Objective:To study assessment value of brachial‐ankle pulse wave velocity (baPWV) for severity of coro‐nary disease in patients with coronary heart disease (CHD) .Methods :According to SYNTAX score of coronary an‐giography ,a total of 206 CHD patients from our hospital were divided into mild group (n=74 ,SYNTAX score <23 scores) ,medium group (n= 72 ,SYNTAX score 23~32 scores) and severe group (n= 60 ,SYNTAX score > 32 scores) .Another 80 healthy subjects undergoing physical examinations were selected as healthy control group during the same period .BaPWV ,ankle brachial index (ABI) and carotid -femoral pulse wave velocity (cfPWV) were measured and compared among all groups .Pearson correlation analysis was used to analyze the correlation among baPWV ,cfPWV ,ABI and SYNTAX score in CHD patients ;multi -factor Logistic regression model was used to analyze whether baPWV ,cfPWV and ABI were risk factors for SYNTAX scores .Results:Compared with healthy control group ,there were significant rise in baPWV [ (1.2 ± 0.3) m/s vs .(1.5 ± 0.4) m/s vs .(1.8 ± 0.6) m/s vs . (2.0±0.7)m/s]andcfPWV [ (1.3±0.5)m/svs.(2.5±0.7)m/svs.(2.9±0.8)m/svs.(3.4±0.7)m/s]in mild group ,medium group and severe group (P<0.05 or <0.01) ,and that of severe group was more than that of medium group ,and>mild group in turn ,there was significant difference by pairwise comparisons ( P<0.05 all);significant reduction in ABI [ (1.02 ± 0.32) vs .(0.82 ± 0.24) vs .(0.73 ± 0.16) vs .(0.56 ± 0.09)] in mild group , medium group and severe group ,and that of severe group was < medium group ,and < mild group in turn ,there was significant difference by pairwise comparisons ( P<0.05 all) .Pearson correlation analysis indicated that baPWV and cfPWV were positively correlated with SYNTAX score ( r= 0.613 , P= 0.007;r=0.528 , P=0.023) ,while ABI had no correlation with SYNTAX score .Multi-factor Logistic regression analysis indicated that diabetes melli‐tus ,hypertension ,baPWV and cfPWV were risk factors for SYNTAX score (OR=4.016~5.809 , P<0.05 or <0.01) .Conclusion:The baPWV can effectively assess severity of coronary disease in CHD patients .

Objective To observe the effect and the mechanisms of ferulic acid on radiationinduced damage of mice peripheral blood and bone marrow hematopoietic function.Methods Ninety-six mice were randomly divided into sham irradiation group,irradiation group,positive drug group and 10,30,90 mg·kg-1 ·d-1 ferulic acid group,16 mice per group.Mice were exposed to 3.5 Gy γ-rays 24 h after first drug taken.Then,mice were given drugs for 7 d after irradiation.White blood cells in peripheral blood of 10 mice per group were counted 2 d before irradiation and 3,7,10,15 and 22 days after irradiation.The bone narrow of the other six mice was taken to detect the micronuclei frequency of polychromatic erythrocyte,the hematopoietic progenitor cell colony formation capacity,Thbd and HMGB1 protein expressions in mice bone marrow on the seventh day after irradiation.Results Compared with the irradiation alone group,the treatment of mice with ferulic acid 90 mg· kg-1 · d-1 increased the number of white blood cells in peripheral blood at 3,10,15 and 22 d after irradiation (t =2.267,2.399,1.945,2.828,P ＜ 0.05).Treatment with mice with ferulic acid 90 mg· kg-1 · d 1 decreased the micronuclei rate of erythrocytes in irradiated bone marrow (t =4.013,P ＜ 0.05),increased the clone numbers of CFU-E,BFU-E and CFU-GM of hematopoietic progenitor cells (t =2.366,2.953,3.115,P ＜0.05),improved the relative expression of the Thbd protein in bone marrow and the HMGB1 protein in nuclear (t =17.75,23.39,P ＜ 0.01).Conclusions Ferulilc acid could protect the bone marrow hematopoietic of mice exposed to irradiation by regulating the expressions of Thbd and HMGB1 protein,and then accelerate the peripheral cells recovery.

The purpose of medicine is to preserve and develop the treatment in the process of saving lives and helping injuries. Medical professionalism is a comprehensive expression of physician’s clinical abilities, relationships and values between different subjects. In practice, white robed doctors utilize high standards of professionalism to practice the medical purpose and goals of "always centering on the interests of the patient" in specific diagnosis and treatment behaviors. At the same time, fulfilling the promises and expectations of medicine to the public. For these reasons, selfless dedication, self-sacrifice, and one-way pure altruism are all internalized into the basic requirements of medical professionalism: doctors should not only have the skill to revive the dead, but also have the benevolence of evangelists; they not only need to achieve maximum efficiency in technology, but also achieve the highest truth, goodness, and beauty in virtue. When these qualities are exaggerated or unattainable due to uncontrollable reasons, there will be a rift between the entrenched value systems and practical needs. In recent years, the global epidemic has had a huge impact on the medical system and medical staff, and the moral beliefs, role expectations, and value systems of doctors have also been impacted unprecedentedly, resulting in moral injury. The international research on moral injury in medical field has also received attention. China is currently in the adjustment period of epidemic related policies, with medical personnel bearing the brunt. Therefore, referring to relevant international research on moral injury to re-examine the relationship between the medical professionalism, which emphasizes one-way pure altruism, dedication and weakening or even neglecting personal well-being, and current medical practices. And constructing a moral injury early warning-repair system that focuses on doctors, patients, medical teams, medical institutions, medical environments, health systems, and other stakeholders, and ensuring its healthy operation. Not only in extreme periods, but also in ordinary daily diagnosis and treatment, it can support doctors to actively, safely, and healthily fulfill their mission of saving lives and helping injuries.

