Coronary artery bypass grafting (CABG) is one of the most effective revascularization treatments for coronary heart disease. Secondary prevention strategies, which rely on antiplatelet and lipid-lowering drugs, are crucial after CABG to ensure the durability of revascularization treatment effects and prevent adverse cardiovascular and cerebrovascular events in the medium to long term. Previous research conducted by Professor Zhao Qiang's team from Ruijin Hospital of Shanghai Jiao Tong University, known as the DACAB study, indicated that dual antiplatelet therapy (DAPT, specifically ticagrelor+aspirin) after CABG can enhance venous graft patency. However, it remains uncertain whether DAPT can further improve the medium to long-term clinical outcomes of CABG patients. Recently, the team reported the medium to long-term follow-up results of the DACAB study, termed the DACAB-FE study, finding that DAPT administered after CABG can reduce the incidence of major cardiovascular events over five years and improve patients' medium to long-term clinical outcomes. This article will interpret the methodological highlights and significant clinical implications of the DACAB-FE study.

Objective:To explore the expressions and clinical significances of tripartite motif-containing protein 28 (TRIM28), 3-phosphoinositide-dependent protein kinase-1 (PDK1), and N-cadherin in pancreatic carcinoma.Methods:A total of 72 patients diagnosed with pancreatic carcinoma underwent radical resection in the Department of Hepatobiliary Surgery, Binzhou People′s Hospital from January 2009 to November 2022 were selected, all of which were pathologically diagnosed as pancreatic ductal adenocarcinoma (PDAC). Immunohistochemistry was used to detect the expression of TRIM28, PDK1, and N-cadherin in 72 cases of pancreatic carcinoma and paracancerous tissues, to explore the correlation between the expression of them and the clinicopathological features of pancreatic carcinoma, and to analyze the influence of their expression and clinicopathological characteristics on the prognosis of patients. The count data were expressed as the number of cases and percentage, and the Chi-square test was used for comparison between groups. Spearman method was used for correlation analysis. Kaplan-Meier method was used for survival analysis, and Log-rank test was used to compare the survival rate, and univariate and multivariate Cox regression analysis were used to analyze the risk factors affecting prognosis.Results:The positive rates of TRIM28 (72.22%), PDK1 (65.28%) and N-cadherin (61.11%) in PDAC were significantly higher than those in para-cancerous tissues (26.39%, 33.33%, 34.72%). Moreover, the patients with high expression of the three had the characteristics of low differentiation, late stage, and lymph node metastasis ( P<0.05). TRIM28 was positively correlated with PDK1 and N-cadherin expression in PDAC ( r=0.720, P<0.001; r=0.714, P<0.001), N-cadherin and PDK1 expression in PDAC was also positively correlated ( r=0.854, P<0.001). Kaplan-Meier survival curve showed that the 2-year survival rate of patients with positive TRIM28, PDK1 and N-cadherin (13.46%, 14.89%, 13.64%) was significantly lower than that of patients with negative tumor (50.00%, 40.00%, 39.29%), the differences were statistically significant ( P<0.05). Univariate Cox regression analysis showed that patients with poor differentiation, nerve infiltration and lymph node metastasis, TNM stage Ⅲ+ Ⅳ, TRIM28 positive, PDK1 positive and N-cadherin positive had a significantly increased risk of death within 2 years after surgery ( P<0.05). Multivariate Cox regression analysis showed that poor differentiation, nerve infiltration, TNM stage Ⅲ+ Ⅳ and TRIM28 positive were independent risk factors for poor prognosis of patients with PDAC ( P<0.05). Conclusions:TRIM28, PDK1 and N-cadherin are highly expressed in PDAC, and the expression level is significantly correlated with the malignant degree of PDAC. TRIM28 is an independent risk factor for the prognosis of patients with PDAC.

Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Objective:To explore the relationship between psychological capital, career decision-making difficulties, and employment anxiety among undergraduate nursing students, in order to help them improve their employability and mental health.Methods:From December 2022 to January 2023, a cross-sectional survey was conducted on 543 undergraduate nursing students from five medical colleges in Shanxi Province interning at the First Hospital of Shanxi Medical University, selected through convenience sampling method, using a General Information Questionnaire, Psychological Capital Scale, College Student Career Decision-making Difficulties Scale, and College Student Employment Anxiety Scale. Spearman correlation analysis was used to explore the relationship among them, and hierarchical model was used to explore the predictive ability of undergraduate nursing students ′ psychological capital and career decision-making difficulties on their employment anxiety by stratified regression analysis. Results:The score of College Student Employment Anxiety Scale of 543 undergraduate nursing students was 36(30, 44). The results of correlation analysis showed that employment anxiety was negatively correlated with psychological capital and its four dimensions (self-efficacy, hope, resilience and optimism), while employment anxiety was moderately correlated with career decision-making difficulties and its three dimensions (lack of preparation, difficulty in information exploration and conflict)( r values were -0.291 to 0.564, all P<0.05). The hierarchical model showed that psychological capital and career decision-making difficulties independently explained the 46.1% variation of employment anxiety after controlling the influence of general data. Conclusions:The score of employment anxiety of undergraduate nursing students is in the middle level, and the difficulty of career decision-making has a positive impact, while the psychological capital has a negative impact. College educators can continuously monitor the psychological capital and provide career development counseling for undergraduate nursing students through positive psychological intervention and effective management measures, so as to reduce the degree of employment anxiety of undergraduate nursing students.

Objective:To investigate the status quo and influencing factors of health self-management ability of scientific and technological workers in Shanxi Province.Methods:This study was a cross-sectional study. Using the general situation questionnaire and the adult health self-management ability evaluation scale, 467 scientific and technological workers who received physical examination in the First Hospital of Shanxi Medical University from January 2022 to September 2022 were investigated by questionnaire, and their height, weight, body mass index, fasting blood glucose, blood lipids and blood uric acid were collected on the day of physical examination. Multiple linear regression analysis was used to explore the influencing factors of health self-management ability, and Pearson and Spearman correlation analysis was used to analyze the correlation between health self-management ability and examination items.Results:The total score of health self-management ability of 467 scientific and technological workers was (153.7±16.5). The results of multiple linear regression showed that the type of medical insurance, self-assessment of health status, staying up late, and sleep quality were independent influencing factors of health self-management ability ( R2=0.141, adjusted R2=0.120, F=6.771; P<0.001). Health self-management ability was positively correlated with high-density lipoprotein ( r=0.114), behavioral subscale was positively correlated with high-density lipoprotein ( r=0.107), environmental subscale was negatively correlated with uric acid ( r=-0.103), triglyceride ( r=-0.118), and positively correlated with high-density lipoprotein ( r=0.129), and cognitive subscale was negatively correlated with triglyceride ( r=-0.125), all of which were statistically significant ( P<0.05). Conclusions:The ability of health self-management of scientific and technological workers in Shanxi Province belongs to the upper middle level, which is affected by the type of medical insurance, the self-assessment of health status, staying up late, and the quality of sleep. It is suggested that the ability of health self-management of scientific and technological workers can be improved by strengthening their health beliefs, providing a more convenient working environment, reducing the frequency of staying up late, and improving their sleep quality.

Objective To investigate the relationship between low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (LHR) and asymptomatic carotid plaques and their stability in high-risk stroke population.Methods Between December 2012 and April 2015,a total of 39 944 permanent resident population ≥40 years were used as subjects of the survey from 11 rural communities in Haitou Town,Banzhuang Town and Tashan Town,Ganyu District,and 9 urban communities in Xinpu District and Haizhou District,Lianyungang City using epidemiological survey method of cluster sampling.Excluding those who took lipid-lowering drugs within 3 months and had a history of stroke or transient ischemic attack,6 592 people at high risk of stroke were finally screened out.Ultrasound was used to detect carotid plaques.The subjects were divided into plaque-free group and plaque group.The latter was further divided into stable plaque group and unstable plaque group.Multivariate logistic regression analysis was used to evaluate the independent risk factor for carotid plaques and their stability.The odds ratio (OR) and 95％ confidence interval (CI) were calculated.Receiver Operating Characteristic (ROC) curve was used to evaluate the prediction efficiency of LHR on carotid plaques.Results Multivariate logistic regression analysis showed that low-density lipoprotein cholesterol (LDL-C) was an independent risk factor for carotid plaques,while high-density lipoprotein cholesterol (HDL-C) was an independent protection factor of carotid plaques.Using the lowest quintile (Q1) of LHR as a reference,carotid plaque risk increased significantly with the increasing LHR (Q2:OR 1.448,95％ CI 1.082-1.937,P =0.013;Q3:OR 2.414,95％ CI 1.754-3.322,P＜0.001;Q4:OR 2.939,95％ CI 1.945-4.441,P＜0.001;Q5:OR 4.884,95％ CI 3.143-7.115,P＜0.001).ROC curve analysis showed that the area under the curve (AUC) of LHR predicting carotid plaques was 0.795 (95％ CI 0.792-0.807;P＜ 0.001),and the optimal cut-off value was 3.00 (sensitivity 68.37％,specificity 75.65％).LHR ≥3.92 (LHR in the Q4 and Q5 subgroups) was an independent risk factor for unstable carotid plaques (OR 2.915,95％ CI 2.104-4.040;P＜0.001).The AUC of the LHR predicting unstable carotid plaques was 0.658 (95％ CI 0.633-0.684;P＜0.001).Conclusions LHR was an independent predictor of carotid plaques in high-risk stroke patients.It had higher predictive value for carotid plaques,and its conversion threshold for promoting plaque formation was 3.00.When LHR was ≥3.92,there was a significant increase in the risk of unstable carotid plaques.

