Objective To evaluate the effects of etomidate preconditioning on etomidate-induced toxicity to rat adrenal cortical cells in vitro.Methods After being primarily cultured for 7-9 days,the rat adrenal cortical cells at the exponential growth phase were seeded into 96-well culture plates (1 × 106 cells/ml) and cultured for 24 h.The cells were then randomly divided into 3 groups with 6 wells in each group:control group (group C),etomidate group (group E),and etomidate preconditioning group (group EP).In group E,the cells were incubated with 700 μmol/L etomidate for 24 h.In group EP,the cells were incubated with 1.25 μmol/L etomidate for 1 h,then washed out and incubated with 700 μmol/L eomidate for 24 h.The cell viability was determined by CCK-8 assay and the concentration of cortisol was determined by ELISA.Results Compared with group C,the cell viability and cortisol concentration were significantly decreased in E and EP groups.Compared with group E,the cell viability and cortisol concentration were significantly increased in group EP.Conclusion Etomidate preconditioning can reduce etomidate-induced toxicity to rat adrenal cortical cells in vitro.

Objective To observe the short-term and long-term effect of mask bi-level positive airway pressure (BiPAP) combined with recombinant human brain natriuretic peptide (rhBNP) on acute heart failure.Methods One hundred cases of acute heart failure patients were divided into BiPAP combined with rhBNP group (51 cases) and conventional treatment group (49 cases) by random digits table.Conventional treatment group was given routine drug for heart failure treatment,and BiPAP combined with rhBNP group on the basis of routine treatment,was given BiPAP combined therapy with rhBNP.Arterial blood oxygen partial pressure (PaO2),arterial blood oxygen saturation (SaO2),and the change of clinical symptoms were recorded before and 30 min,2 h after treatment.All patients were followed up for 3 months,and cardiovascular events,related parameters of echocardiography and 6 min walking distance test were compared between two groups.Results Clinical symptoms (respiratory frequency and heart rate) and blood gas analysis index (PaO2,SaO2) were significantly improved after treatment in two groups,and BiPAP combined with rhBNP group improved more significantly.There was significant difference (P ＜ 0.05).After 3 months' follow-up,the incidence of cardiovascular events in BiPAP combined with rhBNP group was lower than that in conventional treatment group [17.6％ (9/51) vs.38.8％ (19/49),P ＜ 0.05].The left ventricular end-diastolic diameter (LVEDd),left ventricular ejection fraction (LVEF) in BiPAP combined with rhBNP group was better than that in conventional treatment group [(55.0 ± 6.1) mm vs.(63.3 ± 6.5) mm,(52.5 ±7.2)％ vs.(44.7 ± 6.8)％] (P ＜ 0.05).The 6 min walking distance test in BiPAP combined with rhBNP group was higher than that in conventional treatment group [(325.6 ± 36.4) m vs.(210.2 ± 34.1) m] (P ＜0.05).Conclusion BiPAP combined with rhBNP in short-term treatment of acute heart failure is effective and safe,and can improve the long-term prognosis of patients.

Objective To evaluate the relationship between desmosome-related proteins and epidermal tumors. Methods Using anti-desmoglein 1 and 2 monoclonal antibodies, expression of desmoglein 1 and 2 was examined by an immunohistochem ical staining method in various epidermal tumors such as squamous cell carcinoma (SCC), actinic keratosis(AK), keratoacanthoma(KA) and seborrhoeic keratosis(SK). Results Desmoglein 1 and 2 were strongly expressed in intercellular space of wh ole epidermis in normal human skin. Expression of desmoglein 1 and 2 was markedl y reduced or absent in SCC cells. Compared with normal epidermal cells, expressi on of desmoglein 1 and 2 was equal to or reduced,with complete absence of stain ing in dysplastic areas in AK cells. Extensive pericellur staining of desmoglein 1 and 2 was found in KA and SK cells, similar to that observed in normal epider mis. Conclusion Expression of desmoglein 1 and 2 is markedly reduced or absent i n human malignant epidermal cancers, reduction of these molecules may contribute to invasiveness and metastasis of epidermal carcinomas.

