OBJECTIVE: To investigate the effect of Akt2 inhibitor on macrophage polarization in the periapical tissue in a rat model of periapical inflammation. METHODS: Rat models of periapical inflammation were established in 28 normal SD rats by opening the pulp cavity of the mandibular first molars, followed by injection of normal saline and Akt2 inhibitor into the left and right medullary cavities, respectively. Four rats without any treatment served as the healthy control group. At 7, 14, 21 and 28 days after modeling, 7 rat models and 1 control rat were randomly selected for observation of inflammatory infiltration in the periapical tissues by X-ray and HE staining. Immunohistochemistry was used to detect the expression and localization of Akt2, macrophages and the inflammatory mediators. RT-PCR was performed to detect the mRNA expressions of Akt2, CD86, CD163, inflammatory mediators, miR-155-5p and C/EBPβ to analyze the changes in macrophage polarization. RESULTS: X-ray and HE staining showed that periapical inflammation was the most obvious at 21 days after modeling in the rats. Immunohistochemistry and RT-PCR showed that compared with those in the control rats, the expressions of Akt2, CD86, CD163, miR-155-5p, C/EBPβ, and IL-10 increased significantly in the rat models at 21 days (P < 0.05). Compared with saline treatment, treatment with the Akt2 inhibitor significantly decreased the expression levels of Akt2, CD86, miR-155-5p and IL-6 and the ratio of CD86⁺M1/CD163⁺M2 macrophages (P < 0.05) and increased the expression levels of CD163, C/EBPβ and IL-10 in the rat models (P < 0.05). CONCLUSION Inhibition of Akt2 can delay the progression of periapical inflammation in rats and promote M2 macrophage polarization in the periapical inflammatory microenvironment possibly by reducing miR-155-5p expression and activating the expression of C/EBPβ in the Akt signaling pathway.
Rats ; Animals ; Proto-Oncogene Proteins c-akt/metabolism* ; MicroRNAs/genetics* ; Interleukin-10 ; Rats, Sprague-Dawley ; Macrophages/metabolism* ; Inflammation/metabolism*

Proprotein Convertase Subtilisin/Kexin 9 (PCSK9) inhibitor has become a new drug for the treatment of hypercholesterolemia and atherosclerotic cardiovascular disease. Recent studies have shown that the mechanism of PCSK9 in atherosclerotic cardiovascular disease is very complex, which is closely related to the increase of plasma low-density lipoprotein cholesterol level, apoptosis, autophagy, inflammation, foam cell formation and vascular smooth muscle cell calcification, which will help us better understand the " multiple effects" of PCSK9 inhibitors. This review aims to analyze the research status of PCSK9 in molecular structure, cell function and cardiovascular disease treatment, which will further consolidate the success of new treatment strategies for atherosclerosis.

Severe acute pancreatitis-associated acute lung injury (SAP-ALI) is a serious disease associated with high mortality. Emodin has been applied to alleviate SAP-ALI; however, the mechanism remains unclear. We report that the therapeutic role of emodin in attenuating SAP-ALI is partly dependent on an exosomal mechanism. SAP rats had increased levels of plasma exosomes with altered protein contents compared to the sham rats. These infused plasma exosomes tended to accumulate in the lungs and promoted the hyper-activation of alveolar macrophages and inflammatory damage. Conversely, emodin treatment decreased the plasma/pancreatic exosome levels in the SAP rats. Emodin-primed exosomes showed less pro-inflammatory effects in alveolar macrophages and lung tissues than SAP exosomes. In detail, emodin-primed exosomes suppressed the NF-κB pathway to reduce the activation of alveolar macrophage and ameliorate lung inflammation by regulating PPARγ pathway, while these effects were amplified/abolished by PPARγ agonist/antagonist. Blockage of pancreatic acinar cell exosome biogenesis also exhibited suppression of alveolar macrophage activation and reduction of lung inflammation. This study suggests a vital role of exosomes in participating inflammation-associated organ-injury, and indicates emodin can attenuate SAP-ALI by reducing the pancreatic exosome-mediated alveolar macrophage activation.

