Objective:To explore the effect of a nurse-led internet nutrition support team (NST) on home nutrition care for liver cancer patients after transcatheter arterial chemoembolization (TACE) .Methods:A convenience sampling method was used to select 200 liver cancer patients who underwent TACE at the First Affiliated Hospital of Wenzhou Medical University from July 2022 to June 2023. These patients were randomly divided into a control group and an intervention group, each consisting of 100 patients. The control group received traditional nutrition guidance and follow-up, while the intervention group received nurse-led internet NST intervention in addition to the control group's treatment. The nutritional status indicators (hemoglobin, albumin, prealbumin, body mass index) and the Patient-Generated Subjective Global Assessment (PG-SGA) scores were compared at discharge and 3 months after the intervention.Results:At discharge, there was no significant difference in nutritional status indicators and PG-SGA scores between the two groups ( P>0.05) . Three months after the intervention, the hemoglobin, albumin, prealbumin, and body mass index level in the intervention group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Additionally, the PG-SGA score in the intervention group was lower than that in the control group, and the difference was statistically signifiant ( P<0.05) . Conclusions:Nurse-led internet NST can further improve the nutritional status of liver cancer patients after TACE during home nutrition care.

Objective:To explore the effect of a nurse-led internet nutrition support team (NST) on home nutrition care for liver cancer patients after transcatheter arterial chemoembolization (TACE) .Methods:A convenience sampling method was used to select 200 liver cancer patients who underwent TACE at the First Affiliated Hospital of Wenzhou Medical University from July 2022 to June 2023. These patients were randomly divided into a control group and an intervention group, each consisting of 100 patients. The control group received traditional nutrition guidance and follow-up, while the intervention group received nurse-led internet NST intervention in addition to the control group's treatment. The nutritional status indicators (hemoglobin, albumin, prealbumin, body mass index) and the Patient-Generated Subjective Global Assessment (PG-SGA) scores were compared at discharge and 3 months after the intervention.Results:At discharge, there was no significant difference in nutritional status indicators and PG-SGA scores between the two groups ( P>0.05) . Three months after the intervention, the hemoglobin, albumin, prealbumin, and body mass index level in the intervention group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Additionally, the PG-SGA score in the intervention group was lower than that in the control group, and the difference was statistically signifiant ( P<0.05) . Conclusions:Nurse-led internet NST can further improve the nutritional status of liver cancer patients after TACE during home nutrition care.

Objective:To evaluate the impact of self-crosslinked hyaluronic acid (SCH) gel on endometrium recovery after artificial abortion.Methods:A multicenter, prospective randomized controlled trial was conducted across 18 hospitals from December 2021 to February 2023, involving 382 women who underwent artificial abortion. Participants were randomly allocated to receive either treatment with SCH gel (SCH group) or no treatment (control group) in a 1∶1 ratio. The primary outcome was endometrium thickness in 14 to 18 days after the first postoperative menstruation. Secondary outcomes included changes in menstrual volume during the first postoperative menstruation, menstruation resumption within 6 postoperative weeks, time to menstruation resumption, duration of the first postoperative menstruation, and incidence of dysmenorrhea.Results:Baseline characteristics of participants were comparable between the two groups (all P>0.05), with 95.3% (182/191) in SCH group and 92.7% (177/191) in the control group completed the study. The postoperative endometrial thickness in SCH group was significantly greater than that in the control group [(9.78±3.15) vs (8.95±2.32) mm; P=0.005]. SCH group also had significantly fewer participants with reduced menstrual volume [23 cases (12.6%, 23/182) vs 31 cases (17.5%, 31/177); P=0.038]. Although SCH group experienced less dysmenorrhea during the first postoperative menstrual period, this difference was not statistically significant [28.5% (51/179) vs 37.1% (65/175); P=0.083]. Outcomes were similar between SCH group and the control group regarding the proportion of participants who resumed menstruation within 6 weeks postoperatively, time to menstruation resumption, and duration of the first postoperative menstruation ( P=0.792, 0.485, and 0.254, respectively). No serious adverse events were observed during the study period, and no adverse events were attributed to SCH gel treatment. Conclusion:The application of SCH gel after artificial abortion is safe and might aid in the recovery of the endometrium.

