BACKGROUND: Researches on the pathogenesis and pathological changes of rheumatoid arthritis(RA) have achieved significant progress in recent years. But traditional Chinese medicine(TCM) has unique advantage in RA therapy.OBJECTIVE: To study effects of overall alkali in tongbiling(TBL) on the proliferation of lymphocytes and the transferrin receptor of T lymphocytes (CD71) to explore the mechanism of TBL on the modulation of cell immunity.DESIGN: A completely randomized grouping design and an explorative study by employing cells as subjects.SETTING: Sixth internal medicine department of a TCM university,center of tissue transplantation and immunology college of life science of a university PARTICIPANTS: The study was conducted in the central laboratory (tertiary laboratory of National TCM Administrator) of the first affiliated hospital of Guangzhou TCM medical university between July 2002 and August 2003. Ten clean male SD rats were selected.METHODS: Lymphocyte was separated from rat inguinal lymph node for culture. Concanavalin(ConA) was used for 72-hour stimulation. The impacts of overall alkali TBL on lymphocyte proliferation were tested by MTT.The expression of T lymphocyte CD71 was tested by flow cytometer after 48-hour stimulation of phorbol 12,13 -dibutyrate(PDB) or ConA.MAIN OUTCOME MEASURES: The impacts of overall alkali TBL on lymphocyte proliferation and T cell activation.RESULTS: Different concentration of overall alkali TBL could significantly inhibit the proliferation of lymphocytes under ConA stimulation. PDB and ConA-activated T lymphocyte CD71 + expressions were significantly higher than that of blank control group(P<0.01) . CD3+ CD71 + expressions [(62.03±1.51) %,(25.28±1.57) %,(20. 29±1.72)%] activated by ConA under different concentration of overall alkali TBL(50,100,200 mg/L)were significantly lower than(72.03±1.28)% of BPS-positive control group (P<0. 05). CD3 + CD71 + expressions activated by PDB under 100 mg/Land 200 mg/L of overall alkali TBL were significantly lower than that of phosphate buffer solution (PBS-)positive control group(P<0.05). Different concentration of overall alkali TBL had significant down-regulated effects on CD71 expression in T lymphocyte activated by PDB or ConA and there was also a significant dose-effect relationship(P<0. 05). The inhibition on ConA-activated CD71 expression was stronger than that of PDB.CONCLUSION: Overall alkali TBL can inhibit the abnormal proliferation of T lymphocyte and its mechanism might be realized through its inhibition on transferrin receptor.

[Objective]To observe the effects of total alkaloids (TA) of Tongbiling (TBL) prescription on proliferation of T lymphocytes and transferring receptor of T lymphocytes (CD71) in rats and to explore the mechanism of TBL in regulating cellular immunity. [Methods]Isolated lymphocytes from mesenteric lymph node were cultured with various concentrations of TBL TA and canavaline A (ConA) for 72 hours; the proliferation of T lymphocytes was observed by MTT method and CD71 expression rate of T lymphocyte activated by phorbol 12,13-dibutyrate (PDB) or ConA for 48 hours was detected by flow cytometry.[Results]Various concentrations of TBL TA inhibited the proliferation of T lymphocytes activated by ConA and decreased CD71 expression rate of T lymphocyte activated by ConA or PDB in a dose-effect manner. Inhibitory effect of TBL TA on CD71 expression rate of T lymphocyte activated by ConA was superior to that activated by PDB. [Conclusion]TBL TA can inhibit the abnormal proliferation of T lymphocytes and its mechanism may be related to the expression of CD71.

