ObjectiveTo establish the reference value of inhibin-A in the serum of pregnant women with gestational age from 15 to 20+6 weeks in Guangdong province,and assess the efficiency of inhibin-A and quadruple test in Down syndrome screening.Methods A total of 2802 singleton pregnancies receiving triple test screening in Guangzhou Women and Children's Medical Center from March 2008 to December 2010 were included in this study.Inhibin-A was measured by automatic enzyme-linked immunosorbent chemiluminescence assay. The concentration of inhibin-A was expressed as multiples of the median (MoM),and adjusted with maternal weight and gestational age.Parameters of SURUSS were used to recalculate the risk of Down syndrome.The efficacy of single marker and combination were evaluated by receiver operating characteristic curve and the area under the curve. Results(1) In normal singleton pregnancies,the median concentration of inhibin-A was 286.60,267.10,249.10,243.40,242.30 and 256.60 pg/ml respectively for each week of gestational age from 15 to 20+6 weeks.The distribution of inhibin-A in each gestational week was relatively stable.The mean concentration [(852.83±370.04) pg/ml] and MoM (2.82) of inhibin-A in twelve pregnant mothers with Down syndrome fetuses were significantly higher than those without [(293.28±149.46) pg/ml (t=5.37,P＜0.05) and 1,respectively].(2) The detection rate was 83.3％ (10/12) by using the quadruple test including free human chorionic gonadotropin-β,alphafetoprotein,unconjugated estriol and inhibin-A at false positive rate of 5.8％; while when the detection rate of triple test including alpha-fetoprotein,free human chorionic gonadotropin-β and unconjugated estriol was 83.3％,the false positive rate was 7.7％.When the false positive rate was set to 5.0％,the area under the curve of inhibin-A,alpha-fetoprotein,free human chorionic gonadotropin-β and unconjugated estriol was 63.7％,20.5％,46.1％ and 4.8％,respectively,and the relative area under the curve of routine triple test and quadruple test was 45.5％ and 63.1％,respectively.ConclusionsInhibin-A is suggested to be the most effective marker used for secondtrimester screening,which could be used for second trimester Down syndrome screening in Chinese population combined with existing three markers.

Objective To understand the quality of life and self-efficacy of Parkinson patients and explore the relationship between them. Methods A cross-sectional study was conducted on 155 Parkinson patients. The instruments included a self-designed general information questionnarie, the 39-item Parkinson's disease questionnaire (PDQ-39) and self-efficacy scale for chronic patients. Results The total score of the quality of life was 26.12 ± 16.31.The total score of self-efficacy was 5.46 ± 1.87, and the scores of symptom management and disease management were 5.23 ± 1.98 and 5.94 ± 1.96. The quality of life was positively correlated with self-efficacy (r=0.800, P < 0.01). Conclusions Parkinson patients' overall the quality of life and self-efficacy remain a low level, and the quality of life was closely correlated with self-efficacy. The score of patients' self-efficacy was higer, the quality of life was better. Medical and nursing personnel can through strengthening patients' self-efficacy, optimizating of the patient' s health behavior, and improving negative emotion and attitude, so as to improve their quality of life.

Objective To explore the risk factors,the distribution of etiology and drug resistance status of patients with early infection (3 months) after liver transplantation,and to provide reference for clinical diagnosis and treatment.Methods The clinical data of 112 recipients from February 2014 to December 2015 were collected,and logistic regression analysis was performed on the risk factors of early postoperative infection in liver transplant patients.The independent risk factors of infection after liver transplantation were screened out.At the same time,the results of pathogen culture and drug sensitivity test were statistically described.Results The independent risk factors for infection at 3th month after liver transplantation included the operative time ≥600 min [P =0.003,odds ratio (OR) =9.996,95 ％ confidence interval (95 ％ CI),2.221-44.981],intensive care unit (ICU) ≥6 days (P =0.010,OR =6.306,95％ CI =1.563-25.437),Child-Pugh grade of C (P =0.023,OR =6.298,95％ CI =1.294-30.659).Of the 112 liver transplant recipients,59 had an infection (52.68％),and 168 stains of pathogens were isolated.The positive rate of the specimens was highest in sputum,followed by bile,ascites,drainage and catheter end,blood,deep vein catheter,middle urinary,pleural effusion and peripherally inserted central catheter (PICC).The detectable rate of gram-negative bacteria,gram-positive bacteria,fungi and viruses was 46.43％ (78 strains),29.76％ (50 strains),18.45％ (31 strains),and 5.36％ (9 strains) respectively.Infection occurred mainly within 1 month after surgery,accounting for about 80.36％ (135 strains),especially at 1st week after surgery,accounting for about 34.52％ (58 strains).Gram-positive bacteria had a higher drug resistance rate,including penicillins,macrolides,aminoglycosides,quinolones,linamides,etc.especially in the highest rate of Enterococcus faeciurr.Gram-negative bacteria were individualized based on the different strains of the bacteria,and they were relatively low in the resistance of the carbapene.Conclusion Infection is one of the most common complications after liver transplantation.To reduce the incidence of infection after liver transplantation,efforts should be made to shorten the duration of operation and ICU stay time,improve the basic nutritional status of recipients,and enhance monitoring of the recipient's infection after liver transplantation,to further increase the survival rate of postoperative liver transplantation recipients and improve the quality of life.

