OBJECTIVE To investigate the mechanism of Yangfei tongluo formula in delaying airway remodeling in post-infectious bronchiolitis obliterans （PIBO） model rats.METHODS Forty-eight 2-week-old SPF male SD rats were randomly divided into control group （Control group）， PIBO model group （Model group）， Prednisone Acetate tablets+Azithromycin tablets group [positive control group， Prednisone Acetate tablets 0.006 3 g/（kg·d）+Azithromycin tablets 0.031 5 g/（kg·d）]， and high-， medium-， and low-dose Yangfei tongluo formula groups [42.42， 21.21， 10.60 g/（kg·d）]. The PIBO rat model was established by intratracheal instillation of diacetyl. After modeling， rats in each group were administered corresponding drug solution or distilled water by gavage once daily for 21 consecutive days. Hematoxylin-eosin staining was used to evaluate the pathological changes of lung tissue， and Masson staining was used to assess the degree of pulmonary fibrosis. Western blot and real-time quantitative PCR were performed to detect the protein and mRNA expression levels of epithelial-mesenchymal transition （EMT）-related markers [E-cadherin， N-cadherin， α -smooth muscle actin （ α -SMA）， Vimentin] and transcription factors [snail homolog 1（Drosophila）-like 1 protein （Snail1）， zinc finger E-box-binding homeobox protein 1 （ZEB1）， Twist-related protein 1 （Twist1）] in lung tissue. ELISA was used to detect the levels of transforming growth factor-β 1 （TGF-β 1 ） and vascular endothelial growth factor （VEGF） in blood and bronchoalveolar lavage fluid.RESULTS Compared with the Control group， the lung tissues of rats in the Model group showed extensive destruction of alveolar structure and massive inflammatory cell infiltration in the interstitium. The protein and mRNA expression levels of E-cadherin were significantly decreased， while the protein and mRNA expression levels of N-cadherin， Vimentin， α -SMA， Snail1， ZEB1， and Twist1， as well as the collagen-positive area and the levels of TGF-β 1 and VEGF， were significantly increased （ P ＜0.05）. Compared with the Model group， the pathological injury of lung tissue in each administration group was significantly improved， and the above indicators （except collagen-positive area） were significantly reversed （ P ＜0.05）.CONCLUSIONS Yangfei tongluo formula may delay airway remodeling in PIBO by regulating the TGF-β 1 /VEGF-mediated signaling network and inhibiting the activation of EMT-related transcription factors， thereby blocking the EMT process.

Objective:To examine the renoprotective benefits of stroke volume variation(SVV)-guided fluid therapy in older patients under-going laparoscopic colorectal cancer resection with combined administration of epidural and general anesthesia.Methods:A total of 100 older patients underwent laparoscopic colorectal cancer resection with combined administration of epidural and general anesthesia at The Affiliated Hospital of Inner Mongolia Medical University.Participants were randomly allocated into the control(group C)and experimental groups(group S).Each group consisted of an equal distribution of 50 patients.Group C received routine rehydration,while group S under-went SVV-guided fluid rehydration.To compare the two groups,the levels of serum creatinine(Scr),blood urea nitrogen(BUN),neutrophil gelatinase-associated lipocalin protein(NGAL),and kidney injury molecule-1(KIM-1)were analyzed before and after surgery.Results:NGAL concentrations were significantly reduced in group S compared with those in group C at 2 and 24h after surgery(P=0.033,P=0.014).KIM-1 levels were significantly lower in group S than in group C 24h after surgery(P=0.012).Furthermore,Scr levels were significantly lower in group S than in group C 1 day after surgery(P=0.049).The incidence of postoperative acute kidney injury(AKI)was significantly higher in group C than in group S(P=0.027).Conclusions:In older patients undergoing laparoscopic radical resection of colorectal cancer,the imple-mentation of SVV-guided fluid therapy can improve postoperative plasma markers of renal injury and reduce the incidence of postoperative AKI,thereby protecting renal function.

