Background:Intrahepatic cholestasis is a commonly seen clinical manifestation, and often accompanied with jaundice.Study on clinical characteristics of patients with different degrees of jaundice is helpful for the acknowledge of intrahepatic cholestasis.Aims:To explore the clinical characteristics of intrahepatic cholestasis with jaundice.Methods:General data, biochemistry parameters, etiology and treatment of 703 patients with intrahepatic cholestasis were retrospectively analyzed.Results:Jaundice occurred in 168 patients (23.9%), including 149 mild jaundice, 15 moderate jaundice and 4 severe jaundice.Levels of ALT, AST, ALP, GGT, DBIL, TBIL, ratio of DBIL/TBIL, TBA were significantly increased in jaundice group than in non-jaundice group (P<0.05).Levels of ALT, AST, DBIL, TBIL, TBA were statistically different between groups with different degrees of jaundice (P<0.05), however, no significant differences in ALP, GGT, ratio of DBIL/TBIL were seen (P>0.05).The main etiology of intrahepatic cholestasis were digestive system tumors, cardiovascular diseases, shock, hematologic diseases and primary biliary cholangitis.Ursodeoxycholic acid and S-ademetionine were the main drugs for treatment of intrahepatic cholestasis.Conclusions:For patients with intrahepatic cholestasis, levels of ALT, AST, ALP, GGT are increased with the development of jaundice, and attention on damage of hepatocytes should be paid.The etiology of intrahepatic cholestasis with jaundice involves diseases of different organs and systems, most of them are malignant tumor, cardiovascular diseases, shock and primary biliary cholangitis.

This paper reports the nursing care for an elderly patient with stiff person syndrome accompanied with multiple myeloma,which focused on pain management,prevention of muscle spasm,psychological care,close observation of patients' condition,medication monitoring and guidance of functional exercises.After 58 days of careful treatment and nursing care,the patient was discharged from the hospital.

AIM: The aim of this investigation was to confirm the best operation conditions in the membrane separation of protein from the homogenate of red earthworm, Eisenia faefida. METHODS: Ultrafiltration membrane of fresh red earthworm with the cut-off of 10 000 was used as the target process, with the homogenate flux as index, the best value of operation parameters such as pressure、 temperature, surface rotation speed and feed concentration were fixed on. RESULTS: (1) The best suitable operation conditions were 0.25 MPa, 30?C , 200 r/min, pH=6.7, 33.3% (w:w) concentration and not a bit of NaCl. (2) The molecular weight distribution of protein in the homogenate of red earthworm mainly lay between 50 000～100 000. CONCLUSION: The obtained experimental results will provide pilot scale test with data support.

BACKGROUND: It has been proved that interleukin-18 (IL-18) involves in the development of acute cerebral infarction (ACI) and is positively correlated with the time of brain stroke onset, erythrocyte sedimentation rate (ESR), as well as neurological deficit and low-density value of brain CT.OBJECTIVE: To investigate the dynamic changes of serum IL-18 in the course of ACI.DESIGN: Verification analysis with patients as subjects and healthy volunteers as controls.SETTING: Department of neurology of a municipal hospital.PARTICIPANTS: Totally 46 inpatients (29 males and 17 females) with ACI were randomly selected from the Department of Neurology of People's Hospital, Maoming City, between December 2002 and January 2004.Meanwhile, 40 healthy controls (27 males and 13 females) were recruited from those who came to the hospital for routine physical examination. All the participants signed informed consent.METHODS: Fasting peripheral vein blood of 2 mL was collected from the patients on the 1st, 7rh, 14th and 21st days of ACI onset, and from healthy controls on the day of routine examination. The blood samples were centrifuged at 3 000 r/minute for 15 minutes at 4 ℃, and then the supernatant was collected for detecting IL-18 level by ELISA.MAIN OUTCOME MEASURES: The serum IL-18 level of patients on the 1st, 7th 14th and 21st days of ACI onset and that of healthy controls on the day of routine examination.RFSULTS: Totally 46 patients and 40 healthy controls were enrolled in this study and all data were statistically analyzed. The level of serum IL-18 was significantly higher in the patients with ACI than in normal controls on the 1st and 7th days of onset [(178±41) ng/L, (104±34) ng/L, (65±14) ng/L, P ＜ 0.01],but was similar on the 14th and 21st days [(88±36) ng/L, (72±33) ng/L,(65±14) ng/L, P＞ 0.05]. The level of serum IL-18 in ACI patients was significantly higher on the 1st day than on the 7th, 14th and 21 st days of the onset (P ＜ 0.05-0.01); moreover, it was also significantly higher on the 7th day than on the 21st day of the onset (P ＜ 0.05).CONCLUSION: The level of IL-18 increases obviously on the 1st day of ACI onset, and gradually decreases with the extended course of disease and time of treatment.

