Operation agreement letter is forced to perform by the law.For the perspective of law,Operation agreement letter is a medical document for medical staff to certify the legitimacy of medical treatment,for hospital to certify that the duty to apprize has been performed,and also an authorization paper by patient to permit medical staffs to operate.However,there is no enforcement to relieve the responsibility of the medical institutions if medical mistake exist.The ethic meaning of operation agreement letter is to cure the sickness,to save the patient,to heal the wounded,and to rescue the dying.When there is conflict between reality and law,or there is no correlated clause in the law,the medical institutions must consider the spirit of legislation and perform medical treatment in time.

OBJECTIVE: To evaluate the dose-effect relationship of reptilase in hemostasis. METHODS: The effects of different doses of reptilase on bleeding time (BT), Blood coagulation and hemorheology in New Zealand rabbits were examined. RESULTS: Reptilase showed a significant hemostatic effect at the dosages of 0.023, 0.07, 0.21 and 0.63KU?kg-1, respectively, with the hemostatic effect lower in 0.63KU?kg-1 group than in 0.21KU?kg-1 group; and at the 4 different dosages, reptilase showed no significant effect on fibrinolysis system. At a dosage of 1.90 or 5.71KU?kg-1, reptilase showed a significant anticoagulation efficacy and enhanced fibrinolysis function. There was no significance in hemorheology among groups. CONCLUSION: At a dosage range of 0.21～0.63KU?kg-1, reptilase has an optimal hemostatic effect in New Zealand rabbits.

Objectives:To analyze the prevalence and risk factors of chronic nephropathy among hospitalized gout patients.Methods:537 hospitalized gout patients in Tianjin Medical University Chu Hsien-I Memorial Hospital were enrolled. According to the levels of glomerular filtration rate (eGFR>90 ml/min, 60-90 ml/min and <60 ml/min), patients were divided into normal group, mild chronic nephropathy group and moderate-severe chronic nephropathy group. The height, weight, waist, hip and blood pressure of the patients were measured. Blood samples from elbow vein were collected to measure biochemical indexes. The 24-hour urine was collected to measure creatinine and uric acid. Multivariate regression analysis was used to analyze the related factors that may affect eGFR.Results:The prevalence of chronic nephropathy among gout patients was 46.76%(251/537), which the prevalence of mild chronic nephropathy was 34.82%(187/537), and moderate severe chronic nephropathy was 11.92%(64/537). With the decline of eGFR, the older the patients, the longer the course of gout and hypertension, the more the number of joints involved, the higher the blood uric acid, urinary microalbumin, urinary protein, white blood cell count, uric acid excretion fraction (FeUA), and the lower the red blood cell count, hemoglobin and serum albumin. Pearson correlation analysis of eGFR showed that age, duration of gout and hypertension, number of involved joints, hemoglobin, serum albumin, serum uric acid, urinary microalbumin, and FeUA were correlated with eGFR ( r=-0.43, -0.238, -0.25, -0.128, 0.155, 0.138, -0.169, -0.29, -0.372, respectively, P<0.01). Multivariate regression analysis showed that age, the course of gout, serum uric acid, microalbuminuria and FeUA were independent risk factors for eGFR decline ( P<0.01). Conclusions:Eldly, long course of gout, poor control of serum uric acid and increased excretion of uric acid and microalbumin are risk factors of gout.

Aim To investigate the potential role of desipramine(DP) on lipoplysaccharide（LPS）-induced acute lung injury(ALI)and the mechanism of its action.Methods Kunming mice were divided into four groups randomly:NS group(NS),DP control group(DP),LPS group(LPS)and DP treatment group(DP+LPS).The model of ALI in mice was induced by lipoplysaccharidel(LPS,10 mg·kg~(-1),ip).Six hours after LPS challenged,the lung samples were taken for determination of lung wet-to-dry weight ratio(W/D),myeloperoxidase(MPO)activity,and malondialdehyde(MDA)content.The bronchoalveolar lavage fluid(BALF)samples were analyzed for total protein concentrateion and white blood cell(WBC)count.The levels of tumor necrosis factor-α(TNF-α)in lung were measured by ELISA.Results LPS could significantly increase the total protein concentration and WBC number in BALF.The lung W/D ration,MPO activity,MDA content and the levels of TNF-α in lungs all increased after ip injection of LPS.Pretreatment with DP decreased all the changes induced by the LPS.Conclusion Pretreatment with DP protects lung from LPS-induced lung injury in mice,which is,at least in part,through inhibiting the level of TNF-α and decreasing the sequestration of neutrophils and lipid peroxidation.

