OBJECTIVE:To study the effects of particle size of ticagrelor crude drug on in vitro dissolution behavior of Ticagre-lor tablets. METHODS:Ticagrelor crude drug and different particle size of ticagrelor powder A,B,C,D,E after smashing for dif-ferent time(15,30,40,60 s)were used to prepare the tablet by wet granulation method. Accumulative in vitro dissolution rate of prepared tablets within 60 min were determined by UV spectrophotometry at 300 nm(using 0.2% tween as medium,paddle meth-od). Using original tablet as reference preparation,the similarity factor(f2)method was used to compare the similarity of dissolu-tion behavior between 5 prepared tablets and original tablet. RESULTS:d(0.9)of powder A,B,C,D,E were 69.181,40.778, 24.805,12.611,3.083 μm,respectively. The corresponding f2 were 27.77,36.79,50.06,67.68,79.99. CONCLUSIONS:The par-ticle size of ticagrelor crude drug is much smaller,and the dissolution behavior of prepared tablet is closer to that of original tablet. The in vitro dissolution rate of Ticagrelor tablets is improved remarkably by micronization technology. In order to produce Ticagre-lor tablets with the same bioavailability as original tablet,particle size of ticagrelor crude drug powder should be controlled with d(0.9)≤20μm.

Objective To analyze the epidemiological characteristics of measles in the floating population in Daxing District from 2002 to 2015 and to provide a specific guidance for the control and preven-tion of measles. Methods The epidemiological characteristics of measles in the floating population in Dax-ing District were analyzed based on the data collected from Diseases Reporting Information System and Ques-tionnaires for measles cases. Results A total of 1 263 measles cases were reported in the floating population in Daxing District from 2002 to 2015, accounting for 73. 09% of all reported cases in that area. Among the 1 263 measles cases, 1 027 cases (81. 31%) were reported from March to June. The top 5 towns with high incidence of measles were Huangcun, Jiugong, Xihongmen, Yizhuang and Yinghai, from which 80. 29% of measles cases were reported. Age distribution of the measles cases showed that 145 cases were children younger than 8 months, 412 cases were children aged 8 months to 14 years old and the rest 706 cases were a-bove 14 years old. And of all cases, only 224 cases had measles vaccine immunization history. Conclusion It is necessary to maintain the high vaccination rate of 3 doses of measles vaccine by multi-approaches and increase the immunization rate in migrant workers. Moreover, strengthen the surveillance for measles is also an effective way for measles control and elimination.

OBJECTIVETo explore the genetic etiology of a patient with classic maple syrup urine disease (MSUD).

METHODSNext-generation sequencing (NGS) was used to screen the exons of BCKDHA, BCKDHB, DBT and DLD genes. Suspected mutations were verified by Sanger sequencing. Bioinformatic analysis was carried out to predict the influence of mutations on the protein structure and function.

RESULTSNGS and Sanger sequencing have detected a c.550delT mutation in exon 5 of the BCKDHB gene in the mother and a c.1046G>A mutation in exon 10 of the BCKDHB gene in the father, while no mutation was found with BCKDHA, DBT and DLD genes. Among these, the c.550delT is a novel mutation. Bioinformatic analysis suggested that the two mutations both located in a highly conserved region and may decrease the activity of branched-chain α-ketoacid dehydrogenase complex through alternation of its structure.

CONCLUSIONThe compound heterozygous mutations c.550delT and c.1046G>A of the BCKDHB gene probably underlie the clinical manifestations of the patient with classic MSUD.

Liver transplantation has become the most effective treatment of end-stage liver disease. Nursing care for enhanced recovery is safe and effective in the management after liver transplantation, which is conducive to the early recovery of body function of the recipients. In this article, relevant literature review was conducted to summarize the standard operation procedure (SOP) of nursing care for enhanced recovery after liver transplantation from the postoperative vital signs and fluid temperature management, gastrointestinal function and nutrition management, early grading activities, sedation, analgesia and sleep management, infection prevention and control, etc.

