Lung transplantation after paraquat poisoning in an adolescent: one case report and literature review / 器官移植

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

Comparison of short-term visual acuity and visual disturbance phenomena and spectacle independence after implantation of three different intraocular lenses / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the short-term postoperative visual acuity, visual disturbance phenomena, and spectacle independence rate in patients who underwent monocular implantation with trifocal, multifocal, or extended range of vision intraocular lens(IOL).METHODS: A retrospective analysis was conducted on 67 cataract patients(67 eyes)who underwent phacoemulsification cataract extraction combined with IOL implantation from March 2019 to December 2022. A total of 35 cases(35 eyes)received Symfony extended range of vision IOL implantation, 21 cases(21 eyes)received AcrySof IQ ReSTOR +3D multifocal IOL, and 11 cases(11 eyes)received AcrySof IQ PanOptix trifocal IOL. The preoperative uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), and uncorrected near visual acuity(UNVA)and 3 mo postoperatively were documented. Moreover, defocus curves, visual disturbance phenomena, and spectacle independence rates were recorded at 3 mo postoperatively.RESULTS: At 3 mo postoperatively, no statistically significant differences were observed in UDVA among the three groups(P>0.05). A comparison of UIVA showed superior results in the Symfony and PanOptix groups compared to the ReSTOR group(all P<0.01). The UNVA of both the ReSTOR and PanOptix groups outperformed the Symfony group(all P<0.01). The defocus curves indicated that in the intermediate vision range(-1.00 to -1.50 D), the Symfony group exhibited better performance than the ReSTOR group(P<0.05); while in the near vision range(-2.50 to -3.50 D), the ReSTOR group was superior to the Symfony group(P<0.05). The PanOptix group demonstrated superior visual acuity in the near vision range(-2.00 to -3.50 D)compared to the Symfony group(P<0.05)and was also superior in the intermediate vision range(-1.00 to -2.00 D)compared to the ReSTOR group(P<0.05). No significant differences were observed in the incidence of glare or halo and binocular interference phenomena among the three groups(P>0.05). The PanOptix and ReSTOR groups exhibited a higher spectacle independence rate compared to the Symfony group(P<0.0167).CONCLUSION: Compared to Symfony extended range of vision IOL and ReSTOR multifocal IOL, PanOptix trifocal IOL offers a balanced approach to distance, intermediate, and near visual acuity, without a high incidence of glare and halo, and with a higher spectacle independence rate. Caution is still advised when considering monocular implantation with presbyopia-correcting IOLs.

Thoracoscopic laparoscopy-assisted Ivor-Lewis resection of esophagogastric junction cancer / 中华肿瘤杂志

Objective: To investigate the outcome of patients with esophagogastric junction cancer undergoing thoracoscopic laparoscopy-assisted Ivor-Lewis resection. Methods: Eighty-four patients who were diagnosed with esophagogastric junction cancer and underwent Ivor-Lewis resection assisted by thoracoscopic laparoscopy at the National Cancer Center from October 2019 to April 2022 were collected. The neoadjuvant treatment mode, surgical safety and clinicopathological characteristics were analyzed. Results: Siewert type Ⅱ (92.8%) and adenocarcinoma (95.2%) were predominant in the cases. A total of 2 774 lymph nodes were dissected in 84 patients. The average number was 33 per case, and the median was 31. Lymph node metastasis was found in 45 patients, and the lymph node metastasis rate was 53.6% (45/84). The total number of lymph node metastasis was 294, and the degree of lymph node metastasis was 10.6%(294/2 774). Among them, abdominal lymph nodes (100%, 45/45) were more likely to metastasize than thoracic lymph nodes (13.3%, 6/45). Sixty-eight patients received neoadjuvant therapy before surgery, and nine patients achieved pathological complete remission (pCR) (13.2%, 9/68). Eighty-three patients had negative surgical margins and underwent R0 resection (98.8%, 83/84). One patient, the intraoperative frozen pathology suggested resection margin was negative, while vascular tumor thrombus was seen on the postoperative pathological margin, R1 resection was performed (1.2%, 1/84). The average operation time of the 84 patients was 234.5 (199.3, 275.0) minutes, and the intraoperative blood loss was 90 (80, 100) ml. One case of intraoperative blood transfusion, one case of postoperative transfer to ICU ward, two cases of postoperative anastomotic leakage, one case of pleural effusion requiring catheter drainage, one case of small intestinal hernia with 12mm poke hole, no postoperative intestinal obstruction, chyle leakage and other complications were observed. The number of deaths within 30 days after surgery was 0. Number of lymph nodes dissection, operation duration, and intraoperative blood loss were not related to whether neoadjuvant therapy was performed (P>0.05). Preoperative neoadjuvant chemotherapy combined with radiotherapy or immunotherapy was not related to whether postoperative pathology achieved pCR (P>0.05). Conclusion: Laparoscopic-assisted Ivor-Lewis surgery for esophagogastric junction cancer has a low incidence of intraoperative and postoperative complications, high safety, wide range of lymph node dissection, and sufficient margin length, which is worthy of clinical promotion.

Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital

INTRODUCTION@#There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore.@*METHODS@#A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed.@*RESULTS@#A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation.@*CONCLUSION@#The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.

