The mechanism of high mobility group box 1 in coronary artery lesions of Kawasaki disease / 国际儿科学杂志

Kawasaki disease(KD)is a common acute febrile vasculitis in children, but the etiology and pathogenesis of KD are unknown.The most serious complication is coronary artery lesions.The damage of vascular endothelial cell may be the key mechanism of coronary artery lesions in KD.It is found that serum levels of high mobility group box 1(HMGB1) increase in the acute phase of KD, especially in children with coronary artery lesions, and that the gene of HMGB1 is associated with coronary artery lesions in Korean children with KD.HMGB1 is a non-histone DNA binding protein related to inflammation, which plays an important role in promoting the apoptosis of coronary artery endothelial cells in KD.The article reviews the mechanism of HMGB1 in coronary artery lesions of KD.

Professor XUE Bo-shou's Exploration on Coronavirus Disease-2019 and Analysis of Cases / 中国实验方剂学杂志

Professor XUE Bo-shou，a master of traditional Chinese medicine（TCM），believes that coronavirus disease-2019 （COVID-19） belongs to the category of "cold epidemic" or "cold-dampness epidemic" in TCM theory. Cold-dampness obstructing the lungs is the key pathogenesis in the early stage of the disease. Exogenous pathogenic factors of cold and dampness are converted into heat in the interior. Over time，the pathogenesis is the disturbance in ascending and descending of Qi movement，loss of vital Qi， deficiency of both Qi and Yin，and even the occurrence of inner blocking causing Yang collapse. Professor XUE believes that the clinical syndrome differentiation and treatment shall be based on six meridians， and the efficacy could be improved by reference to classical prescriptions of plague in the past dynasties. To treat the disease in the early stage， the prescriptions emphasize on diffusing the lungs，inducing resuscitation and expelling pathogenic factors. He advocates the proper use of Ephedrae Herba， which can induce resuscitation of the lungs，diffuse the lungs and expel pathogenic factors，dissipate the interstitial depression and pathogenic factors in the lung interstitium. Therefore，it is considered that Ephedrae Herba is an effective medicine for diffusing the lungs，expelling pathogenic factors，inducing diuresis，eliminating dampness，promoting blood circulation and removing stasis due to cold coagulation. At the same time，the weakness of vital Qi is the root cause of the disease. The prosperity and decline of vital Qi plays a decisive role in the development， prognosis and efficacy of the disease. Professor XUE attaches importance to overall treatment，and emphasize the basis of pathogenesis， vital Qi， and stomach Qi. We shall expel pathogenic factors of disease，while protecting the vital Qi and stomach Qi. This article summarizes Professor XUE's diagnosis and treatment of COVID-19， enumerates and analyzes professor XUE's consultation cases of COVID-19 in designated hospitals in Linyi， Xinjiang and Beijing， in order to provide more ideas for the anti-epidemic effect of TCM.

Support vector machine based MRI radiomics to identify primary hepatic carcinomas with different pathological types / 中华放射学杂志

Objective To investigate the value of support vector machine based MRI-radiomics in the differential diagnosis of primary hepatic carcinomas (PHCs). Methods PHCs patients were retrospectively collected from July 2013 to February 2017 in the First Affiliated Hospital of Zhejiang University.All patients underwent unenhanced and enhanced MRI liver scan before surgery,and confirmed by pathology. A total of 294 PHCs patients (305 lesions), including 96 cases (97 lesions) of massive type cholangiocarcinoma (mCC), 107(107 lesions)of hepatocellular carcinoma (HCC), and 91 (101 lesions) of mixed hepatocellular and cholangiocellular carcinomas(HCC-CC).All patients underwent unenhanced and dynamic enhanced MRI liver scan including arterial, portal venous and equilibrium phases. Two hundred and three lesions (65 mCC, 71 HCC, 67 HCC-CC) were assigned into the training set, the remaining 102 lesions(32 mCC,36 HCC,34 HCC-CC)into the validation set,according to a ratio of 2:1.The entire lesions were delineated manually using a region of interest on equilibrium phase of enhanced MRI by using a home-made dedicated software(Analysis Kit,AK,General Electrics,US).Then the least absolute shrinkage and selection operator (LASSO) regression was used to select image features with a method of 10 fold cross-validation, and to reduce the dimensionality. The spearman method was used afterwards to condense the image features by removing redundant.A predictive model of diagnosing the different types of PHCs was established based on support vector machines(SVM),and the accuracy of applying the model in the data sets was used to evaluate the diagnostic efficacy of the model. Results A total of 280 quantitative imaging features were extracted in the training set.Thirty one imaging features were selected after LASSO regression and dimensionality reduction,and 21 features were remained after redundancy removing.The SVM showed the best generalization ability when the first 11 imaging features were used due to the Hughes effect.The 11 imaging features include 4 parameters of histogram,2 of textures,4 of gray-level co-occurrence matrix and 1 of gray-level run length matrix. A predictive model for PHCs was established after the study of the 11 imaging features and a regression analysis using SVM.The accuracy of the predictive model was 80.3% (163/203) in differentiating PHCs in the training set. The accuracy of the model was 75.5% (77/102) after applying it in the validation set. The diagnostic accuracy for HCC-CC, HCC and mCC was 85.3% (29/34), 77.8% (28/36) and 62.5% (20/32), respectively, in the validation set. For HCC-CC, 3 cases were misdiagnosed as mCC and 2 cases as HCC.For HCC,3 cases were misdiagnosed as HCC-CC and 5 cases as mCC.For mCC,9 cases were misdiagnosed as HCC-CC and 3 cases as HCC.The model showed the highest accuracy in predicting HCC-CC.Conclusion Radiomics method based on SVM may have a high accuracy in predicting different pathologic types of PHC,with the highest accuracy for HCC-CC.

