AIM:To explore the role and mechanism of calcium-sensing receptor(CaSR)in regulating macro-phage polarization in hypertensive rats.METHODS:Male spontaneously hypertensive rats(SHR)and Wistar-Kyoto(WKY)rats were categorized into WKY group,SHR group,SHR+R568(CaSR agonist)group,and SHR+NPS2143(CaSR inhibitor)group.The thoracic aorta was isolated,and the expression of CaSR and macrophage polarization markers in the aorta was observed through immunofluorescence staining.The primary peritoneal macrophages of SHR and WKY rats were aseptically extracted following anesthesia.After intervention with R568 and NPS2143,the expression levels of M1 and M2 markers of peritoneal macrophages were observed by Western blot and immunofluorescence staining.The levels of interleukin(IL)-1β and IL-10 were measured by ELISA.The concentration of Ca2+in peritoneal macrophages was mea-sured by immunofluorescence.Western blot was employed to identify the expression of CaSR and nucleotide-binding oligo-merization domain-like receptor protein 3(NLRP3)inflammasome components.Following anesthesia,vascular smooth muscle cells(VSMCs)were isolated from SHR using an adherent method.Subsequently,a co-culture system was estab-lished with macrophage supernatant.The optimal action time for this co-culture system was determined through CCK-8 as-say.RESULTS:Compared with SHR group,activation of CaSR resulted in a significant decrease in the protein expres-sion of M1 polarization markers(P<0.05)and a concomitant increase in the protein expression of M2 polarization markers in the aorta(P<0.05).Compared with SHR group,administration of R568 led to a significant decrease in the protein ex-pression of M1 polarization markers(P<0.05)and a concomitant increase in the protein expression of M2 polarization markers(P<0.05)in peritoneal macrophages.Additionally,there was a notable reduction in the protein levels of NLRP3 inflammasome components(P<0.05).Furthermore,the fluorescence intensity of intracellular Ca2+was significantly en-hanced following R568 treatment(P<0.05).After administration of MCC950,an NLRP3 inflammasome inhibitor,the re-sults were consistent with those observed following R568 treatment,demonstrating statistical significance(P<0.05).This effect was reversed by the combined intervention of U73122,a phospholipase C(PLC)inhibitor(P<0.05).Compared with the control(0 h),the 24-h peritoneal macrophage supernatant exhibited the strongest capacity to enhance the viabili-ty of VSMCs after 24 h of culture(P<0.05).CONCLUSION:In hypertensive rats,the CaSR inhibits NLRP3 inflamma-some activation via the PLC-Ca2+signaling pathway,thereby mediating an increase in macrophage polarization towards the M2 phenotype and a decrease towards the M1 phenotype.

Objective To develop a Discharge Readiness Scale for Patients with PICC and to test its reliability and validity.Methods Based on the Meleis transition theory,the initial version of the scale was formed through literature review,qualitative interview,expert enquiry and pre-investigation.Patients with PICC in 2 tertiary hospital in Hangzhou from December 2023 to March 2024 were selected to investigate the reliability and validity of the scale by convenience sampling.Results 352 questionnaires were distributed,and 340 valid questionnaires were recovered,and the validity recovery rate was 96.59％.The exploratory factor analysis extracted 4 common factors with the cumulative variance contribution rate of 80.568％.The confirmatory factor analysis showed that all evaluation indicators of the scale were within ideal standards.The item-level content validity index ranged from 0.79 to 1.00,and the scale-level content validity index was 0.96.The total Cronbach's α coefficient of the scale was 0.963,and the split-half reliability coefficient was 0.889.The Chinese version of the Discharge Readiness Scale was used as a calibration tool,and the correlation coefficients between the total score of the scale and the scores of each dimension and the calibration tool were 0.788 and 0.567～0.878,respectively(all P＜0.05).The Discharge Readiness Scale for Patients with PICC included 26 items in 4 dimensions including physiological and psychological status,knowledge of catheter maintenance,catheter maintenance capability and social support.Conclusion The Discharge Readiness Scale for Patients with PICC has good reliability and validity,and can be used to evaluate the level of discharge readiness among patients with PICC.

