Myelin is an essential structure that facilitates rapid saltatory conduction in the nervous system. Discrepancies in myelin microstructure are a hallmark of numerous neurological disorders, rendering the assessment of myelin integrity and content an indispensable tool in clinical diagnostics and neuroscience research. Extensive research has been dedicated to scrutinizing its biochemical makeup and morphology under normal, pathological, and experimental conditions over the years. In this review, we present an updated summary of the myelin sheath's structure, composition, and developmental trajectory. We systematically enumerate and contrast eight prevalent myelin staining techniques across dimensions of sensitivity, specificity, and resolution, delving into their underlying staining principles. With an initial application of myelin histology on the mouse demyelination model, our review accentuates the accurate delineation of myelination and the microstructural analysis of the myelin sheath. Such insights are anticipated to significantly contribute to the evaluation and understanding of white matter pathologies.
Myelin Sheath/metabolism* ; Animals ; Humans ; Demyelinating Diseases/pathology* ; Staining and Labeling/methods*

Bacillus velezensis DJ1 exhibits broad-spectrum antagonistic activity against diverse phytopathogenic fungi, while its biocontrol mechanisms against Fusarium graminearum, the causal agent of maize stalk rot, remain poorly characterized. In this study, we integrated genomics and transcriptomics to elucidate the antifungal mechanisms of strain DJ1. The results demonstrated that DJ1 inhibited F. graminearum with the efficacy of 64.4%, while its polyketide crude extract achieved the control efficacy of 55% in pot experiments against this disease. Whole-genome sequencing revealed a single circular chromosome (3 929 792 bp, GC content of 47%) harboring 12 biosynthetic gene clusters for secondary metabolites, six of which encoded known antimicrobial compounds (macrolactin H, bacillaene, difficidin, surfactin, fengycin, and bacilysin). Transcriptomic analysis identified 243 differentially expressed genes (152 upregulated and 91 downregulated, P < 0.05), which were potentially associated with the antagonistic activity against F. graminearum. KEGG enrichment analysis highlighted activation (P < 0.05) of cysteine/methionine metabolism, pentose phosphate pathway, and polyketide biosynthesis pathways, indicating that DJ1 employed synergistic strategies involving antimicrobial compound synthesis, energy metabolism enhancement, and nutrient competition to suppress pathogens. This study provides a theoretical foundation for developing novel microbial resources and application technologies to combat phytopathogenic fungi.
Fusarium/drug effects* ; Bacillus/metabolism* ; Plant Diseases/prevention & control* ; Antifungal Agents/pharmacology* ; Genomics ; Zea mays/microbiology* ; Transcriptome ; Gene Expression Profiling ; Antibiosis ; Multigene Family ; Multiomics

A 32-year-old woman,previously diagnosed with schizophrenia and undergoing long-term treatment with clozapine,experienced the onset of symptoms such as shallow coma,persistent high fever,and increased muscle tone one day after transitioning from clozapine to amisulpride.Combining with elevated creatine kinase levels and other examination findings,the patient was diagnosed with amisulpride-related neuroleptic malignant syndrome(NMS).Amisulpride treatment was promptly discontinued,and the patient was treated with bromocriptine,but it failed to relieve the symptoms.On the same day,intravenous administration of dantrolene sodium was conducted,then her body temperature decreased,convulsions and tremors improved,and other symptoms gradually relieved.After 5 days,her consciousness improved,and she was discharged after 10 days.Amisulpride-related NMS are relatively rare,and dantrolene sodium can be used as a potential option when conventional treatments prove ineffective.

Objective:To investigate the application effect of case-based collaborative learning (CBCL) based on data-information-knowledge-wisdom (DKIW) model in the training of the informatization teaching ability of clinical teachers.Methods:From March to August in 2022, 71 clinical teachers from four grade A tertiary hospitals in Tianjin, China, were selected as subjects and were randomly divided into control group with 35 patients and experimental group with 36 patients using a random number table. The teachers in the control group received blended teaching online and offline, and those in the experimental group received CBCL teaching based on DIKW model. The two groups were compared in terms of theoretical assessment score, informatization teaching demonstration score, and informatization teaching ability score before and after intervention. SPSS 27.0 was used for the t-test and the Mann-Whitney U rank sum test. Results:Compared with the control group after intervention, the experimental group had significantly higher scores of theoretical assessment (83.50±3.11) and informatization teaching demonstration (84.19±1.89) ( P<0.05). After intervention, the control group had significant increases in the total score of informatization teaching ability (74.34±4.08) and the scores of each dimension (15.40±1.19, 19.29±1.62, 28.54±1.67, and 11.11±1.79), and the experimental group also had significant increases in the total score of informatization teaching ability (83.64±5.25) and the scores of each dimension (16.53±1.21, 20.94±1.98, 33.03±2.10, and 13.14±1.48); the experimental group had significantly higher scores than the control group ( P<0.05). Conclusions:The CBCL teaching model based on DIKW model can help to improve the comprehensive informatization teaching ability of clinical teachers.

