[Objective] To sum up teacher He Lingzhi’s clinical experience and academic ideas on diagnosing and treating IgA nephrosis. [Method] From casa morbi, mechanism and clinical treatment based on differentiation of signs, it expounds teacher He Lingzhi ’s clinical experience and academic points, exampled with a case. [Result] The disease has main mechanism of Qi deficiency, teacher He Lingzhi divides the IgA nephrosis into types of Qi deficiency of lung and spleen, spleen and kidney, both deficiency of lung and kidney, Yang deficiency of spleen and kidney, Yin deficiency of liver and kidney, both deficiency of Qi and Yin, Yin and Yang, thus forms the treating rules of tonifying Qi to reinforce spleen, tonifying lung to nourish kidney, tonifying liver and kidney, Qi and Yin, Yin and Yang. The case here was relieved the nephrosis symptoms with the treatment. [Conclusion] Teacher He Lingzhi has rich clinical experience in treating IgA nephrosis with differentiation of signs, with definite cure effect.

Objective To investigate the clinical significance of peripheral blood Th17 cells and their cytokines in the patients with tongue squamous cell carcinoma.Methods Sixty-six cases of tongue squamous cell carcinoma in our hospital from January 2013 to January 2016 served as the research subjects and contemporaneous 42 volunteers undergoing healthy physical examination were selected as the control group.Peripheral blood was collected in all subjects.The proportion of peripheral blood Th17 cells was detected by flow cytometry.The IL-17,TGF-β and IL-6 cytokine levels were detected by ELISA.Results The proportion of peripheral blood Th17 cells,IL-17,TGF-β and IL-6 in the observation group and the control group were (1.46±0.41)% vs.(0.31±0.12)%,(123.36±21.20)pg/mL vs.(20.76±8.95)pg/mL,(215.80±21.52)pg/mL vs.(26.90±10.41)pg/mL,(17.32±8.02)pg/mL vs.(5.85±1.49)pg/mL respectively,the differences were statistically significant(P<0.05).The proportion of peripheral blood Th17 cells,IL-17,TGF-β and IL-6 levels were increased with the increase of tongue squamous cell carcinoma clinical stage (P<0.01).The TGF-β level was positively correlated with the IL-17 level (r=0.626,P=0.021),the IL-6 level was positively correlated with the proportion of Th17 cells and IL-17 (r=0.626,0.597,P=0.021,0.034).Conclusion The increase of Th17 cells and IL-17 expression plays an important role in the development and progression of tongue squamous cell carcinoma,Th17 cells and IL-17 cytokine can become the important target spots of anti-tumor therapy.

Objective To investigate the efficiency of levodopa in dopa responsive dystonia (DRD) patients and drugs safety in pregnancy cases confirmed by genetic detection.Methods The clinical characteristics of two patients were analyzed.Direct sequences were performed in guanosine triphosphate (GTP) cyclohydrolase Ⅰ (GCH1) gene and tyrosine hydroxylase (TH) gene mutation screening.Results Case 1 was a young man exhibiting writer's cramp and dystonia of lower legs with marked diurnal fluctuation.Writer's cramp could not be relieved by treatment of low dose levodopa/benserazide.After increasing dose,the symptom of writer's cramp appeared occasionally.Case 2 was a young woman who experienced gait disorder.The symptom disappeared completely by levodopa treatment.She used levodopa and benzhexol during pregnancy.By 38 gestational weeks,she gave birth to a healthy baby.Sequence analysis of GCH1 gene in case 1 revealed a mutation (c.230C ＞ G p.S77C) that is a novel pathogenic mutation.The confirmed mutation c.628delC (p.His210Thrfs* 5) found in case 2 had been reported previously.No mutations in TH gene were detected in two patients.Condnsions Most of DRD patients have dramatic response to levodopa,but patients exhibited writer' s cramp may respond to levodopa incompletely.The previous reports indicate that no adverse events have been reported in DRD pregnant women with the monotherapy of levodopa.

Objective To study the influence of the combined administration of Bletilla striata and Radix aconiti preparata with different doses or ratios on anhydrous ethanol-induced gastric mucosal injury in mice with gastric ulcer. Methods The uniform design method was adopted on the basis of two factors and seven levels, which aims to investigate the influence of combined oral administration of Bletilla striata and Radix aconiti preparata with different doses or ratios on gastric mucosal injury in the mice with gastric ulcer. The indices like gastric ulcer index and stomach mucosa damage index were used to help selecting the right dose or ratio of decoctions for further study. Results The combined administration of Bletilla striata and Radix aconiti preparata at a certain proportion could reduce gastric ulcer index and stomach mucosa damage index. According to the regression analysis, the gastric ulcer index and stomach mucosa damage index were obviously inhibited by Bletilla striata, while this function decreased with the combined administration of Bletilla striata and Radix aconiti preparata. However, an interactive effect between each other has not been found. The influence of decoctions on the gastric ulcer index and stomach mucosa damage index became less when the compatibility ratio of Radix aconiti preparata increased, which referred to the total dose ranged between 3.64 g/kg and 29.32 g/kg. Conclusions The effect of the combined administration of Bletilla striata and Radix aconiti preparata showed relationship among the doses and ratios on anhydrous ethanol-induced gastric mucosal injury in mice with gastric ulcer.

