ObjectiveTo explore the points of nursing cooperation during hand-assisted thoracoscopic surgery for simultaneous operation of bilateral lung metastasectomy.Methods The preoperative preparation,nursing cooperation during the surgery,the cleaning and maintenance of surgical instruments and equipment after operation were retrospectively summarized in 72 patients who underwent hand-assisted thoracoscopic surgery for simultaneous treatment of bilateral pulmonary metastases. ResultsAll the procedures of surgery were smooth.No patients were converted to thoracotomy or died of surgery. Conclusions It is an important challenge for nursing quality in the operation room and the cleaning and maintenance of surgical instruments and equipment in carrying out hand-assisted thoracoscopic surgery.The skilled nursing cooperation and standardized operating procedures could improve the quality of intraoperative nursing cooperation.It could ensure the smooth process of simultaneous operation of bilateral lung metastasectomy.

Objective To explore the influence of integrated traditional Chinese medicine and western medicine on neurological function in patients with ischemic stroke.Methods One hundred patients with ischemic stroke were randomly divided into a treatment group and a control group.Both groups were given basic treatment.At this basis,sixty patients in the treatment group were given Chinese decoction,Kudiezi injection,traditional Chinese medicine soaking,and comprehensive rehabilitation; forty patients in the control group were given citicoline,modem rehabilitation techniques.Both groups were treated for 21 days.The scores of NIHSS,ADL,and MMSE were assessed at 7th day,14th day,and 21st day after admission of the trial,respectively.Results After 14 days,the scores of NIHSS (22.33± 1.06)in treatment group were decreased significantly (P＜0.05).After 21 days,the scores of NIHSS,ADL,MMSE in treatment group were(18.73±1.23),(20.19±2.17),(38.68±2.85),and(21.65±l.41),(25.37±2.34),(32.12±3.11)in control group,the improvement of scores in treatment group were superior to the control group (P＜0.05).The total effective rate was 91.67％ in treatment group,and 70％ in control group,it was significantly higher in treatment group than that in the control group (x2=7.98,P＜0.05).Conclusion The therapy of integrated traditional Chinese medicine and western medicine can significantly improve ischemic stroke,enhance the therapeutic efficiency of patients with ischemic stroke.

Objective To explore the influence of Danhong injection on neurological function and concentration level of high-sensitivity C-reactive protein (hs-CRP),tumor necrosis factor alpha(TNF-α),interleukin 6 (IL-6) in patients with acute cerebral infarction.Methods According to random number table method,eighty patients with acute cerebral infarction were randomly divided into a control group and a treatment gruop.Both groups were treated by aspirin,vitamine E,C and symptomatic treatment.At the same time,the treatment group was added Danhong injection,the control group was added low molecular dextran and citicoline,once a day,for 14 days.Results After the treatment,the concentration levels of hs-CRP [treatment group (2.11 ± 0.31) mg/L,control group (2.72 ± 0.23) mg/L],TNF-α [treatment group (0.35 ± 0.07) μg/L,control group (0.51 ± 0.06) μg/L],IL-6[treatment group (18.17 ± 3.15) pg/ml,control group (28.13 ± 4.97) pg/ml]was significantly lower than those before the treatment in both groups (P＜0.05).However,the concentration level of hs-CRP,TNF-α,IL-6 in treatment group was significantly lower than that in control group (P＜0.05).ADL scores [treatment group (20.26±2.17) scores,control group (28.83 ± 2.93) scores] and NIHSS scores [treatment group (18.34± 1.25) scores,control group s (22.52 ± 1.09) cores] were significantly lower after treatment than those before the treatment in both groups (P＜0.05),but all scores in treatment group were significantly lower than those in control group (P＜0.05).Conclusion Danhong injection decreased the concentration level of hs-CRP,TNF-α,IL-6 and NIHSS scores,ADL scores significantly.It also alleviated neurological function defect,enhanced the patient's activities of daily living,and reduced the disability rate of ischemic brain damage.

Immune-mediated enteropathy (IME) is a rare gastrointestinal disease characterized by malabsorption syndrome caused by immune overreaction. The lack of specificity of clinical manifestations brings difficulties to clinical diagnosis and treatment. This article reviewed several commonly seen IMEs from the aspects of disease introduction, pathogenesis, clinical manifestations, diagnosis, and treatment, so as to improve the clinicians’understanding of the disease.

