Cardiac fibrosis is characterized by an elevated amount of extracellular matrix (ECM) within the heart. However, the persistence of cardiac fibrosis ultimately diminishes contractility and precipitates cardiac dysfunction. Circular RNAs (circRNAs) are emerging as important regulators of cardiac fibrosis. Here, we elucidate the functional role of a specific circular RNA CELF1 in cardiac fibrosis and delineate a novel feedback loop mechanism. Functionally, circ-CELF1 was involved in enhancing fibrosis-related markers' expression and promoting the proliferation of cardiac fibroblasts (CFs), thereby exacerbating cardiac fibrosis. Mechanistically, circ-CELF1 reduced the ubiquitination-degradation rate of BRPF3, leading to an elevation of BRPF3 protein levels. Additionally, BRPF3 acted as a modular scaffold for the recruitment of histone acetyltransferase KAT7 to facilitate the induction of H3K14 acetylation within the promoters of the Celf1 gene. Thus, the transcription of Celf1 was dramatically activated, thereby inhibiting the subsequent response of their downstream target gene Smad7 expression to promote cardiac fibrosis. Moreover, Celf1 further promoted Celf1 pre-mRNA transcription and back-splicing, thereby establishing a feedback loop for circ-CELF1 production. Consequently, a novel feedback loop involving CELF1/circ-CELF1/BRPF3/KAT7 was established, suggesting that circ-CELF1 may serve as a potential novel therapeutic target for cardiac fibrosis.

The theory of "yang transforming qi and yin shaping up body" comes from Huangdi Neijing (Inner Canon of Yellow Emperor),which describes the basic form of human metabolism dominated by "yang transforming qi":the effect of " yang transforming qi" leads the energy metabolism of human body,while the effect of "yin shaping up body" leads the material metabolism. Metabolic syndrome is a clinical syndrome with metabolic disorders of protein,fat and carbohydrate. The theory of "yang transforming qi and yin shaping up body" has a strong guiding value for the pathogenesis analysis and clinical differentiation and treatment of metabolic syndrome. Yin and yang represent the two basic trends of the change and development of things,and the functions of "transforming qi" and "shaping up body" are the main manifestations of them in metabolism. From this perspective,this paper suggests that the key pathogenesis of metabolic syndrome should be "insufficiency of yang transforming qi and impairment of yin shaping up body" based on the mutual assistance of yin and yang. On this basis we take "coordinating yin-yang and promoting the reproduction of them" as the main directions of therapy,which provides a new idea for the treatment of metabolic syndrome.

This paper reviews the origin, content and framework, evaluation tools, and application status of Snyder hope theory in clinical nursing practice both domestically and internationally, and explores the application prospects of Snyder hope theory, aiming to provide a basis for promoting its development in nursing.

Objective To explore the systematic nursing intervention for patients with artificial anal bowel habit of effect.Methods Our hospital from May 2020 to select-treated 100 cases of artificial anal in May,2022 patients as the research object,the patients were randomly divided into control group and research group of consent of all the 50 cases,control group adopted routine nursing care,the team take systematic nursing intervention,compare the effect of two groups of patients with bowel movements.Results The team bowel habit each index compared with control group,difference has statistical significance(P<0.05).Conclusion Systematic nursing intervention to actively promote the use of clinical nursing work in the future.

Nutrition therapy is considered as the basis for prevention and management of chronic kidney disease (CKD), throughout the three-tier prevention strategies of CKD. The primary objective is to delay the disease progression, correct metabolic disorders, and improve the outcomes of CKD. Low protein diet has been recognized as an important therapeutic measure in CKD, but the quantity, quality and source of protein are always the points of contention. Recently, both domestic and foreign guidelines have been updated on the amount of protein intake. In addition to quantity, attention has been paid to the type and diversity of proteins. With the rise of plant-based food consumption and the concept of vegetarian diet, the scientific community began to review the benefits of plant protein again, and a plant-based diet is recommend extensively. Whether the plant-based dietary pattern is also suitable for CKD patients who need a low-protein diet, and whether it could meet the nutritional needs of CKD patients are hot topics, this article reviews the recent progress of these research hotspots.

The focus on enhanced recovery after surgery (ERAS) is still the implementation of the concept at present, and remains in the stage of disordered and low-quality application because of its difficulties in operation, evaluation and repeatability. The main reason is lack of standard, feasible operation plan and process, which may lead to great heterogeneity and low quality. Therefore, It is urgent to explore and establish the quality control system of ERAS, including foundation, process, terminal and tracking quality control, so as to improve the validity, security, homogeneity and accessibility, and promote the further popularization and application. However, due to the conceptual, systematic, innovative and individual differences, the construction of ERAS standard quality control system will be faced with great difficulties and challenges. ERAS quality control platform and center can only be established gradually by hard work and a lot of researches.

The focus on enhanced recovery after surgery (ERAS) is still the implementation of the concept at present, and remains in the stage of disordered and low-quality application because of its difficulties in operation, evaluation and repeatability. The main reason is lack of standard, feasible operation plan and process, which may lead to great heterogeneity and low quality. Therefore, It is urgent to explore and establish the quality control system of ERAS, including foundation, process, terminal and tracking quality control, so as to improve the validity, security, homogeneity and accessibility, and promote the further popularization and application. However, due to the conceptual, systematic, innovative and individual differences, the construction of ERAS standard quality control system will be faced with great difficulties and challenges. ERAS quality control platform and center can only be established gradually by hard work and a lot of researches.

