Clinical death refers to the permanent cessation of life functions. This article reviews the definition of clinical death and the various scenarios in which it occurs, classifies the process of clinical death, and discusses the criteria for determining uncontrollable cardiac death, controllable cardiac death and the criteria and workflow for determining brain death. It elaborates on the relationship between brain death and death, and proposes the areas to note when standardizing the medical documentation of death cases. Based on this, it introduces the content of the management system and workflow construction for death determination in medical institutions, including management structure, personnel qualifications, document norms, quality control system and training mechanism. Paying attention to the construction of the management system and workflow for death determination in medical institutions is of great significance for ensuring medical quality and safety, promoting the healthy development of organ donation, and maintaining the seriousness of legal and ethical practices.

Geraniin, a polyphenol derived from the fruit peel of Nephelium lappaceum L., has been shown to possess anti-inflammatory and antioxidant properties in the cardiovascular system. The present study explored whether geraniin could protect against an isoproterenol (ISO)-induced cardiac hypertrophy model. Mice in the ISO group received an intraperitoneal injection of ISO (5 mg/kg) once daily for 9 days, and the administration group were injected with ISO after 5 days of treatment with geraniin or spironolactone. Potential therapeutic effects and related mechanisms analysed by anatomical coefficients, histopathology, blood biochemical indices, reverse transcription-PCR and immunoblotting. Geraniin decreased the cardiac pathologic remodeling and myocardial fibrosis induced by ISO, as evidenced by the modifications to anatomical coefficients, as well as the reduction in collagen I/III á1mRNA and protein expression and cross-sectional area in hypertrophic cardiac tissue. In addition, geraniin treatment reduced ISO-induced increase in the mRNA and protein expression levels of interleukin (IL)-6, IL-1β and tumor necrosis factor-α, whereas ISO-induced IL-10 showed the opposite behaviour in hypertrophic cardiac tissue.Further analysis showed that geraniin partially reversed the ISO-induced increase in malondialdehyde and nitric oxide, and the ISO-induced decrease in glutathione, superoxide dismutase and glutathione. Furthermore, it suppressed the ISO-induced cellular apoptosis of hypertrophic cardiac tissue, as evidenced by the decrease in Bcell lymphoma-2 (Bcl-2)-associated X/caspase-3/caspase-9 expression, increase in Bcl-2 expression, and decrease in TdT-mediated dUTP nick-end labeling-positive cells.These findings suggest that geraniin can attenuate ISO-induced cardiac hypertrophy by inhibiting inflammation, oxidative stress and cellular apoptosis.

Objective:To explore the mediating effect of intrinsic motivation of nurses between empowering leadership and job performance, with the aim of providing a reference basis for managers to develop a scientific and effective intervention programme to improve nurses′ job performance.Methods:Convenience sampling method was used to select 1 213 clinical nurses from four tertiary general hospitals in Shandong Province, Henan Province, Yunnan Province, and Fujian Province from November to December 2023, and General Information Questionnaire, Empowering Leadership Scale, Intrinsic Motivation Scale, and Job Performance Scale were used to conduct a cross-sectional survey. AMOS26.0 software was used to test the mediating effect of intrinsic motivation of nurses between empowering leadership and job performance.Results:A total of 1 100 nurses completed the survey finally. Among them, there were 58 males and 1 042 females, 474 under 31 years old, 448 between 31-40 years old, and 178 over 40 years old.The total scores of the Empowering Leadership Scale, Intrinsic Motivation Scale, and Job Performance Scale were 49.44 ± 10.04, 82.35 ± 13.54 and 46.27 ± 6.20 in that order. Nurses' job performance were positive correlation with the empowered leadership and intrinsic motivation ( r=0.486, 0.703, both P<0.01), there was a positive correlation between nurse empowerment leadership and intrinsic motivation ( r=0.452, P<0.01). Nurses′ intrinsic motivation partially mediates the relationship between empowering leadership and job performance, accounting for 62.69% of the total effect. Conclusions:Intrinsic motivation of nurses is a mediating variable between empowered leadership and job performance. Nursing managers should focus on nurses' participation in autonomous decision-making to enhance nurses′ sense of competence and meaning at work, and mobilise their motivation to improve job performance.

