OBJECTIVES: To investigate the effect of a variety of kidney-tonifying Chinese medicines on thymus regeneration after acute degeneration in mice. METHODS: Forty-eight 8-week-old male BALB/c mice were randomly divided into normal control group, model control group, negative control group, positive control group, the fructus of Cnidium monnieri (L.) Cuss. group, the fructus of Psoralea corylifolia (L.) group, the fructus of Rubus chingii Hu group, and the tuber onion seed group, with 6 mice in each group. Except for the normal control group, mice in the other groups received intraperitoneal injections of rapamycin (1 mg·kg^－1·d^－1) for 5 consecutive days followed by 14 h of starvation to induce acute thymus degeneration. After successful modeling, in treatment groups ethanol extract of the fructus of Cnidium monnieri (L.) Cuss. (0.78 g·kg^－1·d^－1), fructus of Psoralea corylifolia (L.) (0.39 g·kg^－1·d^－1), fructus of Rubus chingii Hu (0.78 g·kg^－1·d^－1) or the tuber onion seed(0.39 g·kg^－1·d^－1) was intraperitoneally injected once a day for 5 days; while the negative control group was given equal volume of normal saline, and the positive control group was given metformin (300 mg·kg^－1·d^－1). The grip strength was measured with a grip tester 2 h after the last administration. The pathological changes of thymus were observed by hematoxylin and eosin (HE) staining. The structure and distribution of thymic epithelial cells were observed by multiple immunofluorescence method. The proportion of T cell subsets in thymus and peripheral blood was analyzed by flow cytometry. The level of T cell receptor excision circles (TREC) in the genomic DNA of mouse spleen mononuclear cells was detected by quantitative polymerase chain reaction (PCR) for evaluation of thymic output function. The expression of thymus aging- and function-related factors in the thymus tissue were detected by quantitative reverse transcription PCR. The expression of cyclin-dependent kinase inhibitor 1A (p21) and tumor protein 53 (p53) were verified by immunohistochemistry. RESULTS: Rapamycin induced thymic atrophy and significantly reduced limb grip strength in mice (P<0.01). Compared with the negative control group, the limb grip strength of mice in the fructus of Psoralea corylifolia (L.) group, the fructus of Rubus chingii Hu group and the tuber onion seed group was significantly enhanced (all P<0.05), and the level of TREC in spleen of the mice in each administration group was reduced (all P<0.05). Among Chinese herb medicine-treatment groups, the recovery of thymus function and tissue structure in the tuber onion seed group was most obvious. Further study showed that compared with the negative control group, the proportion of CD4 single positive cells (CD3⁺TCR-β⁺CD4⁺CD8^－) in the thymus of the tuber onion seed group was significantly increased (P<0.01), and the proportion of CD3⁺CD28⁺ T cell and CD3⁺CD8⁺CD28⁺ T cell in peripheral blood was significantly increased (all P<0.01). The mRNA levels of IL-1α, IL-6, p21 and p53 in thymocytes were decreased (all P<0.05). The results of immunohistochemistry further confirmed the decrease in p21 and p53 expression. In normal mice, tuber onion seed was observed to enhance limb grip strength (P<0.01), while suppressing thymus output and change the distribution of T cell subsets, and there was no significant effect on thymus weight and the expression of Foxn1, SIRT1, p21, CXCL2 and PTMα. CONCLUSIONS The tuber onion seed and other kidney-tonifying traditional Chinese medicines can accelerate the regeneration process of mouse thymus after acute degeneration induced by rapamycin in mice, and the tuber onion seed exhibits the most pronounced therapeutic effect.
Animals ; Mice ; Male ; Mice, Inbred BALB C ; Thymus Gland/physiology* ; Drugs, Chinese Herbal/pharmacology* ; Sirolimus/adverse effects* ; Regeneration/drug effects*

Objective To study the relationship between blood microRNA-133b(miR-133b)and solu-ble fms-like tyrosine kinase 1(sFLT1)levels with the prognosis in the patients with endometrial cancer.Methods A total of 122 patients with endometrial cancer visited in the gynecology department of this hospital from January 2015 to January 2016 were prospectively selected as the study subjects,and divided into the sur-vival group(n=58)and death group(n=64)according to the 5-year prognosis of the patients with endome-trial cancer.The miR-133b and sFLT1 levels were compared between the two groups.The COX regression was used to analyze the relationship between miR-133b and sFLT1 with the prognosis of the patients with en-dometrial cancer.Results The levels of miR-133b and sFLT1 in the survival group were higher than those in the death group,and the differences were statistically significant(P＜0.05).The median survival time in the miR-133b low-level group was shorter than that in the miR-133b high level group,and the difference was sta-tistically significant(P＜0.05).The median survival time of the sFLT1 low level group was shoeter than that in the sFLT1 high level group,and the difference was statistically significant(P＜0.05).The FIGO stageⅢ-Ⅳ and lymph node metastasis were the independent risk factors for the prognosis of endometrial cancer(P＜0.05),and the pathological G1-G2,high level of miR-133b and sFLT1 were the independent protective factors for the prognosis of endometrial cancer(P＜0.05).Conclusion The miR-133b and sFLTl low levels in the patients with endometrial cancer are associated with the disease progression,and both are the independ-ent risk factors of prognosis.

