Myasthenia gravis is an autoimmune disorder characterized by impaired neuromuscular transmission. Thymectomy is one of the therapeutic options for acetylcholine receptor antibody-positive myasthenia gravis patients. The quality of perioperative care is directly associated with surgical safety and patient outcomes. However, there is currently a lack of specialized nursing consensus or guidelines specifically addressing the care of these patients domestically or internationally. To promote the standardization and normalization of perioperative nursing care for myasthenia gravis patients undergoing thymectomy and to ensure treatment efficacy, a panel of 57 experts from relevant fields was convened. Based on evidence-based medicine and clinical practice experience, discussions were held on various aspects including condition assessment, nutritional support, medication management, and airway care, resulting in a consensus with 18 final recommendations by using the Delphi method through two rounds of expert consultation. This consensus aims to provide a scientific reference for the perioperative nursing care of myasthenia gravis patients undergoing thymectomy.

Atractylodes macrocephala, a plant of the Asteraceae family, as a commonly used traditional Chinses medicine in clinic, has the efficacy of invigorating spleen and supplementing qi, eliminating dampness and inducing diuresis, and expelling wind and dispersing cold. Moreover, it was proved that it has many pharmacological effects such as anti-inflammation, anti-tumor, and improving immunical ability based on the scientific researches. Atractyloside is one of its active ingredients and characteristic ingredients. In this paper, using the search terms of Baizhu lactone, sesquiterpene lactone, quality evaluation, quality control, and chemical composition, the CNKI, Weipu and PubMed literature database were searched. And relevant literature results were compared and summarized. The catagories, structural formula of atractyloside and their transformation mechanism were summarized. It was found that the content of lactone components could be affected by different processing methods, different producing locations, different harvesting season, and different growth years. It was found that for the quality evaluation of Atractylodes macrocephala, the multivariate statistical analysis combined with content determination or fingerprint establishment could be more accurate, reliable and comprehensive, among which the supervised PLS-DA with OPLS-DA analysis was better than the unsupervised PCA analysis. This literature summary could provide a beneficial reference for the quality evaluation and utilization of Atractylodes macrocephala.

Objective:To retrieve, evaluate and integrate the evidence related to the preparation process for initiating extracorporeal cardiopulmonary resuscitation in hospital, so as to provide reference for clinical implementation of extracorporeal cardiopulmonary resuscitation.Methods:According to the evidence-based nursing method and the 6S evidence model, guidelines, clinical decisions, expert consensus, systematic review and other literatures related to the preparation process for initiating extracorporeal cardiopulmonary resuscitation in hospital were searched from National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, and other websites, UpToDate, The Cochrane Library, PubMed, Embase, CNKI, Wanfang and other databases. The retrieval date limit was from the establishment of the database to May 20, 2023. Researchers assessed the quality of the included articles, and extracted and summarized the evidence that met the quality standards.Results:A total of 11 articles were included, including 2 guidelines, 6 expert consensuses, 1 systematic review and 2 quasi-experimental studies. A total of 18 pieces of evidences were summarized from 6 aspects, including medical conditions, team building, materials management, operation mechanism, pre-initiating treatment and initiating judgment.Conclusions:This study summarizes the evidence of preparation process for initiating extracorporeal cardiopulmonary resuscitation in hospital, which can provide reference for promoting the implementation of extracorporeal cardiopulmonary resuscitation. Future studies still need to focus on team building, personnel training and assessment, and optimisation of the management system, so as to improve the efficiency and readiness of treatment.

