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Zeqiang Ji,1,2 Wanxing Ye,2 Xinyu Wen,1,2 Xingquan Zhao,1– 4,&ast; Na Li1– 3,&ast; 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 4Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Na Li, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 S Fourth Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +010-59975029, Email selina1808@163.comAim: We aimed to investigate whether a combination of inflammatory and radiological biomarkers can improve intracerebral hemorrhage (ICH) hematoma expansion (HE) prediction.Methods: A retrospective analysis was conducted on patients with primary supratentorial ICH within 6 h of symptom onset between September 2021 and April 2022. Predictors were explored using univariate and logistic regression analysis. We compared the discrimination of inflammatory indice-based model 1 with models 2 and 3, which included image biomarkers, using the receiver operating characteristic curve and De Long test for area under the curve comparison.Results: A total of 205 eligible participants were included, 56 (27.3%) of whom experienced HE. The neutrophil-to-lymphocyte ratio (NLR), black hole sign, BAT score, and computed tomography angiography (CTA) spot sign were independently associated with HE in the logistic regression (P< 0.05). The addition of non-contrast computed tomography (NCCT) signs did not provide significant discrimination improvement (AUC, Model 2 0.875 [95% CI, 0.822– 0.929] versus Model 1. 0.811 [95% CI, 0.747– 0.875], p=0.089), whereas the added value of the CTA spot sign remained statistically significant (AUC, Model 3 0.922 [95% CI, 0.878– 0.966] versus Model 2; p=0.030; Model 3 versus Model 1, p=0.005).Conclusion: The combination of inflammatory and radiological biomarkers can predict HE with a satisfactory performance.Keywords: intracerebral hemorrhage, hematoma expansion, computed tomography angiography, spot sign, BAT score, neutrophil to lymphocyte ratio

Shuiying Zeng, Hui Liu, Xiaozhen Wen, Yujing Huang Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, 341000, People’s Republic of ChinaCorrespondence: Yujing Huang, Ganzhou People’s Hospital, No. 17 hongqi Avenue, Zhanggong District, Ganzhou City, Jiangxi Province, 341000, People’s Republic of China, Tel +86-0797-8083557, Email huangzhang202202@163.comObjective: This study aims to understand and address the health education needs of family caregivers of people living with epilepsy, irrespective of the patient’s age. It seeks to construct and implement a targeted health education program informed by empowerment education theory and evaluate its effectiveness.Methods: Through semi-structured interviews, we explored the diverse health education needs of family caregivers of people with epilepsy, identifying key themes and constructing a responsive health education plan. The program’s effectiveness was assessed through a quasi-experimental study. The control group received routine health education, while the intervention group participated in an empowerment-based education program in addition to the standard protocol. We evaluated changes in caregivers’ disease management capabilities, knowledge about epilepsy, and quality of life at baseline, one month, and three months post-intervention using appropriate statistical analyses to confirm significance.Results: Sixty-five family caregivers participated, with 32 in the intervention group and 33 in the control group. Guided by phenomenological research, four main themes were identified. Significant improvements in disease management, epilepsy knowledge, and quality of life were observed in the intervention group, exceeding those in the control group at both follow-up intervals (p< 0.05).Conclusion: An empowerment-based health education program significantly enhances caregivers’ competencies across age groups in managing epilepsy, underscoring its effectiveness as an intervention model.Keywords: epilepsy, caregiver, health education, empowered theory

Xiang Wen,1,&ast; Xiaohui Wu,1,&ast; Zhishan Deng,1,&ast; Fan Wu,1,2 Huajing Yang,1 Shan Xiao,1 Cuiqiong Dai,1 Changli Yang,3 Shuqing Yu,4 Ruiting Sun,1 Pixin Ran,1,2 Yumin Zhou1 1State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Guangzhou National Laboratory, Guangzhou, Guangdong, People’s Republic of China; 3Wengyuan County People’s Hospital, Shaoguan, People’s Republic of China; 4Lianping County People’s Hospital, Heyuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yumin Zhou; Pixin Ran, Email zhouyumin410@126.com; pxran@gzhmu.edu.cnBackground: The previous findings on the correlation between spirometry and high-density lipoprotein (HDL) cholesterol are intriguing yet conflicting. The aim of this research is to evaluate the relationship between HDL levels and spirometry as well as imaging parameters in patients with chronic obstructive pulmonary disease (COPD) in China.Methods: This study encompasses a total of 907 COPD patients. Participants with complete data from questionnaire interviews, lipid profile examinations, spirometry testing, and computed tomography (CT) scans were included in the analysis. A generalized additive model was employed to identify the non-linear relationship between HDL levels and both spirometry and imaging parameters. In the presence of non-linear correlations, segmented linear regression model was applied to ascertain threshold effects.Results: After adjusting for various factors, we found a non-linear correlation between HDL levels and spirometry/imaging parameters, with an inflection point at 4.2 (66 mg/dL). When Ln (HDL) was below 4.2, each unit increase correlated significantly with reduced post-bronchodilator FEV1 (0.32L, 95% CI: 0.09– 0.55), decreased predicted FEV1% (11.0%, 95% CI: 2.7– 19.3), and lowered FEV1/FVC (8.0%, 95% CI: 4.0– 12.0), along with notable increases in Ln (LAA− 950) by 1.20 (95% CI: 0.60– 1.79) and Ln (LAA− 856) by 0.77 (95% CI: 0.37– 1.17). However, no significant associations were observed when Ln (HDL) was greater than or equal to 4.2.Conclusion: A non-linear correlation existed between HDL levels with lung function and CT imaging in COPD patients. Prior to reaching 66 mg/dL, an elevation in HDL was significantly associated with impaired lung function, more severe gas trapping and emphysema.Keywords: COPD, high-density lipoprotein, lung function, computed tomography imaging

