ObjectiveTo explore the application of evidence-based nursing in ulcer pressure prevention of patients in cardiovascular surgery department and effect evaluation. MethodsEvidence-based nursing was applied to 342 patients in our department from January 2008 to October 2010,and the nursing effect was evaluated. ResultsNon of the 342 patients suffered ulcer pressure,the course of disease was shortened and the treatment effect was increased. ConclusionsApplication of evidence- based nursing in cardiovascular surgery patients can significantly reduce the occurrence of pressure ulcers,greatly improve the patients' quality of life,and also can increase the observation,analysis and problem solving ability of nursing staff.

Objective:To explore the prognostic risk factors of patients with multiple injuries and establish a nomogram prediction model.Methods:The clinical data of 291 patients with multiple injuries admitted to the Emergency Intensive Care Unit (EICU) of General Hospital of Ningxia Medical University were collected, including sex, age, open injury, norepinephrine use, mechanical ventilation, time to hospital after injury, distance to hospital, relative lymphocyte value, platelet count, lactic acid, injury severity score (ISS), acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), Glasgow coma scale (GCS), number of blood transfusions, number of operations, and previous history of diabetes, hypertension and smoking within 24 h after admission. According to whether the condition worsened during the hospitalization of EICU, the patients were divided into the deterioration group and improvement group. SPSS26.0 software was used for statistical analysis of the data, univariate and multivariate analysis were used to screen the factors affecting the prognosis of patients with multiple injuries, receiver operating characteristic (ROC) curve and forest chart were drawn, and the influencing factors in binary Logistic regression model were used to make the nomogram.Results:Mechanical ventilation, norepinephrine use, age, relative lymphocyte value, lactic acid, APACHE-II score, GCS score, and number of operations were significant for predicting the prognosis of patients with multiple injuries ( P<0.05). The independent influencing factors obtained by binary Logistic regression model were age, lactic acid, APACHE-Ⅱ score and number of operations. ROC curve analysis showed that the area under the curve was the largest in multi-factor combined prediction, followed by APACHE-Ⅱ score. The diagnostic cut-off value of each index was as follows: age >58 years old, relative lymphocyte value≤ 8.62%, lactic acid >1.72, APACHE-Ⅱ score >16, GCS score≤ 6, and number of operations≤ 0. The R software was used to establish a nomogram of the influencing factors in the binary Logistic regression model, which had good predictive value. Conclusions:The nomogram constructed by age, relative lymphocyte value, lactic acid, APACHE-Ⅱ score, GCS score, number of operations, mechanical ventilation, and norepinephrine use has a good predictive value for the prognosis of patients with multiple injuries, and is worthy of promotion..

Juvenile idiopathic arthritis (JIA) is a genetically heterogeneous group of connective tissue diseases that are commonly characterized by chronic joint synovial inflammation with unknown etiology in childhood.It is cu-rrently incurable and the main therapeutic goal is to achieve clinical remission.The drugs currently used to treat JIA mainly include non-steroid anti-inflammatory drugs, glucocorticoid, disease modifying antirheumatic drugs, and biological agents.In this article, recent advances in the understanding of JIA treatment and related clinical research were reviewed, in an attempt to provide prospects for the future direction of drug development and treatment concepts.

Objective:To explore the risk factors of sepsis in patients with multiple trauma and construct a nomogram prediction model.Methods:The data of patients with multiple injuries admitted to the emergency intensive care unit (EICU) of the General Hospital of Ningxia Medical University from January 2021 to April 2022 were respectively collected. Inclusion criteria: (1) meet the diagnostic criteria for multiple injuries; (2) the time from injury to admission ≤ 24 hours; (3) age>18 years old; (4) all examination or rescue measures were approved by the patient or the patient's family; (5) the patient's clinical data were complete. The patients were divided into sepsis group and non-sepsis group according to the definition of Sepsis 3.0 at the 28-day of EICU hospitalization. The receiver operating characteristic curve was drawn. Logistic regression analysis was applied to determine the independent predictors for sepsis, and the nomogram was constructed.Results:A total of 291 patients were included, including 102 in the sepsis group and 189 in the non-sepsis group. Multivariate logistic analysis revealed that age, acute physiology and chronic health status score (APACHE) Ⅱ, Glasgow Coma Scale (GCS), injury severity score (ISS), sequential organ failure assessment (SOFA) within 24 hours after admission, blood transfusion frequency, the application of norepinephrine, mechanical ventilation, pathogenic culture results, and history of diabetes were independent factors influencing the occurrence of sepsis. A nomogram model was constructed by combining these variables (AUC=0.913, 95% CI: 0.847-0.942), and the model had a good fitting calibration curve. Conclusions:The nomogram constructed by age, APACHE-Ⅱ, GCS score, SOFA score, ISS score, number of blood transfusions, mechanical ventilation, norepinephrine drug use, pathogenic culture and diabetes has a good predictive value for sepsis in patients with multiple trauma in the later stage, which is worth promoting.

