Objective To investigate the clinical effect and safety of the application of contitunous renal replacement therapy (CRRT) in non-kidney severe patients in MICU.Methods Twenty-nine cases who underwent the CRRT in MICU were included in the study.Vessel pathway were all through inserting double channel catheter in femoral vein or internal carotid vein.According to the patient's condition,patients were treated by slow continuous ultrafiltration( CVVH )or continuous veno-venous hemodialysis (CVVHDF).The duration was 4-12 hours or continuation if necessary.The volume of blood flow was 100-180 ml/h.The displacement liquid was 30-50 ml/time.The volume of dehydration was 0-4 kg according to the patient's condition.The clinical symptoms,hemodynamics,blood biochemistry,PaO2/FiO2,pH,tumor necrosis factor and acute physiology and chronic health evaluation (APACHE) Ⅱ were observed before and after therapy.The complications were monitored.Results The vital signs of the patients became stable shortly after CRRT therapy,before CRRT temperature ( 37.6 ± 0.88 ) ℃,respiratory rate ( 110.3 ± 19.54)time/min,the oxygention index (262.6 ± 10.6),WBC ( 11.33 ± 2.27) × 109/L,NE (85.62 ± 7.83 ) %,AST ( 74.58 ± 19.34 ) U/L,APPACHE Ⅱ score ( 24.37 ± 9.23 ),after CRRT temperature ＞( 36.84 ± 0.58 ) ℃.respiratory rate ( 102.0 ± 16.2 ) times/min,the oxygention index ( 373.2 ± 11.2),WBC (9.62 ±3.26) × 109/L,NE (71.58 ± 10.54) %,AST(38.34 ± 13.96) U/L,APACHE Ⅱ score ( 14.65 ± 6.54).There were significantly difference between the indices at before and after treatment ( P ＜ 0.05 ).Serious ions and acid base abnormality were rectified during CRRT therapy without any severe complications.Conclusions CRRT therapy could decline the level of infections reaction and improve organs' function,adjust the balance of internal environment,stable hemodynamics without any severe complication after treatment.CRRT is safe and effective.In conclusion,CRRT is a primary treatment and an important supportive therapy.

[Objective]To study the effects of Caspase-1 specific inhibitor AC-YVAD-CMK on intimal hyperplasia after carotid artery balloon injury in rats and its possible mechanism.[Methods]A total of 33 male adult SD rats were randomly divided into sham group,balloon injury group and balloon injury+AC-YVAD-CMK group. Using the method of balloon injury to establish rat carotid ar?tery intimal hyperplasia animal model,rats were sacrificed and blood vessels were harvested 14 days after operation. Fifteen vascular segments embedded in OCT and the intima to media(I/M)area ratio of neointima was measured by hematoxylin-eosin(HE)staining;18 vascular segments were harvested and the expression of NLRP3 inflammasome,cleaved-Caspase-1,interleukin(IL)-1βand IL-18 were measured by Western blot.[Results]HE staining showed that AC-YVAD-CMK significantly inhibited the degree of intimal hyperplasia compared with the balloon injury group[(0.78 ± 0.13)vs(1.52 ± 0.14);P=0.000]. The expression of NLRP3 inflamma?some was increased in balloon injury group while the AC-YVAD-CMK attenuates the expression of NLRP3(P=0.009);The expres?sion of cleaved-Caspase-1 was in line with the expression of NLRP3(P=0.000). The levels of pro-inflammatory cytokines IL-1βand IL-18 in balloon injury+AC-YVAD-CMK group were significantly lower than those in the balloon injury group(P=0.000).[Conclusion]AC-YVAD-CMK can attenuate intimal hyperplasia after balloon injury of carotid artery in rats,which might be related to its effect on inhibiting the activation of Caspase-1,which could affect the release of pro-inflammatory cytokine of IL-1βand IL-18.

OBJECTIVETo study chemical constituents contained in Desmodium caudatum.

