In recent years, China has been vigorously promoting the construction of medical informatization, with ever improving share and interoperability model of medical and health care big data centering on electronic health records. Current problems in the management and utilization of electronic health records were found in such aspects as hidden risk exposure in the centralized data storage, poor access in data sharing, and poor distribution of rights and interests. These problems can be tackled effectively by the distributed storage, efficient secret data sharing, on-demand collaborative intelligent computing and other features of blockchain technology. The blockchain technology is still immature to use in medical archiving, and large-scale application of electronic health archives blockchain faces challengs in technology, governance and operation. The authors suggest to enhance scientific research on blockchain technology, improve the construction of blockchain application enabling system, and to launch the pilot project of health archives blockchain.

Objective To evaluate the efficacy and adverse effects of sequential administration of epidermal growth factor receptor-tyrosine kinase inhibitor(EGFR-TKI)following pemetrexed combined with cisplatin in elderly advanced non-small cell lung cancer(NSCLC)patients with acquired EGFR-TKI resistance.Methods A total of 97 elderly patients with advanced NSCLC confirmed with pathology or cytology in Qingdao Center Hospital from March 2012 to March 2014 were devided into control group and research group according to treatment methods.The control group received pemetrexed 500 mg/m2day 1 and cisplatin 75 mg/m2day 1-3,and the research group received pemetrexed 500 mg/m2and cisplatin 75 mg/m2,then received sequential administration of EGFR-TKI(gefitinib 250 mg/d or elotinib 150 mg/d or icotinib 375 mg/d).The efficacy,progression-free survival(PFS)and toxicity in both groups were compared.Results The disease control rate of control group and research group were 41.67％(20/48)and 65.31％(32/49),the difference was statistically significant(χ2=5.448,P =0.020).The objective response rate of control group and research group were 16.67％(8/48)and 28.57％(14/49),the difference was not statistically significant(χ 2=1.960,P=0.162).The median PFS time of control group and research group were 4.0 months(95％CI 3.554-4.446)and 4.5 months(95％CI 3.902-5.098),the difference was statistically significant(χ 2= 3.936,P= 0.047).There was no significant difference in adverse reactions between the two groups(P＞ 0.05).Conclusion The sequential administration of EGFR-TKI following pemetrexed combined with cisplatin is suitable for the treatment of elderly advanced NSCLC patients with acquired EGFR-TKI resistance.

Objective:To analyze the genetic characteristics of the complete genome of a strain of human respiratory syncytial virus (HRSV) in Qinghai province in 2024.Methods:A total of 300 samples were collected during 2024 influenza surveillance in Qinghai province sentinel hospitals from patients with fever accompanied by severe respiratory infection symptoms. We used real-time fluorescent quantitative reverse transcription polymerase chain reaction RT-PCR) method to screen out HRSV subtype B (HRSVB) positive specimens, whole genome sequencing was performed on positivespecimens meeting the requirements for the sequencing. After downloading the global representative HRSVB genotypes at GenBank database, sequence alignment was performed, related evolutionary tree was built and the calculation and analyses of genetic distance were done, analyses of HRSVB sequencing of sequence homology of nucleotides, amino acids and amino acid mutation were performed.Results:The first strain in Qinghai, China/qinghai/2024-03 had a complete sequence of 15 140 bp nucleotides, with HRSV′s all structural characteristics, and subtype HRSVA prototype strain Long strains of nucleotide the lowest homology was 80.0%, and subtype HRSVB prototype strain nucleotide homology was above 94.7%. The result indicated that the first strain in Qinghai belonged to HRSVB subtype. Genetic evolution shows China/qinghai/2024-03 and USA/WA-S23450/2021 (OR326803.1) and Germany/2021 (OR795235.1) all belong to a branch, they have the closest relationship. Phylogenetic analysis of G gene showed that the strain belonged to BA9 genotype of HRSVB subtype, and the hypervariable regions of the genome were SH and G genes.Conclusions:In this study, the complete genome sequence of HRSV China/qinghai/2024-03 was obtained for the first time, and the basic molecular structural characteristics were elucidated, which filled the gaps in the gene and amino acid data of HRSV in our province, and also provided a basis for HRSV epidemiology.

Objective To investigate the effect of postoperative analgesia nursing on the comfort degree of laparotomy patients in hepatobiliary surgery department.Methods A total of 86 laparotomy patients in our department were randomly divided into observation group and control group,receiving postoperative analgesia nursing and routine nursing,respectively.And postoperative analgesia and postoperative comfort were compared.Results The postoperative pain degree in the observation group was less than that in the control group,the incidence of incomplete analgesia was lower than that in the control group,pain call frequency in the operation day,1 day after operation,and 2 day after operation was lower than that in the control group,the difference was statistically significant (P ＜0.05).Comfort of physiological,psychological,social and cultural aspects in the observation group were higher than that in the control group,nursing satisfaction was higher than the control group,the difference was statistically significant (P ＜ 0.05).Conclusion Postoperative analgesia nursing can significantly reduce degree of pain of laparotomy patients in hepatobiliary surgery department,and improve the postoperative comfort and nursing satisfaction.

