Objective:To explore the possible mechanism of Bupiwei Xieyinhuo Shengyang Prescription on gastroesophageal reflux disease (GERD) based on network pharmacology and molecular docking technology.Methods:The main active components and target information of Bupiwei Xieyinhuo Shengyang Prescription were screened by TCMSP database, and targets were identified by GeneCards, OMIM, TTD and PharmGKB databases. The intersection of active ingredient components and disease targets was selected to construct PPI network by STRING. Cytoscape CytoNCA plug-in was used to extract core targets for analysis. GO function enrichment and KEGG pathway enrichment analysis were performed using Metascape. Cytoscape 3.7.2 was used to construct the "component-target-signal pathway" network, and Autodock was used to complete molecular docking verification. Animal experiments were further used for verification. SPF SD male rats were selected and GERD model was established by esophageal stent implantation. After 14 days of intervention, serum TNF-α and COX-2 levels of rats in each group were detected for verification.Results:A total of 215 effective compounds were screened from Bupiwei Xieyinhuo Shengyang Prescription. The main targets of GERD were TNF, IL6, CASP3, TP53 and PTGS2, which mainly focused on cancer pathway, AGE-RAGE signaling pathway, calcium signaling pathway and NF-κB signaling pathway. The results of molecular docking showed that the binding potential and activity of the key active components of Bupiwei Xieyinhuo Shengyang Prescription and the core target were better. Compared with the model group, Bupiwei Xieyinhuo Shengyang Prescription could reduce the serum expression levels of TNF-α and COX-2 ( P<0.01). Conclusions:By regulating TNF, IL6, CASP3, TP53, PTGS2 and other core targets, Bupiwei Xieyinhuo Shengyang Prescription can regulate NF-κB signaling pathway, calcium signaling pathway and other signaling pathways to play a role in the treatment of GERD.

Organ transplantation is an effective treatment for end-stage organ failure. However, organ shortage has always been a common problem faced by countries around the world. The recognition and active participation of intensive care unit (ICU) medical staff in organ donation contributes to promoting the development of organ donation, thereby alleviating the shortage of donor organ. In this article, the key strategies of ICU donor management to promote organ donation and the key strategies of ICU medical staff management to promote organ donation were summarized, aiming to provide reference for organ donation practitioners (especially ICU medical staff) and jointly facilitate the professional development of organ donation.

Objective To analyze driver genes status and its clinical characteristics of advanced lung adenocarcinoma, then evaluate the status of first-line treatment in a single centric real-world. Methods EGFR, ALK, ROS-1 gene in 204 advanced lung adenocarcinoma tissue were tested by ARMS-PCR method. And the relationship between driver genes status and clinical characteristics was analyzed as the first line treatment in real clinical practice. Results The positive rate of driver genes status in 204 advanced lung adenocarcinoma was 53.9％ (110/204) , including EGFR mutation 46.1％ (94/204) , ALK positive 6.4％ (13/204) and ROS1 positive 1.5％ (3/204). The driving genes status was significantly correlated with gender, smoking history, tumor staging and serosal invasion (P < 0.05). There were significantly differences among the proportion of first-line standard treatment in different subgroup (P = 0.000) , the first-line standard treatment rate of EGFR mutation, ALK/ROS1 positive and drive gene negative were 77.7％, 37.5％, and 46.8％ respectively. And the ratio of using 1 st generation EGFR-TKIs in all patients is 70.6％ (60/85). Conclusion More than half of advanced lung adenocarcinoma have driver genes changes, and EGFR-TKI first-line treatment has higher acceptability in real-word.

OBJECTIVE:To study risk factors for carbapenem-resistant Acinetobacter baumannii(CRAB)infection,and to provide reference for its clinical prevention. METHODS:In retrospective study,302 A. baumannii(AB)infection patients were collected from our hospital during Dec. 2012 to Jun. 2017. According to the results of drug sensitivity test,those patients were divided into CRAB group(116 cases)and non-CRAB group(186 cases). Risk factors for CRAB infection were analyzed by using univariate analysis. Multivariate Logistic regression analysis was performed for variables with significant difference between 2 groups. RESULTS:Univariate analysis showed that the factors of significant difference in 2 groups including patients suffering from septic shock(P=0.003),sepsis(P=0.000),combined with other infection(P=0.006),diabetes(P=0.029),malignant tumors(P=0.036),patients suffering from infection of other site except for pulmonary infection,intraabdominal infection and skin infection(P=0.009)before AB isolation,patients given carbapenems(P=0.002)and antifungal drugs 28 d before AB isolation(P=0.002). Multivariate Logistic regression analysis showed that the factors of significant difference in 2 groups including patients suffering from sepsis(P=0.033)or diabetes(P=0.011)before AB isolation. CONCLUSIONS:Independent risk factors for CRAB infection include patients suffer from sepsis or diabetes before AB isolation.

