Objective To investigate the efficacy and safety of blood purification therapy in the treatment of diuretic resistance in patients with nephrotic edema.Methods 40 cases of primary nephrotic syndrome with diuretic resistance in our hospital were randomly divided into hemodialysis (HD) group and continuous blood purification (CVVH) group and each group were 20 cases.All the patients were given basic treatment (lipid modulation,anticoagulation and glucocorticoid) and the observation time was 4 weeks.The changes of biochemical indexes (24 h urine protein,plasma albumin,serum urea nitrogen and serum creatinine) were observed before and after treatment in two groups.In addition,the complications of four groups were recorded.Results After blood purification treatment,urinary volume of two groups were significantly increased,the quantity of 24 h urinary protein and serum albumin were significantly improved,levels of serum urea nitrogen and serum creatinine were significantly decreased.The differences were statistically significant (P ＜ 0.05 or P ＜ 0.01).Compared with HD group,the urine volume increased more obviously in CVYH group after 2 weeks' treatment (P ＜ 0.05).The same time,24 h urinary protein was reduced and plasma albumin was improved more significantly (P ＜ 0.05),levcls of serum urea nitrogen and serum creatinine were not differ between the two groups (P ＞ 0.05).There was no difference in urine volume and renal function between the two groups (P ＞ 0.05) after 4 weeks' treatment.24 h urinary protein was significantly decreased and serum albumin was significantly higher than HD group (P ＜ 0.05).There were no serious complications in the two groups.Conclusion Blood purification in the treatment of diuretic resistance in patients with nephrotic edema is safe and effective.Continuous blood purification treatment can effectively alleviate nephrotic edema with diuretic resistance,promote the recovcry of renal function and improve the prognosis of kidney disease.

Objective To evaluate the reliability and validity of SF-36 in patients with advanced schistosomiasis,so as to proride scientific basis for the selection of suitable tools for health measure.Methods A Chinese version of SF-36 scale was applied to evaluate the health of patients with advanced schistosomiasis by a household survey in Hanshou County of Hunan Province and Jiangling County of Hubei Province,then the reliability and validity of the scale were tested.Results Atotal of 326 patients were investigated in the two counties.The split-half reliability(with a split-half coefficient of 0.95) and the internal consistency (Cronbach'α coefficients of the eight dimensions ranged from 0.86 to 0.88)were satisfying;the convergent and discriminative validity were high with the test successful rates of 97.14%and 87.86%,respectively;the criterion validity was acceptable with a correlation coefficient between the total score of SF-36 and EQ-5D+C VAS score of 0.70.However,the construct validity seemed to be not so reasonable as only 2 dimensions out of 8 were completely in accordance with the theoretical model on factor loading.The percentages of floor effect and ceiling effect in most dimensions were not significant except RP and RE(with the percentages of floor effect of 50.31%and 48.16%,respectively).Conclusions SF-36 is appropriate to be used in patients with advanced schistosomiasis.but some items need to be improved according to the local settings of endemic areas.

Objective: To detect the changes of systolic function of left ventricle in patients with lymphoma receiving anthracycline by three dimensional speckle tracking imaging(3D-STI). Methods: Thirty patients with newly diagnosed diffused large B-cell lymphoma who had received R-CHOP chemotherapy were enrolled. Left ventricular global longitudinal strain (GLS), global circumferential strain(GCS) and longitudinal strain(LS) on different left ventricular segments were measured by 3D-STI at baseline, after the completion of 2 cycles and 4 cycles of the regimen respectively. Results: Compared with baseline, GLS reduced significantly after four cycles of anthracycline chemotherapy(P=0.002). Analysis of LS on different segments of the left ventricle shows: after 2 cycles of anthracycline chemotherapy, LS only on apical septum was significantly decreased(P=0.019). After 4 cycles of treatment, LS on mid anterior, mid anteroseptal, mid inferoseptal, mid anterolateral, apical anterior, apical septal walls and apex worsened (t=3.321, P=0.002; t=2.497, P=0.018; t=2.387, P=0.024; t=2.096, P=0.045; t=4.015, P=0.000; t=4.064, P=0.000; t=3.370, P=0.002, respectively). Conclusions LS deterioration emerges on some left ventricular walls in patients with lymphma underwent chemotheapy based on anthracycline in early stage of the remedy, especially on apex and mid segments. LS on apical septum manifests firstly. The segmental LS index maybe expected to be valuable for monitoring of early cardiotoxicity of antharcycline.

Digital healthcare empowers optimization of medical services.This article introduced the practices and achievements of Hangzhou in the following aspects: the construction of a hierarchical medical system guided by " people-oriented integrated service" ; development of the five digital platforms, namely regional health information platform, integrated medical care platform, remote consultation platform, intelligent supervision platform and doctor-patient remote interaction platform; development of " Smart Medicine" to promote institutional cooperation, service integration, management coordination, quality improvement and doctor-patient interaction.The paper also analyzed the supporting role of digital healthcare construction in promoting the hierarchical medical system, and put forward corresponding countermeasures and suggestions.

