In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

[Objective]To evaluate the efficacy of Yiqi Yangyin Quyu Prescription in the treatment of primary Sj?gren's syndrome(pSS),and study the epigenetic markers related to the efficacy of traditional Chinese medicine through whole genome bisulfate sequencing(WGBS)technology.[Methods]Fifty patients with pSS were included,including 30 in Chinese medicine group and 20 in western medicine group.Clinical information before treatment and 12 weeks after treatment was evaluated,and the therapeutic effect was analyzed.Three effective patients were selected from Chinese medicine group and their whole blood samples before and after Chinese medicine treatment were subjected to WGBS.Through methylation site analysis,gene ontology(GO)of differentially methylated genes,Kyoto Encyclopedia of Genes and Genomes(KEGG),and molecular signature database(MSigDB)enrichment analysis,efficacy-related differentially methylated genes and pathways were identified.[Results]Compared with pre-Chinese medicine treatment group,the group treated with Chinese medicine after 12 weeks showed a significant decrease in Sj?gren's syndrome disease activity index(SSDAI),erythrocyte sedimentation rate(ESR),and immunoglobulin G(IgG)level(P<0.05).Compared with pre-western medicine treatment group,the SSDAI and ESR levels in western medicine treatment group after 12 weeks decreased significantly(P<0.05).There was no statistically significant difference in SSDAI,ESR,and other indicators between the group treated with Chinese medicine after 12 weeks and the group treated with western medicine after 12 weeks(P>0.05).WGBS identified a total of 29 differentially methylated regions(DMRs),mainly concentrated at the sites of repetitive elements and protein coding genes,covering a total of 68 genes,including three RNA categories:mRNA,long noncoding RNA(lncRNA),and circRNA.Enrichment analysis suggested that the therapeutic effect was closely related to pathways such as antigen processing and presentation,interferon related pathways,and helper T cell(Th)1 and Th2 cell differentiation.[Conclusion]Yiqi Yangyin Quyu Prescription can regulate DNA methylation,thereby inhibiting the immune response in patients with pSS and exerting therapeutic effects.

Objective To investigate the prevalence and molecular features of Cryptosporidium in captive-bred Mustela putorius furo in Jiangsu Province.. Methods A total of 290 fresh stool samples were collected from a ferret farm in Jiangsu Province on May 2017, and the small subunit rRNA (SSU rRNA) gene of Cryptosporidium was amplified in stool samples using nested PCR assay. The actin, cowp and gp60 genes were amplified in positive samples and sequenced to characterize Cryptosporidium species/genotypes. Results A total of 18 stool samples were tested positive for Cryptosporidium SSU rRNA gene, with a detection rate of 6.2%. Sequence and phylogenetic analyses of SSU rRNA, actin and cowp genes characterized Cryptosporidium isolated from captive-bred ferrets as Cryptosporidium sp. ferret genotype. In addition, gp60 gene was amplified in 10 out of 18 stool samples tested positive for Cryptosporidium. Conclusions Cryptosporidium is widely prevalent in captive-bred ferrets in Jiangsu Province, and Cryptosporidium sp. ferret genotype is the only Cryptosporidium genotype in ferrets.

Neoadjuvant chemotherapy has become an indispensable weapon against high-risk resectable cancers, which benefits from tumor downstaging. However, the utility of chemotherapeutics alone as a neoadjuvant agent is incapable of generating durable therapeutic benefits to prevent postsurgical tumor metastasis and recurrence. Herein, a tactical nanomissile (TALE), equipped with a guidance system (PD-L1 monoclonal antibody), ammunition (mitoxantrone, Mit), and projectile bodies (tertiary amines modified azobenzene derivatives), is designed as a neoadjuvant chemo-immunotherapy setting, which aims at targeting tumor cells, and fast-releasing Mit owing to the intracellular azoreductase, thereby inducing immunogenic tumor cells death, and forming an in situ tumor vaccine containing damage-associated molecular patterns and multiple tumor antigen epitopes to mobilize the immune system. The formed in situ tumor vaccine can recruit and activate antigen-presenting cells, and ultimately increase the infiltration of CD8⁺ T cells while reversing the immunosuppression microenvironment. Moreover, this approach provokes a robust systemic immune response and immunological memory, as evidenced by preventing 83.3% of mice from postsurgical metastasis or recurrence in the B16-F10 tumor mouse model. Collectively, our results highlight the potential of TALE as a neoadjuvant chemo-immunotherapy paradigm that can not only debulk tumors but generate a long-term immunosurveillance to maximize the durable benefits of neoadjuvant chemotherapy.

