Rheumatoid arthritis (RA) is an autoimmune disease with a complex etiology. Monocyte-derived macrophages (MDMs) infiltration are associated with RA severity. We have reported the deletion of G-protein-coupled receptor kinase 2 (GRK2) reprograms macrophages toward an anti-inflammatory phenotype by recovering G-protein-coupled receptor signaling. However, as more GRK2-interacting proteins were discovered, the GRK2 interactome mechanisms in RA have been understudied. Thus, in the collagen-induced arthritis mouse model, we performed genetic GRK2 deletion using GRK2^f/fLyz2-Cre^+/- mice. Synovial inflammation and M1 polarization were improved in GRK2^f/fLyz2-Cre^+/- mice. Supporting experiments with RNA-seq and dual-luciferase reporter assays identified peroxisome proliferator-activated receptor γ (PPARγ) as a new GRK2-interacting protein. We further confirmed that fms-related tyrosine kinase 1 (Flt-1), which promoted macrophage migration to induce angiogenesis, was inhibited by GRK2-PPARγ signaling. Mechanistically, excess GRK2 membrane recruitment in CIA MDMs reduced the activation of PPARγ ligand-binding domain and enhanced Flt-1 transcription. Furthermore, the treatment of mice with GRK2 activity inhibitor resulted in significantly diminished CIA pathology, Flt-1⁺ macrophages induced-synovial inflammation, and angiogenesis. Altogether, we anticipate to facilitate the elucidation of previously unappreciated details of GRK2-specific intracellular signaling. Targeting GRK2 activity is a viable strategy to inhibit MDMs infiltration, affording a distinct way to control joint inflammation and angiogenesis of RA.

Postprandial hypotension is an abnormal regulation of blood pressure, which is common in the elderly. Due to insidious symptoms, postprandial hypotension is easily neglected by patients and medical staff in clinical practice, but it has a high degree of harm. There are many factors related to the occurrence of postprandial hypotension, including demographic factors, disease-related factors, lifestyle factors, postprandial postural factors and so on. Among demographic factors, age is positively associated with the occurrence of postprandial hypotension. Among disease-related factors, the existence of some basic diseases such as hypertension and diabetes, and the use of most kinds of anti-hypertensive drugs can increase the risk of postprandial hypotension. Among lifestyle factors, smoking is a risk factor for postprandial hypotension: while reducing the intake of staple foods, drinking large amounts of water or drinking green tea before meals may reduce the risk of postprandial hypotension. By taking different postures after meals, postural factors affect the rate of gastrointestinal emptying and then affect the occurrence of postprandial hypotension. Among the above factors, it is feasible to prevent postprandial hypotension by changing postprandial posture.

Objective:To investigate the effect of virtual-simulation laparoscopic training system in the training of basic skills of endoscopic surgery in trainees with different clinical experience.Method:s Eight refresher physicians, eight residents who received standardized residency training, and eight undergraduate interns in five-year clinical medicine were selected. All of them received the training of endoscopic operations with the laparoscopic training box and the virtual-simulation laparoscopic training system for 30 minutes every day for 4 weeks. Data analyses were performed using SPSS 19.0 and t-test was adopted to compare the scores before and after training among the three groups.Result:s Before training, there were significant differences in endoscopic operations between the undergraduate intern group and the other two groups ( P<0.05); after 4 weeks of training, all three groups had significant increases in the scores and spent less time on training items ( P<0.05). There was no significant difference in simple operations among the three groups ( P>0.05), and the undergraduate intern group had a significantly higher score of complex operations than did the standardized residency training group and the refresher physician group ( P<0.05). Conclusion:The virtual-simulation laparoscopic training system can improve the laparoscopic skills of clinical trainees at different levels, therefore, it is worth being promoted in the teaching of clinical skills.

Objective: To show development status of postprandial hypotension studies comprehensively and intuitively in order to provide a reference for nursing research on postprandial hypotension. Methods: The data was from the literatures included in Web of Science database from 1986 to 2019 related to postprandial hypotension, and CiteSpace information visualization software was used to analyze the issuing country and institution, cited authors, Cited journals, keywords and cited references to postprandial hypotension. Results: A total of 1 140 literatures were obtained. 187 papers were finally included after screening. University of Adelaide in Australia has the most of published articles and the most of cited authors; The cited journals mainly include international high-impact journals such as Annals of Internal Medicine and Journal of the American Geriatrics Society. Through keywords clustering, a total of 5 research hotspots were obtained, including falls, insulin, autonomic nervous system, aged cared, gastrointestinal. Conclusions Postprandial hypotension is one of the convergence points of interdisciplinary fusion. At present, preliminary results have been obtained, but the research on its mechanism is still in the exploratory stage. Falls, insulin, autonomic nervous system, aged cared, gastrointestinal are currently the main focus of postprandial hypotension researches. The prevention of postprandial hypotension has made some achievements, but there are also some risks. It is necessary to conduct further studies on more convenient and safe measures to prevent postprandial hypotension.

