Objective To analyze the relationship between CT characteristics of chronic subdural hematoma (CSDH) and its recurrence, as well as relevant pathological mechanism. Methods The study involved 178 patients with CSDH who underwent surgery, of whom 38 patients (40 lesions) experienced recurrence of CSDH. Univariate and multivariate logistic analyses were performed to assess the correlation among CT characteristics ( including side, density, width, subtype and midline shift of the hematoma) and CSDH recurrence. Results ( 1 ) The width of hematoma, midline shift, type of hematoma were found to be correlated with the recurrence of CSDH in the univariate analysis. The odds ratio (OR)and 95% confidence interval (CI) value of patients with hematoma width ＞30 mm, midline shift ＞10 mm and the separated type were 18. 400 (2.024-167. 301 ), 4. 643 ( 1. 815-11. 877 ) and 14. 385 (3. 601-57.467 ), respectively. (2) The midline shift and type of hematoma were found to be correlated with the recurrence of CSDH in the multivariate analysis, when the OR and 95% CI value of patients with hematoma midline shift ＞ 10 mm and separated type were 5. 280 ( 1. 339-20. 823) and 19. 125 (4. 175-87.619), the OR and 95% CI value of patients with hematoma width ＞30 mm was 14. 838 ( 1. 353-162.698). Conclusions Type of hematoma and midline shift are found to be independently correlated with the recurrence of CSDH, and the width of hematoma is also related with its recurrence.

Objective: To explore the mechanism of traditional Chinese medicine(TCM) combined with regular therapy in the treatment of pneumonia with systemic inflammatory response syndrome(SIRS) in(children).Methods: Sixty-four children with pneumonia including 51 cases with SIRS complication were(randomly) divided into three groups: treatment group(regular therapy+TCM,n=26),control group Ⅰ((regular)(therapy) only,n=25) and the control groups Ⅱ(13 pneumonia children without SIRS(receiving)(routine) treatment). The dynamic changes of tumor necrosis factor-?(TNF-?),interleukin-6(IL-6) and IL-8 were measured before and after treatment in all children.Serum Creactive protein(CRP) and total white blood cell(WBC) count were measured simultaneously.Clinical symptom and sign scores were(performed)(5 days) after treatment in children with pneumonia and SIRS complication.Results: Before(treatment),serum TNF-?,IL-6,IL-8 and CRP concentrations were significantly higher in treatment group and(control) group Ⅰ than(control) group Ⅱ(all P

Objective To investigate the application effect of Kolb experience learning theory in community nursing teaching Methods Convenient sampling method was used to extract the class of 2013 nursing students of 120 people. They were divided into 2 groups with 60 people each. Class one was as control group, and class two was as experimental group. The control group used the tradition teaching, while the experimental group used the teaching mode based on Kolb experience learning theory with specific experience, observation, reflection, active practice four phase of the cycle of learning teaching method. After the teaching the teaching effectiveness was evaluated by the method of theory test, the questionnaire survey. Results The theory exam results of class and the end of the end term were （42.75±2.21），（79.67±3.61）scores in experimental group. The theory exam results of class and the end of term werer（40.65±2.68）,（75.22±4.41）scores. There were significant differences, t=-4.68、-6.05，P＜0.05. The score of learning different dimensions (interest in learning, evaluation thinking ability, cooperation and communication ability, comprehensive analysis ability and problem solving skills) were（2.03±1.01）,（15.22±1.12）,（12.82±1.00）,（14.72±0.99）,（12.68±0.95） points in experimental group and （4.02±0.77），（13.93±1.02），（11.98±1.19），（13.18±0.95），（11.43±0.98）points in control group. There were significant differences，t=-6.21、-6.55、-4.16、-8.65、-7.10，P＜0.05. Conclusions The teaching mode based on Kolb experience learning theory in community nursing teaching can improve the students’ interest in learning and study effect, and push forward the reform of teaching the implementation of teaching reform.

Objective To investigate the effects of honokiol on proliferation and apoptosis of human adipose-derived mesenchymal stem cells(hADSCs),and to investigate the effect of the drug on the tumor microenvironment.Methods hADSCs were incubated with different concentrations of honokiol,the proliferation of hADSCs was detec-ted by MTS and Trypan blue staining,and cell apoptosis was assessed by annexin V/PI double staining.In the meantime,expression of mRNA and protein related to cell proliferation and apoptosis were detected by qPCR and Western blot,respectively.The expression of total MEK,phosphorylated MEK,total ERK and phosphorylated ERK proteins in the MEK-ERK1/2 signaling pathway were detected by Western blot.Results The effect of honokiol on inhibiting proliferation and promoting apoptosis of hADSCs was significantly enhanced with the increase of concen-tration.The expressions of proliferation-related genes CCND1,MKI67 and PCNA were down-regulated.The expres-sions of pro-apoptotic genes BAX and TP53 was up-regulated,and the expressions of anti-apoptotic gene BCL2 was down-regulated.Honokiol inhibited MEK and ERK1/2 phosphorylation in a concentration-dependent manner.Conclusions Honokiol inhibits proliferation and promotes apoptosis of hADSCs,and the specific mechanism is po-tentially related to the inhibition of MEK-ERK1/2 pathway.