Objective:To evaluate the effects of stellate ganglion block (SGB) on the activation of M1 microglia during cerebral ischemia-reperfusion (I/R) in rats.Methods:Fifty-four SPF healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 240-270 g, were divided into 3 groups ( n=18 each) using a random number table method: sham operation group (group Sham), cerebral I/R group (group IR) and SGB group.Blood vessels were only exposed, without occlusion in group Sham.Cerebral I/R was induced by occlusion of the middle cerebral artery for 90 min followed by reperfusion in group IR.Cervical sympathetic trunk transaction was performed to induce left SGB immediately after onset of reperfusion in group SGB.Blood samples were collected from the apex of the heart at 6, 12 and 24 h of reperfusion for determination of the concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β in the serum (using enzyme-linked immunosorbent assay). The animals were sacrificed after the neurological function was evaluated at 24 of reperfusion, and brain tissues were removed for microscopic examination of the pathological changes in cortex, for determination of percentage of cerebral infarct size (by TTC staining), for assessment of cell apoptosis and apoptosis rate in cortex (by TUNEL), and for determination of the expression of microglial biomarker Iba-1 and activated M1 microglia biomarker CD68 (by Western blot). Results:Compared with group Sham, the neurological function score, percentage cerebral infarct size, apoptosis rate in cortex, concentrations of TNF-α, IL-6 and IL-1β in the serum, and the expression of Iba-1 and CD68 were significantly increased in IR and SGB groups ( P<0.05). Compared with group IR, the neurological function score, percentage cerebral infarct size, apoptosis rate in cortex, concentrations of TNF-α, IL-6 and IL-1β in the serum, and the expression of Iba-1 and CD68 were significantly decreased in group SGB ( P<0.05), and the pathological changes of brain tissues were significantly attenuated in group SGB. Conclusion:The mechanism by which SGB reduces cerebral I/R injury is related to inhibiting activation of M1 microglia in rats.

Objective: To investigate the awareness of air pollution protection knowledge and its influencing factors among primary school students in Shennongjia Forest District, Hubei Province, so as to provide insights into targeting implementation of health education on air pollution protection knowledge. Methods: Students in Grade 3 to 5 in Shennongjia Shiyan primary school were enrolled by stratified cluster sampling method, and students' demographic features and awareness of air pollution protection knowledge were investigated using the Investigation on the Effects of Air Pollution Health Protection of Pupils (Volume A). Factors affecting the awareness of air pollution protection knowledge among primary school students were identified using a multivariable logistic regression model. Results: A total of 897 questionnaires were allocated, and 877 valid questionnaires were recovered, with an effective rate of 97.77%. The respondents included 446 men (50.86%) and 431 women (49.14%), 301 third grade students (34.32%), 284 fourth grade students (32.38%), and 292 fifth grade students (33.30%), and had a mean age of (10.32±0.93) years. The overall awareness of air pollution protection was 55.76%, and the awareness rates of basic concepts, basic knowledge, and basic behaviors and skills were 42.99%, 53.48% and 57.24%, respectively. Multivariable logistic regression analysis identified age (OR=1.453, 95%CI: 1.053-2.005), living with parents (OR=2.638, 95%CI: 1.571-4.429), mother's educational level (below primary school, OR=0.270, 95%CI: 0.084-0.862; primary school, OR=0.169, 95%CI: 0.069-0.416; junior high school, OR=0.309, 95%CI: 0.138-0.691; high school, OR=0.352, 95%CI: 0.160-0.773) and average annual family income (50 000 to 100 000 Yuan, OR=1.629, 95%CI: 1.162-2.282; 100 000 to 150 000 Yuan, OR=1.802, 95%CI: 1.101-2.948; ≥150 000 Yuan, OR=1.939, 95%CI: 1.065-3.529) as factors affecting the awareness of air pollution protection knowledge among primary school students. Conclusion The awareness of air pollution protection knowledge is 55.76% among primary school students in Shennongjia Forest District, and is affected by age, mother's educational level, average annual family income and living with parents.

Objective Ti explire the influence if cignitive behaviiral interventiin in effi-cacy if pisitive airway pressure in patients with ibstructive sleep apnea syndrime (OSAHS). Methods 70 patients diagnised as miderate and severe OSAHS were randimly divided ti cintril griup and interventiin griup,35 cases in each griup.Bith griups were treated with AUTO-CPAP,the cintril griup was cinducted with cinventiinal nursing,the interventiin griup was cinducted with cignitive behaviir nursing interventiin in the basis if the cintril griup.Results The cimfirt degree and satisfactiry degree in the interventiin griup were significantly higher than the cintril griup(P <0.05).After treatment,the minimum SaO2 and average SaO2 during the night in the interventiin griup were significantly higher than the cintril griup(P <0.05).The AHI level in the interventiin griup was significantly liwer than that in the cintril griup (P <0.01).Conclusion Cignitive behaviiral interventiin can effectively imprive the cimfirt degree and satisfactiry degree in OSAHS patients,reduce the emitiins if fear and imprive the clinical ef-ficacy.

