Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.

Non-alcoholic fatty liver disease(NAFLD) has become the main cause of chronic liver disease in children worldwide, and the incidence of NAFLD shows an increasing trend year by year. The risk factors leading to the onset of NAFLD in children are diversified and different from those in adults. At present, most medical institutions still pay little attention to NAFLD in children. This paper summarizes the risk factors and mechanisms for NAFLD in children, including gene polymorphism, maternal and fetal conditions, diet and living habits, environmental exposure, metabolic syndrome, endocrine-related mechanisms and intestinal microecology, in order to provide reference for the prevention and management of childhood NAFLD.

ObjectiveTo investigate the mechanism of Ershiwuwei Guijiu pill in preventing and treating postmenopausal osteoporosis （PMOP） by activating the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway and inhibiting excessive autophagy. MethodFemale SD rats were ovariectomized and randomly divided into the sham operation group （Sham）， the operation group （OVX）， the Ershiwuwei Guijiu pill （GJ） group， and the raloxifene hydrochloride （RLX） group， with 10 rats in each group. Enzyme-linked immunosorbent assay （ELISA） and colorimetric methods were used to detect the levels of estrogen， bone metabolism markers in serum， and total superoxide dismutase （T-SOD）， malondialdehyde （MDA）， and glutathione peroxidase （GSH-Px） in tibial tissue. Flow cytometry was used to detect reactive oxygen species （ROS） levels in bone marrow mesenchymal stem cells. Masson staining was used to observe pathological changes in the proximal tibia， and micro-computed tomography （Micro-CT） was used to observe changes in tibial microstructural parameters. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot were used to detect the expression of autophagy-related proteins Beclin1， microtubule-associated protein 1A/1B-light chain 3 （LC3）， autophagy-related 5 （Atg5）， as well as PI3K， Akt， and mTOR in tibial tissue. ResultCompared with the Sham group， the OVX group showed a significant decrease in serum levels of estradiol （E₂） and calcium ion （Ca²⁺）， and T-SOD， GSH-Px， PI3K， Akt， and mTOR mRNA levels in bone tissue （P<0.05， P<0.01）， significantly reduced bone mineral density （BMD）， bone surface/bone volume （BS/BV）， trabecular thickness （Tb.Th）， trabecular number （Tb.N）， and trabecular connectivity （Con） in the tibia （P<0.05， P<0.01）， thinner epiphyseal growth plate， and the bone marrow cavity filled with fat vacuoles. Moreover， the levels of phosphorus （P）， MDA， ROS， and mRNA and protein expression of Beclin1， LC3， and Atg5， as well as trabecular separation （Tb.Sp） were significantly elevated （P<0.05， P<0.01）. Compared with the OVX group， the GJ and RLX groups showed significant increases in serum E₂ and Ca²⁺， and bone tissue levels of SOD， GSH-Px， and the mRNA levels of PI3K， Akt， and mTOR （P<0.05， P<0.01）， significantly increased BMD， BS/BV， Tb.Th， Tb.N， and Con in the tibia， thickened epiphyseal growth plate， and significantly reduced fat vacuoles in the bone marrow cavity （P<0.05， P<0.01）. Additionally， the levels of P， MDA， ROS， Beclin1， LC3， Atg5 mRNA and proteins， and Tb.Sp were significantly decreased （P<0.05， P<0.01）. The ratios of p-PI3K/PI3K， p-Akt/Akt， and p-mTOR/mTOR， which were significantly reduced in the OVX group （P<0.01）， were significantly increased in the GJ and RLX groups （P<0.01）. ConclusionThe Ershiwuwei Guijiu pill reduces oxidative stress and inhibits autophagy， thereby preventing and treating postmenopausal osteoporosis. Its mechanism may be related to the activation of the PI3K/Akt/mTOR signaling pathway， which inhibits autophagy.

