Neutrophil gelatinase-associated lipocalin: a biochemical marker for acute kidney injury and long-term outcomes in patients presenting to the emergency department

INTRODUCTION@#Creatinine has limitations in identifying and predicting acute kidney injury (AKI). Our study examined the utility of neutrophil gelatinase-associated lipocalin (NGAL) in predicting AKI in patients presenting to the emergency department (ED), and in predicting the need for renal replacement therapy (RRT), occurrence of major adverse cardiac events (MACE) and all-cause mortality at three months post visit.@*METHODS@#This is a single-centre prospective cohort study conducted at Singapore General Hospital (SGH). Patients presenting to SGH ED from July 2011 to August 2012 were recruited. They were aged ≥21 years, with an estimated glomerular filtration rate <60 mL/min/1.73 m2, and had congestive cardiac failure, systemic inflammatory response syndrome or required hospital admission. AKI was diagnosed by researchers blinded to experimental measurements. Serum NGAL was measured as a point-of-care test.@*RESULTS@#A total of 784 patients were enrolled, of whom 107 (13.6%) had AKI. Mean serum NGAL levels were raised (P < 0.001) in patients with AKI (670.0 ± 431.9 ng/dL) compared with patients without AKI (490.3 ± 391.6 ng/dL). The sensitivity and specificity of NGAL levels >490 ng/dL for AKI were 59% (95% confidence interval [CI] 49%-68%) and 65% (95% CI 61%-68%), respectively. Need for RRT increased 21% per 100 ng/dL increase in NGAL (P < 0.001), whereas odds of death in three months increased 10% per 100 ng/dL increase in NGAL (P = 0.028). No clear relationship was observed between NGAL levels and MACE.@*CONCLUSION@#Serum NGAL identifies AKI and predicts three-month mortality.

Mechanism of Zhishi Xiebai Guizhitang in Alleviating Myocardial Injury in Rats with Myocardial Infarction Based on TNF/NF-κB Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the effect of Zhishi Xiebai Guizhitang （ZXGT） on isoproterenol （ISO）-induced myocardial infarction （MI） in rats through the tumor necrosis factor/nuclear factor-κB （TNF/NF-κB） signaling pathway. MethodForty-eight SD rats were randomly divided into control group （blank）， model group， perindopril group （4 mg·kg-1）， ZXGT group （24.4 g·kg-1）， ZXGT +inhibitor group （ZXGT， 24.4 g·kg-1， TNF-α receptor inhibitor R7050， 5 mg·kg-1）， and an inhibitor group （R7050， 5 mg·kg-1）， with eight rats in each group. The rats in each group were orally administered with their respective drugs for 7 days. Additionally， in the ZXGT + inhibitor group and the inhibitor group， R7050 was injected intraperitoneally at a dose of 5 mg·kg-1 on the 6th and 7th days. Except for the control group， all other groups were given intraperitoneal injections of ISO for 2 consecutive days to induce MI in rats. On the 7th day of the experiment， the rats were anesthetized 30 min after ISO injection， and their electrocardiograms （ECGs） were recorded to observe ST-segment elevation. Small animal echocardiography was used to measure global longitudinal strain （GLS） and cardiac synchrony. Blood samples were collected from the abdominal aorta to measure the levels of serum cardiac troponin T （cTnT）， creatine kinase-MB （CK-MB）， lactate dehydrogenase （LDH）， tumor necrosis factor-α （TNF-α）， and interleukin-1β （IL-1β）. Histopathological changes in myocardial tissue were observed using hematoxylin-eosin （HE） staining. Immunohistochemistry （IHC） was used to detect the expression of TNF-α， NF-κB p65， and p-NF-κB p65 proteins in myocardial tissue. Western blot was performed to measure the expression of tumor necrosis factor receptor 1 （TNFR1）， tumor necrosis factor receptor-associated factor 2 （TRAF2）， transforming growth factor-beta-activated kinase 1 （TAK1）， NF-κB inhibitory protein alpha （IκBα）， phosphorylated （p）-IκBα， NF-κB p65， and p-NF-κB p65 proteins in myocardial tissue. ResultCompared with the control group， the model group showed significant ST segment elevation on the ECG （P<0.01）， increased GLS， and reduced cardiac synchrony on echocardiography （P<0.01）. Histopathological examination revealed extensive myocardial necrosis. Furthermore， the serum levels of cTnT， CK-MB， LDH， TNF-α， and IL-1β were significantly increased （P<0.01）， and the expression levels of TNF-α， TNFR1， TRAF2， TAK1， p-IκBα， and p-NF-κB p65 proteins in myocardial tissue were significantly elevated （P<0.01）， while the expression level of IκBα was significantly decreased （P<0.01）. Compared with the model group， the perindopril group， the ZXGT group， the ZXGT + inhibitor group， and the inhibitor group rats showed a significant reduction in ST-segment elevation on the ECG （P<0.05， P<0.01）， improvement in GLS and cardiac synchrony （P<0.05， P<0.01）， a decrease in the area of myocardial necrosis， and reduced serum levels of cTnT， CK-MB， LDH， TNF-α， and IL-1β （P<0.01）. Additionally， the ZXGT group， the ZXGT + inhibitor group， and the inhibitor group downregulated the increased TNF-α， TNFR1， TRAF2， TAK1， p-IκBα， and p-NF-κB p65 protein expression levels and upregulated IκBα expression levels in the myocardial tissue （P<0.05， P<0.01）. No significant differences were observed between the ZXGT group and the ZXGT + inhibitor group or the inhibitor group. ConclusionZXGT can protect against ISO-induced myocardial injury in rats and improve cardiac function， and its mechanism of action may be related to the regulation of the TNF/NF-κB signaling pathway.

