Integrated Traditional Chinese and Western Medicine Treatment for Acute Lymphoblastic Leukemia Complicated with Severe COVID-19 in Recovery Stage： A Case Report / 中医杂志

This paper reported a case of severe COVID-19 in the recovery stage with acute lymphoblastic leukemia treated by integrated traditional Chinese and western medicine， with the intention of shedding light on the clinical diagnosis and treatment of similar conditions. The patient， who had acute lymphoblastic leukemia， developed COVID-19 infection during the bone marrow suppression period after chemotherapy. Treatment with western medicine was mainly anti-infection， symptomatic management， and supportive care. During the recovery stage， considering the patient's chemotherapy history and disease progression， the overall syndrome was identified as deficiency of both qi and yin and binding of phlegm and blood. Based on the “state-target” combined treatment strategy， herbal prescriptions were selected and modified to address the “deficiency state”， “disease target”， and “symptom target”. In addition to western medicine， the patient was administered with Shengmai Powder （生脉散） and Compound Zhebei Granules （复方浙贝颗粒） in its modifications to boost qi， nourish yin， and reinforce healthy qi， nourish and cool the blood， ultimately achieving satisfactory therapeutic effects.

Clinicopathologic characteristics of liver inflammation and fibrosis in 310 patients with chronic hepatitis B / 中南大学学报(医学版)

OBJECTIVES@#Long-term hepatitis B virus (HBV) infection can cause recurrent inflammation in the liver, and then develop into liver fibrosis, cirrhosis, and liver cancer. The hepatic pathological change is one of the important criteria for guiding antiviral therapy in patients with chronic hepatitis B (CHB). Due to the limitations of liver biopsy, it is necessary to find valuable non-invasive indicators to evaluate the hepatic pathological changes in CHB patients and guide the antiviral therapy. This study aims to analyze the clinical characteristics of different pathological changes in CHB patients, and to explore the factors influnencing the degree of liver inflammation and fibrosis in CHB patients with normal alanine aminotransferase (ALT).@*METHODS@#This retrospective study was conducted on 310 CHB patients. Liver biopsy was performed in all these patients. The clinical data of the patients were collected. The liver biopsy pathological results were used as the gold standard to analyze the relationship between clinical indicators and liver pathological changes. Then CHB patients with normal ALT were screened, and the independent factors influencing the degree of liver inflammation and fibrosis were explored.@*RESULTS@#Among the 310 patients with CHB, there were 249 (80.3%) patients with significant liver inflammation [liver inflammation grade (G) ≥2] and 119 (38.4%) patients with significant liver fibrosis [liver fibrosis stage (S) ≥2]. The results of univariate analysis of total samples showed that the ALT, γ-glutamyl transferase, alkaline phosphatase, and HBV DNA were related to the significant liver pathological changes. Among the 132 CHB patients with normal ALT, the patients with liver pathology G/S≥2, G≥2, and S≥2 were 80.3% (106/132), 68.2% (90/132), and 43.2% (57/132), respectively. The results showed that the independent influencing factor of significant liver inflammation was HBV DNA>2 000 U/mL (OR=3.592, 95% CI 1.534 to 8.409), and the independent influencing factors of significant liver fibrosis were elevated alkaline phosphatase level (OR=1.022, 95% CI 1.002 to 1.043), decreased platelet count (OR=0.990, 95% CI 0.982 to 0.998), and positive in hepatitis B e antigen (HBeAg) (OR=14.845, 95% CI 4.898 to 44.995). According to the multivariate analysis, a diagnostic model for significant liver fibrosis in CHB patients with normal ALT was established, and the area under the receiver operating characteristic curve was 0.844 (95% CI 0.779 to 0.910).@*CONCLUSIONS@#The liver pathological changes should be evaluated in combination with different clinical indicators. A considerable number of CHB patients with normal ALT still have significant liver pathological changes, which need to be identified and treated with antiviral therapy in time. Among them, HBV DNA>2 000 U/mL suggests the significant liver inflammation, and the diagnostic model for significant liver fibrosis based on alkaline phosphatase, platelet count, and HBeAg can help to evaluate the degree of liver fibrosis.

Research progress on the mechanism of CDK4/6 inhibitors promoting antitumor immunity by regulating the immune microenvironment of triple negative breast cancer / 国际肿瘤学杂志

Triple negative breast cancer is a subtype of breast cancer with poor prognosis and lack of effective treatment. Cyclin dependent kinase (CDK) 4/6 inhibitors promote antitumor immunity by influencing the triple negative breast cancer immune microenvironment, such as increasing the tumor cell surface pragrammed death-ligand 1 protein expression, enhancing T cell activation and antigen presentation, changing the proportion of T cell subgroup and inducing lymphocyte infiltration. The change of immune microenvironment is related to tumor progression, but its mechanism is extremely complex. Exploring the mechanism of CDK4/6 inhibitor affecting immune microenvironment and its biomarkers can provide a new direction for the diagnosis and treatment of triple negative breast cancer.

