Objective:To search, evaluate, and summarize the best evidence for difficult peripheral intravenous catheterization in children.Methods:Following the "6S" evidence pyramid model, literature related to the management of difficult peripheral veins in children was searched in both English and Chinese databases including UpToDate, BMJ Best Practice, National Guidelines Clearinghouse, the Joanna Briggs Institute Evidence-Based Health Care Database, PubMed, Medlive, SinoMed, CNKI, and Wanfang Database. The search period was from the establishment of the database to January 2023. Two researchers trained in systematic evidence-based nursing, independently evaluated the quality of included literature and extracted relevant evidence.Results:Five articles were included: two guidelines, two expert consensuses, and one systematic review. 19 best evidence were summarized, covering five aspects: difficult vein quality management, difficult vein assessment, difficult intravenous catheterization site and needle type selection, difficult intravenous catheterization auxiliary methods, and handling of failed difficult intravenous catheterization.Conclusions:This study summarizes the best evidence for difficult peripheral intravenous catheterization in children, demonstrating clinical nursing practicality. It provides evidence-based guidance for pediatric nursing staff performing difficult intravenous catheterization.

Background and purpose:Limbs soft tissue sarcoma(STS)is a common malignant tumor,and surgical resection is the main treatment method for it.The concept of barrier made us realize the blocking effect of natural barrier on STS,and we aimed to search for tissues that can act as barrier,and to perform complete resection of surgical margins around the tissue barrier.This study aimed to investigate the feasibility,safety and prognosis of barrier resection in the treatment of limbs STS.Methods:From December 2013 to September 2016,data of 72 patients who underwent barrier resection of STS of extremities in department of oncosurgery,Minhang Branch,Fudan University Shanghai Cancer Center were retrospectively analyzed,and the resection margin was sampled.All 72 patients underwent preoperative magnetic resonance imaging(MRI)or computed tomography(CT)design,and the physiological barrier or at least 3 cm distance was found outward from the anatomical location of the tumor.And en bloc excision was performed outside this barrier or at a distance of 3 cm.The influence of postoperative pathological margin,musculoskeletal tumor society(MSTS)score and postoperative complications on the patients were analyzed.The 1-and 3-year locoregional recurrence-free survival(LRFS)rates and sarcoma-specific survival(SSS)rates were evaluated,and the influencing factors were analyzed.This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center(number:1212117-12&1212117-12-1301).Results:All patients had negative margins.The 1-and 3-year LRFS rates were 98.2%and 93.3%,respectively.The 1-and 3-year SSS rates were 98.4%and 94.2%,respectively.The mean MSTS scores were 28.3 preoperatively and 25.5 postoperatively.Surgical complications were grade 1 to 2 in 20 cases and grade 3 in 1 case,and there were no grade 4 to 5 complications.Conclusion:Based on the combination of clinical,imaging and pathology data,barrier resection,including tumor resection and functional reconstruction,can be applied to the surgical treatment of STS,with good feasibility and safety,reliable margin and satisfactory local control.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

Objective:To compare the effects of different doses of prednisone combined with voriconazole on lung function and IgE levels in patients with allergic bronchopulmonary aspergillosis.Methods:From January 2018 to December 2018, 100 patients with allergic bronchopulmonary aspergillosis who admitted to Shaoxing Central Hospital were selected in this research.The patients were divided into two groups by the random number table method, with 50 cases in each group.The control group received high-dose prednisone combined with voriconazole, while the observation group received low-dose prednisone combined with voriconazole.The clinical effects after treatment were compared, including forced vital capacity (FVC), forced expiratory volume at the first second (FEV 1), FEV 1/FVC, peripheral blood eosinophilia (EOS), IgE, tumor necrosis factor alpha (TNF-α ), interleukin-6 (IL-6), interleukin-8 (IL-8) and adverse reactions. Results:After treatment, the total effective rate of the observation group was 94.00%(47/50), which was higher than 68.00%(34/50) in the control group (χ 2=10.981, P<0.05). Before treatment, the FVC, FEV 1, FEV 1/FVC between the two groups showed no statistically significant differences (all P>0.05). After treatment, the FVC, FEV 1, FEV 1/FVC of the observation group [(3.29±0.21)L, (1.86±0.25)L, (73.81±5.16)%] were higher than those of the control group [(2.61±0.21)L, (1.58±0.28)L, (65.85±5.07)%], the differences were statistically significant( t=16.190, 5.274, 7.781, all P<0.05). Before treatment, the EOS and IgE levels in peripheral blood showed no statistically significant differences between the two groups (all P>0.05). After treatment, the peripheral blood levels of EOS and IgE [(0.21±0.11)×10 9/L, (187.36±37.12)U/mL] in the observation group were lower than those in the control group [(0.34±0.14)×10 9/L, (689.35±40.16)U/mL], the differences were statistically significant ( t=5.163, 64.907, all P<0.05). Before treatment, the levels of TNF-α, IL-6 and IL-8 showed no statistically significant differences between the two groups (all P>0.05). After treatment, the levels of TNF-α, IL-6 and IL-8 of the observation group [(13.59±5.14)pg/L, (6.15±3.01)ng/L, (276.25±87.51)ng/L] were lower than those of the control group [(19.48±5.01)pg/L, (10.25±3.52)ng/L, (322.27±99.74)ng/L], the differences were statistically significant ( t=5.802, 6.259, 2.452, all P<0.05). The overall incidence of adverse reactions in the observation group was 6.00%(3/50), which was lower than 26.00%(13/50) in the control group (χ 2=7.441, P<0.05). Conclusion:Low-dose prednisone combined with voriconazole in the treatment of patients with allergic bronchopulmonary aspergillus has significant effect, which can effectively improve the pulmonary function and IgE level of patients, and reduce adverse reactions.

