Identification of banana ADA1 gene family members and their expression profiles under biotic and abiotic stresses / 生物工程学报

The Spt-Ada-Gcn5-acetyltransferase (SAGA) is an ancillary transcription initiation complex which is highly conserved. The ADA1 (alteration/deficiency in activation 1, also called histone H2A functional interactor 1, HFI1) is a subunit in the core module of the SAGA protein complex. ADA1 plays an important role in plant growth and development as well as stress resistance. In this paper, we performed genome-wide identification of banana ADA1 gene family members based on banana genomic data, and analyzed the basic physicochemical properties, evolutionary relationships, selection pressure, promoter cis-acting elements, and its expression profiles under biotic and abiotic stresses. The results showed that there were 10, 6, and 7 family members in Musa acuminata, Musa balbisiana and Musa itinerans. The members were all unstable and hydrophilic proteins, and only contained the conservative SAGA-Tad1 domain. Both MaADA1 and MbADA1 have interactive relationship with Sgf11 (SAGA-associated factor 11) of core module in SAGA. Phylogenetic analysis revealed that banana ADA1 gene family members could be divided into 3 classes. The evolution of ADA1 gene family members was mostly influenced by purifying selection. There were large differences among the gene structure of banana ADA1 gene family members. ADA1 gene family members contained plenty of hormonal elements. MaADA1-1 may play a prominent role in the resistance of banana to cold stress, while MaADA1 may respond to the Panama disease of banana. In conclusion, this study suggested ADA1 gene family members are highly conserved in banana, and may respond to biotic and abiotic stress.

Effect of Common Carotid Artery Sympathectomy on Clinical Efficacy and Serum Levels of IL-6,IL-10 and TNF-α in Patients with Mixed Cerebral Palsy / 医学研究杂志

Objective To investigate the effect of common carotid artery sympathectomy on clinical efficacy and serum inflammatory factors in children with mixed cerebral palsy.Methods Common carotid artery sympathectomy was performed in 50 children with mixed cerebral palsy.The levels of IL-6,IL-10,TNF-α,modified Ashworth spasm score,teacher drooling scale(TDS)grade and gross motor function classification system(GMFCS)were compared before and after operation.Results The levels of IL-6 and TNF-α in 50 children with mixed cerebral palsy after operation were significantly lower than those before operation,and the difference was statistical-ly significant(P＜0.05);but there was no significant difference in the level of IL-10 after operation.The modified Ashworth spasm score and TDS grade after operation were significantly better than those before operation,and the differences were statistically significant(P＜0.05);but there was no significant difference in GMFCS after operation(P＞0.05).The level of TNF-α before and after opera-tion was positively correlated with modified Ashworth spasm score and TDS grade,but there was no correlation between TNF-α level and GMFCS before and after operation,and there was no correlation between IL-6,IL-10 level and modified Ashworth spasm score,TDS salivation grade and GMFCS before and after operation.Conclusion IL-6,IL-10 and TNF-α are involved in the pathogenesis of mixed cerebral palsy,and common carotid artery adventitia sympathectomy can improve clinical symptoms by reducing the levels of IL-6 and TNF-α,which is worth of popularization and application.

Professor SUN Weizheng's Experience in Diagnosing and Treating Multiple Myeloma with the Clearing-Releasing Therapy / 中医杂志

