Objective:To study the pharmacological action of Vernonia Cinerea(L) Less. Methods: The bacteriostatic test in vitro and the evaluation of effect of Vernonia Cinerea(L) Less. on the propellent function of small intestine of mice, etc were carried out. Results: Vernonia Cinerea(L) Less. prossesses the inhibition on Bacillus coli with lapactic action in vitro, but has the drug resistance to Bacillus dysenteriae and Bacillus coli It can also improve the propellent function of small intestine nomral mice. Conclusions: Vernonia Cinerea(L) Less. is effective for acute gastroenteritis and indigestion clinically.

OBJECTIVE:To observe the effects of dexmedetomidine combined with ulinastatin on stress reaction indexes,ex-travascular lung water value(EVLW)and pulmonary vascular permeability indexes(PVPI)and other parameters in one-lung venti-lation(OLV)lobectomy patients. METHODS:A total of 80 patients underwent OLV lobectomy selected from the Affiliated Hospi-tal of Southwest Medical University during Nov. 2015-Nov. 2016 were divided into control group (group N),ulinastatin pretreat-ment group(group U),dexmedetomidine continuous pump group(group D),ulinastatin pretreatment+dexmedetomidine continu-ous pump group(group U+D),with 20 cases in each group. Thirty min before anesthesia induction,all patients were given atro-pine sulfate 0.5 mg intramuscularly and received catheterization of right internal jugular vein and ipsilateral femoral artery under lo-cal anesthesia. Based on that,group N was given 0.9％ Sodium chloride injection 100 mL intravenously;group U was given sodi-um chloride mixed solution 100 mL containing Ulinastatin for injection 200000 U intravenously;group D was given continuous in-travenous pump of Dexmedetomidine hydrochloride injection 2 μg/mL mixed with sodium chloride mixed solution at 1 μg/(kg·h), and after induction intravenous pump at 0.5 μg/(kg·h)until the end of surgery;group U+D was given Sodium chloride mixed so-lution containing 200000 U ulinastatin 50 mL and 4 μg/mL dexmedetomidine sodium chloride mixed solution 50 mL intravenously (same dose as above during induction period and maintenance period). The levels of blood glucose,partial pressure of oxy-gen [p(O2)],adrenocorticotropic hormone (ACTH),norepi-nephrine (NE),heart rate (HR),cardiac output (CO),sys-temic vascular resistance(SVR),EVLW and PVPI were com-pared among 4 groups 30 min before anesthesia induction(T1),2 h after the beginning of surgery(T2),immediately after extuba-tion(T3)and 12 h after surgery(T4). Liquid intake and output volume were recorded during T2-T4. The occurrence of ADR among 4 groups was observed. RESULTS:There was no statistical significance in each index among 4 groups at T1 (P>0.05). During T2-T4,the levels of blood glucose,ACTH,NE,SVR,EVLW and PVPI in group N were significantly higher than other 3 groups, and group U and D were significantly higher than group U+D,with statistical significance(P<0.05);there was no statistical sig-nificance between U and D(P>0.05). The levels of p(O2)and CO in groups U+D were significantly higher than other 3 groups, with statistical significance (P<0.05);there was no statistical significance among other 3 groups (P>0.05). HR of group N and U were significantly higher than other 2 groups,with statistical significance (P<0.05). There was no statistical significance be-tween group N and U,between group D and U+D(P>0.05). There was no statistical significance in liquid intake or output vol-ume among 4 groups (P>0.05). No obvious ADR was found in 4 groups. CONCLUSIONS:Dexmedetomidine combined with ulinastatin can significantly relieve stress reaction,and reduce the levels of part blood flow and respiratory dynamics indexes as EV-LW,PVPI in patients with OLV lobectomy so as to play lung protective effect.

