Objective To investigate the status quo of indwelling needles use in the hospitals at all lev-els in Chongqing city,and to evaluate the normalization and safety of indwelling needles use by referring to Nursing Practice Standards for Intravenous Therapy.Methods A self-designed questionnaire was used in July 2023 to conduct a cross-sectional survey on the use of indwelling needles in the hospitals at all levels in Chongqing city.Results A total of 30 807 patients in 77 hospitals were included,among them 62.67%used indwelling needles.The closed type indwelling needles accounted for 88.87%and the safety type indwelling needles accounted for 41.74%.Non-needle infusion connectors accounted for 37.78%,and steel needle con-nected with heparin caps accounted for 51.69%.95.66%of puncture site was in the upper limb,the non-cor-rosive drug infusion accounted for 87.57%,and the complications occurrence rate was 2.46%.Among the 6 419 surveyed nurses,75.51%removed indwelling needles based on clinical indications.There were statistically significant differences in the usage rates of closed type indwelling needles and non-needle infusion connectors among hospitals at different levels(P<0.05).There were also statistically significant differences in the inci-dence rates of complication and phlebitis(P<0.05).Conclusion The overall application of indwelling needles in the hospitals at all levels in Chongqing city is generally standardized,but the use of safety type indwelling needles and needle-free infusion connectors still needs to be improved.

Objective:To evaluate the efficacy and safety of peri-diaphragmatic hydrodissection in assisting microwave ablation（MWA）of right subphrenic colorectal liver metastasis（CRLM）.Methods:A retrospective analysis was conducted on 101 patients with right subphrenic CRLMs（206 lesions）who underwent percutaneous ultrasound-guided MWA at the Sixth Affiliated Hospital，Sun Yat-sen University from June 2020 to June 2023. Patients were divided into contrast-enhanced ultrasound（CEUS）with hydrodissection group（ n=63）and artificial ascites/pleural effusion group（ n=38，there were 17 patients with artificial pleural effusion，21 patients with artificial ascites）. In the CEUS with hydrodissection group，the peri-diaphragmatic water dissection was established during the post-vascular phase of CEUS. Lesion detection rates，visualization scores，local tumor progression（LTP），and complications were compared between the two groups. Results:In both the CEUS with hydrodissection group and the artificial ascites/pleural effusion group，the lesion detection rates（96.9% and 98.7%）and visualization scores［（3.7 ± 1.3）points and（4.6 ± 0.7）points］improved with water dissection assistance compared to conventional ultrasound［detection rates of 57.5% and 55.7%，visualization scores of（1.9 ± 1.0）points and（2.6 ± 1.5）points］and CEUS alone［detection rates of 78.0% and 78.5%，visualization scores of（3.1 ± 1.5）points and（3.7 ± 1.6）points］（all P<0.001）. The CEUS with hydrodissection group achieved comparable success rates（96.8% vs. 97.4%， P>0.99）but required less saline［60（30，90）ml vs. 500（500，1 000）ml， P<0.001］than artificial ascites/pleural effusion group. No significant differences were observed in LTP rates，complications，or pain scores（all P>0.05）. Conclusions:CEUS combined with peri-diaphragmatic hydrodissection improves detection rates and visualization of right subphrenic CRLM while reducing fluid volume compared to artificial hydrothorax/ascites，serving as a safe and effective adjunct for percutaneous MWA.

