Objective:To investigate the clinical efficacy of radial extracorporeal shockwave therapy(ESWT)for scapulohumeral periarthritis in the elderly.Methods:A total of 82 patients diagnosed with scapulohumeral periarthritis at the rehabilitation medicine department of our hospital from July 2016 to January 2019 were retrospectively analyzed.The visual analogue score(VAS), Constant-Murley score(CMS), range of motion(ROM), adverse reactions, curative effectiveness and survival analysis were examined before treatment and at several time points within 6 months of treatment.Results:Compared with pre-treatment, the VAS, CMS, ROM, curative effects and survival analysis of patients with primary and secondary scapulohumeral periarthritis improved after treatment in both the conventional rehabilitation therapy group and the conventional rehabilitation therapy combined with ESWT group(all P<0.05). The short-term effects(2 weeks and 1 month after treatment)were better in the conventional rehabilitation therapy combined with ESWT group than in the conventional rehabilitation therapy group( P<0.05). There was no significant difference in long-term effects(2, 4 and 6 months after treatment)between the two groups( P>0.05). For patients with primary scapulohumeral periarthritis, conventional rehabilitation therapy combined with ESWT had advantages over conventional rehabilitation therapy in reducing the VAS score and improving shoulder function(CMS score and ROM)( P<0.05). For patients with secondary scapulohumeral periarthritis, conventional rehabilitation therapy combined with ESWT was better in reducing VAS than conventional rehabilitation therapy( P<0.05), while there was no significant difference in shoulder function improvement between the two groups(all P>0.05). Conclusions:Conventional rehabilitation combined with ESWT can relieve shoulder pain, improve range of motion and has a good safety profile in the treatment of scapulohumeral periarthritis in the elderly, but there is no significant difference in long-term efficacy between conventional rehabilitation therapy and conventional rehabilitation therapy combined with ESWT.

Objective To observe and contrast the effects of dexmedetomidine and ketamine on the restlessness and analgesia during recovery period of anesthesia after tonsillectomy in children. Methods Sixty ASA Ⅰ-Ⅱ child patients underwent tonsillectomy and adenoidectomy were randomly divided into three groups, group P (appropriate amount of placebo was given in the operation), group D (dexmedetomidine) and group K (ketamine). Data of mean arterial pressure and heart rate of three groups were documented before anesthesia (T0), during extubation (T1), 5 min (T2), 10 min (T3), 15 min (T4) and 30 min (T5) after extubation were recorded. The analepsia time, adverse reactions, restlessness score and pain score were collected in three groups of patients. Results Compared with group P, values of mean arterial pressure and heart rate were more stable at T1, T2 and T3 in groups D and K (P<0.05). The restlessness score, incidence of restlessness and adverse reactions were lower in groups D and K than those in group P (P<0.05), and which were lower in group D than those of group K (P<0.05). Conclusion Both dexmedetomidine and ketamine can play an analgesic role in recovery period of anesthesia and reduce restlessness, adverse reactions and pain score in child patients. Moreover, dexmedetomidine is more effective on inhibiting restlessness and adverse reactions.

Objective To evaluate the reliability and accuracy of the fully automated erythrocyte sedimentation rate (ESR) analy‐ser Monitor‐100 for determining ESR .Methods 146 outpatients and inpatinets were selected and detected ESR by the fully automa‐ted ESR analyser 1 h ,30 min and the Westergren method .Then these three kinds of method were compared and the repeatability test was performed .Results (1)The ESR values determined by the analyser 1 h ,analyser 30 min and Westergren method were 37 . 8 ± 34 .1 ,38 .1 ± 33 .7 ,36 .4 ± 32 .9 respectively ,there were no statistical significance between any two methods (P>0 .05) .(2)The detection rates of the positive results by the analyser 1 h ,analyser 30 min and Westergren method were 43 .2% ,44 .5% and 45 .2%respectively ,no statistical difference between them was found (P>0 .05) .(3)The Kapper values between the analyser 30 min with the analyser1h ,between the analyser 30 min with the Westergren method and between the analyzer 1h with the Westergren method were 0 .944 ,0 .875 and 0 .903 .4 respectively .(4)The CV values in the repeatability test were very lower and within the acceptable limits .Conclusion Compared with the Westergren method ,the fully automated ESR analyser Monitor‐100 has lower false positive rate and lower false negative rate ,moreover its consistency and repeatability are excellent ,it is convenient ,fast ,safe and should be largely promoted in clinic .

