OBJECTIVE To investigate the reference range of tacrolimus blood concentration in children with Henoch- Schonlein purpura nephritis （HSPN） and analyze the factors affecting the blood concentration， in order to provide a reference for rational use of the drug in clinic. METHODS Clinical data of children with HSPN who were treated with tacrolimus and regularly monitored for blood concentration at the Children’s Hospital Affiliated to Kunming Medical University were retrospectively collected from January 2018 to January 2024. The threshold of effective concentration of tacrolimus was determined by the receiver operating characteristic curve of the subjects. The clinical efficacy of tacrolimus in different concentrations and the incidence of adverse drug reaction （ADR） were compared to determine the reference range of tacrolimus blood concentration. The factors influencing the blood concentration were analyzed by one-way and multiple linear regression. RESULTS A total of 97 pediatric patients were included， and their tacrolimus blood concentrations were monitored 203 times， the blood concentration was 4.26 （2.47， 6.34） ng/mL. The area under the receiver operating characteristic curve of the subjects was 0.723 （95%CI：0.596-0.850， P＜ 0.01）， which corresponded to an effective threshold of 2.19 ng/mL. The clinical efficacy in pediatric patients with tacrolimus blood concentrations of 3-＜5 ng/mL， 5-＜10 ng/mL， and ≥10 ng/mL was significantly higher than that of children with concentrations ＜3 ng/mL （P＜0.05）. Additionally， the overall incidence of ADR in children with concentrations of 5-＜10 ng/mL and ≥10 ng/mL was significantly higher than that in children with concentrations ＜3 ng/mL and 3-＜5 ng/mL （P＜0.05）. The impact of body mass index and CYP3A5 genotype on the blood concentration of tacrolimus was statistically significant （P＜0.05）. CONCLUSIONS When using tacrolimus to treat HSPN in children clinically， the reference range for blood concentration is 3 to 5 ng/mL； body mass index and CYP3A5 genotype are factors that influence the blood concentration of tacrolimus.

Lipedema is a disease in which local fat deposits in the body are the main clinical manifestations. It is often characterized by a disproportionate increase in subcutaneous fat tissue in the extremities, buttocks or hip joints. It is often misdiagnosed as obesity or lymphedema in clinical practice. The pathogenesis is not clearly understood, and there is no standardized clinical treatment method. This paper elaborated on the research status of the pathogenesis of lipedema, and summarized the clinical manifestations and classification, diagnosis and differential diagnosis, treatment methods, etc., aiming to provide up-to-date perspectives of lipedema.

Lipedema is a disease in which local fat deposits in the body are the main clinical manifestations. It is often characterized by a disproportionate increase in subcutaneous fat tissue in the extremities, buttocks or hip joints. It is often misdiagnosed as obesity or lymphedema in clinical practice. The pathogenesis is not clearly understood, and there is no standardized clinical treatment method. This paper elaborated on the research status of the pathogenesis of lipedema, and summarized the clinical manifestations and classification, diagnosis and differential diagnosis, treatment methods, etc., aiming to provide up-to-date perspectives of lipedema.

