Background::Heterotaxy (HTX) is a thoracoabdominal organ anomaly syndrome and commonly accompanied by congenital heart disease (CHD). The aim of this study was to analyze rare copy number variations (CNVs) in a HTX/CHD cohort and to examine the potential mechanisms contributing to HTX/CHD.Methods::Chromosome microarray analysis was used to identify rare CNVs in a cohort of 120 unrelated HTX/CHD patients, and available samples from parents were used to confirm the inheritance pattern. Potential candidate genes in CNVs region were prioritized via the DECIPHER database, and PNPLA4 was identified as the leading candidate gene. To validate, we generated PNPLA4-overexpressing human induced pluripotent stem cell lines as well as pnpla4-overexpressing zebrafish model, followed by a series of transcriptomic, biochemical and cellular analyses. Results::Seventeen rare CNVs were identified in 15 of the 120 HTX/CHD patients (12.5%). Xp22.31 duplication was one of the inherited CNVs identified in this HTX/CHD cohort, and PNPLA4 in the Xp22.31 was a candidate gene associated with HTX/CHD. PNPLA4 is expressed in the lateral plate mesoderm, which is known to be critical for left/right embryonic patterning as well as cardiomyocyte differentiation, and in the neural crest cell lineage. Through a series of in vivo and in vitro analyses at the molecular and cellular levels, we revealed that the biological function of PNPLA4 is importantly involved in the primary cilia formation and function via its regulation of energy metabolism and mitochondria-mediated ATP production. Conclusions::Our findings demonstrated a significant association between CNVs and HTX/CHD. Our data strongly suggested that an increased genetic dose of PNPLA4 due to Xp22.31 duplication is a disease-causing risk factor for HTX/CHD.

South Africa is an ethnically and culturally diverse presidential republic country. The medical and health system consists of public and private medical care. AIDS, lower respiratory infections, neonatal diseases, and interpersonal violence and road injuries are the leading causes of adult death. South Africa has rich herbal resources, and a long history of traditional medicine, which is mainly black African traditional medicine. Until the establishment of diplomatic relations between China and South Africa in 1998, the development of TCM was significantly improved, and legislation of TCM was adopted by the government in 2000. Chinese herbal medicine has not yet formed industrial standardization, the TCM application and TCM education are insufficient. Therefore, it is suggested to accelerate the standardization of TCM, to strengthen the TCM education for professional TCM practitioners, and to form a large-scale, industrial and standardized development model. Only in these ways can TCM provide good medical services for residents in South African.

Objective:To analyze hepatic hemodynamic parameters detected by Doppler ultrasound (DU) of uncomplicated children who underwent left lateral segment(LLS) LDLT (LLS-LDLT), explore their change trends over time and determine the normal reference intervals.Methods:This retrospective study involved the data from 261 pediatric LLS-LDLT cases in Tianjin First Central Hospital from June 2014 to January 2018. Hemodynamic parameters included peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsation index (PI) of hepatic artery (HA), and portal vein velocity (PVV) during intra-operative and on the 1st, 3rd, 5th and 7th days after operation were collected. Among whom, 232 cases with uncomplicated and normal recovery were finally involved in our study, with 200 cases who were collected from June 2014 to August 2017 as test group. Those collected from September 2017 to January 2018, totally 32 cases were set as validation group. The change trends and normal ranges of hemodynamic parameters over time were analyzed in test group, and the results were further tested in the validation group.Results:In the test group, PSV HA, EDV HA showed a similar change trend at one week after surgery, with an overall decrease-rise trend; RI HA, PI HA also changed similarly with an overall rise-decrease trend. PVV at surgery was lower than at all time points after surgery. In addition, this study provided the normal reference intervals of hemodynamic parameters for LDLT patients at early postoperative period, which at intra-operation they were PSV HA 18.4-98.3 cm/s, EDV HA 0-43.3 cm/s, RI HA 0.41-1.0, PI HA 0.51-2.0, PVV 19.0-83.7 cm/s. Within 1 week after surgery: PSV HA 21.0-97.7 cm/s, EDV HA 0-32.7 cm/s, RI HA 0.47-1.0, PI HA 0.62-2.0, PVV 23.0-92.0 cm/s. By using those results, the coincidence rate of Doppler parameter change trend was 84.3%(27/32), 84.3%(27/32), 78.1%(25/32), 78.1%(25/32), 87.5%(28/32) for PSV HA, EDV HA, RI HA, PI HA, PVV in the validation group, respectively. As for the normal reference intervals of blood flow parameters, RI HA and PI HA in one case in the validation group were lower than the lower limits of the normal reference intervals, accounting for 3.1% of the total. PSV HA in two cases was lower than the lower limit of normal reference interval, accounting for 6.2% of the total. Conclusions:The hepatic hemodynamic in post-transplanted children detected by DU has specific changing trends and normal ranges, which provides valuable reference values for ultrasonologists and pediatric transplant clinicians.

