BACKGROUND:Platelet-rich fibrin(PRF)has many advantages,such as simple preparation,low production cost,and high safety,and has been widely used in the study of bone defect repair in oral and maxillofacial surgery,but there are problems such as too fast degradation rate and short release time of growth factors. OBJECTIVE:PRF was loaded into gelatin methacryloyl(GelMA)hydrogel and its osteogenic properties were analyzed by in vivo and in vitro experiments. METHODS:(1)New Zealand white rabbit venous blood was extracted to prepare PRF.GelMA hydrogels containing 0,0.05,0.075,and 0.1 g PRF were prepared,respectively,and were recorded as GelMA,GelMA/PRF-0.05,GelMA/PRF-0.075,and GelMA/PRF-0.1,respectively,to characterize the micromorphology and in vitro slow-release properties of the hydrogels.(2)Four kinds of hydrogels were co-cultured with MC3T3-E1 cells,respectively,and the cell proliferation activity was detected with the single cultured cells as the control.After osteogenic induction,alkaline phosphatase activity,mineralization ability,mRNA and protein expression levels of osteogenic genes(osteocalcin,osteopontin,RUNX2),ERK1/2-p38 MAPK pathway protein mRNA and protein expression levels were detected.(3)Fifteen New Zealand white rabbits were taken.Four full-layer bone defects of 8 mm diameter were prepared in the skull of each rabbit,one of which was implanted without any material(blank control group),and the other three were implanted with GelMA hydrogel,PRF,and GelMA/PRF-0.1 hydrogel,respectively.The bone defect was detected by Micro-CT and bone morphology was observed at 4,8,and 12 weeks after operation. RESULTS AND CONCLUSION:(1)Scanning electron microscopy observed that all the hydrogels of the four groups had honeycomb pore structure,and the pore size of the hydrogels decreased slightly with the increase of PRF content,but there was no significant difference between the groups.The three groups of GelMA/PRF hydrogel could release transforming growth factor β1 and insulin-like growth factor 1 at a certain rate,and the cumulative release of transforming growth factor β1 and insulin-like growth factor 1 increased significantly with the extension of time.(2)CCK-8 assay and live/dead staining showed that GelMA/PRF hydrogel could promote the proliferation of MC3T3-E1 cells.The results of alkaline phosphatase staining,alizarin red staining,and osteogenic gene detection showed that GelMA/PRF hydrogel could promote the osteogenic differentiation of MC3T3-E1 cells,and inhibit the expression of ERK1/2-p38 MAPK pathway protein,and showed a PRF content dependence.(3)Micro-CT scan showed that the bone mineral density and bone volume fraction in the bone defect of GelMA/PRF-0.1 hydrogel group were higher than those in the other three groups(P<0.05).Hematoxylin-eosin staining showed that compared with the other three groups,GelMA/PRF-0.1 hydrogel group had faster and more mature new bone formation at the bone defect.(4)These findings indicate that GelMA/PRF hydrogel has good osteogenic activity both in vivo and in vitro,which may be related to inhibiting the expression of ERK1/2-p38 MAPK pathway protein.

Objective To develop an ultra-high performance liquid chromatography-tandem mass spectrometry （UPLC-MS/MS） method to simultaneously determine 10 main components, including berberine, phellodendrine, specnuezhenide, mangiferin, loganin, paeoniflorin, geniposide, baicalin, and acteoside in Compound Dihuang oral solution. Methods An UPLC-MS/MS method was established with an ACQUITY UPLC BEH-C18 （2.1 mm×100 mm, 1.7 μm）column and mobile phase of 0.1% formic water（A）-methanol solution（B） in a gradient elution manner. The flow rate of mobile phase was 0.2 ml/min.The temperature of column was 30℃. The injection volume was 2 μl. The MS detection was in MRM mode. Results 10 components in Compound Dihuang oral solution had a good linear relationship within their concentration range,and the precision, repeatability, stability and recovery met the requirements. The contents of berberine, phellodendrine, specnuezhenide, mangiferin, loganin, paeoniflorin, geniposide, baicalin, and acteoside in 7 batches of samples were （89.7-95.6） μg/ml, （164.0-177.7） μg/ml, （540.0-610.0） μg/ml, （408.7-429.0） μg/ml, （726.0-825.0） μg/ml, （503.7-572.0） μg/ml, （1380.0-1540.0） μg/ml, （2596.7-2896.7) μg/ml, （4866.7-5520.0) μg/ml, （61.8-67.2) μg/ml, respectively. Conclusion The established method was easy to be repeated and operated. The contents of 10 components in Compound Dihuang oral solution could be determined quickly and accurately, which provided a reference for the quality control of hospital preparation.