This article reports a case of adult neuronal intranuclear inclusion body disease with clinical manifestations of tremor,cognitive decline,and binocular visual impairment,which has not been clearly diagnosed and treated before.By reporting on this case,we aim to enhance physicians'understanding of adult onset of neuronuclear inclusion body disease,and to improve the diagnostic rate of neuronuclear inclusion body disease through imaging,skin biopsy,and NOTCH2NLC gene.

Based on the theoretical reflection on the reflective function of medical records,the important findings in the practice of medical records writing in the field of palliative care,and conceptual analysis of narrative medicine tools,combined with empirical investigation materials and analysis,this paper focused on the practice of medical records writing for reflection and research.The main contents include defining the concept of narrative medical records,which are medical records used in clinical practice that incorporate narrative content;clarifying their characteristics and functions at different levels;and exploring practical paths for their application in clinical practice.Based on an in-depth exploration of the uniqueness of narrative medicine practice at Peking Union Medical College,it also emphasized the necessity of writing medical records with narrative thinking.Specifically,it focused on using narrative thinking and forms to enhance the improvement of current medical records writing,and further sought a general framework and multiple possibilities for narrative medicine clinical pathways.

To summarize the nursing experience of hematopoietic stem cell transplantation for a child with monocytopenia and mycobacterium infection syndrome complicated with pulmonary alveolar proteinosis.The key aspects of nursing encompass the establishment of a multidisciplinary diagnostic and treatment team,as well as the enhancement of warehousing preparation.Fine nursing plays a pivotal role in infection prevention and control,while also promoting hematopoietic reconstruction.Vigilant monitoring of condition changes is crucial to proactively prevent cardiopulmonary failure.Moreover,an intensified management approach towards underlying diseases should be implemented alongside predictive nursing interventions.The utilization of precision medication plans allows for the observation of drug efficacy and adverse reactions.Narrative nursing serves as a foundation to alleviate the child's inner concems,while personalized follow-up plans ensure the continuity of high-quality care.With careful treatment and care,the child successfully underwent hematopoietic stem cell transplantation.After 41 days post-transplantation,the child was discharged from the hospital after a successful recovery.The follow-up after a month showed good progress.

With the progress of hematopoietic stem cell transplantation technology, the reduction of pretreatment intensity, the shortening of bone marrow suppression time and the reduction of infection risk, especially the physical and psychological stress for doctors and patients caused by rigorous protection procedures, the protective environment strategies need improvement. It has been found that, regardless of whether total environment protection is implemented, there is no significant difference in the outcomes of chemotherapy patients with neutropenia. Therefore, the traditional protective environment strategies are being improved. The protective environment strategies for hematopoietic stem cell transplantation patients have developed rapidly in the past two decades, from the replacement of laminar flow equipment by high-efficiency filtration devices to the development of home care after transplantation. In this article, the progress in protective environment strategies for hematopoietic stem cell transplantation patients is reviewed and further reflect, providing reference for future improvement.
Humans ; Hematopoietic Stem Cell Transplantation/adverse effects*

Objective:To understand the relationship between the RNA shedding time of SARS-CoV-2 infected persons and the single nucleotide mutation of the virus, the population of infected persons, underlying diseases and other factors, so as to provide more clues for the study of SARS-CoV-2 infection dynamics.Methods:The data of epidemiology, clinical manifestations, and underlying diseases of infected persons in a cluster epidemic of COVID-19 in Jiangsu province from July to September 2021 were collected. Nasopharyngeal swab samples of cases were collected, and the whole genome of the virus was sequenced by second-generation sequencing technology. The online analysis platform was used to judge the virus type and analyze the mutation site, and Cox proportional risk model was used to analyze the relationship between the RNA shedding time of SARS-CoV-2 and various research factors.Results:There were 350 persons who finally obtained the whole genome sequence of the virus in this COVID-19 outbreak, of which 60.3% were female, the median age was 49 years old (interquartile range, IQR: 37-65 years old)), and the median time of virus shedding was 33 days ( IQR, 26-44 days). The whole-genome sequencing analysis showed that compared with the Wuhan reference strain sequence, the infected persons’ sequence had 34~41 nucleotide mutation sites, belonging to VOC/Delta variant (B.1.617.2 evolutionary branch), and C346T, C1060T, T2803C, T7513C, A29681C were the main single nucleotide polymorphisms (SNPs) of this epidemic. Cox regression analysis showed that age, underlying disease, clinical classification, vaccination, SNP T2803C and T7513C had an impact on the RNA shedding time of SARS-CoV-2. The adjusted multivariate Cox regression result showed that age [ HR=0.73, 95% CI (0.55, 0.95)] and T7513C [ HR=0.37, 95% CI (0.18, 0.77)] were still the risk factors for the extension of SARS-CoV-2 RNA shedding time. Conclusions:This study analyzed the effects of the individual factors and viral single nucleotide variations on the time of viral RNA shedding. Those who were older, suffered from hypertension, had more severe clinical symptoms, were not vaccinated or incompletely vaccinated, and had T7513C mutation in the infected virus, had a risk of a long RNA shedding time of SARS-CoV-2, which should be given special attention and follow-up after rehabilitation.

