Advances on cardiovascular effects of GLP-lRAs / 中国药理学通报

Glucagon-like peptide-1 ( GLP-1 ) is secreted by gut enteroendocrine cells. GLP-1 receptor agonists ( GLP-1 RAs) control glucose-related augmentation of insulin and suppress glu-cagon secretion. GLP-lRAs also inhibit gastric emptying, food intake and limit weight gain. In the past decade, significant progresses have been made in the investigation on the effects of GLP-1 RAs on cardiovascular system. The potential advantages of oral small-molecule GLP-1 RAs could improve the application of this class of drugs. This review highlights the multiple cardiovascular profiles of GLP-1 RAs in the treatment of cardiovascular diseases to provide new insights into cardiovascular benefits of GLP-1 RAs.

Effect of inferior vena cava respiratory variability-guided fluid therapy after laparoscopic hepatectomy: a randomized controlled clinical trial / 中华医学杂志(英文版)

BACKGROUND@#After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).@*METHODS@#This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.@*RESULTS@#Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.@*CONCLUSION@#Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.@*TRIAL REGISTRATION@#ChiCTR-INR-17013093.

Surgical treatment for ipsilateral femoral neck and shaft fracture / 中国骨伤

OBJECTIVE@#To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications.@*METHODS@#From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus.@*RESULTS@#All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair.@*CONCLUSION@#Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

Genetic testing and prenatal diagnosis for two Chinese pedigrees affected with Alport syndrome due to variants of COL4A5 gene / 中华医学遗传学杂志

OBJECTIVE@#To analysis variants of COL4A5 gene in two Chinese pedigrees affected with Alport syndrome (AS) and provide prenatal diagnosis for them.@*METHODS@#Two unrelated ethnic Han Chinese pedigrees who had visited the First Affiliated Hospital of Zhengzhou University respectively in September 2018 and January 2020 were selected as the study subjects. Clinical data were collected, and genomic DNA was extracted from peripheral venous blood and amniotic fluid samples for genetic testing. Following next generation sequencing, candidate variants of the COL4A5 gene were verified by Sanger sequencing and bioinformatic analysis. The gender of the fetuses was determined by the presence of sex-determining region on Y (SRY).@*RESULTS@#Genetic testing revealed that the proband and a fetus from pedigree 1 had both harbored a c.2723G>A (p.Gly908Glu) variant in exon 32 of the COL4A5 gene, whilst the proband and a fetus from pedigree 2 had both harbored a c.3817G>A (p.Gly1273Asp) variant in exon 44 of the COL4A5 gene. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were classified as likely pathogenic (PP2+PM2_Supporting). Following exclusion of maternal contamination, PCR amplification of the SRY region indicated that both fetuses were males.@*CONCLUSION@#The c.2723G>A (p.Gly908Glu) and c.3817G>A (p.Gly1273Asp) variants of the COL4A5 gene probably underlay the AS in the two pedigrees. Detection of the SRY region can reliably identify the fetal sex, which is conducive to the prenatal diagnosis. Above results have also enriched the mutational spectrum of the COL4A5 gene and provided a reference for correlating the genotype and phenotype of the AS.

Design and analysis of shoulder type exoskeleton stretcher for individual soldier / 生物医学工程学杂志

For the transportation process of rescuing wounded personnel on naval vessels, a new type of shoulder type exoskeleton stretcher for individual soldier was designed in this paper. The three-dimensional model of the shoulder type exoskeleton stretcher for individual soldier was constructed using three dimensional modeling software. Finite element analysis technique was employed to conduct statics simulation, modal analysis, and transient dynamics analysis on the designed exoskeleton stretcher. The results show that the maximum stress of the exoskeleton stretcher for walking on flat ground is 265.55 MPa, which is lower than the allowable strength of the fabrication material. Furthermore, the overall deformation of the structure is small. Modal analysis reveals that the natural frequency range of the exoskeleton stretcher under different gait conditions is 1.96 Hz to 28.70 Hz, which differs significantly from the swing frequency of 1 Hz during walking. This indicates that the designed structure can effectively avoid resonance. The transient dynamics analysis results show that the maximum deformation and stress of exoskeleton stretcher remain within the safety range, which meets the expected performance requirements. In summary, the shoulder type exoskeleton stretcher for individual soldier designed in this study can solve the problem of requiring more than 2 people to carry for the existing stretcher, especially suitable for narrow spaces of naval vessels. The research results of this paper can provide a new solution for the rescue of wounded personnel on naval vessels.

