The application of silent MR angiography in the imaging of brain arteriovenous malformation in children / 中华放射学杂志

Objective:To explore the application value of silent MR angiography (MRA) in imaging of brain arteriovenous malformation (BAVM) in children.Methods:A total of 20 children with BAVM confirmed by digital subtraction angiography (DSA) were retrospectively collected. All children were imaged by silent MRA and time-of-flight MRA (TOF MRA) in the same examination. The image quality of feeding artery, nidus and drainage vein of BAVM was evaluated using the four-point method. Wilcoxon rank-sum test was utilized to compare the image quality scores between silent MRA and TOF MRA. Weighted Kappa statistics used to evaluate the inter-modality agreement of silent MRA and TOF MRA with DSA in displaying of angioarchitecture characteristics and determination of Spetzler-Martin grading.Results:Among the 20 BAVMs, significant differences in image quality scores of the nidus (2.75±0.55 versus 2.20±0.70) and drainage vein (2.60±0.68 versus 2.20±0.77) were observed between silent MRA and TOF MRA ( Z=-3.05, P=0.002; Z=-2.13, P=0.033, respectively). The agreement between silent MRA and DSA was excellent in nidus size grading, deep venous drainage, associated aneurysm and SM grading (Kappa 0.91, 1.00, 0.83 and 0.93, respectively); The agreement between TOF MRA and DSA was fair to moderate (Kappa 0.46, 0.59, 0.35 and 0.47, respectively). Conclusions:Silent MRA showes better image quality compared to TOF MRA and improves the evaluation of angioarchitecture characteristics and Spetzler-Martin grading of BAVMs in children.

Clinical and genetics characteristics of adult-onset cerebrotendinous xanthomatosis: analysis of a Chinese pedigree / 中华内科杂志

Objective: Clinical manifestations, imaging findings, pathologic features, and genetic mutations of Chinese adult patients with cerebrotendinous xanthomatosis (CTX) were analyzed in order to achieve a greater understanding of CTX that can improve early detection, diagnosis, and treatment. Methods: Clinical data including medical history, neurologic and auxiliary examinations, imaging findings, and genetic profile were collected for an adult patient with CTX admitted to the Sixth Medical Center of Chinese People's Liberation Army General Hospital in August 2020. Additionally, a systematic review of genetically diagnosed Chinese adult CTX cases reported in major databases in China and other countries was performed and age of onset, first symptoms, common signs and symptoms, pathologic findings, imaging changes, and gene mutations were analyzed. Results: The proband was a 39-year-old female with extensive, early-onset nervous system manifestations including cognitive dysfunction and ataxia. Systemic lesions included juvenile cataract and a tendon mass. Cranial magnetic resonance imaging revealed cerebral atrophy, symmetric white matter changes predominantly in the pyramidal tract, and lesions in the cerebellar dentate nucleus. A novel homozygous mutation in the sterol-27-hydroxylase (CYP27A1) gene (c.1477-2A>C) was identified. There were no family members with similar clinical presentation although some were carriers of the c.1477-2A>C mutation. The patient showed a good response to deoxycholic acid treatment. Totally there were 56 cases of adult CTX patients in China, mostly in East China (31/56, 55.4%), at a male-to-female ratio of 1.8 to 1. Multiple organs and tissues including nervous system, tendon, lens, lung, and skeletal muscle were affected in these cases. The most common neurologic manifestations were cognitive dysfunction (44/52, 84.6%) and ataxia (44/51, 86.3%). The cases were characterized by early onset, chronic progressive damage of multiple systems, long disease course, and delayed diagnosis, making the disease difficult to manage clinically and resulting in poor prognosis. The 2 most common genetic mutations in Chinese adult CTX patients were c.1263+1G>A and c.379C>T. Exon 2 of the CYP27A1 gene was identified as a mutation hot spot. Conclusions: Chinese adult patients with CTX have complex clinical characteristics, a long diagnostic cycle, and various CYP27A1 gene mutations. Early diagnosis and intervention can improve the prognosis of these patients.

Clinical and genetic characteristics of different types of non-obstructive hypertrophic cardiomyopathy / 中华心血管病杂志

