Objective: To compare the clinical effect of Xuebijing or ulinastain combined with the conventional treatment for chronic obstructive pulmonary disease with acute exacerbation (AECOPD) complicated with systemic inflammatory response syndrome(SIRS).Methods: Totally 82 AECOPD patients with SIRS were randomly divided into group A and group B with 41 ones in each and both groups were treated with the conventional therapy.Group A was treated with ulinastatin (dissolved in 100 ml 0.9% sodium chloride injection, intravenous infusion, once daily), group B was given 50ml Xuebijing injection (mixed with 100 ml saline, intravenous infusion, twice a day).The lung function test, blood gas analysis and inflammatory factors were carried out in both groups.Results: After treatment, the lung function indices of FEV, FEV1 and FEV1/FVC in group A and B were significantly higher than those of before treatment (P<0.05), and group B was significantly higher than group A(P<0.05).Two groups of PaO2 and pH were significantly higher than those of before treatment, and PaCO2 was significantly decreased (P<0.05).PaO2 and pH in group B were significantly higher than those in group A, and PaCO2 was significantly lower than that in group A (P<0.05).The levels of APACHE Ⅱ, TNF-α and IL-6 were significantly lower than those of before treatment (P<0.05), and above indices in group B were lower than those in group A(P<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups (P>0.05).Conclusion: The clinical effect of Xuebijing or ulinastain combined with the conventional treatment is promising for AECOPD complicated with SIRS.Xuebijing injection combined with the conventional treatment shows better effect on the improvement of lung function and blood gas, and the levels of inflammatory cytokines can be reduced more significantly, which is also safe in the clinical application.

Objective:To explore the effect of dialysis pipeline nursing group mode combined with predictive nursing measures on hemodialysis efficacy of diabetic nephropathy patients with maintenance hemodialysis (MHD).Methods:A total of 96 patients with MHD of diabetic nephropathy admitted to No. 904 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2015 to December 2019 were selected as the research objects and divided into control group and observation group, 48 cases in each group. Patients in the control group were treated with routine dialysis pipeline and other hemodialysis nursing interventions, while patients in the observation group were treated with predictive nursing measures on this basis. The biochemical indexes, psychological state, compliance, incidence of nosocomial infection and complications and nursing satisfaction of the two groups before and after intervention were compared.Results:After the nursing intervention, the blood urea nitrogen (BUN), creatinine (Cr), and β2 microglobulin (β2-MG) of the two groups of patients were lower than those before the intervention, and the BUN of the observation group after the intervention, Cr and β2-MG were (12.04±1.98) mmol/L, (451.62±82.49) μmol/L, (13.53±2.31) mg/L, respectively, which were lower than those of the control group (15.82±2.31) mmol/L, (591.35±99.21) μmol/L, (18.83±2.92) mg/L, the difference was statistically significant ( t value was 8.608, 7.503, 9.862, P<0.05). After the intervention, the scores of the treatment compliance subscales of the observation group were 29.06±3.58, 23.42±2.99, 20.11±3.01, 14.76±2.94, which were higher than those of the control group (31.91±3.97, 21.53±3.21, 17.03±2.74, 12.36±3.04), the difference was statistically significant ( t value was 2.985-3.932, P<0.05). After the intervention, the SAS and SDS scores of the two groups were lower than those before the intervention, and the SAS and SDS scores of the observation group after intervention were 39.12±4.82 and 36.43±6.03, which were lower than those of the control group 48.25±5.14, 46.75±5.36, the difference was statistically significant ( t value was 8.997, 8.862, P<0.05). The incidence of nosocomial infections and complications in the observation group were 2.08% (1/48) and 4.17% (2/48), which were significantly lower than those in the control group, 14.58% (7/48) and 18.75% (9/48), The difference was statistically significant ( χ2 value was 4.91, 5.26, P<0.05). The nursing satisfaction degree of the observation group was 95.83% (46/48), which was higher than 72.92% (35/48) of the control group, and the difference was statistically significant ( χ2 value was 9.56, P<0.05). Conclusions:The dialysis pipeline combined with predictive nursing can improve the psychological state of patients, reduce the incidence of hospital infection and complications, prolong the service life of vascular access, improve the quality of life of hemodialysis patients, improve the relationship between nurses and patients, and create a harmonious atmosphere, which is worthy of clinical promotion and application.

