Objective:To investigate the protective effect of spironolactone on myocardial injury in septic rats and to provide a novel measure for the diagnosis and treatment of sepsis myocardial injury.Methods:Totally 120 male Sprague-Dawley rats were randomly divided into the sham group, cecal ligation and perforation group (CLP group), and spironolactone group. The sham group was only exposed to the cecum by laparotomy. CLP was performed to induce sepsis in the CLP group and spironolactone group. The cecal perforation was ligated and the contents of the intestine were squeezed out. The spironolactone group was administered spironolactone by gavage with a dose of 20 mg/(kg·d) per rat. The sham and CLP groups were given the same dose of saline. The experiment period was 7 days. After the rats were sacrificed, blood was collected and myocardial tissue was removed. The changes of serum TNF-α, IL-6, cTnI and CK-MB levels were detected by ELISA. Cardiac structure and function were detected by echocardiography. The relative apoptosis of left ventricular myocytes in rats was detected by TUNEL staining. The levels of TNF-α, IL-6, Bcl2-associated X protein (Bax), B cell lymphoma 2 (Bcl2) and Caspase 3 in the left ventricle tissue were detected by immunohistochemistry.Results:Compared with the CLP group, the levels of TNF-α and IL-6 in serum and left ventricular tissue were significantly decreased ( P<0.05) and serum levels of cTnI and CK-MB were significantly down-regulated ( P<0.05). Heart rate (HR) and left ventricular diastolic dimension (LVDd) were significantly reduced ( P<0.05), and ejection fraction (EF) and left ventricular fractional shortening (FS) increased significantly ( P<0.05). Ventricular muscle apoptosis was improved ( P<0.05),the level of apoptosis-related protein Bcl2 was increased and the Bax and Caspase3 expression were significantly down-regulated ( P<0.05).The expression of Bcl2 protein, EF and FS in the CLP group were significantly lower than those in the sham group( P<0.05), and the remaining indexes were significantly higher than those in the sham group( P<0.05). Conclusions:Spironolactone can treat sepsis-induced myocardial injury by reducing inflammatory response caused by sepsis, reducing myocardial damage, alleviating ventricular muscle apoptosis, and improving ventricular structure and function.

Objective:To analyze the clinical characteristics of invasive klebsiella pneumoniae liver abscess syndrome (IKPLAS), and compare it with common pyogenic liver abscess (CPLA). Methods:The social demography and clinical data of inpatients with pyogenic liver abscess from January 2011 to December 2021 in the Peking University People's Hospital were collected. Based on the presence or absence of invasive infections and the results of bacterial etiology, IKPLAS was diagnosed and compared with CPLA. The general information, symptoms, past medical history, auxiliary examinations and prognosis indicators of the two groups of patients were compared.Results:Total of 172 patients with pyogenic liver abscess were collected, including 25 cases of IKPLAS. Compared with CPLA group, the proportion of fever in IKPLAS group was lower, the proportion of diabetes history was higher, the proportion of monocytes was lower, and procalcitonin and urea nitrogen were higher(all P<0.05), the proportion of multiple abscesses is higher, and the positive rate of blood culture and the cultivation of klebsiella pneumoniae are both higher (all P<0.05).A total of 9 cases (5.2%) of patients developed septic shock, of which 2 cases (1.2%) died. The IKPLAS group had a higher proportion of ICU admissions ( P<0.05),but but the difference of mortality between the two groups was not statistically significant ( P>0.05). The most common sites of invasion infection in the IKPLAS group are the lungs(22/25), brain(9/25), and eyes(9/25). Conclusions:There are differences in clinical characteristics between IKPLAS and CPLA, the most common sites of invasion infection are the lungs, brain, and eyes, but there is no difference in mortality in this study. For PLA with pathogenic Klebsiella pneumoniae, it is necessary to carefully evaluate the presence of invasive lesions and provide targeted local treatment to better improve prognosis.

Objective:To summarize the best evidence of rehabilitation exercise in patients with lumbar spinal stenosis surgery.Methods:The evidence-based questions were established based on PIPOST's principles, and Wanfang data, China National Knowledge Infrastructure, China Biology Medicine disc, UpToDate, PubMed, Embase, Web of Science, American Medical Association, Orthopedic Branch of Chinese Medical Doctor Association and other databases and websites were searched by computer. The search period was from the establishment of the databases to October 31, 2022. Two researchers conducted quality evaluation, evidence extraction, and summarization of the included literature.Results:A total of 10 articles were included, including six expert consensus articles, three systematic review articles, and one meta-analysis article. A total of 16 pieces of evidence were summarized from nine aspects of rehabilitation exercise evaluation, principles, timing, methods, health education, psychotherapy, pain management, evaluation and post discharge follow-up.Conclusions:This study summarizes the best evidence for rehabilitation exercise in patients with lumbar spinal stenosis after surgery, and it suggests that healthcare professionals apply evidence based on clinical context and patient willingness.