Objective To evaluate the clinical performance of checklist for early recognition and treatment of acute illness (CERTAIN) on patients in the intensive care unit (ICU). Methods A prospective observational study was performed. 100 patients (age > 18 years old, the length of ICU stay > 72 hours) admitted to ICU of the Second People's Hospital of Lu'an from January to July in 2018 were enrolled. By convenience sampling methods, 50 patients admitted to the hospital from January to April in 2018 were selected as the control group. Standard ward inspection was given to the control group by three senior-level and intermediate-level doctors blinded from the research plan; at the end of March 2018, these three doctors were trained with the CERTAIN checklist and certified by the Mayo Clinic distance learning training. Fifty patients enrolled from March to July 2018 received medical rounds using CERTAIN (observation group). The CERTAIN checklist contained 20 items that cover the range of daily critical ward rounds, which need clinicians to quantify each item. The data included the length of ICU stay, central venous catheter (CVC) indwelling time, catheter indwelling time, duration of mechanical ventilation, drug use rate, ICU mortality, and incidence of adverse events were collected and compared between the two groups. The independent factors affecting ICU death were analyzed by log-rank univariate analysis and Cox regression multivariate analysis. Results Compared with control group, the length of ICU stay (days: 8.68±4.84 vs. 13.64±9.37), catheter indwelling time (days: 8.16±5.29 vs. 13.32±9.31), duration of mechanical ventilation (days: 3.46±4.14 vs. 6.62±9.57) in observation group were significantly decreased, insulin use rate (34.0% vs. 56.0%) and ICU mortality (2.0% vs. 14.0%) were significantly decreased, with statistically significant differences (all P < 0.05). Besides, the use of CERTAIN can significantly improve the efficiency of the ward inspection. The ward inspection time was shortened from (8.00±0.45) minutes to (5.00±0.33) minutes by using the CERTAIN checklist (t = 9.312, P < 0.01). Survival analysis showed that CERTAIN application could reduce ICU mortality (χ2= 3.898, P = 0.048), but the use of CERTAIN was not an independent factor for reducing ICU mortality [odds ratios (OR) = 1.001, P = 0.922]. Conclusions CERTAIN application has a significant effect on critical patients. It is suggested to spread in ICU of China.

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.

OBJECTIVE: To observe the in vivo metabolism and distribution characteristics of nano-cerium oxide( nanoCeO_2) in rats,and to explore the radio-protective effect of nano-CeO_2. METHODS: i) A total of 18 specific pathogen free( SPF) SD rats were randomly divided into 3 groups. Rats of experiment group and CeO_2 blood group were gavaged with1. 0 g/kg body weight( bw) nano-CeO_2 suspension. Rats of control group were gavaged with double distilled water( DDW)in equal volume. At different time-points after treatment,venous blood was collected from the rats' eye socket in CeO_2 blood group,meanwhile urine and excrement of rats of experiment group were also collected. Organ and tissue samples of experiment group and control group were collected 24. 0 hours after treatment. The concentrations of cerium in biological samples were detected by inductively coupled plasma mass spectrometry. ii) A total of 72 SPF BALB/c mice were randomly divided into 6 groups. Mice of low-,medium-and high-dose groups were gavaged with 100,300 and 900 mg/kg bw nano-CeO_2 suspension respectively. Mice of negative control group,irradiation control group and drug positive control group were gavaged with DDW in equal volume once daily. After 14 days,mice of the other 5 groups were exposed by60Coγ-rays once with 3. 5 Gy( 1 Gy/min) except the negative control group. Mice of drug positive control group were given intraperitoneal injection with 200 mg/kg bw amifostine half an hour before irradiation. After exposure,mice were treated by the above gavages once daily. After 3 and 8 days,6 mice were randomly selected to collect the peripheral blood for the count of white blood cell( WBC) and lymph cell measuring. RESULTS: i) The cerium concentration in blood reached peak value in 4. 0 hours after exposure of nano-CeO_2,and the cerium concentration of urine and excrement reached maximum in8. 0 hours after exposure. After 24. 0 hours of exposure,the cerium concentration of brain in experiment group was higher than that of control group( P < 0. 05). Among the experiment group,the cerium concentrations of sternum,duodenum and brain were higher than that of kidney and heart( P < 0. 05),meanwhile the cerium concentrations of thymus and lung were higher than that of kidney( P < 0. 05). ii) There was no statistical difference in interactive effect of WBC count and lymph cell counts between nano-CeO_2 exposure ways and time( P > 0. 05). The WBC counts of the low-and medium-dose groups were lower than those of the negative control group and the drug positive control group( P < 0. 05). The WBC count of high-dose group was lower than those of irradiation control group,drug positive control group and medium-dose group( P <0. 05). The lymph cell counts of the 3 dose groups were lower than that of drug positive control group( P < 0. 05).CONCLUSION: The nano-CeO_2 is mainly cumulated in organs such as sternum,duodenum,brain,thymus and lung. After induced by radiation,nano-CeO_2 has a certain degree of promotion role in increasing the WBC counts.