Prevention of Periprosthetic Infection After Orthopedic Knee Replacement Based on 5E Rehabilitation Nursing Model.

Context: Periprosthetic joint infections (PJIs) are a rare but highly destructive complication after total knee arthroplasty (TKA). Nursing plays an important role in preventing postoperative infections in patients, but different nursing modes have different rates of postoperative infections. Objective: The study intended to explore the effects of "encouragement, education, exercise, employment, and evaluation" (5E) rehabilitation nursing on the prevention of periprosthetic joint infections (PJIs) after TKA. Design: The research team conducted a randomized controlled trial. Setting: The study took place at the First People's Hospital of Huzhou in Huzhou, China. Participants: Participants were 80 TKA postoperative patients at the hospital between January 2023 and July 2023. Interventions: The research randomly divided participants into two groups: (1) the intervention group, the 5E group, with 40 participants and (2) the control group, with 40 participants. The control group received routine nursing, while the 5E group received 5E rehabilitation nursing. Outcome Measures: The research team examined: (1) the prosthesis' location; (2) wound healing; (3) score for knee joint function, using the Berg Balance Scale (BBS) and the Hospital Score for Special Surgery (HSS) of the knee joint; (4) postoperative level of inflammatory factors, using levels of C-reactive protein (CRP); (5) infection occurrence; (6) length of hospital stay; and (7) nursing satisfaction. Results: The prosthesis was well positioned in both groups. Compared to the control group, the 5E group's: (1) wound healing was significantly better (P < .001); (2) at 7 days after surgery, HSS score (P < .001) and BBS score (P < .001) were significantly higher; (3) C-reactive protein (CRP) levels were significantly lower (P < .001); (4) at 90 days after surgery, incidence of postoperative periprosthetic joint infection (PJI) was significantly lower (P < .001); (5) length of hospital stay was significantly shorter (P = .0013); and (7) nursing satisfaction was significantly higher (P = .0338). Conclusions: The 5E rehabilitation nursing for patients after TKA was helpful in promoting wound recovery, supporting the recovery of knee-joint function, reducing the incidence of PJIs, shortening the length of hospital stay, and improving patients' nursing satisfaction.

Degree of Acceptance of Breast Reconstruction and the Associated Factors Among a Population of Chinese Women with Breast Cancer.

BACKGROUND: Breast cancer is one of the most common female "malignancies" reported worldwide in recent years. This study is aimed to understand the degree of acceptance of breast reconstruction among breast cancer patients in Chinese women and to explore the related factors. METHODS: Breast cancer patients were asked to fill in the demographic questionnaire, and consent for evaluation of Breast Reconstruction Acceptance Scale, Social Support Scale, and Functional Assessment of Cancer Therapy-breast Quality of Life Instrument (FACT-B). The data were assessed using multivariate logistic regression analysis for the correlations between the degree of acceptance of breast reconstruction and age, marital status, family monthly income, quality of life, and social support. RESULTS: 57.5% of 715 patients were not familiar with breast reconstruction. Results showed correlation with the degree of acceptance of breast reconstruction. Multivariate analysis indicated that age (41-50 years old, OR: 0.25, 95% CI: 0.08-0.76; > 50, OR: 0.05, 95% CI: 0.02-0.15), marital status (married, OR: 0.15, 95% CI: 0.05-0.43; divorced/widowed, OR: 0.11, 95% CI: 0.03-0.42), family income (3-10 thousand RMB, OR: 2.01, 95% CI: 1.08-3.76; > 10 thousand RMB, OR: 2.14, 95% CI: 1.05-4.37), quality of life (fair, OR: 0.59, 95% CI: 0.39-0.91), and social support (excellent, OR: 0.50, 95% CI: 0.30-0.83) were all correlated with the degree of acceptance of breast reconstruction. CONCLUSION: Chinese breast cancer patients have a low degree of acceptance of breast reconstruction. The degree of acceptance was found to be correlated with age, marital status, family monthly income, quality of life, and social support. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Alpha-tocopheryl polyethylene glycol succinate-emulsified poly(lactic-co-glycolic acid) nanoparticles for reversal of multidrug resistance in vitro.

