Objective:To analyze the etiological characteristics of Clostridium ramosum DZS3717106 isolated from the blood of a patient with septic shock secondary to perianal abscess and the immunological characteristics of the patient. Methods:The isolate was subjected to morphological observation, mass spectrometry, antibiotic susceptibility testing, and 16S rRNA sequencing. Biochemical and cytological test results of the patient were collected. Flow cytometry was used to detect T cell subsets. Impacts of the virulence factors of the isolate on the host immune system were evaluated.Results:DZS3717106 was an anaerobic Clostridium with pleomorphic rod-shaped cells and spores. It was sensitive to penicillin G, piperacillin/tazobactam, and metronidazole, but resistant to clindamycin. It carried various virulence and resistance genes. The patient was immunocompromised with abnormal IL-6, IL-8, and IL-10 levels. Conclusions:Septic shock caused by Clostridium ramosum is rare, and more research is needed on the causes and epidemiology. DZS3717106 infection triggers over-activated inflammatory response in the patient, which may be closely related to the occurrence and development of septic shock.

Objective:To analyze the etiological characteristics of Clostridium ramosum DZS3717106 isolated from the blood of a patient with septic shock secondary to perianal abscess and the immunological characteristics of the patient. Methods:The isolate was subjected to morphological observation, mass spectrometry, antibiotic susceptibility testing, and 16S rRNA sequencing. Biochemical and cytological test results of the patient were collected. Flow cytometry was used to detect T cell subsets. Impacts of the virulence factors of the isolate on the host immune system were evaluated.Results:DZS3717106 was an anaerobic Clostridium with pleomorphic rod-shaped cells and spores. It was sensitive to penicillin G, piperacillin/tazobactam, and metronidazole, but resistant to clindamycin. It carried various virulence and resistance genes. The patient was immunocompromised with abnormal IL-6, IL-8, and IL-10 levels. Conclusions:Septic shock caused by Clostridium ramosum is rare, and more research is needed on the causes and epidemiology. DZS3717106 infection triggers over-activated inflammatory response in the patient, which may be closely related to the occurrence and development of septic shock.

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ²=52.901， P<0.001）， and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention （P<0.001）. WeChat had the best effect， decreasing the incidence by 14.4%， followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services， the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention （χ²=7.129， P=0.008）， and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention （χ²=4.675， P<0.001）. In terms of medical expenses， there was no significant difference between control group and intervention group with different intervention methods before intervention （P>0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P<0.05）. The results of multiple comparisons showed that compared with the control group， the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group， and the difference was statistically significant （P<0.05）. ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD， reduce the rate of consultation and medical expenses due to acute onset， and provide scientific basis for the basic COPD health management model.

Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease (COPD). Methods A questionnaire survey, blood and urine sample collection, physical examination, and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area, Shanghai. The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio (ACR) quartiles (0~1.65 mg/g, 1.65~4.89 mg/g, 4.89~10.78 mg/g, and ≥10.78 mg/g). Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people. Results Among the 3 105 subjects, the median follow-up time was 3.212 years (P25~P75：3.102~3.473). 116 new cases of COPD were observed, with an incidence density of 10.423 per 1000 person-years. The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years, 8.300 per 1 000 person-years , 11.419 per 1 000 person-years, and 13.843 per 1 000 person-years, respectively. Cox regression analysis revealed that as the ACR level increased, there was a rising trend in the incidence rate of COPD (χ²=4.396, P=0.036). After adjusting for gender, age, education level, occupational exposure to dust, history of childhood pneumonia, smoking, family history of COPD, central obesity, and hypertension, the risk of developing COPD was 2.499 times higher (95% CI: 1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g. Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD, and early monitoring of urine protein levels is beneficial for COPD prevention.

CD36, the major scavenger receptor, is intimately involved in the uptake of oxLDL in macrophages. To further study the function of CD36 in macrophages, we constructed CD36 gene silence cell lines (J774A.1) by lentivirus-mediated RNA interference technique, and analyzed the effect of CD36 in caveolin-1 protein expression. At first, 5 shRNA fragments were designed and synthesized according to the coding sequence (CDS) region of CD36 gene. Next, the CD36-shRNA was inserted into lentiviral vector to yield pLKO.1-CD36-shRNA plasmid. After DNA sequencing, the pLKO.1-CD36-shRNA plasmid and psiCHECK-II-CD36 were co-transfected into the 293T cells to screen the efficient CD36-shRNA. The efficient CD36-shRNA plasmid and the helper plasmid were co-transfected into the 293T cells to package the lentivirus, and then infected the J774A.1 cells. After screening by puromycin, CD36 gene silence cell lines (J774A.1) was established. Western blotting and confocal fluorescence microscopy results showed that the CD36 silencing efficiency in the gene silence cell line was 90%. Accompanied by a decrease in CD36 protein on cell surface, oxLDL binding to CD36 was significantly inhibited, indicating that the CD36 gene silence cell line is successfully established. Finally, the oxLDL stimulation and inhibitor experiments results showed that the CD36 knockdown significantly suppresses the phosphorylation of JNK and ERK, thereby inhibiting the oxLDL-induced caveolin-1 protein expression, demonstrating that CD36 modulates the caveolin-1 protein expression through the JNK/ERK-mediated signaling transduction.

