Objective:To compare the prognostic values of different classification by using transpulmonary pressure gradient (TPG), diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) in patients with pulmonary hypertension due to left heart disease (PH-LHD), and investigated hemodynamic and clinical factors associated with mortality in patients with PH-LHD.Methods:This was a single-center prospective cohort study. In-hospital patients diagnosed with PH-LHD via right heart catheterization at the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, from September 2013 to December 2019 were enrolled. Patients were divided according to TPG (cutoff value 12 mmHg; 1 mmHg=0.133 kPa), DPG (cutoff value 7 mmHg), PVR (cutoff value 3 Wood Units), and the combination of TPG and PVR. Baseline characteristic was recorded. All patients were followed up until the occurrence of endpoint event, defined as all-cause death that occurred during the follow-up period, or until April 18, 2022. Receiver operating characteristic curves were used to compare the predictive value of 3 classification methods for all-cause death in PH-LHD patients. The optimal cutoff values were calculated using Jorden index. Survival analysis was performed using Kaplan-Meier analysis, and log-rank test was used to compare the predictive efficacy of classification methods based on optimal cutoff values or guidance-recommended thresholds for the survival of PH-LHD patients. Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality.Results:A total of 243 patients were enrolled, aged (54.9±12.7) years old, including 169 (69.5%) males. During a median follow-up of 57 months, there were 101 (41.6%) deaths occurred. Grouping results were as follows: (1) TPG: TPG≤12 mmHg group 115 patients, TPG>12 mmHg group 128 patients; (2) DPG: DPG<7 mmHg group 193 patients, DPG≥7 mmHg group 50 patients; (3) PVR: PVR≤3 Wood Units group 108 patients, PVR>3 Wood Units group 135 patients; (4) TPG and PVR: TPG≤12 mmHg and PVR≤3 Wood Units group 89 patients, TPG>12 mmHg and PVR>3 Wood Units group 109 patients. PVR ( AUC=0. 698,95% CI:0.631-0.766) had better predictive value for all-cause mortality than TPG ( AUC=0.596, 95% CI: 0.523-0.669) and DPG ( AUC=0.526, 95% CI: 0.452-0.601) (all P<0.05). The optimal cutoff values for TPG, DPG, and PVR were13.9 mmHg, 2.8 mmHg, and 3.8 Wood Units, respectively. Kaplan-Meier analysis based on the optimal cutoff values or guidance-recommended thresholds showed that PVR and TPG were the predictors of survival ( P<0.05), while DPG did not showed significance ( P>0.05). Multivariate Cox regression analysis showed that age, PVR and log 2N-terminal pro-B-type natriuretic peptide were independent risk factors for all-cause mortality in PH-LHD patients (all P<0.05). Conclusion:Classification according to PVR was most valuable in predicting all-cause death in PH-LHD patients, while TPG showed moderate predictive ability and DPG had no predictive value.

