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BACKGROUND:Growth differentiation factor 5 is a member of the transforming growth factor superfamily and one of the earliest markers of joint development.Growth differentiation factor 5 has an important role in cartilage repair. OBJECTIVE:To explore the action mechanism of growth differentiation factor 5-induced chondrogenic differentiation of bone marrow mesenchymal stem cells. METHODS:Rabbit bone marrow mesenchymal stem cells were isolated and cultured.CCK-8 assay was used to detect the effect of different mass concentrations of growth differentiation factor 5 on the proliferation activity of bone marrow mesenchymal stem cells.RT-PCR was utilized to detect the expression of genes related to chondrogenic differentiation of bone marrow mesenchymal stem cells induced by different mass concentrations of growth differentiation factor 5.To further investigate the action mechanism of growth differentiation factor 5-induced chondrogenic differentiation of bone marrow mesenchymal stem cells,we added inhibitor XAV-939 and activator Laduviglusib of Wnt/β-catenin signaling pathways to induce cell culture for 14 days.RT-PCR and western blot assay were performed to detect the expression of cartilage-related genes and Wnt/β-catenin signaling pathway proteins. RESULTS AND CONCLUSION:(1)CCK-8 results showed no significant effect of growth differentiation factor 5 on the proliferation of bone marrow mesenchymal stem cells.(2)Growth differentiation factor 5 promoted the expression of cartilage-related genes type Ⅱ collagen,aggrecan and Sox9,among which growth differentiation factor 5 induced a significant upregulation of cartilage-related genes in the 50 ng/mL group.(3)Addition of Laduviglusib,an activator of Wnt/β-catenin signaling pathway,upregulated Sox9,β-catenin and type Ⅱ collagen expression(P<0.05).Addition of XAV939,an inhibitor of Wnt/β-catenin signaling pathway,down-regulated Sox9,β-catenin and type Ⅱ collagen expression(P<0.05).(4)Taken together,growth differentiation factor 5-induced chondrogenic differentiation of bone marrow mesenchymal stem cells may be associated with the activation of the Wnt/β-catenin signaling pathway.

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BACKGROUND:Growth differentiation factor 5,a member of the transforming growth factor-β superfamily and bone morphogenetic protein family,plays an important role in articular cartilage injury repair,bone regeneration,improvement of intervertebral disc degeneration,tendon healing,and neurodevelopment. OBJECTIVE:To review the research progress of growth differentiation factor 5 in inducing chondrocytes,nucleus pulposus-like cells,tendon cell differentiation,as well as inducing bone formation and neurodevelopment. METHODS:The search terms"growth differentiation factor 5,articular cartilage,bone,nucleus pulposus cells,tendon,nerve regeneration"were used in CNKI,WanFang and PubMed.According to the inclusion and exclusion criteria,the articles not related to the subject matter were excluded and 69 articles related to growth differentiation factor 5 were included. RESULTS AND CONCLUSION:(1)Growth differentiation factor 5 can induce chondrogenic and osteoblastic differentiation of mesenchymal stem cells,but the concentration boundary of growth differentiation factor 5 to induce chondrogenic or osteoblastic differentiation remains unclear.(2)Growth differentiation factor 5 can induce mesenchymal stem cells to differentiate into nucleus pulposus cells,which may play a role in the treatment of intervertebral disc degeneration.(3)Growth differentiation factor 5 can induce mesenchymal stem cells to differentiate into tendon cells and play an important role in tendon repair and prevention of postoperative tendon adhesion.(4)Growth differentiation factor 5 can induce neurodevelopment and promote nerve regeneration.

