Objective: To evaluate the diagnostic performance of magnetic resonance spectroscopy (MRS) in discriminating fumarate hydratase-deficient (FH-d) uterine leiomyomas (ULs) from FH-preserved ULs. Materials and Methods: This study consisted of three stages, with independent cohorts recruited for each stage: 1) sample-size estimation was retrospectively performed on UL specimens (diameter ≥3 cm; age, 20–40 years) from our database with immunohistochemistry (IHC) for 2-succinocysteine (2-SC) as the reference, without genetic testing, 2) MRS sequence optimization in confirmed FH germline mutation participants with ultrasound-detected ULs (diameter ≥3 cm), without IHC analysis, and 3) prospective diagnostic test accuracy was evaluated in consecutive participants with ultrasound-detected ULs (diameter ≥3 cm;age, 20–40 years), using IHC for 2-SC for determining the FH status and subsequent genetic testing in those with positive 2-SC results to identify whether FH mutations were germline or somatic in origin. The choline and fumarate peaks in MRS were classified as positive, negative, or technical failure (TF). TFs were analyzed separately and excluded from the primary diagnostic accuracy calculations. T1-, T2-, and diffusion-weighted images were interpreted as hyperintense or hypointense. The enhancement rate and apparent diffusion coefficient were also acquired. Diagnostic performance was compared between MRS and various magnetic resonance imaging (MRI) features. Results: The optimal MRS parameters for the fumarate peak were echo time (TE) = 140 ms and an average of 256. Among the 360 prospective participants, 37 were confirmed to have FH-dULs. MRS showed positive fumarate peaks in 35 of 37 FH-dULs.After excluding six TFs, the positive fumarate peak on MRS showed 94.6% (35/37) sensitivity, 99.7% (316/317) specificity, and 99.2% (351/354) accuracy, all of which were significantly superior to those of other MRI features (P ≤ 0.002). Conclusion A positive fumarate peak on MRS may be a useful imaging biomarker for diagnosing FH-dULs.

BACKGROUND:Successful uterine spiral artery remodeling is necessary for normal pregnancy,in which vascular smooth muscle cells are important cells.Interferon-γ is associated with the loss of vascular smooth muscle cells during early pregnancy.However,the specific mechanism is not fully understood. OBJECTIVE:To investigate the effects of interferon-γ on migration and apoptosis of vascular smooth muscle cells through NLRP3/caspase-1/GSDMD pyroptosis pathway. METHODS:Human vascular smooth muscle cells were divided into control group and interferon-γ group.The control group was cultured normally,and the interferon-γ group was treated with 10 ng/mL interferon-γ for 24 hours.The migration ability of vascular smooth muscle cells was detected by Transwell assay.The apoptosis of vascular smooth muscle cells was detected by TUNEL assay and flow cytometry.The mRNA expression levels of NLRP3 and caspase-1 were detected by qPCR.Western blot assay was utilized to detect NLRP3,caspase-1,and cleaved N-terminal GSDMD protein expression levels. RESULTS AND CONCLUSION:Compared with the control group,the migration ability and apoptosis rate of vascular smooth muscle cells in interferon-γ group were significantly increased(P<0.05).Compared with the control group,the mRNA expression levels of NLRP3 and caspase-1 in vascular smooth muscle cells of interferon-γ group were significantly increased(P<0.05).Compared with control group,the expression levels of NLRP3,caspase-1,and cleaved N-terminal GSDMD protein in vascular smooth muscle cells in the interferon-γ group were significantly increased(P<0.05).The results suggest that interferon-γ may regulate the migration and apoptosis of vascular smooth muscle cells through NLRP3/caspase-1/GSDMD pyroptosis pathway.

