ObjectiveTo investigate the expression level of lysophosphatidyllecithin acyltransferase 4 （LPCAT4） in pancreatic cancer and its effect on the proliferation of pancreatic cancer cells. MethodsIn this study， the differentially expressed genes of patients with KRAS mutant and wild-type pancreatic cancer were analyzed by online database LinkedOmics. The LPCAT4 expression in pancreatic cancer tissues was analyzed online by the University of Alabama at Birmingham Cancer Data Analysis （UALCAN）， Sangerbox and gene expression profile interaction analysis 2 （GEPIA2）. Kaplan-Meier Plotter database was used to explore the correlation between LPCAT4 and the prognosis of patients with pancreatic cancer. The expression of LPCAT4 in human pancreatic cancer cells were detected by quantitative real-time PCR and Western blot analysis. LPCAT4 was knocked down in the high-expressing SW1990 cell line and overexpressed in the low-expressing MIA PaCa-2 cell line. The effects of LPCAT4 expression on cell proliferation were assessed using CCK-8 and EdU assays. STRING and GEPIA2 databases were used to obtain LPCAT4 binding and coexpressed genes in tumors， which were then analyzed by GO and KEGG. ResultsAnalysis of the LinkedOmics online database revealed a significant upregulation of LPCAT4 in patients with KRAS mutant pancreatic cancer compared to patients with KRAS wild-type pancreatic cancer. The online analysis of GEPIA2， UALCAN and Sangerbox 3.0 showed that the expression of LPCAT4 was higher in pancreatic cancer than in normal tissues. Analysis of the Kaplan-Meier Plotter database revealed that high LPCAT4 expression was associated with poorer prognosis in pancreatic cancer patients.Western blot and qPCR results showed that expression of LPCAT4 in pancreatic cancer cell lines was significantly higher than in normal pancreatic ductal epithelial cells. Knockdown of LPCAT4 in SW1990 cells inhibited proliferation， while overexpression in MIA PaCa-2 cells promoted proliferation. Enrichment analysis indicated that LPCAT4 was closely related to sulfur metabolism. ConclusionsLPCAT4 is highly expressed in pancreatic cancer and is associated with poor prognosis of patients. It plays a significant regulatory role in the proliferation of pancreatic cancer cells， with its expression level closely correlated with cell proliferation capacity. These findings reveal the critical role of LPCAT4 in the malignant progression of pancreatic cancer and provide important evidence for its potential as a therapeutic target.

BACKGROUND:In clinical application,the therapeutic effect of transcranial magnetic stimulation depends on the ability to accurately target the areas of the brain that need to be stimulated.In recent years,with the development of neuronavigation systems,mobile augmented reality technology,and the new methods of processing magnetic resonance imaging(MRI)data,the accuracy of stimulus target localization and the optimization of target selection are expected to improve further. OBJECTIVE:To review the principle of MRI-based image navigation and its application in transcranial magnetic stimulation and summarize the roles of different modal MRI data analyses in guiding the selection of target areas for transcranial magnetic stimulation. METHODS:An online computer search for relevant literature was performed in PubMed,CNKI database and WanFang database,with the keywords"transcranial magnetic stimulation,coil positioning,neuronavigation,augmented reality,magnetic resonance,theory."Finally,63 documents were included for review. RESULTS AND CONCLUSION:Among the traditional methods of positioning transcranial magnetic stimulation coils,the"5 cm rule"and the international electroencephalogram 10-20 positioning method are the most commonly used.These methods have the advantages of simplicity and economy,but they rely too much on the operator's experience and there were technical differences between operators.The neuronavigation system,which is based on stereotactic technology,is the guiding method for positioning transcranial magnetic stimulation coils with the highest visual degree and accuracy.It achieves visual positioning through MRI data acquisition,3D brain reconstruction,head model registration and stereogeometric positioning.It has high application value in clinical treatment and scientific research,but it cannot be promoted in medical institutions due to its high cost.For various medical institutions,mobile augmented reality is a cost-effective and efficient alternative to the neuronavigation system,which achieves visual positioning of brain tissue under the scalp through MRI data acquisition,2D/3D image construction,virtual image and real brain image superposition.It has the advantages of directly visualization and low cost,and is expected to be popularized and applied in primary medical units.Although the superiority of clinical efficacy of visual coil positioning over the electroencephalogram 10-20 localization strategy has not yet been fully demonstrated,with the progress of brain MRI data analysis,visual positioning is expected to further optimize the target selection strategy of transcranial magnetic stimulation therapy and to improve the response rate and individuation degree of transcranial magnetic stimulation treatment.This is a promising and challenging research direction in the future.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective To evaluate the relationship between diabetic nephropathy(DN)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM)based on imaging and clinical testing data.Methods Totally 600 T2DM patients who visited the First People's Hospital of Ziyang from March 2021 to December 2022 were included.The fundus photography and fundus fluorescein angiography were performed on all these patients and their age,gender,T2DM duration,cardiovascular diseases,cerebrovascular disease,hypertension,smoking history,drinking history,body mass in-dex,systolic blood pressure,diastolic blood pressure and other clinical data were collected.The levels of fasting blood glu-cose(FPG),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipo-protein cholesterol(LDL-C),glycosylated hemoglobin(HbA1c),24 h urinary albumin(UAlb),urinary albumin to creati-nine ratio(ACR),serum creatinine(Scr)and blood urea nitrogen(BUN)were measured.Logistic regression was used to analyze the risk factors associated with DR.DR staging was performed according to fundus images,and the convolutional neural network(CNN)algorithm was used as an image analysis method to explore the correlation between DR and DN based on emission computed tomography(ECT)and clinical testing data.Results The average lesion area rates of DR and DN detected by the CNN in the non-DR,mild-non-proliferative DR(NPDR),moderate-NPDR,severe-NPDR and pro-liferative DR(PDR)groups were higher than those obtained by the traditional algorithm(TCM).As DR worsened,the Scr,BUN,24 h UAlb and ACR gradually increased.Besides,the incidence of DN in the non-DR,mild-NPDR,moderate-NPDR,severe-NPDR and PDR groups was 1.67％,8.83％,16.16％,22.16％and 30.83％,respectively.Logistic regression analysis showed that the duration of T2DM,smoking history,HbA1c,TC,TG,HDL-C,LDL-C,24 h UAlb,Scr,BUN,ACR and glomerular filtration rate(GFR)were independent risk factors for DR.Renal dynamic ECT analysis demonstrated that with the aggravation of DR,renal blood flow perfusion gradually decreased,resulting in diminished renal filtration.Conclusion The application of CCN in the early stage DR and DN image analysis of T2DM patients will improve the diag-nosis accuracy of DR and DN lesion area.The DN is worsening as the aggravation of DR.

