Objective:To develop and validate a risk prediction model for cognitive frailty in elderly patients with type 2 diabetes.Methods:A total of 483 elderly patients with type 2 diabetes who visited Tianjin First Central Hospital from June to December 2022 were selected using convenience sampling. They were randomly divided into a modeling group ( n=338) and a validation group ( n=145). Data were collected using a self-designed general information questionnaire, the Short-Form Mini Nutritional Assessment (MNA-SF), the Geriatric Depression Scale-15 (GDS-15), the Frailty Phenotype (FP), the Montreal Cognitive Assessment (MoCA), and the Clinical Dementia Rating (CDR). Logistic regression analysis was performed to identify the influencing factors. A cognitive frailty risk prediction nomogram model was constructed based on the results. The model was validated in the validation group, and its predictive performance and clinical applicability were evaluated using the area under the receiver operating characteristic curve ( AUC), calibration curve, and clinical decision curve analysis. A total of 483 questionnaires were distributed and all were returned as valid, resulting in a 100.0% response rate. Results:The prevalence of cognitive frailty in the 483 elderly patients with type 2 diabetes was 20.3% (98/483). Age, regular exercise, duration of diabetes, HbA1c levels, depression and nutritional status were identified as predictive factors in the model. The AUC of the model was 0.886, and the Hosmer-Lemeshow test showed a χ 2 value of 8.004 ( P=0.433). The optimal cutoff value was 0.335, and the accuracy was 89.0%. Conclusions:The prediction model demonstrates good fit and strong predictive performance, and can intuitively and easily identify elderly patients with type 2 diabetes who are at high risk of cognitive frailty, providing a reference for early screening and intervention.

Objective:To evaluate the effect of activation of splenic plasmacytoid dendritic cells (pDCs) on myocardial ischemia-reperfusion (I/R) injury in mice.Methods:The experiment was performed in two parts. Animal experiment Thirty-six SPF healthy male C57BL/6J mice, aged 10 weeks, weighing 22-27 g, were assigned to 3 groups ( n=12 each) using a random number table method: sham operation group (Sham group), myocardial ischemia group (MI group) and myocardial I/R group (MI/R group). The myocardial ischemia was induced by occluding the left anterior descending coronary artery for 40 min in MI group, while the model of myocardial I/R was established by occlusion of the left anterior descending coronary artery for 40 min followed by 1-h reperfusion in MI/R group. Following successful preparation of the model, 3 animals from each group were randomly selected, and their hearts were removed for determination of myocardial infarct size through a combination of TTC and methylene blue double staining. Another 3 animals from each group were randomly selected, and their hearts were removed for examination of pathological changes of myocardial tissues using HE staining. Blood samples were collected from the abdominal aorta of 6 mice left in each group for determination of plasma interferon alpha (IFN-α) concentrations by enzyme-linked immunosorbent assay. Then the animals were sacrificed and hearts were harvested for collection of cardiac perfusate (CP). Cell experiment Twelve SPF healthy male C57BL/6J mice, aged 10 weeks, weighing 22-27 g, were selected and the splenic pDCs were isolated using anti-mPDCA-1 MicroBeads according to the manufacturer′s instructions (with a positivity rate of >85% for the isolated cells). The cells were divided into 4 groups: group pDCs stimulated by CP in Sham group (pDCs+ CP-Sham group), group pDCs stimulated by CP in MI group (pDCs+ CP-MI group), group pDCs stimulated by CP in MI/R group (pDCs+ CP-MI/R group) and pDCs stimulated by PBS group (pDCs+ PBS group). The CP in Sham, MI and MI/R groups and PBS were used to induce and culture pDCs for 8 h. Flow cytometry was employed to detect the expression of CD45 and co-stimulatory molecules CD80, CD86 and Major Histocompatibility Complex Ⅱ (MHC Ⅱ) on the surface of pDCs. The levels of IFN-α in the cell culture supernatant were determined using enzyme-linked immunosorbent assay. Results:Animal experiments Compared with Sham group and MI group, the percentage of myocardial infarct size was significantly increased, the concentrations of plasma IFN-α were increased ( P<0.05), and cardiomyocytes displayed evident vacuolar degeneration, severe myocardial fiber rupture, and infiltration of a substantial number of inflammatory cells in MI/R group. There was no significant difference in each parameter between Sham group and MI group ( P>0.05). Cell experiment Compared with pDCs+ CP-Sham group, the expression of CD80, CD86 and MHCⅡ was significantly up-regulated in pDCs+ CP-MI group ( P<0.05), and no significant change was found in the aforementioned parameters in pDCs+ CP-MI/R group ( P>0.05). The expression of aforementioned parameters was significantly up-regulated in pDCs+ CP-MI group as compared with pDCs+ CP-MI/R group ( P<0.05). Compared with pDCs+ CP-Sham group and pDCs+ CP-MI/R group, the concentrations of IFN-α in the cell culture supernatant were significantly increased in pDCs+ CP-MI group ( P<0.05). There was no statistically significant difference in the concentrations of IFN-α between pDCs+ CP-MI/R group and pDCs+ CP-Sham group ( P>0.05). Conclusions:The mechanism underlying myocardial I/R injury may be related to activation of splenic pDCs leading to the production of IFN-α following myocardial ischemia in mice.

