ObjectiveTo explore the role of neuroimaging features monitored by functional near-infrared spectroscopy （fNIRS） in postoperative delirium （POD） in elderly patients undergoing joint replacement during perioperative period， and to provide a basis for early clinical prediction. MethodsA total of 105 elderly patients who underwent joint replacement under general anesthesia were included. The Mini-Mental State Examination （MMSE） scale was used to evaluate the patient's cognition one day before the operation. Before the start of the surgery， fNIRS was used to monitor the changes of cerebral blood oxygen saturation when the patient performed the task state. The 3-minute delirium diagnostic scale （3D-CAM scale） was used to evaluate the occurrence of POD at 24， 48 and 72 h after operation. Brain network analysis was performed and Logistic regression analysis was used to explore the relationship between fNIRS monitoring data and POD in elderly patients undergoing joint replacement surgery during preoperative task state. The receiver operating characteristic curve （ROC curve） was constructed to evaluate the diagnostic efficacy， and the Hosmer-Lemeshow goodness-of-fit test was used to test the goodness of fit of the model. ResultsAmong 105 patients， 100 cases were effectively analyzed， of which 20 cases （20%） had POD. Brain network analysis showed that the r value of functional connectivity correlation coefficient in POD group （0.069±0.118） was lower than that in non-POD group （0.073±0.084）. The low channel connectivity of right primary somatosensory cortex-right primary motor cortex （RS1-RM1） and left anterior pole-right Broca's triangle （LFP-RBA44） was an important factor affecting the occurrence of POD （P < 0.05）. Based on this result， the area under the ROC curve was 0.797 and 0.784， respectively. The results of Hosmer-Lemeshow goodness-of-fit test showed that the model fitted well （all P>0.5）. ConclusionThe neuroimaging features extracted from the cerebral oxygen saturation data monitored by fNIRS are significantly correlated with the risk of POD in elderly patients undergoing joint replacement during perioperative period. Among them， the low connectivity of preoperative RS1-RM1 and LFP-RBA44 brain network channels is an important influencing factor of POD occurrence. Predicting the occurrence of POD based on fNIRS is conducive to the early intervention and risk reduction of perioperative complications， improving medical quality and promoting precision medical practice.

Objective:To integrate the best available evidence regarding the management of perinatal intraventricular hemorrhage (IVH) in preterm infants.Methods:Using keywords such as "intracranial hemorrhage", "intraventricular hemorrhage", "germinal matrix hemorrhage", and their Chinese equivalents, we systematically searched for clinical decisions, guidelines, expert consensuses, evidence summaries, group standards, systematic reviews, and meta-analyses related to IVH management in preterm infants. Data sources included BMJ Best Practice, UpToDate, World Health Organization website, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, National Guideline Clearinghouse, American Academy of Pediatrics, Canadian Paediatric Society, European Foundation for the Care of Newborn Infants, British Association of Perinatal Medicine, Yiigle, Cochrane Library, Joanna Briggs Institute, PubMed, Web of Science, CINAHL, MEDLINE, Embase, China National Knowledge Infrastructure, Wanfang Data, and SinoMed. The search period spanned from January 2015 to December 2024. Literature screening, quality appraisal, evidence extraction, and synthesis were performed independently according to uniform standards.Results:A total of 12 publications were included, comprising three clinical decisions, three evidence-based guidelines, and six expert consensuses. Thirty-seven best evidence statements were synthesized across four domains: risk factor identification, diagnosis and monitoring, antenatal and delivery room management, and neonatal intensive care unit management. These included 28 strong recommendations (Grade A) and nine weak recommendations (Grade B).Conclusion:The 37 summarized best evidence statements provide an evidence-based foundation for developing clinical management protocols for perinatal IVH in preterm infants.

