This paper expatiates on the effective application of domestic and foreign daily living ability assessment scale in the elderly's daily living ability assessment, subsidy, care policy assessment and insurance compensation. It analyzes and discusses the problems in the application of the daily living activity ability scale, and provide suggestions for Chinese pension service institutions.

To explore the enzymatic route of cefatrizine synthesis, alpha-amino acid ester hydrolase (AEH) gene was cloned from the whole genome of Xanthomonas rubrillineans, and expressed heterologously in Escherichia coli BL21 (DE3). The effects of temperature, pH and substrates' molar ratio upon the transformation yield of cefatrizine by purified recombinant AEH were investigated. The monomer of AEH was determined as 70 kDa by SDS-PAGE. The optimal pH and temperature reaction were (6.0 +/- 0.1) and 36 degrees C for cefatrizine synthesis. The transformation yield was 64.3% under 36 degrees C, pH (6.0 +/- 0.1), when the concentrations of two substrates were about 30 mmol/L (7-ATTC) and 120 mmol/L (HPGM x HCl), respectively, and the enzyme consumption was 22 U/mL. The results pave the way for optimization of the industrial enzymatic synthesis of cefatrizine.
Carboxylic Ester Hydrolases ; biosynthesis ; genetics ; Catalysis ; Cefatrizine ; metabolism ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Kinetics ; Recombinant Proteins ; biosynthesis ; genetics ; Xanthomonas ; enzymology

Objective To investigate the relationship between peripheral inflammatory cytokines and anxiety symptoms in patients with the first?episode generalized anxiety disorder. Methods 48 patients diagnosed with the first?episode generalized anxiety disorder according to ICD?10 criteria and 48 healthy sub?jects were recruited. Peripheral levels of IL?1, IL?2, IL?4, IL?5, IL?6, IL?8, IL?10, IL?12p70, GM?CSF and IFN?γ of both groups were evaluated by enzyme?linked immunosorbent assay ( ELISA) ,and CRP was evalua?ted by immunoturbidimetric method. Generalized Anxiety Disorder Scale( GAD?7) and State?Trait Anxiety Inventory ( STAI ) were used to assess the levels of overall anxiety, state anxiety and trait anxiety. Results The levels of CRP ( ( 1. 19 ± 0. 80 ) mg/L vs ( 0. 68 ± 0. 70 ) mg/L, t=3. 31 ) , IL?1α( ( 70. 34 ± 3.60)pg/ml vs (16.94±3.42)pg/ml, t=74.50),IL?2((7.25±3.42)pg/ml vs (4.95±2.31)pg/ml, t=3.85), IL?4((102.02±73.14)pg/ml vs (75.55±32.78)pg/ml, t=2.29),IL?6((12.55±2.37)pg/ml vs (2.71±1.35) pg/ml, t=14.79),IL?8((44.64±16.21)pg/ml vs (35.69±11.70)pg/ml, t=3.10),IL?12((18.16±24.17) pg/ml vs (10.82±4.72)pg/ml, t=2.06),IFN?γ((23.32±15.52)pg/ml vs (16.48±6.80)pg/ml, t=2.79), GM?CSF((19.07±11.12)pg/ml vs (13.40±8.54)pg/ml, t=2.80) in patients with the first?episode general?ized anxiety disorder were significantly higher than normal controls(P<0.05) . Both SAI and TAI had signifi? cantly positive correlation with the levels of IL?1α, IL?2, IL?6, IL?8, IL?12, IFN?γ and GM?CSF ( r=0.24?0.76, P<0.05) . Conclusion The levels of some peripheral inflammatory cytokines in patients with the first?episode generalized anxiety disorder are significantly increased,and they have positive correlation with gener?al anxiety,state anxiety and trait anxiety,which may suggest some immune system defects in the patients.

Objective:To discuss the problems that exist in the operation mechanism of the third -party media-tion mode of medical disputes in China and put forward suggestions for improvement , through comparative study of the third-party mediation mode of domestic and foreign medical disputes .Results:People's mediation mechanism of medical disputes in our country still hadsome problems .For example , mediation talents were insufficient;propa-ganda was inadequate;mediation results were difficult to implement;mediation support funds couldn ' t be guaran-teed, and so on.Conclusion:It is recommended to improve the remuneration of employees and standardize the staff selection system;increase propaganda and raise public awareness;improve the judicial confirmation system and en-hance the guarantee of agreement;save regulation cost and increase multi -financing channels .

