Prediction of poor prognosis in patients with acute cerebral infarction / 中国医师进修杂志

Objective:To explore the predictive values of serum monocyte chemoattractant protein-1 (MCP-1), high mobility protein B1 (HMGB1), adiponectin (APN) and oxidized low density lipoprotein (ox-LDL) levels on poor prognosis of patients with acute cerebral infarction(ACI).Methods:One hundred and sixty-fivepatients with ACI in Zibo Hospital, Shandong Guoxin Nursing Group from October 2018 to December 2020 were selected as the observation group, and 147 healthy people in the same period were selected as the normal control group. The levels of serum MCP-1, HMGB1, APN and ox-LDL were detected. In addition, the observation group was followed up for 3 months after discharge, and the observation group was divided into good prognosis group and poor prognosis group by modified Rankin Scale score. The levels of serum MCP-1, HMGB1, APN and ox-LDL between the poor prognosis group and the good prognosis group were compared. The influencing factors of poor prognosis in patients with ACI and the predictive value of serum MCP-1, HMGB1, APN and ox-LDL levels on poor prognosis were analyzed by Logistic multiple regression analysis and receiver operating characteristic (ROC) curve.Results:The levels of serum MCP-1, HMGB1 and ox-LDL in the observation group were higher than those in the normal control group: (322.61 ± 65.27) ng/L vs. (163.18 ± 15.12) ng/L, (6.61 ± 3.54) μg/L vs. (2.90 ± 0.41) μg/L, (481.11 ± 177.67) mg/L vs. (247.47 ± 27.13) mg/L; but the level of serum APN was lower than that in the normal control group: (10.63 ± 3.80) μg/L vs. (17.65 ± 2.87) μg/L, there were statistical differences ( P<0.05). After 3 months of follow-up, the incidence rate of poor prognosis in the observation group was 35.15%(58/165). The serum levels of MCP-1, HMGB1 and ox-LDL in the poor prognosis group were higher than those in the good prognosis group: (372.15 ± 71.33) ng/L vs. (295.76 ± 42.23) ng/L, (9.74 ± 3.96) μg/L vs. (4.91 ± 1.62) μg/L, (631.03 ± 196.84) mg/L vs. (399.85 ± 95.07) mg/L; but the serum APN level was lower than that in the good prognosis group: (7.62 ± 2.83) μg/L vs. (12.27 ± 3.22) μg/L, there were statistical differences ( P<0.05). The results of Logistic multiple regression analysis showed that age, hypertension, hyperlipidemia, infarct volume, nerve function defect score, time from onset to treatment and MCP-1, HMGB1, APN and ox-LDL levels were the influencing factors of poor prognosis in patients with ACI ( P<0.05). The results of ROC curve analysis showed that the sensitivity and area under the curve of serum MCP-1, HMGB1, APN and ox-LDL levels in combined predicting the poor prognosis were 98.28% and 0.954, which were higher than the single index evaluation ( P<0.05). Conclusions:The serum levels of MCP-1, HMGB1 and ox-LDL are closely related to the prognosis of ACI patients, and all of them have a certain predictive value for the poor prognosis of patients, but the combined prediction efficiency of four items is more higher.

Imprinted SARS-CoV-2 humoral immunity induces converging Omicron RBD evolution

Continuous evolution of Omicron has led to a rapid and simultaneous emergence of numerous variants that display growth advantages over BA. 5. Despite their divergent evolutionary courses, mutations on their receptor-binding domain (RBD) converge on several hotspots. The driving force and destination of such convergent evolution and its impact on humoral immunity remain unclear. Here, we demonstrate that these convergent mutations can cause striking evasion of neutralizing antibody (NAb) drugs and convalescent plasma, including those from BA.5 breakthrough infection, while maintaining sufficient ACE2 binding capability. BQ.1.1.10, BA.4.6.3, XBB, and CH. 1.1 are the most antibody-evasive strain tested, even exceeding SARS-CoV-1 level. To delineate the origin of the convergent evolution, we determined the escape mutation profiles and neutralization activity of monoclonal antibodies (mAbs) isolated from BA.2 and BA.5 breakthrough-infection convalescents. Importantly, due to humoral immune imprinting, BA.2 and especially BA.5 breakthrough infection caused significant reductions in the epitope diversity of NAbs and increased proportion of non-neutralizing mAbs, which in turn concentrated humoral immune pressure and promoted convergent evolution. Moreover, we showed that the convergent RBD mutations could be accurately inferred by integrated deep mutational scanning (DMS) profiles, and the evolution trends of BA.2.75/BA.5 subvariants could be well-simulated through constructed convergent pseudovirus mutants. Together, our results suggest current herd immunity and BA.5 vaccine boosters may not provide good protection against infection. Broad-spectrum SARS-CoV-2 vaccines and NAb drugs development should be highly prioritized, and the constructed mutants could help to examine their effectiveness in advance.

