ObjectiveTo analyze the impact of diabetes-related deaths on the probability of premature mortality and life expectancy in Minhang District of Shanghai from 2004 to 2023, and to provide reference data for the optimization of targeted prevention and control strategies. MethodsAll death cases involving diabetes among the registered residents of Minhang District from 2004 to 2023 were collected. The probability of premature mortality and life expectancy was computed using the abridged life table method. The average annual percent change (AAPC) was calculated with Joinpoint 4.9.0.0. The Arriaga decomposition method was employed for statistical analyses of the influence of cause-specific and age-specific mortality related to diabetes on life expectancy. ResultsThe total number of diabetes-related mortality, crude mortality, and standardized mortality for both males and females in Minhang District from 2004 to 2023 exhibited an increasing trend (P<0.001). The primary causes of death among diabetes-related cases were cardiovascular disease (37.68%), diabetes mellitus (31.95%), and malignant tumor (17.80%). From 2004 to 2023, probability of premature mortality to diabetes-related diseases demonstrated a rising trend (P<0.001), contrasting with the declining trend observed in the overall population (P=0.001). Males showed a significant upward trajectory (P<0.001), while females displayed a stable pattern. Among the diseases exerting considerable influence, cardiovascular disease and malignant tumor revealed a marked increase over time (P<0.001), whereas diabetes mellitus maintained a stable trend; both factors negatively impacted the reduction in probability of premature mortality. From 2004 to 2023, diabetes-related mortality reduced life expectancy among residents by an average of 1.22 years (-49.89%), indicating a negative impact; the reduction was 1.41 years in males and 0.90 years in females. The age groups exhibiting greater negative contributions differed by genders, namely males aged 50‒54 years and females aged 70‒74 years. Cardiovascular disease, diabetes mellitus, and malignant tumor contributed significantly to this decline (-0.46 years, -0.42 years, -0.20 years, respectively), with male experiencing higher negative contributions than females. ConclusionIn Minhang District, the rising mortality associated with diabetes-related diseases negatively impact both the reduction of the probability of premature mortality and the increase in life expectancy. This trend is primarily attributed to the rapid escalation of mortality and younger age demographic of male residents, which warrants significant attention. It is recommended that, based on the enhancement of case management, efforts should be directed towards the targeted prevention and control of risk factors and high-risk populations.

Objective To explore the development trajectories of cognitive function in patients with acute ischemic stroke and its latent class predictors.Methods Cluster convenience sampling was used to enroll acute ischemic stroke patients(n=128)who were hospitalized in Neurovascular Center of The First Affiliated Hospital of Naval Medical University and Stroke Center of Air Force Hospital of PLA Eastern Theater Command from Jun.2019 to Mar.2020.Montreal cognitive assessment(MoCA)was used to assess the cognitive function of the patients,and baseline data(such as demographic data,disease-related data,and cognitive function)were collected during the acute hospitalization period.The cognitive function was assessed 3 and 6 months after stroke.Latent growth mixture modeling was used to identify cognitive function development trajectories,and multiple logistic regression was used to analyze predictors of different classes of development trajectories.Results Three latent classes of cognitive function development trajectories were identified in patients with acute ischemic stroke:high-level cognitive maintenance group(n=98,76.6％),low-level cognitive improvement group(n=20,15.6％),and medium-level cognitive decline group(n=10,7.8％).Multiple logistic regression analysis showed that education level,marital status and dysphagia were independent predictors of cognitive function development trajectories in acute ischemic stroke patients(all P＜0.05).Conclusion There is heterogeneity in the development trajectories of cognitive function in acute ischemic stroke patients,and medical staff can conduct personalized evaluation and intervention based on the influencing factors of different classes of cognitive function development trajectories.

