Objective:To explore the relationship between serum soluble myeloid cell trigger receptor-1(sTREM-1)messenger RNA(mRNA),high mobility group protein B1(HMGB1)mRNA levels and intestinal flora and the occurrence of preterm premature rupture of membranes(PPROM)in gestational diabetes mellitus(GDM)patients.Methods:98 GDM pregnant women with GDM combined with PPROM who underwent regular prenatal check ups and delivered at the First Hospital Affiliated to Hebei North University from June 2022 to May 2024 were selected as the GDM combined with PPROM group,102 GDM pregnant women without PPROM were selected as the GDM without PPROM group,and 108 normal pregnant women were selected as the control group.Intestinal flora,serum sTREM-1 mRNA,HMGB1 mRNA levels of the three groups of pregnant women were collected and compared;the correlation between serum sTREM-1 mRNA and HMGB1 mRNA levels and intestinal flora in GDM pregnant women,the factors affecting the occurrence of PPROM in pregnant women with GDM,and the predictive value of serum sTREM-1 mRNA and HMGB1 mRNA in the occurrence of PPROM in GDM pregnant women were analyzed.Results:Compared with control group,colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM without PPROM group and GDM combined with PPROM group(P＜0.05),the colony number of Bifidobacterium and Lactobacillus was significantly de-creased(P＜0.05).The gestational age at delivery of GDM combined with PPROM group was significantly lower than that of control group and GDM without PPROM group(P＜0.05).Compared with GDM without PPROM group,the colony number of Bifidobacterium and Lactobacillus were significantly decreased(P＜0.05),colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM com-bined with PPROM group(P＜0.05).The serum levels of sTREM-1 mRNA and HMGB1 mRNA in control group,GDM without PPROM group,GDM combined with PPROM group were increased sequentially(P＜0.05).Serum sTREM-1 mRNA was positively correlated with HMGB1 mRNA in GDM pregnant women(r＞0,P＜0.05);serum sTREM-1 mRNA and HMGB1 mRNA were positively correlated with the colony numbers of Enterococcus,Enter-obacter,Bacteroides and Fusobacterium(r＞0,P＜0.05),and negatively correlated with the colony numbers of Bifidobacterium and Lactobacillus(r＜0,P＜0.05).Enterococcus,Enterobacter,Bacteroides,Fusobacterium,sTREM-1 mRNA and HMGB1 mRNA were independent risk factors for PPROM in GDM pregnant women(OR＞1,P＜0.05),while Bifidobacterium and Lactobacillus were independent protective factors for PPROM in GDM pregnant women(OR＜1,P＜0.05).The area under curve(AUC)of predicting PPROM in GDM pregnant women by combining serum sTREM-1 mRNA and HMGB1 mRNA(0.922)was higher than the AUC predicted by serum sTREM-1 mRNA and HMGB1 mRNA alone(0.829,0.841)(P＜0.05).Conclusions:Serum sTREM-1 mRNA and HMGB1 mRNA were highly expressed in GDM pregnant women,and the increase trend of serum both was more obvious in GDM pregnant women with PPROM,both of which were related to intestinal flora imbalance and the occurrence of PPROM.The combination of sTREM-1 mRNA and HMGB1 mRNA has high efficacy in predicting the occurrence of PPROM.

Objective:To construct a continuity of care plan for adolescent fixed orthodontic patients based on the theory of timing, and provide systematic and standardized nursing interventions for adolescent fixed orthodontic patients.Methods:Guided by the theory of timing, preliminary plan items were formulated through literature review and questionnaire survey. Using the Delphi method, 15 experts were consulted for two rounds to determine the continuity of care plan for adolescent fixed orthodontic patients from October to December, 2023.Results:The effective response rates of the two rounds of questionnaires were 15/15, respectively. The expert authority levels were 0.93 and 0.94, and the Kendall harmony coefficients were 0.28 and 0.38, respectively. The differences were statistically significant (both P<0.001). The final established plan included 5 primary indicators, 23 secondary indicators, and 47 tertiary indicators. Conclusions:The continuity of care plan for adolescent fixed orthodontic patients based on the timing theory is reliable and scientific, and can meet the continuity of care needs of patients at different stages, providing reliable clinical basis for carrying out continuity of care.

