OBJECTIVE To investigate the mechanism of pachymic acid on renal injury in pregnancy induced hypertension （PIH） rats by regulating the silent information regulator transcript 1/peroxisome proliferator-activated receptor γ coactivator-1α （Sirt1/PGC-1α） pathway. METHODS Pregnant SD rats were prepared by co-caging and PIH model was induced using N-nitro-L- arginine methyl ester （L-NAME） method. PIH rats were randomly divided into model group， L-pachymic acid （low-dose pachymic acid， 10 mg/kg） group， H-pachymic acid （high-dose pachymic acid， 20 mg/kg） group， and H-pachymic acid+EX527 （20 mg/kg pachymic acid+10 mg/kg EX527） group， with 6 rats in each group. Another 6 normal pregnant rats were selected as blank group. Each group was given relevant medicine or solvent intragastrically or intraperitoneally daily， once a day， for 28 consecutive days. After the last administration， 24 h urinary protein and tail artery systolic blood pressure （SBP） were measured in pregnant rats from each group， along with the levels of serum creatinine （Scr）， blood urea nitrogen （BUN），uric acid （UA）， and cystatin C （Cys-C）. The contents of superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， and 8-hydroxy-2′-deoxyguanosine （8-OHdG） in renal tissue， as well as the mRNA and protein expression levels of Sirt1 and PGC-1α， were also determined. Meanwhile， renal histopathological changes in rats from each group were evaluated using hematoxylin-eosin （HE） staining and periodic acid-Schiff （PAS） staining. RESULTS Compared with model group， L-pachymic acid group and H-pachymic acid group exhibited significant decreases in 24 h urine protein quantification， tail artery SBP， Scr， BUN， UA， Cys-C levels， glomerulosclerosis index score of renal tissue， renal tubular injury score， the percentage of PAS positive area， MDA and 8-OHdG （P＜0.05）. Conversely， the contents of SOD and GSH-Px， along with the mRNA and protein expression levels of Sirt1 and PGC-1α， were significantly increased （P＜0.05）. Moreover， these improvements were more pronounced in H-pachymic acid group （P＜0.05）. Compared with H-pachymic acid group， the aforementioned indicators in pregnant rats from the H-pachymic acid+EX527 group showed significant reversal （P＜0.05）. CONCLUSIONS Pachymic acid significantly ameliorates renal injury induced by PIH in rats， potentially through activation of the Sirt1/PGC-1α pathway.

Ethical review represents the core of the scientific and technological ethical governance， and its quality depends on the participation of ethics. The absence of ethics and ethical experts will compromise the quality of the review. According to the spirit of the Guidelines on Strengthening the Governance over Ethics in Science and Technology， this paper analyzed the process of separating scientific and technological ethics from the field of scientific research morality， clarified the ethical attributes of ethical review， and argued that scientific research and technological innovation activities originated from ethics. On this basis， the fundamental principle of “ethics first” was proposed， aiming to proactively embed ethical considerations throughout the entire process of scientific and technological activities. This principle was the primary requirement for ensuring governance effectiveness and can also eliminate the risk of ethics being obscured in ethical governance. In practice， “ethics first” manifested specifically in dimensions such as prioritizing academic systems， prioritizing publicity， education， and training， as well as further advancing ethical considerations.

Drug clinical trials constitute a critical link in new drug development and an essential means to verify the safety and efficacy of pharmaceuticals. The protection of participants’ rights and interests and the prevention of risks directly affect the scientific ethics and social credibility of the trials. Vulnerable groups， due to restricted autonomous decision-making capacities or special social status， are more susceptible to safety risks. Children are a typical representative of vulnerable groups. Their physiological particularities， cognitive limitations， and dependence collectively epitomize the universal protection demands of vulnerable research participants. Taking children as an instance， this paper analyzes the current weak links in the protection of pediatric research participants. Integrating advanced international experience with domestic practical demands， it comprehensively identified protection risk points at every stage and constructed a multi-stakeholder collaborative mechanism for the full-process protection of pediatric research participants. This mechanism incorporated seven main entities， including drug regulatory authorities， sponsors， researchers， and ethics committees， covering the pre-trial， intra-trial， and post-trial phases to meet the requirements of full-chain and multi-dimensional protection. It provided references for the subsequent establishment of a systematic protection mechanism for vulnerable populations.

