Increasing the production and secretion of endogenous opioid peptide by immune cell can significantly induce myocardial protective effects against ischemia-reperfusion injury. Gene therapy is promising to increase endogenous enkephalin (ENK). However, classical viral and plasmid vectors for gene delivery are hampered by immunogenicity, gene recombination, oncogene activation, the production of antibacterial antibody and changes in physiological gene expression. Minimalistic immunologically defined gene expression (MIDGE) can overcome all the deficients of viral and plasmid vectors. The exon of rat's preproenkephalin (PPENK) gene was amplified by PCR and the fragments were cloned into pEGFP-N1 plasmids. The recombined plasmids were digested with enzymes to obtain a linear vector contained promoter, preproenkephalin gene, RNA stable sequences and oligodesoxy nucleotides (ODNs) added to both ends of the gene vector to protect gene vector from exonuclease degradation. A nuclear localization sequence (NLS) was attached to an ODN to ensure the effective transport to the nucleus and transgene expression. Flow cytometry, laser confocal microscopy and Western blotting demonstrated that PPENK-MIDGE-NLS can transfect leukocyte of rat in vivo, increase the expression of proenkephalin (PENK) in tissue, and the transfection efficiency depends on gene vector's dosage. These results indicate that PPENK-MIDGE-NLS could be an innovative method to protect and treatment of myocardial ischemia-reperfusion injury.
Animals ; Cloning, Molecular ; Enkephalins ; genetics ; Gene Expression ; Genetic Therapy ; Genetic Vectors ; Leukocytes ; Plasmids ; Promoter Regions, Genetic ; Protein Precursors ; genetics ; Rats ; Transfection ; Transgenes

Objective:To explore the effect of instant blood glucose monitoring system (FGM) in perioperative blood glucose management in patients with hip fracture complicated with diabetes mellitus, and to provide guidance for perioperative blood glucose management.Methods:A total of 100 patients with hip fracture complicated with diabetes mellitus treated in the Department of Orthopaedics, Gongli Hospital, Pudong New Area, Shanghai from July 2018 to July 2020 were selected as subjects.The patients were divided into experimental group and control group by random digits table method with 50 cases in each group. The patients in both groups adopted the mode of multidisciplinary cooperation.The experimental group was used to monitor blood glucose based on FGM, and traditional blood glucose monitoring was used in the control group. The waiting time before operation, the pain caused by blood glucose acupuncture, the satisfaction of patients and medical staff, the blood glucose level at different time points and the incidence of adverse reactions were compared between the two groups.Results:The waiting time before operation, the proportion of patients with moderate and severe pain after acupuncture and the incidence of hyperglycemia in the experimental group were (2.58 ± 1.30) d, 2% (1/50) and 30% (15/50), respectively, the control group were (3.67 ± 1.59) d, 22% (11/50) and 50% (25/50), respectively. The differences were statistically significant( t value was -2.087, χ2 values were 9.470, 4.170, P<0.05). The satisfaction of patients and medical staff in the experimental group were (46.43 ± 1.87), (46.58 ± 2.10) points, respectively, the control group were (40.67 ± 3.24), (43.84 ± 2.92) points, respectively.The differences were statistically significant( t values were 8.441, 8.087, P<0.05). There was no significant difference in fasting blood glucose, 2-hour postprandial blood glucose and pre-bedtime blood glucose between the two groups( P>0.05). Conclusions:The application of FGM can realize the continuous blood glucose monitoring and management of patients,making the blood glucose reach the standard more quickly and smoothly, meanwhile it may effectively shorten the waiting time before operation and reduce the acupuncture pain of blood glucose monitoring and recognize patients with concealed abnormal blood glucose. The application can improve the satisfaction of patients and medical staff, and promote the rapid recovery of patients as well.