Objective To observe the in vitro influence of recombinant human B7-H4 protein on the cell proliferation cycle, apoptosis and cytokine secretion of peripheral blood activated T lymphocytes in cervical cancer patients.Methods After 48 h co-culture of peripheral blood T lymphocytes in 1 5 cases of cervical cancer with B7-H4 48 h,T lymphocytes′cell proliferation cycle, apoptosis and T lymphocytes subtypes changes were detected by FCM;the cytokines concentration in the culture supernatant was tested by ELISA array.Results After 48 h co-culture of peripheral blood T lymphocytes with B7-H4 48hs,G1,G2 and S phase of T cells accounted for 90.59%,8.55% and 0.87% respectively,which of the blank group were 92.83%,6.09% and 1.13% respec-tively;the Ki67 positive rates of CD4 + T and CD8 + T cells in the B7-H4 group were 2.13%±0.13% and 1.03%±1.33% respec-tively,which of the blank group were 2.74% ±0.98% and 1.71% ± 1.32% respectively;the proportion of CD4 + T and CD8 + T cells accounting for T cells in the B7-H4 group was decreased compared with the blank group,but the ratio of CD4 + T/CD8 + T and the proportion of CD4 + CD25 + Foxp3 + T cells were increased,in addition,the TGF-β1 secretion;concentration in the co-culture su-pernatant in the B7-H4 group was (259.25±32.78)pg/mL,which was higher than (202.75 ±20.1 7)pg/mL in the blank group. B7-H4 had no significant influence on the peripheral blood activated T cells apoptosis.Conclusion B7-H4 block the peripheral blood activated T cells at G2 phase,the S phase cells are obviously decreased;B7-H4 inhibits the cellular proliferation of CD4 + T and CD8 + cells,but may have the promoting effect on Foxp3 + T proliferation and TGF-β1 secretion;B7-H4 has no significant influ-ence on T cell apoptosis.B7-H4 plays a role in depressing anti-tumor T cell immune response of cervical cancer and may become a potential target of cervical cancer immunotherapy.

Objective To determine PD-L2 expression in human cervical squamous cell carcinomas and analyze its association with the clinical and pathologic characteristics of these cases ;observe the role of recombinant PD-L2 protein on apoptosis of active peripheral blood T lymphocytes of cervical carcinoma patients .Methods PD-L2 expression in cervical squamous cell carcinomas was determined by immunohistochemistry staining ,and the association between PD-L2 expression with the clinical and pathologic characteristics of these cases was analyzed .In vitro ,the peripheral blood T lymphocytes of cervical carcinoma patients were divided into blank group ,PD-L2 group and PD-L2+anti-PD-1 group respectively .After these active T cells were cultured 72 h ,their apop-totic rates were detected by flow cytometry .Results PD-L2 expressed in 53 .3% (32/60)cervical squamous cell carcinomas ,and it′s expression associated with lymph node metastasis of these cases (P< 0 .05) .In vitro ,PD-L2 promoted apoptosis of CD4+ T and CD8+ T lymphocytes ,the apoptotic rates were 17 .0% and 22 .4% respectively ,which were higher than 9 .0% and 16 .2% of blank group;however ,the apoptotic rates dropped to 11 .1% and 17 .5% in PD-L2+anti-PD-1 group .Conclusion PD-L2 aberrantly ex-presses in cervical squamous cell carcinomas and is associated with their lymph node metastasis .PD-L2 promotes apoptosis of T lymphocytes and depresses the anti-tumor immunity of cervical microenvironment ,and promotes lymph node metastasis of these cancers .PD-L2/PD-1 pathway may be a potential immunotherapy target of cervical squamous cell carcinomas .

