Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective:To explore the influencing factors of frailty in elderly patients with coronary heart disease (CHD), and to compare and analyze the value of different frailty scales in screening elderly patients with coronary heart disease.Methods:Using cross-sectional research methods，elderly patients with coronary heart disease from November 2019 to January 2020 in the Department of Cardiology of a tertiary hospital in Zhenjiang City were selected as the research objects. The frailty status of the patients was evaluated by the frailty index scale, and the patients were divided into frailty group (54 cases) and non-frailty group (149 cases) according to the evaluation results. F-test was used for the comparison between measurement data groups conforming to normal distribution, and χ 2 test or exact probability method was used for the comparison of counting data. Multivariate Logistic regression was used to analyze the main influencing factors of elderly patients with coronary heart disease. The correlation and consistency of clinical frail scale, frail scale and frail index were compared and analyzed were analyzed by Spearman correlation and Kappa test. ROC curve was used to analyze the sensitivity, specificity and the area under the working characteristic curve. Results:The age ((78.96±6.78) years), the percentage of monocytes >10% (31.48% (17/54)), the specific index for coronary heart disease ≥4 points (57.41% (31/54)), Barthel index <100 points (85.19% (46/54)), the mini nutritional assessment scale <24 points (66.67% (36/54)) of the patients in the frail group was higher than these in non-frail group ((73.94±5.89) years old, 12.08%(18/149), 7.38%(11/149), 22.15%(33/149), 14.77%(22/149)), the differences were statistically significant (statistical values were t=5.15, χ 2=10.46, χ 2=60.45, χ 2=66.26, χ 2=52.32; P values were <0.001,0.001,<0.001,<0.001,<0.001,respectively). The results of multivariate Logistic regression analysis showed that the percentage of monocytes >10% ( OR=5.927, 95% CI:1.854-18.947), the mini nutritional assessment scale <24 ( OR=7.026, 95% CI:2.660-18.555),the specific index for coronary heart disease ≥4 points ( OR=3.333, 95% CI:1.889-26.850,) and Barthel index <100 points ( OR=15.649, 95% CI:5.403-45.321) are the main effects of frailty in elderly patients with coronary heart disease factors ( P values were 0.003,<0.001,<0.001, and <0.001, respectively). Taking the frailty index as the gold standard, the sensitivity of the clinical frailty scale and FRAIL scale were 85.19% and 85.19%, respectively, and the specificity was 90.60% and 94.63%, respectively, with no significant difference (χ 2 values were 0.000 and 1.767; all P>0.05). The Kappa of the clinical frailty scale scale was <0.75, while the Kappa of the FRAIL scale was >0.75. The consistency of the frail scale with the gold standard was better than that of the clinical frailty scale scale. Conclusion:The percentage of monocytes, the specific index for coronary heart disease, the mini nutritional assessment scale and Barthel index are the main factors affecting the frailty of elderly patients with coronary heart disease. Taking the frailty index score as the standard, the consistency between the screening results of frail scale and frailty index score is better than that of clinical frailty scale scale, which has clinical application value.

Nursing homes treat a large number of elderly people such as frail, dementia, disability, and advanced age. During the occurrence of major public health emergencies, it is a key institution for management, prevention and control. This paper proposes the concept of "resilient nursing homes" and analyzes the connotation and structure of resilient nursing homes based on the complex adaptive system theory. This paper also proposes strategies to improve the resilience of nursing homes in order to help nursing homes optimize their existing management systems and models, and improve their ability to respond to public health emergencies.

To compare therapeutic effect of dibutyryl cyclic adenosine monophosphate calcium (DCAMC) on chronic heart failure (CHF) between different administration route .Methods :The 98 CHF patients were ran‐ domly and equally divided into intravenous drip (i .v.gtt) group and intramuscular injection group (i.m .) group , both groups received DCAMC via corresponding administration route based on routine anti heart failure treatment for 10d.Plasma level of N terminal pro brain natriuretic peptide (NT‐proBNP) ,left ventricular end diastolic dimen‐sion (LVEDd) ,LVEF before and after treatment ,and incidence of adverse reactions were observed and compared between two groups .Results :Compared with before treatment , there were significant reductions in plasma NT‐proBNP level [i.v.gtt group :(6846.23 ± 3856. 01)pg／ml vs.(2285.69 ± 2023.79)pg／ml ,i .m .group :(6151. 50 ± 5160.09) pg／ml vs.(2568.37 ± 2488.51)pg／ml] and LVEDd [i.v.gtt group :(4.78 ± 0.44 )cm vs.(4. 69 ± 0.43) cm ,i.m .group :(4.97 ± 0.64)cm vs .(4. 88 ± 0.62) cm] ,and significant rise in LVEF [i.v.gtt group :(59.49 ± 4.64)% vs.(60. 67 ± 4. 52)%,i.m.group :(57.67 ± 7.19)% vs.(58.94 ± 7.05)%] in two groups after treatment , P＝0.001 all.There were no significant difference in above indexes between two groups before and after treatment , P＞0. 05 all.There was no significant difference in incidence rate of adverse reactions between two groups , P＝1.000. Conclusion :DCAMC can improve cardiac function in CHF patients .Therapeutic effect of local intramuscular injection is equal with that of intravenous drip .

