Objective:To explore the role of arginine metabolism in the inflammatory response to influenza A virus (FluA) infection.Methods:Eighteen-month-old mice were infected with FluA via nasal drip, with samples collected on the 6th day post-infection. The concentration of cytokines was determined by the Luminex multifactor assay, while the metabolites in bronchoalveolar lavage fluid (BALF) were analyzed using targeted metabolomic method. Correlation analysis was employed to examine the correlation between cytokines and metabolites. Macrophages were infected with FluA at a multiplicity of infection (MOI) of 1 and cultured with different concentrations of arginine for 24 h. The mRNA and protein expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor α (TNF-α) and IL-10 were detected by real time fluorescence quantitative RT-PCR (qRT-PCR) and Cytometric Bead Array (CBA).Results:In comparison to the control group, the levels of surfactant protein D (SP-D), TNF-α, monocyte chemotactic protein-1 (MCP-1), IL-1α, IL-6, IL-10, recombinant S100 calcium binding protein (S100) A9, interferon inducible protein 10 (IP-10), macrophage inflammatory protein-1α (MIP-1α), matrix metalloprotein-9 (MMP-9), and Complement Factor D in BALF of FluA infection exhibited a significant elevation. The concentrations of arginine, aspartate, citrulline, glutamic acid, ornithine, proline, creatine, and sarcosine in arginine metabolism were up-regulated, which was correlated with most of elevated cytokine levels. The supplementation of arginine after FluA infection significantly decreased the levels of IL-1β, IL-6, and TNF-α, but increased the level of IL-10 in macrophages.Conclusions:Arginine reduces the inflammatory response induced by FluA infection in macrophages, suggesting that it may be a potential intervention target for severe pulmonary inflammation following FluA infection.

ObjectiveTo investigate the clinical efficacy of double plasma molecular adsorption system （DPMAS） and sequential plasma exchange （PE） combined with continuous renal replacement therapy （CRRT） in the treatment of patients with acute-on-chronic liver failure （ACLF） and acute kidney injury （AKI）. MethodsA retrospective analysis was performed for the clinical data of 90 patients with ACLF and AKI who were hospitalized in The Affiliated Hospital of Guizhou Medical University from January 2019 to December 2022， and according to the method for blood purification， they were divided into DPMAS sequential PE+CRRT group （observation group with 31 patients） and DPMAS sequential PE group （control group with 59 patients）. General data on admission and laboratory markers before and after blood purification were collected from all patients， including hepatic and renal function， coagulation function， and inflammation markers， and estimated glomerular filtration rate （eGFR） and MELD combined with serum sodium concentration （MELD-Na） score were calculated. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data within each group before and after treatment， and the Mann-Whitney U test was used for comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsThe observation group had a significantly higher response rate than the control group ［48.4% （15/31） vs 27.1% （16/59）， χ²=4.071， P=0.044］. The methods for blood purification in both groups could effectively improve total bilirubin， alanine aminotransferase， aspartate aminotransferase （AST）， prothrombin time activity， serum creatinine （Scr）， procalcitonin （PCT）， C-reactive protein， eGFR， and MELD-Na score （all P<0.05）， and both groups had significant reductions in platelet count （PLT） and hemoglobin （Hb） after treatment （all P<0.05）， while there were no significant changes in blood urea nitrogen， albumin， and international normalized ratio after treatment （all P>0.05）. There were significant differences between the two groups in the changes in AST， Scr， PCT， eGFR， MELD-Na score， Hb， and PLT after treatment （all P<0.05）. ConclusionDPMAS sequential PE combined with CRRT can effectively remove inflammatory mediators， improve renal function， stabilize the internal environment of human body， and achieve a relatively good clinical efficacy.

OBJECTIVES: Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model. METHODS: The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention. RESULTS: The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful. CONCLUSIONS Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.
Humans ; COVID-19 ; Sleep Initiation and Maintenance Disorders ; Crisis Intervention ; Psychosocial Intervention ; SARS-CoV-2 ; Mental Health ; Depression/epidemiology* ; Health Personnel/psychology* ; Anxiety/etiology*

