Objective:To explore the protective effect of astaxanthin on acute liver injury induced by α-amanitin in mice.Methods:In June 2023, 42 healthy SPF male Kunming mice were selected. The mice were divided into blank control group, model (0.45 mg/kg α-amanitin) group, olive oil (10 ml/kg olive oil) group, low dose (20 mg/kg) astaxanthin group, medium dose (40 mg/kg) astaxanthin group, high dose (80 mg/kg) astaxanthin group and silybin (20 mg/kg) group by random number table method. Each group had 6 animals. Mice in the blank control group were intraperitoneally injected with 10 ml/kg normal saline, and mice in the other group were injected with α-amanitin. After that, the blank control group and model group were infused with 10 ml/kg normal saline, olive oil group and astaxanthin groups were given olive oil and astaxanthin according to dose by gavage, and silybin group was injected with silybin by dose. The drug was administered once every 12 h for a total of 4 doses. After 60 h, the mice were killed, the liver weight was weighed, and the liver index was calculated. The contents of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum of mice were detected, and the contents of superoxide dismutase (SOD), reduced glutathione (GSH), catalase (CAT), malondialdehyde (MDA) in liver tissues were also detected. One-way analysis of variance (ANOVA) was used to compare the difference of indexes among each group, and pairwise comparison was performed by Dunnett- t test. Results:The mice in the blank control group had smooth hair color, good spirit and normal behavior, while the mice in the other groups showed varying degrees of retardation and decreased diet, and no death occurred in each group. Body mass[ (26.67±1.51) g] and liver mass[ (1.23±0.14) g] in model group were significantly lower than those in blank control group [ (33.50±2.43) g and (1.87±0.16) g], and the differences were statistically significant ( P<0.05). The liver index [ (5.39±0.32) %, (5.83±0.30) %, (5.75±0.24) % and (5.78±0.16) %] in low, medium and high dose astaxanthin groups and silybin group were significantly higher than those in model group [ (4.61±0.12) %], and the differences were statistically significant ( P<0.05). Serum ALT and AST contents in model group [ (153.04±13.96) U/L and (59.08±4.03) U/L] were significantly higher than those in blank control group [ (13.77±1.29) U/L and (10.21±0.35) U/L], and the differences were statistically significant ( P<0.05). The contents of CAT, GSH and SOD in liver tissues of model group [ (9.40±2.23) U/mgprot, (3.09±0.26) μmol/gprot and (48.94±3.13) U/mgprot] were significantly lower than those of blank control group [ (26.36±2.92) U/mgprot, (6.76±0.71) μmol/gprot and (89.89±4.17) U/mgprot], the differences were statistically significant ( P<0.05). MDA content[ (6.33±0.24) nmol/mgprot] in liver tissue of model group was significantly higher than that of blank control group [ (0.91±0.21) nmol/mgprot], and the difference was statistically significant ( P<0.05). The CAT contents[ (18.64±1.76) U/mgprot, (18.20±1.76) U/mgprot, and (15.54±1.36) U/mgprot] in liver tissues of low, medium and high dose astaxanthin groups were significantly higher than those of model group, with statistical significances ( P<0.05). Compared with model group, SOD contents[ (72.16±7.44) U/mgprot, (93.18±5.28) U/mgprot, (103.78±7.07) U/mgprot, and (96.60±7.02) U/mgprot] in liver tissues of mice in low, medium and high dose astaxanthin groups and silybin group were significantly increased ( P<0.05), MDA contents [ (4.30±0.84) U/mgprot, (3.66±0.28) U/mgprot, (2.96±0.29) U/mgprot, and (2.88±0.39) U/mgprot] were significantly decreased ( P<0.05). Compared with model group, GSH content [ (7.90±1.25) μmol/gprot] in high dose astaxanthin group was significantly increased ( P<0.05) . Conclusion:Astaxanthin may alleviate acute liver injury induced by α-amanitin by alleviating oxidative stress in mice liver.

