Ischemic stroke is the leading cause of disability and mortality worldwide. The blood‒brain barrier (BBB) is the first line of defense after ischemic stroke. Disruption of the BBB induced by brain microvascular endothelial cells (BMECs) dysfunction is a key event that triggers secondary damage to the central nervous system, where blood-borne fluids and immune cells penetrate the brain parenchyma, causing cerebral edema and inflammatory response and further aggravating brain damage. Here, we develop a novel artificial mesenchymal stem cell (MSC) extracellular vesicles by integrating MSC membrane proteins into liposomal bilayers, which encapsulated miR-132-3p with protective effects on BMECs. The artificial extracellular vesicles (MSCo/miR-132-3p) had low immunogenicity to reduce non-specific clearance by the mononuclear phagocytosis system (MPS) and could target ischemia-injured BMECs. After internalization into the damaged BMECs, MSCo/miR-132-3p escaped the lysosomes via the H_II phase transition of 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE) and decreased cellular reactive oxygen species (ROS) and apoptosis levels by regulating the RASA1/RAS/PI3K/AKT signaling pathway. In the transient middle cerebral artery occlusion (tMCAO) models, MSCo/miR-132-3p targeted impaired brain regions (approximately 9 times the accumulation of plain liposomes at 12 h), reduced cerebral vascular disruption, protected BBB integrity, and decreased infarct volume (from 44.95% to 6.99%).

This article reports a patient with typical Cushing syndrome′s manifestations and extremely low plasma cortisol level, indicating glucocorticoid hypersensitivity syndrome. After treatment with the glucocorticoid receptor antagonist mifepristone, the patient′s Cushing symptoms were significantly relieved, and cortisol levels returned to normal. The aim of this report is to enhance clinical awareness among physicians regarding glucocorticoid hypersensitivity syndrome.

BACKGROUND:Oral and maxillofacial bone tissue defects can seriously affect the physical and mental health of patients.When bone defects occur in diabetic patients,bone metabolism disorders caused by abnormal blood sugar make it more difficult to repair and treat. OBJECTIVE:To attempt to apply AOPDM1,a polypeptide with potential bioactivity to the osteogenic treatment of diabetic patients. METHODS:In normal or high-glucose environment,different concentrations of AOPDM1 were used to interfere with mouse bone marrow mesenchymal stem cells,and cell proliferation,alkaline phosphatase activity,mineralization nodules formation and osteogenic differentiation gene expression were detected.The polycaprolactone scaffold was prepared by electrospinning technology,and the scaffold was modified by polydopamine to prepare the polycaprolactone-polydopamine composite scaffold.Finally,the scaffolds were placed in AOPDM1 solution to prepare polycaprolactone-polydopamine-AOPDM1 scaffolds.The water contact angle and mechanical properties of the scaffolds were tested in the three groups.In normal or high-glucose environment,the three groups of scaffolds were co-cultured with mouse bone marrow mesenchymal stem cells,respectively,and cell adhesion,alkaline phosphatase activity and osteopontin expression were detected. RESULTS AND CONCLUSION:(1)Compared with normal environment,high-glucose environment inhibited the proliferation of bone marrow mesenchymal stem cells.In the same environment,AOPDM1 could promote the proliferation of mouse bone marrow mesenchymal stem cells.When AOPDM1 concentration was the same,alkaline phosphatase activity,mineralization ability and mRNA expression of type Ⅰ collagen,osteopontin,alkaline phosphatase,and Runx2 of bone marrow mesenchymal stem cells were decreased in high-glucose environment compared with normal environment.Under the same environment,AOPDM1 could improve the alkaline phosphatase activity,mineralization ability,and mRNA expression of type Ⅰ collagen,osteopontin,alkaline phosphatase and Runx2 of bone marrow mesenchymal stem cells.(2)The hydrophilicity of polycaprolactone-polydopamine scaffold and polycaprolactone-polydopamine-AOPDM1 scaffold was higher than that of polycaprolactone scaffold(P<0.001),and there was no significant difference in tensile strength and elastic modulus among the three groups(P>0.05).Compared with the other two groups of scaffolds,the cells on the polycaprolactone-polydopamine-AOPDM1 scaffold had better adhesion morphology.When the scaffolds were identical,compared with normal environment,high-glucose environment inhibited alkaline phosphatase activity and osteopontin expression of bone marrow mesenchymal stem cells.When the environment was the same,the alkaline phosphatase activity and osteopontin expression of bone marrow mesenchymal stem cells on the polycaprolactone-polydopamine-AOPDM1 scaffold were higher than those on the other two scaffolds.(3)The above results prove that polycaprolactone-polydopamine-AOPDM composite scaffold can promote the osteogenic properties of bone marrow mesenchymal stem cells in high-glucose environment.

