Anaplastic thyroid carcinoma(ATC)is the most aggressive malignancy with poor prognosis.The pathogenesis of ATC is complex,and there is no effective treatment at present.In recent years,with the deep understanding of the genetic(such as BRAF V600E,TP53,TERT,PIK3CA mutations,etc.)and epigenetic(such as histone methylation,histone deacetylation,microRNA regulatory pathways,etc.)changes driving ATC,molecular targeted therapy has brought new hope to ATC patients.This article reviews the molecular mechanisms of ATC and the latest achievements in targeted therapy and other therapies.

Objective:To investigate the expression of HBB in anaplastic thyroid cancer(ATC)cells and its regulatory effect on proliferation,invasion,migration and apoptosis of ATC cells and its potential mechanism.Methods:The expression of HBB in thyroid cancer and paracancerous tissues was analyzed through TIMER database.The correlation between the expression of HBB and the overall survival time of thyroid cancer patients was analyzed through KM-plotter database.The expression of HBB mRNA in ATC cells was detected by RT-qPCR.The HBB knockout or overexpression plasmid was transfected into ATC cells.The expression of HBB protein was detected by Western blot.The proliferation activity was detected by CCK-8 assay.The migration and invasion ability was detected by Transwell assay.The apoptosis was detected by flow cytometry.The expression of β-catenin was detected by Western blot.Results:The expression of HBB was low in thyroid cancer,and the overall survival time of patients with high expression of HBB was high.The expression of HBB protein was down-regulated in ATC cells.Knockout of HBB increased the ability of proliferation,migration and invasion of ATC cells and the expression of β-catenin protein,and inhibited apoptosis.However,overexpression of HBB decreased the ability of proliferation,migration and invasion of ATC cells and the expression of β-catenin protein,and promoted apoptosis.Conclusions:High HBB expression is associated with higher overall survival in patients with thyroid cancer.It may inhibit the proliferation,migration and invasion of ATC cells and promote apoptosis through Wnt/β-catenin signal pathway.

Objective To explore the short-term and long-term efficacy of arthroscopic surgery,different non-surgical ther-apy and sham operation intervention in the treatment of meniscus related injuries,and to compare their advantages and disadvan-tages,so as to provide guidance for clinical practice.Methods Randomized controlled trials on arthroscopic surgery,meniscecto-my and other surgical and non-surgical treatments for knee meniscus injury were searched in PubMed,Embase,Cochrane Librar-y and Web of Science,and the search time was from its inception to July 2023.Two researchers independently screened the liter-ature according to the established literature ranking criteria,and the Cochrane Risk of Bias Assessment Tool was used to evalu-ate the risk of bias of the included literature,while the PEDro Scale Evaluation Tool was used to evaluate the quality of the liter-ature of the randomized controlled trials,and the collected data were quantitatively analyzed using RevMan 5.3 software.Results From the qualitative analysis,it was clear that surgical therapies might be more appropriately applied to patients without osteo-arthritis and without mechanical symptoms,and that meniscal suture repair surgery had a more favorable long-term outcome compared with traditional partial meniscectomy.Quantitative analysis showed that there was no statistical significance between arthroscopic surgery and other non-surgical therapies in several short and long term efficacy(all P＞0.05).For example,MD=0.15,95％CI:-4.05～4.35,I2=0％in the short-term comparison of Lysholm knee score;MD=-1.30,95％CI:-3.16～0.57,I2=0％;Short-term VAS score MD=-0.18,95％CI:-0.59～0.23,I2=45％;MD=-0.01,95％CI:-0.20～0.19,I2=36％.In addition,in the subgroup analysis of degenerative meniscus injury alone,the difference in clinical efficacy between the two therapies was also not statistically significant(all P＞0.05).Conclusion There is no practical difference between surgi-cal therapy and non-surgical therapy in the short-term and long-term outcomes.For single type injury,such as degenerative me-niscus injury,there is no practical difference between the two therapies.

