目的 分析在对急诊创伤性骨折情况的患者进行救治的过程中采用预见性创伤护理取得的效果.方法 在2018年7月～2019年7月医院急诊收治的患有创伤性骨折情况的患者中选取100例作为研究对象,将其划分为研究组和对照组进行治疗,其中,研究组(n=50例)采用预见性创伤护理对患者进行治疗,对照组(n=50例)采用常规护理模式对患者进行治疗,对治疗情况与护理满意度进行对比.结果 研究组在救治用时与住院用时上显著低于对照组,且抢救成功率与并发症情况优于对照组;在满意度方面,研究组高于对照组;针对以上数据,差异有统计学意义(P<0.05).结论 在对急诊创伤性骨折情况的患者进行救治的过程中,通过对预见性创伤护理模式进行应用,有利于提升患者的治疗效果,对于患者生命安全的保障具有积极的意义,值得在临床范围内进行推广.

目的 探讨预见性护理干预对ICU脑出血患者肺部感染预防的临床效果.方法 从2017年3月～2019年3月本院重症加强护理病房收治的患者当中选取85例脑出血患者,并通过患者就诊的先后顺序,将其分为研究组(n=44例)和对照组(n=41例).给予对照组患者常规护理干预,给予研究组患者预见性护理干预,分别比较两组患者的肺部感染发生率及其他不良反应发生率.结果 观察组肺部感染发生率(9.09％)明显小于对照组(26.83％)(P＜0.05);研究组不良反应发生率(4.55％)明显低于对照组(19.51％)(P＜0.05).结论 对ICU脑出血患者采取预见性护理干预,能够有效预防肺部感染,减少其他不良反应的发生,安全性较高,值得在临床上广泛应用.

目的 研究创新型护理流程模式在综合ICU中的应用效果.方法 选取2018年3月～2019年3月我院综合ICU病房患者为本次研究对象,将其随机分为实验组和对照组,各39例,其中对照组采取常规护理方式,实验组在其基础上采取创新型护理流程模式,对护理效果分别进行观察.结果 实验组护理效果明显优于对照组,差异有统计学意义(P<0.05).结论 创新型护理流程模式是有效的综合ICU护理方式,此方式有明显效果,值得推广.

银屑病关节炎(psoriatic arthritis,PsA)是一种与银屑病相关的血清阴性的炎性关节病,临床表现为银屑病的皮疹及关节、周围软组织及脊柱炎症,病程迁延,不易根治,晚期可致残,使患者的生活质量大大降低.有大量的文献已经证实双重滤过血浆置换疗法(double filtration plasmapheresis,DFPP)可以快速有效地治疗重症及难治性类风湿关节炎(rheumatoid arthritis,RA)、系统性红斑狼疮(systemic lupus erythematosus,SLE)、ANCA相关性血管炎(ANCA-associated vasculitis)等风湿性疾病[1-2],其也被大量用于银屑病的治疗当中[3].但DFPP在治疗银屑病关节炎方面鲜有详细报道.现就诊治过的DFPP治疗2例PsA病例报道如下.

The development of Systemic lupus erythematosus (SLE) has been associated with the balance of Th17 and Treg cells. IL-2 and rapamycin can influence the populations of both Th17 and Treg cells. However, it is unclear whether low dose of IL-2 and rapamycin can relieve the symptoms of SLE patients and what is the mechanisms. In this study, we aim to analyze the effect of low dose of IL-2 plus rapamycin on the number of Tregs, Th17 cells and the ratio of Th17/Treg cells, as well as to evaluate its therapeutic efficacy in refractory SLE patients. Fifty refractory SLE patients and 70 healthy controls were enrolled and followed up for 24 weeks. We found that compared with HC, the refractory SLE patients had a lower number of Tregs, a similar number of Th17 cells, but an increased ratio of Th17/Treg. After the treatment, the number of Tregs of the patients at 12th and 24th week was significantly increased. While the number of Th17 cells was unchanged, the ratio of Th17/Treg was significantly decreased at both 6 weeks and 24 weeks. After 6, 12 and 24 weeks of treatment, the SLEDAI score was significantly reduced. The prednison dosage at 6th,12th and 24th week post treatment was significantly decreased. Our results support that the reduction of Tregs and the imbalance of Th17/Treg cells were correlated with the occurrence and development of refractory SLE. Low dose of IL-2 combined with rapamycin was able to restore the number of Tregs and the balance of Th17/Treg cells. As a result, this approach was able to induce immune tolerance and promote disease remission, allowing for the reduction in prednisone dosage. ChiCTR-IPR-16009451 Registration date: 2016/10/16

