ObjectiveTo explore the mechanism of herbal cake-separated moxibustion using the classical formula Xiaoyaosan in alleviating neuroimmune inflammatory responses in chronic fatigue syndrome （CFS） rats， based on the regulation of the toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear transcription factor-κB （NF-κB） signaling pathway. MethodsFifty SPF-grade SD rats aged 6-8 weeks were randomly divided into five groups： Normal group， model group， sham herbal cake moxibustion group， Chinese medicine intragastric administration group， and herbal cake-separated moxibustion group， with 10 rats in each group. Except for the normal group， all other groups underwent a 21-day modeling process， followed by behavioral testing. The herbal cake-separated moxibustion and sham herbal cake moxibustion groups received interventions at the Shenque （CV8）， Guanyuan （CV4）， Zusanli （ST36）， and Qimen （LR14） acupoints. The Chinese medicine intragastric administration group was treated with a Xiaoyaosan suspension via gavage. Behavioral tests were conducted after 10 days of continuous intervention. Serum levels of interleukin （IL）-1β， IL-6， and tumor necrosis factor-α （TNF-α）， as well as hippocampal levels of IL-1β， IL-6， TNF-α， and NF-κB， were detected by enzyme-linked immunosorbent assay （ELISA）. Morphological changes in the hippocampus were observed using hematoxylin-eosin （HE） staining. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to detect mRNA expression levels of TLR4， MyD88， and NF-κB in the hippocampus. Western blot analysis was performed to detect the relative expression levels of TLR4， MyD88， NF-κB， and p65 proteins in the hippocampus. ResultsCompared with the normal group， the model group showed a significant decrease in upright times during the open field test （P<0.01）， as well as significant reductions in total movement distance， resting time， and center region duration （P<0.01）. In the tail suspension test， immobility time increased （P<0.01）， and struggle times decreased （P<0.01）. Serum and hippocampal levels of IL-1β， IL-6， and TNF-α， as well as hippocampal NF-κB levels and TLR4， MyD88， and NF-κB mRNA expression， were significantly elevated （P<0.01）. After treatment， compared with the model group， the total movement distance and upright times in the open field test were significantly increased in all treatment groups （P<0.01）， while resting time and center region duration were notably prolonged （P<0.05， P<0.01）. Immobility time in the tail suspension test was significantly shortened （P<0.01）， and struggle times significantly increased （P<0.05）. Serum and hippocampal levels of IL-1β， IL-6， TNF-α， hippocampal NF-κB levels， and TLR4 and NF-κB mRNA expression were significantly reduced （P<0.05， P<0.01）. Compared with the sham herbal cake moxibustion group， the herbal cake-separated moxibustion group showed a significant extension in center region duration during the open field test （P<0.05） and a significant increase in upright times （P<0.01）. In the tail suspension test， immobility time was reduced （P<0.01）， and struggle times increased （P<0.01）. Serum TNF-α levels in the Chinese medicine intragastric administration group were significantly reduced （P<0.01）， while serum IL-6 levels， as well as hippocampal levels of IL-1β， TNF-α， NF-κB， and TLR4， MyD88， and NF-κB mRNA expression， were significantly decreased in both the Chinese medicine intragastric administration group and the herbal cake-separated moxibustion group （P<0.05， P<0.01）. Compared with the Chinese medicine intragastric administration group， the herbal cake-separated moxibustion group exhibited significantly increased upright times in the open field test （P<0.01）. In the tail suspension test， immobility time was reduced （P<0.01）， and struggle times increased （P<0.01）. Serum IL-1β， hippocampal TNF-α levels， and TLR4， MyD88， and NF-κB mRNA expression were significantly decreased （P<0.05， P<0.01）. ConclusionHerbal cake-separated moxibustion effectively improves fatigue and memory function in CFS rats， regulates neuroimmune inflammatory responses， and its mechanism may be related to the modulation of the TLR4/MyD88/NF-κB signaling pathway.

