Trends in cardiovascular death related to mechanical complications of cardiac electronic devices in the United States from 1999 to 2020

Background@#While cardiac implantable electronic devices (CIED) are increasingly used, real-world data on the mortality rate due to mechanical complications of CIED is scarce. @*Objective@#This study aimed to determine longitudinal trends in mortality attributed to mechanical complications of CIED. @*Methods@#We queried the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research and performed serial cross-sectional analyses of national death certificate data for mechanical complications of CIED-related mortality among the United States population aged ≥ 35 years from 1999 to 2020. Cardiovascular disease (ICD-10: I00–I99) was listed as the underlying cause of death, and mechanical complication of the cardiac electronic device (ICD-10: T82.1) was stated as the contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals. Linear regression was used to calculate for the significance of the annual percent of changes in AAMRs. @*Results@#1237 cardiovascular deaths related to mechanical complications of CIED were identified between 1999 and 2020. The AAMR dropped significantly from 0.45 per 1,000,000 individuals in 1999 to 0.21 per 1,000,000 individuals in 2020 (p < 0.01). Cumulative AAMRs were higher in males than females (0.39 per 1,000,000 individuals vs. 0.26 per 1,000,000 individuals, p < 0.01), higher in White populations than African American populations (0.32 per 1,000,000 individuals vs. 0.30 per 1,000,000 individuals, p < 0.01), and higher in the rural areas than in the urban areas (0.50 per 1,000,000 individuals vs. 0.27 per 1,000,000 individuals, p < 0.01). @*Conclusion@#While the cardiovascular deaths related to mechanical complications of CIED were decreasing over the past decades, disparities in the AAMRs across sex, races and geographical region still present.

Bayesian Network Meta-analysis of Therapeutic Effect of Oral Chinese Patent Medicines on Coronary Artery Disease Complicated with Carotid Atherosclerosis / 中国实验方剂学杂志

ObjectiveTo compare the therapeutic effects of oral Chinese medicines （including Chinese patent medicines） on coronary artery disease （CAD） by the Bayesian network Meta-analysis. MethodThe randomized controlled trials of treating CAD with oral Chinese medicines were retrieved from the China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， Web of Science， Embase， and Cochrane Library from the inception to December 1， 2022. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included articles. The direct meta-analysis was performed to compare the performance of oral Chinese medicines alone and in combination with Western medicine in the treatment of CAD in terms of intima-media thickness （IMT）， vascular endothelial function， plaque score， hypersensitive C-reactive protein （hs-CRP）， total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， and total response rate. Furthermore， the Bayesian network Meta-analysis was performed to compare the therapeutic effects of different Chinese medicines. ResultA total of 41 articles were included. The direct meta-analysis results showed that Chinese medicines combined with Western medicine outperformed Western medicine alone in recovering all the indicators of CAD. The Bayesian network meta-analysis yielded the following results. In terms of the total response rate， modified Huangqi Guizhi Wuwutang and Sanqi Huayu pills had obvious advantages over other Chinese medicines. In terms of IMT and plaque score， Xiaoban Huazhuo decoction， Yiqi Tongluo formula， Ruangan Jiangzhi capsules， and Guanxin Shutong capsules had obvious advantages over other Chinese medicines. In terms of blood lipid indicators， Shenqi Roumai mixture， Ruangan Jiangzhi capsules， Xiaoban Huazhuo decoction， Qiwei Sanxiong decoction， and Sanqi Huayu pills were superior to other Chinese medicines. The Chinese medicines above mainly had the functions of activating blood， resolving stasis， resolving phlegm， and dredging vessels. ConclusionThe combination of oral Chinese medicines and Western medicine is effective in treating CAD. Clinicians can use the drugs targeting abnormal indicators according to the results of this Bayesian network meta-analysis combined with the actual situation of patients to achieve better therapeutic effects.

