Objective:To investigate the effect of artesunate(ART) on human leukemia cell line K562. Methods:Inhibition of proliferation was measured by a colorimetric MTT assay. The morphological changes of K562 were observed under a light microscope and an electron microscope. Flow cytometry assay detected the ratio of apoptosis and oncosis of K562 cell lines which were induced at three different times by three different concentrations of ART. Results:ART extract clearly inhibited the proliferation of K562. The 50% effective dose evaluated on 24h,48h,and 72h of ordinal exposure to the extract,were 65.17?g/ml,31.63?g/ml,and 10.51?g/ml,respectively,ART extract-treated cells exhibited morphological changes typical of oncosis and apoptosis. Futheremore,the ratio of apoptosis was not different from to that of oncosis. Conclusion:Artesunate can control proliferation of the K562 human leukemia cell line in two forms:oncosis and apoptosis. The ratio of oncosis and apoptosis present typical dose-dependence and time-dependence.

Programmed cell death 1 (PD-1) is an important negative costimulatory molecule discovered in recent years, which is expressed on the surface of T and B cells and plays an important role in the regulation of cellular immune response and immune tolerance.After the combination of PD-1 and its receptor programmed cell death 1 ligand 1 (PD-L1), negative regulatory signals are transmitted to suppress the immune response.Under the activation of stimulating factors, PD-1 and PD-L1 are combined to weaken the conduction of downstream signaling pathways such as PI3K/Akt and ERK through recruitment of phosphorylated SHP2, thereby inhibiting the proliferation of T cells and the production of cytokines, inhibiting the immune response and participating in the occurrence and development of a large number of inflammatory diseases.PD-1 in the field of ophthalmology research is still in its infancy.As far as we know, PD-1 participates in ocular inflammatory diseases such as uveitis, sympathetic ophthalmia, allergic conjunctivitis, also is involved in corneal transplant rejection, optic nerve crush injury and optic myelitis, diabetic retinopathy, thyroid related ophthalmopathy, melanoma and other diseases, thus preventing the interactions between PD-1 and its receptor PD-L1 may become a new potential target for the treatment of ocular tumor, inflammation, autoimmune and neurodegeneration disease.In this article, the latest research progress of PD-1 and its receptor PD-L1 in the pathogenesis of ocular diseases were reviewed.

Objective To analyze the effect of clinical pathway of nursing on health education in patients undergoing tonsil-lectomy.Methods Participants included 180 patients undergoing tonsillectomy in our hospital from September 2012 to September 2013 were randomly divided into the clinical pathway of nursing group ( experimental group) and the traditional nursing group ( control group) with 90 cases in each group.The sleep quality, heart rate, blood pressure, body weight, hemorrhage, health education com-pliance rate and nursing service satisfaction were recorded and compared between the two groups.Results The sleep quality, health education compliance rate and nursing service satisfaction in the experimental group was better than that in the control group;The inci-dence of heart rate speed up, blood pressure increase, loss weight, the standard rate of health education, hemorrhage and the satisfac-tion of nursing quality was lower than that in the control group.There was statistical significance in the difference between the two groups (p<0.05).Conclusion Health education with the clinical pathway of nursing can improve the quality of nursing, promote the rehabilitation and increase the nursing service satisfaction .

