Objective:To evaluate the effect of sevoflurane on Ca 2+ transporter expression in cardiomyocytes during right ventricular remodeling in rats with pulmonary arterial hypertension. Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 200-250 g, were divided into 4 groups ( n=6 each) by the random number table method: control group (CM group), sevoflurane group (CS group), monocrotaline group (M group) and sevoflurane + monocrotaline group (S group). Monocrotaline 60 mg/kg was intraperitoneally injected in group M and group S, and monocrotaline lysate was intraperitoneally injected in group CM. The rats in S and CS groups inhaled 2.5% sevoflurane for 1 h, twice a week, at an interval of 3 days starting from the first day after injection of monocrotaline. Pulmonary artery acceleration time and pulmonary artery ejection time were measured by transthoracic echocardiography at 6 weeks after monocrotaline injection. The chest was exposed under 3% sevoflurane anesthesia, the heart was perfused, and the pulmonary artery branch and right ventricular myocardial tissues were retained. The wall thickness of pulmonary arterioles and cross-section area of right ventricular cardiomyocytes were observed by HE staining. The expression of Ca 2+ transporter in right ventricular cardiomyocytes was detected by Western blot. Results:Compared with CM group, the ratio of pulmonary artery acceleration time to pulmonary artery ejection time was significantly decreased, the cross-section area of right ventricular cardiomyocytes was increased, the wall thickness of pulmonary arteriole was increased, the expression of type 1 sodium-calcium exchange and inositol triphosphate receptor was up-regulated, and the expression of voltage-dependent L-type calcium channel α1C subunit, type 2 ryanodine receptor, sarcoplasmic reticulum calcium pump 2α and proteinphilin-2 was down-regulated in M group ( P<0.01). Compared with group M, the ratio of pulmonary artery acceleration time to pulmonary artery ejection time was significantly increased, the cross-section area of right ventricular cardiomyocytes was decreased, the wall thickness of pulmonary arteriole was decreased, the expression of type 1 sodium-calcium exchange and inositol triphosphate receptor was down-regulated, and the expression of voltage-dependent L-type calcium channel α1C subunit, type 2 ryanodine receptor, sarcoplasmic reticulum calcium pump 2α and proteinphilin-2 was up-regulated in group S ( P<0.01). Conclusions:The mechanism by which sevoflurane improves right ventricular remodeling is related to regulating the expression of Ca 2+ transporter in cardiomyocytes of rats with pulmonary arterial hypertension.

Objective:To analyze and summarize the key points of design and implementation of new drug clinical trials for ankylosing spondylitis.Methods:The platform for drug clinical trial registration and information published on the official website of center for drug review and evaluation of national medical products administration (CDE) was searched to obtain data and classified statistics was conducted then. The Mean±SD and M ( Q1, Q3) were used for quantitative data for statistical description, and the rate, composition or relative ratio of qualitative data were used for statistical description. Results:A total of 23 clinical trials meeting the requirements were screened, among which 19 were biological products included in nine phase Ⅲ clinical trials. Among the four chemical drugs, two were phase Ⅱ clinical trials. One of the clinical trials on AS adopted the 1966 New York classification criteria, accounting for 4%. Nineteen of the trials adopted the1984 New York classification criteria, accounting for 83%. Three other trials adopted unspecified classification criteria, accounting for 13%. In one of these clinical trials, the age of patients included was older than 16 years old, 9 trials were 18 to 65 years old, 6 were 18 years old but without upper limit. In the definition of active AS, 19 trials took BASDAI≥4 as the cut-off value for active disease, and BASDAI, total back pain, spinal pain and morning stiffness were regarded as active disease in 4.Conclusion:The number of dosestic AS clinical trial projects continnes to rise. The 1984 classification criteria is adopted as the classification criteria in clinical trials. The minimum age in the inclusion criteria is 18 years old, there is no upper limit in age for inclusion. Disease activity can be evaluated by BASDAI score, combined with comprehensive indicators such as night-time back pain, global spinal pain and morning stiffness.

