Objective:To evaluate the effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure(PEEP) on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods:One hundred and forty-three elderly patients, aged ≥65 yr, with body mass index of 18.5-30.0 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to either individualized PEEP combined with recruitment maneuvers (group Ⅱ) or fixed PEEP (group Ⅰ) using a random number table method. PEEP was maintained at 6 cmH 2O starting from the beginning of procedure until the end of the procedure in group I. Individualized PEEP titration was performed after induction of anesthesia in group Ⅱ. The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation. Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery, Quality of Recovery-15 scale score on 3rd day after surgery, rate of unplanned admission to intensive care units, length of hospital stay, incidence of intraoperative hypoxemia, usage rate of intraoperative vasoactive drugs, and incidence of postoperative hypotension. Results:Compared with group Ⅰ, the lung ultrasound score, driving pressure and postoperative pulmonary complications were significantly decreased, the dynamic lung compliance was increased ( P<0.05 or 0.01), and no significant changes were found in the other parameters in group Ⅱ ( P>0.05). Conclusions:Individualized PEEP combined with recruitment maneuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.

[Objective]To investigate the effect of Baoyuan Jiedu Decoction(BJD)on serum lipids and white adipose tissue browning in cancer cachexia mice.[Methods]The specific pathogen free C57BL/6 mice were divided into normal group,model group,BJD group and megestrol acetate(MA)group.After 21 days of intervention,the changes of body weight,food intake,water consumption and tumor volume of the mice were observed,multidimensional mass spectrometry-based shotgun lipidomics(MDMS-SL)was used to determine the content of serum lipid of mice,white adipose tissue morphology and lipid droplet area were detected by hematoxylin-eosin(HE)staining,the expressions of white adipose tissue browning related genes were detected by Real-time quantitative polymerase chain reaction(Real-time PCR);and the protein expression of uncoupling protein 1(UCP1)was detected by Western blot and immunohistochemistry(IHC)staining.[Results]Compared with model group,the mice in BJD group were generally in good condition,and their food intake,water consumption and weight were increased significantly(P＜0.05),and the volumes of tumors were significantly suppressed(P＜0.05).Compared with normal group,there were 61 kinds of abnormal lipids in the serum of model group,while 30 kinds of lipids were influenced by BJD treatment(P＜0.05).Compared with model group,BJD alleviated the mass loss and lipid droplets(P＜0.05),inhibited the mRNA expression of UCP1,Cidea,Prdm16(P＜0.05)and the protein expression of UCP1(P＜0.05)in epididymal white adipose tissue(eWAT)and inguinal white adipose tissue(iWAT)of cancer cachexia mice.[Conclusion]BJD can inhibit weight loss,relieve the disorder of serum lipid,and inhibit the white adipose tissue browning of iWAT and eWAT of cancer cachexia mice.

Objective:To evaluate the predictive value of preoperative frailty combined with nutritional status for prolonged postoperative ileus (PPOI) in the patients with gynecological malignancies.Methods:Patients undergoing elective surgery for gynecological malignancies in the Affiliated Hospital of Jiangnan University from April 2022 to February 2023 were selected. The Frail scale was used to evaluate the frailty within 24 h of admission, and the nutritional status was evaluated by the Controlling Nutritional Status score. The general characteristics of patients and occurrence of PPOI were recorded, and the risk factors for PPOI were analyzed by multivariate logistic regression. The ability of frailty, nutritional status and their combination to predict PPOI was assessed by the receiver operating characteristic curve.Results:Two hundred and fourteen patients were finally included, 52 cases developed of PPOI, and 98 cases were frail patients. Preoperative frailty combined with moderate to severe malnutrition was an independent risk factor for PPOI in the patients with gynecological malignancies ( P<0.05), and the area under the curve in predicting the occurrence of PPOI was 0.796 (95% confidence interval 0.736-0.857) in the patients with gynecological malignancies. Conclusions:Preoperative frailty combined with moderate to severe malnutrition has a higher accuracy in predicting PPOI in the patients with gynecological malignancies.

