Acute mountain sickness is a variety of pathological reactions that occur when people enter high altitude areas and are exposed to a hypobaric and hypoxic environment.China has vast high-altitude regions with complex terrains and of strategic importance.With the increase in large-scale combat training activities,more troops have entered high-altitude areas to carry out training.The hypobaric and hypoxic environment at high altitudes impacts the generation of combat effectiveness.The Wilderness Medical Society(WMS)has issued consensus guidelines for the prevention and treatment of acute mountain sickness in 2010,2014,2019 and 2024,respectively.The commonly used drugs for the prevention and treatment of acute mountain sickness include acetazolamide,dexamethasone,acetaminophen and nifedipine while non-pharmaceutical approaches include gradual ascendance,pre-acclimation,oxygen inhalation,descendance to a lower altitude,and portable hyperbaric oxygen chambers.This article was intended to trace the evolution of each means of prevention and treatment specified in the four editions of the guidelines,keep track of the latest approaches to acute mountain sickness,and provide a reference for military medical support for related training.

Objective:To explore the effect of intervention program based on Swanson's caring theory on self-efficacy and quality of life of patients with breast neoplasms.Methods:The convenient sampling method was adopted to select patients who received modified radical mastectomy in People's Hospital of Zhengzhou from March 2018 to November 2019 as the research objects. They were randomly divided into the control group ( n=45) and the observation group ( n=50) . The control group was given routine nursing measures, while the observation group was given intervention measures based on Swanson's caring theory on the basis of routine nursing. The Chinese version of Strategies Used by People to Promote Health (C-SUPPH) and the Chinese version of Functional Assessment of Cancer Therapy-Breast (FACT-B) were used to assess within 24 hours of admission and before discharge. Results:The scores of all dimensions of C-SUPPH of the observation group before discharge were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The scores of social or family status, emotional status, functional status and additional areas of concern in FACT-B in the observation group before discharge were higher than those in the control group, and the differences were statistically significant ( P<0.05) . There was no statistically significant difference in body condition score between the two groups ( P>0.05) . Conclusions:Intervention programs based on Swanson's caring theory can improve the self-management efficiency and quality of life of patients with breast neoplasms, but their effect on the physical status of patients is small.

Objective To observe the effect of exogenous insulin on the expression of P-glycoprotein (P-gp)and the secretion of insulin in pancreatic beta cells (INS-1 832/13).Methods Insulinoma cells (INS-1 832/13) were cultured with 0.5 μmol/L exogenous insulin for 30 days.MTT assay was used to measure cell viability.Quantitative RT-PCR and western blot were used to detect the expression of P-gp mRNA and protein respectively,and glucose stimulated insulin secretion (GSIS) were measured by radioimmunoassay.Results Compared with control group,0.5 μmol/L exogenous insulin promoted the viability of INS-1 832/13 cells [(102.00±12.99) vs (356.00±35.51),P<0.05] and accelerated P-gp expression [(107.50±17.08) vs (307.50±44.25)] both at mRNA and protein levels [(105.00±12.91) vs (192.50±35.94),P<0.05].Glucose stimulated insulin secretion was positively correlated with P-gp expression level,but had no significant effect on basal insulin secretion.Conclusion Exogenous insulin can promote the secretion function of INS-1 832/13 cells,and the mechanism may be related to the expression of P-gp.

The TGF-βsignaling pathway plays a crucial role in regulating cell proliferation, differentiation, and apoptosis. This pathway exerts either tumor-suppressing or tumor-promoting effects, which are cell-or context-dependent, making it simultaneously advanta-geous and disadvantageous in the process of carcinogenesis and tumor progression. Long non-coding RNAs (lncRNAs) do not encode proteins, but they are involved in the regulation of various signaling pathways and biological functions. Moreover, lncRNAs can induce tumor angiogenesis, as well as affect tumor proliferation, invasion, and metastasis by acting as oncogenes or tumor-suppressor genes. Recent studies revealed that some lncRNAs may be induced and regulated by TGF-βto form a complicated crosslinked regulatory net-work. This review focuses on the crosstalk between the TGF-βsignaling pathway and TGF-β-induced lncRNAs.