Objective To study the inhibitory effect of secondary metabolites of Pseudomonas aeruginosa(PA)on Candida albicans(CA)and to explore some of the mechanisms.Methods PA and CA strains were i-solated from clinical specimens from the hospital.Then,PA strains with inhibitory effects on CA were screened through cross-line test and co-incubation test,and crude extracts of PA secondary metabolites were prepared,and were tested together with pyocyanin,phenazine-1-carboxylic acid,1-hydroxyphenazine,and 3-ox-ododecyl-l-homoserine lactone(3-oxo-HSL).The inhibitory effects of various PA secondary metabolites on CA were determined through minimum inhibitory concentration test,minimum bactericidal concentration test,time-sterilization curve measurement,and XTT method activity measurement test,and some mechanisms by which PA secondary metabolites inhibited CA were explored.Results The strongest inhibitory effect on CA was 1-hydroxyphenazine,and at a concentration of 6.250 μg/mL,the relative activity of CA decreased to 0.00%.Next were pyocyanin and PA crude extract,and the relative fungal activity of CA decreased to 0.00%at concentrations of 200 and 100 μg/mL.1-hydroxyphenazine,pyocyanin,3-oxo-HSL and PA crude extract all had inhibitory effects on the formation of CA hyphae.Reactive oxygen species(ROS)were generated in CA cells treated with 1-hydroxyphenazine,phenazine 1-carboxylic acid,pyocyanin,and PA crude extract,and the highest levels of ROS were induced by pyocyanin and 1-hydroxyphenazine.Conclusion Phenazine secondary metabolites 1-hydroxyphenazine and pyocyanin have significant inhibitory effects on the growth and activity of CA,and both induce the highest amount of ROS.The quorum-sensing signal molecule 3-oxo-HSL have no in-hibitory effect on CA growth,but have a significant inhibitory effect on the formation of fungal hyphae.

Objective To develop a tiered training framework for operating room nurses in tertiary hospitals,provi-ding guidance for corresponding training curriculum development and clinical competency evaluation.Methods Delphi method was used to conduct two rounds of expert consultation on the preliminary training indicators,estab-lishing a comprehensive tiered training framework for operating room nurses.Results After two rounds of expert consultation,a tiered training framework for operating room nurses was constructed,which includes 6 primary indi-cators,19 secondary indicators and 62 tertiary indicators.The response rate of the two rounds of expert consultation for valid questionnaires were all over 99％and the expert authority coefficients were all over 0.87.Conclusions The consulted experts have good enthusiasm and authority;the developed framework comprehensively covers training content,laying a foundation for designing and implementing tiered training programs for operating room nurses.

Uncovering the risk factors of pulmonary hypertension and its mechanisms is crucial for the prevention and treatment of the disease.In the current study,we showed that experimental periodontitis,which was established by ligation of molars followed by orally smearing subgingival plaques from patients with periodontitis,exacerbated hypoxia-induced pulmonary hypertension in mice.Mechanistically,periodontitis dysregulated the pulmonary microbiota by promoting ectopic colonization and enrichment of oral bacteria in the lungs,contributing to pulmonary infiltration of interferon gamma positive(IFNγ+)T cells and aggravating the progression of pulmonary hypertension.In addition,we identified Prevotella zoogleoformans as the critical periodontitis-associated bacterium driving the exacerbation of pulmonary hypertension by periodontitis,and the exacerbation was potently ameliorated by both cervical lymph node excision and IFNγ neutralizing antibodies.Our study suggests a proof of concept that the combined prevention and treatment of periodontitis and pulmonary hypertension are necessary.

Objective To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection.Methods The procedure of transnasal skull base surgery was divided into three stages:nasal passage preparation(stage 1),tumor resection(stage 2),and skull base reconstruction(stage 3).Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage;and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed.Results A total of 105 patients were enrolled in this study,and 315 samples were taken.The average time point of sampling in the three stages was 20.3,45.1 and 131.3 min after the beginning of operation,respectively.The positive results were 9 cases(2.9％)in the stage 1,8 cases(2.5％)in the stage 2,and 23 cases(7.3％)in the stage 3,which were 24 cases of Staphylococcus epidermidis,7 cases of Staphylococcus aureus,3 cases of hemolytic streptococcus,2 cases of Klebsiella pneumonia,and 4 cases of Escherichia coli.There was no significant difference in the positive cases between stage 1 and stage 2(P=0.955),but there were significant differences between stage 1 or 2 and stage 3(P=0.013;P=0.007).There were 36(11.4％)patients with at least one positive result in the three stages,17(16.2％)with cerebrospinal fluid leakage,and 12(11.4％)with intracranial infection.The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture(OR=3.1,95％CI:0.9-10.6),which was not statistically significant;patients with CSF leakage were 61.4 times higher than those without CSF leakage(OR=61.4,95％CI:11.2-337.1),which was statistically significant(P＜0.001).The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1％.Conclusion The positive rate of bacterial culture in the operative area of transnasal skull base surgery increases significantly with the extension of operation time,which is a potential risk index of postoperative intracranial infection.

