The relationship of RDW-SD, NLR and FIB with the prognosis of multiple myeloma patients and their predictive value / 中国医师杂志

Objective:To explore the relationship between the standard deviation of red blood cell distribution width (RDW-SD), neutrophil/lymphocyte value (NLR), fibrinogen (FIB) and the prognosis of multiple myeloma (MM) patients and their predictive value.Methods:In this study, a retrospective study method was used to select 120 patients with MM who were initially diagnosed in the department of hematology of the Affiliated Hospital of Jining Medical College from January 2017 to October 2019. The follow-up time was 24 months, including 62 patients who survived (survival group) and 58 patients who died (death group). The RDW-SD, NLR and FIB values of the two groups were compared, and the value of the three indicators in predicting the follow-up outcome of MM patients was analyzed using the receiver operating characteristic (ROC) curve. Logistic regression model was used to analyze the related factors affecting the prognosis of MM patients.Results:Among 120 newly treated MM patients, the RDW-SD, NLR and FIB of the survival group were significantly lower than those of the death group (all P<0.05); The sensitivity, specificity and area under ROC curve (AUC) of RDW-SD+ NLR+ FIB in predicting adverse outcomes of MM patients were 88.96%, 84.50% and 0.919 respectively. Logistic multivariate regression analysis showed that ≥60 years old, International Staging System (ISS) Ⅲ, β2-microglobulin (β2-MG)≥3 500 ng/ml, increased RDW-SD, NLR, and FIB will increase the risk of poor prognosis in MM patients (all P<0.05). Conclusions:The RDW-SD, NLR and FIB have a close relationship with the poor prognosis of newly treated MM patients, and the combined application has certain value in predicting the prognosis of patients.

Case report: the management of a patient with severe malnutrition and swallowing disorder with the involvement of nutrition support nurses / 中华临床营养杂志

Nutrition support nurse specialists play an important role in clinical management of patients with malnutrition and swallowing disorders. Here is the case report where nutrition support nurses were engaged in the whole course management of an elderly patient with severe malnutrition and swallowing disorder, including the early assessment, the multidisciplinary team intervention, and rehabilitation. With this case as well as related literature, the practice of the early intervention, dynamic whole course management, and the role of nutrition support nurses were discussed.

Preliminary exploration on operation process for autologous ozonized blood transfusion / 中国输血杂志

Autologous ozonized blood transfusion(AOBT) is a therapy of re-transfusion of 100-200 mL of autologous blood after shaking and agitation with appropriate amount of oxygen-ozone in vitro. The oxidation of blood through the strong oxidation of ozone can enhance the non-specific immune response of the body, regulate the internal environment and promote health. This therapy has been increasingly applied in clinical practice, while no unified standard for the operation process in terms of ozone concentration, treatment frequency and treatment course had been established. This operation process of AOBT is primarily explored in order to standardize the operation process and ensure its safety and efficacy.

Make full use of the new imaging technology to further explore the key problems of retinal branch vein occlusion / 中华眼底病杂志

With high morbidity, branch retinal vein occlusion (BRVO) is a common retinal vascular disease in the clinic. Although the classic characteristics of BRVO have been recognized for a long time, the traditional understanding of BRVO has been challenged along with development and application of new imaging technologies, including the reasonable classification and staging of the disease, and the vascular characteristics at the occlusive site via multimodal imaging, etc. Thus, re-summarizing and refining these features as well as further improving and optimizing traditional imaging evaluation, can not only deepen the correct acknowledge of the entity, but also find biomarkers of prognosis of visual function, which is helpful to establish better diagnosis and treatment strategy. In the meanwhile, it is necessary that clinical characteristics of BRVO on imaging and the reliability of these imaging techniques are worth correct understanding and objective assessment.

Effectiveness and security of anisodine hydrobromide tablets in treating nonarteritic anterior ischemic optic neuropathy: a Chinese multicenter nonrandomized controlled study / 中华实验眼科杂志

Objective:To evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.