Objective: To investigate the molecular mechanism and identify potential drugs for subthreshold depression (SD), and elucidate the detalied mechanism of Danzhi Xiaoyao powder (DZXY) in SD. Methods: Using RNA-sequencing, we identified differentially expressed genes (DEGs) in leukocytes of SD compared to healthy controls, deciphered their functions and pathways, and identified the hub genes of SD. We also assessed changes in leukocyte transcription factor activity in patients with SD using the TELiS platform. The Connectivity Map database was retrieved to screen candidate drugs for SD. Based on network pharmacology, we elucidated the “multi-component, multi-target, and multi-pathway” mechanism of DZXY in the treatment of SD. Results: We identified 1080 DEGs (padj <0.05 and |log2 (fold change)| ≥ 1 & protein coding) in the leukocytes of patients with SD. These DEGs, including hub genes, were primarily involved in immune and inflammatory response-related processes. Transcription factor activity analysis revealed similarities between the leukocyte transcriptome profile in SD and the conserved transcriptional response to adversities in immune cells. Connectivity Map analysis identified 28 potential drugs for SD treatment, particularly SB-202190 and TWS-119. Constructing the “Direct Compounds-Direct Targets-Pathways” network for DZXY and SD revealed the curative mechanisms of DZXY in SD, primarily including inflammatory response, lipid metabolism, immune response, and other processes. Conclusion These results provide new insights into the characteristics and functional changes of leukocytes in SD, partially illustrate the pathogenesis of SD, and suggest potential drugs for SD. The curative mechanisms of DZXY in SD are also partially elucidated.

ObjectiveTo explore the mechanism of Shaoyaotang （SYT） in the treatment of ulcerative colitis （UC） based on network pharmacology and experimental verification. MethodThe core components， target genes， and main pathways of SYT were predicted based on network pharmacology， and UC-related components， target genes， and pathways were screened. Dextran sodium sulfate （DSS） was used to induce the UC model in mice， and the effect of SYT on UC mice was observed， followed by mechanism verification. ResultNetwork pharmacology indicated that 174 active components and corresponding 159 target genes of SYT were screened， and the related pathways were those mediated by 5-hydroxytryptamine （5-HT） degredation and 5-HT receptor 3. The results of animal experiments showed that compared with the model group， the SYT group showed increased body weight and colon length（P<0.01）， reduced disease activity index （DAI） score （P<0.01）， improved histopathological manifestations， reduced concentrations of 5-HT in the colonic tissues and serum （P<0.05， P<0.01）， and increased mRNA expression of monoamine oxidase A （MAOA）， monoamine oxidase B （MAOB）， sodium-dependent serotonin transporter （SLC6A4）， and 5-HT receptor 3A （5-HTR3A） related to 5-HT metabolism in the colon （P<0.01）. ConclusionSYT can alleviate the local inflammatory response of the intestinal tract in UC by regulating 5-HT degredation pathways.

Objective:To compare the application effect of whole-process seamless nursing and conventional nursing in the perioperative period of ankylosing spondylitis (AS) with kyphosis complicated by cervical spine fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 64 patients with AS with kyphosis complicated by cervical spine fracture admitted to Henan Provincial People′s Hospital from April 2017 to December 2022, including 37 males and 27 females, aged 27-73 years [(49.8±14.6)years]. There were 43 patients with vertebral fractures and 21 with intervertebral space fractures. All patients underwent reduction and fixation or correction and fixation. Thirty-two patients admitted from April 2017 to August 2019 received conventional care (conventional nursing group), and 32 patients admitted from September 2019 to December 2022 received whole-process seamless care (seamless nursing group). The two groups were compared concerning the visual analog scale (VAS) before, at 12 hours, 24 hours, 1 month, 3 months after surgery and at the last follow-up, the American Spinal Injury Association (ASIA) score before surgery, at 1 and 3 months after surgery and at the last follow-up, the health survey questionnaire (SF-36) score and patient satisfaction score before surgery and at the last follow-up, as well as the incidence of postoperative complications.Results:All patients were followed up for 6-12 months [(9.8±3.2)months]. There was no statistical difference in preoperative VAS between the two groups ( P>0.05). The values of VAS in the seamless nursing group were (3.9±1.9)points, (4.2±0.7)points, (2.7±0.9)points, (2.6±0.6)points, and (1.7±0.8)points at 12 hours, 24 hours, 1 month, 3 months after surgery and at the last follow-up, respectively, lower than those of the conventional nursing group [(5.7±1.2)points, (5.8±1.1)points, (3.6±1.2)points, (3.2±1.1)points, and (2.4±1.0)points] ( P<0.05 or 0.01). The VAS of the seamless nursing group at 12 hours, 24 hours, 1 month, 3 months after surgery and at the last follow-up was lower than that before surgery (all P<0.05). The VAS at 1 and 3 months after surgery and at the last follow-up was lower than those before and at 12, 24 hours after surgery and the VAS at the last follow-up was lower than those at 1, 3 months after surgery (all P<0.05). The differences among VAS of the conventional nursing group before and at 12, 24 hours after surgery were statistically insignificant (all P>0.05). The VAS of the conventional nursing group at 1 and 3 months after surgery and at the last follow-up was lower than those before surgery and at 12, 24 hours after surgery and the VAS at the last follow-up was lower than those at 1, 3 months after surgery (all P<0.05). There was no statistically significant difference in VAS of the two groups between 12 hours and 24 hours after surgery, and between 1 month and 3 months after surgery (all P>0.05). There was no significant difference in the ASIA scores before surgery between the two groups ( P>0.05). There were significant improvements in ASIA scores in the seamless nursing group at 1, 3 months after surgery and at the last follow-up compared with those of the conventional nursing group ( P<0.05). There were no statistically significant differences in preoperative SF-36 score and patient satisfaction score between the two groups (all P>0.05). At the last follow-up, the SF-36 score and patient satisfaction score of the seamless nursing group were (47.4±6.2)points and (99.5±1.2)points, respectively, which were higher than those of the conventional nursing group [(42.2±7.3)points and (98.1±1.6)points] (all P<0.05). At the last follow-up, the SF-36 score and patient satisfaction score of the seamless nursing group were higher than those before surgery (all P<0.01). The SF-36 score of the conventional nursing group was higher than that before surgery ( P<0.01), but there was no significant difference in patient satisfaction score ( P>0.05). The incidence of postoperative complications in the seamless nursing group was 6.3% (2/32), lower than that of the conventional nursing group [25.0% (8/32)] ( P<0.05). Conclusion:For AS with kyphosis complicated by cervical spine fracture, whole-process seamless nursing is associated with alleviated postoperative pain, improved spinal nervous function, quality of life and degree of satisfaction, and reduced incidence of complications compared with the conventional nursing.

