Objective To investigate the clinical application value of selective arterial embolization in the treatment of iatrogenic hemorrhage.Methods 32 cases with iatrogenic hemorrhage were retrospectively analyzed.The location and feature of bleeding were identified by selective percutaneous artery angioraphy,and then super-selective interventional embolization were performed.The embolic agents inclued gelfoam medical line,steel coils or polyvinyl alcohol (PVA)particles.Results In 32 patients,26 cases with active bleeding signs were found by angiography,they mainly presented contrast medium overflow,6 cases with pseudo-aneurysms,1 case with ar-teriovenous fistula.All patients underwent interventional embolization successfully.Only 1 case underwent twice procedure because of rehaemorrhagia on the 8 days after embolization.Follow-up for a month after arterial embolization,25 cases had no severe compli-cations,1 case died by multiple organ failure.In 6 negative cases,3 cases died by hemorrhagic shock,3 cases stopped hemorrhage after medical treatment.Conclusion Selective angiography is a safe and effective measure for the treatment of iatrogenic hemor-rhage.

Objective:To observe the therapeutic effect of microwave ablation combined with anhydrous ethanol for cystic thyroid nodules.Methods:From Jan. 2019 to Dec. 2019, 56 patients with thyroid cystic nodules (≥2cm) underwent ultrasound guided thyroid cystic nodule ablation in Department of Thyroid and Breast Surgery, Nanjing Hospital of Traditional Chinese Medicine. According to different ablation methods, the patients were divided into microwave ablation combined with anhydrous ethanol group and microwave ablation group. There were 36 cases in microwave ablation combined with anhydrous ethanol group and 20 cases in microwave ablation group. The volume reduction rate of thyroid nodules, the incidence of postoperative complications and the changes of thyroid function were compared between the two groups after treatment. Statistical analysis were performed using SPSS, version 21.0, the mean±SD deviation ( ± s) was used to describe the statistics, t-test was performed, and the adoption rate of counting data (%) was expressed by χ 2 test. The difference was statistically significant with P<0.05. Results:The nodule volume reduction rates of the microwave ablation combined with anhydrous ethanol group and microwave ablation group were (49.86±6.78) % vs (22.84±1.88) %, (67.57±5.84) % vs (47.25±7.09) % and (75.70±4.51) % vs (71.14±4.65) % at 3 months, 6 months and 12 months after operation, respectively. There was significant difference between the two groups ( P<0.001) . The incidence of postoperative complications in the two groups was 38.89% and 45.00% respectively, and there was no significant difference between the two groups ( P>0.05) , and all complications were cured within 2 months. There was no significant difference in thyroid function (T3, T4, FT3, FT4, TSH) between the two groups before and 12 months after operation ( P>0.05) . Conclusions:Microwave ablation combined with anhydrous ethanol is more effective in treatment of cystic thyroid nodules (≥2cm) than microwave ablation alone. It can significantly improve patients’symptoms and nodule volume reduction, and does not affect thyroid function. It can be used as a recommended option for treatment of cysticthyroid nodules.

Objective:To explore the influence of humanistic management atmosphere on nurses′ intention to stay in hospital, so as to provide reference for stabilizing nursing team.Methods:The convenience sampling method was used to investigate 1 044 clinical nurses in 5 tertiary hospitals in Shandong province by using the general information questionnaire, nurses′ perception of humanistic management questionnaire and nurses′ intention to stay questionnaire in May 2019.Four dimensions of demographic factors and nurses′ perception of hospital humanistic management were used as independent variables, and the total score of nurses′ intention to stay was used as dependent variable for stepwise regression analysis.Results:The total scores of humanistic management perception and intention to stay were 166.70±29.42 and 23.30±4.29 respectively. There was a positive correlation between humanistic management perception and intention to stay( P<0.05). The three dimensions of human management perception, emotional management perception and cultural management perception, as well as the professional title, working years and employment form could explain 27.5% of variation. Conclusions:The nurses′ intention to stay is in the middle and upper level, which is related to the hospital′s humanistic management. The perception of humanistic management of nurses has a positive predictive effect on the intention to stay, especially in talent management, emotional management and cultural management. Hospital managers should improve the humanistic management mode, enhance nurses′ perception of humanistic management in order to stabilize the nursing team and improve nurses′ intention to stay.