Objective This study aimed to analyze the current status of depressive symptoms among middle school students in Jingzhou City in 2023 and the influence of daily lifestyle on these symptoms.Methods A convenience cluster sam-pling method was used to conduct a questionnaire survey among students in 25 middle schools in Jingzhou City from September 2023 to November 2023.The questionnaire included demographic information and standardized questionnaires.Chi-square test was used for univariate analysis,and binary logistic regression model was used for analysis of influencing factors.Results A-mong the 17,499 valid questionnaires,the prevalence of depressive symptoms among middle school students in Jingzhou City was 32.60％.Univariate analysis revealed that students with unhealthy lifestyles(including internet addiction,insomnia,lack of si-esta,frequent late-night activities,less participation in physical exercise,passive participation in group activities,and unbal-anced dietary habits)had a higher prevalence of depressive symptoms.Moreover,high school students(40.95％)had a higher prevalence than middle school students(27.57％),and females(37.43％)had a higher prevalence than males(27.96％);all differences were statistically significant(P＜0.001).Binary logistic regression analysis showed that being female,being a high school student,internet addiction,insomnia,lack of siesta,frequent late-night activities,less participation in physical exercise,passive participation in group activities,and unbalanced dietary habits were risk factors for depressive symptoms among middle school students in Jingzhou City.Conclusion This study revealed the association between depressive symptoms and daily lifes-tyle among middle school students in Jingzhou City.The prevalence of depressive symptoms was related to factors including being female,being a high school student,internet addiction,insomnia,lack of siesta,unbalanced dietary habits,less participation in physical exercise,and passive participation in group activities.It is recommended to focus on cultivating good daily behavioral habits among students in both school and family environments to improve their mental health.

Objective This study aimed to analyze the current status of depressive symptoms among middle school students in Jingzhou City in 2023 and the influence of daily lifestyle on these symptoms.Methods A convenience cluster sam-pling method was used to conduct a questionnaire survey among students in 25 middle schools in Jingzhou City from September 2023 to November 2023.The questionnaire included demographic information and standardized questionnaires.Chi-square test was used for univariate analysis,and binary logistic regression model was used for analysis of influencing factors.Results A-mong the 17,499 valid questionnaires,the prevalence of depressive symptoms among middle school students in Jingzhou City was 32.60％.Univariate analysis revealed that students with unhealthy lifestyles(including internet addiction,insomnia,lack of si-esta,frequent late-night activities,less participation in physical exercise,passive participation in group activities,and unbal-anced dietary habits)had a higher prevalence of depressive symptoms.Moreover,high school students(40.95％)had a higher prevalence than middle school students(27.57％),and females(37.43％)had a higher prevalence than males(27.96％);all differences were statistically significant(P＜0.001).Binary logistic regression analysis showed that being female,being a high school student,internet addiction,insomnia,lack of siesta,frequent late-night activities,less participation in physical exercise,passive participation in group activities,and unbalanced dietary habits were risk factors for depressive symptoms among middle school students in Jingzhou City.Conclusion This study revealed the association between depressive symptoms and daily lifes-tyle among middle school students in Jingzhou City.The prevalence of depressive symptoms was related to factors including being female,being a high school student,internet addiction,insomnia,lack of siesta,unbalanced dietary habits,less participation in physical exercise,and passive participation in group activities.It is recommended to focus on cultivating good daily behavioral habits among students in both school and family environments to improve their mental health.

Objective:To evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.

Objective:To investigate the application of transverse closure of longitudinal incisions in repairing pentagonal full-thickness defects of the lower eyelid margin.Methods:A retrospective analysis was performed on clinical data collected from 26 patients with melanocytic nevi at the lower eyelid margin in Department of Dermatology, The Third People′s Hospital of Hangzhou from July 2016 to June 2019. Among the 26 patients, 10 were males, and 16 were females. After lesion resection, all the pentagonal full-thickness defects of the lower eyelid margin were repaired via transverse closure of longitudinal incisions.Results:All the pentagonal defects of the 26 cases were successfully repaired. The longitudinal incisions perpendicular to the eyelid were successfully converted into transverse incisions parallel to the eyelid margin and near the eyelash, and all incisions healed primarily. After surgery, mild congestion of the lower eyelid occurred in 3 patients, and temporary blurred vision in 1. During 1 - 2 years of postoperative follow-up, 26 patients all achieved symmetrical appearance of the skin and soft tissues around the eyes, without obvious postoperative scars or lower eyelid ectropion.Conclusions:Horizontal closure of longitudinal incisions can be used to repair the pentagonal full-thickness defects of the lower eyelid margin, because it can convert the incision closure line perpendicular to the lower eyelid margin into a horizontal transverse incision closure line parallel to the lower eyelid margin, so that the incisions and scars of the lower eyelid can be hided with a satisfactory cosmetic effect.

