Objective To study the expression and clinical significance of toll-like receptor (TLR) 4 and TLR7 in primary nephrotic syndrome (PNS) of different pathological types in children. Methods Renal expressions of TLR4 and TLR7 were amined and analyzed retrospectively in renal biopsy specimens from 110 PNS patients and 21 healthy controls by immunohisto-chemical method. According to the renal pathologic classification of PNS, the TLR4 and TLR7 expression levels in PNS of dif-ferent types were compared. Results Compared with the renal tissue of healthy controls, the expression level of TLR4 on renal tissue of PNS patients was significantly increased (P<0.01). Among MN, MsPGN and FSGS, the highest expression of TLR4 was observed in MCD (P<0.01). Compared with the renal tissue of healthy controls, the expression level of TLR7 in re-nal tissue of PNS patients was also significantly increased (P<0.01). Among MCD, MN and FSGS, the highest expression of TLR7 was observed in MsPGN (P<0.01). Conclusions TLR4 and TLR7 expression levels are increased in renal tissue of PNS patients and the expression levels may be correlated with renal pathological types.

BACKGROUND:Silk fibroin as natural biological macromolecules has good biocompatibility, but it is difficult to make the three-dimensional scaffold with uniform structure because of its higher crystalization performance and bigger brittleness. OBJECTIVE:To improve the crystalization of silk fibroin through the addition of chitosan, and to get three-dimensional tissue engineering scaffolds with better mechanical strength. METHODS: CaCl2/CH3CH2OH/H2 RESULTS AND CONCLUSION:The introduction of chitosan could improve the properties of scaffolds. The porosity of the composite scaffold with lower porosity was more uniform and orderly with higher content of O ternary solution was used to dissolve silkworm cocoon to extract silk fibroin and form solution. Silk fibroin solution and chitosan solution were mixed according to different mixing ratios of 2:1, 1:1, 1:2, respectively, and then porous silk protein/chitosan scaffolds were prepared by freeze-drying method and treated by methanol. Scaffold morphology was observed by scanning electron microscopy, the chemical structure and crystaline state of the scaffolds were characterized through infrared spectrum and X-ray diffraction test, respectively. Also, the porosity and water uptake were tested and periodic cycle compression mechanical properties under the water environment were determined. chitosan. When the mixture rate of chitosan and silk fibroin was 1:2, the water uptake rate was the highest in the composite scaffolds, and also higher than that of the silk fibroin scaffold but lower than that of the chitosan scaffold. With the increase of silk fibroin, the composite scaffolds had better elasticity and stronger ability to maintain the shape.

Objective To explore the experience in critical nursing intervention for patients with postpartum hemorrhoids. Methods 100 primiparas with hemorrhoids who had normal delivery in our hospital were assigned, by odd or even number of the delivery date, into the control group including 53 patients or the observation group including 47 patients. Patients in the control group received normative vital signs monitoring, hemorrhoid swelling observation, bowel movement observation, medication observation, dietary nursing, psychological support, treatment for complications, health education, and discharge instruction, etc. Patients in the observation group received critical analysis and nursing in addition to the care received in the control group. The hemorrhoid pain intensity and patient-perceived comfort were observed for both groups at 2 h, 24 h and 48 h postpartum. Results The hemorrhoid pain intensity score at 2 h postpartum was (1.30 ± 0.46) points and (1.32 ± 0.47) points , respectively, in the observation group and control group;the comfort score at 2h postpartum was (5.04 ± 0.83) points and (5.11 ± 0.82) points , respectively, in the observation group and control group, without statistically significant difference (t=0.245, 0.426, P>0.05);the hemorrhoid pain intensity score at 24h postpartum was (2.85 ± 0.62) points and (3.53 ± 0.58) points , respectively, in the observation group and control group;the comfort score at 24 h postpartum was (5.85 ± 1.02) points and (4.17 ± 0.89) points , respectively, in the observation group and control group, with statistically significant difference (t=5.643, 8.784, P < 0.01) ;the hemorrhoid pain intensity score at 48 h postpartum was (2.55 ±0.50) points and (3.42 ± 0.50) points , respectively, in the observation group and control group;the comfort score at 48h postpartum was (7.47 ± 1.10) points and (6.47 ± 0.89) points , respectively, in the observation group and control group, with statistically significant difference (t=8.606, 5.001, P<0.01). Conclusions Critical nursing intervention for postpartum patients with hemorrhoids could significantly alleviate hemorrhoid pain, improve patient comfort, and facilitate postpartum recovery.

