Objective To identify the risk factors and investigate etiological spectrum of pulmonary fungal infections(PFIs)in patients with end-stage liver disease(ESLD).Methods A retrospective analysis was performed on the clinical data of 211 ESLD patients.Based on pulmonary imaging,clinical manifestations,and microbiological test results,patients were categorized into three groups,including the PFI group(or the case group),the non-fungal pneumonia group(or the control group 1),and the group without pneumonia(or the control group 2).The clinical characteristics of patients in the the case group were then compared with those of patients in the two control groups.Taking patients without pneumonia as the control,univariate and multivariate logistic regression analyses were performed to identify independent risk factors for PFI,and a nomogram prediction model was constructed based on these risk factors.Results Among the 211 patients,76(36.1%)had PFIs,46(21.8%)had non-fungal pneumonia,and 89(42.2%)did not have pneumonia.According to findings from the multivariate logistic regression,elevated white blood cell count upon admission(OR=1.211;95%CI,1.011-1.460),higher Model for End-Stage Liver Disease-Sodium(MELD-Na)score(OR=1.140;95%CI,1.021-1.282),concomitant hepatorenal syndrome(OR=4.150;95%CI,1.050-17.300),cumulative glucocorticoid use for more than seven days(OR=26.832;95%CI,6.361-113.221),and the administration of broad-spectrum antibiotics at the time of hospital admission(OR=6.601;95%CI,1.951-22.362)were identified as independent risk factors for PFI.A predictive nomogram model named TJLFPFI was constructed based on these risk factors.The area under the receiver operating characteristic(AUC)curve of the model was 0.899(95%CI,0.853-0.945).Etiologic analysis of the 76 PFI cases revealed that 36(47.4%)had positive results for culture,while 40(52.6%)had negative results for sputum culture but tested positive by the 1,3-β-D-glucan test and/or galactomannan test.Aspergillus was the most frequently identified pathogen,detected in 25 of the 36 cases(59.5%).Conclusion PFI in ESLD patients is closely associated with disease severity at admission,early use of broad-spectrum antibiotics,and prolonged glucocorticoid therapy.Aspergillus is the predominant pathogen.The TJLFPFI model shows potential value in identifying high-risk patients,but prospective validation is still warranted.

A 34-year-old female patient with multiple injuries in a car accident was admitted to hospital and received inosine injection.After 11 days,leukemioid reaction mainly characterized by"abnormal increase in white blood cell count"occurred,and the white blood cell count reached up to 38.26×109·L-1.Considering that inosine injection was the cause,the white blood cell count gradually decreased to 15.84×109·L-1 after the drug was stopped.Naranjo's assessment scale was used to evaluate the association of adverse reactions,with a score of 6,and the result was"very likely to be relevant".The cases reported in this paper belong to new adverse reactions caused by inosine injection,suggesting that inosine injection as an adjunct should pay attention to drug safety.If there is an abnormal increase in white blood cell count,it is necessary to be alert to the possibility of"leukemioid reaction"and stop the drug in time if necessary.

A 34-year-old female patient with multiple injuries in a car accident was admitted to hospital and received inosine injection.After 11 days,leukemioid reaction mainly characterized by"abnormal increase in white blood cell count"occurred,and the white blood cell count reached up to 38.26×109·L-1.Considering that inosine injection was the cause,the white blood cell count gradually decreased to 15.84×109·L-1 after the drug was stopped.Naranjo's assessment scale was used to evaluate the association of adverse reactions,with a score of 6,and the result was"very likely to be relevant".The cases reported in this paper belong to new adverse reactions caused by inosine injection,suggesting that inosine injection as an adjunct should pay attention to drug safety.If there is an abnormal increase in white blood cell count,it is necessary to be alert to the possibility of"leukemioid reaction"and stop the drug in time if necessary.

Objective To analyze the core functional component groups(CFCG)in Yinchenhao Decoction(YCHD)and their possible pathways for treating hepatic fibrosis based on network pharmacology.Methods PPI data were extracted from DisGeNET,Genecards,CMGRN and PTHGRN to construct a weighted network using Cytoscape 3.9.1.The data of the chemical components in YCHD were obtained from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and the potential active components and targets were selected using PreADMET Web server and SwissTargetPrediction.A fusion model was constructed to obtain the functional effect space and evaluate the effective proteins to identify the CFCG followed by GO and KEGG pathway enrichment analyses for all the targets.In cultured human hepatic stellate cells(LX-2 cells),the cytotoxicity of different compounds in YCHD was tested using CCK-8 assay;the effects of these compounds on collagen α1(Col1a1)mRNA expression and the pathways in 20 ng/mL TGF-β1-stimulated cells were analyzed using RT-qPCR and Western blotting.Results A total of 1005 pathogenic genes,226 potential active components and 1529 potential targets in YCHD and 52 potential targets of CFCG were obtained.Benzyl acetate,vanillic acid,clorius,polydatin,lauric acid and ferulic acid were selected for CCK-8 verification,and they all showed minimal cytotoxicity below the concentration of 200 μmol/L.Clorius,polydatin,lauric acid and ferulic acid all effectively inhibited TGF-β1-induced LX-2 cell activation.At the concentration of 200 μmol/L,all these 4 components inhibited PI3K,p-PI3K,AKT,p-AKT,ERK,p-ERK,P38 MAPK and p-P38 MAPK expressions in TGF-β1-induced LX-2 cells.Conclusion The therapeutic effect of YCHD on hepatic fibrosis is probably mediated by its core functional components including benzyl acetate,vanillic acid,clorius,polydatin,lauric acid and ferulic acid,which inhibit the PI3K-AKT and MAPK pathways in hepatic stellate cells.