Objective:To study the clinical value of enhanced recovery after surgery(ERAS) strategy combined with early intestinal fluid reinfusion among neonates receiving jejunostomy due to intestinal obstruction.Methods:From December 2018 to December 2022, neonates with intestinal obstruction receiving jejunostomy in the Department of Neonatal Surgery of our hospital were prospectively enrolled. They were randomly assigned into ERAS group and traditional treatment (TT) group after surgery. The ERAS group was treated with ERAS strategy plus early intestinal fluid reinfusion. The TT group was treated with conventional gastrointestinal decompression, analgesia as needed and enteric fluid reinfusion according to the amount of defecation. The postoperative parenteral nutrition (PN) duration (T pn), central venous catheter (CVC) duration (T cvc), daily weight gain, duration of postoperative hospital stay (T hos), complications and readmission rate within 30 days were compared between the two groups. Results:A total of 22 cases were included in the ERAS group and 20 cases were in the TT group. T pn [(22.6±9.4) d vs. (30.7±11.3) d], T cvc [(5.9±0.8) d vs. (9.9±2.1) d] and T hos [(26.8±9.8) d vs. (33.8±11.5) d] in the ERAS group were significantly shorter than the TT group ( P<0.05). No significant difference existed in daily weight gain between the two groups ( P>0.05). The incidence of postoperative gastrointestinal mucosal bleeding in the ERAS group was significantly lower than the TT group (13.6% vs. 45.0%)( P<0.05). No significant differences existed in the following items between the two groups: feeding intolerance, PN-associated cholestasis, CVC-related bloodstream infection, intestinal fluid reinfusion-related complications, premature closure of fistula and readmission rate within 30 days (all P>0.05). Conclusions:The application of ERAS strategy plus early intestinal fluid reinfusion in neonates with enterostomy is safe and feasible, which can reduce the postoperative durations of PN, CVC and hospital stay and accelerate the recovery.

Objective To compare the efficacies between auricular acupuncture combined with drugs and drug alone in the treatment of frequent ventricular premature beats(FVPB).Methods A total of 51 pa-tients with FVPB admitted to this hospital from January to December 2022 were selected as the study sub-jects,including 27 patients in the treatment group and 24 cases in the control group.The treatment group was given auricular acupuncture combined with oral metoprolol tartrate tablets,the heart and ear points and adre-nal ear points were selected,the two ears were treated alternately and the needles were replaced after 3 days.The control group was only given oral metoprolol tartrate tablets,and the adhesive tape of the same color and material were pasted at the same auricular acupoints.The number of premature beats,the TCM symptom score and clinical efficacy on 1 day before treatment and on 1,6 days after treatment were compared between the two groups.Results The number of premature beats on 1 day after treatment in the treatment group was 733(427,1 637)times,which in the control group was 2 244(1 023,2 808)times.On 6 days after treatment,the number of premature beats in the treatment group was 182(116,321)times,which in the control group was 1 025(678,1 127)times.On 6 days after treatment,the number of premature beats in the treatment group was averagely reduced by 765.49 times compared with the control group(95％CI:-976.41 to-554.56,P＜0.001).On 1,6 days after treatment,the TCM symptom scores in the treatment group all were lower than those in the control group,and the difference was statistically significant(P＜0.05).The effective rate of the treatment group was 92.59％,which was higher than 83.33％in the control group,and the differ-ence was statistically significant(P＜0.05).Conclusion Compared with drug therapy alone,auricular acu-puncture combined with drug therapy for treating FVPB could achieve better clinical efficacy.

