Practice and thinking of standardized cultivation of master of public health / 中华医学教育探索杂志

In recent years, in the face of the risks and challenges of public health emergencies, the demand and supply of public health talents are relatively tight, and the reform and exploration of the standardized training of public health professionals has become one of the most urgent and important topics. This study analyzed the problems of curriculum system setting, implementation of practical links and composition of tutors in the training process, and learned that Wenzhou Medical University has carried out practical exploration in strengthening theoretical study, highlighting the combination of research and study, deepening professional practice, etc., which has achieved the orderly promotion of public health training supported by supporting reform measures; Take the post competence as the guidance, and vigorously improve the practicing ability; Based on the process and result assessment, promote the reform of training mode and other preliminary results. However, there are also shortcomings and deficiencies in accuracy, supply and effectiveness. Looking at the current situation, it is suggested to promote mechanism construction, increase skill training, develop training standards, improve supporting measures, establish expert committees and other reform ideas, and explore and implement a new model of degree education connection.

Analysis of 5 ischemic stroke patients caused by pulmonary arteriovenous fistula / 中华神经科杂志

Objective:To investigate the correlation between pulmonary arteriovenous fistula (PAVF) and ischemic stroke, and to improve the diagnosis and treatment of embolic strokes of undetermined source.Methods:Five patients with ischemic stroke caused by PAVF admitted to Xiangya Hospital of Central South University from January 2017 to December 2020 were collected. The diagnosis, treatment and prognosis of stroke caused by PAVF were summarized based on literature review.Results:Among the 5 patients, 1 is male and 4 are females, with age of (34.4±9.3) years. Weakness of unilateral limb, slurred speech, vision changes, drooping eyelids, etc., were the first manifestations of stroke. The location of cerebral infarction was indefinite. In this study, 5 patients were all isolated PAVF, including 3 cases of left lower lung, 1 case of left upper lung and 1 case of right lower lung. All 5 patients underwent interventional therapy, were followed-up for 6 months and 12 months after surgery, and none of them had a new stroke attack, and only 1 case had recanalization of PAVF.Conclusions:PAVF is a rare vascular lesion, stroke caused by which is even rarer, with a lack of specificity in clinical manifestations. For young patients with unexplained embolic stroke, if the stroke has a sudden onset, the anterior and posterior circulation can be involved, and multiple vascular distribution regions are often involved, and it is difficult to find a clear emboli basis, with manifestations such as hypoxemia, PAVF should be considered. Percutaneous catheter intervention for PAVF is safe and effective, and is the preferred method for the treatment of PAVF.

Risk factors and prognosis of acute stroke within 1 year after hip fracture surgery in elderly patients / 中华老年医学杂志

Objective:To study the risk factors of acute stroke within 1 year after hip fracture in the elderly and its effect on prognosis.Methods:From January 2018 to December 2020, 278 elderly hip fracture patients undergoing surgery were retrospectively analyzed, including 101 males and 177 females, aged from 60 to 99 years with an average of(78.9±8.7)years.According to whether acute stroke occurred within 1 year after operation, the patients were divided into stroke group and non-stroke group.A multivariate Logistic regression was used to evaluate the risk factors for acute stroke within 1 year after hip fracture, and the prognosis was analyzed.Results:Acute stroke occurred in 28 patients(10.1%)within 1 year after operation, and the peak of stroke onset occurred in the third months after operation.Patients in the stroke group were older, and had a higher proportion of hypertension, arrhythmia, previous stroke history, and use of anticoagulant or antiplatelet drugs before fracture( P<0.05 for all). Multivariate Logistic regression analysis showed that advanced age( OR=1.078, 95% CI=1.007-1.153, P=0.030), male( OR=2.643, 95% CI=1.060-6.742, P=0.037)and previous stroke history( OR=12.202, 95% CI=4.662-31.940, P<0.001)were independent risk factors for stroke in elderly patients with hip fracture within 1 year after operation.The 1-year mortality, complication rate and readmission rate in the stroke group were significantly higher than those in the non-stroke group( P<0.05 for all). Conclusions:The incidence of stroke is high in elderly patients with hip fracture within 1 year after operation.Older age, male, and previous stroke history were independent risk factors for acute stroke.The prognosis of stroke was poor in elderly patients with hip fracture, and the 1-year mortality, complication and readmission rates were high.

