The mediating effect of chronic disease self efficacy between spiritual well-being and mental resilience in patients undergoing chemotherapy after radical mastectomy for breast cancer / 中国实用护理杂志

Objective:To investigate the chronic disease self efficacy, mental resilience and spiritual well-being level in patients undergoing chemotherapy after radical mastectomy for breast cancer, and to explore whether there is a mediating effect among them.Methods:This study was a cross-sectional study. A total of 376 patients undergoing chemotherapy after radical mastectomy for breast cancer were selected as the survey objects by convenience sampling method from July 2020 to April 2021 in Shandong Provincial Hospital Affiliated to Shandong First Medical University. The chronic disease self efficacy, mental resilience and spiritual well-being were evaluated by Self-Efficacy Scale for Managing Chronic Disease, Functional Assessment of Chronic Illness Therapy Spiritual Well-being, Connor-Davidson Resilience Scale. The correlation among the chronic disease self efficacy, mental resilience and spiritual well-being was tested by Pearson correlation analysis. Structural equation model was used to analyze the intermediary mechanism of the chronic disease self efficacy, mental resilience and spiritual well-being.Results:The total score for chronic disease self-efficacy of the research objects was (33.34 ± 12.77) points, the total score for mental resilience was (66.13 ± 21.67) points, and the total score for spiritual well-being was (28.41 ± 10.13) points. The chronic disease self-efficacy, mental resilience, and spiritual well-being were all positively correlated ( r values were 0.689-0.949, all P<0.01). The chronic disease self-efficacy played a partially mediating role in spiritual well-being and mental resilience in patients undergoing chemotherapy after radical mastectomy for breast cancer ( β=0.387, P<0.01), the mediating effect accounted for 43.33% of the total effect. Conclusions:The chronic disease self-efficacy can indirectly affect the level of spiritual well-being in patients undergoing chemotherapy after radical mastectomy for breast cancer. Clinical medical staff should pay attention to their psychological counseling, broaden their minds, enhance spiritual well-being, and help them recover from adversity.

Interpretation of the limit values of iodide in the "Standards for Drinking Water Quality（GB5749-2022）" in China / 中华预防医学杂志

The Drinking Water Sanitation Standard (GB 5749-2022) has been officially promulgated and implemented, with the iodide listed as a new reference indicator for water quality. This study interprets the distribution of iodine in environmental media, the impact of water iodine on health, the significance of establishing iodide standard limits, and the use of iodide standard limits, in order to provide a scientific basis for the application of iodide standard limits in this revised standard.

Prenatal diagnosis and genetic analysis of a fetus with partial deletion of Yq and mosaicism of 45,X / 中华医学遗传学杂志

OBJECTIVE@#To carry out prenatal diagnosis and genetic analysis for a fetus with disorders of sex development (DSDs).@*METHODS@#A fetus with DSDs who was identified at the Shenzhen People's Hospital in September 2021 was selected as the study subject. Combined molecular genetic techniques including quantitative fluorescence PCR (QF-PCR), multiplex ligation-dependent probe amplification (MLPA), chromosomal microarray analysis (CMA), quantitative real-time PCR (qPCR), as well as cytogenetic techniques such as karyotyping analysis and fluorescence in situ hybridization (FISH) were applied. Ultrasonography was used to observe the phenotype of sex development.@*RESULTS@#Molecular genetic testing suggested that the fetus had mosaicism of Yq11.222qter deletion and X monosomy. Combined with the result of cytogenetic testing, its karyotype was determined as mos 45,X[34]/46,X,del(Y)(q11.222)[61]/47,X,del(Y)(q11.222),del(Y)(q11.222)[5]. Ultrasound examination suggested hypospadia, which was confirmed after elective abortion. Combined the results of genetic testing and phenotypic analysis, the fetus was ultimately diagnosed with DSDs.@*CONCLUSION@#This study has applied a variety of genetic techniques and ultrasonography to diagnose a fetus with DSDs with a complex karyotype.

