Objective To develop novel metformin carbon dots(MCDs)with superior performance to enhance the osteogenic differentiation potential of human periodontal ligament stem cells(hPDLSCs)under inflammatory conditions.Methods Three types of MCDs-MCDsCA,MCDsAA,and MCDsCS were synthesized via a one-step hydrothermal method using metformin(Met)in combination with citric acid(CA),ascorbic acid(AA),and carboxymethyl chitosan(CS),respectively.Their physicochemical properties were characterized by transmission electron microscopy(TEM),Fourier-transform infrared spectroscopy(FTIR),and UV-visible spectrophotometry.The biocompatibility and cellular uptake of the MCDs were assessed using CCK-8 assay and confocal laser scanning microscopy.Alkaline phosphatase(ALP)staining and ALP activity assay were conducted to identify the most effective MCDs type in promoting osteogenic differentiation of hPDLSCs under inflammatory conditions.Subsequently,ALP and Alizarin Red S(ARS)staining,qRT-PCR,and Western blotting were performed to assess the effects of the optimal concentration of MCDsCS and its raw material(Met+CS)on osteogenic differentiation under inflammatory conditions.Results All 3 types of nanoscale MCDs exhibited favorable physicochemical characteristics and biocompatibility,and could be effectively internalized by hPDLSCs.Both MCDsCA and MCDsAA significantly promoted hPDLSCs proliferation at lower concentrations(0～0.50 mg/mL),while MCDsCS exhibited excellent cytocompatibility over a broader range(0～2.00 mg/mL).Under inflammatory conditions,MCDsCA and MCDsAA showed no significant effect on ALP expression in hPDLSCs,whereas MCDsCS significantly enhanced ALP expression in a dose-dependent manner,with the optimal effect observed at 0.10 mg/mL(P<0.05).Compared to Met+CS,0.10 mg/mL MCDsCS significantly enhanced ALP expression and calcium nodule formation under inflammatory conditions.It also upregulated the expression of osteogenesis-related genes(ALP,RUNX2,COL-1,OCN)and proteins(ALP,RUNX2,OCN)(P<0.01),while reducing the levels of inflammatory cytokines IL-1β and IL-6(P<0.01).Conclusion A novel MCDsCS with sound biocompatibility is successfully developed,and can effectively promote osteogenic differentiation of hPDLSCs and exerts anti-inflammatory effects under inflammatory conditions,indicating its potential as a nanotherapeutic agent for periodontitis-associated bone regeneration.

Objective:The predictive model of cardiac arrest in the emergency room was constructed and validated based on Logistic regression.Methods:This study was a retrospective cohort study. Patients admitted to the emergency room of the First Affiliated Hospital of Xinjiang Medical University from January 2020 to July 2021 were included. The general information, vital signs, clinical symptoms, and laboratory examination results of the patients were collected, and the outcome was cardiac arrest within 24 hours. The patients were randomly divided into modeling and validation group at a ratio of 7:3. LASSO regression and multivariable logistic regression were used to select predictive factors and construct a prediction model for cardiac arrest in the emergency room. The value of the prediction model was evaluated using the area under the receiver operator characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).Results:A total of 784 emergency room patients were included in the study, 384 patients occurred cardiac arrest. The 10 variables were ultimately selected to construct a risk prediction model for cardiac arrest: Logit( P)= -4.503+2.159×modified early warning score (MEWS score)+2.095×chest pain+1.670×abdominal pain+ 2.021×hematemesis+2.015×cold extremities+5.521×endotracheal intubation+0.388×venous blood lactate-0.100×albumin+0.768×K ++0.001×D-dimer. The AUC of the model group was 0.984 (95% CI: 0.976-0.993) and that of the validation group was 0.972 (95% CI: 0.951-0.993). This prediction model demonstrates good calibration, discrimination, and clinical applicability. Conclusions:Based on the MEWS score, chest pain, abdominal pain, hematemesis, cold extremities, tracheal intubation, venous blood lactate, albumin, K +, and D-dimer, a predictive model for cardiac arrest in the in-hospital emergency room was constructed to predict the probability of cardiac arrest in emergency room patients and adjust the treatment strategy in time.

