ObjectiveTo investigate the changes in coagulation system in acute decompensated cirrhosis （ADC） patients with or without sepsis and the association of these changes with short-term prognosis. MethodsA prospective study was conducted among 116 ADC patients who were hospitalized in Nanfang Hospital from January 2021 to July 2023， among whom there were 86 patients with sepsis and 30 patients without sepsis， and 54 patients with sepsis alone who had no chronic liver disease were enrolled as control group. Thromboelastography （TEG） and other conventional coagulation parameters were used to comprehensively evaluate the coagulation function of patients. The data including TEG results and short-term prognosis were collected， and a correlation analysis was performed. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. The Spearman correlation coefficient was calculated to investigate the correlation between different variables. The Logistic regression model was used to perform the univariate and multivariate analyses. ResultsFor the ADC patients with sepsis， the lungs and bloodstream were the main infection sites， and bacteria were the main pathogenic microorganism. TEG results showed that compared with the patients with sepsis alone， the patients with ADC and sepsis had a significant reduction in median maximum amplitude （MA）， a significant increase in coagulation time （K time）， and a significant reduction in α angle （all P<0.05）； the patients with ADC and sepsis had a significantly longer reaction time （R time） than those with ADC alone （P=0.02）， and the patients with sepsis alone had a significantly longer R time than those with ADC and sepsis （P=0.04）. There was no correlation between MA and platelet count in the patients with ADC and sepsis （r=-0.133， P=0.057）， while there was a significant correlation between MA and platelet count in the patients with sepsis alone （r=0.595， P=0.001）. SOFA score was negatively correlated with MA in sepsis patients with or without ADC （r=-0.503 and -0.561， both P<0.001）， and for the patients with ADC and sepsis， R time， K time， and α angle were weakly correlated with SOFA score and had a relatively strong correlation with APTT （all P<0.05）. The patients with ADC alone all survived within 90 days， and compared with the death group， the patients with sepsis alone who survived had significantly higher values of MA and α angle （all P<0.05）； there was a significant difference in α angle on day 90 between the survival group and the death group， no matter whether the patients were comorbid with ADC or not （both P<0.01）， while for the patients with ADC and sepsis， there was no significant difference in MA value on day 90 between the survival group and the death group （P>0.05）. ConclusionFor ADC patients comorbid with sepsis， coagulation function assessment and monitoring should be taken seriously in clinical practice， and TEG parameters and SOFA score should be monitored when necessary to develop individualized treatment regimens.

Background Arsenic is a human carcinogen. Arsenic and its metabolites affect the expression of p53, but whether there are any changes of p53 phosphorylation and ubiquitination levels in human bronchial epithelium cells (BEAS-2B) are not clear after exposure to arsenic and its metabolites. Objective To study the effects of arsenic and its metabolites monomethylarsic acid (MMA) and dimethylarsinic acid (DMA) on the expression of tumor suppressor gene p53 in BEAS-2B cells. Methods Different concentrations of sodium arsenite (NaAsO₂) were used to infect BEAS-2B cells, and the cell viability was detected with CCK-8 reagent to determine the dose and time of NaAsO₂ used for the following study. Based on the results of cell viability, the cells were divided into two panels: a sodium arsenide panel and an arsenic methylation metabolite penal. The doses of sodium arsenite were 0, 2, 4, and 6 μmol·L⁻¹ NaAsO₂; the arsenic methylation metabolite panel consisted of 0 μmol·L⁻¹ NaAsO₂ group (control), 6 μmol· L⁻¹ MMA group, 6 μmol· L⁻¹ DMA group， and 6 μmol· L⁻¹ NaAsO₂ group. The cells were collected after 48 h treatment, and the total protein and total RNA were extracted. The relative levels of p53 mRNA expression were determined by quantitative real-time polymerase chain reaction (qRT-PCR), the relative expression levels of p53 protein, p53 Ser9 and Ser15 phosphorylated proteins were determined by Western blot, and the level of p53 ubiquitination was detected by co-immunoprecipitation (CO-IP). Results Compared with the control group, the cell viability rates in all BEAS-2B cells treated by NaAsO₂ were significantly reduced (P<0.05), and the 50% cell viability was observed at 6 μmol·L⁻¹. Compared with the control group, the relative expression level of p53 mRNA gradually decreased after NaAsO₂ (2, 4, 6 μmol·L⁻¹) treatment (P<0.05), the relative expression levels of p53 protein and Ser9 phosphorylated protein induced by NaAsO₂ also decreased gradually (P<0.05), and the relative expression level of p53 Ser15 phosphorylated protein induced by NaAsO₂ followed the same pattern, but it was only lower than that of the control group in the 6 μmol·L⁻¹ NaAsO₂ group (P<0.05). Compared with the control group, there were no significant effects on the relative expression levels of p53 mRNA, p53 protein, Ser9 and Ser15 phosphorylated proteins in the MMA group and the DMA group. Compared with the control group, the expression level of p53 ubiquitination was significantly decreased and the expression of K48 ubiquitination decreased significantly after NaAsO₂ infection. Conclusion Arsenic causes a decrease in the expression of the p53 protein in BEAS-2B cells, largely due to inhibition of the phosphorylated pathway and a decrease in mRNA expression, and protein changes caused by a decrease in p53 ubiquitination do not play a dominant role. MMA and DMA do not affect p53 gene expression.