Analysis of eye screening data in primary and middle school students from 2019 to 2021 / 中华实验眼科杂志

Objective:To analyze the data of vision acuity from primary and secondary school students in different regions in China in a screening program performed by Huaxia Eye Hospital, and to investigate the prevalence and incidence of myopia among them.Methods:A cross-sectional study was conducted.Cross-sectional and cohort analysis of the visual acuity and refraction data of primary and secondary school students in China from 2019 to 2021 from Huaxia Eye Hospital was carried out.Myopia was defined as one eye with the uncorrected visual acuity less than 5.0 and a spherical equivalent <-0.50 D in the screening.The frequency of screening, the number of people, the distribution of vision acuity, and the distribution of myopia among subjects were compared by sexes, grades and regions, and the prevalence and incidence of myopia was analyzed.Standard logarithmic visual acuity chart was used for visual examination and automatic computerized optometry was used for refractive examination.Screening process was consistent in the study.This study protocol was approved by the Ethics Committee of Xiamen Eye Center of Xiamen University (No.XMYKZX-KY-2019-011). The written informed consent was obtained from subjects or their guardians after explaining the examination procedure, methods and purpose prior to any medical examination.Results:A total of 4 027 schools in 51 cities of 19 provinces covering 4.556 million people were included in the vision study.The prevalence of myopia in screening was 64.85% in primary and secondary school population generally, 54.0% in primary school, 78.18% in junior high school and 87.05% in senior high school.There were statistical differences in the prevalence of screening myopia in different education stages ( χ2=100.7, P<0.001). The prevalence rate in females was higher than that in males ( χ2=5 557.5, P<0.001). The incidence of myopia within a year was 18.68% in primary and secondary schools, which was 16.57% in East China, 6.07% in Central China and North China, 15.11% in Southwest and Northwest China, 9.19% in South China, and there was a statistically significant differences among them ( χ2=1 200.9, P<0.001). Conclusions:The prevalence and incidence of myopia in primary and secondary school students are still high and vary with educational stages and regional factors.Scientific prevention and control of myopia should consider the two factors.

Changes of cognitive function in non-fatal drowning rats after blast-induced traumatic brain injury / 中华创伤杂志

Objective:To investigate the changes of cognitive function in non-fatal drowning rats after blast-induced traumatic brain injury (bTBI).Methods:Eighty SD rats were divided into normal group, bTBI group, drowning group and bTBI plus drowning group according to the random number table, with 20 rats per group. Rats in normal group were not injured. In bTBI group, bTBI was established in a BST-I biological shock tube with a pressure of 4.0 MPa in the driving section. In drowning group, rats were subjected to non-fatal drowning by falling into the water with temperature of 18 ℃ and depth of 30 cm from the height of 1 m and were taken out quickly after swimming to exhaustion. After being injured in a biological shock tube, rats in bTBI plus drowning group were immediately forced to drowning using the same method. On day 3 post-injury, the neurocognitive function was evaluated by elevated plus maze and Morris water maze tests. Morphological changes of neurons in CA1 and CA3 regions of hippocampus were observed by Nissl staining, and the number of surviving neurons were counted. The concentrations of hippocampal neurotransmitters glutamate, γ-aminobutyric acid (GABA), glycine and endoplasmic reticulum stress (ERS) related glucose-regulated protein 78 (GRP78) and caspase-12 were examined by ELISA analysis. Levels of B-cell lymphoma-2 (Bcl-2), Bcl-2 associated protein (Bax) and caspase-3 were detected by Western blotting. The ratio of Bcl-2 to Bax was calculated as well.Results:In elevated plus maze test, the percentage of open arm entry and number of head-dipping behaviour were decreased in bTBI plus drowning group compared with normal and bTBI groups at 3 days after injury ( P<0.05 or 0.01), with no statistical difference from those in drowning group ( P>0.05). The number of head-dipping behaviour in drowning group was lower than that in bTBI group ( P<0.05). In Morris water maze test, bTBI plus drowning group showed increased target latency on the third and fourth days of spatial acquisition training and decreased number of crossing the target area and percentage of swimming time in the target quadrant during probe trials as compared with normal group ( P<0.05 or 0.01), but there was no statistical difference among bTBI, drowning and normal groups (all P>0.05). Nissl staining showed that the neurons in the CA1 and CA3 regions of hippocampus in normal group were arranged neatly with clear Nissl bodies at 3 days after injury, while the other groups showed different degrees of injury. In contrast with normal group, the neurons in the CA1 and CA3 regions of hippocampus in all other groups were decreased with the lowest number in bTBI plus drowning groups ( P<0.05 or 0.01). In ELISA analysis, the level of hippocampal glutamate in bTBI plus drowning group was higher than that in all other groups at 3 days after injury and the level in bTBI injury and drowning groups was higher than that in normal group ( P<0.05 or 0.01); the level of hippocampal glycine in bTBI plus drowning group was lower than that in normal group ( P<0.05), but there was no statistical difference among bTBI, drowning or normal groups (all P>0.05); the concentration of hippocampal GABA had no statistical difference among all groups (all P>0.05). In addition, the concentration of GRP78 in bTBI injury, drowning and bTBI injury plus drowning groups were increased compared with normal group ( P<0.05 or 0.01), but did not statistically differ from each other (all P>0.05). The concentration of caspase-12 in drowning and bTBI plus drowning groups were increased compared with normal group ( P<0.05 or 0.01), but was not statistically different from each other ( P>0.05), and its concentration in bTBI plus drowning group was increased compared with bTBI group ( P<0.05). In Western blotting, the level of Bcl-2 in bTBI plus drowning group was decreased compared with all other groups at 3 days after injury, and the level in bTBI and drowning groups were decreased compared with normal group, but a much lower level was observed in drowning group than that in bTBI group ( P<0.05 or 0.01); the level of Bax in bTBI plus drowning group was increased compared with all other groups at 3 days after injury, and the level in drowning group was increased compared with normal group ( P<0.05 or 0.01), with no statistical difference between bTBI and drowning groups ( P>0.05). The ratio of Bcl-2 to Bax in bTBI plus drowning group was decreased compared with all other groups, while the ratio in bTBI and drowning groups were decreased compared with normal group, showing a much lower level in drowning group than that in bTBI group ( P<0.05 or 0.01). Also, the level of caspase-3 in drowning and bTBI plus drowning groups were increased compared with normal and bTBI groups ( P<0.05 or 0.01), but there was no statistical difference between drowning and bTBI plus drowning groups ( P>0.05). Conclusions:Non-fatal drowning can aggravate hippocampal neuron damage in bTBI rats and cause memory, emotion and other cognitive dysfunction. The mechanism may involve the imbalance of hippocampal neurotransmitters glutamate and glycine, which activates the downstream pro-apoptotic pathway through ERS in the early stage of injury to induce hippocampal neuron apoptosis.