Objective:To explore the value of layer-specific strain technique in evaluating the changes of left ventricular myocardial systolic function in patients with aortic stenosis(AS).Methods:From January 2019 to March 2022, 90 AS patients with left ventricular ejection fraction (LVEF) ≥ 50% in Hunan Provincial People's Hospital were selected, including 30 mild AS patients, 30 moderate AS patients, and 30 severe AS patients. In addition, 30 health examinees in the same period were selected as the control group. The normal echocardiographic parameters of the control group and the AS groups with different degrees were compared. The global systolic peak longitudinal strain (GLS) and global circumferential strain (GCS) of the left ventricular three-layer myocardium were measured by the layer-specific strain technique, and the correlation between the strain parameters and the peak systolic velocity (Vmax) of the aortic valve was analyzed.Results:The levels of interventricular septal depth (IVSD), left ventricular posterior wall depth (LVPWD), mean pressure gradient (MPG), and Vmax in mild, moderate and severe AS group were higher than those in the control group (all P<0.05); the GLS of each layer of left ventricle in mild, moderate and severe AS group was lower than those in control group (all P<0.05); the GCS of each layer of left ventricle in moderate and severe AS group was lower than those in control group (all P<0.05). The GLS of left ventricular endocardium in moderate AS group was lower than those in mild AS group (all P<0.05); the GLS and GCS of left ventricular layers in severe AS group were lower than those in mild and moderate AS group (all P<0.05). In AS group, GLS and GCS in endocardium, middle layer and epicardium were negatively correlated with Vmax ( r=-0.716, -0.660, -0.669, P<0.001; r=-0.669, -0.686, -0.598, P<0.001). Conclusions:The layer-specific strain can reflect the changes of left ventricular myocardial function in patients with AS, and has certain application value.

Objective To investigate the influencing factors for recompensation in patients with first-time decompensated hepatitis B cirrhosis. Methods A total of 438 patients with first-time decompensated hepatitis B cirrhosis who attended The Affiliated Hospital of Xuzhou Medical University from September 1, 2011 to December 31, 2019 were enrolled, and all patients received comprehensive treatment including antiviral therapy. According to the outcome at the end of follow-up, the patients were divided into recompensation group and persistent decompensation group, and the independent influencing factors for recompensation were analyzed. Long-term survival rate was compared between the patients with different states of compensation. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data. A multivariate Cox proportional-hazards regression model analysis was used to investigate the influencing factors for recompensation. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison. Results Among the 438 patients with decompensated hepatitis B cirrhosis, 199 (45.4%) achieved recompensation after antiviral therapy. There were significant differences between the recompensation group and the persistent decompensation group in sustained virologic response (SVR) ( χ 2 =72.093, P < 0.001), single or multiple complications ( χ 2 =9.834, P =0.002), presence or absence of gastrointestinal bleeding ( χ 2 =6.346, P =0.012), serum creatinine (SCr) ( Z =-1.035, P =0.011), blood sodium concentration ( Z =-1.606, P =0.019), hemoglobin ( Z =1.455, P =0.006), and alanine aminotransferase (ALT) level ( Z =-2.194, P < 0.001). Baseline ALT level (odds ratio [ OR ]=1.002, 95% confidence interval [ CI ]: 1.000-1.003, P =0.009), SVR ( OR =5.760, 95% CI : 3.634-9.129, P < 0.001), and SCr ( OR =0.990, 95% CI : 0.981-1.000, P =0.047) were independent influencing factors for recompensation. The recompensation group had a significantly higher 5-year survival rate than the persistent decompensation group (87.9% vs 72.0%, χ 2 =9.886, P =0.025). Conclusion After comprehensive treatment, including antiviral therapy, approximately 45.4% of patients can achieve recompensation.Patients with elevated baseline ALT and achieved SVR were more likely to achieve recompensation, patients with elevated baseline serum creatinine had difficulty achieving recompensation, and patients with recompensation had a better long-term prognosis than patients with persistent decompensation.

Background::Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays. Methods::Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed. Results::The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) ( χ2 = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) ( χ2 = 24.65, P < 0.001), and fungal culture (33% [84/253]) ( χ2 = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher’s exact P = 1.000) to and slightly lower specificity (87% [77/89]) ( χ2 = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) ( P = 0.734). Sputum LFD had similar specificity (91% [81/89]) ( χ2 = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) ( χ2 = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) ( χ2 = 6.95, P = 0.008), BDG ( χ2 = 10.43, P = 0.001), and fungal culture ( χ2 = 12.70, P < 0.001). Conclusions::Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.

