Liver failure is a common clinical syndrome with rapid progression and poor prognosis. Currently， there are still limited internal medical treatment methods for liver failure， and artificial liver support therapy is an effective treatment method. Non-bioartificial liver technology is widely used in clinical practice， and clinicians should determine the starting time， mode， and specific parameters of treatment according to the pathophysiological mechanism and dynamic evolution process of the disease， as well as the specific conditions of patients. Compared with non-bioartificial liver， biological artificial liver can better simulate the biological function of liver cells. At present， substantial progress has been made in its core technology， and related clinical studies are being conducted actively， suggesting a vast potential for future development. This article summarizes and discusses the optimization of non-bioartificial liver technology and the advances in biological artificial liver， in order to provide a reference for the clinical application and research of artificial liver technology.

Objective To evaluate effectiveness of evidence-based nursing practice of postoperative delirium management during cardiac surgery under cardiopulmonary bypass.Methods The best evidence was selected for the prevention and management of delirium after cardiac surgery under cardiopulmonary bypass.From May 2022 to April 2023,the evidence-based nursing practice was developed and applied into the Department of Cardiovascular and Macro-vascular Surgery of a tertiary A general hospital in Wuhan.The nurses'knowledge,belief and practice of postoperative delirium,incidence of postoperative delirium and subdelirium syndrome,the implementation rate of examination indicators were compared before and after the application of evidence.Results A total of 27 articles were finally included.Based on this,23 pieces of the best evidence were selected,and 27 review indicators were constructed.Through evidence-based practice,the scores of nurses'knowledge,belief and practice questionnaire were significantly increased from(100.81±13.92)to(105.51±10.35)(P＜0.05).The implementation rate of 24 indicators was significantly higher compared with baseline review(P＜0.05).The incidence of delirium decreased from 43.5％ to 34.7％(P=0.120).The incidence of postoperative subdelirium syndrome decreased from 55.1％ to 40.1％(P=0.010).The duration of postoperative delirium and sub delirium significantly decreased,respectively(P＜0.05).Conclusion Evidence-based practice can reduce the incidence of subdelirium syndrome,and it can reduce postoperative delirium and the duration of subdelirium syndrome.It can improve nurses'knowledge and practice of postoperative delirium care.

β2-adrenergic receptor （β2-AR） agonists are widely used as first-line drugs in the treatment of bronchial asthma （hereinafter referred to as “asthma”）， but long-term use can lead to β2-AR desensitization and reduce its clinical efficacy， resulting in poor symptom control of some asthma patients. The mechanism of β2-AR desensitization induced by β2-AR agonists mainly includes slow hyposensitization （related to the decrease of β2-AR density in airway mucosa） and rapid hyposensitization （related to the mechanism of stimulatory G protein decoupling）. Cyclic adenosine monophosphate（cAMP）-protein kinase A and cAMP- exchange protein activated by cAMP signaling pathways are closely related to β2-AR desensitization. Glucocorticoids， peroxisome proliferator-activated receptor-gamma agonists， ASM-024， Chinese medicine monotherapies and formulations， when combined with β2-AR agonists， can improve the sensitivity of β2-AR， so as to better control asthma symptoms.

Objective To investigate the current status of occupational protection behaviors of nurses in pharmacy intravenous drug admixture service (hereinafter referred to as "PIVAS") and its association with occupational exposure to hazardous drugs. Methods A total of 312 PIVAS nurses from 10 tertiary-A hospitals in Xi'an City were selected as the research subjects using the convenience sampling method. Their occupational exposure to hazardous drugs was investigated, and their occupational protection behaviors were assessed using the "Nurse Occupational Protection Behavior Questionnaire". Results The rate of occupational exposure to hazardous drugs of PIVAS nurses was 40.1% (125/312), and their score for occupational protection behaviors was (77.7±9.3) points. The results of binary logistic regression analysis showed that educational level, length of service, workload, dispensing environment, drug packaging, and occupational protection behaviors were influencing factors for the occupational exposure in PIVAS nurses (all P<0.05). Conclusion The incidence of occupational exposure to hazardous drugs among PIVAS nurses in Xi'an City is relatively high. It is necessary to strengthen training on knowledge of occupational protection behavior to reduce occupational exposure.

