ObjectiveTo investigate the clinical features and outcomes of recompensation in patients with autoimmune hepatitis （AIH）-related decompensated cirrhosis， to identify independent predictive factors， and to construct a nomogram prediction model for the probability of recompensation. MethodsA retrospective cohort study was conducted among the adult patients with AIH-related decompensated cirrhosis who were admitted to The Fifth Medical Center of PLA General Hospital from January 2015 to August 2023 （n=211）. The primary endpoint was achievement of recompensation， and the secondary endpoint was liver-related death or liver transplantation. According to the outcome of the patients at the end of the follow-up， the patients were divided into the recompensation group （n=16） and the persistent decompensation group（n=150）.The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data with heterogeneity of variance； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； the Kaplan-Meier method was used for survival analysis； the Cox proportional-hazards regression model was used to identify independent predictive factors， and a nomogram model was constructed and validated. ResultsA total of 211 patients were enrolled， with a median age of 55.0 years and a median follow-up time of 44.0 months， and female patients accounted for 87.2%. Among the 211 patients， 61 （with a cumulative proportion of 35.5%） achieved recompensation. Compared with the persistent decompensation group， the recompensation group had significantly higher white blood cell count， platelet count （PLT）， total bilirubin （TBil）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bile acid， prothrombin time， international normalized ratio （INR）， SMA positive rate， Model for End-Stage Liver Disease （MELD） score， Child-Pugh score， and rate of use of glucocorticoids （all P0.05）， as well as significantly lower age at baseline， number of complications， and death/liver transplantation rate （all P0.05）. At 3 and 12 months after treatment， the recompensation group had continuous improvements in AST， TBil， INR， IgG， MELD score， and Child-Pugh score， which were significantly lower than the values in the persistent decompensation group （all P0.05）， alongside with continuous increases in PLT and albumin， which were significantly higher than the values in the persistent decompensation group （P0.05）. The multivariate Cox regression analysis showed that baseline ALT （hazard ratio ［HR］=1.067， 95% confidence interval ［CI］： 1.010 — 1.127， P=0.021）， IgG （HR=0.463，95%CI：0.258 — 0.833， P=0.010）， SMA positivity （HR=3.122，95%CI：1.768 — 5.515， P0.001）， and glucocorticoid therapy （HR=20.651，95%CI：8.744 — 48.770， P0.001） were independent predictive factors for recompensation， and the nomogram model based on these predictive factors showed excellent predictive performance （C-index=0.87，95%CI：0.84 — 0.90）. ConclusionAchieving recompensation significantly improves clinical outcomes in patients with AIH-related decompensated cirrhosis. Baseline SMA positivity， a high level of ALT， a low level of IgG， and corticosteroid therapy are independent predictive factors for recompensation. The predictive model constructed based on these factors can provide a basis for decision-making in individualized clinical management.

The paper introduces Professor SUN Shentian's experience in clinical practice of Ningshen (tranquilizing the mind) point. This point is an empirical point discovered by Professor SUN on the basis of meridian differentiation, nerve function and anatomic location, and in association with the years of clinical practice. The point is located in the prefrontal area, jointed with the distribution of the governor vessel, and responded to the body surface projection area of the frontal pole. It works on regulating the mind, regaining consciousness, improving cognition, alleviating depression, mutually treating physical and mental disorders, as well as unblocking collaterals, regulating the tendons and relieving spasm. This point is widely used in treatment of mental disorders, stroke and extrapyramidal diseases and obtains the reliable therapeutic effect in clinical practice.
Humans ; Acupuncture Points ; Acupuncture Therapy/history* ; China ; Meridians ; History, 20th Century

Ovarian cancer is one of the common tumors in female reproductive organs and accounts for about 4% of all malignant tumors in women. It is also the leading cause of death among various gynecological tumors. Surgery combined with chemotherapy is the frequently used treatment for ovarian. Chemotherapy resistance is one of the main reasons for the recurrence and poor prognosis of ovarian cancer. Various components of the MAPK pathway, also known as the RAS-RAF-MEK-ERK signaling cascade, are related to cancer, and ERK1/2 is an indispensable key site in this pathway. Continuous research has found that ERK1/2 is a "ferryman" involved in regulating the occurrence, development, and drug resistance mechanisms of ovarian cancer. This article briefly introduces the activation mechanism and pathway of the ERK1/2 signaling pathway, summarizes its relationship to ovarian cancer, and emphasizes that ERK1/2 inhibitors may be a new treatment strategy with potential advantages in improving poor prognosis in patients with ovarian cancer.

