Objective To investigate the effects of combined exercise training on exercise ability and inflammatory factors in elderly patients with chronic obstructive pulmonary disease(COPD)complicated with sarcopenia.Methods Sixty elderly patients with COPD complicated with sarcopenia who were treated in Hangzhou Third People's Hospital from July 2022 to May 2023 were selected as study objects,and were divided into control group and treatment group according to random number table method,with 30 cases in each group.The control group received routine treatment of COPD,while the treatment group received combined exercise training on the basis of routine treatment for 12 weeks.The appendicular skeletal muscle mass index(ASMI),grip strength,walking speed,6 min walking distance(6MWD),COPD assessment test(CAT),forced expiratory volume in one second(FEV1)/forced vital capacity(FVC)、serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were compared.The correlation between serum IL-6、TNF-α and ASMI,grip strength、walking speed were analyzed.Results After treatment,6MWD in both groups was significantly longer than before treatment,and CAT score was significantly lower than before treatment(P＜0.05).The ASMI,grip strength and walking speed of patients in treatment group were significantly higher than before treatment,and the serum IL-6 and TNF-α were significantly lower than before treatment(P＜0.05).The ASMI,grip strength and walking speed of treatment group were significantly higher than those of control group,6MWD was significantly longer than that of control group,CAT score,serum IL-6 and TNF-α were significantly lower than those of control group(P＜0.05).There was no significant difference in FEV1/FVC between two groups before and after treatment(P＞0.05).Pearson correlation analysis showed that serum IL-6、TNF-α were negatively correlated with ASMI、grip strength and walking speed.Conclusion Combined exercise training can improve muscle mass and strength,improve exercise ability and clinical symptoms,and inhibit inflammatory response in elderly patients with COPD complicated with sarcopenia.

This paper summarized the experience in treating flat warts by Professor XU Xian based on the theory of Bai Qi （白气） micro-discharge. Flat warts is considered as a minor skin disease. Wind-damp attacking the exterior and contention between the muscles are the prerequisites for its occurrence， and failure to diffuse due to wei （卫） constraint， and qi discharge to striae and interstices are the core pathogenesis. For treatment， the core principle is to treat minor diseases with minor adjustment， and therefore， the method of dispelling wind and overcoming dampness is used to produce slight sweating and relieve the symptoms， and by taking advantage of the situation， the constraint is unblocked with diffusion and dispersion. Simultaneously， it is paid attention to not over-damaging blood vessels during treatment to avoid causing other symptoms. Self-made Modified Maxing Yigan Decoction （麻杏薏甘汤） is recommended as the basic formula for flat warts， together with self-made Xi You Formula （洗疣方） in external administration to restore defense qi， eliminate pathogenic qi and remove the warts.

A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.

Objective:To explore the effects of the hierarchical management based on comprehensive quantitative risk assessment strategy in psychiatric inpatients.Methods:Totally 1 356 inpatients admitted at the Department of Psychiatric Rehabilitation in Huaian No.3 People's Hospital between January and December 2019 were included by convenient sampling into a control group, which received routine risk management and nursing intervention; 1 282 inpatients admitted between January and December 2020 were included into an observation group, which underwent hierarchical management based on comprehensive quantitative risk assessment on this basis. The incidence of accidental events was compared between the two groups of patients.Results:The incidence of accidental events in the observation group was 1.87%, lower than 3.54% in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The hierarchical management based on a comprehensive quantitative risk assessment can reduce the incidence of accidental risk events in psychiatric inpatients.

ObjectiveTo explore the mechanism of Gancao Fuzitang （GCFZ）in inhibiting the bone destruction of collagen-induced arthritis （CIA） model in mice. MethodThirty male DBa/1J mice were randomly divided into normal group， CIA group， low-dose GCFZ group （GCFZ-L， 2.4 g·kg^-1）， high-dose GCFZ group （GCFZ-H， 4.8 g·kg^-1）， and methotrexate group （MTX， 1 mg·kg^-1）， with six mice in each group. The CIA model was induced by secondary immunization method. The arthritis index of mice in each group was observed and recorded， and the histopathological changes in ankle joint were observed by hematoxylin-eosin （HE） staining. The damage to ankle cartilage was detected by safranin O-fast green staining. Micro-CT scanning was used to detect the bone destruction of ankle joint， and the expression of nuclear factor-κB p65 （NF-κB p65）， p-NF-κB p65， inhibitory-κB kinase α/β （IKKα/β）， and p-IKKα/β was observed by immunohistochemical staining. ResultCompared with the normal group， the CIA group showed manifest joint swelling and increased arthritis index score （P<0.01）. Compared with the CIA group， the groups with drug intervention could inhibit joint swelling and reduce arthritis index score （P<0.05， P<0.01）. As revealed by HE staining and safranine O-green staining， compared with the CIA group， the groups with drug intervention could inhibit synovial invasion and reduce the destruction of articular cartilage. Micro-CT scanning analysis showed that compared with the CIA group， the GCFZ-H group and the MTX group showed reduced bone destruction scores （P<0.01）. The immunohistochemical results showed that compared with the normal group， the CIA group showed increased optical density values of NF-κB p65， p-NF-κB p65， IKKα/β， and p-IKKα/β（P<0.01）. Compared with the CIA group， the GCFZ-H group and the MTX group showed reduced optical density values of NF-κB p65， p-NF-κB p65， IKKα/β， and p-IKKα/β（P<0.05，P<0.01）. In the GCFZ-L group， only the NF-κB p65 optical density value decreased（P<0.01）. ConclusionGCFZ may inhibit bone destruction in CIA mice by regulating the NF-κB signaling pathway.

