AIM:To observe the effect of folic acid(FA)on C2C12 myoblast proliferation and differentia-tion,and to explore its mechanism.METHODS:During the proliferation stage,C2C12 myoblasts were treated with vari-ous concentrations of FA(0,2.5,5,10 and 20 μmol/L).The cell status was observed under a microscope,cell viability was detected using the MTT method,and cell proliferation was assessed using the EdU method.In the differentiation stage,C2C12 cells were divided into control(Ctrl)group(0 μmol/L FA)and FA group(10 μmol/L FA).On day 2 or 4 of differentiation,immunofluorescence staining and Western blot were employed to detect the expression of myoblast differen-tiation-related proteins,myoblast determination protein 1(MyoD),myogenin(MyoG)and myosin heavy chain(MyHC).The myotubule formation in each group was analyzed.On day 4 of differentiation,C2C12 cells were treated with FA for 0,1,3 and 6 h,and the protein levels of p-JNK,JNK,p-p38 MAPK and p38 MAPK at each time point were detected by Western blot.Additionally,C2C12 cells after 4-day differentiation were divided into Ctrl group,FA group,FA+ SP600125(specific inhibitor of JNK)group,and FA+SB203580(specific inhibitor of p38)group.The cells in FA+ SP600125 and FA+SB203580 groups were treated with 10 μmol/L SP600125 or SB203580 for 1 h,followed by treatment with 10 μmol/L FA for 24 h.The cells in FA group were treated with 10 μmol/L FA for 24 h,while the cells in Ctrl group were left untreated.The protein levels of p-JNK,JNK,p-p38 MAPK,p38 MAPK and MyHC were detected by Western blot.RESULTS:(1)Compared with 0 μmol/L FA group,the number of the cells in other concentration groups in-creased,cell viability was raised(P＜0.05 or P＜0.01),and the rate of EdU positive cells increased(P＜0.05).(2)Com-pared with Ctrl group,the expression levels of MyoD,MyoG and MyHC in FA group were increased(P＜0.05),and the myotube fusion index was raised(P＜0.05 or P＜0.01).(3)Compared with 0 h group,the ratios of p-JNK/JNK and p-p38 MAPK/p38 MAPK were elevated after FA treatment for 1,3 and 6 h(P＜0.05 or P＜0.01),and showed a trend of gradual increase with the extension of treatment time.(4)After FA treatment,the ratios of p-JNK/JNK and p-p38 MAPK/p38 MAPK,and the expression of MyHC were elevated(P＜0.01).Treatment with SP600125 decreased the ratio of p-JNK/JNK and the expression of MyHC(P＜0.05),while SB203580 intervention cut down the ratio of p-p38 MAPK/p38 MAPK and the expression of MyHC(P＜0.05 or P＜0.01).CONCLUSION:Folic acid can promote the differentiation of C2C12 myoblasts by activating the JNK/p38 MAPK signaling pathway.

Objective To analyze the effect of circLRP6 on high glucose-induced renal tubular epithelial cell injury via miR-31-5p/high mobility group protein A1(HMGA1)axis regulation.Methods Human renal tubular epithelial HK-2 cells were cultured in vitro and divided into eight groups:control,high glucose,high glucose+si-NC,high glucose+si-circLRP6,high glucose+si-circLRP6+miR-NC,high glucose+si-circLRP6+miR-31-5p inhibitor,high glucose+si-circLRP6+miR-31-5p inhibitor+si-NC,and high glucose+si-circ-LRP6+ miR-31-5p inhibitor+si-HMGA1.The circLRP6,miR-31-5p,and HMGA1 mRNA levels were determined using real-time quantitative PCR.Cell supernatant IL-6 and tumor necrosis factor-α(TNF-α)levels,lactate dehydrogenase(LDH)activity,and malondialdehyde(MDA)content were also determined.Furthermore,flow cytometry was used to observe cell apoptosis.HMGA1,Bax,and Bcl-2 protein expression was detected by Western blotting.Finally,dual luciferase assay was used to report the targeting relationship of miR-31-5p with circLRP6 and HMGA1.Results Compared with the high glucose group,the HK-2 cell proliferation inhibition rate;cell superserum IL-6,TNF-α,LDH,and MDA levels;apoptosis rate;and Bax protein expression in the high glucose+si-circLRP6 group decreased significantly,whereas Bcl-2 protein expression increased significantly(all P＜0.05).Consequently,miR-31-5p downregulation possibly weakened the protective effect of si-circLRP6 on high glucose-induced renal tubular epithelial cell injury.HMGA1 expression inhibition reversed the effect of the si-circLRP6+miR-31-5p inhibitor on high glucose-induced renal tubular epithelial cell injury.Finally,miR-31-5p exhibited a targeting relationship with circLRP6 and HMGA1.Conclusion Si-circLRP6 protects high glucose-induced renal tubular epithelial cell injury via miR-31-5p upregulation and HMGA1 expression inhibition.

Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.

Objective To investigate the effects of perineal massage combined with hip joint exercise on the outcome of delivery and mental resilience of primipara.Methods 90 pregnant women in the third trimester(after 36 weeks)who obtained the knowledge about perineal massage from midwife clinic were randomly divided into two groups with 45 cases each.The control group received regular antenatal examination and family self-exercise;the experimental group received perineal massage and hip joint training combined treatment.The delivery outcome,birth experience and maternal mental resilience of the two groups were compared.Results the number of vaginal delivery in the experimental group were higher than that in the control group(P<0.05);the second stage of labor was significantly shorter than that of the control group(P<0.05);the perineal integrity rate was higher than that of the control group(P<0.05);the scores of all dimensions in delivery experience questionnaire were higher than that of the control group(P<0.05);the scores of all dimensions in maternal mental resilience were higher than those of the control group(P<0.05)after intervention.Conclusion The perineal massage which conducted by midwives combined with hip movement can effectively improve the quality of delivery,relieve the negative emotions of pregnant women,improve the psychological elasticity level of pregnant women,and improve the delivery outcomes.

Objective To explore the general surgery patients with postoperative incision infection(SSI)of pathogenic microorganism distribution characteristics and serum lactate dehydrogenase(LDH),interleukin(IL)-6 to the predictive value of infection.Methods A total of 100 patients who underwent surgery in the General Surgery Department of the hospital from January 2021 to June 2023 were selected as the research ob-jects.According to the occurrence of postoperative infection,the patients were divided into infection group(28 cases)and non-infection group(72 cases).The basic data of the patients were collected,including age,gender,operation type,operation time,incision type,and incision healing.Bacterial culture and pathogen identification were performed on the incision secretion of patients under sterile conditions.At the same time,the serum LDH and IL-6 levels of the patients on the first and third day after operation were detected,and the differences of LDH and IL-6 levels between the infection group and the non-infection group were compared.Pearson cor-relation analysis was used to analyze the correlation between serum LDH level and IL-6.Multivariate Logistic regression analysis was used to analyze the influencing factors of SSI.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of serum LDH and IL-6 levels for SSI.Results A-mong the 100 patients,28 patients developed SSI,and the infection rate was 28％.There were significant differences in age,operation time,and incision type between the infection group and the non-infection group(P＜0.05).The results of bacterial culture showed that a total of 35 strains of bacteria were isolated from the patients in the infection group,of which Gram-positive bacteria accounted for 54.29％and Gram-negative bac-teria accounted for 45.71％,mainly Staphylococcus aureus(14 strains),Pseudomonas aeruginosa(7 strains),and Escherichia coli(5 strains).The serum levels of LDH and IL-6 in the infection group were higher than those in the non-infection group on postoperative days 1 and 3(P＜0.05).The serum level of LDH in the in-fection group was positively correlated with IL-6(r=0.512,P＜0.001).Multivariate Logistic regression a-nalysis showed that age,operation time,type of incision,and serum LDH and IL-6 levels on postoperative day 3 were independent risk factors for SSI(P＜0.05).ROC curve analysis showed that serum LDH and IL-6 lev-els had a high diagnostic efficacy for SSI,with an area under the curve of 0.89 and 0.88,the best cut-off values of 210 U/L and 15 pg/mL,the sensitivity of 82.14％and 85.71％,and the specificity of 78.57％and 80.36％,respectively.Conclusion Staphylococcus aureus and Pseudomonas aeruginosa are the main pathogenic micro-organisms of SSI in general surgical patients.Serum LDH and IL-6 levels can be used as predictors of SSI,which is of great significance for early diagnosis and treatment of infection.

