ObjectiveTo explore the effect and mechanism of Qigui Didang decoction， formulated based on the principle of Tonifying Deficiency and Unblocking Collaterals， on improving metabolic memory of db/db mice with diabetic nephropathy （DN） through silent information regulator 1 signal regulator 1 （Sirt1）/p53/nuclear factor kappa-B （NF-κB） p65 pathway. MethodsFifteen db/db mice were randomly divided into model group （10 mL·kg^-1·d^-1）， resveratrol group （20 mg·kg^-1·d^-1）， and Qigui Didang decoction group （3.34 g·kg^-1·d^-1） Another five db/m mice were selected as the normal group （10 mL·kg^-1·d^-1）. After the intervention， the kidney weight of each group was measured， and the kidney index （KI） was calculated. Fasting blood glucose （FBG）， creatinine （CRE）， β2-microglobulin （β2-MG）， blood urea nitrogen （BUN）， and cystatin C （CysC） were measured. Renal pathology was observed by hematoxylin-eosin （HE） staining and Masson staining. The mRNA and protein expression levels of Sirt1， NF-κB， tumor suppressor gene p53， interleukin-1β （IL-1β）， and cysteine aspartate protease-3 （Caspase-3） were detected using real-time quantitative polymerase chain reaction （Real-time PCR） and Western blot. ResultsCompared with the normal group， the model group showed disordered renal structure， obvious renal damage， and markedly elevated levels of renal function indexes （CRE， β2-MG， BUN， and CysC） （P<0.01）. The KI and blood glucose were significantly increased （P<0.01）， while Sirt1 expression was markedly decreased （P<0.01）. Expression levels of NF-κB p65， p53， IL-1β， and Caspase-3 were increased significantly （P<0.05）. Compared with those in the model group， DN mice treated with Qigui Didang decoction exhibited significantly decreased FBG， improved renal function， and markedly decreased KI （P<0.01）， along with reduced CRE， β2-MG， BUN， and CysC levels （P<0.05）. Protein expression of Sirt1 was significantly upregulated （P<0.05）， while that of NF-κB p65， p53， IL-1β， and Caspase-3 was markedly decreased （P<0.05）. The mRNA expression levels of NF-κB p65， p53， IL-1β， and Caspase-3 were significantly decreased （P<0.05）. The staining results indicate improved renal fibrosis， significantly decreased fiber deposition （P<0.05）， and less inflammatory infiltration in the Qigui Didang decoction group. ConclusionThe findings suggest that Qigui Didang decoction can alleviate the metabolic memory effect of DN， thereby inhibiting renal cell apoptosis and inflammatory response in mice， and improving renal function. The mechanism of action is closely related to the Sirt1/p53/NF-κB p65 signaling pathway.

Objective To investigate the effect of patient's body shape and image acquisition mode on the radiation dose and image quality in percutaneous coronary angiography.Methods A total of 40 patients,who received selective percutaneous coronary angiography at the Ningbo Medical Center Lihuili Hospital of China between January 2022 and June 2023,were selected for this study.The patients were randomly divided into conventional group(including 11 males and 9 females,using coronary angiography mode to make image acquisition)and low-dose group(including 14 males and 6 females,using electrophysiological mode to make image acquisition).The patient's basic information,body size data,and the various radiation dose data were collected.The image quality rating scale for assessing the image quality was formulated.The independent sample t-test and Mann-Whitney U test were used for the comparison between the two groups.Pearson correlation analysis method was used to make correlation analysis.Results The larger the patient's chest circumference was,the higher the radiation dose would be,there was a positive linear relationship between the patient's chest circumference and the radiation dose.All the radiation dose parameters in the low-dose group were significantly lower than those in the conventional group(P＜0.01),and its reduction percentage was 48.51％-60.74％.No statistically significant difference in image quality score existed between the two groups(P＞0.0l),and in both groups the image quality was rated as good or better,meeting the requirements of intervention procedures.Conclusion In percutaneous coronary angiography the radiation dose is influenced by multiple factors including patient's body shape,image acquisition mode,exposure time,etc.Optimizing the image acquisition mode can remarkably reduce the radiation dose while maintaining the image quality and protecting the health of patients and operators.(J Intervent Radiol,2024,33:599-603)

The popularization and promotion of exercise prescription plays a crucial role in the effective prevention and treatment of chronic diseases. In order to promote the development of sports-medicine integration and the clinical application of exercise prescription, the authors analyzed the basic connotation of exercise prescription, screened out 135 medical service items related to exercise prescription, including 114 exercise practice-type items, 13 experimental inspection-type items and 8 monitoring and evaluation-type items through searching the information query database of the National Medical Insurance Service Platform (data updated to June 2023), and explored the current situation of medical insurance payment for exercise prescription. Then the authors sorted out the existing problems of medical insurance payment for exercise prescription in China, and put forward such suggestions, as strengthening the standardized management of medical service items for exercise prescription, enhancing the enthusiasm of hospitals to apply exercise prescription, guaranteeing the seamless transition of the implementation of exercise prescription both inside and outside the hospitals, perfecting the evaluation system of the effect of exercise prescription medical service as well as advancing the medical insurance payment for exercise prescription.