Objective:To investigate the prognostic value of early serum lactate, albumin, and lactate/albumin ratio (L/A) on the 28-day prognosis of adult patients with sepsis.Methods:A retrospective cohort study was conducted among adult patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University from January to December in 2020. Gender, age, comorbidities, lactate within 24 hours of admission, albumin, L/A, interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and 28-day prognosis were recorded. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of lactate, albumin and L/A for 28-day mortality in patients with sepsis. Subgroup analysis of patients was performed according to the best cut-off value, Kaplan-Meier survival curves were drawn, and the 28-day cumulative survival of patients with sepsis was analyzed.Results:A total of 274 patients with sepsis were included, and 122 patients died at 28 days, with a 28-day mortality of 44.53%. Compared with the survival group, the age, the proportion of pulmonary infection, the proportion of shock, lactate, L/A and IL-6 in the death group were significantly increased, and albumin was significantly decreased [age (years): 65 (51, 79) vs. 57 (48, 73), pulmonary infection: 75.4% vs. 53.3%, shock: 37.7% vs. 15.1%, lactate (mmol/L): 4.76 (2.95, 9.23) vs. 2.21 (1.44, 3.19), L/A: 0.18 (0.10, 0.35) vs. 0.08 (0.05, 0.11), IL-6 (ng/L): 337.00 (97.73, 2 318.50) vs. 55.88 (25.26, 150.65), albumin (g/L): 27.68 (21.02, 33.03) vs. 29.62 (25.25, 34.23), all P < 0.05]. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of lactate, albumin, and L/A were 0.794 (95% CI was 0.741-0.840), 0.589 (95% CI was 0.528-0.647), 0.807 (95% CI was 0.755-0.852) for predicting 28-day mortality in sepsis patients. The optimal diagnostic cut-off value of lactate was 4.07 mmol/L, the sensitivity was 57.38%, the specificity was 92.76%. The optimal diagnostic cut-off value of albumin was 22.28 g/L, the sensitivity was 31.15%, the specificity was 92.76%. The optimal diagnostic cut-off of L/A was 0.16, the sensitivity was 54.92%, and the specificity was 95.39%. Subgroup analysis showed that the 28-day mortality of sepsis patients in the L/A > 0.16 group was significantly higher than that in the L/A ≤ 0.16 group [90.5% (67/74) vs. 27.5% (55/200), P < 0.001]. The 28-day mortality of sepsis patients in the albumin ≤ 22.28 g/L group was significantly higher than that in the albumin > 22.28 g/L group [77.6% (38/49) vs. 37.3% (84/225), P < 0.001]. The 28-day mortality in the group with lactate > 4.07 mmol/L was significantly higher than that in the group with lactate ≤ 4.07 mmol/L [86.4% (70/81) vs. 26.9% (52/193), P < 0.001]. The three were consistent with the analysis results of Kaplan-Meier survival curve. Conclusion:The early serum lactate, albumin, and L/A were all valuable in predicting the 28-day prognosis of patients with sepsis, and L/A was better than lactate and albumin.

【Objective】 To analyze the influence of different Inc parameters in the Monaco planning system on the left breast cancer volumetric modulated arc therapy (VMAT) planning, in the hope of providing some reference for plan design. 【Methods】 Seventeen left-breast cancer patients who were receiving radical radiotherapy were selected. The plans were enrolled in the design of VMAT with the same optimization conditions but different Inc parameters in the Monaco planning system. All plans used different Inc parameters like 10°, 20°, 30°, and 40°. The results of the plan were compared. The dosimetric parameters of the PTV and the organs at risk inquired by the plan were analyzed. The SPSS software was used for calculating the differences between the VMAT plans and evaluating the quality of the plans. 【Results】 The different Inc parameters affected the dosimetric parameters D98%, D2%, D50%, V55 Gy of PTV and CI, HI (F=10.528, F=15.154, F=15.513, F=16.979, F=4.632, F=14.277, all P<0.05). The MU of the four groups significantly differed (F=4.632, P<0.05), and the difference of V10 on the ipsilateral lung was significant (F= 3.324, P<0.05), the remaining parameters in the four groups had no statistically significant difference. 【Conclusion】 For the left-breast cancer volumetric modulated arc therapy, the smaller of Inc parameter on the plan had better dose distribution and conformity index while the monitor units increased. 40° was not suitable for the breast cancer VMAT plan, and the high amount beyond the range would increase the toxic and side effects on the skin.

