Objective To study the average difference of CHN atlas method bone age (BA) determination (left-vs.right-hand) for children and adolescents.Methods Radiographs of hands of healthy children and adolescent (age range:1.0-19.0 years) were analysed to determine BA,producing analysis results for 1380 hand images.The images were assessed by two radiologists based on CHN atlas method,who were blinded to the chronological age (CA) of them.The intra-and inter-observer variations were used for evaluating the reliability of CHN atlas method.The difference of BA using left-or right-hand BA was evaluated by t test.Results No significant difference was found for intra-or inter-observer variations (P ＞ 0.05).The BAs of left-and right-hand radiograph showed significant difference in the groups for boys (16.0-16.9,17.0-17.9 years),girls (6.0-6.9 years) and both of them (6.0-6.9,16.0-16.9 years).The regression model analysis showed no significant difference(t =-0.427,P =0.670).Conclusion Comparison of left-and right-hand BA shos no significant difference using CHN atlas method,indicating that either hand could be used to determine BA.

Objective To analyze risk cause on adverse apparatus events of medical institution for causing the attention of medical institutions and reducing or exempting the occurrences. Methods Through the analysis risk cause on adverse apparatus events of medical institutions, the major factors of causing the medical institutions adverse apparatus events and the ways of solving the problems were found. Results The ways and countermeasure of solving medical institutions adverse apparatus events are brought forward. Conclusion It is preventable in adverse apparatus events of medical institutions.

Objective To assess the effectiveness and safety of heat moisture exchangers (HMEs) on the artificial airway humid-ification in the mechanically ventilated patients .Methods The related literature in the Cochrane Library ,PubMed ,Embase ,CNKI , VIP ,WanFang database and CBM from the establishment to March 2012 were retrieved ,then included the randomized controlled trial(RCT) and quasi-RCT on the effect of HMEs for the artificial airway humidification in the mechanically ventilated patients were performed the meta analysis by using RevMan 5 .1 .2 software .Results 19 RCT were included(involving 2 960 patients) , which were the random parallel controlled trials .The meta analysis results showed that HMEs could not reduce the incidence rate of ventilator-associated pneumonia(VAP)(RR=0 .78 ,95% CI 0 .61-1 .01 ,P=0 .06) ,also could not decrease the hospitalization mor-tality(RR=0 .94 ,95% CI 0 .83-1 .08 ,P=0 .40) ,the length of ICU stay(MD= -0 .32 ,95% CI -3 .13 -2 .50 ,P=0 .82) and the occurrence rate of catheter occlusion (RR=0 .65 ,95% CI 0 .22 -1 .93 ,P= 0 .44) ,the differences between the two groups had no statistical significance .But 5 RCT reported that using HMEs could reduce the patient′s costs .Conclusion HMEs can not reduce the incidence rate of VAP ,mortality ,length of ICU stay ,occurrence rate of airway occlusion ,but can cut down the patient′s cost . Due to the risk of bias existing in all included RCT and the low quality of the obtained evidences ,more strictly designed and imple-mented RCTs are needed to further verify thse evidences .

Objective To analyze the correlation between LC-MS/MS method and enzymatic cycling assay for determination of homocysteine concentration in human serum,and the application of two methods in the determination of homocysteine concentration.Methods Homocysteine concentrations of 63 serum samples were collected and determined by LC-MS/MS method and enzymatic cycling assay,respectively.The correlation between the concentrations by different methods was analyzed and evaluated.Results The concentrations were(19.11 ± 15.69) μmol/L by LC-MS/MS method and(16.95 ± 14.41) μmol/L by enzymatic cycling assay,the P value evaluated by paired-samples T test showed that there was statistical difference among the concentrations determined by two different methods (t =6.25,P ＜ 0.05).The conversion formula was YLC-MS/MS method =1.074Xenzymatic cycling assay + 0.892,R =0.987.Conclusion There is good correlation between LC-MS/MS method and enzymatic cycling assay for the determination of homocysteine concentration in serum,providing a theoretical basis for estimating the concentrations in the same serum sample by the two methods.

Objective:To establish the quality standard for Huashengping capsules. Methods: Milkvetch Root, Hedyotis diffusa Willd and Salvia miltiorrhiza were identified by TLC. The content of astragaloside A was detected by HPLC. The column was Kormasil C18(250 mm ×4.6 mm, 5 μm) and the flow rate was 1.0 ml·min-1. The mobile phases was a mixture of acetonitrile-water (32∶68 ) . The detection wavelength was 203 nm. The column temperature was 25℃ and the sample size was 20μl. Results:The TLC chro-matography spots were clear. Astragaloside A was linear within the range of 2. 000-10. 000 μg(r=0. 999 6) and the average recovery was 100. 8%(RSD=1. 9%,n=6). Conclusion:The method is simple, accurate and reliable, which can be used in the quality con-trol of Huashengping capsules.

