Objective To explore the relationship of content of plasma endothelin(ET)-1 with the change of pulmonary function in patients with chronic obstructive pulmonary disease(COPD).Method Thirty cases of the normal people were as group A ,34 cases of the patients with COPD with acute exacerbation before treatment were as group B and the patients with remission period after treatment were as group C,the plasma ET-1,arterial blood gas and pulmonary function parameters were determined from the patients before and after treatment.Results The plasma ET-1 in group B and group C were significantly higher than that in group A,the content of the plasma ET-1 had negatively correlated with PaO2,and that had positively correlated with PaCO2,P＜0.01.The pulmonary function parameters (VC,FEV1/FVC,MVV,V50 V25)in group B were significantly lower than those in group A and group C[(55.3±24.5)%,(54.8±19.3)%,(54.2±16.2)%,(54,8±9,9)%,(58.7±14.5)%;(114.8±24.1)%,(84.9±21.6)%,(86.4±17.2)%,(78.5±14.8)%,(90.3±15.4)% and (110.1±19.4)%,(85.8±15.5)%,(85.9±16.7)%,(74.5±13.4)%,(89.4±18.6)%,respectively],P＜0.01.Conclusion Pathophysiological effects of patients with COPD can be commonly adjusted by the plasma ET-1,oxygen and carbon dioxide retention,which affect pulmonary function.

Objective To investigate the effect of dexmedetomidine on perioperative cell immune function in patients undergoing hepatoma surgery. Methods Sixty patients (40-65 y/o, 50-80 kg body weight, ASA grad-ing I-II) with hepatoma were allocated into two groups each containing 30 patients:control group (group C) and dex-medetomidine group (group D). 15 minutes before anesthesia induction, a loading dose of dexmedetomidine 0.5μg/kg was injected intravenously, followed by infusion at 0.4μg/(kg · h)until the end of operation in group D. The equal volume of normal saline was administered in group C.Blood samples were obtained from jugular vein before induc-tion of anesthesia (T0), the end of operation(T1) and 24 h after the end of surgery (T2) for detections of the levels of T lymphocyte subsets (CD3+, CD4+, CD8+) and NK cells by flow cytometry. CIM+/CD8+ratio was calculated. Serum IL-2 and IL-10 were detected by ELISA methods. Results When compared with the baseline value (T0), the levels of CD3+, CD4+, CD4+/CD8+ratio and NK cells significantly decreased at T1 and T2 in group C, and the levels of CD3+and CD4+also significantly decreased at T1 and T2 in group D (P<0.05). Compared with group C, the levels of CD3+, CD4+, NK cells and IL-2 at T1 and T2 were significantly higher in group D, and level of IL-10 at T1 and T2 were significantly lower in group D (P < 0.05). Conclusion Dexmedetomidine could improve the postoperative suppression of immune function in patients undergoing hepatoma surgery.

Objective To discuss the treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells. Methods The femoral-head osteonecrosis models on one side were established in forty-two goats using liquid nitrogen, which were randomly classified into three groups after 8 weeks. Group A were conducted umbrella strut bone grafting and bone marrow mesenchymal stem cells transplantation, group B were conducted simple unit side muscle bone flap grafting, and group C were conducted umbrella strut bone grafting and Cancellous bone grafting transplantation. The health side of three groups was treated as self-control. The radiological and histology examination were made at 3,6treated lateral femoral-head shape restored,cystic cnlow-density area disappeared, the original collapse had repaired, and no further collapse of the femoral-head shaped for both group A and B. Bone fusion was good and bone column shadow had been vague for group A, while the bone fusion healed somewhat less and bone column shadow still clear for group B. Group C had irregular contour of femoral head, flat collapse, uneven density, and fracture cracks could be seen at weight-bearing area of femoral head, obviously was the poorest bone had different states: mature and arranged ruled for group A, childish and irregular arrangement for group B, thinning, sparse and fracture for group C. The percentage of empty lacunae counts decreased, while the percentage of trabecular bone area fraction increased for group A. In contrast with group B, and C, the difference was statistically significant (P ＜ 0.05), but the difference was no longer statistically significant when contrast with healthy sides (P ＞ 0.05). 6 months later, the radiological and histology examination showed that:group A and group B had been no significant difference comparing to normal femoral heads, while the femoral head of group C collapsed and disappeared completely. Group A and group B were no difference comparing the healthy side (P ＞ 0.05)in the area fraction of trabecualr bone and percentage of empty lacunae counts, neither it was between group A and group B(P ＞ 0. 05). Conclusion The treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells was good and was better than cancellous bone grafting transplantation and simple unit side muscle bone flap grafting.

