Early cartilage lesion and 5-year incident joint surgery in knee osteoarthritis patients: a retrospective cohort study.

OBJECTIVE: to investigate the association between cartilage lesion-related features observed in knee osteoarthritis (OA) patients' first MRI examination and incident knee surgery within 5 years. Additionally, to assess the predictive value of these features for the incident knee surgery. METHODS: We identified patients diagnosed with knee OA and treated at our institution between January 2015 and January 2018, and retrieved their baseline clinical data and first MRI examination films from the information system. Next, we proceeded to determine joint space narrowing grade, cartilage lesion size grade, cartilage full-thickness loss grade and cartilage lesion sum score for the medial and lateral compartments, respectively. Generalized linear regression models examined the association of these features with 5-year incident knee surgery. Positive and negative predictive values (PPVs and NPVs) were determined referring to 5-year incident knee surgery. RESULTS: Totally, 878 participants (knees) were found eligible to form the study population. Within the 5 years, surgery was performed on 61 knees. None of the cartilage-related features had been found significantly associated with incident surgery. The results were similar for medial and lateral compartments. The PPVs were low for all the features. CONCLUSIONS: Among symptomatic clinically diagnosed OA knees, cartilage lesions observed in the first MRI examinations were not found to be associated with the occurrence of joint surgery within a 5-year period. All these cartilage-related features appear to have no additional value in predicting 5-year incident joint surgery.

Predictive value of C-reactive protein and NT-pro-BNP levels in sepsis patients older than 75 years: a prospective, observational study.

INTRODUCTION: Using biomarkers to predict mortality in patients with sepsis is important because these patients frequently have high mortality rates and unsatisfactory outcomes. The performance of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein (CRP) to predict clinical outcomes in elderly sepsis patients is unimpressive. We aimed to assess the prognostic value of NT-pro-BNP, CRP and the combination of both in selected medical ICU sepsis patients more than 75 years old. METHODS: In total, 245 consecutive patients were screened for eligibility and followed during their ICU stays. We collected the patients' baseline characteristics, including their Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and NT-pro-BNP and CRP levels. The primary outcome was ICU mortality. Potential predictors were analyzed for their possible associations with the outcome. We also evaluated the ability of NT-pro-BNP and CRP levels combined with the APACHE II score to predict ICU mortality by calculating the C-index and net reclassification improvement (NRI). RESULTS: Univariate regression revealed that CRP, NT-pro-BNP, APACHE II score, lactic acid level, NEU count(neutrophil count)and HCT level independently predicted ICU mortality (all P < 0.01). The C-index for the prediction of ICU mortality by the APACHE II score (0.847 ± 0.029; P < 0.001) was greater than that for NT-pro-BNP (0.673 ± 0.039; P < 0.01) or CRP (0.626 ± 0.039; P < 0.01) (all P < 0.01). Compared with the APACHE II score (0.847 ± 0.029; P < 0.001), the combination of CRP (0.849 ± 0.029; P < 0.01) or NT-pro-BNP (0.853 ± 0.028; P < 0.01) or both (0.853 ± 0.030; P < 0.01) with the APACHE II score did not significantly increase the C-index for predicting ICU mortality (all P > 0.05). However, the addition of NT-pro-BNP to the APACHE II score gave an NRI of 8.6% (P = 0.000), the addition of CRP to the APACHE II score provided an NRI of 11.34% (P = 0.012), and the addition of both markers to the APACHE II score yielded an NRI of 29.0% (P = 0.000). In the MOF subgroup (N = 118), CRP (OR = 2.62, P < 0.05) but not NT-pro-BNP (OR = 1.73, p > 0.05) independently predicted ICU mortality, and the addition of CRP to the APACHE II score obviously increased its predictive ability (NRI = 13.88%, P = 0.000). In the non-MOF group (N = 127), neither CRP (OR = 5.447, P = 0.078) nor NT-pro-BNP (OR = 2.239, P = 0.016) was an independent predictor of ICU mortality. CONCLUSIONS: In sepsis patients older than 75 years, NT-pro-BNP and CRP can serve as independent predictors of mortality, and the addition of NT-pro-BNP or CRP or both to the APACHE II score significantly improves the ability to predict ICU mortality. CRP appears to be useful for predicting ICU outcomes in elderly sepsis patients with multiple-organ failure.