Association between hydroxysteroid dehydrogenases gene family single-nucleotide polymorphisms and digit ratio / 解剖学报

Objective To investigate the association between 8 single-nucleotide polymorphisms (SNPs) of hydroxysteroid dehydrogenase (HSD) gene family and human digit ratio (2D ∶ 4D). Methods Randomly selected 808 college students (400 males and 408 females) as subjects, the digit ratio of left and right fingers were measured and calculated using computer image software. Eight SNPs (rs1000283, rs2236903, rs5479, rs56303414, rs676387, rs4445895, rs2066474, rs8190478) in HSD11B and HSD17B gene families were genotyped by multiplex PCR. The association between 2D ∶4D and different genotypes was analyzed by One-Way ANOVA. Results Female left hand(L)2D ∶ 3D, L2D ∶4D, L3D ∶4D, right hand(R)2D ∶4D, R2D ∶5D were significantly higher than male (P0. 05). The genotypes frequency of the 8 SNPs were not significantly associated with digit ratio (2D ∶4D) in both males and females (P>0. 05). Conclusion There are significant gender differences in digit ratio in Ningxia Han college students, but there is no correlation between digit ratio and 8 SNPs in HSD11B and HSD17B gene families, suggesting that HSD11B and HSD17B gene families may have nothing to do with the formation of human digit ratio.

Study on improvement mechanism of caudatin on liver injury in rats / 中国药房

OBJECTIVE To investigate the improvement mechanism of caudatin on liver injury of rats. METHODS SD rats were randomly divided into blank group， model group， caudatin low-dose and high-dose groups （25， 50 mg/kg）， with 6 rats in each group. Diethylnitrosamine （DEN） was injected intraperitoneally three times per week for eight weeks to establish liver injury model of rats. At 5th week of modeling， the rats received relevant medicine or 0.5% sodium carboxymethylcellulose intragastrically for 4 weeks. The levels of liver function indexes [alanine transaminase （ALT）， aspartate transaminase （AST）， total protein （TP） and total bilirubin （TBI）] and inflammatory factors [interleukin （IL-6）， tumor necrosis factor α （TNF-α）， IL-1β] in serum were detected； the histopathological morphological changes of rat liver were observed； the positive protein expressions of nuclear factor κB （NF-κB） and 78 kDa glucose regulatory protein （Grp78） in liver tissue were also determined； the expressions of endoplasmic reticulum stress-related protein Grp78， C/EBP homologous protein （CHOP）， activating transcription factor 6 （ATF6） and inositol requiring enzyme 1α （IRE1α） and the level of protein kinase R-like endoplasmic reticulum kinase robertluoyi@126.com （PERK） in liver tissue were detected. RESULTS Compared with blank group， serum levels of ALT， AST， TBI， IL-6， TNF-α and IL-1β and positive expressions of NF-κB and Grp78 in liver tissue as well as protein expressions of Grp78， CHOP， ATF6 and IRE1α， PERK protein phosphorylation level were all increased significantly in model group （P＜0.05）， while the serum level of TP was decreased significantly （P＜0.05）. The disordered structure of liver lobule， swollen liver cells， unclear intercellular boundary were observed and accompanied by inflammatory cell infiltration. Compared with model group， most of the above indexes were significantly reversed in caudatin groups （P＜0.05）； the structure of hepatic lobule was relatively complete and clear， the cells were arranged orderly， and the infiltration of inflammatory cells was also reduced. CONCLUSIONS Caudatin has a significant improvement effect against DEN-induced liver injury in rats， the mechanism of which may be associated with inhibiting endoplasmic reticulum stress and inflammatory reaction.

Application of clinical value assessment of treatment protocols in guideline development: taking the WFAS Clinical Practice Guideline of Acupuncture and Moxibustion for Migraine as an example / 中国针灸

To enhance the clinical applicability of guidelines and provide more effective guidance for clinical practice, a clinical value assessment was conducted during the development of the World Federation of Acupuncture-Moxibustion Societies (WFAS) Clinical Practice Guideline of Acupuncture and Moxibustion for Migraine, which involved the evaluation of 59 acupuncture and moxibustion treatment protocols from randomized controlled trials (RCTs). This article introduced the methodology, content and results of the clinical value assessment of RCT-based acupuncture and moxibustion treatment protocols, which involved the integration of historical and contemporary medical evidence and expert consensus. It served as a methodological reference for the future development of acupuncture and moxibustion clinical practice guidelines.

