The 24-Hour Intensivists Staffing Model Improves the Outcome for Nighttime Admitted Patients: A Matched Historical Control Study.

INTRODUCTION: We previously showed that a "10-hour daytime on-site" and "nighttime (NT) on-call" staffing strategy was associated with higher mortality for intensive care unit (ICU) patients admitted during NT than it was for patients admitted during office hours (OH). In here, we evaluated the clinical effects of a 24-hour intensivist staffing model. METHODS: We formed an intervention group of 3034 consecutive ICU patients hospitalized from January 2013 to December 2015, and a control group of 2891 patients from our previous study (2009-2011). We applied propensity score matching (PSM) for whole and subgroup analyses adjusting for confounding factors. We compared clinical outcomes of patients under the 2 staffing models using multivariate logistic regression and survival analyses. RESULTS: After PSM, we balanced the clinical data between the complete cohorts and the subgroups. Comparison of ICU survivals between the intervention and control cohorts yielded no significant differences. However, the intervention was significantly associated with a higher ICU survival in the NT (5:30 pm-07:30 am) admission patients (P = .049) than in those admitted during OH (07:30 am to 5:30 pm; P = .456). Additionally, the intervention shortened the LOSHOS (P = .001) and/or LOSICU (P < .001), reduced the hospital (P = .672) and/or ICU (P = .004) expenses, and resulted in earlier mechanical ventilation extubation (P = .442) as compared to the same variables in the control group, especially for NT admissions. CONCLUSIONS: The 24-hour intensivists staffing could significantly improve ICU outcomes, especially for NT-admission patients in high-acuity, high-volume ICUs with frequent NT admissions.

The structure and evaluation of educational research skills and accomplishments among rural teachers: Data from China.

The practice of educational research by rural teachers is highly valued and very important for their professional development and for the revitalization of rural education. This study explored the components of educational research activities among rural teachers (Study 1). Based on the results, a regional norm for Hunan province was formulated, and discriminant criteria were developed for the evaluation of educational research skills and accomplishments among rural teachers (Study 2). In Study 1, data from 892 Chinese rural teachers working at compulsory education schools in Hunan Province (a representative province in central China), divided into two samples, were found to support the constructs included in the measurement instrument. Exploratory and confirmatory factor analyses of the 33 items of the Rural Teachers' Educational Research Self-rating Scale identified a first-order model with three factors: educational research on basic educational activities (BEA), educational research involving the creation of an educational community (CEC), and educational research involving the refinement and popularization of educational theory (RPE). Based on the results of Study 1, in Study 2, a set of norms for educational research skills and accomplishments among rural teachers was formulated based on the data from Hunan Province. This norm can serve as a reference standard for the evaluation of rural teachers' educational research skills and accomplishments. The components of rural teachers' educational research activities are discussed, and suggestions for the formulation of education policies are provided.

Expression of proteasome immunosubunit in labial glands of patients with primary Sjogren's syndrome.

OBJECTIVE: To investigate the expression of proteasome immunosubunit low molecular weight polypeptide (LMP)2 and LMP7 in labial glands of patients with primary Sjogren's syndrome patients, and thus explore their role in the diagnosis, differential diagnosis and pathogenesis of primary Sjogren's syndrome (pSS). METHODS: Labial specimens were collected from 40 patients with pSS, 15 patients with connective tissue diseases other than pSS, and 9 healthy controls. The expressions of LMP2 and LMP7 in labial specimens were determined using immunohistochemical approaches and analyzed using semi-quantitative methods. The positive rate of acinar was calculated. After the square arcsine transformation of data, the differences of the positive rate in acinar between LMP2 and LMP7 were compared among three groups. Spearman's rank correlation coefficient was used for analyzing the correlation of clinical manifestations with LMP2 and LMP7 expressions. RESULTS: The expressions of LMP2 and LMP7 within the acinar and ductal epithelial cells were confirmed. Although the LMP2 expression in labial specimens was not significantly different among three groups(P=0.369), the expression of LMP7 was significantly higher in pSS patients compared with patients with connective tissue disease and healthy controls (P<0.01). Only in pSS group, LMP7 was found to be with higher positive rate in acinar than LMP2 (P<0.01). No significant correlation was found between LMP2/LMP7 and clinical manifestations (P>0.05). CONCLUSION: In patients with pSS, the expression of LMP7 (but not LMP2) is up-regulated in labial gland, indicating these two proteins have different genetic regulation mechanisms.

