In recent years, researches have shown that microglia drive their phenotype polarization through energy and substance metabolism reprogramming, thereby exerting pro-inflammatory or anti-inflammatory effects, which is closely associated with the risk of ischemic stroke. Their specific metabolic pathways involve glucose metabolism, lipid metabolism, and amino acid metabolism. This article reviews regulatory mechanisms of microglia metabolism after ischemic stroke and their role in ischemic stroke.

Objective:To investigate the effect of traditional Chinese medicine (TCM) lotion on incidence of postoperative infection and recurrence of refractory paronychia.Methods:Seventy-eight patients with intractable paronychia who received treatment at Hangzhou Third People's Hospital from January 2019 to November 2022 were included in this study. The patients were randomly divided into the povidone-iodine group ( n = 39) and the TCM lotion group ( n = 39) using the random number table method. Both groups underwent matrixectomy via a lateral incision and rhomboid flap excision surgery. Prior to the procedure, the povidone-iodine group received treatment with a 5% povidone-iodine solution, whereas the TCM lotion group was administered a TCM lotion containing Scutellaria barbata, Verbena, Lonicera japonica, Viola, Rheum palmatum, Atractylodes, Glauber's salt, Phellodendron, red peony root, Glycyrrhiza uralensis, and Magnolia officinalis. Both groups underwent treatment until the patients fulfilled the surgical indications and were subsequently observed for a period of 6 months post-surgery. The clinical efficacy was evaluated 1 month after the surgical intervention. A comparative analysis was conducted to assess the postoperative duration of redness and swelling, pus discharge, granulation, and pain resolution between the two groups. Additionally, the postoperative occurrence of wound-dressing adhesion, the status of wound healing, pain intensity at 1 and 3 days post-surgery, the incidence of infection at 1 week post-surgery, and the recurrence rates at 1 and 6 months post-surgery, were compared between the two groups. Results:At 1 month post-surgery, the total effective rate in the TCM lotion group was 92.31% (36/39), which was significantly higher than that in the povidone-iodine group [71.79% (28/39), χ2 = 4.26, P < 0.05]. The postoperative durations of redness and swelling, pus discharge, granulation, and pain resolution in the TCM lotion group were (5.66 ± 0.58) days, (3.64 ± 0.55) days, (8.42 ± 1.58) days, and (3.36 ± 0.32) days, respectively, which were significantly shorter than those in the povidone-iodine group [(6.73 ± 0.65) days, (4.56 ± 0.48) days, (9.77 ± 2.56) days, (3.89 ± 0.48) days, t = 7.67, 7.87, 2.80, 5.73, all P < 0.05]. The proportion of mild adhesion between the wound and dressing was significantly higher, while the proportion of severe adhesion was significantly lower, compared with the povidone-iodine group ( Z = 4.64, both P < 0.05). The durations of postoperative pain, the time to redness resolution, and wound healing time in the TCM lotion group were (4.22 ± 1.73) days, (3.02 ± 1.16) days, and (11.84 ± 2.50) days, which were significantly shorter than those in the povidone-iodine group [(8.53 ± 2.48) days, (5.20 ± 2.31) days, (13.32 ± 2.86) days, t = 8.90, 5.26, 2.43, all P < 0.001]. At 3 days post-surgery, pain scores in each group were significantly lower than the respective scores at 1 day post-surgery. At 1 and 3 days post-surgery, pain scores in the TCM lotion group were (3.30 ± 0.18) points and (2.28 ± 0.23) points, respectively, which were significantly lower than the respective scores in the povidone-iodine group [(3.61 ± 0.29) points, (2.52 ± 0.33) points, t = 5.67, 3.72, both P < 0.05]. There were no significant differences in the incidence of infection at 1 week post-surgery and the recurrence of refractory paronychia at 1 and 6 months post-surgery between the two groups (all P > 0.05). Conclusion:The combination of TCM lotion and matrixectomy through a lateral incision and rhomboid flap excision surgery for the treatment of refractory paronychia can help shorten pre-operative treatment time, minimizes postoperative wound-dressing adhesion, promote wound healing, alleviate postoperative pain, and decrease the incidence of infection and recurrence of refractory paronychia, demonstrating superior efficacy compared with treatment with a 5% povidone-iodine solution.

