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Objective:To construct Doctor-Nurse-Patient shared decision-making framwork for breast cancer surgery patients, so as to provide a foundation for clinical practice.Methods:The content of the shared decision-making framwork were initially constructed through systematic literature search and group discussion. From March to May 2021, 24 experts were consulted by the Delphi method, and the weight of each element would be determined by the analytic hierarchy process.Results:A total of 2 rounds of expert letter questionnaires were implemented. The authority coefficient of the experts in this study was 0.832, the Kendall coefficient of the experts in the first round was 0.130-0.261 ( P<0.01), and the Kendall coefficient of the experts in the second round was 0.130-0.272 ( P<0.01). The final shared decision-making framwork includes 5 first-level indicators, 15 second-level indicators and 52 third-level indicators. Conclusions:The Doctor-Nurse-Patient shared decision-making framwork of breast cancer surgery patients constructed in this study is scientific and practical, and provides a reference for clinical practice of shared decision-making in the future.
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Objective:To report four male COL4A5 mutation mosaicism patients with X-linked Alport syndrome, and to provide evidence for diagnosis, genetic counseling, and reproduction in the respective families and improve our knowledge of mosaicism in Alport syndrome. Methods:Suspected male mosaic patients for COL4A5 who met the following criteria: clinical diagnosis of Alport syndrome, harbored COL4A5 mutations detected using next generation sequencing or Sanger sequencing, heterozygosity for the mutant and normal COL4A5 alleles in the DNA demonstrated by Sanger sequencing, registered in the on-line registry of hereditary kidney diseases, and admitted to Peking University First Hospital during the period of April 2018 to April 2019 were enrolled. Clinical data and karyotypes were retrospectively analyzed. Genetic DNA isolated from multiple tissues was analyzed for COL4A5 gene mutations by using PCR and Sanger sequencing. Related literatures published in PubMed, CNKI and Wanfang databases were reviewed. Results:Four COL4A5 somatic and germline mosaic male patients with Alport syndrome were included in the study. Patient 1 was characterized by hematuria and proteinuria. His karyotype of peripheral blood was normal. COL4A5 c.3455-1G>A mosaicism was detected in multiple tissues (peripheral blood, saliva and urine). Patient 2 presented with hematuria and microalbuminuria. His karyotype of peripheral blood was normal. COL4A5 c.4994+1G>A mosaicism was detected in multiple tissues (peripheral blood, saliva and skin fibroblasts). Patients 3 showed hematuria without proteinuria. COL4A5 c.3535G>A mosaicism was found in genomic DNA of peripheral blood and hair. Laboratory and physical examinations of patient 4 showed hematuria and normal renal function, without proteinuria, megasoma or small testes. COL4A5 c.3106G>A mosaicism was detected in genomic DNA of skin fibroblasts. Although without karyotype analysis due to unavailable specimens, 47,XXY or 46,XY/47,XXY mosaicism was not considered according to the reproductive history and lack of clinical manifestations of megasoma and small testes in patients 3 and 4. Renal disease in 8 published male cases with mosaicism for COL4A5 was affected by mutant allelic fractions and genotype. Conclusions:Compared with hemizygous males with X-linked Alport syndrome, the renal phenotype of mosaic males was milder, and associated with mutant allelic fractions and mutation type.
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Objective:To investigate the effect of fluid resuscitation and circulatory support, directed by different target mean arterial pressure (MAP), on abdominal blood flow, gastrointestinal function and inflammatory response in septic shock patients with hypertension.Methods:A prospective randomized controlled study was conducted. Hypertensive patients with septic shock admitted to the department of intensive care unit (ICU) of Liuzhou People's Hospital from January 1, 2019 to May 31, 2020 were enrolled. Patients were randomly divided into the low MAP groups (low standard group, LS group) or high MAP group (high standard group, HS group). According to the Surviving Sepsis Campaign Guidelines in 2016 and the updated guideline in 2018, all patients were given treatment of primary disease, fluid resuscitation, supportive management. The target MAP was 65-70 mmHg (1 mmHg = 0.133 kPa) in LS group, and was 75-80 mmHg in HS group. Acute gastrointestinal function injury (AGI) classification was performed on the 1st, 3rd and 7th day. The mean flow rate (Vm) and resistance index (RI) of superior mesenteric artery were evaluated using ultrasound, and the gastrointestinal function was dynamically evaluated using the modified