Objective To approach the effect of ulinastatin (UTI) on protection of vascular endothelial cells in rats with sepsis and its mechanism.Methods Fifty-two Sprague-Dawley (SD) male rats were randomly divided into a normal saline pretreatment group (control group) and a UTI pretreatment group (UTI group), each groupn = 26. The rats in two groups were given lipopolysaccharide (LPS, 10 mg/kg) intra-peritoneal injection for the establishment of rat septic models. In UTI group, 18 hours before LPS injection, intraperitoneal injection of UTI 100 kU/kg dissolved in 5 mL normal saline was given, while in the control group, 3 hours before LPS injection, intraperitoneal injection of 5 mL normal saline was given to the rats for pretreatment. Respectively, at 0.5, 2, 4, 12, 24, 72 hours after model establishment, tail venous blood and myocardial tissue were taken. The levels of tumor necrosis factor-α (TNF-α), interleukins (IL-6, IL-10), vascular cell adhesion molecule (VCAM) and intercellular adhesion molecule-1 (ICAM-1) were detected by enzyme-linked immunosorbent assay (ELISA); the correlation between TNF-α and ICAM-1 was analyzed; the expression of ICAM-1 in myocardial cell was determined by immunohistochemistry.Results After model establishment, the levels of TNF-α, IL-6, IL-10, ICAM and VCAM in two groups were gradually increased, reaching the peaks at 24, 12, 12, 72, 72 hours, respectively. Compared with control group, the levels of TNF-α, IL-6, ICAM-1, VCAM of UTI group were significantly lower at various time points [24 hours TNF-α (ng/L): 119.8±28.9 vs. 190.2±30.4, 12 hours IL-6 (ng/L): 327.8±26.9 vs. 948.7±63.8, 72 hours VCAM (ng/L): 36.3±3.2 vs. 68.8±2.4, 72 hours ICAM-1 (ng/L): 115.6±11.6 vs. 129.4±8.2,P < 0.05 orP < 0.01], IL-10 was significantly increased [12 hours (ng/L): 80.7±1.9 vs. 42.3±4.9,P < 0.01]. TNF-αwas positively correlated to ICAM significantly (UTI group:r = 0.907,P = 0.050; control group:r = 0.961, P = 0.010). Immunohistochemistry showed that after modeling for 0.5 hour, basically no positive expression of ICAM-1 in myocardial cells was found in the two groups; in the control group, at 12 hours the positive expression of ICAM-1 was increased, and in UTI group, a little expression of ICAM-1 was seen; at 72 hours, the expression of ICAM-1 was significantly increased in both groups.Conclusion UTI can protect the function of endothelial cells in rats with sepsis by regulating the expressions of proinflammatory cytokine, anti-inflammatory cytokine, adhesion molecules, and improving the microvascular permeability.

Objective To investigate whether early goal-directed therapy ( EGDT ) could lower the mortality rate in patients with severe sepsis and septic shock. Methods Articles with items sepsis, severe sepsis, septic shock, EGDT were retrieved from MEDLINE, EMBASE, Cochrane, Wanfang Data and CNKI. Inclusion criteria included randomized controlled trial, subjects concerning patients with severe sepsis or septic shock, endpoints with short-term mortality [ in-hospital, intensive care unit ( ICU ) or 28-day ] and long-term mortality ( 60-day or 90-day ). Related risk ( RR ) and 95% confidence interval ( 95%CI ) were used as indices to judge the difference in mortality rate between EGDT group and standard treatment group. RevMan 5.2 software was used for Meta analysis. Results There were 8 studies meeting inclusive criteria with a total of 4 853 patients. For patients with severe sepsis and septic shock, compared with the group with routine treatment, EGDT showed a decrease in the short-term mortality ( RR = 0.74, 95%CI=0.66-0.82, P<0.000 01 ), but did not decrease the long-term mortality ( RR=0.99, 95%CI=0.92-1.06, P=0.81 ). Conclusion EGDT strategy may decrease the short-term mortality in patients with severe sepsis and septic shock, but it showed no influence on the long-term mortality.

