AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or III, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg / kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg · kg

Objective:To identify the risk factors for 1-year death after surgery in elderly patients with hip fractures and evaluate the accuracy of the prediction model based on LASSO-logistic regression analysis.Methods:A case-control study was conducted on elderly patients (age ≥65 yr) who underwent surgical treatment for hip fractures in the Second Affiliated Hospital of Wenzhou Medical University from January to December 2019. Patients were divided into death group and survival group according to their survival status at 1-year after surgery. General data and preoperative laboratory indicators were obtained. The variables were selected by utilizing LASSO regression and incorporated into multivariate logistic regression analysis to identify the risk factors for 1-year death after surgery in elderly patients with hip fractures. Then a prediction model was established based on the results and evaluated.Results:There were 63 patients in death group and 564 in survival group. The results of LASSO regression and multivariate logistic regression analysis showed that age, preoperative cognitive dysfunction, Chalson comorbidity index ≥3 points and preoperative serum prealbumin level were the independent risk factors for 1-year death after surgery in elderly patients with hip fractures ( P<0.05). The area under the receiver operating characteristic curve of the prediction model was 0.788 (95% confidence interval [0.731-0.846]), with the sensitivity and specificity of 76.2% and 68.6% respectively. The average absolute error of the calibration curve was 0.007. The results of Hosmer-Lemeshow goodness-of-fit test showed that there was no significant difference between the predicted value and actual observed value ( χ2=5.065, P=0.751). Decision curve analysis showed that patients had a high net benefit rate when the threshold probability range was 0-0.7. Conclusions:Age, preoperative cognitive dysfunction, Chalson comorbidity index ≥3 points and preoperative serum prealbumin level are the independent risk factors for 1-year death after surgery in elderly patients with hip fractures, and the prediction model developed based on LASSO-logistic regression has high accuracy.

Objective:To introduce the progress in research of rash and fever syndrome (RFS) surveillance and early warning both at home and abroad, and provide reference for surveillance and prevention of RFS in China.Methods:The keywords "fever" "rash" and "surveillance" and others were used for a literature retrieval by using China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed and Web of Science. The languages of literatures were limited in Chinese and English. The key information of the literatures were collected and analyzed with Excel.Results:A total of 36 study papers (21 in Chinese and 15 in English) were included. The studies mainly focused on the pathogen surveillance of RFS ( n=19). The pathogens included measles virus, varicella-zoster virus, rubella virus, enterovirus, human B19 virus, dengue virus, streptococcus group A, Salmonella typhi and Salmonella paratyphoid,human herpesvirus, mumps virus and adenovirus. Eight studies were about the surveillance in major events, such as sport game, World Expo and religious gathering, or sudden natural disasters, such as earthquake and tropical storm, during 2010-2015. Eight studies focused on case or epidemic surveillance, most of which were studies from other counties. The surveillance sites were medical institutions. RFS was diagnosed according to the International Classification of Diseases, 9 th (ICD-9) and symptoms descripted in chief-complaint. Only one study in Mongolia conducted RFS epidemic prediction. The analysis methods of 36 papers included simple descriptive analysis, time-based early warning models (such as regression analysis, fixed threshold method, Hugh Hart control chart method and cumulative sum control chart method) and time series analysis method. Conclusions:In the future, RFS surveillance system should cover both known pathogens and emerging pathogens. Automatic surveillance using information capture and intelligent modelling can be applied to improve the sensitivity and specificity of RFS surveillance and early warning.

Medical and preventive integration effectively bridges the gap between "treating diseases" and "preventing diseases". Over the years, medical and preventive integration research has focused on chronic and chronic infectious diseases, with insufficient attention to acute ones. Confronting newly emerging infectious diseases establishing continuous monitoring, early warning, emergency response, and appropriate treatment will be a key focus for developing and reforming the healthcare system. Interoperability and sharing of medical and health data are essential prerequisites for bridging the gap between medical treatment and disease prevention and are also important for promoting intelligent surveillance and early warning of infectious diseases. Informatization is necessary to achieve efficient collaboration between medical treatment and disease prevention. Reviewing the development of medical and health informatization in the United States and Europe, this paper compares and discusses the problems and challenges in developing medical and health informatization in China. The aim is to provide references for the development of medical and health informatization and the innovation of medical and preventive integration mechanisms in the country.