OBJECTIVE In the process of drug dispensing, using computer vision technology to identify drugs is vulnerable to the influence of lighting, angle, packaging and other factors, which will produce large identification errors. Therefore, this paper proposes an object detection algorithm for drug appearance recognition(YOLOv4-GhostNet-CMB). METHODS Firstly, the algorithm redesigned the backbone feature extraction network in YOLOv4 by using GhostNet. Secondly, the CA attention model was brought into the Ghost module, aggregate features along horizontal and vertical directions to enhance the precise positioning of drugs. Finally, Bi-FPN feature pyramid structure was introduced to connect with the new backbone, and added a feature graph output which could enhance feature extraction and improved the detection accuracy of drugs. RESULTS The experimental results show that the average detection accuracy of YOLOv4-GhostNet-CMB algorithm reached 92.24%, which was a significant improvement of 4.49% compared with YOLOv4 algorithm in term of detection accuracy. CONCLUSION The model size is only 150 MB, nd this algorithm can effectively identify drugs.

ObjectiveTo investigate the ability of the modified albumin-bilirubin （mALBI） grade in predicting the prognosis of patients with Child-Pugh A unresectable hepatocellular carcinoma （uHCC） after transcatheter arterial chemoembolization （TACE） combined with immunotherapy and anti-angiogenic drugs （hereafter referred to as targeted immunotherapy）. MethodsA retrospective analysis was performed for the data of 76 patients with Child-Pugh A uHCC who met the inclusion criteria and underwent TACE combined with targeted immunotherapy in The First Affiliated Hospital of Soochow University from January 2020 to January 2023， and according to the mALBI grade， they were divided into mALBI 1/2a group with 38 patients and mALBI 2b group with 38 patients. The primary endpoint was overall survival （OS）， and the secondary endpoints were progression-free survival （PFS）， objective response rate （ORR）， and disease control rate （DCR）. Evaluation criteria included complete remission， partial remission， stable disease， and progressive disease. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups； the chi-square test was used for comparison of categorical variables between two groups. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison of median OS （mOS） and median PFS （mPFS） between groups. The univariate and multivariate Cox proportional hazards models were used to analyze the influencing factors for prognosis. ResultsThere were significant differences in albumin and tumor burden between the two groups （both P<0.05）. The 76 patients had an mOS of 25.2 months （95% confidence interval ［CI］： 18.4 — 32.0）， an mPFS of 9.4 months （95%CI： 7.1 — 11.7）， an ORR of 63.2%， and a DCR of 82.9%. The mOS was 30.1 months （95%CI： 19.8 — 40.4） in the mALBI 1/2a group and 19.5 months （95%CI： 7.1 — 31.9） in the mALBI 2b group， and there was a significant difference in mOS between the two groups （χ²=4.490， P=0.034）. The mALBI 1/2a group had an mPFS of 10.2 months （95%CI： 8.4 — 12.0）， an ORR of 71.1%， and a DCR of 86.8%， while the mALBI 2b group had an mPFS of 7.6 months （95%CI： 4.6 — 10.6）， an ORR of 55.3%， and a DCR of 78.9%； there were no significant differences in mPFS， ORR， and DCR between the two groups （all P>0.05）. ECOG status， tumor burden， mALBI grade， portal vein invasion， and extrahepatic metastasis were independent risk factors for mOS in patients undergoing TACE combined with targeted immunotherapy （all P<0.05）. There were no treatment-related deaths. ConclusionThe mALBI grade has a good value in predicting the survival of patients with Child-Pugh A uHCC undergoing TACE combined with targeted immunotherapy.

Objective To establish a method for rapid determination of isovelleral,α-amanitin,β-amanitin,γ-amanitin,dihydroxy-phallotoxin and carboxy-dihydroxy-phallotoxin in plasma by ultra performance liquid chromatography-mass spectrometry.Methods Take plasma samples and add acetonitrile solution in a 1:3 ratio.The sample was vortex mixed for 1 min,then centrifugated at 10 000r/min and 4℃ for 3min.The supernatant was injected,while 0.03％ammonia water and acetonitrile were used as mobile phases for ultra high performance liquid phase separation.Multi reaction monitoring was carried out in the positive ion mode of electric spray.Results The separation and detection of isovelleral,α-amanitin,β-amanitin,γ-amanitin,dihydroxy-phallotoxin and carboxyl-dihydroxy-phallotoxin in plasma could be achieved within 4 min by one injection.The linear range of six mushroom toxins in plasma was 40-500μg/L,and the detection limits were 10.0μg/L 10.0μg/L,10.0μg/L,6.0μg/L,6.0μg/L and 6.0μg/L(S/N=3),respectively.The relative standard deviations were 0.60％-1.90％(n=11),and the recovery rates were 90.8％-127.0％.Conclusion This method realizes the rapid and simultaneous determination of 6 kinds of mushroom toxins in plasma,including isovelleral.The operation is simple and the result is accurate,which provides a technical platform for the rapid confirmation of mushroom toxins in poisoned patients.

