BACKGROUND:The long-term patency rate of synthetic blood vessels remains a significant challenge that requires urgent attention.Enhancing the anticoagulant performance of small-caliber artificial blood vessels is crucial in ensuring their long-term efficacy.OBJECTIVE:To investigate the anticoagulation activity of polycaprolactone/low molecular weight fucoidan nanofibers with shell core structure and determine the effect on the activity of human umbilical vein endothelial cells.METHODS:Polycaprolactone nanofiber membranes and polycaprolactone/low molecular weight fucoidan nanofiber membranes with polycaprolactone as shell layer and low molecular weight fucoidan as core layer were prepared by emulsion electrospinning method(the mass ratio of low molecular weight fucoidan to polycaprolactone was 10％,25％,40％,and 55％,respectively).The morphology and structure of the fibers were characterized by scanning electron microscopy,fluorescence microscopy,and infrared spectroscopy.The mechanical strength of the fiber membranes was detected by tensile test.The loading rate and sustained release rate of low molecular weight fucoidan in the nanofibers were detected by 1,9-dimethylmethylene blue dye.The anticoagulant properties of the fiber membranes were verified by hemolysis test,dynamic coagulation test,plasma recalcification test,and platelet adhesion test.The five fiber membranes were co-cultured with human umbilical vein endothelial cells.The cell proliferation was detected by CCK-8 assay and the cell morphology was observed by fluorescence microscopy.RESULTS AND CONCLUSION:(1)Scanning electron microscope showed that the surface of polycaprolactone/low molecular weight brown algae polysaccharide nanofiber membrane was smooth,the fiber diameter was uniform,and there was no obvious beaded structure.With the increase of low molecular weight brown algae polysaccharide content in the fiber membrane,the diameter of the fiber membrane increased and the maximum tensile stress decreased,but it still met the mechanical properties requirements of small-caliber artificial blood vessels.Fluorescence images and infrared spectra confirmed that low molecular weight brown algae polysaccharide was successfully loaded into polycaprolactone nanofiber membrane,and the low molecular weight brown algae polysaccharide loaded in each group of fiber membranes was released suddenly within 12 hours and released at a relatively low rate after 48 hours.(2)Compared with polycaprolactone nanofiber membrane,polycaprolactone/low molecular weight brown algae polysaccharide nanofiber membrane had better anticoagulant activity,among which the group with a mass ratio of low molecular weight brown algae polysaccharide to polycaprolactone of 25％had the best anticoagulant effect.All five fiber membranes supported the growth and proliferation of human umbilical vein endothelial cells without affecting cell morphology and had no obvious cytotoxicity.(3)The results show that the polycaprolactone/low molecular weight brown algae polysaccharide nanofiber membrane has good anticoagulant function,blood compatibility,and cell compatibility.

OBJECTIVE:Patients with osteoporotic vertebral compression fractures still have residual back pain after vertebral augmentation.The current research is characterized by limited sample size,complex confounding factors,and inconsistent research results.To gain a deeper understanding of this phenomenon,the aim of this study was to identify and evaluate the risk factors for residual back pain after surgery through a systematic review and meta-analysis.METHODS:A comprehensive search was conducted in CNKI,VIP,WanFang,CBMdisc,PubMed,The Cochrane Library,Embase,and Web of Science for case-control studies on residual back pain after vertebral body augmentation for osteoporotic vertebral compression fractures from database inception to July 2024.The search terms were a combination of subject terms and free terms.The basic information,patient characteristics,surgical-related indicators,and risk factors for surgical back pain of the included studies were extracted.After evaluating the bias risk of all included studies,a meta-analysis was conducted using Stata 14.0 software on the relevant indicators.RESULTS:(1)21 case-control studies with a total of 8 043 patients were included.Among them,965 patients developed back pain.The quality score of all 21 studies was ≥7.(2)The meta-analysis results showed that age(WMD=0.98,95％CI:0.40-1.56,P=0.010),bone mineral density(WMD=-0.28,95％CI:-0.34 to-0.21,P=0.000),the number of vertebral fractures(OR=3.50,95％CI:2.65-4.62,P=0.000),thoracolumbar fracture index(OR=3.65,95％CI:2.61-5.11,P=0.000),cement volume(OR=6.89,95％CI:2.62-18.17,P=0.000),and cement distribution(OR=2.38,95％CI:1.93-2.93,P=0.000)were risk factors for the development of back pain after vertebral body augmentation in patients with osteoporotic vertebral compression fractures.CONCLUSION:Current evidence indicates that age,bone mineral density,the number of vertebral fractures,thoracolumbar fracture index,bone cement injection volume,and the distribution of bone cement are risk factors for low back pain.Specifically,bone mineral density,the number of vertebral fractures,thoracolumbar fracture index,and non-uniform distribution of bone cement are identified as independent risk factors for low back pain.Patients exhibiting these high-risk factors require vigilant monitoring and prompt intervention to mitigate the occurrence of clinical low back pain,thereby enhancing patient outcomes and quality of life.

