Objective : To identify autophagy-related genes involved in pulmonary infection caused by the highly drug-resistant and virulent methicillin-resistant Staphylococcus aureus strain USA300 ( USA300) ，and to explore the underlying molecular mechanisms ， thereby providing potential targets for immunotherapy． Methods: The GSE220943 dataset of a USA300-induced pulmonary infection mouse model was obtained from the GEO database． Differentially expressed genes ( DEGs ) were identified using the DESeq2 package． Autophagy-related genes ( ARGs) were retrieved from the MSigDB and Autophagy databases．Weighted gene co-expression network analysis ( WGCNA) was performed to construct gene co-expression modules．Genes overlapping among DEGs，ARGs，and WGCNA modules were identified as autophagy-related DEGs．Gene Ontology ( GO) enrichment analysis was con- ducted using the clusterProfiler R package，while Kyoto Encyclopedia of Genes and Genomes ( KEGG) pathway en- richment analysis was performed via the Metascape platform．Immune cell infiltration was analyzed using the Immu- CellAI-mouse website．A protein - protein interaction ( PPI) network was constructed using the STRING database， and hub genes were identified through topological analysis in Cytoscape． Receiver operating characteristic curve ( ROC) curves were plotted via the website https: / /www．bioinformatics．com．cn． Finally，key gene expression was validated in mouse lung tissues by real-time quantitative reverse transcription PCR ( RT-qPCR) ． Results: A total of 6 135，4 075，3 680，and 2 342 differentially expressed genes ( DEGs) were identified at 12，24，48，and 96 hours post-infection，respectively．By integrating DEGs，autophagy-related genes ( ARGs) ，and WGCNA mod- ules，19 autophagy-related DEGs were identified． GO and KEGG enrichment analyses indicated that these genes were mainly involved in CD4 + T cell activation and regulation，innate immune responses，and autophagosome mem- brane formation．Immune infiltration analysis revealed that innate immune cells such as neutrophils and dendritic cells predominated during the early phase of infection，while γδ T cells and M2 macrophages became more promi- nent in the later stages．PPI network analysis identified 12 hub autophagy-related genes，among which three upreg- ulated key genes ( Eif2ak2，Ikbke，and Nfkbiz) were further confirmed．The area under the ROC curve for all three genes was 1. 000．RT-qPCR validation demonstrated significantly elevated expression of these three genes in lung tissues at 24 hours post-infection ( all P＜0. 05) ． Conclusion Eif2ak2，Ikbke，and Nfkbiz may be involved in the pulmonary infection caused by USA300 by promoting autophagy and hold promise as potential targets for immuno- therapy．

Objective:To construct an early rehabilitation management model for postoperative kinesiophobia patients after total knee arthroplasty (TKA) based on a topic-oriented quality control circle method, aiming to improve the quality of early rehabilitation management.Methods:Using a convenience sampling method, 120 TKA patients with kinesiophobia treated in the Department of Orthopedics at the First Affiliated Hospital of Zhengzhou University from January to April 2022 and September to December 2022 were selected. The patients from January to April 2022 were set as the control group, and those from September to December 2022 were set as the observation group, with 60 patients in each group. The control group received routine rehabilitation management after TKA surgery, while the observation group received the early rehabilitation management model based on the 10 steps of the topic-oriented quality control circle (topic selection, activity planning, clarification of the topic, goal setting, countermeasure formulation, pursuit of optimal strategies, etc.) in addition to the routine management. The differences between the two groups were compared in terms of kinesiophobia score, knee function score, pain score, early rehabilitation assessment rate, effective analgesia rate, and 24-hour ambulation rate.Results:After the intervention, the observation group showed significantly lower knee pain scores (2.89±0.66) and kinesiophobia scores (23.27±4.87) compared to the control group, with a significantly higher knee function score (74.47±7.40), all differences were statistically significant (all P<0.01). Additionally, the observation group had a significantly higher early rehabilitation assessment rate, effective analgesia rate, 24-hour ambulation rate, early rehabilitation compliance rate, earlier time for the first ambulation, shorter hospital stay, and reduced costs compared to the control group, with all differences showing statistical significance (all P<0.01) . Conclusions:The application of the topic-oriented quality control circle to construct and implement an early rehabilitation management model for postoperative kinesiophobia patients after TKA can effectively improve the quality of early rehabilitation management, reduce kinesiophobia levels, enhance knee joint function, and alleviate the economic burden.