Responses of blood parameters and hemoglobin subtypes in plateau zokors and plateau pikas to different altitude habitats / 生理学报

The plateau zokor (Myospalax baileyi) and plateau pika (Ochotona curzoniae) are native species unique to the Qinghai-Tibetan Plateau with successful adaptation to the hypoxic environment. In this study, the number of red blood cells, hemoglobin concentration, mean hematocrit and mean volume of red blood cells were measured in plateau zokors and plateau pikas at different altitudes. Hemoglobin subtypes of two plateau animals were identified by mass spectrometry sequencing. The forward selection sites in two animals' hemoglobin subunits were analyzed by PAML4.8 program. Homologous modeling was used to analyze the effect of forward selection sites on the affinity of hemoglobin to oxygen. The adapting strategies of plateau zokors and plateau pikas to hypoxia at different altitudes were analyzed through comparing blood parameters between the two species. The results indicated that, with increasing altitudes, plateau zokors responded to hypoxia by increasing red blood cell count and decreasing red blood cell volume, while plateau pikas took the opposite strategies to plateau zokors. In erythrocytes of plateau pikas, both adult α2β2 and fetal α2ε2 hemoglobins were identified, while erythrocytes of plateau zokors only had adult α2β2 hemoglobin, however the affinities and the allosteric effects of the hemoglobin of plateau zokors were significantly higher than those of plateau pikas. Mechanistically, in the α and β subunits of hemoglobin of plateau zokors and pikas, the numbers and the sites of the positively selected amino acids as well as the side chain groups polarities and orientations of the amino acids differed significantly, which may result in the difference of the affinities to oxygen of hemoglobin between plateau zokors and pikas. In conclusion, the adaptive mechanisms to respond to hypoxia in blood properties of plateau zokors and plateau pikas are species-specific.

Effects of bisphenol A and bisphenol analogs on the nervous system / 中华医学杂志(英文版)

Estrogen impacts neural development; meanwhile, it has a protective effect on the brain. Bisphenols, primarily bisphenol A (BPA), can exert estrogen-like or estrogen-interfering effects by binding with estrogen receptors. Extensive studies have suggested that neurobehavioral problems, such as anxiety and depression, can be caused by exposure to BPA during neural development. Increasing attention has been paid to the effects on learning and memory of BPA exposure at different developmental stages and in adulthood. Further research is required to elucidate whether BPA increases the risk of neurodegenerative diseases and the underlying mechanisms, as well as to assess whether BPA analogs, such as bisphenol S and bisphenol F, influence the nervous system.

Treatment of chronic urticaria with acupuncture and moxibustion by "mind-body regulation" based on "psychosomatic medicine" / 中国针灸

The treatment idea for chronic urticaria with acupuncture and moxibustion by "mind-body regulation" is explored in reference with "psychosomatic medicine". Chronic urticaria refers to "mind and body comorbidity" because qi and blood dysfunction and emotional abnormality are presented simultaneously in the disease and affected each other. In clinical diagnosis and treatment, the mutual regulation of mind and body should be considered to improve the curative effect. In treatment with acupuncture and moxibustion, through regulating the mind of brain, heart and zang organs, as well as qi movement, the mental activity is adjusted; through harmonizing the defensive qi and the nutrient blood, eliminating wind and stopping itching, the unhealthy conditions of body are treated. The comprehensive therapy of acupuncture is adopted in combination with moxibustion, bloodletting and auricular point therapy, in which, "regulating the mind" goes through the whole process of treatment, and the doctors and patients are well cooperated to ensure the qi-blood harmonization and the mind-body wellness.

Determination of iodine in workplace air by inductively coupled plasma mass spectrometry / 中国职业医学

Objective To establish a solvent desorption inductively coupled plasma-mass spectrometry (ICP-MS) method for determination of iodine in workplace air. Methods Iodine in workplace air was collected with alkaline activated carbon tube and desorbed with 10.0 mL pure water or 20 mmol/L sodium bicarbonate solution. Rhenium-185 was used as an internal standard for quantification. The sample was determined in standard mode and kinetic energy discrimination collision (KED) mode by ICP-MS. Results In standard mode, iodine showed a good linear range in the concentration of 9.0 to 1 100.0 μg/L, with a correlation coefficient of 0.999 3 and a detection limit of 2.7 μg/L. In KED mode, iodine showed a good linear range in the concentration of 24.3 to 800.0 μg/L, with a correlation coefficient of 0.999 1 and a detection limit of 7.3 μg/L. The average desorption efficiency using pure water ranged from 99.1% to 106.7%, with within-run relative standard deviation (RSD) of 3.1% to 8.0% and between-run RSD of 4.9% to 9.3%. The average desorption efficiency using sodium bicarbonate solution ranged from 96.5% to 105.3%, with within-run RSD of 4.9% to 8.6% and between-run RSD of 2.5% to 9.9%. There were no statistical significant differences in the main effects of desorption solution, ICP-MS detection mode, their interaction on average desorption efficiency and within-run RSD (all P>0.05). Samples could be stored at room temperature for at least 7 days. Conclusion This method is highly sensitive, accurate, and suitable for the determination of iodine in workplace air. The sample pretreatment is simple and rapid.