Application and prospect of artificial intelligence in the field of endocrinology and metabolism / 中华内分泌代谢杂志

Artificial intelligence (AI) is among the forefront science in recent years. The rapid development of intelligent medicine based on AI, a new concept in the medical field, has resulted in a large impact on traditional medicine. AI poses a great opportunity and also many challenges for clinical physicians. Recently, researches in the development and application of AI are increasingly published in the field of endocrinology, such as the diagnosis and prediction of diabetes and its complications, the optimizing treatment and blood glucose management, the development of artificial pancreas, the diagnosis and treatment of obesity, the prognosis of bariatric surgery, osteoporosis and fracture prediction, bone age analysis, non-invasive assessment of liver steatosis and fibrosis, diagnosis of acromegaly, pathological diagnosis of thyroid and pituitary tumors. Nevertheless, the clinical applications of AI for medicine are still at an initial stage. With the rapid development of AI, we are expecting that it will play a pivotal role in the field of endocrinology and metabolism in the future. This is a new era for medical community to embrace new technology. Only with the properly dealing with the innovation of AI, a win-win result could be achieved.

JAK Inhibitors Therapy for Rheumatoid Arthritis ：An Overview of Systematic Reviews / 中国药房

OBJECTIVE：To overview t he s ystematic revi ews on JAK inhibitors in the treatment of rheumatoid arthritis （RA）， and to provide evidence-based basis for the treatment of RA with these drugs. METHODS ：The Cochrane Library ，PubMed， Embase，CNKI，Wanfang database and VIP were electronically searched to collect systematic reviews of JAK inhibitors in the treatment of RA from inception to Dec. 2020. After data extraction of included systematic review ，PRISMA statement ，AMSTAR2 scale and GRADE were used to evaluate the report quality ，methodological quality and the level of evidence for outcome indicators. RESULTS ：A total of 12 systematic reviews involving 103 outcomes were included. PRISMA score of systematic reviews was between 17.5 and 22.5，and the reported quality defects were mainly reflected in scheme ，registration and other aspects. AMSTAR 2 evaluation results showed that there were 6 studies of low quality and 6 studies of very low quality ，without high-quality study and medium-quality study. GRADE assessment results for outcome indicators showed low to medium quality of evidence. The summary of evidence showed that compared to placebo ，JAK inhibitor could alleviate various indicators of RA ； compared to adalimumab ，the advantage was not obvious. JAK inhibitors did not increase the incidence of serious adverse events ， but the systematic reviews were inconsistent in their effects on the incidence of total adverse events and liver injury. CONCLUSIONS：The efficacy of JAK inhibitors in the treatment of RA has certain advantages over placebo ，but more studies are needed to demonstrate the efficacy of JAK inhibitors in the treatment of RA compared to other drugs ；the advantage of safety is uncertain.

Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study

INTRODUCTION@#Inappropriate attendances (IAs) to emergency departments (ED) create an unnecessary strain on healthcare systems. With decreased ED attendance during the COVID-19 pandemic, this study postulates that there are less IAs compared to before the pandemic and identifies factors associated with IAs.@*METHODS@#We performed a retrospective review of 29,267 patient presentations to a healthcare cluster in Singapore from 7 April 2020 to 1 June 2020, and 36,370 patients within a corresponding period in 2019. This time frame coincided with local COVID-19 lockdown measures. IAs were defined as patient presentations with no investigations required, with patients eventually discharged from the ED. IAs in the 2020 period during the pandemic were compared with 2019. Multivariable logistic regression was performed to identify factors associated with IAs.@*RESULTS@#There was a decrease in daily IAs in 2020 compared to 2019 (9.91±3.06 versus 24.96±5.92, P<0.001). IAs were more likely with self-referrals (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.50-1.66) and walk-ins (aOR 4.96, 95% CI 4.59-5.36), and those diagnosed with non-specific headache (aOR 2.08, 95% CI 1.85-2.34), or non-specific low back pain (aOR 1.28, 95% CI 1.15-1.42). IAs were less likely in 2020 compared to 2019 (aOR 0.67, 95% CI 0.65-0.71) and older patients (aOR 0.79 each 10 years, 95% CI 0.78-0.80).@*CONCLUSION@#ED IAs decreased during COVID-19. The pandemic has provided a unique opportunity to examine factors associated with IAs.

Elastography for the differential diagnosis of malignant versus benign testicular lesions: a meta-analysis

Purpose@#The aim of this study was to evaluate the value of elastography in the differential diagnosis of benign versus malignant testicular lesions. @*Methods@#The PubMed, Cochrane Library, and Embase databases were searched for relevant studies. The diagnostic accuracy of elastography was evaluated using pooled sensitivity, specificity, likelihood ratio, post-test probability, diagnostic odds ratio, and by summarizing the area under the hierarchical summary receiver operating characteristic (HSROC) curve. @*Results@#Seven studies with 568 lesions were included. The pooled sensitivity and specificity were 87% (95% confidence interval [CI], 81% to 92%) and 81% (95% CI, 65% to 90%), respectively. The pooled estimates of the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 4.48 (95% CI, 2.37 to 8.47), 0.16 (95% CI, 0.10 to 0.25), and 28.11 (95% CI, 11.39 to 69.36), respectively. The area under the HSROC curve was 90% (95% CI, 88% to 93%). @*Conclusion@#Elastography is useful for assessing the stiffness of testicular lesions and for differentiating benign from malignant lesions. Elastography can be an effective supplement to conventional ultrasonography.

Regulation and mechanism of hypothalamic inflammation on obesity / 中华内分泌代谢杂志

Many studies of the etiology and intervention for obesity have gradually focused on the brain, trying to curb the occurrence of obesity from the source. Hypothalamic inflammation has been a concern and an unresolved scientific issue in the development of obesity. Studies have shown that hypothalamic inflammation not only impairs energy balance, but also increases obesity-related insulin and leptin resistance, further promotes peripheral tissues storing up fat cells, eventually leads to the development of obesity. In addition, hypothalamic inflammation occurs before weight-gain and peripheral tissue inflammation with high-fat diets. Therefore, more and more scholars believe that hypothalamic inflammation is an important cause of dietary-induced metabolic abnormalities. The occurrence of hypothalamic inflammation is mainly accompanied by a series of complex and rapidly-activated glial, including microglia, astrocytes, and tanycyte. These cells are responsible for maintaining hypothalamic metabolic homeostasis and making up the important components of the regulatory network. Moreover, multiple teams also found that a variety of weight-loss methods(e.g. bariatric surgery, targeted drugs, fecal microbiota transplantation, and so on) can improve hypothalamic inflammation levels. Therefore, it is important to understand the mechanism of hypothalamic inflammation through different neurons, which is expected to find a more effective and safer solution to intervene and treat obesity in the future.

Clinical research of Qingfei-Xiaoyan Decoction combined with conventional western medicine in patients with acute exacerbation of chronic obstructive pulmonary disease / 国际中医中药杂志

