Objective: To understand 24 h physical activity levels of children aged 8-9 years in Pudong New Area and to explore its association with metabolic syndrome, so as to provide scientific basis for children s participation in physical activities and reducing the risk of metabolic syndrome. Methods: A stratified cluster random sampling method was adopted to select 13 schools in Pudong New Area, Shanghai. A total of 2 013 primary school students aged 8-9 years old were included as the research subjects. During September 2021 to December 2022, Actigraph GT3X accelerometer, height measuring gauge, electronic sphygmomanometer and waist circumference tape was used to measure physical activity, height, blood pressure and waist circumference, respectively. A total of 5 mL of venous blood was collected from students, and the levels of triglycerides (TG), highdensity lipoprotein cholesterol (HDL-C) and fasting plasma glucose (FPG) were detected, and online questionnaires were conducted. The ttest and oneway ANOVA were employed to compare the differences in 24 h physical activity levels among children with different characteristics. Multivariate Logistic regression was used to analyze the association between the 24 h physical activity levels and metabolic syndrome as well as its components. Results: Among primary school students, the average daily time of moderate to vigorous physical activity (MVPA) was (34.25±13.49)min, the attainment rate was 1.59%. The average daily sleep (SLP) time was (538.27±28.53) min, attainment rate was 1.89%. The detection rates of metabolic syndrome, abdominal obesity (AO), elevated blood pressure (BP), elevated TG, low HDL-C, and elevated FPG were 2.48%, 34.53%, 10.38%, 10.73%, 1.24% and 0.70%, respectively. Multivariate Logistic regression analysis showed that, for every 10minute increase in sedentary behavior (SB) time, the risks of AO, elevated BP, and elevated TG increased by 2% ( OR=1.02, 95%CI =1.01-1.04), 5% ( OR=1.05, 95%CI =1.01-1.08), and 6% ( OR= 1.06, 95%CI =1.02-1.11), respectively ( P <0.05). For every 10minute increase in MVPA time, the risk of metabolic syndrome decreased by 27% ( OR=0.73, 95%CI=0.57-0.93, P <0.05). For every 10 minute increase in SLP time, the risks of AO, elevated BP, and metabolic syndrome decreased by 16% ( OR=0.84, 95%CI =0.80-0.88), 9% ( OR=0.91, 95%CI =0.82- 0.99 ), and 15% ( OR=0.85, 95%CI =0.77-0.94), respectively （P <0.05). Conclusions The time of MVPA and SLP are seriously insufficient among children aged 8-9 years in Pudong New Area. There is an association between physical activity levels and metabolic syndrome as well as its components. Increasing the time of MVPA and SLP is of great significance for maintaining a relatively low risk of metabolic syndrome in children.

Tuberous sclerosis complex(TSC)is a rare genetic disease that can lead to benign dysplasia in multiple organs such as the skin, brain, eyes, oral cavity, heart, lungs, kidneys, liver, and bones. Its main symptoms include epilepsy, intellectual disabilities, skin depigmentation, and facial angiofibromas, whilst incidence is approximately 1 in 10 000 to 1 in 6000 newborns. This case presents a middle-aged woman who initially manifested with epilepsy and nodular depigmentation. Later, she developed a lower abdominal mass, elevated creatinine, and severe anemia. Based on clinical features and whole exome sequencing, the primary diagnosis was confirmed as TSC. Laboratory and imaging examinations revealed that the lower abdominal mass originated from the uterus. CT-guided biopsy pathology and surgical pathology suggested a combination of leiomyoma and abscess. With the involvement of multiple organs and various complications beyond the main diagnosis, the diagnostic and therapeutic process for this patient highlights the importance of rigorous clinical thinking and multidisciplinary collaboration in the diagnosis and treatment of rare and challenging diseases.

Objective:To explore the effectiveness of applying the ADDIE (analysis, design, develop, implement, evaluate) Model in clinical teaching for nursing interns in spine surgery department.Methods:Using a convenience sampling method, 44 nursing interns in the Department of Orthopedics at Peking Union Medical College Hospital were selected as the control group from July 2021 to May 2022, and were taught using traditional methods. From July 2022 to May 2023, 45 nursing interns were selected as the observation group, and a teaching team was formed to design a training program based on the five stages of the ADDIE instructional design model. This program was tailored to improve the overall clinical competence of the spinal surgery nursing interns. After training, the teaching effects were evaluated based on knowledge test scores, skills test scores, overall clinical competence, and teaching satisfaction.Results:After the training, the skills test scores in specialized nursing for the observation group were (94.87±1.10) points, higher than the control group's (93.98±1.41) points, with a statistically significant difference ( P<0.01). The observation group also scored higher than the control group in clinical judgment, organizational effectiveness, overall performance, and total score in the Mini-Clinical Evaluation Exercise, with statistically significant differences ( P<0.01). Additionally, the observation group reported higher satisfaction with the teaching plan and methods compared to the control group ( P<0.05) . Conclusions:Clinical teaching for spinal surgery nursing interns based on the ADDIE instructional design model can improve their specialized practical skills and overall clinical competence. The interns also expressed a high level of acceptance for this teaching design model.

