Objective To investigate the effectiveness of intravenous thrombolytic therapy mode led by fast-track specialist nurses on patients with acute ischemic stroke(AIS).Methods This study involved 124 AIS patients who underwent intravenous thrombolytic therapy in the Department of Emergency of our hospital from March 2021 to February 2023.Among the patients,61 admitted between March 2021 and February 2022 received conventional AIS thrombolytic therapy were assigned to a control group.While the 63 patients who received AIS thrombolytic therapy under the specialist nurse-led intravenous thrombolytic therapy mode between March 2022 and February 2023 were assigned to an observation group.The two groups were compared in terms of the time from admission to completion of CT examination,time for signing the informed consent for thrombolytic therapy,door to needle time and percentage of DTN<60 minutes,as well as the post-thrombolysis scores according to the National Institute of Health Stroke Scale(NIHSS)and satisfaction to medical consultation.Results The observation group exhibited a significantly shorter time from admission to completion of CT examination,a shorter time for signing an informed consent for thrombolytic therapy,a shorter door to needle time and a higher percentage of DTN<60 minutes,all with significant difference in comparison with those in the control group.After thrombolysis,the NIHSS score of the observation group decreased more than that of the control group(P<0.05).The patients and their families in the observation group reported significantly higher satisfaction compared to those in the control group(both P<0.05).Conclusion The fast-track specialist nurse-led intravenous thrombolytic therapy mode demonstrates the superiority in reduction of the time from admission to completion of CT examination,time for signing an informed consent for thrombolytic therapy,door to needle time and the NIHSS scores,higher percentage of DTN<60 minutes as well as improvement of patient satisfaction.

Light adaptation enables the vertebrate visual system to operate over a wide range of ambient illumination. Regulation of phototransduction in photoreceptors is considered a major mechanism underlying light adaptation. However, various types of neurons and glial cells exist in the retina, and whether and how all retinal cells interact to adapt to light/dark conditions at the cellular and molecular levels requires systematic investigation. Therefore, we utilized single-cell RNA sequencing to dissect retinal cell-type-specific transcriptomes during light/dark adaptation in mice. The results demonstrated that, in addition to photoreceptors, other retinal cell types also showed dynamic molecular changes and specifically enriched signaling pathways under light/dark adaptation. Importantly, Müller glial cells (MGs) were identified as hub cells for intercellular interactions, displaying complex cell‒cell communication with other retinal cells. Furthermore, light increased the transcription of the deiodinase Dio2 in MGs, which converted thyroxine (T4) to active triiodothyronine (T3). Subsequently, light increased T3 levels and regulated mitochondrial respiration in retinal cells in response to light conditions. As cones specifically express the thyroid hormone receptor Thrb, they responded to the increase in T3 by adjusting light responsiveness. Loss of the expression of Dio2 specifically in MGs decreased the light responsive ability of cones. These results suggest that retinal cells display global transcriptional changes under light/dark adaptation and that MGs coordinate intercellular communication during light/dark adaptation via thyroid hormone signaling.
Animals ; Mice ; Dark Adaptation ; Light ; Retina ; Retinal Cone Photoreceptor Cells/metabolism* ; Adaptation, Ocular ; Neuroglia/physiology* ; Cell Communication ; Thyroid Hormones

Objective To develop an expert consensus on artificial airway humidification care in critical adult patients(refer as"Consensus"hereafter)for a standardised procedure of artificial airway humidification.Methods Reviews of domestic and international literatures relevant to artificial airway humidification care in critical adult patients were conducted.Clinical experiences of medical and nursing experts were taken into consideration.Two rounds of expert consultations were conducted to finalise the Consensus.Results Various aspects were studied including concepts,targeted range of temperature and humidification,methods of humidification,selection of humidification liquid and methods for evaluation of humidification effectiveness.The Consensus was applicable to the management of humidification of artificial airway in critical adult patients.Conclusions The Consensus exhibits a certain level of scientific rigor and practical applicability.It serves as a theoretical basis and practical guide to clinical nursing personnel in the management of artificial airway humidification.

