To summarize the nursing experience of a patient with acute injection botulism complicated with respiratory failure.The key nursing points include early standard use of botulinum antitoxin therapy to improve the signs of myasthenia;to strengthen respiratory support and airway management,to carry out respiratory training,and to promote the recovery of respiratory function;swallowing function training and dynamic evaluation were carried out to promote the recovery of swallowing function;narrative nursing was carried out to relieve patient's negative emotions.After 17 days of treatment and nursing care,the patient was removed from the tracheal tube on the 7th day,transferred to the general ward on the 14th day,and discharged successfully on the 17th day with a good prognosis.A telephone follow-up was conducted 4 months after discharge,and the patient recovered well.

Objective : To pathological changes and inducible nitric oxide synthase(iNOS), phosphorylated insulin receptor substrate 1 serine 307(p-IRS1ser 307), phosphorylated protein kinase B serine 473(p-AKTser 473), glycogen synthase kinase-3β(GSK-3β), and gluconeogenic synthase(GS) proteins were observed in the liver of rats under the condition of chronic intermittent hypoxia-replicated oxygen in control. And to explore the role of iNOS/IRS1/AKT/GSK-3β signaling pathway in chronic intermittent hypoxia-induced insulin resistance. Methods : Forty SD rats were randomly divided into a control group(NC group) and an experimental group(CIH group), with 20 rats in each group. The NC group was placed in a normoxic environment for 12 weeks, while the CIH group was first subjected to intermittent hypoxia for 8 weeks, and then resumed normoxic rearing until the 12th week. Fasting blood glucose(FBG) and fasting insulin(FINS) were measured at baseline, week 8 and week 12, and liver tissues were taken for pathology and measurement of iNOS, p-IRS1ser 307, p-AKTser 473, GSK3β and GS levels, to compare the differences between groups. Results: t baseline, there was no significant difference in liver pathology between the two groups, and the observed indexes were not statistically significant(P>0.05); at 8 weeks, compared with the NC group, liver pathology in the CIH group showed significant disorganization of hepatic blood sinusoids and hepatocyte cords, obvious hepatocyte edema, smaller nuclei, increased lymphocyte infiltration, and a small number of fat vacuoles, significantly higher levels of FBG, FINS, insulin resistance index(HOMA-IR), iNOS mRNA, p-IRS1ser 307 protein, GSK-3β protein levels, and decreased p-AKTser 473 protein and GS protein levels, all of which were statistically significant(allP<0.05). IRS1ser 307 protein, GSK-3β protein levels were increased, p-AKTser 473 protein and GS protein levels were decreased, and the differences were statistically significant(allP<0.05); at 12 weeks, no lymphocyte infiltration was seen in the CIH group compared with that of the NC group and fat vacuoles significantly increased, and there was no improvement in the other pathological damage that had already occurred, and the levels of p-AKTser 473 protein significantly increased. AKTser 473 protein level significantly increased, p-IRS1ser 307 protein and GS protein levels were significantly reduced, all of which were statistically significant(allP<0.05), and the rest of the observational indexes were not statistically significant. Pearson′s correlation analysis showed that HOMA-IR of CIH group was significantly positively correlated with the levels of iNOS mRNA, p-IRS1ser 307 protein, and GSK-3β protein at 8 weeks(r=0.874, 0.817,0.872;allP<0.05), and significantly negatively correlated with the levels of p-AKTser 473 protein and GS protein(r=-0.886,-0.879;allP<0.05). Conclusion Chronic intermittent hypoxia can lead to hepatic pathological damage that cannot be reversed even by reoxygenation interventions and may mediate the development of insulin resistance by upregulating the IRS1/AKT/GSK-3β signaling pathway through the upregulation of iNOS mRNA expression.

Inflammation plays a crucial role in the occurrence and development of post-stroke depres-sion(PSD),yet the specific molecular mechanisms are still not fully understood.In the field of drug research,traditional Chinese medicine preparations have attracted increasing attention for improving PSD symptoms due to their advantages of multiple targets,many links,and few side effects.At the same time,they have great re-search value in the prevention and treatment of PSD.This article reviews the mechanism of inflammatory re-action,such as the balance regulation of pro-inflammatory/anti-inflammatory factors,inflammatory markers,gene polymorphism of inflammatory factors in PSD,and the related research progress of Chinese medicine preparations in regulating inflammatory reaction to prevent and treat PSD,with a view to providing reference for the selection of clinical Chinese medicine preparations and the prevention and treatment of PSD.

