Objective To investigate the clinicopathological and prognostic characteristics of intestinal inflammatory myofibroblastic tumours(IMT)in middle-aged and elderly patients.Methods The clinical,pathologi-cal morphology,immunophenotype and follow-up results of 5 cases of intestinal IMT in middle-aged and elderly patients were retrospectively analyzed.Results 4 cases of IMT occurred in the right half colon and 1 in the ileum.Most patients(3/5)had a history of intestinal injury,starting the digestive tract symptoms and increased leukocytes.The tumor tissue was composed of fusiform myofibroblasts and fibroblasts arranged in storiform pattern,with an infiltrative growth pattern,accompanied by a large number of lymphocytes and plasma cells infiltration,collagen formation and myxedema.One case was atypically large and deformed.Immunophenotype:vimentin(5cases),SMA(5 cases),desmin(3 cases),ALK(3 cases),CK(2 cases)were positive.Caldesmon,CD34,β-catenin,MC,CD117,DOG1,S-100,BCL-2,CD99,CD68 were negative,and Ki-67 proliferation index was 1.28%to 10.01%.All the 5 cases underwent complete tumor resection and were followed up for 48.5 to 133 months.Among them,1 patient aged 83 was considered to have tumor recurrence 27 months after surgery.The other patient survived 122 months without tumor and died of other causes.All the others survived without tumor and were in good condition.Conclusion(1)Intestinal IMT in the middle-aged and elderly people in this group was more common in the right half colon,and most of them had a history of intestinal injury,first gastrointestinal symptoms and elevated white blood cells;(2)Vimentin and SMA were positive at the same time,and ALK was more positive;(3)4/5 patients had good surgical resection,and 1/5 patients could relapse 2～3 years after surgery;old age,ALK-positive,Ki67 up to 10%,atypia may be an important risk factor for intestinal IMT recurrence in the elderly,of which ALK-positive patients may have a recurrence risk of 1/3.

Objective To study the clinical and electrophysiological characteristics about ictal facial dystonia of medial temporal lobe epilepsy.Method Data was collected from patients with mesial temporal lobe epilepsy originating from unilateral temporal lobe structures through preoperative evaluation at the Functional Neurology Department of the Second People's Hospital of Shenzhen between July 1,2019 and September 1,2023.All patients did not have seizures for at least 1 year after operation.The ictal symptoms of each patient were analyzed and the patients with ictal facial dystonia were selected and the clinical and electrophysiological characteristics of ictal facial dystonia were summarized.Results Nineteen of 47 patients diagnosed as mesial temporal lobe epilepsy had ictal facial dystonia,of which the electroencephalogram starting at the right side in 11 cases and at the left side in 8 cases.Fifteen patients had the symptom in the first 1/3 period of seizure.Fifteen patients had bilateral symmetrical muscle contraction.Thirteen patients showed with negative expression,5 with neutral expression,and 1 with negative or positive expression in different seizures.None of the patient had the drop of the corners of the mouth.Five patients underwent stereotactic-electroencephalogram(SEEG),including 3 patients with bilateral implantation and 2 patients with unilateral implantation.SEEG showed that the medial temporal structure,insula and orbital lobes were all involved in the onset of ictal facial dystonia.Conclusion The medial temporal lobe epilepsy often present ictal facial dystonia in the first 1/3 period of seizure,with bilaterally symmetrically facial contraction,often accompanied by negative expression,but without drop of the corners of the mouth.The lateralization value of ictal facial dystonia is limited and this symptom involves a wide brain network structure.

Islet transplantation is a promising treatment of diabetes mellitus and its complications. Nevertheless, dysfunction post-transplantation, rejection and shortage of donors are the bottleneck issues in the field of islet transplantation. Optimizing the preservation method of pancreas plays a positive role in obtaining a sufficient quantity of effective islets and maintaining their functions. During the culture stage, anti-rejection and anti-apoptosis treatment of islets, including mesenchymal stem cell (MSC), MSC-derived exosomes, anti-apoptosis drugs and gene modification, may become major approaches for islet protection and functional maintenance in clinical islet transplantation. Use of anti-instant blood-mediated inflammatory reaction (IBMIR) drugs after islet transplantation also plays a critical role in protecting islet function. In this article, the whole process from islet preparation to islet transplantation was illustrated, and relevant strategies of islet protection and functional maintenance were reviewed, aiming to provide reference for improving the quality of donors to compensate for the shortage of absolute quantity of donors and elevating the efficiency of islet transplantation.

