Objective To study the relationship between vaginal microecological balance and serum T cell subsets,Toll-like receptor 2(TLR2)and Toll-like receptor 4(TLR4)after hysterectomy.Methods The clinical data of 120 patients who underwent laparoscopic total hysterectomy in Daxing Teaching Hospital of Capital Medical University from June 2020 to June 2022 were retrospectively analyzed.The patients were assigned to normal group(n=50)and unbalanced group(n=70)according to postoperative vaginal microecological changes.General information,such as age,body mass index(BMI),disease type,expression of CD+4,CD+8,CD+4/CD+8,TLR2,and TLR4 were compared between the two groups.The risk factors affecting vaginal microecological balance after hysterectomy were analyzed by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of serum T cell subsets,TLR2,and TLR4 in predicting vaginal microecological imbalance after hysterectomy.Results The levels of CD+4 and CD+4/CD+8 in the unbalanced group were significantly lower than those in the normal group,while the levels of CD+8,TLR2 and TLR4 in the unbalanced group were significantly higher than those in the normal group(P<0.05).Multivariable Logistic regression analysis showed that CD+4,CD+8,CD+4/CD+8,TLR2 and TLR4 expression were the influence factors of vaginal microecological imbalance after hysterectomy(P<0.05).ROC analysis confirmed that the expression of CD+4,CD+8 and CD+4/CD+8 and the levels of TLR2 and TLR4 could be used to predict vaginal microecological imbalance after hysterectomy,and the areas under the curve were 0.718,0.813,0.785,0.851,and 0.945,respectively(all P<0.05).Conclusion CD+4,CD+8,CD+4/CD+8,TLR2 and TLR4 expression levels are the influence factors of vaginal microecological imbalance after hysterectomy.They can be used as biological indicators for evaluating vaginal microecological balance after hysterectomy.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective:To analyze the prognosis of glucose metabolism and its impacting factors at 6-12 weeks postpartum in patients with abnormal blood glucose during pregnancy.Methods:In this cross-sectional study, a total of 192 patients with abnormal blood glucose during pregnancy enrolled and delivered in the maternity clinic of Daxing Teaching Hospital of Capital Medical University from December 1, 2019 to December 31, 2020 were collected. The 75 g oral glucose tolerance test (OGTT) was applied for diabetes screening at 6-12 weeks after delivery. According to the results of postpartum blood glucose, the patients were divided into two groups: postpartum normal blood glucose group (148 cases) and abnormal blood glucose group (44 cases). Hypothesis testing was used to compare the clinical data before, during and after the pregnancy between the two groups. Multi-factor logistic regression was performed to analyze the influencing factors of postpartum abnormal blood glucose in patients with abnormal blood glucose during pregnancy.Results:Among the 192 patients with abnormal blood glucose during pregnancy, the incidence of postpartum abnormal blood glucose was 22.92% (44/192), including 6 cases of diabetes mellitus (DM) (13.64%), 38 cases of impaired glucose tolerance (IGT) (86.36%). Neck circumference, waist circumference, multiparous women and insulin use during pregnancy in postpartum abnormal blood glucose group were all significantly higher than those in postpartum normal blood glucose group [34.25(33.00, 36.00) vs 33.55 (32.00, 35.00) cm, 87.00 (82.00, 93.00) vs 84.00 (78.00, 90.00) cm, 54.55% vs 37.16%, 18.18% vs 6.76%] (all P<0.05). Neck circumference ( OR=1.315, 95% CI: 1.026-1.685), multiparous women ( OR=2.261, 95% CI: 1.057-4.836), insulin use during pregnancy ( OR=3.767, 95% CI: 1.236-11.478) were positively correlated with the occurrence of postpartum abnormal blood glucose (all P<0.05). Conclusions:The incidence of postpartum abnormal blood glucose is high at 6-12 weeks postpartum in patients with abnormal blood glucose during pregnancy. Neck circumference, waist circumference, parity and insulin use during pregnancy are important impacting factors of postpartum abnormal blood glucose.

Objective:To explore the effect of mind mapping based on evidence-based theme in health education of patients undergoing thoracentesis and drainage.Methods:From September 2020 to December 2021, 78 patients with pleural effusion and thoracentesis drainage diagnosed by infection in Beijing Chaoyang Hospital affiliated to Capital Medical University were selected by convenience sampling as the research object. The patients from September 2020 to March 2021 were set as the control group, and the patients from May to December 2021 were set as the observation group, with 39 cases each. The control group was given traditional health education, while the observation group received evidence-based health education with mind mapping. The health education knowledge examination score, self-care ability, adverse event rate and nursing satisfaction were compared between the two groups.Results:The scores of health education knowledge examination in the observation group were higher than those in the control group before , 24 hours after catheterization and before decannulation, with statistically significant differences ( P<0.01) . The total score and each dimension score of self-care ability in the observation group were higher than those in the control group, with statistically significant differences ( P<0.01) . The incidence of adverse events in the observation group was lower than that in the control group, and the score of Nursing Satisfaction Questionnaire was higher than that in the control group, with statistical differences ( P<0.05) . Conclusions:The mind mapping on the basis of evidence-based themes can effectively improve patients' health education knowledge and self-care ability, reduce the incidence of adverse events, and increase nursing satisfaction.

