Objective To compare the effects of Carvedilol.Bisoprolol therapies for patients with chronic heart failure(CHF). Methods 80 patients with CHF were divided into carvedilol group(40 cases) ,Bisoprolol group (40 cases) ;The two groups were treated respectively with Carvedilol or Bisoprolol in addition to the above conventional therapy. The indicators of heart rate( HR),blood pressure( BP) ,left ventricular end-diastolic diameter( LVEDD) , left ventricular end-systolic diameter( LVESD) ,left ventricular ejection fraction(LVEF) ,6min walking test distance (6min walk) were observed after treatment and before treatment. Results Total effective rates were 82.5% and 87.5% in Carvedilol group and the Bisoprolol group,There was no statistically significant difference between two groups(χ2 =2. 18,P>0.05) ;The indicators of HR,SBP,DBP,LVEDD,LVESD after treatment were lower than before treatment ( all P < 0.05); LVEF, and 6min walk were higher than before treatment (all P < 0.05). Conclusion Bisoprolol and Carvedilol could significantly improve cardiac function in patients with heart failure.

Objective　In order to find out influencing factors of corrosiveness of common chemical disinfectants used at present for medical instruments on varied metal material, and to offer scientific bases for working -out corresponding state standards. Methods　Liquid instruments disinfectants containing chlorine and glutaraldehyde compound disinfectant were chose to take an example to study their corrosiveness to varied sorts and type s of the metal. Sing le related factors were researched by contrast test study in the process of dete rmining metal corrosion rate (R value, mm*a-1) citing from GB10124-88 me thod. Results　Varied chemical disinfectants had different metal R valu e. R value was in fluenced by kinds of metal pieces, sorts of soaked vessel material, drying tempe rature, whether changing liquid disinfectants or not and water quality, while d ifferent capacity of balance measure had no effect on R value. Concl usi ons　R value was affected by kinds and types of metal pieces and other factors. These fac tors should be considered sufficiently while determining or comparing corrosiven ess of chemical disinfectants to soaked metal.

Objective:To explore the correlation between early inflammation indicators and the severity of coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. Patients with COVID-19 admitted to Wenzhou Central Hospital from January 17 to February 14, 2020 were enrolled. The general information, chest CT before admission, the first laboratory parameters and chest CT within 24 hours after admission were collected. Patients were followed up for 30 days after the first onset of dyspnea or pulmonary imaging showed that the lesions progressed more than 50% within 24 to 48 hours (according to the criteria for severe cases) as the study endpoint. According to the endpoint, the patients were divided into two groups: mild type/common type group and severe/critical group, and the differences in general information and inflammation index of the two groups were compared. Logistic regression was used to analyze the inflammation index and the severity of COVID-19. Receiver operating characteristic (ROC) curve was draw to evaluate the predictive value of early inflammation indicators for severe/critical in patients with COVID-19.Results:A total of 140 patients with COVID-19 were included, 74 males and 66 females; the average age was (45±14) years old; 6 cases (4.3%) of mild type, 107 cases (76.4%) of common type, and 22 cases (15.7%) of severe type, 5 cases (3.6%) were critical. There were significantly differences in ages (years old: 43±13 vs. 57±13), the proportion of patients with one chronic disease (17.7% vs. 55.6%), C-reactive protein [CRP (mg/L): 7.3 (2.3, 21.0) vs. 40.1 (18.8, 62.6)], lymphocyte count [LYM (×10 9/L): 1.3 (1.0, 1.8) vs. 0.8 (0.7, 1.1)], the neutrophil/lymphocyte ratio [NLR: 2.1 (1.6, 3.0) vs. 3.1 (2.2, 8.8)] and multilobularinltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hyper-tension and age [MuLBSTA score: 5.0 (3.0, 5.0) vs. 5.0 (5.0, 7.0)] between mild/common group and severe/critical group (all P < 0.05). Univariate Logistic regression analysis showed that CRP, NLR, MuLBSTA score, age, and whether chronic diseases were associated with the severity of COVID-19 [odds ratio ( OR) and 95% confidence interval (95% CI) were 1.037 (1.020-1.055), 1.374 (1.123-1.680), 1.574 (1.296-1.911), 1.082 (1.042-1.125), 6.393 (2.551-16.023), respectively, all P < 0.01]. Further multivariate Logistic regression analysis showed that CRP and MuLBSTA score were risk factors for the development of COVID-19 to severe/critical cases [OR and 95% CI were 1.024 (1.002-1.048) and 1.321 (1.027-1.699) respectively, both P < 0.05]. ROC curve analysis showed that the area under the curve for CRP and MuLBSTA score to predict severe/critical cases were both 0.818, and the best cut-off points were 27.4 mg/L and 6.0 points, respectively. Conclusion:CRP and MuLBSTA score are related to the severity of COVID-19, and may have good independent predictive ability for the development of severe/critical illness.

