Genome editing tools such as the clustered regularly interspaced short palindromic repeat （CRISPR）-associated system （Cas） have been widely used to modify genes in model systems including animal zygotes and human ...Genome editing tools such as the clustered regularly interspaced short palindromic repeat （CRISPR）-associated system （Cas） have been widely used to modify genes in model systems including animal zygotes and human cells, and hold tremendous promise for both basic research and clinical applications. To date, a serious knowledge gap remains in our understanding of DNA repair mechanisms in human early embryos, and in the efficiency and potential off-target effects of using technologies such as CRISPR/Cas9 in human pre-implantation embryos. In this report, we used tripronuclear （3PN） zygotes to further investigate CRISPR/Cas9-mediated gene editing in human cells. We found that CRISPR/Cas9 could effectively cleave the endogenous β-globin gene （HBB）. However, the efficiency of homologous recombination directed repair （HDR） of HBB was low and the edited embryos were mosaic. Off-target cleavage was also apparent in these 3PN zygotes as revealed by the T7E1 assay and whole-exome sequencing. Furthermore, the endogenous delta-globin gene （HBD）, which is homologous to HBB, competed with exogenous donor oligos to act as the repair template, leading to untoward mutations. Our data also indicated that repair of the HBB locus in these embryos occurred preferentially through the non-crossover HDR pathway. Taken together, our work highlights the pressing need to further improve the fidelity and specificity of the CRISPR/Cas9 platform, a prerequisite for any clinical applications of CRSIPR/Cas9-mediated editing.展开更多
BACKGROUND:Portal vein thrombosis(PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis.Prevention and timely detection of PVT are ...BACKGROUND:Portal vein thrombosis(PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis.Prevention and timely detection of PVT are quite significant.There is a lack of knowledge about the clinical features and risk factors of PVT.Our study aimed to investigate the risk factors and clinical characteristics of PVT in order to figure out the high-risk individuals.METHODS:We collected the clinical data of 472 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2008 to December 2010 in our institution.Clinical and surgical characteristics of patients who developed PVT postoperatively and those who did not develop PVT were compared.Univariate and multivariate analyses of risk factors of PVT were performed.The mortality and rebleeding rate of the patients were also evaluated.RESULTS:Of the 472 patients,52 were excluded from the study.PVT developed in 71(71/420,16.9%) patients.Multivariate analysis revealed that wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization were significantly correlated with PVT development [odds ratio(OR):5.701,2.807,1.850 and 2.090,respectively].The incidence of PVT in patients who took antiplatelet drugs was not lower than that in those who did not.Follow-up showed that patients in the PVT group had a tendency towards reduced overall survival but it was not statistically significant.Gastrointestinal bleeding occurred more often in the PVT group than that in the non-PVT group(P=0.044).CONCLUSIONS:Wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization are independent risk factors of PVT.PVT is related with higher risk of postoperative gastrointestinal hemorrhage but has no significant impact on the overall survival.展开更多
Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 ...Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including int展开更多
Background The incidence of congenital heart disease has been studied in developed countries for many years, but rarely in the mainland of China. Fetal echocardiographic screening for congenital heart disease was firs...Background The incidence of congenital heart disease has been studied in developed countries for many years, but rarely in the mainland of China. Fetal echocardiographic screening for congenital heart disease was first performed in Beijing in the early 2000s, but the impact was not clear. The current study was undertaken to determine the incidence of congenital heart disease in Beijing, China and to estimate the impact of fetal echocardiography on the incidence of liveborn congenital heart disease.Methods The study involved all infants with congenital heart disease among the 84 062 total births in Beijing during the period of January 1 and December 31, 2007. An echocardiographic examination was performed on every baby suspected to have congenital heart disease, prenatally or/and postnatally.Results A total of 686 infants were shown to have congenital heart disease among 84 062 total births. The overall incidence was 8.2/1000 total births. Mothers of 128 of 151 babies diagnosed prenatally were chosen to terminate the pregnancy. Two of the 151 infants died in utero. A specific lesion was identified for each infant and the frequencies of lesions were determined for each class of infants （total births, stillbirths and live births）. The incidence of congenital heart disease in stillbirths and live births was 168.8/1000 and 6.7/1000, respectively. The difference between the incidence of total birth and the incidence of live birth was statistically significant （P 〈0.001）. Conclusions The incidence of liveborn congenital heart disease in Beijing is within the range reported in developed countries. Fetal echocardiography reduce significantly the incidence of liveborn congenital heart disease.展开更多
Syncope belongs to the transient loss of consciousness(TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of eme...Syncope belongs to the transient loss of consciousness(TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society(CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association(CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association(CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association(CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association(BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and headup tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.展开更多
