Reactivation of PPARα alleviates myocardial lipid accumulation and cardiac dysfunction by improving fatty acid β-oxidation in Dsg2-deficient arrhythmogenic cardiomyopathy

Arrhythmogenic cardiomyopathy (ACM), a fatal heart disease characterized by fibroadipocytic replacement of cardiac myocytes, accounts for 20% of sudden cardiac death and lacks effective treatment. It is often caused by mutations in desmosome proteins, with Desmoglein-2 (DSG2) mutations as a common etiology. However, the mechanism underlying the accumulation of fibrofatty in ACM remains unknown, which impedes the development of curative treatment. Here we investigated the fat accumulation and the underlying mechanism in a mouse model of ACM induced by cardiac-specific knockout of Dsg2 (CS-Dsg2 -/-). Heart failure and cardiac lipid accumulation were observed in CS-Dsg2 -/- mice. We demonstrated that these phenotypes were caused by decline of fatty acid (FA) β-oxidation resulted from impaired mammalian target of rapamycin (mTOR) signaling. Rapamycin worsened while overexpression of mTOR and 4EBP1 rescued the FA β-oxidation pathway in CS-Dsg2 -/- mice. Reactivation of PPARα by fenofibrate or AAV9-Pparα significantly alleviated the lipid accumulation and restored cardiac function. Our results suggest that impaired mTOR-4EBP1-PPARα-dependent FA β-oxidation contributes to myocardial lipid accumulation in ACM and PPARα may be a potential target for curative treatment of ACM.

Analysis of risk factors associated with protein-energy wasting in elderly hemodialysis and peritoneal dialysis patients / 中华老年医学杂志

Objective:To analyze the risk factors for protein-energy wasting(PEW)in elderly patients undergoing hemodialysis(HD)and peritoneal dialysis(PD), in order to provide evidence for the prevention of PEW and improve the prognosis in these patients.Methods:According to the diagnostic criteria for PEW proposed by the International Society for Renal Nutrition and Metabolism, 112 elderly patients who had undergone PD and HD without PEW from May 2016 to June 2020 in the renal medicine department of the Eighth People's Hospital of Shanghai, the geriatric medicine department of Zhongshan Hospital Affiliated to Fudan University and the renal medicine department of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were included as the non-PEW group.During the same period, 114 cases with PEW were recruited as the PEW group.Differences in general patient data, biochemical test values, anthropometric measurements, bioelectrical impedance and other index values were compared between the two groups.Independent risk factors for PEW in elderly HD and PD patients were analyzed by using binary Logistic regression analysis.Results:Compared with the non-PEW group, the PEW group had a higher mean age( t=0.951, P<0.001), a higher proportion of patients aged ≥65 years( χ2=17.161, P<0.001), a lower body mass index( t=6.740, P<0.001), a higher incidence of diabetic nephropathy( χ2=14.176, P<0.001), a higher hemodialysis rate( χ2=4.543, P=0.033), and a longer duration(months)of dialysis( t=2.306, P=0.023). Levels of serum transferrin, prealbumin, total protein, hemoglobin and total cholesterol and body cell mass index were lower( t=6.262, 13.405, 9.507, 8.341, 4.610, 5.599 and 2.499, all P<0.05), high-sensitivity C-reactive protein levels and the body water percentage were higher( t=6.380, 4.519, both P<0.001), and the upper arm muscle circumference was smaller( t=5.418, P=0.000)in the PEW group than in the non-PEW group.Binary Logistic regression analysis showed that age≥65 years, dialysis duration, serum albumin and high-sensitivity C-reactive protein levels were independent influencing factors for PEW in elderly HD patients( OR=2.762, 0.182, 2.694 and 2.980, P=0.023, 0.007, 0.009 and 0.027). Age ≥65 years, body mass index and the hemoglobin level were independent influencing factors for PEW in elderly PD patients( OR=2.452, 0.671 and 0.962, P=0.013, 0.000 and 0.000). Conclusions:The incidence of PEW is lower in elderly HD patients than in elderly PD patients.Clinical intervention should be carried out based on influencing factors, in order to prevent the occurrence of PEW.