Research advances of debriefing methods in scenario stimulation teaching / 中华医学教育探索杂志

Based on the latest results of international researches, combining with the experiences of our team in the simulation of acute dyspnea, Xiangya Hospital Central South University has summarized 7 characteristics, procedures and methods of debriefing, including that immediate feedback happens after simulation; feedback is provided by a trained instructor with clinical experience; feedback time is at least longer than the simulation time; various international methods of feedback can be used; the content of feedback is the learning objective; oral feedback is preferred; video can be used to review the details. The study aims to provide a theoretical basis for debriefing in domestic scenario stimulation teaching, and finally improve the effectiveness of the scenario stimulation teaching.

Construction and verification of a new nomogram for predicting stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy at high altitude / 临床肝胆病杂志

ObjectiveTo investigate related factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, and to establish a nomogram model for predicting the risk of stone recurrence after surgery based on independent risk factors. MethodsA retrospective analysis was performed for the clinical data of 144 patients with gallstones who underwent endoscopic minimally invasive gallbladder-preserving cholecystolithotomy in Qinghai University Affiliated Hospital from January 2012 to January 2018, and according to postoperative stone recurrence, the patients were divided into non-recurrence group and recurrence group. The chi-square test was used for comparison of categorical data between two groups. LASSO and logistic regression analyses were used to analyze independent risk factors for postoperative stone recurrence, and the corresponding nomogram prediction model was plotted according to regression coefficient. The calibration curve was plotted to evaluate the reliability of the predictive nomogram; Harrell consistency index was used to quantify the discriminatory performance of the predictive nomogram; the receiver operating characteristic (ROC) curve was used to evaluate the sensitivity, specificity, and area under the ROC curve (AUC) of this predictive nomogram. ResultsAll 144 patients underwent successful endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, among whom 14 patients (9.7%) experienced stone recurrence after surgery. The multivariate analysis showed that family history (odds ratio ［OR］= 3.245, 95% confidence interval ［CI］: 0.752-13567, P=0.104), regular diet (OR=3.752, 95% CI: 1.067-14.141, P=0.041), stone homogeneity (OR=5.871, 95% CI: 1636-25.390, P=0.010), and medication compliance (OR=0.225, 95% CI: 0.057-0.799, P=0.024) were independent risk factors for recurrence. The nomogram model had an index of concordance (C-index) of 0.835 (95% CI: 0.732-0.938) in the modeling sample and 0.7925 in the verification sample, suggesting that the nomogram model in this study had good accuracy and discrimination. The predictive nomogram had an AUC of 0.835, suggesting that this nomogram had a relatively high predictive value. ConclusionFamily history, regular diet, stone homogeneity, and medication compliance are independent risk factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, and the nomogram constructed based on these independent risk factors may help to predict the risk of postoperative stone recurrence.

Correlation between systemic immune-inflammation index and prognosis in patients with hepatic alveolar echinococcosis / 临床肝胆病杂志

ObjectiveTo investigate the correlation between systemic immune-inflammation index (SII) and prognosis in patients with hepatic alveolar echinococcosis. MethodsA retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgery for hepatic alveolar echinococcosis, and SII was calculated. The chi-square test was used for comparison of categorical data between two groups, and a Spearman correlation analysis was performed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of SII; the Kaplan-Meier method was used to plot survival curves and analyze overall survival time in the two groups, and the log-rank test was used for comparison of survival rates between the two groups; univariate and multivariate Cox regression analyses were used to identify the influencing factors for the prognosis of patients with hepatic alveolar echinococcosis. ResultsThe Spearman correlation analysis showed that SII was positively correlated with the postoperative fatality rate of patients with hepatic alveolar echinococcosis (r=0.267, P＜0.001). The ROC curve showed that the optimal cut-off value of SII before surgery was 758.92, and based on this, 242 patients with hepatic alveolar echinococcosis were divided into low SII (SII ≤758.92) group with 126 patients and high SII (SII ＞758.92) group with 116 patients. The low SII group had 1-, 3-, and 5-year survival rates of 98.20%, 88.47%, and 6610%, respectively, and the high SII group had 1-, 3-, and 5-year survival rates of 90.80%, 53.05%, and 27.40%, respectively. The low SII group had a cumulative survival rate of ＞50% and a mean survival time of 55.584 months (95% confidence interval［CI］: 53550-57.617), while the high SII group had a cumulative survival rate of ＜50%, a mean survival time of 39.384 months (95% CI: 35.070-43.698), and a median survival time of 43 months (95% CI: 34.694-51.306). The low SII group had a significantly better survival rate than the high SII group, and there was a significant difference in overall survival rate between the two groups (χ2=46.979, P＜005). The univariate analysis showed that SII ＞758.92 (hazard ratio ［HR］=5.907, 95% CI: 3.386-10.306, P=0.001) was an influencing factor for the overall survival time of patients with hepatic alveolar echinococcosis, and the multivariate Cox regression analysis showed that preoperative peripheral blood SII (HR=3.507, 95% CI: 1.911-6.435, P=0.001) was an independent risk factor for the overall survival rate of patients with hepatic alveolar echinococcosis. ConclusionPreoperative SII level is clearly correlated with the prognosis of patients with hepatic alveolar echinococcosis and can thus be used as a clinical indicator to evaluate the prognosis of patients. The higher the peripheral blood SII before surgery, the worse the prognosis of patients.