Objective To explore the efficacy and safety of lung recruitment maneuver(LRM)on postoperative hypoxemia in patients with acute type A aortic dissection(ATAAD).Methods A total of 56 ATAAD patients with postoperative hypoxemia in the First Affiliated Hospital of Guangxi Medical University from November 2019 to May 2022 were selected and randomly divided into LRM group(n=36)and conventional treatment group(n=20).Patients in conventional treatment group received routine mechanical ventilation on the basis of lung protective ventilation.The patients in LRM group were treated with incremental positive end expiratory pressure(PEEP).Arterial blood gas analysis,respiratory parameters,hemodynamics parameters and serum interleukin(IL)-6 and IL-10 levels were compared between two groups before and after treatment.Results At 12h and 24h after treatment,arterial partial pressure of oxygen(PaO2),oxygenation index(OI),static compliance(Cstat)and dynamic compliance(Cdyn)in two groups were significantly higher than before treatment,the alveolar-arterial gradient of oxygen[PO2(A-a)],respiratory index(RI),peak inspiratory pressure(Ppeak)and plateau pressure(Pplat)were significantly lower than before treatment(P<0.05).PaO2,OI,Cstat and Cdyn in LRM group were significantly higher than those in conventional treatment group,PO2(A-a),RI,Ppeak and Pplat were significantly lower than those in conventional treatment group(P<0.05).Systolic blood pressure and mean arterial pressure decreased and central venous pressure increased during pulmonary reexpansion in LRM group(P<0.05),and all patients returned to baseline level after pulmonary reexpansion.At 12h after treatment,serum IL-6 and IL-10 levels in both groups were significantly lower than before treatment(P<0.05).Conclusion Incremental PEEP can improve oxygenation and lung compliance in patients with hypoxemia after ATAAD surgery,but it has transient effects on hemodynamics,and should be closely monitored during treatment.

Background and objective Lung squamous cell carcinoma(LUSC)is a subtypes of non-small cell lung cancer(NSCLC).It has been reported that members of the protocadherin γ family can regulate tumor cell growth by inhibiting the Wnt signaling pathway.Protocadherin-gamma subfamily B4(PCDHGB4)as a family member in LUSC was rarely reported.The aim of this study was to investigate the role and potential prognostic value of PCDHGB4 in the development of LUSC us-ing bioinformatics methods.Methods The Cancer Genome Atlas(TCGA),cBioPortal and UALCAN databases were used to analyze the expression,prognosis,clinicopathological features,immune cell infiltration,immune regulatory genes,immune checkpoint inhibitors(ICIs),and methyltransferases of PCDHGB4 in LUSC.At the single cell level,we analyzed the clustering results of cell subtypes and the expression of PCDHGB4 in different immune cell subpopulations.In addition,we compared the promoter methylation levels of PCDHGB4 in LUSC tissues and normal tissues and performed protein-protein interaction and mutation analysis.Finally,enrichment analysis was performed based on the differentially expressed genes.Results Bioinformat-ics analysis results showed that the expression level of PCDHGB4 in LUSC tissues was lower than that in normal tissues.Sur-vival analysis showed that increased PCDHGB4 expression was associated with poor prognosis.Single-cell sequencing analysis showed that PCDHGB4 was expressed in T cells,monocytes or macrophages,and dendritic cells.It was further found that PCD-HGB4 played an important role in tumor immunity and confirmed that PCDHGB4 was associated with immune checkpoints,immune regulatory genes,and methyltransferases.Besides,enrichment analysis revealed that PCDHGB4 was involved in mul-tiple cancer-related pathways.Conclusion The expression of PCDHGB4 was low in LUSC.PCDHGB4 was related to the poor prognosis of patients,and PCDHGB4 was closely related to the infiltration and pathway of tumor immune cells.PCDHGB4 may be a potential prognostic marker and a new target for immunotherapy in LUSC.

BACKGROUND: Lung cancer is the most common malignant tumor in China, lung adenocarcinoma (LUAD) is the main type of lung cancer, which is a serious threat to people's life and health. At present, there are fewer studies on the role of Dikkopf1 (DKK1) in lung adenocarcinoma. The aim of this study was to investigate the role and potential prognostic value of DKK1 in the development of lung adenocarcinoma by bioinformatics methods. METHODS: Several databases, such as genotype-tissue expression (GTEx), The Cancer Genome Atlas (TCGA) and tumor-immune system interactions database (TISIDB), were used to analyze the expression, clinicopathological features, immune cell infiltration, prognosis and methylation of DKK1 in lung adenocarcinoma. Then, linked immune cell infiltration Omics database was used to analyze the co-expressed genes of DKK1 and their functional enrichment. Finally, 59 pathological samples of paraffin-embedded lung adenocarcinoma patients who underwent surgery at the Affiliated Cancer Hospital of Xinjiang Medical University between 2016 and 2017 were collected for the validation of the prognostic value of expression by immunohistochemistry (IHC) test. RESULTS: The results of bioconfidence analysis showed that the expression level of DKK1 in lung adenocarcinoma tissues was higher than that in normal tissues, the expression in advanced cancers was higher than that in early stages, and the experimental validation revealed that among 59 cases of lung adenocarcinoma, there were 15 cases of negative expression (25.4%), 18 cases of weakly positive expression (30.5%), and 26 cases of strongly positive expression (44.1%). The different expression of DKK1 is related to methylation, prognosis and the activities of various immune cells. Functional enrichment shows that DKK1 may be involved in skin development and cell-substrate junction, and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis shows that DKK1 is related to ABC transporters. Bioinformatics analysis and clinical case specimens showed that high DKK1 expression was associated with poorer prognosis in patients with lung adenocarcinoma. CONCLUSIONS High expression of DKK1 in lung adenocarcinoma is associated with poor prognosis. DKK1 is closely associated with tumor immune cell infiltration and pathways. DKK1 can be considered as a potential prognostic marker and a novel target for immunotherapy of lung adenocarcinoma.