Objective:To investigate the effects of gelatin methacrylate anhydride (GelMA) hydrogel loaded with small extracellular vesicles derived from human umbilical cord mesenchymal stem cells (hUCMSCs-sEVs) in the treatment of full-thickness skin defect wounds in mice.Methods:This study was an experimental study. hUCMSCs-sEVs were extracted by ultracentrifugation, their morphology was observed through transmission electron microscope, and the expression of CD9, CD63, tumor susceptibility gene 101 (TSG101), and calnexin was detected by Western blotting. The human umbilical vein endothelial cells (HUVECs), the 3 rd and 4 th passages of human epidermal keratinocytes (HEKs) and human dermal fibroblasts (HDFs) were all divided into blank control group (routinely cultured) and hUCMSC-sEV group (cultured with the cell supernatant containing hUCMSCs-sEVs). The cell scratch test was performed and the cell migration rates at 6, 12, and 24 h after scratching were calculated, the cell Transwell assay was performed and the number of migration cells at 12 h after culture was calculated, and the proportion of proliferating cells was detected by 5-acetylidene-2'-deoxyuridine and Hoechst staining at 24 h after culture, with sample numbers being all 3. The simple GelMA hydrogel and the GelMA hydrogel loaded with hUCMSCs-sEVs (hereinafter referred to as hUCMSC-sEV/GelMA hydrogel) were prepared. Then the micromorphology of 2 kinds of hydrogels was observed under scanning electron microscope, the distribution of hUCMSCs-sEVs was observed by laser scanning confocal microscope, and the cumulative release rates of hUCMSCs-sEVs at 0 (immediately), 2, 4, 6, 8, 10, and 12 d after soaking hUCMSC-sEV/GelMA hydrogel in phosphate buffer solution (PBS) were measured and calculated by protein colorimetric quantification ( n=3). Twenty-four 6-week-old male C57BL/6J mice were divided into PBS group, hUCMSC-sEV alone group, GelMA hydrogel alone group, and hUCMSC-sEV/GelMA hydrogel group according to the random number table, with 6 mice in each group, and after the full-thickness skin defect wounds on the back of mice in each group were produced, the wounds were performed with PBS injection, hUCMSC-sEV suspenson injection, simple GelMA coverage, and hUCMSC-sEV/GelMA hydrogel coverage, respectively. Wound healing was observed on post injury day (PID) 0 (immediately), 4, 8, and 12, and the wound healing rates on PID 4, 8, and 12 were calculated, and the wound tissue was collected on PID 12 for hematoxylin-eosin staining to observe the structure of new tissue, with sample numbers being both 6. Results:The extracted hUCMSCs-sEVs showed a cup-shaped structure and expressed CD9, CD63, and TSG101, but barely expressed calnexin. At 6, 12, and 24 h after scratching, the migration rates of HEKs (with t values of 25.94, 20.98, and 20.04, respectively), HDFs (with t values of 3.18, 5.68, and 4.28, respectively), and HUVECs (with t values of 4.32, 19.33, and 4.00, respectively) in hUCMSC-sEV group were significantly higher than those in blank control group ( P<0.05). At 12 h after culture, the numbers of migrated HEKs, HDFs, and HUVECs in hUCMSC-sEV group were 550 ±23, 235 ±9, and 856 ±35, respectively, which were significantly higher than 188 ±14, 97 ±6, and 370 ±32 in blank control group (with t values of 22.95, 23.13, and 17.84, respectively , P<0.05). At 24 h after culture, the proportions of proliferating cells of HEKs, HDFs, and HUVECs in hUCMSC-sEV group were significantly higher than those in blank control group (with t values of 22.00, 13.82, and 32.32, respectively, P<0.05). The inside of simple GelMA hydrogel showed a loose and porous sponge-like structure, and hUCMSCs-sEVs was not observed in it. The hUCMSC-sEV/GelMA hydrogel had the same sponge-like structure, and hUCMSCs-sEVs were uniformly distributed in clumps. The cumulative release rate curve of hUCMSCs-sEVs from hUCMSC-sEV/GelMA hydrogel tended to plateau at 2 d after soaking, and the cumulative release rate of hUCMSCs-sEVs was (59.2±1.8)% at 12 d after soaking. From PID 0 to 12, the wound areas of mice in the 4 groups gradually decreased. On PID 4, 8, and 12, the wound healing rates of mice in hUCMSC-sEV/GelMA hydrogel group were significantly higher than those in the other 3 groups ( P<0.05); the wound healing rates of mice in GelMA hydrogel alone group and hUCMSC-sEV alone group were significantly higher than those in PBS group ( P<0.05). On PID 8 and 12, the wound healing rates of mice in hUCMSC-sEV alone group were significantly higher than those in GelMA hydrogel alone group ( P<0.05). On PID 12, the wounds of mice in hUCMSC-sEV/GelMA hydrogel group showed the best wound epithelization, loose and orderly arrangement of dermal collagen, and the least number of inflammatory cells, while the dense arrangement of dermal collagen and varying degrees of inflammatory cell infiltration were observed in the wounds of mice in the other 3 groups. Conclusions:hUCMSCs-sEVs can promote the migration and proliferation of HEKs, HDFs, and HUVECs which are related to skin wound healing, and slowly release in GelMA hydrogel. The hUCMSC-sEV/GelMA hydrogel as a wound dressing can significantly improve the healing speed of full-thickness skin defect wounds in mice.