Objective:To observe the clinical efficacy of Qingfei-Xiaoyan Decoction combined with conventional western medicine in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods:Eighty-two patients with acute exacerbation of COPD were selected in Bozhou People's Hospital from January 2017 to June 2018 and randomly divided into a control group and a treatment group (41 in each group) using randomized number table method. Patients in the control group were treated with conventional western medicine and those in the treatment group with Qingfei-Xiaoyan Decoction on the basis of the control group for 2 weeks. Dyspnea of patients was evaluated with the modified British Medical Research Council dyspnea questionnaire (mMRC). Impact of the disease was measured with the COPD Assessment Test (CAT). The serum levels of C-reactive protein (CRP) and procalcitonin (PCT) were measured by ELISA. Results:The total efficacy rate in trementat group 95.1% (39/41) was significantly higher than that in the control group 73.2% (30/41) ( χ2=4.999, P=0.025). After the treatment, the scores of mMRC (0.63 ± 0.07 vs. 0.95 ± 0.12; t=7.921, P<0.01) and CAT (9.18 ± 0.12 vs. 14.01 ± 1.56; t=11.359, P<0.01) in the treatment group were significantly lower than those in the control group. After the treatment, the forced expiratory volume in one second (FEV1) percentage predicted (51.05% ± 5.63% vs. 45.77% ± 5.31%; t=10.453, P<0.01) and FEV1/forced vital capacity (FVC) (59.15 ± 6.44 vs. 54.24 ± 6.02; t=5.621, P<0.01) in the treatment group were significantly higher than those in the control group. After the treatment, the serum levels of CRP (8.06 ± 0.87 mg/L vs. 10.55 ± 1.21 mg/L; t=10.216, P<0.01) and PCT (4.20 ± 0.48 μg/L vs. 6.33 ± 0.69 μg/L; t=7.004, P<0.01) in the treatment group were significantly lower than those in the control group. Conclusions:Qingfei-Xiaoyan Decoction can inhibite inflammation, improve symptoms and lung function, increase the efficacy in patients with acute exacerbation of COPD.

Regulation and mechanism of hypothalamic inflammation on obesity / 中华内分泌代谢杂志

Many studies of the etiology and intervention for obesity have gradually focused on the brain, trying to curb the occurrence of obesity from the source. Hypothalamic inflammation has been a concern and an unresolved scientific issue in the development of obesity. Studies have shown that hypothalamic inflammation not only impairs energy balance, but also increases obesity-related insulin and leptin resistance, further promotes peripheral tissues storing up fat cells, eventually leads to the development of obesity. In addition, hypothalamic inflammation occurs before weight-gain and peripheral tissue inflammation with high-fat diets. Therefore, more and more scholars believe that hypothalamic inflammation is an important cause of dietary-induced metabolic abnormalities. The occurrence of hypothalamic inflammation is mainly accompanied by a series of complex and rapidly-activated glial, including microglia, astrocytes, and tanycyte. These cells are responsible for maintaining hypothalamic metabolic homeostasis and making up the important components of the regulatory network. Moreover, multiple teams also found that a variety of weight-loss methods(e.g. bariatric surgery, targeted drugs, fecal microbiota transplantation, and so on) can improve hypothalamic inflammation levels. Therefore, it is important to understand the mechanism of hypothalamic inflammation through different neurons, which is expected to find a more effective and safer solution to intervene and treat obesity in the future.

Comparison of Reusable Models in Pericardiocentesis Simulation Training

INTRODUCTION@#Pericardiocentesis is a potentially life-saving procedure. We compared two low-cost models-an agar-based model and a novel model, Centesys-in terms of ultrasound image quality and realism, effectiveness of the model, and learners' confidence and satisfaction after training.@*METHODS@#In this pilot randomised 2x2 crossover trial stratified by physician seniority, participants were assigned to undergo pericardiocentesis training either with the agar-based or Centesys model first, followed by the other model. Participants were asked to rate their confidence in performing ultrasound-guided pericardiocentesis, clarity and realism of cardiac structures on ultrasound imaging, and satisfaction on a 7-point Likert scale before and after training with each model.@*RESULTS@#Twenty participants with median postgraduate year of 4 (interquartile range [IQR] 3.75-6) years were recruited. Pre-training, participants rated themselves a median score of 2.5 (IQR 2-4) for level of confidence in performing pericardiocentesis, which improved to 5 (IQR 4-6) post-training with Centesys (@*CONCLUSION@#Centesys achieved greater learner satisfaction as compared to the agar-based model, and was an effective tool for teaching ultrasound-guided pericardiocentesis and drain insertion.