Evaluation of left and right ventricular systolic function by cardiac MR compressed sensing ultrafast cine sequence / 中华放射学杂志

Objective:To explore the clinical value of cardiac MR (CMR) compression sensing (CS) ultrafast cine sequence in evaluating left and right ventricular systolic function by comparing with traditional segmented acquisition cine sequence (Seg).Methods:Twenty-seven patients with various heart disease were prospectively included. Seg, breath holding CS (bhCS) and free breathing CS (fbCS) covering the left and right ventricles using multi slices in short axis were performed in random order. Friedman test was used to evaluate the overall image quality (grade 1-5 score), blood pool myocardial signal ratio (BMC) and edge sharpness under different methods. Biventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and left ventricular myocardial mass (Mass) were measured for all three methods. The agreements of the functional measurements between bhCS and Seg (gold standard), and between fbCS and Seg were analyzed by Bland-Altman, and the correlation test was performed.Results:Twenty-four patients with diagnostic images(overall image quality score≥2) for all three methods were included in further analysis. The total imaging time of Seg, bhCS and fbCS decreased successively[375.0 (332.0, 405.6) vs. 50.0 (47.8, 53.7) vs. 20.0 (17.8, 23.7) s, χ 2=48.00, P<0.001]. The overall image quality of fbCS was slightly lower than that of Seg ( Z=-2.67, P=0.023), and there was no difference between Seg and bhCS ( Z=-1.44, P=0.447), bhCS and fbCS ( Z=1.23, P=0.660). There were no differences in edge sharpness (χ 2=1.08, P=0.582) and BMC (χ 2=0.58, P=0.747) for three methods. Bland-Altman polts showed good agreement for biventricular functional measurements between bhCS and Seg, and between fbCS and Seg. All functional measurements of bhCS and fbCS were highly correlated with that of seg ( r>0.96, P<0.001). Conclusions:Compared with traditional sequences, CS ultrafast cine sequences can save scanning time and provide similar image quality. No matter whether breath holding or not, the cardiac functional results of CS sequence and traditional cine sequence have good agreement and high correlation.

3D printed guide plate assisted and C-arm X-ray fluoroscopic positioning for femoral tunnel reconstruction of medial patellofemoral ligament in treating recurrent patellofemoral dislocation: a comparison of efficacies / 中华创伤杂志

Objective:To compare the efficacies of 3D printed guide plate assisted positioning and C-arm X-ray machine fluoroscopic positioning for femoral tunnel reconstruction of medial patellofemoral ligament in treating recurrent patellofemoral dislocation.Methods:A retrospective cohort study was performed on the clinical data of 60 patients with recurrent patellar dislocation admitted to the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2022. The patients included 29 males and 31 females, with age range of 14-40 years [(28.6±7.6)years]. The 3D printed guide plate was used to locate the femoral tunnel in 30 patients for medial patellofemoral ligament reconstruction (3D guide group), and C-arm X-ray machine was used for another 30 patients (conventional group). (1) CT data of the knee joint were collected before surgery and at 7 days after surgery. Mimics 19.0 software was introduced to measure the distance between the center of femoral tunnel and Sch?ttle point after surgery. (2) Knee Lysholm score and Kujala score were used to evaluate the knee function before and at 3, 6, 9 and 12 months after surgery. (3) At the same time points, Opti-Knee TM 3D knee kinematics analysis system was used to collect the forward and backward displacement, up and down displacement, internal and external displacement, internal and external flipping angle, internal and external rotation angle, and flexion and extension angle of the affected knee joint. The range of each freedom degree was calculated and 6 freedom degree items of 30 healthy people were subjected to knee kinematics analysis. Results:All patients were followed up for 12-15 months [(12.3±0.7)months]. (1) The distance between the center of femoral tunnel and Sch?ttle point in the 3D guide group was (5.5±2.3)mm, smaller than that in the conventional group [(7.6±2.5)mm] ( P<0.01). (2) The Lysholm score and Kujala score of the 3D guide group and conventional gruop gradually increased after surgery (all P<0.01). There were no significant differences in the Lysholm score or Kujala score between the 3D guide group and conventional gruop before surgery and at 12 months after surgery (all P>0.05). At 3, 6 and 9 months after surgery, the Lysholm score of the 3D guide group [(70.4±4.5)points, (86.4±3.1)points, (91.2±3.2)points] and Kujala score [(74.2±5.3)points, (80.9±3.5)points, (85.2±3.2)points] were higher than those of the conventional group [Lysholm score: (67.3±5.2)points, (81.8±2.5)points, (86.2±1.9)points; Kujala score: (69.8±5.2)points, (77.6±2.1)points, (82.7±2.6)points] ( P<0.05 or 0.01). (3) Before surgery, the forward and backward displacement in the 3D guide group and conventional group [(0.6±0.1)cm, (0.6±0.2)cm], up and down displacement [(0.5±0.1)cm, (0.6±0.0)cm], internal and external displacement [(0.7±0.1)cm, (0.6±0.2)cm], and flexion and extension angle [(50.6±10.3)°, (51.6±8.5)°] were less than those in the healthy controls [(1.6±0.3)cm, (1.7±0.5)cm, (1.0±0.4)cm, (63.2±5.1)°] (all P<0.05), while the internal and external flipping angle [(17.5±4.0)°, (17.1±3.8)°] and internal and external rotation angle [(17.9±1.9)°, (17.5±1.5)°] were greater than those in the healthy controls [(11.8±3.6)°, (15.8±4.9)°] (all P<0.05). At other time points, the results of front and back displacement, up and down displacement, internal and external displacement, internal and external rotation angle in the 3D guide group and conventional group were not significantly different compared with the healthy controls (all P>0.05). The flexion and extension angle in the 3D guide group and conventional gruop were smaller than those in the healthy controls at 3 months after surgery (all P<0.05). At 6 and 9 months after surgery, the flexion and extension angle in the conventional group [(55.0±3.7)°, (57.7±4.8)°] were smaller than those in the healthy controls [(63.2±5.1)°, (63.2±5.1)°] (all P<0.05), but no significant difference was found between the 3D guide group [(61.0±4.8)°, (61.8±4.9)°] and the healthy controls (all P>0.05). The flexion and extension angle in the 3D guide group and conventional gruop was similar with that in the healthy controls at 12 months after surgery (all P>0.05). Conclusions:Compared with the C-arm X-ray machine, the 3D printed guide plate assisted positioning of femoral tunnel is more simple and accurate for the medial patellofemoral ligament reconstruction in treating recurrent patellofemoral dislocation, together with better early knee function recovery, better satisfaction of the patients, and better and faster restoration of the flexion and extension angle of knee joint kinematic function.