Polymorphism study of HLA-A, B, DRB1 alleles in patients with chronic renal failure, in Shandong Peninsula / 中国输血杂志

【Objective】 To investigate the association between HLA-A, B, DRB1 alleles and chronic renal failure (CRF) in Han population of Shandong Peninsula. 【Methods】 Sequence specific oligonucleotide probe-polymerase chain reaction (PCR-SSO) was used to genotype 880 patients with CRF in the Han population of Shandong Peninsula. The allele frequencies of HLA-A, B and DRB1 were compared with 865 hematopoietic stem cell voluntary donors, and the association between HLA gene polymorphism and CRF was analyzed. 【Results】 A total of 33 HLA-A alleles, 76 HLA-B alleles and 39 HLA-DRB1 alleles were detected in the study group. DRB1*11∶01 (6.70% vs 4.45%) and DRB1*12∶02 (8.69% vs 5.90%) in CRF group were significantly higher than those in the control(Pc<0.05), and B*15∶11 (1.82% vs 3.64%) among CRF group was significantly lower compared with the control(Pc<0.05). The frequency of three loci haplotypes A*30∶01 -B*13∶02 -DRB1*07∶01 (16.61% vs 7.61%), A*33∶03 -B*58∶01 -DRB1*03∶01 (4.57% vs 1.62%) and A*02∶07 -B*46∶01 -DRB1*09∶01 (4.06% vs 1.09%) in CRF patients were significantly higher than that of the control(Pc<0.05), which were strongly correlated with CRF. 【Conclusion】 The data on the association of HLA-A, B, DRB1 alleles and haplotype polymorphisms with CRF in Shandong Peninsula has been obtained in this study. DRB1*11∶01 and DRB1*12∶02 may be the susceptibility risk factors for development of CRF, and B*15∶11 may be protective genes against development of CRF, and A*30∶01 -B*13∶02 -DRB1*07∶01, A*33∶03 -B*58∶01 -DRB1*03∶01 and A*02∶07 -B*46∶01 -DRB1*09∶01 may be the susceptible haplotypes in Han population of Shandong Peninsula.

