BACKGROUND:Cervical disc herniation can cause pain in the neck and shoulder area,as well as radiating pain in the upper limbs.The incidence rate is increasing year by year and tends to affect younger individuals.Fully understanding the biomechanical characteristics of the cervical spine in adolescents is of great significance for preventing and delaying the onset of cervical disc herniation in this age group. OBJECTIVE:To reconstruct cervical spine models for both healthy adolescents and adolescent patients with cervical disc herniation utilizing finite element analysis techniques,to analyze the motion range of the C1-T1 cervical vertebrae as well as the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and the cartilage of the small joints. METHODS:A normal adolescent's cervical spine and an adolescent patient with cervical disc herniation were selected in this study.The continuous scan cervical spine CT raw image data were imported into Mimics 21.0 in DICOM format.The C1-T1 vertebrae were reconstructed separately.Subsequently,the established models were imported into the 3-Matic software for disc reconstruction.The perfected models were then imported into Hypermesh software for meshing of the vertebrae,nucleus pulposus,annulus fibrosus,and ligaments,creating valid geometric models.After assigning material properties,the final models were imported into ABAQUS software to observe the joint motion range of the C1-C7 cervical vertebrae segments under different conditions,and to analyze the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and small joint cartilage of each cervical spine segment. RESULTS AND CONCLUSION:(1)In six different conditions,the joint motion range of the C1 vertebra in the cervical spine models of both normal adolescent and adolescent patient with cervical disc herniation was higher than that of the other vertebrae.Additionally,the joint motion range of each cervical spine segment in normal adolescent was greater than that in adolescent patient with cervical disc herniation.(2)In the cervical spine model of normal adolescent,the maximum stress values in the annulus fibrosus and nucleus pulposus were found on the left side during C2-3 flexion conditions(0.43 MPa and 0.17 MPa,respectively).In the cervical spine model of adolescent patient with cervical disc herniation,the maximum stress values were found on the left side during C7-T1 flexion conditions(0.54 MPa and 0.18 MPa,respectively).(3)In the cervical spine model of normal adolescent,the maximum stress value on the endplate was found on the left side of the upper endplate of C3 during flexion conditions(1.46 MPa).In the model of adolescent patient with cervical disc herniation,the maximum stress value on the endplate was found on the left side of the lower endplate of C7 during flexion conditions(1.32 MPa).(4)In the cervical spine model of normal adolescent,the maximum stress value in the small joint cartilage was found in the C2-3 left rotation conditions(0.98 MPa).In adolescent patient with cervical disc herniation,the stress in the small joint cartilage significantly increased under different conditions,especially in C1-2,with the maximum stress found during left flexion(3.50 MPa).(5)It is concluded that compared to normal adolescent,adolescent patient with cervical disc herniation exhibits altered cervical curvature and a decrease in overall joint motion range in the cervical spine.In adolescent with cervical disc herniation,there is a significant increase in stress on the annulus fibrosus,nucleus pulposus,and endplates in the C7-T1 segment.The stress on the left articular cartilage of the C1-2 is notable.Abnormal cervical curvature may be the primary factor causing these stress changes.

Objective:To investigate the differential impact of ultra-high-resolution photon-counting detector CT (UHR PCD-CT) and energy-integrating detector CT (EID-CT) on image quality and calcified plaque-induced luminal stenosis in coronary CT angiography (CCTA).Methods:This retrospective analysis was conducted on patients who underwent both EID-CT and UHR PCD-CT CCTA at the Geriatric Hospital of Nanjing Medical University between January 2021 and November 2024. A total of 141 patients were included in the study, within 46 patients having scans within a 12-month interval. Image quality of all coronary artery segments was subjectively evaluated. Patients with paired scans (interval≤12 months) were included for calcified plaque analysis. Subjective visualization of calcified plaques evaluated. The blooming artifact was calculated as an objective evaluation index for assessing the calcified plaques. Additionally, the degree of coronary artery lumen stenosis resulting from calcified plaques was assessed, along with the measurement of plaque volume and the Agatston score. Changes in lumen stenosis between the two scans were also evaluated. The Wilcoxon signed-rank test was used to compare the subjective scores of coronary artery image quality and calcified plaques between the two groups, and paired-sample t-tests were used to compare the blooming artifact and lumen stenosis degree. Results:The PCD-CT image quality score was significantly higher than that of EID-CT [PCD-CT : 5 (4,5), EID-CT: 4 (4,5); Z=-21.38, P<0.001]. Compared to EID-CT, PCD-CT reduced the blooming artifact (PCD-CT: 38.88%±9.09%, EID-CT: 50.11%±11.52%; t=-12.97, P<0.001), significantly improving the subjective score for visualization of calcified plaques [PCD-CT: 5 (4,5), EID-CT: 3 (2,3); Z=-9.68, P<0.001], and the measured lumen stenosis was notably lower in PCD-CT(PCD-CT:34.88%±18.20%, EID-CT:45.31%±23.42%; t=-9.93, P<0.001). Among 129 analyzed calcified plaques, luminal stenosis was reduced on PCD-CT in 110 plaques (85.3%) and increased in 19 (14.7%), including 4 plaques that had unclear boundaries with the adjacent lumen in EID-CT CCTA images, making the stenosis difficult to assess. Conclusion:Compared to EID-CT, UHR PCD-CT for CCTA significantly improves coronary artery image quality, provides clearer visualization of calcified plaques and adjacent lumen details, and it can reduce the overestimation of coronary artery caleified plaque stenosis.

