Background: Myoclonic epilepsy with ragged-red fi bers (MERRF) is a type of mitochondrial encephalomyopathy, clinical experience with the antiepileptic treatment for myoclonus in MERRF is still limited. Myoclonus appears to be intractable, and some antiepileptic drugs may change the blood lactate level. Objective: In this study, we report on two patients, a girl and her mother, both with MERRF in a Chinese family. We aimed to study their myoclonus attack, response to AEDs and blood lactate level. Methods: The diagnosis was based on muscle biopsies and a genetic test. We recorded their myoclonus and detected alterations of blood lactate when the patients received antiepileptic drugs. Results: The patients displayed substantial differences in their responses to antiepileptic drugs. The mother exhibited a good response to valproic acid, although valproic acid is not recommended for mitochondrial disease; however, her daughter was refractory to many antiepileptic drugs until she received a combination treatment of levetiracetam and topiramate. We did not fi nd valproic acid, levetiracetam or topiramate affected the blood lactate levels. Conclusion: These fi ndings imply that not all MERRF patients are resistant to antiepileptic drugs, and for those who are intractable, combination treatment involving levetiracetam and topiramate may be effective for treating myoclonus in MERRF and does not worsen lactic acidosis.

Objective To measure the expression of CD80 and CD86 in renal tissue of lupus nephritis (LN) and explore its mechanism in the development of LN.Methods Forty-nine patients with active LN and 9 patients with minor glomerular abnormalities tissues as controls were studied.The expression of CD80, and CD86 in renal tissues was detected by immunohistochemical methods.Results CD86 was expressed extensively in glomerulus, periglomerular area, tubular epithelial cells and peritubular interstitium, while CD80 was expressed only in tubular epithelial cells and peritubular interstitium.Moreover, the percentage of CD+80 and CD+86 cells in tubular epithelial cells and peritubular interstitium showed a tendency to increase with tubulointerstitial damage.The expression of CD80 and CD86 in renal tissue correlated with the systemic lupus erythematosus (SLE) disease activity index score, the degree of proteinuria, creatinine clearance and anti- dsDNA antibody.Conclusions This study shows that increased CD80 and CD86 expression with the progression of tubulointerstitial lesion might play an important role in the development of lupus nephropathy, and the tubulointerstitial expression of CD80 and CD86 could potentially serve as a surrogate marker of SLE disease activity.The co-stimulatory molecules CDg, and CD86 might play an important role in the pathogenesis of LN.

Objective To investigate the effects of Lotensin on inflammatory factors, vascular endothelial function and heart function in patients with acute myocardial infarction. Methods 100 cases with acute myocardial infarction from March 2015 to January 2016 in the fifth central hospital of Tianjin were selected as the research object, which were randomly divided into the control group and the observation group. The control group were given routine treatment, at this basis, the observation group were given Lotensin. After treatment, the cardiac function, the levels of inflammatory factors, the blood vessel endothelial function, the serum NO and endothelin 1 and the therapeutic effect in the two groups were compared. Results LVESV, LVEDV (156.28±3.29、213.45±6.12) mL in the observation group were better than (162.98±4.16、202.83±7.16) mL in the control group (P<0.05). LVEF was (48.72± 2.13)% in the observation, which was higher than (40.62±3.29)% in the control group(P<0.05). Hs-CRP, IL-6 were (2.66±0.68) mg/L、(4.90±0.92) ng /L in the observation group , which were less than (6.35±1.50) mg/L、(9.38±2.01) ng/L in the control group (P<0.05). FMD(10.37±0.62)% in the observation group was bet er than (6.16±0.92)% in the control group (P<0.05)、 NO, ET-1 level (71.52±13.21) μmol/L、(56.27±7.10) ng/L in the observation group were bet er than (60.63 ±10.57) μmol/L、(69.72±9.50) ng/L in the control group (P<0.05). The total effective rate in the observation group was 94.00% (47/50), which was better than 62.00% (31/50) in the control group (P<0.05). Conclusion The effect is significant which Lotensin is used in the treatment of acute cerebral infarction, which can reduce inflammatory factors, improve endothelial function and cardiovascular function.

