Objective:To develop a quality assessment index system for infection prevention and control in integrated medical and elderly care facilities, providing methods for assessing infection control quality and a theoretical basis for enhancing infection prevention and control capabilities.Methods:This study initially constructed a framework for the quality evaluation index system through literature reviews, work specifications and standards and expert interviews. The Delphi method was employed to conduct two rounds of consultations with 19 experts to evaluate the necessity, feasibility, stability, and sensitivity of the indicators. The expert′s active coefficient, authority coefficient, degree of consensus, and coordination were statistically analyzed. The indicators were revised based on expert opinions to finalize the evaluation index system. The weights of the evaluation dimensions were determined using the Analytic Hierarchy Process (AHP), while the weights of the indicators were determined using the proportional allocation method. Reliability was assessed via Cronbach′s α coefficient, and content validity was verified through the Content Validity Index ( CVI). Results:After two rounds of expert consultation, the expert positive coefficient, expert authority coefficient ( Cr) and expert coordination coefficient Kendall′s W was 100%, 0.992 and 0.634 ( P<0.001), indicating high expert authority, good concentration and coordination of opinions. The assessment index system for infection prevention and control quality in integrated medical and elderly care facilities was ultimately constructed, comprising three primary indicators, 18 secondary indicators and 68 tertiary indicators. Among the primary indicators, the process quality had the highest weight of 0.338. Within the process quality, the secondary indicators with the highest weights were infection control material allocation, hand hygiene quality and the management of cluster outbreaks. A total of 11 unique evaluation indicators for integrated medical and elderly care facilities were established, with the highest weighted indicator being the rate of standardized surveillance of infection-related risk factors. Reliability and validity analyses demonstrated that the overall Cronbach′s α coefficient of the system was 0.991, and the Scale-level Content Validity Index was 0.936, confirming good reliability and validity. Conclusion:The evaluation index system constructed in this study can serve as an effective assessment tool for the quantitative evaluation of infection control quality in integrated medical and elderly care facilities. Furthermore, it is recommended that the system undergo continuous optimization concerning its application.

BACKGROUND:The hippocampus is crucial for cognitive function,and exercise holds promise for enhancing cognition and alleviating cognitive decline.However,the molecular mechanisms underlying these effects remain unclear.Bioinformatics,by analyzing the impact of exercise on molecular expression in the hippocampus,helps reveal key mechanisms,providing new insights into how exercise promotes cognition and informing the development of intervention strategies.OBJECTIVE:Using bioinformatics methods to conduct an in-depth analysis of the gene expression profiles of hippocampal tissue in mice subjected to voluntary exercise interventions and by examining the biological functions of differentially expressed genes and their potential regulatory networks to elucidate the molecular mechanisms by which exercise modulates neural function in the hippocampus.METHODS:Gene expression microarray datasets(GSE42904 and GSE29075)from the Gene Expression Omnibus(GEO)database were obtained for hippocampal tissue in mice subjected to voluntary exercise interventions.Strict differential gene analysis was performed using the Limma and DESeq2 packages in R,and the results were visually presented using volcano plots generated by the ggplot2 package.Common differentially expressed genes were identified using the FunRich software.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses were conducted using the clusterProfiler package in R.Protein-protein interaction networks of differentially expressed genes were analyzed using the online tool STRING,and core targets were further screened using Cytoscape software.RESULTS AND CONCLUSION:In the GSE42904 dataset,voluntary exercise intervention led to the differential expression of 123 genes in the hippocampus of mice,primarily involved in rhythmic processes,glycosylation,and other GO biological processes.These genes were also associated with multiple KEGG pathways,including interleukin-17,calcium,and ethanol signaling.Key hub genes identified in the protein-protein interaction network included Npy,Mapk3,Mapk11,and Chgb.In the GSE29075 dataset,voluntary exercise resulted in the differential expression of 455 genes in the hippocampus,mainly involved in the positive regulation of cellular projection organization,negative regulation of apoptotic signaling,and other GO biological processes.These genes were significantly enriched in pathways related to neurodegenerative diseases.Key hub genes identified in the protein-protein interaction network included Eed,Bptf,and Nedd8.To conclude,voluntary exercise significantly regulates the expression of key genes such as Chrm1,Eed,Npy,Mapk3,Mapk11,and Map2k1 in the hippocampus of mice.These genes play a core regulatory role in biological processes such as neurodegenerative diseases and calcium signaling.Voluntary exercise may promote cognitive function by influencing neurogenesis and synaptic plasticity.

