Objective:To investigate the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury.Methods:This study was a retrospective case series research. From January 2015 to December 2020, 220 patients with severe burns and inhalation injury meeting the inclusion criteria were admitted to 7 burn treatment centers in China, including 13 cases in the Fourth People's Hospital of Dalian, 26 cases in the First Affiliated Hospital of Naval Medical University, 73 cases in Guangzhou Red Cross Hospital of Jinan University, 21 cases in the 924 th Hospital of PLA, 30 cases in the First Affiliated Hospital of Jiangxi Medical College of Nanchang University, 30 cases in Tongren Hospital of Wuhan University & Wuhan Third Hospital, and 27 cases in Zhengzhou First People's Hospital. There were 163 males and 57 females, and their ages ranged from 18 to 91 years. The patients were divided into survival group and death group according to the survival within 28 d post injury. The following data of patients in the 2 groups were collected, including basic information (gender, age, body weight, body temperature, etc.), the injury characteristics (total burn area, post-injury admission time, etc.), the underlying diseases, the post-injury fluid resuscitation condition (infusion rate and ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, etc.), the results of laboratory tests on admission (blood urea nitrogen, blood creatinine, albumin, pH value, base excess, blood lactate, oxygenation index, etc.), and treatment condition (inhaled oxygen volume fraction, hospitalization day, renal replacement therapy, etc.). After adjusting covariates using univariate Cox regression analysis, the multivariate Cox regression analysis was performed to evaluate the impact of infusion rate in the first 24 h post injury on patient death. The receiver operator characteristic curve for the infusion rate in the first 24 h post injury to predict the risk of death was plotted, and the maximum Youden index was calculated. Patients were divided into 2 groups according to the cutoff value (2.03 mL·kg -1·% total body surface area (TBSA) -1) for predicting risk of death by the infusion rate in the first 24 h post injury determined by the maximum Youden index, and the risk of death was compared between the 2 groups. The correlation between the previously mentioned clinical data and the infusion rate in the first 24 h post injury was analyzed; after the univariate linear regression analysis was used to screen the independent variables, the multivariate linear regression analysis was performed to screen the independent influential factors on the infusion rate in the first 24 h post injury. Results:Compared with those in survival group, patients in death group had significantly higher age and total burn area (with Z values of 12.08 and 23.71, respectively, P<0.05), the infusion rate in the first 24 h post injury, inhaled oxygen volume fraction, and blood urea nitrogen, blood creatinine, blood lactic acid on admission (with Z values of 7.99, 4.01, 11.76, 23.24, and 5.97, respectively, P<0.05), and the proportion of patients treated with renal replacement therapy ( P<0.05) were significantly higher, the albumin, pH value, and base excess on admission were significantly lower ( t=2.72, with Z values of 8.18 and 9.70, respectively, P<0.05), and the hospitalization day was significantly reduced ( Z=85.47, P<0.05). After adjusting covariates, the infusion rate in the first 24 h post injury was the independent influential factor on death (with standardized hazard ratio of 1.69, 95% confidence interval of 1.21-2.37, P<0.05). Patients in infusion rate ≥2.03 mL·kg -1·%TBSA -1 group had a significantly higher risk of death than those in infusion rate <2.03 mL·kg -1·% TBSA -1 group (with hazard ratio of 3.47, 95% confidence interval of 1.48-8.13, P<0.05). There was a significant correlation between total burn area, body weight, inhaled oxygen volume fraction, body temperature, post-injury admission time, the ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, and oxygenation index <300 on admission and the infusion rate in the first 24 h post injury (with r values of -0.192, -0.215, 0.137, -0.162, -0.252, and 0.314, respectively, Z=4.48, P<0.05). After screening the independent variables, total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent influential factors on the infusion rate in the first 24 h post injury (with standardized β values of -0.22, -0.22, -0.19, and 0.46, respectively, 95% confidence intervals of -0.34 to 0.09, -0.34 to 0.10, -0.32 to 0.06, and 0.22 to 0.71, respectively, P<0.05). Conclusions:The infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury is the independent factor of influencing death, and patients with infusion rate ≥2.03 mL·kg -1·%TBSA -1 in the first 24 h post injury have a significantly increased risk of death. The total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent factors of influencing the infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury.

