Heterozygous CARD9 mutation favors the development of allergic bronchopulmonary aspergillosis / 中华医学杂志(英文版)

BACKGROUND@#Previous research demonstrated that a homozygous mutation of g.136372044G>A (S12N) in caspase recruitment domain family member 9 ( CARD9 ) is critical for producing Aspergillus fumigatus -induced ( Af -induced) T helper 2 (T H 2)-mediated responses in allergic bronchopulmonary aspergillosis (ABPA). However, it remains unclear whether the CARD9S12N mutation, especially the heterozygous occurrence, predisposes the host to ABPA.@*METHODS@#A total of 61 ABPA patients and 264 controls (including 156 healthy controls and 108 asthma patients) were recruited for sequencing the CARD9 locus to clarify whether patients with this heterozygous single-nucleotide polymorphisms are predisposed to the development of ABPA. A series of in vivo and in vitro experiments, such as quantitative real-time polymerase chain reaction, flow cytometry, and RNA isolation and quantification, were used to illuminate the involved mechanism of the disease.@*RESULTS@#The presence of the p.S12N mutation was associated with a significant risk of ABPA in ABPA patients when compared with healthy controls and asthma patients, regardless of Aspergillus sensitivity. Relative to healthy controls without relevant allergies, the mutation of p.S12N was associated with a significant risk of ABPA (OR: 2.69 and 4.17 for GA and AA genotypes, P = 0.003 and 0.029, respectively). Compared with patients with asthma, ABPA patients had a significantly higher heterozygous mutation (GA genotype), indicating that p.S12N might be a significant ABPA-susceptibility locus ( aspergillus sensitized asthma: OR: 3.02, P = 0.009; aspergillus unsensitized asthma: OR: 2.94, P = 0.005). The mutant allele was preferentially expressed in ABPA patients with heterozygous CARD9S12N , which contributes to its functional alterations to facilitate Af -induced T H 2-mediated ABPA development. In terms of mechanism, Card9 wild-type ( Card9WT ) expression levels decreased significantly due to Af -induced decay of its messenger RNA compared to the heterozygous Card9S12N . In addition, ABPA patients with heterozygous CARD9S12N had increased Af -induced interleukin-5 production.@*CONCLUSION@#Our study provides the genetic evidence showing that the heterozygous mutation of CARD9S12N , followed by allele expression imbalance of CARD9S12N , facilitates the development of ABPA.

Research advances in natural drug and food monomers in prevention and treatment of alcoholic liver injury / 临床肝胆病杂志

A large number of data show that the prevalence rate of alcoholic liver injury （ALI） is increasing year by year， and it has become one of the main causes of death due to chronic liver diseases such as liver cancer and liver cirrhosis. Quitting drinking is the main method for the prevention of ALI in modern medicine， and the main treatment methods include Western medicine with antioxidant and anti－fibrotic effects and nutritional support. However， Western medicine tends to have an unsatisfactory treatment effect and can only alleviate initial symptoms， and severe ALI still requires surgical treatment. Studies have shown that the monomers extracted from natural drugs and foods have obvious preventive and therapeutic effects on ALI， with high safety and easy access. Therefore， this article systematically summarizes the main natural drug and food monomers used for the prevention and treatment of ALI and proposes the idea of the combination of drug and food for the prevention and treatment of ALI from the perspective of paying attention to the whole process of health， in order to explore more effective prevention， health care， and treatment methods and provide ideas for research on the prevention and control of ALI.

Application of artificial intelligence based on data enhancement and hybrid neural network to site identification during esophagogastroduodenoscopy / 中华消化内镜杂志

Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.

