Objective:To observe any effect of exercise preconditioning on the levels of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in the brain tissue of rats after induced cerebral ischemia and reperfusion, and how it might promote angiogenesis.Methods:Thirty-six male Sprague-Dawley rats were randomly divided into a sham-operation group, a model group and an exercise preconditioning group, each of 12. After adaptive running training for 3 days, the exercise preconditioning group ran daily for 30 minutes at 15m/min for 14 days, while the other two groups did not exercise. Middle cerebral artery occlusion and reperfusion were then induced in the model and exercise preconditioning groups using the modified Zea-Longa suture method. Rats in the sham-operation group were only cut open to expose the right carotid artery. Right after the modeling, and again 24 hours later neurological deficit was evaluated using the Zea-Longa score and modified neurological severity scoring (mNSS). Infarct sizes were measured using 2, 3, 5-triphenyl tetrazolium chloride staining. Any morphological changes were noted using hematoxylin and eosin (HE) staining, and the expression of CD31 protein, hypoxia-inducible factor-1α and vascular endothelial growth factor in the ischemic cerebral cortex were quantified immunohistochemically.Results:Right after the modelling, compared with the sham-operation group, the average Zea-Longa scores of the model and exercise groups had increased significantly, but were not significantly different from each other. Twenty-four hours later the average Zea-Longa score, mNSS score and relative cerebral infarction area of the model group had increased significantly compared with the sham-operation group, while the exercise preconditioning group′s averages had decreased significantly. The HE staining showed that compared with the sham-operation group, pathological changes such as loose tissue, reduced number of nerve cells, nucleolysis, and vacuolization of the cerebral cortex on the ischemic side were found in the model group. Compared with the model group, the pathological changes in the exercise preconditioning group were less serious. The levels of CD31 protein, HIF-1α and VEGF in the ischemic cerebral cortexes of the model group had by then increased significantly. But compared with the model group, those levels had increased more in the exercise preconditioning group.Conclusion:Exercise preconditioning can effectively promote angiogenesis after cerebral ischemia and reduce chronic injury. That may be related to the activation of the HIF-1α and/or VEGF signaling pathways.

ObjectiveTo systematically compare the chemical compositional differences between Puerariae Thomsonii stem base（PTSB） and Puerariae Thomsonii Radix（PTR）， and to explore the potential hepatoprotective effects of PTSB by liver metabolomics. MethodUltra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS） was used to analyze the chemical compositions of PTSB and PTR. Twenty Kunming mice aged 6-8 weeks， half male and half female， were randomly divided into the blank group（sterile water） and PTSB group（1.95 g·kg^-1）， with 10 mice in each group， and the drug was administered by gavage for 14 d， and the body mass was weighed once a day. After the last administration， mice were anesthetized， organs such as heart， liver， spleen， lungs and kidneys were collected， and the organ index was calculated. Enzyme-linked immunosorbent assay（ELISA） was used to measure the levels of aspartate aminotransferase（AST）， alanine aminotransferase（ALT）， total cholesterol（TC） and triglyceride（TG） in the serum of mice from each group， the morphological changes of heart， liver， spleen， lung and kidney tissues were observed by hematoxylin-eosin（HE） staining， and the regulation of PTSB for the hepatic metabolic profiles of mice was analyzed by UPLC-Q-TOF-MS/MS， then the differential metabolites between the blank group and PTSB group were designated， and the metabolic pathways was enriched by Kyoto Encyclopedia of Genes and Genomes（KEGG）. ResultA total of 19 common chemical constituents were identified from PTSB and PTR， all of which were the main pharmacodynamic substances of PTR. The pharmacodynamic results showed that PTSB could control the growth of body mass of mice and reduce the contents of TC， TG， ALT and AST in serum of mice. HE staining observations and organ indexes showed that there was no significant effect of PTSB on all major organs at the highest clinically equivalent dose. A total of 38 differential metabolites were identified by metabolomics， of which 35 were up-regulated and 3 were down-regulated. These differential metabolites were mainly compounds such as amino acids， fatty acids， vitamins， steroids， nucleosides， pyrimidines and alkaloids. Three key metabolic pathways， including tyrosine metabolism， vitamin B₆ metabolism and tryptophan metabolism， were screened by metabolic pathway analysis. ConclusionPTSB has a similar chemical composition to that of PTR， and it may regulate the metabolism of amino acids and vitamins through the flavonoids and isoflavonoids， thus exerting a potential hepatoprotective effect. This study provides an experimental reference for the clinical application and product development of PTSB.

