Objective To explore the damage of intestinal mucosal barrier caused by vinegar retention enema, and compare the degree of injury in intestinal mucosal barrier between isotonic vinegar and traditional hypertonic vinegar treat-ment. Methods Sixteen adult rabbits were randomly divided into two groups. The solution of vinegar mixed with normal so-dium was given to hypertonic group. Isotonic group was administered with isosmotic solution made of vinegar and double dis-tilled water, with the same volume fraction and pH as hypertonic group. Then two different osmosis solutions were given as enema solution to rabbits under the same condition. Finally, damages of intestinal mucosa were observed by light microscope and transmission electron microscope (TEM) in two groups. Results It was observed that injuries of rectum and distal part of colon were more severe in hypertonic group than those of isotonic group through light microscope. Besides, cell structures were morphologically normal, with in-line microvilli and intact tight junction in isotonic group. In hypertonic group, microvil-li of intestinal cells decreased or disappeared, the cell junction is widened, and cell apoptosis and necrosis were found through TEM. Conclusion Results showed that isotonic vinegar had less damage to mucosa. Consequently, isotonic vinegar can be considered as enema solution for hepatic encephalopathy to avoid damage by osmosis in clinic.

Astract: Objective To explore the efifcacy and safety of endoscopic tissue adhesive injection in treatment of gastric variceal bleeding from liver cirrhosis.Methods Object of study are 92 cirrhotic patients (72 male/20 female) in hospital, who had been diagnosed with gastric varices bleeding from June 2014 to May 2016. Child-Pugh score at presentation for cirrhotic patients was A-28; B-36; C-28. According to endoscopic classiifcation of gastric varices, GEV1 were detected in 80 patients, GEV2 in 12. All patients were treated with endoscopic hypertonic glucose tissue adhesive ‘sandwich’ injection.Result Successful injection rate was 100.0% in 92 patients, among which 40 patients had accepted emergency endoscopic treatment and the immediate hemostasis rate was 100.0%. 65 patients were Having gastroscope review after the injection six months, 22 patients were significantly effective, accounting for 33.8%; 38 patients were effective, accounting for 58.4%; 5 patients were invalid, accounting for 7.7%. All the patients were followed up in 1 to 24 months. The late-rebleeding rate was 2.2%. None of them were having early-rebleeding or dead; Complications the incidence of rebleeding rate which caused by removing the needles which trapped in the varices was 2.2%. The incidence of chest pain rate was 4.3%, the bloating rate was 6.5% and the ulceration rate was 15.2%. There was no complications like fever, infection, stomachache, embolism and so on.Conclusion With low rebleeding rate and light side-effect, endoscopic tissue adhesive injection in the treatment of gastric variceal bleeding caused by cirrhosis portal hypertension has really good effect.

Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS) in the diagnosis of postnatal placenta increta. Methods Twenty-six patients with postnatal placenta increta were examined by gray-scale and color Doppler ultrasound and CEUS. Then microvascular perfusion and enhanced features of lesions, myometrium and serous layer were observed. Arriving time (AT), time to peak intensity (TTP) and the lasting time of enhancement (LTE) were recorded. AT,TTP and LTE of enhanced lesions were compared with those of normal myometrium. Results Serous layer, lesions and adjcent myometrium,normal myometrium enhanced in turn. There was no obvious boundary between the lesions enhanced and adjcent myometrium. AT and TTP of the lesions enhanced were both less than those of normal myometrium ( P ＜0. 05). LTE of the part of lesions enhanced was more than that of normal myometrium ( P ＜0.05).Part of lesions never enhanced during the whole process. The serous layer of uterine was smooth and uninterrupted in 24 patients. These 24 patients all recovered after conservative treatment. The local serous layer adjcent lesions was not smooth, but no contrast agent leakage occurred in another 2 patients, and uterine lobectomy were performed in emergency because of massive hemorrhage during conservative treatment. Conclusions Microvascular perfusion and enhanced features of lesions,myometrium and serous layer could be showed clearly through CEUS.

