Objective:To construct a nursing quality evaluation index system for knee ligament injury to provide a basis for standardizing the nursing practice and improving the nursing quality of knee ligament injury.Methods:Based on the three-dimensional quality structure model of "structure-process-outcome" proposed by Donabedian, the quality evaluation index system for knee ligament injury specialties was constructed through literature review, brainstorming, and Delphi expert consultation from April to June 2023.Results:Sixteen experts were included in the inquiry. The effective recovery rate of the two rounds of expert correspondence questionnaires was 16/16, the expert authority coefficient was 0.95, and the Kendell harmony coefficients of the expert correspondence were 0.116 and 0.122, respectively (both P<0.05). The final constructed knee ligament injury specialty care quality evaluation index system contained 3 primary indicators (structural quality, process quality and outcome quality), 16 secondary indicators, and 69 tertiary indicators.Conclusions:The specialized nursing quality evaluation index system for knee ligament injury constructed in this study is scientific and reliable, which can provide a basis for the evaluation and assessment of the nursing quality of knee ligament injury specialties and promote the continuous improvement of their nursing quality.

Objective:A comparison was made between the predictive efficacy of the Padua Score and the simplified Assessment Scheme Recommended by Chinese experts (hereinafter referred to as the Simplified Method) for the risk assessment of venous thromboembolism (VTE) in medical inpatients, aiming to provide a reference for the clinical selection of appropriate risk assessment tools.Methods:A retrospective cohort study was conducted, selecting 42 257 internal medicine inpatients discharged from Peking University Shenzhen Hospital between May 1, 2021, and April 30, 2022, using a convenience sampling method. Data collected included general information upon admission, VTE-related information, occurrences of VTE during hospitalization, and results from the two assessment tools. The predictive efficacy of the tools was evaluated by plotting ROC curves and calculating AUC, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy.Results:Among 42 257 patients, there were 21 065 male and 21 192 female participants, aged (55.04 ± 15.17) years old. The incidence rate of VTE among medical inpatients was 2.24% (948/42 257). The AUC for Padua Score and the Simplified Method in medical patients were 0.735 (95% CI 0.717-0.753) and 0.582 (95% CI 0.561-0.602), respectively. Sensitivities were 49.4% and 18.2%, specificities were 89.6% and 98.1%, positive predictive values were 9.9% and 17.7%, negative predictive values were 98.7% and 98.1%, and predictive accuracy were 88.7% and 96.3%, respectively. The departments with the highest incidence rates of VTE during hospitalization were rehabilitation medicine, emergency, neurology, geriatrics, and respiratory medicine. Within these departments, the AUC values for the Padua Score and the Simplified Method were as follows: 0.864 and 0.612, 0.782 and 0.653, 0.792 and 0.664, 0.850 and 0.551, 0.867 and 0.664, respectively. Conclusions:The Padua Score demonstrated better predictive efficacy compared to the Simplified Method. However, the Simplified Method had more accessible assessment criteria and could serve as an initial VTE risk screening tool in emergency situations or when complete data are not available.

BACKGROUND:Numerous scholars have previously researched certain greater tuberosity fractures and the procedures used to treat them.Few researchers,however,have studied the comminuted split fracture of the greater tuberosity of the humerus(Liu-Gang type IV)with rotator cuff tear in great detail. OBJECTIVE:To compare the clinical therapeutic effect of open repair position modified calcaneal plate combined with suture anchors and proximal humeral internal locking system(PHILOS)plate in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV). METHODS:Case data of 30 patients with comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)from May 2012 to May 2022 were retrospectively analyzed.They were divided into the modified calcaneal plate combined with suture anchor group(group A)and the PHILOS with#2 Johnson group(group B),with 15 cases in each group.Intraoperative blood loss,surgical time,and incision length of all patients were recorded.Pain visual analog scale score,Constant-Murley score,as well as shoulder joint abduction,forward flexion,external rotation,and dorsal expansion activities during the last follow-up(>1 year)were evaluated. RESULTS AND CONCLUSION:(1)The surgical incision length and operation time were shorter,and blood loss was less in group A than those in group B(P<0.05).(2)No significant difference in visual analog scale score and Constant-Murley score was detected between the two groups(P>0.05).(3)During the last follow-up,forward flexion in group A was better than that in group B(P<0.05).No significant difference in abduction,external rotation,and dorsal expansion was determined between group A and group B(P>0.05).(4)In terms of complications,there was 1 case of shoulder joint pain and discomfort in group A(7%),2 cases of subacromial impingement syndrome,2 cases of upward movement of nodules,and 2 cases of shoulder joint pain(40%)in group B.There were significant differences in complication rates between the two groups(P=0.031).(5)In summary,the modified calcaneal plate combined with suture anchors in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)could better restore the forward flexion function of the shoulder joint and has a small incision,less blood loss,shorter operation time and fewer complications.