Objective:To investigate the role of miRNA-4298/PADI4/p53 signal axis in mediating 4f-induced apoptosis of leukemia cells.Methods:The cell growth density was observed under inverted microscope and the proliferation of leukemia cells was detected by CCK-8 counting assay. The expression of PADI4 and P53 at mRNA level was detected by qRT-PCR. Cell cycle and apoptosis were measured with flow cytometry. The expression of PADI4, P53, Bcl-2, Bax, caspase-3 and caspase-9 at protein level was detected by Western blot. Differential miRNA and mRNA expression profiles was detected by next generation sequencing. Databases such as TargetScan were used to predict the potential upstream and downstream genes of PADI4. A luciferase reporter assay was used to detect the 3′UTR of PADI4 targeted by miRNA-4298. Cell transfection assay was used to detect the effect siRNA, PADI4 vector, miRNA mimics and miRNA inhibitor in interference and rescue.Results:Nuclear factor erythroid 2-related factor 2 (Nrf2) inhibitor 4f could inhibit the proliferation of THP-1, K562 and U937 cells, and induce the apoptosis of these leukemia cells. It downregulated the expression of PADI4 mainly through the binding activity of miRNA-4298 to miRNA sponges, which resulted in the proliferation inhibition and apoptosis of leukemia cells. The inhibited proliferation and apoptosis of leukemia cells by 4f were associated with the increase of P53 expression after the decrease of PADI4 expression. The PADI4-dependent upregulation of P53 led to the ratio inversion of downstream Bcl-2/Bax, which activated caspase-3 or caspase-9 to induce the apoptosis of leukemia cells.Conclusions:The apoptosis of leukemia cells induced by Nrf2 inhibitor 4f was mainly associated with the miRNA-4298/PADI4/p53 axis, suggesting that it might be a novel signaling pathway for targeted therapy.

Objective:To explore the risk factors for 30-day death in emergency department patients, and then construct a prediction model and validate it using nomogram.Methods:A retrospective cohort study was conducted. The clinical data of 1 091 patients admitted to the emergency department of the First People's Hospital of Changde from January 1 to June 30, 2021 was collected, including 741 patients from January 1 to March 31 in the development group and 350 patients from April 1 to June 30 in the validation group. General information, first vital signs admitted to the emergency department, and laboratory results were collected, the modified early warning score (MEWS) was calculated, and 30-day outcomes were recorded. Univariate and multivariate Logistic regression analysis was used to screen out the risk factors of 30-day death. According to the results of multivariate analysis, the nomogram was used to construct a 30-day death prediction model. The receiver operator characteristic curve (ROC curve) was used to evaluate the consistency of the prediction model, the calibration of the prediction model was evaluated by the Hosmer-Lemeshow goodness of fit test.Results:A total of 1 091 patients were enrolled. There were 741 patients in the development group, including 356 males and 385 females, aged (51.42±17.33) years old, and the 30-day mortality was 28.88%. There were 350 patients in the validation group, including 188 males and 162 females, aged (52.88±16.11) years old, and the 30-day mortality was 24.00%. The results of the univariate analysis showed that age, primary diagnosis on admission, consciousness, respiratory rate (RR), systolic blood pressure (SBP), heart rate (HR), pulse oxygen saturation (SpO 2), MEWS score, erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and body mass index (BMI) might be the risk factors for 30-day death in patients in the emergency department. The results of the multivariate analysis showed that the MEWS score [odds ratio ( OR) = 14.22, 95% confidence interval (95% CI) was 1.46-138.12], ESR ( OR = 46.71, 95% CI was 20.48-106.53), PCT ( OR = 4.97, 95% CI was 2.46-10.02), BMI (24.0-27.9 kg/m 2: OR = 37.82, 95% CI was 14.69-97.36; ≥28.0 kg/m 2: OR = 62.11, 95% CI was 25.77-149.72) were independent risk factors for 30-day death in the emergency department (all P < 0.05). Using the four variables with the results of multivariate analysis to construct a nomogram prediction model, the area under the ROC curve (AUC) was 0.974 (95% CI was 0.753-0.983) for the development group, and the AUC was 0.963 (95% CI was 0.740-0.975) for the validation group. The Hosmer-Lemeshow test showed no statistically significant difference between the predicted outcome of the nomogram prediction model and the actual occurrence ( χ2 = 1.216, P = 1.270). Conclusion:The prediction model developed by the MEWS score combined with BMI, ESR and PCT can scientifically and effectively predict the 30-day outcome of emergency department patients.

