Objective:To establish the prediction model for postoperative delirium in elderly patients with mild stroke undergoing non-cardiac and non-intracranial surgery.Methods:This was a nested case-control study. Seven hundred and fifty elderly patients of either sex with mild stroke, aged ≥65 yr, undergoing elective surgical procedures under general anesthesia in the Department of Gastrointestinal Surgery, Orthopedics and Urology at the Tangshan Workers Hospital from May to December 2023, were selected. The perioperative clinical data were collected. The incidence of postoperative delirium was assessed using the Confusion Assessment Scale 1-7 days after surgery or 1 day before discharge. The patients were assigned to the training set and the validation set in a ratio of 7∶3 using a simple random sampling method. Multivariate logistic regression was used to identify the risk factors for postoperative delirium, a postoperative delirium risk prediction model was established based on the risk factors, the nomogram was developed, and the receiver operating characteristic (ROC) curve, calibration curve and decision curve were plotted to assess the accuracy of the prediction model. The prediction model was verified using the validation set, and the calibration curve and ROC curve were plotted to assess the predictive performance of the model.Results:A total of 721 patients were finally included, and 108 patients developed postoperative delirium. Older age, high American Society of Anesthesiologists Physical Status classification, history of preoperative hypertension, short years of education, high preoperative Pittsburgh sleep quality index score, high preoperative National Institutes of Health Stroke Scale score, high intraoperative hypothermia, intraoperative hypotension and high postoperative numerical rating scale score were independent risk factors for postoperative delirium ( P<0.05). The area under the ROC curve of the training set prediction model was 0.996, with a sensitivity of 1.000, and specificity of 0.945. The slope of the calibration curve was close to 1, and the predicted risk of postoperative delirium was in good agreement with the actual risk. When the threshold probability of the decision curve was 0-0.9, the net return rate was higher than the null line. Validation set: In the calibration curve of the prediction model, the cohort and calibration curves were close to the ideal line, with an area under the ROC curve of 0.997, sensitivity of 1.000, and specificity of 0.962. Conclusions:Based on age, American Society of Anesthesiologists Physical Status classification, history of preoperative hypertension, years of education, preoperative Pittsburgh sleep quality index score, National Institutes of Health Stroke Scale score, intraoperative hypothermia and hypotension and postoperative numerical rating scale score, the prediction model for postoperative delirium is developed and has a good predictive performance in elderly patients with mild stroke undergoing non-cardiac and non-intracranial surgery.

Objective To explore the protective mechanism of transdifferentiation of glomerular endothelial cells based on the differentiated embryonic chondrocyte gene 2 (DEC2) via the TGF-β/ROCK1 signaling pathway. Methods The 24 mice were randomly divided into sham group, UUO group, UUO combined with vector group and UUO combined with DEC2 group, with 6 mice in each group. A unilateral ureteral obstruction (UUO) model was established in each group, except for the sham group. In the UUO combined with vector group and UUO combined with DEC2 group, 10 μL (10⁸ PFU) of vector or DEC2 was injected into each kidney on day 0 (immediately after UUO) under the guidance of the ultrasound system. The mice were sacrificed 14 days after the operation, and the kidneys were collected for histological examination and Western blot analysis: HE staining was used to observe the histological changes of kidneys, Masson staining to observe the renal fibrosis, and Western blot analysis to detect the protein expression. In vitro, normal human glomerular endothelial cells (GEnCs) was selected as the research objects. GEnCs stimulated with TGF-β were treated with ROCK1 inhibitor Y-27632 or DEC2 transfection. Western blot analysis was used to detect the expression of ROCK1, α-SMA, DEC2 and E-cadherin in GEnC exposed to transforming growth factor β (TGF-β). The localization of ROCK1 and DEC2 in GEnCs cells was detected by immunofluorescence cytochemistry. The relationship between the ROCK1 and DEC2 was confirmed by co-immunoprecipitation. Results Compared with the sham group, the UUO groups showed significant renal fibrosis and collagen accumulation on the 14th day. In the UUO groups, the expression of DEC2 and E-cadherin in the kidney tissue of the mice was significantly reduced, and the expression of α-SMA significantly increased. Compared with the UUO combined with vector group, the kidney fibrosis and collagen accumulation in the UUO combined with DEC2 group decreased, and the expression of ROCK1 and α-SMA decreased and the expression of DEC2 and E-cadherin increased in the kidney tissue. TGF-β enhanced the expression of ROCK1 and α-SMA in GEnCs cells in a time-dependent manner, and the levels of DEC2 and E-cadherin decreased. Treatment with the ROCK1 inhibitor Y-27632 partially abrogated the TGF-β-induced increase in the expression of ROCK1 and α-SMA and decrease in the expression of DEC2 and E-cadherin. In addition, transfection of GEnCs cells with DEC2 before TGF-β stimulation reduced the expression of ROCK1 and α-SMA, and increased the expression of DEC2 and E-cadherin. Immunofluorescence cytochemical staining showed that DEC2 co-localized with ROCK1 in GEnCs, and the co-immunoprecipitation showed that DEC2 and ROCK1 pulled down each other. Conclusions DEC2 is down-regulated in fibrotic renal tissue, while up-regulated DEC2 inhibits epithelial myofibroblast transdifferentiation and renal fibrosis of GEnC by blocking TGF-β/ROCK1 signaling pathway.
Humans ; Animals ; Mice ; Cell Transdifferentiation ; Chondrocytes ; Endothelial Cells ; Cadherins ; Signal Transduction ; rho-Associated Kinases