single section ultrasonic gastric antrum method. The gastric antrum movement index (MI) and gastric empaging time (GET) were recorded. The levels of inflammatory markers in serum were detected by enzyme linked immunosorbent assay (ELISA), such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT) and vascular endothelial growth factor (VEGF). The target MAP, the days of use of vasopressors and the amount of fluid resuscitation were recorded.Results:A total of 208 hypertensive patients with septic shock were enrolled, including 109 in the LS group and 99 in the HS group. There were no significant differences in gender, age, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score between the two groups when diagnosed. After treatment, there was no significant difference in AGI classification between the LS group and HS group on the 1st day. On the 3rd and 7th day, there were statistical differences between the two groups (3rd day: proportion of Ⅰ, Ⅱ, Ⅲ, Ⅳ grades were 25.69%, 56.88%, 11.93%, 5.50% in LS group, 15.15%, 54.55%, 25.25%, 5.05% in HS group, respectively, χ 2 = 7.900, P = 0.048; 7rd day: proportion of Ⅰ, Ⅱ, Ⅲ, Ⅳ grades were 44.96%, 49.54%, 3.67%, 1.83% in LS group, 31.31%, 52.53%, 11.11%, 5.05% in HS group, respectively, χ 2 = 8.178, P = 0.042). The Vm of superior mesenteric artery was higher and the RI was lower in the LS group than those in the HS group on day 1, 3 and 7 [Vm (cm/s): 21.72±3.02 vs. 19.50±2.83, 20.42±2.62 vs. 17.02±1.99, 26.52±2.70 vs. 22.47±4.03; RI: 0.86±0.05 vs. 0.92±0.04, 0.87±0.05 vs. 0.95±0.05, 0.81±0.03 vs. 0.85±0.03, all P < 0.01]. The MI was higher and the GET was shorter in the LS group than those in the HS group on day 3 and day 7 [MI: 3.00±0.33 vs. 2.60±0.29, 4.50±0.51 vs. 3.90±0.33; GET (minutes): 86.01±19.78 vs. 100.99±25.01, 71.00±16.37 vs. 84.98±20.18, all P < 0.01]. In addition, the levels of serum TNF-α, IL-6, PCT, VEGF were lower in the LS group than those in the HS group after 3 days of treatment [TNF-α (ng/L): 147.05±28.32 vs. 256.99±27.04, IL-6 (ng/L): 762.99±57.83 vs. 1 112.30±118.32, PCT (μg/L): 37.00±5.58 vs. 56.00±12.36, VEGF (ng/L): 123.00±19.78 vs. 167.01±21.55, all P < 0.05]. The target MAP was maintained at (68.02±4.71) mmHg in LS group, and (79.04±3.04) mmHg in HS group. The difference between the two groups was statistically significant ( P < 0.01). Compared with the HS group, the days of using vasopressors was shorter in LS group (days: 3.50±1.27 vs. 4.55±1.47), and the amountof fluid was reduced significantly (mL: 1 602.29±275.49 vs. 2 000.30±272.59, both P < 0.01). Conclusion:Maintaining a low target mean arterial pressure (65-70 mmHg) in hypertensive patients with septic shock can improve blood supply of superior mesenteric artery, protect the gastrointestinal function, reduce the level of inflammatory factors, and diminish the duration of using vasopressors and the amount of fluid.
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Taking the Department of Obstetrics and Gynecology as an example, this paper expounds a series of practices of online education, in the process from pre-course training, platform selection, curriculum design, to student evaluation, etc. From that, we can provide a reference for carrying out online teaching in response to the epidemic for clinical medical colleges which have not been exposed to the online course. Furthermore, it is a new attempt to explore a way to make a change of the traditional teaching method and deepen the reform of clinical teaching in our hospital after the epidemic, not only in professional medical education, but also in the popularization of medical knowledge.
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Objective:To study the status and influencing factors of fertility anxiety in breast cancer patients, and analyze the relationship between social support and fertility anxiety and the mediating role of psychological resilience.Methods:From January to May, 2020, 120 young breast cancer patients were investigated by the Cancer Reproductive Anxiety Scale, the Perceived Social Support Scale, and the Self-Resilience Scale and analyze the relationship of psychological resilience, social support with fertility anxiety, as well as the mediating role of psychological resilience among them.Results:Social support, psychological resilience were significantly negatively related to fertility anxiety and all dimensions ( r value was -0.428 to -0.126, P<0.05).Social support had negative predicting effect on fertility anxiety ( β value was -0.386, P<0.001). Psychological resilience of breast cancer patients had a partial mediating role between social support and fertility anxiety, accounting for the 35.8% of the total effect. Conclusions:Psychological resilience plays an important role in alleviating the fertility anxiety of breast cancer patients. Enhancing the psychological elasticity of breast cancer patients is an effective way to alleviate the anxiety of breast cancer patients.
