Objective To evaluate the effect of combination of growth hormone(GH),somatostatin(ST) with hypocaloric parenteral nutrition(HPN) on SAP patients with MOD. Methods forty one cases of SAP complicated with MOD were randomedly divided into control group (20 cases) and experiment group (21 cases). In experiment group ,total calories and nitrogen were given 62.9～83.9kJ/(kg?d) and 0.10～ 0.12g/(kg?d). lipid calorie was supplied in less than 40 percent of the total energy.GH was percutaneously injected for 7d and ST was intravenously injected for 7～14d. Control group was given TPN only.Serum albumin, pre albumin, transferring,CRP,total lymphocyte count(TLC), urea nitrogen, nitrogen balance and serum TNF ?, IL 1,IL 6 level were determined before treatment and on the day 7 after treatment. Results After treatment, serum albumin and pre albumin and transferring increased significantly (P

A high xylanase producing strain 22 of Aspergillus clavatus was screened from 105 strains of molds and yeasts. The suitable medium consisted of (g/L): bagasse hemicellulose 30, NH_4NO_3 5, yeast extract 5, wheat bran 10, Tween 80 1 and a small quantity of other minerals; initial pH 5.5. Theoptimalsporeinoculumwas4.9X10~6spores/ml (final concentration). Theactivity of xylanase was as high as 335.9 U/ml in shake-flask experiment at 28℃ for 72 h. The optimal temperature and pH for xylanase reaction were 50℃ and pH 4.8. 72.6% of its original activity was remained after incubation at 50℃ for 1 h, and 90% of the enzym activity was observed upon storage at 8℃ for 9 days . Sugars. Na~+. Ca~(2+). and Zn~(2+) increased its activity wherease Co~(2+)and Cu~(2+) inhibited it.

Otransplantation is a new subject which is developed so rapid that usually over the development of medical ethics.The shortage of organ supplement made organ transplantation face the challenge of medical ethics.Live organ donation has become a focal point of medical ethics in organ transplantation.It is necessary to eliminate all kinds of human organ commercialization and illegal transaction.We need pay more attention in the medical ethics issue about organ transplant,especially about live organ donation.Here is about the survey of medical ethics on live organ donation in People's Liberation Army No.181 Hospital.

Objective:To summarize the midterm to long-term outcomes and experiences of endovascular treatment (ET) of spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 31 SISMAD patients from Jan 2011 to Dec 2019 treated with ET was retrospectively analyzed.Results:Successful ET was achieved in 29 patients with a technical success rate of 93.5%. A total of 36 self-expandable bare stents were planted in 28 patients and plain old balloon angioplastry (POBA) was performed in 1 patient. Abdominal pain disappeared within 24 hours in 89.3% of the patients after stenting. The rate of perioperative complication was 3.2%. There was no SMA dissection rupture bleeding, nor perioperative death occurred. The mean follow-up time was 53.5 (range, 6 to 110) months. There was no dissecting aneurysm formation, no SMA rupture and bleeding, and no stent rupture during the follow-up. The post ET 1-year, 3-year, and 5-year free from reintervention rate were 100%, 100%, and 91.7%, respectively.Conclusions:ET for SISMAD is safe and effective with satisfactory perioperative and midterm to long-term outcomes.

Building an integrated health care service system is key to the Healthy China strategy. Based on the integrated health care service conceptual framework, the authors took two pilots regions of health-centered medical alliances in Zhejiang province as an example, and analyzed their conception framework, organizational structure, operation elements and effects. The study found initial success of the two alliances in terms of the contents, capabilities, effects and satisfaction of primary health care service. Such alliances feature a health-centered multi-entity participation mechanism, carry out health care and prevention integration leveraging the information platform, hence conducive to the effective governance of the alliances. However, the contents of their health related services are expected to be broadened and deepened; functionalities of health-related institutions need to be clarified and refined, while their performance appraisal needs to be further improved.

