Objective: The effects and molecular mechanisms of micheliolide on cytokine expression in myeloproliferative neoplasm cell lines were explored based on the signal transducer and activator of transcription 3 (STAT3)/nuclear factor-kappa B (NF-κB) signaling pathways. Methods: The UKE-1 and SET-2 cell lines were investigated, and micheliolide concentrations were screened using the CCK-8 assay. The UKE-1 and SET-2 cells were divided into the control and micheliolide-treated groups at concentrations of 2.5, 5.0, and 10.0 μmol/L. Each group received 1 mL of micheliolide solution at final concentrations of 2.5, 5.0, and 10.0 μmol/L, respectively, whereas the control group only received an equal volume of culture medium. The inhibition rates of interleukin-1β(IL-1β), tumor necrosis factor-α (TNF-α), and chemokine ligand 2 (CCL2) mRNA expression in cells from each group were detected using real-time fluorescent PCR (RT-PCR). Western blotting was used to measure STAT3 and phosphorylated STAT3 (p-STAT3) protein expression levels in cells from each group. Reversal experiments with reduced glutathione and dithiothreitol were performed using UKE-1 cells, which were divided into the control group, micheliolide, micheliolide + glutathione, micheliolide + dithiothreitol, and glutathione + dithiothreitol groups. Western blotting was used to detect the STAT3 and p-STAT3 protein expression levels in the cells of each group. UKE-1 cells were stimulated with TNF-α (5 μg/L) to replicate a pathological model of excessive cytokine secretion. Subsequently, UKE-1 cells were divided into the control, model, and three micheliolide-treated groups at concentrations of 2.5, 5.0, and 10.0 μmol/L. RT-PCR was used to measure the indicators above. An enzyme-linked immunosorbent assay (ELISA) was used to detect the CCL2 content in the cell culture media of each group. Western blotting was performed to assess the protein expression levels of STAT3, p-STAT3, and proteins related to the NF-κB signaling pathway. Results: Compared with the control group, the proliferation inhibition rates of UKE-1 cells at 24, 48, and 72 h increased in the micheliolide-treated groups at concentrations of 2.5, 5.0, 10.0, and 20.0 μmol/L. Similarly, the proliferation inhibition rates of SET-2 at 48 and 72 h increased in the micheliolide-treated groups at concentrations of 5.0, 10.0, and 20.0 μmol/L (P<0.05). Concentrations of 2.5, 5.0, and 10.0 μmol/L were selected for further studies to exclude the potential influence of high micheliolide concentrations on subsequent result owing to reduced cell numbers. Compared with the control group, the inhibition rates of TNF-α mRNA expression in UKE-1 and SET-2 cells increased in the micheliolide-treated groups at concentrations of 2.5, 5.0, and 10.0 μmol/L. Similarly, the inhibition rates of IL-1β mRNA expression in UKE-1 and SET-2 cells also increased in the micheliolide-treated groups at concentrations of 5.0 and 10.0 μmol/L. Additionally, the inhibition rate of CCL2 mRNA expression in UKE-1 and SET-2 cells increased in the micheliolide-treated group at a concentration of 10 μmol/L (P<0.05). Compared with the model group, the inhibition rates of TNF-α, IL-1β, and CCL2 mRNA expression in UKE-1 cells increased in the micheliolide-treated groups at concentrations of 2.5, 5.0, and 10.0 μmol/L after stimulation with TNF-α (P<0.05). ELISA showed that compared with the control group, the CCL2 content in UKE-1 cells increased in the model group. Compared with the model group, the CCL2 content in UKE-1 cells decreased in the micheliolide-treated groups at concentrations of 2.5, 5.0, and 10.0 μmol/L (P<0.05). Western blotting showed that compared with the control group, the p-STAT3 protein expression levels in UKE-1 and SET-2 cells were downregulated in the micheliolide-treated groups at concentrations of 5.0 and 10.0 μmol/L, and the protein expression level of STAT3 in SET-2 was also downregulated (P<0.05). Compared with the control group, the p-STAT3 expression level in UKE-1 cells decreased in the micheliolide group in the reductive glutathione and dithiothreitol reversal experiments. Compared with the micheliolide group, the p-STAT3 protein expression levels in UKE-1 cells increased in the micheliolide + dithiothreitol and micheliolide + glutathione groups (P<0.05). Compared with the control group, the model group showed increased p-STAT3, p-IκKα/β, p-IκBα, and p-NF-κB p65 protein expression and decreased IκBα protein expression after stimulation with TNF-α. Compared with the model group, the micheliolide-treated groups showed decreased p-IκKα/β, p-IκBα, p-STAT3, and p-NF-κB p65 protein expression at concentrations of 2.5, 5.0, and 10.0 μmol/L, whereas the micheliolide-treated groups showed increased IκBα protein expression at concentrations of 5.0 and 10.0 μmol/L (P<0.05). Conclusion Micheliolide potently suppresses IL-1β, TNF-α, and CCL2 mRNA expression in UKE-1 and SET-2 cells, as well as CCL2 secretion by UKE-1 cells, which may be associated with STAT3 phosphorylation suppression and NF-κB signaling pathway activation.