Objective:To explore the application effect of PBL teaching guided by anesthesia plan in clinical teaching of anesthesia undergraduate practice.Methods:A total of 34 anesthesiology undergraduates who practiced in Daqing Oilfield General Hospital/The Tenth Affiliated Hospital of Qiqihar Medical University from January 2020 to September 2020 were selected and randomly divided into experimental group ( n=17) and control group ( n=17). The experimental group adopted PBL teaching guided by anesthesia plan, while the control group adopted traditional teaching. The theoretical assessment results, case analysis assessment results, and clinical skills assessment results of the two groups of undergraduate interns were compared and analyzed. Additionally, a questionnaire survey was conducted to evaluate the students' comprehensive ability. SPSS 22.0 was used for t test. Results:The scores and total scores of theoretical knowledge and anesthesia skills in the experimental group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Before learning, there was no significant difference in scores and total scores of comprehensive ability between the two groups ( P>0.05); after learning, the comprehensive ability of the two groups of students were improved, and those of the experimental group were higher than those of the control group ( P<0.05). Conclusion:PBL teaching guided by anesthesia plan can effectively improve the mastery of theoretical knowledge, clinical operation skills and case analysis ability of anesthesia undergraduate interns, and the teaching effect is good, which is worthy of further promotion.

Objective:To investigate the current situation of nurses′ professionalism in secondary and tertiary general hospitals, analyze its influence factors, and establish norms of nurses′ professionalism in secondary and tertiary hospitals, so as to provide references for evaluation the level of professionalism in nurses.Methods:From May to December 2016, the nurses′ professionalism evaluation system was used to investigate 3 315 nurses in 35 secondary and tertiary general hospitals in 14 cities of 7 regions in China by using random cluster sampling, and the corresponding norm, classification norm and delimitation norm were defined.Results:The average norm scores of nurses′ professionalism in the secondary and tertiary general hospitals was (71.02 ± 16.70), and the average norm scores of each dimension were professional ethics (18.97 ± 4.52) , comprehensive capabilities (17.99 ± 4.46), professional skills (17.07 ± 4.80), professional emotions (16.98 ± 4.70) . According to the differences in characteristics, the classification norms for different gender, age, working years, educational background, professional title, position, department, marital status, with or without children were formed. The level of nurses′ professionalism was divided into five grades: the total score in the interval [90.92, 100.00] was excellent, in the interval [78.31, 90.92) was good, in the interval [64.27, 78.31) was general, in the interval [50.49, 64.27) was relatively poor, in the interval [0.00, 50.49) was poor.Conclusions:Nurses′ professionalism in secondary and tertiary hospitals was in the general level and affected by a variety of factors, medical managers and nursing managers should take corresponding measures to improve nurses′ professionalism.

Decision-making aid for cancer patients is of great significance in the diagnosis and treatment for diseases. Breast cancer is one of the most common malignant tumors in women all over the world, and breast cancer patients have become the main target population for decision-aided research. Application of decision-making assistance for patients in Western countries has developed to a certain extent, while relevant research in China is still at the early stage. There are kinds of intervention forms for patients' decision aids, including traditional brochures and videos, decision aids systems, decision coaching, multidisciplinary breast cancer teams, etc. The tools for decision-making quality evaluation include the patients' awareness for decision-making, participation, decision-making conflict, decision-making satisfaction, decision-making regret, which can provide important guidance for the application of decision-making aid treatment in breast cancer patients in the future.
Breast Neoplasms/therapy* ; China ; Decision Making ; Emotions ; Female ; Humans ; Personal Satisfaction

