BACKGROUND:Troxerutin has been found to have a significant ameliorative effect on brain disorders,but there are fewer studies on the effects of troxerutin on the treatment of cerebral infarction and on neuronal cells. OBJECTIVE:To investigate the mechanism by which troxerutin regulates nuclear factor-κB signaling pathway to reduce brain injury and neuronal apoptosis in cerebral infarction rats. METHODS:Fifty clean grade rats were randomized into healthy group,model group,and troxerutin+nuclear factor-κB agonist group,troxerutin group,and nuclear factor-κB inhibitor group.Except for the healthy group,all other groups were used to establish a rat model of cerebral infarction by arterial ligation.The healthy and model groups were treated once a day with an equal amount of physiological saline by gavage.The troxerutin+nuclear factor-κB agonist group was intervened with 72 mg/kg troxerutin by gavage+20 mg/kg RANK intraperitoneally.The troxerutin group was treated with 72 mg/kg troxerutin by gavage.The nuclear factor κB inhibitor group was intervened intraperitoneally with 120 mg/kg nuclear factor κB inhibitor pyrrolidine disulfiram.Administration in each group was given once a day for 30 continuous days.Zea-longa was used to detect neurological damage in rats,hematoxylin-eosin staining was used to observe pathological changes,TUNEL was used to detect neuronal apoptosis,and immunoblotting and PCR were used to detect the expression of nuclear factor-κB p65 and nuclear factor-κB p50 at protein and mRNA levels,respectively. RESULTS AND CONCLUSION:Compared with the healthy group,the neurological function score,neuronal apoptosis rate,nuclear factor-κB p65,nuclear factor-κB p50 mRNA and protein expression levels were elevated in the model group(P＜0.05).Compared with the model group,the neurological function score,neuronal apoptosis rate,nuclear factor-κB p65 and nuclear factor-κB p50 mRNA and protein expression levels were decreased in the troxerutin+nuclear factor-κB agonist group(P＜0.05).Compared with the troxerutin+nuclear factor-κB agonist group,the neurological function score,neuronal apoptosis rate,nuclear factor-κB p65 and nuclear factor-κB p50 mRNA and protein expression levels were reduced in the troxerutin group and nuclear factor-κB inhibitor group(P＜0.05).In addition,there was no difference between the troxerutin group and the nuclear factor-κB inhibitor group(P＞0.05).In the model group,there was a large number of cytoplasmic vacuolation,obvious edema and necrosis,and a large number of inflammatory cell infiltrations.In the troxerutin+nuclear factor-κB agonist,the swelling of brain tissue was reduced,and reticulate structures and condensed cells were reduced,still with some edema.In the troxerutin group and nuclear factor-κB inhibitor group,brain tissue swelling,neuronal edema degeneration,cytoplasmic vacuolation and neuronal nucleus consolidation were reduced,and the inflammatory cell infiltration was significantly decreased.To conclude,troxrutin can reduce the expression of neurological impairment,inhibit neuronal apoptosis and improve the pathological injury of brain tissue in rats with cerebral infarction,and its mechanism of action may be related to the modulation of nuclear factor-κB expression and related signaling pathways.

Objective:To summarize the clinical characteristics of children with severe pneumonia requiring mechanical ventilation due to human Boca virus infection.Methods:Clinical data of children with severe human Boca virus pneumonia required mechanical ventilation who were admitted to the emergency intensive care unit at Beijing Children's Hospital Affiliated to Capital Medical University from October 2022 to June 2023 were retrospectively analyzed.Results:A total of ten children with human Boca virus pneumonia required mechanical ventilation were included,including seven males with a median age of 21.5(10.0-42.0) months and six children less than two years old.Six patients were admitted to hospital in the fall of 2022 and four were in the summer of 2023.All cases had cough,wheezing and fever.The wheezes could be heard in all patients admitted to hospital for physical examination.Respiratory sounds were reduced in six cases,and moist crackles were heard in two cases.Two patients had thrush.One patient with bronchial lavage culture showed streptococcus pneumoniae and staphylococcus aureus.One patient had human herpesvirus type 6 infection on day 5 of the course of disease,and one child had rhinovirus.There was no evidence of co-infection in the remaining five cases.All patients were given mechanical ventilation for respiratory failure,and the median mechanical ventilation time was 85 (46-165) hours.Each patient was examined by bronchoscope for 1-3 times.Bronchoscopy manifested endobronchial inflammation,mucosal swelling,increased secretions (10/10),mucous thrombus formation (8/10) and scattered necrotic epithelium (4/10).All patients were discharged after improvement and the median length of administration was 9 (6-14) days.Conclusion:Human Boca virus is one of the important pathogens of severe pneumonia in children,with severe cough,wheezing and feve,which can lead to endobronchial trachea inflammation,easy to form mucous embolus and mucosal necrosis.In severe cases,mechanical ventilation and bronchoscopy are required,and most of them have good prognosis.