Objective:To explore the reasons for delayed medical treatment in patients with polycystic ovary syndrome (PCOS) using the treatment pathway theory as a framework, and to propose corresponding strategies to guide timely medical care for PCOS patients.Methods:Purposeful sampling was used to select 14 PCOS patients who sought treatment at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between November 2022 and May 2023. Semi-structured interviews were conducted, and directed content analysis was applied to analyze and extract data.Results:The delay in seeking medical treatment for PCOS patients ranged from five to 60 months. Four main themes and 11 sub-themes were identified as reasons for treatment delays: misconception and delayed recognition of the disease (misunderstanding of symptoms, intermittent symptom presentation) ; delayed seeking of medical help (mismanagement of symptoms, feelings of shame, role conflict, distance and financial constraints, lack of social support) ; delayed diagnosis by healthcare providers (misdiagnosis by healthcare providers, lack of medical resources and services) ; and delayed participation in treatment (lack of health education from medical staff, no immediate fertility needs) .Conclusions:Delays in seeking medical care for PCOS patients are common. Efforts should be made to enhance public education on PCOS for adolescent and reproductive-age women, emphasize the management of the disease in patients without immediate fertility needs, improve primary healthcare institutions' capacity for managing PCOS, and mobilize the social support system to encourage patients to seek medical treatment early, thus reducing the occurrence of delayed medical care.

Objective To explore the predictive value of blood pressure variability for long-term prognosis in elderly hypertension patients with coronary heart disease(CHD).Methods A total of 272 elderly patients with CHD and hypertension admitted to our hospital from January 2015 to January 2018 were enrolled retrospectively,and all of them were followed up for 5 years.Accord-ing to that they had adverse cardiovascular events or not,they were divided into adverse cardio-vascular events group(n=102)and control group(n=170).The differences in clinical features were compared between the two groups.ROC curve was plotted to analyze the value of blood pressure variability at first admission in predicting adverse cardiovascular events in elderly hyper-tension patients with CHD.Multivariate logistic regression analysis was applied to identify the risk factors for adverse cardiovascular events in these patients.Results Compared with the con-trol group,the incidence of diabetes,the proportion of coronary artery stenosis＞75％,and 24-hour SBP variability were significantly higher in the adverse cardiovascular events group(P＜0.05,P＜0.01).The area under curve value of 24-hour SBP variability in predicting adverse cardio-vascular events in elderly patients with CHD and hypertension was 0.777(95％CI:0.720-0.835,P=0.000).24-hour SBP variability ≥11.71 mm Hg(1 mm Hg=0.133 kPa,OR=5.017,95％CI:2.911-8.647,P=0.000),diabetes(OR=2.479,95％CI:1.231-4.993,P=0.011),and coronary artery stenosis＞75％(OR=2.303,95％CI:1.022-5.190,P=0.044)were independent risk factors for adverse cardiovascular events in elderly patients with CHD and hypertension.Conclusion 24-hour SBP variability can be used to predict the occurrence of adverse cardiovascu-lar events in elderly hypertension patients with CHD.