Objective: To investigate the characteristics and trends of malaria cases in Lishui City, Zhejiang Province from 2012 to 2023, so as to provide a basis for improving malaria prevention and control measures. Methods: Case data of malaria in Lishui City from 2012 to 2023 were collected from the Parasitic Disease Control Information Management System of the National Information System for Disease Control and Prevention in China. The parasite species, source of infection, temporal distribution, population distribution, geographical distribution, and clinical diagnosis and treatment of the cases were descriptively analyzed. Results: A total of 169 malaria cases were reported in Lishui City from 2012 to 2023, and P. falciparum malaria was the main type, accounting for 79.88% (135 cases). The positive rate of Plasmodium detection was 3.30‰(169/51 212), the highest was 5.41‰ (18/3 327) in 2017, and the lowest was 0.38‰ (1/2 632) in 2021. Malaria cases were reported in every month from 2012 to 2023, with 91 cases (53.85%) reported from May to October. There were 168 imported cases, of which 163 (96.45%) originated from Africa. There were 127 male cases (75.15%), and the majority of cases were aged 20 to 49 years, with 138 cases accounting for 81.65%. The majority of the occupation was overseas labor export workers, with 164 cases accounting for 97.04%. A total of 161 cases (95.27%) were registered residents of Lishui City, and cases were reported from all nine counties (cities, districts), with Qingtian County and Liandu District having the higher numbers of 98 and 41 cases, respectively. The median interval from onset to hospital visit for malaria cases was 2.00 (interquartile range, 4.00) days, and the median interval from hospital visit to diagnosis was 0 (interquartile range, 1.00) day. The diagnostic rate of first-diagnosed malaria cases in municipal and county medical institutions was 95.90% (117/122) and 91.49% (43/47), respectively, with no statistical significance (P>0.05). Conclusions The P. falciparum malaria was the predominant type in Lishui City from 2012 to 2023, with the majority of cases being imported. Male overseas labor export personnel aged 20 to <50 were the key demographic.

Objective:To carry out a scoping review on the development process, main forms, main contents and outcome indicators of decision aids for thyroid cancer patients, providing a theoretical basis for future research in China.Methods:The Arksey and O'Malley's methodological framework was used to analyze the literature. Electronic retrieval was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biomedical Database, and the search period was from database establishment to August 21, 2023.Results:A total of 11 articles were included. The forms of decision aids included paper decision support manuals, web-based decision support tools, conversation support tools and so on. The main content was to provide disease knowledge and the advantages and disadvantages of various treatment plans, help patients clarify their values, understand patient preferences, and assist doctors and patients make decisions. Outcome indicators involved treatment choice, medical knowledge, decision conflict, decision regret, decision satisfaction, anxiety and so on.Conclusions:The application of decision aids has a positive effect in thyroid cancer patients. Future research should encourage many people to participate in decision-making in order to improve the quality of decision-making for thyroid cancer patients.