Objective To analyze the correlation between Glasgow coma score(GCS),blood lactic acid(Lac),and blood transfusion volume in traumatic emergency hemorrhagic shock patients,and their predictive value for patient prognosis.Methods Retrospective collection of clinical data from 128 trauma emergency shock patients who were treated and followed up in the Emergency Medical Center,Jinhua People's Hospital from March 2021 to May 2023.They were divided into good prognosis group(n=106)and poor prognosis group(n=22)according to their prognosis.The general information,GCS score,Lac level,and blood transfusion volume of two groups were compared.Using Cox regression model to analyze the influencing factors of prognosis in trauma emergency hemorrhagic shock patients.Establish receiver operating characteristic(ROC)curve to analyze the predictive value of GCS score,Lac level,and blood transfusion volume on the prognosis of trauma emergency hemorrhagic shock patients.Results Among 128 patients,22 had poor prognosis,accounting for 17.19％.The initial 24-hour blood transfusion volume,Lac,and white blood cell(WBC)in poor prognosis group were higher than those in good prognosis group,while the admission GCS score and hemoglobin(Hb)level were lower than those in good prognosis group,and the differences were statistically significant(P＜0.05).Pearson correlation analysis showed that the initial 24-hour blood transfusion volume was negatively correlated with admission GCS score and admission Hb level(P＜0.05),and positively correlated with admission Lac level(P＜0.05).The initial 24-hour blood transfusion volume,admission GCS score,admission Lac,and admission Hb levels are all independent risk factors affecting the prognosis of trauma emergency hemorrhagic shock patients(P＜0.05).The initial 24-hour blood transfusion volume,admission GCS score,admission Lac,admission Hb level,and combined predicted area under the curve(AUC)were 0.722,0.872,0.881,0.798,and 0.931,respectively,with sensitivity of 68.2％,76.6％,85.7％,75.7％,and 88.8％,and specificity of 70.8％,81.0％,78.5％,81.0％,and 85.7％,respectively.Paired Z-tests showed that the combined AUC was higher than a single indicator,and both sensitivity and specificity were optimal(P＜0.05).Conclusion The initial 24-hour blood transfusion volume,admission GCS score,admission Lac,and admission Hb levels are all independent risk factors for poor prognosis in trauma emergency hemorrhagic shock patients,and the combined prediction of the four has the highest efficacy value.

Objective To analyze cognition,attitude,behavior status and influencing factor of neurological nurses for early rehabilitation of stroke.Methods A tatol of 182 neurological nurses from 8 tertiary hospitals in Urumqi were selected as the research subjects to investigate the cognition,attitude from December 2022 to June 2023,and behavior status of neurology nurses for early rehabilitation of stroke and analyze their influencing factors.Results The scores of 182 neurological nurses during early rehabilitation of stroke were(72.57士6.79),the scoring rate was 72.57％,which was in the middle level.The average score of attitude was(89.62±2.94),and the scoring rate was 89.62％,which was at a high level.The average score of behavior was(62.08±21.50),and the scoring rate was 62.08％,which was in the middle level.Multivariate regression analysis showed that age was the influence factor of nurses'early rehabilitation cognition dimension and attitude dimension(P＜0.05);The influence factors of nurses'early rehabilitation behavior were their professional title and whether stroke had occurred among relatives and friends(P＜0.05).Conclusion Neurological nurses have a positive attitude towards early rehabilitation of stroke,but they do not implement nursing measures enough.It is suggested that rehabilitation nursing training courses should be set up to encourage nurses to update their knowledge and strengthen their self-learning so as to improve nursing behavior and improve nursing quality.

【Objective】 To investigate the early clinical efficacy of full endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases with lumbar instability. 【Methods】 We made a retrospective analysis of 22 cases of lumbar degenerative diseases with lumbar instability treated by full endoscopic lumbar interbody fusion in Department of Orthopedics， Tangdu Hospital of Air Force Military Medical University from January 2019 to June 2020. The operation time， intraoperative bleeding volume， and hospital stay were recorded. The Visual Analogue Scale （VAS） for lower back pain and leg pain and Oswestry disability index （ODI） were compared before operation， 1 week， 1 month， 3 months， 6 months and at the last follow-up after operation. Modified MacNab was used to evaluate the clinical efficacy at the last follow-up. 【Results】 Operations on the 22 patients were all completed successfully. The average operation time was （206.59±5.69） min （with the range of 180-240 min）； the average volume of intraoperative bleeding was （92.73±22.29） mL （with the range of 50-120 mL）； the average hospitalization time was （8.82±1.53） d （with the range of 7-13 d）. All the patients were followed up for an average of （10.95±3.34） months （with the range of 6-18 months）. The VAS score and ODI at each time point after surgery were significantly decreased compared with those before operation （P<0.05）. The modified MacNab used to evaluate the clinical efficacy at the last follow-up showed that the total excellent and good rate was 90.91%， including 17 cases of excellence， 3 cases of good， and 2 cases of fair. 【Conclusion】 The early clinical effect of full endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases with lumbar instability is satisfactory.

