ObjectiveBased on the AMP-activated protein kinase （AMPK）/mammalian target of rapamycin （mTOR） signaling pathway， this study aimed to observe the effect of the Huazhuo Jiedu prescription on renal fibrosis in 5/6 nephrectomy rats and explore its underlying mechanism. MethodsA total of 67 SPF-grade male SD rats were used， of which 11 were randomly selected as the normal group. A chronic renal failure （CRF） model was established using 5/6 nephrectomy. The successfully modeled rats were randomly assigned to the model group， losartan potassium group （4.5 mg·kg^-1）， and low- （1.175 g·kg^-1）， medium- （2.35 g·kg^-1） and high-dose （4.7 g·kg^-1） Huazhuo Jiedu prescription groups， with 9 rats per group. Each group received an equivalent volume of saline or the corresponding concentration of Huazhuo Jiedu prescription by gavage once daily for 8 weeks. Hematoxylin-eosin （HE） and Masson staining were used to observe renal tissue pathological changes. Transmission electron microscopy examined renal ultrastructure. Immunohistochemistry （IHC） detected expressions of α-smooth muscle actin （α-SMA） and transforming growth factor-β₁ （TGF-β₁）. Western blot analyzed expression levels of microtubule-associated protein Ⅰ light chain 3Ⅱ （LC3Ⅱ）， Beclin1， p62， AMPK， phosphorylated AMPK （p-AMPK）， mTOR， and phosphorylated mTOR （p-mTOR）. ResultsCompared with the normal group， the model group exhibited glomerular shrinkage， mesangial and interstitial thickening， and tubular vacuolar degeneration， with no evident autophagosomes or autophagolysosome structures. Expression levels of α-SMA and TGF-β₁ were significantly increased （P0.01）， while p-AMPK/AMPK， Beclin1， and LC3Ⅱ were significantly decreased （P0.01）， and p-mTOR/mTOR and p62 were significantly increased （P0.01）. Compared with the model group， the medium- and high-dose Huazhuo Jiedu prescription groups and the losartan potassium group showed varying degrees of pathological improvement. Autophagosomes with double- or multiple-layer membranes and autophagolysosomes with monolayer membranes containing undegraded organelles were observed. Renal α-SMA and TGF-β₁ protein expression levels were markedly reduced （P0.05， P0.01）， p-mTOR/mTOR and p62 were significantly decreased （P0.05， P0.01）， and p-AMPK/AMPK， Beclin1， and LC3Ⅱ expression levels were significantly increased （P0.05， P0.01）. ConclusionHuazhuo Jiedu prescription may improve renal fibrosis in 5/6 nephrectomy rats by regulating the AMPK/mTOR signaling pathway and enhancing autophagy.

Objective To explore the expression of programmed cell death protein 5 in cervical cancer and its relationship with lymph node metastasis.Methods 98 cases of cervical cancer patients admitted to our hospital were selected as the observation group,and 98 cases of cervical benign lesions were selected as the control group.The expression levels of PDCD5 in serum and lesion tissues of the two groups were compared to analyze the relationship between PDCD5 and pathological features of cervical cancer,and the diagnostic value of PDCD5 in lymph node metastasis of patients with cervical cancer was analyzed by ROC curve.Results The expression levels of PDCD5 in serum and lesion tissue of observation group were lower than those of control group(P<0.05).With the increase of clinical stage and pathological grade of cervical cancer,the expression of PDCD5 in serum and lesion tissue was significantly decreased(P<0.05).Among the 98 patients with cervical cancer,32 had lymph node metastasis.The expression levels of PDCD5 in serum and lesion tissue of lymph node metastasis group were lower than those of non-lymph node metastasis group(P<0.05).ROC curve results showed that the AUCs of PDCD5 in serum and lesion tissue to predict lymph node metastasis of cervical cancer patients were 0.810 and 0.850,respectively,with no statistical significance(P>0.05).Conclusion The Programmed cell death protein 5 is closely related to the pathological features of patients with cervical cancer,and it has a good predictive effect on lymph node metastasis,which is worthy of further study and application.

