In order to explore effective ways to reduce non-suicidal self-injury (NSSI) among female adolescents, a total of 45 female adolescent patients with NSSI in West China Hospital of Sichuan University and Guizhou Second Provincial People's Hospital from June 2021 to June 2024 were selected randomly that divided into groups A, B and C, with 15 cases in each group. Group A was treated with repeated transcranial magnetic stimulation (rTMS) and bipolar depression triple therapy, and group B was treated with bipolar depression triple therapy to compare the effectiveness and safety. Group C received bipolar depression triple therapy combined with sham stimulation which only produced stimulating sounds but no stimulating magnetic field as a control in the study. After treatment, the Hamilton Anxiety Score (HAMA), Hamilton Depression Score (HAMD) and Nurses' Global Assessment of Suicide Risk (NGASR) in group A were significantly lower than those in group B and C ( P < 0.01). rTMS combined with bipolar depression triple therapy has a definite effect on reducing NSSI in female adolescents, which can reduce the incidence rate of short-term NSSI behavior in patients.
Humans ; Female ; Adolescent ; Self-Injurious Behavior/prevention & control* ; Transcranial Magnetic Stimulation/methods* ; Bipolar Disorder/therapy* ; Combined Modality Therapy ; Treatment Outcome

OBJECTIVE: To explore the effect of bear bile powder (BBP) on acute lung injury (ALI) and the underlying mechanism. METHODS: The chemical constituents of BBP were analyzed by ultra-high-pressure liquid chromatography-mass spectrometry (UPLC-MS). After 7 days of adaptive feeding, 50 mice were randomly divided into 5 groups by a random number table (n=10): normal control (NC), lipopolysaccharide (LPS), dexamethasone (Dex), low-, and high-dose BBP groups. The dosing cycle was 9 days. On the 12th and 14th days, 20 µL of Staphylococcus aureus solution (bacterial concentration of 1 × 10^-7 CFU/mL) was given by nasal drip after 1 h of intragastric administration, and the mice in the NC group was given the same dose of phosphated buffered saline (PBS) solution. On the 16th day, after 1 h intragastric administration, 100 µL of LPS solution (1 mg/mL) was given by tracheal intubation, and the same dose of PBS solution was given to the NC group. Lung tissue was obtained to measure the myeloperoxidase (MPO) activity, the lung wet/dry weight ratio and expressions of CD14 and other related proteins. The lower lobe of the right lung was obtained for pathological examination. The concentrations of inflammatory cytokines including interleukin (IL)-6, tumour necrosis factor α (TNF-α ) and IL-1β in the bronchoalveolar lavage fluid (BALF) were detected by enzyme linked immunosorbent assay, and the number of neutrophils was counted. The colonic contents of the mice were analyzed by 16 sRNA technique and the contents of short-chain fatty acids (SCFAs) were measured by gas chromatograph-mass spectrometer (GC-MS). RESULTS: UPLC-MS revealed that the chemical components of BBP samples were mainly tauroursodeoxycholic acid and taurochenodeoxycholic acid sodium salt. BBP reduced the activity of MPO, concentrations of inflammatory cytokines, and inhibited the expression of CD14 protein, thus suppressing the activation of NF-κB pathway (P<0.05). The lung histopathological results indicated that BBP significantly reduced the degree of neutrophil infiltration, cell shedding, necrosis, and alveolar cavity depression. Moreover, BBP effectively regulated the composition of the intestinal microflora and increased the production of SCFAs, which contributed to its treatment effect (P<0.05). CONCLUSIONS BBP alleviates lung injury in ALI mouse through inhibiting activation of NF-κB pathway and decreasing expression of CD14 protein. BBP may promote recovery of ALI by improving the structure of intestinal flora and enhancing metabolic function of intestinal flora.
Animals ; Acute Lung Injury/pathology* ; Lipopolysaccharides ; Ursidae ; Gastrointestinal Microbiome/drug effects* ; Bile/chemistry* ; Lipopolysaccharide Receptors/metabolism* ; Powders ; Male ; Lung/drug effects* ; Mice ; Peroxidase/metabolism* ; Signal Transduction/drug effects* ; Cytokines/metabolism*