Aim To investigate the proliferative effect and the apoptosis of rat epididymal epithelial cells induced by podophyllotoxin and its underlying mechanisms.Methods Primary epididymal epithelial cells were cultured in vitro.CCK-8 assay was used to analyze proliferation of epididymal epithelial cells induced by podophyllotoxin on 24, 48 and 72 h.The ultra structural changes of the epididymal epithelial cells were observed by transmission electron microscope.AnnexinV-FITC/PI staining was used to quantify the percentages of apoptosis in the total cell population.The TdTmediated dUTP nick end labeling(TUNEL) technique was applied to observe the morphological changes of apoptotic cells.The expression of tumor necrosis factor alpha(TNF-α) mRNA was investigated by real-time RT-PCR.The level of TNF-α in cell culture supernatant was measured by enzyme-linked immunosorbent assay(ELISA) technology.Western blot was per-formed to determine the protein expression of cytochrome C, caspase-3, caspase-8, caspase-9.Results Podophyllotoxin significantly inhibited the activity of proliferation and induced apoptosis of epididymal epithelial cells in a dose-and time-dependent manner(P<0.05), with a 50％ inhibitory concentration(IC50) value and corresponding 95％ confidence intervals(CI) of 59.36(15.50～227.41), 0.37(0.080～1.70), 0.077(0.017～0.35) μmol·L-1 at 24, 48 and 72 h, respectively.Podophyllotoxin induced cell volume turned round and cell nuclear fragmentation and mitochondrial vacuolation.RT-PCR and ELISA results showed that podophyllotoxin improved the expression of TNF-α mRNA and protein.Western blot results demonstrated that podophyllotoxin activated the protein expression of cytochrome C, caspase-3, caspase-8 and caspase-9.Conclusion Podophyllotoxin can induce rat epididymal epithelial cell apoptosis through both the mitochondria-regulated intrinsic pathway and the TNF receptor-mediated extrinsic pathway.

Objective:To explore the relationship between the dynamic changes of lymphocytes in the early stage (within 72 hours of admission) and the severity of disease in patients with coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. The clinical data of COVID-19 patients admitted in Wenzhou Central Hospital from January 17, 2020 to February 14, 2020 were collected and analyzed. According to whether there was lymphopenia on the first day of admission [lymphocyte count (LYM) < 0.8×10 9/L], whether the difference between LYM on the third day and the first day of admission (ΔLYM) was less than 0, the patients were divided into four groups: the first group was LYM normal on the first day of admission, ΔLYM ≥ 0; the second group was LYM normal on the first day of admission, ΔLYM < 0; the third group was lymphopenia on the first day of admission, ΔLYM ≥ 0; the fourth group was lymphopenia on the first day of admission, ΔLYM < 0. The study endpoint was the development of severe/critically ill patients within 30 days after admission. Severe/critical standard referred to classification of Diagnosis and treatment protocol for coronavirus disease 2019 (trial version 5, revised edition). The differences in general information, laboratory results, and probability of developing severe/critical were compared among the four groups. Cox regression analysis was used to analyze the correlation between the early dynamic changes of lymphocytes and the probability of severe illness; and the Kaplan-Meier survival curve was drawn to assess the probability of severe illness in patients with different LYM groups. Results:A total of 104 patients with COVID-19 were enrolled, and 21 patients developed to severe/critical cases within 30 days of onset (accounting for 20.2%; 17 severe cases and 4 critical cases). There were significant differences in age ( F = 5.061, P = 0.003), white blood cell count (WBC) on the first day of admission ( Z = 10.850, P = 0.013), C-reactive protein (CRP) on the first day of admission ( Z = -4.449, P < 0.001), LYM on the first day of admission ( Z = 43.132, P < 0.001), LYM on the third day of admission ( Z = 40.340, P < 0.001), and the occurrence of severe/critical illness ( χ2 = 18.645, P < 0.001) among the four groups. Patients in groups 3 and 4 were older; patients in group 3 had the lowest WBC and LYM on the first day of admission; patients in group 4 had the highest CRP on the first day of admission, the lowest LYM on the third day of admission, and high proportion of severe/critical cases. Regarding the probability of severe/critically ill patients within 30 days of admission, univariate Cox regression analysis showed that the probability of severe/critical patients in group 4 was 12.7 times higher than that in group 1 [hazard ratio ( HR) = 12.732, 95% confidence interval (95% CI) was 3.951-41.025, P < 0.001]; age, CRP, albumin (ALB) and lymphocyte grouping were included in multivariate Cox regression analysis, the probability of severe/critically ill patients in group 4 was 6.4 times that of group 1 ( HR = 6.398, 95% CI was 1.757-23.301, P = 0.005); however, there was no difference in the probability among the group 1, 2 and 3. Kaplan-Meier survival curve showed that the probability of severe/critically ill patients in group 4 was significantly higher than that in groups 1, 2 and 3 (Log-Rank test: χ2 = 42.617, P < 0.001). Conclusions:Early lymphocyte dynamics change is related to the severity of patients with COVID-19. Patients with low LYM on the first day and continued decrease within 72 hours of admission have a higher probability to develop into severe/critically cases.