Development of a nomogram for predicting survival of patients with ovarian serous cystadenocarcinoma after based on SEER database / 浙江大学学报·医学版

To develop a survival time prediction model for patients with ovarian serous cystadenocarcinoma after surgery. A retrospective analysis of 5906 postoperative patients with ovarian serous cystadenocarcinoma in the surveillance, epidemiology, and end results (SEER) database from 2010 to 2015 was performed. The independent risk factors for long-term survival were analyzed with multivariate Cox proportional hazard regression model. The nomogram of 3-year and 5-year survival was developed by using R language. The receiver operator characteristic (ROC) curve and were used to test the discrimination of the model and the calibration diagram was used to evaluate the degree of calibration of the prediction model. The survival curves was conducted by the risk factors. Cox proportional hazard regression model showed that age, race, histological grade (poorly differentiated and undifferentiated), stage T (T2a, T2b, T2c, T3a, T3b and T3c), and stage M (M1) were independent factors for the prognosis of patients with ovarian serous cystadenocarcinoma after surgery. A nomogram was developed by the R language tool for predicting the 3-year and survival of patients through age, race, histological classification, stage T and stage M. The C-index was 0.688 and the areas under ROC curve of the nomogram for predicting 3-year and 5-year survival were 0.708 and 0.716, respectively. The results of the calibration indicated that the predicted values were consistent with the actual values in the prediction models. The survival time of patients with high-risk factors was shorter than that of patients with low-risk factors (<0.05). The developed nomogram in this study can be used to predict 3-year and 5-year survival of postoperative patients with ovarian serous cystadenocarcinoma, and it may be beneficial to guide clinical treatment.

Metabolic engineering of L-cysteine supply modules for enhanced production of bacitracin in Bacillus licheniformis / 生物工程学报

Bacitracin is a broad-spectrum antibiotics mainly produced by Bacillus, and is used as veterinary medicine in the fields of livestock and poultry breeding. Insufficient supply of precursor amino acids might be an important factor that hinders high-level microbial production of bacitracin. We investigated the effect of strengthening L-cysteine supply on bacitracin production by an industrial bacitracin producer, Bacillus licheniformis DW2. Overexpression of cysK encoding L-cysteine synthase led to a 9.17% increase of the bacitracin titer. Moreover, overexpression of cysE encoding L-serine acetyltransferase and cysP encoding thiosulfate/sulfate intracellular transporter increased the bacitracin titers by 7.23% and 8.52%, respectively. Moreover, overexpression of a putative cystine importer TcyP led to a 29.19% increase of intracellular L-cysteine, and bacitracin titer was increased by 7.79%. Subsequently, the strong promoter PbacA was used to replace the promoters of genes cysP, cysE and tcyP in strain DW2::ysK, respectively. The resulted strain CYS4 (DW2::cysK-PbacA-(cysP)-PbacA(cysE)- PbacA(tcyP) produced 910.02 U/mL bacitracin, which was 21.10% higher than that of the original strain DW2 (747.71 U/mL). Together with the experiments in 3 L fermenters, this research demonstrated that enhancing intracellular L-cysteine supply is an effective strategy to increase bacitracin production of B. licheniformis.