Retrospective and cost-effective analysis of the result of Changsha Municipal Public Welfare Program by Noninvasive Prenatal Testing / 中华医学遗传学杂志

OBJECTIVE@#To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program.@*METHODS@#A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed.@*RESULTS@#NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035.@*CONCLUSION@#NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.

Analysis of prognostic factors for acral lentiginous melanoma based on SEER database / 中华皮肤科杂志

Objective:To investigate prognostic factors for acral lentiginous melanoma (ALM) , and to construct a nomogram to verify the predictive value of these factors.Methods:Clinical data on 1 573 patients with ALM were collected from the Surveillance, Epidemiology, and End Results (SEER) database of National Cancer Institute in United States between 2004 and 2015. Data about patients′ age, gender, ulcer status, SEER staging, surgical protocols, T-, N- and M-staging, overall survival rates and disease-specific survival rates were extracted. Chi-square test was used to analyze the correlation of clinical characteristics with overall survival rates and melanoma-specific survival rates, and univariate and multivariate Cox proportional hazards regression models were used to investigate prognostic factors and establish predictive models.Results:Among the 1 537 patients with ALM, 714 were males, 823 were females, 818 were under 64 years of age, and 1 363 were Caucasian. Skin lesions occurred on the lower limbs and buttocks in 1 205 cases, and 974 cases had ulcers; according to the SEER staging, non-spread localized skin lesions were observed in 1 048 cases. There were significant differences in the mortality rate among patients of different ages at diagnosis, different gender, with different ulcer status, surgical status, and at different SEER stages, T-stages, N-stages and M-stages (all P < 0.001) . Univariate and multivariate Cox regression analysis showed that age ≥ 65 years, male, ulcers and distant lymph node metastasis in the SEER staging were associated with increased risk of death in the patients (all P < 0.05) , and the mortality rate was significantly higher in the patients with T2-, T3- or T4-stage ALM than in those with T1-stage ALM (all P < 0.05) , and higher in the patients with N1-, N2- and N3-stage ALM than in those with N0-stage ALM (all P < 0.05) . Conclusion:Age, gender, ulcer status, SEER stage, T-stage and N-stage are independent prognostic factors for overall survival rates and disease-specific survival rates of ALM.

Analysis of intrinsic capacity and influencing factors in community-dwelling elderly people / 中华老年医学杂志

Objective:To investigate the level of intrinsic capacity in community-dwelling elderly people and the influencing factors, in order to provide supporting evidence for the improvement of intrinsic capacity, formulation of management strategies, and promotion of quality of life for the elderly.Methods:A cross-sectional survey was carried out from November 2020 to December 2020 with 236 community-dwelling elderly people in Beijing, who were recruited through a convenience sampling method.The investigation used questionnaires for general data and influencing factors for intrinsic capacity, and the World Health Organization intrinsic capacity questionnaire.Multivariate logistic regression was used to analyze the influencing factors for intrinsic capacity of the elderly.Results:Among 236 community-dwelling elderly people, 132(55.9%)had fair intrinsic capacity(≥4 points)and 104(44.1%)had poor intrinsic capacity(<4 points), with an average score of(3.39±0.95). Multiple Logistic regression analysis results showed that sex( OR=2.005, 95% CI: 1.093-3.676, P=0.025), age( OR=1.727, 95% CI: 1.043-2.860, P=0.034), social participation( OR=0.321, 95% CI: 0.170-0.604, P<0.001), entertainment( OR=2.073, 95% CI: 1.079-3.985, P=0.029), exercise( OR=2.975, 95% CI: 1.761-3.784, P=0.039), sleep( OR=0.508, 95% CI: 0.265-0.973, P=0.041), and emotions( OR=0.436, 95% CI: 0.196-0.970, P=0.042)were influencing factors for intrinsic capacity of community-dwelling elderly people. Conclusions:The intrinsic capacity of community-dwelling elderly people is in the middle range.Sex, age, social participation, entertainment, exercise, sleep, and emotions can affect intrinsic capacity.Therefore, intervention strategies based on influencing factors and improvement of lifestyles can help maintain good intrinsic capacity and reduce adverse effects of major health events.

