Objective To assess the effect of different postoperative body positions on respiratory func-tion of patients undergoing shoulder arthroscopy under general anesthesia with interscalene brachial plex-us block.Methods Seventy patients undergoing arthroscopic repair of the supraspinatus tendon were ran-domly allocated to a supine position group and a group with a 30° head elevation.Patients in both groups were in a horizontal position before anesthesia,and diaphragm movement was measured under B-ultrasound as baseline.Promptly after removal of the endotracheal tube upon arrival at the anesthe-sia recovery room,the supine group was conducted blood gas analysis,and monitored heart rate,res-piration,non-invasive arterial blood pressure and blood oxygen saturation,wearing a mask for oxygen supplementation,while the group with a 30° head elevation was given identical nursing procedures af-ter the bed's head was elevated 30°.Then right after entering the anesthesia recovery room,as well as 5 and 15 minutes after deoxygenation,the oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO2)and percutaneous oxygen saturation(SpO2)were recorded and compared between the two groups.Moreover,the diaphragmatic movements during deep breathing before nerve block and pri-or to discharge from the anesthesia recovery room were measured,and such adverse reactions as hypox-emia,labored breathing and glossoptosis were observed.Results Compared with the supine position group,a significant increase in the average PaO2 and SpO2 15 minutes after deoxygenation,diaphrag-matic movement during deep breathing and comfort was observed in the group with a 30° head eleva-tion,but a significant decrease in the incidence of postoperative laboured breathing and glossoptosis.However,no significant differences were found between the two groups in the incidence of hypoxemia and the average PaO2,PaCO2 and SpO2 immediately after entering the anesthesia recovery room and 5 minutes after deoxygenation.Conclusion Elevating the head of the bed by 30° enhances respiratory function in patients undergoing shoulder surgery with general anesthesia intubation and intermuscular groove brachial plexus block,compared to the supine position.Although no significant reduction in hy-poxemia incidence is observed,there is a notable relief of adverse reactions such as laboured breath-ing and glossoptosis,which makes patients feel more comfortable.Therefore,such posture care is wor-thy of application in clinical practice.

Objective To investigate the role of nuclear factor-κB(NF-κB)/NOD-like receptors family pyrin domain containing 3(NLRP3)pathway in limb ischemia-reperfusion injury(IRI)pretreated with ulinastatin(UTI).Methods Twenty-one SD rats were randomly divided into Sham group,IRI group,UTI group.In UTI group,ulinastatin was injected after anesthesia.After 10 minutes,the animal model was established by claming the femoral artery and ligaturing collateral circulation.After 3h of ischemia,the clamp and tourniquet were removed and the rats underwent 2h of reperfusion.In the other groups,the homologous saline was also injected in the same time.Plasma concentrations of lactate dehydrogenase(LDH)and creatine kinase(CK),interleukin(IL)-6,IL-18,tumor necrosis factor-α(TNF-α)were measured.The gastrocnemius muscle was harvested and immediately stored at-80℃.NF-κB and NLRP3 were detected by Western blot and PCR.The other section muscle was stored in triformol for HE staining.The wet/dry was also immediately detecting.Results The level of wet/dry,LDH,CK,IL-6,IL-18,TNF-α,NF-κB,NLRP3 IRI were higher than those in Sham group(P＜0.05).The level of wet/dry,LDH,CK,IL-6,IL-18,TNF-α,NF-κB,NLRP3 IRI were significantly lower than those in IRI group(P＜0.05).Conclusion Ulinastatin can reduce the cellular inflammatory response through the NF-κB/NLRP3 pathway,thereby achieving a protective effect on limb IRI in rats.

