OBJECTIVE:Cold water immersion methods are not standardized in terms of operational indicators such as immersion temperature,duration and depth,leading to controversy over the efficacy of recovery from exercise fatigue in skeletal muscle.In this article,we analyze the effects of cold water immersion on muscle injury,muscle soreness and muscle strength recovery under different factors,in order to find the best immersion implementation plan,and thus provide evidence for the recovery of muscle fatigue. METHODS:A search of CNKI,WanFang Data,Web of Science,and PubMed databases was conducted for relevant literature published from January 1,2000 to August 15,2023.A total of 4 759 articles were initially retrieved,with 4 735 articles excluded through screening and 24 articles finally included.The Physical Therapy Evidence Database Scale was used to assess the methodological quality of the included literature,and Stata-MP 16 software was used to perform effect size combinations,subgroup analyses,Meta-regression,sensitivity tests,and publication bias analyses. RESULTS:(1)The article included a total of 24 randomized controlled trial studies,including 617 subjects,with overall high legal quality.(2)Meta-analysis showed that cold water immersion can significantly reduce creatine kinase blood value[standardized mean difference(SMD)=-0.17,95％confidence interval(CI):-0.29 to-0.05,P<0.01],alleviate muscle pain(SMD=-0.60,95％CI:-0.81 to-0.38,P<0.01),and promote maximum muscle strength recovery(SMD=0.17,95％CI:0.05 to 0.30,P<0.01).(3)Subgroup analysis showed that:The immersing regimen with water temperature>14 ℃(SMD=-0.48,95％CI:-0.76 to-0.20,P<0.01)and duration of 12-14 minutes(SMD=-0.38,95％CI:-0.61 to-0.15,P<0.01)had the best effect in reducing creatine kinase blood values,and had a more significant intervention effect on endurance exercise(SMD=-0.45,95％CI:-0.71 to-0.20,P<0.01),while the immersion regimen with water temperature<10 ℃(SMD=-0.61,95％CI:-0.79 to-0.43,P<0.01),duration<12 minutes(SMD=-0.76,95％CI:-0.98 to-0.53,P<0.01),and immersion depth above the iliac spine(SMD=-0.74,95％CI:-0.97 to-0.52,P<0.01)had the best effect on relieving muscle soreness,and had a more significant analgesic effect after endurance exercise(SMD=-0.42,95％CI:-0.61 to-0.22,P<0.01).(4)Meta regression showed that immersion water temperature,immersion duration,and exercise type were important regulatory factors affecting the effect size of creatine kinase;immersing water temperature and immersing depth were important regulatory factors affecting the effect size of visual analogue scale score,while exercise type was an important regulatory factor affecting the maximum isometric muscle strength effect size. CONCLUSION:(1)Evidence of extremely low to moderate strength suggests that cold water immersion can effectively reduce muscle damage,alleviate muscle soreness,and promote muscle strength recovery.(2)In terms of reducing muscle injury,immersion water temperature,immersion duration,and exercise type are significant regulatory factors that affect the efficacy of immersing.Among them,immersion water temperature>14 ℃ and duration of 12-14 minutes are the best solutions to reduce muscle injury after exercise,and the immersing effect is better for endurance exercise.(3)In terms of reducing muscle soreness,immersion water temperature and immersion depth are important regulatory factors that affect the intervention effect.Among them,immersion water temperature<10 ℃,duration<12 minutes,and immersing depth above the iliac spine are the best solutions to reduce muscle soreness,and have a better analgesic effect after endurance exercise.(4)In terms of promoting muscle strength recovery,exercise type is a key regulatory factor that affects the maximum isometric muscle strength effect.