Objective To develop a Discharge Readiness Scale for Patients with PICC and to test its reliability and validity.Methods Based on the Meleis transition theory,the initial version of the scale was formed through literature review,qualitative interview,expert enquiry and pre-investigation.Patients with PICC in 2 tertiary hospital in Hangzhou from December 2023 to March 2024 were selected to investigate the reliability and validity of the scale by convenience sampling.Results 352 questionnaires were distributed,and 340 valid questionnaires were recovered,and the validity recovery rate was 96.59％.The exploratory factor analysis extracted 4 common factors with the cumulative variance contribution rate of 80.568％.The confirmatory factor analysis showed that all evaluation indicators of the scale were within ideal standards.The item-level content validity index ranged from 0.79 to 1.00,and the scale-level content validity index was 0.96.The total Cronbach's α coefficient of the scale was 0.963,and the split-half reliability coefficient was 0.889.The Chinese version of the Discharge Readiness Scale was used as a calibration tool,and the correlation coefficients between the total score of the scale and the scores of each dimension and the calibration tool were 0.788 and 0.567～0.878,respectively(all P＜0.05).The Discharge Readiness Scale for Patients with PICC included 26 items in 4 dimensions including physiological and psychological status,knowledge of catheter maintenance,catheter maintenance capability and social support.Conclusion The Discharge Readiness Scale for Patients with PICC has good reliability and validity,and can be used to evaluate the level of discharge readiness among patients with PICC.

AIM:To explore the role and mechanism of calcium-sensing receptor(CaSR)in regulating macro-phage polarization in hypertensive rats.METHODS:Male spontaneously hypertensive rats(SHR)and Wistar-Kyoto(WKY)rats were categorized into WKY group,SHR group,SHR+R568(CaSR agonist)group,and SHR+NPS2143(CaSR inhibitor)group.The thoracic aorta was isolated,and the expression of CaSR and macrophage polarization markers in the aorta was observed through immunofluorescence staining.The primary peritoneal macrophages of SHR and WKY rats were aseptically extracted following anesthesia.After intervention with R568 and NPS2143,the expression levels of M1 and M2 markers of peritoneal macrophages were observed by Western blot and immunofluorescence staining.The levels of interleukin(IL)-1β and IL-10 were measured by ELISA.The concentration of Ca2+in peritoneal macrophages was mea-sured by immunofluorescence.Western blot was employed to identify the expression of CaSR and nucleotide-binding oligo-merization domain-like receptor protein 3(NLRP3)inflammasome components.Following anesthesia,vascular smooth muscle cells(VSMCs)were isolated from SHR using an adherent method.Subsequently,a co-culture system was estab-lished with macrophage supernatant.The optimal action time for this co-culture system was determined through CCK-8 as-say.RESULTS:Compared with SHR group,activation of CaSR resulted in a significant decrease in the protein expres-sion of M1 polarization markers(P<0.05)and a concomitant increase in the protein expression of M2 polarization markers in the aorta(P<0.05).Compared with SHR group,administration of R568 led to a significant decrease in the protein ex-pression of M1 polarization markers(P<0.05)and a concomitant increase in the protein expression of M2 polarization markers(P<0.05)in peritoneal macrophages.Additionally,there was a notable reduction in the protein levels of NLRP3 inflammasome components(P<0.05).Furthermore,the fluorescence intensity of intracellular Ca2+was significantly en-hanced following R568 treatment(P<0.05).After administration of MCC950,an NLRP3 inflammasome inhibitor,the re-sults were consistent with those observed following R568 treatment,demonstrating statistical significance(P<0.05).This effect was reversed by the combined intervention of U73122,a phospholipase C(PLC)inhibitor(P<0.05).Compared with the control(0 h),the 24-h peritoneal macrophage supernatant exhibited the strongest capacity to enhance the viabili-ty of VSMCs after 24 h of culture(P<0.05).CONCLUSION:In hypertensive rats,the CaSR inhibits NLRP3 inflamma-some activation via the PLC-Ca2+signaling pathway,thereby mediating an increase in macrophage polarization towards the M2 phenotype and a decrease towards the M1 phenotype.

