Objective To identify long non-coding RNA (lncRNA) associated with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and investigate their mechanisms. Methods Peripheral blood samples were collected from RA-ILD patients (n＝3), RA patients without lung involvement (n＝3), and healthy controls (n＝3). Next-generation sequencing was performed to screen differentially expressed lncRNA. A human fibrotic lung cell model was established by inducing the MRC-5 cell line with transforming growth factor-β (TGF-β). Following siRNA-mediated knockdown of target genes, changes in inflammatory and oxidative stress-related genes were analyzed via real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). Western blotting and dual-luciferase reporter (DLR) assays were used to validate protein expression, ubiquitination levels, and nuclear translocation of oxidative stress regulators, and antioxidant response element (ARE) transcriptional activity. Rescue experiments were conducted to confirm the role of target lncRNA in oxidative stress and inflammation in fibrotic lung cells. Results High-throughput sequencing revealed significant downregulation of LINC00638 in RA-ILD patients. Knockdown of LINC00638 markedly reduced transcriptional levels of interleukin (IL)-4, nuclear factor erythroid-2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and superoxide dismutase 2 (SOD2), while increasing IL-6, IL-1β, interferon-γ (IFN-γ), and reactive oxygen species (ROS) levels. Furthermore, LINC00638 knockdown decreased Nrf2 protein expression, increased its ubiquitination, reduced nuclear translocation, and suppressed ARE transcriptional activity. In MRC-5 cells, LINC00638 knockdown combined with N-acetylcysteine treatment restored Nrf2 and HO-1 levels while reducing IL-6 expression. Conclusions LINC00638 suppresses inflammatory responses in RA-ILD by activating the Nrf2/ARE antioxidant signaling pathway, suggesting its potential as a therapeutic target for diagnosis and treatment.

Objective To report cases of checkpoint inhibitor pneumonitis （CIP） in patients with advanced biliary tract cancer, aiming to provide additional approaches for the assessment, treatment, and monitoring of this condition. Methods Three patients developed oxygen desaturation and interstitial lung lesions during chemotherapy combined with immunotherapy, and were diagnosed with CIP in collaboration with the respiratory department. Antitumor therapy was discontinued in the acute phase, and glucocorticoids were administered, with regular monitoring of disease progression. During follow-up, case 1 developed lung metastasis; case 2 showed improvement; case 3 had concurrent infection and tumor progression. Results Glucocorticoids improved lung lesions and hypoxic symptoms in patients with CIP, but attention should be paid to the potential for concurrent infections and tumor progression. Conclusions Comprehensive assessment and early identification of CIP are crucial for patients with advanced biliary tract cancer. For those with recurrent symptoms after glucocorticoid therapy, timely and accurate adjustment of the treatment regimen is essential.

Objective:To analyze the risk factors of multidrug-resistant organism（MDRO）infection among patients in neurosurgery intensive care unit（NSICU）and to construct a risk prediction nomogram.Methods:A total of 434 patients admitted in the NSICU of the First Affiliated Hospital of Kangda College of Nanjing Medical University from August 2021 to October 2022 were enrolled in the study. Patients were divided into modeling group（ n=217）and validation group（ n=217）. Multivariate Logistic regression was used to analyze the risk factors of MDRO infection in patients，and R software was used to construct a risk prediction nomogram.The prediction power of the nomogram was evaluated with receiver operating characteristic（ROC）curve，the calibration of the model was assessed with Hosmer-Lemeshow（H-L）goodness-of-fit method. Results:Multivariate Logistic regression analysis showed that the underlying disease≥3（ OR=2.580，95% CI 1.322-5.035），the combination of antimicrobial drugs >10 days（ OR=2.336，95% CI 1.182-4.615），hypoproteinemia（ OR=1.962，95% CI 1.031-3.735），invasive operation time（10-20 d： OR=2.358，95% CI 1.048-5.306；>20 d： OR=3.486，95% CI 1.643-7.395）and GCS≤8 points（ OR=2.961，95% CI 1.470-5.963）were independent risk factors of MDRO infection among patients in NSICU. The area under the curve（AUC）of the nomogram in predicting the risk of MDRO infection for patients in modeling group was 0.787（95% CI 0.725-0.849）with a sensitivity of 73.3% and a specificity of 72.5%，the H-L test results were χ2=7.482， P=0.486，the calibration curve was close to the ideal curve，and the mean absolute error was 0.022. The AUC of the nomogram in predicting MDRO infection for patients in verification group was 0.800（95% CI 0.739-0.861）with a sensitivity of 74.7% and a specificity of 73.9%，the H-L test results were χ2=9.824， P=0.278，the calibration curve was close to the ideal curve，and the average absolute error was 0.015. Conclusion:The nomogram constructed based on the risk factors can effectively predict the risk of MDRO infection for patients in neurosurgical ICU，which may be used in clinic pratcice.

