Urticarial vasculitis is a skin disease with urticaria-like lesions and a histopathological pattern of leukocytoclastic vasculitis. It is considered a "hidden rash" in traditional Chinese medicine. Xuanfu is the portal that regulates qi, blood, fluid, and the ascending, descending, exiting, and entering of nutrition qi and defensive qi. Collaterals are the pathways for the circulation of qi and blood. The two accompany each other, connecting zang-fu organs, reaching the surfaces of the skin, hair, and external body, circulating qi and fluid, and moistening and protecting the skin. Based on the theory of Xuanfu-collateral, this study aimed to clarify the etiology, pathogenesis, and treatment method of urticarial vasculitis. External assault by wind and Xuanfu blockage are believed to be the initiating factors of this disease. The malnutrition of Xuanfu and collaterals and accumulated dampness-heat are important links in the occurrence and development of urticarial vasculitis. It spreads from Xuanfu to the collaterals, and blockage of the collaterals is the immanent trend of this disease. Clinically, by closely adhering to the core pathogenesis of blockage of Xuanfu-collateral, treatment method such as using wind medicinals to open Xuanfu with pungent and dispersing properties, using the method of supplement deficiency and removing the blockage, and using medicinals to promote blood circulation and remove blood stasis to unblock the blocked collaterals. The herbs are flexibly added or subtracted to unblock Xuanfu and collaterals, harmonize qi and blood, thus all symptoms can be relieved. We hope that this study will provide new ideas for the treatment of urticarial vasculitis with traditional Chinese medicine.

AIM:To evaluate the efficacy and safe-ty of vedolizumab in the treatment of inflammato-ry bowel disease.METHODS:The clinical data of 25 patients with inflammatory bowel disease(IBD)(13 ulcerative colitis(UC)and 12 Crohn's disease(CD))treated with vedolizumab(VDZ)in the Anorectal department of our hospital from July 2020 to Au-gust 2023 were retrospectively collected.VDZ 300 mg was given intravenously at weeks 0,2 and 6 to induce remission,and 300 mg was given intrave-nously every 8 weeks to maintain remission.The evaluation was carried out after 30 weeks of treat-ment.The primary efficacy indicators included clini-cal response rate,clinical remission rate,and endo-scopic remission rate.The secondary efficacy indi-cators included nutritional status indicators(body weight(Wt),hemoglobin(HGB),albumin(ALB),he-matocrit(HCT)),inflammation degree indicators(high-sensitivity C-reactive protein(hs-CRP),eryth-rocyte sedimentation rate(ESR)).All adverse reac-tions that occurred during VDZ treatment were re-corded.RESULTS:The total clinical response rate of IBD patients treated with VDZ for 6 weeks and 14 weeks was 32％and 60％,respectively.The total clinical remission rate of IBD patients treated with VDZ for 14 weeks and 30 weeks was 16％and 36％,respectively.There was no significant difference in clinical response rate and clinical remission rate be-tween UC and CD treated with VDZ(P＞0.05).After 30 weeks of treatment,the body weight of UC pa-tients was significantly increased,the levels of HCT％,ALB and HGB were significantly improved,and the level of ESR was significantly decreased.Af-ter 30 weeks of treatment,the body weight of CD patients increased significantly,and the inflamma-tory index hs-CRP,nutritional index HCT％,ALB and HGB levels were significantly improved.One pa-tient had an increase in white blood cell count af-ter the third infusion of VDZ,and no other adverse reactions occurred.CONCLUSION:As an induction and maintenance therapy for IBD patients,VDZ can alleviate intestinal inflammation,relieve clinical symptoms,improve nutritional status and improve quality of life of patients,with high safety.

Chronic myeloid leukemia (CML) with e6a2 transcript type is very rare in clinic,which is usually related to disease aggressiveness. Its clinical characteristics and relationship with tyrosine kinase inhibitor efficacy are still unclear. In this paper, the clinical characteristics and related laboratory tests of a patient with e6a2 fusion gene positive CML characterized by multiple osteolytic bone destruction throughout the body and eosinophil infiltration in gastrointestinal tract, lymph nodes and other organs were retrospectively analyzed, and the relevant literature was reviewed. The patient was Ph chromosome positive with chromosome +8, and the common BCR::ABL1 transcript of CML was negative, but e6a2 transcript was positive detected by RT-PCR. The patient was treated with dasatinib 100 mg/d. Three months later, the patients achieved CHR, CCyR and MR4.0. However, the e6a2 transcript is very rare in clinical practice, and more cases of e6a2 transcript need to be studied to clarify its clinical characteristics and improve the treatment effect of these rare cases.

