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The typical hallmark of tumor evolution is metabolic dysregulation. In addition to secreting immunoregulatory metabolites, tumor cells and various immune cells display different metabolic pathways and plasticity. Harnessing the metabolic differences to reduce the tumor and immunosuppressive cells while enhancing the activity of positive immunoregulatory cells is a promising strategy. We develop a nanoplatform (CLCeMOF) based on cerium metal-organic framework (CeMOF) by lactate oxidase (LOX) modification and glutaminase inhibitor (CB839) loading. The cascade catalytic reactions induced by CLCeMOF generate reactive oxygen species "storm" to elicit immune responses. Meanwhile, LOX-mediated metabolite lactate exhaustion relieves the immunosuppressive tumor microenvironment, preparing the ground for intracellular regulation. Most noticeably, the immunometabolic checkpoint blockade therapy, as a result of glutamine antagonism, is exploited for overall cell mobilization. It is found that CLCeMOF inhibited glutamine metabolism-dependent cells (tumor cells, immunosuppressive cells, etc.), increased infiltration of dendritic cells, and especially reprogrammed CD8+ T lymphocytes with considerable metabolic flexibility toward a highly activated, long-lived, and memory-like phenotype. Such an idea intervenes both metabolite (lactate) and cellular metabolic pathway, which essentially alters overall cell fates toward the desired situation. Collectively, the metabolic intervention strategy is bound to break the evolutionary adaptability of tumors for reinforced immunotherapy.
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Type 2 diabetes mellitus (T2DM) therapy is facing the challenges of long-term medication and gradual destruction of pancreatic islet β-cells. Therefore, it is timely to develop oral prolonged action formulations to improve compliance, while restoring β-cells survival and function. Herein, we designed a simple nanoparticle with enhanced oral absorption and pancreas accumulation property, which combined apical sodium-dependent bile acid transporter-mediated intestinal uptake and lymphatic transportation. In this system, taurocholic acid (TCA) modified poly(lactic-co-glycolic acid) (PLGA) was employed to achieve pancreas location, hydroxychloroquine (HCQ) was loaded to execute therapeutic efficacy, and 1,2-dilauroyl-sn-glycero-3-phosphocholine (DLPC) was introduced as stabilizer together with synergist (PLGA-TCA/DLPC/HCQ). In vitro and in vivo results have proven that PLGA-TCA/DLPC/HCQ reversed the pancreatic islets damage and dysfunction, thus impeding hyperglycemia progression and restoring systemic glucose homeostasis via only once administration every day. In terms of mechanism PLGA-TCA/DLPC/HCQ ameliorated oxidative stress, remodeled the inflammatory pancreas microenvironment, and activated PI3K/AKT signaling pathway without obvious toxicity. This strategy not only provides an oral delivery platform for increasing absorption and pancreas targetability but also opens a new avenue for thorough T2DM treatment.
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Objective:To develop a risk prediction lineogram of neooperative atrial fibrillation in patients with esophageal cancer.Methods:The clinical data of 1 509 patients undergoing esophageal cancer surgery admitted to the department of esophageal surgery of our hospital from December 2019 to April 2022 were gathered, and they were divided into two layers according to whether they had new atrial fibrillation after surgery. In each layer, they were randomly divided into training set and test set in a ratio of 7∶3. In the training population, the multi-factor logistic regression method was used to establish the prediction model, and the line graph of the prediction model was drawn. The ROC curve and calibration curve were drawn to assess the differentiation ability and calibration ability of the prediction model. The test set population is used to validate the prediction model. Results:A total of 1 509 patients with esophageal cancer were included in the study, and the incidence of new atrial fibrillation after surgery was 247 patients(16.4%). A total of 1 039 patients(68.9%) were enrolled in the training set. The multivariate logistic regression model indicated that age, gender, BMI, pulmonary infection, the use of invasive ventilator, and the need for additional drainage of fluid accumulation were the influencing factors for new postoperative atrial fibrillation. The AUC of the training set prediction model under ROC curve was 0.775(95% CI: 0.737-0.812, P<0.001), indicating that the model has high predictive discrimination ability. Calibration curve and Hosmer- Lemeshow test results P=0.796, indicating that the model has good consistency of prediction ability. There were 470 subjects(31.1%) in the test set. The results showed that the AUC of the prediction model under the ROC curve was 0.773(95% CI: 0.719-0.826, P<0.001), indicating that the prediction model still has a high discriminative ability in the test set population. Conclusion:Patients with age, gender, BMI, pulmonary infection, the use of invasive ventilator, and the need for additional drainage of effusion are at higher risk of new atrial fibrillation after surgery. The timely prediction, prevention and management of POAF are crucial to improve the prognostic quality of postoperative patients with esophageal cancer by constructing clinical prediction models.
