Objective:To summarize the evidence of cold therapy for patients after knee joint replacement, so as to provide theoretical support for the practical implementation of cold therapy in patients after knee joint replacement in clinical practice.Methods:The literature on cold therapy for patients after knee joint replacement was systematically searched in relevant databases and websites at home and abroad. The search period was from database establishment to September 2022. The evaluation of literature quality and evidence extraction were independently completed by two researchers.Results:A total of 17 articles were included, including two clinical practice guidelines, five systematic reviews, six randomized controlled trials, and four expert consensuses. After independent evaluation and evidence extraction by two researchers, a total of 19 pieces of evidence were collected from 5 aspects: evaluation and education, observation of cold therapy, cold therapy tools, cold therapy parameters, and cold therapy effects. Among them, 8 pieces of A-level recommended evidence and 11 pieces of B-level recommended evidence.Conclusions:Cold therapy for patients after knee joint replacement is widely accepted and applied. Medical and nursing personnel should prioritize patient safety and formulate scientific cold therapy plans based on various factors such as individual differences, patient preferences, actual clinical scenarios, differences in medical equipment, medical and nursing personnel technical level, and cost-effectiveness, in order to maximize patient benefits.

Objective:To investigate the prevalence of frailty in elderly patients with stage 3-5 non-dialysis chronic kidney disease(ND-CKD)and to analyze its related factors.Methods:A cross-sectional study was conducted.Patients ≥65 years old with stage 3-5 CKD who had never undergone dialysis in the nephrology department and the internal medicine department of our hospital between October 2017 to September 2018 were enrolled.Patients were divided into the non-frail group and the frail group according to the Fried frailty phenotype.Clinical data and laboratory results were collected and comprehensive geriatric assessment was carried out to evaluate participants' medication, comorbidities, daily living ability, nutritional status, depression, cognitive and physical performance.The relevant factors for frailty were analyzed.Results:A total of 193 elderly patients with stage 3-5 ND-CKD were enrolled, 106 male and 87 female, including 68 outpatients and 125 inpatients, with a median age of 79.00(73.00, 85.00)years.There were 143 frailty patients(74.1%), including 41 outpatients and 102 inpatients, accounting for 60.3% and 81.6% of the eligible outpatients and inpatients respectively.Multivariable Logistic regression analysis showed that CKD stage( OR=9.74, 95% CI: 1.12-84.54)and polypharmacy( OR=3.69, 95% CI: 1.09-12.42)were associated with frailty in outpatients, and CKD stage( OR=11.75, 95% CI: 1.38-99.99)and malnourishment or risk of malnutrition( OR=4.22, 95% CI: 1.40-12.74)were correlated with frailty in inpatients. Conclusions:The prevalence of frailty is high in elderly patients with stage 3-5 ND-CKD.CKD stage, polypharmacy and malnourishment or the risk of malnutrition are closely correlated with frailty.

Objective:To study the application of the best evidence of dysphagia recognition in acute stroke patients.Methods:The study was performed guided by JBI evidence-based continuous quality improvement pattern, including evidence acquisition, baseline audit, evidence implementation and re-audit. Data were collected by using field observation, questionnaire survey and review of nursing records. 80 patients and 18 nurses were recruited in the study. Barriers to evidence implementation and available solutions were analyzed. Before and after the application of evidence, the compliance of audit criterion, screening rate of swallowing disorder, screening accuracy, screening record rate and knowledge of nurses were compared.Results:Before and after the implementation of evidence, the compliance of all audit criterion was 0-33.3% and 95.0%-100.0%, and had a significant difference ( P<0.05). The dysphagia recognition knowledge score was improved from 40-80(60.56±10.69) to 60-100 (82.78±10.18) and had a significant difference ( t value was -6.39, P<0.05). The screening rate for dysphagia increased from 7.5% to 95.0%, with statistically significant difference ( χ2 value was 119.10, P<0.05). The screening accuracy was 100%, and the screening record rate was 97.4%, only 4 of the 24 patients at risk of dysphagia developed pulmonary infection. Conclusion:The application of the best evidence of dysphagia recognition in acute stroke patients can improve the nurses′ ability of dysphagia screening and improve nursing practice in dysphagia management.

