OBJECTIVE:To optimize the conditions of extractive microbial transformation for producing L-phenylacetylcarbi-nol(L-PAC). METHODS:HPLC was used to determine the concentration of L-PAC,which was extracted by saccharmyces cerevi-siae. Using L-PAC concentration as response value,Box-Behnken response surface design was adopted to investigate the 3 main fac-tors of benzaldehyde,Triton X-100 and glucose dose,and verification test was conducted. RESULTS:The interaction between benzaldehyde and Triton X-100 was the most significant. The optimized combination was as follows as benzaldehyde of 1.1%,Tri-ton X-100 of 0.14 g/mL,glucose of 0.028 g/mL. The average concentration in verification test of L-PAC was 28.04 mmol/L (RSD=1.35%,n=3),showing 0.11% relative error with the predicted value of 28.01 mmol/L. CONCLUSIONS:Response sur-face method has optimized the conditions of extractive microbial transformation for producing L-PAC,obtained optimal combina-tion of each factor,and provided favorable reference for volume-producing L-PAC.

Medical morality,especially dental ethical account is usually demonstrated by ethical theories,including theory of utilitarianism,deontology,and virtue ethics.In fact,the true purpose of medical education is to produce erudite and humane practitioners and medical researchers.The present study discussed the efficacy of dental ethical educations through clinical practical issues.

Objective To share our experience in the placement of a peripherally inserted central cathe -ter ( PICC) in critically ill patients intensive care unit ( ICU) .Method The clinical data of a critically ill pa-tient placed with PICC from neurosurgery department were collected and analyzed .Result A 78-year-old male patient diagnosed with type I respiratory failure , aspiration pneumonia , hypertension , and cerebral infarction sequelae successfully received ultrasound-guided modified Seldinger puncture technique for PICC and was trea-ted with intravenous nutrition after repeatedly vascular puncturing failure .Conclusion PICC placement is an effective method for patients in ICU to protect the peripheral vein and lower the incidence of catheter related in -fections.

Objective To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and macular retina after acute primary angle closure.Methods Prospective clinical case-control study.A total of 26 patients (30 eyes) with acute primary angleclosure glaucoma (APACG) were in the APACG group,whose intraocular pressure were control after a single episode acute primary angle closure;30 age-and sex-matched healthy subjects (30 eyes) in the control group.All subjects underwent three dimensional optical coherence tomography (3D-OCT) examination with 3D optic disk scanning or circle optic disk scanning and 6 mm× 6 mm macular scanning.The parameters included average thickness of entire CP-RNFL,thickness of nasal,superior,temporal and inferior quadrant of CP-RNFL,disc area,disc cup area,rim area,cup/disc (C/D) area ratio,C/D horizontal diameter ratio and C/D vertical diameter ratio.The foveal retinal thickness,center retinal thickness (≤ 1 mm from the fovea),4 quadrants of macular inner-ring (＞ 1 mm but ≤3 mm from the fovea) retinal thickness,4 quadrants of macular outer-ring (＞3 mm but ≤6 mm from the fovea) retinal thickness,average thickness of macular retinal thickness and macular volume were measured and analyzed.Results The disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group (t=3.22,4.12,3.90,3.00,3.23;P＜0.05),rim area was smaller than the control group (t=-2.63,P＜0.05).The average thickness (t=-6.68) and the thickness of superior (t =-5.90),temporal (t =-11.64) and inferior (t =-5.06) quadrants of CP-RNFL,center retinal thickness (t=-2.50),4 quadrants of macular inner-ring retinal thickness (t=-4.91,-4.88,-2.83,-3.59),nasal (t=-2.13) and superior (t=-2.49) quadrants of macular outerring retinal thickness as well as average thickness of macular retinal thickness (t=-2.65) were significantly thinner than the control group (P＜0.05),and the macular volume (t=-2.69) was significantly smaller than the control group (P＜0.05).There was no statistically difference at nasal CP-RNFL (t=-0.11),foveal retinal thickness (t=-0.59),temporal (t=-0.67) and inferior (t=-1.02) quadrants of macular outer-ring retinal thickness between two groups (P＞0.05).Conclusions In comparison with the healthy subjects,the disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio,C/D vertical diameter ratio in APACG eyes were bigger,while rim area was smaller;the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL,fovea,temporal and inferior quadrants of macular outer-ring retinal.

