ObjectiveTo analyze the impact of maternal postpartum depression (PPD) at 2 months postpartum on caregiving for infants aged2 to 24 months, and to provide a scientific basis for future maternal and infant healthcare services. MethodsBased on the Shanghai Maternal-Child Pairs Cohort, 1 060 mother-child pairs were selected from those fully participating in follow-up visits at 2, 6, 12, and 24 months postpartum. Pregnancy and childbirth-related information was collected using standardized questionnaire surveys and hospital obstetric and maternity records. The Edinburgh postpartum depression scale was used to assess the maternal postpartum depressive symptoms at 2 months postpartum. At 2, 6, 12, and 24 months postpartum, questionnaire survey was used to evaluate the maternal responsiveness in caregiving and the provision of early learning opportunities for infants. Scores for responsive caregiving and early learning opportunities at 2, 6, 12, and 24 months were grouped based on the 25th percentile (P₂₅) of total scores. The mixed-effects model was used to analyze the longitudinal impact of maternal postpartum depression at 2 months on the caregiving of 2 to 24-month-old infants. ResultsThe longitudinal results from the mixed-effects model did not show an impact of maternal PPD on infant responsive caregiving within 12 months and early learning opportunities within24 months. However, cross-sectional analysis revealed that, compared to the non-PPD group, the risk of low responsive caregiving at 2 months in the PPD group was 93% higher (OR=1.931, 95%CI: 1.113‒3.364, P=0.019). The risks for low provision of early learning opportunities at2 months and 24 months increased by 59% (OR=1.589, 95%CI: 1.082‒2.324, P=0.017) and 60% (OR=1.598, 95%CI:1.120‒2.279, P=0.010), respectively. ConclusionMaternal postpartum depression increases the risk of low responsive caregiving at 2 months, but its long-term effects warrant further research.

Objective To investigate the effect of blood glucose control parameters on the prognosis of severe pneumonia patients based on continuous glucose monitoring(CGM)system.Methods A retrospective analysis was conducted on 51 severe pneumonia patients monitored by CGM at the Fourth Affiliated Hospital of Soochow University from November 2021 to August 2023.Assessed parameters included baseline clinical characteristics,glycosylated hemoglobin(HbA1c),mean glucose,standard deviation(SD),coefficient of variability(CV),mean amplitude of glycemic excursions(MAGE),maximum glucose level,minimum glucose level,and time in range(TIR)of glucose within the target range(3.9-10.0 mmol/L)as a proportion and levels of inflammatory indicators before and after treatment.Based on the 28-day follow-up results,the patients were divided into the survival group(39 cases)and the death group(12 cases).The blood glucose parameters of the two groups were compared.Multivariate Logistic regression model was used to analyze the influence of blood glucose parameters and infection indexes on the prognosis of patients with severe pneumonia.The efficacy of blood glucose parameters in the diagnosis of 28-day mortality was further evaluated by receiver operator characteristic curve(ROC curve).Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ),SD and CV of blood glucose in death group were higher than those in survival group[APACHEⅡscore:20.5(14.0)vs.15.0(7.0),SD(mmol/L):2.6±0.7 vs.2.1±0.5,CV:(27.7±5.8)%vs.(23.7±4.3)%].However,the TIR(3.9-10.0 mmol/L)proportion was statistically lower than that of survival group[59.0%(17.0%)vs.68.0%(35.0%)],the differences were all statistically significant(all P<0.05).After using CGM,the white blood cell count(WBC)and hypersensitive C-reactive protein(hs-CRP)were significantly decreased[WBC(×109/L):9.2(6.5)vs.11.1(9.2),hs-CRP(mg/L):39.4(59.0)vs.56.2(133.8),both P<0.05].Multivariate Logistic regression showed that TIR(3.9-10.0 mmol/L)proportion was an independent risk factor for 28-day mortality in patients with severe pneumonia[odds ratio(OR)=0.923,95%confidence interval(95%CI)was 0.852-0.999,P=0.046].The ROC curve showed that TIR proportion was valuable in predicting the clinical outcomes of patients with severe pneumonia.Area under the curve(AUC)=0.720,95%CI was 0.563-0.878,P=0.022;when the cut-off value was 63.5%,the sensitivity and the specificity were 59.0%and 83.3%respectively.Conclusion Increase of TIR(3.9-10.0 mmol/L)proportion in patients with severe pneumonia could improve clinical outcomes,especially when TIR proportion≥63.5%.

