Analysis of risk factors of major adverse kidney events within 30 days in patients with acute pancreatitis / 中华危重病急救医学

Objective:To analyze the risk factors of major adverse kidney events within 30 days (MAKE30) in patients with acute pancreatitis (AP).Methods:A retrospective cohort study was conducted. A total of 162 patients who were first diagnosed with AP in the First Affiliated Hospital of Soochow University from June 2019 to June 2021 and the onset time was less than 72 hours were enrolled. Patients were divided into MAKE30 group and non-MAKE30 group according to the occurrence of MAKE30 after hospitalization. MAKE30 was defined as death from any cause, new renal replacement therapy (RRT), and persistent renal insufficiency (PRD). The clinical data of the two groups at admission were compared. The independent risk factors of MAKE30 were analyzed by multivariate Logistic regression method, and a regression equation was established as a quantitative prediction model of MAKE30. Receiver operator characteristic curve (ROC curve) was drawn to analyze the prediction of the quantitative prediction model value.Results:All 162 patients were included in the final analysis, including 32 in the MAKE30 group and 130 in the non-MAKE30 group. Univariate analysis showed that compared with the non-MAKE30 group, the body mass index (BMI), the proportion of severe AP, and the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, the sequential organ failure assessment (SOFA) score, blood urea nitrogen (BUN), serum creatinine (SCr), C-reactive protein (CRP), HCO 3-, Cl - levels and the proportion of hyperchloremia at admission in the MAKE30 group were significantly increased. Multivariate Logistic regression analysis showed that APACHE Ⅱ score at admission [odds ratio ( OR) = 1.659, 95% confidence interval (95% CI) was 1.426-1.956, P = 0.009], SOFA score ( OR = 1.501, 95% CI was 1.236-1.840, P = 0.014) and hyperchloremia ( OR = 1.858, 95% CI was 1.564-2.231, P = 0.004) were independent risk factors for MAKE30 in AP patients. The MAKE30 regression equation was established by the above risk factors [Logit( P) = 0.063+0.525×APACHEⅡ score+0.328×SOFA score+0.895×hyperchloremia], which was used as the MAKE30 quantitative prediction model. ROC curve analysis showed that the area under the ROC curve (AUC) of the model for predicting MAKE30 was 0.846 (95% CI was 0.774-0.923, P = 0.001). The patients were divided into two subgroups with hyperchloremia (Cl -≥110 mmol/L, n = 19) and non-hyperchloremia (Cl - < 110 mmol/L, n = 143) according to the blood Cl - level at admission. The incidence of MAKE30 and acute kidney injury (AKI) in the hyperchloremia group was significantly increased (MAKE30: 68.4% vs. 13.3%, AKI: 89.5% vs. 43.4%), and the levels of BUN and SCr at admission were significantly increased [BUN (mmol/L): 9.3±2.5 vs. 5.9±1.1, SCr (μmol/L): 162.3±26.4 vs. 78.6±9.2], the total length of hospital stay and length of intensive care unit (ICU) stay were significantly longer [total length of hospital stay (days): 10.2±1.6 vs. 5.6±1.2, length of ICU stay (days): 6.2±1.0 vs. 3.1±0.6], the cumulative intravenous infusion volume increased significantly at 48 hours and 72 hours (mL: 7 235.9±1 025.3 vs. 5 659.6±956.7 at 48 hours, 11 052.6±1 659.8 vs. 7 156.9±1 052.4 at 72 hours), differences were statistically significant (all P < 0.01). Conclusions:MAKE30 can be used as an important indicator to evaluate the short-term clinical prognosis of AP patients. APACHEⅡ score, SOFA score and hyperchloremia at admission are the main risk factors. The risk model of MAKE30 based on these three indicators has good predictive performance. AP patients with hyperchloremia are at high risk of developing MAKE30, which should be highly regarded in clinical practice.