Objective To explore the humidification effects between the humidifiers Venturi high-flow oxygen therapy(HVHF)and the high-flow humidified oxygen therapy in the treatment of patients with tracheotomy after the withdrawal of ventilator,and analyse the humidification performance and effect of airway humidification on the two oxygen therapies hence to provide an objective basis for selection of a humidified oxygen therapy.Methods A total of 146 ICU patients who had tracheotomy and completely withdrawal of ventilator in a general hospital in Shenzhen from July 2020 to December 2021 were randomly divided into trial group(n=73)and control group(n=73).With identical speed of airflow,patients in the trial groups were treated with HVHF and the patients of control group were offered with high-flow humidified oxygen therapy via AIRVOTM2.Data of the two groups were compared at the time points of days 0,2,7 and 14 in terms of absolute humidity(AH),relative humidity(RH),temperature(T)),sputum viscosity,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),oxygenation index(PaO2/FIO2)and the incidence of pulmonary infection.Results In the study,total of 61 patients in the control group and 72 patients in the trial group completed the high-flow humidified oxygen therapies,due to tubing detachments in 12 and 1 patients in the two groups,respectively.Repeated-Measures ANOVA analysis showed that,in both groups,there was a time effect(P<0.05)between the absolute humidity,relative humidity,temperature of the gas,PaO2,PaCO2,and PaO2/FiO2 at different time points.PaO2 and PaO2/FiO2 in both groups showed interactions at different time points(P<0.05).PaO2 and PaO2/FiO2 in the trial group were better than those in the control group at the time points of days 2,7 and 14(P<0.05).On days 2,7 and 14,the viscosity of sputum in the intervention group was better than that in the control group,and the incidence of pulmonary infection in the trial group was significantly lower than that in the control group(P<0.05).Conclusions HVHF and AIRVOTM2 both exhibit no obvious difference in gas humidification via high-flow humidification oxygen therapy in the patients with tracheotomy after withdrawal of ventilator.However,HVHF is superior to AIRVOTM2 in terms of improving airway humidification and oxygenation as well as reducing lung infection.Therefore,it is suggested that an HVHF is preferable for high-flow humidified oxygen therapy in treating the patients with tracheotomy after the withdrawal of ventilator.

Objective:To build enhanced recovery after surgery (ERAS) ward management system based on the staff, stuff, structure space and systems (4S) management model, and explore the implementation effects of accelerated rehabilitation nursing management.Methods:A retrospective analysis was carried out on the implementation process of ERAS before 2020 in the Department of Hepatobiliary and Pancreatic Surgery, Ningbo First Hospital, Zhejiang Province. It was found that there were problems such as imperfect multidisciplinary team personnel, lack of systems, and lack of standardized process implementation rules. In April 2020, we created an ERAS ward based on the concept of 4S management model, improved the multi-disciplinary professional staff, equipment and venues, and formulated an ERAS ward system process. Patients undergoing ERAS in Hepatobiliary and Pancreatic Surgery Department from April to September 2019 were selected as the control group (383 cases of gallbladder surgery and 59 cases of liver surgery) , and patients admitted to the ERAS ward from April to September 2020 were selected as the experimental group (332 cases of gallbladder surgery and 72 cases of liver surgery) . The satisfaction, average length of hospitalization, hospitalization expenses and complication rate of the two groups of patients were compared, and doctors and nurses' specification implementation rate of the ERAS ward was counted.Results:The average length of hospitalization of patients with gallbladder surgery and liver surgery in the experimental group was shorter than that of the control group, and the hospitalization expenses were lower than those of the control group, and the differences were statistically significant ( P<0.01) . The complication rate (9.9%, 33/332) of patients undergoing gallbladder surgery in the experimental group was lower than that (16.7%, 64/383) in the control group, and the difference was statistically significant ( P<0.01) . The satisfaction of patients in the experimental group was higher than that in the control group, and the difference was statistically significant ( P<0.01) . The specification implementation rate of doctors and nurses was 96.7% (58/60) . Conclusions:The ERAS ward is based on the scientific supervision of staff, stuff, structure space and systems according to the concept of 4S management model, which is conducive to the comprehensive and standardized implementation of ERAS treatment and nursing, improves patient clinical outcomes and increases patient satisfaction.

