Objective To analyze patients with acute chest pain as their chief complaint in order to improve our capability of early identifying and diagnosing high-risk patients,give them proper treatment in time and avoid misdiagnosis and improper treatment. Methods The clinical data of 813 patients with chest pain as their chief complaint admitted in the emergency department and critical care medicine department in Guangdong Provincial Traditional Chinese Medicine Hospital from January to December in 2011 were retrospectively analyzed. According to the process of diagnosis and treatment formulated by the chest pain center,all the patients must immediately finish the first electrocardiograph(EEC)examination in 10 minutes and the relevant blood biochemical examinations within 30 minutes after admission. Results In accordance with the relevant examinations,the confirmed diagnoses were as follows:there were 276 cases of unstable angina,accounting for 33.95%;145 cases of stable angina,17.84%;121 cases of acute myocardial infarction,14.88%;103 cases of respiratory system disease,12.67%;78 cases of skeletal muscle disease,9.59%;46 cases of the digestive system disease,5.66% and the high-risk non cardiac chest pain(such as aortic dissection/rupture of tumor or acute pulmonary embolism)12 cases,1.48%.Seven hundred and eighty-five patients finished the first EEC examination in 10 minutes,and 147 patients completed the chest computed tomography(CT)scan within an hour. Conclusions Acute chest pain is a common symptom in emergency department. It is necessary to identify the high-risk patients according to a process as soon as possible in order to get an accurate diagnosis and an effective treatment in time.

Objective The purpose of the study is to understand the epidemiology,distribution and molecular characteristics of oxacillin susceptible mecA positive Staphylococcus aureus (S.aureus).Methods Totally 1588 S.aureus isolates collected from 12 hospitals in 10 cities of China between 2010 and 2012 were retrospectively characterized.The isolates were characterized by antimicrobial susceptibility test of 20antimicrobial drugs.Three different methods (cefoxitin disc diffusion,agar dilution for oxacillin and cefoxitin) to detect oxacillin susceptible and mecA positive S.aureus were also compared.All the strains were confirmed to be S.aureus by detecting S.aureus specific genes by PCR (including nuc,femB,and mecA gene),which was viewed as the golden standard of MRSA.The molecular typing methods included SCCmec and spa typing.The statistical analyses were carried out in statistical product and service solutions (SPSS),Version 18.0.The significance level P was set at 0.05.Results According to the MICs of cefoxitin and oxacillin,a total of 60 isolates were oxacillin susceptible methicilin resistance Staphylococcus aureus (MRSA).Based on the differences of the specimen collection date,it is found that oxacillin susceptible MRSA have increased from 2010 to 2012 (P =0.05,95％ CI 0.045-0.056,X2 =6.099).These isolates were distributed in 9 major cities,and the highest prevalence is 30.0％ (18/60) in Guangzhou,followed by Beijing (18.3％,11/60),Wuhan (15.0％,9/60),Hangzhou (13.3％,8/60).Most of the isolates were from skin soft tissue infection (35％,21/60),blood stream infection (30％,18/60) and respiratory infection specimens (18.3％,11/60).The resistance rate to cefoxitin,erythromycin,clindamycin and tetracycline was 100％ (60/60),86.7％ (52/60),66.7％ (40/60) and 50％ (30/60),respectively.The molecular characterization showed that 21 spa and 5 SCCmec types were detected.The most predominant clone was spa t437-SCCmec Ⅳ (25.0％,15/60),followed by spa t437-SCCmecV (13.3％,8/60).Conclusions The detection rate of oxacillin susceptible MRSA is significantly higher from 2010 to 2012.The major clone is t437-SCCmec Ⅳ.The use of cefoxitin should replace oxacillin in detecting this type of MRSA.Further study is needed to confirm whether beta lactam antimicrobial agents should be used in the treatment of oxacillin susceptible mecA positive S.aureus.

