Background:The prognosis of systemic lupus erythematosus complicated with lupus enteropathy is poor. At present, studies on pathogenesis of lupus enteropathy are rare. Aims:To investigate the expressions of intercellular adhesion molecule-1 (ICAM-1),vascular cell adhesion molecule-1 (VCAM-1)and intestinal fatty acid binding protein (I-FABP) in lupus enteropathy in mice. Methods:Twenty MRL/ lpr lupus mice were randomly divided into two groups:lupus enteropathy group and control group. Lupus enteropathy model was established by administration with TNBS enema. Histological score was assessed,expressions of ICAM-1,VCAM-1 and I-FABP were determined by immunohistochemistry, and correlations with histological score were analyzed. Results:Compared with control group,histological score was significantly increased (8. 1 ± 5. 8 vs. 0. 8 ± 0. 5,P = 0. 000),expressions of ICAM-1 (9. 4% ± 2. 1% vs. 6. 2% ± 1. 1%),VCAM-1 (15. 1% ± 2. 1% vs. 12. 2% ± 1. 9%)and I-FABP (17. 5% ± 2. 5% vs. 6. 1% ± 0. 9%)were significantly increased (P < 0. 05)in lupus enteropathy group. Expressions of ICAM-1,VCAM-1 and I-FABP in colon tissue in lupus enteropathy group were positively correlated with histological score (r = 0. 870,P = 0. 010;r = 0. 881,P =0. 010;r = 1. 000,P = 0. 000). Conclusions:ICAM-1,VCAM-1 and I-FABP may be associated with pathogenesis of lupus enteropathy.

Extracurricular activities are necessary to curricular study and significant in quality and practical ability education for medical students.Research and practice on how to improve the interest in extracurricular activities for medical students were carried out,and good results were achieved in the aspect of the development of teaching efficiency.

Objective To investigate the effect and safety of different polyethylene glycol 4000 (PEG)oral regimen on cleanliness of bowel preparation.Methods 280 patients received painness colonoscopy examination were randomly divided into A,B and C groups:group A which drank 1 L of PEG solution the day before colonoscopy and the rest 3 L in the morning at the day of colonoscopy;group B drank 2 L of PEG solution the day before colonoscopy and the rest 2 L in the morning at the day of colonoscopy;group C drank 4 L of PEG solution in the morning at the day of colonoscopy.Bowel cleanliness after taking the drug,stool frequency and adverse events before colonoscopy were observed.Results Group A had better bowel preparation compare with group B (P＜0.05),which was similar to that of group C(P＞0.05);But group A had lower incidence of abdominal distension(abdominal pain),nausea(vomiting) than group C(P＜0.05);and group B had worse sleep quality and more defecate frequency than the other two groups(P＜0.05).Conclusion Drink 1 L of PEG solution the day before colonoscopy and the rest 3 L in the morning at the day of colonoscopy provided a better quality preparation and with less adverse reaction,especially suitable for patients with poor quality of sleep,poor health and severe constipation.