Objective To investigate the effect of postoperative analgesia nursing on the comfort degree of laparotomy patients in hepatobiliary surgery department.Methods A total of 86 laparotomy patients in our department were randomly divided into observation group and control group,receiving postoperative analgesia nursing and routine nursing,respectively.And postoperative analgesia and postoperative comfort were compared.Results The postoperative pain degree in the observation group was less than that in the control group,the incidence of incomplete analgesia was lower than that in the control group,pain call frequency in the operation day,1 day after operation,and 2 day after operation was lower than that in the control group,the difference was statistically significant (P ＜0.05).Comfort of physiological,psychological,social and cultural aspects in the observation group were higher than that in the control group,nursing satisfaction was higher than the control group,the difference was statistically significant (P ＜ 0.05).Conclusion Postoperative analgesia nursing can significantly reduce degree of pain of laparotomy patients in hepatobiliary surgery department,and improve the postoperative comfort and nursing satisfaction.

In this study, the mature peptide sequence of a pectin lyase gene A was amplified from Aspergillus niger strain EIM-6 by using RT-PCR reverse transcription technique. The cloned gene was then inserted into a Pichia pastoris expression vector pPIC9k to produce the recombinant expression plasmid pPIC9K-pelA. By using electric shocks, we successfully transformed the recombinant pPIC9K-pelA into Pichia pastoris GS115. The activity of the engineered strain reached to 2.3 U/mL after induction with the final concentration of 1.5% methanol. SDS-PAGE analysis revealed that the pPIC9K-pelA transformant had an additional protein band of approximately 38 kD, which was not present in the control. There were no significant differences between the recombinant and native pectin lyase with regard to their hydrolysis activities.
Aspergillus niger ; enzymology ; genetics ; Electroporation ; Pichia ; genetics ; metabolism ; Polysaccharide-Lyases ; biosynthesis ; genetics ; Recombinant Proteins ; biosynthesis ; genetics ; Reverse Transcriptase Polymerase Chain Reaction

Objective:To explore the assessment value of multimodal imaging technique for the hepatic fibrosis(HF)of rats.Methods:Forty-eight SD rats were selected,and they were divided into control group,M1 model group,M2 model group and M3 model group according to random number table,with 12 rats in each group.The three model groups were induced by combination method of carbon tetrachloride(CCl4)plus ethanol to establish HF model.At the 4th,6th and 8th week of modelling,the M1 model group underwent ultrasound examination,and the M2 model group underwent examination of magnetic resonance,and the M3 model group adopted the examinations of conventional ultrasound,ultrasound elastography and dynamically contrast enhanced magnetic resonance imaging(DCE-MRI).The rats of control group were randomly divided into three subgroups,with four rats in each subgroup,which were controlled with the rats in the M1,M2 and M3 groups,respectively.At the end of the imaging examinations,the HE staining were conducted on the liver tissues so as to observe the HF degree of rats.The conventional ultrasound was used to observe the morphology of the rat liver,and to measure the inner diameter of the main trunk of the portal vein.colour Doppler ultrasound was used to measure the blood flow velocity of portal vein.Ultrasound elastography was used to observe the color distribution of liver parenchymal stiffness,and to measure the elasticity value of liver parenchyma.The initial area under curve(iAUC)of the receiver operating characteristic(ROC)was adopted to analyze the volume transit constant(Ktrans),rate constant(Kep)and extravascular extracellular space volume fraction(Ve)of the hemodynamic parameters in enhanced magnetic resonance examination.Results:The conventional ultrasound showed there was no abnormal changes in the livers of rats in control group,and the morphology of the liver of M1 group occurred changes.Ultrasound elastography showed that the elasticity values of the liver of rats in M1 group appeared upward trend with the aggravation of the HF degree than control group.Conventional MRI of group M2 showed that the liver morphology was normal in the control group,and the changes of the liver morphologies of rats in M2 group at the 6th and 8th week post modeling were more obvious than that at the 4th week post modeling.The ROC curve analysis of DCE-MRI results showed that Ktrans and Ve had higher diagnostic efficacy for HF,and their iAUC values were>0.9.The results of intergroup comparison of rats among M1 model group,M2 model group and M3 model group indicated that the sensitivity,accuracy,positive predictive value and negative predictive value of multimodal imaging technique were significantly higher than those of single examination in diagnosing HF at early stage of rats,and the differences were statistically significant(x2=0.634,0.644,0.621,0.543,P<0.05),respectively.HE staining results showed that the liver tissues of the rats in the model groups appeared fibroplasia of different degrees.Conclusion:Multimodal imaging technique can be used as an effective test method of evaluating hepatic fibrosis.