Objective To investigate the value of liver fatty acid-binding protein(L-FABP)in predicting the severity and short-term prognosis of patients with acute-on-chronic liver failure(ACLF).Methods A total of 149 patients with ACLF were selected from a prospective multicenter cohort assessing the platelet function of ACLF patients,and according to the 28-day prognosis after admission,they were divided into survival group with 97 patients and death group with 52 patients.The patients were analyzed in terms of sex,age,etiology,and blood routine,biochemical parameters,and organ failure status within 24 hours after admission,and the level of L-FABP in urine and blood was measured.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Spearman test was used to evaluate the correlation between urinary L-FABP and indicators for liver failure.The receiver operating characteristic(ROC)curve was plotted to assess the value of CLIF-OFs,MELD score,and urinary L-FABP in predicting the short-term prognosis of ACLF patients;the Kaplan-Meier analysis was used to evaluate short-term mortality in the high urinary L-FABP group and the low urinary L-FABP group;the Cox proportional hazards model was used to investigate the association of each factor with the short-term prognosis of ACLF.Results There were significant differences between the two groups in white blood cell count,serum total bilirubin(TBil),international normalized ratio,CLIF-OFs,MELD score,urinary L-FABP level,and the proportion of patients with cerebral failure,liver failure,coagulation failure,renal failure,or respiratory failure(all P<0.05).The Spearman correlation analysis showed that urinary L-FABP was significantly positively correlated with serum TBil(r=0.225,P=0.006).Urinary L-FABP level had an area under the ROC curve of 0.804(95%confidence interval[CI]:0.729-0.865,P<0.001)and a cut-off value of 4.779 μg/dL,with a sensitivity of 73.08%,a specificity of 73.91%,and a Youden index of 0.469 9.The Kaplan-Meier survival analysis showed that compared with the low urinary L-FABP group(urinary L-FABP≤4.779 μg/dL),the high urinary L-FABP group(urinary L-FABP>4.779 μg/dL)had a significantly lower 28-day survival rate(P<0.001).The Cox proportional hazards model analysis showed that serum TBil(hazard ratio[HR]=1.003,95%CI:1.001-1.004,P<0.05),CLIF-OFs(HR=2.283,95%CI:1.814-2.873,P<0.05),and high urinary L-FABP level(HR=4.568,95%CI:2.424-8.608,P<0.05)were independent risk factors for the short-term prognosis of ACLF.Conclusion High urinary L-FABP level can be used as a clinical indicator for predicting the short-term prognosis of ACLF,and further studies with larger sample sizes are needed to evaluate its predictive value.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To understand the current situation of the demand for humanistic care of schizophrenics in convalescence and analyze the influencing factors, so as to provide the basis for clinical nurses to carry out targeted humanistic care for patients.Methods:A self-produced scale with a total score of 49-245 was used to investigate 516 convalescent period schizophrenic patients in 18 tertiary mental health institutions in 13 provinces of China, single factor analysis and multiple regression analysis were performed on their influencing factors.Results:The Likert 5-point scoring method was used. The overall score of the nursing care needs of hospitalized schizophrenic patients was (202.85±35.06) points, and the average score of total items were (4.14±0.16) points. Multiple linear regression results showed female ( B=0.100, P=0.024), stable marriage ( B=-0.098, P=0.026),high school (including secondary school) Education ( B=-0.107, P=0.018), family per capita monthly income of 2 000 yuan or above ( B=0.093, P=0.043),central region ( B=-0.110, P=0.014) were the main factors that affect the demand for humanistic care of inpatients with schizophrenia in convalescence. Conclusion:The hospitalized schizophrenic patients have higher and diversified needs for humanistic care. Patients with different genders, marital status, education level, monthly family income and living area have different needs for humanistic care. Individualized and standardized nursing should be given according to the actual situation of patients' needs to provide a more supportive environment for their rehabilitation.

