Chaigui granules(CG)are a compound composed of six herbal medicines with significant antidepressant effects.However,the antidepressant mechanism of CG remains unclear.In the present study,we attempted to elucidate the antidepressant mechanism of CG by regulating purine metabolism and purinergic signaling.First,the regulatory effect of CG on purine metabolites in the prefrontal cortex(PFC)of chronic unpredictable mild stress(CUMS)rats was analyzed by ultra high-performance liquid chro-matography tandem mass spectrometry(UHPLC-MS/MS)targeted quantitative analysis.Meanwhile,purinergic receptors(P2X7 receptor(P2X7R),A1 receptor(A1R)and A2A receptor(A2AR))and signaling pathways(nod-like receptor protein 3(NLRP3)inflammasome pathway and cyclic adenosine mono-phosphate(cAMP)-protein kinase A(PKA)pathway)associated with purine metabolism were analyzed by western blotting and enzyme-linked immunosorbent assay(ELISA).Besides,antidepressant mecha-nism of CG by modulating purine metabolites to activate purinergic receptors and related signaling pathways was dissected by exogenous supplementation of purine metabolites and antagonism of puri-nergic receptors in vitro.An in vivo study showed that the decrease in xanthine and the increase in four purine nucleosides were closely related to the antidepressant effects of CG.Additionally,purinergic re-ceptors(P2X7R,A1R and A2AR)and related signaling pathways(NLRP3 inflammasome pathway and cAMP-PKA pathway)were also significantly regulated by CG.The results of exogenous supplementation of purine metabolites and antagonism of purinergic receptors showed that excessive accumulation of xanthine led to activation of the P2X7R-NLRP3 inflammasome pathway,and the reduction of adenosine and inosine inhibited the A1R-cAMP-PKA pathway,which was significantly ameliorated by CG.Overall,CG could promote neuroprotection and ultimately play an antidepressant role by inhibiting the xanthine-P2X7R-NLRP3 inflammasome pathway and activating the adenosine/inosine-A1R-cAMP-PKA pathway.

OBJECTIVE: To analyze recurrence and progression patterns of primary central nervous system lymphoma (PCNSL) in patients without whole brain radiotherapy (WBRT) and assess the value of WBRT in PCNSL treatment. METHODS: This retrospective single-center study included 27 patients with PCNSL, who experienced recurrence/progression after achieving complete remission (CR), partial remission, or stable disease following initial treatments with chemotherapy but without WBRT. The patients were followed up regularly after the treatment for treatment efficacy assessment. By comparing the anatomical location of the lesions on magnetic resonance images (MRI) at the initial diagnosis and at recurrence/progression, we analyzed the patterns of relapse/progression in patients with different treatment responses and different initial status of the lesions. RESULTS: MRI data showed that in 16 (59.26%) of the 27 patients, recurrence/progression occurred in out-field area (outside the simulated clinical target volume [CTV]) but within the simulated WBRT target area in 16 (59.26%) patients, and within the CTV (in-field) in 11 (40.74%) patients. None of the patients had extracranial recurrence of the tumor. Of the 11 patients who achieved CR after the initial treatments, 9 (81.82%) had PCNSL recurrences in the out-field area but within WBRT target area; of the 13 patients with a single lesion at the initial treatment, 11 (84.62%) experienced PCNSL recurrence in the out-field area but within WBRT target area. CONCLUSIONS Systemic therapy combined with WBRT still remains the standard treatment for PCNSL patients, especially those who achieve CR after treatment or have a single initial lesion. Future prospective studies with larger sample sizes are needed to further explore the role of low-dose WBRT in PCNSL treatment.
Humans ; Lymphoma/radiotherapy* ; Central Nervous System Neoplasms/pathology* ; Retrospective Studies ; Prospective Studies ; Neoplasm Recurrence, Local/drug therapy* ; Combined Modality Therapy ; Brain/pathology* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Methotrexate

The article analyzes chief physician SUN Wuquan's empirical characteristics in treating neck-type cervical spondylosis:disease differentiation combined with pattern differentiation,emphasizing the assessment of tendons and bones,with DING's Tuina(Chinese therapeutic massage)manipulations and static Gongfa(Qigong exercise)as the predominant treatment,inherits the academic features of DING's Tuina school,"paying equal attention to tendons and bones,putting function first";thus provides a reference for treating neck-type cervical spondylosis with Tuina therapy.