Effect of propofol on proliferation of neural stem cells in mice and the role of Sp1-EGFR-Akt signaling pathway / 中华麻醉学杂志

Objective:To evaluate the effect of propofol on proliferation of neural stem cells (NSCs) in mice and the role of specificity protein-1 (Sp-1)-epidermal growth factor receptor (EGFR)-protein kinase B (Akt) signaling pathway.Methods:Primary NSCs harvested from both the cortices and hippocampus of C57BL/6 mouse embryos were identified by immunofluorescent staining of Nestin.NSCs at passages 3-6 were divided into 3 groups ( n=21 each) using a random number table method: normal saline control group (C group), propofol group (P group) and propofol plus Sp1 inhibitor plicamycin group (PP group). Propofol at a final concentration of 10 μmol/L was added in group P. Propofol at a final concentration of 10 μmol/L and plicamycin at a final concentration of 100 nmol/L were added in group PP.The equal volume of normal saline was added in group C. The medium was replaced after 6 h of incubation and the cells were continuously incubated.The proliferation of NSCs was assessed by direct cell counting at 24, 36, 48, 60 and 72 h after the end of treatment with drugs.At 6 h after the end of treatment with drugs, the expression of Sp1 and EGFR mRNA was detected by real-time fluorescent quantitative polymerase chain reaction, and the expression of Sp1, Akt and phosphorylated Akt (p-Akt) by Western blot. Results:Compared with group C, the count of NSCs was significantly increased at 48, 60 and 72 h after treatment with drugs, and the expression of EGFR mRNA, Sp1 protein and mRNA and p-Akt was up-regulated in group P ( P<0.05 or 0.01), and no significant change was found in each parameter in group PP ( P>0.05). Compared with group P, the count of NSCs was significantly decreased at 48 and 60 h after treatment with drugs, and the expression of EGFR protein and mRNA and p-Akt was down-regulated in group PP ( P<0.05 or 0.01). Conclusions:Propofol can promote the proliferation of NSCs, and the mechanism may be related to activation of Sp1-EGFR-Akt signaling pathway in mice.

Involvement of AMP-activated Protein Kinase α/ Nuclear Factor (Erythroid-derived 2) Like 2-iniatived Signaling Pathway in Cytoprotective Effects of Wasabi 6-(Methylsulfinyl) Hexyl Isothiocyanate

6-(Methylsulfinyl) hexyl isothiocyanate (6-MSITC) is an active ingredient present in Wasabi, which is a popular pungent spice used in Japanese cuisine. Our previous studies suggested that the primary antioxidant activity of 6-MSITC may link to other biological activity. This study aimed to clarify how the antioxidant activity of 6-MSITC contributes to preventing overloaded lipid stress in he-patic cell model. HepG2 cells were treated with 6-MSITC at defined concentrations and times in normal medium or in combined fatty acids (CFA) medium, and the targeted proteins were detected by Western blotting. The kinetic data revealed that 6-MSITC activated AMP-activated protein kinase α (AMPKα) and nuclear factor (erythroid-derived 2) like 2 (Nrf2), and then enhanced the protein expression of Forkhead box protein O1 (FOXO1) and Sirtuin1 as well as that of the Nrf2 target proteins, NAD(P)H:quinone oxidoreductase 1 (NQO1) and heme oxygenase (HO-1). Furthermore, lipid metabolic stress was mimicked in HepG2 cells by overloading CFA. 6-MSITC significantly alleviated CFA-induced formation of thiobarbituric acid reactive substances and fat ac-cumulation. Signaling analysis data revealed that 6-MSITC enhanced phosphorylation of AMPKα, upregulated the expression of Nrf2, NQO1, heme oxygenase 1, FOXO1, and Siruin1, and downregulated the expression of PPARα. Taken together, our results suggested that the AMPKα/Nrf2-mediated signaling pathways might be involved in the cytoprotective effects of Wasabi 6-MSITC against metabolic lipid stress.

