Objective To explore the changes and comparisons of the four biochemical indicator detection for the early renal im‐pairment in multiple myeloma patients .Methods The 54 patients with multiple myeloma of early onset(MM group) and 54 healthy peoples(control group) were retrospectively analyzed .The levels of serum Cystatin C(Cys C) ,creatinine(Cr) ,β2‐microglobulin(β2‐MG) ,and lactate dehydrogenase(LDH) were detected .And the results for statistical analysis .Results The levels of serum Cys C , Cr ,β2‐MG and LDH were higher significantly in the MM group than in the control group ,the difference was statistically significant (P<0 .05) .In the MM group ,the positive rate of Cys C ,Cr ,β2‐MG ,LDH ,combined detection of Cys C and Cr ,combined detection of β2‐MG and LDH ,combined detection of Cys C ,Cr ,β2‐MG and LDH was 63 .0% ,42 .6% ,74 .1% ,61 .1% ,66 .7% ,85 .2% and 96 .3% respectively .The positive rate of Cys C was higher than Cr ,the difference was statistically significant(P<0 .05) .Between the positive rate of combined detection of β2‐MG ,LDH and Cys C ,Cr ,the difference was statistically significant(P<0 .05) .The positive rate of combined detection of the four biochemical tests was the most highest .Conclusion In the early stage of the renal in‐jury in the patients with MM ,the combined detection of the four biochemical tests is most sensitive to discovery the early stage of the renal glomerular function injury .

Objective To identify the differentially-expressed proteins of human gastric adenocarcinoma cell in primary or metastatic lymph node tissues by comparative proteomics technology, and to screen the specific metastatic-associated proteins so as to investigate the metastatic molecular mechanism of lymph node metastasis in gastric cancer. Methods 11differential proteins were acquired previously from primary and metastatic lymphnode tissues in gastric adenocarcinoma patients by 2D-DIGE. Some selected differential protein spots were identified by PMF based on MALDI-TOF-MS and database search. Immunohistochemical staining of HSP70 was used to evaluate the reliability of the proteomic analysis results. Results After analyzed on 11 differential proteins by in-gel trypsin digestion and MALDI-TOF-MS-based PMF analysis, a total of 5 differential proteins were identified by searching Mascot-database, HSP70ˊs 8 isoform 2 variant, chaperonin, chaperonin, leucine aminopeptidase, predicted: hypothetical protein XP_515584. Among the differential proteins identified, the levels of HSP70, chaperonin, leucine aminopeptidase expression had a significant up-regulation in gastric primary cancer compared with metastatic lymph node. HSP70 expression rate increased with the metastasis of lymph node and the progress of gastric cancer, agreed with the proteomics results. Conclusions They are similar in differentially-expressed proteins in primary or metastatic lymph node tissues because of the uniformity in source and differention. There are few protein changes in cancer cells between them, taking part in the metastatic of gastric cancer. HSP70 takes part in the progress of gastric cancer and relates to the metastasis of lymph node and malignant degree.

Passive leg raising is widely used in clinic, but it lacks of specialized mechanical raise equipment. It requires medical staff to raise leg by hand or requires a multi-functional bed to raise leg, which takes time and effort. Therefore we have developed a new medical electric leg-raising machine. The equipment has the following characteristics: simple structure, stable performance, easy operation, fast and effective, safe and comfortable. The height range of the lifter is 50-120 cm, the range of the angle of raising leg is 10°-80°, the maximum supporting weight is 40 kg. Because of raising the height of the lower limbs and making precise angle, this equipment can completely replace the traditional manner of lifting leg by hand with multi-functional bed to lift patients' leg and can reduce the physical exhaustion and time consumption of medical staff. It can change the settings at any time to meet the needs of the patient;can be applied to the testing of PLR and dynamically assessing the hemodynamics; can prevent deep vein thrombosis and some related complications of staying in bed; and the machine is easy to be cleaned and disinfected, which can effectively avoid hospital acquired infection and cross infection; and can also be applied to emergency rescue of various disasters and emergencies.

Objective To investigate the influence factors of temporary catheter obstruction after sealing in the CRRT.Methods A total of 811 patients undergoing the CRRT in ICU of our hospital from July 2015 to March 2016 were included in the study. Retrospective analysis was used to investigate the influence factors of CRRT temporary catheter obstruction.Results A number of 755 out of 811 patients were catheter unobstructed,while 56 cases (6.9%) had catheter obstruction. Single factor analysis showed that 5 factors including APTT,PLT,modes of anticoagulation,diabetes and anticoagulants,had statistically significant (t/χ2=5.133,6.092,53.548,10.646,4.765;P<0.05). Logistic multivariate linear regression analysis showed that PLT,history of diabetes,APTT and modes of anticoagulation were influence factors of catheter obstruction after sealing.Conclusions The main influences factors of the CRRT temporary catheter occlusion after sealing were PLT,diabetes,APTT and modes of anticoagulation. However,further multicenter study with large sample size is necessary.