Objective:To evaluate the clinical efficacy of Fried Licorice Decoction Plus-minus in combination with PD-1 therapy for patients with advanced non-small cell lung cancer(NSCLC)with Qi-Yin deficiency.Methods:From December 2020 to December 2022,72 patients diagnosed with advanced NSCLC with Qi-Yin deficiency were enrolled in this study.The patients were recruited from Jilin Provincial Cancer Hospital and the Affiliated Hospital of Changchun University of Chinese Medicine.The patients were randomly assigned into two groups,with 36 patients in each group.The control group received PD-1 treatment alone,and the treatment group received PD-1 combined with Fried Licorice Decoction Plus-minus.The measures of primary outcomes included immune function(CD3+,CD3+/CD4+,and CD3+/CD8+)and quality of life score(Kamofsky,KPS).The measures of secondary outcomes included the objective response rate(ORR);traditional Chinese medicine(TCM)symptom score;serum tumor marker carcinoembryonic antigen(CEA);neuron-specific enolase(NSE);cytokeratin fragment(CYFRA211);and incidence of immune-related adverse events such as gastrointestinal toxicity,pulmonary toxicity,hepatotoxicity,and thyroid toxicity.Results:Regarding immune function regulation,a significant improvement was observed in CD3+,CD3+/CD4+,and CD3+/CD8+.Furthermore,at T3 and T4 time points,an improvement was observed in patient quality of life indicators such as the tumor markers CEA and CY211.In addition,symptoms related to TCM syndrome,including coughing,fatigue,palpitations,and diarrhea were significantly reduced compared to the baseline levels.Moreover,the treatment group exhibited superior outcomes compared to those of the control group in terms of reducing immune-associated pneumonia and diarrhea(P<0.05).The ORR for both groups was similar;36%for those receiving com-bination therapy vs.25%for those receiving PD-1 monotherapy.Therefore,no significant differences between these two groups were ob-served(P>0.05).Conclusions:The combination of Fried Licorice Decoction Plus-minus and PD-1 in the treatment of patients with advanced NSCLC showed a significant enhancement in immune function,improvement in clinical efficacy,reduction in immune-related adverse reac-tions,and had an excellent safety profile.

Objective:To compare the aortic remodeling of the Fabulous stent system and standard thoracic aortic endovascular repair (TEVAR) on distal aorta type B aortic dissection (TBAD). Methods:The prospective data collected between Dec 2017 and Oct 2019 from 134 patients with type B aortic dissection (TBAD) who underwent treatment with the "Fabulous" stent system, and retrospective data from 159 TBAD patients receiving standard TEVAR from corresponding multicenter. By using propensity score matching analysis, we compared the prognosis and aortic remodeling outcomes in patients undergoing Fabulous and standard TEVAR treatments during a 1-year postoperative follow-up.Results:In this study, 62 patients in Fabulous group and 62 patients in standard TEVAR were included.There were no significant statistical differences in baseline characteristics between the two groups. In terms of aortic remodeling in bare stent region, Fabulous group had better change trends of diameter of true lumen [10.6 (4.4, 14.5) mm vs. 4.7 (0.9, 10.7) mm, P=0.001] and false lumen [-24.2 (-30.5, -4.9) mm vs. 0.7 (-11.8, 2.3) mm, P<0.001] than those in the standard TEVAR group. The rate of complete false lumen thrombosis was also higher in the Fabulous group (62.9% vs. 37.1%, P=0.042). Conclusion:The Fabulous stent system, when compared to standard TEVAR surgery, demonstrates good aortic remodeling outcomes in the distal aorta.

Objective To explore the effects of the long non-coding RNA(lncRNA)NK2 homeobox 1-antisense RNA 1(NK2-1-AS1),which mediates the microRNA(miR)-96-5p/PR domain-containing protein 16(PRDM16)axis,on anaplastic thyroid cancer(ATC)cell proliferation,migration,and invasion in vitro and transplanted tumor growth in vivo.Methods The differentially expressed lncRNA NKX2-1-AS1 in ATC tissues and cells,its target miRNA miR-96-5p,and its downstream target gene PRDM16 were screened using a bioinformatics analysis.The dual-luciferase reporter assay validated the relationship between NKX2-1-AS1 and miR-96-5p as well as the connection between miR-96-5p and PRDM16.Western blotting was performed to detect the effect of miR-96-5p overexpression on PRDM16 in CAL-62 cells overexpressed with NKX2-1-AS1.Plate clone formation,scratch,and Transwell assays were used to detect the effects of PRDM16knockdown on the proliferation,migration,and invasion of CAL-62 cells overexpressing NKX2-1-AS1.CAL-62 cells were injected subcutaneously into nude mice and the effect was observed of PRDM16knockdown on the growth of transplanted tumors of CAL-62 cells overexpressing NKX2-1-AS1.Results The bioinformatics analysis revealed that the NK2-1-AS1/miR-96-5p/PRDM16 axis was involved in regulating ATC development.The dual-luciferase reporter assay demonstrated that NKX2-1-AS1 bound to miR-96-5p and miR-96-5p bound to PRDM16.NKX2-1-AS1 overexpression upregulated PRDM16 protein expression in CAL-62 cells,while miR-96-5p overexpression reversed this phenomenon.NKX2-1-AS1 overexpression inhibited CAL-62 cellular proliferation,migration,and invasion in vitro and transplanted tumor growth in vivo,while knocking down PRDM16 reversed these phenomena.Conclusion NK2-1-AS1 may compete with miR-96-5p as an endogenous RNA to bind to its downstream target gene,PRDM16,and upregulate its expression,thus inhibiting ATC cell proliferation,migration,and invasion in vitro and transplanted tumor growth in vivo.

