Objective To explore effect of CYP3A4 gene polymorphism and genetic testing on the efficacy of fentanyl in patients with extensive burns.Methods A prospective randomized controlled study, 149 patients with extensive burns were picked from Feburary to July in 2015.Patients were randomly divided into matched group ( n=56 ) and experimental group ( n=93 ) . The matched group was treated with fentanyl 5 g/kg to finish implementation of anesthesia induction.Depends on the gene detection results, the patients in experimental group were treated with 6 g/kg, 5 g/kg or 4 g/kg fentanyl.The VAS score at different time after operation in the experimental group and the control group were compared , and the dosage of fentanyl was observed.Patients whose VAS score was greater than 7 should treated with intramuscular injection of pethidine 100 mg, recorded all patients with pethidine,s additional cases and the times.At the same time, the adverse reactions of the two groups were recorded before and after hospital discharge. ResuIts The score of VAS was not significantly different after wake up immediatly after the surgery , and the score of VAS was significantly lower in the experimental group patients in 6h,12h after the surgery (P<0.05).The dosage of fentanyl in the experimental group and the number of the cases and the times were significantly decreased (P<0.05).The adverse reactions after the surgery such as nausea, vomiting, itching, drowsiness, and adverse reactions were significantly lower in the experimental group (P<0.05).ConcIusion CYP3A4 gene detection in patients with large area of burn in the individual drug use is important, because of patients’ genotype adjusting fentanyl dosagecan, it enhances significantly the analgesic effect, reduces the amount of drug use, and effectively reduces the adverse reactions.

Objective To investigate the expression of C/EBP homology protein (CHOP) in peripheral brain tissue of patients with severe traumatic brain injury (TBI) and its correlation with the injury severity.Methods The study included peripheral brain tissues of 41 TBI patients (TBI group).Another 16 autopsy specimens succumbed to other diseases (except for TBI or other central nervous system diseases) were selected as controls.The control group and TBI group were subdivided into immaturity group (≤18 years),adult group (18-59 years) and elderly group (＞59 years).According to Glasgow Coma Scale (GCS) on admission,TBI group was classified as severe TBI group (GCS of 6-8) and particularly-severe TBI group (GCS of 3-5).CHOP expression in peripheral tissues after TBI was compared in between different age,gender and GCS.Nerve cell apoptosis was detected by TUNEL technique and correlation between CHOP level and apoptotic number was analyzed.Results There were no age and gender differences regarding CHOP expression in control group (P ＜ 0.05).Compared with control group,expression of CHOP presented notable up-regulation in TBI group (P ＜ 0.05).Expression of CHOP presented no gender difference in TBI group (P ＞ 0.05),but its expression was lower in the aged than in adult or immaturity (P ＜ 0.05) as well as notably higher in particularly-severe TBI group than in severe TBI group (P ＜ 0.05).Nerve cell apoptosis in TBI group was far greater in number than that in control group (P ＜0.05).A positive correlation was observed between CHOP level and apoptotic index (r =0.72,P ＜ 0.05).Conclusion Expression level of CHOP after TBI is closely related to the injury severity and nerve cell apoptosis,but the apoptosis pathway induced by CHOP may not be a major factor in secondary brain injury after TBI in the aged patients.

BACKGROUND: The deficiency of perfect animal femoral head necrosis model limited its further investigation. OBJECTIVE: To verify the feasibility of establishing rabbit femoral head necrosis models using liquid nitrogen rsfdgeration method, and to provide a foundation for subsequent research. METHODS: A total of 20 adult, New Zealand, white rabbits were selected in the study. The round ligament of femur was not cut off and femoral head was not dislocated, and the exposed femoral head were quick frozen using cotton bud carrying liquid nitrogen for successive 25 times, with 10 s per time. The specimens were examined by gross anatomy, X-ray film, MRI and histological observation at day 3, 7 and weeks 2, 4, 6, and 8 after operation. RESULTS AND CONCLUSION: The histolOgical section showed that chondrocyte, osteccyts, and myelold tissues presented necrosis in freezing and periphery at 3days after model preparation, and the repair process appeared at 2weeks after operation. The articular surface of femoral heads appeared collapse at 4 weeks after operation, and these changes became obvious at 6 weeks. The femoral head presented ostecarthdtis-like disorder, with seriously collapsed articular surface at8 weeks, and the contour of femoral head changed in 2 animals. The results demonstrated that without hip dislocation, rabbit femoral head necrosis models can be established successfully using liquid nitrogen refrigeration method. This method is simple, feesible, with high succeed rate, which can be used in subsequent research.