Expression of Heat Shock Protein 105b in Adenocarcinoma of Esophagogastric Junction and Its Relation with Effect of Hyperthermic Intraperitoneal Chemotherapy / 肿瘤防治研究

Objective To explore the expression of heat shock protein (HSP) 105b in advanced adenocarcinoma of esophagogastric junction (AEG) patients and its relation with clinicopathological characteristics and effect of hyperthermic intraperitoneal chemotherapy (HIPEC). Methods We randomly divided 166 cases of advanced AEG who underwent open radical gastrectomy and lymphadenectomy D2 compartment into treatment group (prophylactic HIPEC of paclitaxel after operation) and control group (conventional treatment). Immunohistochemistry was used to detect HSP105b expression in postoperative tumor tissues, and to analyze its relation with clinicopathological characteristics and effect of HIPEC. Results The expression of HSP105b was only associated with tumor vein infiltration (t=4.002, P=0.045). The 3-year disease-free survival rate of the patients with high HSP105b expression was significantly lower than those with low HSP105b expression (56.5% vs. 64.8%, χ2=35.508, P < 0.001), and the disease-free survival rate of the patients with high HSP105b expression in treatment group was significantly lower than that with low HSP105b expression (60.7% vs. 71.5%, χ2=77.459, P < 0.001). Conclusion HSP105b can be used as a prognostic factor and its expression can predict the efficacy of HIPEC in the patients with advanced AEG.

The risk factors of severe birth defects and mild birth defects of Guangdong province / 中国基层医药

Objective To find out and compare the risk factors of the severe birth defects and mild birth defects,and make it more effective to prevent the severe birth defects.Methods Fetus diagnosed with severe birth defects in Shunde district,Foshan during 2016 were selected as case group 1,those who diagnosed with moderate/mild birth defects were selected as case group 2,and those healthy infants whose mother's last menstrual period was at the same time with the case groups were selected as control group.Their mothers' relative information was collected.A case-control study was conducted to analyze the risk factors of the two case groups respectively.We applied Chi-square analysis and multivariate Logistic regressions to find out the independent risk factors.Results Chi-square analysis showed that maternal age above 35 years(χ2=19.69,P<0.01) and gravidity 3 times or more(χ2=10.06,P<0.01) were the risk factors of severe birth defects,and twins was the risk factor of mild birth defects(χ2=4.05,P<0.05).The multivariate Logistic regressions showed that maternal age above 35 years was the independent risk factor of severe birth defects(OR=2.75,P<0.001),and twins was the independent risk factor of mild birth defects(OR=2.22,P=0.05).Conclusion The women with age above 35 years have higher risk to pregnant a baby with severe birth defects and they are worthy of more attention during pre-pregnancy and antenatal examinations.

Expression and its clinical significance of gastric and intestinal phenotypic markers in 47 Siewert type Ⅱ and type Ⅲ early gastroesophageal junctional cancers / 中华消化杂志

