Small Molecules Accelerate Skin Wound Healing: Shikonin Efficacy and Mechanism of Action in Mice / Las Moléculas Pequeñas Aceleran la Curación de Heridas en la Piel: Eficacia de Shikonin y Mecanismo de Acción en Ratones

SUMMARY: The objective of this study was to investigate the therapeutic wound healing potential and molecular mechanisms of shikonin as small molecules in vitro. A mouse burn model was used to explore the potential therapeutic effect of shikonin; we traced proliferating cells in vivo to locate the active area of skin cell proliferation. Through the results of conventional pathological staining, we found that shikonin has a good effect on the treatment of burned skin and promoted the normal distribution of skin keratin at the damaged site. At the same time, shikonin also promoted the proliferation of skin cells at the damaged site; importantly, we found a significant increase in the number of fibroblasts at the damaged site treated with shikonin. Most importantly, shikonin promotes fibroblasts to repair skin wounds by regulating the PI3K/AKT signaling pathway. This study shows that shikonin can effectively promote the proliferation of skin cell, and local injection of fibroblasts in burned skin can play a certain therapeutic role.

El objetivo de este trabajo fue investigar el potencial terapéutico de cicatrización de heridas y los mecanismos moleculares de la shikonina como moléculas pequeñas in vitro. Se utilizó un modelo de quemaduras en ratones para explorar el posible efecto terapéutico de la shikonina; Rastreamos las células en proliferación in vivo para localizar el área activa de proliferación de células de la piel. A través de los resultados de la tinción para patología convencional, encontramos que la shikonina tiene un buen efecto en el tratamiento de la piel quemada y promueve la distribución normal de la queratina de la piel en el sitio dañado. Al mismo tiempo, la shikonina también promovió la proliferación de células de la piel en el sitio dañado. Es importante destacar que encontramos un aumento significativo en la cantidad de fibroblastos en el sitio dañado tratado con shikonina. Lo más importante es que la shikonina promueve la función reparadora de fibroblastos en las heridas de la piel regulando la vía de señalización PI3K/ AKT. Este estudio muestra que la shikonina puede promover eficazmente la proliferación de células de la piel y que la inyección local de fibroblastos en la piel quemada puede desempeñar un cierto papel terapéutico.

EPCs-exos combined with tanshinone Ⅱ_A protect vascular endothelium cells from oxidative damage via PI3K/Akt pathway / 中国中药杂志

This study aims to investigate the molecular mechanism of tanshinone Ⅱ_(A )(TaⅡ_A) combined with endothelial progenitor cells-derived exosomes(EPCs-exos) in protecting the aortic vascular endothelial cells(AVECs) from oxidative damage via the phosphatidylinositol 3 kinase(PI3K)/protein kinase B(Akt) pathway. The AVECs induced by 1-palmitoyl-2-(5'-oxovaleroyl)-sn-glycero-3-phosphocholine(POVPC) were randomly divided into model, TaⅡ_A, EPCs-exos, and TaⅡ_A+EPCs-exos groups, and the normal cells were taken as the control group. The cell counting kit-8(CCK-8) was used to examine the cell proliferation. The lactate dehydrogenase(LDH) cytotoxicity assay kit, Matrigel assay, DCFH-DA fluorescent probe, and laser confocal microscopy were employed to examine the LDH release, tube-forming ability, cellular reactive oxygen species(ROS) level, and endothelial cell skeleton morphology, respectively. The enzyme-linked immunosorbent assay was employed to measure the expression of interleukin(IL)-1β, IL-6, and tumor necrosis factor(TNF)-α. Real-time fluorescence quantitative PCR(qRT-PCR) and Western blot were employed to determine the mRNA and protein levels, respectively, of PI3K and Akt. Compared with the control group, the model group showed decreased cell proliferation and tube-forming ability, increased LDH release, elevated ROS level, obvious cytoskeletal disruption, increased expression of IL-1β, IL-6, and TNF-α, and down-regulated mRNA and protein levels of PI3K and Akt. Compared with the model group, TaⅡ_A or EPCs-exos alone increased the cell proliferation and tube-forming ability, reduced LDH release, lowered the ROS level, repaired the damaged skeleton, decreased the expression of IL-1β, IL-6, and TNF-α, and up-regulated the mRNA and protein levels of PI3K and Akt. TaⅡ_A+EPCs-exos outperformed TaⅡ_A or EPCs-exos alone in regulating the above indexes. The results demonstrated that TaⅡ_A and EPCs-exos exerted a protective effect on POVPC-induced AVECs by activating the PI3K/Akt pathway, and the combination of the two had stronger therapeutic effect.

