Objective In this study,the potential profile characteristics of exercise self-efficacy of patients with inflammatory bowel disease(IBD)were explored,and the influencing factors of different types of patients were an-alyzed,so as to provide a reference for nurses to formulate standardized management measures.Methods From June 2023 to May 2024,a total of 342 hospitalized patients with IBD in tertiary A hospital in Wuxi were recruited as research subjects by a convenience sampling method.The General Information Questionnaire,Exercise Self-effica-cy Scale,Exercise Behavioral Stage Distribution Scale and the Social Support Rating Scale were used for investiga-tion.The latent profile analysis was conducted to classify exercise self-efficacy levels,while multiple Logistic regres-sion analysis was utilized to evaluate the influencing factors.Results A total of 320 valid questionnaires were col-lected,and the effective questionnaire recovery rate was 93.57％.The total score of exercise self-efficacy for IBD pa-tients was(64.61±14.83)points.The exercise self-efficacy was classified into 3 latent categories:low efficacy-somatic emotion group(n=64,20.00％),medium efficacy-work conflict group(n=158,49.38％),and high efficacy-social interfer-ence group(n=98,30.62％).Occupation,recurrence times,comorbid chronic diseases,self-assessed economic pressure,and social support level were found to be influencing factors of the latent profile classification of exercise self-effi-cacy in IBD patients(P＜0.05).Conclusion The levels of exercise self-efficacy of patients with IBD are significant-ly heterogeneous,and there are several important influencing factors.Nursing staff should formulate targeted inter-vention strategies based on the characteristics of exercise self-efficacy in such patients,so as to improve patients' exercise self-efficacy and the effectiveness of disease rehabilitation.

Objective:To explore the effect of Chaibei Zhixian Decoction on intestinal flora and T helper 17/regulatory T cell(Th17/Treg)immune balance in epileptic rats by regulating mammalian target of rapamycin/hypoxia-inducible factor-1α(mTOR/HIF-1α)pathway.Methods:Sixty rats were randomly divided into Sham group,Model group,low-dose Chaibei Zhixian Decoction group(CBZXD-Low)and high-dose Chaibei Zhixian Decoction group(CBZXD-High),with 15 rats in each group.Lateral ventricular injec-tion 1 μl kainic acid(1.5 μg/μl)was used to prepare epileptic rat model,Sham group was injected with an equal amount of physiological saline.CBZXD-Low group and CBZXD-High group were given Chaibei Zhixian Decoction by gavage daily(8.48 g/kg,16.96 g/kg),while Sham group and model group were given an equal amount of physiological saline by gavage.After continuous gavage for 4 weeks,HE staining and Nissl staining were used to detect pathological damage in hippocampal tissue;RT-qPCR was used to detect Th17/Treg related marker mRNA levels in spleen tissue and mTOR,HIF-1α mRNA levels in hippocampus tissue;flow cytometry was used to de-tect Th17/Treg cell ratio in spleen tissue;16S rRNA sequencing of feces in colon segment was performed;Western blot was used to de-tect mTOR and HIF-1α protein levels in hippocampal tissue.Results:Compared with Sham group,Model group rats suffered from spontaneous epilepsy,the arrangement of hippocampal neurons was disordered and severely lacking,intracellular Nissl bodies was de-creased,RORγt,IL-17A mRNA levels in spleen tissue were increased,Foxp3,CTLA-4 and GITR mRNA levels were decreased,the proportion of Th17 cells and Th17/Treg were increased,the proportion of Treg cell was decreased,intestinal flora α/β diversity were decreased,the proportion of harmful bacteria such as Cronobacter and Heliobacillus were increased,the proportion of beneficial bacte-ria such as Bacteroides,Lactobacillus,Prevotella and Akkermansia were decreased;mTOR and HIF-1α mRNA levels,p-mTOR/mTOR,HIF-1α protein levelsin hippocampal tissue were increased(P<0.05);compared with Model group,the seizures of rats in CBZXD-Low group and CBZXD-High group were significantly reduced,and the damage to hippocampal neurons was alleviated,RORγt,IL-17A mRNA levels in spleen tissue were decreased,Foxp3,CTLA-4 and GITR mRNA levels were increased,the propor-tion of Th17 cells and Th17/Treg were decreased,the proportion of Treg cell was increased,intestinal flora α/β diversity were in-creased,the proportion of harmful bacteria such as Cronobacter and Heliobacillus were decreased,the proportion of beneficial bacte-ria,such as Bacteroides,Lactobacillus,Prevotella,and Akkermansia were increased;mTOR and HIF-1α mRNA levels,p-mTOR/mTOR,HIF-1α protein levels in hippocampal tissue were decreased(P<0.05);and it showed a dose-dependent effect of Chaibei Zhixian Decoction(P<0.05).Conclusion:Chaibei Zhixian Decoction can restore intestinal flora and Th17/Treg cell immune balance in epileptic rats,it possibly plays a role by regulating mTOR/HIF-1α pathway.

