In this paper,we summarized nursing care of 9 patients with cytokine release syndrome after receiving the chimeric antigen receptor T cells immunotherapy.Key points of nursing care were as follows:comfortable and effective antipyresis,preventive rehydration,multiple methods of blood oxygen saturation improvement,iatrogenic pressure ulcer prevention,frequent vital signs monitor,close observation of level of cytokine and inflammatory factors,timely and accurate medication,formulating personalized nursing plan according to patients' condition,close collaboration between doctors and nurses.At last,8 patients recovered and were discharged,and 1 case died due to multiple organ dysfunction syndrome.

Immunological imbalance is the foundation for the development of liver damage or fibrosis.Therefore,the treatment of liver disea-ses not only relies on regenerative medicine for cellular replacement,but also depends on immunoregulation.The immunological basis of liver injury and repair,the immunological basis of multipotent stem cells for allograft,and the research advances in the immunoregulatory effect of stem cells in the treatment of liver diseases demonstrated that multipotent stem cells,especially mesenchymal stem cells,have low immuno-genicity and cause immunosuppression,with the immunological basis of allograft;in addition,they can improve the local immune microenvi-ronment of the liver by immunoregulation to reduce the liver injury caused by immune response.It is suggested that multipotent stem cells, which meet the requirements of cellular replacement and immunoregulation in the liver,will become an ideal treatment of liver diseases.

BACKGROUND: Studies about the mechanism of laser occlusion on the varicose great saphenous vein are rare.OBJECTIVE: To explore the ultrastructural changes of the great varicose saphnous vein after it was occluded with laser.DESIGN: An observational study.SETTING: Laser Department of the General Hospital of Chinese PLA .PARTICI PANTS: There were 42 patients with varicose great saphenous veins that were occluded with laser in clinic of the General Hospital of Chinese PLA from January to April 2004. The inclusive criteria: There must be obvious vein tangles beneath the undystrophic skin at ankle without apparent thrombus inside the vein. The patients involved should be voluntary to take part in the study. Finally 9 patients were enrolled in this study.INTERVENTION: The great saphenous vein was intravenously occluded with laser of 810 nm and the working power was 12 W and the exposure time was 1 s. The occluded vein sample was taken out 3 hours after the occlusion.MAINOUTCOME MEASURES: The ultrastrncture of the occluded vein was observed histopathologically. Normal vein and prereatment varicose vein served as control.RESULTS: The normal vein wall can be divided into 3 layers: the internal layer was composed of the simple endothelial cells; the median layer was composed of the smooth muscle cells, elastic fibers and collagenous fibers; the external layer was composed of the loose connective tissues. However, the internal layer of the varicose vein was incomplete, and the endothelial cells were loosely connected. The smooth muscle cells became hyperplasic, hypertrophic or atrophic. The elastic fibers decreased in number in contrast to the increase of collagenous fibers. After laser occlusion, in the vein lumen there was a large number of blood cells. The platelets became flattened with pseudopods and adhered to collagenous fibers. The endothelial cells and smooth muscle cells near the lumen were damaged and the cytoplasma leaked and fused with extracellular matrix. Broken collagenous and elastic fibers could be seen near the lumen and some were observed in the lumen. There was no structure change in the external layer and adjacent elastic fibers and collagenous fibers.CONCLUSION: Laser occlusion damaged the internal layer and part of median layer of the varicose vein, caused aggregation of the blood cells in the lumen and promoted the adhesion of platelets to vein walls.

Progestagen-associated endometrial protein (PAEP) gene mainly expresses in the secretory phase endometrium and decidua in early trimester of pregnancy.In recent years,it is reported that PAEP is abnormally expressed in many kinds of tumors,such as breast cancer,endometrial carcinoma,ovary cancer,stomach cancer and melanoma.PAEP gene plays an important role in tumorigenesis and tumor development.The application of PAEP gene as an indicator for clinical diagnosis,prognostic and therapy needs further studies on the influence of PAEP gene on tumor biological behaviour.

