Objective To explore the correlation of nerve function and prognosis with serum uric acid(UA),homocysteine(Hcy)and low-density lipoprotein cholesterol(LDL-C)in patients with acute cerebral infarction(ACI)after alteplase intravenous thrombolysis.Methods A total of 220 ACI patients undergoing thrombolysis in Changsha First Hospital ICU between January 2020 and December 2022 were enrolled,and according to mRS score at 3 months after thrombolysis,they were divided into poor prognosis group(mRS score＞2,91 cases)and good prognosis group(mRS score ≤2,129 cases).The serum levels of UA,Hcy and LDL-C were compared between the two groups.The correlation between the three indexes and score of National Institutes of Health Stroke Scale(NIHSS),and their predictive value for poor prognosis were analyzed.Results At 1 and 3 d after thrombolysis,the serum levels of UA,Hcy and LDL-C and NIHSS score were sig-nificantly decreased in both groups,and the serum levels of UA and Hcy and NIHSS score at 3 d after thrombolysis were significantly lower than those at 1 d(P＜0.05).The poor prognosis group had obviously higher serum levels of UA,Hcy and LDL-C and NIHSS score at 1 and 3 d after thrombolysis than the good prognosis group(P＜0.05,P＜0.01).Pearson correlation analysis showed that the serum levels of UA,Hcy and LDL-C were positively correlated with NIHSS score at 1 and 3 d after thrombolysis(P＜0.01).ROC curve analysis indicated that the AUC values of UA,Hcy and LDL-C at 1 d after thrombolysis for predicting poor prognosis were 0.707(95％CI:0.639-0.776),0.800(95％CI:0.739-0.860)and 0.624(95％CI:0.550-0.698),respectively,while the values of them at 3 d after thrombolysis were 0.655(95％CI:0.583-0.726),0.730(95％CI:0.664-0.795)and 0.573(95％CI:0.497-0.649),respectively.Conclusion In ACI patients after thrombolysis,the serum levels of UA,Hcy and LDL-C are increased in those with poor prognosis,and are associated with the severity of nerve injury.The levels at 1 d after throm-bolysis have good predictive value for poor prognosis.

In compliance with the data requirements for monitoring medical service capacity and quality safety in the sec-ond part of the"Rules for the Implementation of Evaluation Standards for Tertiary General Hospitals in Hubei Province(2023 Edition)",this paper,in conjunction with the specific circumstances of a tertiary hospital,carried out a brief overview of the da-ta collection process and the challenges faced during the reevaluation of the tertiary hospital.By accurately addressing the prob-lems and challenges in medical services,this paper aimed to enhance medical quality management and advance the hospital's high-quality development.

Objective To explore the value of amplitude integrated electroencephalogram(aEEG)combined with electroencephalogram monitoring α percentage variation(PAV)in evaluating the short-term prognosis of patients with severe acute cerebral infarction(SACI).Methods A total of 212 SACI patients hospitalized in our ICU from January 2020 to December 2022 were recruited and then divided into poor prognosis group(93 cases)and good prognosis group(119 cases)ac-cording to the mRS score at 90 d.The differences in aEEG and PAV were observed between the two groups.Multivariate logistic regression analysis was used to observe the relationship of aEEG and PAV with poor prognosis.ROC curve was plotted to analyze the clinical value of aEEG and PAV in predicting the prognosis of SACI patients.Results The incidence of poor prognosis was 43.9％in 212 patients at the 90th day.The patients from the poor prognosis group had significantly higher aEEG score but lower PAV than those in the good prognosis group(P＜0.01).Multivari-ate logistic regression analysis showed that aEEG was a risk factor for poor prognosis(OR=1.403,95％CI:1.114-3.287,P=0.011),and PAV was a protective factor for poor prognosis(OR=0.714,95％CI:0.591-0.837,P=0.006).ROC curve results revealed that PAV had a high-er sensitivity,specificity and AUC value than aEEG in predicting poor prognosis of SACI pa-tients,and their combination obtained better sensitivity,specificity and AUC value than aEEG or PAV alone in the prediction(P＜0.01).Conclusion The combined use of aEEG and PAV has high clinical value in predicting the prognosis of SACI patients.