Objective To probe into the relationship of the cumulative effect of childhood trauma types and symptoms of depression and anxiety among pregnancy women. Methods A total of 276 cases of pregnancy women were investigated by using Childhood Trauma Questionnaire (CTQ- SF), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Results The cumulative number of childhood trauma types were positively correlated with the scores of EPDS, state anxiety and trait anxiety (r=0.245, 0.262 and 0.292, P<0.01);the scores of CTQ-SF, EPDS, state anxiety and trait anxiety of multi-CTQ group were higher than that of non-CTQ group, as well as the positive rate of depression symptom and anxiety symptom (P<0.05 or 0.01);Logistic regression analysis showed that the cumulative number and accumulation group of CTQ may be predictors or risk factors of depression and anxiety of women during pregnancy, and existed cumulative effect. When the cumulative number of childhood trauma types more than two types, it increased 2.37 and 3.12 times likelihood of depression and state anxiety comparing to non-CTQ group. Conclusions It suggested that childhood trauma experience may be a risk factors of depression and anxiety during pregnancy, and exist cumulative effect.

Structural modifications were performed with natural product of oleanolic acid to search for novel anticancer drugs. Ten oleanolic acid derivatives were designed and obtained by the reaction of oxidation, acylation or hydrolyzation, etc. The cytotoxic activity of derivatives was evaluated against HeLa, HepG2 and BGC-823 cells in vitro by MTT assay, gefitinib and etoposide used as a positive control. The results showed that compound 5a was particularly active to inhibit HepG2 cells growth, and anti-tumor activity of compound 7 on HeLa cells was significantly stronger than oleanolic acid. They are worthy to be studied further.

Object To investigate the in vivo antioxidant effect of the extract from Rosmarinus officinalis L. and its active substances. Methods The contents of MDA, the activites of SOD and GSH Px in serum, heart, liver, brain and skeleton muscle were determined in oxidative stress mouse model caused by exercise. Results It was found that in serum, liver, heart and skeleton muscle except the brain, the contents of MDA were decreased and the activities of SOD and GSH Px were increased by 250 mg/kg and 500 mg/kg of total phenolic diterpenes (TPD) extract taken. Conclusion The results showed that R. officinalis has prominent antioxidant effect in exercise mice and the active constituents may be phenolic diterpenes.

The case is the cornerstone of case teaching. The construction of case database can support case teaching and its orderly development. The clinical cases of gynecology of Chinese medicine were collected, sorted and processed in combination with the teaching syllabus and teaching objective. Operating platform was based on the Excelltable. The column was divided into overview, menstrual disorders, leukorrhoeal diseases, pregnancy disease, postpartum disease and miscellaneous diseases of gynecology with hierarchical set of 15 modules per column, including basic information, complaints, history, symptoms, physical examination, diagnosis, application purpose and context and so on. And the corresponding search term was also selected. Cases can be divided into introduction cases and improvement ones according to their easiness and difficulty , into typical cases and atypical ones according to their feature types. Case database content also needs to be constantly revised by teaching activities to make it more suitable for clinical teaching.

BACKGROUNDAutophagy has been found to be involved in animal and cell models of atherosclerosis, but to date, it lacks general observation in human atherosclerotic plaques. Here, we investigated autophagy in smooth muscle cells (SMCs), endothelial cells (ECs), and macrophages in human atherosclerotic plaques via transmission electron microscopy (TEM), western blotting, and immunohistochemistry analysis.

METHODSThe histopathologic morphology of these plaques was observed via hematoxylin and eosin staining. The ultrastructural morphology of the SMCs, ECs, and macrophages in these plaques was observed via TEM. The localization of microtubule-associated protein 1 light chain 3 (MAP1-LC3), a relatively special maker of autophagy, in plaques was observed by double fluorescent immunochemistry and western blotting.

RESULTSAll of these human atherosclerotic plaques were considered advanced and unstable in histologically observation. By double fluorescent immunochemistry, the expression of LC3-II increased in the SMCs of the fibrous cap, the macrophages, and the microvascular ECs of the plaque shoulders. The protein level of LC3-II by western blotting significantly increased in plaques compared with normal controls. In addition, TEM observation of plaques revealed certain features of autophagy in SMCs, ECs, and macrophages including the formation of myelin figures, vacuolization, and the accumulation of inclusions in the cytosol. These results indicate that autophagy is activated in SMCs, ECs, and macrophages in human advanced atherosclerotic plaques.

CONCLUSIONSOur study is to demonstrate the existence of autophagy in human atherosclerotic plaques by different methods, which may contribute to the development of pharmacological approaches to stabilize vulnerable and rupture-prone lesions.

