Objective To explore propofol dosage difference between in morning and at after-noon undergoing gynecological clinic short operation.Methods One thousands and nine hundred fifty eight female patients,aged 1 6-50 yr,of ASA physical status Ior II,undergoing gynecology clinic short operation,according to the operation time,were divided into two groups,Group morning (8:30-1 1:30,n =1047)and group afternoon (14:00-1 7:00,n =91 1).Each patient was intravenously injected fentanyl 0.01 μg/kg,and then propofol 2.5 mg/kg.When the observer’s assessment of alertness/se-dation (OAA/S)scores reached 0 score,the operation began.If the body moved,the surgery was stopped and 25 mg propofol was intravenously injected quickly.After 10 seconds observation,if the body movement existed,25 mg more propofol was performed,until the movement disappeared.Re-cord patients’year,height,weight,body mass index,and the heart beat,blood pressure of pre-op-eration,the number of times of cervix uteri expansion per vagina,the history of labor per vagina,the total dosage of propofol and the time length of sedation.Results The dosage of group afternoon (1 52.1 6±65.90)mg was higher than group morning’s (135.69±37.67)mg (P <0.05).There was no significant difference of time lengths of sedation between the two groups.Additional use of propofol in the afternoon group 387 (42.5%)was higher than group morning’s 1 99 (23.5%)(P <0.05).Conclusion In gynecological clinic short operation,the propofol dosage in afternoon was higher than that in the morning group.But the sedation time length in afternoon was not longer than that in the morning.

Acute respiratory distress syndrome is an acute,progressive and inflammatory process of lung injury.The disease is very serious with the neonatal mortality as high as 30％-60％.In recent years,with the development of the study on the mechanisms of newborns with acute respiratory distress syndrome,a lot of new viewpoints on diagnosis and treatments have been explored.This review focuses on the recent advances on new mechanisms,diagnosis and therapy strategies of acute respiratory distress syndrome.

With the growing awearness of Big data and its application in economic,social and scientific fields,this paper analyzed the impact and challenges big data has brought to the field of biomedical research,and put forward suggestion of improving applications of big data in biomedical research.

Objective To observe the changes of A20 in mesangial cells of diabetic nephropathy (DN) rat model in?duced by lipopolysaccharide (LPS)-rat, and to explore its possible mechanism. Methods (1)Thirty health male Wistar rats were randomly divided into two group. Model rats were given streptozotocin (STZ) at a dose of 60 mg/kg by intraperitoneal in?jection. Rats in the control group received the same volume of citrate buffer in the same way. Levels of blood glucose and uri?nary microalbumin were detected in two groups at the 6th and the 8th week. Changes of renal pathology were observed by HE staining. Changes of protein A20 were observed by immunohistochemistry. (2) Expression changes of gene and proteins A20, nuclear factor (NF)-κB, IκB, IKKγand MCP-1 in renal cells treated with LPS were determined after treatment with different time points (0, 2, 4, 6, 12, 24, 48 and 72 h) and different concentrations (0.1, 1 and 10μg/L). Results (1) Levels of blood glucose and urinary microalbumin were significantly increased in model group compared with those of control group ( P <0.01). HE stainig showed that hyaline degeneration in tubular epithelial cells was found in model group, especially at the 8th week. Results of immunohistochemistry showed that expression of protein A20 significantly decreased in kidney tubules and nearly disappeared in glomerulus in model group compared with that of control group, which expressed less at the 8th week. (2) There was no significant difference in the expression of IKKγbetween different concentrations and different times. Com?pared with 0 h, the expression of A20 protein was increased at 2 h and 4 h, except that the expression of A20 protein in?creased after 6 h (P<0.05). Meanwhile NF-κB expression increased and IκB expression decreased in different time points (P<0.05). In addition, the expressions of A20 and IκB were decreased concentration-dependently (P<0.05). The expres?sion levels of NF-κB and MCP-1 were increased concentration-dependently (P<0.05). Conclusion A20 may involve in the development of diabetic nephropathy by regulating the NF-κB pathway.

