Objective To explore the echocardiographic features of critically ill patients with infection, and to evaluate the predictive value of echocardiographic parameters for 28-day mortality and myocardial injury. Methods Using a single-center prospective cohort design, 120 critically ill patients with infection admitted to the Intensive Care Unit, Jinshan Hospital of Fudan University from January 2024 to January 2025 were enrolled consecutively. According to the severity of infection, patients were divided into the sepsis group (n＝75) and the non-sepsis group (n＝45). Cox proportional hazards models and modified Poisson regression were used to analyze risk factors of 28-day all-cause mortality and myocardial injury. Kaplan-Meier survival curve and log-rank test were used to assess prognosis differences among patients with different ultrasound parameters. ROC curve and area under the curve (AUC) were applied to evaluate the predictive performance of ultrasound parameters, and restricted cubic spline (RCS) model was used to explore nonlinear relationships. Results The E/e′ ratio was significantly higher in the sepsis group than in the non-sepsis group (P＜0.001), while left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were lower in the sepsis group (P＜0.05). The Cox proportional hazards model found no association between ultrasound parameters and 28-day all-cause mortality. Modified Poisson regression showed that, after adjusting for confounding factors, elevated E/e′ was an independent risk factor of myocardial injury (RR＝1.12, 95% CI 1.07–1.17, P＜0.001). Survival analysis demonstrated that patients with E/e′ ＞10.9 had lower 28-day survival rates (P＝0.02), and the AUC for E/e′ predicting myocardial injury was 0.835. RCS analysis suggested a nonlinear relationship between E/e′ and myocardial injury risk (P＜0.001). Conclusions E/e′, LVEF, and LVFS have no significant predictive value for 28-day mortality risk in critically ill patients with infections. Elevated E/e′ is an independent risk factor of myocardial injury in such patients, with a nonlinear relationship.

Objective:To explore the role and mechanism of Ras homolog gene family member E (RhoE) gene in myocardial fibrosis in diabetic cardiomyopathy.Methods:Wild-type SD rats were intraperitoneally injected with streptozotocin solution (STZ, 70 mg/kg) and an equal volume of sodium citrate solution to establish the type 1 diabetes mellitus (T1DM) group ( n=15) and the T1DM control group ( n=15), respectively. db/db spontaneous type 2 diabetes mellitus (T2DM) mice and wild-type C57BL/6J mice were conventionally housed for 8 weeks to establish the T2DM group ( n=5) and the T2DM control group ( n=5), respectively. Heterozygote SD rats with systemic knockout of the RhoE gene were intraperitoneally injected with STZ solution (70 mg/kg) and an equal volume of sodium citrate solution to establish the RhoE knockout T1DM group ( n=5) and the RhoE knockout control group ( n=5), respectively. Wild-type SD rats were injected with RhoE-overexpressing adeno-associated virus 9 through tail vein and intraperitoneally injected with STZ solution (70 mg/kg) to establish the RhoE overexpression T1DM group ( n=5), while wild-type SD rats injected with negative control virus through tail vein and intraperitoneally injected with an equal volume of sodium citrate solution served as the RhoE overexpression control group ( n=5). After successful modeling, all animals in each group were conventionally housed for an additional 6 or 8 weeks, which marked the experimental endpoint. At the experimental endpoint, echocardiography was performed to assess cardiac function of animals in each group, and left ventricular ejection fraction (LVEF) and the ratio of early to late diastolic transmitral flow velocity (E/A ratio) were analysed. Masson staining was used to detect collagen fiber deposition in myocardial tissue of animals in each group. Western blot analysis was conducted to detect the expression levels of RhoE gene, type Ⅰ collagen, type Ⅲ collagen, Smad2/3, and phosphorylated Smad2/3 protein in myocardial tissue of rats. Enzyme-linked immunosorbent assay was used to measure the levels of transforming growth factor-β1 (TGF-β1) in serum of rats. Results:Compared with their respective control groups, the expression of RhoE in the heart tissues of mice in the T2DM group and rats in the T1DM group was significantly downregulated, and the deposition of collagen fibers was more significant ( P<0.05), and LVEF and E/A ratio were lower (all P<0.05). Compared with the T1DM group, the phosphorylation level of Smad2/3、the levels of type Ⅰ collagen and type Ⅲ collagen in myocardial tissue and the level of TGF-β1 in serum were higher in the RhoE knockout T1DM group (all P<0.05). Additionally, rats in the RhoE overexpression T1DM group had higher LVEF and E/A ratios (both P<0.05) and less collagen fiber deposition ( P<0.05) compared with the T1DM group. Conclusions:Myocardial fibrosis induced by diabetes mellitus activates TGF-β1/Smads signaling pathway by inhibiting RhoE gene expression. Myocardial targeting overexpression of the RhoE mediated by adeno-associated virus 9 can alleviate myocardial fibrosis and improve cardiac function in rats with diabetic cardiomyopathy.