Objective To study the clinical manifestation and MRI feature of toxic encephalopathy after inhaling caffeine and sodium benzoate. Methods Three patients with toxic encephalopathy induced by inhaling caffeine and sodium benzoate were observed clinically and with MRI. Results The 3 patients were male. They all had definite addiction histories (the time of addiction for 3 years to 7 years ). There were special language and retropulsive dystonia besides the common characteristics of toxic encephalopathy:reaction retardation and disturbance of intelligence. MRI showed the change of generalized demyelination in bilateral symmetrical cerebral hemisphere, posterior limbs of internal capsule, corpus callosum, medial lemniscus, and cerebellum hemisphere dentate nucleus. The clinical symptoms of 3 patients were significantly improved 40 days after the adrenocortical steroid and neurotrophic treatment. The mild mood disorder remained in case 1. Conclusion Clinical manifestation and MRI of toxic encephalopathy after inhaling caffeine and sodium benzoate are known, so we could diagnose the patients of the disease in time.

Objective To provide reference and ideas for information service in hospital library by analyzing the influencing factors for its service satisfaction.Methods The satisfaction of hospitalized patients for information service was investigated.The characteristics of patients,their requirements for information service and the influencing factors for their satisfaction were analyzed by logistic regression analysis.Their satisfaction for information service was assessed according to the IPA method and analyzed using the SPSS19.0.P<0.05 was considered statistically significant.Results Health information was provided for 221 patients.No significant difference was found in sex,age,education level between the importance of information service and the influence of satisfaction for information service (P>0.05).The importance of information service and the satisfaction of patients for information service were rather high.IPA analysis showed that the patients considered high the importance of library-provided personal bibliography and departments-provided health pamphlets with a low satisfaction,which should thus be solved.Conclusion The satisfaction of patients for information service is good.However,the importance of library-provided personal bibliography and departments-provided health pamphlets is high and the satisfaction for them is low.It is thus necessary for librarians to improve their service and encourage more medical staff to participate in information service for patients.

Objective: To investigate the incidence of coutrast media iodixanol-induced delayed adverse reaction with the risk factors in general clinical practice.
Methods: A total of 20,185 patients with contrast iodixanol were recruited from 95 medical centers in China. The risk factors for adverse drug reaction as hypertension, asthma, previous contrast reaction were assessed;the administrative processes as route, injection manner, lfow rate of injection, prior heating of iodixanol were monitored and the demographic information was documented. The immediate adverse reaction within 1 hour of media administration and the delayed adverse reaction from 1 hour to 7 days after administration were recorded. The risk factors for iodixanol-induced delayed adverse reaction were studied by singlevariate and multivariate logistic regression analysis.
Results: The overall iodixanol-induced adverse reaction rate was 1.52%, of which the immediate reaction was 0.58%and delayed reaction was 0.97%. The major delayed reaction was mild and it mostly happened in skin (0.68%) including rash, pruritus and urticaria. Multivariate logistic regression analysis revealed that male gender (OR=0.71, P=0.036), age (OR=0.82, P=0.001), route of administration (OR=0.21, P<0.001), prior heating of iodixanol (OR=1.44, P=0.036), lfow rate of injection (OR=1.28, P=0.001) and previous contrast reaction (OR=16.04, P<0.001) were the independent risk factors for delayed adverse reactions.