BACKGROUND:Patients with Parkinson disease (PD) are always supplied exogenous dopamine so as to balance a disproportion of neurotransmitter.However,a long-term administration may easily cause drug resistance;therefore,it is not able to solve nerve injuries at all.A lot of researches suggest that ganglioside can promote neural axon growth,improve neurotrophy,and resist cellular toxicity mediated by glutamic acid (GA).OBJECTIVE:To probe into the duration and effect of oraL administration of ganglioside on improving clinical symptoms of PD patients.DESIGN:Retrospective case analysis.SETTING:Department of Internal Medicine.Shanghai Electric Power Hospital;Departments of Neurosurgery and Internal Medicine,the First Affiliated Hospital of Kunming Medical College.PARTICIPANTS:A total of 6 344 PD patients were selected from Heilongjiang,Hebei,Shandong,Henan, Beijing,Jiangsu,Gansu,Qinghai.Guizhou,Fujian,Hunan,Shanxi, Hubei,Sichuan,Chongqing,Jiangxi, Shanghai and Yunnan from January 2001 to January 2005.All patients met the diagnostic and typing criteria of PD in Practical Neurology.They orally took≥10 mg/d ganglioside for more than 1 month,and all of them were provided the consent.METHODS:Patients who were treated with oral ganglioside accepted neural functional rehabilitation. Every oral solution of ganglioside contained 0.25 g/L ganglioside [including monosialoteterahexosyl ganglioside 1 (21%),diplo-sialoteterahexosyl ganglioside 1a(40%),diplo-sialoteterahexosyl ganglioside 1 b(16%),and tri-sialoteterahexosyl ganglioside 1b(19%)],and patients fastingly took two ampoules in every morning and 2 in every evening before sleeping, or took 4 ampoules in every evening before sleeping. Every 3 months was regarded as a course, and patients were always treated for two or three courses;especially,patients having a long-term duration were treated for above 4 courses.Regular follow-up was performed during the administration to observe the improvements of PD patients on the aspects of chatter, myotone, bradypraxia,posture irregularity, etc. Effective evaluation: Iilness improvements of PD patients who orally took ganglioside were observed within 3,6,9 months and 1 year.Excellent effective: Chatter and myotone disappeared after gradually stopping administration of dopamine preparation;improvement: Symptoms mentioned above were relieved after gradually reducing administration of dopamine preparation (effect=apparent effect+improvement);inefficacy:Symptoms mentioned above were not changed.MAIN OUTCOME MEASURES:Effect at various time Points of administration.RESULTS:Among 5 937 patients who met the inclusion criteria,all of them were involved in the final analysis without any loss.① Improvement of clinical symptoms at various time points of administration:There were 669 PD patients with the effective improvements within 1-3 months.941 within 4-6 months and 1713 within 7-12 months.The total effective rate was 56%.② Therapeutic effective rate of PD patients at various administrating times:The therapeutic effective rates of patients who received administration from 1 to 3 months,from 4 to 6 months and from 7 to 12 months were 30%,57%and 84%respectively.The rate was higher of patients administrated from 4 to 6 months than.of those from 1 co 3 months(P<0.05),and also higher of those from 7 to 12 months than of those from 4 tp 6 months and from 1 to 3 months (P<0.05,P<0.01).CONCLUSION:Ganglioside can effectively improve clinical symptoms,such as chatter,myotone,bradypraxia,posture irregularity,etc.In addition,it has a better effect during a long-term administration.

Objective To observe the clinical effect of health education pathway on patients after hip replacement. Methods Patients after artificial hip replacement (200 cases) were divided randomly into the observation group and the control group with 100 cases in each group.The control group adopted general health education methad.The observation group was given health education according to health education pathway.The level of disease-related knowledge and satisfactory degree were compared between the two groups. Results The level of disease-related knowledge and satisfactory degree in the observation group were higher than those of the control group (P ＜ 0.01 ). Conclusions Health education pathway can facilitate level of disease-related knowledge and positive cooperation with treatment and nursing of patients as well as increase satisfactory degree of patients.

