Objective:To investigate the association of exposure to PM 2.5 and its constituents during pregnancy and fetal growth and to further identify critical windows of exposure for fetal growth. Methods:We included 4 089 mother-child pairs from the Jiangsu Birth Cohort Study between January 2016 and October 2019. Data of general characteristics, clinical information, daily average PM 2.5 exposure, and its constituents during pregnancy were collected. Fetal growth parameters, including head circumference (HC), abdominal circumference (AC), and femur length (FL), were measured by ultrasound after 20 weeks of gestation, and then estimated fetal weight (EFW) was calculated. Generalized linear mixed models were adopted to examine the associations of prenatal exposure to PM 2.5 and its constituents with fetal growth. Distributed lag nonlinear models were used to identify critical exposure windows for each outcome. Results:A 10 μg/m 3 increase in PM 2.5 exposure during pregnancy was associated with a decrease of 0.025 ( β=-0.025, 95% CI: -0.048- -0.001) in HC Z-score, 0.026 ( β=-0.026, 95% CI: -0.049- -0.003) in AC Z-score, and 0.028 ( β=-0.028, 95% CI:-0.052--0.004) in EFW Z-score, along with an increased risk of 8.5% ( RR=1.085, 95% CI: 1.010-1.165) and 13.5% ( RR=1.135, 95% CI: 1.016-1.268) for undergrowth of HC and EFW, respectively. Regarding PM 2.5 constituents, prenatal exposure to black carbon, organic matter, nitrate, sulfate (SO 42-) and ammonium consistently correlated with decreased HC Z-score. SO 42- exposure was also associated with decreased FL Z-scores. In addition, we found that gestational weeks 2-5 were critical windows for HC, weeks 4-13 and 19-40 for AC, weeks 4-13 and 23-37 for FL, and weeks 4-12 and 20-40 for EFW. Conclusions:Our findings demonstrated that exposure to PM 2.5 and its constituents during pregnancy could adversely affect fetal growth and the critical windows for different fetal growth parameters are not completely consistent.

Objective:To discuss the current research status, research hotspots and future trends of artificial intelligence (AI) in the field of nursing education, and provide insights for nursing education researchers, practitioners and policy makers.Methods:The computer searched the literature related to AI and nursing education in Web of Science and China National Knowledge Infrastucture from January 1, 2014 to December 31, 2023. CiteSpace software was used to carry out visual analysis of the annual publication trend, institution distribution and literature data, including keyword co-occurrence, cluster analysis and outburst word analysis, and to explore the research status and trend of AI in the field of nursing education through comprehensive analysis of these data.Results:A total of 934 articles were included, including 769 in English and 165 in Chinese. The analysis of publication trends indicated a general increase in the volume of papers on nursing education both domestically and internationally. The institutional distribution analysis revealed that the number and centrality of AI publications in English literature in the field of nursing education was higher than that in Chinese literature, among which Harvard University had the highest number of publications (26) and the University of California system had the highest centrality index (0.22). The top 10 institutions in terms of Chinese publication volume all published 2 articles, and the centrality index was 0. Co-occurrence and cluster analysis of keywords revealed that research hotspots in AI technology within the field of nursing education primarily focus on three dimensions: enhancing learning experiences, optimizing teaching models, and applications in high-risk nursing scenarios. The research themes concentrated on implementing diverse artificial intelligence technologies to innovate methods of nursing education and training, alongside their application in high-risk nursing scenarios and specialized care requirements. The breakout word analysis revealed emerging trends in nursing education: widespread use of augmented reality and simulation, data-driven nursing education and risk management, intelligent use of electronic health records, preventive health care, and attitudinal change.Conclusions:AI is emerging as a pivotal catalyst in the evolution of nursing education, with substantial scope for domestic researchers to venture further. Future inquiries should delve into the synthesis of simulation technologies, amplify the depth and breadth of data analytics, and execute customized learning stratagems, andto comprehensively improve the quality of nursing education.