Risk factors and interventions for surgical failure of spinal tuberculosis / 中华骨科杂志

Objective:To investigate the risk factors and interventions for surgical failure of spinal tuberculosis (STB).Methods:A total of 317 STB patients aged from 11 to 86 years with an average age of 53.5±16.7 years, who received debridement and fusion with bone grafting from January 2013 to December 2019, were retrospectively analyzed, including 206 males and 111 females. The follow-up duration was at least 1 year. During the follow-up, any one of the following 1)-3) was defined as surgical failure, namely 1) the same tubercular lesion treated by surgery more than 2 times, 2) the number of unplanned readmissions related to tubercular lesion≥1, 3) drug-resistant STB or delayed healing, recurrent lesion with cold abscess/sinus tract, combined with other bacterial infection, or loosening of internal fixation. The other cases were regarded as "curative" cases. Patients' symptoms, medication history, auxiliary examination and surgical plan were collected for univariate analysis. Further, the potential risk factors for surgical failure were analyzed by binary Logistic regression. Failed cases were treated with etiological intervention, such as puncture pumping pus or debridement or revision. The necrosis or granulation tissue was collected and further detected by tuberculosis culture, metagenomic next-generation sequencing (mNGS) and real-time fluorescent quantitative PCR (RT-qPCR).Results:There were 27 cases with surgical failure. Abscess or sinus tract formation was developed in 17 cases, which accounted for 63% (17/27). Among these patients, there were 3 cases of resistance to isoniazid or rifampicin and 2 cases of resistance to isoniazid and rifampicin (multidrug resistance, MDR). Seventeen cases were treated by anti-tuberculosis treatment, while 14 cases by puncture drainage (or puncture catheter irrigation) and 3 cases by debridement and suturing. Seven cases with wound infection or poor healing accounted for 26% (7/27). Among them, 5 kinds of pathogens were detected, none of which showed tuberculosis drug resistance. All of them were treated by anti-infection and debridement suturing, while 2 of them were treated with internal fixation removal. Three cases (11%, 3/27) with internal fixation loosening were treated by revision surgery. There was statistically significant difference between the failed group and the cured group in involved multi-/jumping segment, history of type 2 diabetes, a history of more than three basic diseases, CRP at one week after surgery, WBC at one week after surgery, time of first dose, operation duration and intraoperative blood loss ( P<0.10). Binary Logistic regression analysis showed that multi-/jumping segment ( OR= 3.513, P=0.047), CRP at one week after surgery ( OR=1.021, P=0.005), first dose time ≥20 weeks ( OR=2.895, P=0.039), blood loss ≥800 ml ( OR=5.950, P=0.001) and more than three basic diseases involved ( OR=3.671, P=0.027) were independent risk factors for surgical failure. Conclusion:Early diagnosis, especially the diagnosis of drug-resistant STB and standardized anti-tubercular treatment, should be carried out effectively. Puncture and drainage of abscess is an effective therapy to treat the cases with abscess/sinus tract formation. Some cases involved multi-/jumping segments could be with higher risk of failure after internal fixation. Thus, they should be treated individually with emphasis on the segmental stability reconstruction.

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Correlation of urinary 8-oxoguanosine with health assessment indicators in different age groups / 中华老年医学杂志