Objective To explore the normal values for two-dimension solid state high resolution anorectal manometry (HRAM) in healthy adult volunteers.Methods The healthy adult volunteers were recruited by advertisement and underwent solid state HRAM in the left lateral position.Anorectal pressures and rectal sensation were recorded and analyzed.Results (1) A total of 126 Chinese healthy adult volunteers (male:50 cases (39.7％);age:(37.5 ± 14.2) years old) were recruited in this study.(2)Mean anal resting pressure (MERP) was (71.8 ± 17.3) mmHg (1 mmHg =0.133 kPa).Maximum anal resting pressure (MARP) was (79.3 ± 17.8) mmHg,Maximum anal squeeze pressure (MSP) was (178.7 ± 52.8) mmHg.Anal high pressure zone (HPZ) length was (3.4 ± 0.6) cm.During simulated evacuation,residual anal pressure (RAP) was (63.8 ±20.5) mmHg,and anal relaxation rate (ARR) was (37.0 ± 11.5) ％.Rectal threshold volume for first sensation (FST),desire to defecate (DDT),urgency to defecate (UDT) and maximum discomfort (MDT) was (47.4 ±10.0) ml,(84.5 ±18.2) ml,(125.8 ± 28.5) ml,and (175.5 ±36.1) ml,respectively.(3) Compared with female subjects,male subjects had higher MSP [(211.0 ± 50.7) mmHg vs (157.5 ± 42.5) mmHg],RAP [(71.6 ± 18.1) mmHg vs (58.8 ± 20.5) mmHg]and rectal MDT[(187.0 ±36.4) mmHg vs (168.0 ±34.1)mmHg],but lower ARR [(32.1 ±8.0)％ vs (40.2 ±12.3)％],all P＜0.01.(4) MERP,MARP,MSP and rectal MDT were higher in young group (≤ 40 years old),all P ＜ 0.05.Conclusions These observations provide normal values for two-dimension solid state HRAM,which have significant difference between genders and different age groups.

Objective To investigate the mental health states of health system staffs in a district of Chongqing municipality. Methods Seven hundred and seventy-three health system staffs were taken as the research subjects for conducting the investigation by the Symptoms Checklist-90 (SCL-90).With the total SCL-90 score >160 as the positive psychological symptom,the total mean scores of SCL-90 and the 9 items of factor score of somatization,obsession,personal relations,depression,anxiety,hostility,dread, paranoid and psychotics were performed the statistical analysis.Results The positive rate of psychological symptoms in 773 health system staffs was 17.46% (135/773),among them which in the clinical nurses,clinicians and nonclinical staffs were 23.20%(58/250),15.63%(50/320)and 13.30%(27/203)respectively.The somatization and obsession scores of the health system staffs in this district were obviously higher than those of the national norm (P <0.05),while their personal relations and paranoid scores were obviously lower than those of the national norm(P <0.01).The paranoid scores of the staffs in the district health units were higher than those of the staffs worked in town health units(P <0.05),and other 8 items of factor score and the total mean scores were significantly higher than those in the town health unit staffs (P <0.01).The scores of obsession,depression,anxiety,hostility and the total mean scores of the clinical nurses were significantly higher than those of the clinicians (P <0.01),while scores of so-matization,personal relations,paranoid and psychotics had no significant differences between them(P > 0.05).The total mean scores of the clinical nurses were higher than those of the non-clinical staffs(P <0.05).Conclusion The scores of multiple factors had significant differences between the health system staffs in this district and the national norm.The psychological health status in the clinicians was poorer than that in the non-clinical staffs,especially the psychological health status in the clinical nurses were much poorer.