Objective:To investigate the diagnostic value of cerebrospinal fluid interleukin-6 (IL-6), neuron-specific enolase (NSE) and S100B protein in patients with central nervous system infection.Methods:The clinical data of 78 patients with central nervous system infection (infected group) from October 2015 to February 2019 in the Department of Neurology, Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among the patients, viral meningitis was in 41 cases, tuberculous meningitis was in 23 cases, and purulent meningitis was in 14 cases. Another 100 patients who were admitted to the hospital during the same period for cerebrospinal fluid and other related examinations and excluded central nervous system infection (control group) were selected. Enzyme-linked immunosorbent assay was used to detect the levels of IL-6, NSE and S100B protein.Results:The cerebrospinal fluid levels of IL-6, NSE and S100B protein in infected group were significantly higher than those in control group: 16.70 (8.54, 228.18) ng/L vs. 6.64 (4.96, 8.21) ng/L, 13.62 (11.50, 19.01) μg/L vs. 9.95 (7.54, 12.39) μg/L and 3.07 (0.24, 11.57) μg/L vs. 0.16 (0.12, 0.21) μg/L, and there were statistical differences ( P<0.05). The cerebrospinal fluid levels of IL-6, NSE and S100B protein in patients with tuberculous meningitis were significantly higher than those in patients with viral meningitis and patients with purulent meningitis: 173.30 (13.74, 503.80) ng/L vs. 9.37 (4.80, 113.55) and 89.96 (14.02, 239.60) ng/L, (30.82 ± 14.09) μg/L vs. (12.00 ± 2.33) and (17.62 ± 5.63) μg/L, (18.29 ± 16.05) μg/L vs. (2.12 ± 1.24) and (5.79 ± 4.82) μg/L; the indexes in patients with purulent meningitis were significantly higher than those in patients with viral meningitis, and there were statistical differences ( P<0.05). Conclusions:Cerebrospinal fluid IL-6, NSE and S100B proteins have different expressions in patients with different types of central nervous system infection, and have certain clinical application value for the diagnosis of central nervous system infection.

Objective:To explore the effect of cold-strap endoscopic mucosal resection (CS-EMR) in patients with colorectal polyps.Methods:A prospective randomized clinical trial was conducted to 320 selected patients with colorectal polyps diagnosed by Shenzhen Luohu District People′s Hospital from May 2019 to June 2021. The patients were randomly divided into CS-EMR group and HS-EMR group with 160 cases each, using a random number table generated by Excel 2007. The main parameters for statistical analysis contain the process indicators of the two groups of surgical methods, the complete polypectomy rate of patients after surgery, the degree of postoperative pain and the recovery of gastrointestinal function, and the differences in surgical complications.Results:The polypectomy time of CS-EMR group was shorter than that of HS-EMR group: (4.11 ± 1.20) min vs. (4.42 ± 0.98) min, with a statistically significant difference ( P<0.05). The score of visual analogue pain scale (VAS) in CS-EMR group was lower than that in HS-EMR group at 4 and 12 hours after operation: (3.11 ± 0.78) scores vs. (3.48 ± 0.80) scores, (3.38 ± 0.80) scores vs. (3.61 ± 0.92) scores, with a statistically significant difference ( P<0.05). The first anal exhaust time and first defecation time in CS-EMR group were lower than those in HS-EMR group: (27.83 ± 5.01) h vs. (29.66 ± 4.84) h, (43.73 ± 7.80) h vs. (47.28 ± 8.14) h, with a statistically significant difference ( P<0.05). The complications in CS-EMR group were significantly lower than those in HS-EMR group: 5.63% (9/160) vs. 12.50% (20/160), with a statistically significant difference ( P<0.05). Conclusions:The effect of CS-EMR in the treatment of colorectal polyps is not different from that of HS-EMR, but the former has the advantages of short resection time, rapid recovery of gastrointestinal function after operation, light pain and less complications.

