Objective:To develop and validate a risk prediction model for cognitive frailty in elderly patients with type 2 diabetes.Methods:A total of 483 elderly patients with type 2 diabetes who visited Tianjin First Central Hospital from June to December 2022 were selected using convenience sampling. They were randomly divided into a modeling group ( n=338) and a validation group ( n=145). Data were collected using a self-designed general information questionnaire, the Short-Form Mini Nutritional Assessment (MNA-SF), the Geriatric Depression Scale-15 (GDS-15), the Frailty Phenotype (FP), the Montreal Cognitive Assessment (MoCA), and the Clinical Dementia Rating (CDR). Logistic regression analysis was performed to identify the influencing factors. A cognitive frailty risk prediction nomogram model was constructed based on the results. The model was validated in the validation group, and its predictive performance and clinical applicability were evaluated using the area under the receiver operating characteristic curve ( AUC), calibration curve, and clinical decision curve analysis. A total of 483 questionnaires were distributed and all were returned as valid, resulting in a 100.0% response rate. Results:The prevalence of cognitive frailty in the 483 elderly patients with type 2 diabetes was 20.3% (98/483). Age, regular exercise, duration of diabetes, HbA1c levels, depression and nutritional status were identified as predictive factors in the model. The AUC of the model was 0.886, and the Hosmer-Lemeshow test showed a χ 2 value of 8.004 ( P=0.433). The optimal cutoff value was 0.335, and the accuracy was 89.0%. Conclusions:The prediction model demonstrates good fit and strong predictive performance, and can intuitively and easily identify elderly patients with type 2 diabetes who are at high risk of cognitive frailty, providing a reference for early screening and intervention.

Cerebral small vessel disease (CSVD) is a clinical condition resulting from lesions in the small blood vessels within the brain. Cause and mechanism of CSVD are intricate, and early diagnosis and specific treatment are currently lacking in clinical practice. This paper presents a synthesis of recent methodologies for creating animal models of CSVD, as well as a compilation of imaging and biological markers for CSVD early diagnosis. Additionally, the article reviews intervention strategies that target crucial pathways in the development of CSVD, aiming to offer novel insights into early diagnosis and intervention techniques for CSVD.

The rapid and accurate authentication of traditional Chinese medicines(TCMs)has always been a key scientific and technical problem in the field of pharmaceutical analysis.Herein,a novel heating online extraction electrospray ionization mass spectrometry(H-oEESI-MS)was developed for the rapid and direct analysis of extremely complex substances without the requirement for any sample pretreatment or pre-separation steps.The overall molecular profile and fragment structure features of various herbal medicines could be completely captured within 10-15 s,with minimal sample(＜0.5 mg)and solvent consumption(＜20 μL for one sample).Furthermore,a rapid differentiation and authentication strategy for TCMs based on H-oEESI-MS was proposed,including metabolic profile characterization,characteristic marker screening and identification,and multivariate statistical analysis model validation.In an analysis of 52 batches of seven types of Aconitum medicinal materials,20 and 21 key compounds were screened out as the characteristic markers of raw and processed Aconitum herbal medicines,respectively,and the possible structures of all the characteristic markers were comprehensively identified based on Com-pound Discoverer databases.Finally,multivariate statistical analysis showed that all the different types of herbal medicines were well differentiated and identified(R2X＞0.87,R2Y＞0.91,and Q2＞0.72),which further verified the feasibility and reliability of this comprehensive strategy for the rapid authentication of different TCMs based on H-oEESI-MS.In summary,this rapid authentication strategy realized the ultra-high-throughput,low-cost,and standardized detection of various complex TCMs for the first time,thereby demonstrating wide applicability and value for the development of quality standards for TCMs.

