ObjectiveTo investigate the effects of Chaihu and Longgu Mulitang （CLMT） on hippocampal neural damage in the mouse model of depression via the extracellular signal-regulated protein kinase （ERK）/cAMP-response element-binding protein （CREB） signaling pathway. MethodsSeventy-eight male C57BL/6 mice were randomly allocated into normal control， model， low/medium/high-dose （2.89， 5.78， and 11.56 g·kg^-1， respectively） CLMT， and paroxetine （10 mg·kg^-1） groups. A depression model was established by chronic unpredictable mild stress （CUMS） combined with social isolation. Behavioral tests were carried out to evaluate depressive-like behaviors. Hematoxylin-eosin staining and Nissl staining were performed to assess hippocampal morphology and neuronal damage. Immunofluorescence was employed to detect glial fibrillary acidic protein （GFAP） and ionized calcium-binding adapter molecule 1 （Iba1）. Real-time PCR was employed to measure the mRNA levels of ERK and CREB. Western blot was employed to determine the expression of ERK/CREB pathway proteins and brain-derived neurotrophic factor （BDNF） in the hippocampal tissue. Molecular Operating Environment （MOE） software was used for molecular docking to evaluate the interactions between CLMT components and target proteins. ResultsCompared with the normal control group， the model group showed decreased sucrose preference （P0.01）， increased tail-suspension immobility time （P0.01）， decreased activity in the central region of the open field test （P0.01）， and decreased activity in the middle and open-arm region of the elevated plus maze test （P0.01）. The hippocampal area in the model group showed wrinkled cells and a reduction in the number of cells， neurons with reduced sizes and Nissl bodies， enhanced fluorescence intensity of GFAP and Iba1 （P0.01）， and down-regulated expression of phosphorylated （p）-ERK， p-CREB， and BDNF （P0.05， P0.01） and mRNA levels of ERK and CREB （P0.01）. Compared with the model group， the CLMT group showed increased body weight （P0.05， P0.01）， restored cell morphology， with only a small number of ruptured cells， normal neuronal structure and morphology with obvious nuclei and abundant Nissl bodies， weakened fluorescence intensity of GFAP and Iba1 （P0.05， P0.01）， up-regulated mRNA levels of ERK and CREB （P0.05， P0.01） and protein levels of phosphorylated （p）-ERK， p-CREB， and BDNF in the hippocampal tissue （P0.05， P0.01）. The results of molecular docking indicated that nine active ingredients in CLMT had good binding affinity with ERK and CREB. ConclusionCLMT may ameliorate the hippocampal nerve injury in the mouse model of depression by regulating the ERK/CREB pathway.

Objective:To investigate the factors influencing the success of external cephalic version.Methods:Pregnant women who underwent an external cephalic version due to breech or transverse presentation by the same operator in the Third Affiliated Hospital of Zhengzhou University from July 2015 to July 2021 were selected as the study objects. Univariate analysis and logistic regression analysis were used to explore the clinical factors influencing the success of the external cephalic version. The receiver operating characteristic (ROC) curve was used to analyze the best cut-off value of gestational week and amniotic fluid index at the time of operation and to evaluate the predictive value of the influencing factors on the success of the external cephalic version.Results:(1) A total of 118 cases finally entered this study. Among the 118 cases,77 cases (65.3%) succeeded in the external cephalic version, among which the success rate was 49.1% (27/55) for primipara and 79.4% (50/63) for multipara. The vaginal delivery rate was 56.8% (67/118). (2) Complications occurred in 19 (16.1%) of the 118 cases. The main complications were abnormal fetal heart rate (13 cases, 11.0%), umbilical cord presentation, and fetal position reversion (two cases and 1.7% in each), and the serious complications were intrauterine fetal death and placental abruption (one case and 0.8% in each).The complication rate of patients with successful external cephalic version was 7.8% (6/77), which was lower than that of those who failed the external cephalic version [31.7%(13/41)] ( χ 2=11.33, P=0.001). (3) Multivariate analysis showed that gestational week at surgery before 38, amniotic fluid index >11.10 cm, and multipara were the factors affecting the success of the external cephalic version [ OR(95% CI)=0.561(0.351-0.897), 1.173(1.018-1.351) and 4.201(1.547-11.404), all P<0.05]. (4) The area under the ROC curve of the combination of the gestational week at surgery, amniotic fluid index, and parity was 0.744 (95% CI: 0.640-0.848, P<0.001), and the Youden index was 0.518, with a sensitivity of 70.0% and a specificity of 81.8%. Conclusion:Gestational weeks, amniotic fluid index, and multipara are related to the success of the external cephalic version, and the combination of the three has certain predictive power for the success of the surgery.