Joinpoint regression analysis and Epidemiological characteristics of hepatitis in Changning District of Shanghai in 2009 - 2019 / 公共卫生与预防医学

Objective To investigate the tendency of viral hepatitis in Changning District, Shanghai, and to provide scientific evidence for decision-making of prevention and control. Methods Cases of viral hepatitis in Changning District from 2009-2019 were collected , and the epidemiological characteristics of viral hepatitis were analyzed by descriptive epidemiological method. Joinpoint regression analysis were used to estimate the annual percent change and average annual percent change, and to perform the trend test. Results Among the 2009-2019 in Changning District, a total of 3 397 cases of viral hepatitis were reported , the annual average incidence rate was 49.32/100 000. Results from Joinpoint trend analysis indicated that the incidence of viral hepatitis in Changning District was mainly due to hepatitis A and hepatitis B. Conclusions Although the annual incidence rate of viral hepatitis in Changning District is far below the incidence rate of viral hepatitis in China, but it still shows an increasing trend. This shows that the situation of prevention and control of viral hepatitis in Changning is still serious, and hepatitis B remains the key point of prevention of viral hepatitis in Shanghai.

Early diagnostic value of mNGS for 15 cases with critical rickettsial disease in Hainan / 中华检验医学杂志

Objective:To explore the clinical utility of metagenomic next-generation sequencing (mNGS) for patients with critically ill atypical rickettsial infections in the early diagnosis and therapy.Methods:From Jan 2020 to Aug 2022, clinical features, blood biochemical results, imaging data and mNGS results in patients with unexplained critical illnesses were collected and analyzed retrospectively. Fisher's exact test was used to compare the positive rate of mNGS and weil felix reaction.Results:All 15 patients with rickettsial disease had fever, 12 cases had headache, but only 3 had a typical rash or scab of diagnostic significance, 6 had septic shock and all had multi-organ dysfunction; blood mNGS tests were positive in 15 cases, of which 10 had Orientia tsutsugamushi detected in their blood and the remaining five had Rickettsia moschata detected in their blood. The positive rate of mNGS was significantly higher than that of the weil felix reaction (15/15 vs 0, P<0.001). All patients were given doxycycline and other treatments after diagnosis, of which 14 improved and were discharged, and one died 1 week after discharge due to critical condition and abandonment of treatment. Conclusion:mNGS can improve the detection rate of atypical rickettsiae in patients with negative routine test results, which can provide valuable reference basis for early diagnosis and early anti-infection treatment of patients with critical rickettsial disease.

Comparison between white light endoscopy and narrow-band imaging endoscopy in predicting histological healing of ulcerative colitis in remission / 中华消化内镜杂志

Objective:To investigate the predictive value of mucosal vascular pattern (MVP) under narrow-band imaging (NBI) enteroscopy in patients with ulcerative colitis (UC) in clinical remission for histological healing and clinical recurrence.Methods:A total of 142 patients with UC in clinical remission who visited the First Affiliated Hospital of Weifang Medical University from January 2018 to January 2021 were included in the study and underwent colonoscopy. The white light and NBI endoscopic images were collected and biopsies were obtained. The Mayo endoscopic score (MES) was calculated based on white light images, and MVP staging was evaluated based on mucosal vascular patterns under NBI. Nancy index (NI) was used to evaluate histological healing and patients were followed up for 1 year. The Spearman correlation coefficients of MES and MVP with histological healing and recurrence were calculated. The receiver operator characteristic (ROC) curve was plotted and the area under curve (AUC) was applied to evaluate the accuracy of white light and NBI endoscopy for predicting histological healing of UC in clinical remission.Results:According to the MVP criteria, 47 were defined as clear, 63 blurred, and 32 invisible. Spearman correlation analysis showed a significant correlation between MVP under NBI and histological healing ( r=0.549, P<0.001) and a moderate correlation between MES under white light and histological healing ( r=0.462, P<0.001). Spearman correlation analysis showed a moderate correlation between MVP under NBI and clinical recurrence ( r=0.451, P<0.001) and a moderate correlation between MES under white light and clinical recurrence ( r=0.352, P<0.001). AUC of NBI for diagnosing histological healing of UC in clinical remission was 0.809 (95% CI: 0.738-0.879), with a sensitivity of 84.6% (77/91) and specificity of 64.7% (33/51), superior to the white light endoscopy, of which AUC, sensitivity and specificity were 0.763 (95% CI: 0.678-0.848), 81.3% (74/91) and 66.7% (34/51). Conclusion:MVP staging under NBI could predict histological healing of UC patients in clinical remission and is superior to white light endoscopy.

