Objective To study the mechanism of Yangjing Zhongyu Decoction in regulating the initiation of primordial follicles in model rats with diminished ovarian reserve(DOR)based on lncRNA.Methods Three-day-old female rats were selected and their ovaries were cultured in vitro.The blank group,model group,DHEA group and Yangjing Zhongyu Decoction high-,medium-and low-dosage groups were set.The DOR model was induced by triptolide,corresponding drug containing serum was given to culture respectively.HE staining was used to observe germ cells and follicles,Western blot was used for determining the expressions of AMH,BMP15,PTEN,MST,TGF-β1,p-Smad1 protein,RT-PCR was used to detected AMH,BMP15,PTEN,MST,LTCONS-00011173,TGF-β1,Smad1 mRNA expression.Results Compared with the blank group,the number of primordial and growing follicles in the model group rats decreased(P<0.05),the expression of AMH,BMP15,TGF-β1,p-Smad1 protein in ovarian tissue decreased(P<0.05),expressions of PTEN and MST proteins increased(P<0.05),AMH,BMP15,TGF-β1,Smad1 mRNA expression decreased(P<0.05),while the expressions of PTEN,MST,and LTCONS-00011173 mRNA increased(P<0.05).Compared with the model group,the DHEA group and Yangjing Zhongyu Decoction high-and medium-dosage groups showed an increase in the number of primordial and growing follicles(P<0.05),the expressions of AMH,BMP15,TGF-β1 and p-Smad1 protein in ovarian tissue increased(P<0.05),PTEN and MST protein expressions decreased(P<0.05),AMH,BMP15,TGF-β1,Smad1 mRNA expressions increased(P<0.05),while PTEN,MST,and LTCONS-00011173 mRNA expressions decreased(P<0.05).Conclusion Yangjing Zhongyu Decoction may mediate TGF-β1/Smad1 signaling pathway through LTCONS-00011173,regulating primordial follicle initiation in DOR model rats.

【Objective】 To explore the safety of transrectal ultrasound-guided transperineal injection of sodium hyaluronate to expand the Dirichlet gap in laparoscopic radical prostatectomy. 【Methods】 A total of 14 healthy male purebred beagle dogs were selected and randomly divided into 2 groups, with 7 in either group.The control group was treated with conventional laparoscopic radical prostatectomy, while the experimental group was treated with laparoscopic radical prostatectomy after 2.5 mL sodium hyaluronate was injected into the Dirichlet gap under the guidance of transrectal ultrasound.The total operation time, prostate separation time, intraoperative blood loss and rectal status of the 2 groups were observed. 【Results】 After the injection of sodium hyaluronate into the Dirichlet gap between the prostate and the rectum, no rectal tissue was found in the prostate, and no obvious damage was found in the posterior rectum in either groups.The postoperative hemoglobin (HGB) was [(118.70±2.56) g/L vs.(122.10±2.19) g/L, P=0.02]; the total operation time was [(141.40±9.80) min vs.(119.10±9.16) min, P<0.05]; the prostate separation time was [(24.99±1.75) min vs.(16.64±2.34) min, P<0.05]; the amount of bleeding was [(47.43±4.32) mL vs.(34.86±5.18) mL, P<0.05] in the control group and experimental group. 【Conclusion】 Laparoscopic radical prostatectomy performed after 2.5 mL of sodium hyaluronate injection into the Dirichlet gap under the guidance of transrectal ultrasound can shorten the total operation time, the separation and resection time of the prostate, and reduce the amount of bleeding, which can improve and reduce the incidence of rectal injury, and prove the feasibility of this approach for prostatic cancer.

Objective:To comprehensively search and summarize the evidence on critical ultrasound nursing practice training courses, with the aim of providing a basis for critical ultrasound nursing practice training.Methods:Taking the evidence-based clinical translation model of Fudan University Centre for Evidence-based Nursing as the theoretical framework, the evidence was retrieved, evaluated, and summarized to determine the evidence to be introduced into clinical practice, forming a training program for critical ultrasound nursing practice. From July to August 2023, 25 experts from 10 provinces/municipalities across the country were selected for two rounds of consultation to determine the practical training course system for critical ultrasound nursing.Results:A total of 14 articles were included, including one clinical decision, nine expert consensus, and four systematic reviews. In the two rounds of consultation, the positive coefficients of experts were 90.0% (27/30) and 92.6% (25/27), the authority coefficients of experts were 0.956 and 0.964, and the coefficients of Kendall's harmony were 0.303 and 0.350 ( P<0.01), respectively. The final practical training course system for critical ultrasound nursing included five first-level indicators, 25 second-level indicators, and 67 third-level indicators. Conclusions:Ultrasound examination is a complex skill. The construction method of the practical training course system for critical ultrasound nursing is scientific, reasonable, with strong practicality in content, which can provide reference for the development and evaluation of critical ultrasound nursing training courses.