Objective Salidroside is a major active component of integripetal rhodiola herbal medicine, which has a significant activity against hypoxia and ischemia.This study was to investigate the effects of side chain carbon losssalidroside analogues (N04) on the expressions of HIF-1α-related factors in the hypoxia-injured EAhy926 human vascular endothelial cells.Methods EAhy926 human umbilical vein endothelial cells in the logarithmic growth phase were randomly divided into a normal control, a hypoxia model control, a salidroside, a high-dose N04, a medium-dose N04, and a low-dose N04 group.The hypoxia model was established by depriving the culture medium of sugar and serum and culturing the EAhy926 cells in an environment of 95%N2+5%CO2 for 2 hours, followed by intervention with salidroside at 1×10-6 mol/L and N04 at 1×10-6, 1×10-7, and 1×10-8 mol/L, respectively.Then, the activity of the cells was detected by MTT assay, their LDH activity examined by spectrophotometry, the mRNA expressions of HIF-1α and VEGF measured by RT-PCR, the protein expressions of HIF-1α, VEGF and pVHL determined by Western blot, and the activity of eNOS measured by ELISA.Results Compared with the normal control group, the hypoxia model cells showed significantly reduced activity (0.51±0.05 vs 0.27±0.02, P<0.01), an elevated LDH level ([6.65±1.43] vs [78.82±2.33] U/L, P<0.01), and decreased eNOS activity ([1.56±0.23] vs [1.16±0.20] U/100 mL, P<0.01).In comparison with the hypoxia model group, the cells treated with high-, medium-, and low-dose N04 exhibited remarkably increased activity (0.27±0.02 vs 0.0.42±0.05, 0.40±0.03 and 0.37±0.04, P<0.01), a reduced LDH level ([78.82±2.33] vs [53.05±3.90], [58.42±4.45] and [62.73±3.63] U/L, P<0.01), and increased eNOS activity ([1.16±0.20] vs [3.01±0.47], [2.60±0.26] and [2.32±0.29] U/100 mL, P<0.01).The activity of eNOS was also increased in the salidroside group ([2.32±0.29] U/100 mL, P<0.01).The cell activity in the high-and medium-dose N04 groups was markedly higher than that in the salidroside group (P<0.05), and so was the eNOS activity in the high-dose N04 group and the LDH level in the medium-and low-dose N04 groups (P<0.05).In comparison with the normal control group, the expressions of HIF-1α mRNA, HIF-1α protein and VEGF protein were significantly up-regulated in the hypoxia model group (P<0.01) while that of the pVHL protein markedly down-regulated (P<0.01).Compared with the hypoxia model group, the expressions of HIF-1α mRNA, HIF-1α protein and VEGF protein were remarkably reduced (P<0.05), while that of the pVHL protein markedly elevated (P<0.05).Both the expressions of VEGF mRNA and HIF-1α protein were significantly lower in the medium-and low-dose N04 groups than in the salidroside group (P<0.05).Conclusion N04 can protect vascular endothelial cells against hypoxia-induced injury by regulating the expression of HIF-1α-related factors and eNOS.