Objective:To learn about the infection and gene polymorphisms of hepatitis E virus (HEV) in murine-shaped animals of plague foci in Yunnan Province.Methods:From July to August 2019, around 16 natural villages (4 in Mile City, 6 in Mangshi and 6 in Lianghe County), which were the foci of domestic plague in Yunnan Province, the murine-shaped animals were captured by the night-time method. The liver RNA was extracted, and the target gene of rat HEV was detected by one-step real-time fluorescence quantitative PCR, and the positive rate of rat HEV was calculated. The rat HEV positive samples were amplified by PCR for further clone sequencing, and the resulting sequences were compared with the HEV sequences registered in the GenBank and a phylogenetic tree was constructed by using MegAlign and MEGA 7.0.Results:A total of 491 murine-shaped animals were captured from 3 orders, 5 families, 8 genera, 15 species, and the positive rate of rat HEV was 4.89% (24/491). Among them, the positive rate of Rattus tanezumi and Niviventer fulvescens was 9.39% (23/245) and 1/3, respectively; and other species were negative. There was a statistically significant difference in the positive rate of rat HEV between different habitats ( P = 0.014), and the positive rate of rat HEV in the habitats near the dwellings was higher than that in other habitats ( P < 0.05). The sequence comparison analysis showed that the gene sequence of P018 from Lianghe County was 100.0% homologous to the MG813927.1 sequence of the first patient with rat HEV in Hongkong, and it was clustered into the same branch with the sequences of MG813927.1 and LC549185.1 from rat, was the type HEV C. G024 from Mangshi shared a low homology (20.7% - 31.5%) with other virus strains, and it was clustered into the same branch with a HEV sequence from an avian (AY535004.1). Conclusions:Rat HEV is prevalent in murine-shaped animals of plague foci of Yunnan Province, and there may be gene polymorphisms of rat HEV. In addition, the difference infection rate may be related to the habitats.

Objective:To study the research hot spots of ophthalmology-related coronavirus disease 2019 (COVID-19).Methods:PubMed database as the data source, the literatures of ophthalmology-related COVID-19 published on January 1, 2020 to February 22, 2022 were collected, limited to Medline included, the language type was limited to English and Chinese, and 1 592 literatures were included. By reading the titles and abstracts, the literatures of meeting notice, editor's note, etc. and the literature that was not quite relevant with ophthalmology-related COVID-19 were removed, and finally 1 547 literatures were included. Bibliographic Items Co-occurrence Matrix Builder (BICOMB 2.02 software) was used to collect the frequency of major Mesh terms/subheadings and the frequency of major Mesh terms after removing the subheadings, and the number of included articles published in the top 10 journals by the number of ophthalmology-related COVID-19 articles was recorded. VosViewer 1.6.18 software was used for cluster analysis of collaborator network and major Mesh terms, and the publication status and country or region distribution of active authors of ophthalmology-related COVID-19 were recorded.Results:Of the 1 547 literatures, the active authors were mainly from India, Italy, Singapore, Spain, and Hong Kong, China, and so on; the top 10 journals published 617 articles in total (39.88%, 617/1 547). The high frequency major Mesh terms/subheadings included COVID-19, viral pneumonia, coronavirus infection, eye diseases/epidemiology, complications, prevention & control, diagnosis, virology, and Severe acute respiratory syndrome coronavirus 2, betacoronavirus/isolation & purification, ophthalmology/education, organization & administration, telemedicine, delivery of health care/organization & administration, and mucormycosis/diagnosis, etc. After taking out the subheadings, the high frequency of major Mesh terms also included conjunctivitis, orbital disease, retinal diseases, neuromyelitis optica, retinal vein occlusion, myopia and other eye diseases, eye diseases-related systemic diseases, such as multiple sclerosis and Miller Fisher syndrome, therapy and prevention-related drugs, such as hydroxyl chloroquine, angiogenesis inhibitors, and vaccination.Conclusions:Ophthalmology-related COVID-19 researches have received extensive attention worldwide, COVID-19 is associated with multiple ocular diseases of anterior and posterior segments. COVID-19-related mucormycosis, hydroxychloroquine and possible retinal toxicity, and possible ocular adverse effects associated with vaccination are also noteworthy.

