BACKGROUND: Plasminogen activator inhibitor-1 (PAI-1) plays an important role in the pathophysiology of sepsis, but the exact mechanism remains debatable. In this study, we investigated the associations among the serum levels of PAI-1, the incidence of 4G/5G promoter PAI-1 gene polymorphisms, immunological indicators, and clinical outcomes in septic patients. METHODS: A total of 181 patients aged 18-80 years with sepsis between November 2016 and August 2018 in the intensive care unit in the Xinhua Hospital were recruited in this retrospective study, with 28-day mortality as the primary outcome. The initial serum level of PAI-1 and the presence of rs1799768 single nucleotide polymorphisms (SNPs) were examined. Univariate logistic regression and multivariate analyses were performed to determine the factors associated with different genotypes of PAI-1, serum level of PAI-1, and 28-day mortality. RESULTS: The logistic analysis suggested that a high serum level of PAI-1 was associated with the rs1799768 SNP of PAI-1 (4G/4G and 4G/5G) (Odds ratio [OR]: 2.49; 95% confidence interval [CI]: 1.09, 5.68). Furthermore, a high serum level of PAI-1 strongly influenced 28-day mortality (OR 3.36; 95% CI 1.51, 7.49). The expression and activation of neutrophils (OR 0.96; 95% CI 0.93, 0.99), as well as the changes in the expression patterns of cytokines and chemokine-associated neutrophils (OR: 1.00; 95% CI: 1.00, 1.00), were both regulated by the genotype of PAI-1. CONCLUSIONS Genetic polymorphisms of PAI-1 can influence the serum levels of PAI-1, which might contribute to mortality by affecting neutrophil activity. Thus, patients with severe sepsis might clinically benefit from enhanced neutrophil clearance and the resolution of inflammation via the regulation of PAI-1 expression and activity.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Humans ; Middle Aged ; Young Adult ; Genotype ; Neutrophils ; Plasminogen Activator Inhibitor 1/genetics* ; Polymorphism, Single Nucleotide/genetics* ; Retrospective Studies ; Sepsis/genetics*

The establishment of a landscape of enhancers across human cells is crucial to deciphering the mechanism of gene regulation, cell differentiation, and disease development. High-throughput experimental approaches, which contain successfully reported enhancers in typical cell lines, are still too costly and time-consuming to perform systematic identification of enhancers specific to different cell lines. Existing computational methods, capable of predicting regulatory elements purely relying on DNA sequences, lack the power of cell line-specific screening. Recent studies have suggested that chromatin accessibility of a DNA segment is closely related to its potential function in regulation, and thus may provide useful information in identifying regulatory elements. Motivated by the aforementioned understanding, we in-tegrate DNA sequences and chromatin accessibility data to accurately predict enhancers in a cell line-specific manner. We proposed DeepCAPE, a deep convolutional neural network to predict enhancers via the integration of DNA sequences and DNase-seq data. Benefitting from the well-designed feature extraction mechanism and skip connection strategy, our model not only consistently outperforms existing methods in the imbalanced classification of cell line-specific enhancers against background sequences, but also has the ability to self-adapt to different sizes of datasets. Besides, with the adoption of auto-encoder, our model is capable of making cross-cell line predictions. We further visualize kernels of the first convolutional layer and show the match of identified sequence signatures and known motifs. We finally demonstrate the potential ability of our model to explain functional implications of putative disease-associated genetic variants and discriminate disease-related enhancers. The source code and detailed tutorial of DeepCAPE are freely available at https://github.com/Sheng-quanChen/DeepCAPE.

Objective:To investigate the status of fear disease progression and hope level in patients with transient ischemia attack and to analyze the relationship between them.Methods:From January 2018 to March 2020,a convenient sampling method was used to select 136 patients with transient ischemia attack. The Chinese version of the Fear of Progression Questionnaire-Short Form(FoP-Q-SF) and Herth Hope Index(HHI) were investigated.Results:The total score of FoP-Q-SF in patients with transient ischemia attack was 32.78±5.34, and the total score of HHI was 34.86±5.12. The total score of FoP-Q-SF and the scores of each dimension were negatively correlated with the total score of HHI and the scores of each dimension ( r values were -0.613--0.376, all P<0.05). Conclusions:Patients with transient ischemia attack have a higher level of fear disease progression, which is related to the level of hope, and can reduce the level of fear disease progression by increasing the level of hope.

