ObjectiveTo explore the potential mechanism of Erchen Decoction （二陈汤， ECD） in improving metabolic syndrome （MS） with phlegm syndrome. MethodsForty mice were randomly divided into a blank group of 10 mice and a modeling group of 30 mice. The MS model with phlegm syndrome was induced in the modeling group by high-fat diet. Thirty successfully modeled mice were randomly divided into a model group， a ECD group， and a metformin group， with 10 mice in each group. The ECD group was given 0.4 g/（kg·d） of ECD， while the metformin group was intervened with 11.1 g/（kg·d） of metformin solution， and the blank group and the model group were given 0.02 ml/（g·d） of sterilized drinking water， all by gavage， once daily for 4 weeks. Body weight， abdominal circumfe-rence， body length， Lee's index and food intake were recorded. Blood glucose and blood lipid levels including fasting blood glucose， triglycerides （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C） were measured. ELISA was used to detect serum leptin levels， while HE staining was used to observe liver pathological changes. Western Blot and q-PCR were used to detect protein and mRNA expression of hypothalamic leptin receptor （LepR）， pro melanocortin （POMC）， and neuropeptide Y （NPY） in the hypothalamus. Immunofluorescence was used to detect fluorescence expression of POMC and NPY in the hypothalamic arcuate nucleus region. ResultsPathological results showed that the mice in the model group had numerous fat vacuoles in hepatocytes and significant liver fat deposition， while the ECD and metformin groups showed reduced fat vacuoles and less liver fat deposition. Compared to those in the blank group， the mice in the model group mice showed liver fat deposition， increased body weight， abdominal circumference， Lee's index and food intake； fasting blood glucose， TG， TC， LDL-C， and serum leptin levels were elevated， while HDL-C was decreased； the expression of LepR， POMC protein levels and their mRNA expression decreased， while the protein level and mRNA expression of NPY increased； the fluorescence expression of POMC in the arcuate nucleus was reduced， while NPY fluorescence expression increased （P＜0.05 or P＜0.01）. Compared to the model group， the ECD group and metformin group showed significant improvements in the above indicators （P＜0.05 or P＜0.01）. Compared to the ECD group， the metformin group showed a reduction in body weight and NPY fluorescence expression， and an increase in HDL-C levels （P＜0.05 or P＜0.01）. ConclusionECD can downregulate serum leptin levels and improve glucose and lipid metabolism in the MS of phlegm syndrome. Its mechanism of action may be to reduce liver fat deposition and thereafter affect the expression of neuropeptides related to feeding activity in the hypothalamus.

Objective:To explore the effect of complications simulated experience in school-age children with type 1 diabetes mellitus.Methods:From March to December 2021, 80 school-age children with type 1 diabetes mellitus who were followed up in the Endocrinology Department of Quanzhou Children's Hospital were selected by convenient sampling. Children were divided into a control group and an observation group using random number method, with 40 cases in each group. The control group received routine treatment and traditional health education, while the observation group implemented complications simulated experience intervention on the basis of the control group. Diabetes Self-Management Questionnaire and Diabetes Knowledge Test were used to evaluate the self-management ability and diabetes knowledge of the two groups of children before and after intervention.Results:The observation group included 37 children, while the control group included 38 children. After intervention, the scores of Diabetes Self-Management Questionnaire and Diabetes Knowledge Test of children in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Complications simulated experience can improve the self-management ability and diabetes knowledge of school-age children with type 1 diabetes mellitus, which is worthy of clinical promotion and practice.

