Sepsis is essentially a result from immunological dissonance provoked by severe insults such as fulminant infection,severe trauma and extensive burns.It originates from excessive inflammatory responses and develops into immune paralysis or immunosupression.It has been demonstrated that cellular immune response plays a vital role in the pathogenesis of sepsis.In the stage of excessive inflammation,several kinds of immune cells are activated by pathogen-associated molecular patterns (PAMPs) or damage-associated molecular patterns (DAMPs) and subsequently produce a vast number of pro-inflammatory cytokines,while during the stage of immune paralysis,excessive apoptosis could result in decrease of immune cells with functional compromise.Inhibitory or regulatory immune cell subsets eventually dominate the direction of immune response and the production of inhibitory cytokines is enhanced.For clinical practice,surveillance of changes and shift in overall immune function is a basis for immunotherapy,especially to immunomodulation therapy.However,there is still a lack of adequate indexes or markers for integral evaluation of host immune state in the development of sepsis.

The information commons concept-based stereoscopic resources support system for academic library with brand-new connotations and its application were proposed according to the increasing development and expansion of informationization, networking and digitization in different social fields, the significant change in disseminating methods of information resources, and the need of readers for library service.

A method to assess library-holding journals according to their weighted citations was proposed in light of the actual needs of users for core journals, the use of library-holding journals and references by authors in different orders of precedence.The Western journal of rheumatology, highly cited by authors of Second Military Medical U-niversity, were assessed using this method, showing that this method is better than the citation analysis-based tra-ditional method in assessment of journals.

Objective Feedback of 35 graduates from a Sino-Australia cooperation program was investigated at 1 -year fulfillment of clinical practice,and reflect some of the issues in the process of cultivation and utilization of nursing talents from the program. Methods 32 nursing talents from a Sino-Australia cooperation program at 1 -year fulfillment of clinical practice was selected as research object.Self made questionnaires baaed on the goal of the program were used,which included both open and close questions.The investigation results were analyzed. Results The nursing talents considered that the main advantages of the program were as followed:cultivation of their ability in active communication,improving English level,broaden international vision,and internationalization of courses. Conclusions Stratified and individualized teaching strategies need to be implemented.English study and nursing specialty study are to be appropriately combined.Routes of employment should be broadened.In addition,imported courses are to be adjusted according to domestic situation.While attaching importance in teaching,faculty should also emphasize advising.Finally,it is not to be ignored for the hospitals that they are responsible for greater utilization and cultivation of the nurses with both nursing and English ability.

Objectives By survey the head nurses or nursing instructors,to know the one year professional performance of nurses graduated from Sino-Australia cooperation program of Jinhua Polytechnic,which can help us to make the educational plan and further cultivation.MethodSelf-composed questionnaire is provided to 32 head nurses or nursing instructors from secondary and tertiary hospitals of Zhejiang province.SPSS 18 is applied for data analysis.ResultThe nurses' performance is generally consistent to the objectives ofthe Sino-Australia nursing program and the rating scores are normally distributed. There is no significant difference in the average performance of nurses comparing to a test value of 71,P≤0.08.The scores of professional quality,nursing competency,English ability,humanitarian caring,active learning,team work and adaptability to clinical responsibilities were especially well rated.ConclusionResults indicated that the school should appropriately adjust the direction for students＇ employment,consider to localize the nursing courses introduced from foreign countries.It is necessary for the hospitals to ponder on how to further cultivate and utilize the English competency of the nurses,and use the individualized strategies to retain the nurses who are proficient in English.

