Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF) / 中华内科杂志

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Yiqi Huoxue Tongluo Prescription Inhibits Activation of Astrocytes to Relieve Diabetic Neuropathic Pain in Rats via ERK Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the mechanism of Yiqi Huoxue Tongluo prescription （YHTP） in the treatment of diabetic neuropathic pain （DNP）. MethodNinety SPF-grade SD male rats were randomized into blank， model， low- （2.25 g·kg-1）， medium- （4.5 g·kg-1）， and high-dose （9 g·kg-1） YHTP， and mecobalamin （0.175 mg·kg-1） groups. Except those in the blank group， the rats in the remaining 5 groups were fed with a high-fat and high-glucose diet and subjected to intraperitoneal injection of low-dose （35 mg·kg-1） streptozotocin （STZ） to establish the model of DNP. The sciatic nerve conduction velocity in DNP rats was measured by the neurophysiological method， and the levels of interleukin-6 （IL-6）， IL-1β， and tumor necrosis factor-α （TNF-α） were measured by enzyme-linked immunosorbent assay （ELISA）. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was employed to measure the mRNA levels of glial fibrillary acidic protein （GFAP） and extracellular signal-regulated kinase （ERK） in the spinal cord. Western blot was employed to measure the protein levels of GFAP and phosphorylated ERK （p-ERK）， and immunofluorescence staining to measure the fluorescence intensity of GFAP and p-ERK in the spinal cord. In the cell experiments， 100 mmol·L-1 high glucose was used to induce the activation of astrocytes （CTX-TNA2） for the modeling of nerve cell injury. The cells were randomized into the normal， model， drug-containing serum （10% YQHT）， inhibitor ［10 mol·L-1 corynoxeine （COR）］， drug-containing serum + inhibitor （10% YHTP + 10 mol·L-1 COR） groups. The levels of pro-inflammatory factors （TNF-α and IL-1β） and the anti-inflammatory factor IL-10 in CTX-TNA2 cells were determined by ELISA， and the protein levels of GFAP and p-ERK in CTX-TNA2 cells by Western blot. ResultThe animal experiments showed that compared with the blank group， the model group presented reduced mechanical withdrawal threshold （MWT）， thermal work limit （TWL）， and nerve conduction velocity， elevated levels of fasting blood glucose， IL-1β， TNF-α， and IL-6， and up-regulated protein levels of GFAP and p-ERK， and mRNA levels of ERK1， ERK2， GFAP （P<0.01）. Compared with model group， YHTP increased the MWT， TWL， and sciatic nerve conduction velocity （P<0.01）， lowered the levels of IL-1β， TNF-α， and IL-6 （P<0.01）， and down-regulated the protein levels of GFAP and p-ERK， and mRNA levels of ERK1， ERK2， GFAP in the spinal cord （P<0.05， P<0.01）. The cell experiments showed that compared with the blank group， the model group had decreased survival rate， elevated levels of pro-inflammatory factors， and up-regulated protein levels of ERK and GFAP （P<0.01）. Compared with the model group， the YHTP-containing serum lowered the levels of IL-1β and TNF-α （P<0.05， P<0.01）， elevated the level of IL-10 （P<0.01）， and down-regulated the protein levels of ERK and GFAP （P<0.01）. ConclusionYHTP may inhibit the activation of astrocytes by inhibiting the ERK signaling pathway to reduce inflammation and thus relieve DNP.

Emergency psychological intervention of acute ammonia leakage event / 中华劳动卫生职业病杂志

Objective: To analyze the situation of emergency psychological intervention in an acute ammonia leakage event, and to provide reference for emergency response. Methods: In August 2020, the emergency treatment of 65 patients admitted by Zhangqiu District People's Hospital Affiliated to Jining Medical College of Shandong Province in June 2019 in the ammonia tank car leakage incident was analyzed, the psychological intervention in emergency after the incident was collected, the anxiety and depression were evaluated by symptom checklist 90 (SCL-90) , and targeted psychological intervention was implemented according to the psychological evaluation results, And analyze the intervention efficiency. Results: Among the 65 patients, there were 52 cases of ammonia stimulation reaction, 11 cases of mild poisoning and 2 cases of moderate poisoning. There were 60 cases of chest tightness and dyspnea, 11 cases of bloody sputum, 58 cases of sore throat, 43 cases of hoarseness, 28 cases of photophobia and tears, 13 cases of blurred vision, 18 cases of nausea and vomiting, and 2 cases of dry and wet rales in the lungs. The scores of somatization, depression, anxiety, hostility, phobia, paranoia and negative coping in patients with mild and moderate poisoning were higher than those in patients with stimulus response (P<0.05) . The effective rate of intervention was 98.7%. Conclusion: Emergency psychological evaluation and intervention in mass public health events are helpful to the treatment of patients.