Research progress in genus Alistipes and its association with diseases / 中华微生物学和免疫学杂志

The genus Alistipes is mailnly isolated from the human gut microbiome and belongs to the phylum Bacteroidetes. Various species of the genus Alistipes have been isolated from samples of human feces, patients with appendicitis, abdominal cavity and rectal abscesses. Currently, this genus includes species such as Alistipes finegoldii, Alistipes putredinis, Alistipes onderdonkii, Alistipes shahii and Alistipes timonensis. Some studies have shown that Alistipes has a protective effect against certain diseases, including pancreatic cancer, Alzheimer′s disease, liver fibrosis and cardiovascular disease. Conversely, other studies have shown that Alistipes is pathogenic in some diseases such as Parkinson′s disease, colorectal cancer and depression. In addition, Alistipes has also been proved to play a paradoxical role in colitis as it can promote the development of colitis and suppress inflammation. This article was to increase the understanding about the genus Alistipes and to further summarize the relationship between Alistipes and diseases.

Label-free target discovery technology of small molecule drug and its application in traditional Chinese medicines / 药学学报

The discovery of drug targets plays a crucial role in drug research. Accurate information of small molecule drug-protein interaction can be provided by label-free target discovery technology without any structural modification at the small molecule. So, the label-free drug target discovery technology had become the powerful tool to discover the targets of drugs. Due to the “multi-component and multi-target” characteristics of traditional Chinese medicines (TCMs), the research on its targets and mechanism had been restricted. Based on potential of the label-free target discovery technology in the research of TCMs, this paper summarized the label-free target discovery technology and its application in TCMs research. It will provide a reference for the discovery of targets of TCMs and a new view for promoting the modernization of TCMs.

Patterns of Failure After Minimally Invasive Esophagectomy and Evaluation of Value of Adjuvant Therapy for Esophageal Cancer / 肿瘤防治研究

The current recommendation for postoperative radiotherapy for esophageal cancer in China is mainly based on the data of incomplete two-field dissection of open left thoracotomy. At present, the type of surgery for esophageal cancer gradually transitions from open left thoracotomy to open right thoracotomy and from open esophagectomy to minimally invasive esophagectomy (MIE). Patients with early-stage esophageal cancer are selected as candidates for MIE. MIE is less invasive than open esophagectomy, and the right thoracic approach is conducive to more thorough lymph node dissection. However, few data and related studies are available on the patterns of failure after MIE in esophageal cancer, and guiding an adjuvant therapy is difficult. The feasibility of an adjuvant therapy for selective high-risk patients and the optimized treatment after MIE remains to be explored in clinical practice. In this regard, this article aims to review the safety of MIE, long-term survival outcomes, postoperative recurrence patterns, and recurrence rates of patients to discuss the value of postoperative adjuvant therapy and guide clinical treatment.

Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF) / 中华内科杂志

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Study on regulation of CYP450 enzyme system to reduce liver toxicity through compatibility of Aconiti Kusnezoffii Radix Cocta with Chebulae Fructus and Glycyrrhizae Radix et Rhizoma / 中国中药杂志

