Objective:To evaluate the relationship between preoperative serum albumin concentrations and postoperative delirium (POD) in the patients undergoing total knee/hip arthroplasty.Methods:Five hundred patients of both sexes, aged 50-90 yr, with body mass index of 50-80 kg, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective total knee or hip replacement under combined spinal-epidural anesthesia in our hospital from December 2021 to December 2022, were selected. Cerebrospinal fluid (CSF) samples were collected after successful subarachnoid puncture for determination of amyloid-beta 42 (Aβ42), total tau protein (T-tau) and phosphorylated tau protein (P-tau) concentrations using enzyme-linked immunosorbent assay. Confusion Assessment Method and Memorial Delirium Assessment Scale were used to evaluate the occurrence and severity of POD at 1-7 days after surgery (or before discharge), and the patients were divided into POD group and non-POD group (NPOD group). Logistic regression analysis was used to identify the risk factors for POD. The accuracy of plasma albumin concentration and CSF biomarker concentration in predicting POD was evaluated by the receiver operating characteristic (ROC) curve, and the mediating effect of CSF biomarker was analyzed.Results:A total of 343 patients were finally enrolled in the study, and the incidence of POD was 23.3%. There were statistically significant differences in age, preoperative plasma albumin concentration and Memorial Delirium Assessment Scale score in POD group as compared with NPOD group ( P<0.05). Before and after adjusting for confounding factors, decreased plasma albumin and increased concentrations of P-tau and T-tau in CSF before operation were the risk factors for POD, and increased concentrations of Aβ42, Aβ42/P-tau and Aβ42/T-tau ratio in CSF were protective factors for POD. The area under the ROC curve of preoperative plasma albumin concentrations in predicting POD was 0.668, and the area under the ROC curve of preoperative plasma albumin concentrations combined with CSF biomarker concentrations in predicting POD was 0.810 ( P<0.05). The direct effect of plasma albumin on POD was -0.009 869 2, the total effect was 0.029 443 7, and the mediating effect of P-tau accounted for 33.53% of the total effect. Conclusions:Decreased preoperative plasma albumin concentration is a risk factor for POD, and P-Tau in CSF serves as a key mediator in the relationship between serum albumin concentrations and postoperative delirium in the patients undergoing total knee/hip arthroplasty.

Objective To investigate the role of histone H4 in the polarization of alveolar macrophages (AM) in lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) in mice. Methods i) The specific pathogen free male C57BL/6 mice were randomly divided into control group and 2, 4, 6 and 8 mg/kg LPS groups, with six mice in each group. The mice in the LPS groups were intratracheally administered LPS according to their respective doses, while the mice in the control group received an equivalent volume of 0.9% saline. After 12 hours, the arterial blood gas was analyzed, and the pulmonary edema and histopathological changes in lung tissues of mice in each group were observed. The level of histone H4 in bronchoalveolar lavage fluid (BALF) of mice was detected using enzyme-linked immunosorbent assay , and mice AMs of the five group were isolated using adherent method. ii) AMs from normal mice were isolated using adherent method and randomly divided into control group, histone H4 injury group, BALF injury group and anti-histone H4 antibody (anti-H4) intervention group. In the histone H4 injury group, AMs were treated with histone H4 at a final concentration of 20 mg/L. In the BALF injury group and anti-H4 intervention group, AMs were treated with 200 μL BALF supernatant from mice intratracheally administered 6 mg/kg body weight LPS, with the latter group treated with 25 mg/L anti-H4 antibody. The control group AMs were treated with phosphate-buffered saline. iii) After 12 hours of stimulation, the cells were collected, and the relative expression of tumor necrosis factor-α (Tnfa), interleukin-1β (Il1b), differentiation antigen 206 (Cd206) and arginase 1 (Arg1) in AMs was detected using real-time quantitative polymerase chain reaction. Results i) Compared with the control group, mice in all four LPS groups exhibited rapid breathing, inflammatory reaction and lung edema in lung tissues, which were aggravated in a dose-dependent manner. The ratio of partial pressure of arterial oxygen to fraction of inspired oxygen in mice decreased