Objective To explore the guiding value of thromboelastography(TEG)in blood transfusion therapy for patients undergoing liver rupture repair.Methods A total of 106 patients who underwent liver rupture repair and were admitted to the hospital from June 2021 to June 2024 were selected.According to the random number table method,the patients were divided into 53 patients who underwent liver rupture repair with TEG detection blood transfusion(study group)and 53 patients who underwent liver rupture repair with conventional coagulation function detection blood transfusion(control group).General information of patients was collected.The levels of coagulation function indicators,the dosage of blood products and intraoperative complications of patients in the study group and the control group before blood transfusion and 24 hours after blood transfusion were compared.Results 24 hours after blood transfusion,the fibrinogen level in the study group was higher than that in the control group,while the prothrombin time,activated partial thromboplastin time and thrombin time were shorter than those in the control group,and the differences were statistically sig-nificant(P<0.05).The dosages of red blood cells,frozen plasma,platelets and cryoprecipitate in the study group were all lower than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of intraoperative complications in the study group was lower than that in the con-trol group,and the difference was statistically significant(P<0.05).Conclusion TEG has significant guiding value in blood transfusion therapy for patients undergoing liver rupture repair.

Cardiomyopathy is a group of heterogeneous myocardial diseases with a variety of specific phenotypes that can lead to cardiovascular death or progressive heart failure in severe cases.Because of the severity and complexity of these diseases,the search for new regulatory mechanisms to prevent and treat cardiomyopathy is particularly urgent.Iron death is a form of programmed cell death that differs from other forms of iron dependence and is characterized by the accumulation of iron-dependent lipid peroxides.Studies have shown that iron death can be involved in the occurrence and progression of cardiomyopathy through different signaling pathways.Therefore,targeted regulation of iron death is a new strategy to prevent cardiomyopathy.In this paper,the mechanism of iron death and its important role in cardiomyopathy were reviewed to find the potential relationship between iron death and cardiomyopathy and provide more ideas for the treatment of various cardiomyopathies in the future.

Objective To analyze the role of the key items list in the quality control of running medical records by com-paring the improvements of the quality of medical records,and to explore more effective ways of quality management of medical records.Methods Based on the goal setting theory and influencing factors of goal incentive utility,a list of key items for medi-cal record quality management was formulated,which was implemented in a children's hospital in Tianjin since April 2023.A to-tal of 4 823 operating medical records were collected from June 2022 to September 2023,and the defect rates of quality control items were compared by using statistical methods.Results After the implementation of the key items list,the average score of operating medical records was improved,and the defect rate decreased from 13.63％to 7.94％.Moreover,the defect rates of admission records,first-trip records,senior physician rounds records,consultation records,and surgical records decreased from 4.25％,3.07％,8.26％,and 10.56％to 1.61％,1.56％,4.41％,and 5.06％.Conclusion The implementation of key i-tems list management can effectively improve the quality of running medical records,reduce the defects of medical records,and improve the effects of medical record management.

Radiotherapy can cause functional and morphological changes in the brain tissues of patients with primary or metastatic malignant brain tumors, leading to radiation-induced brain injury. However, the pathogenesis of radiation-induced brain injury has not yet been unanimously determined, and its research advances and treatment protocols are yet to be elucidated and improved. In this study, we explore the pathogenesis of radiation-induced brain injury from the perspective of vascular injury, inflammatory reactions, neuronal dysfunction, glial cell injury, and gut microbiota and reviewed the advances in research on its treatment and prevention. The purpose is to provide a reference and theoretical basis for the research and clinical diagnosis and treatment of radiation-induced brain injury.