BA.2.12.1, BA.4 and BA.5 escape antibodies elicited by Omicron infection

SARS-CoV-2 Omicron sublineages BA.2.12.1, BA.4 and BA.5 exhibit higher transmissibility over BA.21. The new variants receptor binding and immune evasion capability require immediate investigation. Here, coupled with Spike structural comparisons, we show that BA.2.12.1 and BA.4/BA.5 exhibit comparable ACE2-binding affinities to BA.2. Importantly, BA.2.12.1 and BA.4/BA.5 display stronger neutralization evasion than BA.2 against the plasma from 3-dose vaccination and, most strikingly, from post-vaccination BA.1 infections. To delineate the underlying antibody evasion mechanism, we determined the escaping mutation profiles2, epitope distribution3 and Omicron neutralization efficacy of 1640 RBD-directed neutralizing antibodies (NAbs), including 614 isolated from BA.1 convalescents. Interestingly, post-vaccination BA.1 infection mainly recalls wildtype-induced humoral memory. The resulting elicited antibodies could neutralize both wildtype and BA.1 and are enriched on non-ACE2-competing epitopes. However, most of these cross-reactive NAbs are heavily escaped by L452Q, L452R and F486V. BA.1 infection can also induce new clones of BA.1-specific antibodies that potently neutralize BA.1; nevertheless, these NAbs are largely escaped by BA.2/BA.4/BA.5 due to D405N and F486V, and react weakly to pre-Omicron variants, exhibiting poor neutralization breadths. As for therapeutic NAbs, Bebtelovimab4 and Cilgavimab5 can effectively neutralize BA.2.12.1 and BA.4/BA.5, while the S371F, D405N and R408S mutations would undermine most broad sarbecovirus NAbs. Together, our results indicate that Omicron may evolve mutations to evade the humoral immunity elicited by BA.1 infection, suggesting that BA.1-derived vaccine boosters may not achieve broad-spectrum protection against new Omicron variants.

Comprehensive Epitope Mapping of Broad Sarbecovirus Neutralizing Antibodies

Omicron sub-lineage BA.2 has rapidly surged globally, accounting for over 60% of recent SARS-CoV-2 infections. Newly acquired RBD mutations and high transmission advantage over BA.1 urge the investigation of BA.2s immune evasion capability. Here, we show that BA.2 causes strong neutralization resistance, comparable to BA.1, in vaccinated individuals plasma. However, BA.2 displays more severe antibody evasion in BA.1 convalescents, and most prominently, in vaccinated SARS convalescents plasma, suggesting a substantial antigenicity difference between BA.2 and BA.1. To specify, we determined the escaping mutation profiles1,2 of 714 SARS-CoV-2 RBD neutralizing antibodies, including 241 broad sarbecovirus neutralizing antibodies isolated from SARS convalescents, and measured their neutralization efficacy against BA.1, BA.1.1, BA.2. Importantly, BA.2 specifically induces large-scale escape of BA.1/BA.1.1-effective broad sarbecovirus neutralizing antibodies via novel mutations T376A, D405N, and R408S. These sites were highly conserved across sarbecoviruses, suggesting that Omicron BA.2 arose from immune pressure selection instead of zoonotic spillover. Moreover, BA.2 reduces the efficacy of S309 (Sotrovimab)3,4 and broad sarbecovirus neutralizing antibodies targeting the similar epitope region, including BD55-5840. Structural comparisons of BD55-5840 in complexes with BA.1 and BA.2 spike suggest that BA.2 could hinder antibody binding through S371F-induced N343-glycan displacement. Intriguingly, the absence of G446S mutation in BA.2 enabled a proportion of 440-449 linear epitope targeting antibodies to retain neutralizing efficacy, including COV2-2130 (Cilgavimab)5. Together, we showed that BA.2 exhibits distinct antigenicity compared to BA.1 and provided a comprehensive profile of SARS-CoV-2 antibody escaping mutations. Our study offers critical insights into the humoral immune evading mechanism of current and future variants.