Objective To investigate the effects of Sini Powder on serum hypothalamic-pituitary-adrenal(HPA)axis-related hormones and inflammatory factors in liver cancer mice with comorbid depression,and to evaluate its effect on depressive behavior and tumor proliferation activity.Methods Forty-eight specific pathogen-free female C57BL/6 mice were randomly assigned to either a blank(n=8)or model group(n=40).The modeling group was subjected to chronic unpredictable mild stress(CUMS)for six weeks.Both groups underwent orthotopically transplanted liver tumor surgery at the end of the fourth week of CUMS treatment.At the end of the sixth week of CUMS treatment,color Doppler ultrasonography was used to observe tumor formation in the orthotopic transplantation liver tumors,and the tail suspension test was used to assess depressive behavior.Non-tumor-bearing and deceased mice were excluded.The remaining model group mice were stratified by tail suspension immobility time and randomly assigned to the following groups:model group(distilled water),Fluoxetine group(5.0 mg/kg),and Sini Powder low-dose,medium-dose,and high-dose groups(5.2,10.4,and 20.8 g/kg,respectively),with six mice per group.The treatments were administered once daily for 21 consecutive days.After treatment,depressive behaviors were assessed using the open field,tail suspension,and forced swimming tests.The proliferation status of the orthotopic liver transplantation tumor was evaluated by measuring the size of the tumor,observing pathological changes in the tumor tissue through hematoxylin and eosin staining,and detecting the positive cell rate of proliferating cell nuclear antigen(Ki-67)in the tumor tissue using immunohistochemistry.The levels of HPA axis-related hormones in serum,such as corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),corticosterone(CORT),as well as inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),and interleukin-6(IL-6)were measured using an enzyme-linked immunosorbent assay.Western blotting was used to assess mitogen-activated protein kinase(MAPKs)phosphorylation and the expression of nuclear factor-κB(NF-κB),NOD-like receptor family pyrin domain-containing receptor 3(NLRP3),and cysteine aspartic protease-1(Caspase-1)in orthotopic tumors.Results Compared with the blank group,the model group showed reduced total distance traveled in open field test,prolonged immobility times in the tail suspension and forced swimming tests(P<0.05,P<0.01),indicating successful establishment of the liver cancer with comorbid depression mice model.Also,the model group showed increased orthotopic tumor volume(P<0.01),and elevated serum CRH,ACTH,CORT,TNF-α,IL-1β,and IL-6 levels(P<0.01).The phosphorylation of MAPKs in tumor tissues was suppressed(P<0.01),while NF-κB,NLRP3,and Caspase-1 expression levels were downregulated(P<0.01).Compared with the model group,Sini Powder medium-and high-dose groups exhibited increased total distance traveled in the open field test(P<0.05),reduced forced swimming test and prolonged total distance traveled in open field test(P<0.01),while Sini Powder high-dose group showed reduced immobility times in the tail suspension test(P<0.05).Also,Sini Powder low-dose,medium-dose,and high-dose groups showed slower tumor growth,histological changes,including vacuolization and necrosis,decreased Ki-67 positive cell rate(P<0.01),and reduced serum CRH,ACTH,CORT,TNF-α,IL-1β,and IL-6 levels(P<0.05).Additionally,the phosphorylation of MAPKs in tumor tissues was suppressed(P<0.01),and NF-κB,NLRP3,and caspase-1 expression levels were downregulated(P<0.01).Conclusion Sini Powder may alleviate depressive behaviors and suppress tumor proliferation activity in liver cancer mice with comorbid depression by modulating MAPKs activation,inhibiting NF-κB,NLRP3,and Caspase-1 expressions,and reducing serum inflammatory factors and HPA axis-related hormones levels.

