Objective To establish the reference intervals for test indicators of thyroid function,namely thyroid stimulating hormone(TSH),free thyroxine(FT4),and free triiodothyronine(FT3),in the children aged 0 to 15 years old in Nanning,China.Methods A total of 1 289 healthy children aged 0 to 15 years old who attended the Guangxi International Zhuang Medicine Hospital Affiliated with Guangxi University of Chinese Medicine from October 2018 to August 2023 were selected.The concentrations in serum TSH,FT4,and FT3 were measured by chemiluminescent microparticle immunoassay(CMIA).According to the Clinical and Laboratory Standards Institute(CLSI)EP28-A3c guideline,the nonparametric percentile method was used to establish the reference intervals for TSH,FT4,and FT3 in the children aged 0 to 15 years old in Nanning area.Results The established reference intervals were as follows:TSH(male):0 to＜1 month:0.88-7.81 μIU/mL,1 month to 15 years:0.59-5.06 μIU/mL;TSH(female):0 to＜1 month:0.93-8.42μIU/mL,1 month to 15 years:0.60-4.30 μIU/mL.FT4(male):0 to＜1 month:0.99-1.92 pg/mL,1 month to 15 years:0.86-1.33 pg/mL;FT4(female):0 to＜1 month:1.05-2.06 pg/mL,1 month to 15 years:0.85-1.37 pg/mL;FT3:0 to＜1 month:2.16-4.24 pmol/L,1 month to＜11 years:2.75-4.49 pmol/L,11 to 15 years:2.45-4.34 pmol/L.Significant differences were observed among different gender and age groups for TSH,FT4,and FT3 levels(P＜0.05).Conclusion This study successfully established the refer-ence intervals of TSH,FT4,and FT3 in the children aged 0 to 15 years old in Nanning area,which were significantly different among various gender and age groups.

This study explores the application effect of the case-based teaching method based on Xuexitong learning platform in the online teaching of Digestive System, and analyzes the learner's emotional experience, learning behavior, and learning effect in the case-based online teaching. The results of the study show that the case-based online teaching model based on Xuexitong learning platform improves students' online learning interest, and the students have good emotional experience, high learning enthusiasm, good classroom interaction, enhanced self-learning ability before and after class, and good learning effect. In addition, precise teaching can be used for individual students who are not enthusiastic about online learning.

Objective To investigate the effect of Danhuangsan on high glucose-induced vascular endothelial cell injury based on PINK 1/Parkin signaling pathway,and to explore its specific mechanism.Methods Human um-bilical vein endothelial cells were cultured in vitro and randomly divided into control group,growth factor group,Danhuangsan group,high glucose group,high glucose+growth factor group,high glucose+Danhuangsan group,with 3 cases in each group,treated for 48 hours.Cell scratch test was used to detect cell migration rate,and Transwell test was used to detect cell invasion rate.Immunofluorescence was used to detect the expression of anti-apoptotic protein Bcl-2,Beclin-1 and pro-apoptotic protein Bax.Western blot was used to detect the protein expression levels of PINK 1,Parkin and LC 3-Ⅱ.Results Cell scratch test and Transwell test showed that under normal environment and high glucose treatment,Danhuangsan could reduce the cell migration and invasion rate(P＜0.05).Immunofluorescence assay showed that under normal environment and high glucose treatment,Danhuang-san up-regulated the expression levels of Bcl-2 and Beclin-1 protein in cells(P＜0.05).Western blot results showed that under normal environment and high glucose treatment,Danhuangsan increased the protein expression levels of PINK 1,Parkin and LC 3-Ⅱ in cells and down-regulated the expression levels of Bax protein(P＜0.05),and the effects of Danhuang powder were significantly better than those of blank serum and growth factor(P＜0.05).Conclusion Danhuangsan can alleviate high glucose-induced endothelial cell injury by activating PINK 1/Parkin pathway,and the mechanism may be related to promoting mitophagy and enhancing the repair of damage.

