Osteoarthritis （OA） and stroke are common clinical diseases that reduce patients' quality of life and place a burden on families and society. Ruyi Zhenbaowan， a classic prescription in Tibetan medicine， have the functions of clearing heat， awakening the brain and opening orifices， relaxing tendons and promoting meridian circulation， and eliminating yellow water. Clinically， they are used to treat osteoarthritis， post-stroke sequelae， neuropathic pain， and other related conditions. Modern pharmacological studies have demonstrated their anti-inflammatory， analgesic， and nerve-repairing effects. However， current research remains insufficient regarding the appropriate indications， timing， and efficacy of this medicine in treating relevant diseases. To enhance clinicians' understanding of this medicine and promote its standardized and rational clinical use， a panel of national experts， including clinical specialists， Tibetan medicine practitioners， pharmacologists， and methodologists， formulated this consensus based on clinical experience and evidence-based practice. The Cochrane systematic review framework， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system， and the nominal group method were employed to generate seven graded recommendations and 19 consensus-based suggestions. These recommendations clearly define the key points in the clinical application of Ruyi Zhenbaowan， including therapeutic indications， dosage and administration， treatment duration， and medication safety. The consensus specifically addresses the clinical efficacy， appropriate timing of administration， dosage strategies， treatment cycles， and combination medication strategies for treating osteoarthritis and stroke and provides an overview of safety considerations. The aim is to provide standardized guidance for hospitals and healthcare institutions nationwide to ensure the rational application of Ruyi Zhenbaowan in the treatment of osteoarthritis and stroke， reduce medication-related risks， and further leverage its clinical advantages. This consensus has been approved and issued by the China Association of Chinese Medicine， with the standard number GS/CACM 369-2024.

Objective To compare the synergies between the transcutaneous needle electrodes and the ETT surface electrodes used for neurological surveillance in thyroidology,and explore how to identify and protect recurrent laryngeal nerve and vagus nerve when the patient is not suitable for oral plug or surface electrodes are failure.Methods To collect and analyze the clinical data of 32 patients undergoing surgical treatment for thyroid disease,a total of 40 neurons of the recurrent laryngeal nerves and vagus nerves were monitored,and the amplitude and latency were recorded using ETT surface electrodes and transcutaneous needle electrodes for nerve monitoring,respectively.SPSS 26.0 software was used for statistical analysis,paired t-tests were used to analyze and compare the latency periods,and the rank sum test was used to analyze whether there is a difference in the amplitude obtained from stimulation of transcutaneous needle electrodes and ETT surface electrodes.Results When the transcutaneous needle electrodes were used in thyroid surgery,we identified all the nerves,obtained two-phase electrical signals similar to the latency and amplitude of the ETT surface electrodes,and could effectively identify the recurrent laryngeal nerve and vagus nerve[(3.22±0.50)ms vs.(3.85±1.00)ms,P＜0.05]through the incapacity period,with no obvious difference in the monitoring effect from the ETT surface electrodes[(3.04±0.58)ms vs.(3.89±1.07)ms,P＜0.05].At the same time,the visualization and safety of transcutaneous needle electrodes were higher,with great advantages.Conclusion Transcutaneous needle electrodes can effectively assist in identifying and protecting the recurrent laryngeal nerve and vagus nerve,and thus are an important supplement to ETT surface electrodes.