[Preparation of curcumin TPP-PEG-PE nanomicelles with mitochondrial targeting and lysosomal escape functions and its effect on promoting breast cancer cell apoptosis].

Orthogonal experiments were used to optimize the process parameters of curcumin TPP-PEG-PCL nanomicelles; the particle size, electric potential and morphology under the electron microscope were systematically detected for the curcumin TPP-PEG-PCL nanomicelles; and the stability and in vitro release of the curcumin TPP-PEG-PCL nanomicelles were investigated. With DID fluorescent dye as the fluorescent probe, flow cytometry was used to study the uptake of nanomicelles by breast cancer cells, and laser confocal microscopy was used to study the mitochondrial targeting and lysosomal escape functions of nanomicelles. Under the same dosage conditions, the effect of curcumin TPP-PEG-PCL nanomicelles on promoting the apoptosis of breast cancer cells was evaluated. The optimal particle size of curcumin TPP-PEG-PCL nanomicelle was(17.3±0.3) nm, and the Zeta potential was(14.6±2.6) mV in orthogonal test. Under such conditions, the micelle appeared as regular spheres under the transmission electron microscope. Fluorescence test results showed that TPP-PEG-PCL nanomicelles can promote drug uptake by tumor cells, escape from lysosomal phagocytosis, and target the mitochondria. The cell survival rate and Hoechst staining positive test results showed that curcumin TPP-PEG-PCL nanomicelles had a good effect on promoting apoptosis of breast cancer cells. The curcumin TPP-PEG-PCL micelles can significantly reduce the mitochondrial membrane potential of breast cancer cells, increase the release of cytochrome C, significantly increase the expression of pro-apoptotic protein Bcl-2 and reduce the expression of anti-apoptotic Bax protein. These test results were significantly better than those of curcumin PEG-PCL nanomicelles and curcumin, with statistically significant differences. The results revealed that curcumin TPP-PEG-PCL nanomicelles can well target breast cancer cell mitochondria and escape from the lysosomal capture, thereby enhancing the drug's role in promoting tumor cell apoptosis.

[Discussion on historical evolution and modern research progress of Sesami Semen Nigrum processing based on visual thinking].

Sesami Semen Nigrum has a long history of dual use(medicine and food). The research of its processing technology is related to the development and utilization of its own "medicine-food balance" feature, which is the basis for Sesami Semen Nigrum to realize the modernization of technology and standardization of quality. Due to its various processing methods and the long history span, the traditional medical classics(from the end of Han Dynasty to the Republic of China), modern standard specification and researches on processing were sorted out with the help of database and document mining technology, and the visual thinking was adopted to analyze the evolution trend of Sesami Semen Nigrum processing methods. In addition, the processing characteristics of Sesami Semen Nigrum in various periods and effect of processing on its chemical compositions and pharmacological effect were briefly described to explore the differences and their reasons in the processing of Sesami Semen Nigrum from ancient times to the present time, aiming to provide an idea and documentary basis for the study of traditional processing technology.

Critical role of Emx2 in the pluripotency - differentiation transition in male gonocytes via regulation of FGF9/NODAL pathway.