The clinical data of 69 patients with non-HIV-related cryptococcal meningitis admitted in the Second Hospital of Hebei Medical University from January 2013 to May 2019 were analyzed retrospectively.The main presentations of 69 patients are headache,fever,nausea,vomiting, visual impairment, hearing damage.Among them, 36 cases (52%) had underlying diseases, 30 cases (43%) were misdiagnosed, and 38 cases (55%) were complicated with high intracranial pressure. Cerebrospinal fluid examination showed that leukocytes increased in 47 cases, protein increased in 55 cases, chloride decreased in 41 cases, glucose decreased in 34 cases. The imaging findings were cerebral ischemia, hydrocephalus, meningeal or cerebral parenchyma enhancement. During the induction period, 63 cases were treated with combined antifungal drugs and 6 cases were treated with single antifungal drugs. The clinical symptoms were improved in 54 cases, 9 cases were discharged automatically and 6 cases died. The clinical manifestations, routine and biochemical examination of cerebrospinal fluid, imaging findings are not specific for patients with non-HIV-related cryptococcal meningitis.So early and multiple lumbar puncture should be performed to find etiological evidence to reduce misdiagnosis. The combination of antifungal drugs during the induction period is safe and effective.

Bombyx mori is a lepidopteran insect with important economic value. Bombyx mori nucleopolyhedrovirus (BmNPV) causes huge economic loss to silkworm industry in China every year. The objective of this study is to determine the anti-BmNPV mechanism of Bombyx mori strain NC99R, and to provide a basis for understanding the molecular mechanism of the silkworm resistance strain. The normal control Dazao (DZ) strain and the NC99R resistant strain were fed with occlusion bodies (OB). The median lethal dose (LD50) analysis of the DZ and NC99R showed that the LD50 of DZ was 1.2×10⁵ OBs/larva, while NC99R was 1.8×10⁶ OBs/larva. The LD50 of the NC99R was about 15 times higher than the DZ. The mortality of DZ and NC99R were analyzed, which were fed with 1×10⁶ OBs/larva and injection with 1×10⁶ BVs/larva. The results showed that the death peak of DZ was concentrated in the 4th to 6th day. And the death peak of NC99R was concentrated in the 6th to 8th day, with a delay of 1-2 days compared with the control. The BmNPV DNA copy number showed that the BmNPV genome in DZ proliferated rapidly. The copy number of BmNPV DNA in NC99R were increased slowly after oral infection and body injection. HE staining showed that midgut tissue has no significant difference between DZ and NC99R in the early stage of oral infection. At 96 h p.i., the nucleus of DZ midgut became larger and shedding. The NC99R had enlarged nuclei, but the cells were still arranged neatly. Finally, the expression of virus genes in different periods were analyzed by RT-PCR. The results indicated that the immediate early gene ie-1 expression levels began to down-regulate after 24 h p.i.. The early, late, and extremely late genes were also down-regulated, and finally maintained at a lower expression level.

Objective: To understand the current situation of toilet facilities among rural primary schools and toilet-using behavior among primary students,and to provide a reference for improving school environment. Methods: Totally 149 students in 2 rural non-boarding primary schools in northern China were selected. and on-site observation and questionnaire survey were used to obtain the current situation of toilet hygiene, toilet time and toilet behavior, as well as feelings towards school toilet. The results of the survey were statistically analyzed by using SAS 9.4. Methods: Both two schools were deep pit latrine, the number of pit in female toilets is lower than the requirements of the “Code for design of school”, and the urinal trough and the number of pit in male toilet meet the standard requirements. The average total time of toilet-using was (28.46±11.72)s for boys and (42.48±15.52)s for girls, the difference was of significant difference (t=-7.96, P<0.01). The average actual time of toilet-using is (24.27±9.13)s for boys and (24.69±9.40)s for girls, with no statistical difference. The result showed that school 2 was better than school 1 in the behavior of urinating frequency in toilet, queuing when using toilet, and the way to express needs of toilet-using in class(χ2=11.70,27.19,17.74,P<0.05); senior students use less toilets than lower grade students. The main complains for students in school toilet hygiene is its bad smell(χ2=5.28，13.18，P<0.05). Conclusion Primary school students in northern China always take bathroom breaks in the morning, and the average time of toilet-using is different from that of adults. Senior students are more willing to express their toilet needs than lower grade students. Students are not satisfied with the hygiene of school toilets, and the toilet experience is poor.

