【Objective】 To explore the correlation between CSAG1 expression and the prognosis and tumor-infiltrating lymphocytes in renal clear cell carcinoma (RCCC), and to predict the survival and tumor progression. 【Methods】 The gene expression profiles and clinical information of CSAG1 were downloaded from the Cancer Genome Atlas (TCGA). Based on the differential mRNA expression, GO annotation and KEGG pathway analysis were performed. The relationship between CSAG1 and tumor immune infiltration was assessed with Tumor Immunoassay Resource (Timer 2.0) database. The mRNA expression of CSAG1 in human RCCC specimens was validated with qRT-PCR. 【Results】 CSAG1 expression was significantly higher in RCCC tissues than in normal tissues (P<0.05). The qRT-PCR results revealed that the mRNA level of CSAG1 was consistent with that predicted by bioinformatic analysis. The KEGG analysis and GO annotation indicated high GSAG1 expression in RCCC was related to transmembrane transport, tricarboxylic acid cycle and lysosome. CSAG1 expression was positively related to the infiltration of pDC, aDC, CD8⁺ T cells, cytotoxic cells, TFH, TH1 cells, Tem, NK CD56^dm cells, Treg and T cells, but negatively correlated with macrophage infiltration. 【Conclusion】 CSAG1 may be associated with poor prognosis of RCCC and become a potential immunotherapy target.

Objective To study the expression of serum interleukin(IL)-17A,calcium binding protein S100A8 and S100A9 in children with severe Mycoplasma pneumoniae pneumonia(SMPP)and their prognostic significance.Methods A total of 116 children with SMPP who were diagnosed and treated in this hospital from March 2019 to March 2021 were enrolled as the SMPP group.According to the pediatric critical cases score,the SMPP children divided into non-critical group(43 cases),critial group(40 cases),extremely critical group(33 cases).According to the prognosis of 28 d after admission,the SMPP children were divided into a good prognosis group with 82 children and a poor prognosis group with 34 children.A total of 60 physical ex-amination of healthy children in the same hospital during the same period were enrolled as the control group.The levels of serum IL-17A,S100A8,S100A9,procalcitonin(PCT),C-reactive protein(CRP),IL-6 and tumor necrosis factor(TNF)-α were detected in each group.Pearson correlation analysis was used to analyze the cor-relation between serum levels of IL-17A,S100A8,S100A9 and PCT,CRP,IL-6,and TNF-α.Multivariate Lo-gistic regression analysis was used to analyze the factors affecting the poor prognosis of children with SMPP.The receiver operating characteristic(ROC)curve was used to analyze the value of each index in predicting the poor prognosis of children with SMPP.Results The SMPP group had significantly higher serum levels of IL-17A,S100A8,S100A9,PCT,CRP,IL-6,and TNF-α than the control group(P<0.05).In children with SMPP,the serum levels of IL-17A,S100A8,and S100A9 were positively correlated with PCT,CRP,IL-6,and TNF-α(P<0.05).The serum levels of IL-17A,S100A8 and S100A9 in extremely critical group were signifi-cantly higher than those in critical group and non-critical group(P<0.05).Elevated serum levels of IL-17A,S100A8 and S100A9 were independent risk factors for poor prognosis in children with SMPP.The area under the curve(AUC)of combined detection of serum IL-17A,S100A8 and S100A9 for predicting poor prognosis in children with SMPP was 0.895,which was higher than that of single detection of serum IL-17A,S100A8 and S100A9(0.833,0.764,0.810),the differences were all statistically significant(Z=3.780,6.723,5.012,P<0.059).The sensitivity and specificity of combined detection were 0.891 and 0.755,respectively.Conclu-sion The serum levels of IL-17A,S100A8 and S100A9 are increased in children with SMPP,which are related to the severity of SMPP.The combined detection of the three indicators has a high predictive value for the poor prognosis of SMPP.

