[Objective]To explore the expression of transcription factor KLF16 in nonalcoholic fatty liver disease(NAFLD)and its effect on lipid metabolism.[Methods]An animal model of NAFLD was constructed in mice induced by a high-fat diet.The mice were divided into normal diet group(ND)and high fat diet group(HFD).NAFLD cell model was constructed by primary mouse liver cells induced by oleic acid.The cells were divided into control group(Control group)and oleic acid induction group(OA group).Real-time fluorescence quantitative PCR(RT-qPCR)and Western blot were used to detect KLF16 expression in NAFLD animal and cell models.In vitro and in vivo models of KLF16 knockdown were constructed by injection of adeno-associated virus(AAV)into mouse tail veins and transient transfection of cell siRNA.Hematoxylin-eosin staining(HE)and other methods were used to detect changes in lipid deposition in NAFLD models be-fore and after KLF16 knockout.RT-qPCR was used to detect the expression of key genes of lipid metabolism in both cellu-lar and animal NAFLD models before and after KLF16 knockdown.Western blot assay was used to detect the expression of endoplasmic reticulum stress protein in NAFLD model before and after KLF16 knockdown.[Results]The expression level of KLF16 was up-regulated in HFD group and OA group,and lipid deposition was increased in OA group after KLF16 was depressed.There was no change in TC level in hepatocytes between groups(P>0.05),and TG level was increased in differ-ent degrees(P<0.05,P<0.001).At the same time,the change of KLF16 expression also caused the change of ER stress protein expression in OA group.[Conclusion]The transcription factor KLF16 may alleviate lipid deposition in nonalcoholic fatty liver disease by endoplasmic reticulum stress.

Objective:To construct the enteral nutrition nursing scheme of ICU patients with abdominal hypertension based on internal abdominal pressure classification, and provide reference for effectively preventing enteral nutrition intolerance of ICU patients with abdominal hypertension.Methods:According to the "6S" evidence pyramid model, searched from top to bottom for relevant literature on enteral nutrition support for ICU patients with abdominal hypertension in databases such as BMJ Best Practice, Cochrane Library, Guidelines International Network, Medlive, UpToDate, PubMed, Ovid, Web of Science, Embase, China National Knowledge Infrastructure, VIP, Wanfang Medicine, Chinese Biomedical Literature. Developed an enteral nutrition care plan for ICU patients with abdominal hypertension based on intra-abdominal pressure grading, with a search date from database establishment to January 25, 2023. The Delphi expert letter consultation method was used to conduct two rounds of letter consultation with 20 experts to solicit expert opinions and determine the intervention plan.Results:The age of 20 experts was (43.75 ± 5.28) years old, with a working experience of (22.00 ± 6.98) years. The effective recovery rates of the two rounds of Delphi expert correspondence questionnaires were 100%(20/20), the expert judgment basis coefficients were 0.945 and 0.970, the familiarity coefficients were 0.865 and 0.895, and the authority coefficients were 0.905 and 0.932, respectively. Kendall coordination coefficient of importance of the first, second and third level items in the two rounds of expert correspondence were 0.100, 0.093, 0.098 and 0.200, 0.165, 0.119. The Kendall coordination coefficients of operability for the first, second and third level items were 0.117, 0.130, 0.115 and 0.200, 0.184, 0.154, respectively. Finally, an enteral nutrition nursing scheme for patients with abdominal hypertension in ICU was formed, which included 5 primary items, 30 secondary items and 51 tertiary items.Conclusions:The Delphi method in this study has a high degree of authority and enthusiasm of experts, and a good degree of coordination of expert opinions. The established enteral nutrition nursing scheme for ICU patients with abdominal hypertension based on intra-abdominal pressure classification is reliable and scientific, and can provide reference for clinical nursing practice of enteral nutrition for ICU patients with abdominal hypertension.

Objective:To study the urinary iodine levels of children in Jiangxi Province and provide a basis for prevention and treatment of iodine deficiency disorders and scientific iodine supplementation.Methods:From March to July in 2022, a systematic sampling method was used in 99 counties (cities, districts, abbreviated as counties) in Jiangxi Province. One township (street) was selected from each county in five directions: east, west, south, north and middle. One primary school was selected from each township (street), and 40 non boarding children aged 8 - 10 (half male and half female) were selected from each primary school. One random urine sample was collected to test urinary iodine, and the distribution of urinary iodine in different regions, genders, and ages were compared.Results:A total of 19 842 urine samples were collected from children, with a median urinary iodine level of 181.90 μg/L. The median urinary iodine levels of children in different cities ( H = 1 014.05, P < 0.001), genders ( Z = 6.44, P < 0.001) and ages groups ( H = 29.82, P < 0.001) were compared, and the differences were statistically significant. Conclusion:The urinary iodine level of children in Jiangxi Province is at an appropriate level, but the distribution of urinary iodine is uneven among different regions, genders, and ages, indicating that scientific and precise iodine supplementation is necessary for the prevention and treatment of iodine deficiency disorders.