Objective:To investigate the effect of usage of transthoracic echocardiography(TTE) on the prognosis of patients after acute kidney injury (AKI) in intensive care unit (ICU).Methods:The clinical data of patients with AKI in the Medical Information Mart for Intensive Care (MIMIC-Ⅲ v1.4) database was collected retrospectively, and the patients were divided into TTE group (with TTE within 24 hours of AKI diagnosis) and No-TTE group (without TTE examination or first TTE examination was more than 24 hours after AKI diagnosis). Propensity score matching (PSM) was utilized to balance the baseline variables between the two groups and Cox regression analysis was used to evaluate the independent risk factors for 28-day all-cause mortality (the primary outcome). Moreover, after PSM, the effects of TTE usage on the second outcomes (including the volumes of intravenous fluid and urine output in the first, second and third 24-hour after the diagnosis of AKI; the total number of mechanical ventilation-free days, renal replacement therapy-free days and vasopressor-free days within 28 days after ICU admission; use of diuretics after the diagnosis of AKI; reduction in serum creatinine within 48 hours after the diagnosis of AKI; and the length of ICU stay and hospital stay) were also evaluated.Results:Among 23 945 eligible AKI patients, 3 365 patients (14.1%) patients received TTE within 24 hours after the diagnosis of AKI and finally there were 3 361 patients in TTE group and No-TTE group included in this study after PSM based on the ratio of 1∶1. After PSM, all variables in the two groups were well balanced (standardized mean difference<0.1, respectively). Before and after PSM, patients in TTE group had lower 28-day all-cause mortality compared with patients in No-TTE group (10.76% vs 13.04%, χ2=13.535, P<0.001; 10.65% vs 18.80%, χ2=88.932, P<0.001), and Kaplan-Meier survival curves also revealed that patients in the TTE group had higher cumulative survival rate compared with patients in No-TTE group (Log-rank χ2=15.438, P<0.001; Log-rank χ2=75.360, P<0.001, respectively). Multivariate Cox regression analysis showed that TTE was an independent influencing factor for 28-day all-cause mortality before and after PSM ( HR=0.80, 95% CI 0.73-0.89, P<0.001; HR=0.58, 95% CI 0.51-0.65, P<0.001). And all subgroup analyses showed the similar results. Compared with patients in the No-TTE group, patients in the TTE group had higher volume of intravenous fluid on the first day and the second day after the diagnosis of AKI (both P<0.01). Patients in the TTE group had higher volume of urine output on the first day and the third day after the diagnosis of AKI (both P<0.01). The patients in the TTE group had a significantly lower duration of vasopressor-free and mechanical ventilation-free (both P<0.01). The usage of diuretic was significantly higher in the TTE group compared with that in the No-TTE group (54.1% vs 44.2%, χ2=65.609, P<0.001). With respect to serum creatinine, the reduction in serum creatinine within 48 hours after the diagnosis of AKI was higher in the TTE group than that in the No-TTE group [36.6(23.0, 97.2) μmol/L vs 30.1(14.2, 61.9) μmol/L, Z=-9.549, P<0.001]. Moreover, TTE group had shorter ICU stay than that in the No-TTE group [5.03(3.40, 8.90) d vs 5.37(3.77, 10.00) d, Z=-6.589, P<0.001]. There were no significant difference between the two groups in other secondary outcomes (all P>0.05). Conclusions:Timely TTE utilization after AKI incident is associated with better clinical outcomes for ICU patients.

OBJECTIVE:To establish a method for simultaneous determination of P-coumaric acid and ferulic acid in the couple of Sparganium stoloni and Curcuma aeruginosa,and to investigate rational proportion of the couple.METHODS:HPLC method was adopted.The determination was performed on Agilent 20RBAX XDB-C18 column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid (gradient elution) at the flow rate of 1.0 mL/min.The detection wavelength was set at 266 nm,and the column temperature was 30 ℃.The sample size was 10 μL RESULTS:The linear ranges of P-coumaric acid and ferulic acid were 4.218 6-21.093 μg/mL(r=0.999 8),1.836 0-9.180 μg/mL(r=0.999 9),respectively.RSDs of precision,stability and reproducibility tests were all lower than 2.0％.The recoveries were 98.72％-100.30％ (RSD=0.18％,n=9),99.11％-100.45％ (RSD=0.46 ％,n =9).Among 4 compatibility proportions of the couple of S.stoloni and C.aeruginosa (1 ∶ 1,2 ∶ 1,1 ∶ 2,1 ∶ 0,m/m),the dis-solution rate of P-coumaric acid and ferulic acid were the highest when the ratio of S.stoloni-C.aeruginosa (m/m)was 2 ∶ 1.CON-CLUSIONS:The method is simple,accurate,stable and reproducible,and can be used for content determination of P-coumaric acid and ferulic acid in the couple of S.stoloni and C.aeruginosa.when the proportion of the couple of S.stoloni and C.aeruginosa is 2∶1 and the contents of P-coumaric and ferulic acid are the highest,the contents of main etfective components are the highest.

