Background: Metabolic dysregulation is a hallmark of type 2 diabetes mellitus (T2DM), in which the abnormalities in brown adipose tissue (BAT) play important roles. However, the cellular composition and function of BAT as well as its pathological significance in diabetes remain incompletely understood. Our objective is to delineate the single-cell landscape of BAT-derived stromal vascular fraction (SVF) and their characteristic alterations in T2DM rats. Methods: T2DM was induced in rats by intraperitoneal injection of low-dose streptozotocin and high-fat diet feeding. Single-cell mRNA sequencing was then performed on BAT samples and compared to normal rats to characterize changes in T2DM rats. Subsequently, the importance of key cell subsets in T2DM was elucidated using various functional studies. Results: Almost all cell types in the BAT-derived SVF of T2DM rats exhibited enhanced inflammatory responses, increased angiogenesis, and disordered glucose and lipid metabolism. The multidirectional differentiation potential of adipose tissue-derived stem cells was also reduced. Moreover, macrophages played a pivotal role in intercellular crosstalk of BAT-derived SVF. A novel Rarres2+macrophage subset promoted the differentiation and metabolic function of brown adipocytes via adipose-immune crosstalk. Conclusion BAT SVF exhibited strong heterogeneity in cellular composition and function and contributed to T2DM as a significant inflammation source, in which a novel macrophage subset was identified that can promote brown adipocyte function.

Objective : To examine the diagnostic and prognostic value of long non-coding RNA (lncRNA) JPX in mesothelioma, so as to provide insights into diagnosis and prognosis of mesothelioma. Methods: Patients with clinically definitive diagnosis of mesothelioma from 2015 to 2019 that were sampled from asbestos processing plants in Zhejiang Province from 2015 to 2019 were recruited in the mesothelioma group, while healthy residents without asbestos exposure or asbestos-related diseases in the same area served as controls. Participants' demographics, pathologic diagnosis and imaging features were collected, and the expression of blood lncRNA JPX was detected using lncRNA microarrays. The diagnostic value of lncRNA JPX for mesothelioma was evaluated using the receiver operating characteristic (ROC) curve, and the correlation between lncRNA JPX expression and prognosis was examined among mesothelioma patients using survival analysis. Results: There were 17 subjects in the mesothelioma group, with a mean age of (65.71±8.36) years, and 34 subjects in the controls, with a mean age of (64.24±8.70) years. LncRNA microarray detected significantly high lncRNA JPX expression in mesothelioma patients, and higher blood lncRNA JPX expression was detected in the mesothelioma group than in the control group [median (interquartile range), 1.10 (1.31) vs. 0.89 (0.54); t'=-2.300, P=0.034]. The area under the ROC curve was 0.673 (95%CI: 0.507-0.839, P=0.046), and if the cutoff was 1.759, the sensitivity and specificity were 35.3% and 100.0%, respectively. Survival analysis showed no significant difference in the survival rate of mesothelioma patients between the high lncRNA JPX expression group and the low expression group (χ2=0.212, P=0.645). Conclusions LncRNA JPX overexpression is detected in the blood of patients with mesothelioma, and lncRNA JPX expression presents a diagnostic value for mesothelioma; however, it shows little prognostic value for mesothelioma.

BACKGROUND: We have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary studies have demonstrated its superiority over the the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score with respect to outcome predictions for acute myocardial infarction (AMI) patients. The current study hypothesized that the residual CatLet (rCatLet) score predicts clinical outcomes for AMI patients and that a combination with the three clinical variables (CVs)-age, creatinine, and ejection fraction, will enhance its predicting values. METHODS: The rCatLet score was calculated retrospectively in 308 consecutively enrolled patients with AMI. Primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) including all-cause mortality, non-fatal AMI, transient ischemic attack/stroke, and ischemia-driven repeat revascularization, was stratified according to rCatLet score tertiles: rCatLet_low ≤3, rCatLet_mid 4-11, and rCatLet_top ≥12, respectively. Cross-validation confirmed a reasonably good agreement between the observed and predicted risks. RESULTS: Of 308 patients analyzed, the rates of MACCE, all-cause death, and cardiac death were 20.8%, 18.2%, and 15.3%, respectively. Kaplan-Meier curves for all endpoints showed increasing outcome events with the increasing tertiles of the rCatLet score, with P values <0.001 on trend test. For MACCE, all-cause death, and cardiac death, the area under the curves (AUCs) of the rCatLet score were 0.70 (95% confidence intervals [CI]: 0.63-0.78), 0.69 (95% CI: 0.61-0.77), and 0.71 (95% CI: 0.63-0.79), respectively; the AUCs of the CVs-adjusted rCatLet score models were 0.83 (95% CI: 0.78-0.89), 0.87 (95% CI: 0.82-0.92), and 0.89 (95% CI: 0.84-0.94), respectively. The performance of CVs-adjusted rCatLet score was significantly better than the stand-alone rCatLet score in terms of outcome predictions. CONCLUSION: The rCatLet score has a predicting value for clinical outcomes for AMI patients and the incorporation of the three CVs into the rCatLet score will enhance its predicting ability. TRIAL REGISTRATION http://www.chictr.org.cn , ChiCTR-POC-17013536.
Humans ; Coronary Artery Disease/complications* ; Death ; Myocardial Infarction/etiology* ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Outcome

