Objective To compare the effects of continuous femoral nerve block (CFNB) and intravenous patient controlled analgesia(IPCA) on postoperative analgesia and rehabilitation therapy for patients after knee arthrolysis. Methods 60 patients were randomly allocatedinto CFNB group (n=30) in which patients received CFNB via a catheter inserted in femoral sheath and IPCA group (n=30) in which patientsreceived IPCA via an intravenous infusion pump contained with analgesics. All patients were successively offered passive rehabilitationtherapy and active rehabilitation therapy at 6, 24, 30, and 48 h post-operation. An injection of 50 mg ropivacaine (0.25%) was administratedvia the catheter before rehabilitation therapy in CFNB group. Analgesics (200~250 μg sufentanil and 100 mg ketamine in 100 ml normalsaline) were transfused intravenously at a constant rate during the whole postoperative period in group IPCA. Visual Analogue Score(VAS), active flexion angle (AFA) of suffered knee joint, and side effects related to CFNB or IPCA were recorded. Results The VAS scoreand the side effect rate were lower in CFNB group than in IPCA group (P<0.05). And the AFA was significantly larger in CFNB group thanin IPCA group (P<0.001). Conclusion CFNB is a safe and beneficial analgesia for patients in postoperative rehabilitation.

Objective To investigate the correlation between the baseline serum caveolin-1 (Cav-1) levels and the clinical outcome in patients with acute ischemic stroke at day 90 after onset. Methods Consecutive patients with acute ischemic stroke treated in hospital were enrolled. The Cav-1 levels were measured by the enzyme-linked immunosorbent assay. Functional outcomes were assessed at day 90 after onset using the modified Rankin Scale (mRS), and mRS 0-2 was defined as good outcome. The demographic and clinical characteristics of the good outcome group and the poor outcome group were compared. Multivariate logistic regression analysis was used to identify the correlation between the low serum Cav-1 levels and the poor outcome at day 90 after onset. Results A total of 169 patients with acute ischemic stroke were included in the analysis, including 116 males (68. 5% ). Their age ranged from 50 to 83 years (mean, 63. 4 ± 9. 1). The mean serum Cav-1 level was 5. 483 ± 2. 617 ng/ml. Eighty-three-patients (49. 1% ) were in the good outcome group and 86 (50. 9% ) were in the poor outcome group. Univariate analysis showed that the proportions of patients in subcortical infarct (60. 5% vs. 43. 4% ; χ2 = 4. 944, P = 0. 026) and diffusion-weighted imaging-Alberta Stroke Program Early CT Score, (DWI-ASPECT) ≤7 (58. 1% vs. 40. 9% ; χ2 = 4. 984, P = 0. 026), as well as age (65. 5 ± 8. 9 years vs. 61. 2 ± 10. 7 years; t = 2. 793, P =0. 006), baseline systolic blood pressure level (140. 6 ± 17. 2 mmHg vs. 134. 9 ± 13. 4 mmHg; t = 2. 368, P = 0. 019; 1 mmHg = 0. 133 kPa), and National Institutes of Health Stroke Scale (NIHSS) score (4. 8 ± 3. 4 vs. 3. 9 ± 2. 2; t = 2. 211, P = 0. 036) were significantly higher than those of the good outcome group, and the serum Cav-1 level was significantly lower than that of the good outcome group (4. 9 ± 2. 3 ng/ml vs. 6. 1 ± 2. 1 ng/ml; t = 2. 977, P = 0. 003). After adjusting for the related confounding factors, multivariate logistic regression analysis showed that the low Cav-1 level was an independent predictor of poor outcome at day 90 in patients with acute ischemic stroke (odd ratio, 1. 157, 95% confidence interval 1. 016-1. 319;P = 0. 028). Conclusion The low serum Cav-1 level is an independent predictor of poor outcome in patients with acute ischemic stroke.

