Objective To observe the effect of intrathecal p38 MAPK inhibitor(SB203580) treatment on neuropathic pain and the expression of p38 MAPK and BDNF in dorsal horn of spinal cord in rats with chronic constriction injury(CCI),So as to investigate the possible mechanisms of neuropathic pain.Methods Totally 30 SD rats were evenly randomized into 3 groups(n=10) :sham group receiving intrathecal injection of sodium chloride,control group receiving intrathecal injection of sodium chloride and CCI surgery,and SB203580 group receiving intrathecal injection of SB203580 and CCI surgery.SB203580(0.1 ml/kg) was administered 0.5 h before and 1-14 d after CCI surgery.The mechanical thresholds were tested 24 h before and 4-14 d after CCI surgery.p38 MAPK expression and BDNF release in the dorsal horn were determined using immunohistochemistry method 14 d after CCI surgery.Results The mechanical thresholds in the control and SB203580 groups were significantly lower after CCI surgery compared with that before CCI surgery(P0.05).Compared with the sham operation group,the mechanical thresholds were significantly lower in the other two groups after CCI surgery(P

Objective To investigate the changing characteristics and rules of the different period of articular cartilage in rats after dorsal rhizotomy, and to verify the partial sensory disturbance can cause articular cartilage injury. Methods Thirty-three ten-month-old SPF male Wistar rats were randomly divided into experimental group ( n=18 ) and control group ( n=15) .The rats in the experimental group were sectioned the L3、L4 dorsal roots in the right.The rats in the control group were only incised the skin and paravertebral muscles.To observe the behavior changes in rats.At 2, 6 and 10 weeks, the specimens of the right hind lower end of femur were drawn out to make paraffin sections, then HE staining and Safranin O/Fast Green staining.The changes and characteristics of the morphology of the articular cartilage was observed.Results With the prolonging of period, the right hind limb of the experimental rats through the change process of transient paralysis, coordination of movement disorders and active movement.In the experimental group, the patellar surface of right hind femur gradually became shallow and wide.The articular cartilage underwent rough, cells disorganizated, cells decreased, and duplicated drifted and interrupted tide line. The ratios of ACC/TAC of the experimental group were gradually high(t=5.25~8.13,P <0.05).Conclusion Dorsal rhizotomy can cause injury and degenerative changes in articular cartilage.

Objective:To explore the influence of head nurse empowerment on nurses′ voice behavior and the mediating and moderating effects of nurses′ job crafting and proactive personality.Methods:A total of 805 nurses from the 4 grade A hospitals in Shandong province from February to March 2022 were selected by convenience sampling method, the Nurse Managers′ Empowering Behavioral Scale For Staff Nurses, Job Crafting Scale, Voice Behavior Scale and Proactive Personality Scale were used for cross-sectional survey. The mediating effect was analyzed by SPSS 26.0 and Process 3.4 macro.Results:The total score of nurses′ perception of head nurse empowerment was (4.01 ± 0.57) points, the total score of nurses′ job crafting was (4.19 ± 0.66) points, the total score of nurses′ voice behavior was (4.12 ± 0.62) points, and the total score of nurses′ proactive personality was (6.07 ± 0.90) points. Head nurse empowerment, nurse job crafting, voice behavior and proactive personality were positively correlated with each other ( r values were 0.483-0.824, all P<0.01). The mediating effect of job crafting was 0.541, accounting for 86.4% of the total effect; proactive personality had a positive moderating effect on the first half path of the mediation model ( ? R 2=0.163, P<0.01). Conclusions:Head nurse empowerment influenced voice behavior of nurses directly and indirectly through the mediating role of job crafting, proactive personality can moderate the effect of head nurse empowerment on nurse job crafting. It is suggested that the head nurse appropriately delegate power to the nurses and actively authorize them, identify nurses with high proactive personality, stimulate their job remodeling and voice behavior, and improve the quality of nursing work.

Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating diseases of the central nervous system, the underlying cause of which has not been cleared. Previous studies have shown that the pathogenesis of MS is related to the destruction of blood brain barrier, furthermore the drugs used to treat MS have a certain protective effect on the function of blood brain barrier. Therefore, this review combines the research progress at home and abroad to clarify the relationship between the blood brain barrier and MS in pathogenesis and treatment, proposing possible orientation of development.

OBJECTIVE:To provide reference for promoting the rational use of Dexamethasone sodium phosphate injection in the clinic. METHODS:Special comment criteria and evaluation rules was formulated,medical records of 1273 inpatients receiving Dexamethasone sodium phosphate injection were collected from our hospital during Jul. 2014-Jun. 2015. Rationality of drug use was evaluated and analyzed retrospectively. RESULTS:The most use amount and case number of Dexamethasone sodium phosphate injection were in the departments of blood/oncology,obstetrics,emergency minimally invasive surgery,gastrointestinal surgery,emergency trauma of orthopedics and thyroid breast surgery;while much less were in departments of new pediatrics, infection and rehabilitation. There were 138 cases of irrational use of Dexamethasone sodium phosphate injection found in special comment, and the total irrational use rate was 10.84％ . The types of irrational use included inappropriate indication (contraindication,59.42％),inappropriate drug combination(18.84％),inappropriate drug selection (15.94％),inappropriate usage and dosage(3.62％)and inappropriate drug dosage forms or drug delivery methods(2.17％),etc. The irrational use rate of Dexamethasone sodium phosphate injection monthly declined steadily by month from 30.35％ in Jul. 2014 to 7.81％ in Jun. 2015 through the special comment;then a consensus of 5 points for the drug use formed in our hospital. CONCLUSIONS:There are irrational situations in the clinical use of Dexamethasone sodium phosphate injection in our hospital,especially in the cases of inappropriate indications. The rationality of the drug can be improved by the development of the special comment. This work should continue to be carried out in the future and perfected.