OBJECTIVE To investigate the role of clinical pharmacists in the treatment of a patient with Epstein-Barr （EB） virus encephalitis. METHODS Clinical pharmacist participated in drug diagnosis and therapy for a patient with EB virus encephalitis. According to the physiological characteristics of the disease and the pharmacokinetic-pharmacodynamic characteristics of antibiotics， clinical pharmacists suggested that the dose should be adjusted as ceftriaxone 2 g， q12 h+meropenem 2 g， q8 h. Based on the uncontrolled infection of the patient， pharmacists suggested that ceftriaxone should be stopped and vancomycin 1 million U and q12 h should be used as alternative therapy. According to the results of etiology， pharmacists suggested that acyclovir should be discontinued and replaced with ganciclovir 5 mg/kg， q12 h. The electrolyte disturbance of the patient may be adverse drug reactions caused by Mannitol injection， it was recommended to stop the drug. RESULTS The clinician followed the advice of the clinical pharmacists. After treatment， the patient improved and was discharged. CONCLUSIONS Clinical pharmacists can carry out pharmaceutical care for patients with EB virus encephalitis， assist physicians in optimizing the treatment plan of patients， and ensure the effectiveness and safety of drug treatment.

OBJECTIVE: To investigate the efficacy of a novel artificial perfusate based on oxygen-carrying perfluoronaphthalene-albumin nanoparticles in normothermic machine perfusion (NMP) for preservation of porcine liver donation after cardiac death. METHODS: Artificial perfusate with perfluoronaphthalene-albumin nanoparticles was prepared at 5% albumin (w/v) and its oxygen carrying capacity was calculated. The livers of 16 Landrace pigs were isolated after 1 h of warm ischemia, and then they were divided into 4 groups and preserved continuously for 24 h with different preservation methods: cold preservation with UW solution (SCS group), NMP preservation by whole blood (blood NMP group), NMP preservation by artificial perfusate without nanoparticles (non-nanoparticles NMP group) and NMP preservation by artificial perfusate containing nanoparticles (nanoparticles NMP group). Hemodynamics, tissue metabolism, biochemical indices of perfusate and bile were monitored every 4 h after the beginning of NMP. Liver tissue samples were collected for histological examination (HE and TUNEL staining) before preservation, 12 h and 24 h after preservation. RESULTS: The oxygen carrying capacity of nanoparticles in 100 mL artificial perfusate was 6.94 μL/mmHg (1 mmHg=0.133 kPa). The hepatic artery and portal vein resistance of nanoparticles NMP group and blood NMP group remained stable during perfusion, and the vascular resistance of nanoparticles NMP group was lower than that of blood NMP group. The concentration of lactic acid in the perfusate decreased to the normal range within 8 h in both nanoparticles NMP group and blood NMP group. There were no significant differences in accumulated bile production, alanine aminotransferase and aspartate aminotransferase in perfusate between nanoparticles NMP group and blood NMP group (all P>0.05). After 24 h perfusion, the histological Suzuki score in blood NMP group and nanoparticles NMP group was lower than that in SCS group and non-nanoparticles NMP group (all P<0.05), and the quantities of TUNEL staining positive cells in blood NMP group and non-nanoparticles NMP group was higher than those in nanoparticles NMP group and SCS group 12 h and 24 h after preservation (all P<0.05). CONCLUSION Artificial perfusate based on oxygen-carrying nanoparticles can meet the oxygen supply requirements of porcine livers donation after cardiac death during NMP preservation, and it may has superiorities in improving tissue microcirculation and alleviating ischemia-reperfusion injury.
Swine ; Animals ; Liver Transplantation ; Organ Preservation ; Liver ; Perfusion ; Death ; Oxygen/metabolism*