Background Systemic lupus erythematosus (SLE) is multisystem and multiorgan autoimmune diseases and the main treatment is hormone combined with immunosuppressant and biological agents. Since the conventional treatment regimens have not achieved expected effects, it is of great practical value to search for good efficacy, lower side-effects, and low-cost drugs. Recently, we have found that the absolute number of CD4+CD25+FOXP3+ regulatory T (CD4+ Treg) cells reduced in SLE. Metformin, a basic hypoglycemic drug, has been shown to increase the number of Treg cells and decrease the number of Th17 cells.[1,2,3] Objectives To observe the clinical efficacy of metformin on the treatment of SLE and levels of CD4 +Treg and Th17 cells. Methods Twenty-three patients with SLE were enrolled in this study. They fulfilled the ACR 1997 standard, their average age was 32.22±8.18 years, and duration was 51.41±15.52 months. These patients were administered metformin (250 mg Bid) combined with conventional therapy for 6 weeks. At week 0 and week 6, the absolute numbers of Th17 cells and Treg, the symptoms, and laboratory indicators were collected. Results After metformin treatment combined with conventional therapy, average absolute number of Treg cells in 23 patients increased significantly from20.2 (20.28) (week 0) to 25.76 (25.1) (week 6) (p=0.073) while that of Th17 cells increased slightly from5.29 (6.43) (week 0) to 5.57 (6.05) (week 6) (p=0.956), which led to reduce average ratio of Th17/Treg from 0.25 (0.31) (0 week) to 0.19 (0.23) (6 weeks) (p=0.147). The treatment attenuated the symptoms of the patients and meantime, the dose of prednisone was decreased. At week 6, metformin combined with interleukin-2, the dosage of prednisone in SLE patients were decreased from 23.70±19.41 mg/d(0 week) to 20.44±17.03 mg/d(6 weeks) (p=0.548). Conclusions Our findings suggest metformin can effectively up-regulate Treg cells as well as increase Th17 to a certain extent, which restores the balance of Th17/Treg cells in SLE, metformin combined with conventional therapy can reduce the dosage of glucocorticoid, but the long-term effect needs further investigation. References [1] Michalek RD, Gerriets VA, Jacobs SR, et al. Cutting edge: Distinct glycolytic and lipid oxidative metabolic programs are essential for effector and regulatory CD4+ T cell subsets[J]. J Immuno12011;186(6):3299–3303. doi:10.4049/jimmunol.1003613 [Epub 2011 Feb 11]. [2] Kang KY, Kim YK, Yi H, et al. Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis [J]. Int Immunopharmacol2013;16(1):85–92. doi:10.1016/j.intimp.2013.03.020 [3] Sun Y, Tian T,Gao J, et al. Metformin ameliorates the development of experimental autoimmune encephalomyelitis by regulating T helper 17 and regulatory T cells in mice [J]. J Neuroimmunol2016;292:58–67. doi:10.1016/j.jneuroim.2016.01.014 Disclosure of Interest None declared

系统性红斑狼疮(SLE)是一种累及全身多系统的慢性自身免疫病,以在多种器官内自身抗体的产生、免疫复合物(ICs)的沉积,最终导致组织损伤为特点.滤泡辅助性T细胞(Tfh细胞)是CD4+T细胞的一个特殊亚群,主要作用是对B细胞提供帮助.它们在B细胞的滤泡和生发中心产生和成熟,并形成长期的血清学记忆功能,同样地,其可能在SLE的发病中也扮演了重要角色.本文概述了Tfh细胞的分化及功能,并阐述其在SLE发病过程中起到的作用.