The article summarized professor SUN Weizheng's clinical experience in treating multiple myeloma using the clearing-releasing therapy. It is believed that the mechanism of multiple myeloma is kidney essence insufficiency， pathogenic toxin erosion， and blinding of phlegm and stasis. The treatment should consider both the deficiency and the excess， and the root and branch. Thus， the clearing-releasing therapy is proposed. “Clearing” refers to the approach of supplementing deficiency and reinforcing health while advocating the use of clearing and supplementing products to replenish without generating additional pathogenic factors. Additionally， products that clear heat， resolve toxins， dispel stasis， dissolve phlegm， and eliminate masses is suggested to benefit for clearing away pathogenic toxins. “Releasing” means to replenish the normal yang qi with sweet-warm and acrid-warm products on the basis of “clearing” method， and to release the cold pathogen constraint in the muscles and bones. Based on the principle of clearing and releasing， the selfmade Jishi Beverage （济世饮） is formulated to supplement the kidney and secure essence， dispel phlegm and dissolve stasis， resolve toxins and dissipate masses. The prescription can be modified according to syndrome differentiation. It is also advocated to use multiple methods and pay attention to external therapies such as enema for relieving constipation and draining heat， and to combine acupuncture and medicine to relieve pain.

Exploration of four dimensional training path of adversity quotient for nursing undergraduates in medical colleges / 中华医学教育探索杂志

How to improve the ability of nursing undergraduates in medical colleges to face more difficulties and reverse the dilemma in response to public health emergencies is a topic that needs to be further studied. It is an effective way to improve the level of students' adversity quotient by cultivating students' adversity quotient. This paper expounds the four dimensions of the composition of the four-dimensional adversity quotient, analyzes the factors influencing the formation of the four-dimensional adversity quotient, and puts forward the exploration of the path and method to cultivate the four-dimensional adversity quotient of undergraduate nursing students. In the practical teaching of nursing specialty, the adversity quotient can be cultivated through listening and communication.

Study on the relationship of interleukin-37 and osteoprotegerin with coronary artery disease and its risk degree / 中国医师进修杂志

Objective:To investigate the relationship of interleukin (IL)-37, osteoprotegerin with coronary artery disease and its stenosisdegree.Methods:The prospective research method was used. From April 2018 to June 2019, two hundred and eleven suspected or diagnosed coronary artery disease patients who had chest pain or discomfort in Dalian Friendship Hospital were selected. The patients underwent selective percutaneous coronary angiography and completed coronary stenosis score (Gensini score). According to the degree of coronary stenosis, 211 patients were divided into the control group(coronary stenosis<50%, 45 cases), single-vessel stenosis group (single-vessel stenosis ≥ 50%, 52 cases), double-vesselstenosis group (double-vesselstenosis ≥ 50%, 58 cases), and triple-vessel stenosis group (triple-vessel stenosis ≥ 50%, 56 cases). The levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), lipoprotein a, uric acid, creatinine were measured by the automatic biochemical analyzer. The serum levels of IL-37 and osteoprotegerin were detected by enzyme-linked immunosorbent assay.Results:There were no statistical differences in FBG, uric acid, creatinine, TC, TG, LDL-C, HDL-C, ApoA1 and ApoB among 4 groups ( P>0.05). In the control group, single-vessel stenosis group, double-vessel stenosis group and triple-vessel stenosis group, lipoprotein a was (0.266 ± 0.060), (0.283 ± 0.070), (0.289 ± 0.066) and (0.307 ± 0.084) mg/L respectively; coronary stenosis score was (8.27 ± 7.08), (437.45 ± 98.47), (493.72 ± 125.19) and (522.61 ± 149.34) scores respectively; IL-37 was (342.27 ± 122.36), (437.45 ± 98.47), (493.72 ± 125.19) and (522.61 ± 149.34) ng/L respectively; osteoprotegerin was (378.29 ± 111.95), (458.39 ± 115.37), (502.50 ± 116.88) and (533.39 ± 139.83) ng/L respectively; and there were statistical differences among 4 groups ( P<0.05 or <0.01). IL-37, osteoprotegerin and lipoproteina were positively correlated with coronary stenosis score ( r = 0.43, 0.42 and 0.23, P<0.05), the osteoprotegerin was positively correlated with IL-37( r = 0.73, P<0.05). The multivariate linear regression analysis result showed that the IL-37 and osteoprotegerin were independent protective factors of coronary stenosis degree( β = 0.07 and 0.07, t = 2.72 and 2.57, P<0.01 or <0.05),and lipoproteina was independent risk factor of coronary stenosis degree ( β = 0.97, t = 2.89, P<0.01). Conclusions:IL-37 and osteoprotegerin are positively correlated with the degree of coronary stenosis. They are anti-inflammatory and protective factors of coronary heart disease.

