Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis.

BACKGROUND: The efficacy and necessity of prophylactic antibiotics in clean and clean-contaminated surgery remains controversial. METHODS: The studies were screened and extracted using databases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials.gov according to predefined eligibility criteria. Randomized controlled trials (RCTs) comparing the effect of preoperative and postoperative prophylactic antibiotic use on the incidence of surgical site infections (SSIs) in patients undergoing any clean or clean-contaminated surgery. RESULTS: A total of 16,189 participants in 48 RCTs were included in the primary meta-analysis following the eligibility criteria. The pooled odds ratio (OR) for SSI with antibiotic prophylaxis versus placebo was 0.60 (95% CI: 0.53-0.68). The pooled OR among gastrointestinal, oncology, orthopedics, neurosurgery, oral, and urology surgery was 3.06 (95% CI: 1.05-8.91), 1.16 (95% CI: 0.89-1.50), 2.04 (95% CI: 1.09-3.81), 3.05 (95% CI: 1.25-7.47), 3.55 (95% CI: 1.78-7.06), and 2.26 (95% CI: 1.12-4.55), respectively. Furthermore, the summary mean difference (MD) for patients' length of hospitalization was -0.91 (95% CI: -1.61, -0.16). The results of sensitivity analyses for all combined effect sizes showed good stability. CONCLUSION: Antibiotics are both effective, safe, and necessary in preventing surgical wound infections in clean and clean-contaminated procedures, attributed to their reduction in the incidence of surgical site infections as well as the length of patient hospitalization.

Utility of deep learning for the diagnosis of cochlear malformation on temporal bone CT.

OBJECTIVE: Diagnosis of cochlear malformation on temporal bone CT images is often difficult. Our aim was to assess the utility of deep learning analysis in diagnosing cochlear malformation on temporal bone CT images. METHODS: A total of 654 images from 165 temporal bone CTs were divided into the training set (n = 534) and the testing set (n = 120). A target region that includes the area of the cochlear was extracted to create a diagnostic model. 4 models were used: ResNet10, ResNet50, SE-ResNet50, and DenseNet121. The testing data set was subsequently analyzed using these models and by 4 doctors. RESULTS: The areas under the curve was 0.91, 0.94, 0.93, and 0.73 in ResNet10, ResNet50, SE-ResNet50, and DenseNet121. The accuracy of ResNet10, ResNet50, and SE-ResNet50 is better than chief physician. CONCLUSIONS: Deep learning technique implied a promising prospect for clinical application of artificial intelligence in the diagnosis of cochlear malformation based on CT images.

Study on the Teaching Path of Medical Ethics in Medical Colleges and Universities in Ethnic Areas by Integrating the Consciousness of the Chinese National Community / 中国医学伦理学

From an ethical point of view, the ethical characteristics of the consciousness of the Chinese national community contain an ethical starting point based on "love"; ethical path with "people first" as the core; ethical vision for the purpose of "prosperity". The consciousness of the Chinese national community greatly conforms to the teaching objectives and teaching content of medical ethics. Therefore, medical ethics teaching from the perspective of the Chinese national community should implement the fundamental task of helping students develop good morals and enhance the moral quality of "love"; take the "community of doctor-patient destiny" as the starting point of education and build the concept of "people first"; strengthen the country’s sense of responsibility of "prosperity and strength" and establish the mission of "rooting and maintaining health at the grassroots level", build a strong consciousness of the Chinese national community.

A randomized double-blinded study assessing the dose-response of ropivacaine with dexmedetomidine for maintenance of labor with epidural analgesia in nulliparous parturients.

