Objective To explore the influencing factors and timing of acute cholecystitis laparoscopic surgery.Methods One hundred and sixty acute cholecystitis patients treated with laparoscopic surgery were divided into group A (56 cases,performed treatment within 24 h),group B (42 cases,performed treatment at 24 -48 h),group C ( 40 cases,performed treatment at 49 -72 h),group D (22 cases,performed treatment after 72 h).The operation time,rate of conversion to laparotomy,length of stay and average costs were compared among four groups and analyzed the impact of laparoscopic surgery conversion to laparotomy.Results The rate of conversion to laparotomy of group D [ 59.09％(13/22) ] was significantly higher than that in group A [ 19.64％(11/56) ] (P ＜ 0.01 ).The operation time of group A was the shortest and group D was the longest.The length of stay of group D was significantly longer than other groups (P ＜ 0.05 ).The costs of the four groups had no significant difference(P ＞ 0.05 ).Single factor analysis showed that white blood cell (WBC) count,body temperature,timing of surgery,gallbladder neck calculi incarceration were correlated with conversion to laparotomy(P ＜ 0.05 ).Multifactor analysis showed that WBC count,timing of surgery were independent risk factors of conversion to laparotomy (P ＜ 0.05 ).Conclusions WBC count,body temperature,timing of surgery,gallbladder neck calculi incarceration are correlated with acute cholecystitis laparoscopic surgery conversion to laparotomy.While WBC count and timing of surgery are independent risk factors.The best time of laparoscopic surgery is within 72 h and WBC count ＜ 15 x 109/L.

Fungal elicitors are a group of chemicals that can stimulate the secondary metabolite production in plants and microbial cells. After being recognized, it could enhance the expression of related genes through the signal-transduction pathway; regulate the activity of the enzyme involved in the biosynthesis of secondary metabolites. In recent years, the inducible mechanism of fungal elicitors has been studied deeply worldwide. Meanwhile, it has acquired wide concern in the area of biological industry, especially in the fermentation industry. This paper addresses the application and prospect of fungal elicitors in the secondary metabolites of plant and microbial cells.
Alkaloids ; biosynthesis ; genetics ; Camptothecin ; biosynthesis ; Fermentation ; Fungi ; genetics ; metabolism ; Industrial Microbiology ; methods ; Paclitaxel ; biosynthesis ; Plants, Medicinal ; metabolism ; Recombinant Proteins ; biosynthesis ; genetics ; Secondary Metabolism

Objective:To understand the coronavirus disease 2019(COVID-19)prevention and control work and the problems and difficulties faced by non-government primary medical institutions in China during the epidemic period.Methods:A survey on the coronavirus disease 2019(COVID-19)prevention and control work of non-government primary medical institutions was conducted on April 14 to 21, 2020 with the self-designed questionnaire. The questionnaire contained three parts: the first part was basic information of medical staff in non-government primary medical institutions, including position and institutional information; the second part was the status quo of non-government primary medical institutions participating in the prevention and control of COVID-19, including the specific work and difficulties faced by the responders during the epidemic period; and the third part was the prevention and control effect of COVID-19 in the responders′ institutions, including whether there were confirmed cases and infected medical staff. An online invitation was issued among the members of General Practice Branch of Chinese Non-government Medical Institution Association. The invited participants included the heads, general practitioners and other medical personnel of the non-government primary medical institutions the invited participants voluntarily scanned the online two-dimensional code to fill in.Results:A total of 761 individuals in primary health institutions from 20 provinces, municipalities and autonomous regions in China participated in the survey. There were 290 (38.1%) men and 471 (61.9%) women with age of 40(32, 48) years; 83.0% (632/761) had worked for more than 5 years; 33.8% (257/761) owned primary professional titles and 33.0% (251/761) owned intermediate titles. Among all participants 28.5% (217/761) were general practitioners, 26.9% (205/761) were institutions/department managers, 14.6% (111/761) were specialists and 40.3% (307/761) were other related personnel. A total of 549 institutions continued to operate during the epidemic period and 96.5% (530/549) participated in the work related to the prevention and control of the epidemic, including prescreening and triage, health consultation, follow-up of suspected patients, donation, quarantine of suspected cases, follow-up of close contacts/discharged patients, diagnosis and treatment of patients with new coronavirus pneumonia. 44.7% (340/761) of respondents participated in the epidemic prevention as front-line staff and directly contacted patients/suspected patients, and 63.1% (480/761) participated in the epidemic prevention work of primary medical institutions, including clinical outpatient service, prescreening triage and screening. The working sites were not limited to the institutions, but also other sites including high-speed railway station. The 97.8% (744/761) responders expressed their willingness to participate in epidemic prevention work under the unified leadership and command of the state. The 63.9% (486/761) of the responders were worried about the lack of protective equipments and measures, and 90.4% (688/761) respondents showed that they needed medical supplies (protective equipment: masks, goggles, protective gowns, etc.).Conclusion:The participation of non-government primary medical institutions and their staff in COVID-19 infection prevention and control is a key component of the epidemic prevention process.

