Objective To evaluate the effects of electroacupuncture (EA) at Zusanli and Chize on sepsisinduced acute lung injury (ALI) in patients.Methods Sixty patients with sepsis-induced ALI/respiratory distress syndrome,aged 43-78 yr,weighing 49-89 kg,with their APACHE-Ⅱ scores of 16-23 and oxygenation index of 125-256 mm Hg,were randomly divided into 3 groups (n =20 each):conventional therapy group (group S),conventional therapy + acupuncture at non-acupoint group (group SNE) and conventional therapy + acupuncture at acupoint group (group SE).Bilateral Huantiao and Chize points were stimulated with electric stimulator (frequency 2/50 Hz,wave length 300μs,starting at a voltage of 0 and increasing by 0.1 mA every time until the maximal tolerance level was reached) for 30 min once a day for 5 days based on the conventional therapy in group SE.In group SNE,EA was performed at the non-acupoint based on the conventional therapy and the parameters of EA were same as those previously mentioned in group SE.Before EA stimulation (T1) and at 3 and 5 days after the end of EA stimulation (T2-3),arterial blood samples were taken for blood gas analysis,oxygenation index (OI) was calculated,and APACHE-Ⅱ] scores were assessed.Venous blood samples were collected at T1 and T3 for detection of TNF-α and IL-10 concentrations in the broncho-alveolar lavage fluid (BALF) and serum (by ELISA).Results Compared with the baseline value at T1,OI was significantly increased and APACHE-Ⅱ scores were decreased at T2 and T3,and TNF-α concentrations in the BALF and serum were decreased and IL-10 concentrations in the BALF and serum were increased at T3 in the three groups (P ＜ 0.05 or 0.01).The OI was significantly higher and APACHE-Ⅱ scores were lower at T3 than at T2 in the three groups (P ＜ 0.05).Compared with group S,the OI was significantly increased at T2 and T3,APACHE-Ⅱ scores and TNF-α concentrations in the BALF and serum were decreased at T3,and IL-10 concentrations in the BALF and serum were increased at T3 in group SE (P ＜0.05 or 0.01),and no significant changes were found in the parameters mentioned above in group SNE (P ＞0.05).There were no significant differences in the incidence and survival rate of multiple organ dysfunction syndrome among the three groups (P ＞ 0.05).Conclusion EA at Zusanli and Chize is helpful in mitigating sepsisinduced ALI in patients,and regulation of the balance between proinflammatory factors and anti-inflammatory factors and inhibition of inflammatory responses may be involved in the mechanism.

Microbial fouling is important one of fouling in industrial circulating cooling water system. In suitable conditions, microorganisms that caused the forming of fouling could reproduce rapidly, which would increase evidently fouling resistance, flow resistance and corrosion rate, so much as block water cur- rent path to result in running failure of equipments. This paper introduces the concept of microbial fouling, and illuminates the status, function and characteristic of detection technology research for microbial fouling. The present known forming processes of microbial fouling and their important impact factors are summed up. The commonly used monitoring methods at home and abroad, their merits and defects, and also the latest research developments are analyzed especially in the paper. At last, the authors point out the development trends of detection technology for microbial fouling.

Chemoimmunotherapy has attracted much attention as an emerging therapy pattern for the treatment of cancers. Exploring effective drug combination schemes and reasonable delivery methods remained the key issue in current research. Herein, we designed sorafenib (SF) and anti-Tim-3 monoclonal antibody (Tim-3 mAb) co-loaded MMP2-responsive mesoporous silica nanoparticles (ST-MSNs) for combined chemoimmunotherapy of hepatocellular carcinoma (HCC). The shell of ST-MSNs was fabricated by Tim-3 mAb through matrix metalloproteinase 2 (MMP2) sensitive peptides as "gatekeepers" to prevent drug release during the blood circulation. In tumor microenvironment, the high levels of MMP2 caused the responsive shedding of Tim-3 mAb, leading to the triggerred release of SF and Tim-3 mAb. Then, SF could be delivered to tumor cells and Tim-3 mAb could be delivered to T cells, respectively. In vivo tumor inhibition study results demonstrated that ST-MSNs can significantly enhance synergistic antitumor activity compared with sequential administration of free SF solution and Tim-3 mAb solution. Meanwhile, the expression of antitumor cytokines IFN-γ, IL-12 and the percentage of CD3⁺CD4⁺ cells, CD3⁺CD8⁺ cells in tumors were upregulated after the administration of ST-MSNs, demonstrating good immunomodulatory ability. In addition, within the dosage range, the ST-MSNs had low cytotoxicity and hemolysis, and no obvious tissue toxicity was observed. All animal experiments were performed in line with national regulations and approved by the Animal Experiments Ethical Committee of Shandong University. In conclusion, this study provided a promising drug combination of chemoimmunotherapy with good application prospects for clinical HCC treatment, and exhibited a potential drug carrier for clinical chemoimmunotherapy.