The breakage pattern of unit particles during the production of oral solid dosage forms (OSD) is closely related to the quality of intermediate or final products. To accurately characterize the particles and study the evolution law of particle breakage, the Bonding model of the discrete element method (DEM) was used to investigate the breakage patterns of model parameters, particle shape and process conditions (loading mode and loading rate) on the dynamic breakage, force-time curve, breakage rate, maximum breakage size ratio and fracture strength of particles. The results showed that the particle breakage force was positively correlated with normal strength and bonded disk scale, negatively correlated with normal stiffness per unit area and tangential stiffness per unit area, and weakly correlated with tangential strength. The particle breakage rate was negatively correlated with the aspect ratio of the particles, and the maximum breakage size ratio was positively correlated with the aspect ratio of the particles; among the three loading modes, the breakage rate of compression breakage model was the largest, the breakage rate of shear breakage model was the second largest, and the breakage rate of wear breakage model was the smallest; the maximum breakage size ratio was positively correlated with the loading rate, the loading mode and the loading rate had no mutual influence on particle breakage rate, but had mutual influence on the maximum breakage size ratio. The research results will provide a theoretical basis for the shift of OSD from batch manufacturing to advanced manufacturing.

Objective:To analyze the clinical characteristics, imaging, myopathology and outcomes of patients with COVID-19 related autoimmune myopathy.Methods:The clinical features, serum creatine kinase (CK), myositis antibodies, muscle magnetic resonance imaging, myopathology and therapy of 5 patients with COVID-19 related autoimmune myopathy diagnosed in Peking University First Hospital from December 2022 to April 2023 were collected. The effects of the therapy after a short term follow up were analyzed.Results:Among the 5 patients, there were 3 males and 2 females, with onset age of 42-86 years. All patients presented with proximal muscle weakness in the recovery term of COVID-19. Myalgia was noted in 3 cases, dysphagia in 1, skin damage in 2, interstitial lung disease in 1. The serum CK of the 5 patients was 1 663-16 000 IU/L, 1 patient had anti-3-hydroxy-3-methylglutaryl-CoA reductase autoantibodies and 1 patient had anti-signal recognition particle autoantibodies. The electromyography showed myogenic lesions in all patients. Muscle magnetic resonance imaging showed diffuse muscle edema in all patients, myofascial edema in 3 and subcutaneous-tissue edema in 3. The muscle biopsies in 4 patients revealed necrotic myopathy,with high P62 expression in muscle fibers. The electromicroscopy of 2 patients revealed vacuolated mitochondria and intranuclear tubulofilamentous inclusions in muscle fibers. Four patients were treated with glucocorticoids, of whom 2 patients combined with intravenous immunoglobulin, tacrolimus or cyclophosphamide. One case had close monitoring without drug therapy. They showed significant improvement, but the CK was still abnormal in 4 patients.Conclusions:COVID-19 leads to immune mediated myopathy. The manifestation of patients is characterized by proximal predominant weakness and high creatine kinase level. Muscle magnetic resonance imaging shows diffuse muscle edema. The muscle biopsies reveal necrotic myopathy. The effectiveness of immunosuppression needs to be further studied.

Objective To investigate the clinical characteristics and prognosis of pneumococcal meningitis(PM),and drug sensitivity of Streptococcus pneumoniae(SP)isolates in Chinese children.Methods A retrospective analysis was conducted on clinical information,laboratory data,and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.Results Among the 160 children with PM,there were 103 males and 57 females.The age ranged from 15 days to 15 years,with 109 cases(68.1% )aged 3 months to under 3 years.SP strains were isolated from 95 cases(59.4% )in cerebrospinal fluid cultures and from 57 cases(35.6% )in blood cultures.The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87)and 27% (21/78),respectively.Fifty-five cases(34.4% )had one or more risk factors for purulent meningitis,113 cases(70.6% )had one or more extra-cranial infectious foci,and 18 cases(11.3% )had underlying diseases.The most common clinical symptoms were fever(147 cases,91.9% ),followed by lethargy(98 cases,61.3% )and vomiting(61 cases,38.1% ).Sixty-nine cases(43.1% )experienced intracranial complications during hospitalization,with subdural effusion and/or empyema being the most common complication[43 cases(26.9% )],followed by hydrocephalus in 24 cases(15.0% ),brain abscess in 23 cases(14.4% ),and cerebral hemorrhage in 8 cases(5.0% ).Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old,with rates of 91% (39/43)and 83% (20/24),respectively.SP strains exhibited complete sensitivity to vancomycin(100% ,75/75),linezolid(100% ,56/56),and meropenem(100% ,6/6).High sensitivity rates were also observed for levofloxacin(81% ,22/27),moxifloxacin(82% ,14/17),rifampicin(96% ,25/26),and chloramphenicol(91% ,21/23).However,low sensitivity rates were found for penicillin(16% ,11/68)and clindamycin(6% ,1/17),and SP strains were completely resistant to erythromycin(100% ,31/31).The rates of discharge with cure and improvement were 22.5% (36/160)and 66.2% (106/160),respectively,while 18 cases(11.3% )had adverse outcomes.Conclusions Pediatric PM is more common in children aged 3 months to under 3 years.Intracranial complications are more frequently observed in children under 1 year old.Fever is the most common clinical manifestation of PM,and subdural effusion/emphysema and hydrocephalus are the most frequent complications.Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates.Adverse outcomes can be noted in more than 10% of PM cases.SP strains are high sensitivity to vancomycin,linezolid,meropenem,levofloxacin,moxifloxacin,rifampicin,and chloramphenicol.[Chinese Journal of Contemporary Pediatrics,2024,26(2):131-138]

