To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development.

Objective:To investigate the risk factors of lower extremity deep venous thrombosis (LEDVT) in patients with sepsis during hospitalization in intensive care unit (ICU), and to construct a nomogram prediction model of LEDVT in sepsis patients in the ICU based on the critical care scores combined with inflammatory markers, and to validate its effectiveness in early prediction.Methods:726 sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from January 2015 to December 2021 were retrospectively included as the training set to construct the prediction model. In addition, 213 sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from January 2022 to June 2023 were retrospectively included as the validation set to verify the performance of the prediction model. Clinical data of patients were collected, such as demographic information, vital signs at the time of admission to the ICU, underlying diseases, past history, various types of scores within 24 hours of admission to the ICU, the first laboratory indexes of admission to the ICU, lower extremity venous ultrasound results, treatment, and prognostic indexes. Lasso regression analysis was used to screen the influencing factors for the occurrence of LEDVT in sepsis patients, and the results of Logistic regression analysis were synthesized to construct a nomogram model. The nomogram model was evaluated by receiver operator characteristic curve (ROC curve), calibration curve, clinical impact curve (CIC) and decision curve analysis (DCA).Results:The incidence of LEDVT after ICU admission was 21.5% (156/726) in the training set of sepsis patients and 21.6% (46/213) in the validation set of sepsis patients. The baseline data of patients in both training and validation sets were comparable. Lasso regression analysis showed that seven independent variables were screened from 67 parameters to be associated with the occurrence of LEDVT in patients with sepsis. Logistic regression analysis showed that the age [odds ratio ( OR) = 1.03, 95% confidence interval (95% CI) was 1.01 to 1.04, P < 0.001], body mass index (BMI: OR = 1.05, 95% CI was 1.01 to 1.09, P = 0.009), venous thromboembolism (VTE) score ( OR = 1.20, 95% CI was 1.11 to 1.29, P < 0.001), activated partial thromboplastin time (APTT: OR = 0.98, 95% CI was 0.97 to 0.99, P = 0.009), D-dimer ( OR = 1.03, 95% CI was 1.01 to 1.04, P < 0.001), skin or soft-tissue infection ( OR = 2.53, 95% CI was 1.29 to 4.98, P = 0.007), and femoral venous cannulation ( OR = 3.72, 95% CI was 2.50 to 5.54, P < 0.001) were the independent influences on the occurrence of LEDVT in patients with sepsis. The nomogram model was constructed by combining the above variables, and the ROC curve analysis showed that the area under the curve (AUC) of the nomogram model for predicting the occurrence of LEDVT in patients with sepsis was 0.793 (95% CI was 0.746 to 0.841), and the AUC in the validation set was 0.844 (95% CI was 0.786 to 0.901). The calibration curve showed that its predicted probability was in good agreement with the actual probabilities were in good agreement, and both CIC and DCA curves suggested a favorable net clinical benefit. Conclusion:The nomogram model based on the critical illness scores combined with inflammatory markers can be used for early prediction of LEDVT in ICU sepsis patients, which helps clinicians to identify the risk factors for LEDVT in sepsis patients earlier, so as to achieve early treatment.

Objective:To investigate the status of caregivers' benefit finding of senile dementia patients in Shiyan city, Hubei Province, and to analyze its influencing factors, so as to provide basis for carrying out targeted intervention measures.Methods:Totally 252 caregivers of senile dementia patients who visited Taihe Hospital, Shiyan People′s Hospital and Sinopharm Dongfeng General Hospital in Shiyan City, Hubei Province from July 2019 to July 2021 were selected as the research objects by convenience sampling method. The general Information Questionnaire, the Caregiver benefit finding questionnaire, the General self-efficacy Scale (GSES) and the Perceived Social Support Scale (PSSS) were used. The Pearson correlation analysis method was used for the correlation between caregivers' self-efficacy, social support and perceived benefit. Catreg was used to analyze the influencing factors of caregivers' benefit finding in senile dementia patients.Results:The total score of caregiver benefit questionnaire for 252 caregivers of senile dementia patients was (104.74 ± 14.82), the item "made me realize the significance of my health to my family and society" received the highest score (4.70 ± 0.55), while the item "made me quit bad habits" received the lowest score (3.22 ± 1.17). The GSES and PSSS scores of 252 caregivers of senile dementia patients were (24.74 ± 7.02) and (54.21 ± 13.32), which were positively correlated with the benefit finding ( r=0.565, 0.459, both P<0.01). The catreg analysis showed that the age of the caregiver, the average monthly income of the family, self-efficacy and social support were the influential factors of the perceived benefit level of the caregiver of senile dementia patients ( F values were 3.30-104.92, all P<0.05), which could explain 42.4% of the variance. Conclusions:The benefit finding of caregivers of senile dementia patients still needs to be improved. Medical staff should pay attention to the evaluation of benefit finding of caregivers of senile dementia patients, and provide personalized intervention measures to relieve caregivers' care pressure, maintain their physical and mental health, and improve the care quality of caregivers of senile dementia patients.