Evaluation of the comparative influence of magnesium sulfate single and combination with ritodrine hydrochloride in the prevention of preterm delivery / Avaliação da influência comparativa de sulfato de magnésio único e combinação com cloridrato de ritodrina na prevenção de parto prematuro

This project was designedto explore the effects of ritodrine hydrochloride combined with magnesium sulfate in the prevention of preterm delivery of patients with threatened premature birth. 128 cases of threatened premature birth were randomly divided into two groups according to the number table method. The control group was treated with magnesium sulfate, while the study group was treated with ritodrine hydrochloride combined with magnesium sulfate. The data (p > 0.05) was analyzed using SPSS 18.0 and was subjected to Chi-square and t-test. The onset time and prolonged gestation time of the study group were shorter than those of the control group (p < 0.05). There was no difference in the incidence of myocardial ischemia between the study group and the control group (p > 0.05). The heart rate per minute of the study group was higher than that of the control group (p < 0.05). There was no difference in blood pressure between the study group and the control group. Nevertheless, the neurological function, pregnancy outcome, and neonatal status of the group were better than those of the control group (p < 0.05).(AU)

Este projeto foi desenvolvido para explorar os efeitos do cloridrato de ritodrina combinado com sulfato de magnésio na prevenção do parto prematuro de pacientes com risco de nascimento prematuro. 128 casos de nascimento prematuro ameaçado foram divididos aleatoriamente em dois grupos, de acordo com o método da tabela numérica. O grupo de controle foi tratado com sulfato de magnésio, enquanto o grupo de estudo foi tratado com cloridrato de ritodrina combinado com sulfato de magnésio. Os dados (p > 0,05) foram analisados pelo SPSS 18.0 e submetidos ao teste do qui-quadrado e ao teste t. O tempo de início e o tempo prolongado de gestação do grupo de estudo foram menores que os do grupo de controle (p < 0,05). Não houve diferença na incidência de isquemia miocárdica entre o grupo de estudo e o grupo de controle (p > 0,05). A frequência cardíaca por minuto do grupo de estudo foi superior à do grupo controle (p < 0,05). Não houve diferença na pressão arterial entre o grupo de estudo e o grupo de controle. No entanto, a função neurológica, o resultado da gravidez e o status neonatal do grupo foram melhores do que os do grupo de controle (p < 0,05).(AU)

A survey of awareness and knowledge about influenza and vaccination among primary care providers in Shanghai / 中华全科医师杂志

Objective:To investigate the awareness and knowledge of influenza and vaccine among primary care providers in Shanghai.Methods:An online questionnaires survey was conducted by Shanghai Alliance for Respiratory Diseases in Primary Care from December 2017 to August 2018, healthcare providers in district central hospitals and community health care centers of Shanghai were invited to participate in the survey. The questionnaire contained the following items: the basic information of respondents; knowledge of influenza and its vaccine; current status of influenza vaccination; factors affecting promoting vaccination; the intention, attitude, perception of promoting vaccination and the influencing factors, and suggestions on promoting influenza vaccination.Results:A total of 1 542 valid questionnaires were collected, 88.3% (1 361/1 542) responders correctly recognized main symptoms of influenza; 58.2% (898/1 542) ignored the contact transmission of influenza; 41.6% (641/1 542) didn′t know the frequency of influenza vaccination; 82.7% (1 276/1 542) failed to recognize that pregnant women should also receive influenza vaccination. The survey showed that 31.2% (481/1 542) of responders had been vaccinated against influenza. The vaccination rate in community health care institutions was significantly higher than that in district central hospitals [39.1% (304/778) vs. 23.2% (177/764), χ 2=45.44, P<0.05]. Factors affecting vaccination for healthcare providers were: influenza antigen was variable, and vaccination had no effects [49.5% (404/816)]; the efficacy of the flu vaccine was doubt [48.8% (634/1 298)]; the vaccine wasn′t free [46.5%(604/1 298)]. The respondents believed that the main ways to improve the influenza vaccination were to formulate relevant national vaccination policies [79.7%(1 229/1 542)], to regularly publicize knowledge of influenza and influenza vaccine to residents through communities [65.8% (1 015/1 542)], and to recommend the patients by primary care medical staff [64.4% (993/1 542)]. Conclusion:Many healthcare providers have insufficient knowledge about influenza and vaccine. The vaccination rate of community health institutions is higher than that in district central hospitals in Shanghai. The willingness to promote influenza vaccination can be influenced by some factors. Increasing the willingness of healthcare providers might be helpful to improve the vaccination coverage among residents in the community.