Objective To observe the effect of risperidone combined with clozapine in the treatment of vagrants with schizophrenia and its influence on social function of the patients.Methods Eighty patients with vagrant schizophrenia were selected as the study objects by a prospective randomized controlled trial,and were randomly divided into control group(40 cases)and observation group(40 cases).The control group was treated with risperidone,and the observation group was treated with risperidone and clozapine.Both groups received continuous treatment for 8 weeks.The clinical effects of the two groups were observed.The activities of daily living,rehabilitation[Inpatient Psychiatric Rehabilitation Efficacy Rating Scale(IPROS)score],social function,myocardial enzyme profile[lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB)]in the two groups before treatment and eight weeks after treatment were compared.The adverse reactions of the two groups were statistically analyzed.Results The total effective rate of treatment in the obser-vation group was higher than that of the control group(90.00％versus 72.50％,P＜0.05).After eight weeks of treatment,the abilities of daily living and social function of the two groups were stron-ger than before treatment,and the observation group was stronger than the control group.At 8 weeks of treatment,IPROS scores in two groups were lower than before treatment,and observation group was lower than control group(P＜0.05).After 8 weeks of treatment,LDH,CK and CK-MB levels in two groups were higher than before treatment(P＜0.05),but there was no statistical significant between-group difference(P＞0.05).Conclusion Risperidone combined with clozapine has a significant effect in thetreatment of vagrants with schizophrenia,which can enhance the patients'daily living ability and social ability,improve the rehabilitation status,and does not increase the adverse reactions.

Objective To observe the effect of risperidone combined with clozapine in the treatment of vagrants with schizophrenia and its influence on social function of the patients.Methods Eighty patients with vagrant schizophrenia were selected as the study objects by a prospective randomized controlled trial,and were randomly divided into control group(40 cases)and observation group(40 cases).The control group was treated with risperidone,and the observation group was treated with risperidone and clozapine.Both groups received continuous treatment for 8 weeks.The clinical effects of the two groups were observed.The activities of daily living,rehabilitation[Inpatient Psychiatric Rehabilitation Efficacy Rating Scale(IPROS)score],social function,myocardial enzyme profile[lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB)]in the two groups before treatment and eight weeks after treatment were compared.The adverse reactions of the two groups were statistically analyzed.Results The total effective rate of treatment in the obser-vation group was higher than that of the control group(90.00％versus 72.50％,P＜0.05).After eight weeks of treatment,the abilities of daily living and social function of the two groups were stron-ger than before treatment,and the observation group was stronger than the control group.At 8 weeks of treatment,IPROS scores in two groups were lower than before treatment,and observation group was lower than control group(P＜0.05).After 8 weeks of treatment,LDH,CK and CK-MB levels in two groups were higher than before treatment(P＜0.05),but there was no statistical significant between-group difference(P＞0.05).Conclusion Risperidone combined with clozapine has a significant effect in thetreatment of vagrants with schizophrenia,which can enhance the patients'daily living ability and social ability,improve the rehabilitation status,and does not increase the adverse reactions.