Objective:To investigate the clinical efficacy of vitamin D as an adjunct to low-dose aspirin on patients with early-onset severe preeclampsia.Methods:A retrospective analysis was conducted on the clinical data of 102 patients with early-onset severe preeclampsia admitted to Zhoushan Women and Children's Hospital from January 2020 to January 2024. Fifty patients admitted for treatment from January 2020 to January 2022 were included in the control group and received low-dose aspirin treatment. Fifty-two patients admitted between February 2022 and January 2024 were included in the observation group and received vitamin D as an adjunct to low-dose aspirin treatment. Both groups were treated for 7 days. Blood pressure, homocysteine, serum 25-hydroxyvitamin D 3, renal function indicators (glomerular filtration rate, 24-hour urine protein quantification), coagulation function indicators (prothrombin time, thrombin time, D-dimer, activated partial thromboplastin time), and pregnancy outcomes were compared between the two groups. Results:After treatment, systolic blood pressure, diastolic blood pressure, homocysteine, 24-hour urine protein quantification, and D-dimer in the observation group were (134.33 ± 6.28) mmHg (1 mmHg = 0.133 kPa), (88.57 ± 5.76) mmHg, (10.65 ± 3.15) μmol/L, (0.59 ± 0.31) g/24 hours, and (0.51 ± 0.32) mg/L, respectively. These values were significantly lower than those in the control group [(142.28 ± 6.04) mmHg, (93.85 ± 5.38) mmHg, (13.15 ± 2.89) μmol/L, (1.28 ± 0.47) g/24 hours, and (0.73 ± 0.49) mg/L, t = 4.17, -10.37, 4.17, 8.79, 2.69, all P < 0.05]. In the observation group, serum 25-hydroxyvitamin D 3 level and glomerular filtration rate were (27.94 ± 6.43) μg/L and (98.65 ± 14.72) mL·min?1·1.73 m?2, respectively. These values were significantly higher than those in the control group [(15.24 ± 5.92) μg/L, (90.19 ± 12.07) mL·min?1·1.73 m?2 ( t = -10.37, -3.18, both P < 0.05). Additionally, in the observation group, prothrombin time, thrombin time, and activated partial thromboplastin time were (12.19 ± 0.53) seconds, (12.19 ± 0.53) seconds, and (0.51 ± 0.32) seconds, respectively. These times were significantly shorter than those in the control group [(13.22 ± 1.15) seconds, (16.94 ± 2.07) seconds, and (34.21 ± 3.93) seconds ( t = 5.85, 4.27, 3.81, all P < 0.05). There was no statistically significant difference in incidence of pregnancy outcomes between the two groups ( P > 0.05). Conclusions:Vitamin D as an adjunct to low-dose aspirin for the treatment of early-onset severe preeclampsia significantly reduces blood pressure, enhances blood circulation, promotes metabolism, improves coagulation function, and aids in the recovery of renal function in patients.

Objective:To investigate the status of leisure crafting and post competence and their correlation among anesthesia specialist nurses.Methods:A convenience sampling method was used to conducted a questionnaire survey on 280 anesthesia specialist nurses at grade A tertiary hospitals in 19 provinces of China. Data were collected using a general information questionnaire, the Chinese version of Leisure Crafting Scale, and the Post Competency Scale for Anesthesia Specialist Nurses. SPSS 24.0 was used for t test and one-way analysis of variance. A Pearson correlation analysis was used to assess relationships between variables. Results:The total score of leisure crafting was (30.41±6.69) and the average score was (3.38±0.74). The total score of post competency was (141.76±21.76) and the average score was (3.73±0.57). A positive correlation was observed between leisure crafting and post competency ( r=0.215, P<0.01). Conclusions:Managers should encourage anesthesia specialist nurses to actively engage in leisure crafting and provide diverse opportunities for leisure crafting to improve their post competence and ultimately the quality of anesthesia nursing.