Background Steel workers are exposed to occupational hazardous factors such as dust, noise, and heat, and often work in shifts, making them prone to sleep disorders. Objective To explore potential influencing factors of sleep disorders among workers in a steel enterprise in Gansu Province, and provide a basis for reducing the risk of sleep disorders among them. Methods From January to March 2022, a self-made questionnaire combined with the Pittsburgh Sleep Quality Index (PSQI) were used to investigate the employees of a steel enterprise in Gansu Province. According to their PSQI scores, they were divided into a normal sleep group and a sleep disorder group. The general demographic variables of the two groups were balanced by 1∶1 propensity score matching (PSM). Multiple logistic regression was used to analyze the contributing factors of sleep disorders. Restricted cubic spline (RCS) model was used to analyze potential dose-response relationship between weekly working hours and sleep disorders. Results The prevalence of sleep disorders in the steel workers was 48.06% (6029/12544). After PSM, 5847 pairs were successfully matched, and the distributions of matched variables were well balanced between the two groups. The results of multiple logistic regression showed that hypertension (OR=1.39, 95%CI: 1.24, 1.56), diabetes mellitus (OR=1.34, 95%CI: 1.07, 1.66), three-shift system (OR=1.26, 95%CI: 1.12, 1.41), dust exposure (OR=1.14, 95%CI: 1.01, 1.29), noise exposure (OR=1.23, 95%CI: 1.09, 1.39), heat exposure (OR=1.16, 95%CI: 1.04, 1.29), and work injury (OR=1.22, 95%CI: 1.02, 1.46) increased the risk of sleep disorders. Compared with workers with < 10 years of service, those with 10-20 years (OR=1.31, 95%CI: 1.19, 1.44), 20-30 years (OR=1.34, 95%CI: 1.19, 1.52), and ≥30 years of service (OR=1.35, 95%CI: 1.19, 1.53) had a higher risk of sleep disorders. Compared with non-exercise workers, the risk of developing sleep disorders was lower in workers with occasional exercise (OR=0.61, 95%CI: 0.56, 0.66) and regular exercise (OR=0.55, 95%CI: 0.49, 0.62). The RCS model showed that the weekly working hours and sleep disorders in the steel workers showed a nonlinear dose-response relationship (P<0.05 for overall trend, P<0.05 for nonlinear test). The relationship between weekly working hours and sleep disorders showed a "U" shaped distribution, with a significant increase in the risk of sleep disorders when the weekly working hours exceeded 49 h. Conclusion The non-occupational influencing factors of sleep disorders of employees in the steel enterprise include hypertension, diabetes, physical exercise, and occupational influencing factors include length of service, weekly working hours, shifts, dust exposure, noise exposure, heat exposure, and work injuries. It is recommended to consider both occupational and non-occupational factors to formulate appropriate sleep disorder prevention and control measures for steel employees to reduce the risk of sleep disorders.

