Objective To identify the indicators associated with poor prognosis by retrospectively analyzing the clinical data of 129 patients with lung adenocarcinoma (LUAD) complicated by brain metastases (BMs). Methods We retrospectively assessed the clinical data of 129 LUAD patients with BMs who met the inclusion criteria. Follow-up was conducted through electronic medical record review and telephone consultations. Univariate survival analysis was performed using the Kaplan-Meier method with corresponding survival curves. Statistically significant variables identified in the univariate analysis were subsequently incorporated into a multivariate Cox proportional hazards regression model to further identify independent adverse prognostic factors affecting the survival of LUAD patients with BMs. Results The following factors were significantly associated with patient survival prognosis (P<0.05): pathological morphology, KPS score, number of BMs, presence of genetic variations, quantity of genetic variations, type of genetic variations, EGFR mutation status, Cyfra-211, and neutrophil-to-lymphocyte ratio (NLR) at initial diagnosis. Multivariate Cox regression analysis revealed that pathological morphology, KPS score, number of BMs, NLR at initial diagnosis, and presence of genetic variations served as independent prognostic factors for LUAD patients with BMs (P<0.05). Further analysis of the survival conditions of different treatment subgroups revealed that combined therapy could significantly increase the median survival period of patients, and the difference was statistically significant (P=0.034). Conclusion Solid and complex glandular structures, KPS score <80, ≥3 BMs, elevated NLR levels at initial diagnosis, and the presence of genetic alterations are identified as independent poor prognostic factors for LUAD patients with BMs. Combination therapy can significantly prolong the survival of patients.

Nursing skill competitions are the wind vane for clinical nursing development, and the teaching concepts, proposition forms, and evaluation systems demonstrated by competitions have a strong reference value for nursing teaching. This article introduces the knowledge selection and integration from nursing-related courses according to the problems and objectives to be solved by drawing on the STEM education concept in comprehensive nursing practical training in the context of integration of competition and education. Realistic problem scenarios can be created with clinical cases as the carrier or main line, and then the Tanner clinical judgment model is used to guide students to conduct a comprehensive analysis of cases, thereby helping students to develop clinical thinking ability and comprehensive practical skills, so as to bridge the gap between the contents learned at school and nursing work in clinical practice and help nursing students adapt to clinical practice as soon as possible.

Objective To analyze the effect of a high salt diet on ovarian mitochondrial function.Methods Twenty female ICR mice were randomly divided into a normal salt diet(NSD)group and a high salt diet(HSD)group(n = 10 each).The NSD group was given a normal salt diet and the HSD group was given an 8%NaCl diet for 4 weeks.A high salt-treated cell model was established by inducing COV-434 cells cultured in vitro with NaCl.Western blotting was used to detect the protein expression of superoxide dismutase(SOD)and ComplexesⅠ-Ⅴ.The activity of SOD and succinate dehydrogenase(SDH)was detected kinetically.A chemiluminescence assay was used to detect adenosine triphosphate(ATP)levels.Results Compared with the NSD,the HSD significantly reduced the expression level of ComplexⅠin ovarian mitochondria(P＜0.01),significantly increased the expression level of ComplexⅤ(P＜0.05),and significantly reduced the activity of SDH and content of ATP(P＜0.01).The expression level of ComplexesⅠandⅡdecreased significantly(P＜0.05),expression level of ComplexⅤ increased significantly(P＜0.05),activity of SDH decreased significantly(P＜0.01),and content of ATP was insufficient(P＜0.01)in COV-434 cells cultured under high salt conditions.Conclusion High salt can lead to mitochondrial dys-function in the mouse ovary,such as imbalanced oxidative homeostasis,changed expression level of electron transport chain complexes,blocked tricarboxylic acid cycle,and insufficient ATP level.

