Objective To evaluate efficacy and mechanism of Anluohuaxian pilule combined with interferon-γ in the treatment of schistosomal liver fibrosis. To preliminarily study on the relationship of pigment deposition in liver and schistosomal liver fibrosis. Methods Thirty Kunming mice were divided into the normal control group, the infection control group and the combination of Anluohuaxian pilule and Interferon-γ treated group. Schistosomal liver fibrosis model was established by infection with 40 Schistosoma japonicum cercariae. The treated group was treated by combination of Anluohuaxian pilule and Interferon-γ for 8 weeks. The changes of pigment deposition and hepatic egg granuloma in Schistosoma japonicum infected mice were observed. Expressions of collagen Ⅰ and Ⅲ were detected by immunohistochemistry. Transforming growth factor (TGF)-β1 was detected by fluorescent polymerase chain reaetion(PCR). Histopathology and computer image analysis were applied to evaluate the change in the liver tissues. Results The amount of pigment deposition in liver was related to the expression of TGF-β1 mRNA (correlation coefficient = 0. 8). Compared to the infection control group, combination of Anluohuaxian pilule and Interferon-γ can lessen hepatic fibrosis(P<0.05). The combination therapy can also make pigment deposition less and hepatic granuloma smaller than the infection control group(P<0. 05). Conclusions Pigment deposition in liver is related to the expression of TGF-β 1. Combination of Anluohuaxian pilule and Interferon-γ can lessen hepatic fibrosis in mice infected with Schistosoma japonicum. It's one mechanism to of the combination therapy down-regulate the expression of collagen Ⅰ, Ⅲ and TGF-β 1.

Objective To learn the recent development and regional distribution of clinics in China.Methods Based on statistics and a nationwide survey of clinics in the country,a simple linear regression was made to find factors determining clinics regional distribution.Results Clinics in China were found to have grown sizably from 134 000 in 2008 to 155 000 in 2014;medical technology workers to 2.31 per clinic in 2014;and the total revenue of these clinics accounted for only 0.724% of all medical institutions,while there are more clinics in the east than the west regions in China.Conclusions The role of clinics in attracting high quality medical resources to primary care should be further enhanced for development of the hierarchical medical system in China.

Objective To evaluate the efficacy of ultrasound-guided modified anterior approach to sciatic nerve block ( SNB) for orthopedic surgery with general anesthesia. Methods Ninety American So-ciety of Anesthesiology physical status Ⅰ or Ⅱpatients of both sexes, aged 18-64 yr, weighing 19-28 kg∕m2 , scheduled for elective knee joint or distal orthopedic surgery, were divided into 3 groups ( n=30 each) using a random number table method: modified anterior approach ( the puncture needle was almost perpendicular to the ultrasound beam) group, anterior approach group and posterior approach group. SNB ( injecting 0. 5％ ropivacaine 20 ml) combined with femoral nerve block ( injecting 0. 5％ ropivacaine 15-20 ml) was performed under ultrasound guidance. Surgery was completed under combination of the laryngeal mask and combined intravenous-inhalational anesthesia. When the respiratory rate ≥20 beats∕min and∕or the increase in heart rate was more than 20％ of the baseline value, sufentanil 1μg∕time was intravenously injected. When visual analog scale ( VAS) score ≥4 within 24 h after surgery, celecoxib capsules 0. 2 g was taken orally for analgesia. The depth of sciatic nerve, needling depth, sharpness score of needle ima-ging under ultrasound, and operation time and duration of SNB were recorded. VAS scores at rest and dur-ing activity were recorded at 6, 8, 10, 12 and 24 h after surgery. The amount of sufentanil consumed dur-ing surgery and use of celecoxib capsules within 24 h after surgery were recorded. The development of ad-verse reactions such as hematoma at the puncture site, nausea and vomiting was also recorded after surgery. Results Compared with posterior approach group, the depth of sciatic nerve and needling depth were sig-nificantly increased, the operation time of SNB was prolonged, the duration of SNB was shortened, the in-traoperative consumption of sufentanil was increased, VAS scores at rest and during activity were increased at 10 h after surgery, and the sharpness score of needle imaging was increased in modified anterior approach and anterior approach groups (P<0. 05). Compared with anterior approach group, the sharpness score of needle imaging was significantly increased, and VAS scores during activity were decreased at 24 h after sur-gery in modified anterior approach group ( P<0. 05) . There was no significant difference in the requirement for celecoxib capsules within 24 h after surgery or occurrence of adverse reactions among the three groups ( P>0. 05) . Conclusion Although ultrasound-guided modified anterior approach to SNB provides compara-ble efficacy with anterior approach to SNB and is not as good as posterior approach to SNB when used for or-thopedic surgery with general anesthesia, modified anterior approach to SNB is easy to operate, with clear images under ultrasound.