Study on HPLC Fingerprints of Nauclea officinalis Extract Syrup and Content Determination of 9 Components / 中国药房

OBJECTIVE： To establish HPLC fingerprints of Nauclea officinalis extract syrup， and to determine the contents of 9 components. METHODS： HPLC method was adopted. The determination was performed on Diamonsil C18（2）column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid solution （gradient elution） at the flow rate of 1.0 mL/min. The detection wavelength was set at 240 nm， and column temperature was 30 ℃. The sample size was 10 μL. Using strictosamide as reference， HPLC chromatograms of 20 batches of N. officinalis extract syrup were drawn. The similarity of HPLC chromatograms were evaluated by using TCM Fingerprint Similarity Evaluation System （2004A edition） to confirm common peaks. The contents of 9 components were determined by standard curves. RESULTS： There were 26 common peaks in 20 batches of HPLC chromatograms， and the similarity was higher than 0.98. Compared with mixed control， 9 chemical components were identified， such as 3，4-dihydroxybenzoic acid， neochlorogenic acid， loganic acid， chlorogenic acid， cryptochlorogenic acid， swertioside， pumiloside， strictosamide and vincosamide. The linear range of 9 components were 17.24-275.84， 7.56-120.96， 15.40-246.40， 7.84-125.44， 8.64-138.24， 7.96-127.36， 8.40-134.40， 48.56-776.96， 4.16-66.56 μg/mL（all r≥0. 999）， respectively. The limits of detection were 0.043 1， 0.126 0， 0.038 5， 0.130 7， 0.144 0， 0.066 3， 0.070 0， 0.012 1， 0.052 0 μg/mL， respectively. The limits of quantitation were 0.215 5， 0.189 0， 0.077 0， 0.196 0， 0.288 0， 0.132 7， 0.105 0， 0.097 6， 0.138 7 μg/mL， respectively. RSDs of precision， stability and reproducibility tests were all lower than 2.0％ （n＝6）. Average recoveries were 99.6％、106.3％、100.1％、102.0％、98.4％、100.0％、99.3％、100.6％ and 101.2％， and RSDs were 1.20％、0.24％、0.59％、1.00％、0.73％、1.30％、1.10％、1.80％、1.90％（n＝6）. CONCLUSIONS： Established HPLC fingerprints and quantitative determination method of N. officinalis extract syrup are accurate， specific and sensitive. It can provides reference for quality control of N. officinalis extract syrup.

Effects of bariatric surgery on central nervous system regulation of obesity / 中华消化外科杂志

As the incidence of obesity increases globally, treatment strategies of obesity emerge continuously. However, the weight loss effect varies between individuals without explicit explanations. In the recent years, many researchers have revealed regulation mechanisms of central nervous system on eating behavior, proposing that obese individuals exhibit brain functional abnormalities implicated in homeostatic regulation of food intake, central reward and motivation, emotion, memory, and attention system. Therefore, these scholars appeal that treating obesity cannot remain "brainless" . The most effective treatment currently available for obesity is bariatric surgery which lead to excess weight loss of 42%-67% in accompany with changes in brain activity. Functional magnetic resonance imaging showed a decreased activation in the central reward network and increased inhibitory control in the cognitive control system after bariatric surgeries. In this article, the authors introduce the central nervous system regulation of eating and investigate the effects of bariatric surgery on central nervous system.

Effects of bariatric surgery on central nervous system regulation of obesity / 中华消化外科杂志

As the incidence of obesity increases globally,treatment strategies of obesity emerge continuously.However,the weight loss effect varies between individuals without explicit explanations.In the recent years,many researchers have revealed regulation mechanisms of central nervous system on eating behavior,proposing that obese individuals exhibit brain functional abnormalities implicated in homeostatic regulation of food intake,central reward and motivation,emotion,memory,and attention system.Therefore,these scholars appeal that treating obesity cannot remain "brainless".The most effective treatment currently available for obesity is bariatric surgery which lead to excess weight loss of 42％-67％ in accompany with changes in brain activity.Functional magnetic resonance imaging showed a decreased activation in the central reward network and increased inhibitory control in the cognitive control system after bariatric surgeries.In this article,the authors introduce the central nervous system regulation of eating and investigate the effects of bariatric surgery on central nervous system.