【Objective】 To study the correlation between platelet transfusion efficacy and KIR receptor-HLA ligand. 【Methods】 Thirty-three leukemia patients with positive HLA antibody were tested for cross-matching with donor platelets. Platelets from suitable donors were selected for transfusion, and the 24-hour platelet corrected count increment (CCI) was used to determine the transfusion effect. KIR and ligand genotyping were performed on blood samples from patients and donors by PCR-SSP method, and the relationship between platelet transfusion effects and KIR receptor-HLA ligand was analyzed. 【Results】 In 74 occasions of platelet transfusion, 42 were ineffective and 32 were effective. When the donor had C2 gene and HLA-B Bw4-80T gene, the frequency of ineffective platelet transfusion in the recipient was 69.0% (29/42) and 52.4% (22/35), respectively, which was significantly higher than that in the effective group [25.0% (8/32) and 25.0% (8/32)]. When the donor had C1 gene, and the frequency of effective platelet transfusion in the recipient was 100.0%(32/32), which was higher than that in the ineffective group [83.3%(35/42)]. When the recipient-donor matching mode was KIR2DL1-C2 and KIR3DL1-(HLA-B Bw4-80T), the frequency of ineffective platelet transfusion was 69.0%(29/42) and 40.5%(22/42),higher than that of the effective group [25% (8/32) and 18.8% (6/32)]. When the recipient-donor matching model was KIR2DL3-C1, the rate of effective platelet transfusion in 32 patients (100.0%), which was higher than that (35 patients 83. 3%) in the ineffective group. When the mismatch mode of recipient iKIR+donor HLA ligand receptor was KIR2DL1-C2, the frequency of effective platelet transfusion in the recipient was 78.1% (25/32), which was much higher than that in the ineffective group [31.0% (13/42)]. When the mismatch mode was KIR3DL1-(HLA-B Bw4-80T), the rate of effective platelet transfusion in the recipient was 68.8% (22/32), which was higher than that in the ineffective group (42.9%, 18/42). The difference between the above groups was statistically significant(P<0.05). 【Conclusion】 HLA-C1 and HLA-C2 genes are the key factors affecting the efficacy of platelet transfusion.For platelet refractorines, HLA-C1 is the protective gene, while HLA-C2 and HLA-B Bw4-80T are the susceptible genes. The recipient iKIR+donor HLA ligand receptor model may play an important role in platelet refractoriness.

Background The incidence rate of missed abortion is increasing year by year, but the etiology has not been fully elucidated. Adverse pregnancy history and exposure to polycyclic aromatic hydrocarbons (PAHs) may increase the risk of missed abortion. Objective To investigate the interaction between adverse pregnancy history and PAHs exposure on missed abortion in early pregnancy, and to provide evidence for the etiologic research of missed abortion. Methods A total of 114 pregnant women diagnosed with missed abortion in the Department of Obstetrics of the First Hospital of Shanxi Medical University from March to December 2019 were selected as the case group, and 139 pregnant women who visited the same hospital for voluntary induced abortion in the same period as the control group, to collect basic information and medical information of abortion, stillbirth, intrauterine growth retardation, and other adverse pregnancy history. Abortion villus tissues were collected to detect PAH-DNA adducts levels, stratified by pregnancy and adverse pregnancy history and grouped by quartile method: Q₁ (< 404.61 ng·L⁻¹), Q₂ (404.61−453.75 ng·L⁻¹), Q₃ (453.76−506.72 ng·L⁻¹), and Q₄ (≥506.73 ng·L⁻¹). SPSS 25.0 statistical software was used for χ² test and multiple logistic regression, and additive and multiplicative models were used to investigate the interaction between adverse pregnancy history and PAH-DNA adducts level on missed abortion. The PAH-DNA adducts were grouped by tertiles and quartiles, and P₃₃, P₅₀, P₆₇ and P₇₅ were used as data cut points for sensitivity analysis. Results The proportion of adverse pregnancy history in the case group (32.46%) was higher than that in the control group (12.23%) (P < 0.001). Among 160 subjects with≥2 pregnancies, the proportion of adverse pregnancy history in the case group (57.81%) was higher than that in the control group (17.71%) (P < 0.001). The results of χ² test stratified by pregnancy for different PAH-DNA adducts levels between the two groups showed that the PAH-DNA adducts level was associated with missed abortion in subjects with≥2 pregnancies (χ²=10.14, P=0.017). Being further stratified by adverse pregnancy history, the PAH-DNA adducts level in subjects with no adverse pregnancy history was associated with missed abortion (χ²=9.70, P=0.021). The results of logistic regression analysis showed that adverse pregnancy history (OR=5.88, 95%CI: 2.79−12.39) and PAH-DNA adducts (OR=3.01, 95%CI: 1.22−7.40) increased the risk of missed abortion, but no interaction between them was found. The relative excess risk of interaction (RERI), the attributable percentage of interaction (AP), and the synergy index (SI) and its 95%CI were 0.60 (95%CI: −0.58−1.77), 0.74 (95%CI: −0.83−2.30), and 0.20 (95%CI: 0.01−5.43), respectively. Conclusions Adverse pregnancy history and PAH-DNA adducts in pregnant women may increase the risk of missed abortion. The effect of the interaction between them on the occurrence of missed abortion is not supported by the current study.

