OBJECTIVE To investigate the causal association between ticagrelor and risk of infection METHODS Two-sample Mendelian randomization was adopted. Genetic instrumental variables were selected based on the results of the largest genome-wide association analysis to in vivo exposure of ticagrelor and its major active metabolite AR-C124910XX. The causal associations of ticagrelor and its major active metabolite AR-C124910XX with drug indications （coronary artery disease， unstable angina pectoris， myocardial infarction， stroke and ischemic stroke）were analyzed by inverse variance weighted Mendelian randomization model as a positive control for genetic instrumental variables. The causal relationship between ticagrelor and bacterial infection， acute lower respiratory infection， bacterial pneumoniae， pneumoniae，acute upper respiratory infection and sepsis were furtheranalyzed by using this method， and the robustness of the results was assessed by using heterogeneity tests and horizontal 202002030415） pleiotropy tests. RESULTS The increase of area under the curve at steady state （AUCss） of the genetic surrogated ticagrelor significantly reduced the risk of coronary artery disease， myocardial infarction and unstable angina pectoris （P＜0.001）. AUCss genetic instrument variables of its main active metabolite AR-C124910XX failed to pass positive control. Further analysis showed that the increase of the genetic surrogated ticagrelor exposure suggestively reduced the risk of bacterial infection [OR（95%CI）＝0.80（0.65，0.99），P＝0.040] and sepsis [OR （95%CI）＝0.84（0.73， 0.98）， P＝0.023]. The results of the heterogeneity tests showed that there was no heterogeneity in the causal association of the genetic surrogated ticagrelor AUCss with bacterial infection and sepsis （P＞0.05）. The results of horizontal pleiotropy tests showed that the causal association of genetic surrogated ticagrelor AUCss with bacterial infection and sepsis had no effects on horizontal pleiotropy （P＞0.05）. CONCLUSIONS Ticagrelor has a potential role in reducing the risk of sepsis and bacterial infections.

Objective:The arsenic content of drinking water in Aksu Prefecture of Xinjiang Uygur Autonomous Region (referred to as Xinjiang) was analyzed to understand the distribution of arsenic content and arsenic form of water in each county and city.Methods:In 2020, a total of 117 waterworks and villages (towns) under the jurisdiction of waterworks in 7 counties and 2 cities were randomly sampled, arsenic content in water was detected by atomic fluorescence spectrometry, and arsenic form in water was detected by liquid chromatography atomic fluorescence spectrometry.Results:A total of 626 water samples were collected, 614 water samples with water arsenic content < 0.01 mg/L, accounting for 98.08%; 12 water samples with water arsenic content 0.01 - < 0.05 mg/L, accounting for 1.92%; and there was no water sample with arsenic content ≥0.05 mg/L. The form of arsenic in excessive water sample in Aksu Prefecture was found to be five-valent arsenate. The arsenic content in the water of Awati County was the highest (0.004 6 mg/L).Conclusions:There are still some counties and cities with high arsenic content in water in Aksu Prefecture, and there are still hidden dangers of drinking-water brone endemic arsenism. Therefore, the water treatment technology should be improved or the water sources should be changed to prevent endemic arsenism.

Objective:To investigate the emergency surgical effect of ruptured intracranial dural arteriovenous fistula (DAVF).Methods:Patients with ruptured intracranial DAVF underwent microsurgery in the Department of Neurosurgery, Nanping First Hospital Affiliated to Fujian Medical University from May 2013 to July 2022 were retrospectively included. The clinical, imaging and follow-up data were collected, and the clinical characteristics, selection of surgical methods and treatment effects of patients were summarized.Results:A total of 8 patients with DAVF were enrolled. Their age ranged from 11 to 60 years (average, 48 years). There were 7 males and 1 female. All 8 patients suffered from intracranial hemorrhage, manifested as headache and vomiting in 2 cases, simple conscious disturbance in 2 cases, conscious disturbance with cerebral hernia in 3 cases, and conscious disturbance with limb paralysis in 1 case. The fistula was located in the anterior fossa in 4 cases (including 2 cases with aneurysms), the middle fossa in 2 cases (including 1 case with moyamoya disease), the transverse sinus in 1 case, and the anterior 1/3 area of the sagittal sinus in 1 case. Cognard classification: 7 patients were type Ⅲ and 1 was type Ⅳ. After admission, all patients underwent emergency craniotomy and microsurgery to remove hematoma. Among them, 4 patients underwent decompressive craniectomy at the same time, 1 patient with moyamoya disease underwent dural turnover and temporalis muscle application at the same time, and 2 patients with aneurysms at the same location were clipped at the same time. Postoperative re-examination of head CT showed that the hematoma was cleared satisfactorily and the midline was no shift in all 8 patients. CT angiography (CTA) showed that the fistula disappeared within 2 weeks. Seven patients were followed up within 1-12 months after operation. CTA or digital subtraction angiography showed no recurrence of DAVF. Two patients with aneurysms did not have residual or recurrent aneurysms. All patients had no new neurological symptoms, and the Glasgow Outcome Scale score in 2 patients increased by 1 compared with that at discharge.Conclusion:Emergency microsurgery is an effective method for the treatment of ruptured intracranial DAVF, especially for patients with special parts or complicated hematoma, cerebral hernia, and other vascular diseases.