Objective To explore the effects of the Otago Exercise Program(OEP)on activities of daily living,muscle strength,balance,and physical function in older adults with sarcopenia,to compare OEP with conventional exercise training,and to provide a basis for clinical rehabilitation programs for older adults with sarcopenia.Methods In this randomized controlled trial,120 older adults clinically diagnosed with sarcopenia were enrolled.The participants were randomly assigned to the OEP intervention group(experimental group)and the conventional exercise intervention group(control group),with 60 in each group.The experimental group underwent 12 weeks of OEP training,three times a week,with each session lasting 45 minutes.The control group underwent conventional exercise training following the same schedule.The Modified Barthel Index was used as the primary outcome measure to assess activities of daily living.Secondary outcome measures included muscle strength,gait stability,dynamic balance,and physical function status,evaluated using grip strength,6-meter walking speed,the Timed Up and Go Test(TUGT),and the Short Physical Performance Battery(SPPB).Results A total of 120 older adults with sarcopenia were included.The mean age of the participants was(80.17±8.48)years.Baseline data before treatment showed no statistically significant differences between the two groups.Both groups completed the treatment within 12 weeks without experiencing any adverse events.The baseline data for the experimental group were as follows,MBI at(67.00±22.76)points,hand grip strength at(15.29±4.94)kg,gait speed at(0.61±0.26)m/s,TUGT time at(15.05±6.74)s,and SPPB score at(6.17±1.40)points,while the corresponding post-intervention findings were as follows,(78.72±15.83)points,(17.67±5.83)kg,(0.77±0.28)m/s,(13.49±6.16)s,and(9.25±1.71)points,respectively.The experimental group showed improvements in all measures from baseline to post-intervention(P＜0.05 for all measures).As for the control group,the baseline data for the corresponding measures were as follows,(67.20±22.12)points,(15.00±5.35)kg,(0.58±0.23)m/s,(17.29±6.90)s,and(6.00±1.24)points,respectively.The post-intervention findings increased to(71.13±20.28)points,(15.47±5.72)kg,(0.64±0.28)m/s,(16.50±6.99)s,and(6.73±1.61)points,respectively,but the changes were not statistically significant(P＞0.05).Furthermore,an intergroup comparison of intervention effects(post-intervention minus preintervention)revealed significant differences in mean changes from baseline.The experimental group demonstrated improvements of(+11.72±6.32)points in modified Barthel Index,(+11.72±6.32)kg in grip strength,(+0.16±0.09)m/s in gait speed,(—1.56±1.32)s in TUGT time,and(—1.56±1.32)points in SPPB score.In contrast,the control group showed smaller changes of(+3.93±5.65)points,(+0.47±1.37)kg,(+0.06±0.07)m/s,(—0.79±1.54)s,and(+0.73±1.12)points,respectively(all P＜0.05).Intergroup comparisons revealed superior outcomes in the experimental group across all measures.Conclusion OEP significantly enhances activities of daily living,improves muscle strength,balance,and physical function in older adults,and is more effective than conventional rehabilitation exercise programs,making it suitable for extensive clinical application.