Objective: To retrospectively analyze the efficacy and prognostic factors of postoperative intensity modulated radiotherapy for grade Ⅱ gliomas. Methods: Retrospective analysis was conducted on patients with postoperative grade Ⅱ glioma in our hospital from Jan. 2010 to Dec. 2018. The primary endpoint was progression-free survival, and the secondary endpoint was overall survival. Correlative analyses of prognosis by age, gender, initial resection status, the maximum diameter of the lesions, bi-hemisphere, astrocytoma, chemoradiation, adjuvant chemotherapy were conducted. Results: A total of 109 cases with grade Ⅱ glioma were enrolled. The follow-up rate was 91.75%, including 10 cases dead and 27 relapsed. There were 24 cases (88.9%) of in-field failure, and 3 cases (11.1%) of out-field failure. 14 cases of recurrence occurred in 81 cases of total resection group, accounting for 17.3%, and 13 in 28 cases of subtotal resection group, accounting for 46.4%. The recurrence rate in the subtotal resection group was significantly higher than that in the total resection group (χ ²=9.484, P<0.05). The 1-, 2-, 3-, 4- and 5-year progression-free survival rates were 92.5%, 86.0%, 80.6%, 77.5% and 66.8%, respectively. The 2-, 3-, 4- and 5-year overall survival rates were 97.2%, 90.8%, 87.7% and 84.5%, respectively. Multivariate analysis showed that patients with subtotal resection(HR=3.608, P<0.05) and bi-hemisphere(HR=3.183, P<0.05)were significantly correlated with the progression free survival. Conclusions Postoperative intensity modulated radiotherapy for grade Ⅱ gliomas can achieve a better PFS. Recurrence in the radiation field is the main failure mode. Initial resection status and bi-hemisphere of tumor are important influential factors for PFS of grade Ⅱ gliomas patients.

Background/Aims: It is known that post-reflux swallow-induced peristaltic wave (PSPW) index represents the chemical clearance of the esophagus. However, few studies have explored why some reflux episodes could induce PSPW while others in the same patient could not. The purpose of this study is to investigate the characteristics of reflux episodes which could elicit PSPW. Methods: In this study, 269 reflux episodes were detected, of which 90 with a PSPW and 179 without a PSPW. Comparisons were made between the characteristics of reflux episodes with a PSPW and without a PSPW. The characteristics were including nadir pH, pH drop, proximal extent (cm, sec), ascending velocity (cm/sec), volume clearance time, acid clearance time, percentage acidic (%), 15 to 60-minute acid burden (seconds), and 15- to 60-minute volume burden (seconds). The characteristics between the 2 groups were compared through performing Wilcoxon signed rank test. Results: Reflux episodes followed by a PSPW were significantly associated with a higher proximal extent than those without a PSPW. After the reflux episodes, higher volume clearance time and larger volume burden were more likely to trigger a PSPW. However, there were no significant differences between the 2 groups in nadir pH, pH drop, ascending velocity, acid clearance time, percentage acidic, or acid burden. Conclusions The role of acid seems to be less important in a reflux episode inducing a PSPW. Proximal reflux episodes are more likely to induce a PSPW. The depression of volume clearance may also be an important factor in eliciting a PSPW.

Objective: To explore the application effect of a specialized team consisting of specialist nurses and some emergency care′s or intensive care′s head nurses of critically ill patients in the hospital. Methods: From 2016 to 2018, the Critical Care Professional Group of implemented a provincial and above specialist nurses and the backbone of the specialist care departments of the acute and critical departments. A total of 23 members were composed of core members. A total of 56 liaison officers from each ward were selected to participate. The training and assessment activities presided over by the core staff of the professional group; at the same time, the professional group liaison officer is also the leader of the critical care quality control team in this ward, and implements the quality control of critical care patients; the core members are responsible for the guidance of the nursing care of critical patients in the hospital. The liaison staff carries out the training and assessment of the intensive care knowledge, skills and related nursing standards, norms, as well as the sharing of new technologies and new projects or research topics for acute and critical care, and the training of intensive care posts in the hospital. Before and after the operation of the specialized nursing team, the quality control scores of critically ill patients in 2015-2018, the satisfaction survey of nursing, the number of patents published by nurses in 2-25 years, the mortality rate of patients, and the results of unplanned extubation in 2016-2018 Compare. Results: The quality control scores of critical care patients in 2015-2018 were 93.91±1.23, 94.07±1.38,94.33±1.24, 95.42±1.56. The difference was statistically significant (F=49.597, P < 0.01). Satisfaction survey scores were 94.92±2.28, 97.08±1.37, 97.82±1.52, 97.94±1.68, the difference was statistically significant (F=30.882, P < 0.01); work 2-20 years The number of nurses was 678, 809, 853, and 925 respectively. The number of patents published was 76, 119, 147, and 237, respectively. The difference was statistically significant (χ²=36.77, P < 0.01). 2016-2018 unplanned extubation rate was 4.98‰(127/25 517), 4.01‰(115/28 713), 3.25‰(112/34 493), the difference was statistically significant (χ²=10.958, P <0.01). Conclusions The professional nursing team operation mode can improve the core ability and comprehensive quality of nursing staff's intensive care, improve the quality of care management of critically ill patients, ensure patient safety, and achieve continuous improvement of nursing quality.