Objective : To investigate the status of occupational stress and analyze its influencing factors among frontline employees working in a chemical fiber manufacturing enterprise, so as to provide insights into the development of occupational stress interventions. Methods : The frontline employees working in a chemical fiber manufacturing enterprise were selected as the study subjects using a cluster sampling method in October 2018. The status of occupational stress was investigated using the Chinese version of the effort-reward imbalance ( ERI ) questionnaire. The influencing factors for occupational stress were identified using a multivariable logistic regression model. Results : A total of 1 780 questionnaires were sent out, and 1 115 valid ones ( 62.64% ) were recovered. Among the 1 115 respondents, there were 427 men ( 38.30% ) and 688 women ( 61.70% ), and 71.22% were at ages of 21 to 39 years. There were 561 respondents with < 1 year of service ( 50.31% ), and the longest length of service was 11 years. In addition, there were 1 069 respondents ( 95.87% ) exposed to high noise, and 346 respondents ( 31.03% ) were diagnosed at a high occupational-stress state and 769 ( 68.97% ) at a low state. Multivariable logistic regression analysis identified 5 years or longer of service ( OR=1.540, 95%CI: 1.057-2.245 ) and exposure to high noise ( OR=1.917, 95%CI: 1.004-3.659 ) as risk factors for occupational stress among frontline employees in the chemical fiber manufacturing enterprise. Conclusions There are 31.03% of frontline employees at a high occupational-stress state in the chemical fiber manufacturing enterprise, and a high occupational-stress state is associated with exposure to high noise and 5 years or longer of service.

Objective : To analyze the survival of patients with malignant mesothelioma, so as to provide insights into the management of malignant mesothelioma. Methods : Totally 36 patients with malignant mesothelioma admitted to Cixi Third People’s Hospital from October 2012 to January 2021 were enrolled, and the demographic features, exposure to asbestos, and diagnosis and treatment were retrospectively reviewed. The survival rate and median survival time were calculated with the life-table method, and the factors affecting the survival rate of malignant mesothelioma were identified using the Kaplan-Meier estimate and log-rank test. Results : The 36 patients with malignant mesothelioma included 6 men ( 16.67% ) and 30 women ( 83.33% ), and had a median age of 61 ( interquartile range, 14 ) years. There were 30 cases with pleural malignant mesothelioma ( 83.33% ) and 6 cases with peritoneal malignant mesothelioma ( 16.67% ), 32 cases ( 88.89% ) with a history of occupational exposure to asbestos, and 26 cases ( 72.22% ) receiving palliative treatment. The 1-, 2- and 3-year cumulative survival rates were 30%, 15% and 3%, respectively, and the median survival time was 0.71 years. In addition, there were no significant differences in the survival period among patients with malignant mesothelioma in terms of gender, age, route of asbestos exposure, duration of asbestos exposure, pathogenic site and treatment regimens ( P>0.05 ). Conclusion The 36 patients with malignant mesothelioma had a median survival period of 0.71 years, and no association was found between the survival period and asbestos exposure or pathogenic site.