Objective To investigate the gestational weight gain and quality of life in women with gestational diabetes mellitus(GDM) who used Free-Style Libre Flash Glucose Monitoring System. Methods From August of 2017 to January of 2019, the GDM patients diagnosed in the Department of Endocrinology in 3 ClassⅢ Grade A hospitals in Guangzhou were selected and divided into the observation group(n=39) and control group(n=43) according to their glucose monitoring willingness. The Free-Style Libre Flash Glucose Monitoring System was used for the observation group(sensor changed every 14 days) combined with the fingertip blood glucose monitor, it was necessary to monitor fingertip blood glucose contrast when hypoglycemia was identified by sensors. Pregnant women at other monitoring points could selectively monitor fasting and postprandial blood glucose. In the control group, after assigned into the group patients only monitored their fingertip blood glucose(at lease 2 times/d, including fasting and 2h postprandial blood glucose). The two groups were all instructed by self-management on diet, exercise etc according to the result of blood glucose monitor, the Wechat management was included to instruct them of the daily life diary recording method. World Health Organization-5 Well-Being Index (WHO-5) was adopted at the beginning of the study and the second week of follow-up to investigate the well-being index score of the patients in the two groups; at the end of pregnancy, the average perinatal blood sugar level, incidence of hypoglycemia events and the eligible rate of weight gain in different BMI patients were recorded. Results At the 2nd week, the score of well-being index in the observation group was higher than that in the control group with statistical significance(P=0.037).There was no statistically significant difference in fasting and 2 h postprandial glucose between the two groups (P＞0.05). There was no significant difference in blood sugar control (fasting and 2 hours after meal) between the two groups (P＞0.05), but the detection rate of hypoglycemia in the group using Free-style Libre glucose monitoring system was higher than that in the control group (P=0.042). By the end of pregnancy, stratified analysis showed that the qualified rate of weight gain in the observation group with BMI between 18.5 and 24.9 kg/m2 before pregnancy was higher than that in the control group with statistical significance(P=0.035). Conclusions The use of Free- Style Libre Flash Glucose Monitoring System in GDM patients makes gestational weight control more reasonable and painless, and improves the well-being index of patients.

Objective To explore the microsurgery methods in patients with early intracranial aneurysm rupture. Methods Sixty-seven patients with early intracranial aneurysm rupture received the emergency microsurgery after releasing cerebrospinal fluid from improved Paine point via pterion craniotomy. Thirty-nine patients received surgery within 1 d after intracranial aneurysm rupture, and the other 28 patients were within 1-3 d. Results The therapeutic effect was evaluated by Glasgow outcome score (GOS) at discharge. Among the 45 patients with Hunt-Hess Ⅰ-Ⅲ grade, cure was in 41 cases, improved in 4 cases. Among the 22 patients with Hunt-HessⅣ-Ⅴgrade, cure was in 6 cases, improved in 6 cases, moderate disability in 4 cases, severe disability in 1 case, and death was in 5 cases. Conclusions The microsurgery of clipping aneurysm directly via pterion approach is still by far the most reliable treatment. And releasing cerebrospinal fluid from improved Paine points can effectively reduce the acute brain swelling of early operation, which will make it an effective adjuvant therapy to emergency microsurgery of clipping aneurysm.

OBJECTIVE:To provide reference for the patent application of artificial cultivation and seed treatment technology of Paridis Rhizoma and natural resources protection. METHODS:Retrieved from State Intellectual Property Office patent database,“Paridis Rhizoma”and“Paris polyphylla”were used as search keywords from 1985 to March 31,2015;Paridis Rhizoma cultiva-tion and seed treatment technology patents as research object were analyzed in fields of the amount of patent application,regional construction and legal status,etc. RESULTS:Among 54 Paridis Rhizoma cultivation patent application,there were 19 applications from Yunnan,9 from Sichuan,8 from Hubei,5 from Anhui,4 from Hunan,3 from Guizhou,2 from Jiangxi,1 from Fujian, Shanxi,Jiangsu,Guangxi respectively;there were 18 licensed patents,and 13 licensed patents maintained more than 3 years, among which 1 patent right transferred;from aspect of patent without right,6 patent right were given up due to fail to pay annual fee,1 rejected and 5 withdrawn;from main types of patent proposer,enterprise submitted 24 patent application,universities 15, scientific research institutes 8 and other 7. 24 enterprise patents involved 21 enterprises,indicating that patent protection net didn’t form due to disperse proposers. CONCLUSIONS:Patent application is mainly from Yunnan. There still are some problems,such as small number of patent applications,poor quality of application writing,little patent transformation. It is suggested to plan artificial cultivation technology,enhance the quality of patent application,pay attention to patent operation and achievement transformation and other measures,in order to protect Paridis Rhizoma resource and industrial development.

