Objective:To investigate lipid metabolism gene mutations and pathogenicity of hypertriglyceridemia acute pancreatitis (HTG-AP) patients.Methods:Clinical data of 495 HTG-AP patients admitted from June 2018 to June 2020 in the center for severe acute pancreatitis of Eastern Theater General Hospital were retrospectively analyzed. Whole-exome sequencing and mutation verification were performed by next-generation sequencing technology and Sanger sequencing. The pathogenicity of gene mutation was analyzed by population mutation ratio, pathogenicity prediction software, conservation scoring software, protein structure prediction, and in vitro experiments. Results:The mutation ratio of lipid metabolism-related genes, namely LPL, APOA5, LMF1, GPIHBP1, and APOC2, were 14.81%, 55.78%, 43.61%, 1.62%, and 0.61%, respectively. Among them, 44 heterozygous mutations in LPL gene were detected including 36 missense mutations, 5 nonsense mutations and 3 frameshift mutations, which were all rarely carried in single patient. Six HTG-AP patients carried the LPL gene heterozygous mutation c.835C>G (p.Leu279Val). The mean level of serum triglyceride at the onset of HTG-AP was 27.4 mmol/L. All of them had a history of recurrent HTG-AP, and most of them had severe acute pancreatitis. The serum LPL concentration and activity were lower than the normal level. The pathogenicity analysis results suggested that the LPL p.Leu279Val was a rare, highly possible pathogenic and highly conserved gene mutation. The in vitro results showed that the LPL p.Leu279Val could significantly reduce the synthesis and secretion ability of LPL as well as its enzymatic activity. Conclusions:The mutation ratio of lipid metabolism-related genes, including LPL, APOA5, LMF1, GPIHBP1, and APOC2, are relatively high in the HTG-AP patients. The LPL p.Leu279Val is a rare and highly possible pathogenic gene mutation, which may lead to recurrent episodes of HTG-AP.

Objective:To investigate lipid metabolism gene mutations and pathogenicity of hypertriglyceridemia acute pancreatitis (HTG-AP) patients.Methods:Clinical data of 495 HTG-AP patients admitted from June 2018 to June 2020 in the center for severe acute pancreatitis of Eastern Theater General Hospital were retrospectively analyzed. Whole-exome sequencing and mutation verification were performed by next-generation sequencing technology and Sanger sequencing. The pathogenicity of gene mutation was analyzed by population mutation ratio, pathogenicity prediction software, conservation scoring software, protein structure prediction, and in vitro experiments. Results:The mutation ratio of lipid metabolism-related genes, namely LPL, APOA5, LMF1, GPIHBP1, and APOC2, were 14.81%, 55.78%, 43.61%, 1.62%, and 0.61%, respectively. Among them, 44 heterozygous mutations in LPL gene were detected including 36 missense mutations, 5 nonsense mutations and 3 frameshift mutations, which were all rarely carried in single patient. Six HTG-AP patients carried the LPL gene heterozygous mutation c.835C>G (p.Leu279Val). The mean level of serum triglyceride at the onset of HTG-AP was 27.4 mmol/L. All of them had a history of recurrent HTG-AP, and most of them had severe acute pancreatitis. The serum LPL concentration and activity were lower than the normal level. The pathogenicity analysis results suggested that the LPL p.Leu279Val was a rare, highly possible pathogenic and highly conserved gene mutation. The in vitro results showed that the LPL p.Leu279Val could significantly reduce the synthesis and secretion ability of LPL as well as its enzymatic activity. Conclusions:The mutation ratio of lipid metabolism-related genes, including LPL, APOA5, LMF1, GPIHBP1, and APOC2, are relatively high in the HTG-AP patients. The LPL p.Leu279Val is a rare and highly possible pathogenic gene mutation, which may lead to recurrent episodes of HTG-AP.