Aconiti Kusnezoffii Radix Cocta is one of the most commonly used medicinal materials in Mongolian medicine. Due to the strong toxicity of Aconiti Kusnezoffii Radix Cocta, Mongolian medicine often uses Chebulae Fructus, Glycyrrhizae Radix et Rhizoma to reduce the toxicity, so as to ensure the curative effect of Aconiti Kusnezoffii Radix Cocta while ensuring its clinical curative effect, but the mechanism is not clear. The aim of this study was to investigate the effects of Chebulae Fructus, Glycyrrhizae Radix et Rhizoma and Aconiti Kusnezoffii Radix Cocta on the mRNA transcription and protein translation of cytochrome P450(CYP450) in the liver of normal rats. Male SD rats were randomly divided into negative control(NC) group, phenobarbital(PB) group(0.08 g·kg~(-1)·d~(-1)), Chebulae Fructus group(0.254 2 g·kg~(-1)·d~(-1)), Glycyrrhizae Radix et Rhizoma group(0.254 2 g·kg~(-1)·d~(-1)), Aconiti Kusnezoffii Radix Cocta group(0.254 2 g·kg~(-1)·d~(-1))and compatibility group(0.254 2 g·kg~(-1)·d~(-1),taking Aconiti Kusnezoffii Radix Cocta as the standard). After continuous administration for 8 days, the activities of total bile acid(TBA), alkaline phosphatase(ALP), amino-transferase(ALT) and aspartate aminotransferase(AST)in serum were detected, the pathological changes of liver tissue were observed, and the mRNA and protein expression levels of CYP1 A2, CYP2 C11 and CYP3 A1 were observed. Compared with the NC group, the serum ALP, ALT and AST activities in the Aconiti Kusnezoffii Radix Cocta group were significantly increased, and the ALP, ALT and AST activities were decreased after compatibility. At the same time, compatibility could reduce the liver injury caused by Aconiti Kusnezoffii Radix Cocta. The results showed that Aconiti Kusnezoffii Radix Cocta could inhibit the expression of CYP1 A2, CYP2 C11 and CYP3 A1, and could up-regulate the expression of CYP1 A2, CYP2 C11 and CYP3 A1 when combined with Chebulae Fructus and Glycyrrhizae Radix et Rhizoma. The level of translation was consistent with that of transcription. The compatibility of Chebulae Fructus and Glycyrrhizae Radix et Rhizoma with Aconiti Kusnezoffii Radix Cocta could up-regulate the expression of CYP450 enzyme, reduce the accumulation time of aconitine in vivo, and play a role in reducing toxicity, and this effect may start from gene transcription.

Impact of multi-leaf collimator positioning accuracy on quality control of volumetric modulation arc therapy plan for cervical cancer treated with Elekta linear accelerator / 南方医科大学学报

OBJECTIVE@#To investigate the influence of positioning accuracy of the multi-leaf collimators (MLC) on the passing rate of the plan dose verification for volumetric modulation arc therapy (VMAT) of cervical cancer using an Elekta linear accelerator.@*METHODS@#The dose distributions were measured using Sun Nuclear's Mapcheck and Arccheck semiconductors matrix before and after MLC calibration in30 cervical cancer patients undergoing VMAT. Dosimetric comparisons were performed with 2D and 3D gamma passing rates of 3%, 3 mm and 2%, and 2 mm. The 3D gamma distribution was reconstructed with respect to the patient's anatomy using 3DVH software to evaluate the possible influence of MLC positioning accuracy.@*RESULTS@#Before and after MLC calibration, the gamma passing rates of Mapcheck were (88.80±1.81)% and (99.25 ± 0.53)% under 3% and 3 mm standard, respectively, with an average increase of 10.45%. The corresponding gamma passing rates of Arccheck were (87.61±1.98)% and (98.13±0.99)%, respectively, with an average increase of 10.52%. The gamma passing rates of 3DVH were (89.87±2.28)% and (98.3±1.15)%, respectively, with an average increase of 8.43%.@*CONCLUSION@#The MLC positioning accuracy is one of the main factors influencing dosimetric accuracy of VMAT for cervical cancer. The application of Autocal software facilitates MLC calibration and improves the accuracy and safety of VMAT delivery for cervical cancer.

Mechanism of Polygonati Rhizoma on Treating Osteoporosis Based on Network Pharmacology and Preliminary Verification / 中国实验方剂学杂志

