Objective To observe the clinical efficacy of Dan Qi Yishen Prescription in treating diabetic nephropathy(DN)and explore its renal protective mechanism.Methods A total of 150 patients with DN of qi-yin deficiency complicated with blood stasis syndrome who admitted to Sanya Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from October 2021 to April 2023 were divided into a control group and an observation group according to the random number table method,with 75 patients in each group.Both groups were given conventional therapies such as dietary treatment,blood glucose control,blood pressure control,lipid-lowering treatment and treatment of complications.Additionally,the control group was given intravenous injection of reduced glutathione,while the observation group was given oral use of the decoction of Dan Qi Yishen Prescription and ionic introduction of Dan Qi Yishen Prescription in renal region.Thirty days constituted one course of treatment,and both groups were treated for three courses.Before and after treatment,the scores of traditional Chinese medicine(TCM)syndrome,and the levels of renal function indicators,renal hemodynamic indicators,coagulation and fibrinolysis indicators,and vascular endothelial function indicators in the two groups were observed.Results(1)After treatment,the scores of TCM symptoms such as fatigue and weakness,palpitations and shortness of breath,dizziness and tinnitus,spontaneous sweating and night sweating,restlessness and insomnia,and thirst with preference for drinks in the two groups were decreased compared with those before treatment(P<0.01),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).(2)After treatment,the levels of renal function indicators such as blood urea nitrogen(BUN),serum creatinine(SCr),collagen Ⅳ(CⅣ),and plasma laminin(LN)of patients in the two groups were improved compared with those before treatment(P<0.01),and the improvement in the observation group was significantly superior to that in the control group(P<0.01).(3)After treatment,the levels of renal hemodynamic indicators such as systolic maximum blood flow velocity(Vsmax)and diastolic minimum blood flow velocity(Vdmin)of the main renal artery(MRA)and interlobar artery(IRA)in the two groups were increased compared with those before treatment(P<0.05 or P<0.01),while the resistance index(RI)and pulsatility index(PI)of MRA and RI of IRA in the two group as well as PI of IRA in the observation group were decreased compared with those before treatment(P<0.05 or P<0.01).The increase of Vsmax and Vdmin of MRA and IRA as well as the decrease of RI and PI of MRA and IRA in the observation group was significantly superior to that in the control group(P<0.05 or P<0.01).(4)After treatment,the levels of coagulation and fibrinolysis indicators such as prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D),and fibrinogen(FIB)in the two groups were improved compared with those before treatment(P<0.01),and the improvement in the observation group was significantly superior to that in the control group(P<0.01).(5)The analysis of vascular endothelial function indicators showed that after treatment,the serum vasohibin 1(VASH-1)level in the two groups was increased compared with that before treatment(P<0.01),and the serum vascular endothelial growth factor(VEGF)and endothelin 1(ET-1)levels were decreased compared with those before treatment(P<0.01),and the increase of serum VASH-1 level as well as the decrease of serum VEGF and ET-1 levels in the observation group was significantly superior to that in the control group(P<0.01).Conclusion Dan Qi Yishen Prescription exerts good clinical efficacy in treating patients with DN of qi-yin deficiency complicated with blood stasis syndrome,and it has protective effect on renal function probably by improving the coagulation and fibrinolysis system and vascular endothelial function of the patients.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

Objective To investigate the correlation of ceramides(Cer),triglyceride-glucose(TyG)index,residual cholesterol(RC)and intracranial atherosclerotic stenosis(ICAS)in elderly with ischemic stroke(IS).Methods A total of 209 elderly IS patients admitted in the Affiliated Hospi-tal of Xuzhou Medical University from January to December 2022 were recruited,and according to intracranial artery stenosis,they were divided into stenosis group(n=122)and non-stenosis group(n=87).TyG index and RC levels were calculated after testing different types of Cer.Spearman correlation analysis and logistic regression analysis were used.Results Compared with the non-stenosis group,the stenosis group had significantly larger proportions of higher levels of LP(a),HbA1c,TyG index,RC and Cer16∶0,Cer18∶0,Cer24∶1,Cer16∶0/Cer24∶0,Cer24∶1/24∶0 and Cer18∶0/24∶0,and lower Cer24∶ 0 level(P＜0.05,P＜0.01).The levels of Cer16∶0,Cer18∶0,Cer24∶1,Cer16∶0/24∶0,Cer18∶0/24∶0,Cer24∶1/24∶0,LP(a),HbA1c,TyG index and RC were positively correlated with(r=0.290,0.343,0.383,0.436,0.434,0.481,0.166,0.248,0.140,0.204,P＜0.05,P＜0.01),and Cer24∶0 was negatively with ICAS(r=-0.247,P＜0.01).Cer18∶0,Cer24∶1,Cer16∶0/Cer24∶0,Cer18∶0/Cer24∶0 and RC were important influencing factors for ICAS(P＜0.05,P＜0.01).Conclusion The levels of Cer,TyG index and RC are higher in elderly IS patients,and these indicators might be the risk factors for ICAS.

