Dynamic characteristics of soil heavy metals and microbial communities under moss cover at different successional stages in a manganese mining area.

The mining and smelting of manganese ores and the accumulation of slag not only pollute the environment and increase the threat to biodiversity, but also adversely affect the health of human and other organisms. Therefore, it's important to study the restoration of manganese mining area. Since mosses play an irreplaceable role in the ecological restoration of mine sites, this study is carried out in a slag heap area that has been in continuous operation for about 50 years, and spatial variation is used instead of temporal variation to study the diversity of moss plants, the characteristics of soil heavy metal changes under moss cover, and the characteristics of bacterial communities in manganese mine sites at different time scales. A total of 20 moss taxa from 8 genera and 5 families are recorded, the dominant families are Bryaceae (50%) and Pottiaceae (25%), with the development of succession, the alpha-diversity index of mosses increases with the development of succession. The study area has a relatively high level of heavy metal contamination, the heavy metals Mn, V, Cu and Ni are significantly affected by succession in the Manganese mining area, and the soil heavy metal content generally shows a decreasing trend with the development of succession. Actinobacteriota, Proteobacteria, Chloroflexi Acidobacteriota and Gemmatimonadota are the dominant soil bacterial phyla in manganese mining areas (relative abundance > 10%), the composition of soil bacteria at different successional stages at the phylum level was the same, but the abundance of each bacterial community differed. The soil bacterial community in the manganese mining area is significantly affected by soil heavy metals.

Research progress of cell senescence in diabetic foot ulcers / 中华老年医学杂志

Diabetic foot ulcers are common in elderly people with diabetes.Ongoing research is aimed at unraveling the complicated molecular mechanisms underlying diabetic foot ulcers.The role of cellular aging in delayed healing of diabetic foot ulcers has been recognized.Analyzing the relationship between cellular aging and diabetic foot ulcers, examining how cellular aging delays the healing of diabetic foot wounds, and identifying treatment methods for the removal of senescent cells and for slowing down cellular senescence will provide new therapeutic targets and strategies for the development of drugs for diabetic foot ulcers.

Anti-neutrophil cytoplasmic antibody-associated vasculitis with gastrointestinal bleeding as the main symptom: a case report and literature review / 中华危重病急救医学

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has a wide range of symptoms, and it is difficult for clinicians to make a quick and correct diagnosis. On November 11, 2021, a 36-year-old male patient with AAV was admitted to the emergency and critical care department of Yichang Central People's Hospital. He was admitted to the emergency intensive care unit (EICU) with gastrointestinal symptoms (abdominal pain, black stool) as the main physical signs, and was initially diagnosed as AAV with gastrointestinal hemorrhage (GIH). No bleeding point was found after repeated gastroscopy and colonoscopy. Abdominal emission CT (ECT) showed diffuse hemorrhage in the ileum, ascending colon and transverse colon. Multi-disciplinary consultation in the whole hospital considered the diffuse hemorrhage caused by small vascular lesions in the digestive tract caused by AAV. Pulse therapy with methylprednisolone 1 000 mg/d and immunosuppressive therapy with cyclophosphamide (CTX) 0.2 g/d were administered. The patient's symptoms quickly relieved and transferred out of the EICU. After 17 days of treatment, the patient finally died of massive gastrointestinal bleeding. A systematic review of relevant literatures combined with the case diagnosis and treatment process found that only a minority of AAV patients present with gastrointestinal symptoms as their first symptoms, and patients with GIH were very rare. Such patients had a poor prognosis. This patient delayed the use of induced remission and immunosuppressive agents due to the treatment of gastrointestinal bleeding, which may be the main cause of life-threatening GIH secondary to AAV. Gastrointestinal bleeding is a rare and fatal complication of vasculitis. Timely and effective induction and remission treatment is the key to survival. Whether patients should receive maintenance therapy, the duration of maintenance therapy, and the search for markers of disease diagnosis and treatment response are directions and challenges for further research.

Potentially toxic elements have adverse effects on moss communities in the manganese mines of Southern China.