Objective: To investigate the incidence of occupational diseases in Chongqing, China, from 2006 to 2014, and to analyze the harm, features, and trend of occupational diseases in Chongqing. Methods: The data of new cases of occupational diseases from 2006 to 2014 were collected, and the patients with a confirmed diagnosis of occupational diseases were selected as study subjects to analyze the incidence of occupational diseases in Chongqing. Results: There were 17499 cases of occupational diseases in total in Chongqing from 2006 to 2014. Among these patients, 17124 (97.86%) were male, most of whom (95.40%) had occupational pneumoconiosis, and 375 (2.14%) were female, most of whom (72.80%) had occupational chemical poisoning. There were 16400 cases (93.72%) of occupational pneumoconiosis in total, mainly coal workers' pneumoconiosis (55.87%) and silicosis (43.02%) , and the main industries involved were coal mining and washing, railway transport equipment manufacturing, and mining and washing of bituminous coal and anthracite. There were 724 cases of occupational poisoning in total; there were 281 cases of acute occupational poisoning, mainly gas poisoning (39.86%) and carbon monoxide poisoning (33.10%) ; there were 443 cases of chronic occupational poisoning, mainly poisoning caused by benzene (47.63%) , mercury and its inorganic compounds (32.74%) , and lead and its inorganic compounds (9.03%) . Conclusion Occupational diseases in Chongqing are mainly occupational pneumoconiosis, and occupational health supervision should be enhanced in the industries of coal mining and washing and railway transport equipment manufacturing to protect workers’ health.

Objective To evaluate the diagnostic performance of the histogram analysis of mono-exponential and intravoxel incoherent motion(IVIM) models to the dualistic model of epithelial ovarian cancer(EOC). Methods Forty female patients with histopathologically proven epithelial ovarian cancer underwent preoperative MR examination. Scanning sequences included conventional imaging, diffusion-weighted magnetic resonance imaging with 11 b values (0, 30, 50, 100, 150, 200, 400, 600, 800, 1 000, 1 500 s/mm2) and dynamic contrast enhanced MRI (DCE-MRI). Based on the dualistic model of EOC, all patients were divided into two groups:typeⅠ(low grade, n=16) and typeⅡ(high grade, n=24). ADC, D, D*and f maps and their corresponding histograms were generated by post-processing software. Based on an entire-tumour measurement, the following histogram parameters were recorded, respectively: (a) Mean; (b) the 10th percentile (10th);(c) the mean of the top 10 percent (MeanL);(d) the 90th percentile (90th);(e) the mean of the bottom 10 percent (MeanR). Two types were compared using independent sample t test or Mann-Whitney U test. And areas under ROC curve between two groups were assessed. Results For ADC , D, and f, all indices(Mean,10th,MeanL,90th,MeanR) of the histogram were significantly lower in typeⅡthan in type Ⅰ(P<0.05). All of parameters of D* had no significant different(P>0.05). D demonstrated a comparable accuracy with ADC in differentiating the grade of EOC (area under curve: Mean, 0.898 vs. 0.893; 10th, 0.880 vs. 0.846; MeanL, 0.878 vs. 0.858; 90th, 0.895 vs. 0.839; MeanR, 0.872 vs. 0.814), and both ADC and D have better performance than f. Conclusion It is feasible to stratify the grade of EOC by mono-exponential and IVIM models with histogram metrics,diagnositic efficiency of ADC and D values are higher.

OBJECTIVETo investigate the effect of mTOR signal transduction pathway and down-regulating anti-oncogene PTEN on the growth of breast cancer MCF-7 cells.

METHODSMCF-7 cells were transfected with the eukaryotic expression plasmid pcDNA3.1-mTOR and non-loaded plasmid, and the expression of mTOR in the cells was detected using Western blotting. Flow cytometry was used to analyze apoptosis and cell cycle of the transfected cells, and the expression of PTEN was detected after transfection.

RESULTSThe cells transfected with pcDNA3.1-mTOR showed a increased growth rate than those transfected with the non-loaded plasmid and those without transfection. The expression of the protein PTEN decreased obviously in the cells after mTOR trasnfection.

CONCLUSIONmTOR can regulate the expression of PTEN via PI3K/AKT/PTEN pathways through a negative feedback mechanism. Increased mTOR expression promotes MCF-7 cell growth, suggesting the potential value of mTOR specific inhibitor in the treatment of breast cancer.

Apoptosis ; Breast Neoplasms ; pathology ; Cell Cycle ; Down-Regulation ; Gene Expression Regulation, Neoplastic ; Humans ; MCF-7 Cells ; PTEN Phosphohydrolase ; metabolism ; Plasmids ; Signal Transduction ; TOR Serine-Threonine Kinases ; genetics ; Transfection