OBJECTIVE:To provide reference for improving the quality of talent training for medical direction of chain man-agement major in higher vocational college. METHODS:The situation of pharmaceutical retail chain industry market was analyzed in China;the problems of talent training mode were summarized to put forward reform plan and measures according to disadvantag-es. RESULTS:Based on the market situation as continues expansion of pharmaceutical retail chain industry market scale,shortage of professional talent pool,the formulation of new retail mode in China,and training mode situation as not enough in-depth cooper-ation between college and enterprise,poor practicality and pertinence of course setting,irrational teachers'structure,teaching re-form could be conducted on the basis of modern apprenticeship system in following aspects,such as college and enterprise shared the responsibility of training and cultivating,student admission is recruitment;college and enterprise designed curriculum system and assessed students together;double tutorteam of college teacher and enterprise teacher was constructed. CONCLUSIONS:The talent training mode based on modern apprenticeship system is the entry point for teaching reform of medical direction of chain management major in higher vocational college,which is conducive to cultivate high quality pharmaceutical management talents meeting industry needs and social development.

Objective:To explore the clinical effect of simultaneous whole-course hyperfractionated intensity-modulated radiation therapy combined with chemotherapy and nimotuzumab in the treatment of advanced nasopharyngeal carcinoma.Methods:A total of 64 patients with advanced nasopharyngeal carcinoma who were admitted to Kaiping Central Hospital of Guangdong Province from June 2017 to January 2019 were selected and divided into the observation group and control group according to the random number table method, with 32 cases in each group. Both groups were given chemotherapy and nimotuzumab on the basis of radiotherapy. The observation group received simultaneous whole-course hyperfractionated intensity-modulated radiation therapy, and the control group received conventional fractionated intensity-modulated radiation therapy. The short-term efficacy, Karnofsky score, overall survival rate, progression-free survival rate, acute radiation reaction, and late radiation injury in the two groups were observed.Results:Six months after radiotherapy, the efficient rate of the observation group was higher than that of the control group [96.9% (31/32) vs. 75.0% (24/32), χ2 = 6.335, P < 0.05]. At the end of radiotherapy and 3 months after the end of radiotherapy, the Karnofsky scores of the observation group were higher than those of the control group, and the differences were statistically significant [(75±3) points vs. (71±3) points, t = 5.891, P < 0.05; (80±4) points vs.(77±4) points, t = 3.201, P = 0.002]. All patients were well tolerated, no grade 4 acute radiation reaction was observed, and radiotherapy was completed as planned. The incidence rate of oral mucosal reaction in the observation group was lower than that in the control group [21.9% (7/32) vs. 50.0% (16/32), χ2 = 5.497, P < 0.05]. The incidence rates of severe dry mouth and neck soft tissue fibrosis in the observation group were lower than those in the control group [6.2% (2/32) vs. 28.1% (9/32), χ2 = 5.379, P = 0.043; 3.1% (1/32) vs. 21.9% (7/32), χ2 = 5.143, P < 0.05]. The follow-up time was 14-20 months, and the median follow-up time was 17 months. There was no statistical difference in overall survival time between the two groups ( χ2 = 0.553, P = 0.557). The progression-free survival time of the observation group was better than that of the control group ( χ2 = 3.954, P = 0.044). Conclusion:The simultaneous whole-course hyperfractionated intensity-modulated radiation therapy combined with chemotherapy and nimotuzumab are effective in the treatment of advanced nasopharyngeal carcinoma, and the adverse reactions can be tolerated.

