Jasmonic acid (JA), a plant endogenously synthesized lipid hormone, plays an important role in response to stress. This manuscript summarized the biosynthesis and metabolism of JA and its related regulatory mechanisms, as well as the signal transduction of JA. The mechanism and regulatory network of JA in plant response to biotic and abiotic stresses were systematically reviewed, with the latest advances highlighted. In addition, this review summarized the signal crosstalk between JA and other hormones in regulating plant resistance to various stresses. Finally, the problems to be solved in the study of plant stress resistance mediated by JA were discussed, and the application of new molecular biological technologies in regulating JA signaling to enhance crop resistance was prospected, with the aim to facilitate future research and application of plant stress resistance.
Signal Transduction ; Cyclopentanes ; Oxylipins ; Plant Growth Regulators

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

Objective To explore the serum levels of VILIP-1 and Cav-1 in cases with severe craniocerebral injury undergoing decompression and their effects on the prognosis.Methods 108 patients with severe craniocerebral injury who were treated in our hospital from July 2019 to July 2022 were selected as the study group,and 120 healthy people who came to our hospital for physical examination were selected as the health group.All cases were followed up for 6 months,and were divided into good prognosis group(GOS=4-5 points,n=82)and poor prognosis group(GOS=1-3 points,n=26)according to GOS.The levels of serum VILIP-1 and Cav-1 were detected by ELISA.The diagnostic value of serum VILIP-1 and Cav-1 on the prognosis of patients was evaluated by the ROC curve.Multivariate logistic regression analysis was used to explore the prognostic factors of patients.Results The levels of serum VILIP-1 and Cav-1 in study group were higher than those in healthy group(P＜0.05).The levels of serum VILIP-1 and Cav-1 in case with poor prognosis were higher than those in cases with good prognosis(P＜0.05).The AUC(95％CI)of serum VILIP-1 and Cav-1 to predict the prognosis of patients was 0.848(0.797～0.899)and 0.817(0.766～0.868).The AUC(95％CI)of the combined detection was 0.905(0.854～0.956).The time from injury to admission,admission GCS score,history of diabetes,admission pupillary reaction,preoperative brain midline displacement and postoperative complications in good prognosis group were different from those in poor prognosis group(P＜0.05).Preoperative midline displacement≥5 mm(OR=2.467,95％CI:1.619～3.760),postoperative complications≥ 2(OR=2.321,95％CI:1.544～3.489),VILIP-1≥10.37 ng/ml(OR=3.367,95％CI:2.087～5.432),and Cav-1≥32.28 μg/L(OR=2.770,95％CI:1.786～4.298)were risk factors for prognosis in patients(P＜0.05).Conclusion Serum VILIP-1 and Cav-1 can be used as biological indicators to predict the prognosis of patients with severe brain injury after decompression,and the increase of serum VILIP-1 and Cav-1 levels are risk factors for prognosis.

Objective:To study the expression level of programmed death ligand 1 (PD-L1) in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and its correlation with the clinical characteristics and prognosis.Methods:The clinical data of 75 patients with cHCC-CCA undergoing surgery in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2019, including 61 males and 14 females, with a median age of 55 years (36 to 77). Immunohistochemistry was conducted to determine the PD-L1 expression in tumor. The status of PD-L1 expression, clinicopathological data and prognosis of patients were analyzed.Results:In low-differentiated cHCC-CCA tissues, the proportion of PD-L1 expression (21.1%, 8/38) was higher than that in moderately to well-differentiated cHCC-CCA tissues (2.70%, 1/37, χ2=4.366, P=0.037). The median disease-free survival (DFS) and overall survival (OS)of PD-L1 positive patients were 12.3 and 15.1 months, respectively, lower than those of PD-L1 negative patients (14.4 and 23.3 months). The difference of DFS was statistically significant ( χ2=4.052, P=0.044). In multivariate analysis, major vascular invasion (DFS: HR=1.965, 95% CI: 1.119-3.450, P=0.019; OS: HR=1.781, 95% CI: 1.022-3.105, P=0.042) and lymph node metastasis (DFS: HR=2.451, 95% CI: 1.1033-5.814, P=0.042; OS: HR=2.652, 95% CI: 1.120-6.279, P=0.027) were identified as independent prognostic factors affecting DFS and OS. Conclusions:The proportion of PD-L1 positive is higher inthe low-differentiated cHCC-CCA tissue compared to that in moderately to well-differentiated cHCC-CCA. The major vascular invasion and lymph node metastasis are independent factors affecting the prognosis of patients with cHCC-CCA.

