Objective To investigate the expression and clinical significance of serum microRNA-141-3p(miR-141-3p)and Kelch like epichlorohydrin associated protein 1(KEAP1)in neonatal acute respiratory dis-tress syndrome(NARDS).Methods A total of 121 children with NARDS admitted to the hospital from Janu-ary 2022 to March 2024(NARDS group)and 65 healthy neonates during the same period(control group)were selected.According to the degree of disease,the children with NARDS were divided into the mild NARDS group(4≤oxygen index<8,48 cases),the moderate NARDS group(8≤oxygen index<16,46 ca-ses),the severe NARDS group(oxygen index≥16,27 cases),and the children with NARDS were divided into the death group(18 cases)and the survival group(103 cases)according to the 28-day prognosis.Serum miR-141-3p and KEAP1 levels were detected by fluorescence quantitative polymerase chain reaction and enzyme-linked immunosorbent assay.The correlation between serum miR-141-3p and KEAP1 levels in children with NARDS was analyzed by Pearson correlation coefficient.The correlation between serum miR-141-3p and KEAP1 levels and oxygen index in children with NARDS was analyzed by Spearman correlation coefficient.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficacy of serum miR-141-3p and KEAP1 levels on the death in children with NARDS.Results Serum miR-141-3p level in the NARDS group was lower than that in the control group,and KEAP1 level in the NARDS group was higher than that in the control group(t=14.288,12.596,P<0.001).There was a binding site between miR-141-3p and KEAP1 at the 3'-untranslated region 131-138.Pearson correlation showed that serum miR-141-3p was negatively correlated with KEAP1 level in children with NARDS(r=-0.745,P<0.001).The levels of ser-um miR-141-3p increased sequentially in the severe NARDS group,moderate NARDS group,and mild NARDS group,while the level of KEAP1 decreased sequentially(F=185.469,113.126,P<0.001).Spearman correla-tion coefficient showed that oxygen index in children with NARDS was negatively correlated with serum miR-141-3p level(r=-0.815,P<0.001)and positively correlated with serum KEAP1 level(r=0.827,P<0.001).Serum miR-141-3p level in the dead group was lower than that in the survival group,and KEAP1 level was higher than that in the surviving group(t=4.213,4.495,P<0.001).The area under the curve of the combined prediction of serum miR-141-3p and KEAP1 levels for the death in children with NARDS was 0.878(95%CI:0.806-0.930),which was greater than 0.783(95%CI:0.699-0.853)and 0.786(95%CI:0.702-0.855)predicted by serum miR-141-3p and KEAP1 levels alone(Z=2.963,2.021,P<0.05).Conclu-sion The serum miR-141-3p level is decreased and the KEAP1 level is increased in children with NARDS,which is associated with worsening of the disease and poor prognosis.The combination of serum miR-141-3p and KEAP1 levels has high predictive efficacy for death in children with NARDS.

Objective To investigate the induction of L-forms of Yersinia pestis by enrofloxacin,in order to know more about the formation conditions and biological characteristics of L-form Yersinia pestis.Methods Yersinia pestisEV were cultured in Hiss agar media containing 0,0. 5,5,10,50,100,500 and 1 000 ng/mL enrofloxacin respectively. The cultures containing 50 ng/mL enrofloxacin was subcultured in Hiss agar media without enrofloxacin for reversion. The colonial morphology of each sample was observed. The bacterial morphology was observed by Gram staining and cell wall staining,while the cell wall integrity by transmission electron microscope. Yersinia pestis EV and L-form Yersinia pestis were identified by 16S rDNA,analyzed for the homology and the phylogenetic tree were constructed.Results Enrofloxacin 0. 5 ng/mL contained in Hiss agar media caused morphological changes of Yersinia pestis,from typical short-rod to long-rod shape. When the concentration of enrofloxacin was 50 ng/mL,the cell wall of Yersinia pestis was deficient,and the bacteria could not divide and proliferate normally,but showed long-rod shape and coiled into a mass,with the colonial morphology like fried eggs. Enrofloxacin-induced L-form Yersinia pestis reversed in normal Hiss agar media,and displayed a typical Yersinia pestis short-rod shape. 16S rDNA identification showed that the homology between the induced strain and the parent EV strain before induction was 100%.Conclusion Enrofloxacin can induce the L-forms of Yersinia pestis.