Objective:To investigate the treatment efficacy of adjuvant anti-VEGF/VEGFR targeted therapy in patients with non-metastatic (cM 0) non-clear cell renal cell carcinoma and tumor thrombus (nccRCC-VTT). Methods:This retrospective study enrolled 26 patients who underwent radical nephrectomy combined with inferior vena cava tumor thrombectomy at Peking University Third Hospital from January 2014 to July 2021. Patients were divided into adjuvant therapy group (10 cases) and control group (16 cases)based on the use of postoperative targeted therapy. The distribution of baseline clinical characteristics in the adjuvant therapy group and the control group were as follows: gender (6 males and 4 females in the adjuvant therapy group, 12 males and 4 females in the control group, P=0.66), age (56.2±18.5 years old in the adjuvant therapy group; 54.6±14.5 years old in the control group; P=0.80), BMI(24.0±3.5 in the adjuvant therapy group; 24.3±3.3 in the control group; P=0.80), presence of clinical symptoms (8 cases in the adjuvant therapy group; 15 cases in the control group; P=0.54), tumor laterality(6 cases on the left and 4 cases on the right in the adjuvant therapy group; 6 cases on the left and 10 cases on the right in the control group; P=0.42), location of tumor thrombus (2 cases with renal vein tumor thrombus and 8 cases with inferior vena cava tumor thrombus in the adjuvant therapy group; 2 cases with renal vein tumor thrombus and 14 cases with inferior vena cava tumor thrombus in the control group; P=0.67), ASA classification (2 cases in ASA class 1 and 8 cases in ASA class 2 in the adjuvant therapy group; 2 cases in ASA class 1 and 14 cases in ASA class 2 in the control group; P=0.63), surgical approach (7 minimally invasive surgeries and 3 open surgeries in the adjuvant therapy group; 9 minimally invasive surgeries and 7 open surgeries in the control group; P=0.68), conversion to open surgery (2 cases in the adjuvant therapy group; 2 cases in the control group; P=0.63), operation time [287.5(222.2, 456.0) minutes in the adjuvant therapy group; 344.0(287.8, 482.5) minutes in the control group; P=0.34), blood loss [400.0(250.0, 600.0)ml in the adjuvant therapy group; 575.0(175.0, 800.0)ml in the control group; P=0.63), Clavien-Dindo classification of postoperative complications (8 cases with no postoperative complications, 2 cases with level 1-2 complications, and 0 cases with level ≥3 complications in the adjuvant therapy group; 10 cases with no postoperative complications, 4 cases with level 1-2 complications, and 2 cases with level ≥3 complications in the control group; P=0.68), postoperative hospital stay (8.5 [5.5, 11.5] days in the adjuvant therapy group; 7.5 [6.0, 13.0] days in the control group; P=1.00), maximum tumor diameter[ (9.2±2.7)cm in the adjuvant therapy group; (8.9±3.3)cm in the control group; P=0.81], sarcomatoid differentiation (0 cases in the adjuvant therapy group; 1 case in the control group; P=1.00), perinephric fat invasion (2 cases in the adjuvant therapy group; 7 cases in the control group; P=0.40), tumor necrosis (6 cases in the adjuvant therapy group; 5 cases in the control group; P=0.23), pathological subtype (1 case of PRCC type 1, 6 cases of PRCC type 2, and 3 cases of TFE3 rearrangement RCC in the adjuvant therapy group; 2 cases of PRCC type 1, 10 cases of PRCC type 2, and 1 case each of oncocytic PRCC, TFE3 rearrangement RCC, FH-deficient RCC, and unclassified RCC in the control group; P=0.72), WHO/ISUP nuclear grade (10 cases of grades 3-4 in the adjuvant therapy group; 4 cases of grades 1-2 and 12 cases of grades 3-4 in the control group; P=0.14), invasion of tumor thrombus into the vessel wall (5 cases in the adjuvant therapy group; 5 cases in the control group; P=0.43), T stage (1 case of T 3a, 3 cases of T 3b, 5 cases of T 3c, and 1 case of T 4 in the adjuvant therapy group; 1 case of T 3a, 4 cases of T 3b, 10 cases of T 3c, and 1 case of T 4 in the control group; P=1.00), and positive lymph nodes metastasis(3 cases in the adjuvant therapy group; 0 cases in the control group; P<0.05). The recommended doses for sunitinib, axitinib, and pazopanib are 50mg qd, 5mg q12h, and 800mg qd, respectively. The primary endpoint of this study was disease-free survival (DFS), and the secondary endpoint was overall survival (OS). Statistical analyses were performed using R v4.2.2. Confounding factors were adjusted using propensity score weighting. Results:The median follow-up time for DFS was 29 months in the adjuvant therapy group and not reached in the control group, while median follow-up time for OS was 28 and 26 months, respectively. In the univariate Cox regression analysis, there were no statistically significant difference in the impact of all baseline characteristics and exposure factors on DFS and OS between the two groups. In survival analysis, there were no significant difference between DFS and OS curves of patients in the adjuvant therapy group and the control group (DFS, P=0.62; OS, P=0.74). The median DFS of patients in the adjuvant therapy group and the control group were 17 and 19 months, respectively, while the median OS was 43 and 27 months. After adjusting for confounding factors, the median DFS of patients in the adjuvant therapy group and the control group were 26 and 12 months, respectively, and the median OS remained 43 and 27 months, with no significant difference (DFS, P=0.81; OS, P=0.40). Conclusion:There is currently a lack of definitive evidence for survival benefit from adjuvant anti-VEGF/VEGFR targeted therapy in patients with cM0 nccRCC-VTT after surgery.