Objective: To explore the value of SYNTAX revascularization index (SRI) on evaluating the long-term prognosis of coronary artery disease (CAD) patients implanted with biodegradable polymer drug-eluting stents (BP-DES) and define the best threshold of SRI for predicting all-cause mortality in these patients. Methods: Data used in this study derived from the I-LOVE-IT 2 trial (evaluate safety and effectiveness of the Tivoli DES and the Firebird DES for treatment of coronary). I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, non-inferiority study. A total of 1 829 patients implanted with BP-DES were divided into 3 groups, namely SRI=100% group (n=963), 50%≤SRI<100% group (n=527) and SRI<50% group (n=339). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, myocardial infarction(MI), stroke, and/or any revascularization. The secondary endpoints were components of PoCE and definite/probable stent thrombosis at 48 months. The receiver operating characteristic curve was used to investigate the best cut-off point of SRI for 48-month all-cause mortality. The Cox regression analysis was used to identify independent predictors of the all-cause death and PoCE at 48 months. Results: Incidence of PoCE at 48 months was significantly lower in SRI=100% group than patients with 50%≤SRI<100%(17.34% (167/963) vs. 22.20% (117/527), P<0.05) and SRI<50% (17.34% (167/963) vs. 24.78% (84/339), P<0.05). Comparing with SRI=100% group, the patients with 50%≤SRI<100% suffered higher rates of all MI (7.78% (41/527) vs. 4.26% (41/963), P<0.05) and target vessel MI (6.45% (34/527) vs. 4.26% (41/963), P<0.05); patients with SRI<50% had higher rates of all-cause mortality (5.90% (20/339) vs. 3.12% (30/963), P<0.05) and any revascularization (14.16% (48/339) vs. 3.12% (30/963), P<0.05). The receiver operating characteristic curve analysis showed that the SRI=65% was the best cut-off point to predict the all-cause mortality at 48 months (area under the curve was 0.58, sensitive was 0.47, specificity was 0.70). Meanwhile, SRI<65% was an independent predictor of 48-month all-cause mortality (HR=2.06, 95%CI 1.25-3.38) and PoCE (HR=1.34, 95%CI 1.09-1.66). Conclusions SRI serves as a good index for predicting long-term prognosis and SRI<65% is an independent predictor of 48-month PoCE and all-cause mortality for CAD patients with BP-DES implantation. Meanwhile, SRI≥65% might be a reasonable threshold of incomplete revascularization.

Objective: To evaluate the long-term prognosis of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) by risk stratification with American College of Cardiology (ACC)/American Heart Association (AHA) classification of coronary lesions. Methods: Data used in this study derived from the I-LOVE-IT 2 trial. I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, noninferiority study. A total of 1 255 patients in I-LOVE-IT 2 trial with only one lesion and underwent biodegradable polymer drug-eluting stent implantation were included and grouped according to ACC/AHA classification of coronary lesions, namely type A/B1 lesion group (n=184), type B2 lesion group (n=457) and type C lesion group (n=614). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, all myocardial infarction, stroke, and/or any revascularization. The secondary endpoints were target lesion failure (TLF), components of PoCE, major bleeding (bleeding academic research consortium(BARC) type 3-5) and definite/probable stent thrombosis within 48 months. The incidences of endpoint events were compared in the three groups. The multivariable Cox hazard ratio model was used to analyze the independent predictors of PoCE and TLF at 48 months. Results: Incidences of PoCE at 48 months were significantly higher in patients with type C lesion compared with patients with type A/B1 (24.43%(150/614) vs. 14.13%(26/184), P<0.05) or B2 lesion (24.43%(150/614) vs. 15.97%(73/457), P<0.05). The multivariable Cox hazard ratio model showed that the type C lesion were the independent predictors of 48-month PoCE (HR=1.59, 95%CI 1.21-2.08, P<0.001) and TLF (HR=2.31, 95%CI 1.53-3.49, P<0.001). After multivariable adjustment, the HRs of PoCE for patients with type C lesion versus type A/B1 and type B2 were 1.91 (95%CI 1.25-2.92, P=0.003) and 1.64 (95%CI 1.23-2.20, P<0.001), respectively. Meanwhile, the HRs of TLF for patients with type C lesion versus type A/B1 and type B2 were 2.45 (95%CI 1.29-4.64, P=0.006) and 2.55 (95%CI 1.62-4.02, P=0.001), respectively. Conclusions The ACC/AHA classification of coronary lesions has good discrimination with long-term outcomes for CAD patients undergoing PCI. The type C lesion is associated with a worse prognosis, enough attention should be paid in these patients during routine clinical management.

ObjectiveTo establish a droplet digital PCR (ddPCR) method for detecting hepatitis B virus (HBV) covalently closed circular DNA (cccDNA). MethodsHBV cccDNA standard substance was constructed, and HBV cccDNA primers and probes were designed based on the structural differences between HBV cccDNA and relaxed circular DNA (rcDNA). HBV plasmid was amplified to obtain HBV cccDNA standard substance, and a ddPCR detection method was established with the standard substance after gradient dilution as the template for HBV cccDNA detection; the limit of detection and repeatability of this method were analyzed. Liver tissue samples were collected from 20 patients who attended Beijing YouAn Hospital, Capital Medical University, from June 2017 to October 2020, all of whom were diagnosed with HBV infection, and DNA of the samples was extracted and digested with plasmid-safe ATP-dependent DNA enzyme to obtain HBV cccDNA template; the ddPCR detection method was evaluated in clinical samples and was compared with the quantitative real-time PCR (qPCR) detection method. The chi-square test was used for comparison of categorical data between the two groups. ResultsThe HBV cccDNA detection method based on ddPCR was established, which accurately detected HBV cccDNA in standard substance after gradient dilution, with a limit of detection of 1 copy/μl, and the coefficients of variation of 1×103, 1×102, and 1×101 copies/μl standard substances were 441%, 3.98%, and 5.09%, respectively. HBV cccDNA was detected in the samples of 20 patients with HBV infection; the ddPCR detection method detected HBV cccDNA in 17 patients, with a positive rate of 85%, while the qPCR detection method detected HBV cccDNA in 11 patients, with a positive rate of 55%, and there was a significant difference between the two methods (χ2=4.286, P=0038). ConclusionThe established ddPCR method for detecting HBV cccDNA has a low limit of detection and good repeatability, which provides an effective tool for further clinical detection.