Construction and practice of the golden course "doctor-patient communication skills" / 中华医学教育探索杂志

Diagnostics is one of the most important bridge courses for medical students from basic to clinical. Doctor-patient communication runs through the whole process of patient diagnosis and treatment. How to improve medical students' ability of doctor-patient communication? Our teaching team has carried out continuous reform and explored the scientific effective teaching mode. Recently, through the construction of "doctor-patient communication skills" quality online course, efforts have made to build an online and offline blended learning mode, which has gradually realize the integration with diagnostics teaching, and has achieved remarkable results. It also provides a scientific practical basis for the integration of doctor-patient communication and other clinical courses, which is worthy of promotion.

Effect of high-flow nasal cannula oxygen therapy and non-invasive ventilation on patients with acute respiratory failure after gastrointestinal operation under general anesthesia: a prospective randomized controlled trial / 中华急诊医学杂志

objective:To observe the effect of high-flow nasal cannula (HFNC) oxygen therapy on patients with acute respiratory failure after gastrointestinal operation under general anesthesia and its efficacy on prognosis.Methods:Totally 107 patients with acute respiratory failure after gastrointestinal operation under general anesthesia in ICU of our hospital were selected from January 2017 to June 2019. Patients were randomly divided into the HFNC group ( n=57) and non-invasive ventilation (NIV) group ( n=50). The changes of pH, PaO 2, PaCO 2, PaO 2/FiO 2, SpO 2, heart rate (HR), respiration rate (RR), and intra-abdominal pressure (IAP) before and after oxygen treatment were compared. The differences of comfort level, duration of oxygen treatment, re-intubation rate, 48-h pulmonary infection rate, incidence of anastomotic fistula, length of stay in ICU, length of hospital stay, hospitalization cost, and 28-day mortality were compared between the two groups. The t test of two independent samples was used for the comparison of normal measurement data. Non-normal data were expressed by median (quartile), fractional count data by case number (percentage), and comparison between the two groups by Chi-square test. Results:PaO 2, PaCO 2, PaO 2/FiO 2 and SpO 2 were not significantly different after 2-h oxygen therapy. PH of the HFNC group was lower than that of the NIV group (7.39 ± 0.04 vs. 7.42 ± 0.03), PaO 2, PaCO 2, PaO 2/FiO 2 and SpO 2 were higher than that of the NIV group [ (89.22 ± 8.70) vs. (84.99± 9.76) mmHg, (41.3 ± 3.43) vs. (39.34 ± 4.21) mmHg, (250.07 ± 18.34) vs. (237.89±19.38) mmHg, (96.14 ± 2.19) vs. (94.78 ± 2.76)%, P <0.05]; pH, PaO 2, PaCO 2, PaO 2 /FiO 2 and SpO 2 were significantly higher in the HFNC group than those in the NIV group [ (7.39 ± 0.04) vs. (7.36 ± 0.04) ; (97.2 ± 12.45) vs. (93.82 ± 12.54) mmHg; (40.84 ± 5.22) vs. (45.10 ± 6.40) mmHg; (277.16 ± 13.98) vs. (248.86 ± 12.81) mmHg, (98.14 ± 1.64)% vs. (95.48 ± 2.71) %] after 12 h oxygen treatment. The HR, RR and IAP of the HFNC group were lower than those of the NIV group, and the differences were statistically significant ( P <0.05). The duration of oxygen therapy in the HFNC group was shorter than that in the NIV group [(32.01 ± 7.57) vs. (40.88 ± 8.89) h], the reintubation rate was lower than that in the NIV group (1.75% vs. 12%), the pulmonary infection rate within 48 h oxygen therapy was lower than that in the NIV group (8.78% vs.30%), and the length of stay in ICU was shorter than that in the NIV group [(5.61 ± 1.73) vs. (7.60 ± 2.31) d], and the hospitalization cost was lower than that in the NIV group ( t = 4.822, P <0. 05). Conclusions:HFNC can improve the oxygenation index of patients with hypoxemia after gastrointestinal operation under general anesthesia, reduce oxygen treatment time, reduced reintubation rate, reduce pulmonary infection rate within 48 h, and improve the prognosis.