Background: The combination of ropivacaine and dexmedetomidine has been used as an epidural analgesic for inducing labor. However, there is limited data regarding the administration of epidural analgesia for labor maintenance, hence, this study aimed to determine the optimum concentration through dose-response curves of ropivacaine plus dexmedetomidine, which could be used along with the Programmed Intermittent Epidural Bolus (PIEB) technique. Methods: One hundred parturients were randomized into 4 groups who were administered four different doses of ropivacaine (dexmedetomidine at 0.4 µg mL-1): 0.04%, 0.06%, 0.08%, and 0.1%. The primary outcome that was determined included the proportion of patients experiencing breakthrough pain during their 1st stage of labor. Breakthrough pain was described as a visual analog scale [VAS] score of >30 mm, requiring supplemental epidural analgesia after the administration of at least one patient-controlled bolus. The effective concentration of analgesia that was used for labor maintenance in 50% (EC50) and 90% (EC90) of patients were calculated with the help of probit regression. Secondary outcomes included epidural block characteristics, side effects, neonatal outcomes, and patient satisfaction. Results: The results indicated that the proportion of patients without breakthrough pain was 45% (10/22), 55% (12/22), 67% (16/24), and 87% (20/23) for 0.04%, 0.06%, 0.08%, and 0.10% doses of the analgesic that were administered, respectively. The EC50 value was 0.051% (95% confidence interval [CI], 0.011%-0.065%) while the EC90 value was recorded to be 0.117% (95% CI, 0.094%-0.212%). Side effects were similar among groups. Conclusion: A ropivacaine dose of 0.117% can be used as epidural analgesia for maintaining the 1st stage of labor when it was combined with dexmedetomidine (0.4 µg mL-1) and the PIEB technique. Clinical Trial Register: https://www.chictr.org.cn/index.aspx, identifier ChiCTR2200059557.

Effect of palmitoylethanolamide on degeneration of a human-derived retinal pigment epithelial cell induced by all-trans retinal.

AIM: To study the effect of palmitoylethanolamide (PEA) on apoptosis of retinal pigment epithelial (RPE) cells induced by all-trans retinal (atRAL) and to explore the possible molecular mechanism. METHODS: CellTiter 96® Aqueous One Solution Cell Proliferation Assay (MTS) was used to detect the effect of PEA on human-derived retinal epithelial cells (ARPE-19) viability induced by atRAL. A Leica DMi8 inverted microscope was used to observe cell morphology. Reactive oxygen species (ROS) production was evaluated with 2',7'-dichlorodihydrof-luorescein diacetate (H2DCFDA) staining and fluorescence microscopy. Expression of c-Jun N-terminal kinase (JNK), phosphorylated JNK (p-JNK), c-Jun, phosphorylated c-Jun (p-c-Jun), Bak, cleaved caspase-3, C/EBP homologous protein (CHOP), and binding (Bip) protein levels were tested by Western blot. Abca4 -/- Rdh8 -/- mice, mouse models of atRAL clearance defects which displays some symbolic characteristics of dry age-related macular degeneration (AMD) and Stargardt disease (STGD1). In the animal models, PEA was injected intraperitoneally. The full-field electroretinogram was used to detect visual function under scotopic conditions traced from mice. Optical coherence tomography showed reconstitution or thickening of the retinal pigment epithelium layer. Effect of PEA on fundus injury induced by light in Abca4-/-Rdh8-/- mice was observed by fundus photography. RESULTS: PEA ameliorated ARPE-19 cells apoptosis and inhibited ROS (including mitochondrial ROS) production induced by atRAL. PEA improved the retinal functional, prohibited both RPE and photoreceptor from death, ameliorates light-induced fundus impairment in Abca4 -/- Rdh8 -/- mice. In vitro and in vivo, PEA inhibited JNK, p-JNK, c-Jun, p-c-Jun, Bak, cleaved caspase-3, CHOP, and Bip protein levels induced by all-trans retinal in ARPE-19 cells. CONCLUSION: PEA has effect on treating RPE cells apoptosis in retinopathy caused by atRAL accumulation. PEA is a potential treatment strategy for dry AMD and STGD1. The molecular mechanism is affecting the ROS-JNK-CHOP signaling pathway partly.

Prevalence of depression, anxiety in China during the COVID-19 pandemic: an updated systematic review and meta-analysis.