The laterodorsal tegmentum (LDT) is a brain structure involved in distinct behaviors including arousal, reward, and innate fear. How environmental stimuli and top-down control from high-order sensory and limbic cortical areas converge and coordinate in this region to modulate diverse behavioral outputs remains unclear. Using a modified rabies virus, we applied monosynaptic retrograde tracing to the whole brain to examine the LDT cell type specific upstream nuclei. The LDT received very strong midbrain and hindbrain afferents and moderate cortical and hypothalamic innervation but weak connections to the thalamus. The main projection neurons from cortical areas were restricted to the limbic lobe, including the ventral orbital cortex (VO), prelimbic, and cingulate cortices. Although different cell populations received qualitatively similar inputs, primarily via afferents from the periaqueductal gray area, superior colliculus, and the LDT itself, parvalbumin-positive (PV) GABAergic cells received preferential projections from local LDT neurons. With regard to the different subtypes of GABAergic cells, a considerable number of nuclei, including those of the ventral tegmental area, central amygdaloid nucleus, and VO, made significantly greater inputs to somatostatin-positive cells than to PV cells. Diverse inputs to the LDT on a system-wide level were revealed.

Objective To investigate the correlation between 24-h ambulatory blood pressure variability and the overall burden of cerebral small vessel disease (CSVD) in patients with acute ischemic stroke. Methods From March 2016 to December 2017, consecutive patients with acute ischemic stroke admitted to the Department of Neurology, the Affiliated Changshu Hospital of Soochow University were enrolled. The 3. 0 T-MRI was used to assess asymptomatic lacunar infarction, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces within 24 h after admission, and the total CSVD score (0-4) was calculated. 24-h ambulatory blood pressure monitoring was performed 24 to 72 h after admission. Ordinal logistic regression analysis was used to determine the independent correlation between the 24-h ambulatory blood pressure-related index and the total CSVD score. Results A total of 220 patients with acute ischemic stroke were enrolled. The patients were divided into five groups according to the total CSVD score. Univariate analysis showed that there were significant differences in age, homocysteine, the proportion of hypertension, as well as 24 h, daytime and nighttime mean systolic blood pressure (SBP), and coefficient of variation of daytime SBP among the 5 groups (all P < 0. 05). Ordinal logistic regression analysis showed that age (odds ratio [OR] 1. 078, 95％ confidence interval [CI] 1. 051-1. 106; P < 0. 001), 24-h mean SBP (OR 1. 043, 95％ CI 1. 026-1. 060; P < 0. 001), daytime mean SBP (OR 1. 042, 95％ CI 1. 025-1. 059; P < 0. 001), nighttime mean SBP (OR 1. 034, 95％ CI 1. 019-1. 049; P < 0. 001), and coefficient of variation of daytime SBP (OR 1. 129, 95％ CI 1. 052-1. 210; P = 0. 003) were independently correlated with the total CSVD score. Conclusions The elevated 24 h, daytime and nighttime mean SBP levels and coefficient of variation of daytime SBP are independently correlated with the severity of overall CSVD burden in patients with acute ischemic stroke.

Objective To investigate the correlation between 24-h ambulatory blood pressure (BP) variability and cerebral microbleeds (CMBs) in patients with acute ischemic stroke. Methods Consecutive inpatients with acute ischemic stroke were prospectively enrolled. 24-h ambulatory BP was monitored. Magnetic susceptibility-weighted imaging was used to evaluate CMBs and their locations. Univariate analysis was used to compare the baseline data between the CMBs group and the non-CMBs group. Multivariate logistic regression analysis was used to determine the independent correlation between ambulatory BP related indexes and CMBs. Results A total of 178 patients with acute ischemic stroke were enrolled, including 114 males, aged 67.6 ±10.8 years, and 90 (50.6%) with CMBs. The proportion of hypertension and asymptomatic lacunar infarction, periventricular and deep white matter high signal score, 24-h, daytime, nighttime mean systolic and diastolic BP, 24-h, and daytime systolic BP variability in the CMBs group were significantly higher than those in the non-CMB group (all P<0.05). Multivariate logistic regression analysis showed that 24-h systolic BP variability (odds ratio 1.133, 95% confidence interval 1.023-1.255; P=0.016) and daytime mean systolic BP (odds ratio 1.045, 95% confidence interval 1.022-1.069; P<0.001) had significant independent correlation with CMBs. Conclusion 24-h systolic BP variability and daytime mean systolic BP were the independent risk factors for CMBs in patients with acute ischemic stroke.