Objective To investigate nutritional knowledge,attitude,and practice (K-A-P) of medical staff in the nerve-related departments in Hebei province,with the aim of determining a basis for the effective education of nutrition.Methods A multicenter,observational study was utilized to conduct a questionnaire survey.642 medical staff in nerve-related departments from 15 hospitals in 11 prefecture level cities was surveyed from September 2016 to March 2017 in Hebei Province.Results were statistically analyzed.Results The overall scores of nutrition knowledge,attitude,and practice were 34.88±22.90,69.14± 16.75 and 42.86± 18.22,respectively.There were positive correlations between nutrition knowledge and attitude (r=0.150,P＜ 0.001),knowledge and practice (r=0.152,P＜0.001),and attitude and practice (r =0.432,P＜0.001).The nutrition knowledge score of male medical staff was higher than that of female (t =3.546,P＜0.01) however,there was no significant difference between males and females in nutrition attitude and practice scores (t =0.685,P=0.494;t=1.649,P=0.091).In addition,the nutrition knowledge scores of physicians and medical technicians were significantly higher than that of nurses (F=46.89,P＜0.01) while the nutrition practice scores of physicians were significantly higher than both medical technicians and nurses (F=7.85,P＜0.01).It was also found that nutrition attitude scores of senior and secondary medical staff were higher than junior medical staff (F=5.116,P=0.002) and nutrition practice scores of senior and secondary senior medical staff were higher than that of junior medical staff (F=4.074,P=0.007).Furthermore,it was found that nutrition knoledge scores of undergraduate,master and doctoral degree staff were higher than that of junior college staff (F=15.617,P＜0.001) and nutrition attitude score of undergraduate and master degree staff were significantly higher than that of junior college staff (F =4.11,P =0.003).It was also found that the nutrition knowledge scores of medical staff with less than 5 years of work experience were significantly higher than those with more than 5 years of work experience (F=3.312,P =0.02).However,the scores of nutrition attitude of medical staff with more than 15 years of work experience were significantly higher than those with less than 15 years of work experience (F=6.356,P＜0.001) and the scores of nutrition practice of medical staff with 10-15 years of work experience were higher than that of less than 5 years and 5-10 years of work experience (F=2.959,P=0.032).It was also identified that the top three ways to obtain nutrition knowledge were learning at work (68.85％),learning at university (68.69％) and reading books and journals (57.79％).Conclusion The medical staff of nerve-related departments in Hebei province has positive attitudes towards nutrition treatments.However,their mastery of nutritional knowledge and practice could and should be improved further.Therefore,it is necessary to strengthen the nutrition education for medical staff of the nerve profession.

Objective To evaluate the efficacy of early controlled cold atomization inhalation of budesonide in the treatment of post-operative sore throat (POST) after double-lumen endotracheal intubation. Methods A total of 105 ASAⅠ~Ⅲpatients having POST after thoracic surgery with double-lumen endotracheal intubation were randomly divided into three groups(n = 35 each). The patients in the control group were treated with atomization inhalation of 12 mL 20℃saline(Group C)and those in the observation groups were treated with 10 mL 20℃saline plus 2 mL(1 mg)budesonide(Group R)or 10 mL 0℃saline plus 2 mL(1 mg)budesonide (Group L)for 15 minutes immediately after extubation. The 4-score scale was used to evaluate sore throat,dry throat,hoarseness and swallowing difficulty 1,2,6 and 24 h after the extubation and QoR-40 scale to assess post-operative recovery at 24 h. Results The scores of sore throat and dry throat were significant lower in group L than those in group C(P < 0.05)at 1,2 and 24 h and the score of swallowing difficulty(dysphagia)was also signifi-cant relieved at 1,6 and 24 h after the extubation in group L. Furthermore,the score of sore throat was significant lower in group L than that in group R(P<0.05)at 1 h. There were no significant differences of hoarseness in three groups(P > 0.05). The total score of QoR-40 scale was the significantly highest in group L than that in group C and group R(P<0.05)24 h postoperatively. Conclusion Cold atomization inhalation of budesonide immediately after the extubation of double-lumen endotracheal can alleviate POST and bring more benefits to patients which help to enhance the recovery after throracic surgery.