Objective:To investigate the clinical presentations and early recognition features of infant botulism(IB).Methods:Retrospective case analysis.The clinical data of 14 patients with IB admitted to the Department of Emergency of Beijing Children′s Hospital Affiliated to Capital Medical University between January 2019 and June 2023 were retrospectively analyzed.Results:The age of onset was 4.2(1.9-8.6) months.Ten cases(71.4%) were under 6 months, 9 of whom had a toxic trigger.The median time of first visit was 1(0-8) day.Thirteen cases(92.9%) complained of poor feeding/milk refusal, of whom pupillary light reflex was sluggish/absent in 12(85.7%) infants, 11(78.6%) had constipation, 10(71.4%) had weakness and/or lethargy, and 9(64.3%) had myasthenia of limbs and/or reduced movement of the extremities, decreased muscle tone and strength of the extremities occurred in all infants, and bowel sounds were diminished or vanished in 10 infants(71.4%).Only 2 infants were suspected of IB at the first visit.The mouse bioassay showed positive fecal specimens in all 14 infants, with a time of diagnosis of 3(1-10) days.Eleven cases(84.6%) had varying degrees of intestinal stasis, and 1 case had reduced physiologic pneumatosis in the small intestine.Ten infants underwent the neostigmine test: one was positive, and one was suspiciously positive.Ten cases(71.4%) required mechanical ventilation, 7(50.0%) of whom used invasive respiratory support.The median length of hospital stay was 26(11-61) days.All the infants were essentially cured by the time they left the hospital.Conclusions:If infants are previously fit and conscious but have an acute onset of illness with parental complaints of poor appetite, weak reactions, and weakness of the extremities and are found to have cranial nerve palsy, signs of acute flaccid paralysis, abdominal distension, and diminished bowel sounds during the examination, the possibility of IB should be considered, and a fecal specimen should be sent for botulinum toxin assay as soon as possible.

Objective:To explore the application effect of theory of inventive problem solving(TRIZ)in the management of loaner instruments in central sterile supply department(CSSD).Methods:TRIZ management team was set up to analyze problems in cleaning,disinfection and sterilization of loaner instruments.The invention principles of TRIZ were compared to determine targeted solutions to the corresponding problems.A total of 1,000 pieces of loaner instruments received by The Third Affiliated Hospital of Air Force Medical University were selected from January and December 2023 were selected,the 500 pieces received from January to June were managed by routine standard management mode,and the 500 pieces received from July to December were managed by the TRIZ management mode.The qualification rates of instruments cleaning,disinfection,packaging and sterilization,the incidence of adverse events,the satisfaction scores of clinical departments and assessment results of newly hired nurses of CSSD were compared between the two management modes.Results:The qualification rates of instruments cleaning,disinfection,packaging and sterilization of TRIZ management mode were 98.00%(490/500),97.20%(486/500),96.40%(482/500)and 96.00%(480/500),respectively,which were higher than those of routine standard management mode,the difference was statistically significant(x2=12.029,11.685,8.859,8.322,P<0.05).The incidence of adverse events of TRIZ management mode was 0%,the routine standard management mode was 1.20%,the difference was statistically significant(x2=6.036,P<0.05).The average scores of CSSD newly hired nurses in of theoretical knowledge,treatment process,cleaning,disinfection and sterilization and packaging of TRIZ management mode were(89.20±6.69)points,(88.47±3.48)points,(92.47±5.37)points and(92.00±5.83)points,respectively,which were higher than those of routine standard management mode,the difference was statistically significant(t=3.993,4.402,3.926,3.332,P<0.05).The satisfaction scores of clinical department personnel with instruments quality,distribution,handover,information traceability,service attitude and overall satisfaction of TRIZ management mode were(18.65±0.81)points,(18.85±1.04)points,(18.95±1.05)points,(18.40±0.75)points,(18.35±0.93)points and(93.20±1.91)points,respectively,which were higher than those of the routine standard management mode,the difference was statistically significant(t=3.599,5.889,4.851,4.865,2.075,8.723,P<0.05).Conclusion:The application of TRIZ in the management of loaner instruments in CSSD can significantly improve theoretical knowledge and practical skills of newly hired nurses in CSSD,thereby improving the qualification rates of instruments cleaning,disinfection,packaging and sterilization of loaner instruments,reducing the occurrence of instrument-related adverse events and improving satisfaction of department personnel with instruments use.