Objective To explore the application and method of World Health Organization Rehabilitation Competency Framework (RCF) in rehabilitation human resource management, and provide theoretical and practical reference for rehabilitation human resource management.Methods Based on the International Standard Classification of Occupations issued by the International Labour Organization, the application scope of RCF was systematically analyzed. The theoretical framework of rehabilitation human resource management based on RCF was constructed in combination with competency-based human resource management framework. On this basis, taking rehabilitation nurses as an example, the corresponding management methods and paths are proposed from four aspects of human resource management, including career management, recruitment and selection, training and development, and performance appraisal and salary management.Results Based on RCF, the theoretical framework of human resource management for rehabilitation nursing positions was constructed, and the main contents and processes of human resource management based on RCF were clarified from four aspects: recruitment and selection, training and development, performance appraisal and salary management, and career management. Occupational competency of rehabilitation professionals in International Standard Classification of Occupations was analyzed by RCF.Conclusion The rehabilitation competency framework constructed by WHO can be used to supplement the responsibilities of rehabilitation-related professionals in the International Standard Classification of Occupations issued by the International Labour Organization. RCF serves as a tool for practice managers and rehabilitation professionals in identifying selection criteria, learning objectives, and professional title assessment criteria. It can also be used in recruitment and selection, training and development, performance appraisal, salary management and career management in the field of rehabilitation human resource management.

Objective To explore the theory and method of performance evaluation for rehabilitation workers based on the World Health Organization Rehabilitation Competency Framework (RCF).Methods Using the theoretical framework and methods of the RCF, we analyzed rehabilitation workers' related competencies from the five dimensions, namely practice, professionalism, learning and development, management and leadership, and research, integrating core values and beliefs, competencies and behaviors, activities and tasks, and knowledge and skills, to construct a comprehensive evaluation method and pathway for rehabilitation workers' performance.Results Based on the RCF, which confirms the job competency requirements for rehabilitation workers, a multi-dimensional, multi-level and standardized performance evaluation index framework was formed. For example, performance evaluation system of physical therapists was consisted of five primary indicators and 26 secondary indicators from the combination of RCF and job standards.Conclusion The rehabilitation worker performance evaluation based on the RCF can evaluate the performance of rehabilitation workers in a scientific, standardized and comprehensive way. It analyzes the performance of rehabilitation workers in a multi-dimensional and systematic manner with the competence of rehabilitation workers as the center, and evaluates the quality and effectiveness of the performance of rehabilitation workers at different levels of proficiency, which makes the performance evaluation of rehabilitation workers more scientific and comprehensive, and enables rehabilitation workers to understand proficiency and clarify the gap, to promote rehabilitation workers to continuously improve their own level and enhance the quality of rehabilitation services.

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

Objective:To evaluate the role of long-chain non-coding RNA-lung cancer metastasis-related transcript 1/microRNA-145/Bcl-2 and adenovirus E1B19k Da interacting protein 3 (Lnc-MALAT1/miRNA-145/BNIP3) signaling pathway in sufentanil preconditioning-induced cardioprotection in rats.Methods:Rat H9C2 cells were inoculated in 6-well culture plates or flasks at a density of 1×10 6 cells/ml and divided into 5 groups ( n=30 each) using a random number table method: control group (group C), hypoxia-reoxygenation (H/R) group, sufentanil preconditioning group (S group), eukaryotic expression vector pcDNA3.0 group (pcDNA group) and pcDNA-MALAT1 group (MALAT1 group). Cells were incubated with 10 μmol/L sufentanil for 2 h, and then the H/R injury model was established in group S. In pcDNA group and MALAT1 group, cells were transfected with pcDNA3.0 and pcDNA-MALAT1, respectively, and then incubated with 10 μmol/L sufentanil for 2 h starting from 24 h after transfection, and then the H/R injury model was established.At 2 h after reoxygenation, the expression of Lnc-MALAT1, miRNA-145 and BNIP3 mRNA was detected by real-time polymerase chain reaction, the cell survival rate was detected by CCK-8, the apoptosis rate was detected by flow cytometry, the malondialdehyde (MDA) and superoxide dismutase (SOD) levels and amount of lactic dehydrogenase (LDH) released were detected, and the expression of Bcl-2, Bax and cleaved-caspase-3 was detected by Western blot. Results:Compared with group C, the survival rate was significantly decreased, apoptosis rate was increased, the MDA level and amount of LDH released were increased, SOD levels were decreased, the expression of LncRNA-MALAT1, BNIP3 mRNA, Bax, and cleaved-caspase-3 was up-regulated, and miRNA-145 and Bcl-2 expression was down-regulated in the other four groups ( P<0.05). Compared with group H/R, the cell survival rate was significantly increased, apoptosis rate was decreased, the MDA level and amount of LDH released were decreased, SOD levels were increased, the expression of LncRNA-MALAT1, BNIP3 mRNA, Bax, and cleaved-caspase-3 was down-regulated, and miRNA-145 and Bcl-2 expression was up-regulated in S and pcDNA groups ( P<0.05). Compared with group S, the survival rate was significantly decreased, apoptosis rate was increased, MDA level and amount of LDH released were increased, SOD levels were decreased, the expression of LncRNA-MALAT1, BNIP3 mRNA, Bax, and cleaved-caspase-3 was up-regulated, and miRNA-145 and Bcl-2 expression was down-regulated in group MALAT1 ( P<0.05). Conclusion:The mechanism of sufentanil preconditioning-induced cardioprotection is related to inhibiting Lnc-MALAT1/miRNA-145/BNIP3 signaling pathway in rats.