[Objective] To construct a Nomogram model for the prediction of essential hypertension (EH) risks with the use of traditional Chinese medicine (TCM) syndrome elements principles in conjunction with cutting-edge biochemical detection technologies. [Methods] A case-control study was conducted, involving 301 patients with essential hypertension in the hypertensive group and 314 without in the control group. Comprehensive data, including the information on the four TCM diagnoses, general data, and blood biochemical indicators of participants in both groups, were collected separately for analysis. The differentiation principles of syndrome elements were used to discern the location and nature of hypertension. One-way analysis was carried out to screen for potential risk factors of the disease. Least absolute shrinkage and selection operator (LASSO) regression was used to identify factors that contribute significantly to the model, and eliminate possible collinearity problems. At last, multivariate logistic regression analysis was used to both screen and quantify independent risk factors essential for the prediction model. The “rms” package in the R Studio was used to construct the Nomogram model, creating line segments of varying lengths based on the contribution of each risk factor to aid in the prediction of risks of hypertension. For internal model validation, the Bootstrap program package was utilized to perform 1000 repetitions of sampling and generate calibration curves. [Results] The results of the multivariate logistic regression analysis revealed that the risk factors of EH included age, heart rate (HR), waist-to-hip ratio (WHR), uric acid (UA) levels, family medical history, sleep patterns (early awakening and light sleep), water intake, and psychological traits (depression and anger). Additionally, TCM syndrome elements such as phlegm, Yin deficiency, and Yang hyperactivity contributed to the risk of EH onset as well. TCM syndrome elements liver, spleen, and kidney were also considered the risk factors of EH. Next, the Nomogram model was constructed using the aforementioned 14 risk predictors, with an area under the curve (AUC) of 0.868 and a 95% confidence interval (CI) ranging from 0.840 to 0.895. The diagnostic sensitivity and specificity were found to be 80.7% and 85.0%, respectively. Internal validation confirmed the model’s robust predictive performance, with aconsistency index (C-index) of 0.879, underscoring the model’s strong predictive ability. [Conclusion] By integrating TCM syndrome elements, the Nomogram model has realized the objective, qualitative, and quantitative selection of early warning factors for developing EH, resulting in the creation of a more comprehensive and precise prediction model for EH risks.

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Objective:To explore the application of mixed teaching mode based on small private online course (SPOC) and interactive tool in course of obstetric and gynecological nursing bilingual education.Methods:Nursing undergraduates from Batch 2018 of Chongqing Medical University were recruited in the study, with 336 students in the intervention group and 332 students in the control group. Mixed teaching method based on the SPOC and interactive tool was used for teaching in the intervention group, and traditional teaching methods were used in the control group. At the end of the course, formative evaluation indicators, such as students' academic performance, online study and students' classroom performance were compared between the two groups. SPSS 26.0 was used to perform t test and chi-square test of the data. Results:The final scores of the intervention group were (67.84±8.65) points, compared with the control group [(66.50±7.29) points]; the bilingual section scores of the intervention group were (5.32±1.90) points, compared with the control group [(4.95±1.92) points], with statistically significant differences between the two groups ( P<0.05). The online study and students' classroom performances of the intervention group were better than those of the control group ( P<0.05). Most students of the intervention group believed the mixed teaching method based on the SPOC and interactive tool could develop the ability of autonomous learning, improve the professional achievement and enhance the level of English. Conclusion:The mixed teaching method based on the SPOC and interactive tool can develop the students' ability of autonomous learning and enhance the teaching effect.

Objective To evaluate effect of continuous pelvic floor muscle training(PFMT) during pregnancy on delivery outcome, and to provide reference for clinical nursing work. Methods By searching database, the literature about continuous PFMT during pregnancy on delivery outcome were included,then EndNote was used to check the literature and RevMan5.2 was applied for Meta-analysis of the literature which met the inclusion criteria. Results A total of 11 papers were included. Meta-analysis showed that continuous PFMT during pregnancy can reduce lateral perineal resection rate (OR=0.66, 95%CI 0.48-0.89), increase rate of natural childbirth (OR=1.70, 95%CI 1.32-2.19) and promote progress of the first (MD=-0.52, 95%CI-0.92--0.12) and second (MD=-0.18, 95%CI-0.30--0.06) stage of labor. The intervention group shortened the first and the second stage of labor for 0.18h and 0.52h compared with the control group respectively. Conclusions Continuous PFMT during pregnancy can improve natural delivery rate, reduce the incidence of perineal side incision and shorten the time of labor, it is worthy of being promoted in clinical practice.