OBJECTIVES: To investigate the protective mechanism of quercetin, the core component of Zuo Gui Wan, against Alzheimer's disease through the PI3K/AKT signaling pathway, based on network pharmacology, molecular docking, and cell experi-ments. METHODS: The active components of Zuo Gui Wan were identified by searching TCMSP, PubChem, Swiss Target Prediction, and BATMAN-TCM databases, and their potential targets were predicted. The target information was standardized using Uniprot, and Alzheimer's disease-related target genes were obtained from Drugbank, GeneCards, and OMIM. The intersection of these datasets was used to identify the potential targets of Zuo Gui Wan for treating Alzheimer's disease. Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. The protein-protein interaction (PPI) network of potential targets was visualized using Cytoscape 3.10.1 software and the STRING database. The key active compounds and core potential targets for treating Alzheimer's disease with Zuo Gui Wan were identified through calculation. Based on the enrichment analysis results and literature, quercetin and the PI3K/AKT pathway were selected for verification. Molecular docking and binding ability prediction between quercetin and the core target AKT were performed using CB-Dock2, and visualization was conducted with AutoDock and PyMOL software. Finally, Aβ_1-42-induced HT-22 mouse hippocampal neuronal cells were used to construct an Alzheimer's disease cell model. Quercetin, the PI3K inhibitor LY294002, and the activator EGF were used as interventions. The groups were divided as follows: Control, Aβ_1-42, Aβ_1-42+Quercetin 2.5 μM, Aβ_1-42+Quercetin 5 μM, Aβ_1-42+Quercetin 10 μM, Aβ_1-42+EGF, and the PI3K/AKT modulation group: Control, LY294002, LY294002+Quercetin 10 μM, LY294002+EGF. CCK-8 assays were performed to detect cell viability, while JC-1, Calcein AM-PI, and Hoechst staining were used to assess cell apoptosis. Western blotting was employed to detect the expression of relevant target proteins. RESULTS: Network pharmacology and cell experiments collectively demonstrate that the key active ingredient of Zuo Gui Wan, quercetin, targets core proteins such as AKT1 and GSK3β through a network-based approach, significantly enriching the PI3K/AKT pathway. Molecular docking results indicate that quercetin has a strong binding affinity with AKT. Experimental validation in the Aβ_1-42 oligomer-induced HT-22 model reveals that quercetin significantly activates the PI3K/AKT signaling pathway, which is inhibited by Aβ_1-42 oligomers, as well as Bcl-2 protein expression. It also suppresses the expression of Cleaved Caspase 3/Caspase 3, BAX, and Cytochrome C proteins. JC-1, Hoechst 33342, and Calcein AM-PI staining results further show that quercetin can significantly alleviate apoptosis induced by Aβ_1-42 oligomers in HT-22 cells. Treatment with the PI3K inhibitor LY294002 in HT-22 cells leads to reduced cell viability and decreased expression of p-AKT/AKT and Bcl-2 proteins, while increasing the expression of Cleaved Caspase 3/Caspase 3, BAX, and Cytochrome C proteins. Additionally, apoptosis levels increase as observed in JC-1, Hoechst 33342, and Calcein AM-PI staining, all of which can be reversed by quercetin and the PI3K agonist EGF. CONCLUSIONS Quercetin, the key active ingredient of Zuo Gui Wan, exerts its protective effects against Alzheimer's disease by regulating the PI3K/AKT signaling pathway, inhibiting neuronal cell damage and apoptosis.

Peritoneal metastasis is a common form of distant metastasis in patients with colorectal cancer, and it is typically associated with a poor prognosis. The development of peritoneal metastasis involves complex molecular mechanisms and multifactorial regulation of the tumor microenvironment. Due to the presence of the blood-peritoneal barrier, only a small amount of systemic medication reaches the peritoneal cavity, resulting in limited efficacy against peritoneal metastasis. Intraperitoneal administration shows significant therapeutic advantages as it can directly target the tumor microenvironment, maintain high local drug concentrations, and reduce systemic toxicity. Intraperitoneal chemotherapy, especially hyperthermic intraperitoneal chemotherapy, has become a cornerstone therapeutic strategy in the clinical treatment of peritoneal metastasis. When selecting chemotherapy drugs and drug combinations, pharmacokinetic properties, efficacy, and safety must be comprehensively considered to optimize the treatment outcomes. In addition, the unique microenvironment of the peritoneal cavity provides new treatment approaches for biological treatment strategies, including antitoxins, vaccines, immune checkpoint inhibitors, etc. Techniques such as pressurized intraperitoneal aerosol chemotherapy and novel drug delivery systems demonstrate potential for enhanced efficacy, offering promising alternatives to improve patient outcomes. This article will review peritoneal barrier characteristics, intraperitoneal drug transport, intraperitoneal chemotherapy, and intraperitoneal biological therapies, thereby establishing a theoretical framework for precision therapy in colorectal cancer peritoneal metastasis.

