Objective To enhance the quality of medical services in the intensive care unit(ICU)of provincial traditional Chinese medicine(TCM)hospitals.Methods In November 2023,Sichuan Provincial Critical Care Medicine Quality Control Center of TCM launched the"quality control supervision project scoring standard for critical care medicine of TCM"to conduct quality control evaluation and business guidance for all TCM hospitals with independent ICU.The survey covered structural indicators,control indicators,participation of TCM,development of new technologies,and diagnosis and treatment programs for dominant diseases.Results In terms of structural indicators:a total of 110 TCM hospitals in the province have independent ICU,an increase of 1.12 times compared with 2019.The control indicators showed that the ICU patients admission rate was higher than that of the national ICU admission rate in 2017,and the admission rate of patients with acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score≥15 points increased.However,the mortality of ICU exceeded the national average.The implementation of core indicators had been significantly improved,but the incidence of outcome indicators such as ICU ventilator-associated pneumonia(VAP),ICU intravascular catheter-related bloodstream infection(CRBSI),and ICU catheter-related urinary tract infection(CAUTI)had increased since 2019,mainly in secondary hospitals.The average number of new technologies was about(5.5±3.4),the participation rate of TCM decreased,and the dominant diseases increased compared with 2019,mainly sepsis,respiratory failure and hemorrhagic stroke.Conclusions The number of ICU units in TCM hospitals at all levels in Sichuan province has grown rapidly,and key performance indicators have also improved compared to previous periods.However,greater efforts are still needed in preventing the occurrence rates of VAP,CRBSI,and CAUTI.There is a shortage of medical resources allocation,and the imbalance in regional medical resources and professional training remains an urgent issue to be addressed.Additionally,the participation rate of TCM and the dominant diseases need further enhancement.

OBJECTIVE To investigate the improvement mechanism of caudatin on liver injury of rats. METHODS SD rats were randomly divided into blank group， model group， caudatin low-dose and high-dose groups （25， 50 mg/kg）， with 6 rats in each group. Diethylnitrosamine （DEN） was injected intraperitoneally three times per week for eight weeks to establish liver injury model of rats. At 5th week of modeling， the rats received relevant medicine or 0.5% sodium carboxymethylcellulose intragastrically for 4 weeks. The levels of liver function indexes [alanine transaminase （ALT）， aspartate transaminase （AST）， total protein （TP） and total bilirubin （TBI）] and inflammatory factors [interleukin （IL-6）， tumor necrosis factor α （TNF-α）， IL-1β] in serum were detected； the histopathological morphological changes of rat liver were observed； the positive protein expressions of nuclear factor κB （NF-κB） and 78 kDa glucose regulatory protein （Grp78） in liver tissue were also determined； the expressions of endoplasmic reticulum stress-related protein Grp78， C/EBP homologous protein （CHOP）， activating transcription factor 6 （ATF6） and inositol requiring enzyme 1α （IRE1α） and the level of protein kinase R-like endoplasmic reticulum kinase robertluoyi@126.com （PERK） in liver tissue were detected. RESULTS Compared with blank group， serum levels of ALT， AST， TBI， IL-6， TNF-α and IL-1β and positive expressions of NF-κB and Grp78 in liver tissue as well as protein expressions of Grp78， CHOP， ATF6 and IRE1α， PERK protein phosphorylation level were all increased significantly in model group （P＜0.05）， while the serum level of TP was decreased significantly （P＜0.05）. The disordered structure of liver lobule， swollen liver cells， unclear intercellular boundary were observed and accompanied by inflammatory cell infiltration. Compared with model group， most of the above indexes were significantly reversed in caudatin groups （P＜0.05）； the structure of hepatic lobule was relatively complete and clear， the cells were arranged orderly， and the infiltration of inflammatory cells was also reduced. CONCLUSIONS Caudatin has a significant improvement effect against DEN-induced liver injury in rats， the mechanism of which may be associated with inhibiting endoplasmic reticulum stress and inflammatory reaction.

