Objective To quantitatively analyze the palpebral fissure changes in the neostigrnine tests with videonystagmography.Methods Thirty-five patients with myasthenia gravis ( MG),21 non-MG patients and 23 healthy volunteers were intramuscular injected with neostigmine methylsulfate(0.02 mg/kg) and atropine(0.5 mg).The width of palpebral fissure was measured before and after the injection for one hour( once every 10 minutes).The differences of palpebral fissure width of each time point within each group and between groups were analyzed quantitatively with repetitive measure ANOVA.Results There was a significant difference of palpebral fissures (mm) width at different time points within the MG group( before the test:4.67 ± 1.87,after the test:10 min:0.88 ±0.96,20 min:1.49 ± 1.38,30 min:1.71 ± 1.53,40 min:1.77 ± 1.82,50 min:1.79 ± 1.52,60 min:1.62 ± 1.68 ; F =11.202,P =0.002).There were also significant changes of palpebral fissures width in the MG group compared to the non-MG group and the normal control group (F =15.569,P ＜ 0.01; F =15.104,P ＜ 0.01 ).There was alsostatistical significance in the rate of change between these groups.Receiver operating characteristic analytical procedure indicated that 1.17 mm or 17.5％ was of better diagnostic capability in the neostigmine test.Conclusions Measuring palpebral fissure width with videonystagmography could be seen as an objective and accurate method.A patient with palpebral fissure width higher than 1.17 mm or 17.5％ should be highly suspected as MG.

AIM: To investigate the effect of epigallocatechin-3-gallate (EGCG) on lipopolysaccharide (LPS)-induced p38 MAPK activation and tumor necrosis factor-? (TNF-?) secretion in macrophages. METHODS: Western blotting was used to detect the phosphorylation of p38 MAPK in mouse macrophages cultured in vitro. Enzyme linked immunosorbent assay was used to determine the secretion of TNF-? in macrophages. Electron microscopy was used to study the effect of EGCG on the structure of LPS. RESULTS: LPS caused activation of p38 MAPK and more production of TNF-?, EGCG inhibited LPS-induced phosphorylation of p38 MAPK and TNF-? production and had no effect on the structure of LPS. CONCLUSIONS: EGCG has no direct effect on LPS, but blocks cellular signal pathway. The inhibition of EGCG on LPS-induced TNF-? production is mediated, at least in part, through blocking of p38 MAPK pathway. [

AIM: To investigate the effect of Ginkgo Biloba Extract on coronary blood flow in patients with coronary artery disease(CAD). METHODS: Ninety CAD patients confirmed by cardioangiography were randomly assigned to Ginkgo Biloba Extract Injection group(n=45) and control groups(n=45).Before and after intravenous administration,the distal left anterior descending coronary artery(LAD) flow was measured by transthoracic Doppler echocardiography. RESULTS: Ginkgo Biloba Extract Injection treatment demonstrated significant improvement in diastolic peak velocity,systolic peak velocity and diastolic time velocity integral(P0.05). CONCLUSION: CAD patients in the treatment of Ginkgo Biloa Extract lead to the increase in LAD blood flow.

Objective To explore the effect of loading density of different rigid containers on wet package of orthopedic instruments in the department of orthopedics and to provide the basis for right loading of rigid container so as to ensure the success of the sterilization. Methods About 120 cases of orthopedic exotic instruments for knee surgery were selected from our hospital, according to size and weight of the knee surgery instrument and then evenly divided into Groups A, B, C, 40 pieces in each group. Each group for loading had the same length and width. In Group A, the loading was at 1/2 of the container height, in Group B, the loading was at 2/3 of the container height and in Group C the loading was 4/5 of the container height. The 3 groups were given high pressure steam sterilization, the sterilization temperature, sterilization time and drying time were the same, while biological and chemical monitoring was done. After sterilization, the three groups were compared in terms of the biological and chemical monitoring results as well as the incidence of wet pack. Results There were no significant differences between the 3 groups in the qualification rate of indicator cards and the biological monitoring after sterilization in the 5 kinds of packages among the 3 groups of rigid containers (P>0.05). The incidence of wet package in Group A was significantly lower than that of Group C (χ2=6.80, P=0.009<0.017), but no difference was found between Groups B and C ,Group B and C Group . Conclusions The loading density of different rigid containers affects the incidence of wet package of the orthopedic instruments. Our findings indicate that the loading of the instruments in a rigid container reaches the 2/3~4/5 height of the container, for it can reduce the incidence of wet package of orthopedic instruments.