Objective To discuss the technical points, safety and clinical effectiveness of DSA-guided percutaneous acetabuloplasty (PA) for the treatment of acetabular metastases. Methods Fifteen patients, including 6 males and 9 females, with acetabular malignant metastases were enrolled in this study.A total of 19 lesions were detected. The lesions were 13 - 25 mm in size (mean 19 ± 4 mm), the dose of PMMA used for per lesion was 5 - 13 ml (mean 8.2 ± 2.3 ml). All patients complained of greater or less degree of pain in their hips, 8 patients had to use walking stick, 4 patients showed limping although they could walk independently and three patients could not walk alone. DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1 - 12 months. Visual analogue score (VAS), walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness. The complications were analyzed. All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software.Results The procedure was technically successful in all patients. Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery (P < 0.01 ), which further decreased to 2.5 in one month (P < 0.01 ), while walking state score increased from a mean of 1.5before surgery to a mean of 2.5 in 24 hours after surgery (P < 0.01 ). The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient. The bone cement leakage into paraacetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms. Conclusion As a safe, reliable and minimally-invasive technique, DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases. This therapy can markedlyimprove the patient's walking ability and the quality of life.

Objective To evaluate the value of immunofecal occult blood test (IFOBT) as a prognostic indicator in CKD patients with colorectal impairment.Methods A total of 176CKD patients and 180 healthy adults as control were enrolled.Serum biochemistry was measured at baseline and gastrointestinal bleeding was determined by IFOBT.All the CKD patients were followed up for 4.5 years.Renal replacement therapy or death was defined as end-point event.The Logistic regression analysis was used for risk factors.Kaplan-Meier analysis and COX regression model were used for survival analysis.Results The positive rate of IFOBT in CKD patients was significantly higher than healthy control (17％ vs 5.3％,χ2=13.236,P＜0.01).When comparing with IFOBT negitive patients,IFOBT positive patients were older [(62.030±15.544) years old vs (48.660±19.018)years old,P＜0.01],had higher ESR [(71.800±31.657) mu/h vs (57.210±32.712) mm/h,P＜0.05],C-reactive protein [6.230 (3.000～14.148) mg/L vs 3.000 (3.000～6.833)mg/L,P＜0.05],serum creatinine [419.100 (103.200～546.625) μmol/L vs 175.100 (68.150～462.950) μmol/L,P＜0.05],and had lower hemoglobin level [(97.970±20.590) g/L vs (107.170±27.988) g/L,P＜0.05] and eGFR [11.400 (8.671～53.544) ml·min1·(1.73 m2)1 vs 35.274(10.961～82.145) ml·min-1·(1.73 m2)-1,P＜0.01].There was a negative correlation between IFOBT value and eGFR in CKD patients (r=-0.20,P＜0.01).Positive correlations of IFOBT value with age (r=0.175,P＜0.05) and serum creatinine (r=0.171,P＜0.05) were found.Logistic regression and COX regression analysis showed that IFOBT value,eGFR and ESR were important factors that influenced the prognosis of CKD patients.Kaplan-Meier analysis revealed that IFOBT value ＞100μg/L predicted progression of renal function.Conclusions The prevalence of gastrointestinal bleeding disorder is high in patients with CKD.Value of IFOBT independently predicts decline in renal function of CKD patients.

