Construction of anticipatory grief intervention for family caregivers of advanced cancer patients based on narrative theory / 中国实用护理杂志

Objective:To construct an anticipatory grief intervention scheme for family caregivers of advanced cancer patients based on narrative theory, and to provide reference for anticipatory grief nursing intervention.Methods:From October 2022 to May 2023, through literature research, semi-structured interview and brainstorming method, the first draft of nursing intervention plan was constructed, the Delphi method was used to conduct 2 rounds of correspondence consultation with 15 experts, and the indicators at all levels were modified according to the opinions of experts, and the final draft of intervention plan was formed.Results:The experts were all female, aged (49.67 ± 5.83) years old. The authority coefficient of the two rounds of experts was 0.87. The Kendall coordination coefficients of the first, second, and third level indicators after the first round of expert inquiry were 0.195, 0.113, and 0.093, respectively. The Kendall coordination coefficients of the first, second, and third level indicators after the second round of expert inquiry were 0.200, 0.119, and 0.101, respectively. The differences were statistically significant ( χ2 values were 8.76-107.21, all P<0.05).Finally, a nursing intervention plan based on narrative theory was formed, which included 4 primary indicators, 19 secondary indicators and 72 tertiary indicators. Conclusions:The anticipatory grief intervention scheme for family caregivers of advanced cancer patients is scientific, practical and feasible, and can be used for psychological nursing of family caregivers.

Traumatic narrative foreclosure and narrative care in the context of narrative medicine / 中国医学伦理学

In the context of Chinese narrative medicine， narrative foreclosure is an abnormal state in the process of life narrative， which is the “fractured or stagnation of the life narrative process”. Based on analyzing the characteristics and performance of typical traumatic narrative foreclosures in literary works and clinical reality， this paper proposed that narrative care is of great significance for the traumatic subject to get out of narrative foreclosures and re-enter the narrative process of mental and physical comfort. “Narrative care” is a way of care in which medical staff or educator in health institutions use their narrative capital and narrative wisdom to establish interpersonal narrative connections with themselves， their families， and service or education recipients， so as to nourish subjects in narrative foreclosure and help them get out of life’s dilemmas. Narrative caregivers assist the traumatic subjects in gaining the restorative power to repair the fractured narrative process of life through the construction of a narrative community， getting out of isolation， achieving growth， and restoring overall health.

A Comparative Study on the Organ Representation Characteristics of Three Mainstream Anatomical Ontologies / 医学信息学杂志

Purpose/Significance To analyze the characteristics of organ representation of anatomical ontologies,and to provide ref-erences for the research and construction of ontology in other fields.Method/Process The similarities and differences of three mainstream anatomical ontologies of SNOMED CT(SCT),Uberon and the foundational model of anatomy ontology(FMA)in terms of organ classifi-cation methods and term mapping are compared.Result/Conclusion Among the three main types of anatomical ontologies,SCT and Uberon are mainly classified according to the function of organs,while FMA is mainly classified according to the anatomical morphology of organs.The concept of organs in FMA and Uberon is the same as the concept of entire organs in SCT,and the representation forms of paired organs in SCT,Uberon and FMA are similar.

Effects of repetitive transcranial magnetic stimulation on learning-memory and synaptic plasticity in hippocampus of rats with post-stroke sleep deprivation / 中华行为医学与脑科学杂志

