Abstract:Objective To evaluate the effects of continous heat tolerance training in standard heat chamber.Meth-ods A total of 53 healthy officers and soldiers were recruited from January 2021 to December 2024,and underwent 7 consecutive days of heat tolerance training in standard heat chamber(temperature 40 ℃,humidity 40％),the subjects completed 120 min of walking training on the treadmill of 2° slope at the speed of 5 km/h,the maximum core tempera-ture,maximum heart rate,physiological stress index(PSI)and qualified rate of heat tolerance from day 1 to day 7 of the training were compared.Results The basic core temperature of the healthy officers and solders having heat tolerance training was(37.37±0.30)℃,the resting heart rate was(85.36±16.09)beats per minute and the mean arterial pres-sure was(88.45±9.22)mmHg(1 mmHg≈0.133 kPa),after 7 d of continuous training,the vital signs were stable be-fore training.Compared with the first and second days of training,the maximum core temperature taken at test time(TCt)of the officers and soldiers on the third to seventh days of training significantly decreased(P＜0.05).Compared with the first and second days of training,the PSI of the officers and soldiers on the third to seventh days of training sig-nificantly decreased(P＜0.05),compared with the third day of training,the PSI of the officers and soldiers on the fourth to seventh days of training showed a downward trend,but the difference was not statistically significant(P＞0.05).Compared with the first day,the fastest heart rate taken at test time(HRt)of the officers and soldiers on the second day of training had no significant difference(P=0.159),and the HR,of the officers and soldiers on the third to seventh days of training decreased significantly(P＜0.05).During the 7-day thermal tolerance training cycle,the number of subjects who reached the standard of thermal tolerance training test showed an increasing trend every day,27(50.94％)on the first day,30(56.60％)on the second day,41(77.36％)on the third day,44(83.02％)on the fourth day,42(79.25％)on the fifth day,43(81.13％)on the 6th day and 49(92.45％)on the 7th day.Conclusion Three days of heat tolerance training can significantly en-hance the heat tolerance level of personnel engaged in the heat chamber.

Abstract:Objective To evaluate the predictive value of sepsis by integrating speech recognition parameters with vital signs.Methods The data of 343 patients who were admitted to the emergency room of the department of emergency medicine of the author's hospital from April 2022 to June 2024 were collected.According to the diagnostic criteria of sep-sis,the patients were divided into sepsis group(ni=67)and non-sepsis group(n=276).All patients' audio was collected according to the voice acquisition scheme,demographic information,medical history,laboratory and examination indica-tors,clinical information during treatment and hospitalization,acute physiology and chronic health evaluation Ⅱ(A-PACHE Ⅱ)and sequential organ failure assessment(SOFA)were also collected.Least absolute shrinkage and selection operator(LASSO)regression and Logistic regression analysis were used to screen the speech recognition parameters and vital signs.All patients were divided into training set and validation set according to the ratio of 8∶2 by stratified randomization method,the training set was used to con-struct the Logistic regression predictive model,the valida-tion set was used for model evaluation,and the area under the curve(AUC),sensitivity and specificity were calcu-lated by the receiver operating characteristic(ROC)curve,finally,the performance of the Logistic regression model was evaluated by calibration curve and decision curve analysis.Results The age,SOFA,APACHE Ⅱ score,the proportion of vasopressor use,maximum sound intensity and heart rate in the sepsis group were significantly higher than those in the non-sepsis group(all P＜0.05);fundamental frequency perturbation rate,differential perturbation,local am-plitude perturbation ①,local amplitude perturbation ②,three point period of amplitude perturbation,five point period of amplitude perturbation,eleven point period of amplitude perturbation,differential amplitude perturbation,mean sound intensity and oxygen saturation were lower in the sepsis group than in the non-sepsis group(all P＜0.05).According to Logistic regression multivariate analysis,local amplitude perturbation ② and harmonic-to-noise ratio in speech recognition parameters were protective factors against sepsis(all P＜0.05),heart rate was a risk factor for sepsis(P=0.001).The AUC of ROC of the predictive model constructed by the heart rate,local amplitude perturbation ②,harmonic noise ratio and maximum sound intensity was 0.805[95％confidence interval(CI):0.668-0.942],the sensitivity was 0.765 and the specificity was 0.824,the model had good predictive ability;the calibration curve showed that the model prediction was in good agreement with the actual prediction.Clinical decision curve analysis showed that when the threshold was 0.05-0.78,the predictive model showed that patients could gain clinical benefits.Conclusion In the speech recognition parameters,local amplitude perturbation ② and harmonic-to-noise ratio can be used as potential biomarkers for the pre-diction of sepsis.The prediction model combined with heart rate has moderate prediction efficiency and good calibration,which provides a new idea for the non-invasive screening of sepsis.