OBJECTIVE： To systematically evaluate the correlation between CYP3A5 6986A＞G gene polymorphism and blood concentration of Cyclosporine A （CsA） in Chinese renal transplant recipients. METHODS： Retrieved from Cochrane Library， PubMed， Embase， CBM， CNKI， VIP and Wanfang database， case-control or cohort studies about Chinese patients receiving CsA immunosuppressive therapy and blood concentration monitoring after kidney transplantation were collected. After literature screening and data extracting， the quality of literature was evaluated with Newcastle Ottawa scale， and Meta-analysis was performed by using Rev Man 5.3 software. RESULTS： Eight literatures with a total of 890 patients were involved in cohort study. Meta-analysis showed that the trough concentration after dosage correction （C0/D） of CsA in CYP3A5*1/*1 genotype was significantly lower than CYP3A5*1/*3 genotype[MD＝－6.97，95％CI     （－13.18，－0.76），P＝0.03]. The subgroup analysis showed that the C0/D of CsA in CYP3A5*1/*1 genotype was significantly lower than CYP3A5*1/*3 genotype when test time≤1 month after renal transplant [MD＝－8.50，95％CI（－12.57，－4.43），P＜0.000 1] and ＞1-＜6 months after renal transplant [MD＝－14.02，95％CI（－26.28， －1.76），P＝0.02]. C0/D of CsA in CYP3A5*1/*3 genotype was significantly lower than CYP3A5*3/*3 genotype [MD＝－6.04，95％CI（－8.99，－3.09），P＜0.000 1]. The subgroup analysis showed that C0/D of CsA in CYP3A5*1/*3 genotype was significantly lower than CYP3A5*3/*3 genotype when test time ≤1 month after renal transplant [MD＝－6.94，95％CI（－10.21， －3.68），P＜0.000 1]. C0/D of CsA in CYP3A5*1/*1 genotype was significantly lower than CYP3A5*3/*3 genotype [MD＝－12.64，95％CI（－21.09，－4.20），P＝0.003]. The subgroup analysis showed that C0/D of CsA in CYP3A5*1/*1 genotype was significantly lower than CYP3A5*3/*3 genotype when test time ≤1 month after renal transplant [MD＝－16.69，95％CI（－24.03，－9.36），P＜0.000 01] and ＞1-＜6 months after renal transplant [MD＝－16.78，95％CI（－28.63，－4.93），P＝0.006]. There was no statistical significance in CsA of peak concentration after dose correction between CYP3A5*1/*1 genotype and CYP3A5*1/*3 genotype， CYP3A5*1/*3 genotype and CYP3A5*3/*3 genotype， CYP3A5*1/*1 genotype and CYP3A5*3/*3 genotype. CONCLUSIONS： CYP3A5 6986A＞G gene polymorphism is associated with C0/D of CsA in Chinese renal transplantation recipients. The sequence of C0/D when test time ≤1 month after renal transplantation is as follows as CYP3A5*1/*1 genotype＜CYP3A5*1/*3 genotype＜CYP3A5*3/*3 genotype； during＞1-＜6 months after renal transplantation， C0/D of CsA in CYP3A5*1/*1 genotype＜CYP3A5*1/*3 genotype and CYP3A5*1/*1 genotype＜CYP3A5*3/*3 genotype.

