ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke （AIS） patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）. MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method，the patients were assigned into a control group （32 cases） and an observation group （31 cases）. The control group received conventional Western medical treatment，and the observation group took 200 mL Tongnaoyin after meals，twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment，the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale （NIHSS） score and modified Rankin Scale （mRS） score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans，rKep，and rVe values were obtained from the region of interest （ROI） of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment，the NIHSS and mRS scores declined in both groups，and the observation group had lower scores than the control group （P<0.05）. After treatment，the rKtrans and rVe in the observation group were lower than those in the control group （P<0.01）. ConclusionCompared with conventional Western medical treatment alone，conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients，thereby ameliorating neurological impairment after AIS to improve the prognosis.

Objective Emergency response to public health emergencies constitutes a vital component of the modernization of national governance systems and capacities, directly impacting national security, social stability, and public health. This study aims to analyze the key issues and research hotspots in the field of emergency response to public health emergencies, providing theoretical foundations and practical guidance for formulating scientific and effective emergency strategies and policies. Ultimately, it seeks to enhance the nation’s capability to respond to public health emergencies and safeguard public health. Methods Using core journals indexed in the China National Knowledge Infrastructure (CNKI) database as the data source, 1094 journal articles in the field of emergency response to public health emergencies in China from 2003 to September 2024 were selected as the research sample. Citespace visualization software was employed to organize and analyze the research process in the field of emergency response to public health emergencies. Results The current research in this field predominantly involves small-scale cooperation, and the research process can be divided into four stages. The research in the emerging stage mainly focuses on the themes of emergency mechanism and emergency management, the development stage mainly centers on the themes of emergency capacity improvement and system exploration, the outbreak stage emphasizes the themes of COVID-19 and epidemic prevention and control, and the sustainable development stage highlights collaborative governance and informatization. Conclusion The COVID-19 pandemic has accelerated the development of research in this field. Currently, the field shows a continuous growth, with an increasing volume of publications. The focus of current research has shifted towards collaborative governance and the study of assessment tools, aiming to enhance the efficiency and effectiveness in responding to public health emergencies. Moreover, the field is advancing toward more systematic and comprehensive research. However, there is still a need to strengthen scientific communication and collaboration.

Objective To investigate the current level of public awareness regarding nuclear emergency evacuation around a nuclear power plant, analyze the influencing factors, and propose suggestions and countermeasures based on the results. Methods In July 2024, according to the survey protocol and questionnaire developed by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, a field-based centralized online questionnaire was administered. A total of 854 residents living near the nuclear power plant were included as survey participants. An analysis of variance was used to compare the impact of different factors on the public knowledge of nuclear radiation and awareness of nuclear emergency evacuation, while the chi-square test was employed to compare differences between groups. Results A total of 854 questionnaires were collected in this study. The survey revealed that the levels of public knowledge about nuclear radiation and awareness of nuclear emergency evacuation around the power plant were relatively low, with average objective awareness rates of 51% and 47%, respectively. In terms of age, the 30-45 years old group had the highest average score, while the group aged 60 and above had the lowest. Regarding education level, the group with primary school education or below had the lowest average score, whereas those with junior college or undergraduate education scored the highest. The internet (73.7%) was the primary source of emergency information for the public, followed by television (61.7%). The majority of the public (85.0%) expressed trust in the government during evacuation and were willing to follow governmental evacuation arrangements. The main reason for this willingness was the belief that the government could provide sufficient emergency supplies. Conclusion The surveyed population exhibited low levels of knowledge regarding nuclear radiation and awareness of nuclear emergency evacuation, with generally low awareness rates. Awareness levels were influenced by factors such as sex, age, educational background, and distance from the nuclear power plant. To enhance public awareness, it is necessary to strengthen science communication related to nuclear radiation and public protective actions in nuclear emergencies. Targeted dissemination strategies with high communication effectiveness, accessibility, and public acceptance should be adopted to gradually enhance public awareness of nuclear radiation and nuclear emergency protective actions.