Objective:To study whether early leukocytosis after total joint arthroplasty (TJA) requires further workup to exclude infection by observing changes in peripheral blood white blood cell (WBC) count after TJA.Methods:This study included the 294 patients (infection-free group) who had undergone primary hip or knee TJA from June 2019 to June 2020 but reported no periprosthetic joint infection (PJI) within one month after surgery and the 31 patients (infection group) who had undergone the same TJA but reported infection within one month after surgery from May 2012 to June 2020 at Department of Joint Surgery, The First Affiliated Hospital to Xinjiang Medical University. Peripheral blood WBC counts were measured and recorded before surgery and 1 to 5 days after surgery. Differences were compared between time points and multiple linear regression analysis was used to screen the factors associated with early postoperative leukocytosis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of WBC for early PJI.Results:The peripheral WBC level in the infection-free group showed a trend of increasing at first and then decreasing. It reached the peak on day 2 after surgery, increasing by 8.08×10 9/L±2.33×10 9/L compared to pre-surgery, and then began to decrease to a level slightly higher than the preoperative value on day 5 after surgery. The changes in WBC count in the first 2 days after surgery ranged from 6.24×10 9/L to 26.32×10 9/L. The incidence of leukocytosis in the first 5 days after surgery was 95.6% (281/294). The factors associated with postoperative leukocytosis included preoperative WBC count and bilateral surgery. For every increase of 1.00×10 9/L in preoperative WBC count, the postoperative WBC value increased by an average of 0.98×10 9/L [ β=0.984, 95% confidence interval (95% CI): 0.821-1.148, P<0.001]. The postoperative WBC count in the patients undergoing bilateral surgery increased by an average of 1.03×10 9/L compared with that in the patients undergoing unilateral surgery ( β=1.026, 95% CI: 0.565-1.486, P<0.001). The area under the curve (AUC) for prediction of early PJI by absolute WBC count difference (the absolute difference between the maximum postoperative WBC value and the baseline) was 0.655 (95% CI: 0.546-0.764, P<0.05), providing a threshold of 7.96×10 9/L, a sensitivity of 57.5% and a specificity of 74.2%. Conclusions:Leukocytosis is a common phenomenon after TJA, indicating a normal physiological response to surgery. The preoperative WBC count is a predictor for postoperative leukocytosis. In the absence of abnormal clinical symptoms or signs, there is no need for further workup to check infection if the postoperative WBC does not deviate from its changing range and trend.

In order to improve quality of molecular pharmacognosy teaching, the open experiment is applied. Under the guidance of tutors, students conduct the whole experiment independently. Students' abilities of independent thinking and comprehensive-experimental conduction were enhanced in the open experiment. Meanwhile, the authors discuss the problems of open experiment and propose some reflection and suggestions.
Education, Medical, Undergraduate ; economics ; manpower ; methods ; standards ; Humans ; Pharmacognosy ; education

Objective: To analyze the epidemiological characteristics of occupational diseases in Gansu Province, China in 2010-2017, and to provide a scientific basis for the prevention and control of occupational diseases. Methods: The cluster sampling method was adopted to make statistical analysis of 1339 cases of occupational disease reported by "occupational disease and occupational health information monitoring system" in Gansu province from 2010 to 2017, to investigate the diseases, regions and industries of occupational diseases in June 2018. Results: A total of 1339 cases of occupational diseases (39 types, 8 classes) were diagnosed and reposed in 2010-2017. The three most frequent diseases were pneumoconiosis (87.53%, 1172/1339), occupational poisonings (5.83%, 78/1339), and occupational ear, nose, and throat (ENT) diseases (3.14%, 42/1339). The cases of silicosis accounted for 54.61% (640/1172) of all cases of pneumoconiosis, the second was coalworker pneumoconiosis, which accounted for 38.57% (452/1172). In the cases of occupational poisonings, 32.05% (25/78) suffered from carbon monoxide poisoning. Patients with occupational diseases were reported in 14 districts of Gansu, mostly in Lanzhou (27.52%, 347/1261), Jinchang (16.57%, 209/1261), and Baiyin (14.20%, 179/1261). The reported cases are mainly concentrated in mining (71.56%, 468/654) and manufacturing (21.87%, 143/654), the types of state-owned economy (55.63%, 692/1244) and private economy (33.68%, 419/1244), large (43.41%, 540/1244) and small enterprises (35.21%, 438/1244) in 2010-2017 in Gansu. Conclusion The pneumoconiosis caused by silicious and coal dust and the occupational poisonings caused by carbon monoxide seem to be the main occupational hazards in Gansu province. Occupational diseases occur in all districts of Guangzhou and in various industries. The state-owned economy and private sector, large and small enterprises should be the focuses of occupational health supervision.

Objective:To identify the risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children.Methods:The data of 171 children were retrospectively analyzed who had been treated for flexed supracondylar humerus fractures of Wilkins type Ⅲ from January 2013 to December 2021 at Department of Orthopaedics, Children's Hospital of Jiangxi Province and Children's Hospital of Fudan University Anhui Hospital. They were divided into a reduction failure group (35 cases) and a reduction success group (136 cases). Factors such as fracture height, age, body mass index, ulnar-radial offset direction, obvious axial rotation of the distal fracture fragment, combined ulnar nerve injury, and time from injury to operation were listed as risk factors. The independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures were identified by univariate analysis of variance and multi-variate logistic regression analysis.Results:The average age of 171 children was (7.8±2.6) years. There were 151 cases of radial deviation and 20 cases of ulnar deviation, 120 high type fractures and 51 low type fractures, and 20 cases of combined ulnar nerve injury and 115 cases of obvious rotation of the distal fracture fragment. The one-way ANOVA showed statistically significant differences between the reduction failure group and the reduction success group in terms of age, obvious rotation of the distal fracture fragment, and ulnar nerve injury ( P<0.05), but no significant differences in fracture height, body mass index, ulnar-radial offset direction, or time from injury to operation ( P>0.05). Multivariate logistic regression analysis showed that obvious rotation of the distal fracture fragment ( OR=3.287, 95% CI: 1.136 to 9.513, P=0.028) and combined ulnar nerve injury ( OR=6.439, 95% CI: 2.262 to 18.327, P=0.001) were risk factors for failure in closed reduction. Conclusion:As obvious rotation of the distal fracture fragment and combined ulnar nerve injury may be independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children, they should arouse more attention in the treatment of such fractures.