Objective:To explore the relationship between serum soluble myeloid cell trigger receptor-1(sTREM-1)messenger RNA(mRNA),high mobility group protein B1(HMGB1)mRNA levels and intestinal flora and the occurrence of preterm premature rupture of membranes(PPROM)in gestational diabetes mellitus(GDM)patients.Methods:98 GDM pregnant women with GDM combined with PPROM who underwent regular prenatal check ups and delivered at the First Hospital Affiliated to Hebei North University from June 2022 to May 2024 were selected as the GDM combined with PPROM group,102 GDM pregnant women without PPROM were selected as the GDM without PPROM group,and 108 normal pregnant women were selected as the control group.Intestinal flora,serum sTREM-1 mRNA,HMGB1 mRNA levels of the three groups of pregnant women were collected and compared;the correlation between serum sTREM-1 mRNA and HMGB1 mRNA levels and intestinal flora in GDM pregnant women,the factors affecting the occurrence of PPROM in pregnant women with GDM,and the predictive value of serum sTREM-1 mRNA and HMGB1 mRNA in the occurrence of PPROM in GDM pregnant women were analyzed.Results:Compared with control group,colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM without PPROM group and GDM combined with PPROM group(P＜0.05),the colony number of Bifidobacterium and Lactobacillus was significantly de-creased(P＜0.05).The gestational age at delivery of GDM combined with PPROM group was significantly lower than that of control group and GDM without PPROM group(P＜0.05).Compared with GDM without PPROM group,the colony number of Bifidobacterium and Lactobacillus were significantly decreased(P＜0.05),colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM com-bined with PPROM group(P＜0.05).The serum levels of sTREM-1 mRNA and HMGB1 mRNA in control group,GDM without PPROM group,GDM combined with PPROM group were increased sequentially(P＜0.05).Serum sTREM-1 mRNA was positively correlated with HMGB1 mRNA in GDM pregnant women(r＞0,P＜0.05);serum sTREM-1 mRNA and HMGB1 mRNA were positively correlated with the colony numbers of Enterococcus,Enter-obacter,Bacteroides and Fusobacterium(r＞0,P＜0.05),and negatively correlated with the colony numbers of Bifidobacterium and Lactobacillus(r＜0,P＜0.05).Enterococcus,Enterobacter,Bacteroides,Fusobacterium,sTREM-1 mRNA and HMGB1 mRNA were independent risk factors for PPROM in GDM pregnant women(OR＞1,P＜0.05),while Bifidobacterium and Lactobacillus were independent protective factors for PPROM in GDM pregnant women(OR＜1,P＜0.05).The area under curve(AUC)of predicting PPROM in GDM pregnant women by combining serum sTREM-1 mRNA and HMGB1 mRNA(0.922)was higher than the AUC predicted by serum sTREM-1 mRNA and HMGB1 mRNA alone(0.829,0.841)(P＜0.05).Conclusions:Serum sTREM-1 mRNA and HMGB1 mRNA were highly expressed in GDM pregnant women,and the increase trend of serum both was more obvious in GDM pregnant women with PPROM,both of which were related to intestinal flora imbalance and the occurrence of PPROM.The combination of sTREM-1 mRNA and HMGB1 mRNA has high efficacy in predicting the occurrence of PPROM.

OBJECTIVE To analyze the distribution and drug resistance of pathogenic bacteria in hospital-associat-ed infections for patients after renal transplantation,and to provide a reference for the rational selection of antibac-terial drugs for anti-infective treatment in such patients.METHODS Clinical data were collected from 89 hospital-ized patients who underwent renal transplantation and developed hospital-associated infection at Beidaihe Rehabili-tation and Recuperation Center(formerly known as 281 Hospital)from 2017 to 2021.The pathogenic bacteria de-tected in different types of hospital-associated infections and the drug resistance of the main pathogenic bacteria were analyzed.RESULTS A total of 89 pathogenic bacterial strains were isolated from the 89 patients with hospi-tal-associated infection,including 74 gram-negative bacterial strains(83.15％)and 15 gram-positive bacterial strains(16.85％).The predominant pathogenic bacterial strains were Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa.Respiratory tract infection was the most common.E.coli showed severe drug re-sistance,with high drug resistance rates to various antibacterial drugs(complete drug resistance to piperacillin and ampicillin).K.pneumoniae was generally drug resistant to ampicillin.Enterobacter cloacae showed high sensitivi-ty to carbapenems,amikacin and enzyme inhibitor combinations.P.aeruginosa had low drug resistance rates to imipenem and meropenem.Staphylococcus aureus was completely drug resistant to antibacterial drugs such as penicillin,erythromycin and gentamicin,and no drug-resistant strains to vancomycin and linezolid were found.CONCLUSIONS The gram-negative bacteria are dominant among the bacteria isolated from the renal trans-planted patients with postoperative hospital-associated infections,with a high detection rate of E.coli and a severe drug resistance situation.Therefore,it is necessary to strengthen the monitoring of drug resistance in renal trans-plant recipients and make rational choices of antibacterial drugs.

