Objective: To systematically evaluate the influencing factors for medication compliance in patients with comorbidities of chronic diseases, so as to provide the evidence for improving medication compliance. Methods: Literature on influencing factors for medication compliance in patients with comorbidities of chronic diseases were retrived from CNKI, Wanfang Data, VIP, SinoMed, PubMed, Web of Science, Cochrane Library and Embase from inception to January 20, 2024. After independent literature screening, data extraction, and quality assessment by two researchers, a meta-analysis was performed using RevMan 5.4 and Stata 16.0 softwares. Literature were excluded one by one for sensitivity analysis. Publication bias was assessed using Egger's test. Results: Initially, 7 365 relevant articles were retrieved, and 35 of them were finally included, with a total sample size of about 150 000 individuals. There were 30 cross-sectional studies and 5 cohort studies; and 11 high-quality studies and 24 medium-quality studies. The meta-analysis showed that the demographic factors of lower level of education (OR=2.148, 95%CI: 1.711-2.696), lower economic income (OR=1.897, 95%CI: 1.589-2.264), male (OR=0.877, 95%CI: 0.782-0.985), living alone (OR=2.833, 95%CI: 1.756-4.569) and unmarried (OR=2.784, 95%CI: 1.251-6.196); the medication treatment factors of polypharmacy (OR=1.794, 95%CI: 1.190-2.706), potentially inappropriate medication (OR=2.988, 95%CI: 1.527-5.847), low frequency of daily medication (OR=0.533, 95%CI: 0.376-0.754) and adverse drug reactions (OR=3.319, 95%CI: 1.967-5.602); the disease factors of long course of disease (OR=2.118, 95%CI: 1.643-2.730), more comorbidities (OR=1.667, 95%CI: 1.143-2.431) and cognitive impairment (OR=2.007, 95%CI: 1.401-2.874); and the psychosocial factors of poor belief in taking medication (OR=1.251, 95%CI: 1.011-1.547), poor self-rated health (OR=1.990, 95%CI: 1.571-2.522) and being guided by healthcare professionals (OR=0.151, 95%CI: 0.062-0.368) were the influencing factors for medication compliance in patients with chronic comorbidities. Conclusion The medication compliance in patients with comorbidities of chronic diseases is associated with demographic factors, pharmacological factors, disease factors and psychosocial factors, mainly including living alone, adverse drug reactions, course of disease, number of comorbidities and medication beliefs.

Objective To observe the effects of wheat grain moxibustion for"Huantiao"on sciatic nerve function,pathological morphology of sciatic nerve stem and expressions of TLR4/MyD88/NF-κB signaling pathway expression in spinal cord tissue of rats with sciatic nerve injury(SNI);To explore the possible mechanism of wheat grain moxibustion for the treatment of SNI.Methods Totally 24 SD male rats were randomly divided into blank group,sham-operation group,model group and wheat grain moxibustion group,with 6 rats in each group.The model group and the wheat grain moxibustion group used a rat model with sciatic nerve clamping injury.From the 7th day after modeling,the rats were treated with moxibustion on the affected side of"Huantiao"for 6 strokes each time,once a day,for consecutive 10 days.The sciatic nerve function index(SFI)of rats on the 7th day after modeling and after intervention were observed,mechanical withdraw threshold(MWT)in rats were measured using a fiber optic pain gauge,ELISA was used to detect NO and iNOS content in spinal cord tissue,HE staining was used to observe the morphology of sciatic nerve stem,the expression of TLR4,NF-κBp65,p-NF-κBp65,MyD88,IκBα and p-IκBα in spinal cord tissue were detected by Western blot.Results Compared with the sham-operation group,the SFI and MWT of the rats in the model group significantly decreased(P<0.01),the arrangement of nerve fibers in sciatic nerve stem was disordered,with a significant increase in the number of Schwann cells and a large number of vacuolar degeneration,the content of NO,iNOS and the expression of TLR4,p-NF-κBp65,MyD88,p-IκBα protein in spinal cord tissue significantly increased(P<0.01).Compared with the model group,the SFI and MWT of the rats in the wheat grain moxibustion group increased significantly(P<0.01),the damage of sciatic nerve stem was reduced,with orderly cell arrangement,a decrease in the number of Schwann cells,and a decrease in axonal demyelination and cellular vacuolar degeneration,the content of NO,iNOS and the expression of TLR4,p-NF-κBp65,MyD88,p-IκBα in spinal cord tissue significantly decreased(P<0.05).Conclusion Wheat grain moxibustion for"Huantiao"can down-regulate TLR4,p-NF-κBp65,MyD88 and p-IκBα protein expressions in spinal cord tissue of SNI rats,reduce the secretion of NO and iNOS,thereby relieve pain and damaged nerve tissue inflammation response.

Objective To explore the potential categories and influencing factors of the fear of progression in patients with inflammatory bowel diseases(IBD).Methods IBD patients who received inpatient treatment in a tertiary hospital in Nanjing from July 2022 to July 2023 were selected as the study subjects by convenience sampling method.The General Demographic Information Questionnaire,the Chinese version of the Fear of Progression Questionnaire-Short Form(FoP-Q-SF),the Chinese version of Inflammatory Bowel Disease Self-efficacy Scale(IBD-SES),and Social Support Rating Scale(SSRS)were administered to the participants.We applied one-way ANOVA and Logistic regression analysis to identify the factors associated with the potential categories of the fear of progression.Results A total of 303 retumed questionnaires(out of the 310)were valid,resulting an effective response rate of 97.74％.According to the results of latent profile analysis,we classified the respondents into 3 categories by the fear of progression,namely"low risk fear of disease adaptation group"(n=127,41.91％),"medium risk fear of illness distress group"(n=139,45.88％),"high risk fear of dysfunction group"(n=37,12.21％).3 groups showed statistically significant differences in permanent address,self-rated financial pressure,current disease status and self-efficacy(P＜0.05).Conclusion Patients with IBD had obvious differences in characteristics on the fear of progression.Nursing personnel should formulate personalized intervention strategies based on the classification characteristics of the fear of progression of IBD patients.Moreover,nurses should focus on improving patients'self-efficacy and promoting patients to treat medical care,stress and emotion management correctly.

Kidney fibrosis is an inevitable result of various chronic kidney diseases(CKDs)and significantly contributes to end-stage renal failure.Currently,there is no specific treatment available for renal fibrosis.ELA13(amino acid sequence:RRCMPLHSRVPFP)is a conserved region of ELABELA in all vertebrates;however,its biological activity has been very little studied.In the present study,we evaluated the therapeutic effect of ELA13 on transforming growth factor-β1(TGF-β1)-treated NRK-52E cells and unilateral ureteral occlusion(UUO)mice.Our results demonstrated that ELA13 could improve renal function by reducing creatinine and urea nitrogen content in serum,and reduce the expression of fibrosis biomarkers confirmed by Masson staining,immunohistochemistry,real-time polymerase chain reaction(RT-PCR),and western blot.Inflammation biomarkers were increased after UUO and decreased by administration of ELA13.Furthermore,we found that the levels of essential molecules in the mothers against decapentaplegic(Smad)and extracellular signal-regulated kinase(ERK)pathways were reduced by ELA13 treatment in vivo and in vitro.In conclusion,ELA13 protected against kidney fibrosis through inhibiting the Smad and ERK signaling pathways and could thus be a promising candidate for anti-renal fibrosis treatment.

Objective:To summarize the best evidence of medication adherence interventions for patients with multiple chronic conditions.Methods:According to the "6S" evidence model, literature on medication adherence in patients with multiple chronic conditions was retrieved from BMJ Best Clinical Practice, UpToDate, Medlive, National Institute for Health and Clinical Excellence, Cochrane Library, Embase, PubMed, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, WanFang data and so on. The search period was from establishing the database to August 30, 2023.Results:A total of 16 articles were included, including three guidelines, four expert consensus, seven systematic reviews, and two meta-analyses. Twenty-seven pieces of evidence were summarized from six aspects of compliance assessment, educational intervention, behavioral intervention, optimized treatment program, technical reminder intervention, and social-psychological-emotional intervention.Conclusions:The best evidence of medication adherence interventions for patients with multiple chronic conditions summarized provides a reference for medical and nursing staff to develop medication adherence interventions.

Objective To evaluate the efficacy of hypothermia therapy in neonates with hypoxic-ischemic encephalopathy(HIE)through the analysis of amplitude-integrated electroencephalography.Methods A retrospective analysis was conducted on 59 neonates with moderate to severe HIE.They were divided into observation group(n=31,hypothermia therapy)and control group(n=28,conventional therapy)according to different treatment protocols.Chi-square test,independent sample t-test,and one-factor Mann-Whitney U test were used for intergroup difference analysis.Results Significant differences between two groups were observed in lower boundary amplitude after 24 h of treatment,sleep-awake cycle after 72 h of treatment,and total scores after 72 h of treatment(P<0.05).After 48 and 72 h of treatment,the neonates in hypothermia therapy group had obviously lower neuro-specific enolase level than those in control group(P<0.05).Conclusion Early application of hypothermia therapy can significantly improve cerebral function in neonates with HIE and lower the neuro-specific enolase level.