Objective:To investigate the relationship of urinary 8-oxoguanosine(8-oxoGsn)with muscle mass, muscle strength, advanced glycation end products(AGEs), trace elements, heavy metals and other health-related indictors in different age groups of the Beijing area.Methods:A cross-sectional research was conducted.Healthy adults aged 25 to 93 years who sought health examination in the Health Examination Center of Beijing Hospital were recruited.Participants were divided into the young and middle-aged group and the elderly group with age 60 as the cutoff.Urinary 8-oxoGsn levels were detected by mass spectrometry and adjusted using urine creatinine values.Body composition was measured by multifrequency bioelectrical impedance analysis(BIA). Grip strength, 6-meter walking speed and 5-times sit to stand test were conducted by experienced team members.Skin autofluorescence was used to detect skin AGEs.A portable optical scanner was used to detect heavy metals and trace elements using reference points of the palm.Levels of fasting blood glucose, glycosylated hemoglobin, high-density lipoprotein and other common blood biochemical indicators were measured.Results:A total of 106 subjects were enrolled, including 68 in the young and middle-aged group and 38 in the elderly group.The proportion of patients with hypertension(14 ases or 36.8% vs.7 ases or 10.3%), systolic blood pressure[130(120, 140) vs.120(110, 126)mmHg], fasting blood glucose[5.7(5.2, 5.9)mmol/L vs.5.2(4.9, 5.5)mmol/L], glycosylated hemoglobin[6.0(5.7, 6.2)% vs.5.7(5.4, 5.9)%], 8-oxoGsn/Cre[1.9(1.4, 2.6) vs.1.3(1.0, 1.6)], AGEs(2.44±0.46 vs.2.01±0.29), 5-times sit to stand test scores[7.8(6.9, 9.8)s vs.6.0(5.0, 6.8)s], magnesium(31.4±7.2 vs.27.7±6.4), mercury(0.013±0.003 vs.0.008±0.003)and silver[0.011(0.010, 0.012) vs.0.010(0.009, 0.011)]were higher in the elderly group than in the young and middle-aged group, while grip strength[28.0(22.0, 35.1)kg vs.36.6(28.5, 49.1)kg], fat-free mass[44.9(37.5, 51.1)kg vs.53.3(42.4, 58.5)kg], trunk muscle mass[21.0(17.5, 23.9)kg vs.25(19.8, 27.4)kg], appendicular skeletal muscle mass[20.9(17.6, 23.9)kg vs.24.9(19.8, 27.3)kg], calcium[273.3(219.1, 480.0) vs.457.8(428.5, 489.1)], cobalt[0.029(0.027, 0.031) vs.0.031(0.028, 0.034)], selenium[1.44(0.93, 1.71) vs.1.61(1.53, 1.68)]and nickel[3.5(3.3, 4.0)*10 -3vs.3.8(3.6, 4.1)*10 -3]were lower in the elderly group than in the young and middle-aged group( P<0.05). Urinary 8-oxoGsn/Cre levels were positively correlated with age, time of 5-times sit to stand test, AGEs, fasting blood glucose, mercury and aluminum( rs=0.443, 0.292, 0.357, 0.205, 0.316 and 0.214, P<0.05), and negatively correlated with trunk muscle mass, appendicular skeletal muscle mass, fat-free mass, grip strength, silicon and manganese( rs=-0.334, -0.333, -0.332, -0.366, -0.246 and -0.234, P<0.05), with statistical significance. Conclusions:Increased urinary 8-oxoGsn/Cre levels are correlated with decreased muscle mass, poor physical function, accumulation of AGEs, decreased trace element levels and increased heavy metal levels.Therefore, 8-oxoGsn has the potential to be a broadly representative and sensitive indicator for health assessment.

Explore the application of artificial intelligence technology in the transformation of clinical medical papers / 中华医学科研管理杂志

Objective:This article discusses the application of existing artificial intelligence technologies in the transformation of clinical medical papers.Methods:Using artificial intelligence technologies and big data to analyze the ideas of the transformation and application process of clinical medical papers.Results:Through analysis, it is concluded that future clinical medical journals use artificial intelligence technology to transform scientific and technological papers into the application of diagnostic techniques and medical devices to meet the needs of both clinicians and patients.Conclusions:In the coming era of intelligence, artificial intelligence technology will completely change and surpass the existing operating modes and methods of clinical medical journals, so that more scientific and technological papers in clinical medical periodicals will be converted from text to the fruits of affordable clinical applications. Contribute to improving China's medical services and people's health.

Spinal endoscopy via percutaneous transforaminal approach for lumbar posterior ring apophysis separation / 中华创伤杂志

