Objective:To investigate the current status and risk factors of central venous catheter-related thrombus（CRT）in critically ill children，and to provide evidence for proposing preventive measures.Methods:This study was a single-center cross-sectional survey.The hospitalized children with central venous catheters implanted in the intensive care unit of Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine from January to March 2024 were included.Based on the ultrasound diagnosis indicating CRT or the presence of visually detectable thrombi after central venous catheter removal,the children included in the study were categorized into the CRT group and the non-CRT group.The data of demographic，clinical data，laboratory tests，medication treatment，and catheter related information of the affected children were collected.Univariate and multivariate analyses were performed to identify risk factors associated with CRT.Results:A total of 328 children were included，of which 158 cases（48.2%）were female，with the median age of 35.00（9.00，88.75）months.There were 51 cases（15.6%）in CRT group and 277 cases（84.4%）in non-CRT group.After adjusted by pediatric critical illness score，multivariate binary Logistic analysis revealed that the use of normal saline for catheter flushing and sealing (adjust OR=26.52,95% CI 8.32-84.60, P<0.001),longer duration of vasoactive drug use (adjust OR=5.06,95% CI 1.93-13.26, P=0.001),higher Caprini scale score (adjust OR=3.09,95% CI 1.38-6.91, P=0.006),presence of high-risk comorbidities or complications (adjust OR=2.87,95% CI 1.11-7.45, P=0.030),longer immobilization time (adjust OR=1.13,95% CI 1.07-1.19, P<0.001),and lower international normalized ratio after catheter placement (adjust OR=0.10,95% CI 0.02-0.53, P=0.007) were independent risk factors affecting the occurrence of CRT. Conclusion:The incidence of CRT is relatively high among critically ill children,and medical staff can develop targeted intervention measures by taking relevant risk factors into consideration.

Objective:To investigate the current status and risk factors of central venous catheter-related thrombus（CRT）in critically ill children，and to provide evidence for proposing preventive measures.Methods:This study was a single-center cross-sectional survey.The hospitalized children with central venous catheters implanted in the intensive care unit of Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine from January to March 2024 were included.Based on the ultrasound diagnosis indicating CRT or the presence of visually detectable thrombi after central venous catheter removal,the children included in the study were categorized into the CRT group and the non-CRT group.The data of demographic，clinical data，laboratory tests，medication treatment，and catheter related information of the affected children were collected.Univariate and multivariate analyses were performed to identify risk factors associated with CRT.Results:A total of 328 children were included，of which 158 cases（48.2%）were female，with the median age of 35.00（9.00，88.75）months.There were 51 cases（15.6%）in CRT group and 277 cases（84.4%）in non-CRT group.After adjusted by pediatric critical illness score，multivariate binary Logistic analysis revealed that the use of normal saline for catheter flushing and sealing (adjust OR=26.52,95% CI 8.32-84.60, P<0.001),longer duration of vasoactive drug use (adjust OR=5.06,95% CI 1.93-13.26, P=0.001),higher Caprini scale score (adjust OR=3.09,95% CI 1.38-6.91, P=0.006),presence of high-risk comorbidities or complications (adjust OR=2.87,95% CI 1.11-7.45, P=0.030),longer immobilization time (adjust OR=1.13,95% CI 1.07-1.19, P<0.001),and lower international normalized ratio after catheter placement (adjust OR=0.10,95% CI 0.02-0.53, P=0.007) were independent risk factors affecting the occurrence of CRT. Conclusion:The incidence of CRT is relatively high among critically ill children,and medical staff can develop targeted intervention measures by taking relevant risk factors into consideration.

Premature ovarian insufficiency(POI),also known as"ovarian insufficiency",has an incidence of 1％～5％.The incidence has been on the rise in recent years,seriously affecting women's physical and mental health and quality of life.At present,the cause and mechanisms of POI are still unclear,and the method and applications of model construction are also confusing.Most models have some shortcomings in pertinence and stability.The limitations greatly limit research into the clinical diagnosis and treatment of POI.This paper summarizes and discusses the etiology and pathogenesis of POI and the construction of POI animal models to provide a comprehensive reference for those studying POI.