OBJECTIVES: To explore the mechanism by which astragaloside IV (AS-IV) alleviates D-galactose (D-GAL)-induced senescence in human umbilical vein endothelial cells (HUVECs). METHODS: Cultured HUVECs were treated with D-GAL (40 g/L), AS-IV (200 μmol/L), D-GAL+AS-IV, or D-GAL+AS-IV+MTK458 (a mitochondrial autophagy agonist, 25 μmol/L) for 48 h, and the changes in cell proliferation, migration, and angiogenesis capacity were evaluated. Cell apoptosis, reactive oxygen species (ROS) levels, mitochondrial membrane potential, and expressions of autophagy-related proteins (LC3-II/LC3-I) and PINK1/Parkin pathway proteins in the treated cells were detected. RESULTS: AS-IV treatment significantly reduced the inhibitory effect of D-GAL on HUVEC viability, effectively alleviated D-GAL-induced impairment of tube-forming ability, and promoted angiogenesis and migration ability of the cells. AS-IV also significantly reduced the rate of D-GAL-induced HUVECs positive for senescence-associated β-galactosidase (SA-β-Gal) staining and inhibited the expression of senescence-related genes P21 and P53. AS-IV restored mitochondrial membrane potential and reduced intracellular ROS levels in D-GAL-induced HUVECs, and inhibited the fusion of autophagosomes and lysosomes to prevent the completion of autophagic flux. In HUVECs treated with both D-GAL and AS-IV, the application MTK458 significantly increased the number of yellow spots and enhanced the expressions of P21, P53, PINK1, Parkin, LC3, and Beclin proteins. CONCLUSIONS AS-IV alleviates D-GAL-induced endothelial cell senescence by inhibiting the PINK1/Parkin pathway to regulate mitochondrial autophagy.
Humans ; Human Umbilical Vein Endothelial Cells/drug effects* ; Cellular Senescence/drug effects* ; Autophagy/drug effects* ; Saponins/pharmacology* ; Ubiquitin-Protein Ligases/metabolism* ; Mitochondria/drug effects* ; Triterpenes/pharmacology* ; Protein Kinases/metabolism* ; Galactose/pharmacology* ; Reactive Oxygen Species/metabolism* ; Signal Transduction/drug effects* ; Cells, Cultured ; Apoptosis/drug effects* ; Membrane Potential, Mitochondrial ; Cell Proliferation/drug effects*

Objective:To assess the level of moral distress among pediatric nurses in China and explore its influencing factors, providing a reference for future interventions.Methods:A cross-sectional survey was conducted using a convenience sampling method from May 2022 to March 2023. Pediatric nurses meeting the inclusion and exclusion criteria were selected from children′s specialized hospitals, general hospitals, and maternal and child health hospitals across 16 provinces in China. Moral distress was assessed using the Chinese version of the Moral Distress Scale-Revised (MDS-R). Data analysis included descriptive statistics, non-parametric analysis, and multiple linear regression.Results:A total of 509 pediatric nurses participated in the survey, including 10 males and 499 females. Among them, 45 were aged ≤25 years, 268 were aged 26-35 years, 172 were aged 36-45 years, and 24 were aged >45 years.The median moral distress score was 58.00 (26.00, 77.50). Factors independently associated with higher levels of moral distress included having a master′s degree ( t = 2.33), working in a ward with more than 40 beds ( t = 3.38), working in a ward without parental accompaniment ( t = 2.60), being passively assigned to the nursing profession ( t = 2.63), and considering resignation but not leaving the job ( t = 3.85) (all P<0.05). Conclusions:Pediatric nurses in China experience a moderate level of moral distress. Further research is needed to understand its underlying causes and to develop preventive and intervention strategies.

Objective:To deeply explore the thematic needs and characteristics of learners regarding course elements based on the review texts of nursing massive open online courses (MOOC), providing a reference for achieving effective alignment between digital nursing education content and learner needs.Methods:Data were collected from the review texts of 112 nursing courses on the Chinese University MOOC platform using a web crawler script written with Python′s Requests library. The collection period spanned from the course launch dates to December 31, 2023. Sentiment analysis and high-frequency words analysis were conducted using Chinese text Nature language processing library, and core themes of learners′ positive and negative reviews were extracted using the latent dirichlet allocation.Results:A corpus of 18 184 nursing MOOC review texts was constructed, with positive sentiment reviews accounting for 89.30% (16 238/18 184) and negative sentiment reviews making up 10.70% (1 946/18 184). Word frequency analysis revealed that most nursing MOOC serve as carriers for blended online and offline teaching models, with students being the primary target audience, though social participants were also involved. The reviews effectively mirrored real-world clinical nursing scenarios. The need of learners was categorized into three major themes: content design and assessment, course resources and teaching strategies, and software applications and platform functionality.Conclusions:This study, leveraging text mining technology, thoroughly investigated the three thematic characteristics of nursing MOOC needs of online learners and proposed targeted optimization recommendations. Future research could incorporate other online teaching platforms and comprehensively construct a sentiment lexicon for nursing online course reviews using big data modeling and machine learning algorithms. These would enable a holistic analysis of the digital nursing education landscape, allowing for precise improvements to address existing shortcomings.