BACKGROUND:Ligaments are important structures in maintaining the stability of the lumbar spine,and these structures are prone to degradation due to the generated mechanical stress.However,there are few studies on ligament injuries. OBJECTIVE:To determine the range of motion and stress of each ligament in the state of motion based on a three-dimensional finite element model,and to systematically explore the influence of ligament injury on the stability of the lumbar spine and its biomechanical significance. METHODS:The L4-L5 lumbar finite element model was established.All free forces on the lower surface of L5 were constrained,and a torque of 5 N·m was applied to simulate the motion states of the lumbar spine.Progressive ligament damage was simulated by changing Young's modulus of the ligament. RESULTS AND CONCLUSION:(1)The extension range of motion of most ligament injuries increased significantly.In contrast,there was no significant change in the lateral bending range of motion.(2)The range of motion of capsular ligament injury increased significantly in flexion,extension and lateral bending.The extension range of motion increased significantly after the anterior longitudinal ligament injury.Intertransverse ligament injury resulted in a significant increase in the lateral bending range of motion.(3)After a single ligament injury,the most significant change in range of motion was observed during extension.After a single ligament injury,the stress of the remaining ligaments increased,especially the capsular ligament.The stress changes of the interspinous ligament and ligamentum flavum were the least obvious.Ligament stress changes least in lateral bending and most in torsion.(4)Ligament damage did not result in major changes in disc pressure,indicating that ligament injury leads to an increased range of motion of the lumbar spine and affects the stability of the lumbar spine.(5)Capsular ligament was stable in flexion,extension and lateral bending.The anterior longitudinal ligament showed a stable extension;the intertransverse ligament stabilizes the lateral curve.(6)Extension exercise is sensitive to a ligament injury,and the pathological changes of the ligament can be examined by extension exercise.(7)Stress compensation was given to the remaining ligaments to maintain the stability of the lumbar spine after a single ligament injury.(8)Interspinous ligament and ligamentum flavum injuries have the least impact on the peripheral ligaments,while capsular ligament injuries have the greatest impact on the peripheral ligaments.(9)The ligament injury has the least effect on the residual ligament stress during lateral bending exercise,while it has the greatest effect on the ligament stress during the twisting exercise.Patients with ligament injury should avoid twisting exercises.Ligament injuries do not affect disc pressure.

BACKGROUND:Ligaments are an important structure for stabilizing the lumbar spine,and they are prone to degenerative changes with age.Currently,there is limited research on lumbar ligaments. OBJECTIVE:To investigate the effect of different combinations of ligament injuries on biomechanical characteristics of lumbar spine under four motion states of forward bending,backward extension,lateral bending,and torsion under a certain sequence of ligament injuries. METHODS:A finite element model of the L4-L5 segment of the lumbar spine was established,and corresponding moments were applied to simulate four motion states of forward bending,backward extension,lateral bending,and torsion.The combined injuries of the ligaments were performed in order to obtain the motion range of each vertebra and the stress of each ligament. RESULTS AND CONCLUSION:(1)Every time a ligament was removed,the remaining ligament stress would increase.Under all four working conditions,capsular ligament would experience the highest stress,especially during forward bending.With the removal of ligaments,the range of motion of the vertebrae was also continuously increasing.(2)When flexing forward,after removing the first ligament capsular ligament,the average stress change in the remaining ligament was the highest,followed by the removal of supraspinous ligament.After removing capsular ligament,the change rate of range of motion was the highest,while after removing posterior longitudinal ligament,the change rate of range of motion was the lowest.(3)When extending backward,all ligaments had the highest rate of stress change after removing capsular ligament,the highest rate of range of motion change after removing capsular ligament,and the lowest rate of range of motion change after removing posterior longitudinal ligament.(4)When bending,the stress change rate of interspinous ligament decreased after removing intertransverse ligament,while supraspinous ligament increased more.After removing capsular ligament and interspinous ligament,the range of motion change rate increased significantly.(5)During lateral bending,after removing capsular ligament,the stress change rate of the remaining ligament was much higher than that of other ligament damage combinations,and the range of motion change rate was the highest after removing capsular ligament.In other cases,the range of motion change rate did not exceed 8%.(6)If the root ligament is damaged,the remaining ligaments will undergo stress compensation.Ligament damage will affect the stability of the lumbar spine,with minimal impact in cases of lateral curvature.Patients with lumbar instability should avoid forward flexion and backward extension movements,which can make it easier to detect the pathological condition of the ligaments.(7)Capsular ligament is an important structure for maintaining lumbar stability,and supraspinous ligament plays a significant role in anterior flexion,maintaining the integrity of the entire lumbar ligament.

