Objective To investigate the clinical, biochemical, pathological, disease course, and prognostic features of drug-induced liver injury (DILI) patients with different types of bile duct injury. Methods Four patients who were diagnosed with bile duct injury-type DILI by liver biopsy in Shijiazhuang Fifth Hospital, from March 2015 to October 2010 were selected, and related data were collected, including clinical data, laboratory examinations, radiological examination, and prognosis.The semi-quantitative score was determined for liver pathological morphology, and each indicator was compared between the four patients. Results Bile duct injury-type DILI was more common in female patients, and most patients tended to have a good prognosis.Clinical symptoms, liver biochemical parameters, and prognosis varied with the site, grade, scope, regeneration, and repair of bile duct injury. Conclusion Liver biopsy is still the gold standard for making a definite diagnosis of bile duct injury-type DILI, understanding the condition of lesions, and judging the prognosis of this disease.

Objective:To explore the related factors influencing prognosis of patients with grade Ⅲ cholangitis with myocardial injury.Methods:91 patients with grade III cholangitis complicated with myocardial injury treated in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2015 to December 2020 were collected retrospectively. They were divided into endoscopic retrograde cholangiopancreatography (ERCP) group ( n=75) and non-ERCP group ( n=16) according to whether ERCP was performed. According to 28-day survival patients were divided into survival group ( n=56) and death group ( n=35). The level of serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), N terminal pro-brain natriuretic peptide (NT-proBNP), white blood cell (WBC), platelet (PLT), serum creatinine (Scr), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), International Standardized Ratio (INR), Glasgow Coma Score (GCS) at different time points were detected and the risk factors influencing the prognosis of patients were analyzed. Results:The cTnT ( P=0.018), NT-proBNP ( P<0.001), PLT ( P=0.016), GCS score ( P=0.07) on day 3 and cTnI ( P=0.027), cTnT ( P=0.002), CK-MB ( P=0.046), NT-proBNP ( P<0.001), PLT ( P=0.041), GCS score ( P<0.001) on day 7 in the ERCP group were significantly different with the non-ERCP group respectively. The survival rate within 28 days of the ERCP group was significantly different from that in the non-ERCP group ( P<0.001). The cTnT ( P=0.006) on day 1, the cTnT ( P=0.021), NT-proBNP ( P=0.02), WBC ( P=0.037), GCS score ( P<0.001) on day 3, and the cTnI ( P=0.029), cTnT ( P=0.008), CK-MB ( P<0.001), PLT ( P=0.008), NT-proBNP ( P=0.004), GCS ( P<0.001) on day 7 in survival group were significantly different from the death group. Logistic regression showed that the mean value of myocardial injury markers and ERCP process were significantly correlated with the 28 days survival rate. Conclusions:In patients with Grade Ⅲ cholangitis-related myocardial injury, the levels of myocardial injury markers, NT-proBNP, platelet (PLT) and Glasgow Coma Score (GCS) are related to mortality. ERCP for patients can significantly improve 28 days survival and prognosis.

Objective:To investigate the current situation of critical thinking ability of nurses in Catheterization Room in China, and analyze its influencing factors, so as to provide reference for improving the critical thinking ability of nurses in Catheterization Room.Methods:In July 2020, the catheterization nurses from 154 hospitals, including Class Ⅲ Grade A, Class Ⅲ Grade B and Class Ⅱ Grade A, in 28 provincial capital cities of China were investigated with general information questionnaire and Chinese Critical Thinking Disposition Inventory (CTDI-CV) , by convenience sampling method. 422 questionnaires were collected in this survey, 408 were valid, and the effective rate was 96.68%.Results:The total score of critical thinking ability of the 408 catheterization nurses was (247.92±33.77) , which was at a low level as a whole. There were 361 nurses (88.48%) without positive critical thinking, 42 (10.29%) with positive critical thinking, and 5 (1.23%) with strong positive critical thinking. Binary Logistic regression analysis showed that nurse level, education background, professional title and position were the main influencing factors of critical thinking ability of nurses in Catheterization Room ( P<0.05) . Conclusions:The critical thinking attitude of nurses in Catheterization Room is generally negative, which is far from positive, and needs to be further improved. The nursing department should give more tendentious policies and support to the nurses in the Catheterization Room. At the same time, the nursing managers in the Catheterization Room should actively take measures to improve the critical thinking ability of nurses.