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Objective:To investigate the effect of cyclin D1 (CCND1) negatively regulated by miRNA-541 (miR-541-5p) on the proliferation and migration of colon cancer cells as well as its related mechanism.Methods:Expression levels of miR-541-5p in colon cancer cell lines HT29, SW480, SW620, HCT116 and enterocyte line HIEC of the normal people as well as cancer tissues and pericarcinomatous normal tissues of 112 patients undergoing the colon cancer surgery from the First Affiliated Hospital of Hebei North University between April 2017 and March 2020 were detected by using quantitative real-time polymerase chain reaction(qRT-PCR). The potential target gene of miR-541-5p was predicted by using TargetScan, and was verified by using dual luciferase reporter gene assay, qRT-PCR and Western blot. Expression level of CCND1 was detected in colon cancer cell lines and tissues. Cells with the lowest expression level of miR-541-5p were divided into miR-NC group (the transfected control plasmid), miR-541-5p group (the transfected miR-541-5p mimics), miR-541-5p+CCND1 group (the co-transfected miR-541-5p mimics and CCND1). Effect of miR-541-5p and CCND1 on proliferation and migration ability of colon cancer cells was detected by using cell counting kit-8 (CCK8) and Transwell method. The xenograft model of colon cancer in nude mice was constructed to observe the effect of miR-541-5p on tumor growth.Results:The relative expression level of miR-541-5p in colon cancer tissues was lower than that in pericarcinomatous normal tissues (0.45±0.06 vs. 1.00±0.12, t = 43.385, P < 0.01). The relative expression level of miR-541-5p was 0.46±0.03, 0.67±0.04, 0.57±0.06, 0.17±0.02, 1.00±0.15, respectively in colon cancer cell lines HT29, SW480, SW620, HCT116 and enterocyte line HIEC of the normal people, and the difference was statistiacally significant ( F = 5.621, P < 0.01); the relative expression level of miR-541-5p in all colon cancer cell lines was lower than that in enterocyte line HIEC of the normal people. HCT116 cells were selected to make the subsequent experiments. The predicted results of TargetScan showed that 3'UTR of CCND1 might have sites complementary to those of miR-541-5p. Dual luciferase reporter gene assay showed that CCND1 was the target gene of miR-541-5p, and miR-541-5p negatively regulated the expression of CCND1. CCK-8 method showed that cell proliferation rate of HCT116 was (2.00±0.16)%, (0.89±0.08)%, (2.56±0.23)%, respectively in miR-NC group, miR-541-5p group, miR-541-5p+CCND1 group, and the difference was statistically significant ( F = 6.715, P < 0.01); among HCT116 cells with the overexpression of miR-541-5p, the transfected CCND1 chould reverse the inhibitory effect of miR-541-5p on cell proliferation. Transwell results showed that the overexpression of miR-541-5p inhibited the cell migration ability of HCT116, while the co-transfection of miR-541-5p mimics and CCND1 could reverse the inhibitory effect. In the colon cancer nude mice xenograft model, the tumor mass and size of nude mice in miR-541-5p group was decreased compared with that in the control group (all P < 0.05). Conclusions:miR-541-5p inhibits cell proliferation and migration of colon cancer cells via negatively regulating CCND1, and inhibits tumor growth in xenograft model of colon cancer in nude mice, thereby acting as a tumor suppressor in colon cancer.
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Objective:To observe the effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO)combined with prone position ventilation (PPV) on oxygenation index (PaO 2/FiO 2), respiratory compliance (Crs) and vasoactive inotropic score (VIS) in severe acute respiratory distress syndrome (ARDS) patients. Methods:Eighteen patients with severe ARDS requiring VV-ECMO support in Liuzhou People's Hospital from June 2018 to April 2020 were selected for retrospective analysis, and 8 patients among of these cases received PPV after VV-ECMO. The differences in PaO 2/FiO 2, VIS and Crs before and 1, 2 or 3 days after treatment were compared between VV-ECMO group and VV-ECMO combined with PPV group, as well as the differences in these indices before PPV and 2 hours after PPV daily in VV-ECMO combined with PPV group. The incidence of adverse events in two groups were also observed. Results:Before treatment, there was no significant difference in PaO 2/FiO 2, Crs between two groups. Over time, PaO 2/FiO 2 and Crs increased and VIS decreased in both groups. Compared with before treatment, there were statistically significant differences in PaO 2/FiO 2 and VIS from 1 day after treatment [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): VV-ECMO group was 197.75±39.80 vs. 75.57±7.44, VV-ECMO combined with PPV group was 255.20±31.92 vs. 68.24±11.64; VIS: VV-ECMO group was 5.51±3.72 vs. 10.20±7.10, VV-ECMO combined with PPV group was 6.73±3.32 vs. 14.50±2.48, all P < 0.05], up to 3 days after treatment [PaO 2/FiO 2 (mmHg): VV-ECMO group was 231.96±32.76 vs. 75.57±7.44, VV-ECMO combined with PPV group was 285.61±19.40 vs. 68.24±11.64; VIS: VV-ECMO group was 2.26±1.90 vs. 10.20±7.10, VV-ECMO combined with PPV group was 2.13±1.55 vs. 14.50±2.48, all P < 0.05], and the PaO 2/FiO 2 1 day and 3 days after treatment in VV-ECMO combined with PPV group were significantly higher than those in VV-ECMO group (mmHg: after 1 day of treatment was 255.20±31.92 vs. 197.75±39.80, after 3 days of treatment was 285.61±19.40 vs. 231.96±32.76, both P < 0.05). Before treatment, Crs of VV-ECMO combined with PPV group was significantly lower than that of VV-ECMO group (mL/cmH 2O: 17.91±0.82 vs. 20.54±1.26, P < 0.05). From 1 day after treatment, the Crs in VV-ECMO combined with PPV group was significantly higher than that before treatment (mL/cmH 2O: 21.20±1.50 vs. 17.91±0.82), the peak value was (24.93±2.18) mL/cmH 2O on 3 days after treatment, however, there was no significant difference between the two groups (all P > 0.05). In VV-ECMO combined with PPV group, compared with before PPV treatment, the PaO 2/FiO 2 and Crs of 2 hours after PPV treatment in 1, 2 and 3 days were significantly rose, and it reached the highest level in 3 days [PaO 2/FiO 2(mmHg): 285.61±19.40 vs. 189.91±28.34, Crs (mL/cmH 2O): 24.93±2.18 vs. 23.35±1.45, both P < 0.05]; the VIS was only increased in 2 hours after PPV treatment on the first day than before (6.73±3.32 vs. 6.38±3.22, P < 0.05). There were no related serious adverse events happened after PPV treatment. Conclusions:The combination of PPV during VV-ECMO could further increase PaO 2/FiO 2, improve hypoxemia and implement further protective lung ventilation to reduce the potential hazards during mechanical ventilation. In addition, no serious adverse events were observed in this study, suggesting PPV is safe during VV-ECMO.
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Objective:This article explored the experience of nursing care for patients receiving acellular bovine pericardium with implant based breast reconstruction.Methods:A total of 100 cases from February 2017 to March 2019 were retrospectively analyzed. Preoperative use AIDS decision-making to reduce the decision-conflict of patients, and correctly assess the risk factors and aesthetic needs of patients, to assist the selection of appropriate prosthesis. Intraoperative use of antibiotics immersion prosthesis and mesh to prevent infection, and follow the principle of no contact; Postoperative attention should be paid to breast reconstruction, skin observation and catheter care, to avoid infection, skin necrosis and seroma and other complications. And for patients to develop a detailed discharge plan, do a good job of continuing care.Results:Of the 100 patients in this group, local skin necrosis occured in 1 patient, 1 had nipple necrosis, 1 had "red breast" syndrome and 2 had infection.All 100 patients successfully completed the surgery, with high satisfaction for breast reconstruction. The follow-up time ranged from 3 to 21 months, among which the score of breast satisfaction was 96.63 (on a 100-point scale), and the score of patients′ satisfaction with the medical team was 98.78.Conclusions:Careful perioperative nursing can reduce the incidence of related complications, make patients correctly predict the outcome of surgery, and improve the success rate of mesh and prosthesis implantation.
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Background: MicroRNAs (miRNAs) are considered as new biomarkers related to cancer treatment. Studies have shown that miR-760 plays an important role in the development of colorectal cancer. Aims: To investigate the regulatory effect and mechanism of miR-760 on proliferation, cycle, migration and invasion of colon cancer cells. Methods: qRT-PCR was used to detect the expression of miR-760 in colon cancer tissue and colon cancer cell lines HCT116, HT29, SW480 and SW620. The targeted relationship between miR-760 and STIM1 was verified by dual luciferase reporter gene test. Expression of STIM1 in colon cancer cells and tissue was detected by Western blotting and immunohistochemistry, respectively. CCK-8 assay was used to detect cell proliferation ability, flow cytometry was used to detect cell cycle, and Transwell assay was used to detect cell migration and invasion. The xenograft model of colon cancer in nude mice was constructed, and the effect of miR-760 on tumor growth was measured. Results: Expression of miR-760 was significantly decreased in colon cancer tissue and colon cancer cells, while expression of STIM1 was significantly increased in colon cancer tissue and colon cancer cells. MiR-760 inhibited expression of STIM1 by complementary binding to the 3'-UTR of STIM1. Overexpression of miR-760 inhibited colon cancer cell proliferation, S-phase arrest, migration and invasion, and up-regulation of STIM1 reversed the inhibitory effect. In the xenograft model of colon cancer in nude mice, overexpression of miR-760 down-regulated expression of STIM1 and inhibited tumor growth. Conclusions: MiR-760 is involved in the regulation of biological behavior of colon cancer cells by targeting STIM1, and plays a role in tumor inhibition of colon cancer.
