A Case Report of Multidisciplinary Diagnosis and Treatment of a Patient with Tuberous Sclerosis Complex and Multi-Organ Involvement / 罕见病研究

Tuberous sclerosis complex(TSC)is a rare genetic disease that can lead to benign dysplasia in multiple organs such as the skin, brain, eyes, oral cavity, heart, lungs, kidneys, liver, and bones. Its main symptoms include epilepsy, intellectual disabilities, skin depigmentation, and facial angiofibromas, whilst incidence is approximately 1 in 10 000 to 1 in 6000 newborns. This case presents a middle-aged woman who initially manifested with epilepsy and nodular depigmentation. Later, she developed a lower abdominal mass, elevated creatinine, and severe anemia. Based on clinical features and whole exome sequencing, the primary diagnosis was confirmed as TSC. Laboratory and imaging examinations revealed that the lower abdominal mass originated from the uterus. CT-guided biopsy pathology and surgical pathology suggested a combination of leiomyoma and abscess. With the involvement of multiple organs and various complications beyond the main diagnosis, the diagnostic and therapeutic process for this patient highlights the importance of rigorous clinical thinking and multidisciplinary collaboration in the diagnosis and treatment of rare and challenging diseases.

Upper limbs physical fitness training in volleyball players / Treinamento de aptidão física de membros superiores em jogadores de voleibol / Entrenamiento de aptitud física de los miembros superiores en jugadores de voleibol

ABSTRACT Introduction: Dedicated fitness training has greatly influenced many qualities required of volleyball players, but specific upper limb training is still poorly documented. Objective: Study the impacts of fitness training on upper limb strength and functional impacts during volleyball players' ball throws. Methods: Twenty volleyball students were randomly divided into experimental and control groups for a six-week experiment. The experimental group mainly performed a training protocol involving ball throws while the control group continued with traditional training methods. The data regarding functional kinematics and fitness performance were collected and statistically compared. Results: In the experimental group, shoulder flexor strength evidenced an increase from 0.41±0.19 J/kg to 1.29±0.19 J/kg; elbow flexor strength elevated from 0.38±0.23 J/kg to 1.61±0.02 J/kg. On the specific functional performance, the peak score increased from 4.84±1.44 to 7.47±1.43; The overall score increased from 9.05±1.70 to 13.31±1.72. It was noted that the rate of increase of each index was more significant than that of the control group. Conclusion: Dedicated fitness training can improve the upper limb strength and hitting effect of volleyball players, and its combination with special strength training is recommended to improve the overall skills of athletes. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O treinamento dedicado de aptidão física tem mostrado grande influência sobre muitas qualidades requisitadas aos jogadores de voleibol, porém o treinamento específico em membros superiores ainda é pouco documentado. Objetivo: Estudar os impactos do treinamento de aptidão física sobre a força dos membros superiores e os impactos funcionais durante os arremessos de bola dos jogadores de voleibol. Métodos: Vinte estudantes de voleibol foram divididos aleatoriamente em grupo experimental e controle para uma experiência de 6 semanas. O grupo experimental realizou principalmente um protocolo de treinamento envolvendo arremessos de bola enquanto o grupo de controle prosseguiu com os métodos tradicionais de treinamento. Dados referentes a cinemática funcional e desempenho de aptidão física foram coletados e comparados estatisticamente. Resultados: No grupo experimental, a força do flexor do ombro evidenciou um aumento de 0,41±0,19 J/kg para 1,29±0,19 J/kg; a força do flexor do cotovelo elevou-se de 0,38±0,23 J/kg para 1,61±0,02 J/kg. Sobre o desempenho funcional específico, a pontuação do pico aumentou de 4,84±1,44 para 7,47±1,43; A pontuação geral aumentou de 9,05±1,70 para 13,31±1,72. Notou-se que a taxa de aumento de cada índice foi mais significativa do que a do grupo de controle. Conclusão: O treinamento dedicado de aptidão física pode melhorar a força dos membros superiores e o efeito de acertos dos jogadores de vôlei, sendo recomendada a sua combinação com o treinamento especial de força para melhorar as habilidades gerais dos atletas. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El entrenamiento físico específico ha demostrado una gran influencia en muchas cualidades exigidas a los jugadores de voleibol, pero el entrenamiento específico de extremidades superiores está aún poco documentado. Objetivo: Estudiar las repercusiones del entrenamiento físico en la fuerza de los miembros superiores y los impactos funcionales durante los lanzamientos de balón de los jugadores de voleibol. Métodos: Veinte estudiantes de voleibol fueron divididos aleatoriamente en grupo experimental y de control para un experimento de 6 semanas. El grupo experimental realizó principalmente un protocolo de entrenamiento que incluía lanzamientos de balón, mientras que el grupo de control continuó con los métodos de entrenamiento tradicionales. Se recogieron y compararon estadísticamente los datos relativos a la cinemática funcional y el rendimiento físico. Resultados: En el grupo experimental, la fuerza flexora del hombro evidenció un aumento de 0,41±0,19 J/kg a 1,29±0,19 J/kg; la fuerza flexora del codo se elevó de 0,38±0,23 J/kg a 1,61±0,02 J/kg. Respecto al rendimiento funcional específico, la puntuación máxima aumentó de 4,84±1,44 a 7,47±1,43; la puntuación global aumentó de 9,05±1,70 a 13,31±1,72. Se observó que el índice de aumento de cada índice fue más significativo que el del grupo de control. Conclusión: El entrenamiento físico dedicado puede mejorar la fuerza de las extremidades superiores y el efecto de golpeo de los jugadores de voleibol, y se recomienda su combinación con un entrenamiento especial de fuerza para mejorar las habilidades generales de los atletas. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Volleyball fitness in college students during the epidemic / Aptidão física do voleibol em estudantes universitários durante a epidemia / Aptitud física para el voleibol en estudiantes universitarios durante la epidemia