Immune regulation of the population with Qi-deficiency by the treatment of ear holographic tongbian scraping / 中国实用护理杂志

Objective:To investigate the effects of ear holographic tongbian scraping on the constitution, related symptoms and immune function of the population with Qi-deficiency.Methods:From April 2020 to June 2020, 80 subjects judged as Qi-deficiency by the "Traditional Chinese Medicine constitution test" in Suzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine were recruited offline and online. They were divided into control group and experimental group by random number table method, with 40 cases in each group. On the basis of online health education, the control group received online health education, while the experimental group was given ear holographic tongbian scraping, once a week, 4 times as a course of treatment, a total of 3 courses. Related symptom scores, Qi-deficiency transformation scores, peripheral blood CD4 + proportion, CD8 + proportion, CD4 +/CD8 + ratio were compared between two groups. Results:Totally 38 cases were included in experimental group and 34 cases in control group. After intervention, symptom scores of fatigue, shortness of breath, easy to catch a cold, laziness to speak, low voice and Qi-deficiency transformation scores were 3.26 ± 0.76, 2.92 ± 0.82, 3.08 ± 0.82, 2.66 ± 0.97, 2.71 ± 0.80, 46.16 ± 17.96 in experimental group and 4.12 ± 0.41, 3.76 ± 0.55, 3.50 ± 0.56, 3.65 ± 0.65, 3.18 ± 0.67, 56.88 ± 10.80 in control group, the differences were statistically significant ( t values were -6.02 - -2.51, all P<0.05). Peripheral blood test results also showed that the proportion of CD8 + was 24.76(19.92, 28.23)% in experimental group and 27.19(24.39, 31.57)% in control group, the difference was statistically significant ( Z=-2.25, P<0.05). Conclusions:Ear holographic tongbian scraping can regulate the Qi-deficiency constitution and improve the immune function of people with Qi-deficiency.

Bax inhibitor 1 inhibits vascular calcification in mice by activating optic atrophy 1 expression / 南方医科大学学报

OBJECTIVE@#To investigate the effects of Bax inhibitor 1 (BI- 1) and optic atrophy protein 1 (OPA1) on vascular calcification (VC).@*METHODS@#Mouse models of VC were established in ApoE-deficient (ApoE-/-) diabetic mice by high-fat diet feeding for 12 weeks followed by intraperitoneal injections with Nε-carboxymethyl-lysine for 16 weeks. ApoE-/- mice (control group), ApoE-/- diabetic mice (VC group), ApoE-/- diabetic mice with BI-1 overexpression (VC + BI-1TG group), and ApoE-/- diabetic mice with BI-1 overexpression and OPA1 knockout (VC+BI-1TG+OPA1-/- group) were obtained for examination of the degree of aortic calcification using von Kossa staining. The changes in calcium content in the aorta were analyzed using ELISA. The expressions of Runt-related transcription factor 2 (RUNX2) and bone morphogenetic protein 2 (BMP-2) were detected using immunohistochemistry, and the expression of cleaved caspase-3 was determined using Western blotting. Cultured mouse aortic smooth muscle cells were treated with 10 mmol/L β-glycerophosphate for 14 days to induce calcification, and the changes in BI-1 and OPA1 protein expressions were examined using Western blotting and cell apoptosis was detected using TUNEL staining.@*RESULTS@#ApoE-/- mice with VC showed significantly decreased expressions of BI-1 and OPA1 proteins in the aorta (P=0.0044) with obviously increased calcium deposition and expressions of RUNX2, BMP-2 and cleaved caspase-3 (P= 0.0041). Overexpression of BI-1 significantly promoted OPA1 protein expression and reduced calcium deposition and expressions of RUNX2, BMP-2 and cleaved caspase-3 (P=0.0006). OPA1 knockdown significantly increased calcium deposition and expressions of RUNX2, BMP-2 and cleaved caspase-3 in the aorta (P=0.0007).@*CONCLUSION@#BI-1 inhibits VC possibly by promoting the expression of OPA1, reducing calcium deposition and inhibiting osteogenic differentiation and apoptosis of the vascular smooth muscle cells.

