Objective To explore differentially expressed endoplasmic reticulum stress-associated genes(ERSAGs)in aortic dissection(AD)and their correlations with immune cell infiltration to identify new therapeutic targets for AD.Methods Two AD mRNA expression datasets(GSE190635 and GSE98770)were downloaded from GEO database for analysis of differentially expressed genes between the aorta of AD patients and normal aorta using R software.ERSAGs dataset was downloaded from GeneCards website,and GeneMANIA database was used to analyze the protein-protein interaction network of the differentially expressed ERSAGs and the proteins interacting with these genes.Based on GSE98770 dataset we analyzed the distributions of 22 immune cells within the aortic wall of AD patients using CIBERSORT package of R software.Surgical aortic wall specimens were obtained from 10 AD patients and 10 non-AD patients for detecting AGER mRNA expression using qRT-PCR,and the upstream transcriptional factors,miRNAs,and chemicals targeting AGER were analyzed using the TRRUST database and NetworkAnalyst database.Results Bioinformatic analysis suggested significant differential expression of AGER in AD,which interacted with 20 proteins involved in pattern recognition receptor signaling pathway,positive regulation of DNA-binding transcription factor activity,myeloid leukocyte migration,leukocyte migration,and regulation of the I-κB kinase/NF-κB signaling.In AD,AGER expression level was positively correlated with Treg cell abundance(r=0.59,P<0.05).The results of qRT-PCR demonstrated significantly lower expression of AGER mRNA in AD than in non-AD patients(1.00±0.30 vs 1.76±0.68,P<0.05).ROC curve analysis showed that at the cut-off value of 1.335,AGER had an AUC of 0.86(95%CI:0.67-1.00,P=0.0073)for predicting AD.Three transcriptional factors,3 miRNAs,and 27 chemicals were predicted in the AGER regulatory network.Conclusion AGER is lowly expressed in the aorta of AD patients and may influence the occurrence of AD through Treg cells.

Objective:To investigate the effects of cerium oxide nanoenzyme-gelatin methacrylate anhydride (GelMA) hydrogel (hereinafter referred to as composite hydrogel) in the repair of infected full-thickness skin defect wounds in mice.Methods:This study was an experimental study. Cerium oxide nanoenzyme with a particle size of (116±9) nm was prepared by hydrothermal method, and GelMA hydrogel with porous network structure and good gelling performance was also prepared. The 25 μg/mL cerium oxide nanoenzyme which could significantly promote the proliferation of human skin fibroblasts and had high superoxide dismutase activity was screened out. It was added to GelMA hydrogel to prepare composite hydrogel. The percentage of cerium oxide nanoenzyme released from the composite hydrogel was calculated after immersing it in phosphate buffer solution (PBS) for 3 and 7 d. The red blood cell suspension of mice was divided into PBS group, Triton X-100 group, cerium oxide nanoenzyme group, GelMA hydrogel group, and composite hydrogel group, which were treated with corresponding solution. The hemolysis of red blood cells was detected by microplate reader after 1 h of treatment. The bacterial concentrations of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli were determined after being cultured with PBS, cerium oxide nanoenzyme, GelMA hydrogel, and composite hydrogel for 2 h. The sample size in all above experiments was 3. Twenty-four 8-week-old male BALB/c mice were taken, and a full-thickness skin defect wound was prepared in the symmetrical position on the back and infected with MRSA. The mice were divided into control group without any drug intervention, and cerium oxide nanoenzyme group, GelMA hydrogel group, and composite hydrogel group applied with corresponding solution, with 6 mice in each group. The wound healing was observed on 3, 7, and 14 d after injury, and the remaining wound areas on 3 and 7 d after injury were measured (the sample size was 5). The concentration of MRSA in the wound exudation of mice on 3 d after injury was measured (the sample size was 3), and the blood flow perfusion in the wound of mice on 5 d after injury was observed using a laser speckle flow imaging system (the sample size was 6). On 14 d after injury, the wound tissue of mice was collected for hematoxylin-eosin staining to observe the