Emx2 deletion impairs the growth and maintenance of the genital ridge. However, its role in subsequent germ cell differentiation during embryonic stages is unknown. Using a tamoxifen-inducible Cre-loxP mouse model (Emx2(flox/flox), Cre-ER(TM), hereafter called as Emx2 knockdown), we showed that germ cell differentiation was impaired in Emx2-knockdown testes. Representative characteristics of male germ cell differentiation, including a reduced ability to form embryonic germ (EG) cell colonies in vitro, down-regulation of pluripotency markers and G1/G0 arrest, did not occur in Emx2-knockdown testes. Furthermore, FGF9 and NODAL signalling occurred at abnormally high levels in Emx2-knockdown testes. Both blocking FGF9 signalling with SU5402 and inhibiting NODAL signalling with SB431542 allowed germ cells from Emx2-knockdown testes to differentiate in vitro Therefore, EMX2 in somatic cells is required to trigger germ cell differentiation in XY foetuses, posterior to its previously reported role in the growth and maintenance of the genital ridge.

Is extra-pleura Nuss procedure more secure and effective?

PURPOSE: To compare total extra-pleura Nuss procedure with classical Nuss, and evaluate the efficacies and safety of thoracoscopic total extra-pleural approach of Nuss procedure for correction of pectus excavatum in children. METHODS: We managed 69 patients with pectus excavatum from July 2006 to October 2012. Of the 69 patients, 40 underwent thoracoscopic total extra-pleural approach of Nuss (group A), and 29 underwent classical Nuss procedure (group B). In group A, there were 29 boys and 11 girls, and the mean age was 6.4 (ranged from 3.5 to 14.5). Under thoracoscopic guidance, an extra-pleural tunnel was created using a blunt dissector via a right thoracic incision. A steel bar was inserted in the entirely extra-pleural tunnel. The bar was turned and fixed as in standard Nuss procedure. In group B, there were 20 boys and 9 girls, and the mean age was 5.9 (ranged from 4 to 11) years. Under thoracoscopic guidance, a blunt dissector was inserted into pleura cavity directly via a right thoracic incision. It was a standard Nuss procedure. RESULTS: The operations were completed successfully in all patients. None of the children developed pneumothorax or injuries to the pericardium, heart or lungs. The operating time was 42.0 ± 5.3 and 43.4 ± 6.0 min in group A and B, respectively, and the difference was not significant (p = 0.306). Compared to group B, the postoperative hospital stay of group A was shorter (4.0 ± 1.1 vs 5.2 ± 1.2 days, p = 0.001). The outcomes of both groups were similar (97.5% in group A vs 93.8% in group B, p = 0.377) but pain time was shorter, and time of taking painkiller was less than those of group B (2.6 ± 0.8 vs 4.1 ± 1.0 days, p = 0.001; 1.1 ± 0.6 vs 1.8 ± 0.9 time, p = 0.008). No patients in group A developed subcutaneous emphysema or pleural irritation, while 5 patients in group B showed the symptoms (p = 0.004). All patients were followed-up for 4-30 months (mean 20.2). During the follow-up, none of the children had pulmonary infection or dislocation of the steel board or fixation instruments before the bar was removed. 69 patients removed their bar after a 24-month period on average. According to Nuss' postoperative assessment criteria, one patient in group B was fair. The other patients were all excellent or good. CONCLUSIONS: Extra-pleura Nuss procedure under thoracoscopic guidance is a safe and less traumatic procedure for the correction of pectus excavatum. It is not only superior in postoperative recovery and pleural cavity protection, but also results in fewer complications than the intrapleural procedures.

Expression of survivin and livin predicts early recurrence in non-muscle invasive bladder cancer.

