Objective To understand the facilitating and obstacle factors for pediatric nurses in implementing interventions for children's medical fears and to provide a foundation for exploring intervention strategies for pediatric nurses to effectively tackle children's medical fears.Methods By purposive sampling,face-to-face interviews were conducted with 20 pediatric nurses in a tertiary-level A children's hospital in Wenzhou City from December 2023 to February 2024.Traditional content analysis was used for data analysis.Results Facilitators and obstacle factors to the implementation of medical fear interventions by pediatric nurses were extracted.The 4 sub-themes of the facilitator theme include awareness of the importance of medical fear intervention,the drive of individual empathy,positive peer support,and the construction of a suitable hospital environment.The 3 sub-themes of the obstacle theme include the lack of individualized intervention skills for medical fear,heavy workload,interference from negative emotional behavior of family members.Conclusion There are many factors influencing paediatric nurses to implement medical fear interventions for children.It is recommended that clinical nursing administrators should strengthen the systematic training of pediatric nurses'knowledge about medical fear interventions for children,unite with multidisciplinary experts,and recruit medical social workers or volunteers to collaborate with nurses and children's families to cope with children's medical fears together and to promote physical and mental health of hospitalized children.

To explore the application effect of host restriction factors(HRFs)in the development of antiviral gene drugs,this study based on the"common pathway of viral infection"and"host innate immunity HRFs",the genes of three antiviral HRFs,namely cholesterol-25-hydroxylase(CH25H),interferon-induced transmembrane protein(IFITM3)and interferon-stimulated gene 15(ISG15)were fused and expressed using pCK vectors to construct antiviral gene drugs.The fusion expression gene sequence CH25H-IFITM3-ISG15(C Ⅱ)was constructed by linking the gene cod-ing sequences of these three HRFs through the cleavage peptide coding sequence.Subsequently,the C Ⅱ sequence was amplified by PCR,ligated to the pCK expression vector,and the recombinant plasmid was transformed,identified,and extracted to obtain a candidate biodrug based on the DNA expression system,which was named pCK-CⅡ.Then,the recombinant plasmid was transfected in-to HEK 293T cells,and the expression of three antiviral proteins was successfully detected by Western blot.To clarify the antiviral effect of pCK-C Ⅱ at the cellular level,pCK-C Ⅱ was trans-fected into HEK 293 cells and BHK-21 cells,respectively.Twenty-four hours later,the BHK-21 cells were infected with vesicular stomatitis virus expressing green fluorescent protein(VSV-GFP),12 h later,the cells were observed under a fluorescence microscope and detected by flow cy-tometry;HEK 293 cells were inoculated with H3N2 subtype influenza virus,and the expression of H3N2 subtype influenza virus nuclear proteins was detected after 12 h using Western blot.The re-sults showed that transient transfection of pCK-C Ⅱ plasmid could significantly reduce the fluores-cence level of cells and the expression of nuclear protein of H3N2 subtype influenza virus in infec-ted cells.These results indicated that pCK-C Ⅱ had an inhibitory effect on the infection of VSV-GFP and H3N2 subtypes of influenza viruses after transient transfection of cells.

Objective To investigate how dietary supplementation with tetrahydrocurcumin(THC)improves kidney injury in type 2 dia-betic mellitus(T2DM)and its mechanism of action using transcriptome sequencing(RNA-seq).Methods C57BL/6J mice were randomly assigned to the control,T2DM,and T2DM+THC groups.After a high-fat meal and streptozotocin injection,the body weights and fasting blood glucose levels of each mouse with T2DM were measured.Hematoxylin and eosin staining,Oil red O staining,and RNA-seq were performed to examine kidney pathology,lipid deposition,and differentially expressed genes,respectively,in the mice.Results Mice in T2DM group exhibited significantly higher fasting blood glucose levels(P＜0.001),renal tubule degeneration,glomeruli enlargement,disordered epithelial cells,and increased kidney lipid deposition after 12 weeks compared with those of the control group.THC adminis-tration alleviated all these conditions(P＜0.001).RNA-seq analysis revealed significant gene expression variations among the control,T2DM,and T2DM+THC groups.THC may protect against T2DM-induced kidney injury and lipid deposition by regulating the cell cycle(apoptosis),P53 signaling pathway,and PPARγ signaling path way,as indicated by Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.In mice with T2DM,THC intervention may upregulate the expression of Cd36,Lpl,PPARγ,and Plin4 genes in renal tissues,while downregulating Ccnb1,Ccnb2,Cdk1,Bub1,and Cdc25c gene expressions.The proteins encoded by the four upregulated genes interact,as do those encoded by the five downregulated genes.Conclusion THC administration improves fasting blood glucose levels,reduces renal damage,and decreases fat deposition in mice with T2DM.The processes may involve decreasing apoptosis,blocking the P53 signaling pathway,and activating the PPARγ signaling pathway.