This study was designed to evaluate the effect and mechanism of mitogen-activated protein kinase(MAPK)activated protein kinase 2(MK2)in Angiotensin Ⅱ(AngⅡ)-induced mouse renal damage.Total of 16 wild type C57BL/6J mice were randomly divided into MK2+/+control group and MK2+/++AngⅡ group,while 16 MK2 knockout C57BL/6J mice were randomly divided into MK2-/-control group and MK2-/-+AngⅡ group.Kidney damage was induced by subcutaneous injection of AngⅡ for 4 weeks.Then corresponding methods were carried out to detect systolic pressure,serum creatinine,24h urinary albumin,glomerulosclerosis index,renal tubulointerstitial injury score,the expression level of phosphorylated MK2(p-MK2),p-p65 nuclear factor-κB(NF-κB),the contents of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),reactive oxygen species(ROS),superoxide dismutase(SOD)and malondialdehyde(MDA).Compared with the MK2+/+control group,MK2+/++AngⅡ group demonstrated significant increase in systolic blood pressure,serum creatinine,24h urinary albumin,glomerulosclerosis index,renal tubulointerstitial injury score,the expression levels of p-MK2,p-p65 NF-κB expression,and the contents of TNF-α,IL-6,ROS,MDA,while significant decrease in the level of SOD in kidney(P<0.05).Compared with the MK2+/++AngⅡ group,MK2-/-+AngⅡ group showed no significant difference in systolic blood pressure(P>0.05),significant decrease in the serum creatinine,24 h urinary albumin,glomerulosclerosis index,renal tubulointerstitial injury score,the expression levels of p-MK2,p-p65 NF-κB and the contents of TNF-α,IL-6,ROS,MDA,while significant increase in the content of SOD in kidney(P<0.05).In conclusion,MK2 knockout significantly alleviates AngⅡ-induced renal damage and inhibits inflammatory and oxidative stress responses.MK2 is involved in AngⅡ induced renal damage.

Objective To study the influence of hierarchical psychological nursing on anxiety, depression, 5-hydroxytryptamine (5-HT) and Galanin (GAL) of patients with gastroesophageal reflux disease. Methods A total of 238 gastroesophageal reflux disease patients were divided into study group( n=119) and control group( n=119) by random number table. Two groups of patients were given the same routine care. Based on this, patients in the control group were given conventional psychological nursing, the study group were given hierarchical psychological nursing. SAS and SDS were used to evaluate the two group patients mental status before and after different mental care. Enzyme linked immunosorbent assay ( ELISA) was used to evaluate the contents of 5-HT and GAL of the two groups.Results After 4 weeks of hierarchical psychological nursing, SAS and SDS scores of the study group were (41.47±9.37) and (42.13±12.36). Those scores of the control group were (45.68±14.81) and (48.15±14.21). The differences were significant (t=2.62,3.49;P<0.05). After 4 weeks of hierarchical psychological nursing, 5-HT and GAL contents of the study group were (166.05±63.66) ng/ml and (23.18±8.74)pg/ml. Those contents of the control group were (146.30±63.75)ng/ml and (25.45± 9.03)pg/ml. The differences were significant (t=2.39,1.97;P<0.05).Conclusions Hierarchical psychological nursing can decrease anxiety and depression of patients with gastroesophageal reflux disease and help the contents of GAL and 5-HT return to normal level gradually. It is worthy of clinical promotion and popularization.