Mortality and risk factors for hip fractures in elderly patients within 30 days of surgery / 中华老年医学杂志

Objective:To investigate the mortality and related risk factors for hip fractures in elderly patients within 30 days of surgery.Methods:Clinical data of elderly hip fracture patients in our hospital from January 2012 to December 2016 were retrospectively analyzed.Based on whether they survived within 30 days of surgery, patients were divided into the death group and the survival group.Differences in age, gender, comorbidities, timing of operation and fixation mode between the two groups were compared.Univariate analysis was conducted to detect significant factors, and Logistic regression analysis were performed to identify independent risk factors for 30-day mortality after operation.Results:A total of 1350 elderly hip fracture patients were treated in our hospital, and 1004 cases met the inclusion criteria.Forty-three cases(4.28%)died within 30 days of operation.Univariate analysis showed that, compared with the survival group, the death group had a higher average age, a higher white blood cell count, lower hemoglobin and albumin levels, higher proportions of patients with arrhythmia, more pulmonary infections, higher cardiac insufficiency and more people with ≥4 comorbidities.Multivariate Logistic analysis showed that arrhythmia( OR=2.36, P=0.038), pulmonary infection( OR=2.50, P=0.020), cardiac insufficiency( OR=3.15, P=0.016), high white blood cell count( OR=1.14, P=0.006), and low albumin( OR=1.08, P=0.037)were independent risk factors for increased mortality within 30 days of operation. Conclusions:The 30-day mortality rate is high in elderly hip fracture patients.Arrhythmia, pulmonary infection, cardiac insufficiency, high white blood cell count, and low albumin level are independent risk factors for mortality in elderly hip fracture patients.

Enhanced production of bacitracin via energy metabolism engineering in Bacillus licheniformis DW2 / 生物工程学报

Bacitracin is a broad-spectrum cyclic peptide antibiotic, and mainly produced by Bacillus. Energy metabolism plays as a critical role in high-level production of target metabolites. In this study, Bacillus licheniformis DW2, an industrial strain for bacitracin production, was served as the original strain. First, our results confirmed that elimination of cytochrome bd oxidase branch via deleting gene cydB benefited bacitracin synthesis. Bacitracin titer and ATP content were increased by 10.97% and 22.96%, compared with those of original strain, respectively. Then, strengthening cytochrome aa3 oxidase branch via overexpressing gene qoxA was conducive to bacitracin production. Bacitracin titer and ATP content were increased by 18.97% and 34.00%, respectively. In addition, strengthening ADP synthesis supply is also proven as an effective strategy to promote intracellular ATP accumulation, overexpression of adenosine kinase DcK and adenylate kinase AdK could all improve bacitracin titers, among which, dck overexpression strain showed the better performance, and bacitracin titer was increased by 16.78%. Based on the above individual methods, a method of combining the deletion of gene cydB and overexpression of genes qoxA, dck were used to enhance ATP content of cells to 39.54 nmol/L, increased by 49.32% compared to original strain, and bacitracin titer produced by the final strain DW2-CQD (DW2ΔcydB::qoxA::dck) was 954.25 U/mL, increased by 21.66%. The bacitracin titer produced per cell was 2.11 U/CFU, increased by 11.05%. Collectively, this study demonstrates that improving ATP content was an efficient strategy to improve bacitracin production, and a promising strain B. licheniformis DW2-CQD was attained for industrial production of bacitracin.

CT perfusion evaluation before and after revascularization in adult patients with Moyamoya disease / 国际脑血管病杂志

Objective To investigate the application value of CT perfusion (CTP) imaging for the revascularization treatment in adult patients with Moyamoya disease.Methods Adult patients with Moyamoya disease underwent revascularization in the Department of Neurosurgery,Wuhan No.1 Hospital from July 2009 to December 2016 were analyzed retrospectively.CTP and clinical evaluation were performed before and after 3-6 months of procedure.The modified Rankin Scale (mRS) was used to assess the functional outcomes.Results A total of 20 patients were enrolled in the study,including 9 females and 11 males,aged 29 to 73 years,with an average of 53.5 years.The initial symptom was ischemic stroke in 10 patients,transient isehemic attack in 7 patients,and hemorrhagic stroke in 3 patients.All patients underwent superficial temporal artery-middle cerebral artery bypass grafting plus encephalomyo-synangiosis under general anesthesia.All patients have different degrees of improvement in cerebral blood flow after procedure,and the CTP parameters were significantly improved compared with those before procedure (all P ＜0.05).The clinical symptoms were significantly improved in 3 cases (15％) and recovered in 13 cases (65％) at 6 months after procedure.The proportion of the mRS score 0-2 was significantly higher than that before procedure (90.0％ [18/20] 对 50.0％ [10/20];x2 =7.619,P =0.006).Conclusion CTP can evaluate the cerebral perfusion status in various vascular areas through hemodynamic parameters in early stage,which can effectively guide the operation mode of Moyamoya disease,and evaluate the changes of cerebral perfusion status after procedure as a means of follow-up of the disease.