Objective To analyzes the current status and hot spots of nursing of adverse drug reactions in chemotherapy for cancer patients,and provides reference for future research.Methods Literature related to the nursing of chemotherapy adverse drug reactions in cancer patients from 2018 to 2022 was retrieved from CNKI,Wanfang and VIP databases,and statistical analysis was conducted using bibliometrics.CiteSpace information visualization software was used to describe and analyze high-frequency keywords and to describe their graphs.Results A total of 1112 literatures were included,distributed in 256 domestic journals,and 537 literatures were co-authored,with a co-authored rate of 48.29％.Gastrointestinal reaction,cancer-induced fatigue,traditional Chinese medicine nursing,evidence-based nursing,negative emotion are the hot issues in this field.Conclusion The future nursing intervention for adverse reactions of cancer patients should adopt evidence-based nursing method to develop intervention programs.The research in this field has the problems of small sample size and single institution.It is suggested that the cooperation between authors and institutions should be strengthened in the future research,so as to build a closer cooperation network and a stable cooperation group.To construct nursing intervention plan and effect evaluation criteria suitable for nursing of adverse reactions of chemotherapy drugs in cancer patients.To ensure the safety of the intervention process,we should actively carry out multidisciplinary collaboration.

Objective To analyze the hot spots and trends of digital intelligence technology research in intensive care unit(ICU).Methods ICU digital intelligence technology related literature collected in Web of Science core database,China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,VIP Chinese Journal Service Platform were searched,and the retrieval period is from the establishment of the database to December 12,2023,and visualized analysis was performed by CiteSpace software.Results 700 Chinese literatures and 1705 English literatures were included.Conclusion A total of 18 clusters were formed in Chinese literature,including smart phones,data mining,ventricular premature beats,sepsis,etc.A total of 17 clusters were formed in English literature,including deep learning,expert systems,natural language processing,physiological characteristics,etc.Among them,risk prediction model and clinical decision support are the trends of future research.Conclusion By broadening the scope of diseases and populations,joint artificial intelligence research and development of wearable devices and intelligent detection cloud systems,robots,etc.,is the development trend of the future application field of ICU digital intelligence technology.

Objective:To investigate the complications and related etiologies after immediate silicone implant and immediate two-stage tissue expander/implant breast reconstruction.Methods:A retrospective study was conducted in 23 patients who underwent implant or tissue expander/implant breast reconstruction surgery from June 2016 to October 2019. The etiology, medical history and clinical symptoms of each patient were analyzed and related treatments were carried out depending on its complication.Results:All patients were followed up for 3-12 months after surgery. Among the 23 patients, a total of 8 patients had different types of postoperative complications. Partial necrosis of the nipple-areola complex occurred in 1 case, postoperative infection in 2 cases, 2 patients experienced deviation of the implant or tissue expander and displacement of the nipple-areola complex in 3 cases. All complications were treated accordingly, and a good therapeutic effect was finally maintained.Conclusions:For patients with complications after immediate silicone implant and two-stage tissue expander/implant breast reconstruction, treatment should be carried out according to the causes of complications in time. In this way, patient can get better prognosis.