Na Cui,1 Xue Li,1 Xin Wen,1 JingJing Xu,2 Li Chen1 1Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of China; 2Department of Ultrasound, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of ChinaCorrespondence: Li Chen, Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, No. 320 Changcheng North Street, Baoding City, Hebei Province, 071000, People’s Republic of China, Email chenliphd1407@outlook.comObjective: Analyze women treated with underwent cold knife conization (CKC) to remove advanced squamous intraepithelial lesions (CIN) of the cervix. The histopathological upgrading of the lesions previously detected on vaginal biopsy and postoperative pregnancy outcomes of were investigated, to identify high-risk subgroups in women.Methods: A retrospective study was conducted at the First Central Hospital of Baoding City from June 2019 to December 2022 to analyze confirmed cases of Cervical Intraepithelial Neoplasia CIN-II and CIN-III. Investigation of pathological changes in postoperative pathological tissues, and to perform binary logistic analysis to identify risk factors for histopathological escalation in postoperative lesions. We analyze the effects of CKC surgery on pregnancy outcomes in patients by comparing against a control group of healthy pregnant women.Results: Out of the 176 patients diagnosed with CIN-II who underwent cervical biopsy, 39 (22.16%) were found to have a final specimen diagnosis of CIN-III, while 7 (3.98%) were downgraded to CIN-I. Among the 108 patients diagnosed with CIN-III who underwent cervical biopsy, 7 cases (6.48%) were ultimately confirmed to have CIN-III. Ki67-positive, p16-positive (OR = 1.13, 95% CI 1.01– 1.15), and colposcopy biopsy for CIN-II (OR = 1.59, 95% CI 1.33– 3.6) were independent risk factors for pathological upgrade after CKC. Compared with healthy pregnant women, CIN patients had higher rates of premature birth (14.4%), premature rupture of the fetal membrane (13.6%), and cesarean section (37.5%) (P < 0.05). The mode of conception, abortion rate, ectopic pregnancy rate, and postpartum hemorrhage were not different between healthy pregnant women and CIN patients (P > 0.05).Conclusion: Following cervical multi-point biopsy or CKC, along with pathological examination, the accurate diagnosis of cervical lesions is crucial as it allows for more precise identification of such lesions. Additionally, CKC increases the risk of premature birth, premature rupture of membranes, and the need for cesarean section.Keywords: cervical intraepithelial neoplasia, cold knife conization, pregnant women, colposcopy biopsy

Xuan Wang,1,&ast; Hanjie Yu,2,&ast; Yunheng Zhang,3,&ast; Xin Chang,1 Chengyi Liu,1 Xiaodong Wen,1 Feng Tian,1 Yi Li1 1Department of Foot and Ankle Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi’an, Shaanxi, People’s Republic of China; 3The Second Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yi Li, Email liyidoctor@163.comObjective: Osteoarthritis (OA) is a common degenerative disease worldwide. While curcumin has shown therapeutic effects on OA, its mechanism remains unknown. This study aimed to investigate the molecular mechanism of curcumin in treating OA through network pharmacology and both in vivo and in vitro experiments.Methods: Curcumin-related targets were obtained using the HERB and DrugBank databases. GeneCards and DisGeNET were used to build a target database for OA. The STRING database was employed to construct protein-protein interaction networks and analyze related protein interactions. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and gene ontology enrichment analyses of core targets were performed using Metascape. In addition, Autodock software was utilized for molecular docking validation of curcumin and disease targets. Further validation of the main findings was conducted through in vitro and in vivo experiments. In the in vitro experiments, an inflammation model was constructed through nitric oxide donor (SNP) stimulation of chondrocytes. Subsequently, the regulatory effects of curcumin on core targets and signaling pathways were validated using Western blotting and immunofluorescence staining techniques. In the in vivo experiments, an OA model was established by performing medial meniscectomy on male Sprague–Dawley rats. The therapeutic effects were evaluated using enzyme-linked immunosorbent assays, histologic staining, and micro-computed tomography (micro-CT) techniques.Results: Core targets of curcumin relevant to OA therapy included tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, matrix metalloproteinase 9 (MMP-9), B-cell lymphoma 2 (BCL-2), and caspase-3. The major biological processes involved oxidative stress and apoptotic processes, among others. The p38 mitogen-activated protein kinase (p38/MAPK) pathway was identified as the most likely pathway involved. In vitro experiments showed that curcumin significantly reduced oxidative stress levels, inhibited the expression of inflammatory factors IL-6 and Cyclooxygenase-2 (COX-2) and downregulated the expression of MMP-9 and MMP-1. In addition, curcumin was found to regulate the expression of BCL-2 and caspase-3 through the p38/MAPK pathway, inhibiting chondrocyte apoptosis. In vivo animal experiments demonstrated that curcumin significantly reduced the expression of OA-related factors (IL-1, IL-6, and TNF-α). Histological analysis and micro-CT results revealed that curcumin treatment significantly increased cartilage thickness, improved cartilage morphology, structure, and function, inhibited cartilage degradation, and enhanced the resorption of subchondral bone in the knee joints of rats with OA.Conclusion: Curcumin regulates oxidative stress and maintains mitochondrial function, thereby protecting chondrocyte guard. In addition, curcumin attenuates the inflammatory response of chondrocytes by inhibiting the phosphorylation of P38MAPK, slowing down the breakdown of the extrachondral matrix while preventing apoptosis of chondrocytes. Additionally curcumin attenuated cartilage degradation and bone damage while helping to boost bone density.Keywords: osteoarthritis, curcumin, molecular mechanism, network pharmacology, p38/MAPK