Objective:To explore the clinical characteristics, diagnosis and treatment strategies, and prognosis of pulmonary embolism (PE) complicating childhood rheumatic diseases.Methods:A retrospective case series study was performed on the demographic data, laboratory indicators, imaging features, treatment regimens, and follow-up data of 8 children with rheumatic diseases complicated by PE who were admitted to the Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical University from January 2014 to October 2023.Results:Among the 8 children, there were 4 boys and 4 girls, with an age of 12.0 (7.5, 13.0) years. Among the primary diseases, there were 3 cases of systemic lupus erythematosus, 2 cases of Beh?et′s disease, 2 cases of Takayasu arteritis, and 1 case of antiphospholipid syndrome. All children developed PE during the active phase of the primary disease. PE was detected at the onset of the primary disease in 3 cases, and the median time from the diagnosis of the primary disease to the development of PE was 10.0 (6.0, 25.0) months in the remaining 5 cases. Fever was present in all 8 children, 4 cases were accompanied by chest tightness, dyspnea, etc., and 2 cases only presented with fever. Laboratory examinations revealed the following results: erythrocyte sedimentation rate was 42.0 (17.0, 78.0) mm/1 h, high-sensitivity C-reactive protein was 12.7 (2.6, 78.7) mg/L, white blood cell count was 9.6 (7.2, 18.7)×10 9/L; D-dimer was 2.3 (0.9, 6.2) mg/L; and hemoglobin was (109±16) g/L.Imaging examinations revealed that 5 cases had involvement of the bilateral lower pulmonary arteries, 5 cases had peripheral embolism, and 3 cases had central PE. Complications included 3 cases of deep vein thrombosis, 2 cases of intracranial venous sinus thrombosis, and 1 case of mild pulmonary hypertension.In terms of treatment, 7 cases received anticoagulation with heparin followed by warfarin. Immunomodulation was mainly based on glucocorticoids combined with immunosuppressants, and 4 cases were combined with biological agents. The follow-up time of 4.17 (1.75, 7.17) years, the time for complete absorption of PE was 10.5 (6.0, 18.0) months; all 8 children had no target events, with no recurrence or chronic thromboembolic pulmonary hypertension, and the pulmonary artery remodeling was good. Conclusions:PE complicating childhood rheumatic diseases is closely related to the activity of the primary disease. The clinical manifestations are insidious, with fever as the main symptom. Imaging examination is the key to diagnosis.Early adoption of heparin followed by warfarin anticoagulation and glucocorticoids combined with immunosuppressants and (or) biological agents to control the primary disease can achieve a favorable prognosis.