Mast cell activation syndrome (MCAS) is a chronic multisystem disorder caused by inappropriate activation of mast cells. The gastrointestinal tract harbors a large population of mast cells and is easily to be involved by MCAS. Being an under-recognized disease, and because gastrointestinal symptoms are frequently reported, MCAS is often misdiagnosed as functional gastrointestinal disorders(FGIDs). Definite diagnosis should be based on the clinical manifestations, detection of mast cell mediators and pathological examination; and above all, other organic diseases should be excluded. Routine symptomatic treatment is often ineffective in relieving gastrointestinal symptoms. In addition to avoiding triggers, the best treatment modalities are mast cell mediator antagonists and regulation of the activation process of mast cells. In this article, the function of mast cells, and the clinical manifestations, diagnosis, differential diagnosis and treatment of MCAS were briefly introduced.

The purpose of this study was to prepare dabigatran etexilate nanoemulsion to improve bioavailability of dabigatran etexilate, a poorly water-soluble drug. The physicochemical properties and the stability of dabigatran etexilate nanoemulsion were investigated. Equilibrium solubility of dabigatran etexilate in commonly used oil materials for nanoemulsion were determined for selection. Then, surfactant and co-surfactant were chosen based upon the plooted pseudo-ternary diagrams. The formulation and preparation process were further optimized with orthogonal design. As a result, the dabigatran etexilate nanoemulsion was formulated based on the system consisting of Oil Acid/Labrafac Lipophile WL1394/Cremophor RH40/Transcutol P/H2O. The dabigatran etexilate nanoemulsion was found to have a mean diameter of(57. 5±0. 2)nm, Zeta potential of -(20. 9±1. 4)mV, and the drug encapsulation efficiency of(85. 2±1. 0)%. Besides, the droplet size, stability constant and drug content of the nanoemulsion was found to have no significant changes in at least 3 months under room temperature. In conclusion, the uniform and stable dabigatran etexilate nanoemulsion with a clear and translucent appearance was obtained after the optimization of formulation and preparation process. Thus nanoemulsion could be a promising way for the improvement of bioavailability of dabigatran etexilate and other poorly water-soluble drugs.

Objective:To compare the expression levels of absent in melanoma 2 (AIM2) inflammasome pathways in rheumatoid arthritis (RA) and osteoarthritis (OA) synovial specimens.Methods:Synovial tissue samples were collected from 41 RA and 26 OA patients, respectively. Horseradish peroxidase immunohi stochemical staining was used to detect AIM2 inflammasome pathway-related proteins, including AIM2, apoptosis-associated speck-like protein containing a CARD(ASC), caspase-1, and interleukin-1 (IL-1β). A semi-quantitative score (H-score) was performed according to the degree of positiveness. Correlation analysis between H-score results and clinical indicators of erythrocyte sedimentation tate (ESR) and C-reactive protein (CRP) were performed. The H score between RA and OA was analyzed by t test and Spearman correlation analysis were utilized for correlation analysis between H score and ESR and CRP.Results:The H scores of AIM2 protein in RA synovial tissues was (132±7) and (54±8) in OA synovial tissues ( t=7.42, P<0.01). The H scores of ASC protein in RA synovial tissues was (107±9) and (74±6) in OA synovial tissues ( t=2.36, P<0.05). The H scores of caspase-1 protein in RA synovial tissues was (99±5) and (74±10) in OA synovial tissues ( t=2.15, P<0.05). The H scores of IL-1β protein in RA synovial tissues was (118±11) and (76±7) in OA synovial tissues ( t=3.30, P<0.05) . In the correlation analysis, AIM2 was positively correlated with ESR [ r=0.74, P<0.01, 95% CI(0.38, 0.9)], and ASC was positively correlated with ESR [ r=0.5, P<0.05, 95% CI(0.16, 0.74)], IL-1β was positively correlated with ESR [ r=0.62, P<0.05, 95% CI (0.31, 0.81)], and the difference was statistically significant ( P<0.05). At the same time, AIM2 was positively correlated with CRP [ r=0.65, P<0.05, 95% CI(0.25, 0.86)]; ACS was positively correlated with CRP [ r=0.42, P<0.05, 95% CI(0.05, 0.69)]. IL-1β was positively correlated with C-reactive Protein [ r=0.41, P<0.05, 95% CI(0.05, 0.67)] and positively correlated with C-reactive protein, and the difference was statistically significant ( P<0.05). Conclusion::The expression of AIM2 inflammasome pathway-related proteins in RA synovium, including AIM2, ASC, caspase-1, and IL-1β, is higher than that of OA and are positively correlated with disease activity. Activation of AIM2 inflammasome pathway may be associated with the pathogenesis of RA disease activity.