Objective:To investigate the association of exposure to PM 2.5 and its constituents during pregnancy and fetal growth and to further identify critical windows of exposure for fetal growth. Methods:We included 4 089 mother-child pairs from the Jiangsu Birth Cohort Study between January 2016 and October 2019. Data of general characteristics, clinical information, daily average PM 2.5 exposure, and its constituents during pregnancy were collected. Fetal growth parameters, including head circumference (HC), abdominal circumference (AC), and femur length (FL), were measured by ultrasound after 20 weeks of gestation, and then estimated fetal weight (EFW) was calculated. Generalized linear mixed models were adopted to examine the associations of prenatal exposure to PM 2.5 and its constituents with fetal growth. Distributed lag nonlinear models were used to identify critical exposure windows for each outcome. Results:A 10 μg/m 3 increase in PM 2.5 exposure during pregnancy was associated with a decrease of 0.025 ( β=-0.025, 95% CI: -0.048- -0.001) in HC Z-score, 0.026 ( β=-0.026, 95% CI: -0.049- -0.003) in AC Z-score, and 0.028 ( β=-0.028, 95% CI:-0.052--0.004) in EFW Z-score, along with an increased risk of 8.5% ( RR=1.085, 95% CI: 1.010-1.165) and 13.5% ( RR=1.135, 95% CI: 1.016-1.268) for undergrowth of HC and EFW, respectively. Regarding PM 2.5 constituents, prenatal exposure to black carbon, organic matter, nitrate, sulfate (SO 42-) and ammonium consistently correlated with decreased HC Z-score. SO 42- exposure was also associated with decreased FL Z-scores. In addition, we found that gestational weeks 2-5 were critical windows for HC, weeks 4-13 and 19-40 for AC, weeks 4-13 and 23-37 for FL, and weeks 4-12 and 20-40 for EFW. Conclusions:Our findings demonstrated that exposure to PM 2.5 and its constituents during pregnancy could adversely affect fetal growth and the critical windows for different fetal growth parameters are not completely consistent.

Objective To explore the clinical value of serum histone deacetylase 2(HDAC2)and histone deacetylase 6(HDAC6)levels combined with Doppler ultrasound indicators in diagnosing the occurrence of preeclampsia(PE)and fetal growth restriction(FGR)in pregnant women.Methods A total of 176 PE and FGR pregnant women who underwent regular prenatal examination and delivered at Cangzhou Integrated Tra-ditional Chinese and Western Medicine Hospital from March 2021 to May 2023 were selected as the study sub-jects and separated into PE group(94 cases)and FGR group(82 cases),pregnant women with normal prena-tal examination results and delivery during the same period were selected as control group(91 cases).Enzyme linked immunosorbent assay was applied to detect the levels of serum HDAC2 and HDAC6,respectively.Doppler ultrasound was applied to detect resistance index(RI),pulsatile index(PI),and the ratio of maximum systolic and diastolic blood flow velocity of the umbilical artery(S/D).Receiver operating characteristic(ROC)curve was applied to analyze the clinical diagnostic value of Doppler ultrasound indicators(RI,PI,S/D)and HDAC2,HDAC6 for PE and FGR.Results The gestational age and spontaneous delivery rate in the PE and FGR groups were obviously lower than those in the control group(P＜0.05).The levels of serum HDAC2 and HDAC6 in the PE and FGR groups were obviously lower than those in the control group(P＜0.05).RI,PI,and S/D in the PE and FGR groups were obviously higher than those in the control group(P＜0.05).The area under the curve(AUC)of Doppler ultrasound indicators combined with serum HDAC2 and HDAC6 for diagnosing PE and FGR was 0.968 and 0.949,respectively,which was better than that of single detection(all P＜0.001).Conclusion The serum levels of HDAC2 and HDAC6 in pregnant women with PE and FGR are obviously reduced,and the combination of the two and Doppler ultrasound indicators has good di-agnostic value for the occurrence of PE and FGR.

Objective To discuss the clinical effect of biomimetic salivary gland induction technology in alleviating secondary xerostomia after endovascular intervention of isolated superior mesenteric artery dissection(ISMAD).Methods Using random number sampling method,a total of 80 patients with ISMAD,who received endovascular intervention at the Affiliated Nanjing Hospital of Nanjing Medical University of China between March 2020 and December 2022,were selected as the research subjects.For the patients of control group(n=40)the warm-water(25-35 ℃)cotton swab was adopted to moisten the lips from one hour to 48 hours after endovascular intervention,which was given once every 15 minutes within postoperative 1-2 hours,which was followed by once every 30 minutes within postoperative 3-48 hours.For the patients of study group(n=40)with the help of biomimetic salivary gland induction technology a continuous and controlled water flow at a rate of 15 mL/h was given from one hour to 48 hours after endovascular intervention to continuously keep the lips and mouth moist.The postoperative one-,12-,24-and 48-hour degrees of mouth dryness and oral comfort in both groups were analyzed.Results The postoperative one-,12-,24-,and 48-hour incidence of thirsty and the degrees of severity in the study group were significantly lower than those in the control group(all P＜0.01),and the degrees of oral comfort at postoperative different time points in the study group were remarkably better than those in the control group(all P＜0.01).Conclusion The use of biomimetic salivary gland induction technology in patients with ISMAD after receiving endovascular intervention therapy can significantly reduce the incidence and severity of thirsty and improve oral comfort.