Objective:To integrate the best available evidence regarding the management of perinatal intraventricular hemorrhage (IVH) in preterm infants.Methods:Using keywords such as "intracranial hemorrhage", "intraventricular hemorrhage", "germinal matrix hemorrhage", and their Chinese equivalents, we systematically searched for clinical decisions, guidelines, expert consensuses, evidence summaries, group standards, systematic reviews, and meta-analyses related to IVH management in preterm infants. Data sources included BMJ Best Practice, UpToDate, World Health Organization website, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, National Guideline Clearinghouse, American Academy of Pediatrics, Canadian Paediatric Society, European Foundation for the Care of Newborn Infants, British Association of Perinatal Medicine, Yiigle, Cochrane Library, Joanna Briggs Institute, PubMed, Web of Science, CINAHL, MEDLINE, Embase, China National Knowledge Infrastructure, Wanfang Data, and SinoMed. The search period spanned from January 2015 to December 2024. Literature screening, quality appraisal, evidence extraction, and synthesis were performed independently according to uniform standards.Results:A total of 12 publications were included, comprising three clinical decisions, three evidence-based guidelines, and six expert consensuses. Thirty-seven best evidence statements were synthesized across four domains: risk factor identification, diagnosis and monitoring, antenatal and delivery room management, and neonatal intensive care unit management. These included 28 strong recommendations (Grade A) and nine weak recommendations (Grade B).Conclusion:The 37 summarized best evidence statements provide an evidence-based foundation for developing clinical management protocols for perinatal IVH in preterm infants.

Objective: To investigate the effect of glycogen synthase kinase 3 β ( GSK-3 β) and its correlation with microtubule-associated protein 2 (MAP2) during cerebral hypoxia / reoxygenation (H / R) in zebrafish． Methods: The cerebral hypoxia / reoxygenation model of zebrafish was established．Healthy adult zebrafishes of the same size were divided into control group ( Control) ，hypoxia / reoxygenation group ( H / R) and hypoxia / reoxygenation + GSK-3 β inhibitor group (H / R + TDZD-8) for experiment．The brain tissues of zebrafish in each group were selected to determine the mRNA expressions of hypoxia inducible factor 1 αa and 1 αb (HiF-1αa and HIF-1 αb) at different reoxygenation time points by qRT-PCR , and the protein expression levels of HIF-1α , GSK-3 β , p-GSK-3 β (Ser 9) and MAP2 were detected by Western blot，TTC staining and TUNEL staining were used to detect cerebral infarction area and cell apoptosis ，and immunofluorescence was used to detect the distribution and expression of MAP2 in brain. Results: Compared with Control group，the mRNA levels of Hif-1αa and Hif-1 αb(P＜0. 01) and protein expression of Hif-1 α(P＜0. 01) increased in H / R group，the area of cerebral infarction (P ＜0. 01) and apoptotic cells(P ＜0. 01) increased，p-GSK-3 β ( Ser 9) / GSK-3 β ratio，MAP2 protein expression (P ＜0. 05) and immunofluorescence expression of MAP2 (P ＜0. 01 ) reduced ; Furthermore，TDZD-8 pretreatment could relieve the brain injury of H / R zebrafish by decreasing the infarct size and cell apoptosis，improving the ratio of p-GSK-3 β ( Ser 9 ) / GSK-3 β , and increasing the expression of MAP2． Conclusion Hypoxia / reoxygenation can cause brain neuron damage in zebrafish，and its mechanism may be related to inhibition of GSK-3 β phosphorylation and MAP2 expression．GSK-3 β specific inhibitor TDZD-8 can reverse the damage of brain neurons caused by hypoxia / reoxygenation by promoting the expression of P-GSK-3 β (Ser 9) and reducing MAP2 degradation.

In view of the problems existing in the traditional class of Advanced Nursing Practice for nursing masters and the learning characteristics of students, under the guidance of process orientated guided inquiry learning (POGIL) theory, with the medium of information technology, centered on the cultivation of students' clinical practice with different specialties of nursing practice as the carrier, the autonomous online teaching mode of teaching and learning is fully integrated into the teaching process. That has been adopted in the teaching of Advanced Nursing Practice for nursing students in grade 2019 of Nanjing Medical University. As a result, autonomous teaching and learning guided by POGIL theory can improve students' clinical nursing practice ability, critical thinking ability, problem-solving ability, communication and cooperation ability, thus achieving the teaching goal of this course.