The extract rates, multicomponent content and fingerprint were determined in this study to investigate the quality diffe-rence between standard decoction of raw Paeoniae Radix Alba and fried Paeoniae Radix Alba. UPLC fingerprint was established for 17 batches of standard decoction of raw and fried Paeoniae Radix Alba, and the contents of gallic acid, catechin, albiflorin, paeoniflorin and benzoyl paeoniflorin were determined. The peak areas of standard decoction were analyzed by the independent t-test and orthogonal partial least squares discriminant analysis. There was no significant difference in extract rates between the standard decoction of raw and fried Paeoniae Radix Alba. After fried processing, the content of albiflorin increased by 0.26%, while the contents of gallic acid, catechin, paeoniflorin and benzoyl paeoniflorin decreased by 13.04%, 27.97%, 10.30% and 18.79% respectively. There were 14 common peaks in the fingerprint of standard decoction of raw Paeoniae Radix Alba, and 16 common peaks in the fried Paeoniae Radix Alba. Peak 1 and peak 3 were new ones after processing, among which the peak 3 was 5-hydroxymethylfurfural. The results showed that peak 1, peak 3, peak 11 and peak 15 were the key compounds to distinguish standard decoction of raw and fried Paeoniae Radix Alba. In conclusion, this method is stable and can be used for the study of quantity transfer and quality control in the preparation process of standard decoction, granules and other dosage forms for raw and fried Paeoniae Radix Alba, providing reference for the identification of raw and fried Paeoniae Radix Alba and related preparations.
Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; Paeonia ; Quality Control ; Reference Standards

Objective: To investigate the effect of H-uvulopalatopharyngoplasty(H-UPPP) combined with tongue base radiofrequency ablation in the treatment of obstructive sleep apnea hypopnea syndrome(OSAHS). Methods: Sixty-two patients with moderate or severe OSAHS, whose obstructive plane located in the oropharynx and tongue base were divided into two groups two groups according to the patient′s independent choice under the condition of fully informed before the operation. The control group of 30 cases underwent H-UPPP, while the experimental group of 32 patients underwent improved H-UPPP and tongue base radiofrequency. The clinical efficacy between the two groups was compared. Results: There was no significant difference between the two groups before operation. After the operation, the total effective rate of the experimental group was 71.9%, significantly higher than that of the control group (46.7%, χ²=4.09, P<0.05), the difference was statistically significant. After operation, in the control group, AHI was (19.4±8.1)/h, LSaO₂ was 0.767±0.052. In the experimental group, AHI was (17.8±7.8)/h, LSaO₂ was 0.790±0.059. There was significant difference in both groups before and after surgery (P<0.001), with statistical significance. In the experimental group, after operation, the minimum diameter of oropharyngeal cavity was (10.6±2.4) mm, there was obvious increase compared with the diameter of oropharyngeal cavity (9.9±2.2) mm before operation, the difference was statistically significant (t=2.64, P<0.05). In the control group, after operation, the minimum diameter of oropharyngeal cavity was(10.0±2.4) mm, there was no obvious increase compared with the diameter of oropharyngeal cavity (9.9±2.5) mm before operation, the difference was not statistically significant (P>0.05). Compared between control group and experimental group, the differences of AHI, LSaO₂, the minimum anteroposterior diameter of oropharyngeal cavity before and after operation were not statistically significant (P>0.05). Conclusion The effect of same time H-UPPP and radiofrequency ablation surgery is definitive.

