Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.

Objective The preventive effect of epigallocatechin gallate(EGCG)on hyperglycemia-induced hemorrhagic transformation(HT)was analyzed,and the underlying mechanisms were further explored.Methods Male SD rats were randomly divided into sham operation group(Sham,n = 20),model group(n = 27),hyperglycemia model group(HG,n = 43),and EGCG group(n = 43).In the model group,only the electrocoagulation cerebral ischemia model was established,and the HG group and the EGCG group were used to establish the HT model with acute hyperglycemia combined with electrocoagulation cerebral ischemia model.In addition,EGCG was adminis-tered by gavage for 5 days before cerebral ischemia at a dose of 50 mg/kg/d.Further studies confirmed the relevant targets by using network pharmacology to predict the potential targets and pathways of EGCG in the occurrence of HT.Results Compared with the model group,the mortality rate of the rats in the HG group was significantly increased[21.2%(6/27)vs.51.2%(22/43),P＜0.05].The mortality of rats in the EGCG group was significantly lower than that in the HG group[30.20%(13/43)vs.51.2%(22/43),P＜0.05].Second,mNSS,Longa score and infarct volume in the EGCG group were significantly lower than those in the HG group(P＜0.05).The incidence of HT in the HG group was higher than that in the model group(59.3%vs.90.7%).EGCG significantly reduced the incidence of hyperglycemia-induced HT to 69.8%.Compared with the HG group,EGCG decreased the hemoglobin content from(53.42±5.11)mg/dL to(37.04±2.39)mg/dL respectively(P＜0.05).Network pharmacology revealed that Nrf2-Keap1-mediated neuroinflammation may be associated with hyperglycemia-induced HT.The expression of Nrf2 and Keap1 was significantly decreased and the expression of TLR4 and phosphorylation of NF-κB was significantly increased in the HG group,but EGCG reversed this process.Conclusion EGCG pretreatment prevents the occurrence of HT,which may be related to the neuroprotection mediated by activation of the Nrf2-Keap1 signaling pathway.

Objective To explore the role of protective function of Sestrin2(Sesn2)to mitochondria in alleviating cognitive dysfunction in mice with sepsis-associated encephalopathy(SAE).Methods 6-week-old male C57BL/6J mice were randomly divided into three groups:sham group,CLP group and CLP plus eupatilin group,40 mice in each group.A sepsis model was induced by cecal ligation and perforation(CLP).The CLP plus eupatilin group was treated with eupatilin.Neurobehavioral test and Morris water maze(MWM)were used to deter-mine neurobehavior and spatial learning and memory function in mice.The number of neurons in hippocampal CA1 area was counted by Nissl staining.HT22 cells were randomly divided into a control group(Con),lipopolysaccha-ride group(LPS),LPS plus eupatilin treatment group(LPS plus eupatilin)and LPS plus eupatilin and Nrf2 siRNA treatment group(LPS plus eupatilin and si-Nrf2).Apoptosis was analyzed by terminal deoxynucleotidyl transferase-mediated nick end labeling(TUNEL)staining,Mitochondrial membrane potential(MMP)was used to analyze mitochondrial damage.Results Seven days after CLP,as compared with sham mice,Sesn2 in hippocampus and cortex decreased significantly in CLP mice(P<0.01).As compared with CLP group,the survival rate in CLP plus eupatilin group increased significantly(P<0.05).As compared with sham group,the mice in CLP group showed a relatively high nerve injury score(P<0.05),and had fewer platform crossings and shorter target stay time,while the mice in CLP plus eupatilin group exhibited a lower injury score(P<0.05),and stayed in the target area for a longer time(P<0.05).As compared with sham group,the co-localization rate of neurons,Sesn2 and Nrf2 in CLP group decreased significantly(P<0.05),and the number of CD68/Iba-1 positive microglia increased significantly(P<0.05),while CLP plus eupatilin group reversed these changes.As compared with Con group,apoptosis and MMP level in LPS group increased significantly(P<0.01),while apoptosis and MMP level in LPS plus eupatilin group were lower than those in LPS group(P<0.05).However,Nrf2 knockdown(LPS plus eupatilin and si-Nrf2 group)reversed the anti-apoptosis and mitochondrial protection of eupatilin.Conclusions Eupatilin can alleviate cognitive dysfunction and neurological deficit in SAE mice by activating Sesn2-Nrf2 pathway,and improve inflammatory microenvironment by alleviating mitochondrial dysfunction.

Objective To investigate the impact of positive antinuclear antibody(ANA)and subsequent interven-tion therapy on the assisted reproductive technology outcomes among the patients experiencing recurrent implanta-tion failure(RIF).Methods A retrospective study was conducted on 344 RIF patients.Based on ANA test re-sults,the patients were divided into ANA-positive group(294 cases)and negative control group(50 cases).The ANA-positive group was further divided into a low titer group(214 cases)and a high titer group(80 cases).Com-parative statistical analyses such as the Wilcoxon rank-sum test,Mann-Whitney U test,Kruskal-Wallis test and chi-square test,etc.were employed to evaluate differences in general clinical data,embryo-related parameters,and pregnancy outcomes between the positive and negative groups.The impact of ANA on the assisted reproductive out-comes of patients with recurrent implantation failure was analyzed,and the outcomes of ANA-positive patients after intervention therapy were also analyzed.Results Notably,the clinical pregnancy rates of patients in the ANA-pos-itive low titer group and high titer group were significantly lower than those in the negative control group(P＜0.001).Similarly,the rates of fertilization and cleavage of oocytes in ANA-positive patients were also significantly lower than those in the negative control group(P＜0.05).For patients who did not achieve pregnancy after embryo transfer due to ANA positivity,immunomodulatory therapy significantly improved both the clinical pregnancy rate and cumulative clinical pregnancy rate(P＜0.05).Conclusion Compared with the negative control group,the clinical pregnancy rates decrease in both ANA-positive low titer subgroup and high titer subgroup.However,clini-cal intervention therapy enhances the single-cycle clinical pregnancy and cumulative pregnancy rates among ANA-positive patients,indicating that ANA positivity is an important factor in RIF.Immunomodulatory therapy is an ef-fective measure to improve recurrent implantation failure among ANA-positive patients.

Nursing human resource is an important part of health human resource and the basis of ensuring nursing quali-ty.Effective nursing performance management can mobilize nurses'subjective initiative,improve work efficiency and enhance nursing human resource management level.At present,the exploration of nursing performance management in public hospitals in China is in the initial stage,and the management mode still refers to the enterprise human resource management mode,without fully considering the particularity of medical work,leading to many problems in the current nursing performance salary manage-ment.Through questionnaire survey,this paper understands the current situation of nursing human resources and performance man-agement methods of comprehensive public hospitals in different regions of the country,analyzes the problems existing in nursing per-formance management and their causes,and puts forward reasonable suggestions for reform direction.In order to provide reference for the reform of nursing performance management in public hospitals,make the distribution of nursing performance much fair and reasonable,improve the quality of nursing service,and promote the sustainable development of nursing management.