Procalcitonin ( PCT) has closely related to the severity of senile pulmonary infection, and its dynamic detection can be used as the auxiliary diagnosis index for elderly severe pneumonia ( SP) . The effects of serum PCT dynamic detection in the early quick identification, diagnosis, disease course monitoring and prognosis evaluation for elderly SP were reviewed, and the effects and clinical significance of the detection in the optimization of antibiotic therapy were also summarized in the paper. The results showed the impor-tant value of PCT dynamic detection in the diagnosis of elderly SP and anti-infection therapy.

BACKGROUND: Sinomenine is an alkaloid monomer extracted from a Chinese medicinal herb sinomenium acutum stem. It is used in the therapy of the rheumatoid arthritis and has clear and definite therapeutic effects, but the therapeutic mechanism is unclear.OBJECTIVE: To observe the effect of sinomenine at different doses in vitro on the activity of nuclear factor-κB(NF-κβ) and mRNA expressions of the tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β) andinterleukin-10 (IL-10) in the synovial cells of the rats with adjuvant arthritis(AA) to explore the probable mechanism of sinomenine in the treatment of rheumatoid arthritis(RA).DESIGN: A controlled repeated measuring study based on the cells.SETTING: Department of traditional chinese medicine and the institute of burn research of a military medical university.MATERIALS: This study was finished at the Laboratory of the Institute of Burn Research of Chinese PLA. The experimental animals were 25 healthy male Wistar rats of clean grade. The AA model rats were made and the synovial cells were collected and grouped as follows: normal control group, AA group,AA + sinomenine 30 mg/L group, AA + sinomenine 60 mg/L group, AA + sinomenine 120 mg/L group. The activity of the NF-κB was measured by the electrophoresis mobility shift assay(EMSA) . The mRNA expressions of the TNF-α, IL-1β and IL-10 were measured by reverse transcription-PCR assay.MAIN OUTCOME MEASURES: The results of the changes of the activity of the NF-κB and the mRNA expressions of the TNF-α, IL-1β and IL-10 in the synovial cells of the rats with adjuvant arthritis after the treatment with sinomenine at different doses.RESULTS: Compared with the normal control group, the activity of the NF-κB and the mRNA expressions of the TNF-α, IL-1β and IL-10 in the synovial cells in the AA group all increased significantly and the outcomes were 17±6, 0.570±0.047, 0.730±0.093, 0. 683 ±0.081 (t= 2.71 -4.07, P < 0.05). After the administration of sinomenine, the activity of NF-κB showed a good correlation with mRNA expressions of the TNF-αandIL-13(r=0.810, P <0.001; r=0.562, P <0.05), but no statistical relevance with mRNA expression of IL-10 was established. Sinomenine showed a dose-dependent inhibition on the activity of the NF-κB and the mRNA expressions of the TNF-α and IL-1β in a certain range of concentrations(30-120 mg/L), but no dose-dependent inhibition on mRNA expression of the IL-10 was observed.CONCLUSION: Through the inhibition of the activity of the NF-κB,sinomenine decreased the mRNA expressions of the TNF-α and the IL-1β in the synovial membrane cells.

Objective To find the different plasma-associated proteins of rheumatoid arthritis (RA) by using two-dimensional gel electrophoresis for understanding the pathogenesis of RA. Methods The total protein from either RA patients or normal ones was prepared by means of immobilized pH gradient based on two-dimensional gel electrophoresis. After silver staining, gel-image analysis was performed by using PDQuest. The differentially expressed proteins were identified by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF-MS). Results 2-DE patterns of plasma from controls and RA patients were presented. The results showed that average number of protein spots was 592 and 563 respectively, and the corresponding average matching rate was 89% and 87% respectively. Gel-image analysis revealed that there were 24 differential protein spots. A total of 15 differential protein spots were successfully identified by MALDI-TOF-MS, of which 6 proteins were up-regulated as compared with control. Conclusion The differentially expressed proteins can be observed in plasma from RA and controls, which can be used to elucidate the pathogenesis of RA for further study.

ObjectiveTo understand the possible role of some proteins expressed by human synovial fibroblasts(SFs)in the pathogenesis of rheumatoid arthritis.MethodsThe expression difference of synovial fibroblast proteins between rheumatoid arthritis(RA)patients and healthy controls was analyzed by 2-DE.The differential expression spots were identified by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry(MALDI-TOF-MS),followed by bioinformatics analysis,some of which were validated by Western blot.ResultsUsing 12% SDS-PAGE following pH 4-7 IPG strips in IEF,averagely 837 and 852 protein spots were detected in RA patients and normal subjects,respectively.Gel image analysis revealed that there were 49 differential protein spots.By peptide mass fingerprinting strategy,we identified 40 protein spots derived from gels of SFs in RA patients among differential spots and 23 valid proteins were obtained.Western blot analysis showed that expressions of Enolase ?,Annexin I,Cathepsin D,SOD2,Peroxiredoxin 2 were significantly higher in SFs from RA patients than those from normal subjects,which was consistent with proteome analysis.ConclusionThe differential proteins might be involved in inflammation of synovitis in RA.