Study on Flipped Classroom Strategy of Nursing Ethics Based on Learning Ability / 中国医学伦理学

Objectives:The purpose of this study is to explore the teaching effect in flipped classroom stragety of nursing ethics curriculum based on learning ability,so as to provide reference for cultivating ethical thinking of nursing students and promoting their learning ability.Methodts:This study used flipped classroom stragety based learning ability in nursing research ethics section of nursing ethics curriculum,nursing students had a quiz last 10 minutes in class,and evaluated the teaching effect by filling in the scale developed by ourselves in the end of term.Restults:Fourty students in total were involved in this study,The average score of classroom quiz was 9.87 (total score was 10),the total average score of teaching effect evaluation was 4.10,the dimension average score of curriculum design evaluation was 4.30,the dimension average score of improving ability was 4.29,the dimension average score of mastering nursing research knowledge was 3.70.Conclussions:It is feasible that using flipped classroom stragety based on learning ability in nursing ethics curriculum,and could improve the learning ability of nursing students and the teaching effect.

Treatment effects of mindfulness-based four-step approach to obsessive compulsive disorder / 中国实用护理杂志

Objective To explore the effectiveness of mindfulness-based four-step approach to obsessive compulsive disorder. Methods A total of 82 patients with obsessive compulsive disorder were divided into control group and study group with 41 cases each by admission order. The patients in control group were given routine drug treatment and nursing, and the patients in study group were given mindfulness-based four-step approach based on control group. The indexes were evaluated by Yale-Brown Obsessive Compulsive Scale, Hamilton Depressive Scale, Hamilton Anxiety Scale, Short Form 36 questionnaire before and after intervention. Results After 12 weeks treatment, the score of Yale-Brown Obsessive Compulsive Scale, compulsive thinking, compulsive behavior were (6.16 ±4.38), (3.23 ±1.93), (2.98 ± 2.01) points in study group and (10.81 ± 3.26), (6.05 ± 2.02), (4.09 ± 2.15) points in control group, and there were significant differences(t=5.386, 6.384, 2.385, all P < 0.05). The score of anxiety and depress were (1.98 ± 1.91), (2.16 ± 1.38) points in study group, and (4.05 ± 2.01), (5.11 ± 2.26) points in control group, and there were significant differences(t=4.722, 7.045, all P<0.05). The score of total life quality, physiological function, physiological function, body pain, general health, vitality, social function, emotional function, mental health were (77.32 ± 6.26), (89.11 ± 14.27), (78.19 ± 26.36), (82.33 ± 25.22), (60.18 ± 20.39), (55.31 ± 19.68), (80.13 ± 25.76), (72.13 ± 20.16), (60.12 ± 20.88) points respectively in study group, and (71.43 ± 5.62), (82.19 ± 13.36), (55.11 ± 23.27), (70.18 ± 25.71), (49.01 ± 20.13), (45.22 ± 18.11), (62.19±25.63), (45.23±23.02), (44.16±21.08) points in control group, and there were significant differences (t=2.134-6.621, all P<0.05). Conclusions The mindfulness-based four-step approach intervention can obviously relieve anxiety and depressive negativity mood in obsessive compulsive disorder patients. It can improve patient′s obsessive compulsive symptom, enhance the patient′s quality of life. It has important significance for obsessive compulsive disorder patients during their recovering period.