This study is to investigate the protective effects of the SB203580 against radiation induced mortality and intestinal injury of mice. A total of 67 male C57BL/6 mice (20.0-22.0 g) were matched according to body weight and randomly assigned to one of three groups: control, total body irradiation exposure (IR, 7.2 Gy) only, and IR (7.2 Gy) + SB203580 (15 mg x kg(-1)). 30 days survival rate was observed in the experiment. In intestinal injury experiment, the expression levels of caspase-3, Ki67, p53 and p-p38 were assayed in the mice intestine crypts. The results showed that the 30 days survival rate was 100% (control), 0 (IR) and 40% (IR+ SB203580), separately. Compared to the IR groups, the positive cells of caspase-3, p53 and p-p38 in crypt cells decreased 33.00%, 21.78% and 34.63%, respectively. The rate of positive cells of Ki67 increased 37.96%. Significant difference was found between all of them (P < 0.01). SB203580 potently protected against radiation-induced lethal and intestinal injury in mice, and it may be a potential radio protector.

Objective: To evaluate the clinical characteristics, diagnosis criteria, treatment and prognosis in patients with Bing-Neel Syndrome (BNS) . Methods: The clinical characteristics, lab data, treatment and outcomes of 3 Bing-Neel syndrome patients diagnosed at Peking Union Medical College Hospital were collected. Results: The clinical presentation was heterogeneous without any specific common signs or symptoms. One patient was diagnosed with BNS 42 months after diagnosis of Waldenström macroglobulinemia (WM) by cerebrospinal fluid (CSF) cytology and flow cytometry, but dead of infection during the first course of chemotherapy. BNS was the first manifestation of WM in the other 2 cases. They were diagnosed by flow cytometry and cytology of CSF. The detection of MYD88^L265P mutation in CSF contributed to diagnosis and to sequential monitoring of minimal residual disease. They received systemic chemotherapy of FC (fludarabine + cyclophosphamide) ± rituximab and intrathecal therapy, followed by maintenance therapy of chlorambucil or R2 (rituximab + lenalidomide) . They were followed 17 and 20 months respectively without progression of disease. Conclusion The diagnosis approach of BNS should be based on a combination of CSF cytology, flow cytometry and detection of the MYD88^L265P mutation. The detection of MYD88^L265P mutation may be useful in the monitoring of minimal residual disease.