Objective To investigate the effect and underlying mechanism of apolipoprotein E (APOE) genetic polymorphism in treating blood brain barrier (BBB) breakdown after traumatic brain injury (TBI).Methods Human APOE knock-in mice (ε3,ε4),APOE knockout mice,and APOE wild-type mice with each numbering 80 were respectively divided into TBI group (n =50),sham-operation group (n =15) and normal control group (n =15) according to the random number table.TBI group was subdivided at 1 day (n=15),3 days (n=15),and7 days (n=20).TBI was induced with a pneumatically operated injury device.BBB permeability to large or small molecules was evaluated by measuring Evans blue (EB) and fluorescein sodium (NaFI) extravasation into the damage area at 1,3,and 7 days postinjury.Brain water content was determined using the dry-wet method.Western blotting and qRT-PCR for tight junction-associated proteins Occludin and Claudin-5 were performed at 7 days postinjury.Results With respect to normal control group,BBB permeability to EB and NaFI was significantly higher in ε4 and APOE knockout mice than in ε3 and APOE wild-type mice.There appeared significant increase in BBB permeability to EB and NaFI in TBI group,with insignificant differences among rats of each genotype at 1 and 3 days postinjury (P ＞ 0.05).Whereas at 7 days postinjury,BBB permeability to EB in APOE wild-type and e3 mice returned to the normal level (P ＞ 0.05),but it re mained at a high level in APOE knockout and ε4 mice (P ＜ 0.01).Meanwhile,BBB permeability toNaFI was significantly higher in ε4 and APOE knockout mice than in ε3 and APOE wild-type mice (P ＜ 0.01).Brain water content was equivalent among rats of each genotype at 1,3 and 7 days postinjury (P ＞0.05).Western blotting and qRT-PCR demonstrated Occludin and Claudin-5 in ε4 and APOE knockout mice were significantly lower than those in ε3 and APOE wide-type mice (P ＜ 0.05).Conclusion APOE plays an important role in restoration of BBB function after TBI,but ε4 may impede the recovery of BBB breakdown after TBI through its effect on tight junction.

Objective:To sum up nursing experience of a multi-drug resistant patient with upper gastrointestinal hemorrhage who underwent Lateral skull base.Methods:One patient with multi-drug resistant was admitted to our hospital in October, 2019. To observe and prevent the postoperative complications of lateral skull base and to prevent the rupture bleeding of carotid artery. The early detection and treatment the symptoms of upper gastrointestinal bleeding is effective and necessary. Intervention for patient receiving nutrition therapy is promoted.Results:By giving psychological care to improve patient compliance. The patient had no postoperative complications of lateral skull base, and the bleeding symptoms of upper gastrointestinal hemorrhage was controlled in time.Conclusion:The patient was discharged from the hospital with a tracheal tube in a stable condition.