Objective To analyze the evaluation value of dynamic monitoring of changes in serum brain natriuretic peptide(BNP),urinary kidney injury molecule-1(KIM-1),and serum cystatin C(CysC)levels in acute kidney injury(AKI)after pediatric heart surgery.Methods 138 children who underwent cardiopulmonary bypass for congenital heart disease correction in our hospital from January 2023 to June 2024 were selected.The incidence of postoperative AKI in children was counted and they were divided into the AKI group and the non-AKI group accordingly.The changing levels of serum BNP,KIM-1,and CysC in the two groups of children were dynamically monitored and compared.The receiver operating characteristic curve(ROC)was used to evaluate the occurrence and severity of AKI after pediatric heart surgery.Results Among the 138 children,81 did not develop AKI and 57 developed AKI,with an incidence rate of 41.30%.In the AKI group,there were a mild group(n=20)and a moderate-severe group(n=37).Regarding the AKI group and the non-AKI group:there were differences in the levels of BNP,KIM-1,and CysC at 6 h,12 h,24 h,and 48 h after surgery(P<0.05).The levels of BNP,KIM-1,and CysC in the AKI group were higher than those in the non-AKI group(P<0.05),and there were differences in the changing trends of BNP,KIM-1,and CysC levels between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that BNP,KIM-1 and CysC were all factors influencing the occurrence of AKI after pediatric cardiac surgery(P<0.05).The ROC curve showed that the AUC of the three combined to predict the occurrence of AKI after pediatric heart surgery was 0.893,which was significantly higher than 0.723,0.812,and 0.761 of BNP,KIM-1,and CysC respectively.Regarding the mild group and the moderate-severe group:there were differences in the levels of BNP,KIM-1,and CysC at 6 h,12 h,24 h,and 48 h after surgery(P<0.05).The levels of BNP,KIM-1,and CysC in the mild group were lower than those in the moderate-severe group(P<0.05),and there were differences in the changing trends of BNP,KIM-1,and CysC levels between the two groups(P<0.05).The results of multivariate Logistic regression analysis indicated that BNP,KIM-1 and CysC were all factors influencing the severity of AKI after pediatric cardiac surgery(P<0.05).The ROC curve showed that the AUC of the three combined to evaluate the severity of AKI was 0.908,which was significantly higher than 0.780,0.762,and 0.720 of BNP,KIM-1,and CysC respectively.Conclusion Dynamic monitoring of changes in serum BNP,KIM-1,and CysC levels has a high evaluation value for the occurrence and severity of AKI after pediatric heart surgery,and the combined detection has a higher evaluation value.