Background::Exercise, as the cornerstone of pulmonary rehabilitation, is recommended to chronic obstructive pulmonary disease (COPD) patients. The underlying molecular basis and metabolic process were not fully elucidated.Methods::Sprague-Dawley rats were classified into five groups: non-COPD/rest ( n = 8), non-COPD/exercise ( n = 7), COPD/rest ( n = 7), COPD/medium exercise ( n = 10), and COPD/intensive exercise ( n = 10). COPD animals were exposed to cigarette smoke and lipopolysaccharide instillation for 90 days, while the non-COPD control animals were exposed to room air. Non-COPD/exercise and COPD/medium exercise animals were trained on a treadmill at a decline of 5° and a speed of 15 m/min while animals in the COPD/intensive exercise group were trained at a decline of 5° and a speed of 18 m/min. After eight weeks of exercise/rest, we used ultrasonography, immunohistochemistry, transmission electron microscopy, oxidative capacity of mitochondria, airflow-assisted desorption electrospray ionization-mass spectrometry imaging (AFADESI-MSI), and transcriptomics analyses to assess rectal femoris (RF). Results::At the end of 90 days, COPD rats’ weight gain was smaller than control by 59.48 ± 15.33 g ( P = 0.0005). The oxidative muscle fibers proportion was lower ( P < 0.0001). At the end of additional eight weeks of exercise/rest, compared to COPD/rest, COPD/medium exercise group showed advantages in weight gain, femoral artery peak flow velocity (Δ58.22 mm/s, 95% CI: 13.85-102.60 mm/s, P = 0.0104), RF diameters (Δ0.16 mm, 95% CI: 0.04-0.28 mm, P = 0.0093), myofibrils diameter (Δ0.06 μm, 95% CI: 0.02-0.10 μm, P = 0.006), oxidative muscle fiber percentage (Δ4.84%, 95% CI: 0.15-9.53%, P = 0.0434), mitochondria oxidative phosphorylate capacity ( P < 0.0001). Biomolecules spatial distribution in situ and bioinformatic analyses of transcriptomics suggested COPD-related alteration in metabolites and gene expression, which can be impacted by exercise. Conclusion::COPD rat model had multi-level structure and function impairment, which can be mitigated by exercise.

Objective:To investigate abnormal urination and penile appearance satisfaction of preschool children (3-6 years old) after hypospadias repair.Methods:From January 2016 to December 2020, children with primary hypospadias, who had no postoperative complications for more than 1 year and were at pre-school age at the time of investigation (January 2022), were selected. The abnormal urination manifestations and satisfaction with penile appearance of the children after operation were investigated by questionnaires to their parents.The questionnaire was designed based on the reported abnormal urination after hypospadias surgery, including 4 items (urination spraying, urination dripping, deflection of urine line, small urine line). Another questionnaire was used to evaluate the penis appearance satisfaction according to the existing pediatric penile perception score (including 4 items: the position and shape of the external urethral orifice, the shape of glans, the appearance of the prepuce, and the overall appearance; items were scored according to the subjective satisfaction of the subjects: very satisfied 3 points, satisfied 2 points, dissatisfied 1 point, very dissatisfied 0 point). The patients were divided into two groups according to whether the penile curvature after degloving was more than 30°. In group Ⅰ (penile curvature≤30°), 28 patients without severe penile curvature underwent tubularized incised plate (TIP) surgery, with a median age of 3.2 years (ranged 1.1-5.4 years). In group Ⅱ (penile curvature>30°), there were 27 patients with severe penile curvature and they underwent staged flap operation. Their median age was 2.8 years (ranged 1.5-4.7 years). There was no significant difference in age at operation between the two groups ( P=0.82). The questionnaire content was analyzed and the differences between the two groups were compared. Results:Among the 55 children, 21(38%, 21/55) had abnormal urination, and there was a significant difference between group Ⅰ (25%, 7/28) and group Ⅱ (52%, 14/27)( P=0.04). All the items of penis appearance satisfaction were satisfactory (scores ≥2), and the total scores of group Ⅰ and group Ⅱ were respectively 10.3±2.2 and 9.0±2.9, with no significant difference between the two groups (P=0.63). Conclusions:In the postoperative follow-up of preschool children with hypospadias, parents were satisfied with the appearance of the penis.The abnormal urination was common. Compared with children without severe penile curvature treated by TIP surgery, abnormal urination was more common in children with severe penile curvature treated by staged flap operation.