Expression of plasma miRNA-21 and miRNA-200b in epithelial ovarian cancer and its clinical significance / 中国免疫学杂志

Objective:To investigate the expression and clinical significance of plasma microRNA-21 (miRNA-21) and microRNA-200b (miRNA-200b) in epithelial ovarian cancer (EOC).Methods:The levels of plasma miRNA-200b,miRNA-21 and CA125 were detected by RT-PCR in 162 patients with EOC,120 patients with benign epithelial ovarian tumors(benign group) and 108 healthy women(control group),analyze the relation between miRNA-200b and miRNA-21 expression and clinicopathological features of EOC.The sensitivity and specificity of miRNA-200b,miRNA-21 and CA125 to EOC diagnosis were evaluated by ROC curve,and the re-lationship between three indexes and EOC was analyzed by multivariate Logistic regression model.Correlation analysis of plasma miRNA-200b and miRNA-21,CA125 in patients with EOC by Pearson correlation.Results:The levels of plasma miRNA-200b,miRNA-21 and CA125 in EOC group were significantly higher than those in benign group and control group[miRNA-200b(2-ΔΔCt):3.52±1.03 vs 1.26±0.37 and 1.15±0.34;miRNA-21(2-ΔΔCt):2.32±0.45 vs 1.18±0.32 and 1.04±0.28;CA125(U/ml):78.64±30.57 vs 26.27±11.36 and 21.53±9.45,all P<0.01].Plasma miRNA-200b,miRNA-21,CA125 and three combined diagnosis EOC of AUC (95% CI) were 0.896(0.834-0.958),0.792(0.731-0.847),0.908(0.841-0.973),0.947(0.883-0.995),the optimal cut-off values were 2.08,1.46,52.84 U/ml.Logistic regression analysis showed that elevated plasma levels of miRNA-200b,miRNA-21 and CA125 were independent risk factors for EOC[OR(95% CI)= 2.518(1.563-3.547),OR(95% CI)= 1.724(1.103-2.528),OR (95% CI)=2.316(1.347-3.419)].The correlation between plasma miRNA-200b and CA125 in patients with EOC was the best(r=0.702,P<0.01).Conclusion:Plasma miRNA-200b and miRNA-21 can be used as molecular markers for the early diagnosis of EOC, and their diagnostic efficacy is comparable to that of CA125.The combined use of the three methods is expected to improve the accuracy of early diagnosis of EOC.

Surgical treatment for incisions fat colliquation or infections at early stage after operation of lumbar disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the reason, key diagnosic point and therapeutic method of the incisions fat colliquation or infections at early stage after operation of lumbar disc herniation.</p><p><b>METHODS</b>From July 2007 to May 2012, clinical data of 11 patients with incision fat liquefaction or early infection after lumbar discectomy were retrospectively analyzed. There were 5 males and 6 females with an average age of 43.1 years, and the mean time of incisions fat colliquation or infection was 5 days and a half after operation. The main clinical features included local wound pain aggravating, fervescence, fresh seepage in the wound, and blood inflammatory index increased, etc. The wound could heal at the first treatment stage or not was an evaluation standard of curative effect.</p><p><b>RESULTS</b>All patients were followed up with an average period of 21 months. The wounds of 10 cases healed at the first stage without recurrence and complications. In 1 case infected by staphylococcus aureus, distal part of the wound present local red, swelling and with wave motion at 2 months after operation, staphylococcus aureus infection was confirmed after puncture and bacterial culture, and 1 thrum was found after local incision. The wound healed after change dressings for 1 week, without recurrence after followed up for 13 months.</p><p><b>CONCLUSION</b>Preventing the risk factors before operation, minimizing invasive technique during operation reasonable antibiotics application for the lumbar operation reguiring placement objects, and correctly handling with wound after operation could prevent and reduce the incidence of incisions fat liquefaction or infection after operation of lumbar disc herniation. For incision fat liquefaction or infection, early diagnosis, debridement, VSD negative pressure irrigation and drainage, to choosing sensitive antibiotics according to the results of drug sensitivity, may contribute to wound early healing and decrease complication.</p>

