Iron is indispensable for the viablility of nearly all living organisms, and it is imperative for cells, tissues, and organisms to acquire this essential metal sufficiently and maintain its metabolic stability for survival. Disruption of iron homeostasis can lead to the development of various diseases. There is a robust connection between iron metabolism and infection, immunity, inflammation, and aging, suggesting that disorders in iron metabolism may contribute to the pathogenesis of arthritis. Numerous studies have focused on the significant role of iron metabolism in the development of arthritis and its potential for targeted drug therapy. Targeting iron metabolism offers a promising approach for individualized treatment of arthritis. Therefore, this review aimed to investigate the mechanisms by which the body maintains iron metabolism and the impacts of iron and iron metabolism disorders on arthritis. Furthermore, this review aimed to identify potential therapeutic targets and active substances related to iron metabolism, which could provide promising research directions in this field.

Objective To establish a regression equation for risk factors of refeeding syndrome (RFS) in critically ill elderly patients and analyze the relevant intervention measures. Methods Clinical materials of 154 critically ill elderly patients treated in Intensive Care Unit (ICU) from January 2021 to March 2023 were retrospectively analyzed, and they were divided into RFS group (n=51) and non-RFS group (n=103) according to incidence condition of RFS. The influencing factors of RFS were analyzed by Logistic regression model; the predictive values of predictors for RFS were analyzed by receiver operating characteristic (ROC) curve; the relevant Logistic regression equations were constructed and verified, and relevant nursing interventions were formulated. Results The incidence of RFS in critically ill elderly patients was correlated with the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, the Nutritional Risk Screening 2002 (NRS2002) score, invasive mechanical ventilation, fasting time before feeding, D-dimer level, nutritional intake methods, and pre-feeding blood phosphorus, potassium and magnesium levels (P < 0.05). Logistic regression analysis showed that APACHE Ⅱ score, NRS2002 score, nutrient intake methods and pre-feeding blood phosphorus and potassium levels were the independent risk factors of RFS in critically ill elderly patients (P < 0.05). The ROC curve results showed that the values of area under the curve (AUC) of APACHE Ⅱ score, NRS2002 score, nutritional intake methods, pre-feeding blood phosphorus and potassium levels, and the combined predictor in predicting the incidence of RFS in critically ill elderly patients were 0.754, 0.723, 0.707, 0.783, 0.774 and 0.859, respectively (P < 0.05). The Logistic regression equation for RFS was as follow: L=0.085×APACHE Ⅱ score-0.337×NRS 2002 score+0.537×nutrient intake methods-0.776×pre-feeding blood phosphorus level-0.207×pre-feeding blood potassium level+0.942. The predictive value of this equation was good, and targeted nursing interventions could be formulated based on this equation. Conclusion The regression equation of risk factors can be used for clinical prediction of the RFS risk in critically ill elderly patients, and clinical nursing interventions can be formulated based on the regression equation to prevent the occurrence of RFS.

Objective:To investigate epidemiological and clinical characteristics of botulism, and the adverse events among those received botulinum antitoxin treatment.Methods:Patients with discharge diagnosis as botulism in the Second Affiliated Hospital of Xinjiang Medical University were enrolled between 2017 and 2021. The epidemiological and clinical characteristics were evaluated. Infection and mechanical ventilation as in-hospital outcomes according to baseline characteristics were analyzed. Patients with and without the interested outcomes were compared. The adverse outcomes among those received botulinum antitoxin treatment were investigated. Those with and without the adverse outcomes were also compared.Results:Sixty-seven cases of botulism were enrolled, and most cases got sick between January and March (32/67, 47.8%); among them 62 cases were Han ethnicity (92.5%); prevalence was highest in Aksu region (15/67, 22.4%); commonly seen symptoms and signs included fatigue (58/67, 86.6%), dysphagia (48/67, 71.6%), dizziness (42/67, 62.7%), ptosis (42/67, 62.7%), blurred vision (41/67, 61.2%), and limb weakness (35/67, 52.2%). Compared with patients without in-hospital infection ( n=52), patients with in-hospital infection ( n=15) were more likely to have severe botulism (0/52 vs 5/15, χ 2=19.79, P<0.001), diplopia (16/52, 30.8% vs 11/15, χ 2=8.77, P=0.003), dysarthria (17/52, 32.7% vs 11/15, χ 2=7.91, P=0.005), consciousness disorder (1/52, 1.9% vs 4/15, χ 2=10.32, P=0.008). Compared with patients without mechanical ventilation (62/67, 92.5%), patients with mechanical ventilation (5/67, 7.5%) were more likely to have severe botulism (5/5 vs 0/62, χ 2=41.17, P<0.001), and consciousness disorder (4/5 vs 1/62, 1.6%, χ 2=29.58, P<0.001). Among 67 cases of botulism, 19 cases (28.4%) had adverse events after receiving antitoxin treatment, with an average of 6.5 days from the antitoxin treatment beginning to the adverse event onset; among the 19 cases, 18 cases (94.7%) had rash. Age, sex, and severity did not differ between the groups with ( n=19) and without adverse events ( n=48) after receiving antitoxin treatment. Conclusions:Fatigue, dysphagia, dizziness, ptosis were the most frequent symptoms and signs in the botulism in Xinjiang Uygur Autonomous Region, China. Infection was a commonly seen complication of botulism, and proactive prevention and close monitoring were needed. Adverse events after receiving antitoxin were prevalent, and might not be associated with age, sex, and severity of botulism.