Objective To determine the triterpenoid content in Loquat leaf by using HPLC method and to explore the feasibility of ursolic acid and oleanolic acid as the quantitative markers for determination of Loquat leaf and its preparations.Methods Two desugaring methods of Loquat leaf extracts were compared.The contents of ursolic acid and oleanolic acid in Loquat leaf as well as preparations were measured based on a system of HPLC,with a Dumas Diamonsil C18 column (250 mm×4.6 mm,5 μm) was used as analytical column.The mobile phase was consisted of acetonitrile-0.1% phosphoric acid (95∶5) with the flow rate of 0.5 mL·min-1.The column temperature was 30 ℃,the injection volume was 10 μL, the detective wavelength was 210 nm.Results Ursolic acid and oleanolic acid were measured in both Loquat leaf and its preparations,and their contents were fairy stable and comparable.Conclusion Ursolic acid and oleanolic acid can be served as quantitative markers for the determination of Loquat leaf and its preparations.

Objective To explore the effect of nursing support on negative emotion and quality of life in patients with brain tumor. Methods A total of 139 cases of brain tumor in Shandong Provincial Cancer Hospital of Shandong University from September 2014 to February 2016 by convenient sampling , according to the random number table, they were divided into the control group and the intervention group. The patients in the control group were given routine discharge follow-up, while the patients in the intervention group were given emote team nursing support on the basis of the control group. We used anxiety self rating scale (SAS), depression self rating scale (SDS) and quality of life assessment scale (QLICP-BN) evaluation two groups of patients with anxiety, depression and quality of life level in the patients when they were discharged from hospital and discharged after 1 month, 3 months. Results Comparing the two groups of patients with anxiety and depression level and quality of life in the hospital, there was no statistically significant difference (t=0.187,0.174, P > 0.05);1 month after discharge, the scores of SAS and SDS respectively (62.97 ± 485), (63.83 ± 5.24) points in the intervention group, the scores of SAS and SDS respectively (64.58 ± 5.15), (65.17 ± 5.11) points in the control group, the difference is statistically significant (t=2.753, 2.321, P<0.05);3 month after discharge, the scores of SAS and SDS respectively(61.04±4.13),(62.25±3.95)points in the intervention group, the scores of SAS and SDS respectively(63.91 ± 4.73),(64.83 ± 4.29)points in the control group, the difference is statistically significant (t=4.621,5.196, P < 0.01); 1month, 3 months after discharge, the total quality of life scores respectively (65.28 ± 12.53), (68.71 ± 12.78) points in the intervention group, the total quality of life scores respectively (62.07 ± 11.27), (63.86 ± 12.13) points in the control group, the difference is statistically significant (t=2.439, 3.803, P < 0.01). The intervention effects and time effects of anxiety, depression and quality of life were statistically significant (W Mauchly's were 0.823, 0.782, 0.757, P <0.05). Conclusions Remote team nursing support can effectively reduce the negative emotions of patients with brain tumor, improve the quality of life, can be used in the department to promote the quality of clinical care.

OBJECTIVE:To explore the effects of dobutamine on hemodynamics,tissue perfusion and respiratory function in patients with ARDS caused by septic shock. METHODS:Totally 26 patients with ARDS caused by septic shock were given Dobu-tamine hydrochloride injection 5 μg/(kg·min) by continuous pump for 20 min ,increasing by 5 μg/(kg·min) every 20 min to 15μg/(kg·min)for 6 h. Mean artery pressure(MAP)maintained at about 65 mmHg during continuous pump. Hemodynamic index-es [HR,MAP,cardiac output(CO),stroke volume(SV),total end diastolic volume(GEDV),intrathoracic blood volume index (ITBI),extravascular lung water index (ELWI),systemic vascular resistance index (SVRI)],tissue perfusion indexes (norepi-nephrine,urine volume,blood oxygen saturation,blood lactate)and ventilator parameter indexes(positive breathing pressure,min-ute ventilation volume,respiratory rate,peak inspiratory pressure and plateau pressure)of all patients were recorded before medica-tion,6,24,48 h after medication. RESULTS:There were no statistical significances in HR,MAP,GEDV,ITBI,blood oxygen saturation,blood lactate and respiratory rate before and after treatment (P>0.05). CO,SV,urine volume and minute ventilation volume of all patients 6,24,48 h after medication were significantly higher than before medication,and those indexes increased gradually as medication time. ELWI,SVRI,positive breathing pressure,peak inspiratory pressure and plateau pressure of all pa-tients after medication were significantly lower than before medication,and those indexes decreased gradually as medication time, with statistical significance(P<0.05). The levels of norepinephrine in all patients 24,48 h after medication were significantly low-er than before medication and 6 h after medication,with statistical significance(P<0.05);but there was no statistical significance between before medication and 6 h after medication(P>0.05). CONCLUSIONS:The early application of dobutamine ELWI,tis-sue perfusion and respiratory function in patients with ARDS caused by septic shock,and can keep hemodynamics stable.