Objective:To investigate the impact of the size of the liver tumor diameter on the prognosis of patients with hepatitis B-related hepatocellular carcinoma (HCC)-inducing acute-on-chronic liver failure (HBV-HCC/ACLF).Method:A retrospective cohort study was conducted. Clinical data of patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) diagnosed according to the Asia-Pacific Association for the Study of the Liver (APASLT) guidelines who were admitted to the Fifth Medical Center of PLA General Hospital between January 2016 and January 2021 were collected. The patients were enrolled in the HBV-HCC/ACLF group (116 cases) and the HBV-ACLF group (348 cases). General information, medical history, biochemical parameters, complications, and liver cancer status were collected. Clinical data and prognoses at 28 days and 12 months of follow-up were compared between the two groups. Factors influencing mortality in the HBV-HCC/ACLF group were analyzed to determine the prognostic significance of tumor diameter. The t test, χ 2 test, and multivariate logistic regression analysis were used to analyze factors influencing mortality. Receiver operating characteristic (ROC) curves were used to assess the sensitivity and specificity of tumor diameter for 28-day prognosis, and Kaplan-Meier curves were used for survival analysis. Result:There were statistically significant differences in the 28-day mortality rate [(55.17%, 64/116) vs. (38.51%, 134/348)] and 12-month mortality rate [(78.45%, 91/116) vs. (55.75%, 194/348)] between the HBV-HCC/ACLF group and the HBV-ACLF group ( P<0.05). The area under the ROC curve analysis for HBV-HCC/ACLF patients indicated that the tumor diameter was 0.707 (95% CI: 0.615-0.788). The survival group (52 cases) and the mortality group (64 cases) were divided into the HBV-HCC/ACLF group based on 28-day mortality. Univariate analysis showed that the levels of aspartate aminotransferase (AST), alkaline phosphatase, creatinine, alpha-fetoprotein, white blood cell count, international normalized ratio, model for end-stage liver disease score, acute kidney injury (AKI), the occurrence of infections and complications, and others were all significantly higher in the mortality group compared to the survival group ( P<0.05).The mortality group had a larger tumor diameter than the survival group ( P<0.01). The incidence of portal vein tumor thrombosis and distant liver cancer metastasis was also higher in the survival group ( P<0.01). The mortality group had a higher rate of HCC-related minimally invasive treatment within three months before ACLF diagnosis than the survival group ( P<0.01). AST levels, infection, size of tumor diameter, and minimally invasive treatment within three months before onset were independent risk factors for 28-day mortality in the HBV-HCC/ACLF group. The optimal significant value for tumor diameter affecting prognosis was 3.3 cm, with a sensitivity of 67.19% and a specificity of 73.08%. Patients with liver tumor diameters >3.3 cm had significantly lower 28-day survival rates than those with a tumor diameter ≤3.3 cm [(24.56%, 14/57) vs. (64.41%, 38/59)]. Eighty case analyses had the same findings in patients who had not previously received any therapy. Conclusion:Patients with HBV-HCC/ACLF had a high 28-day mortality rate, and the size of the tumor diameter is important in determining the 28-day prognosis.

