Objective    To analyze the surgical efficacy and influencing factors of myasthenia gravis (MG) patients with thymic atrophy after thymectomy. Methods    The clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed. Results    A total of 71 patients were collected, including 40 males and 31 females with a mean age of 45.17±12.42 years. All patients received the surgery successfully. After the surgery, 20 (28.17%) patients were stable remission, 12 (16.90%) patients were minimal manifestation status,19 (26.76%) patients were improved, 5 (7.04%) patients showed no change, 3 (4.23%) patients were worsened, 10 (14.08%) patients were exacerbated and 2 (2.82%) patients were dead. Multivariate logistic regression analysis showed that the preoperative illness duration (OR=4.61, 95%CI 1.13-18.85, P=0.03), and postoperative pyridostigmine combined with immunosuppressive (OR=0.12, 95%CI 0.03-0.45, P=0.00) were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy. Conclusion    Early surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.

Objective To systematically review the efficacy of different artificial liver support systems in the treatment of acute-on-chronic liver failure (ACLF) using a network Meta-analysis. Methods PubMed, Embase, the Cochrane library, Clinical Trial, CNKI, SinoMed, and Wanfang Data were searched for randomized controlled trials (RCTs) on different artificial liver support systems in the treatment of ACLF. Literature screening, data extraction, and method ological quality assessment were performed according to inclusion and exclusion criteria, and Stata15.1 software and R4.1.0 software were used to perform a network Meta-analysis. Results A total of 14 RCTs were included, with 1141 patients in total. The network meta-analysis showed different intervention methods had no significant difference in reducing mortality rate based on cross comparison (all P > 0.05). The probability ranking diagram showed that plasma exchange (PE) showed the best effect in reducing 30-day mortality rate, followed by extracorporeal liver assist device (ELAD), fractionated plasma separation and adsorption with Prometheus system, molecular adsorbent recirculating system (MARS), Biologic-DT liver dialysis device, and PE+MARS. PE showed the best effect in reducing 90-day mortality rate, followed by Prometheus, ELAD, and MARS. Biologic-DT showed the best effect in improving hepatic encephalopathy, followed by MARS, PE+MARS, and ELAD. Patients undergoing ELAD had the lowest risk of bleeding, and compared with standard medical treatment, Biologic-DT might increase the risk of bleeding [risk ratio=1.9×10 8 , 95% confidence interval: (4.6-6.2)×10 27 ]. Conclusion PE might be the best option for reducing 30- and 90-day mortality rates in ACLF patients. Biologic-DT has a better effect in improving hepatic encephalopathy, but it may increase the risk of bleeding.

Objective:To investigate the infection rate in close contacts of COVID-19 patients before and after the last negative nucleic acid test, evaluate the effect of dynamic nucleic acid test in determining the infectivity of COVID-19 patients.Methods:Dynamic nucleic acid test results of COVID-19 cases were collected in a retrospective cohort study. COVID-19 cases with negative nucleic acid test results before their first positive nucleic acid tests were selected as study subjects. Close contacts of the index cases and the secondary close contacts were kept isolation for medical observation to assess their risk of infection.Results:This study included 89 confirmed cases from two local COVID-19 epidemics in Ningbo. A total of 5 609 close contacts were surveyed, the overall infection rate was 0.20%. No close contacts of the COVID-19 cases before the last negative nucleic acid test were infected, and the infection rate in the close contacts of the COVID-19 cases after the last negative nucleic acid test was 1.33%, all of these close contacts lived together with the index cases. No secondary close contacts were infected.Conclusion:COVID-19 patient becomes infectious after the last nucleic acid is negative, and has no infectivity before the last nucleic acid negative.