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Objective:To explore the inhibitory mechanism of herb cake-partitioned moxibustion on tumor growth in colitis-associated colorectal cancer(CAC)based on histone lysine demethylase 4D(KDM4D). Methods:Inbred male Sprague-Dawley rats were randomly divided into a normal group,a CAC group,a herb cake-partitioned moxibustion group,and an inhibitor group.Except the normal group,rats in the other three groups were treated with azoxymethane(AOM)combined with dextran sulfate sodium(DSS)to make CAC rat models.Rats in the normal group and the CAC group did not receive interventions;rats in the herb cake-partitioned moxibustion group received moxibustion at Qihai(CV6)and bilateral Tianshu(ST25),2 cones for one point each time,once a day for 30 d with 1-day rest every week;rats in the inhibitor group received intraperitoneal injection of KDM4D inhibitor,5-chloro-8-hydroxyquinoline(5-c-8HQ),once a day for 30 d.After intervention,the general condition,colon length,tumor number and volume,and histopathological colon changes were observed.The expression of adenomatous polyposis coli(APC),axis inhibitor(Axin),cyclin D1,matrix metalloproteinase(MMP)-7 and MMP-9 mRNAs were detected by real-time quantitative polymerase chain reaction.The proliferating cell nuclear antigen(PCNA),cleaved caspase3,KDM4D,APC,and Axin proteins were detected by immunohistochemistry. Results:Compared with the normal group,the general condition was poor,the colon length was significantly shortened(P<0.01),the number and volume of colonic tumors were increased(P<0.01),the structure of glandular duct was obviously disordered with"back-to-back"and cowall phenomenon,and also high-grade adenocarcinoma formed;the protein expression levels of PCNA and KDM4D were significantly increased(P<0.01),while cleaved caspase3,APC,and Axin were significantly reduced(P<0.01);the mRNA expression levels of cyclin D1,MMP-7,and MMP-9 were significantly increased(P<0.01),while APC and Axin were significantly reduced(P<0.01)in the CAC group.Compared with the CAC group,the general condition was improved,the length of colon was significantly increased(P<0.01),the number and volume of the colonic tumors were reduced(P<0.05),and the colon tissues showed epithelial cell proliferation with enlarged and deep staining nuclei,dysplasia and inflammatory cell infiltration;the protein expression levels of PCNA and KDM4D were significantly reduced(P<0.01),while the cleaved caspase3,APC,and Axin were significantly increased(P<0.01);the mRNA expression levels of cyclin D1,MMP-7,and MMP-9 were reduced(P<0.05),while the APC and Axin were increased(P<0.05)in the colon tissues of rats in the herb cake-partitioned moxibustion group and the inhibitor group. Conclusion:Herb cake-partitioned moxibustion regulated abnormally expressed KDM4D in CAC rats,activated APC and Axin,the upstream molecules of Wnt/β-catenin pathway,inhibited abnormally activated downstream molecules of Wnt/β-catenin pathway.This may be a key mechanism of herb cake-partitioned moxibustion in inhibiting CAC tumor growth.

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Objective:To test the hypothesis that Pertussis toxin (PTX) can promote the occurrence of interstitial lung disease (ILD) in experimental autoimmune myositis (EAM) model and clarify the potential pathogenic mechanism.Methods:EAM mice model were induced by Skeletal muscle thomogenate with or without PTX, and the relationship between ILD phenotypes and neutrophil extracellular traps (NETs) infiltration was analyzed by histopathological and serological studies in EAM with PTX group and EAM without PTX group. Healthy mice were given PTX alone intraperitoneally to clarify whether NETs formation could be induced in vivo, and neutrophils separated from healthy human blood were intervened with PTX to induce NETs formation in vitro. The data was tested for normality using Shapiro-Wilk. Statistical methods and were analyzed using t-test or ANOVA, and multiple comparisons between different groups were tested using Tukey test. Results:Compared with EAM without PTX group, lung tissues in EAM with PTX group had multiple pathological changes similar to polymyositis/dermatomyositis-related ILD. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the main pathological types. The pulmonary interstitial lesions were accompanied by significant infiltration of NETs; and serum NETs markers levels were obviously elevated in EAM with PTX group, compared with the control group [ n=5, (87±10) ng/ml], cfDNA levels were statistically significantly elevated in both the EAM without PTX group [ n=4, (115±27) ng/ml] and the EAM with PTX group [ n=7, (150±50) ng/ml] ( F=4.24, P=0.038); Cit-H3-DNA levels were elevated in the EAM without PTX group ( n=4, 0.24±0.09), and in the EAM EAM with PTX group ( n=6, 0.33±0.11) compared with the control group ( n=4, 0.13±0.02) ( F=6.21, P=0.016). After PTX intervention, serum cfDNA levels were higher in the PTX group [ n=3, (100±40) ng/ml] than in the control group [ n=3, (45±12) ng/ml, t=2.27, P=0.086]; PTX also induced neutrophils to form NETs in vitro. Conclusion:PTX may promote the development of ILD in EAM mice model by inducing the formation of NETs, indicating that EAM mice can serve as a model for targeting NETs to study the pathogenesis ILD.