Expression and diagnostic value of NKX3.1 and NKX2.2 in mesenchymal chondrosarcoma / 中华病理学杂志

Objective: To investigate the immunohistochemical expression of NKX3.1 and NKX2.2 in mesenchymal chondrosarcoma (MC), and to explore the differential diagnostic value of NKX3.1 and NKX2.2 in MC and other types of small round cell malignant tumors. Methods: A total of 12 cases of MC and 97 other small round cell malignant tumors diagnosed in Jinling Hospital, Nanjing University School of Medicine from 2001 to 2020 were collected for NKX3.1 and NKX2.2 immunohistochemical detection. Among them, two kinds of NKX3.1 antibodies [rabbit polyclonal antibody and rabbit monoclonal antibody (EP356)] were used for detection in 12 cases of MC, and one NKX3.1 antibody (rabbit polyclonal antibody) was detected in 97 cases of other small round cell malignant tumors, and the relevant literature was reviewed. Results: The 12 MC patients included 7 females and 5 males, with a mean age of 33 years (14-54 years). Nine cases were from bone and three from soft tissue. Among the 12 MC patients, 8 patients had postoperative recurrence or metastasis, and 3 of them died of tumor recurrence or metastasis. Histologically, 12 cases of MC showed typical bidirectional differentiation.The positive rate of both NKX3.1 antibodies in MC was 12/12, NKX3.1 was focal weakly positive in only one of 12 chondrosarcomas (grade 3), 5 alveolar rhabdomyosarcomas, 5 embryonal rhabdomyosarcomas, and 5 solitary fibrous tumors, respectively. The remaining 70 cases of other small round cell malignant tumors were negative. The positive rates of NKX2.2 in MC, Ewing sarcoma and olfactory neuroblastoma were 12/12, 15/15 and 4/5, respectively. In 12 cases of chondrosarcoma (grade 3), 5 cases of poorly differentiated synovial sarcoma, 5 cases of alveolar rhabdomyosarcoma, and 5 cases of solitary fibrous tumor, NKX2.2 was focally and weakly positive in only one case, respectively, and all the remaining 50 cases of other small round cell malignant tumors were negative. Conclusions: The expression of NKX3.1 and NKX2.2 proteins are significant indicators in the diagnosis of MC, and the combined detection of NKX3.1 and NKX2.2 can help distinguish MC from most other small round cell malignant tumors.

Succinate dehydrogenase-deficient renal cell carcinoma:a clinicopathological, ultrastructural and molecular analysis / 中华病理学杂志

Objective: To investigate the clinicopathological features, immunophenotype, ultrastructure, genetic alterations and prognosis of succinate dehydrogenase-deficient renal cell carcinoma (SDH RCC). Methods: A total of 11 SDH RCCs, diagnosed from 2010 to 2019, were selected from the Department of Pathology of Nanjing Jingling Hospital, Nanjing University School of Medicine for clinicopathologic, immunohistochemical (IHC), ultrastructural investigation and follow-up. The molecular features of seven cases were analyzed by the panel-targeted DNA next generation sequencing (NGS). Results: There were seven males and four females, with ages ranging from 24 to 62 years (mean 41.4 years, median 41 years). Microscopically, SDH RCC was mainly composed of solid and tubular structures with local cystic change. Four cases showed nested or trabecular structure distributed in a loose hypocellular connective tissue or around scar, similar to oncocytoma. The neoplastic cells demonstrated flocculent eosinophilic cytoplasm with typical intracytoplasmic vacuoles. Immunohistochemically, eight cases were negative for SDHB; three cases showed focal and weak expression, whereas normal renal tubular and vascular endothelial cells demonstrated strong cytoplasmic staining. NGS of DNA targeted-panel detected pathogenic mutations of SDHB gene in seven cases (including three cases with equivocal IHC expression of SDHB), without any mutations in other SDH related genes. There were four cases of SDHB missense mutation, one case of frameshift mutation, one case of splicing mutation, and one case of acquired stop codon mutation. Conclusions: SDH RCC is a distinct variant of RCCs with genetic tendency or with hereditary cancer syndrome. NGS is recommended to detect the related gene mutations for a definitive diagnosis. The patients should be closely followed up.