Objective:To investigate the diagnostic value of serum serine protease (Corin) in chronic renal failure (CRF) complicated with heart failure.Methods:A retrospective analysis was conducted on 120 patients, (64.05±13.89) years old, 77 male (64.17%), with chronic renal failure combined with heart failure admitted to Zhengzhou People′s Hospital from January 1, 2023, to December 31, 2023. The control group consisted of 87 patients, (60.59±8.78) years old, 54 male (62.07%), with simple chronic renal failure. Clinical information, laboratory test indicators and echocardiographic parameters were collected. Serum Corin concentration was measured using enzyme-linked immunosorbent assay (ELISA). The experimental group was divided into grade Ⅱ(31 cases), grade Ⅲ(47 cases) and grade Ⅳ(42 cases) according to the New York College of Cardiology heart function classification system. Serum Corin levels were compared between the experimental group and the control group and among different cardiac function grades. Spearman correlation analysis was performed to evaluate the relationship between serum Corin and brain natriuretic peptide (BNP), D-dimer. ROC analysis was conducted to assess the predictive value of serum Corin in CRF complicated with heart failure and cardiac function classification; Binary Logistic regression was used to construct a multi-index joint prediction model, the joint prediction probability was obtained, and ROC curve was drawn to compare the diagnostic value of serum Corin and BNP in CRF combined with heart failure and the diagnostic value of serum Corin combined with D-dimer and BNP in CRF combined with heart failure.Results:The serum Corin level[2 568.97±477.70 pg/ml vs. 1 727.81±480.60 pg/ml, t=12.47, P<0.001], BNP [700.00(256.00, 2 089.75) pg/ml compared with 88.00 (43.00, 230.00) pg/ml, Z=-9.00, P<0.001], D-dimer [1 150.00(643.00, 1 874.75)μg/L compared with 556.00 (301.00, 865.00)μg/L, Z=-6.57, P<0.001] in chronic renal failure complicated with heart failure group was higher than that in simple CRF group, and the difference was statistically significant. Among patients with CRF complicated with heart failure, serum Corin[2 231.74±311.39 pg/ml vs. 2 562.09±365.30 pg/ml vs. 2 825.57±536.83 pg/ml, F=74.33, P<0.001], BNP [234.00(168.00, 612.00) pg/ml compared with 514.00(260.00, 1 455.00) pg/ml compared with 2 200.00(640.50, 4 682.75) pg/ml, H=29.42, P<0.001], D-dimer [753.00(514.00, 1 280.00) μg/L compared with 1 187.00(590.00, 1 840.00) μg/L compared with 1 603.00(810.00, 3 313.25) μg/L, H=14.98, P<0.001] increased with the increase of cardiac function grade, and the difference was statistically significant. According to Spearman correlation analysis, serum Corin was positively correlated with BNP ( r=0.409) and D-dimer ( r=0.299), P<0.001. According to the ROC analysis, the AUC of serum Corin in the diagnosis of CRF complicated with heart failure and cardiac function grade Ⅱ, Ⅲ, Ⅳ were 0.890(95% CI 0.846-0.935), 0.807 (95% CI 0.728-0.885), 0.911 (95% CI 0.864-0.959), 0.927 (95% CI 0.882-0.972) respectively; the AUC of BNP in the diagnosis of CRF complicated with heart failure was 0.867 (95% CI 0.817-0.916), the AUC of serum Corin combined with D-dimer, BNP combined with D-dimer, serum Corin combined with D-dimer and BNP in the diagnosis of CRF complicated with heart failure were respectively 0.930 (95% CI 0.897-0.962), 0.892 (95% CI 0.847-0.936), 0.952 (95% CI 0.927-0.977). Conclusions:Serum Corin expression is elevated in patients with CRF complicated with heart failure, and the degree of elevation is related to cardiac function grade. Serum Corin has a good diagnostic value for CRF complicated with heart failure and its severity. Serum Corin is expected to become a new biomarker for diagnosis of CRF complicated with heart failure.