Objective:To understand the X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) imaging features of Brucella spondylitis (BS) in non-pasture areas. Methods:The medical records of 21 patients with BS diagnosed and treated in the Second Affiliated Hospital, Dalian Medical University from December 2013 to November 2020 were collected. There were 14 males and 7 females. The age was (52.4 ± 15.8) years old, ranging from 21 to 77 years old. They all came from non-pasture areas. The diagnostic criteria refered to the "Diagnosis for Brucellosis" (WS 269-2019). The results of imaging examinations (including X-ray, CT and MRI, 19, 16 and 21 cases respectively) were retrospectively analyzed.Results:In 21 patients with BS, the main lesion site was lumbar vertebrae (16 cases, 76.2%). In 19 cases of X-ray examination, 9 cases (47.4%) showed "Bird's Beak" hyperostosis, and 7 cases (36.8%) had vertebral bone destruction. Among the 16 cases of CT examination, 10 cases (62.5%) had hyperosteosclerosis and 8 cases (50.0%) had vertebral bone destruction, they had been showed the characteristic change of "Lace Like" sign. There were 7 cases (43.8%) of intervertebral disc lesions, 1 case (6.2%) of paravertebral abscess and 1 case (6.2%) of psoas major abscess. In 21 patients with MRI examination, 10 cases (47.6%) showed hyperostosis and 11 cases (52.4%) showed bone destruction; 13 cases (61.9%) had signal changes of intervertebral disc. There were 1 case (4.8%) of prevertebral abscess, 1 case (4.8%) of paravertebral abscess and 1 case (4.8%) of psoas major abscess. Sixteen patients underwent CT and MRI examinations at the same time, MRI was superior to CT in detecting intervertebral disc lesions (13 vs 7 cases, χ 2 = 4.800, P < 0.05). Conclusion:The X-ray, CT and MRI imaging features of BS patients in non-pasture areas are varied, and the lesion site mainly involves the lumbar vertebrae, and MRI is superior to CT in detecting intervertebral disc lesions.

Objective To explore the cognitive and psychological experience of medical staff as the second victims in serious adverse events,so as to provide the basis for the related research on the management system of medical adverse events. Methods Using the phenomenological approach in qualitative research, from January to February 2019,9 medical staff from 3 Class Ⅲ hospitals who had experienced adverse events were interviewed as the second victims. The data were analyzed according to Colaizz 7 steps analysis method. Results A total of 4 themes were refined,including the experiences of various negative experiences,the change of occupational cognition,the importance of identifying and improving the system of prevention of adverse events and the desire to establish a support system for the second victims. Conclusions The competent authorities should pay attention to the plight of medical personnel involved in medical adverse events, and actively construct a support system for the second victim,so as to reduce the harm of the second victims in medical adverse events and ensure medical safety.