AIM:To compare the formation and release of neutrophil extracellular traps(NETs)af-ter exposure to the high-altitude hypoxic environ-ment for different periods,and their relationship with the dynamic changes of microcirculatory disor-ders associated with pulmonary edema.METH-ODS:SD rats were raised under normoxic condi-tions at an altitude of 400 m and under hypoxic conditions at an altitude of 4 200 m.The rats raised under hypoxic conditions at an altitude of 4 200 m for 7 days were returned to normoxic con-ditions at 400 m to observe the changes in physio-logical and pathological indicators of the rats.The dynamic changes of neutrophil extracellular traps(NETs)release and microcirculatory disorders relat-ed to pulmonary edema after high-altitude hypoxia exposure and after returning to the plain were ex-plored by blood routine determination,rat arterial blood gas analysis,ELISA experiment,lung water content determination,H&E staining,and immuno-histochemical staining.RESULTS:In the hypoxic en-vironment at 4 200 m,rats exhibited significant re-ductions in arterial oxygen saturation(SaO2)and partial pressure of oxygen(PO2)(P＜0.01),accompa-nied by a marked increase in lung-tissue water con-tent(P＜0.01).The complete blood count revealed elevated levels of red blood cells,white blood cells,lymphocytes,and neutrophils(P＜0.01).In addition,the formation and release of NETs in neutrophils in-creased,accompanied by an aggravation of the in-flammatory response.After returning to the low-al-titude normoxic area at 400 m,the above indica-tors gradually returned to normal levels on the 7th day.Pathological changes such as alveolar epitheli-al cell shedding and inflammatory cell infiltration were observed in the lung tissues of rats in the high-altitude area,and the pathological changes were restored after returning to the low-altitude normoxic environment.CONCLUSION:The release of NETs from neutrophils is closely related to the re-covery of pulmonary edema and pulmonary ede-ma-related microcirculatory disorders after high-al-titude hypoxia exposure.

Objective:To analyze the molecular epidemiological characteristics of norovirus (NoV) outbreaks in Qingdao.Methods:Anus swab specimens were collected during NoV outbreaks from 2016 to 2020 and detected by real-time RT-PCR. Full length of RNA-dependent RNA polymerase (RdRp) and VP1 gene were amplified by RT-PCR for sequencing, evolutionary analysis, and homology modeling.Results:A total of 65 NoV outbreaks were reported, with 59 outbreaks occurring in kindergartens and primary/secondary schools, showing a double peak epidemic pattern, with peaks occurring from March to May and from October to December. A GⅡ.P16 outbreak in Qingdao first appeared in March 2017 and became the predominant strains from 2017 to 2020(67.9%, 38/56), including two genotypes: GⅡ.2[P16] (97.4%, 37/38) and GⅡ.4 Sydney[P16] (2.6%, 1/38). The GⅡ.2[P16] strains isolated were closely related to the 2010-2012 GⅡ.2[P16] strains, from whichi they probably evolved. The GⅡ.2[P16] Qingdao strains shared five common substitutions, namely D173E (motif F), V175I (motif F), S293T, K357Q (motif D), and T360A (motif D). The RdRp nucleotide consistency between GⅡ.2[P16] and GⅡ.4 Sydney[P16] was greater than 95%, and there were mainly four amino acid differences, namely K54R, V125A, A312T, and K457R.The evolutionary variation of GⅡ.2[P16] VP1 was minimal, with only a few amino acid substitutions taking place. The main functional variations of GⅡ.4 Sydney[P16] VP1 included R297H (epitope A), D310N (NERK motif), D372N (epitope A), and R373H (positive selection site).Conclusions:GⅡ.P16 NoV is the predominant epidemic strain of ad norovirus outbreaks in Qingdao from 2016 to 2020, and continuous monitoring of its epidemic trend and in-depth study of its evolutionary mechanism are necessary.

Objective:To evaluate the efficacy and safety of obinutuzumab combined with glucocorticoid-based therapy in patients with relapsed immune thrombotic thrombocytopenic purpura (iTTP).Methods:This study analyzed the efficacy and adverse reactions of four patients with relapsed iTTP who were treated with a combination of obinutuzumab and glucocorticoids to assess the effectiveness and safety of the treatment.Results:All four patients had a history of multiple relapses and had previously undergone treatment with rituximab and bortezomib. Three patients exhibited additional autoantibodies. Following the combined therapy, all patients achieved clinical remission, with ADAMTS13 activity returning to normal levels and inhibitors testing negative. During a median follow-up period of 11 months (range: 3–17 months), all patients maintained sustained remission. No severe adverse events were reported during treatment or follow-up.Conclusion:The combination of obinutuzumab and glucocorticoid-based therapy is effective and safe for treating relapsed iTTP.

