Objective To observe the effect of Ruanmailing Oral Liquid on angiogenesis in atherosclerosis plaque of Apolipoprotein E (ApoE) gene knock-out mice, and explore the mechanisms of plaque stabilizing. Methods Totally 30 mice 6-8 weeks old ApoE knockout mice were fed a high fat diet for 12 weeks until the formation of a mature atherosclerotic plaque. They were randomly divided into three groups-model group, Ruanmailing group, simvastatin group, with another 6 normal C57BL/6J mice as the control group, and were administered for 12 weeks. Blood was extracted from orbital venous to measure the lipid (TC, TG, LDL-C, HDL-C) variation. HE-stain was used to observe aortic pathomorphological changes, meanwhile, immunohistochemical method was adopted to determine the microvessel density of plagues which is marked by CD105, as well as the expression of CD105 in aorta. Results Compared with the model group, TC, LDL-C, TG of Ruanmailing group and simvastatin group decreased significantly, while HDL-C increased significantly (P<0.01), degree of pathological damage was reduced, microvessel density and the expression of CD105 was significantly lower (P<0.01). There was no significant difference between Ruanmailing group and simvastatin group in above-mentioned indicators (P>0.05). Conclusion Ruanmailing Oral Liquid may reduce the expression of CD105 and inhibit the angiogenesis within the plaque, which is the possible mechanism of stabilizing the atherosclerotic plaque.

Objective:To systematically evaluate the experience of home-based hospice care from two different perspectives of professional caregivers and family caregivers, and summarize the barriers faced by caregivers.Methods:This study was Meta-synthesis. Qualitative studies on the barriers of home-based hospice care among professional caregivers or family caregivers were electronically searched on China National Knowledge Infrastructure, WanFang Data, VIP, PubMed, Web of Science, Cochrane Library, Embase, CINAHL and Medline. The search period was from database establishment to October 3, 2023. The quality evaluation of literature was conducted using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. The aggregation Meta-synthesis method was used to integrate the included article.Results:A total of ten articles were included, all had a quality evaluation level of B. Thirty-five results were extracted and summarized into eight new categories. Two integrated results were formed, including barriers to implementation of home-based hospice care by patients' family members (three categories) and barriers to implementation of home-based hospice care by professional caregivers (five categories) .Conclusions:Due to various factors such as external policies, organizations, and personnel, there are still many challenges in the practical development of home-based hospice care. Government and medical institutions can formulate or improve policies and service processes to address the obstacles to implementing home hospice care for different caregivers, and promote the development of home-based hospice care.

Objective:To systematically review the risk prediction models for diabetic retinopathy in patients with type 2 diabetes mellitus (T2DM) .Methods:Literature regarding the risk prediction models for diabetic retinopathy in T2DM were searched from CINAHL, PubMed, Web of Science, Cochrane Library, Embase, Wanfang, CNKI, VIP, and China Biology Medicine disc, with the search timeframe extending to October 1, 2022. Two researchers independently selected literature and extracted data, and the bias risk and applicability of the included literature were analyzed using the PROBAST tool for assessing risk of bias in prediction model studies.Results:A total of 14 articles were included. Age, duration of diabetes, glycated hemoglobin, proteinuria, blood pressure, and serum creatinine levels were the main predictive factors for diabetic retinopathy in T2DM; the Area Under the Receiver Operating Characteristic (ROC) curve of the predictive models ranged from 0.683 to 0.984, with calibration conducted in 6 models; 4 studies used external validation, while the rest used internal validation. All studies demonstrated good applicability, but all presented bias risk.Conclusions:The risk prediction models for diabetic retinopathy in T2DM demonstrate good predictive performance. However, high bias risk due to methodological flaws (such as improper handling of missing data, inappropriate methods for variable selection, lack of blinding, etc.) indicates they cannot be directly applied to clinical practice. Future work should either conduct extensive validation on existing models or undertake large-scale, diverse prospective studies to develop predictive models with superior performance and user-friendly application.

ObjectiveTo find out the risk factors causing iatrogenic spinal cord injury (ISCI) so as to provide theoretical support for reducing the spinal cord injury during spinal operation. Methods A retrospective study was done on 120 patients undergone cervical or thoracic spinal( C1-T12 ) surgery at Xiangya Hospital of Central South University from January 2002 to January 2009. The patients were randomly divided into injury group (n = 34) and control group (n = 86) and the univariate analysis was used to analyze 30 factors including clinical factors, iconography factors, operation and pathology factors as well as possible protective factors. Then, the factors with statistical difference were analyzed by using the multi-factor unconditioned Logistic analysis.Results The univariate comparison between the two groups showed statistical difference ( P ＜ 0. 05 ) in nine factors including combined hypertension, combined diabetes mellitus, preoperative ASIA grade, spinal canal stenosis rate, ratio of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2WI high signal, bleeding amount during operation, intraspinal prominence adhesion to dura mate of spinal cord as well as intraoperative use of methylprednisolone. The multi-factor Logistic regression analysis revealed that ASIA grade, value of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2W1 high signal and bleeding amount in operation had positive correlation with ISCI. Use of methylprednisolone during operation had negative correlation with ISCI. ConclusionsCombined diabetes mellitus, ASIA grade, spinal cord MRI T2W1 high signal, ratio of spinal cord/vertebral canal area and bleeding amount in operation are the risk factors for ISCI. Use of large dose methylprednisolone exerts preventive effect on ISCI.