Objective To establish an automatic review plan for coagulation tests with image recognition function,and evaluate the correctness and effectiveness of the plan.Methods Artificial intelligence software and hardware were combined to establish an image recognition system that could automatically determine the characteristics of specimens,blood volume and hematocrit.The correctness of the determination results of specimen character was compared with the visual method,the correctness of the determination results of blood volume was compared with the manual measurement method,and the correctness of hematocrit was compared with the hematology analyzer.According to the flow chart,reference interval,medical decision level,critical value range,relevant literature,work experience and historical data,the autoverification rules of coagulation tests were formulated.The autoverification rules were manually verified,and the autoverification pass rate,true positive rate,true negative rate,false positive rate,and false negative rate were calculated.The change of turnaround time in the laboratory after the implementation of the autoverification scheme was evaluated.Re-sults The accuracy rate of sample trait determination in the image recognition system was 96.72％,and the false negative rate of judging hemolytic,jaundice,and lipoid blood samples as normal samples was 0.04％.The image recognition system was compared with the blood volume data of two groups of specimens measured manually,P=0.4881.The image recognition method was not inferior to the manual measurement method.Comparing the two sets of hematocrit data from the image recognition system and the blood cell analyzer,P=0.1130,the image recognition system was not inferior to the blood cell analyzer.A total of 61 automatic re-view rules for coagulation tests had been established,including numerical abnormalities,logical abnormalities,Delta Check,sample quality abnormalities,reaction curve abnormalities,etc.The automatic review pass rate was 76.19％,true positive rate was 23.77％,true negative rate was 76.19％,false positive rate was 0.04％,and false negative rate was 0.00％.After implementing the automatic audit plan,the turnaround time of sam-ples in each quantile was shortened,with an average shortening time of 13.66 min.Conclusion The applica-tion of image recognition technology in the automatic review of coagulation tests makes the automatic review function more automated and scientific,standardizes specimen quality judgment,improves the accuracy of test results,effectively improves work efficiency and saves manpower.

Objective : The purpose of this study was to clarify the regulatory effect and mechanism of Src homology-2 domain containing protein tyrosine phosphatase-2 (SHP2) on human periodontal ligament stem cell (hPDLSC) proliferation and osteogenic differentiation under inflammatory environment and to provide a new target for the treatment of periodontitis. Methods: SHP2 was knocked down in hPDLSCs, and the transfection efficiency of SHP2 was detected by RT-qPCR and Western blot. An in vitro inflammatory environment was created using tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). The effect of SHP2 knockdown on hPDLSC viability under normal and inflammatory conditions was detected by CCK-8, and the osteogenic capacity of hPDLSCs under normal and inflammatory conditions was detected by ALP staining, ALP activity, ARS staining, RT-qPCR and Western blot. The mechanism by which SHP2 knockdown affected the MAPK pathway and its downstream NF-κB pathway under inflammatory conditions was assessed by Western blot. Results: Green fluorescence was observed after transfection for 72 h, and the titer of SHP2 shRNA recombinant lentivirus was 2.9×108 TU/mL. SHP2 expression was significantly downregulated in lentivirus-transfected cells, as demonstrated by Western blot and RT-qPCR (P<0.001). SHP2 knockdown inhibited hPDLSC proliferation to a certain extent and increased the expression of early osteogenic markers under normal conditions, including increased ALP activity and increased ALP and COL-1 expression (P<0.05). However, SHP2 knockdown exerted no effect on mineralized nodule formation. In the TNF-α- and IL-1β-induced inflammatory environment, SHP2 knockdown exerted no effect on hPDLSC proliferation (P>0.05). Osteogenic markers were upregulated (P<0.05), and mineralized nodules were significantly increased (P<0.05) after SHP2 knockdown. Western blot analysis showed that p65 phosphorylation and IκB-α degradation were reduced in SHP2-knockdown hPDLSCs in the inflammatory environment. Moreover, SHP2 knockdown significantly inhibited the expression of p-p38 and p-JNK MAPK, which represent pathways upstream of the NF-κB pathway (P<0.05). Conclusion SHP2 knockdown did not affect cell viability but promoted the osteogenic potential of hPDLSCs by inhibiting the MAPK/NF-κB-mediated signaling pathway under inflammatory environment.