Objective To observe the incidence and prognosis of respiratory failure in patients after cardiac surgery,and the risk factors were analyzed.Methods A total of 559 patients who underwent cardiac surgery were enrolled in Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from July 2020 to November 2023.Clinical data were extracted through the hospital information system(HIS).This included general data such as gender,age,body mass index(BMI),smoking history,alcohol history,comorbidities,and basic disease data like occurrence of respiratory tract infection in the past 1 month before surgery,preoperative use of antimicrobial drugs,ejection fraction,operation time,cardiopulmonary bypass time,intraoperative blood transfusion,nasogastric tube indwelling,nosocomial infection,secondary thoracotomy,preoperative white blood cell count(WBC),length of intensive care unit(ICU)stay,secondary intubation and tracheostomy,discharge diagnosis,and outcome.The patients were divided into two groups according to whether or not they had expiratory failure.The difference of the above data between the two groups was compared.Multivariate Logistic regression was used to analyze the risk factors of respiratory failure in patients after cardiac surgery,the prediction model was constructed based on the above risk factors,and the receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of the prediction model for patients with respiratory failure.Results The incidence of respiratory failure in patients after cardiac surgery was 7.51%(42 cases).Multivariate Logistic regression analysis showed that intraoperative blood transfusion>2000 mL,nasogastric tube,and nosocomial infection were risk factors for respiratory failure in patients after cardiac surgery[odds ratio(OR)and 95%confidence interval(95%CI)were 4.136(1.794-9.535),3.162(1.454-6.878)and 3.488(1.262-9.638),all P<0.05].The ROC curve analysis showed that the prediction model had a certain predictive value for the occurrence of respiratory failure in patients after cardiac surgery[area under the curve(AUC)=0.738,95%CI was 0.658-0.818,P<0.001].The length of ICU stay of patients in the group with respiratory failure was significantly longer than that in the group without respiratory failure(hours:8.16±7.62 vs.4.52±3.95),the secondary intubation rate[80.95%(34/42)vs.0(0/517)]and the tracheostomy rate[88.10%(37/42)vs.0(0/517)]were significantly higher than those in the non-respiratory failure group,and the recovery/improvement rate was significantly lower than that in the non-respiratory failure group[59.52%(25/42)vs.90.13%(466/517)],the differences were statistically significant(all P<0.05).Conclusions Patients with intraoperative blood transfusion>2000 mL,nasogastric tube inserted,and nosocomial infection are the high-risk groups for respiratory failure after cardiac surgery.Medical staff should strengthen the identification of high-risk groups and actively take intervention measures to improve the prognosis of patients.

The kidneys are one of the main excretory organs for drugs and when drugs are not excreted effectively, they can accumulate in the kidneys or in the interstitial tubules, leading to drug-induced kidney injury. The tubulointerstitium accounts for 80% of the volume of the kidney and is the primary site of response to various types of renal injury. This article focuses on drug-induced acute interstitial nephritis, highlighting its clinical symptoms, listing common induction drugs, analysing pathological features, and explaining its pathogenesis from the perspective of immune response, with the aim of providing a basic and clinical evidence for subsequent studies.

Objective To investigate the effect of acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction on hemiplegia,hemorheology and neurotrophic factors in pa-tients with cerebral infarction differentiated as type of Qi deficiency and blood stasis.Methods A to-tal of 84 hospitalized patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis from March 2018 to June 2023 were selected as research objects,and they were randomly divid-ed into observation group and control group,with 42 cases in each group.The control group was con-ducted with acupuncture and routine treatment,while the observation group was conducted with modi-fied Buyang Huanwu Decoction on the basis of the control group.Clinical efficacy after 2 weeks of treatment as well as the scores of main symptoms,neurological function,limb function,hemorheologi-cal indicators and levels of neurotrophic factors before and after treatment were compared between two groups.Results After 2 weeks of treatment,the total effective rate of the observation group was sig-nificantly higher than that of the control group(P＜0.05);after treatment,the scores of symptoms such as hemiplegia,deviated mouth and awkward speech in both groups decreased significantly when compared to those before treatment,and these scores in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the score of the National Institutes of Health Stroke Scale(NIHSS)in both groups decreased significantly when compared to that before treat-ment,and the score in the observation group was significantly lower than that in the control group(P＜0.05);the score of the Motor Function Assessment Scale(Fugl-Meyer)after treatment in both groups was significantly higher than that before treatment,and the observation group was significant-ly higher than that in the control group(P＜0.05).After treatment,the plasma viscosity,red blood cell aggregation index,whole blood high shear viscosity and whole blood low shear viscosity in both groups decreased significantly when compared to those before treatment,and these indexes in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the levels of serum brain derived neurotrophic factor(BDNF),nerve growth factor(NGF)and glial cell line-derived neurotrophic factor(GDNF)in both groups increased significant-ly when compared to those before treatment,and the levels of these indexes in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction can enhance the therapeutic effect for patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis,im-prove clinical symptoms,repair nerve damage,and promote the recovery of limb function.

