Objective To investigate the clinical characteristics of 16 patients with connective tissue diseases associated interstitial lung disease(CTD-ILD)complicated with lung cancer,and to improve the cognition of the disease.Methods Clinical data of 16 patients diagnosed as CTD-ILD associated with lung cancer,who were admitted to our center,were retrospectively analyzed,including general conditions,clinical characteristics,auxiliary examinations,pathological classification of lung cancer,TNM type,treatment and clinical outcome.Results Among the 16 CTD-ILD patients with lung cancer,there were 12 males and 4 females.The mean age at diagnosis of CTD-ILD was(64.7±9.2)years,and the mean age at diagnosis of lung cancer was(66.6±8.7)years.Lung occupying space on imaging(62.5%)was the most common initial symptom in lung cancer patients,followed by cough and phlegm(12.5%)and chest pain(12.5%).Of patients with lung cancer,adenocarcinoma(8 cases,50.0%)was the most common pathological type,followed by small cell lung cancer(4 cases,25.0%).The diagnosis time of CTD-ILD was earlier than that of lung cancer in 8 cases(50.0%),with a median time of 36.0(11.3,57.0)months,followed by 7 cases(43.8%)of CTD-ILD diagnosed with lung cancer at the same time.The diagnosis time of lung cancer was earlier than that of CTD-ILD in 1 case(6.3%).The most common TNM stage for lung cancer was stage Ⅳ(9 cases,56.25%).Sixteen patients were followed up from 1 to 64 months,with a median of 8.5(1.5,14.3)months.Eleven patients(68.8%)died,including 8 patients(72.7%)died of infection and 3 patients(27.3%)died of end-stage lung cancer.Conclusion For CTD-ILD patients,close follow-up and regular imaging monitoring are necessary to help early detection of lung cancer and improve prognosis.

Objective:To investigate the clinical characteristics and treatment strategies of patients with connective tissue disease (CTD) related lymphatic duct obstruction.Methods:The clinical data, laboratory tests results, imaging data, and treatment of CTD patients associated with lymphatic vessel obstruction were retrospectively collected from January 2008 to December 2020 at Beijing Shijitan Hospital. Lymphatic duct obstruction was confirmed by thoracic duct ultrasound or thoracic duct MRI or lymphoscintigraphy or direct lymphangiography. SLE and RA patients were matched with gender and age in a 1∶2 ratio, and SLE and RA patients without lymphatic reflux disorder admitted at the same time were randomly selected as the control group. When comparing the data between the two groups, t-test or rank sum test was used to test continuous variables, and chi-square test or Fisher′s exact probability method was used to test categorical variables. Results:Forty-four patients with CTD complicated with thoracic duct obstruction were included, with a male-to-female ratio of 7∶37, including 14 cases of rheumatoid arthritis (RA), 21 cases of systemic lupus erythematosus (SLE), 8 cases of primary Sjogren's syndrome (pSS), and 1 case of systemic sclerosis (SSc). The onset age of CTD ranged from 14 to 68 years, the mean age was (37±15) years and the median duration of CTD was 66 (range 1~480) months. The median age at the onset of lymphatic duct obstruction such as limb edema or thoracoabdominal effusion was (42±17) years, and the median duration of lymphatic duct obstruction symptoms was 12 (range 3~480) months. 59%(26/44) of patients were diagnosed with CTD followed by the diagnosis of thoracic duct obstruction, and 41%(18/44) of patients had lymphatic duct obstruction symptoms as the initial presentation of CTD. Thoracic duct-related imaging was performed in 44 patients and showed thoracic duct obstruction (64%, 28/44), thoracic duct malformation or variation (36%, 16/44), limb lymphatic reflux disorder (34%, 15/44), and small bowel lymphatic duct dilatation or intestinal protein loss (18%, 8/44), respectively. Compared with the control group, among these patients, patients with RA complicated with lymphatic involvement had a younger onset age [(34±14)years old vs. (44±13)years old, t=-2.15, P=0.037)] and longer RA course [(17±11)months vs. (7±7)months, t=3.38, P=0.002] and presented with limb swelling (12/14). While compared with the control group, SLE patients complicated with lymphatic duct obstruction presented with celiac multi-plasmatic effusion (20/21), more patients presented with multiple serous cavity effusion [95%(20/21) vs. 62%(25/42), χ2=7.63, P=0.006], but the prevalence of lupus nephritis [(60%(12/21) vs. 86%(36/42), χ2=4.87, P=0.027] and lupus encephalopathy [0%(0/21) vs. 16.7%(17/42), χ2=6.11, P=0.013] was lower. 27% (12/44) of patients improved with aggressive glucocorticoids combined with immunosuppressive therapy, 54%(24/44) of patients were performed with lymphatic duct reconstruction surgery on top of medical treatment, 5 patients were lost of follow-up, and 2 patients deceased. Conclusion:CTD patients may develop lymphatic duct obstruction during the disease course, while lymphatic duct obstruction can also be the initial presentation of CTD. Rheumatologists and surgeons should be alert to this rare situation. Young women with refractory polyserositis or lymphedema should be examined for the possibility of combined CTD. Lymphatic duct obstruction may be associated with long-term chronic inflammation in CTD. Glucocorticoids combined with immunosuppressive agents and surgery can be used to treat lymphatic duct obstruction in patients with CTD.