Aim To establish a novel acute hyperuricemia mouse model and apply it to evaluate the hyporucicemia effects of Ulodesine, a purine nucleoside phosphorylase(PNP) inhibitor.Methods The mice were intraperitoneal injected inosine and subcutaneous injected Oteracil potassium to induce accumulation of uric acid, and the animal blood was collected from eyeball or vena angularis in different time points.The levels of serum uric acid were measured and determined to test whether the acute hyperuricemia mouse model were successful or not.In order to verify the hyperuricemia seen in the model was associated with the accumulation of inosine, which was converted to uric acid by action of PNP,hyporucicemia effects of Ulodesine, a PNP inhibitor, was assessed in an enzyme assay and confirmed by using the newly established model.Result Accumulation of uric acid in the blood of mouse models was observed by combined injections of intraperitoneal 200 mg·kg-1 inosine and subcutaneous 200 mg·kg-1 Oteracil potassium respectively after 1.5 h.The enzyme assay indicated that Ulodesine was a potently PNP inhibitor with IC50 of 2.293 nmol·L-1.IV injection of Ulodesine eliminated uric acid accumulations in blood of the mouse model, which was expected as the in vivo action of Ulodesine.Conclusions A novel acute hyperuricemia mouse model is established.This is a relatively easy and more effective protocol to generate the hyperuricemia in mice, which will be a useful platform to assess the anti-hyperuricemia activity of PNP-target drugs in vivo.

Background Idiopathic orbital inflammatory pseudotumor (IOIP) is a commom orbital disease,with serious eye symptoms and replase tendency,and its pathogenesis is still unclear.Nuclear factor-κB (NF-κB)-related proteins participate in many important pathophysiological process,however,whether NF-κB plays a role in the IOIP process is worthy of attention.Objective This study was to explore the roles of NF-κB pathway in IOIP pathogenesis.Methods Twenty-four IOIP specimens were collected during surgery in Beijing Tongren Hospital from September 2010 to May 2016.The histopathological characteristics of IOIP were examined by hematoxylin and eosin staining.The expression and location of NF-κB/p65,p-p65,p50 and inhibitor of κB (IκB-ot) were detected by immunohistochemistry and verified by immunocytochemistry and Western blot assay.Results The histopathological features of IOIP were numerous small lymphocyte infiltraion and fibrous tissue proliferation,and a lot of epithelioid cells were seen in lacrimal gland-involved specimens.NF-κB/p65 was positively expressed in the cytoplasm of all 24 specimens and the nucleus in 15 specimens with the expressing rate of 62.5％.p50 was expressed in the cytoplasm in 22 specimens with the expressing rate of 91.7％ and in the nucleus in 17 specimens with the expressing rate of 70.8％.The positive expression of p-p65 was found in 22 specimens with the expressing rate of 91.7％,and IκB-α was expressed in the cytoplasm of 11 specimens with the expressing rate of 45.8％.These results were confirmed by immunocytochemistry and Western blot assay.Conclusions NF-κB pathway is activiated during IOIP process,and NF-κB pathway may be involved in the pathogenesis of IOIP.