Objective:To explore the surgical technique and efficacy of pure retroperitoneoscopic extravesical standardized seeable (P.R.E.S.S.) technique for bladder cuff excision (BCE).Methods:Ninety five patients with UTUC from five domestic centers (30 cases from Changzheng Hospital, 21 cases from Peking University First Hospital, 20 cases from Yuhuangding Hospital, 21 cases from Dalian Medical University affiliated No.2 Hospital and 3 cases from General Hospital of Eastern Theater Command)between August 2017 and December 2020 were retrospectively analyzed. There were 57 males and 38 females with a mean age of (67.7±10.0) years and median tumor size of 3.0 cm. All patients underwent pure retroperitoneoscopic radical nephroureterectomy with a single surgical position and four (36 cases) or five (59 cases) trocar layout according to the surgeon’s prefer habit and experience. The demographics of the two groups were the age of [(66.3±11.2)years vs. (68.6±9.1)years], male/female ratio of (25/11 cases vs. 32/27 cases), body mass index of [(25.0± 3.0)kg/m 2 vs. (24.8±3.4)kg/m 2], tumor maximum diameter of [2.8(1.6, 3.5)cm vs. 3.0(2.0, 4.0)cm], left/right side tumor of(19/17 cases vs. 34/25 cases), T 1-2/T 3-4/Tis stage of(25/10/4 cases vs. 49/10/0 cases), and multifocal tumors of(3 cases vs. 2 cases), and the difference was not statistically significant( P>0.05). On the other hand, the differences of hydronephrosis of the operated kidney(13 cases vs. 39 cases, P=0.004), and tumor location (in renal pelvis or calyx or upper/middle/lower ureter being 23/9/4 cases vs. 35/4/20 cases, P=0.005), were statistically significant. The umbilical artery cord was used as anatomical landmark in the process of P. R.E.S.S. bladder cuff excision. The pelvic floor and extraperitoneal space around the ureter were expanded, the bladder wall was opened to form pneumovesicum, and a sufficient bladder cuff resection and exact bladder cuff closure was performed. Perioperative outcomes and follow-up data were analyzed, and the clinical outcomes between the four and five trocars were compared to evaluate the impact of trocar layout on the surgical outcomes. Results:There were 91(95.8%) cases successfully undergoing P. R.E.S.S. BCE technique, with one case converted to open BCE due to bleeding and three cases converted to distal ureter Hem-o-lok clipping because of poor exposure. Median operative time was 180(125, 230)min, and estimated blood loss was 100(50, 100)ml. The overall complication rate was 10.5%(10/95), including 2 cases(2.1%) of intraoperative bleeding, with 1 case treated by transfusion (400 ml), the other case converted to open surgery without transfusion. There were 8 cases of postoperative complications(8.4%), including 7 cases of Clavien-Dindo grade Ⅱ(3 cases of secondary hemorrhage, one case for each of drug allergy, acute renal insufficiency, blood creatinine increased to 490 μmol/L, or lung infection with lymphatic leakage), 1 case of grade Ⅲa(intestinal obstruction treated with insertion of the intestinal obstruction catheter under local anesthesia), and all these patients were discharged smoothly. The difference between the four and five trocars was not statistically significant in the following variables, including the rate of surgical conversion(8.3% vs. 1.7%), estimated intraoperative blood loss(100 ml vs. 60 ml), ratio of intraoperative lymph node dissection (25.0% vs.20.3%), P. R.E.S.S. bladder cuff excision success rate(91.7% vs.98.3%), the incidence of intraoperative and postoperative complications (13.8% vs.8.5%), pT 1-2/pT 3-4/pTis stage(22/11/3 cases vs.37/19/3 cases) and the proportion of recurrence or metastasis(8.3% vs.3.4%)(all P>0.05). However, the differences in the operation time(190 min vs.170 min, P=0.011)and postoperative hospital stay(5 d vs.6 d, P=0.005) were statistically significant. Conclusions:P. R.E.S.S. bladder cuff resection technique is safe and feasible during the procedure of pure retroperitoneoscopic radical nephroureterectomy by a single surgical position and facilitates seeable adequate bladder cuff excision by establishing an enlarged pelvic lateral extraperitoneal space and pneumovesicum. Five-trocar technique is more suitable for patients with lower ureteral tumors but may be associated with a longer postoperative hospital stay compared with the four-trocar technique.

Objective:To explore the relations of changes in the cognitive function with brain structure network in patients with cerebellar infarction.Methods:Thirty-six patients with cerebellar infarction at the posterior lobe, admitted to our hospital from July 2016 to October 2019, were chosen as cerebellar infarction group; and 30 healthy subjects matched with age, gender, and education level at the same time period were used as control group. Neurocognitive and behavioral tests were performed on both groups to assess the cognitive functions, and MR imaging was performed to obtain diffusion tensor imaging (DTI) data. Deterministic tractography and graph theory were used to obtain the structural brain network and network parameters of all subjects. The differences of clinical data and brain network topological characteristic parameters between the two groups were compared, and the correlation between the subjects' brain structural network characteristic parameters and cognitive function was analyzed.Results:As compared with the control group, patients in the cerebellar infarction group had significantly lower Mini-mental State Examination (MMSE), Montreal Cognitive Scale (MoCA), Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test (DST), Clock Drawing Test (CDT) and Berg Balance Scale (BBS) scores, and significantly longer Trail Making Test (TMT) time-consuming ( P<0.05). As compared with the control group, the cerebellar infarction group showed significantly decreased global efficiency (Eglob) and local efficiency (Eloc) in the brain network, and significantly increased clustering coefficient (Cp) and length of path (Lp, P<0.05). As compared with the control group, the cerebellar infarction group had significantly reduced nodal efficiency in 14 brain regions ( P<0.05), including bilateral median cingulate and paracingulate gyri (DCG), left inferior frontal gyrus-opercular part (IFGoperc), bilateral supplementary motor area (SMA), bilateral precuneus (PCUN), left inferior frontal gyrus-orbital part (ORBinf), left temporal pole-superior temporal gyrus (TPOsup), left temporal pole-middle temporal gyrus(TPOmid), left inferior parietal-supramarginal and angular gyri (IPL), bilateral posterior cingulate gyrus (PCG), left inferior frontal gyrus-triangular part (IFGtriang). MoCA scores were significantly negatively correlated with Lp ( r=-0.388, P=0.019), and were significantly positively correlated with Eglob ( r=0.350, P=0.036), and efficiencies in the right DCG ( r=0.428, P=0.009), left DCG ( r=0.359, P=0.031) and right PCG ( r=0.350, P=0.037) in the cerebellar infarction patients. The RAVLT scores showed a significantly positive correlation with Eglob ( r=0.338, P=0.044). The TMT-A time-consuming and left DCG had significant negative correlation ( r=0.357, P=0.032). TMT-B time-consuming was significantly negatively correlated with right DCG ( r=-0.432, P=0.008), right PCUN ( r=-0.350, P=0.036) and left DCG ( r=-0.398, P=0.016), and positively correlated with Lp ( r=0.406, P=0.014). Conclusions:There is cognitive dysfunction in multiple domains after acute cerebellar infarction, including memory, executive function, visuospatial ability and attention. At the same time, there are reduced efficiency of information transmission in bilateral PCUN, PCG and DCG, and the frontal temporal lobe; among them, the abnormal changes of the right PCG, bilateral DCG, and right PCUN may play key roles in cognitive dysfunction.