Objective:To explore the application of flash glucose monitoring (FGM) system in patients with type 2 diabetes and its impact on patients, and to provide reference for improving blood glucose management in patients with type 2 diabetes.Methods:Qualitative research method was adopted. Purposive sampling was used to select patients with type 2 diabetes who received FGM in Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing First Hospital from December 2023 to February 2024 as interview subjects. Semi-structured interview method was conducted for one-to-one in-depth interview, and thematic analysis was used to sort out and analyze data, identify and refine themes.Results:A total of 15 interviewees were included, including 7 males and 8 females, aged (61.27 ± 14.07) years. The interview results were summarized into five themes: behavioral changes of wearing FGM system (including changes of patients′blood glucose monitoring, diet, exercise and medication behaviors); FGM system improves the convenience and comfort of blood glucose monitoring; FGM system can effectively improve patients′sense of security; the advice of medical staff affects the willingness of patients to wear FGM system; price factors affect patients′willingness to wear FGM systems on a regular basis.Conclusions:The FGM system plays an important role in the management of patients with type 2 diabetes, improving patients′self-management behavior and blood glucose monitoring experience, and improving patients′sense of security. Medical personnel play an important role in the decision-making of patient disease management. However, price is an important factor restricting patients to wear regularly, and efforts should be made to improve the popularity of FGM system.

Objective:To explore the application effect of Sihuang Powder application on Yongquan Point in patients undergoing hip and knee replacement.Methods:The convenient sampling method was used to select 172 patients after hip and knee replacement in Yantai Mountain Hospital from October 2021 to August 2022 as the research objects. They were divided into the control group ( n=85) and the experimental group ( n=87) by the random number table method. Patients in the control group were treated with routine nursing intervention, while patients in the experimental group were treated with Sihuang Powder application on Yongquan Point on the basis of control group. The fibrinogen content and D-dimer before and after intervention, the incidence of deep vein thrombosis (DVT) in lower limbs during hospitalization and the length of postoperative hospitalization were compared between the two groups. Results:On the thrid day after operation, fibrinogen content and D-dimer level of the experimental group were lower than those of control group, and the differences were statistically significant ( P< 0.05). The incidence of DVT during hospitalization in the experimental group was 5.75% (5/87), lower than 15.29% (13/85) in the control group, and the difference was statistically significant (P<0.05). The postoperative hospitalization days in the experimental group was shorter than that in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:Applying Sihuang Powder to Yongquan Acupoint can effectively improve blood hypercoagulability, reduce the incidence of lower limb DVT in patients after hip and knee replacement surgery, reduce postoperative complications and effectively shorten the length of hospital stay.

Objective:To explore the current status of medication adherence to immunosuppressants in lung transplant recipients and to analyze its correlation with medication beliefs and perceived social support.Methods:This was a cross-sectional study. From June 2022 to April 2023, totally 233 lung transplant recipients who were followed up in the Department of Lung Transplantation at China-Japan Friendship Hospital were selected by convenience sampling. The Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS), the Chinese version of the Beliefs about Medicines Questionnaire, and the Perceived Social Support Scale (PSSS) were used for the survey. Multiple linear regression analysis was conducted to explore the correlation between medication adherence to immunosuppressants, medication beliefs, and perceived social support in these lung transplant recipients.Results:A total of 233 questionnaires were distributed, with 213 valid responses received (91.42%). The incidence of non-adherence to immunosuppressants among the 213 transplant recipients was 41.78% (89/213), with the most common issue being not taking medication on time (27.23%, 58/213). Multiple linear regression analysis showed that age and perceived social support were influencing factors of medication adherence ( P<0.05) . Conclusions:The current level of medication adherence to immunosuppressants in lung transplant recipients is relatively poor. Medication adherence is correlated with age and the level of perceived social support. Healthcare providers should pay attention to medication adherence in younger patients and enhance their perceived social support to increase adherence to immunosuppressive medications.