Application of teaching method for the interpretation of acupoint names in the course of Science of Meridians and Acupoints / 中国针灸

The paper summarizes the valuable experience of the famous teachers of all generations in the teaching & research room of meridians and acupoints of Beijing University of CM. The shortcomings are presented when the acupoints are explained in accordance with the flowing route of meridians in classroom teaching of Science of Meridians and Acupoints. Hence, it is proposed that the acupoint names should be interpreted specially for the acupoints distributed on the same meridians or adjacent ones. It is suggested to emphasize the correlation of each acupoint with its adjacent ones from the perspective of the cultural connotation of acupoint names, and then, the differences and similarities in their clinical indications can be analyzed. Eventually, a new approach to the classroom teaching of Science of Meridians and Acupoints may be provided to guide the excavation of traditional cultural connotation and establish the cultural self-confidence and professional identity.

Tetrahydropalmatine alleviated diabetic neuropathic pain by inhibiting activation of microglia via p38 MAPK signaling pathway / 中国中药杂志

Neuropathic pain is one of the common complications of diabetes. Tetrahydropalmatine(THP) is a main active component of Corydalis Rhizoma with excellent anti-inflammatory and pain-alleviating properties. This study aims to investigate the therapeutic effect of THP on diabetic neuropathic pain(DNP) and the underlying mechanism. High-fat and high-sugar diet(4 weeks) and streptozotocin(STZ, 35 mg·kg~(-1), single intraperitoneal injection) were employed to induce type-2 DNP in rats. Moreover, lipopolysaccharide(LPS) was used to induce the activation of BV2 microglia in vitro to establish an inflammatory cellular model. Fasting blood glucose(FBG) was measured by a blood glucose meter. Mechanical withdrawal threshold(MWT) was assessed with von Frey filaments, and thermal withdrawal latency(TWL) with hot plate apparatus. The protein expression levels of OX42, inducible nitric oxide synthase(iNOS), CD206, p38, and p-p38 were determined by Western blot, the fluorescence expression levels of OX42 and p-p38 in the dorsal horn of the rat spinal cord by immunofluorescence, the mRNA content of p38 and OX42 in rat spinal cord tissue by qRT-PCR, and levels of nitric oxide(NO), interleukin-1β(IL-1β), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), interleukin-10(IL-10), and serum fasting insulin(FINS) by enzyme-linked immunosorbent assay(ELISA). RESULTS:: showed that the mo-del group demonstrated significant decrease in MWT and TWL, with pain symptoms. THP significantly improved the MWT and TWL of DNP rats, inhibited the activation of microglia and p38 MAPK signaling pathway in rat spinal cord, and ameliorated its inflammatory response. Meanwhile, THP promoted the change of LPS-induced BV2 microglia from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype, suppressed the activation of the p38 MAPK signaling pathway, decreased the expression levels of inflammatory factors NO, IL-1β, IL-6, and TNF-α, and increased the expression level of anti-inflammatory factor IL-10. The findings suggested that THP can significantly ameliorate the pain symptoms of DNP rats possibly by inhibiting the inflammatory response caused by M1 polarization of microglia via the p38 MAPK pathway.

Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation

Background@#Coracoacromial ligament transfer is the traditional procedure for treating chronic acromioclavicular separation, but it is significantly inferior to ligament reconstruction according to biomechanical and clinical studies. However, ligament reconstruction carries the risk of complications of graft loosening and peri-tunnel fractures. Currently, there is no ligament reconstruction procedure optimal for preventing such complications. The purpose of this study was to describe and retrospectively analyze the clinical and radiological outcomes of a “duo-figure-8” autogenic graft wrapping technique, which was used to concomitantly reconstruct the acromioclavicular and coracoclavicular ligaments. @*Methods@#Preoperative, immediate postoperative, and final follow-up oputcomes were evaluated in 10 enrolled patients. Radiographic outcomes were indicated by the bilateral difference of the coracoclavicular distance (CCD) and overlapping length of the acromioclavicular joint (OLac). Quality of reduction was classified into 4 grades according to bilateral CCD difference into overreduction ( 8 mm). Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores. @*Results@#The mean side-to-side differences for CCD were 11.9 mm (preoperative), −0.1 mm (immediate postoperative), and 3.4 mm (final follow-up); those for OLac were 9.4 mm (preoperative) and 2.7 mm (final follow-up). CCD and OLac outcomes significantly improved at final follow-up (p < 0.05). At the immediate postoperative stage, 6 and 4 patients had overreduction and anatomic reduction, respectively. At final follow-up, 7 and 3 patients had anatomic reduction and partial loss of reduction, respectively. The magnitude of improvement of ASES scores for patients with anatomic reduction and partial loss of reduction (p = 0.20) was 18.1 and 20.0, respectively. The magnitude of improvement of Constant scores in patients with anatomic reduction and partial loss of reduction (p = 0.25) was 19.9 and 22.3, respectively. @*Conclusions@#The technique yielded acceptable functional outcomes in patients with anatomic reduction or partial loss of reduction. The “duo-figure-8” wrapping method—a single autogenic tendon graft passing beneath the coracoid process with a tendonknot fixation over the distal clavicle and looping around the acromion intramedullary—did not increase the risk of peri-tunnel fractures over the clavicle, coracoid process, or acromion.