Objective:To analyze the characteristics,high-risk factors,and maternal fetal outcomes of intrahe-patic cholestasis of pregnancy(ICP)in twin pregnancies,and provide a basis for clinical intervention.Methods:A retrospective analysis was conducted on 791 cases twin pregnant women who gave birth ≥24 weeks of gestation at Changsha Maternal and Child Health Hospital affiliated to Hunan Normal University from January 1,2021 to No-vember 30,2024.According to whether the pregnant women were complicated with ICP,all included twin pregnant women were divided into two groups,with 732 cases in the non ICP group and 59 cases in the ICP group.The differences in clinical characteristics,high-risk factors,and maternal fetal outcomes between two groups were compared,and Logistic regression analysis was used to identify the influencing factors of ICP in twin pregnancies.Results:①Among the women with twin live births who gave birth at ≥24 weeks of gestation,the incidence of ICP was 7.46％(59/791),and the proportion of mildly elevated total bile acid(TBA)was 83.05％(49/59);The inci-dence of ICP was highest at 34-36+6 weeks of pregnancy,accounting for 52.54％(31/59),and the incidence be-fore full-term was 77.97％(46/59);The treatment rate of TBA lowering drugs was 37.29％(22/59),and the inef-fective rate of drug treatment was 68.18％(15/22).②Univariate analysis found that the proportion of preeclamp-sia(PE)and previous cesarean section history in the ICP group was higher than that in the non ICP group,and the difference was statistically significant(P＜0.05).③ Logistic regression analysis suggests that,PE(OR 3.104,95％CI 1.763-5.466)and a history of previous cesarean section(OR 2.252,95％CI 1.039-4.878)were an inde-pendent risk factor for ICP in twins(P＜0.05).④The gestational age at delivery and birth weight of newborns in the ICP group were lower than those in the non ICP group.The premature birth rate,cesarean section rate,and neonatal transfer rate were higher than those in the non ICP group,and the differences were statistically signifi-cant(P＜0.05).Conclusions:PE and previous cesarean section history are high-risk factors for the occurrence of ICP in twin pregnancies.A detailed understanding of past medical history and active prevention of PE are bene-ficial for preventing the occurrence of ICP in twin pregnancies.

Objective To investigate the clinical efficacy of low-dose Prednisone combined with Tacrolimus in children with refractory nephrotic syndrome(RNS).Methods A total of 106 children with RNS admitted from March 2022 to September 2023 were included and evenly divided into the monotherapy group and the combination therapy group according to the random number table method.The monotherapy group was given low-dose Prednisone tablets,while the combination therapy group was given low-dose Prednisone tablets combined with Tacrolimus.The differences in nailfold microcirculation indicators,lipid metabolism indicators,renal injury markers,clinical efficacy,and adverse reactions were compared between the two groups.Results The total effective rate of the combination therapy group was higher than that of the monotherapy group(P<0.05).At 3 months after treatment,the serum albumin,capillary flow velocity,input branch diameter and output branch diameter in the combination therapy group were all higher than those in the monotherapy group,while the levels of red blood cell aggregation,triglycerides,low-density lipoprotein cholesterol,total cholesterol,serum creatinine,24-hour urine protein quantification,neutrophil gelatin enzyme-associated lipocalin,retinol binding protein,α1-microglobulin,β-N-acetylglucosaminidase,and renal injury molecule-1 were all lower than those in the monotherapy group(P<0.05).The total incidence of adverse reactions in the combination therapy group was lower than that in the monotherapy group(P<0.05).Conclusion In the treatment of children with RNS,the combination of Tacrolimus and low-dose Prednisone can improve the microcirculation status and reduce renal injury markers,with remarkable effects.

Objective:To describe the application methods, types, and effects of wearable devices in sarcopenia.Methods:Following the guidelines for scoping reviews, a systematic search was conducted in PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data, and VIP for literature related to wearable device applications in sarcopenia. The search period covered publications from database inception to August 1, 2024.Results:A total of 12 studies were included. Wearable devices in sarcopenia were primarily used for monitoring gait speed, surface electromyography, sleep duration, activity time, and supporting exercise interventions. Common types of wearable devices included activity trackers, smart belts, and smart wristbands. Their effectiveness, feasibility, and role in ensuring activity safety have been preliminarily demonstrated.Conclusions:The application of wearable devices in sarcopenia is still in its early stages but shows great potential. Currently, wearable devices are mainly used to monitor one or a few individual indicators. Future research should focus on developing multi-parameter monitoring devices and conducting large-scale, high-quality trials to validate their effectiveness in both monitoring and supporting exercise interventions. This will help promote their broader application and assist healthcare professionals in the early identification, diagnosis, prevention, and treatment of sarcopenia.