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Objective To explore the safety,composition and effectiveness of bupivacaine in swelling fluid and to understand the safe use of the swelling fluids contained bupivacaine as local anesthetics in liposuction.Methods The liposuction was completed in 149 patients,aged 18-63 years with the swelling fluid contained bupivacaine in different proportions by negative pressure liposuction for exploring the method and safe use of the swelling fluid contained bupivacaine in general anesthesia.Results The dose range of bupivacaine at 1.14-1.87 mg/kg did not show toxicity.Bupivacaine combined with lidocaine as a part of swelling fluid was suitable for all range of liposuction in general anesthesia.There was no pain sensation first day after the operation.The pain was obvious on the day after surgery in lidocaine group.The advantage using bupivacaine as swelling fluid was that the postoperative recovery was fast,the healing was good,and the complications were few.Conclusions Bupivacaine as the main anesthetic agent for swelling fluid shows the advantages of long analgesic effect,good anesthetic effect,and no pain after operation.It is worth further application.
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Objective To detect the levels of procalcitonin in multiple genes autoinflammatory disease (adult Still disease,systemic juvenile idiopathic arthritis,crohn's Crohn's disease),and to explore the relationship between erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),ESR/CRP and disease or complicated infection combined disease.Methods One hundred and fifty-three patients were en-rolled,88 patients with multiple genes autoinflammatory disease,including 32 cases of adult Still disease,27 cases of systemic juvenile idiopathic arthritis,29 cases of Crohn's disease.In addition,30 cases of healthy controls,35 patients with systemic lupus erythematosus (SLE) were included into this study.Electroche-miluminescence was used to test the value of serum PCT,erythrocyte sedimentation rate was tested by blood sedimentation instrument method,the CRP level was tested by lmmunoturbidimetry,and the data was handed managed and analysised by matlab software and One-way analysis of variance (ANOVA) was used to compare the differences of PCTs between groups.Results ① In the non-infection condition,the PCT value of the autoimmune inflammatory diseases [(0.36±0.74) μg/L,95％confidence interval (CI) (0.174 9,0.550 9) μg/L)] was signifieantly higher than that of the healthy control group [(0.06±0.06) μg/L,95％CI (0.035 1,0.081 7 μg/L)],the difference was statistically significant (F=5.03,P=0.027 4),but there was no statistically significant (F=1.03,P=0.475 5) when comparing with SLE group.② The PCT level of the non-infected inflammatory enteric arthritis [(0.20±0.32),95％CI(0.042 7,0.364 3) μg/L] was different compared with the healthy group,the difference was statistically significant (F=5.77,P=0.020 4),at the same time,the difference was not statistically significant when comparing with the SLE group (F=0.22,P=0.647 6).When the PCT value in non-infected adults Still disease [(0.60±1.02) 95％CI(0.048 4,1.153 6) μg/L] compared with the healthy group,the difference was statistically significant (F=7.22,P=0.01) but the difference was not statistically different when compared with the SLE group (F=2.65,P=0.114 3).The PCT level difference was statistically significant (F=2.23,P＜0.01)when comparing infection-free juvenile idiopathic arthritis [(1.52±2.02) μg/L,95％CI(0.054 8,4.591 9) μg/L] and the healthy group,the difference was statistically significantly different (F=8.34,P=0.004 7) when compared with the PCT of the non-infected SLE group.③ In the case of autoinflammatory diseases without infection,the 95％CI of ESR/CRP ratio was between 1.121 2 and 3.589 4.In the case of co-infection,the 95％ CI of ESR/CRP ratio was between 1.502 2 and 8.718 8,so we considered autoimmune inflammatory diseases might had a high possibility of co-infection when the ESR/CRP ratio was higher than 3.5.Conclusion ① The multiple genes autoinflammatory disease group has a higher value of PCT level than healthy controls even without infection.② The mean and 95％CI range of PCT of the inflammatory bowel disease arthritis,adult Still disease and the juvenile id-iopathic arthritis is significantly higher than the healthy controls,partially higher than SLE group.In addition,the PCT level in the juvenile idiopathic arthritis is the highest.③ In clinical,to estimate whether the multiple genes autoinflammatory disease has bacterial infection,we can't just simply rely on PCT to estimate whether the multiple genes autoinflammatory disease has bacterial infection,we may consider the ratio of the ESR/CRP,when the value is higher than 3.5,we may consider patients has strong probability with infection.