Artemisia annua, commonly known as sweet wormwood or Qinghao, is a shrub native to China and has long been used for medicinal purposes. A. annua is now cultivated globally as the only natural source of a potent anti-m...Artemisia annua, commonly known as sweet wormwood or Qinghao, is a shrub native to China and has long been used for medicinal purposes. A. annua is now cultivated globally as the only natural source of a potent anti-malarial compound, artemisinin. Here, we report a high-quality draft assembly of the 1.74-gigabase genome of A. annua, which is highly heterozygous, rich in repetitive sequences, and contains 63 226 protein-coding genes, one of the largest numbers among the sequenced plant species. We found that, as one of a few sequenced genomes in the Asteraceae, the A. annua genome contains a large number of genes specific to this large angiosperm clade. Notably, the expansion and functional diversification of genes encoding enzymes involved in terpene biosynthesis are consistent with the evolution of the artemi- sinin biosynthetic pathway. We further revealed by transcriptome profiling that A. annua has evolved the sophisticated transcriptional regulatory networks underlying artemisinin biosynthesis. Based on compre- hensive genomic and transcriptomic analyses we generated transgenic A. annua lines producing high levels of artemisinin, which are now ready for large-scale production and thereby will help meet the chal- lenge of increasing global demand of artemisinin.展开更多
Based on the observation by a Regional Air Quality Monitoring Network including 16 monitoring stations, temporal and spatial variations of ozone （O3）, NO2 and total oxidant （Ox） were analyzed by both linear regres...Based on the observation by a Regional Air Quality Monitoring Network including 16 monitoring stations, temporal and spatial variations of ozone （O3）, NO2 and total oxidant （Ox） were analyzed by both linear regression and cluster analysis. A fast increase of regional O3 concentrations of 0.86 ppbWyr was found for the annual averaged values from 2006 to 2011 in Guangdong, China. Such fast O3 increase is accompanied by a correspondingly fast NOx reduction as indicated by a fast NO2 reduction rate of 0,61 ppbV/yr. Based on a cluster analysis, the monitoring stations were classified into two major categories - rural stations （non-urban） and suburban/urban stations. The 03 concentrations at rural stations were relatively conserved while those at suburban/urban stations showed a fast increase rate of 2.0 ppbV/yr accompanied by a NO2 reduction rate of 1.2 ppbV/yr. Moreover, a rapid increase of the averaged O3 concentrations in springtime （13%/yr referred to 2006 level） was observed, which may result from the increase of solar duration, reduction of precipitation in Guangdong and transport from Eastern Central China. Application of smog production algorithm showed that the photochemical O3 production is mainly volatile organic compounds （VOC）-controlled. However, the photochemical O3 production is sensitive to both NOx and VOC for O3 pollution episode. Accordingly, it is expected that a combined NOx and VOC reduction will be helpful for the reduction of the O3 pollution episodes in Pearl River Delta while stringent VOC emission control is in general required for the regional O3 pollution control.展开更多
AIM: To explore the expression and clinicopathological significance of cyclooxygenase-2 (COX-2) and microvessel density (MVD) in gastric carcinogenesis, and to investigate their roles in the invasion and the relations...AIM: To explore the expression and clinicopathological significance of cyclooxygenase-2 (COX-2) and microvessel density (MVD) in gastric carcinogenesis, and to investigate their roles in the invasion and the relationship between biological behaviors and prognosis of gastric cancer. METHODS: Using Envision immunohistochemistry, COX-2 and CD34 expressions in gastric cancer tissue array were examined. MVD was counted and the relationship between the biological behaviors and prognosis was analyzed. RESULTS: The expression of COX-2 in gastric cancer tissue was significantly higher than that in normal mucosa (χ2 = 12.191, P < 0.05). The over-expression of COX-2 in gastric cancer was obviously related to metastasis and depth of invasion (χ2 = 6.315, P < 0.05), but not related to the histological type and Borrmann type (χ2 = 5.391 and χ2 = 2.228, respectively). Moreover, MVD in gastric cancer tissues was significantly higher than that in the normal mucosa (65.49 ± 20.64 vs 36.21 ± 18.47, t/F = 7.53, P < 0. 05). MVD was related to the histologic type and metastasis (t/F = 3.68 and t/F = 4.214, respectively, P < 0. 05), but not related to the depth of invasion and Borrmann type (t/F = 0.583 and t/F = 0.459, respectively). MVD in COX-2-positive tissues was markedly higher compared to COX-2-negative tissues, indicating a positive correlation between COX-2 expression and MVD (t = 13.12, P < 0. 05). CONCLUSION: Tissue microarray (TMA) is a powerful tool for rapid identifi cation of the molecular alterations in gastric cancer. COX-2 expression, via inducingangiogenesis, may play an important role in gastric carcinogenesis. It could be served as a determinant factor for clinical prognosis and curative effect.展开更多
AIM: To investigate the role of perioperative chemoradiotherapy (CRT) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma (ESCC). METHODS: Using preoperative computed tomography (CT)-based...AIM: To investigate the role of perioperative chemoradiotherapy (CRT) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma (ESCC). METHODS: Using preoperative computed tomography (CT)-based staging criteria, 238 patients with ESCC (stage ⅡⅢ ) were enrolled in this prospective study between January 1997 and June 2004. With informed consent, patients were randomized into 3 groups: preoperative CRT (80 cases), postoperative CRT (78 cases) and surgery alone (S) (80 cases). The 1-, 3-, 5and 10-year survival were followed up. Progressionfree survival (PFS) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause. The secondary endpoint was overall survival (OS) determined as the time (in months) between the date of therapy and the date of death. Other objectives were surgical and adjuvant therapy complications.RESULTS: With median follow-up of 45 mo for all the enrolled patients, significant differences in the 1-, 3-, 5-, 10-year OS (91.3%, 63.5%, 43.5%, 24.5% vs 91%, 62.8%, 42.3%, 24.4% vs 87.5%, 51.3%, 33.8%, 12.5%, P = 0.0176) and PFS (89.3%, 61.3%, 37.5%, 18.1% vs 89.1%, 61.1%, 37.2%, 17.8% vs 84.5%, 49.3%, 25.9%, 6.2%, P = 0.0151) were detected among the 3 arms. There were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). For the patients who had radical resection, significant differences in median PFS (48 mo vs 61 mo vs 39.5 mo, P = 0.0331) and median OS (56.5 mo vs 72 mo vs 41.5 mo, P = 0.0153) were detected among the 3 arms, but there were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). The local recurrence rates in the preoperative CRT, postoperative CRT group and S group were 11.3%, 14.1% and 35%, respectively (P < 0.05). No significant differences were detected among the 3 groups when comparing complications but tended to be in favor of the postoperative CRT and S groups (P > 0展开更多