Objective To investigate the treatment effect of ginsenoside compound K (CK) on glucose and lipid metabolism in diabetic mellitus mice and the potential molecular mechanism.Methods A total of 36 mice were randomly divided into normal group,diabetic mellitus group,CK treatment groups (100 or 200 mg/kg body weight),dimethyldiguanide group and p38MAPK pathway agonist P79350 group,with 6 mice in each group.Diabetic mice were established by intraperitoneal injection of streptozotocin combined with high-fat diet,and CK with different doses was administrated by gastric lavage for consecutive 8 weeks.The levels of fasting blood-glucose,triglyceride (TG),total cholesterol (TC),high-density lipoprotein (HDL C),fasting serum insulin were measured,and the insulin sensitive index (ISI) was calculated in different treatment groups.Glucose tolerance was detected by oral glucose tolerance test.The protein levels of ASK1,p-ASK1 and p38,p-p38,was detected by Western blot.The mRNA expression of apoptosis signal regulating kinase-1 (ASK1) was detected by real-time quantitative PCR.Results The fasting blood-glucose,TG,TC,HDL C,fasting serum insulin and ISI were (28.31 ± 3.40),(1.90 ± 0.28),(5.00 ± 0.72),(0.50 ± 0.08),(9.01 ± 1.70) mmol/L and-6.42 ± 0.76 in diabetic mice,respectively.The corresponding values were (12.02± 1.81),(0.97 ±0.09),(2.90 ±0.49),(0.91 ±0.08),(15.12 ± 1.93)mmol/L and-4.33 ± 0.46 in 200 mg/kg CK treatment diabetic mice,and were (12.87 ± 2.61),(1.09 ± 0.11),(3.08 ± 0.27),(0.87 ±0.08),(14.97 ± 1.27) mmol/L and-4.42 ± 0.35 in dimethyldiguanide group.All of the fasting blood-glucose,TG and TC in CK treatment groups were significantly lower than those of diabetic mellitus group (P ＜0.05 or ＜0.01),but the fasting serum insulin and ISI in CK treatment groups were significantly higher than that of diabetic mellitus group (P ＜ 0.05 or ＜ 0.01).There were no significant difference between 200 mg/kg CK treatment group and dimethyldiguanide group.The mRNA levels of ASK1 in normal group,diabetic mellitus group and 200 mg/kg CK treatment group were 1.00 ± 0.07,2.52 ± 0.14 and 1.25 ± 0.08,respectively.The mRNA levels of ASK1 in diabetic mellitus group and 200 mg/kg CK treatment group were significantly up-regulated than that of normal group (P＜0.01),but there was no significant difference between 200 mg/kg CK treatment group and diabetic mellitus group in the mRNA levels of ASK1.There was no significant difference in the protein expression levels of ASK1 and p38 among normal group,diabetic mellitus group and 200 mg/kg CK treatment group,but the protein expression levels of p-ASK1 and p-p38 were significant higher in diabetic mellitus group than that in normal group (P＜0.05 or ＜0.01),and were significant lower in 200 mg/kg CK treatment group than that in diabetic mellitus group (P ＜ 0.05 or ＜ 0.01),and were no significant difference between 200 mg/kg CK treatment group and normal group.Conclusions Ginsenoside CK effectively attenuates diabetic mellitus in mouse model,possibly by inhibiting the phosphorylation of ASK1-p38MAPK signaling pathway.