OBJECTIVE To explore the antidepressant effect and the underlying mechanisms of schisandrin (SCH), a component of the fruits of Schizandra chinesis. METHODS The forced swimming test (FST) and tail suspension test (TST) in mice were used to evaluate the antidepressant activity of SCH (5, 10, and 30 mg · kg-1) following single administration intragastrically, and the locomotor activity was investigated to exclude its neural excitatory effects. Effects of SCH on neural monoamine systems were studied in two pharmacological models, including reserpine induced monoamine depletion test and yohimbine toxicity potentiation test. RESULTS In behavioral despair models, SCH (30 mg·kg-1) signif?icantly decreased the immobility time in the TST and FST (P<0.05) compared with normal control group. Results of the locomotor activity experiment showed that SCH had no excitatory or inhibitory actions on the central nervous system. In the reserpine reversal experiment, SCH (30 mg · kg-1) antagonized thepalpebral ptosis and akinesia symptoms caused by reserpine(2.5 mg · kg-1) treatment (P<0.05) compared with model group, but had little effect on the drop of the anal temperature. Moreover, SCH did not increase the lethality caused by subcutaneous injection of yohimbine (30 mg · kg-1)at the threshold lethal dosage. CONCLUSION SCH exerts potential antidepressant-like effect in mice.

Objective:To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS).Methods:In this study,48 patients (unilateral hand)with CTS were analyzed.The thickness of transverse carpal ligaments at the pisiform bone was measured using high-fre-quency ultrasound.Open carpal tunnel release procedure was performed in the 48 CTS patients,and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under di-rect vision.The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound.High-frequency ultrasound measurement of thickness of transverse carpal ligaments at the ha-mate hook bone and pisiform bone,and determination of the diagnostic threshold measurement index using receiver operating characteristic (ROC)curve,sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study (NCS)ana-lyzed.Results:The thickness of transverse carpal ligaments in the CTS patients were (0.42 ±0.08)cm (high-frequency ultrasound)and (0.41 ±0.06)cm (operation)at hamate hook bone,and there was no significant difference between the two ways (t =0.672,P>0.05 ).The optimal cut-off value of the transverse carpal ligaments at hamate hook bone was 0.385 cm,the sensitivity 0.775,and the specificity 0.788.The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0.315 cm, the sensitivity 0.950,and the specificity 1 .000.The transverse carpal ligaments thickness and wrist-in-
dex finger sensory nerve conduction velocity (SCV),wrist-middle finger SCV showed a negative correla-tion.Conclusion:High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.

OBJECTIVE To study the influence of glycogen synthase kinase3β (GSK3β) over expres?sion in the hippocampus on the antidepressant and anxiolytic effects of total flavoids from Xiaobuxin Tang (XBXT-2). METHODS Adeno-associated virus containing GSK3β(S9A) mutation was microinjected into the hippocampus. After three weeks of recovery, GSK3βand p-GSK3βwere detected by Western blotting, and open field test (OFT) was used to evaluate the locomotor activity. Then, AAV group and GSK3β over expression group were divided into administration group and solvent group, respectively. XBXT-2 (100 mg · kg-1) and solvent were ig administered chronically. After 14 d and 16 d of administra?tion, the tail suspension test (TST) and forced swimming test (FST) were used to investigate the influence of GSK3βover expression on the antidepressant effect of XBXT-2, respectively. After 18 d and 20 d of administration, the elevated plus maze test (EPMT) and staircase test (ST) were used to investigate the influence of GSK3β over expression on the anxiolytic effects of XBXT-2, respectively. RESULTS Western blotting analysis showed that the protein level of GSK3βincreased significantly in GSK3βover expression group (P<0.01) compared with AAV group, but there was no significant difference in p-GSK3β. In OFT, the number of crossings and rearings showed no difference between AAV group and GSK3β over expression group. The results of TST and FST showed that compared with AAV group, the immobility time was significantly reduced in AAV+XBXT-2 group (P<0.05, P<0.01), but compared with GSK3β over expression group, the immobility time showed no difference in GSK3β over expression+XBXT-2 group. In EPMT, compared with AAV group, the percentage of entrances and time into open arms in AAV+XBXT-2 group was significantly increased (P<0.01, P<0.05), but compared with GSK3βover expression group, these indexes showed no difference in GSK3βover expression+XBXT-2 group. In ST, compared with AAV group, the number of rearings was significantly reduced in AAV+XBXT-2 group (P<0.05), but there was no difference between GSK3β over expression+XBXT-2 group and GSK3βover expression group. CONCLUSION GSK3βover expression in the hippocampus can reverse the antidepressant effects of XBXT-2 in the TST and FST, and the anxiolytic effects in the EPM and ST.