Objective:To investigate the characteristics and reliability of a novel sub-classification of Wilkins type III lateral-flexion supracondylar fracture of the humerus in children.Methods:A retrospective cohort study was used to analyze the clinical data of 92 children with supracondylar fracture of the humerus admitted to Provincial Children′s Hospital of Anhui Medical University from January 2013 to August 2021, including 38 males and 54 females, aged 2-13 years [(8.5±2.4)years]. Lateral-flexion Wilkins type III supracondylar humeral fractures were classified into two subtypes according to the fracture features: type IIIA ( n=14), complete fracture with the distal fragment displaced anteriorly and laterally, with no obvious anterior or posterior inclination (<10°) or rotation; type IIIB ( n=78), complete fracture with the distal fragment displaced anteriorly and laterally, with significant anterior or posterior inclination (>10°) or rotation. The incidence and risk ratio of ulnar nerve injury and open reduction were compared between the two subtypes of the fracture. The weighted Kappa method was used to test the inter- and intra-observer agreement of the two new subtypes. Results:Of all, 15 children had ulnar nerve injury, among which 1(6.7%) was type IIIA and 14(93.3%) were type IIIB; while other 77 children had no ulnar nerve injury. The risk of ulnar nerve injury in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=2.84, 95% CI 0.34- 25.56, P>0.05). The open reduction was performed in 11(73.3%) out of the 15 children with ulnar nerve injury, but in 18(23.4%) out of the 77 children with no ulnar nerve injury. The risk of open reduction in children with ulnar nerve injury was 9-fold higher than that in children without ulnar nerve injury ( OR=9.01, 95% CI 2.28- 33.17, P<0.01). Open reduction was performed in 29 children, among which 2(6.9%) were type IIIA and 27(93.1%) were type IIIB. The risk of open reduction in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=3.17, 95% CI 0.66-15.24, P>0.05). The intra-observer Kappa value was 0.49±0.09(95% CI 0.31-0.66), indicating a moderate agreement. The inter-observer Kappa value was 0.80±0.06(95% CI 0.68-0.91), indicating a strong or very strong agreement. Conclusions:Wilkins type IIIB lateral-flexion supracondylar fracture of the humerus in children is more likely to be accompanied by ulnar nerve injury and to be opt to open reduction in comparion with type IIIA. The new subtyping has reliable inter-observer and intra-observer consistency, and is able to facilitate the prediction of surgical plans.

【Objective】 To analyze the mental health status and influencing factors of China medical team （CMT） members in Africa during COVID-19 pandemic. 【Methods】 From July 2021 to August 2021， 72 members of the 8th CMT in Malawi， the 36th CMT in Sudan and the 22nd CMT in Zambia were tested by 12-item General Health Questionnaire （GHQ-12）， Generalized Anxiety Disorder-7 （GAD-7）， and Patient Health Questionnaire-9（PHQ-9）， general information form and influencing factors form. 【Results】 The results of GHQ-12 were positive for 33.3% （24/72） of the CMT members. 51.4% （37/72） of the CMT members showed different levels of anxiety： 40.3% （29/72） of them had mild anxiety， 8.3% （6/72） of them had moderate anxiety， and 2.8% （2/72） of them had severe anxiety. 52.8% （38/72） of the CMT members had different degrees of depression： 34.7% （25/72） of them had mild depression， 11.1% （8/72） of them had moderate depression， 4.2% （3/72） of them had moderate-severe depression， and 2.8% （2/72） of them had severe depression. The CMT members who contacted with COVID-19 patients got significantly high scores of GHQ-12， GAD-7 and PHQ-9 （P<0.05） compared to those who did not have contact with COVID-19 patients. And CMT members who did not adapt to the local social life got significantly higher scores than those who adapted to the local social life （P<0.05）. These factors were the main factors affecting the mental health of the CMT members. 【Conclusion】 During COVID-19， the psychological pressure of CMT members was increased significantly， and both the incidence and severity of anxiety and depression were increased. Paying attention to and improving CMT members’ mental health status can ensure the smooth development of medical aid to Africa.