Arthroscopic treatment of symptomatic anterior cruciate ligament cysts of the knee / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical symptom and effect of arthroscopic treatment of symptomatic anterior cruciate ligament (ACL) cysts of the knee.</p><p><b>METHODS</b>Clinical data from 12 symptomatic ACL cysts patients from January 2005 to December 2010 were retrospectively analyzed,including 8 males and 4 females,with an average age of (33.7±9.5) years old (ranged, 19 to 53 years old). The locations were the left knee in 5 cases and the right knee in 7 cases. The disease duration ranged from 3 to 48 months,with a mean of (15.8±13.2) months. All cysts were arthroscopically resected. Range of motion was measured preoperatively and postoperatively, and Lysholm scoring system was used to evaluate the knee function.</p><p><b>RESULTS</b>All the incisions healed by first intention, and no complications occurred. Twelve patients were followed up for an average of (32.3±6.6) months(ranged, 24 to 48 months). The symptoms of arthralgia,swelling and interlocking of the affected knees disappeared. There was no recurrence during the follow-up. There were significant differences in the range of motion and Lysholm score between pre-operation and post-operation.</p><p><b>CONCLUSION</b>Arthroscopic surgery, showing its advantages of minimal invasion and rapid recovery,is an effective measure in the treatment of ACL cysts.</p>

Prevention of pretreatment with low-dose ketamine on shivering during cesarean section under subarachnoid space and epidural anesthesia / 中国医师进修杂志

Objective To explore the efficacy and safety of low-dose ketamine for prevention of shivering during cesarean section under subarachnoid space and epidural anesthesia.Methods Ninety pregnant women who scheduled cesarean delivery under subarachnoid space and epidural anesthesia were randomized divided into three groups:control group (30 patients) low-dose ketamine group (30 patients) and high-dose ketamine group (30 patients).0.9％ sodium chloride,0.25 mg/kg(3 ml),and 0.50 mg/kg (3 ml) ketamine were given in three groups before operation.The incidence of shivering and adverse effect were recorded respectively before anesthesia,after anesthesia 15 min and 30 min and after operation 1 h.Results The level of mean arterial pressure (MAP) in control group after anesthesia 15 main and 30 min and after operation 1 h[(62 ± 10),(58 ± 8),(61 ± 11) mm Hg(1 mm Hg =0.133 kPa)] were significantly lower than those in high-dose ketamine group [(78 ± 12),(82 ± 8),(76 ± 11)mm Hg] and low-dose ketamine group [(72 ± 10),(76 ± 6),(80 ± 7) mm Hg],there was significant difference (P ＜ 0.05).There was no shivering need treat in low-dose ketamine group and high-dose ketamine group.The rate of hallucinations and nystagmus in low-dose ketamine group [0,6.7％ (2/30)] was significantly lower than that in high-dose ketamine group [20.0％ (6/30),50.0％ (15/30)],there was significant difference (P ＜ 0.05).Conclusion The pretreatment with low-dose ketamine on shivering during cesarean section under subarachnoid space and epidural anesthesia has better preventive effectiveness,0.25 mg/kg of ketamine is more effective than 0.50mg/kg.