Objective:To investigate the differential impact of ultra-high-resolution photon-counting detector CT (UHR PCD-CT) and energy-integrating detector CT (EID-CT) on image quality and calcified plaque-induced luminal stenosis in coronary CT angiography (CCTA).Methods:This retrospective analysis was conducted on patients who underwent both EID-CT and UHR PCD-CT CCTA at the Geriatric Hospital of Nanjing Medical University between January 2021 and November 2024. A total of 141 patients were included in the study, within 46 patients having scans within a 12-month interval. Image quality of all coronary artery segments was subjectively evaluated. Patients with paired scans (interval≤12 months) were included for calcified plaque analysis. Subjective visualization of calcified plaques evaluated. The blooming artifact was calculated as an objective evaluation index for assessing the calcified plaques. Additionally, the degree of coronary artery lumen stenosis resulting from calcified plaques was assessed, along with the measurement of plaque volume and the Agatston score. Changes in lumen stenosis between the two scans were also evaluated. The Wilcoxon signed-rank test was used to compare the subjective scores of coronary artery image quality and calcified plaques between the two groups, and paired-sample t-tests were used to compare the blooming artifact and lumen stenosis degree. Results:The PCD-CT image quality score was significantly higher than that of EID-CT [PCD-CT : 5 (4,5), EID-CT: 4 (4,5); Z=-21.38, P<0.001]. Compared to EID-CT, PCD-CT reduced the blooming artifact (PCD-CT: 38.88%±9.09%, EID-CT: 50.11%±11.52%; t=-12.97, P<0.001), significantly improving the subjective score for visualization of calcified plaques [PCD-CT: 5 (4,5), EID-CT: 3 (2,3); Z=-9.68, P<0.001], and the measured lumen stenosis was notably lower in PCD-CT(PCD-CT:34.88%±18.20%, EID-CT:45.31%±23.42%; t=-9.93, P<0.001). Among 129 analyzed calcified plaques, luminal stenosis was reduced on PCD-CT in 110 plaques (85.3%) and increased in 19 (14.7%), including 4 plaques that had unclear boundaries with the adjacent lumen in EID-CT CCTA images, making the stenosis difficult to assess. Conclusion:Compared to EID-CT, UHR PCD-CT for CCTA significantly improves coronary artery image quality, provides clearer visualization of calcified plaques and adjacent lumen details, and it can reduce the overestimation of coronary artery caleified plaque stenosis.

Objective:To develop evaluation indicators for care ability of caregivers in home-based palliative care based on the Farran caregiver skills model.Methods:Based on the Farran caregiver skills model, a preliminary evaluation index system was constructed through theoretical analysis, literature review, and semi-structured interviews. From July to October 2024, experts in the field were selected to conduct expert consultations, revise and improve the index system, and determine the weight of the indicators through the analytic hierarchy process.Results:A total of two rounds of expert consultations were conducted. The effective response rates for the first and second rounds of expert consultation questionnaires were 90.00% (18/20) and 100.00% (18/18), respectively. In the two rounds of expert consultations, 15 experts (83.33%) and 3 experts (16.67%) respectively proposed revision suggestions. In the two rounds of consultation, the expert authority coefficients were 0.931 and 0.936, respectively, and the Kendall coefficient of concordance were 0.152~0.283、0.183~0.269 ( P<0.05). The final evaluation indicators for care ability of caregivers in home-based palliative care included four first-level indicators, 12 second-level indicators, and 45 third-level indicators. Conclusions:The evaluation indicators for care ability of caregivers in home-based palliative care developed are highly scientific and reliable, and can provide a reference for the evaluation of family caregiver care ability and the formulation of training programs.