Objective To investigate the effects of aldosterone on the expression of endothelin(ET)in cultured neonatal rat cardiac fibroblasts(CFs).Methods CFs were isolated by trypsin digestion.ET concentration in conditioned medium was measured by radioimmunoassay,intracellular ET-1 level was evaluated by immunofluorescence assay,and the expression of preproendothelin-1(ppET-1)was detected using reverse transcriptase-polymerase chain reaction(RT-PCR)method.Results Aldosterone(10-9,10-8,10-7 mol/L)induced a dose-dependent changes in ppET-1 mRNA expression,as well as ET-1 synthesis and secretion in CFs.Meanwhile,aldosterone(10-7 mol/L)time-related induced ppET-1 mRNA expression in CFs,which began to increase in 2 h and reached the highest level in 4 h,thereafter decreased.The effects of aldosterone(10-7 mol/L)were significantly inhibited by the pre-incubation with spironolactone(10-6 mol/L).Conclusion Aldosterone increases the expression of ppET-1 mRNA,ET-1 synthesis and secretion via mineralocorticoid receptor.

Objective To investigate the correlation between family cohesion and adaptability and quality of life in patients with enterostomy. Methods Using Chinese version of Family Adaptability and Cohesion Scale (FACESⅡ-CV) and Chinese version of Stoma-Quality of Life (STOMA-QOL-C) to investigate the status of family cohesion and adaptability, family type and their impact on quality of life of 110 patients with enterostomy. Results Scores of family cohesion and adaptability averaged 59.15 ± 11.94, 47.32 ± 9.40,were significantly lower than 63.90 ± 8.00 and 50.90 ± 6.20 in the norm,and the difference was statistically significant (t=-4.171,-3.990, P<0.01).The family cohesion was positively correlated with the score of quality of life, social interaction and psychological burden(r=0.274, 0.284, 0.263, P<0.05), and the family adaptability was positively correlated with the score of quality of life,social interaction and psychological burden(r=0.316, 0.338, 0.228, P<0.05 or 0.01). The balance type family was 30 cases;scores of quality of life averaged 45.10±7.26, the intermediate type family was 50 cases;scores of quality of life averaged 43.48±9.98, the extreme type family was 28 cases;scores of quality of life averaged 43.37 ± 16.68, and difference between the three was no statistically significant(F=0.442, P=0.665). Conclusions In the nursing process of patients with enterostomy, health care workers should pay attention to improve family cohesion and adaptability, as to achieve the purpose of improving the quality of life of the patients.

