ObjectiveTo investigate the improvement effect of Qibai Pingfei capsules on pulmonary vascular remodeling in rats at different stages of chronic obstructive pulmonary disease （COPD） and to analyze its possible mechanism of action. MethodsMale Sprague-Dawley （SD） rats were randomly divided into a normal group， an early COPD model group， an advanced COPD model group， an early-intervention high-dose group， a late-intervention high-dose group， an early-intervention low-dose group， a late-intervention low-dose group， an early-intervention pyrrolidine dithiocarbamate （PDTC） group， and a late-intervention PDTC group， with 15 rats in each group. A rat model of early COPD was constructed by using cigarette smoke combined with airway infusion using lipopolysaccharide（LPS）， and a rat model of advanced COPD was constructed by using airway infusion with LPS， cigarette smoke， and hypoxia. All groups except the normal group were given LPS airway drops on days 1 and 14 of the experiment， smoked for 1 h per day， and administered the drug once a day for 40 weeks from day 15 onward. In the high- and low-dose groups， rats were given 1 g·kg^-1 and 250 mg·kg^-1 Qibai Pingfei capsules， respectively by gavage， and in PDTC groups， rats were given 100 mg·kg^-1 of PDTC by intraperitoneal injection. The advanced COPD model group underwent 6 h of hypoxia per day in weeks 5-6. Lung function and mean pulmonary artery pressure were tested in rats. Morphologic changes in lung tissues were detected by hematoxylin-eosin（HE）staining. Collagen deposition in lung tissues was examined by Masson staining， and the levels of inflammatory factors including interleukin-1β（IL-1β）， interleukin-6（IL-6）， and tumor necrosis factor-α（TNF-α）in lung tissues were detected by enzyme-linked immunosorbent assay （ELISA）. The number of inflammatory cells in the alveolar lavage fluid of rats in each group was detected by Giemsa staining， and the protein expression of Toll-like receptor 4（TLR4）， myeloid differentiation factor 88（MyD88）， nuclear factor-κB（NF-κB）， TNF-α， vascular endothelial-cadherin（VE-cadherin）， α-smooth muscle actin（α-SMA）， and platelet endothelial cell adhesion molecule-1（CD31） was detected by Western blot in the lung tissues of rats. ResultsCompared with the normal group， the model group showed significantly decreased forced expiratory volume in 0.3 s （FEV_0.3）， forced vital capacity （FVC）， and FEV_0.3/FVC ratio related to lung function （P<0.05）， thickening of pulmonary vasculature， increased collagen deposition in the lungs， and enhanced mean pulmonary arterial pressure and expression levels of IL-6， IL-1β， and TNF-α （P<0.05）. Additionally， the model group also exhibited increased numbers of macrophages， lymphocytes， and neutrophils （P<0.05）， significantly higher protein expression of TLR4， MyD88， NF-κB， TNF-α， and α-SMA （P<0.05）， and significantly lower protein expression of VE-cadherin and CD31 （P<0.05）. Lung function was significantly improved in the Qibai Pingfei capsules groups compared with the model group （P<0.05）， with mean pulmonary arterial pressure reduced and pulmonary vascular thickening and collagen deposition in the lungs ameliorated. The Qibai Pingfei capsules groups also showed reduced expression levels of IL-6， IL-1β， and TNF-α （P<0.05） and decreased numbers of macrophages， lymphocytes， and neutrophils （P<0.05）， as well as reduced protein expression of TLR4， MyD88， NF-κB， TNF-α， and α-SMA （P<0.05） and elevated protein expression of VE-cadherin and CD31 （P<0.05） in rat lung tissues. ConclusionQibai Pingfei capsules inhibits inflammatory response and endothelial-to-mesenchymal transition probably by regulating the TLR4/NF-κB signaling pathway， thus improving pulmonary vascular remodeling in COPD model rats and showing therapeutic effects in the early stage of COPD.