Objective@#To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation (PRAS) via percutaneous transforaminal approach.@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018. There were 20 males and 12 females, aged 20-47 years [(33.7 ± 6.6)years]. All patients had single-segment lesions. The injured segments were at L3/4 in seven patients, L4/5 in 14 patients, L5/S1 in 11 patients. All patients were treated with spinal endoscopic surgery via percutaneous transforaminal approach. The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded. At 24 hours, 3 months and 12 months after operation, the efficacy was evaluated by visual analogue score (VAS), Oswestry dysfunction index (ODI) and modified MacNab criteria.@*Results@#All patients were followed up for 12-30 months, with an average of 15.5 months. The incision length was 7-9.5 mm [(8.0±0.9)mm], the average operation time was 60-155 minutes [(80.5±13.2) minutes], the average intraoperative blood loss was 5-25 ml [(10.6±5.7)ml] and the average number of fluoroscopy was 5-25 times [(9.4±3.4) times]. The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation. Postoperative dysesthesia was noted in one patient, who recovered after neurotrophy and physiotherapy after one week. There were no complications such as open surgery conversion, intervertebral space infection, nerve root injury and dural sac laceration. The VAS and ODI at 24 hours, 3 months and 12 months after operation [low back pain VAS: (3.4±1.5)point, (1.8±1.1)points, (1.7±0.9)points; leg pain VAS: (1.8±1.0)points, (1.6±0.8)points, (1.4±0.6)points; ODI: (26.8±9.7)%, (13.9±4.3)%, (12.8±2.8)%] were significantly improved compared with those before operation [ back pain VAS: (7.3±2.1)points, leg pain VAS: (7.9±2.7)points; ODI: (56.2±15.6)%] (P<0.05). According to the modified MacNab criteria, the results were excellent in 25 patients, good in five patients, and fair in two patients, with the excellent and good rate of 94%.@*Conclusion@#Spinal endoscopic surgery for lumbar PRAS via percutaneous transforaminal approach is an effective method with advantages of small incision, less complications, effective pain relief and fast functional recovery.

Spinal endoscopy via percutaneous transforaminal approach for lumbar posterior ring apophysis separation / 中华创伤杂志

Objective To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation (PRAS) via percutaneous transforaminal approach.Methods A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018.There were 20 males and 12 females,aged 20-47 years [(33.7 ± 6.6)years].All patients had singlesegment lesions.The injured segments were at L3/4 in seven patients,L4/5 in 14 patients,L5/S1 in 11 patients.All patients were treated with spinal endoscopic surgery via porcutaneous transforaminal approach.The incision length,operation time,intraoperative blood loss,intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded.At 24 hours,3 months and 12 months after operation,the efficacy was evaluated by visual analogue score (VAS),Oswestry dysfunction index (ODI) and modified MacNab criteria.Results All patients were followed up for 12-30 months,with an average of 15.5 months.The incision length was 7-9.5 mm [(8.0 ±t 0.9) mm],the average operation time was 60-155 minutes [(80.5 ± 13.2) minutes],the average intraoperative blood loss was 5-25 ml [(10.6 ± 5.7) ml] and the average number of fluoroscopy was 5-25 times [(9.4 ±3.4) times].The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation.Postoperative dysesthesia was noted in one patient,who recovered after neurotrophy and physiotherapy after one week.There were no complications such as open surgery conversion,intervertebral space infection,nerve root injury and dural sac laceration.The VAS and ODI at 24 hours,3 months and 12 months after operation [low back pain VAS:(3.4 ± 1.5) point,(1.8 ± 1.1) points,(1.7 ± 0.9) points;leg pain VAS:(1.8 ± 1.0) points,(1.6 ±0.8)points,(1.4±0.6)points;ODI:(26.8 ±9.7)％,(13.9 ±4.3)％,(12.8 ±2.8)％] weresignificantly improved compared with those before operation [back pain VAS:(7.3 ± 2.1) points,leg pain VAS:(7.9 ± 2.7) points;ODI:(56.2 ± 15.6)％] (P ＜ 0.05).According to the modified MacNab criteria,the results were excellent in 25 patients,good in five patients,and fair in two patients,with the excellent and good rate of 94％.Conclusion Spinal endoscopic surgery for lumbar PRAS via percutaneous transforaminal approach is an effective method with advantages of small incision,less complications,effective pain relief and fast functional recovery.