Objective:To investigate the effect and mechanism of miR-195 regulating FOXK1 gene and PI3K/Akt pathway on stomach adenocarcinoma proliferation, invasion and migration ability.Methods:Public database samples were employed to analyze the expression differences and prognostic significance of miR-195 in stomach adenocarcinoma. After overexpression of mir-195-5p in two cell lines, MGC803 and AGS, altered cell proliferation, invasion, and migration abilities were detected by Alamar Blue, Wound healing, and Transwell assays. The potential target genes and binding sites of miR-195 were predicted by the starBase. Western blot was used to detect the expression levels of foxk1 and phosphorylation sites in the PI3K/Akt pathway of target genes after overexpression of mir-195-5p. A Dual-luciferase reporter assay was used to verify the relationship between mir-195-5p and foxk1. Statistical analyses were performed with IBM SPSS 22 software and R 4.0.3.Results:Our results showed a significant over-expression of miR-195 in the tumor tissues, compared with the paired normal tissues ( P<0.001) , which could inhibit the proliferation and invasion of stomach carcinoma cells and significantly correlated with survival ( P=0.011) . Moreover, our study indicated that miR-195 depressed the expression of FOXK1 and significantly reduced the activation of the PI3K/Akt pathway, which had a negative effect on the proliferation and invasion of stomach carcinoma cells. The phosphorylated Akt (s473 site) expression in the PI3K/Akt pathway was significantly decreased after overexpression of miR-195. Conclusion:Overall, our studies clarify the important function of the miR-195 in the diagnosis and therapy of patients with stomach carcinoma and reveal the FOXK1 and PI3K/Akt pathway regulation by the miR-195, which are of important clinical significance in the differential diagnosis.

Objective:To systematically evaluate the experience of self-management in peritoneal dialysis patients.Methods:Databases including PubMed, Embase, Web of Science, the Cochrane Library, PsycInfo, Scopus and CNKI, Wanfang, VIP, CBM and Google Scholar were searched and relevant qualitative research on self-management experience of peritoneal dialysis patients was retrieved with a time limitation from the establishment of the databases to April 6, 2020. The quality of articles was evaluated by the quality evaluation standard of qualitative research of JBI evidence-based health care center (2008) , and the results were Meta integrated.Results:A total of 8 studies were included, and 26 complete research results were extracted. We summed up 10 new categories, and obtained 3 integrated results. Integration result 1: cognitive and behavioral management. Patients try to maintain the independence and confidence of peritoneal dialysis management through facing renal failure and adapting to dialysis treatment. Integration result 2: crisis identification and management of complications. Through continuous learning of knowledge and skills related to dialysis treatment, as well as identification and treatment of worsening symptoms, patients can improve their ability of crisis identification and management. Integration result 3: role and social relationship management. Patients constantly adjust their roles and emotions to adapt to changes in daily life and maintain social functions and strive to strengthen communication with medical care, family and society to obtain social relationship support, and increase patients' confidence in self-management.Conclusions:The self-management of peritoneal dialysis patients involves many aspects. The medical staff should give understanding, guidance, and support to the patients' self-management and self-care process in combination with family and society, to help them with better self-management and improve their quality of life.

The parahippocampal gyrus-orbitofrontal cortex (PHG-OFC) circuit in humans is homologous to the postrhinal cortex (POR)-ventral lateral orbitofrontal cortex (vlOFC) circuit in rodents. Both are associated with visuospatial malfunctions in Alzheimer's disease (AD). However, the underlying mechanisms remain to be elucidated. In this study, we explored the relationship between an impaired POR-vlOFC circuit and visuospatial memory deficits through retrograde tracing and in vivo local field potential recordings in 5XFAD mice, and investigated alterations of the PHG-OFC circuit by multi-domain magnetic resonance imaging (MRI) in patients on the AD spectrum. We demonstrated that an impaired glutamatergic POR-vlOFC circuit resulted in deficient visuospatial memory in 5XFAD mice. Moreover, MRI measurements of the PHG-OFC circuit had an accuracy of 77.33% for the classification of amnestic mild cognitive impairment converters versus non-converters. Thus, the PHG-OFC circuit explains the neuroanatomical basis of visuospatial memory deficits in AD, thereby providing a potential predictor for AD progression and a promising interventional approach for AD.

