Objective To establish the argatroban drug use evaluation(DUE)criteria and provide reference for the rational use of argatroban in clinical practice.Methods Based on the domestic and foreign drug instructions of argatroban,referring to relevant guidelines and literature,the DUE standard rules were established by expert consultation.Using the established standard rules,the medical records of argatroban in the Fuzhou First Hospital Affiliated with Fujian Medical University from August 2020 to August 2022 were evaluated for the rationality of medication.Results A total of 368 medical records were included,the rational rate of drug use was 48.64％,and the irrational drug use was mainly without indications(46.19％)and inappropriate combination of drugs(4.35％).Conclusion The rational rate of argatroban clinical use in the hospital is not high,and the problems mainly include off-indication drug use and unreasonable combination drug use.Through the establishment and clinical application of DUE standard rules,the clinical use of argatroban can be further standardized and the ability of rational drug use can be improved.

ObjectiveThis study aimed to evaluate the clinical efficacy of Ruyi Zhenbaowan（RYZBW）in the treatment of initial and early knee osteoarthritis （KOA） through a prospective multicenter，randomized，double-blind，and placebo-parallel controlled trial. MethodFrom October 13^th， 2021 to December 25^th， 2021， 240 KOA subjects meeting the acceptance criteria were enrolled in 15 sub-centers including Wangjing Hospital， Chinese Academy of Chinese Medical Sciences， and they were randomly divided into observation group and control group， with 120 cases in each group. The intervention measures for the observation group were RYZBW + health education， and the intervention measures for the control group were RYZBW placebo + health education. The intervention period in both groups was four weeks， and they were followed up for four weeks after the intervention. The primary outcome measure was the total score of Western Ontario and McMaster University Osteoarthritis Index score （WOMAC score）， and the secondary outcome measures were the response rate of visual scale （VAS） pain score， WOMAC sub item scores （joint pain， joint stiffness， and joint function）， quality of life （SF-12） score， and traditional Chinese medicine （TCM） syndrome score. Result（1） Efficacy evaluation. The marginal model results showed that the observation group was better than the control group in improving the WOMAC total score and WOMAC pain score in the treatment of KOA with RYZBW， and the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in improving VAS score response rate， WOMAC function score， WOMAC stiffness score， SF12-PCS （quality of life-physical health） score， SF12-MCS （quality of life-mental health） score， and TCM syndrome score. （2） Subgroup analysis. ① In terms of VAS score response rate， the response rate of the observation group was higher than that of the control group for subjects with baseline VAS score of （4， 5］， and the difference was statistically significant （P<0.05）. ② In terms of TCM syndrome score， for subjects aged ［56， 60］ and ［61， 65］， the decrease in total TCM syndrome score in the observation group was better than that in the control group， and the difference was statistically significant （P<0.05）. ConclusionTibetan medicine RYZBW has good clinical efficacy in improving WOMAC total score， VAS score response rate， WOMAC pain score， WOMAC function score， and TCM syndrome score for patients with initial and early KOA， which can fill the lack of Tibetan medicine RYZBW in the treatment of KOA and make a demonstration study for the inheritance and development of ethnic medicine.

Outpatient information management system is an important part of hospital information system,which plays an important role in hospital management,patient treatment,medical insurance reimbursement and settlement.This study integrated the application modes of big data,cloud computing,Internet of things and other cutting-edge technologies of artificial intelligence,focused on the intelligent decision support and whole-process simplified management of the diagnosis and treatment behavior of clinical TCM physicians,and developed a cloud intelligent TCM outpatient system for primary medical care.The system has intelligent medical functions such as intelligent prescription monitoring driven by the rule engine and intelligent recommendation of traditional Chinese medicine knowledge.It seamlessly connects with the intelligent four-diagnosis instrument for information collection and medical order input,and realizes the cloud storage,computing,distribution,management,service and outpatient process,multi-directional and convenient management mode.