Objective:To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on learning-memory and the expression of synaptic plasticity proteins in hippocampus of rats with post-stroke sleep deprivation.Methods:A total of 28 SPF grade healthy male Wistar rats with 8-week old were randomly divided into four groups (control group, sham operation group, model group and rTMS group) according to random number table method, with 7 rats in each group. The rats in the model group and the rTMS group were treated with middle cerebral artery occlusion and p-chlorophenylalanine intraperitoneal injection to establish the post-stroke sleep deprivation model. The rats in the rTMS group were treated with rTMS intervention for consecutive 14 days after modeling. The rats in the sham operation group were only separated arteries but not ligated and inserted. The rats in control group were fed normally. The open field test (OFT) was used to observe the autonomous behavior of rats.The water maze test(WMT) was used to observe the spatial learning and memory ability of rats.The content of tyrosine kinase receptor type B(TrkB) in hippocampus was detected by Western blot.The expressions of brain-derived neurotrophic factor(BDNF) and immediate early gene c-fos in hippocampus were detected by immunofluorescence.The morphology and structure of neurons in hippocampus were observed by optical microscopy and transmission electron microscopy. SPSS 21.0 software was used for statistical analysis, and repeated measurement ANOVA was used for the escape latency data, one-way ANOVA was used for the comparison of other data among multiple groups, and LSD test was used for further pairwise comparison.Results:(1) The OFT results showed that there were statistical differences in the numbers of crossing squares, upright times and total points of rats in the four groups after intervention ( F=27.638, 10.425, 30.690, all P<0.001). The numbers of crossing squares ((72.71±10.10)), upright times ((6.57±0.87)times) and total points ((79.29±10.03) points) of rats in rTMS group were all higher than those in model group after intervention ((43.71±6.96), (3.43±0.65)times, (47.14±6.82)points) (all P<0.05). As for the escape latency of WMT among the four groups of rats, the interaction effect was not significant( F=1.108, P=0.37), and the time main effect( Ftime=27.295, Ptime<0.01) and group main effect ( Fgroup=8.691, Pgroup<0.01) were significant after rTMS intervention.On the 3rd and 4th day, the escape latency of rTMS group rats was lower than that of the model group (both P<0.01). There were statistically significant differences in the numbers of crossing platform, swimming distance and residence time in target quadrant of rats in the four groups after intervention( F=8.569, 3.308, 3.547, all P<0.05). The numbers of crossing platform ((2.00±0.31)times), swimming distance in target quadrant ((196.95±24.57) cm) and residence time ((17.72±1.36)s) of rats in rTMS group were all higher than those in model group after intervention ((1.57±0.30)times, (146.61±4.79) cm, (13.58±0.98)s)(all P<0.05). (2)Optical microscopy and transmission electron microscopy showed that the hippocampal cells arranged irregularly, the organelles' integrity was destroyed in the model group compared with the normal control group. In rTMS group the arrangement and structure of nerve cells in the hippocampus were improved after rTMS intervention. (3) The immunofluorescence results showed that c-fos (1.49±0.09) and BDNF (0.84±0.06) in the hippocampus of rats in rTMS group were both higher than those in model group ((1.24±0.12), (0.48±0.08))(both P<0.05). The Western blot results showed that the expression level of TrkB (1.81±0.03) in the hippocampus of rats in rTMS group was higher than that in model group (0.96±0.02) ( P<0.05). Conclusion:The rTMS can improve the learning-memory ability and autonomous capacity of rats with post-stroke sleep deprivation, which may be related to promoting the expression of c-fos, BDNF and TrkB in hippocampus tissue.

A qualitative study on the influencing factors of anticipatory grief among family caregivers of terminal-stage cancer patients in the context of narrative medicine / 中国医学伦理学

ObjectiveTo explore the influencing factors of anticipatory grief among family caregivers of terminal-stage cancer patients，and provide a reference for formulating intervention programs for anticipatory grief. MethodsAn interview outline was designed，and the descriptive qualitative research method was used.The aim was to select 11 family narrative caregivers of patients in the Department of Medical Oncology，Nanfang Hospital，Southern Medical University for semi-structured in-depth interviews.Based on the social ecology model，using the narrative theory of life and health as the framework，the content analysis method was adopted to analyze the data. ResultsA total of 3 themes and 12 sub-themes were extracted，including the influencing factors at the individual level （narrative literacy，cognitive level towards death，and sense of self-worth），the influencing factors at the interpersonal level （patient’s disease situation，education level，economic status，family narrative connection，peer narrative connection，and narrative connection between doctors and family members），and the influencing factors at the cultural policy level （social culture，physical environment of the ward，and policy level）. ConclusionAnticipatory grief was affected by multiple factors，and multi-dimensional narrative connection should be constructed from individual，interpersonal，family，social，and other levels to prevent caregivers from falling into a narrative lock of single caregiver identity，alleviate the impact of anticipatory grief on caregivers，and improve their quality of life.

Concept of Osler’s patient view and doctor-patient narrative community in narrative medicine / 中国医学伦理学

In the context of modern medicine， it’s difficult for doctors lacking narrative thinking to get into the hearts of patients and offer high-quality medical service. Precise classification terms and decontextualized abstract language have become communication barriers between doctors and patients， creating an atmosphere of unusual indifference and fear during the medical process. William Osler， the father of modern medicine， emphasized that doctors should respect the individuality of patients， and advocated that doctors should use life-oriented language to provide humanistic care to patients. This echoes the concept of the “doctor-patient narrative community” in the construction of the Chinese narrative medicine system. As a brand new clinical humanistic practice path， narrative medicine focuses on the keyword “narrative” and revolves around the theme of “inter-subjective relationship” in the medical context， advocates that doctors switch flexibly in the two references of science and life， achieve visual fusion with patients and their families， pay attention to patients’ life experiences， and establish narrative connections with them. On this basis， it can achieve two-way narrative interaction， build a harmonious doctor-patient narrative community， and thus enhance the patient’s medical experience.