Objective:To construct a prediction model of psychological distress risk in young and middle-aged patients with gynecologic malignancy based on random forest algorithm and validate its prediction effect, which provided a tool for healthcare professionals to detect patients′ psychological distress in early stage.Methods:This was a cross-sectional study, a total of 385 cases of young and middle-aged patients with gynecologic malignancies admitted to the gynecology and oncology departments of six tertiary hospitals in Tianjin from October 2021 to October 2022 were consecutively included, the study subjects were randomly divided into 270 cases in the training set and 115 cases in the testing set according to 7:3 by R-studio software. After grouping the training set patients according to the presence or absence of psychological distress (positive psychological distress 151 cases and negative psychological distress 119 cases), univariate analysis was performed on each influencing factor. A random forest model for the prediction of psychological distress in young and middle-aged gynecological malignancy patients using R-studio software on the training set, and the prediction effect was verified on the testing set.Results:The prediction accuracy was 94.78%, sensitivity was 96.88%, specificity was 92.16%, positive predictive value was 93.94%, negative predictive value was 95.92%, and AUC was 0.992 (95% CI 0.982-1.000). The top 5 significant predictor variables were ranked according to the average decrease in the Gini coefficient of each influencing factor in the random forest model: General Self-Efficacy Scale score, Herth Hope Index score, Perceived Social Support Scale score, Self-Rating Depression Scale score, Self-Rating Anxiety Scale score. Conclusions:In this study, the prediction model of psychological distress in young and middle-aged patients with gynecologic malignancy constructed by random forest algorithm has high predictive efficacy, which provides reference for healthcare professionals to identify patients′ psychological distress early and formulate interventions.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Objective:To develop the Care Needs Scale for Young and Middle-aged Terminally Ill Patients and test its reliability and validity, so as to provide an effective tool for evaluating the care needs of young and middle-aged terminally ill patients for medical and nursing staff.Methods:This study is a cross-sectional study. Guided by the theory of supportive care needs, an initial scale was formed through literature review, qualitative interviews, Delphi expert consultation, and pre-survey. From July to September 2022, convenience sampling was used to select 570 young and middle-aged terminally ill patients hospitalized in the Oncology Department and Hospice Care Ward of six Class Ⅲ hospitals in Tianjin as the research subject, and a questionnaire survey was conducted on the patients. The items in the scale were selected using item analysis method. The structural validity of the scale was evaluated using exploratory factor analysis and confirmatory factor analysis. The content validity of the scale was evaluated using the scale-level content validity index and the item-level content validity index. The reliability of the scale was evaluated using internal consistency coefficient and half reliability coefficient. A total of 570 questionnaires were distributed, and 565 valid questionnaires were collected, with an effective response rate of 99.12% (565/570) .Results:A total of 18 experts completed two rounds of consultation, with an expert authority coefficient of 0.890, the Kendall's W values of 0.309 and 0.417, respectively ( P<0.05). The Care Needs Scale for Young and Middle-aged Terminally Ill Patients included 6 dimensions and a total of 39 items. Exploratory factor analysis extracted 6 common factors, with a cumulative variance contribution rate of 71.515%. Confirmatory factor analysis showed that the overall model fitted well. The content validity index at the scale level was 0.942, and the content validity index at the item level was 0.833 to 1.000. The total Cronbach's α coefficient of the scale was 0.975, and the half reliability coefficient was 0.911. Conclusions:The reliability and validity of the Care Needs Scale for Young and Middle-aged Terminally Ill Patients are good, and it can be used as an evaluation tool for the care needs of young and middle-aged terminally ill patients.

