BACKGROUND:Slow bone repair and poor bone formation quality are still problems during masquelet technique in the treatment of large segment bone defects.H-type vessels can induce osteogenesis,enhance the local angiogenesis and osteogenesis coupling,and promote bone repair.However,there are few reports on the role of H-type blood vessels in the bone induced membrane.OBJECTIVE:To construct a large segment bone defect model of SD rat tibia,observe the expression characteristics of H-type blood vessels in the bone induced membrane,then to identify the expression peak point of H-type blood vessels in the bone induced membrane and determine the optimal period of bone grafting.METHODS:Sixty SD rats were randomly divided into a control group(n=30)and a model group(n=30)by random number table method.The two groups were further divided into three subgroups at 4,6,and 8 weeks after bone cement implantation,with 10 rats in each group.A 4 mm bone defect model of the right tibia was constructed in both the control and the model groups.Polymethyl methacrylate bone cement was implanted in the model group to induce bone biomembrane formation,while bone cement was not implanted in the control group.At 4,6,and 8 weeks after bone cement implantation,6 rats were randomly selected at each time point.The bone induction membrane tissue was cut from the model group,and the non-bone soft tissue of the corresponding part was cut from the control group.The dynamic expressions of H-type blood vessels in the bone induced membrane were identified by immunofluorescence.The morphological changes of the bone induced membrane were observed by hematoxylin-eosin staining.The formation of blood vessels in the bone induced membrane was observed by angiography.The expression levels of osteoblast-specific transcription factor in the bone induced membrane were detected by immunohistochemistry.Four rats remained at each time point.In the model group,the bone induced membrane was cut open and the bone cement was removed and autologous coccyx was implanted.In the control group,autologous coccyx was implanted in the bone defect area.Micro-CT evaluation of the tibial defect was performed 8 weeks after bone grafting.RESULTS AND CONCLUSION:(1)Immunofluorescence staining showed that the expression of H-type vessels in the model group was most obvious 6 weeks after bone cement implantation,and the expression of H-type vessels in the model group at each time point after bone cement implantation was higher than that in the control group(P＜0.05).(2)Hematoxylin-eosin staining and angiography showed that the number and volume of new blood vessels at each time point after bone cement implantation in the model group were greater than those in the control group(P＜0.05).The order of the number and volume of new blood vessels in the model group was:8 weeks after bone cement implantation＞6 weeks after bone cement implantation＞4 weeks after bone cement implantation.(3)Immunohistochemical staining showed that the positive expression of osteoblast-specific transcription factors at each time point after bone cement implantation in the model group was higher than that in the control group(P＜0.05),and the positive expression of osteoblast-specific transcription factors in the model group was most obvious 6 weeks after bone cement implantation.(4)Micro-CT detection showed that the bone repair effect of the three subgroups in the model group was significantly better than that of the corresponding subgroups in the control group,and the bone repair effect of the subgroup in the model group 6 weeks after bone cement implantation was better than that of the subgroups 4 and 8 weeks after bone cement implantation.The results indicate that H-type blood vessels are dynamically expressed in the bone induced membrane and reached a peak 6 weeks after bone cement implantation.Good bone repair effects can be obtained by the bone induced membrane bone grafting 6 weeks after bone cement implantation.

Objective: To construct and validate a prognostic model for lung cancer based on acrolein-related genes using bioinformatics methods . Methods: Lung cancer datasets GSE30219 and GSE68465 were obtained from the GEO database , and acrolein-related gene sets were retrieved from the CTD database . Differentially expressed genes (DEGs) between cancer and adjacent tissues were identified in the GSE30219 dataset. The intersection of these DEGs and acrolein-related genes was then used to identify candidate genes . Gene set variation analysis ( GSVA) was performed to assess functional alterations based on the intersection genes . A protein-protein interaction (PPI) network was constructed based on the STRING database to identify core hub genes . Subsequently , support vector machine recursive feature elimination (SVM-RFE) and LASSO-Cox regression analyses were employed to develop a prognostic model based on acrolein-related genes , which was independently validated using the GSE68465 dataset. The CIBERSORT algorithm was applied to evaluate the immune cell infiltration characteristics between high- and low-risk groups , and functional enrichment analysis of DEGs between the two groups was conducted to further ex- plore the potential molecular mechanisms underlying the prognostic model . Results : A total of 361 acrolein-related DEGs were identified in lung cancer , and 7 key genes were selected for model construction . Kaplan-Meier survival analysis revealed that patients in the high-risk group had significantly lower survival rates compared to those in the low-risk group (P < 0. 000 1) . Receiver operating characteristic (ROC) curve analysis demonstrated that the mod- el possessed good predictive performance . Moreover , immune infiltration analysis indicated that the risk score was closely associated with multiple immune cell subsets , suggesting a potential role of acrolein-related genes in modula- ting the lung cancer immune microenvironment. Conclusion The prognostic model for lung cancer based on acro- lein-related genes demonstrates significant application value in predicting the prognosis of lung cancer , providing new insights into the potential mechanisms of acrolein in the onset and progression of lung cancer.

