Objective To study the effect of sodium hyaluronate on the expression of transforming growth factor-β3(TGF-β3) and Smad 6 of the epidural scar tissue. Method Totally 60 male SD rats were randomly divided into two groups:the control group(A, n = 30), sodium hyaluronate group(B, n = 30). 0.25 × 1 cm2 dura mater uncovered area laminectomy was performed at L4 and L5, covered with 0.3 ml sodium hyaluronate in group B, covered with same amount of saline in group A. The animals were sacrificed at 2, 4 and 8 weeks after operation. The specimens were prepared for determination of the expression of TGF-β3 and Smad 6 at scar tissue and the degree of scar adhesion according to Rydell method, and observed the ultrastructure changes of scar tissue with transmission electron microscope. Results At 2 weeks after operation, the expression of TGF-β3 mRNA of two groups were 0.22 and 0.257 ( P = 0.027), respectively. At 4 weeks, group B was was increased significantly, and the mean numbers were 0.362 and 0.411 (P = 0.006). At 8 weeks, the expression of TGF-β3 mRNA of group A was increased significantly, too, but the difference between two groups was significantly, they were 0.427 and 0.470 (P =0.015), respectively. The trend of the expression of TGF-β3 and Smad 6 mRNA was similar. At 2, 4, 8, weeks, the expression was 0.169 and 0.205 (P = 0.089), 0.294 and 0.351 (P = 0.031), and 0.469 and 0.543 (P = 0.021), respectively.In group B the duramater adhesion was decreased (P ＜ 0.05), the proliferation of fibroblasts and fihroblastic function were inhibited (P ＜ 0.05). Conclusions Sodium hyaluronate up-regulated the expression of TGF-β3 and Smad6 and reduced the proliferation and collagen synthesis in fibroblast culture in the scar tissue.

Objective To investigate the value of qualitative and quantitative parameters of MRI on diagnosis of benign and malig-nant breast lesions.Methods Patients were scanned with MRI who were confirmed as breast lesions verified by histopathology,and the time-signal curve(TIC),Slopemax ,the apparent diffusion coefficient values (ADC)were deduced.Results There were 24 benign and 11 malignant lesions.Features of benign lesions were shown as follow:The TIC type wasⅠmostly 91.7%,Slopemax was 0.65 %/s,the ADC values was 1.31×10 -3 mm2/s.Features of malignant lesions were shown as follow:The TIC type were Ⅱ and Ⅲ mostly (100%), Slopemax was 1.63 %/s,the ADC values was 1.06 ×10 -3 mm2/s.Conclusion Types of TIC,Slopemax ,the ADC values of MRI are valuable in the diagnosis of benign and malignant breast lesions,integrated functional parameters are better than an individual param-eters in that they can improve the accuracy of diagnosis.

Objective To observe the application of multiple fluorescent PCR (Polymerase Chain Reaction) in the diagnosis and clinical detection of bloodstream infection. Methods 256 blood cultures were collected by the Laboratory Department of Yinzhou People′s Hospital from January 2018 to May 2018, and were detected by multiplex fluorescent PCR. The results of the PCR were compared with the traditional blood culture bacteria identification instrument (traditional blood culture method). The number of positive and negative samples and the number of corresponding samples of the two methods were counted. Then, they analyzed the specificity and sensitivity of multiplex fluorescence PCR in the diagnosis of bloodstream flow infections. Results A total of 18 pathogenic microbes are detected through blood culture and PCR. Multiple fluorescent PCR detects 142 positive samples and 114 negative samples. Among them, 132 samples also show positive through blood culture, and 111 samples show negative. The consistency rate between multiple PCR and traditional blood cultures is 91.8％ (235/256). The negative prediction rate of PCR is 97.4％ (111/114), sensitivity rate 97.8％ (132/135), specificity rate 91.7％ (111/121). 10 samples show positive through multiple fluorescence PCR but negative for blood culture, 3 samples show positive through blood culture but negative for PCR. Besides, there are 3 types of pathogens that exceed the detection range of PCR. Conclusions Multiplex PCR method can detect 17 pathogens in blood culture specimens of patients, which can not only optimize the traditional blood culture process, but also greatly shorten the reporting time and improve the detection rate of blood culture methods. Especially for patients treated with antibiotics, it can reduce missed detection and improve the diagnostic rate of bloodstream infections.

