Invasive pulmonary aspergillosis is the most common type of pulmonary aspergillosis. This paper reported a patient with pulmonary aspergillosis secondary to obstructive pulmonary disease and other underlying diseases. The clinical manifestations included wheezing, cough, fever and wheezing rale in the lungs. Diagnosis was ultimately confirmed through pathogens targeted next generation sequencing and pathological examination of respiratory coughs. Following comprehensive treatment that included antifungal therapy, the patient was cured and discharged with a good prognosis.

Invasive pulmonary aspergillosis is the most common type of pulmonary aspergillosis. This paper reported a patient with pulmonary aspergillosis secondary to obstructive pulmonary disease and other underlying diseases. The clinical manifestations included wheezing, cough, fever and wheezing rale in the lungs. Diagnosis was ultimately confirmed through pathogens targeted next generation sequencing and pathological examination of respiratory coughs. Following comprehensive treatment that included antifungal therapy, the patient was cured and discharged with a good prognosis.

Objective:To retrieve and evaluate the evidence on breastfeeding associated nipple pain and trauma management both domestically and internationally, so as to provide reference for clinical practice.Methods:According to the evidence pyramid "6S", all evidence on breastfeeding associated nipple pain and trauma management, including guidelines, evidence summary, best clinical practice manual, systematic review, expert consensus, and randomized controlled trial was retrieved by computer on China National Knowledge Infrastructure (CNKI), WanFang Data, VIP, China Biomedical Literature Database, PubMed, Embase, Web of Science, Cochrane Library, Joanna Briggs Institute (JBI) in Australia, National Institute for Health and Clinical Excellence (NICE), National Guideline Clearinghouse (NGC), Scottish Intercollegiate Guidelines Network (SIGN), Registered Nurses' Association of Ontario (RNAO), medlive and other websites or databases. The retrieval period was from January 1, 2012 to June 1, 2022.Results:A total of 22 articles were included, including 5 guidelines, 3 evidence summaries, 6 systematic reviews, 1 expert consensus and 7 RCTs. 26 pieces of evidence were summarized from 6 aspects: pain assessment, education and training, non-pharmacological interventions, pharmacological interventions, self-management and precautions.Conclusions:This study summarizes the best evidence for managing breastfeeding associated nipple pain and trauma, providing evidence-based evidence for regulating breastfeeding associated nipple pain and trauma management. It is recommended that nurses comprehensively consider the clinical situation when applying evidence, selectively apply the best evidence, extend breastfeeding time, and promote maternal and infant health.

Background: The benefits and risks of eradicating Helicobacter pylori (Hp) should be balanced in aged people. Aims: To investigate the efficacy, safety and antibiotic resistance status of Hp eradication treatment in the elderly. Methods: Four cohorts of subjects who received Hp eradication treatment in randomized controlled trials conducted in Chongqing Daping Hospital were reviewed; the demographic and clinical data were extracted and recorded. Propensity score matching was performed to select comparable elderly group (≥60 years old) and non-elderly group (<60 years old). The eradication rate, compliance, adverse events, antibiotic resistance, and the influencing factors of eradication were analyzed in these two groups. Results: A total of 994 subjects receiving Hp eradication treatment were enrolled initially, among them, 224 were categorized as elderly group and non-elderly group by propensity score matching, with 122 subjects in each group. The Hp eradication rates were higher than 90% in both elderly and non-elderly groups, and no significant differences were observed in compliance, drug-related adverse events, and antibiotic resistance rates between these two groups (all P>0.05). Furthermore, there were no significant differences in the Hp eradication rates in terms of gender, cigarette smoking, alcohol consumption, comorbidities (hypertension, diabetes, surgical history, and inflammation), compliance, etc. in the elderly group (all P> 0.05). But in retreated elderly subjects, the resistance rate of clarithromycin was higher than that in naïve elderly subjects (P<0.05). Smoking and poor compliance were identified as independent risk factors for Hp eradication by multivariate Logistic regression analysis. Conclusions: Hp eradication in the elderly demonstrates comparable efficacy and safety with non-elderly subjects. Clarithromycin-containing regimens are not recommended for empirical retreatment in aged people.

