Objective Based on the result that a gene coding for human HSS had been identified and prokaryotically expressed, this study is aiming to investigate the proliferative and protective effect of recombinant HSS on hepatoma cells. Methods hHSS protein was produced in BL\|21 strain of E.Coli containing pET\|42a vector and purified with His\5Tag affinity chromatography. A various dosages of 80\|400??g/L were administrated into cell culture. The cell proliferation was analyzed by MTT, cell\|count and flow cytometry methods. Furthermore, cellular growth signaling as indexed by phosphorylation of mitogen\|activated protein kinase (MAPK) was determined with Western blot. In addition to cell growth, protection of hHSS on the cells against H\-2O\-2 was also observed. Results It was showed that recombinaht HSS of 400??g/L was able to promote DNA synthesis by 21\^5% as compared to non\|treated cells. After 24?h of HSS action, the cell division measured by MTT method as well as cell\|count was significantly enhanced. Meantime, it was indicated that the phosphorylation of MAPK Thr202/Tyr204 was increased in 79\^0% as compared with that of the non\|treated cells. Pretreatment of the cells with hHSS for 12?h prior to H 2O 2 injury preserved the survival of them.Conclusion It is postulated that hHSS is an active protein to stimulate liver proliferation. [

Objective To observe the morphologic changes of pancreatic islets in diabetic rats and the protective effects of rosiglitazone natrium (RSG) on the remnant islet.Methods 8 rats were randomly selected from 68 male Sprague-Dawley rats for normal control group (group A),the rest were administered with STZ,and those with FBG≥16.7mmol/L were served as diabetic models,then the rats were randomly assigned as RSG-treated group (group B,n=24).RSG were applied via intragastric administration at a dose of 5mg/(kg·d) in group B.72 hours after the administration of STZ and 1-,2-,4 and 7 week after the administration of RSG,4 rats were randomly selected respectively,pancreas specimens were obtained and preserved.The morphologie changes were observed under light microscopes and transmission electron microscope.Results The diabetic symptoms of the rats in groupe B lessened significantly,and the FBG levels were decreased gradually,the morphologic injuries of remnant islet were recovering. The amount of secretory granule in beta cells increased gradually.Conclusion Rosiglitazone natrium call attenuate morphologic injuries of the islets and protect the remnant islet in type 1 diabetes mellilus rats.

Objective: To investigate the risk factors of scrub typhus complicated with acute respiratory distress syndrome (ARDS) and provide help for the prevention and treatment of this severe disease. Methods: A retrospective analysis on the clinical data of 176 scrub typhus patients in the First Affiliated Hospital of Guangxi Medical University from 2009 to 2016 was conducted. The patients were divided into ARDS group (n=25) and non-ARDS group (n=151). Age, sex, the time from onset to diagnosis, clinical characteristics, laboratory examinations within 24 hours of admission, and acute physiology and chronic health evaluation (APACHE)Ⅱscore were recorded. The differences of clinical characteristics between two groups were compared, and the relevant factors were analyzed. Chi-square test, t-test, and Mann-Whitney U test were chosen for the comparison of categorical data and measurement data of normal or non-normal distribution, respectively, then statistically significant variables were included into logistic regression analysis. Results: Fever (100.0%) was the most common clinical feature and elevated alanine aminotransferase (95.4%) was the most frequent laboratory abnormality. Age (t=3.055), APACHEⅡscore (t=5.592), D-dimer (t=2.704), the time from onset to diagnosis (t=5.719), serum level of creatinine (t=4.099), and the incidence of hepatosplenomegaly (χ²=5.202) in ARDS group were all higher than those in non-ARDS group (all P<0.05), while the platelet count, serum level of albumin in ARDS group were both lower than those in non-ARDS group (both P<0.05). Multiple factor logistic regression analysis demonstrated that age, APACHEⅡscore, D-dimer, the time from onset to diagnosis, and the platelet count were independent risk factors for scrub typhus complicated with ARDS. Fifteen patients died among the 176 cases, with eight (32%) in the ARDS group and seven (4.6%) in the non-ARDS group, the difference between the two groups was statistically significant (χ²=20.6, P<0.01). Conclusion Patients with scrub typhus should be definitely diagnosed at an early stage. Meanwhile, monitoring the risk factors of scrub typhus patients complicated with ARDS, and taking effective treatment can improve the prognosis of scrub typhus patients.

Objective: To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods: The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non-pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results: (1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P<0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P<0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95% CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95% CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant (60.6% vs 84.4%, χ²=16.647, P<0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95% CI 0.832-0.909, P<0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95% CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.

Objective:To explore the regulatory role and mechanism of tribbles pseudokinase 3 (TRB3) on hepatocarcinoma (HCC) cells proliferation, apoptosis and migration.Methods:Immunohistochemistry and Western blot were used to detect TRB3 expression in cancerous and adjacent cancerous liver tissues of HCC patients. TRB3 expression was detected in vitro in HepG2 and Huh7 hepatocarcinoma cell lines. Simultaneously, CCK8 and EdU were used to detect cell proliferation after TRB3 targeted inhibition with small interfering RNA. CCK8 and EdU were used to detect cell proliferation. Flow cytometry assay was used to detect apoptosis. Transwell assay was used to evaluate migration ability. Simultaneously, Western blot was used to detect changes in apoptosis, migration-related proteins and AKT phosphorylation activity. The mean comparison between the two groups was performed by t-test, and the comparison between multiple groups was performed by one-way analysis of variance.Results:Western blot showed that the expression of TRB3 was significantly up-regulated in HCC tissues. Compared with normal liver tissues adjacent to cancer, the relative expression levels were 0.78 ± 0.12 and 0.29 ± 0.09, respectively, P < 0.01, and the difference was statistically significant. After interfering siRNA inhibited TRB3, CCK8 and EdU tests showed that the proliferation activity of HepG2 and Huh7 cells were significantly weakened ( P < 0.05). Flow cytometry results showed that the apoptotic proportions of HepG2 and Huh7 cells was significantly increased ( P < 0.01). Western blot also showed that the expression of apoptosis regulatory proteins BAX and BIM were significantly increased ( P < 0.01). Transwell assay results showed that the migration ability of HepG2 and Huh7 cells was decreased ( P < 0.05), and the expression of migration regulatory proteins MMP4 and MMP9 was also significantly down-regulated. Western blot results showed that the AKT phosphorylation level was significantly increased. Conclusion:TRB3 regulates hepatocarcinoma cells proliferation, apoptosis and migration by inhibiting the AKT phosphorylation activity. Therefore, TRB3 may be a potential target site for the liver cancer treatment.

Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.

Objective To explore the occurrence and related factors of diarrhea in the early stage of enternal nutrition in critically ill patients, therefore providing guidance for the optimization of enteral nutrition. Methods A prospective cross-sectional study was conducted in 29 ICUs of 28 general hospitals of Zhejiang Province between June 1 and October 1, 2016. Patients who were admitted to ICU required for enteral nutrition were included and continuously observed for over 7 days or till discharged from ICU. The patient's general characteristics, severity of disease, enteral nutrition, diarrhea-related and prognostic indicators were recorded. Multivariable logistic regression was performed to analysis risk factors associated with diarrhea and in-hospital mortality. Results A total of 533 critically ill patientswere enrolled in this study. The overall incidence of diarrhea was 30.8％ (n = 164). Diarrhea occurred most frequently on the three days after EN, with a median duration of 2 (1, 3) days. The daily incidence of diarrhea were significantly different between groups (all P< 0.05), which were gradually reduced on day 7. Multivariable logistic regression analysis showed that prokinetic drugs (OR=1.82; 95％ CI: 1.24-2.65), APACHE II score (OR=1.04; 95％ CI: 1.02-1.07), post-pylorus enteral feeding (OR=1.90; 95％ CI:1.11-3.36) were independent risk factors for diarrhea, while interruption of EN (OR=3.74; 95％ CI: 1.85-7.54), APACHE II score (OR=1.07; 95％ CI: 1.04-1.11), vasoactive agent (OR=2.31; 95％ CI: 1.42-3.77), and timing (>48 h) (OR=2.00; 95％ CI: 1.08-3.70) were independent risk factors for in-hospital mortality. Conclusions Our study showed that APACHE II score, the use of prokinetic drugs, and post-pylorus enteral feeding were risk factors for diarrhea. Patients suffering diarrhea experienced increased ICU length of stay, increased the time of mechanical ventilation and in-hospital mortality compared with patients without diarrhea. Interruption of EN induced by diarrhea significantly increased the risk of in-hospital mortality.

Rapid and accurate recognition of human action and road condition is a foundation and precondition of implementing self-control of intelligent prosthesis. In this paper, a Gaussian mixture model and hidden Markov model are used to recognize the road condition and human motion modes based on the inertial sensor in artificial limb (lower limb). Firstly, the inertial sensor is used to collect the acceleration, angle and angular velocity signals in the direction of , and axes of lower limbs. Then we intercept the signal segment with the time window and eliminate the noise by wavelet packet transform, and the fast Fourier transform is used to extract the features of motion. Then the principal component analysis (PCA) is carried out to remove redundant information of the features. Finally, Gaussian mixture model and hidden Markov model are used to identify the human motion modes and road condition. The experimental results show that the recognition rate of routine movement (walking, running, riding, uphill, downhill, up stairs and down stairs) is 96.25%, 92.5%, 96.25%, 91.25%, 93.75%, 88.75% and 90% respectively. Compared with the support vector machine (SVM) method, the results show that the recognition rate of our proposed method is obviously higher, and it can provide a new way for the monitoring and control of the intelligent prosthesis in the future.

OBJECTIVE: To analyze the clinical characteristics and pregnancy outcomes of pregnant women complicated with coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 3 pregnant women with COVID-19 admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 19 to February 10, 2020 were retrospectively analyzed. RESULTS: There was one case in the first-trimester pregnancy (case 1), one in the second-trimester pregnancy (case 2) and one in third-trimester pregnancy (case 3). Cough, fever, fatigue, lung imaging changes were the main manifestations. The white cell count, lymphocyte percentage had no significantly changes in case 1 and case 3, while the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 elevated. The lymphocyte count and lymphocyte percentage decreased and the inflammatory indicators significantly increased in case 2. All patients were treated with antiviral, antitussive, oxygen inhalation; case 3 received glucocorticoids, case 2 with severe illness received glucocorticoids and additionally gamma globulin. All three cases were cured and discharged. Case 1 with early pregnancy chose to terminate pregnancy after discharge; case 2 chose to continue pregnancy without obstetric complications; and case 3 had cesarean section delivery due to abnormal fetal heart monitoring. CONCLUSIONS The report shows that COVID-19 in pregnancy women could be cured with active treatment, and the maternal and fetal outcomes can be satisfactory.
Antiviral Agents ; therapeutic use ; Betacoronavirus ; isolation & purification ; Cesarean Section ; Coronavirus Infections ; complications ; drug therapy ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Oxygen ; therapeutic use ; Pandemics ; Pneumonia, Viral ; complications ; drug therapy ; Pregnancy ; Pregnancy Complications, Infectious ; drug therapy ; pathology ; Pregnancy Outcome ; Retrospective Studies ; Treatment Outcome ; gamma-Globulins ; therapeutic use

The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as and . Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.