OBJECTIVE:To investigate the application of key monitoring varieties among adjuvant drugs in medical institu tions of Yunnan province,and to provide reference for the formulation of related policy and the promotion of clinical rational drug use.METHODS:The related data of key monitoring varieties in medical institutions of Yunnan province during Jan.1st-Mar.31st,2015 were investigated and analyzed statistically.RESULTS:The data with highest effective rate were reported by tertiary hospi tals,being 93.94％.Among top 10 drugs in the list of consumption sum,the number of key monitoring varieties was the highest in tertiary hospitals,being (5.50 ± 2.12) varieties averagely.The consumption sum of key monitoring varieties in tertiary hospitals took up the highest proportion in total consumption sum of hospitalization drug,being(31.94 ± 16.99)％ averagely;being(26.13 ± 11.93)％ and (22.14 ± 16.39)％ in second level hospitals and first level hospitals.Among top 10 drugs in the list of consumption sum,the consumption sum of key monitoring varieties in second level hospitals took up the highest proportion in total consumption sum of hospitalization key monitoring varieties,being (50.34 ± 26.87) ％ in average,up to 98.53 ％;being (39.13 ± 22.55) ％ and (27.38 ± 27.75)％ in tertiary hospitals and first level hospital.Among top 5 key monitoring types in the list of hospitalization con sumption sum,safflower yellow pigment and omeprazole were involved in hospitals at various levels.CONCLUSIONS:Adjuvant drug use are widespread in medical institutions of Yunnan province.Key monitoring varieties are given priority to TCM injection and proton pump inhibitors.It is necessary to take effective measures,formulate and implement the corresponding supervision sys tem so as to promote rational clinical drug use.

OBJECTIVE:To provide data and reference for pharmacist legislation. METHODS:Questionnaire survey was de-signed investigate and analyze the staffing situation,education level,professional composition,age composition,professional titles composition,continuing education and wage of pharmacists who worked in medical and health institutions from 16 states (cities) in Yunnan province,and suggestions were put forward for relevant legislation. RESULTS:Totally 10 questionnaires were received from provincial medical and health institutions,and 16 from state (city) Health and Family Planning Commission,with effective recovery of 100%;data covered 1 561 medical and health institutions,involving 7 409 pharmacists. The numbers of pharmacy per-sonnel/hospital beds in tertiary hospitals,secondary hospitals and class-1 hospitals were 1∶15.49,1∶17.50,1∶20.68,numbers of pharmacy personnel/health professional and technical personnel in hospital accounted for 5.62%,6.18%,5.30%,respectively;most pharmacists in tertiary hospitals were mainly undergraduate degree(35.21%),doctor degree accounted for 0.15%,the high-est ratio of education was junior college degree in secondary hospitals(41.60%)and class-1 hospitals(57.51%);most pharmacists graduated in pharmacy in tertiary hospitals(94.14%),70.22% in secondary hospitals and only 10.50% in class-1 hospitals;phar-macy personnel mainly held the pharmacist professional titles in tertiary,secondary and class-1 hospitals (33.83%,37.89% and 63.55%),senior professional titles accounted for 5.88%,2.71% and 0.21%,respectively;only a few have learning experience and almost less than 6 months (9.17%,5.84% and 21.32%),and 80 pharmacists were certificated as clinical pharmacists in the whole province;generally,all wage was concentrated in 2 000-2 999 per month (27.72%,41.80% and 55.90%,respectively). CONCLUSIONS:Shortage of hospital pharmacists and lack of senior personnel are the main problems in Yunnan province,and wage is not high,especially in primary hospital,this situation is more obvious. The current situation of pharmacists in the hospital should be more taken into consideration during the legislative process in aspects of clearing and guaranteeing access qualifications, responsibilities,status,rights and interests,and pharmaceutical technology and service charges should be established.

PurposeTo explore the value of gemstone spectral imaging (GSI) in diagnosis of thyroid nodule hemorrhage.Materials and Methods Seventeen patients with surgery and pathology confirmed thyroid nodule hemorrhage underwent thyroid spectrum CT scan. The CT value, iodine concentration value, water concentration value and the effective atomic ordinal value as well as spectral curve slope of hemorrhagic nodules and surrounding normal thyroid tissue were measured respectively.Results Hemorrhagic thyroid nodules showed equal or high CT value, low concentration of iodine, high concentration of water, low spectral curve slope, and low effective atomic ordinal value on spectral CT imaging. There were statistically significant differences in concentration of iodine value, concentration of water value, and spectral curve slope between hemorrhagic nodules and surrounding normal thyroid tissue (Z=-5.438,-4.679 and-5.317,P<0.01), and there were statistically significant differences in CT value and effective atomic ordinal value (Z=-2.097 and-2.230,P<0.05).Conclusion Energy spectrum CT scan is important in detection and accurate diagnosis of thyroid nodule hemorrhage.