Objective To evaluate the effect of electroconvulsive therapy (ECT) on the expression of phosphorylated glutamate receptor 1 (p-GluR1) and Ca2+/calmodulin-dependent protein kinase Ⅱ α (p-CaMK Ⅱ α) under small dose ketamine combined with propofol anesthesia in the depressed rats.Methods Forty healthy adult male Sprague-Dawley rats,weighing 200-250 g,aged 2-3 months,were used in this study.Mental depression was induced by exposing the animals to chronic unpredictable mild stress (CUMS).Forty mentally depressed rats were divided randomly into 5 groups (n =8 each) using a random number table:M0-4 groups.Propofol 80 mg/kg and ketamine 10 mg/kg were injected intraperitoneally in M0-4 groups.After disappearance of righting reflex,M1-4 groups received ECT of 60,120,180 and 240 mC once a day for 7 consecutive days,respectively,by means of a current (frequency 50 Hz,sine-wave,pulse width 0.7 ms,1-s duration) delivered via ear-clip electrodes,while group M0 received ECT of no quantity of electric charge via ear-clip electrodes.Before CUMS,at 1 day after CUMS and at 1 day after ECT,sucrose preference test was applied to evaluate the depressive behavior.The sucrose preference percentage (SPP) was calculated.At 4 days after CUMS and 4 days after ECT,the learning and memory function was assessed using Morris water maze test.The rats were then sacrificed,and hippocampi were isolated to detect the expression of GluR1,p-GluRl,CaMK Ⅱ α and p-CaMK Ⅱ α by Western blot.Results The SPP was significantly lower after CUMS than before CUMS in M0-4 groups (P＜0.05).Compared with that after CUMS,the SPP was significantly increased,the escape latency was shortened,and the space exploration time was prolonged after ECT in M1-4 groups (P＜0.05).There was no significant difference in SPP after ECT between M1-4 groups (P＞0.05).Compared with group M0,the SPP was significantly increased,and the expression of pGluR1 and p-CaMK Ⅱ α was up-regulated in M1-4groups (P＜0.05).Compared with group M2,the escape latency was significantly prolonged,the space exploration time was shortened,and the expression of pGluR1 and p-CaMK Ⅱ α was down-regulated after ECT in the other groups (P＜0.05).There was no significant difference in GluR1 and CaMK Ⅱ α expression after ECT between the five groups (P＞ 0.05).Conclusion ECT can induce cognitive decline when applied for anti-depression under small dose ketamine combined with propofol anesthesia,and the mechanism is related to increased phosphorylation of GluR1 and CaMK Ⅱ α expression in rats.

Objective:To investigate the effect of early gradual diet on reducing delirium in elderly patients with hip arthroplasty.Methods:From January 2018 to January 2020, 74 cases of hip arthroplasty patients aged over 65 years old who were treated in the Third Affiliated Hospital of Sun Yat-sen University were selected as the observation objects. They were randomly divided into experimental group and control group with 37 cases in each group. The experimental group was given early gradual diet on the basis of routine postoperative care, while the control group was given routine postoperative diet on the basis of routine postoperative care. The incidence of postoperative delirium, Pittsburgh Sleep Quality Index (PSQI), patient satisfaction rate, average hospitalization days and average hospitalization expenses were used to evaluate the effect of early gradual diet on reducing delirium in elderly patients with hip arthroplasty.Results:The incidence of delirium in the experimental group was 2.70% (1/37) and 16.22% (6/37) in the control group, the difference was statistically significant ( χ2 value was 3.945, P<0.05); the hospitalization days of the experimental group were (10.68±5.13) d, (13.62±7.19) d in the control group. The difference of hospitalization days was statistically significant ( t value was 2.877, P<0.01). The incidence of difficulty in falling asleep and the satisfaction rate of the experimental group were 8.11% (3/37) and 94.59% (35/37) respectively, and those in the control group were 29.73% (11/37) and 78.38% (29/37) respectively, and the differences were statistically significant ( χ2 value was 5.638, 4.163, P<0.05). Conclusions:Early gradual diet after operation can reduce the incidence of delirium in elderly patients with hip arthroplasty, shorten the average hospitalization days, reduce the incidence of difficulty in falling asleep, improve patients' satisfaction, and help patients to pass through the perioperative period more safely and comfortably.