Objective To screen the proteins interacting with FOXP3 in yeast two-hybrid system. Methods The "bait plasmid" pGBKT7 (named as pGBKT7-FOXP3) was constructed successfully. Using FOXP3 as bait, a human liver cDNA library was screened and the proteins interacting with FOXP3 were searched. The false positive clones were discarded by one to one yeast two-hybrid system, and the positive clones were sequenced and analyzed by bioinformatic methods. Results The bait plasmid pGBKT7-FOXP3 was constructed successfully and there was no self-activation or toxicity in AH109. Three proteins had been found in our system to be able to interact with FOXP3. They were tumor protein D52, splicing factor 3b subunit 1 and one hypothetical protein. Conclusion FOXP3 interacts with tumor protein D52, splicing factor 3b subunit 1 and one hypothetical protein, all of which may interfere in cell metabolism and function of T cell.

Objective:Imatinib is extensively used as a first-line therapeutic agent for patients with chronic myeloid leukemia (CML) at the chronic phase (CP). Although CML patients undergoing imatinib treatment are enrolled mainly in the Glivec International Patient Assistance Program (GIPAP) in China since 2003, limited data have been reported on the long-term outcome of these patients. This study aims to compare the treatment response and prognosis of CML-CP patients who received different treatments from January 2003 to December 2013 in the First Affiliated Hospital of Nanchang University. Methods:A total of 295 patients were enrolled, includ-ing 185, 30, 50, and 30 patients for imatinib, interferon-alpha (IFN-α) plus Ara-C, hydroxycarbamide (HU), or allogeneic hematopoietic stem cell transplantation (Allo-HSCT) treatments, respectively. Results:Patients in imatinib and Allo-HSCT groups achieved excellent complete hematologic remission (CHR) (i.e., 96.7%vs. 96.7%), complete cytogenetic response (CCyR) (i.e., 89.7%vs. 93.3%), and com-plete molecular remission (CMoR) (i.e., 49.7%vs. 83.3%, P=0.001). However, significantly low rates of CHR, CCyR, McyR, and CMoR were observed in IFN-αand HU groups. Moreover, patients from imatinib group showed longer overall survival (OS) time than patients from other groups (P<0.001), even patients in Allo-HSCT group (10-year OS, 89.0%vs. 67.0%, P<0.001) because of high risk of Allo-HSCT-related complication. Multivariate analysis showed that receiving imatinib treatment (HR=5.267, 95%CI:1.054-1.940, P=0.022) and achieving CCyR (HR=9.541, 95%CI:1.692-10.513, P=0.002) were independent predictors for OS. Conclusion:Imatinib treatment may be an optimal first-line choice for Chinese patients with CML-CP who have not received any previous treatments.

Objective:To evaluate acute kidney injure ( AKI) induced by vancomycin in elderly patients by the determination of serum C ( Cys-C) , creatinine ( Cr) and urine kidney damage factor 1 ( KIM-1 ) in order to provide theoretical evidence for clinical pharmacists helping clinicians make individualized dosage regimen. Methods:A retrospective collection of 48 elderly patients admitted to ICU in our hospital from July 2016 to May 2017 treated with vancomycin for MRSA blood flow infection was carried out. The basic values of serum Cys-C, Cr and urine KIM-1 were determined before the treatment of vancomycin and 6, 12, 24h and 48h after the drug use. According to the AKI diagnostic criteria, the patients were divided into the AKI experimental group and the control group. The se-rum Cr, Cys-C and urine KIM-1 were compared between the groups after the drug use and the clinical diagnostic values of Cys-C and KIM-1 were assessed by the working characteristic curve ROC of the subjects. Results:Totally 32 cases (66. 67%) of patients were with AKI induced by vancomycin at 48h after the administration. Compared with that of the control group, the serum Cr, Cys-C and u-rine KIM-1 was significantly higher respectively at 48h, 24h and 12h after the drug use in the AKI experimental group, and the differ-ences between the groups were statistically significant(P<0. 05). Using serum Cys-C, Cr and urine KIM-1 as the AKI diagnosis, the number of AKI at 12h after the drug use had statistically significant difference (P<0. 05). The results of ROC curve analysis showed that the area under the KIM-1 curve of urine was 0. 797 with 95% confidence interval of 0. 647-0. 947), and the area under the serum Cys-c curve was 0. 582 with 95% confidence interval of 0. 364-0. 799. Conclusion: Compared with the traditional kidney damage markers Cr, serum Cys-C and urine KIM-1 can earlier predict renal function in elderly patients to provide reliable basis for early evalu-ation of renal function, which is helpful to the timely adjustment of vancomycin dosage regimen by clinicians assisted by clinical phar-macists for elderly patients.