Chronic cough can occur in children of all ages, and the incidence rate and consultation rate increase each year.Clarifying the cause of chronic cough is the key to treatment.At present, there are no convenient, operable and unified standards for etiological analysis of chronic cough in the world.Therefore, the etiological analysis of chronic cough has always been a hot topic in clinical research.With the development of diagnosis and treatment technology, the role of pulmonary function and exhaled nitric oxide in the diagnosis of chronic cough has attracted attention.This article reviews the application value of pulmonary function combined with exhaled nitric oxide in etiology analysis of chronic cough in children, to provide reference for etiology analysis of chronic cough in children.

Objective:This paper analyzes the factors influencing the development of discipline construction in a tertiary specialized hospital, explores discipline improvement measures, so as to provide possible references for other medical institutions.Methods:Taking Henan Eye Hospital as an example, we analyze the current status of discipline construction, review the managing practice for the development in recent years, find out the factors influencing the development of disciplines and new challenges, and puts forward improvement measures.Results:The managing practice showed that the affecting factors of discipline construction included discipline orientation, talent teams, original innovation, medical level, academic exchanges and research platforms. Facing to the new problems under the further goal, to figure out the novel way is a guarantee for the smooth development of the medical institute.Conclusions:These measures may foster the development of discipline construction, which include focusing on discipline direction, strengthening the construction of talents, encouraging scientific and technological innovation, developing medical services, deepening the domestic and international cooperation and exchange and constructing platforms. It is important to achieve high-quality development of high-level specialized medical institutions for reaching the goal of health for all citizens.

Objective To investigate the value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with unexplained biliary stricture, complex bile duct stones, or other biliary tract diseases. Methods A retrospective analysis was performed for the clinical data of the patients with biliary tract diseases who were diagnosed and treated with SpyGlass in The Second Affiliated Hospital of Nanjing Medical University from December 2017 to June 2020. For the patients with biliary stricture, the biliary lesions were fully visualized under the guidance of SpyGlass, and SpyBite biopsy was performed if necessary; the patients with bile duct stones were treated with SpyGlass-guided direct-view laser lithotripsy; for the patients with gallbladder disease, the cystic duct was superselected with the assistance of SpyGlass. The SpyGlass system was analyzed in terms of its sensitivity, specificity, and accuracy rate in diagnosis and treatment, lithotripsy success rate, stone clearance rate, procedure success rate, and incidence rate of complications. Results A total of 58 patients underwent SpyGlass procedure. SpyGlass was used to evaluate biliary stricture of unknown nature in 44 (76%) patients; SpyGlass visual impression had a diagnostic sensitivity of 92% (24/26), a specificity of 94% (17/18), and an accuracy of 93% (41/44), and SpyBite biopsy had a diagnostic sensitivity of 71% (15/21), a specificity of 92% (11/12), and an accuracy of 79% (26/33). SpyGlass was used for the treatment of bile duct stones in 8 patients (14%), with a lithotripsy success rate of 83% (5/6) and a stone clearance rate of 88% (7/8). A guide wire under the SpyGlass system was to superselect the cystic duct in 5 patients (9%), with a procedure success rate of 80% (4/5). In one patient (1%), SpyGlass was used to assist the removal of common bile duct stones after liver transplantation and the treatment of bile duct anastomotic stricture. A total of 5 patients (9%) experienced complications after surgery. Conclusion The SpyGlass choledochoscopy system is accurate, safe, and effective in the diagnosis and treatment of unexplained biliary stricture, complex bile duct stones, and other biliary tract diseases.

