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Objective@#To explore the relationship among osteopontin(OPN), Interleukin-17A(IL-17A), anti-MBP auto-antibody and autism spectrum disorder(ASD), and to provide the theoretical basis for the etiology and pathogenesis of ASD.@*Methods@#Forty autistic children and forty matched healthy children were enrolled in this case-control study. The levels of OPN, IL-17A, anti-MBP autoantibody in serum were measured by enzyme-linked immunosorbent assay (ELISA). The associations between those metabolic levels and the severity and intelligence of ASD children were performed by Pearson or Spearman correlation.@*Results@#Children with ASD had higher serum levels of OPN, IL-17A [(296.89±162.95),0.93] pg/mL compared to healthy control[(217.98±113.39), 0.62] pg/mL(P<0.05). Serum OPN, IL-17A, and anti-MBP auto-antibody levels in ASD group were not correlated with the scores of ABC, CARS, and PPVT(P>0.05). However, anti-MBP auto-antibodies level in children with ASD were positively correlated with OPN and IL-17A levels, respectively(r=0.35, 0.34, P<0.05).@*Conclusion@#It was obvious that the ASD children were found with neuroimmunologic abnormality, and the underlying mechanism needs to be further explored.
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Objective To investigate the association of human leucocyte antigen (HLA-DRB1) with anti-melanoma differentiation-associated gene 5 (MDA5) expression in polymyositis/dermatomyositis (PM/DM).Methods Seventy patients with PM,104 patients with DM and 400 healthy controls were included.Genotyping of HLA-DRB1 was performed using the sequencing-based typing method.Levels of anti-MDA5 were measued by enzyme linked immunosorbent assay using recombinant MDA5 antigen.The frequencies of HLA-DRB1 alleles were compared between the patients and controls using a chi-square test or Fisher's exact test.Results Frequencies of DRB1 * 04∶01 [17.0％ vs 1.3％,corrected P-value (Pc)=3.8×10-8;odds ratio (OR)=16.2;95％ confidence interval (CI) (6.6,39.7)] and DRB1 * 12∶02 [(42.6％ vs 19.3％,Pc=0.008;OR=3.1;95％ CI(1.7,5.7)] were significantly higher in anti-MDA5 positive PM/DM patients compared with the controls.The frequencies of DRB1 * 04∶01 [P=5.2×10-6,OR=17.1,95％CI:(5.3,54.9)\ and * 12∶02 [P=3.8×10-4,OR=3.1,95％CI(1.7,5.7)] in anti-MDA5 positive DM-interstitial lung disease (ILD) patients were higher than those in the controls,whereas the frequencies of DRB1 * 04∶01 and * 12∶02 did not differ between the anti-MDA5 negative DM-ILD patients and the controls.No difference in the frequency of DRB1 alleles,other than * 04∶01,carrying the shared epitope (SE),i.e.* 01∶01,* 01∶02,* 04∶05 and * 10∶01,was observed between the controls and DM patients stratified by the presence of anti-MDA5 and ILD.Conclusion DRB1 * 04∶01 and * 12∶02 confer susceptibility to anti-MDA5 antibody production in DM,which cannot be explained by the SE hypothesis.
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Objective To determine the expression levels of SOCS2 in the mouse livers under starvation, diabetes and obese conditions and to study the effect of SOCS2 on gluconeogenesis.Methods Animals were divided into 3 groups: C57BL/6J mice, the control group was fed ad libtum and the experimental group was fasted for 24 h.Diabetes model db/db and the control db/m mice were fed ad libitum.Obese model ob/ob and the control C57BL/6J mice were fed ad libitum.All the mice above were sacrificed and total RNA was isolated from mouse livers and reverse transcribed to cDNA.The expression of SOCS2 and gluconeogenesis genes in the mouse livers in the 3 groups above were detected by real-time quantitative PCR.SOCS2 was overexpressed in the primary C57BL/6J mouse hepatocytes by the adenovirus system.The effect of SOCS2 on glucose production was measured by glucose output assay.Results C57BL/6J mouse hepatic SOCS2 expression was suppressed by starvation status.The expression of SOCS2 was decreased in the livers of db/db and ob/ob mice.In contrast, the key regulators of gluconeogenesis, PGC-1α, PEPCK and G6Pase exhibited the opposite expression pattern as SOCS2 in the livers underidentical starvation, diabetes and obese conditions.The protein was Mr 23 000 and glucose production was inhibited after SOCS2 being overexpressed in the primary C57BL/6J mouse hepatocytes by adenovirus system.Conclusions SOCS2 may inhibit gluconeogenesis in the C57BL/6J mouse primary hepatocytes, and SOCS2 may be a potential target for the treatment of type Ⅱ diabetes.