In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture dev...In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.展开更多
BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was int...BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was introduced to facilitate choledochojejunostomy and improve the prognosis of patients.METHODS:After ligating the common bile duct for 7 days,16 dogs were randomly divided into two groups (n=8 per group).Anastomats were used in the study group,and the traditional hand-sewn method was used in the control group for standard Roux-en-Y choledochojejunostomy.We compared the operation time,incidence of complications,gross appearance,and pathological disparity in stoma between the two groups in 1-month and 3-month follow-up examinations.RESULTS:The time spent on constructing the anastomosis for the study group was significantly shortened.Although no anastomotic stenosis occurred in the two groups,the narrowing rate of biliary-enteric anastomosis was much higher in the control group.There was one case of bile leakage in the control group,whereas no bile leakage occurred in the study group.A smoother surface,an improved layer apposition,and a lower local inflammatory response were identified in the anastomosis of the study group.CONCLUSION:The structures of the novel magnetic compressive anastomats are simple,and they are time-saving,safe and efficient for performing Roux-en-Y choledocho- jejunostomy procedures in a canine model of obstructive jaundice.展开更多
Sepsis-induced myocardial dysfunction is a common complication in septic patients and is associated with increased mortality.In the clinical setting,it was once believed that myocardial dysfunction was not a major pat...Sepsis-induced myocardial dysfunction is a common complication in septic patients and is associated with increased mortality.In the clinical setting,it was once believed that myocardial dysfunction was not a major pathological process in the septic patients,at least in part,due to the unavailability of suitable clinical markers to assess intrinsic myocardial function during sepsis.Although sepsis-induced myocardial dysfunction has been studied in clinical and basic research for more than 30 years,its pathophysiology is not completely understood,and no specific therapies for this disorder exist.The purpose of this review is to summarize our current knowledge of sepsis-induced myocardial dysfunction with a special focus on pathogenesis and clinical characteristics.展开更多
Lianhuaqingwen(LHQW)capsule,a herb medicine product,has been clinically proved to be effective in coronavirus disease 2019(COVID-19)pneumonia treatment.However,human exposure to LHQW components and their pharmacologic...Lianhuaqingwen(LHQW)capsule,a herb medicine product,has been clinically proved to be effective in coronavirus disease 2019(COVID-19)pneumonia treatment.However,human exposure to LHQW components and their pharmacological effects remain largely unknown.Hence,this study aimed to determine human exposure to LHQW components and their anti-COVID-19 pharmacological activities.Analysis of LHQW component profiles in human plasma and urine after repeated therapeutic dosing was conducted using a combination of HRMS and an untargeted data-mining approach,leading to detection of 132 LHQW prototype and metabolite components,which were absorbed via the gastrointestinal tract and formed via biotransformation in human,respectively.Together with data from screening by comprehensive 2 D angiotensin-converting enzyme 2(ACE2)biochromatography,8 components in LHQW that were exposed to human and had potential ACE2 targeting ability were identified for further pharmacodynamic evaluation.Results show that rhein,forsythoside A,forsythoside I,neochlorogenic acid and its isomers exhibited high inhibitory effect on ACE2.For the first time,this study provides chemical and biochemical evidence for exploring molecular mechanisms of therapeutic effects of LHQW capsule for the treatment of COVID-19 patients based on the components exposed to human.It also demonstrates the utility of the human exposure-based approach to identify pharmaceutically active components in Chinese herb medicines.展开更多
AIM: The purpose of this study was to investigate the effectof laparoscopic surgery on liver function in humans and thepossible mechanisms behind such effect.METHODS: Blood samples from 286 patients whounderwent lapar...AIM: The purpose of this study was to investigate the effectof laparoscopic surgery on liver function in humans and thepossible mechanisms behind such effect.METHODS: Blood samples from 286 patients whounderwent laparoscopic cholecystectomy (LC) and 40patients who underwent open cholecystectomy (OC) weretested for liver function by measuring the level of serumalanine aminotrasferase (ALT) and aspartate aminotrasferase(AST) before and after the operations. The same tests werealso applied to 18 laparoscopic colorectal cancer resection(LCR) patients and 23 open colorectal cancer resection (OCR)patients to determine whether CO2 pneumoperitoneum couldalter the serum liver enzymes.RESULTS: The level of serum ALT and AST increasedsignificantly during the first 48 hours post operations in bothLC and LCR patients. However, no significant change of theserum liver enzymes was detected in both OC and OCRpatients. As a result, there was statistically significantdifference in change of both ALT and AST levels betweenLC and OC patients and LCR and OCR patients, respectively.By the 7th day post operation, the level of both enzymesreturned to normal values in LC, OC and OCR patients exceptLCR patients whose enzymes remained at a higher level.CONCLUSION: Transient elevation of hepatic transaminasesoccurred after laparoscopic surgery. The major causativefactor seemed to be the CO2 pneumoperitoneum. In mostof the laparoscopic surgery patients, the transient elevationof serum liver enzymes showed no apparent clinicalimplications. However, if preoperative liver function was verypoor, laparoscopic surgery may not be the best choice forthe treatment of patients with certain abdominal diseases.展开更多