Study on injury parameters of severe blast injury in mice at plain and plateau based on equivalent trauma / 中华危重病急救医学

Objective:To explore the establishment of the interconvertible injury parameters of same severe blast injury in mice at plain and plateau.Methods:A total of 157 C57BL/6 male mice were randomly divided into plain control group (8 mice), plain injury group (77 mice), plateau control group (8 mice) and plateau injury group (64 mice) according to random number table method. The mice in plateau control group and plateau blast injury group had been placed in animal experimental low-pressure oxygen chamber to simulate 4 000 meters plateau environment for 5 days in advance. Then the mice in plain blast injury group and plateau blast injury group were put into biological shock tube, respectively. Different pressures of the driving section were selected to establish the severe blast injury models in mice at plain and 4 000 meters plateau to reach approximately 70% mortality within 72 hours. The equivalent traumatic condition at 24 hours after blast injury in different groups was verified by the series of experiments including gross autopsy, lung wet/dry weight ratio (W/D), hematoxylin-eosin (HE) staining and histological scoring.Results:The mice mortality were basically consistent between the plain injury group (65%) and plateau injury group (75%) when 5.4 MPa and 4.0 MPa of the driving section pressures were chosen, respectively. Compared with the corresponding control groups, the lungs showed massive hemorrhage (patchy and diffuse) with significant pulmonary edema in both plain 5.4 MPa-injured group and the plateau 4.0 MPa-injured group at 24 hours after blast injury. Compared with the plateau control group, the pulmonary W/D ratio were significantly increased in the plateau injury group (5.579±0.646 vs. 4.476±0.076, P < 0.05), while the difference between plateau injury group and the plain control group was not statistically significant (5.303±1.020 vs. 4.015±0.144, P > 0.05). Also, compared with the corresponding control groups, the analysis of lung histopathological sections showed that there were several pathological changes including large alveolar rupture and fusion, thickened alveolar walls, and a small amount of inflammatory cell infiltration in the alveolar lumen in the groups of plain 5.4 MPa and plateau 4.0 MPa. In addition, the histopathological scores of lung in the groups of plain 5.4 MPa and plateau 4.0 MPa were significantly higher than that in corresponding control group (8.67±0.82 vs. 1.67±0.52, 9.00±1.10 vs. 2.17±0.41, both P < 0.05), however, there was no statistical difference for the above score between plain blast injury group and plateau blast injury group. Conclusions:The pressures of driving section 5.4 MPa and 4.0 MPa are injury parameters to establish equivalent severe blast injury in mice at plain and plateau, respectively, which can be converted to each other. This study provides support for the application and evaluation of prevention and treatment technology for severe blast injury in special environment.

Meta-analysis of the efficacy and safety of percutaneous gastrostomy in stroke patients / 中华临床营养杂志

Objective:To systematically evaluate the efficacy and safety of enteral nutrition via percutaneous endoscopic gastrostomy (PEG) and nasogastric feeding (NGF) in stroke patients.Methods:Databases including PubMed, EMbase, Cochrane Library, Wangfang database (Wangfang data), CNKI and CBM were searched for relevant literature about enteral nutrition via percutaneous gastrostomy in stroke patients. Literature screening, data extraction and quality evaluation of the included study were performed by two independent investigators. RevMan5.3 was used for data analysis.Results:A total of 12 publications were included, of which 7 were randomized controlled trials (RCTs) and 5 were non-RCTs. There were no significant differences in BMI, hemoglobin, serum albumin and mortality. In terms of safety, PEG resulted in effective decreases in the incidence of pneumonia (RR=0.31, 95% CI: 0.18-0.53, P<0.01), hypoproteinemia (RR=0.34, 95% CI: 0.17-0.68, P=0.003) and fluid and electrolyte disorder (RR=0.24, 95% CI: 0.06-0.92, P=0.04) compared with NGF while there was no significant difference in the incidence of abdominal distension, diarrhea and gastrointestinal bleeding .Conclusion:Compared with NGF, enteral nutrition with PEG can effectively reduce the incidence of pneumonia and the risk of infections in stroke patients and can also reduce the incidence of hypoproteinemia and fluid and electrolyte disorder, leading to improved patient outcomes.