Objective:To develop a quality assessment index system for infection prevention and control in integrated medical and elderly care facilities, providing methods for assessing infection control quality and a theoretical basis for enhancing infection prevention and control capabilities.Methods:This study initially constructed a framework for the quality evaluation index system through literature reviews, work specifications and standards and expert interviews. The Delphi method was employed to conduct two rounds of consultations with 19 experts to evaluate the necessity, feasibility, stability, and sensitivity of the indicators. The expert′s active coefficient, authority coefficient, degree of consensus, and coordination were statistically analyzed. The indicators were revised based on expert opinions to finalize the evaluation index system. The weights of the evaluation dimensions were determined using the Analytic Hierarchy Process (AHP), while the weights of the indicators were determined using the proportional allocation method. Reliability was assessed via Cronbach′s α coefficient, and content validity was verified through the Content Validity Index ( CVI). Results:After two rounds of expert consultation, the expert positive coefficient, expert authority coefficient ( Cr) and expert coordination coefficient Kendall′s W was 100%, 0.992 and 0.634 ( P<0.001), indicating high expert authority, good concentration and coordination of opinions. The assessment index system for infection prevention and control quality in integrated medical and elderly care facilities was ultimately constructed, comprising three primary indicators, 18 secondary indicators and 68 tertiary indicators. Among the primary indicators, the process quality had the highest weight of 0.338. Within the process quality, the secondary indicators with the highest weights were infection control material allocation, hand hygiene quality and the management of cluster outbreaks. A total of 11 unique evaluation indicators for integrated medical and elderly care facilities were established, with the highest weighted indicator being the rate of standardized surveillance of infection-related risk factors. Reliability and validity analyses demonstrated that the overall Cronbach′s α coefficient of the system was 0.991, and the Scale-level Content Validity Index was 0.936, confirming good reliability and validity. Conclusion:The evaluation index system constructed in this study can serve as an effective assessment tool for the quantitative evaluation of infection control quality in integrated medical and elderly care facilities. Furthermore, it is recommended that the system undergo continuous optimization concerning its application.

Objective To investigate the effects of Sini Powder on serum hypothalamic-pituitary-adrenal(HPA)axis-related hormones and inflammatory factors in liver cancer mice with comorbid depression,and to evaluate its effect on depressive behavior and tumor proliferation activity.Methods Forty-eight specific pathogen-free female C57BL/6 mice were randomly assigned to either a blank(n=8)or model group(n=40).The modeling group was subjected to chronic unpredictable mild stress(CUMS)for six weeks.Both groups underwent orthotopically transplanted liver tumor surgery at the end of the fourth week of CUMS treatment.At the end of the sixth week of CUMS treatment,color Doppler ultrasonography was used to observe tumor formation in the orthotopic transplantation liver tumors,and the tail suspension test was used to assess depressive behavior.Non-tumor-bearing and deceased mice were excluded.The remaining model group mice were stratified by tail suspension immobility time and randomly assigned to the following groups:model group(distilled water),Fluoxetine group(5.0 mg/kg),and Sini Powder low-dose,medium-dose,and high-dose groups(5.2,10.4,and 20.8 g/kg,respectively),with six mice per group.The treatments were administered once daily for 21 consecutive days.After treatment,depressive behaviors were assessed using the open field,tail suspension,and forced swimming tests.The proliferation status of the orthotopic liver transplantation tumor was evaluated by measuring the size of the tumor,observing pathological changes in the tumor tissue through hematoxylin and eosin staining,and detecting the positive cell rate of proliferating cell nuclear antigen(Ki-67)in the tumor tissue using immunohistochemistry.The levels of HPA axis-related hormones in serum,such as corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),corticosterone(CORT),as well as inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),and interleukin-6(IL-6)were measured using an enzyme-linked immunosorbent assay.Western blotting was used to assess