Objective:To explore the factors influencing the incidence and duration of delirium in ICU patients, so as to provide a reference for early identification and prevention of delirium in these patients.Methods:A retrospective analysis was conducted on the medical records of 1, 500 patients admitted to the ICU of the Affiliated Jiangning Hospital of Nanjing Medical University from January 2020 to December 2024. The data collected included gender, age, anesthesia method, surgical duration, infection duration, extubation time, duration of mechanical ventilation and hypoxia, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score, duration of sedative medication, and ICU length of stay. Binary Logistic regression and multiple linear regression analysis were employed to investigate the factors influencing the incidence and duration of delirium in ICU patients.Results:The incidence of delirium among 1 500 ICU patients was 38.4% (576/1 500), with a duration of 1.10 (1.00, 3.20) d. Binary Logistic regression analysis revealed that infection duration, APACHEⅡ score, mechanical ventilation duration, and sedative medication duration were statistically significant factors influencing delirium incidence in ICU patients ( P<0.05). Multiple linear regression analysis revealed that delirium type, duration of hypoxia, use of sedative medications, and length of ICU stay were statistically significant factors influencing the duration of delirium in ICU patients ( P<0.05) . Conclusions:ICU patients have a relatively high incidence of delirium, and numerous factors influence the incidence and duration of delirium. Clinical nursing professionals should identify risk factors early and develop corresponding intervention measures to reduce the incidence of delirium in ICU patients and promote their recovery.

Objective:To explore the factors influencing the incidence and duration of delirium in ICU patients, so as to provide a reference for early identification and prevention of delirium in these patients.Methods:A retrospective analysis was conducted on the medical records of 1, 500 patients admitted to the ICU of the Affiliated Jiangning Hospital of Nanjing Medical University from January 2020 to December 2024. The data collected included gender, age, anesthesia method, surgical duration, infection duration, extubation time, duration of mechanical ventilation and hypoxia, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score, duration of sedative medication, and ICU length of stay. Binary Logistic regression and multiple linear regression analysis were employed to investigate the factors influencing the incidence and duration of delirium in ICU patients.Results:The incidence of delirium among 1 500 ICU patients was 38.4% (576/1 500), with a duration of 1.10 (1.00, 3.20) d. Binary Logistic regression analysis revealed that infection duration, APACHEⅡ score, mechanical ventilation duration, and sedative medication duration were statistically significant factors influencing delirium incidence in ICU patients ( P<0.05). Multiple linear regression analysis revealed that delirium type, duration of hypoxia, use of sedative medications, and length of ICU stay were statistically significant factors influencing the duration of delirium in ICU patients ( P<0.05) . Conclusions:ICU patients have a relatively high incidence of delirium, and numerous factors influence the incidence and duration of delirium. Clinical nursing professionals should identify risk factors early and develop corresponding intervention measures to reduce the incidence of delirium in ICU patients and promote their recovery.