In August 2024,the European Society of Cardiology Working Group on the management of Peripheral Artery and Aortic disease issued the"Guidelines for the management of peripheral and aortic arterial disease".The guideline stated that peripheral artery and aortic diseases were very common,significantly increasing cardiovascular disease morbidity and mortality in the general population,and their prevention and treatment strategies needed to be strengthened.This article interpreted the content of antithrombotic drug therapy in the guideline from the perspective of drug therapy,which could provide a reference for clinicians and pharmacists to formulate antithrombotic strategies.

Objective To observe the improvement effect and mechanism of emodin on lipopolysaccharide(LPS)-induced podocyte injury.Methods Human glomerular podocytes were used as the study object,and they were randomly divided into the blank control group,the LPS group,the emodin low-,medium-,and high-dose groups,and the emodin+lysophosphatidic acid[LP A,RhoA/RhoRho-associatedcoiled-coil kinase(ROCK)activator]group.Cell counting kit 8(CCK8)and 5-ethynyl-2'-deoxyuridine(EdU)staining were applied to detect the proliferation of glomerular podocytes,Transwell assay was used to test the migration of glomerular podocytes,flow cytometry was used to detect apoptosis of glomerular podocytes,and enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammatory factors tumor necrosis factor α(TNF-α),interleukin(IL)-1β,and IL-18 in the supernatant of glomerular podocytes,and the protein expression levels of RhoA and ROCK in glomerular podocytes were determined by Western Blot.Results The optical density(OD)450nm,EdU positive cell rate and migration number of glomerular podocytes in the LPS group were lower than those in the blank control group,and the apoptosis rate,the levels of TNF-α,IL-1β and IL-18 in the supernatant,as well as the protein expression levels of RhoA and ROCK in the cells were higher than those in the blank control group,the differences being statistically significant(P＜0.05);the OD450nm,EdU positive cell rate and migration number of glomerular podocytes in the emodin low-,medium-,and high-dose groups were higher than those in the LPS group,while the apoptosis rate,levels of TNF-α,IL-1 β and IL-18 in supernatant,as well as RhoA and ROCK protein expression levels in cells were reduced compared with those in the LPS group,the differences being statistically significant(P＜0.05);the OD450nm and EdU positive cell rate and migration number of glomerular podocytes in LPA group were lower than those of emodin high-dose group,while the apoptosis rate,levels of TNF-α,IL-1 βand IL-18 in supernatant,as well as RhoA and ROCK protein expression levels in cells were higher than those of emodin high-dose group,the differences being all statistically significant(P＜0.05).Conclusion Emodin can improve LPS-induced podocyte injury,and its mechanism of action may be related to the inhibition of RhoA/ROCK signaling pathway.

In August 2024,the European Society of Cardiology Working Group on the management of Peripheral Artery and Aortic disease issued the"Guidelines for the management of peripheral and aortic arterial disease".The guideline stated that peripheral artery and aortic diseases were very common,significantly increasing cardiovascular disease morbidity and mortality in the general population,and their prevention and treatment strategies needed to be strengthened.This article interpreted the content of antithrombotic drug therapy in the guideline from the perspective of drug therapy,which could provide a reference for clinicians and pharmacists to formulate antithrombotic strategies.