Epidemic status of imported malaria before and after malaria elimination in Jiaozuo City of Henan Province / 中国血吸虫病防治杂志

Objective To analyze and compare the epidemiological characteristics of imported malaria in Jiaozuo City before and after malaria elimination, so as to provide insights into the malaria surveillance during the post-elimination stage and prevention of re-establishment of imported malaria. Methods Data pertaining to the epidemic situation and individual investigation of malaria in Jiaozuo City before (from 2010 to 2016) and after malaria elimination (from 2017 to November, 2020) were captured from the National Notifiable Disease Reporting System and the Information System for Parasitic Diseases Control and Prevention of Chinese Center for Disease Control and Prevention and were analyzed statistically. Results A total of 74 imported malaria cases were reported in Jiaozuo City from 2010 to 2021. Imported cases were predominantly Plasmodium falciparum malaria cases in Jiaozuo City before and after malaria elimination, and there was no significant difference in the proportion of malaria parasite species (χ2 = 0.234, P > 0.05). The imported malaria cases was predominantly reported in Wuzhi County, and was identified in overseas male farmers and businessmen at ages of 20 to 59 years, while the greatest number of imported malaria cases was reported in June and December before and after malaria elimination. The imported malaria cases predominantly acquired malaria parasite infections in sub-Saharan African countries; however, the proportion of imported malaria cases returning from Southeast Asian counties increased after malaria elimination than before malaria elimination (χ2 = 5.989, P < 0.05). The longest duration from onset to definitive diagnosis of malaria reduced from 27 days before malaria elimination to 18 days after malaria elimination, and the median duration reduced from 3 days to 2 days, while the proportion of definitive diagnosis of malaria increased from 60.47% before malaria elimination to 83.87% after malaria elimination (χ2 = 4.724, P < 0.05). In addition, the proportion of malaria cases definitively diagnosed and reported by medical institutions increased after malaria elimination than before malaria elimination (χ2 = 5.406, P < 0.05). Conclusions The imported malaria patients were predominantly P. falciparum malaria cases in Jiaozuo City during 2010 to 2021, and the patient’s medical care-seeking awareness and medical staff’s diagnosis and treatment ability have improved after malaria elimination. It is necessary to strengthen and improve malaria surveillance and response system and prevent the re-establishment of overseas imported malaria.

Phacoemulsification combined with goniosynechialysis under the gonioscope in the treatment of acute angle-closure glaucoma with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the changes of visual acuity, intraocular pressure(IOP)and anterior chamber structure after phacoemulsification intraocular lens(IOL)implantation and goniosynechialysis in acute angle-closure glaucoma with cataract.<p>METHODS: A prospective study. Totally 80 eyes with acute primary angle-closure glaucoma(APACG)and cataract were selected in our hospital from August 2019 to February 2021. All study underwent phacoemulsification IOL implantation and goniosynechialysis. Visual acuity, IOP, anterior chamber distance(ACD), trabecular iris angle(TIA)and angle opening distance(AOD500)were measured before and 1wk, 1, 3 and 6mo after surgery. Four quadrant angle classifications of upper, lower, nasal and temporal were determined by Scheie classification method and the measured values were statistically analyzed.<p>RESULTS: The postoperative corrected visual acuity in 1wk, 1, 3 and 6mo were improved than preoperative, there were no statistically significant differences between each postoperative period(<i>P</i>>0.05). The IOP in postoperative 1wk, 1, 3 and 6mo were reduced than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The ACD in postoperative 1wk, 1, 3 and 6mo were deepen than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The TIA in postoperative 1wk, 1, 3 and 6mo were widened than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The AOD500 in postoperative 1wk, 1, 3 and 6mo were increased than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The depth of anterior chamber angle in four quadrants were deepened combined with the depth in postoperative 1wk, 1, 3 and 6mo(<i>P</i><0.05).<p>CONCLUSION: Phacoemulsification IOL implantation and goniosynechialysis in the treatment of acute angle-closure glaucoma with cataract can significantly improve visual acuity, increase the depth of central anterior chamber, open angle, reduce IOP. It is an effective and stable surgical method.