Objective:To assess the feasibility of wavelet index (WLI) in monitoring the depth of sedation with propofol in pediatric patients.Methods:This was a prospective observational trial. One hundred and sixty-five pediatric patients, aged >1-12 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective surgery requiring general anesthesia with endotracheal intubation or laryngeal mask airway from July to December 2016 in our hospital, were divided into 11 age groups ( n=15 each): >1-2 yr group, >2-3 yr group, >3-4 yr group, >4-5 yr group, >5-6 yr group, >6-7 yr group, >7-8 yr group, >8-9 yr group, >9-10 yr group, >10-11 yr group, and >11-12 yr group. General anesthesia was induced by injection of propofol 3 mg/kg for more than 30 s. WLI and BIS values were recorded immediately before administration and at 30, 40, 50, 60, 90, 120, 180 and 240 s after the end of administration. If there were differences among age groups, age groups with no statistically significant differences were combined and re-grouped. Pearson linear correlation analysis and Bland-Altman consistency analysis were performed. Results:A total of 149 pediatric patients were actually included. There were no significant differences in BIS values between 4 groups aged > 1-5 yr and between 7 groups aged > 5-12 yr ( P>0.05). Regrouping was performed based on the aforementioned results, 4 groups of children aged > 1-5 yr were divided into > 1-5 yr group ( n=60), and 7 groups of children aged > 5-12 yr were divided into > 5-12 yr group ( n=89). WLI values and BIS values were significantly decreased at each time point after administration compared with immediately before administration in group aged > 1-5 yr and in group aged >5-12 yr ( P<0.05). The BIS values were the lowest at 60 s after the end of the administration, and the WLI values were the lowest at 120 and 180 s after the end of the administration in two groups ( P<0.05). There were no statistically significant differences between WLI values and BIS values at 90 s and 240 s after the end of the administration ( P>0.05), and there was statistically significant difference at the other time points in group aged > 1-5 yr ( P<0.05). There was no significant difference between WLI values and BIS values at 180 s and 240 s after the end of the administration ( P>0.05), but there were significant differences at the other time points in group aged > 5-12 yr ( P<0.05). The Pearson correlation coefficients between WLI values and BIS values were 0.61 and 0.56 in group aged > 1-5 yr and group aged > 5-12 yr, respectively ( P<0.001). Bland-Altman agreement analysis: In group aged > 1-5 yr and group aged > 5-12 yr, the 95% agreement limits were -0.484-0.621 and -0.551-1.015, respectively, and there were 4.6% (23/504) and 5.1% (40/777) of the points outside the 95% agreement limits, respectively, and both limits exceeded the clinically acceptable range. Conclusions:WLI is feasible for monitoring the depth of sedation with propofol in pediatric patients aged > 1-12 yr, but the accuracy is lower than BIS.

Objective:To understand the epidemiological characteristics and incidence trend of severe fever with thrombocytopenia syndrome (SFTS) in China.Methods:The incidence data of SFTS in China from 2018 to 2021 were collected from Chinese Disease Prevention and Control Information System for a statistical and descriptive epidemiological analysis by using software such as Excel 2016, Joinpoint 5.0.2, SPSS 26.0, and GraphPad Prism 8.0, especially, the SFTS cases reported monthly by key provinces were analyzed.Results:From 2018 to 2021, a total of 8 835 SFTS cases were reported in 25 provinces and the annual incidence showed an upward trend. The distribution of SFTS cases showed clustering, but the cases were mainly sporadic ones. The cases began to increase in March, mainly occurred during April to October (96.79%,8 551/8 835), and peaked during May to July. The cases were mainly distributed in middle-aged and old farmers, and slight more cases were women. The average case fatality rate was 5.38%, which varied greatly with areas. The case fatality rate tended to increase with age.Conclusion:From 2018 to 2021, the epidemiological characteristics of SFTS in China remained stable, but the number of reported cases gradually increased and the distribution showed an expanding trend, to which close attention should be paid.