Yuanping Chen,1 Chao Liu,1 Xinglin Wen,2 Chen Wang,1 Jing He1 1Department of Oncology, Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, People’s Republic of China; 2Department of Medical Image, Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, People’s Republic of ChinaCorrespondence: Jing He, Department of Oncology, Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, 341000, People’s Republic of China, Tel +86_15297720705, Email 382505721@qq.comAbstract: Breast cancer with brain metastasis accounts for the second largest number of brain metastases among solid malignancies. Despite advances in HER2-targeted therapy, 50% of patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer develop brain metastases and are associated with poor outcomes. In this article, we report the case of a patient with HER2+ metastatic breast cancer who developed brain metastases, despite experiencing a durable effect on extracranial metastases after treatment with trastuzumab and pertuzumab. The patient exhibited intracranial progression while receiving treatment with trastuzumab deruxtecan monotherapy after secondary brain radiotherapy and multiple lines of therapy with anti-HER2 agents, such as pyrotinib, lapatinib, tucatinib, and ado-trastuzumab emtansine. However, the administration of anlotinib (an antiangiogenesis medication) and trastuzumab deruxtecan resulted in intracranial and extracranial partial response and was linked to manageable side effects. The present case indicates that the combination of anlotinib and trastuzumab deruxtecan may be a promising treatment option for patients with HER2+ breast cancer with brain metastasis. Nevertheless, further studies are warranted to verify the present findings.Keywords: HER2 positive, breast cancer, brain metastases, anlotinib, trastuzumab deruxtecan

Xiaochen Wen,1,&ast; Yaping Zhou,1,&ast; Yinan Li,2 Xiahan Li,1 Pengfei Qu1 1School of Philosophy and Sociology, Lanzhou University, Lanzhou, People’s Republic of China; 2School of Management, Lanzhou University, Lanzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yaping Zhou, School Philosophy & Sociology, Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China, Tel/Fax +86 0931-8913710, Email ypzhou@lzu.edu.cn Yinan Li, School of Management, Lanzhou University, Lanzhou, 730000, People’s Republic of China, Email li8man@outlook.comBackground: In the post-epidemic era, the problem of short-video app addiction among older adults has become increasingly prominent, and people have begun to pay attention to the negative emotional and psychological consequences of Perceived Overload of short-video apps. Given the growing mental health concerns of older adults, it is critical to understand the potential relationship between the Perceived Overload of short video apps for older adults and older adults’ mental health.Methods: This study applied the stress-strain-outcome (SSO) framework to explore the relationship between perceived overload of a short-video application and loneliness, mental health, and Confucianism tenets in 1300 Chinese older adults. The relationship between perceived overload and loneliness, mental health, and Confucianism tenet moderated mediation models of perceived overload and mental health were created using SPSS 26.0 and PROCESS 4.1 for SPSS.Results: The perceived overload of a short video application for older adults directly predicted loneliness and mental health in older adults, and the Confucianism tenet moderated the mediation process between perceived overload and mental health. Perceived overload affects mental health through loneliness in older adults.Discussion: The results of this study are of practical significance for understanding the current problem of short-video addiction among older adults. Understanding the effects of perceived overload on older adults’ loneliness and mental health can help prevent loneliness and mental health problems caused by short-video addiction among older adults on the one hand, and on the other hand, it can also help to develop targeted coping strategies and create psychological intervention programs based on the Confucianism tenet of intervention ethics to improve mental health in a changing technological stress environment.Keywords: perceived overload, loneliness, mental health, Confucianism tenet

Liqun Luo,1 Xiulin Wen,1 Jingrong Wang,2 Qian Xiao,3 Liuju Su,3 Min Zhou3 1Department of Nursing, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Surgical, The Second Affiliated Hospital of the Air Force Military Medical University, Xi’an, People’s Republic of China; 3School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of ChinaCorrespondence: Xiulin Wen, Tel +86 13991893501, Email 332919997@qq.comBackground: Pressure injuries are present in all healthcare environments and not only pose a significant health risk to individuals but also impose a heavy economic burden on society and families. Nurses, as the primary caregivers responsible for the prevention and management of pressure injuries, have knowledge that directly determines the incidence of pressure injuries.Aim: To understand the current status of nurses’ knowledge of pressure injuries in Shaanxi Province and the factors influencing it.Design: A cross-sectional survey.Methods: In April - May 2022, 16,599 nurses from hospitals at all levels in Shaanxi Province were selected as survey subjects by convenience sampling method. They were surveyed using the general information questionnaire and the Pieper-Zulkowski pressure injury Knowledge Questionnaire through the Questionnaire Star platform.Results: 16,599 nurses had a pressure injury knowledge score of (44.32± 10.11). Wound description and pressure ulcer staging dimensions were less than 60% correct. Comparison of pressure injury knowledge scores of nursing staff with different genders, hospital levels, titles, education, whether they were specialized nurses in wound stoma when they last attended a lecture on pressure ulcers, when they last read literature or books on pressure ulcers, and whether they ever looked for information about pressure ulcers on the Internet showed that the differences were statistically significant (P < 0.05), which were the influencing factors of the knowledge scores of the nursing staff in Shaanxi Province.Conclusion: Clinical nurses’ awareness of stress-related injuries still needs to be improved, and nursing administrators can improve the quality of pressure-related injury care by increasing nursing staff’s awareness through continuing education, tiered training, and other measures.Keywords: pressure injury, knowledge, prevention, management, influencing factor