OBJECTIVE To compare the consistency between the semi-quantitative detection of HPV E6/E7 mRNA and the detection of p16 IHC and E6/E7RNA ISH in the tissues,and the feasibility of detecting high-risk HPV in head and neck mucosal lesions by HPV E6/E7 mRNA detection in the swabs was discussed.METHODS A total of 100 cases of head and neck mucosal lesions treated by the Department of Head and Neck Surgery,Beijing Tongren Hospital Affiliated to Capital Medical University from September 2022 to August 2023 were collected.Semi-quantitative detection of HPV E6/E7 mRNA was performed in oropharynx,lesion surface swab and lesion tissue specimen,and p16 immunohistochemical staining(IHC)and E6/E7 mRNA in situ hybridization(ISH)were detected in lesion tissue,and the consistency and difference of different detection results were studied.RESULTS Among the 100 patients,83 met the inclusion criteria and were divided into 21 papilloma cases,10 polyps/chronic inflammation cases,19 laryngeal cancer cases,13 oropharyngeal cancer cases,and 20 hypopharyngeal cancer cases according to pathological diagnosis.The HPV E6/E7 mRNA semi-quantitative results of oropharyngeal swab and lesion surface swab showed moderate or near high consistency with p16 IHC results.The results of HPV E6/E7 mRNA semi-quantitative in diseased tissue were highly consistent with those of p16 IHC(Kappa=0.780).In the diagnostic efficacy analysis,both swabs showed high consistency with HPV E6/E7 mRNA ISH(Kappa=0.690 and 0.708).CONCLUSION In the head and neck mucosal lesions,the HPV semi-quantitative detection results of oropharyngeal and lesion surface swab showed good consistency compared with classical p16 IHC and gold standard HPV E6/E7 mRNA ISH.It is a simple and reliable method for clinical high-risk HPV detection,which is helpful for the screening and individualized precise prevention and control of HPV infection in head and neck mucosal lesions.

Objective To explore the causal relationship between abdominal subcutaneous adipose tissue volume(ASAT)measured by MRI and cardiovascular disease risk with Mendelian randomization(MR).Methods Genome-wide association study(GWAS)data for ASAT measured by MRI were provided by the IEU OpenGWAS project,while GW AS data for cardiovascular disease came from the Finngen database.The primary analysis method employed was the inverse variance weighted(I VW)method.Additional MR analysis methods,included MR-Egger regression,weighted median(WME),simple mode method,and weighted model method.Heterogeneity,horizontal pleiotropy and leave-one-out sensitivity analysis were conducted to verify the robustness of the results and funnel plots were used to verify the evaluation.Scatter plots were used to visualize the causal relationship between ASAT and cardiovascular disease.Results There was a causal relationship between ASAT and the risk of ischemic heart disease(IHD)[odds ratio(OR)1.126,95％confidence interval(CI)1.042-1.217,P=0.003)],heart failure(HF)(OR 1.145,95％CI 1.024-1.281,P=0.017),and hypertension(OR 1.096,95％CI 1.014-1.184,P=0.021),but there was no significant causal relationship with cardiac arrest(CA)(P＞0.05).Heterogeneity was observed in the analysis of ASAT with IHD(Cochran's Q=53.467,P=0.018),HF(Cochran's Q=54.761,P=0.013),and hypertension(Cochran's Q=55.321,P=0.002).Further horizontal pleiotropy MR-Egger intercept tests and funnel plots indicated no horizontal pleiotropy in MR analysis(P＞0.05).Leave-one-out sensitivity analysis results demonstrated the robustness of the study findings.Conclusion There is a causal relationship between ASAT measured by MRI and the risk of IHD,HF,and hypertension.This highlights the need for clinical practitioners to pay attention to the cardiovascular disease risk in obese patients,especially those with abdominal obesity.

Objective:On the basis of introducing and piloting long-term care insurance services and providing home care for older adults with disabilities in Suzhou, this paper aims to explore the working experience of home caregivers in the caring environment, understand their difficulties and issues, explore their true feelings and the relevant causes, and to draw lessons from their experience, providing constructive suggestions for the establishment of caregivers as well as policy recommendations for the government.Methods:The qualitative research method was used to collect the field experience data of 9 home caregivers in the caring environemnt through observation and semi-structured interview. Colaizzi phenomenological analysis was used to process and analyze the data.Result:1. Heavy workload and lack of incentive mechanism; 2. Care experience is diverse, with a sense of achievement and happiness, but lack of family′s trust and identification; 3. Professional trainings and peer support are needed.Conclusion:1. Improving the working environment of caregivers and reducing the burden of care; 2.Improve the employment treatment of home care workers, and actively improve the relevant incentive mechanism;3. Paying attention to the emotional experience of caregivers and helping them adapt to their role; 4.Standardize professional knowledge and skills training, provide risk assessment tools, and improve the quality of care.