With the population aging, the prevalence of chronic kidney disease(CKD)is increasing.Frailty is a complex syndrome in the elderly.Elderly CKD patients have higher risks of frailty and cognitive impairment than the general elderly population.In recent years, the relationship between frailty and cognition has gradually attracted the attention of researchers at home and abroad.Cognitive frailty is regarded as a subtype of frailty and has become one of the research hotspots in the field of gerontology.However, there are few studies on the relationship between CKD and cognitive frailty in the elderly.This article reviews research progress on the topic, including the epidemiology, evaluation methods and possible pathogenesis of cognitive frailty in elderly CKD patients.

Objective To explore the effect of hospital-community integration follow-up pattern on medication compliance in patients with mental disorder. Methods From January 2016 to January 2017, 96 patients were treated effectively with systemic therapy in psychosomatic department and TCM WM department, and 96 discharged mental disorder patients were treated with brief psychiatric rating scale (BPRS) ≤ 28. The patients were randomly divided into 48 cases in the intervention group and the control group; both groups were standardized medication; control group received an outpatient referral, intervention group combined with medical doctors in our hospital and community doctors for one year follow-up intervention. Observed the condition of illness and medication compliance after six months and one year intervention between two groups, compared the patient recurrence rate of one year after discharge. Results BPRS score of intervention group was significantly lower than control group (P＜0. 01), the difference was statistically significant, while intervention group had higher compliance than control group (P＜0. 01), and the difference was statistically significant. Recurrence rate (20. 83％) of intervention group was significantly lower than control group (38. 78％) ( 2 = 4. 03, P＜0. 05), the difference was statistically significant. Conclusion Hospital-community integration follow-up has positive effect on stabilizing patients with mental disorder and improving compliance and decreasing relapse rate.

Objective: To facilitate personalized treatment for major depressive disorder (MDD) among adults, a systematic review was conducted to explore the moderators of treatment outcome between pharmacotherapy and psychotherapy. Methods: A systematic search of papers, published in English before April, 2017, was conducted in Pubmed, PsycINFO and EMbase. Totally 754 papers were screened in accordance with the predefined inclusive and exclusive criteria. Then the selected literatures were scored according to randomized controlled trial (RCT), statistical, and the sample-size quality criteria, and analyzed to find the moderators. Results: A total of 30 papers were included. Totally 11 got " + " in all four domains in RCT quality, 25 got the score of 4 in statistical quality, and 15 got 6 in sample-size quality. And the moderators were tested across 7 categories, namely, social demographic and contextual factors, symptom severity, preference, symptom subtype, comorbid personality traits or disorders, comorbid emotional disorders or emotional reactivity, and biological factors. Hypometabolism of the right anterior insula, positive summed functional connectivity, preference for psychotherapy, a greater number of events, married/co-habiting status, unemployment, therapy sites with better psychotherapists, more prior antidepressant exposures, and childhood trauma might be associated with better outcomes with psychotherapy, while preference for medicine, melancholic features, high levels of neuroticism, comorbid personality disorders, comorbid anxiety emotional disorders predicted better outcomes in pharmacotherapy than in psychotherapy. Conclusion: Patient characters have a moderation effect on outcomes between pharmacotherapy and psychotherapy, thus these characters should be considered in the selection of the two therapies. Due to the limited quantity of these reviewed papers, however, the results should be retested by future studies.

OBJECTIVE:To study the effect of natural emulsifier acacia senegal on in vivo and in vitro performance of chloro-genic acid self-microemulsion. METHODS:Chlorogenic acid self-microemulsion containing acacia senegal(new chlorogenic acid self-microemulsion)was prepared by using acacia senegal to gradually replace polysorbate 80 in chlorogenic acid self-microemul-sion containing nonionic emulsifier (traditional chlorogenic acid self-microemulsion). The appearance,morphology,particle size,conductivity,pH value,stability,in vitro release and intestinal absorption kinetics of the 2 kinds self-microemulsions were evaluated. RESULTS:50％of polysorbate 80 was replaced by acacia senegal in new chlorogenic acid self-microemulsion. The tradi-tional and new chlorogenic acid self-microemulsions had clear appearance,and approximately spherical drops. Particle sizes were (24.53 ± 3.03),(35.51 ± 5.91) nm;dectrical conductivities were (195.6 ± 0.3),(189.5 ± 0.4)μs/cm;and pH were 3.87 ± 0.02, 4.08 ± 0.03 (n=3),respectively. Compared with traditional chlorogenic acid self-microemulsion,the absorption rate constant,ef-fective permeability coefficient and absorption amount of the new one in duodenum,jejunum,ileum were increased a little (P>0.05);the above indexes in colon were obviously decreased (P<0.05). CONCLUSIONS:The new chlorogenic acid self-micro-emulsion can maintain the performance of traditional one,and increase absorption of chlorogenic acid in small intestine.