Objective:To summarize the best evidence of intracavitary electroencephalogram positioning in peripherally inserted central catheter (PICC) catheterization, and investigate the clinical application of the best evidence.Methods:The literature on the intracavitary electroencephalogram positioning technology in the head end positioning of PICC catheterization was searched through computers on websites or data bases such as Cochrane Library, Infusion Nursing Society, PubMed, ScienceDirect, China National Knowledge Infrastructure, WanFang Data, and VIP. The search period was from the establishment of the database to June 30, 2022. The literature evaluation standards and evidence grading system of the Joanna Briggs Institute Evidence-Based Health Care Center Database were used for literature quality evaluation and evidence grading, summarizing the best evidence. Based on the summary of evidence, the best evidence for intracavitary electrocardiogram positioning guided PICC catheterization was applied to the survey questionnaire. From November to December 2022, a snowball sampling method was used to select 119 PICC nurses for a questionnaire survey.Results:A total of 31 articles were included, consisting of 24 randomized controlled trials, two systematic reviews, four Meta-analysis, and one group standard. We summarized 20 pieces of evidence from 7 aspects, including preoperative evaluation and preparation, catheter delivery process, guidewire connection, guided intracavitary electroencephalogram, timing of catheter withdrawal, optimal position judgment, and effect evaluation. The survey results showed that more than half of the nurses were consistent with the evidence in terms of evaluation and preparation, catheter delivery process, guided intracavitary electroencephalogram, guidewire connection, and timing of catheter withdrawal. The selection of the optimal location judgment was relatively scattered and needed further research.Conclusions:This study provides evidence-based basis for the PICC catheterization positioning using intracavitary electroencephalogram. Based on clinical practice, specialized nurses select the best evidence and develop a management plan that suits individual circumstances, which can ensure maximum patient benefits and continuously improve nursing quality.

Objective:To investigate the feasibility and clinical significance of near-infrared fluorescence positive imaging combined with intraoperative rapid parathyroid hormone (PTH) determination in identification and function protection of the parathyroid gland during thyroidectomy.Methods:According to the inclusion and exclusion criteria, patients in the Affiliated Lihuili Hospital of Ningbo University, who needed bilateral thyroidecto-my and central lymph node dissection due to suspected bilateral thyroid cancer from Mar. 2020 to Oct. 2020 were selected for a prospective clinical study. They were randomly divided into the study group (near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination) and the control group (intraoperative experience identification) . The number of parathyroid glands found during operation, PTH before and after the operation, blood calcium, blood phosphorus, the presence of parathyroid tissues in routine pathological section examinations, and postoperative symptoms were collected. SPSS 25.0 statistical software was used for analysis, the measurement data were expressed by mean±standard deviation ( ± s) , t test was used for comparison between groups, and χ2 test was used for counting date. Results:In the study group of 33 cases, 135 suspicious parathyroid glands were exhibited during operation, with an average of (4.09±0.52) ; Hand and foot numbness occurred in 1 case (3.03%) ; On the 1st after the operation, PTH was (23.68±9.48) ng/L. In the control group of 31 cases, 109 parathyroid glands were identified by naked eyes, with an average of (3.52±0.63) ; Hand and foot numbness occurred in 6 cases (19.35%) ; On the 1st after the operation, PTH was (17.93±11.58) ng/L. The differences were statistically significant ( P<0.05) . But no statistical significance was found in operation duration (79.45±30.18) min, postoperative hospitalization days (5.85±2.27) days, PTH (27.10±9.80, 33.08±10.21) ng/L, blood calcium (2.11±0.10,2.25±0.09) mmol/L, and blood phosphorus (1.20±0.20,1.15±0.12) mmol/L on the 3rd day and the 6th month after the operation. Conclusion:Near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination can improve the recognition rate of the parathyroid gland and reduce postoperative complications, which is a safe, effective and rapid method for intraoperative parathyroid gland recognition.