Inquiry-based Teaching in the Nursing Ethics Teaching Reform / 中国医学伦理学

Objective:To probe the implement of inquiry -based teaching in nursing ethics. Method:105 nursing students attended the innovation of inquiry-based teaching for Nursing Ethics. Results:88. 5% nursing students satisfied with innovation of teaching;82 . 9% nursing studentsethics awareness was enhanced largely in understanding for nursing ethics;68 . 6% nursing students considered that their ability for ethical thinking has been enhanced largely;93 . 3% nurs-ing students thought that nursing ethics was important. Different inquiry methods for nursing students led to different level of analysis ability for ethic cases(P﹤0. 001). Conclusions:It's necessary to perform the innovation of inquiry-based teaching, promoting the student's activity, focus on learning process and enhancing the students comprehensive ability.

Application of therapeutic drug monitoring of vancomycin / 中国感染与化疗杂志

Objective To analyze the relationship between plasma concentration and efficacy , adverse drug reactions by monitoring vancomycin serum concentrations for appropriately treating the infections caused by methicillin‐resistant Staphylococcus aureus or other gram‐positive cocci .Methods Vancomycin concentration was monitored in the patients with indications for vancomycin therapy .Blood sample was taken after vancomycin was administered for at least 4 doses .The blood sample collected within 30 minutes before dosing was used to determine the trough blood concentration .The samples were taken within 30 minutes to 1 hour after infusion of vancomycin were used to estimate the peak concentration by fluorescence polarization immunoassay .The clinical data were collected at the same time to analyze clinical efficacy and safety .Results Vancomycin trough concentration ranged from 3 .22 mg/L to 50 .79 mg/L in 25 patients ,specifically ,＜ 5 mg/L in 3 cases ,5‐＜10 mg/L in 11 cases ,10‐15 mg/L in 3 cases ,and > 15 mg/L in 8 csaes .Peak concentration ranged from 13 .57 mg/L to 60 .47 mg/L ,specifically ,＜ 25 mg/L in 14 cases ,25‐40 mg/L in 7 cases ,and > 40 mg/L in 4 cases .The infection was cured in 80 .0% (20/25) of the patients .The gram‐positive cocci were eradicated in 87 .5% (21/24) of the patients .The dosage of vancomycin was adjusted in 13 patients according to the results of blood concentration monitoring .Majority of these patients (12/13 ,92 .3% ) were cured .Renal impairment was observed in 4 patients .Conclusions Vancomycin is safe and effective in treatment of methicillin‐resistant Staphylococcus aureus and other gram‐positive bacterial infections . Vacomycin concentration varies from person to person . Serum concentration monitoring is required to achieve best outcomes and the goal of individualized treatment of vancomycin.

Effects of pulmonary rehabilitation on patients with stable chronic obstructive pulmonary disease / 中华物理医学与康复杂志

Objective To observe the effects of puhnonary rehabilitation on the symptoms and quality of life of persons with chronic obstructive pulmonary disease (COPD).Methods COPD patients were recruited from a hospital and community health centers and given pulmonary rehabilitation in the community.The rehabilitation program included health education and nutrition guidance,medication,breathing exercises,and physical exercise.Each patient was followed up every 4 weeks by telephone.The outcome measures included pulmonary function (FEV1％,FEV1/FVC％),St George's questionnaire (SGRQ),the Medical Research Council scale (MRC),Borg scoring,evaluation of anxiety and depression,the six-minute walk test (6MWT),and an evaluation of nutritional status.All of the patients were observed for one year.Results A total of 85 patients completed the program and were included in the final statistical analysis.There was no difference in FEV1 ％ before and after rehabilitation.Six-minute walking distance improved significantly in statistical terms but the average increase was only from (416.1 ±99.84)m to (437.51 ±116.17)m.The SGRQ scores decreased by an average of 4.8 points after a year of rehabilitation,with significant improvements among the moderately and severely impaired.Incidents of COPD exacerbation also decreased significantly.Patients with a low body mass index had the greatest SGRQ score improvments.Few patients showed depression or anxiety in this research population.Conclusions Pulmonary rehabilitation in the community can improve exercise tolerance and the quality of life for persons with COPD,reducing incidents of acute exacerbation.Patients may benefit from such pulmonary rehabilitation regardless of disease severity.The compliance was good despite the infrequent monitoring.Pulmonary rehabilitation in the community is worthy of more widespread use.