Objective To investigate the value of dual-exponential model intravoxel incoherent motion (IVIM) DWI and conventional single-exponential DWI model based on readout segmentation echo-planar (RS-EP) sequence in differential diagnosis of simple rhinitis and chronic hypertrophic rhinitis.Methods Totally,20 patients confirmed by pathology were enrolled in this study and all of them underwent IVIM DWI and conventional DWI.The pure diffusion (D),pseudo-diffusion (D*),perfusion fraction (f) and conventional ADC maps were obtained respectively.The quantitative parameters of anterior,middle,posterior regions of inferior nasal concha mucosa were measured.Comparative statistical analysis was performed for comparing two groups and three regions.ROC analysis was conducted to assess the diagnostic performance.Results The ADC and D values in the simple rhinitis group were (1 938.84 ± 170.46) × 10-6 mm2/s,and (1 698.91 ±145.17) × 10-6 mm2/s.In chronic hypertrophic rhinitis group,the ADC value was (1 681.76± 132.21) × 10-6 mm2/s,and the D value was (1 439.39 ± 101.26)× 10-6 mm2/s.There were significant differences between the two groups (both P＜0.05).No significant differences were found for D* and f values between two groups (both P＞0.05).ADC values increased significantly from anterior region,middle region to posterior region (all P＜0.05).No significant difference was found for D* value among three regions (P＞0.05).ROC analysis demonstrated a higher area under the curve (AUC) for D value than ADC value (0.932±0.044 vs 0.896±0.058) with sensitivity,specificity,accuracy,positive and negative predictive values of 92.31％,93.75％,90.00％,93.75％,85.71％.Conclusion Based on RS-EP sequence,both IVIM DWI model and conventional single-exponential DWI model demonstrated great value in differential diagnosis of simple rhinitis and chronic hypertrophic rhinitis,and the IVIM-derived D value exhibited a higher diagnostic performance than the conventional ADC value.

Objective:To explore the effects of knocking down glycine cleavage system H protein (GCSH) on proliferation, apoptosis, oxidative stress and migration of gastric cancer SNU-1 cells in vitro. Methods:SNU-1 cells were cultured in vitro and divided into control group (no transfection) , negative control group (transfection of negative control siRNA) and GCSH knockdown group (transfection of GCSH siRNA) . Quantitative PCR was used to detect the knockdown effect. Immunofluorescence was used to observe the morphology of cells in each group. CCK-8 was used to test the proliferation of SNU-1 cells. Flow cytometry was used to detect the apoptosis and oxidative stress level, and scratch test was used to detect the cell migration. Results:Quantitative PCR experiment showed that the relative expression levels of GCSH in the control group, negative control group and GCSH knockdown group were 1.29±0.16, 1.36±0.17 and 0.32±0.04, respectively ( F=90.32, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.497) . Compared to the negative control group, the GCSH knockdown group was significantly decreased ( P<0.001) . Immunofluorescence experiment showed no significant difference in the morphology of cells among the groups. The CCK-8 experiment results showed that the cell proliferation activities of the control group, negative control group and GCSH knockdown group were 2.63±0.12, 2.61±0.14, 2.45±0.14, respectively ( F=6.35, P=0.005) . There was no significant difference between the control group and negative control group ( P=0.751) , and the GCSH knockdown group significantly decreased compared to the negative control group ( P=0.011) . The results of flow cytometry showed that the early stage apoptosis rates of SNU-1 cells in the control group, negative control group and GCSH knockdown group were (13.38±0.45) %, (12.86±0.65) %, (20.04±3.61) %, respectively ( F=15.37, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.559) . Compared to the negative control group, the GCSH knockdown group significantly increased ( P=0.002) . The late stage apoptosis rates of the three groups were (2.21±0.25) %, (2.68±0.45) %, (5.67±1.67) %, respectively ( F=18.24, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.356) . Compared to the negative control group, the GCSH knockdown group showed a significant increase ( P=0.024) . The reactive oxygen species positive rates in the control group, negative control group and GCSH knockdown group were (26.98±8.79) %, (28.27±5.63) %, (48.41±0.94) %, respectively ( F=22.56, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.950) . Compared to the negative control group, the GCSH knockdown group significantly increased ( P<0.001) . The cell migration rates of the control group, negative control group and GCSH knockdown group were (48.29±5.79) %, (51.66±2.29) %, (14.01±1.56) %, respectively ( F=148.80, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.328) . Compared with the negative control group, the GCSH knockdown group significantly decreased ( P<0.001) . Conclusion:Knock down of GCSH gene can inhibit the proliferation and migration, increase cell apoptosis rate and oxidative stress of SNU-1 cells in vitro. GCSH gene may be a potential target for the treatment of gastric cancer.