Objective To investigate the effect of surfactant protein A (SP-A) on the production of MIP-2 and binding activity of NF-?B in rat tubular epithelial cells, and evaluate its possible role in renal inflammation. Methods Confluent cultures of NRK-52E cells (a renal tubular epithelial cell line of rat origin) were pretreated with various concentrations of SP-A(0 to 80 ?g/ml) and stimulated by lipopolysaccharide (LPS) (10 ?g/ml) with 2% serum. MIP-2 expression was measured by enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR). The effect of SP-A on NF-?B binding activity was assessed by electrophoretic mobility shift assay (EMSA). Results MIP-2 mRNA and protein was expressed and up-regulated in NRK-52E cells stimulated by LPS. The expression of MIP-2 was down-regulated by SP-A. NF-?B binding activity was inhibited by SP-A in a concentration-dependent manner. Conclusion SP-A binding activity and down-regulates the expression of MIP-2 in renal tubular epithelial cells, which may play an important role in the modulation of renal tissue inflammation.

Objective To evaluate the effect of ALD on podocyte apoptosis and the possible roles of Akt in ALD-induced apoptosis. Methods The cultured rat podocytes were incubated with increasing concentrations of ALD (10-9~10-5 mol/L) for variable time periods. Apoptosis was evaluated by cell nucleus staining and flow cytometry. RT-PCR was used to examine the expression of mineralocorticoid receptor (MR)and 11 Beta-hydroxysteroid dehydrogenase type 2 (11?-HSD2) mRNA in podocyte. Activation of Akt/PKB was evaluated by performing Akt kinase assay. Results ALD induced podocyte apoptosis in a dose- and time-dependent manner. The proapoptotic effect was attenuated by the presence of spironolactone (10-7mol/L). The expression of MR and 11P-HSD2 mRNA was demonstrated in the podocytes by RT-PCR. ALD also inhibited the activity of Akt in a dose-dependent manner, but the inhibitory effect was significantly ameliorated by the presence of spironolactone. The activity of Akt was negatively correlated with podocyte apoptosis. Conclusion ALD induces apoptosis in rat podocytes through the signaling mechanism by which Akt is inhibited.

Objective:To explore the application of folding transfer shelf in the transportation of critically ill patients.Methods:Patients transferred from the emergency department to the intensive care unit (ICU) admitted to the First Hospital of Jiaxing from January 1st to December 31st in 2019 were enrolled. The patients were divided into study group and control group by whether or not using the self-developed folding transfer shelf. The incidence of adverse events, the stability rate of vital signs and the transport time were compared between the two group.Results:A total of 437 patients were enrolled in the study, with 222 in the study group (which used the self-developed folding transfer shelf) and 215 in the control group (which used the conventional stretcher). The baseline data such as gender, age, disease status and disease severity were balanced between the two groups. The stability rate of vital signs in the study group was higher than that in the control group (89.19% vs. 82.33%, P < 0.05). The transfer time in the study group was shorter than that in the control group (minutes: 6.39±1.35 vs. 7.61±1.34, P < 0.01). The total incidence of adverse transport events in the study group was lower than that in the control group (2.25% vs. 10.23%, P < 0.01). The incidence of miscarriage of emergent materials and instrument falling in the study group were lower than those in the control group (0% vs. 2.79%, 0% vs. 2.33%, both P < 0.05). Conclusions:The folding transfer shelf could reduce the transport risk of critical ill patients, especially the risk of miscarriage and falling of rescue instrument. The application of folding transfer shelf could regulate the management of transport, keep the vital signs of patients stable during transport, shorten the transport time, and facilitate an efficient and high-quality transport.

Objective:To design a tracheotomy cannula cuff filling device for hyperbaric oxygen therapy, which is convenient for clinical operation, improves work efficiency and reduces the incidence of aspiration pneumonia.Methods:This study was a randomized controlled trial. From July 2020 to June 2022, 90 patients with tracheotomy who were treated with hyperbaric oxygen in the First Hospital of Jiaxing were selected as the research objects. According to the random number table method, the patients were divided into the experimental group and the control group, with 45 cases in each group. In the experimental group, the cuff pressure was maintained by the tracheotomy cannula cuff filling device, and in the control group, the traditional water injection method was used to maintain the cuff pressure. The operation time, infection index and incidence of aspiration pneumonia were compared between the two groups.Results:The operation time in the experimental group was (6.33 ± 1.31) s lower than that in the control group (40.96 ± 3.70) s, and the difference was statistically significant ( t=-59.11, P<0.05). Body temperature, C-reactive protein and procalcitonin after treatment in the experimental group were (36.91 ± 0.83) ℃, (34.59 ± 16.25) mg/L, (1.57 ± 0.82) μg/L, respectively, lower than those in the control group (37.42 ± 0.72) ℃, (44.18 ± 18.10) mg/L, (2.45 ± 0.92) μg/L, the differences were statistically significant ( t=-3.09, -2.64, -4.73, all P<0.05). The difference of white blood cell count post-treatment between the two groups was not statistically significant ( P>0.05). The incidence of aspiration pneumonia in the experimental group was 11.11%(5/45) lower than 31.11%(14/45) in the control group, and the difference was statistically significant ( χ2=5.17, P<0.05). Conclusions:The application of tracheotomy cannula cuff filling device can simplify the operation process, reduce the incidence of infection and aspiration pneumonia, and optimize the clinical work.