A 5-year-old girl was admitted due to one episode of melena and one episode of hematemesis.Upon admission,gastroscopy revealed esophageal and gastric varices.Abdominal CT scan,MRI,and color Doppler ultrasound suggested cirrhosis,intrahepatic bile duct dilation,and bilateral kidney enlargement.Genetic testing identified compound heterozygous mutations in the PKHD1 gene:c.2264C>T(p.Pro755Leu)and c.1886T>C(p.Val629Ala).The c.2264C>T(p.Pro755Leu)mutation is a known pathogenic variant with previous reports,while c.1886T>C(p.Val629Ala)is a novel mutation predicted to have pathogenic potential according to Mutation Taster and PolyPhen2.The child was diagnosed with autosomal recessive polycystic kidney disease.In children presenting with gastrointestinal bleeding without obvious causes,particularly those with liver or kidney disease,consideration should be given to the possibility of autosomal recessive polycystic kidney disease,and genetic testing should be conducted for definitive diagnosis when necessary.

Objective:To explore the clinical effects of the best evidence-based practice plan for rehabilitation exercises in patients undergoing surgery for lumbar spinal stenosis (LSS) .Methods:Guided by the evidence-based practice model of the Joanna Briggs Institute (JBI) Center for Evidence-Based Healthcare in Australia, the best evidence was combined with the clinical context to develop quality review indicators for clinical practice. In December 2022, a baseline review was conducted with 30 patients undergoing surgery for LSS (before evidence application). From December 2022 to February 2023, the baseline review results were analyzed to identify facilitating and obstructive factors between the current status and the review indicators, and improvement strategies were implemented based on available resources. In February 2023, another 30 patients (after evidence application) were selected to evaluate the post-application effects. The Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI), Tampa Scale for Kinesiophobia (TSK) score, General Self-Efficacy Scale (GSES) score, and quality of life scores were compared between the two groups at 24 hours, 1 month, 3 months, and 6 months postoperatively. The execution rate of clinical quality review indicators and the knowledge scores on rehabilitation exercises of 25 nurses before and after training were also compared.Results:There were no statistically significant differences in JOA scores, ODI, TSK scores, GSES scores, and quality of life scores between the two groups at 24 hours postoperatively ( P > 0.05). However, there were statistically significant differences in these scores at 1, 3, and 6 months postoperatively ( P< 0.01). After evidence application, the execution rate of seven clinical quality review indicators improved, and the knowledge scores on rehabilitation exercises of the 25 nurses increased significantly ( P< 0.05) . Conclusions:The evidence-based practice for rehabilitation exercises in patients undergoing surgery for LSS is safe and feasible. It standardizes evidence-based nursing practice behavior, enhances nurses' knowledge levels, effectively improves postoperative lumbar function, promotes physical rehabilitation, and enhances the quality of life.