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Objective:To investigate the image quality, radiation dose, and diagnostic efficiency of the regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, in the assessment of coronary in-stent restenosis.Methods:A total of 120 patients (with 142 stents) treated with coronary stent implantation at the Beijing Renhe Hospital from August 2020 to August 2022 were enrolled in this study. They were randomly divided into an observation group (60 cases with 70 stents) and a conventional group (60 cases with 72 stents) using the random number table method. Both groups received GE 256-slice Revolution CT examinations. Patients in the conventional group were injected with 70 ml of iopromide as a contrast agent each, while those in the observation group were given individualized doses based on their body mass indices (BMIs). A tube voltage of 120 kV and a tube current of 534 mA were applied to the conventional group, whereas the tube voltage and current for the observation group were adjusted within the ranges of 80-120 kV and 150-534 mAs based on patients’ BMIs. Both groups received coronary angiography 7-14 d after coronary computed tomography angiography (CCTA). Finally, the CT image quality, radiation dose, iodine intake, and diagnostic efficiency were compared between the two groups.Results:Both groups exhibited no significant differences in CT values, contrast-to-noise ratios, blooming artifacts, and stent diameters of the left main coronary artery ( P > 0.05). The conventional group manifested higher CT dose index, CT dose length product, effective dose, and iodine intake compared to the observation group ( t = 10.30, 8.75, 10.27, 4.60, P < 0.05). With coronary angiography result as the gold standard, the observation and conventional groups yielded Kappa values of 0.904 and 0.879, respectively, suggesting high consistency in diagnostic performance. Additionally, the two groups demonstrated nonsignificant differences in sensitivity and specificity ( P > 0.05). Conclusions:The regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, yielding image quality and diagnostic efficiency equivalent to those of the conventional regimen, can effectively reduce radiation dose and iodine intake. Therefore, this regimen merits wide applicability.

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Objective:To explore the predictive value of systemic immune inflammation index (SII) for the risk of hospital death in critically ill patients.Methods:The basic information and clinical data of critically ill patients were extracted from the Medical Information Mart for Intensive Care database-Ⅳ (MIMIC-IV) database, including demographic data, vital signs, blood routine, Logistic organ dysfunction score (Lods), Oxford acute severity of illness score (Oasis), simplified acute physiology score (Saps-Ⅱ), acute physiology score Ⅲ (APS-Ⅲ), sequential organ failure score (SOFA) and outcome. The main outcome was hospital death, and the secondary outcomes were length of hospital stay, continuous renal replacement therapy (CRRT), invasive ventilation and 1-year mortality. Patients were divided into two groups according to in-hospital death, and the differences between the groups were compared. According to the SII tripartite for inter-group comparison, the patients were further divided into three groups for comparison, and Logistic regression model was used to analyze the odd ratio ( OR) of the three groups. Results:A total of 32 450 critically ill patients were included in the study, of which 3765 died in hospital, with a mortality rate of 11.6%. ① Compared with the survival group, the SII in the death group were significantly higher ( P < 0.05). ② The mortality for the SII tripartite grouping (<817; 817~2 151; >2 151) were 8.4%, 10.2% and 16.3%, respectively, and the differences between groups were statistically significant. ③ Further, Logistic regression model analysis showed that the risk of death increased gradually with the increase of groups (the first group was the reference group, OR of the second group was 1.38, 95% CI 1.24-1.54, and OR of the third group was 2.03, 95% CI 1.83-2.24 ( P < 0.05). Conclusions:SII has a certain value in predicting hospital death in critically ill patients. It is easy to obtain and can be used for risk stratification of critically ill patients.