In recent years,as living standards have continued to improve,the number of diabetes patients in China,along with the incidence of complications associated with the disease,has been increasing.Among these complication...In recent years,as living standards have continued to improve,the number of diabetes patients in China,along with the incidence of complications associated with the disease,has been increasing.Among these complications,diabetic foot disease is one of the main causes of disability and death in diabetic patients.Due to the differences in economy,culture,religion and level of medical care available across different regions,preventive and treatment methods and curative results for diabetic foot vary greatly.In multidisciplinary models built around diabetic foot,the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology.In 2019,under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society,the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease(2020 edition)was established with the participation of scholars from the specialist areas of endocrinology,burn injury,vascular surgery,orthopedics,foot and ankle surgery and cardiology.Drawing lessons from diabetic foot guidelines from other countries,this guide analyses clinical practices for diabetic foot,queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China.This paper begins with assessments and diagnoses of diabetic foot,then describes treatments for diabetic foot in detail,and ends with protections for high-risk feet and the prevention of ulcers.This manuscript covers the disciplines of internal medicine,surgical,nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot.展开更多
The bacterial community structures in two sewage treatment plants with different processes and performance were investigated by denaturing gradient gel electrophoresis （DGGE） of nested polymerase chain reaction （ne...The bacterial community structures in two sewage treatment plants with different processes and performance were investigated by denaturing gradient gel electrophoresis （DGGE） of nested polymerase chain reaction （nested PCR） amplified 16S rRNA gene fragments with group-specific primers. Samples of raw sewage and treated effluents were amplified using the whole-cell PCR method, and the activated sludge samples were amplified using the extracted genomic DNA before the PCR products were loaded on the same DGGE gel for bacterial community analysis. Ammonia-oxidizing bacterial and actinomycetic community analysis were also carried out to investigate the relationship between specific population structures and system or sludge performance. The two plants demonstrated a similarity in bacterial community structures of raw sewage and activated sludge, but they had different effluent populations. Many dominant bacterial populations of raw sewage did not appear in the activated sludge samples, suggesting that the dominant bacterial populations in raw sewage might not play an important role during wastewater treatment. Although the two plants had different sludge properties in terms of settleability and foam forming ability, they demonstrated similar actinomycetic community structures. For activated sludge with bad settling performance, the treated water presented a similar DGGE pattern with that of activated sludge, indicating the nonselective washout of bacteria from the system. The plant with better ammonium removal efficiency showed higher ammonia-oxidizing bacteria species richness. Analysis of sequencing results showed that the major populations in raw sewage were uncultured bacterium, while in activated sludge the predominant populations were beta proteobacteria.展开更多
BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution seconda...BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.展开更多
The characteristics of the energy structure of rich coal,less oil and less gas,coupling with a high external dependence on oil and natural gas and the emphasis on the efficient and clean utilisation of coal,have broug...The characteristics of the energy structure of rich coal,less oil and less gas,coupling with a high external dependence on oil and natural gas and the emphasis on the efficient and clean utilisation of coal,have brought opportunities for coal chemical industry.However,with the large-scale popularisation of coal gasification technology,the production and resulting storage of coal gasification slag continue to increase,which not only result in serious environmental pollution and a waste of terrestrial resources,but also seriously affect the sustainable development of coal chemical enterprises.Hence,the treatment of coal gasification slag is extremely important.In this paper,the production,composition,morphology,particle size structure and water holding characteristics of coal gasification slag are introduced,and the methods of carbon ash separation of gasification slag,both domestically and abroad,are summarised.In addition,the paper also summarises the research progress on gasification slag in building materials,ecological restoration,residual carbon utilisation and other high-value utilisation,and ultimately puts forward the idea of the comprehensive utilisation of gasification slag.For large-scale consumption to solve the environmental problems of enterprises and achieve high-value utilisation to increase the economic benefits of enterprises,it is urgent to zealously design a reasonable and comprehensive utilisation technologies with simple operational processes,strong adaptability and economic benefits.展开更多
基金This study was supported by the National Basic Research Program （973 Program） （Nos. 2010CB945401 and 2012CB911201）, the National Natural Science Foundation of China （Grant Nos. 91019020, 81330055, and 31371508）.