Objective To investigate the effect of progressive early bed physical activity on blood flow in lower limb of patients on mechanical ventilation in intensive care unit (ICU). Methods Adult patients with mechanical ventilation ≥ 72 hours admitted to ICU of the Affiliated Hospital of Zunyi Medical University from February 22nd to November 30th, 2016 were enrolled. The patients were randomly divided into experimental group and control group by random number table method. Patients in the two groups were given the same basic treatment, including antibiotics, analgesia and sedation, mechanical ventilation, nutritional support, and routine ICU activities such as maintaining functional position of limbs and raising of bed head. On the basis of those, the experimental group was given early bed physical activity with gradual enhancement of grades Ⅰ-Ⅲ according to the nerve, circulation and respiration situations, such as passive/active exercise of the bicycle, straight leg lifting exercise, etc. The exercise intensity was evaluated with target heart rate, and the exercise was performed for 15-30 minutes at a time, twice a day. The control group was given intermittent pneumatic compression (IPC), 30 minutes in each time, twice a day. Mean blood flow and blood volume were measured before and immediately, 5, 10 and 15 minutes after intervention on the 3rd day. Heart rate and blood pressure were measured at 5 minutes before intervention, during 5 minutes, and 5, 10, 15, 30 minutes after intervention on the 3rd day. Results 214 adult patients were selected, after excluding the patients who died during the intervention or gave up treatment, 160 patients were included in the data analysis, with 81 in the experimental group and 79 in the control group. The mean blood flow velocity and blood volume were increased in both groups, and the mean blood flow velocity and blood flow volume in the experimental group were significantly increased and lasted longer than those in the control group [mean blood flow velocity (mm/s) of the experimental group were 11.92±1.06, 18.19±0.17, 17.24±0.14, 15.48±0.12, 12.68±0.16, and that of the control group were 12.01±1.41, 15.65±0.18, 12.91±0.14, 12.13±0.12, 11.59±0.16, respectively, the time effect was F = 1 043.101, P = 0.000, the intervention effect was F = 151.001, P = 0.000, and the interaction effect between intervention and time was F = 224.830, P = 0.001; the blood volume (mL/min) of the experimental group were 3.39±0.96, 5.59±0.11, 5.16±0.12, 4.19±0.10. 3.35±0.09, and that of the control group were 3.28±0.82, 4.04±0.11, 3.40±0.12, 3.02±0.10, 3.00±0.10, respectively, the time effect was F = 680.405, P = 0.000, the intervention effect was F = 125.359, P = 0.000, and the interaction effect between intervention and time was F = 79.631, P = 0.012]. The heart rate and blood pressure of the two groups of patients in the course of intervention were increased first, then decreased and then slowly recovered to the change trend before intervention, but the index of the experimental group fluctuated greatly [heart rate (bpm) of the experimental group were 97.64±1.50, 113.91±1.36, 105.96±1.34, 98.52±1.48, 97.84±1.46, 97.54±1.48, and that of the control group were 97.03±1.57, 105.39±1.38, 96.76±1.35, 96.54±1.50, 97.22±1.48, 96.53±1.49, respectively, the time effect was F = 235.030, P = 0.000, the intervention effect was F = 39.473, P = 0.000, and the interaction effect between intervention and time was F = 3.494, P = 0.063; the systolic blood pressure (mmHg, 1 mmHg = 0.133 kPa) of the experimental group were 118.57±1.06, 133.05±1.01, 120.44±1.10, 117.78±1.07, 117.65±1.01, 118.14±1.00, and that of the control group were 118.10±1.08, 126.68±1.02, 118.23±1.11, 117.48±1.08, 118.04±1.03, 118.90±1.10, respectively, the time effect was F = 336.604, P = 0.000, the intervention effect was F = 26.350, P = 0.000, and the interaction effect between intervention and time was F = 0.948, P = 0.332; the diastolic blood pressure (mmHg) of the experimental group were 68.07±0.72, 72.79±0.73, 70.68±0.74, 69.30±0.72, 68.73±0.74, 67.80±0.73, and that of the control group were 68.51±0.73, 72.03±0.74, 70.05±0.75, 69.10±0.73, 68.41±0.75, 67.85±0.74, respectively, the time effect was F = 286.390, P = 0.000, the intervention effect was F = 4.812, P = 0.000, and the interactive effect between intervention and time was F = 0.055, P = 0.815]. Conclusions The effects of progressive early bed physical activity on the mean blood flow velocity and blood volume of lower limbs in ICU patients with mechanical ventilation are better than those of IPC. Although the fluctuation of heart rate and blood pressure is large, it does not cause any harm to the patients.

Objective: To understand the vaccination of varicella attenuated live vaccine (VarV) among students in collective institutions, to provide a basis for analying the protective effect of vaccination. Methods: All collective institutions with chickenpox epidemic and post exposure vaccination in Jing an District from 2017 to 2019 were investigated. All students( n =6 473) in the affected class were included. Vaccination status and the incidence information of disease were collected to analyze vaccine effectiveness (VE). Results: The proportion of study subjects without an immunization history decreased year by year, and 7.5% in 2017, 7.2 % in 2018, and 4.9% in 2019. The proportion with a history of one dose prior to exposure in cases was 90.0%, it was lower than 93.5% in the non cases ( χ 2=6.53, P <0.05). The proportion with one dose as post exposure prophylaxis in cases was 8.3%, it was much lower than 44.1% in the non cases ( χ 2=179.06, P <0.01). The proportion with one dose as post exposure prophylaxis in secondary cases was 28.6%, much lower than 44.1% in the non cases ( χ 2=9.44, P <0.01).Unvaccinated ones and the second dose as post exposure prophylaxis ones in cases had the highest rate of varicella development (11.0%), a history of one dose prior to exposure and one dose as post exposure prophylaxis in cases had the lowest varicella rate (1.0%).There was a clear protective effect within two years after one dose of VarV inoculation, VE was 63.1%(95% CI =11.0%-84.7%). Conclusion The vaccine effectiveness of one dose VarV was limited. Post exposure prophylaxis as early as possible was highly effective in decreasing secondary attack rate.

