Aim: The tandem Claisen rearrangement/Diels-Alder reaction in ionic liquid was carried out to find better changes for the conversion. Methods: The synthesis started with replaced benzoic acid via acylation, cycli-zation, demethylation, allylation and then tandem Claisen rearrangement/Diels-Alder reaction in trational solvent and ionic liquid separately. Results: BmimBF_4 raised the yield of the target compound and shortened the reaction time compared with the traditional solvent Conclusion: BmimBF_4 can promote the tandem Claisen rearrange-ment/Diels-Alder reaction.

The renin-angiotensin system exists locally in bone tissue.The RAS components and the active peptide angiotensinⅡ (Ang Ⅱ)within RAS are directly involved in the pathophysi-ological process of regulating bone metabolism.Ang Ⅱ exerts the effects via its receptors expressed in osteoblasts and osteoclasts. This paper reviewed the pathways of classical RAS,explained the tissue RAS-induced tissue injuries,and especially elaborated the regulation of RAS active peptide Ang Ⅱ on target genes and in-tracellular signaling pathways in osteoblasts,the action of Ang Ⅱon osteoclastic function via acting on osteoblasts,and the inter-action of Ang Ⅱ receptors involved in the modulation on bone metabolism.

BACKGROUND: Carboxymethyl chitosan is a water-soluble derivate modified from chitosan, with various biological activities. It is a good ligand of metal ion and can integrate Ca~(2+) to prepare a novel biological material. OBJECTIVE: To explore a method for preparing carboxymethyl chitosan calcium (CCC) and analyze its properties and structure. METHODS: CCC was produced by carboxymethyl ohitosan reacting with solution of calcium chloride. The solubility, carboxymethylation degree, rotational viscosity, and calcium content of CCC were determined, and infrared and ultraviolet spectral analyses were performed.RESULTS AND CONCLUSION: The calcium content of CCC was approximately 15%. Compared with carboxymethyl chitosan, infrared spectrum and ultraviolet spectrum of CCC were changed. The prepared CCC is a new calcium compound through property and structural analysis.

Objective To investigate the clinical parameters,risk factors,treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective a-nalysis was made for the clinical features,risk factors,treatment and prognoses of the non-HIV infected severe PCP pa-tients hospitalized at Pediatric Intensive Care Unit( PICU) of Children′s Hospital Affiliated to Capital Institute of Pedi-atrics. Results During April of 2010 to April of 2014,there were 10 cases of non-HIV infected severe PCP in PICU of Children′s Hospital Affiliated to Capital Institute of Pediatrics. All of the patients had predisposing diseases,in which 3 cases had connective tissue diseases,2 cases had acute leukemia,3 cases had severe pneumonia and 2 cases had con-genital immunodeficiency. The main clinical manifestations of those 10 patients were fever, cough, tachypnea and obvious dyspnea. All patients developed respiratory failure. The median value of Pediatric Critical Illness Score was 79. The median arterial oxygen pressure was 58 mmHg(1 mmHg=0. 133 kPa). The median oxygenation index was 103 mmHg. The median alveolo-arterial oxygen partial pressure difference was 43. 8 mmHg. The median CD4+T-lympho-cytes counts was 169 ×106/L. Eight patients on admission had mixed infection. Acute respiratory distress syndrome (ARDS) occurred in all of the patients,and 7 cases of them had multiple organ dysfunctions. All of the patients re-quired ventilation support. The median day for invasive mechanical ventilation days was 11 and the median day for non-invasive ventilation days was 6. The pneumothorax occurred in 5 patients. All patients received trimethoprim-Sulfame-thoxazole as initial therapy and Caspofungin treatment in combination in 7 cases of the patients. Six patients had nosoco-mial infection. The median time of PICU stay was 15. 5 days. Six patients survived and the mortality was 40%(4/10 cases) . Conclusions PCP is a kind of fatal diseases which occurred in patients with immunocompromised conditions and concurrent ARDS or multiple organ dysfunctions. Diagnostic suspicion and mechanical ventilation therapy with lung protective ventilation strategies may improve the clinical outcomes of non-HIV-infected PCP in children.