Investigation on physical activity and occupational stress among street office staffs of a city in China / 中华劳动卫生职业病杂志

Objective@#To investigate the relationship between physical activity (PA) and occupational stress(OS) among street office staffs of a city in china.@*Methods@#A total of 504 street office staffs were collected by using stratified cluster sampling method from April to June in 2016, the international physical activity questionnaire(IPAQ) and job content questionnaire(JCQ) were used to survey the PA and OS.@*Results@#In all subjects, the average score of job demand was(3.57±0.83), job decision was(2.71±0.63), social support was (2.79±0.79), demand-control ratio was (1.35±0.47) and 75.60% felt OS in self-evaluation. There were significant differences in OS between subjects with different gender, ages, job rank and job hours (P<0.01), also, there were significant differences in OS between different levels of occupational and leisure related PA (P<0.01). After controlling the potentially confounding effects, compared with low PA group, the OR values of medium-level and high-level groups of occupation-related PA were 1.38(95%CI=1.21~1.94) and 2.21(95%CI=2.06~2.67) respectively, however, the OR values of the medium-level and high-level groups of leisure-related PA were 0.89(95%CI=0.73~1.12) and 0.67(95%CI=0.38~0.96) respectively.@*Conclusion@#Street office staffs have high level of OS, and leisure-related PA may be a protective factor for occupational stress.

Outcome analysis of hip fracture surgery in patients aged 90 and over / 中华老年医学杂志

Objective To investigate the outcomes of hip fracture surgery in patients aged 90 and over. Methods Clinical data of patients aged 90 years and over admitted to our hospital from January 2012 to December 2016 were collected. The data included age ,gender ,comorbidities ,type of fracture , timing of surgery , operation method , complications , mortality , and functional outcomes.Differences in these items were compared between patients who died one year after surgery and those who survived.Independent risk factors for one-year mortality were analyzed. Results A total of 101 patients who met the inclusion criteria were enrolled in the study. There were 43 males and 58 females ,with a mean age of (92.3 ± 2.7)years ;66 cases had intertrochanteric fractures and 35 cases had femoral neck fractures ;in 45 cases patients could walk independently and in 56 cases walking aids were needed before operation. The mortalities at 30 days ,6 months ,and 1 year post-operation were 8.9% (9 cases ) ,16.8% (17 cases ) ,and 26.7% (27 cases ) ,respectively. Pulmonary infection and malnutrition were the main causes of death. Ambulation with walking aids was an independent risk factor for 1-year mortality (OR=7.298 ,P=0.020). Conclusions Surgery for the treatment of hip fractures in patients aged 90 and over is appropriate. Poor preinjury mobility is an independent risk factor for mortality after operation. The main causes of death are pulmonary infection and malnutrition ,and frailty plays an important role in this process.

Enhanced production of bacitracin by knocking out of amino acid permease gene yhdG in Bacillus licheniformis DW2 / 生物工程学报

Bacitracin is a broad-spectrum polypeptide antibiotic, which is formed by 11 amino acids residues. Precursor amino acids supply might be the limit factor during bacitracin fermentation. First, our results demonstrated that increasing Ile and Leu supplies were regarded as the efficient strategies for the enhanced titer of bacitracin. Then, the amino acid permease YhdG, which was identified as the BCAA permease, was deleted and overexpressed in DW2, respectively. Our results showed that knocking out of permease YhdG could improve bacitracin production remarkablely. The bacitracin titer of the yhdG deficient strain DW2ΔyhdG reached 917.35 U/mL by flask fermentation, increased by 11% compared with that of DW2. In addition, the bacitracin titer was decreased by 25% in the YhdG overexpressed strain. Meanwhile, the intracellular concentrations of BCAA were higher than DW2 during the biosynthesis of bacitracin. The above results suggested that the permease YhdG might act as an exporter for branched chain amino acids in B. licheniformis DW2. Taken together, the increasing intracellular concentrations of branched chain amino acids by deleting amino acid permease YhdG could improve bacitracin titer. This study provided a new strategy for high-level production of bacitracin.