Objective To analyze the domestic antibody drug safety and risk research status,the latest research hotspots and frontiers in the current ten years.Methods CiteSpace 6.2.R2 software was used to analyze all literature related to the safety and risk of antibody drugs in CNKI,WanFang data and Vip database from 2012 to 2022.Results A total of 2 773 pieces of literature were obtained from the three databases,which were imported into CiteSpace after deduplication,and finally,1 870 pieces were included in the analysis.In the past decade,the number of articles published in the field of antibody drugs safety and risk research has remained at about 100 articles per year from 2012 to 2019,since 2020,the number of articles published has started to increase,and the annual number of articles published has increased to around 300 articles from 2021 to 2022.The network graph of domestic institutional cooperation showed that there was a lack of cooperation among the research institutions of antibody drug safety and risk research,mainly due to the fact that hospitals were conducting research in this field,and the types of research subjects were relatively single.The author collaboration network graph showed that the core teams in this research field,such as Li Bo,Yang Yanwei,and Lin Zhi,had the closest collaboration,while there was less collaboration among high-yield authors,additionally,some experts and scholars conducted research on their own as individuals or small groups,the research focused on adverse reactions,safety,bevacizumab,Rituximab,Meta-analysis,etc.Conclusion In the past decade,domestic research has mainly focused on the clinical efficacy and safety of antibody drugs,with few scholars exploring the risk of antibody drugs,therefore,in the future,it is necessary to pay attention to the research on the risks of antibody drugs.

Terminally ill patients face multiple difficulties in home care.Home-based palliative care ad-hering to the concept of whole-person,whole-family,whole-team,and whole-course care is able to meet the needs of terminally ill patients and their families.In this paper,we reported the care history and home-based pal-liative care process of a patient with end-stage breast tumor and summarized the experience,aiming to provide reference for the future work of home-based palliative care.

Disturbances of gut microbiota may affect the balance of the host immune system.The metabolism of gut microbiota produces many bioactive molecules interacting with host,typically secondary bile acids(SBAs).SBAs are involved in regulating the energy metabolism and the expression of inflammatory response-related genes by bind-ing to membrane receptors and nuclear receptors,such as takeda G protein-coupled receptor(TGR5)and farnesol X receptor(FXR),which are essential for maintaining host immune homeostasis.

ObjectiveTo investigate effect of Maxing Shigantang and supplemented Guominjian decoction on symptoms and levels of inflammatory cytokines in induced sputum of children with cough variant asthma （CVA）. MethodA total of 118 CVA children who were treated in our hospital from January 2020 to January 2021 were enrolled and randomized into the control group and the observation group with the random number table method. Control group received routine western medicine and the observation group was treated by routine western medicine， Maxing Shigantang， and supplemented Guominjian decoction. In the one-month follow-up， the scores of cough and accompanying symptoms， levels of inflammatory cytokines ［interleukin-10 （IL-10）， interleukin-5 （IL-5）， tumor necrosis factor-α （TNF-α）， neutrophil， eosinophil］ in induced sputum， pulmonary function parameters ［forced vital capacity （FVC）， forced expiratory volume in one second （FEV₁）， FEV₁/FVC］， and treatment outcomes were compared between the two groups. Moreover， the frequency of acute asthma attacks during the three-month follow-up was also compared. ResultNo cases dropped out from this study. After treatment， the scores of cough and accompanying symptoms were decreased in both groups （P<0.05） and were lower in observation group than in control group （P<0.05）. After treatment， FVC， FEV₁， and FEV₁/FVC were raised in both groups and were higher in observation group than in control group （P<0.05）. The increase in the level of IL-10 along with the decrease in levels of IL-5， TNF-α， neutrophil， and eosinophil in induced sputum was found in both groups after treatment （P<0.05）， and observation group had higher level of IL-10 and lower levels of IL-5， TNF-α， neutrophil， and eosinophil than the control group （P<0.05）. The effective rate was 86.44% （51/59） in observation group， which was higher than the 69.49% （41/59） in control group （χ²=4.933， P<0.05）. No serious adverse reaction occurred in either group. The frequency of acute asthma attacks during the three-month follow-up was （1.09±0.18） in observation group， which was lower than the （2.83±049） in the control group （P<0.05）. ConclusionRoutine western medicine combined with Maxing Shigantang and supplemented Guominjian decoction can effectively and safely alleviate the airway inflammatory responses， control the clinical symptoms， improve pulmonary function， and reduce the frequency of acute recurrence in the treatment of CVA children.

Objective:To survey the job satisfaction of online contracted nurses who provide " Internet plus nursing services" for reference of hospital managers in improving their management mechanism in this regard.Methods:Based on the two-factor theory, a questionnaire was designed and a purposive sampling method was used to survey the online contracted nurses in Anhui province in April and May 2022. The motivational factors included such five dimensions as workload, work content, colleague relationship, doctor-patient relationship, and their own development, and the healthcare factors included such three dimensions as salary, job recognition and social status. The questionnaire data and job satisfaction scores were analyzed descriptively, and the correlation between the overall job satisfaction of the online contracted nurses, while each dimension was analyzed by Pearson correlation analysis, and the influence of each dimension on job satisfaction was analyzed by stepwise regression analysis.Results:A total of 335 valid questionnaires were recovered. The mean score of job satisfaction of online contracted nurses was (2.26±0.38), with the highest score of (2.56±0.53) for salary satisfaction and the lowest score of (1.78±0.67) for job recognition, and each dimension was positively correlated with job satisfaction ( r=0.34-0.88, P<0.01). Regression analysis showed that workload ( B=0.07), salary ( B=0.11), job content ( B=0.23), social status ( B=0.12), and self-development ( B=0.15) were the main factors affecting their job satisfaction ( P<0.01). Conclusions:The job satisfaction of online contracted nurses was at a medium level, mainly influenced by workload, salary, job content, social status and their own development. It is recommended that hospitals implement multiple targeted measures to improve the job satisfaction of online contracted nurses and promote the healthy development of " Internet plus nursing services" .

