OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

Objective To compare clinical efficacy of different regimens in treatment of pruritus in maintenance hemodialysis(MHD)patients.Methods A total of 50 patients with MHD admitted to the Sixth People's Hospital of Jiujiang City from August 1,2022 to April 30,2024 as subjects and were divided into two groups according to random number table method.Control group(n=25)was treated with sodium thiosulfate.On this basis,gabapentin combination therapy was added in observation group(n=25).Effects of two groups were compared after 8 weeks of treatment.Results Total clinical effective rate of observation group was significantly higher than that of control group(P＜0.05).After 8 weeks of treatment,scores and total scores of all dimensions of quality of life in two groups were higher than before treatment,and observation group was higher than control group(P＜0.05).Conclusion Sodium thiosulfate combined with gabapentin in treatment of MHD patients with pruritus can not only relieve pruritus symptoms,improve sleep quality,but also have good safety.

Objective To compare clinical efficacy of different regimens in treatment of pruritus in maintenance hemodialysis(MHD)patients.Methods A total of 50 patients with MHD admitted to the Sixth People's Hospital of Jiujiang City from August 1,2022 to April 30,2024 as subjects and were divided into two groups according to random number table method.Control group(n=25)was treated with sodium thiosulfate.On this basis,gabapentin combination therapy was added in observation group(n=25).Effects of two groups were compared after 8 weeks of treatment.Results Total clinical effective rate of observation group was significantly higher than that of control group(P＜0.05).After 8 weeks of treatment,scores and total scores of all dimensions of quality of life in two groups were higher than before treatment,and observation group was higher than control group(P＜0.05).Conclusion Sodium thiosulfate combined with gabapentin in treatment of MHD patients with pruritus can not only relieve pruritus symptoms,improve sleep quality,but also have good safety.

OBJECTIVE To investigate the effects of medicated serum of Siwutang on autophagy of ovarian granulosa cells(KGN cells)in polycystic ovarian syndrome(PCOS)and its underlying mechanism.METHODS Blank serum and different-concentration medicated serum of Siwutang were prepared by intragastric administration of normal saline and different doses of Siwutang[0.52,1.04,2.08 g/(kg·d)]in 3-month-old female SD rats.After screening the intervention concentration of Siwutang medicated serum,KGN cells were divided into control group(without any treatment),dehydroepiandrosterone(DHEA)group(treated with 50 μmol/L DHEA for 48 h),blank serum group(treated with 50 μmol/L DHEA for 48 h and with 10％blank serum for 72 h)and medium-concentration of Siwutang medicated serum group(treated with 50 μmol/L DHEA for 48 h and with 10％medium-concentration Siwutang medicated serum for 72 h).The number of autophagosomes was observed in each group,and protein expressions of pathway-related proteins[fructose-1,6-bisphosphatase 1(FBP1),mammalian target of rapamycin(mTOR),phosphorylated mTOR(p-mTOR)],autophagy-related proteins[p62,microtubule-associated protein 1 light chain 3(LC3)]and mRNA expression of FBP1 were also detected.The(transfected)cells were further divided into Siwutang group(treated with 10％medium dose of Siwutang medicated serum for 72 h after 48 h intervention with 50 μmol/L DHEA),Siwutang+si-NC group[negative control small interfering RNA(siRNA)transfected cells treated with 50 μmol/L DHEA for 48 h,and then with 10％medium-concentration of Siwutang medicated serum for 72 h]and Siwutang+si-FBP1 group(FBP1 siRNA transfected cells treated with 50 μmol/L DHEA for 48 h,and then with 10％medium-concentration Siwutang medicated serum for 72 h).The effects of knocking down FBP1 on the above-mentioned effects of Siwutang were detected.RESULTS Compared with control group,DHEA group exhibited an increase in the number of autophagosomes,an elevated LC3-Ⅱ/LC3-Ⅰ and p-mTOR/mTOR,as well as increases in protein and mRNA expressions of FBP1,and decreased protein expression of p62(P＜0.05).Compared to both DHEA group and blank serum group,the medium-concentration of Siwutang medicated serum group showed a decrease in the number of autophagosomes,a decrease in LC3-Ⅱ/LC3-Ⅰ,and increases in p-mTOR/mTOR,protein expression of p62,protein and mRNA expressions of FBP1(P＜0.05).After knocking down FBP1,compared with Siwutang+si-NC group,Siwutang+si-FBP1 group showed a significant decrease in cell viability,protein expression of p62,protein and mRNA expressions of FBP1 as well as p-mTOR/mTOR,and an increase in LC3-Ⅱ/LC3-Ⅰ(P＜0.05).CONCLUSIONS Siwutang can promote the phosphorylation of mTOR protein by up-regulating the protein and mRNA expressions of FBP1 in KGN cells,thus inhibiting autophagy of KGN cells.