mitogen-activated protein kinase(MAPKs)phosphorylation and the expression of nuclear factor-κB(NF-κB),NOD-like receptor family pyrin domain-containing receptor 3(NLRP3),and cysteine aspartic protease-1(Caspase-1)in orthotopic tumors.Results Compared with the blank group,the model group showed reduced total distance traveled in open field test,prolonged immobility times in the tail suspension and forced swimming tests(P<0.05,P<0.01),indicating successful establishment of the liver cancer with comorbid depression mice model.Also,the model group showed increased orthotopic tumor volume(P<0.01),and elevated serum CRH,ACTH,CORT,TNF-α,IL-1β,and IL-6 levels(P<0.01).The phosphorylation of MAPKs in tumor tissues was suppressed(P<0.01),while NF-κB,NLRP3,and Caspase-1 expression levels were downregulated(P<0.01).Compared with the model group,Sini Powder medium-and high-dose groups exhibited increased total distance traveled in the open field test(P<0.05),reduced forced swimming test and prolonged total distance traveled in open field test(P<0.01),while Sini Powder high-dose group showed reduced immobility times in the tail suspension test(P<0.05).Also,Sini Powder low-dose,medium-dose,and high-dose groups showed slower tumor growth,histological changes,including vacuolization and necrosis,decreased Ki-67 positive cell rate(P<0.01),and reduced serum CRH,ACTH,CORT,TNF-α,IL-1β,and IL-6 levels(P<0.05).Additionally,the phosphorylation of MAPKs in tumor tissues was suppressed(P<0.01),and NF-κB,NLRP3,and caspase-1 expression levels were downregulated(P<0.01).Conclusion Sini Powder may alleviate depressive behaviors and suppress tumor proliferation activity in liver cancer mice with comorbid depression by modulating MAPKs activation,inhibiting NF-κB,NLRP3,and Caspase-1 expressions,and reducing serum inflammatory factors and HPA axis-related hormones levels.

BACKGROUND:The hippocampus is crucial for cognitive function,and exercise holds promise for enhancing cognition and alleviating cognitive decline.However,the molecular mechanisms underlying these effects remain unclear.Bioinformatics,by analyzing the impact of exercise on molecular expression in the hippocampus,helps reveal key mechanisms,providing new insights into how exercise promotes cognition and informing the development of intervention strategies.OBJECTIVE:Using bioinformatics methods to conduct an in-depth analysis of the gene expression profiles of hippocampal tissue in mice subjected to voluntary exercise interventions and by examining the biological functions of differentially expressed genes and their potential regulatory networks to elucidate the molecular mechanisms by which exercise modulates neural function in the hippocampus.METHODS:Gene expression microarray datasets(GSE42904 and GSE29075)from the Gene Expression Omnibus(GEO)database were obtained for hippocampal tissue in mice subjected to voluntary exercise interventions.Strict differential gene analysis was performed using the Limma and DESeq2 packages in R,and the results were visually presented using volcano plots generated by the ggplot2 package.Common differentially expressed genes were identified using the FunRich software.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses were conducted using the clusterProfiler package in R.Protein-protein interaction networks of differentially expressed genes were analyzed using the online tool STRING,and core targets were further screened using Cytoscape software.RESULTS AND CONCLUSION:In the GSE42904 dataset,voluntary exercise intervention led to the differential expression of 123 genes in the hippocampus of mice,primarily involved in rhythmic processes,glycosylation,and other GO biological processes.These genes were also associated with multiple KEGG pathways,including interleukin-17,calcium,and ethanol signaling.Key hub genes identified in the protein-protein interaction network included Npy,Mapk3,Mapk11,and Chgb.In the GSE29075 dataset,voluntary exercise resulted in the differential expression of 455 genes in the hippocampus,mainly involved in the positive regulation of cellular projection organization,negative regulation of apoptotic signaling,and other GO biological processes.These genes were significantly enriched in pathways related to neurodegenerative diseases.Key hub genes identified in the protein-protein interaction network included Eed,Bptf,and Nedd8.To conclude,voluntary exercise significantly regulates the expression of key genes such as Chrm1,Eed,Npy,Mapk3,Mapk11,and Map2k1 in the hippocampus of mice.These genes play a core regulatory role in biological processes such as neurodegenerative diseases and calcium signaling.Voluntary exercise may promote cognitive function by influencing neurogenesis and synaptic plasticity.