Male reproductive system and simulated high-altitude environment: preliminary results in rats / 亚洲男科学杂志(英文版)

This study assessed the effects of a simulated high-altitude environment on the reproductive system of prepubertal male rats and the reversibility of these effects upon return to a normal environment. Three-week-old male Wistar rats were randomly allocated to 4 groups that were exposed to different conditions: a normal environment for 6 weeks and 12 weeks, respectively, hypobaric hypoxia for 6 weeks, and hypobaric hypoxia for 6 weeks followed by a normal environment for 6 weeks. Multiple pathophysiological parameters were evaluated at the histological, endocrine, and molecular levels. Hypobaric hypoxia exposure for 6 weeks during the prepubertal phase significantly altered physiological parameters, body functions, blood indices, and reproductive potential. Six weeks after returning to a normal environment, the damaged reproductive functions partially recovered due to compensatory mechanisms. However, several changes were not reversed after returning to a normal environment for 6 weeks, including disorders of body development and metabolism, increased red blood cells, increased fasting blood glucose, abnormal blood lipid metabolism, decreased testicular and epididymis weights, abnormal reproductive hormone levels, excessive apoptosis of reproductive cells, and decreased sperm concentration. In summary, a hypobaric hypoxic environment significantly impaired the reproductive function of prepubertal male rats, and a return to normal conditions during the postpubertal phase did not fully recover these impairments.

Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries / 中华创伤杂志(英文版)

PURPOSE@#To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees' performance for emergent and urgent thoracic surgeries.@*METHODS@#With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.@*RESULTS@#Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.@*CONCLUSIONS@#Animal model-based simulation training established in the current study could improve the trainees' performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.

Identification of Escherichia coli β-glucuronidase inhibitors from Polygonum cuspidatum Siebold & Zucc

Abstract Gut bacterial β-glucuronidase (GUS) can reactivate xenobiotics that exert enterohepatic circulation- triggered gastrointestinal tract toxicity. GUS inhibitors can alleviate drug-induced enteropathy and improve treatment outcomes. We evaluated the inhibitory effect of Polygonum cuspidatum Siebold & Zucc. and its major constituents against Escherichia coli GUS (EcGUS), and characterized the inhibitory mechanism of each of the components. Trans-resveratrol 4'-O-β-D-glucopyranoside (HZ-1) and (-)-epicatechin gallate (HZ-2) isolated from P. cuspidatum were identified as the key components and potent inhibitors. These two components displayed strong to moderate inhibitory effects on EcGUS, with Ki values of 9.95 and 1.95 μM, respectively. Results from molecular docking indicated that HZ-1 and HZ-2 could interact with the key residues Asp163, Ser360, Ile 363, Glu413, Glu504, and Lys 568 of EcGUS via hydrogen bonding. Our findings demonstrate the inhibitory effect of P. cuspidatum and its two components on EcGUS, which supported the further evaluation and development of P. cuspidatum and its two active components as novel candidates for alleviating drug-induced damage in the mammalian gut.

Investigation on plague foci and epidemic risk analysis in Qiaojia County, Yunnan / 中国热带医学

@#Abstract: Objective　A survey on the plague foci in Qiaojia County of Jinsha River Basin was conducted to understand the composition of plague host vectors and the prevalence of plague among animals, to explore the occurrence and epidemic risk of plague, and to provide scientific basis for plague monitoring and control in this area. Methods　Seven villages and towns in Qiaojia County were selected as the research areas, and the cage night method and the clamp line method were used to investigate the small mammals and their surface parasitic fleas. The host animal organs, serum and surface parasitic flea's samples were collected. The plague indicator animal serum was collected simultaneously on the spot, and the collected host animal organs and flea's samples were cultured and detected for Yersinia pestis. The indirect hemagglutination test (IHA) was used to detect the fraction 1 capsular antigen (F1) antibody of the host animal and the indicator animal serum samples. Results　A total of 525 small mammals belonging to 3 orders, 6 families, 12 genera and 23 species were captured. The dominant species in farming areas were Apodemus chevrieri (31.05%), Niviventer confucianus (13.90%) and Anourosorex squamipes Milne-Edwards (11.43%). The dominant species in residential areas were Rattus norvegicus (66.67%) and Rattus tanezumi (20.00%). The rat densities in agricultural and residential areas were 20.98% and 1.00%, respectively. A total of 277 external parasitic fleas belonging to 15 species, 13 genera, 5 families were collected. The dominant species were Palaeopsylla remota (22.02%), Neopsylla specialis specialis (20.58%), Frontopsylla diqingensis (18.77%) and Ctenophthalmus (Sinoctenophthalmus) quadratus (11.55%), and the rat fleas index was 0.53. No Yersinia pestis was isolated from all rodent organs and flea samples. A total of 167 serum samples from dogs and 15 serum samples from rats were collected, and plague F1 antibody was detected by IHA. IHA detection of plague F1 antibody were negative. Conclusions　Qiaojia County has the distribution of the main host and main vector of plague, and the rat density is high, but the rat body flea index is low. There is no positive detection of plague host animals, vector fleas and indicator animals. It can be considered that the risk of plague occurrence and epidemic in the region is not high in the near future. It is necessary to further strengthen the monitoring and control of plague and other rodent-borne diseases in the region.