文摘Genome editing tools such as the clustered regularly interspaced short palindromic repeat （CRISPR）-associated system （Cas） have been widely used to modify genes in model systems including animal zygotes and human cells, and hold tremendous promise for both basic research and clinical applications. To date, a serious knowledge gap remains in our understanding of DNA repair mechanisms in human early embryos, and in the efficiency and potential off-target effects of using technologies such as CRISPR/Cas9 in human pre-implantation embryos. In this report, we used tripronuclear （3PN） zygotes to further investigate CRISPR/Cas9-mediated gene editing in human cells. We found that CRISPR/Cas9 could effectively cleave the endogenous β-globin gene （HBB）. However, the efficiency of homologous recombination directed repair （HDR） of HBB was low and the edited embryos were mosaic. Off-target cleavage was also apparent in these 3PN zygotes as revealed by the T7E1 assay and whole-exome sequencing. Furthermore, the endogenous delta-globin gene （HBD）, which is homologous to HBB, competed with exogenous donor oligos to act as the repair template, leading to untoward mutations. Our data also indicated that repair of the HBB locus in these embryos occurred preferentially through the non-crossover HDR pathway. Taken together, our work highlights the pressing need to further improve the fidelity and specificity of the CRISPR/Cas9 platform, a prerequisite for any clinical applications of CRSIPR/Cas9-mediated editing.
基金supported by a grant from the National Natural Science Foundation of China(81127005)
文摘BACKGROUND:Portal vein thrombosis(PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis.Prevention and timely detection of PVT are quite significant.There is a lack of knowledge about the clinical features and risk factors of PVT.Our study aimed to investigate the risk factors and clinical characteristics of PVT in order to figure out the high-risk individuals.METHODS:We collected the clinical data of 472 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2008 to December 2010 in our institution.Clinical and surgical characteristics of patients who developed PVT postoperatively and those who did not develop PVT were compared.Univariate and multivariate analyses of risk factors of PVT were performed.The mortality and rebleeding rate of the patients were also evaluated.RESULTS:Of the 472 patients,52 were excluded from the study.PVT developed in 71(71/420,16.9%) patients.Multivariate analysis revealed that wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization were significantly correlated with PVT development [odds ratio(OR):5.701,2.807,1.850 and 2.090,respectively].The incidence of PVT in patients who took antiplatelet drugs was not lower than that in those who did not.Follow-up showed that patients in the PVT group had a tendency towards reduced overall survival but it was not statistically significant.Gastrointestinal bleeding occurred more often in the PVT group than that in the non-PVT group(P=0.044).CONCLUSIONS:Wider preoperative portal vein diameter,postoperative thrombocytosis,prolonged prothrombin time and periesophagogastric devascularization are independent risk factors of PVT.PVT is related with higher risk of postoperative gastrointestinal hemorrhage but has no significant impact on the overall survival.
文摘Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including int
文摘Background The incidence of congenital heart disease has been studied in developed countries for many years, but rarely in the mainland of China. Fetal echocardiographic screening for congenital heart disease was first performed in Beijing in the early 2000s, but the impact was not clear. The current study was undertaken to determine the incidence of congenital heart disease in Beijing, China and to estimate the impact of fetal echocardiography on the incidence of liveborn congenital heart disease.Methods The study involved all infants with congenital heart disease among the 84 062 total births in Beijing during the period of January 1 and December 31, 2007. An echocardiographic examination was performed on every baby suspected to have congenital heart disease, prenatally or/and postnatally.Results A total of 686 infants were shown to have congenital heart disease among 84 062 total births. The overall incidence was 8.2/1000 total births. Mothers of 128 of 151 babies diagnosed prenatally were chosen to terminate the pregnancy. Two of the 151 infants died in utero. A specific lesion was identified for each infant and the frequencies of lesions were determined for each class of infants （total births, stillbirths and live births）. The incidence of congenital heart disease in stillbirths and live births was 168.8/1000 and 6.7/1000, respectively. The difference between the incidence of total birth and the incidence of live birth was statistically significant （P 〈0.001）. Conclusions The incidence of liveborn congenital heart disease in Beijing is within the range reported in developed countries. Fetal echocardiography reduce significantly the incidence of liveborn congenital heart disease.
文摘Syncope belongs to the transient loss of consciousness(TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society(CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association(CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association(CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association(CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association(BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and headup tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.