Objective K93T point mutation exists in the quinoid dihydropteridine reductase ( QDPR) of OLEFT rats which catalyzes QDPR into tetrahydrobinopterin(BH4), while dihydrofolate reductase(DHFR) can reduce QDPR to BH4, which implies crosstalk between hydrobiopterin and folate metabolism.By investigating the influence of QDPR expression on DHFR expression of NRK-52E cells, the article aimed to find out the possible underlying mechanism of QDPR gene in diabetic nephropathy ( DN). Methods Western blot was performed to identify the expression level in NRK-52E cell under high glucose ambience and DHFR pro-tein expression of OLETF rats.NRK-52E cells were transfected by the lentivirus to establish no-load overexpression, overexpressed QDPR and knockdown QDPR models.Each group was given 5.4 mmol/L normal sugar medium and 30mmol/L in high glucose ambi-ence for 72 hours'cell cultivation to simulate DN model.Observation was made on the influence of QDPR gene expression levels on DHFR in high glucose ambience. Results The western blot analysis revealed that DHFR protein decreased in NHG group( [0.33 ± 0.16] vs [0.64 ±0.5], P<0.05) and OLETF rats cortex ([0.56 ±0.16] vs [1.03 ±0.12], P<0.01).In high glucose ambi-ence, compared with LV-OCON-HG group, the protein expression of DHFR was significantly decreased in LV-QDPR-HG group ([0.12 ±0.09] vs [0.63 ±0.08], P<0.01).No difference was found in the comparison of DHFR expression levels between LV-SHQDPR-HG and LV-SHCON-HG group. Conclusion DHFR protein expression decreases in NRK-52E cells of high glucose and LOLETF rat model, which suggests that DHFR protein plays an important role in the development of DN.QDPR overexpression leads to the decreased expression of DHFR, which implies that overexpressed QDPR influences the occurrence and process of DN by down-regulating DHFR expression level.

Objective To investigate the effect of endoscopic transnasal surgery for malignant sinus tumors involving the orbit,and to analyse the factors affecting the prognosis.Methods Thirty-four cases of malignant sinus tumors involving the orbit,who underwent surgical treatment in Chinese people's liberation army general hospital between January 2009 and April 2015,were reviewed retrospectively.The 5-year survival rate,the recurrence rate and the complications was analysed,the factors affecting prognosis were discussed.Results Among 34 patients,2 patients were lost to follow-up.Follow-up time of 32 patients ranged 7 to 75 months.The 5-year overall survival(OS) in this group was 53％.Twelve cases recurred,the recurrence rate was 35％.Eye function improved in 26 cases,the improvement rate was 76.5％.Four cases developed diplopia and peri-orbital swelling after surgery,and simple peri-orbit swelling in 25 cases.The 5-year survive rate of stage 1,stage 2 and stage 3 were 80％,36％ and 25％,respectively,with significant difference(x2 =6.643,P =0.036).Conclusions Endoscopic transnasal surgery for malignant sinus tumors is effective,minimally invasive and accurate.The prognosis is closely related to the clinical stages and the pathological type.

