Objective To investigate the relationship between admission blood glucose and in-hospital adverse events of elderly patients with non-ST-segment elevation myocardial infarction(NSTEMI) combined with multi-organ dysfunction in emergency department,and to assess the prognostic value.Methods Fifty-one geriatric patients with NSTEMI combined with multi-organ dysfunction were selected and divided into the experimental group (26 cases) and control group (25 cases),depending on whether they had adverse events in hospital.After the propensity score matching was used to reduce confounding effects,the difference in admission blood glucose between the two groups was compared.According to the ROC curve,the predictive value of immediate admission blood glucose to the incidence of adverse events during hospitalization was detected.Results After propensity score matching,admission blood glucose of the experimental group ((10.35±4.06) mmol/L) was higher than that of the control group ((7.05±2.45) mmol/L),and this difference was statistically significant (t=2.869,P<0.01).The area under the ROC curve for adverse events during hospitalization was 0.758 (P<0.01),and it may reach the best prognostic value when we choose 8.025mmol/L as the critical value.Under this condition,the sensitivity was 0.765 and specificity was 0.765.Conclusion For geriatric patients with NSTEMI combined with multi-organ dysfunction in emergency department,admission blood glucose is a risk factor for in-hospital adverse event,and the risk is high when admission blood glucose is over 8.025mmol/L.

ObjectiveTo study the teaching method of childbirth turning point and enhances teaching effect in the normal birth of the gynecology and obstetrics department teaching. MethodsAfter carting on the different form the teaching, to 382 students of Qujing medical high school, we carry on the one-to-one skill operation inspection and make the contrastive analysis of the achievement test scores of the students in the experimental group and the control group. Results There is remarkable difference between the conventional experiment teaching and the experiment teaching of adding giant pelvis ( P＜0.01 ). ConclusionThe giant pelvis's application can enhance the teaching effect enormously in the childbirth turning point teaching, and this method has the application and the promoted value.

Objective:To investigate the effect and mechanism of 6-formylindolo[3,2-b]carbazole (FICZ) on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice.Methods:Male C57BL/6J mice aged 8-12 weeks were divided into 4 groups with 8 mice in each group, according to the method of simple random sampling. Sepsis-induced ALI mice model was established by intraperitoneal injection of LPS 5 mg/kg (LPS group), and phosphate buffer saline (PBS) control group (PBS group) was injected with equal volume of PBS. The LPS+FICZ group was intervened by intraperitoneal injection of 1 μg FICZ 1 hour after LPS stimuli, while the FICZ control group (FICZ group) was given the same amount of FICZ 1 hour after intraperitoneal injection of PBS. Serum and lung tissue were collected 24 hours after LPS stimuli, and the pathological changes of lung tissue were analyzed by hematoxylin-eosin (HE) staining and wet/dry weight (W/D) ratio of lung tissue. The concentrations of inflammatory factors in serum and lung tissue were detected by enzyme linked immunosorbent assay (ELISA). The expression levels of endoplasmic reticulum stress signaling pathway related molecules were detected by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) and Western blotting.Results:Compared with PBS group, inflammatory cell infiltration, alveolar collapse and obvious alveolar exudative lesions had increased, lung tissue W/D ratio was significantly increased, serum interleukin-6 (IL-6) level, lung tissue IL-6 mRNA expression, and the mRNA expressions of glucose-regulated protein 78 (GRP78), protein kinase R-like endoplasmic reticulum kinase (PERK), CCAAT/EBP homologous protein (CHOP), and the protein expressions of GRP78, PERK, activating transcription factor 6 (ATF6), CHOP in lung tissue were significantly increased in LPS group. However, the indexes of FICZ group were not affected. Compared with LPS group, LPS+FICZ group had less inflammatory cell infiltration, relatively intact alveolar structure. Lung W/D weight ratio in LPS+FICZ group was significantly decreased (5.38±0.10 vs. 6.60±0.30, P < 0.01), so as serum IL-6 (ng/L: 15.55±3.77 vs. 32.22±3.84) and lung IL-6 mRNA expression (2 -ΔΔCt: 0.79±0.21 vs. 6.89±0.92, both P < 0.01). The mRNA expressions of GRP78, PERK and CHOP were also significantly decreased [GRP78 mRNA (2 -ΔΔCt): 1.90±0.16 vs. 7.55±1.29, PERK mRNA (2 -ΔΔCt): 1.68±0.20 vs. 4.54±0.89, CHOP mRNA (2 -ΔΔCt): 1.13±0.24 vs. 4.44±1.13, all P < 0.05], and the protein expressions of GRP78, PERK, ATF6 and CHOP were significantly decreased (GRP78/GAPDH: 0.59±0.02 vs. 0.77±0.01, PERK/GAPDH: 0.48±0.03 vs. 1.04±0.05, ATF6/GAPDH: 0.51±0.03 vs. 0.65±0.01, CHOP/GAPDH: 0.91±0.05 vs. 1.11±0.07, all P < 0.05). Conclusion:FICZ protects LPS-induced ALI possibly via suppressing endoplasmic reticulum stress and reducing IL-6 expression in blood and lung tissue.