Objective:To explore the experience of elderly patients with diabetes after the first use of real-time continuous glucose monitoring (rt-CGM) through qualitative research.Methods:From January to December 2022, 20 elderly patients with diabetes who received rt-CGM in Beijing Friendship Hospital Affiliated to Capital Medical University were selected as the research object with objective sampling. Semi-structured, personalized, one-to-one in-depth interviews were used to collect data. The qualitative research content analysis method was used to summarize interview data, extract and explain the theme.Results:In this interview, a total of five themes were obtained. There were two themes before continuous glucose monitoring, namely high recognition of rt-CGM by patients and the expectation of understanding blood glucose fluctuations, which was the main purpose for patients to receive rt-CGM. After continuous glucose monitoring, there were three themes, namely, the negative emotions caused by abnormal blood glucose alarms during rt-CGM, disagreements among patients regarding the calibration method of measuring finger blood glucose four times a day during rt-CGM, and patients questioning the accuracy of rt-CGM data.Conclusions:Elderly patients with diabetes are willing to receive rt-CGM, but there are still many misunderstandings. Medical and nursing staff should develop targeted nursing strategies from various aspects such as improving patients ' psychological state, enhancing patients ' correct understanding of treatment, and strengthening standardized training for nurses, so as to increase patients ' treatment compliance and effectively control blood glucose.

Objective:To investigate the early and middle term clinical efficacies of 3D-printed metal prostheses in the reconstruction of bone defects after osteotomy in malignant bone tumors.Methods:A total of 34 patients with malignant bone tumors of lower extremity femur and tibia who underwent 3D printing individualized metal prosthesis replacement surgery in the Department of Bone and Soft Tissue of Affiliated Cancer Hospital of Zhengzhou University from March 2019 to March 2022 were retrospectively analyzed. There were 23 males and 11 females, with an average age of 19.1±15.2 years (range, 7-80 years). There were 22 children and adolescents younger than 18 years old. There were 3 cases in the proximal femur, 15 cases in the middle and distal femur, 10 cases in the proximal tibia and 6 cases in the distal tibia. According to the final pathological diagnosis, 24 cases of osteosarcoma, 6 cases of Ewing's sarcoma, 2 cases of undifferentiated sarcoma, 1 case of osteosarcoma, and 1 case of malignant giant cell tumor of bone were enrolled in this study. Postoperative complications, wound healing, periprosthetic fracture and aseptic loosening, tumor outcome (evaluated by tumor control evaluation criteria), and length difference of lower limbs were recorded. Response evaluation criteria in solid tumor (RECIST) was used to evaluate tumor outcomes. Prosthetic-bone interface healing was evaluated postoperatively, and the function was evaluated based on Musculoskeletal Oncology Society (MSTS) 93.Results:The length of lesions was 70-240 mm in 34 patients, with an average of 125.5±35.4 mm. The length of osteotomy was 80-275 mm, with an average of 160.2±33.9 mm. No tumor was found on the osteotomy surface. The customized prosthesis was firmly installed and closely matched with the side of the preserved articular surface. There were 2 patients with local incision fat liquefaction and 4 patients with superficial wound infection, which healed after debridement and antibiotic treatment. One distal tibia osteosarcoma case developed severe periprosthetic infection 2 months after surgery, resulting in prosthesis implantation failure, limb movement pain and poor ankle function. After removal of the prosthesis, infection control and osteogenesis with the Ilizarov technique, the infection was completely controlled and local osteogenesis was possible. The remaining 33 patients had a good prosthetic-bone interface union. One case was found to have localized bone resorption on the contact surface of the prosthesis 7 months after operation, but the metal prosthesis and screws were not loose. The incisions healed well in other patients, without infection, prosthesis loosening, fracture or other complications. All patients survived and were followed up for 13.8±5.6 months (range, 7-27 months). During the follow-up, there was no recurrence of tumor at the osteotomy end in all patients, but 5 patients developed lung metastasis. At the end of the last follow-up, all patients survived. Among them, 16 patients had unequal length of lower limbs, including 10 cases within 2 cm, 3 cases between 2-5 cm, and 3 cases over 5 cm. With the exception of one patient whose prosthesis was removed due to infection, the MSTS 93 of the other patients was 24.9±2.2 (range, 19-28), and were rated as excellent in 26 cases and good in 7 cases. According to the RECIST evaluation criteria, 26 of 34 patients had complete response, 5 had disease progression, and 3 had stable disease.Conclusion:3D printed metal prosthesis is one of the effective methods for the treatment of bone defects after resection of malignant bone tumors in lower limbs, which is safe, reliable and has satisfactory early curative effect.

