Objective To investigate the effects of pioglitazone on osteoblast proliferation and apoptosis.Methods MC3T3-E1 mouse osteoblastic cells were treated with 0, 5, 10, 20, 30, and 40 μmol/L pioglitazone for 24 h. Cell viability was measured by MTT, cell cycle and apoptosis were inspected with flow cytometry, the expressions of Bcl-2 and Bax proteins were examined via immuno-chemical staining. Results Survival of osteoblasts decreased in a dose-dependent manner. Compared with the control group, the cells in the G0/G1 and G2/M stages increased, while the cells in S stage decreased significantly. The percentage of apoptosis at 5 and 10 μmol/L were lower than that of the control group(P ＜ 0.05), While it was increased significantly at 30 and 40 μmol/L(P ＜0.01). Bax expression was attenuated at 10 μmol/L(P＜0. 01), returned to normal by 20 μmol/L, and was increased by 30 and 40 μmol/L(P ＜ 0. 01). Bcl-2 expression was enhanced at the dose ≤ 20 μmol/L(P ＜0.01). Positive correlation was found between the death rate and the expression intensity of Bax/Bcl-2(n = 15, r=0.796, P＜0.01). Conclusions Pioglitazone inhibits apoptosis of osteoblasts at low concentrations and protects the cells, but promotes their apoptosis at higher concentration, Bax/Bcl-2 may play an important role in mediating the piglitazone-induced apoptosis of osteoblasts. It inhibits DNA synthesis and cell proliferation.

Objective To investigate the risk factors of ICU delirium in critically ill patients. Methods A total of 1 74 critically ill patients in ICU who were older than 18 yrs and stayed in ICU exceeding 24 hs from January 201 5 to June 201 5 were enrolled.Patients were divided into delirium group and non delirium group.Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU)during the first 7 days.The factors such as history of alcoholism and other 12 factors were analyzed by univariate and multivariate logistic regression analysis to identify those risk factors associated with delirium.Results With 22 cases of delirium in 1 74 patients,the in-cidence of delirium was 12.64% (delirium group).Variables associated with delirium were coronary heart history,operation,tracheal intubation,clinical use of mechanical ventilation,hypoxemia and Benzodiazepine.Multivariate logistic regression analysis showed that coronary heart disease (OR 3.932,95%CI 1.225-12.61 7),surgery(OR 9.691,95%CI 2.103-44.657),hypoxemia(OR 6.595, 95%CI 1.377-31.585),Benzodiazepine use (OR 7.620,95%CI 1.713-33.899)was independent risk factors of delirium in critically ill patients (P < 0.05 or P < 0.01 ).Conclusion Coronary heart disease,surgery,hypoxemia and Benzodiazepine are independent risk factors of ICU delirium in criti-cally ill patients.Early screening and prevention of delirium should be given to reduce the occurrence of delirium for patients in ICU.

Objective:To determine the effect of pelvic floor electrical stimulation combined with conventional treatment on neurogenic bladder dysfunction after spinal cord injury.Methods:The Pubmed/Medline, Embase, Cochrane, CINAHL, China National Knowledge Infrastructure, CQVIP and Wanfang databases were electronically searched for reports published before April 2019 of randomized and controlled trials testing the effect of electrical stimulation of the pelvic floor on neurogenic bladder after spinal cord injury. Meta-analysis of all the reports collected was performed.Results:Seven randomized and controlled trials with 319 patients were identified. Together they showed that compared with conventional treatment, pelvic floor muscle stimulation better increased bladder capacity and reduced the volume of residual urine. Average single urination output was increased, while the frequency of urination decreased along with episodes of urinary incontinence. Average lower urinary tract symptoms scores were also significantly better.Conclusions:Electrical stimulation of the pelvic floor combined with conventional therapy may be more effective than conventional therapy alone in alleviating the symptoms of neurogenic bladder.

Objective To observe the effect of surface electromyographic biofeedback (sEMG BFB) combined with routine swallow training in treating dysphagia among those with nasopharyngeal carcinoma after radiation therapy.Methods Fifty dysphagic patients with nasopharyngeal carcinoma after radiation therapy were randomly divided into a biofeedback training group and a routine treatment group,each of 25.Both groups were given routine training including orofacial function training,sensory irritation,behavioral swallowing training,and electrical stimulation.The biofeedback group was additionally given behavioral swallowing training based on sEMG BFB.Before and 4 weeks after the treatment,a videofluoroscopic swallowing study was performed to observe the opening of the upper esophageal sphincter (UES).The penetration aspiration scale (PAS) and the functional oral intake scale (FOIS) were used to evaluate the subjects' swallowing function.Results Before the treatment there were no significant differences between the two groups in terms of UES opening,average PAS score or average FOIS score.Everyone improved significantly after the treatment,but compared with the routine treatment group,UES opening was significantly better after the treatment,the average PAS score was lower and the average FOIS score was higher in the biofeedback training group.Conclusion sEMG BFB combined with routine swallowing training can improve the UES opening and swallowing ability of dysphagic patients with nasopharyngeal carcinoma after radiation therapy.