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease affecting both upper and lower motor neurons in the brain and spinal cord. One important aspect of ALS pathogenesis is superoxide dismutase 1 (SOD1) mutant-mediated mitochondrial toxicity, leading to apoptosis in neurons. This study aimed to evaluate the neural protective synergistic effects of ginsenosides Rg1 (G-Rg1) and conditioned medium (CM) on a mutational SOD1 cell model, and to explore the underlying mechanisms. We found that the contents of nerve growth factor, glial cell line-derived neurotrophic factor, and brain-derived neurotrophic factor significantly increased in CM after human umbilical cord mesenchymal stem cells (hUCMSCs) were exposed to neuron differentiation reagents for seven days. CM or G-Rg1 decreased the apoptotic rate of SOD1^G93A-NSC34 cells to a certain extent, but their combination brought about the least apoptosis, compared with CM or G-Rg1 alone. Further research showed that the anti-apoptotic protein Bcl-2 was upregulated in all the treatment groups. Proteins associated with mitochondrial apoptotic pathways, such as Bax, caspase 9 (Cas-9), and cytochrome c (Cyt c), were downregulated. Furthermore, CM or G-Rg1 also inhibited the activation of the nuclear factor-kappa B (NF-κB) signaling pathway by reducing the phosphorylation of p65 and IκBα. CM/G-Rg1 or their combination also reduced the apoptotic rate induced by betulinic acid (BetA), an agonist of the NF-κB signaling pathway. In summary, the combination of CM and G-Rg1 effectively reduced the apoptosis of SOD1^G93A-NSC34 cells through suppressing the NF-κB/Bcl-2 signaling pathway (Fig. 1 is a graphical representation of the abstract).
Humans ; NF-kappa B/metabolism* ; Ginsenosides/pharmacology* ; Amyotrophic Lateral Sclerosis/genetics* ; Culture Media, Conditioned/pharmacology* ; Superoxide Dismutase-1 ; Neurodegenerative Diseases ; Neurons/metabolism* ; Apoptosis

Objective:To investigate the assessment and occurrence of first-occured venous thromboembolism(VTE) among hospitalized patients.Methods:The clinical data of 6 532 surgical patients in Shenzhen Hospital, Peking University who were admitted from May 1, 2021 to June 30, 2021 were collected and analyzed retrospectively. The demographic data, Caprini score at admission and the incidence of VTE during hospitalization were analyzed by two independent sample t test and chi square test. Results:The Caprini score at admission of 6 532 patients was 1.81 ± 1.71. The number of cases in high, medium and low risks was 363 (5.6%), 1 189 (18.2%), 4 980 (76.2%), respectively. There was significant difference in VTE risk assessment scores and grades in different gender ( t=5.31, χ 2=48.31), length of stay ( F=195.21, χ 2=548.52) and hypertension ( t=17.07, χ 2=280.89), diabetes ( t=12.14, χ 2=51.18), smoking ( F=31.71, χ 2=53.23) and drinking ( F=18.78, χ 2=30.07) ( P<0.05). Forty-four(0.7%) patients got hospital-acquired VTE totally, among which, 24 cases (6.6%) were in high-risk, 14 cases (1.2%) were in medium-risk and 6 cases (0.1%) were in low-risk. What′s more, the top five VTE risky departments based on the assessment were not completely consistent with the top five departments with the highest incidence of VTE. Conclusions:The hospitalized patients are at high risk of VTE. The risk factors of diabetes, hypertension, smoking, drinking and other related factors should be included in the evaluation model. Meanwhile, the VTE risk assessment of in-patients should be emphasized and prophylactic treatments should be taken to reduce the incidence of VTE.