Objective:To explore the protective effect of astaxanthin on acute liver injury induced by α-amanitin in mice.Methods:In June 2023, 42 healthy SPF male Kunming mice were selected. The mice were divided into blank control group, model (0.45 mg/kg α-amanitin) group, olive oil (10 ml/kg olive oil) group, low dose (20 mg/kg) astaxanthin group, medium dose (40 mg/kg) astaxanthin group, high dose (80 mg/kg) astaxanthin group and silybin (20 mg/kg) group by random number table method. Each group had 6 animals. Mice in the blank control group were intraperitoneally injected with 10 ml/kg normal saline, and mice in the other group were injected with α-amanitin. After that, the blank control group and model group were infused with 10 ml/kg normal saline, olive oil group and astaxanthin groups were given olive oil and astaxanthin according to dose by gavage, and silybin group was injected with silybin by dose. The drug was administered once every 12 h for a total of 4 doses. After 60 h, the mice were killed, the liver weight was weighed, and the liver index was calculated. The contents of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum of mice were detected, and the contents of superoxide dismutase (SOD), reduced glutathione (GSH), catalase (CAT), malondialdehyde (MDA) in liver tissues were also detected. One-way analysis of variance (ANOVA) was used to compare the difference of indexes among each group, and pairwise comparison was performed by Dunnett- t test. Results:The mice in the blank control group had smooth hair color, good spirit and normal behavior, while the mice in the other groups showed varying degrees of retardation and decreased diet, and no death occurred in each group. Body mass[ (26.67±1.51) g] and liver mass[ (1.23±0.14) g] in model group were significantly lower than those in blank control group [ (33.50±2.43) g and (1.87±0.16) g], and the differences were statistically significant ( P<0.05). The liver index [ (5.39±0.32) %, (5.83±0.30) %, (5.75±0.24) % and (5.78±0.16) %] in low, medium and high dose astaxanthin groups and silybin group were significantly higher than those in model group [ (4.61±0.12) %], and the differences were statistically significant ( P<0.05). Serum ALT and AST contents in model group [ (153.04±13.96) U/L and (59.08±4.03) U/L] were significantly higher than those in blank control group [ (13.77±1.29) U/L and (10.21±0.35) U/L], and the differences were statistically significant ( P<0.05). The contents of CAT, GSH and SOD in liver tissues of model group [ (9.40±2.23) U/mgprot, (3.09±0.26) μmol/gprot and (48.94±3.13) U/mgprot] were significantly lower than those of blank control group [ (26.36±2.92) U/mgprot, (6.76±0.71) μmol/gprot and (89.89±4.17) U/mgprot], the differences were statistically significant ( P<0.05). MDA content[ (6.33±0.24) nmol/mgprot] in liver tissue of model group was significantly higher than that of blank control group [ (0.91±0.21) nmol/mgprot], and the difference was statistically significant ( P<0.05). The CAT contents[ (18.64±1.76) U/mgprot, (18.20±1.76) U/mgprot, and (15.54±1.36) U/mgprot] in liver tissues of low, medium and high dose astaxanthin groups were significantly higher than those of model group, with statistical significances ( P<0.05). Compared with model group, SOD contents[ (72.16±7.44) U/mgprot, (93.18±5.28) U/mgprot, (103.78±7.07) U/mgprot, and (96.60±7.02) U/mgprot] in liver tissues of mice in low, medium and high dose astaxanthin groups and silybin group were significantly increased ( P<0.05), MDA contents [ (4.30±0.84) U/mgprot, (3.66±0.28) U/mgprot, (2.96±0.29) U/mgprot, and (2.88±0.39) U/mgprot] were significantly decreased ( P<0.05). Compared with model group, GSH content [ (7.90±1.25) μmol/gprot] in high dose astaxanthin group was significantly increased ( P<0.05) . Conclusion:Astaxanthin may alleviate acute liver injury induced by α-amanitin by alleviating oxidative stress in mice liver.

Objective:To summarize the best evidence of rehabilitation exercise in patients with lumbar spinal stenosis surgery.Methods:The evidence-based questions were established based on PIPOST's principles, and Wanfang data, China National Knowledge Infrastructure, China Biology Medicine disc, UpToDate, PubMed, Embase, Web of Science, American Medical Association, Orthopedic Branch of Chinese Medical Doctor Association and other databases and websites were searched by computer. The search period was from the establishment of the databases to October 31, 2022. Two researchers conducted quality evaluation, evidence extraction, and summarization of the included literature.Results:A total of 10 articles were included, including six expert consensus articles, three systematic review articles, and one meta-analysis article. A total of 16 pieces of evidence were summarized from nine aspects of rehabilitation exercise evaluation, principles, timing, methods, health education, psychotherapy, pain management, evaluation and post discharge follow-up.Conclusions:This study summarizes the best evidence for rehabilitation exercise in patients with lumbar spinal stenosis after surgery, and it suggests that healthcare professionals apply evidence based on clinical context and patient willingness.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Objective:To build a specialty nursing construction model based on subspecialty, so as to explore the practice results in clinical specialist nursing construction of hospitals.Methods:A specialty nursing construction mode with subspecialty as the entry point and medical integration mode as the core was constructed. From January 2017 to December 2019, the project was piloted in 9 key nursing specialties and gradually promoted from point to area. Specialty nursing construction effect, nurse practice environment and patient experience in the department level were comprehensively evaluated.Results:After the implementation of specialty nursing construction projects based on subspecialty, 17 specialty nursing items and 14 key nursing technologies were added and 12 subspecialty nursing brand projects were constructed. After the implementation of the specialty nursing construction project based on subspecialty, the total score of nurse practice environment assessment was (80.40±15.72) , higher than (77.97±16.99) before the implementation, and the difference was statistically significant ( P<0.05) . After implementation, the scores of quality management, internal support, medical cooperation, professional promotion, manpower allocation, social status and remuneration were higher than those before implementation, and the differences were statistically significant ( P<0.05) . After the implementation of the project, the satisfaction of discharged patients was improved and the number of hospital-level commendation cases increased from 218 to 567. Conclusions:The specialty nursing construction model based on subspecialty has positive role in promoting the construction of specialist nursing in the department, improving nurses practicing environment and enhancing medical experience of patients.