Objective To introduce the application of multiplex ligation-dependent probe amplification (MLPA) assays in the diagnosis of patients with hereditary neuropathy with liability to pressure palsies (HNPP).Methods Copy numbers of the exons in peripheral myelin prolein 22 (PMP22) gene,tektin 3 (TEKT3) gene and cytochrome c oxidase assembly protein 10 (COX10) gene were analyzed by MLPA in 8 patients diagnosed with HNPP clinically and 5 normal controls.Results Among the 8 patients,7 patients were identified to have deletion mutations according to their reduced peak area of PMP22 gene,TEKT3 gene and COX10 gene compared with that of normal controls.One patient with normal peak area of PMP22 gene,TEKT3 gene and COX10 gene showed no deletion of these genes.Conclusions MLPA assays can detect the copy numbers of genes in HNPP region through semi-quantitative analysis in a rapid,accurate way,which may be utilized widely in the genetic diagnosis among HNPP patients.

Objective To investigate the genetic relation between Cryptococcus neoformans var.the clinical strains in MLMT - 13 genotype and the environmental strains in MLMT - 36 genotype. Methods Multilocus microsatellite typing (MLMT) method was applied for the genotype analysis in our study.Through this method, we recognized two genotypes that distinguish a majority of clinical and environmental strains. In order to compare virulence between the two types, we chose to infect BALB/c mice (6 weeks,female) with 9 MLMT-13 strains and 10 MLMT-36 strains intravenously. Results Forty( 17 clinical and 23 environmental isolates) were analyzed. Of 17 clinical strains, 9 belonged to a major type of MLMT-13 (52.9%). They were mainly isolated from clinical specimens. About 43.5% of strains from the environment belong to a major type of MLMT-36, which are indigenous to environments and which were not isolated from clinical samples. The mortality rate and pathological changes of the above mice were observed during two months after injection. The results showed that the mortality rate of mice infected with MLMT-13 strains was 100%, while the mortality rate with MLMT-36 strains was 7. 5%. The pathological sections showed that lesions of MLMT-13 infected mice appeared in the brain, lungs, liver and kidneys, while the lesions of MLMT-36 infected mice only appeared in the brain. Most brains of MLMT-13 infected mice were distorted,and both the number and size of lesions in such brains were much larger than those of MLMT-36 infected mice. Conclusion Our study illustrated the virulent difference between MLMT-13 and MLMT-36, which are isolated from patients and environment respectively. The results inferred that some genetic changes, such ss microsatellite repeats, might occur between environmental and clinical isolates through their environmental adaptation progress.

Objective:To investigate the antiviral efficacy of direct-acting antiviral agents (DAAs) in the treatment of liver transplantation (LT) recipients with hepatitis C virus (HCV) infection.Methods:Twenty-two HCV-infected LT recipients treated with DAAs at Fifth Medical Center of Chinese PLA General Hospital from December 2014 to June 2018 were retrospectively analyzed, Twenty cases of HCV RNA gene type 1b were treated with sofosbuvir (400 mg/d) + ledipasvir (90 mg/d) or sofosbuvir (400 mg/d) + daclatasvir (60 mg/d) for 12 weeks or 24 weeks; 2 cases of gene type 2a were treated with sofosbuvir (400 mg/d) for 12 weeks. The effect of antiviral treatment, adverse reactions during treatment, and laboratory indicators such as HCVRNA quantification, blood routine, liver and kidney function during treatment and follow-up were studied.Results:The LT recipients of HCV infection included 16 males and 6 females, with a median age of 61.5 (36-71) years old, and the median time of antiviral treatment was 48 (2-117) months after transplantation. Among the 22 patients, 16 received a 12-week course of treatment. Except for 2 patients who did not get HCVRNA negative conversion at 4-week, all achieved a negative HCV RNA at 4-week and the end of the treatment. Six LT recipients received a 24-week course of treatment (gene type 1b), and HCVRNA was negative at 4-week and the end of treatment. All patients achieved end of treatment virological response and a sustained virological response (SVR) rate of 100% at 12 weeks and 24 weeks after the end of treatment. The serum levels of alanine aminotransferase (ALT) and creatinine were 71.5 (30, 110) U/L and (89.4±25.7) mmol/L before treatment, respectively. ALT decreased to 22 (17.8, 28.5) U/L after 4 weeks of treatment, and serum creatinine decreased to (77.4±11.5) mmol/L at 24 weeks after the end of treatment. The differences before and after treatment were statistically significant (all P<0.05). No serious adverse events occurred during the treatment. Conclusions:DAAs have a definite antiviral effect in the treatment of LT recipients with HCV infection, and long-term SVR can be obtained.