Objective:To explore new methods to assist the diagnosis of glucose transporter type 1 deficiency syndrome (GLUT1-DS).Methods:Sixteen children with epilepsy and/or movement disorder carrying the SLC2A1 mutation who admitted to Department of Pediatrics, the First Medical Center, Chinese People′s Liberation Army General Hospital and Department of Nutrition, Shanghai Deji Hospital from October 2019 to October 2020 were retrospectively analyzed.GLUT1-DS was diagnosed based on clinical phenotype, glucose level in CSF and/or genetic testing results.Forty-four healthy children who underwent physical examination in the First Medical Center, Chinese People′s Liberation Army General Hospital during the same period were selected as healthy control group.Glucose transporter 1 (GLUT1) level on the membrane surface of peripheral red blood cells and erythrocyte glucose uptake rate were measured by flow cytometry and glucose oxidase method, respectively.Their differences between groups were compared by the rank sum test.The receiver operating cha-racteristic (ROC) curve was plotted to assess their diagnostic value. Results:Sixteen children were diagnosed as GLUT1-DS.GLUT1 levels of 16 children with GLUT1-DS were significantly lower than those of healthy control group [17.96% (13.43%, 22.12%) vs.27.93% (24.76%, 34.30%), Z=5.249, P<0.001]. Area under curve (AUC) was 0.946, and weighted Kappa was 0.791 ( P<0.001). The erythrocyte glucose uptake was measured in 12 children with GLUT1-DS, which was significantly lower than that of healthy control group [23.14% (14.80%, 26.45%) vs.27.40% (24.61%, 32.82%), Z=2.366, P=0.018]. AUC and weighted Kappa were 0.724 and 0.344, respectively ( P<0.001), showing a poor consistency. Conclusions:GLUT1 level on the surface of human erythrocyte membrane measured by flow cytometry may be a new method to assist the diagnosis of GLUT1-DS.The erythrocyte glucose uptake rate test requires stricter experimental conditions and needs further investigation.

This article introduces the contents of the latest edition Risk of Bias in Non-randomized Studies-of Exposure (ROBINS-E) published in June 2022 [ROBINS-E (2022)], and gives some examples about its usage. ROBINS-E is a tool for assessing the risk of bias in non-randomized studies-of exposure. Compared with ROBINS-E (2019), ROBINS-E (2022) adds more bias for observational studies, covers a more comprehensive range of bias, and adds the assessment of the external authenticity of the study. ROBINS-E (2022) adds a preliminary evaluation process to improve the efficiency of evaluation. In addition, ROBINS-E (2022) visualizes and instrumentalizes the use of signal problems in the form of path graph, making it more convenient to use. ROBINS-E (2022), although more consideration has been given to the issue of co-exposure, still does not address the problem of effect modification in co-exposure, and there is still room to expand the applicable research.

Objective:To explore effects of different flow rates and temperature settings of high-flow nasal cannula oxygen therapy (HFNC) on patients with mild to moderate community-acquired pneumonia (CAP) accompanied by type I respiratory failure.Methods:Using the convenient sampling method, a total of 92 patients with mild to moderate CAP accompanied by type I respiratory failure who were admitted and received HFNC in the Department of Respiratory and Critical Care Medicine in a Class Ⅲ Grade A hospital in Tianjin were selected as the research objects from December 2019 to December 2020. They were randomly divided into 4 groups, including low temperature and low flow rate group (31 ℃, 30 L/min) , low temperature and high flow rate group (31℃, 50 L/min) , high temperature and low flow rate group (34℃, 30 L/min) , high temperature and high flow rate group (34 ℃, 50 L/min) , with 23 cases in every group. Two-factor factorial analysis of variance was used to compare effects of different flow rates and temperature settings of HFNC on the comfort, oxygenation index, respiratory rate and heart rate of patients with mild to moderate CAP.Results:The comfort level of patients in the low flow rate group (30 L/min) was higher than that of the high flow rate group (50 L/min) , and the comfort level of patients in the low temperature group (31 ℃) was higher than that of the high temperature group (34 ℃) . The differences were statistically significant ( P<0.01) . The oxygenation index of patients in the high flow rate group (50 L/min) was higher than that of the low flow rate group (30 L/min) , and the difference was statistically significant ( P<0.01) . Different flow rates and temperatures of HFNC have no interaction effect on the comfort, oxygenation index and heart rate of patients ( P>0.05) , but they have an interaction effects on respiratory rate ( P<0.01) . Individual effect analysis showed that the respiratory rate of patients in the low temperature and high flow rate group (31 ℃, 50 L/min) was lower than that of the high temperature and high flow rate group (34 ℃, 50 L/min) and the low temperature and low flow rate group (31 ℃, 30 L/min) , and the differences were statistically significant ( P<0.01) . Conclusions:For patients with mild to moderate CAP accompanied by type I respiratory failure, the application of HFNC should start with low temperature and low flow rate parameter settings. Under the condition of ensuring the patient's comfort, the overall effect of flow rate and temperature is integrated and the inhalation flow rate of HFNC is appropriately increased, which can increase the clinical effect of high-flow nasal cannula oxygen therapy.