Objective: To improve the awareness of emergency biliary obstruction (BO) disease, and to further improve the diagnosis and treatment ability of BO patients. Methods: Data of the etiology, clinical manifestations, imaging data, laboratory tests, and emergency treatment outcomes in 63 BO patients were retrospectively analyzed. Results: Common bile duct stones were the most common cause of BO patients (63.49%), followed by cholangiocarcinoma (19.05%); the most common clinical manifestations of BO patients were jaundice (90.48%), abdominal pain (87.30%), and fever (53.97%); the diagnostic ability of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in patients with BO was significantly higher than that of ultrasound (P<0.05), but there was no significant difference between CT and MRCP (P=1.000); compared with benign group, hemoglobin and albumin in malignant group were significantly lower, while total bilirubin and direct bilirubin were higher, with statistically significant difference (P<0.05). Most patients in BO patients improved after treatment, and the mortality rate of BO patients was 3.17%(2/63) at the end of emergency visit. Conclusions Common bile duct stones and cholangiocarcinoma are still the most common causes of emergency BO patients. The most common clinical manifestations of patients with emergency BO are jaundice, abdominal pain, and fever. Better than abdominal ultrasound, CT and MRCP have comparable diagnostic capabilities in the diagnosis of emergency BO patients. Anemia, hyperbilirubinemia and hypoproteinemia are alarm indicators for malignant tumors in emergency BO patients. Most patients can temporarily get better at the end of emergency visit.

Objective:To understand the current situation of research in the field of sepsis caused by Gram positive bacteria (G + bacteria) in China, to clarify the research content and analyze its general research direction, so as to find the hot topics of research in recent years. Methods:The literatures in SinoMed related to sepsis caused by G + bacteria and published in Chinese from building database to October 2019 were screened. The distribution and trend of the published year, journals, research institutions and researchers of relevant literature were analyzed, and Ucinet 6.0 software was used to draw the social network graph of the researchers and to analyze their internal relations. The subject words of related literatures were extracted. The relationship among the subject words in related literatures was arranged according to the centrality by NetDraw in Ucinet 6.0 software, the bibliographic information co-occurrence analysis system software (BICOMS2 software) was used to classify the subject words and the visualization matrix was generated. The graph clustering tool software (gCLUTO software) was used to cluster the subject words, and the visualization surface graph was generated to analyze the current research hot spot, research trend and research direction of G + bacteria-induced sepsis. Results:A total of 1 976 literatures about sepsis caused by G + bacteria were retrieved, and 26 literatures in conference summaries, news reports, research information, missing content, or inconsistent with the theme were excluded. Finally, a total of 1 950 literatures were enrolled in final analysis. The number of published literatures analysis showed that from 1979 to 1992, there were few studies about sepsis caused by G + bacteria, which increased geometrically from 2008, and the number of literatures published from 2008 to 2018 was 1 144, accounting for 58.67% (1 144/1 950). From 1979 to 2019, 23 high-yield institutions published more than 5 literatures, of which 6 were institutions with 10 or more literatures, and only one institution with more than 20 literatures. There were only 5 journals with more than 100 articles, 5 381 authors involved in the literatures, but few authors with more than 10 literatures published, and no inter-provincial or inter-municipal cooperation was found. A social network analysis of 103 high-frequency subject words that appeared more than 5 times showed that the study of sepsis caused by G + bacteria mainly focused on "sepsis", including the incidence of sepsis caused by drug resistant Staphylococcus aureus was on the rise, especially in newborns and children with weakened immune systems, the selection of therapeutic drugs gradually developed to glycopeptides with strong anti-drug resistance and synthetic oxazolidinones. The research and development of drugs for the treatment of sepsis caused by G + bacteria might become a new research direction or field in the future. Cluster analysis of 103 high-frequency subject words showed that the research hot spots of G + bacteria-induced sepsis mainly focused on five topics, namely early diagnosis of sepsis; bacterial infection pathway of sepsis, nosocomial infection and bacterial drug resistance; the basis of epidemiological prevention and treatment of sepsis; venous catheter infection-related sepsis; the treatment, nursing and prognosis of patients with sepsis. Conclusion:The studies of sepsis caused by G + bacteria are winning more and more attention, but the resources sharing and academic exchanges among hospitals need to be further improved.

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

OBJECTIVE： To study the diterpenoid alkaloids in Aconitum carmichaeli from Guizhou province， and to provide reference for the further enrichment of chemical constituents of plants from the genus Aconitum and the development and utilization of A. carmichaeli from Guizhou province. METHODS： The root tuber of A. carmichaeli from Guizhou province was collected. The total alkaloids of A. carmichaeli roots were extracted by acid extraction and alkali precipitation method. The diterpenoid alkaloids were obtained by isolating and purifying total alkaloids extract with silica gel column chromatography. The structures of the isolated compounds were elucidated on the basis of NMR and MS analysis. RESULTS & CONCLUSIONS： Fifteen diterpenoid alkaloids， including 12-epi-15-O-acetyl-17-benzoyl-16-hydroxy-16，17-dihydronapelline（Ⅰ），songorine（Ⅱ），songoramine（Ⅲ），10-aconifine（Ⅳ），hypaconitine（Ⅴ），deoxyaconitine（Ⅵ），aconitine（Ⅶ），mesaconitine（Ⅷ），14-benzoyltalasamine（Ⅸ），talatisamine（Ⅹ），neoline（ⅩⅠ），6-epi-chasmanine（ⅩⅡ），isotalatizidine（ⅩⅢ），sachaconitine（ⅩⅣ）and kalakoline（ⅩⅤ） were identified form A. carmichaeli roots from Guizhou Province. Compounds Ⅸ and ⅩⅡ were isolated from this specie for the first time.