Compliance of secondary prevention in patients with coronary artery disease post coronary revascularization / 中华全科医师杂志

Objective To investigate the compliance status of secondary prevention in patients with coronary artery disease (CAD) following revascularization.MethodsA total of 512 patients with CAD who received procedures for coronary revascularization were enrolled in the study from January 2009 to October 2010,including 472 cases of percutaneous coronary intervention stenting,25 cases of coronary artery bypass grafting and 15 cases of stenting plus bypass.The demographic information,prophylactic drug therapies, lifestylechangesandmodifiableriskfactorsweresurveyedwithquestionnaires,anthroposomatologicalmeasurementsandlaboratorytestsinpatients3monthsaftercoronary revascularization.ResultsThe proportion of patients on statins,aspirin,β-blockers,angiotensin-converting enzymeinhibitors/angiotensinreceptorblockers(ACEIs/ARBs)andinfluenzavaccinationwere 81.4％ (417/512),93.9％ ( 481/512 ),82.0％ ( 420/512 ),76.2％ ( 390/512 ) and 3.7％ ( 19/512 ) respectively.Based on the criteria recommended by the American Heart Association/American College of Cardiology (AHA/ACC)Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update, the percentages of achieving therapeutic targets of modifiable risk factor management were as follows:glycosylated hemoglobin (90.2％,462/512 ),total cholesterol ( 68.6％,351/512 ),triglycerides ( 58.8％,301/512 ),high-density lipoprotein cholesterol ( 91.6％,469/512 ),low-density lipoprotein cholesterol ( 44.5 ％,228/512 ),systolic pressure ( 75.2 ％,385/512 ) and diastolic pressure (90.4％,463/512 ) respectively.And the proportions of improved lifestyle were as follows:smoking cessation/non-smoking 81.4％ (417/512),diet control 78.5％ ( 402/512 ),achieving weight targets 61.7％ (316/512)and regular exercise 58.2％ (298/512).ConclusionsThere is a relatively high percentage of standardized antiplatelet therapy and continuous statins medication in patients with coronary artery disease following revascularization. However,many significant modifiable risk factors have not been controlled optimally and lifestyle of patients needs further improvement. There is still a considerable scope for further improvement of secondary prevention in this group of patients.

The Relationship between Cerebrovascular Hemodynamics and Risk of Ischemic Stroke / 中国慢性病预防与控制

Objective To probe into the relations between cerebrovascular hemodynamics indexes(CVHI),risk factors of stroke and risk of ischemic stroke.Methods A nested case-control design was used in the study.Participants were selected from a cohort in the northeast of China.151 ischemic stroke patients occurred during the follow-up term were defined as case group,and the same numbers of individuals,free of stroke,were selected randomly in the cohort and defined as control group.Odds ratio(OR) of CVHI score as well as other risk factors of stroke were estimated.Results Univariate analysis indicated that there were significant etiological relations between stroke and CVHI score,hypertension,heart disease and family history of stroke(P

EFFECT OF ANISODINE ON BRAIN MONOAMINE / 解放军医学杂志

The effect of anisodine on brain monoamine was studied in 30 rats. The brain monoamine levels of caudate nucleus, hippocampus, diencephalon, brain stem and cerebral cortex were estimated by fluoro-metric method in drug-treated rats and saline-treated controls. Only the NE level of the brain stem was significantly increased in anisodine-treated animals 48 hours after injection. There were no significant differences in the dopamine values between anisodine-treated rats and saline-treated controls, while the 5HT and 5HIAA levels were significantly increased in anisodine-treated animals. The relation of brain monoamines to learning and memory is discussed. The increased 5HT and 5HIAA levels caused by anisodine may play a role in the impairment of memory.