Objective: This is a review of our cases and published literature on cheiro-oral syndrome (COS), to better understand its localization, etiology and outcome. Methods: In addition to our database, we reviewed the medical database (including PUBMED, BIOSIS, EMBASE, and SCOPUS) and other sources, searched by the keyword of “cheiro-oral”. The defi nition of COS was a subjective or an objective sensory disturbance confi ned to the perioral area and the fi nger(s)/hand without a detectable abnormality in mental, motor or cerebellar function. Only cases of COS where the clinicoanatomic correlation could be identifi ed by neuroimaging study, autopsy or stereotatic surgery was included. Results: There were a total of 174 patients; 85 patients from our database, 76 patients from medical database, and 13 patients from other sources. They were 111 men and 63 women. Their age ranged from 12 to 85 years; average being 58.2 years. Stroke is the leading etiology and constituted 74% of the patients. The most common location of lesion was thalamus, followed by pons and cortex. Classical unilateral COS was seen in 81% of patients, atypical COS in 19%. Whereas the lesions were from cortex to cervical spinal cord in unilateral COS, atypical COS was associated with lesions in pons or medulla oblongata. An early deterioration was seen in 16.5% of patients, especially in large cortical infarction and subdural hemorrhage. Structural lesions were found in 85% of patients. Conclusion: Classical unilateral COS do not have a high localizing value, the atypical COS is associated with lesion in pons or medulla.

Objective To investigate the association of HLA-DRB31*03,*04 and *11 alleles with alopecia areata(AA)in Han Nationality in East China.Methods Polymerase chain reaction-sequence specific primer(PCR-SSP)method was conducted in 158 Chinese Han patients with AA as well as in 172 healthy human controls in East China.The relationships of HLA-DRB1 polymorphism to age of onset,episode frequency,clinical course,family history,and severity of AA were evaluated.Results No significant differences were observed for the frequency of HLA DRB1*03,*11 alleles between the patients and human controls,while increased frequency of HLA-DRB1*04 was observed in patients(OR=1.99,Pc=0.01).Multiple logistic regression analysis revealed that HLA-DRB1*04 was more prevalent in patients with an onset after 16 years of age(OR=1.94,Pc=0.02),those without family history(OR=1.97,Pc=0.02),those with recurrent AA(OR=2.49,Pc=0.02),those with a clinical course of more than 1 year(OR=2.94,Pc=0.01),those with severe AA(OR=3.53,Pc=0.00)and tbose with single episode of AA(OR=1.83,Pc=0.04)in comparison with the normal human controls.Conclusion This study demonstrates that HLA-DRB1*04 allele is associated with the occurrence and clinical types of AA in Han Nationality in East China.

Objective investigate the analgesic effect of dexmedetomidine combined with remifentanil in patients with mechanical ventilation after ICU surgery. Methods 120 patients with ICU underwent mechanical ventilation were divided into control group (propofol combined remifentanil) and observation group (dexmedetomidine remifentanil) according to the random number table method, 60 cases each group. Record the two groups of total sedation time, withdrawal time after the withdrawal, analgesic effect, adverse reactions. Results The scores of SAS score and CPOT were (3.98±0.52) and (2.23±1.04), respectively, which were significantly lower than those in the control group (4.36±0.96) and (3.46±2.23), respectively (P<0.05). (691.28±236.58) min and (1.22±0.05) min were significantly shorter than those in the control group (2642.33±341.58) min, (3.56±0.74) min, P<0.05, respectively. The adverse reaction rate was 3.33% (2/60) in the observation group, which was significantly lower than that in the control group (13.33%, 8/60),( χ2=3.92, P=0.04). Conclusion ICU postoperative mechanical ventilation patients with dexmedetomidine combined with remifentanil has a good analgesic effect, and is conducive to the patient wake up, less adverse reactions, with a certain safety.