Objective:To compare the treatment outcomes of neoadjoint therapy combined with liver transplantation versus radical hepatectomy for patients with surgically resectable hilar cholangiocarcinoma.Methods:A retrospective study was performed on the data of 64 patients with resectable hilar cholangiocarcinoma operated from January 2009 to December 2014 at the Organ Transplantation Department of the First Central Hospital of Tianjin. There were 43 males and 21 females, with an average age of 61.2 years. There were 45 patients who underwent radical hepatectomy in the liver resection group, and 19 patients who underwent combined neoadjuvant therapy (radiotherapy combined with 5-fluorouracil intravenous drip, transcatheter lumen radiotherapy, capecitabine oral administration) and liver transplantation in the liver transplantation group. The recurrence rates and survival rate were compared between groups.Results:The 1, 3 and 5 years cumulative survival rates of the liver transplantation group were 89.5%, 73.7% and 63.2%, respectively, which were significantly better than those of the liver resection group (80.0%, 53.3% and 35.6%) ( P<0.05). The postoperative tumor recurrence rate in the liver transplantation group was 31.6% (6/19), which was significantly lower than that in the liver resection group of 60.0% (27/45) ( P<0.05). Subgroup analysis using postoperative pathological results showed the cumulative survival rates of patients without lymph node metastasis (N 0) and those with negative resection margins (R 0) were not significantly different between groups ( P>0.05). However, for patients with regional lymph node invasion (N 1) and with R 0 resection margin, the cumulative survival rates at 1, 3 and 5 years after liver transplantation were 83.3%, 66.7% and 50.0%, respectively, which were significantly superior to the 64.3%, 28.6% and 14.3% of the liver resection group ( P<0.05). Conclusion:Hepatectomy is recommended for patients with N 0 R 0 resectable hilar cholangiocarcinoma. For patients with hilar cholangiocarcinoma with marginally resectable N 1R 0, neoadjuvant therapy combined with liver transplantation resulted in significantly better long-term overall survival than resection.