Pulmonary fibrosis is a common respiratory disease in the clinic. Until now, the pathogenesis is still un-clear. Using clotting mechanism as the starting point, this article mainly explored abnormal changes of the coagula-tion - fibrinolysis system in the development of pulmonary fibrosis. The effective treatment through the activation of blood circulation to remove stasis in traditional Chinese medicine (TCM) point of view was also observed on the man-agement of interstitial pulmonary fibrosis. It considered that to carry out the anticoagulant therapy for abnormal coag-ulation, which may become a new target for clinical treatment of interstitial lung diseases. It provided new ideas and theoretical support for clinical treatment of pulmonary interstitial fibrosis.

OBJECTIVE:To screen formulation of Insulin cream and to investigate the effects of insulin cream on wound healing in rabbits.METHODS:The best formulation of insulin cream was selected from 8 kinds of formulations with appearance and stability as index.Rabbit trauma model were induced and divided into matrix group,blank group,Insulin cream groups(high-dose,medium-dose and low-dose).Wound healing rate and healing time were compared among those groups.RESULTS:The fifth formulation possessed good appearance and stability,which included albolene,cetanol,glycerin monostearate,glycerol,etc.Compared with matrix group,the wound healing rates were obviously increased at different time points in Insulin cream groups(P

Objective To get the information about the geriatric syndromes in the elderly with different age and gender so as to provide the basis for management of the geriatric syndromes.Methods A questionnaire survey was used to investigate and analyze the geriatric syndromes in 2 778 older subjects aged 60 years and above from Zhejiang and Jiangsu province.Results Among all 2 778 old adults,(3.4 ± 1.8)geriatric syndromes in average were found.The difference in geriatric syndromes number between different age groups showed a statistical significance(F =145.135,P＜ 0.001),but a significant difference in geriatric syndromes number between male and female group was not found(t=0.817,P=0.414).On the top incidence rate of geriatric syndromes were daily life ability defects 2 199 cases(79.2％),falls 1 828 cases(65.8％),urinary incontinence 1 356 cases(48.8％),sleeping disorder 1 023 cases(36.8 ％),cognitive impairment 908 cases (32.7 ％) and visual impairment 896 cases (32.3 ％).Among above six geriatric syndromes,the incidence of daily life ability defects,falls,urinary incontinence,sleeping disorder and cognitive impairment seemed to increase with ageing (P＜0.001).The incidence of daily life ability defects,falls and urinary incontinence was higher in males than in females (P＜ 0.05).The incidence of sleeping disorder and cognitive impairment was higher in females than in males(P＜0.05).The elderly patients with 3 or more geriatric syndromes exceeded about 66.4 ％.The most common clusters of geriatric syndromes were daily life ability defects combined with falls and urinary incontinence,which seemed to significantly increase along with ageing (x2=202.523,P＜0.001).Conclusions Geriatric syndromes are common in the elderly,medical care workers should pay attention to the management of the geriatric syndromes,and promote the development of the elderly healthcare.

Objective:To explore the application value of problem-based learning (PBL) controlled by closed-loop feedback in the teaching of respiratory medicine.Methods:In PBL teaching, after students' open inquiry, discussion and PBL self-study, closed-loop feedback was given by organizing PPT report, written summary and mechanism diagram display of medical students. The participation of teachers and students, teaching quality, the degree of students' identification of key knowledge points, the breadth and depth of mastering the characteristics of key symptoms and the satisfaction of PBL teaching work were investigated, and the differences were compared before and after the closed-loop feedback. GraphPad Prism 5.01 was used in the analysis.Results:It was found that closed-loop feedback could improve the self-evaluation of tutor's teaching participation [(7.97±0.91) vs. (8.77±0.64), P < 0.001] and students' evaluation on teaching participation of tutor [(8.09±0.79) vs. (8.74±0.45), P < 0.001]. At the same time, students' evaluation on the teaching quality of tutors was also improved [(88.61±6.53) vs. (92.59±5.44), P < 0.001]. After closed-loop feedback, the students' identification of the required knowledge points in the syllabus was significantly increased [(84.00±21.75) vs. (90.22±16.18), P = 0.017]. The overall satisfaction with PBL teaching was also improved obviously [(8.93±0.67) vs. (9.37±0.64), P < 0.001]. Conclusion:Practice has proved that the closed-loop controlled PBL teaching approach has a good effect on the teaching of respiratory medicine, and it's worth popularizing in clinical teaching.