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Objective To study the differences of coagulation indices on the first day of birth in newborns with different gestational ages.Method Premature infants born in our hospital between January 2014 and December 2015 were enrolled in this study as the observational group,and they were divided into early preterm group,moderate preterm group,and late preterm group according to their gestational ages.Healthy full-term infants born during the same period were selected as the control group by 3:1 The clinicaldata and coagulation indices of the infants and their mothers in each group were compared.Result There were 44,50,71,and 52 cases in the early preterm,moderate preterm,late preterm,and control group,respectively.The prothrombin time (PT),activated partial thromboplastin time (APTT),and thrombin time (TT) of the premature infants in the early preterm group,moderate preterm group,and late preterm group were all longer than those of the control group [PT:(16.1 ±4.3) s,(16.8 ±4.9) s,(15.8 ±4.8) s,vs.(13.0±1.3)s;APTT:(88.3±38.1) s,(93.5±37.7) s,(91.0±32.3) s,vs.(66.0±17.8) s;TT:(25.4 ±4.6) s,(25.1 ±5.5) s,(25.0 ±3.3) s,vs.(24.0 ±3.3) s;all P＜0.05].The fibrinogen level of the premature newborns in three groups were all lower than that of the full-term infants in the control group [(1.11 ± 0.46) g/L,(1.12 ± 0.44) g/L,(1.12 ± 0.45) g/L vs.(1.28 ± 0.37) g/L,P ＜ 0.05].The differences of all the indices among the three groups of premature infants were all not statistically significant (P ＞ 0.05).The comparison of the coagulation indices of the mothers of the newborns from all four groups showed no significant differences (P ＞ 0.05).Conclusion Compared with full-term infants,preterm infants showed significantly poorer coagulation function on the first day of birth.However,there were no significant differences in coagulation indices among preterm infants of different gestational ages.
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OBJECTIVE:To analyze the general patterns and characteristics of drug-induced lupus (DIL) induced by inflix-imab,and to provide reference for the safety of drug use. METHODS:Usinginfiximab,lupusas searching words,inflix-imab-induced DIL literatures included in CJFD,VIP and PubMed from Jan. 2002 to Jun. 2016 were retrieved and analyzed. RE-SULTS:Totally 30 effective literatures were retrieved,involving 31 DIL patients,there were 8 male cases (25.81%) and 23 fe-male cases(74.19%);17 patients aged more than 50(54.84%). 20 cases occurred within 5-24 weeks(64.51%). 16 patients re-ceived infliximab alone (51.61%). Main clinical manifestations were skin rash or photosensitivie enteritig (15 cases),joint pain (16 cases,multiple arthritis and synovitis)and fever(12 cases). 5 patients suffered from 3 above symptoms simultaneously. Labo-ratory examination mainly manifested as antinuclear antibody,double stranded DNA antibody and anti-histone antibody positive. Thirty patients with DIL received drug withdrawal or steroid hormones treatment,among which the symptoms of 26 patients disap-peared after drug withdrawal or treatment within 6 months,and 1 patient deteriorated. CONCLUSIONS:DIL-induced by inflix-imab invovle patients'age and gender,disease types,family history and other factors. Clinicians should be aware of rules and char-acteristics of DIL induced by infliximab,and tighten drug use monitoring to reduce ADR.