Objective:To explore the effect of inspiratory muscle training(IMT)on respiratory function,psychological well-being,and sleep in patients recovered from corona virus disease 2019(COVID-19)infection.Method:Seventy-six adults who had recovered from COVID-19 between February and June 2023 at the depart-ment of rehabilitation medicine of the fourth medical center of the PLA general hospital,with a massive inspi-ratory pressure(MIP)of less than 70%were selected for this study.The participants were randomly divided into the control group(n=38)and the experimental group(n=38).The control group received conventional re-habilitation training,while the experimental group underwent an additional 4-week IMT program on top of con-ventional rehabilitation.Respiratory function including maximum massive inspiratory pressure(MIP),forced expi-ratory vital capacity(FVC),forced expiratory volume in the first second(FEV1),forced expiratory volume/forced vital capacity in the first second(FEV1/FVC),and peak expiratory flow rate(PEF),were measured be-fore and after the 4-week intervention.Psychological status and sleep quality were assessed using the Hamilton depression scale(HAMD),the Hamilton anxiety scale(HAMA)and Pittsburgh sleep quality index(PSQI).Result:After 4 weeks of intervention,the MIP,FVC,FEV1,FEV1/FVC,HAMD,HAMA,and PSQI im-proved in both control and experimental group compared with pre-intervention.The MIP,PEF,and PSQI in the experimental group were significantly better than pre-intervention(P<0.05);the control group showed sig-nificant improvement in MIP,FVC,FEV1,HAMA,and PSQI compared to pre-intervention(P<0.05).After 4 weeks of intervention,the MIP and PEF in the experimental group were significantly better than those in the control group(P<0.05);there was no significant difference in FVC,FEV1,FEV1/FVC,HAMD,HAMA,and PSQI between the two groups(P>0.05).Conclusion:IMT can effectively improve the respiratory function,physical and mental health of patients recov-ered from COVID-19,making it an effective rehabilitation strategy for post-COVID-19 recovery.

Objective To investigate the relationship between the expression of absent in melanoma 2(AIM2)gene in peripheral blood peripheral blood mononuclear cell(PBMC)of patients with advanced gastric cancer(GC)and the intestinal flora and the efficacy of targeted therapy.Methods 83 patients with advanced GC who were treated from January to December 2023 were all given Trastuzumab/Nebuliumab combined with conventional chemotherapy for 4 weeks/course and 3 continuous courses of treatment to evaluate the efficacy of targeted therapy.The abundance of intestinal flora was analyzed using 16S rDNA sequencing technologies.Quantitative real-time PCR(qRT-PCR)was used to detect AIM2 mRNA expression levels in PBMC,which were divided into a high expression group and a low expression group according to the median digit.Pearson correlation analysis was used to investigate the relationship between AIM2 expression and the relative abundance of intestinal flora,the efficacy of targeted therapy and clinical features.Results At the phylum level,the relative abundance of Bacteroidetes(0.70±0.15)and Proteobacteria(0.71±0.21)in the high expression group of AIM2 was significantly lower than that in the low expression group(0.81±0.17,0.80±0.16),and the relative abundance of Firmicutes(0.73±0.12)was significantly higher than that in the low expression group(0.64±0.08),and the differences were statistically significant(t=3.108,2.210,4.061,all P＜0.05).At the genus level,the relative abundance of Bacteroides(0.13±0.02)in the high expression group of AIM2 was significantly lower than that in the low expression group(0.19±0.04),and the relative abundance of Enterococcus(0.31±0.08 vs 0.12±0.05)and Escherichia coli(0.18±0.04 vs 0.10±0.02)was significantly higher than that in the low expression group(0.12±0.05,0.10±0.02),and the differences were statistically significant(t=8.472,153.462,11.722,all P<0.05).Pearson correlation showed that at phylum level,AIM2 expression was positively correlated with the relative abundance of Firmicutes(r=0.598,P<0.05),and negatively correlated with the relative abundance of Bacteroides and Proteobacteria(r=-0.641,-0.520,all P<0.05).At the genus level,AIM2 expression was positively correlated with the relative abundance of Enterococcus and Escherichia coli(r=0.529,0.577,all P<0.05),and negatively correlated with the relative abundance of Bacteroides(r=-0.574,P<0.05).Among the 83 patients with advanced GC,17 cases were effective and 66 cases were ineffective,and the Overall response rate(ORR)was 20.48%.The lesion diameter(5.73±0.74cm)and the proportion of cTNM stage IV(53.85%)in AIM2 high expression group were significantly lower than those in low expression group(6.08±0.51cm,75.00%),and the targeted therapy ORR(30.77%)was higher than that in low expression group(11.36%),with statistical significance(t/χ2/Z=2.477,6.558,4.780,all P<0.05).Conclusion The expression of AIM2 in PBMC of advanced GC patients is closely related to the imbalance of intestinal flora and the effect of targeted therapy.Detection of AIM2 expression is conducive to guiding clinical screening of patients who benefit from targeted therapy.