Objective　To analyze and visualize the epidemic changes of schistosomiasis in Wuhan from 2013 to 2022 based on a geographical information system (GIS), providing references for further schistosomiasis control activities. Methods　According to the historical data of the annual reports of schistosomiasis screening and street-level vector map of Wuhan City from 2013 to 2022, a spatial database of epidemic information at the street level was established. The Joinpoint regression model was utilized to analyze the trend of phased changes in blood positivity rate for schistosomiasis. ArcMap 10.8 was employed for the spatial visualization of the positive rate of serological tests for schistosomiasis among the screened population in the endemic areas of Wuhan over the past decade, as well as conducting hot spot analysis (Getis-Ord Gi*) to explore the spatial clustering relationship and spatiotemporal trends. Heatmaps were generated to reflect the changes in the positive rate of blood tests for schistosomiasis over a decade in various streets, and the areas were classified by the ward’s method of hierarchical clustering using the sum of squared deviations. Results　Over the past decade, the overall annual positive rate of schistosomiasis screening in Wuhan declined from 2.23% in 2013 to 0.47% in 2022, showing a general downward trend. The Joinpoint regression model analysis of the blood positive rate indicated the presence of one connection point in 2015; from 2013 to 2015, the annual percent change (APC) of the positive rate was 2.17%, showing an upward trend (P>0.05); from 2015 to 2022, the APC was -23.34%, indicating a downward trend (P<0.05). The map of positive street-level schistosomiasis screening rates for 2013-2022 shows that the positive rate count on the streets of Caidian District and Hannan District in southwestern Wuhan and Huashan Street on the east side, had a significant decrease over the ten years, while the rate in the streets under the jurisdiction of Dongxihu District in the west showed an increase. The hot spot analysis graph revealed that hot spots of the positive rate in Wuhan shifted from the southwest to the west beginning in 2018. The heatmap indicated the largest disparity in trend changes, with the most noteworthy decline in streets under Caidian District and an increasing trend in the streets under Dongxihu District. Conclusions　The overall epidemic situation of schistosomiasis in Wuhan is on a downtrend, although the positive rate of blood tests has increased in some areas. This has been attributed to a reduction in the total number of people participating in the blood tests and the slow decrease of antibodies in certain patients who were repeatedly sampled for testing. It is important to further strengthen the construction of monitoring capabilities, improve the sensitivity of monitoring systems, identify potential risks promptly, and handle them properly.

Filamentous fungi have been extensively used in industrial fermentation processes. One of the most interesting topics of filamentous fungi is their bothersome morphology, which closely correlates with the productivity and broth rheology. Aiming at the optimization of the microbial process, works mainly focused on the relationships between morphology, productivity and environment in the last decades. Based on those works, we tried to interpret the mechanism of filamentous fungi growth from physiological aspects, and reviewed the mathematical models describing the hyphal growth, differentiation during the formation of target products. Above all, efficient and effective morphology controlling strategies were addressed from the engineering view.
Fermentation ; Fungi ; cytology ; physiology ; Models, Theoretical ; Rheology

Objective To explore the prognostic factors that have affected the long-term survival of solitary large hepatocellular carcinoma (SLHCC) patients after hepatectomy.Methods The clinical data of 215 SLHCC patients accepted hepatectomy in the Xiangya Hospital,Central South University from January 2004 to December 2012 were retrospectively analyzed.There were 182 males and 33 females aged from 24 to 69 years(median age was 46 years).Using a variety of statistical methods,including the Kaplan-Meier estimator and the Log-rank test,the impacts of an array of clinicopathologic factors,such as age,gender,liver cirrhosis,chronic viral hepatitis,the Child-Pugh grading,microvascular invasion,macrovascular invasion and TNM staging,on the overall survival and the disease-free survival of SLHCC patients after hepatectomy were analyzed.The prognostic factors were evaluated by univariate and multivariate analyses for the long-term survival of SLHCC patients after hepatectomy.Results The whole group of patients with SLHCC showed 1-,3-,and 5-year overall survival rates of 88.1％,60.2％,and 41.7％,respectively,and exhibited 1-,3-,and 5-year disease-free survival rates of 80.1％,49.4％,and 33.6％,respectively.The 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with microvascular invasion were 82.0％,45.1％,29.0％ and 69.6％,36.1％,23.5％,respectively.In addition,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with macrovascular invasion were 64.7％,34.3％,18.3％ and 54.2％,24.1％,0,respectively.In contrast,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients without vascular invasion were 95.0％,72.3％,51.8％ and 90.1％,60.9％,42.9％,respectively.The results of univariate analysis indicated that liver cirrhosis,microvascular invasion,macrovascular invasion,TNM staging were hazardous factors for the overall survival of SLHCC patients (x2 =4.953,8.835,15.237,19.789 respectively,all P ＜0.05) ; while microvascular invasion,macrovascular invasion,TNM staging were risk factors for the diseasefree survival of SLHCC patients (x2 =12.974,13.247,24.516 respectively,all P ＜ 0.05).Furthermore,the multivariate analysis suggested that microvascular invasion,macrovascular invasion,TNM staging were the independent prognostic factors that have affected the overall survival and disease-free survival of SLHCC patients(all P ＜ 0.05).Conclusion Microvascular invasion,macrovascular invasion and TNM staging were the independent prognostic factors for the long-term survival of patients with SLHCC after hepatectomy.