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Objective To detect levels of interleukin?4(IL?4), IL?10, interferon?γ(INF?γ)and transforming growth factor?β(TGF?β)in the culture supernatant of peripheral blood mononuclear cells (PBMCs)from patients with atopic dermatitis(AD), and to evaluate regulatory effects of benvitimod on these cytokines. Methods PBMCs were isolated from 20 AD patients and 20 healthy controls. Then, PBMCs from AD patients were equally divided into 4 groups to be cultured with phosphate?buffered saline (PBS group), 400 nmol/L benvitimod solution (benvitimod group), 250 nmol/L dexamethasone solution (dexamethasone group) and 10 nmol/L tacrolimus solution (tacrolimus group), respectively. Enzyme?linked immunosorbent assay(ELISA)was performed to detect levels of IL?4, IL?10, INF?γand TGF?βin the culture supernatant of PBMCs. Results Compared with healthy controls, patients with AD showed significantly higher level of IL?4(83.4 ± 12.2 vs. 44.3 ± 5.7 pg/ml, P0.05). Compared with PBS, 400 nmol/L benvitimod could decrease the expression of IL?4(50.2 ± 10.1 vs. 83.3 ± 12.2 pg/ml, P 0.05)and INF?γ(9.56 ± 5.1 vs. 12.5 ± 2.3 pg/ml, P>0.05), but increase the expression of TGF?β(203.6 ± 15.3 vs. 178.9 ± 17.4 pg/ml, P>0.05)by PBMCs. In addition, no significant differences in the expression of IL?4, IL?10, INF?γ or TGF?β were observed between the benvitimod group and dexamethasone group or tacrolimus group(all P>0.05). Conclusion Benvitimod can regulate the expression of IL?4, IL?10, INF?γand TGF?βby PBMCs in patients with AD.
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Objective To evaluate the effect of performance evaluation on pharmacy management at hospitals run by Beijing Municipal Administration of Hospitals.Methods Analysis of performance evaluation indexes,and retrospective analysis of drug use indexes of the recent three years since the initiation of performance evaluation at the hospital.Results Continuous performance management has significantly boosted indexes of hospital pharmacy management. For example in 2014, medicine proportion at municipal hospitals accounted for 41.55%.Conclusion Awareness of rational drug use at hospitals has significantly strengthened, and the pharmacists played a positive role in upgrading pharmacy.Performance evaluation promotes Beijing ’s municipal hospitals to put their pharmacy management on a scientific and standardized track.
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Objective: To explore the effect of oxidative stress injury on the mechanism of vascular smooth muscle cell (VSMC) calciifcation induced by calcium and phosphorus in experimental rats. Methods: The VSMC calcification was induced by incubating the cells with calcium chloride (CaCl2) andβ-sodium glycerophosphate (β-GP) for 8 days, and the cells were divided into 4 groups: ① Control group, ② Calcification group,③ Calciifcation+H2O2 group, ④ Calciifcation+catalase group. The calcium nodule formation and calcium deposition in VSMC were detected by Alizarin red staining and o-cresolphthalein complexone method, the reactive oxygen species (ROS) was detected by DCFH-DA probe staining and the protein expression of Runx2 was examined by Western blot analysis. Results: Compared with Control group, Calciifcation group showed the higher ROS production, more calcium nodule and calcium deposition, higher Runx2 protein expression;while compared with Calciifcation group, the above indexes were even higher in Calciifcation+H2O2 group, P0.05. Conclusion: CaCl2 andβ-GP treatment may induce VSMC calciifcation via activating ROS-Runx2 signal pathway in experimental rats.
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Objective: To explore the effects of Vitamin K2 (VK2) on theaortic artery calciifcation and oxidative stress injury in experimental rats. Methods: A total of 24 rats were divided into 4 groups:①Control group,②6-week calciifcation group,③12-week calciifcation group and④6-week calciifcation + 6-week VK2 group;n=6 in each group. The arterial calciifcation was induced by warfarin (WFN) treatment. The calcium nodule and deposition in rat’s theaortic artery were detected by Alizarin red staining and o-cresolphthalein complexone method, the reactive oxygen species (ROS) were measured by DHE probe staining and the morphological changes of mitochondria in smooth muscle cells were detected by transmission electron microscopy. Results: Calciifcation nodule formed in both 6-week and 12-week calciifcation groups, the calciifcation deposition and ROS were higher than Control group,P Conclusion: Warfarin induced aortic calciifcation is related to oxidative stress injury which may cause the ultra-micro structural damage in smooth muscle cells; VK2 may reduce the oxidative stress injury and improve the condition of vessel calciifcation in experimental rats.