Objective:To investigate the factors associated with delay in anticoagulant therapy in patients with cerebral venous sinus thrombosis (CVST) and its effect on outcome.Methods:Patients with CVST admitted to Changhai Hospital, Naval Medical University from January 2010 to August 2021 were retrospectively enrolled. Patients were divided into early anticoagulation group and late anticoagulation group by the median time interval from first symptom to initiation of anticoagulation. The modified Rankin Scale was used for outcome assessment at 90 d after onset. 0-2 scores were defined as good outcome and 3-6 were defined as poor outcome. Demographic and clinical data were compared for the early versus late anticoagulation group and for the good versus poor outcome groups. Multivariable logistic regression was used to identify independent influencing factors of delay in anticoagulation and the correlation of delay in anticoagulation with poor outcome. Results:A total of 131 patients were included, their age was 40.07±15.11 years old, and 68 (51.91%) were male. Of these, 65 patients (49.62%) were in the early anticoagulation group and 14 (10.69%) were in the poor outcome group. Compared with the late anticoagulation group, the early anticoagulation group had a significantly higher proportion of patients with seizures and brain parenchymal damage as well as higher D-dimer levels on admission, while the proportion of patients with visual impairment/papilloedema was significantly lower (all P<0.05). Compared with the good outcome group, the poor outcome group had significantly higher proportions of patients with seizures, dyskinesia, impaired consciousness, low Glasgow Coma Scale score, and brain parenchymal damage as well as higher D-dimer, total cholesterol and low density lipoprotein cholesterol levels, sites of thrombus involvement were more common in the superior sagittal and straight sinuses, and significantly lower proportions of patients with headache and lower albumin levels on admission (all P<0.05). Multivariate logistic regression analysis showed that visual impairment/papilloedema (odds ratio [ OR] 0.119, 95% confidence interval [ CI] 0.030-0.473; P=0.002) and brain parenchymal damage ( OR 1.341, 95% CI 1.042-1.727; P=0.023) were independently associated with a delay in anticoagulation treatment, and a delay in anticoagulation treatment ( OR 6.102, 95% CI 1.185-30.504; P=0.030) and D-dimer level on admission ( OR 1.299, 95% CI 1.141-1.480; P<0.001) were the independent predictors of poor outcome in patients with CVST. Conclusions:Visual impairment/papilloedema and absence of brain parenchymal damage on cranial imaging are the independent risk factors for delay in anticoagulation in patients with CVST. The delay in anticoagulation is strongly associated with the poor outcome in patients with CVST.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective:Establishment of a new model of human primary colon cancer transplantation tumor in normal immune mice and to provide a reliable experimental animal model for studying the pathogenesis of colon cancer under normal immunity.Methods:Human colon cancer cells come from colon cancer patients who underwent surgery in the Affiliated Hospital of Jining Medical College in 2017. The mice in the cell control group were inoculated with phosphate buffered solution (PBS) containing colon cancer cells, the microcarrier control group was inoculated with PBS containing microcarrier 6, and the cell-microcarrier complex group was inoculated with the PBS containing colon cancer cell-microcarrier complex. The cells of each group were inoculated under the skin of the right axilla of mice by subcutaneous injection, and the time, size, tumor formation rate and pathological changes under microscope were recorded. The transplanted tumor tissue was immunohistochemically stained with the EnVisiion two-step method, and the tumor formation rate of the transplanted tumor was judged according to the proportion of positive cells in the visual field. The polymerase chain reaction (PCR) method was used to detect the expression of human-specific Alu sequence in mice tumor tissue.Results:After inoculation with tumor cells, the mice in the cell control group and the microcarrier control group did not die and did not form tumors; the mice in the cell-microcarrier complex group had palpable subcutaneous tumors in the right axillary subcutaneously on the 5th to 7th days after inoculation, and tumor formation rate is 67% (10/15), and the tumor volume can reach about 500 mm 3 2 to 3 weeks after vaccination. The immunohistochemistry results showed that CK20, CDX-2 and carcinoembryonic antigen were all positively expressed. The PCR results showed that the expression of human-specific Alu sequence can be detected in the transplanted tumor tissue of tumor-bearing mice. Conclusion:Human primary colon cancer cells used microcarrier 6 as a carrier to form tumors in normal immunized mice, and successfully established a new model of human colon cancer transplantation tumor in normal immune mice.

