Malignant tracheoesophageal fistula (MTEF) is pathological communication between the respiratory tracts such as the trachea or bronchia and the esophagus because of malignant tumor dissemination through them.Radiography is an important adjunctive technology in the diagnosis of MTEF,and the location and size of fistula often need the further diagnosis of bronchoscopy and esophagoscopy.The patients are often with an unfavourable prognosis once developed MTEF,and are treated usually with the aim of symptom palliation and life quality improvement.The individual treatment includes esophageal stenting,esophageal exclusion and esophagus bypass,fistula exclusion and repair,radiotherapy and others effective therapy according to the patients condition.These therapies will prolong the life span and improve the life quality of patients.MTEF is not absolute contraindication for chemoradiotherapy.Despite its acute toxicity,this concurrent chemoradiothe rapy protocol appears feasible and effective at closing esophageal malignant fistula,especially in patients in a good general condition and without metastasis.

Objective To investigate the differences in tumor volume and metastatic tumors of the liver and regional lymph nodes between contrast-enhanced computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWMRI) through a comparative analysis,as well the useful information for target volume delineation,and to guide radiotherapy in clinical practice.Methods A total of 40 patients with pancreatic cancer were enrolled and underwent contrast-enhanced CT and DWMRI in the same position.The target volume was delineated,the major axis of the maximum tumor section was measured,and the numbers of liver metastatic tumors and metastatic tumors of the lymph nodes with a diameter of 5-8 mm or＞8 mm were measured based on the CT and DWMRI images.The analysis was performed by using paired t-test or paired Wilcoxon rank sum test.Results The mean gross tumor volume (GTV) delineated by contrast-enhanced CT and DWMRI was 54.95 cm3 and 41.67 cm3(P =0.000),and the mean value-different value was 13.28 cm3.The major axis of the maximum tumor section measured by contrast-enhanced CT and DWMRI were 4.18 cm and 3.94 cm (P=0.000),respectively,and in two patients,dCT was smaller than dDWMRI.A total of 83 liver metastatic tumors were identified by contrast-enhanced CT,and 112 were identified by DWMRI;the liver metastatic tumors detected by contrast-enhanced CT accounted for 74％ of those detected by DWMRI.As for the metastatic tumors of the lymph nodes with a diameter of 5-8 mm or＞8 mm,103 or 46 were detected by contrast-enhanced CT,and 200 or 56 were detected by DWMRI,and the tumors detected contrast-enhanced CT accounted for 52％ or 82％ of those detected by DWMRI.There were significant differences in all data between contrast-enhanced CT and DWMRI.Conclusions GTV and the major axis of the maximum tumor section measured by DWMRI are lower than those measured by contrast-enhanced CT,and contrast-enhanced CT is sensitive in detecting the metastatic tumors of the liver and lymph nodes.However,it is necessary to conduct further controlled experiments with reference to pathology.

ObjectiveTo investigate the role of the benzodiazepine receptor in the amnesic effect of propofol,etomicdate and ketamine in mice.MethodsTwo hundred and eighty-eight Kunming mice of both sexes weighing 18-23 g were randomly divided into 9 groups( n =32 each):gruup normal saline + normal saline (group NN); group normal saline+ fat emulsion (group NF); group flumazenil + normal saline (group FN); group normal saline + propofol (group NP) ; group flumazenil + propofol (group FP) ;group nomal saline + etomidate (group NE) ; group flumazenil + etomidate (group FE); group normal saline + ketamine (group NK) and group flumazenil + ketamine (group NK).Normal saline 10 ml/kg was given IP at 10 min before the tests,and normal saline 10 ml/kg,fat emulsion 10 ml/kg,propofol 25 mg/kg,etomidate 3 mg/kg and ketamine 20 mg/kg at 5 min before the tests in groups NN,NF,NP,NE and NK respectively.Flumazenil 1 mg/kg was given IP at 10 min before the tests,and normal saline 10 ml/kg,fat emulsion 10 ml/kg,propofol 25 mg/kg,etomidate 3 mg/kg and ketamine 20 mg/kg at 5 min before the tests in groups NN,NF,NP,NE and NK respectively.Darkness-avoiding test,platform-mounting test and Morris water maze test were performed to assess the cognition function.The latency of response and number of error were recorded in each test.ResultsPropofol,etomidate and ketamine significanfly shortened the duration of latency of response in platform-mounting test as compared with group NN.Etomidate also significantly increased the number of error in platform-mounting test as compared with group NN,while ketamine prolonged the duration of latency of response in Morris water maze test as compared with group NN.Flumazenil significantly counteracted the above action of the 3 intravenous anesthetics.ConclusionBenzodiazepine receptor may play an important role in the amnesic effect induced by propofol,etomidate and ketamine.