Analysis on the causes of death of elderly inpatients in medical department in a third-grade A hospital in dalian from 2012 to 2019 / 中国医师进修杂志

Objective:To analyze the causes of death of elderly inpatients,so as to provide direction for the precaution of geriatrics.Methods:The first page data of hospitalized medical records of elderly inpatients in medical department in the Second Hospital of Dalian Medical University from 2102 to 2019 were extracted, and the causes of death were analyzed. The statistical analysis was performed by Excel and SPSS 21.0 statistical software.Results:The number of deaths of elderly inpatients in medical department from 2012 to 2019 was 5 249. The proportion of deaths in ICU was 34.43%(1 807/5 249), in oncology department was19.03%(999/5 249), and in cardiovascular department was12.08%(634/5 249). The average age was (78.52 ± 7.82) years. Besides, the age of men was younger than women: (78.18 ± 8.00) years vs. (79.02 ± 7.52) years, and the differences was statistically significant ( P<0.01). Men(59.1%, 3 099/5 249) were more than women (40.96%, 2 150/5 249). The largest number of deaths was in the age of 75-84 years (42.56%, 2 234/5 249). The number of cases with combined above five diseases was 4 552(86.72%, 4 552/5 249). The top three causes of deaths of elderly inpatients in medical department from 2012 to 2019 were cardiocerebrovascular diseases (27.21%, 1 428/5 249), malignant tumor (25.74%, 1351/5 249) and respiratory system diseases (22.10%, 1160/5 249). From 2012 to 2015, the top three causes of deaths were malignant tumor, cardiocerebrovascular diseases and respiratorysystem diseases. From 2016 to 2019,the top three causes of deaths were cardiocerebrovascular diseases, malignant tumor, and respiratory system diseases. The most common cause in cardiocerebrovascular diseases of death was coronary heart disease (51.47%,735/1 428), cerebrovascular disease (43.70%,624/1 428),and hypertension(4.34%, 62/1 428). Among the patients with malignant tumor death, first cause of death waslung malignant tumor (37.53%, 507/1 351), the others in turn were gastric carcinoma (11.10%,150/1 351) and intestinal cancer (11.10%,150/1 351). Among the patients with respiratory system diseases, first cause of death was pulmonary infection (69.66%,808/1 160), the others in turn were chronic obstructive pulmonary disease (15.43%, 179/1 160) and interstitial lung disease (5.09%, 59/1 160). Conclusions:The average age of elderly inpatients in medical department is (78.52 ± 7.82) years. The death age of male is less than that of female, and the number is slightly more than that of female. The top three causes of deaths of elderly inpatients in medical department are cardiocerebrovascular diseases, malignant tumor, respiratorysystem diseases. From 2012 to 2015 the first cause of deaths is malignant tumor. From 2016 to 2019, the cardiocerebrovascular diseases rise to the first.

Mining prognostic marker of glioma based on weighted gene co-expression network analysis / 中国医师杂志

Objective:To identify effective biomarkers for glioma patients.Methods:The mRNA expression profiles of 464 glioma patients with complete clinical follow-up information were downloaded from the Chinese Glioma Genome Atlas (CGGA). Weighted gene co-expression network analysis (WGCNA) was used to identify gene modules related to World Health Organization (WHO) grading of glioma, and univariate and multivatiate Cox regression analysis were performed to identify gliomas survival-related genes.Results:In weighted gene co-expression analysis, the module Brown was significantly positively correlated with glioma WHO stage ( r=0.55, P<0.05). In univariate analysis, five genes (TAGLN2, IGFBP2, METTL7B, ARAP3, PLAT) that were most significantly associated with clinical prognosis were selected for multivariate survival analysis, and the prognosis model was established to calculate the risk score. The receiver operating characteristic curve (ROC) confirmed that the risk score had high accuracy in predicting the 1-, 3-, 5-year survival rate of glioma patients. The above survival analysis results were verified in the Cancer Genome Atlas (TCGA) database. Conclusions:We use mRNA expression profiles to establish prognostic markers for gliomas to assess the overall survival of patients with glioma.