Background Occupational health risk assessment of dust-exposed operations is an important part of occupational health work. However, there is a lack of objective and effective methods for validating the risk assessment results. Objective To explore the application value of chest imaging changes in validating occupational health risk assessment results of dust-exposed operations. Methods Alumina dust-exposed workers in an abrasive manufacturing company were selected as study subjects. The Australian Occupational Health and Safety Risk Assessment model (Australian model), and the Singapore semi-quantitative risk assessment model of occupational exposure to chemical substances (Singaporean model) were used to conduct occupational health risk assessment for the target group. Consistency of the assessment results was compared. The cumulative risk value and cumulative risk level of the subjects were calculated. The subjects were examined and diagnosed by chest radiographs, and the differences in the positive rates of aluminum dust shadows of workers at different job risk levels and different cumulative risk levels were compared. Results The average risk ratios (RR) of selected alumina dust-exposed workers estimated by the Australian model and the Singapore model were both 0.49±0.10, indicating generally medium occupational health risk level. The evaluation results of the two models were obviously consistent (kappa test, k = 0.823, P < 0.001). Among the 192 subjects, 62 (32.3%) were found to have aluminum dust shadows on their chest radiographs, and there were no case of pneumoconiosis. The aluminum dust shadows were mainly classified by shape and size as “s” (30.7%); the profusion of small opacities was mainly "less than 0/1" (31.3%); they were mostly distributed in 2 pulmonary zones (18.8%), and mostly in the right lower lung (18.8%), and none was seen in the two upper lung zones. The positive rate of aluminum dust shadows in the high-risk workplaces (41.7%) assessed by the Australian model was significantly higher than that in the medium-risk workplaces (22.9%) (P < 0.01). The positive rate of aluminum dust shadows in the medium-risk workplaces (42.7%) assessed by the Singapore model was significantly higher than that in the low-risk workplaces (23.3%) (P < 0.01). The cumulative risk levels evaluated by the two models were all atⅠ- Ⅲ levels. With the increase of cumulative risk level by the two models, the positive rates of aluminum dust shadows in the subjects both showed an obvious increase trend (P < 0.05). Conclusion The risk assessment results of the Australian model and the Singapore model are obviously consistent for the target group. They can be jointly applied to the risk assessment of dust-exposed operations. The application of chest imaging changes is of certain value to validate the results of occupational health risk assessment for dust-exposed operations.