Long-term survival influencing and risk factors in peritoneal dialysis patients: a single center study in Southwest China / 中华肾脏病杂志

Patients who initiated peritoneal dialysis (PD) in Sichuan Provincial People's Hospital from January 1, 2001 to December 31, 2013 were enrolled in the single center and retrospective study. Clinical and laboratory data were collected to analyze the long-term survival rates, technique survival rates and associated influencing factors. Patients were followed up until December 31, 2021 or endpoints occurred (death or stopping PD treatment). Kaplan-Meier survival curves were used to estimate survival rates and technique survival rates. Cox proportional hazards regression model was used to analyze the risk factors of death and technique failure in PD patients. A total of 373 patients were enrolled in the study, with age of (52.1±15.8) years old and 199 (53.4%) males. During the follow-up, 154 (41.3%) patients died, 72 (19.3%) patients transferred to hemodialysis, and 40 (10.7%) patients received kidney transplant. Kaplan-Meier survival curves revealed that overall survival rates of PD patients at 1, 3, 5, 7, and 10 years were 92.2%, 76.6%, 66.0%, 52.4% and 38.6%, respectively. Technique survival rates were 93.5%, 84.8%, 74.2%, 62.8% and 44.5% at 1, 3, 5, 7, and 10 years, respectively. Multivariate Cox regression model results showed that age ( HR=1.055, 95% CI 1.039-1.073, P<0.001), transfer from hemodialysis ( HR=2.212, 95% CI 1.514-3.231, P<0.001), episodes of peritonitis ( HR=2.141, 95% CI 1.194-3.837, P=0.011), Charlson comorbidity index ( HR=1.525, 95% CI 1.305-1.783, P<0.001), and baseline albumin ( HR=0.951, 95% CI 0.925-0.978, P<0.001) were independent influencing factors of survival in PD patients. Episodes of peritonitis ( HR=2.327, 95% CI 1.274-4.250, P=0.006) and Charlson comorbidity index ( HR=1.244, 95% CI 1.035-1.496, P=0.020) were independent influencing factors of technique survival in PD patients. PD patients have good early survival rates and technical survival rates, but long-term outcomes need to be further improved. Peritonitis is a major risk factor for low long-term survival rates and technical survival rates in PD patients.

The relationship between sleep arousal, ambulatory blood pressure and heart failure in elderly patients with obstructive sleep apnea / 中华老年医学杂志

Objective:To evaluate the relationship between sleep arousal, ambulatory blood pressure and new-onset heart failure(NOHF)in elderly patients with obstructive sleep apnea(OSA).Methods:A total of 584 elderly patients with OSA who were diagnosed and treated in our hospital between March 2015 and March 2019 were prospectively and consecutively selected, with a mean age of(70.1±7.2)years.Polysomnography(PSG)results were obtained at baseline, and the arousal index(AI)was calculated.Based on the quartiles of AI, patients were divided into 4 groups: a low-level group(AI<18.4/h, 186 cases), a low-medium level group(18.4-29.1/h, 177 cases), a medium-high level group(29.2-41.2/h, 137 cases)and a high-level group(>41.2 /h, 84 cases). Participants were followed up for 18 months, the results of ambulatory blood pressure were recorded and compared, and the relationship between AI and the risk of NOHF was analyzed.Results:Compared with the low-level group, patients in the low-medium, medium-high, and high-level groups were older(70.1, 70.3, 73.3 vs.68.7 years, F=2.726, P=0.043)and had more smokers(43.8%, 49.6%, 54.8% vs.38.2%, χ2=8.809, P=0.032), a larger body mass index(26.3, 26.7, 27.6 vs.25.4 kg/m 2, F=2.731, P=0.042), a higher Epworth sleepiness scale score(7.83, 8.50, 9.91 vs.7.64, F=5.124, P=0.018), a higher apnea hypopnea index(23.5, 34.8, 52.7 vs.17.6, F=5.632, P=0.007), lower nocturnal oxygen saturation(80.2, 75.3, 72.1 vs.83.7 mmHg, F=4.811, P=0.024), and higher N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels(317.5, 337.5, 359.2 vs.267.5 pg/L, F=4.307, P=0.033). At the median follow-up(18 months, 14-24 months), the results of ambulatory blood pressure monitoring showed that 24-hour systolic blood pressure(24 h SBP)(147.3, 148.6, 156.2 vs.143.8 mmHg, F=5.4311, P=0.013), 24-hour diastolic blood pressure(24 h DBP)(80.1, 79.5, 83.7 vs.76.5 mmHg, F=5.679, P=0.011)in the low-medium, medium-high and high-level groups were higher than those in the low-level group.The results of survival analysis showed that there were 75(12.8%)cases of NOHF, mostly with preserved ejection fraction(47 cases)or mid-range ejection fraction heart failure(20 cases). The incidences of NOHF were 6.5%, 12.4%, 16.1% and 22.4%, respectively for the low level, low-medium, medium-high and high-level groups, and the risk of NOHF in the low-medium, medium-high and high-level groups was significantly higher than in the low level group(log-rank χ2=11.624, P=0.007). Variables with P<0.2 in the univariate analysis, age and sex were included in the multivariate Cox regression analysis.The results showed that age( HR=1.724, 95% CI: 1.216-3.135), diabetes( HR=1.514, 95% CI: 1.127-3.058), NT proBNP( HR=1.517, 95% CI: 1.232-2.366), nocturnal diastolic blood pressure( HR=2.004, 95% CI: 1.332-4.638), and middle-high AI level( HR=1.611, 95% CI: 1.204-2.967)and high AI level( HR=1.863, 95% CI: 1.272-3.538)were independent factors of NOHF in elderly OSA patients. Conclusions:Sleep arousal in elderly patients with OSA increases blood pressure levels and the risk of NOHF.