Objective:To evaluate the value of synthetic MRI combined with DWI in the diagnosis of benign and malignant breast lesions.Methods:The data of 184 consecutive patients with suspected breast lesions in Yunnan Cancer Hospital from July to September 2019 were prospectively analyzed. All patients were randomly assigned to training group ( n=110) and validation group ( n=74), and underwent conventional MRI and synthetic MRI respectively before and after contrast injection. At the maximum slice of the lesion, the ROI was drawn along the edge and recorded as "tumor". In the solid area with the most obvious tumor enhancement, the second ROI was drawn and recorded as "local". At the same time, ADC values (ADC local and ADC tumor) and relaxation time values (T local and T tumor) were measured. T and T + represented the relaxation time value of the ROI pre-and post-contrast scanning. ΔT% represented the relative change rate in T value between pre-and post-contrast scanning.The rank sum test was used to test the quantitative parameters of benign and malignant breast lesions in the training group and the validation group, and the variables with P<0.05 were included in the binary logistic regression analysis to screen the independent variables and establish the prediction model. The area under ROC curve was used to evaluate the discrimination of parameters and models. The clinical applicability of model was analyzed by decision curve analysis (DCA). Results:In the training group, univariate analysis showed that there were significant differences in T 1tumor, T 1+tumor, ΔT 1% tumor, T 2local, T 2+local, T 2tumor and T 2+tumor, ADC local, ADC tumor between benign and malignant breast lesions ( P<0.05). Multivariate logistic regression analysis showed that T 1+tumor, ΔT 1% tumor, T 2tumor, ADC local, ADC tumor were independent variables in the diagnosis of breast cancer. The relaxation time model (model A: T 1+tumor, ΔT 1% tumor, T 2tumor) and ADC model (model B: ADC local, ADC tumor) established by combining the above variables had the same diagnostic efficiency (AUC=0.905, 0.914, Z=-1.874, P=0.062), and the multi-parameter combination model (model C: T 1+tumor, ΔT 1% tumor, T 2tumor, ADC local, ADC tumor) had the highest diagnostic efficiency (AUC=0.965). DCA analysis showed that when the threshold probability ranges between 21%-99% (training cohort) and 15%-99% (validation cohort), the net benefit of model C was better than model A and B. Conclusion:The multi-parameter combined prediction model established based on the relaxation time value and ADC can identify breast cancer efficiently and can be used as an auxiliary diagnostic tool.

Objective To construct four types of glucagon-like peptide-1 (GLP-1) and human serum albumin (HSA) fusion proteins that can be realeased at different rate in vivo by introducing protease cleavage sites between these two moieties.The therapeutic effect and release rate are studied to achieve balanced pharmacokinetics ( PK) and pharmacody-namics ( PD) of GLP-1 and HSA fusion proteins.Methods The gene with different polypeptide joint of GLP-1 and HSA fusion proteins were synthesized by overlap extension PCR amplification, cloned into expression vector pPIC9 and transformed into Pichia pastoris GS115.Then, fusion proteins were obtained by protein purification after being induced by methanol.The preliminary PK and PD of the fusion proteins were studied after purification.Results The fusion protein Gly2-GLP-1-GGGGG-HSA showed no release while Gly2-GLP-1-VTR-HSA, Gly2-GLP-1-SARSVRA-HSA, and Gly2-GLP-1-GRSRVTRSV-HSA showed a slow, medium and fast release rate, respectively, after incubation with furin.In vitro biological activity test results dispalyed that each type of fusion protein promoted insulin secretion of MIN6 cells.In vivo PK test indicated the half-life size of fusion proteins was the largest in Gly2-GLP-1-GGGGG-HSA, followed by Gly2-GLP-1-VTR-HSA, Gly2-GLP-1-SARSVRA-HSA, and Gly2-GLP-1-GRSRVTRSV-HSA.In vivo PD test exhibited hypoglycemic activity that was the highest in Gly2-GLP-1-VTR-HSA, followed by Gly2-GLP-1-SARSVRA-HSA, Gly2-GLP-1-GRSRVTRSV-HSA, and Gly2-GLP-1-GGGGG-HSA.Conclusion GLP-1 can be released from fusion proteins with full activity after the introduction of protease cleavage sites.Releasable fusion proteins at an appropriate release rate have the most balanced PK and PD.