文摘Artemisia annua, commonly known as sweet wormwood or Qinghao, is a shrub native to China and has long been used for medicinal purposes. A. annua is now cultivated globally as the only natural source of a potent anti-malarial compound, artemisinin. Here, we report a high-quality draft assembly of the 1.74-gigabase genome of A. annua, which is highly heterozygous, rich in repetitive sequences, and contains 63 226 protein-coding genes, one of the largest numbers among the sequenced plant species. We found that, as one of a few sequenced genomes in the Asteraceae, the A. annua genome contains a large number of genes specific to this large angiosperm clade. Notably, the expansion and functional diversification of genes encoding enzymes involved in terpene biosynthesis are consistent with the evolution of the artemi- sinin biosynthetic pathway. We further revealed by transcriptome profiling that A. annua has evolved the sophisticated transcriptional regulatory networks underlying artemisinin biosynthesis. Based on compre- hensive genomic and transcriptomic analyses we generated transgenic A. annua lines producing high levels of artemisinin, which are now ready for large-scale production and thereby will help meet the chal- lenge of increasing global demand of artemisinin.
基金supported by the National Natural Science Foundation of China(No.21190052,41121004)the Strategic Priority Research Program of the Chinese Academy of Sciences(No.XDB05010500)+1 种基金the National Public Benefit Special Fund for Environmental Protection Research(No.201009001-4)the Special Fund of State Key Joint Laboratory of Environment Simulation and Pollution Control(No.13Z02ESPCP)
文摘Based on the observation by a Regional Air Quality Monitoring Network including 16 monitoring stations, temporal and spatial variations of ozone （O3）, NO2 and total oxidant （Ox） were analyzed by both linear regression and cluster analysis. A fast increase of regional O3 concentrations of 0.86 ppbWyr was found for the annual averaged values from 2006 to 2011 in Guangdong, China. Such fast O3 increase is accompanied by a correspondingly fast NOx reduction as indicated by a fast NO2 reduction rate of 0,61 ppbV/yr. Based on a cluster analysis, the monitoring stations were classified into two major categories - rural stations （non-urban） and suburban/urban stations. The 03 concentrations at rural stations were relatively conserved while those at suburban/urban stations showed a fast increase rate of 2.0 ppbV/yr accompanied by a NO2 reduction rate of 1.2 ppbV/yr. Moreover, a rapid increase of the averaged O3 concentrations in springtime （13%/yr referred to 2006 level） was observed, which may result from the increase of solar duration, reduction of precipitation in Guangdong and transport from Eastern Central China. Application of smog production algorithm showed that the photochemical O3 production is mainly volatile organic compounds （VOC）-controlled. However, the photochemical O3 production is sensitive to both NOx and VOC for O3 pollution episode. Accordingly, it is expected that a combined NOx and VOC reduction will be helpful for the reduction of the O3 pollution episodes in Pearl River Delta while stringent VOC emission control is in general required for the regional O3 pollution control.
文摘AIM: To explore the expression and clinicopathological significance of cyclooxygenase-2 (COX-2) and microvessel density (MVD) in gastric carcinogenesis, and to investigate their roles in the invasion and the relationship between biological behaviors and prognosis of gastric cancer. METHODS: Using Envision immunohistochemistry, COX-2 and CD34 expressions in gastric cancer tissue array were examined. MVD was counted and the relationship between the biological behaviors and prognosis was analyzed. RESULTS: The expression of COX-2 in gastric cancer tissue was significantly higher than that in normal mucosa (χ2 = 12.191, P < 0.05). The over-expression of COX-2 in gastric cancer was obviously related to metastasis and depth of invasion (χ2 = 6.315, P < 0.05), but not related to the histological type and Borrmann type (χ2 = 5.391 and χ2 = 2.228, respectively). Moreover, MVD in gastric cancer tissues was significantly higher than that in the normal mucosa (65.49 ± 20.64 vs 36.21 ± 18.47, t/F = 7.53, P < 0. 05). MVD was related to the histologic type and metastasis (t/F = 3.68 and t/F = 4.214, respectively, P < 0. 05), but not related to the depth of invasion and Borrmann type (t/F = 0.583 and t/F = 0.459, respectively). MVD in COX-2-positive tissues was markedly higher compared to COX-2-negative tissues, indicating a positive correlation between COX-2 expression and MVD (t = 13.12, P < 0. 05). CONCLUSION: Tissue microarray (TMA) is a powerful tool for rapid identifi cation of the molecular alterations in gastric cancer. COX-2 expression, via inducingangiogenesis, may play an important role in gastric carcinogenesis. It could be served as a determinant factor for clinical prognosis and curative effect.