Objective To investigate the extraction process of Yuchang granules .Methods The extraction process was optimized by orthogonal experiment based on the content of berberine ,atractylodes lactone Ⅰ and the extraction yield .Results Through the visual analysis of orthogonal experiment ,the analysis of variance and the verification experiments ,the optimum extraction process was obtained as follows :extracting 1 h for twice with 10 times water of medicinal herbs and the 70％ ethanol depositing concentration .Conclusion This process is consistent and feasible .It is a simple and convenient method to extract Yuchang granules .

Objective:To explore the effect of short-term modularized training mode with clear milestones for case competition of standardized residency training.Methods:Surgical residents, who attended the first case competition of Guangdong Province in 2020, were trained by short-term modularized training mode with clear milestones. This mode contained four modules: SP consultation training, training of disease characteristics and principles of diagnosis and treatment summary, medical documents and case analysis writing training, and comprehensive emergency case training.Results:After the training, they all made great progress in consultation, interpretation of exam results, and first writing of course record, but less in medical documents and case analysis. The satisfaction rate was 100%, and they all considered informed consent writing for operation and formulating principles of diagnosis and treatment summary as difficult tasks.Conclusion:Short-term modularized training mode with clear milestones might improve the level of consultation, interpretation of exam results, and first writing of course record effectively. While, the difficult point is clinical thinking about the surgical treatment, which must be trained more in routine work.

Objective To investigate the relationship between Helicobacter pylori (HP) infection and the development of chronic urticaria.Methods Published case-control studies which concerned HP infection related chronic urticaria were searched in Wanfang,CNKI,CQVIP Chinese databanks and PubMed.Meta-analysis was applied to analyze the pooled odds ratio (OR) and 95％ confidence interval (CI).Results 37 studies which comprised 2 909 cases of chronic urticaria and 1 873 persons served as controls were enrolled.When compared with the controls,HP infection significantly increased the risk of chronic urticaria development with a pooled OR of 3.20 (95％CI:2.31-4.43).Results from Meta-regression analyses showed that the distribution of residential areas and detection method being used were potential influential factors.Conclusion HP infection seemed to be associated with an increased risk of developing the chronic urticaria.

OBJECTIVETo report the results of low-dose computed tomography (LDCT) screening for early lung cancer in 4 690 asymptomatic participants at the Cancer Hospital, Chinese Academy of Medical Sciences between July 2007 and June 2012.

METHODSAfter informed consent and questionnaire forms were obtained, 4 690 asymptomatic participants ≥ 40 years underwent chest low dose spiral CT scanning. According to the National Comprehensive Cancer Network (NCCN) guideline for lung cancer screening (version 1.1, 2012), all participants were assigned to three groups, namely high-risk, moderate-risk and low-risk groups. In terms of gender, smoking history and second-hand tobacco smoking exposure history, two other groups named male and female never-smoker groups who were exposed to second-hand tobacco smoking were designated. The positive results were identified as at least one solid or part-solid nodule measuring ≥ 5 mm, or non-solid nodule ≥ 8 mm in diameter. LDCT scanning protocol, criteria of management according to the size and consistency of pulmonary nodules were compliant with the International Early Lung Cancer Active Program (I-ELCAP). TNM staging of all lung cancers were based on the clinical evidence and pathological findings.

RESULTSIn various risk status group of the participants, the percentage of positive results of baseline CT were 27.0% (86/319), 19.3% (199/1 029) and 11.3% (377/3 342), respectively. A total of 26 participants (27 lesions) were diagnosed as lung cancer (11 in men, 15 in women). The detection rate of lung cancer was 0.6% (26/4 690). Besides a SCLC (limited-disease, LD), 25 cases (76.0%) were stage I including 24 NSCLC and one cacinoid on baseline LDCT and the surgical resection rate was 88.5% (23/26). The diameter of resected cancers was 6.9-29.5 mm (median, 16.3 mm). For female never smokers aged 40 years or older who were exposed to second-hand smoking, the detection rate of lung cancer was higher than that of the high-risk and male never smokers who were exposed to second-hand smoking (1.4% vs. 0.9%, 0.4%).