BACKGROUND:The long-term patency rate of synthetic blood vessels remains a significant challenge that requires urgent attention.Enhancing the anticoagulant performance of small-caliber artificial blood vessels is crucial in ensuring their long-term efficacy.OBJECTIVE:To investigate the anticoagulation activity of polycaprolactone/low molecular weight fucoidan nanofibers with shell core structure and determine the effect on the activity of human umbilical vein endothelial cells.METHODS:Polycaprolactone nanofiber membranes and polycaprolactone/low molecular weight fucoidan nanofiber membranes with polycaprolactone as shell layer and low molecular weight fucoidan as core layer were prepared by emulsion electrospinning method(the mass ratio of low molecular weight fucoidan to polycaprolactone was 10％,25％,40％,and 55％,respectively).The morphology and structure of the fibers were characterized by scanning electron microscopy,fluorescence microscopy,and infrared spectroscopy.The mechanical strength of the fiber membranes was detected by tensile test.The loading rate and sustained release rate of low molecular weight fucoidan in the nanofibers were detected by 1,9-dimethylmethylene blue dye.The anticoagulant properties of the fiber membranes were verified by hemolysis test,dynamic coagulation test,plasma recalcification test,and platelet adhesion test.The five fiber membranes were co-cultured with human umbilical vein endothelial cells.The cell proliferation was detected by CCK-8 assay and the cell morphology was observed by fluorescence microscopy.RESULTS AND CONCLUSION:(1)Scanning electron microscope showed that the surface of polycaprolactone/low molecular weight brown algae polysaccharide nanofiber membrane was smooth,the fiber diameter was uniform,and there was no obvious beaded structure.With the increase of low molecular weight brown algae polysaccharide content in the fiber membrane,the diameter of the fiber membrane increased and the maximum tensile stress decreased,but it still met the mechanical properties requirements of small-caliber artificial blood vessels.Fluorescence images and infrared spectra confirmed that low molecular weight brown algae polysaccharide was successfully loaded into polycaprolactone nanofiber membrane,and the low molecular weight brown algae polysaccharide loaded in each group of fiber membranes was released suddenly within 12 hours and released at a relatively low rate after 48 hours.(2)Compared with polycaprolactone nanofiber membrane,polycaprolactone/low molecular weight brown algae polysaccharide nanofiber membrane had better anticoagulant activity,among which the group with a mass ratio of low molecular weight brown algae polysaccharide to polycaprolactone of 25％had the best anticoagulant effect.All five fiber membranes supported the growth and proliferation of human umbilical vein endothelial cells without affecting cell morphology and had no obvious cytotoxicity.(3)The results show that the polycaprolactone/low molecular weight brown algae polysaccharide nanofiber membrane has good anticoagulant function,blood compatibility,and cell compatibility.

OBJECTIVE:Patients with osteoporotic vertebral compression fractures still have residual back pain after vertebral augmentation.The current research is characterized by limited sample size,complex confounding factors,and inconsistent research results.To gain a deeper understanding of this phenomenon,the aim of this study was to identify and evaluate the risk factors for residual back pain after surgery through a systematic review and meta-analysis.METHODS:A comprehensive search was conducted in CNKI,VIP,WanFang,CBMdisc,PubMed,The Cochrane Library,Embase,and Web of Science for case-control studies on residual back pain after vertebral body augmentation for osteoporotic vertebral compression fractures from database inception to July 2024.The search terms were a combination of subject terms and free terms.The basic information,patient characteristics,surgical-related indicators,and risk factors for surgical back pain of the included studies were extracted.After evaluating the bias risk of all included studies,a meta-analysis was conducted using Stata 14.0 software on the relevant indicators.RESULTS:(1)21 case-control studies with a total of 8 043 patients were included.Among them,965 patients developed back pain.The quality score of all 21 studies was ≥7.(2)The meta-analysis results showed that age(WMD=0.98,95％CI:0.40-1.56,P=0.010),bone mineral density(WMD=-0.28,95％CI:-0.34 to-0.21,P=0.000),the number of vertebral fractures(OR=3.50,95％CI:2.65-4.62,P=0.000),thoracolumbar fracture index(OR=3.65,95％CI:2.61-5.11,P=0.000),cement volume(OR=6.89,95％CI:2.62-18.17,P=0.000),and cement distribution(OR=2.38,95％CI:1.93-2.93,P=0.000)were risk factors for the development of back pain after vertebral body augmentation in patients with osteoporotic vertebral compression fractures.CONCLUSION:Current evidence indicates that age,bone mineral density,the number of vertebral fractures,thoracolumbar fracture index,bone cement injection volume,and the distribution of bone cement are risk factors for low back pain.Specifically,bone mineral density,the number of vertebral fractures,thoracolumbar fracture index,and non-uniform distribution of bone cement are identified as independent risk factors for low back pain.Patients exhibiting these high-risk factors require vigilant monitoring and prompt intervention to mitigate the occurrence of clinical low back pain,thereby enhancing patient outcomes and quality of life.