Objective:Establishment of a new model of human primary colon cancer transplantation tumor in normal immune mice and to provide a reliable experimental animal model for studying the pathogenesis of colon cancer under normal immunity.Methods:Human colon cancer cells come from colon cancer patients who underwent surgery in the Affiliated Hospital of Jining Medical College in 2017. The mice in the cell control group were inoculated with phosphate buffered solution (PBS) containing colon cancer cells, the microcarrier control group was inoculated with PBS containing microcarrier 6, and the cell-microcarrier complex group was inoculated with the PBS containing colon cancer cell-microcarrier complex. The cells of each group were inoculated under the skin of the right axilla of mice by subcutaneous injection, and the time, size, tumor formation rate and pathological changes under microscope were recorded. The transplanted tumor tissue was immunohistochemically stained with the EnVisiion two-step method, and the tumor formation rate of the transplanted tumor was judged according to the proportion of positive cells in the visual field. The polymerase chain reaction (PCR) method was used to detect the expression of human-specific Alu sequence in mice tumor tissue.Results:After inoculation with tumor cells, the mice in the cell control group and the microcarrier control group did not die and did not form tumors; the mice in the cell-microcarrier complex group had palpable subcutaneous tumors in the right axillary subcutaneously on the 5th to 7th days after inoculation, and tumor formation rate is 67% (10/15), and the tumor volume can reach about 500 mm 3 2 to 3 weeks after vaccination. The immunohistochemistry results showed that CK20, CDX-2 and carcinoembryonic antigen were all positively expressed. The PCR results showed that the expression of human-specific Alu sequence can be detected in the transplanted tumor tissue of tumor-bearing mice. Conclusion:Human primary colon cancer cells used microcarrier 6 as a carrier to form tumors in normal immunized mice, and successfully established a new model of human colon cancer transplantation tumor in normal immune mice.

Objective:To investigate the characteristics of subtype diversity and transmission on HIV-1 among 12 to 30 years old student MSM in Zhejiang province.Methods:A total of 290 newly diagnosed HIV infected student MSM were selected as the research objects for molecular studies on HIV, in Zhejiang province during 2013 to 2015. Data on epidemiology and plasma samples of these people were collected. HIV-1 nucleotide sequences of pol gene regions were amplified using the RT-PCR/nested PCR method and sequenced. Phylogenetic analysis was performed to determine the HIV-1 genotypes. Characteristics of transmission mode among these cases were also analyzed. Results:A total of 290 cases, 50.3 % were diagnosed in Hangzhou and 81.0 % had college or above degrees. 178 sequences including 10 subtypes, were obtained, with the main subtypes as CRF01_AE (49.4 %, 88/178) and CRF07_BC (39.3 %, 70/178). A total of 18 molecular transmission clusters were formed (42 cases, cluster size from 2 to 4), with the proportions of clusters as 23.6 % (42/178). 61.9 % (26/42) of student MSM with their schools located in the same district within the transmission clusters. Their sexual partners would include both student MSM and non-student MSM. The proportion of clusters among middle school students was 38.2 % (13/34), higher than that of college students (20.1 %, 29/144) ( χ2=4.996, P<0.05). Conclusions:The HIV-1 subtypes of student MSM in Zhejiang province appeared diversity, which indicated with the diversity of sources of infection. The geographical distribution of cluster cases is relatively centralized. In order to effectively control the spread of AIDS, more attention should be paid to the sexual partners involved and to specific programs on intervention.