Objective To explore the inhibitory effective and mechanism on the proliferation and apoptosis of sorafenib in vitro gastric cancer MGC80-3 cells. Methods The inhibitory effective of sorafenib at different concentrations for gastric cancer cell MGC80-3 were analyzed by MTT assay. Apoptosis rate was observed by AnnexinV/PI staining. Re-sults The proliferation inhibition of sorafenib on gastric cancer MGC80-3 cell was time-dose dependent manner, the difference was statistically significant (P<0.05). Conclusion The apoptosis of gastric cancer MGC80-3 cells is different and the apoptotic rate is increased with the increase of sorafenib concentration.

Objective:To search for evidence of capacity management in patients undergoing extracorporeal membrane oxygenation support therapy, and summarize the evidence to provide evidence-based basis for medical staff to evaluate and manage the capacity of such patients.Methods:This study was an evidence-based nursing study. Based on the 6S evidence model, relevant evidence on patient volume management in extracorporeal membrane oxygenation support therapy was systematically searched for relevant evidence on patient volume management in extracorporeal membrane oxygenation support therapy from top to bottom, including UpToDate, the National Guidelines Library of the United States, the Scottish Interhospital Guidelines Network, the Medical Guidelines Network, the Extracorporeal Life Support Organization website, Cochrane Library, PubMed, CINAHL, Wanfang, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Database. Based on the inclusion criteria, clinical guidelines, expert consensus, clinical decision-making, evidence summary, and systematic evaluation were selected for literature quality evaluation to extract the best evidence. The search period was from April 10, 2017 to April 10, 2022.Results:A total of 11 articles were included and 20 pieces of evidence were extracted, which were categorized into four categories: extracorporeal membrane oxygenation team composition and personnel qualifications, evaluation and monitoring, capacity management objectives, and capacity management measures.Conclusions:Based on a large amount of evidence of extracorporeal membrane oxygenation support for patient capacity management, this study can provide a reference basis for clinical workers to develop extracorporeal membrane oxygenation support treatment capacity management plans.

Objective:To investigate the workload of extracorporeal membrane oxygen(ECMO) patients, estimate the number of hours of care based on the amount of nursing work, and to analyze the status of human resources, improve the quality of care and the effect of nursing.Methods:The Nursing Activity Assessment Scale was used to evaluate the daily workload of ECMO patients in the Intensive Care Unit of Zhejiang Province People′s Hospital, and the relevant factors affecting the workload were analyzed.Results:The average daily workload of ECMO patients was (76.06 ± 7.23) points, the daily nurse care ECMO patients time was 10.31 h, and the number of ideal nurses who needed to participate directly in the daily patients was 2.28. The workload was related to age, whether heparin and vasoactive drugs were used, and prognosis( t values were -3.184-7.291, P<0.05 or 0.01). Conclusions:The workload of ECMO patients is relatively large. At this stage, the ratio of nurse to patient is reasonable in our hospital. The patients′ age, use the heparin, vasoactive drugs and prognosis affect the level of nursing workload of ECMO patients.

Objective:To explore the effect and nursing experience of vein-artery extracorporeal membrane oxygenation (V-A-ECMO) combined with continuous renal replacement therapy(CRRT) in the treatment of fulminant myocarditis.Methods:From January 2014 to October 2019, 15 cases of fulminant myocarditis were treated by V-A-ECMO combined with CRRT in the department of critical care medicine of Zhejiang People′s Hospital. During the operation of V-A-ECMO combined with CRRT, heart rate, blood pressure, coagulation function, troponin, creatinine and other indicators were closely monitored, strict liquid management and extracorporeal circulation pipeline management were implemented, and various complications such as arrhythmia, hypotension, bleeding and acral circulation disorder were timely observed and treated.Results:After 48 hours of treatment with V-A-ECMO and CRRT, the troponin value, lactic acid and creatinine of the patients were (21.53 ± 3.19) μg/L, (2.24 ± 0.37) mmol/L, and (58.13 ± 2.41) μmol/L, which were significantly lower than the start of the machine (79.65 ± 6.08) μg/L, (7.65 ± 1.28) mmol/L, (185.24 ± 5.63) μmol/L, the difference were statistically significant ( t values were -32.784, -15.726, -80.386, P<0.01), except for one dead patient, the left ventricular ejection fraction was significantly increased, reaching 45%-55% within 72 hours, and the left ventricular systolic and diastolic function was normal. Among the 13 patients who successfully withdrew the machine, 11 were cured, 3 were discharged automatically and 1 died. The success rate of withdrawing the machine was 86.67% and the cure rate was 73.33%. Conclusions:V-A-ECMO combined with CRRT can effectively improve cardiac renal function, maintain the stability of internal environment and improve the survival rate of patients. High-quality nursing can effectively improve the healing of patients, clinical need to continue to summarize the relevant nursing experience, improve the level of nursing, prevent various complications, improve the success rate of treatment, promote the recovery of patients.