Objective:To investigate the effect and mechanism of lycium barbarum polysaccharide(LBP)on lipopolysaccharide(LPS)-induced inflammatory response of NLRP3 inflammasome in BV2 microglial cells.Methods:BV2 microglial cells were routinely cultured.CCK-8 assay was used to detect the effect of different concentrations(0.5,1,1.5,2 g/L)LBP on cell activity.Cells were di-vided into three groups:control group,LPS group and LBP+LPS group.Effect of LBP on LPS-induced cell activity was detected by CCK-8 method;RT-qPCR and immunofluorescence assay were used to detect NLRP3,ASC,Caspase-1,IL-18 and IL-1β expressions.Western blot was used to detect expressions of NLRP3,ASC,Caspase-1,TLR4,MyD88,NF-κB p65,IL-18,IL-1β and TNF-α pro-teins.Results:CCK-8 assay showed that 1 g/L LBP was the most applicable.Compared with control group,cell viability in LPS group was decreased;RT-qPCR,immunofluorescence and Western blot results showed that fluorescence intensity,mRNA and protein expres-sions of NLRP3,ASC,Caspase-1,IL-18 and IL-1β were increased in LPS group.Western blot results showed that TLR4,MyD88,NF-κB p65 and TNF-α protein expressions were increased in LPS group.After LBP treatment,cell viability was increased;expres-sions of NLRP3,ASC,Caspase-1,NF-κB p65,TLR4,MyD88,IL-18,IL-1β and TNF-α were decreased.Conclusion:LBP may in-hibit LPS-induced NLRP3 inflammatory vesicles in BV2 cells via TLR4/MyD88/NF-κB signaling pathway.

Objective:To explore how nurses respond to and experience task uncertainty in prehospital emergency care.Methods:Using purposive sampling, 13 prehospital emergency nurses from two tertiary hospitals in Shandong Province were selected between June and August 2024. Semi-structured interviews were conducted face-to-face. The interview data were analyzed using Colaizzi's seven-step method.Results:Four main themes were identified: a certain degree of task uncertainty exists in prehospital emergency care; nurses have varied emotional and cognitive responses to such uncertainty; nurses adopt diverse coping strategies; organizational-level interventions are essential to improving nurses' experiences.Conclusions:Nurses recognize the presence of task uncertainty in prehospital emergency care and demonstrate different responses and coping strategies. This highlights the need for both nurses and healthcare managers to acknowledge this characteristic of emergency work, help nurses alleviate negative experiences, foster positive coping mechanisms, and ensure the quality of prehospital emergency nursing services.

Objective:To investigate the effect and mechanism of lycium barbarum polysaccharide(LBP)on lipopolysaccharide(LPS)-induced inflammatory response of NLRP3 inflammasome in BV2 microglial cells.Methods:BV2 microglial cells were routinely cultured.CCK-8 assay was used to detect the effect of different concentrations(0.5,1,1.5,2 g/L)LBP on cell activity.Cells were di-vided into three groups:control group,LPS group and LBP+LPS group.Effect of LBP on LPS-induced cell activity was detected by CCK-8 method;RT-qPCR and immunofluorescence assay were used to detect NLRP3,ASC,Caspase-1,IL-18 and IL-1β expressions.Western blot was used to detect expressions of NLRP3,ASC,Caspase-1,TLR4,MyD88,NF-κB p65,IL-18,IL-1β and TNF-α pro-teins.Results:CCK-8 assay showed that 1 g/L LBP was the most applicable.Compared with control group,cell viability in LPS group was decreased;RT-qPCR,immunofluorescence and Western blot results showed that fluorescence intensity,mRNA and protein expres-sions of NLRP3,ASC,Caspase-1,IL-18 and IL-1β were increased in LPS group.Western blot results showed that TLR4,MyD88,NF-κB p65 and TNF-α protein expressions were increased in LPS group.After LBP treatment,cell viability was increased;expres-sions of NLRP3,ASC,Caspase-1,NF-κB p65,TLR4,MyD88,IL-18,IL-1β and TNF-α were decreased.Conclusion:LBP may in-hibit LPS-induced NLRP3 inflammatory vesicles in BV2 cells via TLR4/MyD88/NF-κB signaling pathway.

