Objective To study the effective fraction and mechanism of Lycium barbarum leaves on improving learning and memory ability of subacute aging mice induced by D-galactose injection.Methods The model of subacute aging mice was developed by injection of D-galactose subcutaneously,and different extracts of Lycium barbarum leaves were prepared.The effects of the extracts of Lycium barbarum leaves on the learning and memory ability of model mice were evaluated by Y maze experiment and new object recognition experiment.The pathomorphological changes of hippocampus in mice were observed by hematoxylin-eosin and Nissl staining.The levels of brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),glial cell line-derived neurotrophic factor(GDNF),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interferon-γ(IFN-γ)and interleukin-10(IL-10)in hippocampus of mice were detected by enzyme-linked immunosorbent assay.The activities of superoxide dismutase(SOD)and the contents of glutathione(GSH)and malondialdehyde(MDA)in hippocampus of mice were detected by related assay kits.Detection of apoptosis in the hippocampal region of mouse brain tissue using the TUNEL method.Western blotting analysis was used to detect the expressions of antioxidant proteins Nrf2,HO-1 and apoptotic proteins Caspase-3,Caspase-9 in hippocampus of mice.Results The water extraction part and 80%alcohol precipitation supernatant part of Lycium barbarum leaves significantly improved the learning and memory ability of model mice,improved the pathological damage of hippocampus in mice,increased the number of Nissl bodies in hippocampus of mice,and promoted the expression of neurotrophic factors BDNF,NGF and GDNF,and promoted the expression of neurotrophic factors BDNF,NGF and GDNF.Pro-inflammatory factors TNF-α,IL-1β and IFN-γ expression declines while anti-inflammatory factor IL-10 expression rises.The activity of SOD and the expression of GSH were increased,and the expression of MDA was decreased.Increase the expression of Nrf2 and HO-1 antioxidant proteins;reduce the expression of Caspase-3 and Caspase-9 apoptosis pathway proteins.Inhibition of apoptosis in the hippocampal region of mouse brain tissue using a model.Conclusion The water extracts and 80%alcohol precipitation supernatant extracts of Lycium barbarum leaves are the effective fractions of Lycium barbarum leaves to improve the learning and memory ability of D-galactose-induced subacute aging mice,and its mechanism might be related to the inhibition of neuronal apoptosis caused by oxidative stress and inflammation.

The standardized workflow of computer-aided static guided implant surgery includes preoperative exami-nation,data acquisition,guide design,guide fabrication and surgery.Errors may occur at each step,leading to irrevers-ible cumulative effects and thus impacting the accuracy of implant placement.However,clinicians tend to focus on fac-tors causing errors in surgical operations,ignoring the possibility of irreversible errors in nonstandard guided surgery.Based on the clinical practice of domestic experts and research progress at home and abroad,this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection,data collection,guide de-signing and manufacturing and describes strategies to resolve errors so as to gain expert consensus.Consensus recom-mendation:1.Preoperative considerations:the appropriate implant guide type should be selected according to the pa-tient's oral condition before surgery,and a retaining screw-assisted support guide should be selected if necessary.2.Da-ta acquisition should be standardized as much as possible,including beam CT and extraoral scanning.CBCT performed with the patient's head fixed and with a small field of view is recommended.For patients with metal prostheses inside the mouth,a registration marker guide should be used,and the ambient temperature and light of the external oral scan-ner should be reasonably controlled.3.Optimization of computer-aided design:it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers.Properly designing the retaining screws,extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors.4.Improving computer-aided production:it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postpro-cessing procedures.

A rapid growth and steady expansion has been witnessed in hospice care with initial effects in recent years, however, there are significant differences in practice among different regions, and a systematic and comprehensive summary and analysis are needed. Based on the consolidated framework for implementation research, this paper comprehensively analyzes and summarizes the implementation status of hospice care services from five aspects, including innovation, external setting, internal setting, individual characteristics and implementation process. This paper finds that the main factors contributing to the implementation of this service are the varied and individualized services, active implementation of training, clear division of labor among multidisciplinary teams, diversified service models, and emphasis on service publicity. The main challenges faced by the service are insufficient internal and external incentives, insufficient resources available for manpower and medicines, the level of knowledge, attitude, and practice of service providers needs to be improved, the service process needs to be harmonized, and the quality evaluation system needs to be improved. Relevant institutions at all levels should work together to play a positive role in facilitating factors, overcome obstacles, and further promote the development of hospice care in China.

Objective:To construct an evaluation index system for the quality of hospice care services, so as to provide scientific basis for evaluating the clinical practice quality of hospice care in China.Methods:Based on theories related to medical quality, a primary item pool was constructed through literature analysis. From November to December 2023, the Delphi method was used to conduct two rounds of consultation with 18 hospice care experts from 10 provinces and municipalities directly under the central government, to establish the indicators at all levels of the evaluation index system. The weights and combination weights of indicators at all levels were calculated using the analytic hierarchy process. The expert's positive coefficient was expressed as the effective response rate of the questionnaire. The degree of expert authority was expressed as the expert authority coefficient. The degree of coordination of expert opinions was represented by Kendall's W and coefficient of variation. Results:In the two rounds of expert consultation, the effective response rates of the questionnaires were 88.89% (16/18) and 93.75% (15/16), the expert authority coefficients were 0.885 and 0.897, the kendall's W values of the overall indicators were 0.152 and 0.191 ( P<0.01), and the coefficients of variation of indicators at all levels were 0 to 0.31 and 0 to 0.21, respectively. The final constructed evaluation index system for the quality of hospice care services included seven first level indicators, 22 second level indicators, and 42 third level indicators. Conclusions:The evaluation index system for the quality of hospice care services constructed is scientific, comprehensive, and targeted, which can provide reference for the comprehensive evaluation of hospice care service quality in China.