Objective:To explore the dosimetry difference between volumetric modulated arc therapy (VMAT) and tomo direct (TD) in tumor bed simultaneous push radiotherapy after left breast-conserving surgery, and to provide more dosimetry reference for clinic.Methods:A total of 22 patients with left breast cancer who underwent simultaneous quantitative radiotherapy after breast-conserving surgery were selected from the Department of Radiation Oncology, Yunnan Cancer Hospital from December 2018 to June 2020. The localized CT images and target organs at risk and other structural data were collected. Two radiotherapy plans, VMAT and TD, were designed for the same patient, and the dosimetry differences of target areas and organs at risk were compared and analyzed between the two groups.Results:In terms of target dosimetry, there were statistically significant differences in the D 2% [ (59.99±0.19) Gy vs. (59.55±0.51) Gy, t=4.09, P<0.001], D 98% [ (57.19±0.08) Gy vs. (57.46±0.22) Gy, t=-5.10, P<0.001], conformal index (CI) (0.76±0.05 vs. 0.58±0.13, t=8.19, P<0.001) and homogeneity index (HI) (0.05±0.00 vs. 0.04±0.01, t=4.89, P<0.001) of the planning gross tumor volume (PGTV) between VMAT and TD plans. However, there was no statistically significant difference in the D 50% [ (58.73±0.10) Gy vs. (58.73±0.24) Gy, t=-0.03, P=0.974]. There were statistically significant differences in the D 50% [ (52.21±0.33) Gy vs. (53.00±0.72) Gy, t=-4.81, P<0.001], D 98% [ (48.44±0.43) Gy vs. (49.09±0.21) Gy, t=-6.80, P<0.001], CI (0.83±0.06 vs. 0.67±0.06, t=10.52, P<0.001) and HI (0.20±0.01 vs. 0.19±0.01, t=8.75, P<0.001) of the planned target volume (PTV) between the two plans. However, there was no statistically significant difference in the D 2% [ (59.01±0.45) Gy vs. (59.00±0.48) Gy, t=0.22, P=0.830]. In terms of organs at risk, there were statistically significant differences in the V 20 [ (18.81±2.86) % vs. (22.03±1.91) %, t=-5.36, P<0.001] and D mean [ (11.66±1.32) Gy vs. (12.85±1.46) Gy, t=-4.10, P=0.007] of left lung, V 5 [ (5.70±2.90) % vs. (0.30±0.13) %, t=16.44, P<0.001] and D mean [ (2.45±0.29) Gy vs. (0.43±0.14) Gy, t=9.09, P<0.001] of right lung, D mean [ (3.22±0.72) Gy vs. (1.69±0.80) Gy, t=5.41, P<0.001] of right breast, D 2% [ (5.37±1.97) Gy vs. (0.46±0.09) Gy, t=11.75, P<0.001] of cord between VMAT and TD plans. There were no significant differences in the V 5 of left lung [ (53.00±5.99) % vs. (50.00±7.69) %, t=1.91, P=0.061], V 5 of right breast [ (11.51±4.60) % vs. (8.06±3.49) %, t=1.59, P=0.120], V 30 [ (1.49±0.69) % vs. (1.51±0.71) %, t=-0.06, P=0.952] and D mean [ (3.99±0.97) Gy vs. (3.90±1.03) Gy, t=0.56, P=0.581] of heart between the two plans. Conclusion:TD and VMAT can meet the clinical dosimetry requirements for patients with left breast cancer after breast-conserving surgery. However, the two techniques have their own characteristics. VMAT has better conformity and TD has better uniformity. TD is significantly better than VMAT in protecting the right lung, right breast and spinal cord of healthy organs at risk. VMAT is better in protecting the left lung. Both VMAT and TD basically achieve the same protection for heart.