Objective To investigate the infection status after heart transplantation (HT) in a third-grade class-A hospital from 2018 to 2023, and explore its risk factors. Methods A retrospective analysis was conducted on the data of 314 patients who underwent HT surgery from January 2018 to July 2023, they were divided into infection group and control group according to postoperative infection situation, the possible influencing factors of HT postoperative infection were analyzed by univariate analysis, and the risk factors of HT postoperative infection were screened by multivariate Logistic regression analysis. Results A total of 91 patients(28.98%)developed postoperative infections, with infection sites of respiratory tract and blood. Logistic regression analysis showed that the main risk factors for postoperative infection in HT patients included complicating with chronic lung disease, surgical time ≥5 h, long retention time of postoperative thoracic drainage tube, long postoperative urinary tube retention time, long postoperative mechanical ventilation time, and preoperative Alb < 35 g/L. Conclusion Complicating chronic lung disease, surgical time ≥5 h, long postoperative thoracic drainage tube retention time, long postoperative urinary tube retention time, long postoperative mechanical ventilation time, preoperative Alb < 35 g/L are related to postoperative infection of HT. Therefore, active intervention should be carried out for the above factors in patients to reduce the risk of infection.

[Objective]To analyse the distribution of TCM constitution of spontaneous abortion 604 cases and explore the relevant factors affecting physique,so as to provide new ideas for the prevention and treatment of spontaneous abortion.[Methods]The TCM physique results of 604 patients with spontaneous abortion were collected,and the effects of abortion times,age and etiology on physique were analyzed.[Results]The influence of age≥35 on the number of spontaneous abortion was statistically significant[odds ratio(OR)=1.299,P=0.001].The biased constitution of 604 patients with spontaneous abortion accounted for 89.74％,among them,26.16％ were patients with single biased constitution,27.15％ with two biased constitution and 36.42％ with three biased constitution.According to the comparison of various types of physique between the two groups,the quality of Qi depression was related to the number of miscarriages (P=0.000).According to the comparison of various types of physique between the two groups,the quality of Yang deficiency (P=0.000),Yin deficiency (P=0.000),dampness-heat (P=0.002),blood stasis (P=0.007) and phlegm-dampness (P=0.029) were related to age.The anatomical etiology of spontaneous abortion was related to the quality of Qi depression (P=0.016),the cause of infection was related to the quality of dampness-heat(P=0.033) and phlegm-dampness (P=0.033),the etiology of thrombosis was related to the quality of Qi depression (P=0.000),blood stasis (P=0.002) and phlegm-dampness (P=0.000),and the endocrine etiology was related to phlegm-dampness (P=0.001) and characteristics (P=0.026).The immune etiology was related to Yang deficiency (P=0.049),Yin deficiency (P=0.005) and blood stasis (P=0.001),but the genetic etiology had nothing to do with each constitution (P>0.05).[Conclusion]Age ≥ 35 years old could increase the risk of spontaneous abortion.Yang deficiency,Qi depression,Yin deficiency and Qi deficiency were the susceptible constitutions of spontaneous abortion.There was a similar aggregation phenomenon in the biased constitution of patients with different times of spontaneous abortion,in which the quality of Qi depression was related to the number of miscarriages.In patients with spontaneous abortion ≥ 35 years old,the proportion of Yang deficiency,Yin deficiency and blood stasis increased,while the proportion of damp-heat and phlegm-dampness decreased.The anatomical etiology of spontaneous abortion was related to Qi depression,the cause of infection was related to dampness-heat and phlegm-dampness,the etiology of thrombosis was related to Qi depression,blood stasis and phlegm-dampness,and the endocrine etiology was related to phlegm-dampness and characteristics.Immune etiology was related to Yang deficiency,Yin deficiency and blood stasis.