Objective A biomechanical model of cervical kyphosis under the effects of axial traction load and lateral push load was establised,so as to provide a theoretical basis for the treatment of cervical curvature abnormalities,and formulate the most appropriate treatment plan for patients.Methods Based on the CT scan data of patients,the axial data of the cervical spine was extracted to fit the cervical curvature curve.Using the Timoshenko beam theory and the cervical rehabilitation training system,a mathematical model of cervical kyphosis was established for analytical calculations to obtain the recovery curve of the cervical spine under load and the total load required to cure cervical kyphosis,and its rationality was also verified.Results The biomechanical model of cervical kyphosis was established.Under the effects of axial traction load and lateral push load,the cervical spine effectively developed in the direction of physiological bending.The total axial load and lateral load were 353 N and 5 649 N,respectively,and the total axial load increased with the increase in traction angle.The therapeutic moment of the total lateral load decreased as the Bordon value increased.The therapeutic moment of the axial load was smaller than that of the lateral load in the range of normal Bordon value,confirming the rationality of the loads.Conclusions The established biomechanical model of cervical kyphosis can accurately simulate the biomechanical characteristics of the cervical spine,and the analysis results were valid,providing a mechanical theoretical basis for the design of treatment plans for patients.

Objective:To investigate the awareness of Chinese gastroenterologists regarding the treatment targets of inflammatory bowel disease (IBD) as defined by the STRIDE-Ⅱ consensus and to identify challenges encountered in clinical practice.Methods:A nationwide cross-sectional survey was conducted via an online questionnaire distributed to gastroenterologists between February 16 and March 31, 2024. The survey encompassed demographic data, recognition and adherence to the STRIDE-Ⅱ consensus, perceived importance of IBD treatment targets, and clinical challenges.Results:A total of 203 valid questionnaires were collected from 28 provinces (autonomous regions/municipalities). The majority of participants (177/203, 87.2%) reported routinely referencing the STRIDE-Ⅱ consensus in IBD management. Over 90% of physicians identified endoscopic mucosal healing as the core treatment target. Additionally, approximately 80% emphasized the importance of clinical remission, endoscopic remission, quality-of-life improvement, disability prevention, and normalization of growth in pediatric patients. The challenges reported by more than half of physicians in acheiving the goals of the treatment process included lack of a standardized definition for mucosal healing (69.5%), management of psychological comorbidities (89.2%), drug failure (74.4%), penetrating Crohn's disease (72.4%), perianal fistulizing Crohn's disease (65.0%), and IBD management during pregnancy (61.1%).Conclusions:Chinese gastroenterologists demonstrate high awareness and adherence to the STRIDE-Ⅱ consensus, prioritizing mucosal healing as the cornerstone of IBD management. However, numerous challenges remain in clinical practice, particularly regarding operational definitions of therapeutic endpoints and complex disease phenotypes.