BACKGROUND: Survivin and livin are novel members of the inhibitor of apoptosis gene family (IAP) that controls mitotic progression and induces tumor cell invasion. This study aims to evaluate the association of both expression with clinical outcomes and risk of recurrence in patients with non-muscle invasive bladder cancer (NIMBC). PATIENTS AND METHODS: We investigated the expression of survivin and livin in 72 NMIBC samples using immunohistochemical staining (Envision Method). Survivin and livin were considered high-expressed when more than 10% of the cells expressed. The archival bladder tissue specimens from 11 normal controls were examined and studied. All patients with a follow-up of at most 5 years following initial transurethral resection (TUR) were included in the study. The association of both expression with established clinicopathologic factors and recurrence free survival (RFS) was analyzed using log-rank test and Cox regression analysis. RESUTS: Neither survivin nor livin was expressed in normal bladder urothelium. Survivin and livin were high-expressed in 84.7 and 75.0% of NIMBC. And in cases of recurrence, the high-expression (H-exp.) rates were 98.3 and 91.7% (P < 0.01), respectively. The recurrence of NIMBC was significantly associated with high expression of survivin and livin (P < 0.01, P < 0.01), and G-3 tumors had a significantly greater proportion of high survivin expression than G-1 or/and G-2 tumors (P = 0.01); however, no association was found between expression of both and age, gender, pathology stage, or adjuvant therapy. High expression of survivin (RR:9.818, 95% CI: 1.109-86.911, P = 0.040) and livin (RR: 4.199; 95% CI: 1.018-17.321; P = 0.047) was significantly powerful prognostic factors in Cox regression analysis for RFS. CONCLUSIONS: Expression of survivin and livin may influence the prognosis of NIMBC. This finding opens new perspectives for Survivin and livin prediction of early recurrence in NIMBC.

S-propargyl-cysteine promotes the stability of atherosclerotic plaque via maintaining vascular muscle contractile phenotype.

Introduction: Plaque rupture in atherosclerosis contributes to various acute cardiovascular events. As a new sulfide-containing donor, S-propargyl-cysteine (SPRC) has been reported to play a beneficial role in cardioprotection, potentially through its anti-inflammatory, anti-oxidative and anti-atherogenic activities. Our previous study observed an increase in eNOS phosphorylation in endothelial cells. However, it remains unclear whether SPRC influences vascular smooth muscle cells (VSMCs) within the plaque and if this effect contributes to plaque stabilization. Methods: An atherosclerotic unstable plaque mouse model was established by subjecting ApoE-/- mice to tandem stenosis of the right carotid artery along with a Western diet. Daily SPRC administration was conducted for 13 weeks. Plaque morphology and stability were assessed using MRI scanning and histopathological staining. In our in vitro studies, we stimulated human artery vascular smooth muscle cells (HAVSMCs) with platelet-derived growth factor-BB (PDGF-BB), both with and without 100 µM SPRC treatment. Cell phenotype was assessed using both Western blot and Real-time PCR. Cell proliferation was assessed using the BrdU cell proliferation kit and immunofluorescence of Ki-67, while cell migration was measured using scratch wound healing and transwell assay. MiR-143-3p overexpression and knockdown experiments were used to investigate whether it mediates the effect of SPRC on VSMC phenotype. Results and Discussion: SPRC treatment reduced plasma lipid levels, increased collagen content and decreased cell apoptosis in atherosclerotic plaques, indicating improved plaque stability. Both in vivo and in vitro studies elucidated the role of SPRC in preserving the contractile phenotype of VSMCs through up-regulation of miR-143-3p expression. Furthermore, SPRC suppressed the pro-proliferation and pro-migration effects of PDGF-BB on HAVSMCs. Overall, these findings suggest that the inhibitory effect of SPRC on phenotype switch from contractile to synthetic VSMCs may contribute to its beneficial role in enhancing plaque stability.

Synthetic Self-Adjuvanted Lipopeptide Vaccines Conferred Protection against Helicobacter pylori Infection.