In order to investigate the enzyme production mechanism of yak rumen-derived anaerobic fungus Orpinomyces sp. YF3 under the induction of different carbon sources, anaerobic culture tubes were used for in vitro fermentation. 8 g/L of glucose (Glu), filter paper (Flp) and avicel (Avi) were respectively added to 10 mL of basic culture medium as the sole carbon source. The activity of fiber-degrading enzyme and the concentration of volatile fatty acid in the fermentation liquid were detected, and the enzyme producing mechanism of Orpinomyces sp. YF3 was explored by transcriptomics. It was found that, in glucose-induced fermentation solution, the activities of carboxymethyl cellulase, microcrystalline cellulase, filter paper enzyme, xylanase and the proportion of acetate were significantly increased (P < 0.05), the proportion of propionate, butyrate, isobutyrate were significantly decreased (P < 0.05). The results of transcriptome analysis showed that there were 5 949 differentially expressed genes (DEGs) between the Glu group and the Flp group, 10 970 DEGs between the Glu group and the Avi group, and 6 057 DEGs between the Flp group and the Avi group. It was found that the DEGs associated with fiber degrading enzymes were significantly up-regulated in the Glu group. Gene ontology (GO) function enrichment analysis identified that DEGs were mainly associated with the xylan catabolic process, hemicellulose metabolic process, β-glucan metabolic process, cellulase activity, endo-1,4-β-xylanase activity, cell wall polysaccharide metabolic process, carbohydrate catabolic process, glucan catabolic process and carbohydrate metabolic process. Moreover, the differentially expressed pathways associated with fiber degrading enzymes enriched by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were mainly starch and sucrose metabolic pathways and other glycan degradation pathways. In conclusion, Orpinomyces sp. YF3 with glucose as carbon source substrate significantly increased the activity of cellulose degrading enzyme and the proportion of acetate, decreased the proportion of propionate, butyrate and isobutyrate. Furthermore, the degradation ability and energy utilization efficiency of fungus in the presence of glucose were improved by means of regulating the expression of cellulose degrading enzyme gene and participating in starch and sucrose metabolism pathway, and other glycan degradation pathways, which provides a theoretical basis for the application of Orpinomyces sp. YF3 in practical production and facilitates the application of Orpinomyces sp. YF3 in the future.
Animals ; Cattle ; Neocallimastigales/metabolism* ; Anaerobiosis ; Rumen/microbiology* ; Propionates/metabolism* ; Isobutyrates/metabolism* ; Cellulose/metabolism* ; Fungi ; Starch/metabolism* ; Glucose/metabolism* ; Acetates ; Sucrose/metabolism* ; Cellulases ; Cellulase