Objective:To evaluate the effect of ulinastatin on hyperoxia-induced acute lung injury (ALI) and its relationship with Wnt/β-catenin signaling pathway in infantile rats.Methods:A total of 36 clean-grade Sprague-Dawley rats, aged 14 days, weighing 40-50 g, were divided into 3 groups ( n=12 each): control group (C group), hyperoxia-induced ALI group (ALI group) and ulinastatin group (UTI group). Hyperoxia-induced ALI was induced by inhaling oxygen at concentration greater than 90% for 72 h. At 1 day after the model was established successfully, ulinastatin 50 000 U/kg was injected intraperitoneally daily at the same time for 3 consecutive days in group UTI, while the equal volume of normal saline was injected intraperitoneally at the same time point in C and ALI groups.The animals were sacrificed at 4 days after the model was established successfully, the lung tissues were taken for determination of the wet/dry weight ratio (W/D ratio), for microscopic examination of the pathological changes which were scored, for measurement of interleukin-6 (IL-6) IL-1β and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay) and for detection of the expression of phosphorylated glycogen synthase kinase (p-GSK-3β), Wnt3a and β-catenin by Western blot, and ultrastructure was examined with with an electron microscope. Results:Compared with C group, W/D ratio and lung injury score were significantly increased, the contents of IL-6, IL-1β and TNF-α were increased, and the expression of p-GSK-3β, Wnt3a and β-catenin were up-regulated in lung tissues in group ALI ( P<0.05). Compared with group ALI, W/D ratio and lung injury score were significantly decreased, the contents of IL-6, IL-1β and TNF-α were decreased, and the expression of p-GSK-3β, Wnt3a and β-catenin were down-regulated in lung tissues in group UTI ( P<0.05). The ultrastructure injury in group UTI was reduced as compared with group ALI. Conclusion:The mechanism by which ulinastatin can alleviate hyperoxia-induced ALI is related to inhibiting the activation of Wnt/β-catenin signaling pathway and decreasing inflammatory response in infantile rats.

Objective:To evaluate the role of histone deacetylase 6 (HDAC6) in spinal dorsal horn in dexmedetomidine-induced reduction of neuropathic pain (NP) in rats.Methods:Forty clean-grade healthy male Sprague-Dawley rats, aged 7-9 weeks, weighing 190-240 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), sham operation group (group SH), group NP, dexmedetomidine group (group D), and specific HDAC6 inhibitor ACY-1215 plus dexmedetomidine group (group AD). The animals were commonly fed without any treatment in group C. The sciatic nerve was only isolated but not ligated in group SH.The animals were anesthetized with intraperitoneal 10% chloral hydrate 350 mg/kg.NP was induced by chronic constrictive injury (CCI). The right sciatic nerve was exposed, and 4 loose ligatures were placed on the sciatic nerve at 1-mm intervals with 4-0 silk thread in NP and D groups.In group D, dexmedetomidine 40 μg/kg was intraperitoneally injected once a day starting from the end of operation until the animals were sacrificed.In group AD, ACY-1215 25 mg/kg was intraperitoneally injected every day immediately before CCI, and dexmedetomidine 40 μg/kg was intraperitoneally injected daily after CCI until 15 days after CCI.The equal volume of solvent was given instead of dexmedetomidine in S and NP groups.The mechanical paw withdrawal threshold to von Frey filament stimulation (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before CCI (baseline, T 0) and 3, 6, 9, 12 and 15 days after CCI (T 1-5). The rats were then sacrificed, and the dorsal horn tissues of L 4-6 spinal cord were obtained for determination of the expression of myeloid differentiation factor 88 (MyD88) and nuclear factor kappa B (NF-κB) p65 by Western blot. Results:Compared with group C and group SH, the MWT was significantly decreased, and the TWL was shortened at T 1-5, and the expression of MyD88 and NF-κB p65 in the spinal dorsal horn was up-regulated in NP, D and AD groups ( P<0.05). Compared with group NP, the MWT was significantly increased, and the TWL was prolonged at T 1-5, the expression of MyD88 and NF-κB p65 in the spinal dorsal horn was down-regulated in group D ( P<0.05), and no significant change was found in the parameters mentioned above in group AD ( P>0.05). Compared with group D, MWT was significantly decreased, and TWL was shortened at T 1-5, and the expression of MyD88 and NF-κB p65 was up-regulated in the dorsal horn of the spinal cord in group AD ( P<0.05). Conclusion:HDAC6 in spinal dorsal horn is involved in dexmedetomidine-induced reduction of NP in rats, which is related to inhibiting MyD88/NF-κB signaling pathway.