Objective To explore the effects of self-role recognition nursing on the agitation behavior and social interaction in schizophrenic patients with diabetes mellitus. Methods A total of 98 cases of schizophrenia patients with diabetes mellitus treated in Wuxi Mental Health Center of Jiangsu Province from October 2014 to October 2016 were selected as the research objects. The patients were randomly divided into control group and study group by random number table method. The control group was given routine nursing intervention, while the study group was given self-role recognition nursing intervention for 6 months. The level of fasting blood glucose and 2-hour postprandial blood glucose were compared between the two groups. Patients' agitation behavior was evaluated by Cohen-Mansfield agitation inventory (CMAI); social communication ability was evaluated by social skills checklist (SSC) and social adaptive functioning evaluation (SAFE); mental status was evaluated by positive and negative syndrome scale (PANSS). The data of this study were statistically analyzed with SPSS 19.0 statistical software, in which the measurement data were tested by t-test, and the enumeration data were tested by χ2test. Results Before intervention, there was no significant difference in fasting blood glucose and 2-hour postprandial blood glucose between the two groups (P> 0.05). After intervention, the fasting blood glucose and 2-hour postprandial blood glucose level in the study group were significantly lower than those in the control group, and the differences were statistically significant (P< 0.01). The scores of physically aggressive agitation, physically non-aggressive agitation, verbal agitation and the total score of CMAI in the control group were (16.4±3.7), (31.5±4.9), (25.2±4.5), (73.1±4.5) respectively after intervention, and the scores were (11.8±3.2), (24.1±5.3), (17.5±4.2), (53.4±4.7) in the study group. The differences between the two groups after intervention were statistically significant (t=7.268, 8.617, 8.561, 15.341;P<0.01). The results of SSC scale and SAFE scale in both groups decreased than before intervention, and the scores of the study group were all lower than those of the control group, with statistical significance (P<0.01). After intervention, the scores of positive symptoms, negative symptoms, negative symptoms and the total score of PANSS scale of the study group were significantly lower than those of the control group, and the differences were statistically significant (P<0.01). Conclusions Self-role recognition nursing intervention can be used to improve the patients' social interaction ability and mental status in the nursing process of schizophrenia patients with diabetes mellitus, and it is worthy of clinical promotion.

Objective To investigate the resting-state functional connectivity of the two hemispheres between multiple system atrophy (Parkinsonian type,MSA-P) and Parkinson's disease (PD).Methods A total of 25 MSA-P,29 PD patients and 29 well-matched healthy controls recruited in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from June 2013 to December 2015 were scanned with resting-state functional magnetic resonance imaging for voxel mirrored homotopic correlation (VMHC) analysis.The Mini Mental State Examination,Montreal Cognitive Assessment,Frontal Assessment Battery and Unified Parkinson's Disease Rating Scale-Ⅲ (UPDRS-Ⅲ) were used to assess the clinical symptom.Then the relationship between the change of VMHC values and severity of clinical symptoms was investigated.Results Compared with healthy controls,MSA-P and PD patients both showed decreased VMHC in bilateral cerebellum posterior lobe,precuneus gyrus,middle temporal gyrus,and postcentral gyrus.Compared with PD or healthy controls,MSA-P patients exhibited lower VMHC in bilateral putamen.Significant negative correlation between VMHC values of putamen and UPDRS-Ⅲ scores was found in MSAP patients (r =-0.607,P =0.001).Conclusion These functional changes suggest that the abnormal interhemispheric synchrony probably plays an important role in pathophysiology of both MSA-P and PD,and abnormal VMHC values in putamen of MSA-P may be helpful in differentiating MSA-P from PD.