High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore

INTRODUCTION@#Prognostic thresholds for 30-day major adverse cardiac events (MACE) have been studied for high-sensitivity troponin T (hsTnT) in patients with suspected acute coronary syndrome (ACS), but there is limited data on the prognostic performance of hsTnT for one-year MACE.@*METHODS@#We prospectively measured hsTnT (in ng/mL up to two decimal places) at 0, 2 and 7 hours for patients presenting with symptoms suggestive of ACS to our emergency department from March 2010 to April 2013. We assessed the prognostic performance of hsTnT cut-offs for 30-day and one-year MACE, and the utility of delta-hsTnT in predicting MACE.@*RESULTS@#Among 2,444 patients studied, 273 (11.2%) developed MACE (including index MACE) by 30 days and 359 (14.7%) patients developed MACE at one year. The suggested hsTnT cut-off for 30-day MACE was ≥ 10 ng/L at 0 hour (positive predictive value [PPV] 33.5%, negative predictive value [NPV] 94.5%) and 7 hours (PPV 37.3%, NPV 94.5%), and ≥ 20 ng/L at 2 hours (PPV 36.9%, NPV 96.9%). For one-year MACE, the suggested cut-off was also ≥ 10 ng/L at all readings. Plasma hsTnT ≥ 30 ng/L at any reading gave PPV > 54% and NPV > 93% for 30-day MACE. Absolute 0-2 hour and 2-7 hour delta-hsTnT ≥ 10 ng/L gave PPV > 50% for 30-day and one-year MACE.@*CONCLUSION@#Patients with 0-, 2- or 7-hour hsTnT ≥ 30 ng/L and 0-2 hour delta-hsTnT ≥ 10 ng/L had PPV > 50% for 30-day and one-year MACE, and should be investigated thoroughly.

Research on the correlation between uric acid levels and thyroid nodules and gender differences / 中华内分泌代谢杂志

Objective To explore the correlation between thyroid nodules and uric acid levels and to find their gender differences.Methods A total of 68 056 subjects in a regional medical physical examination center of Shanxi Province from January 2013 to June 2015 were enrolled in this study.All the participants′ general information and parameters were recorded.Thyroid nodules were detected by color Doppler ultrasonography.Results The total prevalence of thyroid nodule was 35.5%, 30.7% in males and 40.0% in females.The prevalence of single nodule was 50.1%, and multiple 49.9%.Compared with no nodule group, thyroid nodule group tended to be older, with higher BMI, and with a worse metabolic status(all P<0.01).The uric acid levels were lower[(352.37±78.14 vs 357.70±77.51) μmol/L, P<0.01] in thyroid nodule group in male and higher[(260.22±61.91 vs 253.91±59.18) μmol/L, P<0.01] in female.Conclusion Thyroid nodules may be associated with metabolism and inflammation.In males, hyperuricemia group had lower, while in females, hyperuricemia ones were with a higher prevalence of thyroid nodules.

Effect of Danggui Shaoyao Powder on the Uterine Structure and Estrogen Receptor Expression in Model Rats in Perimenopausal Period / 中国药房

OBJECTIVE:To investigate the effect of Danggui shaoyao powder (DSS) on uterine structure and expressions of estrogen receptorα(ERα),estrogen receptorβ(ERβ)in uterine cavity epithelium and matrix in model rats in perimenopausal peri-od. METHODS:40 female SD rats were randomly divided into sham operation group (normal saline),model group (normal sa-line),DSS low-dose,medium-dose,high-dose groups(1.94,3.87,7.44 g/kg),8 in each group. Except that rats in sham opera-tion group received resection of fat nearby ovaries,rats in other groups received resection of bilateral ovaries to induce models in perimenopausal period. After modeling,rats were intragastrically administrated once a day,for 8 weeks. After administration,wet mass of uterine was weighted. Changes in uterine morphology and structure of rats were observed,expressions levels of ERα and ERβ in uterine cavity epithelium and matrix were determined. RESULTS:Compared with sham operation group,rats in model group showed low columnar in endometrial columnar epithelium,lamina propria layer,muscular layer and serous layer were signifi-cantly atrophied,stromal cells had obvious nuclear condensation. There was marked decrease in uterine wet mass,uterine cavity ar-ea and endometrial thickness as well as the number of uterine glands(P<0.01),and the expression levels of ERαand ERβin uter-ine cavity epithelium and matrix were significantly reduced(P<0.01). Compared with model group,the atrophy degree of endome-trium and lamina propria layer had no significant differences in DSS each dose groups. However,lamina propria layer was rich in glands,and there were significant differences in uterine wet mass,uterine cavity area,endometrial thickness,ERα expression level in uterine cavity epithelium and matrix (P>0.05). However, the number of uterine glands in DSS medium-dose,high-dose groups was significantly increased(P<0.01),and ERβexpres-sion level in uterine cavity epithelium and matrix in DSS high-dose group was significantly increased (P<0.05 or P<0.01). CONCLUSIONS:DSS has not obvious effect on im-proving the symptoms of uterine gland atrophy of model rats in perimenopausal period,but it can increase the number ofuterine glands,and the mechanism may be associated with improving the ERβ expression level in uterine cavity epithelium and ma-trix.