Objective:To construct an early rehabilitation management model for postoperative kinesiophobia patients after total knee arthroplasty (TKA) based on a topic-oriented quality control circle method, aiming to improve the quality of early rehabilitation management.Methods:Using a convenience sampling method, 120 TKA patients with kinesiophobia treated in the Department of Orthopedics at the First Affiliated Hospital of Zhengzhou University from January to April 2022 and September to December 2022 were selected. The patients from January to April 2022 were set as the control group, and those from September to December 2022 were set as the observation group, with 60 patients in each group. The control group received routine rehabilitation management after TKA surgery, while the observation group received the early rehabilitation management model based on the 10 steps of the topic-oriented quality control circle (topic selection, activity planning, clarification of the topic, goal setting, countermeasure formulation, pursuit of optimal strategies, etc.) in addition to the routine management. The differences between the two groups were compared in terms of kinesiophobia score, knee function score, pain score, early rehabilitation assessment rate, effective analgesia rate, and 24-hour ambulation rate.Results:After the intervention, the observation group showed significantly lower knee pain scores (2.89±0.66) and kinesiophobia scores (23.27±4.87) compared to the control group, with a significantly higher knee function score (74.47±7.40), all differences were statistically significant (all P<0.01). Additionally, the observation group had a significantly higher early rehabilitation assessment rate, effective analgesia rate, 24-hour ambulation rate, early rehabilitation compliance rate, earlier time for the first ambulation, shorter hospital stay, and reduced costs compared to the control group, with all differences showing statistical significance (all P<0.01) . Conclusions:The application of the topic-oriented quality control circle to construct and implement an early rehabilitation management model for postoperative kinesiophobia patients after TKA can effectively improve the quality of early rehabilitation management, reduce kinesiophobia levels, enhance knee joint function, and alleviate the economic burden.

Objective:To investigate the safety and effectiveness of robot-assisted total knee arthroplasty (TKA).Methods:From August 2021 to March 2022, the data of 69 patients who received robot-assisted TKA for inflammatory disease of knee in 6 hospitals were collected, including 24 males and 45 females, aged 52±6 years (range, 46-72 years), including 53 cases of knee osteoarthritis,10 cases of rheumatoid arthritis, and 6 cases of traumatic arthritis. Imaging data examination of patients was completed according to the multicenter specification. Preoperatively, the patient's CT data were extracted before surgery and a personalized prosthesis positioning plan was designed by the robotic system to determine the prosthesis size, lower limb force lines, and femoral and tibial osteotomy volumes; intraoperatively, the osteotomy template was robotically controlled to complete the osteotomy according to the prosthesis positioning plan, and the intraoperative osteotomy volumes were measured to verify the accuracy of the robot-assisted TKA osteotomy with the preoperative planning. Postoperatively, the lateral angle of the distal femur, the medial angle of the proximal tibia and the hip-knee-ankle angle were measured in the coronal plane according to radiographs; the postoperative outcome was evaluated 3 months after operation, using the American Knee Society score (KSS), including the KSS knee score and functional score.Results:The operative time was 97.3±2.3 min (range, 80-110 min) and the amount of bleeding was 320.0±6.2 ml (range, 300-350 ml) in 69 patients. Three months after operation, the mean range of motion of knee joint was increased from 82.2°±1.1° before surgery to 119.7°±0.8° after surgery ( t=27.65, P<0.001), and the line of force of lower limb was improved from 160.9°±0.5° before surgery to 178.0°±0.2° after surgery ( t=32.03, P<0.001). KSS-knee score increased from 54.8±0.7 points before operation to 85.0±0.5 points after operation, and KSS-functional score increased from 56.5±0.7 points before operation to 85.9±0.4 points after operation, the difference was statistically significant ( t=35.45, 36.58, P<0.001). The proportion of patients with intraoperative femoral and tibial osteotomies within 2 mm osteotomy error compared with preoperative planning was 97% for the lateral tibial plateau, 100% for the medial tibial plateau, 100% for the lateral distal femur, 99% for the medial distal femur, 93% for the lateral posterior femoral condyle, and 100% for the medial posterior femoral condyle; The proportion of patients with postoperative anteroposterior X-ray measurement angle error within 3° was: 100.0% for the distal lateral femoral angle, 100.0% for the proximal medial tibial angle, and 100% for the hip-knee-ankle angle. No complications occurred in all patients except for one case in which fat liquefaction occurred in the postoperative wound. Conclusion:Robot-assisted TKA is a safe and effective surgical method for the treatment of inflammatory disease of knee with accurate prosthesis installation and good postoperative recovery of lower limb alignment.