[Objective]To analyse the distribution of TCM constitution of spontaneous abortion 604 cases and explore the relevant factors affecting physique,so as to provide new ideas for the prevention and treatment of spontaneous abortion.[Methods]The TCM physique results of 604 patients with spontaneous abortion were collected,and the effects of abortion times,age and etiology on physique were analyzed.[Results]The influence of age≥35 on the number of spontaneous abortion was statistically significant[odds ratio(OR)=1.299,P=0.001].The biased constitution of 604 patients with spontaneous abortion accounted for 89.74％,among them,26.16％ were patients with single biased constitution,27.15％ with two biased constitution and 36.42％ with three biased constitution.According to the comparison of various types of physique between the two groups,the quality of Qi depression was related to the number of miscarriages (P=0.000).According to the comparison of various types of physique between the two groups,the quality of Yang deficiency (P=0.000),Yin deficiency (P=0.000),dampness-heat (P=0.002),blood stasis (P=0.007) and phlegm-dampness (P=0.029) were related to age.The anatomical etiology of spontaneous abortion was related to the quality of Qi depression (P=0.016),the cause of infection was related to the quality of dampness-heat(P=0.033) and phlegm-dampness (P=0.033),the etiology of thrombosis was related to the quality of Qi depression (P=0.000),blood stasis (P=0.002) and phlegm-dampness (P=0.000),and the endocrine etiology was related to phlegm-dampness (P=0.001) and characteristics (P=0.026).The immune etiology was related to Yang deficiency (P=0.049),Yin deficiency (P=0.005) and blood stasis (P=0.001),but the genetic etiology had nothing to do with each constitution (P>0.05).[Conclusion]Age ≥ 35 years old could increase the risk of spontaneous abortion.Yang deficiency,Qi depression,Yin deficiency and Qi deficiency were the susceptible constitutions of spontaneous abortion.There was a similar aggregation phenomenon in the biased constitution of patients with different times of spontaneous abortion,in which the quality of Qi depression was related to the number of miscarriages.In patients with spontaneous abortion ≥ 35 years old,the proportion of Yang deficiency,Yin deficiency and blood stasis increased,while the proportion of damp-heat and phlegm-dampness decreased.The anatomical etiology of spontaneous abortion was related to Qi depression,the cause of infection was related to dampness-heat and phlegm-dampness,the etiology of thrombosis was related to Qi depression,blood stasis and phlegm-dampness,and the endocrine etiology was related to phlegm-dampness and characteristics.Immune etiology was related to Yang deficiency,Yin deficiency and blood stasis.

Objective:To explore the relevance of a new comprehensive respiratory mechanics parameter, elastic power, to the 28-day prognosis of ARDS patients.Methods:Patients with ARDS hospitalized for at least 48 h with invasive mechanical ventilation in five intensive care units in three local hospitals in Lianyungang City from June 2018 to June 2022 were included in the study. Their baseline data and respiratory mechanics parameters were collected. Elastic power, mechanical power, driving pressure and lung compliance are calculated according to the corresponding formulae. The prognostic risk factors of ARDS patients were analysed using COX multi-factor regression, and the predictive value of EP/Cst on the 28-day prognosis of ARDS patients was evaluated based on ROC curve analysis and Kaplan-Meier survival curve.Results:There was no significantly difference in tidal volume and PEEP settings between the patients in the ARDS survivor and death groups ( P> 0.05). However, the differences in respiratory rate, plateau pressure, driving pressure, lung compliance, mechanical work, elastic work, EP/cst and MP/cst between the two groups were significantly different (all P< 0.01). Multifactorial COX regression analysis showed that EP/cst ( HR=1.211, 95% CI:1.091-1.323) and RR ( HR=1.209, 95% CI:1.046-1.339) were strongly associated with a more severe degree of illness and a worse prognosis in ARDS. And the cumulative survival rate at 28 d was significantly lower in the high Cst-EP group than in the low Cst-EP group (50.00% vs. 82.40%, P < 0.01). Conclusions:The new respiratory mechanics parameters EP and EP/Cst can assess the severity of ARDS with a good predictive effect on patient prognosis at 28 days.

