Objective To discuss the morphological characteristics of three types of clinically rare cerebral aneurysms and arterial bifurcations.Methods A total of 17 patients with clinically rare cerebral aneurysms,including anterior cerebral artery-pericallosal artery aneurysms(ACA-PA aneurysms,n=8),internal carotid artery-anterior choroidal artery bifurcation aneurysms(ICA-AChA aneurysms,n=5)and vertebral artery-posterior inferior cerebellar artery bifurcation aneurysms(VA-PICA aneurysms,n=4),who received treatment in the Shijiazhuang People's Hospital between January 2017 and April 2020 were enrolled in this study.The clinical baseline data were recorded,and the morphological parameters of the aneurysms were determined.The bifurcation angle,small lateral angle and large lateral angle were defined as φ1,φ2 and φ3,respectively.D1,S1 and T1 represented the diameter,cross-sectional area and tortuosity of the main blood vessel,respectively.D2,S2 and T2 were defined as the corresponding parameters of the branch vessel forming small lateral angle with the main vessel.D3,S3 and T3 were the corresponding morphological parameters of the contralateral branch vessel.Results All of the ICA-AChA and VA-PICA bifurcation aneurysms were type D aneurysms and oriented towards the small lateral angle.Six ACA-PA bifurcation aneurysms were type C aneurysm,and 5 of them were oriented toward the small lateral angle.The S2 and φ2 of the ACA-PA and ICA-AChA bifurcations harboring aneurysms were significantly smaller than S3 and φ3(P＜0.05),while T2 was remarkably largerthan T3(P＜0.05).The VA-PICA bifurcations also showed a similar manifestations.Conclusion These three types of clinically rare cerebral aneurysms are mostly oriented towards the small lateral angle,and the diameter and cross-section area of the branch forming small lateral angle with parent artery were smaller than those of the contralateral branch vessel,while the tortuosity was greater than that of the contralateral branch.

BACKGROUND:In recent years,with the development of biological scaffold materials and bioprinting technology,tissue-engineered bone has become a research hotspot in bone defect repair. OBJECTIVE:To summarize the current treatment methods for bone defects,summarize the biomaterials and bioprinting technology for preparing tissue-engineered bone scaffolds,and explore the application of biomaterials and printing technology in tissue engineering and the current challenges. METHODS:Search terms were"bone defect,tissue engineering,biomaterials,3D printing technology,4D printing technology,bioprinting,biological scaffold,bone repair"in Chinese and English.Relevant documents published from January 1,2009 to December 1,2022 were retrieved on CNKI,PubMed and Web of Science databases.After being screened by the first author,high-quality references were added.A total of 93 articles were included for review. RESULTS AND CONCLUSION:The main treatment methods for bone defects include bone transplantation,membrane-guided regeneration,gene therapy,bone tissue engineering,etc.The best treatment method is still uncertain.Bone tissue engineering technology is a new technology for the treatment of bone defects.It has become the focus of current research by constructing three-dimensional structures that can promote the proliferation and differentiation of osteoblasts and enhance the ability of bone formation.Biological scaffold materials are diverse,with their characteristics,advantages and disadvantages.A single biological material cannot meet the demand for tissue-engineered bone for the scaffold.Usually,multiple materials are combined to complement each other,which is to meet the demand for mechanical properties while taking into account the biological properties of the scaffold.Bioprinting technology can adjust the pore of the scaffold,build a complex spatial structure,and is more conducive to cell adhesion,proliferation and differentiation.The emerging 4D printing technology introduces"time"as the fourth dimension to make the prepared scaffold dynamic.With the synchronous development of smart materials,4D printing technology provides the possibility of efficient repair of bone defects in the future.

