Objective To investigate the transcriptome differences of ovarian cancer cells after cisplatin(DDP)resistance,and to find potential antagonists based on this screening.Methods DDP-resistant cell line A2780-DDP was constructed with A2780 cells as the research object.Through transcriptome sequencing anal-ysis,the key factors of DDP resistance were found and verified by quantitative real-time PCR(qPCR)and Western blot experiments.Through the screening of small molecule inhibitors,CCK-8 cell viability assay was used to find potential antagonists.Results A2780-DDP were successfully constructed,and it was found that there was no difference in cell proliferation after drug resistance,but the ability of cell invasion and migration was enhanced.Through transcriptome sequencing analysis,it was found that ITGB7 and Akt may be the key genes of A2780-DDP,and qPCR and Western blot showed that they were highly expressed in A2780-DDP.CCK-8 results showed that triptolide(TPL)and Olaparib had good inhibitory effects in DDP-resistant cell lines.Conclusion The ITGB7/Akt pathway plays an important role in DDP resistance,and potential DDP re-sistance antagonists such as TPL can provide new ideas for the treatment of ovarian cancer.

Objective The purpose of writing the"Expert consensus on the prevention and control of intracranial hypertension in adult critical illness"(here in after referred to as the"Consensus")aimed to standardize the nursing work related to the prevention and control of elevated intracranial pressure in adult critical illness,and prevent the occurrence of complications such as cerebral herniation.Methods Guided by evidence-based practice,domestic and foreign databases were searched for guidelines,expert consensuses,systematic evaluation,evidence summaries,and original research related to increased intracranial pressure.The search period is from database establishment to March 2024.The high-quality evidence and suggestions in the field was evaluated,extracted,and summarized to form a preliminary consensus.27 experts were invited to conduct 2 rounds of expert inquiry and 8 experts were invited to conduct 2 expert discussion meetings,to revise and improve the content of the initial draft,and to ultimately form a final consensus.Results The effective response rates for both rounds of inquiry questionnaires were 100％,with expert authority coefficients of 0.884,judgment coefficients of 0.964,and familiarity levels of 0.804.The Kendall harmony coefficients for 2 rounds of inquiry were 0.107 and 0.083(P＜0.01),respectively.The consensus includes 4 aspects,including identification,monitoring,prevention and control strategies,emergency treatment and care for increased intracranial pressure.Conclusion This"Consensus"has strong scientific validity and can provide reference basis for nurses to carry out prevention and control of intracranial pressure increase.

Objective:To investigate the factors contributing to frailty in very elderly patients with multimorbidity.Methods:This cross-sectional study enrolled 119 very elderly patients with multimorbidity who were hospitalized in the Department of Geriatrics of Huadong Hospital Affiliated to Fudan University from August 2022 to March 2023.The study aimed to understand the basic status of multimorbidity by collecting general information, the number and types of diseases, and frailty status.The subjects were divided into frail and non-frail groups through comprehensive geriatric assessment.Various factors including gender, age, Tinetti balance gait score, risk of sarcopenia, dementia, depression, risk of deep vein thrombosis, dysphagia, comorbidity index, medication count, Basic Activities of Daily Living(BADL)score, Instrumental Activities of Daily Living(IADL)score, Nutritional Risk Screening 2002(NRS-2002)score, Norton pressure injury risk assessment score, and Social Support Rating Scale(SSRS)score were compared.The correlation between each factor and the occurrence of frailty was analyzed using univariate analysis and multivariate Logistic regression analysis.Results:A total of 119 elderly inpatients with multimorbidity, with an average age of 90.8±5.9 years old, were included in the study.The incidence of frailty was 68.9%(82 cases).Univariate analysis revealed significant statistical differences between the frail group and the non-frail group in various factors including age( t=-3.131, P=0.002), Tinetti score( Z=-5.544, P<0.001), risk of sarcopenia( χ2=39.205, P<0.001), dysphagia( χ2=5.937, P=0.015), Charlson comorbidity index( Z=-2.565, P=0.010), medication count( Z=-3.325, P<0.001), BADL( Z=-5.871, P<0.001), IADL( Z=-5.062, P<0.001), Norton score( Z=-5.922, P<0.001), and SSRS social support( Z=-2.637, P=0.008).Multivariate logistic regression analysis showed that the Tinetti score( OR=0.843, 95% CI: 0.737-0.966, P=0.014), decreased muscle strength( OR=11.226, 95% CI: 2.157-58.432, P=0.004), sarcopenia( OR=18.084, 95% CI: 2.041-106.211, P=0.009), Norton score( OR=0.462, 95% CI: 0.254-0.838, P=0.011), and medication count( OR=1.153, 95% CI: 1.000-1.329, P=0.049)were independently associated with frailty. Conclusions:In very elderly patients with multimorbidities, the occurrence of frailty is notably increased.Frailty is linked to multiple risks including falls, muscle weakness/sarcopenia, pressure ulcer risk, and polypharmacy, and these risks are independent of other factors.