Objective: To explore the correlation between serum 25-hydroxyvitamin D3 (25[OH]D₃) levels and esophageal variceal bleeding (EVB) in cirrhotic patients. Methods: Eighty-three cases with liver cirrhosis hospitalized from November 2016 to January 2017 were collected. The patients were divided into bleeding group (51 cases) and non-bleeding group (32 cases) depending on the presence or absence of bleeding under gastroscopy. Serological tests were performed on both groups, including hemoglobin (Hb), albumin (ALB), alkaline phosphatase (ALP),γ-glutamyltransferase (GGT), interleukin-6 (IL-6), and 25-hydroxyvitamin D3 (25[OH]D₃). Both groups were analyzed by univariate analysis. The differences between both groups were compared by t-test, after normality test. The other variables were compared by Mann-Whitney U test. The correlation between the relevant variables and EVB were analyzed by Spearman's rank correlation and a multivariate analysis. Cases with primary biliary cirrhosis were relatively low in number (four cases in bleeding group, accounting for 8%, 10 cases in non-bleeding group, accounting for 31%). The effects of ALP and GGT on serum 25(OH)D₃ level were analyzed by stratified analysis. Moreover, ALP and GGT levels were divided into two and three groups: < 140 U/L and >140 U/L and < 30 U/L, > 30 U/L, and ~≤60 U/L. Results: Bleeding group had low levels of hemoglobin (t= -2.827,P= 0.005), alkaline phosphatase (t= -3.097,P= 0.002), gamma-glutamyltransferase (t= -2.292,P= 0.022), and 25(OH)D₃ (t= -3.134,P= 0.002) than non-bleeding group. Both groups (P> 0.05) had similar levels of albumin, interleukin-6, AAR, and FIB-4. Logistic regression analysis showed that 25(OH)D₃, alkaline phosphatase and hemoglobin were independent risk factors for EVB. Spearman’s correlation coefficient analysis showed that 25(OH)D₃was significantly positively and negatively correlated with interleukin-6 (r= 0.306,P= 0.005) and albumin (r= -0.327,P= 0.003). Stratified analysis showed that serum 25(OH)D₃ level was lower in ALP≤140U/L group and the bleeding group, and the difference was statistically significant than non-bleeding group (P= 0.007), while the serum level of 25(OH)D₃was decreased in both groups for alkaline phosphatase > 140 U/L group, and the difference was not statistically significant (P= 0.051). Furthermore, in the GGT > 60 U/L group, the serum level of 25(OH)D₃was significantly lower in the bleeding group, and the difference was statistically significant in non-bleeding group (P= 0.003), while the difference between the two groups was not statistically significant (P> 0.05) in GGT≤30 U/ L, > 30 U/L, and ~≤60 U/L group. Conclusion Serum 25(OH)D₃level was significantly lower in EVB cirrhotic patients, and it was an independent risk factor for EVB. Serum 25(OH)D₃ low levels was more apparent with ALP normalization or GGT level > 60 U/L.

ObjectiveTo establish a hospice care training system for nurses in general hospitals and evaluate its implementation effects, and to explore a new path for hospice care education. MethodsThe nurses from 7 clinical departments in the First Affiliated Hospital of He＇nan University of Chinese Medicine from September 2017 to June 2018 were selected by convenience sampling with 24 nurses from each department and randomly divided into the general training group (12 for every department) and in-depth training group (12 for every department). Based on the classic education theory, the nurse hospice care training system for general hospital was established from five aspects including goal, content, method, management and teachers in the in-depth training group and the general training group received the training according to hospice care nursing plan implementation rules of the First Affiliated Hospital of He＇nan University of Chinese Medicine. The two groups were compared in terms of the training effects. ResultsAfter training, in the in-depth training group, the scores of theoretical assessment and skill assessment of hospice care of nurses in the 7 departments were all higher than those in general training group, and the differences were statistically significant (P＜ 0.05). ConclusionsThe general hospital nurse hospice care training system can effectively improve the employees＇knowledge reserve and skills level of hospice care; the strengthening of the construction of hospice care training system is important to guarantee the qualified hospice care nursing team building and to improve the quality of hospice care services.

Objective To evaluation the effect of high flow humidification oxygen (HFHO) therapy for two elderly cases with respiratory rhythm abnormalities and multiple organ dysfunction weaning from mechanical ventilation.Methods Clinical features and weaning processes of two elderly cases with respiratory rhythm abnormalities and multiple organ dysfunction were analyzed and the related literature was reviewed.Results Two elderly patients had multiple organ dysfunction,respiratory rhythm abnormalities and other difficult weaning factors.After a variety of unsuccessfully weaning patterns,HFHO was successfully used in helping patients wean from mechanical ventilation,with gradually increasing the time of HFHO and restoring respiratory muscle function.Conclusions For elderly patients with artificial airways,respiratory muscle dysfunction(long-term mechanical ventilation)and/or respiratory rhythm abnormalities,HFHO is a promising weaning method.

