Background The contracted family doctor services are the embodiment of the implementation of the new medical reform policy, and the transformation of the grass-roots health service mode. Studies have proved that the occupational stress in medical staff was at a high level. The enhancement of professional identity will contribute to strengthen team building，alleviate job burnout, and reduce turnover intention of family doctors. Objective To investigate the current situation of occupational identity among family doctor teams in Chengdu, to examine potential influencing factors of occupational identity, and to provide a reference for promoting career development and team building of family doctor teams. Methods Multi-stage random cluster sampling was adopted to enroll study participants form 46 primary healthcare centers where family doctor contract services were implemented among 23 districts and counties in Chengdu between March 4 and 26, 2021. A total of 2 681 family doctors participated in this survey. A self-reported survey was conducted to collect participants' demographic and occupational data. The Effort-Reward Imbalance (ERI）questionnaire was implemented to assess occupational stress. The Professional Identity Scale was used to appraise occupational identity. Results A total of 2 327 valid questionnaires were collected, with a valid recovery rate of 86.80%, involving 1 715 females (73.7%) and 612 males (26.3%), with dominant age groups of 26−35 years (43.3%) and 36−45 years (30.4%), a high proportion of being married (82.8%), having college (36.0%) and undergraduate (47.3%) education, a high proportion of primary titles (66.0%) and informal work contract (66.1%). About 88.7% of family doctor team workers reported occupational stress. The average score of occupational identity was (3.68±0.62) points. There were significant differences in occupational identity scores among different professional title, work contract, working years in medical institutions, income, and effort/reward ratio (EER) groups (P < 0.05). ERR was negatively correlated with occupational identity (r_s=−0.495, P<0.05）. The multiple regression model showed that occupational identity score in the non-staffed participants was lower than the score in the staffed ones (OR=0.429, 95%CI: 0.299−0.825). The occupational identity score in the participants having associate senior title or above was higher than in without professional title (OR=1.424, 95%CI: 1.194−2.328). The longer the working years, the higher the occupational identity score among the participants. The score of the more than 20 working years group was 1.820 times that of the less than 5 working years group (95%CI: 1.342−2.543). The higher the income, the higher the occupational identity score. The score of the 9001−12000 yuan per month group was 1.977 times that of the 1000−3000 yuan per month group (95%CI: 0.811−9.696) , and the score of the more than 12000 yuan per month group was 2.283 times that of the 1000−3000 yuan per month group (95%CI: 1.199−10.267）. Conclusion The family doctor team workers generally report occupational stress, and their occupational identity is at a medium level in Chengdu. Relevant managers should implement intervention measures against the main influencing factors to reduce their work tension and improve their occupational identity.

Objective:Retrospective analysis of the occurrence, development, treatment and outcome of three cases of pure red cell aplasia(PRCA) caused by parvovirus B19 after solid organ transplantation and literature review.Methods:Three patients were diagnosed by typical clinical manifestations, laboratory tests, and bone marrow aspiration. The parvovirus DNA was found to be positive in all 3 patients, and case 3 was found to be co-infected with herpes zoster virus. The treatment included a combination of immunosuppressive agents, intravenous gamma globulin, antiviral, hematopoietic, and hematopoietic materials supplementation.Results:The patient′s anemia was corrected, and the viral DNA became negative. No recurrence was found during follow-up.Conclusions:The etiological diagnosis of PRCA after solid organ transplantation is crucial, and comprehensive treatment can have a good effect.

Objective: To observe the feasibility and clinical curative effect of anatomical reduction and fixation of lesser trochanter through posterior-lateral approach for the treatment of comminuted femoral intertrochanteric fractures in elderly patients. Methods: A total of 19 cases with comminuted femoral intertrochanteric fracture, aged 60 to 84 years were enrolled in this study.According to Evans-Jensen classification, 13 cases had type Ⅱ B and 6 cases had type Ⅲ femoral fracture.Through the posterior-lateral approach, the lesser trochanter was fully exposed, reduced and fixed by screw.The proximal and distal femur were well fixed with dynamic hip screw(DHS)or proximal femoral locking plate(PFLP). The lesser trochanter reduction was observed by intraoperative vision and postoperative X-ray.The function evaluation after hip surgery was performed by using Sanders hip function score. Results: All 19 patients obtained the anatomic reattachment in the lesser trochanter.All patients were followed up for an average of 18 months.After treatment, the Sanders hip function score were excellent in 7 patients(36.8%), fine in 12 cases(63.2%). And curative efficacy was good in all cases(100%). There was no significant difference in the curative effect between patients with different classification and gender. Conclusions Through the posterior-lateral approach, the surrounding structures of the lesser trochanter can be fully exposed, and the lesser trochanter can be anatomically repositioned.The posterior-lateral approach to anatomical reduction and fixation of lesser trochanter is an effective and feasible method for the treatment of comminuted intertrochanteric fracture in the elderly.