OBJECTIVE: To investigate the correlation of procalcitonin (PCT), interleukin-6 (IL-6) and antithrombin III (AT III) with the severity of sepsis, and to compare the predictive value of the above indicators alone or in combination. METHODS: A retrospective cohort study was conducted. Eighty-five patients with sepsis admitted to the department of intensive care medicine of Shandong Provincial Hospital Affiliated to Shandong First Medical University from April 2021 to September 2022 were enrolled. General information, sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation II (APACHE II) score within 24 hours of admission, inflammatory indicators [PCT, IL-6, serum amyloid A (SAA), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP)] and coagulation indicators (D-dimer and AT III) levels at admission, and 28-day prognosis were collected. The differences of the above indicators were compared among patients with different prognosis at 28 days and different severity of sepsis. The correlation between PCT, IL-6, AT III and the severity of sepsis was analyzed by Spearman rank correlation method. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of PCT, IL-6 and AT III alone or in combination on the 28-day death of patients with sepsis. RESULTS: Eighty-five patients were enrolled finally, 67 cases survived and 18 cases died at 28 days. The mortality was 21.2%. There were no statistical significant differences in gender, age and other general data between the two groups. The patients in the death group were more serious than those in the survival group, and PCT, IL-6, and CRP levels were significantly higher than those in the survival group [PCT (μg/L): 4.34 (1.99, 14.42) vs. 1.17 (0.31, 3.94), IL-6 (ng/L): 332.40 (50.08, 590.18) vs. 61.95 (31.64, 194.20), CRP (mg/L): 149.28 (75.34, 218.60) vs. 83.23 (48.22, 174.96), all P < 0.05], and AT III activity was significantly lower than that in the survival group [(53.67±28.57)% vs. (80.96±24.18)%, P < 0.01]. However, there were no significant differences in D-dimer, NLR and SAA between the two groups. Among the 85 patients, 36 had sepsis with single organ dysfunction, 29 had sepsis with multiple organ dysfunction, and 20 had septic shock with multiple organ dysfunction. With the increase of the severity of sepsis, PCT and IL-6 levels gradually increased [PCT (μg/L): 0.36 (0.19, 1.10), 3.00 (1.22, 9.94), 4.34 (2.18, 8.86); IL-6 (ng/L): 43.99 (20.73, 111.13), 100.00 (45.37, 273.00), 332.40 (124.4, 693.65)], and the activity of AT III decreased gradually [(89.81±21.42)%, (71.97±24.88)%, and (53.50±25.41)%], all with statistically significant differences (all P < 0.01). Spearman rank correlation analysis showed that PCT and IL-6 levels in sepsis patients were significantly positively correlated with the severity of the disease (r values were 0.562 and 0.517, respectively, both P < 0.01), and AT III activity was significantly negatively correlated with the severity of the disease (r = -0.523, P < 0.01). ROC curve analysis showed that PCT, IL-6, and AT III alone or in combination had some predictive value for the death of sepsis patients at 28 days. The area under the ROC curve (AUC) of the above three indicators in combination was higher than that of the individual tests (0.818 vs. 0.722, 0.725, and 0.770), with a sensitivity of 83.3% and a specificity of 73.1%. CONCLUSIONS PCT, IL-6, and AT III were significantly correlated with the severity of sepsis patients. The combined assay of the above three indicators can effectively improve the prediction of the prognosis of sepsis patients.
Humans ; Procalcitonin ; Interleukin-6 ; Antithrombin III ; Retrospective Studies ; Multiple Organ Failure ; ROC Curve ; Sepsis/diagnosis* ; Prognosis ; C-Reactive Protein/analysis* ; Anticoagulants

【Objective】 To establish a paper-free system of the total whole blood donation flow in constructing intelligent blood stations, and build digitalized whole blood donation system for practice. 【Methods】 A paper-free whole blood collection system was constructed through information process reforming, system frame designing and data network transportation constructing, and was applied in various blood donation scenario. 【Results】 Fixed blood collection sites carried out 49 063 donations via paper-free information system from November 2022 to July 2023, and 24 822 donations( group blood donation) were conducted via paper-free system from April to July 2022. Compared with the traditional paper-based model, paper-free system is safer, more standardized and more convenient, effectively enhancing the experience of blood donors. 【Conclusion】 The construction of paper-free whole blood collection system effectively enhances the experience of blood donors, improves the safety, accuracy, traceability of the data, and has good social value and economic value, which is worth popularizing.