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Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.

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Objective@# To evaluate the effectiveness of craniocervical flexion training using pressure biofeedback combined with cervical traction among patients with cervical spondylotic radiculopathy (CSR).@*Methods@#Sixty patients with CSR receiving treatment in Center of Rehabilitation, Zhejiang Hospital from January 2020 to December 2021 were enrolled and randomly assigned into the control and treatment groups, of 30 patients in each group. All patients were given cervical traction, and patients in the treatment group were given additional craniocervical flexion training using pressure biofeedback for successive four weeks. The effectiveness of craniocervical flexion training combined with cervical traction was evaluated using Visual Analogue Scale (VAS), Neck Disability Index (NDI) and the active range of motion (AROM) of cervical flexion, and the neck pain and cervical functions were compared between the two groups before and after treatments using repeated-measures analysis of variance.@* Results@# Fifteen men were included in the treatment group, with a mean age of (49.47±5.33) years, mean disease course of (5.53±2.89) months, and mean VAS score of (4.73±1.39) points, and there were no significant differences between the control and treatment groups in terms of gender, age, course of disease or VAS score (P>0.05). The VAS score and NDI were lower 4 weeks post-treatment than pretreatment in both the treatment [VAS score: (2.13±1.01) vs. (4.73±1.39); NDI: (12.17±2.12) vs. (20.20±3.78)] and control groups [VAS score: (2.93±1.11) vs. (4.90±1.21); NDI: (15.23±2.39) vs. (19.60±3.30)], and the AROM of cervical flexion was significantly higher 4 weeks post-treatment than pretreatment in both the treatment [(42.87°±2.99°) vs. (37.50°±2.80°)] and control groups [(41.80°±3.61°) vs. (38.07°±2.99°)]; there was an interaction between time and group, and a higher improvement for cervical functions was seen in the treatment group than in the control group (FVAS =5.119, P=0.027; FNDI=15.473, P<0.001; FAROM=11.443, P<0.001). @*Conclusion@#Craniocervical flexion training using pressure biofeedback combined with cervical traction may effectively alleviate the neck pain and increase the AROM among patients with CRS, which is more effective to improve patients' cervical functions than cervical traction alone.

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Human epidermal growth factor receptor-2 （HER-2）-positive breast cancer has higher predilection to metastasize and invade other organs， leading to poor prognosis. The anti-HER-2 drugs， such as trastuzumab， pertuzumab， and trastuzumab emtansinehas， can remarkably prolong the disease free survival （DFS） of patients. However， frequent multidrug resistance， tumor recurrence and metastasis， and adverse reactions such as cardiotoxicity and gastrointestinal discomfort caused by adjuvant therapy are still challenges for the treatment of HER-2-positive breast cancer. The understanding of breast cancer in traditional Chinese medicine （TCM） has a long history. In thousands of years of inheritance and innovation， a standardized treatment system with TCM characteristics has been gradually formed， which shows unique advantages and significant curative effects in breast cancer treatment. The treatment principles of ''treatment based on syndrome differentiation''， ''treatment based on stages and types''， ''treatment according to individual conditions''， and ''treatment of different viscera and viscera based on the toxin and pathogen'' are closely related to the precise treatment concept. In view of the challenges in the treatment of HER-2-positive breast cancer， such as multidrug resistance， tumor recurrence and metastasis， cardiotoxicity， and gastrointestinal discomfort， this paper summarizes the characteristics of TCM in reversing the multidrug resistance， inhibiting tumor recurrence and metastasis， prolonging DFS， improving prognosis， reducing adverse reactions caused by adjuvant therapy， and improving the quality of life after breast cancer surgery according to the principles of reinforcing healthy Qi and eliminating pathogen， and treatment based on syndrome differentiation. This article is expected to serve as a reference for TCM treatment of HER-2 positive breast cancer.

