Objective To investigate the effect and mechanism of Nuanxinkang on plaque formation in obstructive sleep apnea-hypopnea syndrome(OSAHS)comorbid with atherosclerosis(AS)mice by inhibiting endothelial-to-mesenchymal transition(EndMT).Methods Male ApoE-/-mice were randomly divided into six groups:control group,model group,atorvastatin group(2.6 mg·kg-1)and Nuanxinkang low-,medium-and high-dose groups(crude drug 3.5,7.0,14.0 g·kg-1),with eight mice in each group.The mice were exposed to chronic intermittent hypoxia(CIH)environment during sleep for a long time,and fed with high-fat diet to replicate OSAHS comorbid with AS mouse model.Oil red O staining was used to observe the formation of plaque on aortic intima in mice.Masson trichrome staining was used to evaluate the collagen content of atherosclerotic plaques in the aortic root of mice.The expressions of endothelial cell marker CD31 and EndMT marker Vimentin in aortic plaque were detected by immunofluorescence.Blood lipid levels were determined by ELISA;the mRNA expression levels of EndMT markers α-SMA and Cdh2 in aortic tissue were detected by qPCR.Results Compared with the control group,the area of aortic atherosclerotic plaque in the model group was significantly increased(P＜0.01),and the area of collagen deposition in the aortic root plaque was significantly increased(P＜0.01).The number of CD31 positive cells in the plaque were significantly decreased(P＜0.01),and the number of Vimentin positive cells were significantly increased(P＜0.01).Serum TG,T-CHO and LDL-C levels were significantly increased(P＜0.01),and HDL-C level was significantly decreased(P＜0.01).The mRNA expression levels of α-SMA and Cdh2 in aortic tissue were significantly increased(P＜0.01).Compared with the model group,the area of aortic atherosclerotic plaque in Nuanxinkang groups were significantly reduced(P＜0.05,P＜0.01),and the collagen deposition area of aortic root atherosclerotic plaque were significantly reduced(P＜0.05,P＜0.01).The number of CD31 positive expression cells in the plaque of Nuanxinkang high-dose group were significantly increased(P＜0.05),and the number of Vimentin positive expression cells in the plaque of Nuanxinkang medium-and high-dose groups were significantly decreased(P＜0.05,P＜0.01).The serum TG level of mice in the high-dose group of Nuanxinkang was significantly decreased(P＜0.01).The serum T-CHO and LDL-C levels of mice in each Nuanxinkang administration group were significantly decreased(P＜0.05,P＜0.01).The serum HDL-C levels of mice in the medium-and high-dose groups of Nuanxinkang were significantly increased(P＜0.01).The mRNA expression levels of α-SMA and Cdh2 in aortic tissue of mice in each treatment group were significantly decreased(P＜0.01).Conclusion Nuanxinkang can effectively reduce the plaque formation in OSAHS comorbid with atherosclerosis mice,which may be related to its inhibition of EndMT and reduction of collagen fiber formation.

Objective: To investigate the status of insomnia, Internet addiction, and depressive symptoms among medical students and to analyze the effect of Internet addiction on insomnia and the mediating role of depressive symptoms, in order to provide a basis for the development of targeted interventions and measurements for medical students. Methods: A stratified whole group sampling method was used to select full-time college students from three medical universities in Anhui Province. The Chinese version of Insomnia Severity Index (ISI), Internet Addiction Test (IAT) scale and 9-item Patient Health Questionnaire (PHQ-9) were used to evaluate the symptoms of insomnia, Internet addiction and depressive in students. A multivariate Logistic regression analysis was used to explore the factors influencing insomnia among medical students and to analyze the relationship between insomnia with Internet addiction and depressive symptoms, respectively. Results: The overall rate of Internet addiction was 49.5%, depressive symptoms was 39.5%, insomnia was 18.6%. High academic stress, and the presence of surrounding people diagnosed with COVID-19 were associated with a higher risk of insomnia ( P <0.05). The higher the level of Internet addiction (mild, OR =2.60; moderate/severe, OR =4.21) and depression. (mild, OR =6.35; moderate/severe, OR =19.32), the higher the risk of insomnia. Mediated effect analysis showed that Internet addiction had a direct predictive effect ( β =0.02, P <0.05) on insomnia and also indirectly affected insomnia through depression (indirect effect=0.07，95% CI =0.06-0.08). Conclusion The detected rates of insomnia, Internet addiction and depressive symptoms are high among medical students in Anhui Province, and Internet addiction and depressive symptoms are risk factors for insomnia, which should be given more attention and appropriate interventions when necessary to improve their physical and mental health.

