Objective To explore whether butorphanol tartrate as an adjuvant of ropivacaine for brachial plexus block can reduce the incidence of rebound pain after brachial plexus block.Methods Based on sample size calculation,174 patients undergoing upper limb bone surgery were included in this study and randomized into three groups using statistical software:butorphanol tartrate compound local anesthetic(group B1),brachial plexus block with 0.25%ropivacaine 20 mL(including adjuvant butorphanol 1mg);intravenous butorphanol group(group B2),brachial plexus block with 0.25%ropivacaine 20 mL,in addition,1mg of butorphanol was administered i.v;control(group C),only 0.25%ropivacaine 20ml for brachial plexus block.The patients were visited the day before operation,and the basic information of the patients was obtained.At the same time,the Douleur Neuropathique 4 questions(DN4)was used to evaluate whether there were neuropathic components(DN4≥4)in the site to be operated on,and the Numerical rating scale(NRS)was introduced to the patients,and the preoperative NRS value was obtained.30 minutes before the operation,the same anesthesiologist with rich experience in nerve block completed the ultrasound-guided brachial plexus block(interscalene approach),and tested whether the block effect was perfect.After entering the operating room,the patients were given general anesthesia,and the duration of operation,vital signs during operation,dosage of analgesics and whether or not using tourniquet were recorded.After the operation,the patients were sent to the postanesthesia care unit,and then sent to the ward when the patients reached the standard of leaving the room.Distribute pain diaries to patients and their families and instruct them to fill in relevant matters.The patients were followed up at 0 h,6 h,12 h,18 h,24 h and 36 h after operation to obtain the NRS value at each time point after operation,the time when the block disappeared and the highest NRS value within 12 hours,the first use of rescue analgesics,the use of postoperative analgesics,postoperative adverse events and the quality of patient recovery.Results The incidence of rebound pain was 31.6%in B1,48.2%in B2,and 54.4%in C.The pairwise comparison showed statistical difference between B1 and C(P<0.05).Rebound pain score in the three groups was B1 group0.05).There were no statistical differences in the duration of motor block,sensory block duration,duration of analgesia,time to first request for rescue analgesia,and QoR-15 recovery quality score(P>0.05).There was no statistical difference in the incidence of postoperative adverse effects among the three groups(P>0.05).Conclusion This study found that brachial plexus block with 1mg butorphanol tartrate as an adjuvant for ropivacaine reduced the incidence of rebound pain and rebound pain scores after upper limb orthopedic surgery and reduced postoperative opioid consumption.

Objective To explore whether butorphanol tartrate as an adjuvant of ropivacaine for brachial plexus block can reduce the incidence of rebound pain after brachial plexus block.Methods Based on sample size calculation,174 patients undergoing upper limb bone surgery were included in this study and randomized into three groups using statistical software:butorphanol tartrate compound local anesthetic(group B1),brachial plexus block with 0.25%ropivacaine 20 mL(including adjuvant butorphanol 1mg);intravenous butorphanol group(group B2),brachial plexus block with 0.25%ropivacaine 20 mL,in addition,1mg of butorphanol was administered i.v;control(group C),only 0.25%ropivacaine 20ml for brachial plexus block.The patients were visited the day before operation,and the basic information of the patients was obtained.At the same time,the Douleur Neuropathique 4 questions(DN4)was used to evaluate whether there were neuropathic components(DN4≥4)in the site to be operated on,and the Numerical rating scale(NRS)was introduced to the patients,and the preoperative NRS value was obtained.30 minutes before the operation,the same anesthesiologist with rich experience in nerve block completed the ultrasound-guided brachial plexus block(interscalene approach),and tested whether the block effect was perfect.After entering the operating room,the patients were given general anesthesia,and the duration of operation,vital signs during operation,dosage of analgesics and whether or not using tourniquet were recorded.After the operation,the patients were sent to the postanesthesia care unit,and then sent to the ward when the patients reached the standard of leaving the room.Distribute pain diaries to patients and their families and instruct them to fill in relevant matters.The patients were followed up at 0 h,6 h,12 h,18 h,24 h and 36 h after operation to obtain the NRS value at each time point after operation,the time when the block disappeared and the highest NRS value within 12 hours,the first use of rescue analgesics,the use of postoperative analgesics,postoperative adverse events and the quality of patient recovery.Results The incidence of rebound pain was 31.6%in B1,48.2%in B2,and 54.4%in C.The pairwise comparison showed statistical difference between B1 and C(P<0.05).Rebound pain score in the three groups was B1 group0.05).There were no statistical differences in the duration of motor block,sensory block duration,duration of analgesia,time to first request for rescue analgesia,and QoR-15 recovery quality score(P>0.05).There was no statistical difference in the incidence of postoperative adverse effects among the three groups(P>0.05).Conclusion This study found that brachial plexus block with 1mg butorphanol tartrate as an adjuvant for ropivacaine reduced the incidence of rebound pain and rebound pain scores after upper limb orthopedic surgery and reduced postoperative opioid consumption.

