Objective To investigate whether Danshen injection (DSI) can protect human brain organoids from oxidative stress damage by regulating the Nrf2 signaling pathway and its mechanism. Methods A Nrf2 plasmid was constructed, lentivirus was packaged and transfected into human induced pluripotent stem cell (hiPSC) to form a stable cell line. Brain organoids with Nrf2 overexpression (LV-Nrf2 group) and knockdown (sh-Nrf2 group) were constructed using kit. The transfection efficiency was verified by real-time fluorescence quantitative polymerase chain reaction. An oxidative stress injury model was established by inducing hydrogen peroxide (H₂O₂). Intervention was performed either in combination or without DSI pre-treatment. Cell viability was detected by Cell Counting Kit-8 (CCK-8), and the expression levels of Nrf2, malondialdehyde (MDA), interleukin (IL)-1β, sex-determining region Y-box protein 2 (SOX2) and neuronal-specific nuclear protein (NeuN) were detected by Western blot and immunofluorescence staining. Total RNA from human brain organoids was extracted for transcriptome sequencing and analysis. Results LV-Nrf2 group and sh-Nrf2 group brain organoid models were successfully constructed. The CCK-8 results determined that the oxidative stress model was established with 32 mmol/L H₂O₂ intervention conditions. The fluorescence expression of Nrf2 in LV-Nrf2 group was higher than that in control group, and the fluorescence expressions of MDA and IL-1β were lower than those in control group; sh-Nrf2 group showed a damage phenotype of low Nrf2 expression, high MDA and IL-1β expression (all P < 0.05). Compared with H₂O₂ group, the Nrf2 signal in DSI + H₂O₂ group was stronger, and the levels of MDA and IL-1β were lower. Among them, the protective effect of LV-Nrf2 was the most significant. H₂O₂ treatment could down-regulate the protein levels of Nrf2, SOX2 and NeuN, and DSI intervention could effectively reverse the downward trend of these indicators. Sh-Nrf2 could weaken the recovery effect of DSI on SOX2 and NeuN, while LV-Nrf2 could synergistically enhance the regulatory effect of DSI. Conclusions DSI may antagonize oxidative stress damage in human brain organoids through the Nrf2 signaling pathway, and maintaining the stability of the neural cell lineage is its core therapeutic characteristic.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective To identify predictive indicators for unscheduled rehospitalisation within 3 months in patients of oral endotracheal intubation(OEI)with ultrasound gray level co-occurrence matrix(GLCM)and develop a corresponding risk assessment system for the purpose to reduce the event of unscheduled rehospitalisation.Methods A total of 260 OEI patients who underwent extubation in a Tier-IIIA hospital between October 2023 and May 2024 were enrolled by convenience sampling.Patients were divided into a rehospitalisation group and a non-rehospitalisation group according to the event of unscheduled rehospitalisation within 3 months after discharge.Demographic data and laboratory test report,ultrasound morphological indicators and GLCM of rectus femoris muscle were collected on day-1 and day-7 after extubation.Multivariate logistic regression analysis and Framingham risk function were used to identify independent risk factors for unscheduled rehospitalisation within 3 months.A risk assessment system for unscheduled rehospitalisation within 3 months was subsequently developed.Predictive accuracy were evaluated using receiver operating characteristic(ROC)curve and area under the curve(AUC),and Hosmer-Lemeshow test.Results Toally 224 patients were included.The incidence of unplanned rehospitalization within 3 months in patients with oral tracheal intubation was 35.71%(80/224).The independent risk factors for unscheduled rehospitalisation within 3 months in OEI patients were identified as age≥60,nutrition risk screening2002≥3,shock index≥1.0,duration of mechanical ventilation≥251 hours,rectus femoris cross-sectional area≤1.41cm2,angular second moment≤0.71,the proportion change rate of ratio of rectus femoris on quadriceps femoeis for 0 on day-7 after extubation.The risk assessment system exhibited an AUC of 0.791(95%CI:0.707～0.875,P<0.001),with a sensitivity of 75.02%and a specificity of 67.33%.The Hosmer-Lemeshow value was 2.581(P=0.630),and the optimal cut-off value was determined at 3.Conclusion The developed risk assessment system demonstrates a satisfactory predictive performance.It provides a valuable reference for clinical assessment of the patients who had unscheduled rehospitalisation within 3 months in OEI patients.