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Pancreatic cancer is a kind of high degree of malignant gastrointestinal tumor,and its incidence has increased significantly in recent years.Due to the low early diagnosis rate,and the extreme low middile or late resection rate of pancreatic cancer,Pancreatic cancer's prognosis is poor.Therefore,improving the early diagnostic rate of pancreatic cancer has very important significance for improving the prognosis.Early diagnosis of pancreatic cancer is dependent on tumor markers detection to a great extent.And proteomics progress rapidly in recent years and has been widely applied in clinical research.It provides an effective way to find markers.Among all of the spec imens,secrum is easy to obtain,and it allows repetitive detection.What is more,secmm is also renewable.So it is the most ideal for biological specimens.In this review,the proteomics technology role in pancreatic cancer patients serum detection were summarized.
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Objective To evaluate the efficacy of benvitimod on allergic contact dermatitis (ACD) in a mouse model of allergic contact dermatitis.Methods Acute and chronic ACD models were established respectively in 42 BALB/c mice through 2,4-dinitrofluorobenzene (DNFB) sensitization and challenge.Then,the BALB/c mice were equally divided into 7 groups with 6 mice in every group:normal control group receiving no treatment,five treatment groups topically treated with 0.1％ dexamethasone solution,0.1％ tacrolimus (FK506) solution,0.5％ benvitimod solution,1.0％ benvitimod solution and 2.0 ％ benvitimod solution respectively,and dehydrated alcohol group treated with dehydrated alcohol only.All the drug solutions were topically applied at 24 and 36 hours after the last challenge in the murine models of acute ACD which were sacrificed at 48 hours,and twice daily from day 7 to 21 after the initial sensitization in the murine models of chronic ACD which were sacrificed on day 21 after the first topical treatment.Ear tissues were obtained from these mice and subjected to measurement of ear thickness and weight,as well as pathological examination and evaluation of inflammatory infiltrate by hematoxylin-eosin (HE) staining.The safety of these drugs was also estimated at the end of treatment.Results In the murine models of acute ACD,benvitimod showed no obvious therapeutic effect at 24 hours,with no significant differences in bilateral difference in ear thickness or weight between the three benvitimod groups and dehydrated alcohol group (all P ＞ 0.05).Meanwhile,in the murine models of chronic ACD,benvitimod markedly decreased the swelling degree of ears,with significant differences between the three benvitimod groups (0.5％,1.0％ and 2.0％) and dehydrated alcohol group in bilateral difference in ear thickness ((71.50 ± 3.15) × 10-3 mm,(75.50 ± 3.02) × 10-3 mm and (69.50 ± 2.59) × 10-3 mm vs.(91.83 ± 2.04) × 10-3 mm,all P＜ 0.01) and weight ((2.33 ± 0.45) mg,(2.30 ± 0.57) mg and (2.38 ± 0.27) mg vs.(3.73 ± 0.33) mg,all P ＜ 0.01) after 3 weeks of treatment.The inflammatory infiltration in ear tissue was significantly attenuated in murine models of both acute and chronic ACD by the three concentrations of benvitimod compared with dehydrated alcohol (all P ＜ 0.01).Conclusions Topical benvitimod can inhibit chronic ACD in mice induced by 2,4-DNFB,but exhibits no obvious effect on acute ACD.No apparent local adverse effects were observed during the treatment with benvitimod in these mice.
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Objective To evaluate the reliability and validity of the Chinese Version of Communication and Sharing of Information Scale(CSI) in the the assessment of the efficacy and quality of collaboration of the physician and nursing related staffs.Methods All the sample enrolled from 10 hospitals of Tianjin,all the subjects voluntarily signed the informed consent.Totally 600 subjects were tested by CSI.Exploration and confirmation factor analysis were used to examine the construct validity.Cronbaeh' s α was applied for examining internal consistency of the scales,the correlation analysis was used to examining the test-retest reliability of the scales.Results Exploratory Factor Analysis revealed that Communication and Sharing of Information Scale included 3 factors:Communication with nursing related staff,Communication with physician,Medical information sharing.Confirmation Factor analysis revealed that x2/dfwas 5.760,NNFI 0.900,GFI 0.945,AGFI 0.923,REMEA was 0.06,all reached the correction criteria of the scale,indicated that this scale had good construction validity.Cronbach' sαof the total scale was 0.870,the Cronbach' s α of the 3 factors were 0.780,0.788,0.815 respectively,indicated this scale had good inner-consistency.The total scale test-retest reliability was 0.870 after 1 week in 100 subjects randomly enrolled from all the previous subjects,indicated this scale had good reliability.Conclusion CSI has good reliability and validity and is suitable to assess the efficacy and quality of the collaboration of the physician and nursing related staffs.