Background: Mental health risks associated with the aftermath of the COVID-19 pandemic are often overlooked by the public. The aim of this study was to investigate the effects of the COVID-19 pandemic on depression and anxiety disorders in China. Methods: Studies were analyzed and extracted in accordance with the PRISMA 2020 flowchart. The studies were screened and extracted using electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov according to the predefined eligibility criteria. The Cochrane Review Manager software 5.3.1 was used for data analysis and the risk of bias assessment. Results: As of 2023, a total of 9,212,751 Chinese have been diagnosed with COVID-19 infection. A total of 913,036 participants in 44 studies were selected following the eligibility criteria, the statistical information of which was collected for meta-analysis. The pooled prevalence of depression and anxiety were 0.31 (95% CI: 0.28, 0.35; I2 = 100.0%, p < 0.001) and 0.29 (95% CI: 0.23, 0.36; I2 = 100.0%, p < 0.001), respectively. After performing a subgroup analysis, the prevalence of depression among women, healthcare workers, students, and adolescents was 0.31 (95% CI: 0.22, 0.41), 0.33 (95% CI: 0.26, 0.44), 0.32 (95% CI: 0.26, 0.39), and 0.37 (95% CI: 0.31, 0.44), respectively. Conclusion: The prevalence of depression and anxiety among the Chinese was overall high. Monitoring and surveillance of the mental health status of the population during crises such as sudden global pandemics are imperative. Systematic review registration: https://clinicaltrials.gov/, identifier [CRD42023402190].

Recognition and progress of idiopathic intracranial hypertension / 中国医师杂志

Idiopathic intracranial hypertension (IIH) is a syndrome of unexplained increased intracranial pressure with normal cerebrospinal fluid and without organic brain lesions. The etiology and pathogenesis of IIH remain unclear, and IIH patients may develop irreversible visual impairment. At present, there are no guidelines and expert consensus on diagnosis and treatment of IIH in China. This review aims to introduce the pathogenesis, diagnosis and treatment of IIH, in order to help clinicians improve their understanding of the disease and to identify, diagnose and treat IIH as early as possible, and improve the prognosis of patients.

Comparison of epidural dexmedetomidine to fentanyl in reducing ropivacaine dose in Programmed Intermittent Epidural Bolus plus Patient Controlled Epidural Analgesia during labor: A randomized, double-blind, controlled study.

Background: Dexmedetomidine has been documented to reduce the dose of both intrathecal local anesthetic during cesarean delivery, and the concentration of ropivacaine needed for inducing analgesia during labor. However, few studies have compared adjuvant dexmedetomidine to fentanyl on how they impact the dose of ropivacaine required during labor. The aim of the current study was to evaluate the efficacy of epidural dexmedetomidine at doses of 0.3, 0.4, or 0.5 and 2 µg/ml of fentanyl (the traditional clinical concentration), when added to epidural 0.125% ropivacaine. Methods: This was a randomized, double-blinded study that comprised one hundred eighty-eight patients, allocated into four groups receiving either epidural fentanyl at 2 µg/ml, or dexmedetomidine at 0.3, 0.4, or 0.5 µg/ml for labor analgesia. The primary outcome was the amount of ropivacaine necessary per hour. Secondary outcomes included visual analogue pain scale (VAS), motor block (Bromage Scale), side effects, patient satisfaction, and neonatal outcomes. Results: At the completion of the study, data from 165 participants were analyzed. The mean hourly amount of epidural ropivacaine administered was 16.2 ± 3.3, 14.0 ± 3.1, 13.1 ± 3.7 and 12.1 ± 2.5 ml/h in the 2 µg/ml fentanyl group, and the 0.3, 0.4 and 0.5 µg/ml dexmedetomidine groups, respectively. There was a significant difference among groups in the mean hourly consumption of epidural ropivacaine (P < 0.0001 for 1 way ANOVA). The frequency of PCEA (patient-controlled epidural analgesia) was significantly higher in the fentanyl group than in the three dexmedetomidine groups (P < 0.001), and similar among the dexmedetomidine groups. The mean values of the VAS among all groups were similar over time, P > 0.05. The incidence of pruritus in the fentanyl group was 17.5%, whereas no patient experienced pruritus in any of the dexmedetomidine groups, P < 0.0001. Conclusion: The study demonstrated that epidural dexmedetomidine (0.3 and 0.4 µg/ml) was superior to standard dose epidural fentanyl in reducing the mean hourly amount of ropivacaine administered, and minimizing opioid-related side effects. Further large and multicenter studies would be necessary to confirm the benefits of dexmedetomidine, and potentially serve as an alternative to opioids for routine use in labor analgesia. Clinical trial registration: [http://www.chictr.org.cn/showproj.aspx?proj=62846], identifier [ChiCTR2000039067].