Clinical study on urinary retention after apoplexy (kidney qi deficiency type) treated by internal administration of Traditional Chinese Medicine and external application of hot election bag combined with acupuncture / 国际中医中药杂志

Objective:To observe the clinical effect of internal administration of Traditional Chinese Medicine (TCM) and external application of hot election bag combined with acupuncture on urinary retention after stroke with kidney qi deficiency type.Methods:A total of 106 patients admitted to Chengde Hospital of Traditional Chinese Medicine from January 2017 to December 2020 who met the inclusion criteria were randomly divided into 2 groups according to the random number table method, with 53 in each group. The control group was treated with conventional western medicine therapy and bladder function training, while the observation group was treated with TCM, acupuncture and external application on the basis of the control group. Both groups were treated for 28 days. Before and after treatment, TCM syndrome scores were performed, and the maximum urinary capacity and residual urine volume were recorded by abdominal B-ultrasound to evaluate the bladder function of the patients. The improvement time of urinary pain, first urination time, catheter indwelling time, length of hospital stay and adverse reactions during treatment were observed and recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 96.2% (51/53) in the observation group and 84.9% (45/53) in the control group, and the difference between the two groups was statistically significant ( χ2=3.98, P=0.046). The residual urine volume of the observation group after treatment [(54.23±6.23) ml vs. (91.24±11.25) ml, t=20.95] was significantly lower than that of the control group ( P<0.01), and the maximum urinary bladder volume [(366.23±30.23) ml vs. (259.63±26.23) ml, t=19.39] was significantly higher than that of the control group ( P<0.01). After treatment, the TCM syndrome score of the observation group was significantly lower than that of the control group ( t=13.25, P<0.01), and the bladder function score of the observation group was significantly lower than that of the control group ( t=13.53, P<0.01). The improvement time of urinary pain, first urination time, catheter indwelling time and hospital stay in the observation group were significantly lower than those in the control group ( t=5.73, 17.91, 6.76, 9.67, all Ps <0.01). No adverse reactions occurred in the two groups during treatment. Conclusion:The combination of TCM, hot compress therapy and acupuncture plus routine therapy can treat the patients with urinary retention after stroke and kidney qi deficiency type with good bladder function, improved symptoms and fast recovery and safety.

B.1.1.529 escapes the majority of SARS-CoV-2 neutralizing antibodies of diverse epitopes

The SARS-CoV-2 B.1.1.529 variant (Omicron) contains 15 mutations on the receptor-binding domain (RBD). How Omicron would evade RBD neutralizing antibodies (NAbs) requires immediate investigation. Here, we used high-throughput yeast display screening1,2 to determine the RBD escaping mutation profiles for 247 human anti-RBD NAbs and showed that the NAbs could be unsupervised clustered into six epitope groups (A-F), which is highly concordant with knowledge-based structural classifications3-5. Strikingly, various single mutations of Omicron could impair NAbs of different epitope groups. Specifically, NAbs in Group A-D, whose epitope overlap with ACE2-binding motif, are largely escaped by K417N, G446S, E484A, and Q493R. Group E (S309 site)6 and F (CR3022 site)7 NAbs, which often exhibit broad sarbecovirus neutralizing activity, are less affected by Omicron, but still, a subset of NAbs are escaped by G339D, N440K, and S371L. Furthermore, Omicron pseudovirus neutralization showed that single mutation tolerating NAbs could also be escaped due to multiple synergetic mutations on their epitopes. In total, over 85% of the tested NAbs are escaped by Omicron. Regarding NAb drugs, the neutralization potency of LY-CoV016/LY-CoV555, REGN10933/REGN10987, AZD1061/AZD8895, and BRII-196 were greatly reduced by Omicron, while VIR-7831 and DXP-604 still function at reduced efficacy. Together, data suggest Omicron would cause significant humoral immune evasion, while NAbs targeting the sarbecovirus conserved region remain most effective. Our results offer instructions for developing NAb drugs and vaccines against Omicron and future variants.