Objective To investigate the expression and clinical significance of interleukin -6 (IL -6)in aggressive and indolent lymphoma patients.Methods Serum specimens obtained from 1 07 non -Hodgkin's lympho-ma (NHL)patients and 50 healthy controls were collected.Chemiluminescence immunoassay was used to assess the expression of IL -6 in the serum.Results The level of serum IL -6(1 8.54 ±4.53)ng/L in aggressive lymphoma group was significantly higher than (6.90 ±1 .78)ng/L in the inert lymphoma group,and the serum IL -6 levels of two groups were significantly higher than the healthy control group (3.87 ±0.76)ng/L.The lymphoma patients,with B symptoms,elevated CRP or bone marrow involvement presented higher IL -6 level than the other patients (P <0.05).IL -6 level of the IPI high -risk group was higher than the intermediate -risk group and low -risk group, with significant difference (P <0.05 ).The correlation study showed that IL -6 and CRP,IPI /FLIPI,Ann Arbor stage,B symptoms,bone marrow involvement had significantly positive correlation (P <0.05);Through analysis of the effect of the patients with aggressive lymphoma,the serum level of IL -6 in patients with complete remission was sig-nificantly higher than the non complete remission group.By Logistic regression analysis,IL -6 was one of the inde-pendent risk factors affecting the treatment effect of NHL,and the difference was statistically significant (P <0.05). Conclusion The serum IL -6 was significantly elevated in NHL patients,in association with tumor invasion,progno-sis and therapeutic effect.IL -6 may help the diagnosis and prognosis of NHL.

Objective To understand the study habits of medical postgraduates in basic cours-es so as to provide references for the reformation of teaching methods. Methods Totally 250 postgra-duates of grade 2010 in our university were investigated with self-made questionnaire. The contents of the questionnaire included basic condition of postgraduates, study methods and suggestions for teaching methods. Rate, percentage and Chi-square test were applied to do statistical analysis. Results Accor-ding to the results of the collected 246 copies of questionnaire, 91.5%(225/246) did not preview lessons before class, 93.5%(230/246) took notes in class, 78.9%(194/246) simply took notes in the book, 60.6%(149/246) preferred more detailed courseware and 27.2%(67/246) reviewed lessons after class. The percentage of simply taking notes in the book of local students (86.5%) was significantly higher than that of army ones (73.2%) (P=0.030), but the percentages of preferring more detailed courseware and reviewing lessons after class of local students were significantly lower than those of army ones (P=0.008, P=0.016). Conclusions The proportion of previewing before class is low among postgrauates. Postgraduates depend heavily on teachers and do not review after class in time. There are differences between local students and army students in taking notes and review habits. It is important to cultivate postgraduates’good study habits.

Graphene ( GN) and multiwalled carbon nanotubes ( MWCNT) composites were coated on glassy carbon electrode ( GCE ) and then poly ( nicotinic acid ) ( PNA ) was electrodeposited on the modified electrode. The electrochemical behavior of pyridoxine hydrochloride ( VB6 ) was investigated at the modified electrode by cyclic voltammetry ( CV ) and differential pulse voltammetry ( DPV ) . Results showed the oxidation current of VB6 at the GN-MWCNT/PNA/GCE was obviously larger than that at GCE, PNA/GCE and GN/MWCNT/GCE. The oxidation process of VB6 was an irreversible diffusion-controlled process involving one electron and two protons. The liner range between the peak current intensity of DPV and the concentration of VB6 was 0 . 05-200 μmol/L with a detection limit of 0 . 02 μmol/L ( S/N=3 ) . The modified electrode showed a good reproducibility with a relative standard deviation of 3 . 1% ( n=8 ) . The proposed method was applied to the analysis of vitamin B6 in vitamin B6 tablets and compound vitamin B tablets with recoveries between 96 . 1%-104 . 5%.

Astaxanthin is a useful pigmentation source in fish aquaculture. It has strong antioxidative activity and therefore has potential application in delaying aging and degenerative diseases in human and animals. In recent years, there is a growing demand for astaxanthin. The red yeast Xanthophyllomyces dendrorhous (called Phaffia rhodozyma before) is one of the most promising microorganisms for the commercial production of astaxanthin. During fermentation, X. dendrorhous shows the Crabtree effect. Higher glucose concentration will cause significant reductions in biomass and astaxanthin production. Therefore, fed-batch processes are particularly useful. In this paper, effects of glucose-feeding strategies on astaxanthin production by X. dendrorhous were studied. Based on the substrate inhibition model, an optimized two-stage feeding strategy for astaxanthin production of high-cell-density fermentation was proposed. Glucose concentration was first controlled at about 25 g/L during the lag phase and the early exponential phase. In such case, biomass could reach its maximum value in relatively short time. Then the glucose concentration was controlled at about 5 g/L in the later exponential phase and stationary phase. The synthesis of astaxanthin could be effectively prolonged. The results showed that the optimized two-stage feeding strategy was the best among all the feeding strategies, and could obtain the highest biomass (23.8 g/L) and astaxanthin production (29.05 mg/L), which was a significant increase (52.8% and 109% respectively) compared with a batch process.
Basidiomycota ; metabolism ; Fermentation ; Kinetics ; Models, Biological ; Xanthophylls ; biosynthesis