Objective To analyze the molecular epidemiology and resistant mechanisms ofmacrolide-nonsusceptible Moraxella catarrhalis.Methods A total of 383 strains of Moraxella camrrhaliswere collected from nasopharynx of children under 2 years old.The minimum inhibition concentration (MIC)values were determined by Etest method,and the production of β-lactamase was examined by using anitrocefin-based test.The pulsed-field gel electrophoresis (PFGE) method was used to analyze the type ofdifferent isolates.Polymerase chain reaction (PCR) and sequencing were performed for the resistancemechanism of macrolide resistance in Moraxella catarrhalis.The non-susceptibility rates of six cities( Beijing,Shanghai,Jinan,Nanjing,Wuhan and Dongguan) were compared byx2 test.ResultsAccording to Clinicaland Laboratory Standards Institute (CLSI) breakpoints,the non-susceptibility rates for erythromycin andazithromycin in 383 strdns of Moraxella catarrhalis were 40％ and 23％,respectively.Whereas,the non-susceptibility rates were 59％and 60％based on pharmacokinetics/pharmacodynamics(PK/PD)breakpoints.Significant differences in non-susceptibility rates to macrolide were observed in different cities,and the higher non-susceptibility rates were determined in relatively northern cities,such as Beijing andJinan.Among the 383 strains of Moraxella catarrhalis,92％ (353/383) of isolates produced β-lactamase.Atotal of 14 patterns of groups were generated by PFGE in 37 high-level macrolide resistant Moraxella catarrhalis,and 43％ ( 16/37 ) of isolates could be considered to be related or indistinguishable to group A.In this study,the ermA,ermB,mefA,and merE genes were not detected,while the A2982T,A2796T,A2983T mutations in 23S rRNA gene may be related to macrolide resistance in Moraxella catarrhalis.The A2982T and A2796T mutations conferred high-level macrolide resistance,while the A2983T mutation conferred low-level resistance.ConclusionsA large number of macrolide-nonsusceptible Moraxella catarrhalis isolates are detected in the study.The macrolide resistance is probably related to the mutations in 23S rRNA gene,and the relationship between MIC values of macrolide and mutations has been determined.

Objective To identify critical genes in evolution of Staphylococcus aureus (S.aureus).Methods A total of 2457 genes from two whole genomes of S.aureus strains were amplified for fabricating whole genome microarray,which was employed for comparative genome hybridization (CGH) analysis of 23 strains of divergent MRSA clones,including ST239-spa t037 and ST239-spa t030.Representatives of differential genes were confirmed by PCR.Results Four gene clusters were identified to be associated with evolution of major epidemic MRSA clones.The four gene clusters were specific to ST239-spa t030,and belonged to three known genomic islands (vSa4,prophage ΦSa1 and ΦSa3).Eight genes were variable expressed in ST239-spa t030 MRSA from different coutries.Conclusion The acquisition of genomic islands vSa4,prophage ΦSa1 and ΦSa3 enhanced the virulence and resistance of ST239-spa t030 MRSA,and contributed to its rapid replacement of ST239-spa t037 MRSA in China.

Objective To investigate the effect of 1,25-dihydroxyvitamin D3 on proliferation and apoptosis of glomerular mesangial cells via the PI3K/Akt/mTOR signal pathway. Methods The normal control group, 1,25-dihydroxyvitamin D3 (10-8 mol/L) group, rapamycin (0.1 μg/mL) group and the rapamycin in combination with 1,25-dihydroxyvitamin D3 group. The cell proliferation was measured by cell counting kit-8 assay. The cell cycle and cell apoptosis were detected by flow cytometry assay , respectively. Results Compared with the normal control group, the proliferation of glomerular mesangial cells was significantly inhibited in the 1 ,25-dihydroxyvitamin D3 group, in the rapamycin group and in the rapamycin in combination with 1,25-dihydroxyvitamin D3 group. The cells at G1 phase were significantly increased, but the cells at S phase were significantly decreased, with significant increase of cell apoptosis rate. Compared with the 1,25-dihydroxyvitamin D3 group, the proliferation of human glomerular mesangial cells was significantly inhibited in the rapamycin group and in the rapamycin in combination with 1,25-dihydroxyvitamin D3 group. Compared with the rapamycin group, the cells at G1 phase were significantly increased and the cells at S phase were significantly decreased in the rapamycin in combination with 1,25-dihydroxyvitamin D3 Group. Conclusions 1,25-dihydroxyvitamin D3 inhibits cell proliferation and promotes human glomerular mesangial cell apoptosis of human glomerular mesangial through the PI3K/Akt/mTOR signal pathway. 1,25-dihydroxyvitamin D3 and rapamycin can synergistically inhibit the proliferation of human glomerular mesangial cells.

