Objective:To investigate the clinical efficacy of different administration methods for labor analgesia.Methods:This randomized controlled study was conducted on 152 parturient women who underwent vaginal delivery at the Xinxiang Central Hospital from February to June 2023. These women were divided into a control group and an observation group, with 76 women per group. Women in the control group received 3 mL of 0.1% ropivacaine hydrochloride after routine epidural catheterization, followed by 3 mL of analgesic drugs after 3 minutes. For those without any special reactions, an analgesic pump containing 9 mL of medication was used after 3 minutes until the end of labor. In the observation group, 3 mL of 0.1% ropivacaine hydrochloride was administered as a trial dose before the epidural catheter was inserted into the epidural space. After 3 minutes, the postpartum woman lay flat and was given another 3 mL of analgesic pump medication. After 3 additional minutes, an additional 9 mL of the medication was administered. The analgesic pump was connected and turned on until the catheter was removed after delivery. The epidural catheter failure rate was assessed in each group. Before epidural puncture (T 1), within 30 minutes after the onset of anesthesia (T 2), and at the time of full dilation of the cervix (T 3), Visual Analogue Scale scores, the number of patient attempts to additionally use an analgesia pump, maternal satisfaction, the number of cases requiring cesarean section conversion, the incidence of adverse reactions (such as nausea, vomiting, and fever), and Apgar scores for newborns were recorded in each group. Results:The epidural catheter failure rate in the observation group was 1.3% (1/76), which was significantly lower than 10.5% (8/76) in the control group ( χ2 = 5.79, P < 0.05). At T 2 and T 3, the Visual Analogue Scale score in the observation group was (0.89 ± 0.08) points and (2.1 ± 0.07) points, respectively, which were significantly lower than (2.55 ± 0.07) points and (3.35 ± 0.07) points in the control group ( t = 238.54, 133.17, both P < 0.001). The number of patient attempts to additionally use an analgesia pump in the observation group was (1.00 ± 0.84) counts, which was significantly less than (4.00 ± 0.65) counts in the control group ( t = 29.47, P < 0.001). Maternal satisfaction in the observation group was 100% (76/76), which was significantly higher than 92.1% (70/76) in the control group ( χ2 = 6.25, P < 0.05). The number of cases requiring cesarean section conversion in the observation group was 0 (0/76), which was significantly lower than 52.6% (4/76) in the control group ( χ2 = 4.10, P < 0.05). Conclusion:Administering a trial dose (3 mL) of 0.1% ropivacaine hydrochloride before placing the epidural catheter during labor analgesia can greatly increase the placement success rate of the catheter and enhance pain relief effectiveness. This has a certain clinical application value.

Objective:To construct an anticipatory grief intervention scheme for family caregivers of advanced cancer patients based on narrative theory, and to provide reference for anticipatory grief nursing intervention.Methods:From October 2022 to May 2023, through literature research, semi-structured interview and brainstorming method, the first draft of nursing intervention plan was constructed, the Delphi method was used to conduct 2 rounds of correspondence consultation with 15 experts, and the indicators at all levels were modified according to the opinions of experts, and the final draft of intervention plan was formed.Results:The experts were all female, aged (49.67 ± 5.83) years old. The authority coefficient of the two rounds of experts was 0.87. The Kendall coordination coefficients of the first, second, and third level indicators after the first round of expert inquiry were 0.195, 0.113, and 0.093, respectively. The Kendall coordination coefficients of the first, second, and third level indicators after the second round of expert inquiry were 0.200, 0.119, and 0.101, respectively. The differences were statistically significant ( χ2 values were 8.76-107.21, all P<0.05).Finally, a nursing intervention plan based on narrative theory was formed, which included 4 primary indicators, 19 secondary indicators and 72 tertiary indicators. Conclusions:The anticipatory grief intervention scheme for family caregivers of advanced cancer patients is scientific, practical and feasible, and can be used for psychological nursing of family caregivers.