Purpose To investigate the application value in diagnosis,typing and staging of multimodal ultrasound in primary nodal diffuse large B-cell lymphoma(N-DLBCL).Materials and Methods A total of 96 patients(96 nodes)with a pathological diagnosis of N-DLBCL(51 nodes)or benign lymph nodes(45 nodes)in the First Affiliated Hospital of Nanjing Medical University from October 2020 to June 2022 were enrolled,retrospectively.All these patients were examined by high-frequency ultrasound,shear wave elastography(SWE)and contrast-enhanced ultrasonography(CEUS).The differences among the three ultrasound imaging methods in differentiating N-DLBCL from benign lymph nodes,typing and staging of N-DLBCL were analyzed.Receiver operating characteristic curve were drawn to obtain the diagnostic thresholds of SWE and CEUS quantitative indexes,and the efficacy of the different examination methods were assessed.Results Univariate analysis demonstrated 14 parameters were significantly different between the N-DLBCL and benign lymph nodes(χ2=12.289-32.934,all P<0.05).Multivariate analysis showed the difference in long diameter/short diameter(OR=11.205,P=0.012),cortical echo(OR=10.367,P=0.002),maximum elasticity(OR=0.180,P=0.014),peak time(OR=0.111,P=0.025),peak intensity-basic intensity(OR=0.061,P=0.002)and enhancement distribution(OR=0.065,P=0.001)were statistically significant between the two groups.There were statistically significant differences of maximum elasticity(χ2=5.299,P=0.021)between germinal center and non-germinal center N-DLBCL groups.There were statistically significant differences in blood flow pattern(χ2=9.663,P=0.017),arrival time(χ2=2.851,P=0.034)and peak time(χ2=6.702,P=0.018)between the limited and advanced N-DLBCL.The area under the curve for the diagnosis of N-DLBCL and benign lymph nodes by high-frequency ultrasound,SWE,CEUS and multimodal ultrasound were 0.754,0.839,0.875 and 0.963,respectively.Conclusion Multimodal ultrasound has high application value in differential diagnosis,classification and staging of N-DLBCL,and can provide basis for diagnosis and treatment of N-DLBCL.