Paridis Rhizoma is a rare Chinese herbal medicine with variety of medicinal values. In recent years, the demand for Paridis Rhizoma has increased gradually. Artificial cultivation has met difficulties, while exploitation of wild resources was caught in a vicious circle and has overdrawn seriously. So it is of great significance to enhance the protection of Paridis Rhizoma, carry out basic research, in order to solve problems in seeding breeding, promote artificial cultivation to meet the market need and achieve sustainable development and supply. This article reviewed the status qua of seedling breeding of Paridis Rhizoma, including seed breeding, tuber breeding and tissue culture, with a purpose to standardize planting of resource conservation and utilization of Paridis Rhizoma.

Objective To establish an analytical method of chromatographic fingerprint of cortex moutan in Dianjiang County through HPLC;To provide reference for the quality control and general evaluation. Methods HPLC with Shim-pack VP-ODS C18 column (4.6 mm×250 mm, 5μm) was used;paeonol was taken as standard;the mobile phase was MeOH-H2O with liner gradient eluation;the delection mavelength was at 274 nm for paeonol and 230 nm for paeoniflorin;the flow rate was 1.0 mL/min. Fourteen batches of samples were analyzed to establish the fingerprint with paeonol and paeoniflorin as reference. Results The results of the 14 batches of samples and similarity evaluation showed that the similar degrees to the 10 batches among the 14 samples were between 0.968-0.998, which illustrated the good similar degrees among samples. Conclusion The established fingerprint with characteristics of stability, good reproducibility and simplicity, can be used for the quality evaluation and control of cortex moutan.

Objective To systematically review the efficacy of bispectral index (BIS) monitoring for prevention of intraoperative awareness in patients under general anesthesia.Methods The Cochrane Central Register of Controlled Trials (Central),PubMed,Medline,and EMBASE were searched for randomized controlled clinical trials involving detection of intraoperative awareness in patients in whom BIS was used or not under general anesthesia.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included the incidence of intraoperative awareness.Meta-analysis was conducted using RevMan 5.1 software.Results Five randomized controlled clinical trials involving 34181 patients were included in this meta-analysis.There were 17432 cases in whom BIS was applied and the incidence of intraoperative awareness was 0.132％.There were 16749 cases in whom BIS was not used and the incidence of intraoperative awareness was 0.245％.There was no significant difference in the incidence of intraoperative awareness between the two groups (P ＞0.05).Further analysis was performed according to the method of anesthesia.In inhalational anesthesia,there were 13288 cases in whom BIS was applied and the incidence of intraoperative awareness was 0.128％,and there were 13202 cases in whom BIS was not applied and the incidence of intraoperative awareness was 0.113％.There was no significant difference in the incidence of intraoperative awareness between the two groups (P ＞ 0.05).In total intravenous anesthesia,there were 4144 cases in whom BIS was applied and the incidence of intraoperative awareness was 0.145％,and there were 3547 cases in whom BIS was not applied and the incidence of intraoperative awareness was 0.733 ％.The incidence of intraoperative awareness was significantly lower in the patients in whom BIS was applied than those in whom BIS was not applied (P ＜ 0.01).Conclusion BIS monitoring can effectively prevent the development of intraoperative awareness in patients under total intravenous anesthesia,but can not prevent the development of intraoperative awareness in patients under inhalational anesthesia.

Objective To study the quality difference of various processing methods about Angelica dahurica. Methods Samples were selected from different places, clean silt by washing and brushing, cut slices and cut blocks in equal division, dried and comminution, to determine total ash, ethanol thermal extract, imperatorin content and HPLC fingerprint similarity. Results The content of total ash was the lowest in “washed”and “washed & cut slice” sample, dilute ethanol thermal extract was the highest in“cut blocks”and“washed&cut blocks”sample, imperatorin content was the highest in“non-washed”and“non-washed & cut slice” sample. Conclusion Washed and cut process is not suitable in place of origin about Angelica dahurica.