Objective To study the smoking status and revalent cause factors among medical college students in Nanchang and provide information for smoking control .Methods A questionnaire survey was conducted among 935 medical students by stratified cluster random sampling method .912 questionnaires were valid .The valid rate was 97 .540% .Results The total smoking rate was 14 .364% (131/192) .The smoking rate of male was higher than female(χ2 =49 .982 ,P<0 .05) .There was a great difference among different grades(χ2 =22 .503 ,P<0 .05) .There were many factors associated with smoking conducts ,in which older ,higher family income ,higher monthly cost of living ,allowing to smoking in the home were risk factors ,but mother′s educational level ,correct knowledge about the hazards of tobacco were protective factors .Conclusion The smoking rate of medical students is not high .The smoking status are influenced by many factors .Intervention should pay more attention to focus group and better prevent medical students from smoking .

Objective To investigate the effect of dexmedetomidine on activations of pulmonary extracellular signal-regulated kinase 1/2 (ERK 1/2 )and serine-threonine kinase (Akt) during isolated lung ischemia-reperfusion injury (LIRI)in rats.Methods Forty-five adult male Spra-gue-Dawley rats were randomly divided into three groups (n=1 5 each):control group (group C),is-chemia-reperfusion group (group IR)and dexmedetomidine group (group DEX).Isolated rat lungs were maintained for normal physical activity,and only received ventilation and perfusion for 150 min in the IL-2 ex-vivo lung perfusion system in group C.Isolated rat lungs were subjected to 60 min of is-chemia and apnea followed by 75 min reperfusion and ventilation 15 min after perfusion in the IL-2 ex-vivo lung perfusion system in groups IR and DEX.Dexmedetomidine with a dose of 10 nmol/L was ad-ministrated into perfusion fluid at the onset of reperfusion in group DEX,and the same volume of saline was injected when perfusion for 75 min and at the onset of reperfusion in groups C and IR,respectively.Patho-logical changes of lungs were examined and the injured alveolus rate (IAR)was counted under light micro-scope.The expression levels of ERK 1/2 or Akt mRNA and phosphorylate-ERK 1/2 (p-ERK 1/2 )or phosphorylate-Akt (p-Akt)protein of lung tissue were tested by reverse transcription-polymerase chain re-action (RT-PCR)and Western blot,respectively.Results Compared with group C,the IAR and the ex-pression levels of ERK 1/2 and Akt mRNA or p-ERK 1/2 and p-Akt protein in lung tissue were high-er in groups IR and DEX (P<0.05).Compared with group IR,the IAR and the expression levels of ERK 1/2 and Akt mRNA or p-ERK 1/2 and p-Akt protein in lung tissue were lower in group DEX (P<0.05).Conclusion Dexmedetomidine may reduce LIRI in rat isolated lungs via inhibiting the expressions of IL-6 and IL-8,and the mechanism may be related to suppressing activations of ERK 1/2 and Akt.

Objective:To evaluate the optimization strategy of labor analgesia in obese parturients using dural puncture epidural (DPE) combined with programmed intermittent epidural bolus (PIEB).Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ obese primiparae, who were at full term with a singleton fetus in vertex presentation, aged 20-40 yr, with body mass index of 30-40 kg/m 2, at 37-42 week gestation, with cervical dilation of 2-5 cm, and with visual analogue scale score ≥50 mm, were divided into 2 groups ( n=40 each) using a random number table method: DPE plus PIEB group (DPEP group) and DPE plus continuous epidural infusion group (DPEC group). All parturients received DPE labor analgesia, and parturients received PIEB (DPEP group) and continuous epidural infusion (DPEC group) to maintain analgesia during labor. In DPEP group, the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 2 ml/12 min after an initial dose of 8 ml. In DPEC group, the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 10 ml/h after an initial dose of 8 ml. The analgesia solution contained 0.1% ropivacaine plus 0.3 μg/ml sufentanil. The time to achieve adequate analgesia, consumption of ropivacaine per unit time, height of sensory block at the thoracic vertebral level, modified Bromage score, effective pressing times of patient-controlled analgesia, the number of rescue analgesia, Apgar score, delivery mode, occurrence of adverse reactions and maternal satisfaction with labor analgesia were recorded. Results:Compared with DPEC group, the time to achieve adequate analgesia was significantly shortened, the consumption of ropivacaine per unit time was decreased, and the number of rescue analgesia and effective pressing times of patient-controlled analgesia were decreased in DPEP group ( P<0.05). There were no significant differences in the height of sensory block at the thoracic vertebral level, modified Bromage score, Apgar score, delivery mode, incidence of adverse reactions and maternal satisfaction with labor analgesia between the two groups ( P>0.05). Conclusions:DPE combined with PIEB offers faster onset and better effect and achieves a greater local anesthetics-sparing effect when used for labor analgesia in obese parturients.