Objective To identify predictive indicators for unscheduled rehospitalisation within 3 months in patients of oral endotracheal intubation(OEI)with ultrasound gray level co-occurrence matrix(GLCM)and develop a corresponding risk assessment system for the purpose to reduce the event of unscheduled rehospitalisation.Methods A total of 260 OEI patients who underwent extubation in a Tier-IIIA hospital between October 2023 and May 2024 were enrolled by convenience sampling.Patients were divided into a rehospitalisation group and a non-rehospitalisation group according to the event of unscheduled rehospitalisation within 3 months after discharge.Demographic data and laboratory test report,ultrasound morphological indicators and GLCM of rectus femoris muscle were collected on day-1 and day-7 after extubation.Multivariate logistic regression analysis and Framingham risk function were used to identify independent risk factors for unscheduled rehospitalisation within 3 months.A risk assessment system for unscheduled rehospitalisation within 3 months was subsequently developed.Predictive accuracy were evaluated using receiver operating characteristic(ROC)curve and area under the curve(AUC),and Hosmer-Lemeshow test.Results Toally 224 patients were included.The incidence of unplanned rehospitalization within 3 months in patients with oral tracheal intubation was 35.71%(80/224).The independent risk factors for unscheduled rehospitalisation within 3 months in OEI patients were identified as age≥60,nutrition risk screening2002≥3,shock index≥1.0,duration of mechanical ventilation≥251 hours,rectus femoris cross-sectional area≤1.41cm2,angular second moment≤0.71,the proportion change rate of ratio of rectus femoris on quadriceps femoeis for 0 on day-7 after extubation.The risk assessment system exhibited an AUC of 0.791(95%CI:0.707～0.875,P<0.001),with a sensitivity of 75.02%and a specificity of 67.33%.The Hosmer-Lemeshow value was 2.581(P=0.630),and the optimal cut-off value was determined at 3.Conclusion The developed risk assessment system demonstrates a satisfactory predictive performance.It provides a valuable reference for clinical assessment of the patients who had unscheduled rehospitalisation within 3 months in OEI patients.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

This article reviews the high-risk factors, risk assessment tools, information identification systems, and nursing management strategies of incontinence-associated dermatitis, in order to provide evidence for medical and nursing staff to choose appropriate identification tools and early identify high-risk patients with incontinence-associated dermatitis.

Objective:To evaluate and summarize evidence related to structured skin care for incontinence-associated dermatitis (IAD) in adult inpatients, so as to provide a reference for clinical nursing decision-making.Methods:Clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus related to structured skin care for IAD in adult inpatients were retrieved by computer in British Medical Journal Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, Canadian Registered Nurses Association of Ontario, Guidelines International Network, National Guideline Centre, National Institute for Health and Care Excellence, Medlive, the Cochrane Library, PubMed, Web of Science, CINAHL, Embase, WanFang Data, VIP, China National Knowledge Infrastructure, China Biomedical Literature Database. The retrieval time limit was from the establishment of the database to April 30, 2021. Two investigators independently assessed the quality of the included evidence and the level of recommendation.Results:A total of 14 articles were included, involving 2 clinical decisions, 1 practice guideline, 6 evidence summaries, 2 systematic reviews, and 3 expert consensus. A total of 29 best evidence was compiled from 4 aspects of structured skin care assessment, cleansing, moisturizing and isolation.Conclusions:Medical and nursing staff should integrate evidence with clinical scenarios and patient preferences to make optimal clinical decisions on structured skin care and improve the quality of care for adult inpatients with IAD.