This study investigated the distribution of moss species, physiological parameters (superoxide dismutase, peroxide, catalase, and total chlorophyll), and concentrations of potentially toxic elements (Mn, Cr, Zn, Cu, Pb, and Cd) in moss communities and topsoil at the Huayuan manganese mine, Xiangjiang manganese mine, and Nancha manganese mine (Southern China). Partial least squares path modeling (PLS-PM) was then performed to determine the relationship between the indicators. Cd, Mn, and Zn were the main topsoil pollutants, followed by Pb, Cr, and Cu. A total of 73 moss species, comprising 31 genera from 17 families, and 8 community functional groups were identified. The most dominant families were Pottiaceae (30.14%) and Bryaceae (21.92%). PLS-PM revealed that increasing topsoil Mn, Cr, Zn, Cu, Pb, and Cd significantly reduced species diversity and functional diversity. These potentially toxic elements in the topsoil impeded vegetation growth by deteriorating soil conditions and subsequently altering the microenvironment of the moss communities. The community-weighted means demonstrated that functional traits of turfs and warty leaves were the adaptation of the moss communities to an increasingly dry and exposed microenvironment. Moss species with curly and narrow leaves were used to reduce contact with particulate pollutants. PLS-PM also indicated that Mn, Cr, Pb, and Cd may have a detrimental effect on superoxide dismutase, peroxide, catalase, and total chlorophyll, although further validation studies are needed.

Research progress of adipokines and coronary heart disease / 中国医师杂志

Adipokines play an important role in judging the severity and prognosis of coronary heart disease. In recent years, a series of studies have further proved the correlation between adipokines and coronary heart disease. Adipokines can be included in the risk stratification of patients with coronary heart disease and guide the formulation of clinical diagnosis and treatment strategies, and may become a potential therapeutic target of coronary heart disease. This paper mainly summarizes the role of adipokines in the clinical diagnosis and treatment of coronary heart disease.

Effect of repetitive transcranial magnetic stimulation combined with cognitive behavioral therapy on insomnia in menopausal women / 中华行为医学与脑科学杂志

Objective:To explore the effect of repetitive transcranial magnetic stimulation(rTMS) combined with cognitive behavioral therapy for insomnia(CBT-I)for menopausal women with insomnia.Methods:A total of 76 menopausal women with insomnia who were hospitalized from April 2020 to October 2021 were enrolled.Then they were randomly divided into observation group and control group, with 38 cases in each group.Both observation group and control group were treated with CBT-I. Meanwhile, the patients in observation group were treated with low-frequency repetitive rTMS, on the contrary, the patients in control group were treated with sham rTMS.The intervention lasted for 4 weeks.Insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI) and polysomnography (PSG) were all recorded at baseline and 4 weeks after intervention, as well as adverse events. Data was analyzed by SPSS 22.0 software. Data which was normally distributed, was compared by independent t-test and paired t-test. Results:(1)The scores of ISI (16.39±4.03, 15.66±4.89) and the PSQI(14.97±2.70, 14.11±3.60) in observation group and control group at baseline were not significantly different( t=-0.716, -1.190, both P>0.05). After treatment, the ISI and PSQI scores of the observation group (10.08±3.65, 9.58±1.73)were lower than those of the control group (12.82±4.47, 12.13±2.32), and the differences were statistically significant ( t=2.926, 5.440, both P<0.05). (2) After treatment, all sleep parameters were significantly improved from baseline in observation group (all P<0.05). Sleep efficiency, wake time during sleep, and number of awakenings were significantly improved from baseline in control group(all P<0.05). Compared with control group((70.38±12.99)%, (17.39±11.75)%, (13.98±6.35)%), the observation group reported a greater statistically improvement in sleep efficiency, N3% and REM%((79.52±9.31)%, (22.80±6.05)%, (18.78±6.68)%, respectively)( t=-3.526, -2.524, -3.212, all P<0.05). Neither group had serious adverse effects. Conclusion:The rTMS combined with CBT-I can significantly improve the sleep quality in menopausal women with insomnia. With its high safety rTMS combined with CBT-I may be a recommended non-drug therapy among menopausal women with insomnia.

Retrospective and cost-effective analysis of the result of Changsha Municipal Public Welfare Program by Noninvasive Prenatal Testing / 中华医学遗传学杂志

OBJECTIVE@#To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program.@*METHODS@#A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed.@*RESULTS@#NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035.@*CONCLUSION@#NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.

Blood T cell diversity associated with the prognosis of advanced non-small cell lung carcinoma treated with first-line pemetrexed based chemotherapy.