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Objective To study the role of OIf-1/EBF associated zinc finger protein (OAZ),a transcription factor encoded by a positional systemic lupus erythematosus (SLE) candidate gene,in the function of mesenchymal stem cells (MSC) of SLE patients by silencing this gene.Methods OAZ mRNA levels of bone marrow MSC obtained from 5 SLE patients and 5 healthy controls were detected by real-time PCR.Bone marrow MSC obtained from 6 SLE patients were incubated with specific siRNAs for 3 days,then cells were harvested for OAZ measurement,Idl-3 and CCL2 mRNA levels were tested by real-time PCR,and levels of CCL2 were detected in culture supernatants using ELISA.Differences between groups were analyzed using t-test or MannWhitney test.Results ① OAZ mRNA levels of bone marrow MSC were significantly elevated in SLE patients (0.013±0.016) compared to healthy controls (0.001±0.000,P=0.009).② After OAZ silencing,the expression levels of OAZ,Id1,Id2 and ld3 mRNA were significantly decreased (△Ct 10.3±0.7,15.2±1.6,8.1±1.4,10.5±0.6 vs 8.7±0.7,14.1±1.2,7.1±1.5,9.8±0.6) (P all ＜0.05).③ Both the expression levels of CCL2 mRNA (△Ct 2.2±1.1 vs 3.0±1.1 ) and the levels of CCL2 protein in culture supernatants [(341±29) pg/ml vs (304±19) pg/ml] were significantly increased in OAZ silencing group comparing to those in the control group (P all ＜0.05).Conclusion OAZ gene expression is significantly elevated in bone marrow MSC of SLE patients.OAZ may affect autoantibody production in SLE patients by regulating CCL2 expression.
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ObjectiveTo investigate the role of magnetic resonance imaging (MRI) in treatment efficacy evaluation of polymyositis and dermatomyositis.MethodsFifteen patients with polymyositis and dermatomyositis underwent MRI of thigh were included.Scores of MRI signal intensity of the diseased muscle of every patient were compared before and after treatment and the correlation between serum creatinkinase (CK) level and muscle strength grade were also compared.Correlations between muscle strength grade and MRI score,as well as muscle strength grade and creatinkinase level were analyzed.Comparisons between groups were tested by t test,and the relationship between muscle strength and clinical data was analyzed by Pearson's correlation analysis.ResultsThe signal score of MRI was counted before and after therapy(2.37±0.62,1.30±0.28,respectively,P＜0.05),and CK level[(3841±3175),(549±338) U/L,respectively,P＜0.05] and muscle strength (15.1 ±2.4,18.1 ±0.9,respectively,P＜0.05) were assessed at the same time.Muscle strength grade was associated with signal score of MRI and serum CK level,there was a strong correlation between muscle strength grade and signal score of MRI(r=-0.890,P＜0.05 ).ConclusionMRI may be a useful tool for clinical efficacy evaluation in patients with polymyositis and dermatomyositis.
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Objective To investigate the effect and mechanism of murine bone marrow mesenchymal stem cells(BM-MSCs)transplantation on B-cell activating factor(BAFF)expression and B cell activation of MRL/Ipr mice.Methods Eighteen female MRL/Ipr mice were divided into the treatment group and the control group.Five female BAL B/C mice were used as negative controls.At the age of 18 weeks,the treatment group was transplanted with 1×10~6 murine BM-MSCs through vena caudalis,the control group was treated with 0.5ml sodium chloride.Enzyme linked immunoserbent assay(ELISA)was used to measure the level of the BAFF,IFN-γ,IL-2 and IL-10 in the serum.The percentage and numbers of Marginal zone,T1 and T2 B cells in spleen were detected by flow cytometry.Results①Eight weeks after transplantation,the level of BAFF [(32±14)ng/ml]in serum of the treatment group decreased significantly than the control group[(47±13)ng/ml](P＜0.05)as well as the level of serum IL- 10,IFN-γ and IL-2 levels[(19±7)vs(40±13)pg/ml](P＜0.01)[(25±20)pg/ml vs(38±25)pg/ml][(73±10)pg/ml vs(80±15)pg/ml].② Eight weeks after trans-plantation,the mice in the treatment group had lower percentages of marginal zone B cells[(15±4)% vs (21±5)%],and the numbers of marginal zone B cells were significantly decreased in the treatment group as compared with the control group[(9±6)×10~6 vs(19±10)×10~6,P＜0.05].③ Eight weeks after transplantation,the mice in the treatment group had lower percentages of T1 and T2 B cells[(3.4±2.1)% vs(7.3±4.0)%][(2.6+1.4)%vs(4.8±2.7)%],and the numbers of T1[(2.7±1.7)×10~6 vs(5.1±2.0)×10~6,P＜0.05]and T2 B cells[(2.0±1.2)×10~6 vs(3.7±1.7)×10~6,P＜0.05]were both significantly decreased in the treatment group as compared with the control group.Conclusion BM-MSCs transplantation decreases the expression of BAFF in association with the diminished production of the pathogenic cytokines IFN-γ and IL-10.Inhibition of BAFF also results in decreased numbers of T1 and T2 B cells and MZ B cells.