This study selected the military English listening course that combined the production-oriented approach (POA) with small-scale online course, that is, it was guided by POA, combined advantages of online and offline hybrid learning, and completed with three stages of driving, promoting and evaluating. After a semester of experiment, the authors found that the curriculum research effectively integrated the language and subject content of military English. A multi-dimensional and multi-layered learning network was formed among students and their critical thinking ability was enhanced through cooperative learning. After studying students' reflection reports and teachers' reflection on action research, the researchers found the students' gains and problems in the course and gave advice on the practical application of the theory.

Reflective capacity is a very important tool of assessment for health professionals. Re-flective writing (RW) curriculum, aiming at promoting reflective capacity, is proliferating within American medical education. This paper generalizes the training process of RW capacity, its contents and evaluation tool. It discusses the meaningfulness of RW curriculum in improving doctor-patient relationship and profes-sionalism and developing academic goals. For better practice, the paper makes suggestions that we should reform our traditional medical education, develop interdisciplinary teams of teachers and evaluation tool and incorporate RW curriculum into continuing medical education.

Objective To study the clinical effect of treating mild and moderate hypertension in the elderly with flavored liuwei dihuang decoction.Methods From January 2016 to January 2017,120 cases of elderly patients of mild and moderate hypertension with the diagnosis and treatment in our hospital are divided into two groups, the control group was treated with nifedipine zyban, and the observation group was treated with flavored liuwei dihuang decoction;Record two groups of patients with various experiment data, make an analysis of the relevant data obtained and discuss the clinical effect of flavored liuwei dihuang decoction to treat the mild and moderate elderly hypertension.Results The clinical results of the treatment of observation group were better than that of the control group.The patients had fewer adverse reactions, and the differences between two groups were statistically significant (P< 0.05).Conclusion The treatment which using the flavored liuwei dihuang decoction in the mild and moderate elderly hypertension receives significant improvement in the clinical symptoms and little adverse reactions.It is worth using widely in clinical practice.

OBJECTIVE:To analyze the volatile components of Cladia aggregate by SPME-GC-MS. METHODS:The column was ZB-5 MSI 5% benzene-95% dimethylpolysiloxane fused silica capillary column,programmed temperature was heated from 5 ℃/min to 220 ℃(maintaining 2 min),detector was flame ionization detector,carrier gas was high purity He(99.999%),the column flow rate was 1.0 ml/min,vaporization room temperature was 250 ℃,splitless injection. MS conditions:ion source was electron ionization source,ionizing voltage was 70 eV, interface temperature was 280 ℃,ion source temperature was 230 ℃, quadrupole temperature was 150℃,emission current was 34.6μA,multiplier voltage was 1 502 V,solvent delay time was 1.5 min, and quality range was 30-500 amu. RESULTS:19 volatile chemical components were separated and identified from C. aggregate, mainly olefins an aldehydes,alcohols,ketones,furans oxygenated volatile chemical components,relative contents accounted for 63.55% to all chromatographic peaks in total ion chromatogram,in which,2,4-octadiene(29.66%),hexanal(5.93%),3-meth-yl-1,4-heptadiene(5.45%)and furan(4.65%)showed the highest contents. CONCLUSIONS:The study has basically made clear the main volatile components in C. aggregate,which provide certain scientific basis for further exploring C. aggregate.