Aging poses a major risk factor for cardiovascular diseases, the leading cause of death in the aged population. However, the cell type-specific changes underlying cardiac aging are far from being clear. Here, we performed single-nucleus RNA-sequencing analysis of left ventricles from young and aged cynomolgus monkeys to define cell composition changes and transcriptomic alterations across different cell types associated with age. We found that aged cardiomyocytes underwent a dramatic loss in cell numbers and profound fluctuations in transcriptional profiles. Via transcription regulatory network analysis, we identified FOXP1, a core transcription factor in organ development, as a key downregulated factor in aged cardiomyocytes, concomitant with the dysregulation of FOXP1 target genes associated with heart function and cardiac diseases. Consistently, the deficiency of FOXP1 led to hypertrophic and senescent phenotypes in human embryonic stem cell-derived cardiomyocytes. Altogether, our findings depict the cellular and molecular landscape of ventricular aging at the single-cell resolution, and identify drivers for primate cardiac aging and potential targets for intervention against cardiac aging and associated diseases.
Aged ; Animals ; Humans ; Aging/genetics* ; Forkhead Transcription Factors/metabolism* ; Myocytes, Cardiac/metabolism* ; Primates/metabolism* ; Repressor Proteins/metabolism* ; Transcriptome ; Macaca fascicularis/metabolism*

OBJECTIVES: Type 2 diabetes (T2DM) is a common comorbidity in patients with degenerative aortic stenosis (AS).As a key item of the American Society of Thoracic Surgeons (STS) score, it has a vital impact on the clinical prognosis of traditional thoracic surgery. T2DM has an adverse effect on the morbidity and mortality of cardiovascular diseases. At the same time, studies have shown that T2DM are associated with myocardial hypertrophy and remodeling, decreased left ventricular function, and worsening heart failure symptoms in the AS patients. Transcatheter aortic valve replacement (TAVR) as an interventional method to replace the aortic valve has better safety for middle and high risk patients in surgery, but the impact of T2DM on the clinical outcome of TAVR in AS patients is not clear.By analyzing the clinical and image characteristics of patients with AS and T2DM who received TAVR treatment, so as to explore the effect of T2DM on the perioperative complications and prognosis of TAVR. METHODS: A total of 100 consecutive patients with severe AS, who underwent TAVR treatment and were followed up for more than 1 month, were selectedin the Second Xiangya Hospital of Central South University from January 2016 to December 2020.Among them, 5 patients who were treated with TAVR due to simple severe aortic regurgitation were not included, therefore a total of 95 patients with severe aortic stenosis were enrolled in this study.The age of the patients was (72.7±4.8) years old, and there were 58 males (61.1%), and the patients with moderate or above aortic regurgitation had 30 cases (31.6%). The patients were divided into a diabetic group and a non-diabetic group according to whether they were combined with T2DM.There was no statistical difference in age, gender, body mass index (BMI), STS score, and New York Heart Association (NYHA) cardiac function classification between the 2 groups (all P>0.05). The primary end point was defined as a composite event consisting of all-cause death and stroke one month after surgery, and the secondary end point was defined as TAVR-related complications immediately after surgery and one month after surgery.The preoperative clinical data, cardiac ultrasound data, CT data, postoperative medication and the incidence of each endpoint event were compared between the 2 groups.The predictive model of adverse events was constructed by single factor and multivariate logistic regression. RESULTS: Compared with the non-diabetic group, the diabetic group had high blood pressure and chronic renal insufficiency.There was no significant difference in preoperative ultrasound echocardiography between the 2 groups. Preoperative CT evaluation found that the anatomical structure of the aortic root in the diabetic group was smaller than that in the non-diabetic group, and there was no significant difference in the incidence of bicuspid aortic valve between the 2 groups (all P<0.05). In terms of postoperative medication, the use of statins in the diabetes group was significantly higher than that in the non-diabetic group. In the diabetes group, 6 patients (37.5%) received insulin therapy, and 9 patients (56.3%) received oral medication alone.Univariate logistic regression analysis showed that the all-cause death and stroke compound events was increased in the diabetes group in 30 days after TAVR (OR=6.86; 95% CI: 2.14 to 21.79; P<0.01). Heart disease (OR=2.80; 95% CI: 0.99 to 7.88; P<0.05) and chronic renal insufficiency (OR=3.75; 95% CI: 1.24 to 11.34; P<0.05) were also risk factors for all-cause death and stroke compound events.In a multivariate analysis, after adjusting for age, gender, BMI, comorbidities, N-terminal pro-B type natriuretic peptide (NT-proBNP), total calcification score, ejection fraction, and degree of aortic regurgitation, T2DM was still a risk factor for all-cause death and stroke compound events in 30 days after TAVR (OR=12.68; 95% CI: 1.76 to 91.41; P<0.05). CONCLUSIONS T2DM is a risk factor for short-term poor prognosis in patients with symptomatic severe AS after TAVR treatment. T2DM should play an important role in the future construction of the TAVR surgical risk assessment system, but the conclusions still need to be further verified by long-term follow-up of large-scale clinical studies.
Aged ; Aortic Valve/surgery* ; Aortic Valve Insufficiency/surgery* ; Aortic Valve Stenosis/surgery* ; Diabetes Mellitus, Type 2/complications* ; Female ; Humans ; Male ; Renal Insufficiency, Chronic/complications* ; Risk Factors ; Severity of Illness Index ; Stroke ; Transcatheter Aortic Valve Replacement/methods* ; Treatment Outcome ; United States