Objective:To retrieve and summarize the evidence of exercise guidance programs for patients with gynecological malignant tumors and lower extremity lymphedema, so as to provide a reference for medical and nursing staff to formulate and standardize the treatment and management of lower extremity lymphedema.Methods:This study used the population, intervention, professional, outcome, setting, type of evidence (PIPOST) tool to clarify evidence-based issues and set retrieval strategies, and include and exclude criteria. Guidelines, expert consensus, systematic reviews, original studies and other evidence related to gynecological malignant tumor-related lower extremity lymphedema exercises were systematically searched in common databases at home and abroad. The search time limit was from the establishment of the database to March 31, 2021. The quality evaluation of the articles was independently completed by two researchers systematically trained in evidence-based nursing.Results:A total of 16 articles were included, including 5 systematic reviews, 4 guidelines, 4 original studies, and 3 expert consensus. A total of 24 pieces of evidence were summarized from six aspects, namely, taboo population, exercise evaluation, exercise plan, exercise intensity, precautions and health education.Conclusions:The best evidence of exercise programs for patients with gynecological malignant tumor-related lower extremity lymphedema is collected and analyzed, and specific recommendations are put forward. Reliable evidence-based evidence and reference opinions are provided to standardize the use and practice of exercise programs for patients with gynecological malignant tumor-related lower limb lymphedema, so as to reduce the degree of lymphedema in patients and improve their quality of life.

【Objective】 To reveal possible mechanisms of miRNA in diabetic hepatopathy through bioinformatics method. 【Methods】 Subset data of miRNA and their matched mRNAs in the liver of STZ-induced diabetic mice and the normal liver tissues of congenial mice by detecting on microarrays were collected from GEO database； information from the database and bioinformatics analysis were applied to mine a batch of miRNAs in diabetic hepatopathy and targeted mRNAs regulated. Then qRT-PCR was used to verify the expressions of miRNAs in diabetic liver from 20 STZ-treated Kunming mice and 10 normal homologous mice. 【Results】 Via detection and analysis， miRNAs differentially expressed （including 96 up-regulated and 77 down-regulated） were significantly obtained. Groups of miRNAs and their effectors （mRNAs） that may be related to the pathological process of diabetic liver disease in mice were screened by GO and KEGG enrichment analyses， combined with relevant protein annotations in the databases and references. The expressions of miR-200a-3p， miR-200b-3p and miR-222-3p in the mice’s liver tissue detected by qRT-PCR were significantly down-regulated. In addition， the expressions of related effector genes CERS6， MYBL1， SCD2， SLCO1A4 and PLK2 were up-regulated， while the expressions of ACSS2， BCL6 and SLC10A2 were down-regulated. 【Conclusion】 The variation trend of those candidate miRNAs in mouse diabetic liver compared with that in control livers was consistent with that of the previous studies and prediction， which revealed their potential molecular regulation in this disease process.

Objective:To study and analyse the results of postoperative hemorrhage after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of patients who underwent LPD from May 2011 to December 2019 at Hunan Provincial People's Hospital were retrospectively analyzed. The clinical characteristics of patients, onset time of postoperative hemorrhage, location of postoperative hemorrhage, postoperative biliary fistula, pancreatic fistula, infection and other short-term complications, reoperation and mortality rates were analyzed.Results:Of 356 patients who underwent LPD in this study, there were 200 males and 156 females, aged (58.0±10.5) years. The postoperative complication rate was 33.1% (118/356), the reoperation rate was 6.5% (23/356), and the mortality rate was 2.5% (9/356). The most common complications were postoperative hemorrhage [15.2% (54/356)], pancreatic fistula [14.6%(52/356)] and abdominal infection [13.8%(49/356)]. The onset time of postoperative hemorrhage was usually in the 1st - 14th day, and the highest rate of postoperative hemorrhage was 3.9% (14/356) on the first day after surgery. The postoperative hemorrhage rate then showed a downward trend, but increased again on the 7th day. The extraluminal hemorrhage locations were relatively widely distributed, and the incidence of gastrointestinal anastomotic hemorrhage in patients with intraluminal hemorrhage was the highest [67.9%(19/28)]. Of the 9 patients who died, 7 were related to postoperative bleeding.Conclusions:LPD resulted in a high incidence of complications. Postoperative hemorrhage was a complication that had the greatest impact on short-term recovery of patients. It was also an important cause of reoperation and death. In addition to postoperative bleeding caused by pancreatic fistula, gastrointestinal anastomotic bleeding was also clinically important.