Objective:To investigate the effect and molecular mechanism of long non-coding RNA (Linc01278) on the proliferation, invasion and migration, and tumor phenotype of prostate cancer cells.Methods:Prostate cancer tissues and corresponding normal tissues adjacent to the cancer were obtained in 46 patients with prostate cancer confirmed by the hospital from Dec. 2018 to Dec. 2019. Real-time fluorescence quantitative PCR (qPCR) was used to detect the expression levels of Linc01278 and miR-145 in prostate cancer tissues and adjacent normal tissues. The prostate cancer PC-3 cells were transfected with plasmids and cells were divided into four groups: blank group, control group, overexpression group and rescue group. The blank group was not given any treatment; the control group was transfected with blank control vector and miRNA Control; the overexpression group was transfected with Linc01278 overexpression vector and miRNA Control; the rescue group was transfected with Linc01278 overexpression vector and miR-145 mimics. Bioinformatics analysis was used to predict the binding site of Linc01278 to miR-145. Dual Luciferase Reporter Gene Assay was used to analyze the adsorption of Linc01278 on miR-145; Transwell experiment was used to detect the invasion and migration ability of the four groups of cells; CCK-8 method was used to detect the cell proliferation ability of the four groups of cells. Western blot was used to detect the expression of OCT4 and SOX2 in the four groups of cells; qPCR was used to detect the expression of OCT4, SOX2 and miR-145 in the four groups of cells.Results:Compared with adjacent normal tissues, Linc01278 was significantly higher in prostate cancer tissues (adjacent normal tissues: 0.012±0.002 vs prostate cancer tissues: 0.022±0.002, P=0.0072) , while miR-145 was significantly lower (adjacent normal tissues: 0.117±0.011 vs prostate cancer tissues: 0.081±0.007, P=0.0005) . Correlation of both was negative significantly ( P=0.0012) . Targetscan analysis revealed that the 804-825 position of the Linc01278 transcript had a complementary base pairing with miR-145. The results of the double luciferase reporter gene showed that miR-145 mimics could significantly reduce the luciferase activity of Linc01278 ( P<0.01) . Compared with the blank group and the control group, the invasion and migration cells, the relative proliferation ability, the expression of Oct4 and Sox2 mRNA and protein were significantly increased, and the expression of miR-145 was significantly decreased in the overexpression group ( P<0.05) . While compared with the overexpression group, the invasion and migration cells, the relative proliferation ability, Oct4 and Sox2 were significantly decreased in the rescue group, and the expression of miR-145 was significantly increased ( P<0.01) . Conclusion:Linc01278 may promote the proliferation, invasion and migration of prostate cancer cells by specifically adsorbing miR-145.

Objective: To evaluate the effect of penehyclidine hydrochloride (PHC) on Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling pathway in non-ventilated lung injury in the patients undergoing radical operation for lung cancer. Methods: A total of 100 patients, aged 40-64 yr, with body mass index 18-27 kg/m², of American Society of Anesthesiology physical status Ⅱ or Ⅲ, undergoing radical operation for lung cancer, were divided into 2 groups (n=50 each) according to the random number table method: control group (group C) and PHC group.PHC 0.01 mg/kg was intravenously injected at 10 min before anesthesia induction in group PHC, while the equal volume of normal saline was given instead in group C. The peripheral tissues of the removed lung tissues were obtained for determination of wet/dry weight ratio (W/D ratio). The pathological changes and ultrastructure of lung tissues were observed under light microscope, and lung injury was assessed and scored.The expression of TLR4 and NF-κB protein and mRNA was detected by Western blot and real-time polymerase chain reaction, respectively.Before administration (T₀), at the onset of one-lung ventilation (T₁), at 60 min of one-lung ventilation (T₂), immediately after the end of one-lung ventilation (T₃), at the end of operation (T₄) and at 24 h after operation (T₅), blood samples were collected from the internal jugular vein for determination of serum tumor necrosis factor-alpha, interleukin-6 (IL-6) and IL-8 concentrations by enzyme-linked immunosorbent assay. Results: Compared with group C, the W/D ratio and lung injury scores were significantly decreased, the expression of TLR4 and NF-κВ protein and mRNA was down-regulated, and the concentrations of tumor necrosis factor-alpha, IL-6 and IL-8 were decreased at T₂-T₅ in group PHC (P<0.05). The pathological changes and damage to ultrastructure of lung tissues were significantly attenuated in group PHC as compared with group C. Conclusion The mechanism by which PHC attenuates non-ventilated lung injury is related to blocking TLR4/NF-κВ signaling pathway and reducing inflammatory responses in the patients undergoing radical operation for lung cancer.