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Objective To explore the application value of the pulse index continuous cardiac output monitoring technology (PICCO) in treating severe craniocerebral injury complicating neurogenic pulmonary edema(NPE).Methods Fifty-two cases of severe craniocerebral injury complicating NPE in the intensive care medicine department of this hospital were divided into the observation group and control group,26 cases in each group.The control group adopted the routine neurological treatment measures and guided the fluid infusion by monitoring the central venous pressure(CVP),while on the basis of the control group,the treatment group monitored the hemodynamics by PICCO and guided the fluid management according to the cardiac index(CI),extravascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),global end diastolic volume index(GEDVI) and intrathoracic blood volume index(ITBVI).The clinical curative effects,hemodynamic indexes,intracranial pressure(ICP),average daily infusion volume,mechanical ventilation time,hospital stay and GOS prognosis evaluation were compared between the two groups.Results The improvement of the heart rate(HR),mean arterial pressure (MAP),oxygenation index(PaO2/FiO2),ICP and other indicators in the observation group was more obvious than that in the control group(P＜0.05);the CVP rise in the control group was more obvious(P＜0.05);CI,EVLWI,PVPI,GEDVI and ITBVI in the observation group were improved and stabilized;the daily average infusion amount,mechanical ventilation time and hospital stay in the observation group were less than those in the control group(P＜0.05);but the good prognosis rate and mortality rate had no significant difference between the two groups(P＞0.05).Conclusion PICCO can better conduct the liquid management,improves the clinical symptoms,shortens the mechanical ventilation time and hospitalization stay,but the results show no significant improvement in prognosis and mortality.
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Corynebacterium glutamicum is the main industrial strain to produce L-valine by microbial fermentation. In this study, a low L-alanine producing C. glutamicum strain VWB-2 was constructed by knocking out the alanine aminotransferase encoding gene alaT in a high L-valine producing strain VWB-1. Meanwhile, a site-directed mutagenesis (ilvBN₁ (M13)) was done on the regulatory subunit of acetohydroxyacid synthase (ilvBN), a key enzyme in the L-valine synthesis pathway. Furthermore, the overexpression of the genes involved in the biosynthesis of L-valine, the mutated ilvBN₁ (M13), the acetohydroxy acid isomerase coding genes ilvC, the dihydroxy-acid dehydratase coding gene ilvD and branched-chain amino acid aminotransferase coding gene ilvE, could all promote the L-valine production of VWB-1 by strengthening the carbon flow towards L-valine. With the overexpression of the branched chain amino acid transporter coding gene brnFE and its regulator lrp₁, the L-valine producing capability of VWB-1 was further enhanced. The finally obtained engineered strain VWB-2/pEC-XK99E-ilvBN₁ (M13)CE-lrp₁-brnFE could produce 461.4 mmol/L L-valine in a 5 L fermentor with a sugar acid conversion rate of 0.312 g/g glucose.
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ABSTRACT:Objective To investigate the distributional characteristics of anaphylactogens in prurigo nodularis (PN)patients so as to provide clinical basis for selecting the method of allergy test.Methods We divided 262 PN patients into four groups and then used skin-prick (5 4 patients ),skin-patch (5 0 patients ),serum IgE allergen detection (56 patients)and serum IgG allergen detection (102 patients)to analyze anaphylactogen positive rate and their distribution differences in PN.Results For skin-prick test in 54 PN patients,the detection rates of platanus orientalis,artemisia argyi,poplar,dust mite,dirt mite,cod,peanut and tomato were higher than those in the control group (P<0.05 ).For skin-patch test in 50 PN patients,the detection rates of nickel sulfate,flavor compounds,black rubber,and carba mix were higher than those in the control group (P<0.05).For serum IgE test in 5 6 PN patients,the detection rates of house dust,scandent hop,cat/dog hair,bug,penicillium/neurospora and mutton were higher than those in the control group (P<0.05).For serum IgG test in 102 PN ones,the detection rates of crab,shrimp,beef and cod were higher than those in the control group (P<0.05).Conclusion Skin-prick test and serum IgE detection have high application values in PN patients.Serum IgG detection is of certain importance in adjusting PN patients’diet structure while skin-patch test applied in PN needs further exploration.