Objective: To introduce a new surgical procedure for the treatment of neck benign tumors by endoscopic techniques. Methods: Seventeen patients with neck benign tumor underwent surgery by endoscope through a concealed incision in Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University from January 2018 to August 2019 were analyzed, which included 3 cases of tumor in the submental area, 2 cases in submandibular region, 9 cases in lower pole region of parotid gland, 1 case in superior region of sternocleidomastoid muscle, 1 case in central region of sternocleidomastoid muscle, 1 case in inferior region of sternocleidomastoid muscle. All patients underwent routine preoperative examination and CT examination to evaluate tumor size, boundary, morphology and nature. According to the area where the tumor located, concealed incisions in different sites were designed. Lumps in the submental area and submandibular area were treated with oral vestibular sulcus incision. Benign tumors located in the lower pole region of parotid gland and the sternocleidomastoid muscle region were treated with approach of the short hidden postauricular incision. During the operation, the self-developed "maxillofacial suspension device" was used to provide the operating space. The tumors were completely removed with endoscope and all patients were followed up every 3 months. Results: All surgical procedures were performed as expected. Visual analogue scale (VAS) was 9.3 on average at 3 months after operation, all the patients were satisfied with the incision design and the cosmetic effect. No recurrences were found in patients with a follow-up period ranged from 1-15 months. Conclusions These studies have shown that endoscope-assisted neck benign tumor resection is a surgical procedure with covert incision and good cosmetic results.

Objective: To summarize the preliminary experience of endoscope -assisted resection of superficial parotid gland benign tumors, and to discuss the indications, advantages and disadvantages of the operation. Methods: The clinical data of 18 patients who underwent extracapsular resection of superficial parotid gland benign tumor in Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University from March 2018 to March 2019 were retrospectively analyzed, and the surgical methods were introduced. The indications, long axis length of tumor, incision design, operation time, intraoperative blood loss, postoperative drainage and drainage time, aesthetic satisfaction, postoperative complications and follow-up time were counted. Results: All procedures were completed as expected. The length of the long axis of the tumor was (2.3±0.6) cm, the incision in the tragus around the earlobe was short and concealed, the incision length was (5.1±1.3) cm, the operation duration was (2.0±0.4) h, intraoperative blood loss was (168.9±18.8) ml, postoperative drainage was (29.5±11.7) ml, drainage time was (3.6±0.5) d, 2 cases of temporary facial paralysis or earlobe numbness, three months after the operation, the results of the visual analogue scale of the incision design and the aesthetic effect were (9.6±0.1). Conclusions Endoscope-assisted resection of superficial parotid gland benign tumor by inner tragus around earlobe approach is applicable and reliable, can reduce complications, shorten surgical incision to obtain satisfactory aesthetic effect, which is worth further expansion and improvement.

Objective To investigate the application value of CT perfusion (CTP) imaging for the revascularization treatment in adult patients with Moyamoya disease.Methods Adult patients with Moyamoya disease underwent revascularization in the Department of Neurosurgery,Wuhan No.1 Hospital from July 2009 to December 2016 were analyzed retrospectively.CTP and clinical evaluation were performed before and after 3-6 months of procedure.The modified Rankin Scale (mRS) was used to assess the functional outcomes.Results A total of 20 patients were enrolled in the study,including 9 females and 11 males,aged 29 to 73 years,with an average of 53.5 years.The initial symptom was ischemic stroke in 10 patients,transient isehemic attack in 7 patients,and hemorrhagic stroke in 3 patients.All patients underwent superficial temporal artery-middle cerebral artery bypass grafting plus encephalomyo-synangiosis under general anesthesia.All patients have different degrees of improvement in cerebral blood flow after procedure,and the CTP parameters were significantly improved compared with those before procedure (all P ＜0.05).The clinical symptoms were significantly improved in 3 cases (15％) and recovered in 13 cases (65％) at 6 months after procedure.The proportion of the mRS score 0-2 was significantly higher than that before procedure (90.0％ [18/20] 对 50.0％ [10/20];x2 =7.619,P =0.006).Conclusion CTP can evaluate the cerebral perfusion status in various vascular areas through hemodynamic parameters in early stage,which can effectively guide the operation mode of Moyamoya disease,and evaluate the changes of cerebral perfusion status after procedure as a means of follow-up of the disease.