Objective:To explore the diagnosis, staging, and treatment of fibro-adipose vascular anomaly(FAVA).Methods:The data of the patients with FAVA admitted to Xi’an International Medical Center Hospital between October 2019 and February 2023 were retrospectively reviewed. Ultrasound and magnetic resonance imaging (MRI) were routinely performed. X-ray and CT were performed for patients with unequal length of lower limbs, lesions involving joints, and obvious joint deformities. The treatment plan was made according to the stage: stage Ⅰ (pain stage), open or laparoscopi radical resection of the lesion was performed; stage Ⅱ (contracture stage), radical surgery was performed to remove the lesion, sometimes combined with Achilles tendon lengthening or tenolysis, and rehabilitation training was performed 2 weeks after surgery; stage Ⅲ(deformity stage), comprehensive treatment based on surgical resection was adopted, combined with joint capsule release, Achilles tendon lengthening or dissection, tendon transfer and oral sirolimus (each time 0.08 mg/m 2, twice daily ) before and after the operation. For patients with lesions involving multiple anatomical regions, staged surgery was performed, and in principle, only one anatomical region was operated per time. Patients were followed up for pain, joint activity and recurrence. Results:A total of 42 patients were admitted, including 18 males and 24 females. The onset age was (7.3±5.0) years, but the average age of diagnosis was (12.5±6.0) years. The lower limbs were involved in 38 cases, the upper limbs in 4 cases. There were 17 cases of stage Ⅰ, 17 cases of stage Ⅱ and 8 cases of stage Ⅲ. Only 4 cases had no misdiagnosis experience, and the misdiagnosis rate was 90.5%(38/42). Persistent pain, muscle contractures and joint deformities were the main clinical symptoms of the disease. MRI showed heterogeneous high and low signal intensity on T1-weighted images, and the high signal intensity was the same as that of subcutaneous adipose tissue. T2 fat-suppressed sequences showed stronger heterogeneous hyperintensity. The follow-up time was (14.6±10.8) months. Patients who took sirolimus orally before or after surgery experienced significant relief of pain symptoms. Of the 42 patients, the symptoms of 31 patients were completely relieved after the operation, and 11 patients still had residual pain or joint movement disorder or even deformity after the operation. Sixteen of 17 stage Ⅰ patients were cured, the lesion was further expanded and the pain recurred in 1 case after the operation. Of the 17 stage Ⅱ patients, 15 were cured, and 2 had mild limitation of ankle movement after the operation. Eight stage Ⅲ patients had varying degrees of pain or joint movement disorder after surgery, postoperative oral sirolimus significantly relieved symptoms. All 10 patients with stage Ⅰ and Ⅱ who underwent endoscopic resection were cured.Conclusion:FAVA usually occurred in school-age and adolescent children. Pain, muscle contracture and joint deformity were the characteristic clinical features. Combined with MRI features, the diagnosis can be confirmed. FAVA staging system could guide treatment and predict prognosis. For stage Ⅰ and Ⅱ patients, surgery should be performed as soon as possible and the prognosis was good. For stage Ⅲ patients, surgery-based comprehensive treatment could improve symptoms, but it was difficult to cure them radically. Oral sirolimus was also required after surgery.