Objective To explore the intervention effect of liaison nurses on the follow-up care of patients transferred out of the intensive care unit. Methods Totally 156 ICU patients from January to December 2016 were selected as the research object by convenient sampling, with 71 patients from January to June as the control group and 85 patients from July to December as the treatment group. Patients in the control group received conventional transfer, while a team of ICU liaison nurses was established to provide continuing nursing services to the patients transferred from ICU into general wards in terms of the treatment group so that potential risks could be found and intervened as early as possible. The average length of stays, rate of unexpected return to ICU within 48 hours, and incidence of nursing complications were compared between the two groups. The State Anxiety Inventory and Chinese Version of Critical Care Family Satisfaction Survey were used to compare the level of transfer anxiety and family satisfaction of the patients in the two groups. Results The patients in the treatment group showed a shorter average length of stays and a lower rate of unexpected return to ICU within 48 hours and incidence of nursing complications than the patients in the control group (P<0.05). The patients in the treatment group had a lower score in transfer anxiety (P< 0.05). The score in any dimension of family satisfaction and the total score of the patients in the treatment group were higher than those of the patients in the control group (P<0.05). Conclusions Liaison nurses have showed a good effect on the follow-up care of patients transferred out of ICU, which is significant to some extent.

Objective To investigate the clinical value of homemade uniform drainage system and application results in continuous lumbar drainage of cerebrospinal fluid. Methods A total of 75 patients underwent continuous lumbar cistern drainage of cerebrospinal fluid in patients with mechanical sampling were randomly divided into two groups, the control group (35 cases) using the traditional methods of continuous lumbar cistern drainage, the test group (40 cases) with self-designed uniform drainage device, compared with two groups of 24 hours from fluid volume flow control and the incidence of adverse reactions and the workload of nurses. Results The drainage rate equilibrium, the frequency of inspections and time respectively and the incidence of adverse reaction were (1.07 ± 0.35)/h, (23.67 ± 7.23) min/d and 5.00%(2/40) in the test group, less than that in the control group (2.14 ± 0.83)/h, (48.54 ± 11.69) min/d and 25.71%(9/35), there were significant differences (t=8.547, 7.641, χ2=16.347, all P <0.05). Conclusions In order to control the workload of nurses and reduce the incidence rate of adverse reactions, it is worth to promote the application of the continuous lumbar cistern drainage.

Objective To explore the effect of motor imagery therapy and its combination with counterbalance exercise on the fall efficacy of elderly people.Methods Totals of 156 eligible elderly people with fear of falling ( FOF) were selected as objects and randomly divided into three groups. The first group was the control group, treated with routine rehabilitation nursing. People in the second group were treated with routine rehabilitation nursing plus motor imagery therapy. People in the third group were treated with routine nursing plus motor imagery therapy, combined with counterbalance exercise. The intervention lasted for 2 weeks. People in the three groups were assessed by fall efficacy and depression scales before and after the intervention. Results Regarding fall efficacy before and after the intervention, there were not significant differences in the control group [(3.79±1.46) points vs. (4.01±1.35)points, t=0.798, P>0.05)], or in the second group [(3.88±1.86) vs. (4.38±1.14), t=1.653, P>0.05)], but there was significant difference in the third group [(3.91±1.54) vs. (5.75±1.43), t=6.314, P<0.01)]. As for depression scores before and after the intervention, there was not significant difference in the control group [(56.68±8.64) vs. (54.21±8.28), t=1.489, P>0.05)], but there were significant differences in the second group [(55.58±7.42) vs. (47.45± 6.89), t=5.790, P<0.01)], and in the third group [(56.23±6.54) vs. (46.23±7.21), t=7.408, P<0.01)].Conclusions The motor imagine therapy alone can not significantly improve fall efficacy of the elderly with FOF, but can significantly reduce their depression. Combined use of motor imagery therapy and counterbalance exercise can significantly increase their fall efficacy and reduce their depression.