Objective:To summarize the best evidence for the evaluation and management strategies of adolescent non-suicidal self-injury, and provide a basis for medical staff to carry out standardized evaluation and management of adolescent non suicidal self injury.Methods:According to evidence-based nursing methods and the "6S"evidence pyramid model, the evidences of non-suicidal self-injury in adolescents, including guidelines, standards, case report, evidence summary, randomized controlled trial (RCT) , systematic review, clinical practice and other evidences were searched in BMJ Best Practice, UpToDate, World Health Organization, National Institute for Health and Care Excellence, National Guidelines Clearinghouse, Registered Nurses ' Association of Ontario, Scottish Intercollegiate Guidelines Network, American College of Physicians Club, Australian Joanna Briggs Institute (JBI) Evidence-based Health Care Center Library, Cochrane Library, PubMed, Embase, PsycINFO, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Database, Medlive and other databases. The retrieval period was from the establishment of the databases to June 30, 2022. The quality evaluation of the articles was evaluated by two researchers trained in the evidence-based curriculum. Included studies were pre-graded using the Australian JBI Evidence-based Health Centre Evidence pre-grading system and the Evidence Recommendation Level System (2014 edition) . Results:Finally, a total of 18 articles were included, including 5 guidelines, 2 standards, 1 case report, 1 evidence summary, 3 systematic reviews, 1 Meta-analysis, 2 clinical practices and 3 RCT studies. A total of 22 pieces of best evidence were summarized from 6 dimensions, such as screening and assessment, multi-professional and multi-form intervention strategies, training and education, self-management strategies, disposal after self-injury treatment and follow-up.Conclusions:The best evidence based on evidence-based assessment and management strategies of adolescent non-suicidal self-injury is scientific and practical, which can provide reference for the clinical practice of adolescent non-suicidal self-injury.

Objective:To explore the diagnostic value and clinical significance of total volume of quadratus femoris muscle (TQFMV), ischial angle, femoral neck angle (FNV) measured by magnetic resonance imaging (MRI) combined with eccentric distance and lesser trochanter height measured by multi-slice spiral CT (MSCT) in the diagnosis of ischiofemoral impingement (IFI) syndrome.Methods:A total of 82 patients with IFI in Beijing Huairou Hospital from October 2017 to July 2020 were selected as the observation group. In addition, 82 healthy patients who underwent MRI and MSCT were collected as the control group. The general data, MRI and MSCT parameters of the two groups were compared, and IFI influencing factors were analyzed by logistic regression. The correlation between MRI and MSCT parameters and clinical manifestations and the correlation between MRI and MSCT parameters were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of MRI and MSCT parameters for IFI.Results:There were statistically significant difference between the two groups of gender, age, MRI parameters (TQFMV, ischial angle, FNV), and MSCT parameters (eccentricity, lesser trochanter height) (all P<0.05). Logistic regression analysis showed that gender, age, MRI parameters (TQFMV, ischial angle, FNV), MSCT parameters (eccentricity, lesser trochanter height ) were all influencing factors of IFI (all P<0.05). MRI parameters (TQFMV, ischial angle, FNV), MSCT parameters (eccentricity, lesser trochanter height) were all related to quadratus femoris muscle (QFM) edema, fat infiltration and pain degree in IFI patients (all P<0.05). The MRI parameter TQFMV of IFI patients was positively correlated with the MSCT parameter eccentricity and lesser trochanter height, while the ischial angle and FNV were negatively correlated with the MSCT parameter eccentricity and lesser trochanter height (all P<0.05). The AUC of MRI parameters (TQFMV, ischial angle, FNV) and MSCT parameters (eccentricity, lesser trochanter height) in the diagnosis of IFI were high, especially the highest in combined diagnosis, reaching 0.859. Conclusions:MRI parameters TQFMV, ischial angle, FNV and MSCT parameters, eccentricity and lesser trochanter height are related to the clinical manifestations of IFI patients. Combined detection of them can improve the diagnostic value of IFI and avoid missed diagnosis and misdiagnosis.

Adipose-derived mesenchymal stem cells (ASCs) are pluripotent adult mesenchymal stem cells that are expected to be ideal seed cells for bone tissue engineering(BTE) due to their biosecurity, abundance, and easy access. However, in comparison with bone marrow mesenchymal stem cells, ASCs possess a relatively limited osteogenic capacity and often require further induction. Advances on strategies for promoting osteogenic differentiation of ASCs are reviewed from following aspects: optimization of scaffolds, addition of bioactive factors or drugs, non-coding RNA regulation, and physical stimulation, so as to provide references for the use of ASCs in BTE.