Clinical studies on the treatment of Type Ⅱ Diabetic Foot Ulcer treated by Traditional Chinese Medicine compound Tangnaikang combined with conventional western medicine treatment / 国际中医中药杂志

Objective:To observe the clinical effects of Traditional Chinese Medicine (TCM) Tangnaikang granules, supplementing to conventional treatment methods, on type 2 diabetic foot ulcer.Methods:A total of 67 patients, from Beijing University of Chinese Medicine subsidiary Dongfang Hospital, Tuanjie Lake Community Health Service Center, Qingta Community Health Service Center between August, 2019 and November, 2020 were assigned to treatment group (37 patients) and control group (30 patients) using sealed envelope randomization method. The control group underwent conventional treatment methods that manage blood sugar and treat infections. The treatment group received, in addition to the conventional treatment methods administered to the control group, Tangnaikang granules. Both groups were continuously treated for 90 days. The TCM symptom scores, granulation tissue scores, visual analogue scale (VAS), itching scores and Generic Quality of Life Inventory-74 (GQOL-74) score, wound area were observed pre- and post-treatment. The ELISA kits were used to detect the Vascular Endothelial Growth Factor (VEGF), Epidermal Growth Factor (EGF), Basic Fibroblast Growth Factor (bFGF), fasting blood glucose level, glycated hemoglobin test (HbA1c), fasting insulin level, postprandial 2 hour insulin level, insulin resistance index. And all possible adverse events were noted. The overall clinical treatment effects and TCM symptom treatment effects were assessed.Results:Total effective rate for the treatment group 89.2% (33/37), was significantly different from that of the control group 70.0% (21/30) with χ2=3.90 and P<0.01. The TCM symptom effective rate was 86.5% (32/37) for the treatment group and 63.3% (19/30) for the control group. The difference was statistically different with χ2=4.88 and P<0.01. After treatment, whole blood viscosity, plasma viscosity, fibrinogen and erythrocyte sedimentation rate (ESR) of the treatment group were significantly improved than those of the control group ( t=-23.38, -8.01, 18.10, -18.93,all Ps<0.01). The ulcer closure area (5.43±1.65 cm 2vs. 4.65±1.14 cm 2, t=2.20) and ulcer closure area percentage (59.14%±3.37% vs. 42.42%±3.21%， t=20.63) were statistically different of both groups ( P<0.05 or P<0.01). The VEGF, EGF, and bFGF at 90 day of the treatment group were significantly higher than those of the control group ( t=3.19, 40.59, 28.53, all Ps<0.01). The post-treatment fasting blood glucose level, insulin resistance index of the treatment group were significantly lower than those of the control group ( t=-8.55, -21.38, all Ps<0.01). TCM symptoms of thirsty, feverish sensation in chest, palms and soles in the treatment group were significantly improved than the control group ( χ2=4.38, 4.48, all Ps<0.01). Conclusion:TCM compound Tangnaikang granules can relieve diabetic foot ulcer, reduce wound healing time and improve overall treatment outcome, when it was combined of the conventional treatment.

Anti-tumor Effect of Ligustrazine Alone and in Combination with Western Medicine： A Review / 中国实验方剂学杂志

With serious environmental problems and the aging of population， the incidence of cancers worldwide has increased dramatically. For modern medicine， cancer is an incurable malignant disease with a high metastasis rate and strong cell proliferation and invasion ability. At present， clinical anti-cancer therapies mainly include chemotherapy and radiotherapy， but most chemotherapy drugs can cause serious side effects. Therefore， Chinese medicine with high safety has been widely used in anti-cancer treatment， which can inhibit the proliferation of cancer cells， improve the quality of life， and prolong life. Ligustrazine is a pyrazine alkaloid isolated and purified from Chuanxiong Rhizoma， which has pharmacological effects， such as anti-fibrosis， anti-oxidation， and anti-tumor. In recent years， ligustrazine， as an index active component of Chuanxiong Rhizoma alkaloids， has gradually become one of the hot spots in clinical medical research due to its pharmacological actions， and its anti-tumor effect has attracted more attention from researchers. The present study mainly investigated the anti-cancer effect of ligustrazine from the induction of tumor cell apoptosis and autophagy， inhibition of cell proliferation and migration， reversal of multidrug resistance of cancer cells， and inhibition of angiogenesis， and the anti-tumor efficacy was observed in various malignancies such as gastric cancer， lung cancer， rectal cancer， bladder cancer， breast cancer， and ovarian cancer. In addition， ligustrazine can be combined with cisplatin， paclitaxel， podophyllotoxin， chalcone， curcumin， and other drugs to exert an anti-tumor effect. This study conducted a literature review based on the anti-tumor mechanism of ligustrazine to provide a reference for the treatment of clinical malignancies.