BACKGROUND:Slow bone repair and poor bone formation quality are still problems during masquelet technique in the treatment of large segment bone defects.H-type vessels can induce osteogenesis,enhance the local angiogenesis and osteogenesis coupling,and promote bone repair.However,there are few reports on the role of H-type blood vessels in the bone induced membrane.OBJECTIVE:To construct a large segment bone defect model of SD rat tibia,observe the expression characteristics of H-type blood vessels in the bone induced membrane,then to identify the expression peak point of H-type blood vessels in the bone induced membrane and determine the optimal period of bone grafting.METHODS:Sixty SD rats were randomly divided into a control group(n=30)and a model group(n=30)by random number table method.The two groups were further divided into three subgroups at 4,6,and 8 weeks after bone cement implantation,with 10 rats in each group.A 4 mm bone defect model of the right tibia was constructed in both the control and the model groups.Polymethyl methacrylate bone cement was implanted in the model group to induce bone biomembrane formation,while bone cement was not implanted in the control group.At 4,6,and 8 weeks after bone cement implantation,6 rats were randomly selected at each time point.The bone induction membrane tissue was cut from the model group,and the non-bone soft tissue of the corresponding part was cut from the control group.The dynamic expressions of H-type blood vessels in the bone induced membrane were identified by immunofluorescence.The morphological changes of the bone induced membrane were observed by hematoxylin-eosin staining.The formation of blood vessels in the bone induced membrane was observed by angiography.The expression levels of osteoblast-specific transcription factor in the bone induced membrane were detected by immunohistochemistry.Four rats remained at each time point.In the model group,the bone induced membrane was cut open and the bone cement was removed and autologous coccyx was implanted.In the control group,autologous coccyx was implanted in the bone defect area.Micro-CT evaluation of the tibial defect was performed 8 weeks after bone grafting.RESULTS AND CONCLUSION:(1)Immunofluorescence staining showed that the expression of H-type vessels in the model group was most obvious 6 weeks after bone cement implantation,and the expression of H-type vessels in the model group at each time point after bone cement implantation was higher than that in the control group(P＜0.05).(2)Hematoxylin-eosin staining and angiography showed that the number and volume of new blood vessels at each time point after bone cement implantation in the model group were greater than those in the control group(P＜0.05).The order of the number and volume of new blood vessels in the model group was:8 weeks after bone cement implantation＞6 weeks after bone cement implantation＞4 weeks after bone cement implantation.(3)Immunohistochemical staining showed that the positive expression of osteoblast-specific transcription factors at each time point after bone cement implantation in the model group was higher than that in the control group(P＜0.05),and the positive expression of osteoblast-specific transcription factors in the model group was most obvious 6 weeks after bone cement implantation.(4)Micro-CT detection showed that the bone repair effect of the three subgroups in the model group was significantly better than that of the corresponding subgroups in the control group,and the bone repair effect of the subgroup in the model group 6 weeks after bone cement implantation was better than that of the subgroups 4 and 8 weeks after bone cement implantation.The results indicate that H-type blood vessels are dynamically expressed in the bone induced membrane and reached a peak 6 weeks after bone cement implantation.Good bone repair effects can be obtained by the bone induced membrane bone grafting 6 weeks after bone cement implantation.

Objective:To clarify the potential correlation between biological changes of meninges in periodontitis mice and cognitive impairment by analyzing the biological changes of meninges in periodontitis mice using single-cell RNA sequencing.Methods:Thirty C57BL/6 mice were divided into two groups by using random number table method (15 mice in each group). Mice in the control group were locally administered 2% carboxyl methyl cellulose (CMC) without Porphyromonas gingivalis (Pg) on both buccal sides. A mixture of Pg W83 and 2% CMC was applied on both buccal sides in the experimental group mice three times a week, lasting for 16 weeks in total. The absorption of alveolar bone, locomotor activity and cognitive function, the activation of microglia and astrocytes in the cortex were observed and assessed. The mRNA expression levels of Occludin in meninges and brain were detected in two groups. Single-cell RNA sequencing data of meninges were processed by uniform manifold approximation and projection (UMAP). Differential genes expressions of endothelial cells were processed by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. In addition, real-time fluorescence quantitative PCR (RT-qPCR) was used to verify the expressions of transcription activating factor 3 (Atf3) and apolpoprotein L domain-containing 1 (Apold 1). Results:Methylene blue staining found the distances of buccal and palatal cement-enamel junction-alveolar bone crest in experimental mice [(185.60±17.60), (206.90±13.37) μm] increased significantly compared with the control group [(135.33±9.57), (163.05±14.98) μm] ( t=5.02, P=0.002; t=4.37, P=0.005). Open field experiment showed the total distance and average speed of mice in the experimental group [(971.88±164.57) cm, (3.25±0.55) cm/s] were not statistically significant compared with the control group [(914.24±278.81) cm, (3.05±0.93) cm/s] ( t=0.65, P=0.525; t=0.65, P=0.520). The recognition index of the experimental group [(48.02±16.92) %] was lower than the control group [(66.27±17.90) %] ( t=2.40, P=0.027) by novel object recognition tests. Compared with the control group [(63.56±11.88) %], the alternation of experimental group [(50.99±14.17) %] was significantly decreased in Y maze tests ( t=2.33, P=0.030). Immunohistochemistry results showed microglia and astrocytes were activated in the cortex of experimental mice. Compared with the control group (1.02±0.25, 1.04±0.31), the relative mRNA expressions of Occludin decreased significantly in the meninges and brain of periodontitis mice, respectively (0.61±0.10, 0.64±0.20) ( t=3.47, P=0.010; t=2.66, P=0.024). By single-cell RNA sequencing, meninges cells were divided into 11 types, such as endothelial cells, fibroblasts, immune cells and so on. Endothelial cells were the main cell types in meninges [the control group: 26.47% (1 589/6 004), the experimental group: 26.26% (807/3 073)]. Compared with the control group [5.56% (334/6 004)], the percentage of granulocytes increased in the periodontitis mice [11.65% (358/3 073)]. Using clustering analysis to further focus on endothelial cells, GO enrichment analysis revealed differential genes were mainly related to angiogenesis, cell adhesion, apoptosis and so on. KEGG enrichment analysis revealed that differential genes were related to signaling pathways of interleukin-17, relaxin and so on. The relative mRNA expressions of Atf3 and Apold1 in meninges of periodontitis mice (0.42±0.24, 0.54±0.27) were significantly lower than the control group (1.03±0.26, 1.02±0.23) ( t=3.88, P=0.005; t=3.02, P=0.017). Conclusions:The mice chronically infected with Pg W83 occurred memory impairment, neuroinflammation and changes of barrier function. In the meninges of periodontitis mice, there were infiltration of immune cells and down-regulation expressions of Atf3 and Apold1 by single-cell RNA sequencing. Meningeal immunity and changes of barrier function may play an important role in the cognitive impairment caused by periodontitis.