Objective:To investigate the relationship between serum retinol binding protein (RBP), stromal cell derived factor-1 (SDF-1) and renal function in patients with diabetic nephropathy (DKD).Methods:The patients with type 2 diabetes mellitus (T2DM) admitted to Yantai Affiliated Hospital of Binzhou Medical College from October 2017 to October 2020 were prospectively selected, 438 patients were divided into simple T2DM group ( n=276)and DKD group( n=162) according to the presence or absence of DKD, according to the ratio of urinary albinin/creatinine (UACR) were divided into normal( n=25), microalbuminuria ( n=75) and macroalbuminuria group ( n=62), according to the estimated glomerular filtration rate (eGFR) were divided into G1 stage ( n=28), G2 stage ( n=27), G3A + G3B stage ( n=35), G4 stage ( n=39)and G5 stages( n=33). The relationship between RBP, SDF-1 and renal function index UACR, serum uric acid (UA), blood urea nitrogen (BUN), β 2-microglobulin (β 2-MG) and serum creatinine (Scr) was analyzed. Measurement data of normal distribution were expressed as Mean± standard deviation ( Mean± SD). Independent sample t-test was used for comparison between two groups, and one-way analysis of variance was used for comparison between multiple groups.Chi-square test was used to compare the enumeration data between groups. Receiver operating characteristic curve (ROC) was used to analyze the discriminant value of RBP and SDF-1 for DKD. Pearson was used for correlation analysis among indicators. Multivariate linear regression analysis was used to analyze the influencing factors of RBP. Results:In the DKD group, the duration of diabetes was longer, the levels of RBP, UACR, UA, BUN, β 2-MG, Scr were high, SDF-1 and eGFR were lower, with statistically significant differences compared with the simple T2DM group( P<0.05).The areas under the curve of RBP and SDF-1 to distinguish DKD were 0.903 and 0.868, and the optimal cut-off values was 70.71 mg/L and 5.69 ng/mL. With the increase of urinary albumin and clinical stage, the levels of RBP, UACR, UA, BUN, β 2-MG, Scr increased gradually, while SDF-1 and eGFR decreased gradually, and the differences were statistically significant ( P<0.05).RBP was positively correlated with UACR, UA, BUN, β 2-MG and Scr in DKD patients ( r=0.764, 0.787, 0.693, 0.577, 0.801, P<0.000 1), and negatively correlated with EGFR ( r=-0.782, P<0.000 1). SDF-1 was negatively correlated with UACR, UA, BUN, β 2-MG and Scr ( r=-0.744, -0.794, -0.666, -0.605, -0.820, P<0.000 1), and positively correlated with EGFR ( r=0.767, P<0.000 1). The multiple linear regression equation was RBP=29.852+ 0.007UACR+ 0.101UA+ 0.497BUN+ 0.034Scr-0.083eGFR ( P<0.001). Conclusion:RBP and SDF-1 have certain discriminant value for DKD patients in T2DM population, and the degree of DKD renal function injury is positively correlated with RBP and negatively correlated with SDF-1, the increase of UACR, UA, BUN, Scr and the decrease of eGFR are risk factors for the increase of RBP.

AIM To study the effects of No.1 Weiyan Decoction (Codonopsis Radix,Paeoniae Radix alba,Taraxaci Herba,etc.) on hypoxia and hypoxic tolerance in gastric mucosal epithelial cells in rats with precancerous lesion of gastric cancer (PLGC).METHODS Forty rats were randomly divided into normal,model,Vitacoenzyme Tablets and No.1 Weiyan Decoction groups.Except for the normal group,the rats in the other groups were given with N-methyl-N'-nitro-N-nitrosoguanidine and Little Chengqi Decoction to establish a PLGC rat model.Ten weeks after the administration,the gastric mucosal epithelial microvascular ultrastructure was observed,the expressions of Hif1a mRNA,HIF-1 α protein and VEGF protein in gastric mucosal epithelium were detected.RESULTS Compared with the normal group,the number of microvasculatures in gastric mucosal epithelium was decreased;lumen was severely stenosed or expansive;inner wall was not smooth and had adhesion;vascular endothelial cells were swollen;the expression of Hif1α mRNA showed an increasing trend;the expressions of HIF-1α protein and VEGF protein were anomalous in the model group.Compared with the model group,the gastric mucosal vascular lesion of PLGC rats was improved,and the expressions of Hif1a mRNA,HIF-1α protein and VEGF protein were significantly decreased in the No.1 Weiyan Decoction group.CONCLUSION No.1 Weiyan Decoction can improve hypoxia and hypoxia tolerance,and induce angiogenesis in gastric mucosal epithelium in PLGC rats.