Continuous lumbar drainage improves prognosis in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage / 陆军军医大学学报

Objective To analyze the influence of drainage volume on prognosis of acute hydrocephalus(AHC)after aneurysmal subarachnoid hemorrhage(aSAH)by continuous lumbar drainage.Methods A retrospective trial was conducted on 82 AHC patients after aSAH admitted to the First Affiliated Hospital of Chongqing Medical University between January 2017 and January 2022.In 6 months after discharge,modified Rankin Scale(mRS)score was used to evaluate the prognostic outcomes.Univariate and multivariate logistic regression analyses were performed on demographic factors,severity of subarachnoid hemorrhage(SAH)at admission,medical history,cerebral vasospasm,and lumbar drainage data.Then a nomogram prediction model was constructed.Results Univariate analysis found that World Federation of Neurosurgical Societies(WFNS)score,Hunt-Hess grade,modified Fisher grade,time for continuous lumbar drainage,shunt dependence,cerebral vasospasm,and drainage volume were factors affecting the prognosis of the patients.Then logistic regression analysis revealed that high WFNS score(OR:3.25,95％CI:1.11～9.48),high modified Fisher grade(OR:3.66,95％CI:1.08～12.35),shunt dependence(OR:15.56,95％CI:1.22～198.57),and cerebral vasospasm(OR:22.24,95％CI:3.08～160.68)were independent predictors for mRS score,while volume of continuous lumbar drainage(OR:0.57,95％CI:0.40～0.82)was an independent protective factor.ROC curve analysis indicated a good predictive performance of the model(AUC=0.898,95％CI:0.935～0.861).Internal validation through Bootstrap method demonstrated excellent discriminatory ability of the model(C-index=0.950,95％CI:0.904～0.996;adjusted C-index:0.934).Conclusion Increased volume of lumbar drainage is an independent protective factor for poor prognosis following aSAH and can improve the prognosis of SAH patients.

The Ethical Value of Hospice Narrative Doulas in the Context of Great Health / 中国医学伦理学

Death is the last transitional rite in the life process. Whether for the life state, family ethics or social relations of both the dead or the living, death indicates a major change and hides a certain crisis. The bio-health narrative concept puts forward that any transitional rite of life process requires narrative intervention and narrative care, as does death. Under the guidance of the concept, the profession of narrative death-doula came into being. Using the narrative concept as a framework, hospice narrative doulas provide emotional, physical, mental support to the terminal stage subjects and their families by accompanying the dying at close range, listening to their life stories, helping them record and dictate their autobiographies, reconstructing and repairing interpersonal narrative connections, and even planning funeral details with the dying. The death narrative doulas will create a personalized and humanized ritual and process around death, restore the spirituality and humanity which has been lost in the modern medical context to death itself.

Multi-classification prediction model of lung cancer tumor mutation burden based on residual network / 生物医学工程学杂志

Medical studies have found that tumor mutation burden (TMB) is positively correlated with the efficacy of immunotherapy for non-small cell lung cancer (NSCLC), and TMB value can be used to predict the efficacy of targeted therapy and chemotherapy. However, the calculation of TMB value mainly depends on the whole exon sequencing (WES) technology, which usually costs too much time and expenses. To deal with above problem, this paper studies the correlation between TMB and slice images by taking advantage of digital pathological slices commonly used in clinic and then predicts the patient TMB level accordingly. This paper proposes a deep learning model (RCA-MSAG) based on residual coordinate attention (RCA) structure and combined with multi-scale attention guidance (MSAG) module. The model takes ResNet-50 as the basic model and integrates coordinate attention (CA) into bottleneck module to capture the direction-aware and position-sensitive information, which makes the model able to locate and identify the interesting positions more accurately. And then, MSAG module is embedded into the network, which makes the model able to extract the deep features of lung cancer pathological sections and the interactive information between channels. The cancer genome map (TCGA) open dataset is adopted in the experiment, which consists of 200 pathological sections of lung adenocarcinoma, including 80 data samples with high TMB value, 77 data samples with medium TMB value and 43 data samples with low TMB value. Experimental results demonstrate that the accuracy, precision, recall and F1 score of the proposed model are 96.2%, 96.4%, 96.2% and 96.3%, respectively, which are superior to the existing mainstream deep learning models. The model proposed in this paper can promote clinical auxiliary diagnosis and has certain theoretical guiding significance for TMB prediction.

