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Yanju He,1,&ast; Song Wen,1,&ast; Mingyue Zhou,2 Xiucai Li,1 Min Gong,1 Ligang Zhou1,3 1Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China; 2Helen Driller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; 3Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ligang Zhou, Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China, Tel +8613611927616, Email zhouligang@yahoo.comBackground: The mini-clinical evaluation exercise (mini-CEX) is an excellent tool for assessing the clinical abilities of medical students in intense clinical practice. In this study, the Mini-CEX was adapted to professional questionnaires for Diabetes Mellitus (DM), and examined in medical students completing their clerkship rotation in the department of endocrinology.Methods: From January 2021 to January 2022, all rotating medical students at Shanghai Pudong Hospital completed two mini-CEX exams before and following their rotation under the supervision and guidance of six tutors. The mini-CEX form was modified in this study primarily for inpatient management based on our clinical experience and updated DM guidelines of the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the Chinese Diabetes Society (CDS). Each component of the mini-CEX assessment, including medical interviews, physical examination, clinical judgment, clinical management, and overall clinical competence was evaluated using a nine-item questionnaire.Results: Our findings revealed that the second-round performance on the assessments significantly improved, as indicated by higher scores on each component. The Pearson association analysis revealed that the feedback time of the first examination was markedly associated with improved overall scores (r= 0.391, p< 0.001). However, no correlations were discovered between patient age, gender, disease severity disparity, or the interval between examinations (p> 0.05). Additional regression analysis revealed that the feedback time during the initial examination was the most significant contributor to the increased overall scores (β=0.391, p< 0.001).Conclusion: This newly designed mini-CEX form based on current ADA and EASD guidelines may assist trainees in more effectively diagnosing and managing DM in inpatients, particularly those with macrovascular, microvascular, or peripheral nerve neuropathy. This study aims to assess the efficacy of administering a modified mini-CEX form to rotating trainees participating in an endocrine clerkship.Keywords: mini-clinical evaluation exercise, diabetes, medical student, feedback time

Objective: Lung cancer is the most common cancer and can appear as a solitary pulmonary nodule. Early detection of lung cancer in this patient population would be beneficial for the disease management. In this study, the potential application of circulating tumor cells (CTCs) on early detection of lung cancer in this population was investigated. Methods: The number of CTCs in bronchoalveolar lavage fluid and serum levels of tumor-related markers, cancer antigen 125 (CA125), carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) were measured in patients with a solitary pulmonary nodule. The association between CTCs and lung cancer was examined. The diagnosis performances of CTCs and selected tumor-related markers were compared. Results: The CTC positivity was significantly associated with lung cancer ( P = .009). The sensitivity of CTCs and CA125, CEA, NSE, and CA125/CEA/NSE was 75%, 5.6%, 0%, 25%, and 33%, respectively. The sensitivity of CTCs was improved from 75% to 83% by the combination with CA125 or NSE. Conclusion: CTCs may be helpful for the early detection of lung cancer in patients with a solitary pulmonary nodule.

To determine the influence of metformin on the proliferation and apoptosis of advanced glycation end products-induced primary skin fibroblasts and its mechanism. Human skin fibroblasts were purchased and treated with advanced glycation end products of different concentrations separately, on which the fibroblasts were intervened by metformin of different concentrations. The proliferation and apoptosis of cells treated with advanced glycation end products and metformin were evaluated and the changes of oxidative stress markers and microRNA-126 in the cells were also determined. In addition, the cells treated with metformin were transfected with miR-126 mimics and blank plasmids and microRNA-126 mimics, separately, to explore whether the transfection can weaken the effects of metformin. Human skin fibroblasts lines HSF2 showed a decrease in proliferation and superoxide dismutase and an increase in apoptosis rate, reactive oxygen species and malondialdehyde after being treated with advanced glycation end products and metformin weakened the influence of advanced glycation end products on proliferation, apoptosis as well as oxidative stress of human skin fibroblasts cells. In addition, HSF2 cells showed increased microRNA-126 expression after being treated with advanced glycation end products and metformin could inhibit this increase. Transfection of microRNA-126 mimics weakened the protective effect of metformin on HSF2 cells treated with advanced glycation end products. Metformin can inhibit advanced glycation end products-induced cell apoptosis and oxidative stress of human skin fibroblasts by downregulating microRNA-126.

