Objective To construct and evaluate a novel PAMAM dendrimer vector-DNA vaccine for schistosomiasis japonica.Methods Lysine was used to modify 4.0G PAMAM.and the modified product PAMAM-Lys was synthesized.Agarose gel electrophoresis was used to confirm the composite ratio of plasmid DNA and dendrimer.Micrestructure of the compound was observed by using transmission electronic microscopy,and the stability was analyzed by using electrophoresis.The viability of the cells transfected with dendrimers was evaluated by using a MTT technique in vitro.Fiftyty mice were immunized with purified plasmid pJW4303,pJW4303-Sj23 dendrimer PAMAM-Lys and compound PAMAM-Lys/pJW4303-Sj23,respectively.The specific antibodies of the mice in each group were detected to access the immunoreactivity.Results The agarese gel electrophoresis showed that when the charge ratio of the dendrimer vector and DNA was between 2 and 4,the positive and negative charges could be counteraeted completely,and the compound was blocked completely by DNA electrophoresis.The obscrvation results with transmission electronic microscopy showed that the composition of dendrimer vector and DNA caused shrink of DNA structure.Dendrimer-DNA compound had a good stability.MTT showed the modified dendrimer vector and DNA compound system produced a lower cell toxicity on 293T cell than the unmodified Ones.Thk levels of specific antibodies of the mice immunized with PAMAM-Lys/pJW4303Sj23 were significantly higher than those of the mice immunized with naked DNA vaccine(P<0.05).Conclusions The lysinemodified PAMAM-lys is an excellent vector,and has an appropriate biocompatibility.Lysine-modification can reduce the cell toxicity of PAMAM dendrimer significantly.PAMAM-Lys can enhance the immunoreactivity of DNA vacmine which merits further application in schistosomiasis DNA vaccine.

OBJECTIVE: To evaluate the quality of reports published in recent 10 years in China about quantitative analysis of syndrome differentiation for diabetes mellitus (DM) in order to explore the methodological problems in these reports and find possible solutions. METHODS: The main medical literature databases in China were searched. Thirty-one articles were included and evaluated by the principles of clinical epidemiology. RESULTS: There were many mistakes and deficiencies in these articles, such as clinical trial designs, diagnosis criteria for DM, standards of syndrome differentiation of DM, case inclusive and exclusive criteria, sample size and estimation, data comparability and statistical methods. CONCLUSION: It is necessary and important to improve the quality of reports concerning quantitative analysis of syndrome differentiation of DM in light of the principles of clinical epidemiology.

Objective To explore the influence of non-drug bundle of care on incidence rate of VAP. Methods Prospective analysis was performed on patients with mechanical ventilation in ICU from January 2015 to December 2016. The patients were assessed daily, monitored for target, and divided into infected group and non-infected group according to incidence of VAP. Relationship between incidence of VAP and measures taken in non-drug bundle of care, with all data statistically analyzed by SPSS 19.0 for windows. Results A total of 1 326 cases were collected in this study, with 109 infected cases and 1 217 non-infected cases. It was shown in related single factor analysis that factors influencing incidence of VAP included mode of tracheal intubation (whether with subglottic secretion drainage or not), severity of clinical conditions of the patients (APACHEⅡ score >18 points), time of mechanical ventilation (>7 days), hand sanitation, the patients' compliance to operations like elevation of bed head (>30°), oral care, assessment of tracheotomy cuff pressure, monitoring of gastric residual volume, timely dumping of condensed water, and unobstructed subglottic secretion drainage (P< 0.05). It was shown in Logistic regression analysis that mechanical ventilation time was an independent factor affecting incidence of VAP (OR=30.536, P<0.01). Conclusions According to non-drug bundle of care strategies, daily evaluation should be conducted. Early off-machine and early extubation can reduce incidence of VAP.

Objective To investigate the influencing factors of peripheral infections of knee joint tumor prosthesis as well as the value of serum D-D and TLR2 in predicting the infection risks so as to provide a reference for early diagnosis of tumorous periprosthetic infection(PJI)of knee joint.Methods The patients who were treated and followed up in our department from January 2008 to June 2020 were selected.According to the inclusion and exclusion criteria,136 of the patients were selected.The data including age,gender,BMI,history of diabetes,smoking history,tumor location,stage of malignant tumor,operation time,osteotomy length,intraoperative bleed-ing,and the percentage of neutrophils,leukocytes,serum D-dimer,and serum TLR value 3 days after operation were collected.The risk factors of PJI and the diagnostic value of serum D-dimer and serum TLR were analyzed.Results The incidence of PJI was 11.76%.Postoperative chemotherapy and operation time≥180 min were the risk factors of PJI(P<0.05).The area under curve(AUC)of the combination of two indicators,serum D-dimer and serum TLR2 were 0.917,0.894 and 0.778,respectively.The AUC of TLR2 was lower than that of the combina-tion of two indicators(P<0.05);The sensitivity was 0.975,0.908 and 0.708,respectively,and the specificity was 0.75,0.75,and 0.812,respectively.Conclusion Postoperative chemotherapy and operation time≥180 min are the risk factors of PJI.The combination of D-dimer and TLR2 has good diagnostic value.

Objective To investigate the effect of real-case-based training and examination method in ICU nurses training. Methods A test group of multi-level real-case-based training was established and took the examination of nurses in ICU. The examination included the ability of disease observation and assessment, clinical thinking, application of nursing procedure and so on. The frequency of assessment was divided into three parts:once a month, every three months and every six months. Results After the real-case-based training and examination program, the comprehensive score of ICU nurses at excellent and favorable level were improved. The excellent and favorable rates of the first and the fourth season were 31. 6% and 59. 6%, which had a significant difference (χ2 =9. 161,P<0. 05). The nursing quality of the second half of year was significantly improved. There was no case of pressure sore, unplanned extubation, out for inspection. The compliance of hand washing and bed raise was improved. The incidence of ventilator associated pneumonia, catheter related bloodstream infection and urinary tract infection was decreased. The nurse training examination, education level and learning atmosphere were significantly improved (P <0. 05). Conclusions The real-case-based training and examination model can effectively improve the ICU nurses′ clinical nursing competency, and it also can promote the enthusiasm and the quality of nursing.