Objective:To explore the clinical characteristics, diagnosis and treatment strategies, and prognosis of pulmonary embolism (PE) complicating childhood rheumatic diseases.Methods:A retrospective case series study was performed on the demographic data, laboratory indicators, imaging features, treatment regimens, and follow-up data of 8 children with rheumatic diseases complicated by PE who were admitted to the Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical University from January 2014 to October 2023.Results:Among the 8 children, there were 4 boys and 4 girls, with an age of 12.0 (7.5, 13.0) years. Among the primary diseases, there were 3 cases of systemic lupus erythematosus, 2 cases of Beh?et′s disease, 2 cases of Takayasu arteritis, and 1 case of antiphospholipid syndrome. All children developed PE during the active phase of the primary disease. PE was detected at the onset of the primary disease in 3 cases, and the median time from the diagnosis of the primary disease to the development of PE was 10.0 (6.0, 25.0) months in the remaining 5 cases. Fever was present in all 8 children, 4 cases were accompanied by chest tightness, dyspnea, etc., and 2 cases only presented with fever. Laboratory examinations revealed the following results: erythrocyte sedimentation rate was 42.0 (17.0, 78.0) mm/1 h, high-sensitivity C-reactive protein was 12.7 (2.6, 78.7) mg/L, white blood cell count was 9.6 (7.2, 18.7)×10 9/L; D-dimer was 2.3 (0.9, 6.2) mg/L; and hemoglobin was (109±16) g/L.Imaging examinations revealed that 5 cases had involvement of the bilateral lower pulmonary arteries, 5 cases had peripheral embolism, and 3 cases had central PE. Complications included 3 cases of deep vein thrombosis, 2 cases of intracranial venous sinus thrombosis, and 1 case of mild pulmonary hypertension.In terms of treatment, 7 cases received anticoagulation with heparin followed by warfarin. Immunomodulation was mainly based on glucocorticoids combined with immunosuppressants, and 4 cases were combined with biological agents. The follow-up time of 4.17 (1.75, 7.17) years, the time for complete absorption of PE was 10.5 (6.0, 18.0) months; all 8 children had no target events, with no recurrence or chronic thromboembolic pulmonary hypertension, and the pulmonary artery remodeling was good. Conclusions:PE complicating childhood rheumatic diseases is closely related to the activity of the primary disease. The clinical manifestations are insidious, with fever as the main symptom. Imaging examination is the key to diagnosis.Early adoption of heparin followed by warfarin anticoagulation and glucocorticoids combined with immunosuppressants and (or) biological agents to control the primary disease can achieve a favorable prognosis.

The study focuses on the concept of multifunctional traditional Chinese medicine (TCM) formulas and aims to evaluate the efficacy of the classical formula Xiaoyao San (逍遥散). Study employs the integrated evidence chain (Eff-iEC) method to organize, integrate, and evaluate its therapeutic efficacy in treating different diseases with the same therapy, and to investigate the feasibility of using Eff-iEC to evaluate the multifunctionality of TCM formulas. The evaluation covered Xiaoyao San's therapeutic effects on depression, premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Concurrently, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for evaluation, and authoritative medical documents were incorporated to corroborate the recognition of Xiaoyao San within the medical community. Depression and menopausal syndrome received higher ratings than other conditions in the Eff-iEC, GRADE, and Medical Community Recognition assessments. The Eff-iEC evidence grade for Xiaoyao San was rated as "High" or above for chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Premenstrual syndrome received a "Moderate ⁺" rating. The GRADE evidence level was "Low-〇〇⨁⨁" for depression, premenstrual syndrome, and chronic hepatitis; "Moderate-〇⨁⨁⨁" for dyspepsia and menopausal syndrome; and "Very Low-〇〇〇⨁" for irritable bowel syndrome. Depression and menopausal syndrome had the highest inclusion frequency, appearing in all 4 categories. Premenstrual syndrome, chronic hepatitis, and dyspepsia are not recommended in Western medical guidelines, but they are included in TCM guidelines, the China National Basic Medical Insurance Drug List, and the China National Essential Drug List. Irritable bowel syndrome appears only in the China National Basic Medical Insurance Drug List and China National Essential Drug List. The evaluation results obtained using the Eff-iEC method align with Medical Community Recognition, providing an objective and comprehensive assessment of Xiaoyao San's efficacy. The findings suggest that Xiaoyao San has strong evidence for treating depression and menopausal syndrome. However, further experimental and clinical trials are needed to assess its efficacy in treating premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, and dyspepsia. These results support the clinical efficacy and rational use of Xiaoyao San, expand the application scope of the Eff-iEC method, and offer valuable insights and methodological references for the comparative evaluation of multifunctional TCM formulas.