Analysis of the real situation of medication in the population with gout achieving T2T indicators: a multicentre real-world study / 中华风湿病学杂志

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Effect of dexamethasone combined with aminophylline on perioperative airway responses in COVID-19 convalescent patients undergoing gynecological laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of dexamethasone combined with aminophylline on perioperative airway responses in COVID-19 convalescent patients undergoing gynecological laparoscopic surgery.Methods:Sixty-eight COVID-19 convalescent patients, aged 25-57 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing gynecological laparoscopic surgery, were divided into experimental group ( n=34) and control group ( n=34). In experimental group, dexamethasone 10 mg was intravenously injected at the beginning of anesthesia induction, and aminophylline 0.25 g (in 100 ml of normal saline) was intravenously infused for 10 min starting from 15 min before the end of surgery. In control group, the equal volume of normal saline was administrated instead at the same time point. Airway secretions, laryngospasm and bronchospasm were recorded from the time point before operation to 24 h after operation, and coughing was also recorded from emergence to 3 min after extubation. The blood eosinophils (EOS) count, percentage of EOS (EOS%), and neutrophil to lymphocyte ratio were determined, and plasma C reactive protein level was measured by enzyme-linked immunosorbent assay before operation and at 24 h after operation. The serum levels of interleukin-6, tumor necrosis factor-α and interferon-γ were measured before operation, at 5 and 10 min after extubation and at 24 h after operation. Results:Compared with control group, the incidence of coughing, severity of coughing, incidence of increased airway secretion, and grade of airway secretion were significantly decreased, the levels of EOS, EOS%, neutrophil to lymphocyte ratio and plasma C reactive protein in peripheral blood and serum levels of interferon-γ, interleukin-6 and tumor necrosis factor-α were significantly decreased after operation ( P<0.05), and no significant change was found in the incidence of bronchial spasm in experimental group ( P>0.05). No laryngeal spasm occurred in both groups. Conclusions:Dexamethasone combined with aminophylline can relieve the perioperative airway responses by inhibition of inflammatory responses in COVID-19 convalescent patients undergoing gynecological laparoscopic surgery.

The Inheritance of Chinese Narrative Medicine Practice to the Traditional Chinese Medicine’s Life Wisdom / 中国医学伦理学

Starting from the inheritance and development of Chinese philosophy of life and Traditional Chinese Medicine (TCM) wisdom through the Chinese narrative medicine practice, this paper discussed the inheritance and correspondence relationship between the text reading ability in Chinese narrative medicine practice and the "four diagnostic" in TCM wisdom, narrative regulation and the "mind-body philosophy" in TCM, as well as the narrative wisdom and the "Tao produces one" in the Chinese philosophy of life. By analyzing the stories of contemporary doctors’ practice of narrative wisdom, this paper clarified that the Chinese narrative medicine system is a new model of medical education and clinical practice constructed by absorbing the essence elements of Chinese traditional life wisdom and TCM culture, and integrating the concept of western narrative medicine. It advocated for Chinese scholars to actively build the discipline of "narrative traditional Chinese medicine", constantly translate and introduce the achievements to foreign countries, and create a good narrative ecology of TCM.

Cryo-EM structures for the Mycobacterium tuberculosis iron-loaded siderophore transporter IrtAB

The adenosine 5'-triphosphate (ATP)-binding cassette (ABC) transporter, IrtAB, plays a vital role in the replication and viability of Mycobacterium tuberculosis (Mtb), where its function is to import iron-loaded siderophores. Unusually, it adopts the canonical type IV exporter fold. Herein, we report the structure of unliganded Mtb IrtAB and its structure in complex with ATP, ADP, or ATP analogue (AMP-PNP) at resolutions ranging from 2.8 to 3.5 Å. The structure of IrtAB bound ATP-Mg2+ shows a "head-to-tail" dimer of nucleotide-binding domains (NBDs), a closed amphipathic cavity within the transmembrane domains (TMDs), and a metal ion liganded to three histidine residues of IrtA in the cavity. Cryo-electron microscopy (Cryo-EM) structures and ATP hydrolysis assays show that the NBD of IrtA has a higher affinity for nucleotides and increased ATPase activity compared with IrtB. Moreover, the metal ion located in the TM region of IrtA is critical for the stabilization of the conformation of IrtAB during the transport cycle. This study provides a structural basis to explain the ATP-driven conformational changes that occur in IrtAB.