Objective To investigate the effects of 1,25-dihydroxyvitamin D3 [1,25 (OH)2D3] on PCNA expression and cell proliferation in human glomerular mesangial cells. Methods The cultured human mesangial cells, which was subcul?tured 3-8 generations, were randomly divided into four groups: normal control group (plus the DMEM medium containing 5%fetal bovine serum), proliferation in the control group (EGF group, plus 10μg/L of EGF), general intervention group [VD group, plus 10-8 mol/L of 1,25(OH)2D3], proliferation in the intervention group [EGF+VD group, plus 10μg/L EGF and 10-8 mol/L 1,25(OH)2D3] for treatment of 48 h. The cell cycle was detected by flow cytometry,and the expression of PCNA was detected by Western blot assay in four groups. Results (1) Compared with normal control group, G1 phase cells were signifi?cantly reduced, S, G2/M phase cells were increased and PI index was higher in EGF group. And G1 phase cells were signifi?cantly increased, S and G2/M phase cells were significantly decreased, and PI index was lower in VD group. Compared with the EGF group, G1 phase cells were significantly increased in VD group and EGF+VD group, and S, G2/M phase cells de?creased, PI index was lower. (2) Compared with normal control group, the expression of PCNA was higher in EGF group, and lower in VD group. Compared with EGF group, the expression of PCNA was lower in VD group and EGF+VD group. Conclu?sion 1,25 (OH) 2D3 inhibits the proliferation of human glomerular mesangial cells by arresting cell cycle and inhibiting the expression of PCNA protein.

Objective To develop perfluorocarbon lipid particles and investigate their basic properties,and target them to human hepatocellular carcinoma cells in vitro by hepatoma monocolonal antibody HAb18 with avidin-biotin interaction.Methods Rotary evaporation and high pressure homogen were used to prepare perfluorocarbon lipid particles, and the appearance and distribution of them were investigated by microscope and electron microscope, the concentration and the size and electric potential were detected.The biotinylated monoclonal antibody HAbl8 was prepared, then the biotinylated degree of the antibody was determined.The biotinylated perfluoroearbon lipid particles labelled with NBD were prepared and targeted to human hepatocellular carcinoma cells in vitro with avidin-biotin interaction.Results These perfluorocarbon lipid nanoparticles were uniform and stable,and the mean diameter of them was 171.9 nm.Hepatocellular carcinoma cells were surrounded by the biotinylated particles labelled with NBD.Conclusions A steady perfluoroearbon lipid particles were prepared and the biotinylated particles can be targeted to hepatocellular carcinoma cells with avidin-biotin interaction.

OBJECTIVE:To study the purification technology of total flavonoids from Nelumbinis receptaculum by macropo-rous resin. METHODS:Using adsorption rate and desorption rate of total flavonoids from Nelumbinis receptaculum as index,the type of macroporous resin was selected by static adsorption-desorption tests;With adsorption rate of total flavonoids as index,sin-gle factor test was used to investigate the effects of the concentration of total flavonoids,adsorption time,adsorption speed, drug-loading amount,water amount,volume fraction and amount of eluant and other factors on the purification technology. The op-timal technology was validated. RESULTS:Among 10 kinds of resin,HPD-400 macroporous resin was found to have the best ad-sorption and desorption effects. The optimal purification conditions was as follows as the concentration of total flavonoids 7.00 mg/ml, adsorption time of 3 h,flow rate for sampling of 3 column volume (BV)/h,drug-loading amount of 8 BV,water amount of 6 BV,50% ethanol elution amount of 4 BV. In validation test,mass fraction of total flavonoids from purified Nelumbinis receptacu-lum were 63.88%,62.50% and 63.44%(RSD=1.11%,n=3). CONCLUSIONS:HPD-400 macroporous resin could purify total flavonoids from purified Nelumbinis receptaculum,and established purification technology is stable and practical.