Effect of vitamin D drops combined with insulin aspart in the treatment of gestational diabetes mellitus and its influence on serum 1, 25(OH) 2D 3 and RBP4 levels / 中国医师杂志

Objective:To investigate the clinical efficacy of vitamin D drops combined with insulin aspart in the treatment of gestational diabetes mellitus (GDM), and the effect of vitamin D drops on the serum levels of 1, 25 dihydroxyvitamin D 3 [1, 25(OH) 2D 3] and retinol binding protein 4 (RBP4). Methods:A total of 94 GDM patients admitted to the Baoding Second Central Hospital from March 2019 to March 2021 were selected and randomly divided into an observation group and a control group with 47 cases each using a random number table method. The control group received subcutaneous injection of insulin aspartate for treatment, while the observation group received oral vitamin D drops for treatment. After 4 weeks of continuous treatment, the blood glucose control effect and adverse reactions were observed in both groups. The glucose metabolism indicators of the two groups were compared before and after treatment, including fasting blood glucose (FPG), 2-hour postprandial blood glucose (2-hour PG), insulin resistance index (HOMA-IR), and pancreatic islets β Cell Function Index (HOMA-β) and serum levels of 1, 25(OH) 2D 3, RBP4, lipoprotein related phospholipase A2 (Lp-PLA2), and vascular cell adhesion molecule-1 (VCAM-1). All patients were followed up until the end of pregnancy, and Statistical analysis was conducted on the adverse outcomes of two groups of mothers and infants. Results:The time to reach the standard for FPG and 2-hour PG in the observation group, as well as the time for both to reach the standard were significantly shorter than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of dawn phenomenon and hypoglycemia between the observation group and the control group (all P>0.05). After treatment, FPG and 2-hour PG in both groups were significantly reduced compared to those before treatment (all P<0.05); However, after treatment, there was no statistically significant difference between the groups (all P>0.05). Compared with before treatment, HOMA-IR in both groups significantly decreased (all P<0.05), All HOMA- β significantly increased (all P<0.05); And the improvement was more significant in the observation group (all P<0.05). After treatment, the serum levels of 1, 25(OH) 2D 3 in the observation group significantly increased compared to that before treatment ( P<0.05), but there was no significant change in the control group before and after treatment ( P>0.05). After treatment, the levels of serum RBP4, Lp-PLA2, and VCAM-1 in both groups significantly decreased compared to those before treatment (all P<0.05); After treatment, the serum levels of RBP4, Lp-PLA2, and VCAM-1 in the observation group were lower than those in the control group (all P<0.05). The incidence of adverse maternal and neonatal outcomes in the observation group was 14.9%(7/47) and 10.6%(5/47), respectively, which were lower than those in the control group [34.0%(16/47) and 27.7%(13/47)] (all P<0.05). There were 8 cases of hypoglycemia in 94 patients (3 in the observation group and 5 in the control group), and no other adverse events occurred. Conclusions:The combination of vitamin D drops and insulin aspartate in the treatment of GDM can safely, effectively, quickly, and steadily control patients′ blood sugar, improve IR and pancreatic islets β The effect of cell function on reducing the incidence of adverse maternal and fetal outcomes may be related to increasing serum 1, 25(OH) 2D 3 levels and down-regulating the expression levels of serum RBP4, Lp-PLA2, and VCAM-1.

Risk factors analysis and prediction model establishment of anti-MDA5 antibody-positive dermatomyositis with rapid progression of interstitial lung disease / 中国医师杂志