Objective To discuss the application and effect evaluation of the standard operation procedure ( SOP ) teaching method during applying surgical practice teaching in local medical college . Method 123 undergraduate students from Grade 2011 clinical medical major in Medical College of Shaoguan University were selected as objects of study. The students were divided into test (odd) group and control (even) group by draw. The two groups were taught by the same teachers, while the SOP method was applied to the test group (n=62) and the traditional surgical clinical teaching method was applied to the control group (n=61). Meanwhile, we used a combined method of the formative assessment and final assess-ment to compare and analyze the teaching feedback. After their graduate internship, we compared their autonomous study capability, clinical evaluation thought, normativity of the operation and capability in their intern positions as well as the degree of satisfaction of the test of two groups by doing a survey among them. All these were analyzed by SPSS 18.0 software, and t test was used to compare two groups' measurement in-formation and count data with chi-square. Results The comprehensive evaluation scores of the test group were significantly higher than the control group, in which the margin was of statistical value [(79.394 ± 8.049) vs. (71.703±10.462), t=39.632, P=0.000]. The percentage of excellence of the test group was signif-icantly higher than the control group, in which the margin was of statistical value (59.68% vs. 39.35%, χ2=5.082, P=0.024). The percentage of failure of the test group was lower than the group taught by the tradi-tional method, in which the margin was of statistical value (3.22%vs. 16.39%, χ2=4.652, P=0.031). Its for-mative assessment result on the evaluation of the experimental teaching process and summative assessment scores were higher than the control group, and the difference was statistically significant [formative scores points: (46.018 ±5.749) vs. (42.771 ±6.459), t=19.445, P=0.000; summative scores: (33.659 ±3.437) vs. (29.063±4.366), t=36.249, P=0.000]. As far as their clinical graduate internship adaptation capabilities were concerned, students from the test group had more satisfaction on the teaching feedback over 4 perspectives than the other group, in which the margin was of statistical value. Experimental groups' satisfaction showed that: 93.55% of students thought the standard operation procedure (SOP) teaching method was beneficial to improving their clinical practice skills, 91.94%thought that it improved their surgical clinical work ability to adapt, 85.48% thought it helped to cultivate their surgical clinical thinking and innovation ability. Conclusions The SOP teaching method in surgical practice teaching helps to enhance students' clinical operation and adaptation capability and promote the teaching quality.

Objective To compare the identifiability for depressive symptoms using different instruments while interviewing with different respondents in suicide prevention research in China. Methods One hundred and fifty-one suicide death cases (suicide group) and one hundred and twenty suicide attempt cases (attempt group) were recruited. For each identified cases, one family member proxy respondent, and another associate proxy respondent (friend or neighbor) and suicide attempter (only for attempt group) were interviewed separately by qualified psychiatrists. The Di-agnostic Screening Instrument for Depression (DSID) and the Structured Clinical Interview for DSM-Ⅳ Axis Ⅰ Disorders (SCID-Ⅰ) were administered to each respondent to identify the depressive symptoms based on diagnostic criteria for major depressive episode in DSM-Ⅳ. Data collected from family members and associate respondents were merged as proxy data. The concordances of the DSID and SCID-Ⅰfor identifying depressive symptoms, meeting for criteria of Major Depressive Episode (MDE) and Mild and Major Depressive Episode (MMDE), were calculated based on different respondents' data. The prevalence of depressive symptoms, MDE and MMDE, were compared among merged proxy data, family member respondent's data, and associate respondent's data in suicide group and attempt group, and between self-respondent's data and merged proxy data in suicide attempt group. Results In suicide group, based on merged proxy data, the prevalence of MDE was 41.1%(62 cases) for DSID and 41.7%(63 cases) for SCID-Ⅰ, and the Kappa coeffi-cient was 0.77. Based on suicide attempters' self-raported data, the prevalence of MDE was 23.7% (27 cases) and 22.0% (24 cases) for DSID and SCID-Ⅰ respectively, with a Kappa of 0.74. Based on merged proxy report in attempt group, 16 (13.3%) and 15 (12.5%) cases were met for criteria of MDE (Kappa=0.89), using the 2 instruments. In both of the suicide and attempt groups, the merged proxy data got higher prevalence of depressive symptoms, MDE and MMDE than that only based on family respondent's data or associate's respondent's data using both of the 2 instruments (all P<0.05). Compared with merged proxy data, attempters' self-reported data got higher prevalence of MMD and MMDE using both of the 2 instruments (all P<0.05). Conclusions Based on same respondent's data, SCID-Ⅰ performs as well as DSID in identifying depressive symptoms. Collecting data from 2 respondents would get higher prevalence of MDE or MMDE than only from one family member or one associate. In attempt group, the prevalence of MDE or MMDE based on merged proxy data were lower than that based on attempters' self-reported data.