Objective To investigate the expression of gastric and intestinal phenotypic markers in Siewert typeⅡand Ⅲ early gastroesophageal junction(GEJ) cancer, and to explore its correlation with clinic-pathological features.Methods From April 2010 to July 2015, 53 cases diagnosed as early GEJ cancer were enrolled.The gastric and intestinal phenotypic markers such as mucin5AC(MUC5AC),mucin6(MUC6),mucin2(MUC2),caudal related homeodomain transcription 2(CDX2) and cluster of differentiation 10(CD10) were detected, and then the patients were divided into gastric type, gastrointestinal type, intestinal type and non-classified type according to the results of immunohistochemical staining.Combined with Siewert classification the clinicopathological features were analyzed.Chi square test or Fisher′s exact test was performed for statistical analysis.Results In the cancer tissues of 47 patients with Siewert type Ⅱand Ⅲ early GEJ cancer, the case numbers of positive expression of MUC5AC,MUC6,MUC2, CDX2 and CD10 were 21(44.7%),19(40.4%),31(66.0%),27(57.4%) and 17(36.2%),respectively;the case numbers of gastric type, gastrointestinal type, intestinal type and non-classified type were 11(23.4%),14(29.8%),21(44.7%) and one(2.1%), respectively.The positive expression rates of MUC5AC and MUC6 in Siewert typeⅡwere 55.9%(19/34) and 50.0%(17/34),which were higher than those of Siewert typeⅢ(2/13), and the positive expression rate of MUC2 was 55.9%(19/34), which was lower than that of Siewert typeⅢ(12/13), and the differences were statistically significant (x2=6.240,4.679 and 4.053;all P<0.05).In Siewert typeⅡ, the proportion of intestinal type was 32.4%(11/34), which was lower than that of Siewert typeⅢ(10/13), and the differences were statistically significant (x2=7.142,P=0.010).In patients with Siewert typeⅡand Ⅲ early cancer, males predominated in intestinal type which were mostly well differentiated type with less submucosal carcinoma.The maximum diameter of tumor was less than those of gastric type and gastrointestinal type.In paracancerous mucosal tissues, the incidences of intestinal metaplasia in gastrointestinal type and intestinal type were 11/14 and 81.0%(17/21), which were higher than that of gastric type (3/11);the incidences of atrophy in gastrointestinal type and intestinal type were 12/14 and 85.7%(18/21),which were higher than that of gastric type (4/11),and the differences were statistically significant (Fisher′s exact test,all P<0.05).Conclusions Siewert typeⅡand Ⅲ early GEJ cancer can directly originated not only from gastric mucosa, but also from gastrointestinal and intestinal mucosa.Atrophy and intestinal metaplasia could exist before cancer genesis.

A randomized controlled trial of improvement of endoscopic visibility in the upper gastrointestinal tract with N-acetylcysteine / 中华消化内镜杂志

Objective To determine the effects and dosage of N?acetylcysteine( NAC) in the im?provement of the visibility in esophagogastroduodenoscopy( EGD) . Methods A prospective randomized con?trolled study was performed on 193 patients scheduled for EGD from November 2014 to July 2015 were ran?domized into five groups using digital table. In group A, 100 mg dimethicone and 2 g NaHCO3 were given. In group B,100 mg dimethicone, 2 g NaHCO3 and 20 000 U pronase were given. Group C received 100 mg dimethicone, 2 g NaHCO3 and 200 mg NAC. Group D received 100 mg dimethicone, 2 g NaHCO3 and 400 mg NAC and group E 100 mg dimethicone, 2 g NaHCO3 and 600 mg NAC.The agents were dissolved in 100 ml water for each patient.Endoscopy was completed by one endoscopist and the score of image visibility assessment was completed by 2 other endoscopists. The 3 endoscopists were unaware of grouping. The total scores, the time of washing, the time of examination and complications were compared and analysed. The total image scores of group A, B, C,D and E were 30?83±3?78, 35?69±2?88, 33?16±3?90, 34?95±3?46 and 36?76±2?91, respectively. Group A was the lowest(P0?05).Images that were scored 3 were the most in group E.The washing times of each group were 38?00±19?10, 17?03±11?44, 15?92±10?81, 15?78 ±10?24 and 15?55±9?69, and the examination times of each group were 13?49±2?49, 9?41±1?86, 9?08± 1?80, 8?73±1?91 and 8?78±1?79 minutes.Group A was the longest in these two indices(P0?05) . Conclusion The preoperative NAC can improve the visibility in EGD. The best dose is 600 mg, whose effects and safety were similar to those of 20 000 U, but yield to less washing time and the examination time in EGD.