Objective:To summarize the best evidence for exercise intervention in elderly patients with sarcopenia in intensive care unit (ICU) through literature search, and provide a reference for clinical implementation of early exercise intervention in this population through evidence-based practice.Methods:① Summary of best evidence: relevant literature on exercise intervention for elderly patients with sarcopenia in ICU, including guideline, evidence summary, expert consensus, systematic review, and original study [quasi-experiment and randomized controlled trial (RCT)] from UpToDate Clinical Advisor, Ovid database, National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, SinoMed, CNKI, Wanfang Database, VIP, and Yimai Tong Guideline Network were systematically searched. The search period covered from the establishment of these databases up to August 24, 2023. The quality of the literature was evaluated by two researchers with methodological expertise in evidence-based medicine, and the evidences were extracted and summarized. ② Evidence-based practice: the elderly patients with high risk of sarcopenia who had been hospitalized in the ICU for more than 7 days from January to April 2024 were enrolled as the research subjects, and they were divided into a control group and an intervention group using convenience sampling method. The control group received routine intensive care nursing. The intervention group implemented exercise intervention based on the actual situation of the patients, the baseline review was conducted before evidence application, and the effectiveness of evidence application at 7 days and 14 days was evaluated.Results:① A total of 19 pieces of literature were included, including 4 guidelines, 1 summary of evidence, 4 expert consensuses, 4 systematic reviews, and 6 original studies (1 quasi-experiment, 5 RCT). After literature quality evaluation, all 19 articles were enrolled. Finally, 31 pieces of best evidence were extracted from eight aspects, including assessment and diagnosis, multidisciplinary cooperation, indication, preparation before intervention, intervention program, safety monitoring, post-intervention evaluation, and special task. ② Finally, a total of 30 patients were enrolled in the intervention group, of which 17 completed 14 days of rehabilitation exercise, and 13 completed 7 days of rehabilitation exercise. Twenty-seven patients were enrolled in the control group, of which 17 completed 14 days of monitoring, and 10 completed 7 days of monitoring. Clinical evidence application results showed that the patients in the intervention group did not experience adverse events such as increased heart rate, extubation, or physical discomfort. The skeletal muscle mass index (SMI) in both groups was gradually decreased with the prolongation of intervention duration, but the 7-day SMI in the intervention group was significantly higher than that in the control group (kg/m 2: 8.61±2.66 vs. 6.65±1.50, P < 0.01). Conclusion:By summarizing the best evidence and evidence-based practice of exercise intervention for elderly patients with sarcopenia in ICU, this study confirmed the feasibility due to safe and effective of implementing early exercise intervention for elderly sarcopenia patients in ICU.

