Objective To discuss the influence of μ-opioid receptor ( OPRM1) and CYP3A gene polymor-phism on analgesic effect of fentanyl for abdominal hysterectomy patients .Methods 198 cases of gynecologic anes-thesia patients who were treated by elective abdominal hysterectomy surgery ,were selected in the hospital .The rela-tionship between the fentanyl consumption of intravenous analgesia and OPRMI and CYP 3A gene polymorphisms was detected by using polymerase chain reaction-restriction fragment length polymorphism detection .Results In 198 pa-tients,OPRM1 genotyping was 186 cases,the other 10 patients failed to typing were excluded ,including 89 cases of type A/A,type A/G 76 cases,type G/G 21 cases,OPRM1 the frequency of A118G allele was 31.7%.No statistically significant differences were found in mean VAS score of CYP 3A4*1/*1,CYP3A4*1/*1G,CYP3A4*1G/*1G instantly after operation in the three groups and 24h postoperation.By using analysis of variance with body mass ,age and intraoperative volume as a covariate factors after first 24h fentanyl consumption ,the difference was statistically sig-nificant among the three groups (P<0.05),CYP3A4*1G/*1G group was significantly lower than that in CYP3A4*1/*1G group and CYP3A4*1/*1 group,there was no significant difference between CYP 3A4*1/*1G group and CYP3A4*1/*1 group (P>0.05).In addition,because the OPRM1 A118G interacts with CYP3A4*1G, reducedthe quantity of expression of opioid receptor carrying CYP 3A4*1 and OPRM1 A118G/G,and thus more fent-anyl was needed postoperation to achieve the same effect .Conclusion It provided a theoretical basis and reference for clinical application of personalized medicine by analyzing the gynecological patients μopioid receptor gene A118G and CYP3A4*1G polymorphism.

With the change of medical model and the transfer of health to communities and rural towns,the expanding enrollment of colleges and universities makes collegiate internship progrms more and more difficult Clinical College of Guilin Medical University explores the new methodology of teaching practice,constructs and practises the new molde of internal madichine teaching,Combines the coummunity internship programs with hospital internship programs.and was improved the quality of practice teaching

Objective To investigate the application of OSCE evaluation system on the medical skills examination of clinical medical students and the significance of this system on the training of their medical skills.Methods 20 teachers examed 150 students by the OSCE evaluation system with 4 test stations,by comparing the score of the students of different test stations by one-way ANOVA and evaluating the system by questionnaire survey with Likert 5 on the degree of satisfaction and Likert 3 on effects and intrinsic influencing factors of the system.Results The score of the first and forth test stations was lower than that in the other stations(P＜0.05).8/5.48％ students and 1/5％ teachers were not satisfied with the system.The OSCE evaluation system could exam the psychological diathesis,ability of communication,cooperation,and clinical thinking,practical skill of the students and its effects are moderate (the score was more than 2.0).Evaluation on the intrinsic influencing factors:Students considered the questions were more difficulty in the 2nd,3rd,1st,4th test stations order.4/20％ teachers considered the questions of the second test station was easy.8/40％ teachers considered the duration of the second test station was too long.More than 70％ students and teachers considered the other indexes were rational.Conclusion The OSCE evaluation system can play an effective role in directing the teaching and learning.It can also help to culture the comprehensive capacity of the students.We should gradually improve the design of the system by considering the intrinsic influencing factors.

Infection is a catastrophiccomplication in total knee arthroplasty.Reported a case of Nocardiafarcinica infection which appeared after application of cemented total knee replacement.A 64-year-old male patient was admitted to hospital 1 months after knee surgery,with a 2-week history of pain,swelling,and restricted mobility.As no improvement could be a-chieved after synovectomy and antibiotherapy,the prosthesis were removed from him.Although improvement could not be a-chieved in the knee of the patient at the end of 10-month therapy,the case has still being followed-up.

Objective To investigate whether methamphetamine (METH) can enhance human immunodeficiency virus 1 (HIV-1) infection in macrophages and the possible mechanism.Methods Peripheral blood samples were collected from eight healthy adult donors.Monocytes were isolated from blood samples and then cultured in vitro to induce differentiation to macrophages.These macrophages were treated with METH and/or dopamine receptor D1 (DRD1) antagonist,and then infected with HIV Bal strains.The levels of HIV RNA were measured in HIV Bal-infected macrophages by RT-PCR analysis.The real-time RTPCR was performed for the quantification of cellular DRD1.Results METH promoted HIV replication in macrophages in a dose and time dependent manner.This METH-mediated enhancement of HIV infection and replication in macrophages could be blocked by the DRD1 antagonist (SCH23390).Moreover,METH could induce the expression of DRD1.Conclusion METH might play a co-factor role in HIV infection in human macrophages by up-regulating the expression of DRD1.