A qualitative study on clinical nursing managers′management experience of diagnosis-related groups-prepaid payment system / 中国实用护理杂志

Objective:To explore the management experience of clinical nursing managers and to provide reference for the implementation of the reform of DRGs-PPS.Methods:15 clinical nursing managers were surveyed in an in-depth semi-structured interview by phenomenological research methods, and the data were analyzed by Colaizzi 7 analysis method.Results:Four themes were extracted: the positive effect of the reform, the value reflection of nursing work, the promotion and obstacles of nursing management during DRGS implementation.Conclusions:Clinical nursing managers, there are positive experience as well as negative experience for the implementation of the reform of DRGs-PPS, so we need to constantly improve the staff′s cognition, to maximize the value of nursing, draw support from policy guidance and third-party building platforms, optimizes the allocation of human resources, strengthen the management of consumables, promote nursing quality and cost effective integration and effective supervision, and promote healthy development of the DRGs-PPS.

Construction of nursing quality evaluation index system for nurse-led traditional Chinese medicine clinic / 中国实用护理杂志

Objective:To construct the evaluation index system of nursing quality in nurse-led Traditional Chinese Medicine (TCM) clinic, and to provide a tool for evaluation of nursing quality in nurse-led TCM clinic.Methods:Based on Donabedian three-dimensional quality model of "struction-process-outcome" the inital index system of nurse-led TCM clinic was formed through literature review, evidence level and quality evaluation were conducted based on Johns Hopkins evidence-based nursing method. Through 2 rounds of experts′ consultation, the index system was finally determined. The index weight was calculated by analytic hierarchy process.Results:Two rounds of experts consultations resulted in the effective response rate of 95.65%(22/23) and 86.36%(19/22), the expert authority coefficient was 0.80 and 0.81, coefficients of variation ranged from 0.043 to 0.326 and 0.000 to 0.215, and the Kendall coordination coefficient was 0.261 and 0.214, respectively, showing statistically significant difference ( P<0.05 for both); the final indicator system consisted of 3 first-level indicators, 9 second-level indicators and 53 third-level indicators. Conclusions:The evaluation index system of nurse-led TCM clinic has good reliability, and can provide reference for the evaluation of nursing qualityin nurse-led TCM clinic.

Establishment of a prognostic model of Wnt signaling pathway related genes in gastric cancer / 西安交通大学学报(医学版)

【Objective】 To confirm the role of Wnt signaling pathway in the occurrence and development of gastric cancer （GC）， establish a prognostic model composed of Wnt pathway related genes， and then evaluate the predictive value of the model. 【Methods】 We downloaded the gene expression data and survival data of GC in TCGA database， and used GSEA enrichment analysis to verify the enrichment of Wnt pathway in GC and para-cancer samples. In this study， univariable COX regression analysis and survival curve analysis were used to select the prognosis-related genes of GC. Then the multivariate COX proportional hazard regression model was used to obtain the prognostic model of Wnt signaling pathway related genes. Then， receiver operating characteristic （ROC） curve and forest plot were used to verify the clinical predictive value of the model. The model was then validated in GEO external database. Finally， by utilizing quantitative real-time PCR （qPCR）， we detected the expressions of Wnt signaling pathway related genes in 8 pairs of clinical GC and para-cancer samples. 【Results】 We downloaded 32 samples of normal para-cancer samples and 375 cancer samples and their corresponding clinical data. GSEA enrichment showed that compared with normal samples， Wnt pathway was significantly enriched in GC samples （P<0.05）. The results of univariate COX analysis showed that 13 Wnt pathway genes were closely related to the prognosis of GC patients. Multivariate COX determined that the model was multiplied and accumulated by ETV2， SERPINE1， CPZ， VPS35 and IGFBP1 and their corresponding coefficient β. The survival curve and ROC curve showed that the model could accurately predict the prognosis of GC patients， and the 1-year， 3-year， and 5-year areas under the curve （AUC） were 68.0%， 69.4% and 78.5%， respectively. Clinical univariate and multivariate COX analyses showed that the model could become an independent prognostic factor other than TNM system of GC. The external data set （GSE84437） validation results of GC showed that the model could better predict the prognosis of GC patients. qPCR results indicated that ETV2， SERPINE1， CPZ， VPS35 and IGFBP1 expressions were upregulated in GC samples compared with para-cancer samples. 【Conclusion】 This study further confirmed that Wnt pathway plays an important role in the progress of GC from the perspective of bioinformatics， and we have established a prognosis-related risk model， providing a new perspective for clinical genetic testing， targeted therapy and individualized therapy.