Objective To investigate the global level of histone 4 lysine 20 monomethylation (H4K20me1) and expression of base excision repair related mRNA in coal-burning-borne endemic arsenism patients and to analyze its relationship with DNA damage,in order to provide a scientific basis in deepening the interpretation of the role of arsenic in inhibiting repair of DNA damage.Methods In 2014,47 hair samples,blood samples and skin tissue samples of the cases in Xingren County Guizhou Province were collected from the voluntary surgical treatment patients with endemic arsenism (15 general pathological change cases,14 precancerous cases and 18 cancerous cases) and 12 controls.The hair arsenic content was tested via the inductively coupled plasma-mass spectrometry method.The expression of histone H4K20me1 in skin tissues was detected via the immunohistochemistry method;quantitative real-time polymerase chain reaction was used to detect the mRNA levels of poly (ADP-ribose) polymerase (PARP1),N-methylation of purine-DNA-glycosylation (MPG) and X-ray repair cross complementary gene 1 (XRCC1);and DNA damage in peripheral blood was detected by single cell gel electrophoresis test,the level of H4K20me1 in peripheral blood cells was detected by using a sandwich enzyme-linked immunosorbent assay.Results Compared with the control group [median (25 ～ 75 percentile):0.15 (0.07-0.23) μg/L],the hair arsenic content in the case group [0.34 (0.17-0.51) μg/L] was significantly increased (Z =6.037,P ＜ 0.05).Compared with the control group (0.32 ± 0.13,0.17 ± 0.12),the modification level of H4K20me1 in peripheral blood with cancerous group (0.62 ± 0.11) was significantly increased,the modification levels of H4K20me1 (0.54 ± 0.20,0.83 ± 0.10) in skin tissues were increased in the precancerous group and cancerous group (P ＜ 0.05).Compared with the control group [0.95 (0.50-1.49),1.12 (0.98-1.48),0.96 (0.67-1.17)],the mRNA expression levels of PARP1 and MPG in cancerous group [0.37 (0.30-0.44),0.38 (0.15-0.48)] were significantly decreased;the mRNA expression levels of XRCC1 [0.48 (0.38-0.89),0.32 (0.20-0.55)] were significantly decreased in the precancerous group and cancerous group (P ＜ 0.05).Compared with the control group (1.19 ± 0.55,1.27 ± 0.51),Tail DNA％ and Tail moment were significantly increased in the general pathological change group (6.49 ± 0.98,6.60 ± 1.11),the precancerous lesion group (11.22 ± 1.40,10.07 ± 1.11),and the cancerous group (20.38 ± 1.72,27.01 ± 1.78,P ＜ 0.05).There was a positive correlation between the degree of skin lesion and modification level of H4K20me1 in peripheral blood and skin tissues and DNA damage levels (TailDNA％,OTM,r =0.885,0.855,0.806,0.883,P ＜ 0.05).There was a positive correlation between modification level of H4K20me1 in peripheral blood and level of DNA damage (TailDNA％,OTM),the level of H4K20me1 protein expression in skin (r =0.535,0.804,0.754,P ＜ 0.05),and a negative correlation with mRNA expression of MPG,XRCC1 and PARP1 (r =-0.563,-0.514,-0.550,P ＜ 0.05).There was a positive correlation between the modification level of H4K20me1 in skin and DNA damage levels (TailDNA％,OTM,r =0.602,0.875,P ＜ 0.05),and a negative correlation with mRNA expression of MPG,XRCC1 and PARP1 (r =-0.492,-0.502,-0.552,P ＜ 0.05).Conclusion The arsenic pollution of coal burning may affect the level of H4K20me1 modification,inhibit mRNA transcriptional expression of PARP1,MPG and XRCC1 genes related with base excision repair,which may lead to increased DNA damage and participate in the occurrence and development of arsenic poisoning skin lesions.