Clinical characteristics of infective endocarditis in elderly patients with cerebral infarction as the initial presentation / 中华老年医学杂志

Objective:To investigate the clinical characteristics, diagnosis, treatment and prognosis of infective endocarditis(IE)in elderly patients with cerebral infarction as the first presentation.Methods:The clinical data of 5 elderly infective endocarditis patients with cerebral infarction as the first presentation diagnosed and treated in Beijing Shijitan Hospital, Capital Medical University from October 2010 to December 2021 were retrospectively analyzed, and national and international reports from January 1998 to December 2021 on IE in the elderly with cerebral infarction as the first presentation were collected.The clinical characteristics, diagnosis and prognosis were analyzed and summarized.Results:A total of 18 IE cases with cerebral infarction as the first presentation were reviewed, including 5 cases from our hospital.The male to female ratio was 5∶1, and the median age was 70.5 years.IE was diagnosed several hours to 4 months after the onset of cerebral infarction.All the patients had speech impairment symptoms and most of them exhibited hemiparesis.The National Institute of Health Stroke Scale(NIHSS)scores ranged between 2-35.All 18 patients underwent blood culture, and streptococci were the most common pathogens.Most of the lesions were located in the blood supply area of the middle cerebral artery or the junction between the middle cerebral artery and the posterior cerebral artery.Echocardiography showed that mitral valve vegetations were the dominant features, followed by aortic valve vegetations.All 18 patients received antibiotic treatment, 2 underwent valve replacement and removal of vegetations, and 11 underwent intravenous thrombolysis or mechanical thrombectomy.50.0% of patients(9 cases)had a good prognosis and one third(6 cases)died.Conclusions:Cerebral infarction is the first presentation in some elderly IE patients, and misdiagnoses are common, but half of patients can have a good prognosis after timely anti-infection and surgical treatment.

Analysis of risk factors for atrial fibrillation in elderly Chinese patients with severe valvular heart disease / 中华老年医学杂志

Objective:To explore the risk factors for atrial fibrillation(AF)in elderly Chinese patients with severe valvular heart disease(VHD).Methods:This was a cross-sectional study and consecutively enrolled 978 elderly patients with severe VHD diagnosed in 18 Class A tertiary hospitals across the country from September 2021 to March 2022, including 322(32.9%)patients with concurrent AF.Clinical and echocardiographic data were collected to analyze the risk factors for AF.Results:Among VHD patients, compared with the non-AF group, the AF group was older, had a higher female ratio, higher diastolic blood pressure, higher proportions with cerebrovascular disease and chronic kidney disease, lower serum low density lipoprotein cholesterol and higher serum creatinine, amino-terminal A-type natriuretion peptide and glycosylated hemoglobin.As for echocardiographic parameters, the left atrial diameter was larger, the left ventricular end-diastolic diameter, interventricular septum thickness, and left ventricular posterior wall thickness were smaller in the AF group than in the non-AF group.All of the differences were statistically significant(all P<0.05). The results of multivariate Logistic regression analysis showed that the left atrial anteroposterior diameter increased( OR=1.166, P<0.01), the left ventricular end-diastolic diameter decreased( OR=0.929, P<0.01), and advanced age( OR=1.051, P<0.05)was an independent risk factor for elderly VHD patients with concurrent AF. Conclusions:In elderly patients with severe VHD, advanced age, an increased left atrial anteroposterior diameter, and a decreased left ventricular end-diastolic diameter were independently associated with AF.Therefore, evaluation of cardiac structure and regular follow-up should be performed in elderly patients with severe VHD for early intervention to reduce the incidence of AF.

