Objective:To investigate the impact of plasmapheresis therapy on the clinical efficacy in predicted severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) patients.Methods:The clinical data of 500 HTG-AP patients admitted to 36 medical centers across China in the Chinese Acute Pancreatitis Clinical Trials Group-PERFORM database from November 2020 to June 2023 were retrospectively analyzed. Besides the inclusion and exclusion criteria from PERFORM study, patients who had acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score ≥8 or CRP>150 mg/L on admission were included in the final analyses ( n=189). Patients were categorized into the plasmapheresis group ( n=51) and the routine treatment group ( n=138) according to the triglyceride-lowering therapies they received. General data, laboratory findings, AP severity, and clinical outcomes were recorded. Results:Patients undergoing plasmapheresis had higher initial triglyceride levels, APACHEⅡ score, SOFA score, and more organ failure than those receiving routine medical treatment. Results of multivariable logistic regression models showed that the plasmapheresis group, as compared to the routine treatment group, was neither associated with decreased risk of persistent organ failure within 14 days [54.9% (28/51) vs 37.7% (52/138), OR=0.89, 95% CI 0.36-2.21, P=0.810], nor with reduced incidence of organ failure on day 7 [17.7% (9/51) vs 15.9% (22/138), OR=0.60, 95% CI 0.19-1.88, P=0.378]. There was no significant difference on the dynamic changes of serum triglyceride within the first three days of admission ( P=0.108). Conclusions:Early plasmapheresis is not associated with reduced incidence of persistent organ failure in predicted severe HTG-AP patients.

Mixed reality technology combines the benefits of virtual reality and augmented reality to provide a new experience of virtual and real-world interaction, demonstrating great potential in nursing education. This paper reviews the application progress of mixed reality in basic nursing teaching, clinical skills training, personalized learning pathways, and teamwork, and looks ahead to future developments, innovations, and challenges of mixed reality technology to advance nursing education.

Objective:To investigate the impact of plasmapheresis therapy on the clinical efficacy in predicted severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) patients.Methods:The clinical data of 500 HTG-AP patients admitted to 36 medical centers across China in the Chinese Acute Pancreatitis Clinical Trials Group-PERFORM database from November 2020 to June 2023 were retrospectively analyzed. Besides the inclusion and exclusion criteria from PERFORM study, patients who had acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score ≥8 or CRP>150 mg/L on admission were included in the final analyses ( n=189). Patients were categorized into the plasmapheresis group ( n=51) and the routine treatment group ( n=138) according to the triglyceride-lowering therapies they received. General data, laboratory findings, AP severity, and clinical outcomes were recorded. Results:Patients undergoing plasmapheresis had higher initial triglyceride levels, APACHEⅡ score, SOFA score, and more organ failure than those receiving routine medical treatment. Results of multivariable logistic regression models showed that the plasmapheresis group, as compared to the routine treatment group, was neither associated with decreased risk of persistent organ failure within 14 days [54.9% (28/51) vs 37.7% (52/138), OR=0.89, 95% CI 0.36-2.21, P=0.810], nor with reduced incidence of organ failure on day 7 [17.7% (9/51) vs 15.9% (22/138), OR=0.60, 95% CI 0.19-1.88, P=0.378]. There was no significant difference on the dynamic changes of serum triglyceride within the first three days of admission ( P=0.108). Conclusions:Early plasmapheresis is not associated with reduced incidence of persistent organ failure in predicted severe HTG-AP patients.

Mixed reality technology combines the benefits of virtual reality and augmented reality to provide a new experience of virtual and real-world interaction, demonstrating great potential in nursing education. This paper reviews the application progress of mixed reality in basic nursing teaching, clinical skills training, personalized learning pathways, and teamwork, and looks ahead to future developments, innovations, and challenges of mixed reality technology to advance nursing education.

This review introduces the concept,design and implementation of longitudinal mixed methods research.It summarizes its common applications,including the in-depth exploration of potential causes and association among variables of the complex phenomenon over time,the comprehensive evaluation of intervention effectiveness,the identification of facilitators and challenges for implementation,as well as the exploration of changes in behavior and underlying mechanisms.Moreover,this review analyzes existing challenges and future insights of this method.In conclusion,this review aimed to strengthen the nursing researchers'understanding of longitudinal mixed methods research and provide insights for future related studies.