Objective To investigate the expression and clinical significance of serum microRNA-141-3p(miR-141-3p)and Kelch like epichlorohydrin associated protein 1(KEAP1)in neonatal acute respiratory dis-tress syndrome(NARDS).Methods A total of 121 children with NARDS admitted to the hospital from Janu-ary 2022 to March 2024(NARDS group)and 65 healthy neonates during the same period(control group)were selected.According to the degree of disease,the children with NARDS were divided into the mild NARDS group(4≤oxygen index<8,48 cases),the moderate NARDS group(8≤oxygen index<16,46 ca-ses),the severe NARDS group(oxygen index≥16,27 cases),and the children with NARDS were divided into the death group(18 cases)and the survival group(103 cases)according to the 28-day prognosis.Serum miR-141-3p and KEAP1 levels were detected by fluorescence quantitative polymerase chain reaction and enzyme-linked immunosorbent assay.The correlation between serum miR-141-3p and KEAP1 levels in children with NARDS was analyzed by Pearson correlation coefficient.The correlation between serum miR-141-3p and KEAP1 levels and oxygen index in children with NARDS was analyzed by Spearman correlation coefficient.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficacy of serum miR-141-3p and KEAP1 levels on the death in children with NARDS.Results Serum miR-141-3p level in the NARDS group was lower than that in the control group,and KEAP1 level in the NARDS group was higher than that in the control group(t=14.288,12.596,P<0.001).There was a binding site between miR-141-3p and KEAP1 at the 3'-untranslated region 131-138.Pearson correlation showed that serum miR-141-3p was negatively correlated with KEAP1 level in children with NARDS(r=-0.745,P<0.001).The levels of ser-um miR-141-3p increased sequentially in the severe NARDS group,moderate NARDS group,and mild NARDS group,while the level of KEAP1 decreased sequentially(F=185.469,113.126,P<0.001).Spearman correla-tion coefficient showed that oxygen index in children with NARDS was negatively correlated with serum miR-141-3p level(r=-0.815,P<0.001)and positively correlated with serum KEAP1 level(r=0.827,P<0.001).Serum miR-141-3p level in the dead group was lower than that in the survival group,and KEAP1 level was higher than that in the surviving group(t=4.213,4.495,P<0.001).The area under the curve of the combined prediction of serum miR-141-3p and KEAP1 levels for the death in children with NARDS was 0.878(95%CI:0.806-0.930),which was greater than 0.783(95%CI:0.699-0.853)and 0.786(95%CI:0.702-0.855)predicted by serum miR-141-3p and KEAP1 levels alone(Z=2.963,2.021,P<0.05).Conclu-sion The serum miR-141-3p level is decreased and the KEAP1 level is increased in children with NARDS,which is associated with worsening of the disease and poor prognosis.The combination of serum miR-141-3p and KEAP1 levels has high predictive efficacy for death in children with NARDS.

Objective:To discuss the clinical presentations,diagnosis,and treatment methods of the patients with Fournier's gangrene,and to enhance the clinicians'awareness of this condition.Methods:The clinical data including symptoms,signs,radiological findings,and surgical outcomes of one patient with Fournier's gangrene were collected.The relevant literatures were reviewed to summarize the clinical characteristics,diagnosis,and treatment methods for this condition.Results:The patient,a 42-year-old male,was admitted because of a history of infection around the perineum,scrotum,and perianal area for 13 d.His medical history included acute myeloid leukemia for 10 months,during which the patient underwent eight chemotherapy sessions in the local hospital.The abdominal CT scan results showed thickened,dense,and turbid soft tissue in the left inguinal area.The complete blood count reuslts showed the white blood cell count was 23.99×109 L-1.The cultures of wound secretions grew the Escherichia coli and Proteus mirabilis.The examination results showed there was necrosis of the scrotal skin and skin near the anus on the left buttock;the skin was blackened,hard,and demarcated from the surrounding normal skin with slight purulent exudation and no foul smell.The surrounding skin was significantly swollen and red;the rectal examination results showed no bleeding or fistulas.The patient underwent emergency debridement surgery on the admission day,followed by dressing changes,multiple applications of simplified negative pressure,perineal flap reconstruction,and skin grafting.The patient recovered well with normal function and had no complications.Conclusion:Fournier gangrene has acute onset and rapid progression,and the clinical manifestations are non-specific.The range of infection is not consistent with the progression of the disease.The diagnosis mainly depends on intraoperative exploration.Repeated radical surgery is the main treatment.The prognosis of this disease is good,and the recurrence rate is low,although long-term follow-up is still necessary after surgery.