Objective: To analyze the clinical and genetic characteristics of clinical subtypes of non-obstructive hypertrophic cardiomyopathy (HCM). Methods: It was a cohort study. Patients with non-obstructive HCM admitted to Fuwai Hospital, Chinese Academy of Medical Sciences, from January 1999 to April 2019 were enrolled. According to the characteristics of cardiac morphology and function shown by echocardiography, the patients were divided into common type, dilated type, restricted type and reduced ejection fraction type. The clinical data of the patients were recorded, and 8 sarcomere pathogenic genes were screened by full exon sequencing or panel sequencing. Patienst were followed up and cardiovascular endpoint events were recorded. Results: A total of 815 patients with non-obstructive HCM were enrolled, including 27 (3.3%) restricted type, 51 (6.3%) dilated type, 30 (3.7%) reduced ejection fraction type and 707 (86.7%) common type. A total of 704 out of 815 patients underwent genetic testing. Among them, 299 (42.5%) patients carried at least 1 sarcomere gene mutation. MYBPC3 and MYH7 mutation accounted for 42.1% (126/299) and 35.8% (107/299) respectively. 66.7% (16/24) of the patients with restricted type carried sarcomere gene mutation, which was higher than that in patients with dilated type (36.4% (16/44)) and in common type (41.5% (250/602), P=0.015). Among the patients with reduced ejection fraction, 56.7% (17/30) patients carried sarcomere gene mutations, 23.3% (7/30) carried multiple sarcomere mutations, which was higher than that in restricted type (8.3% (2/24)), in dilated type (9.1% (4/44)) and in common type 4.2% ((24/577), P<0.001). MYH7 and MYBPC3 were the main mutation gene types of all clinical subtypes, and the genotypes were similar among groups (all P>0.05). Seven hundred and three out 815 patients were followed up for 2.9 (1.4, 4.0) years. There were 53(7.5%) cardiovascular death. Cardiovascular death occurred in 5.0% (29/578) patients with common type, 13.0% (3/23) patients with restricted type, 16.3% (7/43) patients with dilated type and 46.7% (14/30) patients with decreased ejection fraction. Univariate Cox proportional hazards model analysis showed that the risk of cardiovascular death in patients with restricted, dilated and reduced ejection fraction type was higher than that in patients with common type (P<0.001). After adjusting for gender, age of onset, body mass index, history of hypertension, coronary heart disease and diabetes, multivariate Cox proportional hazards model analysis showed that the HR of cardiovascular death in patients with restricted, dilated and reduced ejection fraction type were 5.454 (95%CI 1.137-26.157, P=0.034) and 6.597 (95%CI 1.632-26.667, P=0.008) and 9.028 (95%CI 2.201-37.039, P=0.002) respectively, as compared to patients with common type. Conclusions: Most of the patients with non-obstructive HCM are common type, featured by mild clinical manifestations and good prognosis. Although the proportion of restricted type and dilated type is relatively low, and cardiac systolic function is mostly preserved, the clinical phenotype and prognosis of these patients are similarly severe and poor as patients with reduced ejection fraction. The genotypes are similar in different clinical subtypes, but the proportion of patients with sarcomere gene mutation is higher in restricted type, and the proportion of patients with multiple sarcomere gene mutation is higher in decreased ejection fraction type.

Current status and quality analysis of interventional therapy for patients with atrial fibrillation in China / 中华心血管病杂志

Objective: To define the current status and analyze the medical quality of interventional therapy for patients with atrial fibrillation (AF) in China. Methods: This survey was performed in all seven large regions of China, one to three regional major medical centers were selected from each region. Medical records of patients underwent interventional therapy for AF in the year 2017 were randomly inspected. CHA2DS2-VASc score, prescribed anticoagulant after ablation, indication of left atrial appendage occlusion (LAAO), and complications in the medical records were analyzed. Results: A total of 10 800 AF catheter ablations and 447 LAAOs were performed in 17 regional medical centers in 2017. There were 10/17 centers performing AF catheter ablation<500 cases and 7/17 centers performing LAAO<20 cases. A total of 1 347 cases of catheter ablation and 160 cases of LAAO were selected for further analysis. Among all selected cases, 15.8% (238/1 505) non-valvar AF cases recorded CHA2DS2-VASc scores. The anticoagulation rate after AF catheter ablation was 98.6% (1 328/1 347), anticoagulation rate was higher than 90% in 16 out of 17 centers. The complication and severe complication rates of AF catheter ablation were 0.9% (12/1 347) and 0.4% (5/1 347), respectively. The differences of complication and severe complication rates in AF catheter ablation were similar between centers performing<500 cases and centers performing ≥500 cases (0.5% (2/413) vs. 1.1% (10/934), P>0.05; 0.5% (2/413) vs. 0.3% (3/934), P>0.05). The coincidence rate of LAAO indication was 81.3% (130/160), and the rate was higher in center performing ≥20 cases than in centers performing<20 cases (84.8% (106/125) vs. 68.6% (24/35), P<0.05). The complication and severe complication rates of LAAO were 3.1% (5/160) and 1.9% (3/160). The rate of complications in LAAO was higher in center performing<20 cases than in centers performing ≥20 cases (8.6% (3/35) vs. 1.6% (2/125), P<0.05), and there was no significant difference in severe complication rate (5.7% (2/35) vs. 0.8% (1/125), P>0.05). Conclusions: Interventional therapy for AF in China is generally standardized and safe. The overall incidence of complications post AF interventional ablation is low, the anticoagulation rate after AF catheter ablation is high, and the adherence rate of LAAO indication is fair. The indicators mentioned above vary widely among centers.