The role of rejection sensitivity in the relationship between the psychological resilience and social adaptability of college students with left behind experience / 中国学校卫生

Objective@#To explore the role of rejection sensitivity in the relationship between the psychological resilience and social adaptability of college students with left behind experience, so as to provide reference for college students to beffer adapt to the society.@*Methods@#Self designed questionnaire, the Conor Davidson Resilience Scale(CD-RISC), the Chinese College Students Adaptation Scale(CCSAS), and the Rejection Sensitivity Questionnaire (RSQ) were administered among 3 418 college students from four universities in Anhui Province with the stratified cluster sampling method. This research investigation used AMOS version 21.0 to construct a structural equation model of rejection sensitivity, psychological resilience, and social adaptability, to analyze the mediation effect.@*Results@#There were 1 324 college students with lefe behind experience. Compared with college students without left behind experience[(64.47±13.79)(197.90±25.57)(10.86±2.98)], students with left behind experience exhibited lower levels of psychological resilience, social adaptability, and rejection sensitivity[(63.26±13.69)(195.14±24.60)(10.45±2.91)](t=-2.50, -3.12, -3.87, P<0.05); Rejection sensitivity was negatively associated with social adaptability, and psychological resilience among college students with left behind experience(r=-0.24, -0.22, P<0.01), while social adaptability was positively correlated with psychological resilience(r=0.64, P<0.01). The results of the mediation model showed that psychological resilience affected the mediation path of social adaptability by rejection sensitivity (mediation effect value=0.02, 95%CI=0.01-0.05, P<0.05).@*Conclusion@#Left behind experience had a negative impact on the psychological resilience and social adaptability of undergraduates. With respect to the psychological resilience of undergraduates with left behind experience, rejection sensitivity played a mediating role in the social adaptability relationship.

Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation

Background@#Coracoacromial ligament transfer is the traditional procedure for treating chronic acromioclavicular separation, but it is significantly inferior to ligament reconstruction according to biomechanical and clinical studies. However, ligament reconstruction carries the risk of complications of graft loosening and peri-tunnel fractures. Currently, there is no ligament reconstruction procedure optimal for preventing such complications. The purpose of this study was to describe and retrospectively analyze the clinical and radiological outcomes of a “duo-figure-8” autogenic graft wrapping technique, which was used to concomitantly reconstruct the acromioclavicular and coracoclavicular ligaments. @*Methods@#Preoperative, immediate postoperative, and final follow-up oputcomes were evaluated in 10 enrolled patients. Radiographic outcomes were indicated by the bilateral difference of the coracoclavicular distance (CCD) and overlapping length of the acromioclavicular joint (OLac). Quality of reduction was classified into 4 grades according to bilateral CCD difference into overreduction ( 8 mm). Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores. @*Results@#The mean side-to-side differences for CCD were 11.9 mm (preoperative), −0.1 mm (immediate postoperative), and 3.4 mm (final follow-up); those for OLac were 9.4 mm (preoperative) and 2.7 mm (final follow-up). CCD and OLac outcomes significantly improved at final follow-up (p < 0.05). At the immediate postoperative stage, 6 and 4 patients had overreduction and anatomic reduction, respectively. At final follow-up, 7 and 3 patients had anatomic reduction and partial loss of reduction, respectively. The magnitude of improvement of ASES scores for patients with anatomic reduction and partial loss of reduction (p = 0.20) was 18.1 and 20.0, respectively. The magnitude of improvement of Constant scores in patients with anatomic reduction and partial loss of reduction (p = 0.25) was 19.9 and 22.3, respectively. @*Conclusions@#The technique yielded acceptable functional outcomes in patients with anatomic reduction or partial loss of reduction. The “duo-figure-8” wrapping method—a single autogenic tendon graft passing beneath the coracoid process with a tendonknot fixation over the distal clavicle and looping around the acromion intramedullary—did not increase the risk of peri-tunnel fractures over the clavicle, coracoid process, or acromion.