Objective: To investigate the efficacy and safety of CD19 chimeric antigen receptor T (CAR-T) lymphocytes for the treatment of B cell lymphoma. Methods: A total of 22 patients with B-cell lymphoma from February 1, 2017 to July 1, 2018 were reviewed to evaluate the efficacy and adverse reactions of CD19 CAR-T. Results: Of 22 patients with B-cell lymphoma received CD19 CAR-T cells, the median dose of CAR-T cells was 7.2 (2.0-12.0) ×10⁶/kg. Nine of 12 cases of relapse refractory patients were overall response. Complete remission (CR) occurred in 2 of 12 patients, partial remission (PR) in 7 of 12 patients. The overall response in minor residual disease positive (MRD) group was 8 of 10 patients. CD19 CAR-T cells proliferated in vivo and were detectable in the blood of patients. The peak timepoints of CAR-T cells proliferated in the relapsed refractory and MRD positive groups were 12 (5-19) and 4.5 (1-12) days after treatment respectively, and among peripheral blood cells, CAR-T cells accounted for 10.10% (3.55%-24.74%) and 4.02% (2.23%-28.60%) of T lymphocytes respectively. The MRD positive patients achieved sustained remissions during a median follow-up of 8 months (rang 3-18 months) . None of all the patients relapsed during a median follow-up time of 10 months (3-18 months) . However, 7 PR responders of the relapsed refractory patients maintained a good condition for 1.5-6.0 months. One patient bridged to hematopoietic stem cell transplantation, another one sustained remission for 12 months. Cytokine-release syndrome (CRS) occurred in 14 patients with grade 1-2 CRS in MRD positive group and grade 3 CRS in relapsed refractory group. Conclusions CAR-T cell therapy not only played a role in the rescue treatment of relapsed and refractory patients, but also produced a surprising effect in the consolidation and maintenance of B-cell lymphoma. CD19 CAR-T cells might be more effective in the treatment of MRD positive B-cell lymphoma patients than in the refractory or relapsed cases. High response rate was observed with fewer adverse reactions.

Objective Investigate the different changes of host cellular immunity in patients with different infection by compa-ring peripheral blood lymphocyte subsets.Methods Flow cytometry was used to detect the peripheral blood lymphocyte subset a-mong 96 patients including 31 bacterial infection cases,13 fungal infection cases and 62 virus infection cases.Results Compared with control group the ratio of CD3 + T cell was increased in virus group,and the ratio of CD4 + T was decreased in fungi and virus group and the fungus is lower than the virus group,while the ratio of CD8 + T cell was increased in the two groups,and fungi group is higher than the virus,CD4 +/CD8 + ratio in the two groups were reduced.Three groups of NK cells (of CD16 + CD56 + )ratio was reduced to some extent,and bacteria group was lower than that of other two groups.The ratio of B cell was increased in Bacteria group and it was more obvious in the G+ bacteria.NK cells in G+ bacteria and G- bacteria group were relatively lower than control group,but the difference between the two groups was not significance.In virus infection cases,the ratio of CD3 + T in HBV group was higher than that of dengue fever group.And the ratio of CD3 + and NK cells were increased in the two groups.The ratio of CD4 + was decreased in dengue fever group.Conclusion Detection of lymphocyte subset can objectively reflect and help to under-stand the state of the immune function of patients with infectious diseases,providing laboratory basis for the diagnosis and preven-tion in order to reduce the infectious risk and side effect.

Objective To establish methods for the determination of spinosin and total saponins in compound Zaoshen tablet .Methods The separation of spinosin was performed on Agilent Zorbax SB C18 column (250 mm × 4 .6 mm ,5 μm) at 30℃ with water and acetonitrile as mobile phase for gradient elution at the flow rate of 1 .0 ml/min .The detection wavelength was 335 nm .Determination of total saponins was fulfilled by column chromatography followed by UV spectrometer with vanil-lin glacial acetic acid colorimetry .The detection wavelength was 560 nm .Results Linear range of spinosin was 20-100 μg/ml (r=0 .9990) and total saponins was 40-200 μg/ml (r=1 .0000) .The average recoveries for accuracy tests were 99 .55% and 99 .85% respectively .Conclusion Those methods are accurate and reliable .They can be used for the quality control of com-pound Zaoshen tablet .