Tumor immune microenvironment is a local external tumor environment composed of tumor immune cells and the cytokines secreted by these cells， and it plays a regulatory role in the development and progression of tumors. In the treatment of hepatocellular carcinoma， amino acid metabolism and its reprogramming of proliferating cell metabolism have attracted more and more attention， showing potential in regulating the tumor immune microenvironment. Although amino acid metabolic reprogramming is regarded as a novel approach for tumor therapy， its specific mechanism remains unclear in the regulation of tumor immunity in hepatocellular carcinoma. This article discusses the mechanism of action of amino acid metabolism in the tumor immune microenvironment of hepatocellular carcinoma and its application prospect in clinical practice， in order to provide new ideas for immunotherapy for liver cancer.

Objective To analyze the core functional component groups(CFCG)in Yinchenhao Decoction(YCHD)and their possible pathways for treating hepatic fibrosis based on network pharmacology.Methods PPI data were extracted from DisGeNET,Genecards,CMGRN and PTHGRN to construct a weighted network using Cytoscape 3.9.1.The data of the chemical components in YCHD were obtained from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and the potential active components and targets were selected using PreADMET Web server and SwissTargetPrediction.A fusion model was constructed to obtain the functional effect space and evaluate the effective proteins to identify the CFCG followed by GO and KEGG pathway enrichment analyses for all the targets.In cultured human hepatic stellate cells(LX-2 cells),the cytotoxicity of different compounds in YCHD was tested using CCK-8 assay;the effects of these compounds on collagen α1(Col1a1)mRNA expression and the pathways in 20 ng/mL TGF-β1-stimulated cells were analyzed using RT-qPCR and Western blotting.Results A total of 1005 pathogenic genes,226 potential active components and 1529 potential targets in YCHD and 52 potential targets of CFCG were obtained.Benzyl acetate,vanillic acid,clorius,polydatin,lauric acid and ferulic acid were selected for CCK-8 verification,and they all showed minimal cytotoxicity below the concentration of 200 μmol/L.Clorius,polydatin,lauric acid and ferulic acid all effectively inhibited TGF-β1-induced LX-2 cell activation.At the concentration of 200 μmol/L,all these 4 components inhibited PI3K,p-PI3K,AKT,p-AKT,ERK,p-ERK,P38 MAPK and p-P38 MAPK expressions in TGF-β1-induced LX-2 cells.Conclusion The therapeutic effect of YCHD on hepatic fibrosis is probably mediated by its core functional components including benzyl acetate,vanillic acid,clorius,polydatin,lauric acid and ferulic acid,which inhibit the PI3K-AKT and MAPK pathways in hepatic stellate cells.

Objective To develop a humanistic care nursing plan for conscious patients in ICU based on narrative nursing theory and to provide a theoretical basis and practical guidance for clinical humanistic care.Methods Literature reviews and qualitative interviews were applied to examine the current situation and needs of humanistic care for critically ill patients at home and abroad.Based on the narrative nursing theory proposed by Jiang and Li,the first draft of humanistic care plan for ICU conscious patients was created based on care procedures by brainstorming among group members.The plan was finalised after two rounds of consultations with nursing specialists using Delphi's method.Results Effective return rate was 100%from both rounds of questionnaires.The expert authority coefficient was 0.917,the Kendall's coefficient of concordance W for the importance of items in the two rounds of inquiries were 0.331 and 0.421,respectively,and the Kendall's coefficient of concordance W for feasibility were 0.328 and 0.349,respectively(P<0.001).The mean scores for the importance of item content were 3.43 to 5.00,and 3.73 to 5.00,with coefficients of variation from 0 to 0.28 and 0 to 0.24,respectively.The mean scores for feasibility were 3.30 to 5.00,and 3.60 to 5.00,with coefficients of variation from 0 to 0.21 and 0 to 0.23,respectively.The finalised humanistic care plan included three first-level items:pre-implementation assessment and preparation,implementation process,and effectiveness evaluation,with a total of 12 secondary items and 31 tertiary items.Conclusion After statistical analysis,it is found that based on narrative nursing theory,the humanistic care nursing plan for conscious patients in ICU developed in this study,is reliable,highly operational,feasible,scientifically sound and practical.