BACKGROUND: The tumor microenvironment is associated with prognosis in advanced non-small cell lung carcinoma (NSCLC). The aim of this study was to explore the relationship between blood T cell diversity and survival of patients treated with pemetrexed-based chemotherapy for nonsquamous NSCLC. METHODS: This prospective clinical study enrolled 26 patients with advanced NSCLC treated with 4-6 cycles of first-line pemetrexed combined with platinum-based therapy. The complementarity-determining region 3 (CDR3) located in the T cell receptor beta chain (TCR ß chain) was captured and deeply sequenced using next-generation sequencing (NGS) technology, and the correlation between TCR changes and efficacy after chemotherapy was analyzed. RESULTS: Patients with an inferior quarter diversity index showed a significantly shorter progression-free survival (PFS) than the others (median, 5.0 months vs. 8.1 months, P = 0.014). After two cycles of chemotherapy, the TCR diversity was significantly higher than the baseline (P = 0.034). Just as with the baseline, patients with an inferior quarter diversity index at the endpoint of cycle 2 showed a shorter progression-free survival (PFS) than the others (median, 5.0 months vs. 8.4 months, P = 0.024). CONCLUSIONS: In advanced NSCLC patients treated with first-line pemetrexed combined with platinum, the low level of blood TCR diversity at baseline with an endpoint of two cycles of chemotherapy was correlated with a poor prognosis.

The changes in resting-state functional connectivity in stroke survivors with depression / 中华物理医学与康复杂志

Objective:To analyze any changes in the functional connectivity between the seed points of the dorsolateral prefrontal cortex (DLPFC) and the whole brain, as well as any fluctuations in the low-frequency amplitude among persons with post-stroke depression (PSD). The aim was to develop correlations among functional imaging results, clinical scales, and inflammation indicators including high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), interleukin 2 (IL-2), interleukin 10 (IL-10), interleukin 17a (IL-17a) and interferon-γ (IFN-γ).Methods:Between 2016 and 2020, 55 ischemic stroke survivors were tested. The 28 scoring 7 or more on the Hamilton Depression Scale (HAMD-17) formed the PSD group, while the 27 others formed the control group. Functional magnetic resonance images were collected, and serum inflammation indicators were determined.Results:When seed points in the left DLPFC were used, in the PSD group the frontal cortex (FC) decreased in one cluster, with a voxel of 129mm3 and the MNI coordinates (x=9, y=30, z=33) indicating that the anatomical automatic labeling (AAL) brain regions were the Cingulum_Ant_L, Cingulum_Mid_R and the frontal_Sup_Medial_L. When the right DLPFC was used as the seed point the FC again decreased in one cluster, with voxels of 44mm 3 and the MNI coordinates (x=-27, y=12, z=47) referring to the AAL brain region of the frontal_Mid_L. In the PSD group, the FC value of abnormal brain areas with the R-DLPFC as the seed point was positively correlated with time since stroke. In the control group, the FC value of abnormal brain areas with L-DLPFC as the seed point was negatively correlated with MoCA, while with R-DLPFC as the seed point it was positively correlated with IFN-γ. The FC values of abnormal areas of the brain showed no significant correlation with other clinical scales, inflammation indicators or lesion volume. Conclusion:Abnormal functional connections within the executive control network and between the salience networks may participate in the mechanism of PSD, and may be related to the time since stroke, cognitive functioning, and IFN-γ levels.

Metabolic disturbances and inflammatory dysfunction predict severity of coronavirus disease 2019 (COVID-19): a retrospective study

BackgroundThe coronavirus disease 2019 (COVID-19) is spreading worldwide with 16,558 deaths till date. Serum albumin, high-density lipoprotein (HDL-C), and C-reactive protein have been known to be associated with the severity and mortality of community-acquired pneumonia. However, the characteristics and role of metabolic and inflammatory indicators in COVID-19 is unclear. MethodsWe included 97 hospitalized patients with laboratory-confirmed COVID-19. Epidemiological, clinical, and laboratory indices; radiological features; and treatment were analysed. The differences in the clinical and laboratory parameters between mild and severe COVID-19 patients and the role of these indicators in severity prediction of COVID-19 were investigated. ResultsAll were Wuhan residents with contact with confirmed COVID-19 cases. The median age was 39 years (IQR: 30-59). The most common presenting symptoms were fever (58.8%), cough (55.7%), and fatigue (33%). Other features were lymphopenia, impaired fasting glucose, hypoproteinaemia, hypoalbuminemia, low high-density lipoproteinemia. Decrease in lymphocyte count, serum total protein, serum albumin, high-density lipoprotein cholesterol (HDL-C), ApoA1, CD3+T%, and CD8+T% were found to be valuable in predicting the transition of COVID-19 from mild to severe illness. Chest computed tomography (CT) images showed that the absorption of bilateral lung lesions synchronized with the recovery of metabolic and inflammatory indicators. ConclusionsHypoproteinaemia, hypoalbuminemia, low high-density lipoproteinemia, and decreased ApoA1, CD3+T%, and CD8+T% could predict severity of COVID-19. Lymphocyte count, total serum protein, and HDL-C may be potentially useful for the evaluation of COVID-19.