Objective To investigate the clinical value of laboratory markers in the diagnosis and treatment of light chain multi-ple myeloma (MM) .Methods Collected 31 cases of light chain MM patients and 60 cases of control group ,the control group con-sisted of 20 health subjects (healthy group) ,20 cases of type IgG κMM ,20 cases of type IgA κMM .The immune globulin ,serum protein electrophoresis ,immunofixation electrophoresis ,UREA ,Cr ,β2-microglobulin ,flow cytometry immunophenotyp and bone marrow cytology was detected .Results The positive rate of serum protein electrophoresis was 29 .03% ,the difference of the M protein comparison in Durie-Salmon stage of phase Ⅱ and phase Ⅲ was statistically significant(P<0 .05);light chain multiple mye-loma patient′s immunofixation electrophoresis results required reviewing by agarose gel electrophoresis plusing IgD and IgE anti-body ;the IgG ,IgA ,IgM ,UREA ,Cr ,β2-microglobulin of light chain MM patients were different compared with healthy group (P<0 .05);the morphological characteristics of MM cells changed significantly ,and the expression of cell antigen was mainly CD38 , CD138 and CD56 .Conclusion Quantitative of immunoglobulins and immunofixation electrophoresis could be used as screening method of M protein ,serum protein electrophoresis can be used for clinical staging and clinical observation of patients .Bone marrow smears plays an important role in the diagnosis of light chain MM .Light chain MM has more severe renal damage than other types of M M .

Objective To investigate possible association between the incidence of nasopharyngeal carcinoma(NPC)and ABO blood type.Methods pathologically confirmed NPC patients(NPC group) with a serologically determined blood group in Sun Yatsen University Cancer Center were reviewed retrospectively.The distribution of blood groups of the NPC group were compared with the distribution of blood groups of healthy donors(control group) admitted to the First Affiliated Hospital of Guangzhou TCM University in the year 2013.Results There was no significant difference between NPC group and the control group in terms of distribution of ABO blood groups(P=0.884),neither with NPC stages(P=0.506).Conclusion In this study,we found that blood type has no association with an increased risk of NPC and NPC stages in a population of Southern China.

The regulation mechanism of arecoline on rat hepatic CYP2E1 was studied in vivo. After oral administration of arecoline hydrobromide (AH; 4, 20 and 100 mg x kg(-1) x d(-1)) to rats for one week, the hepatic CYP2E1 mRNA level remained unchanged, but the hepatic CYP2E1 protein content was dose-dependently increased. Additionally, although the hepatic CYP2E1 activity was induced by AH treatment, the induction was attenuated with the increase in dosage. The results indicate that the effect of arecoline on rat hepaticdoes not involve transcriptional activation of the gene, but largely involves the stabilization of CYP2E1 protein against degradation or increased efficiency of CYP2E1 mRNA translation, and additionally involve the post- ranslational modification of CYP2E1 protein. Furthermore, the CYP2E1 response is fairly equal among the different species, the induction of rat hepatic CYP2E1 by arecoline suggests that there is a risk of metabolic interaction among the substrate drugs of CYP2E1 in betel-quid use human.

Retinoid X receptor α (RXRα) and its N-terminally truncated version tRXRα play important roles in tumorigenesis, while some RXRα ligands possess potent anti-cancer activities by targeting and modulating the tumorigenic effects of RXRα and tRXRα. Here we describe NSC-640358 (N-6), a thiazolyl-pyrazole derived compound, acts as a selective RXRα ligand to promote TNFα-mediated apoptosis of cancer cell. N-6 binds to RXRα and inhibits the transactivation of RXRα homodimer and RXRα/TR3 heterodimer. Using mutational analysis and computational study, we determine that Arg316 in RXRα, essential for 9-cis-retinoic acid binding and activating RXRα transactivation, is not required for antagonist effects of N-6, whereas Trp305 and Phe313 are crucial for N-6 binding to RXRα by forming extra π-π stacking interactions with N-6, indicating a distinct RXRα binding mode of N-6. N-6 inhibits TR3-stimulated transactivation of Gal4-DBD-RXRα-LBD by binding to the ligand binding pocket of RXRα-LBD, suggesting a strategy to regulate TR3 activity indirectly by using small molecules to target its interacting partner RXRα. For its physiological activities, we show that N-6 strongly inhibits tumor necrosis factor α (TNFα)-induced AKT activation and stimulates TNFα-mediated apoptosis in cancer cells in an RXRα/tRXRα dependent manner. The inhibition of TNFα-induced tRXRα/p85α complex formation by N-6 implies that N-6 targets tRXRα to inhibit TNFα-induced AKT activation and to induce cancer cell apoptosis. Together, our data illustrate a new RXRα ligand with a unique RXRα binding mode and the abilities to regulate TR3 activity indirectly and to induce TNFα-mediated cancer cell apoptosis by targeting RXRα/tRXRα.
Apoptosis ; drug effects ; Cell Line, Tumor ; Enzyme Activation ; drug effects ; Humans ; Ligands ; Molecular Docking Simulation ; Nuclear Receptor Subfamily 4, Group A, Member 1 ; genetics ; metabolism ; Oximes ; metabolism ; pharmacology ; Protein Conformation ; Proto-Oncogene Proteins c-akt ; metabolism ; Pyrazoles ; metabolism ; pharmacology ; Retinoid X Receptor alpha ; chemistry ; genetics ; metabolism ; Thiazoles ; metabolism ; pharmacology ; Transcription, Genetic ; drug effects ; Transcriptional Activation ; drug effects ; Tumor Necrosis Factor-alpha ; metabolism