METHODS: Rat BMSCs were isolated, cultured and identified. The time-dependent expressions of TSP-2 and Sox9 in BMSCs under a dynamic mechanical pressure of 0–120 kPa at 0.1 Hz for 1 h were tested by qPCR and Western blotting. The role of TSP-2 in chondrogenic differentiation of BMSCs under mechanical pressure was validated by using small interfering RNA. The impact of TSP-2 and mechanical pressure on chondrogenesis were detected and the downstream signaling molecules were explored using Western blotting. RESULTS: Mechanical pressure stimulation of 0–120 kPa for 1 h significantly upregulated the expression of TSP-2 in BMSCs. The expression of the chondrogenesis markers Sox9, Aggrecan, and Col-II were all upregulated under dynamic mechanical pressure or TSP-2 stimulation. Additional exogenous TSP-2 may potentiate the chondrogenic effect of mechanical stimulation. After knock down TSP-2, the upregulation of Sox9, Aggrecan and Col-II under mechanical pressure was inhibited. The NF-jB signaling pathway responded to both dynamic pressure and TSP-2 stimulation, and the cartilage-promoting effect was blocked by an NF-jB signaling inhibitor. CONCLUSION TSP-2 plays an essential role in the chondrogenic differentiation of BMSCs under mechanical pressure. NF-jB signaling is involved in the mechano-chemical coupling of TSP-2 and mechanical pressure for the chondrogenic differentiation of BMSCs.

Systemic juvenile idiopathic arthritis is one of the common rheumatic and immune diseases in children. It has a sudden onset, obvious systemic symptoms, and lung involvement. However, systemic juvenile idiopathic arthritis with an early manifestation of pulmonary ground-glass opacities combined with macrophage activation syndrome is rare. The clinical data of a child with systemic juvenile idiopathic arthritis with pulmonary ground-glass shadow and macrophage activation syndrome who was admitted to Hubei Maternal and Child Health Care Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology in December 2021 were analyzed retrospectively in order to improve the understanding of rheumatic diseases and pulmonary lesions. The child was admitted to the hospital for 10 days due to rash and fever. Thoracic CT showed scattered ground glass like shadows in both lungs due to the prevention and control screening of COVID-19 pneumonia epidemic situation. After admission, the child was still repeatedly flaccid with high fever, accompanied by dysfunction of both lower limbs. The knee joint MRI found that there was synovitis in the knee joint, and various laboratory indicators suggested macrophage activation syndrome. After that, systemic juvenile idiopathic arthritis was diagnosed. After being treated with methylprednisolone, cyclosporine and topzumab, the clinical remission and the ground-glass shadow of the lung basically disappeared. Through the analysis of this case, it is suggested that clinicians should not ignore other diseases that cause ground glass shadow in the lung during the current epidemic of COVID-19.