OBJECTIVE: To explore the effect of vocal cord reconstruction with sternohyoid muscle flap pedicled with vertical anterior laryngectomy. METHOD: The clinical data of 43 cases of laryngeal carcinoma were analyzed retrospectively. According to whether the vocal cords were reconstructed, they were divided into vocal cord reconstruction group and non reconstruction group. Among them, 20 patients in the reconstruction group were reconstructed with pedicled sternohyoid muscle flap and 23 patients in non-reconstruction group. In the non reconstruction group, the external membrane of thyroid cartilage was used to repair the wounds. Postoperative respiratory function, swallowing function, pronunciation function, postoperative prognosis, complications, and recurrence rate were compared between the two groups. Reconstruction of glottis after vocal cord reconstruction was evaluated by electronic laryngoscope and CT scan. RESULT: ① Patients in both groups survived during the follow-up period. One patient in the non-reconstructed group had recurrence, and the reconstituted group had no relapse, 3 cases with complications occurred in the reconstruction group, including 2 cases with granulation tissue in the glottic area, 1 case with laryngeal fistula, and 2 cases with aspiration pneumonia were found in the non-reconstruction group. ②1 year postoperative tracheal cannula removal rate, gastric tube removal and pronunciation quality: the tracheal cannula removal rate was 100% in the two groups after surgery; the gastric tube removal time in the reconstruction group was(13.2±2.8) days, and (16.6±5.3) days in the non-reconstruction group (P < 0.05); reconstruction group had good pronunciation in 10 cases, moderate in 6 cases, and poor in 4 cases. Non-reconstructed group had good pronunciation in 4 cases, medium in 14 cases, and poor in 5 cases. Those with moderate or higher were compared no significant difference (P>0.05), and those with good pronunciation were statistically different (P < 0.05). ③The transverse and anteroposterior diameter in reconstruction group was similar with the normal people (P>0.05); however, the transverse and anteroposterior diameter in the non-reconstructed group was significantly different with that of the normal people (P>0.05), the transverse diameter of the reconstructed group and the non-reconstructed group were compared with no significant difference (P>0.05), but there was significant difference in the anteroposterior diameter between the two groups (P < 0.05). The area in both groups were different with the normal people (P < 0.05); ④Glottic area morphology: the two groups of patients showed different degrees of swelling in the arytenoid cartilage area, the shape of the glottic region in the reconstructed group was approximately triangular, and the glottic morphology in the non-reconstructed group was approximately circular. CONCLUSION: After vocal cord reconstruction, there were increased rate of tracheal cannula extubation, well covered wallowing and phonation function, and the quality of life of patients was improved.

Background/Aims: Prevention of diabetes requires maintenance of a functional beta-cell mass, the postnatal growth of which depends on beta cell proliferation. Past studies have shown evidence of an effect of an incretin analogue, Exendin-4, in promoting beta cell proliferation, whereas the underlying molecular mechanisms are not completely understood. Methods: Here we studied the effects of Exendin-4 on beta cell proliferation in vitro and in vivo through analysing BrdU-incorporated beta cells. We also analysed the effects of Exendin-4 on beta cell mass in vivo, and on beta cell number in vitro. Then, we applied specific inhibitors of different signalling pathways and analysed their effects on Exendin-4-induced beta cell proliferation. Results: Exendin-4 increased beta cell proliferation in vitro and in vivo, resulting in significant increases in beta cell mass and beta cell number, respectively. Inhibition of PI3K/Akt signalling, but not inhibition of either ERK/MAPK pathway, or JNK pathway, significantly abolished the effects of Exendin-4 in promoting beta cell proliferation. Conclusion: Exendin-4 promotes beta cell proliferation via PI3k/Akt signaling pathway.

The present study investigated the effects of Astragalus polysaccharides (APS) on insulin resistance by modulation of hepatic sirtuin 1 (SIRT1)‑peroxisome proliferator‑activated receptor (PPAR)‑γ coactivator (PGC)‑1α/PPARα‑fibroblast growth factor (FGF)21, and glucose and lipid metabolism. Thirty male Sprague Dawley rats were divided into three groups: A normal control group, a catch‑up growth group and an APS‑treated (APS-G) group. The latter two groups underwent food restriction for 4 weeks, prior to being provided with a high fat diet, which was available ad libitum. The APS‑G group was orally treated with APS for 8 weeks, whereas the other groups were administered saline. Body weight was measured and an oral glucose tolerance test (OGTT) was conducted after 8 weeks. The plasma glucose and insulin levels obtained from the OGTT were assayed, and hepatic morphology was observed by light and transmission electron microscopy. In addition, the mRNA expression levels of PGC‑1α/PPARα, and the protein expression levels of SIRT1, FGF21 and nuclear factor‑κB were quantified in the liver and serum. APS treatment suppressed abnormal glycolipid metabolism and insulin resistance following 8 weeks of catch‑up growth by improving hepatic SIRT1‑PPARα‑FGF21 intracellular signaling and reducing chronic inflammation, and by partially attenuating hepatic steatosis. The suppressive effects of APS on liver acetylation and glycolipid metabolism‑associated molecules contributed to the observed suppression of insulin resistance. However, the mechanism underlying the effects of APS on insulin resistance requires further research in order to be elucidated. Rapid and long‑term treatment with APS may provide a novel, safe and effective therapeutic strategy for type 2 diabetes.

In order to improve the performance of Collaborative filtering (CF), a new method of producing the nearest neighbor for active user is proposed in this paper. Inspired by the conformist of E-commerce consumers, we build the user model of maximum similar clique and we use it to improve the method of producing the nearest neighbors for target users. A collaborative filtering recommendation algorithm MCQ-CF based on user model is present. The experiment results show that the algorithm MCQ-CF has good performance for accuracy and stability.

Aiming at the problem of tag-collision in RFID system, this paper analyses Aloha algorithm and its improvement algorithm. An enhancement dynamic frame slotted Aloha algorithm based on Fibonacci Number was proposed. Furthermore, the strategy of changing the frame length is established. The simulation indicates that the proposed algorithm can improve the throughput and load of RFID system.