Fração de Ejeção do Ventrículo Esquerdo Aumentada, Diminuída ou Estável ao Longo do Tempo em uma Série de 626 Pacientes com Insuficiência Cardíaca que Receberam Tratamento Médico / Increased, Decreased, or Stable Left Ventricle Ejection Fraction over Time in a Series of 626 Heart Failure Patients Receiving Medical Treatment

Resumo Fundamento: A fração de ejeção (FE) tem sido utilizada em análises fenotípicas e na tomada de decisões sobre o tratamento de insuficiência cardíaca (IC). Assim, a FE tornou-se parte fundamental da prática clínica diária. Objetivo: Este estudo tem como objetivo investigar características, preditores e desfechos associados a alterações da FE em pacientes com diferentes tipos de IC grave. Métodos: Foram incluídos neste estudo 626 pacientes com IC grave e classe III-IV da New York Heart Association (NYHA). Os pacientes foram classificados em três grupos de acordo com as alterações da FE, ou seja, FE aumentada (FE-A), definida como aumento da FE ≥10%, FE diminuída (FE-D), definida como diminuição da FE ≥10%, e FE estável (FE-E), definida como alteração da FE <10%. Valores p inferiores a 0,05 foram considerados significativos. Resultados: Dos 377 pacientes com IC grave, 23,3% apresentaram FE-A, 59,5% apresentaram FE-E e 17,2% apresentaram FE-D. Os resultados mostraram ainda 68,2% de insuficiência cardíaca com fração de ejeção reduzida (ICFEr) no grupo FE-A e 64,6% de insuficiência cardíaca com fração de ejeção preservada (ICFEp) no grupo FE-D. Os preditores de FE-A identificados foram faixa etária mais jovem, ausência de diabetes e fração de ejeção do ventrículo esquerdo (FEVE) menor. Já os preditores de FE-D encontrados foram ausência de fibrilação atrial, baixos níveis de ácido úrico e maior FEVE. Em um seguimento mediano de 40 meses, 44,8% dos pacientes foram vítimas de morte por todas as causas. Conclusão: Na IC grave, a ICFEr apresentou maior percentual no grupo FE-A e a ICFEp foi mais comum no grupo FE-D.

Abstract Background: Ejection fraction (EF) has been used in phenotype analyses and to make treatment decisions regarding heart failure (HF). Thus, EF has become a fundamental part of daily clinical practice. Objective: This study aims to investigate the characteristics, predictors, and outcomes associated with EF changes in patients with different types of severe HF. Methods: A total of 626 severe HF patients with New York Heart Association (NYHA) class III-IV were enrolled in this study. The patients were classified into three groups according to EF changes, namely, increased EF (EF-I), defined as an EF increase ≥10%, decreased EF (EF-D), defined as an EF decrease ≥10%, and stable EF (EF-S), defined as an EF change <10%. A p-value lower than 0.05 was considered significant. Results: Out of 377 severe HF patients, 23.3% presented EF-I, 59.5% presented EF-S, and 17.2% presented EF-D. The results further showed 68.2% of heart failure with reduced ejection fraction (HFrEF) in the EF-I group and 64.6% of heart failure with preserved ejection fraction (HFpEF) in the EF-D group. The predictors of EF-I included younger age, absence of diabetes, and lower left ventricular ejection fraction (LVEF). The predictors of EF-D were absence of atrial fibrillation, lower uric acid level, and higher LVEF. Within a median follow-up of 40 months, 44.8% of patients suffered from all-cause death. Conclusion: In severe HF, HFrEF presented the highest percentage in the EF-I group, and HFpEF was most common in the EF-D group.