ABSTRACT Introduction: The COVID-19 epidemic has negatively impacted physical education teaching at colleges and universities, including volleyball teaching, lacking face-to-face teacher feedback. Objective: Study the impacts of physical education teaching during the pandemic on college students' physical fitness. Methods: The experiment was conducted in a controlled fashion where the male and female experimental classes used a combination of face-to-face and remote physical education teaching methods, while the male and female control classes used a fully remote approach. The experiment was conducted according to the curricular arrangement of colleges and universities, with a total duration of 24 class hours. Results: The average volleyball score of the experimental class before was 41.78 points, rising to 46.55 points. The volleyball score was 78.64 points in 24 hours of class time. The average volleyball score of the control class before the experiment was 41.25 points, rising to 45.44 points, with a final test score of 63.25 points, significantly lower than the experimental class. Conclusion: The research results show the composite physical education teaching method can adjust teaching methods according to the changing epidemic situation and allow students to receive outdoor training. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A situação da epidemia da COVID-19 impactou negativamente no ensino de educação física nas faculdades e universidades, incluindo o ensino do voleibol, carente de um retorno presencial dos professores. Objetivo: Estudar os impactos do ensino de educação física durante o período de pandemia sobre a aptidão física dos estudantes universitários. Métodos: A experiência foi conduzida de forma controlada, na qual a classe experimental masculina e a classe experimental feminina utilizaram uma combinação de métodos de ensino de educação física presencial e remota, enquanto as classes de controle masculino e feminino utilizaram uma abordagem totalmente remota. O experimento foi conduzido de acordo com a disposição curricular das faculdades e universidades, com uma duração total de 24 horas/aula. Resultados: A pontuação média de vôlei da classe experimental antes foi de 41,78 pontos, elevando-se para 46,55 pontos. A pontuação no voleibol foi de 78,64 pontos em 24 horas de aula. A pontuação média do voleibol da classe de controle antes do experimento foi de 41,25 pontos, subindo para 45,44 pontos, com pontuação final do teste em 63,25 pontos, significativamente menor do que a da classe experimental. Conclusão: Os resultados da pesquisa mostram que a aplicação do método de ensino de educação física composta pode não só ajustar os métodos de ensino de acordo com as mudanças da situação epidêmica, como também pode permitir que os estudantes recebam um treinamento ao ar livre. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La situación de la epidemia del COVID-19 repercutió negativamente en la enseñanza de la educación física en colegios y universidades, incluida la enseñanza del voleibol, al carecer de información presencial por parte de los profesores. Objetivo: Estudiar las repercusiones de la enseñanza de la educación física durante el periodo de pandemia en la forma física de los estudiantes universitarios. Métodos: El experimento se llevó a cabo de forma controlada, en el que la clase experimental masculina y femenina utilizó una combinación de métodos de enseñanza de la educación física presenciales y a distancia, mientras que las clases de control masculina y femenina utilizaron un enfoque totalmente a distancia. El experimento se llevó a cabo de acuerdo con la organización curricular de los institutos y universidades, con una duración total de 24 horas/clase. Resultados: La puntuación media en voleibol de la clase experimental antes era de 41,78 puntos, y aumentó a 46,55 puntos. La puntuación del voleibol fue de 78,64 puntos en 24 horas de clase. La puntuación media en voleibol de la clase de control antes del experimento era de 41,25 puntos, que aumentó a 45,44 puntos, con una puntuación final en el examen de 63,25 puntos, significativamente inferior a la de la clase experimental. Conclusión: Los resultados de la investigación muestran que la aplicación del método compuesto de enseñanza de la educación física no sólo puede ajustar los métodos de enseñanza en función de la cambiante situación epidémica, sino que también puede permitir a los alumnos recibir formación al aire libre. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Influences of compound exercises on jumpingin volleyball / Influências de exercícios compostos sobre o salto no voleibol / Influencia de los ejercicios compuestos en el salto en voleibol