Objective:To evaluate the role of Nod-like receptor family pyrin domain-containing 3 (NLRP3) in the dorsal root ganglion (DRG) in persistent postoperative pain in rats.Methods:Forty-eight male Sprague-Dawley rats, in which IT catheters were successfully implanted, weighing 200-250 g, aged 2-3 months, were divided into 4 groups ( n=12 each) using a random number table method: sham operation group (S group), persistent postoperative pain group (P group), persistent postoperative pain+ NLRP3-siRNA group (P+ siRNA group) and persistent postoperative pain+ NLRP3-scrRNA group (P+ scrRNA group). A persistent postoperative pain model was established by skin/muscle incision and retraction (SMIR) in anesthetized animals.Normal saline 10 μl were intrathecally injected in S group and P group, NLRP3-siRNA 10 μl and NLRP3-scrRNA 10 μl were intrathecally injected in CP+ siRNA group and CP+ scrRNA group, respectively, at 3 days before operation.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before operation (T 0) and 1, 5, 10, 15 and 20 days after operation (T 1-5). Six rats in each group were randomly selected and sacrificed at T 3, and the L 4-5 DRGs on the operated side were harvested for determination of the expression of NLRP3 and caspase-1 (by Western blot), NLRP3 mRNA expression (by real-time polymerase chain reaction) and content of interleukin-1beta (IL-1β) (by enzyme-linked immunosorbent assay). Results:Compared with group S, the MWT was significantly decreased at T 2-5, the expression of NLRP3 protein and mRNA in DRGs was up-regulated, and the content of IL-1β was increased in group P ( P<0.05). Compared with group P, the MWT was significantly increased at T 2-5, the expression of NLRP3 protein and mRNA and caspase-1 was down-regulated, and the content IL-1β was decreased in group P+ siRNA ( P<0.05), and no significant change was found in the parameters mentioned above in group P+ scrRNA ( P>0.05). Conclusion:NLRP3 in DRGs is involved in the development of persistent postoperative pain, and the mechanism may be related to the development of NLPR3 inflammasomes which further induces peripheral neuroinflammatory response in rats.

Objective To observe prolactin (PRL) and estradiol (E2) levels in lactating women in different iodine nutrition areas.Methods According to the recent national water-borne high iodine area survey and the monitoring results of iodine deficiency disorders,the following places were selected,including Nankang,Xinggang and Yingpan towns of Beihai City,Guangxi (water iodine ≤ 10 μg/L,low iodine areas),Yangcheng Township and Jiajiazhuang Township of Fenyang City,Shanxi (water iodine 50-100 μg/L,adaptive iodine areas),Pingyao County and Jicun Town of Fenyang City,Shanxi (water iodine ≥300 μg/L,high iodine areas),and urinary and blood samples were collected in lactating women (n =100,97,123) from the three regions.The urinary iodine concentration was tested by arsenic cerium catalytic spectrophotometry.Serum levels of PRL and E2 were determined by chemiluminescence immunoassay.Results The urinary iodine medians of lactating women were 51.42,283.62,842.31 μg/L,respectively,in the three regions,the difference between the regions was statistically significant (x2 =241.09,P ＜ 0.05);the iodine levels of lactating women in low iodine areas,adaptive iodine areas and high iodine areas were in the state of iodine deficiency (＜ 100 μg/L),sufficient or adequate (200-299 μg/L) and iodine excess status (≥ 300 μg/L),respectively.Serum PRL and E2 levels of lactating women in the three types of areas were 38.81,20.98,16.41 μg/L and 29.57,43.70,45.51 ng/L,respectively.The differences between the regions were statistically significant (x2 =41.54,24.03,P ＜ 0.05).Conclusion With the increase of iodine nutrition level,PRL in lactating women has presented a gradually decreasing trend,E2 is increased.

