ObjectiveTo evaluate the clinical efficacy and safety of Tongluo Mingmu capsules in the treatment of diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome. MethodA randomized， double-blind， positive-control， and multi-center clinical trial design method was used. 416 patients with diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome in four test centers were included （the ratio of the treatment group to the control group was 3∶1）. On the basis of standardized hypoglycemic treatment， the treatment group was given both four Tongluo Mingmu capsules and two Calcium Dobesilate capsule agents three times a day， while the control group were given both two Calcium Dobesilate capsules and four Tongluo Mingmu capsule agents three times a day. The course of treatment was 12 weeks. The curative effect of Tongluo Mingmu capsules was evaluated by comparing the comprehensive curative effect of diabetic retinopathy， traditional Chinese medicine（TCM） syndrome score， corrected visual acuity， fundus changes， fundus fluorescence angiography， and other curative effect indexes before and after treatment in the two groups. At the same time， general examination， laboratory examination， and adverse events were performed to evaluate the safety of the drug. ResultThe baseline demographic data and disease characteristics of the treatment group and the control group were balanced and comparable， with the difference not statistically significant. After 12 weeks of treatment， the total effective rate of the comprehensive curative effect of diabetic retinopathy in the treatment group （61.0%， 189/310） was better than that in the control group （44.1%， 45/102）， and the difference was statistically significant （χ²=8.880， P<0.01）. The total effective rate of TCM syndromes in the treatment group （88.4%， 259/293） was better than that in the control group （69.9%， 65/93）， and the difference was statistically significant （χ²=17.927， P<0.01）. The disappearance rate of dry eyes （χ²=8.305）， dull complexion （χ²=4.053）， lassitude （χ²=10.267）， shortness of breath （χ²=8.494）， and dry stool （χ²=8.657） in the treatment group was higher than that in the control group， and the difference between the groups was statistically significant （P<0.05， P<0.01）. In terms of improving corrected visual acuity （χ²=8.382）， fundus changes （χ²=6.026） ， the treatment group was significantly better than the control group （P<0.05）. During the trial， the incidence of adverse events in the treatment group and the control group was 1.3% and 2.9%， respectively. There was no significant difference between the two groups. In addition， there were no serious adverse events and adverse events leading to withdrawal in both groups. ConclusionTongluo Mingmu capsules can improve the comprehensive curative effect of diabetic retinopathy and enhance the efficacy of TCM syndromes， visual acuity， fundus changes， and fundus fluorescein angiography， with great safety. Therefore， it can provide a new alternative therapeutic drug for patients with diabetic retinopathy.

[摘 要] 目的：探讨多结节非小细胞肺癌（NSCLC）组织中的驱动基因突变情况与临床病理特征的关系，为多结节NSCLC患者治疗提供分子诊断依据。方法：本研究共纳入2018年1月至2023年10月间云南省肿瘤医院分子诊断中心检测的121例多结节NSCLC患者的253个肺结节肿瘤组织标本，以第二代测序（NGS）技术或扩增阻滞突变系统PCR（ARMS-PCR）技术检测多结节NSCLC 组织中驱动基因突变情况，分析其与患者临床病理特征的关系，比较不同结节间肺癌驱动基因的突变异质性。结果：与非“宣威”NSCLC相比，“宣威”多结节NSCLC患者驱动基因突变具有显著的地域特点，表现在“宣威”患者具有较低（20%）的EGFR敏感突变（L858R、19-del）及较高（27.26%）的EGFR少见突变（主要为G719/S768I、G719）；“宣威”多结节NSCLC患者的KRAS突变率（27.27%）亦显著高于非“宣威”患者突变率（12.59%）（P<0.05）。此外，“宣威”多结节NSCLC患者驱动基因突变不一致率高达69.23%，远高于非“宣威”患者驱动基因突变不一致率（55.07%）（P<0.05）。结论：“宣威”多结节NSCLC患者具有较高的EGFR少见突变及KRAS突变率，同一患者不同病灶之间存在更高的驱动基因突变异质性，本研究将为“宣威”多结节NSCLC的诊疗策略提供更多的选择。