Objective:To compare the efficacy of the Preterm Infant Oral Feeding Readiness Assessment Scale (PIOFRA) and Preterm Infant Oral Feeding Ability Readiness Assessment Scale (POFARA) in predicting the outcome of first oral feeding in preterm infants.Methods:This study was a cross-sectional study. From February 2021 to February 2022, 276 premature infants treated in the Neonatal Intensive Care Unit of the Second Affiliated Hospital of Air Force Medical University of People's Liberation Army and the Second Affiliated Hospital of Shaanxi University of Chinese Medicine were selected by convenience sampling method. According to the outcome of the first oral feeding, the premature infants were divided into a successful first oral feeding group ( n=227) and a failed first oral feeding group ( n=49). PIOFRA and POFARA were used to evaluate premature infants. The area under the receiver operating characteristic curve ( AUC), sensitivity, specificity, Youden index and other indicators were used to compare the predictive efficacy of the two scales for the first oral feeding outcome of premature infants. Results:The success rate of first oral feeding for premature infants was 82.25% (227/276). The PIOFRA and POFARA scores of the successful first oral feeding group were higher than those of the failed first oral feeding group ( P<0.01). The AUC of PIOFRA was 0.830. When the total score of PIOFRA was 27.00, the sensitivity was 78.40%, the specificity was 75.50%, and the Youden index was 0.539 ( P<0.01), and its prediction efficiency was the highest. The AUC of POFARA was 0.928. When the total score of POFARA was 33.00, the sensitivity was 79.70%, the specificity was 95.90%, and the Youden index was 0.757 ( P<0.01), and its prediction efficiency was the highest. The AUC, sensitivity, specificity and Youden index of POFARA were higher than those of PIOFRA. Conclusions:The predictive efficacy of POFARA is higher than that of PIOFRA. It is recommended to use POFARA for the evaluation and prediction of the outcome of first oral feeding in premature infants.

The psychological distress of cancer patients seriously affects their therapeutic effects. Effective psychological rehabilitation of cancer patients significantly improves their survival chance and quality of life. Circadian rhythm results from adaptation to the environment during the organism's evolution. When the endogenous clock system is disrupted or the external environment is changed, the body and the environment are out of synchronization, and the circadian rhythm will be disrupted. Circadian rhythm disorder is a common phenomenon in cancer patients, and the changes of circadian rhythm are closely related to their psychological distress. Many studies believe that the circadian rhythm disorder of cancer patients may directly or indirectly affect their psychology through various mechanisms, and targeted intervention by regulating the circadian rhythm of patients may be an essential means to promote the psychological rehabilitation.
Humans ; Quality of Life ; Circadian Rhythm/physiology* ; Chronobiology Disorders ; Neoplasms

