Objective To explore the value of serological indicators in predicting early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods A total of 276 AIS patients were selected as the study subjects and divided into END group (72 cases) and non-END group (204 cases) based on the occurrence of END. Clinical data from all AIS patients were collected. Multivariable Logistic regression analysis was used to analyze the independent influencing factors of END in AIS patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of various serological markers for END. Results Univariate analysis showed that the END group had a significantly higher proportion of patients aged >75 years, higher National Institutes of Health Stroke Scale (NIHSS) scores, fasting blood glucose (FBG), uric acid, fibrinogen, platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) compared to the non-END group (P < 0.05). Multivariable Logistic regression analysis revealed that age (OR=1.322, 95%CI, 1.049 to 1.666), NIHSS score (OR=1.793, 95%CI, 1.281 to 2.510), FBG (OR=1.392, 95%CI, 1.126 to 1.722), PLR (OR=1.505, 95%CI, 1.128 to 2.008) and NLR (OR=1.677, 95%CI, 1.280 to 2.197) were independent influencing factors for END in AIS patients. The ROC curve showed that the areas under the curve (AUC) for FBG, PLR and NLR in predicting END in AIS patients were 0.642, 0.581 and 0.759, respectively. Conclusion PLR, NLR and FBG are independent influencing factors for the occurrence of END in AIS patients. NLR has a higher predictive value for END in AIS patients.

Objective: To analyze the clinical characteristics and imaging features of occupational pulmonary thesaurosis induced by dust of iron and its compounds (OPTIDIC). Methods: A total of 230 cases of occupational welder's pneumoconiosis (OWP) patients or observation subjects were selected as the research subjects using the retrospective analysis method. They were diagnosed in four occupational disease diagnosis institutions in Shandong Province from 2010 to 2017. The high kV X-ray chest radiography or chest digital radiograph (hereinafter referred to as X-ray) were re-read to screen OPTIDIC patients. The clinical data of OPTIDIC patients were collected and analyzed. Results: Among the 230 cases, 56 cases were diagnosed as OPTIDIC, accounting for 24.3%. The clinical symptoms of the 56 patients with OPTIDIC were cough, sputum, chest tightness, shortness of breath, and difficulty breathing, while their physical signs were low or coarse breath sounds in lungs and others. Most of the X-ray results showed p shadows or q shadows, accounted for 98.2%, of which p/p shadow and q/q shadow accounted for 62.5%. The result of chest computed tomography (CT) showed diffuse point/round shadow and diffuse glass shadow in OPTIDIC patients. The result of fibro-bronchoscopy showed that a large amount of iron lutein particles was accumulated in macrophages and biopsy of lung showed idiopathic pulmonary hemosiderosis in OPTIDIC patients. Conclusion: The clinical characteristics of OPTIDIC patients showed no different from OWP. However, the result of X-ray of OPTIDIC patients mainly showed small circular shadows, and their CT images mainly showed diffuse point/round shadows or grinding glass shadow, which could be used to the differential diagnosis of OPTIDIC and OWP.

Objective: To describe the current reporting of pneumonia of unknown etiology (PUE) and factors that affect reporting by clinicians in China using the PUE surveillance system in order to provide a reference for improving PUE reporting rates in the future. Methods: Clinicians were recruited via the Sojump platform and requested to complete an anonymous self-administered questionnaire. Multivariate logistic regression analysis was used to assess factors influencing clinicians' reporting activities. Results: This study showed a low PUE case reporting rate and a poor understanding of PUE reporting among the investigated clinicians. Of the 136 clinicians who had diagnosed PUE cases, multivariate logistic regression analysis results showed that clinicians who had attended in-hospital training were more likely to report PUE than those who had not (OR 4.48, 95% CI 1.49-13.46). Clinicians with an expert panel on PUE in their hospital were more likely to report PUE cases than those without (OR 5.46, 95% CI 1.85-16.11). Conclusions: There is a need to promote and reinforce PUE surveillance system training among medical staff. In addition, PUE testing technologies in hospital laboratories should be upgraded, especially in primary and unclassified hospitals, to increase surveillance efficiency and improve PUE reporting rates.

