BACKGROUND:Studies have reported that alendronate intake significantly increases bone mineral density in patients with osteoporosis. OBJECTIVE:To analyze and compare the changes in metabolites before and after alendronate intervention in ovariectomized rats by chromatography-mass spectrometry,and to further explore the specific mechanism and target of alendronate in the treatment of osteoporosis. METHODS:A total of 36 female Sprague-Dawley rats were randomly divided into model group,alendronate sodium group and sham operation group.The osteoporosis model was established by ovariectomy in the first two groups.Four weeks after modeling,the rats in the alendronate group were intragastrically given alendronate sodium,while those in the sham operation group and model group were given equal volume of normal saline.After 12 weeks of continuous gavage,the metabolites of the lumbar spine were analyzed by chromatography-mass spectrometry,and the common differential metabolites were obtained,which were analyzed by bioinformatics such as Kyoto Gene and Genome Encyclopedia pathway. RESULTS AND CONCLUSION:Totally 17 different metabolites were obtained in the three groups.The enrichment analysis of the Kyoto Encyclopedia of Genes and Genomes showed that alendronate sodium could regulate unsaturated fatty acid biosynthesis,linoleic acid metabolism and other pathways to protect ovariectomized rats.These results indicate that alendronate sodium may exert its anti-osteoporosis effect by interfering with unsaturated fatty acid bioanabolism and linoleic acid metabolism,so as to achieve the purpose of preventing osteoporosis

Objective:To understand the status and coping strategies of death anxiety among military nurses participating in emergency public health incident response, and to provide references for improving their coping abilities.Methods:A purposive sampling and snowball sampling method were used to select 15 nurses from multiple military hospitals who supported the emergency public health incident. One-on-one semi-structured interviews were conducted, and the Colaizzi's seven-step analysis method was used to analyze the interview data.Results:Four themes were identified: the occurrence of death anxiety at different time points; the presence of significant outbreaks of death anxiety; multiple factors that help military nurses alleviate death anxiety; and the intrinsic motivation and gains of military nurses participating in the response.Conclusions:It is crucial to monitor the occurrence and changes in death anxiety among nurses throughout the entire cycle of emergency public health incidents. Managers should focus on value guidance, leverage individual positive strengths to cope with death anxiety, enhance information and social support, reinforce training on infectious disease prevention and death education, and reduce the level of death anxiety among military nurses and improve their coping abilities.

