BACKGROUND:The study of deer antler stem cells and exosomes to promote the repair of acute skin injuries has received increasing attention in recent years,but the effect and mechanism of exosomes composite hydrogel to promote the repair of burn wounds are still unclear.OBJECTIVE:To investigate the effect of deer antler stem cell exosome composite hydrogel on the healing speed and quality of rat deep third-degree burn wound and its mechanism of action.METHODS:Deer antler stem cell exosomes and bone marrow mesenchymal stem cell exosomes were extracted and compounded with Pluronic F-127 to prepare a temperature-sensitive hydrogel.A constant temperature and pressure burn apparatus was used to prepare a rat model of deep third-degree burn.The drug was administered to four groups:deer antler stem cell exosome composite hydrogel group,bone marrow mesenchymal stem cell exosome composite hydrogel group,human epidermal growth factor gel group,and the control group.The healing of burned rats was observed and the wound healing rate was calculated.At 28 days after burn,hematoxylin-eosin staining was used to observe the generation of skin accessory structures in the healing tissues.Masson staining was used to analyze the accumulation of collagen in the healing tissues.Immunohistochemistry was used to examine the angiogenesis and nflammatory response in the healing tissues.qRT-PCR was used to examine the expression level of mRNA of the wound healing-related genes in the healing tissues.RESULTS AND CONCLUSION:(1)Deer antler stem cell exosome composite hydrogel can significantly promote the healing rate of deep burn wounds in rats,and improve the quality of wound healing by promoting the regeneration of skin collateral structures,increasing the dermal thickness and enhancing the accumulation of collagen.(2)The number of myofibroblasts in the wound healing tissues of deer antler stem cell exosome composite hydrogel group was significantly reduced,and the number of neovascularization and M2 macrophages was significantly increased.(3)The mRNA levels of transforming growth factor β3 and type Ⅲ collagen in the wound healing tissue of deer antler stem cell exosome composite hydrogel group were significantly higher than those of the blank group,and the mRNA levels of transforming growth factor β1,matrix metalloproteinase 3,and type Ⅰ collagen were significantly lower than those of the blank group,and there was no significant difference between the bone marrow-derived mesenchymal stem cell exosome composite hydrogel group and the human epidermal growth factor gel group.In conclusion,deer antler stem cell exosome composite hydrogel can promote the healing speed and the quality of healing of deep burned wounds in rats,which may be achieved by inhibiting fibroblastogenesis,promoting angiogenesis,macrophage M2 polarization,and regulating the expression of genes for collagen production/degradation.

Objective:To detect the biological markers related to Alzheimer's disease(AD)in the peripheral blood of AD patients,and to explore the activities and levels of the antioxidant function indexes and the expressions of related genes and proteins in the blood of AD patients and the changes after intervention of selenium-rich food.Methods:The Mini-Mental State Examination(MMSE)combined with electroencephalogram or brain CT and clinician diagnosis were used for screening AD.Fifty-six elderly patients with AD aged 75-90 years old were selected.Among them,28 cases were selected as normal diet group for AD(AD group),and 28 cases were selected as dietary selenium intervention group(Se-AD group).The patients in Se-AD group were given daily dietary selenium supplementation(increaseing dietary selenium by 15-20 μg per day)for 3 months.Meanwhile,30 people with the same age were selected as healthy control group.The activities of serum superoxide dismutase(SOD),cholinesterase(CHE),and glutathione peroxidase(GSH-Px)and the levels of serum malondialdehyde(MDA),homocysteine(Hcy),and nitric oxide(NO)as well as reagent kit the levels of serum β-amyloid protein(Aβ),and microtubule-associated protein(Tau)and phosphorylated microtubule-associated protein(p-Tau)of the subjects in various groups were detected by and enzyme-linked immunosorbent assay(ELISA)method;the expression levels of apolipoprotein E4(ApoE4),presenilin 1(PS1),presenilin 2(PS2),cysteinyl aspartate specific proteinase 3(Caspase3),sorting associated protein receptor 1(SORL1),β-site amyloid precursor protein cleaving enzyme 1(BACE1),hypoxia-inducible factor 1(HIF1),nuclear factor-kappa B(NF-κB),β-amyloid precursor protein(APP),protein kinase C(PKC),and Aβ mRNA in peripheral blood of the subjects various groups were detected by real-time fluorescence quantitative PCR(RT-qPCR)method.Results:Compared with healthy control group,the serum SOD activities of the patients in Se-AD group and AD group were significantly decreased(P＜0.05),while serum CHE activity and the levels of MDA and Hcy were significantly increased(P＜0.05);the serum GSH-Px activity of the patients in AD group was significantly decreased(P＜0.05),and the level of NO was significantly increased(P＜0.05).Compared with Se-AD group,serum CHE activity and the level of Hcy of the patients in AD group were significantly increased(P＜0.05).The expression levels of ApoE4,PS1,Caspase3,BACE1,NF-κB and APP mRNA of the patients in Se-AD group and AD group were significantly increased(P＜0.05),and the expression levels of PKC mRNA were significantly decreased(P＜0.05);the expression level of PS2 mRNA of the patients in AD group was significantly increased(P＜0.05),and the expression levels of Aβ mRNA of the patients in Se-AD group and AD group were significantly increased(P＜0.05).Conclusion:The activities of serum SOD,GSH-Px and CHE and the levels of MDA,Hcy and NO,the levels of Aβ,Tau and p-Tau proteins,and the expression levels of ApoE4,PS1,Caspase3,BACE1,NF-κB,PKC,PS2,Aβ and APP mRNA in peripheral blood of the AD patients may vary and can be used for clinical diagnosis of the AD patients.Selenium-rich food can improve AD to some extent,and its mechanism is related to reducing the oxidative damage of brain tissue and decreasing the expression of AD related genes PS2 and Aβ.

