Multiple sclerosis (MS) is a neuroinflammatory demyelinating disease, mediated by pathogenic T helper 17 (Th17) cells. However, the therapeutic effect is accompanied by the fluctuation of the proportion and function of Th17 cells, which prompted us to find the key regulator of Th17 differentiation in MS. Here, we demonstrated that the triggering receptor expressed on myeloid cells 2 (TREM-2), a modulator of pattern recognition receptors on innate immune cells, was highly expressed on pathogenic CD4-positive T lymphocyte (CD4⁺ T) cells in both patients with MS and experimental autoimmune encephalomyelitis (EAE) mouse models. Conditional knockout of Trem-2 in CD4⁺ T cells significantly alleviated the disease activity and reduced Th17 cell infiltration, activation, differentiation, and inflammatory cytokine production and secretion in EAE mice. Furthermore, with Trem-2 knockout in vivo experiments and in vitro inhibitor assays, the TREM-2/zeta-chain associated protein kinase 70 (ZAP70)/signal transducer and activator of transcription 3 (STAT3) signal axis was essential for Th17 activation and differentiation in EAE progression. In conclusion, TREM-2 is a key regulator of pathogenic Th17 in EAE mice, and this sheds new light on the potential of this therapeutic target for MS.
Animals ; Humans ; Mice ; CD4-Positive T-Lymphocytes/pathology* ; Cell Differentiation ; Encephalomyelitis, Autoimmune, Experimental/metabolism* ; Mice, Inbred C57BL ; Multiple Sclerosis ; Th1 Cells/pathology*

Hemorrhagic shock (HS) is one of the leading causes of death among young adults worldwide. Multiple organ dysfunction in HS is caused by an imbalance between tissue oxygen supply and demand, which is closely related to the poor prognosis of patient. Mitochondrial dysfunction is one of the key mechanisms contributing to multiple organ dysfunction in HS, while mitochondrial quality control regulates mitochondrial function through a series of processes, including mitochondrial biogenesis, mitochondrial dynamics, mitophagy, mitochondrial-derived vesicles, and mitochondrial protein homeostasis. Modulating mitochondrial quality control can improve organ dysfunction. This review aims to summarize the effects of mitochondrial dysfunction on organ function in HS and discuss the potential mechanisms of mitochondrial quality control, providing insights into the injury mechanisms underlying HS and guiding clinical management.

The World Health Organization (WHO) classification serves as the internationally recognized standard for diagnosing and classifying hematopoietic and lymphoid tissue tumors(WHO-HEAM). Since 2001, it has undergone multiple upgrades and revisions, updating, clarifying, and refining previous tumor diagnostic and classification standards while incorporating numerous new genetic and molecular biological subtypes. In 2022, two classification proposals emerged due to a wealth of clinical and scientific research results: the fifth edition of the WHO hematopoietic and lymphoid tissue classification (WHO-HAEM5), published in Leukemia journal; and the International Consensus Classification (ICC), published in Blood journal. These two schemes differ in their approach to classifying hematopoietic and lymphoid tissue tumors, posing challenges for clinical laboratory diagnosis and treatment.

Objective To explore the medication regularity of prescriptions in Universal Relief:Cough Medicine in that to provide worthy reference for clinical treatment of cough.Methods The prescriptions in Universal Relief:Cough Medicine was collected and then established the database using Excel 2016 softwore,and carried out medication frequency analysis.SPSS Modeler 18.0 and Lantern 5.0 were used to perform association rules analysis and latent structure model analysis to explore medication rules of prescriptions in Universal Relief:Cough Medicine.Results 607 prescriptions were collected,involving 335 traditional Chinese medicines.A total of medication frequency is 3941,The most frequently used TCMs were ganca(glycyrrhizae radixet rhizoma)and shengjiang(zinglberis rhizoma recens)and kuxingren(armeniaeae semen amarum).The main efficacy of the medicine is to dissipate phlegm,relieve cough,relieve asthma,and replenish deficiency,and warm in nature,spicy,bitter,and sweet in taste and lung and spleen in meridian.14 strongly correlated material rules were sorted out by association rule analysis such as banxia(pinelliae rhizoma)+gancao(glycyrrhizae radixet rhizoma)→shengjiang(zinglberis rhizoma recens)、banxia(pinelliae rhizoma)→shengjiang(zinglberis rhizoma recens)and mahuang(ephedrae herba)+gancao(glycyrrhizae radixet rhizoma)→kuxingren(armeniaeae semen amarum).12 variables were obtained by latent structure model analysis,and according to professional knowledge inference,3 integrated cluster models and 1 single cluster and 4 core prescriptions were obtained.It was inferred that the common syndromes of Universal Relief:Cough Medicine were cold drink stoping in the lung,qi deficiency external phlegm dampness inside,phlegm heat blocking lung,and lung deficiency prolonged cough.Conclusion The medication rules of prescriptions in Universal Relief:Cough Medicine is mainly benefiting qi and resolving phlegm,cure both the symptoms and the disease,and in different situations combine with different treatment methods,such as warming the lung and resolving phlegm,clearing heat and resolving phlegm,tonifying qi and resolving external symptoms,and astringent lung qi.