Subcapsular renal haematoma after ureteroscopic lithotripsy: a single-centre, retrospective study in China.

OBJECTIVES: To investigate the incidence, predisposing factors, diagnosis and management of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL). DESIGN: Retrospective observational study. SETTING: Shandong Provincial Hospital, a 4500-bed tertiary hospital in China. PARTICIPANTS: The data from 1535 consecutive patients treated with URSL (including rigid URSL and flexible URSL) between January 2015 and October 2020 were retrospectively analysed. MAIN OUTCOME MEASURES: SRH after URSL confirmed via CT. The characteristics, operative data and outcomes of these patients were documented and compared. RESULTS: Six patients were confirmed to have an SRH after URSL on CT. The total incidence of SRH after URSL was 0.39%. The incidences of SRH after rigid URSL and flexible URSL were 0.38% and 0.41%, respectively. Unendurable ipsilateral flank pain and a significant decrease in haemoglobin after surgery were the typical clinical manifestations of SRH after URSL. There were no significant differences in age, sex, history of diabetes mellitus, preoperative hypertension, body mass index, stone laterality or perfusion pressure (p>0.05). However, SRH was significantly associated with the stone size, stone location, degree of hydronephrosis and operative duration (p<0.01). One patient was managed conservatively without further intervention, percutaneous drainage was performed in four patients and one patient underwent emergency angiography. No patients died of SRH. CONCLUSIONS: SRH is a rare but potentially serious complication of URSL. Severe hydronephrosis and a thin renal cortex preoperatively and prolonged operative duration are strong predisposing factors for SRH. Laparoscopic ureterolithotomy should be considered as an alternative surgery for patients with severe ureteral tortuosity. SRH is treated based on patients' clinical manifestations. Most patients can be managed with conservative treatment or percutaneous drainage alone.

Analysis of the risk of death and clinical management for nasal or nasopharyngeal bleeding occurring after radiotherapy for nasopharyngeal carcinoma.

OBJECTIVE: To retrospectively analyze the risk factors for death in patients with nasal or nasopharyngeal bleeding after radiotherapy for nasopharyngeal carcinoma, and to explore clinical management strategies for the disease. METHODS: This was a retrospective case-control study. The clinical data from patients diagnosed with nasopharyngeal or nasopharyngeal hemorrhage after radiotherapy for nasopharyngeal carcinoma at the First Affiliated Hospital of Guangxi Medical University between January 2006 and October 2021 were retrospectively analyzed. Chi-square analysis and odds ratio (OR) calculation were performed to evaluate the death risk factors associated with the disease. And binary logistic regression analysis was used to detect some independent factors in this study. RESULTS: Of the 85 patients, 71 (83.5%) were male and 14 (14.5%) were female; 11 patients died (mortality rate: 12.9%), of which 9 died of asphyxia (7 with hemorrhagic shock), 1 died of multiorgan failure and acute respiratory distress syndrome, and 1 died of left cerebellar infarction. Nine potential mortality factors were evaluated; age, sex, nasal tamponade, and open mouth restriction were not significantly associated with death (P > 0.5); absence of immediate airway protection (in the major bleeding group) , absence of angiography, skull base destruction, major bleeding, and re-irradiation were significantly associated with death (P < 0.05). Among these factors, binary logistic regression model showed increased risk of death in patients without immediate airway protection (OR=18.14,95%CI:1.48-221.64), in patients without angiography (OR=14.65, 95%CI:2.37-90.73), and in those with re-irradiation (OR=13.23,95%CI:1.004-174.23). CONCLUSION: Binary logistic regression model shows that absence of immediate airway protection, absence of angiography, and re-irradiation are independent risk factors for death. The mortality rate due to bleeding after radiotherapy for nasopharyngeal carcinoma is high, and active management and intervention to address the risk factors for death is key to treat the disease and save patients' lives. At the same time, we need to consider the patient's causative state of bleeding.