Objective:To explore the application effect of health education based on the information-motivation-behavioral (IMB) skills model in the health education of main caregivers of premature infants.Methods:A total of 200 premature infants and 200 primary caregivers admitted to Department of Neonatology in First Hospital of Qinhuangdao were selected as the research objects from January 2017 to December 2019. Using random number table method, they were divided into the control group and the observation group, with 100 premature infants and 100 caregivers in each group. The control group was given regular health education, while the observation group was given health education based on the IMB model skill on the basis of the control group. The growth and development of premature infants and their re-admission after discharge were compared between the two groups. The self-made Premature Infant Caregivers Care Knowledge Evaluation Form, Premature Infant Caregivers Care Ability Scale and Neonatology Satisfaction Questionnaire were used to evaluate the care knowledge, care ability and satisfaction of their caregivers.Results:The growth and development compliance rates of preterm infants in the two groups were respectively 86.00% and 74.00%, and the readmission rates after discharge were respectively 7.00% and 17.00%, and there were statistically significant differences between groups ( P<0.05) . After intervention, the scores of nursing knowledge, nursing ability and nursing satisfaction of caregivers in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of IMB model-based health education in caregivers of premature infants can improve the growth and development compliance rate of premature infants, reduce the re-admission rate after discharge, improve knowledge and ability of care of caregivers and improve satisfaction of caregivers.

Objective:To investigate the clinical effect on ultrasound-guided vascular access-interventional therapy of hemodialysis in day surgery mode.Methods:Hemodialysis patients with vascular access dysfunction who underwent ultrasound-guided interventional therapy in the First Affiliated Hospital of Xi'an Jiaotong University from September 1, 2018 to October 31, 2020 were retrospectively analyzed. Demographic and clinical data were collected by electronic medical record system and telephone follow-up. Kaplan-Meier method was used to analyze the patency rate of vascular access.Results:A total of 421 cases of ultrasound-guided vascular access intervention were performed in 269 patients. The technical success rates of stenosis, chronic occlusion and acute occlusion lesion were 98.8%, 90.6% and 86.4%, respectively, and 406 cases (96.4%) of 246 patients were clinically successful. The postoperative brachial artery blood flow was 821(627, 1 029) ml/min, which was significantly higher than 309(202, 453) ml/min before the operation ( Z=-13.547, P<0.001). No serious complications occurred during and after the operation. At 6, 12, 18 and 24 months after operation, the primary patency rate was 74%, 59%, 48% and 45%, respectively, the assisted primary patency rate was 94%, 91%, 88% and 82%, and the secondary patency rate was 96%, 93%, 91% and 86%. Compared with the conventional inpatient surgery mode, the total cost of the day surgery mode was significantly reduced [12 067(10 051, 13 198) yuan vs 14 986(12 411, 20 643) yuan, Z=-13.185, P<0.001], and the hospital stay was significantly shortened [5.1(3.5, 6.9) h vs 73.4(31.6, 146.6) h, Z=-13.348, P<0.001]. Conclusion:It is safe and effective to perform interventional therapy for vascular access malfunction under ultrasound in day surgery mode, which can save cost and time of hospitalization, and can be carried out in hospitals with relevant conditions.

Objective To explore the independent risk factors of the prolonged time of retention ICU after type A aortic dissection operation,to establish a corresponding perioperative risk assessment system.Methods A total of 509 consecutive patients with type A aortic dissection were enrolled in the study from September 2011 to May 2016,among which,418 patients received emergency operation.The prolonged retention time of ICU was considered as endpoint event.A perioperative assessment system was established through the analysis of related risk factors of the most common complications after type A aortic dissection operation.The possible risk factors of prolonged retention time of ICU were introduced into a single factor analysis.The meaningful variables in the single factor analysis were introduced into logistic regression analysis.The independent risk factors which were obtained from logistic regression analysis were used to establish risk prediction modeL,and the ROC curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the model.Results The perioperative mortality rate was 8.64％,the prolonged retention time of ICU was 5.06 days,and 98 cases exceeded 7 days.The results of logistic regression analysis showed that age,the history of stroke,obesity,emergency operation,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,renal inadequacy,massive transfusion,hypoxemia,and pulmonary infection were the independent risk factors for prolonged retention time of ICU.Accordingly,a mathematical model was established.The area under ROC cure for prediction model(AUC) =0.761,Hosmer-Lemeshow goodness of fit test P =0.512.Conclusion The logistic model estabhshed in this study can successfully predict ICU retention time after type A aortic dissection operation,and the efficacy was predicted satisfactorily.