Objective To evaluate the value of transvaginal two-dimensional and three-dimensional ultrasound in diagnosis of cesarean scar pregnancy (incision area pregnancy ) after cesarean section .Methods Thirty cases of cesarean incision pregnancy at lower section of uterine anterior wall diagnosed by transvaginal two-dimensional ultrasound during 2015-2016 were retrospectively analyzed .On this basis ,all cases conducted transvaginal three-dimensional ultrasound and were verified by magnetic resonance(MR) examination .Then the values of transvaginal two-dimensional and three-dimensional ultrasound in diagnosis of incision area preg-nancy were analyzed .Results One case was diagnosed as the incision site and partial implantation of pregnant capsule by transvagi-nal two-dimensional ultrasound ,and then diagnosed as the complete implantation of pregnant capsule at incision site ,the other types were consistent to the diagnosis by the three-dimensional ultrasound .The MR examination results were consistent to the those by three-dimensional ultrasound .The diagnosis typing coincidence rate had no statistical difference among the three methods ( P>0 .05) .Conclusion Transvaginal three-dimensional can more intuitively display the lesion′s position ,range ,incision involvement sit-uation ,while transvaginal two-dimensional ultrasound has more plentiful diagnostic information .

Objective Metabolites produced by metabolic imbalance such as free fatty acids and lipopolysaccharides can result in a state of chronic low-grade inflammation, or metabolic inflammation, which plays an important role in the pathogenesis of atherosclerosis, type 2 diabetes, non-alcoholic fatty liver disease, and obesity. The above metabolic disorders are closely related with the metabolic inflammation, which always coexist. Therefore, we proposed the concept ofmetabolic inflammatory syndrome ( MIS). According to our study, patients with two or more metabolic disorders above could be diagnosed as MIS. The current research is aimed to investigate the prevalence of MIS and its components, and to compare the clinical values of MIS and metabolic syndrome ( MS) . Methods 2 001 in patients with type 2 diabetes from 6 hospitals in Shanghai were recruited in the current multi-center cross-sectional study. The diagnostic rates of MIS and MS and their components of both syndromes were compared. Results In the patients with type 2 diabetes, the detective rate of MIS was 96. 2%, which was higher than that of MS (71. 3%). Among 4 components of MIS, atherosclerosis showed the highest detective rate (75.6%). MIS[OR=2.252(95%CI1.026-4.942),P=0.043],atherosclerosis[OR=2.726(95% CI1.953-3. 804),P<0. 001], and MS[OR=1. 915 (95%CI 1. 444-2. 540),P<0. 01] were the risk factors of coronary heart disease. Conclusion With atherosclerosis, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and obesity as its 4 components, MIS has a high detective rate in patients with metabolic disorders, and seems to be more sensitive than MS to distinguish inflammation-related metabolic diseases. The concept of MIS will promote the screening and prevention of atherosclerosis in its early stage.

Objective To investigate the features and clinical value of endoscopic ultrasonography and colonoscopy for appendix mucocele. Methods The patients with mucocele of appendix who were diagnosed by endoscopic ultrasonography and colonoscopy in three hospitals all underwent surgery from January 2008 to March 2015. Appendix mucocele in these patients was confirmed by postoperative pathology and clinical data were retrospectively analyzed. Results A total of 22 patients with appendix mucocele were analyzed retrospectively. The average size of intralumen mucocele was 1. 84±1. 42 cm (0. 6-4. 5 cm) . The colonscopic finding of appendiceal mucocele showed submucosal protuberance at the appendiceal orifice with smooth surface. The appendiceal orifice was found at the edge of appendiceal mucocele. Endoscopic ultrasonogrphy showed low echo with smooth cyst wall in 8 patients, mixed equal echo and low echo in 14 cases. Appendicectomy was performed in 11 patients and resection of ileocecum in 11 others. Conclusion Endoscopic ultrasonography and colonoscopy are valuable for diagnosis and treatment in appendiceal mucocele.