Neonatal hypoglycemia，a common disorder of abnormal glucose metabolism，occurs especially in preterm newborns.Hypoglycemia that occurs frequently and persistently may result in severe consequences for premature infants，including death or permanent brain damage.In recent years，an increasing number of research findings have demonstrated that the following conditions have been linked to an increased risk of hypoglycemia in preterm infants：maternal sickness during pregnancy，pharmaceutical use during pregnancy，and various pathophysiological states of the preterm infant.This review summarizes the current pathophysiological mechanism，risk factors，diagnosis，prevention，and treatment of hypoglycemia in preterm newborns through analyzing the pertinent literature that has been published recently both domestically and internationally，with the aim of early detection，early diagnosis and early treatment，and reducing the incidence of hypoglycemia.

Objective To develop an inpatient assessment form for geriatric syndromes,aiming to quickly and accurately determine whether elderly inpatients are at risk of geriatric syndromes.Methods From May 2021 to December 2023,an initial item pool for the scale was proposed through literature review.Sixteen experts from four fields of geriatric nursing,nursing management,nursing education,and geriatric medicine were selected from seven institutions in six provinces and cities across the country.Two rounds of Delphi expert consultation were conducted to inquire about the assessment form.Results The enthusiasm coefficient of the two rounds of expert consultation was 100.00%,and the expert authority coefficient was 0.88.In the first round of expert consultation,the importance ratings of the three-level indicators ranged from 4.06 to 4.75,with a coefficient of variation of 0.09 to 0.25,a full score rate of 43.75%to 81.25%,and a Kendall coordination coefficient W of 0.210.In the second round of expert consultation,the importance ratings of the three-level indicators ranged from 4.63 to 4.94,with a coefficient of variation of 0.05 to 0.13,a full score rate of 62.50%to 93.75%,and a Kendall coordination coefficient W of 0.419.After two rounds of expert consultation,the inpatient assessment form for geriatric syndromes was finally determined,including 5 first-level indicators(past history,physical function,common geriatric symptoms,mental and psychological status,socioeconomic status),26 second-level indicators,and 41 third-level indicators.Conclusion The inpatient assessment form for geriatric syndromes developed in this study is scientifically and practically feasible and can be used to quickly identify the risk of geriatric syndromes in elderly inpatients.