Helicobacter pylori (H. pylori) colonizes the stomach epithelium of half the world's population and is responsible for various digestive diseases and even stomach cancer. Vaccine-mediated protection against H. pylori infection depends primarily on the specific mucosal and T-cell responses. In this study, the synthetic lipopeptide vaccines, Hp4 (Pam2 Cys modified UreB T-cell epitope) and Hp10 (Pam2 Cys modified CagA T/B cell combined epitope), not only induce the bone marrow derived dendritic cells (BMDCs) maturation by activating a variety of pattern-recognition receptors (PRRs) such as Toll-like receptor (TLR), Nod-like receptor (NLR), and retinoic acid-inducing gene (RIG) I-like receptor (RLR), and but also stimulate BMDCs to secret cytokines that have the potential to modulate T-cell activation and differentiation. Although intranasal immunization with Hp4 or Hp10 elicits robust epitope-specific T-cell responses in mice, only Hp10 confers protection against H. pylori infection, possibly due to the fact that Hp10 also induces substantial specific sIgA response at mucosal sites. Interestingly, Hp4 elevates the protective response against H. pylori infection of Hp10 when administrated in combination, characterized by better protective effect and enhanced specific T-cell and mucosal antibody responses. The results suggest that synthetic lipopeptide vaccines based on the epitopes derived from the protective antigens are promising candidates for protection against H. pylori infection.

Establishing a Prognostic Model Based on Three Genomic Instability-related LncRNAs for Clear Cell Renal Cell Cancer.

BACKGROUND: Among all types of renal cell cancer (RCC), clear cell renal cell cancer (ccRCC) is the most common and aggressive one. Emerging evidence uncovers that long non-coding RNAs (lncRNAs) are involved in genomic instability, which correlates to the clinical outcomes of patients who suffer from various kinds of cancers. METHODS: We gathered expression profiles of transcriptome RNA and clinical information about ccRCC from The Cancer Genome Atlas (TCGA) and The Gene Expression Omnibus (GEO) database. The lncRNA expression profiles and somatic mutation data were combined to identify genome instability-related lncRNAs (GILncRs) by significance analysis of T test. By means of univariate and multivariate cox regression analyses, 3 GILncRs strongly associated with patient prognosis were screened out to build a genomic instability-related risk score (GIRS) model. We use R-version 4.0.4 to draw Kaplan-Meier plots and ROC curves for survival prediction. RESULTS: The somatic mutation count was higher in genomic unstable group. PBRM1 showed lower expression in genomic unstable group. Three lncRNAs such as LINC00460, AC156455.1, LINC01606 were included in the GIRS model. Patients had poorer prognosis with higher risk score of GIRS model. The somatic mutation count was higher in patients with higher risk score while PBRM1 expression was lower. The GIRS model was independent from other clinical factors. The GIRS model was superior to other 2 published lncRNA signatures in survival prediction.

Distribution patterns and industry planning of commonly used traditional Chinese medicinal plants in China.

Medicinal plants are the primary material basis for disease prevention and treatment in traditional Chinese medicine (TCM). The conservation and sustainable utilization of these medicinal plants is critical for the development of the TCM industry. However, wild medicinal plant resources have sharply declined in recent decades. To ameliorate the shortage of medicinal plant resources, it is essential to explore the development potential of the TCM industry in different geographical regions. For this purpose, we examined the spatial distribution of commonly used medicinal plants in China, the number of Chinese medicinal material markets, and the number of TCM decoction piece enterprises. Specifically, multispecies superimposition analysis and Thiessen polygons were used to reveal the optimal range for planting bulk medicinal plants and the ideal regions for building Chinese medicinal material markets, respectively. Furthermore, we quantitatively analyzed mismatches between the spatial distribution of commonly used medicinal plant richness, Chinese medicinal material markets, and TCM decoction piece enterprises. We found that the areas suitable for growing commonly used medicinal plants in China were mainly distributed in Hengduan Mountain, Nanling Mountain, Wuling Mountain, and Daba Mountain areas. The Thiessen polygon network based on Chinese medicinal material market localities showed there are currently fewer markets in southwestern, northwestern, and northeastern China than in central and southern China. TCM decoction piece enterprises are concentrated in a few provinces, such as Hebei and Jiangxi. We found that the distribution of commonly used medicinal plants, Chinese medicinal material markets and TCM decoction piece enterprises are mismatched in Henan, Shaanxi, Hunan, Hubei, Zhejiang, Fujian, Chongqing, and Xizang. We recommend strengthening development of the TCM industry in Henan, Hunan, Zhejiang, Shaanxi, Hubei, Chongqing, Fujian, and Xizang; building more Chinese medicinal material markets in southwestern, northwestern, and northeastern China; and establishing medicinal plant nurseries in resource-rich provinces to better protect and domesticate local medicinal plants.