Objective:To investigate the awareness of Chinese gastroenterologists regarding the treatment targets of inflammatory bowel disease (IBD) as defined by the STRIDE-Ⅱ consensus and to identify challenges encountered in clinical practice.Methods:A nationwide cross-sectional survey was conducted via an online questionnaire distributed to gastroenterologists between February 16 and March 31, 2024. The survey encompassed demographic data, recognition and adherence to the STRIDE-Ⅱ consensus, perceived importance of IBD treatment targets, and clinical challenges.Results:A total of 203 valid questionnaires were collected from 28 provinces (autonomous regions/municipalities). The majority of participants (177/203, 87.2%) reported routinely referencing the STRIDE-Ⅱ consensus in IBD management. Over 90% of physicians identified endoscopic mucosal healing as the core treatment target. Additionally, approximately 80% emphasized the importance of clinical remission, endoscopic remission, quality-of-life improvement, disability prevention, and normalization of growth in pediatric patients. The challenges reported by more than half of physicians in acheiving the goals of the treatment process included lack of a standardized definition for mucosal healing (69.5%), management of psychological comorbidities (89.2%), drug failure (74.4%), penetrating Crohn's disease (72.4%), perianal fistulizing Crohn's disease (65.0%), and IBD management during pregnancy (61.1%).Conclusions:Chinese gastroenterologists demonstrate high awareness and adherence to the STRIDE-Ⅱ consensus, prioritizing mucosal healing as the cornerstone of IBD management. However, numerous challenges remain in clinical practice, particularly regarding operational definitions of therapeutic endpoints and complex disease phenotypes.

Objective A biomechanical model of cervical kyphosis under the effects of axial traction load and lateral push load was establised,so as to provide a theoretical basis for the treatment of cervical curvature abnormalities,and formulate the most appropriate treatment plan for patients.Methods Based on the CT scan data of patients,the axial data of the cervical spine was extracted to fit the cervical curvature curve.Using the Timoshenko beam theory and the cervical rehabilitation training system,a mathematical model of cervical kyphosis was established for analytical calculations to obtain the recovery curve of the cervical spine under load and the total load required to cure cervical kyphosis,and its rationality was also verified.Results The biomechanical model of cervical kyphosis was established.Under the effects of axial traction load and lateral push load,the cervical spine effectively developed in the direction of physiological bending.The total axial load and lateral load were 353 N and 5 649 N,respectively,and the total axial load increased with the increase in traction angle.The therapeutic moment of the total lateral load decreased as the Bordon value increased.The therapeutic moment of the axial load was smaller than that of the lateral load in the range of normal Bordon value,confirming the rationality of the loads.Conclusions The established biomechanical model of cervical kyphosis can accurately simulate the biomechanical characteristics of the cervical spine,and the analysis results were valid,providing a mechanical theoretical basis for the design of treatment plans for patients.

Objective:To explore the role and mechanism of Ras homolog gene family member E (RhoE) gene in myocardial fibrosis in diabetic cardiomyopathy.Methods:Wild-type SD rats were intraperitoneally injected with streptozotocin solution (STZ, 70 mg/kg) and an equal volume of sodium citrate solution to establish the type 1 diabetes mellitus (T1DM) group ( n=15) and the T1DM control group ( n=15), respectively. db/db spontaneous type 2 diabetes mellitus (T2DM) mice and wild-type C57BL/6J mice were conventionally housed for 8 weeks to establish the T2DM group ( n=5) and the T2DM control group ( n=5), respectively. Heterozygote SD rats with systemic knockout of the RhoE gene were intraperitoneally injected with STZ solution (70 mg/kg) and an equal volume of sodium citrate solution to establish the RhoE knockout T1DM group ( n=5) and the RhoE knockout control group ( n=5), respectively. Wild-type SD rats were injected with RhoE-overexpressing adeno-associated virus 9 through tail vein and intraperitoneally injected with STZ solution (70 mg/kg) to establish the RhoE overexpression T1DM group ( n=5), while wild-type SD rats injected with negative control virus through tail vein and intraperitoneally injected with an equal volume of sodium citrate solution served as the RhoE overexpression control group ( n=5). After successful modeling, all animals in each group were conventionally housed for an additional 6 or 8 weeks, which marked the experimental endpoint. At the experimental endpoint, echocardiography was performed to assess cardiac function of animals in each group, and left ventricular ejection fraction (LVEF) and the ratio of early to late diastolic transmitral flow velocity (E/A ratio) were analysed. Masson staining was used to detect collagen fiber deposition in myocardial tissue of animals in each group. Western blot analysis was conducted to detect the expression levels of RhoE gene, type Ⅰ collagen, type Ⅲ collagen, Smad2/3, and phosphorylated Smad2/3 protein in myocardial tissue of rats. Enzyme-linked immunosorbent assay was used to measure the levels of transforming growth factor-β1 (TGF-β1) in serum of rats. Results:Compared with their respective control groups, the expression of RhoE in the heart tissues of mice in the T2DM group and rats in the T1DM group was significantly downregulated, and the deposition of collagen fibers was more significant ( P<0.05), and LVEF and E/A ratio were lower (all P<0.05). Compared with the T1DM group, the phosphorylation level of Smad2/3、the levels of type Ⅰ collagen and type Ⅲ collagen in myocardial tissue and the level of TGF-β1 in serum were higher in the RhoE knockout T1DM group (all P<0.05). Additionally, rats in the RhoE overexpression T1DM group had higher LVEF and E/A ratios (both P<0.05) and less collagen fiber deposition ( P<0.05) compared with the T1DM group. Conclusions:Myocardial fibrosis induced by diabetes mellitus activates TGF-β1/Smads signaling pathway by inhibiting RhoE gene expression. Myocardial targeting overexpression of the RhoE mediated by adeno-associated virus 9 can alleviate myocardial fibrosis and improve cardiac function in rats with diabetic cardiomyopathy.