Objective To explore the association of nocturnal serum cortisol levels with diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus. Methods Serum cortisol levels of 316 overweight or obese type 2 diabetic patients were tested at midnight by the method of chemiluminescence. Diabetic microvascular complications were compared among various groups according to nocturnal serum cortisol levels. All the patients with nocturnal serum cortisol level > 50 nmol/L were asked to undergo overnight low-dose dexamethasone suppression test to rule out the possibility of subclincal Cushing's syndrome. The incidences of diabetic nephropathy ( DN ) , diabetic retinopathy ( DR ) , and diabetic peripheral neuropathy ( DPN ) were examined in all the patients. Results (1)The incidence of DN was gradually increased from 13.3％to 27.7％and 44.2％in patients with low, medium, and high cortisol level groups, showing a statistical difference among 3 groups ( P<0.05) . The incidences of DR in medium and high cortisol level groups were higher than that in low cortisol level group (40.6％and 47.7％vs 22.7％, both P<0.01). The incidence of DPN in high cortisol level group was higher as compared with low cortisol level group (60.5％ vs 38.7％, P<0.01). (2) Nocturnal serum cortisol level in patients with diabetic microvascular complications was higher than that in patients without complications [ (136.87 ± 105.78 vs 97.55 ± 93.48) nmol/L, P<0.01]. Nocturnal serum cortisol level in patients with multiple diabetic microvascular complications was higher than that in patients with single diabetic microvascular complication [ (151.66±114.54vs117.69±90.26)nmol/L,P<0.05].(3)Singlefactorlogisticregressionanalysisshowedthat higher nocturnal serum cortisol level was a risk factor for diabetic microvascular complications in addition to female, age, longer diabetic duration, higher fasting plasma glucose ( FPG ) . Multivariate logistic regression analysis showed that higher nocturnal serum cortisol level was still a risk factor for diabetic microvascular complications after adjusted by diabetic duration, FPG, HbA1C, and the use of insulin (P=0.013). Conclusion Nocturnal serum cortisol level seems to be a risk factor for diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus.

Objective: To investigate the clinical effect and safety of long-acting pegylated interferon-α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 μg/week) in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients, with standard-dose Peg-IFN-α-2a as positive control. Methods: This study was a multicenter, randomized, open-label, and positive-controlled phase III clinical trial. Eligible HBeAg-positive CHB patients were screened out and randomized to Peg-IFN-α-2b (Y shape, 40 kD) trial group and Peg-IFN-α-2a control group at a ratio of 2:1. The course of treatment was 48 weeks and the patients were followed up for 24 weeks after drug withdrawal. Plasma samples were collected at screening, baseline, and 12, 24, 36, 48, 60, and 72 weeks for centralized detection. COBAS® Ampliprep/COBAS® TaqMan® HBV Test was used to measure HBV DNA level by quantitative real-time PCR. Electrochemiluminescence immunoassay with Elecsys kit was used to measure HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe). Adverse events were recorded in detail. The primary outcome measure was HBeAg seroconversion rate after the 24-week follow-up, and non-inferiority was also tested. The difference in HBeAg seroconversion rate after treatment between the trial group and the control group and two-sided confidence interval (CI) were calculated, and non-inferiority was demonstrated if the lower limit of 95% CI was > -10%. The t-test, chi-square test, or rank sum test was used according to the types and features of data. Results: A total of 855 HBeAg-positive CHB patients were enrolled and 820 of them received treatment (538 in the trial group and 282 in the control group). The data of the full analysis set showed that HBeAg seroconversion rate at week 72 was 27.32% in the trial group and 22.70% in the control group with a rate difference of 4.63% (95% CI -1.54% to 10.80%, P = 0.1493). The data of the per-protocol set showed that HBeAg seroconversion rate at week 72 was 30.75% in the trial group and 27.14% in the control group with a rate difference of 3.61% (95% CI -3.87% to 11.09%, P = 0.3436). 95% CI met the non-inferiority criteria, and the trial group was non-inferior to the control group. The two groups had similar incidence rates of adverse events, serious adverse events, and common adverse events. Conclusion In Peg-IFN-α regimen for HBeAg-positive CHB patients, the new drug Peg-IFN-α-2b (Y shape, 40 kD) has comparable effect and safety to the control drug Peg-IFN-α-2a.