Objective:To investigate the relationship between lifestyle factors and stroke in the elderly.Methods:Data were obtained from a natural cohort of the Multimodal Intervention to Delay Dementia and Disability in Rural China(MIND-China)study.A total of 5 009 participants aged 60 years and above were enrolled, of whom 954(19.05%)had experienced a stroke.Logistic regression analyses were conducted to assess the association between five lifestyle factors(smoking, drinking, physical exercise, social activity and sleep quality)and the incidence of stroke.Results:In model 1, after adjusting for age, sex and education, only social activity( OR=0.783, 95% CI: 0.668-0.917)and good sleep quality( OR=0.731, 95% CI: 0.621-0.860)emerged as protective factors against stroke(both P<0.05).No statistically significant associations were found between other lifestyle factors and stroke.Analysis of a variety of healthy lifestyle practice combinations showed that having 3( OR=0.639, 95% CI: 0.433-0.944), 4( OR=0.620, 95% CI: 0.409-0.941)and 5( OR=0.397, 95% CI: 0.197-0.799)healthy lifestyle practices were protective factors against stroke(all P<0.05).In model 2, after adjusting for age, sex, education, body mass index, diabetes, hyperlipidemia, hypertension, and the APOE genotype, the results were consistent with those of Model 1. Conclusions:Lifestyle factors are significantly associated with the risk of stroke in the elderly population.The healthier lifestyle practices are adopted, the lower the risk of stroke will be.

Objective:To integrate the best evidence of sexual health management for colorectal cancer patients both domestically and internationally, so as to provide guidance for clinical practice.Methods:Evidence on sexual health management of colorectal cancer patients in domestic and foreign databases and websites was systematically searched, and evidence from literature that met quality evaluation standards was extracted and summarized. The search period was from July 2003 to July 2023.Results:A total of 16 articles were included, including five clinical decisions, six clinical practice guidelines, three expert consensus/group standards, and two systematic reviews. Thirty-four recommended opinions were formed, including eight aspects of evaluation and screening, assessment tools, manifestations of sexual dysfunction, coping strategies for sexual problems, psychological intervention, measures for fertility protection, health education, and follow-up management.Conclusions:This study summarizes the best evidence for sexual health management in colorectal cancer patients. It is necessary to selectively apply evidence based on the evaluation of patient conditions by medical and nursing staff and clinical situations to ensure effective and scientific sexual health management strategies for patients, and promote the translation of best evidence into clinical practice.

Familial hypercholesterolemia (FH) is a group of autosomal co-dominant genetic diseases mainly characterized by abnormal low-density lipoprotein related metabolism. It is one of the most common inherited diseases in children and one of the most serious lipid metabolism diseases which results in various life-threatening cardiovascular diseases and the complications. In recent years, the treatment protocols for FH have diversified thanks to the deeper understanding of the disease in China and abroad and the development of new lipid-lowering drugs. However, the current awareness and diagnosis rate of FH are very low. The treatment of the disease is much inadequate. This paper summarizes the clinical characteristics, diagnosis, screening strategy, and treatment of FH hoping to enhance the understanding and awareness of the disease in the society.

Intelligent responsive drug delivery system opens up new avenues for realizing safer and more effective combination immunotherapy. Herein, a kind of tumor cascade-targeted responsive liposome (NLG919@Lip-pep1) is developed by conjugating polypeptide inhibitor of PD-1 signal pathway (AUNP-12), which is also a targeted peptide that conjugated with liposome carrier through matrix metalloproteinase-2 (MMP-2) cleavable peptide (GPLGVRGD). This targeted liposome is prepared through a mature preparation process, and indoleamine-2,3-dioxygenase (IDO) inhibitor NLG919 was encapsulated into it. Moreover, mediated by the enhanced permeability and retention effect (EPR effect) and AUNP-12, NLG919@Lip-pep1 first targets the cells that highly express PD-L1 in tumor tissues. At the same time, the over-expressed MMP-2 in the tumor site triggers the dissociation of AUNP-12, thus realizing the precise block of PD-1 signal pathway, and restoring the activity of T cells. The exposure of secondary targeting module II VRGDC-NLG919@Lip mediated tumor cells targeting, and further relieved the immunosuppressive microenvironment. Overall, this study offers a potentially appealing paradigm of a high efficiency, low toxicity, and simple intelligent responsive drug delivery system for targeted drug delivery in breast cancer, which can effectively rescue and activate the body's anti-tumor immune response and furthermore achieve effective treatment of metastatic breast cancer.

