【Objective】 To explore the safety of transrectal ultrasound-guided transperineal injection of sodium hyaluronate to expand the Dirichlet gap in laparoscopic radical prostatectomy. 【Methods】 A total of 14 healthy male purebred beagle dogs were selected and randomly divided into 2 groups, with 7 in either group.The control group was treated with conventional laparoscopic radical prostatectomy, while the experimental group was treated with laparoscopic radical prostatectomy after 2.5 mL sodium hyaluronate was injected into the Dirichlet gap under the guidance of transrectal ultrasound.The total operation time, prostate separation time, intraoperative blood loss and rectal status of the 2 groups were observed. 【Results】 After the injection of sodium hyaluronate into the Dirichlet gap between the prostate and the rectum, no rectal tissue was found in the prostate, and no obvious damage was found in the posterior rectum in either groups.The postoperative hemoglobin (HGB) was [(118.70±2.56) g/L vs.(122.10±2.19) g/L, P=0.02]; the total operation time was [(141.40±9.80) min vs.(119.10±9.16) min, P<0.05]; the prostate separation time was [(24.99±1.75) min vs.(16.64±2.34) min, P<0.05]; the amount of bleeding was [(47.43±4.32) mL vs.(34.86±5.18) mL, P<0.05] in the control group and experimental group. 【Conclusion】 Laparoscopic radical prostatectomy performed after 2.5 mL of sodium hyaluronate injection into the Dirichlet gap under the guidance of transrectal ultrasound can shorten the total operation time, the separation and resection time of the prostate, and reduce the amount of bleeding, which can improve and reduce the incidence of rectal injury, and prove the feasibility of this approach for prostatic cancer.

Objective:To summarize the best evidence of thirst management in ICU patients and provide evidence-based basis for dinical practice.Method:According to the "6S" evidence pyramid model, the literature on thirst management of ICU patients was systematically retrieved from relevant guidelines websites, evidence-based databases, association websites and original literature databases at home and abroad. The retrieval time was from the establishment of the database to June 31, 2022. Two researchers with evidence-based nursing training independently completed literature quality evaluation. To extract and summarize the evidence of the literature that meets the quality standard.Results:A total of 17 articles were included, including 8 randomized controlled trials, 5 quasi-experimental studies and 4 cross-sectional studies. The 18 pieces of best evidence were formed, including 5 aspects: basic requirements of thirst management, intervention evaluation, intervention methods, matters needing attention and health education.Conclusions:This study summarized the best evidence of thirst management in ICU patients. Nurses should translate and apply the best evidence in combination with the clinical situation and specific policies of the department to relieve the thirst symptoms of ICU patients.

Objective:To evaluate the expression level of hsa-miR-422a in hypertrophic scars and to identify the target genes of hsa-miR-422a along with their biological functions using bioinformatics approaches.Methods:From June 2020 to December 2020, tissue samples of 3 hypertrophic scar and 3 normal skin were collected from patients (3 males, 3 females, aged 20-42 years) in Department of Plastic and Reconstructive Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine. Primary fibroblasts were isolated and cultured. Real-time quantitative PCR was performed to quantify the expression of hsa-miR-422a. To construct a ceRNA network, starbase and Target Scandata bases were utilized to predict genes as well as long noncoding RNAs (lncRNAs) that may sponge hsa-miR-422a. GO and KEGG pathway enrichment analyses were conducted on the target genes of hsa-miR-422a; protein-protein interaction (PPI) networks were constructed to identify the hub genes whose functions were predicted by functional enrichment analyses. The expression of hub genes was validated through real-time quantitative PCR in hypertrophic scars.Results:The expression of hsa-miR-422a was significantly lower in the hypertrophic scar tissue samples and fibroblasts compared to that in the normal skin ( P<0.05). 133 target genes as well as 1033 lncRNAs were predicted by starBase and TargetScandata bases and used to construct an hsa-miR-422a-centered ceRNA network. PPI networks of the target genes revealed 10 hub genes, including MAPK1, GRB2, and IGF1R, which were discovered to be related to protein serine/threonine/tyrosine kinase activity, ubiquitin protein ligase binding, fibroblast growth factor receptor signaling pathway, muscle cell proliferation, and many others; besides, they may be involved in FoxO, mTOR, Toll-like receptor, Ras, MAPK, PI3K-Akt signaling pathways and signaling pathways regulating pluripotency of stem cells. Three hub genes (MAPK1, GRB2, and IGF1R) were significantly upregulated in hypertrophic scars ( P<0.05). Conclusions:hsa-miR-422a is significantly downregulated in the hypertrophic scars and may target hub genes such as MAPK1 in ceRNA networks, ultimately modulating hypertrophic scar formation.