Objective To analyse the effects of high insulin on the expression and function of P-glycoprotein (P-gp), and preliminarily investigate the influence of insulin on chemotherapeutic sensitivity in MCF-7/ADR cells. Methods MCF-7/ADR cells were cultured with different concentrations of insulin(0.001, 0.005, 0.01, 0.05 and 0.1μmol/L). Real-time PCR was used to detect the expression of P-gp mRNA. Western blot assay was used to detect the expression level of P-gp. Rhodamine 123 was used to detect the efflux function level of P-gp. Cell viability and chemotherapeutic sensitivity were detected by MTT assay. Results High concentration of insulin (0.1 μmol/L) promoted the proliferation of MCF-7/ADR cells. The concentration of insulin (0.05 and 0.1 μmol/L) accelerated P-gp mRNA and protein expression, which also augmented the efflux function of P-glycoprotein and reduced the chemotherapeutic sensitivity to epirubicin. Conclusion High concentration of insulin may influence the drug resistance of breast cancer cells by promoting the expression and function of P-glycoprotein of MCF-7/ADR cells.

Objective To explore the effect of Shenling Baizhu power on inflammatory factors and immune function for recurrent aphthous ulcer. Methods Ninety patients with recurrent aphthous ulcer in our hospital were divided into control group and study group according to random number table method, with 45 cases each group.The control group were given oral vitamin B2, levamisole and cetyl pyridinium chloride gargle solution therapy, and the study group were given Shenling Baizhu power on the basis of control group.After one week treatment, the clinical curative effect were observed, the serum inflammatory factors levels of tumor necrosis factor alpha ( TNF-α) , interleukin 2 ( IL-2 ) and interleukin 6 ( IL-6 ) were determined by Elisa method, the levels of peripheral blood T cell subsets CD3 +, CD4 +, CD8 +and natural killer cells( NKT) were determined by flow cytometry instrument, and the recurrence rate were observed after one year follow-up.Results After one week treatment, the total effective rate 91.30% in study group was significantly higher than the control group 69.57%, the difference was statistically significant(χ2 =5.874, P=0.015).The serum levels of TNF-α, IL-2 and IL-6 in study group were significantly lower than the control group, the difference was statistically significant(P<0.05).The levels of CD3 +, CD4 +, CD8 +and NKT in study group were significantly higher than the control group, the difference was statistically significant(P<0.05).Followed up for 1 year, the recurrence rate 17.78%(8/45) in study group was significantly lower than the control group 46.67%(21/45), the difference was statistically significant(χ2 =8.598, P =0.003).Conclusion The Shenling Baizhu power treatment of recurrent aphthous ulcer has better clinical curative effect, can reduce levels of inflammatory factor, improve immune function, and reduce the recurrence rate.

Objective To investigate the clinical features, phenotypes and genotypes of Pseudomonas aeruginosa (PA) strains isolated from patients with diabetic foot infection (DFI) resisting to aminoglycosides antibiotics (AmAn). Methods The clinical profiles of 209 DFI patients hospitalized in the Tianjin Metabolic Diseases Hospital were collected and ana?lyzed. Forty-one PA strains were identified, and their antibiotic resistance profiles were obtained. The DNAs of PA isolates were extracted and applied to amplifications for several aminoglycosides modifying enzyme genes, including aac(3′)-Ⅰ, aac (3′)-Ⅱ, aac(6′)-Ⅰb, aac(6′)-Ⅱ, ant(2′′)-Ⅰand ant(3′′)-Ⅰby PCR method. Combining with the clinical features and the antibiotic resistance profiles, the relationship between genotypes and phenotypes of the PA strains was analyzed. Results Gram positive bacteria (G+) were the majority of the pathogen with 51.67%detection rate. The total detection rate of PA was 19.62%, listed as the top one pathogenic bacterium among gram negative bacteria (47.67%). There was significant difference in the ratio of ulcer area≥4 cm2 between PA group and non-PA group and G+group. There were significantly higher inci?dence rate of ischemic ulcer and osteomyelitis in PA group than those of G+group. There were higher clinical characteristics and ulcer depth (SAD) score, and increased hypersensitive C-reactive protein in PA group than those of G+ group. There were 30 strains of PA being resistant to AmAn (73.17%). The predominant drug resistance gene to AmAn was ant(3′′)-Ⅰ(65.85%), and aac(3′)-Ⅰgene was not found from all PA isolates. Conclusion The detection rate of PA isolated from DFI patients was higher, and patients were with the characteristics of larger, deeper and severe ischemia of ulcer area. The phe?nomenon of PA resistant to AmAn was more serious, and ant(3′′)-Ⅰgene identified from PA isolates was the most common resistance gene identified to AmAn.

OBJECTIVETo investigate the mechanisms underlying the ability ofheparin-treated dendritic cells (DCs) to promote Th0 to Th1 differentiation in chronic hepatitis B (CHB).