Objective:This study aimed to explore the structural and functional characteristics of the fecal-associated microbiome(FAM)between the phlegm-dampness constitution(PDC)and balanced consti-tution(BC),and to screen the related specific operational taxonomic unit(OTU)biomarkers.Methods:This was a cross-sectional study.After strictly identifying the constitution of subjects,their clinical index was recorded and counted.Fecal samples were collected for 16S rDNA sequencing.Alpha diversity,beta diversity,and the relative abundance of dominant bacterial taxa were used to describe the FAM structure,and the Wilcoxon rank-sum test,MetagenomeSeq,and linear discriminant analysis effect size(LEfSe)were used to screen specific bacterial taxa.Specific OTUs were screened to construct receiver operating characteristic(ROC)curves.Results:Thirty-two subjects were enrolled,including 22 subjects with BC and 10 subjects with PDC.There were significant differences in cold preference,levels of aspartate transaminase,β2-microglobulin,and creatine kinase MB,and alpha diversity indices(Shannon and Shannoneven)between the two groups.In principal coordinate analysis by abund-jaccard distance measure and partial least squares discriminant analysis,bacterial communities clustered separately between the two groups.Furthermore,based on MetagenomeSeq,LEfSe,and the Wilcoxon rank-sum test,a total of 43,18,and 130 OTUs were differentially distributed between BC group and PDC group,respectively,and OTU200,OTU133,and OTU353 were screened when P＜.01.The area under the ROC curve constructed from the 3 selected OTUs was 0.93.Conclusion:The FAM structure and related functional characteristics of the PDC group differed from those of the BC group.In particular,OTU200,OTU133,and OTU353 can be used as unique markers of PDC to assist clinical diagnosis.

Objective:To evaluate the ultrasonography-guided percutaneous leverage reduction in the treatment of pediatric radial neck fractures.Methods:From May 2016 to May 2018, 42 patients with Judet Ⅲ or Ⅳ radial neck fracture were treated at Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. They were 15 boys and 27 girls, aged from 3 to 12 years. All of them were treated by percutaneous leverage reduction and Métaizeau technique. The operative procedures were guided by ultrasonography in 20 cases and by C-arm fluoroscopy in 22 cases. Postoperative evaluation was based on Métaizeau imaging criteria, Tibone and Stoltz functional criteria; complications such as radial nerve injury were recorded.Results:There were no statistically significant differences between the ultrasonography-guided group and the fluoroscopy-guided group in preoperative general data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in terms of Métaizeau imaging, Tibone or Stoltz functional scores ( P>0.05). The frequency of fluoroscopy was (2.7±0.6) times for the ultrasonography group and (14.6±3.4) times for the fluoroscopy group while the operation time averaged (25.8±5.9) min for the former and (38.1±9.2) min for the latter, showing significant differences ( P<0.05). No postoperative complications were observed in the ultrasonography group while 4 cases of radial nerve injury in the fluoroscopy group, also showing significant difference between the 2 groups ( P< 0.05). Conclusion:Ultrasonography-guided percutaneous leverage reduction is a suitable surgical treatment of radial neck fracture in children, because it is simple, effective and safe.

