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 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.

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.

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.

Objective:To investigate the role and mechanism of retinal Sigma-1 receptor antagonist N, N-diethyl-2-[4-methoxy-3-(2-phenylethoxy)phenyl]ethanaminehydrochloride (NE-100) in the formation of form deprivation myopia (FDM) in guinea pigs.Methods:Eighty-five 21-day-old guinea pigs were selected, and 36 of them were randomly divided into normal control group, occluded 14-day group and occluded 11-day group, with 12 in each group.The right eyes of guinea pigs in the occluded 14-day group were covered with translucent eye shield for consecutive 14 days, and guinea pigs in the occluded 11-day group were treated in the same way for consecutive 11 days plus 3 days without cover, and guinea pigs in the normal control group were not covered.The other 49 guinea pigs were randomly divided into FDM group ( n=10), FDM+ NE-100 6 μg group ( n=12), FDM+ NE-100 60 μg group ( n=10), FDM+ NE-100 600 μg group ( n=9), and FDM+ saline group ( n=8). The right eyes in each group received 100 μl peribulbar injection of NE-100 6 μg, 60 μg and 600 μg or saline once a day according to grouping.Ocular refraction and axial dimensions were measured using eccentric infrared photorefractor and A-scan ultrasonography, respectively.Corneal curvature was measured with keratometer.Immunohistochemical staining and Western blot were used to detect the expression levels of Sigma-1 receptor protein, and retinal dopamine content was evaluated by high-performance liquid chromatography with electrochemical detection.This study was approved by an Ethics Committee of the Department of Laboratory Animal Science of Central South University (No.2020sydw0084). The use and care of experimental animals followed the Regulations for the Administration of Affairs Concerning Experimental Animals in China. Results:There were statistical significant differences in diopter and axial length among the normal control group, occluded 14-day group and occluded 11-day group ( F=147.81, 160.10; both at P<0.01). Compared with the normal control group, the relative myopia was the deepest and the axial length was the longest in the occluded 14-day group, then the occluded 11-day group, showing significant differences between them (all at P<0.05). In the normal control group, Sigma-1 protein was mainly expressed in retinal ganglion cells (RGCs), photoreceptor inner segment and the inner nuclear layer.In the occluded 14-day group, Sigma-1 protein staining was enhanced in RGCs and photoreceptor inner segment.Sigma-1 staining positive cells in the inner nuclear layer were increased significantly and were also seen in the inner and outer plexiform layers, especially in Müller cells, in which the expression levels of Sigma-1 receptor protein were significantly increased.Compared with the occluded 14-day group, the Sigma-1 receptor protein expression levels in the retina of the occluded 11-day group was significantly decreased ( P<0.01). The diopters of guinea pigs in the FDM+ NE-100 6 μg, 60 μg and 600 μg groups were lower than those in the FDM group, and the diopters of FDM+ NE-100 60 μg and 600 μg guinea pigs were lower than those in the FDM+ NE-100 6 μg group, and the differences were statistically significant (all at P<0.05). The dopamine content in the retina of the FDM+ NE-100 60 μg group was (0.74±0.09) ng/mg, which was significantly higher than (0.57±0.10) ng/mg in the FDM group, with a significant difference between them ( t=15.18, P<0.01). Conclusions:Sigma-1 receptor antagonist inhibits FDM formation, which may be associated with the elevation of dopamine content in retina.

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.

Objective:To optimize the Manchester needs tool for injured children (MANTIC) scale , and evaluate its reliability and validity among injured children. Methods:The MANTIC scale was optimized through Delphi expert consultation and pre-tests. From March 2023 to June 2023 , a total of 317 injured children admitted in 7 level A tertiary hospitals in Zhejiang and Shandong provinces and their families were surveyed with general data, optimized MANTIC scale, and EuroQol 5-dimension health questionnaire for youth (EQ-5D-Y). Item analysis was conducted on the data of the 317 patients collected with optimized MANTIC scale through the test for homogeneity and value-based decision-making method and the content validity test of the scale was evaluated with item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). It was evaluated with KMO test values and Bartlett′s test of sphericity to determine whether the scale was suitable for exploratory factors. The number of common factors was determined based on the K1 criterion and scree plot to further obtain the structural validity of the scale of the item load value. The correlation validity of the scale was evaluated with the correlation coefficient of the optimized MANTIC scale and EQ-5D-Y. The reliability of the scale was tested with Cronbach alpha coefficient and Guttman split-half reliability coefficient. Results:A total of 332 questionnaires were distributed, among which 317 valid ones were collected, with a response rate of 95.6%. The test of homogeneity in the item analysis showed that the correlation coefficient between each item and the total score of the scale was 0.40-0.80. The results of the value-based decision-making method showed that the critical ratio of high-and low-scored groups was 6.08-28.01. The quality of all the items met the retention requirements so that the reliability and validity tests could be continued. Validity test found that I-CVI was 0.83-1.00, consistent S-CVI was 0.83, and mean S-CVI was 0.95. In structural validity analysis, the KMO value was 0.96, and the Chi-square value of Bartlett′s test of sphericity was 10755.76 ( P<0.01). A total of 9 common factors were extracted with the K1 criterion (eigen value>1), and the scree plot indicated 9 common factors with a cumulative variance contribution rate of 73.46%. Factor extraction and rotation showed that the load value of each item of the scale ranged from 0.589 to 0.874. The correlation coefficient of the optimized MANTIC scale and EQ-5D-Y was r= 0.55 ( P<0.01).Reliability test showed that the Cronbach alpha coefficient of the total scale and all dimensions was 0.96 and 0.77-0.98, and the Guttman split-half reliability coefficient was 0.76 and 0.73-0.98. Conclusion:The optimized MANTIC scale can attain good reliability, validity, consistency and stability, and can reflect the concept to be expressed and the content to be evaluated, indicating that it can be used to evaluate the injury rehabilitation needs of injured children and their families throughout the entire treatment process.