Objective To construct a bait vector containing human Foxp3 gene in yeast two-hybrid system in order to screen the cDNA library of T lymphocyte. Methods RT-PCR was used to amplify the Foxp3 gene fragment from the peripheral blood mononuclear cells (PBMC) with the primers designed in accordance with the sequence in GenBank. The product was inserted into pMD18-T vector. After verified with restriction endonuclease digestion of EcoRⅠ and SalⅠ, the vector was inserted into the “bait plasmid” pGBKT7 (named as pGBKT7-Foxp3). After confirmation with restricted endonuclease digestion and sequence analysis, the plasmid was transformed into the yeast cell AH109, and its toxicity and transcriptional activation was tested by both the phenotype assay and the color assay. Results The amplified product of 1 203 bp was inserted into PMD18-T vector and proven correctly by double restriction enzyme digestion. Sequence analysis revealed that the fragment was correctly inserted into pGBKT7 with a right reading frame and its expression in yeast was verified. Conclusion The bait plasmid pGBKT7-Foxp3 constructed expresses correctly, and can not activate the transcription of reporter gene alone in yeast two-hybrid system

Objective To compare the effectiveness and safety of semaglutide with dulaglutide in patients diagnosed with type 2 diabetes.Methods A multicenter retrospective cohort study was conducted to include patients with type 2 diabetes who received semaglutide or dulaglutide treatment at three hospitals between April 2021 and July 2023 in the study.The patients were divided into the semaglutide group(SEMA group)and the dulaglutide group(DULA group)based on their treatment.Propensity score matching was used to pair the two groups in a 1:1 ratio,aligning them based on baseline characteristics such as gender,age,body mass index,blood glucose levels,duration of diabetes,and complications.Various parameters including fasting blood glucose,2-hour postprandial blood glucose,glycosylated hemoglobin(HbA1c),serum creatinine,urea nitrogen levels,estimated glomerular filtration rate(eGFR),urinary albumin/creatinine ratio(UACR),and occurrences of adverse reactions were assessed at 3,6,9,and 12 months after the treatment.Results After propensity score matching,98 patients were included in both the SEMA and DULA groups,showing no statistically significant differences in baseline characteristics between the groups(P＞0.05).At each follow-up point,the fasting blood glucose,2-hour postprandial blood glucose,and HbA1c levels of both groups showed a significant decrease compared to the baseline(P≤0.05).The inter-group comparison revealed no statistically significant differences in the changes in fasting blood glucose,2-hour postprandial blood glucose,and HbA1c levels between the two groups(P＞0.05).At the 6th month,the SEMA group exhibited a statistically significant higher rate of HbA1c＜7％compared to the DULA group(P＜0.05).In the SEMA group,serum creatinine and urea nitrogen decreased significantly at the 6th month compared to baseline,while eGFR showed an increase at the 3rd and 6th month,and UACR decreased,all with statistical significance(P＜0.05).In the DULA group,there was a statistically significant increase in serum creatinine and decrease at the 3rd and 6th months in eGFR,respectively.Additionally,urea nitrogen levels decreased significantly at the 9th month,all differences were statistically significant(P＜0.05).The inter-group comparison revealed that at the 3rd and 6th month,the SEMA group exhibited a greater reduction in serum creatinine levels compared to the DULA group.Additionally,the SEMA group demonstrated a more pronounced increase in eGFR levels than the DULA group,with statistical significance(P＜0.05).At the 6th month,the SEMA group exhibited a significantly greater decrease in UACR and a significantly lower incidence of renal insufficiency compared to the DULA group(P＜0.05).There were no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Semaglutide and dulaglutide can significantly improve blood glucose control,exhibit comparable effectiveness and safety in lowering blood glucose levels,and semaglutide has a potentially protective effect on renal function.

As a newly epidemic, 2019 coronavirus disease (COVID-19) with a concentrated outbreak poses a great challenge to medical treatment. The severe and critical patients are complex complicatied with the psychological problems, and the medical staff are overworked and under tremendous psychological pressure. The surgeon participated in emergency medical rescue could provide professional treatment for the patients combined with surgical diseases, as well as specialized training for the non-surgeon crew, to reduce surgical-related mortality. With the advantages of good team consciousness, strong aseptic concept and good psychological quality, the surgeons can quickly adapt to and carry out rescue work under the premise of good self-protection. Surgeons need to develop critical care management concepts and focus on the critical care support equipment. Some suggestions are put forward for the standardized training of resident surgeons to cultivate compound talents. It is hoped that this article can lead to the thinking of how to participate in the emergency medical rescue of infectious diseases among surgeons and provide some enlightenment for future surgical education.