Clinical and metabolic characteristics in 165 patients with common COVID-19 / 中华内分泌代谢杂志

Objective:To retrospectively analyze the clinical and serological characteristics in rehabilitated patients with common novel coronavirus pneumonia(COVID-19).Methods:A total of 165 patients with common COVID-19 were enrolled in this retrospective study, in which clinical data was collected from February 23 to March 15, 2020 in Leishenshan Hospital(Wuhan, China). The patients with COVID-19 were divided into elderly group and non-elderly group according to their age, and the differences in the clinical and serological metabolic characteristics between these two groups were analyzed.Results:49.7% patients were over 60 years old. The most common clinical symptoms were fever, cough, and fatigue, followed by muscle soreness. Expectoration and digestive tract symptoms were rare. Dyspnea occurred more frequently in the elderly group than in non-elderly group(47.56% vs 25.30%, P<0.01). Hypertension was the most common concomitant disease(accounting for 29.1%)followed by diabetes. Hypertension was more common in the elderly group than in non-elderly group(41.46% vs 16.86%, P<0.01), but without significant difference in diabetes between the two groups. The counts of leukocytes and lymphocytes in all patients were in the normal range, and no difference was observed between the groups. The comparison of serological indicators showed that serum creatinine in the elderly group was higher than that in the non-elderly group( P<0.01)while serum albumin, glomerular filtration rate, and serum calcium were lower in the elderly group. After serum albumin correction, the levels of albumin corrected calcium in all patients were in the normal range, without significant difference between these two groups. There was no significant difference between the two groups when the length of hospital stay was taken as the index of outcome [(34.01±10.24) vs(30.97±10.51)d, P>0.05]. Conclusion:Fever, cough, and fatigue are the most common clinical symptoms in patients with ordinary COVID-19. The elderly are more likely to develop dyspnea. The blood routine and metabolic characteristics in patients with common COVID-19 are normal, but serum albumin level is more likely to decrease in elderly patients with COVID-19.

Effect of sanguinarine combined with cisplatin on the apoptosis of bladder cancer EJ cells / 中国药科大学学报

@#To investigate the effects of sanguinarine (Sang) combined with cisplatin (Cis) in accelerating the apoptosis of bladder cancer EJ cells, CCK-8 method was used to detect the proliferation of bladder cancer EJ cells treated with different concentrations of Sang with the IC50 values calculated. Annexin V FITC/PI method was used to detect cell apoptosis in the control group, Sang group, Cis group and the combination group. Flow cytometer was used to detect cell cycle arrested. Western blot was used to detect the influence of Bcl-2 expression in the control group, Sang group, Cis group and the combination group. Nude mouse subcutaneous tumor model was constructed to verify that the combination group could accelerate the apoptosis of bladder cancer EJ cells and reduce the side-effects on mice. The safety of the Sang was evaluated by HE staining of vital organs in mice. In vitro, Sang could significantly inhibit the proliferation of EJ cells. Compared with the control group, the number of apoptosis EJ cells in the combination group was significantly increased (P < 0.05), and more cells were arrested in G2/M phase. The expression of Bcl-2 was significantly down-regulated in the combination group (P <0.001). In vivo, compared with the control group, the tumor growth was significantly slower, and a large number of apoptotic cells were inspected (P < 0.05) of the combination group. The side effects of cisplatin were reduced in the combination group. Sang has high biosafety and little side effect. Combined Sang and Cis can increase cell cycle G2/M block, down-regulate Bcl-2 expression, promote cell apoptosis and inhibit tumor growth.

Genetic characterization of EV71 isolates associated with hand, foot and mouth disease in the mainland of China / 中华临床感染病杂志

Objective:To analyse the genetic characteristics of VP1 region and genotypes of enterovirus 71 (EV71) associated with hand, foot and mouth disease (HFMD) in the mainland of China.Methods:The VP1 gene sequences of 3 102 isolates of EV71 from the mainland of China(excluding repetitive sequences)and 30 known EV71 genotypes as reference strains between 1996 and 2018 were obtained from GenBank. Phylogenetic tree, amino acid homology, genetic variation and genotype analyses of the EV71-VP1 protein were performed with MEGA 6.0 software.Results:The amino acid identity was 88.33%-100.00% among the 3 102 EV71 strains, if included reference strains it was 87.34%-100.00%. The amino acid identity was 93.47%-100.00%, compared with vaccine strain H07, and 93.04%-100.00% compared with vaccine strains FY7VP5 or FY-23K-B. Since 2000, the prevalent strains of EV71 were mainly of the C4 genotype; while during 2005 to 2018 the C4a subgenotype was predominant, followed by the C4b, other subgenotypes appeared sporadically. Some amino acid variations in VP1 of EV71 occurred with high frequencies, including A293S (16.75%), S283T (15.73%), A289T (12.44%), E98K (7.22%), H22Q (6.66%), N31D (4.50%) and V249I (4.40%).Conclusion:The C4 genotype of EV71 in China’s mainland matches the vaccine and should effectively control EV71 infection. Genetic characteristics of the EV71-VP1 region should be continuously monitored, which is critical for epidemic control and vaccine design to prevent EV71-HFMD in children.

