Objective: To compare quality control (relative purity and specific activity) and process control [plasminogen (Pg) antigen recovery and potency recovery] indexes of samples before and after adding the Q chromatography step to the full chromatography process of human Pg, thereby determining whether the addition of this step could improve Pg recovery by affinity chromatography. Methods: A Q chromatography step was added before the Pg affinity chromatography in the original Pg chromatography process. The loading solution, flow through solution and eluate of Q chromatography and Pg affinity chromatography were collected. The potency of coagulation factor Ⅱ (FⅡ), Ⅶ (FⅦ), Ⅷ (FⅧ), Ⅸ (FⅨ), and Ⅹ(FⅩ) were detected by the coagulation method, the total protein content was detected by the BCA method, and the Pg potency was detected by the chromogenic substrate method. The content of specific plasma proteins was detected by immunoturbidimetry, the potency recovery of coagulation factors was calculated, and the flow direction of coagulation factors was analyzed. The recovery of different plasma protein antigens were calculated, and the distribution of impurity proteins was analyzed. The relative purity and specific activity of Pg, antigen content, and potency recovery in the target fractions were calculated and compared with the original process indicators, so as to determine the effect of adding Q chromatography on the original process. Furthermore, the reproducibility after process modification was assessed. Results: 100% of FⅡ, FⅩ, and FⅨ, 87.81% of FⅧ, and 40.44% of FⅦ in filtered plasma were removed by Q chromatography. The residual FⅦ (53.26%) and FⅧ (13.30%) in Q flow-through fraction were completely removed by Pg affinity chromatography. In both the original process (without Q-chromatography) and the modified process (with Q-chromatography), non-target plasma proteins mainly existed in the flow-through fraction of Pg affinity chromatography. The antigen recovery of IgM, ceruloplasmin (CER), and fibronectin (FNC) in Q-chromatography flow-through fraction were reduced. In contrast, antigen recovery of other plasma proteins [IgG, IgA, Pg, albumin (AlB), alpha-1-antitrypsin (AAT), and fibrinogen (Fg)] were all >90%, which were consistent with the protein composition and proportion in the original affinity chromatography loading solution. Compared with the recovery rate of Pg antigen in the original process (74.4%), the total recovery of Pg antigen in the modified process was significantly increased (89.97%). Compared with the recovery of IgG (97.48%) and Fg (95.32%) in the Pg affinity flows-through fraction of the original process, the modified process resulted in a slight reduction in the recovery of IgG (94.60%), while the recovery of Fg was not affected (95.05%). The potency recovery rate, specific activity, and relative purity of Pg after Q chromatography were 99.3%, 0.016 U/mg, and 0.15%. These values were the same as those of Pg affinity chromatography loading solution by the original process, indicating that introduction of Q chromatography did not affect subsequent Pg affinity chromatography. Compared with the recovery of Pg antigen in three batches of the original process (66.49±1.02)%, the recovery of Pg antigen in the affinity chromatography eluent of the modified process [five batches; (77.43±4.43)%] was significantly improved. Furthermore, the potency recovery was (86.80±4.28)%, the relative purity was (81.99±1.25)%, the specific activity was (8.679±1.073)U/mg, and the process was reproducible. Conclusion: The addition of Q chromatography could improve the recovery of Pg affinity chromatography in the full chromatography process.

