Objective:To investigate the protective effects and mechanism of Shenyan 1 Prescription on renal fibrosis of unilateral ureteral obstruction (UUO) rats through TGF- β 1/Smad homologous 3 (Smad3) pathway regulating ferroptosis.Methods:Totally 48 male SD rats were divided into four groups: sham-operation group, UUO model group, and Shenyan 1 Prescription low-(10 drug/kg) , and high-dosage (20 crude drug/kg) groups according to random number table method, with 12 rats in each group. The UUO model was induced by the method of unilateral ureteral obstruction except for those sham-operation group. After modeling, rats received corresponding drugs or normal saline by gavage for 4 weeks, once per day. After 4 weeks, the body mass and the left kidney weight were measured. The 24 h urine protein and the levels of serum albumin (ALB), alanine aminotransferase (ALT), serum creatinine (SCr) and blood urea nitrogen (BUN) were detected by biochemical analysis method; the ROS level in renal tissue was measured using a chemical fluorescence assay kit, and the SOD and MDA levels in left renal tissue of rats were measured using ELISA method; the morphology of renal tissue and the specific blue staining of hemosiderin were observed using HE and Prussian blue staining methods, respectively; the expressions of transforming growth factor-β1 (TGF-β1), Smad3, glutathione peroxidase 4 (GPX4), and solute carrier family 1 member 5 (SLC1A5) were detected by Western blot.Results:Compared with the model group, the 24 h urinary protein excretion in Shenyan 1 Prescription high-dosage group decreased ( P<0.05), the serum ALB level increased ( P<0.05), the ALT level decreased ( P<0.05), and the expression of SLC1A5 in renal tissue decreased ( P<0.05); the left kidney weight/body decreased in Shenyan 1 Prescription low- and high-dosage groups ( P<0.05); the levels of serum ROS and MDA decreased ( P<0.05), and the activity of SOD significantly increased ( P<0.05); the expressions of TGF-β1 and Smad3 in renal tissue decreased ( P<0.05), and the expression of GPX4 increased ( P<0.05), and the renal pathological injury and ion deposition were improved. Conclusion:Shenyan 1 Prescription has a protective effect on the structure and function of renal tissues in UUO rats through regulating ferroptosis via inhibition of the TGF-β1/ Smad3 pathway to inhibit renal fibrosis of UUO rats.

Opioid analgesics are currently known as the best analgesics. However， toxicity and side effects such as constipation， tolerance and addiction severely limit their clinical application. With the in-depth understanding of the signal transduction mechanism of opioid receptors and the continuous advancement of drug design technology， researchers have managed to develop many promising new methods to get low-toxic and more efficient opioid analgesics， which are different from the traditional morphine skeleton structure modifications. This article focuses on three new research strategies of G-protein biased activation，“ one drug-multiple targets” and peripheral activation. The basic principles of relative separation of analgesic activity and adverse drug reaction by each strategy are introduced， and the latest research progress of representative drugs is briefly reviewed. Among them， the recently approved novel opioid analgesics oliceridine and tegileridine are G-protein biased μ-opioid receptor agonists， Cebranopadol is a typical “one drug-multiple targets” analgesic， and NFEPP is a representative drug of peripheral opioid receptor agonists. The above several strategies complement each other and provide reference for the development of new opioid analgesic drugs.

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.

Frailty is a clinical condition associated with aging, encompassing deficiencies in physical performance, nutritional status, mental health, and cognition.Physical exercise has proven to be an effective strategy for maintaining functional abilities and alleviating frailty symptoms in older adults.Exercise helps in preserving or enhancing bone density, muscle mass, strength, and overall function.In recent years, there has been increasing attention on the impact of resistance exercise on the prognosis of frailty in the elderly population.This article explores the mechanisms of resistance exercise in preventing and treating frailty, examines the effects of different types of resistance exercise on age-related weakness, and reviews related research on the use of resistance exercise for preventing and treating frailty.The findings of this study provide valuable insights for developing precise exercise prescriptions that incorporate multiple modes of exercise for frail older patients.

Objective:To explore the cognition and nursing needs of patients with urinary incontinence after prostate cancer surgery on "Internet+ nursing service", so as to provide basis for the implementation of high-quality continuous nursing service.Methods:According to the phenomenological research method, 15 patients with urinary incontinence after radical prostatectomy in the Urology Surgery Department of the Affiliated Hospital of Medical School, Ningbo University from October to December 2021 were selected as the research object by intentional sampling method. Semi-structured interview was used to collect data, and Colazzi method was used to sort out, analyze and refine the subject.Results:The patients' awareness of "Internet+ nursing service" was biased. Many factors affected the willingness of patients with urinary incontinence to use "Internet+ nursing service". Factors that promoted willingness to use included public health emergency, traffic, physical and psychological factors. Factors impeding willingness to use included information security, operational and economic factors. The need for the content of "Internet+ nursing service" included the need for rehabilitation treatment related knowledge and supportive relationships. The need for "Internet+ nursing service" included the need to establish a "circle of friends" to obtain support from patients, the need for "online consultation, offline nursing", and the need to enrich the form of health education.Conclusions:The medical and nursing staff should give full play to the role of "Internet+ nursing service", and according to the characteristics of patients with urinary incontinence, enrich the "Internet+ nursing service" in the form of combination of graphics and text, video games, punch card interaction, to meet the needs of patients in rehabilitation training, doctor-nurse communication, patient support and other aspects, while strengthening the convenience of the operation of "Internet+ nursing service" and the timeliness of the service, so as to promote the rapid development of "Internet+ nursing service".