Objective To understand the various causes of nursing postgraduates to engage in clinical nursing work, so as to provide the reference basis for hospital managers to the cultivation of the postgraduate nurses. Methods Using the convenience sampling method, semi-structured interviews were conducted among 12 postgraduate nurses from August to October in 2016. The interview data were collected and analyzed using phenomenological research method. Results Three themes were extracted, including salary and stability factors, self-development factors and career development factors. Conclusions Clinical managers should pay attention to the basic requirements, self-development and career development of postgraduate nurses, and provide more career development opportunities and platforms for them.

Objective:To explore the knowledge, attitude and practice (KAP) status of ICU nurses on enteral nutrition treatment of severe acute pancreatitis and to analyze its influencing factors.Methods:A total of 520 ICU nurses from 7 ClassⅢ Grade A hospitals in Henan Province from February to April 2022 were selected as research objects by the convenient sampling method. General Data Questionnaire and Clinical Nurses' Knowledge, Attitude and Practice Questionnaire on Enteral Nutrition Treatment of Acute Pancreatitis were used to investigate.Results:A total of 520 questionnaires were sent out, and 504 were effectively collected, with an effective recovery rate of 96.92%. The total score of ICU nurses' knowledge, attitude and practice in enteral nutrition for severe acute pancreatitis was (113.68±12.48), including knowledge dimension (10.67±2.58), attitude dimension (61.60±6.38), and practice dimension (41.42±7.44). There were positive correlation among ICU nurses' scores of knowledge, attitude and practice on enteral nutrition in patients with severe acute pancreatitis ( P<0.01). The results of multiple linear regression analysis showed that professional title, length of service in ICU nursing, personnel relations, whether to participate in specialized training, and whether to care for patients with severe acute pancreatitis and enteral nutrition were the influencing factors of knowledge dimension ( P<0.05). Post, whether to participate in specialized training, and whether to care for patients with severe acute pancreatitis undergoing enteral nutrition were influencing factors of attitude dimension ( P<0.05). Gender, professional title, post, whether to participate in specialized training, and whether to care for patients with severe acute pancreatitis undergoing enteral nutrition were the influencing factors of behavioral dimensions ( P<0.05) . Conclusions:ICU nurses have a positive attitude towards enteral nutrition treatment for severe acute pancreatitis, and their knowledge attitude and practice level need to be improved. Nursing managers should establish and improve a training system, strengthen the knowledge and behavior of ICU nurses on enteral nutrition for patients with severe acute pancreatitis and improve their management level of enteral nutrition for patients with severe acute pancreatitis, thereby improving the quality of nursing.

Objective:To explore the influencing factors of enteral nutrition feeding intolerance (FI) in patients with abdominal trauma and construct a risk prediction model.Methods:This was a retrospective study. General and clinical data such as Acute Physiology and Chronic Health Evaluation (APACHEⅡ), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Acute Gastrointestinal Injury (AGI) of patients with abdominal trauma and enteral nutrition admitted to Department of Emergency Surgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to January 2023 were collected by means of medical record inquiry. Patients were divided into FI group and non-FI group according to whether FI occurred within three days after receiving enteral nutrition. Multivariate Logistic regression analysis was used to explore the influencing factors of FI in patients with abdominal injury and to construct the related risk prediction model. The diagnostic value of the prediction model was evaluated by the area under the receiver operating characteristic curve.Results:A total of 101 research objects were included, including 30 patients with enteral nutrition FI and 71 patients without enteral nutrition FI. The multivariate Logistic regression results analysis showed that injury severity score, acute gastrointestinal injury grading, and hypoalbuminemia were the influencing factors of enteral nutrition FI in patients with abdominal injury ( P<0.05). A risk prediction model for enteral nutrition FI in patients with abdominal injury was constructed based on the above factors. The area under the receiver operating characteristic curve (AUC) of the predictive model was 0.856, with a sensitivity of 0.833, a specificity of 0.732, a Jordan index of 0.565, and an optimal critical value of 0.265. Conclusions:The constructed risk prediction model for enteral nutrition FI in patients with abdominal injury has good predictive performance, which can provide a reference for medical staff to predict the risk of enteral nutrition FI in patients with abdominal injury.