Awareness of HPV and HPV vaccine and willingness to be vaccinated among parents of children aged 9-14 / 公共卫生与预防医学

Objective To investigate the HPV vaccination status of children aged 9-14 years, parents’ vaccine-related cognition, willingness to vaccinate children and their influencing factors. Methods From January to April 2021, the convenience sampling method was used to collect data based on the online platform and the Department of Pediatrics and Adolescent Gynecology of the Children's Hospital of Zhejiang University School of Medicine. The data were analyzed by descriptive analysis, Chi-square test, and logistic regression. Results A total of 864 questionnaires were collected, and 846 valid questionnaires were obtained after screening, with an effective rate of 97.9%. 13.57% of mothers and 3.09% of girls were vaccinated, and the vaccine awareness rate was 68.43%. 87.22% of parents were willing to bring their children for vaccination. Risk perception (OR=4.79, 95% CI: 2.22-10.35), willingness to vaccinate themselves (OR =29.01, 95% CI: 12.62-66.69), awareness of sex education (OR =3.73, 95% CI: 1.08-12.83) and whether the vaccines were free (P<0.001) were related to whether parents were willing to vaccinate their children. Conclusion Parents of children aged 9-14 have high awareness of HPV and HPV vaccine and are willing to vaccinate their children with HPV vaccine , but the vaccination rate in children is low. Disease perception, willingness to vaccinate, awareness of sex education, and whether vaccines are free are all the factors influencing parents' willingness to vaccinate children.

Quantifying carotid stiffness in a pre-hypertensive population with ultrafast ultrasound imaging

Purpose@#The aim of this study was to assess carotid stiffening in a pre-hypertensive (PHT) population using ultrafast pulse wave velocity (ufPWV). @*Methods@#This study retrospectively enrolled 626 individuals who underwent clinical interviews, serum tests, and assessments of the systolic blood pressure (SBP), diastolic blood pressure (DBP), carotid intima-media thickness (cIMT), pulse wave velocity-beginning of systole (PWV-BS), and pulse wave velocity-end of systole (PWV-ES) between January 2017 and December 2021. The patients were divided into three groups according to their blood pressure (BP)—normal BP (NBP): SBP 0.05). However, the NBP group had a notably lower PWV-ES than the PHT (P0.05). @*Conclusion@#Carotid morphological and biomechanical properties in the PHT group differed from those in the NBP group. ufPWV could be used for an early evaluation of carotid stiffening linked to pre-hypertension.