Objective:Based on the perspective of supply and demand balance, to analyze the implementation effects of primary-feature medical services measures in medical alliances.Methods:From July to September 2019, two regions with different levels of economic development were chosen, and from each region one leading hospital and two community health service centers/township hospitals were selected from its medical alliance. A total of 213 medical staff and 703 residents were surveyed, to learn their awareness and performance appraisal of these feature services.Frequency and proportion were calculated in a descriptive statistical analysis. The scores of the performance appraisal of both supply and demand sides were tested by independent sample t. Results:In the performance appraisal of such measures, the average scoring by medical staff was 4.39±0.07, and that by residents was 3.85±0.06; the residents were more concerned with service capabilities and contents, while medical staff were more concerned with service content and delivery mode; supply and demand sides were found with consensus in terms of improving the medical service quality of chronic diseases in primary level and service accessibility.Conclusions:The county-level medical alliances should focus on enhancing their capacity of primary medical services, and improving their primary service mode with the help of medical insurance institutions. Meanwhile, it is imperative to optimize the primary medical service policy in view of supply and demand balance.

Building an integrated health care service system is key to the Healthy China strategy. Based on the integrated health care service conceptual framework, the authors took two pilots regions of health-centered medical alliances in Zhejiang province as an example, and analyzed their conception framework, organizational structure, operation elements and effects. The study found initial success of the two alliances in terms of the contents, capabilities, effects and satisfaction of primary health care service. Such alliances feature a health-centered multi-entity participation mechanism, carry out health care and prevention integration leveraging the information platform, hence conducive to the effective governance of the alliances. However, the contents of their health related services are expected to be broadened and deepened; functionalities of health-related institutions need to be clarified and refined, while their performance appraisal needs to be further improved.

Objective:To evaluate the effects of rocuronium on limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.Methods:Ninety patients of both sexes, aged 50-80 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with body mass index<30 kg/cm 2, scheduled for elective unilateral knee arthroplasty under general anesthesia combined with femoral nerve block from January 2019 to October 2019, were divided into 3 groups ( n=30 each) using a random number table method: normal saline group (group S), rocuronium 0.6 mg/kg group (group RL) and rocuronium 1.2 mg/kg group (group RH). Anesthesia was induced by intravenous injection of midazolam, etomidate, sufentanil and rocuronium 0.6 mg/kg (group RL) or 1.2 mg/kg (group RH) or equal volume of normal saline (group S). Mechanical ventilation was performed after placement of laryngeal mask to maintain P ETCO 2 35-45 mmHg.Femoral nerve block was performed under ultrasound guidance.Anesthesia was maintained by inhaling 1% sevoflurane and intravenous infusion of propofol and remifentanil to maintain entropy index at 40-60 during operation.Patient-controlled intravenous analgesia was performed with sufentanil after surgery to maintain visual analogue scale score ≤ 4 points.When visual analogue scale score was > 4, flurbiprofen axetil 100 mg was intravenously injected.The vastus medialis muscle at the edge of the incision was obtained at 60 min after inflation to determine the expression of dystrophin by immunohistochemistry.Arterial blood samples were collected immediately after inflation of the tourniquet, at 60 min after inflation, and at 5 and 30 min after deflation for determination of the serum malondialdehyde (MDA) concentrations by the thiobarbituric acid method.The effective pressing times of the analgesic pump and consumption of sufentanil and flurbiprofen axetil were recorded within 48 h after operation.The occurrence of responses to tourniquet and residual muscle relaxation during recovery from anesthesia, the first postoperative off-bed time and postoperative length of hospital stay were recorded.The thigh girth was measured before operation and at 24 and 48 h after operation, and the difference after and before operation was calculated.The range of motion of knees of the operated limb and tourniquet-related complications in the early postoperative period (3 days) and in the long-term postoperative period (3 months) were recorded. Results:Compared with group S, the expression of dystrophin in skeletal muscle was significantly up-regulated, the concentration of serum MDA was decreased at 30 min after deflation, and the difference in thigh girth at 24 and 48 h after operation was decreased in group RH, and the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH and group RL ( P<0.05). Compared with group RL, the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH ( P<0.05). There was no significant difference in the incidence of responses to tourniquet, postoperative length of hospital stay, effective pressing times of the analgesic pump, postoperative consumption of sufentanil and flurbiprofen axetil, and the incidence of tourniquet-related complications in the early and long-term postoperative periods among the three groups ( P>0.05). No residual muscle relaxation was found during recovery from anesthesia in three groups. Conclusion:Rocuronium 1.2 mg/kg can reduce limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.