Objective To explore the effect of the self-made turnover blanket on the prevention of pressure ulcers.Methods Forty-seven patients with the high risk of pressure ulcers and the score of Braden less than 12 points were chosen in order to carry out the self control study.At first we used the raditional turnover method, and then we used the self-made turnover blanket.The satisfaction rates of patients and nurses were investigated, and the total time of turnover and the time of maintaining the body position were compared before and after the use of the turnover blanket.Results The satisfaction rates of patients, attendants, patients ’ families nurses were 95.7%,92.1%,92.0%,93.7%after the use of the self-made turnover blanket, and were higher than use the traditional turnover method, and the differences were statistically significant (χ2 =39.272, 8.168,14.107,7.101, respectively;P<0.01).The total time of turnover and the time of maintaining the body position were respectively (121 ±15) min, (65 ±9.66) min after the use, and were better than those in the traditional turnover method, and the differences were statistically significant (t=4.726,3.880, respectively;P<0.01).Conclusions The self-made turnover blanket makes patients feel comfortable and specification, and can reduce the operation time and energy consumption, and can increase the time of maintaining the body position after turning over, and can improve the satisfaction rates of patients and nurses, and is consistent with the requirement of high quality nursing service.

Objective To develop the duration knowledge requirement questionnaire of myocardial infarction patients, in order to provide tools for understanding duration knowledge requirement of myocardial infarction patients. Methods By literature review and semi-structure interview as the main sources of questionnaire dimensions and items, the primary questionnaire had been formed by experts conference method, but the formal questionnaire was established after the confirmation and perfection by pre-survey and recognition interview. Results The duration knowledge requirement questionnaire of myocardial infarction patients included 5 dimensions 37 items. The Cronbach′s α coefficient of questionnaire reliability was 0. 839, each dimensions′ Cronbach′s αcoefficient was 0. 704-0. 825. The content of validity was 0. 86. Conclusions This questionnaire has favorable validity and reliability, which is suitable for the survey of duration knowledge requirement in myocardial infarction patients.

Environmental endocrine disrupting chemicals are a kind of exogenous chemicals that generally exist in the environment, and can disturb the endocrine homeostasis and adversely affect reproductive, immune, neurological, and other functions after entering the body, among which the damage to the reproductive system is the most significant one. Studies have confirmed that the long-term exposure to environmental endocrine disrupting chemicals have irreversible and harmful effects on primordial germ cell growth, reproductive organ development, and reproductive endocrine regulation, and also have obvious correlations with the occurrence and development of various reproductive system tumors. This paper reviewed various reproductive toxicities induced by common environmental endocrine disrupting chemicals in the developmental and reproductive stages, and associated mechanisms involved in the occurrence and development of reproductive system tumors.

Objective:Continuous glucose monitoring (CGM) technology is used to compare the advantages of insulin degludec (IDeg) as a basal insulin regimen compared with insulin glargine (IGlar) in the treatment of adult type 1 diabetes mellitus.Methods:30 adult patients with T1DM admitted to Heji Hospital Affiliated to Changzhi Medical College from September 2019 to December 2020 were screened. According to the random number table method, the patients were randomly divided into two groups (insulin degludec group and insulin glargine group) at a ratio of 1∶1, respectively treated with IDeg, IGlar and aspartate insulin for 12 weeks. The main outcome measures were the coefficient of variation of blood glucose (CV), mean amplitude of glycemic excursions (MAGE), time in range (TIR), time above range (TAR) and time below range (TBR). The secondary outcome measures were mean blood glucose (MBG), standard deviation of blood glucose (SD), fasting blood glucose (FPG), 2 h postprandial blood glucose (2 h BG), hemoglobin A1c (HbA 1c), means of daily differences (MOOD), and the frequency of hypoglycemic events. Results:At 12 weeks of treatment, the HbA 1c, FPG, 2 h BG, MBG, SD, CV and MAGE of insulin degludec group were lower than those of insulin glargine group, with statistically significant difference (all P<0.05). The TIR in the insulin degludec group was significantly higher than that in the insulin glargine group [73(63, 75)% vs 43(28, 63)%, P<0.001], and the TAR was lower than that in the glycerine group [25(17, 23)% vs 35(33, 64)%, P=0.003]. From the curve spectrum of blood glucose level of the two groups, the stability of blood glucose in the insulin degludec group was better than that in the insulin glargine group. After 12 weeks of treatment, 8 cases (8/15) in insulin degludec group had HbA 1c<7.0%, and 4 cases (4/15) in insulin glargine group had HbA 1c<7.0%, without statistically significant difference ( P=0.264). There were 7 cases (7/15) in the insulin degludec group and 1 case (1/15) in the insulin glargine group who achieved high quality blood glucose control, with statistically significant difference ( P=0.035). At the 12th week of outpatient follow-up, the incidence of nocturnal hypoglycemic events in insulin degludec group was significantly lower than that in insulin glargine group (4/15 vs 11/15, P=0.027). Conclusions:Compared with insulin glargine, insulin degludec can achieve higher blood glucose compliance rate, lower blood glucose level and reduce blood glucose fluctuations in patients with type 1 diabetes.