newly formed epithelium and for Masson staining to observe the collagen situation (the sample size was both 3). Results:After immersion for 3 and 7 d, the release percentages of cerium oxide nanoenzyme in the composite hydrogel were about 39% and 75%, respectively. After 1 h of treatment, compared with that in Triton X-100 group, the hemolysis of red blood cells in PBS group, GelMA hydrogel group, cerium oxide nanoenzyme group, and composite hydrogel group was significantly decreased ( P<0.05). Compared with that cultured with PBS, the concentrations of MRSA and Escherichia coli cultured with cerium oxide nanoenzyme, GelMA hydrogel, and composite hydrogel for 2 h were significantly decreased ( P<0.05). The wounds of mice in the four groups were gradually healed from 3 to 14 d after injury, and the wounds of mice in composite hydrogel group were all healed on 14 d after injury. On 3 and 7 d after injury, the remaining wound areas of mice in composite hydrogel group were (29±3) and (13±5) mm 2, respectively, which were significantly smaller than (56±12) and (46±10) mm 2 in control group and (51±7) and (38±8) mm 2 in cerium oxide nanoenzyme group (with P values all <0.05), but was similar to (41±5) and (24±9) mm 2 in GelMA hydrogel group (with P values both >0.05). On 3 d after injury, the concentration of MRSA on the wound of mice in composite hydrogel group was significantly lower than that in control group, cerium oxide nanoenzyme group, and GelMA hydrogel group, respectively (with P values all <0.05). On 5 d after injury, the volume of blood perfusion in the wound of mice in composite hydrogel group was significantly higher than that in control group, cerium oxide nanoenzyme group, and GelMA hydrogel group, respectively ( P<0.05). On 14 d after injury, the wound of mice in composite hydrogel group basically completed epithelization, and the epithelization was significantly better than that in the other three groups. Compared with that in the other three groups, the content of collagen in the wound of mice in composite hydrogel group was significantly increased, and the arrangement was also more orderly. Conclusions:The composite hydrogel has good biocompatibility and antibacterial effect in vivo and in vitro. It can continuously sustained release cerium oxide nanoenzyme, improve wound blood perfusion in the early stage, and promote wound re-epithelialization and collagen synthesis, therefore promoting the healing of infected full-thickness skin defect wounds in mice.

Objective To evaluate the clinical effect of intraoperative ultra-early mild hypothermia on severe spontaneous intracerebral hemorrhage.Methods A total of 71 cases of severe spontaneous intracere-bral hemorrhage admitted and treated in the neurosurgery department of this hospital from January 2021 to June 2023 were included,in which 35 cases were in the intraoperative ultra-early mild hypothermia treatment group (the study group),36 cases were in the postoperative mild hypothermia treatment group (the control group).The venous blood samples were collected immediately after operation end,at 6,24,72 h and on 7 d af-ter operation for detecting the C-reactive protein (CRP) and interleukin-6 (IL-6) levels.The national institu-tes of health stroke scale (NIHSS) scoring and the Glasgow Outcome Scale (GOS) scoring in the two groups were conducted in postoperative 3 months.The independent sample t test was used to analyze the differences in CRP,IL-6 and NIHSS score between the two groups and the chi square test was adopted to analyze the good prognosis rate of the two groups.Results There was no statistically significant difference in serum CRP and IL-6 levels immediately after operation between the two groups (P>0.05),but the serum CRP and IL-6 lev-els at 6,24,72 h,7 d after operation in the study group were lower than those in the control group,and the differences were statistically significant (P<0.05).The NIHSS in postoperative 3 months in the study group was lower that that in the control group,while the prognosis good rate in postoperative 3 months was higher than that in the control group,and the differences were statistically significant (P<0.05).Conclusion The intraoperative ultra-early mild hypothermia treatment for severe spontaneous intracerebral hemorrhage has better clinical effect than postoperative mild hypothermia.