Pancreatic cancer is a devastating disease with the worst prognosis among all the major human malignancies. The propensity to rapidly metastasize contributes significantly to the highly aggressive feature of pancreatic cancer. The molecular mechanisms underlying this remain elusive, and proteins involved in the control of pancreatic cancer cell motility are not fully characterized. In this study, we find that histone deacetylase 6 (HDAC6), a member of the class II HDAC family, is highly expressed at both protein and mRNA levels in human pancreatic cancer tissues. HDAC6 does not obviously affect pancreatic cancer cell proliferation or cell cycle progression. Instead, it significantly promotes the motility of pancreatic cancer cells. Further studies reveal that HDAC6 interacts with cytoplasmic linker protein 170 (CLIP-170) and that these two proteins function together to stimulate the migration of pancreatic cancer cells. These findings provide mechanistic insight into the progression of pancreatic cancer and suggest HDAC6 as a potential target for the management of this malignancy.
Cell Cycle ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Gene Knockdown Techniques ; Histone Deacetylase 6 ; Histone Deacetylases ; metabolism ; Humans ; Microtubule-Associated Proteins ; metabolism ; Neoplasm Proteins ; metabolism ; Pancreatic Neoplasms ; enzymology ; metabolism ; pathology ; Protein Binding

Objective To observe the effectiveness of probucol for non-proliferative diabetic retinopathy (NPDR) with hyperlipidemia.Methods Fifty-two patients (104 eyes) of NPDR with hyperlipidemia were enrolled in this study.The patients were randomly divided into treatment group and control group,26 patients (52 eyes) in each group.Both groups received diet and exercise guidance,oral hypoglycemic agents and (or) intensive insulin therapy.After blood sugar and blood pressure were controlled,the treatment group received probucol 0.5 g,two times per day; and the control group received atorvastatin of 10 mg,one time per day.The total course was 12 months.Before and after one,three,six and 12 months,all patients underwent vision,ophthalmoscope,fundus fluorescein angiography,blood and urine tested.Variations of visual acuity,fundus condition,macular edema,triglyceride (TG),total cholesterol (TC),low-density lipoprotein cholesterol (LDLC),high-density lipoprotein cholesterol (HDLC) and 8-0HdG were observed before and after treatment.Results The total effective rate of visual prognosis were 44.23％ and 40.38％ in the treatment group and the control group,the difference had no statistical significacy (Z＝-0.335,P＞0.05).Retinal hemorrhages and microaneurysms alleviated after treatment in both groups.The total efficiency of fundus prognosis was 65.38％ in the treatment group and 36.54％ in the control group,and the difference was statistically significant (Z=-2.973,P＜0.05).Macular edema was in six and five eyes in the treatment group and the control group respectively,which were lower than before treatment,the difference was statisticaly significant (x2=4.833,4.300; P＜0.05).Between the two groups,the difference was not statistically significant (x2 =0.102,P＞ 0.05).Twelve months after treatment,TG,TC and LDLC were decreased in the treatment group (t=15.653,7.634,14.871) and control group (t=13.275,7.415,13.632),and the difference was statistically significant (P＜0.05).HDLC showed no significant difference than before in the two groups (t=0.584,0.275; P＞0.05).TG,TC,LDLC and HDLC showed no difference between the two groups (t＝1.857,0.133,1.671,0.875; P＞0.05).8-0HdG decreased gradually during the one,three,six and 12 months in the treatment group (t=7.352,15.581,27.324,28.143) and control group (t =6.877,8.672,14.671,14.855) after treatment,and the difference was statistically significant (P＜0.05).In the first month aftertreatment,8 0HdG showed no difference between the two groups (t=0.513,P＞0.05).In the 3,6,and 12 months after treatment,the 8 0HdG was lower in the treatment group than that in the control group,and the difference was statistically significant (t =3.434,5.917,5.226; P＜0.05).Conclusion In the treatment of NPDR with hyperlipidemia,probucol can reduce blood lipid,stable visual function and relieve macular edema.