ABSTRACT Introduction: Volleyball requires athletes to have high global sport capacity. Compound exercises require more than one muscle group to complete a given movement. They are ideal for jump development in volleyball because they replicate how the athlete's body moves naturally. However, the attributes relevant to this technique are not fully understood. Objective: Study compound exercise's effects on volleyball players' jumping ability. Methods: The controlled experiment method was used in 30 volunteers equally distributed in two groups, with a duration of 8 weeks. The control group received traditional training. The experimental group received training sessions directed by compound exercises. The sessions were applied twice a week, lasting 80 minutes per session, including 15 minutes of warm-up and 10 minutes of cool-down. The indicators were collected individually before and after the experiment, and the data were analyzed and statistically confronted. Results: The experimental group showed better results on standing vertical jump height, touch height, and blocking height after the compound exercise. Conclusion: The proposed compound exercise can improve players' physical quality, impacting their professional quality, to ensure sporting interest. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O voleibol exige que os atletas tenham alta capacidade esportiva global. Os exercícios compostos requerem mais de um grupo muscular trabalhando em conjunto para completar um determinado movimento, sendo ideal para o desenvolvimento de salto no esporte do voleibol por replicar a maneira como o corpo do atleta move-se naturalmente. Porém, os atributos relevantes para essa técnica não estão totalmente esclarecidos. Objetivo: Estudar os efeitos do exercício composto na capacidade de salto dos jogadores de voleibol. Métodos: Utilizou-se o método de experimento controlado em 30 voluntários igualmente distribuídos em dois grupos, com duração de 8 semanas. O grupo controle recebeu o treinamento tradicional. Treinamentos direcionados foram direcionados por exercícios compostos ao grupo experimental. A sessões foram aplicadas duas vezes por semana, com duração de 80 minutos por sessão, incluindo 15 minutos de aquecimento e 10 minutos resfriamento. Os indicadores forem coletados individualmente antes e depois do experimento, os dados foram analisados e confrontados estatisticamente. Resultados: O grupo experimental apresentou melhores resultados sobre a altura do salto vertical em pé, altura de toque e altura de bloqueio após o exercício composto. Conclusão: O exercício composto proposto pode melhorar a qualidade física dos jogadores, impactando na qualidade profissional, com a premissa de garantir o interesse esportivo. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El voleibol exige que los atletas tengan una alta capacidad deportiva global. Los ejercicios compuestos requieren más de un grupo muscular trabajando en conjunto para completar un movimiento determinado, siendo ideal para el desarrollo del salto en el deporte del voleibol por replicar la forma en que el cuerpo del atleta se mueve naturalmente. Sin embargo, los atributos relevantes para esta técnica no se conocen del todo. Objetivo: Estudiar los efectos del ejercicio compuesto sobre la capacidad de salto de los jugadores de voleibol. Métodos: Se utilizó el método de experimento controlado en 30 voluntarios distribuidos equitativamente en dos grupos, con una duración de 8 semanas. El grupo de control recibió formación tradicional. El grupo experimental recibió sesiones de entrenamiento dirigidas por ejercicios compuestos. Las sesiones se aplicaron dos veces por semana, con una duración de 80 minutos por sesión, incluidos 15 minutos de calentamiento y 10 minutos de enfriamiento. Los indicadores se recogieron individualmente antes y después del experimento, se analizaron los datos y se confrontaron estadísticamente. Resultados: El grupo experimental mostró mejores resultados en la altura de salto vertical de pie, la altura de toque y la altura de bloqueo tras el ejercicio compuesto. Conclusión: El ejercicio compuesto propuesto puede mejorar la calidad física de los jugadores, repercutiendo en la calidad profesional, con la premisa de garantizar el interés deportivo. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Impacts of muscle training loads on college students' physical fitness / Impactos de cargas no treinamento muscular sobre a aptidão física dos estudantes universitários / Impacto de cargas en el entrenamiento muscular sobre la aptitud física de los estudiantes universitarios