Objective:To evaluate the efficacy of long-interval programmed intermittent epidural bolus (PIEB) during the incubation period for labor analgesia.Methods:Seventy-eight nulliparous parturients who were at full term with a singleton fetus in vertex presentation, aged 22-35 yr, with body mass index of 18.0-30.0 kg/m 2, of American Society of Anesthesiologists physical statusⅠorⅡ, were divided into 2 groups ( n=39 each) using a random number table method: routine epidural bolus using a stepwise approach group (C group) and long-interval PIEB group (L group). Epidural puncture was performed at L 2, 3, and the analgesia solution was 0.1% ropivacaine and 0.5 μg/ml sufentanil in the two groups.The parturients in group C received 8 ml pulse dose per hour during the incubation period (cervical dilatation <3 cm), and 10 ml pulse dose per hour during the active phase (cervical dilatation ≥3 cm). In group L, the first pulse dose was 10 ml during the incubation period, 1.5 h later the anesthesia plane was detected, and 10 ml pulse dose was immediately given when the plane was lower than T 10, otherwise it was reevaluated 15 min later.After the interval time reached 2 h, a pulse dose 10 ml was given regardless of whether the plane was lower than T 10, and the pulse dose 10 ml was given at 1 h interval during the active phase.The numerical rating scale scores were recorded when the cervical dilatation was 3, 6 and 10 cm, and at the time of baby delivery.The duration of labor, total consumption of analgesics, and Bromage grade of lower extremities were recorded.The Apgar score <7 at 1 and 5 min after birth was recorded.The maternal adverse reactions and scores for satisfaction with analgesia were also recorded. Results:Thirty puerperae were finally enrolled in each group.The first stage of labor and total duration of labor were significantly shortened, and the total consumption of analgesics was decreased in group L ( P<0.01). There were no significant differences in the numerical rating scale scores at each time point, duration of second and third stages of labor, Bromage grade of lower extremities, incidence of adverse reactions, score for satisfaction with analgesia, and incidence of Apgar score < 7 after birth between the two groups ( P>0.05). Conclusions:When PIEB is used for labor analgesia, prolonging the infusion interval time of epidural bolus to 1.5-2.0 h during the incubation period can produce satisfactory analgesic effect and further decrease the consumption of analgesics and reduce the influence on labor stages when compared with administration using a stepwise approach.

Objective:To establish a rapid and accurate method for the detection of Klebsiella pneumoniae carbapenemase (KPC) carbapenemase gene based on recombinase aided amplification (RAA)-CRISPR-Cas13a (CRISPR-Cas13a) technology. Methods:Twenty-five clinical isolates of carbapenem-resistant Klebsiella pneumoniae (CRKP) and five carbapenem-sensitive Klebsiella pneumoniae (CSKP) strains preserved in 2020-2021 in Beijing Chuiyangliu Hospital were randomly collected, and the total DNA samples of the strains was extracted. RAA primers specific for KPC DNA and CRISPR RNA (crRNA) were designed to establish a rapid and accurate method for the detection of KPC carbapenemase gene based on RAA-CRISPR-Cas13a technology. The method was evaluated by plasmids and clinical sample strains, and the detection was also performed by Quantitative real-time PCR (qPCR) method to compare the detection rate and consistency of the two methods. Results:The RAA-CRISPR-Cas13a method can detect KPC plasmids and samples with a sensitivity of 1 copy/μl, which is higher than that of qPCR (10 1 copies/μl). Among the 30 clinical strains (including 25 CRKP strains and 5 CSKP strains), 23 strains were detected to carry KPC gene by both RAA-CRISPR-Cas13a method and qPCR method, and 7 strains were not detected with KPC gene. The detection rate of KPC gene in the 25 CRKP strains was 92% (23/25). The positive coincidence rate of the two methods was 100% (23/23). Conclusions:This study combined RAA amplification technology with CRISPR-Cas13a technology to establish a rapid and accurate method for detecting KPC carbapenemase gene. The method is useful for accurate screening of KPC carbapenemase-producing strains. It has a wide application prospect in drug resistance monitoring and infection control.

Serum amyloid A(SAA) is a novel marker widely used in the acute infection disease, especially viral infection. SAA has shown a cerntain value in assisting the clinical diagnosis, discrimination of severity and monitoring of progress and outcome of COVID-19. This paper introduces the application of SAA structural, function andits dynamic detection in the diagnosis of COVID-19, and the significance of combined detection with COVID-19 antibodies, nucleic acid and other diagnostic indicators.