Practice and exploration of fine and rational drug use management in hospital / 中华医院管理杂志

Under the background of deepening the medical and health system reform, it is necessary to explore the measures of fine and rational drug use management and strengthen the rational drug use. Through giving full play to the management functions of pharmacy administration and pharmacotherapeutics committee, formulating the performance evaluation index system of pharmacy affairs in the hospital, adhering to the prescription doctor′s advice review and prescription pre audit, continuing to carry out drug dynamic monitoring, implementing standardized-path antimicrobial drug management, the hospital implemented refined and rational drug use management. Before and after the management, the average drug cost, prescription unqualified rate, auxiliary drug amount and antibacterial drugs related indicators were significantly improved, suggesting that fine pharmacy management could promote the rational use of drugs in the whole hospital, promote the transformation of pharmacists′ work, and control the unreasonable growth of drug costs.

Effect of Three Handing-Three Points on Pain Function and Expression of CX3CL1/CX3CR1 in Spinal Cord Dorsal Horn of Rats with Sciatic Nerve Injury / 中国康复理论与实践

Objective:To investigate the mechanism of Three Handing-Three Points on pain function in sciatic nerve injury rats by observing the changes of chemokine (C-X3-C motif) ligand 1, CX3CL1)/chemokine (C-X3-C motif) receptor 1 (CX3CR1) protein and mRNA expression in spinal dorsal horn. Methods:A total of 74 male Sprague-Dawley rats were randomly divided into normal group (n= 12), sham group (n = 24), model group (n = 25), and Three Handing-Three Points group (Tuina group,n = 13). The model group and Tuina group prepared the sciatic nerve injury model. The sham group exposed sciatic nerve only. Tuina group received Tuina on Yinmen (BL37), Chengshan (BL57) and Yanglingquan (GB34) with Tuina manipulation emulator. The photothermal pain threshold was measured seven days after modeling and after 20 days of intervention; cumulative pain score was measured seven days after modeling, and after ten days and 20 days of intervention. The spinal dorsal horn tissues were extracted to detect the protein and mRNA expression of CX3CL1/CX3CR1 with Western blotting and RT-PCR seven days after modeling and after 20 days of intervention. The microglia morphology in spinal dorsal horn was observed with immunofluorescence after 20 days of intervention. Results:Seven days after modeling, compared with the normal group, the photothermal pain tolerance threshold increased in the model group and the sham group (P < 0.05); compared with the sham group, the cumulative pain score increased in the model group and Tuina group (P < 0.05). After ten days of intervention, the cumulative pain score was lower in Tuina group than in the model group (P < 0.05). After 20 days of intervention, both the photothermal pain tolerance threshold and cumulative pain score were lower in Tuina group than in the model group (P < 0.05). There was no significant difference in the expression of CX3CL1/CX3CR1 protein and mRNA on the seven days after modeling and after 20 days of intervention (P > 0.05). The microglia in the model group were partially activated or completely activated, while those in Tuina group were unactivated or partially activated after 20 days of intervention. Conclusion:Three Handing-Three Points can improve the pain function of sciatic nerve injured rats, which may associate with regulating microglia through the pathway other than CX3CL1/CX3CR1.

Effects of Three Handing-Three Points on Motor Function and Expression of Transforming Growth Factor-β1/Smad2 Pathway in Injured Sciatic Nerve of Rats / 中国康复理论与实践

Objective:To investigate the effect of Tuina of Three Handing-Three Points on the motor function of hind limbs, the proliferation of Schwann cell, recovery of myelin sheath and the expression of transforming growth factor (TGF)-β1/Smad2 pathway protein in injured sciatic nerve of rats. Methods:A total of 66 male Sprague-Dawley rats were randomly divided into sham operation group (n = 22), model group (n = 22) and observation group (n = 22). The sciatic nerve injury model was made by clamping method. On the eighth day after modeling, the observation group received stimulation on Yinmen (BL37), Chengshan (BL57) and Yanglingquan (GB34). The sciatic functional index (SFI) was measured before intervention and 21 days after intervention. The Oblique Plate Test was performed before intervention, and seven days, 14 days and 21 days after intervention. The expression of S100, TGF-β1 and Smad2 were observed by immunofluorescence. The expression of TGF-β1, Smad2 and p-Smad2 was detected by Western blotting. Results:Before intervention, SFI was lower in the model group and observation group than in the sham operation group (P < 0.05); 21 days after intervention, SFI and the angle of Oblique Plate Test were higher in the observation group than in the model group (P < 0.05). Immunofluorescence showed that, 21 days after intervention, the expression of S100 was lower in the model group than in the sham operation group (P < 0.01), and was higher in the observation group than in the model group (P < 0.05), no difference was found between the observation group and the sham operation group (P > 0.05). Western blotting showed that, before intervention and seven days after intervention, the expression of TGF-β1, Smad2 and p-Smad2 were higher in the model group than in the sham operation group; 21 days after intervention, no difference was found in the expression among groups (P > 0.05) Conclusion:Three Handing-Three Points could promote the proliferation of Schwann cell and the recovery of myelin sheath, to improve the motor function of hind limbs in rats with sciatic nerve injury, which may not be related to TGF-β1/Smad2 pathway.