OBJECTIVE To analyze the distribution and drug resistance of pathogenic bacteria in hospital-associat-ed infections for patients after renal transplantation,and to provide a reference for the rational selection of antibac-terial drugs for anti-infective treatment in such patients.METHODS Clinical data were collected from 89 hospital-ized patients who underwent renal transplantation and developed hospital-associated infection at Beidaihe Rehabili-tation and Recuperation Center(formerly known as 281 Hospital)from 2017 to 2021.The pathogenic bacteria de-tected in different types of hospital-associated infections and the drug resistance of the main pathogenic bacteria were analyzed.RESULTS A total of 89 pathogenic bacterial strains were isolated from the 89 patients with hospi-tal-associated infection,including 74 gram-negative bacterial strains(83.15％)and 15 gram-positive bacterial strains(16.85％).The predominant pathogenic bacterial strains were Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa.Respiratory tract infection was the most common.E.coli showed severe drug re-sistance,with high drug resistance rates to various antibacterial drugs(complete drug resistance to piperacillin and ampicillin).K.pneumoniae was generally drug resistant to ampicillin.Enterobacter cloacae showed high sensitivi-ty to carbapenems,amikacin and enzyme inhibitor combinations.P.aeruginosa had low drug resistance rates to imipenem and meropenem.Staphylococcus aureus was completely drug resistant to antibacterial drugs such as penicillin,erythromycin and gentamicin,and no drug-resistant strains to vancomycin and linezolid were found.CONCLUSIONS The gram-negative bacteria are dominant among the bacteria isolated from the renal trans-planted patients with postoperative hospital-associated infections,with a high detection rate of E.coli and a severe drug resistance situation.Therefore,it is necessary to strengthen the monitoring of drug resistance in renal trans-plant recipients and make rational choices of antibacterial drugs.

Objective:To construct a continuity of care plan for adolescent fixed orthodontic patients based on the theory of timing, and provide systematic and standardized nursing interventions for adolescent fixed orthodontic patients.Methods:Guided by the theory of timing, preliminary plan items were formulated through literature review and questionnaire survey. Using the Delphi method, 15 experts were consulted for two rounds to determine the continuity of care plan for adolescent fixed orthodontic patients from October to December, 2023.Results:The effective response rates of the two rounds of questionnaires were 15/15, respectively. The expert authority levels were 0.93 and 0.94, and the Kendall harmony coefficients were 0.28 and 0.38, respectively. The differences were statistically significant (both P<0.001). The final established plan included 5 primary indicators, 23 secondary indicators, and 47 tertiary indicators. Conclusions:The continuity of care plan for adolescent fixed orthodontic patients based on the timing theory is reliable and scientific, and can meet the continuity of care needs of patients at different stages, providing reliable clinical basis for carrying out continuity of care.