A clinical research of 11cases of human umbilical cord mesenchymal stem cells for curing senile vascular dementia.

BACKGROUND: Patients affected by senile vascular dementia (VaD) suffer from a gradual deterioration in their cognitive expressions as well as the ability of taking care for themselves. This study aimed to investigate the clinical efficacy and safety of improving cognitive function and daily life activities of patients with VaD by transplanting human umbilical cord mesenchymal stem cells (HUCMSCs). METHODS: A total number of 11 patients with senile VaD, who were admitted through outpatient treatment and hospitalized between February 2013 and February 2016, were selected. The diagnosis was based on CT and MRI examinations. The cultivated HUCMSCs (106 /kg) were injected by intravenous (i.v.) infusion on three occasions. Patients were evaluated for the Mini-Mental State Examination (MMSE) with 25-30 as normal, 21-24 as mild dementia, 10-20 as moderate dementia, and 0-9 as severe dementia. In addition, the Barthel index (BI) was used for a standardized activities of daily living (ADLs) with 0-20 as total dependence, 21-60 as severe dependence, 61-90 as moderate dependence, and 91-95 slight dependence. The t-test was performed to compare statistical significance. RESULTS: The study included 11 subjects, one of whom fell out due to an event unrelated to the study. The results show descriptive statistics at different time points. No matter MMSE score or Barthel index, the difference between before treatment and after treatment or follow-up was statistically significant (P < 0.001).Result interpretation: this intervention method has a significant therapeutic effect, and in the 3-month follow-up period, the intervention effect is still significant compared with that before treatment. CONCLUSIONS: Our preliminary clinical observations suggest that the i.v. infusion of HUCMSCs significantly improved the cognitive function (MMSE) and daily life activities (BI) of patients with senile VaD. This approach may prove to be safe and relatively simple method to be applied for the treatment of senile VaD.

Applications of additive manufacturing (AM) in sustainable energy generation and battle against COVID-19 pandemic: The knowledge evolution of 3D printing.

Sustainable and cleaner manufacturing systems have found broad applications in industrial processes, especially aerospace, automotive and power generation. Conventional manufacturing methods are highly unsustainable regarding carbon emissions, energy consumption, material wastage, costly shipment and complex supply management. Besides, during global COVID-19 pandemic, advanced fabrication and management strategies were extremely required to fulfill the shortfall of basic and medical emergency supplies. Three-dimensional printing (3DP) reduces global energy consumption and CO2 emissions related to industrial manufacturing. Various renewable energy harvesting mechanisms utilizing solar, wind, tidal and human potential have been fabricated through additive manufacturing. 3D printing aided the manufacturing companies in combating the deficiencies of medical healthcare devices for patients and professionals globally. In this regard, 3D printed medical face shields, respiratory masks, personal protective equipment, PLA-based recyclable air filtration masks, additively manufactured ideal tissue models and new information technology (IT) based rapid manufacturing are some significant contributions of 3DP. Furthermore, a bibliometric study of 3D printing research was conducted in CiteSpace. The most influential keywords and latest research frontiers were found and the 3DP knowledge was categorized into 10 diverse research themes. The potential challenges incurred by AM industry during the pandemic were categorized in terms of design, safety, manufacturing, certification and legal issues. Significantly, this study highlights the versatile role of 3DP in battle against COVID-19 pandemic and provides up-to-date research frontiers, leading the readers to focus on the current hurdles encountered by AM industry, henceforth conduct further investigations to enhance 3DP technology.