Abstract:Objective To investigate the relationship between serum silent information regulator protein 1(SIRT1),SIRT6 and glucolipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus(GDM)complicated with preeclampsia(PE).Methods A total of 140 patients with GDM complicated with PE(GDM+PE group),70 patients with simple GDM(GDM group)and 70 healthy pregnant women(normal pregnant women group)were selected in author's hospital from January 2021 to April 2024,patients with GDM+PE were divided into poor group(n=47)and good group(n=93)according to the pregnancy outcome.Serum SIRT1,SIRT6 and glucolipid metabolism indexes were compared among the GDM+PE group,GDM group and the normal preg-nant women group;Pearson correlation analysis was used to analyze the correlation between serum SIRT1,SIRT6 and glucolipid metabolism indexes of pregnant women in GDM+PE group;multivariate Logistic regression was used to ana-lyze the influencing factors of adverse pregnancy outcomes in GDM+PE group;receiver operating characteristics(ROC)curve was used to analyze the predictive efficacy of serum SIRT1 and SIRT6 for adverse pregnancy outcomes in pregnant women with GDM and PE.Results There were significant differences in serum SIRT1,SIRT6 and glucolipid metabolism indexes among normal pregnant women group,GDM group and GDM+PE group(all P＜0.001);compared with the normal pregnant women group,the levels of SIRT1,SIRT6 and high density lipoprotein cholesterol(HDL-C)level of pregnant women in GDM group and GDM+PE group decreased,and those in the GDM+PE group were lower than those in GDM group,fasting plasma glucose(FPG),1 h plasma glucose after glucose administration,2 h plasma glucose after glucose administration,fasting insulin(FINS),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and homeostatic model assessment of insulin resistance(HOMA-IR)levels of pregnant women increased,and GDM+PE group were higher than GDM group(all P＜0.05).Pearson correla-tion analysis showed that SIRT1 and SIRT6 were negatively correlated with FPG,1h plasma glucose after glucose admin-istration,2h plasma glucose after glucose administration,FINS,HbA1c,TC,TG,LDL-C and HOMA-IR,and positive-ly correlated with HDL-C in GDM+PE group(all P＜0.001).Multivariate Logistic regression analysis showed that se-vere PE was an independent risk factor for adverse pregnancy outcomes,and increased SIRT1 and SIRT6 were independ-ent protective factors for adverse pregnancy outcomes(P＜0.05).ROC curve showed that the area under the curve of se-rum SIRT1 and SIRT6 combined to predict adverse pregnancy outcomes in pregnant women with GDM and PE was 0.883[95％confidence interval(CI):0.818-0.931],which was higher than 0.794(95％CI:0.718-0.858)and 0.786(95％CI:0.709-0.851)predicted by serum SIRT1 and SIRT6 alone.Conclusion The levels of serum SIRT1 and SIRT6 in GDM patients with PE decreased,which are closely related to glucolipid metabolism disorders and adverse pregnancy outcomes,and the combination of serum SIRT1 and SIRT6 has a high value in predicting pregnancy outcomes in GDM patients with PE.

Abstract:Objective To analyze the relationship between the levels of circulating fibrocyte(CF)and the infarct size of patients after primary percutaneous coronary intervention(pPCI)for ST-segment elevation myocardial infarction(STEMI).Methods A prospective study was conducted to enroll 103 patients with acute STEMI who underwent pPCI from January 2020 to February 2024,the infarct size at 1 week and 6 months after pPCI were examined by cardiac mag-netic resonance imaging,and CF levels were measured 1 week after pPCI.Results STEMI patients were divided into low CF group(CF＜5.46 × 105/ml,n=51)and high CF group(CF≥5.46 × 105/ml,n=52)with the median CF level of 5.46 × 105/ml as the critical value 1 week after pPCI.The incidence of major adverse cardiovascular events was higher in the high CF group(P＜0.001).The baseline infarct size proportion was 25.67％(16.09％,32.17％)in the low CF group and 25.30％(22.70％,29.48％)in the high CF group,respectively,with no significant difference(P=0.537).However,the infarct size in the low CF group was significantly smaller than that in the high CF group 6 months after sur-gery[25.90％(17.45％,32.20％)vs.32.40％(27.35％,36.60％),P=0.001].Spearman rank correlation analysis showed that only CF level was positively correlated with infarct size 6 months after surgery(r=0.363,P＜0.001).CF level predicted 0.838[95％confidence interval(CI):0.752-0.903]of subjects with infarct size ≥18％6 months after STEMI surgery.Conclusion Among STEMI patients treated with pPCI,postoperative CF levels are positively correlated with infarct size on cardiac magnetic resonance imaging at 6 months.CF levels can be used as a risk stratification tool or as a target for therapeutic response.