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Objective Focusing on the evaluation system of senior health professional titles in Shanghai,it discusses the rationality of the existing policies from the perspective of clinicians who plan to participate in the promotion,and put forward suggestions for optimizing the content and form of the evaluation.Methods Online questionnaire surveys had been conducted for all clinicians who participated in the application for Shanghai's senior health professional titles in 2020 to collect the personal information and their attitudes towards the professional title review system.R 4.0.2 soft-ware was used to conduct statistical description,cluster analysis,chi-square test,non-parametric test,etc.Results A to-tal of 1,674 people from 32 clinical specialties were surveyed.According to the two factors of growth space and growth speed,the participating subjects are divided into four different categories of groups,which are named according to the sample characteristics:Stars,Mainstay and Veteran.There are no differences among the three groups in the familiarity,and difficulty evaluation of clinical indicators for the senior health professional title evaluation system.The proportion of Veteran considered unreasonable is relatively high.There are differences among the three groups in overall difficulty level,scientific research difficulty and qualification difficulty.Conclusion The incentive attribute of the health technical person-nel senior title evaluation system should be continuously strengthened,and the differentiated characteristics of the de-velopment of health talents should be paid attention to.Big data can be used to highlight the quantification and differen-tiation of clinical competency evaluation indicators,which can effectively improve the scientific level of professional title evaluation.

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A 40-year-old male patient with a history of dental disease was sent to the emergency room mainly for fever, unclear consciousness, and purpura. Computed tomography reveals subarachnoid hemorrhage and blood analysis reveals platelet reduction. The patient was started daily intravenous piperacillin tazobactam glucocorticoid and gamma globulin. Two weeks later, symptoms improved but still had severe complications such as fever, platelet reduction, hepatosplenic abscess, and severe myocardial injury. Subsequently, Rothia dentocariosa was cultured from the blood samples of patient's limb. The patient was started on daily injections of tigecycline and penicillin. Ten days later, symptoms improved and amikacin was tried, which was later confirmed to be ineffective in this patient. Cardiac ultrasound revealed aortic valve vegetations and magnetic resonance imaging revealed brain abscess formation. Then, antibiotics were adjusted to vancomycin and meropenem. Finally, the patient underwent valve replacement. Infectious endocarditis - after surgery, vancomycin and meropenem were utilized for a week leading to symptom resolution. The patient was transferred to rehabilitation hospital. This case will provide clinical experience for the treatment of R. dentocariosa.

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This study aimed to characterize the chemical composition of a new sulfated polysaccharide from the red alga Gracilaria chouae and evaluate its activation effects on RAW264.7 macrophages. It showed that the obtained G. chouae polysaccharide (GCP-3A) was a sulfated acidic polysaccharide with a molecular weight of 11.87 kDa. GCP-3A was composed of xylose, galactose, glucose, and mannose with a molar ratio of 3.00:29.28:0.63:0.45, and it contained α,β‍-glycosidic linkages. Scanning electron microscopy (SEM) and a Congo red test showed that it was a heterogeneous polysaccharide with irregular interwoven sheets and rods, and did not have a triple-helix conform‍ation. Furthermore, GCP-3A significantly promoted the proliferation of RAW264.7 macrophages and the secretion of nitric oxide (NO) in tests of 3-‍(4,‍5-dimethylthiahiazo-2-yl)‍-2,‍5-diphenytetrazoliumromide(MTT) and NO.