The aim of our research was to obtain Listeria bacteriophages from food and related environments,and conduc-ted the analysis of the electron microscopic morphology,host range specificity,and biological characteristics of the purified phages.The double-layer agar method and the spot test were employed for the isolation and identification of a virulent Listeria phage named LMLPA5,with the isolated strain Listeria in-nocua Lin08 as the host.Phage morphology was observed by transmission electron microscope.The biological characteris-tics of the phage were assessed by determining their host range,optimal multiplicity of infection(MOI),one-step growth curve,and physicochemical stability.Additionally,the preservation efficacy of the phage at 4 ℃,-20 ℃,and-80 ℃ was explored.The phage LMLPA5 belongs to the family Myoviridae based on morphology,exhibiting clear and transparent plaques without halo surrounded.Strains of sever-al Listeria species and different serotypes strains of Listeria monocytogenes were susceptible to lysis by LMLPA5,indica-ting its broad-spectrum activity against Listeria monocytogenes.Optimal MOIs and single-step growth curve analyses revealed optimal MOIs of 0.1 and latent period of 10 minutes for LMLPA5,with average burst size at 95.2 PFU/cell.LMLPA5 was sensitive to high temperatures,and completely inactivated after exposure to 70 ℃ for 1 h,while the phage remained stable for over 32 hours ranging from 4 ℃ to 40 ℃.Within the pH range of 4 to 10,phage titer remained stable and completely inactiva-ted until 60 minutes of ultraviolet exposure.LMLPA5 displayed insensitivity to chloroform,confirming its non-enveloped phage morphology.The phages remained stable for over 8 months when store at 4 ℃ and-80 ℃.The biological characteristics and lysis capacity of phage LMLPA5 were elucidated in this study,which provide the basis for further application.

Objective:To construct a predictive model for intensive care unit (ICU) and in-hospital mortality risk in patients with traumatic brain injury (TBI) and validate its performance.Methods:A retrospective cohort study was conducted to analyze the clinical data of 3 907 patients with TBI published until May 2018 in the eICU Collaborative Research Database v2.0 (eICU-CRD v2.0), including 2 397 males and 1 510 females, aged 18-92 years [63.0(43.0, 79.0)years]. According to whether the patients died in ICU or at hospital stay, they were divided into ICU survival group ( n=3 575) and ICU mortality group ( n=332), and hospital survival group ( n=3 413) and hospital mortality group ( n=494). The general data, admission diagnosis, laboratory tests, therapeutic interventions, and clinical outcomes were extracted as variables of interest. Univariate analysis and multivariate Logistic regression analysis were conducted on both the survival groups and the mortality groups to identify the independent risk factors that affect ICU and in-hospital mortality in TBI patients, based on which a Logistic regression prediction model was constructed and represented by Nomograms. The extracted dataset was randomly divided into training set ( n=2 735) and validation set ( n=1 172) with a ratio of 7∶3, and was applied for internal validation of the of the predictive model. Meanwhile, the data of TBI patients in the MIMIC-III v1. 4 database were extracted for external validation of the predictive model. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used for discriminability evaluation of the model, and the Hosmer-Lemeshow (H-L) goodness of fit test and calibration curve were used for calibration evaluation of the model. Results:The statistically significant variables identified in the univariate analysis were included in the multivariate logistic regression analysis of ICU mortality and in-hospital mortality risk. The results revealed that acute physiology and chronic health evaluation IV (APACHE IV) score ( OR=1.04, 95% CI 1.03, 1.04, P<0.01), Glasgow coma scale (GCS) ( OR=0.66, 95% CI 0.59, 0.73, P<0.01), cerebral hernia formation ( OR=6.91, 95% CI 3.13, 15.26, P<0.01), international normalized ratio (INR) ( OR=1.33, 95% CI 1.09, 1.62, P<0.01), use of hypertonic saline ( OR=0.45, 95% CI 0.21 0.94, P<0.05), and use of vasoactive agents ( OR=2.19, 95% CI 1.36, 3.52, P<0.01) were independent risk factors for ICU mortality in TBI patients. The age (with 10 years as a grade) ( OR=1.28, 95% CI 1.17, 1.40, P<0.01), APACHE IV score ( OR=1.03, 95% CI 1.02, 1.04, P<0.01), GCS ( OR=0.75, 95% CI 0.71, 0.80, P<0.01), cerebral hernia formation ( OR=6.44, 95% CI 2.99, 13.86, P<0.01), serum creatinine level ( OR=1.07, 95% CI 1.01, 1.15, P<0.05), INR ( OR=1.49, 95% CI 1.20, 1.85, P<0.01), use of hypertonic saline ( OR=0.41, 95% CI 0.21, 0.80, P<0.01), and use of vasoactive agents ( OR=2.27, 95% CI 1.46, 3.53, P<0.01) were independent risk factors of in-hospital mortality of TBI patients. Based on the forementioned independent risk factors for ICU mortality, the model equation was constructed: Logit P (ICU)=7.12+0.03×"APACHE IV score"-0.42×"GCS"+1.93×"cerebral hernia formation"+0.28×"INR"-0.81×"use of hypertonic saline"+0.79×"use of vasoactive agents". Based on the forementioned independent risk factors for in-hospital mortality, the model equation was constructed: Logit P (in-hospital)=2.75+0.25×"age"(with 10 years as a grade)+0.03×"APACHE IV score"-0.28×"GCS"+1.86×"cerebral hernia formation"+0.07×"serum creatinine level"+0.40×"INR"-0.90×"use of hypertonic saline"+0.82×"use of vasoactive agents". In the prediction model for ICU mortality, the AUC of the training set and validation set was 0.95 (95% CI 0.94, 0.97) and 0.91 (95% CI 0.87, 0.95). The result of H-L goodness of fit test of the training set was P=0.495 with the average absolute error in the calibration curve of 0.003, while the result of H-L goodness of fit test of the validation set was P=0.650 with the average absolute error in the calibration curve of 0.012. In the prediction model for in-hospital mortality, the AUC of the training set and validation set was 0.91 (95% CI 0.89, 0.93) and 0.91(95% CI 0.88, 0.94). The result of H-L goodness of fit test of the training set was P=0.670 with the average absolute error in the calibration curve of 0.006, while the result of H-L goodness of fit test of the validation set was P=0.080 with the average absolute error in the calibration curve of 0.021. In the external validation set of ICU mortality risk, the AUC of the prediction model was 0.88 (95% CI 0.86, 0.90), while the result of H-L goodness of fit test was P=0.205 with the average absolute error in the calibration curve of 0.031. In the external validation set of in-hospital mortality risk, the AUC of the prediction model was 0.88 (95% CI 0.85, 0.91), while the result of H-L goodness of fit test was P=0.239 with the average absolute error in the calibration curve of 0.036. The internal and external validation of the model indicated that both the prediction models for ICU and in-hospital mortality had good discriminability and calibration. Conclusion:The ICU mortality prediction model constructed by APACHE IV score, GCS, cerebral hernia formation, use of hypertonic saline, vasoactive agents use of and INR, and the in-hospital mortality prediction model constructed by age grading, APACHE IV score, GCS, cerebral hernia formation, serum creatinine level, hypertonic saline use of, use of vasoactive agents and INR can predict the mortality risk of TBI patients well.

