ObjectiveThis study aimed to elucidate the mechanistic role of Staphylococcus aureus in the pathogenesis of atopic dermatitis (AD), a chronic inflammatory skin disorder characterized by pruritus and barrier dysfunction. A key focus was screening traditional Chinese medicine (TCM) active components with dual antibacterial and antipruritic efficacy, followed by systematic evaluation of their in vitro antibacterial activity. Additionally, a novel drug delivery system was constructed to enable localized efficient drug delivery, inhibiting S. aureus proliferation and alleviating its induced pruritus, thereby providing new strategies for targeted AD therapy. MethodsMale C57BL/6J mice aged 6-8 weeks (body weight 18-22 g) were used to establish an AD model via repeated oxazolone sensitization. On day 14, microbial samples were collected from the lesional area (1 cm²) using sterile cotton swabs, followed by vortex mixing, serial dilution, and plating on 5% sheep blood agar plates (incubated at 37°C for 24 h). Single colonies with complete transparent β-hemolytic zones were isolated and identified as vancomycin-intermediate S. aureus (VISA) via 16S rRNA sequencing. An S. aureus mono-infection animal model was then established by applying gauze saturated with bacterial suspension (McFarland turbidity 0.1) to the nape and back skin of mice. The pruritic phenotype and inflammatory cell infiltration induced by S. aureus were evaluated using comprehensive approaches including behavioral assays (e.g., scratching frequency recording), hematoxylin-eosin (HE) staining, and toluidine blue staining. The in vitro antibacterial efficacy of the TCM monomer pseudolaric acid B (PAB) and double network hydrogel (DN) was separately assessed by disk diffusion assay, while the minimum inhibitory concentration (MIC) of PAB was determined via broth dilution method. Further validation of the pharmacodynamic characteristics of the composite system (PAB@DN, composed of PAB and DN) was conducted through behavioral assays, HE staining, and dermatitis scoring, with its drug release profile evaluated by mass spectrometry analysis. Based on scratching behavioral analysis and dermatitis scoring, the optimal ratio and concentration of PAB@DN were optimized. ResultsThe S. aureus load in AD lesional tissues was significantly higher than in normal skin ((5.3±0.33)×10⁶ CFU vs. (3.6±0.26)×10⁷ CFU, P<0.001). In the S. aureus mono-infection group, mice exhibited a 6.7-fold increase in scratching frequency compared to the control group. HE staining revealed marked epidermal thickening ((10.4±2.39) μm vs. (85.6±1.95) μm, P<0.000 1), and toluidine blue staining showed a 23-fold increase in mast cell degranulation. Pseudolaric acid B exhibited a significant concentration-dependent inhibitory effect onS. aureus growth, with its in vitro antibacterial effect being 57% that of the antibiotic cefepime (inhibition zone diameter: PAB (1.885±0.036) cm vs. cefepime (3.636±0.005) cm, P<0.000 1) and a minimum inhibitory concentration (MIC) of 1 g/L. The carrier double network hydrogel (DN) itself lacked direct antibacterial activity (no significant difference in inhibition zone diameter compared to the control) but effectively ameliorated the dry symptoms of AD-like lesions. The PAB@DN composite system demonstrated a synergistic effect compared to individual components, resulting in a 50% reduction in scratching behavior, an 86% decrease in dermatitis score, and a 60% reduction in epidermal thickening. It also reduced the S. aureus load in mouse skin by approximately 34%, with the optimal effective formulation being PAB at 1 g/L loaded onto DN. ConclusionS. aureus colonization plays a critical driving role in the onset and progression of AD. Using an S. aureus infection model, this study confirmed that the pseudolaric acidB-hydrogel composite delivery system (PAB@DN) can effectively alleviate S. aureus-induced pruritus and skin damage, providing experimental evidence for microbiota-targeted therapy of AD.