Objective:To investigate the effects of remimazolam on hemodynamics during the induction of general anesthesia and postoperative cognitive function in patients undergoing cardiac valve replacement surgery.Methods:A randomized controlled study was conducted involving 80 patients who underwent heart valve replacement surgery at Yan'an University Affiliated Hospital from January 2020 to December 2023. The patients were randomly assigned to either a control group or an observation group, with 40 patients in each group. The control group received routine general anesthesia, while the observation group received additional remimazolam during the routine anesthesia process. Hemodynamic parameters were compared between the two groups at different time points: heart rate and mean arterial pressure were recorded before anesthesia induction (T1), at the beginning of anesthesia induction (T2), 5 minutes after anesthesia induction (T3), at the time of tracheal intubation (T4), and 5 minutes after tracheal intubation (T5). The level of anesthesia during induction was compared between the two groups. Cognitive function in both groups was evaluated before and immediately after surgery. Additionally, the incidence of anesthesia-related adverse events during the perioperative period was compared between the two groups.Results:At T4 and T5, the heart rates in the observation group were (79.23 ± 10.22) beats/min and (78.54 ± 9.94) beats/min, respectively, and the mean arterial pressures were (115.64 ± 21.04) mmHg (1 mmHg = 0.133 kPa) and (108.61 ± 17.99) mmHg. Both values were significantly lower than those in the control group [heart rate: (84.51 ± 10.35) beats/min, (84.31 ± 10.08) beats/min, mean arterial pressure: (130.06 ± 19.25) mmHg, (121.62 ± 18.61) mmHg, t = 2.30, 2.58, 3.20, 3.18, all P < 0.05]. The time taken for the EEG bi-frequency index to drop below 60 and the EEG bi-frequency index before tracheal intubation in the observation group were both significantly lower than those in the control group ( t = 3.03, 3.14, both P < 0.05). Immediately after surgery, the Mini-Mental State Examination (MMSE) score in the control group showed a significant decrease ( t = 6.43, P < 0.05), while the MMSE score in the observation group did not change significantly ( t = 0.60, P > 0.05). Moreover, the immediate postoperative MMSE score in the observation group [(26.98 ± 2.97) points] was significantly higher than that in the control group [(23.15 ± 2.78) points, t = -5.95, P < 0.05]. There was no statistically significant difference in the incidence of anesthesia-related adverse events between the two groups (χ2 = 0.66, P > 0.05). Conclusion:Remimazolam can maintain hemodynamic stability during the induction of anesthesia in patients undergoing cardiac valve replacement surgery, facilitate the rapid attainment of satisfactory sedation, and reduce immediate postoperative cognitive dysfunction. Furthermore, the use of remimazolam in conjunction with routine general anesthesia does not significantly increase anesthesia-related risks, demonstrating a high level of safety.

Objective To investigate the correlation between vitamin A,E,D and folic acid levels and concomitant preeclampsia(PE)in patients with gestational diabetes mellitus(GDM).Methods A total of 108 patients with GDM complicated with PE were used as the PE group,and another 108 GDM patients without PE were used as the GDM group.A total of 108 normal pregnant women with normal pregnancy test were used as the normal control group.The general information and vitamin A,E,D and folic acid levels were compared between the three groups.According to the severity of the disease,the PE group was subdivided into the mild-moderate PE group(62 cases)and the severe PE group(46 cases),and vitamin A,E,D and folic acid levels were compared between these two groups.Results Systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),fasting insulin(FINS)were increased in turn in the normal control group,the GDM group and the PE groups(P＜0.05),and vitamins A,E,D and folic acid levels were decreased in turn(P＜0.05).Triglyceride,total cholesterol and glycated haemoglobin were higher in the PE group than those in the GDM group and the normal control,and high density lipoprotein(HDL)cholesterol was lower than that in the GDM group and the normal control group(P＜0.05).Vitamin A,vitamin E,vitamin D and folic acid levels were lower in the severe PE group than those in the mild to moderate PE group(P＜0.05).Higher levels of vitamin A,vitamin E,vitamin D and folate were protective factors for GDM patients with severe PE.Folic acid showed higher predictive efficacy and specificity in single indicator analysis.Vitamin A showed high predictive specificity.The combined prediction of four indicators for severe PE in GDM patients was more effective than each individual indicator.Conclusion Serum vitamin A,E,D and folate levels are significantly lower in patients with GDM complicated with PE,and the combination of all four may improve the predictive value of severe PE complicated with GDM.