Objective To investigate the changes in CB1R expression in various regions of the hippocampus of rats at different time points after status epilepticus.Methods Use lithium chloride-pilocarpine to induce status epilepticus（SE）in rats.At 1 w，2 w，3 w，and 4 w after SE，rat hippocampal slices were taken，and the cannabinoid type 1 receptor （CB1R） immunohistochemical staining was performed to measure the CA1 stratum radiatum，CA-3 stratum lucidum，and stratum moleculare CB1R mean integrated optical density value（MIOD），all values are statistically analyzed. At the same time，hippocampal slices were taken 4 w after SE and stained with NeuN and GFAP to observe the changes of hippocampal neurons and astrocytes.Results In the stratum radiatum of hippocampal CA-1 area，the expression of CB1R at each time point after SE was higher than that of the control（P<0.05），and the expression of CB1R 4 w after SE was higher than 1 w，2 w，3 w after SE （P<0.05）；In the stratum lucidum of hippocampal CA-3 area，the expression of CB1R at each time point after SE was higher than that of the control （P<0.05），and the expression of CB1R 4W after SE was higher than 1 w after SE （P<0.05）；In the hippocampus stratum moleculare，the expression of CB1R at each time point after SE was higher than that of the control（P<0.05），but the expression of CB1R was not statistically different between 1 w，2 w，3 w，and 4 w after SE （P>0.05）. Neurons in the stratum pyramidale of the hippocampal CA-1 area were significantly lost，and astrocytes proliferated and enlarged 4 w after SE.Conclusion Rats had the characteristics of sclerotic hippocampus at 4 w after SE. After SE，the expression of CB1R in stratum radiatum of CA1 area，stratum lucidum of CA3 area，and stratum moleculare of the rat hippocampus increased. In the CA1 area’s stratum radiatum and CA3 area’s stratum lucidum CB1R increased most significantly at 4 w after SE.The stratum moleculare CB1R increased at 1 w after SE and the increase was not obvious later.

Objective: To examine the correlation between the promoter methylation of Sterol regulatory-element binding protein-2 (SREBP-2) and miR-33a expression as well as serum markers in patients with coronary artery disease (CAD). Methods: The case-control study. 100 participants who underwent coronary angiography from August 2017 to April 2018 in TaiheHospital, Hubei University of Medicine, were recruited in this study.The methylation level of two fragments, including 12 CpG sites in the promoter region of SREBP-2, have been detected by pyrosequencing in 50 patients with coronary artery disease (CAD) and 50 non-CAD controls. Serum miR-33a level and a panel of 15 CAD related biomarkers were examined by qPCR and routine biochemistry methods. Results: Methylation level of one CpG site (F1-4 loci) in SREBP-2 promoter region were significant higher in CAD patients than in controls(4.56%±0.70% vs 3.54%±0.72%, t=-3.864, P<0.001); methylation level of F1-4 site was negatively correlates with the serum miR-33a levels and high-density lipoprotein cholesterol (HDL-C) levels(r=-0.318, P=0.001; r=-0.225, P=0.024, respectively). Furthermore, F1-4 hypermethylation was an independent risk factor of CAD, independent of age, gender, histories of hypertension, hyperlipidemia, and diabetes(OR=2.452, 95%CI=1.398-4.299, P=0.002). Conclusion These results suggest that DNA methylation and miRNA might cooperate to regulate the lipid metabolism in CAD.

To evaluate the value of ultrasonography in diagnosing peripheral intraneural vascular anomalies . Methods The ultrasonographic images of 10 patients with peripheral intraneural vascular anomalies confirmed by surgery or pathology were retrospectively analyzed . T he ultrasonographic features were summarized . Results T he ultrasonographic images could not only clearly show the location , involvement and blood supply of peripheral intraneural vascular anomalies , but also determined the classification of them . Ultrasonography showed enlarging nerves ,within w hich tubular structures could be observed ,and the boundary between the vascular malformations and the perineurium was not clear . Abundant arteriovenous blood flow ( arteriovenous malformation) or low velocity venous blood flow ( venous malformation) within the vascular anomalies could be detected by color Doppler examination . Conclusions Ultrasonography is the preferred imaging method for diagnosis of peripheral intraneural vascular anomalies .

Objective: To investigate the effects of tumor-associated macrophages (TAM) on proliferation, migration, invation and apoptosis of gastric cancer MGC-803 cells and the possible mechanisms. Methods: Human monocyte THP-1 was cultured in vitro. After being added with PMA and IL-4, the levels of interleukin-12 (IL-12) and interleukin-10 (IL-10) in cell supernatant were detected by enzyme-linked immunosorbent assay (ELISA). MGC-803 cells at logarithmic phase and M2-type TAM cells were divided into single cell culture group, non-contact co-culture group and contact co-culture group according to different culture methods. MTT assay was used to detect the proliferation of MGC-803 cells, Transwell assay was used to detect cell migration and invasion, andAnnexin V-FITC/ PI staining flow cytometry was used to examine the apoptosis and cell cycle changes of MGC-803 cells; In addition, the mRNAand protein expressions of matrix metalloproteinase-9 (MMP-9) and MMP-2 were detected by Real-time fluorescence quantitative PCR (qPCR) and Western blotting. Results: Compared with PMA group, the level of IL-12 in cell supernatant of PMA+IL-4 group decreased significantly while the level of IL-10 increased significantly (all P<0.05), indicating THP-1 cells were successfully induced to differentiate into M2-type TAM. Compared with the single cell culture group, the non-contact co-culture group and the contact co-culture group exhibited: (1) significantly increased proliferation rate of MGC-803 cells (P<0.05)； (2) increased number of migrated and invaded cells (all P < 0.05)； (3) significantly decreased apoptotic rate (P<0.05)； (4) increased proportion of S, G2 phase cells and decreased proportion of G1 phase cells (all P<0.05)；and (5) significantly increased mRNA and protein expressions of MMP-9 and MMP-2 (all P<0.05). Conclusion: TAM can promote the proliferation, migration and invasion of gastric cancer MGC-803 cells, relieve G1 phase arrest and reduce cell apoptosis, which may be related to the up-regulation of MMP-9 and MMP-2 expression in gastric cancer cells.