ObjectiveTo explore the potential mechanism of Polygonati Rhizoma on the treatment of osteoporosis （OP） based on network pharmacology and molecular docking method and to verify the mechanism by experiments. MethodThe main active ingredients and corresponding targets of Polygonati Rhizoma were screened out from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） 2.3 by conditional searching. The treatment targets were obtained from the genes related to OP and DisGeNET 7.0. The potential target genes of Polygonati Rhizoma for treating OP were obtained by the crossing of the corresponding targets and the treatment targets. Cytoscape 3.7.1 was used to construct the “Polygonati Rhizoma-active ingredient-potential target” network. The protein-protein interaction （PPI） analysis was carried out by STRING 11.0， and the PPI network was constructed. Metascape 3.5 was used to conduct Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analyses of the key targets. The core ingredients and key targets of Polygonati Rhizoma were selected for molecular docking by AutoDock Vina 1.1.2. Finally， the effect of β-sitosterol on osteogenic differentiation of MC3T3-E1 cells in rats was observed. ResultTwelve active ingredients and 32 potential targets of Polygonati Rhizoma for OP treatment were screened out. Six active ingredients including baicalein and β-sitosterol and key targets including protein kinase 1 （Akt1）， tumor suppressor p53 （TP53）， vascular endothelial growth factorA （VEGFA）， proto-oncogene Jun （JUN）， matrix metalloproteinase-9 （MMP-9）， and proto-oncogene c-Fos （FOS） were obtained by Cytoscape 3.7.1 topological analysis. A total of 995 GO entries and 181 signaling pathways involving the response to reactive oxygen species and regulations of growth were obtained from GO and KEGG enrichment analyses. The results of molecular docking showed that the core active ingredients possessed good binding activities with the respective key targets. The results of cell experiments showed that β-sitosterol promoted the osteogenic differentiation at the concentration of 2.5 μmol·L-1 and 5 μmol·L-1. ConclusionPolygonati Rhizoma had the therapeutic effect on treating OP by regulating inflammation， oxidative stress， apoptosis， and metabolism. The β-sitosterol significantly promoted the osteogenic differentiation of MC3T3-E1 cells.

Clinical efficacy of combined therapy in children with stage 4 neuroblastoma / 中国当代儿科杂志

OBJECTIVES@#To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma.@*METHODS@#A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021.@*RESULTS@#The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years.@*CONCLUSIONS@#Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.

Evaluation of the value of postoperative radiotherapy for esophageal squamous cell carcinoma based on the patterns of failure after right thoracotomy / 中华放射肿瘤学杂志

The current recommendation for postoperative radiotherapy for esophageal cancer in China is mainly based on the data of incomplete two-field dissection of the left thoracotomy (category 2B evidence). However, the surgery of esophageal cancer is undergoing a period of transformation, which has gradually transitioned from left thoracotomy to right thoracotomy, and from open surgery to minimally invasive surgery. Compared with incomplete two-field dissection of left thoracotomy, complete two-field / cervical thoracic and abdominal three-field dissection of right thoracotomy could more thoroughly dissect the upper mediastinum and cervical lymph nodes. Hence, theoretically, it yields a lower recurrence rate of regional lymph nodes and prolongs the survival time. However, under the new technical conditions, whether the tumor recurrence pattern and recurrence rate after esophageal cancer surgery will change significantly compared with the past, whether postoperative radiotherapy still has the value of local control and survival benefits, and whether the indications of postoperative radiotherapy need to be adjusted accordingly have not been determined. Based on the above considerations, the changes in surgical methods for esophageal cancer at the current stage, the survival status of right thoracotomy and postoperative patterns of failure were summarized, aiming to evaluate the value of adjuvant radiotherapy under the condition of right thoracotomy.

Research on revision of origins to Chinese medicinal materials in 2020 edition of Chinese pharmacopoeia / 中国中药杂志

The origins of 9 species of the Chinese medicinal materials in the 2015 edition of the Chinese pharmacopoeia(ChP) has revised in the 2020 edition of ChP. The revision is based on the investigation and textual research on the problems found after screening the original plants, animals or minerals of all the Chinese medicinal materials in the 2015 edition. Among them the Chinese names of Alismatis Rhizoma, Cassiae Semen, Coicis Semen, Corydalis Bungeanae Herba and Echinopsis Radix all do not match to the Latin scientific names, and also do not match the name of the actual medicinal origins. In addition, Alismatis Rhizoma has the omission of original plant. There is confusion about the Chinese name and the family name of the original insect of Cera Chinensis. The original mineral of Gypsum Fibrosum has the wrong group names. Alumstone and melanterite, the original mineral of Alumen and Melanteritum respectively, of which the group names are missing. To solve these problems, field survey and literature research were conducted on the medicinal materials and their origins. The source of these problems are explored. The correct origins and the Chinese names or Latin names are all determined according to the research results to the situation, in which the Chinese and Latin names of the original plants of the medicinal materials do not match. The correct family name and group name are obtained through textual research by taxonomy if the names are confused or mis-sing. The scientific evidence and correct results of revision in the 2020 edition of ChP are determined at last.