Objective To observe the effects of CoC12 treatment on the expression of Hypoxia-inducible factor-1(HIF-1α) in mice hippocampus at different time point.Methods Balb/c mice were injected with CoCl2 and the change of HIF-1 α was detected by western blot and immunofluorescence and confocal laser scanning microscope at different time point(0h,1h,2h,3h,4h,5h and 6h) after injection.Results The relative protein level of HIF-1α was 0.135 ±0.01,0.572 ±0.01,0.595 ±0.03,1.09 ±0.03,1.30 +0.04,1.275 ±0.03,0.947 ±0.03respectively at different time point after the injection.The HIF-1α protein level reached its peak value at 4 h and decreased at 5h and 6h.Fluorescence intensity of HIF-1α was 13.33 ± 3.42,30.95 ± 7.86,46.50 ± 9.65,61.50± 10.02,88.30 + 15.69,71.39 ± 11.28,67.41 ± 10.78 respectively at different time point after the injection.The HIF-1α fluorescence intensity also reached its peak value at 4 h and decreased at 5h and 6h.Conclusion Time dependent HIF-1α accumulation was in close correlation with the CoCl2.

Aim To investigate the influence of intranasal delivery of calcitonin gene-related peptide(CGRP)on cerebral blood supply and expression of vascular endothelial growth factor(VEGF)following experimental subarachnoid hemorrhage(SAH).Methods Wistar rats were divided into normal control group,SAH group,intranasal normal saline(NS)+SAH group and intranasal CGRP+SAH group.SAH models were produced by double injection of autologous arterial blood into cisterna magna.CGRP and NS were given by intranasal perfusion.Dynamic observations of regional cerebral blood flow(rCBF)of cerebral cortex were made using a laser Doppler flowmeter probe.On the third day after the second cisternal injection,the expression of VEGF protein in cerebral cortex was observed by immunofluorescence method combined with laser confocal microscopic observation.Results Anatomic observation revealed that SAH models were successfully manufactured.In SAH and intranasal NS+SAH groups,a drastic and persistent drop in rCBF was noted during the observed periods.The decrease of rCBF in intranasal CGRP+SAH group was slighter as compared with that in SAH and intranasal NS+SAH groups.In SAH and intranasal NS+SAH groups,increased expression of VEGF protein in cerebral cortex was observed on the third day after second cisternal injection as compared with that in normal control group.The expression of VEGF in intranasal CGRP+SAH group was more obvious than that in intranasal NS+SAH group.Conclusion Intranasal delivery of CGRP improves cerebral blood supply and promotes angiogenesis by enhancing the expression of VEGF after SAH.