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Inflammation-associated proteinase functions are key determinants of inflammatory stromal tissues deconstruction. As a specialized inflammatory pathological process, dental internal resorption (IR) includes both soft and hard tissues deconstruction within the dentin-pulp complex, which has been one of the main reasons for inflammatory tooth loss. Mechanisms of inflammatory matrix degradation and tissue resorption in IR are largely unclear. In this study, we used a combination of Cre-loxP reporter, flow cytometry, cell transplantation, and enzyme activities assay to mechanistically investigate the role of regenerative cells, odontoblasts (ODs), in inflammatory mineral resorption and matrices degradation. We report that inflamed ODs have strong capabilities of matrix degradation and tissue resorption. Traditionally, ODs are regarded as hard-tissue regenerative cells; however, our data unexpectedly present ODs as a crucial population that participates in IR-associated tissue deconstruction. Specifically, we uncovered that nuclear factor-kappa b (NF-κB) signaling orchestrated Tumor necrosis factor α (TNF-α)-induced matrix metalloproteinases (Mmps) and Cathepsin K (Ctsk) functions in ODs to enhance matrix degradation and tissue resorption. Furthermore, TNF-α increases Rankl/Opg ratio in ODs via NF-κB signaling by impairing Opg expression but increasing Rankl level, which utterly makes ODs cell line 17IIA11 (A11) become Trap+ and Ctsk+ multinucleated cells to perform resorptive actions. Blocking of NF-κB signaling significantly rescues matrix degradation and resorptive functions of inflamed ODs via repressing vital inflammatory proteinases Mmps and Ctsk. Utterly, via utilizing NF-κB specific small molecule inhibitors we satisfactorily attenuated inflammatory ODs-associated human dental IR in vivo. Our data reveal the underlying mechanisms of inflammatory matrix degradation and resorption via proteinase activities in IR-related pathological conditions.

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Objective:To construct the exercise rehabilitation index system and exercise program for cardiac surgery patients after cardiopulmonary bypass, in order to provide basis for exercise rehabilitation.Methods:By literature analysis and group discussion, initial expert consultation letters were drawn up, and the Delphi method was used to conduct two rounds of consultation with 20 experts in the field of cardiac rehabilitation, and the exercise rehabilitation program was constructed on the basis of index system.Results:Response rate of two rounds of consultation was 100%, respectively. Experts ′ authority coefficients of the two rounds of consultation were 0.882 5 and 0.935 0 respectively. The Kendall coordination coefficients of the first and second level indexes were all statistically significant. The index system included 10 first-class indicators and 48 second-class indicators, forming a three-level exercise rehabilitation program. Conclusions:The index system and exercise rehabilitation program are scientific and practical, which provide reference for the implementation of exercise rehabilitation.

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Objective:To carry out nurse-led evidence-based practices to reduce the incidence of pulmonary complications of patients after thoracic surgery.Methods:A multidisciplinary team was set up. The best evidence-based interventions were obtained by adopting evidence-based nursing procedures and were implemented in the clinical practice after localization. Based on the evidence, examination standards were established, and obstacles and promoting factors in the implementation process were evaluated. Then action strategies were formulated to regulate medical staff′s clinical practice. The patients ′ incidence of pulmonary complications, pulmonary function indicators, patient satisfaction and pulmonary rehabilitation knowledge and medical staff′s compliance with examination standards were compared before and after the application of the best evidence. Results:After the application of the best evidence, the incidence of pulmonary complications decreased from 18.2%(6/33) to 0 ( χ2 value was 4.264, P < 0.05). The pulmonary indicators of FEV1/FVC, breath holding test and six minute walking test were (76.1±3.3)%, (27.2±1.5) s and (522.6±13.0) m before the application of best evidence, respectively, and (82.7±2.8)%, (31.0±5.3) s and (561.5±16.4) m after the application of best evidence, respectively. The differences were all statistically significant ( t value was -8.600, -3.007, 10.542, P < 0.01). Meanwhile the medical staff ′s compliance with the 10 examination standards were all increased to over 85% after the implementation of the best evidence ( χ2 value was 16.834-64.000, P<0.01). Patients ′ pulmonary rehabilitation knowledge was 24.2%(8/33) and 83.9% (26/31) respectively before and after the application of the best evidence, the difference was statistically significant ( χ2 value was 22.823, P<0.01). Patients ′ satisfaction improved. Conclusions:By applying the best evidence, nurse-led multidisciplinary team can reduce the incidence of pulmonary complications and improve the care quality for patients after thoracic surgery.