Objective:To analyze the satisfaction of elderly outpatient experience, based on a satisfaction questionnaire survey of outpatients in public hospitals, for references to improve the medical experience of elderly patients.Methods:This study extracted the satisfaction survey questionnaires for outpatients in second level and above public hospitals nationwide from the National Health Commission′s satisfaction survey platform from 2019 to 2022. The questionnaire content included six dimensions: registration experience, doctor-patient communication, nurse-patient communication, environment and labeling, privacy protection, and medical staff response, as well as overall satisfaction. The satisfaction, relative satisfaction, and dissatisfaction rates of elderly outpatients were analyzed using standardized assignment of question options, etc; T-test was used for inter group comparison.Results:A total of 10.095 7 million outpatient satisfaction questionnaires were included in this study, including 0.576 3 million questionnaires for elderly outpatients. From 2019 to 2022, the overall satisfaction of outpatients had been increasing year by year, and the overall satisfaction scores of elderly patients were significantly higher than that of non-elderly patients( P<0.01). The satisfaction scores of elderly patients in the nurse communication dimension(86.55 to 91.03 points) and relative satisfaction(1.000) were the higher in each year, while the satisfaction scores in the environment and identification dimension(81.05 to 86.03 points) and relative satisfaction(0.935 to 0.955) were lower. In 2019 and 2022, elderly patients had higher dissatisfaction rates in the two dimensions of registration experience(2.26%, 1.91%) and doctor communication(0.80%, 0.53%). Conclusions:From 2019 to 2022, the overall satisfaction of elderly patients in secondary and above public hospitals in China was relatively higher with a steady increasing tendency. However, there was still room for further improvement in the environment and labeling, cultural construction, and registration experience for elderly patients.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Objective:To explore the application of OTD (observation, teaching and discussion) teaching combined with clinical pathway in nursing standardized training in operating room.Methods:A total of 50 nurses who were trained in the Operating Room of The First Affiliated Hospital of Air Force Medical University from August 2017 to June 2020 were selected and divided into control group and study group according to the rotation order, with 25 nurses in each group. Traditional teaching was used in the control group, and OTD teaching combined with clinical pathway was used in the study group. After the rotation training, the teaching effect was evaluated through the assessment of theoretical knowledge and clinical practice comprehensive ability, teaching satisfaction, and the satisfaction scores of participating surgeons and patients. SPSS 22.0 was used for t-test and chi-square test. Results:The results of theoretical assessment, clinical skill assessment and comprehensive ability assessment of operating room of the rotating nurses in the study group were higher than those in the control group, with significant difference ( P < 0.05). The study group was significantly better than the control group in 8 aspects, including learning initiative, stimulating learning interest, problem-solving ability, communication ability, clinical thinking ability, teamwork ability, critical thinking ability and teaching satisfaction ( P<0.05). The satisfaction scores of doctors [(94.06±2.67) vs. (92.17±2.75)] and patients [(94.90±3.22) vs. (91.25±3.10)] in the study group were significantly higher than those in the control group ( P<0.05). Conclusion:OTD teaching combined with clinical pathway can help to improve the theoretical knowledge, clinical practice comprehensive skills and teaching satisfaction of nursing students in operating room, and then improve the teaching quality.

Objective:To improve the understanding of the relationship between lymphedema and retroperitoneal fibrosis (RPF).Methods:Four cases with lymphedema and RPF in Beijing Shijitan Hospital Capital Medical University were reported. The diagnosis and treatment were analyzed and discussed.Results:All four patients had lymphedema onset and imaging showed suspicious RPF. One case of non-Hodgkin's lymphoma was confirmed by lymph node biopsy. The malignant lesions were excluded in the other two cases by pathology or positron emission tomography (PET)/computerized tomography (CT). They were proved to be idiopathic retroperitoneal fibrosis after treatment with glucocorticoid combined immunosuppressive agents. Another case was systemic amyloidosis mimicking retroperitoneal fibrosis.Conclusion:Lymphatic involvement in RPF is relatively rare, and the possibility of RPF should be considered when patients develop lymphedema. Even if the initial diagnosis is RPF, we should be wary of tumors or other diseases. Imaging examination should be performed, and tissue biopsy should be used if necessary, so as to facilitate early diagnosis and treatment and improve the prognosis of patients.