Objective:To deeply understand the inner experiences of undergraduate nursing interns using Nursing Information Systems (NIS) and provide references for formulating relevant intervention strategies.Methods:A descriptive phenomenological approach was adopted for this qualitative study. Purposeful sampling was used to select undergraduate nursing interns from four comprehensive hospitals in Hangzhou during February to May 2023 for semi-structured interviews. The interview data were analyzed using Colaizzi's seven-step method to extract themes.Results:Four themes were identified in this study: insufficient preparedness of undergraduate nursing interns in using NIS, low engagement of undergraduate nursing interns in using NIS, perceived benefits of using NIS by undergraduate nursing interns, and adaptation strategies of undergraduate nursing interns using NIS.Conclusions:There are issues such as insufficient preparedness and low engagement among undergraduate nursing interns in using NIS. Some respondents experience emotions such as anxiety, fatigue, and decreased enthusiasm. It is recommended that colleges and internship hospitals pay attention to the clinical work demands and the learning needs of nursing interns, thus providing education and support for the use of NIS.

Objective:To explore the research status of artificial intelligence in nursing in China, so as to provide reference for conducting research domestically.Methods:The relevant literature collected from January 1, 2003 to May 1, 2023 was searched on China National Knowledge Infrastructure, WanFang Data, and VIP. CiteSpace and VOS viewer were used to visually analyze the research status, hotspots, and frontiers of artificial intelligence in nursing in China from the aspects of annual publication volume, region, institution, author, high-frequency keywords, and emerging words.Results:A total of 494 articles were included. In terms of publication volume, domestic research showed an overall upward trend, with publishing institutions mostly concentrated in economically developed and medically advanced regions. The authors of the articles often collaborated with research groups, with a co-authorship rate of 81.17% (401/494), but there was relatively little collaboration between groups. Research hotspots were focused on the application of artificial intelligence in geriatric nursing, rehabilitation nursing, Operating Rooms, and drug formulation, with a majority of research related to robots.Conclusions:The research enthusiasm in related fields in China is currently on the rise. Research on artificial intelligence in nursing management, nursing education, and psychological nursing can be strengthened, and the application of artificial intelligence can be enriched. At the same time, research institutions and personnel should strengthen mutual cooperation, and relevant national departments should improve laws and regulations to promote the vigorous development of this research field.

ObjectiveTo investigate the risk factors for tumor recurrence and death after liver transplantation in patients with hepatocellular carcinoma (HCC) and their survival. MethodsThe patients with HCC who underwent liver transplantation in The Fifth Medical Center of Chinese PLA General Hospital from January 2005 to February 2019 were enrolled, and according to the presence or absence of HCC recurrence after liver transplantation, they were divided into recurrence group and non-recurrence group. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to determine the risk factors for HCC recurrence and death after liver transplantation. The Kaplan-Meier method was used for survival analysis, and the receiver operating characteristic (ROC) curve was used to investigate the predictive value of death-related risk factors after liver transplantation. ResultsA total of 391 HCC patients who underwent liver transplantation were enrolled, with a median follow-up time of 2 years, among whom 78(19.95%) experienced HCC recurrence. Preoperative alpha-fetoprotein (AFP) level＞200 ng/ml (recurrence: hazard ratio ［HR］=252, 95% confidence interval ［CI］: 1.58-4.03, P＜0.001; death: HR=2.99, 95%CI: 1.59-5.62, P＜0.001］, total tumor diameter (recurrence: HR=1.20, 95%CI: 1.12-1.28, P＜0.001; death: HR=1.10, 95%CI: 1.02-1.17, P=0.002), and vascular invasion (recurrence: HR=1.15, 95%CI: 1.04-1.26, P=0.016; death: HR=1.10, 95%CI: 1.03-1.18, P=0.004) were independent risk factors for tumor recurrence and death after liver transplantation. The 1-, 5-, and 10-year overall survival rates after liver transplantation were 94.8%, 84.2%, and 83.5%, respectively, and the 1-, 5-, and 10-year disease-free survival rates were 840%, 75.1%, and 75.1%, respectively. AFP, involvement of major blood vessels, body mass index, and total tumor diameter had a certain value in predicting the death of HCC patients with recurrence, with an area under the ROC curve of 0.789 (95% CI: 0.719-0858). ConclusionTumor biological features before transplantation are the key factors for tumor recurrence after transplantation.