Comparative study on clinical effect of multidisciplinary treatment model and traditional consultation model in treatment of dangerous upper gastrointestinal hemorrhage / 中华危重病急救医学

Objective:To compare the difference of clinical effects between multidisciplinary treatment (MDT) mode and traditional consultation mode in diagnosis and treatment of patients with dangerous upper gastrointestinal hemorrhage.Methods:The clinical data of patients with dangerous upper gastrointestinal hemorrhage admitted to the department of emergency and critical care medicine of Yichang Central People's Hospital from January 2018 to December 2019 were analyzed retrospectively, taking 30 patients in traditional consultation mode from January 2018 to December 2018 as traditional consultation group, and 26 patients in MDT mode from January 2019 to December 2019 as MDT group. The recovery time of vital signs, length of intensive care unit (ICU) stay, length of hospital stay, medical expenses, rebleeding rate, surgical operation rate, amount of blood transfusion, hospital mortality, and clinical effect of the two groups were observed.Results:The recovery time of vital signs, length of ICU stay and length of hospital stay in the MDT group were significantly shorter than those in the traditional consultation group (days: 1.62±1.30 vs. 2.20±0.93, 10.04±2.82 vs. 13.27±2.86, 3.50±1.63 vs. 4.70±2.17, both P < 0.05), and the medical expenses, rebleeding rate and blood transfusion volume were lower than those in the traditional consultation group [medical expenses (ten thousands Yuan): 6.40±3.07 vs. 8.56±4.07, rebleeding rate: 15.38% (4/26) vs. 43.33% (13/30), blood transfusion volume (U): 5.54±3.20 vs. 7.71±3.83, plasma volume (mL): 330.77±258.87 vs. 458.33±322.73, cold precipitation volume (U): 4.52±4.15 vs. 6.67±4.85, platelet volume (U): 0.40±0.19 vs. 0.77±0.60, all P < 0.05]. The clinical total efficiency in the MDT group was significantly higher than that in the traditional consultation group (88.5% vs. 80.0%, P < 0.05). There was no significant difference in the surgical operation rate and hospital mortality between the two groups. Conclusions:Compared with the traditional consultation mode, MDT mode can significantly shorten the recovery time of vital signs, the length of ICU stay, the length of hospital stay, reduce blood transfusion volume, medical expense and rebleeding risk of patients with upper gastrointestinal hemorrhage, and has better clinical effect. However, there is no significant difference in surgical operation rate and hospital mortality between the two modes.

Prediction model of mid-term fatality risk after radical resection in patients with hepatocellular carcinoma based on ALBI-grade / 浙江大学学报·医学版

OBJECTIVE@#To establish a clinical prediction model of the mid-term fatality risk after radical resection in patients with primary hepatocellular carcinoma (HCC) based on the albumin-bilirubin (ALBI) grade and to assess its prediction value.@*METHODS@#Clinical data of 533 patients who received HCC radical resection in Jinhua Hospital of Zhejiang University, Jinhua People's Hospital, Jinhua Hospital of Traditional Chinese Medicine and Jinhua Guangfu Hospital from January 2010 to August 2016 were retrospectively reviewed. In the training group ( =407), Cox model was used to screen the clinical risk factors of postoperative death, and a predictive model based on ALBI grade was established and then examined in the validation group ( =126). The value of the prediction model was assessed by ROC curve and calibration curve; the prediction results of the model were visualized by the nomogram for the convenience of clinical use.@*RESULTS@#Cox model showed that ALT ≥ 80 U/L, tumor maximum diameter ≥ 5 cm, portal vein tumor thrombus and ALBI grade 2 were independent risk factors for the prognosis of patients with HCC radical resection. The prognosis index (PI) was 0.550×ALT+0.512×ALBI grade+0.872×maximum tumor diameter+1.377×portal vein tumor thrombus. The AUCs for predicting the risk of death in 12, 36 and 60 months were 0.872, 0.814 and 0.810, respectively (all < 0.01), and the goodness of fit ( ) of the established model were 0.953, 0.976 and 0.994. AUC of the established model for predicting risk of death in 36 months after resection was 0.814, which was higher than those of ALBI (AUC=0.683), BCLC (AUC=0.713), CLIP (AUC=0.689), Child-Pugh (AUC=0.645), TNM (AUC=0.612) ( < 0.05 or < 0.01).@*CONCLUSIONS@#ALT ≥ 80 U/L, maximum tumor diameter ≥ 5 cm, portal vein tumor thrombus and ALBI grade 2 are independent risk factors of patients after HCC resection, and ALBI grade-based prediction model is satisfactory in prediction of mid-term death risk of the patients.