Individual mortality risk predictive system of patients with acute-on-chronic liver failure based on a random survival forest model / 中华医学杂志(英文版)

BACKGROUND@#The basis of individualized treatment should be individualized mortality risk predictive information. The present study aimed to develop an online individual mortality risk predictive tool for acute-on-chronic liver failure (ACLF) patients based on a random survival forest (RSF) algorithm.@*METHODS@#The current study retrospectively enrolled ACLF patients from the Department of Infectious Diseases of The First People's Hospital of Foshan, Shunde Hospital of Southern Medical University, and Jiangmen Central Hospital. Two hundred seventy-six consecutive ACLF patients were included in the present study as a model cohort (n = 276). Then the current study constructed a validation cohort by drawing patients from the model dataset based on the resampling method (n = 276). The RSF algorithm was used to develop an individual prognostic model for ACLF patients. The Brier score was used to evaluate the diagnostic accuracy of prognostic models. The weighted mean rank estimation method was used to compare the differences between the areas under the time-dependent ROC curves (AUROCs) of prognostic models.@*RESULTS@#Multivariate Cox regression identified hepatic encephalopathy (HE), age, serum sodium level, acute kidney injury (AKI), red cell distribution width (RDW), and international normalization index (INR) as independent risk factors for ACLF patients. A simplified RSF model was developed based on these previous risk factors. The AUROCs for predicting 3-, 6-, and 12-month mortality were 0.916, 0.916, and 0.905 for the RSF model and 0.872, 0.866, and 0.848 for the Cox model in the model cohort, respectively. The Brier scores were 0.119, 0.119, and 0.128 for the RSF model and 0.138, 0.146, and 0.156 for the Cox model, respectively. The nonparametric comparison suggested that the RSF model was superior to the Cox model for predicting the prognosis of ACLF patients.@*CONCLUSIONS@#The current study developed a novel online individual mortality risk predictive tool that could predict individual mortality risk predictive curves for individual patients. Additionally, the current online individual mortality risk predictive tool could further provide predicted mortality percentages and 95% confidence intervals at user-defined time points.

Reliability and Validity of the Chinese Version of Weekly Calendar Planning Activity for Executive Function Assessment in Community-dwelling Middle-aged and Elderly Adults / 中国康复理论与实践

Objective:To examine the reliability and validity of a performance-based executive function assessment, the Chinese Version of Weekly Calendar Planning Activity (WCPA-C), in community-dwelling middle-aged and elderly adults. Methods:From July to August, 2020, 55 community-dwelling adults aged 41 to 89 years participated in this study. A total of 30 participants were evaluated with the WCPA-C version A. After two weeks and four weeks, they were retested with version B and version A, respectively. The intraclass correlation coefficient (ICC) was calculated. All the participants were divided into the mild cognitive impairment (MCI) group (n = 37) and normal cognition (NC) group (n = 18) according to the scores of the Montreal Cognitive Assessment (MoCA). The results of WCPA-C between two groups were compared. Results:There were four participants lost, and 26 participants completed all three tests. Except the planning time, the ICCs were 0.43~0.78 between the first and the second tests, and were 0.50~0.80 between the second and the third tests. WCPA-C results were significant different between two groups (Z > 1.288, P < 0.05), except the total time and the planning time (Z < 1.641, P > 0.05). Conclusion:WCPA-C demonstrats satisfactory test-retest reliability and discriminative validity in community-dwelling middle-aged and elderly adults.

Anatomic study on safe insertion of acupuncture needle in Qiuhou (EX-HN7) acupoint / 针刺研究

OBJECTIVE: To explore the anatomical structure of acupuncture point Qiuhou (EX-HN7) area for safe insertion of acupuncture needle. METHODS: A total of 28 orbital specimens of adult corpses (14 men and 14 women) were randomly selected to be observed by anatomical sectioning and layering methods. The acupoint EX-HN7, located at the junction between the 1/4 of the outer boundary and 3/4 of the inner boundary of the infraorbital margin according to the "Standardization of Acupoint Position" implemented by the People's Republic of China, and marked first with a color pen, followed by cutting the head into horizontal sections along the cross line by using a cadaver cutter and measuring the distance between the skin and blood vessels and main nerves with a digimatic caliper. When the anatomic hierarchy was performed, the blood vessels and nerves in the orbit, the morphological characteristics of the structure around the needle body were particularly focused. RESULTS: When an acupuncture needle was vertically inserted into EX-HN7 region, the tissues through which the needle passes are skin, subcutaneous tissue, orbicularis muscle, orbital adipose body, inferior oblique muscle and inferior orbital wall, respectively. When an acupuncture needle was inserted obliquely upward and along the inferior orbital wall to a depth of (26.5±1.7)mm, the needle tip met the posterior ciliary artery; when to a depth of (41.4±1.3)mm, it reached the superior ophthalmic vein. When inserted to a depth of (40.4±1.5)mm, the needle tip may damage the ophthalmic artery and optic nerve. When the acupuncture needle was inserted inferiorly and closely along the orbital inferior wall to a depth of (13.2±1.4)mm, the infraorbital artery in the suborbital sulcus would be hurt. CONCLUSION: It is recommended that when insert vertically into a depth of 12.0 mm in EX-HN7, the acupuncture needle tip should be slightly inclined inward and posterior-upward, and the depth should not exceed 26.0 mm.