In recent years, the medical insurance coverage of China has been increased significantly, and the medical insurance policies have been launched continuously, so the traditional manual audit method is unable to support medical institutions to effectively supervise the medical insurance fund. In view of this situation, a tertiary hospital in Beijing had successfully built an intelligent medical insurance audit system for drugs, diagnosis and treatment projects under key supervision, realized the prior audit and in-process control of the illegal use of medical insurance funds, through the establishment of intelligent audit rules, the design of audit trigger points and the interception level of illegal medical orders, and the establishment of a pre-operational preparation system and continuous improvement mechanism. In March 2021, the hospital officially launched the system. After the application of the system, the amount and quantity of outpatient medical insurance refusal from April to September 2021 were 10 587 yuan and 72 respectively, which decreased by 79.21% and 77.50% compared with the same period in 2020. This system effectively improved the quality and efficiency of medical insurance fund supervision.

Objective:To explore the changes of neuron specific enolase (NSE) concentration in serum samples of patients with silicosis.Methods:In January 2020, 455 cases of silicosis diagnosed in Yantaishan Hospital from January 2018 to December 2019 were collected, and 60 healthy cases and 120 cases of lung cancer were selected as the healthy group and the lung cancer group. The serum levels of NSE were detected by chemical immunofluorescence assay and compared.Results:The serum NSE level of silicosis patients was [(22.88±7.86) ng/ml], higher than that of healthy group [(17.96±4.42) ng/ml] ( P<0.05) . Serum NSE levels in the first, second and third stage silicosis groups were higher than those in the healthy group ( P<0.05) , but there was no statistically significant difference between the silicosis groups at different periods ( P>0.05) . The serum NSE level of silicosis patients was lower than that of the small cell lung cancer group ( P<0.05) , but there was no statistically significant difference between silicosis group and non-small cell lung cancer group ( P>0.05) . The area under curve of silicosis NSE was 0.718 ( P<0.01) when the cut-off was 17.49 ng/ml, the sensitivity and specificity of NSE was 78% and 57% respectively. Conclusion:The serum NSE level of patients with silicosis is significantly increased, which can be used as an important reference index for the diagnosis and the differential diagnosis of silicosis.

Objective:To explore the changes of neuron specific enolase (NSE) concentration in serum samples of patients with silicosis.Methods:In January 2020, 455 cases of silicosis diagnosed in Yantaishan Hospital from January 2018 to December 2019 were collected, and 60 healthy cases and 120 cases of lung cancer were selected as the healthy group and the lung cancer group. The serum levels of NSE were detected by chemical immunofluorescence assay and compared.Results:The serum NSE level of silicosis patients was [(22.88±7.86) ng/ml], higher than that of healthy group [(17.96±4.42) ng/ml] ( P<0.05) . Serum NSE levels in the first, second and third stage silicosis groups were higher than those in the healthy group ( P<0.05) , but there was no statistically significant difference between the silicosis groups at different periods ( P>0.05) . The serum NSE level of silicosis patients was lower than that of the small cell lung cancer group ( P<0.05) , but there was no statistically significant difference between silicosis group and non-small cell lung cancer group ( P>0.05) . The area under curve of silicosis NSE was 0.718 ( P<0.01) when the cut-off was 17.49 ng/ml, the sensitivity and specificity of NSE was 78% and 57% respectively. Conclusion:The serum NSE level of patients with silicosis is significantly increased, which can be used as an important reference index for the diagnosis and the differential diagnosis of silicosis.

Objective To investigate the modulation role of autophagy in radiation-induced cell death by detecting the response of src kinase activity and autophagy in HEK293 cells irradiated with different dose of α-particle.Methods HEK293 cells were irradiated by contral group (0 cGy) a low dose group (10 cGy) and high dose group (300 cGy) α-particles.Molecular probe 2',7'-dichlorofluorescin (DCFHDA) was used to detect the cell ROS.The src kinase activity and endogenous protein level of LC3Ⅰ/Ⅱ were monitored by Western Blot.Cell death rate of irradiated cells pretreated with autophagy inducer of rapamycin was tested by flow cytometry.Results Compared with control group,the ratio of LC3Ⅰ/Ⅱ decreased (t =4.07,P ＜ 0.05) and the percentage of cells with GFP-LC3 punctuate dots increased (t =12.29,P ＜0.05) under 10 cGy irradiation,indicating the induction of autophagy.On the contrary,the ratio of LC3Ⅰ/Ⅱ increased (t =2.93,P ＜ 0.05) and the GFP-LC3 morphology had no obvious change under 300 cGy irradiation.The cellular ROS level reached to the maximum value at 4 h postirradiation.Both 10 cGy and 300 cGy irradiation could elevate the ROS level (t =17.93,22.88,P ＜0.05),whereas the amplitude of elevation of 300 cGy irradiation was higher than that of 10 cGy irradiation (t =15.76,22.66,14.22,P ＜ 0.05).Compared with control group,the 419th site of tyrosine residue in src kinase manifested hyper-phosphorylation (t =5.66,P ＜0.05) under 10 cGy irradiation whereas it had hypo-phosphorylation under 300 cGy irradiation (t =4.67,P ＜ 0.05).Treatment of cells with DMSO could partly restore the impact on src kinase activity under high or low dose irradiation.Pre-treating the cells with autophagy inducer rapamycin could reduce cell death under 300 cGy irradiations (t =12.14,P ＜ 0.05).Conclusions High or low dose of α-particles irradiation could inhibit or activate src kinase and autophagy system,respectively.ROS mediated the response of src kinase activity and autophagy system induced by irradiation.Modulation of autophagy could desensitize cell responses to irradiation.