A double signal amplification-based homogeneous electrochemical sensor built on catalytic hairpin assembly and bisferrocene markers.

A facile, sensitive and unmodified Hg2+ homogeneous electrochemical sensor based on bisferrocene signal markers and catalytic hairpin self-assembly (CHA) was built on a gold disk electrode. Three hairpin probes were designed, in which thiol was labeled at both ends of the hairpin probe 1(HP1), while bisferrocene, a redox signal marker, was labeled at both ends of the hairpin probe 2(HP2) and hairpin probe 3(HP3). Due to the Hg2+ mediated thymine-Hg (II)-thymine (T-Hg2+-T) structure, when Hg2+ is introduced, the T-Hg2+-T that occurred between the probe DNA and helper DNA could open the hairpin structure of probe DNA and form a rigid DNA triangles structure by CHA. Simultaneously, four bisferrocene signal markers also reached the surface of the electrode and built potential-assisted Au-S self-assembly to achieve signal amplification. Under the optimized condition, the sensor can achieve good electrochemical response Hg2+detection, and the detection limit is as low as 0.6 pM. furthermore, this sensor has high selectivity for Hg2+ detection.

Postoperative deep vein thrombosis in patients after selective ankle or mid-hindfoot surgery / 中华创伤骨科杂志

Objective:To investigate the prevalence of deep vein thrombosis (DVT) in patients after selective ankle or mid-hindfoot surgery.Methods:A retrospective analysis was conducted of the 109 patients with ankle or mid-hindfoot disease who had been treated from January 2018 to December 2019 at Department of Orthopaedics, Wuhan Fourth Hospital. They were 65 males and 44 females, aged from 32 to 74 years (average, 49.0 years). Ultrasonography was performed at preoperative 1 day, postoperative 2 and 6 weeks to determine the occurrence, location and clinical symptoms of DVT. The patients were divided into an early DVT group, a late DVT group and a DVT-free group according to the occurrence and onset time of DVT. The 3 groups were compared in terms of gender, age, body mass index and tourniquet duration.Results:The incidence of postoperative lower limb DVT was 22.9% (25/109). All the thromboses were observed beyond the distal plane of the popliteal vein. 72.0% of the DVT patients were clinically asymptomatic. There was no significant difference in gender, age or body mass index between early DVT group ( n=17), late DVT group ( n=8) and DVT-free group ( n=84) ( P>0.05). The incidence was 68.0% (17/25) for early DVT and 32.0% (8/25) for late DVT. The intraoperative tourniquet duration for the early DVT group [(77.7±12.3) min] was significantly longer than that for the late DVT group [(66.8±11.2) min] and for the DVT-free group [(65.9±10.5) min] ( P<0.05). Conclusions:The majority of postoperative DVTs may be clinically asymptomatic in patients after selective ankle or mid-hindfoot surgery. Although DVT tends to occur within postoperative 2 weeks, its risk may continue after 2 weeks. Increased tourniquet duration may be associated with incidence of early DVT.

Impact of surgical treatment for locally recurrent rectal cancer on the quality of life of patients / 中华胃肠外科杂志

