This study summarized the nursing experience of midline catheter insertion in 12 patients with a body mass index≥50,providing clinical references.Key nursing interventions included:pre-insertion patient positioning was adjusted to semi-Fowler's or sitting position based on respiratory status.The puncture sites were chosen at the middle or distal third of the upper arm with elbow flexion.The widened tourniquets and extended-length needles/catheter sheaths were used according to vascular depth and puncture angle.The modified pre-insertion length measurement and real-time ultrasound-guided vascular puncture were applied.The catheter with crisscross elastic bandage was secured post-insertion.All 12 patients successfully underwent catheterization,with devices removed after completing intravenous therapy and blood sampling.

Objective To analyze the relationship between serum nuclear factor E2-related factor 2(NRF2),heme oxygenase-1(HO-1)levels and disease activity and prognosis in patients with lupus nephritis(LN).Methods A total of 188 LN patients who visited the hospital from March 2020 to January 2022 were selected as the case group,and were divided into a stable group(60 cases,＜10 points)and an active group(128 cases,≥ 10 points)according to the Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score.Another 160 healthy subjects were selected as control group.The differences of serum NRF2 and HO-1 levels between case group and control group were compared,the serum NRF2 and HO-1 levels and renal func-tion indexes[glomerular filtration rate(GFR),serum creatinine(Scr),urea nitrogen(BUN)]were compared between stable group and active group,and the correlation between serum NRF2 and HO-1 levels and disease activity and renal function in LN patients was analyzed by Pearson.After 2 years of follow-up,LN patients were divided into good prognosis group(117 cases)and poor prognosis group(71 cases)according to the oc-currence of renal-related endpoint events.Serum NRF2,HO-1 levels and other clinical data were compared be-tween two groups,and the prognostic factors of LN patients were analyzed by multivariate Logistic regression model.A nomogram prediction model was constructed and verified based on the influencing factors.Results The levels of serum NRF2 and HO-1 in case group were lower than those in control group(P＜0.05).NRF2,HO-1 and GFR levels in active group were lower than those in stable group,and Scr,BUN and SLEDAI scores were higher than those in the stable group(P＜0.05).Pearson correlation analysis showed that,serum NRF2 and HO-1 levels were negatively correlated with SLEDAI score,Scr and BUN in LN pa-tients(r＜0,P＜0.05),and positively correlated with GFR(r＞0,P＜0.05).The NRF2,HO-1 and GFR in poor prognosis group were lower than those in good prognosis group,and the proportion of CKD stage 3-4 and SLEDAI score in poor prognosis group were higher than those in good prognosis group(P＜0.05).Multi-variate Logistic regression model showed that CKD stage 3-4 and the increase of SLEDAI score were inde-pendent risk factors for poor prognosis of LN patients(P＜0.05),while the increase of NRF2,HO-1 and GFR levels were independent protective factors(P＜0.05).The nomogram prediction model based on influen-cing factors had a good predictive value for the prognosis of LN patients.Conclusion NRF2 and HO-1 are lowly expressed in the serum of LN patients,and the two are closely related to their disease activity and renal function.The high expression of NRF2 and HO-1 will reduce the risk of renal-related endpoint events in LN patients.The nomogram prediction model based on influencing factors has a good predictive value for the prognosis of LN patients.

Objective To establish a combined model of spectral CT multi-parameters and clinical features to distinguish between gastric poorly cohesive carcinoma and tubular adenocarcinoma.Methods A total of 87 patients with gastric cancer confirmed by postoperative pathology were retrospectively selected,including 26 patients with poorly cohesive carcinoma and 61 patients with tubular adenocarcinoma.Predictors were identified by univariate and multivariate logistic regression analyses,and a combined model was established.The area under the curve(AUC)of receiver operating characteristic(ROC)curve was used to evaluate the differential diagnostic efficiency of the parameters and the model.The AUC was compared by DeLong method.Results The gender[odds ratio(OR)5.124,P=0.004],normalized iodine density in the arterial phase(nIoDAP)(OR 5.789,P=0.017),arterial enhancement fraction(AEF)(OR 7.007,P=0.002)and ΔIoD(OR 0.025,P=0.021)were identified as independent predictors for poorly cohesive carcinoma by logistic regression analysis.The AUC of combined model established by four variables in distinguishing poorly cohesive carcinoma and tubular adenocarcinoma was 0.837[95％confidence interval(CI)0.716-0.907],which was significantly higher than that of single tumor spectral CT parameters(P＜0.01).Conclusion The combined model based on patients'gender and tumor spectral CT parameters(nIoDAP,AEF and ΔIoD)can effectively distinguish gastric poorly cohesive carcinoma and tubular adenocarcinoma,providing a basis for gastric cancer patients'individualized treatment strategy.