ABSTRACT Introduction: Due to the excessive value of contemporary intellectual education, the physical fitness of college students has become precarious. This gradual deficit requires innovative solutions to inhibit the negative impacts on the physical quality that inevitably impact students' learning ability. Objective: Verify the impacts of varied loads in muscular strength exercise on college students and their practical repercussions on the diversified development of physical education classes. Methods: We selected 90 non-sporting college students, sedentary and without physical diseases, divided into experimental group 1 with medium intensity load, experimental group 2 with a low-intensity load, and a control group. Before and after the experiment, the relevant fitness indicators were evaluated, and finally, the data were statistically integrated and analyzed. Results: Group 1 increased from 52.25 ± 5.57kg before training to 54.56 ± 6.02kg, with a very significant change; experimental group 2 increased from 53.32 ± 4.89kg before training to 54.21 ± 5.22kg, showing a very significant change as well. Conclusion: Establishing the intensity of load muscle training scientifically and rationally can improve college students' physical quality and muscle strength, and promote the healthy and coordinated development of their psychological and physical quality. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Em detrimento da supervalorização da educação intelectual contemporânea, o condicionamento físico dos estudantes universitários tem se tornado precário. Este déficit gradual requer soluções inovadoras visando inibir os impactos negativos à qualidade física que inevitavelmente repercutiram sobre a capacidade de aprendizagem dos estudantes. Objetivo: Verificar os impactos de cargas variadas no exercício de força muscular sobre os estudantes universitários e sua repercussão prática sobre o desenvolvimento diversificado das aulas de educação física. Métodos: Foram selecionados 90 estudantes universitários de áreas não esportivas, sedentários e sem doenças físicas, divididos em grupo experimental 1 com carga de média intensidade, grupo experimental 2 com carga de baixa intensidade e grupo de controle. Antes e depois do experimento, os indicadores de aptidão física relevantes foram avaliados, e finalmente os dados foram integrados estatisticamente e analisados. Resultados: O grupo 1 aumentou de 52,25 ± 5,57kg antes do treinamento para 54,56 ± 6,02kg, com uma mudança muito significativa; o grupo experimental 2 aumentou de 53,32 ± 4,89kg antes do treinamento para 54,21 ± 5,22kg, apresentando alteração também muito significativa. Conclusão: Estabelecer a intensidade do treinamento muscular de carga no treinamento muscular de forma científica e racional pode melhorar a qualidade física e a força muscular dos estudantes universitários, além de promover o desenvolvimento sadio e coordenado da qualidade psicológica e física desses estudantes. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: En detrimento de la sobrevaloración de la formación intelectual contemporánea, la forma física de los universitarios se ha vuelto precaria. Este déficit gradual requiere soluciones innovadoras destinadas a inhibir los impactos negativos sobre la calidad física, que inevitablemente repercuten en la capacidad de aprendizaje de los alumnos. Objetivo: Verificar los impactos de cargas variadas en ejercicios de fuerza muscular en estudiantes universitarios y su repercusión práctica en el desarrollo diversificado de las clases de educación física. Métodos: Se seleccionaron 90 estudiantes universitarios de áreas no deportivas, sedentarios y sin enfermedades físicas, divididos en grupo experimental 1 con carga de intensidad media, grupo experimental 2 con carga de intensidad baja y grupo control. Antes y después del experimento, se evaluaron los indicadores de aptitud pertinentes y, por último, se integraron y analizaron estadísticamente los datos. Resultados: El grupo 1 aumentó de 52,25 ± 5,57 kg antes del entrenamiento a 54,56 ± 6,02 kg, con un cambio muy significativo; el grupo experimental 2 aumentó de 53,32 ± 4,89 kg antes del entrenamiento a 54,21 ± 5,22 kg, mostrando también un cambio muy significativo. Conclusión: Establecer la intensidad del entrenamiento muscular de carga de forma científica y racional puede mejorar la calidad física y la fuerza muscular de los estudiantes universitarios, así como promover el desarrollo saludable y coordinado de su calidad psicológica y física. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Identification of the antidepressant fraction and its major chemical constituents of Radix Paeoniae Alba / 药学学报

The goal of this work was to investigate the antidepressant fraction from Radix Paeoniae Alba and identify its major chemical constituents. Corticosterone injured rat phaeochromocytoma (PC12) cells and behavioral despair depression models of mice were used to evaluate the antidepressant effects of Radix Paeoniae Alba (Bai-Shao) ethanol extract (BS-E) and its three fractions (BS-10E, BS-60E, BS-95E) isolated by macroporous resin column chromatography. Animal experimental procedures were approved by the Animal Ethics Committee of the Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College (approval No.: SLXD-20210618051). The results showed that BS-E, BS-10E and BS-60E had protective effects against PC12 cells injury induced by corticosterone, among which BS-60E had the strongest protective effect. BS-60E could significantly shorten the time of forced swimming and tail suspension in despair depression models of mice, and was identified as the antidepressant fraction of Radix Paeoniae Alba. The major chemical constituents in the antidepressant fraction were identified by ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS), and their proposed fragmentation pathways in MS spectra were deduced. A total of 79 chemical constituents were identified from BS-60E, including 36 monoterpenes, 34 polyphenols, 6 oligosaccharides, and 3 other constituents, and monoterpenes and polyphenols may be major effective constituents of BS-60E.

Advances in diagnosis and treatment of familial hypercholesterolemia / 南方医科大学学报

Familial hypercholesterolemia (FH) is an autosomal dominant inherited disease caused by abnormal lipoprotein metabolism. Patients with FH have a significantly increased risk of coronary artery disease (CAD) due to long-term exposure to high levels of low-density lipoprotein (LDL). The diagnosis of FH relies heavily on gene detection, and examination of LDL receptor (LDLR) function is of great significance in its treatment. This review summarizes the current advances in the screening, diagnosis, and treatment of FH and functional analysis of LDLR gene mutations.

Expression of interleukin-37, vascular endothelial growth factor A, and transforming growth factor-β1 and their correlation with T cells in children with primary immune thrombocytopenia / 中国当代儿科杂志