Gene cloning, heterologous expression and activity identification of latroeggtoxin-Ⅵ / 生物工程学报

One of the distinct characters of Latrodectus tredecimguttatus is that its toxic components exist not only in the venomous glands, but also in the tissues outside the venomous glands and even in the eggs. Investigation on the toxins outside the venomous glands can deepen our understanding of spider toxins and discover new lead molecules with important application prospects. In order to explore the low-abundance proteinaceous toxins in the L. tredecimguttatus eggs, we used bioinformatic strategies to mine a gene sequence encoding a peptide toxin from the transcriptome of L. tredecimguttatus eggs, and then heterologously expressed the gene successfully with a 3'-RACE combined with nest PCR strategy. Biological activity analyses indicated that the expressed peptide toxin, named latroeggtoxin-Ⅵ (LETX-Ⅵ), could inhibit Na⁺ channel currents in ND7/23 cells and promote dopamine release from PC12 cells, without obvious toxicity against Periplaneta americana and bacteria as well as fungi including Staphylococcus aureus and Candida albicans, demonstrating that LETX-Ⅵ is a mammal-specific neurotoxin with a potential application prospect in development of the tool reagents for neurobiological study and the drugs for treating related diseases.

Electronic crossmatching based on Rh typing: reducing the production of Rh system alloantibody in blood transfusion recipients / 中国输血杂志

【Objective】 To study the application of electronic crossmatching(E-XM) based on Rh typing aimed at reducing the production of alloantibodies in blood recipients. 【Methods】 A total of 22 528 RhD positive patients, admitted to our hospital from Jan 1, 2018 to Mar 31, 2020, required the specific transfusion of leukocyte-depleted suspension red blood cells. Among which, 21 334 reached the priority level Ⅰ and Ⅱ by E-XM and were set as the control group, and 1 194 reached the priority level Ⅲ and were set as the experimental group. ABO and Rh (D, C, c, E and e antigens) blood group systems were serologically tested both in blood recipients and donors, and Rh phenotype database was established based on the blood transfusion management system. The incidence of irregular antibodies against the exposure of new antigens involved with RBC transfusions in the control group and the experimental group was compared. 【Results】 The proportion of antigen C and e was significantly higher than that of c and E. The frequency of DCCee and DCcEe were the highest, while that of Dccee and DCCEE were extremely low. 85.2% and 9.5% of the patients reached priority level Ⅰ and Ⅱ, respectively, and only 5.3% reached priority level Ⅲ. 6 patients(less than 0.001%) in the control group (n=21 334), developed Rh system alloantibodies after blood transfusion, and 24 patients(2.01%) in the experimental group (n=1194) developed Rh alloantibodies against the exposure of antigens after blood transfusion. There were significant differences between the experimental group and the control group (P<0.01). 【Conclusion】 The application of E-XM could minimize the incidence of Rh irregular antibodies after RBC transfusion in patients, which contributes to the safety in clinical blood transfusion.

The distribution characteristics of Rh phenotype and haplotype frequency in Qingdao: An analysis based on some patients and local blood donors / 中国输血杂志

【Objective】 To investigate the distribution characteristics of Rh blood group antigen phenotypes, haplotypes and irregular antibodies between patients in our hospital and local blood donors, so as to ensure safe and effective blood transfusion and improve the rationality and scientificity of clinical blood transfusion. 【Methods】 A total of 113 326 blood samples, from hospitalized patients in our hospital and local blood donors from October 2015 to March 2020, were subjected to Rh antigen typing and irregular antibody detection. The frequency of Rh phenotypes, haplotypes, and irregular antibodies were retrospectively analyzed and calculated. Chi square test was used to compare the data among different population groups. Rh antigen typing and irregular antibody detection were completed using the automatic blood group analyzer. 【Results】 The prevalence of negative RhD was 0.36% (408/113 326). The most prevalent Rh phenotype was DCCee [40.69%(46 112/ 113 326)] followed by DCcEe [36.82%(41 727/ 113 326)]. Anti-E was the most common irregular antibody, accounting for [0.26%(295/ 113 326)], and DCe [62.51%(70 840/ 113 326)] was the most common haplotype. The most common Rh phenotypes and haplotypes in Caucasians in Germany, North Indian and North African were DCcee, DCCee and Dccee, while DCe, DCe and Dce, respectively. 【Conclusion】 The distribution characteristics of Rh phenotypes, haplotypes and irregular antibodies of patients in our hospital and local blood donors were in line with the distribution characteristics of the population in northern China. Corresponding plans concerning blood storage and collection, as well as the establishment of Rh blood type registry should be carried to effectively ensure the safety, rationality and accuracy of clinical blood transfusion.