Objective:To analyze the risk factors for postoperative one-year mortality in elderly patients with femoral intertrochanteric fracture following multidisciplinary treatment (MDT) by intramedullary nailing.Methods:The clinical data were retrospectively analyzed of the 158 elderly patients with femoral intertrochanteric fracture who had undergone MDT by proximal femoral intramedullary nailing between January 2018 and August 2020 at Department of Orthopedics, Trauma Center, Zhongda Hospital Affiliated to Southeast University. There were 41 males and 117 females with an average age of 82.5 years (from 65 to 95 years). By the modified Evans classification, there were 15 cases of type Ⅰ, 16 cases of type Ⅱ, 35 cases of type Ⅲ, 81 cases of type Ⅳ, and 11 cases of type Ⅴ. The one-year mortality was documented in the patients after surgery. To screen for risk factors, univariate analysis was conducted of gender, age, body mass index (BMI), modified Evans classification of fractures, time from injury to operation, American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI) and comorbidities, as well as preoperative hemoglobin (Hb), serum albumin (ALB) and total lymphocyte count (TLC). The factors with P<0.05 were included in the multivariate logistic regression model analysis to determine the risk factors. Results:A total of 13 patients died within one year after surgery, yielding a mortality of 8.2% (13/158). Univariate analysis showed significant differences in age, body mass index, modified Evans classification of fractures, CCI and Hb between the surviving and dead patients ( P<0.05). Multivariate logistic regression analysis showed that age >85 years ( OR=0.122, 95% CI: 0.018 to 0.834, P=0.032), BMI>23.9 kg/m 2 ( OR=0.083, 95% CI: 0.013 to 0.510, P=0.007), CCI≥3 points ( OR=0.051, 95% CI: 0.090 to 0.275, P=0.001) and preoperative Hb<90 g/L ( OR=4.733, 95% CI: 1.036 to 21.624, P=0.045) were the independent risk factors for postoperative one-year mortality in the elderly patients with intertrochanteric fracture following MDT by proximal femoral intramedullary nailing. Conclusions:After MDT by proximal femoral intramedullary nailing of femoral intertrochanteric fractures, the geriatric patients with an age >85 years, BMI>23.9 kg/m 2, CCI≥3 points and Hb<90 g/L are likely to die. Therefore, special care should be taken for them.

Objective:To synthesize a novel site-specifically labelled probe 68Ga-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA)-Cys-Asp-Val (CDV)-Nb109 and explore its potential for detection of the programmed cell death ligand 1 (PD-L1) expression level in different tumors. Methods:Firstly, CDV was inserted into the tail of the sequence of Nb109 by genetic engineering. Then the precursor DOTA-CDV-Nb109 was prepared by mixing the maleimide-DOTA and the single-domain antibody CDV-Nb109 (amount of substance ratio 1∶1) via the maleimide-cysteine site-specific coupling strategy. Subsequently, the DOTA-CDV-Nb109 was labeled with 68Ga and purified by PD-10 column. Human melanoma A375, human PD-L1 transfected melanoma A375-hPD-L1 and human glioma U87 tumor-bearing mice models were established, and the diagnostic value of 68Ga-DOTA-CDV-Nb109 was evaluated by stability assay, cellular uptake, and microPET imaging. One-way analysis of variance and the least significant difference t test were used to analyze the data. Results:The probe 68Ga-DOTA-CDV-Nb109 was obtained with the radiochemical yield of (69.79±4.69)%, radiochemical purity more than 97%, and molar activity of (12.85±1.51) GBq/μmol. 68Ga-DOTA-CDV-Nb109 had strong binding affinity for A375-hPD-L1 with the dissociation constant ( Kd) of (66.43±17.89) nmol/L. The uptake of 68Ga-DOTA-CDV-Nb109 in A375-hPD-L1 and U87 cells were (3.17±0.15) percentage of the added radioactivity dose (%AD) and (2.08±0.03) %AD respectively, which were significantly higher than that in A375 cells ((1.21±0.14) %AD; F=82.87, t values: 15.23, 9.98, P values: <0.001, 0.003). The tumor uptake of the probe in A375-hPD-L1 ((5.21±0.35) percentage of injected dose per ml (%ID/ml)) and U87 tumor-bearing mice ((3.44±0.69) %ID/ml) were significantly higher than that in A375 tumor-bearing mice ((2.17±0.36) %ID/ml; F=249.72, t values: 35.70, 3.43, both P<0.001). Conclusion:The site-specifically labelled probe 68Ga-DOTA-CDV-Nb109, which can non-invasively and dynamically monitor the change of PD-L1 expression level in different tumors and help screen patients who can benefit from PD-L1 immune checkpoint blocking therapy, is successfully synthesized with high radiochemical purity.