Objective: To explore the mediating effect of parental hostile attribution bias on depression and anxiety between parents and children, so as to provide the reference for the promotion of children's mental health. Methods: Students of grades 2-6 in two public primary schools in Linping District, Hangzhou City and their parents were investigated using stratified sampling method in November 2022. Emotions of children were surveyed using Depression Self-Rating Scale for Child (DSRSC) and Screen for Child Anxiety Related Emotional Disorders (SCARED), while emotions and hostile attribution bias of parents were surveyed using Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Social Cognitive Screening Questionnaire (SCSQ). Mediating effect of parental hostile attribution bias on depression and anxiety between parents and children was analyzed using a structural equation model. Results: Totally 300 questionnaires were allocated, and 263 valid questionnaires were recovered, with an effective rate of 87.67%. There were 137 boys (52.09%), and 126 girls (47.91%), with a mean age of (9.95±1.44) years. There were 69 fathers and 194 mothers investigated. The prevalence of depression among parents was 27.00%, the prevalence of anxiety among parents was 4.18%, and the median score of hostile attribution bias was 1.00 (interquartile range, 2.00). The prevalence of depression among children was 11.03%, and the prevalence of anxiety among children was 29.66%. Parents' depression and anxiety affected children's depression and anxiety directly (effect value=0.270, 95%CI: 0.131-0.436), and also indirectly affected children's depression and anxiety by increasing their hostile attribution bias (effect value=0.028, 95%CI: 0.004-0.082), with the mediating effect contributed 9.40% of the total effect. Conclusion Parents' depression and anxiety affect children's depression and anxiety directly or indirectly through hostile attribution bias.