Objective:To study the incidence and influencing factors for clinical deterioration at an early stage in patients with mild posterior circulation infarction (PCI).Methods:Totally 291 patients with mild PCI from January 1, 2016 to January 1, 2020 were retrospectively included. Clinical deterioration within 24 h (CD 24h) and clinical deterioration between 2 d and 14 d (CD 14d) were the endpoint events. IBM SPSS Statistics 19.0 software was used for statistical analysis. Pearson chi-square test or Mann-Whitney U test were used to compare the group differences of corresponding variables. Multivariate logistic regression model was used to analyze the influencing factors of the primary endpoint events. Results:The incidences of CD 24h and CD 14d were 21.6% (63/291) and 30.6% (89/291) respectively, with the reperfusion therapy rate of 13.4% (39/291). The results of multivariate logistic regression analysis with CD 24h as the endpoint event showed that the baseline NIHSS was a positive independent factor increasing the risk of CD 24h ( OR=1.184, 95% CI=1.078-1.300, P<0.01). Cerebellar infarction (compared with brainstem infarction) ( OR=0.250, 95% CI=0.082-0.757, P=0.014)and non-macroatherosclerosis (compared with major atherosclerosis) ( OR=0.026, 95% CI=0.002-0.325, P=0.005) had negative predictive effects on CD 24h. The results of multivariate logistic regression analysis with CD 14d as the endpoint event showed that pulmonary infection complications after stroke ( OR=28.085, 95% CI=6.863-114.927, P<0.01) and baseline NIHSS ( OR=1.114, 95% CI=1.001-1.240, P=0.048) were independent factors of CD 14d. Reperfusion therapy ( OR=0.089, 95% CI=0.013-0.613, P=0.014) could reduce the risk of CD 14d.Top of basilar syndrome(compared with single brainstem infarction) ( OR=7.526, 95% CI=1.565-36.188, P=0.012) increased the risk of CD 14d, while the non-macroatherosclerotic (compared with the macroatherosclerotic subtype) ( OR=0.076, 95% CI=0.009-0.683, P=0.021) negatively predicted the risk of CD 14d. Baseline NIHSS ( OR=0.834, 95% CI=0.758-0.918, P<0.01), CD 14d ( OR=0.048, 95% CI=0.018-0.130, P<0.01) and pulmonary infection complications ( OR=0.045, 95% CI=0.012-0.167, P<0.01) were negatively predicted the good clinical prognosis (modified Rankin score 14 days after onset ≤2). Conclusion:Early clinical deterioration has a negative predictive effect on clinical prognosis improvement of patients with mild PCI. Large artery atherosclerotic stenosis subtype and basilar apex syndrome are the risk factors of CD 24h and CD 14d of patients with mild PCI, and pulmonary infection is the risk factor of CD 14d. Reperfusion therapy in acute phase is helpful to reduce the risk of early clinical deterioration and improve clinical prognosis in patients with mild PCI.