Objective To evaluate the effect of ulinastatin on programmed necrosis in hippocampal neurons in a rat model of global cerebral ischemia-reperfusion (I/R).Methods Forty-eight clean-grade healthy adult male Sprague-Dawley rats,aged 8 weeks,weighing 280-320 g,were divided into 3 groups (n=16 each) using a random number table method:sham operation group (Sham group),global cerebral I/R group (I/R group) and ulinastatin group (UT group).Global cerebral I/R was produced by 4-vessel occlusion method in chloral hydrate-anesthetized rats in I/R and UT groups.Ulinastatin 100 000 U/kg was injected via the tail vein at the onset of ischemia in group UT,and the equal volume of normal saline was given instead in Sham and I/R groups.Neurological deficit score (NDS) was estimated at 6,12 and 24 h of reperfusion.Animals were sacrificed at 24 h of reperfusion,brains were removed and the hippocampi were obtained for examination of pathological changes (with a light microscope) and for determination of the malondialdehyde (MDA) content and superoxide dismutase (SOD) activity (by spectrophotometry),and expression of receptor-interacting protein kinase 1 (RIPK1),RIPK3,and mixed lineage kinase domain-like protein (MLKL) in hippocampal tissues (by Western blot).Results Compared with Sham group,the NDS was significantly increased at each time point,the MDA content was increased,the SOD activity was decreased,and the expression of RIPK1,RIPK3 and MLKL was up-regulated in I/R and UT groups (P＜ 0.05).Compared with I/R group,the NDS was significantly decreased at each time point,the MDA content was decreased,the SOD activity was increased,and the expression of RIPK1,RIPK3 and MLKL was down-regulated in UT group (P＜0.05).The pathological changes of hippocampi were significantly attenuated in UT group when compared with I/R group.Conclusion The mechanism by which ulinastatin ameliorates global cerebral I/R injury is related to inhibiting programmed necrosis in hippocampal neurons of rats.

Objective:To explore the correlation between different smoking status and serum uric acid(SUA)in a middle-aged male in health check-up population.Methods:In this cross-sectional study, a total of 26701 middle-aged men who underwent health check-up in Taihu Sanatorium of Jiangsu Province from January 2014 to June 2015 were studied.The correlation between smoking status and SUA was analyzed by questionnaires, physical examination and serum biochemical assay.Smoking state was divided into no smoking, a occasional smoking and smoking groups.Results:With the increase of age, there was a downward trend of SUA( F=7.38, P=0.000). Among the three smoking groups, the group with occasional smoking had the highest level of SUA.The smoking group had lower level of SUA than the non-smoking group and occasional smoking group( P=0.000 and 0.005). In the non-smoking group, the fourth quartile of SUA(41.5%)had a higher percentage than that in first quartile of SUA(38.4%)( χ2=12.266, P=0.000). In the smoking group, the fourth quartile of SUA(54.9%)had lower percentage than that in the first quartile of SUA(58.4%)( χ2=7.049, P=0.008). Compared with the non-smoking group, the prevalence of hyperuricemia(HUA)in smoking group was lower( OR=0.872, 95% CI: 0.821~0.927, P=0.000), the prevalence of HUA in occasional smoking group was higher( OR=1.194, 95% CI: 1.013~1.408, P=0.035). Conclusions:As compared with the non-smoking group, the prevalence of HUA is lower in smoking group and is higher in occasional smoking group.