Objective:To analyze the Risk factors for rapid progression of inpatients with anti-melanoma differentiation associated gene5 (MDA5) antibody-positive dermamyositis (DM) complicated with interstitial lung disease (ILD), and construct a clinical predictive model.Methods:A total of 63 hospitalized patients with anti MDA5 positive DM combined with ILD (MDA5+ DM-ILD) from January 1, 2016 to May 30, 2022 at the Second Affiliated Hospital of the Air Force Military Medical University were included in the study. They were divided into a control group (DM-ILD) and an observation group (DM-RPPILD) based on whether they had rapidly progressing interstitial lung disease (RPILD). Retrospective collection and organization of clinical case data from patients were conducted, and binary logistic regression was used to summarize the risk factors of DM-RPILD. R software was used to construct a clinical prediction model for RPILD occurrence using training set data, and validation set data was used to verify the predictive ability of the model.Results:The proportion of patients with SpO 2<90% at the initial diagnosis of ILD, the titers of anti MDA5 antibodies, immunoglobulin M (IgM), serum ferritin (FER) levels, and positive rates of anti Ro52 antibodies in the observation group were higher than those in the control group, the lymphocyte (LYM) count level was lower than that of the control group (all P<0.05). Binary logistic regression analysis showed SpO 2<90% at the initial diagnosis of ILD, FER level, LYM count, and anti Ro52 antibody were the influencing factors for the occurrence of RPILD (all P<0.05). The area under the curve (AUC) of the training set prediction model for predicting resistance to MDA5+ DM-RPILD was 0.922(95% CI: 0.887-0.957), with a sensitivity of 95.7% and a specificity of 72.5%; In the validation set, the prediction model predicted an AUC of 0.939(95% CI: 0.904-0.974) for resistance to MDA5+ DM-RPILD, with a sensitivity of 90.0% and a specificity of 88.9%; The calibration curves of the training and validation sets indicated that the predictive model had good calibration ability. Conclusions:SpO 2<90% at the initial diagnosis of ILD, FER levels increase, LYM count levels decrease, and anti Ro52 antibody positivity are risk factors for RPILD. The constructed clinical model has good predictive ability and has certain guiding significance for clinical work.

Correlation of serum 25-hydroxyvitamin D and parathyroid hormone levels with hypertension in patients with type 2 diabetes mellitus / 中国基层医药

Objective:To correlate serum 25-hydroxylvitamin D and parathyroid hormone levels with hypertension in patients with type 2 diabetes mellitus.Methods:A total of 100 patients with type 2 diabetes mellitus admitted to Siming Branch, the First Affiliated Hospital of Xiamen University, China from February 2018 to August 2020 were included in this study. These patients were stratified according to hypertension, and serum 25-hydroxyvitamin D level. The correlation between serum 25-hydroxyvitamin D and parathyroid hormone and hypertension was analyzed.Results:Among the 100 patients with type 2 diabetes meliitus, 25 patients had grade 1 hypertension, 30 patients had grade 2 hypertension, 45 patients had grade 3 hypertension, 5 patients (5%) had sufficient levels of 25-hydroxyvitamin D, 10 patients (10%) had insufficient levels of 25-hydroxyvitamin D, 85 patients (85%) had inadequate levels of 25-hydroxyvitamin D. Serum levels of 25-hydroxyvitamin D in patients with grade 1, grade 2, and grade 3 hypertension were (12.18 ± 2.52) μg/L, (12.45 ± 2.39) μg/L, (10.33 ± 1.26) μg/L, respectively, and parathyroid hormone levels were (36.48 ± 0.25) ng/L, (41.15 ± 0.39) ng/L, and (47.52 ± 1.44) ng/L, respectively. As blood pressure increased, the patient's serum levels of 25-hydroxyvitamin D increased first and then decreased, while parathyroid hormone levels gradually increased. However, there were no statistically significant differences in serum levels of 25-hydroxyvitamin D and parathyroid hormone between patients of different hypertension grades ( F = 0.96, 1.93, both P > 0.05). Logistic regression analysis showed that hypertension in type 2 diabetes patients was correlated with age, body mass index, serum 25 hydroxyvitamin D level, glycated hemoglobin and parathyroid hormone level ( OR = 1.076, 1.266, 0.937, 1.257, 1.000, all P < 0.05). Conclusion:The serum levels of 25-hydroxyvitamin D and parathyroid hormone in patients with type 2 diabetes mellitus are related to hypertension.

Application of virtual intelligent system in bronchoscopy theory and operation training for PCCM physicians / 中华医学教育探索杂志

Objective:To evaluate the role of virtual bronchoscopy intelligent system in improving the theory and operation level of bronchoscopy in pulmonary and critical care medicine (PCCM) teaching for standardized training specialists.Methods:A total of 50 PCCM physicians who had participated in virtual bronchoscopy training in Xijing Hospital, Air Force Medical University from 2018 to 2021 were selected as research subjects. In this study, self-controlled method was adopted to evaluate the change of assessment indicators after 1 week and 2 weeks of training. Questionnaire survey was also used to evaluate the training effect. SPSS 23.0 software was used for paired t-test and Chi-square test. Results:All the 50 PCCM physicians successfully completed the training of virtual bronchoscopy operation. The theoretical score was significantly improved after the training [(80.0±5.2) points vs. (92.4±3.8) points]. The basic operation time [(1 050.9±103.3) s vs. (386.4±47.7) s], and the number of hitting the bronchial wall [(88.3±12.7) times vs. (27.0±5.3) times] were significantly reduced. The recovery rate of alveolar lavage fluid [(27.6±7.4)% vs. (58.0±8.2)%] and the positive rate of biopsy [(19.2±13.1)% vs. (86.8±10.8)%] were significantly increased. The learning curve of the final score indicated that the score improved more rapidly in the first week of training, and the score improved more slowly in the second week of training. Questionnaires before and after the training indicated that virtual intelligent training could significantly improve the confidence and proficiency of students in bronchoscopy.Conclusion:Through the systematic training of virtual bronchoscopy intelligent system, the PCCM physicians have significantly improved their theoretical knowledge and operational proficiency. Therefore, the virtual bronchoscopy training system has practical significance for improving the overall training effect of clinical bronchoscopy for PCCM trainees, which is worthy of promotion.