Abstract:Objective To investigate the effect of endoplasmic reticulum stress(ERS)inhibitor taurour-sodeoxycholic acid(TUDCA)on the inflammatory re-sponse induced by lipopolysaccharide(LPS).Methods RAW 264.7 mouse macrophages were divided into the following groups based on different intervention factors:control group(cell cultured in complete medium),LPS group(1 μg/ml LPS treatment),different concentrations of TUDCA group(100,200,500 μmol/L TUDCA treatment),TUDCA+LPS group(100,200,500 μmol/L TUDCA+1 μg/ml LPS treatment),tunicamycin(TM)group(5 mg/L TM treatment)and TM+LPS group(5 mg/L TM+1 μg/ml LPS treatment).After the intervention,the cell survival rate were assessed using the cell counting kit 8(CCK8);the levels of nitric oxide(NO),interleukin 1 beta(IL-1β),interleukin 6(IL-6)and tumor necrosis factor alpha(TNF-α)were meas-ured by enzyme-linked immunosorbent assay(ELISA);real-time reverse transcription polymerase chain reaction(RT-PCR)and Western blot were employed to detect the mRNA and protein expressions of key signaling molecules in the ERS signaling pathway,including protein kinase-like endoplasmic reticulum kinase(PERK),activated transcription factor 6(ATF6),inositol-requiring enzyme 1 alpha(IRE1α)/X-box binding protein 1(XBP1),binding immunoglobulin protein(BIP)and C/EBP homologous protein(CHOP);additionally,the structural changes in the endoplasmic reticulum were observed using transmission electron microscopy;and cell apoptosis was evaluated terminal deoxynucl neotidyl transfer-ase-mediated dUTP nick end-labeling(TUNEL)staining.Results Compared with the control group,there was no sig-nificant difference in cell survival rate among TUDCA groups with different concentration(all P＞0.05),while the cell survival rate of TUDCA+LPS group was significantly higher than LPS group(P＜0.05).Compared with the control group,the macrophages in the LPS group showed polarization,intracellular endoplasmic reticulum expansion and autoph-agosome formation,and the levels of NOx IL-1β,IL-6 and TNF-α in the LPS group significantly increased(all P＜0.05).Compared with the control group,the cell apoptosis rate of LPS group increased;compared with the LPS group,the cell apoptosis rate in the TUDCA+LPS group significantly decreased(P＜0.05).Compared with the LPS group,the auto-phagosome formation and the lumen of endoplasmic reticulum were reduced in the TUDCA+LPS group.Compared with the control group,the mRNA and protein relative expression levels of BIP,CHOP,PERK,ATF6 and XBP1 in the LPS and TM groups significantly increased(all P＜0.001).Compared with TM+LPS and LPS groups,the mRNA and pro-tein expression levels of BIP,CHOP,PERK,ATF6 and XBP1 significantly decreased in TUDCA+LPS group(all P＜0.001).Conclusion TUDCA can protect cells from LPS-induced inflammatory injury by regulating ERS.

Abstract:Objective To evaluate the application value of the point-of-care nucleic acid test and antigen detection in the detection of clinical influenza A/B virus(FluA/FluB)infection,and to objectively evaluate the consistency of positive classifica-tion reports of antigen test results.Methods A total of 122 patients with upper respiratory tract infection at the author's hospital from March to December 2023 were randomly selected,oropharyngeal swabs were collected from these patients,and real-time fluorescent reverse transcription polymerase chain reaction(RT-PCR),point-of-care nucleic acid test and colloidal gold immuno-chromatography(GICA)were respectively performed on FluA/FluB nucleic acid and antigen detection.The RT-PCR results were used as the"gold standard"to evaluate the performance of point-of-care nucleic acid test and GICA.For the samples with inconsistent results,the second RT-PCR assay was used to further verify the results.At the same time,according to the relative load namely cycle threshold(Ct)of RT-PCR FluA detection,the consistency of three levels of reporting methods of strong positive,positive and weak positive antigen detection was evaluated.Results Statistical analysis revealed that the sen-sitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of point-of-care nucleic acid test for FluA detection were 100.00％[95％confidence interval(CI):92.73％-100.00％],95.00％(95％CI:85.18％-98.70％),95.38％(95％CI:86.24％-98.80％)and 100.00％(95％CI:92.13％-100.00％),respectively;for FluB,the corresponding performance metrics were 100.00％(95％CI:73.24％-100.00％),98.15％(95％CI:92.81％-99.68％),87.50％(95％CI:60.41％-97.80％)and 100.00％(95％CI:95.65％-100.00％).Statistical analysis demonstrated that the FluA/FluB results of point-of-care nucleic acid test exhibited a high degree of consistency with detection results of RT-PCR(K=0.951 and 0.924 respectively),and both methods revealed significantly positive correlation(r=0.754 and 0.678 respectively,P＜0.05).The sensitivity,specificity,PPV and NPV of GICA antigen de-tection for FluA were 92.73％(95％CI:81.57％-97.64％),79.10％(95％CI:67.11％-87.71％),78.46％(95％CI:66.19％-87.32％)and 92.98％(95％CI:82.17％-97.73％),respectively;the corresponding indexes of FluB were 82.35％(95％CI:55.80％-95.33％),98.10％(95％CI:92.62％-99.67％),87.50％(95％CI:60.41％-97.80％)and 97.17％(95％CI:91.35％-99.27％),respectively.Compared with RT-PCR,GICA antigen detection showed moderate consistency in FluA(K=0.707)and high consistency in FluB(K=0.825).Notably,statistical analy-sis of the three-level antigen test reports indicated that the Ct value of FluA in the strong positive group＜Ct value in positive group,Ct value in the strong positive group＜Ct value in the weak positive group(all P＜0.05),but there was no significant difference between the positive group and the weak positive group(P＞0.05).Conclusion The results of point-of-care nucleic acid test and RT-PCR FluA/FluB detection are highly consistent and positively correlated,and the sensitivity,specificity,PPV and NPV of point-of-care nucleic acid detection are higher than GICA antigen detection,which has good application value and prospect in rapid detection of influenza-like illness in outpatient and emergency de-partment.At the same time,it is recommended that the FluA antigen test should be used in the form of strong positive and positive secondary report to ensure the accuracy of the test report.