ObjectiveTo investigate the effects of Linggui Zhugantang （LGZGT）-containing serum on primary astrocytes （AS） induced by β amyloid 1-42 （Aβ_1-42） in a rat model of Alzheimer's disease （AD） and explore the phagocytic and degradative effects of LGZGT on Aβ. MethodAn AD model was established by inducing AS with Aβ_1-42. The cells were divided into normal group， model group， LGZGT low-， medium-， and high-dose （LGZGT-L， LGZGT-M， and LGZGT-H） groups， and donepezil hydrochloride group. The model group was treated with Aβ_1-42 at a final concentration of 10 μmol∙L^-1. The LGZGT-L， LGZGT-M， and LGZGT-H groups were treated with 10% serum containing LGZGT on the basis of the model group. Cell viability was assessed using a cell counting kit-8 （CCK-8）， lactate dehydrogenase （LDH） activity was measured using an LDH assay kit， and cell morphology was observed using an inverted microscope. The expression of Aβ-related degradation enzymes insulin-degrading enzyme （IDE） and cathepsin D （CTSD） was detected using Western blot， and the fluorescence intensity of cathepsin B （CTSB） was measured using immunofluorescence. The content of Aβ_1-42 in cells was determined using an enzyme-linked immunosorbent assay （ELISA）. ResultCompared with the normal group， the viability of AS in all groups decreased， and Aβ_1-42 at different concentrations had inhibitory effects on AS proliferation. After administration， compared with the normal group， the cell survival rate of the model group decreased significantly （P<0.05）. Compared with the model group， the cell survival rates of the LGZGT-H group and donepezil hydrochloride group increased significantly （P<0.05）. The LDH activity of cells in the model group was significantly increased compared with that in the normal group （P<0.05）， and cell bodies were swollen and enlarged with increased protrusions and elongation， suggesting more obvious cell damage. Compared with the model group， the LDH activity of cells in the donepezil hydrochloride， LGZGT-L， LGZGT-M， and LGZGT-H groups decreased significantly （P<0.05）. After administration， the cell swelling in the LGZGT-M， LGZGT-H， and donepezil hydrochloride groups improved， cell protrusions shortened， and cell clustering decreased. Compared with the normal group， the expression of IDE and CTSD in the model group decreased significantly （P<0.05）. Compared with the model group， the expression of IDE increased significantly in the LGZGT-M and LGZGT-H groups （P<0.05）. Compared with the model group， the expression of CTSD increased significantly in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups （P<0.05）. The average fluorescence intensity of CTSB in the model group was significantly lower than that in the normal group （P<0.05）. Compared with the model group， the average fluorescence intensity of CTSD in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups increased significantly （P<0.05）. The intracellular content of Aβ_1-42 in cells in the model group was significantly higher than that in the normal group （P<0.05）. After administration， compared with the model group， the intracellular content of Aβ_1-42 in cells in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups decreased significantly （P<0.05）， and LGZGT-containing serum reduced Aβ_1-42 in a dose-dependent manner （P<0.05）. ConclusionLGZGT has a protective effect on Aβ_1-42-induced AS and can promote the degradation of Aβ. Its mechanism may be related to reducing Aβ toxicity， enhancing cell viability， promoting the expression of IDE， CTSD， and CTSB， and restoring lysosomal function.

OBJECTIVETo study the high risk factors of the third level of lymphatic metastasis in breast cancer patients to guide clinical practice.

METHODSThe clinical data of 746 breast cancer patients (all female, aged from 33 to 80 years with a median of 46 years) received radical or modified mastectomy between 2001 and 2011 was analyzed retrospectively. Eleven individual variables were selected to investigate high risk factors of the third level of lymphatic metastasis in different conditions.

RESULTSAxillary nodes metastasis status (OR = 4.541, 95%CI:3.569-5.776), tumor site (OR = 1.437, 95%CI:1.029-2.007), external nodes involved (OR = 3.809, 95%CI:1.683-8.618) and estrogen receptor (OR = 0.740, 95%CI:0.569-0.964) were high risk factors of the third level of lymphatic metastasis. Further analysis found that it is prone to happen a metastasis, especially when the tumor with a size over 5 cm and located at the lateral quadrant. Negative estrogen receptor was a risk factor of the third level lymphatic metastasis along with the tumor stage.

CONCLUSIONFor preoperative tumor biopsy shows Negative estrogen receptor of tumor stage T3 and over stage T3 when considering suspicious lymph node metastasis or external tissues metastasis intraoperatively should take in account into third level axillary lymph node dissection actively.

Adult ; Aged ; Aged, 80 and over ; Axilla ; pathology ; Breast Neoplasms ; pathology ; surgery ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mastectomy ; methods ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors