Fibrosis can occur in diverse tissue and organs and is the common outcome as multiple chronic diseases progress. It is characterized by over-activation of fibroblasts and excessive deposition of extracellular matrix. Targeting transforming growth factor-β （TGF-β）， a classical signaling molecule in fibrosis， is currently a routine strategy for drug therapy of this disease. The use of traditional Chinese medicine （TCM） in the treatment of fibrotic diseases has been supported by mature theories. The theories emphasize that the internally-accumulated pathogens and mixed deficiency-excess underlie the shared pathology of fibrotic diseases. Qi stagnation， blood stasis， phlegm turbidity， and mass accumulation are key pathological factors. "Yin suppression by Yang" is the core thought for treatment with TCM of the disease. Pharmacological investigations reveal the scientific nature of TCM in treating fibrotic diseases， namely multilevelled and multitargeted. In other words， it refers to networked regulation of signaling activities of fibrosis-related molecules such as TGF-β/Drosophila protein homolog （Smad）， phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）， Hedgehog， Wnt/β-catenin， and inflammatory cytokines， so as to inhibit fibroblast function and provide a promising insight into novel anti-fibrotic drug. This paper summarized the conventional understanding of fibrotic disease treatment with TCM and its mechanism of action by reviewing ancient literature and modern research reports， which offers an idea for follow-up research in this field.

Objective The purpose of writing the"Expert consensus on the prevention and control of intracranial hypertension in adult critical illness"(here in after referred to as the"Consensus")aimed to standardize the nursing work related to the prevention and control of elevated intracranial pressure in adult critical illness,and prevent the occurrence of complications such as cerebral herniation.Methods Guided by evidence-based practice,domestic and foreign databases were searched for guidelines,expert consensuses,systematic evaluation,evidence summaries,and original research related to increased intracranial pressure.The search period is from database establishment to March 2024.The high-quality evidence and suggestions in the field was evaluated,extracted,and summarized to form a preliminary consensus.27 experts were invited to conduct 2 rounds of expert inquiry and 8 experts were invited to conduct 2 expert discussion meetings,to revise and improve the content of the initial draft,and to ultimately form a final consensus.Results The effective response rates for both rounds of inquiry questionnaires were 100％,with expert authority coefficients of 0.884,judgment coefficients of 0.964,and familiarity levels of 0.804.The Kendall harmony coefficients for 2 rounds of inquiry were 0.107 and 0.083(P＜0.01),respectively.The consensus includes 4 aspects,including identification,monitoring,prevention and control strategies,emergency treatment and care for increased intracranial pressure.Conclusion This"Consensus"has strong scientific validity and can provide reference basis for nurses to carry out prevention and control of intracranial pressure increase.

Cathartic colon （CC） is a common and refractory digestive system disease， with the pathogenesis not fully clarified. The effective therapies other than laxatives and surgery remain to be developed for CC. Therefore， establishing the CC animal models that fit the disease characteristics of western medicine and syndrome characteristics of traditional Chinese medicine （TCM） is an important link to promote the research on this disease. The fitting degree of animal models with the latest Chinese and western medical diagnostic criteria is an indicator to assess the effectiveness of the animal models in simulating the disease characteristics of western medicine and syndrome characteristics of TCM. The literature review showed that the model animals， drugs and their dosage forms， doses， administration methods， and modeling period of CC varied in different studies， and the available CC animal models presented different fitting degrees with the disease characteristics of western medicine and syndrome characteristics of TCM. Rats were the preferred animals for the modeling of CC. Rhei Radix et Rhizoma preparations were commonly used for model inducing， which， however， may cause water electrolyte disorders， decreased immunity， and even death of animals at the late stage of modeling. The animals were modeled by gradually increasing the starting dose， while the starting dose and increasing dose varied. The maintenance dose was determined based on 50% of the animals having loose stools， and the end for a cycle was determined as the time when loose stools disappeared in 80% of animals. The modeling always lasted for 2-3 cycles， approximately 2-4 months. The CC models established with Rhei Radix et Rhizoma granules and rhein had high fitting degrees with the disease and syndrome characteristics. In addition， the CC animal models of TCM syndromes were still in the exploration stage. There were only the animal models of four TCM syndromes： liver depression and spleen deficiency， both Qi and Yin deficiency， Qi stagnation and blood stasis， and spleen and kidney deficiency. Efforts should be made to establish the animal models that meet the characteristics of disease of western medicine and syndromes of TCM， so as to facilitate the research on CC mechanism and drug development.

Objective To study the risk of bloodstream infection in relation with peripherally inserted central venous catheter (PICC) in hospitalized non-cancer patients.Methods Clinical data of 172 non-cancer patients admitted to our hospital for PICC were collected.The risk of PICC-related bloodstream infection (CRBSI) in domestic hospitalized non-cancer patients was analyzed and systematically assessed.Results Of the 183 PICCs placed in 172 patients included in this study,61.7％ were placed in general wards,38.3％ were placed in ICU,87.8％ were placed in combination with indwelling urinary catheter,29.7％ were placed in combination with mechanical ventilation.The median PICC indwelling time was 35 days.CRBSI occurred in 6 patients with an incidence of 0.6/1000 PICCs/day.The risk of CRBSI was centralized in domestic tumor patients after PICC.The reported CRBSI was significantly different in hospitalized non-cancer patients (0.26-33.10/100 PICC).Conclusion The risk of CRBSI is lower in hospitalized patients after PICC placement than after traditional central venous catheter placement.Further studies are needed to assess its value in ICU.

Objective To learn the applications and patient experience of mobile payment technology as used in the hospital outpatient service.Methods 342 outpatients using mobile technology (APP)were chosen from the hospital information system for survey,and 300 outpatients registering in the conventional process were chosen as a control.Data of the doctor-seeing experiences of the two groups were analyzed statistically.Results Waiting queue reminder function is found with the highest patient usage among the three officially launched APPs,accounting for 83.6%.The appointment and cellphone payment functions exert the greatest impact on patient experience,boasting a patient satisfaction of 90%. All these functions can save totally one hour for an outpatient.Conclusions The mobile payment technology can significantly reduce outpatient waiting time,and improve outpatient experiences.Such technology therefore needs more promotions and connection with medical insurance system for the sake of outpatients.

Objective: By high performance liquid chromatography determination of metronidazole content of different sterilization parameters metronidazole injection, selection of the optimal sterilization parameters. Methods: The Agilent Extend-C18 analytical column (250 mm×4.6 mm, 5μm) was adopted with the mobile phase of water:Alcohol (80:20) at a flow rate of 1.5 mL/min; The column temperature was at 30℃; The detection wavelength was at 320 nm, 121℃ 15 min, the content of effective components metronidazole injection in 115℃ 30 min sterilization parameters. Results:The average content of metronidazole determination before sterilization liquid is divided into 101.57%, with excessive killing sterilization after liquid content is 101.47%, determined by the probability of survival after sterilization liquid content of 101.60%. The content of active component of different sterilization parameters of metronidazole and before sterilization contrast difference. Conclusion: The method is fast rapid, convenient, in accordance with the level of risk decision trees screened Metronidazole injection sterilization using terminal over kill sterilization accurate and can be used for the metronidazole in metronidazole injection.

OBJECTIVETo investigate clinicopathological features, immunophenotype and differential diagnosis of intravenous leiomyomatosis with intracardiac extension.

METHODSClinical manifestations, morphologic features, and immunohistochemical staining were retrospectively analyzed in 19 cases of intravenous leiomyomatosis with intracardiac extension.

RESULTSThe patients' age ranged from 33 to 59 years (mean 44 years). Clinical presentation included chest tightness, palpitation, dyspnea, edema of low extremity, abdominal distention or hypermenorrhea. However, a few patients were asymptomatic. Grossly, intravenous leiomyomatosis in most cases demonstrated coiled or nodular growth within the myometrium with worm-like involvement of the uterine vein in broad ligament or other pelvic veins with continued extension into the vena cava and the heart. The intravenous tumor surface was generally smooth and rubbery, with a greyish-white color. Microscopically, the tumors were composed of spindle cells with rare mitotic figures and the presence of abundant thick-walled vessels. Marked fibrosis, hyalinization, myxoid and edematous changes were common. The tumor cells were positive for SMA, ER, PR and desmin but negative for HMB45 and S-100. CD10 and CD34 were positive in 4 patients and negative in the remaining cases.

CONCLUSIONIntravenous leiomyomatosis with intracardiac extension is a rare disease among women of child-bearing age, with specific morphologic manifestations and immunohistochemical profiles.

Adult ; Diagnosis, Differential ; Female ; Humans ; Leiomyomatosis ; diagnosis ; pathology ; Middle Aged ; Retrospective Studies ; Uterus ; pathology ; Vena Cava, Inferior ; pathology

Outpatient service constitutes a key part of hospital services.In an effort to optimize services plagued by the too long waiting time in registration,payment and drug dispensary,and the too short time in seeing doctors,Beijing Friendship Hospital introduced mobile Intemet technology into hospital outpatient services.Such measures as mobile payment,and realtime push of the information of patients waiting were adopted to help with outpatients waiting at home,minimize outpatients' movement,queuing and waiting.Simplified service process and higher service efficiency proved effective in winning higher outpatient satisfaction as a result.