Assessment on health risk of drinking water in Hangzhou / 预防医学

Objective@#To assess the health risk associated with drinking water in Hangzhou from 2016 to 2017,and to provide evidence for the safety of drinking water .@*Methods@#The monitoring data of 5 genetic toxic substances（arsenic,hexavalent chromium,cadmium,chloroform,tetrachloromethane）and 13 body toxic substances（lead,mercury,selenium,cyanide,fluoride,nitrate,iron,ammonia nitrogen,manganese,copper,zinc,aluminum,volatile phenol）from 36 source water samples,36 finished water samples and 288 tap water samples in the main urban areas of Hangzhou were collected from 2016 to 2017. The health risk of drinking water containing the chemical pollutants mentioned above were assessed based on the evaluation models recommended by United States Environmental Protection Agency .@*Results@#The concentrations of 5 genetic toxic substances and 13 body toxic substances in source water,finished water and tap water were all within the reference limits issued by Standards for Drinking Water Quality（GB 5749—2006）. The carcinogenic risk,non-carcinogenic risk and total health risk caused by the chemical pollutants in the source water were 2.18×10-5/a,7.75×10-9/a and 2.18×10-5/a. The carcinogenic risk,non-carcinogenic risk and the total health risk caused by the chemical pollutants in the finished water were 1.08×10-5/a,3.70×10-9/a and 1.08×10-5/a. The carcinogenic risk,non-carcinogenic risk and total health risk caused by the chemical pollutants in the tap water were 1.96×10-5/a,3.61×10-9/a and 1.96×10-5/a. The carcinogenic risk and total health risk caused by chemical pollutants ranged from high to low in the source water,tap water and finished water. The non-carcinogenic risks ranged from high to low in the source water,finished water and tap water .@*Conclusion@#The health risks of 18 chemical pollutants in drinking water in Hangzhou were at a low level,with the greater carcinogenic risk than the non-carcinogenic risk. Hexavalent chromium had the highest carcinogenic risk,while fluoride and aluminum had the highest non-carcinogenic risk.

Clinical observation of Weining boil-free granule combined with auricular point pressing with bean in the treatment of chronic atrophic gastritis with liver-stomach disharmony / 中国基层医药

Objective To investigate the clinical effect of Weining boil -free granule combined with auricular point pressing with bean in the treatment of chronic atrophic gastritis with liver -stomach disharmony .Methods 120 patients with chronic atrophic gastritis of liver -stomach disharmony were selected .They were randomly divided into treatment group (n=60) and control group (n=60) according to the digital table.The control group was treated with routine western medicine ,and the treatment group received Weining boil -free granule combined with auricular point pressing with bean .The clinical efficacies of the two groups was compared .Results The total effective rate of the treatment group was 95.0%,which was significantly higher than 76.6% of the control group,the difference was statistically significant(χ2 =8.29,P<0.05).Conclusion The effect of Weining boil -free granule combined with auricular point pressing with bean in the treatment of chronic atrophic gastritis with liver -stomach disharmony is better than that of the routine western medicine .

Expressions of ovarian function-related proteins in ovarian follicles in different development stages and their significances / 吉林大学学报(医学版)

Objective:To detect the expressions of ovarian function-related proteins in the ovarian follicles in different development stages,and to explore their roles and significances in the regulation of follicular development and ovarian function. Methods:The ovarian tissue containing primordial,primary,secondary follicles,mature follicles, atretic follicles and corpus albicans of the woman in the childbearing age was selected. Immunohisto chemical analysis was used to detect the expressions of Glyoxal enzyme I (glyoxalase I),ubiquitin carboxy-terminal hydrolase L1 (UCH-L1),heat shock protein 27 (HSP27),serum amyloid P (SAP)proteins in the ovarian follicles in different stages.The expression intensities of these proteins were compared.Results:The expression intensities of Glyoxalase I and UCH-L1 in the granulosa cells and theca cells of secondary follicles and marure follicles were strong,which were higher than those in the cytoplasm of primordial and primary follicles.The expression intensities of HSP27 in the cytoplasm of primordial and primary follicles were strong,which were higher than those in the granulosa cells and theca cells of secondary follicles and marure follicles.The expression intensities of Glyoxalase I and HSP27 in the atretic follicles were strong,which were higher than that in the growth follicles. The expressions of SAP were positive in the primordial,primary follicles,secondary and mature follicles and the expression intensities were not different.The expressions of four proteins in the corpus albicans did not express. Conclusion:The high expression of UCH-L1 and low expression of HSP27 are associated with the mature and development of follicles;the high expressions of Glyoxalase I and HSP27 are associated with the follicular atresia and ovarian failure.