Objective To explore the potential categories and influencing factors of the fear of progression in patients with inflammatory bowel diseases(IBD).Methods IBD patients who received inpatient treatment in a tertiary hospital in Nanjing from July 2022 to July 2023 were selected as the study subjects by convenience sampling method.The General Demographic Information Questionnaire,the Chinese version of the Fear of Progression Questionnaire-Short Form(FoP-Q-SF),the Chinese version of Inflammatory Bowel Disease Self-efficacy Scale(IBD-SES),and Social Support Rating Scale(SSRS)were administered to the participants.We applied one-way ANOVA and Logistic regression analysis to identify the factors associated with the potential categories of the fear of progression.Results A total of 303 retumed questionnaires(out of the 310)were valid,resulting an effective response rate of 97.74％.According to the results of latent profile analysis,we classified the respondents into 3 categories by the fear of progression,namely"low risk fear of disease adaptation group"(n=127,41.91％),"medium risk fear of illness distress group"(n=139,45.88％),"high risk fear of dysfunction group"(n=37,12.21％).3 groups showed statistically significant differences in permanent address,self-rated financial pressure,current disease status and self-efficacy(P＜0.05).Conclusion Patients with IBD had obvious differences in characteristics on the fear of progression.Nursing personnel should formulate personalized intervention strategies based on the classification characteristics of the fear of progression of IBD patients.Moreover,nurses should focus on improving patients'self-efficacy and promoting patients to treat medical care,stress and emotion management correctly.

Objective:To evaluate the effect of autologous hematopoietic stem cell transplantation (ASCT) on the treatment of relapsed/refractory multiple myeloma (RRMM) with chimeric antigen receptor T cell (CAR-T) therapy.Methods:A retrospective cohort study. The clinical data of 168 patients with RRMM who underwent CAR-T therapy at the Department of Hematology, Xuzhou Medical University Hospital from 3 January 2020 to 13 September 2022 were analyzed. Patients were classified into a transplantation group (TG; n=47) and non-transplantation group (NTG; n=121) based on whether or not they had undergone ASCT previously. The objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and the levels of CD3, CD4, CD8, CD19, CD56 and natural killer (NK) cells before CAR-T infusion were analyzed by χ2 test, Kaplan-Meier method and independent sample t-test. Results:Among 168 patients with RRMM, 98 (58.3%) were male. The median age of onset was 57 (range 30-70) years. After CAR-T therapy, the ORR of patients was 89.3% (92/103) in the NTG and 72.9% (27/73) in the TG. The ORR of the NTG was better than that of the TG ( χ2=5.71, P=0.017). After 1 year of CAR-T therapy, the ORR of the NTG was 78.1% (75/96), and that of the TG was 59.4% (19/32). The ORR of the NTG was better than that of the TG ( χ2=4.32, P=0.038). The median OS and PFS in the NTG were significantly longer than those in the TG (OS, 30 vs. 20 months; PFS, 26 vs. 12 months; both P<0.05). The CD4 level before CAR-T infusion in the TG was significantly lower than that in the NTG (25.65±13.56 vs. 32.64±17.21; t=-2.15, P=0.034), and there were no significant differences in the counts of CD3, CD8, CD19, CD56, and NK cells between the TG and NTG (all P>0.05). Conclusion:Among patients suffering from RRMM who received CAR-T therapy, patients who did not receive ASCT had significantly better outcomes than those who had received ASCT previously, which may have been related to the CD4 level before receiving CAR-T therapy.