Atherosclerosis ; metabolism ; physiopathology ; Autophagy ; physiology ; Endothelial Cells ; pathology ; Humans ; In Vitro Techniques ; Microscopy, Electron, Transmission ; Microtubule-Associated Proteins ; metabolism ; Myocytes, Smooth Muscle ; pathology ; Plaque, Atherosclerotic ; metabolism ; physiopathology ; ultrastructure

Objective To investigate the effect of tripterine combined with fluorouracil on the proliferation,invasion and apoptosis of human hepatocellular carcinoma Hep3B cells,and to identify whether the combining application of the two drugs has synergistic inhibitory effect.Methods The Hep3B cells were divided into blank control group,tripterine (2.5 mol/L) treated group,fluorouracil (25 g/ml) treated group and combined treated group (2.5 mol/L of tripterine and 25 g/ml of fluorouracil) by random number table method.Proliferation,invasion and apoptosis of different drugs treated Hep3B cells were assessed by MTS,Transwell assay,and flow cytometry,respectively.The migration differences of the four groups were detected by the scratch assay.Finally,the levels of the proliferation-related proteins p-AKT,p-ERK and the apoptosis-related proteins cleaved caspase-3 and Bax were detected by Western blotting at 24 and 48 h.Results Compared with the blank control group,the cell proliferation rate (24 h:0.305％ ± 0.016％ vs.0.768％ ± 0.063％;48 h:0.201％ ± 0.008％ vs.1.111％ ± 0.037％),and the cell migration rate (24 h:0.20％ ± 0.03％ vs.0.40％ ± 0.04％,48 h:0.25％ ± 0.02％ vs.0.59％ ± 0.07％) of combined treated group decreased (P＜0.01),while the cell apoptosis rate (24 h:24.33％ ± 3.85％ vs.3.80％ ± 0.40％,48 h:45.10％ ± 4.10％ vs.8.47％ ± 1.65％) significantly increased (P＜0.01).Compared with the blank control group,the cleaved caspase-3 (24 h:1.39 ± 0.11 vs.1.01 ± 0.04,48 h:1.38 ± 0.12 vs.0.99 + 0.03) and Bax (24 h:1.35 ± 0.13 vs.1.00 ± 0.08,48 h:1.39 ± 0.09 vs.0.99 ± 0.05) protein expression of combined treated group significantly increased (P＜0.05).After 24 h of the intervention,the number of cell invasionin (15 ± 6 vs.231 ± 38) the combined group was significantly lower than that in the blank control group (P＜0.05).The protein expression of p-AKT/AKT (0.79 ± 0.04 vs.0.99 ± 0.05) and p-ERK/ERK (0.52 ± 0.04 vs.0.75 ± 0.07) in the combined group was significantly lower than that in the fluorouracil group 48 h after the intervention (P＜0.05).Conclusions The combination application of 5-FU and Tripterine on Hep3B cells significantly inhibited the cells proliferation,migration and invasion ability and promoted the apoptosis of Hep3B cells by down-regulating the expression of p-AKT and p-ERK and up-regulating the expression of cleaved caspase-3 and Bax.

Objective To study the effectiveness of a management model based on the standards proposed by the Joint Commission on Accreditation of International Healthcare Organizations(JCI)in preventing disputes and investigate its impact on patient satisfaction.Methods A total of 102 patients between March 2022 to March 2024 were enrolled in the study.They were randomly divided into JCI standard group(n=51)and conventional group(n=51)using the random number method.The con-ventional group received the conventional management,while the JCI standard group followed the management based on the JCI standard.Occurrence of dispute events,patient satisfaction levels,management quality,and negative emotions before and after treatment were compared between the two groups.Results The total incidence of dispute events in JCI standard group was sig-nificantly lower than that in conventional group(1.96％vs 13.73％,P＜0.05).The JCI standard group scored significantly higher in satisfactions with all items(all P＜0.05)as well as in management quality(all P＜0.05)compared to the convention-al group.Following treatment,negative emotion scores decreased in both groups compared to pre-treatment,with the JCI standard group showing significantly lower scores than the conventional group(all P＜0.05).Conclusion Implementing the management model based on JCI standard notably can reduce the number of disputes,enhance patient satisfaction,improve management quali-ty,and alleviate negative emotions among patients.

Objective? To construct new nurses＇ humanistic care training modules based on the concept of "craftsman spirits", so as to provide the basis of training for nursing managers to improve nurses＇ humanistic care behavior. Methods Underpinned by the "craftsman need-to-know 30 items" in "craftsman spirits", we reviewed the literature about nurses＇ humanistic care training status and patients＇ humanistic needs, and selected 20 typical clinical nursing managers and educators from 3 cities in Jiangsu Province and conducted 2 rounds of consultation by Delphi expert consultation method; we used analytic hierarchy process (AHP) for indicators at various levels to determine the contents and weights of humanistic care training modules for new nurses. Results? After two rounds of consultation, the recovery rate was 100%, the expert authority coefficient (Cr) was 0.92 and 0.87 respectively, and the coordination coefficient(W) was 0.32 and 0.23. The training module of humanistic care for new nurses was finally formulated, including 6 primary indicators, 15 secondary indicators and 30 tertiary indicators. Conclusions The construction method of the new humanistic care nurse training module based on the concept of "craftsman spirits" is scientific and vigorous, the contents are specified and easy to apply, with an emphasis on nurses＇ internal literacy and understanding of the development of the discipline.