Objective: To investigate the influence of different discontinuation time of aspirin and clopidogrel before off-pump coronary artery bypass grafting (OPCABG) on postoperative bleeding and blood products transfusion requirement. Methods: Three hundred and fifty-three coronary artery disease patients who underwent OPCABG from January 2017 to January 2018 at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University were retrospectively analysed. There were 268 males and 85 females, aged (66.0±9.1)years. All patients were divided into three groups: (1) guideline-recommended group: patients who discontinued clopidogrel for >5 days without discontinuing aspirin before surgery; (2) without discontinuing group: patients who discontinued clopidogrel for ≤5 days without discontinuing aspirin before surgery; (3) discontinuing group: patients who discontinued clopidogrel for >5 days with discontinuing aspirin before surgery. Postoperative bleeding recorded as chest tube drainage (CTD) volume and blood products transfusion requirement and perioperative complications were recorded. CTD volumes within 12 hours after surgery between groups were compared by Mann-Whitney U tests, CTD volumes after 12 hours postoperatively were compared by repeated measures analysis of variance and blood products transfusion and complications incidence were compared by χ² test or Fisher′s precise test. Results: The 12 hours CTD volumes of guideline-recommended group, without discontinuing group, discontinuing group after surgery were 280(153) ml (M(Q_R)), 291(229) ml, 225(161) ml, respectively. There were no significant differences in postoperative 12 hours CTD volumes (P=0.865), red blood cells transfusion incidence (χ²=2.626, P=0.149) and fresh frozen plasma (FFP) transfusion incidence (χ²=1.258, P=0.324) between guideline-recommended group and without discontinuing group. However, the 12 hours CTD volumes were significantly higher in guideline-recommended group patients compared with disconutinuing group patients (U=5 247, P=0.002). No significant differences were observed in red blood cells (χ²=0.182, P=0.757) and FFP (χ²=0.083, P=0.839) transfusion rate between these two groups. Repeated measures analysis of variance indicated that when patients began to take antiplatelet drugs (aspirin and clopidogrel) after 12 hours postoperatively, the change of CTD volumes beyond 12 hours after surgery didn′t differ either between guideline-recommended group and without discontinuing group (F=0.019, P=0.941) or between guideline-recommended group and discontinuing group (F=2.447,P=0.113). Besides, the incidence of perioperative arrhythmia was significantly higher in guideline-recommended group patients compared with without discontinuing group patients (4.8% vs. 0, χ²=5.073, P=0.038). Conclusions OPCABG patients who discontinued aspirin before surgery had lower postoperative 12 hours CTD volumes but similar blood products transfusion rate and CTD volumes beyond 12 hours postoperatively compared with patients adhering to the current guideline-recommended protocol. And for patients who discontinued clopidogrel for ≤5 days, postoperative CTD volumes and blood products transfusion requirement were similar but the incidence of perioperative arrhythmia was significantly lower compared with guideline-treated patients.

OBJECTIVETo study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.

METHODSEight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.

CONCLUSIONSVSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Debridement ; Drainage ; Extremities ; surgery ; Fasciitis, Necrotizing ; surgery ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Oxygen ; Pressure ; Skin ; Skin Transplantation ; Ulcer ; Vacuum

Objective To observe the effect of high iodine on mRNA expression of thyroid hormone receptor (TSHR),protein kinase A (PKA) and sodium iodide symporter (NIS) in peripheral blood of patients with thyroid diseases during lacatation.Methods A total of 99 breast-feeding women were selected as observation objects in Shanxi Province's sufficient iodine and high iodine areas,and they were divided into case group and control group according to whether suffer from thyroid disease.In high iodine areas,there were 21 patients and 19 healthy controls.In sufficient iodine areas,there were 30 patients and 29 healthy controls.Peripheral blood of all the observation objects was collected,and mRNA expression of TSHR,PKA and NIS was detected by real-time quantitative PCR.Results The case group [median (M):0.099,0.994] and the control group (M:0.240,0.738) in the high iodine areas were respectively compared with the case group (M:3.087,1.127) and the control group (M:1.823,0.842) in the sufficient iodine areas.The TSHR mRNA expression was significantly decreased (Z =-5.034,-4.010,all P ＜ 0.01);the PKA mRNA expression had a downward trend,and the difference was not statistically significant (Z =2.895,-0.343,all P＞ 0.05).The NIS mRNA expression of the case group in high iodine areas (M:0.485) was obviously lower than that of the the case group in sufficient iodine regions (M:2.680,Z=-3.311,P ＜ 0.01).The control group in high iodine areas (M:0.470) was compared with the control group in sufficient iodine areas (M:0.835),and the difference was not statistically significant (Z =-1.882,P ＞ 0.05).The NIS and the TSHR mRNA were positively correlated [correlation coefficient (r) =0.741,P ＜ 0.01];the NIS and the PKA mRNA was also positively correlated (r =0.293,P ＜ 0.01);but the TSHR mRNA was not significantly correlated with the PKA mRNA (r =-0.081,P ＞ 0.05).Conclusion Lactating women may have protected themselves and their babies through TSH-TSHR-cAMP-PKA signaling pathway that regulating iodine levels.