Objective To evaluate the effect of different doses of aspirin on the platelet inhibition rate by thremboelastography.Methods One hundred and eighty patients with ischemic stroke or transient cerebral ischemic attack (TIA) were randomly divided into aspirin 100 mg/d group (60 patients),aspirin 200 mg/d group (60 patients) and aspirin 300 mg/d group (60 patients) according to the order of treatment.The platelet inhibition rate which arachidonic acid pathway induced was measured by thromboelastography and compared at different time points (before medication; 7 days,6 months,1 year after medication).Results There were significant differences in the platelet inhibition rate after medication at different time points compared with that before medication in three groups (P ＜ 0.05).After medication at different time points,the platelet inhibition rate of aspirin 100 mg/d group and aspirin 200 mg/d group was gradually decreasing.On the contrary,that of the aspirin 300 mg/d group showed gradually increasing.Cross-sectional comparison of the three groups at different time points showed that there was no significant difference in the platelet inhibition rate among three groups before medication,7 days,6 months after medication (P ＞ 0.05).However,there was significant difference at 1 year after medication (P ＜ 0.05).The platelet inhibition rate inaspirin 300 mg/d group [(93.8 ± 18.6)％] was higher than that in aspirin 200 mg/d group [(83.7 ± 11.2)％]and aspirin 100 mg/d group [(76.6 ± 12.8)％] (P ＜ 0.05).During medication there were 9 patients of less than 50％ platelet inhibition rate in aspirin 100 mg/d group,5 patients in aspirin 200 mg/d group,3 patients in aspirin 300 mg/d group,and 2 patients of peptic ulcer bleeding in aspirin 300 mg/d group.Conclusions The appropriate dose of aspirin (100,200,300 mg/d) can play a very good anti-platelet effect.Increasing the dose on the basis of 100 mg/d,the platelet inhibition rate shows no increase in the short-term (≤6 months),but in the long-term (1 year) there may be differences.It may be associated with less aspirin resistance and the relative increasing bleeding risk.

OBJECTIVEA sensitive liquid chromatography-tandem mass spectrometric (LC-MS/MS) method has been developed and validated for the determination of brucine and strychnine in rat plasma.

METHODSamples were extracted by ethyl acetate-n-butanol (7: 3). Chromatographic separation was operated on ZORBAX XDB-C18 column with gradient elution of acetonitrile-methanol-water (0.05% acetic acid and 10 nmol x L(-1) ammonium formate contained), followed by LC-MS/MS in positive electrospray ionization. Quantification was carried out on multiple reaction monitoring (MRM) of the transition m/z 395.2/324.2, m/z 335.2/184.2 and m/z 199.1/171.1 for brucine, strychnine and tacrine (internal standard), respectively.

RESULTThe method was linear in the range of 0.195-100 and 0.07840 microg x L(-1) for brucine and strychnine, with coefficient correlation 0.994 and 0.996 respectively. The recoveries of extraction were 78.9% - 102.4% for brucine and 95.2% - 106.1% for strychnine. Precision, accuracy, stability and matrix effect of the analytes met the requirement. The method was applied to a pharmacokinetic study of brucine and strychnine after cutaneous administration of Semen Strychni niosome gel. The C(max) were (26.20 +/- 5.81) and (12.50 +/- 3.00) microg x L(-1) while the AUC(0-infinity), were (193.75 +/- 39.43) and (98.25 +/- 28.54) microg x h x L(-1) of the two components.

CONCLUSIONWe conclude that the niosomes may reduce the systemic exposures and prolong the local release of brucine and strychnine.

Administration, Cutaneous ; Analgesics ; analysis ; pharmacokinetics ; Animals ; Chromatography, Liquid ; Convulsants ; analysis ; pharmacokinetics ; Female ; Gels ; chemistry ; Liposomes ; chemistry ; Male ; Plants, Medicinal ; chemistry ; Rats ; Rats, Sprague-Dawley ; Seeds ; chemistry ; Semen ; chemistry ; Specific Pathogen-Free Organisms ; Strychnine ; analogs & derivatives ; analysis ; pharmacokinetics ; Strychnos nux-vomica ; chemistry ; Tandem Mass Spectrometry