Objective: To observe the effects of He-Ne laser on the expression of extracellular matrix and its regulatory factors in degenerated temporomandibular joint(TMJ) of rabbits. Methods: 40 New Zealand adult white rabbits were randomly divided into normal group,sham model group,TMJOA model group and laser treatment group(n = 10),the rats in treatment group were treated by He-Ne laser irradination at acupoints. The rats in each group were divided into 1 d and 11 d groups(n = 5). The animals were respectively killed 1 d and 11 d after operation and HE staining was used to observe the histomorpholy. The protein expression of extracellular matrix and its regulatory factors were examined by Western blot. Results: After He-Ne laser treatment,the fiber layer of condylar cartilage was slightly loose,part of the fiber was newly produced. The level of Col-2,PRG-4,TIMP-1,BMP-2 was up-regulated and the of MMP-13 was down-regulated in the 11 d treatment group. Conclusion: He-Ne laser irradiation on acupoints may up-regulate the expression of extracellular matrix (Col-2 and PRG-4) and its regulatory factors (TIMP-1 and BMP-2),down-regulate the expression of MMP-13.

Objective:To investigate the effect of mind mapping on the discharge readiness of patients undergoing first coronary stent implantation, so as to provide basis for seeking effective discharge guidance in clinical practice.Methods:One hundred patients who were hospitalized in the Department of Cardiology, the Second Affiliated Hospital of Dalian Medical University from December 2019 to August 2020 and who underwent coronary stent implantation for the first time were selected as the study objects. They were divided into the control group and the experimental group with 50 cases in each group by the random number table method. The control group was given routine discharge guidance, and the experimental group was given discharge guidance using mind mapping. Readiness for Hospital Discharge Scale and Quality of Discharge Teaching Scale were used to compare the differences of discharge readiness and discharge guidance quality between the two groups after intervention.Results:The personal status, adaptability, predictive support and the total score of discharge readiness in the experimental group were (25.18 ± 3.79), (45.24 ± 3.63), (36.62 ± 3.63), (107.04 ± 8.92) points, which were all higher than those in the control group (23.34 ± 3.04), (41.68 ± 3.62), (35.14 ± 2.14), (100.16 ± 7.36) points, with statistically significant differences ( t values were -4.91--2.48, all P<0.05). The actual acquired content, guiding skills and results, total scores of discharge guidance quality of patients in the experimental group were (56.66 ± 6.06), (94.46 ± 4.33), (151.12 ± 8.26) points, which were all higher than those in the control group (45.38 ± 9.19), (89.44 ± 10.87), (134.82 ± 14.31) points, with statistically significant differences ( t values were -7.25, -3.03, -6.97, all P<0.05). Conclusions:Mind mapping can effectively improve the discharge preparation degree and discharge guidance quality of patients undergoing coronary stent implantation for the first time, and it is a simple and practical discharge guidance tool.

Objective:To understand the level of thirst distress in heart failure and analyze its influencing factors, in order to provide a theoretical basis for implementing the intervention measures to alleviate patients′ thirst distress.Methods:A total of 187 patients with heart failure who met the inclusion criteria from the First Affiliated Hospital and the Second Affiliated Hospital of Dalian Medical University from November 2019 to October 2020 were selected as the research objects. The General Information Questionnaire, Thirst Distress Scale-Heart Failure, Generalized Anxiety Disorder 7-item Scale, Patient Health Questionaire-9 and Brief Illness Perception Questionnaire were used to investigate heart failure patients. Multiple linear regression was used to explore the influencing factors of heart failure patients′ thirst distress.Results:The score of thirst distress in heart failure patients was (23.95 ± 4.21), multiple stepwise linear regression analysis showed that heart function grade, diuretic usage, anxiety, depression and disease perception were the influencing factors of thirst distress in patients with heart failure, which explained 41.9% of the thirst distress in heart failure patients.Conclusions:The thirst distress of heart failure patients is in the middle level, and its thirst distress is affected by many factors, clinical medical staff should pay attention to the severity of thirst distress in patients with heart failure, actively develop different intervention measures to reduce patients′ thirst sensation, and explore effective schemes to alleviate thirst distress in patients with heart failure.