Design and development of clinical decision support system for unplanned extubation / 中国实用护理杂志

Objective:To design and develop an unplanned extubation clinical decision support system, aiming to provide a reference for nurses' clinical decision-making.Methods:Through literature review and expert consultation, the knowledge base of the clinical decision support system for unplanned extubation was constructed, and the system function and interface were designed.Results:The authoritative coefficients of the two rounds of expert consultation were 0.853 and 0.867, respectively, and the Kendall ′s W were 0.458 and 0.492, respectively. The final built knowledge base included catheter evaluation module, unplanned extubation evaluation module, and knowledge reasoning rule module. At present, the knowledge base had sorted out 48 first-level items, 9 second-level items, 72 third-level items in the catheter evaluation module, and 5 first-level items, 12 second-level items, and 73 third-level items in the unplanned extubation evaluation module. Entry, 40 knowledge reasoning rules. Conclusions:The clinical decision-making system for unplanned extubation has changed the implementation of unplanned extubation risk early warning, optimized the management process, and realized the interaction of the hospital system. It can conduct dynamic unplanned extubation risk assessment based on individualization and assist nurses Make clinical decisions and promote the safety of nursing management.

Evidence summary of health workers′ self-protection during aerosol-generating procedures in patients with acute respiratory infectious disease / 中国实用护理杂志

Objective:To evaluate and summarize the best evidence of health workers respiratory protection during aerosol-generating procedures in patients with acute respiratory infectious diseases.Methods:We searched EBM Guidelines, Essential Evidence Plus, Dynamed, UpToDate, JBI, BMJ, Clinical Key, Cochrane Library, NICE, AARC, PubMed, EMbase, CKNI, Wanfang to collect related literature including guidelines,evidence summary, recommended practices, standards, consensus and systematic reviews.Results:A total of 20 articles were included, including 10 guidelines, 1 consensus, 2 standards, 2 evidence summaries, and 5 systematic reviews. 24 best evidences including aerosol-generating procedures, training of protective equipment using, principles of protective equipment using, protective equipment using, aerosol operating environment control and medical staff self-monitoring were summarized.Conclusion:The study integrated the best evidence of healthcare workers respiratory protection during aerosol-generating procedures in patients with acute respiratory infectious disease. It is recommended to combine the current status of institutional protection resources and clinical practice experience to promote the conversion of the best evidence to clinical practice.

Design and development of nursing care planning section of clinical decision support system / 中国实用护理杂志

Objective:To provide reference for the development of a more intelligent and systematic nursing clinical decision support system based on the concept of precision nursing and data sharing, the nursing plan module of clinical decision support system.Methods:An evidence-based knowledge base was constructed based on the nursing process and the standardized nursing terminologies; the nursing plan module was designed according to clinical needs, and the logical reasoning rules were formulated from the generation, sequencing and stopping of nursing problems, objectives, measures and activities, and finally the nursing plan module of clinical decision support system was formed.Results:The nursing plan module of clinical decision support system included the basic information of patients, positive evaluation items and weight values, nursing problems, objectives, measures and activities, etc. the module could automatically deduce the nursing plan according to the patient's individual characteristic index (positive evaluation item), and sort the nursing problems and corresponding measures and activities according to the generation time, weight value and correlation degree. It could automatically distinguish nursing problems, goals, measures and the time of activity stop, and realize intelligent decision-making.Conclusion:The interface of nursing plan module of this system is clear and logical reasoning rules are rigorous. It breaks through the bottleneck of nursing decision-making based on personal professional knowledge and experience in clinical situation for a long time, which can ensure the homogeneity of nursing plan and improve the correctness of decision-making.

Research progress concerning complications related to distal clavicle fracture / 中华创伤骨科杂志

The clavicle, one of the important structures of the shoulder, plays an important role in maintaining shoulder functions, as it is not only a part of several small joints but also the attachment of multiple ligaments and muscles. Non-displaced distal clavicle fractures are mostly treated conservatively while more and more unstable ones treated surgically because conservative treatment may lead to more complications. The complications following the fractures cannot be ignored no matter the fractures are treated conservatively or surgically. The complications mainly include nonunion, internal implant-related ones, peri-glenohumeral joint ones, and acromioclavicular arthritis. Some of them are related to trauma and some to surgery. If they are not treated properly, shoulder functions may be impaired. This review discusses the researches into the complications of distal clavicle fracture.