OBJECTIVE: To evaluate the effectiveness and security of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of single level cervical spondylopathy with intraspinal ossification. METHODS: Twenty three patients with single level cervical spondylopathy with intraspinal ossification were treated by posterior percutaneous endoscopic cervical discectomy between August 2017 and July 2019. There were 16 males and 7 females, aged from 29 to 74 years old with an average of (50±13) years.The disease duration were 3 to 120 months with a median of 6 months. There were 9 cases of cervical spondylotic radiculopathy, 6 cases of cervical spondylotic myelopathy, and 8 cases of mixed cervical spondylopathy. According to the characteristics of ossification, 17 cases were osteophytes on the posterior edge of the vertebral body;3 cases were protrusion ossification;3 cases were posterior longitudinal ligament ossification. According to the position of ossification in spinal canal, 14 cases were medial and lateral type, 5 cases were central type, and 4 cases were mixed type. Posterior percutaneous cervical endoscopic cervical discectomy in patients performed by the same surgeon. Japanese Orthopaedic Association (JOA) score and visual analogue scale(VAS) were compared separately before and after operation. At 3 months after operation, clinical effect was assessed according to modified Macnab standard. RESULTS: All operations were successful. The operative time was 30 to 155 (69.1±27.2) min. The bedridden time was 2 to 3(3.0±0.9) h, length of postoperative hospitalization was 2 to 7(4.1± 1.5) d. Three dimensional CT reconstruction of the cervical spine at 3 days after operation showed that ossified tissue of 13 cases were completely removed, and 10 cases were left after operation, and the residual was located at the posterior edge and/or center of the upper vertebral body. VAS score at discharge from hospital was significantly lower than that before operation ( CONCLUSION For an experienced surgeon, percutaneous posterior cervical endoscopic discectomy is safe and reliable in treating single level cervical spondylopathy with intraspinal ossification, and can obtain good clinical results.
Adult ; Aged ; Cervical Vertebrae/surgery* ; Diskectomy ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Intervertebral Disc Displacement/surgery* ; Male ; Middle Aged ; Osteogenesis ; Retrospective Studies ; Treatment Outcome

Objective:To evaluate the effects of pulmonary rehabilitation on anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) .Methods:The RCTs on application effects of pulmonary rehabilitation in COPD patients were searched in Cochrane Library, Medline, PsycINFO, PubMed, Web of Science, Embase, China Biology Medicine disc, CNKI, Wanfang Database and VIP Database from the establishment of those databases to August 1, 2020. Quality assessment and data extraction were performed for the included articles, and Meta-analysis was performed using Stata 14.0 and RevMan 5.3 software.Results:A total of 14 articles were included, including 1 106 patients. Meta-analysis results showed that pulmonary rehabilitation therapy was helpful to improve the symptoms of depression [ SMD= -0.79, 95% CI (-0.94--0.64) , P<0.01]and anxiety [ SMD=-0.61, 95% CI (-0.82--0.41) , P<0.01]in COPD patients. The results of subgroup analysis showed that the relief degree of depression and anxiety of patients in the intervention group was statistically significantly different from those of the control group ( P<0.01) when the intervention was longer than 3 months or less than or equal to 3 months. Conclusions:Pulmonary rehabilitation can improve the depression and anxiety of COPD patients, and the results of intervention for more than 3 months and less than or equal to 3 months are consistent. Combining the actual clinical situation, the shortest intervention time of 3 months can be used for intervention in order to obtain more ideal intervention effect.

OBJECTIVEThis study aimed to evaluate the effectiveness of multi-disciplinary treatment approaches in reducing neurological disabilities in premature infants.

METHODSA total of 117 infants who were born premature in our hospital between March 2008 and February 2010 but had no congenital malformations and no severe neonatal complications, were enrolled in this study. They were randomly allocated to a multi-disciplinary treatment group (n=63) and a control group (n=54). While patients in the control group underwent an early conventional treatment, those in the multi-disciplinary treatment group were subjected to regular development monitoring, neurological examination and screening for brain injury, neuro-nutrition and neurodevelopment therapies, and rehabilitation training.

RESULTSThe incidence rates of abnormalities in posture, reflex, sleep, muscle tone and EEG were significantly lower in the multi-disciplinary treatment group than in the control froup (P<0.05) at corrected postnatal ages of 6-12 months. At corrected postnatal ages of 6, 12, 18 and 24 months, both mental development index (MDI) and psychomotor development index (PDI) scores were significantly higher in the multi-disciplinary treatment group than in the control group (P<0.05). At corrected postnatal age of 3 years, incidence rates of cerebral palsy, language barrier, abnormal muscle tone and hearing impairment were significantly lower in the multi-disciplinary treatment group than in the control group (P<0.05).

CONCLUSIONSEarly multi-disciplinary intervention approaches may significantly improve mental and motor developments and reduce the incidence of cerebral palsy-associated neurological disabilities in premature infants.

Cerebral Palsy ; prevention & control ; Child, Preschool ; Developmental Disabilities ; prevention & control ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; prevention & control ; Male