Objective:To explore the application of OTD (observation, teaching and discussion) teaching combined with clinical pathway in nursing standardized training in operating room.Methods:A total of 50 nurses who were trained in the Operating Room of The First Affiliated Hospital of Air Force Medical University from August 2017 to June 2020 were selected and divided into control group and study group according to the rotation order, with 25 nurses in each group. Traditional teaching was used in the control group, and OTD teaching combined with clinical pathway was used in the study group. After the rotation training, the teaching effect was evaluated through the assessment of theoretical knowledge and clinical practice comprehensive ability, teaching satisfaction, and the satisfaction scores of participating surgeons and patients. SPSS 22.0 was used for t-test and chi-square test. Results:The results of theoretical assessment, clinical skill assessment and comprehensive ability assessment of operating room of the rotating nurses in the study group were higher than those in the control group, with significant difference ( P < 0.05). The study group was significantly better than the control group in 8 aspects, including learning initiative, stimulating learning interest, problem-solving ability, communication ability, clinical thinking ability, teamwork ability, critical thinking ability and teaching satisfaction ( P<0.05). The satisfaction scores of doctors [(94.06±2.67) vs. (92.17±2.75)] and patients [(94.90±3.22) vs. (91.25±3.10)] in the study group were significantly higher than those in the control group ( P<0.05). Conclusion:OTD teaching combined with clinical pathway can help to improve the theoretical knowledge, clinical practice comprehensive skills and teaching satisfaction of nursing students in operating room, and then improve the teaching quality.

Objective:To understand the work experiences of vaccination nurses in western China under the background of free vaccination with COVID-19 vaccine of the entire population, and provide references for these nurses to better their performance in large-scale COVID-19 vaccination.Methods:Semi-structured interviews were conducted on working experience of COVID-19 vaccination with 11 community outpatient nurses who participated in the " Second Western Immunization Planning and Health Summit Forum" held in Chongqing on April 16 to 18, 2021. The sample size was set as information saturation, and the 7-step Colaizzi analytical methods was used in data clarification and analysis.Results:Such interviews extracted three themes: difficulties and challenges, psychological experience, organization and coordination. Difficulties and challenges included shortage of nursing human resources, shortage of resources for routine vaccination, imperfect online appointments, and epidemic prevention and control risks brought by mass vaccination; psychological experience included strong sense of responsibility, accumulation of anxiety, and lack of social identity; organizational coordination included organizational and the overall integration of vaccination resources.Conclusions:Community vaccination nurses have demonstrated a high sense of responsibility and mission in the work of the COVID-19 vaccination. Software and hardware facilities should be enhanced for higher efficiency; vaccination nurses deserve more psychological assistance to help ease their tension; the localities are recommended to organize their vaccination work to fit local conditions.

Objective:To explore the association between chest high resolution CT (HRCT) scoring and prognostic factors of interstitial lung disease (ILD) in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM).Methods:The patients with DM admitted to Kailuan General Hospital between January 2017 and December 2019 were included into the study including 13 patients with positiveanti-MDA5 antibody (7 survivors, 6 deaths) and 18 patients with anti-synthase (ARS)-antibody positive. All patients underwent chest HRCT prior to treatment. The consolidation, ground-glass opacity (GGO) and fibrosis were scored to assess HRCT findings. The clinical manifestations were compared between the two groups. Cox regression analysis adjusted for age and sex was used to determine the prognostic factors for anti-MDA5 antibody-related ILD.Results:Compared with ARS patients, glutamyl transferase (GGT) and ferritin levels were significantly higher in MDA5-ILD patients [70.0(37.0, 122.5) vs 21.0(16.5, 33.5), Z=-3.37, P=0.001; 977.0(502.5, 1 366.0) vs 307.1(72.3, 546.9) , Z=-3.44, P=0.001]. The cumulative survival rate was significantly lower in patients with positive anti-MDA5 antibody than in those with positive anti-ARS antibody (100% vs 70%, P=0.001). The DM complicated with acute/subacute interstitial pneumonia (A/SIP) were found to significantly relate to death. There were no significant differences in chest HRCT scoringbetween the survivors and the deceased patients [ HR=1.08, 95% CI(0.95, 1.23), P=0.229; HR=0.97, 95% CI(0.72, 1.30), P=0.814]. Conclusion:Anti-MDA5 antibody is an important index for early diagnosis of DM complicated with acute/subacute interstitial pneumonia (A/SIP). The chest HRCT scoreis is not associated with the prognosis of anti-MDA5 antibody-related ILD patients.

