BACKGROUND:Studies have reported that alendronate intake significantly increases bone mineral density in patients with osteoporosis. OBJECTIVE:To analyze and compare the changes in metabolites before and after alendronate intervention in ovariectomized rats by chromatography-mass spectrometry,and to further explore the specific mechanism and target of alendronate in the treatment of osteoporosis. METHODS:A total of 36 female Sprague-Dawley rats were randomly divided into model group,alendronate sodium group and sham operation group.The osteoporosis model was established by ovariectomy in the first two groups.Four weeks after modeling,the rats in the alendronate group were intragastrically given alendronate sodium,while those in the sham operation group and model group were given equal volume of normal saline.After 12 weeks of continuous gavage,the metabolites of the lumbar spine were analyzed by chromatography-mass spectrometry,and the common differential metabolites were obtained,which were analyzed by bioinformatics such as Kyoto Gene and Genome Encyclopedia pathway. RESULTS AND CONCLUSION:Totally 17 different metabolites were obtained in the three groups.The enrichment analysis of the Kyoto Encyclopedia of Genes and Genomes showed that alendronate sodium could regulate unsaturated fatty acid biosynthesis,linoleic acid metabolism and other pathways to protect ovariectomized rats.These results indicate that alendronate sodium may exert its anti-osteoporosis effect by interfering with unsaturated fatty acid bioanabolism and linoleic acid metabolism,so as to achieve the purpose of preventing osteoporosis

BACKGROUND:The mechanisms and targets of alendronate in the treatment of osteoporosis still need to be investigated in depth. OBJECTIVE:To investigate the mechanism by which alendronate regulates bone metabolism in rats with osteoporosis and to perform a bioinformatics analysis of differentially expressed proteins. METHODS:Female Sprague-Dawley rats were randomly divided into three groups(n=12 per group):model group,alendronate group and sham-operated group.Animal models of osteoporosis were prepared using ovariectomy in the model and alendronate groups.At 4 weeks after modeling,rats in the alendronate group were gavaged with alendronate;the other two groups were given the equal volume of normal saline.After 12 weeks of continuous gavage,the bone mineral density of the tibia was measured and the lumbar spine of the rats was taken for proteomic analysis using Tandem mass tag-liquid chromatography-tandem mass spectrometry technique to identify differentially expressed proteins for gene ontology,Kyoto Encyclopedia of Genes and Genomes pathway and protein-protein interaction analysis. RESULTS AND CONCLUSION:There were 32 up-regulated proteins and 51 down-regulated proteins identified between the alendronate group and model group.Gene ontology enrichment analysis showed that the differentially expressed proteins were mainly involved in molecular functions,such as binding and catalytic activity,and in biological processes,such as cellular process and metabolic process.Kyoto Encylopedia of Genes and Genomes enrichment analysis showed that the differentially expressed proteins in the alendronate group and model group were mainly involved in the biosynthesis of pantothenate and coenzyme A.Protein-protein interaction analysis indicated that among the differentially expressed proteins in the alendronate group and model group,Hspa1l,Enpp3,Unc45a,Myh9 and Cant1 were located at the nodes of the protein-protein interaction network and were closely related to bone metabolism.Overall,these findings indicate that alendronate may regulate bone metabolism in the rat model of osteoporosis by regulating the expression of differentially expressed proteins and biosynthesis of pantothenate and coenzyme A.

OBJECTIVE To investigate the clinical efficacy of Gushen antai pills combined with heparin sodium in the treatment of antiphospholipin antibody （ACA）-positive recurrent abortion. METHODS A total of 203 ACA-positive recurrent abortion patients were randomly divided into control group （n＝101） and combination treatment group （n＝102）. Control group was additionally treated with heparin sodium on basis of basic treatment， and combination treatment group was additionally treated with Gushen antai pills on the basis of control group. Serum samples were collected from patients， the levels of interleukin 6 （IL- 6）， tumor necrosis factor α （TNF-α）， cyclooxygenase 2 （COX-2）， β-human chorionic gonadotropin （β-HCG） and ACA were detected by enzyme-linked immunosorbent assay. The antibody-negative conversion rate was calculated， the clinical efficacy of the patient was observed， and the occurrence of adverse drug reactions was recorded. RESULTS After treatment， the pregnancy success rate and antibody-negative conversion rate of combination treatment group were significantly higher than those in the control group （P＜0.05）， and the abortion rate was significantly lower than that in the control group （P＜0.05）. Compared with before treatment， serum levels of IL-6， TNF-α and ACA in 2 groups were decreased significantly （P＜0.05）， while the levels of COX-2 and β-HCG were increased significantly （P＜0.05）； the changes of above indexes in combination treatment group were more significant（P＜0.05）. There was no statistical significance in the incidence of adverse drug reactions between 2 groups（P＞0.05）. CONCLUSIONS Gushen antai pills can maintain high expression of β-HCG， reduce the level of ACA and improve immune microenvironment in patients with ACA-positive recurrent abortion by increasing the serum level of COX-2 and decreasing the serum level of IL-6， so as to increase the success rate of pregnancy.