Objective:To investigate the association between the polymorphisms of the hypothalamus pituitary adrenal axis related genes SKA2, AVPR1B, CRHR2 and suicide attempts in patients with depression, and the interaction between the genes and environmental factors.Methods:From March 2017 to August 2018, sixty-one patients with depression who were hospitalized for suicide were selected (case group), and 57 subjects matched with the age, gender and education level of the case group (control group) were selected in the same period.Snapshot genotyping technique was used to test the genotypes of case group and control group.Barratt impulsivity scale (BIS-Ⅱ) and life event scale (LES) were used to assess the impulsive traits and mental stress of individuals in the past year.Chi-square test and independent sample t-test were used for inter group comparison by SPSS 22.0 software.Gene-environment interaction was analyzed by the generalized multi factor dimensionality reduction. Results:The total scores of BIS-Ⅱ and LES in case group(65.05± 11.14, 34.16±27.23) were higher than those in the control group (53.30 ± 9.07, 11.67±12.64), the differences were statistically significant (both P<0.05). There was no significant difference in gene frequency and allele frequency of SKA2 and CRHR2 between the two groups ( P>0.05). The genotype frequency and allele frequency of rs28373064 of AVPR1B gene were significantly different between the two groups (χ 2=5.763, 4.279, both P<0.05), but there was no significant difference after Bonferroni correction ( P>0.05). The best interaction model in GMDR was the third-order model constructed by rs28373064 of AVPR1B gene, impulsive traits and life events, with the highest accuracy of 0.789 for sample test( P=0.001). In multiple genetic models, rs28373064 of AVPR1B gene was associated with attempted suicide behavior in patients with depression(dominant model: A/G-G/G ( OR=0.38, 95% CI=0.16-0.88, P=0.021), overdominant model: A/G ( OR=0.36, 95% CI=0.15-0.87, P=0.019), log-additive model: A/A, A/G and G/G ( OR=0.44, 95% CI=0.20-0.96, P=0.034)). Conclusion:rs28373064 polymorphism of AVPR1B gene is associated with attempted suicide behavior in patients with depression.AA genotype carriers of AVPR1B gene are more likely to commit suicide under the influence of life events and impulsive.

Objective:To investigate the awareness and knowledge of influenza and vaccine among primary care providers in Shanghai.Methods:An online questionnaires survey was conducted by Shanghai Alliance for Respiratory Diseases in Primary Care from December 2017 to August 2018, healthcare providers in district central hospitals and community health care centers of Shanghai were invited to participate in the survey. The questionnaire contained the following items: the basic information of respondents; knowledge of influenza and its vaccine; current status of influenza vaccination; factors affecting promoting vaccination; the intention, attitude, perception of promoting vaccination and the influencing factors, and suggestions on promoting influenza vaccination.Results:A total of 1 542 valid questionnaires were collected, 88.3% (1 361/1 542) responders correctly recognized main symptoms of influenza; 58.2% (898/1 542) ignored the contact transmission of influenza; 41.6% (641/1 542) didn′t know the frequency of influenza vaccination; 82.7% (1 276/1 542) failed to recognize that pregnant women should also receive influenza vaccination. The survey showed that 31.2% (481/1 542) of responders had been vaccinated against influenza. The vaccination rate in community health care institutions was significantly higher than that in district central hospitals [39.1% (304/778) vs. 23.2% (177/764), χ 2=45.44, P<0.05]. Factors affecting vaccination for healthcare providers were: influenza antigen was variable, and vaccination had no effects [49.5% (404/816)]; the efficacy of the flu vaccine was doubt [48.8% (634/1 298)]; the vaccine wasn′t free [46.5%(604/1 298)]. The respondents believed that the main ways to improve the influenza vaccination were to formulate relevant national vaccination policies [79.7%(1 229/1 542)], to regularly publicize knowledge of influenza and influenza vaccine to residents through communities [65.8% (1 015/1 542)], and to recommend the patients by primary care medical staff [64.4% (993/1 542)]. Conclusion:Many healthcare providers have insufficient knowledge about influenza and vaccine. The vaccination rate of community health institutions is higher than that in district central hospitals in Shanghai. The willingness to promote influenza vaccination can be influenced by some factors. Increasing the willingness of healthcare providers might be helpful to improve the vaccination coverage among residents in the community.