Adipose-derived mesenchymal stem cells (ASCs) are pluripotent adult mesenchymal stem cells that are expected to be ideal seed cells for bone tissue engineering(BTE) due to their biosecurity, abundance, and easy access. However, in comparison with bone marrow mesenchymal stem cells, ASCs possess a relatively limited osteogenic capacity and often require further induction. Advances on strategies for promoting osteogenic differentiation of ASCs are reviewed from following aspects: optimization of scaffolds, addition of bioactive factors or drugs, non-coding RNA regulation, and physical stimulation, so as to provide references for the use of ASCs in BTE.

Objective:To determine the clinical effect of sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser for hypertrophic scar. Methods:A total of 80 hypertrophic scar patients, including 45 male and 35 female, in our clinic were randomly divided into test ( n=40) and control ( n=40) groups from March 2019 to May 2020. Patients aged from 18-42 years with average age 28.1. Patients in test groups were treated with triamcinolone acetonide and lattice CO 2laser sequentially. After final treatments, third-party blind evaluation, Vancouver scar scale, visual analog scale and dermatology life quality index were performed. Results:Test group acquired more satisfied result in third-party blind evaluation (82.5% vs. 52.5%, χ2=8.216, P<0.05). Vancouver scar scale, visual analog scale and dermatology life quality index were not significantly different before treatment for both groups while test group acquired better improvement after treatment ( P<0.05). Conclusions:Sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser is effective for hypertrophic scar and worths wide application in the clinic.

Objective? To design a Seminar curriculum model for graduate nursing students based on the discussion of SCI papers and evaluate its effect on students' scientific research ability. Methods? Using the cluster sampling method, 57 graduate nursing students from a medical university were selected as the control group, and 58 graduate nursing students were selected as the experimental group. Using SCI nursing papers as the subject of discussion, the control group implemented the empirical Seminar curriculum model. The experimental group constructed and implemented the curriculum model based on the research capability structure model and the Seminar learning objectives. The effects of the intervention were evaluated using the Research Motivation Scale (RMS), the Nursing Research Self-Efficacy Scale (NURSES), the Nursing Staff Scientific Research Self-Assessment Scale (SRASES), and the Seminar Survey Questionnaire. Results? After the course, the scores of RMS total score, intrinsic motivation and extrinsic motivation of the nursing students in the experimental group were higher than those in the control group, and the differences were statistically significant (P＜0.05). At the end of the course, the scores of the NURSES total scores, scientific knowledge resources of the nursing students and "effect of collective research" in the experimental group were higher than those in the control group, and the differences were statistically significant (P＜0.05). At the end of the course, the scores of the total scores and dimensions of the SRASES in the experimental group were higher than those in the control group, and the differences were statistically significant (P＜0.05). Conclusions? The Seminar curriculum model based on SCI papers can improve the motivation, scientific research efficacy and scientific research ability of graduate nursing students to a certain extent. However, it is still necessary to further explore the curriculum model to help students avoid the motivation of scientific research failure and the understanding and application of theory.

Objective To establish an easily reproducible rabbit model of acute pulmonary embolism (APE) with right ventricular dysfunction (RVD).Methods Two gelfoam strips (5 rnm×5 mm× 10 mm) were squeezed and were introduced into the pulmonary arteries of each healthy rabbit (n=12).Pulmonary and systemic hemodynamic function were recorded.All rabbits underwent CT pulmonary angiography (CTPA) and pathological examination after the introduction of APE.Results All gelfoam strips located in the bilateral lower lobe arteries.Compared with baseline mean pulmonary artery pressure (mPAP) ([9.75±1.75] mmHg),mPAP increased to (20.58 ± 5.86) mmHg immediately after embolism (P ＜ 0.001),and then decreased to (18.78 ±4.80) mmHg 1 h after embolism (P＜0.001).Right ventricle/left ventricle diameter ratio (RV/LV) increased from baseline (0.67±0.09) to (1.90±0.28) 45 min after embolism (P＜0.001).Conclusion An easily reproducible rabbit model of APE with RVD are established and may be suitable for study of APE pathophysiology.