Objective:To study the trends and ranges of blood pressure in extremely premature infants (EPIs) during the first 7 days after birth.Methods:From January 2016 to December 2020, EPIs born in our hospital were retrospectively analyzed. Their blood pressure were monitored using umbilical arterial catheters and no patients needed anti-hypotension treatment. The clinical data of the infants and their mothers, blood pressure data during the first 7 days after birth, clinical outcomes and complications were collected. The trends of blood pressure in untreated EPIs were analyzed and the blood pressure ranges of EPIs of different gestational ages (GA) were established.Results:A total of 145 cases of EPIs were included and their systolic pressure, diastolic pressure and mean blood pressure showed upward trends during 2~168 h after birth ( P<0.001). The diastolic pressure increased significantly within 24 h after birth ( P<0.05), systolic pressure and mean blood pressure increased significantly within 72 h after birth ( P<0.05). Blood pressure increased with age and GA. Conclusions:The blood pressure of EPIs will increase spontaneously during 7 days after birth. The ranges of blood pressure are measured for infants with different GA to provide clinical evidence for blood pressure management of EPIs during early postnatal period.

Objective:To explore the postoperative biliary leakage and severe complication rate and its related risk factors of hepaticojejunostomy (HJ) for biliary disease.Methods:The clinical data of patients undergoing HJ for benign biliary diseases at the First Affiliated Hospital of Anhui Medical University from Jan 2003 to Dec 2017 were retrospectively analyzed. Multi-factor analysis was used to find a risk factor for postoperative bile leakage and severe complications.Results:Two hundred and eighty-three patients received HJ. The median age was 39 years.The short-term complication rate after surgery was 19.1% ( n=54), and the biliary leakage rate was 11.7% ( n=33), and the severe complication rate was 15.2% ( n=43). By multi-factor analysis: preoperative sepsis[ OR=3.875, 95% CI (1.583, 9.485), P=0.003], liver cirrhosis [ OR=3.212, 95% CI (1.001, 10.307), P=0.050], intraoperative blood loss≥400 ml [ OR=6.054, 95% CI (1.231, 29.781), P=0.027],postoperative hospitalization ≥9 days [ OR=6.738, 95% CI (2.287, 19.855), P=0.001] are the independent risk factors for postoperative bile leakage. Main bile duct stone[ OR=2.764, 95% CI (1.174, 6.510), P=0.020], preoperative sepsis [ OR=4.310, 95% CI (1.666, 11.149), P=0.003], intraoperative bleeding ≥400 ml [ OR=5.944, 95% CI (1.231, 29.781), P=0.022] and postoperative hospitalization ≥ 9 days [ OR=11.422, 95% CI (1.317, 49.859), P=0.001] are the independent risk factors for serious complications. Conclusions:HJ should be conducted when the sepsis was under control and sufficient bile drainage.The patients' condition should be comprehensively and accurately assessed before operation. The indications for partial hepatectomy need to be strictly defined.

Objective:To study the effect of oropharyngeal colostrum administration on salivary secretory IgA (sIgA) levels in extremely/very low birth weight preterm infants fed by gastric tube.Methods:Preterm infants with birth weight <1 500 g ( n=90) hospitalized in neonatal intensive care unit of the Affiliated Shenzhen Maternity & Child Healthcare Hospital of Southern Medical University from August 2020 to January 2021 were enrolled as research subjects. They were assigned into observation group and control group. The observation group accepted oropharyngeal administration of colostrum before being fed by gastric tube once every 3 hours for 7 days. The control group was given normal saline before each feeding. Other nursing interventions were consistent with the observation group. Saliva samples were collected at the 2 hour and 7 day after birth and the levels of slgA were tested. SPSS 26.0 statistical software was applied to analyse the data. Results:A total of 81 preterm infants completed this study. The content of salivary sIgA in observation group (42 cases) on 7 day after birth were significantly higher than those on the 2 hour after birth [15.4 (0.6, 106.7) μg/ml vs. 0.6 (0.0, 5.3) μg/ml] ( P<0.05). There was no statistically significant difference between the sIgA levels in the saliva of the control group (39 cases) at the 7 postnatal day and 2 hour after birth [0.0 (0.0, 1.4) μg/ml vs. 0.0 (0.0, 5.2) μg/ml] ( P>0.05). The content of salivary sIgA in observation group were significantly higher than those in control group on the 7 day after birth, the difference was statistically significant ( P<0.05). The salivary sIgA levels in the observation group were negatively correlated with the starting time of oropharyngeal administration of colostrum ( r=-0.330, P<0.05), and positively correlated with the total number of oropharyngeal administration of colostrum ( r=0.388, P<0.05). Conclusions:Oropharyngeal colostrum administration can improve the levels of salivary sIgA of extremely/very low birth weight preterm infants fed by gastric tube.