We found seven tag sequence with high homology in dbEST by using human musclin gene, and got its cDNA sequence, which consists of 651bp and the open reading frame was 54-452 bp detected by RT-PCR, encoding 132 amino acid residue protein. The new gene has high homology with that of human, mouse and rat, the rate is 87.2%, 77.6% and 77.9%, respectively; the gene fragment was cloned into expression vector pGEX-4T-1, and the recombinant was transformed into E. coli BL21. Induced by IPTG, the fusion protein GST-musclin, a 38.59 kD protein was successfully expressed in E. coli BL21 and identified by Western blotting.
Amino Acid Sequence ; Animals ; Base Sequence ; Cloning, Molecular ; DNA, Complementary ; genetics ; Escherichia coli ; genetics ; metabolism ; Humans ; Mice ; Molecular Sequence Data ; Muscle Proteins ; biosynthesis ; genetics ; Muscle, Skeletal ; metabolism ; Open Reading Frames ; genetics ; Rats ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; isolation & purification ; Swine ; genetics ; Transcription Factors ; genetics

Objective To evaluate the effects of the quality-improving program on reducing the bloodstream infection of preterm infants in NICU.The program included emphasizing hand hygiene,strictly controlling the use of antibiotics and following the extubation indications of peripherally inserted central catheter (PICC).Method From October 2016 to March 2017,preterm infants admitted to NICU after the implementation of quality improvement program were assigned into the intervention group,and the infants admitted from April 2016 to September 2016 without the program were in the control group.The x2 test and t test were used to analyse the effects of the program,the rate of bloodstream infection and related complications.Result A total of 432 cases were enrolled in this study.Among them,221 cases were in the intervention group and 211 cases the control group.The rate of hand hygiene in the intervention group was significantly higher and the duration of antibiotic use per 1 000 hospitalization days and the average days of retaining the PICC were significantly shorter than the control group (P ＜ 0.001).The incidence of bloodstream infection in the intervention group was lower than the control group (5.9％ vs.11.4％,P =0.047),and the duration of non-invasive ventilation,parenteral nutrition,average hospitalization days,and the incidence of stage 11 and above necrotizing enterocolitis were lower than the control group (P ＜ 0.05).Conclusion The evidence-based quality improvement program has positive effects on reducing the bloodstream infections and related complications of preterm infants in NICU.

Objective: To evaluate the clinical characteristics, MYD88^L265P mutation, CXCR4^WHIM mutation and prognosis in patients with Waldenström macroglobulinemia (WM). Methods: The clinical characteristics, International Prognostic Scoring System for symptomatic WM (WPSS) , and overall survival (OS) were retrospectively assayed in 93 patients with newly diagnosed WM at Peking Union Medical College Hospital during January 2000 to August 2016. The MYD88^L265P mutation and CXCR4^WHIM mutation were tested among 34 patients. Results: The median age of the 93 patients was 64 years (range, 33-85 years) with a male-to-female ratio of 2.44. According to WPSS, we included 16 (17.2%) low-risk, 44 (47.3%) intermediate-risk and 33 (35.5%) high-risk patients. Eight patients had secondary amyloidosis. With a median follow-up of 44 (1-201) months, the median OS was 84 months. Cox regression multifactor analysis showed WPSS risk group (HR=2.342, 95% CI 1.111-4.950, P=0.025) , whether patients had secondary amyloidosis (HR=5.538, 95% CI 1.958-15.662, P=0.001) and whether patients received new drugs (HR=3.392, 95% CI 1.531-7.513, P=0.003) were independent factors associated with OS. We have investigated the presence of the MYD88^L265P and CXCR4^WHIM mutation in 34 patients and found that MYD88^L265P mutation was occurred in 32 patients (94.1%) and CXCR4^WHIM mutation was occurred in 8 patients (23.5%). Seven of 8 patients who harbored CXCR4^WHIM-mutated also exhibited the MYD88^L265P mutation. Patients with MYD88^L265PCXCR4^WHIM vs MYD88^L265PCXCR4^WT presented with more severe anemia, lower platelet level, higher M protein level and more hyper-viscosity syndrome. Conclusion WPSS risk group, whether patients had secondary amyloidosis or received new drugs are independent factors for OS in WM. MYD88^L265P and CXCR4^WHIM mutation, the most common somatic variants in WM, often occur together and impact the clinical presentation.