Objective To observe the effects of quetiapine on cognitive function,myelin morphology and expression of myelin basic protein in the corpus callosum of C57BL/6 mice with chronic alcohol exposure.Methods According to random number table,120 male C57BL/6 mice were divided into 6 groups,i.e.,control group,quetiapine control group (10 mg· kg-1· d-1quetiapine),alcohol group,5 mg· kg-1· d1quetiapine plus alcohol group,10 mg· kg-1· d-1 quetiapine plus alcohol group and 15 mg·kg-1· d-1quetiapine plus alcohol group,with 20 mice in each group.Mice in control group and quetiapine control group were maintained with water and solid diet for 20 weeks.Mice in alcohol group and quetiapine plus alcohol groups were maintained with water containing volume fraction of 10％ alcohol and solid diet for 20 weeks.Drug with different doses was dissolved in mice drinking for intervention beginning at the 6th week and continuing to the end of the experiment.Morris water maze experiment was used to test the cognitive function.Luxol fast blue (LFB) staining and electron microscopy were used to observe morphology of corpus callosum.The expression of myelin basic protein in the corpus callosum was evaluated with immunofluorescence.Results (1)Morris water maze test showed that the cognition of mice in each group was different (F=4.702,P=0.002).The latency of mice in alcohol group ((22.8 ±5.5) s) was significantly longer compared with that of the control group((1 1.5± 7.1) s,t=3.546,P＜0.05).The latency of 5 mg· kg1 · d-1and 10 mg· kg-1 · d-1quetiapine plus alcohol groups ((19.1±8.8) s,(20.1±8.3) s) were not significantly different compared with that of the alcohol group (t=0.989,0.748,both P＞0.05).The latency of 15 mg· kg-1· d-1quetiapine plus alcohol group((11.5 ± 5.8) s) was significantly shorter compared with that of the alcohol group (t=3.998,P＜0.05).The latency of quetiapine control group ((10.6±5.5) s) was not significantly different compared with that of the control group (t=0.276,P＞0.05).(2)LFB staining and electron microscope results showed severe myelin damage in the corpus callosum of mice in alcohol group,while the integrity of the myelin sheath in 10 mg· kg-1· d 1and 15 mg·kg-1· d-1quetiapine plus alcohol groups improved significantly compared with the alcohol group.The integrity of the myelin sheath in quetiapine control group was not significantly different compared with that of the control group.(3) Inmunofluorescence results showed that the expression of myelin basic protein of each group was different (F=28.971,P＜0.01).The expression of myelin basic protein in alcohol group (0.038±0.005) was significantly decreased compared to the control group (0.062±0.005,t=8.628,P＜0.05).The expression of myelin basic protein in 5 mg·kg-1· d-1 quetiapine plus alcohol group (0.043±0.003)was not significantly different compared with the alcohol group (t=2.081,P＞0.05).The expression of myelin basic protein of 10 mg·kg-1· d-1 and 15 mg·kg-1· d-1 quetiapine plus alcohol groups (0.047±0.04,0.058±0.006) were significantly increased compared with the alcohol group (t=3.301,6.645,both P＜0.05).The expression of myelin basic protein in quetiapine control group (0.061±0.005)was not significantly different compared with the control group (t=0.041,1.137,both P＞0.05).Conclusion Chronic alcohol exposure could induce cognition impairment and white matter myelin danage in mice.Quetiapine treatment may prevent the brain white matter damage due to chronic alcohol exposure in mice.