Objective:To explore the changing characteristics of self-efficacy, social support, psychological stress in patients with osteoporotic vertebral compression fractures (OVCFs) receiving conservative treatment at different treatment stages and their correlations with the recovery of lower back function.Methods:A total of 116 patients with acute OVCFs who were admitted to the Affiliated Hospital of Medical School, Ningbo University were selected from January 2017 to May 2019. Oswestry Disability Index (ODI) Questionnaire, General Self Efficacy Scale (GSES) , Perceived Social Support Scale (PSSS) and Perceived Stress Scale (PSS) were used to assess the lower back function, self-efficacy, social support and psychological stress of OVCFs patients. Questionnaires were filled out during outpatient reexamination or in-home follow-up, and the evaluation time was at the time of treatment and 1, 3, 6, and 12 months after conservative treatment. Analysis of variance and SNK- q test were used to explore the characteristics of each score over time, and linear regression analysis was used to explore the effects of GSES, PSSS, and PSS on ODI. Results:With the prolongation of treatment time, ODI, GSES, PSSS and PSS scores of OVCFS patients under conservative treatment showed a downward trend, and the scores at 3, 6 and 12 months after treatment were lower than those at 1 month after conservative treatment ( P<0.05) . The scores at 6 and 12 months after conservative treatment were lower than those at 3 months after conservative treatment ( P<0.05) . The scores at 12 months after conservative treatment were lower than that those at 6 months after conservative treatment ( P<0.05) . GSES, PSSS (total score, in-family support, out-of-family support) and PSS were independent influencing factors of ODI at one month after treatment ( P<0.05) . GSES, PSSS (total score, in-family support) and PSS were the influencing factors of ODI at 3 months after treatment ( P<0.05) . Conclusions:The self-efficacy and social support of conservatively treated patients with OVCFs are positively correlated with their lower back function, while psychological stress will reduce lower back function of such patients. It is suggested to add these non-physical factors to the rehabilitation nursing model and take appropriate intervention measures.

Objective:To analyze the relationship between frailty status and the risk of death in the elderly based on the frailty index (FI).Methods:Data from a prospective cohort study conducted between 2005 and 2015 in elderly people of an urban community in Beijing were analyzed. The variables related to health and frailty status based on the 2005 baseline survey and death as outcome variables collected in 2015 were used. A FI model was used to evaluate the correlation between FI and mortality in the elderly people in different age groups was analyzed. Cox regression was applied to evaluate the influence of FI on the risk of death, and Kaplan-Meier curves was used to show the survival rate of different frailty levels in the elderly adults.Results:Of the 1 301 elderly people included in the analysis, 403 died during 2005-2015, with the 10-year mortality rate of 31.0 %(403/1 301). The mortality rate of the elderly increased with the increase of FI, but, with the increase of FI value, the rate of mortality increased slowly. The limit value of FI causing death was around 0.70, indicating any new health problem might cause death at this value. Cox regression analysis showed that higher FI was associated with higher risk for death ( HR=1.143, 95 %CI: 1.034-1.248, P=0.000), and FI was more significantly associated with death than age ( HR=1.143 vs. HR=1.048, t=5.827, P=0.000). With the increase of age, the effect of frailty on the risk of death decreased ( HR=1.179 to HR=1.120). Kaplan-Meier curves showed that the survival rate of the elderly in all age groups decreased with the increase of frailty (Log-rank=317.812, 354.203, 247.258, all P=0.000). The survival time between different frailty levels in the elderly were significantly different, except for the elderly adults aged ≥80 years with severe frailty level (0.4≤FI<0.5, FI≥0.5, P=0.368). Conclusions:Compared with other evaluation tools of frailty, FI model can better reflect the frailty status of the elderly in communities in Beijing and has a high sensitivity in predicting adverse outcomes such as mortality. In the intervention of frailty in the elderly, focusing on relatively young elderly might be more effective in reducing the adverse outcomes caused by frailty.