Xuanwei Wen, Zijian Xiao Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421000, People’s Republic of ChinaCorrespondence: Zijian Xiao, Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421000, People’s Republic of China, Email zijian6340@21cn.com

Zisu Wang,1 Kai Li,1 Shuangshuang Guo,2 Xili Wen,1 Ziyi He,1 Yujun Cai1 1School of Physical Education, Shanghai University of Sport, Shanghai, People’s Republic of China; 2Physical education Group, High school Attached to Shanghai Normal University Minhang Campus, Shanghai, People’s Republic of ChinaCorrespondence: Yujun Cai, School of Physical Education, Shanghai University of Sport, Shanghai, People’s Republic of China, Email caiyujun@sus.edu.cnPurpose: The purpose of this study was to examine the relationships between academic engagement and moderate-to-vigorous physical activity (MVPA), muscle-strengthening exercise (MSE) and sedentary behavior (SB) among adolescents, so as to provide evidence from the perspective of exercising for students to learn efficiently, teachers to improve classroom teaching, and schools to improve educational quality.Methods: A questionnaire survey was conducted in 12 junior high schools in Shanghai, China, which were selected by a multi-stage stratified cluster sampling method. Then, with the valid data of 2078 students collected from the survey. A data analysis was performed using SPSS Statistics 26.0. Multiple linear regression models were adopted to analyze the factors affecting adolescent academic engagement and to determine whether MVPA, MSE, and SB play roles in it.Results: (1) The differences in academic engagement depended on the exercise adherence to the recommended amount of MVPA, MSE, and screen-based SB. (2) In terms of the three independent variables of total time, MSE (β = 0.206) and MVPA (β = 0.175) showed a significant positive correlation with academic engagement, while SB (β = − 0.155) was negatively correlated with academic engagement. (3) From the linear regression model of eight combination groups divided by the exercise adherence to the recommended amount of MVPA, MSE and SB, the group that met none of the recommendations (β = − 0.235) showed a significant negative effect on academic engagement, while the groups that met any two or all three of the recommendations demonstrated strong positive correlations with academic engagement (P < 0.001).Conclusion: Increasing adolescents’ muscle-strengthening exercise and moderate-to-vigorous physical activity and reducing sedentary behavior can effectively promote academic engagement. Therefore, adolescents are suggested to reach the recommended amounts of physical activity, muscle-strengthening exercise, and sedentary behavior so as to improve academic engagement more effectively.Keywords: moderate-to-vigorous physical activity, muscle-strengthening exercise, academic engagement, sedentary behaviors

Xili Wen,1 Yujun Cai,1 Kai Li,1 Zisu Wang,1 Weiyi Zhang,1 Man Qin2 1School of Physical Education, Shanghai University of Sport, Shanghai, People’s Republic of China; 2Shanghai Lixin University of Accounting and Finance, Shanghai, People’s Republic of ChinaCorrespondence: Man Qin, Shanghai Lixin University of Accounting and Finance, Shanghai, People’s Republic of China, Email hnqinman@126.comPurpose: The study aims to explore the relationship and potential mechanisms between screen time and anxiety and have a clear understanding of the role of negative emotions and emotion regulation, thus providing guidance for Chinese college students to improve mental health.Methods: We conducted a questionnaire survey by selecting 1721 academic college students from 6 colleges and universities in 5 provinces in China, and the data were analyzed through the Process program of SPSS for mediating effect and moderating effect.Results: There is a significant positive relationship between screen time and anxiety, negative emotions play a mediating role between the two (indirect effect = 0.32, p < 0.001), mediating effect accounts for 59.88% of the total effect, and emotion regulation regulates the direct relationship between screen time and anxiety (interaction effect = 0.027, p < 0.001).Conclusion: This study sheds light on the potential mechanisms by which screen time affects anxiety in academic college students, providing a fresh perspective on anxiety reduction. Screen time positively affects anxiety levels, where negative emotions have a mediating role and emotion regulation has a moderating role. In the future, we can control screen ++time, increase physical activities, reduce negative emotions, and improve the emotional regulation ability to relieve anxiety, so as to improve the mental health of academic college students, and expect to have a positive impact on future learning, life, and planning.Keywords: college students, sedentary behavior, anxiety, negative emotions, emotion regulation