Background: and Purpose Collateral circulation is considered an important factor affecting the risk of stroke, but the factors that affect collateral circulation remain unclear. This study was performed to identify the factors associated with collateral circulation, especially blood lipids. Methods: The study involved patients who had undergone digital subtraction angiography and were confirmed as having severe unilateral stenosis or occlusion of the internal carotid artery (ICA). We classified the collateral circulation status of each patient as good (Grade 3 or 4) or poor (Grade 0, 1, or 2) according to the grading system of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology. We collected data on patients’ characteristics and identified the factors that affect collateral circulation. Results: This study included 212 patients. The multivariate logistic regression analysis showed that the high-density lipoprotein cholesterol (HDL-C) concentration and a complete anterior half of the circle of Willis were independent protective factors for good collateral circulation, whereas elevated lipoprotein(a) [Lp(a)] and serum creatinine concentrations were independent risk factors for good collateral circulation. The area under the receiver operating characteristics curve (AUC) was 0.68 (95% confidence interval [CI], 0.61–0.76) for HDL-C and 0.69 (95% CI, 0.62–0.76) for Lp(a). A binary logistic regression model analysis of the joint factor of HDL-C and Lp(a) yielded an AUC of 0.77 (95% CI, 0.71–0.84). Conclusions In patients with severe unilateral ICA stenosis or occlusion, the combination of HDL-C and Lp(a) is a useful predictor of collateral circulation.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Background Front-line medical staff are an important group in fighting against Coronavirus Disease 2019 (COVID-19), and their mental health should not be ignored. Objective This study investigates the current situation and influencing factors of post-traumatic stress disorder (PTSD) among front-line anti-epidemic medical staff during COVID-19 epidemic. Methods Medical staff who had participated in fighting against the COVID-19 epidemic wereselected from three grade III Class A hospitals and four grade II Class A hospitals in a city of Hubei Province by convenient sampling method in May 2020. The survey was conducted online using the Post-traumatic Stress Checklist-Civilian Version (PCL-C) as the main survey tool to investigate current situation and characteristics of PTSD among these participants. A total of 1120 questionnaires were collected, of which 1071 were valid, and the effective rate was 95.6%. Results Of the 1071 participants, the average age was (32.59±5.21) years; the ratio of male to female was 1: 5.02; the ratio of doctor to nurse was 1:5.8; nearly 70% participants came from grade III Class A hospitals; married participants accounted for 75.4%; most of them held a bachelor degree or above (86.5%); members of the Communist Party of China (CPC) accounted for 22.9%; 50.9% had junior titles; the working years were mainly 5−10 years (42.8%); more than 80.0% participants volunteered to join the front-line fight; 95.1% participants received family support; 43.0% participated in rescue missions; 78.1% participants fought the epidemic in their own hospitals; more than 60% participants considered the workload was greater than before; 34.4% participants fought in the front-line for 2−4 weeks, and 23.5% participants did for more than 6 weeks. There were 111 cases of positive PTSD syndromes (PCL-C total score ≥38) with an overall positive rate of 10.4%, and the scores of reexperience [1.40 (1.00, 1.80)] and hypervigilance [1.40 (1.00, 2.00)] were higher than the score of avoidance [1.14 (1.00, 2.57)]. The results of univariate analysis revealed that PTSD occurred differently among participants grouped by age, political affiliation, working years, anti-epidemic activities location, accumulated working hours in fighting against COVID-19, having child parenting duty, voluntariness, family support, whether family members participated in front-line activities, and rescue mission assignment (P<0.05). The results of logistic regression analysis showed that the incidence rates of reporting PTSD syndromes in medical personnel aged 31−40 years (OR=0.346, 95%CI: 0.164−0.730) and aged 41 years and above (OR=0.513, 95%CI: 0.319-0.823) were lower than that in those aged 20−30 years; the incidence rates of reporting PTSD syndromes in medical staff who were CPC members (OR=0.499, 95%CI: 0.274−0.909), volunteered to participate (OR=0.584, 95%CI: 0.360−0.945), and received family support (OR=0.453, 95%CI: 0.222-0.921) were lower than those did not (P<0.05); the incidence rates of reporting PTSD syndromes among medical workers who had child parenting duty (OR=2.372, 95%CI: 1.392−4.042), whose family members participated in front-line activities (OR=1.709, 95%CI: 1.135−2.575), and who participated in rescue missions (OR=1.705, 95%CI: 1.133-2.565) were higher than those who did not (P<0.05). Conclusion The positive PTSD syndrome rate is 10.4% in the front-line anti-epidemic medical staff. Age, political affiliation, voluntariness, family support, having child parenting duty, with a family members participating in the fight, and rescue mission assignment are the influencing factors of PTSD.

Abstract OBJECTIVE To explore the effect of the polymorphisms of ATM(rs11212617), KCNJ11(rs5219), CYP2C9(rs1799853, rs1057910), TCF7L2(rs12255372, rs290487) and IRS1(rs1801278) on efficacy of metformin and gliclazide combined treatment for diabetes mellitus type 2. METHODS Eighty-one patients with newly diagnosed diabetes mellitus type 2 in Standardized Metabolic Disease Management Center of the Endocrinology Department of of Zhejiang Chinese Medical University Affiliated Jiaxing TCM Hospital were enrolled in this study, and they were treated with metformin hydrochloride tablets and gliclazide modified release tablets. MassARRAY was used to type the above single nucleotide polymorphism(SNP), and followed up for 3 months. Fasting plasma glucose(FPG), glycosylated hemoglobin type Alc(HbA1c) and fasting insulin(FINS) were compared before and after treatment. RESULTS The gene frequencies of all SNPs were compliant to Hardy-Weinberg equilibrium, the samples were well represented. The rs1799853, rs1057910, rs12255372 and rs1801278 had low mutation frequencies with poor clinical significance. The benefits of FPG compliance rate, increase of FINS, decrease of HbAlc after treatment were stronger in patients with homozygous rs5219 C allele than those with T-allele carriers (P<0.05). However, there were no significant differences in treatment effects among the genotypes of rs11212617 and rs290487. CONCLUSION The rs5219 polymorphism of KCNJ11 gene is associated with the efficacy of metformin hydrochloride tablets and gliclazide modified release tablets in treating diabetes mellitus type 2, with a more significant effect observed in individuals homozygous for the C allele. This finding can serve as a reference for personalized medication in clinical treatment of diabetes mellitus type 2.