【Objective】 To observe the clinical effect of combination therapy of sacubitril valsartan and dapagliflozin in heart failure with reduced ejection fraction (HFrEF) and non-diabetes patients. 【Methods】 This study involved 96 patients with HFrEF and non-diabetes. The patients were randomly divided into control group (50 cases) and observation group (46 cases). On the basis of routine treatment, the control group was treated with sacubitril valsartan, while the observation group was treated with sacubitril valsartan and dapagliflozin. After 1-month and 6-month treatment, we monitored blood pressure, N-terminal pro brain natriuretic peptide (NT-proBNP), high sensitivity troponin T (cTnT), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left atrial diameter (LAD), left ventricular posterior wall thickness (LVPW), Minnesota soda heart failure life quality score (MLHFQ), the incidence of rehospitalization and death, and major adverse cardiovascular events (MACE) in the two groups. 【Results】 After 6 months, systolic blood pressure, cTnT, NT-proBNP, LVEDd, LVPW, and LAD of the observation group were significantly decreased compared with the control group (P<0.05), the LVEF value was significantly increased (P<0.05), and the MLHFQ and MACE incidence were significantly decreased (P<0.05). However, the two groups did not significantly differ in FBG or HbA1c (P>0.05). 【Conclusion】 The combination treatment of sacubitril valsartan and dapagliflozin on HFrEF and non-diabetes patients can significantly improve cardiac function, inhibit myocardial remodeling, reduce the incidence of MACE, and improve the prognosis.

Hemodynamic instability is one of the main causes of death in critically ill children.Real-time and dynamic monitoring of hemodynamic changes is an important part of the work in intensive care units and operating rooms.For the past 50 years, invasive pulmonary catheter thermal dilution has been recognized as the "gold standard" for hemodynamic monitoring, but its clinical use has declined in recent years due to its patient injury, complications, and difficulty in operation.Therefore, hemodynamic monitoring techniques that are minimally or completely noninvasive, simple to perform, and highly correlated in accuracy with invasive methods are receiving increasing attention from pediatric clinicians.This review summarized the measuring principle and application status of various monitoring technologies, in order to provide evidence for the selection of appropriate monitoring methods in clinical practice.

Objective:To prepare a phase-change lipid nanoparticle modified by tumor homing membrane-penetrating peptide (tLyP-1) and carrying paclitaxel (PTX) engineered by metal polyphenol network (TA-Fe 3+ ), and evaluate the therapeutic effects of tumor targeting, ultrasound/photoacoustic imaging and photothermal combined chemotherapy in vitro. Methods:Phase-change lipid nanoparticles (t-P@TFP) with TA-Fe 3+ engineered PTX mediated by tLyP-1 were prepared by solvent replacement method, thin film hydration method and double emulsification method. Its detection and characterization, in vitro targeting ability, photothermal conversion ability, in vitro photoacoustic and ultrasonic imaging ability, CCK-8 method, cell live and death double staining method and flow cytometry method were used to detect the safety of nanoparticles and the killing effects of different nanoparticles on 4T1 cells. Results:t-P@TFP nanoparticles were successfully prepared. Transmission electron microscopy showed that the nanoparticles were spherical with uniform shape and size, with a particle size of (209.8±1.56)nm and a potential of (-25.9±1.36)mV. Laser confocal scanning microscopy showed that t-P@TFP nanoparticles could gather around 4T1 cells in a targeted manner. It had an efficient photothermal conversion effect, and nanoparticles could quickly become microbubbles after being irradiated by near-infrared laser, which enhanced the in vitro ultrasonic imaging effect; The photoacoustic signal of nanoparticles increased with the increase of concentration. CCK-8 method, double staining of living and dead cells and flow cytometry showed that t-P@TFP combined photothermal chemotherapy had the best anti-tumor effect. Conclusions:t-P@TFP nanoparticles are successfully prepared. The nanoparticles have good targeting ability for photoacoustic and ultrasonic imaging and have good photothermal effect, killing breast cancer cells, which is expected to realize the integration of diagnosis and treatment.