Objective:To evaluate the role of Z-DNA-binding protein 1 (ZBP1)/receptor-interacting protein kinase 1 (RIPK1) signaling pathway in lipopolysaccharide (LPS)-adenosine triphosphate (ATP)-induced pyroptosis in macrophages of mice.Methods:The RAW264.7 macrophages from mice were routinely cultured and divided into 6 groups ( n=9 each) using a random number table method: control group (group C), LPS-ATP group, LPS-ATP+ transfection negative control scRNA group (group LPS-ATP+ scRNA), LPS-ATP+ ZBP1 small interference RNA group (group LPS-ATP+ siRNA), LPS-ATP+ dimethyl sulfoxide group (group LPS-ATP+ DSMO), and LPS-ATP+ RIPK1 inhibitor nec-1 group (group LPS-ATP+ nec-1). The siRNA technique was used to inhibit the expression of ZBP1 in group LPS-ATP+ siRNA. The RIPK1 inhibitor nec-1 was given to inhibit the expression of RIPK1 protein in group LPS-ATP+ nec-1. Group C was routinely cultured. Cells were incubated with 10 μg/ml LPS for 24 h, then 5 mmol/L ATP was added, and the cells were incubated for 30 min to develop the cell pyroptosis model in the remaining 5 groups. The cell survival was detected by the CCK-8 assay. The concentrations of interleukin-1beta (IL-1β), IL-6, IL-18 and tumor necrosis factor-alpha (TNF-α) in cell supernatant were determined by enzyme-linked immunosorbent assay. The pyroptosis was determined by propidium iodide fluorescence staining. Western blot was used to detect the expression of ZBP1, RIPK1, caspase-1 and GSDMD. Results:Compared with group C, the cell survival rate was significantly decreased, the cell pyroptosis rate and concentrations of IL-1β, IL-6, IL-18 and TNF-α in the supernatant were increased, and the expression of ZBP1, RIPK1, caspase-1 and GSDMD was up-regulated in group LPS-ATP ( P<0.05). Compared with group LPS-ATP, no significant change was found in the parameters mentioned above in group LPS-ATP+ scRNA and group LPS-ATP+ DSMO ( P>0.05). Compared with group LPS-ATP+ scRNA, the cell survival rate was significantly increased, the cell pyroptosis rate and concentrations of IL-1β, IL-6, IL-18 and TNF-α in the supernatant were decreased, and the expression of ZBP1, RIPK1, caspase-1 and GSDMD was down-regulated in group LPS-ATP+ siRNA ( P<0.05). Compared with group LPS-ATP+ DMSO, the cell survival rate was significantly increased, the cell pyroptosis rate and concentrations of IL-1β, IL-6, IL-18 and TNF-α in the supernatant were decreased, the expression of ZBP1, caspase-1 and GSDMD was down-regulated ( P<0.05), and no significant change was found in the expression of ZBP1 in group LPS-ATP+ nec-1 ( P>0.05). Conclusions:Activation of ZBP1/RIPK1 signaling pathway is involved in LPS-ATP-induced pyroptosis in macrophages of mice.

Objective:To evaluate the association between N-acylsphingosine amide hydrolase 1 (ASAH1) and pyroptosis during acute lung injury (ALI) in septic mice.Methods:Forty SPF-grade healthy male C57BL/6 mice, aged 6-8 weeks, weighing 18-23 g, were divided into 4 groups ( n=10 each) by a random number table method: sham operation group (Sham group), ALI group, HCFU solvent+ ALI group (HA group) and ASAH1 inhibitor HCFU+ ALI group (AA group). The abdominal cavity was only opened in Sham group, and cecal ligation puncture was performed in ALI, HA and AA groups. HCFU solvent 0.2 ml was intraperitoneally injected at 2 h before operation in HA group, and HCFU 10 mg/kg was intraperitoneally injected at 2 h before operation in AA group. The mice were sacrificed at 24 h under deep anesthesia, the eyeballs were removed to collect the blood, the bronchoalveolar lavage fluid (BALF) was collected, and lung tissues and blood samples were collected for microscopic examination of the pathological changes (using HE staining) which were scored and for determination of concentrations of protein in BALF (by BCA method), concentrations of interleukin-1beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) in BALF (by enzyme-linked immunosorbent assay), and expression of NOD-like receptor thermoprotein structural domain-related protein 3 (NLRP3) in lung tissues (by Western blot), gasdermin D protein (GSDMD), ASAH1 and cysteine protease-1 (caspase-1) (by Western blot). The wet/dry lung weight (W/D) ratio was calculated. Results:Compared with Sham group, the lung injury score, W/D ratio and concentrations of protein in BALF, IL-1β, IL-6 and TNF-α in serum were significantly increased, and the expression of NLRP3, GSDMD and caspase-1 in lung tissues was up-regulated in ALI, HA and AA groups, and the expression of ASAH1 was significantly up-regulated in ALI and HA groups ( P<0.05). Compared with ALI and HA groups, the lung injury score, W/D ratio, and concentrations of protein in BALF, IL-1β, IL-6 and TNF-α in serum were significantly increased, the expression of NLRP3, GSDMD and caspase-1 in lung tissues was up-regulated, and the expression of ASAH1 was down-regulated in AA group ( P<0.05 or 0.01). Conclusions:ASAH1 is involved in the endogenous protective mechanism underlying ALI in septic mice, which may be related to the inhibition of cell pyroptosis.