Objective To elucidate the influence of two procedures aortic root remodeling using a straight tubular artificial vessel while preserving the aortic valve and the Florida sleeve procedure on the biomechanics of the aortic root.Methods Five finite element models of the aortic root were reconstructed using computed tomography angiography images,including two cases of aortic root remodeling(A1 and A2),two cases of the Florida sleeve procedure(B1 and B2),and one control group without aortic root pathology(C).Numerical simulations were performed to obtain the blood flow and pressure distribution result to assess the differences in the hemodynamics of the aortic root.Results There were no significant differences in the peak systolic velocity between the two procedures and the control.However,the flow velocity after aortic root remodeling was smoother,similar to the model of the control group,with a more stable average aortic pressure and wall shear stress.In the Florida sleeve procedure,high-speed blood flow affected the vessel wall,leading to various degrees of wall shear stress and pressure concentrations along the aortic wall.Conclusions After aortic root replacement with valve preservation,blood flow patterns in the reconstructed aortic root depended on postoperative changes in sinus geometry.Both surgical procedures showed favorable blood flow patterns;however,the flow pattern after aortic root remodeling was more stable than that after the Florida sleeve procedure.

Objective To investigate the role and mechanism of zinc finger protein 281(ZNF281)in high glucose(HG)-induced epithelial-mesenchymal transition(EMT)and extracellular matrix(ECM)synthesis in renal tubular epithelial cells(RTECs).Methods HG induced RTECs were used to construct a diabetic kidney disease cell model,and cells were divided into the control group,the HG group and the mannitol group.Cell proliferation viability was detected by CCK-8.The expression of ZNF281 was knocked down in HG-treated RTECs using small interfering RNA(siRNA).HG-induced RTECs after knockdown of ZNF281 were divided into the control group,the HG group,the HG+ZNF281 siRNA group and the HG+ZNF281 vector group.Adenosine monophosphate-activated protein kinase(AMPK)was activated using AMPK agonist,acadexin(AICAR),and then cells were divided into the control group,the HG group,the HG+AICAR group and the HG+dimethyl sulfoxide group.The expression levels of ZNF281,EMT and ECM synthesis-related indexes were detected by qPCR and Western blot assay.Results Compared with the control group,the protein and mRNA expression levels of vimentin,α-smooth muscle actin(α-SMA),fibronectin(FN)and collagen Ⅰ(Col Ⅰ)were significantly higher,and the expression of E-cadherin was significantly lower in the HG group.Compared with the HG group,the protein and mRNA expression levels of EMT and ECM synthesis-related indexes were significantly changed in the HG+ZNF281 siRNA group and the HG+AICAR group.The protein and mRNA expression levels of ZNF281 were significantly reduced in the HG+AICAR group compared with the HG group.In cells co-treated with AICAR and transfected with ZNF281 plasmid,the expression levels of vimentin,α-SMA,FN and Col Ⅰ were significantly higher in the AICAR+ZNF281 group,and E-cadherin was significantly lower compared with that of the vector group.Conclusion AMPK inhibits EMT and ECM synthesis in HG-treated RTECs by negatively regulating the expression level of ZNF281.

Microbial fuel cells(MFCs)offer a potential solution for sustainable electricity generation by directly converting organic matter in wastewater into electrical energy.However,MFCs face challenges in practical applications,such as low bacterial loading capacity and relatively poor efficiency of extracellular electron transfer(EET)between the anode and the electrochemically active biofilm.In this study,a green and efficient microwave-assisted method combined with high-temperature annealing was successfully employed to prepare iron-based nanoparticle-modified carbon cloth(Fe3C/Fe@CC).This composite material exhibited excellent biocompatibility and electrocatalytic activity.When used as an anode material for MFCs,the Fe3C/Fe@CC-based MFCs demonstrated superior performance,achieving a power density of 2209 mW/m2,which was a 17%increase compared to MFCs with pure carbon cloth anodes(1933 mW/m2).This enhancement was primarily attributed to the effective improvement in EET efficiency between the microbes and the electrode,the increased electrochemically active surface area,and the promotion of the enrichment of the exoelectrogen Geobacter.This study utilized microwave assistance and high-temperature annealing to achieve rapid preparation of highly conductive composite anodes,providing a universal method for the large-scale production of anodes for MFCs.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To construct a pelvic floor muscle training program for patients undergoing radical prostatectomy,and to provide a reference for clinical practice.Methods The evidence related to pelvic floor muscle training in patients undergoing radical prostatectomy was systematically searched and the quality was evaluated.The draft of pelvic floor muscle training program for patients undergoing radical prostatectomy was constructed based on the KAP theory and it was demonstrated and revised by expert meetings.From February to March 2023,Delphi method was used to determine the final scheme.37 patients were selected as the control group and 38 patients as the experimental group to implement the scheme and evaluate the application effect.Results 2 rounds of Delphi consultations were conducted among 17 experts,and the recovery rate of the questionnaire was 100％.The expert authority coefficient was 0.89.The Kendall harmony coefficients of the importance and feasibility of the second round of consultation were 0.270 and 0.209(P＜0.001).The coefficient of variation of importance and feasibility of items were 0～0.18 and 0～0.20.The final program included 3 first-level items,8 second-level items and 29 third-level items.1 month after surgery,there was no significant difference in urinary incontinence score(P=0.242)and there was significant difference in pelvic floor muscle training compliance(P=0.011)between 2 groups.Conclusion The program was applied preliminary in clinical practice and it was confirmed with scientific and practical meaning,so it can provide a reference for clinical nursing.