Objective: To construct a scientific, practical and objective quality evaluation system for evaluating clinical probation teaching effects of Psychiatry Nursing in undergraduate students. Methods: Protocol of the system was initially made via literature analysis method and experts interview method; indexes were screened via Delphi method; and the evaluation system was formed by comprehensively considering experts' suggestions. The data was analyzed by using SPSS 19.0. Results: All expert authority coefficients were more than 0.8; expert activeness coefficients in two rounds were 100% and 88.3%, respectively; and expert coordination coefficient was 0.235 (P<0.01). The designed teaching evaluation system contained three first-level indexes, seven second-level indexes and forty-one third-level indexes. Conclusion The drafted teaching evaluation system for evaluating clinical probation teaching effects of Psychiatric Nursing reflects requirements and characteristics of psychiatric special training during clinical probation and pays attention to cultivate students' humanistic care and clinical practice ability, with high scientificness and reliability, so as to provide objective and quantitative basis for evaluating probation.

Objective To investigate the expressiorn of microRNA-622(miR-622) and dual specificity tyrosine phosphorylation-regulated kinase 2 (DYRK2) in colon cancer tissues and cell lines and explore the effect of miR-622 on SW11l6 cells migration and invasion.Methods Eighty-two colon cancer tissues and paired para-tumor tissue specimens were collected.C.olon cancer cell line SW1116,SW480 and normal human colon epithelial cell line NCM460 were cultured.MiR-622 was detected by using Real time PCR,DYRK2 expression was measured by using immunohistochemistry,Real time PCR anid Western blot in tissue level and cell level,respectively.The relation of miR-622 and DYRK2 was analyzed by Pearson correlation analysis.miR-622 mimics transfection was conducted to up-regulate miR-622,while negative control,NC group were transfected with control sequence.Expression of DYRK2 was evaluated by using Real time PCR and Western blot,while Transwell chamber assays were used to assess the migration ability changes.Results Real time PCR and Western blot results showed that miR-622 mRNA was highly expressed in colorectal cancer tissue and colon cancer cell SW1116,whereas DYRK2 mRNA and protein were lowly expressed when compared with paracancerous tissue and normal colonic epithelial cell line NCM460.An obvious negative correlation was showed between miR-622 and DYRK2(r=0.916,P＜0.01).Compared to NC group,DYRK2 mRNA and protein expression were down-regulated after transfection of miR-622 mimics,which was observerd through Real time PCR and Western blot(P＜0.01).Correspondingly,compared to NC group,the migration ability of SW116 was remarkably enhanced after transfection of miR-622 mimics(P＜0.01).Conclusion The expression of miR-622 is high and DYRK2 is low in colon cancer.Up-regulation of miR-622 could negatively regulate DYRK2 expression and promote SW1116 cells migration.

Objective To evaluate the value of ultrasonography in diagnosing intraneural ganglion cysts . Methods The ultrasonographic images of 12 patients with intraneural ganglion cysts confirmed by surgery and pathology were retrospectively analyzed . The ultrasonographic features were summarized . Results The ultrasonographic images showed the location ,number ,size ,shape ,boundary ,internal echo , involvement extent and blood supply in intraneural ganglion cysts clearly . Intraneural ganglion cysts showed cystic masses within peripheral nerve ,boundary clear ,irregular-shaped ,ill-acoustic transmissibility ,and separations are common ,color Doppler examination showed no blood flow inside the cysts . Conclusions High frequency sonography is the preferred imaging method for diagnosis of intraneural ganglion cysts .