Objective To detect the changes of cellular immune level in patients with different grades of glioma in perioperative period, and to investigate its relationship with the postoperative intracranial infection. Methods A total of 53 patients with glioma newly diagnosed by pathology who underwent the surgical treatment in the First Hospital of Shanxi Medical University from September 2017 to September 2018 were collected. According to the World Health Organization (WHO) classification criteria, the patients were divided into the low-grade group (grade Ⅰ-Ⅱ, 21 cases) and the high-grade group (grade Ⅲ-Ⅳ, 32 cases). The peripheral blood at the time of 1 day before the operation, 1 day and 7 days after the operation was drawn to detect the T lymphocyte subsets, and then the differences of cell immunity indexes from different grade gliomas were analyzed. The relationship between immune level and postoperative intracranial infection was analyzed. SPSS 22.0 statistical software was used to analyze the data. Results The levels of CD3+, CD4+, CD8+, CD4+CD25+Foxp3+and CD4+/CD8+in the high-grade group at the time of 1 day before the operation were (54.09±4.25)％, (31.93±3.08)％, (34.23±2.48)％, (9.66±1.47)％, 0.93±0.06, respectively; the levels at the time of 1 day after the operation were (48.84±3.69)％, (27.49±2.41)％, (34.99±2.96)％, (11.09±1.70)％, 0.84± 0.05, respectively; the levels at the time of 7 days after the operation were (59.45 ±3.47)％, (33.59 ±2.66)％, (31.99±1.97)％, (7.45±1.48)％, 1.05±0.07, respectively. The levels of CD3+, CD4+, CD8+, CD4+CD25+Foxp3+and CD4+/CD8+in the low-grade group at the time of 1 day before the operation were (62.37±6.57)％, (34.88± 4.43)％, (30.16 ±3.75)％, (6.30 ±1.29)％, 1.16 ±0.11, respectively; the levels at the time of 1 day after the operation were (55.44 ±7.25)％, (29.05 ±4.04)％, (31.66 ±3.13)％, (7.95 ±1.67)％, 0.92 ±0.11, respectively; the levels at the time of 7 days after the operation were (67.73 ±7.18)％, (35.55 ±4.95)％, (28.10 ±3.12)％, (5.50 ± 1.25)％, 1.27±0.12, respectively. The levels of CD3+, CD4+, CD4+/CD8+before and after the operation in the high-grade group were lower than those in the low-grade group (all P< 0.05), while the levels of CD8+and CD4+CD25+Foxp3+were higher than those in the low-grade group (all P<0.05). Compared with the levels at the time of 1 day before the operation, the levels of CD3+, CD4+, CD4+/CD8+at the time of 1 day after the operation of both groups were decreased, while the levels of CD8+and CD4+CD25+Foxp3+were increased (all P< 0.05). The levels of CD3+, CD4+and CD4+/CD8+ at the time of 7 days after the operation in the both groups were increased, while the levels of CD8+ and CD4+ CD25+ Foxp3+ were decreased (all P< 0.05). Among 53 patients, 8 cases had postoperative intracranial infection, and the infection rate was 15.09％. Age, duration of surgery, pathological stage, and intraoperative blood transfusion were the independent affecting factors of postoperative intracranial infection of cerebral glioma (OR= 1.513, P= 0.024; OR= 1.722, P<0.01; OR= 1.365, P= 0.001; OR= 1.262, P< 0.01). Conclusions The peripheral blood cellular immune level of glioma patients is related with the malignancy of glioma. The inhibition degree of the cellular immunity could be relieved after the resection of glioma. The detection of T lymphocyte subsets could be considered as an evaluating index for the malignancy and prognosis in patients with glioma. The clinical detection of cellular immune can play a positive role in predicting and preventing the postoperative intracranial infection in patients with glioma.