Effects of Three Handing-Three Points on Thickness of Myelin Sheath and Expression of Neuregulin 1 and Human Epidermal Growth Factor Receptor 2 after Sciatic Nerve Injury in Rats / 中国康复理论与实践

Objective:To explore the effect of Tuina of Three Handing-Three Points on the recovery of motor function, the expression of neuregulin (NRG) 1 and human epidermal growth factor receptor (ErbB) 2 in the injured point of sciatic nerve and L4-6 spinal cord, and the morphological change of myelin sheath at the injured point of sciatic nerve of rats. Methods:A total of 76 male Sprague-Dawley rats were randomly divided into normal group, sham operation group, model group and Tuina group with 19 rats in each group. The right side sciatic nerve was clamped to make model in the model group and Tuina group. The sham operation group exposed sciatic nerve only. Tuina group received Tuina on Yinmen (BL37), Chengshan (BL57) and Yanglingquan (GB34) with dialing, plucking and kneading using Tuina technique simulator. All of them were tested with Oblique Plate Test before modeling, seven days and 28 days after modeling. Western blotting was used to detect the protein expression of NRG1 and ErbB2 in the injured point of sciatic nerve and L4-6 spinal cord. The change of myelin sheath at the sciatic nerve injury point was observed and analyzed by transmission electron microscope. Results:Seven days and 28 days after modeling, the scores of Oblique Plate Test were lower in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05); 28 days after modeling, the scores was higher in Tuina group than in the model group (P < 0.05). At the sciatic nerve injury point, three days after modeling, the expression of NRG1 and ErbB2 was higher in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05); seven days and 28 days after modeling, there was no significant difference in NRG1 among groups (P > 0.05); 28 days after modeling, the expression of ErbB2 was higher in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05). In L4-6 spinal cord, three days after modeling, the expression of NRG1 and ErbB2 was higher in the model group and Tuina group than in the normal group and sham operation group (P < 0.05); seven days after modeling, the expression of NRG1 was higher in the model group and Tuina group than in the sham operation group (P < 0.05), and the expression of ErbB2 was higher in the model group and Tuina group than in the normal group and the sham operation group (P < 0.05); 28 days after modeling, the expression of NRG1 was higher in Tuina group than in the model group (P < 0.05), and there was no significant difference in ErbB2 among groups (P > 0.05). The electron microscope showed that, 28 days after modeling, the myelin sheath collapsed seriously in the model group; while the ultrastructure of the nerve injury point improved, and the myelin sheath of the nerve fiber was relatively intact in Tuina group; the g-ratio value was lower in the model group than in the sham operation group (P < 0.05), the g-ratio value was higher in Tuina group than in the model group (P < 0.05), and no difference was found in g-ratio value between Tuina group and sham operation group (P > 0.05). Conclusion:Three Handing-Three Points could improve the motor function of hind limbs in rats with sciatic nerve injury, which may be related to the adjustment of NRG1 and ErbB2 in the sciatic nerve and spinal cord, to maintain normal myelin sheath structure.

Changes of functional connectivity between the right anterior insula and the frontal operculum in mild cognitive impairment / 中华老年心脑血管病杂志