Objective:To investigate effect of Yiqi Huoxue Huazhuo Jiedu Prescription(YHHJP)on inflammatory factors of brain tissues,tight junction between brain and colon tissues,intestinal flora and bacterial metabolites in cerebral ischemia reperfusion injury(CIRI)rats based on brain-gut axis.Methods:Fifty male SD rats of SPF grade were randomly divided into sham-operation group(Sham),model group(MCAO),low,medium,high doses YHHJP groups(TCM-L/TCM-M/TCM-H).Middle cerebral artery occlusion model was established according to Zea Longa methods.Neurological function defects were detected 3 days after administra-tion.TTC staining was used to calculate infarct size of brain tissue.Pathological changes of brain tissue were observed by Nissl staining,and pathological changes of brain and colon tissues were observed by HE staining.IL-1β,IL-6,TNF-α in brain tissue and LPS con-tent in serum were detected by ELISA,and D-LA content in serum was detected by biochemical method.Gene expressions of ZO-1 and Claudin-5 in brain tissue and gene expressions of ZO-1,Claudin-1 in colon tissue were studied by Real-time fluorescent quantita-tive PCR.Intestinal flora were detected by 16S rDNA high-throughput sequencing.Results:Compared with Sham group,pathological damage of brain and colon tissue were serious in MCAO group,intestinal flora structure was significantly different,neural function im-pairment was aggravated,infarct size was increased,IL-1β,IL-6,TNF-α contents in brain tissue,and LPS,D-LA contents in serum were increased,gene expressions of ZO-1 and Claudin-5 in brain tissue and gene expressions of ZO-1 and Claudin-1 in colon tissue were decreased significantly(P<0.05).Compared with MCAO group,pathological damage of brain and colon tissue of rats were relieved in TCM-L,TCM-M,TCM-H groups,disturbance of intestinal microflora microecology was improved,neurological function impairment and infarct size were markedly decreased,IL-1β,IL-6,TNF-α contents in brain tissue were decreased,gene expressions of ZO-1 and Claudin-1 in colon tissue were increased significantly(P<0.05);LPS and D-LA contents in serum were decreased in YH-HJP medium and high doses groups,while gene expressions of ZO-1 and Claudin-5 in brain tissue were increased significantly(P<0.05).Conclusion:YHHJP has a good effect on improving CIRI,whose mechanism may be related to regulating diversity of intestinal flora,reducing release of intestinal bacterial metabolites LPS and D-LA,increasing gene expressions of tight junction proteins ZO-1,Claudin-5 and Claudin-1,and down-regulating secretion of proinflammatory cytokine.

Diabetic kidney disease(DKD)is the leading cause of end-stage renal disease.Chinese materia medica shows unique advantages in intervening DKD.Silent information regulator 1(SIRT1)protein plays a vital role in the occurrence and development of DKD.This article was about the SIRT1 signaling pathway and the main molecular regulatory mechanisms to sort out the role of Chinese materia medica in regulating SIRT1 in podocytes,oxidative stress and inflammatory response.It was found that Chinese materia medica monomers and compounds were capable of regulating the PGC-1 α signaling pathway,Nrf2/ARE signaling pathway,AMPK signaling pathway,NF-κB p65 signaling pathway,and PI3K/AKT/FoxO1 signaling pathway by targeting SIRT1,exerting pharmacological effects such as inhibiting cell apoptosis,improving mitophagy,inhibiting inflammatory response,etc.,thus intervening in DKD,which can provide reference for relevant research.

Objective:To explore the effect of scientific research group-based model on the improvement of nursing scientific research ability in a county-level hospital.Methods:A nursing research group was established, the composition of team members and work contents of the group were clarified, tiered focused scientific research training was implemented through progressive research content and flexible training methods, and individual and progressive research guidance was provided through research counseling application forms, while literature reading activities were conducted through article reports and literature debriefings. Retrospective analysis of the nursing research practice, the number of scientific research outputs, and research capacity were applied to evaluate the effect of the nursing research group-based model.Results:Within 2 years of the establishment of the nursing research group, 37 training programs were conducted, 33 scientific research materials were pushed to the WeChat public account, 23 scientific research projects were tutored, and 6 research projects were successfully declared. The scientific research ability score of nursing staff participating in literature reading debriefing increased from 44.24±19.12 to 53.57±13.86( P<0.001). Conclusions:The application of the nursing research group-based model can improve the nursing scientific research ability of the county-level hospital.