Abstract: Objective To analyze the epidemiological characteristics of reported cases of dengue fever in mainland China from 2019 to 2023 and provide a scientific basis for dengue prevention and control efforts. Methods The temporal, spatial, and population distribution characteristics, as well as the trends of dengue fever cases reported in the National Notifiable Disease Reporting System (NNDRS) of China were analyzed using software such as Joinpoint regression, SaTScan, and ArcGIS. Results From 2019 to 2023, a total of 43 095 cases were reported in China, with an average incidence rate of 61/100 000. The annual reported incidence rate fluctuated significantly (AAPC=-3.16%, 95%CI:-54.16%-91.47%), mainly concentrated in 2019 and 2023, accounting for 96.83% of the total reported cases over the past five years. All age groups were susceptible to the disease, with the 30 to <40 age group comprising 22.6% of cases. Cases were reported throughout the year, with a rapid increase starting in June and a peak period concentrated between August and October (n=34 780, RR=12.44, LLR=29 262.52, P<0.05). The epidemic was primarily characterized by imported cases leading to autochthonous transmission, with the majority of imported cases originating from Southeast Asia (86.56%), particularly from Cambodia (46.11%, 3 284 cases) and Myanmar (25.99%, 1 851 cases). The epidemic characteristics varied significantly across different years, with high risks of autochthonous transmission epidemics in Southwest, South, and Southeast China. High-risk local transmission were mainly distributed in Yunnan and Guangdong. The duration of the peak period of the epidemic was affected by the timeliness of early detection of local transmission, and the peak value of the epidemic was related to the effectiveness of prevention and control measures. The scale of the epidemic was influenced by the pressure of by cross-border transmission and the ability to implement local measures for dengue prevention and control. Conclusions With the increasing trend of global dengue transmission, the risk of autochthonous transmission of dengue in China is rising. It is recommended to strengthen proactive early outbreak surveillance, along with well preparation of personnel, technology, and resources for dengue prevention and control.According to autochthonous conditions, reasonable management and risk assessment of cross-border travelers should be explored to effectively.

Radix Bupleuri(RB)is commonly used to treat depression,but it can also lead to hepatotoxicity after long-term use.In many anti-depression prescriptions,RB is often used in combination with Radix Paeoniae Alba(RPA)as an herb pair.However,whether RPA can alleviate RB-induced hepatotoxicity remain unclear.In this work,the results confirmed that RB had a dose-dependent antidepressant effect,but the optimal antidepressant dose caused hepatotoxicity.Notably,RPA effectively reversed RB-induced hepatotoxicity.Afterward,the mechanism of RB-induced hepatotoxicity was confirmed.The results showed that saiko-saponin A and saikosaponin D could inhibit GSH synthase(GSS)activity in the liver,and further cause liver injury through oxidative stress and nuclear factor kappa B(NF-KB)/NOD-like receptor thermal protein domain associated protein 3(NLRP3)pathway.Furthermore,the mechanisms by which RPA attenuates RB-induced hepatotoxicity were investigated.The results demonstrated that RPA increased the abundance of intestinal bacteria with glycosidase activity,thereby promoting the conversion of saikosaponins to sai-kogenins in vivo.Different from saikosaponin A and saikosaponin D,which are directly combined with GSS as an inhibitor,their deglycosylation conversion products saikogenin F and saikogenin G exhibited no GSS binding activity.Based on this,RPA can alleviate the inhibitory effect of saikosaponins on GSS activity to reshape the liver redox balance and further reverse the RB-induced liver inflammatory response by the NF-κB/NLRP3 pathway.In conclusion,the present study suggests that promoting the conversion of saikosa-ponins by modulating gut microbiota to attenuate the inhibition of GSS is the potential mechanism by which RPA prevents RB-induced hepatotoxicity.