Hemorrhagic shock, a life-threatening organ hypoperfusion caused by rapid, massive blood loss, is the leading cause of traumatic death in peacetime and wartime. The vascular endothelial glycocalyx (vEG) plays an important role in maintaining microcirculatory homeostasis. Severe ischemia and hypoxia of hemorrhagic shock can damage the vEG, leading to endothelial dysfunction and exacerbated microcirculatory and organ impairments. Therefore, early prevention and treatment of vEG damage in hemorrhagic shock can improve microcirculation dysfunction, which is of paramount importance for therapeutic efficacies and outcomes. There have been many studies on the prevention and treatment of vEG damage in hemorrhagic shock, but none is based on the management of vEG damage. The authors reviewed the progress on the mechanism and preventive and therapeutic strategies of vEG damage caused by hemorrhagic shock, hoping to provide reference for the further research of hemorrhagic shock-induced vEG damage.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

OBJECTIVE: To evaluate and summarize the relevant evidence of anticoagulation and bleeding risk management in patients with extracorporeal membrane oxygenation (ECMO), and provide the evidence-based basis for the management of anticoagulation and bleeding during ECMO treatment. METHODS: According to the evidence "6S" pyramid model, all evidence on ECMO anticoagulation management and bleeding risk was searched in relevant databases, organizations and guideline websites at home and abroad. Evidence types included guidelines, expert consensus, systematic evaluation, Meta-analysis and original study. The search time limit was from May 31, 2012 to May 31, 2022. Two researchers with evidence-based research background conducted independent literature quality evaluation of the retrieved evidence, and the evidence that met the quality standards was extracted and summarized based on the opinions of industry experts. RESULTS: A total of 315 articles were retrieved, and 13 articles were included, including 3 guidelines, 6 expert consensus, and 4 Meta-analysis. A total of 27 best evidences were summarized from 7 aspects, including the selection of ECMO anticoagulation, anticoagulation in priming, anticoagulation in operation, anticoagulation monitoring, bleeding and treatment, thrombosis and treatment, and prevention and management of terminal limb ischemia. CONCLUSIONS This study provides evidence-based basis for bleeding prevention and anticoagulant management in ECMO patients. It is recommended to selectively apply the best evidence after evaluating the clinical environmental conditions of medical institutions, so as to improve the prognosis of ECMO patients.
Humans ; Extracorporeal Membrane Oxygenation/adverse effects* ; Blood Coagulation ; Hemorrhage/etiology* ; Anticoagulants/adverse effects* ; Thrombosis/prevention & control* ; Retrospective Studies

Objective:To apply the best evidence of phaseⅠ cardiac rehabilitation after coronary artery bypass grafting (CABG) into clinical practice and evaluate its effects.Methods:Following the Australian Jonna Briggs Institute (JBI) clinical evidence program and evidence transformational practice application system, the evidence of phaseⅠ cardiac rehabilitation exercise after CABG was retrieved, screened and evaluated, and the review indicators were formulated. From September 2019 to February 2020, 41 nurses and 109 CABG patients from the Cardiovascular Surgery Ward of the Affiliated Hospital of Qingdao University were selected. The data of 56 patients were collected before the application of the best evidence, and those of 53 patients were collected after the application of the best evidence. The implementation rate of the review indicators, the degree of knowledge of the best evidence among nurses and patients, the Six Minute Walk Test (6MWT) distance and the left ventricular ejection fraction (LVEF) before and after the application of the best evidence were compared.Results:After the application of the evidence, the nurses' implementation rate of the 13 review indicators of phaseⅠ cardiac rehabilitation exercises was improved, and the difference was statistically significant ( P<0.05) ; the nurses' exercise knowledge score increased from (53.66±14.01) points to (71.59±14.93) points; the patients' exercise knowledge score increased from (26.22±17.46) points to (60.49±15.52) points, and the differences were statistically significant ( t=-5.61, -9.40; P<0.01) . After the application of the evidence, the patients' 6MWT distance increased from (241.82±72.05) m to (246.25±69.26) m, and the difference was statistically significant ( t=-2.238, P<0.05) ; however, there was no statistically significant difference in LVEF before and after the application of the evidence ( P>0.05) . Conclusions:The clinical application of the best evidence for phase I cardiac rehabilitation exercises in CABG patients can standardize nurses' behaviors, improve nurses and patients' knowledge of evidence, and increase the 6MWT distance of CABG patients.

