Objective To develop anoverlap syndrome (OS)rat model by intermittent hypoxia (IH) exposure on the base of pre-existing emphysema, and to explore its characters of severe systemic inflammation and immune responses. Methods Sixty Wistar rats were put into four groups:control group, IH group, emphysema group and overlap (emphysema+IH) group. The peripheral blood samples were collected for detecting apoptosis of CD3+CD4+,CD3+CD8+T lymphocytes and neutrophils (PMN). Tumor necrosis factor (TNF)-αand interleukin (IL)-6 were evaluated by ELISA. The bronchoalveolar la-vage fluid (BALF) was taken to calculate the ratio of macrophages, neutrophils and lymphocytes under light microscope. Tis-sue blocks of lung, liver, pancreas, and right carotid artery were taken for pathologic scoring. Results The apoptotic rates of PMN and CD3 +CD8 +T cells were significantly lower in overlap group than those of other three groups (P<0.05). Pro-in-flammatory factor IL-6, TNF-αand peripheral blood CD3 +CD4 +T cell apoptosis were the highest in overlap group com-pared to those of other three groups (P<0.05). The ratio of PMN and macrophages in BALF were significantly higher in em-physema group than those of other three groups (P<0.05) and the pathology scores of lung, liver, pancreas, the ratio of carot-id artery intima-media thickness of whole thickness of vascular were significantly higher in overlap group than those of other three groups (P < 0.05).Conclusion In rat model of intermittent hypoxia-emphysema there are more serious systemic multi-organ inflammation and immune responses.

Objective To observe changes of erythropoietin (EPO) and rheology in moderate and severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients after the noninvasive positive pressure ventilation (NPPV) treatment. Methods Healthy adults were selected as control group (n=40) while moderate to severe OSAHS patients were selected as OSAHS group. OSAHS group was underwent NPPV treatment then, Levels of sleep apnea hypopnea index (AHI), sleep mean minimum oxygen saturation (LSaO2) and serum erythropoietin (EPO) were assessed, routine blood test and hemodynam-ic indexes were also checked before treatment and 1 and 3 months after treatment in both groups. Results In both groups serum EPO, blood, blood rheology indexes, AHI, LSaO2 were analysised at each time point by ANOVA repeated measures, all of which show significant different between groups and between each time points within the same group. Indexes in OSAHS group improved with prolonged treatment , but they are in the normal range in the control. Conclusion OSAHS pa-tients with NPPV therapy can significantly relieve hypoxia, reduce serum EPO level and blood viscosity. So NPPV has impor-tant clinical significance in prevention and treatment of OSAHS.

Objective To explore the effect of intermittent hypoxia (IH) on RhoA/ROCK pathway in lung and on the muscularization in pulmonary vascular in rat model. Methods Wistar rats (n=40) were randomly divided into two groups:the normal oxygen control group (n=20) and the IH group ( n=20). For 4 weeks, rats in control group and IH group were ex?posed to intermittent normal oxygen (21%O2) or IH (5%-21%O2) respectively. Then, mRNA transcription and protein trans?lation levels of RhoA/ROCK were examined by Real-time PCR and Western blot. Expression of proliferation cell nuclear an?tigen (PCNA) andα-smooth muscle actin (SM-α-actin ) of lung and pulmonary artery were detected by immunohistochemis?try. Results RhoA mRNA transcription level(0.463 ± 0.067 vs 0.182 ± 0.040), ROCK mRNA transcription level(0.384 ± 0.062 vs 0.192 ± 0.052), RhoA protein expression level(0.827 ± 0.065 vs 0.424 ± 0.075)and ROCK protein expression level (0.488±0.088 vs 0.336±0.102)were higher in IH group than those in control group(P<0.05);Levels of PCNA in lung tissue [(54.67±1.80)%vs (9.14±0.91)%], PCNA in pulmonary artery [(49.40±1.21)%vs (8.38±1.13)%], SM-α-actin in lung tis?sue [(42.66±1.63)%vs (35.44±1.41)%] and SM-α-actin in pulmonary artery [(62.62±2.53)%vs (45.54±2.58)%] were also higher in IH group than those in control group(P<0.05). Conclusion Rho/ROCK pathway may play an important role in developing pulmonary hypertension (PH) associated with IH;and IH can promote the muscularization in pulmonary vascular to accelerate PH.