OBJECTIVES: This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese. METHODS: Using the 2011-2015 waves of the China Health and Retirement Longitudinal Study, we conducted a cross-sectional analysis included 9,015 subjects and a longitudinal analysis included 4,961 subjects, with 4,872 having full data on the hypertension stage and 4,784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex. RESULTS: NWCO was associated with normal→stage 2 (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.11 to 3.42), maintained stage 1 (OR, 1.62; 95% CI, 1.14 to 2.29), and normal→ISH (OR, 1.39; 95% CI, 1.05 to 1.85). AWCO was associated with normal→stage 1 (OR, 1.75; 95% CI, 1.40 to 2.19), maintained stage 1 (OR, 2.77; 95% CI, 2.06 to 3.72), maintained stage 2 (OR, 2.80; 95% CI, 1.50 to 5.25), normal→ISH (OR, 1.56; 95% CI, 1.20 to 2.02), and normal→SDH (OR, 2.54; 95% CI, 1.72 to 3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages. CONCLUSIONS This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.

Objective:To understand the clinical application status of the best evidence for airway clearance in Intensive Care Unit (ICU) patients, analyze the barriers and enablers in the process of evidence application, so as to provide reference for formulating transformation strategies.Methods:The literature on airway clearance in ICU patients was systematically searched in domestic and foreign databases and association websites. The best evidences were summarized based on the included literature, and corresponding review indicators were constructed based on the best evidence for clinical baseline review. From July to August 2022, convenience sampling was used to select 30 nurses and 30 patients from ICU of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. We conducted barriers and transformation strategy analysis based on the review results.Results:A total of 33 review indicators were formulated. The clinical execution rate of the review indicators was 0 to 100%, with 60.6% (20/33) of the review indicators having a clinical execution rate of <60%. The main barriers were that the specialized team for airway clearance involved great personnel and was difficult to organize, nurses had insufficient awareness and importance of airway clearance knowledge, the department lacked corresponding evaluation tools and equipment, the implementation standards for airway clearance treatment within the department were not sound, and the health education materials for airway clearance were incomplete. The transformation strategy mainly included strengthening leadership support, conducting knowledge training on airway clearance, introducing tools and equipment related to airway clearance, improving the implementation standards of airway clearance and health education materials for airway clearance.Conclusions:There is a significant gap between the best evidence for airway clearance in ICU patients and clinical practice. Timely improvement should be made on relevant barriers to promote the conversion of best evidence into clinical practice and improve patient clinical outcomes.

Spinal muscular atrophy, lower extremity-predominant, 2A (SMALED2A) is a form of spinal muscular atrophy, which predominantly affects muscles of the lower extremity, characterized by early childhood onset of muscle weakness and atrophy. This disorder is caused by mutation in the BICD2 gene. This paper reports a case of SMALED2A with recurrent skin ulceration of both feet. Whole exome sequencing of this case revealed a chr9∶95527083_A>AGCC insertion mutation in the 5’UTR of BICD2 gene.

Spinal muscular atrophy, lower extremity-predominant, 2A (SMALED2A) is a form of spinal muscular atrophy, which predominantly affects muscles of the lower extremity, characterized by early childhood onset of muscle weakness and atrophy. This disorder is caused by mutation in the BICD2 gene. This paper reports a case of SMALED2A with recurrent skin ulceration of both feet. Whole exome sequencing of this case revealed a chr9∶95527083_A>AGCC insertion mutation in the 5’UTR of BICD2 gene.

Intensive Care Unit (ICU) acquired weakness is a common complication in ICU critically ill survivors. Early intervention is an important measure to prevent and treat ICU acquired weakness. The scientific and standardized intervention has a positive effect on the prognosis of patients. In recent years, integrated care, as a management method for some specific patients, can effectively improve the quality of care, reduce the cost of care, and is gradually applied to the prevention and treatment of ICU acquired weakness. This paper describes the research status of integrated care clinical intervention on ICU acquired weakness, in order to provide the basis for the construction of practical plan of integrated care for ICU acquired weakness.