Bendamustine treatment of Chinese patients with relapsed indolent non-Hodgkin lymphoma: a multicenter, open-label, single-arm, phase 3 study / 中华医学杂志(英文版)

BACKGROUND@#Bendamustine was approved in China on May 26th, 2019 by the National Medical Product Administration for the treatment of indolent B-cell non-Hodgkin lymphoma (NHL). The current study was the registration trial and the first reported evaluation of the efficacy, safety, and pharmacokinetics of bendamustine in Chinese adult patients with indolent B-cell NHL following relapse after chemotherapy and rituximab treatment.@*METHODS@#This was a prospective, multicenter, open-label, single-arm, phase 3 study (NCT01596621; C18083/3076) with a 2-year follow-up period. Eligible patients received bendamustine hydrochloride 120 mg/m2 infused intravenously on days 1 and 2 of each 21-day treatment cycle for at least six planned cycles (and up to eight cycles). The primary endpoint was the overall response rate (ORR); and secondary endpoints were duration of response (DoR), progression-free survival (PFS), safety, and pharmacokinetics. Patients were classified according to their best overall response after initiation of therapy. Proportions of patients in each response category (complete response [CR], partial response [PR], stable disease, or progressive disease) were summarized along with a two-sided binomial exact 95% confidence intervals (CIs) for the ORR.@*RESULTS@#A total of 102 patients were enrolled from 20 centers between August 6th, 2012, and June 18th, 2015. At the time of the primary analysis, the ORR was 73% (95% CI: 63%-81%) per Independent Review Committee (IRC) including 19% CR and 54% PR. With the follow-up period, the median DoR was 16.2 months by IRC and 13.4 months by investigator assessment; the median PFS was 18.6 months and 15.3 months, respectively. The most common non-hematologic adverse events (AEs) were gastrointestinal toxicity, pyrexia, and rash. Grade 3/4 neutropenia was reported in 76% of patients. Serious AEs were reported in 29 patients and five patients died during the study. Pharmacokinetic analysis indicated that the characteristics of bendamustine and its metabolites M3 and M4 were generally consistent with those reported for other ethnicities.@*CONCLUSION@#Bendamustine is an active and effective therapy in Chinese patients with relapsed, indolent B-cell NHL, with a comparable risk/benefit relationship to that reported in North American patients.@*CLINICAL TRIAL REGISTRATION@#ClinicalTrials.gov, No. NCT01596621; https://clinicaltrials.gov/ct2/show/NCT01596621.

A comparative study of the effects of different treatment strategies on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer / 中华胃肠外科杂志