Objective To investigate the value of evaluating vertebrobasilar artery atherosclerosis with 3.0 T high-resolution magnetic resonance imaging (HR-MRI) in the progress of posterior circulation transient cerebral ischemia (TIA).Methods From July 2013 to July 2014,30 consecutive patients (outpatients and inpatients) with posterior circulation TIA at the Department of Neurology,the First People's Hospital of Changshu were enrolled respectively.They were all confirmed as the presence of vertebrobasilar atherosclerotic plaques by the head magnetic resonance angiography.The vertebrobasilar artery plaques were examined with 3 T HR-MRI to assess the nature and stability of the plaques.They were randomly divided into either a stable plaque group (n =16) or an unstable plaque group (n =14) according to the results of plaque stability.They were followed up for 24 months.The time and proportion from the first visit to the posterior circulation infarction were recorded and compared between the two groups of patients.Results At the end of follow-up,the time of posterior circulation infarction in the unstable group was significantly shorter than that in the stable group,and the difference was statistically significant (11.5 [7.0,20.0] months vs.24.0[22.5,24.0] months,Z =-2.755,P ＜ 0.05).The ratios of posterior circulation infarction in the stable group and the unstable group were 5/16 and 8/14 respectively.The difference was not statistically significant between the two groups (P ＞ 0.05).Conclusion Evaluating the results of vertebrobasilar artery atherosclerosis plaque with HR-MRI has a certain value for the progression of posterior circulation ischemia disease.

Objective To investigate the risk factors for nosocomial infections and analyze pathogens drug resistance in patients with craniocerebral injury so as to provide scientific basis for clinical precaution and treatment.Methods A retrospective survey was conducted to collect the clinical data of 480 patients with craniocerebral injury including the gender,age and therapeutic process of patients by medical history,for analyzing the related factors causing nosocomial infections via SPSS 18.0 software.Then,the results of bacterial culture and drug sensitivity test were recognized to analyze drug resistance of pathogenic bacteria.Results The nosocomial infections occurred in 100 of 480 patients with craniocerebral injury,with an infection rate of 20.83%.The univariate analysis indicated that the risk of nosocomial infections was associated with age,tracheal tube,deep vein catheterization,the length of tracheotomy,the length of hospital stay,diabetic mellitus and hemoglobin ≤110 g·L-1 (P<0.05).Totally 191 strains of pathogens have been isolated,including 118 (61.8%) strains of gram-negative bacteria,46 (24.1%) strains of gram-positive bacteria and 27 (14.1%) strains of fungi.The Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli were dominant among the gram-negative bacteria,and the drug resistance rates of them to cefazolin and cefotaxime were high;The Staphylococcus aureus,Enterococcus faecalis and Staphylococcus were the major species of the gram-positive bacteria,which were insensitive to penicillin and clindamycin;the Candida albicans was the major species of the fungi.Conclusion The incidence of nosocomial infections is high in the patients with craniocerebral injury,which is accociated with many risk factors.Therefore,it is necessary to strengthen the control of the risk factors so as to effectively reduce the incidence of nosocomial infections.

OBJECTIVE:To investigate the current situation of anticoagulant therapy for patients with non-valvular atrial fibril-lation,and to provide reference for standardized anticoagulant therapy. METHODS:A total of 1056 patients with non-valvular atri-al fibrillation were collected from our hospital during Jul. 2015-Jun. 2016. According to 2012 European Society of Cardiology Guide-lines for the Management of Atrial Fibrillation,the risks of thrombosis and hemorrhage were evaluated,and the standardized anti-coagulant therapy was also evaluated. RESULTS:Among 1056 patients with non-valvular atrial fibrillation,the number of patients with thrombosis risk score ≥1 was 1028,accounting for 97.3%. 763 patients received antithrombosis therapy,and only 139 pa-tients were given warfarin anticoagulant therapy. The international normalized ratio(INR)of prothrombin time in just 30.9% of pa-tients receiving warfarin was in line with the standard before discharge. CONCLUSIONS:The anticoagulant therapy for patients with non-valvular atrial fibrillation is still not optimistic,and effective measure should be adopted to improve the standardization of anticoagulant therapy in the patients with atrial fibrillation.