The application of VR technology in clinical medicine and its influence on medical science and technology periodicals / 中华医学科研管理杂志

Objective With the rapid development of network information technology,media convergence is deepening from simple application to media transformation.This article explores the application of virtual reality technology (VR)in clinical medical research management through media virtual reality,so that medical researchers or clinicians can understand the "reasonable resource integration" of media VR technology in clinical medicine,Application of scientific researchers play an innovative role.Methods Through the literature review to understand the use of VR technology for clinical research or surgical operation of the three-dimensional simulation of the scene to achieve the feeling of exposure to the scene,so as to achieve a richer environment than the real observation angle of thinking space.And then the use of VR media (including magazines,etc.) to create a simulation platform to make medical research magazine more adapt to the development trend of network information technology.Results Media VR technology is changing the traditional mode of paper journals in medical journals and bringing a whole new way of narration to the media.Journal journals,for example,use the new media convergence method to make use of smart phones such as mobile phones to enable the users of information Participate in live and interactive video at any time,and use VR technology and magazine's virtual platform to train and discuss virtual resources through clinical research and manage ment,so that medical researchers or clinicians (including clinical researchers and clinicians) can learn from others on their own,In the virtual space can be freely discussed,thereby enhancing the medical researchers or clinicians interested in learning and clinical research innovation effect.Conclusions Medical and scientific research institutions and their magazines,which promote the achievements of medical research,need to adapt to the development trend of network informa tion technology,learn VR technology,update the scientific research management and publishing concepts,and on the one hand do a good job in the dissemination of scientific research management and scientific and technological paper media.On the other hand,Computer and Internet technologies,and strive to create a relaxed and comfortable knowledge for medical researchers to gain the reverie of space and technological innovation so that medical researchers or clinicians can enhance their interest in diverse services,increase their desire for information needs and enhance their learning Clinical research thinking and practical skills.

Analysis on misdiagnosis of tuberculous meningitis in the elderly / 中华老年医学杂志

Objective To explore the clinical characteristics of elderly patients with tuberculous meningitis (TBM) and analyze the causes of misdiagnosis.Methods The clinical data of patients aged 60 years and over with TBM in Beijing Chest Hospital Affiliated to Capital Medical University from January 2011 to January 2017 were retrospectively analyzed.The clinical characteristics of the elderly patients with TBM were analyzed and compared between misdiagnosis and non-misdiagnosis groups.Results Among 60 elderly patients with TBM,32 cases (53.3%) were misdiagnosed before hospitalization.Among 32 misdiagnosed cases,11 (34.4%) were misdiagnosed as pulmonary infection,6 (18.8%) as infectious diseases with unspecified site,4(12.5%) as upper respiratory tract infections and 3 (9.4%) as cerebral vascular diseases,and so on.The onset time of TBM,fever prevalence and CSF glucose levels were 42.5 (20.3,60.0) d,96.9% (31 cases),1.5(1.1,2.3)mmol/L in misdiagnosis group respectively,and 15.0 (10.0,20.0) d,75.0%(21 cases),2.3(1.4,3.2)mmol/L in non-misdiagnosis group respectively,which was statistically significantly different between the two groups (all P 0.05).Conclusions Elderly patients with TBM have atypical clinical manifestations,many comorbidities,and less specific imaging,and especially,the cerebrospinal fluid pathogen sensitivity is low,which may result in higher misdiagnosis rate.

Teaching practice of patent application for scientific research of the medical postgraduates / 中华医学教育探索杂志

To enhance the scientific research participation of the medical postgraduates, and pro-mote core competitiveness of the medical colleges, based on analysis of the necessity of patent application in medical colleges postgraduate, we constructed the teaching teams including the medical professors, patent engineers, graduate teaching manager, and science and technology managers. The problem-based learning (PBL) and case-based learning (CBL) as teaching methods were used in practice. The patent courses included the reference search and analysis, basic knowledge of patent law, and patent application training module were constructed; and the teaching effect were evaluated and optimized through the scores of the patent basic theory test, research output, and the training of the patent application. The patent course of the medi-cal postgraduates provides a reference for cultivating the compound talents have scientific research innova-tion and patent application capability.