[Abstract] Objective: To observe the short-term efficacy and safety of Apatinib combined with radiotherapy and concurrent docetaxel and cisplatin chemotherapy in driver-gene-negative non-small cell lung cancer (NSCLC) patients with brain metastases. Methods: A total of 72 NSCLC patients with brain metastases, who were treated in our hospital from June 2018 to June 2019, were enrolled in this study. The driver gene was proved to be negative by next generation sequencing (NGS). The patients were divided into control group (36 cases) and treatment group (36 cases) by Digital random grouping method.The control group received 2 cycles of chemotherapy with docetaxel and cisplatin and concurrent radiotherapy for brain metastases, and the treatment group was given Apatinib anti-angiogenic treatment based on the regimen in control group. Primary study endpoints: confirmed objective response rate (cORR) and disease control rate (DCR); Secondary study endpoints: progression-free survival (PFS), quality of life (QOL) score, serum carcinoembryonic antigen (CEA), vascular endothelial growth factor (VEGF), and incidence of adverse drug events (AE). Results: Compared with the control group, cORR and DCR in treatment group were significantly improved [41.67% (15/36) vs 33.33% (12/36), 80.56% (29/36) vs 69.44% (25/36), all P<0.05], the median PFS was significantly prolonged (5.9 vs 4.6 months, P<0.05), and serum CEA and VEGF levels were significantly reduced [(16.5±2.3) vs (22.9±3.7) ng/ml, (291.6±42.6) vs (479.3±50.2) ng/L, all P<0.05], while the QOL score was slightly increased, but the difference was not statistically significant [(69.5±8.5) points vs (64.1±7.3) points, P>0.05]. There was no statistically significant difference in the incidence of acute brain edema, gastrointestinal reaction, bone marrow suppression, and liver dysfunction between the two groups of patients (all P>0.05); however, the incidences of oral mucositis, hand-foot syndrome, hypertension and proteinuria in the treatment group were significantly higher than those in the control group (all P<0.05). Conclusion: The efficacy of Apatinib combined with radiochemotherapy in driver-negative NSCLC patients with brain metastases is significantly better than that of radiochemotherapy alone, and the adverse reactions can be controlled. It is worthy of clinical recommendation.

Fournier gangrene is a relatively rare clinical critical disease, and its clinical symptoms are not specific and easily unrecognized by some clinicians. It has the features of acute onset, quick development, severe illness, and often accompanied by infection shock which is seriously life-threatening. It is difficult in treatment with high medical costs and long length of hospitalization, which increases pain for patients and relatives and brings heavy economic and psychological burden on patients, society, and medical workers. By reviewing the literature home and abroad and combined with clinical practice, I summarize the researches on concept, epidemiology, clinical manifestation, diagnosis and treatment of Fournier gangrene, in order to provide reference for vast number of clinical workers.

Objective:To analyze the laboratory tests in newly hospitalized patients with COVID-19　and their predictive values for the severity of the disease.Methods:83 patients, including 54 males and 29 females, with median interquartile range of 63(53-70)years diagnosed with covid-19　who were managed by Fujian medical team from January 27, 2020 to February 20, 2020 in Wuhan JinYinTan Hospital were studied retrospectively. According to the severity of the disease, they were divided into common, severe and critical groups. White blood cell (WBC), lymphocyte (LYM), loctate dehydrogenase (LDH), interleukin-6 (IL-6), procalcitonin (PCT), serum ferritin (SF), erythrocyte sedimentation rate (ESR), hypersensitive C-reactive protein (hs-CRP) and D-Dimer (D-D) on admission were analyzed retrospectively. And the predictive value of each indicator for critical group was analyzed by Logistic regression.Results:On admission, in common, severe and critical groups, WBC (×10 9/L) values were 7.10±3.88, 7.73±3.77 and 9.07±5.61, respectively ( F = 1.315, P=0.274); IL-6　(μg/L) values were 11.76(9.42-15.18), 11.93(10.15-15.63) and 11.24(8.06-13.75), respectively( Z=0.591, P=0.744);D-D (mg/L) values were 0.70(0.48-1.12), 1.67(1.07-7.14) and 1.96(0.71-8.18), respectively( Z=3.363, P=0.186).There were no significant differences among three groups. On admission, in common, severe and critical groups, LYM(×10 9/L) values were 1.10±0.33, 0.80±0.35 and 0.66±0.32, respectively( F=11.415, P<0.001); SF(μg/L) values were 470.83±283.43, 835.66±819.43, and 1341.15±949.54, respectively ( F=7.98, P=0.001); ESR(mm/h) values were 30.76±15.70, 42.55±22.51 and 51.04±25.09, respectively( F=5.181, P=0.008); LDH(U/L) values were 314.71±105.46, 325.69±109.85 and 444.03±181.07, respectively( F=7.17, P=0.001); hs-CRP(μg/L)values were 16(7.20-19.90), 31.00(20.00-87.60) and 80.50(33.70-113.00), respectively( Z=12.185, P=0.002);PCT(μg/L) values were 0.025(0.02-0.05), 0.05(0.02-0.13) and 0.09(0.05-0.39), respectively( Z=9.694, P=0.008). There were significant differences among three groups. Pairwise comparison showed that the LYM value in common group was higher than those in severe and critical groups, and the hs-CRP values in severe and critical groups were higher than that in common group,while SF, ESR, LDH and PCT values in critical group were all higher than those in severe and common groups( P<0.05). Conclusions:On admission, WBC, LYM, ESR and LDH are helpful to predict the severity of COVID-19. Although the level of IL-6 is increased, it may not be meaningful to judge the severity of COVID-19.