Objective:To prospectively investigate the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill children during extracorporeal membrane oxygenation(ECMO) and explore the clinical characteristics and prognosis of HIT during ECMO.Methods:A total of 22 critically ill children, who had received ECMO support for more than 96 hours in the Intensive Care Unit at the Children′s Hospital of Fudan University from March 2019 to December 2020, were enrolled.According to the 4T score and the heparin/platelet factor 4(PF4) antibody, children whose 4T scores were not less than 6 and heparin/ PF4 antibodies were positive, were classified into HIT group ( n=6), and non-HIT group ( n=16). The clinical outcomes and the incidence of thrombotic events were compared between two groups. Results:The incidence of HIT during ECMO in critically ill children was 27% in this study.The incidence of thrombosis in the ECMO circuit in the HIT group was higher (100% vs.63%, P=0.133), and the average time to the first thrombosis in ECMO circuit in the HIT group was shorter than that in the non-HIT group (3.70 d vs.5.44 d, P=0.06). During the first 14 days of ECMO, the proportion of children with thrombotic events no less than twice was higher in the HIT group (67% vs.19%, P=0.054). There was no significant difference regarding the survival rate at 28 days after ECMO withdrawal between two groups (33% vs.50%, P=0.664). Conclusion:The prevalence of HIT during ECMO in critically ill children is high.Thrombosis events tend to occur earlier and more extensively in children with HIT during ECMO.No significant effect of HIT on the survival rate of children during ECMO is found.Whether HIT has effect on the survival rate of children with ECMO requires a prospective and large clinical study.

Objective: To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland. Methods: In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy. Results: By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children′s hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77). Conclusion The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.

Objective To compare the clinical effects of interscalene brachial plexus block and superior trunk block in arthroscopic shoulder surgery with 0.25% ropivacaine. Methods 46 patients undergoing shoulder arthroscopy surgery were included and randomly divided into group ISB (n=23) and group ST (n=23). Patients in group ISB received 10 ml 0.25% ropivacaine on the lateral side of C5 and C6. Patients in group ST were treated with 5 ml 0.25% ropivacaine on both sides of the superior trunk of brachial plexus. The diaphragmatic excursion, Numerical Rating Scale(NRS), duration of the block, handgrip strength were recorded at different time. Results No statistical difference was detected between the two groups in the reduction of diaphragmatic excursion within 30 min after block (P>0.05). Compared with ISB patients, ST patients had significantly less diaphragmatic excursion at 3 h after block（P<0.05). 30 minutes after block, 8.7% patients in ISB group reached complete HDP and 52.2% patients reached partial HDP. At the same time, no complete HDP and 26.1% partial HDP were detected in ST group. 3 hours after block, patients in ST group had lower complete HDP rate (0.0% vs 17.4%) and lower partial HDP rate (39.1% vs 65.2%) than patients in ISB group. At 30 minutes and 3 h after block, the reduction of grip strength in ST group was significantly lower than that in ISB group (P<0.001). ST group had lower NRS than ISB group (P<0.05). The average block time in ISB group (8.3±1.97 )h was significantly lower than that in ST group (10.9±1.26)h (P<0.01). Conclusion Superior trunk block with 10 ml 0.25% ropivacaine is superior compared to interscalene brachial plexus block in occurrence of HDP, decrease of grip strength, postoperative pain and block duration.

T cell infiltration and proliferation in tumor tissues are the main factors that significantly affect the therapeutic outcomes of cancer immunotherapy. Emerging evidence has shown that interferon-gamma (IFNγ) could enhance CXCL9 secretion from macrophages to recruit T cells, but Siglec15 expressed on TAMs can attenuate T cell proliferation. Therefore, targeted regulation of macrophage function could be a promising strategy to enhance cancer immunotherapy via concurrently promoting the infiltration and proliferation of T cells in tumor tissues. We herein developed reduction-responsive nanoparticles (NPs) made with poly (disulfide amide) (PDSA) and lipid-poly (ethylene glycol) (lipid-PEG) for systemic delivery of Siglec15 siRNA (siSiglec15) and IFNγ for enhanced cancer immunotherapy. After intravenous administration, these cargo-loaded could highly accumulate in the tumor tissues and be efficiently internalized by tumor-associated macrophages (TAMs). With the highly concentrated glutathione (GSH) in the cytoplasm to destroy the nanostructure, the loaded IFNγ and siSiglec15 could be rapidly released, which could respectively repolarize macrophage phenotype to enhance CXCL9 secretion for T cell infiltration and silence Siglec15 expression to promote T cell proliferation, leading to significant inhibition of hepatocellular carcinoma (HCC) growth when combining with the immune checkpoint inhibitor. The strategy developed herein could be used as an effective tool to enhance cancer immunotherapy.