Objective:To develop a negative emotion screening scale for inpatients(NESSI) and test its validity and reliability.Methods:Based on our previous studies and the theory model of psychological stress, the original item pool was established through literature review, expert interviews and patient consultation.The first version of NESSI was constructed by Delphi method, then initially tested in 421 inpatients followed by the project analysis and reliability test. After those above, the formal scale was developed and tested in 318 inpatients followed by confirmatory factor analysis and reliability test.Finally, 7-item generalized anxiety disorder scale (GAD-7), 9-item patient health questionnaire (PHQ-9), anger state expression scale (SAS) and simplified Chinese version of fear of disease progression scale(FoP-Q-SF) were used to test the criterion validity.Results:After exploratory factor analysis, 17 items were retained in the final scale, which can be categorized into four dimensions: fear of illness, depression, somatization and anger, which could explain 63.49% of the total variation.Confirmatory factor analysis showed that the fitting degree of each factor model was good and met the requirements of reference value (χ 2/ df=2.949, RMR=0.044, CFI=0.929, NFI=0.897, IFI=0.930, TLI=0.915, PGFI=0.655, RMSEA=0.078). The Cronbach's α coefficient of the total scale was 0.925, and the Cronbach's α coefficient of the four factors ranged from 0.762 to 0.898.The criterion validity showed that there was a significant positive correlation between the scale and the four criterion scales ( r= 0.574-0.805, all P<0.01). Conclusion:The NESSI scale has good reliability and validity, and can be used as a psychological problem screening tool among non-psychiatric inpatients.

Objective:To explore the feasibility in evaluating segmental extracellular volume (ECV) using dual-layer spectral detector CT in patients with heart failure with various percentages of delayed hyper-enhanced volume, using MRI as a reference.Methods:Twenty-seven patients with heart failure in Peking Union Medical College Hospital were prospectively enrolled in this study from July 2019 to January 2021. All the patients underwent both CT late iodine enhancement and MR late gadolinium enhancement imaging within a week. According to percentages of hyper-enhanced volume on cardiac MR image, myocardial segments were classified into 3 groups: 0-4% (group A), 5%-49% (group B) and 50%-100% (group C). ECV images were independently observed by 2 experienced radiologists. The correlation and agreement between CT-ECV and MRI-ECV for the whole myocardial assessment and for the segmental assessment were evaluated using Spearman correlation and Bland-Altman analysis. Inter-observer agreement was assessed using the ICC.Results:Of the 27 patients, 432 segments were analyzed, with 199 segments in group A, 151 segments in group B and 82 segments in group C. In the whole myocardial analysis, the CT-ECV and MRI-ECV were 32.25% (28.04%, 34.28%) and 32.27% (28.35%, 34.77%), respectively. A good correlation was found between CT-ECV and MRI-ECV ( r=0.969, P<0.001). Bland-Altman analysis between CT-ECV and MRI-ECV showed a small bias (0.4%), with 95% limits of agreement of -6.9% to 7.8%. as for the segmental myocardial assessment, the CT-ECV was 28.23% (26.18%, 29.92%) for group A, 33.29% (30.16%, 35.96%) for group B and 40.22% (34.06%, 46.70%) for group C. There was statistically significant difference in ECV among three groups (all P<0.001). Good correlations between CT-ECV and MRI-ECV were found in group A ( r=0.614, P<0.001), group B ( r=0.852, P<0.001) and group C ( r=0.953, P<0.001). Bland-Altman analysis between CT-ECV and MRI-ECV showed a small bias 2.0% (95% limits of agreement:-17.6%-21.6%) in group A, a small bias -0.4% (95% limits of agreement: -13.8%-12.9%) in group B and a small bias -1.8% (95% limits of agreement: -17.4%-13.9%) in group C. The ICC values between 2 observers were 0.877 and 0.945 on CT-ECV and MRI-ECV, respectively. Conclusions:The larger percentage of hyper-enhanced volume on cardiac MR image, the stronger correlation are between the CT-ECV and MRI-ECV. CT-ECV may be taken as an alternative tool for quantitative evaluation of myocardial tissue in patients with heart failure.