ObjectiveIn order to explore the utilization value of the seeds dropped in the harvesting， processing， storage and transportation of Prunellae Spica， the character， turgidity and chemical composition of the seeds were analyzed and compared with those of the commercially available varieties， such as chia seeds and basil seeds. MethodCharacter was observed directly. The turgidity was determined according to the method of general rule 2101 of Chinese Pharmacopoeia （part Ⅳ， the 2020 edition）. The contents of six phenolic acids （danshensu， protocatechuic acid， protocatechuic aldehyde， caffeic acid， salviaflaside and rosmarinic acid） were determined by ultra performance liquid chromatography （UPLC）， acetonitrile （A）-0.1% formic acid aqueous solution （B） was used as mobile phase for gradient elution （0-7 min， 2%-8%A； 7-13 min， 8%A； 13-14 min， 8%-17%A； 14-30 min， 17%A）， the detection wavelength was at 280 nm. The liposoluble components were extracted by n-hexane and identified by gas chromatography-mass spectrometry （GC-MS）， and the contents of five fatty acids， namely palmitic acid， oleic acid， stearic acid， linolic acid and α-linolenic acid， were determined on a DB-35MS capillary column （0.25 mm×60.0 m， 0.25 µm）， the injection temperature was 250 ℃， the carrier gas was high-purity helium with a flow rate of 1.0 mL·min^-1 and the splitting ratio of 50∶1. The volatile oil was extracted by steam distillation method and its components were identified by GC-MS on a WM-5MS capillary column （0.25 mm×30.0 m， 0.25 µm） with the injection temperature of 250 ℃， the flow rate of 1.0 mL·min^-1 and the splitting ratio of 10∶1. ResultPrunellae Spica seeds were slightly smaller than chia seeds and basil seeds， and their color of seed coat was obviously different. Prunellae Spica seeds had strong water absorption and swelling characteristics， and the turgidity was 17.4 mL·g^-1， which was lower than that of chia seeds （25.2 mL·g^-1） and basil seeds （35.6 mL·g^-1）. Prunellae Spica seeds were rich in phenolic and fatty acids， while the content of volatile oil was very low. The main phenolic acids were salviaflaside and rosmarinic acid， with the contents of 0.579% and 0.392%， respectively. The total content of five fatty acids in n-hexane extract was 90.1%， and total content of unsaturated fatty acids was 80.6%， among which content of α-linolenic acid was 50.0%， which was slightly lower than 57.2% of chia seeds and similar to 50.0% of basil seeds. ConclusionPrunellae Spica seeds have good turgidity， rich in phenolic acids and unsaturated fatty acids， and especially with high amount of α-linolenic acid. It is worthy of being developed as functional food to realize comprehensive utilization of the waste resources of Prunellae Spica.

An effective therapeutic regimen for hepatic fibrosis requires a deep understanding of the pathogenesis mechanism. Hepatic fibrosis is characterized by activated hepatic stellate cells (aHSCs) with an excessive production of extracellular matrix. Although promoted activation of HSCs by M2 macrophages has been demonstrated, the molecular mechanism involved remains ambiguous. Herein, we propose that the vitamin D receptor (VDR) involved in macrophage polarization may regulate the communication between macrophages and HSCs by changing the functions of exosomes. We confirm that activating the VDR can inhibit the effect of M2 macrophages on HSC activation. The exosomes derived from M2 macrophages can promote HSC activation, while stimulating VDR alters the protein profiles and reverses their roles in M2 macrophage exosomes. Smooth muscle cell-associated protein 5 (SMAP-5) was found to be the key effector protein in promoting HSC activation by regulating autophagy flux. Building on these results, we show that a combined treatment of a VDR agonist and a macrophage-targeted exosomal secretion inhibitor achieves an excellent anti-hepatic fibrosis effect. In this study, we aim to elucidate the association between VDR and macrophages in HSC activation. The results contribute to our understanding of the pathogenesis mechanism of hepatic fibrosis, and provide potential therapeutic targets for its treatment.
Humans ; Hepatic Stellate Cells/pathology* ; Receptors, Calcitriol ; Liver Cirrhosis/pathology* ; Macrophages/metabolism*

Objective:To observe the peripapillary atrophy (PPA) and peripapillary choroidal vascularity index (CVI) in patients with different degrees of myopia and to analyze their correlations.Methods:A cross-sectional clinical study. From September 2021 to December 2021, 281 mypoic patients of 281 eyes treated in Eye Hospital of Wenzhou Medical University at Hangzhou were included in this study, and the right eye was used as the treated eye. There were 135 eyes in 135 males and 146 eyes in 146 females. The age was 28.18±5.78 years. The spherical equivalent refraction (SE) was -5.13±2.33 D. The patients were divided into three groups: low myopia group (group A, -3.00 D