Traumatic cataract is relatively common in clinical practice. Typically, non-metallic foreign bodies entering the eye do not cause intraocular reactions, manifesting only as traumatic cataract, while metal foreign bodies entering the eye are more likely to cause complications. Foreign bodies entering the eye can be detected through ophthalmic examination or found during cataract surgery. However, a very small number of patients may experience missed diagnosis in clinical practice. This article reported a case of traumatic cataract with disappearance of intraocular metal foreign body, presenting with a history and signs of ocular trauma and foreign body entry into the eye, but no foreign body was found before, during or after surgery. The reasons for the disappearance of the metal foreign body were also analyzed.

Objective:To analyze the quality control test results of urine fluoride laboratories in Jiangxi Province, and support reliable data for the monitoring and prevention of fluorosis.Methods:From 2019 to 2021, the Jiangxi provincial urine fluoride laboratories used the "Determination of Fluoride in Urine-Ion Selective Electrode Method" (WS/T 89-2015) to detect quality control samples. Origin 9 software was used to analyze the data, and Youden plots and deviation bar plots were produced. The results were evaluated based on the Z-score (qualified: │Z│ ≤2, basically qualified: 2 < │Z│ < 3, unqualified: │Z│ ≥3).Results:The qualified rate of quality control assessment results of urine fluoride laboratories in Jiangxi Province was 95.00% (38/40) . Most of urine fluoride laboratories had scores of │Z│ < 2, and two laboratories had scores │Z│≥3 in 2019 and 2020.Conclusion:The quality control assessment results of urine fluoride laboratories in Jiangxi Province are relatively satisfactory, but some laboratories still need to further improve their detection capabilities.

Objective:The programmed death receptor 1/programmed death ligand 1 (PD-1/PD-L1) pathway can negatively regulate the immune response of the body, and serum soluble PD-L1 (sPD-L1) can reflect the expression level of PD-L1. This study aims to compare the expressional differences of sPD-L1 in serum between patients with chronic hepatitis B (CHB) and C (CHC) and further explore the factors influencing the clinical cure of CHB.Methods:60 cases with CHB, 40 cases with CHC, and 60 healthy controls were selected. Serum levels of sPD-L1 were detected using an ELISA kit. The relationship between sPD-L1 levels and viral load, liver injury indicators, and others was analyzed in CHB and CHC patients. According to the distribution type of the data, a one-way ANOVA or Kruskal Wallis test as well as Pearson’s correlation or Spearman’s rank correlation analysis were performed. A difference of P<0.05 was considered statistically significant.Results:The serum sPD-L1 levels were significantly higher in CHB patients (414.6 ± 214.9) pg/ml than those in CHC patients (58.9 ± 122.1) pg/ml and the healthy control group (66.27 ± 24.43) pg/ml, and there was no statistically significant difference in serum sPD-L1 between CHC patients and the healthy control group. Further grouping and correlation analysis showed that the level of serum sPD-L1 was positively correlated with the content of HBsAg in CHB patients but not with HBV DNA, alanine transaminase, albumin, and other liver injury indicators. Additionally, there was no correlation between serum sPD-L1 levels, HCV RNA, and liver injury indicators in CHC patients.Conclusion:The serum sPD-L1 levels are significantly higher in CHB patients than those in the healthy control group and the CHC group, and there is a positive correlation between sPD-L1 levels and HBsAg. The persistent presence of HBsAg is an important mechanism for the activity of the PD-1/PD-L1 pathway, indicating that the activity of the PD-1/PD-L1 pathway may be an important factor that cannot be clinically cured in CHB as in CHC.

"Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China"(2022)(referred to as the"guidelines")was officially published in August 2022 in the Chinese Journal of Endocrine Metabolism.These guidelines have been extensively updated from the 2007 version,with 15 sections covering the etiology,clinical manifestations,diagnosis,evaluation,and treatment of hyperthyroidism,as well as the management of specific types of thyrotoxicosis.The new version guidelines proposed 107 recommended opinions supported by stronger evidence,offering comprehensive and reliable guidance for clinical doctors and medical professionals dealing with thyrotoxicosis.This article aimed to extract the key points and recommended strategies from the guidelines to help clinical doctors better understand and apply the latest guiding principles.