Objective:To explore the diagnosis, staging, and treatment of fibro-adipose vascular anomaly(FAVA).Methods:The data of the patients with FAVA admitted to Xi’an International Medical Center Hospital between October 2019 and February 2023 were retrospectively reviewed. Ultrasound and magnetic resonance imaging (MRI) were routinely performed. X-ray and CT were performed for patients with unequal length of lower limbs, lesions involving joints, and obvious joint deformities. The treatment plan was made according to the stage: stage Ⅰ (pain stage), open or laparoscopi radical resection of the lesion was performed; stage Ⅱ (contracture stage), radical surgery was performed to remove the lesion, sometimes combined with Achilles tendon lengthening or tenolysis, and rehabilitation training was performed 2 weeks after surgery; stage Ⅲ(deformity stage), comprehensive treatment based on surgical resection was adopted, combined with joint capsule release, Achilles tendon lengthening or dissection, tendon transfer and oral sirolimus (each time 0.08 mg/m 2, twice daily ) before and after the operation. For patients with lesions involving multiple anatomical regions, staged surgery was performed, and in principle, only one anatomical region was operated per time. Patients were followed up for pain, joint activity and recurrence. Results:A total of 42 patients were admitted, including 18 males and 24 females. The onset age was (7.3±5.0) years, but the average age of diagnosis was (12.5±6.0) years. The lower limbs were involved in 38 cases, the upper limbs in 4 cases. There were 17 cases of stage Ⅰ, 17 cases of stage Ⅱ and 8 cases of stage Ⅲ. Only 4 cases had no misdiagnosis experience, and the misdiagnosis rate was 90.5%(38/42). Persistent pain, muscle contractures and joint deformities were the main clinical symptoms of the disease. MRI showed heterogeneous high and low signal intensity on T1-weighted images, and the high signal intensity was the same as that of subcutaneous adipose tissue. T2 fat-suppressed sequences showed stronger heterogeneous hyperintensity. The follow-up time was (14.6±10.8) months. Patients who took sirolimus orally before or after surgery experienced significant relief of pain symptoms. Of the 42 patients, the symptoms of 31 patients were completely relieved after the operation, and 11 patients still had residual pain or joint movement disorder or even deformity after the operation. Sixteen of 17 stage Ⅰ patients were cured, the lesion was further expanded and the pain recurred in 1 case after the operation. Of the 17 stage Ⅱ patients, 15 were cured, and 2 had mild limitation of ankle movement after the operation. Eight stage Ⅲ patients had varying degrees of pain or joint movement disorder after surgery, postoperative oral sirolimus significantly relieved symptoms. All 10 patients with stage Ⅰ and Ⅱ who underwent endoscopic resection were cured.Conclusion:FAVA usually occurred in school-age and adolescent children. Pain, muscle contracture and joint deformity were the characteristic clinical features. Combined with MRI features, the diagnosis can be confirmed. FAVA staging system could guide treatment and predict prognosis. For stage Ⅰ and Ⅱ patients, surgery should be performed as soon as possible and the prognosis was good. For stage Ⅲ patients, surgery-based comprehensive treatment could improve symptoms, but it was difficult to cure them radically. Oral sirolimus was also required after surgery.

Objective:To explore the strategies and complications of the submucosal tunneling endoscopic resection (STER) in the treatment of esophageal duplicated cyst (EDC).Methods:From January 2013 to December 2019, at Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, the clinical data of 11 hospitalized patients with EDC diagnosed by pathological examination who underwent STER were collected. The clinical featured, computed tomography (CT) findings, endoscopic findings, postoperative efficacy, complications and pathological results after operation were summarized.Results:Among the 11 patients, there were 6 males and 5 females, the age ranged from 13 to 67 years, and the mean age was (43.0±18.2) years. One case presented with swallowing obstruction, 1 case with belching, 4 cases with upper abdominal pain, and the remaining 5 cases had no specific clinical symptoms. Under endoscopy, the lesions of 11 patients were hemispherical or mound-shaped with smooth surface submucosal masses in the esophageal cavity, which were soft to touch. Under endoscopic ultrasonography, they all appeared as hypoechoic masses with clear boundary located in the esophageal muscularis propria. The results of CT scan of 9 patients showed round low-density cystic masses, among them 7 cases showed mild enhancement. The maximum diameter of the cysts was 1.5 to 4.4 cm, with mean maximum diameter being (2.8±0.8) cm, and the maximum diameter of most patients (7 cases) were 2 to 3 cm. The other two patients showed only slightly thickened esophageal wall on CT. Five lesions occurred in the horizontal mediastinum of the lower esophagus. All the 11 patients underwent STER operation successfully, among them 6 patients received simple STER and the cysts were completely resected, and the other 5 patients received STER and cauterization with argon ion for the residual cyst wall. The pathological results after operation indicated that 6 cases were congenital esophageal cysts and 5 cases were bronchogenic cysts. The median follow-up time (range) of 11 patients was 42 months (12-86 months). Ten patients recovered well after the operation, and local recurrence, malignant transformation or metastasis were not found. One case had recurrence, and was treated with STER and cauterization with argon ion for residual cyst wall and cured. No complications such as bleeding, fistula, mediastinal infection or death occurred during and after operation in all the 11 patients.Conclusions:STER is a minimally invasive, safe and effective treatment for EDC, and may be a new treatment for EDC.

Objective: To establish a practical framework for critical ultrasonography to provide a basis for clinical practice. Methods: With reference to domestic and foreign literature, expert interviews and research groups developed a preliminary draft of the practice framework for critical ultrasonography, and conducted two rounds of consultation using the Delphi method. Results: A practical framework for critical ultrasonography was developed, including 5 primary indicators and 20 secondary indicators. In the two rounds of expert consultation, the expert′s positive coefficient was 100% and the authoritative coefficient was 0.836. Conclusions Expert opinion has good coordination and high authority, which can provide clinical basis for ICU nurses to carry out ultrasound examination.