OBJECTIVE: To construct a risk prediction model for elderly severe patients with pneumonia infection, and analyze the prevention effect of 1M3S nursing plan under early warning mode. METHODS: Firstly, 180 elderly severe patients admitted to the department of intensive care unit (ICU) of the Second Affiliated Hospital of Xingtai Medical College from September 2020 to September 2021 were enrolled. Their clinical data were collected and retrospectively analyzed, and they were divided into infected group and non-infected group according to whether they developed severe pneumonia. The risk factors affecting severe pneumonia in elderly severe patients were screened by univariate and multifactorial analysis methods, and the risk prediction model was constructed. The predictive efficiency of the model was analyzed by receiver operator characteristic curve (ROC curve). Then the risk prediction model was applied to prospectively include 60 high-risk elderly patients with severe pneumonia admitted from December 2021 to August 2022. The patients were randomly divided into study group and control group by envelope method, with 30 cases in each group. Both groups were given routine nursing. On this basis, the study group adopted 1M3S nursing scheme [standardized nursing management (1M), improving nursing skills (S1), optimizing nursing service (S2), ensuring nursing safety (S3)] in the early warning mode for intervention. Acute physiology and chronic health evaluation II (APACHE II) and Murray lung injury score were compared between the two groups before intervention and 7 days after intervention. RESULTS: Among 180 elderly severe patients, 34 cases were infected with pneumonia (18.89%). The proportion of patients with Glasgow coma scale (GCS) ≤ 8, duration of mechanical ventilation > 7 days, use of antibiotics, poor oral hygiene, hospital stay > 15 days and albumin ≤ 30 g/L in the infected group were significantly higher than those in the non-infected group. Multivariate Logistic regression analysis showed that duration of mechanical ventilation > 7 days, use of antibiotics, GCS score≤ 8, hospital stay > 15 days, albumin ≤ 30 g/L and poor oral hygiene were all independent risk factors for severe pneumonia in elderly severe patients. The odds ratio (OR) values were 3.180, 3.394, 1.108, 1.881, 1.517 and 2.512 (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of the prediction model to predict severe pneumonia in elderly severe patients was 0.838, 95% confidence interval was 0.748-0.927, sensitivity and specificity were 81.25% and 72.57%, respectively, and the Youden index was 0.538. (2) There was no significantly difference in general data between the study group and the control group, which was comparable. After intervention, the APACHE II score and Murray lung injury score of the two groups were significantly decreased, and the APACHE II score and Murray lung injury score of the study group were significantly lower than those of the control group (APACHE II score: 3.15±1.02 vs. 3.81±0.25, Murray lung injury score: 5.01±1.12 vs. 6.55±0.21, both P < 0.01). CONCLUSIONS There are many risk factors affecting the development of severe pneumonia in elderly severe patients. The risk prediction model based on duration of mechanical ventilation > 7 days, hospital stay > 15 days, GCS score≤ 8, albumin ≤ 30 g/L, poor oral hygiene and history of combined antibacterial use has high predictive efficacy. The intervention of 1M3S nursing scheme in the early warning mode can effectively reduce the risk of severe pneumonia in elderly severe patients, and significantly improve the pathophysiological status.
Humans ; Pneumonia/diagnosis* ; Aged ; Risk Factors ; Retrospective Studies ; Intensive Care Units ; Female ; Male ; ROC Curve ; Risk Assessment/methods*

【Objective】 To determine the ELISA kit for screening convalescence plasma with high potency of SARS-CoV-2 IgG by comparing and analyzing the plasma detection results of convalescent plasma collected in different periods via ELISA kits from two manufacturers and the results of mixed plasma with different potency via pseudovirus neutralization experiments. 【Methods】 Two ELISA kits from different manufacturers(named A, B) were used to detect the plasma of 269 convalescent patients collected from Feb.2020~Jan.2022. The correlation and concordance rate of the two results were analyzed to determine the kit preliminarily. According to the titers of diluted series of standard of the preliminary selected kit, 5 mixed plasma samples (G4-G128) with different potency were prepared. The correlation of ELISA IgG results of product A/B, as well as the pseudovirus neutralization test of the original strain, Omicron mutant BA.1 and BA.2 strains were analyzed. Combined with the outside-well dilution mode of the strongly positive samples, the kit for high potency of SARS-CoV-2 IgG screening was determined. 【Results】 When the internal control reference B2 was used as the standard, the detection sensitivity of product A and B was 1∶32 vs 1∶8; the detection sensitivity of product A was 4 times that of product B. The correlation Pearson r between the results given by two kits was 0.944 1(P<0.000 1). Product B with low sensitivity was primarily selected as an alternative kit. The ELISA IgG results of samples from mixed plasma showed that the order of correlation r between product A and B was 0.988. The correlation r between product A and neutralization antibody potency of the three viruses was original strain (0.978)>BA.2(0.970)>BA.1(0.799); the order of correlation r between ELISA IgG results of product B and neutralization antibody potency of the three viruses was original strain(0.994)>BA.2(0.968)>BA.1(0.804). If twice-diluted B2 was taken as the excellent standard, 55.4% of product B met the criterion, while 47.2% of product A met.For positive plasma with high IgG potency, the product B kit required a lower dilution of the sample, which was more convenient to operate. 【Conclusion】 Both of the ELISA IgG kit from product A and B can be used to screen IgG antibodies of SARS-CoV-2, while product B is more suitable for screening positive plasma with high IgG potency.