Objective:To investigate the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury.Methods:This study was a retrospective case series research. From January 2015 to December 2020, 220 patients with severe burns and inhalation injury meeting the inclusion criteria were admitted to 7 burn treatment centers in China, including 13 cases in the Fourth People's Hospital of Dalian, 26 cases in the First Affiliated Hospital of Naval Medical University, 73 cases in Guangzhou Red Cross Hospital of Jinan University, 21 cases in the 924 th Hospital of PLA, 30 cases in the First Affiliated Hospital of Jiangxi Medical College of Nanchang University, 30 cases in Tongren Hospital of Wuhan University & Wuhan Third Hospital, and 27 cases in Zhengzhou First People's Hospital. There were 163 males and 57 females, and their ages ranged from 18 to 91 years. The patients were divided into survival group and death group according to the survival within 28 d post injury. The following data of patients in the 2 groups were collected, including basic information (gender, age, body weight, body temperature, etc.), the injury characteristics (total burn area, post-injury admission time, etc.), the underlying diseases, the post-injury fluid resuscitation condition (infusion rate and ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, etc.), the results of laboratory tests on admission (blood urea nitrogen, blood creatinine, albumin, pH value, base excess, blood lactate, oxygenation index, etc.), and treatment condition (inhaled oxygen volume fraction, hospitalization day, renal replacement therapy, etc.). After adjusting covariates using univariate Cox regression analysis, the multivariate Cox regression analysis was performed to evaluate the impact of infusion rate in the first 24 h post injury on patient death. The receiver operator characteristic curve for the infusion rate in the first 24 h post injury to predict the risk of death was plotted, and the maximum Youden index was calculated. Patients were divided into 2 groups according to the cutoff value (2.03 mL·kg -1·% total body surface area (TBSA) -1) for predicting risk of death by the infusion rate in the first 24 h post injury determined by the maximum Youden index, and the risk of death was compared between the 2 groups. The correlation between the previously mentioned clinical data and the infusion rate in the first 24 h post injury was analyzed; after the univariate linear regression analysis was used to screen the independent variables, the multivariate linear regression analysis was performed to screen the independent influential factors on the infusion rate in the first 24 h post injury. Results:Compared with those in survival group, patients in death group had significantly higher age and total burn area (with Z values of 12.08 and 23.71, respectively, P<0.05), the infusion rate in the first 24 h post injury, inhaled oxygen volume fraction, and blood urea nitrogen, blood creatinine, blood lactic acid on admission (with Z values of 7.99, 4.01, 11.76, 23.24, and 5.97, respectively, P<0.05), and the proportion of patients treated with renal replacement therapy ( P<0.05) were significantly higher, the albumin, pH value, and base excess on admission were significantly lower ( t=2.72, with Z values of 8.18 and 9.70, respectively, P<0.05), and the hospitalization day was significantly reduced ( Z=85.47, P<0.05). After adjusting covariates, the infusion rate in the first 24 h post injury was the independent influential factor on death (with standardized hazard ratio of 1.69, 95% confidence interval of 1.21-2.37, P<0.05). Patients in infusion rate ≥2.03 mL·kg -1·%TBSA -1 group had a significantly higher risk of death than those in infusion rate <2.03 mL·kg -1·% TBSA -1 group (with hazard ratio of 3.47, 95% confidence interval of 1.48-8.13, P<0.05). There was a significant correlation between total burn area, body weight, inhaled oxygen volume fraction, body temperature, post-injury admission time, the ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, and oxygenation index <300 on admission and the infusion rate in the first 24 h post injury (with r values of -0.192, -0.215, 0.137, -0.162, -0.252, and 0.314, respectively, Z=4.48, P<0.05). After screening the independent variables, total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent influential factors on the infusion rate in the first 24 h post injury (with standardized β values of -0.22, -0.22, -0.19, and 0.46, respectively, 95% confidence intervals of -0.34 to 0.09, -0.34 to 0.10, -0.32 to 0.06, and 0.22 to 0.71, respectively, P<0.05). Conclusions:The infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury is the independent factor of influencing death, and patients with infusion rate ≥2.03 mL·kg -1·%TBSA -1 in the first 24 h post injury have a significantly increased risk of death. The total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent factors of influencing the infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury.