Objective:To explore the influence of nursing organization atmosphere on clinical nurses' workplace loneliness, verify and analyze the mediating role of psychological capital between nursing organization atmosphere and workplace loneliness.Methods:This study was a cross-sectional survey, using the convenience sampling to select clinical nurses from two Class Ⅲ Grade A hospitals in Shanxi Province from October to December 2019 as the research object. The survey was conducted using the General Information Questionnaire, Organizational Climate Scale for Nursing, Questionnaire about Workplace Loneliness, and Psychological Capital Scale. The structural equation model was used to analyze the mediating effect of psychological capital between nursing organization atmosphere and workplace loneliness. A total of 1 035 questionnaires were collected in this study, with 963 valid questionnaires, and the effective response rate was 93.04%.Results:Among 963 clinical nurses, the total scores of Organizational Climate Scale for Nursing, Questionnaire about Workplace Loneliness, and Psychological Capital Scale were (88.08±10.08) , (30.42±5.23) and (83.21±12.62) respectively. The structural equation model showed that the nursing organization atmosphere had a direct and indirect predictive effect on nurses' workplace loneliness, and the path coefficients were -0.27 and -0.22 respectively. Psychological capital had a mediating effect between the nursing organization atmosphere and workplace loneliness.Conclusions:Psychological capital plays a mediating role between nursing organization atmosphere and workplace loneliness. Nursing managers should take effective measures to create a good organizational atmosphere, improve the level of psychological capital of clinical nurses, and reduce nurses' workplace loneliness.

Objective:To investigate whether the deficiency of death associated protein kinases (DAPK) 3 can reduce vascular calcification by inhibiting endoplasmic reticulum stress.Methods:The method of prospective cohort study was used to observe and analyze the cell culture in vitro.Human aortic vascular smooth muscle cells (VSMC) were cultured in F10K Kaighn′s modified medium, and divided into calcified group and non-calcified group according to whether β-phosphoglycerin (10 mmol/L) was added into the medium.The cells in calcified group and non calcified group were divided into DAPK3 inhibition group and its control group, endoplasmic reticulum stress inhibition group and its control group, mitogen-activated protein kinase (MAPK) activation group and its control group, DAPK3 inhibition + AMP-activated protein kinase (AMPK) inhibition and blank control group, respectively. DAPK3 mRNA and protein concentration, calcium content, alkaline phosphatase, protein concentration of VSMC differentiation marker genes (SM22α, α-SMA), osteogenic differentiation transcription factor (Runχ2, bone morphogenetic protein-2, BMP-2), endoplasmic reticulum stress markers (AFT4, GRP78, GRP94 and CHOP) and p-PAMK protein expression were measured.Results:The mRNA level(highest value was 15.24±0.72 on the 14th day ) and protein level(highest value was 11.31±0.38 on the 14th day) of DAPK3 were significantly higher than those in non calcified cells(5.63±0.62, 2.59±0.33, respectively). The difference was statistically significant ( P< 0.001). In the calcified cells, calcium content (86.54±8.21) mmol/g in dapk3 deficient group was significantly lower than that in control group (194.63±8.54) mmol/g ( t=22.35, P<0.001), alkaline phosphatase activity was significantly decreased((96.27±10.28) IU/g vs.(224.67±10.94) IU/g, t=20.951, P<0.001), the expression of the VSMC differentiation marker genes (SM22α, α-SMA) were upregulated significantly (SM22α: (0.82±0.14) vs.(0.44±0.13), t=4.872, P=0.001; α-SMA: (0.95±0.18) vs.(0.56±0.13), t=4.303, P=0.002), the level of bone differentiation transcription factor (Runχ 2, BMP2) was significantly decreased (Runχ 2: (1.12±0.28) vs.(2.21±0.35), t=5.957, P<0.001; BMP2: (0.82±0.12 ) vs.(1.26±0.16), t=5.39, P<0.001), MAPK level was up-regulated (DAPK3 inhibited group 0.74±0.12 of calcified cells, 1.04±0.14 of non calcified cells, higher than the control group 0.44±0.10 of calcified cells, 0.78±0.12 of non calcified cells, t=4.704, P=0.001; t=3.454, P=0.006), and the inhibited calcium content of ESR calcified cells significantly reduced (after inhibition of AMPK pathway, cells transfected with shRNA group 150.21±11.98, cells transfected with shRNA group 83.21±12.12 were lower than those transfection blank control group 164.82±12.34, P<0.001). The activity of alkaline phosphatase was significantly reduced (226.54±16.57) IU/g protein in the shRNA group and (112.34±15.96) IU/g protein in the shRNA group were significantly lower than 242.32±16.32 in the blank control group, P<0.001); calcium content and ALP activity in the calcified MAPK cells were significantly reduced ( P<0.001). Conclusion:DAPK3 deficiency can inhibit endoplasmic reticulum stress through AMPK signaling pathway to slow down VSMC calcification.

