Objective To analyze serum characteristics and determine the reference range for thyroid function among healthy 11～16 year-old teenagers in Xi'an in order to offer a theoretical basis for clinical diagnosis and therapy.Methods A sum of 1 378 healthy 11～16 year-old teenagers who met the inclusion criteria from the First Affiliated Hospital of the Air Force Medical University(Xijing Hospital)between January 2020 and December 2022 were selected as research subjects,including 628 males and 750 females.They were divided into three groups based on age:Group 1:11～＜13 year-olds(433 cases),Group 2:13～＜15 year-olds(425 cases),and Group 3:15～≤16 year-olds(520 cases).Differences in serum thyroid function indices among different genders and age groups were analyzed,the reference ranges for these indices were established,and 99 healthy 11-16 year-old teenagers who met the inclusion criteria were chosen for verification.Results There were no significant differences between different genders in thyroid stimulating hormone[TSH,2.56(1.80,3.63)μIU/ml vs 2.43(1.68,3.48)μIU/ml]and total thyroxine[TT4,97.84(85.34,111.00)nmol/L vs 98.20(87.16,111.23)nmol/L],the differences were statistically significant(Z=-1.881,-0.638,all P＞0.05).Meanwhile,the differences in free thyroxine[FT4,16.93(15.49,18.60)pmol/L vs 16.26(14.80,17.83)pmol/L],free triiodothyronine[FT3,6.21(5.66,6.80)pmol/L vs 5.59(4.98,6.19)pmol/L],and total triiodothyronine[TT3,2.24(1.96,2.55)nmol/L vs 2.04(1.78,2.34)nmol/L]between different genders were significant(Z=-5.368,-11.994,-6.417 all P＜0.01).The differences in thyroid function indices were significant among different age groups(Z=10.649～261.003,all P＜0.05).The reference ranges for thyroid function indices across different age groups and genders were established,in which thyroid function indicators were verified to be within the established reference range by 99 samples.Conclusion Teenage hormone secretion varies greatly,and the secretion of thyroid hormones is influenced by various factors.Thus,the diagnosis and treatment of teenage thyroid diseases cannot fully rely on the reference ranges provided by adults or manufacturers.This study established the reference range of the thyroid function indices of 11～16 year-old teenagers in Xi'an,offering clinical doctors'diagnosis and treatment data support.

ObjectiveMetabolomics was used to reveal the mechanism of Aconiti Lateralis Radix Praeparata（ALRP） in attenuating toxicity by processing from the aspects of amino acid metabolism， oxidative stress and energy metabolism by analyzing multiple metabolic pathways. MethodTwenty-four rats were randomly divided into control group， raw group and processed group， 8 rats in each group. The raw and processed group were given with 0.64 g·kg^-1 of raw ALRP and processed ALRP respectively every day， the control group was given with an equal amount of normal saline once a day. After continuous administration for 7 days， the urine， serum and heart tissue of rats were collected. Pathological examination of the heart was carried out using hematoxylin-eosin（HE） staining， and the activities of lactate dehydrogenase（LDH） and creatine kinase-MB（CK-MB） in serum and cardiac tissues were detected by microplate assay and immunoinhibition assay. The effects of ALRP on rat heart before and after processing were compared and analyzed. Ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS） was used to perform urine metabolomics analysis， and multivariate statistical analysis was used to screen for differential metabolites related to ALRP in attenuating toxicity by processing， and pathway enrichment analysis was carried out to explore the processing mechanism. ResultHE staining showed that no obvious pathological changes were observed in the heart tissue of the control group， while obvious infiltration of inflammatory cells such as plasma cells and granulocytes was observed in the heart tissue of the raw group， indicating that the raw ALRP had strong cardiotoxicity. There was no significant difference in HE staining of heart tissue between the processed group and the control group， indicating that the toxicity of ALRP was significantly reduced after processing. Compared with the control group， the activities of LDH and CK-MB were significantly increased in serum and heart tissue of the raw group， and those were significantly decreased in serum and heart tissue of the processed group， suggesting that the myocardial toxicity of processed ALRP was reduced. A total of 108 endogenous differential metabolites associated with the raw ALRP were screened using multivariate statistical analysis in positive and negative modes， of which 51 differential metabolites were back-regulated by the processed ALRP. Biological analysis of the key regulatory pathways and associated network changes showed that the pathways related to toxicity of ALRP mainly included tryptophan metabolism， arginine and proline metabolism， phenylalanine metabolism， aminoacyl-tRNA biosynthesis， alanine， aspartate and glutamate metabolism， etc. The metabolic pathways related to the attenuation of processed ALRP mainly included aminoacyl-tRNA biosynthesis， tryptophan metabolism， phenylalanine， tyrosine and tryptophan biosynthesis， phenylalanine metabolism and caffeine metabolism. ConclusionThe processing technology of ALRP in Guilingji can significantly attenuate the cardiotoxicity of raw products， the mechanism mainly involves amino acid metabolism， oxidative stress and energy metabolism， which can provide experimental bases for the research related to the mechanism of toxicity reduction of ALRP by processing and its clinical safety applications.