Objective:To observe the effects of T-2 toxin on expression of hepatocyte growth factor (HGF) and HGF receptor (C-Met) in articular cartilage and epiphyseal cartilage of rats under low selenium condition.Methods:Twenty-four healthy male SD rats weighted 60-80 g were randomly divided into conventional diet group (selenium content of 101.5 μg/kg) and low-selenium diet group (selenium content of 1.1 μg/kg), with 12 rats in each group. After 30 days of feeding, the conventional diet group was further divided into conventional group and T-2 toxin group (100 μg·kg -1·d -1), and the low-selenium diet group was further divided into low-selenium group and low-selenium+T-2 toxin group (100 μg·kg -1·d -1), with 6 rats in each group. After 30 days of feeding, the rats were sacrificed and the cartilage of knee joint was taken, the morphological changes of knee articular cartilage and epiphyseal cartilage were observed by HE staining under light microscope. Immunohistochemical method was used to detect the expression of HGF and C-Met in knee articular cartilage and epiphyseal cartilage, and positive expression rates of HGF and C-Met were calculated. Results:Under light microscope, chondrocytes of articular cartilage and epiphyseal cartilage in low-selenium+T-2 toxin group were sparse, and the necrosis and structural area were found in the deep layer, and the extracellular matrix of chondrocytes in the region was degraded and light stained, and proliferating granulation tissue was visible nearby. The positive expression rates of HGF in articular cartilage [(21.97 ± 6.90)%, (49.41 ± 8.24)%, (76.39 ± 5.88)%] and epiphyseal cartilage [(23.36 ± 12.49)%, (58.43 ± 14.48)%, (66.59 ± 10.83)%] of rats in low-selenium, T-2 toxin and low-selenium+T-2 toxin groups were higher than those in conventional group [(9.13 ± 6.01)%, (11.14 ± 4.67)%, P < 0.05]. The positive expression rates of C-Met in articular cartilage [(25.34 ± 7.53)%, (58.21 ± 12.54)%, (81.46 ± 7.89)%] and epiphyseal cartilage [(35.21 ± 4.71)%, (40.84 ± 2.03)%, (49.41 ± 6.29)%] of rats in low-selenium, T-2 toxin and low-selenium+T-2 toxin groups were higher than those in conventional group [(11.21 ± 5.11)%, (12.12 ± 4.71)%, P < 0.05]. Conclusion:T-2 toxin may affect the expression of HGF and C-Met in articular cartilage and epiphyseal cartilage of rats under low selenium condition.

Objective To observe the expression level of insulin-like growth factor-1 receptor (IGF-1R) in the cartilage tissue of children with Kaschin-Beck disease (KBD) and T-2 toxin-poisoned rats under low selenium condition,and the effect of IGF-1R inhibitor on apoptosis of human normal chondrocytes (C28/I2 cells),and to investigate the role of IGF-1R in the pathogenesis of KBD.Methods The knuckles of dead children (5 cases) in the KBD areas,car accident death and congenital 6 finger deformity operation children (5 cases) in non-KBD areas in Shaanxi were collected,the expression of IGF-1R in the articular cartilage was detected by immunohistochemistry.Thirty-two male Sprague-Dawley rats with a body mass of 60-80 g were selected,according to the body mass,they were divided into the routine feed group (selenium content:101.5 μg/kg) and the low-selenium feed group (selenium content:1.1 μg/kg) by random number table method,16 rats in each group.After 30 days of feeding,the routine feed group was divided into control group and T-2 toxin group (100 ng·kg-1·d-1),the low-selenium feed group was divided into low selenium group and low selenium + T-2 toxin group,8 rats in each group,the expression of IGF-1R in the articular cartilage of the left knee joint was detected by immunohistochemistry after 30 days of feeding.C28/I2 cells were cultured in vitro and treated with T-2 toxin 0 (control),6,12,and 24 μg/L,and each concentration of T-2 toxin was accompanied with sodium selenite (+ 0.1 mg/L) for 72 h.Meanwhile,IGF-1R inhibitor with 0 (control),250,500,and 1 000 μg/L was treated on C28/I2 cells for 48 h.The expression levels of IGF-1R mRNA and protein in chondrocytes were detected by Real-time PCR and Western blotting,and the apoptosis of chondrocytes was detected by flow cytometry.Results Compared with the control group [(100.00 ± 0.00)％,(100.00 ± 0.00)％],the expression rates of IGF-1R positive cells in articular cartilage surface and middle layers [(72.71 ± 4.75)％,(36.33 ± 4.32)％] of children in KBD group were significantly reduced (t =12.852,32.650,P ＜ 0.01).Compared with control group [(100.00 ± 0.00)％,(100.00 ± 0.00)％,(100.00 ± 0.00)％],the expression rates of IGF-1R positive cells in articular cartilage middle layer [(20.83 ± 2.69)％,(26.45 ± 2.84)％,(20.34 ± 1.82)％],deep layer [(33.55 ± 5.66)％,(48.89 ± 8.39)％,(25.51 ± 7.50)％],and the expression rates of IGF-1R positive cells [(47.50 ± 1.47)％,(28.66 ± 3.58)％,(40.52 ± 6.78)％] in the hypertrophic layer of the metaphyseal plate of rats in low selenium,T-2 toxin,and low selenium + T-2 toxin groups were significantly reduced (P ＜ 0.01).C28/I2 cells were cultured in vitro,compared with the control group,IGF-1R mRNA and protein expression levels in each T-2 toxin groups were significantly reduced (P ＜ 0.05).The expression levels of IGF-1R mRNA (1.95 ± 0.35,2.44 ± 0.17,2.40 ± 0.15) in 6,12,24 μg/L T-2 toxin + 0.1 mg/L selenium groups were significantly higher than those in T-2 toxin groups (0.80 ± 0.08,0.63 ± 0.08,0.61 ± 0.11,t =-12.259,-11.279,-13.371,P＜ 0.05).The expression levels of IGF-1R protein (1.67 ± 0.70,1.07 ± 0.26) in 6,12 μg/L T-2 toxin + 0.1 mg/L selenium groups were significantly higher than those in T-2 toxin groups (0.52 ± 0.05,0.72 ± 0.05,t =-25.977,-10.776,P ＜ 0.05).Compared with the control group [(5.33 ± 0.85)％,(4.03 ± 1.15)％],C28/I2 cells early apoptosis rates [(8.26 ± 1.51)％,(13.00 ± 0.72)％,(13.19 ± 1.05)％] in each of IGF-1R inhibitor groups,and late apoptosis rates [(8.50 ± 0.71)％,(14.21 ± 1.10)％] in 500,1 000 μg/L IGF-1R inhibitor groups were increased significantly (P ＜ 0.05).Conclusions The expressions of IGF-1R in the cartilage tissue of KBD children and T-2 toxin-poisoned rats under low selenium condition are decreased.T-2 toxin decreases the expression of IGF-1R in chondrocytes,and selenium can partly inhibit the effect of T-2 toxin on IGF-1R.Down-regulation of IGF-1R causes chondrocyte apoptosis,and it may play an important role in KBD chondrocyte apoptosis.