Objective To investigate the correlation between subclinical hypothyroidism (SCH) and cerebral atherosclerosis burden in patients with large artery atherosclerotic stroke.Methods Consecutive inpatients with acute large artery atherosclerotic stroke were enrolled.SCH was defined as TSH 4.50-10.0 mU/L and serum thyroxine level was normal.Cerebral atherosclerosis burden score was used to evaluate the severity of cerebral atherosclerosis.The total score of 1 or 2 was defined as mild atherosclerosis,and >2 was defined as severe atherosclerosis.Univariate analysis and multivariate logistic regression analysis was used to evaluate the correlation between SCH and severe cerebral atherosclerosis.ResultsA total of 263 patients with large artery atherosclerotic stroke were enrolled,including SCH 62 (23.6%),mild atherosclerosis 119 (45.2%),and severe atherosclerosis 144 (54.8%).The age (63.6±10.9 years vs.60.5±11.4 years;t=2.274,P=0.024),homocysteine (17.10±6.20 μmol/L vs.15.63±5.17 μmol/L;t=2.058,P=0.041),National Institutes of Health Stroke Scale (NIHSS) score (8.0 [5.0-10.0]vs.6.0 [5.0-9.0];Z=2.059,P=0.039),as well as the proportions of patients with hypertension (72.9%vs.58.8%;χ2=5.812,P=0.016),smoking (38.2%vs.26.1%;χ2=4.366,P=0.037),and SCH (30.6%vs.15.1%;χ2=8.610,P=0.003) in the severe cerebral atherosclerosis group were significantly higher than those in the mild cerebral atherosclerosis group.Multivariate logistic regression analysis indicated that SCH was an independent risk factor for severe atherosclerosis in patients with large atherosclerotic stroke (odd ratio 3.345;95%confidence interval 1.692-6.612;P=0.001) after adjusting for age,sex,hypertension,smoking,homocysteine,and NIHSS score.ConclusionSCH is an independent risk factor for severe cerebral atherosclerosis in patients with large atherosclerotic stroke.

The bone marrow microenvironment is a complex network structure composed of non-hematopoietic cells,hemato-poietic stem cells,extracellular matrix,and various cytokines,which is beneficial to maintain normal hematopoietic function in the body.Once bone marrow microenvironment changes,the types and functions of cells in the bone marrow will change,thereby causing the occurrence of leukemia.Leukemia is a malignant clonal disease that is not only related to abnormal proliferation and differentiation of tumor cells,but also closely related to immune dysfunction.Exosomes,immune cells,mesenchymal cells and bone marrow stromal cells(BMSCs)in the bone marrow microenvironment all have immunoregulation effects and can participate in the formation of immune suppression in leukemia,leading to disease progression.Therefore,this article aims to review the mechanism and effects of bone mar-row microenvironment on the pathogenesis of leukemia so as to provide new ideas for leukemia treatment.

Objective:To investigate the correlation between malnutrition and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with ischemic stroke received intravenous thrombolysis in the Department of Neurology, Nanjing Jiangbei People's Hospital from January 2018 to December 2021 were retrospectively enrolled. Nutritional status was assessed by geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI). END was defined as an increase of ≥4 in the National Institutes of Health Stroke Scale score within 24 h after intravenous thrombolysis compared with the baseline value. The demographic and baseline clinical data of the patients in the END group and the non-END group were compared. Multivariate logistic regression analysis was used to determine the independent correlation between malnutrition and END. Results:A total of 256 patients were enrolled, including 156 males (60.9%), aged 65.6±12.0 years. According to GNRI and PNI, there were 122 (46.7%) and 62 (24.2%) patients with malnutrition respectively. END occurred in 37 patients (14.5%) during hospitalization. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, there was a significant independent correlation between malnutrition and END after intravenous thrombolysis in patients with acute ischemic stroke (severe malnutrition as assessed by GNRI compared to normal nutritional status: odds ratio 5.736, 95% confidence interval 1.033-31.866, P=0.046; severe malnutrition as assessed by PNI compared to normal nutritional status: odds ratio 4.928, 95% confidence interval 1.589-15.282, P=0.006). Conclusion:Malnutrition is very common in patients with acute ischemic stroke and has a significant correlation with END after intravenous thrombolysis.