Objective:To develop the Postoperative Subdelirium Syndrome Knowledge, Attitude, and Practice Questionnaire for Surgical Nurses and test its reliability and validity.Methods:Based on the theory of knowledge, attitude, and practice, the preliminary Postoperative Subdelirium Syndrome Knowledge, Attitude, and Practice Questionnaire for Surgical Nurses was developed through literature search and analysis, Delphi expert consultation, and pre-survey. From February to April 2022, convenience sampling was used to select 375 surgical nurses from five Class Ⅲ Grade A hospitals and three Class Ⅲ Grade B hospitals in Zhejiang Province for questionnaire item analysis, exploratory factor analysis, and reliability testing.Results:The final Postoperative Subdelirium Syndrome Knowledge, Attitude, and Practice Questionnaire for Surgical Nurses consisted of 33 items in three dimensions of knowledge, attitude, and practice. Exploratory factor analysis extracted three common factors with a cumulative variance contribution rate of 67.016%. The total Cronbach's α coefficient of the questionnaire was 0.931, and the Cronbach's α coefficients for each dimension were 0.972, 0.906, and 0.932, respectively. The overall test-retest reliability coefficient of the questionnaire was 0.999, and the test-retest reliability coefficients for each dimension were 0.997, 0.994, and 0.998. The questionnaire-level content validity index was 0.889, and the item-level content validity index was 0.833 to 1.000.Conclusions:The Postoperative Subdelirium Syndrome Knowledge, Attitude, and Practice Questionnaire for Surgical Nurses has good reliability and validity, and can be used to evaluate the knowledge, attitude, and practice of postoperative subdelirium syndrome among surgical nurses.

Humans ; Brain Ischemia/therapy* ; Ischemic Stroke ; Receptors, N-Methyl-D-Aspartate ; TRPM Cation Channels

Humans ; Alzheimer Disease ; Amyloid beta-Peptides ; Neurons ; Lysosomes ; Hydrogen-Ion Concentration

The composition of serum is extremely complex,which complicates the discovery of new pharmaco-dynamic biomarkers via serum proteome for disease prediction and diagnosis.Recently,nanoparticles have been reported to efficiently reduce the proportion of high-abundance proteins and enrich low-abundance proteins in serum.Here,we synthesized a silica-coated iron oxide nanoparticle and devel-oped a highly efficient and reproducible protein corona(PC)-based proteomic analysis strategy to improve the range of serum proteomic analysis.We identified 1,070 proteins with a median coefficient of variation of 12.56％using PC-based proteomic analysis,which was twice the number of proteins iden-tified by direct digestion.There were also more biological processes enriched with these proteins.We applied this strategy to identify more pharmacodynamic biomarkers on collagen-induced arthritis(CIA)rat model treated with methotrexate(MTX).The bioinformatic results indicated that 485 differentially expressed proteins(DEPs)were found in CIA rats,of which 323 DEPs recovered to near normal levels after treatment with MTX.This strategy can not only help enhance our understanding of the mechanisms of disease and drug action through serum proteomics studies,but also provide more pharmacodynamic biomarkers for disease prediction,diagnosis,and treatment.

Objective:A multi-center and large sample volume study was conducted on the verification and improvement of the early established criteria for intelligent routine urinalysis validation (including the microscopic review rules and manual validation rules, referred to as intelligent criteria for short), in order to improve the clinical application of this intelligent criteria.Methods:A total of 31 456 urine specimens were collected from the inpatients and outpatients in six hospitals in China, from March to September 2019. Firstly, 3105 specimens were analyzed for preliminary verification and improvement of the intelligent criteria based on the results of the microscopic examination and manual validation. Secondly, 28 351 specimens were used to verify the clinical application of the improved intelligent criteria. All samples were manually validated as reference.Results:The approval inconsistency rate of the manual validation rules in the original intelligent criteria was 8.59% (202/2 352), and the interception inconsistency rate was 8.84% (208/2 352). The false negative rate and the microscopic review rate of the microscopic review rules were similar to the previous results. Based on an in-depth analysis of big data and the discussions by senior technicians from eight hospitals, one microscopic review rules and four manual validation rules were added, meanwhile two manual validation rule was deleted. The manual validation standards were unified. Finally, the intelligent criteria was improved. Based on the improved intelligent criteria, for microscopic review rules, the false positive rate, false negative rate (misdiagnosis rate), and microscopic review rate did not change significantly, which were 14.72% (457/3 105), 4.06% (126/3 105), and 24.73% (768/3 105), respectively. The approval inconsistency rate and the interception inconsistency rate of manual validation rules were both reduced to 0; the total manual validation rate of the intelligent criteria was 50.89% (1 580/3 105), and the auto-validation rate was 49.11% (1 525/3 105). The large sample volume verification results were consistent with the preliminary verification results of the improved intelligent criteria.Conclusion:This multi-center and large sample volume study had shown that the improved intelligent criteria had better clinical performance.