Objective To evaluate the clinical effect of milrinone nebulized inhalation for improving intraoperative cardiac function and pulmonary arterial pressure in the patients with chronic obstructive pulmonary disease (COPD) complicating pulmonary hypertension (PH).Methods Forty-four surgical patients with COPD complicating PH in the Chongqing Municipal Medical Emergency Center from June 2015 to June 2016 were chosen,including 23 cases of thoracic surgery,13 cases of abdominal surgery and 8 cases of lower extremity fracture surgery.The patients were divided into the control group and treatment group,22 cases in each group.The control group received the routine comprehensive treatment.In addition receiving the conventional comprehensive treatment,milrinone nebulized inhalation in the treatment group was given before general anesthesia.Both of the two groups were imbedded with floating catheter in the right internal jugular vein for detecting the clinical indexes:cardiac output (CO),pulmonary artery systolic pressure (PASP),pulmonary artery mean pressure (PAMP) and pulmonary capillary wedge pressure (PCWP).Results Compared with before treatment,CO after treatment in the treatment group was significantly increased (P＜0.05),PASP,PAMP and PCWP after treatment in the treatment group were significantly decreased(P＜0.05).CO,PASP,PAMP and PCWP in the control group had no statistical difference between before and after treatment,the difference was not statistically significant (P＞0.05).Conclusion Intraoperative milrinone nebulized inhalation in the patients with COPD complicating PH can effectively improve the patient's cardiopulmonary function.

Objective To investigate the value of ultrasound in assessing leuprorelin treatment response of girls with central precocious puberty . Methods Forty girls with central precocious puberty scheduled for leuprorelin treatment were enrolled . Ultrasound examination as well as the serum hormone level test of luteinizing hormone ( LH) and follicle stimulating hormone ( FSH) were performed prior to the treatment ,after 3 and 9 months of treatment . The correlation between uterine volume ,ovarian volume and hormone levels were analyzed . Results After 3 and 9 months of leuprorelin treatment ,both the volumes of uterus and ovary and the levels of LH and FSH were significant reduced ( all P < 0 .05) . After 3 months of leuprorelin treatment ,the reduction rate in ovarian volume was positively correlated with the reduction rate of LH and FSH ( r = 0 .335 , P = 0 .034 ; r = 0 .334 , P = 0 .035) . No correlation was found between the reduction rate of uterine volume and hormone level changes ( r = 0 .110 , P = 0 .501 ; r = 0 .257 , P =0 .109) . After 9 months of treatment ,the ovarian volume reduction rate was positively correlated with the reduction rate of LH and FSH ( r = 0 .327 , P = 0 .039 ; r = 0 .356 , P = 0 .024) ,and the uterine volume reduction rate was positively correlated with the reduction rate of LH and FSH ( r = 0 .439 , P = 0 .005 ;r =0 .433 , P = 0 .005 ) . Conclusions Leuprorelin could effectively inhibit hormone release and gonadal development in girls with central precocious puberty . Ultrasound examination , as a noninvasive and convenient method ,could dynamically monitor the volume changes of uterus and ovary ,thus reflect the development of gonadal development directly and the changes of hormone level indirectly . It could be used as a routine outpatient follow-up method after central precocious medicine treatment .

Objective To explore the correlation between the self-management and self-efficacy of senile patients with chronic heart failure (CHF). Methods In this study, the conveninent sampling method was adopted. From June to December 2016, totally 416 senile CHF patients hospitalized in the Department of Cardiology of 5 general class Ⅲ grade A hospitals in Xi'an were investigated with the general demographic data questionnaire, self-management scale for CHF patients and chronic disease self-efficacy scale. Results The score of self-management in the senile CHF patients in Xi'an totaled (50.76±9.98), with a scoring rate of 63.5%; the scores of medication management, food and beverage management, psychological and social management and symptom management were (13.38±3.38), (7.89±2.14), (12.81±2.91) and (16.69±4.26), with the scoring rates of 66.9%, 65.8%, 64.1% and 59.6%, respectively, showing a medium level; and there was statistically significant difference in the total self-management score between patients with different marital status, per capita income and heart function grading (t=-2.443, 10.906, 16.229;P<0.05). The score of self-efficacy totaled (34.30±11.90), with a scoring rate of 57.17%, showing a medium level. The correlation analysis showed that there was a positive correlation between self-efficacy and self-management (r=0.161, P< 0.05). Conclusions The self-management and self-efficacy of the senile CHF patients in Xi'an remain at a medium level, which could be possibly improved, and the two are closely correlated. The results suggest that we should pay more attention to the patient's management confidence in the disease itself, attach importance to their psychological and social support and enhance their self-efficacy, thus improving their self-management. This is of great significance in controlling CHF and improving the patient's quality of life.