Objective To investigate changes of functional connectivity between the right anterior insula and the frontal operculum in mild cognitive impairment(MCI).Methods Twenty-one MCI patients served as MCI group and twenty age-and gender-matched subjects with normal cognitive function served as a control group in this study.Resting-state fMRI was performed and functional connectivity to right anterior insula and the frontal operculum was obtained with a voxel-wise manner.The difference in functional connectivity between the two groups was obtained with two -sample t-test.Results The mini-mental state examination score was significantly lower in MCI group than in control group(25.8±0.6 vs 29.2±0.3,P＜0.01).In healthy elderly,a distributed set of regions,including bilateral inferior parietal lobule,right middle and posterior cingulated cortex,right middle frontal gyrus,right mediodorsal nucleus of thalamus,right supplementary motor area,left anterior insula and the frontal operculum,left superior temporal gyrus,left inferior frontal gyrus,left precentral gyrus and left olfactory cortex(orbital and vertical gyrus),showed functional connectivity to right anterior insula and the frontal operculum.While bilateral inferior parietal lobule,right inferior frontal gyrus(opercularis,orbitalis,triangularis),right middle frontal gyrus,right middle cingulated cortex,right thalamus,left anterior insula and the frontal operculum and ACC,showed functional connectivity to right anterior insula and the frontal operculum in MCI.Compared to healthy elderly,decreased functional connectivity to right anterior insula and the frontal operculum was identified in left olfactory cortex and left superior parietal lobule,while increased in right medial prefrontal lobe.At the same time,a tendency of decreased functional connectivity to left anterior insula and the frontal operculum was also observed in left olfactory cortex.Conclusion The changes of functional connectivity to right anterior insula and the frontal operculum can be a significant biomarker in the differential diagnosis of MCI.

Downregulation of serum CXCL4L1 predicts progression and poor prognosis in prostate cancer patients treated by radical prostatectomy / 亚洲男科学杂志(英文版)

Our previous study found that plate factor-4 variant (CXCL4L1) was downregulated in the serum of patients with prostate cancer (PCa). The aim of the present study was to investigate the prognostic value of CXCL4L1 in PCa. In total, 213 PCa patients treated with radical prostatectomy were enrolled and peripheral blood samples of all patients were collected. Expression of serum CXCL4L1 in patients with different tumor stages and grades were measured by enzyme-linked immunosorbent assay (ELISA). The Kaplan-Meier method was applied to estimate the progression to castration-resistant prostate cancer (CRPC), metastasis, biochemical recurrence (BCR)-free survival, and overall survival (OS). Prognostic factors for BCR-free survival and OS were determined by univariate and multivariate analyses using the Cox proportional hazards regression model. The expression of CXCL4L1 was significantly lower in PCa patients with advanced pathological tumor stage, high-grade Gleason score, and metastasis. Moreover, downregulation of CXCL4L1 not only strongly correlated with aggressive clinicopathological features, but also predicted tumor progression and unfavorable outcomes. Finally, multivariate Cox regression analyses identified CXCL4L1 as an independent prognostic factor for both BCR-free survival (hazard ratio [HR]: 2.03, 95% confidence interval [CI]: 1.26-3.27; P = 0.004) and OS (HR: 2.26, 95% CI: 1.07-4.79; P = 0.033). In conclusion, our results indicate that CXCL4L1 might serve as a novel and promising prognostic biomarker for patients with PCa and potential therapeutic target in the future.

High-field magnetic resonance imaging with multiple parameters to evaluate the thrombus-thrombolysis model in rhesus monkeys with acute cerebral infarction / 中国比较医学杂志

Objective To examine the nonhuman primate(NHP)model of acute cerebral infarction thrombus-thrombolysis using multi-parameter high-field magnetic resonance imaging(MRI). Methods Altogether, 8 adult male rhesus monkeys aged 8.2(± 1.2)years old and weighing 9.4(± 1.0)kg were randomized into an infarction group(n=4)and thrombolysis group(n =4). Middle cerebral artery occlusion(MCAO)was induced with a clot in the M1 segment. Monkeys in the thrombolysis group were treated with the recombinant tissue plasminogen activator, rt-PA, while those in the infarction group were treated with 0.9% NaCl only. T2 weighted imaging(T2WI), T2-weighted-fluid-attenuated inversion recovery(T2-FLAIR), time-of-flight magnetic resonance angiography(TOF-MRA), and diffusion-weighted imaging(DWI)were used to examine all monkeys at 4 and 24 h after onset of ischemia. Results The rhesus monkey thrombus-thrombolysis model was successfully established. MRA showed that the middle cerebral artery(MCA) was not recanalized in the infarction group, but was recanalized in the thrombolysis group. T2WI sequence showed an increase in infarction volume(12 027 ± 5507 mm3)in the infarction group compared with the thrombolysis group(4910 ± 2764 mm3). DWI sequence showed an increase in infarction volume(9498 ± 5226 mm3)in the infarction group and thrombolysis group(4854 ± 1792 mm3). Both T2WI and DWI sequences showed no significant difference in infarction volume at 4 h between the two groups, while infarction volume in the thrombolysis group at 24 h was significantly lower compared with the infarction group. The increase in infarction volume was significantly lower in the thrombolysis group compared with the infarction group. Conclusions MRI sequences can be used to successfully evaluate recanalization and infarct changes in the thrombus-thrombolysis model in rhesus monkeys.