Objective This study is to explore the correlation between communication skills attitude and general self-efficacy among medical interns. Methods Medical intern students of three medical colleges in Shanghai were participated in this study, and questionnaire survey was conducted by cluster sampling of class. SPSS 19.0 was used to process descriptive analysis, t-test, F-test, correlation analysis and hierarchical regression analysis for data analysis. Result 600 questionnaires were handed out and 575 valid samples were collected. The effective rate was 95.83％. The mean score of positive and negative attitude dimension in CSAS were (51.880 ±7.003) and (31.550 ±5.839). The mean score of GSES was (26.230 ±4.820). A positive correlation was found between positive attitude of communication skills and general self-efficacy (r=0.165, P<0.01). Hierarchical regression analysis indicated that school, cognition about importance of com-munication skills and general self-efficacy significantly predicted positive attitude of communication skill.These three variables could explain 21.8％ of total variance and general self-efficacy can explained 2.1％after control other variables. Conclusion Communication skills attitudes of medical interns is positive on the whole. Enhancing their general self-efficacy is beneficial to improving their positive attitude towards communication skills.

Objective:To investigate the association between C-reactive protein (CRP)/albumin (ALB) ratio (CAR) and mortality in peritoneal dialysis (PD) patients.Methods:Clinical data of 791 PD patients in the Second Affiliated Hospital of Soochow University from January 1, 2004 to December 31, 2019 were retrospectively collected. According to the baseline quartiles of CAR, patients were divided into three groups: low-level CAR group (CAR≤0.161 mg/g, n=264), medium-level CAR group (CAR 0.162-0.214 mg/g, n=263) and high-level CAR group (CAR≥0.215 mg/g, n=264). The clinical data among the three groups were compared. Follow-up was ended on March 31, 2020, or when the patients stopped PD due to death, shift to hemodialysis, renal transplantation or recovery of renal function. Kaplan-Meier survival curve, multivariate Cox proportional hazard model and Fine-Gray competing risk model were used to assess the relationship between CAR and all-cause mortality and cardiovascular and cerebrovascular mortality. The association between CAR, CRP, ALB, neutrophil to lymphocyte ratio (NLR), or platelet to lymphocyte ratio (PLR) and mortality in PD patients was compared by receiver-operating characteristic curve (ROC curve) analysis. Results:The age of the patients was (59.8±15.7) years old, and 447(56.5%) patients were males. 714(90.3%) patients had hypertension. 233(29.5%) patients had diabetes. 182(23.0%) patients had cardiovascular diseases. The median follow-up time was 55(31, 88) months. By the end of the follow-up, 236 deaths (29.8%) happened, and 95 patients (12.0%) died from cardiovascular and cerebrovascular diseases. Kaplan-Meier survival analysis results showed that the overall survival rate of the high-level CAR group was lower than those of the low-level CAR group and medium-level CAR group (Log-rank test χ2=109.50, P<0.001). Multivariate Cox regression analysis and Fine-Gray competing risk model revealed that CAR was independently correlated with all-cause mortality and cardiovascular and cerebrovascular mortality after adjusting for confounding factors ( HR=2.891, 95% CI 1.921-4.351, P<0.001; SHR=1.297, 95% CI 1.128-1.490, P<0.001). ROC curve analysis results showed that the area under the curve ( AUC) of CAR for predicting the risk of all-cause mortality in PD patients was 0.737(95% CI 0.700-0.774), which was superior to those of CRP ( AUC=0.643, 95% CI 0.599-0.687), NLR( AUC=0.608, 95% CI 0.563-0.653) and PLR ( AUC=0.554, 95% CI 0.508-0.601), and slightly lower than ALB ( AUC=0.752, 95% CI 0.716-0.788). The optimal cutoff value of CAR for death was 0.19 mg/g, with the sensitivity and specificity of 70.8% and 68.3%, respectively. Conclusions:Increasing CAR level is an independent risk factor of all-cause mortality and cardiovascular and cerebrovascular mortality in PD patients, and its correlation with mortality is higher than those of inflammatory parameters such as CRP, NLR and PLR.