Objective To study whether electroacupuncture(EA)attenuates traumatic brain injury(TBI)by down-regulating glutamate carboxypeptidase Ⅱ(GCPII)gene expression in rats.Methods Rats were divided into Sham group(n=10),TBI group(n=11),TBI+EA group(n=11),TBI+EA+GCPII-NC group(n=11)and TBI+EA+GCPII-OE group(n=11).Sham group rats underwent sham surgery,while other groups rats underwent TBI modeling using an electronic brain injury instrument.The rats in Sham group and TBI group were fed normally,and the rats in other groups were treated with electroacupuncture for 14 days.On the basis of electroacupuncture treatment,rats in TBI+EA+GCPII-NC group and TBI+EA+GCPII-OE group were injected with GCPII-NC and GCPII-OE,respectively.After treatment,the cognitive function of rats was evaluated by neurological function score and Morris water labyrinth task.HE and TUNEL staining were performed on brain tissue.The water content,glutamate(Glu)content,calcium(Ca2+)concentration,superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px)and malondialdehyde(MDA)in brain tissue of rats in each group were measured.The mRNA or protein expression of GCPII,Bax,Bcl2 and cleaved caspase-3 in brain tissue were detected by qRT-PCR or Western blot.Results Compared with Sham group,the expression of mRNA and protein of GCPII in TBI group increased,the neurological function score and escape latency increased,the number of crossing the platform decreased,the water content increased,the cortex showed obvious damage,the content of Glu increased,the concentration of calcium increased,the levels of SOD,CAT and GSH-Px decreased,the level of MDA increased,the positive rate of TUNEL increased,the expression of Bax and cleaved caspase-3 protein increased,and the expression of Bcl2 protein decreased significantly(P<0.05).Compared with TBI group,the expression level of mRNA and protein of GCPII in TBI+EA group decreased,the neurological function score and escape latency decreased,the number of crossing platform increased,the water content decreased,the morphology of cortex improved obviously,the content of Glu decreased,the concentration of calcium decreased,the level of SOD,CAT and GSH-Px increased,the level of MDA decreased,the positive rate of TUNEL decreased,the expression level of Bax and cleaved caspase-3 protein decreased,and the expression level of Bcl2 protein increased significantly(P<0.05).Compared with TBI+EA group and TBI+EA+GCPII-NC group,the expression level of mRNA and protein of GCPII in TBI+EA+GCPII-OE group increased,neurological function score and escape latency increased,the number of crossing platform decreased,water content increased,cortical injury aggravated,Glu content increased,calcium concentration increased,SOD,CAT and GSH-Px levels decreased,MDA level increased,TUNEL positive rate increased,Bax and cleaved caspase-3 protein expression increased,and the expression of Bcl2 protein decreased significantly(P<0.05).Conclusion By down-regulating the expression of GCPII gene,electroacupuncture reduced the content of glutamate in the brain tissue of TBI rats,thereby inhibiting calcium overload,oxidative stress and neuronal apoptosis in the brain tissue,and thereby improving cognitive function and alleviating brain injury.

Objective:To compare the changes of alveolar bone thickness and height in patients with bimaxillary dentoalveolar protrusion after the treatment with labial straight wire appliance and personalized lingual appliance for the retraction of anterior teeth.Methods:31 cases of labial fixed orthodontic treatment and 31 of personalized lingual orthodontic treatment were included.CBCT images were taken before and after treatment,the thickness and height of the alveolar bone on both sides of the upper anterior teeth were measured and statistically analyzed.Results:After the upper anterior teeth were retracted with labial aligner,the thick-ness of the alveolar bone in the labial root middle 1/2 and apical region of the upper incisors increased,the thickness of the alveolar bone in the cervical region of the labial side of the upper canine increased(P＜0.05),whereas the thickness and height of the alve-olar bone in the palatal side of the upper anterior teeth decreased,and the total thickness of the alveolar bone in the apical region decreased(P＜0.05).After the anterior teeth retracted with lingual aligners,the alveolar bone thickness of the labial cervical of the upper middle incisors and lateral incisors decreased,the alveolar bone thickness of the apical region of the upper middle incisors and upper canine increased,and the thickness and height of the palatal alveolar bone of the upper anterior teeth decreased,with the total thickness of the apical region decreased(P＜0.05).The reduction of alveolar bone thickness of the labial neck and root middle 1/2 of the upper incisors and alveolar bone height of the palatal side of the upper canine in the lingual appliance group was more than that in the laial group(P＜0.05).Conclusion:Labial straight wire appliance and personalized lingual appliance are effective in the retraction of the anterior teeth and the alveolar bone remodeling based on bone resorption,labial appliance is more effective.