Objective:To investigate the effect of metformin(MET)on endoplasmic reticulum stress-induced apoptosis and its role and molecular mechanisms in preeclamptic(PE)rats.Methods:Thirty SD rats were ran-domly assigned into control,PE and MET groups,10 in each group.From days 14 to 18 of gestation,rats in the PE and MET groups were subcutaneously injected with L-nitro-arginine methyl ester(L-NAME)at a dose of 200 mg/(kg·d),while the control group was administered subcutaneous injections containing a 0.9％solution of sodium chloride at the same dose.Additionally,the MET group was administered MET by gavage at a dose of 200 mg/(kg·d)from days 13 to 18 of gestation.On days0,6,12,15,17,and 19 of pregnancy,blood pressure of rats was measured.On days 12 and 19 of pregnancy,24-hour urinary protein content was assessed.On day 20 of pregnan-cy,rats were anesthetized and underwent cesarean section to measure pup weight,crown-rump length,placental weight,and diameter.We used reverse transcription quantitative polymerase chain reaction(qRT-PCR),Western blotting,and immunohistochemistry(IHC)to detected mRNA and protein expression of apoptosis-related genes in rat placental tissue,and enzyme-linked immunosorbent assay(ELISA)to assess the expression of apopto-sis-related genes in rat serum.Results:Compared with the control group,systolic blood pressure on days 15,17 and 19 of gestation and 24h proteinuria level on day 19 of gestation were significantly higher,and body mass and top rump length of littermates were lower in the PE group,and the differences were statistically significant(P＜0.05);Compared with the PE group,systolic blood pressure on days 15,17 and 19 of gestation and 24h proteinuri-a level on day 19 of gestation were significantly decreased,and body mass and top rump length of littermates were increased in the MET group,and the differences were all statistically significant(P＜0.05).Pairwise com-parisons of placental weight,placental diameter,and the number of pups born among the three groups showed no statistically significant differences(P＞0.05).Compared to the control group,the PE group exhibited significantly increased expression of B-cell lymphoma-2(Bcl-2)associated X protein(Bax),bcl-2 antagonist/killer 1(Bak),and apoptosis-inducing factor(AIF)mRNA and protein in placental tissues,decreased expression of Bcl-2 mRNA and protein,as well as elevated levels of Bax,Bak,and AIF in serum,while Bcl-2 expression levels were de-creased.These differences were statistically significant(P＜0.05).Compared to the PE group,the MET group exhibited decreased expression of Bax,Bak,and AIF mRNA and protein in placental tissue,along with increased expression of Bcl-2 mRNA and protein.Serum levels of Bax,Bak,and AIF were decreased,while Bcl-2 expression levels were increased.All differences were statistically significant(P＜0.05).Conclusions:L-NAME significantly induced elevated levels of apoptosis in rat placental tissues,whereas MET was able to effectively inhibit L-NAME-induced apoptosis induced by endoplasmic reticulum stress,which has the potential to be a new therapeu-tic intervention point for PE.

