OBJECTIVES: To explore the molecular mechanism of Jiangzhi Huaban Decoction (JZHBD) for improving atherosclerosis through the "qi meridian-blood channels" pathway. METHODS: ApoE^-/- mouse models of atherosclerosis were established by high-fat diet feeding for 8 weeks, with C57BL/6 mice on a normal diet as the controls. Forty ApoE^-/- mouse models were randomized into model group, low-, medium-, and high-dose JZHBD treatment groups, and atorvastatin treatment group (n=8) for their respective treatments for 8 weeks. The changes in body weight and overall condition of the mice were monitored weekly. After the treatments, serum levels of TC, TG, HDL-C, LDL-C, TBA, ALT, and AST of the mice were measured, pathological changes in the liver and aortic root plaques were examined with HE staining, and lipid accumulation in the liver and aortic wall was assessed using Oil Red O staining. The core molecular mechanism was studied through transcriptomics, and the expressions of the key pathway proteins were confirmed using Western blotting and immunohistochemistry. RESULTS: Treatment with JZHBD significantly reduced blood lipid and total bile acid levels, improved liver function and hepatic steatosis, and decreased aortic lipid deposition and plaque area in the mouse models of atherosclerosis. Transcriptomic analysis suggested that the therapeutic mechanism of JZHBD involved reverse cholesterol transport, PPAR signaling, and the inflammatory pathways. In atherosclerotic mice, JZHBD treatment obviously up-regulated hepatic expressions of PPARγ, LXRα, ABCA1, ABCG1, and CYP7A1, down-regulated hepatic expressions of p-p65/p65, IL-6, IL1β in the liver, increased ABCG5 and ABCG8 expressions in the intestines, and decreased ICAM-1 and VCAM-1 expressions in the aortic plaques. CONCLUSIONS JZHBD improves atherosclerotic vascular damage and plaque formation possibly by regulating hepatic reverse cholesterol transport and inflammation via modulating the hepatic PPARγ/LXRα/NF-κB signaling pathway.
Animals ; Drugs, Chinese Herbal/therapeutic use* ; Mice, Inbred C57BL ; Plaque, Atherosclerotic/metabolism* ; Liver/metabolism* ; Mice ; Atherosclerosis/metabolism* ; Cholesterol/metabolism* ; PPAR gamma/metabolism* ; Male ; Diet, High-Fat ; Biological Transport

BackgroundCompared with absenteeism， health-related productivity loss has a long-lasting negative effect， and poses a greater harm and loss. The health-related productivity loss is mediated by self-efficacy， and perceived social support has been shown to have an impact on health-related productivity loss， whereas the interaction mechanism among the three remains unclear. ObjectiveTo investigate the status of perceived social support， occupational coping self-efficacy and health-related productivity loss among ICU nurses， and to test the mediation role of perceived social support in the relationship between occupational coping self-efficacy and health-related productivity loss. MethodsFrom September to November， 2021， purposive sampling technique was adopted to select 468 ICU nurses in 8 tertiary hospitals in Sichuan Province. Subjects were assessed using self-made general information questionnaire， Perceived Social Support Scale （PSSS）， Occupational Coping Self Efficacy Scale for Nurses （OCSE-N） and Stanford Presenteeism Scale-6 （SPS-6）. Pearson correlation analysis was used to examine the correlation among variables. Amos 24.0 was utilized to test the mediation role of perceived social support in the relationship between occupational coping self-efficacy and health-related productivity loss. ResultsA total of 415 ICU nurses completed the valid questionnaire survey. ICU nurses scored （63.13±11.62） on PSSS， （22.24±6.15） on OCSE-N， and （16.83±4.24） on SPS-6. Health-related productivity loss was detected in 279 ICU nurses （67.23%）. Correlation analysis denoted that PSSS total score was positively correlated with OCSE-N total score （r=0.348， P<0.05）， and negatively correlated with SPS-6 total score （r=-0.274， P<0.05）. OCSE-N total score was negatively correlated with SPS-6 total score （r=-0.421， P<0.05）. The direct effect value of occupational coping self-efficacy on health-related productivity loss was -0.401， and perceived social support showed a mediation role in the relationship between occupational coping self-efficacy and health-related productivity loss （the indirect effect value was -0.052， accounting for 11.48% of the total effect）. ConclusionThe occupational coping self-efficacy of ICU nurses may affect the health-related productivity loss through the action path of perceived social support.［Funded by Scientific Research Project of Sichuan Provincial Health Commission （number， 19PJ042）］