Objective To explore the effect of transcription factor E2F7 on the proliferation,migration,invasion,and tumor growth of anaplastic thyroid cancer(ATC)cells in vitro and to elucidate the underlying mechanisms.Methods Lentivirus transfection was used for a stable E2F7 knockdown in CAL-62 cells,and real-time PCR was used to detect E2F7 expression in these cells to verify the trans-fection efficiency.CAL-62 cells were divided into sh-NC and sh-E2F7 groups,and cell proliferation was measured using the CCK-8 assay,whereas cell migration and invasion abilities were measured using the Transwell assay.CAL-62 cells were subcutaneously injected into nude mice to observe tumor growth.The EPD website predicted an E2F7 binding site on the CXCL5 promoter,and the dual-lucif-erase reporter gene assay measured the effect of E2F7 knockdown on the luciferase activity of the CXCL5 promoter.The impact of E2F7 knockdown on CXCL5 levels in CAL-62 cells was assessed through real-time PCR and ELISA.Further,CAL-62 cells were divided into sh-E2F7+vector and sh-E2F7+CXCL5 groups to study the effects of CXCL5 overexpression on cell proliferation,migration,invasion,and the CXCR2/ERK signaling pathway following E2F7 knockdown.Results E2F7 knockdown inhibited CAL-62 cell proliferation,migra-tion,and invasion in vitro and tumor growth in vivo.The CXCL5 promoter has an E2F7 binding site,and E2F7 knockdown reduced the luciferase activity of the CXCL5 promoter.CXCL5 overexpression reversed the inhibitory effect of E2F7 knockdown on cell proliferation,migration,invasion,and the CXCR2/ERK signaling pathway in CAL-62 cells.Conclusion E2F7 promotes ATC cell proliferation,migra-tion,invasion,and tumor growth in vitro by activating the CXCL5/CXCR2/ERK signaling pathway mediated by CXCL5 transcription.

Objective:To construct a hierarchical management model of performance objectives,and to explore its application value in the management of medical equipment procurement process.Methods:The procurement performance evaluation indicators were screened from the medical equipment procurement declaration level,process level,use level and disposal level,and the comprehensive evaluation model was developed by entropy weight method and data envelopment analysis(DEA)method to form the process management plan at the level of personnel,system,data and equipment.A total of 717 sets of medical equipment purchased by Beijing Youan Hospital from 2019 to 2022 were selected,and the conventional management mode(348 units)and hierarchical management mode(369 units)were used for management according to different performance objectives evaluation methods.The performance objectives achievement,the quality of procurement process management and the satisfaction of clinical allocation management of medical equipment procurement under different management modes were compared.Results:The 369 units of equipment under the hierarchical management model included operating room equipment,laboratory equipment,inpatient treatment equipment,disinfection supply equipment and other medical equipment,and the performance objectives achievement of the procurement were(96.10±3.46)%,(96.76±2.65)%,(95.59±2.52)%,(96.06±2.34)%and(96.88±1.75)%,respectively,which were higher than those of the management model,the difference was statistically significant(t=2.663,2.801,2.858,4.111,3.548,P＜0.05)The effective ratio of DEA in the comprehensive evaluation of the medical equipment procurement declaration level,process level,use level and disposal level under the hierarchical management model were 96.7%,98.6%,94.6%and 99.7%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(x2=10.983,9.327,7.270,12.309,P＜0.05).The satisfaction of clinical departments with the procurement and use of medical equipment under the hierarchical management model were(95.82±2.83)%and(97.25±1.96)%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(t=5.575,5.248,P＜0.05).Conclusion:The hierarchical management model can effectively implement the performance objectives of medical equipment procurement,improve the management quality of medical equipment procurement process,improve satisfaction of clinical departments and management personnel after procurement,and ensure the quality of equipment operation.