Objective:The goal of this study was to analyze the clinical significance of relationship between myocardial collateral and the levels of hypoxia‐inducible factor 1‐alpha (HIF‐1α) and vascular endothelial growth factor A (VEGF‐A) in patients with coronary chronic total occlusion lesion .Methods:89 patients with coronary chronic total occlusion lesion confirmed by clin‐ical data and coronary angiography were identified .The levels of HIF‐1αand VEGF‐A were measured by ELISA ,and the rela‐tive expression of VEGF‐A of peripheral blood mononuclear cell (PBMC) were measured by real‐time PCR .The results were statistically analyzed by the statistical programme for social sciences (SPSS version 18 .0) and software SAS JMP 9 .0 .Results:Compared to Rentrop 0‐1 grade group (18/38 ,47 .4% ) ,Rentrop 2 (11/31 ,35 .5% ) and Rentrop 3 (3/20 ,15 .0% ) grade group had fewer diabetes mellitus .Rentrop 2 [(6 .67 ± 1 .41) mmol/L] and Rentrop 3 [(5 .48 ± 1 .26) mmol/L] grade group had low‐er fasting blood glucose than Rentrop 0‐1 grade group [(7 .24 ± 1 .39) mmol/L] .Rentrop 2 (12/31 ,38 .7% ) and Rentrop 3 (3/20 ,15 .0% ) grade group had fewer clinical heart failure (NYHA Ⅱ ~ Ⅳ grade) than Rentrop 0‐1 grade group (20/38 , 52 .6% ) .Rentrop 2 [(85 .5 ± 27 .7) pg/mL ,(139 .5 ± 42 .1) pg/mL] and Rentrop 3 [(103 .3 ± 30 .2) pg/mL ,(162 .6 ± 43 .3) pg/mL] grade group had higher levels of HIF‐1αand VEGF‐A than Rentrop 0‐1 grade group [(42 .0 ± 16 .1) pg/mL ,(76 .5 ± 32 .2) pg/mL] .Rentrop 2 (1 .31 ± 0 .46) and Rentrop 3 (1 .38 ± 0 .44) grade group had higher level of relative expression of VEGF‐A in PBMC than Rentrop 0‐1 grade group (1 .00 ± 0 .28) .Conclusions:Chronic and consistent ischemia and hypoxia in‐duced the increase of expression of HIF‐1αand VEGF‐A is important for establishment of coronary collateral ,increasing blood supply and improving the heart function and prognosis .

Objective:To analyze the clinical characteristics of patients with immediate severe coronary artery spasm(CAS) af‐ter stent implantation .Methods:The clinical data of 6918 patients who received percutaneous coronary intervention(PCI) from Jan 2012 to Dec 2013 in Zhongshan Hospital ,Fudan University were retrospectively analyzed .And 102 patients with immediate severe CAS after stent implantation were identified and 204 age‐and gender‐matched patients without immediate severe CAS af‐ter stent implantation were selected as control subjects .The general information ,blood indexes ,number and length of stents in the two groups were compared .Results:Compared with the control group ,the ratios of males ,smoking and dyslipidemia were higher in CAS group (P<0 .05) .Patients with CAS had higher neutrophil count and higher level of high sensitive C‐reactive protein(P<0 .05) and received more and longer stents implantation than the control group(P<0 .05 or 0 .01) .Conclusions:Male patients and patients with history of smoking are prone to have immediate severe CAS after stent implantation .Moreover , patients with more and longer stents implantation are prone to have immediate severe CAS .Inflammation may play an important role in the development of CAS after stent implantation .