Objective:To evaluate the effects of sevoflurane on right ventricular myocardial fibrosis caused by pulmonary arterial hypertension (PAH) in rats.Methods:Eighteen SPF healthy adult male Wistar rats, weighing 260-300 g, were divided into 3 groups ( n=6 each) by a random number table method: control group (group C), group PAH and PAH plus sevoflurane group (group PS). The PAH model was established by single intraperitoneal injection of monocrotaline 60 mg/kg in group PAH and group PS, while the equal volume of normal saline was intraperitoneally injected in group C. Sevoflurane 1.5 MAC was inhaled for 1 h starting from the end of injection, twice a week for 6 weeks in total, in group PS.Echocardiography was performed at the end of 6th week to measure right ventricular end-diastolic diameter (RVEDD), right ventricular anterior wall end-diastolic thickness (RVWTd), interventricular septal end-diastolic thickness (IVSTd), pulmonary artery inner diameter (PAID) and pulmonary valve orifice maximum peak velocity (PV). At the end of 6th week, the hearts were taken to measure the weight of right ventricle, interventricular septum and left ventricle, and Fulton′s index was calculated, and the tissue of the lower lobe of the right lung was taken, the outer diameter and inner diameter of the vascular wall were measured to calculate the vascular wall thickness index (WT), and total vascular area and lumen area were measured to calculate the vascular wall area index (WA) after HE staining.The myocardial tissue of the right ventricle was obtained to observe the degree of myocardial fibrosis (with a light microscope after Masson staining) and to detect the expression of TGF-β1 (after immunofluorescence staining) and expression of TGF-β1, phosphorylated Smad3 (p-SMad3) and Smad7 (by Western blot). Results:Compared with group C, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly increased, PV was decreased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was up-regulated, the expression of Smad7 was down-regulated( P<0.01), and myocardial fibrosis occurred in group PAH.Compared with group PAH, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly decreased, PV was increased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was down-regulated, the expression of Smad7 was up-regulated ( P<0.05 or 0.01), and myocardial fibrosis was significantly improved in group PS. Conclusion:Sevoflurane can improve the myocardial fibrosis in right ventricle induced by PAH in rats, and the mechanism may be related to inhibiting activation of TGF-β1/Smad3 signaling pathway.

Objective:To investigate the predictors of clinically important stress-related gastrointestinal bleeding (CIS-GIB) after acute stroke and their impact on short-term outcome.Methods:Consecutive acute stroke patients diagnosed as stress ulcer (SU) and admitted to Beijing Friendship Hospital from January 1, 2016 to January 1, 2020 were enrolled retrospectively. The primary outcome event was CIS-GIB and was defined as dominant gastrointestinal bleeding and corresponding clinical manifestations occurred within 24 h after bleeding. The second outcome event was the short-term clinical outcome assessed by the modified Rankin Scale score at 14 d after onset, and ≤2 was defined as a good outcome. Multivariate logistic regression model was used to analyze the independent influencing factors of CIS-GIB and short-term outcome. Results:A total of 96 patients with post-stroke SU were included, accounting for 2.5% (96/3 819) of all patients with acute stroke; among them, 16 patients (16.7%) developed CIS-GIB, accounting for 0.4% (16/3 819) of all patients with acute stroke. Among the included patients, there were 27 women (29.2%), with a median age of 70 years (interquartile range, 62-79 years). The median National Institutes of Health Stroke Scale (NIHSS) score was 8 (interquartile range, 3-17), and a median time interval between SU and the index stroke event was 2 d (interquartile range, 1-5 days). Compared with the non-CIS-GIB group, the baseline NIHSS score and the proportion of patients with supratentorial stroke were higher, the time interval between SU and the index stroke event was longer, the proportion of patients with coagulation dysfunction, using nasogastric tube and ventilator, receiving gastrointestinal invasive hemostasis and erythrocyte component transfusion were higher, and the risks of poor outcome and death were higher in the CIS-GIB group (all P<0.05). Multivariate logistic regression analysis showed that the baseline NIHSS score (odds ratio [ OR] 1.146, 95% confidence interval [ CI] 1.029-1.275; P=0.013), glycosylated hemoglobin ( OR 1.567, 95% CI 1.025-2.395; P=0.038), history of chronic gastric diseases ( OR 24.900, 95% CI 1.446-428.728; P=0.027), supratentorial stroke ( OR 5.701, 95% CI 1.002-32.443; P=0.050) and activated partial thromboplastin time ≥34.0 s ( OR 11.036, 95% CI 1.154-105.560; P=0.037) were the independent risk factors for CIS-GIB; the baseline NIHSS score was an independent influencing factor for poor outcome ( OR 1.366, 95% CI 1.029-1.812; P=0.031). Conclusion:The incidence of CIS-GIB in patients with acute stroke is about 0.4%, which significantly increases the risk of short-term adverse outcome. High glycosylated hemoglobin level, prolonged activated partial thromboplastin time, high baseline NIHSS score, supratentorial stroke and history of chronic gastric diseases are the independent risk factors for CIS-GIB.