Effect of parathyroidectomy on renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism of uremia / 中国实用内科杂志

OBJECTIVE: To investigate the effect of parathyroidectomy(PTX)on the progression of renal anemia and erythropoietin dose in maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT)of uremia. METHODS: A total of 58 MHD patients with SHPT treated with PTX were retrospectively analyzed. The changes of serum intact parathyroid hormone(iPTH), calcium(Ca), phosphorus(P), alkaline phosphatsae(AKP), hemoglobulin(Hb), hematocrit(Hct), serum ferritin(SF), transferrin saturation(TS), c-reactive protein(CRP), albumin(Alb)and Kt/V at 3 months and6 months after PTX treatment were evaluated. The Hb level at 3 and 6 months after surgery and the doses of recombinant human erythropoietin(EPO)were recorded. RESULTS: Serum iPTH decreased dramatically(before PTX 1828.88±811.2 ng/L,three months after PTX 56.75±158.4 ng/L,six months after PTX 64.52±178.5 ng/L, P<0.05); Ca, P and AKP levels also decreased significantly after PTX(P<0.05). Hb increased after PTX(before PTX 99.92±14.26 g/L, six months after PTX123.2±13.65 g/L, P<0.05); meanwhile, the dose of EPO decreased after the operation[before PTX 235.18±62.65 U/（kg·W), three months after PTX 158.78±34.24 U/（kg·W),six months after PTX 112.53±25.37 U/（kg·W), P<0.05]. CONCLUSION: PTX can effectively control secondary hyperparathyroidism, significantly improve the renal anemia, and decrease dose of erythropoietin in MHD patients with SHPT.

Effect of Leonurine on p38 MAPK Signaling Pathway and miRNA-1 in Cardiomyocyte Hypertrophy Induced by AngⅡ / 中国实验方剂学杂志

Objective: To investigate the inhibitory effect of leonurine on cardiomyocyte hypertrophy induced by angiotensin Ⅱ(Ang Ⅱ) and its effect on p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway and miRNA-1.Method: Cardiomyocyte hypertrophy was induced by Ang Ⅱ (0.1 μmol·L-1) in primary neonatal cardiomyocytes. Experiments were designed in 6 groups as following:normal group, model group, p38 MAPK inhibitor group (SB203580, 10 μmol·L-1), low-dose(5 μmol·L-1), middle-dose(10 μmol·L-1) and high-dose(20 μmol·L-1) group. The cardiomyocyte surface area was measured by image software, and the protein contents were detected by Lowry. The concentrations of ANP in the culture supernatant were measured by enzyme-linked immunosorbent assay (ELISA). The expression level of miRNA-1 was detected by Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR), and the protein expression levels of endothelin-1 (ET-1), p38 MAPK, p-p38 MAPK, myocyte enhancer factor 2 (MEF2), β-myosin heavy chain (β-MHC), α-myosin heavy chain (α-MHC) were detected by Western blot.Result: Compared with normal group, the surface area of cardiomyocyte, the protein contents, the concentrations of ANP, and the protein expression levels of ET-1, p38 MAPK, p-p38 MAPK, MEF2, β-MHC in model group were higher (Pα-MHC and miRNA-1 were lower than those in normal group (Pβ-MHC in high-dose group were lower (Pα-MHC and miRNA-1 were higher than those in model group (PConclusion: Leonurine (20 μmol·L-1) could inhibit cardiomyocyte hypertrophy induced by AngⅡ, and the mechanism is related to the inhibition of activation of p38 MAPK signaling pathway and up-regulation the expression of miRNA-1.

NMR-based metabolomics to select a surgical method for treating papillary thyroid carcinoma

OBJECTIVE: This study aims to investigate differences in the metabolomic profiles of patients who received different surgeries for papillary thyroid carcinoma (PTC). METHODS: Two surgical methods, i.e., unilateral and total thyroidectomy, were employed according to different disease conditions. Sera from patients who were treated with levothyroxine sodium tablets before and after surgery was analyzed with a Bruker 500 Hz nuclear magnetic resonance (NMR) spectrometer. Data were analyzed via principal component analysis (PCA) and partial least squares discriminate analysis (PLS-DA) with SIMCA-P+ 11.0 software, and metabolites were obtained and compared. The first and second principal components were selected from PCA, PLS-DA, and orthogonal partial least squares discriminate analysis (OPLS-DA). A p-value less than 0.05 was considered statistically significant. RESULTS: There were significant differences in serum metabolomics before and after surgery. Compared with unilateral thyroidectomy, total thyroidectomy reversed some highly increased metabolite levels (e.g., taurine and betaine). More significant variations in abnormal metabolites were noted after total thyroidectomy than after unilateral thyroidectomy (e.g., alanine, choline, hippurate, and formic acid). CONCLUSIONS: The choice of surgical method for PTC patients should be based not only on the tumor condition but also on the potential consequences of metabolic variations. Total thyroidectomy reversed some increased metabolite levels but led to accumulation of some other metabolites due to the loss of thyroid function; thus, metabolic disturbances caused by thyroid hormone deficiency should be prevented in advance.