Synthesis of Tert-Octylsalicylaldoxime and Its Application in Extraction of Cu(II).

The alkyl salicylaldoxime has attracted more and more attention recently due to the complex branched alkyl groups. In this study, a novel alkyl salicylaldoxime, tert-octylsalicylaldoxime, was successfully synthesized by the one-pot method. The yield and purity by the elemental analysis were 96.17 and 94.13%, respectively. The structure was confirmed by elemental analysis, FT-IR, 1H NMR (Nuclear Magnetic Resonance), 13C NMR spectroscopy, and MS. Results showed that tert-octylsalicylaldoxime with a new structure exhibited excellent extraction ability and selectivity for Cu(II) and can be successfully used to recover Cu from copper-nickel alloy electroplating wastewater. Thus, this product has the potential to be used as a powerful copper extractant in the future.

Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based computerized navigation.

INTRODUCTION: The treatment of displaced acetabular fractures with formal open reduction and internal fixation has gained general acceptance. However, extensile exposure can lead to complications. Two-dimensional fluoroscopy-based computerized navigation for placement of percutaneous screw across non-displaced acetabular fractures has attracted interest by making use of stored patient-specific imaging data to provide real-time guidance in multiple image planes during implant placement. The purpose of the present study was to document early treatment results and complications associated with this new technique and evaluate its clinical application to displaced acetabular fractures amenable to closed or limited open reduction. MATERIALS AND METHODS: Eighteen adult patients with 12 non-displaced and 8 displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system. There were 14 men and four women with a mean age of 42.1 years (range 19-54 years). According to the AO and Orthopaedic Trauma Association Classification, there were nine 62-A3, five 62-B1, three 62-B2, and three 62-B3. The mean follow-up was 21 months (range 12-28 months). The mean time from injury to surgery was 4 days (range 2-7 days). RESULTS: A total of 30 acetabular screws were inserted, including 21 anterior column screws and 9 posterior column screws. The average operation time was 24.6 min (range 16-47 min) from the image acquisition to wound closure. The average fluoroscopic time was 28.4 s (range 11-58 s). Compared to the final position of the screw, the average deviated distance of wire tip was 2.5 mm (range 1.1-3.6 mm) and the average trajectory difference was 2.45 degrees (range 1.5 degrees -4.6 degrees ). Maximal gap displacement averaged 10 mm (range 2-22 mm) preoperatively and 3 mm (range 0-5 mm) postoperatively; while maximal step displacement averaged 4 mm (range 1-10 mm) preoperatively and 2 mm (range 0-4 mm) postoperatively. One patient sustained a transient femoral nerve palsy and resolved 2 months after the operation. No superficial or deep infection occurred. Using the rating system of D'Aubigne and Postel, 13 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. CONCLUSION: Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based navigation could be applied not only to non-displaced fractures but also to displaced fractures amenable to closed or limited open reduction.

Transcriptome profiling of neuronal model cell PC12 from rat pheochromocytoma.