OBJECTIVE: To explore the genetic basis of two fetuses with an osteogenesis imperfecta (OI) phenotype. METHODS: Two fetuses diagnosed at the Affiliated Hospital of Weifang Medical College respectively on June 11, 2021 and October 16, 2021 were selected as the study subjects. Clinical data of the fetuses were collected. Amniotic fluid samples of the fetuses and peripheral blood samples of their pedigree members were collected for the extraction of genomic DNA. Whole exome sequencing (WES) and Sanger sequencing were carried out to identify the candidate variants. Minigene splicing reporter analysis was used to validate the variant which may affect the pre-mRNA splicing. RESULTS: For fetus 1, ultrasonography at 17+6 weeks of gestation had revealed shortening of bilateral humerus and femurs by more than two weeks, in addition with multiple fractures and angular deformities of long bones. WES revealed that fetus 1 had harbored a heterozygous c.3949_3950insGGCATGT (p.N1317Rfs*114) variant in exon 49 of the COL1A1 gene (NM_000088.4). Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), it was classified as a pathogenic variant (PVS1+PS2+PM2_Supporting) for disrupting the downstream open reading frame resulting in premature translational termination, being de novo in origin, and lacking records in the population and disease databases.For fetus 2, ultrasonography at 23 weeks of gestation also revealed shortening of bilateral humerus and femurs by one and four weeks, respectively, in addition with bending of bilateral femurs, tibias and fibulas. Fetus 2 had harbored a heterozygous c.1557+3A>G variant in intron 26 of the COL1A2 gene (NM_000089.4). Minigene experiment showed that it has induced skipping of exon 26 from the COL1A2 mRNA transcript, resulting in an in-frame deletion (c.1504_1557del) of the COL1A2 mRNA transcript. The variant was inherited from its father and had been previously reported in a family with OI type 4. It was therefore classified as a pathogenic variant (PS3+PM1+PM2_Supporting+PP3+PP5). CONCLUSION The c.3949_3950insGGCATGT (p.N1317Rfs*114) variant in the COL1A1 gene and c.1557+3A>G variant in the COL1A2 gene probably underlay the disease in the two fetuses. Above findings not only have enriched the mutational spectrum of OI, but also shed light on the correlation between its genotype and phenotype and provided a basis for genetic counseling and prenatal diagnosis for the affected pedigrees.
Pregnancy ; Female ; Humans ; Osteogenesis Imperfecta/genetics* ; Collagen Type I, alpha 1 Chain ; Collagen Type I/genetics* ; Mutation ; Fetus

Objective:To understand the current situation of nurses′ implementation of oral care for elderly patients, so as to improve oral care practice standard and quality of oral care constantly.Methods:Using convenient sampling method, 190 nurses in the general ward of the General Hospital of Ningxia Medical University were selected as the research object from September to November 2020. The self-designed questionnaire was used to investigate and analyze the implementation of oral care among elderly patients.Results:A total of 190 questionnaires were collected in this survey, 84.74%(161/190) of the nurses reported that the hospital or department had oral care practice standard; The proportion of nurses who evaluated the oral status of elderly patients by the oral care assessment tool was 17.89%(34/190).Only 14.74%(28/190) and 16.84%(32/190) of the nurses could always set the expected rehabilitation goals and formulate the corresponding nursing plans for the oral problems of elderly patients, respectively. When the elderly patients had special oral problems, 26.32% (50/190) of the nurses would proactively communicate with doctors or search literature; the oral knowledge and oral hygiene habits of the elderly patients would be known to nurses accounting for 5.26% (10/190).Conclusions:Nurses′ cognition of oral care for elderly patients is at a low level on the structure, process and outcome.Relevant nursing managers still need to further improve the oral care operation norms and the training of nurses′ knowledge and skills, so as to continuously promote the oral health of elderly patients.

Objective:To investigate the effect of dexmedetomidine combined with butorphanol on perioperative analgesia in patients subjected to cardiac surgery.Methods:Sixty-three patients who underwent elective cardiac surgery in Weihai Central Hospital from June 2019 to August 2020 were included in this study. They were divided into propofol + sufentanil group ( n = 21), dexmedetomidine + sufentanil group ( n = 23) and dexmedetomidine + butorphanol group ( n = 19) according to different analgesic methods. Postoperative analgesic satisfaction, Visual Analogue Scale score, hemodynamic changes (heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure) and adverse reactions were compared among the three groups. Results:The satisfaction rate of postoperative analgesia in the dexmedetomidine + butorphanol group was 94.7% (18/19), which was significantly higher than 61.9% (13/21) in the propofol + sufentanil group and 60.8% (14/23) in the dexmedetomidine + sufentanil group ( χ2 = 6.16, 6.57, both P < 0.05). At 4, 12, 24 and 48 hours after tracheal extubation, Visual Analogue Scale score in the dexmedetomidine + butorphanol group were significantly lower than that in the propofol + sufentanil group and dexmedetomidine + sufentanil group (both P < 0.05). At the time of tracheal extubation and at 5 minutes after tracheal extubation, heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure in the dexmedetomidine+butorphanol group were significantly lower than those in the propofol + sufentanil group and dexmedetomidine + sufentanil group (both P < 0.05). The incidence of adverse reactions in the dexmedetomidine + butorphanol group was 10.5% (2/19), which was significantly lower than 23.8% (5/21) in the propofol + sufentanil group and 30.43% (7/23) in the dexmedetomidine + sufentanil group [30.4% (7/23), χ2=21.94, P < 0.001]. Conclusion:Dexmedetomidine combined with butorphanol in cardiac surgery can not only stabilize postoperative blood pressure and heart rate, but also lower the degree of pain and is highly safe.