Objective:To dynamically monitor the prevalence and trend of dental fluorosis in children in Shandong Province, and to evaluate the prevention and control measures for drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis), and to provide scientific basis for the next step.Methods:Totally 40 counties (cities, districts) were selected as project counties (cities, districts) from drinking water-borne fluorosis areas in Shandong Province in 2018, and all counties (cities, districts) were selected in 2019 and 2020, to investigate the situation of water improvement, detect water fluoride content, and investigate the prevalence of dental fluorosis in children aged 8 - 12 years.Results:From 2018 to 2020, the detection rates of dental fluorosis in children aged 8 - 12 years were 10.30% (503/4 884), 8.94% (25 895/289 539) and 8.66% (24 061/277 689), respectively, with statistically significant differences (χ 2 = 27.10, P < 0.001), and the dental fluorosis indexes were 0.21, 0.18 and 0.17, respectively. The total detection rates of dental fluorosis in children of different age groups in the 3 years were 7.26% (6 590/90 775), 7.97% (9 303/116 680), 9.29% (12 167/130 915), 9.29% (12 238/131 670) and 9.95% (10 161/102 072), the differences were statistically significant (χ 2 = 615.71, P < 0.001). In the 3 years, the total detection rate of dental fluorosis was 8.93% (28 101/314 737) in boys and 8.69% (22 358/257 375) in girls, the difference was statistically significant (χ 2 = 10.27, P = 0.001). In 2018 and 2019, the detection rates of dental fluorosis of children aged 8 - 12 years in water fluoride qualified villages [5.74% (235/4 095) and 7.98% (20 200/253 082)] were significantly lower than those in villages with excessive water fluoride [33.97% (268/789) and 15.62% (5 695/36 457), χ 2 = 570.61, 2 283.76, P < 0.001]. Conclusions:The prevalence of dental fluorosis among children aged 8 - 12 years has been effectively controlled, and remarkable results have been achieved in prevention and treatment of drinking water-borne fluorosis in Shandong Province. However, the detection rate of dental fluorosis among children in a few endemic villages is high, so it is necessary to continue to strengthen the monitoring of fluoride content in drinking water and the condition of dental fluorosis among children.

Background::Whether anesthetic depth affects postoperative outcomes remains controversial. This meta-analysis aimed to evaluate the effects of deep vs. light anesthesia on postoperative pain, cognitive function, recovery from anesthesia, complications, and mortality. Methods::PubMed, EMBASE, and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients. The co-primary outcomes were postoperative pain and delirium (assessed using the confusion assessment method). We conducted a meta-analysis using a random-effects model. We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression. We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results::A total of 26 trials with 10,743 patients were included. Deep anesthesia compared with light anesthesia (a mean difference in bispectral index of -12 to -11) was associated with lower pain scores at rest at 0 to 1 h postoperatively (weighted mean difference = -0.72, 95% confidence interval [CI] = -1.25 to -0.18, P= 0.009; moderate-quality evidence) and an increased incidence of postoperative delirium (24.95% vs. 15.92%; risk ratio = 1.57, 95% CI = 1.28-1.91, P < 0.0001; high-quality evidence). No publication bias was detected. For the exploratory secondary outcomes, deep anesthesia was associated with prolonged postoperative recovery, without affecting neurocognitive outcomes, major complications, or mortality. In the subgroup analyses, the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively, without statistically significant subgroup differences, and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries, without statistically significant subgroup differences. Conclusions::Deep anesthesia reduced early postoperative pain but increased postoperative delirium. The current evidence does not support the use of deep anesthesia in clinical practice.