Objective:To construct a machine-learning model for predicting the progression of pancreatic cystic lesions (PCLs) based on clinical and CT features, and to evaluate its predictive performance in internal/external testing cohorts.Methods:Baseline clinical and radiological data of 200 PCLs in 177 patients undergoing abdominal thin slice enhanced CT examination at Peking Union Medical College Hospital from July 2014 to December 2022 were retrospectively collected. PCLs were divided into progressive and non-progressive groups according to whether the signs indicated for surgery by the guidelines of the European study group on PCLs were present during three-year follow-up. 200 PCLs were randomly divided into training (150 PCLs) and internal testing cohorts (50 PCLs) at the ratio of 1∶3. 15 PCLs in 14 patients at Jinling Affiliated Hospital of Medical School of Nanjing University from October 2011 to May 2020 were enrolled as external testing cohort. The clinical and CT radiological features were recorded. Multiple feature selection methods and machine-learning models were implemented and combined to identify the optimal machine-learning model based on the 10-fold cross-validation method. Receiver operating characteristics (ROC) curve was drawn and area under curve (AUC) was calculated. The model with the highest AUC was determined as the optimal model. The optimal model's predictive performance was evaluated on testing cohort by calculating AUC, sensitivity, specificity and accuracy. Permutation importance was used to assess the importance of optimal model features. Calibration curves of the optimal model were established to evaluate the model's clinical applicability by Hosmer-Lemeshow test.Results:In training and internal testing cohorts, the progressive and non-progressive groups were significantly different on history of pancreatitis, lesions size, main pancreatic duct diameter and dilation, thick cyst wall, presence of septation and thick septation (all P value <0.05) In internal testing cohort, the two groups were significantly different on gender, lesion calcification and pancreatic atrophy (all P value <0.05). In external testing cohort, the two groups were significantly different on lesions size and pancreatic duct dilation (both P<0.05). The support vector machine (SVM) model based on five features selected by F test (lesion size, thick cyst wall, history of pancreatitis, main pancreatic duct diameter and dilation) achieved the highest AUC of 0.899 during cross-validation. SVM model for predicting the progression of PCLs demonstrated an AUC of 0.909, sensitivity of 82.4%, specificity of 72.7%, and accuracy of 76.0% in the internal testing cohort, and 0.944, 100%, 77.8%, and 86.7% in the external testing cohort. Calibration curved showed that the predicted probability by the model was comparable to the real progression of PCLs. Hosmer-Lemeshow goodness-of-fit test affirmed the model's consistency with actual PCLs progression in testing cohorts. Conclusions:The SVM model based on clinical and CT features can help doctors predict the PCLs progression within three-year follow-up, thus achieving efficient patient management and rational allocation of medical resource.

Objective·To analyze the anatomical and macroscopic characteristics of the pterygopalatine suture(PPS)in Chinese population using cone-beam computed tomography(CBCT)technology,and to preliminarily investigate its developmental pattern and its association with the correction of maxillary underdevelopment.Methods·A total of 134 CBCT images,taken from July to August 2023 at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,were categorized into six age groups.The PPS landmarks were utilized to determine the overall transverse position(XPPS),sagittal position(YPPS),insertion angle(IAP),insertion width of the pyramidal process(IWP),and insertion depth of the pyramidal process(IDP).The pterygomaxillary junction was identified through multiplanar observations.Regression analysis was performed to assess the correlation of these parameters with age and gender,and pairwise comparisons were made to determine the stable age range for parameter changes.Paired t-tests and paired chi-squared tests were conducted to analyze the bilateral parameter differences.Results·Results showed that YPPS and IDP did not exhibit significant correlation with age,whereas XPPS,IAP,IWP,and the incidence of pterygomaxillary fusion were significantly positively correlated with age(P<0.01).Gender differences were only significant for XPPS,with males demonstrating greater values than females(P<0.01).Analysis of age-related trends indicated significant differences in XPPS between group 1(6 years≤age<9 years)and group 2(9 years≤age<12 years)(female:P=0.006,male:P=0.004);significant differences in IAP were observed between group 2 and group 3(12 years≤age<15 years)(P=0.042),with 98.5%of samples having an IAP greater than 45 degrees;IWP differences were significant between group 1 and group 3(P=0.016),and the pterygomaxillary fusion incidence was significantly different among group 1,2,and 3(group 1 vs.2:P<0.001,group 2 vs 3:P=0.037,group 1 vs 3:P<0.001),with an incidence rate exceeding 90%in adults.No significant bilateral differences were found for all parameters.Conclusion·No significant changes were observed in YPPS and IDP after the age of 6,indicating a trend towards fusion of the maxilla with the pterygoid process.The overall transverse position of the PPS tends to stabilize around 12 years of age,while the IAP and IWP continue to increase and reach stability around 15 years of age,with a sagittal insertion orientation of the pyramidal process into the pterygoid notch.