Objective:To explore the effects of action research method in quality control circle (QCC) knowledge training for nurses.Methods:From August 2018 to October 2018, this study selected 216 nurses participating in QCC training by convenience sampling as learners. The action research method was used in QCC knowledge training for 216 nurses in three issues. The training effects were evaluated by theoretical test.Results:After three issues of training for nurses, the theoretical achievements were (84.64±4.91) , (90.23±4.23) and (94.28±3.11) respectively higher than those before training with statistical differences ( t=13.09, 16.54, 25.62; P<0.05) . Conclusions:Action research method improves the training effects of QCC knowledge and perfects the training system for QCC.

Objective To explore the effects of Green model on the prevention of blood-induced occupational exposure in the nurses of the operating room. Methods In March 2016, a total of 124 operating room nurses in He'nan Provincial People's Hospital were selected as the research objects by cluster purposive sampling method and investigated with a self-designed questionnaire. The content of the questionnaire included 4 aspects:general information, the risk factors of blood-induced occupational exposure in nurses, the cognition of nurses about blood-induced occupational exposure in operating room, and the prevention protection of blood-induced occupational exposure. The problems of tendency factors, contributing factors and strengthening factors were analyzed and interfered under the theoretical frame of Green model. The total 124 nurses were reinvestigated in March 2017 to compare the nurses' protection of blood-induced occupational exposure in operating room. Results After the intervention of Green model, the score of nurses' protection of blood-induced professional exposure increased from (30.56±1.24) to (40.24±1.22), and the score of the cognition increased from (4.01±0.91) to (8.71±1.31). The differences of the scores were statistically significant (P<0.05). Conclusions The application of the Green model in the protection of blood-induced professional exposure can effectively improve the cognition of protection and reduce the rate of blood-induced occupational exposure in operating room.

Objective: To analyze the treatment of advanced non-small cell lung cancer (NSCLC) with performance status (PS) scores between 2 and 4, in order to improve the diagnosis and treatment of these patients. Methods: A total of 36 patients with advanced NSCLC with hypoxemia were reviewed. The clinical data of disease characteristics, etiology, complications, manifestation, therapy, progression, and secondary biopsy were collected. The clinical efficacy was graded according to the Response Evaluation Criteria In Solid Tumors (RECIST): complete response (CR), partial response (PR), stable disease (SD) and disease progression (PD). Results: All patients had hypoxemia, of whom 86.1% (31 patients) had complications and 55.6% (20 patients) had noninvasive ventilator for respiratory support. 77.8% (28 cases) received broad-spectrum antibiotic treatment, and 78.6% of them got lung osmotic relief after the anti-infection treatment. 15 cases received bedside fiberoptic bronchoscopy suction, of whom two cases were treated with airway stent deposition due to airway obstruction, four cases with thoracic drainage, four cases with anticoagulation, and one with thrombolytic therapy. After these supportive treatment, the PS score of these patients decreased from 3.4±0.5 to 2.5±0.7, while SPO₂ improved from (89.0±5.2)% to (95.0±3.5)%. As first-ling anti-cancer treatment, nine patients were administrated with targeted medicine orally, 13 patients with a combined chemotherapy of pemetrexed plus bevacizumab or carboplatin, eight patients with paclitaxel plus carboplatin, four patients with gemcitabine plus carboplatin, and two patients with docetaxel plus gemcitabine. In the first response evaluation, there were one case of CR, 23 cases of PR, four cases of SD, and eight cases of PD, with a clinical benefit rate of 66.7% and a disease control rate of 77.8%. A total of 22 patients experienced disease progression, of whom eight cases had a secondary biopsy and six cases had gene sequencing. Of these 36 patients, 10 (27.8%) patients survived at the last follow-up, with a progression-free survival of (10.0±6.5) months. Conclusion Besides prompt anti-cancer treatment and best supportive treatment should be incorporated to improve PS and improve outcome.