Objective? To explore the clinical effects of traditional Chinese medicine at the acupoint on gastrointestinal function recovery after abdominal surgery. Methods? Totally 84 patients receiving laparoscopy were divided into the observation group (n=42) and the control group (n=42) using randomized, double-blinded and placebo controls. Patients in the observation group received traditional Chinese medicine at the acupoint, while patients in the control group received placebo. Both groups were observed continuously for 3 days. Time of postoperative borborygmus recovery, time of first exhaust, and time of first defecation were compared between the two groups postoperatively, and safety evaluation was performed. Results? The time of borborygmus recovery of the observation group was 15.5 (13-22) h, and the time of first defecation was 45.5 (29-62) h, both lower than those of the control group (Z=2.40, 2.05; P＜ 0.05). The time of first exhaust of the control group was 18 (15-27) h, and there was no statistically significant difference as compared with the observation group (Z=1.96,P=0.05). Neither group showed adverse effects on local skin after the use of traditional Chinese medicine. Conclusions? Traditional Chinese medicine at the acupoint can promote gastrointestinal function recovery after abdominal surgery, which is simple, easy, cheap and effective and is worth promoting in clinical practice.

Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures.Methods From February 2013 to December 2015,data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed.In group one (Phlios plate),there were 10 males and 8 females,with an average age of 56.3±5.8 years,including 7 cases of Neer 2-part surgical neck fracture,6 cases of Neer 3-part fracture,4 cases of Neer 4-part fracture,and 1 case of fracture-dislocation.In group two (Multiloc nail),there were 8 males and 11 females,with an average age of 57.2±7.4 years,including 8 cases of Neer 2-part surgical neck fracture,9 cases of Neer 3-part fracture,1 case of Neer 4-part fracture,and 1 case of fracture-dislocation.Operation time,range of motion of shoulder joint,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeon (ASES) score and ConstantMurley score were collected.Results All 37 patients were followed up for an average period of 15.5 months (range,12-36 months).The average bone healing time were 2.5±0.5 months (range,2-3 months)and 2.2±0.5 months (range,1.5-3 months) in the plate and nail group respectively.At the latest follow-up,average VAS score was 0.4±0.6 (range,0-2),the ASES score aver aged 85.4±6.8 points (range,73-96),Constant-Murley score averaged 83.4±7.3 points (range,71-94),and external rotation averaged 30.8°±10.0° (range,10°-50°) in plate group,while average VAS score was 0.2±0.4 (range,0-1),ASES score averaged 89.7± 5.6 points (range,80-98),Constant-Murley score averaged 88.5±6.8 points (range,76-98),and external rotation averaged 40.3°± 7.9° (range,20°-50°) in the intramedullary nailing group.One case had partial necrosis of humeral head in the plate group,while 1 case suffered absorption of the greater tuberosity in the nail group,with the complication rate of 5.6％ (1/18) and 5.3％ (1/19) respectively,without significant difference.The internal and external rotation degrees,ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures,while the forward elevation and abduction degrees were similar.Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail.The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures.

Objective: To observe the effect of Huangjing Zanyu Capsule (HZC) on sperm mitochondrial membrane potential (MMP) in asthenozoospermia patients. METHODS: We assigned 70 asthenozoospermia patients to a treatment group (n = 39) and a control group (n = 31), the former treated with oral HZC at the dose of 4 capsules tid for 3 months while the latter left untreated. We obtained semen parameters from the patients and detected their sperm mitochondrial membrane potentials (MMP) by JC-1 staining and flow cytometry before and after medication, followed by comparison between the two groups. RESULTS: The total effectiveness rate was 71.05% in the treatment group and natural pregnancy was achieved in 3 cases during the medication. A total of 35 patients in the treatment group and 30 controls completed all the laboratory examinations after a 3-month observation. Compared with the controls, the patients treated with HZC exhibited significant improvement after medication in MMP (variation value: ［1.19 ± 10.36］% vs ［20.28 ± 14.21］%, P <0.01), total sperm motility (variation value: ［3.46 ± 8.67］% vs ［20.68 ± 14.12］%, P <0.01), the percentage of progressively motile sperm (variation value: ［2.26 ± 8.29］% vs ［17.58 ± 12.73］%, P <0.01), and the percentage of morphologically normal sperm (variation value: ［0.23 ± 3.48］% vs ［3.37 ± 3.99］%, P <0.01). MMP was significantly correlated with total sperm motility (r = 0.69, P <0.01), progressive sperm motility (r = 0.75, P <0.01) and normal sperm morphology (r = 0.26, P <0.01). CONCLUSIONS Huangjing Zanyu Capsule can enhance sperm mitochondrial membrane potential and sperm mitochondrial function, thus improving total sperm motility, progressive sperm motility and normal sperm morphology. It is safe and effective for the treatment of asthenospermia.
Asthenozoospermia ; drug therapy ; Capsules ; Case-Control Studies ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Female ; Flow Cytometry ; Humans ; Male ; Membrane Potential, Mitochondrial ; drug effects ; physiology ; Pregnancy ; Semen ; drug effects ; Sperm Motility ; drug effects ; Spermatozoa ; drug effects ; ultrastructure ; Staining and Labeling