Objective:To explore the effect of postpartum fatigue(PPF) on maternal behavior in rats and its mechanisms.Methods:Sprague-Dawley (SD) rats on the first day after delivery were randomized into the control group and the PPF group using the random number table method, with eight rats in each group.The rat model of PPF was established by forcing rats to stand in a cage with water and last for seven days.To maintain galactosis and lactation, rats and pups were caged for 90 min after every 3 h of separation.The control group was separated routinely without any stimulus.The length and body mass of the pups were recorded at birth and postnatal day 7.On the seven days after modeling, the following maternal behaviors were observed via video recordings: suckling, nesting, clicking and retrieval.The morphology of neurons in the paraventricular nucleus of hypothalamus (PVH) was observed by HE staining.The expression of oxytocin in the paraventricular hypothalamus (OxtPVH) was determined by immunofluorescence and immunohistochemistry.Western blot and qRT-PCR were performed to detect mRNA and protein expression of prolactin (PRL) in pituitary gland, respectively.Statistical analysis was performed by SPSS version 22.0, normally distributed continuous variables were compared between the two groups using an independent-sample t test, and nonnormally distributed continuous variables were compared between the two groups by Mann-Whitney U test. Results:On the seventh day after modeling, the length and weight gain of pups in the PPF group ((5.82±0.17) cm, (5.33±2.54) g)were significantly lower than those of the control group ((6.24±0.36) cm, (7.92±2.54) g, t=3.199, 2.227, both P<0.05). Compared with the control group, the rats in PPF group exhibited abnormal maternal behaviors, such as gnawing cage, biting tails, turning circles, repeatedly nesting and refusal to suckling.The results from the maternal behavioral test revealed that the latency of first pup retrieval and last pup retrieval ((39.25±3.50) s, (280.75±59.16) s) in the PPF group were significantly prolonged compared with those in the control group((19.25±7.68) s, (146.00±49.62) s, t=-4.742, -3.490, both P<0.05), the duration of nesting building ((19.50±12.69) s)and clicking ((95.50±70.55)s) in the PPF group were significantly shorter than those in the control group((68.00±37.59) s, (243.00±62.07) s; t=2.445, 3.139, both P<0.05). Compared with control group, the neurons cells of PVH in the PPF group were in disordered manner and the OxtPVH content in the PPF group decreased significantly.The mRNA (0.33(0.29, 0.38) vs 0.85(0.76, 1.76), Z=-3.576, P<0.05) and protein ((1.00±0.65) vs (4.17±0.49), t=-7.726, P<0.05) levels of PRL in PPF group were significantly decreased compared with those in the control group. Conclusion:The behaviors of holding back, nesting and licking offspring are decreased in postnatal fatigued rats.This may be related to the decreased expression of OxtPVH and PRL in hypothalamus of female rats.

Objective:To explore the influencing factors of fear of falling in patients with first cerebral infarction in recovery period.Methods:Using the convenient sampling method, a total of 221 patients with first cerebral infarction who were hospitalized and treated in Department of Neurology and Department of Cardiology in Qingdao Hospital of Shandong First Medical University from May 2017 to October 2019 were selected as research objects. Short Falls Efficacy Scale International (SFES-I) was used to evaluate the patients, and the influencing factors of the fear of falling in patients with first cerebral infarction in recovery period were analyzed.Results:The results of univariate analysis showed that SFES-I scores of patients with different ages, marital status, family monthly income, history of falls, number of chronic diseases, anxiety, depression, activity of daily living (ADL) limitation and walking ability had statistically significant differences ( P<0.05) . The results of multivariate logistic regression analysis showed that five variables including age (65-80) , marital status, history of falls, anxiety, and depression were retained in the regression model, and the differences were statistically significant ( P<0.05) . Among them, the marital status of the spouse was the protective factors of fear of falling of patients ( OR<1) , while the other 4 factors were risk factors of fear of falling of patients ( OR>1) . Conclusions:Age, marital status, history of falling, anxiety, and depression are the influencing factors of falling fear in patients with first cerebral infarction in recovery period, so targeted nursing measures should be taken according to different characteristics of patients.

Objective:To construct the nutritional intervention regimen for elderly patients with hip fractures during the perioperative period and rehabilitation period.Methods:Based on Stetler evidence-based practice model, 151 elderly patients with hip fractures surgery who were admitted to Jiading District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences from January to May 2019 were investigated, and nutritional problems were found in the perioperative period and 3 months after surgery. Through systematic literature search, the best evidence was extracted to construct a nutritional intervention regimen for elderly hip fractures patients with oral nutrition supplements (ONS) . The expert meeting method was adopted to demonstrate the scheme and determine the final intervention scheme and process.Results:A total of 7 guidelines were included, and 25 recommendations were formed based on evidence, including 24 strong recommendations and 1 weak recommendation. Nutritional intervention scheme and process for elderly patients with hip fractures, mainly ONS, were determined. The expert authority coefficient was 0.89.Conclusions:In this study, the nutritional intervention regimen for elderly patients with hip fractures, mainly ONS, was constructed with a high degree of expert authority and reliable results, providing a theoretical basis for clinical nutrition intervention for elderly patients with hip fractures in the perioperative period.