Objective:To evaluate the efficacy of esketamine combined with fascia iliaca compartment-subarachnoid block in optimizing anesthesia in elderly patients undergoing hip fracture surgery.Methods:Sixty-two American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ elderly patients of either sex, aged 60-85 yr, with body mass index of 18.5-30.0 kg/m 2, were divided into 2 groups ( n=31 each) using a random number table method: fascia iliaca compartment-subarachnoid block group (FS group) and esketamine combined with fascia iliaca compartment-subarachnoid block group (ES group). In FS group, patients underwent ultrasound-guided fascia iliaca compartment block at 30 min before the operation of subarachnoid anesthesia on the surgical side. In ES group, esketamine 0.25 mg/kg was intravenously administered at 5 min before skin incision based on the fascia iliaca compartment-subarachnoid block. Patient-controlled intravenous analgesia was used for postoperative analgesia, and tramadol 1 mg/kg was intravenously given for rescue analgesia when numerical rating scale score > 4. The pressing times of patient-controlled analgesic pump, the number of rescue analgesia and consumption of tramadol were recorded within 48 h after operation. The occurrence of postoperative adverse reactions (respiratory depression, nausea and vomiting, dizziness, drowsiness, pruritus, illusion, nightmares) was recorded. Results:Compared with FS group, the consumption of postoperative tramadol was significantly decreased, and the pressing times of patient-controlled analgesic pump and the number of rescue analgesia were reduced in ES group ( P<0.05). There were no significant differences in the incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:Combination of esketamine with fascia iliaca compartment-subarachnoid block for hip fracture surgery can raise postoperative analgesia and optimize clinical management strategies in elderly patients.

Objective:To study the protective effects and mechanisms of melatonin (MTn) on lipopolysaccharide (LPS) and hypoxic-ischemic(HI) induced white matter damage (WMD) in neonatal rats.Methods:Seventy-two 3-day-old newborn Sprague-Dawley (SD) rats were randomly assigned into sham operation group (the sham group), model group (the HI group) and MTn intervention group (the HI+MTn group) ( n=24 for each group). For the sham group, only dissection of the right common carotid artery was performed without ligation. Animal models of WMD were established using LPS pretreatment and HI method in both the HI group and HI+MTn group. The HI+MTn group received MTn intraperitoneal injection (15 mg/kg, 1 h before LPS injection and then once daily). The HI group and the sham group received equal volume of normal saline containing 1% ethanol intraperitoneal injection. The rats were sacrificed on d7 of experiment and periventricular white matter (PVWM) was collected for hematoxylin-eosin (HE) and TUNEL staining to determine WMD and apoptosis. The distribution and morphology of microglial cells in the PVWM were studied using IBA1 immunofluorescence staining. Reactive oxygen species (ROS) kit was used to detect ROS. The expression of nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasomes, interleukin (IL)-1β, IL-18 and mitochondrial autophagy markers (pink1 and parkin) were determined using real-time quantitative PCR. Results:Compared with the sham group, the HI group showed WMD, cell degeneration and necrosis,increased cell apoptosis and increased expressions of NLRP3 inflammasomes and downstream inflammatory factors (IL-1β and IL-18) in PVWM. Compared with the HI group,the HI+MTn group showed reduced WMD, cell apoptosis, microglia infiltration and inflammatory factors expression. MTn increased pink1 and parkin expression and reduced ROS production in PVWM.Conclusions:MTn reduces ROS production by enhancing mitochondrial autophagy and inhibits NLRP3 inflammasomes hyperactivation to alleviate endotoxin- and HI-induced WMD in neonatal rats.

Objective:To evaluate the effect of ultrasound-guided single fascia iliaca compartmentblock (FICB) combined with esketamine on postoperative delirium (POD) in elderly patients undergoing hip fracture surgery.Methods:Sixty-two patients of either sex, aged 60-85 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing hip fracture surgery under subarachnoid anesthesia, were divided into 2 groups ( n=31 each) using a random number table method: single FICB group (group FICB) and single FICB combined with esketamine group (group FICB+ E). Ultrasound-guided FICB was performed on the operated side at 30 min before subarachnoid anesthesia. In FICB+ E group, esketamine was intravenously injected as a bolus of 0.3 mg/kg at 5 min before skin incision followed by an infusion of 0.25 mg·kg -1·h -1 until 30 min before the end of procedure. Patient-controlled intravenous analgesia was used for postoperative analgesia, and tramadol 1 mg/kg was given for rescue analgesia. The pressing times of patient-controlled analgesia, the number of rescue analgesia, and consumption of tramadol were recorded within 48 h after operation. The Ramsay sedation score was used to assess the degree of sedation at skin incision, 30 min after the start of surgery, 30 min before the end of surgery, at the end of surgery, and at discharge from the post-anesthesia care unit. Postoperative delirium (POD) occurred within 7 days after surgery was assessed using the Confusion Assessment Method. The serum concentrations of tumor necrosis factor-alpha, interleukin-6, S100β and glial fibrillary acidic protein (GFAP) were detected by enzyme-linked immunosorbent assay on admission to the operating room and at 3 and 7 days after surgery. The occurrence of adverse drug reactions (respiratory depression, nausea and vomiting, dizziness, somnolence, urinary retention) was recorded. Results:Compared with group FICB, the incidence of POD was significantly decreased within 3 days after surgery, the consumption of tramadol, pressing times of patient-controlled analgesia and the number of rescue analgesia were reduced, Ramsay sedation score was increased at each time point, and the serum concentrations of tumor necrosis factor-alpha, interleukin-6, S100β and glial fibrillary acidic protein were decreased after surgery ( P<0.05), and no significant change was found in the total incidence of POD at 7 days after surgery in group FICB+ B ( P>0.05). Conclusions:Ultrasound-guided single FICB combined with esketamine can provide adequate analgesia and sedation in the perioperative period for elderly patients with hip fractures, reducing the risk of early postoperative (within 3 days) POD.