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Objective To explore the effects of fentanyl combined with ischemic post-processing on the pro-tein active concentration of superoside dismutase ( SOD) and the concentration of manlondialdehyde ( MDA) in rab-bits after myocardial ischemia and reperfusion injury.Methods The left anterior descending coronary artery were li-gated for 30 minutes and then reperfusion for 120 minutes to establish myocardial ischemia-reperfusion model of rab-bit.32 Japanese white rabbits were randomly divided into four groups by randomized block method(8 rabbits in each group):Sham-operated group(group S):seperate LAD without ligation;ischemia-reperfusion group(group I/R):re-store reperfusion directly;ischemic post conditioning group( group IPOC):restore reperfusion after ischemic post con-ditioning (filling for 30s/ischemia for 30s,three rounds);combination of fentanyl and ischemic post conditioning group( group F+IPOC):fentanyl post conditioning by ear marginal vein after ischemia 28 minutes,the dose was 5μg/kg, and after 30min,the rabbits was given ischemic post conditioning and then restored reperfusion.Then the differences in the protein active concentration of SOD and in the concentration of MDA were detected.Results The concentra-tion of MDA in the group F+IPOC were lower than that in the group IPOC[(3.52 ±0.45)mmol/mL vs (4.42 ± 0.47)mmol/mL,F =81.619,P <0.01].But the protein active concentration of SOD increased significantly [(178.38 ±20.32)U/mL vs (130.18 ±20.44)U/mL,F=59.359,P<0.01].Conclusion Fentanyl combined with ischemic post-processing can reduce the concentration of MDA and increase the protein active concentration of SOD significantly,which has the effect to decrease the myocardial ischemia and reperfusion injury.
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This study is to establish a paclitaxel [PTX]-resistant human cervical carcinoma HeLa cell line [HeLa/PTX] and to investigate its redox characteristics and the expression of taxol resistance gene 1 [Txr1]. HeLa cells were treated with PTX and effects of PTX on cell proliferation were detected through cell counting and the MTT assay. Levels of cellular reactive oxygen species [ROS], reduced glutathione [GSH], and oxidized glutathione [GSSG] as well as the ratio of GSH to GSSG were measured by the 2,7-difluorescein diacetate [DCFH-DA] method and the 5,5?-dithiobis[2- nitrobenzoic acid] [DTNB] method. Activities of superoxide dismutase [SOD], catalase [CAT], and glutathione peroxidase [GPx] were determined by the nitrite formation method, the molybdate colorimetric method, and the DTNB colorimetric method, respectively. The level of Txr1 mRNA was determined by real-time PCR. Compared with the regular HeLa cells, HeLa/PTX cells were larger in size and had more cytoplasmic granules. The population doubling time for HeLa/PTX cells was 1.32 times of that of HeLa cells [P < 0.01]. HeLa/PTX cells showed stronger resistance to PTX than HeLa cells with a resistance index of 122.69. HeLa/PTX cells had higher levels of ROS [P < 0.01] and Txr1 mRNA [P < 0.01], lower level of GSH [P < 0.05], and lower activities of SOD [P < 0.01] and GPx [P < 0.05] than HeLa cells. HeLa/PTX cells, with higher levels of ROS and Txr1 mRNA expression, are more resistant to PTX than HeLa cells
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The paper briefly introduces the judging points about description fully disclosed and claims supported bydescription.Problems about patent writing are analyzed combining with specific cases,and some guidlinesare provided for authors in universities and scientific research institutions.
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Objective To investigate the relationships of peripheral blood levels of interleukin 6 receptor (IL-6R),a disintegrin and metalloprotease with thrombospondin type 1 motifs (ADAMTS-1) and high sensitive C reactive protein (hs CRP) with Gensini score and Ambrose classification in patients with coronary heart disease,and to investigate the correlations of IL-6R,ADAMTS-1 and hsCRP levels with unstable coronary atherosclerotic plaques.Methods 328 patients undergoing coronary angiography were admitted,and 272 patients were diagnosed as coronary heart disease including 105 cases with acute myocardial infarction (AMI),126 cases with unstable angina peetoris (UA) and 41 cases with stable angina pectoris (SA).The 56 cases with no coronary artery stenosis were selected as control group.We detected the levels of IL-6R,ADAMTS 1 and hs-CRP in all patients,and then evaluated their Gensini scores by coronary angiography,and appraised the character of the plaque by Ambrose classification.Results The serum levels of IL 6R and ADAMTS-1 were higher in AMI and UA groups than in SA and normal control groups (all P＜0.05).The level of hsCRP was higher in AMI group than in UA,SA and control groups (all P＜0.05).The levels of IL-6R,ADAMTS 1 and hs-CRP were higher in complex lesion group evaluated by Ambrose classification than in simple lesion group and normal control group (all P＜0.05).ADAMTS-1 level was higher in simple lesion group than in normal control group (P＜0.05).The level of IL 6R was positively correlated with ADAMTS-1 levels (r=0.70,P＜0.05),while the serum IL-6R,ADAMTS-1 and hsCRP levels had no relationship with Gensini score in patients with coronary heart disease (all P＞ 0.05).Conclusions The IL-6R,ADAMTS-1 and hs-CRP levels can be the indexes for evaluating the plaque stability in patients with coronary heart disease,but have no relationships with the severity of coronary artery stenosis.