with the increase of LPS dose (P<0.05). The wet/dry weight ratio of lung, the level of histone H4 in BALF and the relative expression of Tnfa and Il1b mRNA in AMs increased with the increase of LPS dose (all P<0.05). The mice in the 6 and 8 mg/kg LPS groups developed ARDS. The level of histone H4 in BALF and the relative expression of Tnfa and Il1b mRNA in AMs of mice in 6 and 8 mg/kg LPS groups were higher than those in the other three groups (all P<0.05). ii) The relative expression of Tnfa and Il1b mRNA increased (both P<0.05), and the relative expression of Cd206 and Arg1 mRNA decreased (both P<0.05) in AMs of histone H4 injury group and BALF injury group compared with the control group. Compared with BALF injury group, the relative mRNA expression of Tnfa and Il1b in AMs of anti-H4 intervention group decreased (both P<0.05), while the relative expression of Arg1 mRNA increased (P<0.05). Conclusion LPS can induce a dose-dependent increase in histone H4 levels in BALF in mice. Histone H4 drives the development of ARDS by activating AMs to M1 polarization. Antagonizing histone H4 to interfere with AM polarization to M1 could be a target for the treatment of ARDS.

Toll-like receptor 3 (TLR3), as an important pattern recognition receptor (PRR), dominates the innate and adaptive immunity regulating many acute and chronic inflammatory diseases. Atherosclerosis is proved as an inflammatory disease, and inflammatory events involved in the entire process of initiation and deterioration. However, the contribution of TLR3 to atherosclerosis remains unclear. Herein, we identified the clinical relevance of TLR3 upregulation and disease processes in human atherosclerosis. Besides, activation of TLR3 also directly led to significant expression of atherogenic chemokines and adhesion molecules. Conversely, silencing TLR3 inhibited the uptake of oxLDL by macrophages and significantly reduced foam cell formation. Given the aberrance in TLR3 functions on atherosclerosis progression, we hypothesized that TLR3 could serve as novel target for clinical atherosclerosis therapy. Therefore, we developed the novel ellipticine derivative SMU-CX24, which specifically inhibited TLR3 (IC₅₀ = 18.87 ± 2.21 nmol/L). In vivo, atherosclerotic burden was alleviated in Western diet fed ApoE^-/- mice in response to SMU-CX24 treatment, accompanying notable reductions in TLR3 expression and inflammation infiltration within atherosclerotic lesion. Thus, for the first time, we revealed that pharmacological downregulation of TLR3 with specific inhibitor regenerated inflammatory environment to counteract atherosclerosis progression, thereby proposing a new strategy and probe for atherosclerosis therapy.

Objective:This study aims to discuss the clinical effect of surgical treatment of vascular anomalies in the sciatic nerve region.Methods:Retrospective analysis of clinical data was performed on patients with pain and dysfunction in the sciatic nerve region in the Department of Hemangioma, Henan Provincial People’s Hospital, between July 2013 and December 2018. The operation time, intraoperative blood loss, hospitalization time, postoperative complications, and wound healing were recorded. Postoperative follow-up included physical and imaging examination. Visual analogue scale (VAS) was used to evaluate the pain intensity before operation and at discharge. Oswestry dysfunction index (ODI) was used to evaluate the pain and limb function before operation and during follow-up.Results:This study enrolled 76 cases (32 males, aged from 2 to 55 years ), including 48 cases of venous malformation (VM), 9 cases of arteriovenous malformation (AVM), 6 cases of lymphatic malformation (LM), and 13 cases of fibro-adipose vascular anomaly (FAVA). Thirteen patients had been treated with local sclerotherapy, and four patients had been treated with interventional embolization for AVM without improvement or exacerbation. The operative time, intraoperative blood loss, and hospitalization time of FAVA patients were (113.33±30.11) min, (81.67±22.29) ml, and (3.83±0.98) d respectively, which were less than those of the other three vascular anomalies with the lest surgical damage and quickest recovery. The operative time, intraoperative blood loss, and hospitalization time of AVM patients were (288.33±33.71) min, (981.67±164.85) ml, and (11.17±1.47) d respectively, which were more than those of the other three vascular anomalies. The operation time of VM and LM cases was close, but the amount of blood loss [(396.67±85.71) ml] in VM cases varies greatly, with a minimum of 150 ml and a maximum