With the acceleration of internationalization and the increasing population flow between countries and regions, the cultural background of members of medical teams is becoming more and more diverse, and cross-cultural medical teams have become common in medical institutions in many countries and regions, and cultural differences are drawing great attention about the impacts on cooperation between medical teams. By explaining the concept of cultural differences, summarizing the related theories of team cooperation, and analyzing the influence of cultural differences on medical team cooperation, this study puts forward the management strategies for cultural differences in medical team building, and provides theoretical basis for medical administrative departments to formulate relevant policies.

Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)for common bile duct(CBD)stones before endoscopic retrograde cholangiopancreatography(ERCP). Methods Data of patients with suspected CBD stones admitted to The First People′s Hospital of Hangzhou from July 2012 to July 2013 were reviewed. Diagnostic efficiency and rates of complications were analyzed between patients undergoing EUS(EUS group)and MRCP(MRCP group)before ERCP, and between patients who underwent EUS and ERCP in different sessions(non-one-session group)with those in one session(one-session group). Results A total of 657 patients were included. With ERCP and follow-up results as the gold standard, the sensitivity(97.5% VS 88.4%), accuracy(96.3% VS 88.0%)and negative predictive value(88.9% VS 60.0%)of EUS in the diagnosis of CBD stones were significantly higher than those of MRCP(P<0.05). There were no significant differences between one-session group and non-one-session group in the sensitivity(97.5% VS 97.4%), specificity(91.7% VS 90.0%), positive predictive value(98.3% VS 97.4%), negative predictive value(88.0% VS 90.0%), and accuracy (96.6% VS 95.9%)in diagnosis of CBD stones(P>0.05). There were no significant differences in incidence of postoperative complications of ERCP between EUS and MRCP group[5.4%(13/242)VS 5.1%(21/415),P>0.05],and between one-session group and non-one-session group[5.5%(8/145)VS 5.2%(5/97),P>0.05].Conclusion Preoperative EUS before ERCP could increase diagnostic sensitivity and negative pridictive value of CBD stones without increasing the incidence of complications.

Objective To explore the collagen, typeⅠ, α 1 chain ( COL1A1) gene mutation in a family with type 1 osteogenesis imperfect. Methods The medical records and DNA samples of an osteogenesis imperfect patient and her family members were collected, and their DNA sequencing were performed and compared with 50 non-relative healthy control from the same area. Results The proband and her three family members ( father, younger brother, and younger nephew) with clinical features of osteogenesis imperfect as well as prolactinoma were confirmed of COL1A1 gene mutation at the 24th intron with a shear mutation of c. 1669-1 G＞A which was not reported previously. Other family members were genetically normal compared with the normal. Conclusions We found a new COL1A1 gene mutation family and mutation site, but the relationship between osteogenesis imperfect and prolactinoma was unknown.