AIM: To observe the clinical efficacy of multi -glycoside of tripterygium wilfordii (GTW) on diabetic nephropathy. METHODS: Fifty-one patients with diabetic kidney disease (DKD) with a history of GTW dosing admitted to the outpatient clinic of Yijishan Hospital affiliated to Wannan Medical College from June 2019 to October 2022 were selected as study subjects, and were followed up regularly to observe the changes in laboratory indexes before and after GTW dosing and adverse drug reactions after 6 months of treatment. The t-test, Mann-Whitney U-test or χ

Objective To investigate the quality of life of patients with hypertensive disorder complicating pregnancy, analyze the possible influencing factors, and propose corresponding intervention measures. Methods From October 2017 to February 2018, one hundred patients with gestational hypertension were included in the obstetric wards as subjects. Semi-structure interviews were used to evaluate the quality of life and influencing factors. Results Among the quality of life of patients with hypertensive disorder complicating pregnancy, The scores of physiological function (RP), general health (GH), emotional function (RE) and mental health (MH) were lower than the norm, which were (22.45 ± 32.01), (59.40 ± 19.28), (37.07 ± 38.55). ), (65.63 ± 19.72) points, the norm scores were (57.00 ± 19.35), (64.09 ± 14.08), (65.78 ± 22.35), (70.04 ± 16.25) points, and the difference between the two groups was statistically significant (t=-10.687--2.212, both P<0.05 or 0.01). Univariate analysis found that the differences in physical health scores between patients with different places of residence and whether they had received assisted reproductive technology were statistically significant (F=6.860, t=-2.112, P<0.01 or 0.05). The differences in mental health scores between pregnant women, gestational weeks, place of residence, and whether they had received assisted reproductive patients were statistically significant (F=-4.798-3.463,P<0.05 or 0.01). Multiple linear regression analysis found that the place of residence was an independent influencing factor of patients' physiological health (P=0.003), and whether or not assisted reproductive technology was an independent influencing factor of patients′ mental health (P=0.005). Conclusion The quality of life of patients with hypertensive disorders during pregnancy is poor, and appropriate interventions should be actively taken to improve the quality of life of patients.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective To investigate the effect of different shear stress on the expression of Interleukin-8 (IL-8) and endothelin-1 (ET-1) in vascular endothelial cells.Methods Umbilical vein endothelial cell line (ECV-304) was used as the research cell.The shear stress of 5 dyne/cm2 and 10 dyne/cm2 was regulated by the self-made shearing stress control device.The shear stress in were maintained at 0,5 dyne/cm2 and 10 dyne/cm2 respectively in the control group,the low shear stress group and the high shear stress group.The effects on the levels of IL-8 and ET-1 were analyzed between the three groups at five time points of 30 min,60 min,120 min,300 min,420 min.Pearson correlation analysis was used to analyze the correlation between IL-8 and ET-1.Results The level of IL-8 in the three groups has been on the rise.At the three time points of 30 min,60 min and 120 min,there was no statistically significant difference in IL-8 level between the three groups (P ＞ 0.05).At the two time points of 300 min and 420 min,the difference of the IL-8 level in the three groups was statistically different (P ＜ 0.05),At the two time points of 300 min and 420 min,the IL-8 level in the low shear stress group was higher than that in the control group and the high shear group,the IL-8 level in the high shear group was higher than that in the control group (P ＜ 0.05).The level of ET-1 in the control group and the low shear group showed an upward trend,and the ET-1 level in the high shear group increased continuously in the former 120 min,but began to decrease continuously since then.At the three time points of 30 min,60 min and 120 min,the difference of the ET-1 level in the three groups was statistically different (P ＜ 0.05).The ET-1 level of the high shear group at three time points of 30 min,60 min and 120 min was higher than that of the control group,the level of ET-1 at two time points of 30 min and 60 min was higher than that in low shear stress group (P ＜ 0.05),the ET-1 level of the low shear group at two time points of 60 min and 120 min was higher than that of the control group (P ＜ 0.05).At the two time points of 300 min and 420 min,there was no significant difference in the level of ET1 between the three groups (P ＞ 0.05).Pearson correlation analysis showed that there was a positive correlation between the expression of IL-8 and ET-1 (r =0.384,P =0.031).Conclusions Shear stress can affect the expression of IL-8 and ET-1 in vascular endothelial cells,the shear stress of 5 dyne/em2 can increase the level of IL-8 more efficiently,the shear force of 10 dyne/cm2 can increase the level of ET-1 more obviously,but it may cause damage to the vascular endothelial cells.