Objective To study the compliance of forbidden depasturing livestock on the marshland with Oncomelania snails in schistosomiasis endemic areas. Methods According to 3 levels of human infection rates as > 10% ,5%-10% and <5% , 2 204 residents selected randomly from the schistosomiasis endemic villages were sampled with the stratified cluster sampling method in Hunan, Hubei, Jiangxi, Anhui, Jiangsu, Sichuan and Yunnan provinces, and investigated by questionnaire. The contents of the questionnaire included the recognition and implementation of forbidden depasturing livestock on marshland with Oncomelania snails and breeding livestock in bam. Results A total of 78.4% residents agreed forbidden depasturing livestock on marshland with snails, but 3. 7% residents disagreed it. A total of 83. 9% residents considered the relationship between breeding livestock in bam and schistosomiasis control, but 3. 1% residents thought that it was no relationship. The main reasons of depasturing livestock on marshland with Oncomelania snails were the high cost of breeding livestock in bam (36. 2% ) , unaccustomed (26.4% ) and no room for breeding livestock in bam (25.4% ). Conclusion Forbidden depasturing livestock on the marshland with Oncomelania snails should be strengthened according to the local economic, nature environment, agriculture, residents'culture degree and agriculture habit.

0.05 ). After once injection both observers considered the number of clearly recognized endocardial border segments increased significantly. The number evaluated by observers A increased from 2.68 ? 0.95 to 5.99 ? 0.10 while from 2.82 ? 1.03 to 5.99 ? 0.11 by observers B( P 0.05 ). The average contrast enhancement rate of LV endocardial border was 99.7 %. Perfluoropropane-albumin microsphere injection had no significant effection on vital signs such as blood prssure, heart rate and respiration. Electrocardiogram didn′t change markedly and the variance of the laboratory findings like blood and urine routine examination, hepatic and renal function was in normal range. Only one case( 0.33 %) had slight side-effects who suffered from mild nausea and diarrhea, which suggested the clinical safety of this contrast agent. Conclusions Perfluoropropane-albumin microsphere injection could enhance the resolution of LV endocardial borders and make the judgement of regional myocardial movement easier. It has little side-effects and will be appropriate for clinical use.

Serine elastic chymotrypsin Pr1 is an enzyme that efficiently degrades insect body wall protein through its connection with the virulence of entomogenous fungi. Therefore, it is important to explore the relationship between the Pr1 protease activity, the Pr1 gene expression and the virulence of different strains of entomogenous fungi. Specific peptide substrate Suc-Ala-Ala-Pro-Phe-pNA and fluorogenic quantitative PCR were used for detecting Pr1 protease activity and Pr1 gene expression, and the slope spray method was used for evaluating the virulence of the fungi on the Myzus persicae. The results indicated that the linear regression equation of the Pr1 protease activity and the virulence of different strains were: y=3.64x+0.62, R²=0.432. It was shown that there is a positive correlation between the Pr1 protease activity and virulence of different strains. Moreover, the result of the multiple linear regression analysis between Pr1 protease activity, Pr1 gene expression and the virulence of different strains was: y=0.236+10.833x₁-0.039x₂ (x₁ represents Pr1 protease activity while x₂ represents Pr1 gene expression), R²=0.568, which suggested that the raw data could be represented by a linear fitting equation. The serial correlation coefficient was high (D-W was 2.444), indicating that Pr1 protease activity and Pr1 gene expression have great effect on the virulence of the fungi. Additionally, VIF=12.705, which shows that moderate multiple collinear exists between Pr1 protease activity and Pr1 gene expression. Therefore, Pr1 protease activity and Pr1 gene expression could be recommended as important indicators for strain virulence selection.
Fungi ; Gene Expression ; Insect Proteins ; Peptide Hydrolases ; Virulence

Objective:To explore the effect of applying individualized progressive nutrition guide sheet in postoperative enteral nutrition (EN) for patients with oral cancer.Methods:Using convenient sampling method, 40 oral cancer patients admitted to Sichuan Cancer Hospital from November 2017 to October 2018 were selected as the control group, and 46 from November 2018 to October 2019 were selected as the observation group. Both groups received EN support but the observation group were applied with progressive nutrition guide sheet. The pre- and post-operative body weight, nutrition related indicators, gastrointestinal symptoms, proportion of patients achieving daily target energy intake, patient/family satisfaction and other indicators were compared between the two groups.Results:There were significant differences in preoperative potassium, total protein and albumin at 7 days after operation, prealbumin at 3 and 7 days after operation, potassium at 3 days after operation and sodium at 3 days after operation between the two groups( Z=4.963, P<0.01; Z=5.094, P<0.01; Z=-2.022, P<0.05; Z=4.048, P<0.01; Z=2.14, P<0.05, Z=-6.04, P<0.01, Z=-7.13, P<0.01). The dynamic changes of potassium and sodium in the two groups were compared before operation, 3 days after operation and 7 days after operation ( F=30.20, F= 118.51, all P<0.01). There were significant differences in incidence of abdominal pain, abdominal distension and diarrhea between the two groups ( χ2=6.91, P=0.009, χ2=10.36, P=0.001, χ2=4.71, P=0.03). There were also significant differences in the proportion of patients achieving daily target energy intake at 1 day, 2 days, 3 days, 4 days, 5 days, and 6 days after operation between the two groups ( χ2=41.77, χ2=45.09, χ2=45.71, χ2=40.53, χ2=29.97, χ2=6.11, all P<0.01). Conclusion:The application of progressive nutrition guidelines in early postoperative EN support for patients with oral cancer can help to improve postoperative nutritional status, avoid potassium, sodium and electrolyte disturbance, alleviate postoperative gastrointestinal symptoms, improve the achievement of daily target energy intake and patient/family satisfaction, and promote disease recovery.