Objective To explore the effectiveness of endoscopic surgery and microsurgery for treating hypertensive intracerebral hemorrhage(HICH)in the basal ganglia region.Methods A total of 132 patients with hypertensive intracerebral hemorrhage in the basal ganglia region in this hospital from June 2019 to Janu-ary 2023 were randomly divided into the endoscopic surgery group and microsurgical group,66 cases in each group.The endoscopic surgery group received the endoscopic surgery treatment,while the microsurgical group was given the microsurgical treatment.The differences in the operation time,intraoperative blood loss vol-ume,hospitalization duration,good prognosis rate,quality of life,clinical effect,hematoma clearance rate,post-operative infection and adverse reactions were compared between the two groups.Results The operation time and hospitalization duration in the endoscopic surgery group were shorter compared with the microsurgical group,and intraoperative blood loss volume was less(P＜0.05).After treatment,the good prognosis rate,quality of life,treatment effective rate and hematoma clearance rate in the endoscopic surgery group were higher than those in the microsurgical group(P＜0.05),the postoperative infection rate was lower than that in the microsurgical group(P＜0.05);the incidence rate of adverse reactions in the two groups was lower,but the difference was not statistically significant(P＞0.05).Conclusion Compared with microsurgery for trea-ting HICH in basal ganglia region,the endoscopic surgery could remarkably enhance the clinical efficacy and hematoma clearance rate,reduce the operation time,hospitalization duration,intraoperative blood loss volume and postoperative infection,and the prognosis is better,which is more conducive to the recovery of postopera-tive neurological function,life activities and quality of life of patients.

Objective To explore differentially expressed endoplasmic reticulum stress-associated genes(ERSAGs)in aortic dissection(AD)and their correlations with immune cell infiltration to identify new therapeutic targets for AD.Methods Two AD mRNA expression datasets(GSE190635 and GSE98770)were downloaded from GEO database for analysis of differentially expressed genes between the aorta of AD patients and normal aorta using R software.ERSAGs dataset was downloaded from GeneCards website,and GeneMANIA database was used to analyze the protein-protein interaction network of the differentially expressed ERSAGs and the proteins interacting with these genes.Based on GSE98770 dataset we analyzed the distributions of 22 immune cells within the aortic wall of AD patients using CIBERSORT package of R software.Surgical aortic wall specimens were obtained from 10 AD patients and 10 non-AD patients for detecting AGER mRNA expression using qRT-PCR,and the upstream transcriptional factors,miRNAs,and chemicals targeting AGER were analyzed using the TRRUST database and NetworkAnalyst database.Results Bioinformatic analysis suggested significant differential expression of AGER in AD,which interacted with 20 proteins involved in pattern recognition receptor signaling pathway,positive regulation of DNA-binding transcription factor activity,myeloid leukocyte migration,leukocyte migration,and regulation of the I-κB kinase/NF-κB signaling.In AD,AGER expression level was positively correlated with Treg cell abundance(r=0.59,P<0.05).The results of qRT-PCR demonstrated significantly lower expression of AGER mRNA in AD than in non-AD patients(1.00±0.30 vs 1.76±0.68,P<0.05).ROC curve analysis showed that at the cut-off value of 1.335,AGER had an AUC of 0.86(95%CI:0.67-1.00,P=0.0073)for predicting AD.Three transcriptional factors,3 miRNAs,and 27 chemicals were predicted in the AGER regulatory network.Conclusion AGER is lowly expressed in the aorta of AD patients and may influence the occurrence of AD through Treg cells.