Objective:To compare the changes of alveolar bone thickness and height in patients with bimaxillary dentoalveolar protrusion after the treatment with labial straight wire appliance and personalized lingual appliance for the retraction of anterior teeth.Methods:31 cases of labial fixed orthodontic treatment and 31 of personalized lingual orthodontic treatment were included.CBCT images were taken before and after treatment,the thickness and height of the alveolar bone on both sides of the upper anterior teeth were measured and statistically analyzed.Results:After the upper anterior teeth were retracted with labial aligner,the thick-ness of the alveolar bone in the labial root middle 1/2 and apical region of the upper incisors increased,the thickness of the alveolar bone in the cervical region of the labial side of the upper canine increased(P＜0.05),whereas the thickness and height of the alve-olar bone in the palatal side of the upper anterior teeth decreased,and the total thickness of the alveolar bone in the apical region decreased(P＜0.05).After the anterior teeth retracted with lingual aligners,the alveolar bone thickness of the labial cervical of the upper middle incisors and lateral incisors decreased,the alveolar bone thickness of the apical region of the upper middle incisors and upper canine increased,and the thickness and height of the palatal alveolar bone of the upper anterior teeth decreased,with the total thickness of the apical region decreased(P＜0.05).The reduction of alveolar bone thickness of the labial neck and root middle 1/2 of the upper incisors and alveolar bone height of the palatal side of the upper canine in the lingual appliance group was more than that in the laial group(P＜0.05).Conclusion:Labial straight wire appliance and personalized lingual appliance are effective in the retraction of the anterior teeth and the alveolar bone remodeling based on bone resorption,labial appliance is more effective.

Objective To explore the functional connectivity(FC)changes of hippocampus and amygdala in type 2 diabetes mellitus(T2DM)patients with erectile dysfunction(DMED),and the central pathological neural mechanisms underlying DMED.Methods 61 T2DM patients who visited Department of Endocrinology,Nanjing First Hospital,Nanjing Medical University from January 2020 to December 2021 were selected and divided into a simple T2DM group(n=30)and a combined DMED group(n=31).Another 47 healthy individuals were selected as control group(NC).The international erectile function scale(IIEF-5)was used to evaluate the erectile function.Resting-state functional magnetic resonance imaging(rs-fMRI)data were acquired from all participants.MRI data were preprocessed by the DPABI software package.Bilateral hippocampus and amygdala were selected as regions of interest(ROI)and the whole brain FC values were calculated.The FC values of brain regions between groups were tested by two-sample t-test with REST software package.Results Left hippocampus as ROI:compared with the NC group,FC values of the left superior temporal gyrus increased in the T2DM group,FC values of the left superior frontal gyrus,left inferior temporal gyrus,left posterior central gyrus and rectus gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left inferior parietal gyrus,left supramarginal gyrus,left middle occipital gyrus and right posterior central gyrus decreased in the DMED group.Right hippocampus as ROI:compared with the NC group,FC values of the right middle temporal gyrus and right rolandic operculum increased while FC values of the right calcarine fissure decreased in the T2DM group;FC values of bilateral anterior cingulate gyrus,right middle temporal gyrus and left rectus gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left middle frontal gyrus,left inferior parietal gyrus and right inferior temporal gyrus decreased in the DMED group.Left amygdala as ROI:compared with the NC group,FC values in the left parahippocampal gyrus,left fusiform gyrus and right insula increased in the T2DM group;FC value of the left middle temporal gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left middle frontal gyrus and left supramarginal gyrus decreased in the DMED group.Right amygdala as ROI:compared with the NC group,FC values of the left insula,right parahippocampal gyrus,right superior temporal gyrus and right supramarginal gyrus increased while FC values in the right caudate decreased in the T2DM group;FC values of the right middle frontal gyrus,left rectus gyrus and left middle occipital gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left middle frontal gyrus and left inferior parietal gyrus decreased in the DMED group.Conclusions DMED patients have abnormalities in the hippocampus,amygdala and other brain regions,especially the frontal lobe functional cortex,which may be related to changes in their brain function.