Objective:To explore the correlation between serum glucose regulated protein 78 (GRP78) and prohibitin1 1 (PHB1) with poor prognosis in emergency sepsis patients.Methods:A prospective study was conducted to select 99 patients with sepsis admitted to the emergency department of the Zibo 148 Hospital from January 2021 to January 2024 as the study subjects. After admission, serum GRP78 and PHB1 levels were tested, and the survival status of patients within 28 d of admission was statistically analyzed. In addition, 99 non-infected people who came to the Zibo 148 Hospital for physical examination during the same period were taken as the control group. The serum levels of GRP78 and PHB1 between patients with sepsis and the control group were compared. Baseline data and serological indicators of sepsis patients with different prognoses were compared. Correlation analysis, Logistic regression analysis and receiver operating characteristic curve (ROC) were used to explore the relationship between serum GRP78, PHB1 and poor prognosis in patients with emergency sepsis.Results:The serum levels of GRP78 and PHB1 in sepsis patients were higher than those in the control group: (125.08 ± 27.92) μg/L vs. (97.73 ± 15.62) μg/L, (186.65 ± 26.85) ng/L vs. (147.89 ± 24.63) ng/L, there was statistical difference ( P<0.05). Among the 99 patients with sepsis, 25 patients (25.25%) died within 28 d of admission. The deceased patients were included in the poor prognosis group, while the remaining 74 patients (74.75%) were included in the good prognosis group. The age of the poor prognosis group was older than that of the good prognosis group: (66.52 ± 4.72) years vs. (62.24 ± 3.67) years, the proportion of diabetes in the good prognosis group was higher: 72.00% (18/25)vs. 25.68%(19/74), the infectious shock group was higher than that of the good prognosis group: 60.00% (15/25) vs. 16.22%(12/74), and the serum GRP78 and PHB1 levels were higher than those in the good prognosis group: (149.50 ± 31.53) μg/L vs. (116.82 ± 21.13) μg/L, (209.91 ± 19.06) ng/L vs. (178.79 ± 24.51) ng/L, there were statistical differences ( P<0.05). The correlation analysis showed that age, diabetes, disease severity, serum GRP78, PHB1 were associated with poor prognosis of emergency sepsis patients (correlation coefficient was 0.428, 0.416, 0.427, 0.511, 0.506, P<0.05). Logistic regression analysis showed that serum GRP78, PHB1, age, diabetes and severity could affect the poor prognosis of emergency sepsis patients ( P<0.05). ROC curve was drawn, and the results indicated that the area under the curve value of serum GRP78 and PHB1 combined to predict poor prognosis in patients with emergency sepsis was 0.889 (95% CI 0.823 - 0.955), the sensitivity was 96.00%, and the specificity was 66.20%, which was higher than any single index. Conclusions:The occurrence of poor prognosis in patients with emergency sepsis is related to the increased expression of serum GRP78 and PHB1.Clinically, the risk of poor prognosis in patients with sepsis can be evaluated in advance by the levels of serum GRP78 and PHB1 detected at admission.