GeneChip microarray is a cutting-edge technology being used to study the expression patterns of genes with in a particular cell type. In this study, the Affymetrix RAE230A platform was used to profile stably expressed mRNA transcripts from PC12 cells at passage 5 and 15. The whole-cell PC12 transcriptome revealed that a total of 7,531 stable transcripts (P < 0.05), corresponding to 6,785 genes, were found to be consistently expressed between passage 5 and 15. The data analysis revealed 3,080 functional proteins, belonging to 13 families, which indicate that about 65% of the proteins expressed in PC12 cells are uncharacterized. By using our custom-built rat neuronal reference genome database, we mapped endogenously expressed stable neuronal transcripts from PC12 cells comprising about 765 genes responsible for neuronal function and disease. These neuronal transcripts were further analyzed to provide a genetic blueprint that can be used by neurobiologist to unravel the complex cellular and molecular mechanisms underlying biological functions and their associated signalling networks for diseases affecting the nervous system.

[Plasmodium falciparum infection by blood transfusion：a case report].

This paper reported one acute lymphoblastic leukemia patient who infected with Plasmodium falciparum after blood transfusion. Through the epidemiological investigation on this patient and the related blood donors as well as laboratory detections, the source of infection was ascertained. This blood donor was an overseas student from Africa, whose blood sample was positive in the rapid diagnostic test, and the results of microscopic examination of peripheral blood smear and PCR both suggested P. falciparum positive.

Genetic mechanisms of scorpion venom peptide diversification.

The diversity of scorpion venom peptides is well shown by the presence of about 400 such polypeptides with or without disulfide bonds. Scorpion toxins with disulfide bonds present a variety of sequence features and pharmacological functions by affecting different ion channels, while the venom peptides without disulfide bonds represent a new subfamily, having much lower sequence homology among each other and different functions (e.g. bradykinin-potentiating, antimicrobial, molecular cell signal initiating and immune modulating). Interestingly, all scorpion venom peptides with divergent functions may have evolved from a common ancestor gene. Over the lengthy evolutionary time, the diversification of scorpion venom peptides evolved through polymorphism, duplication, trans-splicing, or alternative splicing at the gene level. In order to completely clarify the diversity of scorpion toxins and toxin-like peptides, toxinomics (genomics and proteomics of scorpion toxins and toxin-like peptides) are expected to greatly advance in the near future.

The protective effect and mechanism of soybean oil and its extracts on DNA damage in human ECV304 cells exposed to UV-C.

The degree of DNA damage in the human endothelial cell line ECV304 exposed to UV-C, with or without the presence of soybean oil (SBO), was assessed by the Comet assay. After 5-min exposure to UV-C, the %Tail DNA in the ECV304 cells ranged from 0% to 20% for SBO treatment groups and from 50% to 70% for the control group. The result indicated a strong protective effect of SBO against UV-C-induced DNA damage. To clarity the mechanism of this protective effect of SBO, the methanol extract of SBO (MESO) was analyzed and its capacity against UV-C-induced DNA damage was evaluated. Gas chromatography mass spectrometry (GC-MS) analysis confirmed that MESO contained many antioxidants including n-3-polyunsaturated fatty acid (n-3-PUFA), tocopherols and phytosterols. Comet assay revealed that the MESO was also active in reducing the DNA damage dose-dependently (P<0.0001) vs. control in the ECV304 cells. Therefore, we concluded that these potential antioxidants may be responsible for the scavenge of oxidative radicals induced by UV-C irradiation. This study suggested that dietary SBO, which is abundant of antioxidants, may reduce the content or impact of reactive oxygen species (ROS) and lower the risk of diseases caused by ROS.

Treating breast cancer radiotherapy-induced moist desquamation with a traditional Chinese medicine formula: a case series pilot study.