Objective:To explore the role and molecular mechanisms of S100A6 protein in neonatal meningitis caused by Streptococcus agalactiae. Methods:Human brain microvascular endothelial cells (HBMECs) were used as an in vitro experimental model, and siRNA was employed to construct S100A6 gene knockdown HBMECs strain. The S100A6 gene overexpression cell line was established by lentiviral transfection method. Western blot was used to detect the expression level of S100A6 protein in HBMECs after Streptococcus agalactiae infection, and the change in intracellular inflammatory cytokine protein levels after S100A6 gene knockdown or overexpression. A neonatal bacterial meningitis model was established by injecting Streptococcus agalactiae suspension into the cisterna magna of neonatal Sprague-Dawley (SD) rats. HE staining was used to observe pathological changes in brain tissue; immunohistochemistry was used to detect the expression and distribution of S100A6 protein in brain tissue; Western blot and ELISA were used to measure S100A6 protein levels in cerebrospinal fluid (CSF). Results:Compared with the control group, the intracellular S100A6 protein level in HBMECs increased significantly following Streptococcus cgalactiae infection. After S100A6 gene knockdown, the invasion rate of Streptococcus agalactiae into the HBMECs was significantly reduced ( P<0.01), while intracellular TNF-α and IL-6 protein levels were elevated markedly ( P<0.01). In contrast, overexpression of S100A6 gene increased the invasion rate ( P<0.01) and notably decreased TNF-α and IL-6 protein levels ( P<0.001). In the neonatal SD rat bacterial meningitis model, HE staining revealed substantial neutrophil infiltration in brain tissue after Streptococcus agalactiae infection. Immunohistochemistry showed extensive deposition of S100A6 protein around the meninges, and significant expression of S100A6 protein was also detected in CSF. Conclusions:S100A6 protein is crucial in mediating neonatal meningitis caused by Streptococcus agalactiae infection. S100A6 gene knockdown promotes the production of intracellular inflammatory cytokines and reduces Streptococcus agalactiae invasion into cells, thereby alleviating bacteria-induced cellular damage. Additionally, the increased expression of S100A6 protein in brain tissue and CSF after Streptococcus agalactiae infection suggests its potential as a diagnostic biomarker for bacterial meningitis.

In modern society, sugary foods have become an integral part of many people′s lives. However, excessive sugar consumption has adverse effects on both overall health and oral health, serving as a contributing factor to the global increasing incidence in oral diseases, cardiovascular diseases, cancers, obesity, and diabetes. In response to the health risks related to high-sugar diets, the World Health Organization (WHO) and World Dental Federation (FDI) have proposed initiatives and recommendations, with various governments implementing different policies and strategies to reduce sugar intake. Chinese government has also taken proactive measures. The "Healthy China Action (2019-2030)" initiative introduced by the State Council in 2019 established a crucial benchmark in limiting the average daily intake of added sugar to 25 g per person forward to 2030. Experts from Chinese Center for Disease Control and Prevention and the field of oral health have meticulously examined the impacts of sugar reduction on oral health, as well as strategies, methods, and practical considerations related to reducing sugar intake through several meeting and wrote the "Expert consensus: reducing free-sugar for caries prevention", which was subsequently reviewed and revised based on the feedback from multiple stakeholders. They have conducted thorough analyses of global trends in sugar reduction and best practices to provide valuable insights to China for crafting effective policies and strategies on sugar reduction. This consensus mainly includes the classification of free sugars, the latest scientific evidence on dental caries, recommendations from WHO on sugar-sweetened beverage taxes, nutrition labeling, advertising, food reform, adjusting supply systems, education, and promotion strategies, as well as sugar reduction actions taken by various governments around the world. Combining the actual situation in China, policy recommendations and authoritative popular science knowledge on sugar reduction for caries prevention to public are proposed to advocate for experts in multiple fields to focus on sugar reduction for caries prevention, promote the work process, and provide the scientific basis for oral health educators.

