Objective:To explore the effect of progressive case teaching based on Omaha system in standardized training for new nurses.Methods:Using convenience sampling method, 58 new nurses from Yantai Affiliated Hospital of Binzhou Medical University from January to December 2021 were selected as control group, and 58 new nurses from January to December 2022 were selected as experimental group. Experimental group received progressive case teaching based on Omaha system, while control group received routine standardized training. Both groups received training for six months. After six months of training, the academic performance, clinical thinking ability, and satisfaction of the two groups were compared.Results:After intervention, experimental group scored higher in various dimensions of academic performance and clinical thinking ability, as well as satisfaction scores with the teacher, teaching methods, and teaching effectiveness, compared to the control group, with statistical differences ( P<0.05) . Conclusions:The progressive case teaching based on Omaha system in standardized training for new nurses can improve academic performance, enhance clinical thinking abilities, and gain recognition from new nurses.

Cardiovascular disease(CVD)is the leading cause of death in humans and has received widespread attention.The clinical indicators for predicting the risk of CVD occurrence and development are expensive and difficult to popularize in grassroots areas.Triglyceride glucose(TyG)index,as an alternative biomarker for insulin resistance,can predict the risk of CVD.The clinical TyG index is easy to obtain and is gradually receiving attention.This article reviews the research progress on the correlation between TyG index and CVD risk.

Objective:To investigate the effect of Xuanbai Chengqi Decoction (XBCQT) on lung-gut injury and intestinal function, and analyze its effect on intestinal flora in sepsis mice.Methods:C57 male mice were randomly divided into three groups with 12 mice in each group: control group, model group and treatment group. The sepsis model was prepared by intra-peritoneal injection of lipopolysaccharide (LPS) 5 mg/kg. XBCQT was administered by gavage 24 h before, 0.5 h after and 12 h after modeling. The lung, colon and blood samples were collected at 24 h after modeling. The pulmonary and intestinal inflammatory cytokine content of interleukin-1β (IL-1β), IL-6, tumor necrosis factor α (TNF-α) and monocyte chemoattractant protein (MCP-1) was measured by real-time fluorescence quantitative PCR. HE staining was used to evaluate the structural damage and changes of lung and gut, and Western blot and Immunohistochemistry methods were used to analyze the expression of occludin and claudin-1 in intestinal epithelium. Finally, the plasma endotoxin content of each group was tested by Limulus test kit. Fecal DNA of mice was extracted and the changes of intestinal flora in sepsis mice were detected by 16S rDNA quantitative PCR. The measurement data among the three groups were compared by one-way analysis of variance.Results:(1) XBCQT significantly reduced the pulmonary inflammatory cytokine IL-1β, IL-6, TNF-α and MCP-1 expression (all P<0.05), and attenuated lung injury. (2) Compared to the model group, the treatment group exhibited a reduction in intestinal damage and a decrease in the intestinal inflammatory cytokines (all P<0.05). XBCQT increased the expression of epithelial tight junction and mucin of colon, and improved the intestinal epithelium barrier function. (3) XBCQT treatment decreased the content of endotoxin in plasma of sepsis mice ( P<0.05), promoted the growth of beneficial bacteria Akkermansia muciniphila and reduced the expression of Enterococcus in the intestine of sepsis mice (all P<0.05). Conclusions:XBCQT can significantly improve the intestinal inflammatory injury, regulate the intestine epithelium barrier and improve the intestinal function in sepsis mice.

Objective:To report embryonic testicular regression syndrome(ETRS) caused by DHX37 heterozygous variant for the first time in China and summarize the clinical manifestations of ETRS as to improve the understanding of doctors for this disease.Methods:The clinical data and whole exome sequencing results of five cases of ETRS from Shenzhen Children′s Hospital were collected. The reported cases of DHX37 heterozygous variant were reviewed.Results:Five patients with ETRS visited the doctors at the age of 2 months to 5 years and 5 months. Three patients raised as males came to hospital due to virilition and 2 female patients visited a doctor due to clitoral hypertrophy. No uterus was detected by ultrasound in all patients. The gonadal pathologies from 4 cases displayed no testicular tissue or gonadal dysgenesis, complicated with gonadoblastoma in one case. The genetic testing revealed that the heterozygous variant(c.923G>A, p. R308Q) in DHX37 was found in 2 cases, without variant in other 3 cases. According to the review, ETRS and 46, XY gonadal dysgenesis due to DHX37 herozygous variant was firstly reported in 2019. A total of 40 cases, including 21 cases of ETRS, presented with the virilition or female phenotype, with the disappearance of testicular tissue as the main pathologies. There is no report in China.Conclusion:The article summarized the clinical manifestations and whole exome sequencing results of 5 patients with ETRS, among which two cases were caused by DHX37 variants and one was complicated with gonadoblastoma.

Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the sacroiliac joints, spine and peripheral joints. In China, standardized diagnosis and treatment of AS is still to be popularized. Based on the evidence and guidelines from China and other countries, Chinese Rheumatology Association developed standardization of diagnosis and treatment of AS. The purposes are: (1) to standardize the diagnosis and evaluation of AS; (2) to promote rational use of non-steroidal anti-inflammatory drugs, biological as well as traditional disease modifying anti-rheumatic drugs, so as to improve the patient′s quality of life.