OBJECTIVE： To observe neuroprotective effects of low-molecular-weight chondroitin sulfate （CS） on dopaminergic neurons in Parkinson’s disease （PD） mice model induced by 1-methyl-4-phenyl-1，2，3，6-tetrahydropyridine （MPTP）. METHODS： C57BL/6 mice were randomly divided into control group， MPTP injury group， low-molecular-weight CS low-dose and high-dose groups （100， 400 mg/kg）. Control group and MPTP injury group were given constant volume of normal saline intragstrically， administration groups were given relevant medicine intragastrically， once a day， for consecutive 17 d. Since 11th day after medication， except for control group， other groups were given MPTP solution （20 mg/kg） intraperitoneally to induce PD model， once a day， consecutive 5 d. After last medication， behavioral changes of mice （10 mice in each group） were evaluated by rotary rod fatigue tester. The damage of dopamine neurons （the percentage of TH positive cell and the percentage of fluorescence intensity） in substantia nigra of mice （3 mice in each group） was detected by immunohistochemistry and immunofluorescence. The content of dopamine in striatum was determined by HPLC （6 mice in each group）. The changes of oxidant stress indexes （SOD， GSH-Px， MDA） in substantia nigra of mice were determined by chemical colorimetry （6 mice in each group）. RESULTS： Compared with control group， retention time of mice on rotating rods was shortened significantly in MPTP injury group； TH positive cells of substantia nigra were decreased significantly， fluorescence intensity was obviously weakened； the percentage of positive cells and fluorescence intensity， the content of dopamine in striatum， the activities of SOD and GSH-Px in substantia nigra were decreased significantly， while the content of MDA was increased significantly （P＜0.01）. Compared with MPTP injury group， retention time of mice on the rotating rods was prolonged significantly in low-molecular-weight CS groups， the number of TH positive cells was increased significantly in substantia nigra and fluorescence intensity was increased significantly； the percentage of positive cells， the percentage of fluorescence intensity and the content of dopamine in striatum were increased significantly， while above indexes of high-dose group were significantly longer or higher than those of low-dose group （P＜0.05 or P＜0.01）. The activities of SOD and GSH-Px in substantia nigra were increased significantly in low-molecular-weight CS groups， while the content of MDA in substantia nigra was decreased significantly in low-molecular-weight CS high-dose group （P＜0.05 or P＜0.01）. CONCLUSIONS： Prophylactic administration of low-molecular-weight CS can relieve the damage of dopaminergic neurons in substantia nigra of PD model mice induced by MPTP in a dose-dependent manner， and increase the secretion of dopamine in striatum. The effect may be related to the inhibition of lipid peroxidation and the enhancement of antioxidant capacity of tissues.

Objective: To explore the effect of case management on postoperative affected limb lymphedema in breast cancer patients. Methods: This study is a non-concurrent control trial. A total of 157 cases of breast cancer patients who met the inclusion/exclusion criteria were selected from the Sun yet-sen University Cancer Center from June 2016 to July 2017 and from June 2016 to July 2017 by the convenient sampling method. Among them, 80 patients from June to July 2016 were listed as the control group, and 77 patients from June to July 2017 were listed as the intervention group. The control group implemented the routine nursing mode of breast cancer. The intervention group implemented case management on the basis of routine nursing. Lymphedema of the affected limb were compared between the two groups before intervention, 3 months after surgery, 6 months after surgery and 1 year after surgery. Results: The incidence of postoperative lymphedema (OR=2.467, 95%CI1.177-5.169, P<0.05) of the affected limb was lower in the intervention group than in the control group. The incidence of lymphedema in the limbs of the two groups was not statistically different 3 months after operation (χ²=0.617, P>0.05). There was a statistically significant difference between the two groups 6 months after operation (χ²=5.835, P<0.05) and 1 year after operation (P=0.003). The incidence of lymphedema in the affected limbs in the experimental group was lower than that in the control group. There was an increased incidence of lymphedema in the control group, the incidence of side pain, but an incidence of lymphedema in the intervention group was in a downward trend. Conclusion Case management mode can effectively prevent and improve the occurrence of postoperative lymphedema in patients with breast cancer.