Tumor necrosis factor alpha inhibitors(TNFαi)are a class of biological agents that suppress the immune system and lower inflammatory levels,and they are increasingly employed to treat autoimmune diseases.However,TNFαi theoretically can increase the risk of infection,tumor,and other complications.To increase the safety of perioperative medicine,it is necessary to balance the relative risks of increased complication rates due to continuous medication and symptom aggravation due to medication suspension for patients undergoing surgery.Currently,there is no comprehensive clinical guideline for the perioperative management of TNFαi in China.To provide a reference for the perioperative management of TNFαi,this article used the indications of rheumatoid arthritis,ankylosing spondylitis,inflammatory bowel disease,and psoriasis as its starting point to systematically sort out the recommendations and considerations for the use of TNFαi in the perioperative drug treatment of patients.

Objective To establish a liver-specific Rbp4 gene knockout mouse model and to explore the effect of liver Rbp4 gene deletion on glucose metabolism.Methods Cre-LoxP technology was used to construct a liver-specific Rbp4 gene knockout mouse model using C57/BL6J and Alb-Cre mice.The genotype of the mice was identified by polymerase chain reaction and agarose gel electrophoresis.Ten 18 week old C57/BL6J male mice were included in the WT group,10 flox homozygous and Alb-Cre negative mice of the same age were included in the experimental control group(Rbp4flox/flox:Cre-),and 10 flox homozygous and Alb-Cre positive mice of the same age were included in the experimental group(Rbp4flox/flox:Cre+).Expression levels of RBP4 protein and mRNA in the liver were verified by Western Blot and quantitative reverse transcription-polymerase chain reaction(qRT-PCR),respectively,and expression levels of Rbp4 mRNA in other tissues were detected by qRT-PCR.Morphological changes in liver tissue were detected by hematoxylin and eosin staining.Blood glucose values were detected in mouse tail vein blood samples using a blood glucose meter,and glucose tolerance and insulin tolerance were determined.Expression levels of the liver glucose metabolism genes phosphoenolpyruvate carboxylase(Pepck)and glucose-6-phosphatase(G6pase)were detected by qRT-PCR.Results Liver-specific Rbp4 knockout mice were successfully bred and identified.RBP4 protein and mRNA levels were significantly decreased in the liver of Rbp4flox/flox:Cre+mice(P＜0.05),but there was no significant difference in the relative expression levels of Rbp4 mRNA in fat,kidney,pancreas,spleen,heart,or muscle tissues among the three groups(P＞0.05).Liver-specific Rbp4 knockout had no significant effect on liver morphology,glucose tolerance,or insulin tolerance(P＞0.05).Pepck mRNA levels in the liver differed significantly among the three groups(P＜0.05),and pairwise comparison showed that liver Pepck mRNA levels were significantly lower in Rbp4flox/flox:Cre+mice compared with levels in Rbp4flox/flox:Cre-mice(P＜0.05).There was no significant difference in liver glucose-6-phosphatase(G6pase)mRNA expression among the three groups(P＞0.05).Conclusions We successfully constructed a liver-specific Rbp4 knockout mouse model.Deletion of Rbp4 in the liver inhibited expression of Pepck mRNA in the liver,thus providing a basis for further exploration of the role of this gene in glucose metabolism in mice.