Objective:To understand the degree of professional autonomy of nurses in Pediatric Nursing Alliance and the status of pediatric nursing practice environment, which providing guidance for the development of a series of specialized training in the alliance.Methods:Stratified random sampling method was used to conduct a questionnaire survey on nursing staff of different professional levels in Pediatric Nursing Alliance, which through the questionnaire star by using the questionnaire general information and training demand questionnaire, nurses practice professional autonomy scale, pediatric nursing staff structural empowerment questionnaire and nursing practice influencing factors questionnaire through the questionnaire star.Results:The total score for professional autonomy of nurses in the pediatric alliance was 192.66±18.63, the structural empowerment ( OR=1.137, 95% CI=1.084-1.194), lack of caring team ( OR=2.763, 95% CI=1.443-5.292) and performance evaluation ( OR=0.498, 95% CI= 0.274-0.908), specialized education and professional experience ( OR=0.548, 95% CI= 0.334-0.871) were affecting the clinical nursing practice. Conclusion:The degree of professional autonomy of nurses in the Pediatric Nursing Alliance is in the middle and high level. Key factors affecting nursing practice including insufficient structural empowerment, lack of opportunities to continue learning, lack of nursing teams, lack of effectiveness evaluation and the lack of specialized education and work experience, which guiding the pediatric nursing alliance to continuously deepen the connotation of pediatric nursing professional and innovative team collaboration new model, utilize the advantages of resources to actively cultivate specialized nursing research personnel, carry out multi-disciplinary and cross-disciplinary cooperation, improve the nursing quality evaluation index system, so as to enhance the professional nursing service capacity and value.

Objective:To investigate the application of Folly urethral catheter in transvastatal resection of adhesion (TCRA) and its preventive effect on prevention of re-adhesion.Methods:A total of 78 patients with intrauterine adhesions admitted to the Department of gynecology and obstetrics of the Maternal and Child Health Care Hospital Affiliated to Anhui Medical University from March 2018 to March 2019 were selected as the study objects.The prospective study was conducted and divided into two groups according to the computer random number method.In the control group, 39 cases were treated by TCRA combined with intrauterine placement of contraceptive ring, while in the observation group, 39 cases were treated by hysteroscopic adhesion separation operation combined with Folly catheter placement.The curative effect, intrauterine adhesions, menstrual improvement score, recurrence and pregnancy were compared before and 6 months after operation.Results:The total effective rate of the observation group was 94.87% (37/39), and that of the control group was 79.49% (31/39), The difference between the two groups was statistically significant (χ 2=4.129, P<0.05). The score of intrauterine adhesions was (22.14±2.57) in the control group and (1.76±0.87) in the observation group, and (23.05±3.08), (1.81±0.60) in the observation group, there was no significant difference between the two groups( t=1.417, 0.295; all P>0.05). At 3 months after operation, the scores of intrauterine adhesions and menstrual states in the control group were (17.63±2.88) and (1.07±0.38), respectively, and those in the observation group were (14.27±3.52) and (0.53±0.21), the difference between the two groups was statistically significant( t=4.614, 7.767, all P<0.001). There were significant differences in the scores of intrauterine adhesions and menstrual state before and after operation in the observation group ( t=7.297, 4.539, all P<0.001). There were significant differences in the scores of intrauterine adhesions and menstrual states before and after operation in the observation group ( t=11.723, 12.575, all P<0.001). The recurrence rate was 23.08% (9/39) in the observation group and 46.15% (18/39) in the control group at 6 months after operation.The difference was statistically significant ( P=0.032). The pregnancy rate of the observation group was observed.12.82% (5/39), 7.69% (3/39) in the control group, the difference was not statistically significant( P=0.455). Conclusion:Hysteroscopic adhesion separation combined with Folly catheter placement for the treatment of intrauterine adhesions can significantly improve the short-term efficacy, prevent re-adhesion, and better regulate the menstrual cycle.