Objective To investigate the types of common chronic diseases and common drugs in the elderly visiting primary medical institutions in China.Methods Cluster sampling was adopted in eight provinces/cities/autonomous region of Zhejiang,Jilin,Henan,Shanghai,Chongqing,Gansu,Guangxi and Jiangsu.Sampling sites were selected and information was collected through the online reporting system of common diseases and drug costs of the elderly in primary hospitals at all levels in China.On these grounds,the basic situation of primary medical institutions,the common chronic diseases and common drugs for people aged 65 years and above were investigated.Results Primary hypertension(65.7％ or 46/70)and arthropathy(10.0％ or 7/70)were the most common chronic diseases in the elderly visiting primary medical institutions.The consultation rate of primary hypertension was highest both in rural areas(58.3％,i.e.the ratio of 21 over 36 primary medical institutions)and in urban areas(73.5％,i.e.the ratio of 25 over 34 primary medical institutions).The primary medical institutions with consultation rates of hypercholesterolemia/hyperlipidemia (x2 =5.137,P=0.023),diabetes(x2 =3.868,P =0.049)and dyspepsia(Fisher's exact test,P =0.026)as the top 3 chronic diseases were more often seen in urban areas than in rural areas,while the primary medical institutions with consultation rates of cerebrovascular diseases as the top 3 chronic diseases were more often seen in the rural areas than in urban areas(x2=9.974,P =0.002).More primary medical institutions with consultation rates of benign prostatic hyperplasia and primary osteoporosis as the top 10 chronic diseases were found in urban areas than in rural areas(x2 =4.054 and 3.861,P =0.044 and 0.049,respectively),while more primary medical institutions with consultation rates of heart failure as the top 10 chronic diseases were found in rural areas than in urban areas(x2 =3.865,P =0.049).Aspirin,nifedipine and simvastatin one by one were most commonly used in people aged 65 years and over in primary medical institutions.Conclusions Primary hypertension is the most common chronic disease among the elderly visiting primary medical institutions in both rural and urban.Common chronic diseases in primary medical institutions are different between the urban and rural areas.Regional differences and urban-rural differences should be taken into account in drug preparation.There are some irregularities in the use of drugs and insufficient stocks of essential drugs in basic-level medical institutions.

Objective To summarize the outcomes and clinical experience of combined heart and kidney transplantation.Methods The clinical data of one case of combined heart and kidney transplantation were retrospectively analyzed.The kidney transplant was completed immediately after the heart transplant.The immunosuppressive therapy strategies included tacrolimus,corticosteroids and mycophenolate mofetil.Results For heart transplantation,heart cold ischemia time was 200 min,aorta blocking time was 136 min,and extracorporeal circulation time was 201 min.The kidney was transplanted to the right iliac fossa after heart transplantation.The endotracheal tube was removed 15 h after surgery.The patient was transferred to the general ward on the 8th day after surgery.The patient was discharged from the hospital at 27th day after surgery,the renal function was normal and no activity was restricted.Conclusion Reasonable perioperative management and selection of surgical methods are the keys to the success of combined heart and kidney transplantation.

Objective To explore the relationship between the severity of frailty and muscle mass/function in older people,and to determine whether and/or how the results would be influenced by the assessment method for frailty.Methods A total of 106 older adults aged 63-95 years were recruited from individuals undergoing regular health examinations at the Outpatient Department of Beijing Hospital.The characteristics of participants were collected through a questionnaire and subsequently evaluated.Frailty was assessed by both the Fried phenotype and an index of accumulated deficits (FI).Sarcopenia was identified based on the criteria of the Asian Working Group for Sarcopenia (AWGS).Average skeletal muscle mass,appendicular skeletal muscle mass and the appendicular skeletal muscle index (ASMI) were measured by bioelectrical impedance analysis (BIA).Furthermore,grip strength,the 4 m walking test,the timed up and go test (TUGT),the five times sit to stand test (FTSST),and the balance test were performed to investigate the physical performance.Results There were 15 (14.2％) frail and 65 (61.3％) pre-frail cases in this group.Poor grip strength 59 (55.7％) and slow gait speed 33 (31.1％) were more prevalent in frail older people.Meanwhile,when the phenotypic definition of frailty was used,muscle mass and ASMI decreased as the severity of frailty increased (F=6.579,3.969,4.507,respectively;all P＜0.05).Frail older people had significantly slower gait speed and poorer grip strength than those who were not frail (F=23.897,4.583,respectively;both P＜0.05).Moreover,frail older people were more likely to be sarcopenia (53.5％) than those who were pre frail (30.8％) or not frail (3.8％).Participants with frailty performed worse on FTSST,TUGT and the balance test (all P＜0.05) and had markedly lower levels of FI (0.15±0.04,0.18±0.06,and 0.28±0.09,respectively;F=21.764,P＜0.05) than those in the pre-frail and non-frail groups.Appendicular skeletal muscle mass,skeletal muscle mass,grip strength and walking speed were negatively correlated with FI (r =-0.256,-0.321,-0.343,-0.374,respectively;all P＜0.05) while ASMI showed no statistical correlation with FI (P＞0.05).Conclusions Poor grip strength and slow gait speed are very common in frail older people.There is a close correlation between muscle mass/function and frailty.The degree of association of frailty severity with physical performance remains largely unchanged regardless of what assessment method is used.