Objective To observe the effect of different explosion impulse on rabbit lung injury and decide the death curve,so as to provide a reference for the prediction of lung injury.Methods Six healthy male New Zealand white rabbits with weight of 2.0-2.5 kg and age of (6 ± 1)months were selected.The rabbits were put 0.5 m,0.6 m,0.7 m,0.9 m,1.0 m,and 1.2 m away from 90 g TNT to carry out the blast injury experiment.The characteristic parameters of blast shock wave and general lung injury were recorded.Based on the experimental results combined with theoretical analysis,the changes of rabbit lung injury depending on the explosion distance as well as the rabbit death curve were determined.Results After the 90 g TNT explosion,the peak overpressure of shock wave and the corresponding specific impulse decreased quickly with the increase of explosion distance.The peak overpressure was 0.79 MPa and the specific impulse was 82 Pa · s at the explosion distance of 0.5 m.The peak overpressure was 0.1 MPa and the specific impulse was 34 Pa · s at the explosion distance of 1.2 m.The rabbits at 0.5 m and 0.6 m died,the rabbit at 0.7 m was severely injured,and the rabbits at 0.9 m,1.0 m,and 1.2 m were slightly injured.The dependence of lung injury degree on the explosion distance under 90 g TNT explosion was established based on dimensional analysis theory.The lung injury degree was exponentially attenuated with the explosion distance:φ =(R/0.6)-5.64(φ represented lung injury degree,and R represented the explosion distance).Considering the combined injury effects of peak overpressure of shock wave and its specific impulse on rabbit lung,the death curve of rabbit was determined:(p-0.1) (I-59) =2.6 (p represented peak overpressure,and I represented specific impulse).The criterion of "overpressure-specific impulse" was used to estimate the death of rabbit,and the death curve of rabbit was determined as (p-0.1)(I-59) =2.6(p represented peak overpressure and I represented specific impulse).The critical overpressure was 0.1 MPa and the critical specific impulse was 59 Pa · s.Conclusions Under the explosion condition of 90 g TNT,the relationship between degree of lung injury in rabbits and explosion distance is established.Death curve of rabbits is determined based on the damage effect of shock wave peak overpressure and specific impulse on the lungs of rabbits,which is significant for predicting the blast injury.

OBJECTIVETo investigate the impact of preoperative oral liquid carbohydrate on postoperative insulin resistance (IR) in gastric cancer patients undergoing elective resection, and to examine the association of IR index (homeostasis model assessment, HOMA-IR) with tumor necrosis factor-α (TNF-α).

METHODSBetween January 2013 and September 2013, 35 patients undergoing elective resection for gastric cancer were prospectively enrolled and randomized into two groups. Patients in trial group (n=18) received oral 500 ml of 10% glucose solution two hours before surgery. Patients in control group (n=17) were asked to fast for 8-12 hours before operation. About 300 mg of rectus abdominis and subcutaneous fatty tissues was removed before the closure of abdominal wall. Blood samples were collected to measure the serum concentration of TNF-α with double antibody sandwich ELISA in perioperative period (3-hour before operation, end of operation, 1-day and 3-day after operation). HOMA-IR was calculated on preoperative 3-hour and postoperative 1-day. Western blotting was used to detect protein expression of TNF-α. Correlation of HOMA-IR with TNF-α was examined.

RESULTSHOMA-IR on the first day after surgery was not different from that at 3-hour before surgery in trial group (P=0.090), which was significantly lower than that in control group (P=0.000). In trial group, serum TNF-α at the end of operation was higher than that at 3-hour before surgery, which declined rapidly on the first day after surgery and had no significant difference compared with that on the third day after surgery. In control group, serum TNF-α at the end of operation was also higher than that before surgery, which rose to the peak on the first day after surgery and was still higher than that at 3-hour before surgery. The TNF-α protein expression in muscle tissues of trial group was higher than that of control group (P=0.001), while no significant difference was observed between two groups in adipose tissues (P=0.987). Correlation analysis showed that HOMA-IR was positively correlated with TNF-α on the first day after surgery (r=0.832, P=0.000).

CONCLUSIONOral intake of liquid carbohydrate 2 hours before surgery can reduce the level of TNF-α, which is likely to improve the postoperative insulin resistance.

Objective To investigate the diagnosis measures and treatment methods of white line hernia. Methods Analyze the clinical data of 12 cases of white line hernia who were treated by surgery. We performed peritoneal adipose tissue before resection on hernia without hernial sac type. And for those with hernial sac type, apothesis of material in hernia were firstly made, then ligated the hernia sac neck and resection were made. Then according to the white line defect size, we used pure involution suture and Onlay without tension patch repair to repair defect in the white line. Results Surgery of all the 12 cases were successful. 2 cases of them merged postoperative renal dysfunction and infection, and after hemodialysis and anti-infection treatment, they both recoverd well without recurrence. Conclusion There is no spe-cific symptoms and signs in white line hernia, but incarceration and strangulation may cause life threaten, so we should pay more attention to it. For symptomatic, large, difficult, incarcerated or strangulated white line hernia,we should take timely surgical treatment.