Research progress of 5-aminolevulinic acid-mediated photodynamic therapy for the treatment of anal canal condyloma acuminatum / 中国基层医药

Condyloma acuminatum is a sexually transmitted disease caused by human papillomavirus infection. In recent years, the incidence of anal canal condyloma acuminatum is gradually increasing, which seriously affects the physical and mental health of patients. At present, various treatment options are available for condyloma acuminatum. There is no method to completely eradicate condyloma acuminatum. 5-Aminolevulinic acid-mediated photodynamic therapy is a novel approach that uses photosensitizers and light to treat condyloma acuminatum and has been widely used in the clinic. This paper reviews the underlying action mechanism of 5-aminolevulinic acid-mediated photodynamic therapy and the clinical research progress of 5-aminolevulinic acid-mediated photodynamic therapy for the treatment of anal canal condyloma acuminatum.

Research on the application of Internet + technical liaison service model in elderly osteoporotic hip fractures patients after surgery / 中国实用护理杂志

Objective:To explore the effect of Internet + technical liaison service mode on the postoperative continuing nursing of elderly patients with osteoporotic hip fractures.Methods:A total of 92 elderly patients with osteoporotic hip fractures who were admitted into in Orthopaedics Department of the First Affiliated Hospital of Soochow University from July 2018 to December 2019 were selected, and randomly divided into intervention group and control group by random number table method, with 46 cases in each group. The control group was given routine follow-up outside hospital, while the intervention group was given the continuing nursing led by the orthopedic specialist nurses based on the Internet + Technology home orthopedic care platform. All patients were followed up to 6 months after operation, and the differences of Harris Hip Score (Harris), Numeric Rating Scales (NRS), Barthel Index, Short Form 36-item Health Survey (SF-36) between the two groups were compared.Results:The Harris scores were 49.74 ± 4.28, 76.59 ± 4.33 and 90.78 ± 2.61 in the intervention group, and 46.17 ± 3.85, 74.26 ± 4.24 and 88.65 ± 2.17 in the control group in 1, 3 and 6 months after operation, respectively. The differences were statistically significant ( t=-4.20, -2.60, -4.26, all P<0.05). The NRS scores in the intervention group were 1.33 ± 0.47, 0.83 ± 0.38 and 0.76±0.43 in 1, 3 and 6 months after operation respectively, while the NRS scores in the control group were 1.61 ± 0.54, 0.96 ± 0.42 and 0.84 ± 0.38, respectively. The difference in pain scores between the two groups was statistically significant only at 1 month after operation ( t=2.68, P<0.05). The Barthel Index in the intervention group were 61.74 ± 8.90, 93.80 ± 5.29 and 98.26 ± 2.83 in 1, 3 and 6 months after operation respectively, while those of the control group were 60.33 ± 5.81, 91.09 ± 7.52 and 97.83 ± 3.10, respectively. The difference in Barthel Index between the two groups was statistically significant only in 3 months after operation ( t=-2.00, P<0.05). The scores of SF-36 in the intervention group were 93.73 ± 3.89, 100.26 ± 3.77 and 107.50 ± 3.56 at 1, 3 and 6 months after operation respectively, while those of the control group were 92.67±3.42, 97.71±2.67 and 103.68±2.83, respectively. The difference in SF-36 scores between the two groups was statistically significant only at 3 and 6 months after operation ( t=-3.74, -5.71, P<0.05). Conclusions:The continuing nursing based on multi-disciplinary team cooperation in hospital + Internet + Technology home orthopaedic nursing platform led by orthopaedic specialist nurses can improve joint function, relieve pain and improve quality of life of elderly patients with osteoporotic hip fractures after operation.

Study of level Ⅴmetastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of the neck node levels / 中华放射肿瘤学杂志