Objective:To assess the changes of left ventricular systolic function and global myocardial work in heart failure with preserved ejection fraction (HFpEF) patients by speckle tracking layer-specific strain combined with myocardial work technique and explore the diagnostic value of each parameter for HFpEF.Methods:From December 2019 to December 2020, 38 HFpEF patients (HFpEF group) and 38 healthy individuals with age- and sex-matched (control group) were enrolled consecutively in the Fourth Affiliated Hospital of Harbin Medical University. Conventional ultrasound parameters were collected. Layer-specific strain and myocardial work techniques were used to obtain the global longitudinal strain (GLS) of the left ventricular endocardium, mid-myocardium, and epicardium (GLSendo, GLSmid, GLSepi), global myocardial work index (GWI), global myocardial work efficiency (GWE), global constructive work (GCW), and global wasted work (GWW). The absolute difference of GLS(ΔGLS) between endocardium and epicardium were calculate.All parameters were analyzed statistically. ROC curves were plotted to compare the effectiveness of layer-specific strain and myocardial work parameters in predicting left ventricular systolic function impairment in HFpEF patients.Results:①Left atrial diameter, interventricular septum at end-diastole, left ventricular posterior wall at end-diastole, relative wall thickness, left ventricular mass index, and average early diastolic peak velocity (E)/early diastolic tissue velocity (e′) in HFpEF group were significantly higher compared with control subjects, while late diastolic peak velocity (A), E/A, and e′ were significantly lower (all P<0.05); E, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, fraction shortening, and left ventricular ejection fraction were not different between HFpEF and control groups (all P>0.05). ②The global longitudinal strain of the left ventricule was highest in the endocardium and lowest in the epicardium. ③Compared with control subjects, HFpEF patients demonstrated significantly decreased GLSendo, GLSmid, GLSepi, ΔGLS, GWI, GWE, GCW and increased GWW (all P<0.01). ④The ROC results showed that the area under the curve of ΔGLS and GWE for predicting left ventricular contractile function impairment in HFpEF group, was 0.884 and 0.882, respectively; The cutoff values were -5.8% and 95%; The sensitivity were 84.2% and 71.1%, and the specificity was 84.2% and 89.5%, respectively. ⑤The ROC curve of combining the two technologies showed that the maximum area under the curve of the ΔGLS in tandem with GWE was 0.944, the sensitivity was 81.6%, and the specificity was 97.4%. Conclusions:Both speckle tracking layer-specific strain and myocardial work techniques can sensitively detect left ventricular myocardial function impairment in HFpEF patients at an early stage. ΔGLS and GWE are more reliable indexes for predicting left ventricular systolic function damage in HFpEF patients. Combining the two techniques can improve the diagnostic performance in HFpEF patients.

Objective: To investigate the molecular mechanism of chemokine CCL20/CCR6 in promoting invasion and migration of colon cancer SW480 cells. Methods: Colorectal cancer SW480 cells with high expression of CCR6 receptor were screened by immunochemistry (IHC). After co-culture with recombinant human CCL20, the invasion and migration of SW480 cells were detected by Transwell assay and Wound-Healing assay, respectively. Expressions of EMT markers, AKT signal protein and target protein MMP3 were detected by immunofluorescence (IF) and WB. AKT signaling pathway as the key mechanism was confirmed by MK2206 blocking assay. The expressions of CCL20 and MMP3 in colorectal cancer tissues as well as their correlation were analyzed by TCGAdatabase resources (https://portal.gdc.cancer.gov/). Results: CCL20 promoted the invasion and migration ability of SW480 cells significantly (all P <0.01), and this was induced by activation of AKT signaling and up-regulation of downstream target protein MMP3, instead of EMT. Blocking AKT signaling could significantly inhibit the invasion and migration of SW480 cells, and down-regulate MMP3 expression (P<0.05). TCGA platform data showed that the expressions of CCL20 and MMP3 in colorectal cancer tissues were significantly higher than those in normal mucosa tissues (P<0.05 or P<0.01), and an evidently positive correlation was found between CCL20 and MMP3 (r =0.051, P<0.01). Conclusion: The chemokine CCL20 promotes the invasion and migration of SW480 cells throughAKT/MMP3 signal axis, but not the EMT.

Objective In this study,Protosappanin A,Caesalpinia Sappan L extract and Cisplatin were combined with radiotherapy in gastric cancer cell SGC-7901 to investigate whether the Protosappanin A could in-crease radiosensitivity( SER) in gastric cancer SGC-7901 cells. This will be medication to create new areas of in-novation in the future. Methods The cell proliferation of SGC-7901 cells was detected by MTT assay. The rela-tionship between the effect of the Protosappanin A on cell proliferation and the time of action was determined. Caesalpinia Sappan L extract and Cisplatin were as controls. The fitted cell survival curve and clonal formation as-says were used to determine the SER to analyze the sensitizative effect of Protosappanin A. Results Protosappa-nin A could inhibit the growth of SGC-7901 cells,and its inhibitory effect is relatively weak. Its cytotoxicity has a time-and concentration-dependent manner. Cellular morphological changes were observed accompanying with increased concentrations and time treatments of Protosappanin A. Clonal formation experiment showed that the Protosappanin A significantly increased the radiosensitivity of SGC-7901 cells when compared to the radioactive group. They showed a statistically difference. Conclusion The inhibitory effect of the Protosappanin A on SGC-7901 cells in a concentration and time-dependent manner. Protosappanin A combined radiotherapy can improve the radiosensitization of cells,both of which may have synergistic anti-tumor effect.