of 1 100 ml. The vital signs of all patients were stable during and after the operation, without injury of main vessels and nerves. Seventy-one patients had grade A wound healing, four patients had grade B wound healing, and one patient had grade C wound healing. The postoperative follow-up was 6-36 months (mean 13 months), and the pain was completely relieved in 73 cases and partially relieved in 3 cases at the last follow-up. Seventy-two cases returned to normal, and 4 cases improved with lower limb dysfunction. Imaging examination showed that lesions of 70 cases disappeared and of 6 cases were residual. Preoperative VAS scores of four groups were 2.00 (1.00, 3.75), 2.00 (1.00, 3.50), 4.00 (0.75, 6.25), 4.00 (1.50, 6.00) respectively, and the postoperative VAS scores were all 0.00 (0.00, 0.00). The preoperative ODI scores of four groups were 17.78% (15.56%, 22.22%), 17.78% (13.33%, 35.56%), 50.00% (31.67%, 84.44%), 42.22% (31.11%, 56.67%). Apart from LM [4.44% (0.00%, 22.22%)], the postoperative ODI of the others was all 0.00% (0.00%, 0.00%). VAS and ODI were statistically significant differences before and after surgical treatment among all four groups ( P<0.05). Conclusions:Surgical treatment is safe and effective for vascular anomalies in the sciatic nerve region, which can significantly improve pain and joint mobility disorders.

Objective:This study aims to discuss the clinical effect of surgical treatment of vascular anomalies in the sciatic nerve region.Methods:Retrospective analysis of clinical data was performed on patients with pain and dysfunction in the sciatic nerve region in the Department of Hemangioma, Henan Provincial People’s Hospital, between July 2013 and December 2018. The operation time, intraoperative blood loss, hospitalization time, postoperative complications, and wound healing were recorded. Postoperative follow-up included physical and imaging examination. Visual analogue scale (VAS) was used to evaluate the pain intensity before operation and at discharge. Oswestry dysfunction index (ODI) was used to evaluate the pain and limb function before operation and during follow-up.Results:This study enrolled 76 cases (32 males, aged from 2 to 55 years ), including 48 cases of venous malformation (VM), 9 cases of arteriovenous malformation (AVM), 6 cases of lymphatic malformation (LM), and 13 cases of fibro-adipose vascular anomaly (FAVA). Thirteen patients had been treated with local sclerotherapy, and four patients had been treated with interventional embolization for AVM without improvement or exacerbation. The operative time, intraoperative blood loss, and hospitalization time of FAVA patients were (113.33±30.11) min, (81.67±22.29) ml, and (3.83±0.98) d respectively, which were less than those of the other three vascular anomalies with the lest surgical damage and quickest recovery. The operative time, intraoperative blood loss, and hospitalization time of AVM patients were (288.33±33.71) min, (981.67±164.85) ml, and (11.17±1.47) d respectively, which were more than those of the other three vascular anomalies. The operation time of VM and LM cases was close, but the amount of blood loss [(396.67±85.71) ml] in VM cases varies greatly, with a minimum of 150 ml and a maximum of 1 100 ml. The vital signs of all patients were stable during and after the operation, without injury of main vessels and nerves. Seventy-one patients had grade A wound healing, four patients had grade B wound healing, and one patient had grade C wound healing. The postoperative follow-up was 6-36 months (mean 13 months), and the pain was completely relieved in 73 cases and partially relieved in 3 cases at the last follow-up. Seventy-two cases returned to normal, and 4 cases improved with lower limb dysfunction. Imaging examination showed that lesions of 70 cases disappeared and of 6 cases were residual. Preoperative VAS scores of four groups were 2.00 (1.00, 3.75), 2.00 (1.00, 3.50), 4.00 (0.75, 6.25), 4.00 (1.50, 6.00) respectively, and the postoperative VAS scores were all 0.00 (0.00, 0.00). The preoperative ODI scores of four groups were 17.78% (15.56%, 22.22%), 17.78% (13.33%, 35.56%), 50.00% (31.67%, 84.44%), 42.22% (31.11%, 56.67%). Apart from LM [4.44% (0.00%, 22.22%)], the postoperative ODI of the others was all 0.00% (0.00%, 0.00%). VAS and ODI were statistically significant differences before and after surgical treatment among all four groups ( P<0.05). Conclusions:Surgical treatment is safe and effective for vascular anomalies in the sciatic nerve region, which can significantly improve pain and joint mobility disorders.