Background Osteoclast stimulatory transmembrane protein (OC-STAMP) is involved in silicosis fibrosis induced by silicon oxide (SiO₂) exposure. Its role in silicosis fibrosis by inducing ferroptosis of alveolar type II epithelial cells and its related mechanism remain unclear. Objective To explore the effect and possible mechanism of OC-STAMP on ferroptosis of alveolar type II epithelial cells and silicosis fibrosis in rats under SiO₂ exposure. Methods Twenty male Wistar rats of SPF grade were randomly divided into two groups: control (Sham) group and SiO₂ group, 15 rats in each group. Rats in the SiO₂ group were given 1 mL of 50 mg·L⁻¹ SiO₂ suspension at one time through the non-exposed intratracheal instillation method to establish an animal model of silicosis, and rats in the Sham group were give 1 mL of 0.9% sodium chloride solution in the same way. Rats were sacrificed after 8 weeks. Samples of lung tissue were fixed in glutaraldehyde or paraformaldehyde for observing ultrastructure of mitochondria by transmission electron microscopy; HE, Masson, VG, and Prussian blue were used to observe changes in lung tissue structure and iron deposition. The expression level of OC-STAMP and the degree of lung fibrosis were evaluated by immunohistochemistry and immunofluorescence. The expression level of OC-STAMP in rat lung tissue was detected and the transfection effect of OC-STAMP was verified by real-time fluorescence quantitative polymerase chain reaction (RT-PCR). Overexpression (OCS group) and inhibition expression (SI-OC group) models were constructed by OC-STAMP plasmid and OC-STAMP small interfering RNA (siRNA) transfection to cultured MLE-12 cells, respectively. The relative expression levels of glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), and other proteins in lung tissue and MLE-12 were detected by Western blotting. Results The results of HE, Masson, and VG staining showed that the silicosis modeling was successful after 8 weeks of SiO₂ exposure. The immunofluorescence results showed that OC-STAMP and ATP binding cassette subfamily A member 3 (ABCA3) co-localized in alveolar type II epithelium. The immunohistochemical results showed that the levels of OC-STAMP and collagen I in the SiO₂ group were significantly higher than those in the Sham group (P<0.01). The RT-PCR results showed that the OC-STAMP mRNA in the lung tissue of the SiO₂ group was significantly higher than that of the Sham group (P<0.01). The Prussian blue staining in the lung tissue of the SiO₂ group showed positive brownish-yellow particles. Compared with the Sham group which showed normal mitochondrial structure, the mitochondrial structure was generally swollen and the mitochondrial cristae dissolved and disappeared in the SiO₂ group by transmission electron microscope observation. The Western blotting results showed that the expression levels of SLC7A11 and GPX4 both decreased in the lung tissue of the SiO₂ group (P<0.05, P<0.01), and the expression level of Vimentin increased (P<0.01). In the transfected MLE-12 cells, compared with the Sham group, the expression levels of SLC7A11 and GPX4 in the OCS group were significantly reduced (P<0.05, P<0.01). Conclusion OC-STAMP may affect the expression of proteins related to ferroptosis, and promote lung fibrosis induced by SiO₂ exposure.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Objective:To evaluate the value of systematic education for primiparas undergoing epidural labor analgesia.Methods:A total of 240 primiparas who were suitable and voluntarily requested epidural labor analgesia, aged 20-35 yr, at 37-41 + 6 weeks gestation, with a singleton fetus, in vertex presentation without fetal abnormality, were selected.According to whether the primiparas and their accompanying family members had received systematic education on epidural labor analgesia during pregnancy, the primiparas were divided into 2 groups ( n=120 each): education group and control group.When the uterine contraction was regular and the diameter of the uterine orifice reached 2 cm or more, epidural labor analgesia was carried out.Before the begining of epidural puncture, the degree of anxiety of pregnant women was evaluated using the self-rating anxiety scale.The time of communication before analgesia, time of placing body position, and satisfaction of puerperae and their family members with labor analgesia were observed and recorded. Results:Compared with control group, the self-rating anxiety scale score was significantly decreased, the time of communication before analgesia and time of placing body position were shortened, and the rate of satisfaction of puerperae and their family members with labor analgesia was increased in education group ( P<0.05). Conclusions:Systematic education is helpful in relieving the anxiety of primiparas during epidural labor analgesia, increasing the efficiency of analgesia implementation and improving the delivery experience of puerperae.