ObjectiveTo investigate the predisposing factors and pathogenic fungal species of Malassezia folliculitis in different geographical areas and body sites.MethodsTotally,241 patients diagnosed with Malassezia folliculitis were asked to complete a questionnaire.The content of hair follicles was obtained and subjected to fungal smear and culture examination.Fungal species were identified according to morphological,physiological and biochemical features.Results Of the 241 patients with Malassezia folliculitis,204 (84.65％) were positive for smear examination.A total of 259 specimens were collected from these patients,and fungal culture grew 213(82.24％) strains,of which,209 belonged to Malassezia species,4(1.54％) to Candida species.Among the 209 Malassezia strains,186 were activated and subjected to species identification which resulted in 6 species,including M.furfur (111 strains,59.68％ ),M.sloofiae (43 strains,23.12％ ),M.sympodialis (17 strains,9.14％),M.globosa (9 strains,4.84％),M.pachydermatis (4 strains,2.15％),and M.obtuse(2 strains,1.08％ ).Of the pathogenic fungi of Malassezia folliculitis,M.furfur predominated in the chest,back,abdomen,face and neck,M.sloofiae in the upper limbs,shoulders and vertex,M.globosa in the lower limbs.There were obvious differences in the distribution of pathogenic fungal species at different body sites in a same host,and M.furfur with M.sloofiae or M.sympodialis appeared to be the most common pathogens.ConclusionsIn this study,6 Malassezia species are identified in patients with Malassezia folliculitis in Nantong and Nanjing area,M.furfur and M.sloofiae appear to be the dominant pathogens.

With the rapid development of neuroimaging technology and related data processing methods, multimodal neuroimaging has been widely used in research fields such as neuroscience and clinical diseases. In this paper, the current development of multimodal neuroimaging fusion algorithm and its application in the diagnosis and treatment of brain diseases were reviewed. The definitions, applications, and advantages of the three levels of multimodal neuroimaging fusion, i.e. early fusion, late fusion, and intermediate fusion, were introduced and analyzed. The commonly used multi-modal neuroimaging algorithm basing on signal source separation method and deep multi-modal learning was introduced. The application of multimodal neuroimaging technology in the diagnosis and treatment of severe brain diseases such as schizophrenia and Alzheimer's disease was further discussed. Finally, the existing challenges and future research directions of multimodal neuroimaging methods and applications were summarized.

Objective To investigate the clinical significance of serum citrulline levels in evaluating the remnant bowel absorptive function with enterostomy in the neonatal period by means of tandem mass spectrum so as to guide clinical treatment with parenteral nutrition(PN) or not.Methods The serum amino acid profiles of 30 enterostomy infants including small intestinal enterostomy 17 cases of enterostomy and 13 cases of colon enterostomy and 20 cases of control infants in Wuhan Children's Hospital,Tongji Medical College University of Science & Technology from January 2016 to June 2018 were performed by using tandem mass spectrum,and the related amino acid with the bowel absorbing ability-citrulline was screened out.The Pearson correlation of the serum citrulline levels with the gain weight of the infants was studied.Results The weight of small intestinal enterostomy was significantly lower than colon enterostomy and control infants [(3.22 ± 1.00) kg vs.(5.63 ± 0.66) kg and (6.09 ± 0.85) kg],and there was statistical significance (F =57.23,P ＜ 0.05).Serum citrulline levels were significantly lower in small intestinal enterostomy compared with colon enterostomy and controls [(10.65 ± 5.82) μmol/L vs.(16.57 ± 4.33) μmol/L and (16.52 ± 4.20) μmol/L],and there was statistical significance (F =8.29,P ＜ 0.05).In enterostomy infants serum citrulline was positively correlated with gain weight everyday(r =0.65,P ＜ 0.05).Serum citrulline level ＜ 12 μmol/L had 81.3％ sensitivity and 71.4％ specificity for underweight.Conclusions Serum citrulline is a simple and accurate biomarker for evaluation of the absorptive function and adaptation of the enterostomy infants.Serum citrulline level ＜ 12 μmol/L is a strong predictor of PN-dependence in infants with temporary enterostomy.

