BACKGROUND:Plastic as a durable,inexpensive,easy to manufacture organic synthetic polymer materials are widely used.At the same time,plastic resistance to high temperatures,acid and alkali resistance,corrosion-resistant properties make it difficult to degrade in nature,and ultimately forming a huge number of microplastic pollution threatening human health. OBJECTIVE:To investigate the effects of microplastic exposure on growth and development and hepatic lipid metabolism in mice. METHODS:Twenty C57BL/6J male mice were adaptively fed for one week,and then randomly divided into normal and microplastic groups(n=10 per group).Mice in the normal group were given a normal diet and water,for 4 weeks.Mice in the microplastic group were given a normal diet and free drinking of microplastic(polystyrene)water with a concentration of 1 000 μg/L,for 4 weeks.At 2 and 4 weeks of drinking,body mass and grip strength,blood lipids and liver and kidney function,ultrasonic morphology and pathological morphology of liver and lipid deposition were detected. RESULTS AND CONCLUSION:(1)With the extension of time,the body mass of mice in the two groups gradually increased,and the body mass of mice in the microplastic group was greater than that in the normal group after 2,4 weeks of drinking water(P<0.05).With the extension of time,the grip strength of mice in the normal group gradually increased,and the grip strength of mice in the microplastic group first decreased and then increased,and the grip strength of mice in the microplastic group was lower than that in the normal group after drinking water for 4 weeks(P<0.05).(2)Liver ultrasound examination showed that compared with the normal group,the ultrasonic echo signal of the liver in the microplastic group was enhanced after 2 and 4 weeks of drinking water.(3)Hematoxylin-eosin staining showed that the morphology of liver cells in the microplastic group did not change significantly after 2 and 4 weeks of drinking water,but inflammatory cell infiltration could be seen.Oil red O staining showed that obvious lipid deposition was observed in the liver of microplastic group after 2 and 4 weeks of drinking water.(4)Compared with the normal group,the levels of serum high density lipoprotein cholesterol,triacylglycerol,and aspartate aminotransferase in the microplastic group were decreased after 2 weeks of drinking water(P<0.05),and the serum triacylglycerol concentration was decreased after 4 weeks of drinking water(P<0.05).(5)These findings confirm that microplastics may cause weight gain,loss of physical strength,and abnormal hepatic lipid metabolism in mice.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Objective To study the role of ubiquitin-conjugating enzyme 9(UBC9)in the pyroptosis of homocysteine-induced macrophages mediated by small ubiquitin-like modifier(SUMO)modification.Methods First,the effects of homocysteine at different concentrations(0 μmol/L,50 μ.mol/L,100 μmol/L,150 μmol/L and 200 μmol/L)on the viability and pyrodeath of mouse macrophages(RAW264.7)were detected by CCK-8 and Western blot.Western blot was used to detect the expression levels of UBC9,SUMO-1,and the inflammatory cytokine IL-1β in different groups of cells.qRT-PCR was used to detect the mRNA expression of UBC9 before and after RNA interference and the expression of UBC9,pyrogen-related protein,and SUMO-1 after RNA interference.Results After stimulation with 100 μmol/L homocysteine,the effect of macrophage activity was minimal,and NLRP3 and Caspase-1 were the proteins with the most obvious increase in expression(P＜0.05).Compared with the Control group,the Hcy group's expression of IL-1β and SUMO-1 was increased(P＜0.01).Compared with the Control group,the Hcy group's UBC9 protein and mRNA levels were increased(P＜0.05).The expression of NLRP3,Caspase-1,IL-1β,UBC9,and SUMO-1 was decreased in the si-UBC9+Hcy group compared with the si-NC+Hcy group(P＜0.01).Conclusions Homocysteine induces pyroptosis in macrophages,and its mechanism of action is related to the up-regulation of UBC9 to induce SUMO modification.