ObjectiveTo investigate the clinical effect of Fuhe Beihua prescription combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary liver cancer patients with liver depression and spleen deficiency and its effect on T lymphocyte subsets. MethodsA retrospective analysis was performed for the clinical data of stage Ⅲ primary liver cancer patients with liver depression and spleen deficiency who were treated in Department of Hepatology and Department of Oncology in The First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2018 to January 2020. According to whether the traditional Chinese medicine Fuhe Beihua prescription was used, the patients were divided into treatment group (treated with routine TACE and oral administration of Fuhe Beihua prescription) and control group (treated with routine TACE alone), and the course of treatment was 16 weeks for both groups. The two groups were compared in terms of short-term response rate, quality-of-life score, serum alpha-fetoprotein (AFP) level, four indicators of liver fibrosis, coagulation function parameters, peripheral blood T lymphocyte subsets, and liver function parameters. The independent samples t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A repeated-measures analysis of variance was used for comparison of continuous data between different groups at different time points. ResultsA total of 218 patients were selected, with 118 in the control group and 100 in the treatment group. The treatment group had an objective response rate of 33% and a disease control rate of 66% at week 8 of treatment and an objective response rate of 34% and a disease control rate of 69% at week 16 of treatment, and the control group had an objective response rate of 26.27% and a disease control rate of 68.64% at week 8 of treatment and an objective response rate of 30.51% and a disease control rate of 68.64% at week 16 of treatment; there was a significant difference in objective response rate between the two groups at weeks 8 and 16 of treatment (P＜0.05). Both groups had significant increases in Karnofsky Performance Scale (KPS) score, fibrinogen, and albumin (Alb) from before treatment to weeks 8 and 16 of treatment (all P＜0.05), and there were significant differences in KPS score, fibrinogen, and Alb between the two groups at weeks 8 and 16 of treatment (all P＜0.05). Both groups had significant reductions in AFP, the four indicators of liver fibrosis, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), and traditional Chinese medicine (TCM) syndrome score after treatment (all P＜0.05), and at weeks 8 and 16 of treatment, there were significant differences between the two groups in AFP, the four indicators of liver fibrosis, ALT, AST, PT, and TCM syndrome score (all P＜0.05). At weeks 8 and 16 of treatment, the treatment group had significant increases in the levels of CD3+, CD4+, and CD4+/CD8+ (all P＜0.05) and a significant reduction in the level of CD8+ (P＜0.05), and there were significant differences in the levels of T lymphocyte subsets between the two groups at weeks 8 and 16 of treatment (all P＜0.05). ConclusionFuhe Beihua prescription combined with routine TACE has a better clinical effect than TACE alone in the treatment of primary liver cancer patients with liver depression and spleen deficiency, possibly by regulating the levels of T lymphocyte subsets.

Objective To observe the preventive effect of early comfort using analgesia,minimal sedatives and maximal humane care(eCASH)concept on delirium in patients in coronary care unit(CCU).Methods The clinical data of 136 CCU patients admitted from June 2021 to January 2023 were retrospectively analyzed.Patients received routine delirium prevention care from June 2021 to March 2022 were included in control group(n=69),and patients received eCASH philosophy care from April 2022 to January 2023 were included in observation group(n=67).Delirium prevention effect,condition of restlessness and sedation,CCU length of stay and cognitive function were compared between the two groups.Results The incidence of delirium in the observation group was 4.48％,which was significantly lower than 17.39％in the control group(P＜0.05).The duration of delirium and CCU length of stay in the observation group were significantly shorter than those in the control group(P＜0.05).After intervention,the scores of Richmond Agitation and Sedation Scale(RASS)and Montreal Cognitive Assessment Scale(MoCA)were significantly higher in the two groups than be-fore intervention,and the observation group was significantly higher than the control group(P＜0.05).The average dose of analgesic and sedative drugs(propofol and regal)in the observation group was significantly lower than that in the control group(P＜0.05).Conclusion The analgesic and sedative control scheme based on eCASH concept can reduce the incidence of delirium,shorten the duration of delirium and hospital stay,and improve the agitation sedation and cognitive function of CCU patients.