Objective To investigate the efficacy and safety of rotational atherectomy(RA)combined with drug eluting stent(DES)implantation in the treatment of severe coronary artery calcification,and analyze key operation points.Methods The clinical data of sixty-two patients(68 lesions)treated with RA combined with DES from January 2014 to December 2015 were retrospectively analyzed,including the characteristics of operation,postoperative curative effect,complications,incidence of major adverse cardiovascular events(MACE) during hospitalization and follow-up period.Results A total of 75 rotary blur were used in the 62 cases,with an average of(1.18±0.27)per case,the blur diameter/target vessel diameter was(0.54±0.07),the success rate of RA was 98.4%(61/62);A toal of 103 DES were implanted in 61 patients,with an average of(1.67±0.55)per case,average length was(44.5 ± 11.8)mm,immediate DES success rate was 100%.After RA,target vessel diameter was(2.33± 0.52)mm,target vessel narrow degree was(29.6 ± 4.8)%,thrombolysis in myocardial infarction grade Ⅲ blood flow ratio was 66.2%,which have been significantly improved compared with preoperation((0.75±0.21)mm,(82.5±7.2)%,10.3%)(P<0.05),the target vascular lumen diameter and stenosis of target vessel continued to improve after DES((3.26 ± 0.43)mm,(8.7 ± 2.1)%,98.5%)(P<0.05);At 3 days after operation,the left ventricular ejection fraction was significantly higher than that before the operation((60.5±5.5)% vs.(56.8±4.7)%)(P<0.05).The incidence of complications associated with interventional procedures was 9.7%,in which 1 case with burr incarceration switched to coronary artery bypass grafting.The incidence of major adverse cardiovascular events incidence during hospitalization was 4.8%,the follow-up period was 9.0-22.0 months.The incidence of major adverse cardiovascular events incidence during follow-up was 8.2%.Conclusion DES implantation following RA in the treatment of severe coronary artery calcification can further improve blood flow and artery stenosis,medium-term efficacy is safe and reliable;standardized RA operation is the key to ensure the success of interventional therapy.