A rapid, sensitive and simple liquid chromatography-tandem mass spectrometric (LC-MS/MS) method was developed for the simultaneous determination of yogliptin and its metabolite in Wistar rat plasma. Linagliptin and dexamethasone were chosen as the internal standards of yogliptin and its metabolite, (R)-8-(3-hydroxypiperidine- -yl)-7-(but-2-yn-1-yl)-1-((5-fluorobenzo[d]thiazol-2-yl)methyl)-3-methyl- H-purine-2, 6 (3H, 7H)-dione, respectively. After a simple protein precipitation using acetonitrile as the precipitating solvent, both analytes and ISs were separated on a Grace Altima HP C18 column (2.1 mm x 50 mm, 5 microm) with gradient elution using methanol (containing 0.1% formic acid, 4 mmol x L(-1) ammonium acetate)-0.1% formic acid (containing 4 mmol x L(-1) ammonium acetate) as the mobile phase. A chromatographic total run time of 4.4 min was achieved. Mass spectrometric detection was conducted with electrospray ionization under positive-ion and multiple-reaction monitoring modes. Linear calibration curves for yogliptin and its metabolite were over the concentration range of 0.5 to 500 ng x mL(-1) with a lower limit of quantification of 0.5 ng x mL(-1). The intra- and inter- assay precisions were all below 14%, the accuracies were all in standard ranges. The method was used to determine the concentration of yogliptin and M1 in Wistar rat plasma after a single oral administration of yogliptin (27 mg x kg(-1)). The method was proved to be selective, sensitive and suitable for pharmacokinetic study of yogliptin and M1 in Wistar rat plasma.

To investigate the protective effects of scutellarin benzyl ester on neonatal rats' cardiomyocytes injured by ischemia and its anti-apoptosis mechanism.

Objective To investigate the causes of arterial reocclusion in diabetic feet patients after endovascular treatment and its remedial measures.Methods From January 2009 to October 2013,clinical data of 371 arterial reocclusion of diabetic feet patients after endovascular treatment in Tianjin First Central Hospital were reviewed retrospectively.We summarized the causes of reocclusion,treatment methods and the short term results.Results According to the Trans-Alantic Inter-Society Consensus (TASC) Ⅱ grading standards,the first time when the endovascular treatment started there were 37 cases of grade A,85 cases of grade B,143 cases of grade C,106 cases of grade D.Arterial re-occlusion developed from one day to 36 months,averaging at (21 ± 8) months.Causes of re-occlusion included intimal hyperplasia in 263 cases (70.9％),thrombosis in 65 cases (17.5％),dissection in 19 cases (5.1％),stent fracture in 17 cases (4.6％),vascular rupture in 7 cases (1.9％).Remedial therapy adopted for arterial reocclusion was repeated endovascular treatment in 327 cases (88.1％),arterial bypass surgery in 23 cases (6.2％),conservative treatment in 13 cases (3.5％),amputation (cut toe) in 4 cases (1.1％),4 cases (1.1％) died perioperatively.275 cases were followed up for 1 to 36 months,the average was (13 ± 8) months.patency rate was 82.9％,71.3％ and 63.0％ at 6 months,1 year and 2 years.Amputation rate was 1.1％,1.8％ and 2.5％ at 6 months,1 year and 2 years.Conclusions Intimal hyperplasia is to blame for arterial reocclusion after endovascular treatment of diabetic foot.In this case most patients still can benefit from second time endovascular treatment,with a satisfactory short term patency rate.