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Objeefive To explore the clinical efficacy and safety of allogenic bone marrow derived mesenchymal stem cells transplantation(MSCT) in patients with refractory systemic lupus erythematosus(SLE).Methods Eleven patients with refractory SLE(nine females and two males aged from 16～41 years(mean 25±8).were entailed in the study.The infcIrmed consents which were approved by the Ethics Committee of the Affiliated Drum Tower Hospital of Naniing University Medical School were obtained from all participants.Bone marrow of healthy donors were obtained and the mesenchymal stem cells(MSC)were expanded in vitro.Each patient was infused MSC 1×106/kg body weight intravenously.Before MSCT.all patients were administrated with cvclophosphamide (CTX)800～1800 mg divided by two to three days.The clinical manifestations and laboratory tests were compared before and after MSCT.Results The eleven patients were followed up for one to thirteen months after MSCT.A11 patients did not develop transplantation related complications.The systemic lupus erythematosus disease activity index (SLEDAI)score decreased from 1 1.7±5.1 to 5.6±3.4 one month after MSCT(n=11,P＜0.01).Ufine protein excretion decreased from(1989+842)mg/24 h to(1118±700)mg/24 h one month after MSCT(n=10,P=0.02).Five patients were followed up for six months and their urine protein excretion decreased significantly [(522±151)mg/24 h vs (2478±797)rag/24 h.n=5.P＜0.01j.The serum albumin level of 5 patients with hypoalbuminemia increased gradually one month after MSCT [(28±6)g/L vs (32±7)g/L,n=5,P＜0.05].Serum complement C3 level increased from(0.50±0.12) g/L to(0.75±0.10)g/L (n=9.P＜0.01) and their anti-nuclear antibody (ANA) titer decreased one month after MSCT.In two patients with chronic renal failure.the serum creatinine decreased gradually.Conclusion Allogenic MSCT is an effective and safe approach for the treatment of refractory SLE.However.extensive follow-up study is needed for long-term benefit evaluation.
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Objective To study the quality control of yinpian of Isatis Root.Methods Optical microscope was used to identify the microscopic features,TLC was adopted to identify the arginine in Isatis Root,and HPIC-ELSD was used to detect the quality of arginine.Results and Conclusion There is no difference between yinpian and crude powder of Isatis Root.Arginine can be detected bv TLC.The moisture contents.the total ash contents and the acid-insoluble ash contents in the yinpian should be less than 9.0%,10.0%,and 2.0% respectively;while the alcohol-soluble extractive contents and the contents of arginine in Isatis Root should be more than 25.0% and 2.01% respectively.
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Objective To develop a kind of medical rescue vest which is suitable to single pawn in emergency mission. Methods According to the rescue mission of single pawn and medical soldier in the early stage, the quantity and species of rescue equipment in medical rescue vest are studied to meet the medical needs of rescue mission; the determine ways of recovery effect are researched to ensure the adaptation of personnel and equipment; the vest structure is designed by people somatotyoe, the principle of human work efficiency and combination of disaster field characteristics. Results In the course of rescue drilling and rescue practice, the rescue vest is convenient and practical and meets the technology needs of war injury cure such as hemostasis, bandaging, fixing, handling, ventilation and basic life supporting etc. Conclusion The lightweight and practical medical rescue equipments are provided for single pawn and health soldiers to improve the ability of complete rescue mission.