Objective To observe the effectiveness and safety of Regional Citrate Anticoagulation(RCA)in CRRT combined with artificial liver treatment.Methods Clinical data of 54 sessions of CRRT linked with artificial liver treatment using RCA in 21 patients with acute on chronic liver failure(ACLF)combined with acute kidney injury(AKI)admitted to our center from December 2019 to June 2023 were collected..The improvement of liver and kidney function indicators,anticoagulant effect and adverse reactions of citric acid,and patient outcomes were observed and analyzed before and after treatment.Results The 54 cases of liver and renal function indexes were improved,which showed a statistically significant difference(P<0.05);All 54 cases of CRRT linked artificial liver treatment were successfully completed,and no obvious blood clots were found in the extracorporeal circulation tubing,filters,and adsorbers;There was no statistically significant difference(P>0.05)in the total calcium and ionized calcium levels of all patients at each stage of artificial liver treatment compared to before treatment;However,three cases of CRRT combined with PE and one case of CRRT combined with DPMAS+LPE experienced citrate accumulation after treatment,which returned to normal after 24 hours of timely correction and supplemen-tation;The 30-day survival rate of the 21 patients was 13 survivors,5 deaths,and 3 discharged automatically.Conclusion Under strict monitoring and timely adjustment,the application of RCA in CRRT series artificial liver treatment is safe and feasible,and is worthy of clinical promotion.

Purpose: To analyze the gene mutation, immune infiltration and tumor growth of primary tumor and distant tumor under different treatment modes. Materials and Methods: Twenty B16 murine melanoma cells were injected subcutaneously into the of both sides of the thigh, simulating a primary tumor and a secondary tumor impacted by the abscopal effect, respectively. They were divided into blank control group, immunotherapy group, radiotherapy group, and radiotherapy combined immunotherapy group. During this period, tumor volume was measured, and RNA sequencing was performed on tumor samples after the test. R software was used to analyze differentially expressed genes, functional enrichment, and immune infiltration. Results: We found that any treatment mode could cause changes in differentially expressed genes, especially the combination treatment. The different therapeutic effects might be caused by gene expression. In addition, the proportions of infiltrating immune cells in the irradiated and abscopal tumors were different. In the combination treatment group, T-cell infiltration in the irradiated site was the most obvious. In the immunotherapy group, CD8+ T-cell infiltration in the abscopal tumor site was obvious, but immunotherapy alone might have a poor prognosis. Whether the irradiated or abscopal tumor was evaluated, radiotherapy combined with anti-programmed cell death protein 1 (anti-PD-1) therapy produced the most obvious tumor control and might have a positive impact on prognosis. Conclusion Combination therapy not only improves the immune microenvironment but may also have a positive impact on prognosis.

Electroacupuncture treatment of primary insomnia is widely used and with confirmed efficacy. The factors influencing the therapeutic effect of electroacupuncture include waveform selection, treatment frequency, stimulation intensity, stimulation time and acupoint selection. The mechanism of electroacupuncture in treating this disease mainly includes regulating the levels of excitatory neurotransmitters, γ-aminobutyric acid, melatonin and interleukin cytokines.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore the application effect of task-driven teaching method combined with Sandwich teaching method in the standardized residency training of oral general practitioners.Methods:A total of 40 trainees of the standardized residency training of the Teaching and Research Section of Oral General Practice in Chongqing Medical University were randomly divided into experimental group and control group. The experimental group ( n=20) adopted task-driven teaching method combined Sandwich teaching method, and the control group ( n=20) adopted the traditional teaching method. The theory assessment, skills assessment and the teaching satisfaction questionnaire survey were conducted to evaluate the teaching effects. SPSS 19.0 software was used for t-test. Results:The theoretical test scores of the experimental group were significantly higher than those of the control group [(85.85±25.61) points vs. (74.35±10.53) points], and the difference between the two groups was statistically significant ( t=8.56, P < 0.001). The skill test scores of the experimental group were significantly higher than those of the control group [(86.50±18.20) points vs. (73.40±16.57) points], and the difference was statistically significant ( t=9.94, P<0.001). The results of the teaching satisfaction questionnaire showed that the experimental group had significantly higher scores than control group in such seven aspects as improving students autonomous learning ability and interest in learning, teamwork and interpersonal relationships, diagnostic ability of cases and the accuracy, doctor-patient expression and communication ability, ability to find and solve problems, stimulating interest in scientific research and teaching, mastering and understanding the oral theoretical knowledge and so on ( t=10.40, 10.40, 9.95, 5.43, 7.66, 8.08, 9.60, respectively, all P<0.001). Task-driven teaching combined with Sandwich teaching method stimulated the learning interest of trainees and improved their comprehensive ability. Conclusion:Task-driven teaching combined with Sandwich teaching method has greatly improved the teaching effect of standardized residency training of oral general practitioners.