ObjectiveTo describe the incidence and distribution characteristics of congenital heart disease in newborns， and to analyze the trend of the notification rate from 2009 to 2018 in Chongming District， Shanghai. MethodsBased on the shanghai birth defects surveillance system， newborns delivered in all medical institutions in Chongming District from 2009 to 2018 were examined for congenital heart disease at birth and followed up to 42 days. The notification rate and trends of various congenital heart diseases were described. ResultsThere were 548 cases of neonatal congenital heart disease in Chongming District from 2009 to 2018， and the notification rate was 20.11‰ （95%CI： 18.47‰-21.85‰）， with statistically significant differences between years during the study period （Z=10.616， P<0.001）. The four most common types of congenital heart disease were patent ductus arteriosus （313， 11.49%）， patent foramen ovale （312， 11.45%）， atrial septal defect （88， 3.64%） and ventricular septal defect （73， 2.68%）. Majority of the congenital heart disease cases were patent ductus arteriosus and patent foramen ovale that could be further closed during growth and development. Isolated patent ductus arteriosus and isolated patent foramen ovale accounted for 18.61% and 23.18% respectively of the total cases. ConclusionThe notification rate of congenital heart disease in Chongming District shows a trend of fluctuating decline followed by an increase. Community follow-up and outcome tracking should be strengthened for children with congenital heart disease， especially those with patent ductus arteriosus or patent foramen ovale.

Postnatal heart maturation is the basis of normal cardiac function and provides critical insights into heart repair and regenerative medicine. While static snapshots of the maturing heart have provided much insight into its molecular signatures, few key events during postnatal cardiomyocyte maturation have been uncovered. Here, we report that cardiomyocytes (CMs) experience epigenetic and transcriptional decline of cardiac gene expression immediately after birth, leading to a transition state of CMs at postnatal day 7 (P7) that was essential for CM subtype specification during heart maturation. Large-scale single-cell analysis and genetic lineage tracing confirm the presence of transition state CMs at P7 bridging immature state and mature states. Silencing of key transcription factor JUN in P1-hearts significantly repressed CM transition, resulting in perturbed CM subtype proportions and reduced cardiac function in mature hearts. In addition, transplantation of P7-CMs into infarcted hearts exhibited cardiac repair potential superior to P1-CMs. Collectively, our data uncover CM state transition as a key event in postnatal heart maturation, which not only provides insights into molecular foundations of heart maturation, but also opens an avenue for manipulation of cardiomyocyte fate in disease and regenerative medicine.
Gene Expression Regulation ; Heart ; Myocytes, Cardiac/metabolism* ; Single-Cell Analysis ; Transcription Factors/metabolism*

Objective To investigate the effect of Yipi Yanggan prescription on the malignant transformation of liver stem cells in liver precancerous lesion induced by diethylnitrosamine (DEN) and its possible molecular mechanism. Methods A total of 35 male Sprague-Dawley rats were randomly divided into normal control group (blank group), DEN model group (model group), DEN+Yipi Yanggan prescription group (Yipi Yanggan prescription group), and DEN+Hugan tablet group (Hugan tablet group), with 5 rats in the blank group and 10 rats in the other three groups. Intraperitoneal injection of DEN was performed to establish a model of liver precancerous lesion, the rats were sacrificed after 16 weeks of administration. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (Alb) were measured; liver tissue was collected to observe the changes in size and appearance and calculate liver weight ratio (liver index); HE staining and Sirius Red staining were used to observe the pathological and morphological changes of rat liver tissue; immunohistochemistry was used to measure the expression of OV6 and glutathione S-transferase-Pi (GST-Pi); RT-PCR was used to measure the mRNA expression of EpCAM, CD133, and CD90, and Western blot was used to measure the protein expression of PI3K, Akt, and mTOR and their phosphorylation level. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t -test was used for further comparison between two groups. Results Compared with the model group, the Yipi Yanggan prescription group and the Hugan tablet group had significant improvements in liver pathology and morphology, significant reductions in liver index and the levels of ALT and AST, and a significant increase in the level of Alb (all P < 0.05), as well as significant reductions in the protein expression levels of GST-Pi, OV6, p-PI3K, p-Akt, and p-mTOR and the mRNA expression levels of EpCAM, CD133, and CD90 (all P < 0.05). Compared with the Hugan tablet group, the Yipi Yanggan prescription group showed a more significant protective effect on the liver, with significant reductions in liver index and the levels of ALT and AST, and a significant increase in the level of Alb (all P < 0.05), as well as significant reductions in the protein expression levels of GST-Pi, OV6, p-PI3K, p-Akt, and p-mTOR and the mRNA expression levels of EpCAM, CD133, and CD90 (all P < 0.05). Conclusion Yipi Yanggan prescription can improve liver precancerous lesion induced by DEN in rats by inhibiting the malignant transformation of liver stem cells, and its mechanism of action may be associated with the PI3K/Akt/mTOR signaling pathway.