Objective:To investigate COVID-19 vaccination status and relevant adverse reactions in patients with psoriasis treated with biological agents, and to explore the effect of COVID-19 vaccination on psoriatic lesions.Methods:Clinical data were collected from 572 psoriasis patients aged 18 - 60 years, who were registered in the management system of psoriasis patients treated with biological agents in the University of Hong Kong-Shenzhen Hospital from May 2019 to June 2021. The COVID-19 vaccination status was investigated by telephone interviews, and the vaccination-related information was obtained by fixed healthcare workers during a fixed time period according to a predesigned questionnaire. Measurement data were compared between two groups by using t test, and enumeration data were compared by using chi-square test or Fisher′s exact test. Results:The COVID-19 vaccination coverage rate was 43.13% (226 cases) among the 524 patients who completed the telephone interview, and was significantly lower in the biological agent treatment group (30.79%, 105/341) than in the traditional drug treatment group (66.12%, 121/183; χ2 = 60.60, P < 0.001) . The main reason for not being vaccinated was patients′ fear of vaccine safety (49.66%, 148/298) , followed by doctors′ not recommending (26.51%, 79/298) . In the biological agent treatment group after vaccination, the exacerbation of psoriatic lesions was more common in patients receiving prolonged-interval treatment (42.86%, 6/14) compared with those receiving regular treatment (4.40%, 4/91; Fisher′s exact test, P < 0.001) . Skin lesions were severely aggravated in two patients after COVID-19 vaccination, who ever experienced allergic reactions and whose skin lesions did not completely subside after the treatment with biological agents. Conclusions:The COVID-19 vaccination coverage rate was relatively low in the psoriasis patients treated with biological agents, and no serious adverse reaction was observed after vaccination. Prolonged-interval treatment due to COVID-19 vaccination ran the risk of exacerbation of skin lesions.

ObjectiveTo explore the effect of external diaphragm pacing therapy combined with abdominal functional electrical stimulation on respiratory function for stroke patients. MethodsFrom October, 2020 to September, 2022, 54 stroke patients were randomly divided into control group (n = 18), external diaphragm pacing group (n = 18) and combined treatment group (n = 18). All the groups received breathing training, while the external diaphragm pacing group received external diaphragm pacing therapy, and the combined treatment group received external diaphragm pacing and abdominal functional electrical stimulation therapy, for two weeks. They were measured forced vital capacity (FVC), forced expiratory volume in first second (FEV₁), ratio of forced expiratory volume in first second in forced vital capacity (FEV₁/FVC), peak expiratory flow (PEF), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) with pulmonary function instrument; measured diaphragmatic excursion (DE) and diaphragmatic thickness (DT) with ultrasound, before and after treatment. ResultsThree cases in the control group, two cases in the external diaphragm pacing group and one case in the combined treatment group dropped off. The FVC, FEV₁, PEF, MIP, MEP and DE improved in all the groups (|t| > 3.366, P < 0.01) after treatment; and the FVC, FEV₁, MIP and DE increased more in the combined treatment group and the external diaphragm pacing group than in the control group (P < 0.05); the FVC and FEV₁ increased more in the combined treatment group than in the external diaphragm pacing group (P < 0.05). ConclusionExternal diaphragm pacing therapy may improve ventilation and inspiratory muscle strength, and increase diaphragm movement for stroke patients; while the ventilation improved more after combining with abdominal functional electrical stimulation.