Objective:To systematically evaluate the qualitative research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients′experience of participating in advance care planning (ACP), so as to provide reference for the application of ACP in HIV/AIDS patients.Methods:Computer searched qualitative studies on HIV/AIDS patients′participation in ACP experience in Web of Science, PubMed, Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang, VIP, China Biomedical Literature Database. The search time limit was from inception to December 1, 2023, and the research results were integrated using Meta integration method after quality evaluation.Results:A total of 10 articles were included, and 58 research results were extracted, forming 12 new categories, and 4 integrated results were obtained: HIV/AIDS patients′understanding of ACP; attitudes of HIV/AIDS patients towards ACP; the influencing factors of HIV/AIDS patients′participation in ACP; suggestions for implementing ACP for HIV/AIDS patients.Conclusions:Medical staff should promptly identify the needs of HIV/AIDS patients for ACP, help them increase their awareness and acceptance of ACP. At the same time, based on China′s unique cultural background and healthcare system, relevant laws and regulations should be continuously improved to promote the development and improvement of ACP in China.

Objective:To analyze the risk factors of systemic inflammatory response syndrome (SIRS) caused by wasp stings.Methods:A prospective case-control study was conducted to analyze the clinical data of 225 patients with wasp stings admitted to Taihe hospital of Shiyan City and Ankang Central Hospital from January 2014 to December 2018, including 131 males and 94 females, with the age of 49 (41, 60) years. The patients were divided into SIRS group ( n=62) and non-SIRS group ( n=163) according to the SIRS diagnostic criteria. The data were collected including gender, age, sting in the head, sting in waist and back, sting in the abdomen, sting in the limbs, number of stings, admission time, hospitalization day, and mortality. The plasma levels of interleukin(IL)-6 and IL-8 in peripheral blood of the patients were analyzed by ELISA method. The whole genome DNA was extracted from white blood cells, and the IL-6: -174G/C, -572G/C, -597G/A, -634C/G and IL-8: -251A/T, -738T/A, -845T/C, + 396T/G were selected for research. The PCR method was used to perform bidirectional sequencing and comparison after amplification, and record the genotyping and frequency. The risk factors of SIRS caused by wasp stings were investigated by univariate analysis and multivariate Logistics regression analysis. Results:(1) The two groups showed significant differences in sting in the limbs, sting in waist and back, sting in the abdomen, number of stings, hospitalization day and mortality ( P<0.01), while there were no significant differences in gender, age, sting in the head and admission time ( P>0.05). (2) ELISA test showed the plasma levels of IL-6 and IL-8 in SIRS group were higher than those in non-SIRS group ( P<0.01). (3) Three genotypes of CC, GC and GG were observed in IL-6-572G/C. There were significant differences in the frequencies of genotypes and alleles between SIRS group and non-SIRS group ( P<0.01). Three genotypes of AA, AT and TT were observed in IL-8 -251A/T. There were significant differences in the frequencies of genotypes and alleles between SIRS group and non-SIRS group ( P<0.01). (4)Univariate analysis showed sting in waist and back, sting in the abdomen, sting in the limbs, number of stings, IL-6-572G allele, IL-8-251T allele were related to SIRS caused by wasp stings ( P<0.01). (5)Multivariate Logistics regression analysis showed limb stings ( OR=2.15), number of stings ≥10 ( OR=11.10), IL-6-572G allele ( OR=3.91) and IL-8-251T allele ( OR=3.97) were significantly related to SIRS caused by wasp stings ( P<0.05 or 0.01). Conclusions:The plasma levels of IL-6 and IL-8 are increased in patients with SIRS after wasp stings. The limbs stings, number of stings ≥10, IL-6 -572G and IL-8 -251T are all independent risk factors for SIRS caused by wasp stings.

Conversion therapy has become the core in the treatment of borderline resectable or unresectable liver cancer, which provides resectable opportunities for more advanced liver cancer patients. In accordance with the first-choice treatment regimen recommended by the guidelines, the authors reported a successful case of Atezolizumab and Bevacizumab (T+A regimen) conversion therapy. The patient with initially borderline resectable advanced liver cancer was performed liver segment resection sucessfully after conversion therapy, and non-tumor recurrence was observed at postoperative 9 months. Postoperative pathological examination showed combined hepatocellular-cholangiocarcinoma, which also indicated the important value of T+A regimen in the conversion therapy of combined hepatocellular-cholangiocarcinoma.