BACKGROUND:Photothermal therapy is a novel tumor treatment strategy that uses photothermal agents to transform light energy into heat energy to accomplish non-invasive tumor ablation.The rise of photothermal therapy and nanotechnology has provided a new perspective on breast cancer treatment.OBJECTIVE:To prepare a new type of near-infrared biomimetic nanoprobe that has been modified by breast cancer cell membrane,to investigate the effect of near-infrared fluorescence/ultrasound imaging in vitro,and to observe its targeting ability and photothermal therapy effect on homologous tumor cells in vitro.METHODS:Organic small molecule ITIC-4CI with A-D-A structure was used as photothermal agents;polylactic acid/glycolic acid copolymer as nanocarrier;4T1 cell membrane of mouse breast cancer cells as a surface modifier of nanoparticles;perfluorohexane(PFH)was loaded.A novel near-infrared biomimetic nanoprobe(4T1m/ITIC-4CI/PFH)was prepared by the double emulsion evaporation method and sonication method.The basic characterization of the nanoprobe and the homologous targeting ability were detected.The photothermal properties and photothermal stability of the probe were investigated,and the near-infrared fluorescence/ultrasound imaging effect of the probe under laser irradiation was observed.The CCK-8 assay and calcein/propidium iodide staining were used to assess the efficacy of photothermal therapy.RESULTS AND CONCLUSION:(1)The prepared 4T1m/ITIC-4CI/PFH nanoprobes had uniform size,high stability,and an average particle size of(92.7±2.3)nm.The probe's protein composition was identical to that of the 4T1 cell membrane.The nanoprobe's ability to target homologous 4T1 cells was validated by an in vitro cell uptake assay.(2)The nanoprobe had a red-shift absorption spectrum and tail emission extending to the near-infrared-Ⅱ,which emitted a bright near-infrared-Ⅱ fluorescence signal under laser irradiation.(3)After laser irradiation,the nanoprobe 4T1m/ITIC-4CI/PFH could be turned into microbubbles and enhanced ultrasound imaging.The results of CCK-8 assay and calcein/propidium iodide staining showed that the nanoprobe 4T1m/ITIC-4CI/PFH had an obvious photothermal killing effect on 4T1 cells.(4)The results show that the nanoprobe 4T1m/ITIC-4CI/PFH has the ability to target homologous tumors and enhance near-infrared-Ⅱ fluorescence imaging/ultrasound imaging and photothermal therapy effects.

Objective To investigate the current status of nurses'knowledge,attitude and practice regarding sleep management of critically ill children in pediatric ICU,and to analyze its impact factors.Methods A self-designed questionnaire on general information and a questionnaire on knowledge and practical behaviors of pediatric ICU nurses on child's sleep management were used.In March 2023,902 pediatric ICU nurses from 24 hospitals in China were surveyed using a convenient sampling method,and the impact factors were analyzed using multiple stepwise linear regression.Results 893 valid questionnaires were collected and the recovery rate of valid questionnaires was 99.00％.Nurses in pediatric ICU scored(33.71±7.76)in knowledge dimension,(37.38±4.86)in attitude dimension and(80.60±16.78)in practice dimension,with a total score of(151.78±24.27).The scores of knowledge and attitude,knowledge and practice,attitude and practice are all positively correlated(r=0.393,P＜0.001;r=0.495,P＜0.001;r=0.320,P＜0.001).The results of multiple stepwise linear regression analysis showed that gender,region,whether they had received sleep management training were the influencing factors of pediatric ICU nurses'total score of knowledge,attitude and practice towards children's sleep management(P＜0.05).Conclusion Nurses in pediatric ICU are positive about sleep management for critically ill children,but their knowledge and practice levels need to improve.Nursing managers should strengthen the theoretical knowledge and practical behavioral training of pediatric ICU nurses on child sleep management,develop scientific sleep management plans,and guide nurses to make reasonable evaluation and interventions to improve children's sleep quality.