OBJECTIVE To systematically review the efficacy and safety of ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with mild ischemic stroke or transient ischemic attack(TIA). METHODS Databases such as PubMed, Embase, the Cochrane Library, CNKI, and Wanfang were systematically searched, and the search period was from database establishment to June 2022. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of the included studies. Meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 2 studies with 7 087 patients were included. Compared with clopidogrel, ticagrelor reduced the incidence of stroke[RR=0.78, 95%CI(0.66−0.93), I2=0%, P=0.007] and vascular event[RR=0.78, 95%CI(0.66−0.91), I2=0%, P=0.002] in patients with mild ischemic stroke or TIA carrying the CYP2C19 loss-of-function allele. The incidence of any bleeding[HR=2.18, 95%CI(1.66−2.85)] and minor bleeding[HR=2.41, 95%CI (1.81−3.20)] in the ticagrelor-aspirin group was higher than that in the clopidogrel-aspirin group, and dyspnea (1.2% vs 0.2%, P<0.001) and arrhythmias(1.7% vs 0.8%, P=0.001) were more common in the ticagrelor-aspirin group than in the clopidogrel-aspirin group. There was no significant difference in the incidence of severe bleeding between the two groups. CONCLUSION Compared with clopidogrel, ticagrelor reduces the incidence of stroke and vascular events in patients with mild ischemic stroke or TIA carrying the CYP2C19 loss-of-function allele, and did not increase the risk of severe bleeding. However, the ticagrelor group had a higher incidence of minor bleeding, dyspnea and arrhythmias.

Objective To explore the effect of ephedrine on airway remodeling and its regulation effect on transfor-ming growth factor-β1(TGF-β1)/Smads pathway in asthmatic mice.Methods All mice were randomly separated into control group,model group,dexamethasone group,ephedrine low-dose group,ephedrine high-dose group,and ephedrine high-dose+TGF-β1 activator group,with 12 mice in each group.Except for the control group,mice in other groups were intraperitoneally injected with 40 μg ovalbumin(OVA)and 2 mg 10％aluminium hydroxide sensitizer to induce asthma models.After 8 weeks,the airway hyperresponsiveness of mice in each group was detec-ted;eosinophils in bronchoalveolar lavage fluid(BALF)were counted;ELISA was applied to detect the levels of interleukin(IL)-4,IL-5,and IL-13 in BALF;hematoxylin-eosin(HE)staining and Masson staining were applied to observe the pathological changes and collagen fiber area of mouse lung tissue;immunohistochemistry was applied to detect the expression of α-smooth muscle actin(α-SMA)protein in mouse lung tissue;Western blot was applied to detect the expression of TGF-β1/Smads pathway related proteins in mouse lung tissue.Results Compared with the control group,the airway hyperreactivity at different doses of methacholine,total area of airway wall(Wat)/perimeter of the basement membrane(Pbm)ratio,collagen fiber area,eosinophil,the contents of IL-4,IL-5,IL-13,the expression of α-SMA,TGF-β1,the ratios of p-Smad2/Smad2 and p-Smad3/Smad3 in the model group in-creased(P＜0.05),the expression of Smad7 decreased(P＜0.05);compared with the model group,the airway hyperreactivity at different doses of methacholine,Wat/Pbm ratio,collagen fiber area,eosinophil,the contents of IL-4,IL-5,IL-13,the expression of α-SMA,TGF-β1,the ratios of p-Smad2/Smad2 and p-Smad3/Smad3 in the dexamethasone group,the ephedrine low-dose and high-dose groups decreased(P＜0.05),the expression of Smad7 increased(P＜0.05);compared with the ephedrine high-dose group,the airway hyperreactivity at different doses of methacholine,Wat/Pbm ratio,collagen fiber area,eosinophil,the contents of IL-4,IL-5,IL-13,the ex-pression of α-SMA,TGF-β1,the ratios of p-Smad2/Smad2 and p-Smad3/Smad3 in the ephedrine high-dose+TGF-β1 activator group increased(P＜0.05),the expression of Smad7 decreased(P＜0.05).Conclusion E-phedrine can improve airway remodeling in asthmatic mice,and its mechanism is related to the regulation of TGF-β1/Smads signaling pathway.

