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Objective: To evaluate the clinical outcomes after implant restoration in the posterior region of severe periodontitis patients and to investigate the factors of natural tooth affecting the implant from the perspective of improving natural periodontal health, which may provide a reference for clinical practice. Methods: Fifty-three patients with severe periodontitis who visited the Department of Periodontology at the Affiliated Stomatological Hospital of China Medical University from June 2014 to June 2023 and completed posterior implant treatment with single crown were included, among which were 16 males and 37 females, aged (52.2±8.0) years old, with a total of 136 implants, 135 adjacent natural teeth in the edentulous area. We retrospectively compared the changes of probing depth (PD), bleeding on probing (BOP) and tooth mobility (TM) before and after implant placement. Besides, we explored the effects of the natural periodontal status on PD, BOP and marginal bone loss (MBL) of the implant at the last follow-up examination by univariate analysis and multivariate analysis. Results: Fifty-three patients were followed up for (44.5±14.1) months in average, with longest interval of (8.3±2.7) months. The PD of adjacent natural teeth in the edentulous area improved from 4.3 (3.6, 4.6) mm before implantation to 3.6 (3.2, 4.0) mm in the last review ( P< 0.01), while the proportion of BOP (+) improved from 69.6% (94/135) before implantation to 46.7% (63/135) in the last review ( P< 0.01). The proportion of teeth with mobility≥Ⅱ decreased from 15.6% (21/135) to 5.9% (8/135) ( P< 0.01). The percentage of natural teeth with PD≥4 mm in the same segment improved from 21.0% (13.3%, 26.0%) before implantation to 18.0% (12.0%, 25.0%) in the last review ( P< 0.05). The BOP (+)% improved from 29.0% (24.0%, 35.0%) before implantation to 23.0% (18.0%, 31.0%) in the last review ( P< 0.05), and the number of teeth with mobility≥Ⅱ decreased from 0.0 (0.0, 1.0) to 0.0 (0.0, 0.8) ( P< 0.05). The functional tooth unit score of full natural teeth increased from 8.0 (6.0, 10.0) points before implantation to 12.0 (12.0, 12.0) points in the last review ( P< 0.01). PD≥4 mm % increased from 11.0% (6.0%, 25.0%) before implantation to 13.0% (3.0%, 21.0%) in the last review ( P< 0.05) and there was no significant differences in BOP (+)% [(17.0±9.7) % vs (14.6±7.2) %, P> 0.05]. The number of teeth with mobility≥Ⅱ decreased from 1.0 (0.0, 1.8) to 0.0 (0.0, 0.8) ( P< 0.05). Conclusions: Under the premise of regular supportive care, implant restorative treatment in the posterior region of severe periodontitis patients is helpful to improve the PD, BOP and TM of remaining natural teeth. Besides, the stages and grades of periodontitis at initial diagnosis can affect the PD and BOP of implants.

Objective: To investigate the clinical efficacy and safety of ixazomib-containing regimens in the treatment of patients with multiple myeloma (MM)., Methods: A retrospective analysis was performed on the clinical efficacy and adverse reactions of 32 MM patients treated with a combined regimen containing ixazomib in the Hematology Department of the First People's Hospital of Lianyungang from January 2020 to February 2022. Among the 32 patients, 15 patients were relapsed and refractory multiple myeloma (R/RMM) (R/RMM group), 17 patients who responded to bortezomib induction therapy but converted to ixazomib-containing regimen due to adverse events (AE) or other reasons (conversion treatment group). The treatment included IPD regimen (ixazomib+pomalidomide+dexamethasone), IRD regimen (ixazomib+lenalidomide+dexamethasone), ICD regimen (ixazomib+cyclophosphamide+dexamethasone), ID regimen (ixazomib+dexamethasone)., Results: Of 15 R/RMM patients, overall response rate (ORR) was 53.3%(8/15), among them, 1 achieved complete response (CR), 2 achieved very good partial response (VGPR) and 5 achieved partial response (PR). The ORR of the IPD, IRD, ICD and ID regimen group were 100%（3/3）, 42.9%（3/7）, 33.3%（1/3）, 50%（1/2）， respectively， there was no statistically significant difference in ORR between four groups (χ 2 =3.375, P =0.452). The ORR of patients was 50% after first-line therapy, 42.9% after second line therapy, 60% after third line therapy or more, with no statistically significant difference among them (χ 2 =2.164, P =0.730). In conversion treatment group, ORR was 88.2%(15/17), among them, 6 patients achieved CR, 5 patients achieved VGPR and 4 patients achieved PR. There was no statistically significant difference in ORR between the IPD（100%， 3/3）, IRD（100%， 6/6）, ICD（100%， 3/3） and ID（60%， 3/5） regimen groups (χ 2 =3.737， P =0.184). The median progression-free survival (PFS) time of R/RMM patients was 9 months (95% CI : 6.6-11.4 months), the median overall survival (OS) time was 18 months (95% CI : 11.8-24.4 months). The median PFS time of conversion treatment group was 15 months (95% CI : 7.3-22.7 months), the median OS time not reached. A total of 10 patients suffered grade 3- 4 adverse event (AE). The common hematological toxicities were leukocytopenia, anemia, thrombocytopenia. The common non-hematological toxicities were gastrointestinal symptoms (diarrhea, nausea and vomit), peripheral neuropathy, fatigue and infections. Grade 1-2 peripheral neurotoxicity occurred in 7 patients., Conclusion: The ixazomib-based chemotherapy regimens are safe and effective in R/RMM therapy, particularly for conversion patients who are effective for bortezomib therapy. The AE was manageable and safe.

Objective: To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation., Methods: A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled. The confusion assessment method (CAM) was used to evaluate the delirium of the patients in intensive care unit (ICU). The score of CAM ≥ 1 was defined as delirium. Mini nutritional assessment short-form (MNA-SF) was used to assess the nutritional status of patients, and MNA-SF score ≤ 7 was defined as malnutrition. Patients were divided into delirium group and non-delirium group according to whether delirium occurred. The differences in clinical indicators, length of ICU stay, duration of mechanical ventilation and wake-up time after drug withdrawal were compared between the two groups. After 28 days of short-term follow-up, the patients were divided into death group and survival group, and the differences in the incidence of delirium and malnutrition between the two groups were compared. Binary multivariate Logistic regression analysis was used to screen the risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. Kaplan-Meier survival curve was used to analyze the effect of delirium on prognosis., Results: A total of 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation were enrolled, of whom 98 survived and 34 died within 28 days, with a mortality of 25.76%. The incidence of malnutrition and delirium in the death group was significantly higher than that in the survival group (61.76% vs. 37.76%, 64.71% vs. 26.53%, both P < 0.05), and the MNA-SF score was significantly lower than that in the survival group (6.32±1.80 vs. 8.72±2.23, P < 0.01). Procalcitonin (PCT), interleukin-6 (IL-6) and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group [PCT (μg/L): 4.47 (2.69, 10.39) vs. 2.77 (1.28, 5.94), IL-6 (ng/L): 204.08 (126.12, 509.85) vs. 120.46 (60.67, 290.99), Lac (mmol/L): 5.14 (2.75, 8.60) vs. 3.13 (2.16, 4.30), all P < 0.05], and the wake-up time after drug withdrawal was significantly longer than that in the survival group (minutes: 33.94±8.51 vs. 28.92±7.03, P < 0.01). Among 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation, 48 patients had delirium during ICU stay, and 84 patients did not have delirium. The incidence of delirium was 36.36%. The 28-day mortality in the delirium group was significantly higher than that in the non-delirium group (45.83% vs. 14.29%, P < 0.01), and the MNA-SF score was significantly lower than that in the non-delirium group (6.46±1.77 vs. 9.05±2.15, P < 0.01), the length of ICU stay, duration of mechanical ventilation, and wake-up time after drug withdrawal were also significantly longer than those in the non-delirium group [length of ICU stay (days): 13.40±9.59 vs. 10.06±7.81, duration of mechanical ventilation (hours): 197.06±89.80 vs. 138.81±82.30, wake-up time after drug withdrawal (minutes): 35.85±7.01 vs. 26.99±6.12, all P < 0.05]. Binary multivariate Logistic regression analysis showed that malnutrition [odds ratio (OR) = 7.527, 95% confidence interval (95%CI) was 2.585-21.917], Lac (OR = 5.345, 95%CI was 1.733-16.483), wake-up time after drug withdrawal (OR = 6.653, 95%CI was 2.021-21.904) were independent risk factors for delirium during ICU stay in elderly patients with severe pneumonia undergoing invasive mechanical ventilation (all P < 0.01). Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate of patients in the delirium group was significantly lower than that in the non-delirium group (54.17% vs. 85.71%), and the difference was statistically significant (Log-Rank test: χ 2 = 16.780, P < 0.001)., Conclusions: The risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation during ICU stay include malnutrition, Lac, and wake-up time after drug withdrawal. The occurrence of delirium is closely related to poor prognosis.