Objective To explore the relationship between dietary fiber intake and hypertension in different populations.Methods Dietary fiber intake was calculated using the data from 2015-2016 National Health and Nutrition Examination Survey(NHANES)database by combining dietary data collected by the 24-hour dietary recall method with the USDA Food and Nutritional Database.Hypertension was defined based on blood pressure values obtained through questionnaires and mobile center measurements.Logistic regression models were used to analyze the relationship between dietary fiber intake and hypertension in individuals aged≥18 years.Generalized additive model(GAM)and smoothed curve fitting were used to analyze the dose-response relationship between them.Results Compared with the low dietary fiber intake(＜17.75 g/d)group,in the total population,the prevalence risk of hypertension was 18% lower in the high dietary fiber intake(≥18.85 g/d)group(OR=0.82,95% CI 0.68-0.98).In the male population,the risk of hypertension in the high dietary fiber intake group decreased by 23% (OR=0.77,95% CI 0.60-0.98).In the female population,when dietary fiber intake was＞28.05 g/d,the risk of hypertension decreased by 6% (OR=0.94,95% CI 0.89-0.99)for 1 g/d increase in dietary fiber intake.In the population aged＞60 years,the risk of hypertension decreased by 31% in the high dietary fiber intake group(OR=0.69,95% CI 0.48-0.99).In the population aged≤45 years,the risk of hypertension decreased by 6% (OR=0.94,95% CI 0.88-0.99)for 1 g/d increase when dietary fiber intake＞34.5 g/d.Conclusions High dietary fiber intake is associated with a decreased risk of developing hypertension,and a reasonable increase in dietary fiber intake can help reduce the incidence of hypertension.

Intraoperative hypotension is closely associated with postoperative poor prognosis.Machine learning hypotension predictive index(HPI)based on invasive and non-invasive blood pressure monitoring can predict hypotension in non-cardiac and cardiac surgery,which makes blood pressure manage-ment from passive processing to preventive active control.Hemodynamic management based on HPI reduces the occurrence of hypotension in surgery.In this artical,the introduction of HPI,the application of HPI in-vasive and non-invasive blood pressure monitoring in surgery,and the limitations of HPI are reviewed.

Objective To analyze the relationship between soluble α-Klotho(SKL)levels and continuous glucose monitoring(CGMS)-derived measures of glycemic management in diabetic kidney disease(DKD)patients.Methods A total of 140 T2DM patients admitted to the Department of General Medicine Affiliated Hospital of Yan'an University from May 2020 to May 2022 were selected and divided into two groups according to the levels of UACR:T2DM group(UACR<30 mg/g,n=60),DKD group(UACR≥30 mg/g,n=80)and 45 healthy persons(NC group)who received physical examination in the hospital during the same period were the NC group.Results The SKL level of DKD group was lower than that of T2DM group and NC group(P<0.05).Spearman correlation analysis showed that SKL was positively correlated with eGRF and TIR(P<0.01),and negatively correlated with Scr,UACR,CysC,β2-MG,FPG,HbA1c,MG,TAR and GMI(P<0.01).Multiple linear regression analysis showed that HbA1c and GMI were the influencing factors of SKL.Conclusion The level of SKL in DKD patients is correlated with HbA1c and GMI.

Objective To evaluate the feasibility,reliability and validity of the symptom identification scale for kidney yang deficiency syndrome.Methods The symptom identification scale for kidney yang deficiency syndrome developed in previous research was administered to 200 vascular cognitive impairment patients from September 2020 to September 2022 to assess feasibility through recall rate,completion rate,and completion time;reliability was measured using retest reliability,split-half reliability,homogeneity reliability,and inter-rater reliability;and validity was evaluated based on discriminant and structural validity.Results A total of 200 scales were sent out,and all of them cooperated and were completed and retrieved within 20 min.The results of reliability analysis showed that the retest reliability of the scale was 0.828 for the dimension of yang deficiency and 0.718 for the dimension of kidney qi deficiency;the Spearman-Brown coefficient of split-half reliability was 0.784;the Cronbach coefficient of the dimension of yang deficiency was 0.799,and the Cronbach coefficient of the dimension of kidney qi deficiency in the homogeneity reliability was 0.670.The results of the analysis showed that the differences between the kidney yang deficiency syndrome group and the non-kidney yang deficiency syndrome group in the yang deficiency dimension,kidney qi deficiency dimension scores and total scale scores in the discriminant validity were statistically significant(P<0.001);the KMO value in the structural validity was 0.842,and a total of two factors with eigenvalues greater than 1 were extracted,with a cumulative variance contribution rate of 58.227%.Conclusion The symptom identification scale for kidney yang deficiency syndrome demonstrates adequate reliability and validity,potentially enhancing the prediction of kidney yang deficiency in vascular cognitive impairment.However,the validity of the scale is somewhat limited and requires further refinement for clinical application.