High-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone analogs (GnRHa) and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis: a case series with long-term follow up.

Objective: This research was conducted to assess the long-term outcomes of a combination treatment of High-intensity focused ultrasound (HIFU) ablation, gonadotropin-releasing hormone analogs (GnRHa) and Levonorgestrel-releasing intrauterine system (LNG-IUS) for women with adenomyosis (AD).Methods: One hundred and forty-two patients with AD were enrolled and treated with HIFU conservative treatment in combination with adjuvant therapy of GnRHa and LNG-IUS. All the cases were followed up to 5 years after treatment. The volumes of uteri, AD lesions, and menstrual blood, and dysmenorrhea scores were measured. Also, the incidences of recurrence and complications were recorded.Results: Both the uterine and lesion volumes significantly decreased after treatment. The uterine volume gradually reduced after treatment, reaching the lowest level of 122.07 ± 44.12 cm3 at 12 months after treatment, with an average reduction rate of 45%, and then increased slightly, maintaining a reduction rate of about 35% compared with the baseline level. Similar decreases in AD lesion volumes, dysmenorrhea scores, and menstrual flow were also demonstrated. Hemoglobin levels increased. Moreover, the long-term recurrence rates were low, with 5.68% and 7.91% in dysmenorrhea and menorrhagia, respectively. No serious complications or adverse events were reported.Conclusions: HIFU ablation, in combination with GnRHa and LNG-LUS, might be a safe and effective alternative in the treatment for women with adenomyosis.

Pan-Cancer Analysis of DEAH-Box Helicase 16 Expression and Prognostic Significance / 中国医科大学学报

Objective To investigate the expression and prognostic significance of DEAH-box helicase (DHX16) by pan-cancer analysis. Methods The expression and prognostic significance of DHX16 were analyzed using the UALCAN web-portal. Gene ontology and kyoto encyclopedia of genes and genomes analyses of proteins interacting with DHX16 were performed using DAVID 6.8 functional annotation software. Results DHX16 was highly expressed in bladder urothelial carcinoma, head and neck squamous cell carcinoma, esophageal carcinoma, liver hepatocellular carcinoma, and cholangiocarcinoma (all P ＜ 0.001). Proteins interacting with DHX16 were located mainly in catalytic step 2 spliceosome, nucleoplasm, and cell membrane, and participated in mRNA splicing and processing, binding to poly (A) RNA and nucleic acids, and RNA helicase activity. Spliceosome, mRNA surveillance, RNA degradation, and transport pathways were implicated. Conclusion The high expression of DHX16 is helpful for the prognosis of bladder urothelial carcinoma prognosis, and unfavorable for prognoses of adrenocortical carcinoma, sarcoma, brain lower grade glioma, liver hepatocellular carcinoma, and acute myeloid leukemia. Thus, DHX16 may have value as a prognostic marker.

Investigation on grass-roots nurses' core competency in Jiangsu Province / 中华护理杂志

Objective To investigate the core competency of grass-roots nurses in Jiangsu Province,and to provide references for training grass-roots nurses.Methods The Competency Inventory for Registered Nurse(CIRN)was used to investigate 593 grass-roots nurses in Jiangsu Province.Results The overall score of importance judgement for core competency was 4.45±0.73.The overall execution frequency was 4.26±0.69.There were significant differences in the importance judgment of clinical care,interpersonal relationship,leadership,and professional development among nurses with different job titles(P＜0.05).There were significant differences in the execution frequency of clinical care,interpersonal relationship,ethical/legal practice,critical thinking and scientific research among nurses with different job titles (P＜0.05).There were certain differences in the importance judgment and the execution frequency for core competency among nurses with different job titles and nurses from different institutions.Conclusion The score for grass-roots nurses' core competency in Jiangsu Province was not high and unbalanced.There were differences between the importance judgment and the execution frequency.Hospital managers should take appropriate measures to address existing problems and improve the grass-roots nursers' core competency according to different characteristics.