Objective:To evaluate the effect of different clear fluid fasting duration on the fluid responsiveness after anesthesia induction in pediatric patients with congenital heart disease.Methods:One hundred pediatric patients with congenital heart disease who underwent elective atrial septal defect or ventricular septal defect correction surgery at Shanghai Children′s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from December 2023 to February 2024 were selected. They were of either sex, aged 6 months to 3 yr, with a body mass index of 13-19 kg/m 2, and classified as American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ. Patients who adhered to the prescribed preoperative clear fluid fasting regimen, with a fasting duration of 6 h or longer before surgery, were included in the long fasting (LF) group, while those who were prescribed multi-dimensional nutritional solution until 2 h before surgery with a solid fasting duration≥6 h were considered for inclusion in the short fasting (SF) group. The diastolic blood pressure (DBP) was recorded immediately before and after liver compression test at pre-induction of anesthesia and immediately before and after liver compression test at post-induction of anesthesia, and the changes in DBP before and after the liver compression test (ΔDBP) were calculated. Positive fluid responsiveness was defined as an increase in ΔDBP ≥ 6.25%. The positive rate of fluid responsiveness before and after anesthesia induction was calculated. Results:Sixty-four patients were finally included, and both LF and SF groups included 32 cases. Before the induction of anesthesia, the positive rate of fluid responsiveness induced by liver compression was 28.1% in LF group and 18.8% in SF group, and the difference was not statistically significant ( P>0.05). However, after the induction of anesthesia, the positive rate of fluid responsiveness induced by liver compression was 56.3% in LF group and 28.0% in SF group, with a statistically significant difference observed ( P<0.05). Compared with the baseline before anesthesia induction, the positive rate of fluid responsiveness was significantly increased in LF group( P<0.05), and no significant change was found in the positive rate of fluid responsiveness in SF group ( P>0.05). Conclusions:The prolonged clear fluid fasting may lead to an increase in the positive rate of fluid responsiveness following anesthesia induction in pediatric patients with congenital heart disease, presenting as a state of hypovolemia.