Objective:According to 2013 updated consensus guidelines of neck node levels, the distribution characteristics of cervical lymph nodes of nasopharyngeal carcinoma (NPC) were analyzed, aiming to provide preliminary reference for the clinical target volume (CTV) delineation of level Ⅴ in NPC.Methods:A total of 1110 patients pathologically diagnosed with NPC from 2012 to 2020 were retrospectively recruited for further analysis. All patients’ MRI and contrast-enhanced CT simulation scan imageswere retrospectively reviewed, metastatic lymph nodes were mapped using the 2013 International Consensus Guidelines. Then, the correlation between Ⅴa, Ⅴb and Ⅴc metastatic lymph nodes and other lymph nodes was analyzed. An NPC case diagnosed with T 1N 0M 0 was selected as the baseline standard for the normal anatomical structure and proportion of Ⅴc area. The metastatic lymph nodes in Vc were delineated on the CT simulation scan image of sample case, and the distribution characteristics of the metastatic lymph nodes inⅤc were analyzed. Results:Among the 1110 patients, 1004(90.5%) patients had lymph node metastases. The most common area of metastatic lymph node levels were level Ⅶa (74.7%) and level Ⅱb(70.7%), and the skip metastasis of lymph nodes was rare (1.0%). The multivariate analysis showed lymph node metastasis in level Va was correlated with levels Ⅱb, Ⅲ, Ⅳa, Ⅴb, and Ⅷ region ( P=0.010, 0.001, 0.001, 0.001, 0.037). Lymph node metastasis in level Ⅴb was correlated with levels Ⅲ, Ⅳa, Ⅴa and Ⅴc region ( P=0.006, 0.001, 0.001, 0.001). Lymph node metastasis in level Ⅴc was correlated with levels Ⅳb and Ⅴb region ( P=0.008, 0.001). There were 28 cases of lymph node metastasis in levelⅤc. A total of 38 metastatic lymph nodes were counted in level Vc. Among them, 33(86.8%) lymph nodes were located in the medial of the omohyoid muscle (Ⅴc-1 region), and 5(13.2%) were located in the lateral of the omohyoid muscle (Ⅴc-2 region). Conclusions:This study reflects the principle of individualized CTV delineation, which is based on the levels of nodal spread in NPC patients. When correlation is observed among different level V, V should be delineated as the moderate risk lymphatic drainage (CTV n2). It is recommended to individualized delineate level Vc when the CTV n2 covers Vc. The Ⅴc-2 region should be delineated as CTV n2 only when there is nodal spread in the ipsilateral Ⅴc-1 region.

Individualized enteral nutrition support nursing for the patient with severe pneumonia who underwent extracorporeal membrane oxygenation with prone position ventilation: a case report / 中国实用护理杂志

Objective:To summarize the nursing experience of enteral nutritionin a patient with severe pneumonia who received extracorporeal membrane oxygenation combined with prone ventilation.Methods:A patient with severe pneumonia who underwent extracorporeal membrane oxygenation combined with prone ventilation from Xiangya Hospital of Central South University on November 8, 2020 was given individualized nutrition support program. The patient′s condition was evaluated, individual nutrition support plan was formulated, early nutrition was implemented, appropriate feeding route was selected, tolerance was evaluated during the implementation process, and enteral nutrition-related complications were nursing.Results:After careful treatment and nursing, the patient′s condition was improved and was transferred out of ICU for continued treatment.Conclusions:For this kind of patients with severe pneumonia who underwent extracorporeal membrane oxygenation combined with prone ventilation to choose the pyloric feeding to reduce aspiration. Early nourishing nutrition to protect the intestinal mucosa; ultrasonic monitoring of antral motility index was used to guide the implementation of enteral nutrition. Regular evaluation of feeding tolerance during nutrition implementation, the strategy and implementation of enteral nutrition were adjusted according to the intra-abdominal pressure combined with feeding tolerance, and the prevention and nursing of enteral nutrition complications were carried out at the same time.

Isolation and Identification of Arisaema Cum Bile Fermentation Strain and Preliminary Investigation on Its Compound Strain Fermentation / 中国实验方剂学杂志

ObjectiveIn order to solve the problem that the quality and stability of Arisaema Cum Bile in the fermentation process with hybrid bacteria were not easy to control， the microorganism in the fermentation process of Arisaema Cum Bile was isolated and identified， the dominant strains were screened and the fermentation process of Arisaema Cum Bile with compound bacteria was investigated. MethodThe submerged culture during the fermentation process of Arisaema Cum Bile was taken out for strain separation and purification. Bacteria and fungi multiphase identification and detection methods and automatic microbial analysis system were used to analyze and compare DNA sequences and identify microorganisms. The isolated and identified strains were respectively inoculated and fermented. After screening the dominant strains， a preliminary exploration of compound strain fermentation were carried out. The contents of index components in Arisaema Cum Bile fermented by compound strain and traditional Arisaema Cum Bile were compared by ultra-performance liquid chromatography-triple quadrupole tandem mass spectrometry （UPLC-QqQ-MS/MS）. Mmobile phase was 0.1% formic acid acetonitrile solution （A）-0.1% formic acid aqueous solution （B） for gradient elution （0-2 min， 35%-45%A； 2-10 min， 45%-48%A； 10-12 min， 48%-100%A； 12-12.01 min， 100%-35%A； 12.01-15 min， 35%-65%A）， the flow rate was set at 0.35 mL·min-1. The mass spectrographic analysis employed electrospray ionization （ESI）， negative ion acquisition mode and multiple reaction monitoring （MRM） scanning mode were adopted to collect information， the collection range was m/z 50-1 000. ResultEight microorganisms were isolated and identified from the submerged culture of Arisaema Cum Bile. Among them， Enterococcus sp. （anaerobic） and E. casseliflavus were selected as the dominant strains in the fermentation process. Compared with the traditional fermentation method， the contents of chenodeoxycholic acid， hyodeoxycholic acid and hyocholic acid in free cholic acid increased by 1.76， 0.06， 0.19 mg·g-1， respectively. In bound cholic acid， glycochenodeoxycholic acid， taurochenodeoxycholic acid， glycohyodeoxycholic acid， taurohyodeoxycholic acid， glycohyocholic acid， taurine porcine cholic acid decreased by 0.63， 0.23， 0.26， 0.16， 0.03， 0.04 mg·g-1， respectively. ConclusionArisaema Cum Bile with compound strain fermentation （Enterococcus sp. and E. casseliflavus） can be fermented more completely， the fermentation cycle can be shortened， and the quality and stability of products can be improved.