Objectives:To observe the clinical effect of surgical treatment of suppurative spondylitis after percutaneous vertebroplasty(PVP).Methods:The medical records of 14 patients with suppurative spondylitis after PVP treatment admitted to the Department of Orthopedics of our hospital from March 2017 to February 2022 were retrospectively analyzed.There were 6 males and 8 females,aged 53-83 years,with an average age of 69.3±7.8 years.The patients were followed up for 12 months.The operation time,intraoperative blood loss,postoperative complications,postoperative recurrence rate,postoperative visual analogue scale(VAS)and American Spinal Injury Association(ASIA)improvement,postoperative bone graft fusion rate,and postoperative quality of life(short form-36,SF-36)improvement were analyzed to observe the clinical effect and related risks of surgical treatment of suppurative spondylitis after PVP treatement.Results:The operative time of 14 patients was 123-300min,with an average of 205.1±57.4min.Intraoperative blood loss was 200-900mL,with an average of 517.9±181.5mL.Postoperative incision complications occurred in 2 patients(14.3％),of which,1 case was incision effusion,healed after drainage and dressing change;The other case was delayed healing,which healed after regular dressing change,improving nutritional status and blood sugar control.The VAS scores ranged from 3 to 8 points(6.1±1.6 points)before operation,which was 0-2 points(0.9±0.8 points)at fi-nal follow-up,and the difference was statistically significant(t=11.034,P=0.000).The bone graft fusion rate was 92.8％(13/14),and the fusion time was 3 to 7 months(4.6±1.3 months).Spinal infection recurred at 7 months after surgery in the 1 patient with unfused bone graft,who presented internal fixation loosening and kyphotic deformity and was cured after anti-infection,control of complications,and reoperation.According to the ASIA classification,2 patients were grade D and 12 patients were grade E before surgery,which all im-proved to grade E at final follow-up.At final follow-up,the SF-36 scores of the patients were significantly improved compared with those before surgery,and the comprehensive measurement score of physiological health was 31.4±6.9 before surgery and 79.8±6.0 after surgery,and the difference was with statistical signifi-cance(t=19.721,P=0.000).The comprehensive measurement score of mental health was 46.9±7.2 before surgery and 88.5±6.4 after surgery,and the difference was statistically significant(t=16.027,P=0.000).Conclusions:Surgery can effectively treat suppurative spondylitis after PVP treatment and improve the quality of life of pa-tients.

Objective:To investigate the role of hepatitis B virus X protein (HBx) in glomerular podocyte immune disorder and its regulatory mechanism.Methods:Fourteen 6-week-old male hepatitis B virus (HBV) transgenic (HBV-Tg) mice were selected, and age-matched wild type (WT) mice were as controls. They were fed to different weeks, and 24 h urinary protein, blood biochemistry, renal pathology and podocyte changes under electron microscope were detected. The expression of HBx and the infiltration of immune cells in kidney tissue of HBV-Tg mice were observed by immunohistochemistry. Human podocyte cell line was transfected with pcDNA3.1/myc-HBx plasmid, and the localization of HBx and Nephrin in podocytes was detected by immunofluorescence. The expression of major histocompatibility complex Ⅱ (MHC-Ⅱ) and co- stimulatory molecule CD40 on the cell surface was detected by flow cytometry. The contents of multiple cytokines in cell culture supernatants were determined by enzyme-linked immunosorbent assay. Transcriptome sequencing (RNA-seq) was used to screen the downstream related genes regulated by HBx, and real-time quantitative PCR was used to verify their expressions. After overexpression or silencing of Notch1 gene with overexpressed plasmids or short hairpin RNA (shRNA) in podocytes, the effects on the expression of immune molecules and cytokines secretion was observed. The Notch receptor inhibitor N-[N-(3, 5-difluorophenyl-l- alanyl)]-(s)-phenylglycine tert-butyl ester (DAPT) was used to block Notch1 signaling pathway in HBV-Tg mice, and then blood biochemistry, renal pathological changes and infiltration of immune cells in kidney tissue were observed. Results:Twenty-four-hour urine protein, serum creatinine and urea nitrogen levels were markedly increased (all P<0.05) and renal pathological injury was significantly aggravated in HBV-Tg mice than those in WT mice. Also, HBx was up-regulated and immune cells infiltrated in the glomerulus of HBV-Tg mice. After transfection with HBx in podocytes, the expression of MHC-Ⅱ and CD40 on the cellular surface was up-regulated (all P<0.05), the contents of monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor -α (TNF-α) and interleukin (IL)-1β in the supernatants were increased (all P<0.05), and the secretion of IL-4 and interferon γ (IFN-γ) was unbalanced. RNA-seq screened downstream genes of HBx, such as Notch1, PLA2R, TLR4, etc; and further confirmed that HBx could promote the up-regulation of Notch1 mRNA and protein (all P<0.05). After over-expression of Notch1 gene, HBx-induced expression of MHC-Ⅱ and CD40 on the cellular surface was significantly up-regulated (all P<0.05), and the contents of MCP-1, TNF-α and IL-1β in the supernatants were obviously increased (all P<0.05), and the imbalance of IL-4/IFN-γ was further aggravated. After Notch1 gene silencing, the above results showed the opposite changes. In vivo, the results indicated that serum creatinine levels were obviously decreased (all P<0.05), renal pathological injury and immune cell infiltration were significantly alleviated in HBV-Tg+DAPT group than those in HBV-Tg+DMSO group. Conclusions:HBx protein can promote the up-regulation of Notch1 signaling pathway in podocytes. And Notch1 signaling pathway promotes the expression of immune molecules on the surface of podocytes and regulates the imbalance of cytokines, then causes glomerular injury and dysfunction of immune microenvironment.