A survey and an intervention study on Chinese medical students' willingness to pursue a career in geriatrics / 中华老年医学杂志

Objective:To explore the attitudes of Chinese medical students toward the elderly and their willingness to practice in geriatrics, and to investigate the influence of geriatrics education on their attitudes.Methods:Medical students studying diagnostics in four medical universities were enrolled in a cross-sectional survey and, for the intervention study, graduate trainees from non-geriatrics specialties taking a geriatrics course were interviewed before and after the course.An electronic questionnaire was used to collect general information, the experience of interacting with the elderly, attitudes towards the elderly and the willingness to develop careers in geriatric medicine.Changes in attitudes towards the elderly and their willingness to practice in geriatrics before and after the 40-hour geriatric medicine course were compared.Results:A total of 648 medical students completed the cross-sectional survey, with the highest score in compassion for the elderly(3.54±0.54)and the lowest score for medical services for elderly patients(3.36±0.78). Only 2.2%(14/648)of the students showed strong interest in geriatric medicine.The results of the intervention from 42 graduate trainees showed that the average scores of revised Geriatric Attitude Scale(r-GAS)were 3.80±0.43 and 3.92±0.40 before and after the course, respectively, and the difference was statistically significant( t=2.148, P=0.038). At the end of the course, 7 trainees(16.7%, 7/42)showed great interest in geriatrics, significantly different from 2 trainees(4.8%, 2/42)before the course( χ2=8.211, P=0.025). Conclusions:Chinese medical students show a serious lack of interest in geriatrics, and geriatrics education can improve their attitudes towards the elderly and their willingness to work in geriatrics.With the rapid population aging in China, it is urgent to strengthen the education of geriatric medicine.

Exploration of standardized development of pulmonary and critical care medicine discipline / 中华医院管理杂志

Objective:To summarize the achievements in standardized development of pulmonary and critical care medicine discipline, for references of developing respiratory discipline at secondary and tertiary hospitals.Methods:Questionnaire survey was used to understand the input and technical promotion of the secondary and tertiary medical institutions in the standardized construction.Results:The secondary and tertiary medical institutions invested 1.116 billion yuan to carry out standardized development of the discipline, recruiting 1 164 doctors, 2 535 nurses and 334 technicians. In terms of key medical technologies, 58 tertiary medical institutions and 45 secondary medical institutions meet the basic standards of " guidance on medical service capacity of respiratory discipline(2018 edition)" after carrying out standardized development.Conclusions:The discipline of pulmonary and critical care medicine should continue to strengthen its input in the development of respiratory and critical medical integration, with standardized development projects as the breakthrough. Evaluation should be carried out persistently so as to promote the development, for the purpose of improving the prevention and treatment capability of pulmonary and critical care medicine.

6-hydroxydopamine-induced Parkinson's disease cell injury can be inhibited by P2X4R silencing / 中华神经医学杂志