Objective:To investigate the effects of sleep disorders (SD) on the radiation injury of hematopoietic stem cells (HSCs) in bone marrow (BM).Methods:Totolly 56 C57BL/6J male mice aged 6-8 weeks were enrolled in this study. They were subjected to whole body irradiation of 60Co γ-rays with doses of 5.0 and 7.5 Gy. A SD model was established using a SD device. According to the random number table method, the mice were divided into seven groups: the control group (Con group), the SD group, the mere radiation group (IR group), the group of post-irradiation SD (IR+ SD group), the group of post-irradiation SD treated with phosphate buffer solution (IR+ SD+ PBS group), the group of post-irradiation SD treated with GSK2795039 (IR+ SD+ GSK group), and the group of post-irradiation SD treated with N-acetylcysteine (IR+ SD+ NAC group), with in eight mice each group. The changes in the peripheral blood of the mice after 5.0 Gy irradiation were detected using the collected tail venous blood, and the survival rates of the mice after 7.5 Gy irradiation were observed. The changes in the density and count of bone marrow cells were observed using hematoxylin and eosin (HE) staining. The number of hematopoietic stem cells in bone marrow (LSK cells), as well as their apoptosis level and changes in cell cycle, were detected using flow cytometry. Furthermore, indicators of LSK, such as reactive oxygen species(ROS) and mitochondrial-derived reactive oxygen species (mtROS), were analyzed. Nicotinamide adenine dinucleotide phosphate (NADP+ /NADPH) and glutathione (GSSG/GSH) were detected using an enzyme microplate reader in order to observe the oxidative stress level of LSK. Furthermore, flow cytometry was employed to sort the LSK cells from the mice, and flow cytometry was used to detect the expression of NADPH oxidase 2(NOX2) and cysteinyl aspartate specific proteinnase-1(Caspase-1), and polymerase chain reaction (PCR) was used to detect the expression of inflammatory factors such as NOX1-4, interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 18 (IL-18), and tumor necrosis factor α (TNF-α). Results:Compared to the IR group, the IR+ SD group exhibited significantly slower recovery of white blood cells (WBC) and platelets (PLT) ( t = 4.39, 6.37, P < 0.05), the bone marrow cell count decreasing from (2.14 ± 0.38) × 10 7 to (3.59 ± 0.29) × 10 7 ( t = 8.55, P < 0.05), significantly decreased proportion of G 0-phase LSK cells, significantly increased proportion of apoptotic cells ( t = 7.53, 8.21, P < 0.05), and significantly increased DCFH-DA, MitoSOX, and NADP+ /NADPH ( t = 22.99, 29.47, 3.77, P<0.05). In the case of IR, SD further promoted the activation of NOX2 and led to increases in the mRNA expression of downstream inflammatory factors such as IL-1β, IL-6, IL-18, and TNF-α ( t = 6.95, 6.01, 8.39, 4.91, 5.56, P < 0.05). Inhibition of NOX2-ROS could prevent the SD-induced aggravation of post-irradiation hematopoietic injury. This significantly reduced the apoptotic rate of LSK cells and the expression of inflammatory factors, ultimately accelerating the hematopoietic recovery of LSK cells ( t = 9.24, 3.92, P < 0.05). Conclusions:SD can aggravate the IR-induced injury of hematopoietic stem cells in bone marrow, primarily by activating the NOX2-ROS-Caspase-1 axis. This will increase the levels of intracellular inflammatory factors and ROS, promote cell apoptosis, and ultimately inhibit the hematopoietic recovery of bone marrow.

Objective:To identify serum metabolic markers for early prediction and diagnosis of gestational diabetes mellitus (GDM).Methods:A retrospective case-control study was conducted.The study subjects were from pregnant women enrolled in the Birth Cohort Study of the Women′s Hospital, Zhejiang University, from1 November 2018 to 30 March 2020.100 cases of GDM (GDM group, Age 36.03±3.91) and 150 non-GDM pregnant women matched for clinical information (control group, Age35.49±3.46) were retrospectively selected for the study. Fasting serum samples were collected at 15-20 weeks of gestation (prior to GDM diagnosis, T1 period) and 24-28 weeks of gestation (during GDM diagnosis, T2 period). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to quantify GDM-related serum metabolic small molecules, including 1, 5-anhydroglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine. These molecules, along with basic clinical information (age, gestational week, BMI) and standard biochemical indicators (FPG), were used to develop predictive models for the early detection of GDM at T1 and the diagnosis of GDM at T2. Statistical analysis was performed using t-tests or Mann-Whitney U-tests.Result:The results of the targeted quantitative validation study indicate: At the T1 stage, the level of 1, 5-anhydroglucitol was found to be significantly lower ( P=0.001) in the GDM group compared to the control group. Conversely, the level of isoleucine was significantly higher ( P=0.027) in the GDM group. There were no significant differences in the levels of 3-hydroxybutyrate and phenylalanine between the two groups ( P>0.05). The combination of the 4 metabolites yielded the highest predictive value (AUC) for GDM at T1, with an AUC of 0.670 (95% CI: 0.602-0.739), P<0.001.At the T2 stage, the GDM group had significantly lower levels of 1, 5-anhydroglucitol ( P<0.05) and significantly higher levels of 3-hydroxybutyric acid and isoleucine ( P<0.05) than the control group, with no significant differences in phenylalanine levels ( P=0.626). The combination of the four metabolites had the highest diagnostic value (AUC) for GDM, 0.717 (95% CI 0.651-0.783), P<0.001.The analysis of seven different combinations of GDM prediction/diagnostic models created by combining four metabolites with basic clinical information and routine biochemical indicators showed: We found that the AUC value of the GDM diagnostic model built with FPG, BMI, pre-pregnancy BMI, age, gestational week, and the 4 metabolite indicators in T2 stage was the best, 0.794 (95% CI 0.736-0.851), P<0.001, with a sensitivity of 72%;The best AUC value for the GDM prediction model built with the same indicators at T1 was 0.711(95% CI 0.646-0.776), P<0.001, with a sensitivity of 77%. Conclusions:Four metabolic small molecules, 1, 5-anhydroxyglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine, were integrated with clinical indicators (FPG) and clinical information (age, gestational week, BMI) to develop a predictive model for GDM at gestation (T1) and a diagnostic model for GDM at gestation (T2), demonstrating promising clinical prediction and diagnostic capabilities. 1, 5-Anhydroglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine show potential as valuable markers for the prediction and diagnosis of GDM.