CONCLUSIONSThe results indicate that LDCT can detect small lung cancers and most of the cancers are detected at an early stage. Emphasis should be placed on the non-smoking female individuals who are exposed to second-hand smoking in China.

Carcinoma, Non-Small-Cell Lung ; diagnosis ; epidemiology ; China ; Early Detection of Cancer ; Female ; Humans ; Lung Neoplasms ; diagnosis ; epidemiology ; Male ; Mass Screening ; Neoplasm Staging ; Prevalence ; Risk Factors ; Smoking ; epidemiology ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

Objective To prepare berberine hydrochloride nanoemulsion, optimize its formulation composition and preparation process, and investigate its in vitro characteristics. Methods BBR-NE was prepared by water drop addition and pseudo-ternary phase diagram was drawn. The formulation of NE was optimized by central composite design-response surface methodology to choose the optimal formulation composition. The particle size, potential and appearance of the prepared BBR-NE were characterized. Results The optimal prescription of BBR-NE was determined as the oil phase Capryol 90 accounted for 32.84% of the system, the surfactant Tween-80 accounted for 33.90%, the co-surfactant 1,2-propylene glycol accounted for 16.95%, and water relative system accounted for 15.25%. The prepared NE was clear and transparent in appearance, regular in shape and uniform in size, with an average particle diameter of (68.85±8) nm, polydiseperse index of (0.245±0.03) and drug loading of 0.83 mg/g. The in vitro drug release results of NE showed that the in vitro drug release behavior was passive diffusion, which had a certain slow releasing effect and met the first-order release equation. Conclusion The BBR-NE can provide a new dosage form for the clinical use of berberine.

The occurrence, development and prognosis of sepsis are closely related to immune regulation.Immunometabolism has been the research hotspot of immune intervention in sepsis in recent years.AMP-activated protein kinase(AMPK)and mammalian target of rapamycin(mTOR)are star molecules involved in metabolic regulation.As an important way of immunometabolic regulation in sepsis, AMPK-mTOR is involved in the process of chemotaxis of neutrophils, the polarization of macrophages, the development and differentiation of natural killer cells and dendritic cells, and the development and functional regulation of T cells.This article reviewed the research progress of AMPK-mTOR signaling pathway on regulating metabolic reprogramming in immune cells, which contributes to immunoregulation in sepsis.

Background::Gut-resident macrophages (gMacs) supplemented by monocytes-to-gMacs differentiation play a critical role in maintaining intestinal homeostasis. Activating transcription factor 4 (ATF4) is involved in immune cell differentiation. We therefore set out to investigate the role of ATF4-regulated monocytes-to-gMacs differentiation in sepsis-induced intestinal injury.Methods::Sepsis was induced in C57BL/6 wild type (WT) mice and Atf4-knockdown ( Atf4+/-) mice by cecal ligation and puncture or administration of lipopolysaccharide (LPS). Colon, peripheral blood mononuclear cells, sera, lung, liver, and mesenteric lymph nodes were collected for flow cytometry, hematoxylin and eosin staining, immunohistochemistry, quantitative reverse transcription polymerase chain reaction, and enzyme-linked immunosorbent assay, respectively. Results::CD64, CD11b, Ly6C, major histocompatibility complex-II (MHC-II), CX3CR1, Ly6G, and SSC were identified as optimal primary markers for detecting the process of monocytes-to-gMacs differentiation in the colon of WT mice. Monocytes-to-gMacs differentiation was impaired in the colon during sepsis and was associated with decreased expression of ATF4 in P1 (Ly6C hi monocytes), the precursor cells of gMacs. Atf4 knockdown exacerbated the impairment of monocytes-to-gMacs differentiation in response to LPS, resulting in a significant reduction of gMacs in the colon. Furthermore, compared with WT mice, Atf4+/- mice exhibited higher pathology scores, increased expression of inflammatory factor genes ( TNF-α, IL-1β), suppressed expression of CD31 and vascular endothelial-cadherin in the colon, and increased translocation of intestinal bacteria to lymph nodes and lungs following exposure to LPS. However, the aggravation of sepsis-induced intestinal injury resulting from Atf4 knockdown was not caused by the enhanced inflammatory effect of Ly6C hi monocytes and gMacs. Conclusion::ATF4, as a novel regulator of monocytes-to-gMacs differentiation, plays a critical role in protecting mice against sepsis-induced intestinal injury, suggesting that ATF4 might be a potential therapeutic target for sepsis treatment.