Folypolyglutamate synthetase(FPGS) catalyzes the addition of multiple glutamate molecules to compounds with the basic pteroylglutamate structure,such as polyglutamylation-dependent novel antifolates.As the antifolates like methotrexate require polyglutamation by FPGS for activation,FPGS has an established position in the cytotoxic action of methotrexate and has become a essential part in methotrexate resistance.Recent studies have indicated that decreased mRNA expression and activity of FPGS can cause reduction of methotrexate-polyglutamates accumulation,which have been observed as a dominant mechanism leading to methotrexate resistance.Furthermore,single nucleotide polymorphism in FPGS has been displayed significant associations with methotrexate sensitivity and susceptibility of deseases,though the detail mechanism is unknown.This paper is to review the relationship among FPGS enzyme activity,gene polymorphism and methotrexate drug sensitivity.

Objective To explore the predictive value of combined measurement of D-dimer (D-D),fibrinogen (FIB),and peripheral blood leukocyte count (PBLC) for the severity of acute pancreatitis (AP).Methods We collected the clinical data of 134 hospitalized patients who were diagnosed with AP in the General Hospital of Ningxia Medical University from January 2014 to January 2016.These patients were divided into mild acute pancreatitis (MAP) group (n =72) and severe acute pancreatitis (SAP) group (n =62).Also,these patients were divided into hyperlipidemic acute pancreatitis (HAP) group (n =43) and biliogenic acute pancreatitis (BAP) group (n =91).The initial measurements of D-D,FIB,and PBLC for the patients who were admitted to the hospital within 24 hours of onset and received no treatment before admission were collected.The t test was used for comparison of normally distributed continuous data,while the Mann-Whitney U test was used for non-normally distributed continuous data.The chi-square test was used for comparison of categorical data.In addition,the Spearman correlation test and Pearson correlation test were used for correlation analyses.The receiver operating characteristic (ROC) curve was used to analyze the predictive values of D-D,FIB,and PBLC for the severity of AP.Results Compared with the MAP group,the SAP group had significantly increased D-D and FIB levels in peripheral blood (Z =-3.171,P =0.002;t =-2.339,P =0.021).Compared with the HAP group,the BAP group had a significantly higher D-D level (Z =-4.178,P ＜ 0.001),an insignificantly higher FIB level (P ＞ 0.05),and a significantly lower PBLC (t =2.466,P =0.015).The areas under the ROC curve (AUCs) of D-D,FIB,and PBLC were 0.659,0.611,and 0.591,respectively,and D-D had a higher value than FIB and PBLC in predicting the severity of SAP.The AUC of a combination of D-D,FIB,and PBLC was 0.712.Plasma D-D and FIB levels were positively correlated with the severity of AP (r =0.275 and 0.192,P =0.001 and 0.026).Conclusions D-D,FIB,and PBLC are important for early judgment of the severity of AP,and a combination of the three markers has greater significance.

Objective The aim of this study is to provide guidance on rehabilitation nursing via observing the effect of comprehensive relaxation training on perioperative psychological stress in patients with coronary intervention treatment. Methods In this study, eighty patients ready to receive coronary intervention were randomly divided into the experimental group and the control group (40 patients in each). The control group were treated with routine percutaneous coronary intervention care, and the experimental group received both comprehensive relaxation training and routine care. The anxiety state and subjective feelings on comprehensive relaxation training in both groups were dynamically investigated via State-Trait Anxiety Inventory questionnaire and subjective feeling questionnaire from pre-operation to 7 days after operation. Results Anxiety levels between two groups showed the similar trend, and there was statistically significance between two groupsin the state anxiety level. The subjective feeling in the experimental group improved. Conclusions The psychological stress in patients receiving coronary intervention surgery maintains at high level form pre-operation to 24h post operation, and comprehensive relaxation training can significantly reduce the level of state anxiety. These patients consider that this simple training shows obvious relaxing effect.

An integration of British healthcare and social services has been underway in recent years, and a typical methodology has been formed in the process of regional explorations . Using qualitative research methods of on-site observation and in-depth interviews, the paper studies the Care Programme Approach ( CPA) system of mental health and emergency multidisciplinary teams of Oxfordshire, a typical case of the integrated healthcare system re-forms in the British healthcare system. England’s integrated healthcare reforms have placed primary care and commu-nity health services at the center of the healthcare system and have included social services within the system. The ex-periences of multidisciplinary teams, integrated care pathways, personalized care planning and patient involvement and independence from the reforms are worthy subjects of study for China’s own healthcare delivery system reforms.