Purpose To explore the influence of different spin-locking frequencies on T1ρ values based on a 3.0T MR system.Materials and Methods Thirty-eight healthy adult volunteers underwent cardiac magnetic resonance imaging at the First Affiliated Hospital of Anhui Medical University from July to September 2023.T1ρ mapping and short-axis cine imaging with steady-state free precession sequences were performed with 3.0T MR system.T1ρ mapping sequence in three short-axis slices with three spin-lock frequencies at the amplitude of 5 Hz,300 Hz,400 Hz,and 500 Hz was scanned,respectively.T1ρ relaxation times and myocardial fibrosis index were quantified for each slice and each myocardial segment,the difference in T1ρ of different spin-locking frequencies and myocardial fibrosis index was analyzed using one-way repeated-measures analysis of variance method.Results T1ρ of 5 Hz,300 Hz,400 Hz,and 500 Hz were(33.9±2.8)ms,(43.4±2.1)ms,(45.4±2.6)ms and(46.5±2.4)ms,respectively;and T1ρ values showed a significant progressive increase from the low spin-lock frequency to the high spin-lock frequency of the heart(300 Hz vs.400 Hz:P<0.001;300 Hz vs.500 Hz:P<0.001;400 Hz vs.500 Hz:P=0.043).In addition,the measured myocardial fibrosis index at 300 Hz,400 Hz and 500 Hz were(9.4±2.2)ms,(11.3±2.9)ms and(12.6±2.7)ms,respectively.Statistical analysis underscored significant variations among these measurements(300 Hz vs.400 Hz:P<0.001;300 Hz vs.500 Hz:P<0.001;400 Hz vs.500 Hz:P=0.033).Conclusion In this prospective study,myocardial T1ρ values for the specific cardiac magnetic resonance setting are provided,and we found that spin-lock frequency can affect the T1ρ values.

Objective:To develop a risk prediction model of acute cerebral infarction (ACI) in patients with type 2 diabetes mellitus (T2DM).Methods:It was a cross-sectional study. The clinical data of 798 patients with T2DM hospitalized in the Department of Endocrinology and Neurology of Shanxi Bethune Hospital from August 2021 to October 2023 were collected. Based on whether they had concurrent ACI, the patients were divided into T2DM with ACI group (case group) and pure T2DM group (control group). The patients were then allocated to a training set ( n=558) and a validation set ( n=240) in a 7∶3 ratio by the sample functions in R software. LASSO regression was employed to screen and optimize variables, and a multivariate logistic regression analysis was used to establish the nomogram prediction model. The discriminative ability, calibration, and clinical usefulness of the risk prediction model were assessed with receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis, respectively. Results:LASSO regression identified gender, age, systolic blood pressure, fasting plasma glucose (FPG), albumin (ALB), and carotid vascular condition as the variables for prediction. The multivariable logistic regression analysis showed that female ( OR=0.489, 95% CI: 0.308-0.778) and ALB ( OR=0.846, 95% CI: 0.795-0.901) were protective factors for ACI occurrence in T2DM patients, while age ( OR=1.051, 95% CI:1.025-1.077), systolic blood pressure ( OR=1.047, 95% CI: 1.034-1.059), FPG ( OR=1.185, 95% CI: 1.089-1.288), and carotid plaque ( OR=7.359, 95% CI: 3.050-17.756) were risk factors. The area under the ROC curve (AUC) for risk of ACI in the training set was 0.863(95% CI: 0.833-0.893), and it was 0.846(95% CI: 0.797-0.896) for the validation set. Calibration curves and the Hosmer-Lemeshow goodness-of-fit test indicated good model fit (training set χ2=8.311, P=0.404; validation set χ2=3.957, P=0.861). Decision curve analysis showed that the clinical effectiveness of the model was higher when the threshold probabilities of the training set and the validation set was 0.02-0.93 and 0.12-0.99, respectively. Conclusion:In this study, a prediction model of ACI risk in T2DM patients was successfully established.