Objective To investigate the correlation of hs-CRP and systemic immunoinflammatory index(SII)with the severity of coronary artery stenosis in elderly T2DM patients.Methods A retrospective trial was conducted on 158 elderly T2DM patients admitted to the Affiliated Hospi-tal of Xuzhou Medical University from August 2021 to August 2023.According to the results of coronary angiography,they were divided into mild(Gensini score≤60,79 cases)and severe steno-sis groups(＞60,79 cases).Spearman correlation analysis and logistic regression analysis were ap-plied to analyze the correlation and the risk factors for severe stenosis.Results Significantly high-er hs-CRP and SII were observed in the severe stenosis group than the mild stenosis group(P＜0.01).Hs-CRP,SII,glycosylated hemoglobin,neutrophils,hsTNT,NLR,and PLR were positively correlated with Gensini score(r=0.424,P＜0.01;r=0.367,P＜0.01;r=0.207,P＜0.01;r=0.259,P＜0.01;r=0.187,P＜0.05;r=0.317,P＜0.01;r=0.256,P＜0.01),and the course of T2DM was negatively correlated with Gensini score(r=-0.224,P＜0.01).Multivariate logistic regression showed that hs-CRP and SII were independent risk factors for severity coronary artery stenosis in elderly T2DM patients(OR=3.191,95％CI:1.847-5.513,P=0.000;OR=1.006,95％CI:1.004-1.009,P=0.000).Conclusion Elderly T2DM patients have higher levels of hs-CRP and SII,which may be independent risk factors for the pathogenesis of coronary stenosis.

Objective:To evaluate the efficacy and safety of intradermal injection of botulinum toxin A (BTX-A) in the treatment of erythematotelangiectatic rosacea.Methods:From January 2019 to December 2020, 30 patients with erythematotelangiectatic rosacea were treated in the Department of Dermatology at Xijing Hospital, Fourth Military Medical University. There were 26 females and 4 males, the age range from 23 to 42 years, with the average (30.9±5.7) years. Patients were randomly divided into two groups and given intradermal injection of botulinum toxin A. In detail, 0.25 U and 0.5 U was injected at each point in the low and high concentration group of BTX-A. The clinician erythema assessment (CEA) scores were recorded before treatment and at 2, 4, 8 and 12 weeks after treatment. The standard grading system scores for rosacea were recorded before treatment and at 12 weeks after treatment.Results:Both treatments could significantly reduce CEA scores, but the declined degree was more significant ( P<0.05), the onset time was shorter and the duration of efficacy was longer in the high concentration group. The scores of flushing, persistent erythema, burning sensation, stinging sensation and the total score of the standard grading system for rosacea after treatment in both two groups were significantly lower than those before treatment (high concentration group: t=5.00, 5.93, 4.10, 2.74, 12.37; low concentration group: t=6.17, 4.12, 2.87, 2.81, 7.88; P<0.05), and the improvement in high concentration group was significantly more than that in low concentration group ( t=2.02, 2.31, 2.15, 2.56, P<0.05). There was no significant difference in the overall effective rate between the two treatments ( P>0.05). Conclusions:Intradermal injection of BTX-A is safe and effective in the treatment of rosacea. Compared with the low concentration group, the efficacy is better, the onset time is shorter and the duration of efficacy is longer in the high concentration group.

Objective:To evaluate the clinical efficacy and safety of a cream containing madecassoside, 5% panthenolon skin repairing after nonablative fractional 1 565 nm laser therapy.Methods:A total of 84 patients who received nonablative fractional laser surgery in our hospital from April 2017 to April 2018 were included as research objects. The patients were divided into observation group and control group by random number table method, 42 cases in each group. The control group was treated with routine facial intervention after operation, while the observation group was treated with a cream containing madecassoside, 5% panthenolon skin repairing on the basis of routine intervention. The postoperative skin barrier function of the two groups were recorded and compared through skin property system and VISIA complexion analysis system.Results:At 1 and 2 weeks after operation, the sebum content and cuticle water content in the observation group were higher than those in the control group, and the transdermal water loss in the observation group was less than that in the control group, and the differences were statistically significant ( t=4.927, 7.833, 12.430, 4.538, 10.083, 8.017, P<0.05). The erythema index (EI) and melanin index (MI) of the observation group were lower than those of the control group at 1 and 2 weeks after operation, and the incidence of complications was significantly lower than that of the control group ( t=2.392, 2.807, 3.485, 3.009, P<0.05). Conclusions:The application of a cream containing madecassoside, 5% panthenolon in skin repairing is helpful to enhance the moisturizing effect, reduce the complications and promote the early recovery of patients with skin trauma after fractional laser operation.

Objective To explore nursing care of the ex-utero intrapartum treatment (EXIT) in fetal neck mass oppressing airway. Methods A case of EXIT in which a fetal neck mass was diagnosed on ultrasound was fully prepared supplies and carried out. Nursing care was well implemented and vital signs of the puerpera and fetus were observed in preoperative and intraoperative surgery. Results The EXIT procedure was successful performed and vital signs of the puerpera and fetus were steadied. The score of Apgar was seven to eight. Conclusions Adequate equipment, multi-department collaboration, preoperative exercise and close cooperation are the important guarantee for the success of ex-utero intrapartum treatment.