Objective: To compare the effects of 3 treatment strategies (emergent surgery, self-expanding metallic stents, self-expanding metallic stents plus neoadjuvant chemotherapy) on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer. Methods: A retrospective cohort study was conducted. Clinical data of patients with complete obstructive left hemicolon cancer admitted to General Surgery Department of Beijing Chaoyang Hospital between January 2017 and October 2019 were retrospectively collected. Patient inclusion criteria: (1) complete obstructive left hemicolon cancer was confirmed through clinical manifestation and abdominal computed tomography; (2) adenocarcinoma was confirmed by postoperative pathology; (3) emergent radical resection of primary tumor was performed with temporary stoma, or radical resection of primary tumor and primary anastomosis was performed without stoma, 7 to 14 days after completion of insertion of self-expanding metallic stents. Patients who did not receive stoma reversion after emergent operation were excluded. According to different therapies, patients were divided into three groups: emergent surgery (ES) group, self-expanding metallic stents (SEMS) group and self-expanding metallic stents plus neoadjuvant chemotherapy (SEMS+NAC) group. Wexner score for incotinence (higher score indicates the worse anal function), Vaizey score (>10 indicates fecal incontinence) and low anterior resection syndrome (LARS) scale (higher score indicates the worse anal function) were applied to evaluate anal function of patients among groups at postoperative 1-, 6- and 12-month. EORTC QLQ-C30 questionnaire was used to assess the quality of life. Risk factors of decreased anal function were identified by logistic regression analysis. Results: A total of 72 patients were enrolled, including 27 (37.5%) patients in ES group, 23 (31.9%) in SEMS group and 22 (30.6%) in SEME+NAC group. The baseline characteristics including age, gender, tumor location, comorbidities, total blood loss, operation time and postoperative complications, were comparable among groups, except that the proportion of laparoscopic surgery was significantly lower in ES group (4/27, 14.9%) than that in SEMS (15/23, 65.2%) and SEMS+NAC group (16/22, 72.7%) with significant difference (P<0.001). The follow-up ended up to October 2020, and the overall follow-up rate was 79.2% (57/72). No significant differences existed in the Wexner score of patients among groups at postoperative 1-, 6- and 12-month (all P>0.05). The Vaizey scores at postoperative 1-month in ES, SEMS and SEMS+NAC group were 7 (0-17), 3 (0-7) and 4 (0-8) respectively with significant difference (H=18.415, P=0.001), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). Vaizey scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The LARS scores at postoperative 1-month in ES, SEMS and SEMS+NAC groups were 20 (0-37), 15 (0-24) and 16 (0-28) respectively with significant difference (H=3.660, P=0.036), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC groups (P>0.05). LARS scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The QLQ-C30 score revealed that the social function of patients in SEMS group and SEMS+NAC group was significantly better than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). The logistic regression analysis revealed that only ES was an independent risk factor of decreased anal function (OR=2.264, 95% CI: 1.098-4.667, P=0.027). Conclusion: Compared to ES, SEMS may improve quality of life and short-term anal function of patients with complete obstructive left hemicolon cancer.

Progress in research of Müller cell reprogramming in retinal regeneration / 中华实验眼科杂志

Müller glia, the major type of glial cells in retina, is crucial for maintaining retinal homeostasis.Although Müller cells have the features to re-enter into the cell cycle and differentiate into neural cells for promoting retinal regeneration after retinal damage in zebrafish, these features are rigorously restricted in higher animals.It has been reported that the reprogramming of Müller cells cannot be activated spontaneously in higher animals, but the reprogramming ability and transdifferentiation to neuron can be achieved by induction.The neurogenic potential of mammalian Müller glia makes it promising in restoring retinal regeneration.In this article, we review the progresses of Müller glia-to-neuron transdifferentiation with respect of the origin, and summarize the pathophysiology characters of Müller glia, mechanisms of reprogramming, methods of inducing mammalian Müller glia to neuron and factors limiting Müller glia-to-neuron in higher animals.Besides, we propose the advantages as well as the current challenges of Müller glia-to-neuron transdifferentiation.

Evaluation of short-term clinical effect of minimally invasive total hip arthroplasty with direct anterior approach in lateral position / 中国骨伤