Objective To observe the effect of Shenmai injection combined with enteral nutrition (EN) on immune function in patients with severe cardiac insufficiency. Methods Fifty-seven patients with severe cardiac insufficiency admitted to the Department of Critical Care Medicine of Taizhou Hospital of Zhejiang Province from June 2015 to June 2018 were divided into an EN group (31 cases) and an EN group combined with Shenmai injection group (26 cases). The EN group was given EN on the basis of routine western medicine treatment, while in the EN combined with Shenmai injection group was treated additionally by intravenous drip of Shenmai injection 100 mL/d on the basis of above EN group treatment. The efficacies of the two groups were evaluated after consecutive 7-day treatment in the two groups. The changes in levels of subsets of T-lymphocytes (CD3+, CD4+, CD8+, CD4+/CD8+) and immunosuppressive cells CD14+ monocyte human leukocyte antigen DR (HLA-DR) were observed before and after treatment. Results After treatment, the levels of T-cell subsets CD3+, CD4+, CD4+/CD8+ and CD14+ monocytes HLA-DR in the peripheral blood of the two groups were significantly higher than those before treatment [CD3+: EN group was 0.539±0.126 vs. 0.379±0.093,Shenmai injection group was 0.652±0.185 vs. 0.393±0.091; CD4+: EN group was 0.402±0.121 vs. 0.275±0.066,Shenmai injection group was 0.524±0.168 vs. 0.281±0.077; CD4+/CD8+:EN group was 1.83±0.70 vs. 1.11±0.70,Shenmai injection group was 2.81±0.91 vs. 1.19±0.58; CD14+HLA-DR:EN group was (43.3±7.1)% vs. (35.4±5.7)%,Shenmai injection group was (54.9±6.2)% vs. (36.1±8.3)%]; After treatment, CD8+ in EN group decreased (0.223±0.052 vs. 0.253±0.081), while CD8+ in shenmai injection group increased (0.288±0.051 vs. 0.259±0.078), and the increase degrees of the above-mentioned indexes in EN combined with Shenmai injection group were more obvious than those in the EN group after treatment [CD3+: 0.652±0.185 vs. 0.539±0.126, CD4+: 0.524±0.168 vs. 0.402±0.121, CD8+: 0.288±0.051 vs. 0.223±0.052, CD4+/CD8+: 2.81±0.91 vs. 1.83±0.70, CD14+HLA-DR: (54.9±6.2)%, (43.3±7.1)%, all P < 0.05]. Conclusion The combined use of Shenmai injection and early EN can improve the immune function of T-lymphocytes in patients with severe cardiac insufficiency. The mechanism may be related to the enhancement of the activation of T lymphocytes and promotion of the CD14+ monocytes increase and immune function.