Objective To explore the risk factors of earlier neurological function deterioration in acute cerebral infarction patient.Methods 157 cases with acute cerebral infarction had been studied,including the patient's history,general syndromes,clinical characteristic,CT or MRI and laboratory test.Multivarivate noncondition stepwise Logistic model analysis was made after single variable analysis.Results There were 58 patients with neurological function deterioration in 157 cases acute cerebral infarction patient.The morbidity was 36.3%.The following nine factors were associated with earlier neurological function deterioration in acute cerebral infarction i.e. the history of hypertension and diabetes,CT or MRI abnormal,higher WBC count,fever,higher blood sugar,lover mean arterial press,higher fibrin,higher serum Fe-protein;But age,sex,weight,the history of drink and smoker,blood lipemia lever were associated with the disease.Conclusion Earlier neurological function deterioration in acute cerebral infarction patient is caused by multiple factors.Singer test is not easy to calculate the result.To analyze generally patient's clinical material may calculate if earlier neurological function deterioration in acute cerebral infarction patient takes place.

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2，3 in group A, while lower at T2，3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.

Aim To investigate the effect of berberine on the expression of nephrin, podocin and intergrinα3β1 in diabetic nephropathy ( DN ) rat model, and further probe in to the renoprotective effects of berber-ine and its potential mechanisms. Methods The rat model of DN was induced by intraperitoneal injection of streptozotocin ( STZ ) after fed with high-sugar and high-fat diet for six weeks. The rats were assigned into 6 groups randomly: normal control group, DN model group, BBR (50,100 and 200 mg·kg-1 ) treatment group and enalaprilat positive control group ( 1 mg · kg-1 ) . The distribution and expression of kidney podocyte related proteins nephrin, podocin and interg-rinα3β1 were detected by immunohistochemical meth-od following electron microscopy observation ( × 1000 ) and high magnification observation( × 400) and West-ern blot. Results The podocyte related protein neph-rin, podocin and intergrin α3β1 were mainly distribu-ted in podocyte, but slightly different. Compared with normal control group, the expresion of podocyte related protein nephrin, podocin and intergrin α3β1 was de-creased obviously; compared with model group, BBR (100 and 200 mg·kg-1 ) treatment group could sig-nificantly suppress the abnormalities of pathological changes of the kidney and upregulate the expression levels of podocyte specific protein nephrin, podocin and intergrin α3β1 in the kidney of diabetic rats with nephropathy. Conclusions Berberine could alleviate the abnormalities of kidney pathological changes and proteinuria production in the DN model rats, which may be related to the upregulation of the expression of the podocyte proteins nephrin, podocin and intergrinα3β1.

Objective To estimate the value of fecal tumor M2-PK in the detection of colorectal adenoma and to evaluate its potential as a screening tool for colorectal adenoma.Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect the fecal tumor M2-PK in stool samples of 65 patients with colorectal adenoma and 25 controls.At the same time,the peripheral blood tumor markers such as carcinoembryonic antigen (CEA),carbohydrate antigen (CA) 19-9,CA24-2 and fecal occult blood test (FOBT) were detected in the colorectal adenoma group.Results The detection value of fecal tumor M2-PK in the colorectal adenoma group showed a significant increase,compared with the control group((6.033±4.123) U/ml vs.(2.782±1.464) U/ml,t=-3.839,P=0.000).The highest detection value was found in the group where the diameter of adenoma was greater than or equal to 2 cm ((8.775±6.548) U/ml,t=9.635,P=0.034).The larger the diameter of adenoma,the higher the positive rate of fecal tumor M2-PK (85.7% vs.41.7% vs.29.6%,χ2=11.977,P=0.003).In the colorectal adenoma group,The positive detection rate of fecal tumor M2-PK was significantly higher than that of CEA,CA19-9,CA24-2 and FOBT (46.2% vs.6.2% vs.1.5% vs.1.5% vs.27.7%,?2=76.607,P=0.000).Conclusion Fecal tumor M2 pyruvate kinase has a good clinical value in the diagnosis of colorectal adenoma.