OBJECTIVES@#To investigate the expression of interleukin-37 (IL-37), vascular endothelial growth factor A (VEGFA), and transforming growth factor-β1 (TGF-β1) in children with primary immune thrombocytopenia (ITP) and their correlation with T cells.@*METHODS@#A retrospective analysis was conducted on 45 children with ITP (ITP group) who were admitted to Handan Central Hospital from January 2020 to April 2022, and 30 healthy children who underwent physical examination during the same period were included as the healthy control group. The mRNA expression levels of IL-37, VEGFA, and TGF-β1 and the levels of regulatory T cells (Treg) and helper T cells 17 (Th17) were measured before and after treatment, and the correlation between the mRNA expression levels of IL-37, VEGFA, and TGF-β1 and the levels of Treg, Th17, and Treg/Th17 ratio were analyzed.@*RESULTS@#Compared with the healthy control group, the ITP group had a significantly higher mRNA expression level of IL-37 and a significantly higher level of Th17 before and after treatment, as well as significantly lower mRNA expression levels of VEGFA and TGF-β1 and significantly lower levels of Treg and Treg/Th17 ratio (P<0.05). After treatment, the ITP group had significant reductions in the mRNA expression level of IL-37 and the level of Th17 and significant increases in the mRNA expression levels of VEGFA and TGF-β1 and the levels of Treg and Treg/Th17 ratio (P<0.05). Correlation analysis showed that in the ITP group, the mRNA expression levels of IL-37 and TGF-β1 were negatively correlated with the levels of Treg and Treg/Th17 ratio (P<0.05) and were positively correlated with the level of Th17 (P<0.05) before and after treatment; the mRNA expression level of VEGFA was positively correlated with the levels of Treg and Treg/Th17 ratio (P<0.05) and was negatively correlated with the Th17 level (P<0.05) before and after treatment.@*CONCLUSIONS@#Abnormal expression levels of IL-37, VEGFA, and TGF-β1 may be observed in children with ITP, which is significantly associated with the imbalance of Treg/Th17 ratio. It is speculated that the cytokines such as IL-37, VEGFA, and TGF-β1 may be involved in the development and progression of ITP or may become important potential targets for the treatment of children with ITP. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(11): 1131-1136.

Acupuncture for Patients with Chronic Spontaneous Urticaria: A Randomized, Sham-Controlled Pilot Trial / 中国结合医学杂志

OBJECTIVE@#To determine the feasibility of conducting a full-scale randomized controlled trial (RCT) and investigate the basic information and safety of acupuncture for patients with chronic spontaneous urticaria (CSU).@*METHODS@#A total of 80 participants with CSU from July 2018 to July 2019 were randomly assigned to receive active acupuncture (n=41) on a fixed prescription of acupoints or sham acupuncture (n=39) with superficial acupuncture on non-acupuncture points through the completely randomized design. Patients in both groups received 5 sessions per week for 2 weeks, and participants were followed for a further 2 weeks. Feasibility was assessed by recruitment and randomization rates, retention of participants, treatment protocol adherence, and the incidence of adverse events (AEs). The clinical primary outcome was the changes from baseline weekly urticaria activity scores (UAS7) after treatment at 2 weeks. Secondary outcomes included the Visual Analogue Scale (VAS) score of itching intensity, Dermatology Life Quality Index (DLQI), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA).@*RESULTS@#A total of 80 participants were enrolled. The recruitment rate of 24.02%, randomization rate of 100%, a loss rate of 6.25%, and no obvious AEs were observed in either group. The decrease from baseline in the mean UAS7 total score at week 2 in the active acupuncture group was -8.63 (95%CI, -11.78 to -5.49) and -6.21 (95%CI, -9.43 to -2.98) in the sham acupuncture group for a between-group difference of -2.42 (95% CI, -6.93 to 2.07). The change in the DLQI, VAS of itching intensity, HAMA, and HAMD were a slightly better improvement trend in the active acupuncture group than the sham acupuncture group, but the between-group difference was not significant.@*CONCLUSIONS@#Active acupuncture had a better improvement trend in alleviating symptoms, improving quality of life and regulating the mood of anxiety and depression in patients with CSU than sham acupuncture. (Registration Nos. AMCTR-ICR-18000190 and ChiCTR2100054776).

Electroacupuncture Alleviates Functional Constipation in Mice by Activating Enteric Glial Cell Autophagy via PI3K/AKT/mTOR Signaling / 中国结合医学杂志

OBJECTIVE@#To investigate autophagy-related mechanisms of electroacupuncture (EA) action in improving gastrointestinal motility in mice with functional constipation (FC).@*METHODS@#According to a random number table, the Kunming mice were divided into the normal control, FC and EA groups in Experiment I. The autophagy inhibitor 3-methyladenine (3-MA) was used to observe whether it antagonized the effects of EA in Experiment II. An FC model was established by diphenoxylate gavage. Then the mice were treated with EA stimulation at Tianshu (ST 25) and Shangjuxu (ST 37) acupoints. The first black stool defecation time, the number, weight, and water content of 8-h feces, and intestinal transit rate were used to assess intestinal transit. Colonic tissues underwent histopathological assessment, and the expressions of autophagy markers microtubule-associated protein 1 light chain 3 (LC3) and Beclin-1 were detected by immunohistochemical staining. The expressions of phosphoinositide 3-kinases (PI3K)-protein kinase B (AKT)-mammalian target of rapamycin (mTOR) signaling pathway members were investigated by Western blot and quantitative reverse transcription-polymerase chain reaction, respectively. The relationship between enteric glial cells (EGCs) and autophagy was observed by confocal immunofluorescence microscopy, localization analysis, and electron microscopy.@*RESULTS@#EA treatment shortened the first black stool defecation time, increased the number, weight, and water content of 8-h feces, and improved the intestinal transit rate in FC mice (P<0.01). In terms of a putative autophagy mechanism, EA treatment promoted the expressions of LC3 and Beclin-1 proteins in the colonic tissue of FC mice (P<0.05), with glial fibrillary acidic protein (GFAP) and LC3 significantly colocalized. Furthermore, EA promoted colonic autophagy in FC mice by inhibiting PI3K/AKT/mTOR signaling (P<0.05 or P<0.01). The positive effect of EA on intestinal motility in FC mice was blocked by 3-MA.@*CONCLUSION@#EA treatment can inhibit PI3K/AKT/mTOR signaling in the colonic tissues of FC mice, thereby promoting EGCs autophagy to improve intestinal motility.