Objective:To investigate the effect of P2X4R silencing on 6-hydroxydopamine (6-OHDA) induced Parkinson's disease (PD) cell model and its mechanism. Methods:(1) According to the 6-OHDA concentrations, the SH-SY5Y cells were divided into 0 μmol/L 6-OHDA group, 50 μmol/L 6-OHDA group, 100 μmol/L 6-OHDA group, and 150 μmol/L 6-OHDA group. CCK-8 was used to detect the cell survival rate, Western blotting was used to detect the P2X4R protein expression, and real time quantitative RT-PCR was used to detect the P2X4R mRNA expression. The optimal concentration of 6-OHDA was selected to induce PD cell model. (2) SH-SY5Y cells at logarithmic phase were transfected with P2X4R siRNA lentiviral plasmids of different sequences (P2X4R-siRNA540, P2X4R-siRNA792, and P2X4R-siRNA1401) and nonsense sequence normal control plasmid (NC-siRNA), respectively (P2X4R-siRNA540 group, P2X4R-siRNA792 group, P2X4R-siRNA1401 group, and NC-siRNA group); the P2X4R mRNA and protein expressions were detected by real time quantitative RT-PCR and Western blotting, and the P2X4R siRNA sequence with the best silencing effect was screened to establish P2X4R silencing cell line. (3) The PD cells induced by the optimal concentration of 6-OHDA were transfected by P2X4R-siRNA enjoying the best silencing effect, NC-siRNA, and P2X4R antagonist CORM-2 (PD+P2X4R-siRNA group, PD+NC-siRNA group, and PD+CORM-2 group); CCK-8 and flow cytometry were used to detect the survival rate and apoptosis rate of cells in each group, and Western blotting was used to detect the protein expressions of connexin (PANX1), toll-like receptor (TLR)-2, Caspase-3 and cleaved Caspase-3. (4) The PANX1 or TLR-2 over-expression plasmids (pCMV3-PANX1 and pCMV3-TLR2), and negative control plasmid (pCMV3-NCV) were transfected into cells from the PD+P2X4R-siRNA group (PD+P2X4R-siRNA+pCMV3-PANX1 group, PD+P2X4R-siRNA+pCMV3-TLR2 group, and PD+P2X4R-siRNA+pCMV3-NCV group); CCK-8 and flow cytometry were used to detect the survival rate and apoptosis rate of cells in each group; Western blotting was used to detect the TLR-2, Caspase-3 and cleaved Caspase-3 protein expressions. Results:(1) As compared with that in the 0 μmol/L 6-OHDA group, the cell survival rate in 50, 100, and 150 μmol/L 6-OHDA groups was significantly decreased in a dose-dependent manner, and the P2X4R protein and mRNA expression levels were significantly increased in a dose-dependent manner ( P<0.05); among them, 100 mol/L 6-OHDA was the most suitable concentration to induce PD cell model. (2) As compared with those in the NC-siRNA group, the P2X4R mRNA and protein expressions in P2X4R-siRNA540 group, P2X4R-siRNA792 group, and P2X4R-siRNA1401 group were significantly decreased ( P<0.05); P2X4R mRNA and protein expressions were the lowest in the P2X4R-siRNA540 group. (3) As compared with PD+NC-siRNA group, the PD+P2X4R-siRNA group and PD+CORM-2 group had significantly increased survival rate, significantly decreased apoptosis rate, and statistically decreased Caspase-3, cleaved Caspase-3, PANX1 and TLR-2 protein expression levels ( P<0.05). (4) As compared with PD+P2X4R-siRNA+pCMV3-NCV group, the TLR2 protein expression in PD+P2X4R-siRNA+pCMV3-PANX1 group was significantly lower ( P<0.05); as compared with PD+P2X4R-siRNA+pCMV3-NCV group, PD+P2X4R-siRNA+pCMV3-TLR2 group had significantly increased cell survival rate, significantly decreased apoptosis rate, and significantly decreased Caspase-3 and cleaved Caspase-3 protein expressions ( P<0.05). Conclusion:P2X4R silencing can significantly improve the survival rate of PD cell model induced by 6-OHDA, reduce apoptosis and expressions of apoptosis related proteins (Caspase-3 and cleaved Caspase-3), and play a neuroprotective role, whose mechanism may be related to PANX1/TLR-2 signal pathway.