Objective:To describe a systematic approach on identification of poisonous mushroom by investigating two cases of Omphalotus guepiniformis poisoning in Jianyang district, Nanping, Fujian province. Methods:Two incidents of food poisoning on 10 migrant workers were investigated. The remaining suspected mushroom samples were collected and the same fresh mushroom specimens were also collected in the following field investigations from the same dead tree and fallen trunk. These mushroom specimens were identified based on morphological and phylogenetic analyses.Results:On November 24 and 26, 2018, 8 and 2 migrant workers from Jianyang District, Nanping ate wild mushrooms and developed acute nausea, vomiting, abdominal pain and other symptoms within 10 to 90 min after consumption. They were diagnosed as mushroom poisoning, with gastroenteritis as the main manifestation. Further analysis showed that the more poisonous mushroom were consumed, the shorter latency and longer duration of nausea and vomiting were resulted. After admission, gastric lavage, catharsis, acid preparation, gastric protection, fluid replenishment and other symptomatic support treatments were given in time, all patients were discharged in 1-3 d. Based on morphological and phylogenetic analyses, the samples were identified as O. guepiniformis. Conclusions:The two incidents were caused by accidental consumption of O. guepiniformis. Awareness education about poisonous mushroom should be provided to migrant workers to prevent more such poisoning incidents in the future.

Objective:To investigate the association of WWP2 single nucleotide polymorphism (rs3790088, rs4247109) with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) , and explore the influences of DEACMP genetic predisposition. Methods:From November 2006 to December 2017, 235 DEACMP cases and 429 acute carbon monoxide poisoning (ACMP) cases were selected. All ACMP patients were followed up for more than 90 days without DEACMP. The DNA in all blood samples were extracted with the blood Genome DNA Extraction Kit. The method of Sequenom Mass Array SNP technique was used to detect the genotype and allele of WWP2. All DEACMP patients were assessed every 3 days after hospitalization by the Hasegawa Dementia Scale (HDS) and Activity of Daily Living Scale (ADL) . The distribution of genotypes in conformty with Hardy-Weinderg law was analyzed by goodness-of-fit χ 2 test, and χ 2 test was used for association analysis. Results:For rs3790088, there were 226 DEACMP cases and 414 ACMP cases. For rs4247109, there were 234 DEACMP cases and 428 ACMP cases. For rs3790088 and rs4247109 in WWP2 gene: there were not significant differences in the gene genotype distribution and allele frequency of both DEACMP group and ACMP group ( P>0.05) . According to gender, there were not significant differences in WWP2 gene genotype distribution and allele frequency between two female groups and two male groups ( P>0.05) . After analysis by genetic model, the genotype distributions in both DEACMP group and ACMP group were not significantly differences in three genetic models (codominant genetic model, recessive genetic model and dominant genetic model, P>0.05) . Conclusion:It has not confirmed the genetic correlation between the two gene single nucleotide polymorphisms (rs3790088, rs4247109) of WWP2 gene and the incidence of DEACMP.

Objective:To investigate the association of WWP2 single nucleotide polymorphism (rs3790088, rs4247109) with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) , and explore the influences of DEACMP genetic predisposition. Methods:From November 2006 to December 2017, 235 DEACMP cases and 429 acute carbon monoxide poisoning (ACMP) cases were selected. All ACMP patients were followed up for more than 90 days without DEACMP. The DNA in all blood samples were extracted with the blood Genome DNA Extraction Kit. The method of Sequenom Mass Array SNP technique was used to detect the genotype and allele of WWP2. All DEACMP patients were assessed every 3 days after hospitalization by the Hasegawa Dementia Scale (HDS) and Activity of Daily Living Scale (ADL) . The distribution of genotypes in conformty with Hardy-Weinderg law was analyzed by goodness-of-fit χ 2 test, and χ 2 test was used for association analysis. Results:For rs3790088, there were 226 DEACMP cases and 414 ACMP cases. For rs4247109, there were 234 DEACMP cases and 428 ACMP cases. For rs3790088 and rs4247109 in WWP2 gene: there were not significant differences in the gene genotype distribution and allele frequency of both DEACMP group and ACMP group ( P>0.05) . According to gender, there were not significant differences in WWP2 gene genotype distribution and allele frequency between two female groups and two male groups ( P>0.05) . After analysis by genetic model, the genotype distributions in both DEACMP group and ACMP group were not significantly differences in three genetic models (codominant genetic model, recessive genetic model and dominant genetic model, P>0.05) . Conclusion:It has not confirmed the genetic correlation between the two gene single nucleotide polymorphisms (rs3790088, rs4247109) of WWP2 gene and the incidence of DEACMP.