The reverse island flap pedicled with the dorsoulnar artery of the thumb for skin coverage of the thumb tip / 中华显微外科杂志

Objective To explore the operative methods and clinical effects of the reverse island flap pedi-cled with the dorsoulnar artery of the thumb for skin coverage of the thumb tip. Methods From February, 2013 to July, 2016, there were 11 cases of thumb tip defect distal to the superior nail fold who were treated with reverse dor-soulnar island flap, which was located on the dorsoulnar side of proximal thumb, and rotated with a 2 mm-wide pedi-cle at the dorsal arcade of the proximal nail fold. The skin over the rotated pedicle was sutured tensionless and the donor site was sutured directly. Postoperative follow-up was done termly. Results All 11 flaps survived eventually, and 9 cases were followed-up with a period of 3-38 months. Benefitting from the fair colored, well textured, plump but not bulky flap, the restored thumb had a satisfactory figure. The thumb also had good algesthesia and thalposis togeth-er with the flap. The thumb had a nearly normal ROM of interphalangeal joint and metacarpophalangeal joint, and opening angle of first web compared with the contralateral side. Conclusion The reverse island flap of dorsoulnar thumb, which is nourished with a constant vessel, is easily harvested and reliable. The flap can be used to repair the small skin defect of the thumb tip with a good result and few complication.

Association of Toll-like receptor 2 and 4 gene polymorphisms with risk of coronary atherosclerotic artery disease in Hunan Han population / 中南大学学报(医学版)

Objective:To explore Toll-like receptor 2 (TLR2) and TLR4 polymorphism in Han people from Hunan region and its association with coronary atherosclerotic heart disease.Methods:Sanger sequence and statistical analysis were performed to identify the polymorphism of TLR2 and TLR4 genes in 347 unrelated Hunan Han subjects,including 180 healthy people (control group) and 167 patients with coronary atherosclerotic heart disease (coronary atherosclerotic heart disease group).Results:There was no significant difference in the genotype frequency and allelic frequency for TLR2 SNP2258G＞A and TLR4 SNP896A＞G between the 2 groups (P＞0.05),while there was significant difference in the TLR4 SNP1196C＞T between the 2 groups (P＜0.05).Conclusion:TLR4 SNP 1196C ＞T polymorphism is associated with coronary atherosclerotic heart disease in Chinese Han populationin in Hunan region.

Sodium humate accelerates cutaneous wound healing by activating TGF-β/Smads signaling pathway in rats

Sodium humate (HA-Na) has been topically used as a wound healing and anti-inflammatory agent in folk medicine. In the present study, HA-Na was investigated for cutaneous wound healing in Sprague-Dawley rats. HA-Na solution (1.0%, w/v) was topically administered to rats undergoing excision wound models. Healing was assessed with a recombinant bovine basic fibroblast growth factor for external use as positive control. Wound healing rates were calculated on Day 3, 6, 9, 14 and 21 after injury, and tissues were also harvested after the same intervals for histological analysis. In addition, tissue hydroxyproline levels were measured. Furthermore, mRNA levels and protein expressions of transforming growth factor-β1, 2, 3 (TGF-β1, 2, 3) were determined by RT-PCR and western blot. Protein expression levels of Smad-2, -3, -4 and -7 were also detected by western blot. Our study demonstrates that HA-Na has the capacity to promote wound healing in rats via accelerated wound contraction and increased hydroxyproline content. More importantly, these wound healing effects of HA-Na might be mediated through the TGF-β/Smad signaling pathway. HA-Na may be an effective agent for enhanced wound healing.

Influence of beraprost on coagulation and neurological function in patients with acute cerebral infarction / 中国生化药物杂志

Objective To study the effect of blood coagulation function and nerve function of beraprost in the treatment of acute cerebral infarction.Methods 80 cases of acute cerebral infarction were randomly divided into 2 groups, 40 cases in the control group and 40 cases in the experiment group.The control group received routine treatment, the experiment group were treated with the same as the control group combined with beraprost.Changes of coagulation function and nerve function were compared pre-and post-treatment between two groups.Results Compared with pre-treatment, APTT, PT, Fib level, serum NGF level, Barthel score increased post-treatment of the two groups, D-D, serum NSE, S100b, NIHSS score decreased, compared with the control group, APTT, PT, Fib level, serum NGF level, Barthel score were higher in the experiment group, the total effective rate was higher than the control group, two D-D, serum NSE, S100β, NIHSS scores were lower than the control group, the differences were statistically significant (P<0.05).Conclusion Beraprost can reduce the high coagulation state in patients with acute cerebral infarction, improve the degree of neurological impairment, and has good clinical efficacy.