Objective: To observe the therapeutic effect of terlipressin on refractory ascites (RA) in cirrhosis, and its role and impact on acute kidney injury (AKI). Methods: A non-randomized controlled clinical trial data of 111 hospitalized cases of liver cirrhosis accompanied with RA was collected from Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhongshan Hospital of Hubei Province, The First Affiliated Hospital of Zhengzhou University, The First Affiliated Hospital of Medical School of Zhejiang University, and People's Hospital of Pudong New Area of Shanghai between March 2015 and March 2017. 26 cases of conventional treatment group (control group) were divided into two subgroups: RA without AKI (RA-NAKI) and RA with AKI (RA-AKI), and each subgroup consisted 13 cases. Patients with bacterial infection were treated with diuretics, albumin supplementation and antibiotics. 85 cases were presented in terlipressin combined treatment group, of which 27 cases were of RA-NAKI and 58 cases were of RA-AKI. Control group was injected terlipressin 1mg of intravenous drip or static push (once q6 h ~ 12 h) for more than 5 days. The treatment duration lasted for 2 weeks with 4 weeks of follow-up. Body weight, 24-hour urine volume, abdominal circumference, mean arterial pressure (MAP), liver and kidney function, anterior hepatic ascites, deepest point of ascites, and ultrasonographic detection of ascites in supine position before treatment, one and two weeks after treatment and 4 weeks after follow-up were compared. Count data were tested by χ ². Samples of four groups at baseline were compared. One-way analysis of variance was used for normal distribution data and Kruskal-Wallis H test for non-normal distribution data. Repeated measures analysis of variance was used to compare the difference in efficacy between different time points before and after treatment in the group. The LSD method of one-way ANOVA was used to compare the two groups. A t-test of independent samples was used to compare the efficacy of different time series between the two groups. Mann-Whitney rank- sum test was used to compare the data of non-normal distribution between the two groups. Results: (1) Baseline data were compared among 4 subgroups of terlipressin RA-NAKI and control RA-AKI. Control group age was higher than that of terlipressin group, and the serum creatinine (SCr) of the RA-AKI group was higher than RA-NAKI group, and there was no significant difference in the rest of the baseline data and the combined medication (P > 0.05). (2) An intra-group comparison between control and trelipressin before and after treatment showed that all patients had lower body mass, abdominal circumference and deepest ascites, and higher serum albumin (P < 0.05). 24-hour urine volume and MAP was significantly increased in the terlipressin group, while the pre-ascites, SCr and child Turcotte Pugh (CTP) scores were decreased. Body weight, abdominal circumference, pre-ascites, and deepest ascites of the terlipressin group were decreased, while MAP was increased during the treatment and follow-up periods. The differences were statistically significant when compared with the control group at the same time (P < 0.05). There was a statistically significant difference in the increase of 24-h urine volume in the terlipressin group compared with the control group (P < 0.05). The decrease in SCr and CTP in the terlipressin group after 2 weeks of treatment and 4 weeks of follow-up was statistically significant compared with the control group (P < 0.05). (3) Among the two subgroups of RA-AKI and RA-NAKI in the terlipressin group, the baseline SCr value of the former was higher than that of the latter. After treatment, the body weight, abdominal circumference, pre-ascites, deepest ascites and CTP scores were decreased. In the RA-AKI group, 24-hour urine volume, MAP, SCr and serum albumin concentration were significantly increased. The difference between the two subgroups before and after treatment was compared, and the body weight of RA-AKI group at 1, 2 weeks of treatment and 4 weeks of follow-up was significantly lower than RA-NAKI group, which were (- 2.3 ± 0.2 vs. - 1.5 ± 0.2) kg, (- 4.1 ± 0.2 vs. - 2.6 ± 0.2) kg, (- 4.2 ± 0.3 vs. - 2.4 ± 0.3) kg, respectively. RA-NAKI group urine volume was significantly increased at 2 weeks of treatment and 4 weeks of follow-up, which was (468 ± 42 vs. 110 ± 131) ml, (272 ± 34 ml vs. 11 ± 112) ml, respectively. SCr reduction (18.3 ± 4.7 vs. 0.9 ± 2.4) µmol/l at 4 weeks of follow-up was apparent in RA-NAKI group, and the difference was statistically significant (P < 0.05). Conclusion Addition of terlipressin to conventional treatment may significantly increase MAP, 24-h urine volume, improve renal function and promote ascites resolution in patients with refractory cirrhotic ascites. Moreover, its combination effect is more obvious in AKI patients, and adverse reactions are mild.

Seventy two patients with initial cerebral infarction admitted in the Second Hospital of Jiaxing from March 2017 to October 2017 were enrolled. Patients underwent conventional ultrasonography and contrast-enhanced ultrasonography for two-dimensional echo grading and neovascularization grading of carotid artery plaques respectively. There were 113 carotid plaques in 72 patients with cerebral infarction,27 cases recurred after 1 years with 44 patches. The echo grading of recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 23,18,and 3,respectively. The echo grading of non-recurrence group was mainly grade Ⅲ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 36,23,and 40,respectively. The echo grading of carotid artery plaque between the two groups was significantly different (P<0.05). The grade of carotid neovascularization in recurrence group was mainly grade Ⅲ and grade Ⅳ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 2,5,27 and 10,respectively. The echo grading of non-recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 24,52,14 and 9,respectively. There was significant difference in the grade of carotid neovascularization between the two groups (P<0.05). The area under curve(AUC) of echo grade<Ⅱ,echo grade<Ⅲ,neovascularization grade>Ⅰ,neovascularization grade>Ⅱ and neovascularization grade>Ⅲ in predicting the recurrence of cerebral infarction were 0.553,0.641,0.587,0.793 and 0.557,respectively,the AUC of neovascularization grade>Ⅱ was significantly higher than the other four criteria (P<0.01). The recurrence curves of carotid plaques with different neovascularization grades were significantly different (χ²=49.18,P<0.01). Carotid plaque vulnerability evaluated by contrast-enhanced ultrasonography is an effective indicator for predicting recurrence of cerebral infarction.