Objective:To explore the main management points and ethical considerations of diabetic subjects involved in hypoglycemic drug clinical trials.Methods:Taking the subject management of a hypoglycemic drug clinical trial in Yuncheng Central Hospital as an example, the problems and measures in the subject management of diabetic patients were systematically discussed.Results:In hypoglycemic drug clinical trial that involving diabetic patients, ethical considerations regarding to the subjects' rights, safety and health should take into account in the whole process of subjects' recruitment, screening, enrollment and follow-up.Conclusions:Subject management taking into account of ethical consideration can better protect the safety and rights of subjects, enhance the compliance of subjects and improve the quality of drug clinical trials.

Dopamine is the precursor of a variety of natural antioxidant compounds. In the body, dopamine acts as a neurotransmitter that regulates a variety of physiological functions of the central nervous system. Thus, dopamine is used for the clinical treatment of various types of shock. Dopamine could be produced by engineered microbes, but with low efficiency. In this study, DOPA decarboxylase gene from Sus scrofa (Ssddc) was cloned into plasmids with different copy numbers, and transformed into a previously developed L-DOPA producing strain Escherichia coli T004. The resulted strain was capable of producing dopamine from glucose directly. To further improve the production of dopamine, a sequence-based homology alignment mining (SHAM) strategy was applied to screen more efficient DOPA decarboxylases, and five DOPA decarboxylase genes were selected from 100 candidates. In shake-flask fermentation, the DOPA decarboxylase gene from Homo sapiens (Hsddc) showed the highest dopamine production (3.33 g/L), while the DOPA decarboxylase gene from Drosophila Melanogaster (Dmddc) showed the least residual L-DOPA concentration (0.02 g/L). In 5 L fed-batch fermentations, production of dopamine by the two engineered strains reached 13.3 g/L and 16.2 g/L, respectively. The residual concentrations of L-DOPA were 0.45 g/L and 0.23 g/L, respectively. Finally, the Ssddc and Dmddc genes were integrated into the genome of E. coli T004 to obtain genetically stable dopamine-producing strains. In 5 L fed-batch fermentation, 17.7 g/L of dopamine was produced, which records the highest titer reported to date.
Animals ; Dopa Decarboxylase/genetics* ; Dopamine/biosynthesis* ; Drosophila melanogaster/genetics* ; Escherichia coli/metabolism* ; Humans ; Metabolic Engineering

Metabolic engineering has been developed for nearly 30 years since the early 1990s, and it has given a great impetus to microbial strain breeding and improvement. Aromatic chemicals are a variety of important chemicals that can be produced by microbial fermentation and are widely used in the pharmaceutical, food, feed, and material industry. Microbial cells can be engineered to accumulate a variety of useful aromatic chemicals in a targeted manner through rational engineering of the biosynthetic pathways of shikimate and the derived aromatic amino acids. This review summarizes the metabolic engineering strategies and biosynthetic pathways for the production of aromatic chemicals developed in the past 30 years, with the aim to provide a valuable reference and promote the research in this field.
Biosynthetic Pathways ; Fermentation ; Metabolic Engineering ; Shikimic Acid

p-coumaric acid is an important natural phenolic compound with a variety of pharmacological activities, and also a precursor for the biosynthesis of many natural compounds. It is widely used in foods, cosmetics and medicines. Compared with the chemical synthesis and plant extraction, microbial production of p-coumaric acid has many advantages, such as energy saving and emission reduction. However, the yield of p-coumaric acid by microbial synthesis is too low to meet the requirements of large-scale industrial production. Here, to further improve p-coumaric acid production, the directed evolution of tyrosine ammonia lyase (TAL) encoded by Rhodotorula glutinis tal gene was conducted, and a high-throughput screening method was established to screen the mutant library for improve the property of TAL. A mutant with a doubled TAL catalytic activity was screened from about 10,000 colonies of the mutant library. There were three mutational amino acid sites in this TAL, namely S9Y, A11N, and E518A. It was further verified by a single point saturation mutation. When S9 was mutated to Y, I or N, or A11 was mutated to N, T or Y, the catalytic activity of TAL increased by more than 1-fold. Through combinatorial mutation of three types of mutations at the S9 and A11, the TAL catalytic activity of S9Y/A11N or S9N/A11Y mutants were significantly higher than that of other mutants. Then, the plasmid containing S9N/A11Y mutant was transformed into CP032, a tyrosine-producing E. coli strain. The engineered strain produced 394.2 mg/L p-coumaric acid, which is 2.2-fold higher than that of the control strain, via shake flask fermentation at 48 h. This work provides a new insight for the biosynthesis study of p-coumaric acid.
Ammonia-Lyases/genetics* ; Escherichia coli/genetics* ; Propionates ; Rhodotorula ; Tyrosine/genetics*

Total 1 452 newborns were home visited within 28 d after birth during January 2016 to December 2016,and 27 cases of skin infections were found.Umbilical inflammation was more common (11 cases),followed by folliculitis (9 cases) and impetigo (7 cases).Samples were collected for bacterial culture and identification from the skin of infected newborns,the hands and nasal cavity of family baby caretakers,and household articles,including faucets,mobile phones,toilet buttons and so on.The pathogens identified were Staphylococcus aureus in 20 cases (including 2 methicillin-resistant strains) and Escherichia coli in 7 cases.The isolation of Staphylococcus aureus in household articles was significantly correlated with newborns infected with Staphylococcus aureus (x2=678.808,P＜0.01);and the isolation of Staphylococcus aureus from family baby caretakers was also significantly associated with neonatal Staphylococcus aureus infection (x2=820.396,P＜0.01).In 7 cases of Escherichia coli infection,the Escherichia coli were detected from samples of baby caretakers or household articles.The study suggests that the awareness of baby caretakers and home hygiene are important to reduce neonatal skin infections.