Pancreatic cancer induced by mutation KRAS exhibited a higher risk of incidence, recurrence and mortality. C-Myc is downstream of KRAS and can be involved in the regulation of multiple oncogenic pathways and signaling pathways in pancreatic cancer. Over expressing of C-Myc promotes glycolysis and glutamine uptake in pancreatic cancer cells, promotes cell metabolism and proliferation, is an important factor driving the progress and maintenance of pancreatic cancer, and is related to chemotherapy and immunotherapy drug resistance. C-Myc also interacts with cell cyclin-dependent kinase(CDK) and non-coding RNA to regulate the proliferation, development and metastasis of pancreatic cancer. Therefore, targeting C-Myc was regarded as an effective strategy for the treatment of pancreatic cancer. The activation of C-Myc depends on heterodimerization with its partner MAX and thereby paly a role through binding to the canonical E-Box sequence 5’-CACGTG-3’. Researches showed direct targeting of C-Myc can inhibit the growth of pancreatic carcinoma,such as promoting the degradation of C-Myc, inhibiting the binding of C-Myc/MAX and blocking the binding of C-Myc/MAX to E-box. However, direct targeting has been proved challenging because of its special protein structure. Indirect targeting of C-Myc provided a new strategy for the treatment of pancreatic cancer. C-Myc can be indirected targeting through inhibiting transcription and translation of C-Myc, C-Myc-MAX heterodimerization and promote the ubiquitination and degradation of C-Myc, thus affects the occurrence, development and metastasis of pancreatic cancer.

Objective:To translate the perceived stressors in intensive care units Scale into Chinese version,and to validate its validity and reliability and in intensive healthcare professionals.Methods:The Perceived Stressors in Intensive Care Units Scale was translated according to the Brislin translation model.After cultural adjustment,495 ICU healthcare professionals were selected to evaluate the validity and reliability of the scale,and univariate analysis was conducted on the scores of the Scale with different characteristics.Results:The Chinese version of the scale re-tained 40 items,and 6 common factors were extracted after exploratory factor analysis.The cumulative variance contribution rate reached 58.21％.Confirmatory factor analysis showed a basic fit of the model(x2/df=2.85,CFI=0.93,TLI=0.93,RMSEA=0.09).The total Cronbach coefficient of the scale was 0.940 and the split-half relia-bility was 0.87.The retest reliability after 2 weeks was 0.92.The item-level content validity index of the Chinese version of The Perceived Stressors in Intensive Care Units Scale was 0.83～1.00,the scale-level content validity index was 0.93,and the average content validity was 0.98.Comparison of the total scores of scale among ICU healthcare professionals with different occupations,professional titles,marital status and working years showed sta-tistically significant differences(P＜0.05).Conclusion:The Chinese version of the Perceived Stressors in Intensive Care Units Scale is proved to be a good instrument with acceptable validity and reliability.

Objective To evaluate the impact of different dosing times of doxycycline(DOX)on children with macrolide-resistant Mycoplasma pneumoniae pneumonia(MR-MPP).Methods Clinical data of children diagnosed with MR-MPP at Hangzhou Children's Hospital from January 2022 to December 2023 were analyzed.Children were divided into three groups based on treatment regimens:the doxycycline(DOX)group,the intravenous azithromycin converted to oral DOX(ATD)group,and the intravenous azithromycin alone(AZI)group..The ATD group was further divided into ATD1 group(＜3 days)and ATD2 group(＞3 days)according to the duration of azithromycin treatment.Clinical symptoms of each group were compared,and propensity score matching(PSM)analysis was used for adjustment.Results A total of 156 children with MR-MPP were included in the study,with 25 in the DOX group,85 in the ATD group,and 46 in the AZI group.Compared with the ATD and AZI groups,the DOX group had a shorter hospital stay and fever duration,higher chest radiograph improvement rate,and lower glucocorticoid usage rate(P＜0.05).The DOX group and ATD1 group had lower hospital stays,post-treatment fever durations,and glucocorticoid usage rates than the ATD2 group,and higher 96-hour fever resolution rates and chest X-ray improvement rates than the ATD2 group(P＜0.05).The DOX group had a higher fever resolution rate within 72 hours compared to the ATD1 and ATD2 groups(P＜0.05).PSM analysis showed that the DOX-ATD1 group had a lower hospital stay,post-treatment fever duration,and glucocorticoid usage rate than the ATD2 group,and a higher 72-hour fever resolution rate than the ATD2 group(all P＜0.05).No adverse reactions related to DOX were observed during the treatment period.Conclusion Early oral administration of DOX within 72 hours can significantly improve the clinical efficacy in children with MR-MPP.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective To understand the pathological role of nitric oxide synthase 2 (NOS2) in rat allograft vascular lesions and the effects of triptolide.Methods The abdominal aorta transplantation between Wistar and SD rats was used as an animal model.Three groups were set up..the same genome group (group A),the allogeneic control group (group B),and the isogene Triptolide group (group C).The grafts were removed at 7th,28th,and 56th day after surgery.The transplant artery intima thickness was measured.The irnmunohistochemical staining was applied to observe the NOS2 expression in the vascular tissue layers.The integral optical density value in each group was calculated.Results The arterial intima of transplants at 28th and 56th day postoperation was thickened,and that was thickest in group C among the three groups (P＜0.05).There was significant difference in intima thickness and integral optical density between group C with groups A and B (P＜ 0.05).The expression of NOS2 was strongest in group B,and that in group C was significantly weaker than that in group B (P ＜ 0.05).Conclusion Triptolide is capable of slowing down the progression of graft vascular disease by inhibiting the expression of NOS2.