ObjectiveThe lung mesenchymal stem cells （LMSCs） induced by D-galactose （D-gal） were intervened by Wenfei Huaxian decoction-containing serum to explore the mechanism of Wenfei Huaxian decoction in delaying the senescence of LMSCs through the nicotinamide phosphoribosyltransferase/silent information regulator 1 （NAMPT/SIRT1） signaling pathway. MethodWenfei Huaxian decoction-containing serum was prepared. LMSCs were isolated by gradient density centrifugation， and they were cultured and identified in vitro. The senescence model in vitro was established by stimulating cells via D-gal for 24 h. LMSCs cells were modeled after being treated with different volume fractions （5%， 10%， 20%， 40%， and 80%） of Wenfei Huaxian decoction-containing serum for 24 h， and the cell proliferation level was detected by methyl thiazolyl tetrazolium （MTT） method. The cells were randomly divided into blank serum group， model group， and high， medium， and low dose groups of Wenfei Huaxian decoction-containing serum. Senescence-associated β-galactosidase （SA-β-gal） staining was used to detect the senescence of LMSCs in each group. The content of NAD + was detected by colorimetry. The levels of senescence-associated factors （p16 and p53）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） in cell culture supernatant were detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the relative expression of senescence-associated proteins and NAMPT/SIRT1 signaling pathway-related proteins. ResultCompared with the blank serum group， the proliferation of LMSCs was significantly inhibited after D-gal stimulation for 24 h （P<0.01）. Compared with the model group， the proliferation of LMSCs could be promoted after intervention with the corresponding Wenfei Huaxian decoction-containing serum （P<0.05， P<0.01）. Compared with the blank serum group， the SA-β-gal staining of LMSCs in the model group after D-gal stimulation was enhanced， and the content of NAD⁺ was increased （P<0.01）. The expression levels of senescence factors p16 and p53， as well as SASP pro-inflammatory factors IL-6 and TNF-α in the cell culture supernatant， were significantly increased （P<0.01）. The expression of senescence-associated proteins p16， p21， and p53 increased （P<0.01）， and the protein expression of NAMPT， SIRT1， peroxisome proliferator-activated receptor γ coactivator 1α （PGC-1α）， and forkhead box family transcription factor O1 （FoxO1） decreased （P<0.01）. Compared with the model group， the SA-β-gal staining of LMSCs in each group of Wenfei Huaxian decoction-containing serum was significantly reduced， and the content of NAD⁺ was decreased （P<0.01）. The senescence factors （p16 and p53） and inflammatory factors （IL-6 and TNF-α） in the cell culture supernatant were significantly decreased （P<0.01）. The expression of senescence-associated proteins （P16， P21， and P53） decreased （P<0.05， P<0.01）. The protein expressions of NAMPT， SIRT1， PGC-1α， and FoxO1 were significantly up-regulated （P<0.05， P<0.01）. ConclusionWenfei Huaxian decoction can alleviate senescence and inflammatory response damage of D-gal-induced LMSCs， and its mechanism may be related to the regulation of the NAMPT/SIRT1 signaling pathway.

Objective To analyze the influencing factors of unplanned extubation(UE)occurrence of peripherally inserted central catheter(PICC)in the patients with hematological diseases.Methods A retro-spective cohort study method was adopted.The data of 7 298 patients with hematological diseases implanted with PICC catheter and followed up to its removal from January 1,2016 to December 31,2020 in the Hematol-ogy Hospital of Chinese Academy of Medical Sciences were collected,including the demographic information,catheterization records,maintenance and extubation records.According to whether UE occurring,they were divided into the UE group(n=262)and normal extubation group(n=7 036).The general data were com-pared between the two groups.The COX regression was used to analyze the influencing factors of UE in pa-tients with hematological diseases.The dose-effect relationship between age and PICC UE occurrence risk was studied by the restrictive cubic spline method.Results The incidence rate of UE was 3.6％(262/7 298).The COX regression analysis results showed that the gender,disease diagnosis,fibrinogen,prothrombin time,PLT,catheter material,number of punctures during catheterization,positioning method of catheter tip,num-ber of catheter-related complications occurrence were related to PICC UE occurrence in the patients with he-matological diseases(P＜0.05).The results of restricted cubic spline showed that there was a"U"-type non-linear relationship between age and UE risk(X2=17.710,P＜0.05),and the risk of UE was the lowest when the age was 30 years old.Conclusion In PICC,the emphasis should be paid to the male patients with hemato-logical malignancies who have repeated punctures during catheterization,no intracardiac electrocardiographic positioning during catheterization,bleeding tendency,indwelling polyurethane catheters and repeated catheter-related complications in order to decrease the UC occurrence probability.