Objective:To evaluate direct and indirect costs for schizophrenia,major depressive disorder(MDD)and bipolar disorder,and to compare their differences of cost composition,and to explore the drivers of the total costs.Methods:A total of 3 175 inpatients with schizophrenia,MDD,and bipolar disorder were recruited.In-patient's self-report total direct of medical costs outpatient and inpatient,out-of-pocket costs,and direct non-medical costs were regarded as direct costs.Productivity loss and other loss caused by damaging properties were defined as indirect costs.The perspectives of this study included individual and societal levels.Multivariate regression analysis was applied for detecting the factors influencing disease costs.Results:The total cost of schizophrenia was higher than those of MDD and bipolar disorder at individual and societal levels.The indirect costs of three mental disorders were higher than the direct costs,and the indirect cost ratio of bipolar disorder was higher than those of schizophre-nia and MDD.Age,gender,working condition and marital status(P＜0.05)were the important drivers of total costs.Conclusion:The economic burden of the three mental disorders is relatively heavy.Schizophrenia has heaviest disease burden,and the productivity loss due to mental disorders is the driving force of the soaring disease cost

Objective:To investigate the acute effect of fructose intake on serum uric acid, plasma glucose, and insulin levels in healthy young adults.Methods:Sixty-four healthy young subjects were recruited, and randomized to 25 g, 50 g, 75 g fructose group, and 75 g glucose group( n=16) by random number table. The anthropometric parameters, blood pressure, heart rate were measured. Several biochemistry parameters were measured, which were serum uric acid, plasma glucose, plasma insulin, serum total cholesterol, triglyceride, low density lipoprotein-cholesterol (LDL-C) at 0, 60, 120, and 180 min before and after ingestion of fructose or glucose. Results:(1) The serum uric acid level after fructose administration increased significantly than after glucose over 3 h, and peaked at 60 min. The increment of uric acid at 60 min and area under curve of uric acid at 3 h after fructose administration were significantly higher than those of glucose. The increment of uric acid at 60 min increased significantly as fructose dose was increased, especially in the 75 g fructose (increment rate of uric acid at 60 min in 25g, 50g, 75g fructose groups were 9.33%, 13.11%, 17.69% vs 0.75% respectively; Areas under curve of uric acid were 1 674.1±410.38, 1 598.3±417.03, 1 504.6±292.46 vs 1 434.8±328.94, P<0.01). (2) The glucose and insulin levels increased after fructose/glucose intake in four groups with top augment in glucose followed by 75 g fructose. The increase peaked at 30 min, began to decline at 120 min, and returned to fasting level at 180 min. The area under curve of insulin at glucose group was significantly higher than those among fructose groups. With the increase of fructose dose, the increment rate of glucose and insulin at 60 min also increased obviously, especially in the 75 g fructose (the increment rates of glucose at 60 min in 25 g, 50 g, 75 g fructose, 75 g glucose were 7.40%, 8.29%, 13.74%, 28.22% respectively; The increment rates of insulin at 60 min were 54.29%, 115.25%, 185.58%, 730.31% respectively, P<0.01). (3) There were no difference of cholesterol, triglyceride, and LDL-C after fructose/glucose ingestion. Conclusion:Acute fructose intake can lead to the increase of uric acid and insulin; Moreover, the increments of uric acid and insulin after fructose consumption were dependent on fructose dose.