Multidrug resistance (MDR) is one of the factors in the failure of anticancer chemotherapy. In order to enhance the anticancer effect of P-glycoprotein (P-gp) substrates, inhibition of the P-gp efflux pump on MDR cells is a good tactic. We designed novel multifunctional drug-loaded alpha-tocopheryl polyethylene glycol succinate (TPGS)/poly(lactic-co-glycolic acid) (PLGA) nanoparticles (TPGS/PLGA/SN-38 NPs; SN-38 is 7-ethyl-10-hydroxy-camptothecin), with TPGS-emulsified PLGA NPs as the carrier and modulator of the P-gp efflux pump and SN-38 as the model drug. TPGS/PLGA/SN-38 NPs were prepared using a modified solvent extraction/evaporation method. Physicochemical characterizations of TPGS/PLGA/SN-38 NPs were in conformity with the principle of nano-drug delivery systems (nDDSs), including a diameter of about 200 nm, excellent spherical particles with a smooth surface, narrow size distribution, appropriate surface charge, and successful drug-loading into the NPs. The cytotoxicity of TPGS/PLGA/SN-38 NPs to MDR cells was increased by 3.56 times compared with that of free SN-38. Based on an intracellular accumulation study relative to the time-dependent uptake and efflux inhibition, we suggest novel mechanisms of MDR reversal of TPGS/PLGA NPs. Firstly, TPGS/PLGA/SN-38 NPs improved the uptake of the loaded drug by clathrin-mediated endocytosis in the form of unbroken NPs. Simultaneously, intracellular NPs escaped the recognition of P-gp by MDR cells. After SN-38 was released from TPGS/PLGA/SN-38 NPs in MDR cells, TPGS or/and PLGA may modulate the efflux microenvironment of the P-gp pump, such as mitochondria and the P-gp domain with an ATP-binding site. Finally, the controlled-release drug entered the nucleus of the MDR cell to induce cytotoxicity. The present study showed that TPGS-emulsified PLGA NPs could be functional carriers in nDDS for anticancer drugs that are also P-gp substrates. More importantly, to enhance the therapeutic effect of P-gp substrates, this work might provide a new insight into the design of pharmacologically inactive excipients that can serve as P-gp modulators instead of drugs that are P-gp inhibitors.

[Analysis of related risk factors for the refracture of adjacent vertebral body after percutaneous kyphoplasty].

OBJECTIVE: To investigate the risk factors of vertebral refracture after percutaneous kyphoplasty (PKP) for osteoprotic vertebral compression fractures (OVCFs), and to provide reference for clinical prevention. METHODS: A retrospective analysis of 228 OVCFs patients who met the inclusion criteria admitted from November 6, 2013 to December 14, 2018. There were 35 males and 193 females, with a male-to-female ratio of 3∶20, and aged 58 to 91 years with an average of (69.70±7.03) years. All patients were treated with PKP and had complete clinical data. According to whether refracture occurred after operation, they were divided into refracture group (24 cases) and non refracture group (204 cases). Factors that may be related to refracture (including gender, age, surgical segment, number of vertebral bodies in the surgical segment, whether combined with degenerative scoliosis, whether anti-osteoporosis treatment) were included in the univariate analyses, and the single factor analysis of statistically significant risk factors was carried out with multiple Logistic regression analysis to further clarify the independent risk factors for vertebral body refracture after PKP. Survival analysis was performed using the time of vertebral refracture after PKP as the end time of follow up, the occurrence of refracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor. RESULTS: All 228 patients were followed up for 1.8 to 63.6 months with an average of (28.8±15.6) months, and the refracture rate was 10.5%(24/228). There were statistically significant differences between two groups in age, number of operative vertebral bodies, whether combinedwith degenerative scoliosis and whether anti osteoporosis treatment (P<0.05). Univariate Logistic regression analysis showed that the number of vertebral bodies in the surgical segment and whether combined with degenerative scoliosis may be risk factors for refracture after PKP. Multiple Logistic regression analysis of the above possible risk factors showed that combined scoliosis was an independent risk factor for vertebral refracture of the vertebral body. Survival analysis showed that the mean survival time was 42.1 months, the P value was 0.00, and the mean 95% confidence interval was 34.4-49.7 months, indicating that the combination of degenerative lateral bending might be related to the occurrence of refracture. CONCLUSION: Combined scoliosis is an independent risk factor for refracture after OVCFs vertebroplasty, and it is also a possible high-risk factor for refracture after surgery.