Background: Glycolytic function is obviously related to the proliferation, metastasis and drug resistance of colorectal cancer, and there is still a lacking of corresponding indicators for quantitatively evaluating the level of glycolysis. Aims: To investigate the correlation between

Colonoscopy with polypectomy significantly reduces the incidence of colorectal cancer and cancer - related mortality. However, a pooled miss rate of 22% for polyps was documented. Aims: To explore the clinical application value of an artificial intelligence (AI)-based colorectal polyp diagnostic system for polyp detection. Methods: A total of 400 patients who underwent colonoscopy in the First Affiliated Hospital of Soochow University from September to November 2021 were selected according to the inclusion and exclusion criteria and were randomly divided into two groups: one group received routine colonoscopy, and the other group received AI system assisted colonoscopy. There were 200 cases in each group. The Boston Bowel Preparation Scale (BBPS) was used to evaluate bowel preparation quality. The primary outcome was polyp detection rate (PDR), and the secondary outcome was polyps per colonoscopy (PPC). Results: AI system significantly increased PDR and PPC (37.0% vs. 23.0%, 0.775 vs. 0.495, all P<0.05), especially for diminutive and small polyps (diminutive polyps: 23.0% vs. 13.0%, 0.410 vs. 0.295; small polyps: 16.0% vs. 8.0%, 0.255 vs. 0.095; all P<0.05). No significant difference in large polyp detection was observed between the two groups (all P>0.05). The bowel preparation quality was classified as“poor”(BBPS 0-5 points),“qualified”(BBPS 6-7 points) and“excellent”(BBPS 8-9 points). There were no significant differences in polyp detection between the two groups when the bowel preparation quality was“poor”or “excellent”(all P>0.05). PDR and PPC were significantly increased in AI group when the bowel preparation quality was “qualified”(33.0% vs. 20.0%, 0.670 vs. 0.450, all P<0.05). Conclusions: AI-based colorectal polyp diagnostic system can significantly improve PDR and PPC because of the significant increase in the number of diminutive and small polyps detected. In addition, when the bowel preparation is qualified, the AI system can play better for polyp detection.

Objective:To analyze and summarize the efficacy and safety of thalidomide in the treatment of refractory systemic juvenile idiopathic arthritis（sJIA）.Methods:The clinical data of ten patients with refractory sJIA admitted to Department of Nephrology and Immunology in Children's Hospital of Hebei Province from January 2015 to March 2022 were collected，and the clinical manifestations，efficacy and safety of thalidomide in the treatment of refractory sJIA were analyzed retrospectively. Systemic juvenile arthritis disease activity score（sJADAS）was used to evaluate the efficacy of the treatment. Statistical analysis was performed by repeated measurements using general linear models.Results:Among the 10 children（4 males and 6 females）with refractory sJIA，the average age of onset was（7.5±3.3）years. Seven patients were complicated with macrophage activation syndrome at an early stage of disease.The average course of disease was（4.4±1.7）years，and the longest course of disease was 8.3 years. Before the application of thalidomide，all the 10 children experienced relapses（ranging from 2 to 10 times）. The indices of 10 children treated with thalidomide at 6 months and 12 months were compared with those before treatment. Peripheral blood leukocytes［（10.19±3.67）×10 9/L，（8.53±2.83）×10 9/L vs.（16.11±7.81）×10 9/L， F=7.918，11.084， P=0.020，0.009］，C-reactive protein［19.13（0.38，35.21）mg/L，8.05（0.10，18.00）mg/L vs. 59.34（24.20，131.90）mg/L， F=7.030，12.731， P=0.026，0.006］，sJADAS scores［6.00（1.50，12.50）scores，3.00（0，12.50）scores vs. 20.00（11.50，28.00）scores， F=14.710，17.870， P=0.004，0.002］were decreased significantly. The doses of prednisone［0.13（0，0.45）mg/（kg·d），0.02（0，0.06）mg/（kg·d）vs. 0.42（0.16，1.47）mg/（kg·d）， F=5.890，7.623， P=0.041，0.022］were significantly decreased.All the differences were statistically significant. Prednisone was successfully discontinued in 7 cases. Tocilizumab was gradually withdrawn in 3 cases，and tocilizumab administration interval was prolonged in 1 case. None of the 10 children had serious adverse reactions. Conclusion:Thalidomide is clinically effective in the treatment of sJIA，and can reduce the required dose of prednisone and prolong the tocilizumab free remission.