Objective To investigate the effects of crocodilian plasma on 12 bacteria(including G+ bacteria and G-bacteria) lines in vitro.Methods The bacteria CFUs on nutrient broth agar plates were determined after bacteria and crocodilian plasma incubated together for 1h.Then effects of the samples on the survival rate of various concentrations of bacteria were calculated.To evaluate the antibacterial spectrum of crocodilian plasma,the zones of bacterial inhibition were measured through agar disk method.Results and Conclusion Crocodilian plasma had superior bactericidal effects on Escherichia coli M421C1,O111B4,E240-3 LT,Micrococcus catarrhalis,Shiga's bacillus,Pseudomonas aeruginosa and Diplococcus pneumoniae.The results indicated why wound of crocodilian by tearing each other was not susceptible,and crocodilian plasma could be developed a natural antibacterials.

T A R D N A-binding dom ain protein 43 (T D P-43) is a highly conserved and w idely expressed nuclear protein. N ow adays, the expression of T D P-43 can be found in m ost neurodegenerative diseases such as A lzheim er's disease, w hich m akes it becom e a neurodegenerative disease associated m arker pro-tein. From the current research status at hom eland and abroad, and around the relationship betw een the expression of T D P-43 and brain injury, this article em phatically probes into the specific expression and function of T D P-43 in acute and chronic brain injury based on the know ledge of its biological charac-teristics, w hich aim s to explore the feasibility for determ ining the cause of death and the injury and dis-ability situations by T D P-43 in forensic pathology.

Objective:To systematically evaluate the clinical efficacy of laparoscopic common bile duct exploration (LCBDE) combined with endoscopic nasobiliary drainage (ENBD) versus T-tube drainage in the treatment of choledocholithiasis.Methods:Databases including PubMed(Medline), Embase, the Cochrane Library, Web of Science, Wanfang, CNKI and CBM were searched for literatures from January 1960 to May 2019 with the key words including "胆总管结石病,胆总管结石; T管引流, T管;鼻胆管引流,经内镜鼻胆管引流术, ENBD管, ENBD引流; cholelithiasis, common bile duct stone, jaundice, obstructive, Jaundice, gallstone; T-tube drainage, T-tube, t-tube, biliary tract drainge, drainge tube; endoscopic nasobiliary drainage, nasobiliary drainage, nasobiliary tube, endoscopic drainage tubes, endoscopic drainage tube, endoscopic retrograde biliary drainage" . The randomized controlled trials (RCTs) and high quality non-randomized controlled trials (NRCTs) on comparing ENBD and T-tube drainage during laparoscopic choledocholithotomy were included.Patients who received LCBDE combined with preoperative or intraoperative ENBD were allocated into ENBD group, and patients who received LCBDE combined with postoperative T-tube drainage were allocated into T-tube drainage group. Reported outcomes: operation time, volume of intraoperative blood loss, duration of postoperative hospital stay, time to drainage tube removal, time to postoperative gastrointestinal function recovery, treatment expenses, rate of surgical failure, incidence of postoperative biliary fistula, incidence of postoperative incisional infection, incidence of postoperative residual stones, incidence of postoperative pancreatitis, incidence of postoperative hyperamylasemia, incidence of postoperative bile peritonitis. Count data were represented as odds ratio ( OR) and 95% confidence interval (95% CI). Measurement data were represented as mean difference ( MD) and 95% CI. The I2 and Q tests were used to analyze literature heterogeneity. I2≤50% or P>0.10 indicated no significant heterogeneity, so fixed effects model was used for Meta analysis. I2>50% and P≤0.10 indicated a significant heterogeneity, so random effects model was used for Meta analysis. When analyzing the measurement data, subgroup analysis of individual indicators was performed if there were more than 4 RCTs included, and NRCTs were analyzed for supplement if there were no more than 4 RCTs included. When analyzing the count data, RCTs and NRCTs were combined for analysis. Funnel plots were used to test potential publication bias if there were more than or equal to 10 studies included, while no test was needed if there were less than 10 studies included. Results:(1) Document retrival: 26 literatures meeting the standards were included, including 9 RCTs and 17 NRCTs (4 semi-randomized studies and 13 case-control studies). There were 2 098 patients, including 1 114 patients in the ENBD group and 984 patients in the T-tube drainage group. (2) Results of Meta analysis. ① Duration of postoperative hospital stay: there was a significant difference in the duration of postoperative hospital stay between the ENBD group and T-tube drainage group ( MD=-6.53, 95% CI: -8.64 to -4.43, P<0.05). Further analysis of 9 RCTs showed significant differences in the duration of postoperative hospital stay between patients without acute complications of choledocholithiasis in the ENBD group and those in the T-tube drainage group, between patients with acute complications of choledocholithiasis in the ENBD group and T-tube drainage group, respectively ( MD=-5.88, -8.77, 95% CI: -8.32 to -3.45, -12.39 to -5.15, P<0.05). ② Time to drainage tube removal: for the RCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-46.01, 95% CI: -83.64 to -8.37, P<0.05). For the NRCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-24.05, 95% CI: -32.93 to -15.18, P<0.05). ③ Time to postoperative gastrointestinal function recovery: for the RCTs, there was a significant difference in the time to postoperative gastrointestinal function recovery between the ENBD group and T-tube drainage group ( MD=17.80, 95% CI: -31.11 to -4.48, P<0.05). For the NRCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-5.64, 95% CI: -10.16 to -1.12, P<0.05). ④ Incidence of postoperative biliary fistula: there was a significant difference in the incidence of postoperative biliary fistula between the ENBD group and T-tube drainage group ( OR=0.50, 95% CI: 0.28-0.89, P<0.05). ⑤ Incidence of postoperative incisional infection: there was a significant difference in the incidence of postoperative incisional infection between the ENBD group and T-tube drainage group ( OR=0.35, 95% CI: 0.17-0.73, P<0.05). (3) Analysis of publication bias. The incidence of postoperative biliary fistula in the two groups was analyzed by funnel plot based on the 15 studies. The bilateral symmetry was presented in the funnel plot for incidence of postoperative biliary fistula, suggesting that publication bias had little influence on results of Meta analysis. Conclusion:For patients with choledocholithiasis that endoscopic lithotomy is not feasible, LCBDE combined with ENBD can significantly shorten duration of postoperative hospital stay, time to drainage tube removal, postoperative gastrointestinal function recovery time, reduce the incidence of postoperative biliary fistula and incisional infection compared with LCBDE combined with T-tube drainage.