Objective:To explore the chain mediating effect of anxiety and flow experience on perceived stress and mobile phone addiction in nursing college students.Methods:In December 2021, a cross-sectional design survey was conducted on 4 179 freshmen and sophomores in a nursing college in Heilongjiang Province. The Chinese perceived stress scale, generalized anxiety disorder-7, flow state scale, and mobile phone addiction tendency scale were selected separately to assess perceived stress, anxiety symptoms, flow experience and mobile phone addiction. SPSS 26.0 software was used for descriptive analysis, independent sample t-test, Spearman correlation analysis, and AMOS 24.0 software was used for mediating effect test. Results:(1) Among the 3 050 nursing students, there were 714(23.41%) students who were addicted to mobile phones. (2) Spearman correlation analysis indicated that perceived stress(27.31±9.56) was positively correlated with anxiety(7.00(1.00, 10.00), r=0.441, P<0.05), flow experience((12.00±3.40), r=0.517, P<0.05), and mobile phone addiction((42.42±13.05), r=0.476, P<0.05).Anxiety was positively correlated with flow experience ( r=0.430, P<0.01) and mobile phone addiction ( r=0.538, P<0.01).Flow experience was positively correlated with mobile phone addiction ( r=0.490, P<0.01). (3) Anxiety and flow experience played seperate mediating and chain mediating roles between perceived stress and mobile phone addiction, accounting for 26.06%(0.165/0.633), 23.54%(0.149/0.633) and 3.48%(0.022/0.633) of the total effect. Conclusion:Perceived stress not only directly affects the mobile phone addiction of nursing students, but also indirectly affects mobile phone addiction through the independent and chain mediating effects of anxiety and flow experience.

Objective:To investigate the impact of elevated glucose-induced RNA oxidation on pancreatic β-cell function, activity, and underlying molecular mechanisms.Methods:Rat pancreatic islet β-cell tumour INS-1 cells were cultured in vitro and subjected to nucleic acid oxidation assessment using isotope dilution ultra-high performance liquid tandem mass spectrometry(ID LC MS/MS)following high glucose exposure.In vitro simulation of increased RNA oxidation in INS-1 cells was achieved using 8-oxoguanosine-5'-triphosphate(8-oxoGTP).Cell proliferation was evaluated through CCK-8 assay, apoptosis was measured via flow cytometry, and gene expression of insulin(INS), pancreatic-duodenal homologous cassette 1(PDX1), cysteine-aspartate proteinase 3(Casp3), and cysteine aspartate protease 6(Casp6)was analyzed at the mRNA level.Additionally, whole transcriptome sequencing was performed to elucidate the molecular mechanisms underlying the impact of RNA oxidation on INS-1 cells.Results:Elevated glucose levels induced an increase in RNA oxidation within INS-1 cells.This heightened RNA oxidation led to the inhibition of INS-1 cell proliferation, a reduction in mRNA levels of INS and PDX1 genes, and the promotion of apoptosis-related casp3 and casp6 gene mRNA synthesis.Transcriptome sequencing analysis unveiled that the elevated RNA oxidation caused differential expression of mRNA, lncRNA, miRNA, and circRNA in INS-1 cells.This included a significant down-regulation of transcription factors such as Mafa, Pdx1, Pax6, and Mnx1, alongside an up-regulation of various miRNAs like rno-miR-124-3p, rno-miR-133a-3p, rno-miR-3120, rno-miR-212-3p, and rno-miR-7a-2-3p.These molecular changes contributed to the altered expression of associated lncRNAs, ultimately hindering insulin synthesis and secretion, as well as β-cell proliferation.Conclusions:Increased RNA oxidation down-regulates the levels of key β-cell transcription factor mRNAs, contributes to the differential expression of related non-coding RNAs(ncRNAs), particularly lncRNAs, impacts β-cell insulin synthesis and secretion, hinders cell proliferation, and serves as a significant factor in β-cell dysfunction and decreased activity in type 2 diabetes mellitus(T2DM).

