Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.

Objective To investigate the correlation between serum neuregulin 4(Nrg4)level and metabolic associated fatty liver disease(MAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 240 T2DM patients admitted to the Department of Endocrinology of Second People's Hospital of Yichang from June 2021 to August 2022 were collected and divided into simple T2DM group(n=120)and MAFLD group(MAFLD,n=120).120 healthy individuals were selected as the normal control(NC)group.Results The serum Nrg4 decreased gradually from NC group,T2DM group to MAFLD group(P＜0.05).Pearson correlation analysis showed that serum Nrg4 was negatively correlated with WC,HOMA-IR and hs-CRP(P＜0.05),and positively correlated with HDL-C(P＜0.05).Logistic regression analysis showed that Nrg4,WC,HOMA-IR and hs-CRP were the influencing factors of MAFLD.After adjusting for age,sex,smoking history,BMI,TC,TG,HDL-C,LDL-C,FPG,FIns,HbA1c and other factors,serum Nrg4 was still the influencing factor of MAFLD.Conclusion The decrease of serum Nrg4 is a risk factor for T2DM combined with MAFLD.

The TEA domain (TEAD) family proteins (TEAD1‒4) are essential transcription factors that control cell differentiation and organ size in the Hippo pathway. Although the sequences and structures of TEAD family proteins are highly conserved, each TEAD isoform has unique physiological and pathological functions. Therefore, the development and discovery of subtype selective inhibitors for TEAD protein will provide important chemical probes for the TEAD-related function studies in development and diseases. Here, we identified a novel TEAD1/3 covalent inhibitor (DC-TEADin1072) with biochemical IC

Objective:To understand the basic situation of noise hazards in wood furniture manufacturing, stone processing and special equipment manufacturing industries in Shenzhen City, and to provide basis for preventing and controlling noise hazards.Methods:In August 2019, stratified random sampling ws used to select 21 wood funiture manafacturing, 15 stone processing and 24 special equipment manufactruing as survey object. Through the methods of occupational health field investigation, noise intensity measurement and occupational health examination data collection, the noise hazards of 60 enterprises in three industries were statistically analyzed.Results:There were 154, 44 and 113 noise detection points in wood furniture manufacturing, stone processing and special equipment manufacturing enterprises, and 101, 27 and 78 out of standard points respectively, and the exceeding standard rates were 65.6% (101/154) , 61.4% (27/44) and 69.0% (78/113) , respectively. There were 1670, 172 and 856 workers exposed to noise in the three industries. Among them, 1198, 134 and 703 people had taken occupational health examination. The physical examination rates were 71.7% (1198/1670) , 77.9% (134/172) and 82.1% (703/856) , respectively. The abnormal rates were 19.1% (229/1198) , 51.5% (69/134) and 37.8% (266/703) , respectively.Conclusion:High intensity noise working environment, too long noise exposure time, incorrect wearing of personal protective equipment and neglect of occupational health examination are important reasons for hearing loss of noise exposed personnel.

Objective:To understand the basic situation of noise hazards in wood furniture manufacturing, stone processing and special equipment manufacturing industries in Shenzhen City, and to provide basis for preventing and controlling noise hazards.Methods:In August 2019, stratified random sampling ws used to select 21 wood funiture manafacturing, 15 stone processing and 24 special equipment manufactruing as survey object. Through the methods of occupational health field investigation, noise intensity measurement and occupational health examination data collection, the noise hazards of 60 enterprises in three industries were statistically analyzed.Results:There were 154, 44 and 113 noise detection points in wood furniture manufacturing, stone processing and special equipment manufacturing enterprises, and 101, 27 and 78 out of standard points respectively, and the exceeding standard rates were 65.6% (101/154) , 61.4% (27/44) and 69.0% (78/113) , respectively. There were 1670, 172 and 856 workers exposed to noise in the three industries. Among them, 1198, 134 and 703 people had taken occupational health examination. The physical examination rates were 71.7% (1198/1670) , 77.9% (134/172) and 82.1% (703/856) , respectively. The abnormal rates were 19.1% (229/1198) , 51.5% (69/134) and 37.8% (266/703) , respectively.Conclusion:High intensity noise working environment, too long noise exposure time, incorrect wearing of personal protective equipment and neglect of occupational health examination are important reasons for hearing loss of noise exposed personnel.

Objective:To observe the expression of serum nuclear factor-κB (NF-κB) and monocyte chemotactic protein-1 (MCP-1) in patients with early diabetic nephropathy (EDN) and the effect of pioglitazone on the expression of inflammatory factors and renal protective mechanism.Methods:A retrospective case-control study was conducted.From January 2019 to December 2019, the patients were divided into pioglitazone group ( n=35) and glimepiride group ( n=34). At the same time, 30 healthy people in the physical examination center of our hospital were selected as the control group.The levels of serum NF-κB and MCP-1 were detected by immunohistochemistry.The changes of fasting glucose, Hemoglobin A1C (HbA1c), renal function, urinary albumin excretion rate (UAER), and hypersensitive C-reactive protein(hsCRP), interleukin-6(IL-6), homeostasis model insulin Resistance index (HOMA-IR) were detected and compared among the three groups before treatment, pioglitazone group and glimepiride treatment group after treatment.To observe the effect of pioglitazone on serum NF-kB and MCP-1 expression in patients with early type 2 diabetic nephropathy. Results:Serum NF-κB, MCP-1, UAER, fasting blood glucose, HbA1c, HOMA-IR, hsCRP, IL-6 were significantly higher in the diabetic nephropathy group than those in the control group before treatment ( t values were 9.16, 7.61, 16.99, 17.01, 17.05, 12.01, 8.69, 6.28, all P<0.01). After 12 weeks of treatment, the levels of NF- κB, MCP-1, HOMA-IR, hsCRP, IL-6 and UAER in pioglitazone group were lower than those in glimepiide group ( t values were -5.03, -4.63, -2.35, -8.03, -3.06, -2.10, P<0.05 or P<0.01). After treatment, there were no statistically significant differences in fasting blood glucose and HbA1c between the pioglitazone group and the glimepiide group (all P>0.05). Serum NF-κB, MCP-1, HbA1c, HOMA-IR and UAER in EDN group were significantly positively correlated ( R values were 0.568, 0.532, 0.521, 0.466, all P<0.05). Conclusion:The expression of NF - κ B and MCP-1 in serum of EDN patients was increased, which indicated that there was chronic inflammation in patients.Pioglitazone could down regulate the expression of NF - κ B and MCP-1, so as to play an anti-inflammatory and renal protective role.