Objective To investigate the association between atherogenic index of plasma (AIP) and metabolic associated fatty liver (MAFLD) in type 2 diabetes mellitus (T2DM). Methods A total of 375 patients with T2DM who were hospitalized and treated in Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, from September 2021 to September 2022 were enrolled, and according to the presence or absence of MAFLD, they were divided into T2DM+MAFLD group with 245 patients and T2DM group with 130 patients. Related clinical data were recorded, and AIP was calculated. According to the quartiles of AIP, the patients were divided into Q1 group (AIP≤0.20), Q2 group (0.20 < AIP≤0.24), Q3 group (0.24 < AIP≤0.48), and Q4 group (AIP > 0.48). The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the trend chi-square test was used for the trend analysis of categorical data. The multivariate logistic regression analysis was used to investigate the effect of AIP on MAFLD, and the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to assess the value of the indicators such as AIP, body mass index (BMI), and alanine aminotransferase (ALT) in predicting T2DM with MAFLD. Results Compared with the T2DM group, the T2DM+MAFLD group had significant increases in BMI, systolic pressure, uric acid, fasting blood glucose, glycosylated hemoglobin, ALT, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, triglyceride, low-density lipoprotein, and AIP and a significant reduction in high-density lipoprotein (all P < 0.05). The trend chi-square test showed that the prevalence rate of MAFLD in T2DM patients tended to increase with the increase in AIP level ( χ trend 2 =20.338, P < 0.05). The multivariate logistic regression analysis showed that compared with the Q1 group, the Q4 group had a significant increase in the risk of MAFLD (odds ratio =2.396, 95% confidence interval: 1.018-5.640, P =0.045). The ROC curve analysis showed that the diagnostic model of AIP combined with BMI and ALT had the best diagnostic performance (AUC=0.816), with a sensitivity of 70.2% and a specificity of 78.5% at the optimal cut-off value of 0.670. Conclusion AIP is an independent risk factor for MAFLD in T2DM patients, and AIP combined with BMI and ALT has a good predictive value for T2DM with MAFLD.

Objective To investigate the protective effect of hydrogen-rich water on rat cognitive dysfunction induced by ionizing radiation.Methods A total of 20 SD rats were randomly divided into four groups with the ramdom number table method: control group(C),hydrogen-rich water group(HRW),irradiation group(IR)and hydrogen-rich water intervention group(HRW+IR),with 5 rats in each group.The spatial memory ability of rats was tested by a morris water maze.The expression of apoptosis-related genes was detected by real-time fluorescence quantitative PCR.The changes of glutathione(GSH),8-hydroxydeoxy guanosine(8-OHdG)and malondialdehyde(MDA)and SOD were also measured.Results The escape latency(F＝6.003,P＜0.05)and the swimming distances(F＝3.850,P＜0.05)of rats in four different groups had statistically significant differences.Compared with the IR group,the escape latency of the HRW+IR group was significantly decreased at 3,4,5 d after irradiation(P＜0.05),and the swimming distance of this group became much longer(P＜0.05).The levels of GSH,8-OHdG and MDA in these four groups had statistically significant differences(F＝6.450,5.033,4.113,P＜0.05).Compared with IR group,the concentration of GSH was increased(P＜0.05),but MDA and 8-OHdG decreased(P＜0.05)in the brain tissue of HRW+IR group,and the expressions of caspase-3,caspase-9 and bax genes were reduced(t＝2.956,3.087,5.246,P＜0.05),while the expression of bcl-2 gene was enhanced(t ＝-3.640,P ＜0.05)in the HRW+IR group.Conclusions Hydrogen-rich water attenuates the oxidative damage of ionizing radiation by neutralizing oxyhydrogen free radicals and thus protects brain from radiation damage.