As the detection rate of pancreatic cystic lesions(PCL)increases,artificial intelligence(AI)has made breakthroughs in the imaging workflow of PCL,including image post-processing,lesion detection,segmentation,diagnosis and differential diagnosis.AI-based image post-processing can optimize the quality of medical images and AI-assisted models for lesion detection,segmentation,diagnosis and differential diagnosis significantly enhance the work efficiency of radiologists.This article reviews the application progress of AI in PCL imaging and provides prospects for future research directions.

Humans ; Staphylococcus lugdunensis/genetics* ; Peptides, Cyclic ; Chromosomes ; Operon/genetics* ; Staphylococcal Infections/genetics* ; Bacterial Proteins/genetics* ; Anti-Bacterial Agents

Unplanned readmission to intensive care unit (ICU) is one of the indicators to evaluate the quality of medical care in ICU. Patients who were readmitted to ICU usually show worse outcomes, longer length of stays, increased mortality, and more consumption of medical resources. This article reviews the definition, incidence, risk factors, risk prediction models and measures to reduce the incidence of unplanned readmission to ICU in critically ill patients, providing a reference for ICU medical and nursing staff, as well as scholars in China to carry out relevant clinical practice and research.

Objective:To explore the popularization and practice ofearly mobility idea in Intensive Care Units (ICUs) in Sichuan Province.Methods:Based on literature review, we designed the Early Mobility Implementation Questionnaires for ICU patients by ourselves. We selected ICUs at 103 ClassⅡ Grade A and above hospitals in 18 cities, Sichuan Province, to carry out the survey.Results:There were statistical differences in different levels hospitals whether it was from an affiliated hospital of a university, with different numbers of beds and bed utilization rates ( P<0.05) . Among 70 ICUs that developed the early mobility, there were statistical differences in early mobility implementation of patients in the ICU whether to form a special team, whether to conduct a written evaluation for patients, whether to sign the early mobility informed consent and whether there was an emergency plan ( P<0.05) . Between ICUs with early mobility of ICU patients and standard plan, and ICUs without early mobility, single factor Logistic regression analysis showed that the influencing factors of early mobility implementation of ICU patients included the numbers of beds, nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists, implementing the daily interruption as well as sedation score with statistical differences ( P<0.05) ; between ICUs with early mobility of ICU patients and without standard plan, and ICUs without early mobility, the influencing factors of early mobility implementation of ICU patients included the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists and implementing the daily interruption with statistical differences ( P<0.05) . Multivariate Logistic regression analysis indicated that the influencing factors of early mobility implementation with standard plan were the nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists with statistical differences ( P<0.05) ; the influencing factors of early mobility implementation without standard plan were the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists with statistical differences ( P<0.05) . Conclusions:The implementation rate of early mobility in ICU is still insufficient in Sichuan Province, and implementation quality is no ideal. We should further explore the relevant issues, such as multidisciplinary cooperation as well as human resource allocation, and improve the early mobility forms, strengthen the evidence-based clinical practice and formulate a scheme suitable for China.

Objective To analyze the clinical significance of early lymphocyte recovery after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute myeloid leukemia.Methods The clinical data of 89 patients with acute myeloid leukemia undergoing allo-HSCT were retrospectively analyzed.The absolute lymphocyte count at Day 21 (ALC21) after allo-HSCT was used for representing the recovery rate of lymphocyte.And the effects of ALC21 on disease relapse,overall survival (OS),disease-free survival (DFS) and other parameters were analyzed.Results The recurrent rate of ALC21 ≥0.5 × 109/L group (high ALC21 group) was significantly lower than that of ALC21 ＜0.5× 109/L group (low ALC21 group) (19.6 ％ vs 48.5 ％,P=0.004).The 2-year OS and DFS of high ALC21 group spiked markedly as compared with low ALC21 group [(74.0 ± 6.0 ％ vs (46.5±9.5) ％,P=0.002],[(70.5 ± 6.2) ％ vs (44.9±9.3) ％,P =0.009] while viral infection rate declined markedly (37.5 ％ vs 60.6 ％,P =0.035).However,non-recurrence mortality (NRM),acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) (P =0.556) were not elevated in high ALC21 group as compared with low ALC21 group (P=0.584,P =0.08,P =0.556).Conclusions Early lymphocyte recovery after in acute myeloid leukemia patients has significant early predictive value for recurrence and long-term prognosis after allo-HSCT.