Private cloud is an internal cloud featuring multi-tenant,dynamic configuration and optimization infrastructure,which enables developers to achieve service self-deployment and self-hosting within security coverage of the enterprise data center.This paper introduced the concept of cloud computing.Then it went on to present the private cloud architecture of the hospital by analysis of problems in the hospital including information construction costs,management and maintenance,and information expansion.In the end,the authors analyzed the cloud computing service model,hospital private cloud architecture,along with outcome analysis for hospital private cloud implementations.

Objective To evaluate the efficacy and safety of minor endoscopic sphincterotomy (EST)with endoscopic papillary large balloon dilation(EPLBD)for common bile duct stones(CBDS)in elderly patients and to study the influence of the periampullary diverticula on efficacy. Methods Data of 209 patients with CBD stones(more than 1. 0 cm)over the age of 70 were retrospectively analyzed. The pa-tients were divided into EST group(103 cases)and the EST with EPLBD group(106 cases),which was further divided into two subgroups with and without periampullary diverticula.Operation time,complete stone removal rate in the first session,mechanical lithotripsy usage rate and complications were compared between the two groups. Results Compared with EST group,the EST with EPLBD group had shorter operation time [(25. 65±8. 76)min VS(35±6. 67)min,P= 0. 000],a higher success rate of the complete stone removal in the first session( 90. 57% VS 83. 50%,P = 0. 030),lower rate of mechanical lithotripsy( 8. 50% VS 55. 34%,P= 0. 000),but with a higher incidence of hyperamylemia(18/ 106 VS 7/ 103,P = 0. 044).The o-verall stone removal rates showed no difference(96. 23% VS 95. 14%,P= 0. 700).In the EPLBD group,di-verticulum had no effects on the results and complications of ERCP( P> 0. 05). Conclusion EST with EPLBD is a safe and effective method for CBDS in elderly patients. Periampullary diverticula does not affect the therapeutic effects of this method.

In recent years, organ transplantation has developed rapidly in China, whereas the proportion of supply and demand of organs for donation is severely unbalanced. To resolve the shortage of donor livers, repairing extended criteria donor liver and improving the quality of donor liver are critical research directions. Mesenchymal stem cell (MSC) is a category of stem cells with self-renewal and differentiation potential, which possess the functions of immunomodulation and tissue repair. The derivatives of MSC have the advantages of low immunogenicity and high biocompatibility, which have been widely applied in the treatment of multiple diseases. In this article, research progress on the role of MSC, exosomes and extracellular vesicles in alleviating liver steatosis, repairing ischemia-reperfusion injury and promoting the regeneration of small-for-size liver allograft was reviewed, and the feasibility and safety of MSC and the derivatives in repairing donor liver were summarized, aiming provide novel ideas for repairing marginal donor liver and enhancing the quality of liver allograft.

Objective:To explore the effect of the implantation of absorbable stents on the prognosis of patients with inferior knee artery balloon dilatation.Methods:From March 2018 to January 2021, twenty-five patients with drug absorbable stent implantation after inferior knee artery balloon dilatation (stent group) and 25 patients without absorbable stent implantation after inferior knee artery balloon dilatation (control group) were included in Qingdao Haici Medical Group Affiliated to Qingdao University. The improvement of symptoms, ankle brachial index, Rutherford classification and claudication distance before and after operation were compared. The symptoms, ankle brachial index, Rutherford grade, claudication distance and patency rate of the two groups were compared 6 months after operation. The preoperative and postoperative data were analyzed by independent sample t-test, and the patency rate was analyzed by χ 2 test. Results:The ankle brachial index in the stent group and the control group on the first day after operation was significantly higher than that before operation (0.18±0.11 vs. 0.85±0.15, t=18.5, P<0.05, 0.22±0.15 vs. 0.87±0.10, t=20.8, P<0.05), and the Rutherford classification decreased significantly (4.66±0.21 vs. 2.1±0.11, t=9.2, P<0.05, 4.58±0.33 vs. 2.3±0.22, t=12.9, P<0.05), the limp distance increased significantly ((27±8) m vs. (300±43) m, t=20.8, P<0.05, (42±14) m vs. (320±18) m, t=32.6, P<0.05). There was no significant difference in preoperative ankle brachial index, postoperative ankle brachial index, Rutherford grade and claudication distance between the two groups ( P>0.05). Six months after operation, the ankle brachial index (0.72±0.03 and 0.54±0.12; t=10.2, P<0.05), Rutherford classification ((1.72±0.17) and (3.23±0.22); t=12.8, P<0.05) and claudication distance ((580.00±137.00) m and (267.00±54.00) m; t=8.2, P<0.05) in the stent group and the control group were significantly better than those in the control group. The patency rate of stent group at 6 months was 68% (17/25), which was better than that of ordinary balloon dilatation group by 56% (14/25). Conclusion:Implantation of drug absorbable stents can significantly improve the prognosis of patients undergoing arterial balloon dilatation.