Objective:To investigate the diagnostic value of serum serine protease (Corin) in chronic renal failure (CRF) complicated with heart failure.Methods:A retrospective analysis was conducted on 120 patients, (64.05±13.89) years old, 77 male (64.17%), with chronic renal failure combined with heart failure admitted to Zhengzhou People′s Hospital from January 1, 2023, to December 31, 2023. The control group consisted of 87 patients, (60.59±8.78) years old, 54 male (62.07%), with simple chronic renal failure. Clinical information, laboratory test indicators and echocardiographic parameters were collected. Serum Corin concentration was measured using enzyme-linked immunosorbent assay (ELISA). The experimental group was divided into grade Ⅱ(31 cases), grade Ⅲ(47 cases) and grade Ⅳ(42 cases) according to the New York College of Cardiology heart function classification system. Serum Corin levels were compared between the experimental group and the control group and among different cardiac function grades. Spearman correlation analysis was performed to evaluate the relationship between serum Corin and brain natriuretic peptide (BNP), D-dimer. ROC analysis was conducted to assess the predictive value of serum Corin in CRF complicated with heart failure and cardiac function classification; Binary Logistic regression was used to construct a multi-index joint prediction model, the joint prediction probability was obtained, and ROC curve was drawn to compare the diagnostic value of serum Corin and BNP in CRF combined with heart failure and the diagnostic value of serum Corin combined with D-dimer and BNP in CRF combined with heart failure.Results:The serum Corin level[2 568.97±477.70 pg/ml vs. 1 727.81±480.60 pg/ml, t=12.47, P<0.001], BNP [700.00(256.00, 2 089.75) pg/ml compared with 88.00 (43.00, 230.00) pg/ml, Z=-9.00, P<0.001], D-dimer [1 150.00(643.00, 1 874.75)μg/L compared with 556.00 (301.00, 865.00)μg/L, Z=-6.57, P<0.001] in chronic renal failure complicated with heart failure group was higher than that in simple CRF group, and the difference was statistically significant. Among patients with CRF complicated with heart failure, serum Corin[2 231.74±311.39 pg/ml vs. 2 562.09±365.30 pg/ml vs. 2 825.57±536.83 pg/ml, F=74.33, P<0.001], BNP [234.00(168.00, 612.00) pg/ml compared with 514.00(260.00, 1 455.00) pg/ml compared with 2 200.00(640.50, 4 682.75) pg/ml, H=29.42, P<0.001], D-dimer [753.00(514.00, 1 280.00) μg/L compared with 1 187.00(590.00, 1 840.00) μg/L compared with 1 603.00(810.00, 3 313.25) μg/L, H=14.98, P<0.001] increased with the increase of cardiac function grade, and the difference was statistically significant. According to Spearman correlation analysis, serum Corin was positively correlated with BNP ( r=0.409) and D-dimer ( r=0.299), P<0.001. According to the ROC analysis, the AUC of serum Corin in the diagnosis of CRF complicated with heart failure and cardiac function grade Ⅱ, Ⅲ, Ⅳ were 0.890(95% CI 0.846-0.935), 0.807 (95% CI 0.728-0.885), 0.911 (95% CI 0.864-0.959), 0.927 (95% CI 0.882-0.972) respectively; the AUC of BNP in the diagnosis of CRF complicated with heart failure was 0.867 (95% CI 0.817-0.916), the AUC of serum Corin combined with D-dimer, BNP combined with D-dimer, serum Corin combined with D-dimer and BNP in the diagnosis of CRF complicated with heart failure were respectively 0.930 (95% CI 0.897-0.962), 0.892 (95% CI 0.847-0.936), 0.952 (95% CI 0.927-0.977). Conclusions:Serum Corin expression is elevated in patients with CRF complicated with heart failure, and the degree of elevation is related to cardiac function grade. Serum Corin has a good diagnostic value for CRF complicated with heart failure and its severity. Serum Corin is expected to become a new biomarker for diagnosis of CRF complicated with heart failure.

Objective To analyze the emergency treatment protocols and nursing measures for patients with diquat and paraquat poisoning,aiming to provide references for updating future clinical practice.Methods A retrospective study was conducted involving 53 patients with diquat and paraquat poisoning admitted to the department of emergency of the First Affiliated Hospital of Wenzhou Medical University from January 1,2019,to December 31,2023.The patients were divided into survival and death groups based on their prognosis.Clinical data were collected to compare organ dysfunction,the proportion of hemoperfusion(HP),average number of HP sessions,the proportion of blood purification,average duration of blood purification,and the proportion of HP combined with continuous renal replacement therapy(CRRT)between two groups of patients with different prognoses.Results Among the 53 patients,27(50.94%)were male and 26(49.06%)were female;with an age range of 14 to 86 years and a mean age of(38.13±19.68)years.Fifty-two cases were due to intentional ingestion,and 1 was accidental.The detected blood concentrations of diquat ranged from 57.38 to 119762.00 μg/L,while those of paraquat ranged from 60.12 to 71 244.89 μg/L.Forty patients developed multiple organ dysfunction syndrome(MODS),with 38 ultimately progressing to multiple organ failure,primarily affecting the gastrointestinal tract,kidneys,and liver.After aggressive treatment and nursing,the blood concentrations of 13 patients(24.53%)dropped below 50 μg/L,and they were discharged after 4 to 34 days of hospitalization.Thirty-two patients'families opted for withdrawal of treatment and discharge,with subsequent confirmation of death after follow-up,hospital stay:1-4 days.Eight patients died in-hospital,hospital stay:1-3 days,resulting in a total mortality rate of 40 cases(75.47%).Compared to the survival group,the death group had significantly higher rate of neurological,renal,respiratory,and liver injuries[neurological:90.00%(36/40)vs.15.38%(2/13),renal:95.00%(38/40)vs.69.23%(9/13),respiratory:97.50%(39/40)vs.30.77%(4/13),liver injury:85.00%(34/40)vs.46.15%(6/13),all P<0.05].Furthermore,the death group had significantly lower average number of HP sessions and average duration of blood purification compared to the survival group[average number of HP sessions:4.35±2.42 vs.6.62±1.17,average duration of blood purification time(days):1.53±1.09 vs.5.23±3.90,both P<0.05].Conclusions Poisoning with a mixture of diquat and paraquat is life-threatening and associated with a high mortality.In addition to systematic treatment,individualized and dynamic nursing support should be provided,including close monitoring of the manifestations and laboratory indicators of affected organ systems.Therefore,optimization treatment protocols during the peak mortality period may help reduce mortality in patients with diquat and paraquat poisoning.