Objective:To construct and validate a nomogram model for predicting the risk of 28-day mortality in sepsis patients.Methods:A retrospective cohort study was conducted. 281 sepsis patients admitted to the department of intensive care unit (ICU) of the 940th Hospital of the Joint Logistics Support Force of PLA from January 2017 to December 2022 were selected as the research subjects. The patients were divided into a training set (197 cases) and a validation set (84 cases) according to a 7∶3 ratio. The general information, clinical treatment measures and laboratory examination results within 24 hours after admission to ICU were collected. Patients were divided into survival group and death group based on 28-day outcomes. The differences in various data were compared between the two groups. The optimal predictive variables were selected using Lasso regression, and univariate and multivariate Logistic regression analyses were performed to identify factors influencing the mortality of sepsis patients and to establish a nomogram model. Receiver operator characteristic curve (ROC curve), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the nomogram model.Results:Out of 281 cases of sepsis, 82 cases died with a mortality of 29.18%. The number of patients who died in the training and validation sets was 54 and 28, with a mortality of 27.41% and 33.33% respectively. Lasso regression, univariate and multivariate Logistic regression analysis screened for 5 independent predictors associated with 28-day mortality. There were use of vasoactive drugs [odds ratio ( OR) = 5.924, 95% confidence interval (95% CI) was 1.244-44.571, P = 0.043], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ: OR = 1.051, 95% CI was 1.000-1.107, P = 0.050), combined with multiple organ dysfunction syndrome (MODS: OR = 17.298, 95% CI was 5.517-76.985, P < 0.001), neutrophil count (NEU: OR = 0.934, 95% CI was 0.879-0.988, P = 0.022) and oxygenation index (PaO 2/FiO 2: OR = 0.994, 95% CI was 0.988-0.998, P = 0.017). A nomogram model was constructed using the independent predictive factors mentioned above, ROC curve analysis showed that the AUC of the nomogram model was 0.899 (95% CI was 0.856-0.943) and 0.909 (95% CI was 0.845-0.972) for the training and validation sets respectively. The C-index was 0.900 and 0.920 for the training and validation sets respectively, with good discrimination. The Hosmer-Lemeshoe tests both showed P > 0.05, indicating good calibration. Both DCA and CIC plots demonstrate the model's good clinical utility. Conclusions:The use of vasoactive, APACHEⅡ score, comorbid MODS, NEU and PaO 2/FiO 2 are independent risk factors for 28-day mortality in patients with sepsis. The nomogram model based on these 5 indicators has a good predictive ability for the occurrence of mortality in sepsis patients.

Helicobacter pylori (H. pylori) neutrophil-activating protein (HP-NAP) is one of the newly discovered main virulence factors of H. pylori, and is expressed in almost all strains of H. pylori. After being activated, HP-NAP can participate in the development of inflammation and tissue damage by stimulating neutrophils, monocytes, dendritic cells, mast cells and lymphocytes. This paper reviewed the latest research progress of HP-NAP in the prevention and treatment of related diseases.