Chemical constituents from Dendrobium nobile / 中成药

AIM To study the chemical constituents from Dendrobium nobile Lindl..METHODS The 95％ ethnol extract from D.nobile was isolated and purified by silica and Sephadex LH-20,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Eight compounds were isolated and identified as erianin (1),gigantol (2),moscatin (3),confusarin (4),4,5-dihydroxy-2-methoxy-9,10-dihydro-phenanthrene (5),coumarin (6),hexadecanoic acid,methyl ester (7),dibutyl phthalate (8).CONCLUSION Compounds 1,3,5,6,7,8 are isolated from this plant for the first time.

"Based on ""pulmonary gangrene"" warming yang and supporting, promoting blood circulation and Huoxuegongtan method for treatment of pulmonary alveolar proteinosis" / 中国中西医结合急救杂志

Pulmonary alveolar proteinosis (PAP) is a rare disease clinically, and at present no western medicine can effectively cure the disease. After the analysis of literatures related to Traditional Chinese Medicine (TCM) for treatment of the disease in the China National Knowledge Internet Database, it was discovered that the syndrome differentiation showed the disease closely associated with phlegm, blood stasis and yin deficiency. In this study, from view point of pulmonary gangrene TCM theory and treatment combined with PAP pathophysiological characteristics, it is emphasized that phlegm accumulation, blood stasis and yang deficiency are the key pathological manifestations of PAP, thus Yanghe decoction, Tounong powder, Kongxian pellet were used for treatment of one such case, the rational thinking in diagnosis and treatment of this patient being consistent with the idea learning western medicine for China use.

Clinical research on effect of Xijiaodihuang decoction for treatment of elderly patients with sepsis / 中国中西医结合急救杂志

Objective To observe the effect of Xijiaodihuang decoction on the release of inflammatory mediators and prognosis in elderly patients with sepsis.Methods A prospective randomized controlled study was conducted. Seventy-four patients with sepsis admitted to the Department of Geriatrics of Changshu Hospital of Traditional Chinese Medicine (TCM) Affiliated to Nanjing University of TCM from March 2015 to February 2017, and they were divided into a TCM treatment group and a control group randomly, 37 cases in each group, there were 2 patients transferred to other department during the period of study to continue treatment, 2 patients discharged automatically and 1 case transferred to other hospital in the TCM treatment group; and there were 3 patients transferred to other hospital, 1 patient discharged automatically, 1 patient dead in 7 days after entering the control group and 1 patient transferred to other department during the period of observation to continue treatment in the control group. Finally, 32 patients were in TCM treatment group and 31 patients in the control group, completing the study. All patients in the two groups received conventional treatment of sepsis, patients in the TCM treatment group took Xijiaodihuang decoction 100 mL concentrated [rhinoceros horn (replaced with buffalo horn) 30 g, rehmannia root 24 g, peony 12 g, tree peony bark 9 g] taken orally or by nasal feeding, and patients in the control group received the same amount of normal saline, the two groups were treated 1 time a day for consecutive 7 days to complete 1 therapeutic course, then the treatment efficacy was evaluated in the two groups. The differences of serum interleukins (IL-1β, IL-6), tumor necrosis factor-α (TNF-α), white blood cells (WBC), C-reaction protein (CRP), lactate levels between the two groups were compared before treatment and on the 3rd, 7th and 14th day after treatment, the incidence of staying in intensive care unit (ICU), time of staying in ICU and 28-day mortality were also observed. The 28-day survival rate between two groups was analyzed by Kaplan-Meier survival curve.Results After treatment in the two groups, the levels of IL-1β, IL-6 and TNF-α had a tendency of increase at first and then decrease. After treatment for 14 days, the IL-1β was significantly lower in the TCM treatment group than that of the control group (ng/L: 83.27±21.84 vs. 96.73±26.33), the levels of IL-6 and TNF-α in TCM treatment group were obviously lower than those in the control group since 7 days after treatment [IL-6 (ng/L): 48.27±24.13 vs. 62.15±24.34, TNF-α (μg/L): 1.41±0.31 vs. 1.96±0.29]. IL-6 and TNF-α were still lower than those in the control group until 14 days after treatment [IL-6 (ng/L): 29.25±18.57 vs. 56.24±23.61, TNF-α (μg/L) 1.35±0.28 vs. 1.83±0.22, allP 0.05). After treatment, the lactate in the control group was gradually decreased, while in the TCM treatment group, the lactate level after treatment presented a tendency firstly decreased and then elevated, and after treatment for 3 days in TCM treatment group, the level of lactate began markedly lower than that in the control group (mmol/L: 1.26±0.43 vs. 2.01±0.59,P < 0.05). The ICU hospitalization rate and ICU length of stay in the TCM treatment group were significantly lower than those in the control group [56.25% (18/32) vs. 83.87% (26/31), (10.2±5.4) days vs. (13.5±5.8) days], and the 28-day mortality was also obviously lower in TCM treatment group than that in control group [9.37% (3/32) vs. 29.03% (9/31)]. Kaplan-Meier survival curve analysis showed that the 28-day survival rate in TCM treatment group was significantly higher than that in control group (P = 0.045).Conclusion Xijiaodihuang decoction can reduce the levels of IL-1β, IL-6, TNF-α and lactate in serum, reduce the incidence of staying in ICU, decrease the time of staying in ICU and improve the prognosis of elderly patients with sepsis.