Objective: To compare the safety and clinical efficacy of endoscopic and surgical treatment of patients with delayed iatrogenic bile duct injury (DBDI) with severity (SG) grade 1 to 2. Methods: The clinical data of 129 patients with SG grade 1 to 2 DBDI who received endoscopic or surgical treatment in the First Hospital of Lanzhou University from November 2007 to November 2021 were retrospectively collected. There were 46 males and 83 females,aged ( M (IQR)) 54(22)years(range: 21 to 82 years). The baseline data of the two groups were matched 1∶1 by propensity score matching(caliper value was 0.2). Independent sample t test,rank sum test, χ 2 test or Fisher exact probability test were used to analyze the data of the two matched groups. Results: There were 48 patients in each of the endoscopic treatment and surgical groups after matching,and there was no difference in general information between the two groups(both P >0.05). The bile duct injury-repair interval and intraoperative anesthesia complications were not statistically significant between the two groups after matching(all P >0.05). Compared with the surgical group, patients in the endoscopic treatment group had significantly shorter operative time(50 (30) minutes vs. 185 (100) minutes, Z =7.675, P <0.01) and postoperative hospital stay(5 (5) days vs. 12 (7) days, Z =5.848, P <0.01).For safety,there was no statistical difference in the incidence of immediate postoperative complications between the two groups with Clavien-Dindo classification of surgical complications<Ⅲ;the incidence of serious postoperative complications (Clavien-Dindo classification of surgical complications≥Ⅲ) was significantly higher in the surgical group than in the endoscopic treatment group( P =0.012). The incidence of long-term postoperative complications was not statistically different between the two groups(28.1% vs. 20.7%, P =0.562). In terms of efficacy,the postoperative liver function indexes of patients in both groups improved significantly compared with the preoperative period and returned to normal or near normal levels; the postoperative infection indexes of both groups showed an increasing trend,but were within the normal range. Of the 96 patients in both groups,61 obtained follow-up,and the follow-up time was (89.4±48.0)months(range: 3 to 165 months),and there was no statistical difference between the two groups( P =0.079). The probability of excellent long-term follow-up (78.1% vs. 86.2%) was not statistically different between the two groups( P =0.412).In patients with Strasberg-Bismuth type E1,the probability of excellent long-term follow-up was higher in the endoscopic treatment group compared with the surgical group(13/14 vs. 2/5, P =0.037). Conclusions: For DBDI patients with SG grade 1 to 2 and bile duct continuity,endoscopy can be used as the first deterministic treatment. The advantages of endoscopic therapy compared to surgery are the lower incidence of postoperative serious complications,and the shorter duration of surgery and postoperative hospital stay.

As a neglected tropical disease defined by the World Health Organization (WHO), echinococcosis causes a huge public health burden. Understanding the disease burden due to echinococcosis facilitates the progress towards elimination of the disease. This review analyzes the advances in disease and economic burdens of echinococcosis, describes the status quo disease burden due to echinococcosis in different areas of the world, compares the difference between international and national studies on disease and economic burdens of echinococcosis, and discusses the shortcomings of the current international and national studies on disease burden of echinococcosis. Currently, the studies on disease burden of echinococcosis suffer from problems of few field survey data and lack of authoritative disability weights for echinococcosis, while the studies on economic burden of echinococcosis suffer from problems of lack of comprehensive study populations and indicators.

Objective: To investigate the carrier rate and clinical characteristics of epigenetic modification gene mutations (EMMs) among patients with acute myeloid leukemia (AML)., Methods: One hundred seventy two patients who were initially diagnosed with AML at the First People's Hospital of Lianyungang from May 2011 to February 2021 were selected as the study subjects. Next-generation sequencing was carried out to detect variants of 42 myeloid genes among these patients. Clinical and molecular characteristics of patients with EMMs and the effect of demethylation drugs (HMAs) on their survival were analyzed., Results: Among the 172 AML patients, 71 (41.28%) were found to harbor the EMMs, and carrier rates were TET2 (14.53%, 25/172), DNMT3A (11.63%, 20/172), ASXL1 (9.30%, 16/172), IDH2 (9.30%, 16/172), IDH1 (8.14%, 14/172), EZH2 (0.58%, 1/172). Patients with EMMs (+) had lower peripheral hemoglobin compared with those with EMMs(-) (72 g/L vs. 88 g/L, Z = -1.985, P = 0.041). The proportion of EMMs(+) among elderly AML patients was significantly higher than that of young AML patients[71.11% (32/45) vs. 30.70% (39/127), χ² = 22.38, P < 0.001]. EMMs(+) were significantly correlated with NPM1 gene variants (r = 0.413, P < 0.001), while negatively correlated with CEPBA double variants (r = -0.219, P < 0.05). Compared with conventional chemotherapy regimens, HMAs-containing chemotherapy regimens have improved the median progression-free survival (PFS) and median overall survival (OS) among intermediate-risk AML patients with EMMs(+) (PFS: 11.5 months vs. 25.5 months, P < 0.05; 12.5 months vs. 27 months, P < 0.05). Similarly, Compared with conventional chemotherapy regimens, chemotherapy with HMAs had increased median PFS and median OS in elderly AML patients with EMMs(+) (4 months vs. 18.5 months, P < 0.05; 7 months vs. 23.5 months, P < 0.05)., Conclusion: Patients with AML have a high rate of EMMs carriage, and HMAs-containing chemotherapy regimens can prolong the survival of elderly patients with AML with poor prognosis, which may provide a reference for individualized treatment.

Objective: To investigate the efficacy, prognosis and safety of decitabine combined with modified EIAG regimen in the treatment of patients with relapsed/refractory acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS)., Methods: The clinical data of 44 patients with relapsed/refractory AML and high-risk MDS admitted to our hospital from January 2017 to December 2020 were analyzed retrospectively. The patients were equally divided into D-EIAG group (decitabine combined with EIAG regimen) and D-CAG group (decitabine combined with CAG regimen) according to clinical treatment regimen. The complete response (CR), CR with incomplete hematologic recover (CRi), morphologic leukemia-free state (MLFS), partial response (PR), overall response rate (ORR), modified composite complete response (mCRc), overall survival (OS) time, 1-year OS rate, myelosuppression and adverse reactions between the two groups were compared., Results: In D-EIAG group, 16 patients (72.7%) achieved mCRc (CR+CRi+MLFS), 3 patients (13.6%) achieved PR, and ORR (mCRc+PR) was 86.4%. In D-CAG group, 9 patients (40.9%) achieved mCRc, 6 patients (27.3%) achieved PR, and ORR was 68.2%. Difference was observed in mCRc rate between the two groups (P=0.035), but not in ORR (P>0.05). The median OS time of D-EIAG group and D-CAG group was 20 (2-38) months and 16 (3-32) months, and 1-year OS rate was 72.7% and 59.1%, respectively. There was no significant difference in 1-year OS rate between the two groups (P>0.05). After induction chemotherapy, the median time for absolute neutrophil count recovery to 0.5×10 9 /L in D-EIAG group and D-CAG group was 14 (10-27) d and 12 (10-26) d, for platelet count recovery to 20×10 9 /L was 15 (11-28) d and 14 (11-24)d, the median red blood cell suspension transfusion volume was 8 (6-12) U and 6 (6-12) U, and the median apheresis platelet transfusion volume was 4 (2-8) U and 3 (2-6) U, respectively. There were no statistically significant differences in comparison of the above indicators between the two groups (P>0.05). The hematological adverse reactions of patients were mainly myelosuppression. Grade III-IV hematological adverse events occurred in both groups (100%), with no increase in the incidence of non-hematological toxicities such as gastrointestinal reactions or liver function damage., Conclusion: Decitabine combined with EIAG regimen in the treatment of relapsed/refractory AML and high-risk MDS can improve remission rate, provide an opportunity for subsequent therapies, and have no increase in adverse reactions compared with D-CAG regimen.

Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.