Background::Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA); however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures.Methods::This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed.Results::A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5% vs. 80.9%; χ2 = 4.10; P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06; 95% CI: 1.43-17.95; P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60; 95% CI: 1.17-5.76; P = 0.019), and short neck (OR, 2.85; 95% CI: 1.08-7.52; P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups ( P > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair. Conclusions::Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.

Sepsis, a series of pathophysiological abnormalities caused by infection, is also one of the most important factors of death and disability in infected patients all over the world, so it has always been the focus of the medical community. Cytokines are small molecule proteins secreted by cells with biological activity, involved in the immune and inflammatory regulation of sepsis. Many studies using cytokine targeting to treat sepsis have achieved beneficial effects, and the level of cytokines is also believed to be related to the development, severity of sepsis, so they are reliable biomarkers of sepsis. Among them, pro-inflammatory cytokines such as interferon-β (IFN-β) and interleukins (IL-1β, IL-3, IL-6, and IL-7) are the focus of the discussion in this review. IFN-β and IL-1β are double-sided in the treatment of sepsis, namely early low-dose treatment can reduce sepsis by restoring the function of immune cells and play a protective effect, but they are also related to severe inflammatory response of sepsis and can aggravate the mortality of sepsis patients. IL-3 and IL-6 focus more on enhancing inflammatory factors and play a damage role. IL-7 mainly participates in immune regulation, promoting lymphocyte activation and protecting sepsis.

Objective:To evaluate the efficacy and safety of mild hypothermia for patients with severe traumatic brain injury (sTBI).Methods:PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Database were searched for prospective randomized controlled researches on mild hypothermia and normothermia for patients with sTBI. The search time was from the establishment of the databases to February 2023. RevMan 5.3 software was used for Meta-analysis. The evaluation indicators included literature search results, basic characteristics and quality of the literature, poor prognosis rate and mortality at 6 and 12 months after treatment, incidence of pulmonary infection, arrhythmia, thrombocytopenia, intracranial infection, renal insufficiency, gastrointestinal ulcer/bleeding and electrolyte disorder during the treatment, and publication bias.Results:A total of 16 papers involving 2 640 patients were included, comprising 1 381 patients in the mild hypothermia group and 1 259 patients in the normothermia group. The poor prognosis rate in the mild hypothermia group was significantly lower than that in the normothermia group at 6 and 12 months after treatment ( RR=0.81, 95% CI 0.69, 0.95, P<0.01; RR=0.65, 95% CI 0.51, 0.84, P<0.01). There was no significant difference in the mortality between the two groups at 6 and 12 months after treatment ( RR=0.81, 95% CI 0.61, 1.08, P>0.05; RR=0.69, 95% CI 0.47, 1.03, P>0.05). In contrast with the the normothermia group, in the mild hypothermia group the incidence of pulmonary infection was significantly different ( RR=1.18, 95% CI 1.04, 1.34, P<0.01); the incidence of arrhythmia was not significantly different ( RR=1.35, 95% CI 0.73, 2.49, P>0.05); the incidence of thrombocytopenia was significantly different ( RR=1.78, 95% CI 1.34, 2.37, P<0.01); the incidence of intracranial infection was not significantly different ( RR=1.32, 95% CI 0.54, 3.23, P>0.05); the incidence of renal insufficiency was not significantly different ( RR=1.22, 95% CI 0.71, 2.09, P>0.05); the incidence of gastrointestinal ulcer/bleeding was not significantly different ( RR=0.98, 95% CI 0.73, 1.31, P>0.05); the incidence of electrolyte disorders was not significantly different ( RR=1.39, 95% CI 1.00, 1.94, P>0.05). The funnel plot was approximately symmetrical and the scattered points were concentrated in the narrow area in the upper part of the funnel plot, suggesting no publication bias. Conclusions:In comparison with normothermia for sTBI, mild hypothermia can not reduce the mortality at 6 and 12 months after treatment, but it can reduce the incidence of poor prognosis at 6 and 12 months after treatment. Moreover, mild hypothermia has no obvious effect on the incidence of arrhythmia, intracranial infection, renal insufficiency, gastrointestinal ulcer/bleeding, and electrolyte disorder, but it can increase the incidence of pulmonary infection and thrombocytopenia.