Objective To explore the nursing experience of inter-hospital referral in hierarchical medical system, so as to provide references for further improvement in patient referral. Methods From March to April 2017, a total of 16 emergency nurses from a Class Ⅲ Grade A hospital were selected by purposive sampling method. Semi-structured interviews were conducted using the method of phenomenology in qualitative research, and Nvivo 8.0 qualitative analysis software was applied for data collation and analysis. Results In the current stage, the factors causing the poor access of patient referral could be summarized in the evaluation, communication and medical documents. There were 7 themes of it: lack of assessment, poor observation of patients' conditions, poor notification, poor communication between hospitals, lack of effective handover, incompleteness of the medical documents, and irregular of the medical documents. Conclusions It is necessary to strengthen the skills of evaluation and communication of medical staff in the hierarchical medical system. At the same time, standardizing medical documents and improving the efficiency of inter-hospital referral were to improve patients' referral and ensure patients safety.

Objective? To construct the critical illness patient inter-hospital referral process of primary hospitals based on Delphi method so as to provide a basis for the inter-hospital critical illness patient standardized referral process in the medical alliance model. Methods? The inter-hospital referral process was designed by retrieving literatures at home and abroad, and was demonstrated and revised with the modified Delphi method. Results? We constructed a total of 30 items from four aspects including work preparation of medical staff as well as reception medical staff before inter-hospital referral, risk-prevention during referral and patients' condition after referral. Among two rounds of expert consultation, the active coefficients were all 100% and the authority coefficients were all 0.843 respectively. Conclusions? The critical illness patient inter-hospital referral process of primary hospitals based on modified Delphi method accords with the principle of scientific nature and operability which has positive a meaning for standardizing clinical inter-hospital critical illness patient referral.

Rituximab is currently used as a first-line therapy for phospholipase A 2 receptor-associated membranous nephropathy due to its good efficacy and safety. Although the remission rate after rituximab treatment is more than 60%, nearly 40% patients still do not respond to treatment. We used obinutuzumab to treat 3 cases of rituximab resistant PLA 2R-associated membranous nephropathy. After the first dose of 1 000 mg with or without additional dose, the amount of anti-PLA 2R antibody and urinary protein decreased significantly and the adverse reactions were mild. The results show that obinutuzumab has a certain therapeutic effect on rituximab resistant PLA 2R-associated membranous nephropathy, but the time of follow-up observation is short and can only be used as individual cases, which needs to be confirmed by a large sample and high-quality prospective cohort study.

Objective:To design a new jaw-lifting auxiliary tool and explore its effect in painless bronchoscopy.Methods:From January to December 2023, convenience sampling was used to select 160 patients who underwent painless bronchoscopy at the Endoscopy Center of the First Hospital of Jiaxing as subjects. The subjects were divided into an experimental group ( n=80) and a control group ( n=80) using a random number table method. During painless bronchoscopy, the experimental group used a new jaw-lifting auxiliary tool to open the airway, while the control group used traditional manual methods to open the airway. Two groups were compared patient oxygen saturation at different time points, and bronchoscopy passage time through the glottis. Results:The number of cases in which blood oxygen saturation <95% occurred at different time points in the experimental group was lower than that in the control group (all P<0.05). The time for bronchoscopy to pass through the glottis in the experimental group was shorter than that in the control group, and the difference was statistically significant [ (2.86±0.69) s vs. (3.20±0.96) s, P<0.05] . Conclusions:Using a new jaw-lifting auxiliary tool during painless bronchoscopy can reduce the decreased oxygen saturation in patients and shorten the time for bronchoscopy to pass through the glottis. It can be further promoted and applied in clinical practice.