Objective To explore the application of failure mode and effect analysis in management of precision instrument in operating room of ophthalmology department.Methods We designed the handover process between operating room of ophthalmology department and supply room,the process of using precision instrument,the workflow of instrument management in nurses. And then,we assessed and analyzed the potential failure mode in the management of precision instrument with the method of failure mode and effect analysis.Besides,failure mode was also evaluated and improved.Results There were failure modes with high risk in the management of precision instrument including that the handover process between operating room of ophthalmology department and supply room was not precise enough (risk priority number,RPN=448);the staff of handover process was not fixed (RPN=360);there was no full-time cleaning staff in supply room (RPN=288);use registers in nurses and the check in precision instrument were all in a lack of standardization (RPN=210, 180) and so on. After adopting targeted corrective actions,the corresponding scores of RPN fell to 0,0,40,70, 90.Conclusions The application of failure mode and effect analysis in management of precision instrument in operating room of ophthalmology department has good effects with no related adverse event on precision instrument.

Objective To explore the application of knowledge-attitude-practice theory in Operating Room nurses to improve the prevention management of deep venous thrombosis ( DVT ) . Methods A total of 114 nurses participated in operations in Operating Room were randomly divided into control group (57 cases) and intervention group ( 57 cases ) . Nurses of two groups accepted training of routine knowledge, operation training and guidance, while nurses in intervention group also accepted knowledge-attitude-practice intervention. Cognition situation and implementation situation on prevention of lower limb venous thrombosis were compared among nurses between two groups. Results The score of cognition situation on prevention of lower limb venous thrombosis was (9. 41 ± 2. 26) in control group and (17. 27 ± 2. 03) in intervention group with a significant difference (P<0. 01). The score of implementation situation on prevention of lower limb venous thrombosis was (4. 60 ± 1. 83) in control group and (7. 52 ± 1. 69) in intervention group with a significant difference ( P<0. 01). There were statistically significant differences in score of each dimension (P<0. 01). Conclusions The intervention of knowledge-attitude-practice can effectively improve cognition situation and implementationsituation on prevention of lower limb venous thrombosis so as to reduce the incidence rate of lower limb venous thrombosis.

Objective To analyze the detected pathogens composition in positive blood culture samples and drug resistance in our hospital from January 2005 to December 2012 in order to accumulate the data information of pathogenic bacteria distribution and drug resistance in bacteremia .Methods The BD9240 and BacT /Alert3D 240 blood culture systems were used to perform the blood culture .The identification of isolated bacteria and the drug susceptibility test were conducted by using Microscan walkaway 40 sys‐tem and the Vitec2 compact system .The Data were analyzed by adopting the Whonet5 .6 software .Results In 1 829 positive bacte‐rial strains by blood culture ,986 strains were Gram negative bacilli ,accounting for 53 .9% ;721 strains were Gram positive coccus , accounting for 39 .4% ;104 strains were fungi ,accounting for 5 .68% .The resistant rate of staphylococcus to vancomycin ,linezolid and teicoplanin was 0% ,which to amoxycillin/clavulanic acid ,rifampicin ,amikacin ,sulfamethoxazole compound and chloramphenicol was lower than 40% .The sensitive of enterococcus to linezolid and teicoplanin was 100% ,but enterococcus faecium was resistant to vancomycin(2 .6% ) .The penicillin resistant rate of Streptococcus was 21 .7% .The resistant rates of E .coli and K lebsiella pneumo‐nia were 0% to imipenem and meropenem ,and less than 22% to amikacin ,piperacillin/tazobactam and cefoxitin .The resistant rates of salmonella to CLSI recommended five kinds of detection drug were less than 6 .5% .The resistant rates of pseudomonas aerugino‐sa were more than 25% to imipenem and more than 25% to meropenem .Conclusion The pathogens spectrum detected by blood culture is widespread .The resistance rates of different bacteria vary widely .

Objective To explore the ill experience of patients with deep vein thrombosis (DVT),and supply reference for making corresponding intervention.Methods The qualitative phenomenological study method was adopted in this study.Self-structured in-depth interviews were conducted with 12 patients with deep vein thrombosis and data were collected for analysis.Results After repeated refinement of the collected data,the early ill experience of deep vein thrombosis could be extracted as 4 topics.Conclusions According to the ill experience of patients with DVT,nurses can provide targeted intervention for such diseases to instruct clients to rehabilitate rapidly and improve the patients' quality of life.