Objective:To investigate the improvement and clinical effect of lip depilation with 810 nm semiconductor laser.Methods:Retrospective analysis was performed on female labial hair removal patients admitted to Bethune Hospital in Shanxi from January 2017 to October 2018. The patients who visited the clinic from January 2018 to October 2018 were taken as the experimental group, and those who visited the clinic from January 2017 to December 2017 were taken as the control group. A combination model of super hair removal(SHR) + hair removal(HR) was adopted to perform the treatment with 810 nm YfTON semiconductor freezing point laser hair removal. The experimental group was treated with surface anesthetic and SHR mode dumbbell sliding mode 8 J/cm 2+ HR mode with high energy (starting from the upper limit of reference energy value), and the patients were treated with local drum and chin coordination. In the control group, no surface anesthetic was applied, and SHR mode was used for linear round-trip sliding + HR mode for reference energy treatment. After the third and fifth treatment, the patients in the two groups were treated with a hair size of 1 cm×1 cm on one side of the mouth corner with heavy hair. A hair analyzer was used to count the number of similar hairs visible to the naked eye at a social distance of about 1 meter. The final hair removal rate was calculated as excellent (70%-90%, including 70%), as improvement (40%-70%, including 40%), as invalid (<40%). The depilation rate after 3 and 5 treatments was compared between the 2 groups, the number of treatments was analyzed, and the recurrence rate and comfort level of the patients were followed up 6 months after treatment. Wilcoxon rank sum test was used to compare the measurement data. Comparison of counting data was tested, and P<0.05 was considered statistically significant. Results:A total of 200 patients were included in this study, including 100 in the experimental group, with an age of (28.58±6.01) years. The control group included 100 patients (28.57±6.07) years old. The skin type of patients was performed according to Fitzpatrick and Chinese characteristics Ⅱ-Ⅳ. After statistical test, there were no statistically significant differences in age and skin type between the two groups. After half a year of follow-up, the average number of treatment times in the experimental group was 5(5, 6) times, lower than that in the control group 7(6, 8) times( T=-9.279, P<0.001). The three and five depilation rates of the experimental group were[70.0%(68.0%, 74.8%), 86.0%(83.0%, 88.0%)], and the final depilation rates of the experimental group were 89.0%(86.7%, 90.0%), all higher than those in the control group[40.0%(37.0%, 42.0%), 72.0%(70.0%, 74.0%), 86.5%(85.0%, 88.0%)]. The differences between the two groups were statistically significant ( T3=43.986, T5=25.151, Tfinal=5.547, all P< 0.001). The intermittent times of single sliding treatment in the experimental group ≤2 times, compared with the control group > 2 times, the comfort level was improved. No blisters or coloration occurred in any of the patients. Patients in the 2 groups were followed up for half a year after the last hair removal. In the 2 groups, there were sparse new fine hairs and soft hair growth that were not included in the hair count, and the included hairs were thinner than those before the treatment. Conclusions:Compared with the control group, the treatment cycle is shorter, the efficiency is higher and the comfort level of the patients is higher in the experimental group.