Objective:To get a deep understanding of true feelings of nurses using intelligent nursing technology in intelligent hospital and to provide basis for optimizing the use, management and promotion of intelligent nursing technology.Methods:By using the phenomenological approach of qualitative research, 15 clinical nurses in a Class Ⅲ Grade A hospital (Intelligent Hospital) in Chongqing from April to June 2019 were selected for face-to-face in-depth interviews. Colaizzi analysis was used to analyze the data.Results:The true experience of nurses in the intelligent hospital on intelligent nursing technology was summarized into four main themes, including the experience of intelligent nursing, lack of adequate equipment and technical support, some time needed for learning and mastering new technologies and full of earnest expectations for intelligent nursing technology.Conclusions:The managers of intelligent hospitals should pay attention to the real feeling of nurses using intelligent nursing technology, solve the problems encountered in use in time, do a good job in communication, feedback and training and optimize the evaluation index of nursing quality in time.

Objective: To evaluate the role of extracellular signal-regulated kinase (ERK) signaling pathway in intrathecal dexmedetomidine-induced reduction of spinal cord ischemia-reperfusion (I/R) injury in rats. Methods: Eighty clean-grade male Sprague-Dawley rats, aged 9-10 weeks, weighing 300-350 g, were divided into 4 groups (n=20 each) using a random number table method: sham operation group (group S), spinal cord I/R group (group I/R), dexmedetomidine group (group D), and dexmedetomidine plus ERK signaling pathway blocker PD98059 group (group P). Spinal cord ischemia was produced by cross-clamping of the abdominal aorta distal to the left renal artery for 25 min followed by reperfusion to establish the model of spinal cord I/R injury.Dexmedetomidine 1 μg/kg was intrathecally injected at 20 min before establishing the model in D and P groups, PD98059 2 mg/kg was given via the tail vein at the same time in group P, and the equal volume of normal saline was given instead in S and I/R groups.Five rats were selected at 6, 8, 10 and 12 h of reperfusion, and the modified Basso, Beattie, Bresnahan (BBB) scale was used to assess the hindlimb locomotor function.Five rats were sacrificed after assessing the locomotor function at 6 h of reperfusion, and the L_3-5 segments of the spinal cord were taken for determination of cell apoptosis (by TUNEL) and expression of phosphorylated ERK (p-ERK) (by Western blot). The apoptosis index was calculated. Results: Compared with group S, the BBB scores were significantly decreased at each time point of reperfusion, the apoptosis index was increased, and the expression of p-ERK was up-regulated in the other three groups (P<0.05). Compared with I/R group, the BBB scores were significantly increased at each time point of reperfusion, the apoptosis index was increased, and the expression of p-ERK was up-regulated in group D, and no significant change was found in the apoptosis index or p-ERK expression in group P (P>0.05). Compared with group D, the BBB scores were significantly decreased at each time point of reperfusion, the apoptosis index was increased, and the expression of p-ERK was down-regulated in group P (P<0.05). Conclusion The mechanism by which intrathecal dexmedetomidine reduces spinal cord I/R injury is related to activating ERK signaling pathway in rats.

This review explains the concept of cardiac rehabilitation (CR), clarifies the benefits of CR, and analyses the role of nurses in CR, the obstacles and countermeasures in promoting CR, and the specific problems in implementing cardiac rehabilitation in China. It also points out the research direction in the future, and provides the basis for the development of CR nursing model for the elderly in the future.

Vitamin D is an important organic substance in the body to maintain the balance of calcium and phosphorus, and it is also closely related to the occurrence and development of coronary atherosclerotic heart disease (referred to as coronary heart disease). Vitamin D deficiency can lead to the occurrence of coronary heart disease by activating the inflammatory response, weakening the protective effect of the vascular endothelium, activating the renin-angiotensin-aldosterone system, impairing insulin function, triggering abnormal glucose and lipid metabolism, and increasing body weight. The effect of vitamin D supplementation on coronary heart disease still requires large-scale clinical trials to confirm.