Objective:To study the effect of Long non-coding RNA(LncRNA)small nucleolar RNA host gene 12(SNHG12)regulating miR-138-5p/hypoxia inducible factor-1(HIF-1α)axis on improving the damage of hypoxia/reoxygenation(H/R)human vas-cular endothelial cells.Methods:Human umbilical vein endothelial cells(HUVECs)were cultured in vitro and randomly divided into control group,H/R model group,H/R+LncRNA SNHG12 overexpression group,H/R+miR-138-5p mimics group,H/R+co-transfec-tion group and H/R+co-transfection negative control group,each transfection group was transfected separately,and except for control group,the remaining groups were given hypoxia for 5 hours and then reoxygenated for 1 hour to induce the cell models,and then the cell viability of each group was detected by CCK-8 experiment;the cell apoptosis in each group was detected by flow cytometry experi-ment,and the apoptosis rate of each group was compared;the levels of reactive oxygen species(ROS),lactate dehydrogenase(LDH)and inflammatory factors IL-6,IL-17 and IL-18 in each group were measured by the kit;the expressions of miR-138-5p and HIF-1α mRNA in cells of each group were measured by real-time quantitative PCR(qRT-PCR)experiment;the expressions of apoptotic pro-teins caspase-9,Bcl-2-associated X protein(Bax)and HIF-1α in each group were evaluated by Western blot.Results:Compared with control group,the apoptosis rate,cellular ROS,LDH,IL-6,IL-17 and IL-18 levels,cellular HIF-1α mRNA and protein levels,cellular caspase-9,Bax and HIF-1α protein levels were increased in H/R model group(P<0.05),the cell viability and miR-138-5p level were decreased(P<0.05).Compared with H/R model group and H/R+co-transfection group,the cell viability,cell HIF-1αmRNA and protein levels were increased in H/R+LncRNA SNHG12 overexpression group(P<0.05),the apoptosis rate,cellular ROS,LDH,IL-6,IL-17 and IL-18 levels,cellular caspase-9 and Bax protein levels,and miR-138-5p level were decreased(P<0.05);the cell viability,cellular HIF-1α mRNA and protein levels were decreased in H/R+miR-138-5p mimics group(P<0.05),the apoptosis rate,cellular ROS,LDH,IL-6,IL-17 and IL-18 levels,cellular caspase-9 and Bax protein levels were increased(P<0.05).Com-pared with H/R model group,there was no significant difference in cell index levels between the H/R+co-transfection negative control group and the H/R+co-transfection group(P>0.05).Conclusion:LncRNA SNHG12 can upregulate HIF-1α expression by downregulat-ing miR-138-5p expression,inhibit H/R-induced inflammation and oxidative stress in HUVECs,and reduce cell damage and apoptosis.