The course, progression, and prognosis of fetal congenital cystic adenomatoid malformation (CCAM) depend on the size of the mass, whether the mediastinum is displaced, changes in fetal hemodynamics, and the occurrence of fetal hydrops, with large CCAM being relatively rare. In this case, a fetus was suspected of having a large CCAM with fetal hydrops and cardiac insufficiency at 27 weeks of gestation. After multiple imaging evaluations and multidisciplinary consultations, a delivery plan and neonatal resuscitation plan were formulated. At 31 +4 weeks of gestation, in-utero thoracentesis and drainage were performed. Postoperatively, the fetal CCAM was reduced compared to before, and the maternal symptoms of chest tightness and shortness of breath were also improved. Three days after the procedure, the mother experienced premature rupture of membranes and delivered a male infant vaginally at 32 weeks of gestation. On the fifth day after birth, the newborn underwent resection of the pulmonary cystic adenomatoid malformation, confirming the diagnosis. Follow-up for two years post-birth showed good prognosis for both the mother and the child. Therefore, when CCAM is detected during pregnancy, thorough in-utero evaluation should be conducted, and a monitoring plan should be developed based on potential perinatal conditions to avoid unnecessary termination of pregnancy. If the pregnancy continues, multidisciplinary evaluation and preparation for perinatal surgery are necessary.

OBJECTIVEThis study will explore whether reactive oxygen species (ROS) is involved in TGF-β1-induced JNK activation, pulmonary fibroblast proliferation and collagen type I and III synthesis.

METHODSPulmonary fibroblasts were randomly divided into control (0.4% serum) and TGF-β1 (5 µg/L) groups to detect whether TGF-β1 could induce pulmonary fibroblast proliferation, synthesis of collagen I and III, phosphorylated-JNK (p-JNK) and 8-OHdG (indicator of ROS); while in the part to explore whether NAC (N-acetyl-L-cysteine, antioxidants) has the inhibitory role in TGF-β1-induced pulmonary fibroblast, it did control (0.4% serum), H2O2 (0.1 mmol/L, positive control), H2O2+NAC (10 mmol/L), TGF-β1 (5 µg/L), TGF-β1+NAC groups. Pulmonary fibroblast proliferation, 8-OHdG levels, expressions of JNK and collagen I and III were used by MTT assay, immunofluorescence and western blot respectively.

RESULTSIn the experiments to detect the effect of TGF-β1 on pulmonary fibroblasts, compared with control, TGF-β1 significantly stimulated pulmonary fibroblast proliferation and increased collagen I and III protein, p-JNK and 8-OHdG levels. In the next experiments to explore whether NAC has the inhibitory role in TGF-β1-induced pulmonary fibroblasts, compared with control, pulmonary fibroblast proliferation and the levels of collagen I and II, p-JNK, 8-OHdG were all significantly increased in H2O2 and TGF-β1 groups; while these changes were markedly blocked with the treatment of NAC.

CONCLUSIONTGF-β1 induces pulmonary fibroblasts to generate ROS, which contributes to JNK activation and pulmonary fibroblast proliferation as well as collagen synthesis, while ROS inhibition suppresses this effet of TGF-β1 in pulmonary fibroblasts.

Acetylcysteine ; Cell Proliferation ; Collagen ; biosynthesis ; Collagen Type I ; Fibroblasts ; cytology ; Hydrogen Peroxide ; Lung ; cytology ; MAP Kinase Signaling System ; Phosphorylation ; Reactive Oxygen Species ; metabolism ; Transforming Growth Factor beta ; metabolism ; Transforming Growth Factor beta1 ; metabolism

Objective To investigate the changes of nutrients in colostrum， transitional milk， mature milk and late milk after storage at indoor temperature for 3 h， at 4 ℃ for 24 h， at -18 ℃ for 30 d， and at -18 ℃ for 90 d， so as to select the most suitable storage method of milk. Methods Fifteen pregnant women registered in the Shanghai Hongkou Liangcheng Village Street Community Health Service Center， who were expected to give birth from January to June in 2019， were selected. The breast milk of each woman was followed from delivery to 10 months after breast-feeding. Colostrum， transitional milk， mature milk and late milk were sampled， and each sample was divided into 5 parts. Changes in protein， fat， lactose， minerals， carbohydrates， vitamins and bacterial colony number of breast milk were detected according to 0 h（16-18 ℃）， 3 h （16-18 ℃）， 24 h （4 ℃） to 37 ℃， 30 d （-18 ℃） to 37 ℃ after thawing at 40 ℃ and 90 d （-18 ℃） to 37 ℃ after thawing at 40 ℃. Results The results showed that the nutritional components of milk in different stages decreased with time. However， there was no significant difference in the decline of nutritional components in different stages of milk after the same duration of time （ P >0.05）. Conclusion The milk at each stage can be stored， and the lactating mother can store the excess milk at any stage as she wishes.