Objective:To retrospectively analyze the clinical efficacy and safety of rivaroxaban alone or in combination with folic acid/methylprednisolone in the treatment of livedoid vasculopathy (LV) .Methods:Clinical data were retrospectively collected from LV patients who were treated with rivaroxaban alone or in combination at the Department of Dermatology, Kaifeng People's Hospital from April 2020 to September 2023. Before treatment, all the patients underwent serum folate and homocysteine tests. Folic acid therapy was given to patients with low folate levels; glucocorticoid therapy was given to patients with generalized skin lesions in the extremities in the acute stage or with dense inflammatory cell infiltration around the dermal vessels on histopathological examination. Clinical symptoms (erythema, ulceration and pain) were scored before and after 8 weeks of treatment. Adverse reactions were recorded during the treatment.Results:A total of 11 patients were collected, including 6 males and 5 females; their ages ranged from 15 to 73 (29.00 ± 17.85) years, and the disease duration ranged from 1 month to 4 years (13.36 ± 15.87 months). Among the 11 patients, 3 were treated with rivaroxaban combined with methylprednisolone and folate, 1 with rivaroxaban combined with methylprednisolone, 5 with rivaroxaban combined with folate, and 2 with rivaroxaban alone. The total score of clinical symptoms was 5.00 ± 2.28 points before treatment, and significantly decreased to 1.18 ± 0.75 points after 8 weeks of treatment with rivaroxaban alone or in combination ( t = 6.90, P = 0.001). In addition, the pain scores of 5 patients who reported pain dropped to 0 point after 8 weeks of treatment. One patient experienced coagulation abnormalities after 2 weeks of treatment, and the coagulation parameters returned to normal without special treatment after 4 weeks. Conclusion:Rivaroxaban alone or in combination with folic acid/methylprednisolone was effective for the treatment of LV with a good safety profile.

Under the background of the comprehensively implementing the rule of law, the construction of legal practice of medical institutions in China is directly related to the sustainable and high-quality development of the medical service industry. However, at present, each medical institution lacked a systematic plan for the construction of legal practice, and the health administrative department mostly implemented the measures of inspection and punishment for illegal practice, which led to the situation that the illegal practice of medical institutions was " investigated but not corrected, and changed but invalid" . This paper creatively put forward the application research of administrative reconciliation theory in the legal practice management of medical and health institutions, for promoting medical and health institutions and medical staff to strengthen legal practice management, standardizing medical behavior, ensuring medical safety, and achieving high-quality development through the institutional incentive and guidance.

Objective To explore the possible mechanism of activating blood circulation and removing blood stasis herbs in the treatment of endometriosis (EM) with network pharmacology approach. Methods Seven kinds of commonly used activating blood circulation and removing blood stasis herbs, such as: peach kernel, safflower, zeilan, salvia miltiorrhiza, leonuri, radix cyathulae, and wang buliuxing were selected as the research subjects. TCMSP platform, a database of traditional Chinese medicine chemical ingredients, was used to retrieve the effective ingredients of 7 herbs. The targets of the effective ingredients were obtained through the Targets information software. GeneCards database was used to collect EM related target genes. Venn diagram tool was used to obtain the target genes of active ingredients of activating blood circulation and removing blood stasis herbs. Cytoscape 3.6.0 software was used to construct the active ingredient-target-disease network. KEGG database was used to analyze the signal pathways of target gene enrichment. Results A total of 94 active ingredients and 119 targets of 7 herbs were screened. Quercetin, luteolin and kaempferol were the key active components. PTGS2, PTGS1, NCOA2 and NCOA1 were the key targets. The 7 herbs have 20 related KGEE pathways, involving sex hormones, inflammation, apoptosis and angiogenesis. PI3K-Akt signaling pathway, IL-17 signaling pathway, TNF signaling pathway were the main pathways. Conclusion The treatment of EM with activating blood circulation and removing blood stasis herbs has the characteristics of multiple components, multiple targets and multiple pathways, which can relieve the pain, inflammation and menstrual disorders symptoms of EM.