Establishment and evaluation of liver fibrosis diagnosis model based on MRI and serological markers / 中国医师杂志

Objective:To detect the level of serological indexes in patients with chronic hepatitis B and carry out magnetic resonance imaging (MRI) examination at the same time, so as to construct a diagnostic model for liver fibrosis and evaluate its diagnostic value.Methods:A total of 267 patients with chronic hepatitis B in Fushun Central Hospital from January 2018 to June 2020 were selected as the research objects. The apparent diffusion coefficient (ADC) was measured by introvoxel incoherent motion (IVIM) magnetic resonance imaging, and the related serological indexes were detected; Pearson method was used to analyze the correlation among Frons index, aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the 4 factor (Fib-4), red blood cell volume distribution width to platelet ratio (RPR) and ADC; Logistic regression analysis was used to establish a new diagnosis model of hepatic fibrosis; receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of liver fibrosis model.Results:The pathological examination of 267 patients with chronic hepatitis B showed that there were 35 cases in F0 stage, 47 cases in F1 stage, 58 cases in F2 stage, 66 cases in F3 stage and 61 cases in F4 stage. There were significant differences in platelet (PLT), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), prothrombin activity (PTA), collagen Ⅳ (CⅣ), laminin (LN), hyaluronic acid (HA), precollagen Ⅲ (PCⅢ), Frons index, aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the 4 factor(Fib-4), red blood cell volume distribution width to platelet ratio (RPR) and ADC in patients with mild liver fibrosis (F0-F1), moderate liver fibrosis (F2-F3) and severe liver fibrosis (F4) ( P<0.05). Pearson analysis showed that Frons index, APRI, Fib-4, RPR and ADC were positively correlated ( P<0.05). The comparison of value of logistic probability risk estimating (PRE) and Frons index, APRI, Fib-4, RPR in the diagnosis of chronic hepatitis B liver fibrosis showed that the area under the curve (AUC) of Frons index, Fib-4 and APRI in the diagnosis of moderate liver fibrosis were higher than that of mild and severe liver fibrosis, with AUC of 0.903, 0.928 and 0.957, respectively; the AUC of RPR in the diagnosis of mild and moderate hepatic fibrosis was higher (0.861); the AUC of PRE in the diagnosis of mild, moderate and severe liver fibrosis was 0.860, 0.861 and 0.865, respectively; the sensitivity was 64.6%, 76.6%, 73.8%, and the specificity was 96.3%, 89.5% and 95.1%, respectively. Conclusions:Frons index, APRI, Fib-4, RPR and PRE liver fibrosis diagnostic models have certain diagnostic value. Among them, the liver fibrosis diagnostic model predicted by MRI and serological indexes has the best comprehensive efficiency. The best diagnostic scheme should be selected according to the actual situation.

Analysis of monitoring results of drinking water-type endemic fluorosis areas in Gansu Province / 中华地方病学杂志

Objective:Analyze the monitoring results of drinking water-type endemic fluorosis in Gansu Province, understand the epidemic situation of endemic fluorosis and the operation of water improvement projects, combined with the comprehensive evaluation of water improvement measures, to provide data support and scientific suggestions for making prevention and control measures and strategies of endemic fluorosis.Methods:A simple random sampling method was adopted; six surveillance cites in Gansu Province were selected from 2014 to 2017, including Zhangye, Wuwei, Linxia, Tianshui, Pingliang and Qingyang. In addition, three epidemic villages were selected as fixed monitoring villages in each city. The operation situation of water improvement projects and the fluoride content in drinking water were determined, and the dental fluorosis of children aged 8 to 12 was diagnosed.Results:There was no significant difference in water fluoride from 2014 to 2017 ( H = 1.397, P > 0.05), the normal operation rates of water improvement projects were 84.63% - 100.00%, and the water fluoride of all the water improvement projects in villages with water changed was up to the standard in 2017. In 2017, the average value of water fluoride in 3 of the 4 villages without water improvement exceeded the standard. A total of 4 901 children aged 8 to 12 were investigated, the dental fluorosis prevalence rate of whole children was 38.93% (1 908/4 901), and the dental fluorosis index was 0.64, showing a mild prevalence of dental fluorosis. In 2014 - 2017, the dental fluorosis prevalence rates of children were 29.47% (262/889), 47.24% (735/1 556), 46.60% (700/1 502) and 22.12% (211/954), respectively. Conclusions:The water improvement projects in Gansu Province run well, and the water fluoride exceeds the standard in some areas without water improvement. The detection rate of dental fluorosis of children shows a downward trend year by year, and the condition of fluorosis is effectively controlled. It is suggested to strengthen the operation monitoring and later maintenance of the water improvement projects, implement the water improvement projects in the villages without water improvement as soon as possible, and solve the problem of excessive fluoride content in drinking water of residents in the villages without water improvement.