Objective:To explore the effect of "WeChat official account"+multidisciplinary team (MDT) cooperative nursing in discharged patients with cerebral infarction.Methods:From January 2019 to December 2020, 118 discharged patients with cerebral infarction were selected by convenience sampling from Qingdao Hospital affiliated to Shandong First Medical University as the research object. The patients admitted from January to December 2019 were taken as the control group, and the patients admitted from January to December 2020 were taken as the observation group, with 59 cases each. The control group was given routine intervention and follow-up after discharge. The observation group received "WeChat official account"+ MDT cooperative nursing on the basis of the control group. Both groups were intervened for three months. The Stroke Behavior Change Questionnaire, Fugl-Meyer Assessment (FMA) , Self-Rating Anxiety Scale (SAS) , Self-Rating Depression Scale (SDS) , compliance and adverse events of the two groups were compared before and after the intervention.Results:Before the intervention, there was no statistical difference between the two groups in the scores of Stroke Behavior Change Questionnaire, FMA, SDS and SAS ( P>0.05) . After the intervention, the scores of Stroke Behavior Change Questionnaire and FMA in the observation group were higher than those before the intervention and the control group, and the SDS and SAS scores were lower than those before the intervention and the control group, with statistical differences ( P<0.01) . The treatment compliance of the observation group was 94.92% (56/59) , higher than 81.36% (48/59) of the control group, with a statistical difference ( P<0.05) . Conclusions:"WeChat official account" + MDT cooperative nursing can effectively improve the exercise behavior of discharged cerebral infarction patients, increase compliance, promote neurological recovery, alleviate negative emotions, and reduce the incidence of adverse events after discharge, which is worthy of clinical practice.

ObjectiveTo investigate a suspected outbreak of healthcare-associated infection with carbapenem-resistant Klebsiella pneumoniae (CRKP) in a geriatric emergency ward, and to provide references for the prevention and control of multidrug-resistant bacteria in a hospital in Shanghai. MethodsOn-site epidemiological investigation, combined with environmental hygiene monitoring and pulsed field gel electrophoresis (PFGE) molecular typing method, were adopted to investigate a suspected outbreak of CRKP infection in the geriatric emergency ward of a hospital from October to November 2022, aiming at finding out factors caused the outbreak before taking corresponding control measures. ResultsA total of 3 cases of healthcare-associated CRKP infection were identified, of which 2 cases were homologous to a previous case of community-associated CRKP infection. What’s more, the 2 cases lived in the same ward with the latter and with adjacent beds, but the third case was non-homologous to the community-associated infection case. A total of 46 samples were collected from the environmental surfaces and the hands of healthcare workers, of which 7 samples tested positive for CRKP and were identical to the strains from the 2 healthcare-associated infection cases and the 1 community-associated infection case, originating from the bedrails, bedside tables, surface of non-invasive ventilator, bed curtains and panels of monitoring equipment, with a detection rate of 15.22%. But none of the 11 samples from the hands of healthcare workers tested positive for CRKP. The outbreak was effectively controlled after taking specific prevention and control measures such as strengthening personnel management, intensifying environmental cleaning and disinfection and strictly enforcing hand hygiene among healthcare workers. Subsequently, no similar new cases were reported during the 14-day follow-up period. ConclusionIncomplete environmental cleaning and disinfection, as well as inadequate enforcement of hand hygiene among heatheare workers may have contributed to the suspected outbreak of CRKP in the geriatric emergency ward. Early warning and timely investigation of suspected outbreaks of multidrug-resistant bacteria are crucial for preventing and controlling such outbreaks in hospitals.