SuWen Yang,1– 3,&ast; Bing Wang,2,4,5,&ast; Jing Li,6 Xue Zhao,7 Yan Zhu,8 Qian Sun,9 HongMei Liu,2,4,5 XiaoJun Wen1 1School of Basic Medical Sciences, Basic Medical School, Guizhou Medical University, Guiyang, 550025, People’s Republic of China; 2Engineering Research Centre of Medical Biotechnology, Guizhou Medical University, Guiyang, Guizhou, 550025, People’s Republic of China; 3People’s Hospital of Kaiyang, Guiyang, 550300, People’s Republic of China; 4Key Laboratory of Biology and Medical Engineering, Guizhou Medical University, Guiyang, Guizhou, 550025, People’s Republic of China; 5School of Biology and Engineering, Guizhou Medical University, Guiyang, Guizhou, 550025, People’s Republic of China; 6Department of Microbial Immunology, The First Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People’s Republic of China; 7Department of Clinical Laboratory, The First People’s Hospital of Guiyang, Guiyang, 550002, People’s Republic of China; 8Department of Clinical Laboratory, The Fourth People’s Hospital of Guiyang, Guiyang, 550002, People’s Republic of China; 9Department of Emergency Medicine, The First People’s Hospital of Guiyang, Guiyang, 550002, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: XiaoJun Wen; HongMei Liu, Guizhou Medical University, Guiyang, 550025, People’s Republic of China, Email 2547285543@qq.com; hmliu@gmc.edu.cnPurpose: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common pathogens of community- and hospital-acquired infections, and its prevalence is increasing globally. Guiyang is the capital city of Guizhou Province, Southwest China; as the transport and tourism centre of Southwest China, Guizhou Province is bordered by Yunnan, Sichuan, Chongqing, and Guangxi Provinces. Although MRSA prevalence is increasing, little is known about its aspects in the area. The purpose of this study was to analyse MRSA molecular characteristics, antimicrobial resistance, and virulence genes in Guiyang.Methods: In total, 209 MRSA isolates from four hospitals (2019– 2020) were collected and analysed by antimicrobial susceptibility testing and molecular classification by the MLST, spa, and SCCmec typing methods. Isolate antibiotic resistance rates were detected by a drug susceptibility assays. PCR amplification was used to detect the virulence gene-carrying status.Results: Twenty-four STs, including 4 new STs (ST7346, ST7347, ST7348, and ST7247) and 3 new allelic mutations, were identified based on MLST. The major prevalent ST type and clone complex were ST59 (49.8%) and CC59 (62.7%), respectively. Spa type t437 (42.1%) and SCCmec IV (55.5%) were identified by spa and SCCmec typing methods as the most important types. Drug sensitivity data showed that the multidrug resistance rate was 79.0%. There were significant differences in multidrug resistance rates and virulence gene-carrying rates for seb, hla, hlb, cna and bap between ST59 and non-ST59 types.Conclusion: ST59-SCCmecIV-t437 is a major epidemic clone in Guiyang that should be monitored by local medical and health institutions. The situation differs from other adjacent or middle provinces of China, which may be due to the special geographical location of the region and the trend in antibiotic use or lifestyle. This study provides empirical evidence for local medical and health departments to prevent and control the spread of MRSA.Keywords: methicillin-resistant Staphylococcus aureus, MRSA, multilocus sequence type, MLST, Staphylococcal protein A type, SPA, Staphylococcal chromosomal cassette mec type, SCCmec, multidrug-resistant organism, virulence gene

Jiamin Li,1 Chen Zhu,1 Ying Liu,1 Baoyun Song,2 Jingfen Jin,3 Yilan Liu,4 Xianxiu Wen,5 Shouzhen Cheng,6 Xinjuan Wu1 1Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China; 3Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, People’s Republic of China; 4Department of Nursing, Wuhan Union Hospital, Jianghan District, Wuhan, People’s Republic of China; 5Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan People’s Hospital, Chengdu, People’s Republic of China; 6Department of Nursing, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People’s Republic of ChinaCorrespondence: Xinjuan Wu, Email wuxinjuan@sina.comBackground: Pressure injury is a common problem in intensive care units. Critical care nurses play an important role in multidisciplinary teams performing pressure injury treatment. Identifying the clinical status of pressure injury treatment may contribute to improving care quality.Aim: To identify the knowledge, attitudes, and practices regarding pressure injury treatment in critical care nurses.Design: A cross-sectional survey.Methods: Secondary data were extracted from a multicenter clinical trial. Knowledge and attitudes toward pressure injury treatment were assessed through a self-administered eight-item questionnaire. The observed practices were recorded using a case report form. The report was in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement.Results: A total of 950 critical care nurses in 15 hospitals from six provinces/municipalities of China were investigated. The mean knowledge score was 2.89 ± 1.16 (95% confidence interval: 2.82– 2.97) out of a possible total of 5 points. The correct rates of selecting wound dressings and pain management were 34.4% and 45.6%, respectively. The mean attitude score was 9.07 ± 1.09 (95% confidence interval: 9.00– 9.13) out of a possible total of 12 points. A total of 2092 patient days of pressure injury treatment practices were observed and recorded. Repositioning was the most commonly employed treatment measure (98.8%). Foam dressing was the common dressing for stage I (53.6%), stage II (47.5%), and more severe pressure injury (67.9%), including stage III, IV, unstageable, and suspected deep tissue injury.Conclusion: Critical care nurses exhibited a generally low level of knowledge and moderate attitudes regarding pressure injury treatment. Practices of pressure injury treatment were generally acceptable.Keywords: pressure injury, treatment, knowledge, attitude, practice, evidence implementation