Objective:To investigate the improvement and clinical effect of lip depilation with 810 nm semiconductor laser.Methods:Retrospective analysis was performed on female labial hair removal patients admitted to Bethune Hospital in Shanxi from January 2017 to October 2018. The patients who visited the clinic from January 2018 to October 2018 were taken as the experimental group, and those who visited the clinic from January 2017 to December 2017 were taken as the control group. A combination model of super hair removal(SHR) + hair removal(HR) was adopted to perform the treatment with 810 nm YfTON semiconductor freezing point laser hair removal. The experimental group was treated with surface anesthetic and SHR mode dumbbell sliding mode 8 J/cm 2+ HR mode with high energy (starting from the upper limit of reference energy value), and the patients were treated with local drum and chin coordination. In the control group, no surface anesthetic was applied, and SHR mode was used for linear round-trip sliding + HR mode for reference energy treatment. After the third and fifth treatment, the patients in the two groups were treated with a hair size of 1 cm×1 cm on one side of the mouth corner with heavy hair. A hair analyzer was used to count the number of similar hairs visible to the naked eye at a social distance of about 1 meter. The final hair removal rate was calculated as excellent (70%-90%, including 70%), as improvement (40%-70%, including 40%), as invalid (<40%). The depilation rate after 3 and 5 treatments was compared between the 2 groups, the number of treatments was analyzed, and the recurrence rate and comfort level of the patients were followed up 6 months after treatment. Wilcoxon rank sum test was used to compare the measurement data. Comparison of counting data was tested, and P<0.05 was considered statistically significant. Results:A total of 200 patients were included in this study, including 100 in the experimental group, with an age of (28.58±6.01) years. The control group included 100 patients (28.57±6.07) years old. The skin type of patients was performed according to Fitzpatrick and Chinese characteristics Ⅱ-Ⅳ. After statistical test, there were no statistically significant differences in age and skin type between the two groups. After half a year of follow-up, the average number of treatment times in the experimental group was 5(5, 6) times, lower than that in the control group 7(6, 8) times( T=-9.279, P<0.001). The three and five depilation rates of the experimental group were[70.0%(68.0%, 74.8%), 86.0%(83.0%, 88.0%)], and the final depilation rates of the experimental group were 89.0%(86.7%, 90.0%), all higher than those in the control group[40.0%(37.0%, 42.0%), 72.0%(70.0%, 74.0%), 86.5%(85.0%, 88.0%)]. The differences between the two groups were statistically significant ( T3=43.986, T5=25.151, Tfinal=5.547, all P< 0.001). The intermittent times of single sliding treatment in the experimental group ≤2 times, compared with the control group > 2 times, the comfort level was improved. No blisters or coloration occurred in any of the patients. Patients in the 2 groups were followed up for half a year after the last hair removal. In the 2 groups, there were sparse new fine hairs and soft hair growth that were not included in the hair count, and the included hairs were thinner than those before the treatment. Conclusions:Compared with the control group, the treatment cycle is shorter, the efficiency is higher and the comfort level of the patients is higher in the experimental group.

Objective:To investigate the cognition and attitudes of patients with end-stage lung cancer towards advance care planning (ACP) by qualitative research.Methods:Using the purposive sampling method, a total of 17 patients with end-stage lung cancer who were hospitalized in Department of Geriatrics in Beijing Friendship Hospital, Capital Medical University from December 2018 and July 2019 were selected as research objects. Semi-structured interviews were used to conduct one-to-one, face-to-face in-depth interviews, and qualitative research content analysis methods were used to transcribe, code, analyze categories, describe and organize the interview data and refine and explain the theme.Results:The cognition of patients with end-stage lung cancer on ACP extracted two themes, including lack of ACP-related knowledge and great differences in the timing of ACP determination. The feelings of patients with end-stage lung cancer about ACP extracted three themes, including higher ACP recognition, increased negative emotions caused by the setting of ACP and questioning the role of ACP.Conclusions:Patients with end-stage lung cancer have higher recognition of ACP, but there are still more misunderstandings. Medical staff should strengthen the health education of patients, carry on the psychological construction to patients step by step, eliminate psychological concerns and help to realize the expectation of the future end-of-life treatment, nursing needs.

Objective To Analyze the clinical outcomes of pediatric liver transplantation (LT) for liver-based metabolic disorders.Methods We conducted a retrospective analysis on 42 pediatric patients with liver-based metabolic disorders from June 2013 to March 2017,and analyzed the pediatric end stage liver disease model (PELD),growth and development,type of transplant,postoperative complications and prognosis of patients.Results There were 42 children with liver-based metabolic disorders (15.56%) out of all the 270 children who underwent LT.The median age was 51.0 months (range,3.4-160.9 months).Of the 42 children,19 received living donor liver transplantation (LDLT),18 cases received deceased donor liver transplantation (DDLT) and 5 cases received domino liver transplantation.1-,2-and 3-year cumulative survival rate of 42 recipients was 97.7%,93.6% and 93.6%,and that of the grafts was 95.3%,91.4% and 91.4%,respectively.As compared with the 194 children with biliary atresia who underwent LT,significant difference was found in PELD and weight Z-score between the two groups.Conclusion Liver transplantation is a valuable option for children with metabolic disorders,and it has gained a better prognosis.