Objective:To verify the protective effect of terazosin on cognitive function of rats after whole-brain irradiation (WBI) and to investigate its mechanism.Methods:A total of 64 1-month-old male SD rats were randomly divided into the untreated control group, terazosin group, irradiation group and irradiation plus terazosin group (combination group). WBI was administered at a single dose of 20 Gy in the irradiation and combination groups. The open field test and the Morris water maze (MWM) test were used to evaluate the effect of terazosin on cognitive function after WBI.Starting from the three aspects of juvenile neuron apoptosis, neurogenesis disorderand microglia activation, the possible cellular mechanism wasassayed by double-label immunofluorescence staining for BrdU (bromodeoxyuridine) / NeuN, DCX(Doublecortin) / Caspase-3 and single-label immunofluorescence staining for Iba-1 (ionized calcium binding adaptor molecule-1).Results:Terazosin intervention improved the short-term memory retention of irradiated rats ( P=0.032). After terazosin treatment, the number of DCX + cells in the combination groupwas increased by approximately 35% compared with that in the irradiation group ( P=0.038). The number of BrdU +/NeuN + cells in the combination group was increased by approximately 15% than that in the irradiation group ( P>0.05). The number of Iba-1 + cells in the irradiation plus terazosin group was decreased by 49% compared with that in the irradiation group ( P=0.036). Conclusion:Terazosin may reduce the hippocampal juvenile neuron loss and inhibit neuroinflammation via microglia activation, which can alleviate WBI-induced cognitive dysfunction to a certain extent.

Objective To identify and verify proteins that interact and collaborate with ATF3 in inhibiting hepatocarcinogenesis.Methods Immunoprecipitation (IP),co-IP and protein spectrum analysis were used to identify the protein which interacted with ATF3 in HepG2.Immunohistochemistry (IHC) and Western blot (WB) were used to detect the expression pattern of ATF3 and its candidate interacting proteins in liver tissue.Results The protein expression differences were detected by IP in two HepG2 groups.The experimental group was infected by lentiviral vector with ATF3 over-expression and the control group was infected by mock-vehicle.Several protein bands with expression diversity were analyzed by protein spectrum,which revealed several candidate proteins that may be related with ATF3.Peptide sequences were analyzed by Mascot software and NCBI database.Combined with the existing literature and our study results,Gelsolin (GSN) was identified as a protein closely interacting with ATF3 and confirmed by co-IP,IHC and WB.Conclusions GSN is identified and verified as an interacting protein with ATF3.ATF3 may function as a suppressor of liver cancer via protein-protein interactions with Gelsolin.