Objective:To explore the job responsibilities, core competencies, and training certification of information nurses in China.Methods:This study is qualitative research. From January to March 2022, purposive sampling was used to select five information nurses and 9 nursing informatics experts from Zhejiang, Jiangsu, Henan, Fujian, and Taiwan in China for semi-structured in-depth interviews. The Colaizzi analysis method was used to analyze data.Results:After interviews, five themes were identified, namely the job responsibilities of information nurses, the need for information nurses to possess multiple core competencies, the need for unified qualification admission for information nurses, the need for systematic and standardized training methods for information nurses, and the need for qualification certification for information nurses.Conclusions:Nursing managers should focus on cultivating the core competencies of information nurses, including professional knowledge and skills, critical thinking, communication and collaboration abilities, specialized expansion abilities, and nursing management abilities, aiming to improve the professional level of information nurses, which is of great significance for the development of nursing informatics.

Objective:To evaluate the relationship between preoperative malnutrition and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.Methods:The elderly patients who underwent elective thoracoscopic and laparoscopic radical esophagectomy in the Affiliated Hospital of Jiangnan University were enrolled.The general clinical data and nutritional status, Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, tumor pathological stage and operation-related variables based on the Gobal Leader Initiative on Malnutrition criteria were recorded.The patients were divided into 2 groups according to whether PPCs occurred during hospitalization, and the differences between the variables were compared.Logistic regression analysis was used to identify the risk factors for PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.The accuracy of the ARISCAT score and ARISCAT score combined with malnutrition in predicting the occurrence of PPCs was evaluated by receiver operating characteristic curve.Results:A total of 256 elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy were included, and the incidence of PPCs was 23.8%.There were no significant differences between patients with and without PPCs in FEV 1/FVC, age, American Society of Anesthesiologists physical status, chronic obstructive pulmonary disease ratio, malnutrition ratio and ratio of patients with high ARISCAT score ( P<0.05). The results of logistic regression analysis showed that increasing age, chronic obstructive pulmonary disease, malnutrition and high ARISCAT score were independent risk factors for PPCs.The area under the receiver operating characteristic curve of ARISCAT score and malnutrition combined with ARISCAT score in predicting the occurrence of PPCs was 0.722 and 0.777, respectively, and the difference was statistically significant ( P<0.05). Conclusions:Preoperative malnutrition is an independent risk factor for the occurrence of PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy, which is helpful in improving the accuracy of ARISCAT score in predicting the occurrence of PPCs.

Objective:To establish autoverification rules for coagulation tests in multicenter cooperative units, in order to reduce workload for manual review of suspected results and shorten turnaround time (TAT) of test reports, while ensure the accuracy of results.Methods:A total of 14 394 blood samples were collected from fourteen hospitals during December 2019 to March 2020. These samples included: Rules Establishment Group 11 230 cases, including 1 182 cases for Delta check rules; Rules Validation Group 3 164 cases, including 487cases for Delta check; Clinical Application Trial Group 77 269 cases. Samples were analyzed for coagulation tests using Sysmex CS series automatic coagulation analyzers, and the clinical information, instrument parameters, test results, clinical diagnosis, medication history of anticoagulant and other relative results such as HCT, TG, TBIL, DBIL were summarized; on the basis of historical data, the 2.5 and 97.5 percentile of all data arranged from low to high were initially accumulated; on the basis of clinical suggestions, critical values and specific drug use as well as relative guidelines, autoverification rules and limits were established.The rules were then input into middleware, in which Stage I/Stage II validation was done. Positive coincidence, negative coincidence, false negative, false positive, autoverification pass rate, passing accuracy (coincidence of autoverification and manual verification) were calculated. Autoverification rules underwent trial application in coagulation results reports.Results:(1) The autoverification algorisms involve 33 rules regarding PT/INR, APTT, FBG, D-dimer, FDP,Delta check, reaction curve and sample abnormalities; (2)Autoverification Establishment Group showed autoverification pass rate was 68.42% (7 684/11 230), the false negative rate was 0%(0/11230), coincidence of autoverification and manual verification was 98.51%(11 063/11 230), in which positive coincidence and negative coincidence were respectively 30.09% (3 379/11 230) and 68.42%(7 684/11 230); Autoverification Validation Group showed autoverification pass rate was 60.37%(1 910/3 164), the false negative rate was 0%(0/11 230), coincidence of autoverification and manual verification was 97.79%(3 094/3 164), in which positive coincidence and negative coincidence were respectively 37.42%(1 184/3 164) and 60.37%(1 910/3 164); (3) Trialed implementation of these autoverification rules on 77 269 coagulation samples showed that the average TAT shortened by 8.5 min-83.1 min.Conclusions:This study established 33 autoverification rules in coagulation tests. Validation showedthese rules could ensure test quality while shortening TAT and lighten manual workload.

