Objective To assess the clinical application values of HC visual laryngoscope in emergency tracheal intubation for severe craniocerebral trauma patients with basilar fracture.Methods Retrospective analysis was used to review 60 patients of severe traumatic brain injury with basilar fracture in emergency resuscitation room who needed the hospital emergency tracheal intubation.There were 30 patients operated with visual HC laryngoscope (the observation group), and the other 30 patients underwent common direct laryngoscope (the control group).The index of the degree of exposure,intubation time,success rate of intubation were compared between the two groups.ResultsThere were 28 cases (93.33%) of Cormark-Lehane grading Ⅰ to Ⅱ in observation group,which was significantly higher than 20 cases (66.67%) in the control group(P< 0.05).The average intubation time in observation group was (34.3±6.7) seconds,and it was shorter than (44.5±5.7) seconds in the control group (P<0.05).In observation group,26 cases (86.67%) were of one-time successful intubation,which was higher than 19 cases (63.33%) in the control group,and the difference was statistically significant(P<0.05).ConclusionHC visual laryngoscope in emergency tracheal intubation for severe craniocerebral trauma patients with basilar fracture can improve the success rate of intubation,shorten the intubation time,reduce adverse reactions,and it is worthy of clinical application.

ObjectiveTo investigate emergency diagnosis and treatment of pelvic fracture complicated with traumatic rupture of urethra and bladder,and to improve the success rate of treatment on pelvic fracture.MethodsClinical data of 52 cases of pelvic fracture complicated with traumatic rupture of urethra and bladder in department of emergency and urology from 2000 to 2010 was retrospectively analyzed.Results Among the 52 patients,there was 41 cases of pelvic fracture complicated with posterior urethral disruption,15 cases complicated with rupture of bladder and 4 cases complicated withtraumatic rupture of urethra and bladder at the same time.In 41 cases with posterior urethral rupture,6 individual's condition were relatively so severe that they onlyunderwent bladder puncture nephrostomy,and 29 cases underwent traction urethral realignment,the other 6 cases didn't undergo surgery; In 15 cases of patients with bladder rupture,2 patients were performed urethral realignment and bladder repair,11 patients underwent the bladder repair only and the other 2 patients were not performed surgery.There were 8 patients died and the mortality rate was 15.4％.Six died cases failed to conduct emergency surgery because of uncontrollable bleeding and another 2 cases died due to multiple organ failure.ConclusionPelvic fractures is a disease with more complications,it should be diagnosed as early as possible.Patients invalid for conventional anti-shock should be performed pelvic external fixation and emergency embolization to stop bleeding in the emergency department,and undergo associated processing after they are in stable condition.

Objective:To discuss the effect of pharmacist intervention on the use of antimicrobial agents in the clinical pathway of community-acquired pneumonia ( CAP) in our hospital to standardize the rational medication and promote the rational use of antimicro-bial agents. Methods:Totally 100 bacterial CAP patients in 2013 ( before the intervention) and 2014 ( after the intervention) in the pneumology department were studied. The antibacterial drug cost, total hospitalization cost, use intensity of antimicrobial drugs, hospi-talization time, therapeutic effects and so on in the two groups were observed during the treatment. Results: There were significant differences between the two groups in antibacterial drug cost, total hospitalization cost, use intensity of antimicrobial drugs, hospitaliza-tion time and so on, whereas there was no significant difference in the curative effect. Conclusion:After the pharmacist intervention, the application of antibiotics is more rational, the antibiotics use density and per capita cost are reduced, the hospitalization day is shortened and the value of pharmacists is also improved.