Gastrodin is a phenolic glycoside that has been demonstrated to provide neuroprotection in preclinical models of central nervous system disease, but its effect in subarachnoid hemorrhage (SAH) remains unclear. In this study, we showed that intraperitoneal administration of gastrodin (100 mg/kg per day) significantly attenuated the SAH-induced neurological deficit, brain edema, and increased blood-brain barrier permeability in rats. Meanwhile, gastrodin treatment significantly reduced the SAH-induced elevation of glutamate concentration in the cerebrospinal fluid and the intracellular Ca overload. Moreover, gastrodin suppressed the SAH-induced microglial activation, astrocyte activation, and neuronal apoptosis. Mechanistically, gastrodin significantly reduced the oxidative stress and inflammatory response, up-regulated the expression of nuclear factor erythroid 2-related factor 2, heme oxygenase-1, phospho-Akt and B-cell lymphoma 2, and down-regulated the expression of BCL2-associated X protein and cleaved caspase-3. Our results suggested that the administration of gastrodin provides neuroprotection against early brain injury after experimental SAH.
Animals ; Apoptosis ; drug effects ; Astrocytes ; drug effects ; metabolism ; Benzyl Alcohols ; administration & dosage ; Blood-Brain Barrier ; drug effects ; metabolism ; Brain ; drug effects ; metabolism ; Brain Edema ; etiology ; prevention & control ; Calcium ; metabolism ; Glucosides ; administration & dosage ; Glutamic Acid ; metabolism ; Male ; Microglia ; drug effects ; metabolism ; Neurons ; drug effects ; Neuroprotective Agents ; administration & dosage ; Oxidative Stress ; drug effects ; Rats, Sprague-Dawley ; Subarachnoid Hemorrhage ; complications ; metabolism ; prevention & control

Objective: To evaluate the feasibility of ICU nurse-performed lung ultrasound in screening the reason of dyspnea in ICU patients, and to explore the effect on nursing decisions. Methods: ICU nurses trained on lung ultrasound with 16 hours performed point-of-care lung ultrasound in patient with acute respiratory failure to assess the condition of the patient′s lungs and screen for pleural effusion, atelectasis/lung consolidation. Etc; Repeated examinations by ICU physicians accredited by the International Critical Ultrasound Alliance to evaluate the accuracy of ICU nurse interpretation. Results: A total of 510 lung ultrasonographic examinations were performed in 51 patients. Compared with physicians, ICU nurses correctly interpreted 472 ultrasound signs, accounting for 92.53%. ICU nurses found that the sensitivity of the pleural effusion was 86.7%, the specificity was 95.2%, and the diagnostic accuracy rate was 90.2%, and Youden index was 81.9%. The ultrasonography revealed a sensitivity of 92.1% for atelectic/pulmonary consolidation and a specificity of 92.3.%, the diagnostic accuracy rate was 92.2% and Youden index was 84.4%. Conclusion ICU nurses who have undergone standardized training can correctly interpret lung ultrasound signs and have good diagnostic value for screening of pleural effusions and atelectasis/lung consolidation; they provide the basis for optimization of chest physiotherapy programs.

Objective To describe the current accuracy of ICU nurses in evaluating Glasgow Coma Scale (GCS) and to analyze its influencing factors, so as to provide a basis for observing patients' consciousness level dynamically. Methods Totally 206 patients hospitalized at the Intensive Care Unit of a ClassⅢ Grade A hospital in Beijing from November 2016 to January 2017 were selected by convenience sampling. Then both researchers and clinical nurses measured the GCS of these patients respectively, and analyzed the differences in their GCS as well as its influencing factors by using SPSS 17.0 software. Results In the GCS evaluation, the members of the study group composed of primary nurses were completely consistent with 129 evaluations, with 62.6% accurate, but the congruence of evaluation on motor reaction was poor, accounting for 68.0%. According to Logistic regression analysis, the consistency of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, delirium and Richmond Agtation-sedation Scale(RASS) score assessment are the influencing factors of the accuracy of GCS assessment (OR=0.904, 0.389,4.980; P<0.05). Conclusions The accuracy of GCS score evaluation is low, and the accuracy of motor reaction assessment is lower than that of eye opening response and verbal response assessment. The consistency of APACHE Ⅱ score, delirium and RASS score evaluation are the main influencing factors for the accuracy of GCS assessment.