Objective:To investigate the application value of new urinary biomarkers insulin-like growth factor binding protein 7 (IGFBP7) and tissue matrix metalloproteinase inhibitor-2 (TIMP-2) in acute kidney injury with decompensated hepatitis B virus-related liver cirrhosis.Methods:45 newly hospitalized cases with decompensated hepatitis B virus-related liver cirrhosis were selected. Among them, 19 cases were combined with AKI on admission (cirrhosis-AKI group), 26 cases without AKI (cirrhosis-non-AKI group), and 12 healthy cases (normal control group). First-morning urine samples were collected and IGFBP7 and TIMP-2 were detected by enzyme-linked immunosorbent assay (ELISA). Urinary IGFBP7 and serum creatinine (SCr) were dynamically monitored after hospitalization in cirrhosis-non-AKI group. Normally distributed measurement data were compared by t-test, and non-normally distributed measurement data were compared by rank sum test. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the diagnostic accuracy of the indicators.Results:Urinary IGFBP7, IGFBP7 with TIMP-2 (IGFBP7×TIMP-2) in cirrhosis-AKI group ( n = 19) were equally higher than that of the cirrhosis-non-AKI group ( P < 0.05). Urinary IGFBP7, TIMP-2 and IGFBP7×TIMP-2 in cirrhosis-AKI group or cirrhosis-non-AKI group were significantly higher than those of the normal control group ( P < 0.01). The AUC of urinary IGFBP7 and urinary IGFBP7×TIMP-2 for diagnosis of AKI were 0.703 (95% CI 0.547-0.860) and 0.700 (95% CI 0.541-0.859), respectively. In the liver cirrhosis-non-AKI group ( n = 26), 5 cases of AKI were newly diagnosed according to the changes in SCr during hospitalization (progressive group). Urinary IGFBP7 was significantly increased 2 days before the diagnosis of AKI. The concentration of urinary IGFBP7 at admission in the progressive group ( n = 5) was higher than that of the non-progressive group ( n = 21) ( P < 0.05). Conclusion:Urinary IGFBP7 and TIMP-2 concentrations were significantly increased in patients with decompensated hepatitis B virus-related liver cirrhosis. When AKI occurred, urinary IGFBP7 and IGFBP7×TIMP-2 was further increased. Urinary IGFBP7 is valuable for early AKI diagnosis, and may play a role in predicting AKI occurrence.

Immune metabolism is an emerging highlight in recent years.Revealing the metabolic characteristics of different immune cells in different responses may provide new perspective and direction for the pathogenesis and therapy of many immune-related diseases.Sepsis is a complex systemic inflammation caused by trauma,infection and other pathogenic factors.The immune cells have different metabolic features at different stages of the disease.These metabolic features are also involved in the regulation of immune cell proliferation,differentiation and function.By summarizing and analyzing the relevant literatures of immune cell metabolism and inflammation regulation in recent years,the metabolic regulatory factors of different immune cell subgroups and the related characteristics of immune cell metabolism in patients with sepsis were summarized.The in-depth understanding of the metabolic state in different immune cells,and the pathophysiological mechanism of septic immune disorders,especially the immune paralysis stage,would provide a theoretical basis for the clinical application of immune metabolic therapy.

Objective To investigate the relationship between body position and fracture reduction in cephalomedullary nailing for femoral intertrochanteric fractures. Methods Included in this analysis were 368 femoral intertrochanteric fractures undergoing cephalomedullary nailing from January 2010 to De-cember 2015. They were 191 men and 177 women, aged from 42 to 102 years ( average, 73. 1 ± 11. 0 years ) . By AO classification, there were 105 cases of type 31-A1, 131 ones of 31-A2, and 132 ones of type 31-A3. Supine position A ( contralateral hip and knee flexed at 90 degrees ) was applied in 99 cases, supine position B ( contralateral limb supine straight and abduction ) in 178 cases, and lateral position in 91 cases. The 3 groups were compared in terms of reduction quality, fluoroscopy time, fluoroscopy frequency, operative time, and Harris hp score at 6 months after operation. Results Reduction quality: supine position A group ( 97. 8％) > supine position B group ( 87. 9％) > lateral position group ( 72. 5％) . Fluoroscopy time: lat-eral position group ( 34. 4 ± 5. 8 min ) > supine position A group ( 29. 4 ± 6. 4 min ) > supine position B group ( 27. 1 ± 5. 2 min ) . Fluoroscopy frequency: lateral position group ( 15. 5 ± 5. 0 times ) > supine posi-tion A group ( 14. 0 ± 3. 4 times ) > supine position B group ( 11. 2 ± 2. 9 times ) . The above differences were significant between any 2 groups ( P <0. 05 ) . Operation time: lateral position group ( 59. 0 ± 10. 7 min ) >supine position A group ( 58. 4 ± 11. 2 min ) > supine position B group ( 51. 2 ± 8. 7 min ) . There were sig-nificant differences between supine position B group and either of the other 2 groups ( P < 0. 05 ) . There were no significant differences among the 3 groups in the Harris hp score at 6 months after operation ( P >0. 05 ) . Conclusion In cephalomedullary nailing for patients with femoral intertrochanteric fracture, the position of contralateral limb supine straight and abduction can benefit fracture reduction, affect anteroposterior and lateral fluoroscopy the least, provide convenience for surgical maneuver and thus shorten surgical time.

