OBJECTIVE To explore the effect of paeoniflorin on glucose metabolism， inflammation and oxidative stress in rats with gestational diabetes mellitus （GDM） and its potential mechanism based on nuclear factor-erythroid 2-related factor 2 （Nrf2）/ heme oxygenase-1 （HO-1）/nicotinamide adenine dinucleotide phosphate：quinone oxidoreductase 1 （NQO1） signaling pathway. METHODS The female rats fed with high fat and high sugar diet and the male rats fed with an ordinary diet were caged， the successfully conceived rats were collected， and streptozotocin was injected intraperitoneally once to induce the GDM model. The successfully modeled rats were randomly divided into the model group， metformin hydrochloride group （200 mg/kg metformin by gavage）， paeoniflorin low-， high-dose groups （45， 90 mg/kg paeoniflorin by gavage， respectively）， paeoniflorin+ML385 group （90 mg/kg paeoniflorin by gavage and intraperitoneal injection of 30 mg/kg Nrf2 inhibitor ML385）， with 12 rats in each group； in addition， another 12 conceived rats fed with an ordinary diet were selected as the control group. The rats in each drug group were given the corresponding drug/normal saline， once a day， for 2 consecutive weeks. Glucose metabolism indexes [fasting blood glucose （FBG）， fasting insulin （FINS）， insulin resistance index （HOMA-IR）]， serum inflammatory factors [interleukin-6 （IL-6）， tumor necrosis factor- α （TNF- α）] and renal tissue oxidative stress indexes [superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）] were detected； the pathological changes of renal tissue were observed， and the protein expressions of Nrf2， HO-1 and NQO1 in renal tissue were detected. RESULTS Compared with the control group， the renal tissue lesions of the model group were obvious， including glomerular atrophy， edema degeneration of renal tubular epithelial cells and a large number of inflammatory cell infiltration； the levels of FBG and FINS， HOMA-IR， the levels of IL-6 and TNF-α in serum， and the level of MDA in renal tissue were significantly increased （P＜0.05）， while the levels of SOD and GSH-Px and the protein expressions of Nrf2， HO-1 and NQO1 in renal tissue were significantly decreased （P＜0.05）. Compared with the model group， the renal tissue lesions of rats in paeoniflorin low-dose and high-dose groups were reduced， the above quantitative indexes were significantly improved， and the improvement effect was better in high-dose group （P＜0.05）， while ML385 could significantly reverse the improvement effect of paeoniflorin on the above indexes （P＜0.05）. CONCLUSIONS Paeoniflorin can improve the abnormal glucose metabolism， inflammation and oxidative stress damage of renal tissue in GDM rats， which may be related to the activation of Nrf2/HO-1/NOQ1 signaling pathway.