Male lower urinary tract symptoms is a collective term for a group of symptoms associated with lower urinary tract disorders characterized by frequent urination, urgent urination, and difficulty of urination, of which the common causes are benign prostatic hyperplasia or overactive bladder. With the aging of the global population, the incidence of male lower urinary tract symptoms is increasing year by year. Based on the theoretical connotation of " zang-fu extraordinary connection", the relationship between the lungs and the bladder, the spleen and the small intestine, and the kidneys and the sanjiao with the formation of male lower urinary tract symptoms is explained from three perspectives. It is believed that lung qi depression and closure, disturbance of qi transformation in bladder, and insufficient spleen transport occur, the small intestine is dysfunctional, kidney yang is exhausted, and obstruction of the sanjiao waterway are the basic pathogenesis of male lower urinary tract symptoms. It is emphasized that the location of the disease should be identified. If it is related to the lungs and the bladder, then the disease should be treated by lifting the pot to lift the lid and diffusing the lung qi to benefit the bladder with Wuling Powder plus perilla leaf and bitter apricot seed; if it is related to the spleen and the small intestines, then the disease should be treated by raising the clear and directing the turbid downward and improving the spleen qi in order to support the small intestines with Shenling Baizhu Powder; if it is related to the kidneys and the sanjiao, then the disease should be treated by seeking the yang within the yin and warming and tonifying the kidney qi in order to dredge up the sanjiao with Bawei Shenqi Pill. According to the patient's condition, treatment can be combined with acupuncture, exercise, and other therapies. This paper can provide reference for clinical treatment of male lower urinary tract symptoms.

Objective:To understand the current rehabilitation status and existing problems of patients with degenerative scoliosis after surgery, and analyze the needs of continuous health education for patients.Methods:A total of 15 patients with degenerative scoliosis undergoing surgical treatment in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from December 2021 to June 2022 were selected by the convenient sampling method. The semi-structured interview was used to understand the patient's feelings on the operation effect, experience on the postoperative life impact, thoughts on rehabilitation exercise, self-cognition of home status and future development planning. Based on the rooted theory, Colaizzi 7-step analysis was applied to extract the topic.Results:The four themes related to the continuous health education needs of patients with degenerative scoliosis after surgery were summarized, which were unacceptable movement limitation of lower back or lower extremity, blind area of continuous rehabilitation exercise, lack of knowledge of self-management of spinal disease after surgery and need for social and psychological support.Conclusions:Patients with degenerative scoliosis lack of postoperative rehabilitation knowledge and skills, and the need for health education is strong. Medical staff can meet the patients' transitional care needs by educating them to adapt to the current situation, providing personalized rehabilitation goals, guiding patients in managing risk factors that affect their own rehabilitation and improving social and family support systems, thereby promoting rapid recovery of patients.

Objective:To explore the clinical effects of the best evidence-based practice plan for rehabilitation exercises in patients undergoing surgery for lumbar spinal stenosis (LSS) .Methods:Guided by the evidence-based practice model of the Joanna Briggs Institute (JBI) Center for Evidence-Based Healthcare in Australia, the best evidence was combined with the clinical context to develop quality review indicators for clinical practice. In December 2022, a baseline review was conducted with 30 patients undergoing surgery for LSS (before evidence application). From December 2022 to February 2023, the baseline review results were analyzed to identify facilitating and obstructive factors between the current status and the review indicators, and improvement strategies were implemented based on available resources. In February 2023, another 30 patients (after evidence application) were selected to evaluate the post-application effects. The Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI), Tampa Scale for Kinesiophobia (TSK) score, General Self-Efficacy Scale (GSES) score, and quality of life scores were compared between the two groups at 24 hours, 1 month, 3 months, and 6 months postoperatively. The execution rate of clinical quality review indicators and the knowledge scores on rehabilitation exercises of 25 nurses before and after training were also compared.Results:There were no statistically significant differences in JOA scores, ODI, TSK scores, GSES scores, and quality of life scores between the two groups at 24 hours postoperatively ( P > 0.05). However, there were statistically significant differences in these scores at 1, 3, and 6 months postoperatively ( P< 0.01). After evidence application, the execution rate of seven clinical quality review indicators improved, and the knowledge scores on rehabilitation exercises of the 25 nurses increased significantly ( P< 0.05) . Conclusions:The evidence-based practice for rehabilitation exercises in patients undergoing surgery for LSS is safe and feasible. It standardizes evidence-based nursing practice behavior, enhances nurses' knowledge levels, effectively improves postoperative lumbar function, promotes physical rehabilitation, and enhances the quality of life.

Objective To analyze the epidemic characteristics of pneumoconiosis in Jingmen City from 2011 to 2022, and to provide theoretical basis for formulating the occupational disease prevention plan of the ^“14th Five-Year Plan^” in Jingmen City. Methods The data of pneumoconiosis cases in Jingmen City from 2011 to 2022 were collected from the Occupational Disease and Health Hazard Factors Monitoring Information System, and the information of disease classification, enterprise economic type, scale distribution, regional distribution, job distribution, dust exposure years and so on was statistically analyzed. Results A total of 260 cases of pneumoconiosis were reported in Jingmen City from 2011 to 2022, with an average of 13.81 years of exposure to dust, including 164 cases of coal workers' pneumoconiosis, 90 cases of silicosis and 6 cases of other pneumoconiosis. The cases were mainly distributed in Dongbao District with 160 cases (61.54%), Zhongxiang City with 72 cases (27.69%), and Duodao District with 18 cases (6.92%). The difference was statistically significant（χ²=217.846，P<0.05）. The cases were mainly distributed in private enterprises (76.54%, 199 cases). The enterprise sizes were mainly medium-sized (28.46%, 74 cases) and small (61.15%, 159 cases) enterprises, and the difference was statistically significant (χ²=46.025，P<0.05). Conclusion Coal workers' pneumoconiosis and silicosis are the main types of occupational pneumoconiosis in Jingmen area, which will become the key prevention and control targets in Jingmen City for a long time and should be paid attention to. The cases are mainly concentrated in joint-stock, private economic type enterprises and small and medium-sized enterprises, which should be monitored intensively.