OBJECTIVE: To investigate the predictive value of oxygenation index (PaO₂/FiO₂) at intensive care unit (ICU) admission on 30-day mortality in patients with sepsis. METHODS: A retrospective study was conducted. Patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to October 2023 were enrolled. The demographic information, comorbidities, sites of infection, vital signs and laboratory test indicators at the time of admission to the ICU, disease severity scores within 24 hours of admission to the ICU, treatment process and prognostic indicators were collected. According to the PaO₂/FiO₂ at ICU admission, patients were divided into Q1 group (PaO₂/FiO₂ of 4.1-16.4 cmHg, 1 cmHg ≈ 1.33 kPa), Q2 group (PaO₂/FiO₂ of 16.5-22.6 cmHg), Q3 group (PaO₂/FiO₂ of 22.7-32.9 cmHg), and Q4 group (PaO₂/FiO₂ of 33.0-94.8 cmHg). Differences in the indicators across the four groups were compared. Multifactorial Cox regression analysis was used to assess the relationship between PaO₂/FiO₂ and 30-day mortality of patients with sepsis. The predictive value of PaO₂/FiO₂, sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) on 30-day prognosis of patients with sepsis was analyzed by receiver operator characteristic curve (ROC curve). RESULTS: A total of 1 711 patients with sepsis were enrolled, including 428 patients in Q1 group, 424 patients in Q2 group, 425 patients in Q3 group, and 434 patients in Q4 group. 622 patients died at 30-day, the overall 30-day mortality was 36.35%. There were statistically significant differences in age, body mass index (BMI), history of smoking, history of alcohol consumption, admission heart rate, respiratory rate, APACHE II score, SOFA score, Glasgow coma score (GCS), site of infection, Combined chronic obstructive pulmonary disease (COPD), blood lactic acid (Lac), prothrombin time (PT), albumin (Alb), total bilirubin (TBil), pH, proportion of mechanical ventilation, duration of mechanical ventilation, proportion of vasoactive medication used, and maximal concentration, length of ICU stay, hospital stay, incidence of acute kidney injury, in-hospital mortality, 30-day mortality among the four groups. Multivariate Cox regression analysis showed that after adjusting for confounding factors, for every 1 cmHg increase in PaO₂/FiO₂ at ICU admission, the 30-day mortality risk decreased by 2% [hazard ratio (HR) = 0.98, 95% confidence interval (95%CI) was 0.98-0.99, P < 0.001]. The 30-day mortality risk in the Q4 group was reduced compared with the Q1 group by 41% (HR = 0.59, 95%CI was 0.46-0.76, P < 0.001). The fitted curve showed that a curvilinear relationship between PaO₂/FiO₂ and 30-day mortality after adjustment for confounders. In the inflection point analysis, for every 1 cmHg increase in PaO₂/FiO₂ at PaO₂/FiO₂ < 28.55 cmHg, the risk of 30-day death in sepsis patients was reduced by 5% (HR = 0.95, 95%CI was 0.94-0.97, P < 0.001); when PaO₂/FiO₂ ≥ 28.55 cmHg, there was no statistically significant association between PaO2/FiO2 and the increase in the risk of 30-day death in sepsis (HR = 1.01, 95%CI was 0.99-1.02, P = 0.512). ROC curve analysis showed that the area under the curve (AUC) for the prediction of 30-day mortality by admission PaO₂/FiO₂ in ICU sepsis patients was 0.650, which was lower than the predictive ability of the SOFA score (AUC = 0.698) and APACHE II score (AUC = 0.723). CONCLUSION In patients with sepsis, PaO₂/FiO₂ at ICU admission is strongly associated with 30-day mortality risk, alerting healthcare professionals to pay attention to patients with low PaO₂/FiO₂ for timely interventions.
Humans ; Sepsis/mortality* ; Intensive Care Units ; Retrospective Studies ; Prognosis ; Hospital Mortality ; Oxygen ; Male ; Predictive Value of Tests ; Female ; Middle Aged ; Aged