Background: Carbohydrate antigen 72-4 (CA72-4) is generally recognized as a tumor marker of digestive system. However, elevated serum CA72-4 level is also evident in many benign diseases and healthy subjects, and its sensitivity in diagnosing malignant tumor is quite poor. Aims: To reassess the value of CA72-4 in tumor screening and diagnosis. Methods: Three cohorts were established in this study. Inpatients who underwent a serum CA72-4 measurement and had a definite final diagnosis were included into Cohort 1 (retrospective study). Inpatients with elevated serum CA72-4 level who had not been diagnosed as malignant tumor before admission were included into Cohort 2 (retrospective study). Individuals who underwent a serum CA72-4 measurement and willing to take a follow-up for at least 2 years were included into Cohort 3 (prospective study). Malignancies had been preliminarily excluded in all individuals in Cohort 3 before enrollment. Results: Among the 2 173 patients recruited in Cohort 1, the prevalence of positive serum CA72-4 was significantly higher in patients with malignancies than those without (16.4% vs. 7.4%, P<0.05). The sensitivity and specificity of CA72-4 for diagnosis of malignant tumor were 36.5% and 76.2%, respectively, at the cut-off value (2.955 U/mL) identified by ROC curve analysis. Among the 1 807 patients recruited in Cohort 2, most of the participants (76.5%) did not have malignancies. Serum CA72-4 level was associated with the histological classification, tumor differentiation and TNM staging of malignancies (P<0.05). Among the 376 individuals who underwent a follow-up for no less than 2 years in Cohort 3, elevated serum CA72-4 level did not increase the risk of malignant tumor (OR=1.268, 95% CI: 0.283-5.687). Conclusions: CA72-4 is not a sensitive marker for tumor screening, its value as an item in physical examination should be re-evaluated. In patients who had positive serum CA72-4 and malignant tumor was ruled out in initial examination, the necessity of long-term follow-up of serum CA72-4 needs to be discussed.

Objective To investigate the characteristics of self perceived burden (SPB) in patients with chronic obstructive pulmonary disease (COPD) and explore the relationship between the perceived burden and self-efficacy,coping style.Methods A total of 96 cases with COPD in our hospital from January 2015 to June 2017 were enrolled in the study.The clinical data of patients were retrospectively analyzed.The patients were surveyed by self perceived burden scale,self-efficacy scale and coping style scale.The relationship between self perceived burden and self efficacy,coping style were investigated.Results The self perceived burden score of COPD patients was (33.76 ± 7.65) points with moderate level.The symptom management self-efficacy,common disease management self-efficacy score of COPD patients were (8.13 ± 1.09) and (8.22 ± 1.13) respectively with moderate self-efficacy.The total score of coping style in COPD patients was (35.09 ± 10.83) points with positive coping style.The each dimension and the total score of self perceived burden were negatively correlated with positive coping style in COPD patients (P ＜ 0.05),and positively correlated with negative coping styles (P ＜ 0.05).The total score of coping style had no significant correlation with perceived burden scores (P ＞ 0.05).The each dimension and the total score of self perceived burden were negatively correlated with the each dimension scores and total scores of self-efficacy in COPD patients (P ＜ 0.05).Conclusions There are significant correlation between SPB and self-efficacy and coping style in COPD patients.Medical staff should strengthen communication with patients,and guide them with positive coping style in the face of disease,which can effectively improve their self-efficacy and reduce the self perceived burden and promote physical and mental health.

Endophytic fungi strains (n = 81) were isolated from the leaves, barks, and fruits of Camellia oleifera from Hunan province (China) to delineate their species composition and potential as biological control agents of C. oleifera anthracnose. The fungi were identified by morphological and phylogenetic analyses. Fungal colonization rates of the leaves, barks, and fruits were 58.02, 27.16, and 14.81%, respectively. The isolates were identified as 14 genera, belonging to two subdivisions, Deuteromycotina and Ascomycotina; 87.65% of all isolates belonged to Deuteromycotina. The dominant species, occurring with a high relative frequency, were Pestalotiopsis sp. (14.81%), Penicillium sp. (14.81%), and Fusarium sp. (12.35%). The Simpson’s and Shannon’s diversity indices revealed the highest species diversity in the leaves, followed by the barks and fruits. The similarity index for the leaves versus barks comparison was the highest, indicating that the number of endophytic fungal species shared by the leaves and barks was higher than barks and fruits or leaves and fruits. Based on the results of dual culture experiments, only five strains exhibited antifungal activity against C. oleifera anthracnose pathogen, with isolate ty-64 (Oidium sp.) generating the broadest inhibition zones. Our results indicate that the endophytes associated with C. oleifera could be employed as natural agents controlling C. oleifera anthracnose.
Biological Control Agents ; Camellia* ; Colon ; Endophytes ; Fruit ; Fungi* ; Fusarium ; Penicillium