Objective: To investigate the impact of surgical treatment on quality of life in patients with locally recurrent rectal cancer (LRRC). Methods: A descriptive case series study was performed. The complete clinical data of 62 patients who met the diagnostic criteria of LRRC and treated by surgical procedures in Huashan Hospital of Fudan University from January 2012 to November 2019 were analyzed retrospectively. All the patients were followed up at least 12 months. Assessments of urinary function, sexual function, mobility function of lower limb and quality of life were documented. Patients with distant metastasis and surgical history of the urinary system were excluded. According to the criteria of Memorial Sloan Kettering Cancer Center (MSKCC), recurrence were divided into central (n=27), anterior (n=20), posterior (n=7), and lateral (n=8) subtypes. Baseline characteristics, surgical procedures and short-term complications were analyzed. International prostate symptom score (IPSS) and grade of voiding dysfunction were used to evaluate the urinary function. Higher score of IPSS and higher grade of voiding dysfunction indicated worse voiding function. Sexual function for both genders was assessed preoperatively and postoperatively. International index of erectile function-5 (IIEF-5) was used for assessment of male patients and higher score indicated better function. Female sexual function index (FSFI) was used in females and higher score indicated better function. Short-form health survey with 36 items (SF-36), yielding an 8-scale profile of functional health (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, emotional health and mental health) was used to evaluate the quality of life. The higher score indicated the better quality of life. Results: All the operations of 62 patients completed successfully and R0 resection rate was 88.7% (55/62). Postoperative surgical complications occurred in 16 cases (25.8%), including 3 patients of Clavien-Dindo classification III. At postoperative 3-month, 42 patients without ileum cystectomy or ureterostomy suffered from different grade of voiding dysfunction. IPSS increased significantly after the surgery (before surgery: 12.36±4.75, after surgery: 18.40±4.77, t=-9.128, P<0.001). There was no significant difference among the subtypes (P>0.05). At postoperative 12-month, IIEF-5 decreased from 14 (0~25) to 9 (0~19) in males (Z=-5.174, P<0.001) and FSFI deceased from 8.4 (2.0-27.0) to 2.0 (2.0-18.4) in females (Z=-3.522, P<0.001). Scores of physical functioning and role-physical decreased significantly [physical functioning: before surgery 70 (35-85), after surgery 65 (30-80), Z=-3.685, P<0.001; role-physical: before surgery 50 (0-50), after surgery 25(0-75), Z=-4.065, P<0.001], while those of social functioning role-emotional and mental health increased significantly after the surgery [social functioning: before surgery 44 (22-78), after surgery 56 (0-89), Z=-3.509, P<0.001; role-emotional: before surgery 17 (0-100), after surgery 33 (0-100), Z=-2.439, P=0.015; mental health: before surgery 40 (36-76), after surgery 52 (24-80), Z=-3.395, P<0.001]. All surgical procedures decreased the voiding function of LRRC patients and the sexual function of male patients (all P<0.01). However, only total pelvic exenteration and posterior pelvic exenteration decreased FSFI in female patients [before surgery: 8.4 (2.0-27.0) after surgery: 2.0 (2.0-18.4), Z=-2.810, P=0.005]. Conclusions: Multi-visceral resection in LRRC patients may damage voiding and sexual function. However, successful and effective surgical treatment can improve the psychosocial health of LRRC patients.

Stability and bifurcation of a delayed diffusive predator-prey system with food-limited and nonlinear harvesting.

Based on ecological significance, a delayed diffusive predator-prey system with food-limited and nonlinear harvesting subject to the Neumann boundary conditions is investigated in this paper. Firstly, the sufficient conditions of the stability of nonnegative constant steady state solutions of system are derived. The existence of Hopf bifurcation is obtained by analyzing the associated characteristic equation and the conditions of Turing instability are derived when the system has no delay. Furthermore, the occurrence conditions the Hopf bifurcation are discussed by regarding delay expressing the gestation time of the predator as the bifurcation parameter. Secondly, by using upper-lower solution method, the global asymptotical stability of a unique positive constant steady state solution of system is investigated. Moreover, we also give the detailed formulas to determine the direction, stability of Hopf bifurcation by applying the normal form theory and center manifold reduction. Finally, numerical simulations are carried out to demonstrate our theoretical results.

Individual chronic mountain sickness symptom is an early warning sign of cognitive impairment.