This article reported a prenatally diagnosed case of complete ring chromosome 15. A 38-year-old woman who conceived by in vitro fertilization and frozen embryo transfer underwent amniocentesis for prenatal diagnosis at 18 +5 weeks of gestation due to advanced maternal age. The result of G-banding karyotyping was mos 46,XX,r(15)[88]/45,X,-15[11]/46,XX,r(15;15)[1]. No numerical abnormalities of chromosomes or definite pathogenic copy number variations (CNVs) were detected by chromosomal microarray analysis. Amniocentesis was performed again at 31 +6 weeks of gestation. The result of genome copy number variation sequencing indicated no pathogenic CNV and fluorescence in situ hybridization on cultured amniocytes revealed nuc ish(15q)×1[15]/(15q)×3[5]/(15q)×2[80]. Based on all the prenatal diagnosis results, it was suggested that the fetus carried a complete ring chromosome 15. As the peripheral blood chromosomes of the couple were normal and no obvious abnormalities were detected by the prenatal ultrasound either in our hospital or another hospital, the pregnant woman decided to continue the pregnancy after genetic counseling and delivered a baby girl at 41 weeks of gestation. The girl showed no physical abnormalities during a seven-month follow-up.

AIM:To investigate the influencing factors of abnormal telangiectasia secondary to diabetic retinopathy(DR).METHODS: Prospective studies. A total of 153 cases(240 eyes)with DR treated in our hospital from January 2021 to January 2023 were selected to analyze the risk factors of abnormal telangiectasia secondary to DR and its predictive efficacy.RESULTS: The patients were divided into dilated group(77 eyes of 40 cases)and non-dilated group(163 eyes of 113 cases)according to whether they had secondary abnormal telangiectasia. There were significant differences in diabetic macular edema, hard exudates grade and fasting blood glucose level between the two groups(P<0.05). Logistic regression analysis showed that diabetic macular edema, high hard exudates grade and high blood glucose level were the risk factors for abnormal telangiectasia secondary to DR(P<0.05).CONCLUSION: The occurrence of telangiectasia secondary to DR may be related to diabetic macular edema, grade 3 hard exudates and high blood glucose level.

On February 5,2024,the American Heart Association(AHA)released a scientific statement on the pharmacological management of cardiac arrhythmias in the fetal and neonatal periods.The statement discussed the mechanisms of arrhythmias,medication regimens,and fetal and neonatal aspects of pharmacokinetics.The statement proposed a consensus on drug treatment for arrhythmias in fetuses and newborns.This article interpreted the drug treatment part,and summarized the recommended medication and drug characteristics for fetal and neonatal arrhythmias to provide a reference for the drug treatment of fetal and neonatal arrhythmias in China.