For optimal adaptive cultivation region selection, we used ecology factors characterized Duolun region as model area to carry out the adaptive habitat division of Paeonia lactiflora. Similar priority comparison of ecology factors.in 91 cities were calculated by Fuzzy methods, then, distance of the ecology factors were transferred to spacial model by geography information system (,GIS) and modified by soil utilization map of China. The results showed that P. lactiflora were mainly distributed in the Daxing'an Mountain, Changbaishan and qinling range which were divided into six grades of suitable regions belonging to three geographical distributed units. The most similar areas to Duolun were Huade, Xilinhaote, Suolun and Zhangbei. P. lactiflora's distribution and quality are relevant with longitude and latitude, and temperature and rainfall.
China ; Environment ; Fuzzy Logic ; Paeonia ; classification ; growth & development ; Temperature

Objective To evaluate the effect of anti-microbia-l coated central venous catheter (CVC),compared with routine CVC,on catheter-associated deep venous thrombosis (CADVT). Methods A total of 1 359 patients,aged 26-82 years,ASA physical status Ⅰ-Ⅲ,undergoing internal jugular,axillary-subclavian,or femoral vein CVC catheterization during January to June of 2017,were retrospectively reviewed.The patients were divided into intoanti-microbial-coated CVC group (group A)and routine CVC group (group B).Gender,age,ASA class,pre-operative risk of thrombus (Caprini score),CVC site,surgical site,ultrasound-guided catheterization,and anticoagu-lation therapy,CADVT and the degree,as well as the other adverse events were recorded.Results A total of 938 patients were successfully matched.There were 323 (34.4%)articipants diagnosed with CADVT with bedside point-of-care ultrasound,in which 172 cases (36.7%)in group A and 151 (32.2%)in group B.There was no statistical significance of CADVT and the degree between the two groups.The subgroup analysis results indicated that the patients using anti-microbial-coated CVC with high risk of thrombus (Caprini score ≥ 5 points)(OR 1.34,95% C I 1.01-1.78),undergoing catheterization according to anatomical landmark (OR 1.69,95% C I 1.04-2.74),and not-receiving anticoagulation therapy (OR 1.39,95% C I 1.01-1.92)had an increased risk of CADVT compared with those using routine CVC.A significantly decreased incidence of catheter-associated infection in group A was observed compared with group B (0.9% vs 4.1%,P<0.05).Conclusion Anti-micro-bial-coated CVC does not increase the incidence of CADVT.

Objective: To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones. Methods: Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE), and B group(49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). The curative effect of the two groups was observed.The operation time, the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery, and the complications of the two groups were recorded. Results: In A group, the average diameter of common bile duct stones was (1.02±0.25)cm, the average diameter of common bile duct diameter was (1.15±0.25)cm.In B group, the mean diameter of common bile duct stones was (0.99±0.26)cm, and the average diameter of common bile duct was (1.13±0.26) cm.The differences between the two groups were not statistically significant (t=0.513, 0.437, 0.367, P=2.083, 1.533, 1.095). The successful operation rate of A group was 92.11%(35/38), which in B group was 91.84%(45/49), the difference was not statistically significant between the two groups(χ²=0.006, P=0.974). The incidence rate of complications in B group was 20.41%, which was significantly higher than that in A group, the difference was statistically significant(χ²=3.654, P=0.019). The hospitalization time, hospitalization expenses in A group were (10.6±2.6)d, (26 649.8±3 478.6)CNY, respectively, which were significantly better than those in B group (t=21.971, 17.168, all P<0.05). Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery, and the safety of the former is higher than the latter.

Objective To investigate the effect of preoperative preplacement of nasobiliary drainage in radiofrequency ablation of small hepatocellular carcinoma at hepatic portal. Methods 7 patients with small hepatocellular carcinoma who were admitted to our hospital from June 2014 to June 2017 were selected. All patients were the cases who were prone to injure the bile duct at hepatic portal upon the radiofrequency electrode needle entering liver cancer in the small hepatocellular carcinoma at hepatic portal. The nasal bile duct was pre-placed preoperatively, and infusion of water into nasobiliary bile duct was conducted to expand the bile duct for intraoperative identification and avoiding false puncture. In some cases, after intraoperative bile duct injury, postoperative nasobiliary drainage was given to avoid obstructive jaundice or the occurrence of bile tumor at hepatic portal. Results The treatment effective rate in the patients was 100％ (7/7). Blood biochemistry, routine blood test, liver function were re-examined after surgery. Liver CT or MRI was reexamined 30 to 60 d after surgery. After the preplacement of nasal biliary, there was one case of pancreatitis, with the incidence rate of complications of 14. 3％. The long-term treatment effect was favorable, without tumor recur-rence. Conclusion For small hepatocellular carcinoma at hepatic portal, preoperative preplacment of nasobiliary drainage is used, and the direction of the bile duct during radiofrequency ablation can be clearly observed, so as to effectively avoid the bile duct injury.

OBJECTIVETo screen out serum differential proteins between vinyl chloride monomer (VCM)-exposed workers and healthy controls by proteomics and analyze the functions of differential proteins, and to provide a basis for elucidating the pathogenesis of diseases caused by VCM exposure and searching for the protein biomarkers.

METHODSFasting venous blood was collected from 125 VCM-exposed workers and 40 healthy controls according to accumulated exposure doses. Proteins were precipitated by acetone precipitation. These proteins were identified by 2D-nano LC-ESI-TOF/MS and quantified by isobaric tags for relative and absolute quantitation. The functions of differential proteins were analyzed by gene ontology.

RESULTSA total of 596 proteins were identified, including 194 quantified proteins. There were 21 differential proteins according to the screening criteria (19 upregulated proteins and 2 downregulated proteins), including complement, apolipoprotein, and glycoprotein. The functions of these differential proteins were binding, enzyme regulator activity, catalytic activity, and transporter activity, and they were involved in the biological processes including immune system process and response to stimulus.

CONCLUSIONThe complement, apolipoprotein, and glycoprotein identified in the proteomics may be related to liver injury caused by VCM exposure, and they could be used as candidate protein biomarkers of diseases caused by VCM exposure.

Biomarkers ; blood ; Blood Proteins ; analysis ; Humans ; Liver ; injuries ; Occupational Exposure ; Proteins ; metabolism ; Proteomics ; Vinyl Chloride ; toxicity