Objective: To systematically evaluate the effects of the implementation of the cognitive behavior intervention program on the rehabilitation of patients with degenerative lumbar spine surgery. Methods: 6 Chinese-English databases, The Cochrane library, PubMed, EMBASE, Medline, CNKI, Wanfang, were used for the randomized controlled trial of cognitive behavioral intervention in patients undergoing degenerative lumbar surgery. Two researchers independently retrieved and extracted data and conducted meta-analysis using RevMan5.3 software. Results: The meta analysis results of 7 literatures showed that the Oswestry dysfunction index questionnaire [MD=-9.55, 95%CI(-11.09,-8.02)] in the experimental group, pain VAS score [MD=-1.06, 95%CI(-1.70,-0.41)], fear of sport belief (TSK) [MD=-0.84, 95%CI(-1.41,-0.28)] were significantly superior to the control group (Z=12.21, 3.23, 2.93, P<0.01). The difference was statistically significant. Conclusion Perioperative cognitive behavior intervention can alleviate preoperative anxiety, effectively improve postoperative self-pain management level and the enthusiasm to participate in rehabilitation exercise, reduce the degree of functional disability, and improve the long-term quality of life after surgery.

Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting , bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33％(1/30) and 13.33％(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00％(24/30) and 83.33％(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P<0.05). There were not statistically significant in the time of anal exsufflation and first defecation time between the two groups(P>0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice.

Objective:To observe the effect of clinical pharmacists on the pain education in the patients with fracture. Methods:A total of 122 fracture patients with ASAⅠ/Ⅱaged 18-80 years were randomly divided into the intervention group (n=61) and the control group(n=61). The control group received the conventional orthopedic treatment..Flurbiprofen was injected for the postopera-tive analgesia,and if the pain VAS score was above 6,pethidine solution was given at the dose of 50 mg immediately. Based on the conventional treatment,the patients in the intervention group were educated by clinical pharmacist one day before the surgery,and then strengthened education was given after the surgery.The pain VAS score,and sleeping quality at 6h,24h,48h and 72h and satisfaction of pain management were compared between the groups.Results:The VAS score of the intervention group was significantly lower than that of the control group at 6 h,24 h,48 h and 72 h after the operation (P<0.05). The scores of sleeping quality in the intervention group at 6 h and 24 h after the operation were higher than those in the control group (P<0.05). The scores of patients' satisfaction were significantly higher in the intervention group than those of the control group (P<0.05). Conclusion: The clinical pharmacist's pain education can improve the degree of pain control and sleeping quality,increase the patients' satisfaction with pain control to a cer-tain extent.

Objective To investigate the clinical outcomes of hemiarthroplasty with Wagner SL prosthesis in treating failed internal fixation of intertrochanteric fractures of elderly patients.Methods Aretrospective case series study was conducted on the clinical data of 14 patients with failed internal fixation of intertrochanteric fractures admitted between March 2015 to April 2018.There were seven males and seven females with a mean age of 82.2 years (range,75-94 years).The primary internal fixators were proximal femoral nail anti rotation in nine patients,dynamic hip screw in three patients,and proximal femoral locking plate in two patients.The main causes of internal fixation failure were screw loosening in six patients,cutting out of screws in five patients,nonunion in two patients,and plate breakage with nonunion in one patient.Affected limb shortening and coxa varus deformity to various degrees were seen in all the patients before operation.The mean interval from internal fixation to hemiarthroplasty was 6.6 months (range,2-12 months).All patients received hemiarthroplasty using Wagner SL prosthesis,of which nine patients had additional trochanter claw plate with titanium cable fixation and two patients had tension band wire fixation.The operation time,intraoperative,and postoperative complications were recorded.Harris hip scores were measured before operation and at the last follow up to evaluate hip function.Radiographs were performed to assess the fracture healing,prosthesis position,and biological fixation.Results All patients were followed up for 6-30 months (mean,14.5 months).The mean operation time was (108.0 ± 12.4) minutes (range,88-130 minutes).No iatrogenic fracture occurred during the operation.One patient was seen contralateral intertrochanteric fracture during follow-up,and no complications such as periprosthetic fracture,prosthetic sinking,and infection occurred in the 13 patients.The Harris score increased from (26.1-±7.5)points before operation to (83.1 ±4.1)points after operation (P ＜ 0.01).All patients were able to stand and walk,of which four needed crutch assistance.At the last follow-up,X-ray film showed that the prosthesis was well positioned and that all of them reached bony fixation.Fourteen cases of greater trochanteric fracture were healed,with two cases of slight displacement.Conclusions Hemiarthroplasty is an effective remedial treatment for failed internal fixation of intertrochanteric fractures in the elderly,which can improve hip function and enhance the life quality of patients.Wagner SL prosthesis can obtain stable fixation.

Corpus Callosum infarction is relatively rare in clinical practice, of which the pathogenesis is still unclear. The artical reports a patient with bilateral corpus callosum infarction associated with Moyamoya syndrome, discussing the etiology from the perspective of vascular anatomy and risk factors. With the review of relevant clinical cases home and abroad nearly a decade, we analyzed and summarized the vascular features of corpus callosum infarction and the main etiology, in order to contribute to clinical diagnosis and treatment.