Objective To analyze the predictive value of bispectral index(BIS)dynamic changes for hypotension after laparoscopic surgery in elderly patients with primary liver cancer.Methods 197 elderly patients with primary liver cancer who underwent laparoscopic surgery in the hospital from November 2021 to July 2024 were selected as the research subjects,and all patients received general anesthesia,and their perioperative BIS was monitored.The patients were divided into a hypotension group and a non hypotension group based on the occur-rence of hypotension after laparoscopic surgery.The general information and the BIS at 5 minutes before anesthesia induction(T0),5 minutes after anesthesia induction(T1),30 minutes after the start of surgery(T2)and the end of surgery(T3)in the two groups were compared.The influencing factors of hypotension after laparoscopic surgery in elderly patients with primary liver cancer were analyzed through Logistic regression analysis,and the predictive value of BIS for hypotension after laparoscopic surgery in elderly patients with primary liver cancer were analyzed through receiver operating characteristic(ROC)curve.Results 51 patients were experienced hypotension after laparoscopic surgery among 197 elderly patients with primary lung cancer,and the incidence rate was 25.89％.The proportion of hypertension and operative time in the hypotension group were higher than those in the non hypoten-sion group(P<0.05),while the levels of albumin(ALB)and BIS at T2 and T3 were lower than those in the non hypertension group(P<0.05).logistic regression analysis showed that hypertension,long operative time,low ALB level,low BIS value at T2 and low BIS value at T3 were all risk factors for hypotension after laparoscopic surgery in elderly patients with primary liver cancer(P<0.05).The sensitivity,specificity and area under curve(AUC)of BIS combined prediction of hypotension after laparoscopic surgery in elderly patients with primary liver cancer at T2 and T3 were 92.16％,78.08％and 0.902％respectively,and the sensitivity and AUC were higher than those single prediction(P<0.05),but the specificity was similar to that of single prediction.Conclusion The predictive value of BIS at 30 minutes after the start of surgery and the end of surgery for hypotension after laparoscopic surgery in elderly patients with primary liver cancer are good,and the joint prediction of this two can further enhance the predictive value.