Objective:To investigate the impact of andrographolide (AND) on intestinal inflammation in rats with diarrhea type irritable bowel syndrome (IBS-D) and its regulatory mechanism on the NLRP3/caspase-1 signaling pathway.Methods:After the IBS-D rat model was established by low concentration acetic acid combined with restraint stress, the rats were grouped into control group, model group, positive drug group, AND low-dose (AND-L) group, AND medium dose (AND-M) group, and AND high-dose (AND-H) group, with 10 rats in each group. The score of fecal traits and fecal water content of rats in each group were detected; the abdominal withdrawal reflex (AWR) of rats in each group was scored; HE staining was applied to observe the changes of colonic histopathology of rats in each group; enzyme linked immunosorbent assay (ELISA) was applied to detect the levels of tumor necrosis factor-α (TNF- α), interleukin-6 (IL-6), interleukin-1 β (IL-1 β), and interleukin-18 (IL-18) in the colon tissue of rats in each group; Western blot was applied to detect the expression levels of NLRP3, ASC, and caspase-1 proteins in the colon tissue of rats in each group. Results:The scores of fecal traits of rats in the control group was 2.43±0.19, fecal water content was 31.76±2.81, AWR score was 0.43±0.02, TNF-α was 123.49±12.35, IL-6 was 76.45±6.23, IL-1 β was 195.76±15.14 and IL-18 was 167.31±13.92, the protein expression levels of NLRP3 was 0.96±0.06, ASC was 1.01±0.08, and caspase-1 was 0.94±0.06. The scores of fecal traits in model group was 6.12±0.58, fecal water content was 65.24±4.13, AWR score was 2.42±0.18, which were higher than those in control group ( P<0.05), the TNF- α in model group was 315.73±19.47, IL-6 was 231.97±14.65, IL-1 β was 435.83±28.67, IL-18 was 382.56±26.84, the protein expression levels of NLRP3 was 2.41±0.18, ASC was 2.23±0.15, and caspase-1 was 2.15±0.16, which were higher than those in control group ( P<0.05). The scores of fecal traits in the low, medium, and high dose AND groups were 5.38±0.46, 4.57±0.38, 3.31±0.27, fecal water content were 54.68±3.67, 46.87±3.75, 38.11±3.10, AWR scores were 1.79±0.16, 1.35±0.10, 0.69±0.04, which were higher than those in model group ( P<0.05), the TNF- α in the low, medium, and high dose AND groups were 268.65±17.23, 224.91±16.36, 178.16±14.65, IL-6 were 187.74±14.57, 159.64±11.39, 124.18±8.62, IL-1 β were 369.51±21.96, 314.72±23.64, 263.93±16.82, IL-18 were 334.72±25.17, 280.16±21.43, 235.67±19.32, the protein expression levels of NLRP3 were 1.94±0.15, 1.56±0.12, 1.25±0.09, ASC were 1.89±0.14, 1.61±0.13, 1.28±0.10, and caspase-1 were 1.76±0.14, 1.49±0.11, 1.20±0.09, which were higher than those in model group ( P<0.05) . Conclusion:AND may alleviate intestinal inflammation in IBS-D rats by inhibiting the NLRP3/caspase-1 signaling pathway.

Objective:To explore the effects of early goal-directed mobilization (EGDM) in rehabilitation of patients after cardiac surgery.Methods:Totally 200 patients admitted into ICU after cardiac surgery in Zhejiang Provincial People's Hospital were selected. A total of 100 patients admitted between January and April 2019 were included into the control group who received routine care, while 100 patients admitted from May to August 2019 were included into the observation group received EGDM on this basis. The postoperative rehabilitation indicators (indwelling time of tracheal intubation, time of first exhaust, time of admission to ICU, complication cases) and satisfaction before transferring to ICU were compared between the two groups of patients.Results:The indwelling time of tracheal intubation, time of first exhaust and time of admission to ICU was (25.93±2.42) h, (28.44±1.62) h and (38.63±4.91) h in the observation group, which were shorter than that in the control group, and the difference was statistically significant ( t=45.932, 78.464, 32.702; P<0.01) ; the incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant ( P<0.05) ; before transferring to ICU, the patient satisfaction of the observation group was (57.58±1.15) , while that of the control group was (49.32±1.26) , and the difference was statistically significant ( t=-48.420, P< 0.01) . Conclusions:EGDM is conducive to the early recovery of patients after cardiac surgery and can improve patient satisfaction.