Children have unique physiological and pathological characteristics, and their various system diseases are closely related to immune function, such as respiratory system, digestive system, nervous system, endocrine system, etc. These correlations are directly or indirectly related to the intestinal micro-ecosystem. In recent years, more and more study results show that as a major component of the human micro-ecosystem, the intestinal micro-ecosystem plays a decisive role in the important physiological functions of children such as immunity, metabolism, nutrition, etc. Children's intestinal micro-ecosystem is also associated with the treatment and prognosis of infectious diseases, chronic intestinal inflammatory diseases, allergic diseases, autoimmune diseases and metabolic diseases. In this paper, the related research of intestinal micro-ecology and some common diseases in pediatrics were summarized and discussed, the correlation between intestinal micro-ecology and pediatric diseases were deeply analyzed, in order to further understand the potential pathogenesis of pediatric diseases, and to provide new ideas for guiding the clinical treatment and long-term rehabilitation.

Objective:To investigate the correlation between different serum uric acid (SUA) levels and impaired fasting glucose (IFG) in adults.Methods:From March 2019 to February 2020, 5006 adults in Wuxi area of Taihu Sanatorium in Jiangsu Province were selected as subjects. Quintile method was divided into the following five groups: Q1: SUA<270 μmol/L, Q2: 270 μmol/L SUA 318 μmol/L or less, Q3: 319 μmol/L ≤SUA≤360 μmol/L, Q4: 361 μmol/L SUA 410 μmol/L or less, and Q5: SUA>410 μmol/L. Correlation was analyzed by logistic analysis, with IFG as the outcome index, five SUA groups as the observation index, and gender, age, body mass index (BMI), blood lipid, and blood pressure as confounding factors. Three logistic regression analysis models were constructed to explore the relationship between different SUA level groups and IFG risk, as well as the influence of BMI on the risk correlation between SUA and IFG.Results:The BMI, DBP, FPG, TC, TG, and LDL-C all increased with the increase in SUA level; however, HDL-C gradually decreased with the increase in SUA level (P<0.01). The SUA levels among the five groups were positively correlated with fasting blood glucose level in the IFG group ( r=0.589, P<0.001). After adjusting for age, sex, and BMI, SUA level was strongly associated with fasting glucose in the IFG group ( r=0.534, P<0.001). After further adjustment for blood lipid and blood pressure, the correlation persisted ( r=0.523, P<0.001). With Q1 as the control group, the calculated OR values of IFG risk were 1.199, 2.660, 2.784 and 3.629, respectively. After further adjustment for various confounding factors, the calculated OR values of each group were 1.130, 2.389, 2.350 and 2.895, respectively. The IFG risk in the group with SUA level in the corresponding Q2 and Q5 groups was 1.13 times and 2.90 times higher, respectively, than that in the normal group, indicating that with the increase in SUA level, the IFG risk in the population increased. With the increase in BMI and SUA levels after BMI stratification, the mean fasting glucose level increased ( P<0.001). Conclusion:The SUA level and IFG risk are closely related. Increased SUA level increases IFG risk, and SUA and IFG are associated with weight gain, which should be paid attention to.

Depressive disorder ranks as a major bur-den of disease worldwide,yet the current antidepressant medications are limited by frequent non-responsiveness and significant side effects.The lateral septum(LS)is thought to control of depression,however,the cellular and circuit substrates are largely unknown.Here,we identified a subpopulation of LS GABAergic adenosine A2A receptors(A2AR)-positive neurons mediating depres-sive symptoms via direct projects to the lateral habenula(LHb)and the dorsomedial hypothalamus(DMH).Activa-tion of A2AR in the LS augmented the spiking frequency of A2AR-positive neurons leading to a decreased activation of surrounding neurons and the bi-directional manipula-tion of LS-A2AR activity demonstrated that LS-A2ARs are necessary and sufficient to trigger depressive pheno-types.Thus,the optogenetic modulation(stimulation or inhibition)of LS-A2AR-positive neuronal activity or LS-A2AR-positive neurons projection terminals to the LHb or DMH,phenocopied depressive behaviors.Moreover,A2AR are upregulated in the LS in two male mouse mod-els of repeated stress-induced depression.This identifica-tion that aberrantly increased A2AR signaling in the LS is a critical upstream regulator of repeated stress-induced depressive-like behaviors provides a neurophysiological and circuit-based justification of the antidepressant poten-tial of A2AR antagonists,prompting their clinical transla-tion.