ObjectiveTo investigate the correlation of the serum levels of aminotransferases and their ratios with liver inflammation activity in pediatric chronic hepatitis B （pCHB） patients， and to provide a basis for selecting the dominant population for treatment. MethodsThis study was conducted among 1 267 pCHB patients who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2010 to August 2022 and these patients did not receive antiviral therapy. The patients were analyzed in terms of demographic features， blood routine， blood biochemistry， HBV serological markers， and liver biopsy data. According to liver inflammation activity based on liver biopsy， the patients were divided into no or mild inflammation activity （G0‍ ‍—‍ ‍G1） group and significant inflammation activity （G2‍ ‍—‍ ‍G4） group. The serum levels of aminotransferases and their ratios were compared between groups， and their correlation with liver inflammation activity in pCHB patients was analyzed. Additionally， the patients were stratified by the age， and the relationship between serum aminotransferase levels and liver inflammation activity was analyzed in each age group. For comparison of continuous data between two groups， the independent samples t-test was used when the data were normally distributed， while the Mann-Whitney U test was used when the data were not normally distributed； the chi-square test was employed for comparison of categorical data between two groups. A Spearman’s correlation analysis was performed for correlation assessment. ResultsAmong the 1 267 pCHB patients， there were 468 （36.9%） in the G0‍ ‍—‍ ‍G1 group and 799 （63.1%） in the G2‍ ‍—‍ ‍G4 group， and there were significant differences between the two groups in the levels of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， AST/ALT ratio， gamma-glutamyl transpeptidase （GGT）， total bilirubin， direct bilirubin， HBeAg quantification， low-density lipoprotein， and platelet count （PLT） （all P<0.05）. The correlation analysis showed that liver inflammation activity was negatively correlated with PLT and low-density lipoprotein （both P<0.05） and was positively correlated with GGT， total bilirubin， direct bilirubin， and HBeAg titer （all P<0.05）， while it was not significantly correlated with ALT， AST， and AST/ALT ratio （all P>0.05）. In the 0‍ ‍—‍ ‍12 years group， the 13‍ ‍—‍ ‍18 years male group， and the 13‍ ‍—‍ ‍18 years female group， liver inflammation activity aggravated with the increases in the serum levels of ALT and AST， and there were significant differences between groups （all P<0.05）. In the 0‍ ‍—‍ ‍12 years group， there was a significant difference in significant liver inflammation activity between the AST/ALT ratio >1 group and the AST/ALT ratio ≤1 group （P<0.001）. Among the 1 267 patients， 447 （35.28%） had an ALT level of <2×upper limit of normal （ULN）， among whom 196 （43.85%） had G≥2 liver inflammation， accounting for 15.47% of all children enrolled. ConclusionLiver inflammation activity is not significantly correlated with ALT， AST， and AST/ALT ratio in pCHB patients， suggesting that the serum levels of aminotransferases cannot truly reflect liver inflammation activity in pCHB patients with an aminotransferase level of <2×ULN. In clinical practice， liver biopsy should be performed for children with an aminotransferase level of <2×ULN to clarify whether antiviral therapy should be performed.

BACKGROUND:There is a significant correlation between sperm DNA fragmentation index and fertilization,embryonic development potential,embryo implantation,miscarriage,and offspring safety.However,its clinical reference value is affected by many factors,resulting in extremely limited clinical significance.This study took live birth as the outcome,corrected other confounding factors through propensity score matching,constructed the best clinical cutoff value of sperm DNA fragmentation index and live birth,and conducted internal and external tests on it,which has good predictive value and clinical application efficiency. OBJECTIVE:To investigate the reference threshold and offspring short-term security of in vitro fertilization-embryo transfer sperm DNA fragmentation index based on live birth. METHODS:A total of 1 921 patients who received in vitro fertilization and embryo transfer in Changzhou Maternal and Child Health Area Hospital from May 2019 to May 2021 were selected.On the basis of tendency matching tolerance of 0.02 and propensity score matching of 1:1,540 cases were successfully matched in each live birth group and non-live birth group,and the model group was established.135 patients who received in vitro fertilization and embryo transfer in Nanxishan Hospital of Guangxi Zhuang Autonomous Region were selected as the external validation group.The optimal clinical cutoff value of sperm DNA fragmentation index for live birth was investigated by the receiver operating characteristic curve.The accuracy and clinical application efficacy of the cutoff value were evaluated by restricted cubic spline curve,standard curve,clinical decision curve,clinical impact curve and internal and external validation tests. RESULTS AND CONCLUSION:(1)The DNA fragmentation index of sperm in the non-live birth group was significantly higher than that in the live birth group and had a significant negative correlation with live birth(r=-0.444,P<0.001).(2)Receiver operating characteristic curve results showed that the optimal cut-off value of DNA fragmentation index for live birth was 24.33%;the area under the curve was 0.775(0.746,0.804);the specificity was 72.60%;the sensitivity was 78.90%,and the accuracy was 75.70%.(3)Restricted cubic spline curve fitting the results of Logistic regression showed that when the sperm DNA fragmentation index was greater than 24.57%,the risk of clinical non-live birth increased.(4)The probability of Logistic regression analysis results showed that sperm DNA fragmentation index was a risk factor for live birth[OR(95%CI)=0.916(0.904,0.928),P<0.001],and when sperm DNA fragmentation index was greater than 27.78%,the probability of clinical live birth would be less than 50%.With the increase of sperm DNA fragmentation index by 1 unit,the probability of a live birth fell by 8.4%.(5)Internal and external to the validation of the clinical cutoff value showed that the cutoff point had certain clinical predictive value and accuracy.(6)Clinical decision curve and clinical impact curve results exhibited that the prediction model based on the clinical cut-off value had the maximum clinical net benefit value when the threshold probability was 0.22-0.73,and the ratio of loss to gain within the threshold probability range was always less than 1,which confirmed that the prediction model had good clinical application effectiveness.(7)The results of sperm DNA fragmentation index and offspring short-term security analysis showed that sperm DNA fragmentation index had no significant differences with preterm birth,body weight,deformity and sex.(8)These findings suggest that the optimal clinical cut-off value of sperm DNA fragmentation index for in vitro fertilization-embryo transfer live birth was 24.33%.The established clinical prediction model has good differentiation,accuracy and clinical application effectiveness.Sperm DNA fragmentation index has no significant impact on offspring short-term security,but large samples and long-term follow-up evaluation are still needed.