Objective To explore different construction models and experiences of clinical laboratory centers under exist-ing Integrated county healthservices entity,analyze and discuss the characteristics of various construction models,and provide ref-erences for the development of county-level clinical laboratory centers.Methods Based on the five factors of"man,machine,material,method,and environment"in Total Quality Management theory,an interview outline and questionnaire were designed for county-level clinical laboratory centers.Eleven county-level clinical laboratory centers across the country were investigated to analyze their construction models,investment returns,and other aspects.Literature reviews and case studies were also conducted to summarize the construction models and characteristics of county-level clinical laboratory centers.Results The construction models of county-level clinical laboratory centers are mainly divided into five types,each with distinct features.Through an analy-sis of the investment returns of these models unde rIntegrated county healthservices entity,it was found that a profit distribution ratio of approximately 5∶5 between county-level clinical laboratory centers and township health centers for referred samples is more conducive to maintaining the stability of sample sources.The construction model of county-level clinical laboratory centers is closely related to the medical service capacity of both county and township levels.Conclusion Counties with stronger county hospital capabilities tend to establish relatively independent regional laboratory centers based on the county hospital's laboratory department.Regardless of the model,the primary goal of county-level clinical laboratory centers should be to provide high-quality testing services coverage across the entire county.The key to the success of county-level clinical laboratory centers lies in motiva-ting grassroots personnel.

BACKGROUND:The study of deer antler stem cells and exosomes to promote the repair of acute skin injuries has received increasing attention in recent years,but the effect and mechanism of exosomes composite hydrogel to promote the repair of burn wounds are still unclear.OBJECTIVE:To investigate the effect of deer antler stem cell exosome composite hydrogel on the healing speed and quality of rat deep third-degree burn wound and its mechanism of action.METHODS:Deer antler stem cell exosomes and bone marrow mesenchymal stem cell exosomes were extracted and compounded with Pluronic F-127 to prepare a temperature-sensitive hydrogel.A constant temperature and pressure burn apparatus was used to prepare a rat model of deep third-degree burn.The drug was administered to four groups:deer antler stem cell exosome composite hydrogel group,bone marrow mesenchymal stem cell exosome composite hydrogel group,human epidermal growth factor gel group,and the control group.The healing of burned rats was observed and the wound healing rate was calculated.At 28 days after burn,hematoxylin-eosin staining was used to observe the generation of skin accessory structures in the healing tissues.Masson staining was used to analyze the accumulation of collagen in the healing tissues.Immunohistochemistry was used to examine the angiogenesis and nflammatory response in the healing tissues.qRT-PCR was used to examine the expression level of mRNA of the wound healing-related genes in the healing tissues.RESULTS AND CONCLUSION:(1)Deer antler stem cell exosome composite hydrogel can significantly promote the healing rate of deep burn wounds in rats,and improve the quality of wound healing by promoting the regeneration of skin collateral structures,increasing the dermal thickness and enhancing the accumulation of collagen.(2)The number of myofibroblasts in the wound healing tissues of deer antler stem cell exosome composite hydrogel group was significantly reduced,and the number of neovascularization and M2 macrophages was significantly increased.(3)The mRNA levels of transforming growth factor β3 and type Ⅲ collagen in the wound healing tissue of deer antler stem cell exosome composite hydrogel group were significantly higher than those of the blank group,and the mRNA levels of transforming growth factor β1,matrix metalloproteinase 3,and type Ⅰ collagen were significantly lower than those of the blank group,and there was no significant difference between the bone marrow-derived mesenchymal stem cell exosome composite hydrogel group and the human epidermal growth factor gel group.In conclusion,deer antler stem cell exosome composite hydrogel can promote the healing speed and the quality of healing of deep burned wounds in rats,which may be achieved by inhibiting fibroblastogenesis,promoting angiogenesis,macrophage M2 polarization,and regulating the expression of genes for collagen production/degradation.