BACKGROUND:Dexmedetomidine is an efficient, highly selective alpha-2 adrenergic receptor agonist, with sedative, analgesia and anti-anxiety effects, it has little impact on the respiration.
OBJECTIVE:To observe the analgesic effect induced by intrathecal injection of dexmedetomidine in rat model of spared nerve injury.
METHODS:A total of 60 male Sprague-Dawley rats were randomly divided into three groups (n=12):normal control group, dexmedetomidine group and saline group. Except for the normal control group, spared nerve injury model was established in the rats of dexmedetomidine group and saline group. Dexmedetomidine group was treated with intrathecal injection of dexmedetomidine 3μg/kg every day within 14 days after injury. Saline group was given equal volume of saline for 14 days. The thermal withdrawal latency and mechanical withdrawal threshold were measured respectively before injury, after injury, before injection, and 2, 7, 14 days after intrathecal injection. Four rats were sacrificed in each group at day 2, 7 and 14 after injection, and the lumbar segments (L 4-6 Hematoxylin-eosin staining was performed to detect the morphology of the spinal dorsal horn neurons and ) of the spinal cord were removed. Real-time RT-PCR and western blot analysis were used to determine the expression of protein kinase C mRNA and protein in the spinal dorsal horn neurons. immunohistochemistry staining was carried out to assess the expression level and distribution of protein kinase C.
RESULTS AND CONCLUSION:The thermal withdrawal latency and mechanical withdrawal threshold in dexmedetomidine group and saline group were significantly decreased compared with normal control group before or after injection (P<0.05). However, both the thermal withdrawal latency and mechanical withdrawal threshold in dexmedetomidine group after intrathecal injection were significantly higher than those in saline group (P<0.05). The protein kinase C expression in spinal dorsal horn neurons was significantly decreased in dexmedetomidine group compared with saline, and reached to the most lowest levels as normal control group on 14 days after injection. Moreover, the apoptosis of spinal dorsal horn neurons in dexmedetomidine group was lighter than that in saline group, and was similar to the morphology of neurons in normal control group on 14 days after injection. Intrathecal injection of dexmedetomidine could attenuate the hyperalgesia induced by spared nerve injury, which might be associated with the inhibition of protein kinase C expression in spinal dorsal horn.

BACKGROUND:Dexmedetomidine is an effective high-selectivityα2-adrenoceptor agonist that has sedative, analgesic, anxiolytic effects, but slightly affects respiration.
OBJECTIVE:To observe the analgesic effect of dexmedetomidine on selective damage of sciatic nerve branch in a rat model by intrathecal injection.
METHODS:A total of 36 male Sprague-Dawley rats were randomly divided into normal control group, physiological saline group and dexmedetomidine group. A rat model of selective damage of sciatic nerve branch was established by knotting off the common peroneal nerve and tibial nerve in the physiological saline group and dexmedetomidine group. Rats in the dexmedetomidine group were daily injected with dexmedetomidine 3μg/kg by intrathecal injection within 14 days after injury. Rats in the physiological saline group were injected with physiological saline.
RESULTS AND CONCLUSION:Compared with the physiological saline group, the mechanical withdrawal threshold and the thermal withdrawal latency were significantly increased in the dexmedetomidine group (P<0.05). Neuronal nitric oxide synthase mRNA and protein expression levels were significantly decreased in the spinal dorsal horn (P<0.05). The injury to spinal dorsal horn neurons was obviously lessened. Moreover, neuronal nitric oxide synthase mRNA and protein expression levels and the injury to spinal dorsal horn neurons were similar between 14 days after administration and normal control group. Results indicated that intrathecal injection of dexmedetomidine could inhibit the expression of neuronal nitric oxide synthase in the spinal dorsal horn and relieve the pain induced by sciatic nerve injury.

Objective Our preliminary study demonstrates that quercetin can inhibit the proliferation of HL-60 cells. This sudy aimed to find some drugs which could have synergistic effects with quercetin on apoptosis of HL-60 cells. Methods HL-60 cells were cultured with bortezomib at different concentrations (1, 2, 4, 8, 16, and 32μmol/L) alone or combined with quercetin at different concentrations for 48 h. HL-60 cells were cultured with lenalidomide at different concentrations (5, 10, 20, 40, 80, 160, and 320 μmol/L) alone or in combination with quercetin at different concentrations for 48 h. The CCK-8 assay was used to determine the effects on proliferation of HL-60 cells. Results Bortezomib significantly inhibited the proliferation of HL-60 cells (P<0.01). IC50 of quercetin was 49.24μmol/L after cells treated by quercetin combined with bortezomib, which was 13.44μmol/L lower than that treated by quercetin alone. Isobolographic analysis revealed the two drugs had synergistic effect. The results of cell viability of HL-60 cells treated by lenalidomide at lower concentrations (5, 10, 20, 40, and 80μmol/L)were not different from those of the control group (P > 0.05). The results of cell viability of HL-60 cells treated by lenalidomide at higher concentrations (160 and 320μmol/L) were lower than those of the control group (P<0.05). IC50 of quercetin after cells treated by quercetin combined with bortezomib was not different from that treated by quercetin alone. Isobolographic analysis revealed the two drugs had no synergistic effect. Conclusions Bortezomib can inhibit the proliferation of HL-60 cells and it has a synergistic effect with quercetin on HL-60 cells. Lenalidomide has a weaker role in inhibition of the proliferation of HL-60 cells, and it has no synergistic effect with quercetin on HL-60 cells.