Experimental study of online teaching based on reflective experience in the cultivation of professional core competence of nursing / 中华医学教育探索杂志

Objective:To evaluate the practical effect of online teaching based on reflective experience to promote the cultivation of professional core competence of nursing.Methods:A total of 160 intern nurses who entered the clinic from July 2019 to December 2019 in The Affiliated Hospital of Inner Mongolia Medical University were selected as the research subjects, and they were randomized into a control group and an experimental group, with 80 nurses in each group. Both groups were given the creation of clinical practice teaching online classroom under the existing nursing online teaching framework. The control group conducted general online course education, and the experimental group created a problem-solving reflective experience course task and teaching process from the core competence training content of nursing. After the internship, the core competence assessment of the standardized training for nursing major was conducted, and the difference in teaching was evaluated using the "Nurse Core Competency Scale" and the self-designed "Teaching Acceptance Questionnaire". SPSS 22.0 was used for t-test and Chi-square test. Results:The excellent rates of the professional theory and practical skills assessments of the students in the experimental group were 58.75% (47/80) and 51.25% (41/80), which were higher than those in the control group, 48.75% (39/80) and 31.25% (25/80). The differences between the two groups were statistically significant ( P<0.05). In the comparison of the "Core Competency Scale" of nurses between the two groups of nurse students, the total score of the experimental group and the score of each dimension were significantly higher than those of the control group ( P<0.05). They survey of "Teaching Acceptance Questionnaire" showed that the nursing students of the experimental group had higher recognition of the teaching methods of this group, and there were significant differences between the two groups ( P<0.05). Conclusion:Carrying out online training content of clinical practice teaching based on reflective experience is conducive to the establishment of core competence of nursing students and the improvement of clinical practice ability.

Study of preventing venous graft restenosis by local application of simvastatin and mechanical preconditioning / 中国胸心血管外科临床杂志

@#Objective    To investigate the effect of simvastatin and mechanical pretreatment on intimal hyperplasia of venous graft and its mechanism. Methods    Twelve New Zealand rabbits were selected and randomly divided into 4 groups: a blank control group, a simvastatin topical treatment group, a mechanical precondition group and a combined group (n=3 in each group). Ultrasound was used to evaluate the changes of graft wall and blood flow velocity in the graft, and pathological section was used to evaluate the intimal hyperplasia. Human umbilical cord endodermal cells were cultured in vitro. A simvastatin group and a solvent control group were set to detect YAP phosphorylation, downstream target gene expression and cell proliferation. Results    Vascular ultrasound showed that except the simvastatin topical treatment group, the flow velocity in vein grafts in the other three groups significantly increased 21 days after surgery compared with 7 days after surgery (P<0.01). Pathological sections showed that the thickness of new intima in the simvastatin topical treatment group, mechanical precondition group, combined group and blank control group were 45.56±4.11 μm, 201.28±16.71 μm, 143.57±7.82 μm, 249.45±13.33 μm, respectively, and there were statistical differences compared with the blank control group (P<0.05). In vitro results showed that compared with the solvent control group, cell death was observed in high concentration simvastatin (5 mmol/L) group, cell proliferation was inhibited in low concentration simvastatin (2.5 mmol/L) group (P<0.05), the expression of YAP protein in the simvastatin group was unchanged, but the expression of phosphorylated YAP protein significantly increased (P<0.05), and the expression of downstream target gene ccn1 was down-regulated (P<0.001). Conclusion    Intravascular local application of simvastatin and mechanical preconditioning alone or in combination can inhibit intimal hyperplasia of venous graft. High concentration of simvastatin has cytotoxicity, while low concentration of simvastatin has inhibitory effect on cell proliferation. Simvastatin can inhibit the formation of new intima by inhibiting the entry of YAP into the nucleus and reducing the transcription of cell proliferation-related target gene ccn1.

Study on the intestinal absorption characteristics of saikosaponins / 中国药房

OBJECTIVE To explore the intestinal absorption characteristics of saikosaponins. METHODS Based on everted intestinal sac model， using accumulative absorption amount （Q） and absorption rate constant （Ka） as indexes， UHPLC-MS/MS technique as a method， the absorption of saikosaponin A， B2， C， D and F from total saponins of Bupleurum chinense （8 g/mL， by crude drug） in the duodenum， jejunum and ileum was detected. RESULTS The correlation coefficients （r） of the regression equations for the absorption of saikosaponins A， B2， C and F in the duodenum， jejunum and ileum were all higher than 0.95， while the r of saikosaponin D in the above intestinal segments was lower than 0.95； compared with the absorption of the same composition in the duodenum， the Q and Ka of saikosaponin A and C circulating in jejunum and ileum for 120 min， as well as the Q and Ka of saikosaponin F circulating in the ileum for 120 min were significantly decreased （P＜0.05）. CONCLUSIONS Saikosaponin A and the other 4 saikosaponins are all absorbed in the duodenum， jejunum and ileum； among them， saikosaponin A， B2， C and F are linearly absorbed， which conforms to the zero-order absorption characteristics， but saikosaponin D shows non- linear absorption.