Objective:To evaluate the efficacy and prognosis of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC).Methods:Data of 393 patients with 400 EGC lesions who underwent ESD between January 2010 and April 2019 in the First Affiliated Hospital of Nanjing Medical University were collected in the retrospective study. Patients were divided into undifferentiated-type group (50 cases with 50 lesions) and differentiated-type group (343 cases with 350 lesions) according to postoperative pathology. Their data including age, gender, size and location of the resected lesion, general classification, depth of infiltration, presence or absence of ulcers, and follow-up were compared.Results:Logistic regression analysis showed that age ≤60 years ( OR=2.02, 95% CI: 1.04-3.95, P=0.011), female ( OR=2.83, 95% CI: 1.41-5.68, P=0.003), gastric antrum lesions ( OR=3.92, 95% CI: 1.65-9.30, P=0.002), endoscopic depressed type ( OR=5.37, 95% CI: 2.16-13.38, P<0.001), and submucosa invasive depth ( OR=5.09, 95% CI: 2.40-10.80, P<0.001) were independent risk factors for undifferentiated EGC. The undifferentiated-type group showed a significantly higher non-curative resection rate [90.0% (45/50) VS 19.8% (68/343), χ2=104.902, P<0.001]. Of the 393 patients, 5(4.4%) died in the 113 patients with non-curative resection, while 2 (0.7%) died in the 280 patients with curative resection. Patients with non-curative resection had a higher mortality ( χ2=5.558, P=0.023). There were 27 and 51 patients undergoing additional surgery in the undifferentiated-type group and the differentiated-type group, respectively. None of them had recurrence. Among the 315 patients who did not undergo surgery, the recurrence rate of the undifferentiated-type group was significantly higher than that of the differentiated-type group [26.1% (6/23) VS 4.1% (12/292), χ2=5.560, P<0.001]. Conclusion:Young age (≤60 years), female, gastric antrum lesions, endoscopic depressed type, and submucosa invasive depth are predictors of undifferentiated EGC. Patients with undifferentiated EGC have a higher non-curative resection rate and higher possibility of recurrence after ESD, and additional operation are suggested.

Objective To study the utility of fibrin glue on prevention of bleeding after endoscopic submucosal dissection ( ESD).Methods Consecutive patients with gastrointestinal tumors who underwent ESD between July 2015 and June 2016 in the First Affiliated Hospital of Nanjing Medical University were enrolled in the study. The patients receiving ESD before December 31, 2015 were assigned into the fibrin glue group, and patients receiving ESD after December 31, 2015 were assigned into the control group. The fibrin glue group was sprayed with fibrin glue on wound followed by routine hemostasis method, and the control group was given routine hemostasis method only. The bleeding rate after ESD, mean hospital stays and cost were compared between the two groups.Results The bleeding rate after ESD in the fibrin glue group was significantly lower than that in the control group[7. 45%(12/161) VS 14. 79%(25/169), P＝0. 035]. There was no significantly difference in the mean hospital stays (9. 09±2. 65 days VS 9. 20±2. 99 days, P＝0. 744) and mean cost (24 246±5 519 yuan VS 25 214±6 258 yuan, P＝0. 138) between the two groups.Multivariate analysis revealed that the use of fibrin glue was a protective factor for bleeding after ESD. Conclusion Fibrin glue is safe, effective and economical in prevention of bleeding after ESD.