Purpose: This study aimed to investigate the changes in microRNA-130a (miR-130a) and its correlation with cardiotoxicity during epirubicin/cyclophosphamide followed by docetaxel plus trastuzumab (EC-D+T) adjuvant chemotherapy in human epidermal growth factor receptor-2-positive (HER2+) breast cancer patients. Methods: A total of 72 HER2+ breast cancer patients who underwent resection and were scheduled to receive EC-D+T adjuvant therapy were consecutively enrolled. The expression of miR-130a and cardiotoxicity (defined as any of the following situations: 1) absolute decline of left ventricular ejection fraction (LVEF) ≥ 10% and LVEF < 53%; 2) heart failure; 3) acute coronary artery syndromes; and 4) fatal arrhythmia) were assessed every 3 months throughout the 15-month EC-D+T treatment. Results: The accumulating cardiotoxicity rate was 12 (16.7%), of which the incidence of heart failure, acute coronary syndrome, life-threatening arrhythmias, ΔLVEF ≥ 10%, and LVEF < 53% was 0 (0.0%), 1 (1.4%), 0 (0.0%), and 12 (16.7%), respectively. Baseline miR-130a expression was negatively correlated with LVEF (%) and positively correlated with cardiac troponin I. The expression of miR-130a gradually increased in both cardiotoxicity and noncardiotoxicity patients during EC-D+T treatment, while the increment of miR-130a was more obvious in cardiotoxicity patients compared with non-cardiotoxicity patients. Further logistic regression and receiver operating characteristic curve analysis indicated that miR-130a was an independent predictive factor for increased cardiotoxicity risk. Conclusion MiR-130a increases constantly and predicts high cardiotoxicity risk during ECD+T adjuvant chemotherapy in HER2+ breast cancer patients.

Purpose: This study aimed to investigate the changes in microRNA-130a (miR-130a) and its correlation with cardiotoxicity during epirubicin/cyclophosphamide followed by docetaxel plus trastuzumab (EC-D+T) adjuvant chemotherapy in human epidermal growth factor receptor-2-positive (HER2+) breast cancer patients. Methods: A total of 72 HER2+ breast cancer patients who underwent resection and were scheduled to receive EC-D+T adjuvant therapy were consecutively enrolled. The expression of miR-130a and cardiotoxicity (defined as any of the following situations: 1) absolute decline of left ventricular ejection fraction (LVEF) ≥ 10% and LVEF < 53%; 2) heart failure; 3) acute coronary artery syndromes; and 4) fatal arrhythmia) were assessed every 3 months throughout the 15-month EC-D+T treatment. Results: The accumulating cardiotoxicity rate was 12 (16.7%), of which the incidence of heart failure, acute coronary syndrome, life-threatening arrhythmias, ΔLVEF ≥ 10%, and LVEF < 53% was 0 (0.0%), 1 (1.4%), 0 (0.0%), and 12 (16.7%), respectively. Baseline miR-130a expression was negatively correlated with LVEF (%) and positively correlated with cardiac troponin I. The expression of miR-130a gradually increased in both cardiotoxicity and noncardiotoxicity patients during EC-D+T treatment, while the increment of miR-130a was more obvious in cardiotoxicity patients compared with non-cardiotoxicity patients. Further logistic regression and receiver operating characteristic curve analysis indicated that miR-130a was an independent predictive factor for increased cardiotoxicity risk. Conclusion MiR-130a increases constantly and predicts high cardiotoxicity risk during ECD+T adjuvant chemotherapy in HER2+ breast cancer patients.

Objective:To evaluate the effects of human umbilical cord mesenchymal stem cells-derived exosomes (hUCMSCs-ex) injection on cardiac function and myocardial fibrosis in dilated cardiomyopathy (DCM) rats induced by Adriamycin(ADR).Methods:One hundred male SD rats were randomly divided into the normal group (20 rats) and the DCM group (80 rats). The rats in DCM group were treated with ADR by intravenous injection to induce DCM.DCM rats were randomly divided equally into DCM group, low-dose group, medium-dose group and high-dose group which were received intravenous injection 1 mL/kg Dulbecco′s modified eagle medium(DMEM), 20 μg/kg, 100 μg/kg and 250 μg/kg exosomes.After modeling, 10 rats in normal group and 30 rats in DCM group were randomly selected to receive echocardiography to evaluate the cardiac function.After exosomes treatment, 10 rats were randomly selected form each group for echocardiography to evaluate the cardiac function.The morphological changes in myocardial cells were observed by using Masson staining in each group; Western blot detection between groups of rats was used to analyze the expression of myocardial collagen Ⅰ type(COLⅠ), Smad2 and alpha smooth muscle actin (α-SMA).Results:Left ventricular ejection fraction(LVEF) and left ventricular fraction shortening (LVFS)in the DCM group [(64.30±3.51)% and (38.70±2.85)%] were significantly lower than those of the normal group [(78.80±1.52)% and (50.60±1.50)%], and the differences were statistically significant ( t=20.518, 22.311, all P<0.01). The left ventricular end-diastolic diameter(LVEDD) and left ventricular end-systolic diameter (LVESD) [(4.62±0.13) mm and (3.40±0.12) mm] of the DCM group were significantly higher than those of the normal group[(3.29±0.24) mm and (3.16±0.33) mm], and the differences were statistically significant( t=2.854, 3.800, all P<0.01). After exosomes treatment, LVEF[(84.3±2.6)% and (83.4±3.2)%] in the medium-dose and high-dose groups were significantly higher than that in the DCM group [(79.2±2.4)%], and the diffe-rences were statistically significant(all P<0.01). Masson staining found that collagen fibers were less in exosomes treating group than those in the DCM group; Western blot test showed that high-dose exosomes can reduce the expression of α-SMA and Smad2, high-dose and low-dose exosomes can both significantly reduce the expression of COLⅠ. Conclusions:It suggests that exosomes intravenous injection from hUCMSCs-ex can significantly improve myocardial fibrosis in DCM rats induced by ADR and cardiac function.