MAFLD: How is it different from NAFLD?

“Metabolic dysfunction-associated fatty liver disease (MAFLD)” is the term suggested in 2020 to refer to fatty liver disease related to systemic metabolic dysregulation. The name change from nonalcoholic fatty liver disease (NAFLD) to MAFLD comes with a simple set of criteria to enable easy diagnosis at the bedside for the general medical community, including primary care physicians. Since the introduction of the term, there have been key areas in which the superiority of MAFLD over the traditional NAFLD terminology has been demonstrated, including for the risk of liver and extrahepatic mortality, disease associations, and for identifying high-risk individuals. Additionally, MAFLD has been adopted by a number of leading pan-national and national societies due to its concise diagnostic criterion, removal of the requirement to exclude concomitant liver diseases, and reduction in the stigma associated with this condition. The current article explores the differences between MAFLD and NAFLD diagnosis, areas of benefit, some potential limitations, and how the MAFLD terminology has opened up new fields of research.

Effect of electroacupuncture on enteric neuronal autophagy in functional constipation mice / 中国针灸

OBJECTIVES@#To explore the effect mechanism of electroacupuncture (EA) on functional constipation (FC) at the combined lower he-sea and front-mu points of large intestine based on enteric neuronal autophagy.@*METHODS@#A total of 40 SPF Kunming mice were randomly divided into 5 groups (n = 8), i.e. a control group, a model group, an acupuncture group, a 3-methyl adenine (3-MA) group, and a 3-MA + acupuncture group. Except the control group, the FC model was established by gavage with compound diphenoxylate suspension for 14 days in the other 4 groups. After successful modeling, the mice of the acupuncture group and the 3-MA + acupuncture group received EA at bilateral "Tianshu" (ST 25) and "Shangjuxu" (ST 37), stimulated for 30 min with disperse-dense wave, 2 Hz/15 Hz of frequency, 1 mA of intensity. EA was delivered once daily. One course of treatment was composed of 5 days and 2 courses were needed, with an interval of 2 days. An intraperitoneal injection of 3-MA (15 mg/kg) was administered 30 min before EA in the mice of the 3-MA group and the 3-MA + acupuncture group, once daily. Before and after intervention, the time of the first black stool defecation and defecation behaviors in 6 h were observed in each group. After intervention, in every group, the small intestine propulsion rate was calculated, the colon tissue morphology was observed using HE staining, the ultrastructure of enteric neuronal autophagy was observed under transmission electron microscope, and the expressions of microtubule-associated protein 1 light chain 3 (LC3), Beclin-1 and neuronal nuclear antigen protein (NeuN) in neurons of colonic muscularis were determined by immunohistochemistry.@*RESULTS@#Before intervention, when compared with those in the control group, the time of the first black stool defecation was prolonged (P<0.01, P<0.05), and numbers (P<0.01), wet weight (P<0.01, P<0.05) and water content (P<0.05, P<0.01) of stool in 6 h were reduced in the model, acupuncture, 3-MA and 3-MA + acupuncture groups. After intervention, compared with those in the control group, the time of the first black stool defecation was longer (P<0.05), and numbers (P<0.01), wet weight (P<0.01) and water content (P<0.01) of stool in 6 h were decreased in the model group. The time of the first black stool defecation was shortened (P<0.01), and numbers (P<0.01), wet weight (P<0.01) and water content (P<0.01) of stool in 6 h were increased in the acupuncture group when compared with those in the model group. The time of the first black stool defecation was extended (P<0.01), and numbers (P<0.01), wet weight (P<0.01) and water content (P<0.01) of stool in 6 h were declined in the 3-MA + acupuncture group in comparison with those in the acupuncture group. All layers of colon tissue were normal and intact in each group. When compared with the control group, the small intestine propulsion rate and the average optical density (OD) values of LC3, Beclin-1 and NeuN in neurons of colonic muscularis were decreased (P<0.01), and autophagosomes were dropped in the model group. In the acupuncture group, the small intestine propulsion rate and the average OD values of NeuN, LC3 and Beclin-1 in neurons of colonic muscularis increased (P<0.01,P<0.05), and autophagosomes were elevated when compared with those in the model group. The small intestine propulsion rate and the average OD values of NeuN, LC3 and Beclin-1 in neurons of colonic muscularis were dropped (P<0.05,P<0.01) in the 3-MA + acupuncture group in comparison with those in the acupuncture group.@*CONCLUSIONS@#Electroacupuncture may promote enteric neuronal autophagy and increase the number of neurons so that the intestinal motility can be improved and constipation symptoms can be relieved in FC mice.