The Ethical Value of Hospice Narrative Doulas in the Context of Great Health / 中国医学伦理学

Death is the last transitional rite in the life process. Whether for the life state, family ethics or social relations of both the dead or the living, death indicates a major change and hides a certain crisis. The bio-health narrative concept puts forward that any transitional rite of life process requires narrative intervention and narrative care, as does death. Under the guidance of the concept, the profession of narrative death-doula came into being. Using the narrative concept as a framework, hospice narrative doulas provide emotional, physical, mental support to the terminal stage subjects and their families by accompanying the dying at close range, listening to their life stories, helping them record and dictate their autobiographies, reconstructing and repairing interpersonal narrative connections, and even planning funeral details with the dying. The death narrative doulas will create a personalized and humanized ritual and process around death, restore the spirituality and humanity which has been lost in the modern medical context to death itself.

Youth Narrative Foreclosure and Narrative Empowerment / 中国医学伦理学

In the context of life health narratives, narrative foreclosure is considered as "the rupture or stagnation of the life narrative process". Narrative foreclosure occurs in people of all ages, and the life stories of those with narrative foreclosure often end prematurely or remain in a stagnant state that cannot be updated. The youth stage will experience three crises of narrative relationships rupture, including identity location, social and family narrative relationships rupture, which are the important reasons for youth narrative foreclosure. By analyzing the characteristics and manifestations of typical youth narrative foreclosures in literature and clinical practice, this paper aimed to draw more researchers to pay attention to the phenomenon of narrative foreclosure in youth groups, understand the importance of narrative empowerment, and help them improve their narrative literacy, and restart new life experiences, so as to break through the foreclosure from inside to outside, and achieve the physical and mental health of the subject.

Effects of different inhalation time on minimum alveolar concentration of sevoflurane in adult rats / 中华麻醉学杂志

Objective:To evaluate the effects of different inhalation time on the minimum alveolar concentration (MAC) of sevoflurane in adult rats.Methods:Two hundred SPF healthy adult Sprague-Dawley rats (half male, half female), aged 8-10 weeks, weighing 200-260 g, were divided into 2 groups using a random number table method: inhalation of sevoflurane for 1 h group and inhalation of sevoflurane for 20 min group, with 100 rats in each group.Each group was subdivided into 10 subgroups with 10 rats in each subgroup, the initial concentration was preset at 1.50%, and the ratio between two successive concentrations r was 1.08.The tail clamping stimulus was applied to evaluate the efficacy of anesthesia in each subgroup, a positive response was defined as a body movement occurred within 1 min after tail clamping stimulus, and the response was defined as negative when no body movement occurred within 1 min after tail clamping.The Bliss method was used to calculate the MAC, EC 95 and 95% confidence interval (CI) of sevoflurane. Results:The MAC and EC 95 (95% CI) of sevoflurane were 2.09% (1.98%-2.20%) and 2.75% (2.56%-3.04%), respectively, in inhalation of sevoflurane for 1 h group, and 2.35% (2.22%-2.49%) and 3.10% (2.87%-3.45%), respectively, in inhalation of sevoflurane for 20 min group ( P<0.05). Conclusions:The MAC of sevoflurane in adult rats inhaled sevoflurane for 1 h is decreased than that inhaled for 20 min.

Evaluation of Smart Dose's predictive effectiveness on vancomycin blood concentration / 药学实践杂志

Objective To evaluate clinical utility of the personalized drug delivery decision support system, Smart Dose, applied to the monitoring of therapeutic drugs in Chinese population. Methods Use Smart Dose system to predict the trough concentration of vancomycin in patients, analyze the difference between the predicted value and the measured value of the trough concentration, and to evaluate the prediction performance of the system for vancomycin blood concentration. Results Smart Dose adjusts the difference between the predicted value of concentration and the measured value, the average percentage error, and the average absolute percentage error is less than the difference between the predicted value of initial concentration and the measured value. The difference between the initial concentration prediction value and the measured value of the neurosurgery group was smaller than that of the non-neurosurgery group, and the prediction efficiency was better than that of the non-neurosurgery group. The predicted initial concentration of the high trough concentration group and the low-age group (<59 years old) are closer to the measured value. The predictive performance of different BMI for the initial concentration is similar. Conclusion Smart Dose system is more suitable for predicting the adjusted concentration of vancomycin; When used for initial concentration prediction, the prediction values of neurosurgery group, high trough concentration, and low age group are more accurate. Different BMI has similar performance in predicting initial concentration.