Objective To evaluate the effectiveness of WeChat group integrating with BOPPPS instructional model in the standardized training of nurses in an orthopedics department.Methods A total of 56 nurses in orthopedical standardized training from a hospital were selected and divided into a control group(28 nurses from September 2022 to August 2023)and an interven-tion group(28 nurses trained via WeChat groups and the BOPPPS model from September 2023 to August 2024).The two groups were compared in terms of their final assessment scores,critical thinking,and self-directed learning capabilities.Results After training,the intervention group had significantly higher scores in the final assessment,all items of the California Critical Thinking Disposition Inventory,and all dimensions of the Learning Ability Assessment Scale compared to the control group(all P＜0.05).Conclusion WeChat groups combined with the BOPPPS teaching mode effectively improves the self-directed learning ability,critical thinking skills,and assessment results of orthopedic nurses.

Objective To evaluate the effectiveness of WeChat group integrating with BOPPPS instructional model in the standardized training of nurses in an orthopedics department.Methods A total of 56 nurses in orthopedical standardized training from a hospital were selected and divided into a control group(28 nurses from September 2022 to August 2023)and an interven-tion group(28 nurses trained via WeChat groups and the BOPPPS model from September 2023 to August 2024).The two groups were compared in terms of their final assessment scores,critical thinking,and self-directed learning capabilities.Results After training,the intervention group had significantly higher scores in the final assessment,all items of the California Critical Thinking Disposition Inventory,and all dimensions of the Learning Ability Assessment Scale compared to the control group(all P＜0.05).Conclusion WeChat groups combined with the BOPPPS teaching mode effectively improves the self-directed learning ability,critical thinking skills,and assessment results of orthopedic nurses.

Objective To investigate the effect of Scutellarin(Scu)regulating miR-26a-3p/Survivin molecular axis on myocardial ischemia/reperfusion injury(MIRI)in rats and its mechanism.Methods Fifty SD rats were randomly divided into sham group,model group,scutellarin group(Scu),miR-26a-3p agomir group(agomir)and scutellarin+miR-26a-3p agomir group(Scu+agomir)with 10 rats in each group.The animal model of MIRI was established by ligating the anterior descending coronary artery.The rats in each group were given 20 mg/kg Scu or 10 nmol agomir before and during operation,respectively,and the rats in sham group and model group were given the same amount of solvent.At 48 h after operation,the cardiac function of rats was examined by echocardiography.The pathological changes of myocardial tissue were detected by HE staining.The levels of myocardial injury markers creatine kinase isoenzyme MB(CK-MB),lactate dehydrogenase(LDH)and cardiac troponin I(cTnI)in serum and the contents of oxidative markers Malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)in myocardial tissue were detected by biochemical kit.The apoptosis of rat cardiomyocytes was detected by TUNEL staining.The mRNA expression levels of miR-26a-3p and Survivin in rat myocardium were detected by qRT-PCR.Expression levels of Survivin,cyclin-dependent kinase inhibitor(p21)and cleaved-caspase 3 were detected by Western blot.Results Compared with sham group,the pathological damage of myocardial tissue in the model group was serious,the levels of cardiac function LVEDP and serum CK-MB,LDH and cTnI significantly increased(P<0.01),and the levels of LVESP,LVEF and LVFS significantly decreased(P<0.01).The apoptosis level and MDA level of myocardial tissue significantly increased(P<0.01),while the SOD and GSH-Px levels significantly decreased(P<0.01).Meanwhile,the expression levels of miR-26a-3p and cleaved-caspase 3 protein significantly increased(P<0.01),the p21 protein and Survivin mRNA and protein expression levels significantly decreased(P<0.01).Compared with model group,the pathological injury of myocardium in Scu group was significantly improved,the levels of cardiac function LVEDP and serum CK-MB,LDH and cTnI significantly decreased(P<0.01),and the levels of LVESP,LVEF and LVFS significantly increased(P<0.01).The apoptosis level and MDA level of myocardial tissue significantly decreased(P<0.01),while the SOD and GSH-Px levels significantly increased(P<0.01).Meanwhile,the expression levels of miR-26a-3p and cleaved-caspase 3 protein significantly decreased(P<0.01),the p21 protein and Survivin mRNA and protein expression levels significantly increased(P<0.01).However,intervention with miR-26a-3p agomir could significantly reverse the improvement effect of Scu on MIRI in rats.Conclusion Scu can improve cardiac function and myocardial injury and inhibit myocardial cell apoptosis in MIRI rats,and its mechanism may be related to the regulation of miR-26a-3p/Survivin molecular axis.