Objective:To investigate the influence of different degrees of facet joint arthropathy on the indirect decompression effect of crenel lumbar interbody fusion (CLIF), and the clinical outcomes of CLIF for the treatment of lumbar spinal stenosis with severe facet joint arthropathy (grade 3).Methods:This study reviewed a total of 269 surgical segments in 156 patients with lumbar spinal stenosis treated with CLIF technique from November 2016 to February 2020. According to preoperative CT images, the facet joint was graded according to Pathria classification. There are 19 segments with grade 0, 156 segments with grade 1, 67 segments with grade 2, and 27 segments with grade 3. Radiographic parameters included disc angle, anterior and posterior disc height, and bilateral intervertebral foramen height on CT, and the midsagittal canal diameter and axial central canal area. In 30 patients with at least one segment of grade 3, the clinical efficacy was assessed using visual analogue scale (VAS) and Oswestry disability index (ODI).Results:The average the anterior and posterior intervertebral space height, intervertebral space angle, height of bilateral intervertebral foramina, spinal canal sagittal diameter and spinal canal area were significantly improved after the operation of grade 3 facet joint degeneration segment compared to preoperation. The preoperative mean spinal canal sagittal diameter and spinal canal area of grade 3 facet joint degeneration segment were significantly less than grade 1 and grade 2. The average change of spinal canal area after grade 3 articular degeneration was significantly less than that of grade 1 and 2, but there was no significant difference with that of grade 0. The posterior decompression rate was 55.56% (15/27) for grade 3, 35.82% (24/67) for grade 2, 16.03% (25/156) for grade 1, and 21.05% (4/19) for grade 0. The posterior decompression rate of grade 3 articular process degeneration was significantly higher than that of other grades ( P<0.001). Severe lateral recess stenosis and 24.24% of severe intervertebral foraminal stenosis were found in 81.48% of grade 3 degenerative segment. The 23 patients were followed up with an average of 21.62±6.52 months, and the average improvement of ODI was 24.10%±11.09%; the average VAS for leg pain and back pain were improved significantly. Conclusion:The degrees of facet joint degeneration do not prevent intervertebral space distraction of CLIF. However, because segments with severe facet joint arthropathy were usually associated with severe spinal canal stenosis, CLIF had a high rate of second-stage posterior decompression in the treatment of lumbar spinal stenosis with severe facet joint arthropathy.

Objective:To investigate whether nursing students face the transition shock problems in the stage of clinical practice, and analyze the performance in the dimensions of physical, emotional, intellectual, sociocultural and developmental, and provide reference for formulating clinical intern training programs for nursing students.Methods:A cross-sectional survey of nursing students on the impact of transition shock and its influencing factors were conducted using the General Survey Form and the Transition Shock of Newly Graduated Nurses Scale.Results:The transition shock score of nursing students was 64.49±16.33. The score of physical dimension was 15.73±5.22, intellectual dimension was 13.13±3.80, emotional dimension was 19.15±5.32, sociocultural and developmental dimension was 16.47±5.41. The proposed academic qualifications ( F value was 5.96, P<0.01), the reason for choosing nursing profession ( F value was 7.28, P<0.01), family support level ( t value was -2.75, P=0.01), first internship department ( F value was 5.22, P<0.01), and internship intention ( F value was 3.43, P=0.03) cause the differences in the transition shock of nursing students. Conclusions:Nursing students will face the transition shock problems in the stage of clinical practice, and the impact of physical dimension is the most obvious. In the development of clinical internship training programs, hospitals and institutions should take into account the transition shock of nursing students, as earlier as possible perceive and prevent the occurrence and intensification of nursing students' clinical transformation problems, and assist them to successfully pass the transitional impact stage.

Objective: To assess the relationship between body mass index (BMI) and mortality in adults of Shanxi, China. Methods: Baseline data were from the '2002 China Nutrition and Health Survey’ in Shanxi province. All the death-related investigation and follow-up visits were carried out from December 2015 to March 2016. The follow-up program covered 5 360 people from all the 7 007 participants aged 18 years and over that having complete core information, with a rate as 76.5%. Participants of this study were divided into eight groups, according to the appearance of BMI. Taking the group with the lowest mortality density as the reference group, Cox regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of deaths by the whole population, gender and age groups (≥60 years, <60 years). Results were then adjusted by age, gender, smoking, alcohol use and education level from the baseline survey. Sensitivity analysis was also conducted. Results: Results from the study showed that among the total number of 67 129 person- years from the average period of 12.5 years, there were 615 deaths occurred, with the mortality density as 916 per 100 000 person-years. Taking the BMI range of 26.0-27.9 kg/m² as the reference, the aHRs of death increased to 1.90 (95%CI: 1.26-2.86), 1.68 (95%CI: 1.15-2.45), 1.49 (95%CI: 1.08-2.06) and 1.72 (95%CI: 1.07-2.76) after the multivariate adjustment, in these four groups (BMI<18.5, 18.5-19.9, 22.0-23.9 and ≥30.0 kg/m²), respectively. Low body weight (BMI<18.5 kg/m²) was associated with higher risks of death in the elderly of ≥60 years, with the aHR of death as 1.94 (95%CI: 1.20-3.15). Conclusions When BMI appeared as ≤19.9 kg/m², 22.0-23.9 kg/m² and ≥30.0 kg/m², the risks of death would increase. In addition to programs that focusing on obesity, special attention should be paid to the high risk of mortality which was caused by low-weight and malnutrition in the elderly.