Objective: To investigate the clinical significance of transcranial Doppler (TCD) in early diagnosis of sepsis-associated encephalopathy(SAE). Methods: Septic patients admitted to the intensive care unit(ICU) were recruited at Xiangya Hospital, Central South University from July 2015 to March 2016. Clinical data and TCD parameters during 24 hours after admission were collected. All patients were screened for delirium using the confusion assessment method for the intensive care unit (CAM-ICU) twice a day. The gold standard of the diagnosis of SAE was positive CAM-ICU evaluation. Patients were divided into SAE group and the non-SAE group. TCD data including systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI) and resistant index (RI) were analyzed to determine the optimal diagnostic cut-off value. Results: A total of 43 patients were enrolled including 12 in SAE group and 31 in non-SAE group. Vm and Vd were lower in SAE group [Vm: (53.50±12.22) cm/s vs. (61.68±9.63) cm/s, P<0.05; Vd: (33.42±10.87) cm/s vs. (43.16±7.84) cm/s, P<0.01] but PI and RI were significant higher in SAE group[PI:(1.16±0.2) vs. (0.90±0.15), P<0.01;RI:(0.65±0.08) vs. (0.56±0.06), P<0.01] than in non-SAE group. The cut-off values of Vs, Vm, Vd, PI and RI for the diagnosis of SAE were 112cm/s, 55.50cm/s, 34.50cm/s, 1.16, 0.65, respectively, with the relevant sensitivities of 19.4%, 83.9%, 93.5%, 58.3%, 58.3% and the specificities of 100.0%, 50.0%, 58.3%, 96.8%, 96.8%, respectively. The diagnostic AUC of Vd, PI and RI were 0.741, 0.808 and 0.808 respectively. Conclusions The parameter changes of TCD suggest that the pathogenesis of SAE is related to cerebral hypoperfusion, TCD is a helpful method for the early diagnosis of SAE.

OBJECTIVE： To study the improvement effects of Bee venom（BV） plastics on experimental cerebral thrombosis in rats. METHODS： Totally 96 SD rats were randomly divided into sham operation group （normal saline）， model group （plastics blank matrix）， Nimodipine group （positive drug， 4.00 mg/kg） and BV plastics low-dose， medium-dose， high-dose groups （1.67， 3.33， 6.67 mg/kg）， with 16 rats in each group. Rats in sham operation group and Nimodipine group were given medicine intragastrically， while rats in model group and BV plastics groups were given medicine by transdermal smearing. After 5 days of continuous administration， the experimental cerebral thrombosis model was established by ligating the right external carotid artery and pterygomandibular artery， and injecting compound thrombus inducer into the internal carotid artery. The wet mass ratio of right brain to left brain was measured to investigate the degree of brain edema on the infarcted side. The content of Evans blue （EB） in the left and right hemispheres of rats was determined by ultraviolet spectrophotometry to investigate the cerebral vascular permeability. Blood rheology and coagulation function indicators of rats were measured. The pathological changes of brain tissue in rats were observed by HE staining， and the number of survival neuron cells was counted. RESULTS： Compared with the indexes of sham operation group， the cerebral thrombosis model was established successfully. Compared with model group， the area of blue staining in the right brain （infarcted side） of rats in BV plastics groups was significantly reduced， and the right brain/left brain wet mass ratio and the content of EB in the right brain tissue were significantly reduced （P＜0.05 or P＜0.01）. The whole blood viscosity and Casson viscosity of rats in BV plastics groups， and the plasma viscosity of rats in BV plastics medium-dose and high-dose groups decreased significantly （P＜0.01）. PT and APTT of rats were prolonged significantly in BV plastics medium-dose group （P＜0.01）. The pathological changes of brain tissue in rats in BV plastics groups were significantly alleviated. The arrangement of neuron cells was more orderly， the shape and structure of cells were clear， the nucleolus was clear， the membrane was intact， and the number of survival neuron cells was significantly increased （P＜0.01）. CONCLUSIONS： BV plastics can alleviate brain edema， inhibit cerebral vascular permeability， improve hemorheology and coagulation function indicators of rats after the formation of cerebral thrombosis， and alleviate nerve cell injury after ischemia.