Objective:To compare surgical methods and clinical efficacy among different types of cesarean scar pregnancy (CSP).Methods:A total of 158 patients with CSP who received treatment in Yuncheng Central Hospital from January 2016 to June 2019 were included in this study. According to Expert Consensus on Diagnosis and Treatment of Cesarean Scar Pregnancy (2016 version), type I CSP was found in 55 patients, type II in 86 patients and type III in 17 patients. These patients were divided into groups A (ultrasound-guided suction curettage), B (uterine artery chemoembolization + ultrasound-guided suction curettage) and C (laparoscopic scar pregnancy lesion resection + scar repair) according to different surgical methods. The amount of intraoperative blood loss, the difference in human chorionic gonadotropin (HCG) level between before and after surgery, the time to postoperative HCG level returning to normal level, menstruation recovery, and re-pregnancy were compared between groups.Results:The amount of intraoperative blood loss in the groups A, B and C was (43.33 ± 72.31) mL, (34.41 ± 17.16) mL, (65.71 ± 70.52) mL, respectively. There was significant difference between groups ( F = 8.51, P = 0.014]. The difference in HCG level between before and after surgery in groups A, B and C was (0.64 ± 0.18), (0.79 ± 0.10), (0.76 ± 0.19), respectively. There was significant difference in the difference in HCG level between groups ( F = 19.21, P < 0.001). There was significant difference in the incidence of postoperative menstrual volume reduction between group B and the other two groups ( χ2 = 6.73, P = 0.003). After surgery, intrauterine pregnancy occurred in 12 patients, including 8 patients in group A (type I CSP in 2 patients, type II CSP in 3 patients, type III CSP in 3 patients), 4 patients in group B (type I CSP in 3 patients, type II CSP in 1 patient). Finally, full-term fetus delivery by cesarean section was performed in 6 patients (4 patients in group A and 2 patients in group B). Conclusion:Uterine artery chemoembolization combined with uterine curettage had less blood loss, during surgery and leads to an obvious decrease in HCG level, but it can result in reduction of menstrual volume. Ultrasound-guided suction curettage is preferred for type I and type II CSP. Balloon compression can be used to stop bleeding if massive bleeding occurs. Laparoscopic scar pregnancy lesion resection plus scar repair is recommended for type III CSP.

Objective:To investigate the differences in CT imaging features of head and neck mucoepidermoid carcinomas (MEC) from different origins and different histological grades.Methods:Clinical and CT imaging findings of 53 patients with pathologically proved MEC in the First Affiliated Hospital of Kunming Medical University admitted from January 2009 to May 2019 were retrospectively reviewed. On the basis of origins, all MECs were divided into 2 groups: large salivary gland group (23 cases) and small salivary gland group (30 cases). All MECs were further divided into 3 groups based on histological grades: highly differentiated (19 cases), moderately differentiated (28 cases) and poorly differentiated (6 cases). The CT imaging features of MEC from different origins and different histological grades (including location, number, size, morphology, boundary, density, calcification, cystic cavity, necrosis, bone changes, flat CT scan value, arterial phase CT enhancement value-added, venous phase CT enhancement value-added, enhancement method, adjacent structure invasion, cervical lymph node metastasis and distant metastasis) were analyzed and compared using t test, χ 2 test, Fisher exact probability or rank-sum test. Results:Comparisons of characteristics between different origins: only lesion size, morphology, bone changes, and plain CT values ( P<0.05) was significantly between different origin groups. There was no significant difference of residual image features ( P>0.05). Compared with MECs derived from large salivary glands, the small salivary gland group had larger MEC lesions, irregular shapes and was prone to have bone changes (including expansion and destruction). In addition, the plain scan CT value of MEC from the large salivary glands was slightly lower than that of the small salivary glands MEC (all P<0.05). Comparison of characteristics among different histological grade groups: only cystic cavity was statistically different (χ2=8.045, P=0.015). Compared with poorly differentiated MEC, highly differentiated MEC was more prone to have cysts (χ2=7.707, P=0.012). Conclusion:There are some differences in CT findings of head and neck MEC from different origins. The cystic cavity has reference value for evaluating histological grade.