Objective Ultrasound diagnosis and treatment is easy to perform and takes little time.It is widely used in clinical practice thanks to its non-invasive,real-time,and dynamic characteristics.In the process of ultrasound diagnosis and treatment,the probe may come into contact with the skin,the mucous membranes,and even the sterile parts of the body.However,it is difficult to achieve effective real-time disinfection of the probes after use and the probes are often reused,leading to the possibility of the probes carrying multiple pathogenic bacteria.At present,the processing methods for probes at home and abroad mainly include probe cleaning,probe disinfection,and physical isolation(using probe covers or sheaths).Yet,each approach has its limitations and cannot completely prevent probe contamination and infections caused by ultrasound diagnosis and treatment.For example,when condoms are used as the probe sheath,the rate of condom breakage is relatively high.The cutting and fixing of cling film or freezer bags involves complicated procedures and is difficult to perform.Disposable plastic gloves are prone to falling off and causing contamination and are hence not in compliance with the principles of sterility.Furthermore,the imaging effect of disposable plastic gloves is poor.Therefore,there is an urgent need to explore new materials to make probe covers that can not only wrap tightly around the ultrasound probe,but also help achieve effective protection and rapid reuse.Based on the concept of physical barriers,we developed in this study a heat sealing system for the rapid reuse of ultrasound probes.The system uses a heat sealing device to shrink the protective film so that it wraps tightly against the surface of the ultrasound probe,allowing for the rapid reuse of the probe while reducing the risk of nosocomial infections.The purpose of this study is to design a heat sealing system for the rapid reuse of ultrasound probes and to verify its application effect on the rapid reuse of ultrasound probes.Methods 1)The heat sealing system for the rapid reuse of ultrasound probes was designed and tested by integrating medical and engineering methods.The system included a protective film(a multilayer co-extruded polyolefin thermal shrinkable film)and a heat sealing device,which included heating wire components,a blower,a photoelectric switch,temperature sensors,a control and drive circuit board,etc.According to the principle of thermal shrinkage,the ultrasound probe equipped with thermal shrinkable film was rapidly heated and the film would wrap closely around the ultrasound probe placed on the top of the heat sealing machine.The ultrasound probe was ready for use after the thermal shrinkage process finished.Temperature sensors were installed on the surface of the probe to test the thermal insulation performance of the system.The operation procedures of the system are as follows:placing the ultrasound probe covered with the protective film in a certain space above the protective air vent,which is detected by the photoelectric switch;the heating device heats the thermal shrinkable film with a constant flow of hot air at a set temperature value.Then,the probe is rotated so that the thermal shrinkable film will quickly wrap around the ultrasound probe.After the heat shrinking is completed,the probe can be used directly.2)Using the convenience sampling method,90 patients from the Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Xi'an Jiaotong University were included as the research subjects.All patients were going to undergo arterial puncture under ultrasound guidance.The subjects were divided into 3 groups,with 30 patients in each group.Three measures commonly applied in clinical practice were used to process the probes in the three groups and water-soluble fluorescent labeling was applied around the puncture site before use.In the experimental group,the probes were processed with the heat sealing system.The standard operating procedures of the heat sealing system for rapid reuse of ultrasonic probes were performed to cover the ultrasonic probe and form a physical barrier to prevent probe contamination.There were two control groups.In control group 1,disinfection wipes containing double-chain quaternary ammonium salt were used to repeatedly wipe the surface of the probe for 10-15 times,and then the probe was ready for use once it dried up.In the control group 2,a disposable protective sheath was used to cover the front end of the probe and the handle end of the sheath was tied up with threads.Comparison of the water-soluble fluorescent labeling on the surface of the probe(which reflected the colony residues on the surface of the probe)before and after use and the reuse time(i.e.,the lapse of time from the end of the first use to the beginning of the second use)were made between the experimental group and the two control groups.Results 1)The temperature inside the ultrasound probe was below 40℃and the heat sealing system for rapid reuse did not affect the performance of the ultrasound probe.2)The reuse time in the heat sealing system group,as represented by(median[P25,P75]),was(8.00[7.00,10.00])s,which was significantly lower than those of the disinfection wipe group at(95.50[8.00,214.00])s and the protective sleeve group at(25.00[8.00,51.00])s,with the differences being statistically significant(P<0.05).No fluorescence residue was found on the probe in either the heat sealing system group or the protective sheath group after use.The fluorescence residue in the heat sealing system group was significantly lower than that in the disinfection wipes group,showing statistically significant differences(χ2=45.882,P<0.05).Conclusion The thermal shrinkable film designed and developed in this study can be cut and trimmed according to the size of the equipment.When the film is heated,it shrinks and wraps tightly around the equipment,forming a sturdy protective layer.With the heat sealing system for rapid reuse of ultrasonic probes,we have realized the semi-automatic connection between the thermal shrinkable film and the heating device,reducing the amount of time-consuming and complicated manual operation.Furthermore,the average reuse time is shortened and the system is easy to use,which contributes to improvements in the reuse and operation efficiency of ultrasound probes.The heat sealing system reduces colony residues on the surface of the probe and forms an effective physical barrier on the probe.No probes were damaged in the study.The heat sealing system for rapid reuse of ultrasonic probes can be used as a new method to process the ultrasonic probes.