The continued aging of the population has led to a surge in long-term care needs for the elderly.Proactive preparation for future care(PFC)for the elderly can effectively meet the care needs caused by aging,improve their physical and mental health,and promote the elderly to maximize their physiological,psychological and social functions,finally realizing healthy aging.This paper reviews the theoretical basis,concept connotation,measurement tools,influencing factors and intervention strategies of PFC for the elderly,and puts forward the prospects for future research,so as to provide references for potential mechanism and empirical research of PFC for Chinese seniors.

BACKGROUND/OBJECTIVES: Previous research has shown maternal betaine supplementation alleviates fetal-derived hepatic steatosis. Therefore, this study examined the anti-inflammatory effect of maternal betaine intake in offspring mice and its mechanism.MATERIALS/METHODS: Female C57BL/6J mice and their offspring were randomly divided into 3 groups according to the treatment received during gestation and lactation: control diet (CD), fatty liver disease (FLD), and fatty liver disease + 1% betaine (FLD-BET). The FLD group was given a high-fat diet and streptozotocin (HFD + STZ), and the FLD-BET group was treated with HFD + STZ + 1% betaine. After weaning, the offspring mice were given a normal diet for 5 weeks and then dissected to measure the relevant indexes. RESULTS: Compared to the CD group, the offspring mice in the FLD group revealed obvious hepatic steatosis and increased serum levels of alanine aminotransferase, interleukin (IL)-6, and tumor necrosis factor (TNF)-α; maternal betaine supplementation reversed these changes. The hepatic mRNA expression levels of IL-6, IL-18, and Caspase-1 were significantly higher in the FLD group than in the CD group. Maternal betaine supplementation reduced the expression of IL-1β, IL-6, IL-18, and apoptosis-associated speck-like protein containing C-terminal caspase recruitment domain (ASC). Maternal betaine supplementation also reversed the increasing protein expressions of nitric oxide dioxygenase-like receptor family pyrin domain containing 3 (NLRP3), ASC, Caspase-1, IL-1β, and IL-18 in offspring mice exposed to HFD + STZ. Maternal betaine supplementation decreased the homocysteine (Hcy) and s-adenosine homocysteine (SAH) levels significantly in the livers. Furthermore, the hepatic Hcy concentrations showed significant inverse relationships with the mRNA expression of TNF-α, NLRP3, ASC, and IL-18. The hepatic SAH concentration was inversely associated with the IL-1β mRNA expression. CONCLUSIONS The lipotropic and anti-inflammatory effect of maternal betaine supplementation may be associated with the inhibition of NLRP3 inflammasome in the livers of the offspring mice.

Objective:To investigate the application value of small private online course (SPOC) based on the concept of outcomes-based education (OBE) in rehabilitation nursing training for elderly patients after lumbar surgery.Methods:A total of 46 clinical nurses in Department of Spinal Surgery in our hospital were selected as subjects, and they were divided into control group and observation group using a simple random number table, with 23 nurses in each group. The nurses in the control group were trained by the traditional teaching method, while those in the observation group were trained by SPOC teaching based on the educational concept of OBE. The two groups were assessed in terms of the effect of training, professional core competencies, and degree of satisfaction with the training mode. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:Compared with the control group, the observation group had significantly better overall evaluation [（89.52±5.07）vs.（86.48±4.13）], mastery of practical operation skills (91.30% vs. 65.22%), and proficiency in the operation of commonly used clinical instruments (95.65% vs. 80.95%)( P<0.05). The observation group had a significantly better score of the professional core competence scale than the control group ( P<0.05). Compared with the control group, the observation group had a significantly higher degree of satisfaction with the training ( P<0.05). Conclusion:In rehabilitation nursing training for elderly patients after lumbar surgery, SPOC teaching based on the educational concept of OBE can improve the training effect of clinical nurses, enhance their professional core abilities, and increase the degree of satisfaction with training.