Objective:To evaluate the effects of GSK484 on ventilator-induced lung injury (VILI) and neutrophil extracelluar traps (NETs) in mice.Methods:Forty-eight SPF healthy male C57BL/6 mice, aged 5-6 weeks, weighing 15-20 g, were divided into 4 groups ( n=12 each) by a random number table method: spontaneous breathing group (group S), spontaneous breathing+ GSK484 intervention group (group SG), VILI group (group V), and VILI + GSK484 intervention group (group VG). The animals kept spontaneous breathing for 4 h after tracheal intubation in S and SG groups. The animals were mechanically ventilated for 4 h (tidal volume 30 ml/kg, respiratory rate 75 breaths/min, inspiratory/expiratory ratio 1∶2, positive end-expiratory pressure 0 mmHg, fraction of inspired oxygen 21%) in V and VG groups. At 3 days before developing the VILI model, GSK484 4 mg/kg was intraperitoneally injected once a day in SG and VG groups, while the equal volume of normal saline was given instead in S and V groups. Blood samples were collected from the abdominal aorta for blood gas analysis at 4 h of spontaneous breathing or mechanical ventilation, and PaO 2 was recorded. The mice were then sacrificed and bronchoalveolar lavage fluid (BALF) was collected and lung tissues were obtained for microscopic examination of the pathological changes (with a light microscope after HE staining) which were scored and for determination of wet to dry weight ratio (W/D ratio), concentrations of interleukin-1beta (IL-1β), IL-6, tumor necrosis factor-alpha (TNF-α) and myeloperoxidase (MPO) in BALF (by enzyme-linked immunosorbent assay), expression of peptidylarginine deiminase 4 (PAD4), neutrophil elastase (NE), high mobility group box 1 (HMGB1) and citrullinated-histone 3 (Cit-H3) in lung tissues (by Western blot). Results:Compared with S and SG groups, the lung injury score and W/D ratio were significantly increased, PaO 2 was decreased, concentrations of IL-1β, IL-6, TNF-α and MPO in BALF were increased, and the expression of PAD4, NE, HMGB1 and Cit-H3 in lung tissues was up-regulated in V and VG groups ( P<0.05). Compared with group V, the lung injury score and W/D ratio were significantly decreased, PaO 2 was increased, the concentrations of IL-1β, IL-6, TNF-α and MPO in BALF were decreased, and the expression of PAD4, NE, HMGB1 and Cit-H3 was down-regulated in group VG ( P<0.05). Conclusions:GSK484 can alleviate VILI in mice, and the mechanism is associated with inhibition of PAD4, reduction of the production of NETs and attenuation of inflammatory responses in lung tissues.

Objective:To explore the clinical value of synovial fluid calprotectin for the diagnosis of periprosthetic joint infection (PJI).Methods:Based on prospective cohort study design, a total of 82 patients suspected of PJI after hip and knee arthroplasty in the First Medical Center of the PLA General Hospital from July 2021 to June 2022 were selected. Patients were divided into infection group (PJI, n=39) and non-infection group (non-PJI, n=43) according to the diagnostic criteria proposed by the Second International Consensus Conference in 2018. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used for double-blind detection of calprotectin and internal reference standard (IRS) in synovial fluid of patients. The peaks of target protein and IRS were recorded for further analysis. Mann-Whitney U test was used to compare the concentrations of S100A8 and S100A9 between the two groups, and receiver operating characteristic curve (ROC) was used to analyze the diagnostic efficacy of S100A8 and S100A9 for PJI. Results:Calprotectin was detected as monomers S100A8 and S100A9. Synovial fluid S100A8 was significantly higher in the PJI group than that in the non-PJI group [1.57 (0.48, 4.17) vs 0.00 (0.00, 0.05), Z=?7.221, P<0.05]. Synovial fluid S100A9 was also significantly higher in the PJI group than that in the non-PJI group [0.74 (0.29, 1.70) vs 0.06 (0.00, 0.10), Z=?6.255, P<0.05]. When using S100A8 and S100A9 to diagnose PJI, the sensitivity were 97.4% and 87.2%, the specificity were 86.0% and 88.4%, and the area under the ROC were 0.964 (95% CI 0.929-0.998) and 0.902 (95% CI 0.924-0.996), respectively. Conclusion:The detection of synovial fluid S100A8 and S100A9 by MALDI-TOF MS can make a satisfactory diagnosis for PJI.