Establishment of Scoring System for Risk Factors of Invasive Fungal Infection in Patients with Hematologic Diseases / 中国药房

OBJECTIVE:To establish a risk scoring system for identifying invasive fungal infection(IFI)patients with hematologic diseases. METHODS:Risk factors were investigated among 200 patients diagnosed with IFI and 200 control patients at the same time from Jan. 2008 to Dec. 2015. The single factor analysis and Logistic multivariate regression analysis were conducted for potential risk factors to screen and assign risk factors of IFI. The risk scoring system of IFI was established,the performance of scoring system was evaluated by receiver operating characteristic(ROC)curve. Using the scoring system,103 patients of validation group were scored during Jan. to Jun. in 2016.The incidence of IFI in each group was compared. 18 high-risk patients were intervened by the scoring system. RESULTS:Community acquired infection,the reduction of neutrophils,fungal infection history,corticosteroids and broad-spectrum antibiotics(Enzyme inhibitors,glycopeptides,quinolones,aminoglycosides and carbapenems)were risk factors of IFI(P<0.001),and the score of them were 17,10,39,14,14 according to the regression coefficients. IFI risk scoring system was divided into low,medium and high risk(scoring 0-30,31-40,≥41),AUC of ROC curve was 0.916. The incidence of IFI in low-risk,medium-risk and high risk groups were 3.0%,10.7% and 62.5%,high-risk group was significantly higher than low and medium-risk groups(P<0.05).The incidence of IFI was 16.7% in intervention group, there was statistical significance compared to high-risk group of validation group(P<0.05). CONCLUSIONS:This scoring system shows good ability to distinguish risk stratification. It can help clinicians identifying IFI high-risk groups and timely guiding timely intervention for patients.

Prenatal diagnosis of two cases of paternal uniparental disomy of chromosome 6 / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To report on prenatal diagnosis and follow up of two patients with paternal uniparental disomy of chromosome 6 (pUPD6).</p><p><b>METHODS</b>Fetal cells were subjected to in situ culturing and G-banded chromosomal analysis. DNA samples of the fetuses and their parents were also analyzed with single nucleotide polymorphism microarray (SNP array).</p><p><b>RESULTS</b>Both fetuses had a normal male karyotype. SNP array analysis showed both have carried pUPD6.</p><p><b>CONCLUSION</b>pUPD6 can lead to transient neonatal diabetes mellitus type 1. Homozygous status of recessive mutations, disorder of gene imprinting, and its influence on placental function are the main factors to be considered during prenatal diagnosis and genetic counseling for pUPD6.</p>

Efficacy of Sitagliptin Combined with Irbesartan in the Treatment of Early Diabetic Nephropathy / 中国药师

Objective: To observe the clinical efficacy and safety of the combination therapy of sitagliptin and irbesartan in the treatment of early diabetic nephropathy.Methods: Totally 49 cases of initial diagnosed diabetic nephropathy were randomly divided into the observation group (25 cases) and the control group (24 cases).On the basis of diabetic diet, health education and regular hypoglycemic drugs, the control group was treated with irbesartan tablets, 150 mg, po , qd, and on the basis of the control group, the observation group was treated with sitagliptin tablets 100mg, po , qd.All the patients were treated for 3 months.The fasting blood glucose (FBG), postprandial blood glucose (PBG), glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), urinary microalbumin (mAlb) and body massindex(BMI) were compared between the groups before and after the treatment.Results: After the treatment, FBG, PBG, HbA1c, SBP, DBP and mAlb in the observation group were significantly lower than those before the treatment (P＜0.05).Hypoglycemia occntrredin in one patient in the observation group.There were no significant changes in FBG, PBG and HbA1c in the control group (P＞0.05), and SBP, DBP and mAlb decreased significantly (P＜0.05).After the treatment, the decrease of FBG, PBG, HbA1c and mAlb in the observation group was more significant than that in the control group, and the difference was statistically significant (P＜0.05).The decrease of blood pressure between the groups was not statistically significant (P＞0.05).Hypoglycemia occnrredin in one patient in the observation group.There was no significant difference in BMI between the groups and before and after the treatment (P＞0.05).There was no significant difference in the incidence of hypoglycemia between the groups after the treatment (P＞0.05).Conclusion: The combination of sitagliptin and irbesartan in the treatment of early diabetic nephropathy can effectively decrease blood glucose, reduce mAlb excretion and delay the progression of nephropathy.