Objective:To explore the value of laparoscopic and endoscopic cooperative surgery with the patient lying on supine position under general anesthesia in the operation of type I Mirizzi syndrome with choledocholithiasis.Methods:From Jan 2018 to Jan 2020, 53 cases of Mirizzi syndrome with choledocholithiasis undergoing laparoscopic and endoscopic cooperative surgery (preLC+ ERCP+ EST) at the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed.Results:53 patients successfully underwent LC without conversion to open surgery, and 2 patients failed in ERCP + EST attempt, with a success rate of 96.2%. One patient developed pancreas pseudocyst as a result of post-operative hemorrhagic necrotizing pancreatitis. Two patients suffered from chronic pancreatitis. Three patients complaining postoperative upper abdominal discomfort were finally diagnosed as stump cystic duct inflammation by MRCP, and no abnormalities were found in the follow-up of the remaining cases.Conclusion:Laparoscopic and endoscopic cooperative surgery in the treatment of patients with type I Mirizzi syndrome combined with choledocholithiasis is minimally invasive and effective.

Objective To explore the condition of cortistatin (CST)expression in human renal tissue and the changes in the level of CST in IgA nephropathy (IgAN)of different degrees.Methods Ten tumor adjacent normal renal tissue samples were collected.The mRNA and protein expressions of CST in human renal tissue were detected by reverse transcription-polymerase chain reaction (RT-PCR)and Western blotting,respectively.Immunohistochemisty (IHC)was performed to locate the expression of CST in renal tissue.According to the grading system of Lee et al,IgAN was divided into three groups:grade Ⅰ -Ⅱ (group A),grade Ⅲ -Ⅳ (group B),and grade Ⅴ (group C),and ten renal biopsy tissue samples were collected for each group.IHC was performed to detect the change in the level of CST in normal and IgAN renal tissue of different degrees.The effect of clinical indices on the level of CST in IgAN renal tissue was assessed by multiple linear regression analysis.Results RT-PCR and Western blotting showed that CST was expressed in renal tissue and IHC showed that CST was expressed on renal tubular epithelial cells.In IgAN,the higher the pathological grade was, the higher the expression of CST in renal tubules was.Multiple linear regression analysis showed that the pathological grade was associated with the expression of CST in renal tissue (r =0.875,P <0.01).Conclusion CST may participate in the inflammatory reaction of IgAN pathological injury and exert anti-inflammation effects.

Objective To compare the sensitivity of four kinds of drug susceptibility test method in detecting sensitivity of tigecycline against Acinetobacter baumannii.Methods The susceptibility of 72 clinically isolated strains of carbapenemase-resistant Acinetobacter baumannii(CRAB) to tigecycline in vitro was detected with disk diffusion method,VITEK 2 Compact system,E-test and MIC test strip(MTS) test strip respectively,according to FDA standards,and the differences of four kinds of drug susceptibility test methods were compared.Results The susceptibility rates of 72 strains of CRAB to tigecycline by disk diffusion method,VITEK 2 Compact system,E-test and MIC test strip were 50.00%,69.44%,36.11% and 98.61% respectively,the intermediate rates were 48.61%,29.17%,26.39% and 1.39% respectively,the resistant rates were 1.39%,1.39%,37.50% and 0.00% respectively.Compared with MTS,the classification consistency rates of E-test,disk diffusion method and VITEK 2 Compact system were 36.11%,51.39% and 70.83% respectively.Conclusion There is difference among four kinds of method for conducting the drug susceptibility testing of tigecycline against CRAB,the consistency of disk diffusion method,VITEK 2 Compact system and E-test is lower.Detecting mediation or drug resistant strains of CRAB by disk diffusion method,VITEK 2 Compact system and E-test needs to be verified by MTS or Broth dilution method.