9β,11β-Epoxypregn-4-ene-17α,21-diol-3,20-dione 21-acetate (Ⅰ) is a substrate for the production of 9β,11β-Epoxypregn-1,4-diene-17α,21-diol-3,20-dione (Ⅳ),which is a key precursor for the production of many 9-fluoro-substituted corticosteroid hormones.By comparing whole cells catalysis and cellular lysates conversion,it was found that whole cells of Mycobacterium sp.MS136 could only convert Ⅰ to 9β,11β-Epoxypregn-4-ene-17α,21-diol-3,20-dione (Ⅱ),and Ⅰ can be effectively converted toⅣ by cellular lysates.The reaction order is that Ⅰ is spontaneously hydrolyzed to Ⅱ and Ⅱ undergoes C1,2-dehydrogenation reaction to Ⅳ.In order to improve the productivity of Ⅳ,the key genes kstD,kstD3 and kstDM encoding C1,2-dehydrogenase (KSTD) were overexpressed in Mycobacterium sp.MS136 to enhance the C1,2-dehydrogenation reaction rate,and the results showed that 1 g/L substrate Ⅰ can be converted by recombinant strain MS136-kstDM cellular lysates at pH 7.0,the productivity of Ⅳ reached 78.4％ after 45 h,which is 38.9％ higher than original strain.The reaction rate is enhanced by optimizing the pH,and the results showed that 1 g/L substrate (Ⅰ) can be converted by recombinant strain MS136-kstDM cellular lysates at pH 7.5,the productivity of Ⅳreached 92.8％ after 45 h,which was 63.4％ higher than original strain.

Objective To enhance the quality and efficiency of the outpatient cashier service.Methods A comprehensive outpatient cashier management system based on RFID was developed and put into use.Results The system could be used in outpatient cashier department for attendance checking,schedule management,bonus distribution,personnel management,data statistics and report printing.Conclusion The comprehensive outpatient cashier management system can improve the efficiency of the outpatient department.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Occupational Exposure ; prevention & control ; Poisoning ; epidemiology ; Young Adult

Robotic system helps surgeons in performing surgery. Currently Da Vinci system is the most popular. Da Vinci system has been used for the stomach and bowel diseases in 27 cases(18 cases of stomach and 9 cases of colon and rectum) in the Zhongshan Hospital, Fudan University. Accurate preoperative staging is crucial, and Da Vinci system is advantageous in lymph node dissection, preservation of nerve plexus, and complete resection of mesorectum. Adoption of gastrointestinal tract reconstruction technique should depend on the operation and experience in surgery. Though Da Vinci system has limitations and the cost is high, it is believed to be the future trend.
Digestive System Surgical Procedures ; methods ; Humans ; Robotics ; methods

Objective To explore the expression and mechanisms of MMP-9 in vascular remodeling of two-kidney and one-cliped hypertension rats. Methods Male Wistar rats were randomly divided into sham operation group( n = 10), two-kidney and one-clip model (2KIC) group ( n = 10) and telmisartan group ( n = 7 ). Telmisartan group were injected with telmisartan every day. The blood pressure was determined every week. The morphologic change of carotid artery and thoracic aorta was observed with HE stainning 8 weeks after treatment with telmisartan.Arteries was performed to evaluate the expression of MMP-9 with immunohistochemisty. Results The blood pressure,vessel wall,and the expression of MMP-9 in model group were significantly higher than that of control group.Telmisartan nearly normalized arterial pressure and suppressed all these changes. Conclusion MMP-9 was related to vascular remodeling and Telmisartan could regulate vascular remodeling in 2-kidney and 1-cliped hypertension rats by inhibiting the pathway of MMP-9.

Objective To evaluate cerebrospinal fluid adenosine deaminase(CSF-ADA)activity in the diagnosis of tuberculous meningitis(TMB), and to observe its dynamic changes. Methods A total of 160 patients were included and were divided into two groups: 76 cases of TBM and 84 cases of non-TBM.Among the cases of non-TBM, there were 36 cases of bacterial meningitis, 30 cases of viral meningitis and 18 cases of cryptocoocal meningitis. All the patients were measured with their CSF-ADA activity by Enzymecoupled assay(Trinder method)and 47 patients of TBM were measured again after 2 weeks' and 6 weeks'antitubercular therapy. Results were expressed as(-x)± s. Mann-Whitney U test and paired-samples t test were used. Results CSF-ADA activity in TBM group was(12.9 ±6.4)U/L, while that in the non-TBM group was(6.0 ± 4.1)U/L, the difference was of statistical significance(U = 7.860, P ＜ 0.05). With the cutoff value of 9 U/L, the sensitivity and specificity to differentiate TBM from non-TBM was 84.21% and 83. 33%, respectively. CSF-ADA activity decreased in TBM patients after antitubercular treatment.Conclusions CSF-ADA activity can be an effective laboratory marker for early differential diagnosis of TMB with the cut-off value of 9 U/L. Dynamic changes of CSF-ADA activity may be a indicator for the effect of antitubercular treatment.