文摘AIM: To investigate the role of perioperative chemoradiotherapy (CRT) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma (ESCC). METHODS: Using preoperative computed tomography (CT)-based staging criteria, 238 patients with ESCC (stage ⅡⅢ ) were enrolled in this prospective study between January 1997 and June 2004. With informed consent, patients were randomized into 3 groups: preoperative CRT (80 cases), postoperative CRT (78 cases) and surgery alone (S) (80 cases). The 1-, 3-, 5and 10-year survival were followed up. Progressionfree survival (PFS) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause. The secondary endpoint was overall survival (OS) determined as the time (in months) between the date of therapy and the date of death. Other objectives were surgical and adjuvant therapy complications.RESULTS: With median follow-up of 45 mo for all the enrolled patients, significant differences in the 1-, 3-, 5-, 10-year OS (91.3%, 63.5%, 43.5%, 24.5% vs 91%, 62.8%, 42.3%, 24.4% vs 87.5%, 51.3%, 33.8%, 12.5%, P = 0.0176) and PFS (89.3%, 61.3%, 37.5%, 18.1% vs 89.1%, 61.1%, 37.2%, 17.8% vs 84.5%, 49.3%, 25.9%, 6.2%, P = 0.0151) were detected among the 3 arms. There were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). For the patients who had radical resection, significant differences in median PFS (48 mo vs 61 mo vs 39.5 mo, P = 0.0331) and median OS (56.5 mo vs 72 mo vs 41.5 mo, P = 0.0153) were detected among the 3 arms, but there were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). The local recurrence rates in the preoperative CRT, postoperative CRT group and S group were 11.3%, 14.1% and 35%, respectively (P < 0.05). No significant differences were detected among the 3 groups when comparing complications but tended to be in favor of the postoperative CRT and S groups (P > 0
文摘In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.
基金supported by a grant from the National Natural Science Foundation of China (30830099)
文摘BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was introduced to facilitate choledochojejunostomy and improve the prognosis of patients.METHODS:After ligating the common bile duct for 7 days,16 dogs were randomly divided into two groups (n=8 per group).Anastomats were used in the study group,and the traditional hand-sewn method was used in the control group for standard Roux-en-Y choledochojejunostomy.We compared the operation time,incidence of complications,gross appearance,and pathological disparity in stoma between the two groups in 1-month and 3-month follow-up examinations.RESULTS:The time spent on constructing the anastomosis for the study group was significantly shortened.Although no anastomotic stenosis occurred in the two groups,the narrowing rate of biliary-enteric anastomosis was much higher in the control group.There was one case of bile leakage in the control group,whereas no bile leakage occurred in the study group.A smoother surface,an improved layer apposition,and a lower local inflammatory response were identified in the anastomosis of the study group.CONCLUSION:The structures of the novel magnetic compressive anastomats are simple,and they are time-saving,safe and efficient for performing Roux-en-Y choledocho- jejunostomy procedures in a canine model of obstructive jaundice.
基金supported by grants from the National Natural Science Foundation of China(81372028,81170222)the Guangzhou S cience and Technology Projec ts(201508020005)the Project of the Department of Education of Guangdong Province(No.2013KJCX0019)
文摘Sepsis-induced myocardial dysfunction is a common complication in septic patients and is associated with increased mortality.In the clinical setting,it was once believed that myocardial dysfunction was not a major pathological process in the septic patients,at least in part,due to the unavailability of suitable clinical markers to assess intrinsic myocardial function during sepsis.Although sepsis-induced myocardial dysfunction has been studied in clinical and basic research for more than 30 years,its pathophysiology is not completely understood,and no specific therapies for this disorder exist.The purpose of this review is to summarize our current knowledge of sepsis-induced myocardial dysfunction with a special focus on pathogenesis and clinical characteristics.
基金supported by Natural Science Foundation of China,China,(Grant Nos.81773688,U1903119,81973291,and 81973275)Zhejiang University Special Scientific Research Fund for COVID-19 Prevention and Control,China+1 种基金“Phospherus”Project of Shanghai Science and Technology Committee,China,(Grant Nos.19QA1411500)National Major Scientific and Technological Special Project for"Significant New Drugs Development",China,(Grant No.2020ZX09201005)
文摘Lianhuaqingwen(LHQW)capsule,a herb medicine product,has been clinically proved to be effective in coronavirus disease 2019(COVID-19)pneumonia treatment.However,human exposure to LHQW components and their pharmacological effects remain largely unknown.Hence,this study aimed to determine human exposure to LHQW components and their anti-COVID-19 pharmacological activities.Analysis of LHQW component profiles in human plasma and urine after repeated therapeutic dosing was conducted using a combination of HRMS and an untargeted data-mining approach,leading to detection of 132 LHQW prototype and metabolite components,which were absorbed via the gastrointestinal tract and formed via biotransformation in human,respectively.Together with data from screening by comprehensive 2 D angiotensin-converting enzyme 2(ACE2)biochromatography,8 components in LHQW that were exposed to human and had potential ACE2 targeting ability were identified for further pharmacodynamic evaluation.Results show that rhein,forsythoside A,forsythoside I,neochlorogenic acid and its isomers exhibited high inhibitory effect on ACE2.For the first time,this study provides chemical and biochemical evidence for exploring molecular mechanisms of therapeutic effects of LHQW capsule for the treatment of COVID-19 patients based on the components exposed to human.It also demonstrates the utility of the human exposure-based approach to identify pharmaceutically active components in Chinese herb medicines.