Objective:To evaluate the effect of remote ischemic conditioning (RIC) on left ventricular (LV) myocardial perfusion, myocardial viability, LV remodeling, regional and global LV function serially following acute myocardial infarction (AMI) in Chinese mini-pigs.Methods:AMI was established in 12 Chinese mini-pigs (8 males, 4 females; age: 6-8 months) and they were randomly divided into RIC group ( n=6) and non-RIC group ( n=6). RIC was performed in pigs by blood pressure inflation on the lower limbs for 5 min period and 4 cycles immediately after surgery. A series of myocardial perfusion imaging and gated 18F-fluorodeoxyglucose (FDG) myocardial metabolism PET/CT imaging were performed longitudinally at the 1st, 14th, 28th and 56th days after AMI, and parameters including total perfusion defect (TPD), hibernating myocardium (HM), Scar, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), summed motion score (SMS), summed thickening score (STS) and changes of these parameters were obtained. Independent-samples t test and Mann-Whitney U test were used to analyze data. Results:Nine Chinese mini-pigs survived after surgery and were performed imaging. Compared to non-RIC group ( n=4), HM at the 28th ((6.0±2.4)% vs (17.0±4.6)%; t=-4.158), TPD 14th-1st ((-11.8±5.4)% vs 9.0%(4.5%, 15.0%); z=2.449), TPD 28th-1st ((-15.3±3.9)% vs (12.0±3.0)%; t=-10.071), TPD 56th-1st ((-18.0±6.5)% vs 9.0%(4.5%, 12.0%); z=2.449), HM 28th-1st ((-10.5±6.9)% vs (8.3±2.1)%; t=-4.507), HM 56th-1st (-15.0%(-17.5%, -8.5%) vs 2.0%(0%, 7.0%); z=2.449) and LVEDV 14th-1st (-0.5(-2.5, 0) ml vs (13.0±4.4) ml; z=2.470) were reduced in RIC group ( n=5; all P<0.05). Conclusion:RIC can improve myocardial perfusion, delay LV remodeling in the acute stage and salvage hibernating myocardium in the subacute stage and chronic stage.

OBJECTIVETo study the chemical constituents from the 60% ethanol extract of Corydalis yanhusuo.

METHODThe chemical constituents were separated and purified by various chromatographic techniques, and their structures were elucidated by chemical evidence and spectroscopic analysis.

RESULTNine alkaloids were obtained and determined as 7-formyldidehydroglaucine (1), nantenine (2), (+)-O-methylbulbocapnine (3), d-corydaline (4), tetrahydrocoptisine (5), 8-oxocoptisine (6), palmatine (7), tetrahydropalmatine (8), and dehydrocorydaline (9), respectively.

CONCLUSIONCompound 1 was obtained from natural products for the first time, and its NMR data were firstly reported. Compound 3 was reported from Papaveraceae for the first time, and compound 6 was firstly reported from Corydalis yanhusuo.

ObjectiveTo investigate the clinical features of adult liver injury patients with drug reaction with eosinophilia and systemic symptoms (DRESS), adult-onset Still’s disease (AOSD) or hemophagocytic lymphohistiocytosis (HLH) and the correlation of the degree of liver injury with inflammatory indices and immune indices. MethodsRelated clinical data were collected from 58 patients with liver injury caused by the above three systemic inflammatory diseases who were admitted to Peking University First Hospital from January 2008 to April 2019, among whom 7 had DRESS, 29 had AOSD, and 22 had HLH. General information, liver biochemical parameters, inflammatory indices, and immune indices were collected before treatment. The t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Bonferroni method was used for further comparison between two groups. Four inflammatory indices were compared between the groups with different alanine aminotransferase (ALT) levels (≤200 U/L or ＞200 U/L), and a Spearman correlation analysis was used to investigate the correlation of ferritin and immune indices with ALT level. ResultsThe median age of the patients with DRESS or AOSD was 38 years, and the median age of the patients with HLH was 34 years. DRESS patients were mostly male (5/7, 71%), while most of AOSD patients (20/29, 69%) and HLH patients (12/22, 55%) were female. For liver injury indices, there were no significant differences between the three groups in ALT peak, aspartate aminotransferase level, and alkaline phosphatase level (all P＞0.05). For the indices for the synthetic function of the liver, there were no significant differences in blood glucose, albumin, and prothrombin activity between the three groups (all P＞0.05). For inflammatory indicators, there were significant differences between the three groups in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (all P＜0.001), while there were no significant differences between the three groups in lactate dehydrogenase, ferritin, and procalcitonin (all P＞0.05); the AOSD group had significantly higher median CRP and ESR than the other two groups (all P＜0.05). For the patients with the three diseases, there were no significant differences in the four inflammatory indices between any two the groups with different ALT levels (all P＞0.05), and the level of ferritin was positively correlated with ALT level (R2=0.702 1, P＜0000 1). As for immune indices, there were no significant differences in IgG, IgA, C4, and the counts of NK and B cells between the three groups (P＞0.05), and CD8+ T cells were positively correlated with ALT level in HLH patients (R2=0.969 6, P＜0.000 1). ConclusionVarying degrees of liver injury are observed in patients with DRESS, AOSD or HLH. Ferritin and CD8+ T cells are well correlated with ALT level and can reflect liver injury, systemic inflammation, and immune status in patients with the three diseases, and therefore, they may become important indices for evaluating disease condition, guiding treatment, and judging treatment outcome and prognosis.