OBJECTIVE:To observe the efficacy and safety of aerosol inhalation recombinant human interferon α1b in the treat-ment of bronchiolitis in children. METHODS:60 children with bronchiolitis were randomly divided into low-dose group,high-dose group and control group. All children were given tracheal suctioning,phlegm dispersing and other symptomatic treatment. Based on it,low-dose group was given recombinant human interferon α1b 1-2 μg/(kg·times),adding into 3 ml 0.9% Sodium chloride injec-tion,compression aerosol inhalation,twice a day;high-dose group was given recombinant human interferon α1b 3-4 μg/(kg·times), adding into 3 ml 0.9% Sodium chloride injection,compression aerosol inhalation,twice a day;control group was given ribavirin 10-15 mg/(kg·d),adding into 5% Glucose injection at ratio of 1∶1 by intravenous infusion,once a day. The treatment course for all groups was 5-7 d. Clinical efficacy,disappearance time of cough,respite,rale and three depressions,hospitalization time and incidence of adverse reactions in all groups were observed. RESULTS:Disappearance time of cough,respite,rale and three depres-sions and hospitalization time in high-dose group were significantly shorter than low-dose group and low-dose group shorter than control group,the differences were statistically significant(P<0.05). Total effective rate in high-dose group was significantly high-er than low-dose group and low-dose group higher than control group,the differences were statistically significant (P<0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Based on conventional treatment,both efficacy and safety of aerosol inhalation recombinant human interferonα1b in the treatment of bronchiolitis in children are good.

Objective To evaluate the capability of internal transcribed spacer (ITS) region sequencing analysis to identify clinical isolates of filamentous fungi.Methods A total of 267 filamentous fungi isolates collected from clinical specimens were analyzed by ITS region sequencing analysis.Alignment of acquired sequences with known sequences in GenBank and MycoBank was conducted to identify the species of those isolates.Results ITS sequences of the 267 isolates were amplified successfully.Among these isolates, 53.9％ (144/267) were identified to species level and 44.2％ (118/267) to genus level.Only five isolates were failed to be identified at genus level as they shared >95％ homology in ITS sequence with multiple genera.Conclusion ITS region sequencing analysis is preferred for identification of clinical isolates of filamentous fungi at genus level for its high universality and great capability.When species-level identification is required, some informative DNA markers besides ITS region should be included accordingly.

Objective To explore the relationship between general self-efficacy sense and psycho-logical health of nursing staff. Methods 230 healthy nursing staff were investigated with self-rating de-pression scale, serf-rating anxiety scale and general serf-efficacy scale. Correlation analysis and t test were adopted to analyze the data. Results There was a negative correlation between the scores of general self-efficacy scale and the scores of self-rating anxiety and depression scale. Moreover, the scores of anxi-ety and depression of nursing staff with higher self-efficacy were higher than those with lower self-effica-cy. Conclusions Self-efficacy sense has positive effects on the level of psychological health of nursing staff. The higher self-efficacy sense will help maintain higher psychological health state.

Objective To investigate the effects of triptolide on lipopolysaccharide (LPS)-induced acute lung injury in rats.Methods Sixty-five male SD rats weighing 200-250 g were randomly divided into 5 groups: control group (group C,n =5),LPS group (group L,n =15),different doses of triptolide groups (groups TP1-3,n =15).In group C normal saline was injected iv and 1％ DMSO injected intraperitoneally(ip).In group L LPS 5 mg/kg was injected iv and 1％ DMSO injected ip.In groups TP1-3 LPS 5 mg/kg was injected iv and triptolide 25,50 and 100 μg/kg was injected ip respectively.Blood samples were collected at 1 h before administration and 1,3,6 and 12 h after administration for blood gas analysis.The animals were sacrificed at 12 h after administration.TNF-α concentrations in serum and bronchoalveolar lavage fluid (BALF) were determined by ELISA.The lungs were removed for microscopic examination,evaluation of diffuse alveolar damage (DAD) score and determination of W/D lung weight ratio and the expression of Toll-like receptor4 (TLR4) protein and mRNA.Results Compared with group C,PaO2 was significantly decreased at 3,6 and 12 h after administration,DAD score and W/D lung weight ratio were increased in groups L and TP1-3,TNF-α concentrations in serum and BLAF were increased,expression of TLR4 mRNA and protein was up-regulated in groups L,TP1 and TP2,whlie TNF-α concentrations in serum and BLAF were significantly decreased,expression of TLR4 mRNA and protein was down-regulated in group TP3 ( P ＜ 0.05).Compared with groups L and TP1,PaO2 was significantly increased at 6 and 12 h after administration,DAD score,W/D lung weight ratio and TNF-α concentrations in serum and BLAF were decreased,expression of TLR4 mRNA and protein was down-regulated in groups TP2 and TP3 ( P ＜ 0.05).There was no siginificant difference in blood gas parameters,DAD score and W/D lung weight ratio between group L and group TP1 and between group TP2 and TP3 ( P ＞ 0.05).Compared with group TP2,TNF-α concentrations in serum and BLAF were significantly decreased,expression of TLR4 mRNA and protein was down-regulated in group TP3 (P ＜ 0.05).The lung pathologic injury was reduced in groups TP1-3 as compared with group L.Conclusion Triptolide can attenuate acute lung injury induced by LPS in a dose-dependent manner in rats,and the inhibition of up-regulation of TLR4 expression and release of TNF-α may be involved in the mechanism.