Objective:To investigate the core competence of newly recruited nurses in ClassⅢ hospitals in Shanxi Province so as to provide a basis for the training of core competence of newly recruited nurses.Methods:From August 15 to 21, 2019, cluster sampling was used to select 2 913 newly recruited nurses and their real-time teachers from 46 Class Ⅲ general hospitals and 13 specialized hospitals in 11 cities in Shanxi Province. The Core Competency Self-rating Questionnaire of Newly Recruited Nurses and the Core Competency Observer Rating Questionnaire of Newly Recruited Nurses were used to investigate newly recruited nurses and evaluate the real-time teaching teachers of newly recruited nurses respectively.Results:In the end, 2 575 valid self-rating questionnaires and 2 400 valid observer rating questionnaires were recovered. Among 2 575 newly recruited nurses, the total score of self-rating core competence was (154.22±17.15) , and the scores of each dimension from high to low were quality accomplishment, personal traits, management ability, professional ability and professional development. Among 2 400 teachers of newly recruited nurses, the total score of the core competence evaluated by teachers in real-time teaching was (155.60±20.71) , and the scores in each dimension from high to low were quality cultivation, personal traits, professional ability, management ability and professional development. There was a statistically significant difference between the self-rating of the core competency scores of newly recruited nurses and the evaluation of teaching teachers ( P<0.05) . Conclusions:The core competence of newly recruited nurses in Shanxi Province is at the upper -middle level, and the professional development ability needs to be strengthened. There is a difference between the self -rating of the core competence of newly recruited nurses and the evaluation by teaching teachers. Therefore, the selection and training of newly recruited nurse teachers should be emphasized.

Objective To investigate the relationships among current alexithymia, social relational quality and quality of life in breast cancer patients receiving chemotherapy. Methods By convenient sampling method, from April 2015 to September 2016, totally 151 patients were invited to complete demographic questionnaire, Toronto alexithymia scale, social relational quality scale and functional assessment of cancer therapy-breast. The Pearson correlation method was used to analyze the relationship among current alexithymia, social relational quality and quality of life. Results All of the patients got the average score (59.11±15.75) on Toronto alexithymia scale, which was moderate level. The total scores of social relational quality and life quality were (53.45±5.13) and (93.84±15.17). There was a negative relationship between alexithymia with social relational quality (r=-0.441) and quality of life (r=-0.597) (P<0.05). Conclusions Breast cancer patients has serious alexithymia after the operation. Nurses can carry out activities which gives patients more opportunities to express emotion, encourage patients to face difficulties and challenges, communicate with others actively, and get more support from others and encourage family members participate in the patient care process to reduce alexithymia and improve quality of life.

Objective To explore the diagnosis value of X-ray breast imaging reporting and data system (BI-RADS) combined with wire-guided localization biopsy for breast microcalcifications in impalpable breast cancer.Methods 192 palpation negative patients with 205 microcalcification lesions were detected by mammography.All lesions were classified according to BI-RADS descriptors for calcification and were categorized by the BI-RADS.The patients with BI-RADS category 4a and above underwent X-ray positioning guide wire-guided biopsy and pathological diagnosis.Results In 205 microcalcification lesions,74 (36.1％) were malignant lesions,131 (63.9 ％) were less than benign lesions.The positive predictive value of malignant breast lesions in clustered,segmental,regional linear branching calcifications were higher [83.3 ％ (5/6),100.0 ％ (11/11),100.0 ％ (1/1)],followed by clustered,linear,segmental,regional pleomorphic calcifications [55.9 ％ (38/68),50.0 ％ (1/2),40.0 ％ (8/20) and 33.3 ％ (4/12),respectively].The positive predictive values of malignant in linear branching calcifications and pleomorphic calcifications were significantly higher than those of coarse heterogeneous calcifications,amorphous or indistinct calcifications (x2 values were 34.44,51.87,16.71,29.86,all P ＜ 0.05).The linear branching calcification had the highest possibility.The proportions of malignant lesions in four different types of glands were extremely dense 40.5 ％ (30/74),heterogeneously dense 39.2 ％ (29/74),scattered areas of fibroglandular density 10.8 ％ (8/74) and fat 9.5 ％ (7/74),respectively.Conclusions BI-RADS categorization for breast microcalcification lesions can improve the detection rate of impalpable breast cancer.Linear branching calcification has higher predictive value for malignant lesions.Dense breast is the risk factors of breast cancer,which should be attached great importance.

This article,in view of the research status and development tendency of hospital core competence,introduced the index selection process and constructed the evaluation index system of core competence.This system comprises 3 level-1 indexes (social reputation,hospital health resources and development potential)and 9 level-2 indexes,with recommendations on improvements of the existing system.