The Identification of Differentially Expressed Proteins in Maternal Serum of Fetuses with Congenital Heart Defects by Using the iTRAQ Technology / 中国医科大学学报

Objective To screen for serum protein differentially expressed between women whose fetuses had congenital heart defects(CHD) and women who had normal fetuses. Methods Serum samples were collected from pregnant women whose fetuses had CHD and those whose fe?tuses had no CHD,including a CHD group of 40 women and a control group of 10 women. The CHD group included 4 subgroups as follows:tetralo?gy of Fallot,ventricular septal defects,persistent truncus arteriosus,and a mixture of relatively rare types of CHD(n=10 each). Samples in the same group were pooled to obtain equal amounts of proteins ,and the iTRAQ proteomic approach was used to identify and quantify the proteins dif?ferentially expressed among these groups. Results We successfully identified 606 proteins,among which 47 showed at least a 1.5?fold difference between the CHD and control groups. Among the 47 proteins,23 and 24 were upregulated and downregulated,respectively. Conclusion Several proteins associated with CHD could be identified by using the iTRAQ proteomic approach ,and various proteins were involved in the pathogenesis of CHD in this study.

Contents Determination of 7 Ingredient in Xianglian Huazhi Pill by HPLC / 中国药房

OBJECTIVE:To establish a method for the contents determination of paeoniflorin,hesperidin,baicalin,palmatine, berberine,glycyrrhizic acid,magnolol in Xianglian huazhi pill. METHODS:HPLC was conducted on the column of Agilent Porlshell 120 SB-C18 with mobile phase of 90% acetonitrile(A)-0.1% phosphoric acid 5% aqueous acetonitrile(B)(gradient elu-tion)at a flow rate 1.0 ml/min,the column temperature was 30 ℃,the injection volume was 3 μl,and the detection wavelength was 230 nm for paeoniflorin(0-10.0 min),283 nm for hesperidin(10.1-13.0 min),277 nm for baicalin(13.1-14.4 min),265 nm for palmatine and berberine (14.5-20 min),250 nm for glycyrrhizic acid (20.1-25.0 min) and 290 nm for magnolol (25.1-60.0 min). RESULTS:The linear range was 0.013 88-0.694 5μg for paeoniflorin,0.039 93-1.996 8μg for hesperidin,0.070 08-0.389 3μg for baicalin,0.006 48-0.324 0μg for palmatine(counted by palmatine hydrochloride),0.010 52-0.526 2μg for berberine(counted by berberine hydrochloride),0.008 816-0.440 7 μg for glycyrrhizic acid(counted by ammonium glycyrrhizinate)and 0.007 224-0.361 2 μg for magnolol(r≥0.999 0);RSDs of precision,stability and reproducibility tests were lower than 2.0%;average recoveries were 97.47%-102.88%(RSD=1.91%,n=6),102.06%-102.81%(RSD=0.25%,n=6),97.91%-100.80%(RSD=1.25%,n=6), 97.53%-101.60%(RSD=1.66%,n=6),97.54%-100.68%(RSD=1.15%,n=6),96.23%-99.00%(RSD=1.11%,n=6) and 97.91%-101.44%(RSD=1.36%,n=6),respectively. CONCLUSIONS:The method is simple,rapid and accurate,and can be used for the quality control of Xianglian huazhi pill.

Transrectal shear wave elastography combined with transition zone biopsy for detecting prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the application of shear wave elastography (SWE) combined with transition zone biopsy in the detection of prostate cancer (PCa).</p><p><b>METHODS</b>A total of 489 patients with suspected PCa underwent transrectal ultrasonography (TRUS) and SWE-guided prostatic biopsy. We evaluated the role of SWE combined with transition zone biopsy in promoting the detection rate in comparison with the results of biopsy pathology.</p><p><b>RESULTS</b>The pathological results confirmed 221 malignant and 268 benign cases. Based on systematic biopsy, SWE combined with transition zone biopsy achieved a detection rate of 45. 19% , significantly higher than that of systematic biopsy alone (33.13%) (P < 0.05). The diagnostic sensitivity, specificity, and accuracy of SWE were significantly better than those of TRUS (P < 0.05). The mean elasticity (Emean) of SWE was remarkably higher for malignant than for benign lesions ([40.1 ± 9.5] vs [21.6 ± 8.3] kPa, P < 0.05). With 28.5 kPa as the threshold of the Emean value, the area under the ROC curve was 0. 899, and the diagnostic sensitivity and specificity were 88.71% and 86.23%, respectively.</p><p><b>CONCLUSION</b>SWE combined with transition zone biopsy could significantly improve the detection rate of prostate cancer.</p>