Objective: To investigate the clinical characteristics of RAS gene mutations in patients with acute myeloid leukemia (AML)., Methods: 43 myeloid gene mutations were detected using next-generation sequencing (NGS) in 180 patients with AML who were first diagnosed between May 2011 and February 2021. The molecular and clinical features of RAS gene mutations and their effects on efficacy and survival of patients were retrospectively analyzed., Results: Among 180 AML patients, the proportion of mutations in RAS pathway-related genes were NRAS (14.4%), KRAS (2.2%), FLT3-ITD (13.8%), PTPN11 (7.7%), KIT (5.0%), FLT3-TKD (3.8%) and CBL (2.7%). Seventy-three (40.6%) AML patients had gene mutations associated with the RAS pathway.The number of peripheral blood white blood cells and the proportion of bone marrow primitive juvenile cells in patients with NRAS/KRAS gene mutation were higher than those of patient with RAS wild-type, the difference was statistically significant (P<0.05). NRAS/KRAS gene mutations were significantly associated with the CBL gene mutation(r=0.287). In young AML patients (age <60 years), there were no significant differences in complete response rate (CR), progression-free survival (PFS), and overall survival (OS) between patients with RAS gene mutation and those with wild-type(P>0.05). In elderly AML patients (age≥60 years), PFS and OS in RAS mutants were significantly lower than those in wild-type patients(P<0.05)., Conclusion: In AML patients, RAS gene mutation is relatively common, and RAS gene mutation is associated with clinical characteristics and efficacy of patients, and may be a molecular marker of poor prognosis for elderly AML.

Yarrowia lipolytica is a non-conventional yeast with unique physiological and metabolic characteristics. It is suitable for production of various products due to its natural ability to utilize a variety of inexpensive carbon sources, excellent tolerance to low pH, and strong ability to secrete metabolites. Currently, Y . lipolytica has been demonstrated to produce a wide range of carboxylic acids with high efficiency. This article summarized the progress in engineering Y . lipolytica to produce various carboxylic acids by using metabolic engineering and synthetic biology approaches. The current bottlenecks and solutions for high-level production of carboxylic acids by engineered Y . lipolytica were also discussed, with the aim to provide useful information for relevant studies in this field.

Ischemic cardiovascular and cerebrovascular diseases threatening human health and survival have high morbidity and mortality. The common cause of them is reduced blood supply caused by vascular stenosis, atherosclerosis, and infarction. However,the pathological processes of ischemic cardiovascular and cerebrovascular diseases are complex, involving oxidative stress, calcium overload, inflammation, apoptosis, autophagy and other mechanisms. Protein drugs such as recombinant tissue plasminogen activator(rt-PA) and urokinase have been proved with excellent therapeutic effects and huge economic and social benefits in the clinical treatment and interventional therapy. Among them, peptide drugs have shown unique advantages and potential prospects owing to their strong biological activity, high target specificity, biochemical diversity, and low toxicity. Chinese medicinal materials, characterized by multi-component and multi-target therapy, have also shown excellent clinical efficacy against ischemic cardiovascular and cerebrovascular diseases. However, the research and development of related peptides in Chinese medicinal materials is at the initial stage. Therefore, this paper reviewed the targets and action mechanisms of a variety of Chinese medicinal material-derived polypeptides with activities against ischemic cardiovascular and cerebrovascular diseases, aiming to provide support for the in-depth research as well as the clinical development and application of these polypeptides.

Polycyclic aromatic hydrocarbons (PAHs) are a class of persistent pollutants that are widely distributed in the environment. Due to their stable structure and poor degradability, PAHs exhibit carcinogenic, teratogenic, and mutagenic toxicity to the ecological environment and organisms, thus increasing attentions have been paid to their removals and remediation. Green, safe and economical technologies are widely used in the bioremediation of PAHs-contaminated soil. This article summarizes the present status of PAHs pollution in soil of China from the aspects of origin, migration, fate, and pollution level. Meanwhile, the types of microorganisms and plants capable of degrading PAHs, as well as the underlying mechanisms, are summarized. The features of three major bioremediation technologies, i.e., microbial remediation, phytoremediation, and joint remediation, are compared. Analysis of the interaction mechanisms between plants and microorganisms, selection and cultivation of stress-resistant strains and plants, as well as safety and efficacy evaluation of practical applications, are expected to become future directions in this field.

Compound Renshen Buqi Granules have been widely used to treat chronic heart failure(CHF) due to Qi deficiency and blood stasis, but the mechanism of action remains unclear. This paper explored the pathogenesis of CHF due to Qi deficiency and blood stasis and the intervention mechanism of Compound Renshen Buqi Granules based on quantitative proteomics for uncovering the biological basis. SD rats were divided into the normal control(N) group, normal+Compound Renshen Buqi Granules(ND) group, model(M) group, model+Compound Renshen Buqi Granules(D) group, and positive control(Y) group. The rat model of CHF due to Qi deficiency and blood stasis was established by ligation of the left anterior descending(LAD) coronary artery and chronic sleep deprivation. The rats in the ND group and D group were provided with Compound Renshen Buqi Granules, while those in the Y group received valsartan. Six weeks later, the serum was sampled and the data-dependent acquisition(DDA) was employed for the non-targeted quantitative proteomics analysis of the differences in protein expression among groups, followed by the targeted analysis of differentially expressed proteins(DEPs) generated by data-independent acquisition(DIA). Compared with the N group, the rats in the M group pre-sented with decreased body weight, grip strength, and pulse amplitude and increased RGB value on the tongue surface. The pathomorphological examination revealed inflammatory cell infiltration, cell degeneration and necrosis, tissue fibrosis, etc. After the intervention with Compound Renshen Buqi Granules, multiple indicators were reversed. As demonstrated by proteomics results, there were 144 and 111 DEPs found in the M group and ND group in comparison with the N group. Compared with the M group, 107 and 194 DEPs were found in the D group and the Y group, respectively. Compared with the ND group, 119 DEPs were detected in the D group. As illustrated by DIA-based verification, the quantitative results of six proteins in each group were consistent with those by DDA. The syndrome indicators and pathomorphological examination results demonstrated that the protein expression profile of rats with CHF due to Qi deficiency and blood stasis changed obviously. However, Compound Renshen Buqi Granules were able to reverse the differential expression of immune proteins to regulate CHF of Qi deficiency and blood stasis syndrome, which has provided clues for figuring out the pathogenesis of CHF due to Qi deficiency and blood stasis and the intervention mechanism of Compound Renshen Buqi Granules.

The traditional Chinese medicine(TCM) syndrome of blood stasis refers to blood stagnation in meridians and viscera, with the main symptoms of pain, mass, bleeding, purple tongue, and unsmooth pulse. Cardiovascular and cerebrovascular diseases are among the major chronic diseases seriously harming the health of the Chinese. Among the coronary heart disease and stroke patients, most demonstrate the blood stasis syndrome. Platelet is considered to be one of the necessary factors in thrombosis, which closely relates to the TCM syndrome of blood stasis and the occurrence of cardiovascular and cerebrovascular diseases. The clinical and laboratory research on platelet activation and aggregation has been paid more and more attention. Its purpose is to treat and prevent blood stasis syndrome. In this study, the authors analyzed the research on the dysfunctions of platelets in blood stasis syndrome, biological basis of TCM blood stasis syndrome, and the effect of blood-activating stasis-resolving prescriptions on platelets, aiming at providing a reference for exploring the mechanism of platelet intervention in the treatment of TCM blood stasis syndrome and the pathways and targets of Chinese medicine in the prevention and treatment of the syndrome.

Objective: To analyze the clinical and prognosis of children with kidney retransplantation. Methods: Clinical data of 11 children who underwent kidney retransplantation from January 2011 to December 2020 in Department of Nephrology, Children's Hospital of Fudan University were retrospectilely analyzed. The clinical data including demographic parameters, primary diagnosis, characteristics in the follow-up of renal allograft were analyzed. Results: Totally 11 cases received secondary renal transplantation (male 6, female 5). They were initially diagnosed with chronic kidney disease at the age of 11.9 (7.4, 13.3) years. The median duration of dialysis was 22.1 (3.5, 36.5) months. In the first transplantation, recipient age was 13.9 (11.1, 15.2) years. Ten cases received donation from cardiac death donor (DCD) (9 cases received donors aged less than one year, 5 of them received whole kidney transplantation and one case received donor aged one to three years) and 1 case with living-related donor. Ten graft failures occurred within 1 month after renal transplantation and the other one occurred at the fifth month after transplantation. The causes included vascular factors (9 cases), rejection (1 case) and primary non-function (1 case). In the second transplantation, recipient age was 14.7 (11.7, 16.2) years. All the 11 children received dialysis (7 with PD and 4 with HD) and successfully completed the second transplantation. The median time between the two transplants was 210 (16, 1 041) days. Donors were all DCD donors from 3 years of age or older. The mean follow-up duration was (42±15) months. The estimated glomerular filtration rate was (85±34)ml/(min·1.73 m 2 ) when the last investigation after kidney retransplantation with the kidney and patient all survived. Conclusions: Kidney retransplantation may have better prognosis in children. Dialysis transition during waiting period and DCD donor from 3 years of age or older can effectively ensure the success of kidney retransplantation.