General Control Non-derepressible 1 (AtGCN1) Is Important for Flowering Time, Plant Growth, Seed Development, and the Transcription/Translation of Specific Genes in Arabidopsis.

We have previously demonstrated that General Control Non-derepressible 1 (AtGCN1) is essential for translation inhibition under cold stress through interacting with GCN2 to phosphorylate eukaryotic translation initiation factor 2 (eIF2). Here, we report that the flower time of the atgcn1 mutant is later than that of the wild type (WT), and some siliques of atgcn1 cannot develop and produce seeds. Total and polysomal RNA of atgcn1-1 and wild type (WT) after cold treatments were sequenced. The sequencing results show that the mutation of atgcn1 selectively alters the expression of genes at both transcriptional and translational levels. The classification of AtGCN1 target genes reveals that AtGCN1 regulated gens are involved in flower development, seed dormancy and seed development, response to osmotic stress, amino acid biosynthesis, photosynthesis, cell wall organization, protein transport and localization, lipid biosynthesis, transcription, macroautophagy, proteolysis and cell death. Further analysis of AtGCN1 regulated genes at translational levels shows that the Kozak sequence and uORFs (upstream open reading frame) of transcripts affect translation selection. These results show that AtGCN1 is required for the expression of selective genes in Arabidopsis.

Document authentication at molecular levels using desorption atmospheric pressure chemical ionization mass spectrometry imaging.

Molecular images of documents were obtained by sequentially scanning the surface of the document using desorption atmospheric pressure chemical ionization mass spectrometry (DAPCI-MS), which was operated in either a gasless, solvent-free or methanol vapor-assisted mode. The decay process of the ink used for handwriting was monitored by following the signal intensities recorded by DAPCI-MS. Handwritings made using four types of inks on four kinds of paper surfaces were tested. By studying the dynamic decay of the inks, DAPCI-MS imaging differentiated a 10-min old from two 4 h old samples. Non-destructive forensic analysis of forged signatures either handwritten or computer-assisted was achieved according to the difference of the contour in DAPCI images, which was attributed to the strength personalized by different writers. Distinction of the order of writing/stamping on documents and detection of illegal printings were accomplished with a spatial resolution of about 140 µm. A Matlab® written program was developed to facilitate the visualization of the similarity between signature images obtained by DAPCI-MS. The experimental results show that DAPCI-MS imaging provides rich information at the molecular level and thus can be used for the reliable document analysis in forensic applications.

Differentiation of various kinds of Fructus schisandrae by surface desorption atmospheric pressure chemical ionization mass spectrometry combined with principal component analysis.

Various kinds of Fructus schisandrae were studied by surface desorption atmospheric pressure chemical ionization mass spectrometry (DAPCI-MS) without any sample pretreatment. The volatile components in F. schisandrae were detected in the ambient environment and the analytical time for each sample was only 30s. F. schisandrae are produced mainly in 5 different geographical regions (Elunchun, Mudanjiang, Tonghua, Tieling and Shangluo), and they could be successfully differentiated according to their chemical markers by Principal Component Analysis (PCA). A total of 8 components which gave more contribution for PCA analysis were unambiguously identified by comparison of the MS(2) data of chemical markers to the data of reference compounds as reported in the literature. Similarly, wild grown and cultivatable species of F. schisandrae were well separated by the above-mentioned method. In addition, raw and processed cultivatable F. schisandrae (steamed by water, alcohol, vinegar, or honey, and fried by honey) were found to be clustered at different location, respectively. Furthermore, the clustered degree of differently processed products was correlated with their clinical effects. Our results demonstrated that DAPCI-MS in combination with PCA was a feasible technique for high-throughput differentiation of various kinds of F. schisandrae. It is also possible that DAPCI-MS could become a powerful technology in the studies of traditional Chinese medicine studies and in situ analysis of Chinese herbs.