Clinical characteristics and outcomes of monochorionic monoamniotic twin pregnancy / 中华妇产科杂志

Objective:To investigate the clinical characteristics and outcomes of monochorionic monoamniotic (MCMA) twin pregnancy.Methods:The clinical data of 60 MCMA twin pregnant women who were terminated in Peking University Third Hospital from January 2011 to December 2019 were collected, and the general clinical data, prenatal examination and pregnancy outcomes were analyzed retrospectively.Results:The age of 60 MCMA twin pregnant women was (31.0±4.1) years old, among which 44 cases were primiparas (73%, 44/60) and 16 cases were multiparas (27%, 16/60). Fifty-eight cases were diagnosed as MCMA twin pregnancy prenatally and were confirmed after delivery. Median ultrasonic diagnosis of gestational age was 12 weeks (range: 8-30 weeks). In the 60 MCMA twin pregnancies, 6 cases were conjoined twins, 5 cases were complicated with twin reversed arterial perfusion sequence (TRAPS), and 10 cases were diagnosed as other fetal malformation by prenatal ultrasound examination. Among the 60 MCMA twin pregnant women, 19 cases had spontaneous abortion or induced abortion due to fetal malformation, fetal death or other reasons within 28 weeks of pregnancy, 41 cases entered the perinatal period, a total of 70 newborns survived. The main cause of perinatal fetal or neonatal death was fetal dysplasia.Conclusions:There is a high incidence of fetal abnormality and perinatal mortality in MCMA twin pregnancy. Accurate early diagnosis, enhanced management and monitoring during pregnancy, and individualized treatment are the keys to improve MCMA twin pregnancy outcomes.

Surgical treatment of cirrhotic portal hypertension: Current status and research advances / 临床肝胆病杂志

Liver cirrhosis can lead to continuous pathological elevation of portal venous pressure, resulting in various complications such as esophageal and gastric varices, ascites, hepatic encephalopathy, and secondary circulatory dysfunction. Multimodality therapy is the main treatment method for portal hypertension, among which surgical treatment is mainly used to control and prevent massive esophagogastric variceal bleeding. Currently, interventional therapy and liver transplantation have gradually become a routine method for surgical intervention and can significantly improve patients’ quality of life, but devascularization and shunt are still the mainstream surgical procedures. Each surgical strategy for cirrhotic portal hypertension has its own characteristics. It will be a trend in the future to evaluate patients’ general conditions and clinical features and select individualized treatment regimens to achieve the best treatment outcome.

Cross-sectional study of secondary prevention of osteoporotic fractures in the elderly in two hospitals of Liaoning province / 中国医师进修杂志

Objective:To study the diagnosis and treatment of osteoporotic fractures in the elderly in two third Grade A hospitals in Shenyang and Dalian, and to provide scientific basis for prevention and treatment of osteoporotic fractures in Dalian and Shenyang.Methods:Patients of osteoporotic fractures over 60 years old from January 2015 to December 2015 in the Second Hospital of Dalian Medical University and the People′s Hospital of Liaoning Province were chosen, and the basic characteristics, fracture site, the number of fracture site, diagnosis treatment and secondary prevention of osteoporosis fractures of them were analyzed.Results:Among the patients of osteoporotic fractures over 60 years old in the hospitals of Shenyang and Dalian, women were more than men ( P = 0.00). The predilection sites of elderly osteoporotic fractures in two hospitals were both followed by the hip, spine, ulnar and radial distal, proximal humerus. The rates respectively were 38.26%(295/771), 34.63% (267/771), 9.34%(72/771), 5.71%(44/771). The rate of fracture-again was 10.89%(84/771). The rates of in-hospital diagnosis, in-hospital treatment and treatment of discharged medical advice among osteoporosis were 13.88%(107/771), 24.64%(190/771) and 18.81%(145/771). There were 0.65% (5/771) patients who had diagnosis of osteoporosis, basic osteoporosis treatment (vitamin D 3 and calcium) and anti-osteoporosis treatment in both in-hospital and discharged medical advice. Conclusions:The rates of in-hospital diagnosis, in-hospital osteoporosis treatment and anti-osteoporosis treatment in discharged medical advice are both very low in the two third Grade A hospitals. The secondary prevention of osteoporosis fractures in the elderly has not been taken attention, and the situation of prevention and treatment are serious.