Practice of palliative medicine education in the teaching of geriatrics / 中华医学教育探索杂志

This article introduces the development history of palliative medicine at home and abroad, investigates the existing problems of palliative medicine teaching in geriatrics, explores the improvement of geriatric palliative medicine education, and elaborates adopting theoretical teaching and clinical practice, including PBL teaching, case teaching and narrative medicine teaching, to carry out palliative medical education for geriatrics graduate students. The results showed that 67.9% of the students have increased the learning sense of palliative medicine, 92.5% of them think that palliative medicine is very important, and 75% of them think that they have enhanced their ability of language expression and communication with patients with advanced diseases, namely, the ability of end-of-life care.

Preparation and characterization of recombinant human-source collagen / 生物工程学报

This study aimed to obtain a recombinant human-source collagen for industrialization. First, based on the Gly-X-Y sequence of human type I collagen, we optimized the hydrophilic Gly-X-Y collagen peptide, designed the human collagen amino acid sequence and the corresponding nucleotide sequence. Next, the expression vector pPIC9K-COL was constructed via endonuclease digestion technology. We obtained an engineering strain of human-source collagen by electrotransforming Pichia pastoris, and then it was fermented, purified and identified. As a result, the expression level reached 4.5 g/L and the purity was over 95%. After amino acid N-terminal sequencing, molecular weight analysis, amino acid analysis and collagenase degradation test, we confirmed that the obtained collagen was consistent with designed primary structure of human-source collagen. After freeze-drying, we analyzed the collagen by scanning electron microscope and cell cytotoxicity, confirming that the collagen has porous fiber reticular structure and superior cytocompatibility. This indicates that human-source collagen has potential to be applied as biomedical material. In conclusion, we successfully obtained the expected human-source collagen and laid a foundation to its further application.

Effect of remifentanil on MACBAR of sevoflurane in patients with hepatic dysfunction undergoing lap-aroscopic surgery / 中华麻醉学杂志

Objective To evaluate the effect of remifentanil on the minimum alveolar concentration of sevoflurane required to blunt the adrenergic response(MACBAR)in the patients with hepatic dysfunction undergoing laparoscopic surgery.Methods The patients,aged 18-64 yr,with body mass index ＜ 30 kg/m2,undergoing elective laparoscopic hepatobiliary surgery,were selected.Patients with normal liver function were selected as control group(C group),and patients with liver dysfunction(Child-Pugh grade B)were selected as test group and divided into 3 subgroups by a random number table method: no remifen-tanil group(R0 group)and different target plasma concentrations of remifentanil groups(R1 group and R2 group).Anesthesia was induced by intravenously injecting propofol 2-3 mg/kg,remifentanil 2 μg/kg and cisatracurium 0.15 mg/kg.After endotracheal intubation,mechanical ventilation was performed.The end-tidal sevoflurane concentration was adjusted to the preset concentration in each group and maintained at the level for 20 min before the pneumoperitoneum was established.Anesthesia was maintained as follows:remifentanil was not used in C group and R0 group,and the target plasma concentration of remifentanil was 1 and 2 ng/ml in group R1 and group R2,respectively,and sevoflurane was inhaled.The MACBAR of sevoflurane was determined using the sequential method.The initial end-tidal sevoflurane concentrations were 5.0％,4.6％,2.6％and 2.4％in group C,group R0,group R1 and group R2,respectively.MAP and HR were recorded and blood samples were collected before and after pneumoperitoneum,and the plas-ma epinephrine and norepinephrine concentrations were measured by enzyme-linked immunosorbent assay,and the difference in MAP and HR before and after pneumoperitoneum was calculated.Results A total of 14 cases in group C,19 cases in group R0,19 cases in group R1 and 15 cases in group R2 completed the study.Compared with group C,the MACBAR of sevoflurane and plasma adrenergic concentration before and after pneumoperitoneum were significantly decreased(P＜0.05),and no significant change was found the other parameters in group R0(P>0.05).Compared with group R0,the MACBAR of sevoflurane was signifi-cantly decreased in group R1 and group R2,and HR before and after pneumoperitoneum and the difference were significantly decreased in group R2(P＜0.05).The MACBAR of sevoflurane was significantly lower in group R2 than in group R1(P＜0.05).Conclusion Remifentanil can decrease the MACBAR of sevoflurane and enhance the efficacy in inhibiting the stress responses in the patients with hepatic dysfunction undergo-ing laparoscopic surgery.