Objective:To construct a quality evaluation index system of discharge planning for elderly patients, so as to provide a reference basis for the evaluation of the quality of discharge planning for elderly patients.Methods:The overall research time was from August 2020 to August 2021. Taking the three-dimensional quality evaluation model as the framework, through literature review, a preliminary construction of the quality evaluation index system of discharge planning for elderly patients was established. The Delphi method was used to conduct 2 rounds of consultation with 20 experts, and finally the quality evaluation index system of discharge planning for elderly patients was determined, and the weight of each index was determined by the network analytic hierarchy process.Results:Among 2 rounds of consultation, the effective recovery rates of the questionnaires were 85.00% (17/20) and 100.00% (17/17) , the expert authority coefficients were 0.912 and 0.909, and the Kendall harmony coefficients were 0.141 and 0.134, respectively ( P<0.05) . The quality evaluation index system of discharge planning for elderly patients included 3 first-level indicators, 12 second-level indicators, and 50 third-level indicators. Conclusions:The quality evaluation index system of discharge planning for elderly patients is scientific and reliable, and can provide a reference basis for comprehensive evaluation of the quality of discharge planning for elderly patients.

Objective:To explore the symptoms and psychological experience of elderly patients with chronic obstructive pulmonary disease (COPD) and urinary incontinence.Methods:From January to February 2021, a total of 17 patients in General Hospital of Ningxia Medical University and Wuzhong People's Hospital were enrolled by phenomenological method and interviewed using semi-structured interview method. KJ method was used to analyze, summarize and refine the interview data.Results:A total of 4 themes were extracted, including confusion in cognition and management between COPD and urinary incontinence symptoms, affected compliance of lung rehabilitation, intertwined physical and mental burden and psychological adjustment, and eager for medical staff's attention and help to symptom interaction.Conclusions:Elderly patients with COPD and urinary incontinence have many trouble under the interaction of symptoms. Medical staff should pay attention to the complexity of symptom process and the interaction between symptoms, and carry out timely and effective symptom evaluation and intervention, so as to improve patients' compliance of lung rehabilitation and quality of life.

Objective:To explore the experience of the treatment of patella inferior pole fracture with non excitation tension band technique.Methods:From April 2009 to December 2019, 76 patients with inferior patellar fracture were treated with non excitation tension band technique. There were 42 males and 34 females; The age was 35.48 ± 18.12 years (17-66 years), with an average of 35 years. There were 45 cases on the left and 31 cases on the right. Causes of injury: fall injury in 46 cases, bicycle injury in 16 cases and traffic accident injury in 14 cases. The time from injury to operation was 0.25-5 d, with an average of 3.2 d. There were 18 cases of open fractures, 64 cases of articular surface fractures and 52 cases of comminuted fractures. Open fracture patients were debridement first, and all cases were fixed with non excitation tension band technique. The intraoperative fracture reduction, postoperative fracture healing and internal fixation were observed. The knee function was evaluated according to the degree of claudication, the use of supports, the feeling of joint strangulation, joint instability, pain, swelling, stair climbing and squatting.Results:All 76 patients successfully completed the operation and were followed up for 18.24 ± 6.18 months (range 12-24 months). There was no wire fracture during and after operation. All incisions healed in the first stage after operation, and there was no deep venous thrombosis of lower limbs. The X-ray film showed that there was no further fracture and fracture displacement after operation, and there was no Kirschner wire slip before the internal fixation was taken out. Only one case had steel wire relaxation due to buckle (which did not affect fracture healing). All fractures healed well, with an average of 7.5 weeks, and the fracture line basically disappeared. 12 months after operation, according to Lysholm knee score standard, the knee function of patients was evaluated. The score of 76 cases was 95.40±4.60 points (range 82-100 points): excellent in 54 cases, good in 21 cases and fair in 1 case. The excellent and good rate was 98.7%. According to the visual analogue scale (VAS) pain score standard, the patients were scored for postoperative pain. The score of 76 cases was 0.09±2.05 points (range 0-3 points): 4 cases had mild pain, with an average score of 0.09.Conclusion:The results of the treatment of patellar inferior pole fracture with tension free band technique are satisfactory, the pain caused by tissue irritation by the internal fixation was lower, clinical application can be popularized.