Objective:In a relatively "loose" macro policy environment, formulate highly operational implementation management methods for scientific research at institutional level to optimize the research management services, improve risk prevention and control, and at the same time play a role of "relaxing" scientific researchers.Methods:Combining with practical management issues, this article takes Southwest Hospital affiliated to The Third Medical University as an example, focuses on the existing problems and risk points in the institutionalization of scientific research management in hospitals. Discussions are carried out, including establishment and improvement of labor charge management, scientific research financial assistant system through labor dispatching service, catalogued reagents and consumable procurement mode, and out-put and in-put of warehouse management. In addition, specific solutions pertinent to the potential problems arising in institutionalization are proposed, especially in the ambiguity zone of higher-level policies.Results:Based on the analysis of problems existed in the practice, we puts forward some concrete solutions, and suggests " institutionalization" should replace the " inertia" management to make sure compliance. Improve labor management practices, more refined payment range on the basis of relevant national policies, specifically issuing qualifications of different categories of staff and set according to the local yearbooks a more appropriate standard for payment; explore research finance assistant institutional foundation dispatch mode, in order to make up the shortcomings of financial assistants include low salaries and the short employment periods. Establish a cataloged reagent and consumables procurement management mode and storage system. It is recommended to use information management measures to achieve visual management of procurement and use of various links.Conclusions:The institutional reform and innovation can stimulate the vitality of scientific research and improve academic integrity.

Objective: To explore the value of diffusion-weighted magnetic resonance imaging (MR-DWI) technique in predicting the efficacy of radiotherapy in patients with esophageal cancer, using experimental animal models. Methods: BALB/c nude mice were subcutaneously injected with Eca-109 cell lines and then tumor formed. The experimental group (16 cases) received a single dose of 15 Gy (6 MV X-rays) delivered by a medical linear accelerator, while the control group (24 cases) did not receive any treatment. The two groups were scanned every other day, started one day before the radiotherapy. The scanning sequences included T1-weight imaging, T2-weight imaging, and DWI. The observation time was 1 month. According to the changes of the tumor volume and apparent diffusion coefficient (ADC) value of the two groups, 7 key time points were selected to observe the difference of cell density and tissue necrosis ratio between the two groups (6 cases in each group). Results: From day 7 after radiotherapy, the experimental group had statistically smaller volume of transplanted tumors than the control group, namely (1.729±0.906) cm³ vs (2.671±0.915) cm³(P<0.05). From day 3 after radiotherapy, the experimental group had statistically higher ADC values [(1.017±0.255)×10^-6 vs (0.833±0.142)×10^-6 mm²/s, P<0.05], lower cell density of transplanted tumor (25.56±1.40 vs 33.48±4.18%, P<0.05), and less proportion of tissue necrosis [(32.19±1.21) % vs (29.16±2.16)%, P<0.05], respectively. The ADC value was negatively correlated with cell density (r=-0.703, P<0.001) and positively correlated with tissue necrosis ratio (r=0.658, P=0.003). Conclusions Single dose of large fraction radiotherapy could inhibit the growth of xenograft. ADC values may change at the early stage prior to morphological changes of tumor. The change of cell density and necrosis ratio of transplanted tumor are in line with the change of ADC value. MR-DWI has the value of early prediction of esophageal cancer radiotherapy efficacy.