METHODThe chemical compounds were separated by using such chromatographic methods as macroporous resin, Sephadex LH-20, ODS and normal phase silicagel column, and their structures were identified by spectroscopic data analysis.

RESULTFifteen compounds were separated and identified as stigmasterol (1), beta-sitosterol (2), citrusinol (3), hibiscone A (4), yukovanol (5), kenusanone I (6), neophellamuretin (7), desmodol (8), erythrotriol (9), hibiscone D (10), kaempferol (11), 8-prenylquercetin (12), leachianone G (13), 5,7,4'-trihydroxy-dihydroflavonol (14), and 4H-1-benzopyran-4-one, 2-(3,4-dihydroxyphenyl) -2, 3-dihydro-3,5,7-trihydroxy-8-( 3-methyl-2-butenyl) -, (2R-trans)-(9CI) (15).

CONCLUSIONAll of the compounds were separated from D. caudatum for the first time except compound 8.

OBJECTIVETo compare the efficacy between left radial approach (LRA) and right radial approach (RRA) for coronary angiography (CAG).

METHODSThe following databases were searched, including PubMed, Embase, Web of science, Cochrane Library, CBM, VIP, Wanfang databases and CNKI, from creation of database to January 2013. Two reviewers extracted data independently, according to inclusive criteria, exclusion criteria and methods of Cochrane Collaboration. Statistical analysis was performed using Review Manager Software (RevMan 5.1).

RESULTSEleven trials with 5 442 patients were included in the systematic review. The results of meta-analysis showed that when compared with RRA, LRA did not increase the failure rate of the procedures (OR = 1.04, 95%CI 0.80-1.35, P > 0.05) and amount of contrast medium (mean difference = 2.39, 95%CI -0.30-5.08), P > 0.05). However, LRA was superior to RRA in reducing fluoroscopy time (standardized mean difference = 0.15, 95%CI 0.06-0.24, P < 0.01). In addition, the incidence of severe tortuosity of subclavian artery was significantly lower with LRA (OR = 4.65, 95%CI 1.98-10.88, P < 0.01).

CONCLUSIONSBased on the current evidence, LRA shares similar safety with RRA for CAG and is superior to RRA in certain respects. LRA can thus be used either as an alternative approach or routine approach for CAG.

Objective:To compare the contracting status for combination medical service( "1+1+1" contract)between elderly residents in Shanghai urban and suburban communities and its influencing factors.Methods:Total 574 outpatients aged over 60 were selected with stratified sampling and convenient sampling method from 3 urban community health service centers and 3 suburban community health service centers in Shanghai. A questionnaire survey was conducted from July to September 2017, the survey included the general information, health status, health concern, purpose of this visit, satisfaction with the center, frequency of visit, choice of first contact, willingness of referral, understanding "1+1+1" contract and preferential policies, contract signing status and reasons.Results:Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with an effective rate of 98.25%. Of the 292 participants in urban areas, 167 (57.2%) had signed the contract; of the 272 participants in the suburbs, 133 (48.9%) had signed the contract. Univariate analysis showed that self-evaluated health status, visits to the community health service center, satisfaction with the center, concerning health knowledge, long-term medication, the choice of community health center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contract-signing in urban residents (χ 2=13.05, 8.51, 13.89, 10.76, 6.26, 12.98, 24.73, 76.77, respectively; all P<0.05); while age, self-evaluated health status, the purpose of this visit, medical examination, type of chronic disease, long-term medication, the choice of community health service center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contrct-signing in suburban residents (χ 2=9.56, 14.26, 13.83, 18.30, 18.65, 11.96, 5.99, 5.46 83.44, respectively all P<0.05). Multivariate analysis showed that self-rated health status and awareness of "1+1+1" contract were independent influencing factors for contract-signing in urban residents ( P<0.05); while the awareness of "1+1+1" contract, the purpose of this visit and the frequency of physical examination were influencing factors for contract-signing in suburban residents ( P<0.05). Conclusion:The "1+1+1" signing rate in urban residents is higher than that in suburban residents due to more self health-concerns and higher awareness of the "1+1+1" contracts. It is suggested that the government attach importance to construction of the "1+1+1" contract system for suburb community health service institutions.