OBJECTIVE To analyze the clinical characteristics of pulsatile tinnitus induced by sigmoid sinus abnormalities in high and normal intracranial pressure states.METHODS There were 66 patients of pulsatile tinnitus induced by sigmoid sinus abnormalities,including 55 cases of sigmoid sinus wall dehiscence and 11 cases of sigmoid sinus diverticulum.The index of transverse sinus stenosis(ITSS)was used to assess intracranial pressure in magnetic resonance venography(MRV).We obtained 41 cases in intracranial hypertension group and 25 cases in normal intracranial pressure group.The age,gender,handedness,tinnitus lateralization,mean arterial pressure(MAP),body mass index(BMI),tinnitus duration,tinnitus frequency,tinnitus loudness,tinnitus handicap inventory(THI)and blood biochemical examination were recorded to analyze.RESULTS The BMI was 24.98 kg/m2(22.87 kg/m2,28.46 kg/m2)and 24.01 kg/m2(20.34 kg/m2,25.03 kg/m2)and THI score was 45.59±23.47 and 33.84±20.13 in intracranial hypertension group and normal intracranial pressure group,respectively.Compared with normal intracranial pressure group,the BMI and THI of intracranial hypertension group were significantly increased(P was 0.047 and 0.042 respectively).No significant difference were found in other indicators.CONCLUSION There are some different characteristics in pulsatile tinnitus induced by sigmoid sinus abnormalities in high and normal intracranial pressure states,which manifest obviously increased BMI and THI score in pulsatile tinnitus patients with intracranial hypertension.

【Objective】 To analyze the relevant studies on blood donor cohort and explore the current research status, research hotspots and development trends of blood donor cohort studies abroad. 【Methods】 Based on the Web of Science Core Collection, the literature related to blood donor cohort was searched. After screening and data processing, bibliometric analysis was carried out from the volume of literature trends, disciplines, authors, institutional distribution and other aspects of the included literature. At the same time, CiteSpace 5.6R5 software was used to carry out visual analysis of countries/regions, literature co-citation, keyword co-occurrence, keyword clustering and keyword emergence. Results A total of 672 papers (654 research papers, 18 review papers) were included. The total number of papers published in the field of blood donor cohort study showed a steady upward trend since 1991, the fastest growth was between 2019 and 2020. The top three cited authors were Kaaks R (1 301 citations), Rinaldi S (1 186 citations) and Riboli E (1 130 citations); the top three institutions were RLUK library in the UK, the University of California and the University of Copenhagen; the top three countries/regions in the volume of literature were the United States (176 papers), Germany (64 papers) and France (54 papers), and they all co-operated closely with other countries. The top five keywords were "blood donor" , "prevalence" , "infection" , "risk" and "antibody" . A total of 19 clusters were obtained by keyword cluster analysis, it was reflected in the immune mechanism and prevalence of blood-borne diseases, the relationship between blood donation behavior and non-communicable disease and its influencing factors, and the classification of the characteristics of blood donors. "Non-hepatitis B" was the keyword with the greatest burst intensity. The keywords that have burst out in recent years and continue to this day include "donation" , "seroprev-alence" , "donor" and "management" . Conclusion At present, the cohort study of blood donors has been paid more and more attention in the world, and its research trends mainly focus on the study of transfusion-transmitted disease risk. However, more researches begin to pay attention to the health problems and influencing factors of blood donors or recipients, which provides the research ideas and directions for establishing cohort study among blood donors in China.