Objective To develop a group psychological training program to cultivate a sense of meaning in life for retired soldiers during the transitional period,and to explore the efficacy of the training.Methods A psychological training program for retired soldiers during the transitional period was developed based on Delphi method.A total of 64 retired soldiers who participated in a retirement training in transitional period were subjected through cluster sampling in a certain city in Shandong province and assigned into a training group(n=31)and a control group(n=33).The training group attended group psychological training based on the developed training program(twice a week,1.5～2 h each time,for 4 weeks),and the control group received routine adaptive training for retirement.Purpose in Life(PIL)Test,Chinese Perceived Stress Scale(CPSS)and Social Adaptability Scale(SAS)were used to survey the participants before(T1),and at the end of(T2)and 1 month after the training(T3).Results ① The results of 2 rounds of expert consultation showed that the coefficient of authority(Cr)was 0.89,and the Kendall's coefficient(ω)of the 2 rounds was 0.134 and 0.204,respectively(P＜0.001),with a coefficient of variation ranging from 0.05 to 0.14.The prepared group psychological training program consisted of 3 first-level indexes,6 second-level indexes,and 24 third-level indexes.② The results of the interaction between group and time after training showed that the training group had significantly higher total score and score of each dimension in sense of meaning in life,and increased total score of social adaptability,but lower total score of perceived stress when compared with the control group(all P＜0.001).③ The results of group main effect after training indicated that obviously higher total score and score of each dimension in sense of meaning in life(P＜0.01),elevated total score of social adaptability(P＜0.01),and reduced total score of perceived stress(P＜0.001)were observed in the training group than the control group.④ The results of the post-training time main effect revealed that the training group had notably higher total score and score of each dimension in sense of meaning in life(P＜0.05),increased total score of social adaptability(P＜0.001),and decreased total score of perceived stress(P＜0.001)when compared with the control group.Conclusion Our developed group psychological training can significantly improve the sense of meaning in life,reduce perceived stress and improve their social adaptation ability for retired soldiers during the transitional period.

Objective: To evaluate the efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in prophylaxis neutropenia after chemotherapy in patients with lymphoma. Methods: This was a multicenter, single arm, open, phase Ⅳ clinical trial. Included 410 patients with lymphoma received multiple cycles of chemotherapy and PEG-rhG-CSF was administrated as prophylactic. The primary endpoint was the incidence of Ⅲ/Ⅳ grade neutropenia and febrile neutropenia (FN) after each chemotherapy cycle. Meanwhile the rate of antibiotics application during the whole period of chemotherapy was observed. Results: ①Among the 410 patients, 8 cases (1.95%) were contrary to the selected criteria, 35 cases (8.54%) lost, 19 cases (4.63%) experienced adverse events, 12 cases (2.93%) were eligible for the termination criteria, 15 cases (3.66%) develpoed disease progression or recurrence, thus the rest 321 cases (78.29%) were into the Per Protocol Set. ②During the first to fourth treatment cycles, the incidences of grade Ⅳ neutropenia after prophylactic use of PEG-rhG-CSF were 19.14% (49/256) , 12.5% (32/256) , 12.18% (24/197) , 13.61% (20/147) , respectively. The incidences of FN were 3.52% (9/256) , 0.39% (1/256) , 2.54% (5/197) , 2.04% (3/147) , respectively. After secondary prophylactic use of PEG-rhG-CSF, the incidences of Ⅳ grade neutropenia decreased from 61.54% (40/65) in the screening cycle to 16.92% (11/65) , 18.46% (12/65) and 20.75% (11/53) in 1-3 cycles, respectively. The incidences of FN decreased from 16.92% (11/65) in the screening cycle to 1.54% (1/65) , 4.62% (3/65) , 3.77% (2/53) in 1-3 cycles, respectively. ③The proportion of patients who received antibiotic therapy during the whole period of chemotherapy was 34.39% (141/410) . ④The incidence of adverse events associated with PEG-rhG-CSF was 4.63% (19/410) . The most common adverse events were bone pain[3.90% (16/410) ], fatigue (0.49%) and fever (0.24%) . Conclusion During the chemotherapy in patients with lymphoma, the prophylactic use of PEG-rhG-CSF could effectively reduce the incidences of grade Ⅲ/Ⅳ neutropenia and FN, which ensures that patients with lymphoma receive standard-dose chemotherapy to improve its cure rate.

OBJECTIVE To study the anti-inflammatory immune response effects of lactoferrin in the treatment of periodontitis and its mechanism. METHODS One hundred SD rats were randomly divided into blank control group, model group, lactoferrin administration group low, medium, high dose group(1, 2, 3 g·kg-1), metronidazole positive control group (0.02 g·kg-1), PDTC group(200 mg·kg-1), lactoferrin+PDTC group(2 g·kg-1, 200 mg·kg-1), MCC950 group(1 mg·kg-1) and lactoferrin+MCC950 group(2 g·kg-1, 1 mg·kg-1), 10 rats in each group. Silk thread ligation combined with 10% sucrose drinking water was used to establish the model, and then the drug was administered orally once a day. The blank control group and the model group were administered orally with 0.9% NaCl. The rats in each group were sacrificed after one month of continuous administration. The contents of IL-1b, IL-8 and IL-10 were detected by ELISA kit, and the expressions of TLR2-NF-κB pathway and NLRP3 inflammasome related proteins were detected by Western blotting. HE staining was used to observe the pathological changes of the periodontal tissues of the rats in each group. RESULTS Compared with the model group, the symptoms of periodontitis in each dose group of lactoferrin were significantly improved. HE staining showed that the infiltration of inflammatory cells was reduced, and the proliferation of fibroblasts was active. The protein expressions of TLR2, NF-κB, NLRP3, Caspase-1 p20 and GSDMD-N decreased, the content of pro-inflammatory factor IL-8 and IL-1b decreased, and the content of anti-inflammatory factor IL-10 increased. CONCLUSION Lactoferrin may play a role in the regulation of inflammatory immune response in the treatment of periodontitis by down-regulating the protein expression of TLR2-NF-κB-NLRP3 pathway, reducing the initiation of inflammatory response and the release of inflammatory factors, so as to achieve the purpose of anti-inflammatory.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