Bone metastasis-caused pain （BMP） is a common complication of cancer， and the incidence has been on the rise with the increase in the overall prevalence of cancer， threatening the survival and quality of life of patients. BMP is a kind of special pain with the characteristics of inflammatory pain and neuropathic pain， but is different from the two. Therefore， its pathogenesis is very complicated， and it is of great significance to understand the pathogenesis. The currently available studies mainly focused on osteoclast activation， changes in the bone microenvironment， glial cell activation， spinal cord neuron activation， and miRNA dysregulation. Modern therapies include the three-step analgesics， bisphosphonates， palliative radiotherapy， and interventional therapy for bone metastases， which show definite efficacy in short term. However， the long-term effect is unsatisfactory due to the adverse reactions， addiction， and drug resistance. Studies have shown that traditional Chinese medicine （TCM） has definite curative effect on BMP， which is safe， enhances efficacy， reduces toxicity， and boosts immunity. Moreover， it exerts the effect through multiple components， multiple targets， and multiple pathways. As a result， it has unique advantages in the prevention and treatment of BMP and has become a research focus. This paper summarizes the research on the pathogenesis of BMP， the intervention of TCM （compound Chinese medicine prescriptions， Chinese medicinals， and monomers from Chinese medicinals）， and the mechanisms of TCM， such as inhibiting osteoclast activation， glial cell activation， and spinal cord neuron activation， regulating pain mediators and abnormal expression of microRNA， and anti-tumor， which is expected to further clarify the pathogenesis of BMP and provide ideas and methods for the effective prevention and treatment of BMP with TCM.

AIM: To observe the effect ofacacia honey (AH) on serum uric acid level and renal function in potassium oxonate modelrats after drinking AH aqueous solution. METHODS: Sixty male SD rats were selected and randomly divided into control group (CON group), potassium oxonate model group (OA model group), 10% fructose group (10% F group) and different concentration honey groups (25%, 12.5% and 6.25% AH groups). All rats were fed with normal diet.The rats in CON group were subcutaneously injected with 5% sodium carboxymethyl cellulose (CMC-Na) solution and drunk sterile water every day, while rats in other groups were injected with 100 mg / kg OA solution suspended with 5% CMC-Na subcutaneouslyand drunksterile water orfructose solution or AH solution of different concentrations every day. Before and during the 4-week test, rats were weighed and blood was taken once a week. At the end of test, urine and feces specimens or kidney tissues were collected and blood was taken from the abdominal aorta. The uric acid content in blood, urine, and feces and the levels of serum creatinine (Cre) and blood urea nitrogen (BUN) or inflammatory factors in kidney tissues were measured. Renal function and histology were evaluated. RESULTS: Compared with CON group, AH could significantly reduce the body weight of rats (P<0.05), increase the kidney organ coefficient, the levels of serum uric acid, and uric acid in urine or feces, and reduce the level of fecal uric acid (FUA) in rats. AH can down regulate the level of tumor necrosis factor alpha (TNF-a) (P< 0.05) and up regulate the expression of monocyte chemoattractant protein 1 (MCP-1) and transforming growth factor β - 1 (TGF - β1) in rats kidneys; AH can cause slight to mild dilatation of renal tubules and mild to moderate basophilic lesions of renal rubules in rat kidney in a dose dependent manner. CONCLUSION: In the doses rang of present study, AH can cause hyperuricemia, renal tubular dilatation and basophilic lesions, and lead to renal function damage in rats.

Objective:To investigate the classification of patients with gout, and further analyze their clinical features.Methods:Outpatients with gout were enrolled from January 2018 to July 2019 in Depart-ment of Rheumatology, Zhongshan Hospital. Subjects were classified into four groups according to their 24-hour urinaryexcretion and fractional excretion of urate. Clinical features of different groups were analyzed using one-way Analysis of Variance (ANOVA), Kruskal-Wallis H test, or χ2 test. Results:Finally, 378 subjects were enrolled in this cross-sectional study. Among them, 186(49.2%) were renal underexcretion type, 100(26.5%) were combined type, 57(15.1%) were renal overload type, 35(9.3%) were the normal type. Renal underexcretion type was the main subtype in any age-stratified groups. With aging, the proportion of combined type decreased, while the normal type increased. Participants in the combined type were the youngest [(42±14) years of age] with the highest estimated glomerular filtration rate [(94±18) ml·min -1·1.73 m -2], while their serum urate levels were the highest [(554±104) μmol/L]. Subjects in the normal type were the oldest [(60±15) years of age] with the lowest estimated glomerular filtration rate [(71±19) mL·min -1·1.73 m -2], however, their serum urate concentrations were the lowest [(427±118) μmol/L], The difference was statistically significant (age, F=13.98; estimated glomerular filtration rate, F=16.11; urate, F=17.14; P<0.01). Prevalence of urolithiasis were similar among the four groups ( χ2 =2.00, P>0.05). Conclusion:The renal underexcretion type is the main type of gout. Young patients are more likely to suffer from combined type with the highest serum urate levels and the best renal function.