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Objective To compare the perioperative and recent efficacy of different mitral valve treatment strategies for mitral regurgitation caused by infective endocarditis. Methods From January 2009 to December 2014, 168 patients with mitral regurgitation caused by infective endocarditis underwent surgical treatment. Among them, mitral valve repair was performed in 65 patients (group A) and mitral valve replacement was performed in 103 patients (group B). Preoperative clinical profiles, perioperative details and follow-up data were reviewed retrospectively. Results There was no operative death in both groups. The cardiopulmonary bypass time and aorta clamp time were similar between the two groups. Intensive care stay was significantly shorter in group A [(1.4 ± 0.6) d] compared with group B [(1.9 ± 0.9) d](P＜0.05), and hospital stay had no significant difference between two groups (P＞0.05). Perioperative cerebral hemorrhage was observed in no patient in group A and 2 patients (1.9%) in group B. There was no in-hospital death in group A, and 2 patients (1.9%) in-hospital deaths occurred in group B. The difference was not statistically significant (P＞0.05). The incidence of heart-related adverse events in group A and group B was 6.2%(4/65) and 7.9%(8/101), and the incidence of infection related events was 0 and 3.0% (3/101) 3 years after operation (P＞0.05). Conclusions Mitral valve repair for patients with mitral regurgitation caused by infective endocarditis is safe and reliable, and the short-term effect is satisfactory. However, infection tissue should be eliminated thoroughly, and the related complications of valve replacement can be avoided and the risk of anticoagulation can be reduced.
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The Pricing and Payment Regulation on Chinese Diagnosis Related Groups (C-DRG) was designed by National Health Development Research Center,directly under the leadership of Department of Finance,NHFPC (formerly Dept.of Planning and Finance,Ministry of Health),which organized a large study group consisted of nearly 1 000 experts since 2010.It introduced the general design of C-DRG and the principles and main points of applying C-DRG system,which could be referenced by all countries in carrying out the pricing and payment reform system.
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Objective To investigate the influence of chronic pain on the sleep quality in the patients with Parkinson′s disease (PD) .Methods 232 cases of PD in the neurology department of this hospital from March 2009 to March 2013 were selected and di‐vided into the pain PD group (PPD group ,106 cases) and the non‐pain PD group (NPPD group ,126 cases) according to whether accompanying chronic pain .Contemporaneous 140 individual of healthy physical examination were selected as the control group .The Pittsburgh Sleep Quality Index Scale (PSQI) and the fatigue scale (FS‐14) were used to judge whether sleep disorders existing . Then the differences in the sleep quality and fatigue condition were compared among three groups .The related factors of sleeping disorders were also analyzed .Results The scores of PSQI and FS‐4 had statistically significant differences among 3 groups (P<0 .05) ,in which the differences in the aspects of sleep latency ,subjective sleep quality ,sleep continuity ,habitual sleep efficiency and sleep disorders also were statistically significant (P<0 .05) .The influencing factors of sleeping disorders were the Hoehn‐Yahr stage (r = -0 .79 ,P<0 .05) ,dopamine dose (r = -0 .38 ,P=0 .04) ,presence of pain (r = -0 .57 ,P<0 .05) and severity of de‐pression (r = -0 .63 ,P<0 .05) .Conclusion The PD patients accompanying pain are more susceptible to develop sleep disorders , the sleep quality accompanying pain is worse than that without accompanying pain .Therefore the early intervention should be well conducted in clinic .