Objective To analyze changes in the percentages of circulating follicular helper T (Tfh) cells and Tfh subsets in patients with systemic lupus erythematosus (SLE) for better understanding their relationships with SLE , and to investigate effects of steroids on circulating Tfh cells .Methods Pe-ripheral blood mononuclear cells (PBMCs) from 27 patients with SLE (including 10 inactive patients and 17 active patients ) and 21 sex-and age-matched healthy donors were analyzed by flow cytometry to detect the percentage of CD4+CD45RA-CXCR5+Tfh-like cells.Disease activity and the concentration of anti-double-stranded DNA ( anti-dsDNA) antibody were evaluated by SLEDAI score ( SLE disease activity index ) and ELISA, respectively.PBMCs from healthy donors were treated with or without prednisone to evaluate its effects on circulating Tfh cells .Twelve patients with SLE were treated with high-dose steriods ( 200-500 mg/d, 2-3 d) and the percentages of circulating Tfh cells and Tfh subsets in them were analyzed before and after treatment .Results No significant difference in the percentage of circulating Tfh cells was ob-served between patients with SLE and healthy donors (P>0.05), but the percentage of Tfh17 cells in pa-tients with SLE was significantly higher than that in healthy donors (P<0.05).Compared with patients with inactive SLE and healthy donors , patients with active SLE had a lower percentage of Tfh 1 cells (P<0.05).Moreover, the percentage of Tfh1 cells was negatively correlated with SLEDAI score (r=-0.44, P<0.05). The percentage of Tfh2 cells in anti-dsDNA antibody-positive group was significantly higher than that in anti-dsDNA antibody-negative group (P<0.05).In vitro treatment of PBMCs from healthy donors with predni-sone could significantly down-regulate the percentage of circulating Tfh (P<0.01), Tfh1 (P<0.05) and Tfh2 cells (P<0.01), and up-regulate the percentage of Tfh17 cells (P<0.01).In vivo treatment of pa-tients with SLE with steriods could significantly down-regulate the percentage of circulating Tfh (P<0.01), Tfh1 (P<0.05) and Tfh2 cells (P<0.01) and up-regulate the percentage of Tfh17 cells (P<0.01).Con-clusion Abnormal distribution of Tfh subsets is correlated with SLE disease activity and anti -dsDNA anti-body .Steroids in the treatment of SLE could affect the percentage of circulating Tfh cells and the distribution of Tfh subsets .

Objective To evaluate the role of combined detections of routine blood test,serum iron and hemoglobin electrophoresis in screening thalassemia in non-high incidence area.Methods Peripheral blood and serum samples of 1 000 outpatients from the department of hematology and the department of gynecology and obstetrics were obtained.Common mutations of thalassemia were detected by using GAP-PCR and reverse dot blotting,and Sanger sequencing was performed to discover rare mutations of ct-and β-thalassemia.Routine blood test,serum iron and hemoglobin electrophoresis were also performed for every patient.Results Among 1 000 samples,225 (22.5％) are detected as α-thalassemia,403 (40.3％) β-thalassemia and 15 (1.5％) composite thalassemia.Among 225 α-thalassemia patients,28 were silent,138 were intermedia,and 59 were HbH disease.Of 403 β-thalassemia,390 were carriers,7 were double heterozygote,and 6 were homozygote.In all samples,there were 357 patients detected with no common mutations,38 patients had higher result values for both MCV and MCH and none detected with thalassemia gene.There were 48 patients who had higher serum iron but normal or lower MCV,42 of them (87.5％) had thalassemia gene.Furthermore,38 patients showed abnormal hemoglobin electrophoresis,35 of them were HbH disease,while the other 3 were HbF-related thalassemia.Five patients showed abnormal hemoglobin electrophoresis,lower MCV and MCH,as well as higher serum iron,had no frequent mutation but rare ones.Conclusion Patients with higher MCV and MCH can mostly be excluded to have thalassemia,while higher serum iron represents thalassemia possibility and can provide a preliminary indication of thalassemia type,and last but not least abnormal hemoglobin electrophoresis indicates the disease.It is recommended to further carry out sequencing of rare mutations for those who had abnormal results in the combined screening,and detected with no frequent mutation.Combination of these three examinations can improve the detection efficiency of patients with thalassemia.