Objective:To review the clinical status based on the best evidence of drug administration in patients with dysphagia, systematically analyze the obstacle factors and promoting factors in the process of evidence transformation, and formulate reform strategies.Methods:Based on the evidence-based nursing research method and the guidance of the Ottawa Model of Research Use (OMRU), the review indicators were developed based on the best evidence. The current status of clinical practice behaviors of 223 patients and 75 nurses in the Neurology, Neurosurgery and Geriatric departments of the Affiliated Hospital of Jiangsu University were reviewed from July to December 2021.Based on the results of the review, qualitative interviews were conducted with 32 potential adopters, and content analysis was used to assess the barriers and contributing factors to the clinical translation of evidence in three aspects: evidence-based change, potential adopters and practice environment, so as to develop effective strategies.Results:Based on the 22 best evidence selected, the evidence-based team developed 25 review indicators to carry out clinical review, showing that the compliance rate of 16 indicators were less than 60%. By analyzing and summarizing the interview results of potential adopters, the main obstacles leading to the low compliance rate of nurses were analyzed as follows: evidence-based reform changed the traditional work mode, and the application of evidence was not convenient; at the level of potential adopters, nurses had poor knowledge and practice, heavy work burden, and low awareness of patients and caregivers; at the level of practice environment, there was lack of nursing norms and procedures for clinical transformation of evidence, and the channels of multi-disciplinary collaboration and communication were not smooth. The main promoting factors were the perfect supervision mechanism of evidence-based nursing projects, the evidence-based group had rich experience in evidence transformation, the management was willing to change, and the practitioners were good at innovation.Conclusions:There is still a large gap between the clinical practice and the best evidence of drug administration in patients with dysphagia. The promoting factors should be fully utilized to overcome the obstacles and implement improvements to promote the effective transformation of evidence into clinical practice.

Objective:To explore the ideal way of using the stereoscopic unequal S-plasty in reconstruction of the congenital hypoplastic ear lobe cleft with soft tissue deficiency.Methods:Data of 10 patients with the congenital hypoplastic ear lobe cleft associated with soft tissue deficiency who were treated using the stereoscopic unequal S-plasty in the plastic cosmetic surgery of Xuzhou Central Hospital from Aug 2018 to Aug 2022 were retrospectively analyzed. Six patients were male, 4 were female. Their ages ranged from 6 years to 19 years old, with a mean age of 13 years. Lobe deficiency size ranged from 0.8 cm×0.5 cm to 1.2 cm×1.0 cm.Results:The post-operation flaps had no venous congestion, infection or necrosises. During 3 to 12 months of follow-up, the technique made the shape of the ear lobe smoother. The incisions left inconspicuous scars. The result was satisfactory in terms of matching the contralateral normal ear lobe in shape and symmetry. Doctors and patients were satisfied with the results.Conclusions:The stereoscopic unequal S-plasty is an effective way to correct the the severe congenital ear lobe deformity. The good result,simple manipulation and short operation time are the advantages of this method.

Objective:To investigate the repair of the severe nasal deformity in the unilateral cleft lip secondary with the methods in the composite tissue Z-plasty and the nasolabial anatomical reconstruction.Methods:A total of 25 patients with severe nasal deformity due to secondary unilateral cleft lip underwent the reconstructive surgery using the technique of composite tissue Z-plasty and the nasolabial anatomical reconstruction for anatomical restoration of cartilage, muscle, and soft tissue layers. All patients were followed up for 3-24 months, with an average period of 7.6 months. The treatment outcomes were evaluated by a questionnaire in postoperative follow-up.Results:All the 25 patients had achieved satisfactory nostril shape and no other complications such as bleeding, infection and flap necrosis were recorded. A total of 25 patients were evaluated postoperatively. The average columella length was significantly improved from an average of 14.2 mm preoperatively to 20.2 mm postoperatively. The average ratio of the cleft side columella height to the alar base width was 0.18 preoperatively and 0.30 postoperatively. The postoperative basal and frontal views revealed a better shape of the nostrils, columella and nasal floor. GAIS questionnaires of 25 patients demonstrated that 20 patients reported great improvement, 4 patients reported moderate improvement, 1 patient had poor improvement in size and shape of the affected side nostril who undevwent the another repair of the rdure in 12 months postoperation. The ectopic muscles around the pear hole was completely released and the effect was good after repair. The satisfactory rate was 96%.Conclusions:Combining the composite tissue Z-plasty with the nasolabial anatomical reconstruction allows for thorough anatomical restoration of cartilage, muscle, and skin layers in unilateral cleftlip nasal deformities. This single-step approach is a safe and technically easy therapeutic option that is associated with high patients′ satisfaction. This method should be considered for promotion in clinic.