Analysis of clinical features and prognosis of acute severe autoimmune hepatitis / 中华肝脏病杂志

Objective: To analyze the clinical features and prognosis of acute severe autoimmune hepatitis (AIH). Methods: A retrospective analysis of the clinical data of patients with acute severe AIH admitted to our hospital from 2008 to 2019 was divided into acute AIH (A-AIH) and chronic acute AIH (AC-AIH) according to the presence or absence of liver diseases. Patients' general condition, liver biochemistry, immunology, histological features of liver, hormonal therapies prognosis and related factors were analyzed. Results: A total of 41 cases [39 females, age (54.24 ± 10.55) years] were collected. Alanine aminotransferase (ALT) and total bilirubin (TBil) were significantly increased, and the international normalized ratio (INR) was > 1.5. Acute lobular inflammation was the feature of acute and severe AIH in the histology of liver. The serum IgG level was (28.36 ± 8.35) g / L. The positive rate of antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA) was 82.9%, and 17.1%, respectively. Over 70% of acute severe AIHs were AC-AIH. The duration of onset of AC-AIH was > 8 weeks, while most A-AIHs < 8 weeks, and the differences between the two groups were statistically significant (P = 0.001). The mortality rate within 30 days after hormonal treatment was 19.5%. There were statistically significant differences in TBil, Model for End-Stage Liver Disease (MELD) score and leukocyte count between the death and survival group. Conclusion: The mortality rate in acute severe AIH is high, and most of them have the basis of chronic liver disease. Serum IgG level, autoantibodies and acute lobular inflammation are important factors for diagnosis. The prognosis of hormonal therapy is related to the patients' condition and course of disease.

Protective association of Klotho rs495392 gene polymorphism against hepatic steatosis in non-alcoholic fatty liver disease patients

Background/Aims@#Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic dysfunction. Among the multiple factors, genetic variation acts as important modifiers. Klotho, an enzyme encoded by the klotho (KL) gene in human, has been implicated in the pathogenesis of metabolic dysfunctions. However, the impact of variants in KL on NAFLD risk remains poorly understood. The aim of this study was to investigate the impact of KL rs495392 C>A polymorphism on the histological severity of NAFLD. @*Methods@#We evaluated the impact of the KL rs495392 polymorphism on liver histology in 531 Chinese with NAFLD and replicated that in the population-based Rotterdam Study cohort. The interactions between the rs495392, vitamin D, and patatin-like phospholipase domain containing 3 (PNPLA3) rs738409 polymorphism were also analyzed. @*Results@#Carriage of the rs495392 A allele had a protective effect on steatosis severity (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.42–0.89; P=0.010) in Chinese patients. After adjustment for potential confounders, the A allele remained significant with a protective effect (OR, 0.66; 95% CI, 0.45–0.98; P=0.040). The effect on hepatic steatosis was confirmed in the Rotterdam Study cohort. Additional analysis showed the association between serum vitamin D levels and NAFLD specifically in rs495392 A allele carriers, but not in non-carriers. Moreover, we found that the rs495392 A allele attenuated the detrimental impact of PNPLA3 rs738409 G allele on the risk of severe hepatic steatosis. @*Conclusions@#The KL rs495392 polymorphism has a protective effect against hepatic steatosis in patients with NAFLD.

Lifestyle Interventions for Non-Obese Patients Both with, and at Risk, of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease occurring in non-obese subjects (the so-called non-obese NAFLD) is a highly prevalent but neglected liver condition, which is closely associated with metabolic disorders and suboptimal lifestyles. Landmark studies have shown that lifestyle interventions are potentially beneficial in decreasing the risk of developing non-obese NAFLD and in ameliorating NAFLD in non-obese individuals with pre-existing NAFLD. Lifestyle interventions usually refer to changes in eating habits and physical activity, both of which have a powerful effect on non-obese NAFLD and on risk factors for non-obese NAFLD. However, to date, patients and health-care professionals have a poor awareness and understanding of non-obese NAFLD and the beneficial effects of lifestyle interventions in this patient population. The aim of this narrative review is to briefly discuss the evidence for the effects of lifestyle changes and what changes are needed amongst medical personnel and other stakeholders in order to raise awareness of non-obese NAFLD.