Objectives: To analyze the expression level of ubiquitin conjugating enzyme E2C (UBE2C) in lung adenocarcinoma and its clinical significance., Methods: The differences in mRNA and protein expression levels of UBE2C in normal lung tissues and lung adenocarcinoma (LUAD) tissues were determined with the Cancer Genome Atlas (TCGA), Oncomine, and human protein atlas (HPA) databases. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of UBE2C in LUAD. The correlation between UBE2C and LUAD clinicopathological parameters, as well as its relationship with LUAD prognosis was analyzed based on TCGA, International Cancer Genome Consortium (ICGC), and cbioPortal databases. Gene set enrichment analysis (GSEA) was used to analyze the possible pathways of UBE2C in the progression of LUAD., Results: The mRNA expression level of UBE2C was higher in LUAD tissues than in the normal lung tissues ( P <0.01) and it was positively correlated with TNM and N stages (both P <0.05). The UBE2C protein expression level was also increased in LUAD tissues than in the normal lung tissues ( P <0.01). ROC curve analysis indicated that UBE2C could be used as an auxiliary diagnostic index for LUAD (AUC=0.969, 95% CI 0.953 to 0.984, P <0.01). Survival analysis showed that the overall survival (OS) of UBE2C high expression group was significantly lower than that of low expression group ( P <0.05). The OS of LUAD patients with UBE2C change was lower than that of patients without change ( P <0.01). UBE2C was highly expressed in the gene set relevant to cell cycle, p53 signaling pathway, DNA mismatch repair, and DNA replication (all P <0.01)., Conclusions: The expression level of UBE2C is significantly up-regulated in LUAD tissues. The high expression or genetic alteration of UBE2C indicates poor prognosis in LUAD patients. UBE2C can be used as a potential molecular diagnostic marker for LUAD and a potential target for LUAD treatment.

Twenty-six batches of Gardeniae Fructus from different producing area were collected for the development of the fingerprint, and the main components of Gardeniae Fructus were identified by liquid chromatography-mass spectrometry. The producing areas of Gardeniae Fructus were distinguished by chemical pattern recognition technology, and the index components of Gardeniae Fructus were quantitated. An UPLC wavelength switching method was adopted, and the separation was carried out on a Waters Acquity UPLC HASS C&#95;(18)(2.1 mm×100 mm, 1.7 μm) column using the mobile phase of acetonitrile-0.5% formic acid water for gradient elution. Principal component analysis(PCA) and orthogonal partial least square discriminant analysis(OPLS-DA) were used for the data ana-lysis. The results showed that the similarity of 26 batches of Gardeniae Fructus was more than 0.89, and ten common peaks were defined. Sixteen compounds including monoterpenes, iridoids and diterpenoids were identified by reference identification, literature comparison and high-resolution mass spectrometry data analysis. The distinguishment of origin of Gardeniae Fructus was realized by PCA and OPLS-DA analysis, and two quality differential markers were screened as geniposide and crocin Ⅰ. The contents of crocin Ⅰ, crocin Ⅱ and geniposide in Gardeniae Fructus from different places were different. These results will provide reference for the geographical origin traceability of Gardeniae Fructus.

Interstitial lung disease (ILD) is a risk factor for lung cancer. Patients with lung cancer associated with ILD (LC-ILD) often appear clinically. During the treatment of LC-ILD, there is a risk of causing acute exacerbation or even death in the treatment of lung cancer. At the same time, combining ILD has become the exclusion criteria for prospective clinical trials of most lung cancers. Therefore, when lung cancer is combined with ILD, it often becomes a difficult point for the treatment of lung cancer. Because LC-ILD patients have a certain proportion in the clinic, it is necessary to explore the best treatment options. Here we review the results of existing clinical studies for reference.

Viral pneumonia is caused by a spreading of lung infection caused by respiratory viruses. Some virus infections were found to be highly aggressive, leading to lung inflammation and severe damage in respiratory system with high fatality rate. Currently, there is no effective therapeutic drugs in the clinic. The common clinical symptoms of viral pneumonias include fever, rhinitis, runny nose, nonproductive cough, fatigue, myalgias and headaches after the immune system being tricked by driving cytokines and overactivated immune response induced by cytokine storms. Patients with severe symptoms could get persistent high fever, dysfunctional breathing, consciousness disorders and even respiratory failure, post-inflammatory pulmonary fibrosis, multi-organ damages, shock and so on. Most clinical treatments are used to inhibit virus replication, relieve symptoms, inhibit excessive inflammatory response, regulate immune balance and protect organs. Both applied and basic research demonstrate that Chinese patent medicine has certain anti-viral effects, effectively inhibiting viral pneumonia transiting from mild to severe, rapid relieving of patient symptoms because of their multi-component and multi-target integrated roles. This review has summarized the reports on the treatment of viral pneumonia. Based on the pathogenic characteristics of viral pneumonia, this paper summarizes the diverse roles of the marketed Chinese patent medicine, such as their effects in inhibiting the progress of viral replication and overactivated inflammatory response, regulating immune balance, attenuating pulmonary fibrosis and so forth. Our paper summarizes the advantages of Chinese patient medicine in the treatment of viral pneumonia, based on which improvements of clinical therapy are expected to be made soon.

Objective: To compare the clinical effects of ultrasonic subgingival debridement and ultrasonic subgingival debridement combined with manual root planing on severe periodontitis and then to investigate the necessity and significance of manual root planing., Methods: Twenty-three patients with severe periodontitis participated in this split-mouth randomized-controlled clinical trial. Baseline examination and randomization were performed after supragingival scaling: each of the upper and lower jaws had a quadrant as the test group treated with ultrasonic subgingival debridement combined with manual root planing, whereas the other two quadrants were the control group treated with ultrasonic subgingival debridement. Treatment of each patient was at intervals of one week and completed in two visits. Clinical indicators concerning probing depth (PD), clinical attachment loss (CAL) and bleeding index (BI) were recorded at baseline and 1 month, 3 months, 6 months after treatment., Results: There was no significant difference of periodontal indicators between the test group and the control group at baseline. Both the test group and control group resulted in significant improvement of PD, CAL and BI. One and three months after treatment, reduction of PD in the test group was higher than that in the control group [1 month: (2.13±1.31) mm vs. (1.79±1.33) mm, P<0.01; 3 months: (2.46±1.33) mm vs. (2.17±1.38) mm, P<0.01] and reduction of CAL in the test group was higher than that in the control group [1 month: (1.89±2.03) mm vs. (1.65±1.93) mm, P<0.01; 3 months: (2.03±2.05) mm vs. (1.83±1.97) mm, P<0.05]. Six months after treatment, PD in the test group and the control group decreased by (2.52±1.40) mm and (2.35±1.37) mm respectively, and the improvement in the test group was significantly better than that in the control group (P<0.01). CAL in the test group and the control group decreased by (1.89±2.14) mm and (1.77±2.00) mm respectively, and there was no statistical difference between the groups. There was no significant difference in the changes of BI between the two groups 1, 3 and 6 months after treatment., Conclusion: Ultrasonic subgingival debridement combined with manual root planing has more reduction in PD and CAL compared with ultrasonic subgingival debridement. Therefore, it is still necessary to use manual instruments for root planing following ultrasonic subgingival debridement.

Objective: To establish a quantitative three-dimensional method based on intraoral scan to evaluate the changes of soft tissue, and to evaluate the changes of supracrestal gingival thickness (SGT) in skeletal class Ⅲ patients induced by periodontal regenerative and corticotomy surgery (PRCS). Methods: Twenty-two systematically and periodontally healthy skeletal class Ⅲ patients (4 males and 18 females, aged between 19 and 35 years), who were in need of combined orthodontic-orthognathic treatment and referred to the Department of Periodontology from the Department of Orthodontics and the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from January, 2018 to March, 2019, were collected in the study. The teeth involved were 112 anterior teeth (46 maxillary anterior teeth and 66 mandibular anterior teeth). PRCS in anterior tooth area was conducted before orthodontic decompensation. Probing depth (PD), bleeding index (BI) and keratinized gingiva width (KGW) were recorded before surgery and 6 months post-surgery. The intraoral digital impressions of maxillary and mandibular anterior teeth were obtained by 3-shape intraoral scanner before surgery and 6 months after surgery. The Standard Tessellation Language (STL) files were processed using Geomagic qualify 12.2 software to establish the soft tissue morphological measurement model, and to quantitatively analyze the changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin on the median sagittal measurement plane. Results: Probing depth and bleeding index had no significant difference before and 6 months after operation ( P >0.05). KGW in 6-month post-operation group [(5.18±2.32) mm] was significantly higher than that in pre-operation group [(4.22±1.43) mm] ( P< 0.05). Supracrestal gingival thickness situated 1 to 2 mm apical to the free gingival margin also significantly increased 6 months after surgery ( P< 0.05). The changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin in the upper anterior area were (0.68±0.56) and (1.00±0.69) mm, respectively. The changes in the lower anterior area were (0.38±0.42) and (0.58±0.45) mm, respectively. The gingival changes of the upper anterior teeth were also significantly higher than those of the lower anterior teeth ( P< 0.01). Conclusions: The described quantitative measurement based on intraoral scan could be an effective method for quantitative evaluation of the changes of soft tissue. PRCS could safely increase the supracrestal gingival thickness as well as KGW in skeletal class Ⅲ patients who were in need of combined orthodontic-orthognathic treatment.