Objective:To analyze the distribution of clopidogrel metabolism-related gene variability in Kawasaki disease (KD) children with coronary artery lesions (CAL) across different age groups and the impact of genetic variability on the efficacy of clopidogrel antiplatelet therapy.Methods:A retrospective cohort study was conducted. Clinical data were collected from 46 KD children with CAL who were hospitalized in the Cardiovascular Center of Children′s Hospital of Fudan University between January 2021 and August 2022 and were treated with clopidogrel, including gender, age, body mass index, course of KD, CAL severity grade, and baseline platelet count. According to their age, the children were divided into ≥2-year-old group and <2-year-old group. Their platelet responsiveness was assessed by adenosine diphosphate-induced platelet inhibition rate (ADPi) calculated via thromboelastography, and children were categorized into high on-treatment platelet reactivity (HTPR) and normal on-treatment platelet reactivity (NTPR) groups. Genotypes of CYP2C19, PON1 and ABCB1 were detected. The t test, one-way analysis of variance and Chi-square test were used for intergroup comparison. Results:Among the 46 KD children with CAL, 34 were male and 12 were female; 37 were ≥2-year-old and 9 were <2-year-old; 25 cases were in the HTPR group and 21 cases were in the NTPR group, with 19 HTPR and 18 NTPR in the ≥2-year-old group, and 6 HTPR and 3 NTPR in the <2-year-old group. Genetic analysis showed that 92 alleles among the 46 children, with frequencies of CYP2C19*1, CYP2C19*2, CYP2C19*3, CYP2C19*17, PON1 192Q, PON1 192R, ABCB1 3435C, ABCB1 3435T at 59% (54/92), 32% (29/92), 9% (8/92), 1% (1/92), 36% (36/92), 64% (59/92), 63% (58/92) and 37% (34/92), respectively. Analysis of the impact of genotype on ADPi revealed that in children aged ≥2 years, those with CYP2C19*1/*3 genotype had significantly lower ADPi than those with CYP2C19*1/*1 genotype ((34±15)% vs. (61±29)%, t=2.18, P=0.036). There were also no significant difference in ADPi among children with PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes ((40±22)% vs. (52±33)% vs. (65±27)%, F=2.17, P=0.130), or among those with ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((55±34)% vs. (60±27)% vs. (49±24)%, F=0.33, P=0.719). In <2-year-old group, there were no significant differences in ADPi across CYP2C19*1/*1, CYP2C19*1/*2 and CYP2C19*2*2 genotypes ((40±20)% vs. (53±37)% vs. (34±16)%, F=0.37, P>0.05). There were no significant differences in ADPi across CYP2C19*1/*1 and CYP2C19*1/*3 genotypes ((44±27)% vs. (42±20)%, t=0.08, P>0.05). There were no significant differences in ADPi across PON1 192Q homozygous, PON1 192R heterozygote and PON1 192R homozygous genotypes (45% vs. (55±27)% vs. (24±5)%, F=1.83, P>0.05). There were no significant differences in ADPi across ABCB1 3435C homozygous, ABCB1 3435T heterozygote and ABCB1 3435T homozygous genotypes ((36±16)% vs. (50±35)% vs. 45%, F=0.29, P>0.05). The risk analysis of HTPR in different genotypes revealed that in children aged ≥2 years, carrying at least 1 or 2 loss-of-function alleles of CYP2C19 was a risk factor for HTPR ( OR=4.69, 10.00, 95% CI 1.11-19.83, 0.84-119.32, P=0.033, 0.046, respectively), and PON1 192R homozygosity and carrying at least one PON1 192R allele were protective factors against HTPR ( OR=0.08, 0.13, 95% CI 0.01-0.86, 0.01-1.19, P=0.019, 0.043, respectively). Conclusion:KD children aged ≥2 years carrying CYP2C19 loss-of-function alleles and PON1 192Q are more likely to develop HTPR.

Objective To explore the impact of temperature and environmental factors on the risk of deaths from cardiovascular and cerebrovascular diseases (CVD) in Wuhan during the course of high temperature. Methods The daily CVD death data and meteorological and atmospheric pollutant concentration data during the high temperature process in Wuhan from 2014 to 2019 were collected. The generalized additive models (GAM) were used to obtain the characteristics of meteorological factors, atmospheric pollutant concentrations, high impact factors and thresholds affecting the relative risk of CVD death. Results The analysis results showed that: (1) When the maximum temperature reached 36.7°C and the lowest temperature reached 25.3°C, the relative risk of CVD death increased significantly; (2) The risk of CVD death during the first high temperature process was the largest, and the average CVD excess mortality rate during the first high temperature process from 2014 to 2019 reached 21.7%; and (3) The average temperature, maximum temperature and PM₁₀ during the course of high temperature were important environmental factors that increased the risk of CVD deaths, and the relative risks were 1.14 (95% confidence interval (95% CI): 1.11-1.17), 1.11 (95% confidence interval (95% CI): 1.08-1.15, and 1.06 (95% confidence interval (95% CI): 1.02-1.09), respectively. Conclusion Temperature and PM₁₀ are important environmental factors that increase the risk of death from CVD during the high temperature process in Wuhan from 2014 to 2019, with the first annual high temperature process having the greatest impact on the risk of CVD death.

Aggressive angiomyxoma (AAM) is a rare clinical entity. A case of AAM was reported in this paper. The patient presented with severe hydronephrosis of the left kidney and was diagnosed with a pelvic mass compressing the ureter. The patient underwent laparoscopic resection of the pelvic mass. The postoperative pathology and immunohistochemistry confirmed the diagnosis of AAM. The patient had no recurrence and metastasis after 9 months of follow-up.