Objective To explore the association between estimated glomerular filtration rate (eGFR) and prognosis of acute ischemic stroke (AIS) patients who were treated by intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA).Methods We consecutively screened AIS patients who were treated by intravenous thrombolysis with rt-PA from January 2006 to September 2016 in Tangshan Gongren Hospital.According to eGFR value of patients at admission,the eligible patients were divided into two groups:normal eGFR group (eGFR ≥ 90 ml ? min-1 ? 1.73 m-2) and decreased eGFR group (eGFR ＜ 90 ml? min-1 ? 1.73 m-2).The incidence of symptomatic intracerebral hemorrhage (SICH),early neurological deterioration (END) at 24 hours and seven days after thrombolysis,mortality within seven days and 90 days,and excellent recovery at 90 days were compared between the two groups.The OR with 95％ CI and the adjusted OR with 95％ CI were analyzed by univariate and multivariate Logistic regression models.Results A total of 258 patients were enrolled,including 182 cases in the normal eGFR group and 76 cases in the decreased eGFR group.After adjusting for the potential confounders,multivariate Logistic regression analysis showed that the rates of SICH (13.2％ (10/76) vs 3.3％ (6/182),OR =3.859,95％ CI 1.313-11.341),END at 24 hours (21.1％ (16/76) vs 8.2％ (15/182),OR =2.958,95％ CI 1.347-6.495) and seven days (32.9％ (25/76) vs 12.6％ (23/182),OR =3.129,95％ CI 1.555-6.293),mortality within seven days (22.4％ (17/76) vs 6.0％ (11/182),OR =4.079,95％ CI 1.588-10.477) and 90 days (23.7％ (18/76) vs 9.9％ (18/182),OR =2.457,95％ CI 1.050-5.749) were higher in the decreased eGFR group than in the normal eGFR group.On the other hand,the chance of excellent recovery at 90 days (22.4％ (17/76) vs 43.4％ (79/182),OR =0.435,95％ CI 0.229-0.824) was less in the decreased eGFR group than in the normal eGFR group.Conclusion Decreased eGFR may not only increase the risks of SICH,END and death,but also reduce the chance of 90-day excellent recovery in AIS patients after intravenous thrombolysis with rt-PA.

Objective To analyze the correlation of serum levels of galectin-3(Gal-3), N-terminal pro brain natriuretic peptide(NT-proBNP),brain natriuretic peptide(BNP)and C reactive protein(CRP)with prognosis of patients with decompensated acute attack of chronic heart failure (DAACHF),and to evaluate its significance in predicting mortality during 30-day hospitalization. Methods 103 DAACHF patients admitted in Peking University First Hospital and Capital Medical University-affiliated Beijing Anzhen Hospital Department of Cardiology from July 2012 to June 2015 were divided into death group(n=53,died of DAACHF)and survival group(n=50)matched for age, gender,cardiac function during 30-day hospitalization.Serum levels of Gal-3,NT-proBNP,BNP,CRP and the Minnesota Living with Heart Failure Questionnaire(MLHFQ)were retrospectively collected and compared on the first hospital day and 3 days,7 days,14 days after treatment.After 7 days of treatment,the serum levels of four markers were correlated with MLHFQ.The areas under the receiver operating characteristic(ROC)curve were used for estimating efficiencies of serum levels of four markers in predicting DAACHF patients' mortality during 30-day hospitalization. Results With prolonged treatment,the scores of Gal-3,NT-proBNP,BNP,CRP and MLHFQ were gradually increased in the group of death,and gradually decreased in survival group.The scores of Gal-3,NT-proBNP,BNP,CRP and MLHFQ were higher in the death group than in control group(P<0.05)at the day of hospital admission and at 3 days,7 days and 14 days after treatment(P<0.05).On 7 days after treatment,Gal-3,NT-proBNP, BNP,and CRP were positively correlated with MLHFQ score(r=0.748,0.730,0.6872,all P<0.01),and the areas under ROC curves predicting performance for mortality during 30-day hospitalization were 0.943, 0.907,0.876,0.867,0.913 for Gal-3,NT-proBNP,BNP,CRP and MLHFQ score,respectively,all P<0.01). Conclusions Serum levels of Gal-3,NT-proBNP,BNP and CRP were positively correlated with adverse prognosis for DAACHF patients,and they may be predictors of mortality during 30-day hospitalization with sequence effect of Gal-3>NT-proBNP>BNP>CRP.And their joint monitoring is better in predicting the prognosis of patients with heart failure.