Objective To investigate the influence of co-culture of microglia and neural stem cells (NSCs) on differentiation from NSCs into dopaminergic neurons in vitro.Methods (1) The microglia from neonatal SD rats was purified and identified.After the NSCs were isolated from 14-day pregnant SD rats,the cells were cultured and identified.(2) The identified NSCs were randomly divided into 2 groups:simple NSCs culture group and NSCs+microglia co-culture group.After the cells in both groups were cultured for 6 days,immunofluorescence assay and Westem blotting were performed to detect the protein expression of TH,DAT and Pitx3,the factors associated with the differentiation and maturity of dopaminergic neurons.(3) PCR was used to detect the gene transcription of TH,DA T and Pitx3 in the cells from the 2 groups and differences were compared between the 2 groups.Results (1)The staining of CD1 1b/c in the microglia mixed cultured in the neonatal SD rats was positive,with a purity of above 95％;the staining of NSCs identified via nestin was positive in the 14-day pregnant SD rats.(2) The immunofluorescence assay showed that the amounts of positive proteins of TH,DAT and Pitx3 in the NSCs+microglia co-culture group were significantly larger than in the simple NSCs culture group (P＜0.05).The Western blotting showed that the protein expression levels ofTH,DAT and Pitx3 in the NSCs+microglia co-culture group were significantly higher than in the simple NSCs culture group (P＜0.05).(3) The PCR detection showed that the gene transcription levels of TH,DA T and Pitx3 in the NSCs+microglia co-culture group were significantly higher than in the simple NSCs culture group (P＜0.05).Conclusion Co-culture of NSCs and microglia via Transwell may promote differentiation from NSCs into dopaminergic neurons.

Background:Rectal cancer is a common malignant tumor of alimentary tract.It has been demonstrated that oxaliplatin-based neoadjuvant chemotherapy is effective for rectal cancer,however,its mechanism is not fully clarified.Aims:To explore the effect of neoadjuvant chemnotherapy with FOLFOX4 (folinic acid,fluorouracil,and oxaliplatin) on expressions of Ki-67,a proliferating cell-associated nuclear antigen,matrix metalloproteinase-2 (MMP-2),and Fas,a death receptor in cancerous tissue of patients with rectal cancer.Methods:A total of 104 cases of patients with histologically proven rectal cancer from Aug.2014 to Feb.2016 at Central Hospital of China National Petroleum Corporation were enrolled prospectively and randomly allocated into treatment group (n =58) and control group (n =46).Patients in treatment group finished 6 cycles of neoadjuvant chemotherapy with FOLFOX4 before surgery,and those in control group underwent surgery directly.Expressions of Ki-67,MMP-2 and Fas protein in cancerous tissue of surgical specimens were determined immunohistochemically.Results:Immunoreactivity of Ki-67 mainly located in the nucleus of rectal cancer cells,and those of MMP-2 and Fas mainly located in the cytoplasm.Expression rates of Ki-67 and MMP-2 were significantly lower in treatment group than in control group (41.4％ vs.80.4％,P ＜ 0.05;36.2％ vs.73.9％,P ＜ 0.05),while those of Fas was significantly higher in treatment group than in control group (62.1％ vs.32.6％,P ＜ 0.05).Conclusions:The therapeutic effect of neoadjuvant chemotherapy with FOLFOX4 on rectal cancer might be associated with the inhibition of proliferative,invasive and metastatic capacities and induction of apoptosis in cancer cells.