Objective:To investigate and analysis of the occurrence and influencing factors of sarcopenia in elderly critically ill patients in the intensive care unit (ICU).Methods:A prospective cohort study was conducted. Elderly patients (aged ≥ 60 years) admitted to the ICU of Tianjin Medical University General Hospital from November 2023 to June 2024 were enrolled. Clinical records were collected, and conduct muscle mass and strength measurements, as well as upper arm circumference and calf circumference were measured. Appendicular skeletal muscle index (ASMI) of less than 7.0 kg/m 2 for males and less than 5.7 kg/m 2 for females was defined as reduced muscle mass, grip strength of less than 28 kg for males and less than 18 kg for females was defined as decreased muscle strength, patients meeting both low muscle mass and low muscle strength criteria were diagnosed with sarcopenia. According to the diagnostic criteria for sarcopenia, patients were divided into sarcopenia group and non-sarcopenia group. Multivariate Logistic regression analysis was applied to identify risk factors for sarcopenia in the elderly and to develop a predictive model for the occurrence of sarcopenia. The predictive value of various risk factors for sarcopenia in elderly critically ill patients were evaluated by receiver operator characteristic curve (ROC curve). The Kaplan-Meier curve for the length of ICU stay of two groups patients were drawn. Results:Finally, 540 elderly critically ill patients were included, including 43 patients with sarcopenia, and the incidence of sarcopenia was 8.0%. Univariate analysis showed that there were significantly differences in body mass index (BMI), number of hospitalizations in the past year, the length of ICU stay, ventilation mode, duration of mechanical ventilation, pre-admission exercise habits, nutritional support methods, upper arm circumference, calf circumference, and albumin infusion between the sarcopenia group and the non-sarcopenia group. Multivariate Logistic regression analysis showed that BMI [odds ratio ( OR) = 0.79, 95% confidence interval (95% CI) was 0.67-0.93, P = 0.004], calf circumference ( OR = 0.64, 95% CI was 0.54-0.76, P < 0.001), and duration of mechanical ventilation ( OR = 1.06, 95% CI was 1.01-1.12, P = 0.034) were associated with an increased risk of sarcopenia in elderly critically ill patients. The ROC curve results showed that the area under the curve (AUC) and 95% CI of BMI, calf circumference, and duration of mechanical ventilation for predicting sarcopenia in elderly critically ill patients were 0.828 (0.767-0.888), 0.889 (0.844-0.933), and 0.397 (0.299-0.496), respectively, with cut-off values of 22.95 kg/m 2, 28.25 cm, and 50.50 days, respectively. The Kaplan-Meier curve showed that the cumulative survival rate of patients with sarcopenia was significantly lower than that of the non-sarcopenia group (Log-Rank test: χ 2 = 5.619, P = 0.018). Conclusion:Lower BMI, smaller calf circumference, and longer duration of mechanical ventilation are associated with an increased risk of sarcopenia in critically ill elderly patients.

Objective:To explore the relationships between medical coping modes of patients with COVID-19 and general information and social supports.Methods:From January 28 to February 20, 2020, a total of 128 patients in a designated hospital in Wuhan with novel coronavirus pneumonia were investigated using the General Information Questionnaire and the Chinese version of the Medical Coping Modes Questionnaire (MCMQ) by convenient sampling. Pearson univariate analysis and multiple linear regression were used to analyze the relationship between the basic situation of patients with novel coronavirus pneumonia and coping modes.Results:The scores of the face dimension and avoidance dimension of patients with COVID-19 were lower than the norm model, while the yield dimension was higher than the norm model, and the differences were statistically significant ( P<0.05) . Support utilization and complexity were influencing factors of the face dimension ( P<0.05) . Support utilization and age were influencing factors of the yielding dimension ( P<0.01) . Subjective support, the complexity dimension of disease uncertainty and the number of confirmed patients in the family were influencing factors of the avoidance dimension ( P<0.01) . Conclusions:Patients with COVID-19 have poor medical coping modes, and they are prone to face the disease with a negative attitude. Patients are unwilling to face the disease and the tendency to yield to the disease is greater. And the older the patients, the less likely they are to succumb to the disease. The more patients diagnosed in the family, the less likely they are to avoid the disease. Patients with higher social supports and utilization have a more reasonable medical coping mode. This reminds medical staff to pay more attention to the psychological problems of patients in coping with COVID-19 and improve their coping modes and methods.

Objective:To understand the sleep quality and mental health status of nurses in public health emergencies, and analyze the correlation between them.Methods:A total of 128 first-line nursing staff participating in public health emergencies on February 22-23, 2020 in Tianjin Beichen Hospital, Tianjin First Central Hospital, Tianjin Fourth Central Hospital were investigated by the general data questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Symptom Checklist 90 (SCL-90).Results:70.3%(90/128) of nursing staff had poor sleep quality, and the total score of PSQI was (9.71±4.01) points, which was statistically significant compared with the domestic norm ( t value was 16.479, P<0.01). The total score of SCL-90 was 1.59±0.52, which was statistically significant compared with the domestic norm ratio ( t value was 4.505, P<0.01). One-way ANOVA showed that the nursing staff's age had a significant impact on sleep quality, and the difference was statistically significant ( F value was 4.092, P<0.05). Pearson correlation analysis showed that the Pittsburgh sleep quality scale index scores and symptom self-assessment scale and somatization, force, sensitive interpersonal relationship, depression, anxiety, hostile, terrorist, paranoia, and psychosis were positively correlated( r values were 0.292-0.444, P< 0.01). Conclusions:The sleep quality and mental health status of nurses in public health emergencies are poor, and the sleep quality is correlated with mental health status.