Objective:To investigate characteristics of fever and drug-induced liver injury (DILI) in inpatients with severe drug eruptions.Methods:A retrospective analysis was carried out on clinical data collected from 63 inpatients with severe drug eruptions from June 2007 to June 2020, and their characteristics of fever and DILI were investigated. Two-independent-sample t test or Kruskal-Wallis H test was used for intergroup comparison of measurement data, and intergroup comparison of enumeration data was performed using chi-square test or Fisher′s exact test. Results:Among the 63 patients with severe drug eruptions, 54 developed fever; low, moderate and high/ultra-high fever all occurred in about one third of the patients; of 17 patients with high/ultra-high fever, 16 sufferred from Stevens-Johnson syndrome (SJS) , toxic epidermal necrolysis (TEN) or drug hypersensitivity syndrome (DHS) ; 45 had irregular fever; fever duration ranged from 1 to 14 days in 51 patients; there were no significant differences in the fever grade or duration among the patients with different clinical types of drug eruptions ( P = 0.303, 0.719, respectively) ; rashes occurred earlier than or at the same time as fever in 92.59% of the patients. DILI occurred in 11 patients, 8 of whom had hepatocellular injury at admission, including 5 with DHS, 2 with SJS and 1 with TEN; 6 patients were accompanied by low, moderate or high fever, with the fever duration being 7.33 ± 4.97 days, and they all had grade 1 liver injury; liver function retesting at discharge showed complete recovery in 5 patients, improvement in 1, as well as conversion from hepatocellular injury to mixed liver injury in 1, and 1 patient did not undergo the liver function retesting due to against-medical-advice discharge. The other 3 patients had cholestatic liver injury, all of whom were diagnosed with DHS and accompanied by high or ultra-high fever, wtih the fever duration being 8.33 ± 3.51 days, and 1 patient had grade 4 liver injury (acute liver failure) ; liver function was improved in all the 3 patients at discharge. Conclusions:Patients with severe drug eruptions are prone to be accompanied by various types of fever, irregular fever is more common, fever usually lasts 2 weeks, and rashes often occur earlier than or at the same time as fever. DILI can occur in patients with severe drug eruptions, and is usually accompanied by fever; hepatocellular injury is more common, and prone to be improved rapidly; cholestatic liver injury is characterized by severe clinical symptoms and a long disease course, and most frequently occurs in patients with DHS.

Objective: To investigate the signing status of combination contract( "1+1+1" contract) for primary care among elderly residents in Shanghai communities and its influencing factors. Methods: The policy of combination contract for primary care has been implemented in Shanghai since 2015, the residents signed a service contract with general practitioners in community health service center as well as with one of the secondary or tertiary hospitals ( "1+1+1" ). The questionnaire survey on the signing status of "1+1+1" contract was conducted among residents over 60 years in 6 communities in Shanghai which were selected by stratified and convenience sampling method from September 2017 to November 2017. The questionnaire was designed based on the previous research results of the qualitative interviews. The contents of the questionnaire included the basic characteristics, health status, understanding of the "1+1+1" signing policy, the status and reasons for contract signing, and so on. The date were analyzed by descriptive method, chi-square test, and binary logistic regression. Results: Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with a recovery rate of 98.25%. Among all participants, 300 (53.2%) had signed and 264 (46.8%) had not signed. Univariate analysis showed that age, self-evaluated health status, chronic disease, medication, visits to the community health service center, the purpose of this visit,satisfaction with the community health service center, medical examination, concerning health knowledge, the willingness of community doctor as gatekeeper, the willingness of community referral, whether or not know the "1+1+1" contract policy, influence the rate of signing were associated with the signing of the contract (all P<0.05). Multivariate analysis showed that whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status were independent factors affecting "1+1+1" contract signing (all P<0.05). The reason for signing the contract were convenience to visit doctor (69.00%, 207/300), and having a good relationship with family doctor (29.33%, 88/300). The reasons for not signing the contract were not understanding the policy (65.15%, 172/264), lack of help for signing (25.38%, 67/264), and restricted choice of seeking medical services (7.58%, 20/264). Conclusion Whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status are the main influencing factors of signing "1+1+1" contract for primary care among elderly residents in Shanghai communities.