A rat model with isoproterenol (ISO)-induced myocardial ischemia was obtained. Liquid chromatography-mass spectrometry (LC-MS)was conducted on the serum and heart tissue metabolites of normal and model rats. Principal component analysis (PCA) and differentiation analysis of supervised partial least-squares method (PLS-DA) were applied to the metabolomics data for multidimensional statistical analysis, and the resulting biomarkers were screened. Compared with the normal group, 18 different endogenous metabolites in plasma and tissues were detected, including the products of arginine and proline metabolism; glycine, serine, and threonine metabolism; glutamine and glutamate metabolism; and taurine and hypotaurine metabolism. These metabolites can be used as important biomarkers for myocardial ischemia. The results of this study can help reveal the pathogenesis of myocardial ischemia and aid clinical diagnosis.

Objective: Drug retention enema is a common therapy for various illnesses. However, it is impossible to keep the drug in the colon for a long time, due to the limitation of the current equipment, and it is unable to achieve the purpose of retention enema. A retention enema device was designed by the department of intensive care unit (ICU) of Dongfeng Hospital Affiliated to Hubei University of Medicine. The retention enema device adds a spindle shaped inflatable air bag on the basis of the traditional enema device, which not only fix on the anus, but also prevent the leakage of enema fluid. It can achieve retention enema, play the enema drug effect fully, and significantly reduce the nursing workload, in addition, the silica gel material of the retention enema device ensures the comfort of the patients, the decompression air bag also avoids the damage of the high pressure of the spindle fixed air bag for the patients, which is worthy of clinical use.

Objective To investigate the autophagy and the expression of CD40 and CD80 of dendritic cells (DCs) induced by hypoxia and lipopolysaccharide (LPS). Methods DCs were divided into normal group, hypoxia group, lipopolysaccharide (LPS) treatment group and hypoxia combined with LPS treatment group. Each group was treated for 24 hours, and the cell proliferation was detected by MTT assay. The protein levels of autophagy microtubule-associated protein 1 light chain 3I (LC3I), LC3II and beclin1 were detected by Western blot analysis. The formation of autophagosomes in DCs was observed under a transmission electron microscope after LPS treatment. The expression of CD40 and CD80 on DCs was detected by flow cytometry and immunofluorescence cytochemical staining. Results Hypoxia and LPS could induce autophagy in mouse DCs and increase the expression of CD40 and CD80 on their surface. After hypoxia combined with LPS treatment, autophagy in DCs was significantly enhanced; more autophagosomes were formed; and the expression of co-stimulatory molecules CD40 and CD80 were raised. Conclusion Hypoxia and LPS can induce autophagy and increase the expression of CD40 and CD80 in mouse DCs.

The visualization of the microcosmic behavior of proteins in vivo is the key to real-time monitoring of proteins. A series of wash-free SNAP-tag probes were designed and synthesized based on the combination of SNAP-tag and small organic molecule fluorescent dyes. SNAP-tag, which specifically recognized O6-benzylguanine, could be labeled with a fluorophore (e. g., 1,8-naphthalimide) through the formation of covalent bonds. Furthermore, the change from a hydrophilic environment to the hydrophobic cavum of SNAP-tag realized a 2-13-fold enhancement in fluorescence. Through the fusion of SNAP-tag and the target protein, the probes could recognize the mitochondrial proteins (e. g., cytochrome oxidase, Cox8A) and nuclear proteins (e. g., H2B) in living cells. Besides, the fluorescent probes allowed the in-situ real-time monitoring of proteins without washing.

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman's rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods ( P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion: Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

Objective: To study the correlation between the level of T-bet expression and liver damage in peripheral plasma cells of patients with autoimmune hepatitis (AIH) in order to provide reference for the study of pathogenesis and development of diseases. Methods: The peripheral venous blood and clinical examination data of 29 cases with AIH and 6 healthy volunteers were collected. The percentage of subpopulations of peripheral blood B cells and the proportion of T-bet(+) cells in each subgroup were detected by flow cytometry. Plasma cells (CD19(+)CD10(-)CD27(hi)CD38(hi)), primary B cells (CD19(+)CD10(-)CD27(-)IgD(+)), transitional B cells (CD19(+)CD10(+)), and memory B cells (CD19(+)CD10(-)CD27(+)IgD(-)) were the included subsets of B cells. Serum immunoglobulin G (IgG) and alanine aminotransferase (ALT) levels, the proportion of B cells in peripheral blood subsets and IgG level, the proportion of T-bet(+) cells in each subset and the proportion of T-bet(+) plasma cells in each subset in B cells, the proportion of T-bet(+) plasma cells and the level of serum ALT were analyzed for correlation analysis. Statistical analysis was performed using two independent sample t-tests and linear regression. Results: The serum IgG level of AIH patients with abnormal ALT (19.47 ± 1.039)g/L was significantly higher than that of normal ALT patients (15.5 ± 1.069)g/L, and the difference was statistically significant ( t = 2.65, P < 0.05). The percentage of peripheral plasma cells in B cells of AIH patients (2.80 ± 0.14) % was higher than that of healthy volunteers (0.73 ± 0.09) %, and the difference was statistically significant ( P < 0.01). The percentage of T-bet(+) cells in peripheral plasma cells of AIH patients (23.54 ± 1.61) % was higher than that of healthy volunteers (6.59±0.59) % , and the difference was statistically significant ( P < 0.01). The correlation analysis showed that the proportion of T-bet(+) cells in peripheral plasma cells of AIH patients was positively correlated with the proportion of plasma cells to B cells ( r = 0.224 7, P < 0.01), and the percentage of peripheral plasma cells to B cells was positively correlated with the level of serum IgG ( r = 0.299 1, P < 0.01). Serum IgG level was correlated with the level of ALT, reflecting an indicator of liver damage ( t = 2.65, P < 0.05). Conclusion: The increase of T-bet expression in the peripheral plasma cells of AIH patients is associated with liver damage, which is a new mechanism of AIH pathogenesis and disease progression.

The discovery of hydroxylases in the anticancer drug taxol biosynthesis pathway is a hotspot and difficulty in current research. In this study, a new hydroxylase gene TcCYP725A22 (GenBank accession number: MF448646.1) was used to construct a sub-cellular localization vector pCAMIBA1303-TcCYP725A22-EGFP to get the transient expression in onion epidermal cells. Laser confocal microscopy revealed that the protein encoded by this gene was localized in the cell membrane. Furthermore, the recombinant plant expression plasmid pBI121-TcCYP725A22 was constructed. After transient transformation to the Taxus chinensis mediated by Agrobacterium tumefaciens LBA4404, qRT-PCR and LC-MS were utilized to analyze the effects of TcCYP725A22 overexpression on the synthesis of taxol. The results showed that, in the TcCYP725A22 overexpressed cell line, expression levels of most defined hydroxylase genes for taxol biosynthesis were increased, and the yield of taxanes were also increased. It was concluded that the hydroxylase gene TcCYP725A22 is likely involved in the biosynthetic pathway of taxol.

Pectobacterium carotovorum subsp. carotovorum is one of the world's top ten plant pathogens, mainly infecting cruciferous economic crops and ornamental flowers. In this study, an antibacterial gene cpxP (Gene ID: 29704421) was cloned from the genome of Pectobacterium carotovorum subsp. carotovorum, and constructed on the prokaryotic expression plasmid pET-15b, and the recombinant plasmid was transformed into Escherichia coli BL21 (DE3), then stability and bacteriostatic experiments of the purified CpxP protein were performed. The final concentration of IPTG was 1 mmol/L, obtaining high-efficiency exogenous expression of the CpxP protein. There was no other protein after purification, and the destined protein exhibited good thermal stability and pH stability. The antibacterial test results showed that the inhibition rate of the CpxP protein on carrot slice was 44.89% while the inhibition rate on potato slice was 59.41%. To further explain its antibacterial mechanism, studying the spatial structure of this protein can provide new ideas for the control of soft rot and new protein pesticide targets.

We collected death data of children under 5-year-old in China from the national child mortality surveillance system from 2010 to 2016. The change of mortality rate and causes of death were described. The mortality rate of Chinese children under 5-year-old decreased from 16.4‰ to 10.2‰ in all areas between 2010 and 2016, from 20.1‰ to 12.4 ‰ in rural areas and from 7.3‰ to 5.2‰ in urban areas, respectively, with a greater average annual decreasing rate in rural areas than urban area. During these years, in addition to traffic accidents and sepsis, other 8 cause-specific mortality rates showed a downward trend. There were substantial decreases of mortality rates of premature birth or low birth weight, birth asphyxia and neural tube defects. In urban areas, the mortality rate of premature birth or low birth weight, birth asphyxia decreased, and the mortality rate of congenital heart disease and diarrhea substantially decreased. However, there was a substantial increase of mortality rate of septicemia in urban areas. In rural areas, the change of major cause-specific mortality rates were consistent with the national trend.