AidE encodes an N-acyl homoserine lactonase in Acinetobacter / 生物工程学报

Quorum sensing (QS) is a cell-cell communication mechanism that allows bacterial populations to coordinate gene expression in response to cell density. N-acylhomoserine lactones (AHL) are used as quorum-sensing signal molecules by many Gram negative bacteria. Acinetobacter sp. 77, an AHL-degrading bacterium, was isolated in our previous work. The gene aidE for AHL inactivation was cloned in this study by screening a genomic DNA library. The deduced protein AidE is 268 amino acids in length and shares a high identity (95%) with the beta-lactamase family protein in Acinetobacter gyllenbergii CIP110306, but low identities with known AHL-degrading enzymes. HPLC analysis of the AidE-degraded C6-HSL products revealed that AidE functioned as an AHL lactonase. Sequences alignment suggested that the aidE gene is not conserved in Acinetobacter species, flanking sequences of aidE and their arrangement are specific in Acinetobacter sp. 77 genome, and some IS insertion sequences were found downstream of the aidE gene. These evidences indicated that the aidE gene might be foreign DNA taken up via horizontal gene transferring or had changed its relative location due to the genome rear-arrangement. Expression of the aidE gene in Pectobacterium carotovorum subsp. carotovorum Z3-3 significantly reduced its AHL production as well as the pathogenicity on host plants, indicating that AidE was able to effectively quench quorum sensing-dependent functions in bacteria. In conclusion, aidE is a newfound AHL-lactonase with a potential for suppression of bacterial infections.

Future service mode of Journals medicine technology for clinical and research personnel / 中华医学科研管理杂志

The knowledge economy development depends on knowledge and innovation.Prime Minister,Keqiang Li,proposed that the development of Internet + action plan in the government's report of the Twelfth National People's Congress third meeting of,which made the whole China's Businesses animate.In such rapid development situation in terms of big data,cloud computing,Internet +,and other modern technology,integrate Internet resources,transfer big data into required da ta after analysis,change the magazine service mode,then promote clinical science and technology magazine to make it more humane-oriented as well as satisfy the need of each reader.This study proposed certain ideas on the development of the Internet + and medical technology magazines.

The clinical application of predicting the rate of variation flowing rate of femoral artery by ultrasonic measurement / 中国基层医药

Objective Using Doppler ultrasound measured in femoral artery flow velocity variation rate method to predict fluid responsiveness.Methods 80 patients were measured femoral artery flow velocity variation rate (△Vpeak)by mastering the ultrasound skills of the attending physician.Passive leg raising test (PLR)stroke vol-ume variation (△SV)was used to analyze the peak value of the femoral artery flow velocity,rate of femoral artery peak velocity of respiratory changes,and the results were compared with results of PICCO monitoring to predict patients with their response to the treatment capacity,to evaluate clinical feasibility.Results Reactive groups in the PLR test before the experiment and hemodynamic changes:PLR test reaction group in before the test and test process, HR,MAP,CAP index changes were not obvious (P >0.05),but ultrasonic detection and PICCO detection showed SV and CO varied significantly (t =15.24,P =0.00;t =13.64,P =0.00),the two kinds of methods to forecast results was consistent.In the absence of the anti should patients in PLR test before the experiment and hemodynamic chan-ges:PLR test unreacted group in before the test and test process,HR,MAP,CAP,SV and CO index change were not obvious (all P >0.05).Conclusion By ultrasonic method for measuring femoral artery flow speed variation rate can exactly evaluate the capacity status of critically ill patients,and effectively predict fluid responsiveness,the prediction results and PICOO monitoring results are highly consistent.It is a safe and efficient prediction method,which is worthy of promotion in clinical intensive observation.

Quality Analysis of Radix Aucklandiae in Xianglian Preparation / 中国药师

Objective:To analyze and evaluate the quality control of Radix Aucklandiae in Xianglian preparation and develop a new quality control method for the preparation through standard testing and exploration study on 127 batches of samples .Methods:Ac-cording to the mandatory method , Radix Aucklandiae was identified by TLC .In the exploratory research , the volatile compounds in Xianglian preparation was analyzed by SPME/GC-MS, and the GC-MS fingerprints of volatile compounds in Xianglian preparation with different dosage forms were established .The contents of costunolide and dehydrocostuslactone in Xianglian preparation were determined by UPLC.Results:According to the current quality standard , all the batches of samples met the standard with the qualified rate of 100%.The composition of volatile compounds in different dosage forms was similar , while the relative contents were quite different . The contents of costunolide and dehydrocostuslactone in Xianglian preparation were different .Conclusion: The exploratory research provides reference for the further revision of drug standard and monitoring quality of the preparation .