Objective To observe the preventive effect of early comfort using analgesia,minimal sedatives and maximal humane care(eCASH)concept on delirium in patients in coronary care unit(CCU).Methods The clinical data of 136 CCU patients admitted from June 2021 to January 2023 were retrospectively analyzed.Patients received routine delirium prevention care from June 2021 to March 2022 were included in control group(n=69),and patients received eCASH philosophy care from April 2022 to January 2023 were included in observation group(n=67).Delirium prevention effect,condition of restlessness and sedation,CCU length of stay and cognitive function were compared between the two groups.Results The incidence of delirium in the observation group was 4.48％,which was significantly lower than 17.39％in the control group(P＜0.05).The duration of delirium and CCU length of stay in the observation group were significantly shorter than those in the control group(P＜0.05).After intervention,the scores of Richmond Agitation and Sedation Scale(RASS)and Montreal Cognitive Assessment Scale(MoCA)were significantly higher in the two groups than be-fore intervention,and the observation group was significantly higher than the control group(P＜0.05).The average dose of analgesic and sedative drugs(propofol and regal)in the observation group was significantly lower than that in the control group(P＜0.05).Conclusion The analgesic and sedative control scheme based on eCASH concept can reduce the incidence of delirium,shorten the duration of delirium and hospital stay,and improve the agitation sedation and cognitive function of CCU patients.

Objective? To construct the certification evaluation index system for specialized nurse in operating room in accord with nursing practice in China, so as to provide a reference for administrative department to formulate the standards. Methods? From November 2017 to February 2018, we established the certification evaluation index and standard for specialized nurse in operating room by literature review, expert interview and Delphi method, and we tested the reliability of expert enquiry by the concentration degree of expert opinion, coordination coefficient, active coefficient and authority coefficient. The analytic hierarchy process was used to determine the indexes and weight of evaluation standards. Results? A total of 22 experts participated in the study. Among two rounds of enquiries, the active coefficients were 86.67% and 84.62% respectively, and authority coefficients were 0.89 and 0.93 respectively. In the second enquiry, the coordination coefficient was 0.215. The certification evaluation index system for specialized nurse in operating room consisted of 8 primary indexes, 28 secondary indexes and 76 evaluation criteria. The weight of primary indexes, secondary indexes and valuation criteria ranged from 0.031 4 to 0.275 8,from 0.002 0 to 0.206 9 and from 0.000 7 to 0.137 9 respectively. CI values of comparison matrix were from 0 to 0.0480 and CR values were from 0 to 0.053 3. Conclusions? The certification evaluation index system for specialized nurse in operating room is reliable, which can be a reference standard for certification evaluation for specialized nurse in operating room.

Objective:To investigate the differential expression of miRNAs during white adipose tissue(WAT)browning in mice under different stimulation conditions, and to analyze the potential regulatory mechanisms.Methods:Mouse models of subcutaneous WAT(sWAT)browning were established by different methods: cold-induced browning and intraperitoneal injection of CL316-243.HE staining and analysis of thermogenesis-related gene expression were used to validate the browning models.miRNAs expression profiles in different conditions were described by RNA-sequencing(RNA-seq)and miRNAs with similar expression patterns in the two groups were detected via screening.Target genes of miRNAs were predicted by bioinformatics, and their expression levels were verified by quantitative real-time PCR(qRT-PCR).Results:Both cold-induced browning and intraperitoneal injection of CL316-243 were able to activate the browning of sWAT, and the miRNA expression profile of sWAT showed significant differences before and after induction.After screening differentially expressed miRNAs, the expression of Mir-30E-3p was increased and the expression of Mir-181A-5p was decreased under different browning-inducing conditions in WAT.The prediction and validation of target genes revealed that cyclin-dependent kinase 6(Cdk6)and sirtuin 1(Sirt1)were potential targets regulated by miR-30e-3p and miR-181a-5p in the browning of sWAT, respectively.Conclusions:There are significant differences in miRNA expression during the browning of sWAT in mice induced by cold stimulation and CL316-243 injection.MiR-30e-3p and miR-181a-5p may be involved in the regulation of the sWAT browning process through target genes Cdk6 and Sirt1, respectively.