Objective: To discuss the application of three dimentional(3D)visualization technologies in treatment plan of hepatic malignant tumor. Methods: The clinical data of 300 patients with liver malignant tumor who received treatment from January 2016 to January 2017 in the Third Department of Hepatic Surgery of Eastern Hepatobiliary Surgery Hospital was retrospectively analyzed in this study, including 221 male and 79 female patients aged from 7 to 76 years with median age of 54 years. The median height was 168 cm (115-183 cm), the median weight was 65 kg (20-105 kg) and the median tumor volume was 142 ml (23-2 493 ml). Three-dimensional visualization technology was used in all patients to reconstruct liver three-dimensional graphics. Also, two and three-dimensional methods were taken respectively to evaluate patients and develop treatment strategy. The change of treatment strategy caused by 3D evaluation, actual surgical plan, operation time, time of hepatic vascular occlusion, intraoperative blood loss, volumes of blood transfusion and postoperative complications was observed. Results: After three-dimensional visualization technology was applied, 75(25%) of 300 patients′ treatment strategies had been changed. The range of hepatectomy was extended in 25 patients. And 7 of them were due to hepatic venous variation, which resulted in increasing drainage area. In other 4 patients, liver resections were extended due to lack of perfusion of the liver parenchyma after the removal of portal vein. And hepatectomy was expanded in 14 patients in order to increase the surgical margin. The range of hepatectomy was reduced in 8 patients, 4 of which were due to hepatic venous variation, such as hepatic vein of segment 4 or lower right posterior hepatic vein. The remaining 4 cases were because of insufficient residual liver volume.The surgical resection was performed in 278 cases, 257 of which received operation directly. Left hepatectomy was performed in 24 patients and right hepatectomy was performed in 33 patients. Left trisectionectomy was carried out in 12 patients and right trisectionectomy was carried out in 11 patients. Caudate lobectomy was applied in 10 patients. There were 18 cases of left lateral sectionectomy, 7 cases of right anterior sectionectomy, 25 cases of right posterior sectionectomy and 18 cases of mesohepatectomy. Single or multi segment resection was performed in 99 patients. The treatment strategy of thirty-six patients was converted to staged hepatectomy (ALPPS 11 cases and portal vein embolization 25 cases). The median operation time was 130 minutes (90-360 minutes) and the median inflow blood occlusion time was 20 minutes (0-75 minutes). Median blood loss volume was 200 ml (20-1 600 ml). Thirty-seven of 278 patients received transfusions, and the average red blood transfusion volume was (4.4±1.7)units (0-8 units). Median hepatic resection volume was 530 ml(30-2 600 ml). There were 117 cases of pleural effusion after operation, including 3 patients needing invasive therapy. Ascites occurred in 23 patients, 6 of whom needed invasive therapy. Biliary leakage was observed in 30 patients. Eight patients occurred hepatic cutting surface hemorrhage, 6 of whom received blood transfusion, and 4 of whom underwent laparotomy to stop bleeding. Three patients had pulmonary infection after surgery and 3 patients appeared biliary obstruction. Deep vein thrombosis took place in 2 patients and portal vein thrombosis was observed in 4 patients. No postoperative liver failure and death ever happened in our study group. Conclusion Three-dimensional visualization technique can optimize the treatment strategy of patients with liver malignant tumor, improve surgical safety.