Luxinyi Xu,1,2 Xiaotong Wen,1,2 Ying Yang,1,2 Dan Cui1,2 1School of Public Health, Wuhan University, Wuhan, 430071, People’s Republic of China; 2Global Health Institute, Wuhan University, Wuhan, 430071, People’s Republic of ChinaCorrespondence: Dan Cui, School of Public Health, Wuhan University, 115&num; Donghu Road, Wuhan, 430071, People’s Republic of China, Tel +86 133 1715 0755, Email 00008766@whu.edu.cnBackground: Patients with both diabetes and hypertension could face more health risks than those with either condition alone, and less attention has been paid to their management outcomes, so this study may be the first to specifically address this problem. We aimed to examine the management outcomes of blood pressure (BP) in hypertensive patients with/without diabetes and fasting plasma glucose (FPG) in diabetic patients with/without hypertension.Methods: Follow-up data were obtained from the National Basic Public Health Service Project in Sanming (2017– 2021). A total of 25,795 adults with hypertension only, 4111 adults with diabetes only, and 5729 comorbid adults (namely, hypertensive patients with diabetes) were included. Generalized estimating equations were applied.Results: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension only both dropped significantly (Coef. = − 0.00088, P < 0.001; Coef. = − 0.00081, P < 0.001). DBP in comorbid patients decreased considerably (Coef. = − 0.00033, P < 0.001). Pulse pressure in comorbid patients grew rapidly (Coef. = 0.00044, P < 0.001). BP control rate in patients with hypertension only increased significantly (OR = 1.00039, P < 0.001). FPG control rates in diabetic patients with/without hypertension grew markedly (OR = 1.00013, P < 0.001; OR = 1.00020, P < 0.001). Comorbid patients had lower baseline SBP and DBP but higher latest SBP than patients with hypertension only (Coef. = − 1.18872, P < 0.001; Coef. = − 1.16049, P < 0.001; Coef. = 1.0634, P < 0.001). Comorbid patients had lower baseline BP and FPG control rates than those with either condition alone, and differences were greater at the latest follow-up (OR = 0.28086, P < 0.001; OR = 0.91012, P = 0.049; OR = 0.04020, P < 0.001; OR = 0.69465, P < 0.001).Conclusion: BP and FPG management outcomes have achieved progress. Comorbid patients have poorer performance than patients with either disease alone in BP levels especially the SBP level and control rates of SBP, DBP, and FPG. Future studies should be conducted using national data and include more confounding factors.Keywords: hypertension, diabetes mellitus, comorbidity, blood pressure, fasting plasma glucose, longitudinal studies

Xiaofang Wen,1,&ast; Nan Zeng,1,&ast; Ningbo Zhang,1,2,&ast; Tingting Ou,1 Xiaowei Li,1 Xiaoying Li,1 Wangen Li,1 Kang Xu,3 Tao Du1 1Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, People’s Republic of China; 2Department of Endocrinology, Peking University Shenzhen Hospital, Shenzhen, 518036, People’s Republic of China; 3Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tao Du; Kang Xu, Email dutao@gzhmu.edu.cn; xukang@mail.sysu.edu.cnBackground: Although flash continuous glucose monitoring systems (FCGM) accuracy has been extensively studied in diabetes, its accuracy is still not fully evaluated in type 2 diabetes (T2D) patients in real-world settings. In the present study, we aim to assess the effects of diabetes complications and related comorbidities on FCGM accuracy in T2D patients with diabetes complications and related comorbidities in the real world.Methods: FCGM data were collected at eight-time points daily (3 AM, 7 AM, 9 AM, 11 AM, 1 PM, 5 PM, 7 PM, and 9 PM) from 742 patients with T2D and compared with simultaneous fingertip capillary blood glucose (reference blood glucose, REF), and the difference was evaluated using Parkes error grid (PEG), surveillance error grid (SEG), and logistic regression analysis.Results: In total, 25,579 FCGM/REF data pairs were included in the study. The FCGM values were lower than the paired REF values in 75% of the pairs. The maximum bias (− 23.0%) and maximum mean absolute relative difference (24.5%) were observed at 3 AM among eight-time points. SEG analysis also demonstrated the highest percentage of paired readings in moderate and great risk zone (C and D) at 3 AM than PEG analysis (7.33% vs 0.43%, P< 0.001). According to the SEG classification, hypoglycemia, infection, diabetic foot, diabetic ketoacidosis, and hypertension were independent risk factors that impaired FCGM accuracy in patients.Conclusion: FCGM commonly underestimates blood glucose levels. Compared with PEG, SEG analysis seems more conducive to the analysis of FCGM performance. The present data highlights the impairment of diabetes complications and related comorbidities on the FCGM accuracy in T2D patients.Keywords: flash continuous glucose monitoring system, type 2 diabetes, surveillance error grid, Parkes error grid, diabetes complications