Objective:To investigate the value of evaluating pancreatic exocrine insufficiency with fecal pancreatic elastase-1 in the clinical staging of chronic pancreatitis and prognosis evaluation.Methods:A total of 100 patients with pancreatic exocrine insufficiency (patient group) who received treatment in Wenzhou Central Hospital from January 2021 to June 2022 and 100 subjects without pancreatic exocrine insufficiency (control group) were included in this study. Fecal pancreatic elastase-1 content was measured by an enzyme linked immunosorbent assay. The receiver operating characteristic (ROC) curve was plotted to evaluate the value of fecal pancreatic elastase-1 content in the diagnosis of pancreatic exocrine insufficiency. Fecal pancreatic elastase-1 content was compared among patients with different clinical stages of chronic pancreatitis. The factors that affect the prognosis of patients with chronic pancreatitis were analyzed using logistic regression analysis.Results:Pancreatic elastase-1 content in the patient group was (63.28 ± 13.24) μg/g, which was significantly lower than (768.29 ± 102.59) μg/g in the control group ( t = 68.16, P < 0.05). The sensitivity, specificity, Youden index, and 95% CI of using pancreatic elastase-1 content to diagnose pancreatic exocrine insufficiency were 74.7%, 63.5%, 0.724, and 0.740-0.870, respectively. Among the 200 included subjects, 103 had chronic pancreatitis. With the increase in M-ANNHEIM clinical stage, fecal pancreatic elastase-1 content in patients with chronic pancreatitis gradually decreased ( F = 182.66, P < 0.05). Pancreatic elastase-1 content < 200 μg/g was used as a standard to evaluate pancreatic exocrine function. Results showed that 35 patients had stage I chronic pancreatitis, 40 patients had stage II chronic pancreatitis, and 28 patients had stage III chronic pancreatitis. There was no significant difference in the number of patients with different stages of chronic pancreatitis between the two clinical stage classification methods ( χ2 = 12.46, P = 0.002). Six-month follow-up results showed that among 103 patients with chronic pancreatitis, 31 had a poor prognosis (30.1%). Univariate analysis revealed that there were significant differences in age at onset, body mass index, triglyceride level, alcohol consumption, and pancreatic elastase-1 content among patients with different prognoses ( χ2 = 24.07, 4.27, 5.43, 8.38, 4.93, P < 0.05). Multivariate logistic regression analysis showed that age at onset, body mass index, triglyceride level, alcohol consumption, and pancreatic elastase-1 content were the independent influential factors of prognosis in patients with chronic pancreatitis [ OR (95% CI) = 4.207 (2.741-11.609), 1.870 (1.241-2.972), 1.984 (1.437-3.113), 2.769 (1.827-5.125), 1.951 (1.469-3.387), all P < 0.05]. Conclusion:Pancreatic elastase-1 content is of great value in assessing pancreatic exocrine insufficiency, and is closely related to the clinical staging and prognosis of patients with chronic pancreatitis. Therefore, fecal pancreatic elastase-1 content is expected to be a reliable reference for assessing the progress of chronic pancreatitis and predicting its prognosis.

Objective:To explore the current situation of nurses' turnover intention and its influencing factors based on the intergenerational differences, analyze the similarities and differences.Methods:From January to March 2018, 12 291 nurses from 23 general hospitals were selected by stratified cluster sampling. The nurses were investigated with the Turnover Intention Questionnaire, Work-Family Conflict Scale and Perceived Person-Environment Fit Scale. Pearson correlation analysis was used to explore the correlation between nurses' work-family conflict, person-environment fit and turnover intention. Multiple linear regression analysis was used to explore the influencing factors of nurses' turnover intention among different generations. A total of 12 291 questionnaires were distributed and 12 291 were retrieved. After eliminating the questionnaires with obvious logical errors, 11 753 valid questionnaires were finally recovered, with an effective recovery rate of 95.62% (11 753/12 291) .Results:The turnover intention of post-70s nurses was lower than that of post-80s and post-90s nurses. Work-family conflict, person-environment fit and whether the nurses have experienced negative events in the past year were the common influencing factors of nurses' turnover intention among different generations ( P<0.01) . The professional title, the number of night shifts and the fertility were the specific influencing factors of the post-90s nurses' turnover intention ( P<0.05) . The employment form was the specific influencing factor of post-80s nurses' turnover intention ( P<0.05) . Conclusions:The turnover intention of post-80s and post-90s nurses were higher than that of the post-70s nurses. There are differences in the current situation and influencing factors of nurses' turnover intention in different birth years. It is suggested that intervention strategies should be formulated according to the intergenerational characteristics of nurses to effectively reduce nurses' turnover intention.