UNLABELLED: Abstract Objective: A case series is presented to investigate the efficacy and safety of Erhegao for patients with breast cancer who have radiotherapy-induced moist desquamation. METHODS: Eighteen women with breast cancer who received radiotherapy and developed moist desquamation were enrolled. Erhegao cream, a Traditional Chinese Medicine formula consisting of zinc oxide powder, calamine powder, and lithospermum oil, was applied on areas of moist desquamation. Application was repeated once a day until healing. The primary end point for efficacy was the time to healing of the moist desquamation areas. A numerical rating scale was used to measure wound pain relief daily. Incidence of toxicity was also assessed. RESULTS: The average time to healing of the moist desquamation area was 13.56 days. The mean pain scores on the first, third, and seventh days were 5.22, 2.94, and 0.83, respectively. Eight-three percent of patients reported pain relief after the first 3 days, and 94%, after the first week. The mean daily reduction in the pain score was 0.40. None of the patients developed clinical infections or reported any toxicity. CONCLUSIONS: This formula is effective and safe, especially for pain relief, and may be an alternative treatment for radiotherapy-induced moist desquamation in patients with breast cancer. Future randomized, controlled studies are needed to better evaluate the efficacy of Erhegao cream.

Cloning and molecular characterization of BmHYA1, a novel hyaluronidase from the venom of Chinese red scorpion Buthus martensi Karsch.

In this communication, the full protein sequence of a novel venom hyaluronidase BmHYA1 was reported. It is the first full hyaluronidase amino acid sequence from scorpion venom. It was deduced from nucleotide sequence by 3' Rapid Amplification of cDNA Ends (RACE) PCR cloning, followed by alignment with the N-terminal amino acid sequence, which was obtained by Edman degradation. BmHYA1 has 385 amino acid residues containing five potential N-glycosylation sites. The phylogenetic analysis indicates early divergence and independent evolution of BmHYA1 from other hyaluronidases.

Isolation and characterization of a hyaluronidase from the venom of Chinese red scorpion Buthus martensi.

A hyaluronidase, named BmHYA1, was purified from the venom of Chinese red scorpion (Buthus martensi), using successive chromatography. The homogeneity of BmHYA1 was confirmed by SDS-PAGE and MALDI-TOF mass spectrometry. The molecular mass of BmHYA1 was 48,696 Da determined by MALDI-TOF MS. The optimal temperature and pH of BmHYA1 were 50 degrees C and pH 4.5, respectively. It could be inhibited by DTT, Cu(2+), Fe(3+) or heparin, but not Mg(2+), Ca(2+), reduced glutathione, l-cysteine or EDTA. The sequence of thirty N-terminal amino acids of BmHYA1 was obtained by Edman degradation, as TSADF KVVWE VPSIM CSKKF KICVT DLLTS; but no similarity was found to other venom hyaluronidases. Further, BmHYA1 can hydrolyze hyaluronan into relatively smaller oligosaccharides and modulate the expression of CD44 variant in the breast cancer cell line MDA-MB-231.

Cdc6 knockdown inhibits human neuroblastoma cell proliferation.

The cell division controller Cdc6 plays a central role in the initiation of DNA replication. It was found that elevated levels of Cdc6 were present in many of human cancer cells, and the accumulation of Cdc6 is required for cell proliferation. In this study, we have investigated the control of Cdc6 expression and its effect on cell proliferation and death in human neuroblastoma cells. Elevated levels of Cdc6 are found in the LA-N-2, CHLA255, and other cell lines that grow fast. Cdc6 knockdown via a Cdc6 short hairpin RNA lentivirus causes the accumulation of sub-G1 populations with the decrease of S contents in the LA-N-2 and CHLA255 cells. Expression profile from the selected genes shows the reduction of cyclin E, cyclin A, and Cdc25C, with a boosted increase of the CDK inhibitor p27Kip1, indicating the suppression of tumor cell proliferation. Further, Cdc6 knockdown causes the increase of pro-apoptotic Bax accompanied with the decrease of anti-apoptotic Bcl-2, resulting in the increased cell death. Furthermore, Cdc6 knockdown causes a sharp reduction of tumor suppressor protein p53, and Cdc6 overexpression renders a boosted p53 expression; and this regulation is at p53 posttranscriptional level. Our study indicates that human Cdc6 functions in several pathways to control the cell proliferation and the cell death.