L-glutamic acid is the world's largest bulk amino acid product that is widely used in the food, pharmaceutical and chemical industries. Using Corynebacterium glutamicum G01 as the starting strain, the fermentation by-product alanine content was firstly reduced by knocking out the gene encoding alanine aminotransferase (alaT), a major by-product related to alanine synthesis. Secondly, since the α-ketoglutarate node carbon flow plays an important role in glutamate synthesis, the ribosome-binding site (RBS) sequence optimization was used to reduce the activity of α-ketoglutarate dehydrogenase and enhance the glutamate anabolic flow. The endogenous conversion of α-ketoglutarate to glutamate was also enhanced by screening different glutamate dehydrogenase. Subsequently, the glutamate transporter was rationally desgined to improve the glutamate efflux capacity. Finally, the fermentation conditions of the strain constructed using the above strategy were optimized in 5 L fermenters by a gradient temperature increase combined with a batch replenishment strategy. The glutamic acid production reached (135.33±4.68) g/L, which was 41.2% higher than that of the original strain (96.53±2.32) g/L. The yield was 55.8%, which was 11.6% higher than that of the original strain (44.2%). The combined strategy improved the titer and the yield of glutamic acid, which provides a reference for the metabolic modification of glutamic acid producing strains.
Glutamic Acid ; Corynebacterium glutamicum/genetics* ; Ketoglutaric Acids ; Metabolic Engineering ; Alanine

Background A large amount of iron deposition in the brain can cause neuronal damage by inducing oxidative stress, neuroinflammation, and abnormal mitochondrial function. In addition, iron deposition is also reported to be closely related to the pathogenesis of Alzheimer's disease (AD). The neurofibrillary tangles aggregated by tau hyperphosphorylation are one of the important pathological features of AD. Objective To investigate potential effect of exogenous trivalent iron ions on neuronal activity in human neuroblastoma (SH-SY5Y) cells and tau hyperphosphorylation and aggregation. Methods SH-SY5Y cells were treated with ferric chloride (FeCl₃) at four concentrations (10, 100, 200, and 400 mg·L⁻¹). Cell survival rate was then detected by CCK8 assay. Intracellular iron content was determined prussian blue (Perl's) by iron staining after 24 h exposure to FeCl₃ at 10 or 200 mg·L⁻¹. Transfection of tau-P301L plasmid was conducted to construct an AD-like cell model for tau overexpression. The differences in the expression of the phosphorylated tau (p-tau) protein in SH-SY5Y cells and SH-SY5Y cells with tau overexpression were detected by Western blotting after 24 h exposure to FeCl₃ at 10 and 200 mg·L⁻¹. After dilution with phosphate buffered saline (PBS), FeCl₃, human tauR3, and FeCl₃ + tauR3 were incubated at 37℃, and the fluorescence intensity reflecting tau aggregation level was measured by thioflavin T(ThT) method at 12, 24, 36, 48, 60, 72, 84, and 96 h, respectively. Meanwhile, after 96 h coincubation of FeCl₃ and tauR3, the fibers formed by tau aggregation were observed under a transmission electron microscope (TEM). Results After 24 h of FeCl₃ exposure, the cell survival rate of SH-SY5Y cells among all groups was statistically different (F=8.63, P<0.01). The cell survival rates in the 200 and 400 mg·L⁻¹ groups were 80.1% and 68.7% of the control group, respectively (P<0.05). Compared with the control group, the nuclei of the 200 mg·L⁻¹ FeCl₃ group were mainly yellowish-brown after iron staining and the positive cell rate was up-regulated by 12.9% (P<0.01). After 24 h of FeCl₃ exposure , the p-tau (Ser396) protein expression was statistically different among all groups (F=11.6, P<0.01). Compared with the control group, the p-tau protein expression level of SH-SY5Y cells in the 200 mg·L⁻¹ group was up-regulated by 72.7% (P<0.01). After FeCl₃-treated SH-SY5Y cells with tau overexpression for 24 h, the p-tau (Ser396) protein expression was statistically different among all groups (F=27.8, P<0.01). Compared with the tau group, the p-tau (Ser396) protein expression level of SH-SY5Y cells in the tau + 200 mg·L⁻¹ group was up-regulated by 44.6% (P<0.05). Compared with the tauR3 group, the fluorescence intensities in the 84 and 96 h tauR3 + FeCl₃ groups were up-regulated by 49.9% and 53.7% (P<0.01) respectively. After 96 h of coincubation, compared with the tauR3 group, FeCl₃ + tauR3 aggravated tau aggregation and formed fiber deposition under TEM. Conclusion Exogenous trivalent iron ions may inhibit SH-SY5Y cell viability, promote the phosphorylation of tau in SH-SY5Y cells transfected with tau-P301L plasmid, and aggravate tauR3 aggregation and fiber production.