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Objective:To carry out nurse-led evidence-based practices to reduce the incidence of pulmonary complications of patients after thoracic surgery.Methods:A multidisciplinary team was set up. The best evidence-based interventions were obtained by adopting evidence-based nursing procedures and were implemented in the clinical practice after localization. Based on the evidence, examination standards were established, and obstacles and promoting factors in the implementation process were evaluated. Then action strategies were formulated to regulate medical staff′s clinical practice. The patients ′ incidence of pulmonary complications, pulmonary function indicators, patient satisfaction and pulmonary rehabilitation knowledge and medical staff′s compliance with examination standards were compared before and after the application of the best evidence. Results:After the application of the best evidence, the incidence of pulmonary complications decreased from 18.2%(6/33) to 0 ( χ2 value was 4.264, P < 0.05). The pulmonary indicators of FEV1/FVC, breath holding test and six minute walking test were (76.1±3.3)%, (27.2±1.5) s and (522.6±13.0) m before the application of best evidence, respectively, and (82.7±2.8)%, (31.0±5.3) s and (561.5±16.4) m after the application of best evidence, respectively. The differences were all statistically significant ( t value was -8.600, -3.007, 10.542, P < 0.01). Meanwhile the medical staff ′s compliance with the 10 examination standards were all increased to over 85% after the implementation of the best evidence ( χ2 value was 16.834-64.000, P<0.01). Patients ′ pulmonary rehabilitation knowledge was 24.2%(8/33) and 83.9% (26/31) respectively before and after the application of the best evidence, the difference was statistically significant ( χ2 value was 22.823, P<0.01). Patients ′ satisfaction improved. Conclusions:By applying the best evidence, nurse-led multidisciplinary team can reduce the incidence of pulmonary complications and improve the care quality for patients after thoracic surgery.

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Objective To investigate the clinical effect of paclitaxel coated balloon in the treatment of symptomatic lower extremity arteriosclerosis obliterans.Methods From January 2016 to April 2017,64 patients with symptomatic lower limb arteriosclerosis obliterans ( ASO ) of femoral and popliteal artery stenosis admitted to Chongming Branch Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine were selected as the research subjects.According to the principle of randomization, they were divided into two groups, 32 cases in each group.In the drug?coated group, ordinary balloon was pre?expanded,and then paclitaxel drug?coated balloon was used to expand.If there were still retraction and stenosis of diseased vessels, which affected the blood flow of lower limbs, remedial stents were implanted.Bare stent group used a slightly smaller balloon to pre?expand superficial femoral artery and then release the stent.After one year follow?up, the changes of ankle?brachial index ( ABI), restenosis rate of target lesion vessels, Rutherford grading changes, clinical drive target vessel revascularization rate, perioperative period,death rate of patients during follow?up period, amputation rate and complication rate were observed.Results There were no amputations or deaths in the whole group during the perioperative period and follow?up.The incidence of complications in the drug?coated group was 3.1%( 1／32 ), significantly lower than that in the bare stent group 18.8%( 6／32) ( χ2 ＝4.010, P＝ 0.045).Before treatment,the ABI of patients in drug?coated group and bare stent group at 6 months and 12 months after treatment were significantly different ( Finter?group ＝ 7.028, Pinter?group ＝ 0.024, Fintra?group ＝ 219.028, Pintra?group＝0.000,Finteraction＝350.028,Pinteraction＝0.000),and ABI of the two groups at 12 months after treatment were (0.73± 0.11) and ( 0.68 ± 0.09),respectively, the difference was statistically significant ( t＝1.990, P＝0.025).Six months after operation, the restenosis rates of target lesions in the two groups were 9.4%(3／32) and 15.6%(5／32), respectively, with no significant difference ( χ2 ＝0.571, P＝0.450); The restenosis rate of bare stent group was 37.5%(12／32) 12 months after operation,which was significantly higher than that of drug?coated group by 15.6%(5／32) (χ2＝3.925,P＝0.048).Clinical observation results showed that 12 months after operation,the target?lesion revascularization (TLR) of the drug?coated group was 3.1%(1／32) and that of the bare stent group was 9.4%(3／32),with no significant difference.Rutherford grading was improved in both groups(χ2＝1.067,P＞0.05). Conclusion Paclitaxel drug?coated balloon is safe and effective in the treatment of symptomatic lower limb arteriosclerosis obliterans,which is worthy of clinical application.