Objective:To explore the effect of the method "four-step posture gargle" on the prevention of oral mucositis (OM) in patients with blood tumor after chemotherapy.Methods:A total of 90 cases with malignant hematological diseases who were treated with chemotherapy in the department of hematologic oncology from January 2018 to June 2019 were selected by convenient sampling method. The control group used "drum gargle", and the test group used "four-step posture gargle". Oral evaluation was conducted on the days of using chemotherapy day, 3d, 7d, 14d and 21d after chemotherapy. The differences of OM occurrence days, OM grading, OM healing time, oral pH value and chemotherapy delay days were compared between the two groups.Results:No significant difference was found between the two groups in OM days and the number of patients with delayed chemotherapy ( P >0.05). After chemotherapy, the oral pH value of the test group was 6.53±0.64, higher than that of the control group (6.01±0.57). The healing time of OM in the test group was (6.76±1.82) d, shorter than that of the control group (8.87±3.06) d, which were with statistically differences ( t value was 4.047 and 3.978, P <0.05). Group level 0, Ⅰ, Ⅱ, Ⅲ, Ⅳ OM cases respectively, 6, 8, 8, 17, 6 cases were lower than the control group of 10, 11, 12, 10, 2 cases, with statistically significant differences ( χ 2 value was 8.000-27.000, P < 0.05). Conclusions:"Four-step body position gargle method" provides a new method of oral care for patients with hematological tumor. The method can effectively reduce the occurrence of oral mucositis, reducing disease-related complications, improving treatment continuity.

This study elaborates on the content of caregiving preparation, the related theory model, the relevant evaluation tools and the intervention effect of caregiving preparation for stroke caregivers, in order to provide reference for health education, discharge guidance and nursing intervention research of stroke caregivers.

Objective? To explore the change regulation of periodical needs of main caregivers during transition period from being admitted to hospital to home among patients with initial stroke in 9 hospitals in Shanghai Pudong New Area and to analyze the reasons. Methods? From May 2017 to January 2018, we selected 1 200 initial stroke patients and 1 200 main caregivers of them in 9 hospitals of Shanghai Pudong New Area as subjects by convenience sampling. The Family Needs Questionnaire (FNQ) was used to investigate the change of needs of them on admission, at discharge and two weeks after discharge. A total of 1 200 questionnaires were sent out and 1 089 valid questionnaires were collected. Results? Among 1 089 main caregivers of initial stroke patients, the scores of importance of total demand on admission, at discharge and two weeks after discharge were (3.44±0.77),(3.24±0.82) and (3.01±0.71) respectively with statistical differences (P＜ 0.05). At different stages, the need for health information and need for professional support were two dimensions with the high importance of care need of main caregivers among initial stroke patients; the stage with the highest satisfaction with the total demand was at discharge; the items with high rates of no satisfaction with needs included "to be shown that my opinions are used in planning the treatment" "to have enough resource for myself" and "to be shown what to do when the patient is upset" on admission, at discharge and two weeks after discharge. Conclusions? The importance of total demand of main caregivers of initial stroke patients decreases with the increasing of disease course on admission, at discharge and two weeks after discharge. The need satisfaction is high at the stage of discharge and is low after discharge. Medical staff should strengthen the family follow-up.

Objective The aim of the present study is to measure multi-directional strain in patients with hyperuricemia through 3-dimensional speckle-tracking echocardiography (3D-STE) in order to investigate the left ventricular function early changes and clinical application value of 3D-STE. Methods 3-dimension dynamic images of left ventricular full volume in Apical 4-chamber heart view was collected and stored. 3-dimensional specke-tracking technology was applied to measure and compare the left ventricular multi-directional strain of patients with hyperuricemia and healthy controls in order to evaluate the left ventricular systolic function. Results A total of 24 healthy controls and 38 patients with hyperuricemia were included into the study. Among them,patients with hyperuricemia were divided into simple hyperuricemia group(n=12), hyperuricemia complicated with hyperlipidemia group (n=16)and hyperuricemia complicated with both hyper-tension and hyperlipidemia group (n=10). The circumferential strain [(-18.8±4.4)% vs (-25.9±6.4)%, t=-3.48, P=0.001] and area strain [(-31.2±3.9)% vs (-36.8±7.1)%, t=-2.55, P=0.018] of patients with simple hyper-uricemia significantly decreased compared with healthy controls. Besides, the circumferential strain [(-19.9 ± 5.8)% vs (-25.9 ±6.4)%, t=-3.02, P=0.002], longitudinal strain [(-12.6 ±3.3)% vs (-14.4 ±2.5)%, t=-1.95, P=0.038] and area strain [(-29.9±6.6)% vs (-25.9±6.4)%, t=-3.15, P=0.001] of patients with hyperuricemia complicated with hyperlipidemia significantly decreased compared with healthy controls. Conclusion Myo-cardial strain of patients with hyperuricemia complicated with hyperlipidemia or not is both decreased, indicating a decline in left ventricular systolic function.