OBJECTIVE To study main way and target of Euphorbia kansui after stir-frying with vinegar. METHODS Twenty-four SPF grade SD rats were randomly divided into blank group， E. kansui group （850 mg/kg） and vinegar stir-fried E. kansui group （850 mg/kg）， with 8 rats in each group. Blank group was given 0.5% sodium carboxymethyl cellulose solution intragastrically， and E. kansui group and vinegar stir-fried E. kansui group were given relevant test sample for consecutive 20 d. The rats’ urine of 12 hours was collected on the 20th day. The urine samples of rats in each group were determined by UPLC-Q- Exactive-MS. The data was pre-processed by Compound Discoverer 3.0 software， and the metabolite structure was identified by BioCyc， HMDB and other databases. Whether different groups presented their own clustering phenomenon was observed by principal component analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA）， etc. Based on the pathway analysis of MetaboAnalyst， the potential targets of detoxification mechanism of E. kansui after stir-frying with vinegar were predicted. RESULTS Twenty significantly differential endogenous metabolites were identified， of which 10 target metabolites， such as N-acetyl-L-aspartate and 3-phosphonooxypyruvic acid， were targets of detoxification mechanism of E. kansui after stir- frying with vinegar. The main metabolic pathways included arginine biosynthesis， alanine， aspartic acid and glutamic acid metabolism， cysteine and methionine metabolism， and arginine and D-ornithine metabolism. The biological significance of all related metabolites in the pathways was analyzed and speculated； after stir-frying with vinegar， E. kansui may alleviate neurotoxicity by reducing the level of N-acetyl-L-aspartic acid； E. kansui had a protective effect on cardio-cerebrovascular system by increasing the level of L-high arginine. CONCLUSIONS After stir-frying with vinegar， E. kansui can significantly improve the adverse factors in terms of nervous system， cardio-cerebrovascular system， immune system and energy metabolism. The most concentrated metabolic pathway related to its detoxification mechanism is arginine biosynthesis.

Objective:To determine the priority of diabetes prevention and control measures in the perspective of the economy and importance, and provide theoretical support for guiding relevant departments to implement measures based on actual economic level.Methods:An online survey was conducted on the importance, feasibility and implementation of major chronic disease prevention and control measures in 488 national demonstration areas for comprehensive chronic disease prevention and control. The content of the survey was divided into individual and group levels, with 10 dimensions and 44 measures, to obtain the scores of the economy and importance. IPA model was used to divide the dimension index of diabetes prevention and control into quadrants. The standardized factor load coefficient of the second-order confirmatory factor analysis was used to determine the priority of dimension index in the same quadrant. The priority of prevention and control measures in each dimension was determined by the discriminant parameter of project response theory.Results:The mean scores of economy and importance were 66.50 and 89.94, respectively, and the matrix was divided into four quadrants. The first quadrant was the "highest priority" with high importance and economy, including medical insurance and family doctors, health education, high-risk detection and intervention, patient management and community action. The second quadrant was characterized as high importance but low economy, which was the priority for improvement, including only one dimension of complication screening. The third quadrant was the lowest priority due to low importance and economy, including personal health service evaluation and follow-up, environmental support, diabetes co-infection prevention and glycemic policy. The last quadrant had low importance but high economy, which was the second improvement level. The priority measures in different quadrants were: (1) the highest priority: blood lipid control, occupational site, prevention and control work plan, blood glucose testing, family doctor contract service; (2) the priority improvement: annual neuropathy screening; (3)the lowest priority: universal access to risk scoring, healthy eating, healthy dining innovations and tuberculosis screening.Conclusion:IPA model can be used to construct a decision-making model for diabetes prevention and control and determine the priority of corresponding measures.

