Objective To explore potential categories of post-stroke depression in acute-phase stroke patients and its correlation with the degree of neurological deficits,and to provide references for healthcare professionals in developing targeted interventions.Methods Using convenience sampling,patients with acute stroke who were hospitalized in neurological ward of 2 tertiary general hospitals in Henan Province from January to April 2024 were selected as the survey participants.The investigation was conducted using the General Information Questionnaire,the National Institute of Health Stroke Scale,and the Patient Health Questionnaire-9.The correlation between potential categories of post-stroke depression and the degree of neurological deficit was analysed using unordered multiclassified logistic regression.Results Post-stroke depression score was 10.22±3.61 in 193 acute-phase stroke patients,and post-stroke depression could be categorized into 3 potential categories,namely"low depressive symptoms"(44.6％),"melancholic depression"(15.0％),and"atypical depression"(40.4％).There was a significant difference in the degree of neurological deficits(H=38.074,P＜0.001).Compared with severe neurological deficits,patients with mild deficits were more likely to be categorized as"melancholic depression"(OR=0.016,P=0.001)and"atypical depression"(OR=0.040,P＜0.001),and patients with moderate deficits were more likely to be classified as"atypical depression"(OR=0.085,P=0.001).Conclusion Post-stroke depression in acute-phase stroke patients has obvious categorization characteristics,and it is recommended that healthcare professionals should pay more attention to patients with different degrees of neurological deficits and adopt targeted interventions according to the different categories of post-stroke depression in order to alleviate their depressive symptoms.

Objective:To study the application effect of the Hazard Analysis and Critical Control Point(HACCP)system in risk assessment and dynamic management of operational safety of medical equipment in surgery rooms.Methods:Based on the HACCP principle,hazard analysis and risk assessment were conducted on the operational safety of equipment in surgery room,and the critical control points were determined,and measures of monitor and management were formulated to conduct whole-process dynamic management for equipment in surgery room.A total of 120 medical equipment in use in the surgery room of Shaanxi Provincial Cancer Hospital from January 2022 to January 2024 were selected.According to random number table method,they were divided into conventional management mode group(60 equipment that received conventional management mode)and dynamic management mode group(60 equipment that received the mode of risk assessment and dynamic management based on HACCP system for operational safety of medical equipment in surgery rooms)to receive different managements.The effect,operational quality,the score of management standardization,and management level for equipment in managing and controlling risk of safety of equipment were compared between two management modes.Results:The average pressure-related injury,electrical injury,extravasation of body fluid,and incidence of unqualified cleaning and disinfection of equipment in the dynamic management mode group were respectively(3.01±1.01)%,(2.65±0.78)%,(1.65±0.64)%and(1.15±0.16)%,all of which were lower than those in the conventional management mode group,and the differences were statistically significant(t=16.311,13.434,12.018,12.629,P<0.05).The average utilization rate,cost-benefit amplification and social benefit amplification of the equipment in the dynamic management mode group were respectively(95.36±2.87)%,(7.98±1.32)%and(10.68±2.36)%,all of which were higher than those in the conventional management mode group,and the average operating rate in the dynamic management mode group was(9.87±1.54)%,which was lower than that in the conventional management mode group,and the differences of the above indicators were significant(t=7.657,15.567,10.354,12.466,P<0.05).The scores of the standard degrees of use and operation,disinfection and sterilization,operation and maintenance,and repairing fault of equipment in the dynamic management mode group were higher than those in the conventional management mode group,and the differences of the above data between two groups were statistically significant(t=16.289,11.415,13.396,9.420,P<0.05),respectively.The rate of standard placement,the rate of reasonable recording and integrity rate of equipment in the dynamic management mode group were higher than those in the conventional management mode group,and the failure rate was lower than that of the conventional management mode group,and the differences of the above indicators between the two groups were statistically significant(x2=6.708,7.070,8.491,13.333,P<0.05).Conclusion:The risk assessment and dynamic management based on HACCP system for operational safety of medical equipment in surgery room can improve the management effect for equipment in surgery room,and reduce the operational risk of equipment,and realize the whole-process management and control for medical equipment in surgery room.