METHODSPeripheral blood mononuclear cells (PBMCs) were isolated from CHB patients and cultured in RPMI-1640 with recombinant GM-CSF and IL-4 with or without heparin to obtain DCs for study. The levels of Toll-like receptors (TLRs) on the DCs were measured using FACS and qPCR techniques.DC subsets with high expression of TLRs were selected for analysis of functional changes by treatment with the corresponding TLR-siRNA. The CD4+ T cell subpopulation was purified from peripheral blood by Dynal immunomagnetic beads, and then the production of IL-12 by DCs in the presence of poly(I:C) or R848 and ofIFN and IL-4 by Th cells co-cultured with DCs was evaluated by ELISA. The t-test was used for statistical analysis.

RESULTSTLR3 expression, and not expression of TLR 7 or TLR8,was significantly increased in heparin-treated DCs as compared to levels detected in the DCs without heparin treatment (t =2.849,P less than 0.05;t =3.027,P less than 0.05). The level of IL-12 produced by heparin-treated DCs stimulated with poly(I:C) was obviously higher than that produced by DCs without heparin treatment and stimulated with poly(I: C) (t =8.68,P less than 0.01) or with R848 (t =19.01,P less than 0.01). However, the IL-12 production by TLR3-siRNA transfected-DCs was significantly reduced (t =31.49, P less than 0.01).When Th cells from allogenic patients with CHB were co-cultured with the TLR3-siRNA transfectedDCs, the frequency ofCD4+ IFN+ cells was significantly reduced (1.64+/-0.57% vs.6.31+/-0.88%,P less than 0.01),as was the capability of Thl to generate IFNg (t =20.83,Pless than 0.01).

CONCLUSIONHeparin may have up-regulated the TLR3 expression level of DCs, and sequentially promoted Th0 to Th1 differentiation.

CD4-Positive T-Lymphocytes ; cytology ; Cell Differentiation ; Coculture Techniques ; Dendritic Cells ; cytology ; Granulocyte-Macrophage Colony-Stimulating Factor ; pharmacology ; Heparin ; pharmacology ; Hepatitis B, Chronic ; immunology ; Humans ; Interferon-gamma ; metabolism ; Interleukin-12 ; metabolism ; Interleukin-4 ; pharmacology ; Monocytes ; cytology ; Recombinant Proteins ; pharmacology ; Toll-Like Receptor 3 ; metabolism

Objective To observe the effects of high glucose and anoxia on Amot expression in vascular endothelial cells (VECs),and explore its role in angiogenesis.Methods VECs were incubated with different glucose concentrations for 48 h,and then cultured at normal oxygen concentration or anaerobic condition for 24 h.The protein expressions of p130-Amot and p80-Amot were detected by Western blot.After Amot expression was downregulated in VECs by siRNA,wound healing experiments and angiogenesis experiments were performed to test the effect of decreased Amot expression on angiogenesis.Results pl30-Amot protein expressions in low glucose (5.5mmol/L) plus normal oxygen group and low glucose plus anaerobic group were higher than those in high glucose (30mmol/L) plus normal oxygen group,high glucose plus anaerobic group,middle glucose (15 mmol/L) plus normal oxygen group,and middle glucose plus anaerobic group (all P＜0.01).Compared with low glucose plus anaerobic group,p130-Amot expression was higher in low glucose plus normal oxygen group (P ＜ 0.01).However,the expression of p80-Amot showed no statistically significant difference among different groups (P＞0.05).Compared to the normal VECs,the cells with decreased Amot expression by siRNA exhibited an attenuated cell migration in the wound healing experiments and a lesser tube formation in the angiogenesis experiments.Conclusions High glucose exerts a more significantly negtive effect on the Amot expression than anoxia in VECs.The downregulation of Amot expression inhibits migration and angiogenesis of VECs.

BACKGROUNDCopious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus.

METHODSFrom May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin (HbA1c), and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep status. "Good sleep quality" was defined as PQSI <5, "average sleep quality" was defined as PQSI 6-8, and "poor sleep quality" was defined as PQSI >8. Poor glycemic control was defined as HbA1c ≥7%. Sleep quantity was categorized as <6, 6-8, and >8 hours/night. Short sleep time was defined as sleep duration <6 hours/night.

RESULTSIn the poor glycemic control group, the rate of patients who had insufficient sleep was much higher than that in the other group (χ(2) = 11.16, P = 0.037). The rate of poor sleep quality in poor glycemic control group was much greater than that in the average control group (χ(2) = 9.79, P = 0.007). After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score's OR was 1.048 (95% CI 1.007-1.092, P = 0.023) for HbA1c level. The sleep duration's OR was 0.464 (95% CI 0.236-0.912, P = 0.026) for HbA1c level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance (P < 0.01).

CONCLUSIONSInadequate sleep, in both quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night's sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.

Adult ; Aged ; Aged, 80 and over ; Blood Glucose ; metabolism ; physiology ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; blood ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Sleep ; physiology ; Young Adult