Yuqi Zhou,1,&ast; Guifang Wang,2,&ast; Tianqi Wang,1 Jiajia Wang,3 Xutao Wen,3 Haishui Sun,1 Lei Yu,1 Xiaoying Liu,4 Juanjuan Zhang,1 Qin Zhou,3 Yan Sun1 1School of Stomatology, Weifang Medical University, Weifang, People’s Republic of China; 2Department of Prosthodontics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China; 3Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China; 4School of Bioscience and Technology, Weifang Medical University, Weifang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qin Zhou, Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, People’s Republic of China, Tel +86 15900827810, Email qin_zq@163.com Yan Sun, School of Stomatology, Weifang Medical University, Weifang, Shandong Province, 261053, People’s Republic of China, Tel +86 13356797219, Email sunyan@wfmc.edu.cnIntroduction: The nanostructural modification of the oral implant surface can effectively mimic the morphology of natural bone tissue, allowing osteoblasts to achieve both proliferation and differentiation capabilities at the bone interface of the dental implant. To improve the osteoinductive activity on the surface of titanium implants for rapid osseointegration, we prepared a novel composite coating (MAO-PDA-NC) by micro-arc oxidation technique and immersion method and evaluated the proliferation, adhesion, and osteogenic differentiation of osteoblasts on this coating.Methods: The coatings were prepared by micro-arc oxidation (MAO) technique and immersion method, and characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM) for different coatings; the loading of PDA was examined using Fourier transform infrared spectroscopy (FTIR); the ion release capacity of the coatings was determined by inductively coupled plasma emission spectrometry (ICP-OES); the interfacial bonding of the coatings was examined using nanoscratch experiment strength. The cytotoxicity of the coating was examined by live/dead staining kit; cell proliferation viability was examined by CCK-8 kit; adhesion and osteogenic effect of the coating were examined by immunofluorescence staining and RT-PCR; osteogenic differentiation was examined by alkaline phosphatase staining.Results: The surface morphology of titanium implants was modified by micro-arc oxidation technology, and a new MAO-PDA-NC composite coating was successfully prepared. The results showed that the MAO-PDA-NC coating not only optimized the physical and chemical properties of the titanium implant surface but also significantly stimulated the biological properties of osteoblast adhesion, proliferation, and osteogenic differentiation on the coating surface.Conclusion: These results show that MAO-PDA-NC composite coating can significantly improve the surface properties of titanium implants and achieve a stable bond between implant and bone tissue, thus accelerating early osseointegration.Keywords: proliferation, differentiation, micro-arc oxidation, osseointegration

Mu-zi Li,1– 5 Xiao-yang Wen,1– 5 Xiao-qiang Liu,1– 6 Yu-qing Wang,1– 5 Lei Yan1– 5 1Center for Reproductive Medicine, Shandong University, Jinan, People’s Republic of China; 2Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, People’s Republic of China; 3Shandong Key Laboratory of Reproductive Medicine, Jinan, People’s Republic of China; 4Medical Integration and Practice Center, Shandong University, Jinan, People’s Republic of China; 5Reproductive Hospital Affiliated to Shandong University, Jinan, People’s Republic of China; 6Reproductive Medicine Center, Qingdao Women and Children’s Hospital, Qingdao, People’s Republic of ChinaCorrespondence: Lei Yan, Email yanlei@sdu.edu.cnIntroduction: Chronic endometritis is a common disease in women of childbearing age and can cause pelvic inflammatory disease. The cGAS-STING pathway plays an important role in many inflammatory diseases.Purpose: The aim of this study was to investigate the relationship between the cGAS-STING pathway and endometritis.Methods: We collected endometrium samples from patients with endometritis to detect changes in the cGAS-STING pathway. In vitro, human endometrial stromal cells (HESC) were stimulated with lipopolysaccharide (LPS), and a mouse STING gene-knockout model was established by CRISPR/cas9 for STING to further explore the mechanism underlying its effects in endometritis. We used Western blotting (WB) and immunohistochemical staining to detect the variations in protein levels and real-time PCR to study the variations in gene expression.Results: We observed the activation of the cGAS-STING pathway and an increase in the expression of cytokine-encoding genes, including IL-8, IL-6, IL-1β, and IFN-β 1, in endometrial tissues of patients with endometritis. Stimulation of HESCs using LPS demonstrated increase in the expression of proteins involved the cGAS-STING pathway and the gene expression of inflammatory cytokines. STING-knockdown experiments demonstrated a decrease in the gene expression levels of inflammatory cytokines. Moreover, we also identified the translocation of IRF3 and STING after LPS stimulation. Regarding mitochondrial function, LPS led to an increase in reactive oxygen species levels and a reduction in mitochondrial membrane potential. However, we observed that the mitochondrial DNA (mtDNA) leaked into the cytoplasm, upregulating the levels of proteins involved in the cGAS-STING pathway upon LPS stimulation. Furthermore, our results showed that LPS induced hyperemia, inflammatory factor production, and expression of Pho-TBK1 in wild-type mice compared with the levels in control mice, and STING gene-knockdown alleviated these effects.Conclusion: LPS induces mitochondrial dysfunction in endometrial stromal cells, resulting in mtDNA leakage and promoting endometritis by stimulating the cGAS-STING pathway.Keywords: endometritis, cGAS-STING, lipopolysaccharide, mitochondrial dysfunction, mitochondrial DNA, inflammatory factors