Objective To explore the effect of TCM external treatment on the patients with hyperplasia of mammary glands by meta-analysis.Methods Literatures about TCM external treatment on the patients with hyperplasia of mammary glands that were published on domestic or international magazines were extensively solicited and assessed with uniform effect criteria. The total number and valid number of patients in these literatures were counted, and the literatures were also assessed and chosen by meta-analysis with Review Manager 5.3.OR values and a 95% confidence interval (CI) were calculated and consolidated.Results Finally, totally 11 literatures and 945 patients were included in our study, of which 464 received TCM external treatment, an effective rate of 89.22%, while the control group included a total of 481 patients, an effective rate of 82.33%. TCM external treatment showed the same effect on hyperplasia of mammary glands as the oral liquid of Chinese medicines, massage and acupuncture did [OR=1.91,95%CI (0.74-4.97)]. When comparing the effect of TCM external treatment and Rupixiao oral liquid on hyperplasia of mammary glands, totally 6 literatures and 509 patients were included in the study, of which 258 received TCM external treatment, an effective rate of 97.29%, while 251 patients took Rupixiao oral liquid, an effective rate of 88.45%. TCM external treatment had a significantly better effect than Rupixiao oral liquid [OR=4.52,95%CI (1.98-10.33)].Conclusions TCM external treatment has the same effect with oral liquid of Chinese medicines, massage and acupuncture, while TCM external treatment on hyperplasia of mammary glands which promotes the circulation of qi and blood and eliminates phlegm and frees channels has a significantly better effect than Rupixiao oral liquid. It suggests that in our clinical work we should treat patients based on whatever methods they can withstand so as to improve their satisfaction.

Objective To evaluate the dose reduction technology using in CT-guided percutaneous lung biopsy of pulmonary lesions using automated core needle biopsies (ACNB).Methods 412 ACNB cases included 146 consecutive conventional patients (group A,120 kV/100 mA) and 266 consecutive patients (group B,120 kV/20 mA,low-dose scanning,reduce scanning width and scanning frequency).The quality of images was compared by grain homogeneity,fine structure,clearness of tissue interface and artifacts.The total diagnostic accuracy rate,the examination time and radiation dose between group A and group B were compared.Results The fine structure of group B was significantly lower (X~2 ＝7.0508,P ＜ 0.05).The total diagnostic accuracy rate was 95.9% vs 95.1% (X~2 ＝0.1296,P ＜ 0.05).The examination time for biopsy procedure was (16 ±2.2)min vs (15.9 ±2.0)min (t ＝ 1.3579,P ＜ 0.05) ,and the mean effective dose (E) was (1.74 ± 0.7) mSv vs (0.59 ± 0.14) mSv (t ＝ 19.3415 ,P ＜ 0.05) .The E of group B decreased by 66%.Conclusions ACNB is a feasible and accurate method for diagnosing pulmonary lesions,and the E can significantly reduce the dose received in low-dose scanning.

OBJECTIVESTo identify the cortical areas engaged during Chinese word processing using functional magnetic resonance imaging (fMRI) and to examine the reliability and reproducibility of fMRI for localization of functional areas in the human brain.

METHODSFMRI data were collected on 8 young, right-handed, native Chinese speakers during performance of Chinese synonym and homophone judgment tasks on two different clinical MRI systems (1.5 T GE Signa Horizon and 1.5 T Siemens Vision). A cross correlation analysis was used to statistically generate the activation map.

RESULTSBroca's area, Wernicke's area, bilateral extrastriate, and ventral temporal cortex were significantly activated during both the synonym and homophone activities. There was essentially no difference between results acquired on two different MRI systems.

CONCLUSIONSFMRI can be used for localizing cortical areas critical to Chinese language processing in the human brain. The results are reliable and well reproducible across different clinical MRI systems.