OBJECTIVETo investigate the efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT）in the treatment of patients with Ⅲ,Ⅳ non-Hodgkin lymphoma（NHL）, and compared the efficacy between Cy- fractionated to talbody irradiation（fTBI）based conditioning regimen and Maryland, horse flange and mitoxantrone（BMM）.

METHODSThe clinical data of 47 patients with Ⅲ, Ⅳ NHL after allo- HSCT from November 1998 to May 2014 were collected and retrospectively analyzed. To observe the hematopoietic reconstruction recovery after transplantation, cumulative incidence of acute graft- versus- host- disease （aGVHD） and chronic graft- versus- host- disease （cGVHD）, transplantation related mortality （TRM）, recurrence rate （RR）, disease- free survival （DFS）, overall survival（OS）. Compare the efficacy of fTBI and BMM conditioning regimen at the same time.

RESULTSNeutrophils achieving 0.5×10⁹/L and platelets achieving 50×10⁹/L on day 17 （range, 10- 72） post transplantation. Acute GVHD occurred in 53.19%, among them, grade Ⅰ-Ⅱ occurred in 42.55%, grade Ⅲ-Ⅳ occurred in 10.65%, and cGVHD occurred in 21.28%. 21 patients were alive with a median follow up of 9.7 months（0.2-149.1 months）. Overall survival（OS）was 73.5%, 49.3%, 40.1% respectively in the first, third and fifth year in Cy-fTBI group; in BMM group it was 67.8%, 32.9% and 31.4% respectively, and disease-free survival（DFS）was 65.3%, 45.6%, 30.2% respectively in the first, third and fifth year. In Cy-fTBI group, the recurrence rate（RR）and transplantation related mortality（TRM）in the first year were 18.9%, 23.0% respectively, the third year were 19.5%, 38.3% and the fifth year were 35.2%, 39.2%. In BMM group, RR and TRM in the first year were 27.4%, 24.5% respectively, the third year were 38.9%, 46.4% and the fifth year were 39.2%, 48.2%. However, there was no significant difference in the indicator of OS, DFS, RR, TRM in the two groups.

CONCLUSIONAllo-HSCT could make some Ⅲ,Ⅳ NHL patients achieve long-term disease- free survival, but the TRM was still high relatively. Moreover, compared with the program of BMM conditioning regimen, Cy-fTBI might reduce the TRM and RR, meanwhile, increase the DFS and OS. However, due to the small number cases of two groups, there was no statistical significant difference.

Disease-Free Survival ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Lymphoma, Non-Hodgkin ; therapy ; Neoplasm Recurrence, Local ; Retrospective Studies ; Transplantation Conditioning ; methods ; Transplantation, Homologous

BACKGROUNDSteady-state bone marrow (SS-BM) and granulocyte colony-stimulating growth factor-primed BM/peripheral blood stem-cell (G-BM/G-PBSC) are the main stem-cell sources used in allogeneic hematopoietic stem-cell transplantation. Here, we evaluated the treatment effects of SS-BM and G-BM/G-PBSC in human leucocyte antigen (HLA)-identical sibling transplantation.

METHODSA total of 226 patients (acute myelogenous leukemia-complete remission 1, chronic myelogenous leukemia-chronic phase 1) received SS-BM, G-BM, or G-PBSC from an HLA-identical sibling. Clinical outcomes (graft-versus-host disease [GVHD], overall survival, transplant-related mortality [TRM], and leukemia-free survival [LFS]) were analyzed.

RESULTSWhen compared to SS-BM, G-BM gave faster recovery time to neutrophil or platelet (P < 0.05). Incidence of grade III-IV acute GVHD and extensive chronic GVHD (cGVHD) was lower than seen with SS-BM (P < 0.05) and similar to G-PBSC. Although the incidence of cGVHD in the G-BM group was similar to SS-BM, both were lower than G-PBSC (P < 0.05). G-BM and G-PBSC exhibited similar survival, LFS, and TRM, but were significantly different from SS-BM (P < 0.05). There were no significant differences in leukemia relapse rates among the groups (P > 0.05).