Objective:To explore the value of red blood cell distribution width (RDW) in evaluating the severity of patients infected with novel coronavirus Delta variant.Methods:A total of 28 patients infected with novel coronavirus Delta variant in designated hospital treated by the First Affiliated Hospital of Xi'an Jiaotong University medical team from December 2021 to January 2022 were enrolled (23 cases of common type, 4 severe and 1 critical cases). The detailed clinical data of patients was collected. Then, Pearson's correlation analysis was used to identify the blood examination indexes which affected the arterial partial pressure of oxygen (PaO 2) and arterial partial pressure of carbon dioxide (PaCO 2). According to the median standard deviation of red blood cell distribution width (RDW-SD, 42.5 fL), 28 patients were divided into low RDW-SD group (≤ 42.5 fL, 16 cases) and high RDW-SD group (> 42.5 fL, 12 cases), and the immune related indexes of the two groups were compared. Receiver operator characteristic curve (ROC) was drawn to evaluate the predictive value of RDW-SD on the severity of illness of coronavirus disease 2019 (COVID-19). Results:Correlation analysis showed that RDW-SD was the only index related to PaO 2 and PaCO 2 on the first day of admission, which was negative correlation with PaO 2 ( r = -0.379, P = 0.047) and positive correlation with PaCO 2 ( r = 0.509, P = 0.006). The results of effects of different clinical characteristics on RDW-SD level showed that there was no statistically significant difference in RDW-SD between groups with different clinical characteristics (including male/female, ≥ 65 years old/< 65 years old, having/without hypertension, having/without diabetes, smoking/not smoking, having/without hyperpyrexia, with/without fever for 3 days, with/without respiratory symptoms, with/without digestive symptoms). It was suggested that RDW-SD be relatively stable and not affected by the patient's baseline level. The percentage of B cells in low RDW-SD group was higher than that in high RDW-SD group (23.01±3.01 vs. 15.34±5.34, P < 0.05), immunoglobulin G (IgG) level in low RDW-SD group was lower than that in high RDW-SD group (g/L: 11.43±3.20 vs. 15.42±1.54, P < 0.05). The area under ROC curve (AUC) of RDW-SD in evaluating severe cases was 0.83 [95% confidence interval (95% CI) was 0.59-1.06], which was close to multilobularinltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hyper-tension and age (MuL BSTA score; AUC = 0.82, 95% CI was 0.51-1.12) and better than British Thoracic Society's modified pneumonia score (CURB-65 score; AUC = 0.70, 95% CI was 0.50-0.91). Conclusion:RDW-SD has significant evaluative effect on the severity of COVID-19 patients with Delta variants.