Thickness measurement of frequency domain OCT on photoreceptor cell layer in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To compare the outer nuclear layer ( ONL) , inner and outer segments (IS/OS), photoreceptor cell layer in healthy people and diabetic retinopathy by frequency-domain optical coherence tomography ( OCT) .·METHODS: Totally 100 eyes of 50 healthy people were selected as control group. According to conventional mydriasis for examination of fundus and fundus fluorescein angiography ( FFA ) examination, all diabetic cases were divided into 3 groups: normal retina group ( NDR ) , non - proliferative diabetic retinopathy group (NPDR), proliferative diabetic retinopathy group (PDR). Using OCT measure the thickness of ONL, IS/OS and photoreceptor cell layer of fovea and parafovea ( nasal side and temporal side) in the four groups.·RESULTS: Compared with the control group, the ONL and photoreceptor cell layer's thickness of macular fovea and temporal parafovea in NPDR group and PDR group were statistically significant(all P<0. 05). The differences between ONL and photoreceptor cell layer's thickness of macular fovea and temporal parafovea in NDR group and PDR group were not statistically significant(P>0. 05). The IS/OS of macular fovea and temporal parafovea was not significantly different among those groups (P>0. 05). The thickness of different layers of nasal parafovea were not different (P>0. 05).·CONCLUSION: The thickness of macular fovea and temporal parafovea has relation with degree of DR; the change of photoreceptor cell layer's thickness occurs mainly in ONL, but IS/OS no change; the change in temporal parafovea more obvious than in nasal parafovea. Frequency-domain OCT can quantitatively and qualitatively observe the subtle diabetic macular changes in diabetic patients with macular disease, and provides a reliable detection for the early diagnosis and treatment.

Gene Variations of Sixth Complement Component Affecting Tacrolimus Metabolism in Patients with Liver Transplantation for Hepatocellular Carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Orthotopic liver transplantation (OLT) improves the prognosis of patients with hepatocellular carcinoma (HCC). Moreover, the complement system is a powerful immune effector that can affect liver function and process of liver cirrhosis. However, studies correlating the complement system with tacrolimus metabolism after OLT are scarce. In this study, the role of single nucleotide polymorphisms (SNPs) associated with the sixth complement component (C6) in tacrolimus metabolism was investigated during the early stages of liver transplantation.</p><p><b>METHODS</b>The study enrolled 135 adult patients treated with OLT for HCC between August 2011 and October 2013. Ten SNPs in C6 gene and rs776746 in cytochrome P450 3A5 (CYP3A5) gene were investigated. The tacrolimus levels were monitored daily during 4 weeks after transplantation.</p><p><b>RESULTS</b>Both donor and recipient CYP3A5 rs776746 allele A were correlated with decreased concentration/dose (C/D) ratios. Recipient C6 rs9200 allele G and donor C6 rs10052999 homozygotes were correlated with lower C/D ratios. Recipient CYP3A5 rs776746 allele A (yielded median tacrolimus C/D ratios of 225.90 at week 1 and 123.61 at week 2), C6 rs9200 allele G (exhibited median tacrolimus C/D ratios of 211.31 at week 1, 110.23 at week 2, and 99.88 at week 3), and donor CYP3A5 rs776746 allele A (exhibited median C/D ratios of 210.82 at week 1, 111.06 at week 2, 77.49 at week 3, and 85.60 at week 4) and C6 rs10052999 homozygote (exhibited median C/D ratios of 167.59 at week 2, 157.99 at week 3, and 155.36 at week 4) were associated with rapid tacrolimus metabolism. With increasing number of these alleles, patients were found to have lower tacrolimus C/D ratios at various time points during the 4 weeks after transplantation. In multiple linear regression analysis, recipient C6 rs9200 group (AA vs. GG/GA) was found to be related to tacrolimus metabolism at weeks 1, 2, and 3 (P = 0.005, P = 0.045, and P = 0.033, respectively), whereas donor C6 rs10052999 group (CC/TT vs. TC) was demonstrated to be correlated with tacrolimus metabolism only at week 4 (P = 0.001).</p><p><b>CONCLUSIONS</b>Recipient C6 gene rs9200 polymorphism and donor C6 gene rs10052999 polymorphism are new genetic loci that affect tacrolimus metabolism in patients with HCC after OLT.</p>