Pain is one of the most common and unendurable symptoms in cancer patients and a major factor affecting their quality of life.Patient-controlled analgesia(PCA) is an important palliative measure in additional to conventional pharmacological control of pain.Nurses play the primary role in the management of PCA for cancer pain, and their knowledge, attitude and practice about PCA for cancer pain directly affect the effectiveness of cancer pain management.This article summarizes and analyzes the current status of nurses' knowledge, attitude and practice and associated influencing factors, aiming to improve nursing management of PCA, reinforce specialized nursing training, propose recommendations for an expert consensus on PCA for cancer pain and provide a reference for nursing practice in PCA for cancer pain.

Humans ; Microglia ; Spinal Cord ; Neuralgia ; Hyperalgesia

Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.

Objective:To focus on the physical activity strategy to maintain the activity ability of the elderly in the community, comprehensively retrieve and integrate the best evidence, form practical suggestions with the goal of the transformation and practice of evidence, so as to provide scientific, reliable and up-to-date basis for the implementation of relevant evidence.Methods:According to the 6S pyramid model, the British Medical Journal (BMJ) Best Practice, UpToDate, DynaMed, World Health Organization, Chinese Medical Association, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, PubMed, SinoMed and other databases were retrieved layer by layer from top to bottom. This study obtained all articles of evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review and other types related to physical activity strategies to maintain the activity ability of the elderly in the community from January 1, 2017 to March 1, 2022. According to the inclusion and exclusion criteria of the article, 2 to 4 researchers conducted independent methodological quality evaluation on different types of article according to the tool requirements, extracted and summarized the best evidence, and formed practical suggestions.Results:A total of 14 articles were included, including 2 evidence-based decision-making, 6 guidelines, 1 expert consensus, 3 systematic reviews, and 2 overviews of systematic review. Seven dimensions such as "overall advice, health benefits, diversified sports training, aerobic training, balance training, muscle strengthening/resistance training, flexibility training" and 22 best pieces of evidence were extracted and summarized, and practical suggestions were formed.Conclusions:Medical and nursing staff should adopt evidence-based methodological practical suggestions to provide management guidance and consultation for the maintenance of physical activity ability of the elderly in the community, so as to help the elderly to maintain physical activity ability and gain health benefits.

The immune checkpoint blockade therapy has profoundly revolutionized the field of cancer immunotherapy. However, despite great promise for a variety of cancers, the efficacy of immune checkpoint inhibitors is still low in colorectal cancer (CRC). This is mainly due to the immunosuppressive feature of the tumor microenvironment (TME). Emerging evidence reveals that certain chemotherapeutic drugs induce immunogenic cell death (ICD), demonstrating great potential for remodeling the immunosuppressive TME. In this study, the potential of ginsenoside Rg3 (Rg3) as an ICD inducer against CRC cells was confirmed using in vitro and in vivo experimental approaches. The ICD efficacy of Rg3 could be significantly enhanced by quercetin (QTN) that elicited reactive oxygen species (ROS). To ameliorate in vivo delivery barriers associated with chemotherapeutic drugs, a folate (FA)-targeted polyethylene glycol (PEG)-modified amphiphilic cyclodextrin nanoparticle (NP) was developed for co-encapsulation of Rg3 and QTN. The resultant nanoformulation (CD-PEG-FA.Rg3.QTN) significantly prolonged blood circulation and enhanced tumor targeting in an orthotopic CRC mouse model, resulting in the conversion of immunosuppressive TME. Furthermore, the CD-PEG-FA.Rg3.QTN achieved significantly longer survival of animals in combination with Anti-PD-L1. The study provides a promising strategy for the treatment of CRC.

Objective:To investigate the distribution and clinical significance of subtypes of antimitochondrial antibodies (AMA)-M2, M4, M9 in primary biliary cholangitis (PBC).Methods:A total of 1 367 patients were detected with AMA-M2, M4, M9 in Peking Union Medical College Hospital (PUMCH) from Jan 2014 to Dec 2019 and the clinical parameters were collected. The distribution patterns of AMA subtypes in different groups were analyzed and the diagnostic sensitivity and specificity of AMA subtypes in PBC were calculated. Chi-square test was used for statistical analysis.Results:In 1 367 patients, 236 of whom were positive for AMA subtypes. The positivity of AMA subtypes in female was significantly higher than in male (20.34% vs 9.41%, χ2=23.792, P<0.01). In addition, the positivity of AMA subtypes was significantly higher in 30-65 years old patients than in patients younger than 30 years old or older than 65 years old [(20.00%(193/965) vs 10.97%(17/155) vs 10.53%(26/247), χ2=17.209, P<0.01]. 110 patients with positive AMA subtypes were diagnosed with PBC. The diagnostic sensitivity and specificity of AMA-M2 were both desirable [94.64%(106/112) and 92.35%(1 159/1 255)]. Although the specificity of AMA-M4 was as high as 99.12%(1 244/1 255), its sensitivity was very low [15.18%(17/122)]. Combined detection of different AMA subtypes could not improve the diagnostic sensitivity and specificity significantly. Diseases other than PBC can be positive for AMA subtypes, predominantly for AMA-M2. Conclusion:Female and 30-65 years old patients were more frequently positive for AMA subtypes. AMA-M2 was the most valuable AMA subtype for diagnosing PBC.