Objective To identify lipid metabolism genes in cerebral infarction;To explore the intervention effect of Huoxue Rongluo Prescription.Methods Multi-chip combined differential analysis(GSE61616,GSE30655)was used to identify lipid metabolism genes in cerebral infarction in combination with Reactome database,and the expression differences of lipid metabolism genes in cerebral infarction were identified and verified in GSE97537 chip;Pearson correlation analysis was used to analyze the correlation of 51 cerebral infarction samples in GSE61616,GSE30655,GSE97537,GSE137595,GSE22255,GSE163614,and GSE78731 datasets;PPI,GO and KEGG analysis of lipid metabolism genes in cerebral infarction were performed through STRING database and R clusterProfiler package.SD rats were made to the model of cerebral infarction,and was administered with Huoxue Rongluo Prescription extract 11.7 g/kg by intragastric administration for 7 days.The symptoms of neurological deficit,the changes of Nissl bodies and the mRNA expressions of PLA2G4A,SPHK1,and PTGES key genes in lipid metabolism in cerebral infarction were observed.Results TSPO,CYP1B1,PLIN2,CH25H,PLA2G4A,ANGPTL4,PTGS1,SPHK1,and PTGES were identified as lipid metabolism genes in cerebral infarction,and were significantly highly expressed and positively correlated in cerebral infarction.Among them,PTGS1,PLA2G4A,and SPHK1 interacted with each other,which were the key genes of lipid metabolism in cerebral infarction;the lipid metabolism gene in cerebral infarction mainly exerted molecular functions such as oxidoreductase activity,iron ion binding,heme binding,etc.,mediating arachidonic acid metabolism,phospholipase D signaling pathway,VEGF signaling pathway,involved in regulation of lipid metabolism process,fatty acid metabolism process,fatty acid derivative metabolism process.The symptoms of neurological deficit in the model rats with cerebral infarction were severe(P<0.001),and Huoxue Rongluo Prescription could effectively improve the neurological deficit of model rats(P<0.001).The Nissl staining indicated that the neuronal structure was abnormal and the number was significantly reduced after cerebral infarction(P<0.001).Huoxue Rongluo Prescription could increase the number of neurons(P<0.001)and repair the neuronal structure.RT-qPCR showed that the key genes of lipid metabolism in cerebral infarction were significantly higher in cerebral infarction(P<0.001),corroborated with the bioinformatics results,and Huoxue Rongluo Prescription could reduce the expression of key lipid metabolism genes of PTGS1,PLA2G4A,and SPHK1(P<0.001,P<0.01,P<0.05).Conclusion Huoxue Rongluo Prescription can down-regulate the expressions of PTGS1,PLA2G4A,SPHK1,exert molecular functions such as oxidoreductase activity,iron ion binding,heme binding,and mediate arachidonic acid metabolism,phospholipase D signaling pathway,and VEGF signaling pathway.It participates in the process of lipid metabolism regulation,fatty acid metabolism,and fatty acid derivative metabolism,increases the number of Nissl bodies,improves the symptoms of neurological deficits,and exerts neuroprotective effects.

Sepsis is a severe and life-threatening symptom that poses a significant risk to human health.Treatment mainly involves supportive care,but research on new drugs is ongoing.Advancements have been achieved in the management of immune function,inflammatory pathway,blood coagulation,and vascular endothelial homeostasis in sepsis.The advances in the treatment of sepsis in recent years were these reviewed in this article.