HIV-1 gp41 ectodomain enhances Cryptococcus neoformans binding to HBMEC.

Cryptococcus neoformans infection has significantly increased recently, particularly in AIDS patients and immunocompromised individuals. C. neoformans has a predilection to the brain, resulting in devastating meningoencephalitis. We have previously shown the invasion of C. neoformans into the human brain microvascular endothelial cells (HBMEC), which constitute the blood-brain barrier. Here, we demonstrated that C. neoformans invasion of HBMEC was enhanced by HIV-1 gp41 protein. Peptide mapping defined its functional domain around the disulfide-bond linkage of gp41 molecule (a.a. 579-611). Recombinant protein gp41-I90 (a.a. 550-639) can also enhance the binding activity. The enhancement of C. neoformans binding to HBMEC is a strain-independent manner, suggesting that gp41 ectodomain peptide exerts its function directly on HBMEC. Importantly, the enhancement could be observed in mouse animal model. Our results suggest that HIV-1 gp41 ectodomain and C. neoformans may follow a similar invasion mechanism, possibly actin reorganization and/or membrane activation, during pathogen infections on HBMEC.

Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails.

UNLABELLED: Fifteen patients with 26 nonunions of diaphyseal forearm fractures were treated with interlocking intramedullary nails and iliac bone grafts. The purpose of our study was to evaluate the rate of successful healing and complications that developed after using this technique. The mean followup was 31 months (range, 25-38 months). The average length of bone loss after freshening the bone ends was 20 mm (range, 10-30 mm). Radiographic union was achieved in 14 patients (96%). Compared with the uninjured contralateral arm, the mean loss of flexion and extension motion at the wrist was 27 degrees. The mean loss of the arc of motion at the elbow was 18 degrees, and the mean loss of rotation of the forearm was 39 degrees. In seven patients, the amount and location of the maximum radial bow on the injured side were significantly different from those of the contralateral arm. Using the rating system of Anderson et al, two patients (13%) had excellent results, six patients (40%) had satisfactory results, six patients (40%) had unsatisfactory results, and one patient (7%) had a failed result. The mean Disabilities of the Arm and Shoulder Score was 35 points (range, 16-56 points), indicating moderate residual impairment. There were three postoperative complications (an incidence of 12%). Our results showed that interlocking intramedullary nailing of nonunions of the diaphysis of the radius or ulna with an open reaming technique should not be considered an adequate alternative to plate fixation of these injuries. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series no, historical control group).

In vitro study on the genotoxicity of dichloromethane extracts of valerian (DEV) in human endothelial ECV304 cells and the effect of vitamins E and C in attenuating the DEV-induced DNA damages.

To study the genotoxicity of valepotriates in vitro, the degree of DNA damage in human endothelial cell line ECV304 treated with 5-60 microg/mL of dichloromethane extracts of valerian (DEV) was analyzed by the Comet assay. No DNA damage was observed in ECV304 cells after culture for 48 h in the presence of 5,10, and 20 microg/mL of DEV. But a moderate degree of DNA damage was observed in the cells treated with 40 or 60 microg/mL of DEV. Quantitative analyses of DNA damage in the presence of antioxidants vitamin E (VE) and vitamin C (VC) were also carried out. The study revealed that both VE and VC exhibited a biphasic effect, reducing DEV-induced DNA damages at low concentrations but increasing them at high concentrations. We concluded that (1). the observed DNA damage in ECV304 cells induced by high concentrations of DEV was mainly through epigenetic mechanisms, i.e., reactive oxygen species mediated oxidative DNA damage (2). at the low doses, DEV did not appear to have any significant genotoxicity in ECV304 cells, and (3). VE and VC, at proper concentrations, can reduce or eliminate the adverse effects derived from high doses of DEV. This study should serve as scientific guidance for clinical therapy of valerian preparation.