Aim To investigate the role of autophagy and its mechanism in Raji cell death induced by arse-nic trioxide. Methods Transmission electron micros-copy ( SEM) and MDC fluorescence staining were used to observe autophagy. MTT colorimetry was employed to assay the cellular proliferating activity. Cell apopto-sis and cell cycle analysis were performed using FITC-Annexin-V/PI double staining and flow cytometry ( FCM) . The expressions of LC3 and the conversion of LC3-I to LC3-II were measured by western bloting. The expression of bcl-2 mRNA and p53 mRNA were detected by reverse transcription-polymerase chain re-action ( RT-PCR ) . Results Arsenic trioxide could obviously inhibit the proliferation of Raji cells, arrest the cells at G2/M phase and induce apoptosis. Mean-while, arsenic trioxide markedly inhibited the expres-sion of bcl-2 mRNA and enhanced the expression of p53 mRNA in Raji cells. Arsenic trioxide also induced autophagy synchronously which paralleled with the in-duction of apoptosis in Raji cells, and 3-MA, an auto-phagy inhibitor, was able to reverse the arsenic triox-ide-activated autophagic activity, up-regulate bcl-2, down-regulated p53 expression and suppress the lethal effect of arsenic trioxide on Raji cells to reduce their sensitivity to arsenic trioxide. In contrast, the Rapamy-cin, an autophagy inducer, possessed the completely opposite effects on Raji cells compared with 3-MA. Conclusions The apoptosis and autophagic cell death are coexistent in arsenic trioxide-triggered death of Raji lymphoma cells, and Bcl-2 and p53 may play a key regulating role in this process.

With the organic combination of rapid on-site evaluation (ROSE) and interventional pulmonary diagnostic technology, we can build a complete The System of Diagnostic Interventional Pulmonology Based on Rapid on-site Evaluation. With the help of ROSE, changing the ways, methods and modalities of interventional pulmonary diagnostic technology to obtain the target lesions is the core of this system. In this statement, the most commonly used standard operating techniques in The System of Diagnostic Interventional Pulmonology Based on Rapid on-site Evaluation are described in detail, including double-hinge curette operating technique, transbronchial lung biopsy (TBLB) technique, and transbronchial brushing technique.