Objective To investigate the incidence of colorectal disease in patients with chronic kidney disease (CKD) and analyze the risk factor of colorectal disease in patients with CKD.Methods The clinical data of 719 patients with CKD underwent colonoscopy examination and 404 patients without CKD underwent colonoscopy examination were collected.The incidence of colorectal disease was compared between patients of the two groups.According to the results of colonoscopy examination,the patients with CKD were divided into colonoscopy positive group and negative group,and clinical biochemical indexes of the two groups were analyzed.The rank-sum test or t-test was used to compare the measurement data.Rates were compared by Chi-square test.The risk factors of colorectal disease in patients with CKD were evaluated by logistic regression.Results The positive rate of colonoscopy examination in 719 patients with CKD was 21.28％ (153/719),which was higher than that of patients without CKD (12.62 ％,51/404; x2 =13.036,P＜0.01).The positive rate of colonoscopy in patients with CKD at stage 1 was 17.50％ (56/320),at stage 2 or 3 was 22.68％(66/291),at stage 4 or 5 was 28.70％ (31/108).There were significant differences among the three groups (x2-6.623,P＜0.05).The incidence of colorectal cancer in patients with CKD was 3.89 ％ (28/719),which was higher than that of patients without CKD (1.73％,7/404; x2 =4.003,P＜0.05).The incidence of colorectal polyps in CKD group was 8.34％(60/719),which was higher than that of non-CKD group (5.20％,21/404; x2 =3.827,P＜0.05).The incidence of inflammatory bowel disease in CKD group was 9.04％(65/719),which was higher than that of non-CKD group (5.69 ％,23/404; x2 =4.013,P＜0.05).The incidence of colorectal cancer and colorectal polyps in patients with CKD at stage Ⅰ was 2.50％(8/320) and 6.25％(20/320),at stage 2 or 3 was 3.78％(11/291) and 8.59％(25/291),at stage 4 or 5 was 8.33％(9/108) and 13.89％ (15/108).There were significant differences among the three groups (x2-7.359 and 6.199,both P＜ 0.05).The age of colonoscopy positive group was older than that of colonoscopy negative group (t=-3.821,P＜0.01); there were lower hemoglobin (t=3.541,P＜0.01),increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (Z=-4.996 and-7.493,both P＜0.01),higher cholesterol and low density lipoprotein (t=-2.659 and-3.248,both P＜0.01),increased serum creatinine (Z=-3.683,P＜0.01) and declined glomerular filtration rate (Z=-6.227,P＜0.01) in colonoscopy positive group than in colonoscopy negative group; the differences were statistically significant.Logistic regression analysis indicated that age (β=0.981,95％ CI 0.965 to 0.998,P =0.032),serum creatinine (β=1.006,95％CI 1.002 to 1.009,P=0.001) and ESR (β=1.029,95％CI 1.018 to 1.040,P＜0.01) were risk factors of colorectal disease in patients with CKD.Conclusions The incidence of colorectal disease in patients with CKD is high,and it increases along with the declined glomerular filtration rate.The colorectal disease in patients with CKD patients may be associated with age,anemia,lipid metabolism,inflammation and impaired renal function.

Objective To study the protective effect and its mechanism of anti-tumor necrosis factor-?antibody (TNF-? Ab) on lung injury after cardiopulmanary bypass(CPB).Methods Twenty-eight healthy rabbits were selected and randomly divided into four groups:group Ⅰ only received open chest operation;groups Ⅱ-Ⅳ underwent CPB.In the group Ⅳ,rabbit TNF-? Ab (2 400 pg/kg) was dropped into the intracheal tube before operation and just after releasing the aortic clamp.Saline was given to the group Ⅲ in- stead.Blood neutrophils count,TNF-?,MDA from the right and left atrium in the four groups were determined perioperatively.Water volume,TNF-? mRNA,TNF-? protein,apoptosis and pathomorphological changes were measured in the lung tissues.Results TNF- ? Ab can restrain leukocyte accumulation,reduce releasing of TNF-? and MDA in the lung.It can also reduce the occurrence of apop- tosis and attenuate pathomorphological changes in the lung tissue.However,it cannot reduce the secretion of TNF-? at the transcrip- tion level and protein level.Conclusion Intratracheal TNF-? Ab administration has markedly protective effect on lung injury after CPB.