Objective:To examine the effects of Zishenwan Prescription on bile acid metabolism in mice with diabetic encephalopathy; To explore its mechanism of improvement of diabetic encephalopathy.Methods:Male C57BL/6J mice were used to replicate the mouse model of type 2 diabetes mellitus by using high-fat chow and a single intraperitoneal injection of streptozotocin (120 mg/kg). The mice were screened for diabetic encephalopathy by using the Morris water maze test after 8 weeks of continuous stimulation with hyperglycemia, and were divided into model group and Zishenwan Prescription group according to random number table method, with 12 mice in each group. The mice in the Zishenwan Prescription group were treated with the crude extract of Zishenwan Prescription (9.36 g/kg) by gavage, and the normal group and the model group were treated with the same volume of distilled water once a day for 8 weeks. At the end of the treatment, Morris water maze test was used to investigate the cognitive function of diabetic encephalopathy mice; cresyl violet staining was used to detect the number of granule neurons in the hippocampus; serum and feces were collected to detect the content of bile acids by liquid-liquid coupling; hepatic bile acid synthase CYP7a1 and CYP27a1, farnesol X receptor (FXR), fibroblast growth factor 15 (FGF15), fibroblast growth factor receptor 4 (FGFR4), and ileocecal apical sodium-dependent bile acid transporter protein (ABST) mRNA levels were detected by using fluorescence quantitative PCR assay.Results:Compared with the model group, mice in the Zishenwan Prescription group had shorter evasion latency time ( P<0.05 or P<0.01), decreased time to first reach the platform ( P<0.01), increased number of times to traverse the platform ( P<0.01), and reduced neuronal cell damage in hippocampal area; mice in the Zishenwan Prescription group showed decreased serum and fecal total bile acid content ( P<0.05 or P<0.01); the liver CYP7a1 and CYP27a1 mRNA expressions increased ( P<0.01), and FXR and FGF15 mRNA expressions decreased ( P<0.01); ileal ABST mRNA expression decreased ( P<0.01). Conclusion:Zishenwan Prescription may regulate bile acid metabolism, inhibit FRX-FGF15/FGFR4 signaling and ABST expression to promote new bile acid synthesis and conjugated bile acid reabsorption, and thus improve cognitive function in diabetic encephalopathy mice.

Objective:To explore the effect of standardized training and intelligent assessment system for nurses.Methods:In August 2020 and August 2021, convenience sampling was used to select new nurses who received standardized training at Beijing Tiantan Hospital affiliated with Capital Medical University as participants. Forty-two new nurses in August 2020 were designated as control group, and 42 new nurses in August 2021 were designated as intervention group and assessed through an intelligent assessment system. The assessment costs of two groups of nurses were compared.Results:Intervention group had shorter pre-exam preparation time, pre-exam waiting time, score summary time, and consumables costs compared to control group, and the differences were statistically significant ( P<0.05) . Conclusions:The construction of an intelligent assessment system improves the scientificity, effectiveness, and fairness of standardized training for nurses. Continuous improvement and perfection are still needed in the future.

Objective:To build a nursing care plan decision-making support system based on the hospital's nursing information system and evaluate its effects in newly hired nurses.Methods:This study adopted a non-synchronous pre-post control design. Totally 181 newly hired nurses recruited by Beijing Tiantan Hospital, Capital Medical University, were selected by convenience sampling. The control group consisted of 85 new nurses hired in August 2021, while the intervention group consisted of 96 new nurses hired in August 2022. The control group received traditional training methods, while the intervention group received training through the nursing care plan decision-making support system in addition to the traditional methods. The nursing decision-making ability and the quality of specialty nursing care were compared between the two groups.Results:Finally, 81 nurses were included in the control group, and 93 nurses were included in the intervention group. The nursing decision-making ability score in the intervention group was (80.15±4.59), which was significantly higher than the (78.62±5.13) in the control group ( t=-2.080, P=0.039). The intervention group also had a significantly higher qualified rate of specialty nursing care compared to the control group (χ 2=6.626, P=0.036) . Conclusions:The application of the nursing care plan decision-making support system in the standardized training of newly hired nurses can improve their nursing decision-making abilities and the quality of specialty nursing care.