Objective:To construct a prediction model for peripherally inserted central catheter-related upper extremity deep vein thrombosis (PICC-UEDVT) in patients with traumatic brain injury (TBI) and validate its effectiveness.Methods:A case-control study was conducted on the clinical data of 222 TBI patients admitted to Xiangya Hospital of Central South University from January 2019 to December 2021, including 171 males and 51 females, aged 18-86 years [54.5(46.0, 65.0)years]. Glasgow coma scale (GCS) motor score was 4.0(3.0, 5.0)points on the day of catheterization. A total of 82 patients (36.9%) had PICC-UEDVT. The patients were randomly divided with a ratio of 7∶3 into training set ( n=156, including 58 with PICC-UEDVT) and validation set ( n=66, including 24 with PICC-UEDVT) using R programming language. The baseline data of general information, intravenous medication, catheterization, and laboratory indices were compared between the training set and the validation set. Lasso regression analysis was employed to identify those variables, with the diagnosis of PICC-UEDVT as the outcome variable. Variables with non-zero regression coefficients were included in a multifactorial Logistic regression model and independent variables were selected based on the Akaike Information Criterion (AIC) of R programming language. The regression equation was constructed, based on which, the predictive nomogram model was constructed for PICC-UEDVT in TBI patients. Receiver operating characteristic (ROC) curves for the training set and validation set were plotted and the discriminability of the model was assessed. The calibration of the model was evaluated using the Hosmer-Lemeshow (H-L) goodness-of-fit test and calibration curves and the clinical practicality of the model was assessed with decision curve analysis (DCA). Results:The baseline analysis of both the training set and the validation set demonstrated a well-balanced sample distribution. Through Lasso regression analysis, 5 prediction variables were identified: GCS motor score on the day of catheterization, Caprini score on the day of catheterization, use of glucocorticoids, tip position of the catheter, and D-dimer (D-D) level before catheterization. The multivariate Logistic regression analysis revealed that the Caprini score on the day of catheterization ( OR=1.20, 95% CI 1.08, 1.33), use of glucocorticoids ( OR=3.13, 95% CI 0.99, 10.46), and D-D level before catheterization ( OR=1.16, 95% CI 1.07, 1.33) were independent risk factors for PICC-UEDVT in TBI patients. The regression equation was developed as: Logit [ P/(1- P)]=-2.56+0.18×"Caprini score on the day of catheterization"+1.14×"use of glucocorticoids"+0.15×"D-D level before catheterization". In the prediction model which was constructed based on the equation, the AUC values for the training set and validation set were 0.73 (95% CI 0.65, 0.81) and 0.77 (95% CI 0.65, 0.87) respectively. The H-L goodness-of-fit test indicated χ2=3.28, P=0.950 for the training set and χ2=13.05, P=0.160 for the validation set. Calibration curves for both sets demonstrated alignment between the actual and predicted probabilities of PICC-UEDVT in TBI patients. DCA results showed that the net benefit rate of patients was optimal when the threshold probability ranged from 15% to 72% for the training set and from 10% to 81% for the validation set. Conclusion:The prediction model based on the Caprini score on the day of catheterization, use of glucocorticoids, and D-D level before catheterization demonstrates good predictive accuracy, calibration and clinical practicality in predicting PICC-UEDVT in TBI patients.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective:To explore the effects of status epilepticus(SE)on neuronal processes and synapses in the cerebral cortex and hippocampus of young mice.Methods:The young mice of SE model was established by intraperito-neal injection of lithium chloride and pilocarpine.Morris water maze test was used to detect the behavioral changes in the mice.Immunofluorescence staining was used to observe the morphological changes of axons,dendrites and synaptic connections of neurons in the cerebral cortex and hippocampus of mice,and the ultrastructural changes of synapses of pyramidal neurons in the mouse hippocampus were observed with transmission electron microscopy.Results:The sei-zure rate of grade IV and above in mice was 80％,and the mortality rate was 25％.The escape latency of SE mice was prolonged(P＜0.05),the trajectory of exploring the platform was significantly longer and more complicated,and the time spent in the target quadrant and the number of crossing the platform were significantly reduced(P＜0.05).Posi-tive expression of axonal neurofilament marker protein SMI312 and microtubule-associated protein 2(MAP2)were found in the cerebral cortex and hippocampus of both groups,and the axonal neurofilaments and neuronal dendrites in the SE group were of different lengths and arranged densely and scatteredly.The positive expression of synaptophysin(SYP)and the number of positive spots increased significantly in in the hippocampus of SE group(P＜0.01).The number of synaptic vesicles in the SE group increased significantly,and the postsynaptic density(PSD)thickness decreased significantly(P＜0.01).Conclusion:SE might lead to acute injury of synapses in the cerebral cortex and hippocampal area of young mice,induce synaptic vesicle circulation disorders,and then cause widespread destruction and disorder of the axon and dendrite networks,the reactive or compensatory reconstruction of synaptic.