Objective: To analyze the gene sequencing in eight patients with Glanzmann's thromboasthenia(GT), and combined with clinical manifestations and laboratory findings to investigate the molecular mechanism of GT. Methods: Eight patients who were diagnosed as GT based on platelet aggregation test and flow cytometry were enrolled, as well as 4 pedigrees. Next-generation sequencing was used to analyze all the exons and flanking sequences of αⅡ band β3 gene and also platelet-type bleeding disorders related genes. Gene polymorphism was excluded by retrievaling HGMD and PubMed databases and relative literature. Mutations were confirmed by sanger sequencing. Results: All the eight patients had relatively normal platelet counts and coagulation profiles. But their platelet response to ADP was impaired, and their platelet response to ristocetin was relatively normal. Flow cytometry showed that of the 8 patients, platelet surface αⅡb/β3 was lower than 5% of the normal value in 5 cases, and in 2 cases was 5% to 20% of normal value, and in 1 case there was no significant platelet surface αⅡb/β3 reduction compared with normal level. Gene analysis revealed that five mutations in ITGA2B gene were identified, including c. 1750C>T(p.Arg584Ter), c.1882C>T(p.Arg628Ter), c.814G>C(p.Val272Leu), c.2333A>C(p.Gln778Pro), c.432G>A(p.Trp144Ter). Six mutations in ITGB3 gene, including c. 719G>A(p.Arg240Gln), c.2248C>T(p.Arg750Ter), c.1495T>C(p.Cys499Arg), c.1728delC(p.Ser577ProfsTer92), c.877C>T(p.Gln293Ter), c. 1260G>A were identified. In addition, mutations in genes such as RUNX1, HPS4, MYH9, ACTN1, HPS3 and SETBP1 were identified in patients with GT. Conclusions: Rather than homozygous mutations, heterozygous mutations, especially compound heterozygous mutations, are more common in patients with GT. The pathogenesis of GT may relate to gene mutations such as RUNX1 in addition to the ITGA2B gene and the ITGB3 gene.

Objective: To evaluate the effects of CYP2C19 genetic polymorphism on the plasma concentration of voriconazole in patients with hematological disease and the value of serial monitoring plasma concentrations in the treatment and prevention of invasive fungal disease (IFD). Methods: From January 2016 to December 2016, 65 hematological patients who received voriconazole intravenous administration for the treatment of invasive fungal disease were enrolled in this study. The population CYP2C19 polymorphism of voriconazole were performed using PCR-Pyrosequencing. The trough plasma concentrations of vriconazole (C trough ) was detected by ultra performance liquid chromatography tandem mass spectrometry. Results: Based on the genotype analysis, 65 subjects were identified as extensive metabolizers' group (30 cases) and poor metabolizers' group (35 cases). The C trough of the 65 patients were detected for 169 times totally, and there was a significant difference of C trough values between the two groups [0.98(0.38-2.08) mg/L vs 2.19(1.53-4.27) mg/L, z=10.286, P <0.001]. The medium of C trough in 65 hematological patients were described. Lack of response to therapy was more frequent in patients with voriconazole levels <1.5 mg/L (50.0%) than in those with voriconazole levels >1.5 mg/L (20.5%) ( P =0.052). And the risk of adverse events was more frequent in patients with voriconazole levels >5.5 mg/L (80.0%) than in those with voriconazole levels ≤5.5 mg/L (8.3%) ( χ 2 =11.689, P =0.020). Conclusion: Patients with CYP2C19 wild-type phenotype are extensive metabolizers, their C trough of voriconazole are significantly lower than patients with CYP2C19 non-wild-type phenotype (poor metabolizers). Appropriate concentrations of vriconazole can improve the efficacy and safety during treatment.

Objective: To investigate the current status of job burnout in in-service sailors, and to provide a basis for the development of intervention measures for job burnout in sailors. Methods: From September 2015 to May 2016, stratified cluster random sampling was used to select 6 172 in-service sailors from 13 provinces and cities as research subjects. General demographic data including age, education background, and household registration and occupational characteristics such as job position, navigating zone, and nature of employment were collected. The Maslach Burnout Inventory-General Survey (MBI-GS) was used to measure the levels of emotional exhaustion, depersonalization, low occupational efficiency, and job burnout, and the influencing factors for job burnout were also analyzed. Results: Of all 6 172 in-service sailors, 112 (1.8%) had a positive result in emotional exhaustion, 870 (14.1%) had a positive result in depersonalization, and 3 517 (57.0%) had a positive result in low occupational efficiency. Of all sailors, 63.3% had job burnout, among whom 54.1% had mild burnout, 8.7% had moderate burnout, and 0.5% had severe burnout. There was a significant difference in the score of job burnout between the sailors with different ages, education backgrounds, types of household registration, job positions, navigating zones, ornature of employment ( P <0.05). Age, education background, household registration, job position, navigating zone, and nature of employment were major influencing factors for job burnout in in-service sailors ( P <0.05) , and there was a higher level of job burnout in the sailors with an age of 30-39 years, education background of junior college or above, urban registration, a job position of second mate/third engineer, a navigating zone of coastal lines, orthe nature of employment of freelance sailor. Conclusion: There is a high incidence rate of job burnout among in-service sailors, and the sailors with a young age, urban registration, a navigating zone of coastal lines, or thenature of employment of freelance sailor tend to have low occupational efficiency. Related measures should be adopted for active intervention.

Objective: To investigate the clinical efficacy and outcome determinants in cardiac arrest patients secondary to acute myocardial infarction treated with extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI). Methods: The clinical data of 27 patients hospitalized from January 2014 to March 2017 in 3 hospitals were retrospectively analyzed. The clinical data of the surviving group (12 cases) and the death group (15 cases) were compared and the outcome determinants were explored. Results: Twenty seven patients were successfully treated with coronary angiography and emergency PCI under ECMO assistance, and the successful procedure rate was 100%. The survival rate was 44.4% (12/27). There was no significant difference in gender, age, body weight, myocardial infarct location, past disease history and smoking status between the two groups (all P >0.05). Traditional cardiopulmonary resuscitation time was significantly longer, the CCU hospitalization time was significantly shorter, the number of diseased vessels was significantly higher, and the prevalence of distribution of blood vessels in left main stem was significantly higher and mean artery pressure at 24 and 48 hours post ECMO was significantly lower in the death group than in survival group (all P <0.05). Multiple logistic regression analysis showed that left anterior descending artery lesion, higher number of lesion vessels, longer traditional cardiopulmonary resuscitation time, longer time interval between cardiac arrest and ECMO placement were related increased risk of death post ECMO and emergency PCI in this patient cohort( OR =1.316, 95% CI 1.217-5.792, P =0.002; OR =1.238, 95% CI 1.107-4.961, P =0.000; OR =1.712, 95% CI 1.136-3.973, P =0.001; OR =1.629, 95% CI 1.132-4.521, P =0.000, respectively), while higher mean artery pressure at 48 hours post ECMO was related with reduced risk of death post ECMO and emergency PCI in this patient cohort( OR =0.672, 95% CI 0.326-0.693, P =0.001). Conclusions: ECMO combined with emergency PCI can improve the success rate of traditional cardiopulmonary resuscitation in patients with cardiac arrest secondary to acute myocardial infarction. Left anterior descending artery lesion, number of lesion vessels, traditional cardiopulmonary resuscitation time, time interval between cardiac arrest and ECMO placement and mean artery pressure at 48 hours post ECMO are outcome determinants post ECMO and emergency PCI in this patient cohort.