Objective:To analyze the characteristics,high-risk factors,and maternal fetal outcomes of intrahe-patic cholestasis of pregnancy(ICP)in twin pregnancies,and provide a basis for clinical intervention.Methods:A retrospective analysis was conducted on 791 cases twin pregnant women who gave birth ≥24 weeks of gestation at Changsha Maternal and Child Health Hospital affiliated to Hunan Normal University from January 1,2021 to No-vember 30,2024.According to whether the pregnant women were complicated with ICP,all included twin pregnant women were divided into two groups,with 732 cases in the non ICP group and 59 cases in the ICP group.The differences in clinical characteristics,high-risk factors,and maternal fetal outcomes between two groups were compared,and Logistic regression analysis was used to identify the influencing factors of ICP in twin pregnancies.Results:①Among the women with twin live births who gave birth at ≥24 weeks of gestation,the incidence of ICP was 7.46％(59/791),and the proportion of mildly elevated total bile acid(TBA)was 83.05％(49/59);The inci-dence of ICP was highest at 34-36+6 weeks of pregnancy,accounting for 52.54％(31/59),and the incidence be-fore full-term was 77.97％(46/59);The treatment rate of TBA lowering drugs was 37.29％(22/59),and the inef-fective rate of drug treatment was 68.18％(15/22).②Univariate analysis found that the proportion of preeclamp-sia(PE)and previous cesarean section history in the ICP group was higher than that in the non ICP group,and the difference was statistically significant(P＜0.05).③ Logistic regression analysis suggests that,PE(OR 3.104,95％CI 1.763-5.466)and a history of previous cesarean section(OR 2.252,95％CI 1.039-4.878)were an inde-pendent risk factor for ICP in twins(P＜0.05).④The gestational age at delivery and birth weight of newborns in the ICP group were lower than those in the non ICP group.The premature birth rate,cesarean section rate,and neonatal transfer rate were higher than those in the non ICP group,and the differences were statistically signifi-cant(P＜0.05).Conclusions:PE and previous cesarean section history are high-risk factors for the occurrence of ICP in twin pregnancies.A detailed understanding of past medical history and active prevention of PE are bene-ficial for preventing the occurrence of ICP in twin pregnancies.

To summarize the nursing experience of a patient with acute injection botulism complicated with respiratory failure.The key nursing points include early standard use of botulinum antitoxin therapy to improve the signs of myasthenia;to strengthen respiratory support and airway management,to carry out respiratory training,and to promote the recovery of respiratory function;swallowing function training and dynamic evaluation were carried out to promote the recovery of swallowing function;narrative nursing was carried out to relieve patient's negative emotions.After 17 days of treatment and nursing care,the patient was removed from the tracheal tube on the 7th day,transferred to the general ward on the 14th day,and discharged successfully on the 17th day with a good prognosis.A telephone follow-up was conducted 4 months after discharge,and the patient recovered well.

Objective To investigate the clinical efficacy of low-dose Prednisone combined with Tacrolimus in children with refractory nephrotic syndrome(RNS).Methods A total of 106 children with RNS admitted from March 2022 to September 2023 were included and evenly divided into the monotherapy group and the combination therapy group according to the random number table method.The monotherapy group was given low-dose Prednisone tablets,while the combination therapy group was given low-dose Prednisone tablets combined with Tacrolimus.The differences in nailfold microcirculation indicators,lipid metabolism indicators,renal injury markers,clinical efficacy,and adverse reactions were compared between the two groups.Results The total effective rate of the combination therapy group was higher than that of the monotherapy group(P<0.05).At 3 months after treatment,the serum albumin,capillary flow velocity,input branch diameter and output branch diameter in the combination therapy group were all higher than those in the monotherapy group,while the levels of red blood cell aggregation,triglycerides,low-density lipoprotein cholesterol,total cholesterol,serum creatinine,24-hour urine protein quantification,neutrophil gelatin enzyme-associated lipocalin,retinol binding protein,α1-microglobulin,β-N-acetylglucosaminidase,and renal injury molecule-1 were all lower than those in the monotherapy group(P<0.05).The total incidence of adverse reactions in the combination therapy group was lower than that in the monotherapy group(P<0.05).Conclusion In the treatment of children with RNS,the combination of Tacrolimus and low-dose Prednisone can improve the microcirculation status and reduce renal injury markers,with remarkable effects.