Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.

As a special type of signaling molecules, mitokines have attracted widespread attention in the fields of cell biology and aging research in recent years.Currently researchers discovered mitokines including fibroblast growth factor 21, growth differentiation factor 15 and humanin, etc., which are mainly secreted and produced by stressed cells during mitochondrial stress(e.g., oxidative stress, metabolic stress, and toxin exposure). Through different signaling pathways, mitokines regulate cellular function and metabolic status, playing an important role in maintaining the health of organisms and regulating the aging process.This article summarizes the current research progress on mitokines and the occurrence and development of aging, as well as their roles in aging-related diseases.

Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.

As a special type of signaling molecules, mitokines have attracted widespread attention in the fields of cell biology and aging research in recent years.Currently researchers discovered mitokines including fibroblast growth factor 21, growth differentiation factor 15 and humanin, etc., which are mainly secreted and produced by stressed cells during mitochondrial stress(e.g., oxidative stress, metabolic stress, and toxin exposure). Through different signaling pathways, mitokines regulate cellular function and metabolic status, playing an important role in maintaining the health of organisms and regulating the aging process.This article summarizes the current research progress on mitokines and the occurrence and development of aging, as well as their roles in aging-related diseases.

Objective:To investigate the effects of RNA binding protein 15(RBM15)on the malignant biological behaviors of cervical cancer cells by regulating the Wnt/β-catenin pathway through ATPase family AAA-domain containing 3A(ATAD3A).Methods:TCGA database was used to analyze the expression level of RBM15 mRNA in cervical cancer tissues and its relationship with patient prognosis.32 samples of cervical cancer tissues and adjacent para-cancerous tissues surgically removed in Ganzhou People's Hospital between January and October 2024,as well as cervical cancer cells HeLa,MS-751,C-33A,and SiHa,were collected.The expression levels of RBM15 in cervical cancer tissues and cells were detected by immunohistochemistry and WB assay.m6A modification sites in ATAD3A mRNA were screened by the SRAMP online database.The interaction between RBM15 and ATAD3A mRNA were identified by RNA immunoprecipitation assay,RNA decay assay,and salvage assay.Knockdown or overexpression of RBM15 and ATAD3A in cervical cancer HeLa and SiHa cells were conducted by RNA interference and viral infection.The expressions of mRNA and protein were detected by qPCR and WB methods,while the proliferation,migration,and invasion abilities of cells in each group were assessed by CCK-8 method,scratch assay,and Transwell assay.Results:The positivity rates of RBM15 mRNA and protein in cervical cancer tissues were significantly higher than those in adjacent para-cancerous tissues(both P<0.001).The protein expression levels of RBM15 in cervical cancer cell lines HeLa,MS-751,C-33A,and SiHa were significantly higher than those in normal cervical cell lines Ect1/E6E7(all P<0.001).The 5-year progression free survival rate of the RBM15 mRNA high expression group was lower than that of the low expression group(P<0.001).Compared with that in adjacent para-cancerous tissues,the expression level of ATAD3A was significantly upregulated in cervical cancer tissues(P<0.001).RBM15 mRNA was positively correlated with ATAD3A mRNA(r=0.601,P<0.05).There were highly reliable m6A modification sites at position 501,5 312,12 137 in ATAD3A mRNA.Overexpression of RBM15 in HeLa and SiHa cells led to an increase in ATAD3A mRNA and protein expressions,while knockdown of RBM15 resulted in a decrease in ATAD3A mRNA and protein expression(all P<0.001).RNA immunoprecipitation experiment showed that compared with the IgG group,ATAD3A mRNA was significantly enriched in the immunoprecipitation of RBM15 antibody(both P<0.001).MeRIP-qPCR experiment showed that there was significant m6A methylation enrichment at positions ATAD3A mRNA 501,5 312 and 12 137(all P<0.001).RNA decay experiments showed that knocking down RBM15 in HeLa and SiHa cells could reduce the half-life and stability of ATAD3A mRNA(all P<0.001).Knocking down the expression of RBM15 in HeLa and SiHa cells could significantly inhibit the proliferation,migration,and invasion of cancer cells and significantly reduce the expressions of Wnt/β-catenin pathway related proteins Wnt3,β-catenin,and vimentin,while overexpression of ATAD3A could completely reverse the above inhibiting effects(all P<0.001).Conclusion:RBM15 can modify ATAD3A mRNA and regulate the Wnt/β-catenin pathway through m6A,and thus promote the proliferation,migration and invasion of cervical cancer cells.