Objective To investigate the effect of acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction on hemiplegia,hemorheology and neurotrophic factors in pa-tients with cerebral infarction differentiated as type of Qi deficiency and blood stasis.Methods A to-tal of 84 hospitalized patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis from March 2018 to June 2023 were selected as research objects,and they were randomly divid-ed into observation group and control group,with 42 cases in each group.The control group was con-ducted with acupuncture and routine treatment,while the observation group was conducted with modi-fied Buyang Huanwu Decoction on the basis of the control group.Clinical efficacy after 2 weeks of treatment as well as the scores of main symptoms,neurological function,limb function,hemorheologi-cal indicators and levels of neurotrophic factors before and after treatment were compared between two groups.Results After 2 weeks of treatment,the total effective rate of the observation group was sig-nificantly higher than that of the control group(P＜0.05);after treatment,the scores of symptoms such as hemiplegia,deviated mouth and awkward speech in both groups decreased significantly when compared to those before treatment,and these scores in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the score of the National Institutes of Health Stroke Scale(NIHSS)in both groups decreased significantly when compared to that before treat-ment,and the score in the observation group was significantly lower than that in the control group(P＜0.05);the score of the Motor Function Assessment Scale(Fugl-Meyer)after treatment in both groups was significantly higher than that before treatment,and the observation group was significant-ly higher than that in the control group(P＜0.05).After treatment,the plasma viscosity,red blood cell aggregation index,whole blood high shear viscosity and whole blood low shear viscosity in both groups decreased significantly when compared to those before treatment,and these indexes in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the levels of serum brain derived neurotrophic factor(BDNF),nerve growth factor(NGF)and glial cell line-derived neurotrophic factor(GDNF)in both groups increased significant-ly when compared to those before treatment,and the levels of these indexes in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction can enhance the therapeutic effect for patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis,im-prove clinical symptoms,repair nerve damage,and promote the recovery of limb function.

Background and Objectives: Human umbilical cord mesenchymal stem cells (HUC-MSCs) are promising candidates for cell-based therapy in regenerative medicine or other diseases due to their superior characteristics, including higher proliferation, faster self-renewal ability, lower immunogenicity, a noninvasive harvest procedure, easy expansion in vitro, and ethical access, compared with stem cells from other sources. Methods: and Results: In the present study, we knocked down the expression of SOX9 in HUC-MSCs by lentivirus interference and found that knockdown of SOX9 inhibited the proliferation and migration of HUC-MSCs and influenced the expression of cytokines (IL-6 and IL-8), growth factors (GM-CSF and VEGF) and stemness-related genes (OCT4 and SALL4). In addition, the repair effect of skin with burn injury in rats treated with HUC-MSCs transfected with sh-control was better than that rats treated with HUC-MSCs transfected with shSOX9 or PBS, and the accessory structures of the skin, including hair follicles and glands, were greater than those in the other groups. We found that knockdown of the expression of SOX9 obviously inhibited the expression of Ki67, CK14 and CK18. Conclusions In conclusion, this study will provide a guide for modifying HUC-MSCs by bioengineering technology in the future.

Objective:To investigate the relationship between plasma levels of complements before treatment and the clinicopathological feathers and prognoses of diffuse large B-cell lymphoma (DLBCL) patients treated with Rituximab (R)-CHOP or R-CHOP-like therapy.Methods:The clinicopathological data of 105 DLBCL patients treated in cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2016 were collected. The plasma samples from 105 DLBCL patients treated with R-CHOP or R-CHOP-like therapy and 80 healthy controls were used to detect 34 complement levels before treatment by utilizing antibody microarray. The relationship between plasma levels of complements and the clinicopathological feathers and prognosis of DLBCL patients were analyzed.Results:The signal values of C1QA and CR1L in patients with international prognostic index (IPI) scores of 3-5 were 1 261.43±138.9 and 2 214.69±98.58, respectively, higher than 950.79±80.19 and 984.67±121.79 in patients with IPI scores of 0~2 (both P<0.05). The levels of C1QA and CR1L in the non-complete response (CR) group were 1 165.43±98.56 and 2 263.13±145.63, respectively, higher than 914.70±100.77 and 1 821.34±84.68 in the CR group (both P<0.05). Cox regression analysis showed that elevated C1QA signal value was associated with poor progression-free survival (PFS) and poor overall survival (OS) (PFS: HR=2.063, 95% CI: 1.220-3.489, P=0.007; OS: HR=2.23, 95% CI: 1.036~4.798, P=0.040). After IPI correction by Cox multivariate model, the elevated C1QA signal value was still correlated with poor PFS ( HR=1.765, 95% CI 1.034~3.013, P=0.037). Conclusions:The baseline plasma levels of C1QA and CR1L are correlated with IPI scores and therapeutic effects of DLBCL patients treated with R-CHOP. The baseline plasma level of C1QA has a certain predictive value for the prognostic evaluation of DLBCL.