Abstract:Objective To analyze the expression of long non-coding RNA(lncRNA)STARD13-AS in osteosarcoma and to explore the effect and mechanism of up-regulating STARD13-AS on the proliferation and invasion of osteosarcoma cells.Methods The cBioPortal database was used to analyze the expression of STARD13-AS in osteosarcoma tissues.Real-time reverse transcription quantitative polymerase chain reaction(RT-qPCR)was used to detect the expressions of STARD13-AS in immortalized osteoblast in hFOB1.19 and osteosarcoma cells HOS,MG-63,Saos2,143B and U-2OS.The expression of STARD13-AS in MG-63 cells was the least,so MG-63 cells were selected for this study,MG-63 cells were divided into STARD13-AS group and negative control group,and the proliferation and invasion ability of MG-63 cells were detected by MTS method and Transwell invasion assay.The STARD13-AS-WT and STARD13-AS-MUT vectors were co-transfected into MG-63 cells with miR-181a or microRNA negative control(miR-NC),respectively,dual luciferase assay was used to verify the targe-ted binding between STARD13-AS and miR-181a,the expression of miR-181a was detected by RT-qPCR.The correlation between the expression of STARD13-AS and miR-181a in osteosarcoma tissues was analyzed using cBioPortal database.Expressions of phosphatase and tensin homolog deleted on chromosome 10(PTEN),phosphorylated protein kinase B(p-AKT),phosphorylated mammalian target of rapamycin(p-mTOR)and phosphorylated glycogen synthase kinase-3 beta(p-GSK-3β)were detected by Western blot.Results Compared with normal bone tissues,the expression of STARD13-AS in osteosarcoma tissues decreased(P＜0.01).Compared with immortalized osteoblast hFOB 1.19,the expressions of STARD13-AS in HOS,MG-63,Saos2,143B and U-2OS cells decreased(all P＜0.01).Compared with the negative con-trol group,STARD13-AS was overexpressed in MG-63 cells in STARD13-AS group(P＜0.01).Compared with the neg-ative control group,the proliferation and invasion ability of MG-63 cells in the STARD13-AS group significantly de-creased(P＜0.05).Compared with miR-NC,overexpression of miR-181a could reduce the luciferase activity of STARD13-AS-WT(t=8.892,P＜0.01).Compared with the negative control group,the expression of miR-181 a in MG-63 cells was down-regulated in STARD13-AS group(P＜0.01).The expression of STARD13-AS was negatively correla-ted with that of miR-181a in osteosarcoma tissues(r=-0.830,P＜0.01).Compared with the negative control group,the expression of PTEN protein in MG-63 cells in the STARD13-AS group significantly increased(P＜0.01),and the ex-pression of p-AKT,p-mTOR and p-GSK-3β protein decreased(P＜0.01).Conclusion STARD13-AS is lowly expressed in osteosarcoma tissues and cells,and overexpression of STARD13-AS reduces the proliferation and invasion ability of os-teosarcoma cells by targeting and regulating the miR-181a/PTEN/AKT axis.

Abstract:Objective To assess the current status of burn pain evaluation among nurses in burn departments in military hospitals and offer guidance on pain assessment and management.Methods A convenience sampling survey was conducted among 184 nurses in military hospitals from January 2023 to February 2023,the self-designed questionnaire on the current situation of burn pain assessment for nurses in burn department was shared by WeChat.The subjects were divided into coastal area group and inland area group,the general data of the nurses were compared,and the results of the pain assessment and pain cognition status questionnaire were analyzed.Results The reliability and validity of the pain as-sessment survey questionnaire were tested,and the Cronbach's a coefficient was 0.902,indicating that the reliability was good.For validity assessment,the KMO(Kaiser-Meyer-Olkin)value was 0.882,which was suitable for exploratory fac-tor analysis;the rotated sum of squared loadings was 75.88％confirming high validity.The proportion of nurses with junior and senior professional title in burn department in the inland area group was higher than that in the coastal area group(P＜0.05).The questionnaire was divided into two dimensions:for aspects of pain assessment,the scores of nurses in inland area group were higher than those in coastal area group(P＜0.05);there was no significant difference in pain perception between the two groups(P＞0.05).There were statistically significant differences of nurses with different seniority in understanding the classi-fication of burn pain and the timing of assessment(P＜0.05).The 600 items of 184 nurses were analyzed using the burn pain scale,the main scales used for burn pain assessment included numerical rating scale(159 items,26.50％),faces pain rating scale(145 items,24.17％)and verbal description scale(112 items,18.67％);in the analysis of the selection results of 693 non-pharmacological intervention methods for burn pain,pain education and psychological comfort(142 i-tems,20.49％)and cold therapy(133 items,19.19％)were more clinically used.Conclusion It is recommended to strengthen burn pain assessment training in burn departments in military hospital,especially in coastal areas.According to the professional standards of nurses in burn department,the training system of primary,junior and senior nurses is im-plemented,the pain nursing training of junior nurses is strengthened,the specialized training channels are broadened,and the training of new progress,new guidelines and new technologies are further strengthened,so as to continuously improve the pain nursing level and practical ability of burn department of military hospitals.