OBJECTIVES: Neurodegenerative diseases are closely associated with myelin loss, and the proliferation and differentiation of oligodendrocyte precursor cells (OPCs) are crucial to remyelination. However, the regulatory mechanisms involved remain incompletely understood. This study aims to investigate how astrocytes (ASTs) regulate the secretion of chitinase-3-like protein 1 (CHI3L1) via connexin 47 (Cx47)-mediated exosome signaling, and its subsequent effect on OPC proliferation. METHODS: Primary cells were isolated from postnatal day 1 Sprague-Dawley (P1SD) rats to establish 3 culture conditions: OPCs alone (Group O), OPCs in direct contact with ASTs (Group C), and OPCs cultured with AST-conditioned medium (Group A). Cellular morphology and proliferation were assessed using optical microscopy, 5-ethynyl-2'- deoxyuridine (EdU) incorporation, and flow cytometry. RNA sequencing (RNA-Seq) and bioinformatics analysis (BA) were conducted to identify differentially expressed genes (DEGs) among groups. Protein expression and cell cycle distribution were analyzed by Western blotting (WB) and flow cytometry. Exosomes were isolated and purified via differential centrifugation, characterized by nanoparticle tracking analysis (NTA) and transmission electron microscopy (TEM), and CHI3L1 expression in exosomes was verified via WB. Cx47 was silenced using small interfering RNA (siRNA) to evaluate its effect on OPC proliferation and exosome secretion. Artificial exosomes were constructed by encapsulating CHI3L1 in single unilamellar vesicles (SUVs), whose structure and size were validated by NTA and TEM. Following Cx47 knockdown, artificial exosomes were added back, and OPC proliferation was assessed via flow cytometry and EdU assay. RESULTS: Direct co-cultured with ASTs (Group C) resulted in significantly enhanced OPC proliferation compared to the Group O and Group A (P<0.05). RNA-Seq and WB analyses revealed that ASTs promote OPC proliferation and exosome secretion enriched in CHI3L1 through Cx47. Cx47 knockdown by siRNA led to significant decreases in OPC proliferation and exosome release (P<0.05). The inhibitory effect of Cx47 silencing on OPC proliferation was partially reversed by supplementation with either isolated exosomes or exogenous CHI3L1. CONCLUSIONS This study reveals a novel mechanism by which ASTs regulate OPC proliferation: Through direct contact, ASTs enhance the secretion of CHI3L1-rich exosomes via Cx47, thereby converting intercellular contact signals into secretory signals that promote OPC proliferation. As a key exosomal molecule, CHI3L1 may play an important role in neural function and remyelination and warrants further investigation.
Animals ; Exosomes/metabolism* ; Cell Proliferation ; Rats, Sprague-Dawley ; Rats ; Connexins/genetics* ; Oligodendrocyte Precursor Cells/metabolism* ; Astrocytes/metabolism* ; Chitinase-3-Like Protein 1/metabolism* ; Cells, Cultured ; Cell Differentiation

Objective To explore potential categories of post-stroke depression in acute-phase stroke patients and its correlation with the degree of neurological deficits,and to provide references for healthcare professionals in developing targeted interventions.Methods Using convenience sampling,patients with acute stroke who were hospitalized in neurological ward of 2 tertiary general hospitals in Henan Province from January to April 2024 were selected as the survey participants.The investigation was conducted using the General Information Questionnaire,the National Institute of Health Stroke Scale,and the Patient Health Questionnaire-9.The correlation between potential categories of post-stroke depression and the degree of neurological deficit was analysed using unordered multiclassified logistic regression.Results Post-stroke depression score was 10.22±3.61 in 193 acute-phase stroke patients,and post-stroke depression could be categorized into 3 potential categories,namely"low depressive symptoms"(44.6％),"melancholic depression"(15.0％),and"atypical depression"(40.4％).There was a significant difference in the degree of neurological deficits(H=38.074,P＜0.001).Compared with severe neurological deficits,patients with mild deficits were more likely to be categorized as"melancholic depression"(OR=0.016,P=0.001)and"atypical depression"(OR=0.040,P＜0.001),and patients with moderate deficits were more likely to be classified as"atypical depression"(OR=0.085,P=0.001).Conclusion Post-stroke depression in acute-phase stroke patients has obvious categorization characteristics,and it is recommended that healthcare professionals should pay more attention to patients with different degrees of neurological deficits and adopt targeted interventions according to the different categories of post-stroke depression in order to alleviate their depressive symptoms.