Objective:To explore the effects of different approaches for second-trimester multifetal pregnancy reduction on pregnancy outcome in women with dichorionic triamniotic (DCTA) triplet.Methods:A retrospective study was performed on 51 women with DCTA triplet pregnancies who were referred to Guangdong Women and Children Hospital for second-trimester multifetal pregnancy reduction from January 2014 to January 2020. All participants were divided into either preventive group ( n=39) or treatment group ( n=12) according to the indication for multifetal pregnancy reduction, and they were further allocated to three subgroups based on different reduction methods, which were reduction to dichorionic twin by radiofrequency ablation (RFA) (RFA subgroup), reduction to monochorionic singleton (KCl-singleton subgroup) or monochorionic twin (KCl-twin subgroup) by cardiac injection of potassium chloride. Pregnancy loss rate, neonatal birth weight, gestational age at delivery, incidence of intrauterine death, and neonatal death were compared and analyzed between different groups using t-test, analysis of variance, Chi-square test, Fisher's exact test and Bonferroni correction. Results:(1) The mean gestational week at operation in the treatment group was significantly later than that in the preventive group [(18.5±3.1) vs (15.0±2.3) weeks, t=-4.209, P<0.001]. In the preventive group, the mean gestational week at operation in the RFA subgroup was later than the KCl-singleton and KCl-twin subgroup[(17.2±1.6) vs (13.8±1.5) and (12.7±1.0) weeks, t=6.630 and 3.875, respectively, both P<0.05]. (2) The postoperative pregnancy loss rate in the preventive group was decreased compared with the treatment group [10.3%(4/39) vs 5/12, Fisher's exact test, P<0.05], and the live birth ratio was increased [ 85.7%(48/56) vs 10/18, χ2=5.640, P=0.018]. No live birth infants with birth weight <1 500 g was reported in the KCl-singleton subgroup in preventive group, and the statistical significance was observed in the intra-group differences ( P<0.05) rather than the pairwise comparison differences in the preventive group. For the proportion of live births, there was a statistically significant difference in the intra-group comparison in the treatment group, which was higher in the RFA subgroup than that in the KCl-twin subgroup (6/6 vs 1/6, P=0.045). No significant difference was revealed among pregnancy loss rate, gestational weeks at delivery, the mean birth weight, premature delivery <32 gestational weeks, and full-term birth rate among three different approaches within the two groups. (3) No monochorionic twin complications or perinatal death occurred in any RFA or KCl-singleton subgroups in the two groups. In the KCl-twin subgroups including five cases with ten fetuses, including three live birth, four miscarriage, three intrauterine death occured, while no neonatal death was reported. One case with selective fetal uterine growth restriction in the preventive group delivered two live births, and one case with twin-to-twin transfusion syndrome in the treatment group had intrauterine death in one fetus and one survival neonate. Conclusions:The pregnancy outcome of multifetal pregnancy reduction to dichorionic diamniotic twins by RFA or reduction to singleton by cardiac injection of potassium chloride are comparative in women with DCTA triplet, regardless of whether it is a preventive or therapeutic reduction.