Objective:To analyze the association between inflammation-related dietary patterns and the risk for cognitive impairment in older adults aged ≥65 years in longevity areas in China by using reduced rank regression (RRR) analysis.Methods:This study used cross-sectional data from the 2021 Healthy Aging and Biomarkers Cohort Study, including the information about study participants' demographic characteristics, lifestyles, daily life activities, and disease histories. Dietary intake was obtained by using a simplified food frequency questionnaire. Cognitive impairment was evaluated based on the Mini-Mental State Examination Scale combined with years of education. Fasting venous blood samples were collected to detect inflammatory markers, especially high-sensitivity C-reactive protein (hs-CRP) and the platelet-to-lymphocyte ratio (PLR). RRR analysis was used to obtain inflammation-related dietary patterns using hs-CRP and PLR as response variables. Multivariate logistic regression model was used to analyze the association between dietary pattern score and the risk for cognitive impairment. Restricted cubic spline was used to explore the dose response relationship, and mediation analysis was used to quantify the mediating effects of hs-CRP and PLR.Results:Two dietary patterns were identified with RRR. The primary pattern was characterized by higher intakes of flour, red meat, and dairy products, and lower intake of fresh vegetables, explaining 6.84% of the variance in food intake and 0.50% of the variance in inflammatory markers. Compared with the T1 group, the T3 group had significantly higher risk for cognitive impairment ( OR=1.242, 95% CI: 1.034-1.491). Each one standard deviation increase in the dietary pattern score was associated with an 8.7% increase in the risk for cognitive impairment ( OR=1.087, 95% CI: 1.008-1.172), with a significant linear trend (overall-model P<0.001, non-linear P=0.295). Mediation analysis indicated that hs-CRP mediated 6.2% of the association between the dietary pattern and the risk for cognitive impairment. Conclusion:The inflammation- related dietary pattern characterized by higher consumption of flour, red meat, and dairy products and lower consumption of fresh vegetables is associated with an increased risk for cognitive impairment in older adults, and hs-CRP partially mediates this association.

Objective:To explore the difficulties and needs of wound ostomy incontinence specialist nurses when applying convex baseplates, with the aim of providing a basis for standardizing ostomy care.Methods:Purposeful sampling was used to select 13 wound ostomy incontinence specialist nurses from tertiary hospitals in Hebei, Jilin, Hunan, Beijing, and Tianjin for semi-structured interviews between November and December 2024. Content analysis was used to analyze the data.Results:Two main themes were identified: application dilemmas and application needs. Application dilemmas included four subthemes: insufficient understanding of convex baseplate characteristics, unclear indications and contraindicated populations, lack of unified standards for assessment timing, and inadequate awareness of health education. Application needs included two subthemes: urgent need for related evidence-based evidence and a desire for clinical guidelines and expert consensus.Conclusions:Currently, wound ostomy incontinence specialist nurses in China face challenges in understanding the characteristics of convex baseplates, scope of application, identifying contraindications, determining the optimal timing for application assessment, and providing patient education. Administrators should develop clinical application standards for convex baseplates based on these challenges. Furthermore, researchers should develop relevant clinical guidelines or expert consensus for convex baseplate application in China, providing a basis for the standardized use of ostomy care products.

Objective:To investigate the current status of convex baseplate selection and use among clinical nurses.Methods:A convenience sampling method was employed to survey 1 873 nurses from 180 hospitals across China between November and December 2024 using a general information questionnaire and a self-designed questionnaire on convex baseplate selection and use. A total of 1 873 questionnaires were distributed, and 1 860 valid responses were collected, yielding a response rate of 99.31% (1 860/1 873) .Results:Among the 1 860 nurses, 88.98% (1 655/1 860) had access to convex baseplates in clinical practice. However, only 8.82% (146/1 655) used them immediately postoperatively, and only 4.53% (75/1 655) chose convex baseplates without considering any product features. The five common clinical indications for convex baseplate use included stoma retraction (96.62%, 1 599/1 655) , peristomal skin folds or depressions (96.56%, 1 598/1 655) , flush stomas (80.12%, 1 326/1 655) , leakage (70.03%, 1 159/1 655) , and abdominal laxity (66.89%, 1 107/1 655) . Common contraindications for use included peristomal varicose veins (77.46%, 1 282/1 655) , peristoma pressure injuries (75.35%, 1 247/1 655) , stoma prolapse (74.50%, 1 233/1 655) , parastomal hernia (72.87%, 1 206/1 655) , and pyoderma gangrenosum (67.01%, 1 109/1 655) . Key assessment areas when selecting convex baseplates included the stoma itself (97.28%, 1 610/1 655) , peristomal skin (96.50%, 1 597/1 655) , abdominal wall contour (95.41%, 1 579/1 655) , excretion patterns (87.37%, 1 446/1 655) , and previous convex baseplate use (82.36%, 1 363/1 655) . Measures commonly used by nurses to enhance adhesion included the use of stoma belts (95.29%, 1 577/1 655) , barrier rings or paste (94.80%, 1 569/1 655) , smoothing peristomal skin folds (90.57%, 1 499/1 655) , advising patients to limit bending (82.96%, 1 373/1 655) , and abdominal binders (57.28%, 948/1 655) .Conclusions:The clinical application of convex baseplates requires further promotion. Nursing administrators should strengthen training on the selection, characteristics, and indications of convex baseplates, with particular emphasis on the understanding of the five key product features.