To explore the application effect of host restriction factors(HRFs)in the development of antiviral gene drugs,this study based on the"common pathway of viral infection"and"host innate immunity HRFs",the genes of three antiviral HRFs,namely cholesterol-25-hydroxylase(CH25H),interferon-induced transmembrane protein(IFITM3)and interferon-stimulated gene 15(ISG15)were fused and expressed using pCK vectors to construct antiviral gene drugs.The fusion expression gene sequence CH25H-IFITM3-ISG15(C Ⅱ)was constructed by linking the gene cod-ing sequences of these three HRFs through the cleavage peptide coding sequence.Subsequently,the C Ⅱ sequence was amplified by PCR,ligated to the pCK expression vector,and the recombinant plasmid was transformed,identified,and extracted to obtain a candidate biodrug based on the DNA expression system,which was named pCK-CⅡ.Then,the recombinant plasmid was transfected in-to HEK 293T cells,and the expression of three antiviral proteins was successfully detected by Western blot.To clarify the antiviral effect of pCK-C Ⅱ at the cellular level,pCK-C Ⅱ was trans-fected into HEK 293 cells and BHK-21 cells,respectively.Twenty-four hours later,the BHK-21 cells were infected with vesicular stomatitis virus expressing green fluorescent protein(VSV-GFP),12 h later,the cells were observed under a fluorescence microscope and detected by flow cy-tometry;HEK 293 cells were inoculated with H3N2 subtype influenza virus,and the expression of H3N2 subtype influenza virus nuclear proteins was detected after 12 h using Western blot.The re-sults showed that transient transfection of pCK-C Ⅱ plasmid could significantly reduce the fluores-cence level of cells and the expression of nuclear protein of H3N2 subtype influenza virus in infec-ted cells.These results indicated that pCK-C Ⅱ had an inhibitory effect on the infection of VSV-GFP and H3N2 subtypes of influenza viruses after transient transfection of cells.

Objective:To preliminarily assess the biocompatibility and durability of the TruDelta TM transcatheter mitral valve replacement (TMVR) system. Method:Six adult sheep were divided into 3 groups based on the duration of follow-up: 30 days ( n=1), 90 days ( n=3) and 180 days ( n=2). The TruDelta TM TMVR system was implanted through a transapical approach under transesophageal echocardiographic guidance. The operability of the TMVR system was evaluated using an instrument performance evaluation scale (consisting of 39 items), with scores ranging from 1 (worst) to 10 (best) assigned by the operator. Echocardiography was conducted preoperatively, immediately after surgery, and at 30, 90, and 180 days post-implantation. At the last follow-up time point, the intervention mitral valve membrane and major organs were dissected for observation. The artificial valves were taken for hematoxylin eosin (HE) staining and observed under a scanning electron microscope. Result:All six procedures were successfully completed using 29S size TruDelta TM TMVR device. At the final follow-up, echocardiogram demonstrated good valve function without obvious paravalvular leakage, with a transvalvular gradient of (7.8±3.2) mmHg (1 mmHg=0.133 kPa) and a mitral valve orifice area of (1.8±0.2) cm 2. Autopsy findings revealed no structural valve failure and almost complete endothelialization (>75%) with 90 to 180 days. Both HE staining and scanning electron microscopy confirmed optimal endothelialization of the valve stent. Conclusion:The preclinical animal study indicates that the TruDelta TM device exhibits favorable biocompatibility and durability.