OBJECTIVE： To investigate the reasons for drug shortage in medical institutions of Sichuan province and put forward relevant countermeasures， and to provide reference for establishing supply security mechanism of drug shortage. METHODS： Questionnaire survey was conducted to investigate drug shortage in 78 medical institutions of the province during Jan. 2015-Jun. 2017. Traceability investigation was conducted from manufacturers and distribution enterprises involved in drug shortage. Questionnaire survey and field investigation were combined to analyze the reasons for drug shortage in Sichuan province and put forward countermeasures. RESULTS： Totally 78 questionnaires were sent out to medical institutions with recovery rate and effective rate of 100％. A total of 206 drugs were reported by 78 medical institutions， involving 240 specifications for shortage in total. Totally 140 questionnaires and 68 questionnaires were distributed to the manufacturers and distribution enterprises involved in drug shortage， and the recovery rate and effective rate were all 100％. Combined with the field survey， survey results of shortage drugs of 212 specifications were obtained. From the perspective of manufacturers， the most important factors causing drug shortage were the increase of production cost （66.51％） and circulation cost（26.88％）. From the perspective of distribution enterprises，the main factors causing drug shortage were insufficient supply of drugs（75.47％），inventory management（16.51％） and price inversion（11.32％）. CONCLUSIONS： Main reasons of drug shortage from manufacturers and distribution enterprises include the increase of production cost and circulation cost， drug price inversion， inventory management and bidding procurement. It is suggested that measures should be taken to improve the bidding and pricing system of drugs， mobilize the enthusiasm of enterprises； improve the early warning mechanism of drug shortage on the enterprises， strengthen information communication； establish the mechanism of drug shortage reserve， organize the emergency production of drug for shortage； strengthen the management of drug shortage supply chain， purify the unhealthy atmosphere in the market； improve the emergency disposal methods of drug shortage， and improve the supply guarantee ability of drug shortage. Departments cooperate to reduce the emergence of drug shortage and ensure the continuous access to safe and effective drugs in clinic.

OBJECTIVE： To investigate the situation and reasons of drug shortage in some medical institutions from Sichuan province. METHODS： A questionnaire survey was conducted among 78 medical institutions in Sichuan province by stratified random sampling. The situation of drug shortage were collected from Jan. 2015 to Jun. 2017， mainly including the basic information of medical institutions， drug shortage situation， specific drug shortage information and the reasons for drug shortage. Descriptive analysis of the information collected by the questionnaire was carried out， and Logistic regression analysis of the data by SPSS 20.0 software was adopted to find out the key factors affecting drug shortage. RESULTS & CONCLUSIONS： Totally 78 medical institutions include 13 third-level hospitals， 22 second-level hospitals and 43 primary medical institutions （10 community health service centers， 33 township health centers）. A total of 78 questionnaires were sent out， and the recovery rate and effective rate both were 100％. Among them， 68 medical institutions reported 206 shortage drugs totally， involving 240 specifications. The prices of more than 88.34％ of the shortage drug were less than 50 yuan. Main types of shortage drugs included anti-infective drugs， central nervous system drugs and cardiovascular system drugs， and most of them were purchased directly through internet. The proportion of temporary shortage （shortage time＜3 months） and long-term shortage （shortage time＞12 months） was relatively high （more than 68％ in total）. Drug supply and medical institutions’own factors were two main causes of drug shortage. Logistic regression analysis showed that main factors affecting the time of drug shortage were hospital drug purchase process， location of medical institution and drug purchase price. The main factors affecting the specifications of drug shortage in medical institutions were the process of drug purchase， the limitation of hospital purchase catalogue， primary or non-primary medical institution， comprehensive or specialized hospitals. It is suggested that medical institutions in this region can reduce the drug shortage caused by their own reasons by building a platform for drug information management， optimizing drug purchase catalogues and plans， strengthening the management of pharmacy inventory and establishing a regulatory system for distribution enterprises.