Objective To observe the choroidal blood flow and morphological changes in patients with severe stenosis of internal carotid artery stenosis (ICAS).Methods A retrospective case-control study. Forty-six patients (46 eyes) with ICAS were enrolled in this study. There was severe stenosis in one side (the eyes in this side were set as case group) and mild or no stenosis in other side (the eyes in this side were set as control group). Color doppler ultrasound (CDI) was used to observe the changes of hemodynamic parameters of the ophthalmic artery (OA) and posterior ciliary artery (PCA),the main parameters of ultrasound Doppler imaging are peak systolic velocity (PSV), end diastolic velocity (EDV), resistance indices (RI) and the calculation of the pulsation indices (PI) through the use of a formula. Enhanced binarization of deep imaging coherence tomography (EDI-OCT) was used to measure the subfoveal choroidal thickness (SFCT). The total subfoveal choroidal area (TCA), luminal (LA), stromal (SA) and choroidal vascularity index (CVI) were obtained by modified image binarization technique.Results In the case group, the PSV in the OA and PCA was significantly lower than that of the control group (t=?2.200, ?2.612;P=0.030, 0.011). There were no significant differences in EDV, RI, PI of OA (t=0.337, ?1.810, ?1.848;P=0.737, 0.074, 0.068) and PCA (t=?1.160, 1.400, 0.815;P=0.249, 0.165, 0.417). The SFCT (t=?3.711,P<0.001), TCA (t=?2.736,P=0.007), LA (t=?3.188, P=0.002) and CVI (t=?2.096,P=0.039) of the case group was significantly lower than that of the control group. There were no significant differences in SA (t=?1.262,P=0.210) and LA/SA (t=?1.696,P=0.093).Conclusion In severe stenosis ICAS eyes, the PSV in the PCA and SFCT, TCA, LA, CVI are decreased.

Objective　To explore the relationship between the levels of serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and angiopoietin-like protein 8 (ANGPTL8) and the degree of neurological deficit and prognosis of patients with acute watershed cerebral infarction.Methods　From June 2018 to July 2021,105 patients with acute watershed cerebral infarction accepted by our hospital were enrolled as the research group,the NIHSS scale was used to evaluate the degree of neurological deficit,and the patients were divided into mild neurological deficit group and moderate-severe neurological deficit group;the modified Rankin scale was used to evaluate the prognosis of the patients,and they were grouped into a good prognosis group and a poor prognosis group;another 100 healthy subjects were enrolled as the control group,the serum levels of LOX-1 and ANGPTL8 of subjects in each group were detected,and the differences between groups were compared.Receiver operating characteristic (ROC) curve was drawn to analyze the evaluation value of serum LOX-1 and ANGPTL8 levels for the degree of neurological deficit and prognosis in patients with acute watershed cerebral infarction.Results　The levels of serum LOX-1 and ANGPTL8 in the study group were obviously higher than those in the control group,the levels of serum LOX-1 and ANGPTL8 in the moderate to severe neurological deficit group were obviously higher than those in the mild neurological deficit group,and the levels of serum LOX-1 and ANGPTL8 in the poor prognosis group were also obviously higher than those in the good prognosis group (P<0.05).The area under the curve (AUC) of serum LOX-1 and ANGPTL8 combined to assess moderate to severe neurological deficit in patients with acute watershed cerebral infarction was 0.894,which was greater than that of LOX-1 (0.763) and ANGPTL8 (0.852) alone (P<0.05);the AUC of the two combined assessment of acute watershed cerebral infarction patients with poor prognosis was 0.932,which was greater than that of LOX-1 and ANGPTL8 alone (P<0.05).Conclusion　Serum LOX-1 and ANGPTL8 levels are up-regulated in patients with acute watershed cerebral infarction,and the combination of the two has a higher efficacy in evaluating the degree of neurological deficit and prognosis of patients.

COVID-19 is caused by coronavirus SARS-CoV-2. Current systemic vaccines generally provide limited protection against viral replication and shedding within the airway. Recombinant VSV (rVSV) is an effective vector which inducing potent and comprehensive immunities. Currently, there are two clinical trials investigating COVID-19 vaccines based on VSV vectors. These vaccines were developed with spike protein of WA1 which administrated intramuscularly. Although intranasal route is ideal for activating mucosal immunity with VSV vector, safety is of concern. Thus, a highly attenuated rVSV with three amino acids mutations in matrix protein (VSV_MT) was developed to construct safe mucosal vaccines against multiple SARS-CoV-2 variants of concern. It demonstrated that spike protein mutant lacking 21 amino acids in its cytoplasmic domain could rescue rVSV efficiently. VSV_MT indicated improved safeness compared with wild-type VSV as the vector encoding SARS-CoV-2 spike protein. With a single-dosed intranasal inoculation of rVSV_ΔGMT-S_Δ21, potent SARS-CoV-2 specific neutralization antibodies could be stimulated in animals, particularly in term of mucosal and cellular immunity. Strikingly, the chimeric VSV encoding S_Δ21 of Delta-variant can induce more potent immune responses compared with those encoding S_Δ21 of Omicron- or WA1-strain. VSV_MT is a promising platform to develop a mucosal vaccine for countering COVID-19.