Neutral desorption extractive electrospray ionization mass spectrometry for fast screening sunscreen agents in cream cosmetic products.

High throughput analysis of sunscreen agents present in cream cosmetic has been demonstrated, typically 2 samples per minute, using neutral desorption extractive electrospray ionization mass spectrometry (ND-EESI-MS) without sample pretreatment. For the targeted compounds such as 4-Aminobenzoic acid and oxybenzone, ND-EESI-MS method provided linear signal responses in the range of 1-100 ppb. Limits of detection (LOD) of the method were estimated at sub-ppb levels for the analytes tested. Reasonable relative standard deviation (RSD=8.4-16.0%) was obtained as a result of 10 independent measurements for commercial cosmetics samples spiked with each individual sunscreen agents at 1-10 ppb. Acceptable recoveries were achieved in the range of 87-116% for direct analysis of commercial cream cosmetic samples. The experimental data demonstrate that ND-EESI-MS is a useful tool for high throughput screening of sunscreen agents in highly viscous cream cosmetic products, with the capability to obtain quantitative information of the analytes.

Ghrelin attenuates plasminogen activator inhibitor-1 production induced by tumor necrosis factor-alpha in HepG2 cells via NF-kappaB pathway.

Plasminogen activator inhibitor type 1 (PAI-1), produced partly from liver is a risk factor for macrovascular and microvascular complications of diabetes. Ghrelin, a recently described orexigenic peptide hormone, attenuates PAI-1 induced by TNF-alpha in the human hepatoma cell line (HepG2). Exposure to TNF-alpha (1 ng/ml) for 24h caused a significant increase in PAI-1 mRNA expression and protein secretion, as evaluated by RT-PCR and ELISA, but pretreatment with ghrelin (1-100 ng/ml) inhibited both basal and TNF-alpha-induced PAI-1 release in a dose and time-dependent manner in HepG2. PDTC, selective NF-kappaB inhibitor, had no additive inhibitory effects with ghrelin. The results indicate that ghrelin inhibits both basal and TNF-alpha-induced PAI-1 production via NF-kappaB pathway in HepG2 cells, and suggest that the peptide plays a therapeutic role in atherosclerosis, especially in obese patients with insulin resistance, in whom ghrelin levels were reduced.

Effect of ghrelin on human endothelial cells apoptosis induced by high glucose.

Endothelial dysfunction is thought to be a major cause of vascular complications in diabetes. Our research shows that ghrelin attenuates high glucose-induced apoptosis in cultured human umbilical vein endothelial cells (ECV-304). Exposure to glucose (33.3mM) for 72 h caused a significant increase in apoptosis, as evaluated by TUNEL and flow cytometry, but pretreatment of ghrelin (10(-7)M) eliminated high glucose-induced apoptosis in ECV-304. Ghrelin also prevented the induction of caspase-3 activation, in cells incubated with glucose (33.3 mM). Exposure of cells to ghrelin (10(-7)M) caused rapid activation of Akt. PI3K inhibitor, LY294002 attenuated ghrelin's inhibitory effect on caspase-3 activity. Ghrelin protected endothelial cells from high glucose by inhibiting reactive oxygen species (ROS) generation. Results of our study indicate that ghrelin inhibits both high glucose-induced apoptosis via PI3K/Akt pathway and ROS production in ECV-304. This peptide may have potential in preventing diabetic complications, especially in obese patients.