Objective:To evaluate the association between the eye exercises and one-year axial eye elongation in grade 7 students in Beijing.Methods:Sampling was performed using a multistage random cluster approach, and 1 443 students of grade 7 were selected from 9 middle schools in 6 districts for the baseline survey. Data were collected by questionnaires and axial length measurement. Multiple linear regression analysis was used to evaluate the association between eye exercises and excessive axial eye elongation.Results:Among 1 197 (82.95%) students with complete information, the median ( Q R) age was 12.00 (1.00) years old, girls accounted for 44.28%, and the median ( Q R) axial eye elongation was 0.22 (0.18) mm. In the multiple linear regression analysis, the frequency of eye exercises was significantly correlated with excessive axial eye elongation in boys ( β=-0.135, 95% CI:-0.253--0.018) but not in girls ( β=-0.075, 95% CI:-0.207- 0.058) after adjusting for sex, age, body height, the number of myopic parents, time spent outdoors and time spent on reading and writing outside class; while the seriousness of eye exercises was not significantly associated with axial eye elongation in boys ( β=-0.028, 95% CI: -0.114-0.058) and girls ( β=-0.035, 95% CI: -0.134-0.064). Conclusion:The increased frequency of eye exercises is beneficial to control the axial eye elongation in boys in Beijing.

Objective: To clarify the situation of the detection of upper gastrointestinal cancer and precancerous lesions in the Feicheng city and discuss the possible influencing factors. Methods: A cluster sampling method was used to determine the participants. A unified questionnaire was used to investigate the basic information including history of alcohol intake, smoking and chinese tea, as well as other eating habits, medical history of digestive tract and cancer. Endoscopy was used to to screen the patients with upper gastrointestinal cancer and precancerous lesions. Influential factors were explored by non-conditional logistic regression model. Results: 911 of 7 291participants were positive, and the total detection rate was 12.49%. The total positive detection rate of male and female was 17.94% and 8.71%, respectively (P<0.001). Multivariate logistic regression analysis showed that the sex (OR=0.527, 95%CI: 0.440-0.631), age (OR=2.037, 95%CI: 1.849-2.245), smoking (OR=1.240, 95%CI: 1.014-1.516) and alcohol consumption (OR=1.232, 95%CI: 1.012-1.500) , meat and protein intake (OR=0.794, 95%CI: 0.638-0.987) and drink tea (OR=1.233, 95%CI: 1.056-1.440) may be influencing factors of the total detection rate of upper gastrointestinal cancer and precancerosis. Conclusions In Feicheng city, intake of meat and protein is the protective factor of the upper gastrointestinal cancer and precancerous lesions. Men, aged, smoking, drinking and tea will increase the risk of upper gastrointestinal cancer and precancerous lesions.

Objective:To analyze the magnetic resonance imaging (MRI) features of parasellar cavernous haemangioma and improve the diagnosis and differential diagnosis accuracy.Methods:13 patients with parasellar cavernous haemangioma were collected.All the patients were diagnosed by MRI and confirmed by pathology.Based on the pathologic findings,the MRI features were discussed.Results:9 cases presented horizontal dumbbell.The lesions located in the parasellar were larger than the sella turcica.The main body position of the lesions were centered lateral to the parasellar and encasesed the intracavernous internal carotid artery (ICICA).While,1 cases were similar in size and shape.1 case was located in the sella turcica.2 cases was centered lateral to the ICICA.pituitary were detected obscurity in 7 cases and displaced in 6 cases,6 cases appeared extremely high homogeneous intensity on T2-weighted images:as bright as cerebrospinal fluid signal.Only 5 cases underwent three-dimensional arterial spin labelling perfusion imaging (3D-ASL).The lesions revealed marked hypoperfusion.The cases of misdiagnosis were 9,including 4 cpituitary adenomas and 5 meningiomas.Conclusions:The characteristics of MR images ofparasellar cavernous haemangioma were horizontal bottle gourd form,the main body position of the lesions were centered lateral to the parasellar and encasesed the (ICICA),and their extremely high homogeneous intensity on T2-weighted images:as bright as cerebrospinal fluid signal.In cases that are equivocal,3D-ASL were useful in differentiating cavernous haemangiomas from parasellar meningiomas,which could decrease mistaken diagnosis.Graspping the imaging feature and differential diagnosis were helpful for the diagnosis of this disease.