Objective:To investigate of AIDET communication model in caring for type 2 diabetes mellitus of hospitalized patients.Methods:A total of 113 patients with type 2 diabetes mellitus treated in our department from January 2018 to November 2019 were enrolled, and divided into the control group(receiving a conventional communication mode)and the observation group(receiving an AIDET communication mode)according to a time order in the selecting of the research patients.The changes of self-care behavior and glucose metabolism index were evaluated and analyzed between the two groups.Results:On admission, the fasting blood glucose, 2-h postprandial blood glucose and glycosylated hemoglobin were(9.1±1.7)mmol/L, (13.8±2.9)mmol/L and(8.4±3.5)% in the observation group, and(9.4±2.1)mmol/L, (14.1±3.2)mmol/L and(8.1±2.9)% in the control group, respectively, with no statistically significances( P>0.05). At discharge, the observation group versus the control group showed a statistically significantly improved levels in FPG of(5.9±1.5)mmol/L vs.(7.8±1.9)mmol/L, in 2h-PBG of(10.1±3.7)mmol/L vs.(12.8±3.9)mmol/L and in glycosylated hemoglobin of(6.3±1.2)% vs.(7.5±0.9)%, respectively( P<0.05). The scores of management of poor blood glucose, foot care, blood glucose monitoring, medication compliance, regular exercise and diet control were higher in the observation group than in the control group at discharge( P<0.05). Conclusions:The application of AIDET communication mode can effectively enhance the self-care behavior of patients and help improve the glucose metabolism in hospitalized patients with type 2 diabetes mellitus.It has very positive effects on controlling the development of type 2 diabetes mellitus and improving the quality of life.

Objective To assess the effectiveness of traditional Chinese Medicine (TCM ) syndrome differentiation treatment for diabetic nephropathy in elderly patients. Methods A total of 96 elderly patients with diabetic nephropathy admitted to our hospital from January 2015 to December 2017 were recruited and divided into a regular care group (n= 48)and a TCM group(n= 48).Both groups received conventional treatment ,with TCM syndrome differentiation treatment added to the TCM group. The effectiveness of the treatment modalities was compared. Results In the regular care group ,significant effectiveness was observed in 12 patients ,effectiveness in 24 patients ,and ineffectiveness in 12 patients ,with a total effectiveness rate of 75％ .In the TCM group ,significant effectiveness was seen in 18 patients ,effectiveness in 27 ,and ineffectiveness 3 ,with a total effectiveness rate of 93％. The total effectiveness rate of the TCM group was higher than that of the regular care group(χ2 =6.400 ,P=0.011).After treatment ,fasting blood glucose ,2 h postprandial blood glucose , urea nitrogen ,creatinine ,and 24 h urine protein in the TCM group were significantly lower than in the regular care group and than pre-treatment levels(P<0.05). Conclusions TCM differentiation can not only significantly improve the treatment effectiveness in elderly patients with diabetic nephropathy ,but also relieve the clinical symptoms.

Objective To evaluate the efficacy of different concentrations and small dose of lidocaine of combined spinal epi-dural anesthesia(CSEA) in elderly patients with non-procedure for prolapse and haemorrhoids(PPH) anorectal surgery .Methods One hundred and twenty elderly patients undergoing non-PPH anorectal surgery were selected and randomly dividedin to 4 groups , the group A(1 .5% lidocaine) ,B(1 .0% lidocaine) ,C(0 .8% lidocaine) and D ,30cases in each group .The group A ,B and C adopted CSEA ,and the group D adopted the sacral anesthesia .The changes of mean arterial pressure(MAP) and heart rate(HR) at different time points ,stress reactions before and after operation ,anesthetic operating time ,effect onset time ,postoperative reactivating time , anesthetic grade ,success rate ,postoperative patient satisfaction ,postoperative surgeon satisfaction and urine retention were recor-ded .Results MAP and HR at different time points had no statistical difference among 4 groups(P>0 .05) .The anesthetic onset time and postoperative activity recovery time in the group A ,B and C were significantly less than those in the group D(P<0 .01) . The postoperative activity recovery time in the group A was longer than that in the group B and C .The urine retention time in the group A ,B and C was significantly less than that in the group D (P<0 .05) .The postoperative patient satisfaction and surgeon sat-isfaction in the group A and B were 100% .Conclusion 1% lidocaine CSEA is more suitable for the elderly patients with non-PPH anorectal operation .