Objective To examine the antidepressant effects of resveratrol (RSV),and its possible mechanism specialized on improving cognitive function.Methods Thirty-two C57BL/6J mice were randomly divided into four groups:Control,Model,Model+RSV and Model+NA+RSV groups.The mice were subjected corticosterone (20 mg/(kg · d)) intraperitoneal injection for 21 consecutive days except the control mice.From the 22nd to 42nd day,the mice in different groups received further treatment with vehicle/ RSV (400 mg/(kg · d),op)/NA (100 mg/(kg · d),ip)+RSV (400 mg/(kg · d),op).The sugar preference test,novel object recognition test,novel location recognition test and water maze test were applied to evaluate the cognitive effects of RSV on mice.Subsequently,the silence information regulation factor 1 (SIRT1),peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α),parvalbumin (PV) transcription and translation level were evaluated by RT-PCR and Western blotting.Results The sugar preference test showed that the depression model mediated by CORT injection was successfully established(F（1,30） =6,P=0.038).In in the novel object learning test,resveratrol significantly increased the proration on the frequency ((-0.20±0.37) vs (0.16±0.29))and duration((0.10±0.45) vs (0.62±0.29)) and decreased the proration on the distance((0.09±0.36) vs (0.55±0.27)).In the water maze test,resveratrol reduced the time((41±9)s;(26± 8) s) and distance ((295± 70) cm;(224±43) cm) to find the platform.All the results were accompanied with the increased expression of protein SIRT1 (F(3,29) =15.60,P＜0.01),PGC-1α(F(3,29)=7.51,P=0.0006) and PV (F(3,29) =17.87,P=0.0004).While pretreatment with nicotinamide,resveratrol could not rescue the cognitive impairment and could not reverse the iecreased expression level of protein SIRT1,PGC-1 α and PV.Conelusion Resveratrol can reverse the cognitive dysfunction of depressant mice,which may be achieved by activating the SIRT1/PGC-1α signaling pathway and increasing the transcription and protein expression of PV.

Objective To investigate the role and mechanism of oncogene spindle and kinetochore associated complex subunit 3 (SKA3) in the proliferation regulation of hepatocellular carcinoma (HCC) cells. Methods The expression of SKA3 in HCC tissues and cells was detected by Western blot and RT-PCR. SKA3 overexpression group (Huh7-SKA3) and control group (Huh7-Vector) were constructed using lentivirus transfection. Cell models of SKA3 interference group (Huh7-shSKA3) and control group (Huh7-Scramble) were constructed as well. The ability of cell proliferation was detected by MTT assay and cell clony formation assay. The cell cycle was detected by flow cytometry, and the expression of cyclin related proteins was detected by Western blot and RT-PCR. The experimental data were compared byt test.Results The expression of SKA3 protein in HCC tissues and Huh7 HCC cells increased significantly, and the expression level of mRNA was respectively 15.46±2.10 and 9.26±0.80, significantly higher than 1.48±0.17 and 1.11±0.07 of normal liver tissues and normal liver cells LO2 (t=6.58, 10.08; P<0.05). The cell growth curve showed that the proliferation ability of cells in overexpression group was significantly better than those in control group, and the proliferation ability of cells in interference group was lower than those in control group. The number of cell clones in the overexpression group was 259±20, significantly higher than 97±11 in control group (t=9.12, P<0.05), and the number of cell clones in interference group was 11±2, significantly lower than 97±11 in control group (t=-8.13, P<0.05). The ratio of phase G2/M and phase S in overexpression group was respectively (5.5±0.6)％ and (41.9±3.6)％, and was correspondingly (15.8±1.5)％ and (31.9±3.3)％ in control group, and significant differences were observed (t=-10.89, 6.39; P<0.05). The ratio of phase G1/G0 and phase S in interference group was respectively (71.7±6.1)％ and (20.2±2.9)％, and was correspondingly (53.4±5.4)％ and (31.3±4.2)％ in control group, and significant differences were observed (t=8.59,-5.17;P<0.05).Conclusions SKA3 is highly expressed in HCC and can promote the proliferation of HCC cells, which may be related to its promotion of cell cycle from phase G1 to phase S.