Clinical study on the treatment of postoperative pain and edema caused by mixed hemorrhoids by atomization fumigation and washing of Jiedu-Shengji Decoction combined with Maren soft capsule / 国际中医中药杂志

Objective:To evaluate the clinical effect of Jiedu-Shengji Decoction combined with Maren soft capsule in the treatment of postoperative pain and edema of mixed hemorrhoids. Methods:110 patients with circular mixed hemorrhoids in the People's Hospitalof Lujiang County from January 2017 to January 2019 who met the inclusion criteria were divided into two groups according to the random number table method, with 55 patients in each group. Both groups were treated with external dissection and internal ligation operation of mixed hemorrhoids. The control group was treated with Maren soft capsule after the operation. The study group was treated with atomization fumigation and washing of Jiedu-Shengji Decoction on the basis of the control group. Both groups were treated for 14 days. VAS was used to evaluate the degree of anal pain. The anal edema was observed and graded. Serum levels of VEGF, basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) were measured by ELISA. 14 days after the operation, to observe and evaluate the complications, the clinical effect was evaluated. Results:The total effective rate of the study group was 92.7% (51/55), and that of the control group was 74.6% (41/55), the difference was statistically significant ( χ2=6.643, P<0.01). The VAS score and anal edema score of the study group on the 7 d ( t values were 9.144 and 8.541, respectively, all Ps<0.01) and 14 d ( t values were 13.720 and 12.819, respectively, all Ps<0.01) after operation were significantly lower than those of the control group. The level of VEGF, bFGF and PDGF in the study group on the 7 d ( t values were 7.491, 2.972 and 5.170, respectively, all Ps<0.01) and 14 d ( t values were 6.117, 3.031 and 4.599, respectively, all Ps<0.01) after operation were significantly higher than those in the control group. The incidence of postoperative complications was 7.3% (4/55) in the study group and 3.6% (2/55) in the control group, there was no significant difference between the two groups ( χ2=0.705, P=0.401). Conclusions:The clinical effect of atomization fumigation and washing of Jiedu-Shengji Decoction combined with Maren soft capsule in the treatment of postoperative pain and edema of mixed hemorrhoids is significant, which can significantly improve symptoms, accelerate the formation of new blood vessels, promote wound healing, and have fewer complications.

Investigation and Study on Occupational Exposure for Hazardous Drugs of Healthcare Workers in Shaanxi Province and Relative Cognition Level / 中国药房

OBJECTIVE：To understand the situation of healthcar e workers’occupational exposure of hazardous drugs （chemotherapeutic drugs and antiviral drug ）and relative cognition level ，and to provide reference for improving the level of occupational protection. METHODS ：During Oct. 2018 to Mar. 2019，healthcare workers from 12 hospitals of different levels and different departments in Shaanxi province were selected as respondents to conduct a self-designed questionnaire survey. Information we surveyed contained baseline characteristics ，hazardous drugs exposure ，physical health status ，and occupational protection. Valid questionnaires were collected and analyzed statistically. RESULTS ：A totally of 1 848 questionnaires were sent out ，and 1 767 questionnaires were collected ，including 95 were pharmacists ，100 were physicians ，and 1 572 were nurses. The frequency of diarrhea and menstrual disorders in healthcare workers with long-term exposure to antiviral drugs （antiviral drug exposure group ） and cross-exposure to antiviral drugs and chemotherapeutic drugs （cross-exposure group ）were significantly higher than unexposed group （P＜0.05）. The incidence of routine blood abnormalities in cross-exposure group ，antiviral drug exposure group and healthcare workers with long-term exposure to chemotherapy drugs （chemotherapy drug exposure group ） was higher than unexposed group by 9.13％，5.50％ and 12.34％，respectively. 84.7％ of the respondents had little knowledge of hazardous drugs ， and 8.15％ of the respondents had never received occupational protection training. Additionally ，the ratio of healthcare workers receiving occupational protection training in the cross-exposure group was significantly higher than unexposed group （P＜0.05）， and the ratio of healthcare workers receiving occupational protection training in antiviral drug exposure group were significantly lower than unexposed group （P＜0.05）. CONCLUSIONS ：Long-term exposure to hazardous drugs will cause certain occupational hazards to healthcare workers. It is necessary to improve healthcare workers ’awareness of self-protection ，increase the input of hospitals in occupational protection training and establish occupational protection standards in order to improve the current situation of occupational protection of healthcare workers.

Noninvasive biomarkers of premature delivery: Research progress and application prospect / 第二军医大学学报

Preterm birth is one of the most common obstetric complications. In recent decades, the incidence of premature birth remains high throughout the world, and even shows a rising trend in some countries and areas. Therefore, understanding the mechanisms of human parturition and developing the effective prevention and treatment strategies of premature delivery are urgent to improve maternal and fetal health and overall quality of population. Due to the limitation of ethics and testing methods, the prediction and early diagnosis of premature birth have been the primary problem that perplexes obstetricians. Various body fluids, including amniotic fluid, cervicovaginal fluid, urine, saliva and blood, provide rich sources of putative biomarkers that may be causative or reflective of preterm labor. In recent years, the exploration of novel biomarkers for noninvasive detection is in the ascendant, which sheds new lights for the prediction and early diagnosis of preterm labor. This review compares the biomarkers for the detection of preterm birth, and discusses the future prospect.