【Objective】 To evaluate the effect of multi-disciplinary patient blood management(PBM) on perioperative blood transfusion in patients with cardiothoracic surgery of gradeⅢ~Ⅳ. 【Methods】 The blood transfusion data and relevant clinical information of adult patients underwent grade Ⅲ~Ⅳ cardiothoracic surgeries before and after PBM (from January 2016 to December 2018)in our hospital were collected using Hospital Information System and Management System of Blood Transfusion Department. Patients were grouped according to three separate12-month periods: 933 cases subjected to conventional blood transfusion practice from Jan. to Dec.2016 as the control group, 1 139 cases experienced initial implement PBM(started on Jan.1, 2017)from Jan. to Dec.2017 as the early PBM group, and 1 411 cases received improved PBM from Jan. to Dec.2018 as the improved PBM group. The perioperative autotransfusion rate, allogeneic transfusion rate, length of hospital stay and hospitalization expenses of the three groups were compared by χ² test and variance analysis. 【Results】 The comparison results among control group, early PBM group and improved PBM group were as following: 1) The proportion of patients using iron and EPO to treat preoperative anemia were 15.12%(44/291)vs 19.73%(72/365)vs 26.65%(125/469)(P<0.01) and 10.31%(30/291)vs 12.33%(40/365)vs 15.57%(73/469)(P<0.05), respectively. 2) The incidence of autotransfusion were 57.98%(541/933)vs 44.76%(544/1 139)vs 37.00%(522/1 411)(P<0.01). The allogeneic transfusion volume per capita(U) were 351.91±35.85 vs 392.76±43.33 vs 421.75±73.84(P<0.05). The incidence of allogeneic blood transfusion were 18.11%(169/933)vs 17.56%(200/1 139)vs 13.32%(188/1 411)(P<0.01). The allogeneic blood transfusion volume per capita (U) were 6.56±8.33 vs 5.52±6.28 vs 5.56±6.17(P<0.01). 3) The per capita hospital stay (d) and ICU stay (d) were19.54±16.56 vs 16.46±12.06 vs 15.11±10.18 and 4.45±9.31 vs 3.56±6.93 vs 3.26±5.29(P<0.05), respectively. The per capita hospitalization expenses (ten thousand yuan/person) were 10.76±8.39 vs 9.58±7.58 vs 9.13±5.9(P<0.05). 【Conclusion】 The application of PBM in perioperative blood transfusionfor adult cardiothoracic surgery Ⅲ ~ Ⅳcan significantly decrease the incidence of autologous and allogeneic blood transfusion, the length of hospitalstay and hospitalization expenses.

Objective:To analyze the clinical effect of extracorporeal membrane oxygenation (ECMO) in the treatment of burn patients with acute respiratory distress syndrome (ARDS).Methods:The retrospective observational study and the systematic review were applied. From March 2014 to July 2020, five burn patients with ARDS received ECMO treatment in the First Affiliated Hospital of Army Medical University (the Third Military Medical University). All the five patients were male, aged from 40 to 62 years. The average total burn surface area was 58.8% total body surface area (TBSA) and four cases had severe inhalation injury. Patient's ECMO starting time, duration and mode, and whether successfully weaned or the cause of death, and others. were recorded. Furthermore, the changes of oxygenation and infection before, during, and after utilizing ECMO were analyzed. PubMed and Web of Science from the establishment of each database to August 2021 were searched using "Extracorporeal Membrane Oxygenation", "ECMO", "burn", "inhalation" as the search terms and "Title/Abstract" as the field to retrieve the clinical articles that meet the selection criteria . Basic information were extracted from the articles, including sample size, gender, age, total burn area, inhalation injury, the indication of ECMO, the start and lasting time of ECMO, ECMO mode, rate of successful weaning, complications of ECMO, mortality, the combined application of continuous renal replacement therapy (CRRT). Results:Five patients started venovenous ECMO on an average of 10.2 days after injury and lasted an average of 180.4 hours. Three out of 5 patients were weaned successfully with one patient survived. Four patients died of multiple organ dysfunction syndrome (MODS) and septic shock. Compared with those before ECMO treatment, the arterial oxygen partial pressure (PaO 2) and oxygen saturation in arterial blood (SaO 2) of three successfully weaned patients obviously increased during and after ECMO treatment. The fraction of inspired oxygen (FiO 2) decreased below 50% and PaO 2/FiO 2 ratio increased above 200 mmHg (1 mmHg=0.133 kPa) during and after ECMO. Furthermore, lactic acid and respiratory rate decreased, basically. Compared with those before ECMO, PaO 2 and SaO 2 in the other two patients during ECMO, who failed to