Objective:To evaluate the efficay of different doses of remimazolam for anesthesia induction during reoperation in asthenic patients with tracheotomy.Methods:One hundred and twenty patients of both sexes, aged 19-64 yr, with a modified frailty index score ≥3, of American Society of Anesthesiologists physical status Ⅳ, scheduled for reoperation after tracheotomy, were divided into 4 groups ( n=30 each)using a random number table method: propofol group (group C) and different doses of remimazolam groups (R 1, R 2 and R 3 groups). Anesthesia was induced with intravenous sufentanil 5 μg, propofol 1.5 mg/kg in group C and with remimazolam 0.1, 0.2 and 0.3 mg/kg in R 1, R 2 and R 3 groups, respectively.The tracheotomy cannula was replaced with a reinforced endotracheal intubation (ID=6.0 mm) when bispectral index value ≤ 65.Mean arterial pressure and heart rate were recorded before induction (T 0), immediately before replacement of the tube (T 1) and immediately after replacement of the tube (T 2). The onset time of anesthesia and adverse reactions such as hypotension, bradycardia and bucking during replacement of the tube, and requirement for rescue sedation were recorded. Results:Compared with group C, mean arterial pressure was significantly increased at T 1, 2 in group R 1 and group R 2, the onset time of anesthesia was significantly prolonged, the incidence of hypotension and bradycardia was decreased in R 1, R 2 and R 3 groups, and the requirement for rescue sedation in group R 1 and incidence of bucking in group R 1 and group R 2 were increased ( P<0.05 or 0.01). Compared with group R 1, heart rate at T 2 was significantly decreased, the onset time of anesthesia was shortened, and the requirement for rescue sedation and incidence of bucking were decreased in C, R 2 and R 3 groups, and the incidence of hypotension was significantly increased in group R 3 ( P<0.05 or 0.01). Compared with group R 2, the onset time of anesthesia was significantly shortened in group R 3 ( P<0.05). Conclusions:Remimazolam 0.2 mg/kg provides good efficacy when used for anesthesia induction with fewer side effects during reoperation in asthenic patients with tracheotomy.

Objective To investigate the role of CD4⁺CD45RC^low regulatory T cell (Treg) in the immune tolerance induction of rats undergoing liver transplantation. Methods Liver transplantation rat models of acute rejection (AR) [Lewis→Brown Norway (BN), AR group] and spontaneous tolerance (BN→Lewis, tolerance group) were established, with 6 rats in each group. Moreover, 3 Lewis rats and 3 BN rats were assigned into the sham operation group (control group). The liver tissues of rats in each group were subject to pathological staining. The expression of T cell subsets and plasmacytoid dendritic cells (pDC) in the peripheral blood, liver graft and spleen of rats was detected in each group. The correlation between pDC and CD4⁺CD45RC^lowTreg was analyzed. The expression levels of CD4, CD45RC and CD103 in the liver graft and spleen of rats were quantitatively measured in each group. Results In the AR group, pathological manifestations mainly consisted of inflammatory cell infiltration and structure disorders of transplant liver. Compared with the AR group, the expression levels of CD4⁺CD25⁺Treg and CD8⁺Treg in the peripheral blood were significantly up-regulated in the tolerance group (all P < 0.05). In the peripheral blood, the expression level of CD4⁺CD25⁺Treg was positively correlated with that of CD8⁺Treg (r=0.742, P=0.022). In the AR group, the expression level of CD4⁺CD45RC^highT cell in the peripheral blood was significantly higher than those in the tolerance and control groups (both P < 0.05). Compared with the AR group, the expression level of CD4⁺CD45RC^lowTreg in the spleen, and the expression levels of CD8⁺CD45RC^lowTreg in the peripheral blood, transplant liver and spleen were significantly up-regulated in the tolerance group (all ^P < 0.05). Compared with the control and AR groups, the ratio of CD8⁺CD45RC^lowTreg/CD8⁺T in the peripheral blood and the expression levels of pDC in the peripheral blood, transplant liver and spleen were all significantly up-regulated in the tolerance group (all P < 0.05). The expression level of CD4⁺CD45RC^lowTreg was positively correlated with the changes of pDC (r=0.506, P=0.016). The expression levels of CD4, CD45RC and CD103 in the transplant liver and spleen of rats were up-regulated in the tolerance group. In the AR group, the expression levels of CD4 and CD45RC were up-regulated, whereas that of CD103 was down-regulated. Conclusions CD4⁺CD45RC^lowTreg is a cell subgroup with negative immune regulation, which may construct a regulatory cell network of immune tolerance induction along with CD8⁺CD45RC^lowTreg and pDC.