Objective:To analyze the effect of cognitive conflict in teaching practice nurses in emergency department.Methods:102 nursing students who practiced in the emergency department of Huai′an First Hospital Affiliated to Nanjing Medical University were selected as the research objects by quasi-experimental study, 52 students from December 2021 to July 2022 were set as the research group, and 50 students from March 2021 to November 2021 were set as the control group. The control group received on-site first aid sitnation teaching. The research group combined cognitive conflict teaching on the basis of on-site first aid situation teaching, and compared the emergency nursing skills, theoretical knowledge, critical thinking, clinical strain ability and teaching satisfaction of the two groups of interns.Results:After practice, the scores of emergency nursing skills, theoretical knowledge, critical thinking ability, clinical adaptability and satisfaction with the teaching mode (theoretical memory, interest in learning, practical ability) in the research group were (87.25 ± 2.66), (90.01 ± 2.74), (298.10 ± 8.27), (84.37 ± 3.45), (90.13 ± 3.26), (89.03 ± 3.37) and (91.34 ± 3.16), which were significant higher than the (83.76 ± 2.87), (85.16 ± 3.11), (290.47 ± 8.55), (80.05 ± 3.68), (85.46 ± 3.53), (86.28 ± 3.61) and (88.47 ± 3.38), the difference were significant ( t values were 3.98-8.37, all P<0.05). Conclusions:Cognitive conflict teaching can significantly improve the professional level, critical thinking and clinical adaptability of nursing interns and their satisfaction with teaching.

Objective:To investigate the effect of failure mode and effect analysis (FMEA) based catheter information platform in preventing catheter-related bloodstream infection (CRBSI) in intensive care unit to improve the current status of CRBSI.Methods:In this study, a retrospective cohort study was conducted using the purposive sampling method, and 140 patients with indwelling central venous catheters admitted to the ICU of Peking University Shenzhen Hospital from August to December 2021 were set as the control group; the 140 patients with indwelling central venous catheters admitted to the ICU from January to May 2022 were set as the observation group. The control group used electronic forms to record and manage at the bedside after CRBSI cluster nursing measures were given, and the observation group used the catheter information platform based on FMEA to conduct information management on catheter evaluation and maintenance process after CRBSI cluster nursing measures were given. Compared the implementation rate (6 items), implementation time, qualification rate, and incidence of CRBSI in ICU patients between two groups of ICU nurses.Results:The implementation rate of CRBSI cluster nursing measures among ICU nurses in the observation group: strict hand hygiene by nurses was 87%(122/140), maximum aseptic barrier during puncture was 97%(136/140), aseptic operation during catheter maintenance was 91%(128/140), 75% alcohol disinfection of connectors was 84%(118/140), 24-hour change of infusion lines was 95%(133/140), and timely change of patches/dressings was 89%(125/140), they were greater than those in the control group 70%(98/140), 87%(122/140), 71%(100/140), 61%(86/140), 71%(99/140), 69%(96/140), the differences were statistically significant ( χ2 values were 9.67 to 29.07, all P<0.05); the execution time and qualification rate among ICU nurses in the observation group were (9.11 ± 2.83) minutes and 91.4% (128/140), the control group were (10.00 ± 2.84) minutes and 60.7% (85/140), with statistically significant differences ( t value was -2.64, χ2 values was 36.28, all P<0.05). Conclusions:The FMEA-based catheterization information platform can help enhance the efficiency of the implementation of CRBSI clustering nursing measures by ICU nurses, improve the quality of care, and thus reduce the occurrence of CRBSI, and the feasibility of clinical promotion is high.

Objective:To explore the current situation of clinical nurses' disaster nursing ability and its influencing factors, and to provide basis for carrying out clinical nurses' disaster nursing education and training.Methods:By convenient sampling method, 322 clinical nurses from Peking University Shenzhen Hospital in September 2020 were selected. The disaster nursing ability assessment tool and general information questionnaire were used to conduct a questionnaire survey to analyze the current situation of clinical nurses' disaster nursing ability and its main influencing factors.Results:The total score of disaster nursing ability of clinical nurses was (199.07±34.31) points, which was at the middle and lower level; the scores of each dimension from high to low were as follows: disaster preparedness score was (72.94±12.89) points, coping ability score was (80.00±13.82) points, disaster reduction/prevention capability score was (28.19±6.09) points, recovery/reconstruction ability score was (17.94±3.27) points. Regression analysis showed that the highest degree, clinical department, whether they have autonomously studied disaster nursing related courses after work, and whether they have participated in disaster rescue after work were the main influencing factors of clinical nurses' disaster nursing ability ( t values were -4.715-5.508, P<0.05). Conclusions:The overall level of disaster nursing ability of clinical nurses is at the middle and lower level. It should be combined with clinical nurses' work department, whether clinical nurses have disaster rescue experience and whether they have independently studied disaster nursing related courses, and targeted disaster nursing related training should be carried out to improve their disaster nursing knowledge and skill.