OBJECTIVE: This study aimed to evaluate the association between susceptibility genes and non-alcoholic fatty liver disease (NAFLD) in children with obesity. METHODS: We conducted a two-step case-control study. Ninety-three participants were subjected to whole-exome sequencing (exploratory set). Differential genes identified in the small sample were validated in 1,022 participants using multiplex polymerase chain reaction and high-throughput sequencing (validation set). RESULTS: In the exploratory set, 14 genes from the NAFLD-associated pathways were identified. In the validation set, after adjusting for sex, age, and body mass index, ECI2 rs2326408 (dominant model: OR = 1.33, 95% CI: 1.02-1.72; additive model: OR = 1.22, 95% CI: 1.01-1.47), C6orf201 rs659305 (dominant model: OR = 1.30, 95% CI: 1.01-1.69; additive model: OR = 1.21, 95% CI: 1.00-1.45), CALML5 rs10904516 (pre-ad dominant model: OR = 1.36, 95% CI: 1.01-1.83; adjusted dominant model: OR = 1.40, 95% CI: 1.03-1.91; and pre-ad additive model: OR = 1.26, 95% CI: 1.04-1.66) polymorphisms were significantly associated with NAFLD in children with obesity ( P < 0.05). Interaction analysis revealed that the gene-gene interaction model of CALML5 rs10904516, COX11 rs17209882, and SCD5 rs3733228 was optional ( P < 0.05), demonstrating a negative interaction between the three genes. CONCLUSION In the Chinese population, the CALML5 rs10904516, C6orf201 rs659305, and ECI2 rs2326408 variants could be genetic markers for NAFLD susceptibility.
Humans ; Non-alcoholic Fatty Liver Disease/genetics* ; Child ; Male ; Female ; Genetic Predisposition to Disease ; Case-Control Studies ; Exome Sequencing ; Adolescent ; Polymorphism, Single Nucleotide ; Obesity/complications* ; Pediatric Obesity/complications* ; China

Objective To investigate the perioperative outcomes and postoperative pregnancy outcomes of patients with intrauterine adhesions(IUA)treated by see-and-treat hysteroscopy and traditional hysteroscopy in transcervical resection of adhesions(TCRA).Methods A retrospective cohort study was performed on 485 patients with moderate-to-severe IUA who met the inclusion criteria and admitted in our hospital from January 2019 to December 2021.According to surgical approaches,the patients were assigned into a see-and-treat mode group and a traditional mode group.After clinical diagnosis(ultrasound and symptoms)of IUA,the patients from the former group received direct hysteroscopic adhesion separation surgery,and those of the latter group were diagnosed by outpatient hysteroscopy first and then hysteroscopic adhesion separation surgery.The perioperative indicators,postoperative three-dimensional transvaginal ultrasound(3D-TVUS)examination related characteristics,postoperative menstrual recovery,postoperative pregnancy outcomes,obstetric related complications,and neonatal outcomes were collected and compared between the 2 groups.Results Among the enrolled 485 patients,there were 277 in the see-and-treat group and 208 in the traditional group.The success rate of surgical treatment was 89.89%in the see-and-treat group and 92.79%in the traditional group,but no statistical difference was seen between them(Chi-square=1.234,P=0.267).3D-TVUS examination displayed that the see-and-treat mode group obtained better improvement of endometrial morphology,uterine morphology and menstruation after operation than the traditional group(P<0.001).The postoperative pregnancy rate was slightly higher in the see-and-treat group than the traditional mode group(58.84%vs 58.17%,P=0.882).However,the see-and-treat mode showed obvious advantage in the postoperative natural pregnancy rate,with a rate of 90.80%,obviously higher than that in the traditional mode group(81.82%,P=0.026).The live birth rate was 70.55%in the see-and-treat mode group,excluding 1 case with ongoing pregnancy in the second trimester and 1 case with ongoing pregnancy in the third trimester,and the rate was 74.38%in the traditional group,excluding 3 cases with ongoing pregnancy in the third trimester,but there was no statistical difference between the 2 groups(P=0.303).In terms of obstetric-related complications,there were 0 cases of blood transfusion during delivery hospitalization in the see-and-treat group,while there were 7 cases in the traditional group(P=0.003).In neonatal outcomes,the rate of transfer to the pediatric department was 10.43%in the see-and-treat mode group and 22.22%in the traditional mode group(P=0.021).For health economics,the see-and-treat hysteroscopy group demonstrated a significant advantage over the traditional hysteroscopy group(P<0.001).There was no significant difference in pain scores between the 2 groups.Conclusion The see-and-treat approach is a safe,feasible,and highly efficient strategy for integrating the diagnosis and treatment of IUA,enabling maximal minimization of surgical trauma while optimizing time and cost efficiency.

Objective To evaluate the position of the talus on the axial images of magnetic resonance imaging(MRI)of the ankle joint in patients with chronic ankle instability(CAI)and to identify the indirect signs for diagnosing CAI.Methods Fifty patients hospitalized in our hospital between January 1,2021 and July 1,2023 for chronic ankle instability(CAI)were selected into the experimental group,while 50 counterparts treated in our hospital for other diseases were chosen into the control group.The basic information of both groups was recorded.The internal measurement tools of the Picture Ar-chiving and Communication System(PACS)were used to measure the malleolar talus index(MTI)and two new measurement methods:talus movement index(TMI)and talus comprehensive index(TCI)on the axial images of ankle MRI to evaluate the position of the talus in the ankle mortise.Sta-tistical analysis was then performed.Results There was no significant difference between the two groups in terms of age,sex ratio,affected side ratio,height,weight and body mass index(BMI)(P>0.05).Compared with the control group,the MTI(86.56°±3.54° vs.85.28°±2.77°,P<0.05),TMI(2.00°±2.36° vs.-2.00°±2.54°,P<0.001)and TCI(4.70°±2.98° vs.1.90°±2.01°,P<0.001)of the experi-mental group increased.The area under the ROC curve of TMI and TCI was 0.841 and 0.794,respec-tively.The optimal cut-off points for diagnosing CAI based on TMI and TCI were 0.5° and 4.5°,re-spectively.Conclusion Patients with CAI show changes in the bony structure of the ankle joint.Specifi-cally,on the axial MRI images of the ankle joint,there are simultaneous posterior displacement and internal rotation of the talus,which may be an indirect sign for the diagnosis of CAI.