Objective:To investigate the role of cholinergic anti-inflammatory pathway in the regulation of peptide transporter 1 (PepT1) expression in small intestinal epithelium of septic rats by Ghrelin.Methods:One hundred adult male Sprague-Dawley (SD) rats were randomly divided into sham operation group, sepsis group, sepsis+vagotomy group, sepsis+Ghrelin group, and sepsis+vagotomy+Ghrelin group, with 20 rats in each group. In the sham operation group, the cecum was separated after laparotomy, without ligation and perforation. In the sepsis group, the rats received cecal ligation puncture (CLP). In the sepsis+vagotomy group, the rats received CLP and vagotomy after laparotomy. In the sepsis+Ghrelin group, 100 μmol/L Ghrelin was intravenously injected after CLP immediately. The rats in the sepsis+vagotomy+Ghrelin group received CLP and vagotomy at the same time, then the Ghrelin was intravenously injected immediately with the same dose as the sepsis+Ghrelin group. Ten rats in each group were taken to observe their survival within 7 days. The remaining 10 rats were sacrificed 20 hours after the operation to obtain venous blood and small intestinal tissue. The condition of the abdominal intestine was observed. The injury of intestinal epithelial cells was observed with transmission electron microscopy. The contents of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in serum and small intestinal tissue were detected by enzyme-linked immunosorbent assay (ELISA). The brush border membrane vesicle (BBMV) was prepared, the levels of mRNA and protein expression of PepT1 in the small intestinal epithelium were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blotting.Results:All rats in the sham operation group survived at 7 days after operation. The 7-day cumulative survival rate of rats in the sepsis group was significantly lower than that in the sham operation group (20% vs. 100%, P < 0.05). The cumulative survival rate of rats after Ghrelin intervention was improved (compared with sepsis group: 40% vs. 20%, P < 0.05), but the protective effect of Ghrelin was weakened after vagotomy (compared with sepsis+Ghrelin group: 10% vs. 40%, P < 0.05). Compared with the sham operation group, in the sepsis group, the small intestine and cecum were dull red, the intestinal tubules were swollen and filled with gas, the intestinal epithelial cells were seriously injured under transmission electron microscopy, the levels of TNF-α and IL-1β in serum and small intestinal were significantly increased, and the expression levels of PepT1 mRNA and protein in the small intestinal epithelium were significantly decreased. It indicated that the sepsis rat model was successfully prepared. After vagotomy, the intestinal swelling and gas accumulation became worse in septic rats, leading to the death of all rats. Compared with the sepsis group, the abdominal situation in the sepsis+Ghrelin group was improved, the injury of intestinal epithelial cells was alleviated, the serum and small intestinal TNF-α and IL-1β were significantly decreased [serum TNF-α (ng/L): 253.27±23.32 vs. 287.90±19.48, small intestinal TNF-α (ng/L): 95.27±11.47 vs. 153.89±18.15, serum IL-1β (ng/L): 39.16±4.47 vs. 54.26±7.27, small intestinal IL-1β (ng/L): 28.47±4.13 vs. 42.26±2.59, all P < 0.05], and the expressions of PepT1 mRNA and protein in the small intestinal epithelium were significantly increased [PepT1 mRNA (2 -ΔΔCt): 0.66±0.05 vs. 0.53±0.06, PepT1 protein (PepT1/GAPDH): 0.80±0.04 vs. 0.60±0.05, both P < 0.05]. Compared with the sepsis+Ghrelin group, after vagotomy in the sepsis+vagotomy+Ghrelin group, the effect of Ghrelin on reducing the release of inflammatory factors in sepsis rats was significantly reduced [serum TNF-α (ng/L): 276.58±19.88 vs. 253.27±23.32, small intestinal TNF-α (ng/L): 144.28±12.99 vs. 95.27±11.47, serum IL-1β (ng/L): 48.15±3.21 vs. 39.16±4.47, small intestinal IL-1β (ng/L): 38.75±4.49 vs. 28.47±4.13, all P < 0.05], the up-regulated effect on the expression of PepT1 in small intestinal epithelium was lost [PepT1 mRNA (2 -ΔΔCt): 0.58±0.03 vs. 0.66±0.05, PepT1 protein (PepT1/GAPDH): 0.70±0.02 vs. 0.80±0.04, both P < 0.05], and the injury of small intestinal epithelial cells was worse. Conclusion:Ghrelin plays a protective role in sepsis by promoting cholinergic neurons to inhibit the release of inflammatory factors, thereby promoting the transcription and translation of PepT1.

Objective:To explore the effect of the solution focused approach combined with the two-part, five-zone and five-finger rotation in diabetic insulin injection patients.Methods:From August 2019 to October 2021, convenience sampling was used to select 108 diabetic insulin injection patients admitted to Lishui People 's Hospital as the research object. The patients were divided into the control group and the experimental group by random number table method, with 54 cases in each group. The control group was given routine nursing, while the experimental group received the solution focused approach combined with the two-part, five-zone, and five-finger rotation on the basis of the control group. The scores of the Insulin Injection Position Rotation Knowledge Questionnaire, State-Trait Anxiety Inventory (STAI) , Patient Activation Measure (PAM) and the Chinese version of the Mishel 's Uncertainty in Illness Scale (MUIS) and the total incidence of adverse reactions at insulin injection sites were compared between the two groups before nursing and after four weeks of nursing. Results:After four weeks of nursing, the scores of the Insulin Injection Position Rotation Knowledge Questionnaire in the experimental group were higher than those in the control group, the scores of State Anxiety Inventory, Trait Anxiety Inventory in STAI and MUIS score were lower than those in the control group, and the PAM score was higher than that in the control group. All were statistically significant ( P<0.05) . The total incidence of adverse reactions at the insulin injection site in the experimental group was 1.85% (1/54) , which was lower than 12.96% (7/54) in the control group, but there was no significant difference between the two groups ( P>0.05) . Conclusions:The solution focused approach combined with the two-part, five-zone and five-finger rotation is beneficial to improve the knowledge of insulin injection in diabetic patients, relieve their anxiety, and increase patients ' enthusiasm for disease treatment.