Objective:To investigate the common disease spectrum of grass-root troops, to provide a basis for meeting the needs for military medical support among officers and soldiers, and to improve targeted training of military general practitioners in grass-root troops.Methods:With reference to International Classification of Diseases (9th edition), a questionnaire survey was conducted to investigate 146 types of diseases among the military doctors in grass-root troops. SPSS 23.0 was used to determine the score of the common degree of each disease, and the mean score of each disease was ranked. At the same time, the Kendell consistency test was used to compare the scores of doctors between different altitudes and troops.Results:Most grass-root military doctors were male graduates aged 20-39 years, among whom 109 (51.90%) did not receive continuing education, and there were 140 doctors (66.67%) belonging to the health company, 11 (5.24%) belonging to the health platoon, 35 (16.67%) belonging to the health clinic, and 24 (11.42%) belonging to the health team. As for the location of the troops, there were 42 doctors (20.00%) in the temperate zone, 56 (26.67%) in the subtropical zone, 57 (27.14%) in the alpine region, 37 (17.62%) in the plains, and 18 (8.57%) on the islands. There were 173 patients with an age of 20-29 years, accounting for 82.38%. The Kendell consistency test showed Kendell's W=0.968 ( χ 2=711.51, P<0.001), suggesting a consistent evaluation of 146 diseases by grass-roots doctors from different altitudes. Conclusion:With reference to the investigation of disease spectrum, it is necessary to formulate characteristic training objectives and contents for the training of military general practitioners, explore the training models and methods for military general practitioners in grass-root troops, promote the construction of military general practitioners during the new military reform, and improve the post competency of military doctors.

Abdomen/diagnostic imaging* ; Artificial Intelligence ; Body Composition ; Magnetic Resonance Imaging ; Practice Guidelines as Topic

Objective:To explore solutions to the "grey zone" of activated partial thromboplastin time (APTT) mixing study, and establish the clinical application pathway of it.Methods:Patients treated in West China Hospital of Sichuan University from January 1, 2018, to December 31, 2019, with a prolonged APTT were included in this study. The ROC curve was used to analyze the"cut-off"of different methods and explore solutions to the "grey zone" by combination of the 1∶1 and 4∶1 mixing study. Similar samples from January 1, 2020 to December 31, 2020 were included to verify the diagnostic efficiency of the clinical application pathway.Results:The traditional Rosner index criterion had a low diagnostic accuracy in differentiating factor deficiencies from inhibitors. A total of 49 cases (15%) in the establishment group and validation group were located in the "grey zone". The optimal cut-off value of the Rosner index in our 1∶1 mixing study for determining factor deficiency was 5.0%, and inhibitor was 9.1%. The sample between 5.0% and 9.0% needed 4∶1 mixing studies, which could significantly improve the detection sensitivity of inhibitors. The percentage of extended time after incubation-P (1∶1 mixing>10.8% and 4∶1 mixing>13.5%) was better than the traditional criterion mentioned by"consensus"in determining whether the inhibitor was time-dependent. The sensitivity, specificity, positive predictive value and negative predictive value of combined the 1∶1 and 4∶1 mixing study in differentiating factor deficiencies from inhibitors all attained more than 90%. Only 7% (3/43)of inhibitors were incorrectly classified into the factor deficiency group by the combination, which was 20.9% (9/43) by traditional criterion. The specificity for detecting time-dependent inhibitor was increased from 54.2% to 100%, and accuracy was increased from 63.3% to 97.4%.Conclusions:The combination of 1∶1 and 4∶1 mixing study can better resolve the "grey zone". The established clinical application pathway is beneficial for the further promotion and clinical application of APTT mixing study.

Objectives To design an objective and structured evaluation system for the clinical competence of orthopedic postgraduates in the diagnosis and treatment of distal radius fractures, and to ana-lyze its reliability and validity. Methods 28 orthopaedic postgraduates representing six levels of surgical training were tested for competence in performing surgical approach for distal radius fracture on cadaver specimens during which four measures were used to assess competency: examination of basic theory based on network item bank, objective structured operation assessment,overall assessment and operation examina-tion results. In addition, the time for completion of the surgery was also recorded. Each assessment tool was correlated with the others as well as with the resident’s level of training. Results There was a significant correlation between the seniority of candidates and the score of theoretical examination (F=6.193, P=0.000), the score of structured operation examination (F=6.374, P=0.002), the score of overall assessment (F=2.321, P=0.030), and the passing rate of final operation examination (F=36.300, P=0.000). No significant differ- ences were found between seniority and time to completion of the surgical approach exposure (F=2.282, P<0.073). Conclusions The results of the present study suggested that both theoretical examination and cadaver testing discriminate between novice and accomplished postgraduates. However, although the theo-retical test scores could predict the operational test results, but the theoretical results can not guarantee excellent operational skills.