This study investigated the regulatory effects of carvacrol on lipopolysaccharide(LPS)-induced inflammatory response and endoplasmic reticulum(ER)stress in bovine mammary epithe-lial cells using in vitro cell culture techniques.Western blot analysis revealed significantly elevated expression levels of NF-κB pathway-related proteins and ER stress marker proteins in mastitis samples compared to healthy mammary tissues(P＜0.05).Cells were divided into a blank control group and carvacrol(CAV)treatment groups with varying concentrations(50,100,250,500,750,1 000 μmol/L).After 24 hours of culture,cell proliferation was assessed using the CCK-8 assay.An inflammatory model was established by stimulating MAC-T cells(a bovine mammary epithelial cell line)with LPS(10 mg/L)for 12 h,followed by measurement of the transcriptional levels of inflammatory-related genes(IL-6,IL-1β,and TNFα).MAC-T cells were pretreated with low,medi-um,and high doses of CAV for 12 h before LPS stimulation.Molecular docking analysis was per-formed to examine the interaction between CAV and GRP78,a key ER stress protein.Real-time quantitative PCR(qPCR)was used to analyze the mRNA expression levels of inflammatory cyto-kines(IL-6,IL-1β,TNFα),while Western blot was employed to assess the expression levels of NF-κB pathway proteins(p-IκB,p-NF-κB p65)and ER stress-related proteins(p-PERK,p-IRE1α,ATF6,GRP78,CHOP).The results from Western blot and qPCR demonstrated that CAV alleviated LPS-induced inflammatory response and cellular damage by inhibiting the NF-κB signa-ling pathway and ER stress.

In recent years,the intensification of dairy farming has significantly improved production efficiency but has also led to a rise in the incidence of metabolic diseases.Conditions such as keto-sis,fatty liver,and hypocalcemia pose serious threats to dairy cattle health and productivity.These diseases not only profoundly affect individual physiological function but also impose considerable economic pressures and challenges on farm management.As research advances,exosomes have e-merged as a novel intercellular signaling molecule,showing unique potential in regulating dairy cattle's nutritional metabolism.Studies suggest that exosomes hold promise as biomarkers for dis-ease and can even serve as carriers for disease detection and prevention.Acting as a crucial mediator of intercellular communication,exosomes play an important role in modulating the metabolic processes of dairy cattle.This review aims to systematically explore the role of exosomes in bovine nutritional metabolism and to provide new perspectives and theoretical support for their potential as tools for diagnosing,treating,and preventing metabolic diseases in dairy cattle,thus advancing research and practice in this field.

In recent years,the intensification of dairy farming has significantly improved production efficiency but has also led to a rise in the incidence of metabolic diseases.Conditions such as keto-sis,fatty liver,and hypocalcemia pose serious threats to dairy cattle health and productivity.These diseases not only profoundly affect individual physiological function but also impose considerable economic pressures and challenges on farm management.As research advances,exosomes have e-merged as a novel intercellular signaling molecule,showing unique potential in regulating dairy cattle's nutritional metabolism.Studies suggest that exosomes hold promise as biomarkers for dis-ease and can even serve as carriers for disease detection and prevention.Acting as a crucial mediator of intercellular communication,exosomes play an important role in modulating the metabolic processes of dairy cattle.This review aims to systematically explore the role of exosomes in bovine nutritional metabolism and to provide new perspectives and theoretical support for their potential as tools for diagnosing,treating,and preventing metabolic diseases in dairy cattle,thus advancing research and practice in this field.

This study investigated the regulatory effects of carvacrol on lipopolysaccharide(LPS)-induced inflammatory response and endoplasmic reticulum(ER)stress in bovine mammary epithe-lial cells using in vitro cell culture techniques.Western blot analysis revealed significantly elevated expression levels of NF-κB pathway-related proteins and ER stress marker proteins in mastitis samples compared to healthy mammary tissues(P＜0.05).Cells were divided into a blank control group and carvacrol(CAV)treatment groups with varying concentrations(50,100,250,500,750,1 000 μmol/L).After 24 hours of culture,cell proliferation was assessed using the CCK-8 assay.An inflammatory model was established by stimulating MAC-T cells(a bovine mammary epithelial cell line)with LPS(10 mg/L)for 12 h,followed by measurement of the transcriptional levels of inflammatory-related genes(IL-6,IL-1β,and TNFα).MAC-T cells were pretreated with low,medi-um,and high doses of CAV for 12 h before LPS stimulation.Molecular docking analysis was per-formed to examine the interaction between CAV and GRP78,a key ER stress protein.Real-time quantitative PCR(qPCR)was used to analyze the mRNA expression levels of inflammatory cyto-kines(IL-6,IL-1β,TNFα),while Western blot was employed to assess the expression levels of NF-κB pathway proteins(p-IκB,p-NF-κB p65)and ER stress-related proteins(p-PERK,p-IRE1α,ATF6,GRP78,CHOP).The results from Western blot and qPCR demonstrated that CAV alleviated LPS-induced inflammatory response and cellular damage by inhibiting the NF-κB signa-ling pathway and ER stress.