Objective To explore different construction models and experiences of clinical laboratory centers under exist-ing Integrated county healthservices entity,analyze and discuss the characteristics of various construction models,and provide ref-erences for the development of county-level clinical laboratory centers.Methods Based on the five factors of"man,machine,material,method,and environment"in Total Quality Management theory,an interview outline and questionnaire were designed for county-level clinical laboratory centers.Eleven county-level clinical laboratory centers across the country were investigated to analyze their construction models,investment returns,and other aspects.Literature reviews and case studies were also conducted to summarize the construction models and characteristics of county-level clinical laboratory centers.Results The construction models of county-level clinical laboratory centers are mainly divided into five types,each with distinct features.Through an analy-sis of the investment returns of these models unde rIntegrated county healthservices entity,it was found that a profit distribution ratio of approximately 5∶5 between county-level clinical laboratory centers and township health centers for referred samples is more conducive to maintaining the stability of sample sources.The construction model of county-level clinical laboratory centers is closely related to the medical service capacity of both county and township levels.Conclusion Counties with stronger county hospital capabilities tend to establish relatively independent regional laboratory centers based on the county hospital's laboratory department.Regardless of the model,the primary goal of county-level clinical laboratory centers should be to provide high-quality testing services coverage across the entire county.The key to the success of county-level clinical laboratory centers lies in motiva-ting grassroots personnel.

As the use of nursing information systems (NIS) in clinical nursing practice has proliferated, NIS education has received increased attention. This paper introduces the background and research form of NIS in nursing education at home and abroad, and summarizes the deficiencies in the application and puts forward suggestions, in order to provide references for the subsequent development of a high-quality system and the development of courses that fit the actual situation of nursing students in China.

Objective:To explore the correlation between serum glucose regulated protein 78 (GRP78) and prohibitin1 1 (PHB1) with poor prognosis in emergency sepsis patients.Methods:A prospective study was conducted to select 99 patients with sepsis admitted to the emergency department of the Zibo 148 Hospital from January 2021 to January 2024 as the study subjects. After admission, serum GRP78 and PHB1 levels were tested, and the survival status of patients within 28 d of admission was statistically analyzed. In addition, 99 non-infected people who came to the Zibo 148 Hospital for physical examination during the same period were taken as the control group. The serum levels of GRP78 and PHB1 between patients with sepsis and the control group were compared. Baseline data and serological indicators of sepsis patients with different prognoses were compared. Correlation analysis, Logistic regression analysis and receiver operating characteristic curve (ROC) were used to explore the relationship between serum GRP78, PHB1 and poor prognosis in patients with emergency sepsis.Results:The serum levels of GRP78 and PHB1 in sepsis patients were higher than those in the control group: (125.08 ± 27.92) μg/L vs. (97.73 ± 15.62) μg/L, (186.65 ± 26.85) ng/L vs. (147.89 ± 24.63) ng/L, there was statistical difference ( P<0.05). Among the 99 patients with sepsis, 25 patients (25.25%) died within 28 d of admission. The deceased patients were included in the poor prognosis group, while the remaining 74 patients (74.75%) were included in the good prognosis group. The age of the poor prognosis group was older than that of the good prognosis group: (66.52 ± 4.72) years vs. (62.24 ± 3.67) years, the proportion of diabetes in the good prognosis group was higher: 72.00% (18/25)vs. 25.68%(19/74), the infectious shock group was higher than that of the good prognosis group: 60.00% (15/25) vs. 16.22%(12/74), and the serum GRP78 and PHB1 levels were higher than those in the good prognosis group: (149.50 ± 31.53) μg/L vs. (116.82 ± 21.13) μg/L, (209.91 ± 19.06) ng/L vs. (178.79 ± 24.51) ng/L, there were statistical differences ( P<0.05). The correlation analysis showed that age, diabetes, disease severity, serum GRP78, PHB1 were associated with poor prognosis of emergency sepsis patients (correlation coefficient was 0.428, 0.416, 0.427, 0.511, 0.506, P<0.05). Logistic regression analysis showed that serum GRP78, PHB1, age, diabetes and severity could affect the poor prognosis of emergency sepsis patients ( P<0.05). ROC curve was drawn, and the results indicated that the area under the curve value of serum GRP78 and PHB1 combined to predict poor prognosis in patients with emergency sepsis was 0.889 (95% CI 0.823 - 0.955), the sensitivity was 96.00%, and the specificity was 66.20%, which was higher than any single index. Conclusions:The occurrence of poor prognosis in patients with emergency sepsis is related to the increased expression of serum GRP78 and PHB1.Clinically, the risk of poor prognosis in patients with sepsis can be evaluated in advance by the levels of serum GRP78 and PHB1 detected at admission.

As the use of nursing information systems (NIS) in clinical nursing practice has proliferated, NIS education has received increased attention. This paper introduces the background and research form of NIS in nursing education at home and abroad, and summarizes the deficiencies in the application and puts forward suggestions, in order to provide references for the subsequent development of a high-quality system and the development of courses that fit the actual situation of nursing students in China.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.