Peritoneal metastasis is a common form of distant metastasis in patients with colorectal cancer, and it is typically associated with a poor prognosis. The development of peritoneal metastasis involves complex molecular mechanisms and multifactorial regulation of the tumor microenvironment. Due to the presence of the blood-peritoneal barrier, only a small amount of systemic medication reaches the peritoneal cavity, resulting in limited efficacy against peritoneal metastasis. Intraperitoneal administration shows significant therapeutic advantages as it can directly target the tumor microenvironment, maintain high local drug concentrations, and reduce systemic toxicity. Intraperitoneal chemotherapy, especially hyperthermic intraperitoneal chemotherapy, has become a cornerstone therapeutic strategy in the clinical treatment of peritoneal metastasis. When selecting chemotherapy drugs and drug combinations, pharmacokinetic properties, efficacy, and safety must be comprehensively considered to optimize the treatment outcomes. In addition, the unique microenvironment of the peritoneal cavity provides new treatment approaches for biological treatment strategies, including antitoxins, vaccines, immune checkpoint inhibitors, etc. Techniques such as pressurized intraperitoneal aerosol chemotherapy and novel drug delivery systems demonstrate potential for enhanced efficacy, offering promising alternatives to improve patient outcomes. This article will review peritoneal barrier characteristics, intraperitoneal drug transport, intraperitoneal chemotherapy, and intraperitoneal biological therapies, thereby establishing a theoretical framework for precision therapy in colorectal cancer peritoneal metastasis.

Objective:To explore how nurses respond to and experience task uncertainty in prehospital emergency care.Methods:Using purposive sampling, 13 prehospital emergency nurses from two tertiary hospitals in Shandong Province were selected between June and August 2024. Semi-structured interviews were conducted face-to-face. The interview data were analyzed using Colaizzi's seven-step method.Results:Four main themes were identified: a certain degree of task uncertainty exists in prehospital emergency care; nurses have varied emotional and cognitive responses to such uncertainty; nurses adopt diverse coping strategies; organizational-level interventions are essential to improving nurses' experiences.Conclusions:Nurses recognize the presence of task uncertainty in prehospital emergency care and demonstrate different responses and coping strategies. This highlights the need for both nurses and healthcare managers to acknowledge this characteristic of emergency work, help nurses alleviate negative experiences, foster positive coping mechanisms, and ensure the quality of prehospital emergency nursing services.

Objective:To evaluate the efficacy and safety of peri-diaphragmatic hydrodissection in assisting microwave ablation（MWA）of right subphrenic colorectal liver metastasis（CRLM）.Methods:A retrospective analysis was conducted on 101 patients with right subphrenic CRLMs（206 lesions）who underwent percutaneous ultrasound-guided MWA at the Sixth Affiliated Hospital，Sun Yat-sen University from June 2020 to June 2023. Patients were divided into contrast-enhanced ultrasound（CEUS）with hydrodissection group（ n=63）and artificial ascites/pleural effusion group（ n=38，there were 17 patients with artificial pleural effusion，21 patients with artificial ascites）. In the CEUS with hydrodissection group，the peri-diaphragmatic water dissection was established during the post-vascular phase of CEUS. Lesion detection rates，visualization scores，local tumor progression（LTP），and complications were compared between the two groups. Results:In both the CEUS with hydrodissection group and the artificial ascites/pleural effusion group，the lesion detection rates（96.9% and 98.7%）and visualization scores［（3.7 ± 1.3）points and（4.6 ± 0.7）points］improved with water dissection assistance compared to conventional ultrasound［detection rates of 57.5% and 55.7%，visualization scores of（1.9 ± 1.0）points and（2.6 ± 1.5）points］and CEUS alone［detection rates of 78.0% and 78.5%，visualization scores of（3.1 ± 1.5）points and（3.7 ± 1.6）points］（all P<0.001）. The CEUS with hydrodissection group achieved comparable success rates（96.8% vs. 97.4%， P>0.99）but required less saline［60（30，90）ml vs. 500（500，1 000）ml， P<0.001］than artificial ascites/pleural effusion group. No significant differences were observed in LTP rates，complications，or pain scores（all P>0.05）. Conclusions:CEUS combined with peri-diaphragmatic hydrodissection improves detection rates and visualization of right subphrenic CRLM while reducing fluid volume compared to artificial hydrothorax/ascites，serving as a safe and effective adjunct for percutaneous MWA.