Objective:To explore the initial motivation of nursing students to engage in voluntary service for the aged, and to provide scientific basis for the formulation of strategies and measures of voluntary service for the aged.Methods:Totally 25 nursing students volunteers who regularly participated in the volunteer service for the aged in Changsha First Welfare Home were selected by objective sampling method for semi-structured in-depth interviews, and the data were analyzed by Colaizzi phenomenological 7-step analysis method.Results:Four themes of nursing students' initial motivation to participate in voluntary service for the aged were extracted: self-interest motivation, altruistic motivation, affinity motivation and achievement motivation. Among them, self-interest motivation included two sub-themes: enriching college life and life experience, improving one's own ability and gaining professional experience; altruistic motivation included two sub-themes: accompanying and helping the elderly and eliminating loneliness of the elderly; affinity motivation included two sub-themes: establishing emotional sustenance and making up for the lack of emotion; achievement motivation included two sub-themes: facing challenges bravely, acquiring a sense of achievement, serving society and others, and realizing one's own value.Conclusion:Nursing students have a clear initial motivation to participate in the voluntary service for the aged of the aged care facilities, and schools can strengthen the relevant education for students to participate in voluntary service in the training of nursing talents. The voluntary service for the aged can formulate corresponding development strategies and incentives according to the initial motivation of nursing students, so that promote the expansion and stability of the voluntary service for the aged team, and promote the development and improvement of voluntary service for the aged.

Objective:To explore the effect of plan-do-check-action (PDCA) cycle combined with detail nursing on improving safety management in outpatient Operating Room.Methods:Using the lottery method, a total of 120 patients who underwent surgery in outpatient Operating Room of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February 2018 to January 2019 were selected as the control group, and 124 patients from February 2019 to January 2020 were selected as the experimental group. The control group adopted the conventional Operating Room nursing mode, while the experimental group adopted Operating Room safety management mode combining PDCA cycle with detail nursing. Nursing quality score, incidence of adverse events and incidence of nursing errors were compared between the two groups.Results:The scores and total scores of all aspects of Operating Room nursing quality in the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . The total incidence of adverse events in the experimental group was 0.81% (1/124) , which was lower than 5.83% (7/120) in the control group, and the difference was statistically significant (χ 2=4.860, P<0.05) . The total incidence of nursing errors in the experimental group was 3.23% (4/124) , which was lower than 10.00% (12/120) in the control group, and the difference was statistically significant (χ 2=4.567, P<0.05) . Conclusions:PDCA cycle combined with detailed nursing can effectively improve the safety management of outpatient Operating Room and reduce adverse nursing events.

Objective:To assess the health status and health service utilization of children born to syphilis infected mothers during pregnancy, in order to prevent mother-to-child transmission of syphilis to the newborns.Methods:Women with maternal syphilis were studied by trained researchers via phone calls, in Shanghai during 2014-2015. Data related to demographics, status of infection and health care, utilization by both mothers and their children were collected through specifically designed questionnaires. Non-parametric tests including chi-square were used to assess the health status and health service utilization of children born to mothers with different demographic and socioeconomic characteristics.Results:A total of 495 children born to mothers with maternal syphilis were recruited from 1 000 syphilis infected parturient women. A total of 61 out of the 495 children were diagnosed as having congenital syphilis (57 children were diagnosed at birth and another 4 were diagnosed during the follow-up period). Children born to women who received syphilis treatment during pregnancy were at lower risk on congenital syphilis ( χ2=7.214, P=0.027). 37.8 % of the children were reported to have had different illnesses in the past three months, mainly involving upper respiratory infections (32.3 %) or diarrhea (3.6 %). Children diagnosed with congenital syphilis showed a higher prevalence of different kinds of diseases, compared to those without congenital syphilis (47.5 % vs. 36.6 %). 81.6 % of the children had received regular child health care services. Subjects with the following factors as: being immigrant, with lower education, unemployed, unmarried and multipara, were related to the less use of regular child healthcare services. Only 39.7 % of the parents would inform the care-takers about the risk of congenital syphilis infection of their own children at the child health care centers. Mothers with residency of Shanghai, having higher education level and employed, were less willing to inform doctors about the risk of congenital syphilis infection of their children. Conclusions:Loss to follow-up among children born to syphilis infected pregnant women remained a serious problem. Few parents would be willing to inform the healthcare takers that their children are at risk of syphilis, when receiving child health care services at the centers. It was necessary to integrate the congenital syphilis follow-up programs into the routine child care services so as to timely diagnose and treat the patients with congenital syphilis.

Objective: To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients. Methods: A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy. Results: Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23%, 36.52%, 41.11% and 3.14% respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P<0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1%. The right internal jugular vein stenosis rate was 66.4% and 44.1% in the age<65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0% and 32.8% (P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95% CI 1.083-2.568, P=0.020). Conclusions There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.