Objective: To investigate the impact of bladder filling status on the movement of uterine and on the volume of organs at risk(OAR), so as to provide theoretical basis for individualized internal target volume (ITV) and planning target volume (PTV). Methods: Simulation CT images for a total of 27 patients with locally advanced cervical cancer were acquired with empty bladder, 1.0 h after bladder filling, 1.5 h after bladder filling, respectively. The volumes of uterine corpus, cervix, OARs, CTV and PTV 1.0 h after bladder filling were delineated. The impact of bladder filling status on the displacements of cervix and corpus, volumetric changes of rectum, small intestine, and the volumes of small intestine, bladder and rectum within PTV were analyzed. The correlation between bladder filling status and uterine displacement and volume of OAR was also investigated, as well as the volume of cervix and corpus in the PTV with empty bladder and 1.5 h after bladder filling. Results: Bladder filling status is different for individual cases. The maximum movement range of cervix and uterine body with bladder filling state was 0-3.04 cm and 0-4.31 cm respectively. The anterior displacements of corpus (F=7.818, P<0.05), the volumetric changes of blander, as well the volume of bladder and small intestine in the PTV (F=46.197, 44.609, 29.546, P<0.05) were significantly different between different bladder filling status. The bladder filling status was correlated with the displacements of the anterior of corpus, volumetric changes of small intestine, and the volumes of bladder and small intestine within the PTV (r=-0.232, -0.298, 0.915, -0.336, P<0.05). The volumes of cervix and corpus out of the PTV were significantly different between the empty bladder and 1.5 h after bladder filling (t=-1.326, -1.559, P<0.05). Conclusions Bladder filling status was different for individual patients. The displacements of the anterior of the corpus were significantly affected by the bladder filling status. Increasing the anterior margin of PTV was recommended. The consistency of bladder filling status was critical for the precise cervical cancer IMRT.

Objective To explore the feasibility of quantitative evaluation in fibrosis by geometrical characteristics of hepatic capsule based on computer technology . Methods Fifty-nine rabbits models of fibrosis were established and then were divided into four groups according to the results of pathologic examination:S0-S1 ,S2 ,S3 and S4 groups . Two-dimensional high-frequency ultrasound images of hepatic capsule of the rabbits were collected at 6th week ,12th week and 18th week . All the images were collected to obtain the contour line of the capsule and its shape control points by combining manual monitoring and gradient optimization methods . Subsequently ,the mean value and variance of angles between adjacent seed points and the number of continuous segments of the contour line ,were extracted to evaluate the smoothness and continuity of the contour line of the hepatic capsule . Results With aggravating fibrosis ,the mean value and variance of the angles were gradually increased ,and the differences between S0-S1 and other 3 groups were all statistically significant( P <0 .05) . Similarly ,the number of segments required to make the sum of lengths of continuous segments reach up to 80％ of the total width of the imaging section was gradually increased . The differences between S0-S1 and S4 group( P =0 .025) ,S2 and S4 group( P =0 .004) were also statistically significant . Conclusions Analysis of geometrical characteristics of the hepatic capsule partially indicates the presence of early-stage fibrosis ,and is expected to provide a quantitative method for non-invasive assessment of fibrosis .

