Objective To carry out health education nursing intervention mode for patients with hemodialy-sis,and to study and analyze the clinical nursing effect.Methods 112 cases of hemodialysis patients were randomlydivided into the observation group and the control group according to random number table,56 cases in each group. The patients of the control group were given conventional nursing model,and the patients of the observation group were given nursing intervention model on the basis of health education.The blood pressure,the internal fistula blockage, indwelling catheter caused by the incidence of infection and blood phosphorus level of compliance rate were compared in the two groups.Results After nursing intervention,diastolic blood pressure(76.17 ±7.02)mmHg and systolic blood pressure (131.17 ±8.77)mmHg of the observation group were significantly better than the control group [(90.91 ±8.44)mmHg,(141.29 ±7.08)mmHg],there were statistically significant differences(t =10.49,13.75, all P <0.05).The incidence rate of fistula obstruction (1.79%)and the catheter infection incidence rate(1.79%) of the observation group were significantly lower than the control group (28.57%,26.79%),there were statistically significant differences(χ2 =8.22,9.17,all P <0.05).The blood phosphorus level standard rate(60.71%)of the observation group was significantly higher than the control group(33.93%),there was statistically significant differ-ence (χ2 =11.45,P <0.05).Conclusion The incidence of complications is significantly decreased after nursing intervention of health education in patients with hemodialysis,and the indexes are improved significantly,and there is no obvious conflict of interest.

Background and purpose: Phosphatase and tensin homologue deleted on chromosome 10 (PTEN) gene is a kind of tumor suppressors, which has been reported to be underexpressed in endometrial carcinoma (EC) tissues by several reports. However, the biological effects and possible mechanisms of PTEN on EC have been known less. In this study, we tried to investigate the effects and possible mechanisms of PTEN on the invasion and migration of endometrial carcinoma cells and to provide a potential target for endometrial carcinoma therapy. Methods:The recombinant plasmid pIRES2-ZsGreen1-PTEN was rebuilt by gene recombination technology;The plasmid was transferred into HEC-1B cells and the cells transfected with pIRES2-ZsGreen1 plasmid were used as control;The expression of PTEN was observed by fluorescence microscope and Western blot assay;Cell migration and invasion was determined by the wound healing assay, transwell migration and invasion assays respectively;The Western blot analysis was performed to detect the expression of ATP-dependent tyrosine kinase (AKT), phosphorylated-AKT (p-AKT) and matrix metalloproteinase-2 (MMP-2). Results:The agarose gel electrophoresis showed a stripe of 1.2 kb which was same to PTEN cDNA;The sequence analysis showed the PCR products owned the same sequence with the coding region of PTEN cDNA in GenBank, suggesting the recombinant plasmid was constructed successfully;The green light of cells observed by fluorescence microscope and the Western blot analysis showed the expression of PTEN was upregulated in the cells transfected with the recombinant plasmid, suggesting the plasmid expressed successfully in HEC-1B cells;The wound healing assay as well as transwell migration assay showed ectopic expression of PTEN suppressed cell migration;The invasive capacity of HEC-1B cells was significantly decreased upon transfection with PTEN plasmid compared to control and untreated groups;Moreover, compared with the control groups, the expression of p-AKT and MMP-2 was downregulated, while there was no significant alteration of the expression of AKT. Conclusion:PTEN could suppress cell migratory and invasive ability of endometrial carcinoma cells by suppressing the phosphorylation of AKT followed by the decrease of MMP-2.

Delirium is a common complication in elderly hospitalized patients and a marker of poor outcome. The Hospital Elder Life Program has been shown to be highly efficient and cost-effective in reducing delirium incidence in the USA. This article describes the Hospital Elder Life Program, a new model of care designed to prevent delirium in America, and its clinical applications. The article also analyzes the key points in the delivery of HELP in domestic health care system. It is expected to provide reference for improving delirium care for hospitalized older adults in China.