The study was designed to investigate the peripheral anti-inflammatory effect of nicotinamide riboside(NR)in experimental autoimmune encephalomyelitis(EAE)mice and its mechanisms.Female C57BL/6 mice were induced by MOG35-55 to prepare EAE model,which then randomly divided into EAE model group and NR treatment group.Mice in EAE model group were given normal saline at a dose of 200 μl/d and mice in NR treatment group were given NR at a dose of 500 mg/kg(200 μl/d)by intragastric administration.Clinical score and body weight of mice in each group were observed and recorded.After mice were sacrificed on the 28th day after immunization,frozen sections of spleen and spinal cord were prepared and proteins of spinal cord were extracted.HE staining was used to detect peripheral inflammatory cells infiltrating spinal cord;immunofluorescence staining was used to detect the number of CD4+T cells and CD68+macrophages in spinal cord of mice;Western blot was used to detect the expression of IFN-γ and IL-1β in spinal cord of mice;immunofluorescence staining was used to detect the number of ROCK-Ⅰ+cells,TLR4+cells,p-NF-κB+cells,TNF-α+cells,IL-1β+cells,IFN-γ+cells,IL-6+cells,IL-10+cells,IL-17+cells,iNOS+cells and Arg-1+cells in spleen of mice.Data showed that compared with EAE model group,NR significantly delayed the onset time of EAE mice(P<0.05),decreased clinical score(P<0.05 or P<0.01),alleviated weight loss,prevented peripheral inflammatory cells from infiltrating spinal cord,decreased the number of CD4+T cells and CD68+macrophages in spinal cord(P<0.01),down-regulated the expression of IFN-γ and IL-1β of spinal cord(P<0.05),inhibited the expression of ROCK-Ⅰ,TLR4 and p-NF-κB in spleen of mice(P<0.01),reduced the secretion of IFN-γ,iNOS,IL-6 and other pro-inflammatory factors in spleen(P<0.05 or P<0.01),and increased the secretion of anti-inflammatory factors Arg-1 and IL-10 in spleen(P<0.05 or P<0.01).In conclusion,NR can effectively alleviate the clinical symptoms of EAE mice and significantly reduce inflammatory response of peripheral and central nervous system,and its mechanism may be related to the inhibition of Rho/ROCK signaling pathway and TLR4/NF-κB signaling pathway in spleen of EAE mice.

The lack of preoperative guidelines for the management of drugs for psychiatric disorders will affect the quality of surgical management of psychiatric patients and increase the probability of perioperative complications.To standardize the preoperative management of medications for the treatment of mental disorders,the Perioperative Assessment and Quality Improvement Society issued《Preoperative Management of Medications for Psychiatric Diseases:Society for Perioperative Assessment and Quality Improvement Consensus Statement》in February 2022 to provide clinicians with recommendations for the preoperative management of psychotropic medications.This article interpreted the consensus,summarized the perioperative interactions,special precautions,and auxiliary examination precautions,and provided corresponding preoperative suggestions on antidepressants,mood stabilizers,anxiety,antipsychotics,and attention deficit hyperactivity disorder drugs,to provide a reference for the standardized management of perioperative drugs.

Objective:To explore mechanism of Fasudil reducing Aβ1-42 induced BV2 cell injury based on NLRP3 inflamma-some.Methods:BV2 cells were divided into:normal control group,Aβ stimulation group,Aβ+Fasudil intervention group,Aβ+MCC950(NLRP3 inhibitor)intervention group.Cell morphology was observed under microscope.Cell activity was determined of by CCK8.NO release was measured by Griess.NLRP3,caspase 1 and IL-18 expressions were detected by immunofluorescence staining.NLRP3,ASC,caspase 1,IL-1β and IL-18 expressions were detected by Western blot.Results:Compared with normal control group,BV2 cells in Aβ stimulation group were activated and showed amoeba-like shape,cell activity was decreased,NO production was increased,NLRP3,ASC,caspase 1,IL-1β and IL-18 expressions were increased.Fasudil intervention and MCC950 intervention inhibited cell injury induced by Aβ1-42 in which BV2 cell morphology tended to be normal,cell activity was increased,while produc-tion of NO was reduced,and NLRP3,ASC,caspase 1,IL-1β and IL-18 expressions were down-regulated,there was no significant difference between Fasudil intervention group and MCC950 intervention group.Conclusion:Fasudil may alleviate Aβ1-42 induced BV2 cell injury and inflammatory reaction by inhibiting NLRP3 inflammasome activation.