文摘AIM: The purpose of this study was to investigate the effectof laparoscopic surgery on liver function in humans and thepossible mechanisms behind such effect.METHODS: Blood samples from 286 patients whounderwent laparoscopic cholecystectomy (LC) and 40patients who underwent open cholecystectomy (OC) weretested for liver function by measuring the level of serumalanine aminotrasferase (ALT) and aspartate aminotrasferase(AST) before and after the operations. The same tests werealso applied to 18 laparoscopic colorectal cancer resection(LCR) patients and 23 open colorectal cancer resection (OCR)patients to determine whether CO2 pneumoperitoneum couldalter the serum liver enzymes.RESULTS: The level of serum ALT and AST increasedsignificantly during the first 48 hours post operations in bothLC and LCR patients. However, no significant change of theserum liver enzymes was detected in both OC and OCRpatients. As a result, there was statistically significantdifference in change of both ALT and AST levels betweenLC and OC patients and LCR and OCR patients, respectively.By the 7th day post operation, the level of both enzymesreturned to normal values in LC, OC and OCR patients exceptLCR patients whose enzymes remained at a higher level.CONCLUSION: Transient elevation of hepatic transaminasesoccurred after laparoscopic surgery. The major causativefactor seemed to be the CO2 pneumoperitoneum. In mostof the laparoscopic surgery patients, the transient elevationof serum liver enzymes showed no apparent clinicalimplications. However, if preoperative liver function was verypoor, laparoscopic surgery may not be the best choice forthe treatment of patients with certain abdominal diseases.
基金The National Natural Science Foundation of China(grant number:81770810)。
文摘In recent years,as living standards have continued to improve,the number of diabetes patients in China,along with the incidence of complications associated with the disease,has been increasing.Among these complications,diabetic foot disease is one of the main causes of disability and death in diabetic patients.Due to the differences in economy,culture,religion and level of medical care available across different regions,preventive and treatment methods and curative results for diabetic foot vary greatly.In multidisciplinary models built around diabetic foot,the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology.In 2019,under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society,the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease(2020 edition)was established with the participation of scholars from the specialist areas of endocrinology,burn injury,vascular surgery,orthopedics,foot and ankle surgery and cardiology.Drawing lessons from diabetic foot guidelines from other countries,this guide analyses clinical practices for diabetic foot,queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China.This paper begins with assessments and diagnoses of diabetic foot,then describes treatments for diabetic foot in detail,and ends with protections for high-risk feet and the prevention of ulcers.This manuscript covers the disciplines of internal medicine,surgical,nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot.
基金Project supported by the National Natural Science Foundation of China (No. 20510076, 50238050).
文摘The bacterial community structures in two sewage treatment plants with different processes and performance were investigated by denaturing gradient gel electrophoresis （DGGE） of nested polymerase chain reaction （nested PCR） amplified 16S rRNA gene fragments with group-specific primers. Samples of raw sewage and treated effluents were amplified using the whole-cell PCR method, and the activated sludge samples were amplified using the extracted genomic DNA before the PCR products were loaded on the same DGGE gel for bacterial community analysis. Ammonia-oxidizing bacterial and actinomycetic community analysis were also carried out to investigate the relationship between specific population structures and system or sludge performance. The two plants demonstrated a similarity in bacterial community structures of raw sewage and activated sludge, but they had different effluent populations. Many dominant bacterial populations of raw sewage did not appear in the activated sludge samples, suggesting that the dominant bacterial populations in raw sewage might not play an important role during wastewater treatment. Although the two plants had different sludge properties in terms of settleability and foam forming ability, they demonstrated similar actinomycetic community structures. For activated sludge with bad settling performance, the treated water presented a similar DGGE pattern with that of activated sludge, indicating the nonselective washout of bacteria from the system. The plant with better ammonium removal efficiency showed higher ammonia-oxidizing bacteria species richness. Analysis of sequencing results showed that the major populations in raw sewage were uncultured bacterium, while in activated sludge the predominant populations were beta proteobacteria.
基金supported by grants from the National Natural Science Foundation of China(81372613 and 81170431)Doctoral Fund of Ministry of Education of China(21022307110012)Special Fund of Ministry of Public Health of China(210202007)
文摘BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.
基金financially supported by the National Key Research and Development Program of China(2019YFC1904302)Foundation of State Key Laboratory of High-efficiency Utilisation of Coal and Green Chemical Engineering(2021-K81)the Technology of Coal-to-liquids Research Institute of National Energy Group([2020]010)。
文摘The characteristics of the energy structure of rich coal,less oil and less gas,coupling with a high external dependence on oil and natural gas and the emphasis on the efficient and clean utilisation of coal,have brought opportunities for coal chemical industry.However,with the large-scale popularisation of coal gasification technology,the production and resulting storage of coal gasification slag continue to increase,which not only result in serious environmental pollution and a waste of terrestrial resources,but also seriously affect the sustainable development of coal chemical enterprises.Hence,the treatment of coal gasification slag is extremely important.In this paper,the production,composition,morphology,particle size structure and water holding characteristics of coal gasification slag are introduced,and the methods of carbon ash separation of gasification slag,both domestically and abroad,are summarised.In addition,the paper also summarises the research progress on gasification slag in building materials,ecological restoration,residual carbon utilisation and other high-value utilisation,and ultimately puts forward the idea of the comprehensive utilisation of gasification slag.For large-scale consumption to solve the environmental problems of enterprises and achieve high-value utilisation to increase the economic benefits of enterprises,it is urgent to zealously design a reasonable and comprehensive utilisation technologies with simple operational processes,strong adaptability and economic benefits.