The global coronavirus disease 2019 epidemic is still in a pandemic state. Aging population with underlying diseases is prone to become severe, and have a higher mortality. The treatment capacity of the critical care department directly determines the treatment success rate of critical illness. At present, there is still a certain gap between domestic and foreign countries in intensive care unit (ICU), which is not only in the allocation of medical staff, but also in the beds and settings. The current medical model cannot fully meet the needs of development. The experience and lessons of many major public health emergencies suggested that " dual track of peace and war" approach in discipline construction of critical care is the best medical model. Following the concept of "combination of peace and war", strengthening the discipline construction of critical care department in municipal and district designated hospitals, allocating reasonable standard ICU, step-down ICU and combat readiness ICU, establishing rapid response team, and strengthening regular training and scientific management may be the key measures to deal with the epidemic.

Objective:To explore the effect of closed-loop nursing on self-efficacy and nursing satisfaction in children with nephrotic syndrome (NS) .Methods:From March 2019 to January 2021, convenience sampling was used to select 104 children with NS and their accompanying parents in Henan Provincial People's Hospital as the research object. The children were divided into the control group and the observation group by random number table method, 52 cases in each group. The control group received routine nursing, and the observation group carried out closed-loop nursing on the basis of the control group. The scores of the General Self-efficacy Scale and Satisfaction Scale were compared between the two groups.Results:After three months of intervention, the children's self-efficacy score in the observation group was higher than that in the control group, and the parents' satisfaction with nursing was 94.23% (49/52) , which was higher than 78.85% (41/52) in the control group. The differences were all statistically significant ( P<0.05) . Conclusions:The closed-loop nursing can improve the self-efficacy of children with NS and the satisfaction of their parents, which is worthy of clinical promotion.

OBJECTIVETo observe and evaluate the clinical efficacy of transcutaneous vagus nerve stimulation (taVNS) at auricular concha for primary insomnia (PI) and affective disorder.

METHODSA total of 35 patients who met the diagnosis standard of PI in(5th edition) were included. The self-developed auricular vagus nerve stimulator (TENS-200A) was applied at auricular concha, 30 min per treatment, twice a day, 5 days a week for consecutive 4 weeks. The follow-up visit was conducted at the end of 6th week. The Pittsburg sleep quality index scale (PSQI), 17-items Hamilton depression scale (17HAMD) and Hamilton anxiety scale (HAMA) were applied for evaluation. The PSQI, HAMA and 17HAMD were observed before and after treatment; the safety was also observed.

RESULTSCompared before treatment, the PSQI was significantly decreased to (13.20±3.61) at the end of 2nd week (<0.05); compared before treatment, the 17HAMD and HAMA were significantly decreased at the end of 4th week and 6th week (all<0.05). No adverse reaction was observed.

CONCLUSIONSThe taVNS could not only relieve PI symptoms, but also improve the depressive and anxiety symptoms, in addition, it may have positive long-term efficacy and safety.

Objective: To explore the clinicopathological characteristics of primary hepatic neuroendocrine neoplasm (HNEN) and metastatic HNEN from digestive tract, to screen the risk factors of hepatic metastasis of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) and to analyze the differences between primary and metastatic HNEN in clinical features, diagnosis, treatment and prognosis. Methods: From January 2010 to June 2017, the clinical data of 182 patients with HNEN admitted at The First Affiliated Hospital of Zhengzhou University were retrospectively analyzed, including 39 cases of primary HNEN, 129 cases of metastatic HNEN and 14 cases of HNEN with unknown primary lesions. Chi-square test and t test were performed to analyze the pathologic characteristics among groups. Logistic regression method was used to analyze the risk factors of hepatic metastasis. Kaplan-Meier method and log-rank test were used for survival analysis. Cox model was used for the prognostic multivariate survival analysis. Results: Metastatic HNEN from digestive tract was more common in male (70.5%, 91/129). The case number of serological tumor biomarkers neuronspecific enolase and alpha-fetoprotein positive in primary HNEN were two cases and one case, respectively, and the positive rates in metastatic HNEN were 37.2% (32/86) and 6.4% (7/110). Most primary HNEN was single lesion (61.5%, 24/39), while multiple lesions were more common in metastatic HNEN (78.3%, 90/115). Primary HNEN mainly occurred in the right lobe of the liver (44.7%, 17/38), while metastatic HNEN located simultaneously in the left and right lobes of the liver (68.4%, 78/114). There were significant differences between primary HNEN and metastatic HNEN in tumor number, pathological grading, location of tumors and maximum diameter of tumors (χ²=21.264, 11.696, 19.461 and 4.547, all P<0.05). The median survival time of patients with primary HNEN and metastatic HNEN were 17.0 months and 10.0 months, and there was a significant difference in survival curves between the two groups (χ²=7.235, P=0.007). The type of hepatic tumors (primary or metastatic)(P=0.002), pathological grading of hepatic tumors (P=0.044), lymph node metastasis (P=0.024), the growth pattern of tumors (P<0.01) and treatment methods (P=0.018) were the independent factors for the prognosis of patients. Conclusions There are significant differences between primary HNEN and metastatic HNEN in tumor number, size and location. The type of hepatic tumors, pathological grading, lymph node metastasis, growth pattern of tumors and treatment methods are the independent factors for the prognosis of patients. Early topical treatment and combination treatment can help to prolong survival time of HNEN patients.