ObjectiveTo investigate the effect of intrathecal (IT) Ro25-6981 (a selective NR2B receptor antagonist) on focal cerebral ischemia-reperfusion (I/R) injury in rats.MethodsSixty healthy male SD rats weighing 280-320 g in which IT catheter was successfully implanted without complication were randomly divided into 4 groups ( n ＝ 15 each):group sham operation (group S) ; group focal cerebral I/R(group I/R) ; group I/R + Ro25-6981 (group Ro) and group I/R+ normal saline (group NS).The right middle cerebral artery was occluded for 2 h with a nylon thread with rounded tip which was inserted into right internal carotid artery and advanced cranially until resistance was met in groups I/R,Ro and NS.In group Ro Ro25-6981 100 μg/10 μl was injected IT at 0,2,23 h of reperfusion,while in group NS NS was injected IT instead of Ro25-6981.Neurological dificit was assessed and scored (0 ＝ no deficit,3 ＝ severe deficit) at 24 h of reperfusion.The infarct size was determined by 2,3,5-triphenyl tetrazolium chloride staining.ResultsIT administration of Ro25-6981 significantly reduced cerebral I/R-induced infarct sized and neurological deficit score in group Ro as compared with groups I/R and NS.ConclusionRo25-6981 injected IT can protect the brain against local cerebral I/R injury.

Objective To observe the effects of one kind of angiotensin converting enzyme inhibitor (ACE1) drugs fosinopril (FOS) on transforming growth factor β1 (TGF-β1)and β1- integrin( Itg-31 ) expression in rat glomerular mesangial cells (GMC)induced by lipopolysacchatide (LPS).Methods We established the cultured glomerular mesangial cells of rat in vitro and passages 3 ～ 10 of cells were used in the experiment after identification.The experiment included the following groups:Control group,LPS induced group (LPS group) and FOS intervened group.According to the different concentrations of FOS,FOS intervened group was divided into high,middle and low dose FOS groups,which were FOS1 group,FOS2 group and FOS3 group respectively.The changes of TGF-β1 protein secretion was detected by the enzyme-linked immunosorbent-assay; The changes of TGF-β1 and Itg-β1 mRNA expression was detected by quantitative real-time RT-PCR.Results (1) TGF-β1protein secretion in rat GMC at 6h,12h,24h three time points:They were 958.55 ± 34.67 ( ng/L),1052.05 ±48.59( ng/L),1166.06 + 35.39 (ng/L) respectively in Control group.They were 1342.12 + 39.87 ( ng/L),1432.31 + 39.33 (ng/L) and 1 537.77 + 43.79 (ng/L) respectively in LPS group,which were higher significantly than those in Control group ( all P ＜ 0.01 ).They were 779.58 ± 48.64 ( ng/L),878.33 ± 29.50 (ng/L) and 962.57 ±31.94( ng/L) in FOS1 group,989.311±73.56(ng/L),1073.29±66.89(ng/L) and 1210.75 ±61.68(ng/L) in FOS2 group,1 253.78 ±45.32( ng/L),1 348.18 ±45.81 (ng/L) and 1450.06 ±46.24( ng/L) in FOS3 group respectively,which were lower significantly in all FOS intervened groups than that in LPS group (all P＜O.01).(2)TGF-β1 mRNA expressions in rat GMC at6h,12h,24h three time points were higher significantly than that in Control group.TGF-β1 mRNA expressions were lower significantly in all FOS intervened groups than that in LPS group.( 3 ) Itg-β1 mRNA expressiones in rat GMC at 6h,12h,24h three time points were higher significantly than that in Control group.Itg-β1 expressions were lower significantly in all FOS intervened groups than that in LPS group.Conclusions LPS can induce the increase of TGF-β1 secretion and mRNA expression.FOS can inhibit the TGF-β1 secrection and mRNA expession in GMC as dose-dependent manner,at the same time down regulated the Itg-β1 mRNA expression iuduced by LPS.All above supply the theoretical evidence for the renal protection of FOS by non-hemodynamics mechanism.