Objective:To investigate the asymmetric geometry of middle cerebral artery (MCA) bifurcations and aneurysm formation.Methods:From January 2017 to April 2020, 65 patients with MCA aneurysm underwent 3D-digital subtraction angiography (DSA) in our hospital were recruited in this study; 170 patients without arterial stenosis or cerebral aneurysm at the same time period were selected as normal control group; their corresponding morphological parameters of MCA bifurcations in the imaging data were analyzed. Bifurcation angle was termed as φ1, while small and large lateral angles were termed as φ2 and φ3, respectively. D2, S2, C2, T2 and E2 represented diameter, sectional area, circumference, tortuosity and ellipticity of the branch forming angle φ2 with parent vessel, respectively; whereas D3, S3, C3, T3 and E3 represented diameter, sectional area, circumference, tortuosity and ellipticity of the branch forming angle φ2 with parent vessel on the contralateral branch, respectively. The independent factors affecting the formation of MCA aneurysm were screened by binary Logistic regression, and the predictive value of independent factors affecting the formation of MCA aneurysm was evaluated by receiver operating characteristic (ROC) curve.Results:(1) The aneurysmal group had significantly larger φ1, significantly smaller φ2 and φ3 than the normal control group ( P<0.05); D3, S3, C3, T2, T3 and E2 in the aneurysmal group were significantly higher/larger than those in the normal control group ( P<0.05). In terms of the symmetry of bilateral branches of blood vessels, the difference of φ3/φ2 ratio between the normal control group and aneurysm group was statistically significant ( P<0.05). (2) Binary Logistic regression results showed that φ2 was the protective factor for aneurysm formation ( OR=0.880, 9 5%CI: 0.844-0.918, P=0.000), while D3 and φ3/φ2 ratio were the risk factors for aneurysm formation ( OR=4.493, 9 5%CI: 1.414-14.278, P=0.011; OR=30.676, 95%CI: 9.884-95.202, P=0.000). (3) The ROC curve showed that the area under the curve of φ2 was the largest, reaching 0.93, and the optimal cut-off point was 104.59°, enjoying sensitivity and specificity of 87.7% and 85.9%, respectively. Conclusion:Normal MCA bifurcations almost show symmetrical morphology, whereas aneurysmal MCA bifurcations show asymmetrical morphology in both lateral angles and daughter branches; φ2 is the best morphological parameter to predict the aneurysm formation of MCA bifurcations.

Objective:To analyze the current research status, hotspots, and trends in the field of cancer symptom management in recent 10 years, and to provide a reference for further research.Methods:Articles published from January 2010 to December 2019 were retrieved with "cancer OR tumor OR neoplasm" and "symptom management" as the subject terms from the core collection of Web of Science database. CiteSpace 5.7.R1 was used for analysis and visualization of researchers, countries, institutions, journals, documents, keywords and other content.Results:The number of papers published in the field of cancer symptom management was basically on the rise, but the number of co-authored papers by multiple authors and institutions was insufficient. The United States, the United Kingdom, Canada, and Australia were the main countries in the field of cancer symptom management. They occupied a key position in this field and cooperated closely with each other. China's number of publications ranked the fifth, but it did not take a central place, and it had less international cooperation. Journal of Clinical Oncology, Journal of Pain and Symptom Management, and Supportive Care in Cancer were the core journals in this field. The related articles published on them reflected the foundation of this field, and provided important reference for this field. Cancer, symptoms, intervention measures, self-care, remote management, etc. have been research hotspots in recent years. Conclusions:This study provides a perspective for understanding the related research in cancer symptom management, and supplies valuable information for researchers to identify potential collaborators and cooperative institutions, core journals, hot topics, and research frontiers. In the future, researchers may focus on such hotspots and frontiers as symptoms, interventions, self-care, and remote management.

Objective To investigate the influence factors of lymphovascular space invasion(LVSI)in patients with low-grade endometrioid carcinoma.Methods Clinical data of 167 patients with low-grade(G1,G2)endometrioid carcinoma of uterus diagnosed by surgical pathology from January 2015 to May 2023 were retrospectively analyzed.Univariate analysis of the following 9 indicators was performed:age,postmenopausal status,abnormal vaginal bleeding duration,combined with metabolic syndrome,increased CA125(≥ 35 U/ml),endometrial thickness,uterine occupation,combined with adenomyosis of uterus,stage of the International Federation of Gynecology and Obstetrics(FIGO)2009 standards.The binary logistic refression analysis was made on factors with P＜0.05.Results Among the 167 patients with low-grade endometrioid carcinoma of uterus,24 cases(14.4％)had LVSI.The binary logistic regression analysis was performed for 4 factors(abnormal vaginal bleeding duration ≥ 4 months,increased CA125,combined with adenomyosis of uterus,stage Ⅱ and above)with P＜0.05 in the univariate analysis,and the results showed stage Ⅱ and above(OR=7.357,95％CI:2.140-25.288,P=0.002)and increased CA125(OR=4.883,95％CI:1.612-14.794,P=0.005)were an independent prognostic factor for LVSI in low-grade endometrial carcinoma of uterus.Conclusion Stage Ⅱ(FIGO 2009)and above and CA125≥35 U/ml are associated with LVSI in patients with low-grade endometrioid carcinoma,indirectly suggesting the risk of lymph node metastasis,which should be paid close attention to before surgery in order to develop a more accurate surgical plan.