Retrospective Analysis on Implement Effect of Traditional Chinese Medicine Clinical Pathway for Wind-warm Lung-heat Disease (Non-severe Community-acquired Pneumonia) / 世界科学技术-中医药现代化

This study was aimed to evaluate the feasibility of wind-warm lung-heat disease (non-severe community-acquired pneumonia, CAP) from the clinical curative effect, hospitalization days, medical expenses and other aspects. This study selected 198 wind-warm lung-heat disease (non-severe CAP) inpatients from January, 2012 to December, 2012 with the conventional therapy in the Respiratory Department, Wuhan Integrated Traditional Chinese Medicine (TCM) & Western Medicine Hospital as the control group. And another 179 wind-warm lung-heat disease (non-severe CAP) inpatients were selected from January, 2013 to December, 2013 with the TCM clinical pathway treatment in the Respiratory Department of the same hospital as the treatment group. Retrospective analysis was used to compare the clinical curative effects, hospitalization days, and medical cost differences. The results showed that TCM clinical pathway for wind-warm lung-heat disease (non-severe CAP) can shorten the hospitalization days and reduce patients’ medical costs, and ensure the clinical curative effects. It was concluded that the standardized TCM clinical pathway had positive effect on wind-warm lung-heat disease (non-severe CAP). Therefore, the formulation and implementation of TCM clinical pathway was of great significance in the treatment of wind-warm lung-heat disease (non-severe CAP).

Effects of dietary interventionversus metformin treatment on retinol binding protein 4 expressions in rats with non-alcoholic fatty liver disease / 中国组织工程研究

BACKGROUND:Conflicting data have been reported regarding the expression of retinol-binding protein 4 in non-alcoholic fatty liver disease. OBJECTIVE:To evaluate the impact of dietary interventionversus metformin treatment on expression of retinol-binding protein 4 in rats with non-alcoholic fatty liver disease. METHODS: Fifty male Sprague-Dawley rats were randomized to six groups, including two normal control groups (rats were kiled after 8 and 16 weeks of normal diet), two HFD groups (rats were kiled after 8 and 16 weeks of high-fat diet), one dietary intervention group (rats were kiled after 8 weeks of high-fat diet and 8 weeks of normal diet) and one metformin treatment group (rats were kiled after 8 weeks of high-fat diet and 8 weeks of high-fat diet and metformin treatment). The levels of retinol-binding protein 4 in serum and biochemical indexes were detected through enzyme-linked immunosorbent assay. The expression of retinol-binding protein 4 mRNA in liver tissues was measuredvia western blot analysis, immunohistochemistry and RT-PCR. RESULTS AND CONCLUSION:Non-alcoholic fatty liver disease models were successfuly established by high-fat diet. Liver tissues of high-fat diet fed rats showed progressing non-alcoholic fatty liver disease histology, from non-alcoholic fatty liver to non-alcoholic steatohepatitis. Dietary intervention increased retinol-binding protein 4 expression in liver tissue as wel as improving liver enzyme, dyslipidemia and insulin resistance, and aleviated impaired liver histology. Metformin treatment only aleviated hepatic steatosis caused by high-fat diet. The results indicated that retinol-binding protein 4 expression might play a role in the pathogenesis of non-alcoholic fatty liver disease. Metformin treatment can aleviate non-alcoholic fatty liver disease histology,dietary intervention should be the fundamental treatment.

Role of nursing classification and marking management in ICU nursing management / 现代临床护理

Objective To probe into the role of nursing classification and marking management in ICU nursing management. Methods According to the admission date,the first 87 patients hospitalized in our department were assigned into the control group and another 84 into the intervention group.Then the human resources were divided based on the ABCD nursing classification and marking management for ICU.The two groups were compared in terms of adverse events.Results The incidences of pressure sores, non-planned extubation,improper clinostatism for using respirator,hypoglucycaemia during reinforced treatment with insulin, respirator-associated pulmonary pneumonia,tube-associated infection,and multidrug resistant bacteria in the intervention group were all significantly lower than those in the control group (allP<0.05).Conclusion The nursing classification and marking management for ICU nursing management can enhance the nursing quality.