Objective:To study the application effect of the Hazard Analysis and Critical Control Point(HACCP)system in risk assessment and dynamic management of operational safety of medical equipment in surgery rooms.Methods:Based on the HACCP principle,hazard analysis and risk assessment were conducted on the operational safety of equipment in surgery room,and the critical control points were determined,and measures of monitor and management were formulated to conduct whole-process dynamic management for equipment in surgery room.A total of 120 medical equipment in use in the surgery room of Shaanxi Provincial Cancer Hospital from January 2022 to January 2024 were selected.According to random number table method,they were divided into conventional management mode group(60 equipment that received conventional management mode)and dynamic management mode group(60 equipment that received the mode of risk assessment and dynamic management based on HACCP system for operational safety of medical equipment in surgery rooms)to receive different managements.The effect,operational quality,the score of management standardization,and management level for equipment in managing and controlling risk of safety of equipment were compared between two management modes.Results:The average pressure-related injury,electrical injury,extravasation of body fluid,and incidence of unqualified cleaning and disinfection of equipment in the dynamic management mode group were respectively(3.01±1.01)%,(2.65±0.78)%,(1.65±0.64)%and(1.15±0.16)%,all of which were lower than those in the conventional management mode group,and the differences were statistically significant(t=16.311,13.434,12.018,12.629,P<0.05).The average utilization rate,cost-benefit amplification and social benefit amplification of the equipment in the dynamic management mode group were respectively(95.36±2.87)%,(7.98±1.32)%and(10.68±2.36)%,all of which were higher than those in the conventional management mode group,and the average operating rate in the dynamic management mode group was(9.87±1.54)%,which was lower than that in the conventional management mode group,and the differences of the above indicators were significant(t=7.657,15.567,10.354,12.466,P<0.05).The scores of the standard degrees of use and operation,disinfection and sterilization,operation and maintenance,and repairing fault of equipment in the dynamic management mode group were higher than those in the conventional management mode group,and the differences of the above data between two groups were statistically significant(t=16.289,11.415,13.396,9.420,P<0.05),respectively.The rate of standard placement,the rate of reasonable recording and integrity rate of equipment in the dynamic management mode group were higher than those in the conventional management mode group,and the failure rate was lower than that of the conventional management mode group,and the differences of the above indicators between the two groups were statistically significant(x2=6.708,7.070,8.491,13.333,P<0.05).Conclusion:The risk assessment and dynamic management based on HACCP system for operational safety of medical equipment in surgery room can improve the management effect for equipment in surgery room,and reduce the operational risk of equipment,and realize the whole-process management and control for medical equipment in surgery room.

Objective To explore the professionalization model of nursing management team in an international medical center in a provincial public tertiary hospital.Methods Through literature research and Delphi method,a three-person nursing management team was established respectively in three nursing units:outpatient,first-ward,and second-ward of the center,and then trained professionally to define management boundaries and responsibilities.The training effect was verified by applying the professionalization management in the international medical center.The three nursing teams(nine nurses totally)were compared in terms of leadership,patient satisfaction,and nursing discipline construction before and after the training.Results Following the training,the three teams all exhibited a significant improvement in leadership as well as its dimensions(P＜0.05),and pa-tient satisfaction(P＜0.05).Additionally,care quality,scientific research capacity,and innovation ability were all elevated across the three groups.Conclusion The establishment of a nursing management team and performance of professional training can effectively promote the concept of professionalization management,improve the leadership of nurses,cultivate talent eche-lons,drive the overall development of disciplines and teams,and expand the connotation of nursing culture.For all these bene-fits,this model is suitable for promotion and application among clinical departments.