Objective To research superconducting magnetocardiography signal measurement technology and coronary heart disease screening for solving the difficulties in weak magnetocardiography signal measurement,and to verify the value of clinical application.Methods The principle of superconducting magnetocardiography signal measurement technology was analyzed for constructing a framework for superconducting magnetocardiography signal measurement technology.Then,the key circuits such as the host controller,magnetic flux-locked loop,and signal conditioning module were designed,and software systems and core algorithms were developed.Finally,a total of 255 volunteers with healthy hearts,mild myocardial ischemia and severe myocardial ischemia were enrolled in the study,and a comparative experiment was performed between synchronous magnetocardiography and coronary angiography(CAG).Results The peer-to-peer bipolar structure was only observed in the current density vector distribution of healthy subjects instead of myocardial ischemia subjects.The overall coincidence rate,total Kappa value,severe ischemia coincidence rate,mild ischemia coincidence rate and negative coincidence rate of magnetocardiography with CAG were 86.22%,78.21%,86.79%,84.09%and 86.67%,respectively.Magnetocardiography had a sensitivity,specificity,positive rate,negative rate,positive likelihood ratio and negative likelihood ratio of 87.16%,84.41%,86.00%,86.67%,5.98 and 0.08,respectively.Conclusion Magnetocardiography has a high coincidence rate and consistency with CAG in the diagnosis of myocardial ischemia.Superconducting magnetocardiography signal measurement technology can be served as an accurate and reliable screening method for coronary heart diseases.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Child ; Humans ; Granulomatous Disease, Chronic/complications* ; Pneumonia

Objective:To describe demographic,clinical and physiological characteristics,treatment between first-episode major depressive disorder(MDD)and relapse MDD,and to explore characteristics of relapse MDD.Methods:Totally 858 patients who met the diagnostic criteria for depression of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5),were included by using the Mini International Neuropsychiatric Interview(MINI),Clinician-Rated Dimensions of Psychosis Symptom Severity,and Hamilton Depression Scale etc.Among them,529(58.6％)were first-episode depression and 329(36.0％)were relapsed.The differences of demographic characteristics,clinical and physiological characteristics,treatment were compared byx2test and Kruskal-Wallis rank sum test.Multivariate logistic regression was used to explore the characteristics of MDD recur-rence.Results:Compared to first-episode MDD,relapse MDD had more comorbidity(OR=2.11,95％CI:1.00-4.44),more days out of role(OR=1.26,95％CI:1.01-1.56),more history of using psychiatric drug more than one month(OR=1.41,95％CI:1.02-1.97)and electroconvulsive therapy(OR=3.23,95％CI:1.42-7.36),and higher waist-hip ratio(OR=33.88,95％CI:2.88-399.32).Conclusion:Relapse MDD has positive as-sociation with comorbidity of mental disorders,out of role,and higher waist-hip ratio.

Objective To develop a health-promoting lifestyle scale for women with polycystic ovary syndrome(PCOS),and to test its reliability and validity,and preliminarily apply it.Methods Based on the Pender health promotion model,the item pool of the scale was constructed through literature research,semi-structured interviews and group discussions.After 2 rounds of Delphi expert consultation and pre-survey,the initial scale was formed.From April to July 2022,316 patients with PCOS in the health management center,reproductive medicine center and endocrinology department of a tertiary hospital in Nanjing were selected for item analysis,exploratory factor analysis and reliability test,respectively.From August to October 2022,358 PCOS patients were selected for confirmatory factor analysis.From November 2022 to February 2013,294 PCOS patients were selected,and the scale was used to investigate the status of health-promoting lifestyle in PCOS patients.Results The health-promoting lifestyle scale for PCOS patients included 5 dimensions and 33 items.The total content validity index of the scale was 0.942,and the content validity index of each item was 0.810-1.000.5 common factors were extracted by 2 exploratory factor analyses,and the cumulative variance contribution rate was 62.399％.Confirmatory factor analysis showed that the model fit was good.The Cronbach's a coefficient of the total scale was 0.930;the split-half reliability was 0.842;the test-retest reliability was 0.888.The preliminary application results showed that the total score of health-promoting lifestyle in PCOS patients was(96.925±14.273),and the average score of items was(2.937±0.433),which was at a medium level.Conclusion The health-promoting lifestyle scale for PCOS patients has good reliability and validity,which can be used as a tool for medical staff to assess the level of health-promoting lifestyle of PCOS patients,and can help nurses to quickly identify the level and dimensions of health-promoting lifestyle of patients,so as to formulate individualized precise health management plans.