Effect of gastric capsule combined with psychological intervention on immune function and quality of life in patients with advanced gastric cancer / 中国生化药物杂志

Objective To investigate the effect of gastric capsule combined with psychological intervention on immune function and quality of life in patients with advanced gastric cancer.Methods A total of 130 patients with advanced gastric cancer were enrolled in this studyfrom July 2014 to August 2016 in our hospital,andrandomly divided into two groups.Twogroups were treated with chemotherapy,andobservation group was treated anotherwithWeinaian capsule.The immune indexes, quality of life and side effects of the 2 groups before and after chemotherapy were compared and analyzed.Results After chemotherapy,CD4+、CD8+、CD4+/CD8+、CD3+ and NKlevel of observation group were better than that of control group(all P<0.05).After chemotherapy,SF-36 score of physical function, health status, vitality, emotional and mental health scores of observation group werebetter than that of control group(all P<0.05).During chemotherapy,proportion of gastrointestinal reaction and liver and kidney injury of observation group were 35.38% and 21.54%,lower than that of control group 63.08% and 40.00%(all P<0.05).Conclusion Weinaian capsule can improve immunologic function of advanced gastric cancer patients undergoing chemotherapy and reduce adverse reactions,so as to improve the quality of life of patients.

Effect of Standardized Pain Management on Old Patients after Hip Fracture Surgery / 中国康复理论与实践

Objective To observe the effects of standardized pain management on old patients with hip fracture. Methods From January, 2015 to June, 2016, 75 old patients (more than 58 years old) with hip fracture were randomly divided into control group (n=37) and observa-tion group (n=38). The control group accepted routine pain management, while the observation group accepted standardized pain manage-ment. They were assessed with Visual Analogue Score (VAS) of the most intensive pain, and their scores for satisfaction were compared. Re-sults There was no significant difference in VAS between two groups before operation (Z=0.845, P>0.05). The VAS was significantly lower in the observation group than in the control group postoperatively (Z=5.427, P<0.001). The scores of satisfaction was more in the observa-tion group than in the control group (t=21.346, P<0.001). Conclusion Standardized pain management can significantly reduce perioperative pain in old patients after hip fracture surgery, and improve the satisfaction.

Research advances in human infection with avian-origin influenza A (H7N9)virus / 中华临床感染病杂志

Human avian-origin influenza A (H7N9)virus is a novel subtype of avian influenza A virus,which firstly emerged at the end of March 2013 in Shanghai and Anhui province.It rapidly spread in China within a short time,causing high morbidity and mortality,arousing fear and panic in public,and attracting extensive attention worldwide.The analysis of human H7N9 avian influenza virus gene shows a high affinity for α-2,6-linked sialic acid receptors expressed on human respiratory epithelial cells.At present,the sporadic cases of human H7N9 avian influenza virusare occasionally reported with an epidemic peaksat winter and spring.This article reviews clinical features,epidemiology and genetic characteristics of H7N9 avian influenza virus,proving scientific evidences foreffective prevention and control of H7N9 virus infection.

Construction of a high efficient pancreatic duodenal homeobox 1/insulin dual-reporter vector and its preliminary application / 中国组织工程研究

BACKGROUND:Islet beta cell replacement therapy is one of the most promising approaches for treating type 1 diabetes mellitus. However, its large scale application is hampered by a shortage of islet beta cells for transplantation. Pluripotent stem cells are one of ideal seed cells for islet beta cell replacement therapy, but pancreatic beta-cell differentiation is time-consuming and labor-intensive. OBJECTIVE:To construct a high efficient pancreatic and duodenal homeobox 1 (Pdx1)/insulin dual-reporter vector and to monitor the key genes expression during pancreatic beta-cell differentiation from pluripotent stem cells. METHODS:In order to construct a high efficient Pdx1/insulin dual-reporter vector, puromycin resistance gene was firstly introduced into pTiger vector, and then the original 410 bp mouse Ins1 promoter of the vector was replaced by 646 bp mouse Ins1 promoter. Finally, the dual-reporter vector was transduced into INS-1 and human induced pluripotent stem cells to testify its function. RESULTS AND CONCLUSION:The high efficient Pdx1/insulin dual-reporter vector was constructed successfully. The vector successfully acquired puromycin resistance gene and high gene expression efficacy of insulin in INS-1 cells. The specific gene expression pattern of Pdx1/insulin was first found in INS-1 cells. To conclude, the real-time monitoring function of Pdx1/insulin expression is preliminarily confirmed during pancreatic beta-cell differentiation.