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BACKGROUND AND PURPOSE: Both genetic factors and smoking are associated with ischemic stroke (IS) risk. However, little is known about the potential interaction of these factors. We aimed to assess whether smoking and a positive family history interact to increase the risk of IS. METHODS: The nationwide prospective study recruited 210,000 men and 300,000 women in 2004 to 2008 at ages 30 to 79 years. During 9.7 years of follow-up, we documented 16,923 and 20,656 incident IS cases in men and women without major chronic diseases at baseline, respectively. Multivariable Cox regression models were used to examine associations between family history and IS. Likelihood ratio tests were used to test the smoking-family history interactions on IS. RESULTS: About 67.8% (n=135,168) of men ever smoked regularly compared with 2.7% (n=7,775) of women. Among men, a significant interaction between family history and smoking on IS was observed (P for interaction=0.03), with more pronounced association between family history and IS among ever-regular smokers (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.16 to 1.27) than among never-smokers (HR, 1.11; 95% CI, 1.01 to 1.23). The association between family history and IS among ex-smokers after more than 10 years of cessation (HR, 1.01; 95% CI, 0.85 to 1.20) appeared similar to that among never-smokers. Among women, a similar but not significant interaction between family history and smoking on IS was observed. Ever-regular smokers who had a family history of stroke had the highest risk of IS. CONCLUSIONS: Among Chinese men, the association of family history with IS was accentuated by smoking, and such accentuation tended to be lowered by cessation.

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The purpose of this article is to review the trauma emergency system in foreign countries,102 references were searched through in PubMed,Wanfang Data,CNKI,and 8 related thesis searched though manual, then exclusion is not in conformity with the articles, finally into 35 references. Through the analysis of the related factors of extraction, the advantages of foreign trauma emergency system, to explore suitable for China's national conditions and trauma model of medical environment, improve the trauma team rescue ability,reduce the mortality of the patients after trauma.

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Objective To screen for selective transforming growth factor β(TGF-β)inhibitors from the compound library, and analyze their structure-activity relationship. Methods The inhibiting activities of 170 compounds to TGF-βpathway were evaluat-ed by the SMAD3 luciferase reporter system;the positive hits were examined for their selectivity towards activin receptor like kinase (ALK)4、ALK5 or ALK7 by a molecule based screening system composed of SMAD3,ATP and the purified kinase domain for ALK4, ALK5 or ALK7;the EGFP-SMAD2 fusion protein redistribution assay was used to confirm the inhibiting effects of positive hits. The structure-activity relationship was analyzed by comparing the docking module of SB431542 with ALK5 kinase domain. Results Fif-teen compounds were found capable of inhibiting luciferase expression downstream of SMAD3 with≥25%inhibitory rate;several of them showed different selectivity towards ALK4,ALK5 and ALK7. Compound 63 selectively inhibited the activity of ALK4 and ALK7 with IC500.234 and 0.370μmol/L,respectively,while compound 64 showed inhibiting activity towards all three kinases with the IC50 values 10,6 and 85 nmol/L for ALK4、ALK5 and ALK7,respectively. In addition,compounds 63 and 64 further inhibited the TGF-β1 induced EGFP-SMAD2 nuclear translocation,with the IC50 values of 0.45 and 6.30μmol/L,respectively. The MTT anti-proliferative assay indicated that compounds 63 and 64 exerted these activities at non-toxic concentrations. The analysis of structure-activity rela-tionship indicated that the compounds sharing a core structure,the 1,2,4-triarylimizazole or 1,3,5-triarylpyrazoline,with the 3,4 methyoenedioxyphenyl,6-methylpyridine and 4-aminocarboxyl substitution groups tended to exhibit better activities. Conclusion The two potent TGF-βpathway inhibitors,63 and 64 are identified through this screening project,of which,63 selectively inhibited the ALK4 and ALK7 activity,while 64 showed inhibiting activity towards all three tested types of ALKs.