Objective:To discuss the safety and feasibility for the use of 3D uniportal VATS sleeve resection.Methods:Totally 32 patients with central lung cancer received 3D uniportal VATS sleeve resection(group A) from June 2017 to May 2020 at Shanghai Chest Hospital. Meanwhile, 63 patients received conventional VATS sleeve resection(group B). The clinicopathological and perioperative outcome data were retrospectively collected and analyzed.Results:The baseline clinicopathological characteristics between these two groups were statistically similar. Compared with group B, the mean operative time[(174.19±73.69)min vs.(212.46±50.02)min, P=0.004] and blood loss[(73.13±42.70)ml vs.(130.48±133.72)ml, P=0.020] of group A were decreased, harvested lymph node stations was increased(7.63±1.59 vs. 6.76±1.70, P=0.018). Lymph nodes dissected showed no statistical difference(1.31±1.58 vs 1.21±1.96, P=0.803). There was no intraoperative death in both groups. Inspiringly, group A possessed lower rate of conversion to thoracotomy(0 vs. 36.5%, P=0.000), shorter chest drainage durations[(4.88±1.15)days vs.(6.81±3.8)days, P=0.007]. Although there were no deaths during hospitalization in both groups, the incidence of postoperative complications in group A was significantly lower than that in group B(25.0% vs. 47.6%, P=0.046). It also presented more complicated operations including pulmonary artery plasty(25.0% vs. 6.3%, P=0.024) and carina plasty(12.5% vs. 1.6%, P=0.005) against group B. Conclusion:3D uniportal VATS was a safe and feasible technique for the surgical treatment of central lung cancer when conducting a thoracoscopic sleeve resection.

Objective    To analyze the risk factors of the death associated with infective endocarditis, and to evaluate the timing of surgical treatment of infective endocarditis. Methods    We retrospectively analyzed the clinical data of 62 patients with infective endocarditis in our hospital between August 2015 and August 2017. There were 43 males and 19 females at age of 19–75 (46.1±16.6) years. The clinical data were divided into a death group and a survival group, a paravalvular leakage group and a no periannular leakage group, an emergency operation group and a non-emergency operation group.The risk factors of infective endocarditis and the choice of operation time were analyzed. Results    Three of the 62 patients (4.8%) died after surgery. Postoperative perivalvular leakage (regurgitation over 2 mm) in 8 patients, accounting for 12.9% of the total. Univariate analysis showed that albumin content, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative mortality (P<0.05). The results of logistic analysis showed that age, preoperative albumin level, creatinine level, total cardiopulmonary bypass time, and ascending aorta occlusion time were significantly associated with early postoperative perivascular leakage (P<0.05), and long ascending aorta occlusion time is an independent risk factor for early death (P<0.05). There was no statistical difference in early death and the perivalve leakage between the emergency operation and the non emergency operation. Conclusion    Patients with infective endocarditis should accept early surgical treatment. The choice of surgical approach should be selected according to the actual situation of patients. And we should pay more attention to albumin and creatinine levels in preoperative patients. In the operation, to shorten extracorporeal circulation  time and aortic clamping time can improve the prognosis of patients.

Objective To study the effect of scenario case based learning for nurse-patient communicationon empathy of un-dergraduate nursing students. Methods The undergraduate nursing students who had completed the basic nursing courses and the course of"communication in nursing"were enrolled as participants.Seventy-two students recruited in 2013 were assigned as the control group,where only individual guidance was given before taking examination;while eighty-nine students recruited in 2014 as the inter-vention group,where a self-compiled Collection of Scenarios for Nurse-Patient Communication was given when they were preparing for the final examination and the students were required to give their own communication plans based on the scenario cases from the collec-tion.The two groups were compared in view of empathy. Result The intervention group were better in empathy ability assessment, with statistically significant difference (P<0.001). Conclusions The scenario case based learning for nurse-patient communication makes up for the shortcomings of traditional teaching methods.It encourages nursing students to think from the patients'perspective and improves the empathy ability of students.

According to the theory of medical ethics,ethical guidelines and moral criterions for medical laboratories are proposed based on the characteristics of the laboratories.Internal management in terms of ethics need to be strengthened,and t the quality of service needs to be improved continually,so as to ensure the rights of patient,protect staffs against professional hazards,and protect the environment.