OBJECTIVE To study the effects of enteral immune microecological nutrition combined with ω-3 fish oil fat emulsion on postoperative recovery， immune function， liver function and inflammation level in patients with hepatocellular carcinoma resection， as well as the safety of the medication. METHODS A total of 106 patients with hepatocellular carcinoma admitted to our Hospital from June 2020 to December 2023 were selected and divided into control group and study group according to the random number table method， with 53 cases in each group. After undergoing hepatocellular carcinoma resection， control group was given Intacted protein enteral nutrition solution+Enhanced enteral immune microecological nutrition， and the study group was given ω-3 fish oil fat emulsion injection based on the control group. The clinical indicators （postoperative exhaust time， defecation time， postoperative ambulation， and hospital stay）， liver function indicators [alanine transaminase （ALT）， lactate dehydrogenase （LDH）， aspartate transaminase （AST）]， immune function indexes （CD3+ ， CD4+ ， CD8+ ， CD4+/CD8+）， inflammatory factor indexes [tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， IL-6， IL-8]， and indicators of intestinal mucosal barrier [D-lactic acid， intestinal fatty acid binding protein （I-FABP）] were compared between 2 groups， and the occurrence of ADR was recorded. RESULTS Compared with the control group， the postoperative exhaust time， postoperative defecation time， and hospital stay of the study group were shortened significantly， and postoperative ambulation increased significantly （P＜0.05）. After treatment， ALT， LDH， AST， CD8+， inflammatory factors， D-lactic acid and I-FABP of 2 groups were significantly lower than before treatment， and the study group was significantly lower than the control group （P＜0.05）； CD4+， CD3+， and CD4+/CD8+ of two groups were significantly higher than before treatment， and the study group was significantly higher than the control group （P＜0.05）. There was no significant difference in the incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS Enteral immune microecological nutrition combined with ω-3 fish oil fat emulsion injection can shorten the recovery time of patients after hepatocellular carcinoma resection， improve immune function， reduce inflammatory response， and improve liver function with good safety.

Unplanned readmission is one of the adverse outcomes of patients after left ventricular assist device implantation,which seriously affects the prognosis of patients.This article reviews the incidence,causes,influencing factors and intervention measures of unplanned readmission of patients after left ventricular assist device implantation,in order to improve the attention of nursing staff,early identify high-risk groups of unplanned readmission of patients after left ventricular assist device implantation and provide references for formulating personalized intervention measures.

ObjectiveTo investigate the effect of anodal transcranial direct current stimulation (atDCS) combined with contralaterally controlled functional electrical stimulation (CCFES) on upper limb motor function of stroke patients. MethodsFrom January to December, 2022, 60 stroke patients from Zhejiang Provincial People's Hospital were randomly divided into atDCS group (n = 20), CCFES group (n = 20) and combined group (n = 20). All the groups accepted routine rehabilitation, while atDCS group accepted atDCS on the primary motor (M1) area of the damaged hemisphere, CCFES group accepted CCFES on the triceps brachii and extensors carpi muscles, and the combined group accepted atDCS on the M1 area of damaged hemisphere and CCFES on triceps brachii and extensors carpi muscles, for six weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), and the electromyography root mean square (RMS) ratio of bilateral triceps brachii muscles and extensor carpi muscles, before and after treatment. ResultsThe FMA-UE score, WMFT score, and the RMS ratio of the triceps brachii muscles and extensor carpi muscles improved in all the groups after treatment (|t| > 5.007, P < 0.001), and improved the most in the combined group (F > 14.492, P < 0.001). ConclusionatDCS combined with CCFES can effectively improve upper limb motor function of stroke patients.

Eubhorbia neriifolia L. is a plant of Euphorbia family.Five known lignans were isolated from the aerial parts of E. neriifolia L. by silica gel for column chromatography and preparative high-performance liquid chromatography (HPLC).Their potential antitumor activities were evaluated in vitro.Compound 2 exhibited proliferation inhibition and cytotoxicity against esophageal squamous cancer cells, especially KYSE-410 and KYSE-450 cells.Further analyses showed that compound 2 could significantly induce apoptosis through the activation of caspase 3/9 and down-regulation of the Bcl-2/Bax protein ratio.These results suggested that compound 2 had a significant inhibitory effect on the esophageal squamous cancer cells, especially KYSE-410, which deserves further research as a potential antitumor agent.