Objective:At present, the postgraduate education of emergency medicine in China mainly relies on the internal medicine system and lacks specialty pertinence. The purpose of this study is to establish a compulsory curriculum system for professional postgraduates of emergency medicine.Methods:Modified Delphi method was used to subscribe questionnaires to experts, and the contents were mainly about medical education management and research of emergency in the affiliated teaching hospitals of Peking University. Microsoft Excel 2016 was used for double entry of questionnaire contents, and SPSS 22.0 software was used for statistics.Results:The panel was consisted of 14 experts in total and two rounds of Delphi questionnaires were completed. The response rate of the two rounds were both 100%. The authority coefficient of experts was > 0.9 and the average score of each evaluation index was 4.07-5.00 points. The coefficient of variation of each index was 0-0.22 and the Kendall coefficient of concordance was 0.07-0.10.Conclusion:As a result, a comprehensive emergency professional postgraduate curriculum system has been established.

Objective To measure the value of orthopedic physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth modified POSSUM (P-POSSUM) scoring systems in predicting operative risks in aged hip fracture patients.Methods Orthopedic POSSUM and P-POSSUM were performed to predict complication incidence and mortality for 164 aged patients operated for hip fracture.Validation of the scoring systems was tested by assessing observed to expected ratio,discrimination,and calibration.Discriminative ability and calibration of both scores were estimated using receiver operation characteristic curve (ROC) and Hosmer-Lemeshow test respectively.Results Orthopedic POSSUM score performed in predicting incidence of postoperative complications showed overall observed to expected ratio of 0.86,area under the curve of 0.82,and good calibration (H2 =3.66,df=8,P ＞ 0.05).P-POSSUM performed in predicting mortality showed overall observed to expected ratio of 0.80,area under the curve of 0.93 and good calibration (H2 =3.21,df =4,P ＞ 0.05).While orthopedic POSSUM overestimated postoperative mortality (overall observed to expected ratio =0.27).Conclusion Orthopedic POSSUM and P-POSSUM scores are respectively accurate in predicting postoperative complication incidence and mortality in aged hip fracture patients,but orthopedic POSSUM score overestimates the mortality.

According to the characteristics of our hospital,we establish a PACS/RIS system by adopting individual adaptive compartments and design,and study the net connection methods,key technique as well as the application value of the PACS/RIS system.As a result,PACS/RIS system enables the interchange of images among different models,brings about the centralized storage,the transference and process of remote images,and accomplishes the digitalization of registration and reporting.It optimizes the work flow for the radiography department.

OBJECTIVETo investigate the efficacy of allogeneic peripheral blood stem cell transplantation (PBSCT) in the treatment of severe aplastic anemia (SAA) and severe infection.

METHODSA patient with SAA and pseudomonas aeruginosa septicemia was treated with PBSCT from an HLA-identical sibling with cyclophosphamide (CY) and total body irradiation (TBI) for conditioning. The patient was infused with 20.3 x 10(8)/kg mononuclear cells including 61.0 x 10(6)/kg CD34(+) cells following the conditioning regimen.

RESULTSTwelve days after PBSCT, the absolute neutrophil count (ANC) of 1.0 x 10(9)/L was achieved, with platelet count > 50 x 10(9)/L at twenty days. The donor origin of engraftment was confirmed by polymerase chain reaction (PCR) analysis of short tandem repeats at the end of the first, sixth and twelfth month. The patient's body temperature dropped to normal level when her ANC reached 0.5 x 10(9)/L on day 10, and the bacterial culture of blood sample became negative subsequently. Symptoms and signs of acute or chronic graft versus host disease (GVHD) were not observed in 30 months after PBSCT.

CONCLUSIONSHematopoiesis was reconstituted shortly after PBSCT. The combination of CY and TBI and the infusion of sufficient peripheral blood stem cells may contribute to the successful engraftment. PBSCT may be considered as the first choice when hematopoietic stem cell transplantation is needed for SAA patients complicated with severe infection.

Adult ; Anemia, Aplastic ; immunology ; therapy ; Bacteremia ; complications ; Female ; Humans ; Peripheral Blood Stem Cell Transplantation ; methods ; Prognosis ; Pseudomonas Infections ; complications ; Transplantation, Homologous ; immunology