This article summarizes the nursing care of a pediatric patient with melioidosis complicated by septic shock.Key nursing interventions included:to arrange the sequence of drugs reasonably to ensure the safety of the combined use of multiple drugs;systemic anti-infection treatment combined with special treatment of locally infected skin promotes wound healing;in view of the characteristics of the bacteria causing melioidosis,strict isolation and long-term monitoring measures for hospital infection control should be formulated;to enhance the disease coping ability of the child and parents and alleviate negative emotions.After 100 days of intensive treatment and meticulous nursing care,the patient's condition improved,and the discharge was achieved.

BACKGROUND:Exosomes derived from human umbilical cord mesenchymal stem cells are widely used for bone repair and reconstruction,significantly enhancing osteogenesis and promoting angiogenesis.OBJECTIVE:To explore the mechanisms of exosomes derived from human umbilical cord mesenchymal stem cells in the treatment of osteoporotic fractures.METHODS:H uman umbilical cord mesenchymal stem cells were extracted using tissue block culture method.Exosomes derived from human umbilical cord mesenchymal stem cells were extracted using ultracentrifugation method for identification.Thirty 12-week-old female SD rats were randomly divided into sham-operated group(n=6)and ovariectomized group(n=24).Osteoporosis model was established by castration in the ovariectomized group.12 weeks after modeling,6 rats in the ovariectomized group and 6 rats in the sham-operated group were randomly selected for Micro-CT and hematoxylin-eosin staining to verify the models.After verification,the remaining 18 rats in the ovariectomized group were randomly assigned to three groups to establish osteoporotic fracture models.The fracture end was separately injected with PBS(PBS group),exosomes at 1.5×1011 particles/mL(low-concentration exosome group),and 3×1011 particles/mL(high-concentration exosome group).Four weeks after operation,fracture healing and bone angiogenesis were evaluated by imaging and histological observations.RESULTS AND CONCLUSION:(1)In the gross specimens,compared with the PBS group,the exosome group had faster fracture healing and more callus formation.(2)The X-ray score of fracture healing in the exosome group was significantly higher than that in the PBS group,and the difference was significant(P＜0.05).(3)Micro-CT three-dimensional imaging:Compared with the PBS group,the fracture healing in the exosome group was accelerated and the callus formation was significantly increased;the bone volume fraction in the exosome group was significantly higher than that in the PBS group,and the difference was significant(P＜0.01).(4)Hematoxylin-eosin staining and Masson's trichrome staining showed that bone trabeculae and the new bone tissue in the exosome group were more than those in the PBS group.(5)Immunohistochemical staining showed that the expression of CD31 and osteocalcin in the exosome group was significantly higher than that in the PBS group.The high-concentration exosome group had a higher density of new blood vessels,more callus formation,and faster fracture healing than the low-concentration exosome group,showing a concentration-dependent manner.The results show that exosomes derived from human umbilical cord mesenchymal stem cells can promote the repair of osteoporotic fracture by enhancing the angiogenesis and osteogenesis.The mechanism may be related to the increased expression of CD31 and osteocalcin.