Objective:To compare the clinical features between chronic active Epstein-Barr virus infection(CAEBV) and infectious mononucleosis(IM)in adult patients.Methods:Clinical data from 56 adult IM patients and 14 adult CAEBV patients admitted in the First Affiliated Hospital of Nanjing Medical University during January 2011 to December 2019 were enrolled. Clinical manifestations, laboratory indicators, treatment and outcomes were compared between two groups. Chi-square test and Mann-whitney U test were used to analyze data. Results:The average age of CAEBV patients was higher than that of IM patients [36.0(23.8, 50.5)years vs. 19.0(17.3, 22.8) years; U=90.0, P<0.05]. The symptoms of sore throat, throat congestion, tonsilla enlargement and lymphadenopathy in IM group were more common than those in CAEBV group( χ2=14.088, 16.875, 31.855 and 10.938, all P<0.01). However, the incidence of pulmonary infection, sleepiness/dysphoria and splenomegaly in CAEBV group were significantly higher than those in IM group( χ2=17.217, 5.809 and 6.254, P<0.05 or <0.01). The white blood cell counts, hemoglobin levels, platelet counts, alanine aminotransferase(ALT) and albumin in CAEBV group were significantly lower than those in IM group( U=47.0, 49.5, 158.5, 173.0 and 263.5, all P<0.01). The levels of neutrophil ratio, C-reactive protein, serum ferritin and EBV DNA load in CAEBV group were significantly higher than those in IM group( U=145.0, 140.0, 128.5 and 115.0, P<0.05 or <0.01). The proportions of CD3 + T cell counts and CD8 + T cell counts in CAEBV group were significantly lower compared to those in IM group( U=42.0 and 24.5, P<0.01); the proportions of CD4 + T cell counts, the CD4 + T/CD8 + T cell counts ratio and B lymphocytes in CAEBV group were significantly higher compared to those in IM group( U=29.0, 23.5 and 34.5, P<0.01). Fifty-six IM patients were all cured and discharged from hospital. In CAEBV group, 8 cases died, 3 cases were improved and 3 cases lost follow-up. Conclusions:Patients with IM represent a favorable prognosis, while the prognosis of CAEBV is relatively poor and complication with HLH may occur. For older patients with EBV infection complicated with pulmonary infection, lethargy/irritability, attention should be paid to monitor blood routine, liver function, serum EBV DNA load and peripheral blood lymphocyte subsets.

Objective:To establish an intelligent management system and explore its application in the management of high-value consumables in Interventional Operating Room.Methods:Supply and processing and distribution (SPD) combined with the intelligent management system was applied in the Intervention Center at Ningbo First Hospital of Zhejiang Province in October 2019. High-value consumables managed with traditional information management between October 2018 and September 2019 were included into the control group, while those managed with SPD combined with the intelligent management system from October 2019 to September 2020 were included into the observation group. The high-value consumable system and inventory compliance rate, average daily inspection time, average daily claim time, timely supply of consumables, return rate of unused consumables, and nurse satisfaction under the two different management modes were compared.Results:The coincidence rates of the high-value consumable system inventory and actual inventory in the observation group and the control group were 98.26% (226/230) and 85.21% (196/230) , respectively; the average daily inspection time, (67.44±1.42) min in the observation group was less than (108.00±2.51) min in the control group, and the average daily claim time, (53.41±5.24) min was less than (118.22±4.68) min in the control group; the total rate of untimely supply of consumables and unreturned unused consumables in the observation and control groups were 3.46% (138/3 986) and 20.86% (881/4 224) , respectively; and the satisfaction of nurses in the two groups were 93.75% (135/144) and 63.89% (92/144) . The differences between the two groups were all statistically significant ( P<0.05) . Conclusions:The construction and application of the intelligent consumable management system can effectively improve the standardization and refinement of the management of high-value consumables in the Interventional Operating Room, and reduce the operating cost of the department.