Objective:To evaluate the predictive performance of the individualized drug delivery decision-making system including Smart Dose, PharmVan and JPKD on predicting the Vancomycin plasma concentration and to analyze the related factors affecting the predictive performance.Methods:The clinical data of patients who were treated with Vancomycin and received therapeutic drug monitoring (TDM) admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to July 2020 were retrospectively collected. Smart Dose and PharmVan were used to predict the plasma concentration of Vancomycin of the initial regimen. Smart Dose, PharmVan and JPKD were used to predict the plasma concentration of Vancomycin of the adjustment regimen for patients whose initial steady-state trough concentration were not qualified. The relative predictive error (PE) between the measured plasma concentration and predicted plasma concentration was calculated and box plotted. Mann-Whitney U test was used to evaluate the difference of the absolute value of PE (APE) predicted by each software for Vancomycin plasma concentration. The TDM results were divided into accurate prediction group (APE < 30%) and the inaccurate prediction group (APE≥30%) according to the APE value. Patients and disease characteristics including gender, age, body weight complication, Vancomycin medication and TDM results were collected from electronic medical records. Univariate analysis and multivariate Logistic regression analysis were used to screen the related factors that influence the predictive performance of Smart Dose, PharmVan and JPKD; and receiver operating characteristic curve (ROC curve) was drawn to evaluate its predictive value. Results:A total of 185 patients were enrolled, and 258 plasma concentration of Vancomycin were collected, including 185 concentrations of initial regimen and 73 concentration of adjustment regimen. There was no significant difference in the APE of the initial regimen of plasma concentration between Smart Dose and PharmVan. No significant difference in the APE of the adjustment regimen of plasma concentration was found among Smart Dose, PharmVan and JPKD. The accuracy of Smart Dose in predicting the plasma concentration of the adjustment regimen was better than that of the initial regimen [22.94% (10.50%, 36.24%) vs. 29.33% (13.07%, 47.99%), P < 0.05]. The univariate analysis of factors affecting the performance of Smart Dose in predicting the concentration of initial regimen showed that the proportion of patients with hypertension in the accurate prediction group was significantly higher than that in the inaccurate prediction group [43.3% (42/97) vs. 27.3% (24/88), P < 0.05]. The univariate analysis of factors affecting the performance of Smart Dose in predicting the concentration of adjustment regimen showed that the proportion of patients with valvular heart disease in the accurate prediction group was significantly lower than that in the inaccurate prediction group [23.4% (11/47) vs. 46.2% (12/26), P < 0.05]. The univariate analysis of factors affecting the performance of JPKD in predicting the concentration of adjustment regimen showed that the body weight of patients in the accurate prediction group was significantly higher than that in the inaccurate prediction group (kg: 62.8±14.9 vs. 54.8±12.8, P < 0.05). Multivariate Logistic regression analysis indicated that hypertension was a beneficial factor for Smart Dose to predict the initial plasma concentration of Vancomycin [odds ratio ( OR) = 0.526, 95% confidence interval (95% CI) was 0.281-0.983, P = 0.044], and low body weight was an independent risk factor for the inaccurate prediction of JPKD for adjustment regimen ( OR = 1.042, 95% CI was 1.001-1.085 , P = 0.043). ROC curve analysis indicated that the area underROC curve (AUC) of the body weight for evaluating the accuracy of JPKD in predicting Vancomycin plasma concentration was 0.663, and 95% CI was 0.529-0.796 ( P = 0.023). When the body weight was less than 55.95 kg, the risk of inaccurate prediction of JPKD in predicting Vancomycin plasma concentration was increased, and the predictive sensitivityand specificity were 75% and 60% respectively. Conclusions:There is no significant difference in the predictive performance of Smart Dose, PharmVan or JPKD on Vancomycin plasma concentration. Smart Dose had a better predictive performance for the Vancomycin plasma concentration of adjustment regimen than initial regimen. Smart Dose had a better predictive performance when the patient was concomitant with hypertension. JPKD had a poor predictive performance for low-body weight patients. The predictive performance of JPKD was decreased when the body weight was lower than 55.95 kg.

Objective: To evaluate the effect of bioactive peptides combined with probiotics on serum uric acid (SUA) in patients with hyperuricemia (HUA), so as to provide the evidence for prevention and treatment of HUA. Methods: The patients with HUA aged 18 to 65 years were selected and randomly divided into an intervention group and a control group. The patients in the intervention group received bioactive peptides combined with probiotics for 28 days at a dose of 3 g/d, while the patients in the control group received an equal dose of placebos. Demographic information, body mass index (BMI), blood pressure and blood lipid were collected through questionnaire surveys, physical examination and laboratory tests. SUA levels were detected before and after 14 days and 28 days of interventions. The differences of SUA levels between the two groups were compared using generalized estimation equation. Results: Totally 108 patients with HUA were recruited, including 54 patients in the intervention group and 53 patients in the control group (1 dropout). Before interventions, there were no statistically significant differences in gender, age, course of HUA, exercise duration, frequency of alcohol consumption, frequency of meat broth consumption, BMI, prevalence of hypertension and prevalence of dyslipidemia between the two groups (all P>0.05). After 14 days of interventions, the SUA levels of the patients in the intervention group decreased by 3.00 μmol/L, while those in the control group increased by 7.00 μmol/L. After 28 days of interventions, the SUA levels of the patients in the intervention group and the control group decreased by 26.00 μmol/L and 16.00 μmol/L, respectively. However, there was no statistically significant interaction between the intervention time and group (both P>0.05). Subgroup analysis showed that after 28 days of interventions, the decrease in SUA levels in the patients aged 55 years and older and without hypertension in the intervention group was greater than those in the control group (both P<0.05). Conclusions Bioactive peptides combined with probiotics showed no significant difference in reducing SUA levels in patients with HUA compared to the control group. The effect was more significant for patients aged 55 years and older and without hypertension.