Objective:To determine the priority of diabetes prevention and control measures in the perspective of the economy and importance, and provide theoretical support for guiding relevant departments to implement measures based on actual economic level.Methods:An online survey was conducted on the importance, feasibility and implementation of major chronic disease prevention and control measures in 488 national demonstration areas for comprehensive chronic disease prevention and control. The content of the survey was divided into individual and group levels, with 10 dimensions and 44 measures, to obtain the scores of the economy and importance. IPA model was used to divide the dimension index of diabetes prevention and control into quadrants. The standardized factor load coefficient of the second-order confirmatory factor analysis was used to determine the priority of dimension index in the same quadrant. The priority of prevention and control measures in each dimension was determined by the discriminant parameter of project response theory.Results:The mean scores of economy and importance were 66.50 and 89.94, respectively, and the matrix was divided into four quadrants. The first quadrant was the "highest priority" with high importance and economy, including medical insurance and family doctors, health education, high-risk detection and intervention, patient management and community action. The second quadrant was characterized as high importance but low economy, which was the priority for improvement, including only one dimension of complication screening. The third quadrant was the lowest priority due to low importance and economy, including personal health service evaluation and follow-up, environmental support, diabetes co-infection prevention and glycemic policy. The last quadrant had low importance but high economy, which was the second improvement level. The priority measures in different quadrants were: (1) the highest priority: blood lipid control, occupational site, prevention and control work plan, blood glucose testing, family doctor contract service; (2) the priority improvement: annual neuropathy screening; (3)the lowest priority: universal access to risk scoring, healthy eating, healthy dining innovations and tuberculosis screening.Conclusion:IPA model can be used to construct a decision-making model for diabetes prevention and control and determine the priority of corresponding measures.

Objective:To investigate the regulatory effects of microRNA-23b-3p (miR-23b-3p) on the autophagy and apoptosis of human lens epithelial cells induced by high glucose.Methods:Thirty diabetic cataract (DC) patients as DC group and 30 patients with simple cataract as simple cataract group were enrolled in The First Affiliated Hospital of Xi'an Medical University from September 2019 to October 2020.Conventional phacoemulsification and intraocular lens transplantation were performed in both groups.The anterior capsular tissue was collected during the operation.The expression of miR-23b-3p in the anterior lens capsule was detected by real-time fluorescence quantitative PCR (RT-qPCR). Human lens epithelial cell line HLEB3 cells were cultured in vitro and divided into normal control group and high-glucose group, which were cultured in normal and high-glucose medium, respectively.The targeting relationship between proto-cadherin 17 (PCDH17) and miR-23b-3p was predicted according to the bioinformatics database, and was verified by the dual-luciferase reporter gene experiment.High glucose-cultured HLEB3 cells were divided into miR-23b-3p mimics group, negative control (NC) mimics group, NC-siRNA group, PCDH17-siRNA group, miR-23b-3p mimics+ Vector group, miR-23b-3p mimics+ pcDNA-PCDH17 group, and were transfected with corresponding reagents according to grouping.The expression of miR-23b-3p and PCDH17 mRNA was detected by RT-qPCR.The expressions of a mammalian homolog of yeast Atg6/Vps30 (Beclin-1), microtubule-associated protein 1 light chain 3 (LC3B), c-Jun N-terminal kinases (JNK), phosphorylated (p-) JNK, c-Jun, p-c-Jun, B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X protein (Bax) proteins were assayed by Western blot.The apoptosis rate was detected by flow cytometry.The study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Xi'an Medical College (No.LSL2019037). Written informed consent was obtained from each patient. Results:The relative expression of miR-23b-3p in the anterior lens capsule of DC group was 0.35±0.15, which was significantly lower than 1.00±0.09 of simple cataract group ( t=44.627, P<0.01). There were significant differences in the relative expression levels of miR-23b-3p, LC3B Ⅱ/Ⅰ, Beclin-1, Bcl-2 and Bax proteins among normal control group, high glucose group, high glucose+ NC mimics group and high glucose+ miR-23b-3p mimics group ( F=21.325, 28.318, 17.634, 15.482, 22.325, 26.537; all at P<0.01). Compared with normal control group, the apoptosis rate, LC3B Ⅱ/Ⅰ, Beclin-1 and Bax protein expressions in high glucose group were significantly increased, and the Bcl-2 protein expression was significantly decreased (all at P<0.05). Compared with NC mimics group, the apoptosis rate, LC3B Ⅱ/Ⅰ, Beclin-1, and Bax protein expressions were significantly decreased and the Bcl-2 protein expression was significantly increased in miR-23b-3p mimics group (all at P<0.05). The results of bioinformatics and dual-luciferase reporter gene experiments showed that PCDH17 was a target gene of miR-23b-3p, and the relative expression of PCDH17 mRNA in miR-23b-3p mimics group was significantly lower than that in NC mimics group ( P<0.05). Compared with NC-siRNA group, the apoptosis rate, LC3B Ⅱ/Ⅰ, Beclin-1 and Bax protein expressions in PCDH17-siRNA group were significantly decreased, and the Bcl-2 protein expression was significantly increased ( t=9.116, 12.413, 5.349, 3.273, 8.419; all at P<0.01). There were significant differences in the relative expression levels of p-JNK/JNK, p-c-Jun/c-Jun, LC3B Ⅱ/Ⅰ, Beclin-1, Bcl-2 and Bax proteins in NC mimics group, miR-23b-3p mimics group, miR-23b-3p mimics+ Vector group and miR-23b-3p mimics+ pcDNA-PCDH17 group ( F=24.724, 19.319, 23.418, 17.562, 20.263, 15.249; all at P<0.05). Compared with the miR-23b-3p mimics+ Vector group, the expressions of p-JNK/JNK, p-c-Jun/c-Jun, LC3B Ⅱ/Ⅰ, Beclin-1 and Bax were significantly increased, and the expression of Bcl-2 protein was decreased in miR-23b-3p mimics+ pcDNA-PCDH17 group (all at P<0.05). Conclusions:MiR-23b-3p have a protective effect on HLEB3 cells in a high-glucose environment, mainly by targeting PCDH17 to regulate the JNK signaling pathway to inhibit high glucose-induced autophagy and apoptosis.

