OBJECTIVE:To investigate the effects of small dose of bupivacaine lumbar-epidural block on related indexes inwomen underwent cesarean section. METHODS:124 singleton term primipara underwent elective cesarean section were randomly divided into observation group(62 cases)and control group(62 cases). Observation group received 0.5% bupivacaine 7.5 mg lum-bar anesthesia+1.6% lidocaine epidural block. Control group received 0.5% bupivacaine 10 mg lumbar anesthesia+1.6% lidocaine epidural block. HR,SBP,DBP,onset time of sensory block,fixation time of block level,operation start time,the occurrence of traction reaction and supine hypotensive syndrome,the application of ephedrine,Apgar score the occurrence of ADR were ob-served in 2 groups before anesthesia(T0),1(T1),3(T2),5 min(T3)after anesthesia,at skin incision(T4),after fetal disengage-ment(T5). RESULTS:There was no statistical significance in HR,SBP and DBP between 2 groups at T0(P>0.05). There was no statistical significance in HR,SBP and DBP of observation group at different time points(P>0.05). At T1-3,SBP and DBP of con-trol group were significantly lower than at T0 and observation group;HR was significantly higher than at T0 and observation group, with statistical significance(P<0.05);there was no statistical significance in HR,SBP and DBP of control group,compared to at T1-3(P>0.05);there was no statistical significance in above 3 indexes of control group at T4-5,compared to at To and observation group(P>0.05). The onset time of sensory block,fixation time of block level and operation start time in observation group were all longer than control group;the incidence of supine hypotensive syndrome,the number of ephedrine cases,the amount of ephed-rine,the incidence of nausea and vomiting,the incidence of postoperative urinary retention were significantly lower than control group;the incidence of traction reaction was significantly higher than control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of respiratory depression,Apgar score,overall incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:The small dose of bupivacaine lumbar-epidural block for women underwent cesarean section keep he-modynamics stable and reduce the incidence of supine hypotensive syndrome without increasing the incidence of ADR.

Objective To observe the suppressing effect of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on ultraviolet ray (UV)-induced erythema.Methods A solar simulator and an UV phototherapy device were used as light sources,respectively.Erythema reaction was induced on the back skin of 30 healthy volunteers by 1,2 and 3 minimal erythema doses (MED) of irradiation.Five preparations including butyl flufenamate 2.5％ ointment,butyl flufenamate 5％ ointment,the base of butyl flufenamate ointment,halometasone ointment,and diclofenac 1％ ointment,were applied to the irradiation sites respectively half an hour before or immediately after the irradiation.One irradiation site remained untreated and served as the control.The degree of erythema was evaluated by a chromameter at 4,24,and 48 hours after the irradiation.Intragroup and intergroup comparisons were done by t test and analysis of variance,respectively.Results When applied half an hour before solar-simulated irradiation,both 2.5％ and 5％ butyl flufenamate ointment totally suppressed the erythema reaction induced by 1-3 MED of UV irradiation,with no significant increase in erythema index at all the three time points after irradiation (all P ＞ 0.05); diclofenac 1％ only inhibited the erythema induced by 1 MED of UV irradiation at 4 and 48 hours,with no difference observed in erythema index between the baseline and these time points after irradiation; however,halometasone significantly aggravated the erythema reaction (P ＜ 0.05).Neither NSAIDs nor corticosteroids applied immediately after solar-simulated irradiation showed statistical effect on the degree of UV-induced erythema.When applied immediately after irradiation using the phototherapy device,butyl flufenamate 2.5％ ointment,butyl flufenamate 5％ ointment and halometasone ointment all induced a significant reduction in erythema reaction at 4 hours after 1 MED of irradiation (all P ＜ 0.05),and diclofenac caused a statistical decrease in erythema reaction at all the time points after 1-3 MED of irradiation (all P ＜0.05).Conclusions Topical use of butyl flufenamate before UV irradiation can effectively inhibit erythema reaction induced by 1-3 MED of irradiation.When applied immediately after irradiation,diclofenac shows the strongest erythema-suppressive effect,followed sequentially by butyl flufenamate and halometasone.