Objective To study the epidemic characteristics of hand foot mouth disease (HFMD) and the influence of meteorological factors on the incidence of HFMD in Beijing from 2010 to 2019, and to provide scientific evidence for the warning, prediction, prevention and control of HFMD. Methods Descriptive statistical analysis was conducted to analyze the epidemic characteristics of HFMD in Beijing from 2010 to 2019 using R4.0.2 software, and the relationship between meteorological factors such as daily average temperature, daily average relative humidity, daily average precipitation, daily average air pressure, and daily average wind speed and HFMD incidence from 2015 to 2019 was analyzed by using distribution lag nonlinear model. Results In 2010-2019, a total of 324 864 HFMD cases were reported in Beijing, with an average incidence rate of 155.10/100,000. May to July was the annual peak of HFMD. The average daily temperature, relative humidity and precipitation were positively correlated with the incidence of HFMD (Rs=0.66, 0.45 and 0.24, P=0.0000, 0.0000 and 0.0000, respectively). The average daily wind speed and pressure were negatively correlated with the incidence of HFMD (Rs=-0.14 and -0.3, P=2.22×10^-9 and 0.0000, respectively). The RR was the highest when the air temperature was 25℃ and at the lag of 10 day, which was 1.41 (95%CI:1.12-1.77). Humid weather conditions were the risk factors of HFMD, and the influence time was relatively long. The RR was the highest when the relative humidity was 84.5% and the lag was 15 days, which was 1.51 (95%CI:1.34-1.70). When daily average wind speed was 3m/s, and the lag was 14 days, the RR was the highest, which was 1.22 (95%CI:0.86-1.73). The RR was the highest when the daily average pressure was 842.5 hPa and the lag was 5 day, which was 1.20 (95%CI:0.66-2.07). When the daily average precipitation was 166.5 mm and the lag was 7 days, the RR was the highest, which was 4.37 (95%CI:1.61-11.84). When the above meteorological conditions were met, the risk of HFMD was the highest. Conclusion Meteorological factors such as daily average temperature, daily average relative humidity, daily average precipitation, daily average pressure and daily average wind speed are closely related to the incidence of HFMD, which is nonlinear and has certain lag. It can be used to predict the risk and epidemic intensity of HFMD, and to provide a scientific basis for the prevention and control, early warning, and prediction of infectious diseases.

Objective:To investigate the clinical efficacy and safety of 90Sr- 90Y β-ray low dose applicator, topical timolol maleate, and their combination in the treatment of superficial infantile hemangioma (IH). Methods:From May 14, 2013 to April 11, 2017, 400 children (126 males, 274 females, age 5.3(3.9, 7.1) months) with superficial IH in Department of Nuclear Medicine, the First People′s Hospital of Foshan were prospectively enrolled. All patients were randomly divided into 4 treatment groups according to the proportion of 1∶1∶1∶1 by the method of random number table: topical timolol maleate (group A, control group), 90Sr- 90Y β-ray low dose applicator (group B), single course applicator combined with timolol (group C), and multi-course applicator combined with timolol (group D). Lesions were followed up to the 104 th week (W104). Cure rate of W104 was considered as primary end point. Efficacy and safety of different treatment were compared. Kruskal-Wallis rank sum test, Mann-Whitney U test, and logistic regression analysis were used for statistical analysis. Results:Totally, 438 lesions in 400 cases were included in this prospective study. There was no significant difference in baseline characteristics among 4 groups ( χ2 values: 1.709-11.616, H values: 3.681-7.653, all P>0.05). As of W104, 11 lesions (2.51%, 11/438) were lost follow-up, 32 lesions (7.31%, 32/438) were with early withdrawal, 357 lesions (81.51%, 357/438) were cured, 15 lesions (3.42%, 15/438) were with residual, 23 lesions (5.25%, 23/438) were with rebound growth, and no serious adverse events occurred in the 4 groups. Multivariate analysis showed that lesions thickness (<3 mm vs ≥ 3 mm, odd ratio ( OR)=16.689, 95% CI: 7.908-35.223; χ2=54.555, P<0.001) and treatment (considering group A as reference category, OR (95% CI) of group B, C and D were 16.842(6.179-45.901), 4.801(2.167-10.638) and 39.127(10.468-146.243), respectively; χ2=47.663, P<0.001) were independent factors affecting the cure rate of W104. 90Sr- 90Y low-dose fractionation radiotherapy was significantly better than topical timolol maleate ( OR=16.842, 95% CI: 6.179-45.901), and the combination with timolol could significantly reduce the cumulative absorbed dose of radiotherapy (group D vs B: 16(8, 16) vs 16(16, 24) Gy; z=-4.947, P<0.001). Conclusion:90Sr- 90Y low dose applicator therapy is superior to topical timolol maleate for superficial IH, and the combination with timolol could significantly reduce the cumulative absorbed dose of applicator.