Objective To establish a mice model of diffuse large B-cell lymphoma (DLBCL) that was treated with adoptive immunity of Th17 cells cultured in vitro,and to analyze the relationship between IL-17 and MHC Ⅱ expression and their relation with tumor growth.Methods The CD4+CD62L+ T cells purified by MACS were stimulated under cytokine conditions including anti-CD3,anti-CD28,TGF-β and IL-6 in vitro,and SUDHL-4 cells were cultured and inoculated the SCID mice to establish DLBCL mice models.The mice were divided into Th17 cells immunity group (30 mice) and control group (20 mice).Th17 cells were injected to mice to get the adoptive immunity in immunity group,and 0.9 ％ NaCl in control group.The half mice were terminated at median disease onset time and median survival time,respectively.ELISA was used to detect IL-17 expression,and immunohistochemistry was applied to detect MHC Ⅱ expression in the tumor tissues.Results The median disease onset time of DLBCL mice model was 8 d,and median survival time was 28 d.The IL-17 and MHC Ⅱ expression levels in Th17 cells immunity group [(11.93±0.56) pg/ml,(69.13t0.36) ％] were higher than those in control group [(9.82±0.26) pg/ml,(42.59±0.12) ％] (both P＜ 0.000 1).Along with the progress of DLBCL,IL-17 and MHC Ⅱ expression levels were decreased [(9.53±0.18) pg/ml,(54.63±0.45) ％,both P ＜ 0.000 1].There was a significantly positive correlation between IL-17 and MHC Ⅱ (r=0.89,P=0.000).Conclusions The expression level of MHC Ⅱ can be used as a factor to judge the disease situation of DLBCL,and combination detection of the expression of both IL-17 and MHC Ⅱ will provide more reference values for judgment of the disease situation and the progress of DLBCL.

Objective To investigate the relationship between the helper T cell 17 (TH 17)/ Regulatory T cells (Treg cells) balance in peripheral blood with acute graft-versus-host reaction (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT),as well as the impact of anti-thymocyte immunoglobulin (ATG) on helper T cells in peripheral blood.Method Seventyeight hematologic patients underwent allo-HSCT,conditioning with or without ATG.Ten healthy volunteers severed as a control group.The helper T and regulatory T cells in peripheral blood were detected by flow cytometry.Enzyme-linked irnmunosorbent assay (ELISA) was used to detect serum concentrations of interleukin(IL)-17,IL-21,IL22,IL23,γ interferon (IFN-γ),and transforming growth factor β1 (TGF-β1).Result The percentage of Treg cells,TH17 cells and ratio of TH17/Treg cells in patients without aGVHD showed no significant difference from the healthy controls (P＞ 0.05).As compared with control group and non aGVHD group,the ratio of Treg cells was increased,the percentage of TH 17 cells,and TH 17/Treg cells were significantly increased in 1-2-degree aGVHD group (P＜0.01).With increased degree of aGVHD,the difference as above was more significant in 3-4-degree aGVHD recipients (P＜0.01).In aGVHD group,the IL-17,IL-23,IL-21 and IFN-γ concentrations were higher than the healthy group (P＜0.01) and non-aGVHD group (P＜0.05).Serum TGF-β1 level in aGVHD group was significantly decreased as compared with healthy group and non-GVHD group (P＜0.05),while IL-22 concentrations showed no statistically significant difference among three groups (P＞0.05).In anti-thymocyte immunoglobulin (ATG) pretreatment group,the absolute count of peripheral blood lymphocytes was less than in healthy control group (P＜0.01).In ATG group,the absolute counts of TH1 cells,TH17 cells,CD3+ CD4+ cells and non-TH1/17 cells were less than in non-ATG group (P =0.0000),while the absolute counts of lymphocytes,CD3+ CD4-cells,and TH 1/17 cells were less than in non-ATG group,but there was significant difference (P＞0.05).Conclusion The balance of TH 17/Treg cells and related cytokines were closely associated with aGVHD after allo-HSCT,and ATG influences the reconstruction of TH 17 and Th1 cells at early stage.

Objective To study the influence of biofeedback combined electrical stimulation therapy in parturients occurred breast pain under the cooperation between doctors and nurses. Methods Method of randomized controlled study was adopted. 112 puerperants were randomized chosen to experimental group (56 cases) and control group (56 cases). Diagnosed by doctors and confirmed that was normal. One group received biofeedback combined electrical stimulation therapy, the other group received regular therapy. Results There were great differences in breast hardness and milk volume ,when 3 days after the intervention, Z=5.91, P<0.01 (the cases of one degree of swelling in the two groups was 19 and 1 respectively). There were great differences in breast swelling and the hardness and milk volume, when 7 days after therapy and postpartum 42 days. The score of cooperation between doctors and nurses were (98.66±2.96) points, the satisfaction to this therapy was 94%(47/50). Conclusions Biofeedback combined electrical stimulation therapy can reduce breast pain and hardness in puerperants, it has great difference in breastfeeding status under the cooperation between doctors and nurses.