Objective To develop a humanistic care nursing plan for conscious patients in ICU based on narrative nursing theory and to provide a theoretical basis and practical guidance for clinical humanistic care.Methods Literature reviews and qualitative interviews were applied to examine the current situation and needs of humanistic care for critically ill patients at home and abroad.Based on the narrative nursing theory proposed by Jiang and Li,the first draft of humanistic care plan for ICU conscious patients was created based on care procedures by brainstorming among group members.The plan was finalised after two rounds of consultations with nursing specialists using Delphi's method.Results Effective return rate was 100%from both rounds of questionnaires.The expert authority coefficient was 0.917,the Kendall's coefficient of concordance W for the importance of items in the two rounds of inquiries were 0.331 and 0.421,respectively,and the Kendall's coefficient of concordance W for feasibility were 0.328 and 0.349,respectively(P<0.001).The mean scores for the importance of item content were 3.43 to 5.00,and 3.73 to 5.00,with coefficients of variation from 0 to 0.28 and 0 to 0.24,respectively.The mean scores for feasibility were 3.30 to 5.00,and 3.60 to 5.00,with coefficients of variation from 0 to 0.21 and 0 to 0.23,respectively.The finalised humanistic care plan included three first-level items:pre-implementation assessment and preparation,implementation process,and effectiveness evaluation,with a total of 12 secondary items and 31 tertiary items.Conclusion After statistical analysis,it is found that based on narrative nursing theory,the humanistic care nursing plan for conscious patients in ICU developed in this study,is reliable,highly operational,feasible,scientifically sound and practical.

The gut microbiota has been found to interact with the brain through the microbiota-gut-brain axis, regulating various physiological processes. In recent years, the impacts of the gut microbiota on neurodevelopment through this axis have been increasingly appreciated. The gut microbiota is commonly considered to regulate neurodevelopment through three pathways, the immune pathway, the neuronal pathway, and the endocrine/systemic pathway, with overlaps and crosstalks in between. Accumulating studies have identified the role of the microbiota-gut-brain axis in neurodevelopmental disorders including autism spectrum disorder, attention deficit hyperactivity disorder, and Rett Syndrome. Numerous researchers have examined the physiological and pathophysiological mechanisms influenced by the gut microbiota in neurodevelopmental disorders (NDDs). This review aims to provide a comprehensive overview of advancements in research pertaining to the microbiota-gut-brain axis in NDDs. Furthermore, we analyzed both the current state of research progress and discuss future perspectives in this field.
Humans ; Brain-Gut Axis ; Autism Spectrum Disorder/metabolism* ; Brain/metabolism* ; Gastrointestinal Microbiome ; Neurodevelopmental Disorders/metabolism*

Background The tobacco epidemic as one of the most serious public health problems in the world contributes great harm to human health. It is urgent to develop tobacco control strategy. Civil servants' behaviors as a role model for society have a great influence on the rest of society. Thus, it is important to promote tobacco control program on helping civil servants to quit smoking. Objective To understand the smoking and second-hand smoking exposures status, the awareness of knowledge of tobacco hazards, and the attitudes to tobacco control policies of civil servants in Minhang District, Shanghai. Furthermore, to explore the related strategies and measures for tobacco control, to provide a basis for the development and revision of relevant intervention measures and policies. Methods A total of 20 government agencies with newly installed smoking-free programs from 10 subdistricts and towns in Minhang District, including Xinzhuang, Wujing, Maqiao, Qibao, Meilong, Hongqiao, Zhuanqiao, Jiangchuan, Gumei, and Xinhong were selected as study sites.A questionnaire survey was conducted to investigate all civil servants (n=801) of selected agencies. The questionnaire included general characteristics, smoking and second-hand smoking exposure status, knowledge of tobacco hazard, and attitudes to tobacco control policies. Results A total of 794 civil servants returned valid questionnaires. The awareness rate of tobacco hazards in the smoking group was lower than that in the non-smoking group (P<0.05). Relatively high smoking rates were reported in those being male (17.08%), age ≥51 years old (25.61%), divorced or widowed (12.50%), technical secondary school or below education level (22.81%), having more than 10 years of working years (11.57%), being willing to dissuade indoor smoking (24.54%), having no punishment or warning measures for violation of smoking regulations in workplaces (18.37%), and having no dedicated smoking spot at home (15.38%). The results of multiple logistic regression analysis showed that age 31-40 years old (OR=3.446, 95%CI: 1.236-9.609) and to avoid confronting indoor smoking (OR=3.686, 95%CI: 1.041-13.049) were risk factors for smoking in civil servants. Conclusion Civil servants aged 31-40 years old who deliberately avoid confronting indoor smoking behaviors are the key intervention population of smoking control in Minhang District, Shanghai.