Objective To review the methodological quality of evidence-based guidelines on prevention and repair of perineal injury at vaginal delivery,and analyze the characteristics of guidelines to provide references for evidence-based decision-making.Methods We systematically searched websites of professional organizations,websites of clinical practice guidelines and databases for guidelines on prevention and repair of perineal injury,and used AGREE Ⅱ to evaluate the chosen guidelines.Results We identified totally 7 relevant evidence-based guidelines in this field.The average standardized scores of guidelines in 6 domains of AGREE Ⅱ were 90.21％(scope and purpose),68.25％ (stakeholder involvement),69.94％ (rigor of development),89.41％ (clarity of presentations),70.63％ (applicability),and 68.25％(independence),respectively.The overall standardized score for 7 guidelines was 75.65％,and the total score was 5.67 (7 points).For overall quality,4 of them were grade A and 3 of them were grade B.Conclusion The overall quality of included guidelines were high,but stakeholder involvement,rigor of development and independence in some guidelines needs to be improved.There was no Chinese evidence-based gui-deline in this field,and high-quality foreign guidelines could be used as evidence in combination with local conditions.

Objective:To investigate the gap between the health education and the best evidence among nurses and patients with postdialysis fatigue (PDF) , find out the problems and analyze the reasons, and provide a reference and basis for future clinical nursing decisions among the dialysis room nurses.Methods:By searching the evidence-based guideline websites and integrating the best evidence comprehensively, a health knowledge questionnaire for dialysis room nurses and patients with PDF was made. In December 2018, a total of 7 nurses and 56 patients in the dialysis room of Dongzhimen Hospital, Beijing University of Chinese Medicine were selected by purpose sampling method, and they were investigated by the health knowledge questionnaire for dialysis room nurses and patients.Results:The score of the PDF knowledge questionnaire for the 7 nurses was (56.43±4.37) , with a highest score of 64 and a lowest score of 51, and the standard-reaching rate was 28.57% (2/7) . The score of the PDF knowledge questionnaire for the 56 patients was (52.41±9.54) , with a highest score of 70 and a lowest score of 20, and the standard-reaching rate was 28.57% (16/56) . Patients and nurses received verbal health education and small lectures in the department, and there was no unified education content.Conclusions:There is no unified and scientific education content nor standardized education model. Evidence-based health education should be carried out for nurses to improve the awareness of nurses and patients in this regard, thereby reducing patients' fatigue.

Objective:To explore the cognition of community health care workers and the elderly on frailty, and attitudes towards frailty management.Methods:The semi-structured interview was conducted with 14 community health care workers and 17 community elderly in 3 communities in Beijing with the method of phenomenological research. We interviewed respondents' cognition on frailty management and attitudes towards frailty management. Colaizzi 7-step method was used for data analysis.Results:Three themes of cognition on elderly frailty were extracted including that the elderly in the community had different cognition and understandings of elderly frailty; community health care workers had a comprehensive understanding of the concept of elderly frailty, but not much contact with this concept; there were several misunderstandings about the cognition of elderly frailty. Four themes of attitudes towards frailty management were extracted including that the elderly want scientific frailty management; the elderly in the early stage of frailty did not agree with frailty management; community health care workers affirmed the importance of frail management; there were many obstacles to the frailty management in Beijing communities.Conclusions:It is necessary to strengthen education and publicity for the elderly frailty, speed up the formulation of evidence-based frailty management plans, guide community practice, and improve the quality of life of the elderly.