Advances in gene editing of Corynebacterium glutamate / 生物工程学报

Corynebacterium glutamicum, an important microorganism to produce amino acids and organic acids, has been widely applied in food and medicine fields. Therefore, using editing tools to study the function of unknown genes in C. glutamicum has great significance for systematic development of industrial strain with efficient and novel production capability. Recently, gene editing has been greatly developed. Traditional gene editing based on homologous recombination and gene editing mediated by nuclease are successfully applied in C. glutamicum. Among these, the CRISPR system has been developed to be a main tool used for gene knockout of C. glutamicum due to its advantages of efficiency, simplicity and good target specificity. However, more efficient and reliable knockout system is still urgently demanded, to help develop high-performing strains in industrial application.

Protective effect of MAAs extracted from Porphyra tenera against UV irradiation-induced photoaging in mouse skin.

The objective of this study was to investigate the effect of Mycosporine-like amino acids (MAAs) extracted from Porphyra tenera skin against UV irradiation-induced photoaging using an ICR mouse model of skin photoaging and to explore the curative effects of the compounds in MAAs. The skin damage and collagenous tissue impairments induced by ultraviolet radiation were observed by histopathological analysis, and the effects of MAAs on protecting against skin damage and maintaining an intact structure of collagenous tissue were studied. The expression of NF-κB and the MAPK signaling pathway and nuclear transcription factors MMP-1, MMP-3 and TNF-α was analyzed used quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) and ELISA assays. The results showed that the MAAs extracted from Porphyra tenera contained Porphyra-334 and shinorine, which could prevent skin photoaging induced by ultraviolet irradiation and reduce the damage to collagen and elastin. Meanwhile, MAAs significantly inhibited the decrease in hydroxyproline and collagen content and protected against pathological damage to collagen fibers in photoaging skin. MAAs resulted in a reduction in the expression of interstitial collagenase (MMP-1), matrix metalloproteinases (MMP-3) and tumor necrosis factor-α (TNF-α) and a reduction in the content of tissue matrix metalloproteinase (MMPs). Furthermore, MAAs may promote procollagen synthesis by downregulating the expression of TNF-α and downregulating the levels of MMPs, which demonstrates that MAAs are involved in matrix collagen synthesis by activating the NF-kB pathway in photoaging skin. Based on these results, we concluded that MAAs protect skin from UV irradiation-induced photodamage, and therefore, MAAs may be a potentially effective agent for the prevention of photoaging.

Hepatic Resection Provides Survival Benefit for Selected Intermediate-Stage (BCLC-B) Hepatocellular Carcinoma Patients.

PURPOSE: The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the 'beyond Milan and within up-to-7' criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi's subclassification. MATERIALS AND METHODS: One thousand and one hundred three patients diagnosedwith HCC and treatedwith hepatic resectionwere enrolled in our hospital between 2006 and 2012. According to Bolondi's subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS: According to Bolondi's subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLC-B1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). CONCLUSION: In our study, HCC patients at B1 stagewere benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.

"Five-minute emergency life chain" centering on department of emergency and intensive care unit patients:experience in the integration of department of emergency and intensive care unit of Yichang Central People's Hospital in Hubei Province / 中华危重病急救医学

Yichang Central People's Hospital is a large prefecture-level tertiary hospital in Hubei Province. Since the late foundation and interdisciplinary characteritics, the department of emergency and critical care medicine faced many difficulties during development. Based on the actual situation of the hospital, leaders of the hospital and two disciplines advocated their core values of "putting patients' interests first and building team spirit". In consideration of the timeliness, multidisciplinary collaboration and importance of critical care, the department of emergency and critical care medicine in Yichang Central People's Hospital of Hubei Province was set up, and an integrated first-aid platform was established. The concept of "5-minute emergency life chain" was proposed, which highlighted the status and role of the department of emergency and critical care medicine in modern medical rescue and modern general hospitals. In the past 5 years, the emergency department and intensive care unit have made rapid development, including successful establishment of national demonstration centers for chest pain and stroke. Quality of the discipline has also been greatly improved, and a new construction path of department of the emergency and critical care medicine has been created.