OBJECTIVE: To investigate the relationship between various chronic mountain sickness (CMS) symptoms and cognitive performances and identify whether individual CMS symptom can be used as early warning signs of specific cognitive impairment in long-term high altitude migrators. METHODS: A total of 287 workers living at an altitude of 3850 m for 1-5 years participated in the study. According to the International Qinghai CMS Diagnostic Criteria, a questionnaire survey was conducted to measure the existence and severity of 7 self-perceptible CMS symptoms in addition to hemoglobin (Hb) levels in the blood. Six neurobehavioral tests were then conducted to assess cognitive function, and physiological indices, including Pittsburgh Sleep Quality Index (PSQI) and arterial oxygen saturation were also measured. RESULTS: Compared with a score of 0 for each CMS symptom, scores of 1-3 universally corresponded to impairment in some aspects of cognition. Moreover, the correlation analysis revealed that subjects with different CMS symptoms exhibited specific aspects of cognitive impairment. Cyanosis was associated with slower auditory and visual reactions, reduced motion agility and poor visual memory ability (R = =0.236, 0.261, 0.155, 0.221, P < 0.01). Sleep disturbance and excessive erythrocytosis were significantly correlated to poor memory ability (R = =0.206~0.251, P < 0.01), and the symptoms of headache were mainly associated with impaired motion agility (R = =0.266, P < 0.01). The results also indicated that Hb ≥ 200 g/L, SpO2 ≤ 88%, and PSQI scores ≥ 7, which correspond to excessive erythrocytosis, cyanosis and sleep disturbance symptoms respectively, predicted the decline of cognitive function. CONCLUSIONS: The characteristics of symptoms used in Qinghai CMS Score System were associated with specific cognitive impairments in long-term plateau migrators, which supported the usefulness of monitoring cognitive status using CMS-related symptoms for both CMS patients and non-CMS people at high altitude.

Rate-limiting steps in the Saccharomyces cerevisiae ergosterol pathway: towards improved ergosta-5,7-dien-3ß-ol accumulation by metabolic engineering.

Ergosterol is the predominant nature sterol constituent of plasma membrane in Saccharomyces cerevisiae. Herein, the biosynthetic pathway of ergosterol was proposed to be metabolically engineered for the efficient production of ergosta-5,7-dien-3ß-ol, which is the precursor of vitamin D4. By target disruption of erg5, involved in the end-steps of post-squalene formation, predominantly accumulated ergosta-5,7-dien-3ß-ol (4.12 mg/g dry cell weight). Moreover, the rate-limiting enzymes of ergosta-5,7-dien-3ß-ol biosynthesis were characterized. Overexpression of Hmg1p led to a significant accumulation of squalene, and induction of Erg1p/Erg11p expression raised the yield of both total sterols and ergosta-5,7-dien-3ß-ol with no obvious changes in growth behavior. Furthermore, the transcription factor allele upc2-1 was overexpressed to explore the effect of combined induction of rate-limiting enzymes. Compared with an obviously enhanced yield of ergosterol in the wild-type strain, decreases of both the ergosta-5,7-dienol levels and the total sterol yield were found in Δerg5-upc2-1, probably due to the unbalanced NADH/NAD+ ratio observed in the erg5 knockouts, suggesting the whole-cell redox homeostasis was also vital for end-product biosynthesis. The data obtained in this study can be used as reference values for the production of sterol-related intermediates involved in the post-squalene biosynthetic pathway in food-grade S. cerevisiae strains.

4-hydroxybenzyl aldehyde can prevent the acute cerebral ischemic injury in rats / 中成药

AIM To investigate the anti-neuroinflammation effects of 4-hydroxybenzyl aldehyde (4-HBAL) from Gastrodia elata Blume on acute cerebral ischemic injury in rats and its nechanism of action.METHODS The rat model of acute cerebral ischemic injury was induced by injecting arachidonic acid via intracarotid artery.Brain tissue samples were taken from the animals 3 h after the model of acute cerebral ischemic injury.Tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) were detected in brain tissue to evaluate the effects of 4-HBAL in vivo.Lipopolysaccharid (LPS)-induced activation of BV-2 microglia cells model was used to explore the anti-neuroinflammation mechanism of 4-HBAL.RESULTS The experimental results showed that 4-HBAL had a significant protective effect on acute cerebral ischemic injury.It could significandy decrease the contents of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β),and obviously inhibit the production of nitric oxide (NO),prostaglandin E2 (PGE2) and TNF-α in LPS-stimulated BV-2 cell,and increase the production of interleukin-10 (IL-10) and transforming growth factors-β (TGF-β) in BV-2 cell.CONCLUSION The mechanism of 4-HBAL may be related to the suppression of the excessive activation of microglia after cerebral ischemia and the promotion of the transformation of microglia into anti-inflammatory phenotype.