Objective Ti explire the influence if cignitive behaviiral interventiin in effi-cacy if pisitive airway pressure in patients with ibstructive sleep apnea syndrime (OSAHS). Methods 70 patients diagnised as miderate and severe OSAHS were randimly divided ti cintril griup and interventiin griup,35 cases in each griup.Bith griups were treated with AUTO-CPAP,the cintril griup was cinducted with cinventiinal nursing,the interventiin griup was cinducted with cignitive behaviir nursing interventiin in the basis if the cintril griup.Results The cimfirt degree and satisfactiry degree in the interventiin griup were significantly higher than the cintril griup(P <0.05).After treatment,the minimum SaO2 and average SaO2 during the night in the interventiin griup were significantly higher than the cintril griup(P <0.05).The AHI level in the interventiin griup was significantly liwer than that in the cintril griup (P <0.01).Conclusion Cignitive behaviiral interventiin can effectively imprive the cimfirt degree and satisfactiry degree in OSAHS patients,reduce the emitiins if fear and imprive the clinical ef-ficacy.

Objective:To evaluate the immunogenicity and protective effect of a multicomponent recombinant protein vaccine EPRHP014 constructed independently and provide a scientific basis for developing new tuberculosis (TB) vaccine and effective prevention and control of TB.Methods:Three full-length Mycobacterium ( M.) tuberculosis protein antigens (EsxH, Rv2628, and HspX) and two epitope-predicted and optimized epitope-dominant protein antigens (nPPE18 and nPstS1) were selected, from which five protein antigens were used to construct a protein antigen composition EPRHP014, including a fusion expression multi-component protein antigen (EPRHP014f) and a multi-component mixed protein antigen (EPRHP014m) formed with the five single protein using clone, purification, and purification respectively. Multicomponent protein vaccines EPRHP014f and EPRHP014m were prepared with aluminum adjuvant, and the BCG vaccine was used as a control. ELISA detected the titer of serum-specific antibodies, the secretion of various cytokines was detected by ELISpot and Luminex, and immune protection was observed by the M.tuberculosis growth inhibition test in vitro. The results were statistically analyzed by t-test or rank sum test, and P<0.05 was considered a statistically significant difference. Results:Mice Immunized with EPRHP014m and EPRHP014f could produce highly effective IgG antibodies and their subtypes IgG1 and IgG2a, and the antibody titers were similar to those of mice immunized with BCG, with no statistical significance ( P>0.05). The number of spot-forming cells (SFC) secreting IFN-γ and IL-4 induced by EPRHP014f group was significantly higher than those by EPRHP014m group and BCG group ( P<0.05), but there was no significant difference in the number of SFC for IFN-γ and IL-4 induced between EPRHP014m group and BCG group ( P>0.05). The secretion levels of GM-CSF and IL-12p70 induced by the EPRHP014m group were higher than those of the BCG group ( P<0.05), but there was no significant difference in the levels of IL-6 and IL-10 induced between EPRHP014m group and BCG group ( P>0.05). There was no significant difference in the secretions of IL-6, IL-10, IL-12, and GM-CSF between the EPRHP014f and BCG groups ( P>0.05). EPRHP014m group, EPRHP014f group, and BCG group had obvious antibacterial effects in vitro, and the difference was insignificant ( P>0.05). Conclusion:Both EPRHP014f and EPRHP014m can induce strong humoral and cellular immune responses in mice after immunization, and have a strong ability to inhibit the growth of M. tuberculosis in vitro, indicating that the antigen composition EPRHP014 has good potential in the development and application of TB vaccine.

Objective To analyze the incidence and risk factors of postoperative esophageal stenosis after endoscopic submucosal dissection(ESD)with mucosal defect of 1/2?<3/4 circumference. Methods A retrospective analysis was performed on the data of 301 patients with early esophageal cancer or precancerous lesions undergoing ESD at Drum Tower Hospital between January 2013 and August 2015. The incidence and risk factors for postoperative stenosis were analyzed. Results Esophageal stenosis was observed in 13 cases among the 113 cases of 1/2?<3/4 circumference mucosal defect. The rate of stenosis was 11.5%. There was no significant difference between stenosis group and non?stenosis group in regard of gender, age, family history, concomitant diseases, lesion type, operation time, invasion depth, lesion longitudinal length,pathological diagnosis or complications after ESD(P>0.05),while the rate of lesions in the upper esophagus in stenosis group was higher than that in the control group(P<0.05). Conclusion Mucosal defect of 1/2?<3/4 circumference has a lower esophageal stenosis rate after ESD,which is related to the location of lesion. The ratio of upper esophagus lesion in the stenosis group is significantly higher than that in the non?stenosis group.