Objective To investigate the correlation between the expression of phospholipase Cβ1 (PLCβ1) and the clinical relevant parameters and prognosis in patients with hepatocellular carcinoma (HCC).Methods By using tissue microarray technique and immunohistochemical method,the expressions of PLCβ1 in tumor and pericancerous tissues were tested in 141 HCC patients.The relationship between the expressions of PLCβ1 and the clinical and pathological characteristics was analyzed.Colony formation assay and apoptosis experiments were used to check the effect of PLCβ1 on proliferation of HCC cells.KaplanMeier analysis and Cox multivariate regression model analysis were adopted to analyze the prognosis of HCC patients.Results The expression level of PLCβ1 in tumor tissues was obviously higher than that in pericancerous tissues,which was closely related to the tumor staging.Kaplan-Meier survival analysis indicated that the survival rate in HCC patients with high expression level of PLCβ1 was lower than that in HCC patients with low expression level of PLCβ1.Cox multivariate regression analysis revealed that high expression of PLCβ1 was an independent prognostic factor for HCC patients.Over expression of PLCβ1 in HCC cells could promote the proliferation of HCC cell and inhibit its apoptosis.Further investigation showed that activation of extracellular regulated protein kinase signaling pathway might be involved in PLCβ1-mediated HCC cell growth.Conclusion PLCβ1 can promote the progression of HCC,and the expression level of PLCβ1 can be regarded as an independent prognostic factor for HCC,and it is expected that PLCβ1 may become an ideal therapeutic target.

Objective To investigate the influence of sorafenib on the expressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines,including HepG2,Hep3B,BEL-7402,BEL-7404,BEL-7405,QGY-7701,QGY-7703,SMMC-7721,MHCC97H,MHCC97L,HCCLM3 and HCCLM6.Methods Western blotting and MTT assay were used to check the influence of sorafenib on the expressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines and to test the inhibitory effect of sorafenib on different human hepatocellular carcinoma cell lines.Results Compared with normal human liver cells (HL-7702),the expressions of B7-H3 and B-H4 proteins in different human hepatocellular carcinoma cell lines were significantly up-regulated (P＜0.01).The cytotoxic activity IC50 values of sorafenib to Hep3B,BEL-7404,MHCC97H,HCCLM3 and HCCLM6 were 14.56,9.14,9.46,17.21 and 9.29 μmol/L respectively.After treating Hep3B,BEL-7404,MHCC97H,HCCLM3 and HCCLM6 with sorafenib at the doses of 5,10 and 20 μmol/L separately,the expressions of B7-H3 and B7-H4 proteins were strikingly down-regulated when compared with the control group (P＜0.01).Conclusion The overexpressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines are a common finding,which can influence tumor immune escape.It may be a new target for prevention and treatment of liver cancer in future.

Objective To investigate the clinical characteristics of hemodialysis (HD) patients complicated with arteriosclerosis obliterans (ASO) of lower extremity,and to discuss the factors that influence the curative prognosis of percutaneous transluminal angioplasty (PTA).Methods The clinical data of 211 patients with ASO of lower extremity receiving HD or not receiving HD,who were admitted to authors' hospital during the period from January 2008 to October 2015,were retrospectively analyzed.PTA was successfully accomplished in all patients.Results The median follow-up time was 2.24 years.Theamputation-free survival of HD group was significantly lower than that of non-HD group (P＜0.000 1),and the postoperative artery patency rate of HD group was also obviously lower than that of non-HD group (P＜0.000 4).The factors influencing the survival rate without amputation of the two groups were different.The independent influence factor in HD group was diabetes mellitus,while in non-HD group the independent influence factors were Fontaine stage and hyperlipidemia.The infection mortality of HD group was 55.5％ (10/18),which was higher than 22.2％(6/26) of non-HD group,the difference was statistically significant (P＜0.05).Conclusion In treating ASO of lower extremity,the curative effect of PTA is poorer in HD patients than in non-HD patients,and the presence of diabetes mellitus may be an independent factor influencing prognosis.