China emerges as a major country in nuclear energy development and the application of nuclear and radiologic technology. The diagnosis and treatment of acute radiation syndrom (ARS) caused by external irradiation represent a core function in the country′s medical rescue of nuclear and radiological emergencies. Clinically, ARS manifests hematopoietic, gastrointestinal, cutaneous, and central nervous system syndromes, with specific clinical manifestations, signs, severity, and prognosis strongly correlated with radiation dose. China has established a number of national and provincial centers for treating radiation-induced damage. Nevertheless, most medical staff have limited experience in ARS treatment. This consensus presents a summary of recent experience in treating ARS of China. In combination with recommendations from international organizations such as the World Health Organization (WHO), this consensus proposes key evidence of critical clinical issues of ARS, covering all links in the rescue of external irradiation-induced ARS. Initially, clinical diagnosis, syndromes, and severe degrees should be determined based on clinical symptoms and dose estimates. It is necessary to normalize clinical treatment measures for hematopoietic recovery, gastrointestinal injury treatment, infection control, symptomatic treatment, and multi-organ function preservation. To this end, this consensus offers cautions. This consensus provides principles of treatment with traditional Chinese medicine, psychological intervention, and follow-up. Additionally, it highlights multidisciplinary collaboration. It is recommended that this consensus be applied in relevant treatment centers.

Objective To use imaging features of pulmonary nodules to predict the risk of lymph node metastasis in patients with cT1-stage non-small cell lung cancer (NSCLC), providing a reference for clinical decision-making. Methods A retrospective analysis was conducted on the imaging features and postoperative pathological results of cT1 NSCLC patients who underwent surgical treatment at Linyi People’s Hospital from July 2019 to July 2022. Patients were grouped and analyzed according to lymph node metastasis status. Results A total of 1 123 patients were included, comprising 471 males and 652 females, with a median age of 59 (52, 66) years. Comparative analysis revealed that sex, age, nodule location, nodule size on imaging, solid component size, consolidation tumor ratio (CTR), average CT value, and tumor proximity to the pleura all influenced lymph node metastasis. A nomogram was constructed, indicating that the probability of lymph node metastasis in cT1 NSCLC was positively correlated with solid component size, CTR, and average CT value of the pulmonary nodule, and negatively correlated with patient age. The area under the receiver operating characteristic curve was 0.929. Conclusion For cT1 NSCLC patients, the probability of lymph node metastasis can be predicted by measuring the solid component size, CTR, and average CT value of the pulmonary nodule, in conjunction with patient age. However, relying solely on pulmonary nodule imaging characteristics is insufficient to determine a specific lymph node dissection strategy.

Objective:To explore the effectiveness of find-organize-clarify-understand- select-plan-do-check-act (FOCUS-PDCA) cycle management in improving the accuracy of Nutritional Risk Screening 2002 (NRS 2002) scoring in inpatients.Methods:This study was a retrospective study. Data from a continuous quality improvement project, namely Improving the Accuracy of Nutritional Risk Screening for Inpatients from People's Hospital of Longhua in 2021 were selected. The NRS 2002 scores of newly admitted patients from 8 departments with relatively high nutritional risk (departments of gstroenterology, neurology, nephrology, respiratory medicine, oncology and hematology, neurosurgery, gastrointestinal surgery, and critical care medicine) from April 10, 2021 to April 29, 2021 (before intervention) were collected. The NRS 2002 scores were evaluated by a multidisciplinary nutrition support team in terms of accuracy and error types. Possible issues in the process of nutritional screening were analyzed and mitigated using the FOCUS-PDCA cycle management method. The NRS 2002 scores from July 18, 2021 to August 8, 2021 (after intervention) were collected in real time to summary the data on accuracy and error types and to evaluate the effect of FOCUS-PDCA.Results:The accuracy of NRS 2002 score in the 8 departments was increased from 52.97% (294/555) to 81.13% (473/583) after intervention, and the difference was statistically significant ( χ2=102.606, P<0.001). The accuracy of nutritional status impairment score was 64.14% before intervention, compared with 90.57% after intervention ( χ2=114.484, P<0.001). The accuracy of disease severity score was 78.56%, compared with 89.54% after intervention( χ2=25.736, P<0.001). The false-negative rate was 68.02% before intervention and 31.87% after intervention, and the difference was statistically significant ( χ2=31.501, P<0.001). Conclusion:FOCUS-PDCA can improve the accuracy of NRS 2002 scoring in inpatients, reduce the risk of failing to identify patients at nutritional risk, and contribute to further nutritional diagnosis and treatment.