Analysis of duration of ICU delirium and its influencing factors / 中华护理杂志

Objective To describe the status of duration of ICU delirium and to analyze its influencing factors.Methods We studied patients who were delirium positive from April 2016 to January 2017 in ICU in Peking Union Medical College Hospital.We collected general information and clinical information including mechanical ventilation,usage of sedation,analgesia and antipsychotics,hypoxia,infection,internal environment and types of delirium after initial onset of delirium.We also recorded management of delirium patients until resolution of delirium or patients were discharged from ICU.We analyzed data by Kaplan-Meier single factor analysis and Cox multiple-factors analysis.Results The average duration of ICU delirium was(5.06±4.59) days.APACHE Ⅱ score(x2=4.670,P=0.031),persistent delirium or not(x2=5.801,P=0.016),duration of hypoxia(x2=14.438,P＜0.001),and duration of usage of antipsychotics(x2=13.360,P＜0.001)were influencing factors of delirium duration.Conclusion Duration of ICU delirium has huge variation.To decrease duration of ICU delirium and improve outcomes of patients,medical workers should pay attention to patients with high APACHE score,persistent delirium and hypoxia,and be cautious when using antipsychotics.

Diagnosis and treatment of rare complications of pelvic fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To enhance the awareness of rare complications of pelvic fracture and describe the correct diagnosis and effective treatment.</p><p><b>METHODS</b>A total of 188 cases of pelvic fractures were retrospectively reviewed, and four patients who suffered from four types of rare pelvic fracture complications were described, namely ureteral obstruction caused by retroperitoneal hematoma-induced abdominal compartment syndrome (ACS), bowel entrapment, external iliac artery injury, and open scrotal sac injury.</p><p><b>RESULTS</b>We demonstrated that combined measures should be employed to prevent the occurrence of ACS following major pelvic fractures. Ureteral catheter support may be a good option at an early stage when ACS occurred. Contrasted computed tomography examination and sufficient awareness are keys to a correct diagnosis of bowel entrapment following pelvic fractures. Recognition of risk factors, early diagnosis, and prompt treatment of suspected injury of the external iliac artery are keys to patient survival and to avoid limb loss. Scrotal and/or testicular injury complicated by pelvic fractures should be carefully treated to maintain normal gonad function. Additionally, establishment of a sophisticated trauma care system and multi-disciplinary coordination are important for correct diagnosis and treat- ment of rare complications in pelvic fractures.</p><p><b>CONCLUSIONS</b>Rare complications of pelvic fractures are difficult to diagnose and negatively impact outcome. Recognition of risk factors and sufficient awareness are essential for correct diagnosis and prompt treatment.</p>

Strategy by stages for preventing respiratory complications of acute cervical spinal cord injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects of strategy by stages for preventing respiratory complications of patients with acute cervical spinal cord injury (ACSCI).</p><p><b>METHODS</b>From September 2009 to May 2013,the clinical data of 91 patients with ACSCI underwent surgery were retrospectively analyzed. Among the patients, 42 patients were divided into in-stages group, including 30 males and 12 females with an average age of 50 years old (ranged 28 to 76) which were treated with strategy by stages for preventing respiratory complications; others 49 patients which were not treated with the strategy regarded as control group, including 38 males and 11 females with an average age of 47 years old (ranged 30 to 77). All of them had definite history of trauma, and were admitted to orthopaedics within 48 h after trauma. In in-stages group, respiratory muscle strength training, high-dose ambroxol using and other treatment were performed to prevent respiratory complilcations according to preoperative, intraoperative and postoperative stage. While in control group, there were no systematic and effective measures utilized. Chi-square test was used to evaluate the difference for respiratory complications rate, the rate of tracheostomy or intubation and mortality caused by the respiratory complications between two groups.</p><p><b>RESULTS</b>Ten patients developed with respiratory complications in in-stages group (7 patients with pneumonia, 1 with atelectasis and 2 with respiratory failure), among which 3 patients underwent tracheostomy or intubation. In control group, 24 patients developed with respiratory complilcations (15 with pneumonia,3 with atelectasis and 6 with respiratory failure), among which 11 patients underwent tracheostomy or intubation. There was significant difference between two groups (χ2 = 6.12, 4.07; P = 0.013, 0.044). Five patients died because of respiratory complications, one case were in in-stages group and 4 in control group. There was significant difference between two groups (χ2 = l.39, P = 0.238).</p><p><b>CONCLUSION</b>The strategy by stages is an effective method for preventing respiratory complications of ACSCI and can reduce the respiratory complications rate and improve the prognosis of respiratory complications.</p>

Enhancement of Bone Formation by Bone Morphogenetic Protein-2 Released from Poly (L-lactic-co-glycolic acid) Microsphere.