Objective: To investigate the clinical value of two-dimensional speckle tracking echocardiography(2D-STE) combined with high-sensitive cardiac troponin T (hs-cTnT) in early detection of the cardiotoxicity induced by chemotherapy drug. Methods: Seventy-five non-Hodgkin′s lymphoma patients who received the CHOP regimen were recruited in this study. Conventional echocardiography and 2D-STE were performed on these patients before chemotherapy, the second day after the third course of chemotherapy (during chemotherapy) and the second day after the last course of chemotherapy (after chemotherapy). The parameters included left ventricular ejection fraction (LVEF), global longitudinal strain (LS), global circumferential strain (CS) and global radial strain (RS). The serum hs-cTNT levels were tested simultaneously. Results: Three cycles of CHOP were completed in 30 patients and 6-8 cycles of CHOP were completed in 45 patients. The LVEF of 75 patients before, during and after chemotherapy was (63.8±2.6)%, (63.8±2.8)% and (64.0±3.3)%, respectively, without significant difference (P=0.91). However, the LS of 75 patients before, during and after chemotherapy was (-18.5±1.7)%, (-16.5±1.9)% and (-16.0±1.6)%, respectively. The CS was (-20.9±2.9)%, (-19.3±3.5)% and (-19.2±3.2)%, respectively. The RS was (39.2±6.4)%, (35.3±5.2)% and (35.0±6.2)%, respectively. The hs-cTnT was (0.001 0±0.002 0)ng/ml, (0.006 3±0.008 9)ng/ml and (0.007 3±0.003 8)ng/ml, respectively. The LS, CS and RS were significantly decreased while hs-cTnT was significantly increased during chemotherapy when compared to those before chemotherapy (all of P<0.01). Alternatively, the LS, CS, RS and hs-cTnT after chemotherapy were marginally different from those during chemotherapy (all of P>0.05). Moreover, T_LS-SD, T_CS-SD and T_RS-SD showed no significant difference before, during and after chemotherapy (all of P>0.05). The reduction of LS was positively associated with the enhancement of hs-cTnT after chemotherapy (r=0.60, P<0.01). Conclusion 2D-STE combined with hs-cTnT can effectively and precisely detect the occult cardiotoxicity induced by anthracycline.

OBJECTIVE： To study the effects of benzoyl aconitine （BAC） on autophagy and apoptosis of human lung cancer A549 cells， and to investigate its mechanism in anti-non-small cell lung cancer. METHODS： A549 cells were treated with different doses of BAC （10， 50， 100， 200， 400 μmol/L）， and then cell morphology was obtained； the proliferation inhibition rate of the cell was determined by CCK-8 assay. The cells were divided into control group （without drug）， BAC low-dose and high-dose groups （200， 400 μmol/L）. After treated with relevant drugs， the apoptosis rate of cells was determined by flow cytometry. The gene and protein expression of apoptosis-related factors Bcl-2， Bax， Caspase-3 as well as autophagy-related factors Beclin1， LC3， P62 were determined by RT-PCR and Western blotting assay. RESULTS： After treated with different doses of BAC， the cells were shrunken and sparsely arranged； inhibitory rate of cell proliferation was increased significantly in BAC 100， 200， 400 μmol/L groups （P＜0.05 or P＜0.01）. Results of flow cytometry showed that the apoptotic rates of cells were increased to different extents in BAC low-dose and high-dose groups after treated for 24 and 48 h， in a concentration and time-dependent manner. Compared with control group， mRNA and protein expression of Bcl-2 and P62 were decreased to different extents in BAC groups； mRNA expression of Bax， Caspase-3， Beclin1 and LC3 as well as protein expression of Bax， Active caspase-3， P62， Beclin1， LC3Ⅱ/Ⅰ were increased to different extent； there was statistical significance in mRNA expression of Caspase-3， and protein expression of Bcl-2， Active Caspase-3， Beclin1， LC3Ⅱ/Ⅰ and P62 in BAC low-dose group as well as all target mRNA and protein expression in BAC high-dose group （P＜0.05 or P＜0.01）， in dose-dependent manner. CONCLUSIONS： BAC can inhibit the proliferation and promote the apoptosis of A549 cells， promote Beclin1， LC3（LC3Ⅱ/Ⅰ），Bax and Caspase-3 （Active Caspase-3） gene and their protein expression， but inhibit P62 and Bcl-2 gene and their protein expression. The mechanism may be related to BAC inducing apoptosis by promoting excessive autophagy of cells.