Objective To investigate the clinical efficacy of adefovir dipivoxil in antiviral treatment of chronic hepatitis B and its effect on peripheral blood T lymphocyte subsets.Methods 40 cases of patients with chronic hepatitis B were selected from The Fourth People’s Hospital of Qinghai in October 2009 to June 2012,the patients were given the antiviral treatment of adefovir dipivoxil.Before treatment,3 months,6 months and 12 months after treatment,the changes of liver function indicators of alanine transaminase(ALT),aspartate transaminase(AST)and total bilirubin(TBiL),and hepatitis B virus-DNA(HBV-DNA)were recorded;the total effective rate was observed;the peripheral blood T lymphocyte subsets changes was tested and analyzed by flow cytometry.Results The ALT,AST and TBiL of the patients all improved good,and the indicators of ALT,AST and TBiL after 12 months decreased significantly than before treatment,the HBV-DNA testing of the patients recovered negative,the difference was statistically significant (P<0.05 );the total effective rate of hepatitis B patients is 92.5%;the peripheral blood T lymphocyte subsets has no significant improvement in patients after antiviral treatment for 3 months.After the treatment for 6 months and 12 months,the CD4 +T and CD4 +/CD8 +T were significantly higher than those before treatment,there was no significant changes in CD3 +T and CD8 +T before and after treatment.Conclusion Adefovir dipivoxil has a good clinical efficacy in antiviral treatment of chronic hepatitis B,and can significantly improve the patients’liver function,improve peripheral blood T lymphocyte subsets imbalance.

AIM: To investigate that nicotine inhibits HMGB1 expression and release in RAW264.7 cells.METHODS: (1) RAW264.7 cells were cultured in 6 wells plate, treated with 250 μg/L LPS and 1 μmol/L or 10 μmol/L nicotine, in which the cells treated with or without 250 μg/L LPS were regarded as nicotine 1 group (N1), nicotine 2 group (N2), LPS group (LPS) and control group (C), respectively. HMGB1 protein in the cell culture media and in cell nuclear was examined by Western blotting and the cellular HMGB1 mRNA level was detected by RT-PCR. (2) Transfected with antisense RNA or sense RNA of α~7 subunit-containing nicotinic receptor (α~7nAChR), RAW264.7 cells were treated with 250 μg/L LPS and 10 μmol/L nicotine, HMGB1 protein in the culture media was also tested by Western blotting.RESULTS: (1) HMGB1 mRNA level in C group was low (1 659.20±121.05) and no significant statistical difference among groups of N1, N2 and LPS was observed (P>0.05). (2) Higher HMGB1 accumulation in the cell culture media was detected in LPS group (445.34±28.52) than that in C group. Compared to LPS group, both N1 and N2 groups distinctly attenuated HMGB1 accumulation in culture media (P<0.05). (3) Nuclear HMGB1 accumulation was lower in LPS group than that in C group, and two different nicotine concentrations markedly increased the nuclear HMGB1 accumulation compared to LPS group (P<0.05). (4) No significant difference of HMGB1 levels in culture media between antisense RNA group and LPS group was observed (P>0.05). In sense RNA group, however, HMGB1 level was observably reduced compared to antisense group (P<0.05).CONCLUSION: The present results suggest that nicotine dramatically inhibits RAW264.7 cell nuclear HMGB1 translocation and extracellular release, and this effect relies on α~7nAch receptor expression.

OBJECTIVE To investigate the current situation and rationality of clinical usage of antibacterial drugs in our hospital and to find out corresponding supervision measures. METHODS According to the same method and criterion,3343 medical records of discharged patients in 14 departments were investigated retrospectively by utilizing the designed questionnaire. RESULTS The total application rate of antibacterial drugs was 60%,and the rate of preventive usage took up 41% of the total application rate,the application rate of cephalosporins was the highest,and that of quinolones was the next.For the combined usage of drugs,1 150 patients were treated with one drug,730 were treated with two drugs,and 99 were treated with more than three drugs.The treatment period of 1 086 patients was less than 7 days. CONCLUSIONS The usage of antibacterial drugs should be supervised more intensively and the training for medical personnel be strengthened to improve their knowledge of using antibacterial drugs,in order to achieve the rational usage of antibacterial drugs.