Objective To explore the effects of glycyrrhizic acid(GA)on neurons injury in traumatic brain injury(TBI)rats and the possible mechanism.Methods The rats were randomly divided into sham-operation group,model group,control group and experimental-L,-M,-H groups,with 20 rats each group.The sham-operation group was only treated with craniotomy;the other 5 groups were used to establish TBI models by extracorporeal shock method.At 0,24 and 48 h after modeling,the experimental-L,-M,-H groups were intraperitoneally injected with 10,50 and 100 mg·kg-1 GA solution,respectively;control group was intraperitoneally injected with 2 mg·kg-1 nimodipine;sham-operation and model groups were intraperitoneally injected with the equal volume of phosphate buffered solution.The degree of neurological dysfunction was evaluated by cerebral edema and modified neurological severity score(mNSS).The apoptosis rates of neurons in rat brain tissue was evaluated by apoptosis staining.Western blot was used to analyze the expression levels of apoptosis-related proteins and aquaporin 4(AQP4)protein.Results The mNSS scores of experimental-M,-H groups,control group,model group,sham-operation group were(6.98±0.82),(5.28±0.37),(5.91±0.52),(13.28±1.59)and(0.36±0.01)points;the degrees of brain edema were(63.27±10.33)％,(60.09±9.38)％,(66.86±9.91)％,(85.92±11.93)％and(52.17±8.53)％;the apoptosis rates of neurons were(6.81±0.73)％,(5.39±0.25)％,(5.87±0.62)％,(15.13±3.29)％and(2.56±0.03)％;the relative expression levels of B cell lymphoma 2(Bel-2)protein were 0.49±0.06,0.68±0.15,0.62±0.03,0.13±0.03 and 0.95±0.13;the relative expression levels of Bel-2 associated X protein were 0.61±0.08,0.55±0.17,0.39±0.09,0.92±0.19 and 0.16±0.02;the relative expression levels of AQP4 protein were 0.69±0.15,0.38±0.03,0.47±0.09,0.86±0.13 and 0.13±0.09,respectively.There were statistically significant differences in the above indexes between the model group and the experimental-M,-H groups and control group(all P＜0.05).Conclusion GA is able to reduce the brain edema degree and neurological dysfunction in TBI rats,and inhibit neuronal damage and apoptosis,and the mechanism of action may be associated with the inhibition of AQP 4 expression.

Objective To investigate the influence of the national volume-based procurement(NVBP)policy on the economy and use structure of anti-infective drugs in a general 3-A hospital,and to provide a reference for the standardization of clinical application management and policy implementation.Methods The price,defined daily doses(DDDs),average defined daily cost(DDDc),actual cost saving,substitution rate of selected drugs(SRSD)and avoidance rate of alternative drugs(ARAD)of anti-infective drugs before and after the implementation of 1-7 collection NVBP policy were analysed.Results The NVBP policy led to a＞70％reduction in the price of 70.73％of the hospital's target drugs,69.70％of the DDDs increased,81.82％of the DDDc decreased and 63.64％showed the relationship of"volume increase and price decrease".The average SRSD was 84.49％in the first cycle and 95.94％in the second cycle.The average actual cost saving in the first cycle was 474 100 yuan,with an average saving rate of 407.60％,and in the second cycle was 803 100 yuan,with an average saving rate of 1 257.04％,showing an increasing trend year by year.The consumption of alternative drugs increased by 53.85％in the first cycle and 66.67％in the second cycle,with the highest annual increase of 555.63％,and the average of 74.65％.Conclusion After the implementation of NVBP policy,selected drugs mainly replaced unselected drugs,and the cost of anti-infection treatment was greatly reduced.However,it was necessary to strengthen the control of alternative drugs,standardize the management of clinical application,carry out clinical comprehensive evaluation of selected drugs and real world research.