Objective To investigate the value of ultrasound screening for congenital cytomegalovirus (CMV) infection in fetuses and to summarize the clinical manifestations.Methods From January 2012 to December 2017,we retrospectively analyzed the clinical data of 905 gravidas who received invasive prenatal diagnosis in Fujian Provincial Maternity and Children's Hospital for abnormal prenatal ultrasound findings including ventriculomegaly,intracranial calcification,microcephaly,echogenic bowel and fetal growth restriction (FGR).CMV DNA loads in amniotic fluid and neonatal urine were detected by real-time polymerase chain reaction.CMV-specific IgM and IgG in umbilical cord and neonatal peripheral blood were detected by commercial enzyme 1 inked immunosorbent assay kits.Eighteen fetuses with normal karyotype were diagnosed as congenital CMV infection.Relationships of ultrasound features and CMV DNA loads in amniotic fluid to pregnancy outcomes were analyzed with x2 test or Fisher's exact test.Results (1) Congenital CMV infection was detected in 18 fetuses in this study with an detection rate of 1.99％ (18/905).Three pregnancies were terminated immediately after the diagnosis was confirmed,two terminated when the ventriculomegaly progressed,five terminated for hydrocephaly and eight continued to delivery.(2) Congenital CMV infection rate was significantly higher in those with two or more ultrasound abnormalities than that in those with only one abnormal indicator [3.92％(8/204) vs 1.28％(9/701),x2=4.619,P=0.032].Fetuses with craniocerebral abnormalities were more likely to have congenital CMV infection than those without [3.11％(13/418) vs 0.82％(4/487),x2=6.392,P=0.012].(3) Among the 18 fetuses with congenital CMV infection,those with serious ultrasound abnormalities had a significantly higher rate of adverse outcomes than those without (11/11 vs 3/7,Fisher's exact test,bilateral P=0.043).No significant difference in the rate of adverse outcomes was found between fetuses with low and high CMV DNA loads in amniotic fluid (3/4 vs 12/14,Fisher's exact test,bilateral P=1.000).Conclusions Ultrasound abnormalities including ventriculomegaly,intracranial calcification,microcephaly,echogenic bowel and FGR,especially those with multiple abnormalities and brain abnormalities,increased risk of congenital CMV infection.Congenital CMV fetuses with serious ultrasound abnormalities has adverse outcomes.

Objective The aim of this study is to investigate the proliferation, differentiation and apoptosis of periodontal ligament stem cells (PDLSC) derived from different aged donors, and to evaluate the effects of aging on the biological characteristics of PDLSC.Methods Periodontal ligament tissues were obtained from 24 surgically extracted human premolars during orthodontics therapy. The specimens were divided into three groups according to the donor's age. Group A: 18-20 years, group B: 30-35 years, group C: 45-50 years. PDLSC were isolated and cultured using a tissue-block-based enzymolytic method by limiting dilution assay. The colony forming efficiency of PDLSC for three experimental groups was determined. Senescence-Associated β-Galactosidase (SA-β-G) expression in the three groups was examined using β-galactosidase staining working solution. Cell cycle and apoptosis of the PDLSC were examined by the flow cytometry. Alkaline phosphatase (ALP) activity was evaluated by ALP staining. The expression of osteoplastic differentiation related genes Runt-related transcription factor-2 (Runx-2), Collagen Type 1 (col-1), and ALP of PDLSC were examined by quantitative real-time RT-PCR.Results The colony forming efficiency of PDLSC in Group A, B and C was 36.67%, 22.67% and 9.33%, respectively, which decreased with donors' age (P<0.05). SA-β-G expression of the senescent PDLSC in group A, B and C were 4.14%, 16.39%, 50.38%, respectively (P<0.05). Cells in G2/S phase was 38.73%, 29.88%, 18.25% (P<0.05), and the apoptosis rate was 1.57%, 4.56%, 5.84% (P<0.05), in group A, B and C respectively. The ALP staining in the three groups decreased with the increase of donors' ages, and the expression of Runx-2, col-1 and ALP decreased gradually from group A to group C (all P<0.05), which indicated the osteogenic differentiation capacity of PDLSC decreased while donor aging.Conclusion Human PDLSC could be successfully isolated from periodontal ligament tissues of different aged donors. However, the proliferation and osteogenic differentiation capacity of PDLSC decreased while donor aging.
Adolescent ; Adult ; Aging ; Alkaline Phosphatase ; genetics ; Apoptosis ; Cell Cycle ; Cell Differentiation ; Cell Proliferation ; Humans ; Middle Aged ; Osteogenesis ; Periodontal Ligament ; cytology ; Stem Cells ; cytology