Objective:To explore the influence of fatty liver donor on the prognosis of benign liver disease liver transplantation.Methods:The clinical data of 229 recipients and donors who underwent liver transplantation at Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2015 to December 2019 due to benign liver diseases were retrospectively analyzed. According to the degree of fatty degeneration of the donor liver, the patients were divided into non-fatty liver group( n=168), mild-medium fatty liver group( n=43), and severe fatty liver group( n=18). First, the overall prognosis after liver transplantation was analyzed, the general data of the donor and recipient were compared, and the perioperative complications of the three groups were compared. Finally, survival analysis was performed to compare the long-term prognosis of the three groups. Measurement data with the normal distribution were represented as ( Mean± SD), comparisons among groups were analyzed using t test. Comparisons of counting data between groups were analyzed using chi-square test. The theoretical frequency was less than 1. Fisher exact probability method was used, and variance analysis was used for the comparison among the multiple groups. Results:The overall 1-year, 3-year, and 5-year survival rates of the patients were 86.9%, 70.7%, 70.7%, respectively, and the average survival time was 53.1 months. The general data of donors and recipients were not significantly different among the three groups. The probability of perioperative transplanted liver failure, delayed liver function recovery, and acute kidney injury in recipients with severe fatty liver was significantly higher than that of mild to moderate fatty liver group and non-fatty liver group ( P<0.05). The results of survival analysis showed that the 1-year, 3-year, and 5-year survival rates of the non-fatty liver group were 90.5%, 71.7%, 71.7%, the mild-moderate group were 88.4%, 76.7%, 64.0% and the severe fatty liver group were 61.1%, 49.4%, 49.4%, the survival rate of patients with severe fatty liver was significantly lower than that of the other two groups ( P<0.05). Conclusion:Donor weight-grade steatosis leads to a higher incidence of transplanted liver failure, delayed liver function recovery, acute kidney injury, and worse long-term prognosis.

Objective:To evaluate the efficacy of remimazolam combined with low-dose propofol for sedation during induction of anesthesia.Methods:A total of 228 patients of both sexes, aged 18-64 yr, with body mass index of 19-35 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic cholecystectomy, were divided into 2 groups ( n=114 each) by a random number table method: remimazolam combined with low-dose propofol group (group R) and propofol group (group P). Anesthesia was induced with intravenous injection of sufentanil 0.3 μg/kg, remimazolam 0.3 mg/kg, propofol 0.5 mg/kg and micuronium 0.2 mg/kg in group R, and sufentanil 0.3 μg/kg, propofol 2 mg/kg and micuronium 0.2 mg/kg in group P. Endotracheal intubation was performed when bispectral index value ≤ 50.Before induction (T 0), immediately before intubation (T 1), at 1 min (T 2) and 3 min (T 3) after intubation, mean arterial pressure (MAP) and heart rate (HR) were recorded.The anesthesia induction time and the incidence of hypotension and bradycardia were recorded in the two groups. Results:There was no significant difference in MAP and HR at T 0 between the two groups ( P>0.05). Compared with the value at T 0, MAP in two groups and HR were significantly decreased at T 1-3 in group P ( P<0.01). Compared with group P, the anesthesia induction time was significantly prolonged, and hypotension and bradycardia was decreased in group R ( P<0.05). Conclusion:The combination of remimazolam and low-dose propofol exerts better efficacy for sedation during induction of anesthesia than propofol alone.