Objective:To describe the clinical characteristics , overall survival as well as to evaluate the prognostic factors in Chinese diffuse large B cell lymphoma ( DLBCL) patients.Methods: DLBCL pa-tients who were initially diagnosed and treated in Peking University Cancer Hospital from January 1995 to December 2008 were identified and analyzed ,retrospectively .The 5-year OS rates were estimated with Ka-plan-Meier.Log-rank test was used to compare the survival curves of the different groups .The multivari-ate analysis of prognostic factors was conducted with Cox regression model , which included all statistically significant prognostic factors in the univariate analyses .Results:A total of 525 DLBCL patients were in-cluded in this retrospective analysis , of whom , 294 were male and 231 female ( male∶female=1 .27∶1 ) . The median age at the initial diagnosis was 55 (range 16-90) years, and 37.0% (n=194) were 60 years and above .Regarding the clinical staging at the initial diagnosis , 54 patients (10.3%) were diag-nosed as Stage Ⅰ of the disease, 152 (28.9%) as Stage Ⅱ, 117 (22.3%) as Stage Ⅲ and 202 (38.5%) as Stage Ⅳ.The ‘B symptoms’ and increased serum LDH were presented in 206 (39.2%) and 192 (36.6%) patients, respectively.A total of 197 (37.5%) patients were treated with rituximab (R).The survival follow-up continued till 31 January 2014 with a median follow-up time of 77.5 ( range:0-205) months.A total of 267 patients (50.9%) died during the follow-up period.The medi-al overall survival ( OS) time was 84 months, and 5-year OS rate was 52.3%.There were six statistically significant prognostic factors that were identified in both univariate and multivariate analyses : gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .The relative risk ( RR) of these prognostic factors in the multivariate analyses were: age >60 years /≤60 years=1.380 (95%CI 1.078 -1.765), male /female =1.315 (95%CI 1.025 -1.687), stage Ⅲ/stageⅠ=3.034(95%CI 1.667-5.522), stage Ⅳ/Ⅰ=3.748(95%CI 2.102 -6.681), with B symp-toms/without B symptoms=1.278(95%CI 0.999-1.636),serum LDH increased/LDH not increased=1.351(95%CI 1.057 -1.726), without R treatment /with R treatment =1.543(95%CI 1.182 -2 .015 ) .Compared with the IPI , age >50 years/≤50 years was a statistically significant factor in both univariate and multivariate analyses RR =1.478 (95%CI 1.148-1.902), P=0.002.Conclusion:Six factors were related to DLBCL survival:gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .Compared with the IPI , several specific factors may predict a poor prognosis in Chinese DLBCL patients:male , age>50 years and the presence of ‘B symptoms ’ .But this result is not conclusive until these factors are further tested .

Background:As an important catalytic subunit of telomerase,human telomerase reverse transcriptase (hTERT)plays an important role in the development and progression of many cancers including gastric cancer.It has been reported that several single nucleotide polymorphisms (SNPs)of hTERT had varying degrees of association with risk of neoplasms. Aims:To study the correlation between SNPs of hTERT rs2853676 and rs2853677 and susceptibility to gastric cancer. Methods:Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the genotypes of rs2853676 and rs2853677 of hTERT in 297 gastric cancer patients,105 atrophic gastritis and 402 controls. Helicobacter pylori (Hp)infection was detected by pathological examination and 13 C-urea breath test.Results:Frequency of AA genotype of rs2853676 was significantly higher in gastric cancer group when compared with control group (15.2%vs.6.5%,P =0.01).The risk of gastric cancer in AA genotype carriers increased 2.47-fold (95% CI:1.46-4.16) when compared with GG carriers.No significant differences in the frequencies of CC,TC and TT genotypes of rs2853677 were found among gastric cancer patients,atrophic gastritis patients and controls.Hp infection rates in atrophic gastritis group and gastric cancer group were significantly increased than those in controls (64.8%,56.9% vs.40.3%,P all <0.01),OR were 2.73 (95% CI:1.74-4.26),1.96 (95% CI:1.44-2.67),respectively.Logistic regression analysis showed that there was no significant interaction between Hp infection and gene mutation.Conclusions:Polymorphism of hTERT gene rs2853676 may play a role in susceptibility to gastric cancer,and Hp infection may not be involved in the increase of risk of gastric cancer caused by hTERT gene polymorphism.