Objective:To understand the current status of nurses' awareness and needs for the Employee Assistance Program (EAP), as to provide basis for the hospital to formulate EAP.Methods:Using the purpose sampling method, 352 ICU nurses from the Nanjing Drum Tower Hospital Affiliated of Nanjing University Medical School were selected as the research subjects from December 2019 to January 2020. Finally, 350 valid questionnaires were obtained. Use the EAP demand questionnaire to investigate the ICU nurses' awareness and demand for EAP.Results:Among the 350 nurses in the intensive unit, 214 cases (61.14%) had never understood EAP, only 8 (2.29%) had understood and experienced the EAP, and 332 cases (94.86%) believed that the hospital′s implementation of EAP was a benefit provided to nurses. The top two service requirements were: "Relief of work pressure" and "mental health consultation", and hope to receive mixed-mode EAP services; in ICU and CCU, nurses hope EAP can help resolve work-family conflicts; in EICU, they need to provide Specific job skills training services.Conclusions:ICU nurses have insufficient cognition of EAP and urgently need to obtain EAP implementation knowledge; at the same time, it is necessary to formulate an implementation plan that meets ICU nurses′ needs for EAP, that is, to relieve work pressure and carry out psychological counseling to ensure that EAP is launch successfully in ICU nurses.

Objective: To introduce the method of making mesh elastic gloves, and to explore its application effect in the treatment of zinc oxide paste in patients with subacute eczema in the hands. Methods: This study was a kind of experimental study. A total of 96 patients with subacute eczema in the hands in the Dermatology Ward of the First Affiliated Hospital of Yangtze University were selected as the study subjects.They were divided into the control group (admitted from June to December in 2017) and the experimental group (admitted from June to December in 2018) according to the time of admission, 48 cases in each group. After the two procedures(apply medicine and cover with sterile gauze) of the conventional zinc oxide paste coating, the control group was fixed with "gauze bandage+ medical tape", and the experimental group was fixed with "mesh elastic gloves". The external fixed cost and time, the disassembly time, the dressing fixation, the comfort condition, the grip strength, the daily activity of the hand, and the healing effect of the skin lesions were evaluated. Results: The external fixed cost and time, the disassembly time, grip strength and hand daily activities ability of the patients in the experimental group were (0.37±0.05) yuan, (26.06±2.53) s, (13.70±1.28) s, (25.96±5.83) kg, and (65.04±7.10) points, significantly better than the control group (1.63±0.21) yuan, (160.98±22.82) s, (22.36±3.50) s, (20.01±3.56) kg, (61.83±6.31) points, the difference between the two groups was statistically significant (t value was-40.931--2.340, P< 0.01 or 0.05). The total rate of comfort, the total rate of dressing loss and the total effective rate of skin lesion healing in the experimental group were respectively 100%(48/48), 0, 98% (47/48), significantly better than the control group 79% (38/48), 46% (22/48), 71% (34/48), the difference between the two groups were statistically significant (χ² value was 11.163, 28.541, 13.353, all P<0.01). Conclusions The application of mesh elastic gloves in the treatment of zinc oxide paste in patients with subacute eczema in the hands can not only save the cost of external fixation and the time of external fixation and disassembly, but also improve dressing fixation and comfort, and improve grip and hand daily activities. At the same time, the healing effect of hand skin lesions can also be improved. In short, it meets the needs of dermatology hand coating.