Objective: To explore the value of baseline geriatric nutritional risk index (GNRI) in evaluating the prognosis of patients with end-stage renal disease (ESRD) who underwent peritoneal dialysis (PD). Methods: The clinical data of patients who underwent PD catheterization and started PD therapy at the First Affiliated Hospital of Zhengzhou University from January 1, 2013 to December 30, 2018 were collected retrospectively. The follow-up endpoint was death or hemodialysis. The follow-up deadline was March 1, 2019. The GNRI cut-off value was determined according to the ROC curve, and the patients were divided into GNRI≤90.5 group and GNRI>90.5 group. The differences of clinical data and laboratory tests were compared between the two groups. Kaplan-Meier survival curves were used to compare the difference in PD rate between the two groups during follow-up, and the factors that affecting patients PD withdrawal were analyzed by Cox regression. Results: The GNRI cut-off value was determined to be 90.5 based on the ROC curve. Until the deadline for follow-up, the drop-out rate of GNRI≤90.5 group was significantly higher than the GNRI>90.5 group (35.88% vs 21.58%, P=0.003). Kaplan-Meier survival curves showed a higher rate of maintaining PD in the GNRI>90.5 group than that in GNRI≤90.5 group during follow-up (P=0.021). Cox univariate regression showed that male, GNRI and serum Alb were protective factors for PD patients, and Scr was a risk factor. After multiple factors correction, male and GNRI were also the protective factors for PD patients. Conclusion As an objective indicator of nutritional evaluation, baseline GNRI can be used as a prognostic indicator for PD patients.

Objective:To explore the effects of "rain classroom" wisdom teaching on geriatric students′ autonomous learning ability and self-efficacy.Methods:From June to August, 2021, 61 nursing students who practiced in the department of gerontology of the Second Xiangya Hospital, Central South University were selected as research subjects, and divided into experimental group (30 students) and control group (31 students) by random number table method. In the experimental group, wisdom teaching based on "Rain classroom" was carried out at the same time as conventional teaching, while in the control group, conventional teaching was carried out, and the teaching effect was evaluated by the independent learning ability measurement scale and academic self-efficacy scale of nursing students.Results:The score of autonomous learning ability of nursing students in the experimental group was 68.55 ± 11.06, and that in the control group was 74.29 ± 9.16. The difference between the two groups was statistically significant ( t = -2.01, P<0.05). The academic self-efficacy scores of nursing students in experimental group and control group were 52.27 ± 11.56 and 52.64 ± 9.28 respectively. There was no significant difference between the two groups ( P>0.05). Conclusions:The wisdom teaching of "rain classroom" improves the independent learning ability of geriatric nursing students, and attaches importance to the cultivation of self-efficacy of nursing students, and the improvement of self-efficacy needs further research.

Objective:To assess whether cardiac structure and function are associated with frailty in elderly inpatients.Methods:This was a cross-sectional study.Inpatients aged 65 years or over, admitted to Beijing Hospital, Chinese PLA General Hospital and Beijing Tsinghua Changgeng Hospital, were consecutively recruited from September 2018 to April 2019.A total of 925 elderly inpatients were enrolled in the study, including 285 frailty patients and 640 non-frailty patients.Frailty was assessed with the Fried frailty phenotype.Clinical and echocardiographic data were collected.The association of cardiac structure and function with frailty was analyzed.Results:Compared with the non-frailty group, the frailty group was older, had lower body mass index, and had higher rates of heart failure, atrial fibrillation/atrial flutter, history of stroke/transient ischemic attack, renal insufficiency, and history of falls.N-terminal B-type natriuretic peptide(NT-proBNP)levels were higher while creatinine clearance and hemoglobin levels were lower(all P<0.05); The frailty group had a larger anterior-posterior left atrial diameter[(37.8±7.1)mm vs.(36.3±5.1)mm, t=-3.134, P=0.002]and a higher proportion with the left atrial anterior posterior diameter ≥45 mm[15.8%(45/285) vs.6.1%(39/640), χ2=22.452, P<0.001], a lower left ventricular ejection fraction[(60.1±9.5)% vs.(61.9±7.5)%, t=2.817, P=0.005]and a faster peak mitral inflow velocity[(0.8±0.3)cm/s vs.(0.7±0.2)cm/s, t=-2.675, P=0.003]. Multivariate logistic regression analysis showed that the left atrial anterior posterior diameter ≥45 mm was an independent correlation factor for frailty( OR=2.249, P=0.015). Increased age( OR=1.099, P<0.001), heart failure( OR=1.786, P=0.049), history of stroke/transient ischemic attack( OR=1.960, P=0.001)and decreased hemoglobin( OR=0.984, P=0.008)were independently associated with frailty. Conclusions:The left atrial anterior posterior diameter ≥45 mm and heart failure were independently associated with frailty.Assessing cardiac structure and function and screening for cardiovascular diseases in frailty patients should be emphasized.