The incidence rate of nonalcoholic fatty liver disease (NAFLD) keeps increasing year by year, making NAFLD one of the most common liver diseases in the world. Reasonable diet and exercise are currently recognized as the most crucial step in the treatment of NAFLD and are the cornerstone of the management of NAFLD patients. However, diet and exercise regimens vary across countries, regions, and societies due to various objective reasons. This article reviews the diet and exercise regimens for NAFLD patients reported in different countries, regions, and literatures in recent years, in order to provide a basis for clinicians to guide NAFLD patients to develop reasonable diet and exercise strategies.

ObjectiveTo investigate the association between serum interleukin (IL) and liver pathological changes in patients with chronic hepatitis B (CHB). MethodsA total of 59 patients with CHB who were treated in Putuo District Central Hospital of Shanghai from February 2018 to February 2019 were enrolled as subjects, and liver biopsy was performed for all patients. According to the degree of liver inflammation, the patients were divided into mild inflammation (G1-G2) group and severe inflammation (G3-G4) group, and according to the degree of liver fibrosis, the patients were divided into mild fibrosis (S0-S2) group and severe fibrosis (S3-S4) group. Serum liver function parameters, blood lipids, interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) were measured for all patients. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon non-parametric test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was also performed. ResultsThe degree of liver fibrosis increased with the increase in liver inflammation (rs=0.538, P＜0.001). Compared with the mild inflammation group, the severe inflammation group had significantly higher serum levels of alanine aminotransferase ［95.00 (45.00-16925) U/L vs 51.00 (29.00-88.00) U/L, Z=-2.625, P=0.009］, aspartate aminotransferase ［54.50 (34.75-84.50) U/L vs 38.00 (30.00-49.00) U/L, Z=-2.014, P=0.044］, and gamma-glutamyl transpeptidase ［91.00 (56.72-192.25) U/L vs 44.00 (24.00-100.00) U/L, Z=-2.400, P=0.016］. The severe fibrosis group had a significantly higher serum level of high-density lipoprotein than the mild fibrosis group ［0.97 (0.32-1.08) mmol/L vs 1.23 (0.36-1.38) mmol/L, Z=-1.300, P=0.008］. The severe inflammation group had a significantly higher serum level of IL-2 receptor than the mild inflammation group ［704.00(418.00-103800) U/ml vs 436.00(335.00-555.00) U/ml, Z=-3.405, P=0.001］, and the severe fibrosis group had a significantly higher serum level of IL-2 receptor than the mild fibrosis group ［735.00(523.00-890.50) U/ml vs 447.00 (351.50-624.50) U/ml, Z=-5.358, P=0.001］. ConclusionThe degree of liver inflammation is positively correlated with that of liver fibrosis, while the serum level of IL-2 receptor increases with the increase in the degrees of liver inflammation and fibrosis, indicating that IL-2 receptor can reflect the degrees of liver inflammation and fibrosis to some extent.

Objective:To analyze the characteristics of drug resistance genes in a Klebsiella pneumoniae strain coproducing carbapenemases KPC-2 and NDM-5. Methods:Klebsiella pneumoniae KPN-hnqyy was separated from the stool specimen of a patient in the Hematology Department of Affiliated Cancer Hospital of Zhengzhou University. The strain was identified with a BD Phenix-M50 automated microbiology system and the minimum inhibitory concentration against the strain was measured as well. The genotypes of the carbapenemases were tested by enzyme immunochromatographic assay and PCR method. The transferability of related plasmids was analyzed by conjugation test. Whole-genome sequencing of the strain was conducted using PacBio and Illumina platforms. The MLST type, resistance gene and plasmid type of the strain were retrieved in BacWGSTdb. The genome and open reading frame sequence of the strain were compared using Easyfig_2.2.3. Visual cycle graphs were generated using BRIG v0.95. Results:Klebsiella pneumoniae KPN-hnqyy was resistant to carbapenem antibiotics. It belonged to ST11 and carried two carbapenemase genes of blaKPC-2 and blaNDM-5. The conjugant only harbored the blaKPC-2 gene. Whole-genome sequencing revealed that the strain contained one chromosome and three plasmids. Its chromosome genome shared more than 99.9% similarity with that of Klebsiella pneumonia KP69 and KP19-2029. Moreover, a similar IncR and IncFⅠ resistance gene fusion region was contained in different types of plasmids carried by them: the blaKPC-2 gene was located in a structure—which evolved from the Tn3-△Tn4401-Tn1721/Tn1722 sequence—inside this fusion region with its ends inserted into the transposase IS26 gene; the blaNDM-5 gene was located on a transposon containing the special plasmids of the insertion fragment in phages, with its ends inserted into the transposase IS26 gene too. Conclusions:The IncR and IncFⅡ resistance gene fusion region of blaKPC-2 carried by Klebsiella pneumoniae ST11 might be widely coexistent with the chromosomal genome. The blaNDM-5 gene carried by special plasmids might be accidentally obtained through gene recombination mediated by transposable element IS26. The wide transmission of Klebsiella pneumoniae ST11 carrying the blaKPC-2 gene in China and its ability to obtain other carbapenemase genes through transposable element IS26 were well worth attention.

The incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing year by year and NAFLD has become one of the most common liver diseases in the world. Metabolomics follows the research thoughts of genomics and proteomics and conducts a quantitative analysis of all metabolites in organisms to explore the association between metabolites and physiological and pathological changes, which provides a new way for studying the traditional Chinese medicine diagnosis and treatment of NAFLD. This article summarizes the research advances in metabolomics and traditional Chinese medicine syndromes in NAFLD, so as to provide new thoughts and methods for further exploration of NAFLD.

Objective:To analyze the characteristics of plasmids in KPC-2-producing Serratia marcescens ( S. marcescens) isolates. Methods:Four carbapenem-resistant S. marcescens strains were isolated from four patients admitted to the hepatobiliary ward of Affiliated Cancer Hospital of Zhengzhou University in 2016. BD Phenix-100 was used to identify the strains and detect the minimum inhibitory concentrations (MICs). Homology analysis was performed using pulsed-field gel electrophoresis (PFGE). The modified Hodge test was used to detect the phenotypes of carbapenemase. PCR and gene sequencing were used to detect the types of carbapenem resistance genes. The transferability of plasmids was detected by conjugation test. The characteristics of plasmids were analyzed by genomic alignment method after whole genome sequencing. DNAMAN V9 software was used to compare the amino acid sequences of the replication initiation proteins. A phylogenetic tree was constructed with neighbor-joining method using MEGA7.0. Results:All of the four S. marcescens strains were resistant to carbapenem antibiotics. They were highly homologous according to PFGE. Hodge test results were all positive and the carbapenemase genotype was blaKPC-2. Conjugation test results were positive. The plasmid was a circular DNA of 42 742 bp in length. It had the similar skeleton of incX6 plasmid and the similar amino acid sequence of replication initiation protein. Moreover, it and incX6 plasmid were at the same node in the phylogenetic tree. The blaKPC-2 was located in the core of drug resistance, which was composed of insertion elements including Tn3 family transposons, recombinant enzyme genes, △ISKpn6 and ISKpn27. Conclusions:The plasmid was incX6-like. The blaKPC-2 gene was located in the transposon of △Tn6296. More attention should be paid to the bacteria carrying KPC-2 in incX plasmids.

ObjectiveTo observe the efficacy and safety of sertraline combined with low-dose olanzapine in the treatment of depression and anxiety comorbidity and its effect on sleep quality， so as to provide references for the related clinical treatment. MethodsA total of 121 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for depressive episode and generalized anxiety disorder in The Third People's Hospital of Tianshui and the Sanatorium for Mental Illness of Veterans in Tianshui from October 2019 to August 2020 were enrolled， and they were divided into two groups according to the random number table method. Study group （n=61） received sertraline combined with low-dose olanzapine， while control group （n=60） received sertraline only. Then the disease severity degree， sleep quality and adverse reactions were assessed using Hamilton Depression Scale - 17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pittsburgh Sleep Quality Index （PSQI） and Treatment Emergent Symptom Scale （TESS） at the baseline， 1^st， 2^nd， 4^th， 6^th and 8^th weekend， respectively. ResultsPost-treatment HAMD-17， HAMA and PSQI scores in both groups were lower than those before treatment （P<0.05）. At each time point after treatment， HAMD-17， HAMA and PSQI scores of study group were lower than those of control group， with statistical significance （P<0.05）. ConclusionSertraline alone and its combination with low-dose olanzapine are both effective in the treatment of depression and anxiety comorbidity， while the combination therapy achieves better efficacy and higher safety in alleviating anxiety and insomnia symptoms.