Objective:To analyze the electroencephalogram (EEG) features of patients with Alzheimer’s disease (AD) and mild cognitive impairment (MCI), and to combine the characteristics for classification and prediction.Methods:One hundred and thirty-five patients attending the Department of Neurology at the General Hospital of Tianjin Medical University were enrolled, including 34 patients with AD, 67 patients with MCI, and 34 healthy control (HC). The electroencephalogram signals of these patients in the resting state were collected and preprocessed. Relative power spectral density features and sample entropy features on a multi-band scale were extracted to compare the whole-brain differences in electroencephalogram features among the 3 groups of subjects, and then subdivided into brain regions and individual leads for in-depth analysis. The above two features were fused to classify and predict AD, MCI, and HC by support vector machine (SVM).Results:The frontal regions had higher δ relative power spectral densities than the other regions, and the occipital and temporal regions showed relatively lower distributions. θ-Band relative power spectral densities had a more even distribution of sizes across brain regions. α-Band relative power spectral densities were concentrated in the occipital lobe, while β-band relative power spectral densities were mainly concentrated in the parietal and temporal lobes. Except for the central lobe, the δ-band relative power spectral densities of the AD group were higher than those of the MCI group ( P < 0.05) and HC group ( P < 0.01) in all brain regions and the whole brain. θ-band relative power spectral densities of the AD group were higher than those of the MCI gourp ( P < 0.001) and HC group ( P < 0.001) in the whole brain and in all brain regions. α-Band relative power spectral densities of the AD group were lower than those of the other groups only in the temporal lobe (all P < 0.05). The relative power spectral density of the β-band in the AD group was higher than that of the other groups in the whole brain and in all brain regions ( P < 0.05, 0.01, 0.001). The difference in the relative power spectral density of the δ-band in the C3 lead in the central lobe of the AD and HC groups was statistically significant ( P < 0.05). The relative power spectral density of the γ-band in the temporal lobe was higher than that in the other regions of the AD group, the MCI group, and the HC group. The relative power spectral density of the γ-band in the T3 lead in the AD group was significantly lower than that in the T4 lead. The average entropy of samples in the whole brain and in each brain region was lower than that in the HC group in the AD and MCI groups (all P < 0.05). The entropy of the samples at lead C3 in the AD group was lower than that in the MCI group ( P < 0.05). The differences between the relative power spectral density, sample entropy, and the actual data classification evaluation indexes (accuracy rate, precision rate, recall rate, and F1 score) that fused the two features, and the rearranged data were all statistically significant (all P < 0.001). When the relative power spectral density feature and the sample entropy feature were fused in the classification features, the best classification prediction was achieved, with an accuracy rate of 80%, a precision rate of 78%, a recall rate of 78%, and the F1 score of 79%. Conclusions:Relative power spectral density and sample entropy analysis can reveal the abnormalities of electroencephalogram activities of AD and MCI patients from different perspectives (linear and nonlinear), and the combination of these two features in classification prediction can improve the classification effect.

Objective:To systematically review the predictive model for de novo stress urinary incontinence (de novo SUI) after pelvic organ prolapse (POP) surgery, with the aim of providing reference for preventing the occurrence of de novo SUI.Methods:Literature on the prediction model of de novo SUI after POP surgery was electronically retrieved in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang, and VIP. The search period was from the establishment of the database to December 31, 2023, and the language was limited to Chinese and English. Two researchers independently screened literature, extracted data, and used the prediction model risk of bias assessment tool (PROBAST) to evaluate the quality of the models.Results:A total of 13 articles were included, including 13 de novo SUI risk prediction models. One literature was a prospective study, one literature was a secondary analysis of data, and the rest were retrospective studies. The area under the receiver operating characteristic curve in nine models ranged from 0.595 to 0.842, and the C-index of three models ranged from 0.710 to 0.738. Five models were not validated or only internally validated after construction. Six models were validated in one external population. The predictive performance of one model was validated in six external populations. The overall applicability of the 13 prediction models was good, but there was a certain risk of bias in all of them. Conclusions:There is a significant difference in the predictive performance of the de novo SUI risk prediction model after POP surgery, and the number is relatively small, indicating that it is still in the development stage. Future research should continuously optimize existing models and conduct external validation, and construct predictive models suitable for postoperative de novo SUI in POP patients in China.

Objective The objective of this study was to analyze the incidence of malignant tumors among the insured popu-lation in the first division Alar city(hereinafter referred to as Alar city)from 2020 to 2022,and provide reference for the prevention and control of malignant tumors in the local area.Methods The data of malignant tumor incidence from the insured population in Alar city from 2020 to 2022 were collected and sorted out.The crude incidence,age-standardized incidence rate by Chinese standard population(ASIRC)and by World standard population(ASIRW),cumulative rate of 0 to 74 years old,truncated rate of 35 to 64 years old,the incidence sequence and its composition of malignant tumors were analyzed by gender,age and nationality(Han and minority).Results From 2020 to 2022,the insured population in Alar city covered 79.02%of the city′s population.There were 2,778 new ma-lignant tumors.The crude incidence was 276.84/100,000,the ASIRC was 225.64/100,000,the ASIRW was 220.66/100,000,the cumulative rate(0-74 years old)was 23.72%,and the cutoff rate was 394.11/100,000.The incidence indicators of women and Han people were higher than those of men and ethnic minorities.The incidence increased rapidly after 40 years old,with women having higher incidence before age 60 and men having higher incidence after age 60.The top five cancers were lung cancer,thyroid cancer,colorectal cancer,breast cancer and stomach cancer,accounting for 58.42%.Lung cancer and digestive tract tumor were the main tumors in men and Han nationality,while thyroid cancer and breast cancer were relatively prominent in women and ethnic minorities.Conclusion Among the insured population in Alar city,lung cancer,breast cancer,thyroid cancer,and digestive tract cancer are the common tumors,and the incidence of malignant tumors in women is higher.