The analysis of the sacroiliac joint CT examination in the detection rate and missed diagnosis of sacral canal cyst / 中国医师进修杂志

Objective To investigate the detection rate and missed diagnosis reason of sacral canal cyst with sacroiliac joint CT scan.Methods Retrospectively analyzed the changes of sacral canal in 1 286 cases with sacroiliac joint CT scan.CT scanning included bone algorithm reconstruction and standard algorithm reconstruction.Results Among 1 025 patients who had negative sacroiliac joint CT scan were found in 36 cases of sacral canal cyst,the detection rate was 3.5％ (36/1 025).Single cyst in 34 cases and multiple cysts in 2 cases.Cyst in S1 level 5 cases,S1-2 level 4 cases,S2 level 22 cases,S2-3 level 4 cases,S3 level 3 cases.The minimal short diameter of the cysts was 0.5 cm and the maximal diameter was 3.2 cm,average 1.2 cm.CT scan showed a round uniform cystic low density,and combined with sacral canal expansion in 19 cases.CT scan used bone algorithm reconstruction in 29 cases,used standard and bone algorithm reconstruction in 7 cases.Clinical findings and correctly diagnosed in 11 cases,accounted for 30.6％ (11/36),about 69.4％ (25/36) cases were missed diagnosis.Conclusions About 3.5％ patients are found sacral canal cyst who have negative sacroiliac joint CT scan.Both the standard and bone algorithm reconstruction should be used to avoid the missed diagnosis of sacral canal cyst.

Investigation on the influencing factors of perioperative patients with mania / 中国基层医药

ObjectiveTo discuss the mental state and its influencing factors of perioperative patients with mania.Methods 40 perioperative mania patients were investigated with Bech-Rafaelsdn Mania Rating Scale (BRMS) and Life Event Scale(LES) ,assisted with self-designed influential factors to survey the correlation factors.ResultsThe perioperative patients were interestd in therapeutic correlation question preoperative and worry about their recovery after operation.The worry showed that operations was mental work load and psycho-burden to the patients.Perioperative patients' mental activities were main of perceptual insecurity.The psycho-feature must influence the compliance of mania patients' therapy and nursing.What follows next is the quality of therapy and nursing.ConclusionThe main problem to be solved is intervention the tension, anxiety, scare psychology of the patients in perioperative.At the same time it must be strengthened to talk to the family member of the patients knowledge about the disease and its recovery.

Clinical analysis of risk factors of acute kidney injury in patients with chronic kidney disease / 中国医师进修杂志

Objective To evaluate the risk factors of patients with acute kidney injury (AKI) in patients with chronic kidney disease (CKD) for the early detection and early treatment of CKD.Methods One hundred and twenty-seven CKD patients were divided into groups according to AKI existing, 60 cases with out AKI (CKD group), 67 cases with AKI (A/C group) and then A/C group patients were divided into non-older age group (35 cases, ＜60 years old) and older age group (32 cases, ≥60 years old).The protopathy, causative factors and so on were analyzed.Results There was different causative factors in different age group.Logistic regression model indicated that the major risk flactors of AKI in CKD were severe infection (OR = 5.236),hypovolemia (OR = 5.083 ),heart failure (OR = 8.283) and using renal toxicity medicine (OR = 5.246),P ＜ 0.05.Conclusion The major risk factors of AKI in CKD patients include severe infection, hypovolemia, heart failure and renal toxicity medicine.

