half inhibitory concentration of bentysrepinine of HepG2 cells was 359 μmol·L-1.Compared with the control group, bentysrepinine could reduce the MMP, raise the level of lactic acid, increase the content of ROS and lower the activity of mitochondrial respiratory chain complex enzymes Ⅰ to Ⅲ with the concentration of 400 μmol·L-1(196 mg·L-1), showing an obvious mitochondrial toxicity.Compared with lamivudine and adefovir dipivoxil, bentysrepinine exerted no influence on indexes above with the same concentration 100 μmol·L-1.Conclusions Bentysrepinine shows an obvious mitochondrial toxicity on HepG2 cells with the concentration of 400 μmol·L-1.This mitochondrial toxicity is not presented with the concentration of 200 μmol·L-1.It shows that the safety range of bentysrepinine about mitochondrial toxicity is relatively wide.The test plays a guiding role in clinical trial dose design as well as clinical treatment.

Objectives To investigate the effects of Apelin 13 on myocardial metabolism in diabetic rats.Methods A total of 40 male Wister rats were randomly divided into normal control group (NC,n=8) and experimental group (n =32).Diabetic rats model were induced by high-sugar and high-fat diet combined with low-dose intraperitoneal injection of streptozotocin (STZ).The wellestablished 28 diabetic model rats were randomly divided into diabetic model group (DM,n=14) and apelin-13 treated group (n=14).In the Apelin-13 group,diabetic rats were administered Apelin-13 [0.1 μmol/(kg · d)]by intraperitoneal injection for 10 weeks,while the control group and diabetic model group were given an equal volume of 0.9％ NaCl.At the end of the 10th week,all rats were sacrificed after fasting glucose measurement.Levels of serum free fatty acids (FFA) and myocardial FFA were measured by ELISA.Expression of myocardial glucose transporter member 4 (GLUT4) were detected by immunohistochemistry.The mRNA expressions of myocardial PPARα,CD36 and CPT-1 were detected by real-time fluorescence quantitative PCR.Results Fasting blood glucose,serum FFA and myocardial FFA were significantly higher in DM group than in NC group (all P＜ 0.05).The level of plasma glucose and myocardial FFA were significant lower(P＞0.05) in Apelin-13 treated group than in DM group;but serum FFA was not significantly lower(P＜0.05).The mRNA expressions of PPARα,CD36,CPT-1 in cardiac myocyte were higher in DM group and Apelin-13 treated group than in control(P＜0.05),and lower in Apelin-13 treated group than in DM group(P＜ 0.05).The expression of myocardial GLUT4 was significantly lower in DM group(1.138±0.316)and in Apelin-13-treated group (4.631 ± 1.832) than in NC group(9.132 ± 2.156),(F=65.507,P＜ 0.05),and higher in Apelin-13-treated group than in DM group(P＜0.05).Conclusions Apelin-13 increases myocardial expression of GLUT4,improves utilization of FFA,and it can effectively reduce the expression of PPARα,CD36 and CPT-1.Therefore,it may play a vital role in the improvement of myocardial metabolism in diabetic rats.

Objective To learn the present efficiency of medical equipments at public hospitals in Liaoning province, and provide scientific basis for rational distribution of such resources, and for control of medical expenses.Methods Data envelop analysis (DEA) was used to appraise the deployment efficiency of 2 784 such equipments worth over 100 000 yuan per unit, with equipments randomly sampled from 31 public hospitals in the province.Results The equipment deployment at public hospitals in Liaoning was found at a low level.9.7% of the hospitals were found as relatively efficient, 3.2% of them as in relatively weak efficiency, while 87.1% of them relatively inefficient.Gaps were found between urban hospitals and tertiary hospitals, and rural hospitals and secondary hospitals in their deployment efficiency, as evidenced in overinvestment of equipments and insufficiency of competent operators.Conclusions Hospitals should strengthen their scientific management of the equipments, and emphasize human resource investment, thus elevating the efficiency of equipment deployment.

Objective To construct and implement the nursing quality information feedback system based on QUACERS model and control theory, and discuss its application effect and the problems that should be paid attention to and to provide operational cases and practical basis for nursing quality management. Methods Through literature review and expert consultation, the framework and content of nursing quality information feedback system were set up and implemented. The changes of the nursing quality and the repeated occurrence of nursing problems were evaluated before (2013) and after (2015) the implementation of this project. And in December 2015, a self-made questionnaire was conducted among the nurses in the hospital to evaluate the importance of the feedback and it′s effect of improving the nursing quality. And evaluate the timeliness and effectiveness of different feedback forms. Results 1 120 and 1 136 nurses were followed-up in 2013 and 2015 respectively. The scores of human resource management, clinical nursing service and nursing safety management were higher than before, and the repeated occurrence of nursing problems was lower than before. A total of 450 questionnaires were distributed, 438 copies were collected, the effective recovery rate was 97.33%. Ratings for the importance of each item was from 3.37 to 4.57. Ratings for the effect of improving the quality of care was 3.79 to 4.39. The percentage of quality information received by nurses was more than 95%, and the average score of feedback timeliness was 4.29 to 4.53. Conclusions Quality information feedback system based on QUACERS model can cover multiple dimensions of quality management, and it was conducive to obtaining comprehensive information;Combined with multiple feedback forms can improve the effect of information feedback.