Nisin is an antimicrobial peptide widely used in food industry. In this study, Nisin A production in Lactococcus lactis ATCC 11454 was improved by overexpression of Nisin A structural gene nisA through introducing a shuttle expression vector pMG36ek-nisA and an integrated vector pDG780-nisA into the host strain. The differences of growth profiles and Nisin A production level between the two obtained genetic engineering strains FMM1/FMM2 and the parent strain were investigated. Our results show that while the growth profile (the growth rate, biomass and pH) of FMM1 was similar to the parent strain, its Nisin A production increased 31%. In contrast, the biomass of FMM2 was notably lower than the parent strain, while its yield of Nisin A enhanced slightly. The transcription level of genes involved in Nisin A biosynthesis in both engineering strains was further detected by RT-PCR. We found that all the 11 Nisin A biosynthetic genes in FMM1 and FMM2 had a higher transcription level than those in the parent strain, and these genes exhibited more significant increasing degree of transcription level in FMM1 which hosted the autonomous replicating nisA gene. These data suggest that expression of nisA may act as a rate-limit factor in Nisin A biosynthesis. In conclusion, this work provides a new method to improve Nisin A production by increasing the transcription level of nisA, paving the way to further large-scale industrial production of Nisin A.
Bacterial Proteins ; genetics ; Genes, Bacterial ; Genetic Engineering ; Genetic Vectors ; Lactococcus lactis ; genetics ; metabolism ; Nisin ; biosynthesis ; genetics ; Transcription, Genetic

Objective:To investigate the clinical application value of ultrasound in the diagnosis and differential diagnosis of Takayasu arteritis (TA ). Methods: A total of 39 suspected TA patients were examined by ultrasonography,erythrocyte sedimentation rate (ESR),C reactive protein (CRP)and CT angiography (CTA), and the ultrasound examination results were compared and analyzed with the final chinical diagnosis results. Results:Of the 39 cases of suspected TA patients which had been examined by ultrasound,33 cases were diagnosed as TA,2 cases were diagnosed as atherosclerosis (AS),2 cases were diagnosed as fibromuscular dysplasia (FMD) and 2 cases were diagnosed as thromboangiitis obliterans (TAO).Compared with final chinical diagnosis results, 1 FMD patient was misdiagnosed as TA,and the rest of the diagnostic results were consistent with the final chinical diagnosis results.Conclusion:Ultrasound examination can provide objective and accurate basis for the diagnosis and differential diagnosis of TA,and it is an effective method of imaging examination.

This paper summarizes the concept of rapid recovery, the its application in trauma orthopeadics of rapid recovery in limb fractures and the future prospect. That rapid rehabilitation is not a pure time acceleration, in patients with perioperative safety and improve the life quality, shorten the hospitalization time and lower cost only its added value, focusing on how to make the patients safe, painless, no cross for perioperative complications. To make the patient with more humanized, individualized, full-dimensional embodiment of professional characteristics of quality care services. It is required that nurses quickly change their ideas, improve their professional knowledge, strengthen communication skills and develop in a more professional direction.

Due to the reform of medical system, sudden infectious diseases and the increasing demand of patients, the problems of insufficient allocation of human resources and low quality of nursing human resources in China not only affect the treatment and prognosis of patients, but also hinder the development of nursing itself. In order to improve the current situation of nursing staffing in China, this paper summarizes the RAFAELA system of nursing resource allocation in Finland and the need for improvement. In order to promote the improvement and development of the optimal allocation of nursing human resources in China.

Objective:To explore the related factors affecting the prognosis of children with parenteral nutrition-associated cholestasis (PNAC).Methods:Twenty children with PNAC admitted to Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2014 to December 2020 were selected as research objects by retrospective study. According to prognosis, children were divided into good (15 cases) and poor prognosis group (5 cases). Clinical data such as general condition, intravenous nutrition duration, related biochemical examination indexes and main treatment methods of children in the two groups were collected. Spearman correlation analysis was used to quantify the correlation between alanine aminotransferase (ALT) and poor prognosis. Univariate analysis was used to analyze the risk factors affecting the prognosis of children with PNAC, and receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive value of ALT on the prognosis of children.Results:There were no significant differences in gender, body weight, gestational age, age, feeding mode, duration of intravenous nutrition, direct bilirubin (DBil), aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT), total protein (TP), serum albumin (Alb), globulin (GLB), alkaline phosphatase (ALP), platelet count (PLT), white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), lymphocyte count (LYM), urine culture, AST/PLT ratio (APRI) and main treatment methods between the two groups. Total bilirubin (TBil), ALT, neutrophil count (NEU) and monocyte count (MONO) in the good prognosis group were significantly lower than those in the poor prognosis group [TBil (μmol/L): 120.00±48.63 vs. 175.26±29.14, ALT (U/L): 73.25±44.29 vs. 145.30±74.33, NEU (×10 9/L): 2.55±1.29 vs. 5.08±4.10, MONO (×10 9/L): 1.23±0.87 vs. 2.13±0.60, all P < 0.05]. Logistic regression analysis showed that ALT was the risk factor affecting the prognosis of children with PNAC, when ALT increased by 1 U/L, the probability of poor prognosis increased by 3.6% [odds ratio ( OR) = 1.04, 95% confidence interval (95% CI) was 1.00-1.07, P = 0.04]. Spearman correlation analysis showed that the incidence of poor prognosis was positively correlated with ALT ( r = 0.49, P = 0.03). ROC analysis showed that ALT had certain predictive value for the prognosis of children with PNAC [area under ROC cure (AUC) = 0.83, 95% CI was 0.00-1.00, P = 0.03]; when the cut-off value was 121.50 U/L, its sensitivity was 80% and specificity was 93%, suggesting that ALT could be used as the main indicator for clinical prediction of poor prognosis for PNAC. Conclusion:ALT is an independent risk factor of poor prognosis in children with PNAC.