Clinical Reasoning Training Learned from Physical Therapy Programs in the USA / 中国康复理论与实践

Clinical reasoning training is the manifestation of comprehensive performance in the students of physical therapy.Strength-ening the clinical-oriented curriculum system,facilitating evidence-based practice knowledge and skills,introducing specialization educa-tion,and applying continuously the evaluation instruments of students'performance in clinical reasoning training would contribute to better education outcome.

Comparative Study Between Complete Ultrasound Guidance and Radiation Guidance in Percutaneous Balloon Pulmonary Valvuloplasty / 中国循环杂志

Objective:To evaluate the safety and efficacy of ultrasound guidance for percutaneous balloon pulmonary valvuloplasty (PBPV) in comparison with conventional X-ray guidance.Methods:Our research included in 2 groups:Ultrasound group,n=102 patients with PBPV under ultrasound guidance in our hospital from 2013-03 to 2016-08 and X-ray group,n=280 patients with PBPV under traditional X-ray guidance in our hospital at the same period of time.Post-operative effect was evaluated by echocardiography and compared between 2 groups.Results:The patients' age,body weight,pulmonary artery diameter,immediate post-operative pulmonary transvalvular pressure gradient (PTPG),the in-hospital time and cost were similar between 2 groups,P＞0.05.The success rate of operation in Ultrasound group and X-ray group was 99.0％ vs 100％,P=0.267.In the ultrasound group,1 patient was converted to a conventional surgery due to right ventricular outflow tract muscle spasm after dilation.The operation time in X-ray group was longer than Ultrasound group,(38.9±9.2) min vs (34.6±10.0) min,P＜0.001.The X-ray exposure time was (3.9±1.2) min in X-ray group.The mean follow-up time was (25.5±13.2) months and PTPG in Ultrasound group and X-ray group were (16.2±4.3) mmHg and (15.3±4.5) mmHg,P=0.120.No serious complications as death,peripheral vascular injury,cardiac perforation and pericardial effusion occurred in either group.Conclusion:PBPV under complete ultrasound guidance may not only avoid radiation and contrast agent,but also keep the safety and efficacy of minimally invasive conventional percutaneous interventional treatment.

Comparative Study Between Complete Ultrasound Guidance and Radiation Guidance in Percutaneous Balloon Pulmonary Valvuloplasty / 中国循环杂志

Objective:To evaluate the safety and efficacy of ultrasound guidance for percutaneous balloon pulmonary valvuloplasty (PBPV) in comparison with conventional X-ray guidance.Methods:Our research included in 2 groups:Ultrasound group,n=102 patients with PBPV under ultrasound guidance in our hospital from 2013-03 to 2016-08 and X-ray group,n=280 patients with PBPV under traditional X-ray guidance in our hospital at the same period of time.Post-operative effect was evaluated by echocardiography and compared between 2 groups.Results:The patients' age,body weight,pulmonary artery diameter,immediate post-operative pulmonary transvalvular pressure gradient (PTPG),the in-hospital time and cost were similar between 2 groups,P＞0.05.The success rate of operation in Ultrasound group and X-ray group was 99.0％ vs 100％,P=0.267.In the ultrasound group,1 patient was converted to a conventional surgery due to right ventricular outflow tract muscle spasm after dilation.The operation time in X-ray group was longer than Ultrasound group,(38.9±9.2) min vs (34.6±10.0) min,P＜0.001.The X-ray exposure time was (3.9±1.2) min in X-ray group.The mean follow-up time was (25.5±13.2) months and PTPG in Ultrasound group and X-ray group were (16.2±4.3) mmHg and (15.3±4.5) mmHg,P=0.120.No serious complications as death,peripheral vascular injury,cardiac perforation and pericardial effusion occurred in either group.Conclusion:PBPV under complete ultrasound guidance may not only avoid radiation and contrast agent,but also keep the safety and efficacy of minimally invasive conventional percutaneous interventional treatment.