There are some problems such as difficulty of pressure control, inconvenience of use and carry, congested easily and dredged hardly in clinical application of vacuum extractor in common use. For solving the above problems, researchers have designed a new portable and pressure stabilized abdominal drainage system which was composed of integral double spherical aspirator and separated double cannula. The new apparatus has achieved good effects in drainage which is suitable for not only rescuing of abdominal trauma and war wound, but also abdominal surgery that manifested as sucking safe and effective, using easily and convenient, that was verified by testing.

This paper summarized the etiology of pressure ulcers in traditional Chinese medicine, the stages of pressure ulcers, the mechanism of action of moxibustion therapy in treating pressure ulcers as well as the status quo of the application of moxibustion therapy in patients with pressure ulcers and looked into its deficiencies, so as to provide a reference for improving the moxibustion therapy for patients with pressure ulcers.

Objective To determine the effect of Nuclear factor-erythroid 2-related factor 2 ( Nrf2 ) on acute hephrotoxicity induced by CCl4 in male rat.Methods 20 male Wistar rats were randomly divided into control group and CCl4 group, 10 rats in each group, another 10 male Wistar rats were transgenic rats microinjection through the carrier, obtained the Nrf2-tk gene integration and specific transgenic rats, as the CCl4 +Nrf2 integration group.The groups was given 1%polysorbate 80 for 4 days,Then the CCl4 and CCl4 +Nrf2 integration group were intraperitoneally injected with a single dose of CCl47.5 mg· kg-1 and were killed 24 h after CCl4 injection.The serum chemical parameters including asparate aminotransferase ( AST) ,alanine aminotransferase ( ALT) and lactate dehydrogenase ( LDH) were measured.Also malonaldehyde ( MDA) ,glutathione ( GSH) ,oxidized glutathione ( GSSG) levels in the liver as well as glutathione ( GSH)/oxidized glutathione ( GSSG ) ratios were detected. Histopathologic changes in the liver were examined. Results F1generation TK transgenic rats in liver and testis and other tissues and organs were not detected the transcription of Nrf2-tk, indicating that Nrf2-tk expression in tissues is specific good.Nrf2 significantly reduced serum AST, ALT and LDH levels in a dose-dependent manner.The results of MDA levels and GSH/GSSG ratios in liver and kidney showed that Nrf2 reduced CCl4-induced hepatic lipid peroxidation,and ameliorated glutathione depletion.The histopathologic results showed that Nrf2 restrained liver and kidney damage induced by CCl4 .Conclusion Nrf2 can effectively protect male rat from acute hepatotoxicity and nephrotoxicity induced by CCl4 .

Objective To systematically review the efficacy of hydromorphone hydrochloride injection for treatment of chronic pain.Methods Web of Science Proceedings and PubMed were searched for clinical trials involving the efficacy of hydromorphone for treatment of chronic pain, with no language or time limit.Evaluation indexes included visual analogue scale (VAS) score and the rate of pain control or relief.The studies were screened independently, and the data were extracted by two researchers.Meta-analysis was conducted using the Stata 10 software.Results Eleven studies involving 452 patients were included in our meta-analysis.VAS score was significantly decreased after treatment compared with that before treatment.For the patients with cancer pain, VAS score was significantly decreased after treatment with hydromorphone hydrochoride injection, and the rate of pain control or relief was increased when compared with the other opioid analgesics.Conclusion Hydromorphone hydrochloride injection can treat chronic pain, and it may provide better therapeutic effect than the other opioid analgesics for the patients with cancer pain.

OBJECTIVETo investigate the influence of different pressures of CO2 pneumoperitioneum on pathomorphism and function of intestines following laparoscopic gastrectomy (LG).

METHODSForty-eight gastric cancer patients were prospectively enrolled in the study. Among them, 36 patients scheduled for elective LG were randomly assigned to low pressure group (LP), middle pressure (MP), and high pressure group (HP) with 12 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 8-10 mmhg in LP, 11-13 mmhg in MP, and 14-16 mmhg in HP. The control group was open gastrectomy group (OG) in 12 cases. The intestinal pathomorphism and level of plasma D-lactic acid before, during and after operation, and postoperative intestinal function of four groups were examined and compared.

RESULTSThere were no statistical differences in preoperative data among the four groups(all P>0.05). LG group was associated with a lower rate of surgical complications than OG (8.3% vs. 41.7%, P<0.05). No obvious damage of intestinal mucosa was found in OG group. Damage degree of intestinal mucosa after operation in LP, MP and HP groups was 0-1, 1-2, and 2-3 respectively. There was significant change in intestinal pathomorphism after operation in both HP and MP groups. The levels of D-lactic acid before operation were not significantly different among all the four groups, but increased significantly in each group after operation (all P<0.05). HP group had the highest level of plasma D-lactic acid and presented with delayed bowel sound return (4.5 d), time to first flatus (5.4 d), and intake (6.0 d) as compared to the other 3 groups (all P<0.05).

CONCLUSIONSLaparoscopic radical gastrectomy is safe and minimally invasive. Higher pneumoperitoneal pressure is harmful to the recovery of intestinal mucosa and function. Therefore the pneumoperitioneum pressure should be maintained as low as possible under clear visualization during operation.