Objective:To investigate the clinical value of the novel approach,radical resection of the retroperitoneal lipo-lymphatic layer (RRRLLL),in the surgical treatment of resectable pancreatic head cancer.Methods:Between June 2020 and June 2022,a total of 221 patients with pancreatic head cancer underwent surgical treatment using the RRRLLL approach(RRRLLL group),while 107 patients received traditional surgical treatment(traditional group) in five high-volume pancreatic centers in China. Data from surgical technique and clinical perioperative outcomes,including lymph node harvested,surgical time,and complications,were analyzed. The RRRLLL group consisted of 144 males and 77 females with an age of (67.5±9.0) years(range:41.3 to 81.1 years). The traditional group included 71 males and 36 females,with an age of (66.3±8.1) years(range:45.1 to 79.2 years). Statistical analysis was performed using the K-S test, Z test,or χ 2 test, respectively. Results:Pancreaticoduodenectomy was performed successfully in all patients,achieving R0 resection. RRRLLL group surgery required mobilization of retroperitoneal adipose and lymphatic tissues starting from the right edge of the inferior vena cava and extending to the left side,up to the superior mesenteric artery,down to the inferior mesenteric artery,and left to the left side of the aorta,including the perineural and lymphatic tissues around the superior mesenteric artery and the sheath of the mesenteric artery. However,the traditional group did not include the areas mentioned above in the scope of clearance. There were no statistically significant differences between the RRRLLL group and the traditional group in terms of age,sex,tumor size,T stage,and vascular invasion (all P>0.05). However,the number of lymph nodes harvested in the RRRLLL group was significantly higher at 28.7±9.0 (range: 18 to 39) compared to 18.2±8.0 (range: 12 to 21) in the traditional group ( Z=-10.691, P<0.05). There were no statistically significant differences in the number of positive lymph nodes,N staging,and postoperative complications between the two groups. Conclusion:The RRRLLL approach improved lymph node dissection compared to the traditional approach,potentially leading to reduced recurrence rates.

Objective:To investigate the clinical value of the novel approach,radical resection of the retroperitoneal lipo-lymphatic layer (RRRLLL),in the surgical treatment of resectable pancreatic head cancer.Methods:Between June 2020 and June 2022,a total of 221 patients with pancreatic head cancer underwent surgical treatment using the RRRLLL approach(RRRLLL group),while 107 patients received traditional surgical treatment(traditional group) in five high-volume pancreatic centers in China. Data from surgical technique and clinical perioperative outcomes,including lymph node harvested,surgical time,and complications,were analyzed. The RRRLLL group consisted of 144 males and 77 females with an age of (67.5±9.0) years(range:41.3 to 81.1 years). The traditional group included 71 males and 36 females,with an age of (66.3±8.1) years(range:45.1 to 79.2 years). Statistical analysis was performed using the K-S test, Z test,or χ 2 test, respectively. Results:Pancreaticoduodenectomy was performed successfully in all patients,achieving R0 resection. RRRLLL group surgery required mobilization of retroperitoneal adipose and lymphatic tissues starting from the right edge of the inferior vena cava and extending to the left side,up to the superior mesenteric artery,down to the inferior mesenteric artery,and left to the left side of the aorta,including the perineural and lymphatic tissues around the superior mesenteric artery and the sheath of the mesenteric artery. However,the traditional group did not include the areas mentioned above in the scope of clearance. There were no statistically significant differences between the RRRLLL group and the traditional group in terms of age,sex,tumor size,T stage,and vascular invasion (all P>0.05). However,the number of lymph nodes harvested in the RRRLLL group was significantly higher at 28.7±9.0 (range: 18 to 39) compared to 18.2±8.0 (range: 12 to 21) in the traditional group ( Z=-10.691, P<0.05). There were no statistically significant differences in the number of positive lymph nodes,N staging,and postoperative complications between the two groups. Conclusion:The RRRLLL approach improved lymph node dissection compared to the traditional approach,potentially leading to reduced recurrence rates.