ObjectiveTo investigate the synergistic effect of Coptidis Rhizoma crude polysaccharide （CCP） and berberine （BBR） in treating ulcerative colitis （UC） model mice. MethodThirty male BALB/c mice were randomized into five groups. Except the 6 mice in the normal group， the rest were given 5% dextran sodium sulfate in their daily drinking water to establish the UC model. After modeling， the mice were administrated with corresponding agents by gavage once daily for 4 days： BBR （100 mg·kg^-1） group， BBR （100 mg·kg^-1） + low-dose （22.8 mg·kg^-1） CCP group， BBR （100 mg·kg^-1） + high-dose （45.6 mg·kg^-1） CCP group. The mice in the model group and normal group were administrated with the same volume of normal saline. At the end of the experiment， the mice were sacrificed for the collection of colon， and the expression of tight junction proteins zonula occluden-1 （ZO-1）， Claudin-1， and Occludin in colon tissue was detected by Western blot. With the normal group as the control， the disease activity index （DAI） score， colon length， colon histomorphology， and expression levels of tight junction proteins in other groups were evaluated. ResultCompared with the normal group， the modeling down-regulated the protein levels of ZO-1， Claudin-1， and Occludin （P<0.01）. Compared with the model group， BBR did not significantly change the protein level of Claudin-1 and up-regulated those of ZO-1 and occludin （P<0.01）. The expression levels of Claudin-1， ZO-1， and Occludin were up-regulated in BBR + CCP groups （P<0.01）. The expression levels of tight junction proteins in BBR + CCP groups were significantly higher than those in the BBR group （P<0.05）. ConclusionThe administration of CCP combined with BBR can effectively ameliorate intestinal mucosal barrier damage in the mice with UC.

【Objective】 To provide reference for fine management of blood donors by classifying and analyzing different types of blood donors from domestic blood stations. 【Methods】 The resident population of 15 regions in China from 2016 to 2019 were taken as the research object, among which the blood donors were divided into three categories: age-eligible citizens, registered donors and donated donors. The average value and proportion of the three categories were calculated and statistically analyzed. 【Results】 The resident population of the 15 regions varied greatly. The mean 95% CI of the proportion of age-eligible citizens to resident population from 2016 to 2019 was (60.16%, 67.84%); registered donors to age-eligible citizens and resident population was (2.21%, 2.86%) and (1.41%, 1.79%), respectively; donated donors to registered donors, age-eligible citizens and resident population was (84.63%, 91.68%), (1.93%, 2.55%) and(1.23%, 1.59%), respectively. 【Conclusion】 There were differences in the number and proportion of different types of blood donors in different regions. The fine management of blood donors can help blood stations carry out more effective recruitment and retention strategies.

【Objective:】 To construct the training index system of humanistic care for nursing students, and to provide reference for optimizing the educational model of humanistic care. 【Methods:】 Taking the quality care model as the theoretical framework, through the literature analysis, semi-structured interviews, and Delphi expert consultation, the nursing students’ humanistic care training index system was initially constructed, and the weights were determined by the analytic hierarchy process. 【Results:】 After two rounds of expert consultation, the expert authority coefficients were 0.89 and 0.91, the effective recovery rates of the questionnaires were 91.30% and 95.24%, respectively; the Kendall’s W values of expert correspondence were 0.179 and 0.118, respectively (P<0.05); The mean value of each index was 4.45~4.95, the coefficient of variation was 0.05~0.17, and the full score rate was 50%~95%. The humanistic care training index system for nursing students included 5 first-level indicators and 30 second-level indicators. 【Conclusion:】 Based on Delphi method and analytic hierarchy process, the training index system of humanistic care for nursing students has high enthusiasm, authority, concentration and coordination of experts, which is scientific, reliable and practical, and can provide reference for the development of caring education in colleges and universities.

Objective:To explore the effect of family-participated dietary management on dietary compliance behavior and nutritional status in elderly maintenance hemodialysis (MHD) patients.Methods:From July 2019 to December 2020, a total of 120 elderly MHD patients admitted in the First Affiliated Hospital of Zhengzhou University were selected as the research objects, and divided into the experimental group and the control group with 60 cases in each group by random number table method. The control group conducted routine dietary management, and the experimental group received dietary management based on family participation. Six months after intervention, the dietary compliance attitude, dietary compliance behavior and nutritional status were compared between the two groups.Results:Six months after intervention, the scores of social restriction attitude, self-care attitude, acceptance attitude and dietary compliance behavior attitude of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The scores of fluid restriction behavior, potassium intake behavior, self-care compliance, compliance in the face of difficulties, and dietary compliance of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The serum prealbumin (PA) , albumin (ALB) , hemoglobin (Hb) , and transferrin (TRF) of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Diet management based on family participation can enhance the attitude of dietary compliance, promote the development of dietary compliance behavior, and improve the nutritional status of elderly patients with MHD.