Acute lymphoblastic leukemia (ALL) is a common hematological malignant tumor with high malignancy , great harm and high recurrence rate. In addition, the treatment process of ALL is complicated and the treatment cost is high , which not only brings great pain to patients , but also increases the economic burden of patients' families and even society . The pathogenesis of ALL is still inconclusive , but studies have found that environmental factor and genetic factor may play an important role in the pathogenesis of ALL . Therefore , this paper summarizes the reports on environmental chemical exposure factors and ALL epigenetics studies in recent years , and tries to review the relationship between environmental chemical exposure and pathogenesis of ALL , so as to provide reference ideas for clinical research.

Objective:To investigate the correlation between the degree of hepatic fibrosis and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke (AIS) and its predictive value.Methods:Patients with AIS received intravenous thrombolysis at Nanjing Jiangbei Hospital from January 2018 to March 2023 were retrospectively included. Hepatic fibrosis-4 index (FIB-4) was used to evaluate the degree of hepatic fibrosis in patients. FIB-4 ≥ 2.67 was defined as severe hepatic fibrosis. END was defined as an increase of ≥4 from baseline on the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after intravenous thrombolysis. The relevant factors of END were analyzed through univariate analysis and multivariate logistic regression model. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of FIB-4 for END. Results:A total of 313 patients were included, of which 184 (58.8%) were male, aged 64.8±11.8 years old. The median baseline NIHSS score was 6 (interquartile range, 4-9), and the median FIB-4 was 1.76 (interquartile range, 1.28-2.56). Forty-five patients (14.4%) experienced END. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, higher FIB-4 was significantly independently correlated with END (odds ratio 2.121, 95% confidence interval 1.422-3.162; P=0.001). ROC curve analysis shows that FIB-4 has a good predictive value for END (the area under the curve 0.689, 95% confidence interval 0.595-0.784; P=0.001). The optimal cutoff value of FIB-4 was 1.82, and its sensitivity and specificity in predicting END were 71.1% and 54.9%, respectively. Conclusion:FIB-4 has good predictive value for END in patients with AIS after intravenous thrombolysis.

Objective: To investigate the mechanism of action of Wuzi Yanzong pill (WYP) in rats with oligoasthenozoospermia (OAZ) via metabolomics and to provide a possible basis for improving this WYP-based treatment. Methods: A rat model of OAZ was established by treating male Sprague–Dawley rats with glucosides from Tripterygium wilfordii Hook. F. Seventy-two rats were randomly divided into six groups: control, L-carnitine (positive control), model, and low-, medium-, and high-dose WYP groups. Rats in the experimental groups were treated with WYP for 4 weeks. At the end of the treatment period, sperm cell quality (density, motility, and viability) was assessed using a semen analysis system, mitochondrial membrane potential (MMP) was assessed using flow cytometry, and testicular injury was assessed using hematoxylin and eosin staining to validate the therapeutic effect of WYP in OAZ. Further, serum metabolomics-based analysis was performed using high-performance liquid chromatography-mass spectrometry to identify differential metabolic pathways and possible mechanisms of action of WYP in OAZ treatment. Results: A rat model of OAZ was considered successfully-established after comparing the quality of spermatozoa in the model group to that in the control group. WYP-M and WYP-H treatments significantly improved sperm cell density, motility, and viability compared with those in the model group (all P < .05). Compared with the model group, both WYP-M and WYP-H treatments increased MMP values (P = .006 and P = .021 respectively), while there was no significant difference in the L-carnitine group. L-carnitine and WYP administration reversed damage to the testes to varying degrees compared with that in the model group. Further, 44 differential metabolites and four metabolic pathways, especially autophagy pathway, related to OAZ were identified via metabolomics. Conclusions WYP improves sperm cell quality and MMP in OAZ primarily via autophagy regulation. These findings can be employed to improve the efficacy of WYP in humans.