Objective To explore the correlation of MPV,NLR,PT,APTT and FIB with early pro-gression of ACI in patients with BAD.Methods A total of 303 ACI patients with BAD admitted in our department of neurology from October 2021 to September 2023 were consecutively recrui-ted,and according to their progression within 7 d of onset,they were divided into progression group(89 cases)and un-progression group(214 cases).The general clinical data,blood routine re-lated indicators(MPV,NLR)and coagulation related indicators(PT,APTT,FIB)were compared between the two groups.Multivariate logistic regression analysis was applied to identify the rela-tionship of above indicators with early progression of ACI in BAD patients.ROC curve was plot-ted to analyze the predictive value of the indictors for disease progression in these patients.Results The progression group had significantly advanced age,larger proportions of diabetes,hyperlipi-demia and stroke history,and increased levels of uric acid,LDL-C,homocysteine,MPV,platelet distribution width,NLR,D-dimer and FIB,and shorter TT,PT and APTT when compared with the un-progressed group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that MPV,NLR,PT,APTT,and FIB were all independent influencing factors for early disease pro-gression of ACI in patients with BAD(P＜0.05,P＜0.01).ROC curve indicated that the AUC value of combined MPV,NLR,PT,APTT and FIB in detecting early disease progression was 0.859(95％CI:0.813-0.905).Conclusion Blood routine(MPV,NLR)and coagulation related indicators(PT,APTT,FIB)are closely associated with the early disease progression of ACI in BAD patients,and these indicators are of high value in predicting the early disease progression.