Objective To learn the present pre-hospital emergency resources allocation in Liaoning province.Methods Site survey and questionnaire survey were used to survey the basic information,number of pre-hospital emergency ambulances,human resources,and communication/control systems of 19 pre-hospital emergency centers in Liaoning province in 2014.Results The number of pre-hospital emergency sub-stations,ambulances and human resource fall short of demand.Furthermore,these resources are found with such problems as greater service radius of average pre-hospital emergency service and longer average pre-hospital response time in countryside than cities,insufficient and obsolete ambulances short of onboard equipment and communication systems,not to mention shortage of medical workers of higher degrees and academic titles.Conclusions A great gap is found between urban and rural pre-hospital emergency resource allocation in Liaoning province,with poor resources in the countryside.The government is recommended to step up financial support in increasing pre-hospital emergency substations and resources allocation,regularly update pre-hospital emergency vehicles,set up independent title promotion mechanism,perfect communication scheduling system,in order to satisfy the demands of pre-hospital first aid.

Zishengwan is one of the representative prescription of invigorating spleen and stomach,which is widely used in different clinic departments.This article introduces Zishengwan being used in treating different diseases in the past few years,aiming at certifying that different diseases can be treated with same method,providing the basis of expanding clinical applied range of Zishengwan.

Objective To investigate the effect of exogenous apelin-13 on oxidative stress, myocardial inflammatory cytokines and apoptosis in diabetic model rats.Methods A total of 40 male Wistar rats were randomly divided into 2 groups: normal control group (NC, n=8) and experimental group (EX, n=32).Diabetes was induced by feeding with high-sugary and high-fat diet for 8 weeks and a single intraperitoneal injection of streptozotocin (STZ) (30 mg/kg).The wellestablished 28 diabetic model rats were then randomly divided into 2 subgroups: model group (DM, n =14) and apelin-13 administration group (AP, n =14).The rats in AP group were given intraperitoneal administration of apelin-13 at a single dose of 0.1 μtmol · kg-1 · d-1 for 10 weeks, while NC group and DM group were given 0.9％ NaCl in the same way.All rats were sacrificed at the end of the week 10.Blood hydrogen peroxide (H2O2), nitric oxide (NO) and malonaldehyde (MDA) were measured by colorimetry, and superoxide dismutase (SOD) was measured by enzyme-linked immunosorbent assay (ELISA).The expressions of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in rat myocardium were detected by immunohistochemistry.Masson staining was used to observe the myocardial fibrosis in rats of different groups.Cardiomyocyte apoptosis was determined by TUNEL.Results (1) Compared with NC groups, DM group showed that MDA, H2O2 and NO were significantly increased, while SOD was significantly decreased (F=22.400, 6.230, 4.267 and 8.901, all P＜0.0167).There was a statistically significant difference in the levels of MDA, H2O2,SOD between DM group and AP group.(2) The expression of TNF-α and IL-6 was significantly higher inDMgroup than inNCgroup (0.0599±0.0208 vs.0.0076±0.0031, F=35.139;0.0503±0.0243 vs.0.0071± 0.0024, F=15.946, both P＜0.0167).After 10 weeks of apelin-13 administration, the levels of inflammatory cytokines were significantly decreased in AP group than in DM group.(3) The myocardial apoptosis and fibrosis were significantly increased in DM group than in NCgroup [0.0293±0.0061 vs.0.0030-t-0.0013 and 0.0708±0.0420 vs.0.0013±0.0003, F=84.930 and 19.420, both P＜0.0167].The myocardial apoptosis and fibrosis were significantly decreased in AP group than in DM group (both P＜0.0167).Conclusions To some extent, apelin13 reduces the levels of oxidative stress and myocardial inflammation reaction in type 2 diabetes.Moreover, it may play a vital role in the improvement of myocardial apoptosis and fibrosis.

Objective To explore the needs of clinical nursing manager leadership skills, so as to provide a reference for the training and promotion. Methods Semi-structured interview was adopted in 15 nursing managers in 4 Jinan level three class A hospitals, and data were analyzed by Colaizzi′s phenomenological procedures. Results Four aspects were exacted for leadership skills: leadership power skills, management skills, professional skills, personal qualities. Conclusions The requirement of clinical nursing manager leadership skills is necessary and urgent, mainly concentrated on the management skills. The management skills should be strengthened, and pay attention to the power of leadership, professional skills and personal qualities at the same time, in order to adapt to the management requirements, and improve the quality of nursing management.