Acute kidney injury during pregnancy (P-AKI) threatens the health of both the mother and fetus, which should be given sufficient attention. During pregnancy, the kidneys undergo a series of physiological changes to adapt to the demands from the mother and infant, leading to the kidneys more susceptible to damage than non pregnant individuals. This article analyzes the pathophysiological changes, causes, diagnostic criteria, related diseases, and therapeutic measures of P-AKI. It also points out that for severe preeclampsia, thrombocytopenia syndrome, and acute fatty liver disease, the pregnancy should be terminated upon diagnosis. While for thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, plasma exchange should be the main treatment. Further analysis of the dialysis indications for P-AKI is aimed at providing reference for accurate clinical diagnosis and effective treatment, thereby improving the survival rates of pregnant women and fetuses.

Acute kidney injury during pregnancy (P-AKI) threatens the health of both the mother and fetus, which should be given sufficient attention. During pregnancy, the kidneys undergo a series of physiological changes to adapt to the demands from the mother and infant, leading to the kidneys more susceptible to damage than non pregnant individuals. This article analyzes the pathophysiological changes, causes, diagnostic criteria, related diseases, and therapeutic measures of P-AKI. It also points out that for severe preeclampsia, thrombocytopenia syndrome, and acute fatty liver disease, the pregnancy should be terminated upon diagnosis. While for thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, plasma exchange should be the main treatment. Further analysis of the dialysis indications for P-AKI is aimed at providing reference for accurate clinical diagnosis and effective treatment, thereby improving the survival rates of pregnant women and fetuses.

Objective:To discuss the atypical radiological features of posterior Monteggia fracture and appropriate treatment of the fracture.Methods:A retrospective study was conducted of the 12 patients who had been treated for posterior Monteggia fracture with atypical radiological features at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from July 2019 to December 2020. They were 7 males and 5 females, aged from 18 to 65 years (mean, 46.5 years). Their elbow X-ray and CT scan features included unidentified upper ulnoradial dislocation, presence of triangular or quadrilateral butterfly fracture pieces in front of the fracture end at the level of ulnar coronal process, normal humeroradial joint or forward dislocated radial head, comminuted fracture or anterior edge fracture of the radial head, or backward angulated fracture of the radial neck. The proximal ulnar fractures were fixated with olecranon anatomical locking compression plate or with assistant kirschner wire and tension band fixation; the ulnar coronoid process fractures were fixated with kirschner wire or lag screws or a mini-plate; the radial head fractures were fixated with headless compressing screws or a mini-plate or treated with radial head replacement; the severe injury to the radial collateral ligament was repaired with a suture anchor. Fracture union time, complications and range of elbow motion at the final follow-up were recorded. Elbow function was assessed by Mayo elbow performance score (MEPS).Results:All patients were followed up for 6 to 28 months (mean, 16.4 months). All fractures achieved bony union after 12 to 19 weeks (14.6 weeks). The final follow-ups revealed the following: the range of elbow flexion and extension ranged from 75° to 145°, averaging 100.5°; the range of forearm rotation ranged from 80° to 155°, averaging 132.0°; the MEPS ranged from 50 to 100 points, averaging 86.2 points and yielding 5 excellent, 4 good, 2 fair and 1 poor cases. Elbow stiffness developed in 3 cases.Conclusion:Understanding the atypical radiological features of posterior Monteggia fracture can promote better diagnosis and treatment of the posterior Monteggia fracture in clinic.