Objective:To explore the rapid evaluation of the early pathogen of severe Chlamydophila psittaci pneumonia by bedside diagnostic bronchoscopy, so as to start effective anti-infection treatment before the results of macrogenome next generation sequencing (mNGS) test. Methods:The clinical data of three patients with severe Chlamydophila psittaci pneumonia who were successfully treated in the First Affiliated Hospital of Xinjiang Medical University, the First People's Hospital of Aksu District, and the First Division Hospital of Xinjiang Production and Construction Corps from October 2020 to June 2021 were retrospectively analyzed, including the rapid assessment of early pathogens by bedside diagnostic bronchoscopy and the use of antibiotics to start anti-infection treatment. These patients were successfully treated. Results:The three patients were male, aged 63, 45 and 58 years old, respectively. Before the onset of the penumonia, they had a clear medical history of bird exposure. The clinical manifestations mainly included fever, dry cough, shortness of breath and dyspnea. One case had abdominal pain and lethargy. The results of laboratory examination indicated that the peripheral blood white blood cell count (WBC) of two patients were high [(10.2-11.9)×10 9/L], the percentage of neutrophils increased (85.2%-94.6%) and the percentage of lymphocytes decreased (3.2%-7.7%) in all 3 patients after admission to hospital and entering into intensive care unit (ICU). The procalcitonin (PCT) of 3 patients increased after admission, and still increased when entering ICU (0.3-4.8 ng/L), so did C-reactive protein (CRP, 58.0-162.0 mg/L) and erythrocyte sedimentation rate (ESR, 36.0-90.0 mm/1 h). After admission, serum alanine transaminase (ALT) increased in 2 cases (136.7 U/L, 220.5 U/L), so did aspartate transaminase (AST) in 2 cases (249.6 U/L, 164.2 U/L). ALT (162.2-267.9 U/L) and AST (189.8-223.2 U/L) increased in 3 patients when they entered ICU. The level of serum creatinine (SCr) of 3 patients were normal after admission and entering ICU. The chest computed tomography (CT) findings of 3 patients were acute interstitial pneumonia, bronchopneumonia and lung consolidation, of which 2 cases were accompanied by a small amount of pleural effusion, and 1 case was accompanied by more regular small air sacs. Multiple lung lobes were involved, but mainly one lung lobe. The oxygenation index (PaO 2/FiO 2) of the 3 patients admitting to ICU were 100.0, 57.5 and 105.4 mmHg (1 mmHg ≈ 0.133 kPa), respectively, which met with the diagnostic criteria of moderate and severe acute respiratory distress syndrome (ARDS). All three patients received endotracheal intubation and mechanical ventilation. Under the bedside bronchoscope, the bronchial mucosa of 3 patients were obviously congested and edematous, without purulent secretion, and there was 1 case with mucosal hemorrhage. Three patients underwent bedside diagnostic bronchoscopy, and the evaluation result of the pathogen was that it might be atypical pathogen infection, so they were given moxifloxacin, cisromet and doxycycline intravenously, respectively, and combined with carbapenem antibiotics intravenously. After 3 days, the detection results of mNGS in bronchoalveolar lavage fluid (BALF) showed that only Chlamydia psittaci was infected. At this time, the condition was significantly improved, and PaO 2/FiO 2 was significantly increased. Therefore, the antibiotic treatment scheme remained unchanged, and mNGS only served to verify the initial diagnosis. Two patients were extubated on the 7th and 12th day of admission to the ICU, respectively, while one patient was extubated on the 16th day of admission to the ICU due to nosocomial infection. All 3 patients were transferred to the respiratory ward after the condition was stable. Conclusion:The bedside diagnostic bronchoscopy based on clinical characteristics is conducive to not only the rapid assessment of the early pathogens of severe Chlamydia psittaci pneumonia, but also effective anti-infection treatment before the returning of mNGS test results, which can make up for the lag and uncertainty of the mNGS test results.

OBJECTIVE: Providing a risk assessment method for the implementation of radiotherapy to identify possible risks in the implementation of the treatment process, and proposing measures to reduce or prevent these risks. METHODS: A multidisciplinary expert evaluation team was developed and the radiotherapy treatment process flow was drawn. Through the expert team, the failure mode analysis is carried out in each step of the flow chart. The results were summarized and the (risk priority ordinal) score was obtained, and the quantitative evaluation results of the whole process risk were obtained. RESULTS: One hundred and six failure modes were obtained, risk assessment of (20%) high risk failure model are 22 and severity (≥ 8) high risk failure model are 27. The reasons for the failures were man-made errors or hardware and software failures. CONCLUSIONS Failure mode and effect analysis can be used to evaluate the risk assessment of radiotherapy, and it provides a new solution for risk control in radiotherapy field.
Healthcare Failure Mode and Effect Analysis ; Risk Assessment