Objective:This study aimed to investigate the effect of lipohypertrophy induced by insulin injection on blood glucose fluctuation in patients with type 1 diabetes mellitus.Methods:A total of 80 patients with type 1 diabetes mellitus were recruited between June 2021 and December 2021 from the First Affiliated Hospital of Nanjing Medical University. And these patients all received insulin injection more than six months. Lipohypertrophy was assessed by ultrasound scanning, and blood glucose fluctuation was evaluated using the flash glucose monitoring system(FGM). Univariate analysis and multivariate linear regression were used to analyze the relationship of lipohypertrophy and and core indicators of blood glucose fluctuation.Results:Compared with patients without lipohypertrophy, patients with lipohypertrophy had higher mean amplitude of glycemic excursions(MAGE), coefficient of variation(CV), mean of daily differences(MODD), standard deviation(SD) of blood glucose, time above range(TAR), and high blood glucose index(HBGI; all P<0.05), while time in range(TIR) of glucose markedly become lower( P<0.01). Moreover, multivariate linear regression analysis showed that lipohypertrophy detected by ultrasound was an independent influencing factor of TIR( β=-9.423, P=0.032), MAGE( β=1.114, P=0.039), CV( β=4.304, P=0.041), MODD( β=0.717, P=0.046) after adjusting for age at diagnosis, duration of insulin injection, fasting C-peptide, and daily dose of insulin per unit weight. Conclusion:Lipohypertrophy increases glycemic variability and imposes negative impact on glycemic control rate in patients type 1 diabetes mellitus.

Objective:To investigate the ego-depletion level of adolescents with type 1 diabetes mellitus (T1DM) and to explore its association with glycemic control and quality of life.Methods:This was a cross-sectional survey study. A total of 195 adolescents with T1DM were recruited from the First Affiliated Hospital of Nanjing Medical University from March to September 2022 by convenient sampling method. The Self-Regulatory Fatigue Scale (SRF-S) and Short Form of the Chinese version Diabetes Quality of Life for Youth Scale (C-DQOLY-SF) and the general information questionnaire were collected and the glycated hemoglobin (HbA 1c) value was detected. Results:The total score of self-regulatory fatigue for 195 adolescents with T1DM was (42.23 ± 9.94) points, with a scoring rate of 52.79%, which was at a medium level. Pearson correlation analysis showed that the total score of self-regulatory fatigue was positively correlated with HbA1c ( r = 0.25, P<0.01), and negatively correlated with quality of life ( r = -0.61, P<0.01). The hierarchical linear regression results showed that after controlling for demographic sociolagy and disease variables, ego-depletion had a positive predictive effect on HbA1c ( t = 3.69, P<0.01), while ego-depletion had a negative predictive effect on Quality of life ( t = -8.48, P<0.01). Conclusions:Ego-depletion of adolescents with T1DM may affect their blood glucose control and quality of life, which should be noticed by medical workers.

Inflammatory bowel disease (IBD) is a chronic non-specific intestinal inflammatory disease of unknown etiology, which is characterized by recurrent episodes and prolonged refractory recovery. Financial toxicity refers to the objective economic burden and subjective economic distress caused by medical expenses caused by the disease to patients. IBD patients show a certain level of financial toxicity due to frequent visits to doctors for a long time. This article reviews the concept of financial toxicity, evaluation tools and the current status of financial toxicity in IBD patients, analyzes the influencing factors of financial toxicity in IBD patients from the aspects of general demography factors, disease and treatment and psychosocial aspects, summarizes and puts forward the countermeasures of toxicity of IBD patients to reduce the economic and the direction of the future study, so as to provide reference for related research.