Objective:Based on the Delphi method, the electronic intelligent kanban system for general ward nursing was constructed, and its clinical application was studied.Methods:This study was the quasi experimental research, 39 nursing staff working in the experimental ward of electronic intelligent kanban in general surgery of Zhongshan Hospital Fudan University in November 2021 and November 2022 were selected, Delphi expert consultation was used to develop the menus and detailed contents of general ward nursing electronic intelligent kanban system, and it was used in clinical practice. We used the Chinese version of the Nursing Assessment of Shift Report to evaluate the effect of nursing staff before and after the application.Results:The authority coefficients of the two rounds of expert consultation were 0.868 and 0.886 respectively, and the Kendall coordination coefficients of expert consultation were 0.068 and 0.076 respectively (all P<0.01). Finally, the electronic intelligent kanban consisted of 4 first-level menus, 8 second-level menus and 13 third-level menus. After the application of electronic intelligent kanban, the score of Nursing Assessment of Shift Report increased from (79.62 ± 7.64) to (83.51 ± 2.47), with a statistically significant difference ( t=-3.03, P<0.05). Conclusions:The constructed nursing electronic intelligent kanban system was scientific and reliable, which will be beneficial to improve the the effect of nurse shift handover.

Male ; Humans ; Aged ; Sleep Duration ; Aging ; Testosterone ; China ; Sleep

Objective:To detect gene mutations in patients with mild phenotypes of neurofibromatosis type 1 (NF1) .Methods:From June 2017 to June 2020, 5 probands with mild phenotypes of NF1 only involving the skin and their family members were collected from Department of Dermatology, Fengxian Institute of Dermatosis Prevention and Treatment in Shanghai. Pedigree investigation was performed to evaluate the clinical phenotypes of NF1. The second-generation targeted gene sequencing combined with Sanger sequencing was performed to detect and verify pathogenic mutations.Results:All the 5 probands presented with only skin lesions, including café-au-lait spots, freckles, neurofibromas, but no other systemic involvement. A total of 5 mutations were identified in different exons of the NF1 gene in the 5 families, including 1 large-fragment deletion mutation (hg38: chr17:31327199-31335928 del 8 730 bp) , 1 splicing mutation (C.7970+1G>T) , 1 insertion mutation (C.3011_3012insTATG, p.N1004fs*) , 1 deletion mutation (C.1754_1757delTAAC, p.T586Vfs*18) , and 1 nonsense mutation (c.C503G, p.S168X) , and the first 3 above mentioned mutations were previously unreported novel mutations.Conclusion:Five mutations were identified in the 5 families with mild phenotypes of NF1, including 3 novel mutations, which expand the mutational spectrum of NF1.

Objective: To investigate the mechanisms by which D-methionine (D-Met) eradicates Porphyromonas gingivalis biofilms by suppressing cyclic dimeric GMP (c-di-GMP) levels. Methods : Cell viability, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were measured to determine the effective concentrations of D-Met, which were subsequently used in the following experiments. During the P. gingivalis biofilm formation inhibition experiment and the mature biofilm disassembly experiment, biofilm biomass, exopolysaccharide (EPS), biofilm morphology, integrity of the cell membrane, and the level of c-di-GMP were determined. Results : D-Met < 40 mmol/L was biocompatible. During the biofilm formation inhibition and mature biofilm disassembly experiments, D-Met ≥ 20 mmol/L decreased the biofilm biomass and the production of EPS. SEM analysis showed that the extracellular matrix and bacterial density were drastically reduced by D-Met ≥ 20 mmol/L. TEM detection showed that 35 mmol/L D-Met ruptured the cell membrane during biofilm formation and increased the permeability of the cell membrane in the disassembly phase of mature biofilms. C-di-GMP levels decreased with increasing concentrations of D-Met in a concentration-dependent manner. Conclusion D-Met ≥ 20 mmol/L could eradicate P. gingivalis biofilms by suppressing c-di-GMP levels.