Jun Hou,1,&ast; Dezhi Zheng,2,&ast; Xudong Wen,3,&ast; Wenjing Xiao,4 Fei Han,5 Hongmei Lang,6 Shiqiang Xiong,1 Wei Jiang,5 Yonghe Hu,4 Mengshan He,7 Pan Long4,5 1Department of Cardiology, Chengdu Third People’s Hospital/Affiliated Hospital of Southwest Jiaotong University, Chengdu, People’s Republic of China; 2Department of Cardiovascular Surgery, the 960th Hospital of the PLA Joint Logistic Support Force, Jinan, People’s Republic of China; 3Department of Gastroenterology and Hepatology, Chengdu First People’s Hospital, Chengdu, People’s Republic of China; 4School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, People’s Republic of China; 5Department of Ophthalmology, the General Hospital of Western Theater Command, Chengdu, People’s Republic of China; 6The Center of Obesity and Metabolic Diseases, Department of General Surgery, Chengdu Third People’s Hospital & the Affiliated Hospital of Southwest Jiaotong University, Chengdu, People’s Republic of China; 7Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Pan Long, Department of Ophthalmology, the General Hospital of Western Theater Command, Rongdu Avenue #270, Chengdu, People’s Republic of China, Tel +86-181-9125-6132, Email longpan1005@qq.com Yonghe Hu, School of Materials Science and Engineering, Southwest Jiaotong University, No. 111, North First Section of the Second Ring Road, Chengdu, People’s Republic of China, Tel +86-138-8059-6789, Email huyonghe789@sina.comPurpose: High-altitude environment mainly with hypobaric hypoxia could induce pathological alterations in ocular tissue. Previous studies have mostly focused on sporadic case reports and simulated high-altitude hypoxia experiments. This aim of this study was to explore the proteomic and morphological changes of ocular tissue in mice at real altitude environment.Methods: In this study, mice were flown from Chengdu (elevation: 500 m) to Lhasa (elevation: 3600 m). After exposure for 1day, 3, 6, 10, 20, 30, and 40days, the mice were euthanatized to obtain blood and ocular tissue. Serological tests, ocular pathological examinations, integral ocular proteomics analysis, and Western blot were conducted.Results: We focused on acute phase (1– 3 days) and chronic phase (> 30 days) during high-altitude acclimatization. Serum interleukin-1 was increased at 3 days, while superoxide dismutase, interleukin-6, and tumor necrosis factor-α showed no statistical changes. H&E staining demonstrated that the cornea was edematous at 3 days and exhibited slower proliferation at 30 days. The choroid showed a consistently significant thickening, while there existed no noticeable changes in retinal thickness. Overall, 4073 proteins were identified, among which 71 and 119 proteins were detected to have significant difference at 3 days and 40 days when compared with the control group. Functional enrichment analysis found the differentiated proteins at 3 days exposure functionally related with response to radiation, dephosphorylation, negative regulation of cell adhesion, and erythrocyte homeostasis. Moreover, the differential profiles of the proteins at 40 days exposure exhibited changes of regulation of complement activation, regulation of protein activation cascade, regulation of humoral immune response, second-messenger-mediated signaling, regulation of leukocyte activation, and cellular iron homeostasis. Interestingly, we found the ocular proteins with lactylation modification were increased along high-altitude adaptation.Conclusion: This is the first work reporting the ocular proteomic and morphological changes at real high-altitude environment. We expect it would deep the understanding of ocular response during altitude acclimatization.Keywords: altitude response, ocular proteomics analysis, cornea edema, choroid thickening, post-translational modification

Cuiqiong Dai,&ast; Zihui Wang,&ast; Zhishan Deng, Fan Wu, Huajing Yang, Shan Xiao, Xiang Wen, Youlan Zheng, Jianwu Xu, Lifei Lu, Ningning Zhao, Peiyu Huang, Yumin Zhou, Pixin Ran State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Pixin Ran; Yumin Zhou, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, People’s Republic of China, Tel +86-020 83205187, Fax +86-020 81340482, Email pxran@gzhmu.edu.cn; zhouyumin410@126.comBackground: Serum total bilirubin has been reported to have antioxidant properties against chronic respiratory diseases. The objective of our study is to evaluate the association of total bilirubin (TB) with annual lung function decline in COPD patients with different GOLD stages.Methods: This study used pooled data from two observational and prospective cohorts of 612 COPD patients whose TB levels were measured at baseline. The associations between TB and postbronchodilator FEV1, FEV1pred, FVC, FVCpred, FEV1/FVC, and the rate of their decline were all determined using linear regression models in the total population and strata of GOLD stages.Results: Serum TB was positively related to FEV1 and FVC in the total group (β 0.02, 95% CI 0.001∼ 0.02, P = 0.025 and β 0.02, 95% CI 0.002∼ 0.03, P = 0.022, respectively). Additionally, TB was inversely associated with the annual decline in FEV1 and FEV1pred (β 4.91, 95% CI 1.68∼ 8.14, P = 0.025 and β 0.21, 95% CI 0.06∼ 0.36, P = 0.022, respectively) when adjusted for multivariables. After stratification, the significant associations merely persisted in COPD patients with GOLD 2 and GOLD 3– 4.Conclusion: Increased TB level was related to less annual decline in FEV1 as well as FEV1pred in moderate-to-severe COPD but not mild COPD, which indicated the different status of TB in different COPD severity and the possible role as potential biomarker merely in moderate-to-severe COPD. Future researches to determine whether TB could be served as biomarker for COPD and the mechanisms should be focused on some target patients with a certain disease severity.Keywords: total bilirubin, COPD, lung function, GOLD stage, decline