Objective:To analyze the early identification, clinical characteristics, diagnosis and treatment of gestational hypertension crisis combined with adrenal disease.Methods:The clinical data of 23 patients of HCP complicated with adrenal disease admitted from Jul. 2009 to Jul. 2019 were retrospectively studied. The clinical characteristics, imaging characteristics, treatment and clinical transfer were studied.Results:The occurrence of all the 23 cases were acute. Among them, 16 cases had eclampsia combined with Cushing’s syndrome, 4 cases were pregnancy combined with primary aldosteronism (PA) and extreme hypokalemia, and 3 cases had eclampsia combined with pheochromocytoma (PHEO) . After admission, the patients were given symptomatic support treatment for sedation, analgesia, blood pressure control, dehydration, cranial pressure reduction, electrolyte balance and spasmolysis, and patients with severe preeclampsia and preeclampsia terminated their pregnancy in time. After treatment, 3 patients gave live birth, 12 received postpartum surgical treatment and 10 received drug treatment. The clinical symptoms improved and imaging examination suggested the lesions in the brain narrowed and disappeared, except one patient had major cerebral hemorrhage and died of multiple organ failure.Conclusions:In case of HCP and severe hypokalemia, relevant examinations should be improved in combination with symptoms to comprehensively diagnose whether it is complicated with adrenal diseases. The treatment methods and process of HCP with adrenal diseases need to be optimized, so as to judge the timing of termination of pregnancy, and minimize the impact on mother and fetus.

Objective:To observe and analyze the structural characteristics of the optic discs in high myopia (HM) combined with primary open-angle glaucoma (POAG) and the optic disc parameters with diagnostic efficacy.Methods:A cross-sectional study. From August 2020 to March 2021, a total of 114 eyes of 68 patients with POAG, HM and healthy volunteers who were diagnosed by Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University were included in the study. Among them, 21 POAG patients (39 eyes) were divided into H+P group (9 patients, 18 eyes) and non-H+P group (12 patients, 21 eyes) according to whether or not HM was combined; 26 HM patients (37 eyes) were selected as HM group; 21 healthy volunteers (38 eyes) were selected as normal control group. The subjects included 31 males (51 eyes) and 37 females (63 eyes), whose average age was 36.93±12.60 years old. Diopter, central corneal thickness (CCT) and axial length (AL) were measured. There was no significant difference in age ( F=8.333), sex composition ratio ( χ2=0.863), and CCT ( F=1.425) among the four groups ( P>0.05); while, there were significant differences in AL ( F=69.956), diopter ( F=37.711), visual field index (VFI) ( F=43.254) and mean defect (MD) ( F=49.793) among the four groups ( P<0.01). Enhanced depth imaging using optical coherence tomography was used to obtain the tilt parameters, the disc rim parameters, the lamina cribrosa parameters and the retinal nerve fiber layer (RNFL) thickness. The tilt parameters included optic disc horizontal diameter, optic disc vertical diameter, optic disc ellipse index (horizontal diameter/vertical diameter); the disc rim parameters included Bruch’s membrane opening-minimal rim width (BMO), optic cup area, optic disc area, disc rim area, cup-disc area ratio; the lamina cribrosa parameters included anterior laminar insertion depth (ALID), prelaminar neural tissue (PLNT), and lamina cribrosa thickness. The pairwise comparison between groups were performed by ANOVA test. Pearson correlation analysis was used to analyze the correlation between disc tilt parameters, disc rim parameters, lamina cribrosa parameters and visual field parameters, as well as between disc rim parameters and RNFL thickness. According to receiver operating characteristic (ROC) curve and area under the curve (AUC), the predictive value of those above related factors for HM combined with POAG was evaluated. Results:Tilt parameters: compared with the optic disc horizontal diameter of non-H+P group, those of normal control group, HM group and H+P group were significantly decreased ( P<0.05), the ellipse indices of HM group and H+P group were significantly lower than those of normal control group and non-H+P group ( P<0.05). The results of correlation analysis showed that the optic disc horizontal and vertical diameters were negatively correlated with MD ( r=-0.302,-0.235; P=0.002, 0.017), and negatively correlated with VFI ( r=-0.291,-0.246; P=0.003, 0.013). Disc rim parameters: the disc cup area and cup-disc area ratio of non-H+P group and H+P group were significantly larger than those of normal control group and HM group ( P<0.05). The disc rim area and the average BMO of HM group, non-H+P group and H+P group were significantly smaller than those of normal control group ( P<0.05). The results of correlation analysis showed that the cup-disc area ratio ( r=-0.584), the average BMO ( r=0.650) had the highest correlation with the average RNFL thickness ( P<0.001). The superior, inferior, nasal and temporal BMO were all positively correlated with the corresponding quadrant RNFL thicknesses ( r=0.431, 0.656, 0.362, 0.375; P<0.05); the optic disc rim area, the average BMO were positively correlated with MD ( r=0.449, 0.618) and VFI ( r=0.449, 0.605) ( P<0.05), among which the correlation of the average BMO was the highest; the optic cup area and cup-disc area ratio were negatively correlated with MD ( r=-0.346,-0.559) and VFI ( r=-0.312,-0.548) ( P<0.001), among which the correlation of the cup-disc area ratio was the highest. Lamina cribrosa parameters: ALID of non-H+P group and H+P group were significantly deeper than those of normal control group and HM group ( P<0.05). LC of non-H+P group and H+P group were significantly thinner than those of normal control group and HM group ( P<0.05). The results of correlation analysis showed that ALID was negatively correlated with MD and VFI ( r=-0.402, P<0.001), VFI ( r=-0.405, P=0.001); LC was positively correlated with MD and VFI ( r=0.403, P<0.001), VFI ( r=-0.401, P=0.015). Comparison of diagnostic efficiency between various optic disc parameters: the results of ROC analysis showed that the cup-disc area ratio had the highest diagnostic performance (AUC=0.847, P=0.007), the maximum Youden index was 0.563, the sensitivity and specificity were 0.833 and 0.730, respectively, and the best critical value was 0.340. Conclusions:Optic disc tilt is more pronounced in HM combined with POAG; BMO in each quadrant could objectively reflect the disc rim defect of HM combined with POAG; the thinning and the backward shift of the lamina cribrosa were consistent with the aggravation of the visual field defect. Among them, the cup-disc area ratio had better diagnostic performance.