OBJECTIVE: To investigate the phylogenetics and prevalence of bloodstream infections with ST131, the antimicrobial resistance profiles of the pathogens, and the clinical features. METHODS: Non-duplicate isolates were collected from 144 patients with bloodstream infections in our hospital between January and December, 2016.The phylogenetic groups of the isolates were analyzed using multiplex PCR, and O serotyping of ST131 strains was performed by allele-specific PCR.The clinical characteristics of the 144 patients were analyzed to define the differences in the clinical features between patients with ST131 infection and those with non-ST131 infection.Antibiotic susceptibility of the isolates was determined using the Vitek 2 compact system. RESULTS: The phylogenetic group analysis showed a domination by group B2 (41.0%[59/144]), followed by group F, group B1 and group E, which accounted for 16.7%(24/144), 13.9%(20/144), and 13.2% (19/144), respectively.Nine strains (6.3%) of were identified to be ST131 strains, among which 8 were O25b-B2-ST131 strains and 1 was O16-B2-ST131 strain.Of the 9 cases of ST131 infection, 7(77.8%) were found to occur in a nosocomial setting.The demographic characteristics and clinical features of the ST131-infected patients were similar to those of non-ST131-infected patients.ST131 strains were sensitive to piperacillin/tazobactam, imipenem, ertapenem, and amikacin, but showed high resistance rates to cefazolin, ceftriaxone, ciprofloxacin, levofloxacin, gentamicin, and trimethoprim/ sulfamethoxazole (all over 50%).The positivity rate of ESBLs in the ST131 strains was 77.8%, and the multidrug resistance rate reached 88.9%, which was higher than that of non-ST131 isolates, but the difference was not statistically significant. CONCLUSIONS The most common phylogenetic groups of isolates from patients with bloodstream infections are group B2 and F, and the positivity rate of ST131 is low.We for the first time detected O16-ST131 in patients with blood-borne infections in China.The clinical features of ST131-infected patients are similar to those of non-ST131-infected patients.The positivity rate of ESBLs and the multidrug resistance rate are high in ST131 strains, which may raise concerns in the future.
Anti-Bacterial Agents ; therapeutic use ; Bacteremia ; drug therapy ; epidemiology ; microbiology ; China ; Drug Resistance, Bacterial ; Escherichia coli ; classification ; drug effects ; genetics ; Escherichia coli Infections ; drug therapy ; epidemiology ; microbiology ; Genotype ; Humans ; Microbial Sensitivity Tests ; Molecular Epidemiology ; Phylogeny ; Species Specificity

Objective To investigate the effects of VCAM-1 on migration and invasion of glioma cell lines . Methods The techniques of lentivirus pSGU6/GFP/Neo-based VCAM-1 shRNA and EF1 a-GFP/puro-based VCAM-1 expression vector, the scratch wound healing migration and transwell invasion assays , and the Western blot and cell staining were applied to observe the effects of VCAM-1 expression levels on migration and invasion of glioma cell line cells.There are four groups in T98G cells including control, vector, scramble and shRNA-VCAM-1 groups and three groups in U251 cells covering control, vector and VCAM-1 overexpressed groups ( n=6 per group) .Results The stabled glioma cell lines of T98 G cells with down-regulated VCAM-1 and U251 cells with VCAM-1 overexpression were established by using lentivirus-based VCAM-1 shRNA and expression vector.The ability of scratch wound healing (migration activity) decreased significantly (P<0.01) in T98G cells with lower VCAM-1 expression levels, while the migration activity was obviously improved in U251 cells with overexpressed VCAM-1 ( P <0.05 ) .Similarly, the invasion ability was significantly inhibited ( P <0.05) in T98G cells with silenced VCAM-1, as well as VCAM-1 overexpression could enhance the invasion ability of U251 cells ( P<0.01 ) .Conclusions VCAM-1 improves the migration activity and invasion ability of human glioma cell line cells.