Pternopetalum paucifoliolatum (Apiaceae), a new Critically Endangered species from Sichuan, China.

Pternopetalum paucifoliolatum, a new species from Sixigou Scenic Area, Emeishan City, Sichuan Province, is proposed and described. Diagnostic morphological characters, full description, detailed illustrations, and a distribution map are provided. The new species is similar to P. porphyronotum in possessing the 1-pinnate leaves and the abaxially purple-red leaflets, but differs from the latter by shorter stature, fewer leaflets ((1-) 3-7) and rays (5-8), the leaflet margin white-ciliate. The new species, which is assessed as Critically Endangered (CR), was only found on limestone cliffs. We also provide a new key to the species of Pternopetalum.

Propofol alleviates the disruption of blood-brain barrier caused by cerebral ischemia / 局解手术学杂志

Objective To investigate the protective effect and mechanism of propofol on the blood-brain barrier in rats with cerebral ischemia.Methods A total of 48 10-week-old male SD rats were randomly divided into the sham group,the cerebral ischemia group,the propofol group and the propofol+LY294002 group.Twenty-four hours before the induction of the model,the rats in the propofol+LY294002 group were intracerebroventricularly injected with PI3K inhibitor LY294002(0.3 mg·kg-1),and the rats in the other groups were administrated with saline(10 μL).Rats in the cerebral ischemia group,the propofol group and the propofol+LY294002 group established cerebral ischemia models by carotid artery occlusion.Rats in the sham group only isolated the common carotid artery and ligated the external carotid artery without other treatment.During the modeling period,the rats in the propofol group and the propofol+LY294002 group were given propofol(10 mg·kg-1)via the tail vein,and the sham group and the propofol group were treated with saline.After 24 hours,the neurological function of rats was evaluated by Zea Longa method;the area of cerebral infarction was detected by TTC staining;the degree of cerebral edema was detected by the dry-wet weight method.EB tracer method was used to evaluate the integrity of the blood-brain barrier;ELISA was used to detect inflammatory cytokines in cerebrospinal fluid;Western blot was used to detect the expression of PI3K/AKT signaling pathway proteins and blood-brain barrier tight junction proteins Claudin-5 and Occludin.Results Cerebral ischemia led to the increase of neurological function scores and local infarction of brain tissues in rats.Compared with the sham group,the EB content in the brain tissue of rats in the cerebral ischemia group increased,the degree of brain edema increased,and the content of inflammatory cytokines in the cerebrospinal fluid increased.And the use of propofol could significantly decrease the neurological function scores,reduce the area of cerebral infarction,inhibit EB penetrating blood-brain barrier,reduce the degree of brain edema,reduce the release of inflammatory cytokines,and up-regulate the expression of PI3K/AKT signaling pathway proteins and tight junction proteins Claudin-5 and Occludin.LY294002 significantly reversed the above effects of propofol.Conclusion Propofol can maintain the expression of tight junction proteins Claudin-5 and Occludin through the PI3K/AKT signaling pathway,protect the structural and functional integrity of blood-brain barrier,reduce the degree of brain edema,prevent other inflammatory cytokines into the brain tissue,reduce cerebral infarction,and alleviate the neurological functional damage caused by cerebral ischemia.

Study on cognitive load level and influencing factors of emergency nurses / 中国现代医生

Objective To explore the cognitive load level and influencing factors of emergency nurses.Methods Using convenience sampling method,48 nurses in emergency department of China-Japan Friendship Hospital from April to May 2022 were selected as research objects.General data were collected and total cognitive load and three different types of cognitive load were measured.Results Regression analysis showed that nurse-patient relationship was influencing factor of total cognitive load of nurses in emergency department(β=6.202,P=0.007),the noisy working environment was the influencing factor of the internal cognitive load(β=1.042,P<0.001),and the living situation(sharing with others)was the influencing factor of the external cognitive load(β=-3.917,P=0.006).The factors of associated with cognitive load were not found.Conclusion The total cognitive load and the three types of cognitive load of nurses in emergency department are high.Nursing managers can reduce the cognitive load of nurses in emergency department by adjusting related influencing factors,so as to improve nursing work efficiency.