Application of flipped classroom combined with surgical simulation training system in clinical clerkship teaching of gynecology and obstetrics / 中华医学教育探索杂志

Various contents, relatively insufficient class hours, few practical operation opportunities and lack of teacher-student interaction are the main difficulties in clinical clerkship teaching of gynecology and obstetrics. In this study, the flipped classroom, surgery simulation training system and online self-test module are added to the clinical clerkship teaching of obstetrics and gynecology, and also the WeChat group interactive platform is established to make up for the deficiency of traditional teaching mode. The questionnaire survey showed that 59 clerkship students' satisfaction with the course was 92.6 points, 98.3% of students thought that the surgery simulation training was helpful, and 93.2% of them thought that the flipped classroom was helpful, and the students' scores of the final exam was higher than those of the previous students in the same period with the same difficulty of the exam. Therefore, rational use of flipped classroom, surgery simulation training system and other modules can improve the overall effect of clinical clerkship teaching in gynecology and obstetrics to a certain extent.

Prenatal ultrasonographic diagnosis of the fetal ductus venosus abormalities / 中华超声影像学杂志

Objective To explore the prenatal ultrasound image features and clinical significance of fetal ductus venosus abormalities . Methods Fifteen fetuses with ductus venosus abormalities diagnosed by prenatal ultrasonography at Peking University T hird Hospital were retrospective review . T he prenatal findings ,umbilical shunting type ,perinatal outcomes ,and autopsy reports were analyzed . Results Fourteen fetuses were found with absence of ductus venosus . In 6 fetuses the umbilical vein connected to the portal vein ,5 fetuses the umbilical vein connected to the inferior vena cava and 3 fetuses the umbilical vein connected to the right atrium . T he remaining 1 fetus was found obliteration of ductus venosus . Absence of ductus venous showed no normal ductus venous and the umbilical vein almost always drained directly into portal vein ,inferior vena cava or right atrium . Obliteration of ductus venous showed normal ductus venous was replaced by a tiny echogenic string without blood flow . T hree cases had intracardiac and extracardiac abnormalities ; 4 cases had extracardiac abnormalities only ; 8 of these ,ductus venosus abormality were isolated . T wo cases had trisomy 21 syndrome . Four patients underwent legal termination of pregnancy ; 2 were intrauterine fetal death ; and 8 carried to term wit normal outcome ; the remaining one underwent operation due to extracardiac abnormality and postoperative course was uneventful . Conclusions Prenatal ultrasound can be used to diagnose fetal ductus venosus abormalities . Hemodynamic depends on umbilical venous drainage site and diameter . T he prognosis for this group of anomalies depends on the chromosomal abnormalities and additional findings . Chromosome and ultrasonic monitoring are suggested for following pregnancy .

Job satisfaction and influencing factors of medical staff at 136 tertiary hospitals in China / 中华医院管理杂志

Objective To investigate job satisfaction and influencing factors of medical staff in China.Methods From December 2017 to January 2018, based on the third round third-party evaluation of the Healthcare Improvement Initiative, data on job satisfaction of medical staff at 136 tertiary public hospitals in 31 provinces of China were collected.Chi-square test and binary multivariate logistic regression were used to analyze the influencing factors of job satisfaction.Results The job satisfaction of medical staff at 136 sample hospitals was relatively low. 34.6% of the doctors were satisfied with their job, while the corresponding rate in the nurses was 48.7%. Multi-factor analysis showed that income level, workload, doctor-patient relationship, hospital′s compensation policy, and promotion policy were all significant factors influencing medical staff′s job satisfaction ( workload OR <1, remaining variables OR >1, P <0.05 ). Conclusions Improvement of the medical staff′s job satisfaction depends on optimizing their income distribution policy, increasing their income, improving the promotion policy of professional titles, reducing their workload rationally and building a harmonious relationship between doctors and patients.