OBJECTIVE@#To investigate the short-term clinical effect of direct anterior approach (DAA) in total hip arthroplasty(THA).@*METHODS@#From January 2018 to September 2018, the data of 30 patients(33 hips) who underwent the first THA using the side lying DAA completed by the same operation team were followed up and evaluated. There were 19 males and 11 females;the age was 58 to 80 (69.0±5.4) years old;the visual analogue scale (VAS) of pain was used, Harris scoring system, operation time, intraoperative blood loss, related complications and hip radiographs were evaluated in clinical and imaging aspects.@*RESULTS@#Thirty patients (33 hips) were followed up for 12 to 20(14.3±3.7) months, operation time (66.0±7.2) min and intraoperativehemorrhage (156±32) ml. The position of acetabulum prosthesis was examined by imaging:anteversion angle (18.6±3.6)° and abduction angle (41.2±4.8)° respectively. The VAS score was improved from 7 to 9(8.1±1.4) before operation to 1 to 3(1.9±0.7) at 1 month after operation. Harris score of hip joint improved significantly, from 28 to 46(35.4±5.2) before operation to 76 to 92 (88.6±4.5) at 1 month after operation, 74 to 93 (85.6±6.9) at 6 months after operation, and 79 to 95 (90.7±8.1) at 12 months after operation, the difference was statistically significant(<0.05). Complications occurred in 3 cases of fracture of the proximal femur, including 1 case of hip sprain fracture due to careless walking one month after operation. Considering that incomplete fracture may have occurred during the operation, 1 case of avulsion fracture of anterior inferior iliac spine, no deep infection, no dislocation. There were 1 case of injury of lateral femoral cutaneous nerve and 2 cases of injury of tensor fascia lata, among which 1 case was complete incision of the edge of the hook.@*CONCLUSION@#The primary THA with DAA in lateral position has a good short;term clinical effect, can meet the needs of patients' rapid recovery, and is a safe and effective surgical approach.

Experiences of prevention and control of hospital infection in the emergency wards:the designated hospital treating new novel coronavirus disease in Shanghai as an example / 上海预防医学

Since the outbreak of novel coronavirus pneumonia, the World Health Organization and the National Health Commission have issued multiple guidance documents.Medical facilities across the nation have actively implemented the countermeasures in response to the epidemic.However, in the real scenario of prevention and control, hospital infection remains a great concern.It is crucial to formulate measures and procedures based on standard prevention and transmission route prevention to avoid cross infection between medical workers and patients.Based on the practice, we summarize the institutional management, layout process, prevention and control of hospital infection in the emergency wards for further discussion and improvement.

Screening of Components with Potential Regulation Effect in Lagotis brevituba Based on Target Cell and Molecular Docking / 中国实验方剂学杂志

Objective:To study the components with urate anion transporter 1（URAT1） regulation effect and their combination mechanisms of Lagotis brevituba by integrating techniques of HK-2 cell capture，UPLC-Q-TOF-MS and molecular docking，so as to provide material and theory bases for the development of new hypouricemic medicines based on L. brevituba. Method:The HK-2 cells were applied to capture the components of L. brevituba. UPLC-Q-TOF-MS was used to identify those components. The molecular docking technique was adopted to study the interaction mechanism between the compounds and URAT1. Result:Eight components were successfully screened and identified as hyperoside，plantamajoside，kaempferol-3-O-glucoside，lugrandoside，nepitrin，isolugrandoside，homoplantaginin，luteolin，respectively. Those components could combine with URAT1 mainly through hydrogen bond，van der Waals force and hydrophobic action，which were closely related to structure and compound types. Furthermore，the LibDock score of phenylethanoids was higher than that of flavonoids. Conclusion:The integration of target cell capture，UPLC-Q-TOF-MS and molecular docking techniques could be successfully used to identify captured compounds of L. brevituba with URAT1 regulation effects and illustrate their potential combination mechanisms as well as the structure-activity relationships. The findings may provide material and theory bases for the development of new hypouricemic medicines based on L. brevituba.

Study on pathological mechanism and establishment of animal model of ICU acquired weakness / 医学研究生学报