Objective:To investigate the effects of forced-air warming blankets combined with conventional warming strategies on the quality of postoperative recovery and cognitive recovery in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods:This was a prospective, randomized, controlled trial.A total of 70 patients aged 65-75 years, who were classified as American Society of Anesthesiologists(ASA)grade-Ⅱ or Ⅲ, undergoing the laparoscopic radical resection of colorectal cancer under general anesthesia, were enrolled.Patients were randomly divided into two groups: the forced-air warming group(group FAW, n=35)and the conventional warming group(group CW, n=35). The inadvertent perioperative hypothermia(IPH), postoperative shivering, postoperative agitation, anesthesia recovery time and other postoperative complications were compared between the two groups.The post-operative quality of recovery scale(PQRS)was used to evaluate the quality of postoperative recovery and the recovery of cognitive function before and 1, 3, and 7 days after operation.Results:As compared with the group CW, the group FAW showed that the incidences of IPH, postoperative shivering and agitation were decreased(5.7% vs.22.8%, 2.8% vs.28.6%, 5.7% vs.31.4%, χ2=4.200, 10.057 and 7.652, P=0.042, 0.003 and 0.006), and the satisfaction degree of patients was increased at 48 hours after operation( P<0.01). The postoperative wake-up time was prolonged in the group CW as compared with the group FAW( P<0.01). Compared with the group CW, the proportion of patients with excellent overall recovery quality was increased in the group FAW 1 day after surgery( P<0.05). There was no significant difference in general recovery quality and cognitive recovery between the two groups at 3 and 7 days after operation. Conclusions:For elderly patients undergoing laparoscopic radical resection of colorectal cancer, the forced-air warming blanket combined with conventional warming strategies is more helpful to decrease the incidence of IPH, reduce postoperative shivering and improve the overall recovery quality at 1 day after operation, but no significant effect on postoperative recovery of cognitive function is found.

Objective:To evaluate the effect of flurbiprofen postconditioning on the permeability of blood brain barrier in a rat model of focal cerebral ischemia-reperfusion (I/R) injury.Methods:Eighty healthy male Wistar rats, aged 8-9 weeks, weighing 280-320 g, were divided into 4 groups ( n=20 each) using a random number table method: sham operation group (group Sham), focal cerebral I/R group (group I/R), lipo-microballoons group (group V) and flurbiprofen 10 mg/kg group (group F). Focal cerebral I/R model was established by left middle cerebral artery occlusion for 2 h followed by 24-h reperfusion in anesthetized rats.Flurbiprofen 10 mg/kg (group F), the equal volume of lipo-microballoons (group V) or the equal volume of normal saline (group Sham and group I/R) was injected via the tail vein at the onset of reperfusion.The rats were sacrificed at 24 h of reperfusion, brains were immediately removed, and cerebral tissues were obtained for measurement of brain water content, Evans blue content, expression of matrix metalloproteinase-9 (MMP-9) in ischemic penumbra (by immuno-histochemistry), and expression of phosphorylated p38 mitogen-activated protein kinase (p-p38 MAPK) and inducible nitric oxide synthase (iNOS) in ischemic penumbra (by Western blot). Results:Compared with Sham group, brain water content and Evans blue content in brain tissues were significantly increased, and the expression of MMP-9, p-p38 MAPK and iNOS in ischemic penumbra was up-regulated in I/R, V and F groups ( P<0.05). Compared with group I/R, brain water content and Evans blue content in brain tissues were significantly decreased, and the expression of MMP-9, p-p38 MAPK and iNOS in ischemic penumbra was down-regulated in group F ( P<0.05), and no significant change was found in the above parameters in group V ( P>0.05). Conclusion:Flurbiprofen postconditioning can decrease the permeability of blood brain barrier during focal cerebral I/R in rats, and the mechanism may be related to inhibiting the activation of p38 MAPK/iNOS signaling pathway and down-regulating the expression of MMP-9.