Objective: To investigate the knowledge, attitude and practice of hepatitis B prevention and control among junior high school students in Linping District, Hangzhou City, so as to provide insights into management of hepatitis B among adolescents. Methods: Two classes were sampled using a cluster sampling method from grades 2 in 12 public junior high schools in Linping District, and all students in these two classes were enrolled. Students' knowledge, attitude and practice of hepatitis B prevention and control were collected using questionnaire surveys, and factors affecting knowledge, attitude and practice of hepatitis B prevention and control were identified using a multivariable logistic regression model. Results: A total of 1 102 questionnaires were allocated and 1 094 valid questionnaires were recovered, with an effective recovery rate of 99.27%. The respondents included 540 males (49.36%) and 554 females (50.64%), and 542 rural students (49.54%) and 552 urban students (50.46%). The awareness of hepatitis B prevention and control knowledge was 43.60%, and a low awareness rate was seen for the item “use of condom may prevent hepatitis B” (21.12%). The percentage of correct attitudes towards hepatitis B prevention and control was 57.77%, and a low percentage was found for the item “individuals living with hepatitis B will tell others” (38.67%). The percentage of positive practices towards hepatitis B prevention and control was 80.07%, and a low percentage was seen for the item “hepatitis B vaccines have been inoculated in recent five years” (16.54%). Multivariable logistic regression analysis identified gender (females, OR=1.483, 95%CI: 1.159-1.898), household registration (urban, OR=1.300, 95%CI: 1.011-1.670), and parental highest educational level (high school or technical secondary school, OR=0.703, 95%CI: 0.532-0.929) as factors affecting the awareness of hepatitis B prevention and control knowledge among junior high students, and parental highest educational level (high school or technical secondary school, OR=0.705, 95%CI: 0.533-0.934) and serving as class cadres (OR=1.449, 95%CI: 1.128-1.860) were factors affecting the attitudes hepatitis B prevention and control, while household registration (urban, OR=1.566, 95%CI: 1.144-2.143) and route of acquiring hepatitis B control knowledge (internet or magazine, OR=0.473, 95%CI: 0.288-0.776) were factors affecting the formation of practices towards hepatitis B prevention and control. Conclusions The overall awareness of and percentage of attitudes towards hepatitis B prevention and control, and the percentage of hepatitis B vaccination are low among junior high school students in Linping District. Targeted health education pertaining to hepatitis B prevention and control is required to be reinforced and promotion of hepatitis B vaccination is recommended.