Objective To investigate how dietary supplementation with tetrahydrocurcumin(THC)improves kidney injury in type 2 dia-betic mellitus(T2DM)and its mechanism of action using transcriptome sequencing(RNA-seq).Methods C57BL/6J mice were randomly assigned to the control,T2DM,and T2DM+THC groups.After a high-fat meal and streptozotocin injection,the body weights and fasting blood glucose levels of each mouse with T2DM were measured.Hematoxylin and eosin staining,Oil red O staining,and RNA-seq were performed to examine kidney pathology,lipid deposition,and differentially expressed genes,respectively,in the mice.Results Mice in T2DM group exhibited significantly higher fasting blood glucose levels(P＜0.001),renal tubule degeneration,glomeruli enlargement,disordered epithelial cells,and increased kidney lipid deposition after 12 weeks compared with those of the control group.THC adminis-tration alleviated all these conditions(P＜0.001).RNA-seq analysis revealed significant gene expression variations among the control,T2DM,and T2DM+THC groups.THC may protect against T2DM-induced kidney injury and lipid deposition by regulating the cell cycle(apoptosis),P53 signaling pathway,and PPARγ signaling path way,as indicated by Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.In mice with T2DM,THC intervention may upregulate the expression of Cd36,Lpl,PPARγ,and Plin4 genes in renal tissues,while downregulating Ccnb1,Ccnb2,Cdk1,Bub1,and Cdc25c gene expressions.The proteins encoded by the four upregulated genes interact,as do those encoded by the five downregulated genes.Conclusion THC administration improves fasting blood glucose levels,reduces renal damage,and decreases fat deposition in mice with T2DM.The processes may involve decreasing apoptosis,blocking the P53 signaling pathway,and activating the PPARγ signaling pathway.

Objective:To clarify the natural course of renal angiomyolipoma and the risk factors for its progression.Methods:This was a retrospective case-control study that included 401 patients diagnosed several times by ultrasound examination in the hospital physical examination system from January 2012 to June 2024. All patients were untreated. There were 128 male cases (31.90%) and 273 female cases (68.10%). The average age at initial diagnosis was (44.04 ± 10.24) years (range 22-78 years). The median longest diameter of the tumor at initial diagnosis was 9.0 (7.0, 11.5) mm. There were 359 cases (89.50%) with single tumors and 42 cases (10.50%) with multiple tumors. The patients were divided into the progression group(≥1 mm/year) and the non-progression group (<1 mm/year)based on the average growth rate of tumor. The differences in gender, age at initial diagnosis, initial tumor size, number of lesions and lesion site between the two groups were compared. Univariate logistic regression analysis was used to explore the relationship between the above factors and the progression of renal angiomyolipoma. Multivariate logistic regression analysis was conducted to identify the risk factors for progression.Results:A total of 401 cases were followed up for an average of (88.15 ± 21.09) months (range 48-140 months). The median maximum diameter of the tumors at the initial diagnosis was 9.0 (7.0, 11.5) mm, and at the end of the follow-up, it was 11 (8, 14) mm. The average growth rate was 0.38 mm/year, and the median growth rate was 0.25 (0, 0.60) mm/year. Among them, 341 cases (85.04%) were in the non-progression group with an average growth rate of 0.14 mm/year, and 60 cases (14.96%) were in the progression group with an average growth rate of 1.74 mm/year. The age of the progression group was lower than that of the non-progression group [(41.43 ± 9.64) years vs. (44.50±10.29) years], the initial maximum diameter of the tumors in the progression group was larger than that in the non-progression group [11.0 (8.0, 16.0) mm vs. 9.0 (7.0, 11.0) mm], and the proportion of multiple tumors in the progression group was higher than that in the non-progression group [14 cases (23.30%) vs. 28 cases (8.20%)], and the differences were all statistically significant ( P<0.05). Age at initial diagnosis( OR=0.96, 95% CI 0.93-0.99), initial tumor size ( OR=1.08, 95% CI 1.04-1.12) and number of lesions ( OR=2.96, 95% CI 1.38-6.34) were the risk factors for the growth of renal angiomyolipoma ( P<0.05), according to the results of multivariate logistic regression analysis. Conclusions:The natural history of most renal angiomyolipoma shows slow growth or relative quiescence, with a small number showing a significant increasing trend. Age at initial diagnosis, initial tumor size and number of lesions were independent risk factors for the growth of renal angiomyolipoma.