CONCLUSIONSG-CSF-primed bone marrow shared the advantages of G-PBSC and SS-BM. We conclude that G-BM is an excellent stem-cell source that may be preferable to G-PBSC or SS-BM in patients receiving HLA-identical sibling hematopoietic stem-cell transplantation.

Adolescent ; Adult ; Aged ; Bone Marrow ; drug effects ; Bone Marrow Transplantation ; methods ; Child ; Female ; Granulocyte Colony-Stimulating Factor ; pharmacology ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; therapy ; Leukemia, Myeloid, Acute ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stem Cells ; cytology ; Young Adult

Objective To investigate the value of pathological examination in the diag-nosis of lethal cases due to acute poisoning.Methods The macroscopic and microscopic find-ings in 28 autopsy cases (10 cases of toxic gas,7 cases of pesticide,6 cases of drug,3 cases of alcohol and 2 cases of chinese herbal medicine) died of acute poisoning during the period from October,2001 to June,2012 were retrospectively reviewed.Results Gross Changes were found on gross examination in 22 of the 28 cases studied.Of them,7 cases died of acute carbon mono-xide poisoning had showed cherry red of Shiban,muscle,visceral organs and blood.In addition,11 and 8 cases had been found gastric mucosa hemorrhage and epicardium petechial hemorrhage respectively.Histologically,myocardial interstitial hemorrhage was observed in 9 cases,pulmonary hemorrhage in 18 cases,bronchospasm in 12 cases,cerebral hemorrhage in 4 cases,hepato-cyte necrosis in 11 cases,renal tubular necrosis in 7 cases and gastric mucosa hemorrhage in 11 cases.In 6 cases of oral pesticides poisoning,besides they had all gastric mucosa hemorrhage,the change of character of gastric contents was found in 3 cases and pesticide odor from stomach in 3 cases.In addition,acute inflammatory and necrosis of gastric wall in 6 cases of oral pesticides poisoning were observed under the light microscope.Drug addicts often suffered from chronic lesions in multiple organs,such as chronic liver disease,fatty infiltration of the myocardium with myocardial atrophy,interstitial lung disease and pulmonary foreign body granuloma.Conclusions Pathology examination is helpful in the diagnosis of some lethal cases due to acute ooisoning,and it can provide pathological basis to study on treatment of acute poisoning.

Objective To compare clinicopathological characteristics of coronary artery disease (CAD) patients with or without sudden coronary death(SCD).Methods A total of 145 autopsy cases with CAD were divided into SCD group(38 cases)and non-SCD group (107 cases).The difference on age,number of diseased coronary vessel,coronary athemsclerotic stage (fatty streak stage,fibrous plaque stage and atheromatous plaque stage),composite lesions of coronary artery,grade of stenosis severity,acute myocardial infarction,old myocardial infarction,hypertensive cardiomyopathy,myocardial fatty infiltration and arteriosclerosis of the arteries on the base of the brain were compared between SCD group and non-SCD group.Results (1) Patients were older in SCD group than in non-SCD group [(55.3 ± 14.5) years vs.(48.5 ± 13.3) years,P ＜ 0.01].(2) There was a significant positive correlation between coronary atherosclerotic stage and grade of coronary stenosis severity (rs =0.79,P ＜ 0.01).(3) The rate of multiple vessel disease,coronary atherosclerotic stage,composite lesions of coronary artery,grade Ⅲ-Ⅳ coronary artery stenosis,old myocardial infarction and arteriosclerosis of the arteries on the base of the brain were 60.5％ (23/38),84.2％ (32/38),63.2％ (24/38),86.8％ (33/38),36.8％ (14/38) and 34.2％ (13/ 38),respectively in SCD group,which were significantly higher than those in non-SCD group [25.2％ (27/ 107),29.0％ (31/107),18.7％ (20/107),19.6％ (21/107),3.7％ (4/107) and 6.5％ (7/107),respectively,all P ＜ 0.01].Conclusion Coronary artery atherosclerotic lesion is severer and patients are older in SCD patients than in non-SCD patients in this coronary artery disease patient cohort.