Objective:To explore the effect of establishing oncology special nursing sensitive quality index on nursing quality in Oncology Department.Methods:A total of 1 024 tumor patients who were admitted to Shaanxi Provincial People's Hospital from August 2019 to February 2020 were selected as the observation group by the convenient sampling method. In addition, 1 038 tumor patients admitted to Shaanxi Provincial People's Hospital from January 2018 to July 2019 were set as the control group. Patients in the control group were given routine nursing intervention in tumor specialty. According to the "structure-process-result" quality management model, the observation team used evidence-based analysis and Delphi expert correspondence method to clarify the sensitive quality indexes of oncology special nursing and used this as a basis for oncology special nursing. The construction of oncology special nursing sensitive quality indexes was analyzed. The clinical indexes of the observation group and the control group were compared.Results:A total of 6 oncology special nursing sensitive quality indexes were formed, which included the incidence of chemotherapy extravasation, the incidence of chemotherapy-related nausea and vomiting, the incidence of deep vein thrombosis, the incidence of PICC catheter-related infection, the incidence of accidents in tumor patients and incidence of anxiety and depression. After the intervention, the incidence of chemotherapy-related nausea and vomiting, deep vein thrombosis, PICC catheter-related infection, accidents in tumor patients and anxiety and depression in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . There was no statistically significant difference in the incidence of chemotherapy extravasation between the two groups ( P>0.05) . Conclusions:Construction of oncology special nursing sensitive quality indexes can improve the quality of oncology special nursing, which is worthy of promotion and application.

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Objective To investigate the risk factors of hypertension patients combined with coronary artery disease(CAD)and analyze the correlation. Methods A total of 258 hospitalized hypertension patients from August 2015 to December 2016 were divided into hypertension group(n = 124)and hypertension combined with CAD group(n = 134),according to the results of coronary angiography. The general data,platelet parame-ters,blood lipid level and renal function indexes of all objects were recorded. The differences of all indexes between 2 groups were compared,and the correlation between these indexes and CAD in hypertensive patients was analyzed. Results(1)More smokers and older patients were found in hypertension combined with CAD group;the values of mean platelet volume(MPV),platelet distribution width,creatinine,serum uric acid were higher, but HDL-C level was lower and all the differences were statistically significant(P < 0.05).(2)Multivariable logistic regression analysis demonstrated that age,smoking history,MPV,serum uric acid and low level of HDL-C were independent hazardous factors of CAD in hypertensive patients[OR = 1.062,95% CI:1.032 ~ 1.093;OR =2.048,95% CI:1.078~3.893;OR=2.737,95% CI:1.193~6.278;OR=1.006,95% CI:1.001~1.010;OR=0.280,95% CI:0.115~0.681(all,P<0.05)].(3)Pearson correlation analysis showed that MPV was positively correlated with serum uric acid(r = 0.17,P < 0.05). Conclusions Age,smoking history,MPV,serum uric acid and lower HDL-C value are risk factors of CAD in hypertensive patients and active detection and prevention will benefit reducing the risk for the occurrence of CAD in hypertensive patients.

Disability is one of the common geriatric syndromes.Researches addressing elderly disability are still in starting stages.Both opportunities and challenges occur in this field.In this review,we summarized the definition and diagnostic criteria popular assessment tools for the diagnosis of elderly disability,the disease burden and relevant studies regarding elderly disability.