To improve the expression level and catalytic efficiency of (R)-carbonyl reductase from Candida parapsilosis in Escherichia coli, we optimized the mRNA secondary structure of (R)-carbonyl reductase gene in translation initiation region (from +1 to +78), and constructed the corresponding variant. The formation of hairpin structure was significantly reduced and the Gibbs free energy was dramatically decreased from -9.5 kcal/mol to -5.0 kcal/mol after optimization. As a result, the expression level of (R)-carbonyl reductase in the variant was increased by 4-5 times and its specific activity in cell-free extract was enhanced by 61.9% compared to the wild-type strain. When using the whole cells as catalyst and 2-hydroxyacetophenone as substrate with a high concentration of 5.0 g/L, the variant showed excellent performance to give (R)-1-phenyl-1, 2-ethanediol with optical purity of 93.1% enantiomeric excess and a yield of 81.8%, which were increased by 27.5% and 40.5% respectively than those of the wild-type. In conclusion, the optimization of mRNA secondary structure in translation initiation region can overcome the steric hindrance of translation startup, promote translation smoothly to acquire high expression of target protein, and favor protein folding correctly to efficiently improve the enzyme specific activity and biotransformation function.
Alcohol Oxidoreductases ; biosynthesis ; chemistry ; genetics ; Base Sequence ; Biocatalysis ; Candida ; enzymology ; Catalysis ; Escherichia coli ; genetics ; metabolism ; Molecular Sequence Data ; Mutant Proteins ; genetics ; Nucleic Acid Conformation ; Peptide Chain Initiation, Translational ; RNA, Messenger ; chemistry ; Recombinant Proteins ; biosynthesis ; genetics ; Stereoisomerism

OBJECTIVE: To describe the incidence and to discuss the risk factors of premature birth in rural areas of Liuyang. METHODS: We collected subjects from villages and towns in Liuyang through cluster sampling method. Before enrolling in this cohort, all of them had established health records from January 2010 to December 2011. We followed up the early, middle and late stages of pregnancy until delivery, and collected medical records and maternal health care manual of this cohort as our data materials. We explored the main influence factors of premature delivery by χ2 test and unconditional logistic regression analysis for single factor and multivariate analysis. RESULTS: Among 6270 women who enrolled in our cohort, 259 were diagnosed as premature birth. The incidence (4.13%) was lower than the national average level. Non-conditional logistic regression analysis showed that the risk factors of premature birth were as follows: OR of placental abruption was 7.678 (95% CI: 2.249-26.215), that of premature rupture of fetal membranes (PROM) was 5.177 (95% CI: 3.945-6.793), that of uterine abnormal and deformity was 2.675 (95% CI: 1.007-7.107), that of placenta anomaly was 2.633 (95% CI: 1.666-4.162), that of hypertension in pregnancy was 2.172 (95% CI: 1.044-4.521), that of pregnancy complications was 1.806 (95% CI: 1.033-3.157), that of male fetus was 1.429 (95% CI: 1.086-1.881). Protective factors of preterm birth were too frequent prenatal examination (OR=0.502, 95% CI: 1.033-3.157) and single pregnancy (OR=0.155, 95% CI: 0.075-0.319). CONCLUSION Preterm delivery is caused by complicated factors, such as placental abruption, PROM and male fetus. Comprehensive measures should be taken to reduce preterm birth.
Abruptio Placentae ; etiology ; Adult ; China ; epidemiology ; Female ; Fetal Membranes, Premature Rupture ; etiology ; Humans ; Incidence ; Logistic Models ; Pregnancy ; Premature Birth ; epidemiology ; etiology ; Risk Factors ; Rural Population ; Sampling Studies ; Young Adult