This study summarized the nursing experience of midline catheter insertion in 12 patients with a body mass index≥50,providing clinical references.Key nursing interventions included:pre-insertion patient positioning was adjusted to semi-Fowler's or sitting position based on respiratory status.The puncture sites were chosen at the middle or distal third of the upper arm with elbow flexion.The widened tourniquets and extended-length needles/catheter sheaths were used according to vascular depth and puncture angle.The modified pre-insertion length measurement and real-time ultrasound-guided vascular puncture were applied.The catheter with crisscross elastic bandage was secured post-insertion.All 12 patients successfully underwent catheterization,with devices removed after completing intravenous therapy and blood sampling.

Objective To establish a combined model of spectral CT multi-parameters and clinical features to distinguish between gastric poorly cohesive carcinoma and tubular adenocarcinoma.Methods A total of 87 patients with gastric cancer confirmed by postoperative pathology were retrospectively selected,including 26 patients with poorly cohesive carcinoma and 61 patients with tubular adenocarcinoma.Predictors were identified by univariate and multivariate logistic regression analyses,and a combined model was established.The area under the curve(AUC)of receiver operating characteristic(ROC)curve was used to evaluate the differential diagnostic efficiency of the parameters and the model.The AUC was compared by DeLong method.Results The gender[odds ratio(OR)5.124,P=0.004],normalized iodine density in the arterial phase(nIoDAP)(OR 5.789,P=0.017),arterial enhancement fraction(AEF)(OR 7.007,P=0.002)and ΔIoD(OR 0.025,P=0.021)were identified as independent predictors for poorly cohesive carcinoma by logistic regression analysis.The AUC of combined model established by four variables in distinguishing poorly cohesive carcinoma and tubular adenocarcinoma was 0.837[95％confidence interval(CI)0.716-0.907],which was significantly higher than that of single tumor spectral CT parameters(P＜0.01).Conclusion The combined model based on patients'gender and tumor spectral CT parameters(nIoDAP,AEF and ΔIoD)can effectively distinguish gastric poorly cohesive carcinoma and tubular adenocarcinoma,providing a basis for gastric cancer patients'individualized treatment strategy.

Indoleamine 2, 3-dioxygenase (IDO) is one of the rate-limiting enzymes that degrade tryptophan (Trp) into kynurenine (Kyn). Inflammatory factor IFN-γ mediates tumor′s immune escape by activating the IDO signaling pathway, upregulating theKyn/Trp (K/T ratio) and suppressing the activity of both CD 8+T and regulatory T cells. Radiotherapy plays a major role in treating non-small cell lung cancer. It not only bi-directionally regulates immune response of the host, but also collaborates with immunosuppressive agents to kill tumors. Meanwhile, immune status of the host can affect the therapeutic effect of radiotherapy. In recent years, studies have shown that IDO activity levels change before and after radiotherapy and is related to clinical prognosis. Nevertheless, relevant mechanism remains unclear. This article aims to elucidate the application of IDO signaling pathway in radiotherapy for non-small cell lung cancer.

Objective To observe any effect of pulmonary rehabilitation in preventing ventilator-associated pneumonia (VAP) among patients receiving invasive mechanical ventilation (MV). Methods A total of 117 a-dults who had be receiving mechanical ventilation for at least 48 hours were randomly divided into an observation group and a control group. Both groups were given routine drug treatment and nursing, but the observation group al-so received comprehensive and individualized pulmonary rehabilitation interventions including airway clearance, respiration training, electrical stimulation of the sacral nerve, lung expansion and early mobilization. The main indi-cators were the incidence of VAP, mortality, MV duration, ICU stay time, and total hospital stay. Results At the end of the treatment the average clinical pulmonary infection score, the acute physiology and chronic health e-valuation Ⅱ score, SpO2 level and oxygenation index of the observation group were all significantly better than those of the control group. The incidence of VAP within one month after leaving the ICU was 47. 5％ in the observation group and the mortality rate was 44.1％, both significantly lower than in the control group. The average MV dura-tion, total hospitalization time and the ICU stay of the observation group were also significantly shorter than those of the control group. Conclusion Early and comprehensive pulmonary rehabilitation can prevent VAP and shorten the length of hospital stays, ICU stays and time on a mechanical ventilator, improving patients' survival chances and prognoses.

Objective To investigate the effect of retinoblastoma binding protein 4 (RBBP4)in Sp1 -mediated HIV long terminal repeat(LTR)transcription.Methods RBBP4 expression vector and Sp1 expression vector were respectively co-transfected into 293 T cells with HIV promoter pHIV-LTR-Luc or Sp1 site mutated pHIV-LTR-sp1 -mut by liposome transfection,and the transfected cells were examined by dual luciferase reporter assay system.The effect of RBBP4 on the binding of Sp1 to LTR was further studied by chromatin immunoprecipitation (ChIP)and electrophoretic mobility shift assay (EMSA).Results The relative firefly luciferase activity activated by Sp1 was decreased from 62.5 to 16 at the dose of 500 ng of RBBP4 expression vector (t =14.52,P <0.01 ).When the Sp1 binding sites were mutated,the effects of 100,300 or 500 ng of RBBP4 expression vector on the firefly luciferase activity of HIV LTR were not statistically significance (t =1 .897,2.357 and 3.162,all P <0.05).ChIP results showed that when the binding of RBBP4 on HIV LTR increased,the binding of Sp1 on HIV LTR increased significantly (t =11 .93,P <0.01 ),while the reduced binding of RBBP4 on HIV LTR significantly attenuated the binding of Sp1 onto LTR(t =11 .38,P <0.01 ).The effect of RBBP4 on the binding of Sp1 to DNA in ChIP assays was further verified by EMSA assays.Conclusion RBBP4 can inhibit the Sp1 -mediated HIV LTR transcription in 293 T cells.