Objective:To investigate the effect of metformin(MET)on endoplasmic reticulum stress-induced apoptosis and its role and molecular mechanisms in preeclamptic(PE)rats.Methods:Thirty SD rats were ran-domly assigned into control,PE and MET groups,10 in each group.From days 14 to 18 of gestation,rats in the PE and MET groups were subcutaneously injected with L-nitro-arginine methyl ester(L-NAME)at a dose of 200 mg/(kg·d),while the control group was administered subcutaneous injections containing a 0.9％solution of sodium chloride at the same dose.Additionally,the MET group was administered MET by gavage at a dose of 200 mg/(kg·d)from days 13 to 18 of gestation.On days0,6,12,15,17,and 19 of pregnancy,blood pressure of rats was measured.On days 12 and 19 of pregnancy,24-hour urinary protein content was assessed.On day 20 of pregnan-cy,rats were anesthetized and underwent cesarean section to measure pup weight,crown-rump length,placental weight,and diameter.We used reverse transcription quantitative polymerase chain reaction(qRT-PCR),Western blotting,and immunohistochemistry(IHC)to detected mRNA and protein expression of apoptosis-related genes in rat placental tissue,and enzyme-linked immunosorbent assay(ELISA)to assess the expression of apopto-sis-related genes in rat serum.Results:Compared with the control group,systolic blood pressure on days 15,17 and 19 of gestation and 24h proteinuria level on day 19 of gestation were significantly higher,and body mass and top rump length of littermates were lower in the PE group,and the differences were statistically significant(P＜0.05);Compared with the PE group,systolic blood pressure on days 15,17 and 19 of gestation and 24h proteinuri-a level on day 19 of gestation were significantly decreased,and body mass and top rump length of littermates were increased in the MET group,and the differences were all statistically significant(P＜0.05).Pairwise com-parisons of placental weight,placental diameter,and the number of pups born among the three groups showed no statistically significant differences(P＞0.05).Compared to the control group,the PE group exhibited significantly increased expression of B-cell lymphoma-2(Bcl-2)associated X protein(Bax),bcl-2 antagonist/killer 1(Bak),and apoptosis-inducing factor(AIF)mRNA and protein in placental tissues,decreased expression of Bcl-2 mRNA and protein,as well as elevated levels of Bax,Bak,and AIF in serum,while Bcl-2 expression levels were de-creased.These differences were statistically significant(P＜0.05).Compared to the PE group,the MET group exhibited decreased expression of Bax,Bak,and AIF mRNA and protein in placental tissue,along with increased expression of Bcl-2 mRNA and protein.Serum levels of Bax,Bak,and AIF were decreased,while Bcl-2 expression levels were increased.All differences were statistically significant(P＜0.05).Conclusions:L-NAME significantly induced elevated levels of apoptosis in rat placental tissues,whereas MET was able to effectively inhibit L-NAME-induced apoptosis induced by endoplasmic reticulum stress,which has the potential to be a new therapeu-tic intervention point for PE.