Objective To explore the safety and efficacy of localized anatomical segmental resection (LASR) in the treatment of patients with centrally located large hepatocellular carcinoma (HCC). Methods Clinical data of 34 patients with centrally located large HCC underwent LASR in the First Affiliated Hospital of Kunming Medical University between January 2011 and January 2016 were analyzed retrospectively. There were 30 males and 4 females, aged from 36-68 and with a median age of 53 years old. All the patients were with graded A liver function by Child-Pugh Classification, and 31 were complicated with cirrhosis. The informed consents of all patients were obtained and the local ethical committee approval was received. The porta hepatis was dissected first in all patients. The portal vein and left primary and right secondary branches of hepatic artery were suspended respectively. Corresponding vessels were cut off or clamped according to the extent of planned resection, the ischemic line was determined and the liver was resected by ultrasonic scalpel with clamping technique. Results All patients underwent LASR as scheduled, and no perioperative death occurred. The mean length of operation was (233±48) min. The intraoperative blood loss was (304±151) ml. Four patients received blood transfusion during the operation. The postoperative overall incidence of complications was 24%(8/34), including 1 case of liver failure who was cured with conservative treatments. All patients were followed up for 12-60 months, during which recurrence or metastasis occurred in 24 patients. The median disease-free survival time was 29 months, and the 1, 5-year overall survival was 83% and 45%. Conclusions LASR is safe and effective in the treatment of patients with centrally located large HCC, especially for patients with cirrhosis, and it can reduce the incidence of liver failure and operative mortality.

Objective To explore the effect of the clinical case oriented management model on nurses comprehensive ability, psychological and critical mind. Methods In 2014 on the implementation ofroutine clinical case management modelas the control group, collected 97 cases of clinical cases. In 2015 on the implementation ofthe clinical case oriented management modelas the observation group, collected 110 cases of clinical cases. Compared two methods of management to improve the nurse management theoretical knowledge, clinical practice ability and deal with the size of the case skills help. When/after clinical special case found the influence for nurses, including psychology, work in the nursing work will, enthusiasm, independent ability to deal with related cases and the nurse critical thinking ability, etc. Results The proportion of the nurses thought that it was helpful to improve the management of theoretical knowledge, clinical practice ability and deal with the size of the case skills and the case analysis of satisfaction were 98.79%(244/247), 99.19%(245/247), 98.79%(244/247), 99.60%(246/247) in the observation group, and 88.57%(217/245), 87.35%(214/245), 87.76%(215/245), 90.61%(222/245) in the control group. The differences were statistically significant (χ2=21.390-27.571, P < 0.01). The proportion of the nurse considered that special case on the psychological effects of nursing work, engaged in the willingness and enthusiasm were the main factor were 15.79%(39/247), 13.77%(34/247), 11.34%(28/247) in the observation group, and 31.84%(78/245), 31.02%(76/245), 30.61%(75/245) in the control group. The differences were statistically significant (χ2=17.475, 21.097, 27.611, P < 0.01). After special case, the percentage of nurses to independently handle the case, help others, loss rates were 97.57%(241/247), 2.02% (5/247), 0.40% (1/247) in the observation group, and 85.71% (210/245), 12.24% (30/245), 2.04% (5/245) in the control group. The proportion of nurses to independently handle the case in the observation group was higher than that in the control group, but the ratio of nurses to help others, loss rates in the observation group were lower than those in the control group, the differences were statistically significant (χ2=22.647, P<0.01).Critical thinking score, the observation group of nurses in the search for truth, open mind, analytical ability, system organization, judging thinking self-confidence, curiosity, cognitive maturity, such as total score were respectively (43.24±4.01), (43.03±4.12), (47.66±4.23), (44.21± 3.92), (44.00 ± 4.97), (52.13 ± 4.44), (48.23 ± 4.85), (319 ± 14.57) points. The control group nurses were respectively (39.00±3.56), (38.90±3.28), (43.65±2.47), (40.55±1.99), (39.00±3.40), (47.87±4.01), (41.89± 5.11), (292.23 ± 6.02) points. The differences were statistically significant(t =12.15-24.19, P < 0.01). Conclusions The clinical case oriented management model can improve nurses comprehensive ability, reduce the adverse impact of the special case for nurses, improve the clinical nurses' critical thinking ability, to ensure patient safety.