Objective:To explore the effects of perianesthesia position nursing model based on enhanced recovery after surgery (ERAS) in patients undergoing thoracoscopic surgery.Methods:Totally 100 patients undergoing thoracoscopic pulmonary surgery in Huzhou Central Hospital between July and December 2019 were selected by convenient sampling and divided into the control group and the experimental group according to the random number table, with 50 cases in each group. Patients in the experimental group received perianesthesia position nursing, while patients in the control group received conventional position nursing. The time of position placement, number of placement personnel, intubation time, comfort and pain were compared between the two groups.Results:There were statistically significant differences in the placement time and number of placement personnel between the two groups ( P<0.05) . The GCQ score of the experimental group was higher, while the VAS score was lower than that of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The perianesthesia position nursing model based on ERAS can shorten the time of posture placement, reduce the pain, and improve the comfort in patients undergoing thoracoscopic surgery.

OBJECTIVE: To assess the clinical application of single nucleotide polymorphism microarray (SNP array) in patients with intellectual disability/developmental delay(ID/DD). METHODS: SNP array was performed to detect genome-wide DNA copy number variants (CNVs) for 145 patients with ID/DD in Women's Hospital, Zhejiang University School of Medicine from January 2013 to June 2018. The CNVs were analyzed by CHAS software and related databases. RESULTS: Among 145 patients, pathogenic chromosomal abnormalities were detected in 32 cases, including 26 cases of pathogenic CNVs and 6 cases of likely pathogenic CNVs. Meanwhile, 18 cases of uncertain clinical significance and 14 cases of likely benign were identified, no significant abnormalities were found in 81 cases (including benign). CONCLUSIONS SNP array is effective for detecting chromosomal abnormalities in patients with ID/DD with high efficiency and resolution.
Chromosome Aberrations ; DNA Copy Number Variations ; Genome-Wide Association Study ; Humans ; Intellectual Disability ; diagnosis ; genetics ; Oligonucleotide Array Sequence Analysis ; standards ; Polymorphism, Single Nucleotide

OBJECTIVE: To assess the clinical application of single nucleotide polymorphism microarray (SNP array) in prenatal genetic diagnosis for fetuses with absent nasal bone. METHODS: Seventy four fetuses with absent nasal bone detected by prenatal ultrasound scanning were recruited from Women's Hospital, Zhejiang University School of Medicine during June 2015 and October 2018. The chromosome karyotypes analysis and SNP array were performed. The correlation between absent fetal nasal bone and chromosome copy number variants was analyzed. RESULTS: Among 74 fetuses, 19 were detected to have chromosomal abnormalities, including 16 cases of trisomy-21, 1 case of trisomy-18 and two cases of micro-deletion/duplication. Among 46 cases with isolated absence of nasal bone, 3 had trisomy-21, and 1 had a micro-duplication. Absence of nasal bone in association with nuchal translucency thickening had a higher rate of abnormal karyotypes compared with isolated absence of nasal bone (=32.27,<0.01). CONCLUSIONS Fetuses with absent nasal bone and nuchal translucency thickening are likely to have chromosome abnormalities, and SNP array testing is recommended to exclude the chromosome abnormalities.
Chromosome Aberrations ; Female ; Fetus ; Humans ; Nasal Bone ; abnormalities ; Oligonucleotide Array Sequence Analysis ; standards ; Polymorphism, Single Nucleotide ; genetics ; Pregnancy ; Pregnancy Trimester, First ; Prenatal Diagnosis ; methods

OBJECTIVE: To conduct genetic analysis in a fetus with complex translocation of four chromosomes. METHODS: G-banded chromosome karyotype analysis, single nucleotide polymorphism array (SNP array) and fluorescence hybridization (FISH) were performed in a fetus with multiple malformations. Peripheral blood chromosome karyotype and FISH were also carried out for the parents. RESULTS: The fetal amniotic fluid karyotype was 46, XY, t(12; 13)(q22; q32). SNP array analysis showed that there were 20 192 kb duplication at 1q42.13q44 and 13 293 kb deletion at 15q26.1q26.3 in the fetus. The results of karyotype and SNP array were inconsistent. FISH analyses on the parental peripheral blood samples demonstrated that the mother was a cryptic 46, XX, t(1; 15)(q42.1; q26.1) translocation. The fetus had inherited 46, XY, t(12; 13)(q22; q32) from his father and der(15)t(1; 15)(q42.1; q26.1) from his mother. CONCLUSIONS The 1q42.13q44 duplication and 15q26.1q26.3 deletion may have contributed to the abnormal sonographic features of the fetus. The combination of cytogenetic, SNP array and FISH techniques was beneficial for providing an accurate genetic counseling.
Chromosome Aberrations ; Female ; Fetus ; abnormalities ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Male ; Polymorphism, Single Nucleotide ; Translocation, Genetic