OBJECTIVE: To analyze the 28-day survival status and influencing factors of adult patients with sepsis, providing reference for early diagnosis of sepsis prognosis and reducing sepsis mortality. METHODS: A retrospective cohort study was conducted. A total of 160 adult patients with sepsis in the department of intensive care unit of the 940th Hospital of Joint Logistic Support Force of PLA from January 2021 to December 2022 were enrolled. The general information, laboratory examination results within 24 hours after admission, clinical treatment measures, and prognosis of patients were collected. Univariate analysis and binary multivariate Logistic regression were performed to screen the risk factors that might affect the short-term prognosis of patients with sepsis. Receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of various risk factors on the short-term death risk of sepsis patients. RESULTS: A total of 160 patients with sepsis were enrolled, of whom 91 survived in 28 days, and 69 died with a mortality of 43.12%. Compared with the survival group, the patients in the death group were older, more severe, had higher blood lactic acid (Lac) level, and had more complications such as hypertension and multiple organ dysfunction syndrome (MODS). A total of 22 related factors were statistically significant: age, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, length of hospital stay, Lac, interleukin-6 (IL-6), fibrinogen (FIB), international normalized ratio (INR), ratio of prothrombin time (PT) to healthy people, prothrombin activity (PTA), PT, thrombin time (TT), oxygenation index (PaO₂/FiO₂), aspartate aminotransferase (AST), ratio of AST to alanine amninotransferase (ALT), serum creatinine (SCr), blood urea nitrogen (BUN), site of infection, history of hypertension, concurrent MODS, implementation of continuous renal replacement therapy (CRRT), and treatment with vasoactive drugs. Combined with the results of the univariate analysis, variables that might affect the short-term prognosis of septic patients were included in the multivariate Logistic regression analysis. The results showed that APACHE II score ≥ 20 [odds ratio (OR) = 1.106, 95% confidence interval (95%CI) was 1.003-1.219], Lac ≥ 5 mmol/L (OR = 1.430, 95%CI was 1.041-1.964), combined with hypertension (OR = 13.879, 95%CI was 1.082-178.016), concurrent MODS (OR = 98.139, 95%CI was 18.252-527.672) was an independent risk factor for 28-day death in adult septic patients (all P < 0.05). ROC curve analysis showed that the combination of the four indicators including APACHE II score, Lac, combined with hypertension, concurrent MODS, had predictive value for short-term outcomes in patients with sepsis. The area under the ROC curve (AUC) was higher than that of the 4 indicators alone [AUC (95%CI): 0.952 (0.918-0.986) vs. 0.745 (0.670-0.820), 0.816 (0.748-0.883), 0.608 (0.518-0.699), 0.868 (0.810-0.927)], the sensitivity was 94.2%, and the specificity was 90.1%. CONCLUSIONS APACHE II score within 24 hours, Lac, combined with hypertension, and concurrent MODS are independent risk factors for short-term mortality in adult septic patients in ICU. The combination of these indicators can make meaningful early clinical judgments on the short-term prognosis of septic patients, thereby reducing the mortality.
Adult ; Humans ; Retrospective Studies ; ROC Curve ; Sepsis/diagnosis* ; Prognosis ; Intensive Care Units ; Risk Factors ; Hypertension

Programmed death-1 and programmed death-ligand 1(PD-1/PD-L1)are regulatory immune checkpoint molecules that inhibit T cell activation and,therefore,play an important role in tumor immunotherapy.In recent years,increasing numbers of targeted therapeutic agents have been developed,but single immune checkpoint blockers cannot completely inhibit tumor occurrence,and tumor escape sporadically occurs.Consequently,combination therapy of targeted drugs is considered a useful method to inhibit tumorigenesis and tumor development.T cell immunoglobulin and immunoreceptor tyrosine-based inhibition motif(ITIM)domain(TIGIT)is an inhibitory type 1 poliovirus receptor that has recently been a hotspot of targeted drug therapy research.It has been shown that the combination therapy of TIGIT plus PD-1/PD-L1 can reduce tumor escape and inhibit tumorigenesis more effectively.Therefore,this review summarizes and discusses the progress on the dual blockade of TIGIT and PD-1/PD-L1 pathways in tumor immunotherapy to provide a theoretical basis for tumor im-munotherapy.