Objective To construct and express a prokaryotic expression vector carrying the gene of FimH 1-156 that comprises human lysosome membrane protein 2 P41-49 gene ,and to express and purify the fusion protein .Methods FimH1-156 gene was cloned from plasmid pPKL241 by PCR ,and inserted into vector pET-28a(+ ) to obtain prokaryotic expression plasmid pET-28a-FimH . After transforming Escherichia coli BL21(DE3) with pET-28a-FimH ,fusion protein FimH1-156 was expressed under induction .The target fusion protein was purified ,and its antigenicity was detected through Western blot .Results The expressed recombinant pro-tein was purified ,the expression of protein was the highest when IPTG was 1 mmol/L and 4h after induction ,it was expressed as include body form ,and the expressed protein was identified to react with monoclonal antibodies 6 × His by Western blotting .Conclu-sion We cloned FimH1-156 fusion protein expressed genes successfully ,constructed prokaryotic expression vector ,and won the in-clusion body purification of FimH1-156 fusion protein .

0.05).The Nestin and C-kit expressions can be detected in all cases of GISTs by RT-PCR and Western Blot.Conclusion In conjunction with C-kit,Nestin may be a useful marker for diagnosis of GISTs but it cannot be used as a tumor differentiation index.

Poly(ADP-ribose)polymerase-1(PARP-1)plays a vital role in the regulation of DNA repair and apoptosis. Breakthrough has been made in the treatment of cancer with PARP-1 inhibitors, but the emergence of drug resistance has limited its further application in clinic. This paper reviews advances in the research on PARP-1 inhibitors combined with other drugs to overcome drug resistance, highlights and evaluates the existing drug combination strategies and their therapeutic effects in clinical practice. It is proposed that the development of dual-target or multi-target drugs will become a promising approach to overcome the resistance of PARP-1 inhibitors and broaden their indications.

Objective To study the relevance between the polymorphisms and haplotype of multidrug resistant gene (MDR1) and the ratio of blood concentration/dosage in individuals treated by tacrolimus in stable phases post renal transplanta-tion ,and to provide data for personalized FK-506 administration .Methods The MDR1 C1236T ,G2677T/A and C3435T gen-otypes of 104 renal transplantation patients were determined by PCR followed sequencing method .The blood concentration of tacrolimus was detected by EMIT method .The differences in concentration/(dose × weight) (C/D) ratios were compared a-mong all of the genotype groups treated by tacrolimus .Results In the 104 renal transplantation recipients ,the frequency of MDR1 C1236T ,G2677T/A and C3435T mutation alleles was 56 .73% ,55 .77% and 33 .17% ,respectively .A correlation was revealed among SNP of MDR1 C3435T ,TTT haplotype and the C/D ratios (P<0.05) .In patients of CYP3A5*3*3 ,A cor-relation was also found among TTT haplotype and the C/D ratios (P< 0.05) .No difference was found among the MDR1 C1236T ,G2677T/A ,CGC haplotype and the C/D ratios (P>0.05) .Conclusion It is demonstrated that genetic polymor-phisms of MDR1 C3435T and TTT haplotype are correlated with C/D ratio of tacrolimus in Chinese renal transplant patients in stable stage .These findings affect the dose-adjusted concentration of tacrolimus individually .