Objective:To investigate the correlation between sleep quality and risk of female complicated vulvovaginal candidiasis (VVC).Methods:From January 2021 to June 2021, patients in the gynecological clinic of Xiangya Hospital of Central South University were continuously enrolled as the research objects using a cross-sectional survey. A self-made questionnaire was used to collect the age, marital status, education level, family monthly income, place of residence in the past two years, maternity history, number of births, intrauterine device, number of abortions, frequency of sex life, use of contraceptives within two months, use of antibacterial drugs within two weeks. Generalized Anxiety Disorder Scale, Patient Health Questionnaire, Health Questionnaire Somatic Symptom Group Scale, Pittsburgh Sleep Quality Index were used to collect patients′ anxiety, depression, somatization symptoms, and sleep quality conditions. The total scores of sleep quality and the scores of each dimension were used as observation indicators. Three logistic regression analysis models were constructed to explore the relationship between sleep quality and complicated VVC groups.Results:Patients in the complex VVC group were significantly higher in age, married, middle school education, rural area of residence in the last two years, birth history, number of births ≥3, sexual frequency≥1/week, and no antibiotic use within two weeks compared to those in the control group (all P<0.05). Without adjusting for confounding factors, women with poor subjective sleep quality had a 6.73-fold increased risk ( OR=7.73, 95% CI: 3.22-18.55) of complex VVC compared with those with good subjective sleep quality. After adjusting for confounding factors, the risk was further increased to 9.08 fold ( OR=10.08, 95% CI: 3.47-29.33)(all P<0.05). Compared with women without sleep disorders, women with mild sleep disorders had a 97% increased risk of complex VVC ( OR=1.97, 95% CI: 1.15-3.37). After adjusting for confounders, the risk remained 97% higher ( OR=1.97, 95% CI: 1.10-3.55)(all P<0.05). Conclusion:Poor subjective sleep quality and mild sleep disorder may be associated with the risk of complex VVC.

The clinical data of 5 patients with autoimmune encephalitis admitted to the psychiatric department of the 904th Hospital of the Joint Logistics Service Force from January 2016 to June 2020 were retrospectively analyzed. Among 5 patients, 4 had stress psychological events within one month before the onset, and 3 had precursor symptoms such as fever and vomiting. They were all characterized by rapid progress of atypical mental and behavioral abnormalities and cognitive impairment. In terms of neurological symptoms, 1 case had faciobrachial dystonic seizures (FBDS), 3 cases had seizures, 2 cases had involuntary movement, and 4 cases had autonomic dysfunction, including central hypopnea, arrhythmia, blood pressure instability and paroxysmal facial flushing. Most neurological symptoms occur within 1 month of the onset. MRI revealed abnormalities in cerebral cortex, thalamus, temporal lobe and insular lobe in 4 cases; EEG demonstrated bilateral short-range medium amplitude θ wave in 2 cases. Abnormal cerebrospinal fluid (CSF) pressure was detected in 4 cases and 2 cases had abnormal cell number CSF. Three patients had positive anti-N-methyl-D-aspartate receptor (NMDAR) antibody, one patient had positive anti-LGI1 antibody, and one patient had positive anti-γ-aminobutyric acid B receptor (GABA BR) antibody. One case was discharged automatically, the remaining 4 patients were treated with glucocorticoid or combined with gamma globulin and cyclophosphamide, antiepileptic drugs, antipsychotic drugs and other symptomatic treatment, and their symptoms were relieved. Patients were followed up for six months, there was slightly slow residual reaction in 2 cases and personality change in 1 case. Autoimmune encephalitis characterized by mental symptoms is likely to be misdiagnosed as mental disorders. Clinicians should identify symptoms different from mental disorders, taking into account of the possibility of autoimmune encephalitis, to make early diagnosis and treatment.