Teaching competency is one of the basic skills for teachers to accomplish daily teaching routine.This article focused on issues like imbalanced development in teaching competency,young teachers' lack of solid basic teaching ability,teachers' weak research ability and their lack of research ability to support teaching process in local medical colleges.In theory it systematically explained the teachers' teaching competency structure.Through the implementation of three linkage training of university-faculty-teaching and research department,normalized and institutionalized training for teachers from teaching-hospital,cooperation between clinical and basic medicine teachers,teachers' basic teaching ability was improved.And by transforming teaching evaluation philosophy,setting teaching quality standards at different levels,strengthening teachers' teaching introspection,teachers' ability in teaching evaluation was increased.Besides,by delivering encouragement policy and project driven teachers were guided to upgrade research ability in order to reflect on teaching.

Objective To explore the risk factors and clinical features of systemic lupus erythematosus (SLE) patients with venous thromboembolic disorders (VTE). Methods Twenty SLE patients with VTE (VTE group) and 40 SLE cases without VTE (control group) were retrospectively analyzed for clinical and laboratory features. T test, Mann-Whitney U rank sum test, χ2 test, Logistic regression analysis were used for statistical analysis. Results The prevalence of VTE in SLE patients was 1.5%(20/1 326). Renal involvement, increased blood pressure, history of lower extremity deep vein catheter, merging with antiphospholipid antibody syndrome (APS) could be seen more frequently in VTE group than control group ( χ2=5.508, 7.033, 5.208, 7.882, respectively), and the difference were statistically significant (both P<0.05). Hydroxychloroquine dosage used in the VTE group (133±119) mg/d was lower than that of the control group (211±126) mg/d (t=2.156, P=0.034), antiplatelet drug use rate was lower than the control group too, the difference were statistically significant ( χ2=7.080, P=0.008). Logistic regressions showed that renal involvement [OR=5.5, 95%CI (3.6, 12.7), P=0.003], lower C3 level [OR=2.3, 95%CI (1.8, 5.2), P=0.005], SLEDAI activity score [OR=8.13, 95%CI (5.2, 7.3), P=0.001] were independent risk factors for VTE in SLE. Conclusion SLE patients with renal involvement, increased blood pressure, history of lower extremity deep vein catheterization or complicated with APS were risk factors for VTE, while hydroxylchloroquine, antiplatelet drugs may help prevent VTE.

Objective To investigate the clinical features of rheumatoid arthritis (RA) associated with thyroid function abnormalities.Methods Serum thyroid function,anti-thyroglobulin antibodies (TGAb) and anti-thyroid peroxidase antibodies (TPOAb) were detected in 186 RA patients.Clinical data were then analyzed.Comparison of continuous data between groups was made by t test,while comparison of categorical data was made by x2 test.The non-normal distribution of the data was analyzed by Mann-Whitney U rank sum test.Results Fifty-six RA cases (30％) had abnormal thyroid function,including 25 low T3 syndrome cases,16 subclinical hypothyroidism cases,10 hypothyroidism cases and 5 Graves' disease cases.Among them 23 cases were diagnosed as Hashimoto's thyroiditis.The positive rate in the hypothyroidism group with chills (45 cases,80.3％,x2=99.94),lazy words (14 cases,25.0％;x2=7.896),lethargy (24 cases,42.9％;x2=7.433) and abdominal distension (21 cases,37.5％;x2=7.15) was higher than that in the group with normal thyroid function (all P＜0.05).Level of serum high density lipoprotein was decreased in hypothyroid group [(1.0±0.5) mmol/L vs (1.4±0.6) mmol/L,t=4.087,P＜0.05].Patients with abnormal thyroid function had higher positive rate of ANA [(10 cases,7.7％) vs (25 cases,44.5％),x2=34.98],anti-SSA [(3 cases,2.3％) vs (23 cases,41.1％),x2=48.91],anti-SSB [(2 cases,1.5％) vs (12 cases,21.4％),x2=22.25],TGAb [(20 cases,15.4％) vs (43 cases,76.7％),x2=65.88] and TPOAb [(13 cases,10.0％) vs (27 cases,48.2％),x2=35.90] than those with normal thyroid function (all P＜O.05).Conclusion Rheumatoid arthritis is often accompanied by thyroid disease.The positive rate of auto-antibodies in RA with abnormal thyroid function is higher than those with normal thyroid function and has no relationship with the disease activity.

OBJECTIVE To investigate the application of antibacterials in patients accepted operation in grass-roots(hospitals),so to standardize the application of antibacterials and cut down the medical cost.METHODS Full-time administrators for nosocomial infection investigated the application of antibacterials in patients who accepted(operation) in Sep 2004,and filled in the questionnaires.RESULTS In 1 383 cases of 11 hospitals the application rate of antibacterials was 98.63%;in which 86.50% were for prophylactic usage and 13.50% for therapeutic usage;(29.90%) for single antibiotics treatment and 50.15% for bigeminy,18.70% were for trigeminy.Time of(application) differentiated(6.90,7.00,6.60d) fromⅠto Ⅲ kinds of operation.Per capita cost of antibacterials was $956.50(47.60%).CONCLUSIONS High cost of antibacterials results from such factors as multiple kinds,long time and(combined) application.