Objective To evaluate the position of the talus on the axial images of magnetic resonance imaging(MRI)of the ankle joint in patients with chronic ankle instability(CAI)and to identify the indirect signs for diagnosing CAI.Methods Fifty patients hospitalized in our hospital between January 1,2021 and July 1,2023 for chronic ankle instability(CAI)were selected into the experimental group,while 50 counterparts treated in our hospital for other diseases were chosen into the control group.The basic information of both groups was recorded.The internal measurement tools of the Picture Ar-chiving and Communication System(PACS)were used to measure the malleolar talus index(MTI)and two new measurement methods:talus movement index(TMI)and talus comprehensive index(TCI)on the axial images of ankle MRI to evaluate the position of the talus in the ankle mortise.Sta-tistical analysis was then performed.Results There was no significant difference between the two groups in terms of age,sex ratio,affected side ratio,height,weight and body mass index(BMI)(P>0.05).Compared with the control group,the MTI(86.56°±3.54° vs.85.28°±2.77°,P<0.05),TMI(2.00°±2.36° vs.-2.00°±2.54°,P<0.001)and TCI(4.70°±2.98° vs.1.90°±2.01°,P<0.001)of the experi-mental group increased.The area under the ROC curve of TMI and TCI was 0.841 and 0.794,respec-tively.The optimal cut-off points for diagnosing CAI based on TMI and TCI were 0.5° and 4.5°,re-spectively.Conclusion Patients with CAI show changes in the bony structure of the ankle joint.Specifi-cally,on the axial MRI images of the ankle joint,there are simultaneous posterior displacement and internal rotation of the talus,which may be an indirect sign for the diagnosis of CAI.

Objective:To explore the effects of an intervention strategy based on dyadic illness management theory on dyadic coping level, supportive care needs, and patients' disease symptoms with chemotherapy-stage ovarian cancer patients and their spouses, and to provide reference for improving their disease coping ability and quality of life.Methods:This study used the method of randomized controlled trial. Seventy pairs of ovarian cancer patients and their spouses who received regular chemotherapy and their spouses from Obstetrics and Gynecology Hospital, Fudan University from July 2022 to June 2023 were selected using convenience sampling method. They were assigned to the control group (36 pairs) and the observation group (36 pairs) by the random number table method. Participants in the control group received routine nursing care and the observation group received the intervention strategy of dyadic illness management theory. Data were collected and compared the differences in dyadic coping levels, care needs, and disease symptoms between two groups of patients and their spouses before intervention (before chemotherapy) and after intervention (after the end of the chemotherapy cycle). SPSS 20.0 software was used for analysis, and t-tests, χ2 tests, and Wilcoxon rank sum tests were used to compare the two groups. Results:Finally, 36 pairs were included in the control group and 34 pairs in the observation group. The age of the control group patients was (52.03 ± 9.44) years old, while that of the observation group patients was (53.41 ± 10.14) years old. After the intervention, the total score of dyadic coping level in the patients and their spouses of the observation group were (113.50 ± 8.03), (114.62 ± 10.59) points, respectively, which were higher than (106.64 ± 10.06), (108.78 ± 10.89) points of the control group with significant differences ( t=-3.14, -2.27, both P<0.05); the total score of care needs in the patients and their spouses of the observation group were (89.65 ± 8.29), (95.12 ± 7.25) points, respectively, which were lower than (100.25 ± 10.82), (110.11 ± 7.58) points of the control group with significant differences ( t=4.58, 8.45, both P<0.001); the total score of disease symptoms in the patients of the observation group was (20.09 ± 4.70) points, which was lower than (31.53 ± 6.08) points of the control group with significant differences ( t=8.77, P<0.001). Conclusions:The model of dyadic illness management can improve dyadic coping level and supportive care needs of chemotherapy-stage ovarian cancer patients and their spouses, and alleviate patients′ disease symptoms.