Objective:To investigate the pregnancy outcomes of different treatment methods for triplet pregnancies with different chorionicities.Methods:A retrospective study was conducted on 97 triplet pregnancies who visited and delivered at the Department of Obstetrics, the Third Affiliated Hospital of Zhengzhou University, from January 1, 2017, to November 30, 2023. The pregnancies were categorized based on chorionicity into monochorionic triamniotic (MCTA) ( n=24), dichorionic triamniotic (DCTA) ( n=33), and trichorionic triamniotic (TCTA) ( n=40). They were further divided into expectant management group ( n=46), reduction to twins group ( n=40), and reduction to singleton group ( n=11) based on the treatment method. Pregnancy outcomes were compared among the groups. Statistical analysis were performed using t-test, corrected t-test, one-way analysis of variance and LSD test, Kruskal-Wallis test and Mann-Whitney U test, Chi-square test, continuity correction Chi-square test, Fisher's exact test, and Bonferroni correction. Results:(1) Comparison of pregnancy outcomes with different treatment methods for the same chorionicity: In MCTA, there were no statistically significant differences in gestational age at delivery, live birth rate before 37 weeks, live birth rate before 32 weeks, neonatal birth weight, and incidence of severe neonatal complications between the expectant management group and the reduction to monochorionic diamniotic (MCDA) group (all P>0.05). In DCTA, compared to the reduction to singleton group, the expectant management group had lower gestational age at delivery [(31.8±2.7) vs. (37.9±1.3) weeks, U=－3.66] and neonatal birth weight [(1 604.3±422.6) vs. (2 997.1±598.9) g, U=－3.84] (both P<0.05), but higher live birth rate before 37 weeks (9/10 vs.1/8, Bonferroni correction, P<0.017). The expectant management group showed a trend towards higher rates of pregnancy complications (5/10 vs. 2/15 and 0/8) and severe neonatal complications [37.0% (10/27) vs. 10.7% (3/28) and 0/7] compared to the groups reduced to dichorionic diamniotic (DCDA) twins and singletons. However, the differences between the groups were not statistically significant (all P>0.017). In TCTA, compared to the expectant management group, the reduction to DCDA group had a higher gestational age at delivery [(37.1±0.9) vs. (34.1±2.7) weeks, t'=－4.36], and increased neonatal birth weight [(2 647.5±377.8) vs. (1 902.5±459.9) g, t'=－6.98] (both P<0.05). The incidence of maternal pregnancy complications [3/15 vs. 54.2% (13/24)] and live birth rate before 37 weeks [3/15 vs. 66.7% (16/24)] were lower (Fisher's exact test, both P<0.05). (2) Comparison of pregnancy outcomes with different chorionicities for the same treatment method: In the expectant management group, the DCTA group had the lower neonatal birth weight compared to the MCTA and TCTA groups [(1 604.3±422.6) vs. (1 948.3±573.4) and (1 902.5±459.9) g, LSD test, both P<0.05]. In the fetal reduction group, the TCTA group had higher neonatal birth weight compared to the MCTA and DCTA groups [(2 657.6±373.3) vs. (2 000.8±443.3) and (2 078.8±799.9) g, U=－2.91 and U=－3.12] (both P<0.05). Conclusions:The appropriate treatment method for triplet pregnancies should be selected based on chorionicity. Expectant management is recommended for MCTA, fetal reduction is suggested for DCTA to improve pregnancy outcomes. For TCTA, the pregnant woman should be informed of the risks of preterm birth associated with expectant management, who should then decide whether to undergo fetal reduction.

Objective:To analyse the pathogenic bacteria distribution and clinical characteristics of late-onset sepsis (LOS) among premature infants with gestational age less than 34 weeks in Henan Province.Methods:The clinical data of 6 590 premature infants admitted to 17 medical institutions in Henan Province from January 2019 to December 2020 were retrospectively analyzed. The gestational age of infants was less than 34 weeks and was admitted to the neonatal ward within 7 days after birth. SPSS 19.0 statistical software was used for data analysis.Results:Among 6 590 premature infants LOS developed in 751 cases (11.40%), of whom the diagnosis was confirmed in 276 cases (36.75%) and 475 cases (63.25%) were diagnosed clinically. The fatality rate related to LOS was 13.58%. There were significant differences in the incidence of LOS and infection-related mortality among infants with different gestational ages and body weights ( χ2=388.894 and 13.572, χ2=472.282 and 9.257, P<0.05 or <0.01). Among 276 children with confirmed LOS, 286 strains of pathogenic bacteria were isolated. Gram-negative bacteria were most prevalent (178 strains), accounting for 62.24% of all infections, followed by fungi (58 strains, 20.28%). Klebsiella pneumoniae was most frequently detected Gram-negative bacteria (117 strains, 40.91%), among which 32.48% (38/117) was carbapenem-resistant Klebsiella pneumoniae. The proportion of diagnosed sepsis, the proportion of catheterization, and the infection-related mortality of infants with LOS in tertiary hospitals were all higher than those in secondary hospitals ( χ2=6.212, 5.313 and 4.435, all P<0.05). The proportion of exclusive breastfeeding in secondary hospitals was lower than that in tertiary hospitals ( χ2=19.216, P<0.05). The time of antibacterial drug use before infection in specialized hospitals was longer than that in general hospitals ( χ2=3.276, P<0.05). Conclusion:The incidence of LOS among preterm infants in Henan Province is high, which was mainly caused by Gram-negative bacteria. The clinical characteristics of LOS caused by different pathogens and in different health institutions are different, the prevention and control strategy should be developed accordingly to reduce the incidence LOS of preterm premature infants.