Objective: To analyze the causes of equinus deformity caused by intramuscular venous malformation onset posterior muscles of leg, and discuss the corresponding treatment methods. Methods: A retrospective study was conducted on 69 cases of intramuscular venous malformations with equinus deformity from January 2012 to December 2017. Based on patient's main complain, physical examination and imaging data, the causes were divided into two categories: pain disorder and contracture disorder. Classification was on the basis of definite diagnosis of MRI. When the main complaint of medical history and physical examination indicated pain relief or passivity of the affected limb, and when the back extension of ankle joint was greater than 75 degrees, it was a pain disorder; when the medical history and physical examination indicated pain relief or passivity of the affected limb, the back extension of ankle joint was less than 15 degrees, it was a contracture disorder. Therapeutic methods included drug conservative treatment and surgical treatment. For the patients with pain disorder, the first choice was drug conservative treatment, and for the patients with contracture disorder, the first choice was surgery. Operative methods include simple venous malformation resection, venous malformation resection and Z-type Achilles tendon anastomosis lengthening. After operation patients received systematic functional rehabilitation exercise and calculated the satisfaction rate. Results: 13 cases of painful disorders were firstly treated by conservative medicine, but 4 cases were treated by operation after series of conservative treatments, satisfaction rate was 69.2%(9/13). 56 contracture cases were treated by operation, including 11 cases of simple venous malformation resection, 45 cases resection and Z-type anastomosis lengthening of Achilles tendon. All the patients were followed up for 6 months to 2 years after operation. 53 patients recovered to normal walking after operation, and 3 patients had mild limp, satisfaction rate was 94.6%(53/56). Patient satisfaction was 100%. Conclusions The equinus deformity caused by intramuscular venous malformation onset posterior muscles of leg affect the quality of life. Muscle/tendon contracture was the main cause. Correct surgical treatment combined with early rehabilitation exercise post operation can restore normal walking posture.

Objective:To study the degree of recognition about the protection of traditional knowledge of Chi-nese medicine and its influencing factors among Shaanxi University of Chinese Medicine students and provide scien-tific evidence for improving relevant policies.Methods: 1,162 college students were chosen by stratified cluster sampling from Shaanxi University of Chinese Medicine and questionnaires were surveyed among them.Rank sum test and multiple linear regression model were used to explore the related factors on degree of recognition about the protection of traditional knowledge of Chinese medicine.Results: The overall cognition-scoring rate was 36.55％,and subscales in descending order by scoring rate were loss of traditional knowledge of Chinese medicine,international and domestic related protection systems.There were significant differences in scores between age groups,majors,grades,place of origin,family monthly income per capita,parents'educational background,moti-vation of applying for medical school,and whether they had taken the protection of traditional knowledge of Chinese medicine courses(P<0.05).Conclusion:The overall cognition-scoring rate among Shaanxi University of Chi-nese Medicine students was generally low.In order to motivate students to protect traditional knowledge of Chinese medicine and promote a healthy development of Chinese medicine,measures from national institution and school education should be conducted.