Objective To investigate the effects of nicotinamide phosphoribosyl transferase (NAMPT) inhibitor FK866 on polymicrobial sepsis-induced liver injury in mice. Methods Eighty-four healthy male C57BL/6J mice were divided into four groups by random number table method (n = 21): sham group, sepsis-induced liver injury model by cecal ligation and perforation group (CLP group), vehicle+CLP group and FK866+CLP group. FK866 (10 mg/kg) or same volume dimethyl sulfoxide were given intraperitoneally into mice 24, 12 and 0.5 hours prior to CLP in the FK866+CLP group or the vehicle+CLP group, respectively. Fifteen mice in each group were used to observe the 48-hour survival after operation. The remaining 6 mice were sacrificed 20 hours after operation to harvest venous blood and liver tissue samples for index detection. The levels of serum alanine transaminase (ALT) and aspartate aminotransferase (AST) were measured by colorimetry; the levels of serum NAMPT, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured by enzyme linked immunosorbent assay (ELISA); the mRNA expressions of TNF-α and IL-6 were measured by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR); the protein expressions of hepatic NAMPT, cytoplasmic IκBα and nuclear factor-κB (NF-κB) were measured by Western Blot. Results Compared with the sham group, the 48-hour survival in the CLP group was significantly decreased; serum and liver NAMPT protein levels were significantly increased, serum ALT, AST, TNF-α, IL-6 levels and mRNA expressions of TNF-α, IL-6 in liver tissue were significantly increased; the expression of cytoplasmic IκBα protein was significantly decreased, and the expression of nuclear NF-κB protein was significantly increased; which indicated that CLP induced NF-κB activation, inflammation and liver injury. There was no significant difference between the vehicle+CLP group and the CLP group. Compared with the vehicle+CLP group, the 48-hour survival in FK866+CLP group was significantly increased (53.33% vs. 26.67%); serum ALT, AST, TNF-α, IL-6 levels and mRNA expressions of TNF-α, IL-6 in liver tissue were significantly decreased [serum ALT (U/L): 128.94±32.48 vs. 237.24±58.61, serum AST (U/L):289.89±68.74 vs.468±82.17, serum TNF-α (pg/L): 65.17±18.74 vs.127.64±48.18, serum IL-6 (ng/L): 31.78±5.23 vs. 60.87±13.12, liver TNF-α mRNA (2-ΔΔCt): 8.37±4.17 vs. 18.24±6.12, liver IL-6 mRNA (2-ΔΔCt): 18.58±7.12 vs.34.24±6.71], the expression of cytoplasmic IκBα protein was significantly increased (IκBα/GAPDH: 0.23±0.03 vs. 0.12±0.04), while expression of nuclear NF-κB protein was significantly decreased (NF-κB/Lamin B1: 0.25±0.04 vs. 0.42±0.05), with statistically significant differences (all P < 0.05). Conclusion NAMPT inhibitor FK866 protects polymicrobial sepsis-induced liver injury via the inhibition of NF-κB activation and inflammation.

Hypoxia is beneficial for the differentiation of stem cells transplanted for myocardial injury, but mechanisms underlying this benefit remain unsolved. Here, we report the impact of hypoxia-induced Jagged1 expression in cardiomyocytes (CMs) for driving the differentiation of cardiac stem cells (CSCs). Forced hypoxia-inducible factor 1 (HIF-1) expression and physical hypoxia (5% O) treatment could induce Jagged1 expression in neonatal rat CMs. Pharmacological inhibition of HIF-1 by YC-1 attenuated hypoxia-promoted Jagged1 expression in CMs. An ERK inhibitor (PD98059), but not inhibitors of JNK (SP600125), Notch (DAPT), NF-B (PTDC), JAK (AG490), or STAT3 (Stattic) suppressed hypoxia-induced Jagged1 protein expression in CMs. c-Kit CSCs isolated from neonatal rat hearts using a magnetic-activated cell sorting method expressed GATA4, SM22 or vWF, but not Nkx2.5 and cTnI. Moreover, 87.3% of freshly isolated CSCs displayed Notch1 receptor expression. Direct co-culture of CMs with BrdU-labeled CSCs enhanced CSCs differentiation, as evidenced by an increased number of BrdU/Nkx2.5 cells, while intermittent hypoxia for 21 days promoted co-culture-triggered differentiation of CSCs into CM-like cells. Notably, YC-1 and DAPT attenuated hypoxia-induced differentiation. Our results suggest that hypoxia induces Jagged1 expression in CMs primarily through ERK signaling, and facilitates early cardiac lineage differentiation of CSCs in CM/CSC co-cultures HIF-1/Jagged1/Notch signaling.