Objective: To study the biomechanical property and histocompatibility of acellular porcine fascia so as to supply a new substitute material for tissue repair. Methods: Samples of normal porcine fascia, acellular porcine fascia and normal human fascia were prepared for histological and biomechanical examination. Xenogeneic fresh porcine fascia, acellular porcine fascia and allogeneic rabbit fascia were implanted into the back of rabbit. Tissues were taken for HE staining and histocompatibility test. Results: Histological examination showed that the cellular components which elicit immune rejections had been removed in the acellular porcine fasciam, with the complete extracellular matrix reserved. Arrangement of collagen fiber was loose in the acellular porcine fascia. The biomechanical performance test of the three samples showed that there was no significant difference in the extreme tensile strength (4.47±0.54) MPa, (4.49±0.91) MPa, (4.79±1.35) MPa for acellular porcine fascia, normal porcine fascia and normal human fascia respecively, P>0.05). There was no significant difference between acellular porcine fascia extracellular matrix and porcine fascia with the cell in breaking elongation (501.83%±52.01%, 661.17%±200.28%, P>0.05). However, there was a significant difference in the breaking elongation between human fascia (98.08%±26.02%)and the other 2 kinds of porcine fascia (P<0.01). Histocompatibility test showed the local reactions of the acellular porcine fascia group were weaker than the normal porcine fascia group. Conclusions With sound preparativemethod, the acellular porcine fascia has good biomechanical property and histocompatibility and may serve as a good alternative material for tissue repair.

Objective To investigate the parameters of diffusion?weighted magnetic resonance imaging ( DWMRI) for prediction of the efficacy of chemoradiotherapy ( CRT) for esophageal squamous cell carcinoma ( ESCC) , to determine the optimal time point and threshold for prediction, and to provide a basis for clinical practice. Methods From 2010 to 2011, 38 patients with ESCC were consecutively enrolled as subjects. All patients received three?dimensional conformal radiotherapy with 60 Gy in 30 fractions for 6 weeks. They also received concurrent or consolidation chemotherapy ( FP or TP scheme ) as adjuvant treatment. Patients received DWMRI scans before radiotherapy and at weeks 1?6 during radiotherapy. The apparent diffusion coefficient ( ADC ) values and tumor lengths obtained from serial DWMRI scans were recorded and analyzed. Comparison was made by paired t test. Repeated measurements were analyzed by analysis of variance ( ANOVA) and multivariate ANOVA. The prognosis was predicted by the Logistic model. The effectiveness analysis and threshold screening were performed using the receiver operating characteristic (ROC) curve. Results In all patients, 20(52?6%) had complete response (CR) and 18(47?4%) had partial response ( PR) . There were no significant differences in the ADC values before radiotherapy and at weeks 1?6 during radiotherapy between patients with CR and PR ( 1?82 vs. 1?42;1?92 vs. 1?49;2?06 vs. 1?67;2?35 vs. 1?79;2?62 vs. 2?11;2?71 vs. 2?18;2?96 vs. 2?28×10-3 mm2/s;P=0?006,0?003,0?012, 0?001,0?003,0?008,0?002) . The ADC value at third week during radiotherapy was the only independent prognostic factor for short?term treatment outcomes in patients with ESCC ( OR=0?134, P=0?007) . These results were also supported by the multivariate ANOVA analyses. The analysis of the ROC curve showed that at the third week during radiotherapy, the area under the ADC curve was the largest ( A z=0?857) and the diagnostic effectiveness was the best;the threshold value, sensitivity, and specificity were 2?02×10-3 mm2/s, 80?0%, and 92?9%, respectively. Eight patients who had tumor out of control or recurrence within 1 year after treatment had the ADC curve fall down at the end of the fifth week and the reduction of tumor length substantially slow down from the fifth week. Conclusions DWMRI is an effective imaging approach for monitoring tumor response to CRT in patients with ESCC. The ADC value at the end of the third week during radiotherapy may be the optimal time point for prediction of treatment outcomes. The reduction in the ADC value or non?reduction in tumor length at the end of the treatment indicates a high risk of recurrence.