Objective To explore the application value of rehabilitation strategies guided by cardiopulmonary exercise testing (CPET) in patients after interventional therapy for myocardial infarction. Methods A total of 96 patients after interventional therapy for myocardial infarction were selected as study subjects and divided into control group (n=48) and observation group (n=48) according to the order of admission. The control group received traditional cardiac rehabilitation strategies, while the observation group received rehabilitation strategies guided by dynamic CPET. The medication compliance rate and the incidence of adverse events were compared between the two groups. Peak oxygen uptake, anaerobic threshold, left ventricular ejection fraction (LVEF), 6-minute walk test (6MWT) distance, scores of the Self-Efficacy for Exercise (SEE) and the Chinese Quality of Life Questionnaire for Cardiovascular Patients (CQQC) were compared between the two groups before and after surgery. Results Three months after surgery, the medication compliance rate in the observation group was 87.50%, which was significantly higher than 68.75% in the control group (P < 0.05). At 1 month and 3 months after surgery, the LVEF, peak oxygen uptake, anaerobic threshold, SEE score and 6MWT distance in the observation group were significantly higher or larger than those in the control group (P < 0.05). Three months after surgery, the scores of the CQQC in the observation group were significantly higher than those in the control group (P < 0.05). Three months after surgery, the incidence of adverse events in the observation group was 4.17%, which was significantly lower than 18.75% in the control group (P < 0.05). Conclusion The rehabilitation strategies guided by dynamic CPET have high application value in patients after interventional therapy for myocardial infarction, helping them establish medication compliance behavior, improve cardiopulmonary function and quality of life, and reduce the incidence of adverse events.

The identification of clinical questions for clinical practice guidelines of Chinese patent medicine （CPM） is important for subsequent evidence retrieval， evaluation of evidence quality， formation of recommendations. This paper described a methodological proposal for the identification of clinical questions for CPM guidelines to highlight the characteristics of Chinese patent medicine and reflect its effect in specific stage of the disease. Considering four aspects， namely， the drug of Chinese patent medicine （D）， the specific disease stage （S）， comparison （C）， and specific outcome （O）， DSCO framework has been proposed to formulate the clinical questions. Multi-source information through scientific research， policy or standard documents， and clinical data are suggested for collecting clinical questions， and clear selection criteria should be set to finalize the clinical questions to be addressed by the guideline. In addition， the above process needs to be transparently and publicly reported in order to ensure the clarity and completeness of the guidelines.

Rapid and living guidelines are those developed in response to public health emergencies in a short period of time using a scientific and standardized approach. Subsequently， they provide timely and credible recommendations for decision makers through regular and frequent updates of clinical evidence and recommendations. In this paper， we introduced the definition of rapid and living guideline as well as analyzed the basic characteristics of eight rapid and living guidelines in the field of traditional Chinese medicine （TCM） published till 2023 June， summarizing three core methodological issues in relation to how to rapidly develop guidelines， how to formulate recommendations when there is lack of evidence， and how to ensure the timeliness of guidelines. Based on the analysis of current rapid and living guidelines， it is implicated that there is necessity to carry out rapid and living guideline in the field of TCM， and the methodology of rapid integration of multivariate evidence in the field of TCM needs to be further explored； furthermore， it is necessary to further explore the obstacles of implementation of guidelines and promote timely updating， all of which provide certain theoretical references for relevant guideline developers and researchers.

In developing rapid and living guidelines of traditional Chinese medicine （TCM） in response to public health emergencies， it is important that evidence continue to be reviewed， and clinical questions and recommendations updated if necessary， due to the rapid changes in disease progression and the continuous generation of relevant research evidence. This paper proposed that the updating scope in dynamic mode should first be identified； then evidence monitoring should be carried out in four aspects， including clinical research， related guidelines or laws and regulations， disease progression， as well as clinical use of recommendations and clinical needs； finally， based on the results of the evidence monitoring， different options should be made， including revising the clinical questions， updating the evidence and recommendations， and withdrawing the guideline.