Objective To simulate the process of thrombus removal from the open-type stent retrievers, so as to provide theoretical references for the design and clinical application of the open-type stent retrievers. Methods Finite element models of the open-type stent retrievers with 3,4,5 supporting units (K3,K4,K5), the crimping tools, simulated vessels and simulated thrombus (three types) were established. Radial displacement load was applied on the crimping tool until the stent was crimped to 0.5 mm, and the maximum principal strain (MPS) peak and radial force (RF)of the stent were analyzed. When displacement of the crimping tool was restored, the stent self-expanded and contacted with blood vessels, and MPS of the stent and von Mises stress (VMS) of blood vessels were analyzed. Axial displacement was applied to proximal end of the stents to allow the stent to drive the clots to migrate, and the blood vessel VMS and withdrawal force of the stents (the ability to capture thrombus) were analyzed. ResultsThe MPS peaks for 3 types of stent retrievers during crimping process were 6.94%, 8.30% and 5.48%, which were all smaller than the 12% fracture limit. When the outer diameter of the stent was 3 mm (equal to the inner diameter of blood vessels), the K4 stent had the largest RF. The results of self-expanding release process showed that the larger the number of support units, the greater the VMS of blood vessels. At the stage of thrombus migration and removal,the VMS of blood vessels was generally small and concentrated on the thrombus. The withdrawal force of the stent reached the maximum at the initial stage of thrombus migration and removal, then gradually decreased. The peak withdrawal force of the K4 stent was larger than that of the K5 and K3 stent. Conclusions Although the MPS and VMS for 3 types of open-type stent retrievers were within the safe range, the K4 stent showed better performance in RF and withdrawal force with the three types of thrombus. The research findings can provide the analysis methods and ideas for optimizing the open-type stent retrievers, to avoid clinical complications such as vascular injury and improve safety and effectiveness of the stent retrievers.

Objective:To observe the clinical characteristics of primary retinitis pigmentosa (RP) complicated with glaucoma.Methods:A retrospective clinical study. From June 2008 to March 2020, the diagnosis of primary RP were included in the diagnosis confirmed by the eye examination of West China Hospital of Sichuan University included 4794 eyes of 2432 patients. Among them, 4679 eyes (97.2%, 2364/2432) were in 2364 cases with RP alone, and 115 eyes were in 68 cases with RP combined with glaucoma (2.80%, 68/2432). All affected eyes underwent best corrected visual acuity (BCVA) and intraocular pressure examination. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. The 67 eyes of 40 patients with RP and glaucoma with complete follow-up data were analyzed to observe the proportion of different glaucoma types, logMAR BCVA, intraocular pressure and other clinical characteristics, as well as treatment methods and post-treatment intraocular pressure control. After treatment, the intraocular pressure ≤21 mm Hg (1 mm Hg=0.133 kPa) was regarded as intraocular pressure (IOP) control; >21 mm Hg was regarded as uncontrolled IOP.Results:Among the 67 eyes of 40 cases with complete follow-up data, 5 cases (7 eyes) with primary open-angle glaucoma (10.45%, 7/67), 56 cases (58 eyes) with angle-closure glaucoma (ACG) (86.57%, 58/67), 4 cases (4 eyes) with neovascular glaucoma (5.97%, 4/67), 2 of them had both ACG and neovascular glaucoma. Among 58 ACG eyes, 17 eyes were acute ACG (25.37%, 17/67), 21 eyes were chronic ACG (31.34%, 21/67), and 2 eyes were suspicious angle closure (2.99%, 2/67), lens dislocation secondary to angle-closure glaucoma in 8 eyes (11.94%, 8/67), chronic angle-closure glaucoma after anti-glaucoma surgery, intraocular lens shift in 5 eyes (7.46%, 5/67), 5 eyes (7.46%, 5/67) secondary to glaucoma with true small eyeballs. The logMAR BCVA 3.50 of the affected eye,<3.50->2.00, ≤2.00-≥1.30,<1.30->1.00, ≤1.00- 0.52,<0.52 were 9 (13.43%, 9/67), 30 (44.78%, 30/ 67), 7 (10.45%, 7/67), 4 (5.97%, 4/67), 11 (16.42%, 11/67), 6 (8.96%, 6/67) eyes, which correspond to mean intraocular pressure were 32.31±11.67, 30.15±14.85, 28.17±13.19, 31.50±17.25, 18.71±8.85, 14.12±4.25 mm Hg. Among 67 eyes, 37eyes (55.22%, 37/67), 18eyes (26.86%, 18/67), and 6 (8.96%, 6/67) eyes underwent surgery, medication alone, and peripheral iris laser perforation treatment, respectively. The treatment of 6 eyes was abandoned (8.96%, 6/67). Malignant glaucoma occurred in 3 eyes (8.11 %, 3/37) after the operation, all of which were after trabeculectomy of the ACG eye. After treatment, intraocular pressure was controlled in 37 eyes (55.22%, 37/67), 19 eyes were not controlled (28.36%, 19/67), and 11 eyes were lost to follow-up (16.42%, 11/67).Conclusions:The incidence of glaucoma in patients with primary RP is 2.80%. ACG is more common, and the combined lens dislocation or intraocular lens shift is more common.