Cardiotoxicity in Zebrafish Embryos of Euphorbiae Pekinensis Radix Before and After Processing with Vinegar / 中国实验方剂学杂志

Objective:Taking zebrafish embryos as research model, to investigate the toxic effect of different polar fractions of Euphorbiae Pekinensis Radix before and after processing with vinegar on heart. Method:Zebrafish embryos with normal development at 12 h after fertilization were treated with petroleum ether, dichloromethane and ethyl acetate extracts of Euphorbiae Pekinensis Radix before and after processing with vinegar for observation of cardiac development and function at 72 h. Result:Various polar fractions of Euphorbiae Pekinensis Radix before and after processing with vinegar had the cardiotoxicity on zebrafish embryos in a dose-dependent manner. In addition, the cardiotoxicity of different polar fractions was followed by petroleum ether, dichloromethane and ethyl acetate. The cardiotoxicity was mainly manifested as slow cardiac development, pericardial edema, decrease of heart rate and apoptosis of cardiac cells. Compared with the corresponding polar fraction of raw products, the cardiotoxicity of the same polar fraction of vinegar-processed products with similar doses decreased. Conclusion:Euphorbiae Pekinensis Radix has cardiotoxicity to zebrafish embryos and the cardiotoxicity is reduced after processing with vinegar, which can provide some experimental basis for further elucidation of the detoxication mechanism of Euphorbiae Pekinensis Radix processed with vinegar.

Clinical significance of serum gastrin, C-reactive protein and D-dimer in Henoch-Schönlein purpura children with abdominal symptoms / 中华实用儿科临床杂志

Objective@#To investigate the clinical significance of serum gastrin-17, C-reactive protein (CRP) and D-dimer (D-D) levels in early diagnosis and severity evaluation of Henoch-Schölein purpura (HSP) children with abdominal symptoms.@*Methods@#Retrospective analysis was performed in 120 children with initial HSP admitted to the Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University from December 2016 to December 2017, among them, there were 70 cases with abdominal symptoms, and 50 patients without abdominal symptoms.And 20 healthy children who underwent health consultation at the First Affiliated Hospital of Anhui Medical University were selected as a healthy control group.Serum gastrin-17, CRP and D-D levels in acute phase in the HSP children were detected, and the correlation between these parameters and purpura symptom scores was analyzed.Together with gastroscope, the severity of HSP with abdominal symptoms was evaluated.@*Results@#(1) Serum gastrin-17 level in HSP children with abdominal symptoms were obviously lower than that of the other of type HSP group and the healthy control group [(3.12±1.64) pmol/L vs.(6.85±1.28) pmol/L and (7.15±1.03) pmol/L], and the differences were statistically significant (all P<0.001); the levels were decreased most significantly in HSP children with early gastrointestinal symptoms [(1.77±0.50) pmol/L vs.(4.01±1.51) pmol/L], and the difference was statistically significant (P<0.001); the pathological changes under gastroscope were obvious in HSP children with early gastrointestinal symptoms (χ2=8.095 2, P<0.05). (2) Serum CRP and D-D levels in the HSP children with abdo-minal symptoms were striking higher than those in the healthy control group [(18.39±4.48) mg/L vs.(3.95±1.65) mg/L; (2.53±1.17) mg/L vs.(0.59±0.41) mg/L], and the differences were statistically significant (all P<0.001), which were both increased most significantly in the HSP children with early gastrointestinal symptoms [(19.98±5.45) mg/L vs.(17.33±3.37) mg/L; (3.48±0.96) mg/L vs.(1.89±0.80) mg/L], and the diffe-rences were statistically significant (all P<0.05). (3) Serum gastrin-17 level was negatively correlated with purpura symptom scores (r=-0.907, P<0.01); serum CRP and D-D levels were both positively correlated with purpura symptom scores (r=0.974, 0.928, all P<0.01).@*Conclusions@#Serum gastrin-17, CRP and D-D levels in acute phase can be used as serological markers for early diagnosis of HSP children with abdominal symptoms, especially in HSP children with early gastrointestinal symptoms.