Objective:To investigate the function and mechanism of CXC chemokine receptor 7 (CXCR7) in neuronal cells of ischemic stroke.Methods:The expression of CXCR7 in human neuroblastoma SH-SY5Y cells was interfered by small interfering RNA (si-RNA) technique. Oxygen-glucose deprivation/reoxygenation (OGD/R) injury model was constructed in SH-SY5Y cells. CXCR7 protein expression and cell cycle were detected by flow cytometry (FCM). The protein expression of CXCR7 and Akt signaling pathway was detected by Western blotting.Results:After 6 hours of OGD/R, the expression of CXCR7 was significantly decreased compared with OGD/R 0 hour (CXCR7/GAPDH: 0.483±0.098 vs. 1.000±0.000 by Western blotting and 0.686±0.0524 vs. 1.000±0.000 by FCM, both P < 0.01), cell cycle arrest in G0/G1 phase (1.190±0.040 vs. 1.000±0.000, P < 0.01). After CXCR7 si-RNA interference with SH-SY5Y cells, OGD/R was constructed again for 6 hours. Compared with negative control group (si-NC group) under the same environment, the expression of CXCR7 and phosphorylated Akt (p-Akt) was significantly decreased (CXCR7/GAPDH: 0.471±0.051 vs. 1.000±0.000, p-Akt/GAPDH: 0.616±0.027 vs. 1.000±0.000, both P < 0.001) and cell cycle arrest in G0/G1 phase (1.105±0.033 vs. 1.000±0.000, P < 0.05). Conclusion:The CXCR7 could regulate the cycle of neuronal cells in ischemic stroke through Akt signaling pathway, which has a protective effect on neuronal cells.

Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)for common bile duct(CBD)stones before endoscopic retrograde cholangiopancreatography(ERCP). Methods Data of patients with suspected CBD stones admitted to The First People′s Hospital of Hangzhou from July 2012 to July 2013 were reviewed. Diagnostic efficiency and rates of complications were analyzed between patients undergoing EUS(EUS group)and MRCP(MRCP group)before ERCP, and between patients who underwent EUS and ERCP in different sessions(non-one-session group)with those in one session(one-session group). Results A total of 657 patients were included. With ERCP and follow-up results as the gold standard, the sensitivity(97.5% VS 88.4%), accuracy(96.3% VS 88.0%)and negative predictive value(88.9% VS 60.0%)of EUS in the diagnosis of CBD stones were significantly higher than those of MRCP(P<0.05). There were no significant differences between one-session group and non-one-session group in the sensitivity(97.5% VS 97.4%), specificity(91.7% VS 90.0%), positive predictive value(98.3% VS 97.4%), negative predictive value(88.0% VS 90.0%), and accuracy (96.6% VS 95.9%)in diagnosis of CBD stones(P>0.05). There were no significant differences in incidence of postoperative complications of ERCP between EUS and MRCP group[5.4%(13/242)VS 5.1%(21/415),P>0.05],and between one-session group and non-one-session group[5.5%(8/145)VS 5.2%(5/97),P>0.05].Conclusion Preoperative EUS before ERCP could increase diagnostic sensitivity and negative pridictive value of CBD stones without increasing the incidence of complications.