Objective:To retrieve and summarize evidence for prevention of hypothermia at birth in newborn.Methods:Databases such as Up To Date, BMJ Best Practice, National Institute for Health and Care Excellence(NICE), Joanna Briggs Institute (JBI), Cochrane Library, Registered Nurses′Association of Ontario (RNAO), American Heart Association(AHA), Web of Science, PubMed, Chinese Biology Medical Literature database, Wanfang Med Online were searched to collect relevant evidence for prevention of hypothermia at birth in newborn, including guidelines, systematic reviews, evidence summaries and expert consensus. Two researchers independently evaluated the quality of the literature and extracted the data of the literature which met the criteria.Results:Six articles were selected, including 1 clinical decision support system, 2 guidelines, 1 systematic review and 2 expert consensuses. Nineteen pieces of best evidence were summarized.Conclusions:This study summarized the best evidence for the prevention of hypothermia at birth in newborn, and provided evidence-based support for clinical practice.

The article introduces the content and organization of the training program for newly recruited nurses in the three hospitals of Massachusetts General Hospital, Mayo Clinic, and University of Illinois Chicago Medical Center in the United States. This article also summarizes the characteristics and highlights of the program implementation, and discusses and analyzes the training program by combining the current situation of newly recruited nurses training in my country, and makes suggestions for further improvement in the future.

Objective:To investigate the predictive value of mean platelet volume (MPV) for early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke treated with intravenous thrombolysis in the Department of Neurology, Jiangsu Provincial Hospital of Chinese Medicine from September 2016 to December 2019 were enrolled retrospectively. Immediately after admission, hematology analyzer was used to detect the MPV level. END was defined as the National Institutes of Health Stroke Scale (NHISS) score at any time point within 7 d after the admission increased by ≥2 from baseline. Univariate analysis was used to compare the differences in baseline data between the END group and the non-END group, and multivariate logistic regression analysis was used to determine the independent risk factors for END. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value of MPV for END. Results:A total of 103 patients were enrolled. Their age was 68.0±13.3 years old, and 80 were male (77.7%). There were 28 patients (27.2%) in the END group and 75 (71.8%) in the non-END group. The proportion of ischemic heart disease (28.6% vs. 9.3%; χ2=6.065, P=0.014), baseline NIHSS score (8.5 [4.0-16.5] vs. 5.0 [3.0-11.0]; Z=2.198, P=0.028), symptomatic intracranial hemorrhage (1.9% vs. 0%; χ2=5.463, P=0.019), low-density lipoprotein cholesterol (2.9 [2.2-3.4] mmol/L vs. 2.4 [1.8-3.1] mmol/L; Z=2.165, P=0.030), high-sensitivity C-reactive protein (7.0 [1.2-36.0] mg/L vs. 2.1 [1.0-6.0] mg/L; Z=2.159, P=0.031) and MPV levels ( 10.4±1.3 fl vs. 9.5±1.2 fl, t=2.771, P=0.007) of the END group were significantly higher than those of the non-END group. Multivariate logistic regression analysis showed that after adjusting for the confounding factors, the larger MPV was an independent predictor of END (odds ratio 1.668, 95% confidence interval 1.079-2.579; P=0.021). ROC curve analysis showed that MPV had a certain predictive value for END (area under the curve, 0.653, 95% confidence interval 0.533-0.774). Its optimal cutoff value was 102 fl, and the sensitivity and specificity at this time were 57.4% and 70.3%, respectively. Conclusion:A larger baseline MPV had a certain predictive value for END after intravenous thrombolysis in patients with acute ischemic stroke.