Objective:To explore the influencing factors for poor prognosis in patients with severe traumatic brain injury (TBI).Methods:A retrospective analysis was performed; the clinical data of 389 patients with severe TBI admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from January 2018 to December 2022 were collected. Glasgow Outcome Scale (GOS) was used to evaluate the prognoses 6 months after discharge. Differences in clinical data between the good prognosis group (GOS scores of 4-5) and poor prognosis group (GOS scores of 1-3) were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in severe TBI patients, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the regression model in severe TBI patients. Results:At 6 months after discharge, 182 patients (46.8%) had favorable prognosis and 207 patients (53.2%) had unfavorable prognosis. Compared with the good prognosis group, the poor prognosis group had significantly older age, lower Glasgow Coma Scale (GCS) scores, higher proportions of patients with subdural hematoma (SDH), cerebral hernia, cerebral infarction and encephalocele, higher blood glucose, lower albumin, lower K +, Ca 2+ and CO 2, higher international normalized ratio (INR) and C-reactive protein (CRP), lower lymphocyte/monocyte ratio (LMR), and higher neutrophil/lymphocyte ratio (NLR) and systemic immunoinflammatory index (SII, P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.045, 95% CI: 1.025-1.066, P<0.001), GCS score ( OR=0.487, 95% CI: 0.388-0.612, P<0.001), cerebral hernia ( OR=3.471, 95% CI: 1.604-7.511, P=0.002), blood glucose ( OR=1.109, 95% CI: 1.010-1.218, P=0.030), INR ( OR=8.073, 95% CI: 1.199-54.354, P=0.032) and high SII ( OR=8.311, 95% CI: 4.089-16.892, P<0.001) were independent influencing factors for poor prognosis in severe TBI patients. ROC curve showed that area under the curve of the regression model predicting poor prognosis in severe TBI patients was 0.935 (95% CI: 0.905-0.957, P<0.001), enjoying sensitivity of 88.89% and specificity of 85.16%. Conclusion:Severe TBI patients with advanced age, low GCS score, high INR and SII, elevated blood glucose, or cerebral hernia have poor prognosis.

Objective:To explore the clinical effect of perforator pedicled propeller flap (PPPF) in reconstruction of soft tissue defect in ankle and foot, as well as the role of preoperative ultrasonography in assistance of the location of perforators in donor site.Methods:From January 2017 to June 2023, the Department of Microorthopedics of the Second Affiliated Hospital of Luohe Medical College of Higher Education applied PPPF to reconstruct small and medium-sized soft tissue defects in the ankle and foot for 26 patients. The patients were 17 males, 9 females, aged 18 to 68 years old with 46 years old in average. The defect sites were 3 in forefoot and 6 in midfoot and combined with different degrees of tendon and bone exposure, 17 in ankle and heel and combined with various degrees of bone exposure, 12 with ankle open injury and 5 with Achilles tendon exposure. The area of soft tissue defects ranged from 2.5 cm×1.5 cm to 16.0 cm × 6.5 cm. The width of injury was measured before surgery, and a HHD was used to detect the perforators proximal to the defect site, and then high-frequency CDU was used to locate and confirm the location of the perforator and its alignment, blood flow and diameter. The line drawn between the 2 perforators was set as the axis of flap. The donor site was assessed by a "pinching and lifting" method to determine a direct closure of donor site or to have it closed by a flap transfer. The sizes of flap were from 2.8 cm×1.5 cm to 24.0 cm×7.5 cm. Twenty-two donor sites were directly closed and 4 received flap transfers. Four flaps had sutures with the skin nerves in the recipient site. Masquelet technique was performed in 6 patients with bone defects in the surgery. Patients received outpatient reviews with 1-2 weeks of intervals in the first 2 months after surgery, and X-ray reviews per 1-2 months for those with bone implants until bone healing.Results:All flaps survived successfully without any special treatment after surgery, except 1 flap that had blood vessel congestion and showed swelling and poor blood supply to the distal flap at 24 hours after surgery. The blood vessel congestion was revised by removal of part of the suture at the tip of flap pedicle. One week later, the tip of the flap remained with a small area of necrosis, which was then healed after dressing changes. A total of 21 patients were included in postoperative follow-up with 4 months to 3 years. All of the flaps had satisfactory appearance, colour and texture, and without any ulceration. Three cases of nerve suture were also included in follow-up. According to the assessment criteria of British Medical Research Council (BMRC), the sensory recovery of the flaps was found of S 2 in 1 flap and S 3 in 2 flaps. According to the American Orthopaedic Foot and Ankle Society (AOFAS), the ankle-hindfoot function scores, there were excellent in 16 patient and good in 5 patients. Conclusion:With the assistance of ultrasound, the PPPF can be effectively used in reconstruction of soft tissue defects in ankle and foot.