The article expounds systematically the status quo of nursing management in the medical alliances from four aspects: exploring the nursing management model; standardizing, normalizing and optimizing the nursing management; completing the training system of nursing talents, and improving the training of nursing management talents; supporting orderly flow of quality nursing resources within the medical alliance. The authors pointed out the development trend of nursing management in medical alliances as informatization, the long-term training mechanism for management talent, and the last is achieving the homogenization of nursing management.

We compared the ways of deproteinization for crude polysaccharides of Coprinus comatus, and finally selected Sevage method as the optimal method. Two main fractions of Ccp-I-A and Ccp-I-B were obtained after DEAE-52 cellulose and Sephadex G-200 chromatography, both were white-floc, soluble in water, insoluble in absolute ethyl alcohol, acetone and other organic solvents. Additionally, Fehling reagent, CTAB, Sulphuric acid-carbazole, I-KI and FeCl₃ reaction were all negative. GC analysis showed Ccp-I-A was composed of mannitose, glucose and galactose in molar ratios of 2.03:9.52:1, whereas Ccp-I-B was composed of fucose and galactose with molar ratios of 1:5.21. Antioxidant activity test showed that Ccp-I-A and Ccp-I-B had good scavenging abilities on DPPH and ·OH. Compared to Ccp-I-B,the scavenging activity of Ccp-I-A was much stronger, and the scavenging rate could reach 72.1% and 55.3% respectively when the concentration was 300 μg/mL.

Enantioselective hydrolysis of 2-carboxyethyl-3-cyano-5-methylhexanoic acid (CNDE) is the key step in chemoenzymatic synthesis of pregabalin. We purified an intracellular carboxyl esterase from Morganella morganii ZJB-09203, which exhibited high enantioselectivity and activity towards CNDE. The carboxyl esterase was purified to electrophoretic homogeneity by ammonium sulfate fraction precipitation, Phenyl Sepharose 6 FF hydrophobic interaction chromatography, anion exchange with DEAE Sephadex A-50 and Bio-Scale CHT column. The purified enzyme was a monomer with molecular mass of 68 kDa determined by SDS-PAGE and gel chromatography. Substrate specificity of the enzyme towards p-nitrophenyl esters suggested that the purified enzyme was an esterase. The optimal reaction pH for CNDE hydrolysis was 9.0, and optimal temperature was 45 degrees C. The esterase was stable between pH 7.0 and 9.0, and at 40 degrees C. The enzyme activity was enhanced by Ca2+, Cu2+ and Mn2+, whereas strongly inhibited by Co2+, Fe3+, Ni2+ and EDTA. Meanwhile, we investigated the kinetic parameters of the esterase towards p-nitrophenyl esters and effect of CNDE concentration on conversion. The present study reported the esterase capable of stereospecific hydrolysis of CNDE for the first time. Our research will provide foundations for industrial production of Pregabalin using the new biocatalyst.
Chromatography, Gel ; Electrophoresis, Polyacrylamide Gel ; Esterases ; metabolism ; Hydrogen-Ion Concentration ; Kinetics ; Molecular Weight ; Morganella morganii ; enzymology ; Substrate Specificity ; Temperature