Objective To observe the effects of quetiapine on cognitive function,myelin morphology and expression of myelin basic protein in the corpus callosum of C57BL/6 mice with chronic alcohol exposure.Methods According to random number table,120 male C57BL/6 mice were divided into 6 groups,i.e.,control group,quetiapine control group (10 mg· kg-1· d-1quetiapine),alcohol group,5 mg· kg-1· d1quetiapine plus alcohol group,10 mg· kg-1· d-1 quetiapine plus alcohol group and 15 mg·kg-1· d-1quetiapine plus alcohol group,with 20 mice in each group.Mice in control group and quetiapine control group were maintained with water and solid diet for 20 weeks.Mice in alcohol group and quetiapine plus alcohol groups were maintained with water containing volume fraction of 10％ alcohol and solid diet for 20 weeks.Drug with different doses was dissolved in mice drinking for intervention beginning at the 6th week and continuing to the end of the experiment.Morris water maze experiment was used to test the cognitive function.Luxol fast blue (LFB) staining and electron microscopy were used to observe morphology of corpus callosum.The expression of myelin basic protein in the corpus callosum was evaluated with immunofluorescence.Results (1)Morris water maze test showed that the cognition of mice in each group was different (F=4.702,P=0.002).The latency of mice in alcohol group ((22.8 ±5.5) s) was significantly longer compared with that of the control group((1 1.5± 7.1) s,t=3.546,P＜0.05).The latency of 5 mg· kg1 · d-1and 10 mg· kg-1 · d-1quetiapine plus alcohol groups ((19.1±8.8) s,(20.1±8.3) s) were not significantly different compared with that of the alcohol group (t=0.989,0.748,both P＞0.05).The latency of 15 mg· kg-1· d-1quetiapine plus alcohol group((11.5 ± 5.8) s) was significantly shorter compared with that of the alcohol group (t=3.998,P＜0.05).The latency of quetiapine control group ((10.6±5.5) s) was not significantly different compared with that of the control group (t=0.276,P＞0.05).(2)LFB staining and electron microscope results showed severe myelin damage in the corpus callosum of mice in alcohol group,while the integrity of the myelin sheath in 10 mg· kg-1· d 1and 15 mg·kg-1· d-1quetiapine plus alcohol groups improved significantly compared with the alcohol group.The integrity of the myelin sheath in quetiapine control group was not significantly different compared with that of the control group.(3) Inmunofluorescence results showed that the expression of myelin basic protein of each group was different (F=28.971,P＜0.01).The expression of myelin basic protein in alcohol group (0.038±0.005) was significantly decreased compared to the control group (0.062±0.005,t=8.628,P＜0.05).The expression of myelin basic protein in 5 mg·kg-1· d-1 quetiapine plus alcohol group (0.043±0.003)was not significantly different compared with the alcohol group (t=2.081,P＞0.05).The expression of myelin basic protein of 10 mg·kg-1· d-1 and 15 mg·kg-1· d-1 quetiapine plus alcohol groups (0.047±0.04,0.058±0.006) were significantly increased compared with the alcohol group (t=3.301,6.645,both P＜0.05).The expression of myelin basic protein in quetiapine control group (0.061±0.005)was not significantly different compared with the control group (t=0.041,1.137,both P＞0.05).Conclusion Chronic alcohol exposure could induce cognition impairment and white matter myelin danage in mice.Quetiapine treatment may prevent the brain white matter damage due to chronic alcohol exposure in mice.

Objective To investigate the relationship between the urinary albumin excretion (UAE) and serum uric acid in general population. Methods The study participants were derived from the epidemiological study on the association of metabolic syndrome and chronic kidney disease (CKD) in Pinggu district, Beijing. A total of 992 participants (463 men and 529 women) aged from 30 to 75 years were enrolled in this study. For each participant, UAE, serum uric acid, serum creatinine, and serum lipids were detected and other potential risk factors for CKD were surveyed. Results ( 1 ) The frequencies of microalbuminuria, macroalbuminuria and hyperuricemia were 12.9% , 1.8% and 4.3% respectively. The persons with hyperuricemia had significantly higher frequency of albuminuria than those without hyperuricemia (37. 2% vs 13. 7% , P ＜0. 01). (2) The participants were divided according to the quartiles (25% , 50% , 75% ) of serum uric acid level, and the frequencies of albuminuria in males were 13. 2% , 13. 9% , 17. 2% and 25.4% , while those in females were 8. 4% , 6. 2% , 9. 6% and 24. 8%. ( 3 ) Multivariate logistic regression analysis showed, hyperuricemia was significantly associated with albuminuria in females (OR =2. 31, 95% CI 1. 15-4. 68; P=0.02), but not in males. If the persons with reduced renal function were excluded, similar result still could be gained. Conclusions The prevalence of albuminuria increases gradually with uric acid elevation. Serum uric acid is an independent risk factor of elevated UAE, especially in females.