Objective To investigate the relationship between the expression of claudin 10(CLDN10)and chondroitin sulfate proteoglycan 4(CSPG4)of tissue and clinicopathologic characteristics and prognosis in non-small cell lung cancer(NSCLC).Methods A total of 136 NSCLC patients who underwent surgery in Taizhou People's Hospital,Nanjing Medical University from January 2017 to April 2018 were randomly selected as the study subjects,and these subjects were grouped into survival group(n=63)and death group(n=69)based on follow-up outcomes(survival or death).Specimens of cancer tissue and adjacent tissues excised during surgery were collected from 136 patients.Real-time fluorescence quantitative PCR(RT-qPCR)was applied to detect the expression levels of CLDN10 and CSPG4 in cancer tissue and adjacent tissues.Based on the average expression levels of CLDN10 and CSPG4 in cancer tissues of NSCLC patients,they were grouped into CLDN10 high expression group(n=66),CLDN10 low expression group(n=70)and CSPG4 high expression group(n=71),CSPG4 low expression group(n=65).Multivariate COX regression analysis was used to determine the prognostic factors of NSCLC patients.Kaplan-Meier survival curve was applied to analyze the relationship between the expression levels of CLDN10 and CSPG4 in NSCLC patients and their prognosis.Results The expression level of CLDN10(0.96±0.25)in NSCLC tissues was lower than that in adjacent tissue(1.73±0.42),and the expression level of CSPG4 in NSCLC tissues(1.80±0.46)was higher than that in adjacent tissues(1.04±0.27),with statistical significance(t=18.372,16.617,all P<0.05).Compared with the survival group,the proportion of low undifferentiated,lymph node metastasis and CSPG4 expression of cancer tissues in the death group were higher,and the CLDN10 expression level of cancer tissues in the death group was lower,with statistical significance(t/χ2=8.463,7.423,11.696,6.426,all P<0.05).The five-year survival rate of the high expression group of CLDN10(58.46%)was higher than that of the low expression group(37.31%),and the five-year survival rate of the low expression group of CSPG4(55.56%)was higher than that of the high expression group(40.58%),and the differences were statistically significant(χ2=7.848,4.018,all P<0.05).Multivariate COX analysis results showed that low expression of CLDN10,high expression of CSPG4,low differentiation degree,and lymph node metastasis were all risk factors affecting the prognosis of NSCLC patients(HR=1.362,1.368,1.335,1.314,all P<0.05).Conclusion The expression level of CLDN10 was low and CSPG4 was high in cancer tissues of NSCLC patients,which was closely related to the development and prognosis of NSCLC.

Objective To compare the efficacy of percutaneous transforaminal approach and translaminar approach in the treatment of L5/S1 disc herniation(LDH)under endoscopic discectomy.Methods Adopted a retro-spective case-control study,and selected 62 cases of patients with L5/S1 LDH who were treated with percutaneous endoscopic surgery in the spine surgery department of our hospital from June 2020 to December 2022,and the transforaminal approach was used.(TELD)in 32 cases(TELD group),and interlaminar approach(IELD)in 30 cases(IELD group).The observation indicators included intraoperative fluoroscopy times,operation time,hospitaliza-tion days,hospitalization expenses,leg pain VAS score,ODI score,modified MacNab curative effect evaluation and complications.Results All 62 patients successfully completed the operation and follow-up,and no serious complications occurred.There were statistically significant differences in operation time,fluoroscopy times,and hospitalization expenses between the two groups(P<0.001),but there was no significant difference in hospitaliza-tion days between the two groups(P>0.05).The lower extremity VAS scores at the last follow-up and the last follow-up were significantly improved compared with those before operation(P<0.001),and the ODI scores of the two groups were significantly improved at 2 days,1 month and at the last follow-up(P<0.001).At the same time point,there was no statistical difference(P>0.05);there was no significant difference in the excellent and good rate of surgery between the two groups(P>0.05).11 patients with high iliac crest in the TELD group successfully completed the surgery.Conclusions Both the endoscopic surgery through the intervertebral foramen and the inter-laminar approach can achieve satisfactory results in the treatment of L5/S1 LDH.However,local anesthesia through the intervertebral foramen approach reduces hospitalization costs,and patients with high iliac crest can successfully complete the surgery by selecting a suitable puncture path.The translaminar approach has fewer fluoroscopy times and shorter surgical time,but there is a higher risk of dura mater and nerve damage,which requires careful opera-tion for beginners.