Objective : To investigate the effects of luteolin on invasion and migration of endometriosis stromal cells and whether its mechanism is related to the regulation of 15-hydroxyprostaglandin dehydrogenase (HPGD) expres- sion． Methods : The endometrial stromal cells HEM15A were divided into control group (cells were cultured in nor- mal medium) ，luteolin group ( cells were treated with different concentrations of luteolin) ，si-HPGD group ( cells were transfected with si-HPGD) ，si-NC group ( cells were transfected with si-NC ) ，luteolin + si-HPGD Group (cells were transfected with si-HPGD and treated with 20 μmol / L luteolin) ，Luteolin + si-NC Group ( cells were transfected with si-NC and treated with 20 μmol / L luteolin) . Real-time quantitative PCR was used to detect mRNA level of HPGD．Cell proliferation was detected by CCK-8 assay，Transwell and scratch assays were used to detect cell invasion and migration．The protein expression of proliferating cell nuclear antigen (PCNA) ，matrix metallopro- teinase (MMP-2) ，MMP-9 and HPGD were detected by Western blot，and the level of prostaglandin E2 ( PGE2) was detected by ELISA. Results : Compared with 0 μmol / L luteolin，luteolin at 20，50 and 100 μmol / L significantly inhibited the proliferation activity of hEM15A cells，and reduced PCNA expression ( all P＜0. 05) ．Compared with the control group，20 μmol / L of luteolin significantly inhibited cell invasion and migration (P ＜0. 05) ，decreased the expressions of MMP-2 and MMP-9 (P＜0. 05) ，and up-regulated the mRNA and protein levels of HPGD (P < 0. 05) ，while inhibited cellular PGE2 level (P＜0. 05) ．Compared with the luteolin group，the luteolin + si-HPGD group increased cell invasion and migration (P ＜0. 05 ) ，increased the expressions of MMP-2 and MMP-9 (P < 0. 05) ． Conclusion Luteolin regulates HPGD / PGE2 signaling pathway to inhibit the invasion and migration of en- dometrial stromal cells.

Objective:To explore the clinical effect of Intensive Care Unit (ICU) catheter whole life cycle management system.Methods:An ICU catheter whole life cycle management system was constructed and applied in clinical practice. This study collected data on catheter management and hospital infection of patients in ICU of Zhejiang Hospital before the application of the catheter whole life cycle management system from April to December 2019 and after the application of the catheter whole life cycle management system from April to December 2020. The accuracy of catheter recording, the compliance rate of daily catheter nursing quality, and the incidence of major catheter-associated infections were compared before and after the application of the ICU catheter whole life cycle management system. The time-consuming of catheter information recording under the two methods of applying the ICU catheter whole life cycle management system and computer manual input was analyzed, and the nurses' experience of using the ICU catheter whole life cycle management system was investigated through semi-structured interviews.Results:After the application of the ICU catheter whole life cycle management system, the accuracy rate of catheter recording increased from 89.96% (22 491/25 001) to 96.09% (30 897/32 155) , and the difference was statistically significant ( P<0.05) . The compliance rate of daily catheter nursing quality increased from 89.81% (22 453/25 001) to 95.94% (30 849/32 155) , and the difference was statistically significant ( P<0.05) . There was no significant difference in the incidence of major catheter-associated infections before and after system application ( P>0.05) . In addition, the time-consuming of catheter recording by nurses using the ICU catheter whole life cycle management system was less than that of manual input by computer, and the difference was statistically significant [ (0.98±0.28) min vs. (1.78±0.50) min, P<0.05] . The semi-structured interview results showed that nurses had a good experience in using the ICU catheter whole life cycle management system. Conclusions:The ICU catheter whole life cycle management system provides nurses with a systematic, convenient and standardized catheter management method. The system has a good user experience, can improve the accuracy of nurse catheter recording and the catheter nursing quality, and shorten catheter recording time. However, further studies are needed to confirm whether it helps to reduce the incidence of major catheter-associated infections.