The mechanism of modified Gan Cao Fu Zi Decoction in the treatment of rheumatoid arthritis based on network pharmacology and experimental validation / 药学学报

We used network pharmacology to predict the mechanism in the treatment of rheumatoid arthritis (RA) via modified Gan Cao Fu Zi Decoction (GCFZ), and validated the results of the analysis and explored the pharmacodynamic effects of GCFZ through animal experiments. Firstly, TCMID, SymMap, HERB, STITCH and GEO databases were utilized to obtain the target genes of GCFZ for the treatment of RA, which yielded a total of 1 250 differentially expressed genes for RA, 534 genes for GCFZ targets and 83 intersecting genes. Then functional enrichment analysis of the intersecting genes was performed through GO and KEGG databases, and the results revealed that GCFZ and its active ingredients mainly functioned through cytokine pathways, where chemokine signaling pathway and tumor necrosis factor (TNF) signaling pathway were enriched with a high number of genes. Cytoscape 3.8.0 software was used to construct the drug-target-disease network and screen key proteins, which included TNF, C-X-C chemokine ligand 8 (CXCL8), C-X-C chemokine ligand 10 (CXCL10), C-C chemokine ligand 5 (CCL5), C-X-C chemokine ligand 2 (CXCL2) and C-X-C chemokine receptor type 4 (CXCR4). The molecular docking technology was used to confirm the binding ability of the main active ingredients of GCFZ to the core proteins. Additionally, the therapeutic effects of GCFZ in low (4 g·kg-1), medium (8 g·kg-1) and high (16 g·kg-1) dose groups were investigated by constructing the collagen-induced arthritis (CIA) rat model. X-ray imaging approach, HE staining and Safranin O-Fast Green staining showed that GCFZ treatment significantly improved bone destruction, synovial hyperplasia and cartilage damage in CIA rats, while immunofluorescence results showed that GCFZ treatment could regulate the expression of TNF, CXCL8 and CCL5. In summary, our results indicate that GCFZ contains a variety of small molecule pharmacodynamic substances, which can exert therapeutic effects via multiple targets and pathways, and obviously reduce the symptoms of arthritis in CIA rats. This animal experiment of our research was approved by the Experimental Animal Management and Ethics Committee of Bengbu Medical College.

Intrapatient variability of tacrolimus trough concentrations and its effect on serum creatinine level in kidney transplant recipients treated with nematvir/ritonavir / 器官移植

Objective To investigate the intra-patient variability (IPV) of tacrolimus trough concentrations and its effect on serum creatinine (Scr) level in kidney transplant recipients treated with nematvir/ritonavir. Methods Clinical data of 41 kidney transplant recipients infected by SARS-CoV-2 and treated with nematvir/ritonavir were collected. The usage of nematvir/ritonavir and tacrolimus was summarized. The distribution of tacrolimus trough concentrations and the attainment rate of target concentration were analyzed. The correlation between the IPV distribution of tacrolimus trough concentrations and the changes of Scr level was determined. Results Among 41 kidney transplant recipients, 46%(19/41) were given with full- and low-dose nematvir/ritonavir, and 7%(3/41) were given with high-dose nematvir/ritonavir. Use of tacrolimus was discontinued at 24 h before nematvir/ritonavir treatment in 95%(39/41) patients, and at 24 h after use of nematvir/ritonavir in 5%(2/41) patients. Tacrolimus was given at least 3 d after the 5-d course of nematvir/ritonavir in all patients. The attainment rate of tacrolimus trough concentration was 73%(30/41), 30%(3/10), 48%(15/31), 35%(11/31) and 53%(16/30) before, during, 1 week, 2 weeks and 1 month after use of nematvir/ritonavir, respectively. The median IPV was 35%(23%, 51%). Spearman correlation analysis showed that the increase of Scr level was positively correlated with IPV (rs=0.400 7, P=0.028 2). Conclusions The attainment rate of tacrolimus trough concentration is declined in kidney transplant recipients treated with nematvir/ritonavir. The IPV of tacrolimus trough concentrations is elevated. The recipients with higher IPV are prone to an elevation in Scr level.

Syndrome Differentiation and Treatment of Obesity from "Orchids to Eliminate Stagnant Qi" / 中国实验方剂学杂志