Objective:To evaluate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on tourniquet-induced hypertension (TIH) in the patients undergoing anterior cruciate ligament reconstruction.Methods:Seventy-four patients of either sex, aged 18-60 yr, of American Society of Anesthesiologists Physical Status classification I or II, with body mass index of 18-30 kg/m 2, undergoing elective anterior cruciate ligament reconstruction under general anesthesia combined with preoperative femoral nerve block, were divided into 2 groups ( n=37 each) using a random number table method: sham stimulation group (group SS) and group taVNS. Group SS received stimulation on the ear lobe and the tail of the helix of the left ear. Group taVNS received stimulation on the cymba concha and the earlobe of the left ear. Both groups received stimulation from 1 h before induction of anesthesia until the end of the procedure (frequency of 30 Hz, pulse width of 300 μs, and amplitude of the strongest current that could be tolerated by the patient in the absence of pain). The tourniquet inflation pressure was 280 mmHg, with an inflation time of 60-90 min. Systolic blood pressure, diastolic blood pressure and heart rate were recorded before tourniquet inflation to assess the development of intraoperative TIH. The consumption of intraoperative propofol, remifentanil, nitroglycerin, esmolol, norepinephrine and atropine was recorded, and the occurrence of postoperative nausea and vomiting, skin itching and headache and dizziness was also recorded. Results:Compared with group SS, the incidence of TIH and the number of patients used nitroglycerin were significantly reduced ( P<0.05), and no significant changes were found in the other parameters in group taVNS ( P>0.05). Conclusions:taVNS can decrease the occurrence of TIH in the patients undergoing anterior cruciate ligament reconstruction.

Objective:To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021.Methods:A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children.Results:The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M ( Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 ( χ 2trend=111.427, P<0.001). The median of urinary iodine concentration M ( Q1, Q3) in children was 182.50 (121.00, 261.00) μg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [ M ( Q1, Q3): 190.90 (128.80, 269.00) μg/L] was significantly higher than that in children in coastal areas [ M ( Q1, Q3): 173.00 (113.00, 250.30) μg/L] ( P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95% CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95% CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95% CI: 2.64%-3.10%), 588/20 530] ( P=0.001). Conclusion:From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.

Food poisoning caused by Nassariidaes has occurred frequently in coastal areas of China, especially in summer and autumn. Nassariidaes poisoning can be manifested as lip and tongue paralysis, dizziness, headache, nausea and vomiting, arrhythmia and even respiratory failure. We admitted a case of respiratory failure caused by eating Nassariidaes. After timely respiratory support, hemoperfusion and other active treatment, the patient was recovered and was discharged. This paper summarized clinical characteristics and treatment of Nassariidaes poisoning, in order to provide reference for clinical diagnosis and treatment of similar cases.

Food poisoning caused by Nassariidaes has occurred frequently in coastal areas of China, especially in summer and autumn. Nassariidaes poisoning can be manifested as lip and tongue paralysis, dizziness, headache, nausea and vomiting, arrhythmia and even respiratory failure. We admitted a case of respiratory failure caused by eating Nassariidaes. After timely respiratory support, hemoperfusion and other active treatment, the patient was recovered and was discharged. This paper summarized clinical characteristics and treatment of Nassariidaes poisoning, in order to provide reference for clinical diagnosis and treatment of similar cases.