Objective:To evaluate the efficacy of Baduanjin combined with mecobalamin tablets in the treatment of type 2 diabetic peripheral neuropathy. Methods:Eighty patients with type 2 diabetic peripheral neuropathy who met the inclusion criteria were randomly divided into two groups with 40 patients in each group ( n=40). The control group took oral mecobalamin tablets and self-management, and the treatment group were treated with Baduanjin on the basis of the control group. All patients were treated for 12 weeks. The clinical symptoms were evaluated by Toronto Clinical Scoring System (TCSS), and the motor nerve conduction velocity (MCV) of tibial nerve and the sensory conduction velocity (SCV) of superficial peroneal nerve were measured by EMG evoked potential instrument. The hemorheological indexes (whole blood low shear viscosity, whole blood high shear viscosity and plasma viscosity) were measured before and after treatment. The clinical efficacy was evaluated and adverse events were recorded. Results:In the course of treatment, 39 patients in each group completed the study with each one dropout. The total effective rate was 87.2% (34/39) in the treatment group and 64.1% (25/39) in the control group. There was significant difference between the two groups ( χ2=5.64, P=0.018). After treatment, the TCSS score of the treatment group was significantly lower than that of the control group ( t=-6.23, P<0.01), the tibial nerve MCV (43.06 ± 4.19 m/s vs. 39.55 ± 4.30 m/s, t=3.65), the superficial peroneal nerve SCV (43.23 ± 4.31 m/s vs. 39.92 ± 3.74 m/s, t=3.62) in the treatment group were significantly higher than the control group ( P<0.001), while the whole blood high shear viscosity, the whole blood low shear viscosity, and the plasma viscosity in the treatment group were significantly lower than the control group ( t value were -10.36, -14.21, -13.88, all Ps<0.001). During the treatment, no serious adverse events occurred in both groups. Conclusion:Baduanjin combined with mecobalamin tablets in the treatment of type 2 diabetic peripheral neuropathy can reduce blood viscosity, promote blood circulation, increase nerve conduction velocity, improve clinical symptoms and signs, and improve clinical efficacy.