Effect of miR-939-5p on the migration and proliferation of hepatocellular carcinoma by regulating the expression of USP22 gene / 国际外科学杂志

Objective To investigate the regulation of miR-939-5p on USP22 gene expression and its effect on liver cancer migration and proliferation.Methods The expression of miR-939-5p in hepatoma cell lines (HepG2,MHCC-97H,SMMC-7721,BEL-7404 and Huh7) and normal liver cell line LO2 was detected by realtime PCR (qPCR).The liver cancer cells with the lowest expression were used as experimental subjects,and transfected with miR-939-5p (Experimental group) or miR-NC (Control group).qPCR was used to detect the transfection efficiency of miR-939-5p.Transwell migration assay and MTT proliferation assay were used to detect the migration and proliferation of hepatoma cells after transfected miR-939-5p.Bioinformatics software predicted target genes for miR-939-5p.The dual luciferase reporter gene verified the interaction of miR-939-5p with the target gene.qPCR and Western blotting were used to detect the expression of target genes at mRNA and protein levels after over-expression of miR-939-5p.Measurement data were expressed as (Mean ± SD),and t test was used for comparison between groups.Results The expression of miR-939-5p was significantly lower in hepatoma cell lines than in normal hepatocytes (P ＜0.01),and the expression of miR-939-5p was the lowest in SMMC-7721 cells (P＜0.01).miR-939-5p was efficiently transfected into SMMC-7721 cells [(1.01 ±0.07) vs (20.12 ± 1.27),P ＜0.01].High expression of miR-939-5p inhibited the migration ability (P ＜ 0.01) and proliferative capacity of liver cancer SMMC-7721 cells (P ＜0.05).The USP22 gene may be a target gene of miR-939-5p.The luciferase reporter gene confirmed that miR-939-5p specifically binds to the 3'-UTR of USP22 mRNA (P ＜ 0.01).USP22 expression was decreased at mRNA and protein levels after high expression of miR-939-5p (P ＜ 0.01).Conclusions The expression of miR-939-5p was down-regulated in hepatocellular carcinoma cell lines,and miR-939-5p inhibited the migration and proliferation of liver cancer SMMC-7721 cells.The molecular mechanism was to interfere with the expression of USP22 gene.

Clinical significance of serum gastrin,C _ reactive protein and D _ dimer in Henoch _ Sch?nlein purpura children with abdominal symptoms / 中华实用儿科临床杂志

Objective To investigate the clinical significance of serum gastrin _17,C _ reactive protein ( CRP)and D_dimer(D_D)levels in early diagnosis and severity evaluation of Henoch_Sch?lein purpura(HSP) children with abdominal symptoms. Methods Retrospective analysis was performed in 120 children with initial HSP admitted to the Department of Pediatrics,the First Affiliated Hospital of Anhui medical University from December 2016 to December 2017,among them,there were 70 cases with abdominal symptoms,and 50 patients without abdominal symptoms. And 20 healthy children who underwent health consultation at the First Affiliated Hospital of Anhui medical University were selected as a healthy control group. Serum gastrin_17,CRP and D_D levels in acute phase in the HSP children were detected,and the correlation between these parameters and purpura symptom scores was analyzed. Together with gastroscope,the severity of HSP with abdominal symptoms was evaluated. Results (1)Serum gastrin_17 level in HSP children with abdominal symptoms were obviously lower than that of the other of type HSP group and the healthy control group[(3. 12 ± 1. 64)pmol/L υs.(6. 85 ± 1. 28)pmol/L and(7. 15 ± 1. 03)pmol/L],and the differences were statistically significant(all P<0. 001);the levels were decreased most significantly in HSP children with early gastrointestinal symptoms[(1. 77 ± 0. 50)pmol/L υs.(4. 01 ± 1. 51)pmol/L],and the difference was sta_tistically significant(P<0. 001);the pathological changes under gastroscope were obvious in HSP children with early gastrointestinal symptoms(χ2 =8. 095 2,P<0. 05).(2)Serum CRP and D_D levels in the HSP children with abdo_minal symptoms were striking higher than those in the healthy control group[(18. 39 ± 4. 48)mg/L υs.(3. 95 ± 1. 65) mg/L;(2. 53 ± 1. 17)mg/L υs.(0. 59 ± 0. 41)mg/L],and the differences were statistically significant( all P <0. 001 ),which were both increased most significantly in the HSP children with early gastrointestinal symptoms [(19. 98 ± 5. 45)mg/L υs.(17. 33 ± 3. 37)mg/L;(3. 48 ± 0. 96)mg/L υs.(1. 89 ± 0. 80)mg/L],and the diffe_rences were statistically significant(all P<0. 05).(3)Serum gastrin_17 level was negatively correlated with purpura symptom scores(r= _0. 907,P<0. 01);serum CRP and D_D levels were both positively correlated with purpura symptom scores(r=0. 974,0. 928,all P<0. 01). Conclusions Serum gastrin_17,CRP and D_D levels in acute phase can be used as serological markers for early diagnosis of HSP children with abdominal symptoms,especially in HSP children with early gastrointestinal symptoms.