A 65-year-old male patient received oral Anweiyang capsules 0. 4 g four times daily for chronic gastritis. About 1 month after the medication,the patient developed intermittent headache, dizziness,and increased blood pressure,whose highest value was 180 / 100 mmHg. Levamlodipine besylate tablets 2. 5 mg once daily was given orally but the patient′s blood pressure was not well controlled. About 4 months later,laboratory tests showed obviously increased free cortisol in urine (2330 nmol/ 24 h),which was considered to be caused by Anweiyang capsules. Anweiyang capsules were stopped and the patient continued to take levamlodipine besylate tablets. On day 4 after the drug withdrawal,the patient′s blood pressure and urinary free cortisol began to decrease,which finally returned to normal on day 9. At 1 month of follow-up,no abnormalities were found on the blood pressure and urinary free cortisol in the patient.

Objective To explore the clinical efficacy of "Zhishen-Tiaosui" acupuncture treatment for the stroke patients with unilateral spatial neglect. Methods A total of 66 patients who met the inclusion criteria were randomized into two groups, 33 in each group. The control group was treated with conventional body acupuncture, and the treatment group was treated with Zhishen-Tiaosui acupuncture treatment. Both groups were treated for 20 days and followed up for 8 weeks. The Fugl-Meyer Assessment (FMA) was used to assess limb motor function, and the Catherine Bergego Scale (CBS) was used to assess the daily living ability and the extent of unilateral spatial neglect. The Modified Barthel Index (MBI) assesses the ability of daily living and evaluates clinical outcomes. Results After treatment, FMA (39.21 ± 8.96 vs. 26.34 ± 8.06, t=6.135), MBI (49.62 ± 10.19 vs. 40.18 ± 9.52, t=5.919) in the treatment group were significantly higher than those in the control group (P<0.01), CBS (9.55 ± 4.68 vs. 18.20 ± 6.97, t=3.889) were significantly lower than those in the control group (P<0.01). Treatment group brain regions in the left frontal back, the left inferior frontal gyrus, left occipital in back to back to back to before the left temporal and temporal, left and right side of the anterior cingulate, back in the right frontal, cingulate gyrus of the left side, left precuneus activation intensity were significantly higher than the control group (t=4.615, 3.052, 3.644, 3.575, 3.152, 2.816, 2.579, 3.511, P<0.01). The total effective rate was 78.8% (26/33) in the treatment group and 54.5% (18/33) in the control group. The difference between the two groups was statistically significant (χ2=5.657, P=0.017). Conclusions The Zhishen-Tiaosui can improve the blood circulation of the brain in the unilateral space of the stroke, enhance the cognitive function and exercise capacity, and improve the daily living ability.

A 65-year-old male patient received oral Anweiyang capsules 0. 4 g four times daily for chronic gastritis. About 1 month after the medication,the patient developed intermittent headache, dizziness,and increased blood pressure,whose highest value was 180 / 100 mmHg. Levamlodipine besylate tablets 2. 5 mg once daily was given orally but the patient′s blood pressure was not well controlled. About 4 months later,laboratory tests showed obviously increased free cortisol in urine (2330 nmol/ 24 h),which was considered to be caused by Anweiyang capsules. Anweiyang capsules were stopped and the patient continued to take levamlodipine besylate tablets. On day 4 after the drug withdrawal,the patient′s blood pressure and urinary free cortisol began to decrease,which finally returned to normal on day 9. At 1 month of follow-up,no abnormalities were found on the blood pressure and urinary free cortisol in the patient.