Objective To find the efficient modification groups of anti-proteinase hydrolyzation in polypeptide by investigat-ing and comparing the relation between the functional groups and their ability to inhibit proteinase hydrolyzation. Methods Reverse phase-high performance liquid chromatography(RP-HPLC)method was developed to investigate in vitro metabolisms of new drug LXT101 and its structural modified analogs LZN series and LMP series in pancreatin system. All the separations of peptide drugs and their digested fragments were monitored at 225 nm. Results The good linear range was 4.0-400 μg/ml(r>0.9990)for new drug LXT101 and its structural modified analogs,i.e.,LZN series and LMP series. The recoveries of all peptide drugs ranged from 95.0%to 98.7%in pancreatin systems. The relative standard derivations(RSD)of intra-day and inter-day were less than 1.5%and 2.5%,re-spectively. The revealed order of digested half-life of the peptide drugs was LZN series>LMP series>LXT101. Conclusion The study of different sites and different functional groups on the lifetime indicates that the half-lives of peptides are prolonged by introducing the functional groups in the suitable sites of peptide,which feature as proteinase inhibitors,such as carbamoyl(Cbm),acetyl(Ac),para-amino-phenylalanine(Aph)or para-uramido-phenylalanine(Uph),which work as either proton donor or acceptor. Our results can pro-vide some useful and valuable information on structural design of peptide drug with long lifetime and high activity.

Objective To investigate the value of serum cholinesterase (S-ChE) levels in judgment of severity and prognosis in patients with severe pneumonia. Methods The clinical data of patients with severe pneumonia, who were admitted to the Department of Internal Medicine in the First Affiliated Hospital of Sun Yat-sen University, or the Department of Neurology in the Third People's Hospital of Foshan from May 2011 to May 2015, whose hospital time was longer than 24 hours, were retrospectively analyzed. They were divided into survival group and death group according to the final outcome. Lab data, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, multiple organ dysfunction syndrome (MODS) score, the improved pneumonia score of British Thoracic Society (confusion, uremia, respiratory, blood pressure, age 65 years, CURB-65), and S-ChE levels of all patients were collected after they were hospitalized into the intensive care unit (ICU) within 24 hours. Independent risk factors for prognosis were analyzed by binary logistic regression analysis, and receiver operating characteristic curve (ROC) was plotted. Best truncation point analysis was used to compare their estimated value for prognosis of patients with severe pneumonia. Results Eighty-six patients with severe pneumonia were studied. Among them 46 patients survived, and 40 patients died. By the single factor analysis, the following lab data in the death group were found significantly lower than those in the survival group: S-ChE levels (kU/L: 2.748±0.826 vs. 4.489±1.360, t' = 7.274, P = 0.000), arterial partial pressure of oxygen [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 52.55±18.29 vs. 60.83±16.65, t = 2.196, P = 0.031], oxygenation index (mmHg: 114.20±48.01 vs. 167.10±69.68, t' = 4.229, P = 0.000), and carbon dioxide combining power [CO2-CP (mmol/L): 22.85±5.44 vs. 26.00±7.63, t' = 2.225, P = 0.029]. The following clinical data were significantly higher in the death group than those in the survival group, namely body temperature (℃: 38.67±1.18 vs. 37.74±1.18, t = -3.627, P = 0.000), pulse (bpm: 130.65±15.72 vs. 107.26±19.61, t' = -6.133, P = 0.000), the ratio of concomitant chronic lung disease [45.0% (18/40) vs. 13.0% (6/46), χ2 = 10.860, P = 0.001], fraction of inspired oxygen [FiO2: 0.495 (0.410, 0.600) vs. 0.380 (0.290, 0.500), Z = -3.265, P = 0.001], APACHE Ⅱ score (25.80±5.07 vs. 16.39±5.12, t =-8.540, P = 0.000), CURB-65 score [3 (3, 4) vs. 2 (1, 2), Z = -5.562, P = 0.000], MODS score (8.15±2.49 vs. 4.35±2.01, t = -7.832, P = 0.000), international normalized ratio [INR: 1.22 (1.08, 1.31) vs. 1.07 (1.00, 1.10), Z = -4.231, P = 0.000], and activated partial thromboplastin time [APTT (s): 33.80 (32.13, 38.75) vs. 28.50 (25.70, 36.00), Z = -3.482, P = 0.000]. Binary logistic regression analysis showed that, S-ChE levels, APACHE Ⅱ score and MODS score were found to be the independent risk factors for prognosis in the patients with severe pneumonia, respectively [S-ChE: odds ratio (OR) = 0.084, 95% confidence interval (95%CI) = 0.017-0.424, P = 0.003; APACHE Ⅱ score: OR = 1.675, 95%CI = 1.098-2.556, P = 0.017; MODS score: OR = 2.189, 95%CI = 1.262-3.800, P = 0.005]. The area under ROC (AUC) for S-ChE levels, APACHE Ⅱ score and MODS score were 0.874±0.036, 0.889±0.033 and 0.884±0.035, respectively (all P > 0.05 as compared between any two means). At the best truncation points of S-ChE levels, APACHE Ⅱ score and MODS score were 3.372 kU/L, 19.5 score, and 6.5 score respectively. The sensitivity, specificity, positive predictive value and negative predictive value in predicting death risk in patients with severe pneumonia were (80.0%, 78.0%, 76.19% and 81.82%), (95.0%, 70.0%, 73.08% and 94.12%) and (70.0%, 91.0%, 87.50%, 77.78%), respectively. If S-ChE levels was combined with APACHE Ⅱ score or combined with MODS score, the sensitivity, specificity, positive predictive value and negative predictive value [S-ChE levels combined APACHE Ⅱ score: 100%, 92.0%, 93.75% and 100%; S-ChE levels combined MODS score: all 100%] were higher than single power of S-ChE levels, APACHE Ⅱ score or MODS score. Conclusions S-ChE levels can be considered as an effective and practical index to estimate the severity and prognosis in patients with severe pneumonia. The combined application of S-ChE levels and APACHE Ⅱ score or MODS score can obviously improve the prognostic power in patients with severe pneumonia.