Objective To compare the clinical application of Da Vinci robot surgical system (RSS) with traditional open surgery (TOS).Methods From Feb 2015 to Jul 2016,48 cases of upper abdominal surgical disease patients were divided into RSS group (23 cases) and TOS group (25 patients) randomly.Results The anesthesia time [(194 ±16)min vs.(181 ±11)min,t=3.262,P=0.002] and operation time [(167 ± 14) min vs.(158 ± 14) min,t =2.292,P =0.027] were much longer in the RSS,while the blood loss during operation significantly less than the TOS [(128 ± 62) ml vs.(190 ± 86) ml,t =-2.886,P =0.006].The RSS has obvious advantages in 24 h-drainage [(69 ± 27) ml vs.(114 ± 54) ml.t =-3.680,P =0.001],time to out-of-bed activity [(27.7 ± 8.0) h vs.(35.7 ± 9.9) h,t =-3.067,P =0.004],BPS,postoperative exhausting time[(27.2 ±5.9)h vs.(32.8 ±8.3)h,t =-2.690,P =0.01] and length of hospital stay [(10.4 ± 1.8) d vs.(11.8 ± 1.9) d,t =-2.600,P =0.013].But the total hospital cost was higher in RSS [(117 000 ± 10 000) yuan vs.(77 000 ± 8 000) yuan,t =15.087,P =0.000)].Conclusions The RSS is a much minimally invasive surgery,reducing blood loss and postoperative pain,promoting rapid recovery,shortening hospital stay.

Objective To explore the effects of group guidance on the cognitive ability of empty nesters in a community.Methods Totally 179 empty nesters aged above 60 from a community in Xicheng District,Beijing between April 2014 and April 2015 were selected by convenience sampling,and divided into an intervention group (n=89) and a control group (n=90). Patients in the intervention group were treated by group guidance,once a week (60 min each time) for 12 months,while patients in the control group received no intervention. And the empty nesters' cognitive ability was evaluated with Mini-mental State Examination (MMSE) before and after the intervention.Results The differences found in comparing the orientation,memory, linguistic competence and cognitive ability of the empty nesters in the intervention group were statistically significant (P<0.05). And the differences found in comparing the memory and cognitive ability of the empty nesters in the control group were also statistically significant (P<0.05). Before the intervention,however,there was no significant difference between the empty nesters in the two groups in cognitive ability and other indicators (P>0.05). After the intervention,the empty nesters in the observation group scored higher in orientation, attention,numeracy,linguistic competence and cognitive ability than the empty nesters in the control group (P<0.05).Conclusions Empty nesters' cognitive ability comes to weaken and decline with age,and group guidance helps to improve their cognitive ability significantly.

Objective To report a new surgical approach (modified anconeus flap approach) in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture (AO type C).Methods To design the modified anconeus flap approach,the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens (30 sides).The new surgical approach was compared with the triceps-reflecting anconeus pedicle (TRAP) approach in terms of the area of exposure at the distal humeral articular surface.Furthermore,the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture (AO type C) from May 2005 to May 2013.The clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and Broberg-Morrey scoring systems.Results The blood supply and innervation of the anconeus was interrupted minimally during incision along the radical edge of triceps tendon.The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42.66％ ± 0.03％ at the elbow flexion from 0° to 50°.This was significantly smnaller than that provided by the TRAP approach (46.11％ ±0.03％) (P ＜0.05).Of the 16 patients,15 obtained complete follow-ups from 6 months to 4 years(average,16.5 months).The mean MEPS at the last follow-up was 90.5 points (range,from 82 to 93 points),with 10 excellent and 4 good cases and one poor case.The Broberg & Morrey score system showed 11 patients with no articular cartilage degeneration (level-0),3 patients with level-1 degeneration,and 2 patients with level-2 degeneration.Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures,thereby leading to early active motion and satisfactory clinical outcomes.