Objective To study the effect of sitagliptin on insulin resistance and glucose variability in elderly patients with type 2 diabetes mellitus(T2DM) requiring high-dose insulin therapy.Methods A total of 100 elderly patients with T2DM failing to reach the standard application of large-dose insulin(＞60 U/d) treatment for three months or more [glycosylated hemoglobin (HbA1c) ＞8.0％] was randomly divided into sitagliptin group and pioglitazone group.Patients in sitagliptin group(50 cases) were treated with sitagliptin for oral use,100 mg each time,once a day,and patients in pioglitazone group(50 cases) were treated with pioglitazone for oral use,15 mg each time,once a day.The insulin dose was adjusted according to the blood glucose level in the two groups.Two groups were treated for 12 weeks.The indicators in both groups were compared,including fasting blood glucose (FBG),2 hours postprandial glucose (2hPG),glycosylated hemoglobin (HbA1c),24 hours glucose area under the curve (AUC),blood glucose coefficient of variation (CV),fasting C-peptide (FCP),2 hours postprandial C-peptide (2hPCP),fasting glucagon (FGG),2 hours postprandial glucagon(2 hFGG),cholesterol (TC),triglyceride (TG),systolic blood pressure (SBP),diastolic blood pressure(DBP),blood uric acid(BUA),daily insulin dosage(DID),body mass index(BMI),incidence of hypoglycemia and drug adverse reactions.Results After 12 weeks of treatment,the levels of FPG,2hPG,HbA1c,AUC,CV,FGG,2hFGG,TC,TG,SBP,DBP,DID and BMI in the sitagliptin group were significantly decreased than those before treatment(P＜0.05 or P＜0.01);The levels of FPG,2hPG,H bA1c,AUC,CV and BUA in the pioglitazone group were significantly decreased than those before treatment (P＜ 0.0 5 or P＜ 0.01);Compared with the pioglitazone group,the levels of 2 hPG,HbA1c,AUC,CV,FGG,2 hFGG,TC,TG,SBP,DBP,DID and BMI were significantly decreased in the sitagliptin group(all P＜0.05),and the levels of FCP and 2hPCP in the sitagliptin group were higher than those in the pioglitazone group(all P＜0.01).The incidence of hypoglycemia in the sitagliptin group was lower than that in the pioglitazone group(x2 =4.039,P =0.045).The incidence of adverse reactions in the sitagliptin group was lower than that in the pioglitazone grouP(x2 =3.979,P=0.043).Conclusion Sitagliptin combined with insulin is better than insulin combined with pioglitazone in elderly patients with T2DM requiring the application of high-dose insulin therapy,and the combining treatment could decrease insulin resistance,insulin dosage and the incidence of hypoglycemia.

Objective:To investigate the baseline levels of 25-hydroxy-vitamin D [25-(OH) D] in 3340 hospitalized children, analyze the 25-( OH) D levels in children with different diseases, age and gender in different seasons, and study the correlation between the 25-( OH) D levels and the clinical indicators. Methods:Totally 3340 hospitalized children were randomly selected, the 25-( OH) D levels were detected by an ELISA method, and Pearson correlation analysis of 25-( OH) D levels and clinical indicators such as liver function, myocardial enzymes, immunoglobulins, lymphocyte subtypes and thyroid function was performed. Results: The serum 25-(OH) D level in 3340 cases (1850 male, 1490 female) was (33. 00 ± 13. 42) ng·m1 -1, and that in those with neonatal diseases was the lowest followed by those with primary nephrotic syndrome, Henoch-schordeinpurpura and juvenile idiopathic arthritis. The ser-um 25-( OH) D levels in the premature was higher than that in full term infant. Except the newborn, the level of serum 25-( OH) D gradually reduced along with the age increase, while the percentage of insufficiency gradually increased. The serum 25-( OH) D level between the male and the female had no significant difference. The 25-( OH) D levels of hospitalized children were the highest in sum-mer. The serum level of 25-( OH) D was positively correlated with body mass index ( BMI) , alanine transaminase ( ALT) , aspartate transaminase (AST), creatine kinase (CK), creatine-phosphokinase (CK-MB), lactate dehydrogenase(LDH), free T4 (FT4) and free T3 (FT3), and negative correlation with alkaline phosphatase(ALP), immunoglobulin E (IgE) and immunoglobulin M (IgM). Conclusion:The incidence of vitamin D insufficiency is high in hospitalized children. The level of vitamin D is different among various diseases. The level of serum 25-( OH) D may have certain relevance with BMI, allergies, myocardial damage and thyroid function.