Objective To investigate the clinical effect of initiative content reduction surgery in the herniorraphy on the prevention and treatment of postoperative intra-abdominal hypertension of obese patients with giant ventral hernia.Methods The retrospective cross-sectional study was adopted.The clinical data of 62 obese patients with giant ventral hernias who were admitted to the Chao-Yang Hospital of Capital Medical University from January 2011 to December 2015 were collected.The initiative content reduction surgery was adopted during the herniorraphy of ventral hemia.Observation indices:(1) surgery situations:operation time,length of resected intestines,volume of intraoperative blood loss.(2) Postoperative recovery situations:change between preoperative and postoperative urethral bladder pressure,organ function of heart,lung,liver and kidney,time of gastrointestinal function recovery,time of drainage tube removal and duration of postoperative hospital stay.(3) Postoperative complications:incisional infection and intestinal fistula.(4) Follow-up situations.Follow-up using outpatient examination at 1 week,1 month,3 months and 6 months after surgery and using telephone interview at postoperative year 1 was conducted up to June 2016.The follow-up included hernia recurrence and chronic infection.Measurement data with normal distribution were represented as x ± s.Measurement data with skewed distribution were represented as M (range) and analyzed by rank-sum test.Results (1) Surgery situations:all the 62 patients received successful herniorraphy of giant ventral hemia combined with initiative content reduction surgery.Operation time,length of resected intestines and volume of intraoperative blood loss were (115 ±22)minutes,(207 ± 64)cm and (52 ± 35)mL.(2) Postoperative recovery situations:the preoperative urethral bladder pressure was 18 cmH2O (range,15-22 cmH2O,1 cmH2O =0.098 kPa) and postoperative urethral bladder pressure was 8 cmH2O (range,6-11 cmH2O),with a significantly statistical difference between before and after surgery (Z =-9.662,P ＜ 0.05).There was no abnormal function of heart,lung,liver and kidney after operation.The time of gastrointestinal function recovery,time of drainage tube removal and duration of postoperative hospital stay were 3.8 days (range,3.0-6.0) days,(3.8 ± 1.1) days and (14.5 ± 1.9) days.(3)Postoperative complications:of 62 patients,4 were complicated with incisional infection and improved after symptomatic treatment.There was no intestinal fistula.(4) Follow-up situations:all the 62 patients were followed up for (36 ± 19) months.During the follow-up,3 patients had incisional hernia recurrence and then were followed up without reoperation.No chronic infection occurred.Conclusion Initiative content reduction surgery is effective and feasible in the prevention and treatment of intraoperative intra-abdominal hypertension of obese patients with giant ventral hernia.

Objective:To analyze the consistency of HER-2 expression among endoscopic biopsy and radical operation specimens of gastric adenocarcinoma and to investigate the clinical application value of HER-2 detection in trastuzumab treated patients. Methods:From March 2013 to February 2014, 167 patients from Shanghai Changhai Hospital were diagnosed with gastric adenocarcinoma using endoscopic biopsy specimens. The corresponding surgical specimens were collected for pathological analysis. The relevant clinical and pathological data were collected. HER-2 protein expression of endoscopic biopsy specimens was detected by immunohistochemistry (IHC). HER-2 protein expression and gene amplification status of the corresponding tumor resection specimens were detected by IHC and fluorescence in situ hybridization (FISH). Results were analyzed for clinicopathological characteristics. Results:Among the 167 cas-es, 18 cases (10.8%) were HER-2 positive, including 10 cases showing IHC3+and 8 cases showing IHC2+with FISH positive. The consis-tency rate result among endoscopic biopsy and surgical operation specimens was 82%. Excluding the cases showing IHC2+, the true positive rate and the true negative rate were 73.3%and 97.0%, respectively. Conclusion:HER-2 detection of endoscopic biopsy speci-men by IHC shows great predictive value. The main reason for the difference of surgery and biopsy specimens is the heterogeneity of tumor expression. Increasing the number of specimens and combined testing with FISH are important methods to reduce misjudge-ment.