Objective To analyze the data of TB/HIV dual infection screening and treatment monitoring in Guangxi during 2010-2015 and to evaluate the prevention and treatment status quo and development trend.Methods The annual monitoring report forms of TB/HIV dual infection during 2010-2015 were collected for deriving the special data of AIDS in corresponding years.Then the data were conducted the comparison and trend analysis.Results The acceptance rates of HIV detection among Guangxi TB patients and the acceptance rate of TB related screening detection in patients with HIV infection/AIDS showed the increasing trend year by year (P＜0.05);the positive detection rate of two-way showed the decreasing trend year by year (P＜0.05).The patients with TB/HIV dual infection were mainly concentrated in the central area of Guangxi.The annual monitoring report table data in annual monitoring TB/HIV dual infection prevention and treatment work trended to be consistent with the twoway registration and screening data in the special report system,but the errors still existed;the rate of receiving anti-TB and anti-viral combined therapy in the patients with TB/HIV dual infection was lower,which was fluctuated from 20％ to 60％;the treatment success rate was still elevated year by year,but which was affected by death,lose and other outcomes.Conclusion The TB/HIV dual epidemic situation has already obtained a certain effect along with comprehensively promoting the dual infection prevention and control work in Guangxi area.

Objective: To explore the utility of pharyngeal pH monitoring which positive standard is Ryan index in diagnosis of laryngopharyngeal reflux disease. Methods: In a retrospective study, clinical data of 590 patients who had symptoms laryngopharyngeal reflux disease from February 2016 to March 2017 were analyzed. All patients were received electronic laryngoscopy, assessment of reflux symptom index(RSI) and reflux finding score(RFS), and pharyngeal pH monitoring. SPSS 19.0 software was used to analyze the date. Results: There were 94 patients whose Ryan index were positive(15.93%). Among the 94 patients, 70 were positive during upright, 12 during supine and 12 during both upright and supine. There were 40 patients(6.78%)with pH decline events related to symptoms, while those Ryan index were normal. There were 536(90.85%), 417(70.68%), 233(39.49%) and 117(19.83%) patients with pH<6.5, pH<6.0, pH<5.5 and pH<5.0 events respectively. The positive rate of RSI, RFS, RSI and RFS, RSI or RFS were 44.24%, 16.78%, 7.12%, 53.90% respectively. The RFS score in Ryan index positive group was higher than that in Ryan index negative group[(8.2±2.4) vs (4.0±2.9), u=5.424, P<0.05], while the RSI score in Ryan index positive group was not statistically different from that in Ryan index negative group[(11.3±6.2) vs (12.7±5.8), t=1.247, P=0.167]. Conclusions Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly. However, with the Ryan index as a criterion for the diagnosis of laryngopharyngeal reflux disease, partial patients may be missed. Further studies are needed to obtain more accurate and objective laryngopharyngeal pH statistical index for diagnosis of laryngopharyngeal reflux disease.