Development and practice of medical alliances for respiratory diseases in China / 中华医院管理杂志

Respiratory disease is currently one of the main causes of human deaths. Due to the shortage, fragmentation, imbalance and heterogeneity of health resources and medical resources in China, it is urgent to strengthen the prevention and control system and capacity construction for respiratory science and innovate the prevention and treatment mode.The authors expounded the necessity of constructing a medical alliance for respiratory diseases, and held that such an alliance can achieve the purpose of patient care and discipline development, by means of integration of resources and system building, from such aspects as healthcare, teaching, research and department construction.

Research advances in Alzheimer's disease and DNA methylation / 中华神经医学杂志

Prevalence of Alzheimer's disease,a neurodegenerative disease of the central nervous system,is increasing with the aging of population,causing serious social and family burdens.It is influenced by a variety of factors,including genetic and environmental ones.Epigenetics is an important bridge connecting genetic and environmental factors.DNA methylation,the most important modification in epigenetics,is related to many diseases like aging,cancer and dementia.In this paper,we reviewed the recent studies on the role ofDNA methylation in AD.

Recent advances in early diagnosis markers of Alzheimer's disease / 中华神经医学杂志

Alzheimer's disease (AD) is the main and common cause of cognitive dysfunction in the elderly. It is particularly important to find a biomarker that can be used for diagnosis of AD in the early stage. This article reviews the biomarkers that have been discovered or applied to the early diagnosis of AD from the perspectives of pathological changes, imaging and genetics, in order to provide clues and evidences for early diagnosis of AD.

Surgical technique and early clinical outcomes of direct anterior approach to total hip arthroplasty / 北京大学学报(医学版)

Objective:To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes.Methods: A series of 100 consecutive,unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed.There were 50 male patients and 50 female patients.The average patient age was 51 years,and the average body mass index was 24.69 kg/m2.The preoperative diagnosis included avascular necrosis of femoral head,hip osteoarthritis,osteoarthritis se-condary to acetabular dysplasia,sequelae of hip old infection,ankylosing spondylitis,rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture.There were 7 hips which had surgical history prior to the index hip arthroplasty,including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach,2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach,and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual).All were uncemented hips.The stems used in this study included 67 Triloc stems (DePuy company,USA),45 Corail stems (DePuy company,USA),2 Accolade stems (Stryker company,USA),1 Synergy stem (Smith-Nephew company,USA) and 1 Polarstem (Smith-Nephew company,USA).Results: The average follow up period was 8.5 months,the average incision scar length was 10 cm,and the average postoperative Harris score was 93.62.There was 95％ postoperative leg length discrepancy within 3 mm.The average cup inclination angle was 38.7°with 94.8％ in the range of 30° to 50°.The average cup anteversion angle was 14.3° with 94.2％ within the target range of 5° to 25°.The were 15 (12.9％) operative complications,including two femoral perforations (changing stem from Triloc to Corail),three calcar fractures (treated with cerclage wires),four greater trochanter fractures (2 were treated wire tension band,and 2 nondisplaced fractures untreated),one deep infection (debridement and retaining of the prothesis),one superficial infection (debridement),one hematoma and three wound healing complications (debridement).All the complications were successfully treated without any sequelae at the end of the latest follow-up.There was no postoperative dislocation.There was no major nerve and vascular injuries.There were 35 cases (30.2％) reporting symptoms of lateral femoral cutaneous nerve palsy.Conclusion: Direct anterior approach to total hip arthroplasty allows accurate and reproducible cup orientation positioning and leg length restoration and decreases the risk of postoperative dislocation,which is helpful for early rapid postoperative recovery.