OBJECTIVE To explore the effect of single dose and multiple doses of silibinin on the in vivo pharmacokinetics of nevirapine in rats. METHODS Thirty male SD rats were randomly divided into blank control group, multiple administration of low-dose group(30 mg·kg−1) , multiple administration of high-dose group(100 mg·kg−1), single administration low-dose group(30 mg·kg−1) , and single administration high-dose group(100 mg·kg−1). Blood samples were collected to determine the concentration of nevirapine and its metabolites in rat plasma after an oral administration of 10 mg·kg−1 nevirapine. The kinetic parameters of nevirapine and its metabolites in each group were calculated by DAS and analyzed statistically. RESULTS Compared with the blank control group, multiple doses of 100 mg·kg−1·d−1 silibinin significantly increased the AUC of nevirapine by 61.78%, Cmax by 124.62% and decreased the clearance rate to 64.11%; multiple doses of 30 mg·kg−1·d−1 silibinin significantly increased the Cmax of nevirapine by 84.85%; a single dose of 100 mg·kg−1 or 30 mg·kg−1 silibinin significantly increased the Cmax of nevirapine by 65.19% and 32.12%, respectively. The metabolic ratio of 12-hydroxy-nervirapine was decreased by 31.5% by multiple doses of 100 mg·kg−1·d−1 silibinin where the pharmacokinetic parameters of 4-carboxyl-nervirapine remained unchanged. CONCLUSION Silibinin significantly affects the pharmacokinetics of nevirapine in rats. The drug-drug interaction should be considered when nevirapine and silibinin are concomitant.

Objective: To assess the efficiency and safety of low-dose decitabine in patients with lower-risk myelodysplastic syndrome (MDS) to couple with the clinical significance of MDS-related gene mutations. Methods: This study was done in 4 institutions in Zhejiang Province. A total of 62 newly diagnosed patients with lower-risk MDS were assigned to two groups of decitabine (12 mg·m^-2·d^-1 for 5 consecutive days) and best supportive care (BSC) . Their bone marrow samples were subject to examinations of MDS-related 15 gene mutations. The primary endpoints were the proportion of patients who achieved overall response (ORR) after at least two cycles and progression-free survival (PFS) , and their relevances to the gene mutations. Results: Of 62 enrolled patients, and 51 cases were included in the final analysis. 16 of 24 patients (66.7%) in decitabine group achieved ORR versus 8 of 27 (29.6%) in BSC group (χ²=6.996, P=0.008) ; PFS prolongation of decitabine versus BSC was statistically significant (not reached vs 13.7 months, P=0.037) . Among 51 patients, at least one gene mutation was identified in 20 patients (39.2%) , including 4 single SF3B1 mutation. PFS in cases with gene mutations (not including single SF3B1 mutation) was significantly shorter than of no gene mutation (9.2 months vs 18.5 months, P=0.008) , but not for ORR (37.5% vs 58.1%, P=0.181) . Among 16 patients with mutated genes, ORR in decitabine and BSC groups were 75% (6/8) and 0 (0/8) , respectively. The most adverse events in decitabine group were grade 3 to 4 neutropenia (45.8%) and grade 3 to 4 infections (33.3%) . Conclusion This preliminary study showed that low-dose decitabine produced promising results with an acceptable safety in lower-risk MDS patients, especially for those with mutated genes. Further study targeting poor prognostic lower-risk MDS patients should be warranted.