Analysis and Optimization of Work Efficiency of Intelligent Dispensing System in Outpatient Pharmacy of Our Hospital / 中国药房

OBJECTIVE:To improve the working efficiency of the drug delivery system. METHODS:The kinds of drugs in delivery system and manual dispensing window were adjusted through comparing the number of prescriptions and drug box dis-pensed by the system and manual window in our hospital before adjustment (Jun. 2014),combining with analysis of EIQ(En-try-item-quantity)-ABC. The improvement effect was evaluated through analyzing related index after adjustment(Aug. 2014). RE-SULTS:The data before adjustment showed the workload of the delivery system was lower than that of manual delivery in term of the number of drug box (P=0.000),and they were similar in term of the number of prescription (P=0.122). The drug delivery system was significantly better than manual delivery in terms of two indexes after resetting the type of drugs in the system(P=0.000). CONCLUSIONS:Optimized delivery system can effectively improve the working efficiency.

Minocycline postconditioning protects myocardium from ischemia-reper-fusion injury through attenuating poly(ADP-ribose) polymerase excessive activation / 中国病理生理杂志

AIM:To investigate whether minocycline postconditioning protects rat myocardium from ischemia-reperfusion ( I/R ) injury through attenuating poly ( ADP-ribose ) polymerase-1 ( PARP-1 ) excessive activation. METHODS:The left anterior descending coronary artery was ligated for 45 min and then reopened for 2 h to establish the rat model of myocardial ischemia-reperfusion injury.The male Wistar rats ( n =90 ) were randomly divided into sham group, I/R group, low-and high-dose minocycline groups, and 3-aminobenzamide (3-AB, PARP inhibitor) group.The myocardial infarct size was measured by Evans blue and 2,3,5-triphenyltetrazolium chloride ( TTC) staining.The morpho-logical changes of the myocardium were observed with HE staining.The cardiomyocyte apoptosis was detected using in situ TDT-mediated dUTP nick end labeling ( TUNEL) .The level of tumor necrosis factorα( TNF-α) and interleukin 1β( IL-1β) in the serum were measured by ELISA.The content of poly( ADP-ribose) ( PAR) in the reperfused myocardium and peripheral leukocytes were detected by Western blot.RESULTS: Compared with sham group, PAR expression, TNF-αcontent and IL-1βconcentration increased in all other groups.Compared with I/R group, treatment with low and high doses of minocycline and 3-AB significantly reduced the infarct size and myocardial apoptosis.PAR expression, TNF-αcontent and IL-1βconcentration in low-and high-dose minocycline groups and 3-AB group all decreased.No significant difference of the above parameters between high-dose minocycline group and 3-AB group was observed.CONCLUSION: Minocy-cline postconditioning may attenuate myocardial ischemia-reperfusion injury by depressing the activation of PARP-1 in car-diomyocytes and peripheral leukocytes in rats.

Protective Effect of Intravenous Infusion of Low Dose Minocycline Postconditioning on Myocardial Ischemia-reperfusion Injury in Rat / 中国医科大学学报

Objective To evaluate the effects of low dose intravenous minocycline postconditioning on myocardial ischemia-reperfusion injury in rat,and to investigate the possible mechanisms. Methods Forty-eight male wistar rats were randomly divided into four groups:sham-operation (SO)group,ischemia-reperfusion(IR)group,low-dose minocycline(3 mg/kg,LM)group and high-dose minocycline(10 mg/kg,HM)group. The rat model of myocardial IR was established by occlusion of the left anterior descending coronary artery for 45 minutes and reperfusion for 120 minutes.After the reperfusion,the parameters of haemodynamics were recorded;creatine kinase MB(CK-MB),cardiac troponin-I(cTn-I),malond-ialdehyde(MDA),superoxide dismutase(SOD)in serum and myocardium,myocardial apoptosis index(AI)and the myocardial tissue morphology were determined. Results Compared with IR group,LM and HM treatment significantly reduced the levels of CK-MB form,cTn-I,AI and MDA, lowered LVEDP,enhanced LVSP and ±dp/dtmax,elevated the activity of SOD in serum and myocardium(P0.05). Conclusion LM postconditioning can protect against myocardial IR injury,and the protective effect may be related to the scavenging of oxide free radical,which further restrain the reac-tion of lipid peroxidation and apoptosis.