Effects of penehyclidine hydrochloride postconditioning on hind limb ischemia-reperfution injury in rats / 中华麻醉学杂志

Objective To investigate the effects of penehyclldine hydrochloride postconditioning on hind limb ischemia-reperfusion (I/R) injury in rats. Methods One hundred and forty-four male Wistar rats weighing 220-250 g were randomly divided into 4 groups (n = 36 each): control group (group C), I/R group, ischemic postconditioning group (group IPO) and penehyclidine hydrochloride postconditioning group (group PHPO). Limb ischemia was induced by occlusion of bilateral hind limb for 3 h followed by 24 h reperfusion. In group IPO, the animals were subjected to three cycles of 30 s reperfusion and 30 s ischemia on the proximal part of the hind limb,while in group PHPO, the animals received iv injection of penehyclidine hydrochloride 0.15 mg/kg (in normal saline 1 wl) via the caudal vein immediately after reperfusion. Blood samples from the inferior vena cava were taken for determination of activities of serum LDH and CK and concentrations of TNF-α and IL-10 at O, 1, 3, 6, 12 and 24 h of reperfusion. Then 6 rats were sacrificed at each time point respectively and the quadriceps femoris tissues of the hind limb were removed for determination of MDA content, activities of SOD, MPO, Na+ -K+-ATPase and Ca2 + - Mg2+ -ATPase, and HIF- 1 α expression and microscropic examination. Results Compared with group C, the activities of serum LDH and CK and concentrations of TNF-α and IL-10 were significantly increased, the activities of SOD, Na+-K+-ATPase and Ca2+-Mg2+-ATPase were decreased, MPO activities and MDA content were increased, HIF-1α expression was up-regulated in group I/R, IPO and PHPO (P ＜0.05 or 0.01). Compared with group I/R, the serum activities of serum LDH and CK and TNF-α concentration were significantly decreased, IL- 10concentration was increased, activities of SOD, Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase were increased, and MPO activity and MDA content were decreased, HIF-1α expression was down-regulated (P ＜ 0.01), and the pathologic changes was reduced in group IPO and PHPO. Compared with group IPO, the serum LDH activity and TNF-α concentration were significantly decreased, CK activity and IL-10 concentration were increased, activities of SOD and MPO and MDA content were decreased and HIF-1α expression was down-regulated (P ＜ 0.05 or 0.01).Conclusion Penehyclidine hydrochloride postconditioning can reduce hind limb I/R injury in rats, and the mechanism is related to inhibiting inflammatory response and lipid peroxidation, reducing calcium overload and improving cellular energy metabolism.

Prevalence and clinical significance of FLT3 mutations in acute promyelocytic leukemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the prevalence of Fms-Like tyrosine kinase 3 (FLT3) mutations including internal tandem duplication (ITD) of juxtamembrane region and point mutation in the second tyrosine kinase domain (TKD) in acute promyelocytic leukemia (APL) and its clinical significance.</p><p><b>METHODS</b>Bone marrow mononuclear cells from 160 newly diagnosed APL patients were analyzed. Polymerase chain reaction (PCR) was used to detect FLT3-ITD mutations, FLT3-ITD positive samples were further analyzed for the ITD allelic ratio (ITD-AR, mutant-wild type ratio). The FLT3-TKD mutation was analyzed by PCR amplification of exon 20 followed by EcoR V digestion and sequencing.</p><p><b>RESULTS</b>Out of 160 patients, 30 (18.75%) patients were FLT3-ITD positive, 17 (10.62%) were FLT3-TKD positive, 2 had both of mutations. The initial WBC count and the ratio of short type PML-RAR alpha isoforms in FLT3-ITD positive and FLT3-TKD positive patients were all higher than that in patients with wild-type FLT3 (FLT3-wt) (P < 0.05). For FLT3-ITD positive patients, the incidences of retinoic acid syndrome (RAS) and disseminated intravascular coagulation (DIC) were 41.7% and 65.4%, respectively, being higher than that of FLT3-wt patients, while their complete remission (CR) rate was lower (69.2% vs 90.3%, P < 0.05). For FLT3-TKD positive patients, the incidence of RAS, DIC and CR rate were not significantly different from that of FLT3-wt patients (P > 0.05). FLT3-ITD positive patients had a shorter overall survival (OS) (P < 0.05), but not disease-free survival (DFS) (P > 0.05) as compared with FLT3-wt patients. There was no significant difference in either OS or DFS between FLT3-TKD positive and FLT3-wt patients. The ITD-AR of 30 FLT3-ITD positive patients varied from 0.11 to 6.55 with a median of 1.0. The initial WBC count, incidence of RAS and DIC, CR rate were not significantly different between the patients with ITD-AR greater than 1.0 and lower than 1.0 (P > 0.05).</p><p><b>CONCLUSIONS</b>FLT3 mutations (FLT3-ITD or FLT3-TKD) are frequently identified in patients with newly diagnosed APL, both mutations are associated with higher initial WBC and short type PML-RAR alpha isoforms. FLT3-ITD mutation is more frequent than FLT3-TKD mutation, and predicts a poorer prognosis, whereas FLT3-TKD mutation does not show the same unfavorable prognostic effect on APL patients.</p>