Objective To discuss the feasibility and safety of simultaneous bilateral adrenal vein sampling(AVS)using two 4F-MPA1 catheters via right elbow vein access.Methods A total of 51 consecutive patients with primary aldosteronism,who received simultaneous bilateral AVS using two 4F-MPA1 catheters(one of the two catheters was shaped into pig tail figure)via right elbow vein access at Xiangyang Municipal Central Hospital between October 2021 and October 2022,were enrolled in this study.The used catheter,the success rate of simultaneous bilateral AVS,and the incidence of complications rate were calculated.Results The 4F-MPA1 catheter was used for all of the right AVS,while a specially shaped 4F-MPA1 catheter was used for the main trunk vein AVS of the left adrenal gland and the central vein AVS of the left adrenal gland.The success rate of simultaneous bilateral AVS was 92.2%(47/51).Adrenal hematoma occurred in one patient(1.96%).Conclusion The technique of simultaneous bilateral AVS using two 4F-MPA1 catheters via right elbow vein access is simple to operate,less traumatic,and clinically safe and feasible.However,due to the small sample used in this study,the clinical value of this technique still needs further investigation and verification.

Summarizing the nursing experience of a child with HHV-6B encephalitis after umbilical cord blood transplantation and CAR-T therapy. The child was 4 years old and was diagnosed with acute T lymphocytic leukemia on May 28, 2021. Nursing points: meticulously observe symptoms for early diagnosis and treatment; develop a specialized management plan, implement individualized care; enhance medication management to improve the quality of care; establish a shared decision-making communication model to prevent hospital-acquired infections; provide patient-centered care for lumbar puncture; assess the needs of the child and family, alleviate negative emotions; improve pre-discharge preparation, emphasize continuity of care. With proactive treatment and careful nursing, the child′s condition improved, and they were discharged. Follow-up for six months showed the child in a sustained remission state with no adverse sequelae, and normal life resumed.

Objective:To investigate the current status and influencing factors of care preparedness in primary caregivers of children with acute leukemia, so as to provide theoretical basis for targeted nursing intervention plans in the future.Methods:A total of 160 primary caregivers of children with acute leukemia in Hematology Hospital of the Chinese Academy of Medical Sciences recruited by convenient sampling were investigated by the general data questionnaire, the Preparedness for Caregiving Scale, the Herth Hope Index, the Family Caregiver Task Inventory and the Mishel Uncertainty in Illness Scale-Family Member Form. Descriptive analysis, Mann-Whitney U test, Kruskal-Wallis H test, Spearman rank correlation and multiple stepwise liner regression were used for statistical analysis. Results:One hundred and fifty-nine questionnaires were effectively collected, including 13 males and 146 females, aged (34.61 ± 8.60) years old. The total score of care preparedness, hope, uncertainty in illness, care ability for caregivers were (26.47 ± 7.53), (37.72 ± 4.11), (61.96 ± 17.02), (15.06 ± 12.94) points. The total score of care preparedness for caregivers was negatively correlated with the score of uncertainty in illness( r=-0.300, P<0.05), and positively correlated with the hope and care ability of main caregivers ( r=0.166, 0.254, both P<0.05). Caregivers′ uncertainty in illness, caregiver gender, availability of other caregivers, caregivers′ hope entered the multiple stepwise regression equation, which could explain 20.4% of the total variation of resilience. Conclusions:The preparation of the primary caregivers for children with acute leukemia is at a medium level. The primary caregivers who are male, who have insufficient knowledge of the disease, who have no co-caregivers, and who have low hope level should be focused on in clinical practice. Pertinent measures should be taken to improve care preparedness and care quality.