Background Corneal neovascularization and inflammation occur in herpes simplex keratitis (HSK).Aciclovir (ACV) is an antiviral medication which is primarily used for the treatment of HSV infection.Bevacizumab is an angiogenesis inhibitor which has the ability to slow the growth of corneal neovascularization.However,whether bevacizumab play treating effects on HSK is worth studing.Objective This study attempted to study the effects of bevacizumab on cornea lesion in mouse models of HSK.Methods The solution containing herpes simplex virus type-1 (HSV-1) of Mckrae strain was induced by cultured and infectious Vero cells and prepared by ten-times step dilution with free-serum DMEM,and plaque assay was used to detect the viral titers.HSV-1 of 1 ×l07 plaque-forming unit (PFU) in 0.6 μl was injected into the corneal stroma of 6 to 8-week-old SPF male C57BL/6 mice using a microliter syringe to establish latent HSK mouse models.The models were examined under the slit lamp microscope at day 5,7,11,14 and 17 after modeling as well as day 0,2,4 and 6 after recurrence,and the central cornea touch sensitivity was recorded.The models were divided into ACV-injected group,ACV+bevacizumabinjected group and normal saline-injected group,and 5 μl normal saline with 50 μg ACV,50 μg ACV + 5 μl bevacizumab or 10 μl normal saline was subconjunctivally iujected according to grouping in 4 eyes of each group,respectively.Twelve model eyes were exposed to ultraviolet (UV)-B to induce the recurrent HSK.Corneal wholemounts were prepared at day 9 after modeling for the assessment of corneal neovascularization and nerve fiber distribution by immunofluorescence assay of CD31 and β Ⅲ Tubulin antibodies.The areas of corneal neovascularization and scarring were mcasured with Image J software.The change rate of lesion was calculated and described as a ratio of lesion size at day 8 with day 0 after induction recurrence.Results The modeling success rate was over 80％,and all infected mice showed latent period at day 45 after modeling.Corneal opacification was the most serious at day 7 after modeling and day 2 after recurrence,and the largest corneal neovascular area was seen at day 15 after modeling and at day 2 after recurrence,and the central cornea touch sensitivity was the worst at day 9 after initial infection.The mean corneal lesion area was 3.348 mm2 in the ACV+bevacizumab-injected group,which was smaller than 3.930 mm2 in the ACV-injected group (Z=-2.309,P =0.021).The central corneal sensitivity in the ACV+bevacizumab-injected group was significantly higher than that in the normal saline-injected group (5.50± 0.71 versus 0.50± 1.41,Z =-2.397,P =0.029).The increase rate of corneal lesion area in the ACV +bevacizumabinjected group was evidently lower than that in the normal saline-injected group ([167.10 ± 52.53]％ versus [312.30± 74.18] ％,Z =-1.992,P =0.046).At the 7th day after modeling,the relative expressing levels of thymidine kinase (TK) and infected-cell protein-27 (ICP-27) mRNA in the corneal tissue and trigeminal ganglion were significantly increased at day 7 and reduced at day 45 after modeling,and the factors raised again at day 2 and retreated at day 7 after induction of recurrence.In addition,the expression of LAT mRNA peaked at day 45 after modeling and reduced gradually at day 2 after recurrence until a new increasing peak at day 7 after recurrence (all at P＜0.01).Immunofluorescence showed that compared with the normal saliue-injected group,the corneal new vessels were lessened and corneal never fibers were increased in the ACV-injected group and ACV +bevacizumab-injected group.Conclusions The combination of bevacizumab with ACV can inhibit corneal neovascularization and scarring in HSK mice,and bevacizumab exhibits a synergistic effect with ACV in management of HSK.

Objective Our preliminary study demonstrates that quercetin can inhibit the proliferation of HL-60 cells. This sudy aimed to find some drugs which could have synergistic effects with quercetin on apoptosis of HL-60 cells. Methods HL-60 cells were cultured with bortezomib at different concentrations (1, 2, 4, 8, 16, and 32μmol/L) alone or combined with quercetin at different concentrations for 48 h. HL-60 cells were cultured with lenalidomide at different concentrations (5, 10, 20, 40, 80, 160, and 320 μmol/L) alone or in combination with quercetin at different concentrations for 48 h. The CCK-8 assay was used to determine the effects on proliferation of HL-60 cells. Results Bortezomib significantly inhibited the proliferation of HL-60 cells (P<0.01). IC50 of quercetin was 49.24μmol/L after cells treated by quercetin combined with bortezomib, which was 13.44μmol/L lower than that treated by quercetin alone. Isobolographic analysis revealed the two drugs had synergistic effect. The results of cell viability of HL-60 cells treated by lenalidomide at lower concentrations (5, 10, 20, 40, and 80μmol/L)were not different from those of the control group (P > 0.05). The results of cell viability of HL-60 cells treated by lenalidomide at higher concentrations (160 and 320μmol/L) were lower than those of the control group (P<0.05). IC50 of quercetin after cells treated by quercetin combined with bortezomib was not different from that treated by quercetin alone. Isobolographic analysis revealed the two drugs had no synergistic effect. Conclusions Bortezomib can inhibit the proliferation of HL-60 cells and it has a synergistic effect with quercetin on HL-60 cells. Lenalidomide has a weaker role in inhibition of the proliferation of HL-60 cells, and it has no synergistic effect with quercetin on HL-60 cells.