Objective:To explore the effect of perspective-taking on HIV-related stigma intervention among medical college students.Methods:192 medical college students selected from one medical college were randomly divided into experimental group and control group.Perspective-taking intervention was implemented in the experimental group.HIV-related Stigma Questionnaire was used to measure the level of HIV-related stigma before and after the intervention for two groups.Results:Before intervention,there was no significant difference in the total score of HIV-related stigma between the two groups (P ＞ 0.05);there was significant difference in the total score of HIV-related stigma between the two groups after the intervention (P ＜ 0.05).Empathy had a partial mediating effect on the relationship between perspective-taking and HIV-related stigma,and the ratio of mediation effect to total effect was 0.260.Conclusion:The perspective-taking effectively can reduce the level of HIV-related stigma through the mediation effect of empathy.

OBJECTIVE:To investigate the application of vitamins in parenteral nutrition (PN) prescription,and to provide reference for rational use of vitamins in PN. METHODS:Usingparenteral nutritionintravenous nutritionprescription analy-sisrational drug useanalysis of medical orderas keywords,the literatures about the rationality analysis of PN prescriptions were retrieved from CNKI and Wanfang database during 2006-2015,and the utilization of vitamin included in literatures were ana-lyzed and summarized. RESULTS:A total of 34 literatures were included. There were 158874 prescriptions,among which vitamin was used in 145400 prescriptions (91.52%). 12 or 13 kinds of vitamin were used in 73508 prescriptions (46.27%);over-dose drug use was found in 53388 prescriptions(33.60%),and vitamin was not completely added into 18504 prescriptions(11.65%);no vitamin was added into 1663 prescriptions (1.05%). The proportion of the prescriptions including 12 or 13 kinds of vitamin was the highest in northern China (52.00%). 12 or 13 kinds of vitamin were added into the prescriptions and the author believed that the proportion of excessive use of vitamin,incomplete addition of water-soluble vitamin and fat-soluble vitamin in class three grade A hospitals were all lower than hospitals below class three grade A. The prescriptions including 12 or 13 kinds of necessary vi-tamin were adopted in oncology department(97.72%),internal medicine department(86.62%),intensive care unit(77.99%)and surgery department(52.83%). CONCLUSIONS:The standardized use of vitamin PN prescriptions occupies low proportion in Chi-na. It is necessary to enhance the conception that multiple recommended vitamins should be added into PN.

The concepts of cold and hot herbal properties in traditional Chinese medicine (TCM), reflecting the efficacy trends of medicinal herbs, have the Fuzzy characteristics. It is suited for the application of Fuzzy mathematics in research of herbal properties. For a comprehensive evaluation of herbal properties, this work constructed and made a practice of the Fuzzy discrimination model regarding the biological performance of Chinese materia medica.

ObjectiveTo evaluate the therapeutic effect of endoscopic full-thickness resection (EFTR) for gastric stromal tumors.MethodsA total of 33 patients with gastric stromal tumor orgination from deep muscularis propria layer received EFTR from January 2010 to July 2011.The effectiveness and safety of EFTR were compared with those of other 34 patients with gastric stromal tumor origination from muscularis propria layer who underwent endoscopic submucosal dissection (ESD).ResultsExcept in 2 patients with lesions larger than 3.0 × 3.0 cm,EFTR was successful in others 31 patients,who recovered well and had no recurrence during the follow-up within 12 months.There were no significant differences in resection rate,incidence of complications,body temperature,white blood cell counts or recovery time between 2 procedures (P ＞ 0.05 ).However,the number of clips used in EFTR ( 7.0 ± 3.5 vs.4.9 ± 3.1,P =0.013 ) and postoperative fasting days (3.4 ± 1.5 vs.2.0 ± 1.0,P =0.001 ) were significantly higher than those of ESD procedures.ConclusionEFTR is effective and safe for gastric stromal tumors with no higher risk than ESD,but it is more complex technically.EFTR can be used as an expanding method of ESD in endoscopic treatment of gastric stromal tumors.

Based on information entropy theory, this study analyzes the experimental indicators of glucocorticoid-induced traditional Chinese medicine yang deficiency or yin deficiency syndrome in animal models, thus laying the foundation of defining and interpreting the model state.