Objective:To systematically evaluate the predictive model of intensive care unit (ICU) -acquired weakness so as to provide objective basis for clinical workers to choose appropriate predictive model and provide reference for future model update and new model development.Methods:Sixth databases including PubMed, Embase, web of science, The Cochrane Library, CNKI and Wanfang were searched by the computer. The retrieval time was the construction of the database to October 15, 2019, and the language was limited to Chinese and English. A total of two researchers conducted independent screening of literature, data extraction and evaluated the quality of the included literature in turn, and then used prediction model risk of bias assessment tool (PROBAST) to evaluate the quality of the models included in the literature.Results:A total of 8 articles with high quality were included. The area under the ROC curve of the five models were all greater or equal to 0.7. The model risk of bias assessment showed that only Witteveen's model was rated as low bias, and the remaining 7 models all had a higher risk of bias, but all models had good applicability.Conclusions:The predictive performance of ICU acquired weakness model is good, but there are some biases in development and report. In the future, the whole process of model development and verification should be reported in a standardized way to reduce methodological bias and provide high-quality evidence for clinical practice. Future studies should focus on external validation and updating of models to continuously improve model prediction performance and provide practical models for clinical practice.

Objective To explore the correlation between lipoprotein a (Lpa),fibrinogen (FIB) and D-dimer (D-D) and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases (CSVD).Methods Totally 300 patients with ischemic CSVD who were admitted to the Department of Neurology,Affiliated Hospital of North China University of Science and Technology were selected as the research objects,and 70 healthy outpatients in the same period were selected as the control group.Cognitive function was assessed with Mini Mental State Examination (MMSE).According to the results of MMSE,patients with ischemic CSVD were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases).The cognitive impairment group was further divided into mild cognitive impairment group (100 cases),moderate cognitive impairment group (60 cases) and severe cognitive impairment group (34 cases).Lpa level was detected by latex immunoturbidimetry,FIB level by coagulation and D-D level by ELISA.The results were compared and analyzed.Results (1) Compared with the control group (Lpa:(101.67±37.37) rmg/L,FIB:(3.02±0.67) g/L,D-D:(231.49±95.00) mg/L),the levels of Lpa,FIB and D-D in normal group (Lpa:(150.58± 89.55) mg/L,FIB:(3.48 ± 0.80) g/L,D-D:(287.79± 125.25)mg/L) and cognitive impairment group (Lpa:(257.98 ± 189.23) mg/L,FIB:(3.86± 0.97) g/L,D-D:(347.23± 120.69) rmg/L)increased significantly (all P＜0.01).Compared with the cognitive normal group,the levels of Lpa,FIB and D-D in cognitive impairment group increased significantly (all P＜0.01).(2)Compared with mild cognitive impairment group (Lpa:169.08±51.63 mg/L,FIB:(3.10±0.69)g/L,D-D:(288.91±92.58) mg/L),the levels of Lpa,FIB and D-D of in moderate cognitive impairment group (Lpa:(236.78± 107.15) mg/L,FIB:(3.52±0.67) g/L,D-D:(345.03± 132.68) mg/L),severe cognitive impairment group (Lpa:(292.65±108.19) mg/L,FIB:(4.04±1.08) g/L,D-D:(401.58±84.87) mg/L)increased significantly (all P＜0.01).Compared with the moderate cognitive impairment group,the levels of Lpa,FIB and D-D in the severe cognitive impairment group increased significantly (all P＜0.01).(3) The ROC curve was fitted with cognitive impairment as state variable.The area under the ROC curve of Lpa was 0.706,P＜0.01,95％ CI was (0.646-0.766),the area under the ROC curve of FIB was 0.613,P=0.001,95％ CI was (0.548-0.679),and the area under the ROC curve of D-D was 0.670,P＜0.01,95％ CI was (0.604-0.736).(4) Lpa,FIB and D-D were positively correlated with the degree of cognitive impairment in patients with ischemic cerebral small vessel diseases (rLpa =0.522,P＜0.01;rFIB =0.410,P＜0.01;rD-D =0.488,P＜0.01).Conclusion Serum Lpa,FIB and D-D are closely related to the degree of vascular cognitive impairment and cognitive impairment in patients with ischemic CSVD,which may be involved in the occurrence and development of cognitive impairment.Detection of serum levels of Lpa,FIB and D-D is of great clinical value in the early diagnosis,assessment and treatment of cognitive impairment in ischemic CSVD.