This study was performed to investigate a potential marker for the presence of spermatozoa in the ejaculate following varicocelectomy in Chinese men with nonobstructive azoospermia and varicoceles. The micro-RNA (miR)-192a levels in seminal plasma and testicular tissue were evaluated by quantitative real-time polymerase chain reaction from 60 men with nonobstructive azoospermia and varicoceles (Group A: 27 men with spermatozoa found in the ejaculate after surgery; Group B: 33 men without spermatozoa found in the ejaculate after surgery) and 30 controls. The seminal plasma and testicular tissue miR-192a levels were higher in Group B than in Group A and the controls (P < 0.001), and there was no significant difference between Group A and the controls (P > 0.05). Apoptosis and proliferation assays with miR mimics and inhibitors showed that miR-192a induced GC-2 cell apoptosis through the activation of Caspase-3 protein. Thus, seminal plasma miR-192a appears to be a potential marker for successfully indicating spermatozoa in the ejaculate following microsurgical varicocelectomy in men with nonobstructive azoospermia and varicoceles. Seminal plasma miR-192a may be a useful clinical marker for prescreening to determine which patients with nonobstructive azoospermia and varicoceles would benefit from varicocelectomy.
Adult ; Apoptosis ; Asian People ; Azoospermia/surgery* ; Biomarkers/analysis* ; Caspase 3/analysis* ; Cell Proliferation ; Humans ; Infertility, Male/etiology* ; Male ; MicroRNAs/biosynthesis* ; Microsurgery ; Predictive Value of Tests ; Semen/metabolism* ; Testis/metabolism* ; Treatment Outcome ; Varicocele/surgery*

Objective To investigate the influencing factors of in-hospital delay using alteplase for intravenous thrombolytic therapy in patients with acute ischemic stroke.Methods From January 2006 to May 2015,220 consecutive patients with acute ischemic stroke admitted to the Department of Neurology,Tangshan Gongren Hospital Affiliated to North China University of Science and Technology were enrolled retrospectively.They all received alteplase for intravenous thrombolytic therapy.Their mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 16±8.According to door-to-needle time (DNT),they were divided into either a delay group (DNT >60 min;n=151) or a non-delay group (DNT ≤60 min;n=69).The baseline data,laboratory tests,onset-to-door (OTD) time,imaging,and etiology classification of trial of org 10172 in acute stroke treatment (TOAST) of both groups were recorded.Univariate analysis was performed on both groups,and further multivariate logistic analysis was performed.Results (1) The proportion of the past history of transient ischemic attack,blood glucose level on admission,time from onset to hospital in the non-delay group were significantly higher than those of the delay group.There were significant differences between the two groups (43.5%[30/69] vs.3.3%[5/151],7.9±3.0 mmol/L vs.6.9±2.1 mmol/L,95±53 min vs.80±34 min,all P<0.05).There were significant differences in the constituent ratio of TOAST classification between the two groups (P<0.05).There were no significant differences in other baseline data and clinical features between the two groups (all P>0.05).(2) Multivariate Logistic regression analysis showed that the risks of patients with the past history of transient ischemic attack (OR,0.330,95%CI 0.109-0.998,P=0.046),elevated blood glucose levels on admission (OR,0.775,95%CI 0.657-0.914,P=0.005),prolonged onset-to-door time (OR,0.648,95%CI 0.504-0.831,P=0.013),internal carotid artery lesions (OR,0.192,95%CI 0.038-0.960,P=0.044) for occurring in-hospital delay after thrombolysis were low.Systolic pressure on admission(OR,1.275,95%CI 1.091-1.491,P=0.027)and cardioembolism(OR,3.892,95%CI 1.661-9.112,P=0.006) for occurring in-hospital delay after thrombolysisin were high.Conclusion The patients with past history of transient ischemic attack,higher blood glucose,prolonged onset-to-door time,and having internal carotid artery lesions may be cause the attention of family members and doctors,and were less prone to having thrombolytic in-hospital delay,whereas those with higher systolic blood pressure on admission and cardioembolism were prone to having in-hospital delay.