Objective:To investigate the diagnostic value of ultrasonic measurement of optic nerve sheath diameter (ONSD) and optical disk elevation (ODE) for intracranial hypertension in patients with cerebral venous sinus thrombosis(CVST).Methods:A total of 50 patients with CVST who underwent lumbar puncture and ONSD examination in the Department of Neurology and Emergency Department of Xuanwu Hospital, Capital Medical University from January 2021 to December 2021 were retrospectively enrolled. After lumbar puncture, the patient′s initial intracranial pressure was recorded. Normal ICP was defined as ICP between 80 and 200 mmH 2O, and increased ICP was defined as ICP>200 mmH 2O. Fifty patients with CVST were divided into normal ICP group (14 cases) and increased ICP group (36 cases). The differences of baseline data, ONSD and ODE between the two groups were compared, and the receiver operating characteristic (ROC) curve was generated. The area under the curve (AUC) and the diagnostic cut-off value of ONSD were analyzed. Spearman correlation analysis was used to analyze the correlation between ONSD, ODE, CVST involvement range scores and intracranial pressure. Results:①There were no significant differences in gender, age and body mass index between the normal ICP group and the increased ICP group (all P>0.05). ②The ONSD and ODE in the increased ICP group were higher than those in the normal ICP group, and the differences were statistically significant [(4.83±0.33)mm vs (4.21±0.21)mm, (0.67±0.44)mm vs (0.24±0.29)mm, all P<0.001]. Spearman correlation analysis showed that ONSD and ODE were positively correlated with intracranial pressure ( rs=0.74, 0.51, all P<0.001). ③The extent of CVST involvement in the intracranial hypertension group was higher than that in the normal intracranial pressure group, and the difference was statistically significant [5.0(3.0, 7.5) vs 2.5(2.0, 5.0), P=0.015]. Spearman correlation analysis showed that CVST involvement score was positively correlated with intracranial pressure ( rs=0.43, P<0.001). ④In the diagnosis of intracranial hypertension in patients with cerebral venous sinus thrombosis, the AUC of ONSD was 0.935, the best diagnostic threshold of ONSD was 4.5 mm, the sensitivity was 0.81, and the specificity was 0.93. Conclusions:ONSD and ODE measured by ultrasound are reliable imaging methods to identify intracranial hypertension in patients with CVST.

Objective:To explore the application of the semi-flipped classroom combined with knowledge point auction learning method in the theoretical teaching among stomatological students and its effectiveness.Methods:Undergraduates from four classes at Guanghua School of Stomatology, Sun Yat-Sen University were taken as research subjects. Students from two classes ( n=198) were taught using the semi-flipped classroom combined with the knowledge point auction learning method, while students from the other two classes ( n=172) were taught with the regular classroom teaching method as controls. Classroom quizzes were used to compare the two classes' mastery of important and difficult points, and a questionnaire was used to investigate students' feedback on the class outcomes. SPSS 22.0 was used for the independent samples t-test. Results:The mean test score of the experimental class was higher than that of the control class (88.51±11.02 vs. 80.40±8.53). The results of the questionnaire showed that students' interest in the course, comprehension and absorption of knowledge points, degree of satisfaction with the class, and mastery of the contents in sections in the experimental class were significantly higher than those in the control class (7.28±1.51 vs. 9.10±0.73, 6.92±1.44 vs. 8.69±1.62, 6.09±1.87 vs. 7.61±1.46, 6.40±1.04 vs. 7.70±0.86 ).Conclusions:The semi-flipped classroom combined with the knowledge point auction learning method is innovative and achieves good teaching outcomes. It holds promise for wider use in the theoretical teaching of various clinical subjects. To explore the application of the semi-flipped classroom combined with knowledge point auction learning method in the theoretical teaching among stomatological students and its effectiveness.