Objective To investigate the feature of Th1 cytokines induced by Mtb-specific antigen in patients with refractory pulmonary tuberculosis.Methods 28 patients with refractory pulmonary tuberculosis,67 patients with first-treated pulmonary tuberculosis,and 25 healthy controls with positive T.spot (LTBI group) were enrolled.IFN-γ,IL-2 and TNF-α in supernatants from PBMCs stimulated with ESAT-6 and CFP-10 were analyzed with Bender Flowcytomix on flow cytometry.Results The levels of the three cytokines were utmost high in patients with first-treated pulmonary tuberculosis.The lowest level of IFN-γ and IL-2 were induced in patients with refractory pulmonary tuberculosis,and were significantly lower than the LTBI group(Mann-Whitney U ＝ 105.5,162.5,P ＜ 0.01).Conclusions The immunotherapy with IFN-γ and IL-2 may play a role in treatment for refractory pulmonary tuberculosis but not for most of first-treated pulmonary tuberculosis.

Objective To translate the Work Limitations Questionnaire and examine its reliability and validity,and explore its applicability at home.Methods 300 nurses were surveyed with the Chinese version of the Work Limitations Questionnaire by convenience sampling; and internal consistency reliability,test-retest reliability,construct validity and criterion validity were applied to evaluate the questionnaire.Results The Cronbach α coefficients of the time managing scale,physical scale,mental-interpersonal scale,output scale and total questionnaire were 0.882,0.864,0.913,0.839 and 0.922 respectively;and their test-retest reliability coefficients were 0.857,0.837,0.871,0.803 and 0.893 respectively.Four common factors were abstracted by using factor analysis,with the cumulative variance contribution rate at 61.293％.Using SF-36 as an external criterion,the correlation coefficients of the WLQ scores with the physical function dimension and mental health dimension of the SF-36 were-0.24 and-0.33.Conclusions The reliability and validity of the questionnaire is reasonable.So this questionnaire can be used to measure employee's presenteeism.

Objective To observe the effect of carboxymethyl chitosan calcium(CCC) on the concentration of lead,calcium,and liver antioxidative capacity in lead poisoned mice.Methods mice were randomly divided into 6 groups.Three test groups were treated with CCC at three doses.The lead poisoned mice model was established by giving water containing lead acetate,and then CCC was administered to mice once a day.After 30 days,the mice were killed and the content of lead in blood,liver,brain and femur were determined by atomic absorption spectrophotometer,and antioxidative capacity in liver was measured using assay kit.Results CCC could reduce the contents of lead in blood,brain,liver and femur significantly,decrease the level of maleicdialdehyde(MDA),increase activities of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and total antioxidative capacity(T-AOC) in liver markedly. Conclusion CCC can promote the excretion of lead,increase the content of calcium in femur and antioxidative capacity in lead poisened mice.

Objective To explore the effects of family empowerment model on medication adherence in youth patient with cerebral infarction.Methods By convenience sampling,a questionnaire survey was conducted among 84 patients and families of neurology department in a third-grade and a-level general hospital in Zhengzhou.The patients and families were randomly divided into the control group and the intervention group,each group consisted of 42 patients and families.Patients and families in the control group got routine health education,but patients and families in the intervention group were intervened under family empowerment.The medication adherence of the patients were compared between the two groups before and after health education.Results The medication adherence in both groups were higher after health education than that before health education,the diffidence in the comparison of medication adherence was statistically significant between the two groups after health education.Conclusions The family empowerment model can improve the medication adherence in youth patient with cerebral infarction.