Alzheimer's disease(AD)is a typical progressive neurodegenerative disease,mainly manifesting as severe cognitive dysfunction,and involving memory,thought processes,and emotion.The kynurenine pathway(KP)is one of the main metabolic pathways of tryptophan,which can be divided into neurotoxicity and neuroprotective branches.Increasing evidence has suggested that KP is involved in the pathogenesis of AD.This review considers the role of KP in the pathogenesis of AD,with reference to the relevant literature on KP interventions in AD in the PubMed database.The result will provide an important reference for the use of KP as a target for AD drug development.

Objective:To evaluate the effects of a reduced-positioning restrictions nursing program on postoperative recovery, sleep quality, self-care ability, and hip joint function in patients undergoing total hip arthroplasty (THA), providing a reference for postoperative positioning management.Methods:A randomized controlled trial was conducted, and 140 THA patients admitted to Zhejiang Provincial People′s Hospital from January 2022 to June 2023 were selected using convenience sampling. They were divided into a control group (70 cases) and an observation group (70 cases) using a random number table. The control group received conventional rehabilitation care, while the observation group received a reduced-positioning restrictions nursing program in addition to the conventional care. The incidence of dislocation at 3 months postoperatively, the activities of daily living, the hip joint function recovery at 1 month and 3 months postoperatively, the sleep quality at 1 month postoperatively were compared between the two groups.Results:Finally 63 cases in the control group and 64 cases in the observation group completed the study. The control group included 25 males and 38 females, with an average age of (65.44 ± 10.97) years, while the observation group included 28 males and 36 females, with an average age of (65.13 ± 12.18) years. At 3 months postoperatively, there was no significant difference in the dislocation rate between the control group and the observation group ( P>0.05). At 1 month and 3 months postoperatively, the scores of activities of daily living in the observation group were (77.89 ± 6.71) and (93.52 ± 6.59) points respectively, which were higher than those in the control group [(69.68 ± 5.53) and (87.38 ± 7.72) points], the differences were statistically significant ( t=5.38, 6.96, both P<0.05), the time, interaction and inter-group effects were all statistically significant ( F=33.93, 10.81, 876.91, all P<0.05). At 1 month postoperatively, the excellent and good rate of hip joint function score grade in the observation group was 73.44% (47/64), which was higher than 41.27% (26/63) in the control group, the difference was statistically significant ( Z=-3.67, P<0.05), there was no statistically significant difference between the two groups at 3 months postoperatively ( P>0.05). At 1 month after the operation, the excellent and good rate of sleep quality score grades in the observation group was 81.25% (52/64), which was higher than 57.14% (36/63) in the control group, and the difference was statistically significant ( Z=-3.00, P<0.05). Conclusions:Incorporating a reduced-positioning restrictions nursing program into the perioperative management of THA does not increase the risk of prosthesis dislocation. This approach enhances patient comfort, improves sleep quality, increases self-care ability, and supports the recovery of hip joint function.