Effect of Gupi Xiaoji Decoction on Pyroptosis of HepG2.2.15 Cells Based on Network Pharmacology and Molecular Docking / 中国实验方剂学杂志

ObjectiveTo screen the active antitumor components of Gupi Xiaoji decoction by network pharmacology and molecular docking based on the pyroptosis mediated by cysteinyl aspartate-specific protease 1 （Caspase-1） and explore its molecular mechanism in intervening in the pyroptosis of HepG2.2.15 cells through in vitro experiments. MethodThe compounds and targets of Gupi Xiaoji decoction were screened out by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） to obtain the corresponding gene symbols. The targets of Caspase-1 were collected from GeneCards，online mendelian inheritance in man（OMIM），PharmGKB，and TTD，and the compound-gene target regulatory network was constructed by Cytoscape. The protein-protein interaction（PPI） network was established and analyzed by STRING. The mechanism of the effective components of Gupi Xiaoji decoction on Caspase-1 was predicted by gene ontology（GO） functional enrichment and Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway enrichment analyses. The molecular docking was verified with AutoDock Vina. The plasma medicated with Gupi Xiaoji Decoction was prepared and HepG2.2.15 cells were cultured in vitro. HepG2.2.15 cells were divided into a blank plasma group，a VX-765 group，a VX-765+medicated plasma group， and a medicated plasma group. After 48 hours of intervention with 15% medicated plasma， the expression and distribution of gasdermin D-N （GSDMD-N） on the surface of the cell membrane were detected by immunofluorescence staining. The release of lactic dehydrogenase （LDH）， interleukin（IL）-1β，and IL-18 in the cell supernatant was measured by enzyme-linked immunosorbent assay（ELISA） kits. The expression of Caspase-1 and GSDMD-N was measured by Western blot. ResultThe mitogen-activated protein kinase 14 （MAPK14），MAPK1，protein kinase B1 （Akt1）， MAPK8， V-Jun sarcoma virus oncogene homolog （JUN）， and TP53 screened by network pharmacology were the main targets. The compounds 7-hydroxy-5，8-dimethoxy-2-phenyl-chromone，wogonin，rhamnazin，moslosooflavone，isorhamnetin，7-O-methylisomucronulatol，formononetin，calycosin，luteolin，quercetin，kaempferol，β-sitosterol，and baicalein screened by network pharmacology were the main active components of Gupi Xiaoji decoction. Go enrichment analysis showed that multiple biological processes were involved， including responses to oxidative stress and metal ions，ubiquitin-like protein ligase binding，and phosphatase binding. KEGG pathway enrichment analysis showed MAPK pathway，nuclear factor（NF）-κB pathway，p53 pathway， and hypoxia-inducible factor-1（HIF-1） pathway were involved. Molecular docking showed that the targets had good binding with the components. In vitro experiments displayed that compared with the blank plasma group，the VX-765 group showed weakened GSDMD-N fluorescence signal，reduced release of LDH，IL-1β，and IL-18，and declining expression of Caspase-1 and GSDMD-N（P<0.01）， and the medicated plasma group showed increased GSDMD-N fluorescence signal， increased release of LDH，IL-1β，and IL-18，and up-regulated expression of Caspase-1 and GSDMD-N（P<0.01）. ConclusionGupi Xiaoji Decoction can induce the pyroptosis of HepG2.2.15 cells by regulating Caspase-1 through multiple targets and multiple pathways.