Objective:To explore the relationship between geriatric nutritional risk index (GNRI) and modified creatinine index (mCI) and all-cause mortality in maintenance hemodialysis (MHD) patients.Methods:It was a prospective cohort study. The MHD patients aged≥50 years old at hemodialysis centers of eleven hospitals in Beijing from April to June 2017 were selected as subjects. Baseline clinical data of the patients were collected. The patients were divided into high GNRI group (≥98) and low GNRI group (<98), and high mCI group (≥20.16 mg·kg -1·d -1) and low mCI group (<20.16 mg·kg -1·d -1), and further divided into 4 groups: G1 group (high GNRI and high mCI), G2 group (high GNRI and low mCI), G3 group (low GNRI and high mCI) and G4 group (low GNRI and low mCI). The differences of clinical characteristics among the four groups were compared. The patients were followed-up until June 2018 or death or loss, and the endpoint event was all-cause mortality. Kaplan-Meier survival analysis was used to compare the differences of the cumulative survival rates among the four groups. A multivariate Cox regression model was used to analyze the relationship between GNRI and mCI and all-cause mortality. Results:A total of 613 patients were included in the study, aged (63.65±7.78) years old (ranged from 50 to 81 years old), with 355 males (57.91%). The GNRI and mCI were (99.35±5.75) and (20.16±2.79) mg·kg -1·d -1, respectively. There were 232 patients (37.85%) in the G1 group, 177 patients (28.87%) in the G2 group, 95 patients (15.50%) in the G3 group, and 109 patients (17.78%) in the G4 group. There were statistically significant differences in age, sex, proportion of diabetes, proportion of coronary heart disease, body mass index, serum albumin and serum creatinine among the four groups (all P<0.05). A total of 69 patients (11.26%) died during a median follow-up time of 52(4, 52) weeks. Kaplan-Meier survival curve results showed that the mortality of patients with low GNRI was higher than that of patients with high GNRI (log-rank χ 2=26.956, P<0.001), and the mortality of patients with low mCI was higher than that of patients with high mCI (log-rank χ 2=25.842, P<0.001). The mortality was 3.45% in group G1, 10.73% in group G2, 9.47% in group G3, and 30.28% in group G4, and the differences among the four groups were statistically significant (log-rank χ 2=57.153, P<0.001). Multivariate Cox regression analysis results showed that as continuous variables, GNRI ( HR=0.911, 95% CI 0.882-0.941, P<0.001) and mCI ( HR=0.873, 95% CI 0.797-0.956, P=0.003) were correlated with all-cause death. As categorical variables, compared with high GNRI group and high mCI group, patients with low GNRI ( HR=3.469, 95% CI 2.125-5.665, P<0.001) and low mCI ( HR=3.255, 95% CI 1.879-5.640, P<0.001) had higher risks of death. Compared with G1 group, patients in G2 group ( HR=2.488, 95% CI 1.079-5.738, P=0.033) and G4 group ( HR=9.449, 95% CI 4.362-20.470, P<0.001) had higher risks of death. Conclusions:GNRI and mCI are independent predictive factors of all-cause mortality in MHD patients. The combination of GNRI and MCI can more accurately predict the risk of all-cause death in middle-aged and elderly MHD patients.

Objective:To investigate the association between body mass index (BMI) and waist circumference (WC) with all-cause mortality in middle-aged and elderly patients receiving maintenance hemodialysis (MHD).Methods:It was a prospective cohort study. The clinical data of MHD patients aged ≥50 years old from eleven hemodialysis centers from April to June 2017 in Beijing were analyzed. The patients were divided into low BMI group [body mass index (BMI)<18.5 kg/m 2], normal BMI group (18.5 kg/m 2≤BMI <24.0 kg/m 2), overweight group (24.0 kg/m 2≤BMI<28.0 kg/m 2) and obesity group (BMI≥28.0 kg/m 2) by BMI, and central obesity group (male ≥85 cm, female ≥80 cm) and normal WC group (male <85 cm, female <80 cm) by WC. Kaplan-Meier survival analysis method was used to compare the difference of all-cause mortality between those groups. Multivariate Cox regression model was used to analyze the association of BMI and WC with all-cause mortality. Results:A total of 613 MHD patients were enrolled, with age of (63.82±7.14) years old and 258 (42.09%) females. There were 46 (7.50%) patients in the low BMI group, 303 (49.43%) patients in the normal BMI group, 227 (37.03%) patients in the overweight group and 37 (6.04%) patients in the obesity group. In addition, 346 (56.44%) patients were categorized as central obesity. Kaplan-Meier survival analysis results showed that the all-cause mortality rates of low BMI group (log-rank χ2=13.571, P<0.001) and obesity group (log-rank χ2=6.664 P=0.010) were higher than that of normal BMI group, and the all-cause mortality rate of central obesity group was higher than that of normal WC group (log-rank χ2=5.698, P=0.017). Multivariate Cox regression analysis results showed that，besides the low BMI group and obesity group (with normal BMI group as a reference, HR=5.289, 95% CI 2.318-12.067, P<0.001; HR=5.360, 95% CI 2.088-13.760, P<0.001, respectively), normal BMI and overweight combined with central obesity were also independently correlated with all-cause mortality (with normal WC group as a reference, HR=2.605, 95% CI 1.199-5.663, P=0.016; HR=1.787, 95% CI 1.026-3.732, P=0.031, respectively). Conclusions:Lower and higher BMI or combined central obesity are independently associated with all-cause mortality in the middle-aged and elderly patients receiving MHD.