An appropriate carrier acting as a sustained delivery vehicle for bone morphogenetic proteins (BMPs) is required for the maximal clinical effectiveness of these osteogenic proteins to enhance bone formation. The purpose of this study was to evaluate a lowmolecular- weight poly(L-lactic-co-glycolic acid) (PLGA) copolymer as a synthetic, biodegradable carrier for the sustained delivery of bone morphogenetic protein-2 (BMP-2), and then to address the hypothesis that BMP-2 delivery from this vehicle could promote cell proliferation in vitro and ectopic bone formation in vivo. The BMP-2 was entrapped in microspheres of PLGA by using an improved water-in-oil-in water double-emulsionsolvent- extraction technique. The in vitro release kinetics of rhBMP-2 was determined by ELISA. Then we verified the effect of the sustained delivery vehicle on MSC cell proliferation. The ectopic bone induction in intramuscular implants of mice was evaluated at 2 and 4 weeks post-implantation. The results showed the PLGA microsphere released a total of 14.2%±0.71% rhBMP-2 at the initial phase followed by a prolonged release for 28 days. The rhBMP-2 released from the PLGA microsphere stimulated an increase in alkaline phosphatase (ALP) activity of MSC cells for 5 days in vitro, suggesting that the delivery vehicle releases BMP-2 for a prolonged period in an active form. Moreover, the released rhBMP-2 from the PLGA microsphere significantly promoted MSC cells proliferation after days 5 in culture. In vivo bone formation studies showed the rhBMP-2- loaded PLGA microsphere induced ectopic bone formation to a much greater extent than did rhBMP-2 treated mice. These results demonstrated that the PLGA copolymer material is capable of potentiating the osteogenic efficacy of BMP-2 and, as such, represents a promising delivery vehicle for BMP-2 for orthopedic and dental repair.

Comparison of chromosome karyotype between myelodysplastic syndrome and acute leukemia patients confirmed at the same period / 中国实验血液学杂志

This study was purposed to compare and analyze the relationship between the abnormality of chromosome karyotypes and diagnosis, prognosis of MDS and AML patients, as well as to explore the characteristics of chromosome prognostic stratification in MDS and AML patients of different ages. The cytogenetic karyotype analysis was performed in 134 cases of MDS and 123 cases of AML by using bone marrow short-term culture and R-banding technique. The results indicated that the detected rates of chromosome abnormal karyotypes in MDS and AML patients were 41% and 61% respectively. The abnormal karyotype analysis of MDS and AML group showed that the abnormal karyotype in MDS group displayed number abnormality as the dominate (mainly the +8), while the abnormal karyotype in AML group displayed structure abnormality as the dominant [mainly, t(15;17) and t(8;21)]. The detected abnormal karyotype are mainly for the +8 which has ambiguous correlation with FAB subtype; the detection rates of complex karyotype abnormalities, favourable prognosis karyotype as well as poor prognosis karyotype in the MDS group obviously higher than that of AML group. Among patients with MDS transformed into AML, 12 cases had chromosome abnormal karyotype. There were 3 cases of chromosome abnormal karyotype in AML group which were transformed by MDS. The analysis of age stratification between two groups showed that the detected rate of abnormal karyotype was enhanced with the increase of age in MDS group, and detected rate in ≥ 60 years old group was obviously higher than that in patients with ≤ 30 age group.The detected rate of complex karyotype abnormalities in three age groups of MDS did not show statistical difference; the detected rate of abnormal karyotype in AML group decreased with the increase of age, the detected rate in ≤ 30 years old group was obviously higher than that in ≥ 60 age group,while the detection rate of complex karyotype abnormalities showed that the detected rate in patients ≥ 60 years old group was obviously higher than that in patients with ≤ 30 years old group; Analysis of karyotype prognosis revealed that the detected rate of poor prognosis karyotype increased along with the age growth both in MDS and AML groups, and detected rate in ≥ 60 years old group was obviously higher than that in ≤ 30 years old group; while analysis of favourable prognosis karyotype in MDS and AML group showed that the detected rate in ≤ 30 years old group was obviously higher than that in ≥ 60 years old group. It is concluded that the patients with MDS and AML have higher chromosomal abnormalities,which have important reference value for the diagnosis, treatment and prognosis, meanwhile, the analysis of chromosome karyotype provides an important basis for prognostic stratification.