Objective:To compare the therapeutic effects of nasal high-flow oxygen therapy (HFNC) and nasal canal oxygenation (NCO) during breaks off non-invasive ventilation (NIV) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore the feasibility of NIV combined with HFNC in the treatment of AECOPD.Methods:From August 2017 to July 2019, AECOPD patients with type Ⅱrespiratory failure (arterial blood gas pH <7.35, PaCO 2 > 50 mmHg) who were treated with NIV were randomly (random number) assigned to the HFNC group and NCO group at 1:1. The HFNC group received HFNC treatment during breaks from NIV and the NCO group received low-flow NCO during the NIV interval. The primary endpoint was the total respiratory support time. The secondary endpoints were endotracheal intubation, duration of NIV treatment and breaks from NIV, length of ICU stay, total length of hospital stay and so on. Results:Eighty-two patients were randomly assigned to the HFNC group and the NCO group. After secondary exclusion, 36 patients in the HFNC group and 37 patients in the NCO group were included in the analysis. The total respiratory support time in the HFNC group was significantly shorter than that in the NCO group [(74 ± 18) h vs. (93 ± 20) h, P = 0.042]. The total duration of NIV treatment in the HFNC group was significantly shorter than that in the NCO group [(36 ± 11) h vs. (51 ± 13) h, P=0.014]. There was no significant difference of the mean duration of single break from NIV between the two groups, but durations of break from NIV in the HFNC group were significantly longer than those in the NCO group since the third break from NIV ( P < 0.05). The intubation rates of the HFNC and NCO groups were 13.9% and 18.9%, respectively, with no significant difference ( P=0.562). The length of ICU stay in the HFNC group was (4.3 ± 1.7) days, which was shorter than that in the NCO group [(5.8 ± 2.1) days, P=0.045], but there was no significant difference in the total length of hospital stay between the two groups. Heart rate, respiratory rate, percutaneous carbon dioxide partial pressure and dyspnea score during the breaks from NIV in the NCO group were significantly higher than those in the HFNC group, and the comfort score was lower than that in the HFNC group ( P<0.05). Conclusion:For AECOPD patients receiving NIV, compared with NCO, HFNC during breaks from NIV can shorten respiratory support time and length of ICU stay, and improve carbon dioxide retention and dyspnea. HFNC is an ideal complement to NIV therapy in AECOPD patients.

Inflammatory immune response runs through the course of ischemic stroke. Different subgroups of CD4 + T cells play a complex and important role in the course of ischemic stroke. Among them, the balance of pro-inflammatory effect of T helper cell 17 (Th17) and anti-inflammatory effect of regulatory T cells (Treg) is closely associated with the outcome of stroke. This article reviews the role of Th17/Treg balance in ischemic stroke, in order to deepen the understanding of the mechanism of immune inflammation after ischemic stroke and explore possible therapeutic targets in the course of ischemic stroke.

Objective:To observe the clinical effect of Shenfu injection in preventing septic cardiomyopathy (SIC) in septic patients.Methods:From June 2022 to January 2023, patients with sepsis or septic shock who did not develop SIC were randomly divided into treatment group and control group according to the ratio of 1:1. In the treatment group, Shenfu injection (50 mL) was pumped intravenously once every 12 hours for 5 days. In the control group, 50 mL of normal saline was pumped intravenously once every 12 hours, and the course of treatment was 5 days. The primary end point was the incidence of SIC in the first 5 days. The secondary end points were the application time of vasoactive drugs, fluid balance in the previous week, hospitalization time in ICU, total ventilation time and 28-day mortality.Results:112 patients were randomly divided into two groups. Seven patients in the treatment group were excluded twice, and finally 49 patients were included in the analysis, while six patients in the control group were excluded twice and 50 patients included in the analysis. The total incidence of SIC in the treatment group within 5 days was significantly lower than that in the control group (42.9% vs. 64.0%, P = 0.035). Among them, the left ventricular systolic dysfunction in the treatment group was significantly lower than that in the control group (24.5% vs 52.0%, P=0.005), and there was no significant difference in the incidence of left ventricular diastolic dysfunction between the two groups. The incidence of right ventricular dysfunction in the control group was 28.0%, which was significantly higher than 10.2% in the treatment group ( P = 0.025). The duration of using vasoconstrictors in the treatment group was 75(48, 97) hours, which was significantly lower than 97(66, 28) hours in the control group ( P = 0.039). The duration of inotropic drugs use in the treatment group was 32(18, 49) h, which was also significantly shorter than 44(25, 61) h in the control group ( P=0.046). The fluid balance of the control group in the first week was (1 260±850) mL, which was significantly higher than (450±520) mL in the treatment group ( P=0.008). There was no statistical difference in ICU stay, total ventilation time and 28-day mortality between the two groups (all P > 0.05). Conclusion:Early application of Shenfu injection can significantly reduce the incidence of SIC, accompanied by less use of vasoactive drugs and positive fluid balance, which has a good clinical application prospect.

Dermatomyositis is an autoimmune disease involving the skin and muscles. At the onset of dermatomyositis, it is difficult to make an early diagnosis due to atypical clinical manifestations and lack of serological markers. Skin and muscle lesions are associated with disease activity and prognosis in patients with dermatomyositis or clinical amyopathic dermatomyositis. Computed tomography, magnetic resonance imaging, ultrasonography, dermoscopy and other imaging techniques may be used to assess skin and muscle involvements, which can not only improve the accuracy of early diagnosis of dermatomyositis, but also provide important reference for the assessment of disease activity and prognosis.