Abstract：Objective To optimize the production process of inactivated vaccine of Aeromonas veronii（AV）CA07 strain. Methods The fermentation culture process of AV CA07 strain liquid was determined through the optimization of the culture time（2～16 h），medium（optimized fermentation medium，LB medium and NB medium）and fermentation conditions（in⁃ oculation amount of 1%，5%，10% and 15%；ventilation rate of 2，4，6 and 8 L／min and fermentation time of 6，8，10 and 12 h）. The optimal inactivation process was determined through the comparison of the final concentration of formalde⁃ hyde solution（0. 10%，0. 20%，0. 30% and 0. 40%），inactivation temperature（28 and 37 ℃）and inactivation time（24， 48 and 72 h）. The large⁃scale production process of inactivated vaccine of AV CA07 strain in 500 L fermentor was estab⁃ lished and the prepared vaccines were tested for safety and immunogenicity. Results The optimal inoculation amount of AV CA07 strain was 5%，ventilation rate was 4 L／min and culture time was 10 ~ 12 h. The optimal inactivation condition was adding formaldehyde solution with final concentration of 0. 30% incubating at 37 ℃ for 24 h. The number of viable bacteria in the fermentation broth of AV CA07 strain prepared in 500 L fermentor was more than 8 × 109 CFU／mL. All crucian carps immunized with the inactivated vaccine by abdomen survived. After challenge，the relative immune protection rate was more than 90%. Conclusion AV CA07 strain inactivated vaccine prepared by optimized production process showed good safety and immunogenicity.

Prosthetic infection is one of the severe postoperative complications of arthroplasty. Mixed bacterial-fungal prosthetic infection is rare but can be disastrous. This case was a 76-year-old female suffered from prosthetic infection following total hip replacement due to femoral neck fracture and underwent multiple debridements. The culture of periprosthetic tissue was bacteriologically sterile following the first debridement, while the Staphylococcus hominis was identified in the second debridement in the previous hospitalization where fungal infection had not been considered. Thus the pathogen spectrum of anti-infection therapy failed to contain fungus. Ultimately, the culture result of our sampled periprosthetic tissue during the third debridement was Candida albicans without bacterium in our hospital. The fungal prosthetic infection was successfully treated by a two-stage revision with antifungal drugs. Accurate diagnosis and standardized treatment is the key to the therapy of infection after hip arthroplasty, especially for mixed bacterial-fungal prosthetic infection.
Aged ; Anti-Bacterial Agents/therapeutic use* ; Arthroplasty, Replacement, Hip/adverse effects* ; Debridement ; Female ; Fungi ; Hip Prosthesis/adverse effects* ; Humans ; Mycoses/drug therapy* ; Prosthesis-Related Infections/therapy* ; Reoperation ; Retrospective Studies ; Treatment Outcome

Objective:To compare the dose and image quality of selected photon shield (SPS) technique, organ-based tube current modulation (OBTCM) technique and the combination of these two techniques for reducing the organ dose in head CT examination for infants.Methods:Two anthropomorphic head phantoms (CIRS 1-yr-old and 5-yr-old) were scanned by using Reference mode, Reference + OBTCM mode, SPS mode and SPS + OBTCM mode, respectively. Radiation doses to the lens of the eye, the anterior of the brain, the posterior of the brain, noise level and CNR of orbit and brain in different phantoms were measured and compared by using different scanning modes.Results:Compared with Reference mode, the doses to the lens of the eye in 1-yr-old and 5-yr-old phantom decreased by (21.89 ± 0.01)% and (28.33 ± 0.34)%, respectively. In SPS mode, the reduction in doses to the lens of the eye in 1-yr-old and 5-yr-old phantom were (71.38 ± 1.30)% and (53.72 ± 2.42)%, respectively. In SPS + OBTCM mode, the reduction was (71.12 ± 2.54)% and (55.73 ± 1.90)%, respectively. There was significant difference in the noise level of orbit and brain in different phantoms under various scanning modes ( F=5.67-85.47, P< 0.05). The noise level in OBTCM mode compared with reference mode increased slightly (<1.45 HU) in various phantoms. SPS and SPS + OBTCM mode resulted in a small noise increase (<2.58 HU). There was no significant difference in CNR of different phantoms under various scanning modes ( P>0.05). Conclusions:SPS and SPS + OBTCM mode can significantly reduce the radiation dose of lens and the whole image plane in the head CT scan for infants, with maintaining the image quality.

The solubilization and protection of curcumin (Cur) by mixed surfactants were studied through the determination about the critical micellar concentration (CMC) of the mixed surfactants of Tween 80 and dodecyl trimethyl ammonium bromide (DTAB), molar solubilization ratio (MSR), degradation rate (k) of Cur in pH 13 solution and mixed surfactant solutions prepared at pH 13. The results showed that when Tween 80 was used alone, it exhibited high solubilization ability but poor stability. DTAB was used alone, it showed strong stability but poor solubilization ability. When DTAB was mixed with Tween 80 at different mole fractions, the stability of Cur was enhanced, and the best stability was observed when the mole fraction of DTAB was 0.4, although the solubilization ability was not the best at this mole fraction, but MSR was increased by 1.7 times compared to DTAB used alone. Mixed surfactant not only increased the solubility but also improved the stability of Cur. In addition, mixed surfactant has the advantages of less dosage and low toxicity, which is worth popularizing in application.