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With the publish of National Medical Service Pricing Item Regulation(2012 edition), a new round of medical service items matching and pricing work across the country. Under the guidance of new pricing elements and pricing policy, to actively discuss on designing more scientific pricing method. Based on the field survey and qualitative interviews, several main pricing methods currently used in China were summarized to analyze the advantages and disadvantages of these methods.
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Teaching purpose, teaching content, experiment and examination forms etc. were discussed, and how to practice the teaching of the public selective course Nutriology of Traditional Chinese Medicine was pointed out. All these are invaluable experience for the development and progress of this course.
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Objective:Analysis of two ethnic Uygur and Han investigate ischemic stroke adiponectin (Adiponectin) gene single nucleotide rs182052 , rs6444175 , rs1501296 allele polymorphism point whether the differences.Methods:Gene sequencing methods were used to detect 210 was used cases of acute ischemic stroke patients ( case group ) and 104 healthy people ( control group ) Adiponectin gene ,using case-control association analysis of genotype and allele frequencies compared explore the two ethnic differences in different gene polymorphism loci.Results: When the case group and the control group were compared , it was found that the Adiponectin gene rs64441759G/A was significantly higher in the case group.The risk rate increased significantly to 1.481 times (OR=1.481;95%CI:1.219-1.910; P=0.000).Conclusion: Adiponectin gene rs6444175A allele may be susceptible to pathogenic gene.No significant differences show on the 3 SNP loci of Adiponectin genes between Uygur and Han patients.
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Through analyzing domestic medical service payment method and day surgery payment method in USA and Australia, combine the current domestic progress of day surgery and its main prevailing payment to explore the future day surgery payment system in China.
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The per-diem payment is a unit packaged payment used for the medical cost of hospitalization. At present some areas in our country explored the per-diem payment in hospitalization and have received obvious effect. The experiences of different areas carrying out the per-diem payment in our country were compared to find the strengths and weaknesses, and provide references for other areas.
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The combined use of chemometrics and chemiluminescence（CL）measurements,with the aid of the stopped-flow mixing technique,developed a simple time-resolved CL method for the simultaneous determination of captopril（CPL）and hydrochlorothiazide（HCT）.The stopped-flow technique in a continuous-flow system was employed in this work in order to emphasize the kinetic differences between the two analytes in cerium（IV）-rhodamine 6G CL system.After the flow was stopped,an initial rise of CL signal was observed for HCT standards,while a direct decay of CL signal was obtained for CPL standards.The mixed CL signal was monitored and recorded on the whole process of continuous-flow/stopped-flow,and the obtained data were processed by the chemometric approach of artificial neural network.The relative prediction error（RPE）of CPL and HCT was 5.9% and 8.7%,respectively.The recoveries of CPL and HCT in tablets were found to fall in the range between 95% and 106%.The proposed method was successfully applied to the simultaneous determination of CPL and HCT in a compound pharmaceutical formulation.
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The combined use of chemometrics and chemiluminescence (CL) measurements,with the aid of the stoppedflow mixing technique,developed a simple time-resolved CL method for the simultaneous determination of captopril (CPL) and hydrochlorothiazide (HCT).The stopped-flow technique in a continuous-flow system was employed in this work in order to emphasize the kinetic differences between the two analytes in cerium (Ⅳ)-rhodamine 6G CL system.After the flow was stopped,an initial rise of CL signal was observed for HCT standards,while a direct decay of CL signal was obtained for CPL standards.The mixed CL signal was monitored and recorded on the whole process of continuousflow/stopped-flow,and the obtained data were processed by the chemometric approach of artificial neural network.The relative prediction error (RPE) of CPL and HCT was 5.9％ and 8.7％,respectively.The recoveries of CPL and HCT in tablets were found to fall in the range between 95％ and 106％.The proposed method was successfully applied to the simultaneous determination of CPL and HCT in a compound pharmaceutical formulation.