Objective To investigate the influencing factors and their weights of professional choice among medical school graduates in Shanghai.Methods Base on literature review and interviews with medicine students in a university of Shanghai,a questionnaire of"employment intention for general practice in medical graduates"was developed.A questionnaire survey on influencing factors of general practice among five year medical students was conducted in the medical college of a university in Shanghai during May to June 2016.The weights of each factor were calculated with analytic hierarchy process(AHP). Results The valid questionnaires were retrieved from 14 male and 26 female students.The results showed that 53.8%(21/40)preferred Beijing, Shanghai, Guangzhou and other economically developed cities as future working place,and 38.5%(15/40)chose to go home town; for general practice 22.5%(9/40) chose"very like",70%(28/40)chose"like"and 7.5%(3/40)chose"not like"; only 10%(4/40) were willing to be a general practitioner, 55.0%(22/40)were depended on the working conditions of community health center,and 35%(14/40)were not ready to be a GP.AHP analysis showed that the weights of influencing factors were: the salary(0.380 2), the doctor-patient relationship(0.262 3),professional interest and occupation development prospects(0.220 4),social status and family contribution (0.137 1).Weight analysis for the affecting factors on professional interest and occupation development showed that the guidance of mentors in theoretical study and clinical practice were the major factors (comprehensive weight was 0.067 3 and 0.062 1,respectively),and the attitude GPs to general practice in community learning was more important(comprehensive weight was 0.042 5 and 0.019 6).Conclusion The willingness to be a general practitioner is not strong in the medical school graduates in Shanghai.It is important to improve the status and working conditions of general practitioners, and to strengthen education and guidance of the general practice in theoretical study and clinical practice for medical students.

Objective Compared with chest CT,endoscopic ultrasonography (EUS) can more accurately determine the upper and lower margins of esophageal cancer,and marking the upper and lower margins of the esophageal cancer with titanium clip contributes to the delineation of target area of esophageal cancer during radiotherapy.To compare the effects of esophageal X-ray,chest computed tomography (CT)scan and EUS-assisted placement of marker clip in the determination of the length of gross target volume (GTV),aiming to provide reference for the determination of GTV during esophageal cancer radiotherapy.Methods Thirty patients who were initially diagnosed with thoracic esophageal cancer by histological and cytological examinations and scheduled to receive radiotherapy were recruited in this investigation.All patients received esophageal X-ray,CT scan,and EUS-assisted placement of marker clip.The length of GTV was quantitatively measured and statistically compared among three different methods.Results The length of GTV was (6.1 ± 1.4) cm,(6.8± 1.9) cm and (6.3± 1.9) cm determined by esophageal X-ray,CT scan and EUS-assisted placement of marker clip,respectively.Compared with CT scan,the length of GTV determined by EUS-assisted placement of marker clip did not significantly differ (P=0.11).The length of GTV determined by esophageal X-ray was significantly shorter than that by CT scan (P =0.03).Among all patients,the length of GTV determined by EUS-assisted placement of marker clip was longer compared with that by chest CT scan in 22.2％ of patients.The length of GTV determined by EUS-assisted placement of marker clip was the same as that by chest CT scan in 11.1％ of patients.The length of GTV determined by EUS-assisted placement of marker clip was shorter compared with that by chest CT scan in 66.7％ of patients.Conclusions EUS-assisted placement of marker clip differs from esophageal X-ray and CT scan in determining the length of GTV,which acts as one of the effective methods in the determination of the length of GTV during esophageal cancer radiotherapy.