Objective To investigate the effect of blood glucose control parameters on the prognosis of severe pneumonia patients based on continuous glucose monitoring(CGM)system.Methods A retrospective analysis was conducted on 51 severe pneumonia patients monitored by CGM at the Fourth Affiliated Hospital of Soochow University from November 2021 to August 2023.Assessed parameters included baseline clinical characteristics,glycosylated hemoglobin(HbA1c),mean glucose,standard deviation(SD),coefficient of variability(CV),mean amplitude of glycemic excursions(MAGE),maximum glucose level,minimum glucose level,and time in range(TIR)of glucose within the target range(3.9-10.0 mmol/L)as a proportion and levels of inflammatory indicators before and after treatment.Based on the 28-day follow-up results,the patients were divided into the survival group(39 cases)and the death group(12 cases).The blood glucose parameters of the two groups were compared.Multivariate Logistic regression model was used to analyze the influence of blood glucose parameters and infection indexes on the prognosis of patients with severe pneumonia.The efficacy of blood glucose parameters in the diagnosis of 28-day mortality was further evaluated by receiver operator characteristic curve(ROC curve).Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ),SD and CV of blood glucose in death group were higher than those in survival group[APACHEⅡscore:20.5(14.0)vs.15.0(7.0),SD(mmol/L):2.6±0.7 vs.2.1±0.5,CV:(27.7±5.8)%vs.(23.7±4.3)%].However,the TIR(3.9-10.0 mmol/L)proportion was statistically lower than that of survival group[59.0%(17.0%)vs.68.0%(35.0%)],the differences were all statistically significant(all P<0.05).After using CGM,the white blood cell count(WBC)and hypersensitive C-reactive protein(hs-CRP)were significantly decreased[WBC(×109/L):9.2(6.5)vs.11.1(9.2),hs-CRP(mg/L):39.4(59.0)vs.56.2(133.8),both P<0.05].Multivariate Logistic regression showed that TIR(3.9-10.0 mmol/L)proportion was an independent risk factor for 28-day mortality in patients with severe pneumonia[odds ratio(OR)=0.923,95%confidence interval(95%CI)was 0.852-0.999,P=0.046].The ROC curve showed that TIR proportion was valuable in predicting the clinical outcomes of patients with severe pneumonia.Area under the curve(AUC)=0.720,95%CI was 0.563-0.878,P=0.022;when the cut-off value was 63.5%,the sensitivity and the specificity were 59.0%and 83.3%respectively.Conclusion Increase of TIR(3.9-10.0 mmol/L)proportion in patients with severe pneumonia could improve clinical outcomes,especially when TIR proportion≥63.5%.

Objective:To comprehensively search, evaluate and summarize the relevant evidence of early ambulation in patients with total knee arthroplasty (TKA), so as to provide evidence-based basis for the nursing practice of early ambulation in patients with TKA.Methods:Clinical decisions, best practice manuals, guidelines, systematic reviews, expert consensus and evidence summaries for early postoperative ambulation of TKA patients were searched by computer on PubMed, Web of Science, BMJ Best Practice, Cochrane Library, UpToDate, OVID, CINAHL, Embase, Joanna Briggs Institute (JBI) Centre for Evidence-based Health Care, Physiotherapy Evidence Database, China National Knowledge Infrastructure, WanFang Data, VIP, China Biology Medicine disc, Guidelines International Network, National Guideline Clearinghouse, National Institute for Health and Care Excellence, Canadian Medical Association Clinical Practice Guideline, Scottish Intercollegiate Guidelines Network, American Academy of Orthopaedic Surgeons and American Association of Hip and Knee Surgeons. The retrieval time was from the establishment of the databases to March 31, 2023. Four nursing graduate students trained in evidence-based nursing systems independently evaluated the quality of the included literature and divided the evidence levels according to the JBI Evidence Pre Grading System (2014 edition) .Results:A total of 15 articles were included, including four clinical decision papers, three guidelines, six expert consensus papers, one evidence summary and one systematic review. According to the judgment of professionals, 23 pieces of best evidence were formed from seven aspects, including the director of ambulation, evaluation before ambulation, ambulation planning, ambulation timing, ambulation content, ambulation evaluation and health education.Conclusions:The best evidence of early postoperative ambulation of patients with TKA summarized in this study is scientific and practical, which can provide evidence-based basis for clinical nursing work.