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery / 法医学杂志

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

A comparative analysis of direct stenting versus deferred stenting for the treatment of elderly patients with acute ST segment elevation myocardial infarction with a high thrombus load / 中华老年医学杂志

Objective:To compare the safety and effectiveness of direct stenting versus deferred stenting for the treatment of acute ST segment elevation myocardial infarction(STEMI)with a high thrombus load in patients aged 60 years and above.Methods:In this study, we analyzed 252 elderly STEMI patients with a high thrombus load(thrombus score ≥ 4 points)who received percutaneous coronary intervention(PCI)at Beijing Anzhen Hospital Affiliated or at the Affiliated Hospital of Beihua University from January 2015 to December 2018.They were divided into the direct stent group(n = 126)and the deferred stent group(n = 126)according to whether the stent was inserted immediately or not.Baseline information, surgical information, clinical outcomes and major adverse cardiac events were compared between the two groups at 1 year follow-up.Cox regression analysis was used to determine whether deferred stent implantation was a prognostic factor.Results:There were no significant differences in the distribution of infarct-related arteries, time from onset to balloon dilatation, thrombus load scores and the number of stents between the two groups(all P> 0.05). The diameter and length of the stent were(3.20 ± 0.47)mm and(18.33 ± 5.06)mm in the deferred stent group and(3.03 ± 0.50)mm and(22.60 ± 5.08)mm in the direct stent group, respectively, with a significant difference between the two groups( t=2.926, 6.678, P=0.004, 0.000). The incidences of slow blood flow, distal embolism and low myocardial perfusion staining in the deferred stent group were 2.38%(3/126), 3.17%(4/126)and 2.38%(3/126), respectively, significantly lower than those in the direct stent group, which were 15.87%(20/126), 24.60%(31/126)and 20.63%(26/126), respectively( χ2=13.827, 24.188, 20.614, all P=0.000). The left ventricular ejection fraction(LVEF)at 1 year in the deferred stent group was (0.60±0.05)%, significantly higher than that in the direct stent group(0.57±0.05)%( t=3.859, P=0.000). There was no significant difference in major adverse cardiac events between the two groups at 1 year follow-up( P> 0.05). Cox regression analysis results showed that deferred stent implantation was not a factor affecting the clinical outcome( HR=0.827, 95% CI: 0.288~2.372, P=0.724). Conclusions:Deferred stent implantation and direct stent intervention are equally safe and effective for STEMI patients aged over 60 with a high thrombus load if admitted to the hospital within 12 hours after onset.Deferred stent implantation can significantly improve the infarct-related artery blood flow classification, reduce the distal embolism rate, increase the grade 3 rate of myocardial perfusion staining, increase the diameter of the stent, reduce the length of the stent and improve left ventricular ejection fraction.

APN/CD13 inhibitor Ubenimex: A molecular chaperone of antineoplastic chemotherapeutic drugs / 中国药理学通报

Cytotoxic anti-neoplastic drugs are a kind of chemotherapeutic drugs that directly kill or inhibit the growth and proliferation of tumor cells, and it is one of the main drugs for the treatment of malignant tumors. These drugs may have toxic side effects on normal cells of human body (especially those with strong division and proliferation) when they are used to kill tumor cells. And patients may usually have adverse reactions even at a normal dose when using this kind of drugs. Due to the strong toxic side effects of cytotoxic chemotherapeutic drugs, their clinical application is limited. In recent years it has been found that aminopeptidase N inhibitor Ubenimex has a significant synergistic effect with anti-neoplastic chemotherapeutic drugs, which has the advantages of enhancing the therapeutic effect of drugs and reducing the toxic side effects of chemotherapeutic drugs. This review enumerates that the combination of Ubenimex and a variety of cytotoxic drugs can enhance the anti-tumor effect of cytotoxic drugs and reduce the occurrence of adverse reactions. In addition, the mechanism of combined use of Ubenimex in reversing drug resistance is also introduced. At the same time, is is further confirmed the clinical value of Ubenimex as an effective adjuvant in the treatment of malignant tumors, so as to provide a basis for clinical application.