Obesity is a chronic， recurrent， and progressive metabolic disorder characterized by the abnormal or excessive accumulation of body fat caused by multiple factors such as genetics， dietary structure， lifestyle and behavior， psychology， environment， and society， leading to an energy surplus. Obesity is a major risk factor that increases the risk of developing various chronic diseases， including type 2 diabetes， hypertension， cardiovascular diseases， stroke， and certain malignancies. The global incidence of obesity is increasing year by year. With the continuous improvement of people's living standards， more than half of adults in China are now overweight or obese， posing a serious threat to people's health and increasing the social and economic burden. It has become a pressing major public health issue that needs to be addressed urgently. The concept of obesity can be traced back to the Huangdi’s Internal Classic （Huang Di Nei Jing）， which describes it as "the problems in fat and affluent people are caused by excessive taking of rich food"， and suggests that ''frequent intake of rich and greasy foods can produce interior heat. Sweet flavor causes chest fullness. That is why its spleen-Qi flows upwards and changes into consumption-thirst disease. It can be treated by Eupatorii Herba which is used to remove stagnant Qi''. The stagnant qi is caused by the transformation failure of rich and greasy food and wine， so obesity is the disease of stagnant qi. Obesity is caused by indulging in rich and greasy food， wine， spicy and flavorful foods， raw and cold foods， and sweet and greasy foods， or overeating and leading a sedentary lifestyle， staying up late， or experiencing emotional imbalances such as excessive joy， anger， worry， pensiveness， and fear. It can also be caused by congenital abnormalities， leading to improper functioning of the spleen and stomach， dysregulation of the absorption and secretion of the small intestine， and the accumulation of stagnant Qi in the organs and muscles， resulting in a plump physique. The intake of food and drink depends on the functions of the stomach in receiving and decomposing， the small intestine in absorbing and secreting， and the spleen in transforming and transporting. The affected organs in obesity are the spleen， stomach， and small intestine. Orchids， specifically Eupatorii Herba and Lycopi Herba， are aromatic herbs that can regulate the smooth flow of Qi， eliminate stagnation， and cleanse impurities. In a broader sense， any aromatic and pungent substance that can invigorate the spleen， promote clarity， harmonize the stomach， reduce turbidity， and assist in the normal secretion and absorption functions of the small intestine， thereby eliminating excess， is referred to as orchid. Therefore， the treatment principle for obesity is to use ''orchids to eliminate stagnant Qi''， aiming to regulate the functions of the spleen， stomach， and small intestine using aromatic and pungent substances， gradually eliminating excessive dampness， phlegm， turbidity， and heat， and restore the balance of the middle energizer. This way， individuals who are obese can achieve a non-obese state.

Effect of Modified Huangqi Guizhi Wuwutang on Apoptosis-related Bax and Caspase-12 of Sciatic Nerve Cells in Diabetes Rats / 中国实验方剂学杂志

ObjectiveTo investigate the effect of modified Huangqi Guizhi Wuwutang （MHGW） on the protein and mRNA expression of B-cell lymphoma-2-associated X protein （Bax） and cysteinyl aspartate specific proteinase-12 （Caspase-12） related to the apoptosis of sciatic nerve cells in diabetes rats to explore the mechanism of MHGW in the treatment of peripheral neuropathy in diabetes. MethodAnimal experiments were conducted. A diabetes model was induced in sixty male sprague-dawley （SD） rats by feeding on a high-sugar and high-fat diet combined with streptozotocin （STZ） intraperitoneal injection. Rats with random blood glucose levels ≥ 16.7 mmol·L-1 for three consecutive days were considered to have successfully developed diabetes. Forty-eight rats that successfully developed diabetes were randomly divided into a model group， an α-lipoic acid group （0.026 8 g·kg-1·d-1）， a high-dose MHGW group （2.5 g·kg-1·d-1）， and a low-dose MHGW group （1.25 g·kg-1·d-1）， with 12 rats in each group. Another 10 rats were assigned to the normal group. Body weight and random blood glucose levels of the rats were monitored. At the end of a 16-week intervention period， the sciatic nerve conduction velocity of the rats was measured using the Key point electromyography collection system. The protein and mRNA expression of Bax and Caspase-12 in the sciatic nerve cells was detected by Western blot analysis and real-time quantitative polymerase chain reaction （Real-time PCR）， respectively. ResultCompared with the normal group， the model group showed a significant decrease in body weight （P<0.01） and a significant increase in random blood glucose levels （P<0.01）. After a 16-week intervention， compared with the model group， the high-dose MHGW group exhibited a significant increase in body weight （P<0.05）， while there were no statistically significant differences in body weight changes among the other treatment groups. Random blood glucose levels significantly decreased in all treatment groups （P<0.01）. After 16 weeks of intervention， compared with the normal group， the model group had significantly reduced motor and sensory nerve conduction velocities （P<0.01）. Compared with the model group， all treatment groups showed significant increases in motor and sensory nerve conduction velocities （P<0.05， P<0.01）. The expression of Bax and Caspase-12 proteins in the sciatic nerve cells was significantly elevated in the model group compared with that in the normal group （P<0.01）. In contrast， all treatment groups showed significant reductions in the expression of Bax and Caspase-12 proteins in the sciatic nerve cells as compared with that in the model group （P<0.01）. The expression of Bax and Caspase-12 mRNA in the sciatic nerve cells significantly increased in the model group compared with that in the normal group （P<0.01）. Compared with the model group， the α-lipoic acid group and the high-dose MHGW group showed significant reductions in the expression of Bax mRNA in the sciatic nerve cells （P<0.05， P<0.01）， while the low-dose MHGW group showed a decreasing trend in the expression of Bax mRNA. The expression of Caspase-12 mRNA in the sciatic nerve cells significantly decreased in all treatment groups （P<0.01）. ConclusionMHGW may improve and repair sciatic nerve damage in diabetes rats by inhibiting sciatic nerve cell apoptosis.