Objective To investigate the exposure to stroke risk factors, the proportion of high?risk individuals, and the relationship between risk factor exposure and impaired cerebrovascular hemodynamics in patients at Pu'er People's Hospital. Methods Between April 2014 and June 2017, this study enrolled inpatients and outpatients of the neurology department of Pu'er People's Hospital who underwent cerebrovascular hemodynamic examinations to evaluate stroke risk. A total of 30 103 (12 793 males and 17 310 females) participants aged 22 to 99 (53.3±14.5) years were included. The distribution of exposure rates for stroke risk factors and proportion of high?risk individuals were determined according to age and sex. The relationships between integral scores of cerebrovascular hemodynamics and exposure to risk factors were also analyzed. Results Exposure rates for risk factors of hypertension, dyslipidemia, diabetes, heart disease, stroke family history, cigarette smoking, alcohol drinking, and overweight or obesity in males were 36.6%, 11.4%, 8.8%, 5.9%, 7.0%, 41.6%, 37.8%, and 51.4%, respectively. The exposure rates in females were 31.2%, 11.3%, 7.6%, 5.5%, 6.8%, 0.7%, 1.6%, and 48.8%, respectively. Differences between age groups for all risk factors were significant (P<0.01). Exposure rates for hypertension, diabetes, cigarette smoking, alcohol drinking, and overweight or obesity in males were significantly higher than in females (P<0.01). High?risk males and females accounted for 41.8% and 35.6% (χ2=119.82, P<0.01) and the rates in both groups increased significantly with age (χ2=1 838.2, 2 881.5, P<0.01). Risk factors including age, hypertension, dyslipidemia, diabetes, heart disease, stroke family history, alcohol drinking, and body mass index were independent predictors of increased individual risk of stroke. Conclusions Exposure levels for stroke risk factors and the proportion of individuals at high risk of stroke were relatively high in the hospital population. Cerebrovascular dysfunction is closely related to exposure to common risk factors for stroke.

Objective To explore the relationship between serum albumin (ALB) combined with red blood cell distribution width (RDW) in progression and prognosis of children with heart failure. Method A total of 144 children with heart failure were divided into light, medium, and heavy group according to the modified ROSS score; another aspect, they also were divided into survival group and death group. ALB, RDW, and modified ROSS score were measured to assess the relationship between the factors and the death by logistic regression analysis. Results There are 73 boys and 71 girls. The cases of mild, moderate, and severe group were 78, 39, and 27, respectively. Age and gender difference in three groups were not statistically significant (P>0.05). The ratio of high RDW was 54.86% (79/144), the ratio of low serum ALB was 33.33% (48/144). Chi-square analysis indicated that a severer status of the disease correlated with a lower ALB level (P <0.05) and a higher RDW. The analysis of rank correlation indicating the degree of heart failure was negatively correlated with the related trends of ALB and RDW (P<0.05). Logistic regression analysis indicating a higher risk of death of the disease correlated with a lower ALB level (P<0.05, OR=0.839)and a higher modified ROSS score(P<0.05,OR=1.324).Conclusions The ALB,RDW,and the modified ROSS score are closely related to the severity in heart failure children. The ALB and the modified ROSS score have important clinical prognostic significance in evaluating the prognosis.