The integration of regional medical centers and community health service centers is an effective way to improve the professional ability of general practitioners in post-practice training. Its major advantage lies in the establishment of a regional general practitioner ability improvement system integrating assessment, practice and teaching under the unified health administrative department. This article introduces the path of general practitioner post-training developed by Shanghai Tongren Hospital in forms of a regional medical center combined with the community health service center under the "integrated dual-drives" model, which was carried out in Shanghai Changning District; and its preliminary accomplishment is also discussed. It may provide reference for regional medical centers to improve the ability of general practitioners through practice-driven and teaching-driven.

Objective:To analyze the clinical knowledge and training needs of general practitioners from subjective perception and objective assessment, and to analyze their relationship.Methods:A survey was conducted among general practitioners from community health service centers in Shanghai Changning district from September to December 2020. Based on the general practitioner competency indicator system designed by the project team, 17 clinical knowledge competency evaluation indicators were developed through expert consultation, and used for subjective perception and objective assessment of clinical knowledge and learning needs among general practitioners. The influencing factors of objective assessment scores were analyzed, and the relationship between subjective perception and objective assessment scores was analyzed using the four quadrant method.Results:A total of 136 general practitioners participated in the study with the mean age of (39.25±5.90) years, most of whom were attending physician (67.65%, 92/136) and had undergraduate education (88.20%, 122/136). The average daily application frequency score was (1.55±0.21), and the training needs score was (1.65±0.09) for 17 clinical knowledge items; the average objective evaluation score was (74.21±14.0) points. The older the age ( OR=1.25, 95% CI:1.14-1.37), the higher the educational level ( OR=2.11, 95% CI:1.57-2.83), and the longer the working years ( OR=1.16, 95% CI:1.04-1.30) were significantly correlated with the higher objective evaluation scores (all P<0.05). The objective evaluation scores of endocrine diseases such as diabetes, cerebrovascular diseases and respiratory diseases are the highest, and the daily application frequency and learning needs are high (the first quadrant); The objective evaluation scores of common orthopedic diseases, common psychological diseases, and planned immunity indicators were relatively low, but their daily application frequency and learning needs were relatively high (second quadrant). The objective evaluation scores of indicators such as common malignant tumors, common dermatology diseases and health problems, and common ENT diseases were low, and the daily application frequency and learning needs were also low (the third quadrant). The objective evaluation scores of indicators such as hospice and palliative care are relatively high, but their daily application frequency and training needs are relatively low (listed in the fourth quadrant). Conclusions:The clinical knowledge levels of general practitioners are correlated with age, education level, and years of practice. There is a certain overlap between the objective evaluation results of clinical knowledge and the frequency of knowledge usage and training needs of general practitioners, and a targeted training mechanism should be established.

Objective:To retrieve, evaluate and summarize the evidence on exercise therapy in patients with breast cancer related lymphedema, so as to provide basis for clinical practice.Methods:According to the "6S" evidence resource pyramid model, all the evidence on exercise therapy for patients with breast cancer related lymphedema, including clinical guideline, expert consensus, best practice information book, Meta-analysis, systematic review and other evidence, were searched layer by layer from top to bottom in British Medical Journal (BMJ) Best Practice, UpToDate, Guidelines International Network, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Agency for Healthcare Research and Quality, National Comprehensive Cancer Network, National Lymphedema Network, International Society of Lymphedema, Yimaitong, Cochrane Library, China Biology Medicine, PubMed, Web of Science, China National Knowledge Infrastructure, and WanFang Data. The search period was from January 2000 to October 2021. Two researchers conducted literature quality evaluation, evidence extraction and summary.Results:A total of 28 articles were included, including one best clinical practice, one clinical decision-making, 7 clinical guidelines, three expert consensus, and 16 systematic reviews. A total of 40 best pieces of evidence were extracted from 7 aspects, including exercise guarantee, exercise instructions, exercise form, exercise intensity, exercise time, exercise frequency, and follow-up and health education.Conclusions:Exercise therapy is very important for patients with breast cancer related lymphedema. In the process of applying evidence, medical and nursing staff should combine the actual situation to form a professional medical team, fully consider the patient's physical and mental condition and exercise habits, dynamically adjust and develop personalized exercise plans based on the patient's health status and preferences, thereby improving the effectiveness of exercise therapy and patient's quality of life.