Objective: To assess the differences between ultrasound cardiac output monitor (USCOM) and thermodilution (TD) systematically in cardiac function monitoring of critically ill patients. Methods: The Chinese and English literatures about the clinical trials which using USCOM and TD to monitor cardiac function published in CNKI, Wanfang database, China biomedical literature database, VIP database, China Clinical Trial Registration Center, PubMed, Embase and Cochrane Library were searched by computer from the establishment to December 2018. Some indicators, like cardiac output (CO), cardiac index (CI), stroke volume (SV) and other parameters were used to evaluate cardiac function. Literature search, quality evaluation and data extraction were conducted independently by two authors. The tailored Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used for literature quality evaluation. EndNote X6 was used for literature screening and management. RevMan 5.3 was used for Meta-analysis. Funnel chart analysis was used for publication bias. Results: A total of 26 studies involving 772 patients were included. Among them, there were 5 literatures found that the agreements of cardiac function between the USCOM and TD methods were poor. Meta-analysis showed that there was no significant difference between the two methods in CO and CI monitoring [CO: mean difference (MD) = -0.06, 95% confidence interval (95%CI) was -0.17 to 0.05, P = 0.31; CI: MD = -0.04, 95%CI was -0.13 to 0.05, P = 0.38]. Subgroup analysis of different TD methods [pulmonary artery catheter (PAC), pulse indicator continuous cardiac output (PiCCO)] and different windows of USCOM ultrasonic probe [aorta (AA), pulmonary artery (PA)] in CO monitoring was not shown significant difference yet (PAC: MD = -0.07, 95%CI was -0.18 to 0.04, P = 0.23; PiCCO: MD = 0.09, 95%CI was -0.31 to 0.50, P = 0.65; AA windows: MD = -0.14, 95%CI was -0.31 to 0.02, P = 0.09; PA windows: MD = -0.00, 95%CI was -0.15 to 0.14, P = 0.95; AA/PA windows: MD = 0.23, 95%CI was -0.40 to 0.86, P = 0.47). However, the difference in SV was statistically significant between the USCOM and TD method (MD = 1.48, 95%CI was 0.04 to 2.92, P = 0.04). Funnel chart showed that the literature distribution of CO and CI monitoring were basically symmetrical, indicating that the bias of literature publication is small. Conclusion USCOM has good consistency with TD method in monitoring the cardiac function parameters of CO and CI, and different windows of ultrasonic probe of USCOM have no significant influence on the monitoring results, but there is significant difference in the consistency of the two methods in SV monitoring.

OBJECTIVES: The long-term trends of cognitive function and its associations with physical performance remain unclear, particularly in Asian populations. The study objectives were to determine cognitive trajectories in middle-aged and elderly Chinese individuals, as well as to examine differences in physical performance across cognitive trajectory groups. METHODS: Data were extracted from the China Health and Retirement Longitudinal Study. A total of 5,701 participants (47.7% male) with a mean age of 57.8 (standard deviation, 8.4) years at enrollment were included. A group-based trajectory model was used to identify cognitive trajectory groups for each sex. Grip strength, repeated chair stand, and standing balance tests were used to evaluate physical performance. An ordered logistic regression model was employed to analyze differences in physical performance across cognitive trajectory groups. RESULTS: Three cognitive trajectory groups were identified for each sex: low, middle, and high. For both sexes, higher cognitive trajectory groups exhibited smaller declines with age. In the fully adjusted model, relative to the low trajectory group, the odds ratios (ORs) of better physical performance in the middle cognitive group were 1.37 (95% confidence interval [CI], 1.17 to 1.59; p<0.001) during follow-up and 1.40 (95% CI, 1.20 to 1.64; p<0.001) at the endpoint. The ORs in the high trajectory group were 1.94 (95% CI, 1.61 to 2.32; p<0.001) during follow-up and 2.04 (95% CI, 1.69 to 2.45; p<0.001) at the endpoint. CONCLUSIONS Cognitive function was better preserved in male participants and individuals with higher baseline cognitive function. A higher cognitive trajectory was associated with better physical performance over time.

Fanconi anemia (FA) is an inheritable disorder that presents with bone marrow failure, developmental anomalies, and an increased susceptibility to cancer. The etiology of this condition stems from a genetic mutation that disrupts the proper repair of interstrand DNA cross-links (ICLs). The resultant dysregulation of the DNA damage response mechanism can induce genomic instability, thereby elevating the mutation rates and the likelihood of developing cancer. The FA pathway assumes a pivotal role in safeguarding genome stability through its involvement in the repair of DNA cross-links and the maintenance of overall genomic integrity. A mutation in the germ line of any of the genes responsible for encoding the FA protein results in the development of FA. The prevalence of aberrant FA gene expression in somatic cancer, coupled with the identification of a connection between FA pathway activation and resistance to chemotherapy, has solidified the correlation between the FA pathway and cancer. Consequently, targeted therapies that exploit FA pathway gene abnormalities are being progressively developed and implemented. This review critically examines the involvement of the FA protein in the repair of ICLs, the regulation of the FA signaling network, and its implications in cancer pathogenesis and prognosis. Additionally, it explores the potential utility of small-molecule inhibitors that target the FA pathway.