Objective To evaluate the application value of situational simulation method based on SimMan 3G in anesthesiology teaching. Methods 5-years anesthesiology under-graduates of 2012 grade and 2013 grade in Wannan Medical Colloge anticipating in clinical practice of anesthesia were selected as observation group. All students were divided into two groups: control group (teachers demonstrated cases, 2012 grade, n=35) and observation group (students role-played simulation cases, 2013 grade, n=36). In control group, teachers firstly applied a multimedia courseware, and then demonstrated the cases to adopt the SimMan 3G simulated system. In observation group, SimMan 3G situational simulation method was used to teach the course , and then the students played roles and videotaped the whole course in the simulated operating room. After training, the students discussed their performance in the simulated training (by the playback of the simulated video), and the teachers commented and summarized the case. The effect of teaching was evaluated by questionnaire and examination. The date were analyzed through Chi-square and t-test test. Results There was no significant difference in essential characteristics, including age, gender, the scores of specialized theory at routine examination between two groups (P>0.05). Statistical difference was found in the theoretical assessment between observation group and control group [(79.44±5.41) vs. (73.46± 4.62), P=0.001]. Meanwhile, questionnaire survey of teaching effect showed that in observation group 31 students (86.1％) were satisfied with the teaching contents, 33 students (91.7％) had consolidated clinical thinking, and 34 students (94.4％) believed it improved their teamwork and communication ability (P=0.031, P=0.018, P=0.013). Conclusion Using SimMan3G for role-playing situational simulation teaching can significantly improve student's comprehensive theoretical scores, facilitate the exercise of clinical thinking, and improve their teamwork and communication skills.

Objective To explore the value of automated functional imaging(AFI)in predicting coronary artery stenosis in patients without ventricular wall motion abnormalities.Methods A total of 40 patients without ventricular wall motion abnormalities under two-dimensional echocardiography and confirmed coronary artery heart diseases(CHD)(coronary stenosis≥70％)by coronary angiography(CAG)at the Xinxiang Central Hospital from July 2018 to September 2019 were selected as the research subjects.The detection rates of coronary artery stenosis ≥70％by AFI and CAG were compared.With reference to CAG as the gold standard,the predictive value of AFI for coronary artery stenosis ≥70％was evaluated.Results There was no significant difference in the detection rates of coronary artery stenosis ≥70％by AFI and CAG(x2=1.667,P＞0.05).The predictive efficacy of AFI for coronary artery stenosis ≥70％was as follows:a sensitivity of 100％,a specificity of 63.6％,the positive predictive value of 69.2％,the negative predictive value of 100％,and an accuracy of 80％for predicting stenosis ≥70％in the left anterior descending artery;a sensitivity of 56.2％,a specificity of 91.6％,the positive predictive value of 81.8％,the negative predictive value of 75.8％,and an accuracy of 77.5％for predicting stenosis ≥70％in the left circumflex artery;a sensitivity of 95.6％,a specificity of 47.0％,the positive predictive value of 70.9％,the negative predictive value of 88.0％,and an accuracy of 75.0％for predicting stenosis ≥70％in the right coronary artery;the overall sensitivity of 85.9％,the overall specificity of 69.8％,the overall positive predictive value of 72.0％,the overall negative predictive value of 84.6％,and the overall accuracy of 77.5％.Conclusion AFI can provide a sensitive,objective,non-invasive,and inexpensive examination method for the early clinical forecast of coronary artery stenosis.