Visualization analysis on implementation science in translation of clinical practice guidelines based on knowledge graph / 中国实用护理杂志

Objective:To investigate the hot topics and trends of implementation science in the transformation of clinical practice guidelines, in order to provide ideas and references for clinical managers to reasonably apply and implement scientific promotion guidelines.Methods:CiteSpace6.2.R3 software was used to visualize the literature, which retrieved from the core database of Web of Science, including the number of articles, countries and high-frequency keywords and keyword clustering and emergence for visual analysis, etc.Results:A total of 4 593 articles were included in the final analysis. Since 1993, the number of published papers had increased year by year. The hot topics focused on primary care, attitudes, knowledge translation, clinical trials, risk factors and machine learning. The research trends included older adults and artificial intelligence.Conclusions:The rapid development of implementation science in guideline translation research suggests that scholars from various countries, especially hospital administrators should reasonably apply implementation science framework to integrate evidence into clinical practice, and promote the implementation of clinical practice guidelines.

Development and progress in the application of smart health technologies for older adults with mild cognitive impairment / 中华老年医学杂志

Under the backdrop of smart health management technology development, this article reviews research advances in smart monitoring, assessment and intervention technologies for older people with mild cognitive impairment, including the types, typical applications and results of monitoring, assessment and intervention technologies.In addition, from the perspective of community-dwelling older adults' cognitive health management, a model for innovative management of community-dwelling older adults' cognitive function taking advantage of smart health management technologies is proposed, aiming to enhance the acceptance of smart health technologies among older people with cognitive impairment and to provide policy advice on developing friendly communities for older people with cognitive impairment.

Safety and efficacy of linaclotide combined with polyethylene glycol for bowel preparation / 基础医学与临床

Objective To evaluate safety and efficacy of linaclotide combined with polyethylene glycol(PEG)for bowel preparation.Methods A total of 612 patients from Department of Gastroenterology at the Affiliated Hospital of Qingdao University for colonoscopy examination from January to June 2023 were selected.They were divided into group 1(1 L PEG+2 L PEG),group 2(linaclotide+2 L PEG)and group 3(1 L PEG+linaclotide+1 L PEG)by random number table method,with 204 cases in each group.The Ottawa Bowel Preparation Quality Scale(OBPS),the insertion time of colonoscopy,the time of the first defecation,the frequency of defecations,the occurrence of adverse effects and patients'tolerability were compared among the three groups.Results A total of 601 patients completed bowel preparation and accepted colonoscopy.Group 1 exhibited no statistically significant differences to group 2 with regards to OBPS and insertion time.However,Group 2 demonstrated a shorter duration for the time of the first defecation in comparison to both group 1 and group 3(P＜0.05).Group 1 displayed a higher frequency of defecations as compared to Group 2 and Group 3(P＜0.05).The incidence of adverse reactions was significantly lower in group 2 and group 3 than in group 1(P＜0.05).The overall tolerance score of patients in group 1 was low-er than that in group 2 and group 3(P＜0.05).Conclusions The effect of combining 2 L PEG with 290 μg of lina-clotide for bowel preparation before colonoscopy is similar to that of 3 L PEG.It can reduce the incidence of adverse reactions and patients exhibit good tolerance.For patients who are intolerant to a single high-dose administration of PEG,they need divided-dose regimen of 2 L PEG in combination with linaclotide.

Clinical analysis of 11 cases multisystem inflammatory syndrome associated with SARS-CoV-2 Omicron variant infection in children / 中华儿科杂志

Objective: To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection. Methods: A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study. Results: The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months. Conclusions: MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.