Objective To explore the pregnancy outcomes in women whose fetal/embryonic heart rate( FHR) were below 120 beats per minute( bpm) before 8 weeks pregnancy and determine the predictive value of FHR in pregnancy outcome . Methods The laboratory examinations ,clinical data and clinical history of the pregnant women whose FHR were below 120 bpm before 8 weeks pregnancy were retrospectively analyzed . Results When gestational age(GA) was less than 8 weeks ,pregnancy loss was observed in 11 .0% ( 110/998 ) cases with an FHR less than or equal to 120 bpm ,and pregnancy loss occurred in all the cases ( 23/23) with an FHR less than or equal to 70 bpm . The proportions of first trimester loss were 86 .4% (19/22) for pregnancies with an FHR of 71 －80 bpm ,75 .7% (28/37) for pregnancies with an FHR of 81－90 bpm ,25 .5% (14/55) for pregnancies with an FHR of 91 －100 bpm , 6 .3% (13/208) for pregnancies with an FHR of 101 －110 bpm ,and 2 .0% (13/653) for pregnancies with an FHR of 111 －120 bpm .ROC analysis showed that the best cut-off value to predict adverse pregnancy outcomes was an FHR of 94 bpm . The area under the ROC curve was 0 .906 ( P ＜ 0 .0001 ) and its sensitivity and specificity values were 97 .86% and 71 .43% respectively . Conclusions Fetal/embryonic heart monitoring before 8-weeks pregnancy can be an effective predictor for early pregnancy outcome . The best cut-off value to predict adverse pregnancy outcomes is an FHR of 94 bpm .

Objective To evaluate the efficacy of different interventions to the extra cranial lesions in acute ischemic stroke(AIS)due to anterior tandem lesions(TL)on reperfusion.Methods As a multi-center,cross-sectional study,AIS due to anterior TL receiving mechanical thrombectomy(MT)were retrospectively collected.Interventions to the extra-cranial stenosis were recorded.Post-procedural reperfusion was assessed using the modified thrombolysis in cerebral infarction(mTICI)score.Complete revascularization was defined as mTICI 3 and good revascularization was defined as mTICI 2b/3.The relationship between different extra-cranial intervention regi-mens and rate of re-vascularization was compared.Results Totally 117 patients were included with 92.3% reaching good recanalization and 63.2% reaching complete re-canalization.There was no significant difference in good re-canalization rates among various extra-cranial intervention regimens.The rate of complete re-canalization was significantly higher in patients receiving endovascular therapy(P＜0.05)and there was significant difference among various endovascular treatment regimens(P＜0.01):acute balloon angioplasty only group presented the highest rate of complete re-canalization(100.0% ),followed by acute stenting only group(80% ),acute stenting+balloon angioplasty group(73.7% )and conservative treatment group(54.3% ).Conclusions Endovascular inter-vention to extra-cranial stenosis contributes to complete re-canalization in AIS due to anterior TL receiving MT,and acute balloon angioplasty seems to be quite effective than acute stenting.

OBJECTIVE To explore the clinical efficacy and safety of Ruyi jinhuang powder for external application combined with immune checkpoint inhibitors （ICIs） in the treatment of patients with advanced liver cancer complicated with dampness and heat syndrome of liver and gallbladder. METHODS All patients with advanced liver cancer complicated with dampness and heat syndrome of liver and gallbladder were admitted to our hospital from January 2018 to June 2022 and assigned into observation group and control group according to random number table method. Patients in the control group （n＝56） were treated with ICIs （Navulizumab injection/Sintilimab injection/Camrelizumab for injection） 200 mg， ivgtt， 21 days as a treatment cycle. Patients in the observation group （n＝56） were additionally treated with Ruyi jinhuang powder for external application， once a day， on the basis of control group. The therapeutic effects of 2 groups were compared after a treatment cycle. The levels of interleukin-6 （IL- 6）， matrix metalloproteinase-9 （MMP-9）， cyclooxygenase-2 （COX-2）， prostaglandin E2 （PGE2）， carbohydrate antigen 199 （CA199）， alpha-fetoprotein （AFP） and vascular endothelial growth factor （VEGF） in serum were compared between 2 groups before and after treatment. Karnofsky functional status （KPS） score， digital rating scale （NRS） score， total symptom score of traditional Chinese medicine， and the occurrence of adverse reactions were recorded for both groups of patients. RESULTS After treatment， the levels of IL-6， MMP-9， COX-2， PGE2， CA199， AFP， VEGF， NRS score and total symptom score of traditional Chinese medicine in observation group were significantly lower than control group （P＜0.05）， KPS score was significantly higher than the control group （P＜0.05）. The zypp-04） total effective rate and remission rate of the observation group were 64.29% and 80.36%， those of control group were 60.71% and 73.21%. There was no statistical significance between two groups （P＞0.05）. The adverse drug reactions of both groups were mainly nausea and vomiting， liver function injury， fever hlshli@yeah.net and so on； the incidence of adverse reaction in observation group was significantly lower than that of control group （P＜0.05）. CONCLUSIONS In patients with advanced liver cancer complicated with dampness and heat syndrome of liver and gallbladder， the combination of Ruyi jinhuang powder for external application and ICIs can help inhibit the secretion of pain mediators， regulate vascular endothelial function， reduce the inflammatory response， promote the recovery of cardiopulmonary function， improve clinical efficacy and has good safety.