Objective:To investigate the current status of health-promoting lifestyle in patients with chronic low back pain and explore its influencing factors.Methods:Convenience sampling method was adopted to select patients with chronic low back pain who visited a ClassⅢ Grade A hospital in Guangzhou from March to October 2019 as the research object ( n=189) . All patients with chronic low back pain were investigated with the General Information Questionnaire, Health-Promoting Lifestyle ProfileⅡ, Social Support Rate Scale, Low Back Pain Knowledge Questionnaire and the Chronic Disease Self-efficacy Scale. Single factor analysis, Pearson correlation analysis, multiple linear regression analysis were used to explore the influencing factors of health-promoting lifestyle. Results:Among 189 patients with chronic low back pain, the total score of health-promoting lifestyle was (118.68±18.61) , and scores from high to low were stress management (2.59±0.62) , interpersonal support (2.47±0.67) , nutrition (2.35±0.25) , self-actualization (2.33±0.35) , exercise (2.04±0.35) , health responsibility (1.93±0.19) . Single factor analysis showed that there were statistical differences in health-promoting lifestyle scores among chronic low back pain patients with different ages, marital status, co-resident, education level, occupation, body mass index (BMI) and with or without chronic diseases ( P<0.05) . Correlation analysis showed that the health-promoting lifestyle of patients with chronic low back pain was positively correlated with social support ( r=0.358, P<0.01) , self-efficacy ( r=0.418, P<0.01) and disease knowledge ( r=0.369, P<0.01) with statistical differences. Regression analysis indicated that social support, disease knowledge, self-efficacy, age and educational level were the main factors affecting whether patients with chronic low back pain adopted a health-promoting lifestyle ( P<0.05) . Conclusions:Patients with chronic low back pain have poor health-promoting lifestyles, especially in exercise and health responsibility, and health-promoting lifestyles are affected by social support, disease knowledge and self-efficacy. Scientific, professional and personalized health guidance should be strengthened to improve patients ' awareness of disease development, treatment, and control, strengthen patients ' health responsibilities and improve the accuracy of exercise therapy. At the same time, we should provide multi-channel information acquisition methods, encourage family participation, meet patients ' health promotion needs, and enhance their disease management self-efficacy.

Methods:Cultured human alveolar epithelial A549 cells were assigned into LPS group and blank control group. LPS group was stimulated with LPS and adenosine triphosphate to induce pyroptosis and inflammation. A549 cells were divided into 4 groups: miR-20a mimics group, mimics-negative control (NC) group, inhibitor group and inhibitor-NC group. MiRNA-20a mimics, mimics-NC, inhibitor, and inhibitor-NC were transfected respectively into A549 cells, and after 24 h, the cells were collected to verify transfection efficiency by qPCR. MiRNA-20a mimics and the constructed TLR4-3'UTR double luciferase reporter plasmid were co-transfected into A549 cells, and luciferase activity was analyzed. MiRNA-20a mimics/inhibitors were transfected into A549 cells, and then the cells were stimulated by LPS for 8 h followed by adenosine triphosphate for 30 min. QPCR, Western Blot and ELISA were used to detect the expression of GSDMD, inflammatory factors (ASC, NLRP3, Caspase-1, IL-1β) and Signaling molecules (TLR4、NF-κB) in A549 cells at mRNA level and protein level. Immunofluorescence was used to detect the expression of TLR4 in the A549 cells and NF-κB in the nucleus of A549 cells after transfecting with miRNA-20a mimics/inhibitor.Results:The mRNA and protein expression of pyroptosis marker molecule (GSDMD) and inflammatory factors (ASC, NLRP3, Caspase-1, IL-1β) in A549 cells stimulated with LPS were significantly higher than those in the blank control group, and the differences were statistically significant ( P<0.05). The expression of miRNA-20 in the mimics group was significantly higher than that in the mimic-NC group ( P<0.05), while the expression of miRNA-20a in the inhibitor group was lower than that in the inhibitor-NC group ( P<0.01). The double luciferase reporter gene experiment showed that the relative fluorescence value of the co-transfection group for TLR4-3'UTR-WT and miRNA-20a mimics was significantly lower than the co-transfection group for TLR4-3'UTR-WT and miRNA-20a mimics-NC ( P<0.05). The mRNA and protein levels of pyroptosis marker molecule (GSDMD) , inflammatory factors (ASC, NLRP3, Caspase-1, IL-1β) and signaling molecules (TLR4, NF-κB) were decreased in the mimics group compared to the mimics-NC group, and increased in inhibitor group compared to inhibitor-NC group. Conclusions:miRNA-20a may inhibit LPS-induced pyroptosis and inflammation of A549 cells via TLR4/NF-κB signal pathway.Objetive:To explore the potential role of miRNA-20a in lipopolysaccharide (LPS) induced pyroptosis and inflamation of human alveolar epithelial A549 cells and its regulation mechanisim.

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.