Objective:To explore the different reaction patterns among family caregivers of patients with advanced gynecological malignancies, and to analyze the influencing factors of different profiles.Methods:A cross-sectional study was conducted with 210 family caregivers of patients with advanced gynecological malignancies from Obstetrics and Gynecology Hospital in Shanghai from January 2022 to December 2022. Data were collected by Caregiver Reaction Assessment, Mishel's Uncertainty in Illness Scale-Family Member Form and Perceived Social Support Scale. Latent profile analysis was used to explore the different reaction patterns among family caregivers of patients with advanced gynecological malignancies. The influencing factors of caregiver reaction were identified by multivariate Logistic regression.Results:Totally 208 questionnaires were effectively collected. The family caregivers among patients with advanced gynecological malignancies included 163 males and 45 females, aged (53.89 ± 12.61) years old. The reaction characteristics of 208 family caregivers among patients with advanced gynecological malignancies were divided into three categories: low burden and high benefit group (24.5%, 51/208), moderate burden and benefit group (30.8%, 64/208), and high burden and low benefit group (44.7%, 93/208). Compared to the low burden and high benefit group, caregivers with lower levels of social support were more likely to be classified as moderate burden and benefit group, high burden and low benefit group ( OR = 0.563, 0.407, both P<0.01). Caregivers with moderate burden and benefit group, high burden and low benefit group had higher levels of disease uncertainty ( OR = 1.328, 2.064, both P<0.01). The caregiver′s age, monthly family income, education level, and co-caregivers were also influencing factors regarding to care reaction among family caregivers of patients with advanced gynecological malignancies ( OR values were 0.207-6.422, all P<0.05). Conclusions:The care reaction of family caregivers among patients with advanced gynecological malignancies has obvious categorical features. Healthcare professionals should implement targeted nursing interventions according to their reaction characteristics, so as to reduce the care burden of family caregivers and improve the quality of care for patients with advanced gynecological malignancies.

Vitamins,as important micronutrients widely involved in human physiological functions,play a significant role in parenteral nutrition therapy due to their inability to be synthesized or insufficient synthesis in the body,requiring exogenous supplementation. However,a consensus does not exist in China regarding the dosage and monitoring of vitamins in parenteral nutrition. Experts in the field are recruited by Chinese Nutrition Society for Medical Food and Nutrition Support,Chinese Society for Parenteral and Enteral Nutrition (CSPEN),Shanghai Medical Association for Parenteral and Enteral Nutrition and the Shanghai Nutrition Society to formulate a consensus paper.The current paper aims to provide standardized guidance for clinical use of vitamins in parenteral nutrition. The consensus paper is a composite of systematically reviewing pertinent literature,Chinese clinical practice and multiple sessions of debate,discussion,and composition,with reference to guidelines from European Society for Parenteral and Enteral Nutrition (ESPEN),American Society for Parenteral and Enteral Nutrition (ASPEN),Australasian Society for Parenteral and Enteral Nutrition (AuSPEN) and CSPEN.This includes 37 recommendations regarding the recommended dosage and monitoring of fat-soluble vitamins (vitamins A,D,E,K) and water-soluble vitamins (vitamin C and vitamins B1,B2,B6,B12,niacin,pantothenic acid,biotin,and folate) to serve varied adult parenteral nutrition patients.

Objective: To investigate the molecular mechanism and identify potential drugs for subthreshold depression (SD), and elucidate the detalied mechanism of Danzhi Xiaoyao powder (DZXY) in SD. Methods: Using RNA-sequencing, we identified differentially expressed genes (DEGs) in leukocytes of SD compared to healthy controls, deciphered their functions and pathways, and identified the hub genes of SD. We also assessed changes in leukocyte transcription factor activity in patients with SD using the TELiS platform. The Connectivity Map database was retrieved to screen candidate drugs for SD. Based on network pharmacology, we elucidated the “multi-component, multi-target, and multi-pathway” mechanism of DZXY in the treatment of SD. Results: We identified 1080 DEGs (padj <0.05 and |log2 (fold change)| ≥ 1 & protein coding) in the leukocytes of patients with SD. These DEGs, including hub genes, were primarily involved in immune and inflammatory response-related processes. Transcription factor activity analysis revealed similarities between the leukocyte transcriptome profile in SD and the conserved transcriptional response to adversities in immune cells. Connectivity Map analysis identified 28 potential drugs for SD treatment, particularly SB-202190 and TWS-119. Constructing the “Direct Compounds-Direct Targets-Pathways” network for DZXY and SD revealed the curative mechanisms of DZXY in SD, primarily including inflammatory response, lipid metabolism, immune response, and other processes. Conclusion These results provide new insights into the characteristics and functional changes of leukocytes in SD, partially illustrate the pathogenesis of SD, and suggest potential drugs for SD. The curative mechanisms of DZXY in SD are also partially elucidated.