Objective:To explore the application effect of humanistic care nursing model in patients with gynecological tumors.Methods:Using the convenient sampling method, a total of 136 gynecological tumor patients who were hospitalized in Henan Cancer Hospital from March 2020 to March 2021 were selected as the research objects. Patients were divided into the observation group and the control group using the random number table method, with 68 patients in each group. The control group received routine nursing intervention during hospitalization, while the observation group received humanistic care based on routine nursing. The intervention effect was compared using Symptom Checklist 90 (SCL-90) , Pittsburgh Sleep Quality Index (PSQI) and Nursing Satisfaction Questionnaire.Results:After intervention, the SCL-90 and PSQI scores of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . After intervention, the scores of each item in the Nursing Satisfaction Questionnaire of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The application of humanistic care model in gynecological tumor patients can effectively improve their psychological status and sleep quality and increase patient satisfaction, which is worthy of clinical promotion.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Chaigui granules(CG)are a compound composed of six herbal medicines with significant antidepressant effects.However,the antidepressant mechanism of CG remains unclear.In the present study,we attempted to elucidate the antidepressant mechanism of CG by regulating purine metabolism and purinergic signaling.First,the regulatory effect of CG on purine metabolites in the prefrontal cortex(PFC)of chronic unpredictable mild stress(CUMS)rats was analyzed by ultra high-performance liquid chro-matography tandem mass spectrometry(UHPLC-MS/MS)targeted quantitative analysis.Meanwhile,purinergic receptors(P2X7 receptor(P2X7R),A1 receptor(A1R)and A2A receptor(A2AR))and signaling pathways(nod-like receptor protein 3(NLRP3)inflammasome pathway and cyclic adenosine mono-phosphate(cAMP)-protein kinase A(PKA)pathway)associated with purine metabolism were analyzed by western blotting and enzyme-linked immunosorbent assay(ELISA).Besides,antidepressant mecha-nism of CG by modulating purine metabolites to activate purinergic receptors and related signaling pathways was dissected by exogenous supplementation of purine metabolites and antagonism of puri-nergic receptors in vitro.An in vivo study showed that the decrease in xanthine and the increase in four purine nucleosides were closely related to the antidepressant effects of CG.Additionally,purinergic re-ceptors(P2X7R,A1R and A2AR)and related signaling pathways(NLRP3 inflammasome pathway and cAMP-PKA pathway)were also significantly regulated by CG.The results of exogenous supplementation of purine metabolites and antagonism of purinergic receptors showed that excessive accumulation of xanthine led to activation of the P2X7R-NLRP3 inflammasome pathway,and the reduction of adenosine and inosine inhibited the A1R-cAMP-PKA pathway,which was significantly ameliorated by CG.Overall,CG could promote neuroprotection and ultimately play an antidepressant role by inhibiting the xanthine-P2X7R-NLRP3 inflammasome pathway and activating the adenosine/inosine-A1R-cAMP-PKA pathway.

Objective:To investigate the prevalence of lymphocytic choriomeningitis virus (LCMV) and hantavirus (HV) specific antibodies among cross-border migrant workers for assessment of the risk of rodents-borne virus infection.Methods:From 2019 to 2020, a survey was conducted on cross border migrant workers engaged in outdoor activities, and serum samples were collected, LCMV specific IgG antibody was detected by an indirect ELISA and Western blot based on recombinant nucleoprotein, and indirect immunofluorescence assay (IFA) based on recombinant expressed glycoprotein. HV IgG antibody in serum was detected by a commercial indirect IgG ELISA kit and IFA based on hantavirus infected Vero cells.Results:A total of 139 cross-border workers, aged 25~57, were surveyed; 64% (89/139) had working experience in multiple countries, involving 26 countries, including 14 countries in Asia and 12 countries in Africa; 11.51% (16/139) of serum samples were tested positive for LCMV antibodies, and the positive samples were verified by Western blot and IFA. The antibody detection rate was slightly higher than the published infection rate from other similar studies. And, HV antibodies were detected from one serum sample (0.72%, 1/139) by ELISA and IFA. However, it was still uncertain when and where the viral infections were acquired.Conclusions:Through this serological cross-sectional preliminary analysis, the infection status and existing risks of LCMV and HV viruses among cross border migrant workers were revealed, which suggested the necessity of strengthening the prevention and control of rodents borne diseases in outdoor engineering sites.