"Five-minute emergency life chain" centering on department of emergency and intensive care unit patients:experience in the integration of department of emergency and intensive care unit of Yichang Central People's Hospital in Hubei Province / 中华危重病急救医学

Yichang Central People's Hospital is a large prefecture-level tertiary hospital in Hubei Province. Since the late foundation and interdisciplinary characteritics, the department of emergency and critical care medicine faced many difficulties during development. Based on the actual situation of the hospital, leaders of the hospital and two disciplines advocated their core values of "putting patients' interests first and building team spirit". In consideration of the timeliness, multidisciplinary collaboration and importance of critical care, the department of emergency and critical care medicine in Yichang Central People's Hospital of Hubei Province was set up, and an integrated first-aid platform was established. The concept of "5-minute emergency life chain" was proposed, which highlighted the status and role of the department of emergency and critical care medicine in modern medical rescue and modern general hospitals. In the past 5 years, the emergency department and intensive care unit have made rapid development, including successful establishment of national demonstration centers for chest pain and stroke. Quality of the discipline has also been greatly improved, and a new construction path of department of the emergency and critical care medicine has been created.

Diagnosis and treatment of painful leg ulcers / 中华皮肤科杂志

Painful leg ulcers are very common in clinic,including arterial ulcers,venous ulcers,autoimmune diseases-related ulcers,gangrenous pyoderma,necrobiosis lipoidica and hypertensive ulcers.At present,few painful leg ulcer-related researches have been conducted in China,and pain is only treated as a concomitant symptom of leg ulcers.However,a series of painful leg ulcer-related researches have been carried out in other countries.This review comprehensively expounds the definition,epidemiological characteristics,etiology and management of,as well as pain mechanism and assessment in painful leg ulcers.

Efficacy and Safety of Nalbuphine for Post-operative Analgesia ：a Meta-analysis / 中国药房

OBJECTIVE： To evaluate the efficacy and safety of nalbuphine for postoperative analgesia systematically， and to provide evidence-based reference in clinic. METHODS： Retrieved from Embase， Medline， PubMed， CNKI， VIP and Wanfang database， RCTs about nalbuphine hydrochloride （trial group） vs. other analgesics （control group） for postoperative analgesia were collected. After literature screening， data extraction and literature quality evaluation with modified Jadad scale， Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS： A total of 10 RCTs were included， involving 796 patients. Results of Meta-analysis showed that there was no statistical significance in satisfaction rate of analgesia [OR＝1.11，95％CI（0.70，1.74），P＝0.66]， the incidence of nausea [OR＝1.20，95％CI（0.79，1.83），P＝0.39]， vomiting [OR＝1.02，95％CI（0.69，1.50），P＝0.92] or narcolepsy [OR＝1.32，95％CI（0.47，3.76），P＝0.06] between 2 groups. The incidence of pruritus [OR＝0.29，95％CI（0.14，0.58），P＝0.000 6]， respiratory depression [OR＝0.21，95％CI（0.08，0.58），P＝0.003] and uroschesis [OR＝0.05，95％CI（0.01，0.37），P＝0.004] in trial group were significantly lower than control group. CONCLUSIONS： Nalbuphine has better efficacy and safety for postoperative analgesia.

"Five-minute emergency life chain" centering on department of emergency and intensive care unit patients: experience in the integration of department of emergency and intensive care unit of Yichang Central People's Hospital in Hubei Province / 中华危重病急救医学

Yichang Central People's Hospital is a large prefecture-level tertiary hospital in Hubei Province. Since the late foundation and interdisciplinary characteritics, the department of emergency and critical care medicine faced many difficulties during development. Based on the actual situation of the hospital, leaders of the hospital and two disciplines advocated their core values of "putting patients' interests first and building team spirit". In consideration of the timeliness, multidisciplinary collaboration and importance of critical care, the department of emergency and critical care medicine in Yichang Central People's Hospital of Hubei Province was set up, and an integrated first-aid platform was established. The concept of "5-minute emergency life chain" was proposed, which highlighted the status and role of the department of emergency and critical care medicine in modern medical rescue and modern general hospitals. In the past 5 years, the emergency department and intensive care unit have made rapid development, including successful establishment of national demonstration centers for chest pain and stroke. Quality of the discipline has also been greatly improved, and a new construction path of department of the emergency and critical care medicine has been created.