With the in-depth study of heart development, many human cardiomyocytes (CMs) have been generated in a laboratory environment. CMs derived from pluripotent stem cells (PSCs) have been widely used for a series of applications such as laboratory studies, drug toxicology screening, cardiac disease models, and as an unlimited resource for cell-based cardiac regeneration therapy. However, the low maturity of the induced CMs significantly impedes their applicability. Scientists have been committed to improving the maturation of CMs to achieve the purpose of heart regeneration in the past decades. In this review, we take CMs maturation as the main object of discussion, describe the characteristics of CMs maturation, summarize the key regulatory mechanism of regulating maturation and address the approaches to promote CMs maturation. The maturation of CM is gradually improving due to the incorporation of advanced technologies and is expected to continue.

OBJECTIVE：To est ablish the working mode of the first pharmaceutical ward rounds of clinical pharmacists in our hospital，in order to provide a useful reference for establishing a national standardized pharmaceutical ward rounds model. METHODS：By sharing the clinical cases of the first pharmaceutical ward rounds ，the work content and process of the first pharmaceutical ward rounds in our hospital were introduced. RESULTS & CONCLUSIONS ：The clinical pharmacist ’s first pharmaceutical ward round in our hospital mainly includes self introduction of clinical pharmacists ，diagnosis of patients ’condition under the guidance of doctors ，collection and evaluation of patients ’previous medication information （including previous medication varieties ，usage methods ，efficacy and safety evaluation ），assistance for doctors in formulating initial treatment plan ， carrying out initial medication and diet education ，and intensive communication and cooperation with nurses. The development of first pharmaceutical ward rounds promotes the rational use of drugs in clinic ，elevates the hospitalization satisfaction of patients and improves the professional quality of clinical pharmacists.

OBJECTIVE： To establish the method for PCR identification of bullwhip， and to identify the authenticity of bullwhip at the molecular level. METHODS： DNA samples of bullwhip and its counterfeits （donkey whip， pig whip， sheep whip） were extracted and their integrity， purity and concentration were detected. Using GenBank related information， using mitochondrial cytochrome b （Cyt b） gene of bullwhip as target gene， Primer-BLAST online software was used to design specific primer. PCR amplification was performed for whips of different species， and electrophoretic analysis was conducted for the product. PCR products of bullwhip samples were cloned and confirmed by DNA sequencing. The specificity and repeatability of the established PCR method were verified. RESULTS： DNA purity of the bullwhip and its counterfeits was high， and there was no protein or RNA pollution. 1.5％ agarose gel electrophoresis showed that there were obvious target gene bands of bullwhip samples at 200-300 bp， while no corresponding bands appeared in other counterfeit products. The results of DNA sequencing showed that the nucleotide sequence of the gene fragment of bullwhip was 100％ similar to that of the bullwhip in GeneBank. Results of methodological validation showed that established method was specific and reproducible. CONCLUSIONS： The established PCR identification method based on Cyt b gene in the study is simple， rapid， accurate， specific and reproducible， and can meet the requirements of analysis and identification of bullwhip and its counterfeits.

Objective: To investigate the incidence of contact dermatitis among workers in cemented carbide production enterprises. Methods: From October 1997 to October 2017, an occupational epidemiological survey was conducted on a large-scale cemented carbide production enterprise, and occupational health examinations were conducted for employees. 152 people were exposed to hard metal dust (hard metal raw material dust and alloy dust) . The employees in the work group were contact groups, and 142 employees in the non-dusting operation of the company were in the control group. A detailed retrospective survey of hard metal production workers with contact dermatitis history in the two groups was conducted to analyze the risk factors of contact dermatitis exposure to hard metal dust. Results: The incidence of allergic diseases in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ²=23.793, P<0.05) . The incidence of contact dermatitis in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ²=24.659, P<0.05) ; the changes of contact dermatitis in the contact group were mainly allergic contact dermatitis, and some showed irritative contact dermatitis; the operator had respiratory symptoms (including work-related nasal congestion, cough, wheezing) , difficulty breathing may be the influencing factors of contact dermatitis (RR=2.60, 95%CI: 1.10-6.20, P<0.05) . Conclusion Hard metal alloy enterprises are exposed to hard metal dust. The incidence of contact dermatitis is high in workers, and the occurrence of contact dermatitis may be associated with those with respiratory symptoms.