Abstract:Objective To investigate the preliminary effect of the modified Peyton's four-step teaching approach on the basic skills of musculoskeletal ultrasound of elbow joint for primary health sergeants.Methods A total of 40 primary health sergeants trained in author's hospital from March 2022 to December 2023 were collected as objects.Twenty primary health sergeants in 2022 were included in the control group,and the traditional teaching method was adopted;20 students in 2023 were included in the observation group,and modified Peyton's four-step teaching approach was used,after training,the teaching effect was assessed by learning efficacy self-evaluation,teaching efficiency was analyzed by teaching satisfaction questionnaire and the objective structured assessment of ultrasound skills(OSAUS)mode was used to assess the skill opera-tion between two groups,and OSAUS mode was used to assess the skill operation again 3 months after the training,and the retention of skills was observed.Results The self-assessment of learning efficacy,teaching satisfaction,skill mastery and skill retention in the observation group were better than those in the control group,and the differences between the two groups were statistically significant(all P＜0.05).Conclusion The modified Peyton's four-step teaching approach in the group teaching of elbow joint musculoskeletal ultrasound can effectively improve the learning confidence of primary health sergeants,strengthen interaction and cooperation,stimulate learning motivation,make primary health sergeants better mas-ter musculoskeletal ultrasound related skills,and has advantages in the short and medium term skills retention compared to the traditional teaching method,which has a positive significance for strengthening the strength of medical support at the bat-tle site.

Abstract:Objective To explore the intervention effects of hypnotherapy on nurse's perceived professional benefits(NPPB)and professional quality of life,and to provide new ideas for preventing the loss of nursing human resources and stabilizing the nursing team.Methods A total of 80 front-line clinical nurses who had worked in the author's hospital for more than one year and voluntarily participated in this study were selected and randomly divided into experimental group and control group,with 40 participants in each.The control group received routine mental health education,while the experimental group received hypnotherapy in addition to the routine mental health education for a period of 6 months.The NPPB questionnaire was used to investigate the NPPB of two groups of nurses,and the Chinese version of the profession-al quality of life scale for nurses was used to investigate the nurse's professional quality of life,and the NPPB and professional quality of life before intervention,3 months and 6 months after intervention of two groups were compared.Results After 6 months of intervention,the NPPB scores of nurses in the two groups were significantly higher than those before intervention and 3 months after intervention(P＜0.05);before the intervention,there was no significant differ-ence in the NPPB score and the scores of each factor between the two groups(P＞0.05),after 3 months and 6 months of intervention,the scores of the experimental group were higher than those of the control group(all P＜0.05).After 3 months of intervention,the severe proportion of burn out(BO)in the experimental group was significantly lower than that in the control group(P＜0.05);after 6 months of intervention,the proportion of severe cases on compassion satis-faction(CS)dimension in the experimental group was higher than that in the control group,and the proportion of severe cases on BO dimension was significantly lower than that in the control group(all P＜0.05).Conclusion Hypnotherapy can effectively enhance NPPB and professional quality of life.

Abstract:Objective To investigate the status of demoralization syndrome in patients with colorectal cancer and to analyze its influencing factors.Methods A total of 300 patients with colorectal cancer were selected and investigated by sampling method,the general data questionnaire,everyday dis-crimination scale(EDS),emotion regulation questionnaire(ERQ)and demoralization scale Ⅱ(DS-Ⅱ)was used to investigate.Results The EDS score of 300 patients with colorec-tal cancer was 34.00(28.00,37.00),the cognitive reappraisal strategy score of ERQ was 29.00(22.00,35.00),the ex-pression suppression strategy score was 20.00(10.00,24.00)and the score of DS-Ⅱ was 9.00(5.00,15.75).Among them,123(41.00％)patients were mildly demoralized,130(43.30％)patients were moderately demoralized,and 47(15.70％)patients were in a state of severe demoralization.The results of multiple linear regression analysis showed that gender,EDS score,cognitive reappraisal strategy score and expression suppression strategy score entered the regression equation,which could explain 35.30％of the variation of demoralization syndrome in colorectal cancer patients.Conclusion The demoralization syndrome of colorectal cancer patients is serious,and the proportion of patients in moder-ate and severe demoralization is relatively high.Medical staff should focus on female patients,reduce the level of per-ceived discrimination of patients through corresponding intervention measures,help patients choose appropriate emotional regulation strategies,so as to reduce the level of demoralization syndrome of patients and improve their quality of life.

Abstract:Objective To construct an evaluation index system for the core competencies of nursing sergeants orien-ted traing under the background of military-civilian joint training,providing a basis for the curriculum setting and reform of higher vocational colleges undertaking the training of nursing officers.Methods Based on the actual job requirements and core competencies,the initial draft of the index system was constructed,a total of 30 experts from both military and civilian fields were selected from November to December 2023,and the questionnaire was sent to the experts by mail,and each item was revised according to the experts' opinions.Results In the two rounds of expert inquiries,the questionnaire recovery rate and the degree of enthusiasm were both 100％,the authority coefficient was 0.88,and the coefficient of var-iation(CV)was 0.03-0.25 and 0-0.21,respectively,the Kendall's coefficient of concordance for importance was 0.23 and 0.11,respectively.Finally,an evaluation index system for the core competencies of nursing officers under military-ci-vilian joint training was formed,which including 5 first-level items,15 second-level items and 64 third-level items.Conclusion The evaluation index system for the directional training of nursing sergeant students provides a basis for im-proving the core competence of the directional training of nursing sergeant students,so as to realize the docking of training standards and job requirements.