Clinical analysis of retroperitoneal laparoscopic partial nephrectomy on patient with incidental renal cell carcinoma / 中国综合临床

Objective To evaluate the safety and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy (LPN) in patients with incidental renal cell carcinoma.Methods Twenty-six patients with T1 incidental renal cell carcinoma treated with retroperitoneal LPN from Dec.2011 to Oct.2013 were analyzed retrospectively.The operation time,warm ischemia time,intraoperative blood loss,complications and prognosis of perioperative periods were collected.Results All 26 cases were operated successfully without conversion to open or other surgery.The operation period was 90-190 minutes.Blockage of renal artery was applied in all 26 cases,and the warm ischemia time was 15-30 minutes.The intraoperative blood loss was 100-360 ml.The drainage was removed 3-7 days postoperatively,and the hospitalization period was 7-12 days.All cases were clear cell renal cell carcinoma by pathological examinations,and showed negative surgical margins.No complications such as postoperative bleeding,inflammation and leakage of urine were occurred.All cases had normal renal function during the follow-up of 3-25 months without local recurrence or distant metastasis.Conclusion Retroperitoneal LPN for the treatment of T1 incidental renal cell carcinoma is worthy of application with the advantages of safety,minimal invasiveness,fewer complications,quick recovery and good nephron-sparing functional recovery.

Glycosyl-phosphatidylinositol-anchored interleukin-2 expressed on tumor-derived exosomes induces anti-tumor immune response / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To prepare IL-2-anchored and tumor-derived exosomes vaccine, and investigate the antitumor efficiency of the special cytotoxic T-lymphocytes induced by Ex/GPI-IL-2.</p><p><b>METHODS</b>To construct pEGFP-N1-IL2gpi plasmid coding a fusion gene of a DNA oligo encoding GPI-anchor signal sequence attaching to human IL-2 cDNA. Then T24 cell lines stably expressing GPI-IL-2 proteins (T24/GPI-IL-2) were established. Ex/GPI-IL-2 were isolated and purified by ultrafiltration and sucrose gradient centrifugation, and the morphology and molecule markers were analyzed. The mixed lymphocyte reaction study and cytotoxic study were performed to determine the proliferative effect of T lymphocytes and the cytotoxicity induced by Ex/GPI-IL-2.</p><p><b>RESULTS</b>The pEGFP-N1-IL2gpi plasmid was successfully constructed, and cell lines stably expressing GPI-IL-2 fusion proteins were established. Ex/GPI-IL-2 were small vesicular and saucer-shaped in diameter of 30-90 nm, containing heat shock protein 70, intercellular adhesion molecule-1, MAGE-1 and GPI-IL-2. Ex/GPI-IL-2-pulsed could dendritic cells induce proliferation of T cells and cytotoxic immune response more efficiently (P<0.05).</p><p><b>CONCLUSIONS</b>GPI-IL-2 gene-modified tumor cells can make the exosomes containing GPI-IL-2 with an increased anti-tumor effect. Our study provides a feasible approach for exosome-based tumor immunotherapy of bladder transitional cell tumors.</p>

Expression of Snail in bladder urothelial carcinoma and its relationship with E-cadherin and a subset of T cell Groups / 中华泌尿外科杂志

ObjectiveTo investigate the expression of Snail in bladder urothelial carcinoma and evaluate its relationship with E-cadherin and a subset of T cell groups.MethodsImmunohistochemical method was used to detect the expression of Snail and E-cadherin proteins in tissue from 156 cases of bladder urothelial carcinoma and 80 cases of the para-cancerous mucosa. The proteins expression status was analyzed with clinico-pathological data. Meanwhile, correlations with Snail and CD4+, CD8+, CD4+/CD8+ were analyzed.ResultsThe positive rate of Snail in bladder urothelial carcinoma was 65.4％ , which was significantly higher than that in para-cancerous mucosa (48.8％). The expression of Snail was significantly correlated with the clinical stage, pathological grade, tumor quantity, distant metastasis and tumor recurrence.There was negative correlation between the expression of Snail and E-cadherin in bladder urothelial carcinoma. Positive expression of Snail had a negative correlation with the number of CD4+ and CD4+/CD8+ , whereas it had no significant correlation with the number of CD8+.ConclusionsBy inhibition of the E-cadherin expression and inducing local immunosuppression, Snail might play an important role in the process of the invasion and metastasis of bladder urothelial carcinoma.