Objective To observe the impact of improving the compliance of ventilator bundle on morbidity of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients undergoing mechanical ventilation (MV) guided by context of Joint Commission International (JCI) settings, and to study the oral care efficacy of suction tube sponge brush. Methods A prospective study was conducted. The patients who needed MV admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2013 to December 2016 were enrolled. In the context of JCI settings, necessary measurements were taken to enhance the compliance of ventilator bundle each year. In 2013, the preventive measures were set up and the education was strengthened. In 2014,the compliance of hand hygiene and bedside elevation was strengthened. In 2015, a control study was conducted to evaluate the effect between the traditional cotton dipped in chlorhexidine and the suction tube sponge brush rinsed with chlorhexidine on oral health impact parameters. The suction tube sponge brush rinsed with chlorhexidine oral care was introduced to improve compliance. In 2016, electronic bundle checklist for daily self-audits was conducted. The annually morbidity of VAP through the software of hospital and ICU was collected and calculated. The annual incidence of VAP was indicated by the VAP cases per 1000 MV days. Based on the VAP incidence rate in 2013 as 1, the VAP incidence-rate ratio (IRR) of each year was calculated. Results During the study period, a total of 2733 patients admitted to the ICU, including 1403 patients undergoing MV. Ninety-four of the 1403 patients with community-acquired pneumonia (CAP), aspiration pneumonia, back elevation ban, incomplete information, and withdrew from the study were excluded. 1399 patients undergoing MV were enrolled in the final analysis, with total MV days of 11012 days, and 94 patients occurred VAP. The annual incidence of VAP was progressively declined from 2013 to 2016, and the VAP cases per 1000 MV days were 17.0, 10.0, 5.9, 3.5 cases, respectively. Based on the VAP incidence rate in 2013, the IRR of VAP from 2014 to 2016 was also progressively declined, which was 0.59 [95% confidence interval (95%CI) = 0.35-0.98], 0.35 (95%CI = 0.18-0.64), and 0.21 (95%CI = 0.09-0.41), with statistical significance (all P < 0.05). In 2013, ICU patients had the lowest rates of bedside elevation and hand hygiene compliance, which were 28.57% and 54.29%, respectively. Compared with 2013, by the implementation of two quality control circle (QCC) projects for bedside elevation and hand hygiene, the rates of bedside elevation and hand hygiene compliance were improved significantly in 2014, which were 82.35%, 91.18%, respectively (both P < 0.05). In 2015, the compliance of chlorhexidine oral care which was the worst performed in 2014 had been improved by the method of QCC, and the rate of the compliance was significantly higher than that in 2013 (87.10% vs. 62.86%, P < 0.05). Compared with 2013, bundle compliance was significantly increased in 2016, except for the sterile operation of the suction tube [daily wake and weaning: 95.00% vs. 71.43%, bedside elevation for over 30°: 92.50% vs. 28.57%, hand hygiene: 97.50% vs. 54.29%, chlorhexidine mouth care once per 6-8 hours:95.00% vs. 62.86%, turned back and posture drainage: 97.50% vs. 80.00%], the differences were statistically significant (all P < 0.05). The incidences of bad breath, dirt residue and plaque were significantly lower in the group of oral care by using suction tube sponge brush with chlorhexidine (30 cases) compared with the group of traditional cotton pad with chlorhexidine (30 cases; bad breath: 10.0% vs. 40.0% %, dirt residue: 16.7% vs. 70.0%, plaque: 3.3% vs. 30.0%, all P < 0.05). There was no significant difference in the incidence of oral ulcers between the oral brush group and the traditional group (10.0% vs. 30.0%, P > 0.05). Conclusion Ventilator bundle can effectively reduce the morbidity of VAP in the context of JCI settings, and the oral care by using suction tube sponge brush and chlorhexidine can effectively improve oral hygiene.

non-myeloablative BuCy+fludarabine conditioning regimen,and another one was treated with TBI+VP-1 6 +CTX+CCNU conditioning regimen.Only one case received short-term MTX,cyclosporin A and ATG regimen for prevention of graft-versus-host disease (GVHD).The GVHD prevention regimens of the other patients were based on short-term MTX,cyclosporin A,ATG and mycophenolate mofetil regimen.The hematopoietic reconstitution, complications and prognosis were observed.Results One patient died of intracranial hemorrhage,and hematopoi-etic reconstitution was achieved in the other 20 patients.The median time for hematopoietic reconstitution shortened by one day in large-dose group compared with that in low-dose group.Adverse reactions included high fever, shivering,gastrointestinal tract adverse reaction,liver injury,oral mucositis and other rare side effects.GVHD occurred more frequently in patients with HLA mismatched transplantation.Nine patients with aGVHD and 9 patients with cGVHD recovered after effective treatment.Within 100 days after transplantation,18 patients had bacterial or fungal infection,mainly upper respiratory tract infection;7 patients had cytomegalovirus infection;2 had EB viremia,and one had urinary BK virus infection.Only one patient died of VOD.Hemorrhagic cystitis occurred in 5 patients and improved after treatment.The median survival time was 24 months (ranging from 136 days to 9 years).One-year and 3-year overall survival rates were 85.2% and 63.9%,the disease free survival rates were 81% and 23.8%,recurrence free survival rates were 71.4% and 14.3%,respectively.Conclusion URD-HSCT was an effective method to treat leukemia.Conditioning regimen of BuCy and modified BuCy2 were safe and effective,the adverse reactions were reversible and well tolerated.Hematopoietic reconstitution time shortened in large-dose MNC and CD34 + cell number groups compared with that in low-dose group.The occurrence rate of GVHD with HLA mismatched transplantation was more than that of HLA matched transplantation.Low-dose heparin,prostaglandin E1 and Danshen injection can effectively prevent VOD.