Objective:To observed the effects of electroacupuncture frequency on the nerve function and postsynaptic destination-95 (PSD-95), growth associated protein-43 (GAP-43) in brain tissue of rats with cerebral ischemia were observed.Methods:Healthy adult male SD rats were randomly divided into the blank group, sham operation group, model group and 2 Hz, 50 Hz, 100 Hz electroacupuncture groups. MCAO models were prepared in each group, except blank group and sham operation group. After modeling, Qiansanli and Waiguan acupoints were given stimulation with 2 Hz, 50 Hz and 100 Hz respectively in 2 Hz electroacupuncture group, 50 Hz electroacupuncture group and 100 Hz electroacupuncture group, 1 time/d and 20 min/time for 21 consecutive days. All groups were scored by Bederson score on the 1st, 3rd, 7th, 14th and 21th day after operation. The ultrastructure of synapses was observed by transmission electron microscope, and the positive expression of PSD-95 and GAP-43 was detected by immunohistochemistry. Results:After modeling 7, 14 and 21 days, compared with the model group, the Bederson behavioral score (1.70 ± 0.52 vs. 2.40 ± 0.56, 1.20 ± 0.65 vs. 2.30 ± 0.46, 0.70 ± 0.72 vs. 2.00 ± 0.86) in 50 Hz electroacupuncture group significantly decreased ( P<0.01 or P<0.05). The expression of PSD-95 (58.67 ± 1.72, 55.22 ± 2.45, 60.10 ± 2.49 vs. 70.87 ± 2.34) intergral optical density of rats’ cortex in 2 Hz, 50 Hz, 100 Hz electroacupuncture groups significantly decreased ( P<0.01), the expression of GAP-43 in 2 Hz and 50 Hz electroacupuncture groups (58.89 ± 1.28, 64.76 ± 3.94 vs. 53.24 ± 2.58) significantly increased ( P<0.01). Conclusions:Electroacupuncture with different frequency can improve motor nerve disfunction of cerebral ischemia rats, and 50 Hz electroacupuncture group showed the most obvious effect. It can regulate PSD-95 and GAP-43 expressions of ischemic area, lower neural excitatory toxicity, increase neuronal axon regeneration and exert the neural protect function.

Objective:To investigate the therapeutic effect of dorsal skin-tightening technique on the correction of mild penile curvature in children with hypospadias.Methods:The clinical characteristics of hypospadias patients (95 cases) with mild penile curvature (<30°) after degloving penis during operation in our hospital from Jan 2017 to Sep 2020 were analyzed retrospectively. Group A: A new technique, reconstructing penile pubic angle at 12 o'clock position of penile dorsal side after degloving and suturing forskin outer and inner plate with tension at 12 o'clock position, was performed in dorsal skin-tightening group (43 cases). Gtoup B: while in dorsal midline tunica albuginea plication group (52 cases), Buck fascia was incised on dorsal midline area, following by tunica albuginea plication with one or two stitches. The patients in Group A were 0.4 to 1.5 years old, and the median age was 1.1 years, urethral orifice were located on distal shaft in 36 cases, proximal in 7 cases.The patients in Group B were 0.5 to 2.6 years old, and the median age was 1.5 years, urethral orifice were located on distal shaft in 41 cases, proximal in 11 cases. The penile ventral curvature degree was recorded during regular follow-up (postoperative 6 and 12 months), as well as postoperative complications.Results:Artificial erection test showed penile curvature was corrected during surgery by measuring with protractor. There was no chordee by measuring with the side photos in all patients during an average of 1.6 years follow-ups. There were 4 case of urethral fistula in Group B and 3 cases in Group A. No cases of urethrostenosis, diverticulum or concealed penis was recorded. The difference of postoperative complications had no statistical significance.Conclusion:Hypospadias with mild penile curvature could be effectively corrected by dorsal skin-tightening technique, which showed a good result of early follow-up.