Objective:To investigate the relationship between serum soluble CD155 (sCD155), soluble CD163 (sCD163) and chemotherapy efficacy and prognosis in patients with diffuse large B-cell lymphoma (DLBCL).Methods:A total of 126 patients with DLBCL admitted to Handan Central Hospital from May 2018 to May 2020 (DLBCL group) and 126 healthy subjects (control group) were prospectively selected to compare serum sCD155 and sCD163 levels. According to the chemotherapy effect of DLBCL patients, they were divided into effective group and ineffective group, and the serum sCD155 and sCD163 levels were compared before and after treatment. The effective rate of chemotherapy in patients with different serum sCD155 and sCD163 levels was compared. Kaplan-Meier method was used to analyze the relationship between serum sCD155 and sCD163 levels and 3-year overall survival (OS) and progression-free survival (PFS) of DLBCL patients. Cox proportional risk regression model was used to analyze the prognostic factors of DLBCL patients.Results:The serum levels of sCD155 and sCD163 in DLBCL group were higher than those in control group before treatment (all P<0.05). The effective rate of chemotherapy in 126 DLBCL patients in this group was 69.8%(88/126). Compared with the effective group, the serum levels of sCD155 and sCD163 were higher in the ineffective group before and after treatment (all P<0.05). Compared with before treatment, serum sCD155 and sCD163 levels in the effective group were decreased after treatment (all P<0.05). The effective rate of DLBCL patients in sCD155 and sCD163 high level groups was lower than that in sCD155 and sCD163 low level groups (all P<0.05). Kaplan-Meier analysis showed that the 3-year OS and PFS of DLBCL patients in the low level group of sCD155 and sCD163 were higher than those in the high level group (all P<0.05). The high level of sCD155 and sCD163 were independent risk factors for 3-year PFS and OS in DLBCL patients (all P<0.05). Conclusions:Abnormal levels of serum sCD155 and sCD163 in DLBCL patients may reduce the efficacy of chemotherapy and lead to poor prognosis.

OBJECTIVE To investigate the mechanisms by which Pinggan Yishen Decoction(PGYSD)contributes to alleviating target organ damage in spontaneously hypertensive rats.METHODS The chemical components of PGYSD were determined by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS)and were analyzed by target a-nalysis and functional enrichment combined with network pharmacology methods to predict the potential mechanism of PGYSD in trea-ting hypertension and its target organ damage.Spontaneously hypertensive rats were randomly divided into the model group,low-dose PGYSD group(2 g·kg-1),high-dose PGYSD group(5 g·kg-1),and valsartan group(7.2 mg·kg-1),with 6 rats in each group.Wistar-Kyoto rats were used as the control group,and the control group and the model group were gavaged with normal saline for 8 consecutive weeks.HE and Masson staining were used to observe the pathological damage and fibrosis degree of rat heart and tho-racic aorta.Immunohistochemical staining and Western blot were used to detect the expression level of EGFR in the heart,liver and kidney of rats.Immunofluorescence staining was used to detect the co-localization of EGFR and EEA1 in the heart,liver and kidney of rats.RESULTS Twenty-six components of PGYSD were detected by UPLC-Q-TOF/MS.Network pharmacology revealed that EG-FR,PIK3R1 and EP300 may be key therapeutic targets of action of PGYSD for the treatment of hypertension and its target organ dam-age,and that the treatment of hypertension and its target organ damage by PGYSD may be closely related to EGFR tyrosine kinase in-hibitor resistance,lipids and atherosclerosis and HIF-1 signaling pathway.The high-dose group of PGYSD significantly reduced sys-tolic blood pressure and mean blood pressure in rats(P<0.05,P<0.01),attenuated pathological damage and fibrosis in the heart and thoracic aorta(P<0.01,P<0.001),significantly reduced the expression level of EGFR in the liver and kidney of rats(P<0.01),and treated fibrosis in liver and kidney,reduced the co-localization of EGFR and EEA1 in the kidney of rats(P<0.001),attenuated fibro-sis in kidney.CONCLUSION The paper integrates UPLC-Q-TOF/MS,network pharmacology and spontaneously hypertensive rat model and preliminarily explores the effect mechanism of PGYSD in the treatment of hypertension and its target organ damage,provi-ding a scientific basis for further mechanism research and clinical application of PGYSD in the treatment of hypertension.