Objective To verify the influence of oncology nurses'empathy on the psychological dis-tress and benefit finding in breast cancer patients. Methods 30 oncology nurses were selected by random sampling and their empathy scores were measured with the interpersonal reactivity index (IRI-C).And they were divided into three groups based on empathy scores. 12 breast cancer patients from each primary nurse were selected by random sampling.Their psychological distress and benefit finding were measured by distress thermometer (DT) and benefit finding scale (BFS).Variance analysis was used to compare psychological distress and benefit finding among patients in different groups. The effect of nurse empathy on patients psy-chological distress and benefit finding was measured by Spearman correlation analysis and logistic regression. Results The empathy score of nurses was (44.87±17.23).The difference of empathy score in the three groups of nurses was statistically significant (F=55.941,P<0.01).There was no significant difference in psy-chological distress (low-score group:5.0(4.0,6.0),middle-score group:5.0(4.0,6.0),high-score group:5.0 (4.0,6.0)) and benefit finding (low-score group:47.5(42.0,52.8),middle-score group:48.0(43.0,54.0), high-score group:46.0(42.0,52.0)) in the three groups of patients at admission(P>0.05),while at dis-charge,the psychological distress of the patients in the high-score nurse group was lower than that of the low-score nurse group (P<0.01),and the benefit was higher than that of the low-score group (P<0.01).There was a negative correlation between the nurses'empathy abilities and patients'psychological distress ( r=-0.470, P<0.01) ,and a positive correlation between the nurses'empathy abilities with the patients'benefit finding ( r=0.521,P<0.01).When controlling for other variables,patients in nurse group with higher empathy scores would result in lower psychological distress(95％CI=0.042-0.397) and higher benefit finding (95％CI=0. 095-0.554) than patients in nurse group with lower empathy scores.Conclusion Oncology nurses'empathy effect breast cancer patients'psychological distress and benefit finding.Nurses should enhance their empathy further.

Objective To investigate the Th1/Th2 cytokines and chemokine CXCL 13 levels in peripheral blood and cerebrospinal fluid(CSF)of patients with neurosyphilis and their clinical significance. Methods Forty seven HIV negative patients with neurosyphilis, 36 syphilis patients without neurological involvement(syphilis group)and 23 patients without infectious intracranial diseases(control group) admitted in Hangzhou Third Hospital during July 2011 to December 2014 were enrolled in the study.CSF pressure, protein contents, white blood cell counts and IgG index were detected in patients with neurosyphilis.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of Th1 cytokines (IL-2,IL-12 and IFN-γ),Th2 cytokines(IL-6,IL-10)and CXCL13 in serum and CSF in three groups.Th1/Th2 cytokines,CXCL13 levels and CSF routine were also examined in neurosyphilis patients after treatment for 3 and 12 months.ANOVA, Kruskal-Wallis test and Spearman correlation were used for data analysis.Results The levels of IL-6 and IL-10 in serum and CSF from neurosyphilis patients were higher than those in syphilis group and control group(χ2IL-6=15.43, 15.39 and 14.44, 20.01,χ2 IL-10 =16.46, 23.86 and 15.11,24.44;P<0.05 or <0.01), while the levels of IL-2, IL-12 and IFN-γin the serum and CSF were lower than those in syphilis group and control group(χ2IL-2=14.55,17.14 and 16.14,17.97;χ2IL-12=13.65,20.50 and 18.48,21.04;χ2IFN-γ=16.95,17.53 and 16.00,15.21;P<0.05 or <0.01). CXCL13 contents in CSF of neurosyphilis patients were significantly higher than those in other two groups (χ2=52.51 and 53.76, P <0.01), and were positively correlated with leucocyte counts, protein concentrations,IgG index,IL-6 and IL-10(r=0.325,0.544,0.750,0.333 and 0.382,P<0.05 or <0.01),but were negatively correlated with IL-12 levels in neurosyphilis patients(r=-0.303,P<0.05). In neurosyphilis patients,CXCL13 and IL-6 levels were reduced after treatment for 12 months(χ2=102.00 and 22.17,P<0.05 and <0.01), while the levels of IL-2 and IL-12 were increased(χ2=18.28 and 24.10,P<0.05 and <0.01).Conclusion Chemokine CXCL13 and Th1/Th2 cytokines are involved in the immune response in neurosyphilis patients, which may be used for the diagnosis and evaluation of therapeutic efficacy in patients with neurosyphilis.