To observe the results of different treatment of congenital heart disease (CHD) complicated with severe pneumonia in infants.
 Methods: A total of 27 infants with CHD and severe pneumonia were admitted to the Department of Pediatrics, Xiangya Hospital from January 2014 to December 2014, of whom 18 were male and 9 were female. The average age was 2.0-19.0(5.9±4.3) months, with an average body weight of 3.3-10.0 (5.8±1.8) kg. Infants were treated with a strategy of complete control of the lung infection before surgery (internal medicine group). From January 2015 to December 2015, 29 infants with same condition were admitted, of whom 15 were males and 14 females. The average age was 2.0-27.0 (6.1±3.9) months, with an average body weight of 3.1-8.0 (4.8±1.0) kg. Infants were treated with a strategy of combined treatment (combined treatment group), in which early surgical treatment were performed after a short time antibiotics and supportive treatment.
 Results: One nosocomial death in internal medicine group, with an average hospital stay for 3-26 (11±6) d. Further surgeries were performed in 5 patients after discharge with no surgical death. The mean preoperative hospital stay in combined treatment group was 1-21 (10±6) d. The mean total hospital stay for combined treatment group was 14-48 (24±9) d and the mean postoperative hospital stay was 6-35 (14±7) d. One patient died soon after surgery in combined treatment group. Thirty-day follow-up found that no other patient died in combined treatment group, and 6 patients died in internal medicine group. The 30-day mortality was 3.4% in combined treatment group and 22.2% in internal medicine group (P<0.01).
 Conclusion: Infant congenital heart disease complicated with severe pneumonia requires early surgical treatment, which contributed to the control of pulmonary infection and reduce mortality.
Female ; Heart Defects, Congenital ; therapy ; Humans ; Infant ; Length of Stay ; Male ; Pneumonia ; therapy ; Postoperative Period

Objective: To understand the confidence-related factors of refusing unprotected sex behavior among college students in Zhejiang province. Methods: Stratified cluster random sampling method was conducted among college students from 13 colleges and universities in Zhejiang province, from October to November, 2018. A total of 3 718 students who self-reported "ever having had sexual contacts" were enrolled. Chi-square test was used to compare the confidence of rejecting unprotected sex under different demographic characteristics, sexual attitude/behaviors and different intervention approaches. Multivariate logistic regression model was used to analyze the related factors. Results: A total of 3 718 college students were involved in this study with average age as (20.17±1.38) years old and 70.5% (2 620/3 718) were male. The proportions of having confidence to refuse unprotected sex behavior were 74.9% (1 963/2 620) of male and 77.9% (896/1 098) of female students, respectively. According to the results from multivariate logistic regression analysis, factors that related to the confidence of refusing unprotected sex behavior in male students would include, did not accept casual sex behavior (compared with accepted students, OR=2.247, 95%CI: 1.828-2.762), did not accept homosexual behavior (compared with accepted students, OR=1.810, 95%CI: 1.302- 2.516), having casual sex behavior in the past one year (compared with having no sex behavior, OR=1.345, 95%CI: 1.051-1.721), aware of the availability of HIV self-test reagents service in college (compared with did not knew, OR=1.381, 95%CI: 1.011-1.887), having taken the HIV infection risk self-assessment in college (compared with did not take, OR=1.707, 95%CI: 1.374-2.121). In female students, the factors would include: being urban resident (compared with rural residence, OR=1.816, 95%CI: 1.225-2.693), 21 years old or above (compared with 20 years old or below, OR=1.469, 95%CI: 1.075-2.007), having taken the HIV infection risk self-assessment in college (compared with did not take, OR=1.597, 95%CI: 1.093-2.333), etc. Conclusions Both male and female college students had higher confidence in refusing unprotected sex behavior. For male students, refusing casual or homosexual contacts, having casual sex in the recent year, knowing HIV self-test reagents service and having had HIV-related risk self-assessment in college as related factors. However, for female students; city residence, 21 years old and above, and having a HIV infection risk self- assessment in college appeared as related factors. Sexual health education should be strengthened to reduce unprotective sex behavior and to promote HIV infection risk self-assessment among the college students.