Background Voriconazole is the traditionally used antifungal agent,but its ophthalmic form is unsatisfactory.A novel ophthalmic drug delivery system with biomedical devices may be of promising for the prognosis of fungal keratitis.Objective This study was to investigate the sustained release,therapeutic effect and biocompatibility of effect and quaternized chitosan functionalized with carboxylated graphene and nano-silver and voriconazole (CS-ETA/Ag/GO/Vor) for fungal keratitis.Methods This study complied with the Regulations for the Administration of Affair Concerning Experimental Animals of State Science and Technology Commission.Two hundred and ten SPF female C57BL/6 mice were selected with the age 6-8 weeks for the biocompatibility experiment (30 mice) and therapeutic observation of CS-ETA/Ag/GO/Vor (180 mice).CS-ETA/Ag/GO and CS-ETA/Ag/GO/Vor were attached on the normal corneas of mice and compared with the normal mice to assess the histopathological changes.Aspergillus fumigatus-infected mouse models were established in the left eyes of 180 mice by intrastromally injection of 2.0 μl Aspergillus fumigatus suspension with the density of 5 × 107 CFU/ml,then the mice were randomized into the model control group,CS-ETA/Ag/GO group and CS-ETA/Ag/GO/Vor group,and the corresponding membrane were attached the central corneas in different groups.In 1 day,3,5,7 days after modeling,the corneas were examined under the slit lamp microscope and scored,and corneal sections were prepared for the histopathological examination.Fungal activity was confirmed by plate counts,and real-time PCR was employed to assay the relative expressions of interleukin-1β (IL-1β) mRNA and tumor necrosis factor-α (TNF-α) mRNA in the corneas.Results No morphological abnormality was seen in the corneas in the normal control group,CS-ETA/Ag/GO group and CSETA/Ag/GO/Vor group.Corneal inflammatory score was significantly lower in the CS-ETA/Ag/GO/Vor group in various time points,with a significant differences among the groups and time points (Fgroup =237.29,P=0.00;Ftime =260.33,P=0.00).The edema,necrosis or perforation of cornea were seen in the model control group,and slighter inflammatory response in the CS-ETA/Ag/GO group,and corneal edema was gradually disappear in the CS-ETA/Ag/GO/Vor group.The corneal fungal loads were highest in the model control group and lowest in the CS-ETA/Ag/GO/V or group,with significant differences among the three groups and various time points (Fgroup =113.15,P =0.00;Ftime =126.52,P=0.00).The relative expressions of IL-1β mRNA and TNF-α mRNA in the corneas peaked in the fifth day after modeling in all of the three groups,and the expression levels of IL-1β mRNA and TNF-α mRNA in the corneas were lowest in the CS-ETA/Ag/GO/Vor group,showing significant differences among the groups and time points (IL-1β:Fgroup =189.90,P =0.00;Ftime =108.56,P =0.00;TNF-α:Fgroup =82.55,P =0.00;Ftime =44.36,P =0.00).Conclusions CS-ETA/Ag/GO/Vor delivery system plays an anti-fungal activity in fungal keratitis by the synergistic effect of voriconazole and Ag+.In addition,CS-ETA/Ag/GO/Vor appears to have a good safety after topical application.

In this article, HPLC fingerprint analysis method for total flavonoids from pollen of Brassica campestris L.was established., The HPLC fingerprint was performed on Waters C18 column (250 mm × 4.6 mm, 5 μm), eluted gradiently with the mixture of acetonitrile and 0.4% phosphoric acid aqueous solution at a flow rate of 0.8 mL·min-1. The column temperature was 40℃. The detection wavelength was 320 nm. The HPLC standard fingerprint of total flavonoids from pollen of Brassica campestrisL. was established, and 16 common peaks were calibrated. The method was simple, stable, and reproducible. It could be applied for quality control of total flavonoids from pollen of Brassica campestris L.