Objective: To evaluate the effect of functional training on the improvement of Cobb Angle, ATR and quality of life in adolescent idiopathic scoliosis. Methods: Database of CNKI, WanFang, WeiPu, Web of Science, PubMed were reconnoitered for the purpose of research articles of Interest. Literature was screened according to the inclusion criteria, randomized controlled trials (RCTS) were collected and Cochrane risk bias assessment methodology quality was used, and Revman 5.3 software was used to conduct combined effector subgroup analysis on outcome indicators (Cobb Angle, ATR, SRS-22 patient questionnaire). Results: A total of 10 RCT (398 AIS patients) were included in the study. There were two high , five moderate and three low quality studies, respectively. Compared with other non operative treatments, functional training could reduce Cobb horn in patients, MD = -6.56 (95% CI =-7.30--5.83, P <0.01, I 2=0). Further subgroup analysis showed that there were no statistically significant differences in effect size between the subgroups of Cobb Angle, age, intervention period and control method at the time of inclusion ( P >0.05). Compared with the non intervention blank group, the functional training group could reduce the Cobb Angle of patients ( MD = -5.25 , 95% CI =-8.27- -2.98 , P < 0.01 ), with high heterogeneity ( I 2=61%). Effect on angle of trunk rotation(ATR):functional training group could reduce patients ATR, MD =-1.91 (95% CI =-2.25--1.57, P <0.01, I 2=0). The impact on the quality of life:functional training of patients with SRS-22 questionnaire function, pain had no statistical significance ( P >0.05), and self image ( MD =0.64, 95% CI =0.53- 0.75 , P <0.01), mental health ( MD =0.44, 95% CI =0.15-0.74, P <0.01), satisfaction ( MD = 0.58 , 95% CI =0.11- 1.06 , P = 0.02 ) were statistically significant. Conclusion Functional training can not only reduce the Cobb Angle and ATR of AIS patients, but also improve the quality of life in terms of self image, mental health and satisfaction of the patients. However, due to heterogeneity and bias, more high quality studies are needed to verify.

NDM-1 (New Delhi metallo-beta-lactamase) gene encodes a metallo-beta-lactamase (MBL) with high carbapenemase activity, which makes the host bacterial strain easily dispatch the last-resort antibiotics known as carbapenems and cause global concern. Here we present the bioinformatics data showing an unexpected similarity between NDM-1 and beta-lactamase II from Erythrobacter litoralis, a marine microbial isolate. We have further expressed these two mature proteins in E. coli cells, both of which present as a monomer with a molecular mass of 25 kDa. Antimicrobial susceptibility assay reveals that they share similar substrate specificities and are sensitive to aztreonam and tigecycline. The conformational change accompanied with the zinc binding visualized by nuclear magnetic resonance, Zn(2+)-bound NDM-1, adopts at least some stable tertiary structure in contrast to the metal-free protein. Our work implies a close evolutionary relationship between antibiotic resistance genes in environmental reservoir and in the clinic, challenging the antimicrobial resistance monitoring.
Amino Acid Sequence ; Anti-Bacterial Agents ; pharmacology ; Aztreonam ; pharmacology ; Cephalosporinase ; chemistry ; genetics ; metabolism ; Computational Biology ; methods ; Drug Resistance, Bacterial ; genetics ; Enzyme Stability ; drug effects ; Evolution, Molecular ; Minocycline ; analogs & derivatives ; pharmacology ; Molecular Sequence Data ; Phylogeny ; Protein Structure, Tertiary ; drug effects ; Sequence Homology, Nucleic Acid ; Sphingomonadaceae ; drug effects ; enzymology ; genetics ; Tigecycline ; Zinc ; pharmacology ; beta-Lactamases ; chemistry ; genetics ; metabolism