be weaned, continuously decreased while lactic acid increased. Before and during ECMO, the PaO 2/FiO 2 ratios of unsuccessfullg weaned cases were less than 200 mmHg, and partial pressure of carbon dioxide in arterial blood (PaCO 2) were more than 40 mmHg. Compared with those before ECMO, there were no significant changes in body temperature during and after ECMO, which were less than 38 ℃. Compared with those before ECMO, the leucocyte number (the index without this in unsuccessfully weaned cases was omitted, the same as below) in four patients showed a significant decrease during ECMO, but rose after removal of ECMO. The proportion of neutrophils in three patients were slightly higher during ECMO than before ECMO, and did not change significantly after removal of ECMO. Compared with those before ECMO, platelet counts in three patients were significantly reduced during ECMO, and all five patients during ECMO were below normal levels. Compared with those before ECMO, the procalcitonin levels in four deaths were significantly increased during ECMO. Catheter culture of microorganism was performed in three successfully weaned patients, all of which were negative. A total of 13 literature were included, ranging from 1990 to 2019. The sample size in 6 studies was less than 10, and the sample size in 4 studies was between 10 and 20, and only 2 literatures had a sample size larger than 50. ECMO was applied in 295 burn patients with overall mortality of 48.8% (144/295), including 157 adults and 138 children. The most common indication of ECMO was severe ARDS. Among 157 adult burn patients (95 males and 65 females), 36 cases had inhalation injury. The average burn area was 27%-37%TBSA in 5 reported studies and was more than 50%TBSA in 2 reported studies. The most common mode was venovenous ECMO. ECMO treatment began 26.5 hours to 7.4 days after injury and lasted from 90 hours to 18 days, and the rate of successful weaning ranged from 50% to 100%. The most common complications were bleeding and infection. The mortality was 52.9% (83/157). MODS and sepsis were the leading causes of death. Among 138 pediatric burn patients (77 boys and 61 girls), 29 patients had inhalation injury. The average burn area was 17%-50.2%TBSA in 3 studies. ECMO treatment lasted from 165.2 hours to 324.4 hours. Bleeding was the most common complication. The mortality was 44.2% (61/138). Conclusions:ECMO is an effective strategy for the salvage treatment of burns complicated with ARDS. Furthermore, the prevention and treatment of bleeding, infection and organ dysfunction should be emphasized during the use of ECMO. More importantly, evidence-based guidelines for burns are urgently needed to further improve the clinical effect of ECMO.

Objective:To investigate the epidemiological characteristics of children respiratory pathogen infection in Ningbo city, and provide scientific reference for clinical prevention, control, diagnosis and treatment.Methods:A total of 3 103 specimens were collected from the children with acute respiratory infections in Ningbo Women and Children′s Hospital from July to October 2019. Thirteen common respiratory pathogens were detected by multiple reverse transcription-polymerase chain reaction (RT-PCR) based on capillary electrophoresis, and the result were analyzed.Results:Of the 3 103 specimens, 2 053 were positive for respiratory pathogens, with a total positive rate of 66.16%. The detection rates of Mycoplasma pneumoniae (Mp) 33.19% (1 030/3 103), human rhinovirus (HRV) 24.20% (751/3 103), and human adenovirus (HADV) 8.77% (272/3 103) were in the first three. The positive rates of pathogens in the male and female children were 65.70% (1 157/1 761) and 66.77% (896/1 342), respectively, and the difference was not statistically significant( χ2=0.386, P=0.535); the positive rates in the age groups of ≤1 year old, 1~≤3 years old, 3~≤6 years old and 6~≤16 years old were 58.02% (626/1 079), 74.37% (589/792), 73.78% (543/736) and 59.48% (295/496), respectively, and the difference among the groups was statistically significant( χ2=84.770, P=0.000); the positive rates in July to October were 71.64% (341/476), 68.81% (536/779), 67.01% (648/967) and 59.93% (528/881), respectively, the difference was statistically significant( χ2=24.395, P=0.000); the single infection rate was 52.30% (1 623/3 103), and the mixed infection rate of two or more pathogens was 13.86% (430/3 103), most of which were mixed infections of two pathogens. Conclusions:The main respiratory pathogens of children in Ningbo city were Mp and HRV, and the detection rates of respiratory pathogens varied among different ages and months.