Objective:To investigate the key factors of renal damage in patients with primary Sj?gren′s syndrome (pSS), to construct a risk prediction model.Methods:Clinical data of 419 pSS inpatients in the Nanjing Drum Tower Hospital from 2017 to 2020 were retrospectively analyzed. The patients were randomly divided into the model group (315 cases) and the validation group (104 cases) in a 3∶1 ratio by R software randomized package. T test was used in accordance with the normal measurement data, Chi square test was used for counting data, and Kruskal-Wallis H and Mann-Whitney U test were used for non-normal distributed data. A nomogram model was created based on independent factors of renal damage by using LASSO Cox regression analysis, and the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were applied to evaluate the sensitivity, accuracy and clinical practicability of the model. Results:Renal impairment occurred in 127 (30.3%)pSS patients, including 89 (70.1%) cases with renal insufficiency, 86 cases with hematuria (67.7%), 107 cases with proteinuria (84.2%) and 49 cases with renal tubular acidosis. Compared with those without renal damage, patients with renal damage had a longer course of disease [3.00 (1.00, 8.00) years vs 1.00 (0.30, 5.00) years; Z=2.33, P=0.005], presence of fatigue [35.1% (33/94) vs 23.5% (52/221), Z=4.49, P=0.038], decreased blood cells count [white blood cell 4.50(3.30, 6.75)×10 9/L vs 5.40(3.70, 8.05)×10 9/L, Z=2.02, P=0.043; hemoglobin 99.00(79.00, 111.00)g/L vs 120.00 (109.00, 128.00)g/L, Z=6.59, P<0.001; platelet 152.00 (89.25, 204.25)×10 9/L vs 188.00 (117.99, 241.00)×10 9/L, Z=2.61, P=0.009], stronger inflammatory reactions [ESR 48.50 (29.75, 86.25)mm/1 h vs 26.00 (11.00, 52.00)mm/1 h, Z=5.83, P<0.001; CRP 5.80 (3.40, 18.45)mg/L vs 4.40 (2.60, 11.40) mg/L, Z=2.33, P=0.020] and higher positive rate for anti-SSA/B antibodies [79.79%(75/94) vs 61.99%(137/221), χ2=9.49, P=0.002; 37.23%(35/94) vs 18.10%(40/221), χ2=13.31, P<0.001], but relatively less pulmonary involvement [20.2%(19/94) vs 33.9%(75/221), χ2=5.93, P=0.016], the differences were statistically significant ( P<0.05). Lasso binary logistics regression analysis showed that EULAR Sj?gren′s syndrome disease activity index score >9[ OR(95% CI)=9.019(3.294, 24.689), P<0.001], dry eye[ OR(95% CI)=2.853(1.502, 5.422), P=0.011], anemia[ OR(95% CI)=3.819(1.913, 7.626), P<0.001], low complement C3 level[ OR(95% CI)=2.453(1.233, 4.879), P=0.011]and hypoalbuminemia [ OR(95% CI) =6.898 (3.007, 15.821), P<0.001] as well as C-reactive protein [ OR (95% CI)=2.168 (1.136, 4.139), P=0.019] were significant related factors of renal impairment. The AUC (95% CI) of the prediction group and the validation group were 0.851 (0.806, 0.896) and 0.832 (0.742, 0.922), respectively, and the model plot and DCA showed that the model had good specificity and clinical efficacy. Conclusion:We propose a new nomogram model with good differentiation and calibration to assist in clinical screening of renal damage in pSS.

Objective:To discuss the practice effect of process evaluation on Nursing Aesthetics teaching evaluation.Methods:Vocational college nursing students from two classes of 2017 in the school were selected as the control group, and two of 2018 the experimental group. The experimental group, which contained 84 students, was implemented process evaluation method. The students′ satisfaction to the teaching method and their examination results of theory and practice were compared between the two groups. The opinions and self-evaluation of the experimental group on the process evaluation were investigated.Results:The students′ satisfaction degree with teaching of the experimental group was (96.10±0.36) points, significantly better than (90.00±0.58) points of the control group, and the difference was statistically significant ( tvalue was 5.03, P<0.05). The score of theory course and practice personal evaluation of students in experimental group (84.35±6.65, 87.21±5.47) was obviously higher than that of control group (81.57±8.21, 84.64±6.78). The t-value was 5.968 and 6.687 respectively, and the difference was statistically significant ( P<0.05 or 0.01). In experimental group, 39.3 percent (33/84) of students strongly agree that the process evaluation fully and truly reflects their knowledge and ability, while 51.2 percent (43/84) of students comparatively agree with that. More than 90 percent of students believed that the process evaluation has improved their comprehensive application ability of aesthetic knowledge, enhanced their sense of identity to nursing profession, helped to develop good study habits and so on. Conclusions:Process evaluation have helped increase students′ comprehensive quality and ability.