Objective To investigate current status in knowledge,attitude and practice(KAP)of transitional care among the nurses in Shaanxi province,identify the influencing factors that hinder the transitional care and carry out training of transitional care for the nurses in different specialties in order to provide a theoretical basis for establishing a transitional care model for discharged patients.Methods A total of 2 288 nurses were selected to participate the survey from 41 hospitals in Shaanxi province by the stratified two-stage random sampling method.A self-designed questionnaire for general information,an obstacle factor scale,and a KAP of transitional care questionnaire were used as the survey instruments.The data acquired from the survey were processed by Cluster analysis to identify potential categories and the influencing factors.Results Totally 2085 nurses finished the study.Total score of KAP of transitional care among the nurses in Shaanxi province was found at(134.96±23.75),which was at a medium level.The scores of knowledge,attitude and practice were 77.24%,80.64%and 76.98%respectively.Cluster analysis showed that all the nurses could be categorised into either a lower scored group(n=1 596,76.5%)or a higher scored group(489,23.5%),with a best potential category number of 2 for the 2 085 nurses who participated the survey.There were statistically significant differences between the groups in terms of care training,telephone follow-up,network platform,outpatient service of nursing experts,family visits,patient club and hospital categories(all P＜0.05).Logistic regression analysis on even factors above showed that care training,telephone follow-up,network platform and patient club could significantly affect the potential categorisation of KAP of the nurses in transitional care(all P＜0.05).The main factors that hindered the transitional care included insufficient human resources(93.81%),insufficient supply of community services(93.57%)and lack of a standardised flowchart for transitional care(93.09%).Conclusions Levels of KAP about the transitional care are at a medium level among the nurses of 41 hospitals in Shaanxi province,which indicates that the nurses are active in attitude,but the knowledge and practice are required to be further improved and standardised.The results of cluster analysis indicate that it is necessary for nursing managers to carry out targeted trainings in transitional care for the nurses in different categories.This study provides a theoretical basis to establish a diversified transitional care mode for discharged patients in Shaanxi province.

ObjectiveTo observe the effectiveness and safety of the Chinese herbal medicine Mingshi Granules （明视方颗粒） for low myopia in children with heart yang insufficiency. MethodsA multicentre， prospective， double-blind randomised controlled study was conducted， in which 290 children with low myopia from 8 centres were randomly divided into 145 cases in the treatment group and 145 cases in the control group， and the treatment group was given education， dispensing glasses， and Chinese herbal medicine Mingshi Granules， while the control group was given education， dispensing glasses， and granules placebo. Both Mingshi Granules and placebo granules were taken orally， 1 bag each time， twice daily， 4 weeks of oral intake and 2 weeks of rest as 1 course of treatment， a total of 4 courses of treatment （24 weeks）. Equivalent spherical lenses， best naked-eye distance visual acuity， ocular axis， corneal curvature K1， adjustment amplitude， traditional Chinese medicine （TCM） symptom scores， calculate the amount of progression of equivalent spherical lenses， were observed at the 12th and the 24th week of treatment， at the 36th week and 48th week of follow-up， resectively， the control rate of myopia progression was evaluated at the 24th week， and safety indexes were observed before treatment. ResultsThe amount of progression of equivalent spherical lenses was lower in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The control rate of myopia progression at 24 weeks after treatment in the treatment group was higher （57.60%， 72/125） than that in the control group （44.63%， 54/121） （P＜0.05）. The best naked-eye distance visual acuity at 36-week follow-up in the treatment group was higher than that in the control group （P＜0.05）. Equivalent spherical lenses were significantly lower in both groups at all observation time points compared with pre-treatment （P＜0.05）， and were higher in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The ocular axes of both groups were significantly higher at each observation time point after treatment and at follow-up compared with before treatment （P＜0.05）. The amount of eye axis growth in the treatment group was lower than that in the control group at 24 weeks after treatment and at the 48-week follow-up （P＜0.05）. Corneal curvature K1 was significantly lower in the treatment group at the 24th week of treatment compared to pre-treatment （P＜0.05）. The magnitude of adjustment in the treatment group was significantly higher at the 36-week follow-up and at the 48-week follow-up than before treatment （P＜0.05）. The scores of white/dark complexion， white coating thin pulse， fatigue and total TCM symptom scores of children in both groups at the 12th， 24th， 36th and 48th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； the scores of blurred vision at the 24th and 36th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； and the scores of blurred vision in the treatment group at the 48th week of follow-up were signi-ficantly lower than those before treatment （P＜0.05）. In the treatment group， the score of fatigue was higher than that of the control group at the 36-week follow-up， and the score of blurred vision was lower than that of the control group at the 48-week follow-up （P＜0.05）. No adverse reactions or obvious abnormalities of the safety indexes were observed of the two groups during the treatment. ConclusionChinese herbal medicine Mingshi Granules showed the effect of controlling the progression of low myopia， improving the best naked eye distance visual acuity， slowing down the growth of the eye axis， improving some of the TCM symptoms， with good safety.