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Objective To observe the clinical effects of early use of neuromuscular blocking agents (NMBA) in patients with severe sepsis and acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.96 patients with severe sepsis and ARDS admitted from July 2012 to September 2013 to intensive care unit (ICU) of Liuzhou People's Hospital in Guangxi Zhuang Autonomous Region were enrolled and divided into severe ARDS group (n=48) and moderate ARDS group (n=48) according to the Berlin definition of ARDS.Then patients in each group were randomly divided into treatment group (n =24) and control group (n=24).All patients with diagnosis in accordance with the 2008 international septic shock and severe sepsis treatment guidelines were provided with comprehensive treatment and mechanical ventilation on the basis of analgesia and sedation.The patients in treatment group were given a loading dose of vecuronium during mechanical ventilation,started with 0.l mg/kg up to 0.05 mg ·kg 1 ·h 1 for continuous intravenous infusion for 24-48 hours.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA),arterial oxygenation index (PaOfFiO2),central venous oxygen saturation (ScvO2),arterial blood lactate (Lac),C-reactive protein (CRP) levels of two groups were compared before treatment and 48 hours after treatment,and 21-day mortality rate was finally compared.Results In moderate or severe ARDS group,there were no statistically significant difference in APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,Lac and CRP before treatment between two groups.APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,and Lac 48 hours after treatment were significantly improved in severe ARDS group compared with control group [APACHE Ⅱ score:16.58 ± 2.41 vs.19.79 ± 3.52,t=3.679,P=0.010; SOFA score:12.04 ± 2.17 vs.14.75 ±3.26,t=3.385,P=0.010; PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa):159.31 ±22.57 vs.131.81 ± 34.93,t=3.239,P=0.020; ScyO2:0.673 ± 0.068 vs.0.572 ± 0.142,t=3.137,P=0.030; Lac (mmol/L):3.10 ± 1.01 vs.4.39 ± 1.72,t=3.161,P=0.030],while the value of CRP (mg/L) showed no significant difference (180.91 ±37.14 vs.174.66 ± 38.46,t=0.572,P=0.570).21-day mortality in treatment group was significantly lower than that in control group [20.8％ (5/24) vs.50.0％ (12/24),x2=4.463,P=0.035].In moderate ARDS group,each of the above clinical parameters were improved in both groups expect for CRP at 48 hours after treatment,but the indexes showed no statistically significant difference between two groups (all P＞0.05).21-day mortality rate in the treatment group was slightly lower than that in the control group which showed no statistically significant difference [16.7％ (4/24) vs.25.0％(6/24),x2=0.505,P=0.477].Conclusion The early use of NMBA treatment of patients with severe sepsis and severe ARDS cannot only improve the severity but also reduce 21-day mortality.
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Objective To understand the clinical characteristics and correlative factors of ANCA-associated systemic vasculitis with interstitial lung disease.Methods Seventy-five AASV patients in Shanghai Renji Hospital from January 2010 to June 2013 were selected.The clinical data of those cases with interstitial lung disease were analyzed retrospectively and logistic regression model was applied to analyze the correlative factors.Results Of the 75 AASV patients,52％ were male,48％ were female,and the average age was (56±19) years.Forty-four cases were defined as interstitial lung disease.Among patients with interstitial lung dis-ease,31 (70％) cases were chronic onset,32(72％) cases had pulmonary infection and 8 (18％) cases died.The main chnical manifestations were dry cough,shortness of breath after labour and fever,the proportion was 68％,36％ and 50％ respectively.Irregular linear shadow was the main imagine changes,the rate was 55％.Pulmonary function changes varied in degrees with diffusion capacity reduction.Multivariate logistic regres-sion analysis showed that those who were older than 60 years (OR=3.44,95％CI:1.05-11.28),positive for MPO-ANCA (OR=3.7,95％CI:1.10-12.65) and Birmingham vasculitis activitv score higher than15 (OR=3.67,95％CI:1.21-11.15) were more likely to have interstitial lung disease.Conclusion Interstitial lung disease is one of the common pulmonary damages of ANCA-associated systemic vasculitis and it will lead to death because of respiratory failure or secondary pulmonary infection.Those who are elders,with positive MPO-ANCA,and with active disease are at high risk for interstitial lung disease among AASV patients.The results of this study sugest that clinicians should pay more attention to patients with these high risk factors.