Objective:To explore the clinical characteristic and risk factors of subcutaneous tophus among hospitalized gout patients.Methods:The clinical data of 646 inpatients with gout from April 2014 to December 2019 in Tianjin Medical University Chu Hsien-I Memorial Hospital were retrospectively analyzed. The patients were divided into tophus group (172 cases) and non-tophus group (474 cases) according to the presence of subcutaneous tophus. The body height, body mass, waist circumference, hip circumference and blood pressure were measured. The total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea nitrogen, creatinine, uric acid and C-reactive protein (CRP) were detected; urine was collected for 24 h to detect uric acid. The body mass index (BMI), estimated glomerular filtration rate (eGFR) and uric acid excretion fraction (FUA) were counted. Binary Logistic regression analysis was used to analyze the independent risk factors of subcutaneous tophus among hospitalized gout patients.Results:The proportion of male, course of disease, number of joint involved in attack, rate of smoking history, rate of drinking history, smoking amount, alcohol consumption volume, length of time spent drinking, length of time spent smoking, LDL-C, urea nitrogen, serum creatinine and serum uric acid in tophus group were significantly higher than those in non-tophus group: 98.84% (170/172) vs. 94.09% (446/474), 10 (5, 16) years vs. 5 (2, 9) years, 6 (4, 8) joints vs. 3 (2, 5) joints, 66.86% (115/172) vs. 58.44% (277/474), 65.70% (113/172) vs. 57.38% (272/474), 11 (0, 20) cigarettes /d vs. 10 (0, 20) cigarettes/d, 100 (0, 250) ml/d vs. 50 (0, 162) ml/d, 10 (0, 26) years vs. 0 (0, 20) years, 20 (0, 30) years vs. 10 (0, 20) years, (3.44 ± 0.98) mmol/L vs. (3.25 ± 0.97) mmol/L, 5.81 (4.61, 7.46) mmol/L vs. 5.38 (4.39, 6.66) mmol/L, 89.4 (74.3, 107.5) μmol/L vs. 85.1 (72.5, 98.9) μmol/L and 514.4 (452.9, 595.2) μmol/L vs. 499.0 (404.8, 572.4), the onset age, red blood cell, hemoglobin and eGFR were significantly lower than those in non-tophus group: (37.78 ± 10.56) years old vs. (40.17 ± 13.06) years old, (4.72 ± 0.74) × 10 9/L vs. (4.88 ± 0.56) × 10 9/L, (141.15 ± 17.19) g/L vs. (146.00 ± 13.06) g/L and 87.7 (65.9, 108.4) ml/min vs. 93.3 (75.9, 113.1) ml/min, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in family history of diabetes, family history of hypertension, family history of gout, BMI, waist-hip ratio, blood pressure, FUA, white blood cell, TC, TG, HDL-C and CRP between 2 groups ( P>0.05). The patients were grouped according to the course of disease, the incidences of tophus in patients with course of disease ≤5.0 years, 5.1 to 10.0 years and >10.0 years were 15.34% (50/326), 27.67% (44/159) and 48.45% (78/161), and there was statistical difference ( χ2 = 60.59, P<0.01); the patients were grouped according to the quartiles of serum uric acid, the incidences of tophus in patients with serum uric acid <424.05 μmol/L, 424.05 to 505.24 μmol/L, 505.25 to 576.17 μmol/L and ≥576.18 μmol/L were 14.91% (24/161), 32.72% (53/162), 29.01% (47/162) and 29.81% (48/161), and there was statistical difference ( χ2 = 15.70, P<0.01). Binary Logistic regression analysis result showed that the course of gout, smoking amount, number of joint involved in attack, serum uric acid and LDL-C were the independent risk factors of subcutaneous tophus among hospitalized gout patients ( OR = 1.069, 1.020, 1.317, 1.002 and 1.262; 95% CI 1.032 to 1.097, 1.006 to 1.032, 1.223 to 1.417, 1.000 to 1.003 and 1.033 to 1.541; P<0.01 or <0.05). Conclusions:The duration of disease, number of involved joint, serum uric acid level, unhealthy lifestyles and lipid metabolism disorders are the independent risk factors of subcutaneous tophus among hospitalized gout patients.