Objective To evaluate the effectiveness of lumbosacral plexus block combined with the use of dexmedetomidine in elderly patients undergoing proximal femoral nail antirotation (PFNA).Methods A total of 60 patients received elective PFNA were divided into tracheal intubation combined with inhalation anesthesia group (group G) and ultrasound and nerve stimulator-guided lumbosacral plexus block following with dexmedetomidine infusion group (group N).Then we observed HR,SBP,DBP for both groups at the time entering the theater (T0),immediately after tracheal intubation or after dexmedetomidine infusion (T1),skin incision moment (T2) and 30 minutes after skin incision (T3).Visual analogue scale (VAS) scores were assessed for both groups at the time point of 2,6,12,24 and 48 hours after surgery.The number of use of patient controlled intravenous analgesia (PCIA),assessment of consciousness status 1-3 days after surgery,adverse reactions were recorded for both groups as well.The following post-surgery data were recorded:the time of first feeding,first urination and first ambulation,the length of hospitalization,the expense of hospital stay.Results HR,SBP,DBP of the group G changed more significantly at T1,T2,T3 than those of T0 (P＜0.05).The VAS scores and the number of use of PCIA of group N were lower than those of group G at all time points after operation (P＜0.05).The group N had lower CAM-CR scores and less adverse reactions of nausea and vomiting and dizziness than those of group G on days 1 to 3 after surgery (P＜0.01).Compare to group G,the group N were early in terms of post-operation first feeding,first urination and first ambulation (P＜0.01).The length of hospitalization was shorter and the cost of the hospital stay was lower in the group N than the group G (P＜0.01).Conclusion Ultrasound and nerve stimulator-guided lumbosacral plexus block combined with low dose of dexmedetomidine could meet the needs of elderly patients undergoing PFNA.

Objective To study the mechanism of Chaihu Guizhi Decoction(CGD)in the treatment of influenza and staphylococcus aureus co-infection.Methods The co-infection model of influenza and staphylococcus aureus was established and CGD was used to intervene.The chemical components of CGD were qualitatively analyzed by UPLC-Q-Exactive/MS technology.The potential action targets of chemical components in CGD and the related targets of influenza Staphylococcus aureus co-infection were mined by network pharmacology method.The"component target disease"network was constructed.Core targets were selected according to degree ranking.Core action pathways were enriched by KEGG analysis and GO annotation analysis.The core target was verified by RT-qPCR,and the interaction between the core component and the key target was verified by molecular docking.Results CGD could significantly improve the decrease of body weight and thymus index(P<0.05)caused by co-infection.The lung index(P<0.05),relative amount of MmRNA expression(P<0.05)and bacterial load(P<0.05)were decreased,and the survival rate was improved.51 chemical constituents were identified from CGD.Through network pharmacological analysis,107 related targets corresponding to CGD treatment of bacterial pneumonia secondary to influenza were excavated.TNF,AKT1,ALB,VEGFA,MAPK3,PTGS2,STAT3,EGFR and other targets with strong correlation,mainly involved Fc epsilon RI signal pathway,GnRH signal pathway,NF-κB signal path,etc.Molecular docking study showed that the main active component of CGD,including oroxyloside,baicalein and wogonin have strong affinity with TNF,PTGS2 and EGFR targets.Compared with co-infection model group,in CGD group TNF-α、EGFR and PTGS2 increased significantly(P<0.05).Conclusion The main active ingredient of CGD is oroxyloside,baicalein and wogonin.TNF-α,PTGS2,EGFR and other targets to played a role in the treatment of influenza staphylococcus aureus co-infection.

The basic information and clinical data of 4 Phelan-McDermid syndrome (PMS) patients in the Pediatric Outpatient Department of the Peking University First Hospital from January 2014 to October 2019 were retrospectively analyzed.Genetic diagnoses were performed using the whole exon sequencing assay.The genotype-phenotype correlation analysis was then performed.All patients presented with intellectual disability/developmental delay, especially the most-common manifestation in language disability.Patient 2 had an autism behavior.Four novel variations of the SHANK3 gene were found in this study, including the c. 2861delC p. (S955Pfs*109), c.3166delC p. (A1039Afs*39), c.3711_3723delGCCCAGCCCCCGG p. (L1241Lfs*29) and c. 2223+ 1G>A.All of them were analyzed as new pathogenic variations according to the American College of Medical Genetics and Genomics criteria.The present study expan-ded the mutant spectrum of the SHANK3 gene, which provided a basis for further accurate genetic counseling and prenatal diagnosis of PMS.