Objective:To explore the role of video-assisted feedback in clinical skill teaching in undergraduate classes and its application effect.Methods:The experimental control method was adopted in the study. A total of 185 students from Eight-year program of clinical medicine of Batch 2014 and Five-year program of clinical medicine of Batch 2016 in Tongji Medical College of Huazhong University of Science and Technology were collected as the experimental group, and another 166 students from Eight-year program of clinical medicine of Batch 2013 and Five-year program of clinical medicine of Batch 2015 as the control group. The experimental group adopted the teaching mode of video-assisted feedback and the control group received the traditional teaching mode. By the end of training sessions, the differences between the two groups in both the skill assessments and the theories were compared. A satisfaction survey about the video-assisted feedback was made in the experimental group. GraphPad Prism 5 was used for t test. Results:In the students from Five-year program of clinical medicine, the scores of theoretical assessment in the experimental group were (87.64±0.94) points and the scores of skill assessments were (84.78±0.54) points; the scores of theoretical assessment in the control group were (85.14±0.80) points and the scores of skill assessments were (83.10±0.53) points. In the students from Five-year program of clinical medicine, the difference of both the theoretical and the skill assessment scores between the experimental group and the control group was statistically significant ( P<0.05). In the students from Eight-year program of clinical medicine, the scores of theoretical assessment in the experimental group were (86.46±0.66) points and the scores of skill assessments were (86.38±0.73) points; the scores of theoretical assessment in the control group were (84.90±1.21) points and the scores of skill assessments were (83.79±0.64) points. The difference of the skill assessment scores between the experimental group and the control group was statistically significant ( P<0.05), and no significant difference was found in the theoretical assessment. The questionnaire survey in the experimental group based on video-assisted feedback teaching method showed that 93.3% (168/180) of students said that they would not take the initiative to practice after class if there was no video shooting session; 87.8% (158/180) of the students thought the video-assisted feedback teaching method improved their ability of independent learning; 82.8% (149/180) of students thought this method significantly increased their learning efficiency and confidence in clinic; 71.1% (128/180) of the students felt that after-class video shooting, their self-confidence was improved when they faced the corresponding operation clinically. Conclusion:The application of video-assisted feedback has significantly improved the outcome of clinical skill training for students, as compared to the traditional teaching mode.

Objective:To evaluate the clinical efficacy of multi-disciplinary single center's CCCG-HB-2016 regimen in the treatment of hepatoblastoma (HB) in children.Methods:Clinical data of 36 HB patients treated with CCCG-HB-2016 program from Aug 2016 to March 2020 were analyzed.Results:These 36 patients included 20 boys and 16 girls. The serum AFP was all higher than 2 792 ng/ml,there was a correlation between AFP and tumor risk stratification ( H=14.973, P<0.05). Twenty eight cases (77.78%) were epithelial type and 8 cases (22.22%) were mixed epithelial mesenchymal type.All children were treated by tumor resection combined with chemotherapy, and there was a correlation between tumor risk stratification and surgical resection of liver lobe ( H=8.847, P<0.05). The probability of bone marrow suppression in the low-risk group was 58.33% (35/60),that in the intermediate-risk group was 73.49% (61/83) and in the high-risk group was 80.23% (69/86).All 36 cases were followed up to March 31, 2020,with an average follow-up of 21.9 months and the median survival was 22.5 months.The overall survival rate (OS) and event-free survival rate (EFS) were 97.2% and 83.3% respectively. Conclusions:The multidisciplinary CCCG-HB-2016 regimen was with a high success rate and along with a high incidence of bone marrow suppression.

Objective:To analyze the results of external quality control network of iodine deficiency disorders (IDD) laboratories in Jiangxi Province in 2018, to summarize the total detection level and capability at all levels, and to provide reliable quality assurance for monitoring and prevention of IDD.Methods:In 2018, IDD laboratories of provincial, municipal and county-level in Jiangxi Province were examined for the external quality control of salt iodine, urinary iodine and water iodine. Among them, there were 1 provincial, 11 municipal and 30 county-level laboratories participated in salt iodine assessment; there were 1 provincial, 11 municipal and 100 county-level laboratories participated in urinary iodine assessment; and there were 1 provincial and 11 municipal laboratories participated in water iodine assessment. Salt iodine was determined by direct titration method (GB/T 13025.7-2012); urinary iodine was determined by As 3+-Ce 4+ catalytic spectrophotometry method (WS/T 107.1-2016) or inductively coupled plasma mass spectrometry method (WS/T 107.2-2016); water iodine was determined by the method in the range of 0 - 100 μg/L in "Study on the Method Suitable for the Detection of Water Iodine in Areas with Iodine Deficiency and High Iodine" recommended by national IDD reference laboratory. Urinary iodine was determined with Z score method, when│Z│≤ 2, it was qualified; when 2 <│Z│ < 3, it was basically qualified; when│Z│≥ 3, it was not qualified. Water iodine and salt iodine were determined by the method of reference value ± uncertainty, and the average value of the test results within this range was judged to be qualified; otherwise, it was judged to be unqualified. Results:In 2018, the feedback rates and qualified rates of salt iodine, urinary iodine and water iodine in 1 provincial and 11 municipal laboratories in Jiangxi Province were all 100.00%. Thirty county-level laboratories participated in the salt iodine assessment, and 1 of them failed. One hundred county-level laboratories participated in the urinary iodine assessment, and 3 of them failed.Conclusion:Laboratory testing technology of IDD continues to maintain at a high level in Jiangxi Province in 2018, and the detection ability of some county-level laboratories needs to be further improved.