Diurnal variation of PM 2.5 mass concentration is analyzed based on data of BAOLIAN (representing urban area) and SAHNDIANZI BAP-Station (representing rural area) from 2005 to 2014. Furthermore, the influence of meteorological factors was also discussed. The results showed that 10-year-average diurnal variation of PM 2.5 mass concentration in urban area had a two-peak pattern being coincident with rush-hour. However, it became clear only after 2007. The monthly (including seasonal) variation presented the change from one-peak pattern to two-peak pattern with the max mass concentration appearing in the morning or late afternoon during rush hour. The mass concentration in the morning rush hour reached its maximum between May and August which was to some degree related with weak wind and high relative humidity as well as great water vapor pressure (indicating the absolute water content in the air). But the smaller variety of mass concentration in the late afternoon attributed to the thicker mixing layer, higher wind speed and more showers. By contraries, it went up greatly after 4 pm in Nov., Dec., Jan. and Feb.. One of the reasons was that the height of mixing layer top decreased sharply. Besides, in some severely and seriously polluted days, the PM 2.5 mass concentration increased after morning rush hour till afternoon which was different from the mean pattern and that in moderately polluted day. The main mechanism attributed to the aerosol from aerial source around brought by south wind to Beijing. The more severe the pollution was, the greater the daily concentration fluctuated. The range of PM 2.5 diurnal variation was determined by the max wind speed and daily change of relative humidity in a day. Besides, it also extended the diurnal variation of concentration when the south wind speed reached 4-6 m·s -1 in the afternoon. In rural area, the mean diurnal variation of PM 2.5 mass concentration showed a one-peak pattern. And the time of concentration reaching its maximum was ahead of that of urban area. Moreover, the values in the day time during May and July were higher than that in winter. These results would be helpful to make policy for finer emission control when the atmosphere is in lower diffusivity situation.

Objective: To investigate the correlation between the positive rate of high risk human papillomavirus(HPV)mRNA E6/E7 and cervical cancer, and provide evidence for the prevention and treatment of cervical cancer., Methods: A total of 100 cervical cancer cases and 100 healthy controls were selected in our hospital from January 2015 to December 2015. The fluorescence quantitative PCR and pathological examination on HPV E6/E7 mRNA were carried out. The correlation between HPV E6/E7 mRNA and cervical squamous epithelial lesions were analyzed., Results: In case group, the positive rate of HPV E6/E7 mRNA was 76.0%(76/100). In control group, the positive rate was 13.0%(13/100). The positive rate in case group was significantly higher than that in control group, and the difference was statistically significant(χ(2)=24.522, P<0.001). The positive predictive value and negative predictive value of the two groups were compared, and the difference was not significant(P>0.05). The positive rate of HPV E6/E7 mRNA was significantly higher than high-grade squamous intraepithelial lesion(SIL)rate(26.1%), low-grade SIL rate(17.6%)and atypical squamous cell hyperplasia rate(6.7%), the difference was statistically significant(χ(2)=7.615, P= 0.001; χ(2) =9.114, P=0.001; χ(2)=18.241, P<0.001)., Conclusions: The detection rate of HPV E6/E7 mRNA in cervical cancer patients was high. And with the increased severity of cervical squamous epithelial lesions, the positive rate of HPV E6/E7 mRNA increased.

Objective: To investigate the effect of Iptakalim (Ipt) preventing injury of endothelial microvesicles (EMVs) derived from hypoxia/reoxygenation (H/R)-treated HUVECs on the relaxation of rat thoracic aortic rings and explore the underlying mechanism., Methods: H/R injury model was established to release H/R-EMVs from HUVECs. H/R-EMVs from HUVECs were isolated by ultracentrifugation from the conditioned culture medium. H/R-EMVs were characterized by using Transmission Electron Microscope (TEM). Thoracic aortic rings of rats were incubated with 10 -7 -10 -3 mol/L Ipt and co-cultured with 10 μ g/ml H/R-EMVs for 4 hours, and their endothelium-dependent relaxation in response to acetylcholine (ACh) was recorded in vitro. The nitric oxide (NO) production of ACh-treated rat thoracic aortic rings was measured by using Griess reagent. The expression of endothelial NO synthase (eNOS), phosphorylated eNOS (p-eNOS, Ser-1177), serine/threonine kinas (Akt) and phosphorylated Akt (p-Akt, Ser-473) in the thoracic aortic rings of rats was detected by Western blotting., Results: H/R-EMVs were induced by H/R-treated HUVECs and isolated by ultracentrifugation. The isolated H/R-EMVs subjected to TEM revealed small, rounded vesicles (100-1 000 nm) surrounded by a membrane. H/R-EMVs impaired relaxation induced by ACh of rat thoracic aortic rings significantly. Compared with H/R-EMVs treatment individually, relaxation and NO production of rat thoracic aortic rings were increased by Ipt treatment in a concentration-dependent manner ( P <0.05, P <0.01). The expression of total eNOS (t-eNOS) and total Akt (t-Akt) was not affected by Ipt or H/R-EMVs. However, the expression of p-eNOS and p-Akt increased after treated with Ipt ( P <0.01)., Conclusions: Based on H/R-EMVs treatment, ACh induced endothelium-dependent relaxation of rat thoracic aortic rings was ameliorated by Ipt in a concentration-dependent manner. The mechanisms involved the increase in NO production, p-eNOS and p-Akt expression.

Objective: To determine whether intramural administration of rapamycin (RPM)-loaded polylactic-polyglycolic acid (PLGA) nanoparticles (NPs) can reduce intimal thickening and affect the mRNA expressions of matrix metalloproteinase (MMP)-2, tissue inhibitor of metalloproteinase (TIMP)-2 and p27(kipl) in a coronary injury-stenosis model of minipigs., Methods: Twenty eight minipigs were randomly separated into four groups: saline group (n=7), blank PLGA NPs group (5.0 mg/ml)(n=7), RPM group (1.0 mg/ml)(n=7), and RPM-PLGA NPs(5.0 mg/ml)group (n=7), respectively. Different treatments were intracoronary locally delivered via a Dispatch™ catheter for 10 minutes. Serial angiography was performed pre-and post-modeling 30 days and the percent stenosis degree was assessed. Hematoxylin-Eosin (HE) staining, Weigert's resorcin fuchsin staining and picric acid-sirius red staining were used for morphometric analysis. Immunohistochemistry was performed to assess the levels of proliferating cell nuclear antigen (PCNA), MMP-2, and TIMP-2 at early and late time points, respectively. The expression of p27(kip1) mRNA was detected by in situ hybridization staining., Results: Data from 21 minipigs had been collected at the end of the experiment with 6, 4, 5, and 6 from the former mentioned 4 groups, respectively. For the instant injury index, there was no significant difference among the four groups. The percent stenosis degree of RPM-PLGA NPs group was significantly lower than that of the other three groups respectively (all P< 0.05). The neointima area, net external elastic lamina area to external elastic laminal area ratio, and proliferative index of RPM-PLGA NPs group were significantly less than those of the other three groups, with all the P values less than 0.05. The mean value of integral optical density of p27(kip1)mRNA expression of RPM-PLGA group was 0.35 ± 0.06, higher than that of blank PLGA NPs group (0.12 ± 0.05, P< 0.01), saline group (0.16 ± 0.03, P< 0.05), and RPM group (0.15 ± 0.03, P< 0.05), respectively. The MMP-2/TIMP-2 ratio and the positive expression index of PCNA in RPM-PLGA group were lower than that of the other groups (P< 0.05)., Conclusions: Locally delivered rapamycin-loaded PLGA NPs significantly reduces MMP-2/TIMP-2 ratio and PCNA expression, increases p27(kip1) mRNA expression and significantly relieves percent stenosis degree and shows excellent acute procedural results in the minipig interventional coronary artery oversized balloon injury model. The results from minipig model further support that this approach could be a potential clinical procedure for vascular proliferative disease.

Objective: To investigate the clinical and high-resolution computed tomography (HRCT) features of the welder's pneumoconiosis., Methods: A total of 10 patients diagnosed by bronchoscopy and pathology from January 2010 to January 2015 in Nanjing Drum Tower Hospital were recruited in this study, and the clinical manifestations, pulmonary function tests, pathology and HRCT data were collected and analyzed retrospectively., Results: Ten patients all had welder's occupational history for 5-30 years, with the main clinical manifestations of cough, sputum production, chest tightness and other symptoms. And the ratio of forced expiratory volume in one second and forced vital capacity (FEV1/FVC) of 4 patients was lower than 75.0% in the pulmonary function tests. Transbronchial lung biopsy specimen showed numerous hemosiderin-laden macrophages within the alveolar space, associated with positive iron staining. In welder's pneumoconiosis, small centrilobular nodules (10 cases) were frequently seen on HRCT in bilateral lung fields, with branching linear structures or the tree buds like shadows in 7 cases; 3 patients also showed areas of ground-glass attenuation. And the patients were misdiagnosed as tuberculosis (1/10), interstitial pneumonia (3/10), allergic alveolitis (1/10), diffuse lung disease (2/10), and vasculitis (1/10)., Conclusions: Clinical manifestations of welder's pneumoconiosis are not specific; small centrilobular nodules are frequently seen on HRCT, with linear opacities or tree bud-like shadows.