Objective:To fully understand the maternal and neonatal outcomes in pregnant women with COVID-19 and explore the evidence of intrauterine vertical transmission of 2019-nCoV by analyzing clinical and laboratory information in peer-reviewed publications on COVID-19 in pregnant women.Methods:PubMed, Embase, China National Knowledge Infrastructure, China Academic Journals, and Wanfang Databases were searched to retrieve articles on COVID-19 in pregnancy published from December 1, 2019, to April 9, 2020. In addition, the World Health Organization COVID-19 Database and the reference lists in each included article were also searched. All included cases were positive for 2019-nCoV nucleic acid with maternal and neonatal outcomes regardless of delivery or not. Clinical manifestations, perinatal and neonatal outcomes were analyzed systematically.Results:This study reviewed 29 publications involving 146 pregnant women who tested positive for 2019-nCoV nucleic acid and their 116 newborns (including two twins). Five cases of severe COVID-19 and three cases of unidentified type that were admitted to ICU for treatment were severe symptoms, accounting for 5.5% (8/146) of all cases. Totally, 69.9% (102/146) of the women underwent cesarean section and 8.2% (12/146) gave birth vaginally. Thirty (20.5%) women continued their pregnancies. One case (0.7%, 1/146) terminated the pregnancy at 26 weeks of gestation due to bidirectional affective disorder and one (0.7%, 1/146) received artificial abortion at 6 weeks of gestation. Fever (58.2%, 85/146) and cough (32.9%, 48/146) were the most common symptoms. However, 15.8% (23/146) of the pregnant women were asymptomatic on admission and symptoms appeared or became worse after delivery in 20.5% (30/146). Lymphocytopenia (49.6%, 56/113) and elevated C-reactive protein (58.4%, 66/113) were the main laboratory findings. The most common computed tomography (CT) finding was bilateral multiple patchy ground-glass opacity in lungs (79.7%, 94/118). The outcomes of 92.2% (107/116) of the newborns were good, and the rest 7.8% (9/116) showed different abnormalities of varying degrees. Among the nine newborns, six showed different degrees of dyspnea, cyanosis and vomiting including one died of multiple organ failure and disseminated intravascular coagulation; one tested positive for viral nucleic acid 36 hours after birth; one was stillbirth due to unknown reason, but intrauterine vertical transmission was excluded; one neonatal death in a critically ill mother undergoing cesarean delivery.Conclusions:Pregnant women are less likely to progress to severe COVID-19 and mostly have a good outcome. Despite reports of adverse neonatal outcomes, evidence of intrauterine vertical transmission of 2019-nCoV remains insufficient.

Objective:To investigate the effect of intensive blood glucose monitoring and nursing program on blood glucose variability of patients transferred to general wards after coronary artery bypass grafting (CABG) .Methods:A convenient sampling method was used to select 106 patients with coronary heart disease and hyperglycemia who were transferred from the ICU within 72 hours after CABG from Beijing Anzhen Hospital from June to December 2018. They were divided into control group (54 cases) and research group (52 cases) according to the random number table method. The control group was given routine nursing care, and the research group adopted a comprehensive nursing strategy including intensive blood glucose monitoring based on the control group. The average daily blood glucose level (MGL) , standard blood glucose standard deviation ( SD) , daily average blood glucose fluctuation range (MAGE) , and blood glucose variation coefficient ( CV) of the two groups were compared within 3 days after CABG patients were transferred to the general ward. Results:After the patients were transferred from the ICU to the general ward, there were time effects, inter-group effects, and time-group interaction effects in SD; inter-group effects in SD; time- and inter-group effects in MAGE; and inter-group effects and time and group in CV interaction effect. Conclusions:Within 1 to 3 days after the patient is transferred from the ICU to the general ward, compared with the conventional nursing group, continued intensive blood glucose monitoring and nursing can reduce the degree of blood glucose variation.

Objective The aim of this study was to investigate the expression of antithrombinⅢ(AT3)gene in hepatocellu-lar carcinoma(HCC)and its relationship with clinical features and prognosis.Methods The profiles of gene expression and related clinical data of 214 HCC tissues were collected from the public database.Correlation analysis was conducted to investigate the associa-tion between the level of AT3 expression and clinical features,and the prognosis.Results Univariate analysis showed that with the low expression of AT3 in HCC tissues,there were a higher level of blood alpha fetoprotein(AFP)(P<0.001),a larger tumor size(P=0.015),a poorer TNM stage(P=0.001),and a higher metastasis risk(P<0.001).Survival analysis showed that tumor size was larger(P=0.023),multiple nodules(P=0.047),simultaneous cirrhosis(P=0.016),a poorer TNM stage(P<0.001),a higher metastasis risk(P=0.001),and the lower expression of AT3(P=0.005).These were the risk factors of prognosis.Multivarate Cox a-nalysis also showed a negative association between the expression of AT3 and the prognosis of HCC(HR=0.850,95% CI:0.745~0.970,P=0.016).Conclusion The expression of AT3 in HCC is associated with the clinical characteristics and prognosis of the patients.The low expression of AT3 is one of the risk factors for the prognosis of HCC.

The nursing students of Grade 2009 to Grade 2016 were selected.Their skills,midterm,usual and final performances as well as comprehensive scores of normal human morphology course were analyzed by one-way ANOVA in combination with different stages of curriculum integration in order to compare the teaching effect between traditional teaching mode + evaluation system and mixed teaching mode + formative evaluation in the course of normal human morphology.Statistical analysis by SPSS 17.0 showed that the average score of formation stage (traditional teaching mode) was 67.55 ± 12.72,the average score of integration stage (mixed teaching mode) was 72.79 ± 10.93 and the average score of development stage (formative evaluation +mixed teaching mode) was 83.94 ± 9.58.After making comparisons,the P values of ANOVA of the course of normal human body morphology in all stages were all less than 0.001,having statistical significance.The results showed that the overall development of the curriculum is becoming mature and the new teaching model can help students who usually do not like to review.