Objective:To apply the best evidence of non-drug management of chemotherapy induced nausea and vomiting (CINV) in clinical practice, and evaluate the effect of practice.Methods:After searching domestic and foreign databases, 14 articles were finally included, including 3 systematic reviews, 3 evidence summaries and 8 guidelines. According to the evidence-based continuous quality improvement model of Joanna Briggs Institute (JBI) Evidence-based Nursing and Health Care Center, we conducted the review before and after evidence application, obstacle factors, available resources and strategy analysis, and evaluation of the effect of evidence application. From March to May 2020, convenience sampling was used to select 52 inpatients with gynecological chemotherapy in the Affiliated Hospital of Qingdao University and 26 clinical nurses as subjects for baseline review. From June to August 2020, 42 inpatients with gynecological chemotherapy and 26 clinical nurses (same as before) were selected for re-review.Results:The management process, nursing routine, nursing path, and risk assessment and follow-up form for CINV were improved, and an evidence-based education video was produced. After application of the evidence, the compliance of nurses' review indicators improved, and the differences were statistically significant ( P<0.05) . The scores of nurses on the non-drug management evidence-based knowledge questionnaire for gynecological CINV increased, and the difference was statistically significant ( P<0.05) . The incidence of acute CINV decreased, and the difference was statistically significant ( P<0.05) . The incidence of delayed CINV decreased, and the difference was not statistically significant ( P> 0.05) . Conclusions:The development of the evidence-based practice project promotes the improvement of related processes, routines, and paths, enriches the forms and content of CINV non-drug antiemetic education, standardized nurses' behavior, improves nurses' compliance with evidence-based practice, and reduces the incidence of acute nausea and vomiting in patients.

A 47-year-old male patient with bipolar disorder was given olanzapine tablets 10 mg orally once daily combined with lithium carbonate sustained-release tablets 0.3 g orally once daily due to manic episode. On the 6th day of medication, the patient received irbesartan and hydrochlorothiazide (containing irbesartan 150 mg and hydrochlorothiazide 12.5 mg in each tablet) 1 tablet orally once daily due to elevated blood pressure. Due to the aggravation of the patient′s manic symptoms, the dose of lithium carbonate was increased to 0.9 g/d from the 11th day of medication. After 13 days of combination therapy, the patient′s body temperature rised (up to 39.0 ℃) and headache and tremor of both hands appeared. Laboratory test showed that his lithium concentration was 1.58 mmol/L (target plasma concentration was 0.80-1.20 mmol/L) and lithium poisoning was diagnosed. Lithium carbonate sustained-release tablets and other oral drugs were stopped immediately and symptomatic and supportive treatments such as rehydration, cooling, and diuresis were given. Meanwhile, vital signs were monitored. On the 2nd day of drug withdrawal, the plasma lithium concentration decreased to 1.14 mmol/L, the body temperature returned to normal, and the tremor of hands was relieved. On the 8th day after drug withdrawal, the plasma lithium concentration decreased to 0.45 mmol/L, and the symptoms and abnormal signs disappeared.

A 47-year-old male patient with bipolar disorder was given olanzapine tablets 10 mg orally once daily combined with lithium carbonate sustained-release tablets 0.3 g orally once daily due to manic episode. On the 6th day of medication, the patient received irbesartan and hydrochlorothiazide (containing irbesartan 150 mg and hydrochlorothiazide 12.5 mg in each tablet) 1 tablet orally once daily due to elevated blood pressure. Due to the aggravation of the patient′s manic symptoms, the dose of lithium carbonate was increased to 0.9 g/d from the 11th day of medication. After 13 days of combination therapy, the patient′s body temperature rised (up to 39.0 ℃) and headache and tremor of both hands appeared. Laboratory test showed that his lithium concentration was 1.58 mmol/L (target plasma concentration was 0.80-1.20 mmol/L) and lithium poisoning was diagnosed. Lithium carbonate sustained-release tablets and other oral drugs were stopped immediately and symptomatic and supportive treatments such as rehydration, cooling, and diuresis were given. Meanwhile, vital signs were monitored. On the 2nd day of drug withdrawal, the plasma lithium concentration decreased to 1.14 mmol/L, the body temperature returned to normal, and the tremor of hands was relieved. On the 8th day after drug withdrawal, the plasma lithium concentration decreased to 0.45 mmol/L, and the symptoms and abnormal signs disappeared.