Objective:To systematically review, assess, extract, and summarize the most effective evidence on non-pharmacological traditional Chinese medicine interventions for promoting pulmonary rehabilitation in stable patients with chronic obstructive pulmonary disease, aiming to provide a theoretical foundation for clinical nurses to implement traditional Chinese medicine nursing interventions.Methods:According to the "6S" evidence model, relevant evidence on non-pharmacological traditional Chinese medicine interventions for stable chronic obstructive pulmonary disease was retrieved from domestic and foreign databases, guideline websites and professional society websites, including clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus, etc. The retrieval time was from January 1, 2018 to August 10, 2023. Two researchers evaluated the quality of the included literature, and extracted data and summarized evidence.Results:A total of 23 articles were included, including 6 guideline, 1 evidence summary, 7 systematic reviews, 8 Meta analysis and 1 expert consensus. The 37 evidences were summarized from 11 aspects, including target population, intervention focus, moxibustion therapy, acupoint sticking therapy, transcutaneous electrical acupoint stimulation, acupuncture therapy, acupoint injection therapy, traditional Chinese exercises, diet therapy, follow-up procedures, safety considerations.Conclusions:This study summarizes the evidences of traditional Chinese medicine non-drug pulmonary rehabilitation in the stable stage of chronic obstructive pulmonary disease. When applying the evidence in clinical practice, the traditional Chinese medicine nursing ability of nurses and the actual situation of patients should be fully considered to formulate an individualized traditional Chinese medicine nursing plan.

Objective To construct a prognostic risk model for colorectal cancer(CRC)with good prediction ability based on upda-ted ferroptosis-related genes.Methods Transcriptome levels,clinical information and updated ferroptosis-related genes of CRC pa-tients were downloaded from UCSC Xena and FerrDb V2databases.The genes related to prognosis were screened out by R language and univariate COX regression analysis,and the final prognostic risk model was established by LASSO regression combined with multivariate COX regression analysis.Then,survival analysis and the predictive power of the model were assessed by R language"survival"package,"timeROC"package and COX regression.Results There were 8differentially expressed ferroptosis-related genes including NEDD4L,TIMP1,KIF20A,GDF15,ENO3,TERT,MS4A15,HOTAIR which composed of the prognostic risk model.The model divided the CRC patients into two groups,and the difference in survival prognosis was between the two groups was statistically significant(P＜0.05).The area under the receiver operating characteristic(ROC)curves of the model in 1,3 and 5 year were 0.732,0.702 and 0.738,respective-ly.The results of GO and KEGG analysis showed that the genes between the two groups were enriched in pathways and functions such as tumor process,inflammatory response,and even immunity.Immune-related functions,immune cell infiltration,and immune check-points were significantly different between high and low risk groups(P＜0.05).Conclusion The prognostic model constructed based on 8differentially expressed ferroptosis-related genes has an independent prognostic effect on CRC,providing a new way to predict the prog-nosis of CRC.