Objective:To understand the potential categories of self-efficacy in stress injury management of nurses in operating room and analyze the characteristics of different categories of nurses.Methods:A cross-sectional survey was conducted from June to August 2022. A total of 469 operating room nurses from 12 Grade A hospitals in Guangxi, Sichuan, Guizhou, Yunnan, Shanxi, Xinjiang and Chongqing were selected by convenient sampling method as subjects. General data questionnaire, proactive personality Inventory, Caring behavior Inventory, transformational leadership inventory, nursing clinical Decision scale and nurses stress injury management self-efficacy scale were used to investigate. Potential profile was used to analyze nurses' self-efficacy in stress injury management, and multiple Logistic regression was used to analyze different potential factors.Results:The self-efficacy of nurses in the management of stress injury in operating room could be divided into three potential profiles: poor self-efficacy group (23.9%, 112/469), medium self-efficacy group (33.0%, 155/469) and good self-efficacy group (43.1%, 202/469). Proactive personality, caring behavior, transformational leadership, nursing clinical decision-making and educational background were the factors influencing self-efficacy of operating room nurses in stress injury management (all P<0.05). Conclusions:There are three potential profiles of self-efficacy in the management of stress injury in operating room nurses. Nursing managers can give targeted intervention strategies according to different characteristics of nurses to improve their self-efficacy.

BACKGROUND: The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts. METHODS: Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts. RESULTS: In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use. CONCLUSIONS Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
Humans ; Arthritis, Psoriatic/drug therapy* ; East Asian People ; Enthesopathy/complications* ; Registries ; Severity of Illness Index ; Spondylarthritis/epidemiology*

Objective:To investigate the influencing factors of hyperuricemia(HUA) and explore early intervention of metabolic diseases.Methods:A total of 70 523 participants were selected from the database of check-ups in 2016. Univariate analysis and logistic regression analysis were used to identify related factors of HUA. Correspondence analysis was performed for the aggregation of different levels of uric acid(UA) and related factors. The mediating effect of mean blood pressure(MBP) between abnormal metabolic indicators and abnormal renal function was tested.Results:The age, sex, occupation, body mass index(BMI), systolic blood pressure, diastolic blood pressure, blood urea nitrogen(BUN), creatinine(Cr), estimated glomerular filtration rate(eGFR), fasting plasma glucose(FPG), total cholesterol(TC), triacylglycerol(TG), high density lipoprotein-cholesterol(HDL-C), low density lipoprotein-cholesterol, plasma viscosity were significantly related to HUA( P<0.001). Logistic regression analysis showed that youth, male, hypertension, TC, TG, and Cr were risk factors for HUA, while HDL-C was a protective factor for HUA( P<0.001). Correspondence analysis showed that during the gradual increase of UA, TC was the first to appear abnormal, followed by hypertension and TG, and the increase of Cr appeared last. Mediating effect showed that in changes of UA, the mediating effects of MBP on TC, TG, and HDL-C were 36.35%, 12.63%, and 9.41%, respectively. In changes of eGFR, the mediating effects of MBP on TC, TG and HDL-C were 30.20%, 27.70%, and 6.13%, respectively. Conclusions:UA is positively correlated with blood pressure, TC, and TG, and inversely with HDL-C. TC and TG have an impact on renal impairment, in which MBP plays a mediating role.

Objective:To construct the admission standard and job responsibility scheme for oncology nurse navigator (ONN) .Methods:Through literature analysis, semi-structured interview, group discussion and pre-consultation, the admission criteria and job responsibility scheme of ONN were preliminarily constructed. Using the purposive sampling method, a total of 22 experts from 16 hospitals in 11 provinces and cities including Sichuan, Xi'an, Chongqing, Wuhan, Shanghai, Hangzhou, Xiamen, Guangzhou, Tianjin, Beijing and Changsha were selected as the research objects from October to December 2021. Using the Delphi method, 22 experts were consulted for 2 rounds, and the AHP was used to determine the index weights.Results:The effective recovery rates of the two rounds of expert consultation were 91% (20/22) and 100% (20/20) , respectively. In the second round, the authority coefficient of experts was 0.875, and the Kendall's coordination coefficients of admission standard and job responsibilities were 0.164, 0.303 and 0.150, 0.203, 0.238, respectively (all P<0.05) . The final formed ONN admission standard and job responsibility scheme included 4 first-level indicators and 22 second-level indicators of the admission standard and 4 first-level indicators, 15 second-level indicators and 49 third-level indicators for job responsibilities. Conclusions:The ONN admission standard and job responsibility scheme determined by expert consultation is scientific, feasible, practical and innovative, which can provide a theoretical basis for the training and implementation of ONNs in China.