OBJECTIVE: To review the literature regarding diagnosis and treatment of labral tear. DATA SOURCES: A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy. STUDY SELECTION: For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted. RESULTS: Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown. CONCLUSIONS Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.
Acetabulum ; injuries ; Arthroscopy ; Hip Injuries ; Humans ; Rotator Cuff Injuries ; Rupture ; diagnosis

Codeine-O-demethylase (CODM) is a key enzyme in the biosynthesis of codeine and morphine. In this study, CODM gene sequences were cloned from Papaver somniferum and Papaver rhoeas, and were compared with each other by sequence alignment and bioinformatics analysis. The results showed that there were three genotypes of CODM in Papaver somniferum and five genotypes of CODM in Papaver rhoeas. Bioinformatics analysis showed that all CODM proteins had no signal peptide sequence, and these proteins were predicted to be non-secretory proteins, belonging to the Pcbc supergene family. Although the amino acid sequences of CODM in poppies are the same, the expression levels of CODM in different poppy resources are significantly different. It is speculated that the variation of transcription level of CODM may be related to its non-coding region sequence, which lays a foundation for further research on the synthesis and regulation mechanism of alkaloids in poppies.

Objective To investigate the effect of scan table on size-specific dose estimate ( size-specific dose estimate, SSDE) in children's CT scan. Methods CT imaging data and CTDIvol of 44 children ( 15 heads, 13 chests, 16 abdomen-pelvis) who underwent Siemens SOMATOM Definition AS+ 64 row 128-slice CT scan were retrospectively collected. CTDIvol of each patient was recored, WED ( water equivalent diameter) was calculated by two different methods ( with or without table) , donated as WED-T and WED-NT, then the corresponding SSDEWED ( SSDEWED-T and SSDEWED-NT ) was calculated. And the SSDEWED-NT was used as reference to evaluate the difference between WED and SSDEWED obtained by two different methods. Results Including part of table will lead to the overestimate for WED, with mean differences of 0. 10％, 2. 82％ and 2. 54％ for head, chest and abdomen-pelvis, respectively, while SSDEWED will be underestimated by 0. 06％ ( head ) , 2. 70％ ( chest ) and 1. 59％ ( abdomen-pelvis ) . Conclusions Including par of the patient table has a certain effect on SSDEWED for children, more attention should be paid for the application of SSDEWED.

Objective: To explore the effects of continuous veno-venous hemodiafiltration (CVVHDF) as a rescue therapy in children with Kawasaki disease (KD) complicated with multiple organ dysfunction syndrome (MODS). Methods: The medical records of 5 patients diagnosed as KD with MODS treated with CVVHDF, who were admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from November 2015 to October 2017 were retrospectively collected. The inflammatory factors and parameters of organ function before and after CVVHDF treatment were analyzed. Wilcoxon test was used to compare the changes of parameters before and after CVVHDF treatment. Results: The pediatric critical illness score (PCIS) and the pediatric risk of score mortality score Ⅲ (PRISMⅢ) were 74.0 (70.0, 81.0) and 14.5 (12.5, 17.0), respectively. The duration of CVVHDF treatment was 46.0 (24.5, 48.0) h. The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), blood lactic acid were significantly decreased after the CVVHDF treatment (0.4 (0.1, 28.8) vs. 142.0 (123.1, 1 454.6) ng/L, Z=-2.023, P=0.043; 0.1 (0.1, 9.3) vs. 1.7(1.1, 30.0) ng/L, Z=-2.023, P=0.043; 1.2(1.1,1.4) vs. 2.5(2.4, 2.7) mmol/L, Z=-2.041, P=0.041 respectively). Moreover, the lung, liver and kidney function were significantly improved as indicated by the ratio of PaO₂ to FiO₂ (380.0 (182.5, 397.5) vs. 160.0 (52.5, 185.0)mmHg (1 mmHg=0.133 kPa), Z=2.041, P=0.041), the level of total bilirubin ((14.9±1.3) vs. (86.4±9.9) μmol/L), and the levels of creatinine (2 cases: 24.0vs. 103.0 μmol/L, 38.0 vs. 142.0 μmol/L). Conclusion CVVHDF as an adjuvant therapy can rapidly reduce the levels of IL-6 and TNF-α,and improve the organ functions in children with KD complicated with MODS.