Objective:To observe any effect of family rehabilitation interventions based on digital health management on elderly type 2 diabetes mellitus (T2DM) patients with sarcopenia.Methods:One hundred elderly T2DM patients with sarcopenia who had been discharged from hospital after treatment were divided into an observation group and a control group, each of 50. Both groups continued the diet control and training begun during their hospitalization, but the observation group was additionally provided with family rehabilitation based on digital health management. Before and after 3 months, the glucose and lipid metabolism and sarcopenia of both groups were evaluated with related symptom indexes, and their levels of diabetes self-management were compared.Results:Significant improvement was observed in both groups, but the average glucose and lipid metabolism indexes and sarcopenia-related symptom indexes of the observation group were significantly better than the control group′s averages. Their diabetes self-management was also significantly superior.Conclusion:Family rehabilitation based on digital health management can significantly improve glucose and lipid metabolism and muscle mass in elderly T2DM patients with sarcopenia. Such intervention is worthy of promotion and application in clinical practice.

Objective To investigate the effect and mechanism of Zhike Pingchuan Formula on reducing airway inflammation in mice with bronchial asthma(BA).Methods A total of 84 BALB/c mice were randomly separated into the control group,the BA group,the low-dose Zhike Pingchuan Formula group,the high-dose Zhike Pingchuan Formula group,the dexamethasone group,the lipopolysaccharide(LPS)group and the high-dose Zhike Pingchuan Formula+LPS group,with 12 mice in each group.The BA model was constructed in all groups of mice except the control group.After successful modeling,mice were treated with drug administration once a day for 3 weeks.Serum immunoglobulin E(IgE)concentration and levels of interleukin-17(IL-17)and tumor necrosis factor-α(TNF-α)in alveolar lavage fluid were detected by enzyme linked immunosorbent assay(ELISA).Pathological changes in lung tissue was detected by HE staining.The bronchial epithelium goblet cell proliferation and mucus secretion were determined by PAS staining.Flow cytometry was used to detect levels of T helper cell 17(Th17)and regulatory T(Treg)cell in mouse spleen tissue.Western blot assay was used to detect toll-like receptor 4(TLR4)/tumor necrosis factor receptor-associated factor 6(TRAF6)/nuclear factor kappa-B(NF-κB)pathway-related protein expression in lung tissue.Results Compared with the control group,damage of lung tissue was serious,the proliferation of bronchial epithelial goblet cells and the secretion of mucus increased,IgE concentration,TNF-α,IL-17 levels,Th17 cell proportion,Th17/Treg ratio,and TLR4,TRAF6,p-NF-κB p65 protein expression increased,while Treg cell proportion decreased in the BA group(P＜0.05).Compared with the BA group,the bronchial epithelial cupular cell proliferation and mucus secretion were reduced in the low-dose Zhike Pingchuan Formula group,the high-dose Zhike Pingchuan Formula group and the dexamethasone group,the lung tissue damage was improved,the concentration of IgE,levels of TNF-α,IL-17,the proportion of Th17 cells,the ratio of Th17/Treg and expression of protein levels of TLR4,TRAF6 and p-NF-κB p65 were reduced,and the proportion of Treg cell was elevated(P＜0.05).The trend of corresponding indexes in the LPS group was opposite to the above(P＜0.05).Compared with the high-dose Zhike Pingchuan Formula group,the pathological damage of lung tissue increased in the high-dose Zhike Pingchuan Formula+LPS group.The proliferation of bronchial epithelial goblet cells and the secretion of mucus increased,the IgE concentration,TNF-α,IL-17 levels,Th17 cell proportion,Th17/Treg ratio and TLR4,TRAF6,p-NF-κB p65 protein expression increased,while the Treg cell proportion decreased(P＜0.05).Conclusion Zhike Pingchuan Formula may reduce airway inflammation in BA mice by inhibiting TLR4/TRAF6/NF-κB pathway.