We present an unusual case of an unstable pelvic fracture during pregnancy period, who suffered fetal death and splenic rupture simultaneously which developed massive delayed hemorrhage in abdomen. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. A cesarean section and splenectomy could rescue the maternal life from the hemorrhage situation. Successful treatment of these rare cases is possible with careful pre-, peri-, and post-operative evaluation of the mother and fetus by a multidisciplinary team.
Cesarean Section ; Female ; Fetal Death ; Fractures, Bone ; Hemorrhage ; Humans ; Pelvic Bones ; injuries ; Pregnancy

Objective: To observe the effects of acupuncture plus spinal manipulations on the physical functioning and levels of alkaline phosphatase (ALP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and osteoprotegerin (OPG) in patients with ankylosing spondylitis (AS). Methods: A total of 128 AS cases were allocated into a control group and an observation group using random number table method, with 64 cases in each group. Patients in both groups took sulfasalazine and meloxicam. Patients in the observation group received additional acupuncture plus spinal manipulations. The efficacy, Bath AS functional index (BASFI), Bath AS disease activity index (BASDAI), and the levels of ALP, ESR, CRP and OPG were compared between the two groups after eight weeks of treatment. Results: After treatment, the symptom scores of traditional Chinese medicine in both groups were decreased (all P<0.05), and these scores in the observation group were significantly lower than in the control group (all P<0.05); the VAS, BASFI and BASDAI scores in both groups were decreased (all P<0.05), and these scores in the observation group were significantly lower than in the control group (all P<0.05); and the ALP, ESR, CRP and OPG levels in both groups were decreased (all P<0.05), and these levels in the observation group were significantly lower than in the control group (all P<0.05). The total efficacy rate was 92.2％ in the observation group, versus 78.1％ in the control group, presenting a statistical significance (P<0.05). Conclusion: Conventional medication combined with acupuncture and spinal manipulations can improve clinical symptoms, accelerate the recovery of physical functioning, and reduce the ALP, ESR, CRP and OPG levels.

Tropane alkaloids (TAs) are a class of anticholinergic drugs widely used in clinical practice and mainly extracted from plant, among which Atopa belladonna is the main commercial drug source. It is of great industrial value to obtain TAs in large quantities by plant metabolic engineering. In TAs pathway, cytochrome oxidase CYP82M3 catalyze the synthesis of tropinone and then tropinone reductase I (TRI) compete with TRII for tropinone to form tropine leading to the TAs synthesis (drainage). In this study, based on the "increasing flow and drainage" metabolic engineering strategy, two genes, namely HnCYP82M3 and DsTRI from Hyoscyamus niger and Datura stramonium, respectively, were overexpressed in the hair roots of A. belladonna, with a view to promote the TAs accumulation. The HnCYP82M3 gene was cloned from the root of H. niger, and it encoded amino acid with 91.7% sequence identity with AbCYP82M3 from A. belladonna. Overexpression of HnCYP82M3 alone did not affect the content of TAs in hair roots of A. belladonna, indicating that CYP82M3 was not a key enzyme in TAs biosynthesis. Simultaneous overexpression of HnCYP82M3 and DsTRI greatly promoted the accumulation of the three TAs, and the contents of hyoscyamine, anisodamine and scopolamine were 4.97 times, 2.83 times and 2.19 times that of the control, respectively, and the increase amplitude was greater than that of single overexpression of DsTRI. This study showed that the "increasing flow and drainage" strategy of enzyme genes co-expression at branch points was a promising metabolic engineering method to effectively improve the biosynthesis of TAs in A. belladonna, and laid a theoretical and technical foundation for the large-scale industrial acquisition of TAs.

Purpose: Nowadays most children with congenital heart disease (CHD) are expected to survive to adulthood. The healthcare focus needs to pay close attention to the important developmental tasks during their growth process. The women with CHD face some challenges in their critically developmental stages during pregnancy, delivery, and even motherhood. The lived experience of being a mother needs to be further concerned. This study aimed to explore the lived experience of first-time mothers with CHD. Methods: Descriptive phenomenological design was adopted. Semi-structured interviews were conducted from April to August 2018 with 11 primiparous women with CHD, who were recruited from the pediatric and adult cardiology outpatient departments at a medical center and who had a child aged between 6 months and 3 years. Giorgi's phenomenological analysis method was employed. Results: Six main themes arose from the analysis: (1) recognizing pregnancy risks, (2) performing self-care for health, (3) building self-worth from my baby, (4) adapting to postpartum life and adjusting priorities, (5) enjoying being a first-time mother, and (6) the factors contributing to success in high-risk childbirth. Conclusions The experiences that occurred prior to and after labor that were identified in this study can assist women with CHD to more capably prepare for and understand the process of becoming a mother, including recognition of the importance of a prepregnancy evaluation. The findings of this study can help women with CHD to better understand the path to becoming a mother and prepare themselves for the challenges that lie ahead.