Objective:To explore the effect of team positive psychological intervention on psychological state and coping style of nurses after being impacted by life events.Methods:From September 2020 to January 2021, 84 nurses who had suffered life events in Shanxi Provincial People's Hospital were selected by the convenient sampling method. According to the enrollment time, they were divided into the experimental group ( n=42) and the control group ( n=42) . The nurses in the control group were not give external intervention measures, while nurses in the experimental group adopted team positive psychological intervention. After 6 weeks of intervention, the Chinese version of Psychological Resilience Scale, Symptom Checklist 90 (SCL-90) and Simple Coping Style Questionnaire were used to compare changes in the psychological resilience level, mental health level and coping style of nurses in the two groups. Results:After intervention, the scores of toughness, strength and optimism dimensions and the total scores of Psychological Resilience Scale in the experimental group were significantly higher than those in the control group, and the differences were statistically significant ( P<0.05) . The total score of SCL-90 in the experimental group was significantly lower than that in the control group, and the difference was statistically significant ( P<0.05) . The score of positive coping dimension of nurses in experimental group was significantly higher than that in control group, and the score of negative coping dimension was significantly lower than that in control group, and the differences were statistically significant ( P<0.05) . Conclusions:Team positive psychological intervention can improve psychological resilience and mental health level of nurses who are impacted by life events. At the same time, it can also encourage them to adopt active coping methods to face problems, which is conducive to improving quality of nursing.

Objective:To investigate the effects of evidence-based precision nursing in patients with sarcopenia undergoing total knee arthroplasty (TKA) .Methods:By convenience sampling, totally 41 TKA patients with sarcopenia treated in the Department of Orthopedics at The First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were selected as the control group, and 41 TKA patients with sarcopenia treated from March 2022 to March 2023 as the observation group. Patients in the control group received conventional nursing care, while patients in the observation group received an evidence-based precision nursing plan. The differences in muscle mass, grip strength, physical activity ability, knee joint function, and quality of life between the two groups before and after the intervention were compared.Results:After the intervention, the total muscle mass, affected limb skeletal muscle mass, limb skeletal muscle mass, limb skeletal muscle mass index, and grip strength in the observation group were significantly higher than those in the control group ( P< 0.05). The scores on the Short Physical Performance Battery, Lysholm Score, and Sarcopenia Quality of Life Scale in the observation group were also significantly higher than those in the control group ( P<0.05) . Conclusions:Evidence-based precision nursing can improve postoperative muscle mass and strength, enhance physical activity ability and joint function, and improve the quality of life in TKA patients with sarcopenia.

Objective:To explore the effect of out-of-hospital nursing based on gratitude extension-construction theory on self-management efficacy of young and middle-aged patients undergoing percutaneous coronary intervention (PCI) .Methods:A total of 136 young and middle-aged patients who underwent PCI in Coronary Heart Disease Ward of Department of Cardiology in Henan Provincial People's Hospital were selected as the research objects by the convenient sampling method. The patients were randomly divided into the control group and the observation group by the envelop method, with 68 patients in each group. The control group received routine out-of-hospital nursing, while the observation group received out-of-hospital nursing based on gratitude extension-construction theory. Self-management efficacy was compared before and after intervention between the two groups.Results:After intervention, the scores for self psychological management, self-management confidence, self-management behavior, self-management cognition and self-management information in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.01) . Conclusions:Out-of-hospital nursing based on gratitude extension-construction theory can significantly improve self-management efficacy of young and middle-aged patients undergoing PCI.