Objective:To investigate the clinical characteristics of patients with acquired aplastic anemia (AA) accompanied by abnormal antinuclear antibody (ANA) and autoantibodies and their effects on the efficacy of immunosuppressive therapy (IST).Method:A retrospective case-control study was conducted, analyzing the clinical data of 291 patients with AA who underwent IST and were screened for autoantibodies at initial diagnosis between January 2018 and December 2019 at Blood Diseases Hospital, Chinese Academy of Medical Sciences. According to the titer of ANA at the initial diagnosis, extracted nuclear antigen antibodies (ENAs) abnormality and the change of ANA titer after treatment, the treatment responses of 3 months and 6 months after IST were compared. The correlation between clinical features and ANA abnormality was analyzed by univariate and multivariate logistic regression analysis. The parameters of univariate analysis P<0.1 were included in multivariate analysis, stepwise regression analysis and subgroup analysis. Results:A total of 291 patients were included in the study, of which 145 (49.83%) were male. Among all patients, 147 (50.52%) tested positive for ANA at initial diagnosis, with titers of 1∶100, 1∶320, and 1∶1 000 observed in 94, 47, and 6 cases, respectively. Female gender, older age, presence of paroxysmal nocturnal hemoglobinuria (PNH) clone, and higher levels of IgG, IgA, and thyroid hormone were significantly associated with ANA positivity at initial diagnosis, while white cell counts, reticulocytes, and free triiodothyronine were significantly lower than that of ANA-negatively patients (all P<0.05). Furthermore, logistic regression analyses revealed that female gender ( OR=1.980, 95% CI 1.206-3.277), older age ( OR=1.017, 95% CI 1.003-1.032), and presence of PNH clone ( OR=1.875, 95% CI 1.049-3.408) were independent risk factors for ANA positivity at initial diagnosis. Subgroup analysis indicated that the risk of ANA positivity at initial diagnosis was even higher in PNH clone-positive patients in the subgroups of females ( OR=1.24, 95% CI 1.02-1.51), severe AA ( OR=1.26, 95% CI 1.07-1.47), and age≥40 years ( OR=1.26, 95% CI 1.05-1.52) (all P<0.05). However, ANA titers at initial diagnosis, presence of other abnormal ENAs, and changes in ANA titers after treatment with IST were not correlated with treatment response (all P>0.05). Conclusions:Approximately 50% of patients with AA had abnormal ANA, and their presence was significantly associated with female gender, older age, and presence of PNH clone at initial diagnosis. However, the presence of abnormal ANA and changes in ANA titers after treatment did not affect the efficacy of IST in patients with AA.

Objective:To analyze the vaginal microecological status of vaginitis population and non-vaginitis population of gynecological female outpatients.Methods:A total of 30 265 women who visited the gynecological outpatient clinic of Beijing Obstetrics and Gynecology Hospital from December 2018 to December 2020 completed vaginal microecological examination. After removing the follow-up patients, 23 181 women were divided into group with symptoms and signs of vaginitis (6 697 cases) and group without symptoms and signs of vaginitis (16 484 cases), according to whether the women with symptoms and signs of vaginitis or not. And the vaginal microecological status of the two groups was compared and analyzed.Results:(1) The total detection rate of vaginitis in the initial women was 34.87% (8 083/23 181), of which 46.10% (3 087/6 697) in group with symptoms and signs of vaginitis and 30.31% (4 996/16 484) in group without symptoms and signs of vaginitis, nearly 1/3 of the gynecological outpatients without signs and symptoms of vaginitis had vaginitis. (2) Among the types of simple vaginitis, vulvovaginal candidiasis (VVC) was the most frequent in group with symptoms and signs of vaginitis (16.01%, 1 072/6 697), followed by aerobic vaginitis (AV; 12.83%, 859/6 697), with significant differences compared with group without symptoms and signs of vaginitis (all P<0.001). There were no statistical differences between the two groups of bacterial vaginosis (BV) and trichomonal vaginitis (TV), indicating that BV and TV were more likely to be neglected (all P>0.05). (3) The proportion of various combinations of vaginitis among 2 632 cases of mixed vaginitis were, in descending order: BV+AV, VVC+AV, BV+AV+VVC, AV+TV, AV+TV+BV, BV+VVC. (4) Microecological analysis of 15 098 cases diagnosed with non-vaginitis had normal flora (including those with normal flora and those with normal flora but decreased function) in 14 013 cases (92.81%, 14 013/15 098), abnormal flora in 429 cases (2.84%, 429/15 098) and the BV intermediate in 656 cases (4.34%, 656/15 098); this indicated that the vast majority of the microecological tests were normal in the vaginal microbiota of those without vaginitis. Conclusions:Microecological examination could diagnose multiple pathogenic infections at once, and is especially important as a guide for the definitive diagnosis of mixed vaginitis and vaginitis with atypical clinical symptoms. Vaginal infections such as BV and TV that are easily overlooked should be concerned.