Unlike adult mammalian heart, zebrafish heart has a remarkable capacity to regenerate after injury. Previous study has shown Notch signaling activation in the endocardium is essential for regeneration of the myocardium and this activation is mediated by hemodynamic alteration after injury, however, the molecular mechanism has not been fully explored. In this study we demonstrated that blood flow change could be perceived and transmitted in a primary cilia dependent manner to control the hemodynamic responsive klf2 gene expression and subsequent activation of Notch signaling in the endocardium. First we showed that both homologues of human gene KLF2 in zebrafish, klf2a and klf2b, could respond to hemodynamic alteration and both were required for Notch signaling activation and heart regeneration. Further experiments indicated that the upregulation of klf2 gene expression was mediated by endocardial primary cilia. Overall, our findings reveal a novel aspect of mechanical shear stress signal in activating Notch pathway and regulating cardiac regeneration.

OBJECTIVE:To investigate the effects of UGT1A6 and UGT1A9 gene polymorphisms on blood concentration of valproic acid in Han epileptic patients.METHODS:Totally 107 Chinese Han epileptic patients were selected from outpatient department of our hospital during Jan.2014-Apr.2015.They were given valproic acid monotherapy treatment for 3 months to 6 years.The steady state concentration ofvalproic acid was detected by EMIT.UGT1A6 (rs2070959,rs6759892) and UGT1A9 (rs13418420,rs2741045,rs2741049,rs6731242,rs72551330) genotypes were detected by MALDI-TOF-MS.The correlation of gene polymorphism with con centration dose ratios (CDR) of valproic acid was investigated.RESULTS:UGT1A9 rs72551330 mutation had not been detected,and the frequency of genotypes in other 6 sites were all in line with Hardy-Weinberg balance (P＞0.05).The CDR of valproic acid in pa tients with UGT1A6 rs2070959,rs6759892 mutation (AG+GG or TG+GG type) were significantly lower than those with wild homozy gote (AA or TT type),with statistical significance (P＜ 0.05).There was no statistical significance in CDR of valproic acid among patients with UGT1A9 rs13418420,rs2741045,rs2741049 and rs6731242 wild homozygote and mutation (P＞0.05).CONCLUSIONS:UGT1A6 rs2070959,rs6759892 gene polymorphisms of Han epileptic patients are associated with blood concentration of valproic acid,and the patients with UGT1A6 rs2070959,rs6759892 mutation need more dose ofvalproic acid.

Objective To investigate the effects of different surgical position on the comfort of surgeons and patients during hepatectomy.Methods One hundred patients with liver carcinoma in Southern Hospital of Southern Medical University from October 2014 to October 2015 were selected by purposive sampling method. Patients were simply randomly divided into the observation group and the control group by computer generated random numbers,with 50 patients in each group. Patients in two groups were operated by the same team of surgeons using the same basic surgical approach. The control group adopted the traditional supine position, while the observation group used the modified position placement method. Patient's comfort,the convenience and comfort of surgeons as well as postoperative position related complications were evaluated.Results In the observation group,after the application of modified supine position placement,patients' comfort was significantly higher compared to the control group (Z=-3.458,-9.210;P<0.01). The convenience of surgeons significantly increased,and the operation comfort was significantly higher compared to the control group (χ2=7.440,6.061;P<0.01). The satisfaction of patients and surgeons significantly increased. In the observation group,patients' satisfaction was 94.0% and the surgeons' satisfaction was 96.0%,and they were significantly higher compared to the control group (patients:74.0%,surgeons:80.0%;P<0.01).Conclusions During hepatectomy,the application of modified operation position has a good effect on reducing intraoperative physical fatigue and improving the postoperative comfort of patients.

Objective To analyze the current situation and influencing factors of job satisfaction of advanced practice nurses ( APN ) in military hospital after training, and provide scientific basis for further research on the rational use of APN. Methods Self-designed general information questionnaire and Spector′s job satisfaction questionnaire were used to survey the job satisfaction and influencing factors of 338 cardiovascular APN in military hospital ( cluster sampling method ) . Results The total score of job satisfaction of 338 cardiovascular disease nurses was (130. 79 ± 22. 06), which was lower than that of the American norm(t= -2. 300,P<0. 05). Multiple linear regression analysis showed that the time of certification, category of personnel and work position affected the nurses′job satisfaction. Conclusions The job satisfaction of APN in the military cardiovascular disease should be strengthened. Hospital managers should be according to the influencing factors, change the management mode to realize the transition from identity management to postmanagement, and provide APN better work environment, so as to exert the positive role of clinical nurse specialist.