Objective: To investigate the application and outcome of pediatric extracorporeal membrane oxygenation (ECMO) in a single center. Methods: The clinical data of 52 pediatric patients with cardiopulmonary failure received ECMO support in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command of PLA were collected from January 2012 to October 2016. All patients were divided into two stages by time. January 2012 to December 2014 was stage one. January 2015 to October 2016 was stage two. A retrospective analysis was done for these patients between two stages. In addition, all clinical data were compared with the data of extracorporeal life support organization (ELSO). The constituent ratio differences in different groups were tested by chi square test. Results: In 52 cases, there were 40 boys and 12 girls, aging from 1 day to 7 years, weighing from 2 to 20 kg. There were 35 cases who successfully weaned from ECMO (67%), and 25 cases were able to be discharged alive (48%). In stage one, there were 24 ECMO cases, 18 boys and 6 girls. There were 15 cases successfully weaned from ECMO (63%). Nine patients survived until discharge (38%). Complications were found in 15 cases during ECMO support (63%). In stage two, there were 28 ECMO cases, 22 were boys and 6 were girls. There were 20 cases successfully weaned from ECMO (71%). Sixteen patients survived until discharge (57%). Complications were found in 12 cases during ECMO support (43%). There was no significant difference in survival rates between two stages. However, the neonatal survival rate was higher in stage two than in stage one (71% (12/28) vs. 31% (5/24), χ²=5.107, P=0.038). The proportion of respiratory support was higher in stage two than in stage one (50% (14/28) vs. 21% (5/24), χ²=4.741, P=0.029), while the proportion of extracorporeal cardiopulmonary resuscitation (ECPR) decreased significantly (21% (6/28) vs. 67% (16/24), χ²=10.835, P=0.001). Application of peritoneal dialysis treatment in stage two was higher (6 vs. 0 cases, χ²=8.097, P=0.025). Mortality of ECMO was still higher than that of ELSO (48% (25/52) vs. 62% (34 655/55 886), χ²=4.281, P<0.05). The constituent ratio of different types of support varied between ECMO and ELSO patients (χ²=19.562, P<0.001). Conclusions ECMO technology can provide effective support for severe cardiopulmonary failure in critically ill children. Due to the multidisciplinary nature of ECMO technology, the complexity and characteristics of pediatric patients, it takes long time to improve ECMO management and prognosis.

Objective:To investigate the feasibility of early off-bed mobility in patients with mechanical ventilation and its effect on delirium and the duration of delirium in the intensive care unit (ICU).Methods:Adult patients who were admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st 2020 for invasive mechanical ventilation and no early activity contraindication were selected. The patients were randomly divided into two groups. The experimental group conducted early off-bed mobility, such as using the shift machine off-bed sitting and walking aids to assist standing and walking, and the off-bed mobility is based on patient tolerance. The control group was given early bed activities, including conducting the joint range activity, limb movement, bed sitting, upper limb elastic belt movement, and lower limb cycling, once a day. Each joint moved 15-20 times, a total of 30 minutes. Both groups were treated with anti-infection, mechanical ventilation, analgesia and sedation, and nutrition therapy. After intervention, confusion assessment method for the ICU (CAM-ICU) was used to assess the onset and duration of delirium, physical restraint rate and duration of physical restraint, mechanical ventilation time, and the length of ICU stay.Results:After excluding patients who died or gave up treatment during the intervention period, 266 patients were included, with 133 patients in the experimental group and 133 patients in the control group. There were no significant differences in gender, age, diagnosis, degree of illness, sedative drugs between the two groups. The incidence of the delirium in intervention group was significantly lower than that in control group [26.3% (35/133) vs. 42.1% (56/133), χ 2 = 7.366, P = 0.007], the duration of delirium was shorter than that in control group (hours: 11.26±4.11 vs. 17.00±3.29, t = -4.157, P = 0.000), the rate of physical restraint was lower than that in control group [19.5% (26/133) vs. 45.1% (60/133), χ 2 = 19.864, P = 0.000], the duration of physical restraint was shorter than that in control group (hours: 9.71±4.07 vs. 13.55±7.40, t = -5.234, P = 0.000), the mechanical ventilation time and the length of ICU stay were shorter than those in control group [mechanical ventilation time (hours) : 106.23±42.25 vs. 133.10±41.88, t = -3.363, P = 0.001; length of ICU stay (days) : 8.35±6.21 vs. 13.25±9.98, t =-4.190, P = 0.000]. Conclusions:Early off-bed mobility can reduce physical restraint rate and the incidence of delirium, and thus can accelerate rehabilitation in critically ill patients. Early off-bed mobility is safe and effective for patients with mechanical ventilation in ICU.