Objective To assess the noninvasive index for diagnosing the degree of esophageal varices (EV) in patients with hepatitis B virus (HBV)-related cirrhosis. Methods The clinical data of 112 patients with HBV-related cirrhosis were studied retrospectively. The patients were divided into non-EV (NEV) group (30 cases) and EV group (82 cases) according to the results of gastroscopy. In EV group, there were mild varices in 21 cases (mild EV group), moderate varices in 47 cases (moderate EV group) and severe varices in 14 cases (severe EV group). The age, gender, platelets, glutamyl transpeptidase, prothrombin time, albumin, bilirubin, portal vein diameter, spleen vein diameter and thickness of spleen were compared, and the relationship was analyzed between each index and EV. Results There were no statistical differences in gender, age, albumin, bilirubin, prothrombin time and glutamyl transpeptidase between NEV group and EV group (P>0.05). The portal vein diameter, spleen vein diameter and thickness of spleen in EV group were significantly higher than those in NEV group:(14.1 ± 3.1) mm vs. (10.6 ± 2.3) mm, (8.9 ± 2.1) mm vs. (7.6 ± 1.6) mm and (4.8 ± 0.9) mm vs. (3.8 ± 1.0) mm, the platelets in EV group was significantly lower than that in NEV group:(86.8 ± 20.2) × 109/L vs. (163.5 ± 18.1) × 109/L, and there were statistical differences (P<0.01 or<0.05). The portal vein diameter, spleen vein diameter and thickness of spleen in moderate EV group and severe EV group were significantly higher than those that in NEV group and mild EV group: (13.5 ± 2.1) and (14.8 ± 3.6) mm vs. (10.6 ± 2.3) and (11.2 ± 3.1) mm, (8.3 ± 2.1) and (9.1 ± 1.1) mm vs. (7.6 ± 1.6) and (8.1 ± 1.9) mm, (4.7 ± 1.1) and (4.9 ± 0.9) mm vs. (3.8 ± 1.0) and (4.1 ± 1.2) mm, the platelet levels were significantly lower than those in NEV group and mild EV group: (72.8 ± 11.6) × 109/L and (63.8 ± 15.6) × 109/L vs. (163.5 ± 18.1) × 109/L and (100.2 ± 10.3) × 109/L, and there were statistical differences (P<0.05). The area under curve of response operating characteristic for predicting the presence of moderate and severe EV with portal vein diameter and platelets were 0.719 and 0.735, and the cut off value were 14 mm and 69 × 109/L. Conclusions The portal vein diameter and platelets can predict the presence of moderate and severe EV in patients with HBV-related cirrhosis.

Objective To explore the mechanism of latent human immunodeficiency ciency virus type 1 (HIV-1) infection is unclear, especially in dendritic cells (DC).We hypothesized that DC-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN) binds with HIV-1 may activate HIV-1 provirus.Methods We generated a model by transfecting 293T cells with a DC-SIGN expression plasmid and a HIV-1 5'long terminal repeat (LTR) reporter plasmid, and then stimulated the 293T cells with HIV-1 gp120 protein, wild-type HIV-1 and VSV-G-pNL4.3 pseudotype virus ( without gp120 protein).CEM-Bru cells were transfected with the DC-SIGN expression plasmid and stimulated by HIV-1 gp120 protein.Then HIV-1 replication was detected.The involvement of the ERK, p38 and NF-κB pathways signaling in this response were determined by inhibiting the pathways specifically and detecting the phosphorylation of the signaling kinase.Results The HIV-1 5'LTR was reactivated by HIV-1 gp120 in DC-SIGN-expressing 293T cells.After HIV-1 gp120 protein stimulation of the mold of CEM-Bru cells, the increasing expression of HIV-1 Tat mRNA and HIV-1 p24,which implies early and late HIV-1 provirus replication was reactivated by the HIV-1 gp120/DC-SIGN stimulation.HIV-1 gp120/DC-SIGN stimulation reactivates latent HIV-1 provirus via the NF-κB signal pathway.Conclusion HIV-1 gp120/DC-SIGN stimulation reactivates latent HIV-1 provirus via the NF-κB signal pathway.