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By means of field survey and expert consultation, the paper made a summary of the experiences learnt from medical aid in Wenchuan Earthquake, along with problems found. The summary and assessment covered the disaster-caused casualty and health among local residents, cost estimates for post-disaster medical aid, and targeted measures to improve medical aid plans. In addition, the authors proposed to emphasize the uniqueness of earthquake disasters and develop pre-plans in this regard, as well as such mid-and long-term plans for the promotion of disaster medicine, development of disaster medicine talents, upgrading of emergency medical rescue skills of medical staff, and volunteers management systems.
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Reform of the medical service payment system plays a key role in deepening the ongoing health reform.China will launch in a large scale the trials of the payment system for its betterment.The author probed deeply into the current compensation mechanism of public hospitals,as well as the inherent and theoretical roots of the negative outcomes resulting from the item-based payment system.On such basis,the paper discussed the nature of the public hospitals,and the theoretical basis for public hospitals' compensation system.In addition,the author discussed the reform principles and key points for reforming the payment system amid the ongoing health reform,proposing to link this reform with resolving major setbacks of the compensation mechanism of public hospitals.Objectives for the medical service payment system reform are advocated as follows: Cost control,management enhancement,mechanism shift,and win-win,which aim to deep reforms of the public hospitals.
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OBJECTIVE: To establish headspace capillary gas chromatography for the content determination of residual solvents in letrozole, such as chloroform, ethanol, acetone, ethyl acetate, DMF and isopropanol. METHODS: Dissolved in dimethyl sulfoxide, chloroform, ethanol, acetone, ethyl acetate, DMF and isopropanol in letrozole were determined by headspace gas chromatography with HP-5 capillary gas chromatography. ECD was applied for chloroform, while FID was applied for the other residual solvents. RESULTS: The liner ranges of chloroform, ethanol, acetone, ethyl acetate, DMF and isopropanol were 1.028～10.28 mg?L-1(r=0.999 9), 94.68～946.8 mg?L-1 (r=0.999 7), 94.64～946.4 mg?L-1(r=0.999 7), 110.64～1 106.4 mg?L-1(r=0.999 7), 15.12～151.2 mg?L-1(r=0.999 6), 116.48～1 164.8 mg?L-1(r=0.999 5), respectively. The average recoveries of the residual organic solvents ranged from 97% to 102%. The detection limits were 20～90 ?g?L-1. The residual levels of the six organic solvents in three batches of samples were all up to the standard stipulated in Chinese Pharmacopeia. CONCLUSIONS: The method is simple, sensitive, accurate and reliable for the content determination of residual organic solvents in letrozole.
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To conduct environmental education intervention for medical students,a survey of environmental protection and sustainable development-related knowledge,attitudes,behavior were conducted through questionnaire among the medical students to explore the impact of envi-ronmental quality with creation of environmental education curriculum and the appropriate way for institutions of higher medical education.
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Object To study the chemical constituents of Chamaenerion angustifolium (L ) Scop Methods The compounds were isolated on Diaion HP 20 (Tsk), Toyoperari HW 40 (C), MCI gel CHP 20P (Mitsubishi) column and their structures were identified by physiochemical properties and spectral methods Results Four flavonoids were isolated from the whole plant of C angustifolium and they were identified as quercetin 3 O ? D galactoside (Ⅰ), quercetin 3 O ? L arabinoside (Ⅱ), quercetin 3 O (6′ O galloyl) ? D galactoside (Ⅲ), quercetin (Ⅳ) respectively Conclusion Compounds Ⅰ, Ⅱ, Ⅲ were isolated from this plant for the first time