Objective:To explore the current situation of discharge preparation services for elderly patients in ClassⅢ hospitals in Ningxia Hui Autonomous Region, so as to provide a reference for optimizing implementation plans and service processes.Methods:This study was a cross-sectional study. From November 10 to 30, 2020, convenience sampling method was used to select 175 head nurses of clinical departments from 10 Class Ⅲ hospitals in Ningxia Hui Autonomous Region as the research subject. The General Information Questionnaire and Discharge Preparation Service Implementation Questionnaire were used for investigation. A total of 175 questionnaires were distributed, and 175 valid questionnaires were returned with the valid response rate of 100.00%.Results:Among 10 ClassⅢ hospitals, a total of 86.29% (151/175) departments carried out discharge preparation services for elderly patients, of which 61.59% (93/151) departments completed the screening of discharge preparation service targets within 24 to 48 hours after the patients were admitted; 25.81% (24/93) departments used standardized assessment tools; 76.16% (115/151) departments fully considered the social resources available near the home of elderly patients when formulating individualized discharge preparation services; 58.28% (88/151) departments carried out nurses collaborating with multidisciplinary teams during the implementation of discharge preparation services, and 95.36% (144/151) departments followed up discharged elderly patients.Conclusions:The overall development rate of discharge preparation services for elderly patients in ClassⅢ hospitals in Ningxia Hui Autonomous Region is at a medium to high level. There are still deficiencies in the timeliness of discharge preparation services, the use of mature assessment tools, the coordination and use of available social resources, and the communication and cooperation of multidisciplinary teams. Relevant departments and department personnel need to further perfect the implementation process and continuously improve the quality of services for elderly patients to prepare for discharge.

Objective:To investigate the early clinical characteristics and radiographic changes in confirmed novel coronavirus pneumonia (COVID-19) and COVID-19 excluded patients.Methods:Twenty-four patients with suspected COVID-19 admitted to Shanghai Jiaotong University Affiliated Sixth People’s Hospital and Jinshan Branch Hospital between January and February, 2020 were enrolled in this research. Early clinical features and radiographic changes were analyzed in 10 confirmed COVID-19 patients and 14 COVID-19 excluded patients.Results:In the early stage, all 24 suspected patients had minor symptoms, and had normal blood gas analysis results. Of 10 confirmed COVID-19 patients, 5 patients were male. All the 10 patients had fever and fatigue, with body temperature between 37.5 and 38.5 °C. Only 1 patient had hacking cough. Two patients had no clear epidemiological exposure history, the other 8 had clear epidemiological exposure history, with a possible incubation period of 1-10 days. From CT imaging, lesions were characterized as ground glass shadow ( n=9), which could be unilateral ( n=1) or bilateral ( n=9), and were mainly close to the pleura ( n=9), with nodule shadow ( n=1) and without focal necrosis, and could combined with pleural effusion ( n=1). Among the COVID-19 excluded patients, all 14 patients had clear history of epidemic exposure, with an onset time of 1 to 13 days. Twelve patients had fever, including 4 patients with body temperature > 38.5 °C, 8 patients with body temperature bwteen 37.3-38.5 °C, and 2 patients without fever. All patients had fatigue, 7 patients had hacking cough and 2 patients had chest pain. From CT imaging, ground glass shadow appeared in 4 patients, lesions were unilateral in 10 patients and bilateral in 4 patients, and the lesions were relatively sporadic, without necrosis or pleural effusion. Conclusions:Not all patients with COVID-19 have a direct epidemiology exposure history, some patients may be infected unknowingly. According to CT imaging, COVID-19 seems to have no special manifestations being different from other viral pneumonia. COVID-19 is more common among middle-aged people.