Objective:To observe the effect of ubiquilin 2 gene (UBQLN2) on the radiosensitivity of human esophageal squamous cell carcinoma cells (ESCC) of EC109 and KYSE30, and explore underlying molecular mechanism.Methods:siRNA and lentivirus transfection techniques were used to establish UBQLN2-knockdown and UBQLN2-overexpression cell lines. The cells were irradiated with a dose of 4 Gy X-rays. UPLC-Q-TOF-MS technique was used for metabolite difference analysis and KEGG pathway analysis. The results of metabonomics analyses were verified by qRT-PCR assay. The influence of UBQLN2 level on the radiosensitivity of ESCC was confirmed by CCK-8 cell proliferation assay and clone formation assay and further verified by treating the cells with metabolic enzyme inhibitors and exogenous metabolites.Results:Compared with irradiation alone, down-regulating UBQLN2 in EC109 and KYSE30 cell lines reduced the cell survival by 32.29% and 16.42% ( t=5.35, 4.88, P<0.05), and reduced the clone formation rate by 11.07% and 7.47% after 4 Gy irradiation, respectively ( t=4.18, 5.09, P<0.05). On the contrary, up-regulating UBQLN2 in EC109 and KYSE30 cell lines increased the survival rate by 14.07% and 10.64% ( t=5.88, 4.21, P<0.05), and increased the clone formation rate by 6.53% and 7.87% after 4 Gy irradiation, respectively ( t=8.60, 8.26, P<0.05). Metabonomics study showed that the purine metabolic pathway was significantly enriched after down-regulating UBQLN2 in EC109 cell. The qRT-PCR experiment showed a positive correlation between the expression level of UBQLN2 and the mRNA level of five purine metabolism enzymes. The viability of irradiated UBQLN2-overexpression cells decreased by 18.28% and 25.58%, respectively ( t=7.76, 10.95, P<0.05), and the clone formation rate decreased by 9.33% and 9.93%, respectively ( t=5.97, 8.02, P<0.05) after adding mycophenolic acid(MPA). However, the survival rate of cells increased by by 8.28% and 10.74% ( t=2.83, 6.20, P<0.05), and the clone formation rate increased by 7.33% and 5.80%, respectively ( t=7.16, 5.49, P<0.05), when exogenous supplementation of nucleotides (ATP + GTP) were added. Conclusion:The expression level of UBQLN2 was negatively related to the radiosensitivity of ESCC by up-regulating purine metabolism.

Objective To evaluate an effective and feasible quantitative evaluation table of traditional Chinese medicine (TCM) syndrome differentiation, and to observe the effect of combination of TCM syndrome differentiation and standard bundle therapy in patients with septic shock. Methods A prospective randomized controlled trial was conducted. The septic shock patients with acute deficiency syndrome admitted to department of critical care medicine of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1st, 2016 to December 31st, 2017 were enrolled. The patients were randomly divided into control group and Shenfu group. The patients in both groups received early application of standardized bundle therapy; those in Shenfu group received 60 mL Shenfu injection infusion in addition for 7 days. The TCM syndrome score was evaluated by classification and scoring method of TCM symptoms. The circulation and tissue perfusion, severity of disease, organ function, inflammation response, adjuvant treatment and 28-day mortality were compared between the two groups. Results A total of 50 patients with septic shock were enrolled in the analysis, 25 in control group and 25 in Shenfu group. The markedly effective rate of TCM symptoms score in Shenfu group was significantly higher than that in control group [60.0% (15/25) vs. 16.0% (4/25), P < 0.01]. There was no significant difference in all parameters before treatment between the two groups. After treatment, the observation indexes of both groups were improved. Compared with control group, the mean arterial pressure (MAP) in Shenfu group increased more significantly [mmHg (1 mmHg = 0.133 kPa): 13.0 (2.5, 28.5) vs. 6.0 (0, 13.5)], the lactate (Lac) and procalcitonin (PCT) decreased more significantly [Lac (mmol/L): 0.8 (0.1, 3.7) vs. 0.5 (-0.6, 1.7), PCT (μg/L): 2.0 (0.7, 32.3) vs. 0 (-1.8, 3.8)], activated partial thromboplastin time (APTT) was shortened more significantly [s: 8.5 (0, 12.9) vs. 0 (-7.2, 10.0)], and interleukins (IL-2 receptor and IL-6) levels decreased more significantly [IL-2 receptor (ng/L):1 031.0 (533.0, 1 840.0) vs. 525.5 (186.0, 1 166.8), IL-6 (ng/L): 153.1 (21.4, 406.8) vs. 35.1 (16.3, 110.1)] with significant differences (all P < 0.05). There was no significant difference in the use time of vasoactive drugs, duration of mechanical ventilation, severity of the disease or 28-day mortality between the two groups. However, the use time of vasoactive drugs in Shenfu group was shorter than that in control group (days: 5.48±4.81 vs. 8.28±7.83), and the 28-day mortality was decreased [8.0% (2/25) vs. 20.0% (5/25)]. Conclusions TCM syndrome score is helpful to evaluate the effect of TCM syndrome differentiation and treatment, and it is effective and feasible in clinical application. Septic shock patients treated with TCM syndrome differentiation and treatment combined with standard bundle therapy were significantly improved in circulation, tissue perfusion, coagulation function and inflammation reaction.