OBJECTIVE: To evaluate therapeutic eff ect of siRNA-HDAC5 on non-obese diabetic (NOD) mice by using small interference RNA (siRNA) technique to knock down the expression of HDAC5 in spleen CD4+ T cells. METHODS: NOD mice, 12-weeks old, were randomly divided into 3 groups and were given normal saline, siRNA-Control or siRNA-HDAC5 through caudal vein injection. The spleens and other samples were collected at the 18th, 24th or 30th week. The blood glucose was tested by blood glucose meter. The urinary albumin and serum levels of IL-1, IL-6, IL-18, and TNF-α were detected by ELISA. The mRNA levels of CD11a, CCR5, and CX3CR1 in spleen CD4+ T cells were measured by quantitative Real-time PCR. The HDAC5 protein level in spleen CD4+ T cell was detected by Western blot. RESULTS: Compared with the control group, the siRNA-HDAC5 group showed a significant decrease in blood glucose, urine albumin excretion rate, serum cytokine and the mRNA levels of CD11a, CCR5, and CX3CR1, consist with the decrease in protein level of HDAC5. CONCLUSION Inhibition of HDAC5 expression in NOD mice could effectively alleviate the onset and development of kidney damage caused by diabetes.
Animals ; CD11a Antigen ; metabolism ; CD4-Positive T-Lymphocytes ; metabolism ; CX3C Chemokine Receptor 1 ; Cytokines ; blood ; Diabetes Mellitus, Experimental ; genetics ; therapy ; Enzyme-Linked Immunosorbent Assay ; Histone Code ; Histone Deacetylases ; genetics ; Mice ; Mice, Inbred NOD ; RNA, Messenger ; metabolism ; RNA, Small Interfering ; genetics ; therapeutic use ; Random Allocation ; Real-Time Polymerase Chain Reaction ; Receptors, CCR5 ; metabolism ; Receptors, Chemokine ; metabolism ; Spleen ; cytology

Histone acetylation is a crucial part of histone modifications in epigenetics.Histone acetylation is involved in the onset of diabetes and diabetic complications,through the mechanism of inducing hyperglycemia by means of metabolic memory effect,interfering islet development and regulating the expression of inflammatory factors and pathogenic genes.Genome-wide association studies are gradually unveilling the pathogenesis of diabetes and preclinical studies are rapidly elucidating that histone deacetylase should be considered as a new target for the treatment of diabetes.

Objective To investigate the effect of trichostatin A (TSA) and 5-azacitidine (5-AzaC) on pancreatic β-cells impaired by cytokine,via measuring the proliferation,apoptosis,and function of pancreatic β-cells.Methods RIN-m5f was impaired by interleukin-1β and interferon-γin vitro,and treated with TSA and 5-AzaC.Experiment groups included blank control group,cytokine induction group,0.05/0.10 μmoL/L TSA group,0.63/1.25 μmoL/L 5-AzaC group,and0.10 μmol/L TSA plus 1.25 μmol/L 5-AzaC group.The viability of RIN-m5f cells was detected by MTT assay.Apoptotic rate was determined by Annexin V-fluorescein isothiocyanate (FITC) /propidium iodide flow cytometry.Insulin secretion was measured by enzyme-linked immunosorbent assay.Results The viability of RIN-m5f cells in 0.05/0.10 μmoL/L TSA group,0.63/1.25 μmol/L 5-AzaC group,and 5-AzaC plus TSA group was 70.1％/79.2 ％,67.3 ％/82.9 ％,and 89.1％ respectively,being higher than that in the cytokine group (33.9％,P＜0.05) ; the apoptosis rate was 10.3％/10.5％,7.9％/9.6％,and 8.2％,being lower than that in the cytokine group (16.6％,P＜0.05) ; the capacity of glucose-stimulated insulin secretion of all the treated groups was higher than that in the cytokine group (P＜0.05).Conclusion TSA and 5-AzaC might promote the proliferation of pancreatic β-cells impaired by cytokines,inhibit its apoptosis and recover its insulin secretion.