Objective To explore the prognostic factors that have affected the long-term survival of solitary large hepatocellular carcinoma (SLHCC) patients after hepatectomy.Methods The clinical data of 215 SLHCC patients accepted hepatectomy in the Xiangya Hospital,Central South University from January 2004 to December 2012 were retrospectively analyzed.There were 182 males and 33 females aged from 24 to 69 years(median age was 46 years).Using a variety of statistical methods,including the Kaplan-Meier estimator and the Log-rank test,the impacts of an array of clinicopathologic factors,such as age,gender,liver cirrhosis,chronic viral hepatitis,the Child-Pugh grading,microvascular invasion,macrovascular invasion and TNM staging,on the overall survival and the disease-free survival of SLHCC patients after hepatectomy were analyzed.The prognostic factors were evaluated by univariate and multivariate analyses for the long-term survival of SLHCC patients after hepatectomy.Results The whole group of patients with SLHCC showed 1-,3-,and 5-year overall survival rates of 88.1％,60.2％,and 41.7％,respectively,and exhibited 1-,3-,and 5-year disease-free survival rates of 80.1％,49.4％,and 33.6％,respectively.The 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with microvascular invasion were 82.0％,45.1％,29.0％ and 69.6％,36.1％,23.5％,respectively.In addition,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with macrovascular invasion were 64.7％,34.3％,18.3％ and 54.2％,24.1％,0,respectively.In contrast,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients without vascular invasion were 95.0％,72.3％,51.8％ and 90.1％,60.9％,42.9％,respectively.The results of univariate analysis indicated that liver cirrhosis,microvascular invasion,macrovascular invasion,TNM staging were hazardous factors for the overall survival of SLHCC patients (x2 =4.953,8.835,15.237,19.789 respectively,all P ＜0.05) ; while microvascular invasion,macrovascular invasion,TNM staging were risk factors for the diseasefree survival of SLHCC patients (x2 =12.974,13.247,24.516 respectively,all P ＜ 0.05).Furthermore,the multivariate analysis suggested that microvascular invasion,macrovascular invasion,TNM staging were the independent prognostic factors that have affected the overall survival and disease-free survival of SLHCC patients(all P ＜ 0.05).Conclusion Microvascular invasion,macrovascular invasion and TNM staging were the independent prognostic factors for the long-term survival of patients with SLHCC after hepatectomy.

Objective:The paper aims at developing a method of defining and visualizing the scope of the basic medical insurance pharmacy service, and provides a new way of thinking for the designated pharmacy planning. Methods:Collecting the basic data and information on administrative divisions in the planning area taking equity and efficiency as the guidance, using ArcGIS and its function modules to define and visualize the scope of the medical in-surance pharmacy service. The procedure of issue focus, method improvement, data simulation, expert consultation, methodology perfecting were followed to define and visualize the scope. Results:Forming a whole set of operative pro-cedures of defining and visualizing the scope of the medical insurance pharmacy service based on medical resources allocation standard, and the operation commands and procedures in ArcGIS were clarified. Conclusion:Operating ac-cording to the appropriate method steps, the following can be achieved:(1) The adjacent scope of medical insurance pharmacy service are adjacent to each other but do not overlap or cross;(2) Spatial relations can be clearly and ef-fectively expressed;(3) The shape is flat and regular;(4) The data collected at different times can be comparable in space, providing good prerequisites for medical insurance designated pharmacy planning.