Effects of Simvastatin on myocardial apoptosis and oxidative stress mechanism in immature rabbits with chronic heart failure / 中华实用儿科临床杂志

Objective To observe the effects of Simvastatin on myocardial apoptosis and oxidative stress mechanism in immature rabbits with chronic heart failure.Methods Thirty-six male New Zealand big-eared immature rabbits were randomly divided into 3 groups:Adriamycin(ADR) ± Simvastatin group(ADR-s group,n =12),in which ADR(1.5 mg/kg) received injection via the auricular vein of rabbits weekly,and the rabbits received oral Simvastatin [1.5 mg/(kg · d)] simultaneously for 12 weeks;ADR group (n =12),in which the rabbits received ADR like ADR-S group,and 9 g/L saline instead of Simvastatin;control group (CON group,n =12),which received the same amount of 9 g/L saline.Echocardiography examination was performed in 13th week.Myocardial fibrosis degree was detected by using MASSON staining,and the myocardial apoptosis was detected by using terminal deoxynucleotidyl transferase dUTP nick end labeling.Colorimetric method was used to detect the myocardial concentration superoxide dismutase (SOD) and malondialdehyde (MDA).Enzyme-linked immunosorbent assay was used to detect serum B-type brain natriuretic peptide (BNP) level.Results (1) In CON group,the immature rabbits were all alive.Four rabbits died in ADR group,and the survival rate was 66.7％,while 2 rabbits died in ADR-s group,and the survival rate was 83.3％.(2)Compared with CON group,the left ventricular end diastolic diameter (LVEDd) and left ventricular end systolic diameter (LVESd) in ADR-s group and ADR group increased [(11.90 ±1.09) mm,(ll.34 ±0.92) mm vs.(10.73 ±0.48) mm;(9.80 ±0.88) mm,(8.47 ± 1.23) mm vs.(7.31 ±0.36) mm];left ventricular fractional shortening(LVFS) and left ventricular ejection fraction(LVEF) decreased [(17.65 ± 1.70)％,(22.58 ± 2.19)％ vs.(31.79 ± 2.58) ％;(41.35 ± 3.19) ％,(49.17 ± 3.53) ％ vs.(64.34 ± 3.97) ％],and all the differences were significant(all P ＜ 0.05);LVEDd and LVESd in ADR-s group were lower than those of ADR group,while LVEF and LVFS in ADR-s group were higher than those of ADR group,and the differences were significant(all P ＜ 0.05).(3)MASSON staining:compared with ADR group,there was less myocardial cell hyperplasia of fibrous tissue in ADR-s group.(4) Compared with CON group,the apoptosis index was higher in ADR and ADR-s group [(34.25 ±11.13) ％,(24.00 ±6.85)％ vs.(16.58 ± 5.34)％],but ADR-s group had less than ADR group,and the differences were significant (all P ＜ 0.05).(5) Compared with ADR group,SOD activity of ADR-s group was higher [(13.40 ± 2.68) kU/L vs.(10.66 ± 2.99) kU/L],but MDA content was lower [(5.67 ± 1.36) μmol/mg vs.(7.08 ±0.98) μmol/mg],and the differences were significant (all P ＜0.05).(6) Serum BNP level in ADR group and ADR-s group was higher than that of the CON group[(33.28 ±9.58) μg/L,(26.71 ±6.72) μg/L vs.(13.56 ±2.82) μg/L],while was higher in ADR group than that of ADR-s group,and the differences were significant (all P ＜ 0.05).Conclusions Simvastatin can protect cardiac function of immature rabbits with chronic heart failure.The possible mechanism may be the up-regulation of myocardial SOD activity,reduction of cell lipid peroxidation and inhibition of myocardial apoptosis.