A simple strategy for delivery of carbon monoxide against septic lung injury / 药学学报

Carbon monoxide (CO) is an important chemical gas messenger molecule in the body with anti-inflammatory activity. As an active substance in gaseous state, the method for its safe and effective delivery towards the lesion sites remains to be established. Based on the natural affinity of carbon monoxide to hemoglobin, a main component of red blood cells (RBCs), this study proposes a carbon monoxide-red blood cell (CO-RBC) composite system, and tested its therapeutic effect against lung injury in an animal model. The mouse model of septic lung injury was adopted, and the carbon monoxide release molecule (CORM-2) was used as a positive control. CO-RBC system was characterized by CO release, stability, toxicity and in vivo lung targeting. The expression of intercellular adhesion molecule (ICAM-1) and pulmonary surfactant protein-A (SP-A) were evaluated in the animal model and the therapeutic effect of CO-RBC system for sepsis was measured by inflammatory factors tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), as well as survival time of mice and pathological changes of the lung. Our results show that CO-RBC system exhibited satisfactory stability with negligible CO release during 48 h storage under nitrogen protection, while the CO release was about 70% within 12 h under physiological condition, in contrast to CO burst release from CORM-2. The CO-RBC system showed no significant toxicity in the animal model, and in vivo fluorescence imaging results showed effective accumulation in the lungs, supporting its lung targeting effects. The secretion of TNF-α and IL-6 in the CO-RBC group was significantly lower than that in other groups, the degree of pulmonary interstitial edema was relieved, the white blood cell infiltration was decreased, and the survival rate was significantly improved. Therefore, the CO-RBC system has a significant inhibitory effect on the pulmonary inflammatory response in septic mice compared with CORM-2. This system provides a new hope for therapeutic treatment of sepsis.

Effects of Euphorbiae Pekinensis Radix before and after processing with vinegar on liver and gastrointestinal toxicity of zebrafish embryos / 中国中药杂志

To study the effects of different fraction of Euphorbiae Pekinensis Radix before and after processing with vinegar on liver and gastrointestinal toxicity of zebrafish embryos,the zebrafish embryos after fertilized 12 h(12 hpf) were exposed to different concentrations of solution until 96 h(96 hpf),for observation of the toxicity response of the liver and gastrointestinal of individual zebrafish embryos. The results showed that toxicity increased in a dose-dependent manner. The liver and gastrointestinal toxicity of the zebrafish embryos in various polar fractions of Euphorbiae Pekinensis Radix before and after processing with vinegar was mainly manifested as slow liver development,smaller liver area,edema of yolk sac,delayed absorption,slowing of gastrointestinal motility,abnormal function of gastrointestinal goblet cell secretion. In addition,the toxicity of different polarity was followed by petroleum ether,dichloromethane,ethyl acetate. The above results indicated that the toxicity was reduced after processing with vinegar,and the fractions of petroleum ether and methylene chloride were the main sites responsible for liver and gastrointestinal toxicity.

Trends in mortality of emergency departments patients in China / 世界急诊医学杂志（英文）

BACKGROUND@#Emergency medical service system (EMSS) in China is becoming more important. However, studies on mortality of emergency departments (EDs) patients in tertiary hospitals and on the trends in mortality of ED patients all over China are stagnant. The objective of this study was to quantify and describe the trends in mortality of ED patients in China.@*METHODS@#Nine tertiary teaching hospitals were selected from tertiary teaching hospitals in different regions. The annual numbers of ED visits and deaths of these hospitals in 2004, 2009 and 2014 were recorded and analyzed. Chi-square test was used to compare the mortality of the EDs' visits. Moreover, data on the mortality of ED patients in China from 2005 to 2015 were summarized and analyzed from the China Health and Family Planning Statistical Yearbooks (2006–2016).@*RESULTS@#From 2004 to 2014, the overall annual mortalities in EDs increased among the tertiary hospitals (P<0.001). However, the overall annual mortality in EDs all over China decreased from 0.12% in 2005 to 0.08% in 2015. And the mortalities of EDs patients in the eastern, central and western regions of China all decreased. In addition, the average mortality of EDs patients in northern China was obviously higher than that in southern China (P<0.05).@*CONCLUSION@#The ED mortality was increased in tertiary hospitals while decreased all over China during the past decade, which may be partly caused by some critical challenges faced by China's EMSS, such as overcrowding and long length of stay in EDs of tertiary hospitals.