Objective: To investigate the effectiveness and safety of inhaled granulocyte-macrophage colony-stimulating factor (GM-CSF) therapy in idiopathic pulmonary alveolar proteinosis (PAP)., Methods: Ten PAP patients were enrolled, who were hospitalized in the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2012 to January 2014.All the patients were treated with inhaled GM-CSF therapy, high-dose therapy for 12 weeks, GM-CSF 150 µg twice a day on days 1-7, none for days 8-14, 6 cycles, low-dose therapy for 12 weeks, GM-CSF 150 µg inhaled once a day on days 1-7, none for days 8-14, 6 cycles, and followed-up for one year. Physiologic, serologic and radiologic features of the patients were analyzed., Results: After inhaled therapy, clinical symptoms, oxygenation indexes, pulmonary function of nine patients were improved, and high resolution CT (HRCT) showed ground-glass lesions reduced. After inhaled therapy for 6 months, the average level of arterial oxygen partial pressure (PaO₂) was significantly higher than that before therapy ((75.5 ± 7.0) vs (63.6 ± 8.9) mmHg (1 mmHg=0.133 kPa)), while alveolar-arterial oxygen pressure difference (P(A-a)O₂) was lower than before ((25.1 ± 7.1) vs (41.2 ± 13.5) mmHg) (both P<0.01). Similarly, vital capacity (VC)% predicted, forced vital capacity (FVC)% predicted and carbon monoxide diffusing capacity (DLCO)% predicted all improved after therapy ((77.3 ± 16.6)% vs (63.3 ± 16.6)%), (79.5 ± 17.6)% vs (64.9 ± 17.1)%), (69.4 ± 23.0)% vs (50.0 ± 19.9)%) (all P<0.01). The score of HRCT reduced after therapy for six months (P<0.05). While the levels of serum lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), CYFRA211 were unchanged. No serious adverse events occurred during observation., Conclusion: Inhaled GM-CSF therapy is safe and effective.

Objective: To investigate the difference in clinical features and radiologic findings between patients with cryptogenic organizing pneumonia (COP) and connective tissue disorder related organizing pneumonia (CTD-OP)., Methods: A total of 30 subjects with COP and 22 subjects with CTD-OP collected from 2005 to 2013 were retrospectively reviewed in the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, and the diagnosis of all patients were confirmed by lung biopsy., Results: The common underlying diseases in patients with CTD-OP were Sjogren syndrome(SS), poly-/dermatomyositis(PM/DM), rheumatoid arthritis (RA). There were no significant differences in clinical manifestations between CTD-OP and COP. Compared with COP patients, the proportion of female patients was higher in CTD-OP. Higher positive rate for ANA was found in CTD-OP group (CTD-OP:63.6%; COP:10.0%; P<0.01). There were no significant differences in parameters of lung function between CTD-OP and COP. As to radiological findings, the most common patterns were multiple patchy, linear shadows and ground-glass opacity. Some patients showed solitary nodule or consolidation and pleural effusion. Reticular shadow was a rare pattern among these patients. Most lesions were under the pleura and/or around the bronchus., Conclusions: There are no significant differences in clinical and radiologic manifestations between COP and CTD-OP, except that the proportion of women and ANA positive rate were higher in CTD-OP.

Objective: To investigate the relationship between gastrointestinal dysfunction and both severity and prognosis in patients with heatstroke ( HS )., Methods: A retrospective analysis was conducted. Clinical data from 39 patients with HS seeking for treatment in Department of Critical Care Medicine of Chinese PLA General Hospital from January 2013 to September 2014 were enrolled. The patients were divided into two groups: gastrointestinal dysfunction group and non-gastrointestinal dysfunction group. The acute physiology and chronic health evaluation II ( APACHEII) score within 24 hours of admission and 28-day mortality were compared between two groups. In gastrointestinal dysfunction group, the gastrointestinal dysfunction score, the duration days of gastrointestinal dysfunction, the length of intensive care unit ( ICU ) stay, and the duration of mechanical ventilation were collected. Pearson correlation analysis was used to analyze the relationship between gastrointestinal function and the severity of the ailment as well as the prognosis., Results: Among 39 patients with HS, 32 of them showed gastrointestinal dysfunction with an incidence of 82.05%. In gastrointestinal dysfunction group, the gastrointestinal dysfunction score was 2.3±0.8, the duration of gastrointestinal dysfunction was ( 17.3±15.2 ) days, the length of ICU stay was ( 37.8±25.0 ) days, and the duration of mechanical ventilation was ( 27.8±14.0 ) days. APACHEII score in gastrointestinal dysfunction group was significantly higher than that of the non-gastrointestinal dysfunction group ( 26.30±6.00 vs. 17.40±6.00, t = 3.555, P = 0.001 ). The 28-day mortality in gastrointestinal dysfunction group was slightly higher than that of the non-gastrointestinal dysfunction group without statistically significant difference [ 43.75% ( 14/32 ) vs. 14.29% ( 1/7 ), P = 0.216 ]. It was shown by Pearson analysis that gastrointestinal dysfunction score was positively correlated with APACHEII score ( r = 0.727, P = 0.000 ), and the duration of gastrointestinal dysfunction was positively correlated with the length of ICU stay ( r = 0.797, P = 0.000 ) and the duration of mechanical ventilation ( r = 0.634, P = 0.000 )., Conclusions: The results suggest that gastrointestinal function in patients with HS reflects the severity and prognosis of the ailment.

Objective: To investigate the relationship between RAD51-G135C and XRCC3-C241T single nucleotide polymorphisms and onset of acute myeloid leukemia (AML)., Methods: The study was performed in 2 groups: AML patient group and normal person group as control group. Genomic DNA was extracted from peripheral blood cells of 545 AML patients and 1 034 normal persons. Genotypes of RAD51-G135C and XRCC3-C241T were analyzed by TaqMan probe technology and the ralatienship between RAD51-G135C/XRCC3-C241T polymorphisms and onset of acute myeloid leukemia was investigated., Results: Compared with the control group, RAD51-G135C homozygous mutant (CC) could significantly increase the risk of AML patients (OR=3.07), and there was no statistical relationship between heterozygous mutant (GC) of RAD51-G135C and onset of AML. There was no statistical relationship between homozygous mutant (TT) of XRCC3-C241T and onset of AML, and the XRCC3-C241T heterozygous mutation type (CT) increased the risk of AML patients (OR=0.66)., Conclusion: RAD51-G135C homozygous mutant and XRCC3-C241T heterozygous mutation significantly increase the risk of the AML onset, which can provide more predictive value for incidence of AML.

Objective: To assess the perfusion changes in brains of patients with varying levels of generalized anxiety disorder (GAD)., Methods: A total of 38 GAD outpatients of Department of Psychiatry at our hospital from February to August, 2014 and 10 healthy controls received a 99mTC-ECD SPECT/CT scan with scenium analysis. Differences between brain perfusion and anxiety levels were analyzed by SPSS 16. 0 with one-way ANOVA, Pearson's Chi-square, t test and Spearman's correlation., Results: They were grouped according to the levels of anxiety severity, i. e. mild (n = 11) , moderate (n = 16) and severe (n = 11). They had significantly lower blood flow in right superior frontal medial gyrus, right precuneus, right putamen, bilateral paracentral lobule and bilateral supplementary motor area (t = -2.19, -2.14, -2.22, -2.34, -2.08, -3.26, -2.72, P < 0.05). Individuals had significantly greater blood flow in mild group than those of control group in right olfactory (t = 2.09 P = 0.05). Individuals of moderate group had significantly lower blood flow than those of control group in left superior frontal gyrus medial orbital, right superior frontal gyrus medial orbital and left supplementary motor area, but greater in right olfactory (t = -2.16, -2.24, -2.49, 2.17, P = 0.04, 0.04, 0.02, 0.04). Individuals had lower blood flow in severe group than those of control group in left frontal lobe, right putamen, left paracentral lobule, right paracentral lobule, left precuneus, right precuneus, left parietal lobe, left precentral, right precentral, right postcentral, left rolandic operculum, left supplementary motor area, right supplementary motor area and left central region (t = -2.32, -2.11, -3.16, -2.61, -2.39, -2.18, -2.32, -2.67, -2.14, -2.11, -2.25, -4.38, -3.54, -2.38, P = 0.03, 0.05, 0.01, 0.02, 0.03, 0.04, 0.03, 0.02, 0.05, 0.05, 0.04, 0.00, 0.00, 0.03). Statistical differences existed in right middle frontal gyms orbital part (mild: 0.96 ± 0.07, moderate: 1.03 ± 0.06, severe: 0.98 ± 0.08, P = 0.04) and left paracentral (mild: 0.91 ± 0.07, moderate: 093 ± 004 severe: 0.87 ± 0.07, P = 0.02). There was a tendency of negative correlation between perfusion in right middle cingulate and paracingulate gyri, left precuneus, right precuneus and left thalamus and anxiety scores by Spearman's correlation analysis (r = -0.28, -0.28, -0.27, -0.29, P = 0.09, 0.09, 0.10, 0.07)., Conclusion: Scenium software provides quantitative measurements for diagnosis of GAD in different anxiety levels. Also larger samples are required for confirming the results in further studies.