OBJECTIVE To study the improvement effect and mechanism of Gubenanshen decoction on menopausal syndrome model rats . METHODS Totally 70 rats were anesthetized and placed on the operating table for bilateral ovariectomy to induce menopausal syndrome model . Other 10 rats without modeling were taken as sham operation group . Sixty model rats were divided into model group ，Gengniananpian group （TCM positive control group ，0.56 g/kg），Estradiol valerate tablet group （chemical drug positive control group ，0.1 mg/kg），Gubenanshen decoction high -dose，medium-dose and low -dose groups （18.0，9.0，4.5 g/kg）， with 10 rats in each group . Model group and sham operation group were given normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day ，for consecutive 4 weeks. After last administration ，the plasma contents of luteinizing hormone （LH），follicle stimulating growth hormone （FSH）and estradiol （E2）were determined .The indexes of uterus，adrenal gland ，spleen and thymus were measured ；pathological changes of rat uterus were observed ；mRNA expressions of kisspenptin 1（Kiss-1），inositol triphosphate receptor 1（IP3R1）and gonadotropin -releasing hormone （GnRH）in hypothalamic tissues were detected ，and the protein expressions of Kiss -1，ERK1/2 and p -ERK1/2 were also detected . RESULTS Compared with sham operation group ，the contents of LH and FSH in the plasma of rats were significantly increased in model group （P＜0.05 or P＜0.01）. The contents of E 2，organ index ，mRNA expressions of Kiss -1，IP3R1 and GnRH and protein expressions of Kiss -1 and p-ERK1/2 were decreased significantly in hypothalamic tissues （P＜0.05 or P＜0.01）. The glands of the uterus were reduced and the cells in the lamina propria were dense . Compared with model group ，above indexes of Gubenanshen decoction groups （except for the content of E 2 in the low -dose group ）were reversed significantly （P＜0.05 or P＜0.01）. The number of uterine glands increased，and single columnar epithelial cells were arranged orderly （except for the low -dose group ）. CONCLUSIONS Gubenanshen decoction can increase mRNA expressions of Kiss -1，IP3R and GnRH and protein expressions of Kiss -1 and p -ERK1/2 in hypothalamic tissues of rats ，and activate GnRH secretion signaling pathways so as to improve the menopausal syndrome .