Objective:To explore the nursing work items and the technical difficulty in post anesthesia care unit, so as to provide the basis for accurate calculation of anesthesia nursing workload and reasonable matching of human resources.Methods:The primary and secondary indicators of the nursing working system in post anesthesia care unit were determined through the literature review and group discussion. Delphi method was used to revise the indicators and evaluate the importance and difficulty degree of the indicators. Finally, analytic hierarchy process and linear weighted sum method were used to calculate the weight value and difficulty coefficient of each index.Results:The positive coefficients of the experts in the two rounds were 100.00%, the authority coefficients of the experts were 0.90 and 0.96, the variation coefficients ranged from 0.000 to 0.342 and 0.042 to 0.307, and the Kendall coefficients were 0.239 and 0.273 (both P<0.01). The evaluation index system of the difficulty of nursing work in post anesthesia care unit was finally composed of 10 primary indicators and 85 secondary indicators. The weight of the primary index ranged from 0.016 4 to 0.186 4, and the weight of the secondary index ranged from 0.000 8 to 0.064 3. The standardized difficulty coefficient of the secondary index ranged from 1.02 to 1.59. Conclusions:The evaluation index system of the difficulty of nursing work items in post anesthesia care unit was comprehensive and the difficulty coefficient was in line with the actual clinical work in this study, which provides reference for the follow-up scientific calculation of nursing workload and human resources matching in post anesthesia care unit.

Objective:To comprehensively retrieve and summarize the best evidence on the prevention of position-related nerve injury in adult patients undergoing general anesthesia, in order to provide evidence-based guidance for standardized position management during general anesthesia surgery in adults.Methods:Clinical decision-making, guidelines, evidence summaries, best practice, practice advisories, systematic reviews, expert consensuses were systematically search in UpToDate, BMJ Best Practice, Guidelines International Network (GIN), Canadian Medical Association: Clinical Practice Guideline(CMA Infobase), National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence(NICE), Cochrane Library, PubMed, CNKI, Wanfang, and related websites. The literature retrieval period was from the database construction to September 30,2022. The guidelines were independently assessed by 4 researchers, and the remaining literature was independently evaluated by 2 researchers. The literature that met the criteria was extracted. Finally, the expert meeting integrated the evidence and summarized the evidence topics.Results:A total of 17 articles were included, including 6 clinical decision-making, 3 guidelines, 2 practice advisories,5 systematic reviews, and 1 expert consensus. A total of 32 pieces of best evidence and 5 evidence topics were formed: personnel placement, perioperative evaluation, points of surgical position, key points in special surgery or situation, other general principles.Conclusion:This study summarized the best evidence for the prevention and management of surgical position related nerve injuries, and provides a scientific theoretical reference for postural management of adult patients undergoing operation with general anesthesia, to reduce the incidence of nerve injuries related position.