The morbidity and mortality of gastric cancer are high in China.It is of great significance to explore a screening scheme for gastric cancer that suits Chinese conditions.This article reviews the risk factors,the status of screening at home and abroad and the commonly used screening methods of gastric cancer.The articlealso recommends a screening model,in which endoscopic and imaging examination are applied for high-risk population identified by detection of the serum markers such as pepsinogen,gastrin-17 and Helicobacter pylori antibody.

Objective To investigate the value of endorectal ultrasonography (ERUS) and MRI examination in the preoperative evaluation of T staging and circumferential resection margin (CRM) of rectal cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 193 patients [122 males and 71 females,age (60± 12)years with the range of 26-90 years] who underwent radical resection of rectal cancer at the First Hospital of Jilin University from May 2016 to January 2018 were collected.All patients underwent ERUS and MRI examination before surgery,total mesorectal excision during surgery and postoperative pathological examination.Postoperative pathological results as the gold standard,the sensitivity,specificity in T staging and the CRM diagnostic coincidence rate of rectal carcinoma by ERUS and MRI examination are evaluated.Observation indicators:(1) evaluation of T staging of rectal cancer by ERUS and MRI examination;(2) evaluation of CRM in rectal cancer by ERUS and MRI examination.Measurement data with normal distribution were represented as Mean±SD.Sensitivity,specificity and coincidence rate were calculated by chi-square test of paired fourfold table.McNemar test was used to compare the coincidence rate of T staging between ERUS and MRI examination.Consistency between CRM measurement by ERUS examination and pathological examination of rectal cancer was conducted by Kappa analysis.Fisher exact probability test was used to compare the coincidence rate of positive CRM between ERUS and MRI examination.Results (1) Evaluation of T staging of rectal cancer by ERUS and MRI examination.The overall coincidence rate of T staging of rectal cancer and coincidence rates of T1,T2,T3,T4 staging by ERUS examination were 74.61％ (144/193),93.78％ (181/193),80.83％ (156/193),79.79％ (154/193) and 94.82％ (183/193),respectively.The sensitivity ofT1,T2,T3 and T4 staging was 55.56％ (10/18),77.50％ (31/40),78.46％ (102/130),20.00％ (1/5),and the specificity was 97.71％ (171/175),81.70％ (125/153),82.54％ (52/63),96.81％ (182/188),respectively.The overall coincidence rate of T staging of rectal cancer and coincidence rates of T1,T2,T3,T4 staging by MRI examination were 50.78％ (98/193),90.67％ (175/193),74.09％ (143/193),58.55％ (113/193) and 78.24％ (151/193),respectively.The sensitivity of T1,T2,T3 and T4 staging was 0 (0/18),17.50％ (7/40),68.46％ (89/130),40.00％ (2/5),and the specificity was 100.00％ (175/175),88.89％ (136/153),38.10％ (24/63),79.26％ (149/188),respectively.There was statistically significant difference between the overall coincidence rate of ERUS and MRI examination for T staging of rectal cancer (x2 =8.631,P＜0.05).(2) Evaluation of CRM in rectal cancer by ERUS and MRI examination.The sensitivity and specificity of positive CRM evaluation of rectal cancer by ERUS examination were 100.00％ (5/5) and 97.34％ (183/188) respectively,and the coincidence rate with results of pathological examination was 97.41％ (188/193),showing a high consistency between positive CRM evaluation of rectal cancer by ERUS examination and pathological examination (Kappa value =0.655,P ＜ 0.05).The sensitivity and specificity of positive CRM evaluation of rectal cancer by MRI examination were 40.00％ (2/5) and 92.02％ (173/188),and the coincidence rate with pathological examination was 90.67％ (175/193),respectively,showing a high consistency between positive CRM evaluation of rectal cancer by MRI and pathological examination (Kappa value =0.206,P＜0.05).There were statistically significant differences in the diagnostic coincidence rate and specificity of CRM positive evaluation for rectal cancer between ERUS and MRI examination (x2 =5.896,P＜0.05).Conclusion ERUS examination has a high coincidence rate in the preoperative T staging of rectal cancer and a high consistency between positive CRM evaluation of rectal cancer with pathological examination,which are superior to MRI examination in the two aspects.