Objective:To investigate the risk factors of lower extremity deep venous thrombosis (LEDVT) in patients with sepsis during hospitalization in intensive care unit (ICU), and to construct a nomogram prediction model of LEDVT in sepsis patients in the ICU based on the critical care scores combined with inflammatory markers, and to validate its effectiveness in early prediction.Methods:726 sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from January 2015 to December 2021 were retrospectively included as the training set to construct the prediction model. In addition, 213 sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from January 2022 to June 2023 were retrospectively included as the validation set to verify the performance of the prediction model. Clinical data of patients were collected, such as demographic information, vital signs at the time of admission to the ICU, underlying diseases, past history, various types of scores within 24 hours of admission to the ICU, the first laboratory indexes of admission to the ICU, lower extremity venous ultrasound results, treatment, and prognostic indexes. Lasso regression analysis was used to screen the influencing factors for the occurrence of LEDVT in sepsis patients, and the results of Logistic regression analysis were synthesized to construct a nomogram model. The nomogram model was evaluated by receiver operator characteristic curve (ROC curve), calibration curve, clinical impact curve (CIC) and decision curve analysis (DCA).Results:The incidence of LEDVT after ICU admission was 21.5% (156/726) in the training set of sepsis patients and 21.6% (46/213) in the validation set of sepsis patients. The baseline data of patients in both training and validation sets were comparable. Lasso regression analysis showed that seven independent variables were screened from 67 parameters to be associated with the occurrence of LEDVT in patients with sepsis. Logistic regression analysis showed that the age [odds ratio ( OR) = 1.03, 95% confidence interval (95% CI) was 1.01 to 1.04, P < 0.001], body mass index (BMI: OR = 1.05, 95% CI was 1.01 to 1.09, P = 0.009), venous thromboembolism (VTE) score ( OR = 1.20, 95% CI was 1.11 to 1.29, P < 0.001), activated partial thromboplastin time (APTT: OR = 0.98, 95% CI was 0.97 to 0.99, P = 0.009), D-dimer ( OR = 1.03, 95% CI was 1.01 to 1.04, P < 0.001), skin or soft-tissue infection ( OR = 2.53, 95% CI was 1.29 to 4.98, P = 0.007), and femoral venous cannulation ( OR = 3.72, 95% CI was 2.50 to 5.54, P < 0.001) were the independent influences on the occurrence of LEDVT in patients with sepsis. The nomogram model was constructed by combining the above variables, and the ROC curve analysis showed that the area under the curve (AUC) of the nomogram model for predicting the occurrence of LEDVT in patients with sepsis was 0.793 (95% CI was 0.746 to 0.841), and the AUC in the validation set was 0.844 (95% CI was 0.786 to 0.901). The calibration curve showed that its predicted probability was in good agreement with the actual probabilities were in good agreement, and both CIC and DCA curves suggested a favorable net clinical benefit. Conclusion:The nomogram model based on the critical illness scores combined with inflammatory markers can be used for early prediction of LEDVT in ICU sepsis patients, which helps clinicians to identify the risk factors for LEDVT in sepsis patients earlier, so as to achieve early treatment.

OBJECTIVE To provide ideas and reference for the anti-infection treatment and pharmaceutical care for severe pneumonia caused by Chlamydia psittaci. METHODS Clinical pharmacists participated in the whole process of the treatment for a patient with C. psittaci-induced severe pneumonia. According to the patient’s medical history， clinical symptoms and test results， clinical pharmacists assisted the physician to dynamically adjust the anti-infective scheme； for C. psittaci infection， the patient was treated with tigecycline combined with azithromycin successively， and other infection therapy plans were dynamically adjusted according to the results of pathogen examination. During the treatment， the patient suffered from suspicious adverse drug reactions such as prolonged QTc interval， elevated lipase and amylase； the clinical pharmacists conducted pharmaceutical care and put forward reasonable suggestions. RESULTS The physician adopted the pharmacists’ suggestion， and the patient was discharged after treatment. CONCLUSIONS For the treatment of severe pneumonia caused by C. psittaci， the characteristics of patients， drugs and pathogens should be taken into account to develop individualized anti-infective treatment. Tetracyclines and macrolides have a definite effect on C. psittaci infection， but attention should be paid to the possible ADR caused by drugs in clinical application.

Organ preservation fluid could mitigate cold ischemia injury and maintain normal function of the grafts. At present, how to reduce a series of injury caused by cold ischemia of donor liver and improve the preservation quality of grafts are the hot and challenging spots in this field. Currently, preservation fluid in clinical practice has not achieved ideal preservation effect, especially for the protection of marginal donor organs. In the context of severe donor shortage, the key solution is still to explore the optimal preservation protocol for donor liver to prevent grafts from cold ischemia injury. In this article, the mechanism of donor liver injury during cold ischemia, the classification and evolution of donor liver preservation fluid were summarized, the development direction and challenges of donor liver preservation fluid were discussed, aiming to provide novel ideas and references for the research and development of donor liver preservation fluid.