Objective:To investigate the relationship between osteoarthritis and generalized anxiety disorder (GAD)/depression among rural middle-aged and elderly people in Bayannur, Inner Mongolia Autonomous Region.Methods:From 2016 to 2018, a one-to-one interview questionnaire survey was conducted among 832 rural middle-aged and elderly people aged 45 or above in Bayannur. Logistic regression model was used to explore the relationship between osteoarthritis and GAD/depression.Results:Of 832 rural middle-aged and elderly participants, 28.73% (239/832) were diagnosed with osteoarthritis. The risk of GAD and depression increased by 71% [adjusted odds ratio ( AOR): 1.71, 95% confidence interval ( CI): 1.12 - 2.60] and 68% ( AOR: 1.68, 95% CI: 1.10 - 2.58), respectively, in patients with osteoarthritis compared with those without osteoarthritis. Conclusions:The prevalence of osteoarthritis is high among the middle-aged and elderly people in Bayannur, Inner Mongolia Autonomous Region. Osteoarthritis may increase the risk of GAD/depression. It is necessary to take corresponding intervention measures to prevent the occurrence of osteoarthritis to reduce GAD/depression.

Objective: To investigate the effects and mechanism of digoxin on atrium electrical remodeling and susceptibility of atrial fibrillation (AF) in aged rabbits. Methods: Twenty aged male New Zealand rabbits were divided into aged group and aged plus digoxin group (n=10 each). Electrical parameters including heart rate (HR), RR and QT interval, ST segment and P wave dispersion from normal Ⅱ electrocardiogram, and the maximum upstroke velocity (Max_dv/dt), plateau potential (plateau P), action potential duration of 10%, 20% and 90% (APD₁₀, APD₂₀, APD₉₀) from recording of monophasic action potential (MAP), as well as atrial effective refractory period (AERP₂₀₀) and dispersion (dERP₂₀₀) with 200 ms of basic cycle length (BCL), and frequency self adaptation of AERP with 300 ms and 150 ms of BCLs (fERP) were recorded and compared between the 2 groups. BCLs and inducibility of AF post programmed electrical stimulation and Burst-pacing in left atrium tissue of rabbits in vivo were also analyzed. The L-type calcium current (I_Ca-L) in 2 groups were recorded via whole-cell patch clamp technique, and the fluorescence intensity of intracellular free Ca²⁺ was detected with Flup-3/AM loading by the laser scanning confocal microscope in enzymatically dissociated single rabbit atrial myocytes. Results: Compared with aged group, the heart rate was faster, RR and QT interval were obvious shorter, ST segment was raised and P wave dispersion was significantly increased in aged plus digoxin group (all P<0.05). Moreover, compared with aged group, the Max_dv/dt and plateau P were obviously increased, APD₁₀ and APD₂₀ were significantly prolongated, and APD₉0 was significantly shorter in aged plus digoxin group (all P<0.01). Otherwise, the fERP was markedly increased (0.81±0.15 vs. 0.67±0.05), and the induced rate of AF was obviously higher in aged plus digoxin group than in aged group (6/8 vs. 4/9) (all P<0.01). With voltage clamp model, digoxin significantly increased I_Ca-L of atrial myocytes of aged rabbits, When command potential was 10 mV, the current densities of I_Ca-L were significantly higher in digoxin group than that in aged group ((15.45±2.38) pA/pF vs. (7.03±1.69) pA/pF, P<0.01). Otherwise, the I-V curve of I_Ca-L was downward shifted of all I-V curves in digoxin perfused aged atrial cells of rabbits. Moreover, the fluorescence intensities of intracellular free Ca²⁺ was significantly higher in aged plus digoxin group than in aged group ((1 748±173) μmol/L vs. (478.13±87.63) μmol/L, P<0.01). Conclusion Digoxin could aggravate the atrial electrical remodeling in atrium of aged rabbits, facilitate susceptibility of atrial fibrillation in aged rabbit, increased current density of I_Ca-L and concentration of intracellular free Ca²⁺, followed Ca²⁺ overload and oscillations might be part of the underlying mechanisms.

Objective To investigate the predictors of early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke and its impact on short-term outcomes. Methods From January 2017 to April 2019, patients with acute ischemic stroke treated with intravenous thrombolysis in the Second Affiliated Hospital of Xuzhou Medical University were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after admission increased by ≥2 compared with the baseline. The short-term outcomes were evaluated by the modified Rankin Scale at discharge. 0-2 was defined as good outcomes and 3-6 was defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent predictors of END and their correlation with short-term outcomes. Results A total of 199 patients with acute ischemic stroke received intravenous thrombolysis were enrolled. The median age was 68 years (interquartile range: 62- 76 years), 69 were women (34. 7％), and the baseline median NIHSS score was 6 (interquartile range: 3- 12). END occurred in 35 patients (17. 6％). Symptom progression occurred mainly 2 days after admission (31 patients, 88. 6％). Most of the causes of END were ischemic progression or recurrence (28 patients, 80. 0％). The univariate analysis showed that fasting blood glucose and symptomatic intracranial hemorrhage were associated with END (all P < 0. 05). However, multivariate logistic regression analysis did not find independent predictors of END. Excluding 12 patients with missing short-term outcome data, a total of 187 patients were included in the short-term outcome analysis. Among them, 110 patients had good outcomes and 77 had poor outcomes. Univariate analysis showed that ischemic heart disease, atrial fibrillation, mild stroke, etiological classification, baseline NIHSS score, absolute lymphocyte count, fasting blood sugar, neutrophil/lymphocyte ratio, whether to receive interventional therapy, and END were correlated with short-term outcomes (all P < 0. 05 ). Multivariate logistic regression analysis indicated that high baseline NIHSS score (odds ratio 1. 350, 95％ confidence interval 1. 182-1. 541; P < 0. 001) and END (odds ratio 32. 540, 95％ confidence interval 6. 149- 172. 21; P < 0. 001 ) were the independent risk factors for short-term poor outcomes. Conclusions END still occurs in some patients after intravenous thrombolysis for acute ischemic stroke, and END is an independent risk factor for short-term poor outcomes.