Objective:To investigate the association of serum protein kinase Cε(PKCε)activity with insulin resistance in elderly patients with concurrent type 2 diabetes mellitus(T2DM)and non-alcoholic fatty liver disease(NAFLD).Methods:Clinical data of 229 patients with T2DM admitted to the Department of Geriatric Endocrinology of the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to October 2018 were retrospectively analyzed.Patients were divided into the T2DM group(T2DM patients without NAFLD, n=112)and the T2DM+ NAFLD group(T2DM patients with NAFLD, n=117). Healthy elderly subjects who underwent physical examination during the same period served as the control group(n=110). Clinical data and laboratory results were compared between the three groups.Serum PKCεactivity was measured by enzyme-linked immunosorbent assay, and the correlation between serum PKCεactivity and insulin resistance was analyzed statistically.Results:Serum PKCεactivity and HOMA-IR were higher in the T2DM+ NAFLD group than in the T2DM group and the control group[PKCε: (195.5±62.1) μg/L vs.(188.7±61.2 )μg/L and (89.1±20.2 )μg/L, F=9.76, P=0.010; HOMA-IR: 12.5±7.9 vs. 14.1±5.7 and 5.8±4.1, F=10.21, P=0.010]. Pearson correlation analysis revealed that serum PKCεactivity, HOMA-IR and TG were positively correlated with T2DM+ NAFLD( r=0.339, P=0.01; r=0.305, P=0.01; r=0.329, P=0.01)and that serum PKCεactivity was positively correlated with HOMA-IR and triglyceride( r=0.339, 0.305 and 0.329, P=0.01). Logistic regression analysis showed that serum PKCε activity, HOMA-IR and triglycerides were risk factors in the T2DM+ NAFLD group, and the regression coefficients were 0.849, 0.022 and 0.710, respectively.Increased serum PKCεactivity was an independent influencing factor for T2DM+ NAFLD. Conclusions:Elevated serum PKCεactivity is positively correlated with insulin resistance in elderly T2DM patients with NAFLD.Reducing serum PKCεactivity and improving insulin sensitivity will help to delay or reverse the development of T2DM and NAFLD.

ObjectiveTo analyze the epidemiological characteristics and the vaccination status of the cases in Jing’an District from 2017 to 2019， so as to provide reference basis for the strategy of prevention and control of varicella epidemic. MethodsDescriptive epidemiological methods were used to analyze the epidemiological characteristics of varicella in Jing’an District. The differences between the vaccinated group and the unvaccinated group were compared by statistical methods. ResultsA total of 2 508 cases of varicella were reported with an average annual incidence of 78.7/10⁵ from 2017 to 2019. There was no significant difference in the incidence among the three years（χ²=5.535，P=0.063）. There were 1 308 males and 1 200 females， and sex ratio was 1.1∶1. The highest incidence occurred in the age group from 5 to 9 years old （562 cases， 479.3/10⁵）. Two annual peaks occured in May and November. The incidence in the aged 18 and below decreased year by year. There was significant difference in the proportion among the three years（χ²=78.129， P<0.001）. The median interval from vaccination to onset was 5 years among the vaccinated cases. There was significant difference in the cases who received two doses of vaccine in three years（χ²=90.902， P<0.001）. ConclusionWe should strengthen the monitoring system and pay more attention to the epidemiological characteristics of varicella. The protective efficacy of two-doses vaccine needs to be systematically evaluated.

Objective: To explore the application effect of blending-learning model on clinical teaching for practice nursing students in ICU. Methods: Totally 165 nursing students who practiced in ICU from 2016 to 2017 were selected by convenient sampling.82 nursing students in the traditional teaching mode were used as the control group in 2016, while 83 nursing students in the blending-teaching model on the basis of the control group were used as the observation group in 2017. Results: The aspects of theory and skill operation, clinical nursing comprehensive ability, teaching content, teaching method, language expression, interpersonal relationship, learning atmosphere, learning opportunity and overall evaluation in nursing students of the observation group were (83.89±7.01), (93.05±2.60) , (6.61±1.15), (3.64±0.68) , (3.85±0.77) , (3.76±0.73) , (3.84±0.91) , (3.68±0.78) , (3.74±0.81) , (3.73±0.66) points, which were higher than (69.93±10.28) , (87.94±3.11) , (5.51±1.53) , (2.79±0.84) , (2.69±0.63) , (2.39±0.52) , (2.01±0.70) , (2.43±0.57) , (2.50±0.55) , (2.46±0.55) points in the control group, the differences were significant (t=-14.235- -5.176, P<0.05) .There was no significant difference between the two groups in terms of sex, age, educational level, scores of entrance examination, teachers′ quality, teaching attitude, work atmosphere and organizational support (P>0.05). Conclusions The blending-teaching model is beneficial to improve the learning achievement, clinical nursing comprehensive ability and satisfaction in nursing students who practiced in ICU, and promote the continuous improvement of clinical teaching quality.