【Objective】 To compare the current standards and explore the influencing factors for hemolysis rate of leukocyte-reduced red blood cells at the end of the preservation period, in order to formulate reasonable internal control indicators. 【Methods】 A retrospective analysis was performed on hemolysis rate of 427 samples of leukocyte-reduced red blood cells at the end of the preservation period in Nanning Blood Center from 2015 to 2022. Compared with the current standard for hemolysis rate at the end of the preservation period (GB 18469-2012 Quality Requirements for Whole Blood and Component Blood), the differences were analyzed, and the factors influncing the hemolysis rate were analyzed in terms of different blood donor groups. 【Results】 1) Among the 427 samples, the hemolysis rate of 418 (97.89%) did not exceed 0.4%, all lower than 0.8%; 2)the hemolysis rate of the male group was higher than that of the female group; 3) the hemolysis rate of the 18-29 years old group was lower than that of the 30-39 year old group and the 40-60 year old group, with statistically significant difference; 4) in terms of occupation, the hemolysis rate of students was the lowest, and the differences between groups were statistically significant; 5) no statistical significance was found in ethnicity and blood type. 【Conclusion】 Statistics indicated that gender, age, blood donation volume and occupation of blood donors were the influencing factors of hemolysis rate. The current standard is obviously higher in the qualified range of blood quality control in Nanning. It is advisable to formulate a reasonable quality control strategy with internal control index of hemolysis rate set <0.4%, which is conducive to making accurate evaluation of internal quality control and ensuring blood safety.

Objective:To explore the application effect of continuous quality improvement based on trauma team activation model in emergency triage.Methods:This study is a historical controlled study. A total of 12 215 trauma patients receiving initial treatment in the Emergency Department of the First Affiliated Hospital with Nanjing Medical University from January 2020 to June 2021 were selected as the research objects by the convenience sampling method, and 3 896 trauma patients from January to June 2020 were enrolled as the baseline group, and 4 054 patients from July to December 2020 were enrolled as the phaseⅠ improvement group, and 4 265 patients from January to June 2021 were enrolled as the phaseⅡ improvement group. The baseline group adopted the one-tiered trauma team activation model, which was evaluated and decided by the first-visiting doctor. The phaseⅠ improvement group received the one-tiered trauma team activation model, which was evaluated and decided by pretest triage nurses. The stageⅡ improvement group conducted the two-tiered trauma team activation model, which was evaluated and decided by pretest triage nurses. The trauma team activation time, overtriage rate and undertriage rate were compared between the three groups.Results:The trauma team activation time of the phaseⅠ improvement group and phaseⅡ improvement group was shorter than that of the baseline group, and the difference was statistically significant ( P<0.05). The overtriage rate of the phaseⅡ improvement group was lower than that of the baseline group and the phaseⅠ improvement group, and the differences were statistically significant ( P<0.05). The underage rate of the three groups were <5%, and the differences were not statistically significant ( P>0.05) . Conclusions:The two-tiered activation of trauma team mode led by nurses can shorten the trauma team activation time, reduce the overtriage rate and undertriage rate, improve the quality of trauma team activation.

Objective:To investigate the status quo of organizational silence behavior of nurses in Emergency Department, and analyze the influence of working environment and psychological capital on organizational silence.Methods:This study was a cross-sectional study. Using the convenient sampling method, a total of 232 emergency department nurses from 5 ClassⅢ Grade A hospitals in Jiangsu Province were selected as the research objects from April to June 2022. The research objects were surveyed using the general information survey questionnaire, Nurse Organization Silence Assessment Questionnaire, Nurse Work Environment Scale and Nurse Psychological Capital Scale. Pearson correlation was used to analyze the correlations among organizational silence, work environment and psychological capital. The mediation model was modeled using AMOS 24.0 software, and the Bootstrap method was used to verify the mediating effect of psychological capital between work environment and organizational silence. A total of 232 questionnaires were sent out in this study, and 210 were effectively received with effective recovery of 90.5% (210/232) .Results:The organizational silence score of 210 emergency department nurses was (54.70±15.02), The working environment score was (80.72±11.07), and the psychological capital score was (71.59±11.57). Organizational silence was negatively correlated with work environment and psychological capital scores ( r=-0.309, -0.670, respectively; P<0.05) ; Working environment was positively correlated with psychological capital score ( r=0.266, P<0.05). The mediating effect analysis showed that psychological capital had a partial mediating effect between working environment and organizational silence (β=-0.311, P<0.05). The direct effect size of working environment on organizational silence was -0.241 ( P<0.05) . Conclusions:The organizational silence of nurses in emergency department is at a medium high level, and the working environment can indirectly affect the organizational silence through psychological capital. Nursing managers can improve organizational silence by creating a healthy working environment, cultivating nurses' psychological capital and creating more opportunities to communication.