Objective To analyze the therapeutic effects of chemotherapy after chidamide pretreatment in 16 cases of high-risk and refractory lymphoid malignancy. Methods The efficacy and adverse reactions of 16 patients with high-risk and refractory lymphoid malignancy who received chidamide combined with chemotherapy after 3 days pretreatment of chidamide were analyzed. Results Sixteen patients included 6 males and 10 females, and the median age was 49.5 years old (23-88 years old). The median course of previous systemic chemotherapy was 4 (range 0-22). Among 14 patients who received induction chemotherapy, 7 patients achieved complete remission (CR), 7 patients achieved partial remission (PR). Fourteen patients had achieved clinical efficacy, and the overall response rate (ORR) was 100 %. After 2 cases had remission , the patients who entered this regimen for consolidation chemotherapy also had durable CR. The median follow-up time was 13 months (range 2-24 months) until December 2017. Nine cases had overall survival (OS), 7 cases died and 9 cases had progression-free survival. Common adverse effects of the chemotherapy included mild and controllable gastrointestinal reactions after chidamide. Conclusion Chemotherapy after chidamide pretreatment may improve the effect and prognosis of high-risk or refractory lymphoid malignancy.

Objective To investigate the distribution and antimicrobial resistance profile of the common pathogens isolated during the period from 2009 to 2015.Methods All the bacterial strains isolated from pediatric inpatients in Beijing Children's Hospital during the period from 2009 to 2015 were analyzed. Antimicrobial susceptibility was determined by disk diffusion method and Phoenix 100 Automated Microbiology System. Results were analyzed according to the guidelines of CLSI (2014) using WHONET 5.6 software.Results The total strains were 26630. The most common gram-positive isolates were Streptococcus pneumoniae,Staphylococcusaureusand coagulase-negative Staphylococcus (CNS), while the most frequently isolated gram-negative microorganisms were Klebsiella spp.,Pseudomonas aeruginosa and Escherichia coli. The prevalence of S. pneumoniae was up to 25.7 % (4101/15973) in all respiratory tract specimens. About 50.2 % of the S. pneumoniae isolates were not susceptible to penicillin. The prevalence of methicillin-resistant strains was 20.6 % in S. aureus (MRSA) and 87.8 % in coagulase negative Staphylococcus (MRCNS) on average. The prevalence of MRSA increased from 11.1 % in 2009 to 29.8 % in 2015. No S. pneumoniae or staphylococcal strains were found resistant to vancomycin or linezolid. The Enterococcus strains were still highly susceptible to vancomycin and linezolid. Overall 0.3 % of the Enterococcus faecium isolates were resistant to vancomycin. The extended-spectrum beta-lactamases (ESBLs) producing strains accounted for 71.4 % -78.1 % of E. coli and 65.1 % - 76.9 % of K. pneumoniae isolates. The carbapenem-resistant E. coli and K. pneumoniae were reported for the first time in 2010, but in 2014, the strains resistant to carbapenems had increased to more than 7 % in E. coli, and higher than 20 % in K. pneumoniae. In 2015, up to 27.7 % and 25.7 % of P. aeruginosa isolates were resistant to imipenem and meropenem, respectively, and 59.9 % of the A. baumannii isolates were resistant to imipenem and meropenem. Beta-lactamase was positive in 46.3 % of the H. influenzae isolates. Conclusions MRSA and the carbapenem-resistant strains of E. coli,K. pneumoniae and A. baumannii are still on the rise in pediatric inpatients, which poses a serious threat to clinical practice and implies the importance of strengthening infection control.