Objective To collect data related to nursing quality,describe and analyze the application effect,and explore its application value by combining the contents of key contents of nursing quality control with information technology in clinical nursing work.Methods Based on the clinical nursing quality control information system currently operated in Yichun People's Hospital,actual contents of nursing quality control were incorporated into the system,focusing on key links of nursing quality control,such as patient identification management,medication safety management,doctor's order check management,nursing document writing,overall nursing responsibility system,and health education management.Additionally,the study compared the performance of these quality control points before and after the integration of information technology.Results Following the inte-gration of key quality control contents in nursing with information technology,all departments of the hospital achieved a signifi-cantly higher pass rates for patient identification management,medication safety management,doctor's order check management,health education management,and follow-up rates of discharged patients(P＜0.05),while they had a significant decrease in the incidence of fall injuries,in-hospital pressure injuries,and unplanned extubation among inpatients(P＜0.05).Additionally,the time for post-ward nursing data extraction,problem feedback,and correction cycle was significantly shortened after implemen-tation(P＜0.05).Conclusion The information-oriented key contents of nursing quality control yields effectiveness in enhancing the performance of various quality control measures and reducing the occurrence of adverse events such as fall injuries and pres-sure injuries.This integration allows for more accurate data collection,improves patient follow-up rates,and facilitates timely ad-justments in nursing practices.The study recommends utilizing scientific methods to extract reliable monitoring information,en-hance data accuracy,and minimize adverse events.

The physiological function of postoperative patients had not returned to normal, coupled with surgical trauma, residual effects of anesthesia and analgesic drugs and potential risk factors, so postoperative patients need to be transferred to the post-anesthesia care unit for observation, until the vital signs were stable before being transferred to the general ward. This paper summarized the importance, safety management status, influencing factors and intervention measures of patient handover between operating room and post-anesthesia care unit, to provide guidance for clinical patient handover and improve the safety of patient handover.

Objective To investigate the effects of Shechuangzi San on Th1/Th2 immune function in eczema rats and analyze its mechanisms in treating eczema.Methods Fifty SD rats were randomly divided into blank group,model group,Shechuangzi San high dose group,Shechuangzi San low dose group,and Bingbaiye liquid group,with 10 rats in each group.The rat eczema model was established using 2,4-dinitrochlorobenzene.The blank group and model group were topically treated with 0.9%saline,the Shechuangzi San high dose group was topically treated with a decoction of Shechuangzi San at a concentration of 2.32 g·mL-1,and the low dose group was topically treated with a decoction of Shechuangzi San at a concentration of 1.16 g·mL-1.And the Bingbaiye liquid group was topically treated with the original liquid of Bingbaiye,once in the morning and once in the evening,for a total of 14 days.After the last administration,the skin lesions on the rats'backs were observed and the skin lesion scores were evaluated.The pathological changes of eczema lesions were observed by HE staining,and semi-quantitatively scored.ELISA method was used to detect the levels of IFN-γ,IL-4,IL-18,and IL-33 in rat serum.Flow cytometry was used to determine the Th1/Th2 ratio in the serum.Results Compared to the blank group,the rat skin lesion score in the model group was significantly increased(P<0.05),with a series of skin lesions including edema,erythema,scaling,lichenification appearing on the back.Pathological sections showed excessive keratosis,thickening of cuticular layer,edema of epidermis sponge,infiltration of a large number of inflammatory cells in epidermis,and the semi-quantitative score of skin lesions was significantly increased(P<0.05).Serum levels of IL-4,IL-18,and IL-33 were significantly increased(P<0.05),while the level of IFN-γ was significantly decreased(P<0.05).Serum Th1/Th2 ratio decreased(P<0.05).Compared to the model group,the rat skin lesions in the Shechuangzi San high and low dose groups and the Bingbaiye liquid group were significantly improved(P<0.05),Pathological sections showed that the structure of epidermis was restored to normal,the cuticle became thinner,the spongy edema of epidermis disappeared,epidermal inflammatory cells disappeared,and the semi-quantitative score of skin lesions decreased(P<0.05).Serum levels of IL-4,IL-18,and IL-33 were decreased(P<0.05),while the level of IFN-γ was increased(P<0.05),serum Th1/Th2 ratio increased significantly(P<0.05).and the therapeutic effect of the Shechuangzi San high and low dose groups was superior to that of the Bingbaiye liquid group(P<0.05).Conclusion Shechuangzi San can effectively improve the skin lesions of rats with eczema,repair the pathological damage of skin lesions,and reduce the levels of inflammatory factors.Its mechanism may be related to the inhibition of secretion of inflammatory factors such as IL-4,IL-18,and IL-33,promotion of IFN-γ release,and restoration of Th1/Th2 imbalance.