Objective To investigate the effects of Tuina of Three Handing-Three Points on hindlimb motor function and expression of protein NogoA and its receptor NgR in the spinal cord of rats with sciatic nerve injury. Methods A total of 64 male Sprague-Dawley rats were randomly assigned to normal group (n = 16), sham group (n = 16), model group (n = 16) and Tuina group (n = 16). The model group and Tuina group prepared the sciatic nerve injury model with brace method. Tuina group received Tuina in methods of pressing, strumming and circular rubbing on Yinmen (BL37), Chengshan (BL57) and Yanglingquan (GB34) with Tuina manipulation emulator. The rats were assessed with oblique plate test seven days after operation and 20 days after Tuina. Then, the spinal cord tissues were extracted to detect the expression of protein of NogoA and NgR with Western blotting. Results The scores of the oblique plate test decreased in the model group and Tuina group seven days after operation compared with those in the normal group (P < 0.05), while the expression NgR increased (P < 0.05). The scores of the oblique plate test increased in Tuina group compared with those in the model group 20 days after Tuina (P < 0.05), while the expression of NgR decreased (P < 0.05), similar to the normal group (P > 0.05). Conclusion Tuina of Three Handing-Three Points can improve the hindlimb motor function in rats with sciatic nerve injury, which may be related to inhibition of the expression of NgR in the spinal cord after sciatic nerve injury.

ObjectiveTo observe the clinical efficacy and safety of treating mediate-risk pure ground glass pulmonary nodules （pGGNs） based on the state theory. MethodsA prospective clinical randomized controlled trial was used. Totally 141 cases of mediate-risk pGGNs were divided into treatment group （92 cases） and control group （49 cases） according to the random table method. The treatment group was given the basic Sanjie Formula （基础散结方） orally with modification according to the identification of traditional Chinese medicine （TCM） state， 1 dose per day， 3 months as a course of treatment.Three months after the treatment patients were checked by CT. Patients who were clinically judged as cure， moderate to low risk， and turned to surgical resection do not carry out a second course of treatment，and the rest of the patients continued to complete the second courses. Patients in the control group did not receive any treatment and were only followed up periodically. Patients in both groups received a CT review 3 months and 6 months after enrolled. Comprehensive curative effect was evaluated according to the reduction rate of the area of pulmonary nodules shown in chest CT， to further explore the clinical effective difference for patients at different TCM state； the risk of malignancy index （Mayo score） was calculated by Mayo model at enrollment and 3 months and 6 months after enrolled. Adverse events were monitored continuously during the study. ResultsDuring the follow-up， 8 cases in the treatment group and 7 cases in the control group were lost. A total of 126 cases completed the whole process， including 84 cases in the treatment group and 42 cases in the control group. The total effective rates at 3 months and 6 months of the treatment group were 46.15% （30/65） and 45.71% （32/70） in the treatment group， while the total effective rates at 3 months and 6 months in the control group were 12.5% （4/32） and 10.00% （4/40）. Compared with the control group， the comprehensive curative effect of 3 months and 6 months of enrollment in treatment group was significantly better than that in corresponding control group （P＜0.01）. The pulmonary nodule area and Mayo score in the treatment group decreased after 3 and 6 months of enrollment （P＜0.01）. In contrast， there was no statistically significant difference in nodule area between pre- and post-enrollment time points in the control group （P＞0.05）， and probability of Mayo risk increased in the control group after 6 months of enrollment compared to pre-enrollment （P＜0.05）. Among the 84 patients in the treatment group， there were 15 cases of qi deficiency state， 7 cases of yin deficiency state， 5 cases of yang deficiency state， 20 cases of qi depression state， 32 cases of damp-heat state， and 5 cases of harmonious state； the difference in the distribution of the total clinical effective rate of the patients with different TCM states after treatment was statistically significant （P＜0.05）， and the total effective rate of two-by-two comparison of qi depression state was higher （13/20，65.00%） than that of the total effective rate of damp-heat state （8/32，25.00%， P＜0.00833）. There were no significant changes in blood routine， urine routine， liver function and kidney function in both groups， and no adverse events occurred. ConclusionTreating mediate-risk pGGNs based on the state theory can effectively reduce the area of pulmonary nodules and inhibit the growth of malignant risk of pulmonary nodules.