Objective To investigate the effect of membrane-bound prostaglandin E2 synthase 1 (mPGES-1) inhibitor MK886 on cell cycle of the human acute myeloid leukemia HL-60/A cells.Methods Flow cytometry,Western blot and ELISA were used to measure the difference of cell cycle,expression of cyclin D1, mPGES-1 among HL-60/A cells,MNC and HL-60 cells.The effect of MK886 on cell cycle,cyclin D1,mPGES-1,PGE2,P-Akt and c-myc of HL-60/A cells were observed.Results Compared with MNC and HL-60 cells,the expression of cyclin D1 and mPGES-1 were higher in HL-60/A cells,the percentage of G0-G1 phase was decreased [MNC (62.63±6.58) ％,HL-60 (38.86±2.25) ％,HL-60/A (30.53±2.15) ％]and S phase increased[MNC (12.18±4.43) ％,HL-60 (47.70±1.88）％,HL-60/A (57.56±1.54) ％](all P＜ 0.05).After treated with MK886,cell cycle was arrested in G0-G1 phase.The expression of mPGES-1,cyclin D1,P-Akt and c-myc and synthesis of PGE2 were decreased.Conclusion MK886 can arrest HL-60/A cell cycles in G0-G1 phase,which possibly through down-regulation of mPGES-1/PGE2,reduction cyclin D1,P-Akt and c-myc expression.

Objective To detect eight kinds of clinical common pathogenic bacteria by DNA microarray.Methods Eight kinds of common pathogenic bacteria,including Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,Proteus mirabilis,Enterobacter aerogenes,Pseudomonas fluorescens,Shigella sonnei were collected.Universal primers were designed to amplify 16S rRNA gene fragment from the genomic DNA of the eight bacteria,and probes were designed in the highly variable regions.DNA microarray detection system was established and used for detection of colleted bacteria.A total of 50 samples were collected from the Zhongnan Hospital of Wuhan University,including 6 blood samples,32 sputum samples,9 feces samples and 3 bronchoscope lavage samples.DNA were extracted and detected by the established DNA microarray system.Results The desired fragments were well amplified by the self-designed universal primers.The selected probes had good detection results according to repeated detection.Of the 50 samples detected,pathgenic bacteria were accurately detected in 47 samples.Other three samples were not detected as those bacteria were not included in the chip.By optimizing the detection process,the results could be reported within 8 hours.Observation of probe signal attenuation indicated that even attenuated after 60 days,but the attenuation did not affect the results.Conclusion A microarray system was established for detection of clinical common bacteria accurately and quickly,which provided foundation for its clinical application.

Objective To develop a gene microarray system for detection of clinical common pathogenic fungi.MethodsThere were 8 clinical common fungi chosen as the subjects including Candida albicans,Candida glabrata,Candida tropicalis,Candida parapsilokis,Candida pseudotropicalis,Aspergillus terreus,Aspergillus flavus,Aspergillus oryzae,Aspergillus fumigatus.Universal primers,probes and specific probes for the PCR amplification and microarray preparation were designed in ITS region of the fungi genomic DNA.The PCR products amplified from those fungi's genome DNA were denatured and hybridized with the probes in gene microarray.The rapid detection of fungi was based on the investigation on the fluorescent signal intensity in the chip.The detection results of gene microarray system were verified by true positive and negative clinical samples.Results There were totally 25 positive samples identified by clinical routine microbiological methods.The 10 samples identified as bacteria positive were determined as negative without fluorescent signal by the fungi gene microarray,while the 12 samples identified as fungi positive were determined as positive with certain fungus by the fungi gene microarray.And 3 artificial Candida krusei samples were detected as fungi positive,while they were failure to be identified as certain fungus.There was no fluorescent signal in positions of the 8 fungi specific probes,but there was fluorescent signal in the position of fungi universal probe.It indicated that there were fungi in the samples but it couldn't identify the species of the fungi,because the Candida krusei wasn't included in the detection fungi list of the fungi gene microarray.ConclusionsThe fungi gene microarray established by the study could detect the common fungi in clinic rapidly and accurately.This study lays technology foundation for clinical application of gene chip.