Objective To investigate the difference between Han nationality residents and the Hani nationality residents in southern Yunnan about the effects of stroke risk factors on cerebral vascular hemodynamic indicators.Methods In the cohort crowds,Hani nationality outpatient patients were selected as the Hani nationality group,the Han nationality outpatient patients with the same gender and similar age were randomly selected as the Han nationality group with the ratio of nearly 1 ∶ 3.The risk factors of stroke and the differences of the hemodynamic indicators were compared between the two groups.Results The dyslipidemia proportion of the Hani nationality group was lower than that of the Han nationality group [48 cases (11.5 ％) vs.257 cases (17.5 ％),x2 =8.867,P =0.003],and the drinking proportion of the Hani nationality group was higher than that of the Han nationality group [79 cases (18.9％) vs.214 cases(14.6％),x2 =4.498,P =0.034],the other risk factors exposure rates had no statistically significant differences between the two groups (all P ＞ 0.05).The ratio of numbers of cerebral vascular hemodynamic indicators below 75 points(optimum truncation points) in the Hani nationality group and the Han nationality group were 30.3％ and 31.9％,respectively,the proportion of the two groups of integral value distribution had statistically significant difference (x2 =12.614,P ＜ 0.01);Vmean (left:t =0.632,P =0.527;right:t =0.642,P =0.532),Vmin (left:t =-0.349,P =0.727;right:t =-0.540,P =0.589),Wv(left:t =0.297,P =0.767;right:t =1.119,P =0.263),Zcv(left:t =0.297,P =0.767;right:t =1.247,P =0.213),Rv(left:t =0.837,P =0.403;right:t =1.222,P =0.222),DR(left:t =0.720,P =0.482;right:t =0.396,P =0.692),Cp(left:t =0.614,P =0.539;right:t =1.486,P =0.138) and other indicators of the two groups had no statistically significant differences.Conclusion The Hani nationality residents'stroke risk factors and CVHI integral distribution in different age groups are different from Han people in southern Yunnan.

Objective To explore the association of synovial fluid vasoactive intestinal peptide levels with cartilage damage,radiological changes and symptomatic severity in patients with ankle post-traumatic osteoarthritis. Methods 74 patients with ankle traumatic osteoarthritis undergoing ankle anthroscopic debridement or joint replacement and 69 healthy controls receiving body check were enrolled in the this study. Serum and synovial fluid VIP concentrations were measured by a special radioimmunoassay method. Cartilage degradation biomarker colla-gen type Ⅱ(CTX-II)and inflammatory marker interleukin-6 were determined by enzyme-linked immunosorbent assay (ELISA). The symptomatic and functional severity was evaluated using Teeny & Wiss and AOFAS ankle-hindfoot rating scale. The radiographic progression of PTAOA was identified according to the modified ankle osteoar-thritis Kellgren-Lawrence (K-L) grading system. The mankin score was used for assessing the histopathological severity for cartilage lesions. Receiver operating characteristic (ROC) curve was conducted and the area under curve(AUC)was used to evaluate the diagnostic value of VIP,IL-6 and CTX-II levels for the prediction of the modified K-L grading by comparing with other biomarkers. Results There were no significant differences in serum VIP levels between PTAOA patients and controls. VIP levels in synovial fluid showed a negative correlation with modified ankle K-L grading,Mankin scores,CTX-Ⅱand IL-6. In addition,VIP levels were also positively associated with Teeny&Wiss and AOFAS ankle-hindfoot scores. The AUC area of VIP was similar to CTX-Ⅱat early stage of the disease. Conclusions Synovial fluid VIP levels show an independent and negative correlation with disease severity in patients with PTAOA. Low level of VIP in SF can be used as a potential biomarker for reflecting disease progression.

Objective To explore the effects of Bcl-2 and BaK gene silencing on cell apoptosis ,osteogen-esis activity and free Ca2+concentration of MG-63 cell lines. Methods The siRNA sequences targeted Bcl-2 and BaK respectively were designed;Bcl-2 and BaK silencing adenovirus vector scramble RNA vector and empty vec-tor were constructed to transfect MG-63 cell lines. MTT method was used to examine cell viability;ALP and flow cytometry were conducted to observe osteogenesis activity and free Ca2+concentration. Results Bcl-2 gene silenc-ing decreased cell viability,reduced osteogenesis activity and increased free Ca2+ concentration when compared with controls but BaK gene silencing had the opposite effects. The effect of Bcl-2+BaK gene silencing on cell was similar to the empty control. Conclusions Cell apoptosis,osteogenesis activity and free Ca2+concentration of MG-63 change following Bcl-2 and BaK gene silencing,implicating their roles in osteoporosis.