Bacterial cell division is strictly regulated in the formation of equal daughter cells. This process is governed by a series of spatial and temporal regulators, and several new factors of interest to the field have recently been identified. Here, we report the requirement of gluconate 5-dehydrogenase (Ga5DH) in cell division of the zoonotic pathogen Streptococcus suis. Ga5DH catalyzes the reversible reduction of 5-ketogluconate to D-gluconate and was localized to the site of cell division. The deletion of Ga5DH in S. suis resulted in a plump morphology with aberrant septa joining the progeny. A significant increase was also observed in cell length. These defects were determined to be the consequence of Ga5DH deprivation in S. suis causing FtsZ delocalization. In addition, the interaction of FtsZ with Ga5DH in vitro was confirmed by protein interaction assays. These results indicate that Ga5DH may function to prevent the formation of ectopic Z rings during S. suis cell division.
Bacterial Proteins ; chemistry ; genetics ; metabolism ; Cell Division ; Cell Shape ; Cytoskeletal Proteins ; chemistry ; genetics ; metabolism ; Mutation ; Oxidoreductases ; deficiency ; genetics ; metabolism ; Protein Binding ; Streptococcus suis ; enzymology

Objective:To compare the clinical efficacy of two-dimensional (2D) fluoroscopic guided robot-assisted and conventional TESSYS surgery in the treatment of lumbar disc herniation, the feasibility and precautions of 2D fluoroscopic guided robot-assisted TESSYS surgery were discussed.Methods:A retrospective analysis was performed on 34 male and 36 female patients aged 44.57±6.10 years (range 27 to 60 years) who received 2D guided robot-assisted TESSYS surgery and conventional TESSYS surgery from July 2019 to April 2020. 2D guided robot assisted TESSYS surgery group (the robot group) 32 cases, conventional TESSYS surgery (the conventional group) 38 cases. The number of puncture, number of fluoroscopy, puncture-channel time, operation time, visual analogue scale (VAS) and Oswestry disability index (ODI) before and after surgery and at the last follow-up were compared between the two groups to verify the clinical efficacy, and the complications were analyzed.Results:There were no significant differences in age, gender, body mass index, surgical level, Michigan State University (MSU) grading and average follow-up time between the robot group and the conventional group (all P>0.05). All patients completed surgery. The number of puncture times was 1.22±0.79 in the robot group and 4.66±1.86 in the conventional group, and the difference was statistically significant ( t=10.320, P<0.001). The number of fluoroscopy in the robot group was 10.97±1.96 times, and that in the conventional group was 17.45±4.30 times, the difference was statistically significant ( t=8.313, P<0.001). The puncture-channel time of the robot group was 10.66±3.62 min and that of the conventional group was 20.21±5.47 min, and the difference was statistically significant ( t=8.446, P<0.001). The operation time of the robot group was 62.25±6.68 min, and that of the conventional group was 72.89±10.48 min, the difference was statistically significant ( t=4.956, P<0.001). VAS scores of the robot group were 6.91±0.93 points before surgery, 2.97±0.65 points 1 d after surgery, and 1.53±0.51 points at the last follow-up, while those of the conventional group were 7.29±1.14 points before surgery, 2.89±0.56 points 1 d after surgery, and 1.42±0.50 points at the last follow-up. The ODI index of the robot group was 40.13%±1.54% before surgery, 17.28%±1.69% 1 day after surgery, and 10.84%±1.25% at the last follow-up, while that of the conventional group was 40.03%±1.46% before surgery, 17.42%±2.45% 1 day after surgery, and 10.92%±1.17% at the last follow-up. There were no statistically significant differences (all P>0.05). Two patients (6.3%) in the robot group and four (10.5%) in the conventional group had residual disc, there was no significant difference ( P>0.05). Conclusion:2D guided robot assisted TESSYS surgical treatment of lumbar disc herniation, which can plan puncture path in the stage of percutaneous target puncture, rigid guidance and accurate puncture target, and has obvious advantages in reducing puncture times and fluoroscopy times.

In order to further strengthen the training and management of clinical teachers, broaden the career development channels of clinical teachers, and truly stimulate their teaching enthusiasm and initiative, this study further classifies clinical teachers according to the principle of the Snell model, focuses on the training of educational clinicians, and explores the training mechanism of teaching talents in line with the actual development needs of hospitals affiliated to universities from the aspects of selection, training, incentive, and assessment. The results of practice show that related practices have a good effect, and the mean number of teaching achievements was 1.98 for the 56 educational physicians, which was 3.9 times that for non-educational physicians. The per capita teaching achievements of educational physicians tended to increase every year compared with those of non-educational physicians. The training path for educational physicians provides useful experience for the construction of clinical teaching team and the high-quality development of education and teaching, and at the same time, it is necessary to further strengthen the dynamic adjustment of talent echelon, the improvement of operating mechanism, and the introduction of new technology.