Abstract:Objective To evaluate the effect of rapid reconstruction of heat tolerance of officers and soldiers with heat illness.Methods Ten healthy soldiers were selected as the control group and 25 officers and soldiers after recovery from heat illness were selected as the heat illness group,the heat tolerance reconstruction training was carried out in an artificial heat room(40 ℃,40％relative humidity)for 5 d.The duration and distance of heat tolerance training,the in-crease rate of tympanic membrane temperature,the increase rate of heart rate and physiological stress index(PSI)were recorded in the control group and the heat illness group.The laboratory indexes of the two groups before and after train-ing were detected,including the classical coagulation function tests,four new coagulation tests and thromboelastogram(TEG)test parameters.Results In the heat illness group,the exercise time and distance on the fifth day of training were significantly longer than those on the first day of training(P＜0.05),and the PSI on the fifth day was significantly lower than that on the first day of training(P＜0.05).Compared with the first day of training,the increase rate of tympanic membrane temperature and heart rate in the heat illness group decreased significantly after the fifth day of training(all P＜0.05).There was no significant difference in PSI on the fifth day of training between the heat illness group and the con-trol group(P＞0.05).Compared with before training,the activated partial thromboplastin time(APTT)of the heat ill-ness group on the fifth day of training was significantly longer,fibrin degradation products(FDP)significantly decreased and antithrombin(AT)significantly increased(all P＜0.05).Conclusion A 5-day heat tolerance training in the artificial heat room can restore the heat tolerance of heat illness patients to the level before heat illness,and reduce the effect of heat stress on coagulation function.

Abstract:Objective To explore the difficulties and challenges faced in clinical trials of military special drugs,so as to provide reference for developing relevant policy formulation,recruiting the clinical experiments,ethical review and other aspects of clinical trials.Methods Through literature review and case analysis of clinical trials of military special drugs,the problems and challenges in clinical trials of military special drugs were identified and summarized.Results Research has found that the main difficulties faced by clinical trials of military special drugs including difficulties in recrui-ting subjects,complexity of ethical review,challenges in trial implementation and uncertainty in the regulatory environ-ment of clinical trials.Conclusion Clinical trials of military special drugs face a series of unique difficulties and challenges due to their specificity.To overcome these difficulties,cross regional cooperation,policy support and optimization and in-novation of process models are needed during trial execution.This study provides some insights for the improvement of clinical trials of military special drugs,so as to provide reference for future research and practice.

Abstract:Objective To analyze the effects on oxidative stress and renal function in patients with diabetic nephropa-thy treated with the combination of Pioglitazone Metformin and Cordyceps sinensis preparation.Methods A total of 125 patients with diabetic nephropathy treated in author's hospital from January 2021 to December 2023 were select-ed as research subjects.The patients were divided into con-trol group(n=59)and study group(n=66)according to different treatment programs.The diabetic nephropathy patients in the control group were treated with Metformin Hydro-chloride combined with Cordyceps sinensis preparation,and the diabetic nephropathy patients in the study group were treated with Pioglitazone Metformin combined with Cordyceps sinensis preparation.The general information,the differences of oxi-dative stress response indicators,renal function,blood glucose,inflammatory factors,hemorheological indicators,clinical efficacy and adverse reactions of patients with diabetic nephropathy before and after treatment were compared between the two groups.Results Before treatment,oxidative stress response indicators including oxidized low density lipoprotein choles-terol(OXLDL),malondialdehyde(MAD),glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)levels,renal function indicators including urine trace albumin excretion rate(UAER),serum creatinine(Scr),Cystatin C(CysC),urea nitrogen(BUN)levels,blood glucose indicators including glycosylated hemoglobin A,c(HbA1c),2h postprandial blood glucose(2hPBG),fasting plasma glucose(FPG)levels,inflammatory factors including interleukin 17(IL-17),tumor nec-rosis factor alpha(TNF-α),transforming growth factor beta 1(TGF-β1),hypersensitive C-reactive protein(hs-CRP)levels,hemorheological indicators including high shear viscosity of whole blood(WBHSV),low shear viscosity of whole blood(WBLSV)and plasma viscosity(PV)levels were statistically significant(P＞0.05).After treatment,the levels of OXLDL and MAD in the two groups of diabetic nephropathy patients were significantly lower than those before treatment,and GSH-Px and SOD were significantly higher than those before treatment,and the improvement in the study group was more signifi-cant than that in the control group(all P＜0.05);renal function indicators including UAER,Scr,CysC and BUN levels,blood glucose indicators including HbA1c,2hPBG and FPG levels,inflammatory factors including IL-17,TNF-α,TGF-β1 and hs-CRP levels,and hemorheological indicators including WBHSV,PV and WBLSV levels in the two groups were signif-icantly lower than those before treatments,and the study group was lower than the control group(all P＜0.05).The total effective rate of the study group was higher than that of the control group(P＜0.05),but there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The combined treatment of Pioglita-zone Metformin and Cordyceps sinensis preparations in patients with diabetic nephropathy can effectively alleviate the oxida-tive stress response and inflammatory response,improve the renal function,effectively control the blood glucose,which has a good clinical efficacy for patients and can be widely promoted and applied in clinical applications.