Abstract OBJECTIVE To analyze the characteristics of drug poisoning in children, and to explore the diverse pharmaceutical services that pharmacists can provide in the process of prevention and treatment. METHODS The 47 children diagnosed as drug poisoning in Ningbo Women and Children's Hospital from January 1, 2020 to June 30, 2023 were retrospectively enrolled. Combined with the actual situation of Ningbo Women and Children's Hospital, pharmaceutical services were discussed. RESULTS The majority of children with drug poisoning were adolescent girls. The main cause of poisoning was intentional drug ingestion for suicide, accounting for 33 cases(70.21%). Additionally, 12 cases(25.53%) were accidental ingestion by children and 2 cases(4.26%) of drug overdose were caused by parents misreading the dosage of drugs. The clinical symptoms included drowsiness and/or lethargy(28 cases), dizziness(16 cases), nausea and/or vomiting(14 cases), and abdominal pain(11 cases). The majority of toxic substances were psychiatric drugs, accounting for 39 cases(82.98%). After hospitalization, 40 patients(85.11%) were treated with gastric lavage, and 11 patients(23.40%) were treated with blood purification. Diuresis and catharsis were also applied to remove poison. In addition, specific drug antidotes were selected according to the type of poisons. Meanwhile, symptomatic and supportive therapies were used. Finally, all 47 patients improved or cured after hospitalization. CONCLUSION Based on the characteristics of drug poisoning in children, pharmacists can actively participate in prevention and treatment, in order to reduce the occurrence of drug poisoning and improve the prognosis of poisoned children. In terms of prevention, pharmacists should provide medication instructions and education when dispensing drugs, especially for psychotropic drugs and drugs with easily confused dosage. In the treatment, clinical pharmacists can provide comprehensive pharmaceutical care for poisoned children from various aspects such as drug detection and analysis, removal of toxics, selection of specific antidotes, and inquiry of drug dosage for children.

Objective:To investigate the application value of ambulatory surgery mode for small and medium abdominal wall hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 33 patients with small and medium abdominal wall hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2019 to January 2021 were collected. There were 19 males and 14 females, aged 54(range, 26?85)years. Patients individually underwent Onlay repair, Sublay repair, intraperitoneal onlay mesh repair (IPOM)according to the diagnosis and treatment mode of ambulatory surgery. Observation indicators: catogaries of small and medium abdominal wall hernia, surgical methods, intraoperative measured diameter of hernia ring defect, operation time, volume of intraoperative blood loss, duration of hospital stay, delayed discharge of patients, hospitalization expenses, postoperative follow-up, complications, postoperative visual analogue scale of pain, chronic pain, postoperative satisfaction. Follow-up using telephone interview or outpatient examinations was conducted to detect hernia recurrence, surgical-related complications (wound infection, pain, hematoma or seroma, intestinal leakage, intestinal obstruction) and postoperative satisfaction at postoperative 3 days, 7 days, 1 month, 3 months, 6 months and 12 months. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and count data were represented as absolute numbers. Results:Of the 33 patients, 16 cases had umbilical hernia, 14 cases had incisional hernia, 3 cases had lumbar hernia. There were 7 patients treated with Onlay repair, 16 with Sublay repair, and 10 cases with IPOM. The intraoperative measured diameter of hernia ring defect, operation time and volume of intraoperative blood loss of 33 patients were 2.8(range, 1.0?6.0)cm, 51(range, 20?85)minutes, 4.3(range, 1.0?10.0)mL. The duration of hospital stay of 33 patients was 24?48 hours, including 25 cases with duration of hospital stay ≤24 hours, 8 cases with duration of hospital stay >24 hours and ≤48 hours. Of the 8 patients undergoing IPOM with delayed discharge, 5 cases had postoperative pain and 3 cases had dizziness, nausea and vomiting after general anesthesia. They were recovered and discharged from hospital after observation and symptomatic support until the next morning. The hospitalization expenses were 17 139(range, 6404?34 124)yuan. All the 33 patients were followed up regularly after operation. No hernia recur-rence, wound infection, hematoma and seroma, intestinal fistula or intestinal obstruction was observed during the follow-up period. From postoperative 3 days to 12 months, the visual analogue scale of pain was from 2.90±0.10 to 0 for patients with Onlay repair, from 3.10 ±0.10 to 0 for patients with Sublay repair, from 3.50 ±0.20 to 0 for patients with IPOM. No patient suffered from chronic pain after the operation and postoperative satisfaction of patients was 100%. Conclusion:The ambulatory surgery mode has safety and feasibility in small and medium abdominal wall hernia repair.

Afatinib, a second-generation oral tyrosine kinase inhibitor (TKI), is suitable for first-line treatment of advanced non-small-cell lung cancer (NSCLC) and second-line treatment of squamous NSCLC. At present, a large number of strong clinical research data has confirmed the efficacy and safety of afatinib. Therefore, this article reviews the mechanism of action, pharmacokinetic clinical efficacy, combination of drugs, adverse reactions and dose adjustment of afatinib in order to provide ideas for individual rational drug use guidance.