Objective:To analyze the efficacy and safety of Daratumumab for the treatment of primary AL light chain systemic amyloidosis.Methods:Twenty one patients who were diagnosed as primary AL light chain systemic amyloidosis and treated with Daratumumab from 7 centers were retrospectively analyzed. Daratumumab was administrated as first line therapy in seven patients and 14 patients with relapsed settings. Hematological response, safety and survival were analyzed.Results:All 7 patients achieved very good partial response (VGPR) or better with first-line application of daratumumab. Three patients died, and the other four achieved organ remission. Among 14 relapsed patients, 2 patients had a difference of free light chain (dFLC) less than 20 mg/L before treatment, and 9 with a dFLC of more than 50 mg/L. All patients reached partial response (PR) or better, including 4 patients with complete response (CR), 3 with VGPR and 2 with PR. The response rate was 100% in 3 patients with dFLC 20-50 mg/L at baseline. The organ remission rate was 50% in patients with heart involvement and 58.3% in patients with kidney impairment. The overall median follow-up period was 5.3 months, and 11 months in surviving patients. One patient died of severe infection and disseminated intravascular coagulation (DIC) with stable amyloidosis. One patient switched to other regimens because dFLC elevated but did not fulfill progressive disease after 2 year application. As to safety, no grade 3/4 infusion reaction developed, and grade 1 infusion reaction occurred in 3 cases during the first infusion. Lymphocytopenia was seen in 75% patients including grade 3 or more in 30% patients.Conclusion:Daratumumab is effective to eliminate serum free light chain in both newly diagnosed and relapsed patients with systemic amyloidosis.

Objective:To build a medical service experience system based on role play of hospital staff, and explore its contribution to upgrading medical service, elevating medical service quality, and improving patients′ satisfaction.Methods:An indicator system for medical service experience was developed via literature review. 20 newly recruited hospital employees in 2019 were sampled randomly to form a service experience team, who were arranged to experience the full medical service process of outpatients and inpatients based on role play. The questionnaire for service quality based on patient perception and expectation was used to survey the expectation and perception values of those role players on their medical service experiences, and summarize the defects found on such six dimensions as hospital reliability, responsiveness, tangibility, assurance, empathy and cost-effectiveness. After due corrections of these defects, further experiences and patient satisfaction survey were made to assess the effects of such actions taken. Paired t test was used respectively in statistical analysis of service experience value and actual perception value, as well as the perception values before and after the actions taken, and χ2 test was used for a statistical analysis of patient satisfaction. Results:Role players experienced respectively at the emergency, outpatient and inpatient departments of the hospital for a week in August 2019. Statistics of their experiences indicated≥0.50 points difference between the mean expectation and perception values on doctor-patient communication, patient help responsiveness, outpatient process, examination report delivery duration, service attitude, patient trust on medical workers, medical environment and patient privacy protection.Following a 3-month reform, role players found improvements in such aspects as hospital reliability, responsiveness, tangibility, assurance, empathy and cost-effectiveness; patient satisfaction improved sizably in December 2019 over January of the same year( P<0.05). Conclusions:The construction and application of the medical service experience system based on role play of hospital staff prove highly useful in upgrading medical service actions, improving medical service quality, and improving patient satisfaction.

OBJECTIVE: To systematically evaluate the efficacy difference between warming acupuncture and other acupuncture methods in the treatment of primary obesity. METHODS: A computer-based retrieval was conducted at PubMed, EMBASE, CENTRAL, CINAHL, Alt HealthWatch, CNKI, CBM, WANFANG database and VIP database. Retrieval time was from the establishment date of database to October 4, 2017. Randomized controlled trial (RCT) of warming acupuncture comparing with other acupuncture methods for the treatment of primary obesity were included. The relative risk () and weighted mean difference ( ) were used as combined effects for categorical variables and continuous variables, respectively. RESULTS: Totally 13 RCTs were included involving 878 patients. The Meta-analysis indicated compared with other acupuncture methods, warming acupuncture could more reduce weight (: -1.49 kg, 95% : -2.53 to -0.45, =0.005), improve the total effective rate (=1.16, 95% : 1.09 to 1.24, <0.000 01), reduce BMI (: -1.24 kg/m, 95% : -2.34 to -0.14, =0.03), reduce waist circumference (: -1.65 cm, 95% : -2.53 to -0.76, =0.02) and reduce hip circumference (: -2.86 cm, 95% : -4.37 to -1.35, =0.000 2), but had no significant influence on total cholesterol (: -0.05 mmol/L, 95% :-0.98 to 0.88, =0.91). CONCLUSION The warming acupuncture has better efficacy on primary obesity than other acupuncture methods, but less effects on lipid indicators.
Acupuncture Therapy ; Databases, Factual ; Humans ; Lipids ; Obesity ; therapy ; Randomized Controlled Trials as Topic

Objective To investigate the examination of tumor cells in pleural effusion by body fluid mod-el of Sysmex XN-9000 automated hematology analyzer ,and set the cutoff value of HF-BF# and HB-FB%for screen-ing tumor cells in pleural effusion. Methods One hundred and six pleural effusion specimens were detected by Sysmex XN-9000,and malignant samples were confirmed by TCT(Thinprep Cytology Test)and immunohistochem-istry method. Results Of 106 specimens,44 cases of HF-BF count were positive,and 12 samples were confirmed malignant by TCT and immunohistochemistry method. The cutoff value of HF-BF#(× 106/L)and HF-BF%/100WBC were 3.5 and 1.55 respectively. The detection sensitivity,specificity,positive predictive value,negative predictive value,accuracy of HF-BF# were 66.7%,40.1%,27.3%,91.7% and 63.2% respectively and those of HF-BF%were 83.3%,40.6%,27.3%,91.7%and 63.2%respectively. Conclusions HF-BF# and HF-BF%of body fluid model of Sysmex XN automated hematology analyzer are effective for screening tumor cell in pleural effusion ,and all the screening samples must be confirmed by pathology methods.