Abstract:Objective To construct a scientific,comprehensive and practical key technology index system for the full-cycle rehabilitation of exertional heat stroke(EHS),so as to provide theoretical and practical guidance for improving survival rate of EHS,reducing the incidence of sequelae and promoting the recovery of patients.Methods A preliminary three-level index system was established by systematically searching Web of Science,PubMed,Embase and other domes-tic and foreign authoritative databases and combining with clinical practice experience.Eighteen experts with rich experi-ence in EHS treatment and high rehabilitation academic level from 5 hospitals in Fujian,Hainan and Tianjin provinces were selected via the Delphi method based on their specialties,professional titles and clinical experiences,and two rounds of consultations were conducted with a defined interval.Data analysis was carried out using Excel,SPSS 26.0 and SPS-SAU software,expert engagement was assessed by the questionnaire recovery rate,the authority coefficient was deter-mined by the arithmetic mean of the judgment basis and familiarity coefficients,and the degree of coordination of expert opinions was measured using the coefficient of variation(CV)and Kendall's coordination coefficient.Results Two rounds of consultations achieved 100％response rate,and the expert authority coefficient was 0.89,and the difference of Kendall's coordination coefficient was statistically significant by x2 test(P＜0.05),which indicating that experts had high participation,strong authority and good coordination of opinions.Finally,the key technical index system for full-cy-cle rehabilitation of EHS was successfully constructed,including 3 first-level indicators,9 second-level indicators and 33 third-level indicators,covering the early rehabilita-tion and recovery stages.Specific rehabilitation technical indicators were formulated for the key areas such as dis-turbance of consciousness,cardiopulmonary function and motor function,and the inclusion basis and interrelationship of each indicator were analyzed in depth,which highlight the scientific nature and uniqueness of the system.Conclusion The key technical index system for full-cycle rehabilitation of EHS constructed in this study has been verified by scientific and rigorous research methods,which is highly scientific,reliable and practical,and can provide important reference for medi-cal institutions to formulate personalized rehabilitation programs and standardize rehabilitation processes.At the same time,this study discusses the prospects and potential challenges of the index system in practical application,so as to point out the direction for the follow-up research and practice of EHS rehabilitation.

Abstract:Objective To construct absent in melanoma 2(AIM2)gene overexpression and knockdown lentiviral vectors,and to verify the effect of the above lentiviral overexpression and knockdown of AIM2 gene in human multiple myeloma(MM)cell line RPMI8226.Methods Recombinant plasmids containing the full AIM2 gene fragment and recom-binant plasmids containing AIM2-targeted short hairpin RNA(shRNA)gene fragments were synthesized by using recom-binant DNA technology.After validation by colony polymerase chain reaction(PCR)and sequencing,lentivirus packaging and titer determination were carried out,and RPMI8226 cells were infected with lentivirus under appropriate conditions.AIM2 overexpression experimental group were grouped:WT group(no lentivirus added,blank control),OE-NC group(50 μl OE-NC lentivirus added,negative control),OE-AIM2 group(AIM2 overexpression,66.67 μl OE-AIM2 lentivirus added).AIM2 knockdown experimental group were grouped:WT group(no lentivirus added,blank control),NC group(32.26 μl NC lentivirus added,negative control),shRNA1 group(33.33 μl shRNA1 lentivirus added,AIM2 knockdown target 1),shRNA2 group(33.33 μl shRNA2 lentivirus added,AIM2 knockdown target 2),shRNA3 group(33.33 μl shRNA3 lentivirus added,AIM2 knockdown target 3).Fluorescence was detected using fluorescence microscope,and the effects of lentivirus on the overexpression and silencing of the AIM2 gene in cells were evaluated by quantitative polymer-ase chain reaction(qPCR)and Western blot.Results The sequencing results showed that the target sequence was presented in the AIM2 overexpression recombinant plas-mids,and the 3 target sequences were contained in the AIM2 knockdown recombinant plasmids.The results of qPCR and Western blot analysis indicated that the AIM2 mRNA and protein expression levels in the OE-AIM2 group were significantly upregulated than those in the OE-NC group(all P＜0.05);the AIM2 mRNA and protein expres-sion levels in the shRNA1,shRNA2 and shRNA3 groups were all down regulated than those in the NC group(all P＜0.05).Conclusion The AIM2 gene overexpression and knockdown lentiviral vectors are successfully constructed,and the effectiveness of overexpressing and knocking down AIM2 gene is verified,resulting in RPMI826 cells with stable AIM2 overexpression and stable AIM2 knockdown.