ObjectiveTo investigate the regulatory effect and molecular mechanism of berberine （BBR） on lipophagy in the prevention and treatment of atherosclerotic （AS） lesions in mice. MethodFifty apolipoprotein E-knockout （ApoE^-/-） mice were randomly divided into an AS model group， an atorvastatin group （5 mg·kg^-1）， and low-， medium-， and high-dose BBR groups （2.5， 5， 10 mg·kg^-1）. Ten C57BL/6J mice were assigned to the control group. After 12 weeks， hematoxylin-eosin （HE） and oil red O staining were performed to assess the histopathological changes of AS plaques in the aorta. Biochemical analysis was used to measure serum lipid levels， and enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of inflammatory cytokines interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α）， oxidative stress marker reactive oxygen species （ROS）， and serum lipophagy marker Beclin1 and microtubule-associated protein 1 light chain 3 Ⅱ （LC3Ⅱ）. The xanthine oxidase method was used to measure serum superoxide dismutase （SOD） activity. Immunohistochemistry （IHC） was used to detect the distribution of wingless-type MMTV integration site family member 5a （Wnt5a） and Nieman Pick type C1 （NPC1） in the aorta， and Western blot was used to determine the protein expression of Wnt5a and NPC1 in the aorta. ResultCompared with the control group， the AS model group showed significant AS plaque formation， significantly elevated levels of serum total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， IL-6， TNF-α， and ROS， aortic Wnt5a distribution and protein expression （P<0.01）， and significantly reduced levels of serum high-density lipoprotein cholesterol （HDL-C）， SOD， Beclin1， LC3Ⅱ， and aortic NPC1 distribution and protein expression （P<0.01）. Compared with the AS model group， the atorvastatin group， and high- and medium-dose BBR groups showed a significant reduction in AS plaque area （P<0.05， P<0.01）， significantly decreased levels of serum TC， TG， LDL-C， IL-6， TNF-α， ROS， and aortic Wnt5a distribution and protein expression （P<0.05， P<0.01）， and significantly increased levels of serum HDL-C， SOD， Beclin1， LC3Ⅱ， and aortic NPC1 distribution and protein expression （P<0.05， P<0.01）. There was no statistically significant difference in the above indicators between the atorvastatin group and the medium-dose BBR group. ConclusionBBR can competitively bind to Wnt5a to activate NPC1 expression， upregulate lipophagy levels， reduce blood lipids， and inhibit the release of inflammatory mediators and oxidative stress damage， thereby exerting a preventive and therapeutic effect on AS.

A triple-transgenic (tyrosine hydroxylase/dopamine decarboxylase/GTP cyclohydrolase 1, TH/DDC/GCH1) bone marrow mesenchymal stem cell line (BMSCs) capable of stably synthesizing dopamine (DA) transmitters were established to provide experimental evidence for the clinical treatment of Parkinson's disease (PD) by using this cell line. The DA-BMSCs cell line that could stably synthesize and secrete DA transmitters was established by using the triple transgenic recombinant lentivirus. The triple transgenes (TH/DDC/GCH1) expression in DA-BMSCs was detected using reverse transcription-polymerase chain reaction (RT-PCR), Western blotting, and immunofluorescence. Moreover, the secretion of DA was tested by enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC). Chromosome G-banding analysis was used to detect the genetic stability of DA-BMSCs. Subsequently, the DA-BMSCs were stereotactically transplanted into the right medial forebrain bundle (MFB) of Parkinson's rat models to detect their survival and differentiation in the intracerebral microenvironment of PD rats. Apomorphine (APO)-induced rotation test was used to detect the improvement of motor dysfunction in PD rat models with cell transplantation. The TH, DDC and GCH1 were expressed stably and efficiently in the DA-BMSCs cell line, but not expressed in the normal rat BMSCs. The concentration of DA in the cell culture supernatant of the triple transgenic group (DA-BMSCs) and the LV-TH group was extremely significantly higher than that of the standard BMSCs control group (P < 0.000 1). After passage, DA-BMSCs stably produced DA. Karyotype G-banding analysis showed that the vast majority of DA-BMSCs maintained normal diploid karyotypes (94.5%). Moreover, after 4 weeks of transplantation into the brain of PD rats, DA-BMSCs significantly improved the movement disorder of PD rat models, survived in a large amount in the brain microenvironment, differentiated into TH-positive and GFAP-positive cells, and upregulated the DA level in the injured area of the brain. The triple-transgenic DA-BMSCs cell line that stably produced DA, survived in large numbers, and differentiated in the rat brain was successfully established, laying a foundation for the treatment of PD using engineered culture and transplantation of DA-BMSCs.
Rats ; Animals ; Dopamine ; Parkinson Disease/metabolism* ; Mesenchymal Stem Cells/metabolism* ; Cell Line ; Brain/metabolism* ; Cell Differentiation ; Mesenchymal Stem Cell Transplantation