Effect of Modified Huangqi Guizhi Wuwutang on Stress-related IRE1α/CHOP Pathway of Sciatic Nerve Endoplasmic Reticulum in Diabetes Rats / 中国实验方剂学杂志

ObjectiveTo investigate the protective effect of modified Huangqi Guizhi Wuwutang （MHGW） on endoplasmic reticulum stress in the sciatic nerve of diabetes rats based on the pathways of inositol-requiring enzyme 1α （IRE1α） and CCAAT/enhancer-binding protein homologous protein （CHOP）. MethodSixty rats were fed on a high-sugar and high-fat diet for six weeks， followed by intraperitoneal injection of streptozotocin at a dose of 35 mg·kg-1. Random blood glucose levels were measured three days later and rats with a sustained blood glucose level ≥ 16.7 mmol·L-1 were included in study （n=48）. The rats were randomly divided into a model group， an α-lipoic acid group （0.026 8 g·kg-1·d-1）， a high-dose MHGW group （2.5 g·kg-1·d-1）， and a low-dose MHGW group （1.25 g·kg-1·d-1）. Another 10 rats were assigned to the normal group. The intervention lasted for 16 weeks. After 16 weeks， the sciatic nerve structure of the rats in each group was observed under light microscopy using Luxol fast blue （LFB） staining. Transmission electron microscopy was used to observe the ultrastructure of the sciatic nerve. Chemiluminescence method was employed to measure the serum reactive oxygen species （ROS） levels. Western blot and real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） were used to evaluate the expression of p-IRE1α protein， IRE1α mRNA， CHOP protein， and CHOP mRNA in the sciatic nerve of the rats. ResultCompared with the normal group， the model group showed elevated serum ROS levels （P<0.01）. In contrast， the serum ROS levels were significantly reduced in the treatment groups compared with those in the model group （P<0.01）. The sciatic nerve of the model group showed pathological changes compared with that in the normal group， while the treatment groups exhibited improvement in sciatic nerve pathology compared with the model group. The protein expression of p-IRE1α and CHOP in the sciatic nerve significantly increased in the model group as compared with that in the normal group （P<0.01）. However， the treatment groups showed a significant decrease in the protein expression of p-IRE1α and CHOP in the sciatic nerve compared with the model group （P<0.05， P<0.01）. Furthermore， compared with the normal group， the model group showed upregulated mRNA expression of IRE1α and CHOP in the sciatic nerve （P<0.01）， while the treatment groups exhibited a significant decrease in the mRNA expression of IRE1α and CHOP compared with the model group （P<0.01）. ConclusionMHGW can alleviate endoplasmic reticulum stress-induced cell apoptosis and improve the structure and function of the sciatic nerve in diabetes rats by inhibiting the expression of IRE1α/CHOP pathway-related proteins and mRNA， thereby preventing and treating peripheral neuropathy in diabetes.

Sleep disturbance and association with social behavior in preschool children with autism spectrum disorder / 中国康复理论与实践

ObjectiveTo explore sleep disturbance in preschool children with autism spectrum disorder (ASD) and analyze the relationship between sleep disturbance and social behavior. MethodsFrom December, 2020 to December, 2022, 221 preschool children with ASD from Beijing Bo'ai Hospital and other two institutes, and 246 healthy preschool children socially recruited were investigated with Children's Sleep Habits Questionnaire (CSHQ). A total of 47 ASD children and 47 healthy children were selected from them to wear a sleep monitoring watch for seven days, while the ASD children were evaluated with Gesell Development Diagnosis Scale (GDDS), Psychoeducational Profile-Third Edition (PEP-3), Autism Diagnostic Observation Schedule-2 (ADOS), Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS) and Social Responsiveness Scale (SRS). ResultsAll the factor-scores were more in the ASD children than in the healthy children (t > 2.491, P < 0.05), except that of daytime sleepiness. The prevalence of sleep disturbance (CSHQ ≥ 41) was 89.6% in ASD children, which was more than that of the healthy children (76.8%) (χ2 = 13.360, P < 0.001). The sleep problems in ASD children included bedtime resistance, sleep anxiety, sleep duration, sleep onset delay, parasomnias and sleep disordered breathing. ASD children were shorter in total bedtime, shorter in total sleep time, longer in sleep latency, longer in awake time and lower in sleep efficiency (|t| > 2.001, P < 0.05), compared with those of healthy children. For ASD children, the total bedtime negatively correlated with GDDS-language, PEP-3-expressive language, PEP-3-communication and PEP-3-maladaptive behaviors (r < -0.300, P < 0.05); the sleep efficiency negatively correlated with total score of CARS (r = -0.365, P < 0.05); sleep latency correlated with GDDS-social, PEP-3-cognitive, PEP-3-expressive language, PEP-3-receptive language, PEP-3-visual-motor imitation, PEP-3-characteristic verbal behaviors, PEP-3-communication, original score of ADOS, ADOS-social affect, and total score of CARS (|r| > 2.90, P < 0.05); and total awake time positively correlated with total score of CARS (r = 0.406, P < 0.05). ConclusionSleep disturbance is prevalent and various in preschool ASD children, and influence their social behaviors.

Research progress on correction schemes of hyperopia for patients of different ages / 国际眼科杂志(Guoji Yanke Zazhi)

Among typical hyperopia patients, the light is focused behind the retina, resulting in blurry vision either at a distance or near. Frequent and excessive accommodationis prone to visual fatigue and internal strabismus, and children may even develop amblyopia, which requires timely correction and a careful design of an individualized correction scheme to avoid problems above. Due to the age-related physiological changes in the refractive system, the accommodation of hyperopic patients varies greatly at different ages and doctors need to design reasonable correction schemes according to different refractive characteristics. This article will review the existing hyperopia correction methods, compare their advantages, disadvantages and indications, and summarize the clinical manifestations of hyperopia patients of different ages and the clinical progress of the corresponding correction plan, hoping to provide a reference for the clinical correction of hyperopia.