Objective:To construct an evaluation index system for the quality of physical constraint care for elderly patients, providing a reference basis for clinical evaluation of the quality of physical constraint care for elderly patients, so as to reduce the rate of physical restraint in elderly patients.Methods:Based on the three-dimensional quality model of "structure-process-outcome", combined with literature review and theoretical analysis, a preliminary draft of an evaluation index system for the quality of physical constraint care for elderly patients was established. From May to August 2022, 17 experts were selected by convenience sampling for Delphi consultation. The evaluation indicators and their weights for the quality of physical restraint care for elderly patients were determined using the analytic hierarchy process.Results:Two rounds of consultation were conducted, and the effective response rates of the questionnaire were 88.24% (15/17) and 100.00% (15/15) , respectively. The expert authority coefficients were 0.97, and the Kendall harmony coefficients were 0.34 and 0.39 ( P<0.05) . The final evaluation index system for the quality of physical constraint care for elderly patients included 3 first-level indicators, 15 second-level indicators, and 34 third-level indicators. Conclusions:The content of the evaluation index system for the quality of physical restraint care for elderly patients constructed in this study is scientific, reliable, comprehensive, and targeted, which can provide a reference basis for measuring the quality of physical restraint care for elderly patients.

【Objective】 To evaluate the efficacy and safety of human coagulation factor Ⅷ developed by Shenzhen Weiguang Biological products Co, Ltd in the treatment of patients with hemophilia A. 【Methods】 A prospective, multi-center, open, single-group clinical study was conducted. A total of 65 subjects with hemophilia A were enrolled, and human coagulation factor Ⅷ(FⅧ) was injected according to the patients’ bleeding severity. The improvement score of bleeding symptoms and signs after the first infusion of the first bleeding event and the transfusion efficiency of FⅧ activity at 10 min and 1 hour after infusion were taken as the main efficacy indexes. The improvement scores of bleeding symptoms and signs after the first infusion and the increase of FⅧ activity at 10 min and 1 hour after infusion were the secondary efficacy indexes. 【Results】 The 65 subjects were enrolled in safety analysis set (SS) and full analysis set (FAS), and 58 of them were enrolled in protocol analysis set (PPS). Ten minutes and one hour after the first infusion, the level of factor Ⅷ activity in the subjects increased significantly, and the FⅧ activity increased by 100% or more in more than 79% of the subjects. The average infusion efficiency of FⅧ activity in all subjects was more than 100%. In 70% of the subjects, the pain was relieved rapidly and /or the bleeding symptoms were significantly improved 8 hours after each bleeding infusion, and the improvement rate of bleeding symptoms and signs reached 100% 72 hours after infusion. 【Conclusion】 After infusion of human coagulation factor Ⅷ, the activity level of factor Ⅷ in patients with hemophilia A significantly increased. The infusion efficiency can reach a optimal level, and the bleeding symptoms can be significantly improved.

【Objective】 To evaluate the clinical efficacy and safety of one kind of human prothrombin complex concentrate in treatment of patients with hemophilia B. 【Methods】 The clinical data of 36 patients with hemophilia B treated with human prothrombin complex concentrate produced by Shenzhen Weiguang Biological Products Co. Ltd. from May 2018 to April 2019 were retrospectively analyzed, and its clinical efficacy and safety were analyzed. 【Results】 A total of 35 subjects entered the full analysis set (FAS)and safety set (SS), 33 subjects entered the per protocol Set (PPS). Thirty minutes after the first infusion of FAS subjects, the activity of coagulation factor Ⅸ increased from (3.93±0.975) IU/dL to (25.61±9.337) IU/dL, and the infusion efficiency was (96.43±22.007)%. The increased value of coagulation factor Ⅱ activity was (73.25±14.874) IU/dL. The activity of coagulation factor Ⅶ was (42.79±16.847) IU/dL. The increased value of coagulation factor Ⅹ activity was (65.29±17.042) IU/dL. The increased value of coagulation factor Ⅸ activity was (21.68±9.434%) IU/dL. Twenty-four hours after the first infusion of FAS subjects, the improvement of bleeding symptoms and signs was excellent in 21 cases (60%), improved in 14 cases (40.0%), and the effective rate was 100%. The incidence of adverse reactions was 2.9%(1/35), and there was no antibody to human coagulation factor Ⅸ and new virus infection. 【Conclusion】 Infusion of human prothrombin complex concentrate produced by Shenzhen Weiguang Biological Products Co. Ltd. in the treatment of hemophilia B has significant clinical efficacy and good safety.

Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.