Objective:To establish the normal values of water-perfused high resolution esophageal manometry (HREM)(GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing in Chinese population.Methods:From September 1, 2019 to June 30, 2020, 91 healthy volunteers receiving water-perfused HREM (GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing were selected from 9 hospitals (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; the First Affiliated Hospital of Dalian Medical University; the Second Hospital of Hebei Medical University; the Second Affiliated Hospital, Naval Medical University; the First Affiliated Hospital, Sun Yat-sen University; the First Affiliated Hospital, University of Science and Technology of China; Aviation General Hospital of China Medical University; the Affiliated Hospital of Medical School of Nanjing University and the First People′s Hospital of Yichang). Parameters included the position of the upper and lower edges of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), the length of the LES and UES, the position of the pressure inversion point (PIP), the resting pressure of UES and LES and swallow-related parameters such as the distal contraction integral (DCI), 4 s integrated relaxation pressure (IRP), distal latency (DL) and UES residual pressure. One-way analysis of variance, post-hoc test and sum rank test were used for statistical analysis.Results:A total of 87 healthy volunteers were enrolled, including 40 males and 47 females, aged (38.5±14.2) years old (ranged from 19 to 65 years old). The position of the upper and lower edges of the LES was (42.7±2.8) and (45.6±2.8) cm, respectively, the length of the LES was (2.9±0.4) cm, and the position of PIP was (43.3±2.8) cm. The position of the upper and lower edges of the UES was (18.1±3.0) and (22.6±2.0) cm, respectively, and the length of the UES was (4.8±1.0) cm. The resting pressure of LES and UES was (17.4±10.7) and (84.1±61.1) mmHg (1 mmHg=0.133 kPa), respectively. The DCI value at solid swallowing was higher than those at water swallowing and semisolid swallowing ((2 512.4±1 448.0) mmHg·s·cm vs. (2 183.2±1 441.2) and (2 150.8±1 244.8) mmHg·s·cm), and the differences were statistically significant ( t=-4.30 and -3.74, both P<0.001). The values of 4 s IRP at semisolid swallowing and solid swallowing were lower than that at water swallowing ((4.6±4.1) and (4.9±3.9) mmHg vs. (5.4±3.9) mmHg), and the differences were statistically significant ( t=3.38 and 2.09, P=0.001 and 0.037). The DL at water swallowing was shorter than those at semisolid swallowing and solid swallowing ((8.5±1.8) s vs. (9.8±2.2) and (10.6±2.8) s), and the DL at semisolid swallowing was shorter than that at solid swallowing, and the differences were statistically significant ( t=-10.21, -13.91 and -4.68, all P<0.001). The UES residual pressure at water swallowing was higher than those at semisolid swallowing and solid swallowing (9.5 mmHg, 6.5 to 12.3 mmHg vs. 8.0 mmHg, 4.5 to 11.7 mmHg and 5.5 mmHg, 2.0 to 9.3 mmHg), and the UES residual pressure at semisolid swallowing was higher than that at solid swallowing, and the differences were statistically significant ( t=3.48, 10.30 and 6.35, all P<0.001). Conclusions:The normal values of water-perfused HREM (GAP-36A) in Chinese population at resting period, water swallowing, semisolid swallowing and solid swallowing can provide a reference basis for clinical diagnosis and treatment for patients receiving water-perfused HREM examination.