Objective To establish the chromatographic fingerprint of mushroom polysaccharides by 1-phenyl-3-methyl-5-pyrazolone( PMP) pre-column derivatization. Methods The mushroom polysaccharides was extracted by hot distilled water, precipitated by alcohol, and hydrolyzed into monosaccharides by Trifluoroacetic Acid (TFA). The hydrolysate was derivatized with 1-phenyl-3-methyl-5-pyrazolone ( PMP ) and tested via HPLC to study the monosaccharide components in mushroom polysaccharides. Results Fingerprint was established with 13 common peaks, 6 peaks in which were identified as mannose, D-glucuronic acid, D-glucose, galactose, xylose and L-fucose. The glucose accounted for the most, followed by mannose, galactose and fucose. Conclusion Development of fingerprint chromatogram by HPLC is a stable, simple, and repeatable way, which can be applied to the quality control of mushroom polysaccharides.

Objective By collecting and analyzing the laryngeal cancer related genes and the miRNAs,to build a comprehensive laryngeal cancer-related gene database,which differs from the current biological information database with complex and clumsy structure and focuses on the theme of gene and miRNA,and it could make the research and teaching more convenient and efficient.Methods Based on the B/S architecture,using Apache as a Web server,MySQL as coding language of database design and PHP as coding language of web design,a comprehensive database for laryngeal cancer-related genes was established,providing with the gene tables,protein tables,miRNA tables and clinical information tables of the patients with laryngeal cancer.Results The established database containsed 207 laryngeal cancer related genes,243 proteins,26 miRNAs,and their particular information such as mutations,methylations,diversified expressions,and the empirical references of laryngeal cancer relevant molecules.The database could be accessed and operated via the Internet,by which browsing and retrieval of the information were performed.The database were maintained and updated regularly.Conclusion The database for laryngeal cancer related genes is resource-integrated and user-friendly,providing a genetic information query tool for the study of laryngeal cancer.

Objective To investigate the phacoemulsification combined with trabeculectomy in glaucoma complicated with cataract treatment clinical curative effect.Methods 72 cases of glaucoma patients with cataract were randomly divided into the combined group and control group with 36 cases in each group,the combined group using phacoemulsification and trabeculectomy in the treatment,while the control group was treated with trabeculecto-my,combined group and control differences in visual acuity,intraocular pressure,anterior chamber depth and postoper-ative complications of patients were compared.Results After treatment,the two groups of intraocular pressure ( list the concrete data ) , anterior chamber depth ( list the concrete data ) were ( list the concrete data ) significantly improved (t=2.98,3.06,15.21,5.17,all P<0.05).In addition,the intraocular pressure after the operation of the combination group (10.65 ±1.58) mmHg,anterior chamber depth (2.41 ±0.81) mm compared with the control group after obvious difference (t=4.98,3.22,all P<0.05).In 1 weeks after operation,1 months and 3 months com-bined group's vision is significantly superior to the control group (t=2.87,3.38,4.01,all P<0.05).The incidence of complications of operation united group ( 11.11%) was significantly lower than the control group ( 25.00%) (χ2 =3.98,P<0.05).Conclusion Compared with the traditional method,phacoemulsification and trabeculectomy for glaucoma and cataract treatment has obvious curative effect,low incidence of adverse reactions,postoperative IOP control satisfaction,faster visual recovery characteristics,deserves generalization and application.

Objective To design a quantitative criterion and grading system for injury from adverse drug reaction (ADR) in order to serve the compensation system of injury from ADR. Methods Based on the other grading system of injury cases, the independent scores and serial grades were given to the ADR injury of different organs or different levels through two turns of consultation to 27 experts from Shanghai. Results Injury from ADR was graded from stage 1 to stage 10 according to the damage degree, with 1 stand for death and 10 for slightest injury. Conclusion The grading method of ADR based on the characteristics of injury accords with the condition of China, and can provide reference for making up the compensation system of ADR injury.