OBJECTIVE:To provide reference for the formulation of correct antifungal treatment strategy,and to promote stan-dard use of antifungal agent. METHODS:A retrospective survey was conducted for 138 haematologic patients from May 2013 to May 2014 in a third grade class A hospital,of whom all had used antifungal drugs during hospitalization. We collected all patients' information and analyzed it statistically. RESULTS:Of 138 haematologic patients,3 were proven IFD (all were Candida infec-tion),6 were probable IFD,12 were possible IFD,and 117 were undefined IFD. The positive rates of fungi pathogenic detection, fungal smear,G-test,and GM-test were 15.3%,9.4%,6.4% and 23.4% respectively. 6 kinds of antifungal were used,and vori-conazole had the highest frequency,followed by fluconazole,itraconazole,amphotericin B,caspofungin and micafungin. 62.3%patients used only one kind of antifungal,but 15.9% patients used 2 or more kinds of antifungal. The average medication course was 20.5 days(1 day to 125 days). Irrational drug use showed improper drug selection,unreasonable dose,and replacing antifun-gal with insufficient basis. CONCLUSIONS:The antifungal use in haematologic patients in the hospital is consistent with the re-quirements of guidelines,but there are still some issues as insufficient antifurgal drug treatment course to be further standardized.

OBJECTIVETo compare the efficacy of the erlotinib versus gefitinib in the first-line treatment of patients with advanced EGFR mutation-positive NSCLC.

METHODSFifty patients with untreated advanced EGFR mutation- positive NSCLC were randomly divided into gefitinib group (n=27) and erlotinib group (n=23). The progression-free survival, objective response rate and disease control rate were evaluated to compare the efficacy of gefitinib and erlotinib.

RESULTSThere were no significant differences in the objective response rate (P=0.711) and disease control rate (P=0.861) between the two groups. The progression-free survival of gefitinib group and erlotinib group was 8.0 months and 10.0 months, respectively. The efficacy of the two drugs was similar (P=0.293).

CONCLUSIONThere is no significant differences between gefitinib and erlotinib in the first-line treatment of patients with advanced EGFR mutation-positive NSCLC.

Carcinoma, Non-Small-Cell Lung ; drug therapy ; Disease-Free Survival ; Erlotinib Hydrochloride ; Humans ; Lung Neoplasms ; drug therapy ; Mutation ; Quinazolines ; therapeutic use ; Receptor, Epidermal Growth Factor ; metabolism

BACKGROUND:Papain-induced rat knee osteoarthritis is a common modeling method, which can obtain a stable osteoarthritis model.
OBJECTIVE:To observe the change of ultrastructure of chondrocytes in the early process of papain-induced rat knee osteoarthritis under transmission electron microscope.
METHODS:A total of 18 Sprague-Dawley rats were randomly divided into three groups. Two rats were considered as a normal control group, without intervention. The mixture of papain and L-cysteine was injected in right knee joint cavity of 16 rats to induce osteoarthritis models (osteoarthritis model group). Physiological saline was injected in the left side (physiological saline control group). At 1, 2, 4 and 6 weeks after injection, samples were col ected. Transmission electron microscope was used to observe the change of cartilage ultrastructure of the medial femoral condyle joint.
RESULTS AND CONCLUSION:For the normal control group and physiological saline control group, their cytoplasm contained abundant rough endoplasmic reticulum and mitochondria. After 1 week of injection,
mitochondria vacuoles and light expanded rough endoplasmic reticulum were visible. Two weeks later, lipid droplets appeared, mitochondria degeneration was distinct, vacuolization was serious and its number was reduced, and rough endoplasmic reticulum expansion was obvious. Four weeks later, lipid droplets became increased, and the number of mitochondria decreased significantly. Most of the rough endoplasmic reticula were highly expanded, and part of the rough endoplasmic reticula were dissolved and fractured. Six weeks later, a number of lipid droplets were visible in cytoplasm, most of the mitochondria disappeared, only a smal number of mitochondria existed, and most of the rough endoplasmic reticula were dissolved and fractured. These results confirmed that cartilage ultrastructure changes gradual y in the early process of papain-induced rat knee osteoarthritis under transmission electron microscope.

Objective To compare the efficacy of the erlotinib versus gefitinib in the first-line treatment of patients with advanced EGFR mutation-positive NSCLC. Methods Fifty patients with untreated advanced EGFR mutation-positive NSCLC were randomly divided into gefitinib group (n=27) and erlotinib group (n=23). The progression-free survival, objective response rate and disease control rate were evaluated to compare the efficacy of gefitinib and erlotinib. Results There were no significant differences in the objective response rate (P=0.711) and disease control rate (P=0.861) between the two groups. The progression-free survival of gefitinib group and erlotinib group was 8.0 months and 10.0 months, respectively. The efficacy of the two drugs was similar (P=0.293). Conclusion There is no significant differences between gefitinib and erlotinib in the first-line treatment of patients with advanced EGFR mutation-positive NSCLC.