Abstract:Objective To demonstrate the critical role of helicopters in the military medical support system and their development direction,explore the necessity and construction pathways of helicopter rescue models in the context of modern warfare and non-war military actions,based on the unique advantages that helicopters provide in patient's searc-ing,rescuing and medical evacuating.Methods The classic domestic and international helicopter rescue cases during peacetime and wartime,as well as the development trends of military medical forces were analyzed,and this study com-bined the innovative practice of helicopter mobile medical force grouping currently carried out by the Chinese military,and comprehensively assessed the application status of technologies such as modular medical equipment mounting.Results It had been emphasized in this article that the helicopter rescue models was necessary for the construction of military medical support forces,starting from domestic and international helicopter rescue data during peacetime and wartime and future development trends of medical forces.Establishing helicopter rescue system was an essential choice to enhance the effec-tiveness of military medical support,which specifically involved the development of rapidly deployable modular medical units,optimizing integrated solutions for airborne medical equipment and establishing coordinated air-ground rescue net-work.Conclusion To promote the leapfrog development of the Chinese military's helicopter medical support capabilities,it is necessary to conduct exploratory training based on existing equipment,personnel and resources,while timely ad-dressing shortcomings in equipment,personnel and institutional standards.Additionally,it is important to explore the synergistic rescue system of drones for search and helicopter for evacuation,integrating the helicopter mobile medical force grouping model and medical equipment mounting practices that the military is currently exploring,and to propose thoughts and suggestions for the future direction of helicopter medical support construction.

Abstract:Objective To analyze the effect of body fat composition and thyroid function on peripheral nerve hypersen-sitivity in patients with diabetes mellitus type 2(T2DM).Methods A total of 100 T2DM patients who received blood glu-cose management in the author's hospital from August 2020 to August 2021 were selected as the research objects.Accord-ing to the results of the sensory nerve quantitative detector,the patients with a normal range of fast section of range current perception threshold(R-CPT)were included in the control group(n=49),and the patients with lower R-CPT than the nor-mal range were included in the hyperesthesia group(n=51).Thyroid function in biochemical indicators,body composition analysis(body fat mass,body fat rate,visceral fat area and other indicators)and R-CPT were measured in the two groups of T2DM patients,the differences in body fat composition and thyroid function between the two groups were compared,and the correlation between 2 000,250,5 Hz R-CPT and body fat composition was analyzed.Results Body mass index(BMI),body fat mass,body fat rate,visceral fat area,trunk fat mass,lower limb fat mass and free thyroxine(FT4)in T2DM pa-tients with hyperesthesia were higher than those in control group(all P＜0.05).In T2DM patients,2 000 Hz R-CPT was negatively correlated with BMI,waist circumference,waist hip ratio,FT4,visceral fat area and HCY(P＜0.05),the 250 Hz R-CPT was negatively correlated with FT4(P＜0.05),there was no significant correlation between 5 Hz R-CPT and body composition indexes(P＞0.05).Logistic regression analysis showed that body fat mass and FT4 were risk factors for peripheral nerve hypersensitivity in T2DM patients(P＜0.05).Conclusion Obesity and high body fat composition are im-portant factors affecting the progression of peripheral neuropathy in T2DM patients in the early stage of neuropa-thy.

Abstract:Objective To investigate the therapeutic effects of mesenchymal stem cell(MSC)-derived microvesicles on sepsis by regulating iron ion metabolism to alleviate ferroptosis in endothelial cells.Methods Endothelial cells were di-vided into control group,lipopolysaccharide(LPS)group and MSC-microvesicle group according to the different treat-ment of endothelial cells.Endothelial cells in the control group were untreated;endothelial cells in the LPS group were stimulated with 1 μg/ml LPS for 24 h;endothelial cells in the MSC-microvesicle group were treated with 2 × 106 MSC-mi-crovesicles on the basis of LPS stimulation.Enzyme-linked immunosorbent assay(ELISA)was used to measure interleu-kin 1 beta(IL-1β),IL-6 and tumor necrosis factor alpha(TNF-α)concentrations;reactive oxygen species(ROS)and iron specific kits were used to measure ROS and iron levels of endothelial cells;cell counting kit 8(CCK-8)was used to assess cell proliferation ability;immunofluorescence was used to evaluate lipid peroxidation level;real-time fluorescence quantifi-cation reverse transcription polymerase chain reaction(RT-PCR)was employed to analyze expression of iron metabolism-related genes FPN1,FTH1 and IREB2.Results Compared with the control group,the levels of IL-1β,IL-6,TNF-α and ROS in endothelial cells in LPS group and MSC-microvesicle group increased,and the cell proliferation ability decreased(all P＜0.05);the content of iron ion was reduced and the level of lipid peroxidation significantly increased(all P＜0.05);the expression of FPN1 and FTH1 increased,and the expression of IREB2 decreased(all P＜0.05).Compared with the LPS group,the levels of IL-1β,IL-6,TNF-α and ROS in endothelial cells decreased,and the cell proliferation ability was up-regulated in the MSC-microvesicles group(all P＜0.05);the content of iron ion was reduced and the level of lipid peroxidation decreased(all P＜0.05);the expression of FPN1 and FTH1 decreased,and the expression of IREB2 increased(all P＜0.05).Conclusion Endothelial cells undergo ferroptosis during sepsis,and MSC-microvesicles alleviate this process by modula-ting iron metabolism.