Objective:To construct an early rehabilitation exercise program for patients with agoraphobia after total knee arthroplasty (TKA) to provide guidance for orthopedic rehabilitation nursing practice.Methods:The first draft of an early rehabilitation exercise program for patients with agoraphobia after TKA was developed through literature search, semi-structured interviews, and group discussions. From November to December 2023, 20 experts from nine provinces and centrally administered municipalities were selected for two rounds of expert consultation using the Delphi method to form the final draft of the early rehabilitation exercise program for patients with agoraphobia after TKA.Results:In two rounds of consultation, the questionnaire recovery rates were 91.30% (21/23) and 95.24% (20/21), with authority coefficients of 0.92 and 0.96, and Kendall's coordination coefficients of 0.28 and 0.34, respectively ( P<0.05). After the second round of consultation, the mean importance assignment scores for all levels of indicators ranged from 3.90 to 5.00, with coefficients of variation ranging from 0 to 0.20. The finalized early rehabilitation exercise program for patients with agoraphobia after TKA contained two parts, including the preface and the main text, and the main text consisted of five first-level items, 21 second-level items, and 35 third-level items. Conclusions:The content of the early rehabilitation exercise program for patients with agoraphobia after TKA is scientific, reasonable, comprehensive, practical and targeted, which can provide a basis for clinical medical and nursing personnel to guide the early rehabilitation exercise for patients with agoraphobia after TKA.

Objective:To construct an early rehabilitation exercise program for patients with agoraphobia after total knee arthroplasty (TKA) to provide guidance for orthopedic rehabilitation nursing practice.Methods:The first draft of an early rehabilitation exercise program for patients with agoraphobia after TKA was developed through literature search, semi-structured interviews, and group discussions. From November to December 2023, 20 experts from nine provinces and centrally administered municipalities were selected for two rounds of expert consultation using the Delphi method to form the final draft of the early rehabilitation exercise program for patients with agoraphobia after TKA.Results:In two rounds of consultation, the questionnaire recovery rates were 91.30% (21/23) and 95.24% (20/21), with authority coefficients of 0.92 and 0.96, and Kendall's coordination coefficients of 0.28 and 0.34, respectively ( P<0.05). After the second round of consultation, the mean importance assignment scores for all levels of indicators ranged from 3.90 to 5.00, with coefficients of variation ranging from 0 to 0.20. The finalized early rehabilitation exercise program for patients with agoraphobia after TKA contained two parts, including the preface and the main text, and the main text consisted of five first-level items, 21 second-level items, and 35 third-level items. Conclusions:The content of the early rehabilitation exercise program for patients with agoraphobia after TKA is scientific, reasonable, comprehensive, practical and targeted, which can provide a basis for clinical medical and nursing personnel to guide the early rehabilitation exercise for patients with agoraphobia after TKA.

CD47 is a transmembrane glycoprotein widely expressed on cells and an important signal molecule for immune escape of tumor cells. CD47, which is highly expressed in bladder cancer cells, can interact with signal regulatory proteins on the surface of macrophages- α (SIRPα). It combines and transmits immunosuppressive signals to protect tumor cells from phagocytosis, thereby mediating their immune escape. CD47-SIRPα signal pathways have become the focus of tumor cell immune checkpoint research at this stage. This article reviewed the research progress in the mechanism and clinical value of CD47 in bladder cancer.

9β,11β-Epoxypregn-4-ene-17α,21-diol-3,20-dione 21-acetate (Ⅰ) is a substrate for the production of 9β,11β-Epoxypregn-1,4-diene-17α,21-diol-3,20-dione (Ⅳ),which is a key precursor for the production of many 9-fluoro-substituted corticosteroid hormones.By comparing whole cells catalysis and cellular lysates conversion,it was found that whole cells of Mycobacterium sp.MS136 could only convert Ⅰ to 9β,11β-Epoxypregn-4-ene-17α,21-diol-3,20-dione (Ⅱ),and Ⅰ can be effectively converted toⅣ by cellular lysates.The reaction order is that Ⅰ is spontaneously hydrolyzed to Ⅱ and Ⅱ undergoes C1,2-dehydrogenation reaction to Ⅳ.In order to improve the productivity of Ⅳ,the key genes kstD,kstD3 and kstDM encoding C1,2-dehydrogenase (KSTD) were overexpressed in Mycobacterium sp.MS136 to enhance the C1,2-dehydrogenation reaction rate,and the results showed that 1 g/L substrate Ⅰ can be converted by recombinant strain MS136-kstDM cellular lysates at pH 7.0,the productivity of Ⅳ reached 78.4％ after 45 h,which is 38.9％ higher than original strain.The reaction rate is enhanced by optimizing the pH,and the results showed that 1 g/L substrate (Ⅰ) can be converted by recombinant strain MS136-kstDM cellular lysates at pH 7.5,the productivity of Ⅳreached 92.8％ after 45 h,which was 63.4％ higher than original strain.