Objective:To investigate the efficacy of naloxone in improving health-related quality of life in patients with chronic arsenic exposure-related pruritus, and to explore the modification effect of gene polymorphisms associated with arsenic metabolism and endorphin receptors.Methods:A randomized, double-blind, placebo-controlled trial was conducted between January and March 2019 in Changde City, Hunan Province, China. Eligible patients with moderate to severe chronic pruritus under arsenic exposure were recruited, and randomly assigned to the naloxone group and the control group to receive sublingual naloxone and placebo (0.4 mg/d) respectively for 7 consecutive days. Outcomes were assessed before treatment and on day 7 after treatment, including the primary outcome (the dermatology life quality index [DLQI]) and secondary outcomes (depression symptoms, anxiety symptoms, and quality of sleep). Genotyping of the arsenic (+3 oxidation state) methyltransferase and 3 opioid receptor genes was performed using ligase detection reaction. Data analysis was performed using t test for normally distributed continuous variables, non-parametric tests for skewed continuous variables, and chi-square test for categorical data. Linear regression analysis was carried out to evaluate the effect of naloxone on outcome measures, while the interactive effect of demographic factors, genotypes and treatment methods on changes in DLQI were assessed by the generalized linear model. Results:A total of 126 patients with chronic arsenic exposure-related pruritus were enrolled, including 73 males and 53 females. They were randomly divided into the control group (64 cases) and the naloxone group (62 cases), with the ages being 60.0 ± 9.1 years and 58.4 ± 8.6 years, respectively. There were no significant differences between the two groups in terms of age, gender, income, education levels, or hair arsenic concentrations (all P > 0.05). After treatment, the decrease in DLQI scores was significantly higher in the naloxone group than in the control group (-8.79 ± 6.84 vs. -5.19 ± 8.10; P = 0.008). However, there were no significant changes in depression symptoms, anxiety symptoms, or quality of sleep between the naloxone group and control group (all P > 0.05). Linear regression analysis showed that naloxone significantly affected DLQI with a crude regression coefficient of -3.60 (95% CI: -6.25, -0.96; P = 0.008). Stratification analysis revealed that patients with the κ-opioid receptor gene rs1051660 (wild-type, CC) responded better to the treatment than those with the mutated genotype (CA), and there was a significant interaction between the rs1051660 genotype and therapeutic drugs in relation to DLQI changes ( P = 0.014) . Conclusion:Naloxone can effectively improve health-related quality of life in patients with chronic arsenic exposure-related pruritus, and its efficacy is modified by the gene polymorphism of the κ-opioid receptors.

Objective:To analyze clinical characteristics of Mycoplasma pneumoniae-induced rash and mucositis in children. Methods:Clinical data were collected from children diagnosed with Mycoplasma pneumoniae -induced rash and mucositis in the Department of Dermatology, Capital Center for Children's Health, Captital Medical University from August 1, 2023, to December 1, 2023, and their clinical features were analyzed. Results:A total of 15 children with Mycoplasma pneumoniae-induced rash and mucositis were collected, including 8 males and 7 females, aged 4 to 12 years. They were clinically characterized by obvious mucositis, and skin lesions were relatively mild. Oral mucosal involvement was observed in 13 cases, including lip ulcers (12 cases), oral mucositis (7 cases), tongue ulcers (3 cases), and glossitis (1 case) ; ocular mucosal involvement was reported in 7 cases, including suppurative conjunctivitis (4 cases), and eyelid edema (3 cases) ; 3 children had vulvogenital mucosal involvement, including coronary sulcus ulcers (1 case), urethral meatus ulcers (1 case), labia minora ulcers (1 case), and perianal ulcers (1 case) ; 1 child had nasal mucosal ulcers. Skin lesions occurred on the upper limbs in 5 cases, on the lower limbs in 6 cases, on the face in 2 cases, on the vulva in 2 cases, as well as on the trunk in 1 case. The types of skin lesions included targetoid erythema in 11 cases, vesiculobullous lesions in 6 cases and atypical targetoid erythema in 2 cases. PCR for the detection of Mycoplasma pneumoniae in vesiculobullous fluids showed negative results in the 6 patients with vesiculobullous lesions. The patients received systemic and topical treatment with antibiotic agents and glucocorticoids, as well as supportive therapy. Main pulmonary symptoms as well as skin and mucosal lesions of the 15 children subsided within 3 weeks, and they all had a favorable prognosis, without obvious complications or sequelae. Conclusion:Mycoplasma pneumoniae-related skin and mucosal lesions predominantly present as mucositis, with mild or absent skin involvement. The disorder usually has a mild course, characterized by short disease duration and favorable prognosis.