Objective To measure the number of lymphocytes, B lymphocytes, CD5+B lymphocytes and level of IL-10 in peripheral blood of patients with systemic lupus erythematosus (SLE), and analyze their effects in the disease. Methods In this study, 84 cases of patients with SLE were randomly selected and evaluated according to the activity index (SLEDAI). These cases were divided into low activity group (SLEDAI<9) and high activity group (SLEDAI≥9). Ten healthy individuals were selected as the control group at the same time. The number of peripheral blood lymphocytes, B lymphocytes, CD5 + B lymphocytes, erythrocyte sedimentation rate (ESR), C3, C4 and interleukin (IL)-10 levels in serum were measured respectively and the correlation between the above indexes and SLEDAI and complement levels were analyzed. Pair-wise comparison of means of groups was conducted with one-way ANOVA. Comparison between the two groups was conducted by LSD-t test. Correlations between variables were carried out using Spearman's rank correlation test. Results The total number of lymphocytes in SLE group was lower than that in normal control group ( F=7.216, P<0.001); The number of CD19+ B lymphocytes in SLE group was higher than that in normal control group (F=3.589, P=0.036). The number of CD5+B lymphocytes of peripheral blood [(2.5±0.6)%] in patients with systemic lupus erythematosus was significantly lower than that in the normal control group [(3.2 ±0.8)%], but the difference was not statistically significant (t=3.412, P=0.698). The number of CD5+B lymphocytes in the high activity group was significantly lower than that in the low activity group (t=7.365, P=0.027)and the normal control group (t=5.649, P=0.002). The number of CD5+ B lymphocytes was negatively correlated with SLEDAI score (r=-0.692, P=0.001) and positively associated with the level of complement 3 (r=0.305, P=0.038), but not with complement 4 and ESR (P>0.05). In addition, the level of serum IL-10 in whether the low activity group (t=1.935, P=0.031) or the high activity group (t=3.048, P=0.012) was all higher than the normal control group. The level of serum IL-10 in patients with systemic lupus erythematosus was positively associated with SLEDAI score (r=0.425, P=0.024) and ESR (r=0.479, P=0.008), but was negatively correlated with complement 4 (r=-0.359, P=0.031). Conclusion The total number of lymphocytes in patients with SLE decreases significantly, while B lymphocytes increases significantly. The number of CD5+ B lymphocytes and the serum IL-10 level are also changed. It maybe related to the patient's inflammatory environment, and the number of CD5+B lymphocytes and the serum IL-10 level may be associated with disease activity.

SLE是一种累及全身多个系统的自身免疫病, 目前病因尚未完全明确,现在认为免疫失衡在其发病机制中具有重要作用. 辅助性T细胞17(Th17)和调节性T细胞是CD4+T细胞的2个重要亚群,已经证明Th17细胞分泌IL-17,在人类和小鼠中IL-17具有促炎作用,且与许多炎症相关,而调节性T细胞则具有抑制炎症的作用,并参与了维持自身环境的免疫耐受[1]. IL-2对于Th17及调节性T细胞的发展都很关键,然而,IL-2或IL-2受体(IL-2R)缺陷的小鼠模型患有严重的自身免疫病[2],这可能是由于调节性T细胞的减少,而其发展及其功能需要适当的IL-2的存在.本文就IL-2对SLE中Th17、调节性T细胞影响的研究进展予以综述.

The pathogenesis of systemic lupus erythematosus (SLE) is complexity. Many studies have confirmed that there existed the CD4+ T cell subsets disorders in peripheral blood of patients with SLE. Therefore, to correct the abnormity of CD4+ T cell subsets and to restore the immune homeostasis are the key to the treatment of the SLE. At present, it is found that regulatory B (Breg) cells have a certain effect on the differentiation of CD4+ T cell subsets. This promptes that analysis of the mechanism of Breg cells regulating the differentiation of CD4+ T cell subsets is helpful to provide a new way for the treatment of SLE.

Objective To analyze subjective well-being of nurses in emergency department, discuss its influence fac-tors. Methods 217 cases of nurses in Department of Emergency, the Second Affiliated Hospital of Xi'an Jiaotong Uni-versity were selected as respondents. Campbell happiness index scale was used for subjective well-being evaluation. The influence of gender, age, educational background, working time and job title on subjective well-being was analyzed. SPSS 19.0 statistical software was used for data statistics and analysis. Results Single factor analysis results showed that subjective well-being scores of nurses with different gender, age, educational background, working time and job ti-tle had statistically significant (P< 0.05). Multi-factor Logistic analysis showed that age (OR=1.424, P< 0.05), gender (OR=1.354, P<0.05), educational background (OR=1.299, P< 0.05), working time (OR=1.301, P< 0.05) and job title (OR=1.227, P< 0.05) were the influence factors of nurse subjective well-being. Conclusion Subjective well-being of nurses has affected by multiple factors. Corresponding measure should be adopted to improve the nurse subjective well-being.

Objective:To study the application effect of remote nursing intervention for discharged stroke patients with dysphagia.Methods:A total of 80 stroke patients with dysphagia who received the home nasal feeding were randomly divided into control group and intervention group,40 cases in each.The patients in control group re-ceived routine nursing care.The patients in intervention group received the remote nursing intervention by tele-phone,mail and QQ styles on the basis of routine nursing follow up.The quality of life,the incidence of com-plications of nasal feeding and improvement of swallowing function were compared between both groups.Re-sults:The quality of life score of patients in both groups were improved after 6 months.And the improvement range in intervention group was more obvious than that in control group.The incidence of complication of nasal feeding in intervention group was lower than that in control group.The improvement of swallowing function in intervention group was higher than that in control group,and the difference was statistically significant(P<0.05).Conclu-sion:Remote nursing intervention could effectively reduce the incidence of complications in patients with dys-phagia after stroke,improve the patients’swallowing function and their quality of life.