Objective To observe the variation of phosphatidylinositol-3 kinase (PI3K),protein kinase B (AKT),sodium iodide symporter (NIS) mRNA and protein expression in rat mammary tissues and serum insulin growth factor Ⅰ (IGF-1) under different iodine nutrition levels,and to study the role of PI3K-AKT signaling pathway in the process of mammary gland intaking iodine during lactation period.Methods Totally 130 Wistar rats (100 female rats,30 male rats) were randomly divided into five groups with 20 female rats in each group:①control group (NI):was feed with normal diet and iodine content 50 μg/L in deionized water;②low iodine group 1 (LI1 group):was feed with low iodine diet and deionized water;③low iodine group 2 (LI2):was feed with low iodine diet and iodine content 5 μg/L in deionized water;④high iodine group 1 (HI1 group):was feed with normal diet and iodine content 3 000 μg/L in deionized water;⑤high iodine group 2 (HI2):was feed with normal diet and iodine content 10 000 μg/L in deionized water.After feeding for 3 months,females were mated with male rats,then male rats were taken out and every female rat was feed individually.Urinary iodine level of rats in lactation period 10 days after giving birth was tested.Blood and mammary tissue samples of rats in lactation period were taken after killing them.Enzyme linked immunosorbent assay (ELISA) was used to detect serum IGF-1 level,real-time fluorescence quantification PCR to detect the mRNA expression of mammary gland PI3K,AKT and NIS,Western blotting to detect mammary gland PI3K,total AKT,phosphorylation AKT (p-AKT) and NIS protein expression.Results The medians urinary iodine of lactation period rats in LI1 and LI2 (3.16,6.36 μg/L) were significantly lower than that in NI group (162.59 μg/L),and were significantly higher in HI1 and HI2 (2 356.27,11 507.29 μg/L) than that in NI group.The differences were statistically significant (all P ＜ 0.01).Compared with control group [(8.84 ± 2.12) μg/L],the content of serum IGF-1 increased significantly in lactation period rats in LI1 and LI2 groups [(13.30 ± 2.37) and (10.90 ± 1.92) μg/L,all P＜ 0.01].The real-time fluorescence quantification PCR detection results indicated that the differences were statistically significant by comparing NIS,AKT,PI3K mRNA expression of the mammary tissues of lactation period rats in the five groups (F=14.916,36.477,14.994,all P＜ 0.01).Among them,NIS mRNA expression quantities in LI1 and LI2 groups (0.75 ± 0.40,0.89 ± 0.51) were significantly higher than that in NI group (0.53 ± 0.31),and significantly lower in HI2 group (0.30 ± 0.24) than that in NI group (P ＜ 0.05 or ＜ 0.01).AKT mRNA expression quantities in LI1 and LI2 groups (0.90 ± 0.19,0.64 ± 0.22) were significantly higher than that in NI group (0.43 ± 0.22),and significantly lower in HI2 group (0.29 ± 0.15) than that in NI group (P ＜ 0.05 or ＜ 0.01).PI3K mRNA expression quantity in LI1 group (0.85 ± 0.42) was significantly higher than that in NI group (0.50 ± 0.24),and significantly lower in HI2 group (0.28 ± 0.10) than that in NI group (all P ＜ 0.01).Western blot detection results indicated that the differences were statistically significant by comparing mammary gland NIS protein expression of lactation period rats in the five groups (F=4.510,P＜ 0.01).Among them,LI1 group (1.67 ± 0.97) was significantly higher than NI group (0.87 ± 0.43,P ＜ 0.05).The differences were statistically significant by comparing the p-AKT protein expression among groups (F =3.528,P ＜ 0.05).Among them,HI2 group (1.10 ± 0.30) was significantly higher than NI group (0.75 ± 0.23,P ＜0.05).The differences were not statistically significant by comparing total AKT and PI3K protein expression among groups (F =0.558,1.319,all P ＞ 0.05).Conclusion The inhibitory effect of PI3K-AKT signaling pathways on NIS in the mammary gland was weaker than the effect of iodine intake.But the expression of functional p-AKT was gradually increased with the increment of iodine intake,which had been presented inhibit effect on NIS expression in lactating mammary gland.