Aspirin can reduce serum C reactive protein level in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To identify the efficacy and safety of aspirin in reducing the serum high sensitivity C reactive protein(hsCRP)level and preventing the internal arteriovenous fistulas(AVF)embolism in maintenance hemodialysis patients. Methods One hundred and ten hemodialysis patients using AVF more than 3 months were randomly divided into 2 groups,the intervention group(n=55,received aspirin 100 mg/d)and the control group(n=55).Examinations were performed at baseline and 6-month after treatment.Serum hsCRP level,platelet aggregates ratio(PAR),coagulation and inflammation indicators were measured.AVF embolism and the adverse events were monitored. Results Six months later.PAR and hsCRP level of the intervention group patients aged≤60 years decreased significantly [(68.14±8.45)%vs (82.37±9.12)%;(4.79±4.81)mg/L vs(6.94±10.26)mg/L,all P＜0.05],and were significantly lower as compared to.the control group[(68.14±8.45)%vs(74.7±11.50)%,(4.79±4.81)mg/L vs(5.12±9.25)mg/L,all P＜0.05].There were 2 cases of AVF embolism occured in both groups,which showed no statistical difierence (P=0.676).The incidence of adverse effeets was higher in the intervention group than that in the control group but no statistical significance was found (20.0%vs 7.2%,P=0.052),while the mortality rate had no difference between 2 groups (3.6%vs 0,P=0.495).Conclusion Use of aspirin 100 mg/d for 6 months can significantly reduce the serum hsCRP level and PAR in hemodialysis patients under 60-year-old without serious adverse reactions.

Grading of cerebral glioma with susceptibility weighted imaging evaluation of bleeding / 中国医学影像技术

Objective To explore the relationship between the amount of bleeding and the histopathologic grade of cerebral glioma with susceptibility weighted imaging (SWI), so that to assess the diagnostic value of SWI in grading cerebral glioma. Methods Totally 30 patients with cerebral glioma underwent SWI. The area of hemorrhage of every slice displayed in SWI was measured with software. The rate and amount of bleeding were compared between high and low grade tumors. Results There was no statistical significance in the incidence of detected bleeding on SWI (P=0.064), though it was higher in highly malignant group (80.00%) than that in low grade group (46.67%), while there was statistical significance in the amount of bleeding detected on SWI (Z=-2.275, P=0.026) between highly malignant group and low grade group. Conclusion The amount of tumor hemorrhage displayed in SWI is valuable for the preoperative grading of cerebral glioma.

High CD11b expression on monocyte and neutrophile granulocyte correlates with type 2 diabetes mellitus complicated with macroangiopathy / 中华内分泌代谢杂志

The expression of CD11b on monocytes and neutrophils were measured by direct immunofluorescence techiques and flow cytometry in controls and type 2 diabetic patients.CD11b expression on monocyte and neutrophil in diabetic patients with macroangiopathy was higher than that in cases without macroangiopathy [3.85±1.46 vs 2.88±0.92,6.36 (4.58-9.79) vs 4.23 (3.70-4.83),both P<0.01].Monocyte CD11b and neutrophil CD11b might be independent risk factors of macroangiopathy in type 2 diabetes mellitus.

Assessment of ascending aortic elasticity in hypertension patients by quantitative tissue velocity imaging / 华中科技大学学报（医学）（英德文版）

The elasticity of the ascending aorta in healthy volunteers and hypertension patients were examined by using quantitative tissue velocity imaging (QTVI), and the age-related change in the ascending aortic elasticity was investigated. The anterior and posterior walls of the ascending aorta were imaged with tissue Doppler method in all the subjects and QTVI was performed. Stable curves were obtained from 173 hypertension patients and 185 healthy adults. The peak early diastolic velocity (V(e)), peak late diastolic velocity (V(a)) and peak systolic velocity (V(s)) were measured. The relation of age with these measures was assessed. The results showed that the elasticity of the ascending aorta was much lower in the hypertension patients than in normal controls (P<0.05), and the elasticity was decreased with age in both groups (P<0.05). Our results suggested that QTVI, a new non-invasive ultrasonic technique, is helpful for the assessment of the aortic elasticity in hypertension patients.