Objective To observe the characteristics offundus autofluorescence (FAF) in patients with polypoidal choroidal vasculopathy (PCV) before and after intravitreal ranibizumab injections.Methods A retrospective case series.Seventeen patients (17 eyes) including 11 males and 6 females were enrolled in this study.Best corrected visual acuity (BCVA),FAF and indocyanine green angiography examination were performed on all eyes.The eyes were divided into hypo-autofluorescence group (8 eyes) and mixed autofluorescence group (9 eyes) according to the fluorescence degree.There was no differences of BCVA between two groups (t=2.403,P=0.072).A11 eyes received monthly intravitreal ranibizumab injections for 3 months followed by an as-needed reinjection schedule.All eyes were followed up for 12 months.FAF was performed at the 3rd,6th and 12th month after first treatment.The changes of FAF characteristics and BCVA before and after treatment were observed.Results Before the treatment,the PCV lesions showed two distinct FAF patterns:the confluent hypo-autofluorescence at the polypoidal lesions and the granular hypo-autofluorescence at branching choroidal vascular networks (BVN).During the treatment,the abnormal FAF area of the whole lesions in all eyes reduced and gradually returned to normal.At the 3rd month after treatment,the central hypo-autofluorescence of polyps was surrounded by a hyper-autofluorescence ring,and with time,the ring was weakened or eliminated.However,all the hypo-autofluorescence findings in BVN at baseline were unchanged during the follow-up period.There was no significant differences in BCVA between hypo-autofluorescence group and hyper-autofluorescence group at different follow-up times (t=2.674,2.862,2.250;P=0.058,0.052,0.081).At final follow-up,5 eyes (62.5％) in hypo-autofluorescence group and 3 eyes (33.3％)in hyper-autofluorescence group had increased BCVA,the different was not significant (P=0.347).Conclusions Before the treatment,there were the central hypo-autofluorescence of polyps and circumferential hypo-autofluorescence ring or confluent hypo-autofluorescence.After the treatment,the autofluorescence of polyps increased and then gradually returned to normal.

Objective: To investigate the efficacy and safety of IA regimen which contains idarubicin (IDA) 8 mg/m², 10 mg/m² or 12 mg/m² as induction chemotherapy for adult patients with de-novo acute myeloid leukemia (AML) . Methods: A total of 1 215 newly diagnosed adult AML patients, ranging from May 2011 to March 2015 in the First Affiliated Hospital of Soochow University and other 36 clinical blood centers in China were enrolled in the multicenter, single-blind, non-randomized, clinical controlled study. To compare the response rate of complete remission (CR) , adverse events between different dose idarubicin combined with cytarabine (100 mg/m²) as induction chemotherapy in newly diagnosed patients of adult AML. Results: Of 1 207 evaluable AML patients were assigned to this analysis of CR rate. The CR rates of IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 73.6% (215/292) , 84.1% (662/787) and 86.7% (111/128) , respectively (P<0.001) . After adjusted for age, blast ratio of bone marrow, FAB classification and risk stratification, the odds ratios (95% CI) of IDA 10 mg/m² group and IDA 12 mg/m² group were 0.49 (0.34-0.70) and 0.36 (0.18-0.71) , as compared with the IDA 8 mg/m² group (P<0.001, P=0.003) . In the intermediate and favorable groups, CR rates was 76.5% (163/213) , 86.9% (506/582) and 86.1% (68/79) in different doses of IDA (P=0.007) . Interestingly, IA regimen with IDA 10 mg/m² was the only beneficial factor affecting CR in this group after adjusted for age, blast ratio of bone marrow and FAB classification[OR=0.47 (95% CI 0.31-0.71) , P<0.001]. CR rates in adverse group was 50.0% (18/36) , 60.6% (43/71) and 81.8% (18/22) respectively (P=0.089) . However, the odds ratios (95% CI) of IDA 12 mg/m² when compared with the IDA 8 mg/m² was 0.22 (0.06-0.80) , after adjusted for age, blast ratio of bone marrow and FAB classification. The median time (days) of neutrophil count less than 0.5×10⁹/L in IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 14 (11-18) , 15 (11-20) and 18 (14-22) , respectively (P=0.012) and of platelet count lower than 20×10⁹/L were 14 (7-17) , 15 (11-20) and 17 (15-21) , respectively (P=0.001) . The incidences of lung infection in the three groups were 9.8%, 13.5% and 25.2%, respectively (P<0.001) . Conclusions For young adult patients (aged 18-60 years) with AML in China, intensifying induction therapy with idarubicin 10 mg/m² is clinically superior to IDA 8 mg/m² and IDA 12 mg/m² in favorable intermediate AML subgroup. However, idarubicin 12 mg/m² is more suitable to adverse AML subgroup.