Objective:To construct a perioperative venous thrombosis prevention program for patients with spinal surgery based on evidence-based nursing, and to discuss its application effect.Methods:Using the convenient sampling method, a total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from June 2019 to June 2020 were selected as the control group and received routine nursing management. A total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from July 2020 to July 2021 were selected as the observation group, and they were given a venous thrombosis prevention scheme based on evidence-based nursing. The prothrombin time, thrombin time, activated partial thromboplastin time, fibrinogen and D-dimer levels, blood flow velocity of common femoral vein, popliteal vein, iliac vein and occurrence of thrombosis were compared between the two groups.Results:The prothrombin time, thrombin time, fibrinogen and D-dimer levels in the two groups had interaction, and the differences were statistically significant ( Finteraction=6.079, 8.735, 6.918, 8.657; all P<0.01) . Postoperative prothrombin time, thrombin time and activated partial thromboplastin time all showed a trend of decreasing first and then increasing and the levels of fibrinogen and D-dimer showed a trend of increasing first and then decreasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, postoperative prothrombin time, thrombin time, and activated partial thromboplastin time in the observation group were longer than those in the control group, and the levels of fibrinogen and D-dimer were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The blood flow velocity of common femoral vein, popliteal vein, and iliac vein in the two groups were interacted, and the difference was statistically significant ( Finteraction=6.257, 3.281, 7.697; all P<0.05) . After operation, the blood flow velocity of common femoral vein, popliteal vein and iliac vein all showed a trend of first decreasing and then increasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, the postoperative blood flow rates of the common femoral vein, popliteal vein and iliac vein in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The incidence of venous thromboembolism in the observation group was 1.11%, which was lower than 6.67% in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The perioperative venous thrombosis prevention and management plan based on evidence-based nursing can provide individualized nursing intervention for spinal surgery patients according to different thrombosis risks, which can improve patients' coagulation and lower extremity venous function and effectively reduce the risk of thrombosis.

Objective:To construct a perioperative venous thrombosis prevention program for patients with spinal surgery based on evidence-based nursing, and to discuss its application effect.Methods:Using the convenient sampling method, a total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from June 2019 to June 2020 were selected as the control group and received routine nursing management. A total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from July 2020 to July 2021 were selected as the observation group, and they were given a venous thrombosis prevention scheme based on evidence-based nursing. The prothrombin time, thrombin time, activated partial thromboplastin time, fibrinogen and D-dimer levels, blood flow velocity of common femoral vein, popliteal vein, iliac vein and occurrence of thrombosis were compared between the two groups.Results:The prothrombin time, thrombin time, fibrinogen and D-dimer levels in the two groups had interaction, and the differences were statistically significant ( Finteraction=6.079, 8.735, 6.918, 8.657; all P<0.01) . Postoperative prothrombin time, thrombin time and activated partial thromboplastin time all showed a trend of decreasing first and then increasing and the levels of fibrinogen and D-dimer showed a trend of increasing first and then decreasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, postoperative prothrombin time, thrombin time, and activated partial thromboplastin time in the observation group were longer than those in the control group, and the levels of fibrinogen and D-dimer were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The blood flow velocity of common femoral vein, popliteal vein, and iliac vein in the two groups were interacted, and the difference was statistically significant ( Finteraction=6.257, 3.281, 7.697; all P<0.05) . After operation, the blood flow velocity of common femoral vein, popliteal vein and iliac vein all showed a trend of first decreasing and then increasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, the postoperative blood flow rates of the common femoral vein, popliteal vein and iliac vein in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The incidence of venous thromboembolism in the observation group was 1.11%, which was lower than 6.67% in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The perioperative venous thrombosis prevention and management plan based on evidence-based nursing can provide individualized nursing intervention for spinal surgery patients according to different thrombosis risks, which can improve patients' coagulation and lower extremity venous function and effectively reduce the risk of thrombosis.

Based on the current situation of pediatric surgery practice teaching in Qilu Hospital of Shandong University, 10 mind maps of common clinical diseases made by Imindmap 11 were applied to the practice teaching and teaching assessment through WeChat public platform. Mind map not only revealed the relationship between related disciplines and reappeared the clinical thinking process, but also greatly improved the enthusiasm and efficiency of interns' learning, and trained their innovative spirit and practical ability. At the same time, as a formative evaluation method, mind map facilitates teachers to evaluate and improves teaching activities. What’s more, it effectively improves the quality of teaching, and is worth promoting in clinical teaching.

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.

Objective To observe the clinical effect of repairing the defect after extended resec-tion of lower lip cancer by modified lip and cheek fan-shaped flap .Methods Six cases of lower lip cancer were treated .The defect of the lower lip was about 1/3-1/2 after 1 cm of enlarged resection outside the margin of the mass .The defect was repaired with modified lip and cheek fan-shaped flaps . The morphology and function were observed 3-36 months after operation .Results All patients healed in one stage ,and the shape and function of lower lip recovered well without complications .Conclusions Lower lip defect about 1/3-1/2 of patients with modified lip and cheek fan-shaped flap is an ideal method of restoration and reconstruction ,with satisfactory results after surgery .