ObjectiveThere are few animal experiments on ICU acquired weakness (ICU AW), and suitable animal models are the main constraints. The study was to explore the method of ICU AW animal model which satisfies the clinical requirements of ICU and suitable for large-scale animal trials.MethodsThirty six SD rats were randomly divided into Control group(0.9%NS at 2.5 ml/kg intraperitoneal injection once a day for consecutive 3 days), immobilization group(the left hindlimb was immobilizated for 7d, then the immobilization was removed to 14 d), sepsis group(lipopolysaccharide at 2.5 mg/kg intraperitoneal injection once a day for consecutive 3 days) and sepsis-immobilization group(the left hindlimb was immobilizated for 7d, then the immobilization was removed to 14 d and lipopolysaccharide at 2.5 mg/kg intraperitoneal injection once a day for consecutive 3 days).To determine whether the model was successful, the muscle strength of left hindlimb, gastrocnemius/body weight ratio and pathological changes of gastrocnemius were measured at 0 d( immediately after intervention), 3d, 7 d, 10 d, 14 d. To explore the possible pathological mechanism, creatinine/body weight ratio, albumin, lymphocyte, and gastrocnemius pathological scores were measured.Results7 days later, the scores of left hindlimb muscle strength and pathology in sepsis immobilization group were significantly higher than those in the sepsis group and the control group(P<0.05), contary body weight and gastrocnemius weight were lower than those in control group, immobilization group and sepsis group(P<0.05), and gastrocnmiu/body weight ratio(0.528±0.018) was significantly lower than those in control group(0.756±0.315) and sepsis group(0.813±0.040)(P<0.05). Creatinine / body weight in sepsis immobilization group(0.283±0.0268) was significantly higher than those of blank group (0.185±0.022), immobilization group (0.207±0.027) and sepsis group (0.246±0.043)(P<0.05). The lymphocyte count [(5.193±1.493) ×109/L] was significantly lower than that in the blank group[(7.005±0.702) ×109/L] and the immobilization group[(7.208±0.832) ×109/L)](P< 0.05). 14 days later, the scores of left hindlimb muscle strength, body and gastrocnemius weight in sepsis immobilization group were significantly lower than those in control group, immobilization group and sepsis group(P<0.05). Gastrocnmiu/body weight ratio in sepsis immobilization group(0.519± 1.493) was significantly lower than those in control group(0.798±0.015), immobilization group (0.570±0.022)and sepsis group(0.693±0.022)(P<0.05).ConclusionThe qualified animal model of ICU AW can be established by repeated intraperitoneal injection in low dose of lipopolysaccharide combined with limb immobilization. Immunosuppression and Hypercatabolism in ICU AW rats is an important reason that ICU AW can not to be mitigated. Thus, we supposed that it may be the mechanisms for the development of ICU AW,which needs further experimental verification.

Effects of Aidi Injection () with Western Medical Therapies on Quality of Life for Patients with Primary Liver Cancer: A Systematic Review and Meta-Analysis / 中国结合医学杂志

OBJECTIVE@#To evaluate the effects of Aidi Injection (, AD) in combination with Western medical therapies (WMT) in patients with primary liver cancer (PLC).@*METHODS@#Randomized controlled trials (RCTs) comparing AD plus WMT with WMT alone were retrieved from inception to March 2013 by retrieving the literature database thoroughly and systematically. The extracted data from included studies were analyzed and synthesized by Review Manager 5.2 software. The Cochrane risk of bias tool was used to assess the quality of included studies, and Begg's and Egger's tests were used to evaluate the potential presence of publication bias. The studies were divided into 7 separate subgroups in terms of quality of life (QOL), recent chemotherapy and the incidence of leukocyte reduction. The subgroup analysis was applied to assess the heterogeneity between included researches, and the sensitivity analysis was used to weigh the stability of studies.@*RESULTS@#Twenty-four RCTs were included in this study. Compared with WMT used alone, AD as additional intervention was more effective on improving QOL (P<0.01), increasing short-term efficacy (P<0.01), prolonging life (P<0.05 or P<0.01), relieving clinical symptoms (P<0.01), and reducing adverse events (e.g. reduce white blood cell counts, P=0.002; reduce in platelet counts, P<0.01). Subgroup analysis showed that the hepatic artery interventions with AD was superior in improving QOL (P<0.01) and enhancing short-term response rates (P=0.007) and reducing white blood cell counts (P=0.0004) than hepatic artery interventions alone (P<0.01). The chemoembolization plus AD or the chemotherapy plus AD were both better than chemoembolization or the chemotherapy alone in improving the QOL and short-term response rate (P<0.05 or P<0.01).@*CONCLUSIONS@#AD in combination with WMT improves QOL in patients with PLC. Considering the inherent limitations of the included studies, further well-designed, rigorously performed, high-quality, and double-blinded RCTs with large sample sizes are needed.