Predictive value of hemoglobin glycation index for chronic kidney disease / 中华内科杂志

Objective:To investigate the influence of hemoglobin glycation index (HGI) on the risk of incident chronic kidney disease (CDK) among nondiabetic patients.Methods:Prospective cohort study. At baseline, a total of 7 407 nondiabetic patients without a history of CKD from Pingguoyuan Community of the Shijingshan District in Beijing were included from December 2011 to August 2012, who were then divided into three groups according to the tertiles of their baseline HGI levels. The CKD incidence rate was compared among the different HGI groups at last follow-up. Cox multivariable regression was applied to evaluate whether HGI measures predicted CKD risk. Test for trend across tertiles were examined using ordinal values in separate models.Results:The mean age of the subjects was (56.4±7.5) years, and 4 933 (66.6%) were female. At mean follow-up of 3.23 years, 107 (1.4%) individuals developed CKD. The incidence of CKD was gradually increasing from the low to high HGI groups [1.1% (28/2 473) vs. 1.2% (31/2 564) vs. 2.0% (48/2 370), P=0.016]. In the multivariate Cox regression analysis, after adjustment for potential confounders, the high HGI group had a 68.5% increased risk of CKD compared with the low HGI group ( HR=1.685, 95% CI 1.023 to 2.774). CKD risk increased with increasing HGI tertiles ( P for trend=0.028). Conclusion:High HGI is associated with an increased risk for CKD in the nondiabetic population, indicating that HGI may help identify individuals at high risk for CKD.

Immunomodulatory effects of flazin from Crassostrea sikamea on splenic lymphocytes of Sprague-Dawley rats / 中国天然药物

Crassostrea sikamea (C.sikamea) is an important edible and medicinal seafood in China. In the present study, a compound named flazin was separated and identified from the ethyl acetate extract of C.sikamea (EAECs) for the first time. In addition, the 3-(4, 5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetra zolium (MTS) assay revealed that EAECs and flazin inhibited the transformation of splenic lymphocytes in vitro. Moreover, flazin (20 μg·mL

Non-alcoholic steatohepatitis and risk of hepatocellular carcinoma / 中华医学杂志(英文版)

The emergence of non-alcoholic fatty liver disease (NAFLD) as the leading chronic liver disease worldwide raises some concerns. In particular, NAFLD is closely tied to sedentary lifestyle habits and associated with other metabolic diseases, such as obesity and diabetes. At the end of the disease spectrum, non-alcoholic steatohepatitis (NASH) may progress to cirrhosis and hepatocellular carcinoma (HCC), representing a serious health problem to modern society. Recently, an increasing number of HCC cases originating from this progressive disease spectrum have been identified, with different levels of severity and complications. Updating the current guidelines by placing a bigger focus on this emerging cause and highlighting some of its unique features is necessary. Since, the drivers of the disease are complex and multifactorial, in order to improve future outcomes, having a better understanding of NASH progression into HCC may be helpful. The risks that can promote disease progression and currently available management strategies employed to monitor and treat NASH-related HCC make up the bulk of this review.

Pre-anesthetic clinic internship: new teaching method of pre-anesthesia evaluation for undergraduates

Background@#This study aimed to observe the effect of internship in a pre-anesthetic clinic on the teaching quality of pre-anesthesia evaluation for undergraduates. @*Methods@#A total of 120 undergraduates from July 2017 to July 2018 in the anesthesia department of our hospital were randomly divided into two groups: pre-anesthetic clinic internship teaching group (n = 60) and traditional teaching group (n = 60). The knowledge in the pre-anesthesia evaluation teaching chapters was evaluated between the two groups of undergraduates. @*Results@#There were no significant differences in the demographic information between the two groups. The scores in the case analysis and theoretical knowledge test in the pre-anesthetic clinic internship teaching group were significantly higher than those in the traditional teaching group. In addition, the students’ satisfaction with the curriculum design was significantly higher in the pre-anesthetic clinic internship teaching group than in the traditional teaching group. @*Conclusion@#Pre-anesthetic clinic internships can improve the quality of pre-anesthesia assessment teaching for undergraduates.

Serum lipocalin-2 is a potential biomarker for the clinical diagnosis of nonalcoholic steatohepatitis

Background/Aims@#Nonalcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease (NAFLD) characterized by hepatic steatosis, inflammation, hepatocellular injury, and fibrosis. We aimed to investigate the usefulness of a key biomarker, lipocalin-2 (LCN2), for the detection of NASH progression. @*Methods@#A mouse NASH model was established using a high-fat diet and a high-sugar drinking water. Gene expression profile of the NASH model was analyzed using RNA sequencing. Moreover, 360 NAFLD patients (steatosis, 83; NASH, 277), 40 healthy individuals, and 87 patients with alcoholic fatty liver disease were recruited. @*Results@#Inflammatory infiltration, focal necrosis in the leaflets, steatosis, and fibrosis were documented in the mouse liver. In total, 504 genes were differentially expressed in the livers of NASH mice, and showed significant functional enrichment in the inflammation-related category. Upregulated liver LCN2 was found to be significantly interactive with various interleukins and toll-like receptors. Serum LCN2 levels were significantly increased in NAFLD patients. Serum LCN2 levels were correlated with steatosis, intralobular inflammation, semiquantitative fibrosis score, and nonalcoholic fatty liver disease activity score. The area under the curve of serum LCN2 was 0.987 with a specificity of 100% and a sensitivity of 93.5% for NASH diagnosis, and 0.977 with almost the same specificity and sensitivity for steatosis. @*Conclusions@#LCN2 might be involved in the transition from NAFL to NASH by mediating inflammation. Serum LCN2 levels might be a novel biomarker for the diagnosis of NASH.