Application of enhanced recovery after surgery in patients undergoing thoracoscopic lobectomy with pain management / 中国实用护理杂志

Objective To explore the effect of Enhanced Recovery after Surgery in patients undergoing thoracoscopic lobectomy with pain management. Methods A total of 160 patients with lung cancer admitted from September 20 to July 2017 at the Affiliated Chest Hospital of Shanghai Jiaotong University were randomly divided into observation group and control group. The observation group was treated with enhanced recovery care and the control group was treated with routine care. Results The incidence of postoperative complications, hospitalization time and hospitalization decreased, the difference was not statistically significant (P>0.05). The early postoperative ambulation time, postoperative exhaust time, postoperative nausea and vomiting, postoperative pain intensity at 6h, postoperative pain intensity at 12 h, postoperative pain intensity at 24 h and postoperative pain intensity at 48 h were (18.35 ± 7.18) h, 28.75％,(1.17 ± 0.84) points, (1.79 ± 1.36) points, (2.45 ± 1.12) points and (2.14 ± 1.26) points in research group,(28.11 ± 9.07) h, (36.35 ± 16.95) h, 45.00％(36/80), (1.91 ± 0.88) points, (3.05 ± 1.33) points, (4.20 ± 1.31) points and (3.89 ± 1.20) points in controlled group. There was significant difference between the two groups (t=-7.36-78.34,χ2=4.54, P<0.05). Conclusions The idea of Enhanced Recovery after Surgery for thoracoscopic lobectomy has a good clinical effect. It can reduce the perioperative stress, shorten the hospital stay and reduce the hospital cost, and have the clinical value.

Relationship of pulse pressure index with intracranial and extracranial atherosclerosis / 中华老年心脑血管病杂志

Objective To study the relationship of pulse pressure index (PPI) with intracranial and extracranial arteriosclerosis.Methods Two hundred and fifty-five patients with cerebrovascular disease,peripheral vertigo and headache admitted to our hospital were divided into normal control group (n=99),plaque group (n=53),mild stenosis group (n=53) with a stenosis rate of ＜30％,moderate stenosis group (n=29) with a stenosis rate of 30％-69％,and severe stenosis group (n=21) with a stenosis rate of 70％-99％ according to their head and neck CT vascular imaging.The patients were further divided into intracranial stenosis group (n=68) and extracranial stenosis group (n =35).Their general condition,laboratory blood test parameters,ambulatory blood pressure (ABP) and mean PPI were recorded.Results The PPI was significantly higher in mild,moderate and severe stenosis groups than in normal control group (0.41 ±0.08,0.41 ±0.05 vs 0.38±0.06,P＜0.01;0.43±0.05 vs 0.38±0.06,P＜0.05).However,no significant difference was found in PPI between intracranial and extracranial stenosis groups (0.41 ±0.06 vs 0.40±0.05,P＞0.05).Correlation analysis showed that intracranial arteriosclerosis was positively related with PPI,hypertension and age (P＜0.01),but not related with gender,diabetes,TC,TG and LDL-C (P＞0.05).Conclusion PPI is related with intracranial arterosclerosis.

Clinical and imaging characteristics of acute marchiafava-bignami disease / 重庆医学

Objective To investigate the presentation and radiologic findings of acute marchiafava‐bignami disease(MBD) . Methods Three cases of acute MBD who were diagnosed and treated in our hospital were retrospectively analyzed ,including the clinical symptoms ,laboratory tests ,imaging examination(such as cranial CT ,magnetic resonance imaging(MRI) ,prognosis .Results Three cases were acute onset .The symptoms may be non‐specific ,such as consciousness disorder ,psychosis ,seizures ,delirium tremor and high fever .The imaging changes in the genu and splenium of corpus callosum could be found ,even in the bihemispheric white matter of all cases .CT revealed low‐density areas ,meanwhile MRI showed iso‐or hypo‐intensity on T1WI and ADC ,hyper‐in‐tensity on T2WI and fluid attenuated inversion recovery and restricted diffusion weighted imaging .The lesions involved in bihemi‐spheric brachium pontis in one case and in the body of corpus callosum in another case .Conclusion Acute MBD may present with various clinical forms ,but have characteristic imaging findings .

"Breast cancer treatment research based on ""ancient literature""" / 国际中医中药杂志

Objective Through researching the name,etiology,pathogenesis and therapeutic methods and prescriptions of the breast cancer in ancient medical documents to provide the theoretical basis and syndrome differentiation thinking for the treatment of breast cancer clinically.Methods By disease name searching,content analysis was used to screening the ancient literature that associated with breast cancer.The pathogenesis,treatment and medicine used of breast cancer in these ancient literatures were summarized.Results The stagnation of Qi and phlegm,blood stasis,and vital deficiency are important factors for breast cancer formation,while the deficiency of vital qi and viscera deficiency are important pathogenesis of breast cancer.Prevention before the onset of disease,eliminating pathogenic factors at the early period of the disease,supplement vital qi and eliminating pathogenic vital qi in the middle stage,and supplementing vital qi at the late stage of the disease should be emphasized.Meanwhile soothing liver to regulate mode and depression should also be paid attention.Conclusion The recognition of breast cancerby TCM and advantage of TCM in treating this disease need further literature researches.