Objective:To investigate age-related histological and ultrastructural changes of the pancreas in Sprague-Dawley(SD)rats, and to provide a theoretical basis for the high incidence of pancreatic diseases in the elderly.Methods:Thirty 6-month-old specific pathogen-free male SD rats were fed until 6, 12, 18 and 25 months of age.Five rats of each age group were randomly selected, killed and then sampled to make histological(HE staining)and electron microscopic sections to observe age-related changes in pancreatic histology and ultrastructure.Results:The pancreatic tissue of rats showed increasing fibrosis with age, especially around the duct.Fat infiltration of the pancreatic tissue also increased with age( H=15.88, P=0.001). With the increase of age, the number(density)of pancreatic islets decreased gradually( F=3.55, P=0.039), but the average cross-sectional area of islets increased significantly( F=7.76, P=0.002), and the round and oval islets became irregular.Nuclear pyknosis, mitochondrial dehydration, mitochondrial swelling, and dilatation and loose organization of rough endoplasmic reticula were observed in the cytoplasm of pancreatic acinar cells and islet beat cells in aged rats.With the increase of age, the number of zymogen granules at the apical pole of pancreatic acinar cells of rats decreased( F=9.73, P<0.001), and the average area and total area of granules were significantly decreased( F=6.51, P=0.001; F=22.18, P<0.001); The number of non-senescent mitochondria and senescent mitochondria in the cytoplasm of acinar cells increased significantly( H=8.22, P=0.045; H=32.95, P<0.001); The amount of proinsulin in islet beta cells was significantly decreased( F=16.20, P<0.001). Conclusions:With aging, the rat pancreas exhibits a series of degenerative manifestations(stromal hyperplasia, adipose tissue infiltration, decreased numbers of zymogen granules in acinar cells, increases in the number of senescent mitochondria, reduced islets and reduced proinsulin in islet beta cells), while there are some compensatory phenomena(increasing numbers of islets and non-senescent mitochondria).

To analyze the lesion distribution situations and relationship of lesions detected by gastroscopy and colonoscopy in asymptomatic population in Beijing. Data of 1 663 patients who received gastroscopy and colonoscopy in the physical examination center of Peking Union Medical College Hospital and Beijing Hospital between January 2016 and December 2018 were analyzed retrospectively. Statistical analysis was conducted on the detection rate and relationship of different lesions based on the information of gender and ages. Gastroscopy data showed that chronic non-atrophic gastritis and chronic atrophic gastritis accounted for 1 240 (74.6%)and 423 (25.4%)cases respectively. Chronic atrophic gastritis was more common in population aged over 40. Other common diseases included erosions of gastric body and/or antrum, fundic gland polyps, reflux esophagitis, duodenitis, bile regurgitation and so on. Upper gastrointestinal tumors including esophagus cancer and gastric cancer were both early lesions. Colonoscopy results showed that colonic polyps were common lesions, among which there were 382 (23.0%)cases of colonic adenoma and 217 (13.0%)hyperplastic polyps. Incidence of colonic polyps increased with age. Colorectal cancer accounted for 0.7%. Colon diverticulum and melanosis coli were more common in population aged over 40. Colon adenoma was more common in male and melanosis coli was more common in female. The positive rate of HP was 32.2%. There was no positive relationship between HP infection and fundic gland polyps( P=0.329). There was no positive relationship between fundic gland polyps and colon adenomas as well as colorectal cancer( P=0.152, P=0.616). Gastroscopy and colonoscopy play important roles in different kinds of digestive diseases, especially in the early detection of tumors. More attention should be paid to the application of endoscopy in asymptomatic population.

Background: Thyroid diseases are highly prevalent worldwide, but their diagnosis remains a challenge. We established reference intervals (RIs) for thyroid-associated hormones and evaluated the prevalence of thyroid diseases in China. Methods: After excluding outliers based on the results of ultrasound screening, thyroid antibody tests, and the Tukey method, the medical records of 20,303 euthyroid adults, who visited the Department of Health Care at Peking Union Medical College Hospital from January 2014 to December 2018, were analyzed. Thyroid-associated hormones were measured by the Siemens Advia Centaur XP analyzer. The RIs for thyroid-associated hormones were calculated according to the CLSI C28-A3 guidelines, and were compared with the RIs provided by Siemens. The prevalence of thyroid diseases over the five years was evaluated and compared using the chi-square test. Results: The RIs for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3) were 0.71–4.92 mIU/L, 12.2–20.1 pmol/L, 3.9–6.0 pmol/L, 65.6–135.1 nmol/L, and 1.2–2.2 nmol/L, respectively. The RIs of all hormones except TT4 differed significantly between males and females. The RIs of TSH increased with increasing age. The prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was 0.5% and 0.8%, 0.2% and 0.6%, 3.8% and 6.1%, and 3.3% and 4.7% in males and females, respectively, which differed from those provided by Siemens. Conclusions Sex-specific RIs were established for thyroid-associated hormones, and the prevalence of thyroid diseases was determined in the Chinese population.