Objective:To explore the status quo of self-learning readiness of in-service nurses in self-taught examination and its correlation with general self-efficacy.Methods:Convenience sampling method was conducted with nurses who studied in the self-taught nursing examination of a university from a university in Sichuan Province from March to May 2020. General information questionnaire, Chinese version of Self-regulated Learning Readiness Scale for Nursing Education (SLDRS) and General Self-Efficacy Scale (GSES) were used to investigate the research. SPSS 24.0 was used to analyze the scores, multiple linear stepwise regression analysis was used to analyze the influencing factors, and Pearson correlation analysis was used to analyze the correlation between self-learning readiness and general self-efficacy. A total of 468 questionnaires were collected and 455 were valid.Results:The total scores of 455 nurses were (147.93±18.07) points, and the overall average scores were (3.70±0.45) points. Multiple linear stepwise regression analysis showed that the desire to continue to study for postgraduate students, the times of face-to-face classes in each subject, the preference for nursing major, aimlessness and satisfaction with the forms of assistance were the important influencing factors of autonomous learning readiness ( P<0.05). There is a positive correlation between self-learning readiness and general self-efficacy ( r=0.551, P<0.05). Conclusion:The self-learning readiness of nurses for self-taught examination is at a medium level. Their self-learning ability may be improved by encouraging them to carry out career planning, improving their professional identity and self-efficacy, and choosing teaching methods that are more suitable for in-service staff.

Objective:To investigate the asymmetric geometry of middle cerebral artery (MCA) bifurcations and aneurysm formation.Methods:From January 2017 to April 2020, 65 patients with MCA aneurysm underwent 3D-digital subtraction angiography (DSA) in our hospital were recruited in this study; 170 patients without arterial stenosis or cerebral aneurysm at the same time period were selected as normal control group; their corresponding morphological parameters of MCA bifurcations in the imaging data were analyzed. Bifurcation angle was termed as φ1, while small and large lateral angles were termed as φ2 and φ3, respectively. D2, S2, C2, T2 and E2 represented diameter, sectional area, circumference, tortuosity and ellipticity of the branch forming angle φ2 with parent vessel, respectively; whereas D3, S3, C3, T3 and E3 represented diameter, sectional area, circumference, tortuosity and ellipticity of the branch forming angle φ2 with parent vessel on the contralateral branch, respectively. The independent factors affecting the formation of MCA aneurysm were screened by binary Logistic regression, and the predictive value of independent factors affecting the formation of MCA aneurysm was evaluated by receiver operating characteristic (ROC) curve.Results:(1) The aneurysmal group had significantly larger φ1, significantly smaller φ2 and φ3 than the normal control group ( P<0.05); D3, S3, C3, T2, T3 and E2 in the aneurysmal group were significantly higher/larger than those in the normal control group ( P<0.05). In terms of the symmetry of bilateral branches of blood vessels, the difference of φ3/φ2 ratio between the normal control group and aneurysm group was statistically significant ( P<0.05). (2) Binary Logistic regression results showed that φ2 was the protective factor for aneurysm formation ( OR=0.880, 9 5%CI: 0.844-0.918, P=0.000), while D3 and φ3/φ2 ratio were the risk factors for aneurysm formation ( OR=4.493, 9 5%CI: 1.414-14.278, P=0.011; OR=30.676, 95%CI: 9.884-95.202, P=0.000). (3) The ROC curve showed that the area under the curve of φ2 was the largest, reaching 0.93, and the optimal cut-off point was 104.59°, enjoying sensitivity and specificity of 87.7% and 85.9%, respectively. Conclusion:Normal MCA bifurcations almost show symmetrical morphology, whereas aneurysmal MCA bifurcations show asymmetrical morphology in both lateral angles and daughter branches; φ2 is the best morphological parameter to predict the aneurysm formation of MCA bifurcations.