Patients' subjective feelings, that is, patient-reported outcomes, has attracted increasing attention in patients with inflammatory bowel disease (IBD) , which plays an important role in monitoring the progress of patients' disease and guiding clinical decision-making. This article reviews the current status of assessment tools and clinical applications of patient-reported outcomes in IBD patients. This article aims to help medical and nursing staff choose assessment tools suitable for IBD patients in China, standardize the development and localization process of assessment tools, promote the application and development of patient-reported outcomes of IBD patients in China, and optimize disease management of IBD patients.

Natural products, and especially the active ingredients found in traditional Chinese medicine (TCM), have a thousand-year-long history of clinical use and a strong theoretical basis in TCM. As such, traditional remedies provide shortcuts for the development of original new drugs in China, and increasing numbers of natural products are showing great therapeutic potential in various diseases. This paper reviews the molecular mechanisms of action of natural products from different sources used in the treatment of inflammatory diseases and cancer, introduces the methods and newly emerging technologies used to identify and validate the targets of natural active ingredients, enumerates the expansive list of TCM used to treat inflammatory diseases and cancer, and summarizes the patterns of action of emerging technologies such as single-cell multiomics, network pharmacology, and artificial intelligence in the pharmacological studies of natural products to provide insights for the development of innovative natural product-based drugs. Our hope is that we can make use of advances in target identification and single-cell multiomics to obtain a deeper understanding of actions of mechanisms of natural products that will allow innovation and revitalization of TCM and its swift industrialization and internationalization.

Objective:To observe the local reactions and efficacy of CD19 CAR-T therapy in recurrence/refractory B-cell non-Hodgkin's lymphoma (R/R NHL) patients with >7.5 cm lesions.Methods:32 R/R NHL patients with >7.5 cm lesions were enrolled and injected with CD19 CAR-T cells. Flow cytometry was used to detect and observe the amplification of CD19 CAR-T cells in vivo. Enzyme-linked immunosorbent assay (ELISA) was used to detect cytokines in peripheral blood of patients. The side effects of CD19 CAR-T cell therapy included systemic side effects and local reactions of tumor. The local side effects were observed by Ultrasound, Computed tomography and Magnetic resonance imaging. Treatment options included glucocorticoid, interleukin-6 antibody and drainage of exudate. Overall response rate (ORR) and overall survival rate (OS) were observed.Results:①Among the 32 patients, CR (40.63%) , PR (31.25%) and ORR (71.88%) were 13, 10 and 23, respectively. ②In all 23 patients received ORR, 13 patients had grade 1-2 CRS, while 10 patients had grade 3-4 CRS. All the 9 patients in the SD+PD group had grade 1-2 CRS ( P=0.030) . ③A total of 15 patients with tumor local reactions, included 9 patients with CR, 5 patients with PR and 1 patient with SD. The local reactions of the tumor included that the diameter of the superficial lesions increased with redness, swelling and heat pain. The deep lesions presented abdominal pain, abdominal distension, suffocation and local pain, and burning of the tumor. The deep lesions were enlarged or accompanied by local edema. The local exudative lesions were found in the abdominal cavity and pleural cavity. ④ Peak proportion of CD19 CAR-T cells in ORR group was higher than that of in SD+PD group[16.8% (5.3%-48.2%) vs 2.9% (1.5%-5.7%) , z=-4.297, P<0.001]. The peak proportion of CD19 CAR-T cells in ORR group with local reactions was higher than that of in patients without local reactions [22.2% (10.5%-48.2%) vs 12.6% (5.3%-21.6%) , z=-3.213, P=0.001]. The peak proportion of CD19 CAR-T cells in multiple lesion group was higher than that of in single lesion group [35.8% (1.5%-48.2%) vs 16.8% (10.5%-18.5%) , z=-2.023, P=0.040]. ⑤Occurrence of local reactions and tumor shrinkage time were both delayed compared with systemic side effects. ⑥In the ORR group, the OS of patients with tumor local reactions was longer than that of patients without tumor local reactions, but there was no difference in the two groups (75% vs 34.6%, P=0.169) . Conclusions:CD19 CAR-T cell therapy in R/R NHL patients with >7.5 cm lesions might cause tumor local reactions later than systemic side effects.Clinicaltrial::ChiCTR1800018059