Objective: To investigate the in vitro antibacterial activity of triclosan combined with different antibacterial agents against triclosan-resistant multidrug-resistant Acinetobacter baumannii (A.baumannii). Methods: A total of 626 A. baumannii strains were collected from the First Affiliated Hospital of Wenzhou Medical University from 2016 to 2017. The sensitivity of these A. baumannii strains to common antibiotics was detected by VITEK 2-compact automatical microbiological analyzer and the minimum inhibitory concentrations (MIC) of triclosan were detected by agar dilution method. Checkerboard method was used to detect the changes in MIC values of triclosan against 16 triclosan-resistant multidrug-resistant A. baumannii strains after it was used in combination with four external ointments, including gentamicin, erythromycin, chloramphenicol and kanamycin, and three common antibiotics of imipenem, meropenem and ciprofloxacin, respectively. Fractional inhibitory concentration index (FICI) was used to evaluate the joint bacteriostatic effects. Results: Among the 626 A. baumannii strains, 17 were resistant to triclosan with a drug resistance rate of 2.7% (17/626). These triclosan-resistant strains had high MIC values for ciprofloxacin, imipenem, ceftazidime and other commonly used clinical antibiotic and most of them were multidrug-resistant. After triclosan was used in combination with seven different antibacterial drugs, the MIC values of all drugs decreased to various degrees compared with those when they were used alone. Triclosan in combination with gentamicin, chloramphenicol and ciprofloxacin showed synergistic effects on 62.5%, 56.25% and 62.5% of the 16 strains and additive effects on 37.5%, 43.75% and 37.5%, respectively. When it was used in combination with erythromycin, kanamycin, imipenem and meropenem, synergistic effects on 37.5%, 25%, 12.5% and 12.5%, additive effects on 37.5%, 56.25%, 62.5% and 62.5%, and indifferent effects on 25%, 18.75%, 25% and 25% of the strains were detected, respectively. No antagonistic effect was found between triclosan and any of the above antibiotics. Conclusions Triclosan combined with gentamicin, chloramphenicol and ciprofloxacin had better in vitro antibacterial effects against the triclosan-resistant multidrug-resistant A. baumannii strains in this study with synergistic and additive effects. Some indifferent effects were found between triclosan and kanamycin, erythromycin, imipenem and meropenem, but no antagonistic effects were detected.

Objective: To investigate the self-reported prevalence, clinical characteristics, complications of allergic rhinitis (AR) and the sensitization of outdoor air pollen allergens in children in the Inner mongolia grassland region. Methods: A multistage, stratified and random clustered sampling with a face-to-face interview survey study in children from 0 to 17 years old was performed together with 10 common allergen skin prick tests (SPT) and measurements of the daily pollen count in 6 regions in the Inner mongolia grassland region from May to August of 2015. SAS 9.4 software was used for data analysis. Results: A total of 2 443 subjects completed the study. The self-reported prevalence of AR was 26.6%. The prevalence of boys was higher than that of girls (28.8% vs 24.3%, χ²=6.157, P<0.05). Subjects from urban areas showed higher prevalence than rural areas (34.7% vs 18.8%, χ²=79.107, P<0.05). There was significant regional difference in the prevalence of AR among the six areas investigated (χ²=221.416, P<0.05). The main clinical symptoms of AR were sneezing (88.2%) and nasal congestion (78.6%). Among combined diseases, asthma accounted for 16.5% (107/650), rhinoconjunctivitis accounted for 47.9% (311/650). The peak season of AR was April and July, with the top SPT positive allergens of Artemisia species and chenopodium in this area. Conclusions The prevalence AR in children in the Inner mongolia grassland region is extremely high. Sneezing is the main clinical symptom. Rhinoconjunctivitis is the most common combined disease. High summer and autumn pollen exposure is the main cause of AR.