Research progress on non motor symptoms of multiple system atrophy / 中国医师杂志

Multiple system atrophy (MSA) is a rapidly developing and serious Degenerative disease of the nervous system. It is characterized by different combinations of prominent autonomic dysfunction, Parkinson′s syndrome and cerebellar Ataxia in clinical practice, and its core symptom is extensive and serious autonomic dysfunction in the early stage of the disease. Non motor symptoms of MSA involve nervous system, cardiovascular system, gastrointestinal system, Genitourinary system and many other fields. Early clinical heterogeneity is large. This article describes the non motor symptoms of MSA, including prodromal symptoms, to help clinicians identify MSA earlier.

Risk factors for acute kidney injury after off-pump coronary artery bypass grafting: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To analyze the risk factors for acute kidney injury (AKI) after off-pump coronary artery bypass grafting (OPCABG). Methods     The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang data, CBM, VIP, CNKI were searched by computer for researches on risk factors associated with the development of AKI after OPCABG from the inception to March 2022. The meta-analysis was performed using RevMan 5.4 software. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Results    A total of 18 researches were included, involving 9 risk factors. The NOS score of all included studies was≥6 points. Meta-analysis results showed that age [OR=1.03, 95%CI (1.01, 1.06), P=0.020], body mass index (BMI) [OR=1.10, 95%CI (1.05, 1.15), P<0.001], history of hypertension [OR=1.45, 95%CI (1.27, 1.66), P<0.001], history of diabetes [OR=1.50, 95%CI (1.33, 1.70), P<0.001], preoperative serum creatinine level [OR=2.05, 95%CI (1.27, 3.32), P=0.003], low left ventricular ejection fraction [OR=4.51, 95%CI (1.39, 14.65), P=0.010], preoperative coronary angiography within a short period of time [OR=2.10, 95%CI (1.52, 2.91), P<0.001], perioperative implantation of intra-aortic balloon pump [OR=3.42, 95%CI (2.26, 5.16),  P<0.001], perioperative blood transfusion [OR=2.00, 95%CI (1.51, 2.65), P<0.001] were risk factors for AKI after OPCABG. Conclusion    Age, BMI, history of hypertension, history of diabetes, preoperative serum creatinine level, low left ventricular ejection fraction, preoperative coronary angiography within a short period of time, perioperative implantation of intra-aortic balloon pump, perioperative blood transfusion are risk factors for AKI after OPCABG. Medical staff should focus on monitoring the above risk factors and early identifying, in order to prevent or delay the onset of postoperative AKI and promote early recovery of patients.

The effect and mechanism of Xihuang pill inhibits the formation of vasculogenic mimicry in human glioblastoma cells by down-regulating HIF-1α/VEGFA/VEGFR2 signaling pathway / 药学学报

Our studies were aimed to explore the effect and mechanism of the inhibition of the formation of vasculogenic mimicry (VM) in human glioblastoma cells by Xihuang pill (XHP) medicated serum through regulating the hypoxia inducible factor-1α (HIF-1α)/vascular endothelial growth factor A (VEGFA)/vascular endothelial growth factor receptor 2 (VEGFR2) signaling pathway. The medicated serum of XHP was prepared by gavage for 7 days to male SD rats (approval number of animal experiment ethics: 202105A051). The hypoxia model of U251 cells was established using 200 μmol·L-1 of CoCl2. After treatment with XHP-medicated serum, cell viability and proliferation of U251 cells were detected by CCK-8 and cell cloning experiment. Cell apoptosis and cell cycle of U251 cells were determined by flow cytometry. Cell migration and invasion were evaluated by wound healing and Transwell invasion assay. The formation of VM was assessed by three-dimensional cell culture of U251 cells. The protein expression levels of HIF-1α, VEGFA, VEGFR2, phosphorylated-VEGFR2 (p-VEGFR2), vascular endothelial-cadherin (VE-cadherin), Eph receptor tyrosine kinases A2 (EphA2), matrix metalloproteinase 2 (MMP2), matrix metalloproteinase 14 (MMP14) and laminin γ2 in U251 cells were detected by Western blot. The results showed that 10% XHP-medicated serum had little effect on the cell viability, proliferation, apoptosis and cell cycle of U251 cells under hypoxia. Compared with the model group, 10% XHP-medicated serum at 1.0, 1.5 and 2.0 h significantly decreased the migration rate (P < 0.01) and the number of invading U251 cells (P < 0.01). 10% XHP-medicated serum at 2.0 h significantly suppressed the formation of VM tubular structures in U251 cells under the condition of hypoxia (P < 0.01). Western blot experiment showed that 10% XHP-medicated serum significantly down-regulated the expression of HIF-1α, VEGFA, phospho-VEGFR2, VE-cadherin, EphA2 and MMP14 proteins (P < 0.05). In conclusion, XHP could inhibit the formation of VM in human glioblastoma U251 cells to suppress the angiogenesis by down-regulating the HIF-1α/VEGFA/VEGFR2 signaling pathway.

Postoperative corneal topography generation based on attention mechanism and Pix2Pix network / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the use of attention mechanism and Pix2Pix generative adversarial network to predict the postoperative corneal topography of age-related cataract patients undergone femtosecond laser arcuate keratotomy.METHODS:In this retrospective case series study, the 210 preoperative and postoperative corneal topographies from 87 age-related cataract patients(105 eyes)undergoing femtosecond laser arcuate keratotomy at Shanxi Eye Hospital between March 2018 and March 2020 were selected and divided into a training set(180)and a test set(30)for model training and testing. The peak signal-to-noise ratio(PSNR), structural similarity(SSIM)and Alpins astigmatism vector analysis were used to compare the accuracy of postoperative corneal topography prediction under different attention mechanisms.RESULTS:The model based on attention mechanism and Pix2Pix network can predict postoperative corneal topography, among which the model based on Self-Attention mechanism has the best prediction effect, with PSNR and SSIM reaching 16.048 and 0.7661, respectively. There were no statistically significant differences in the difference vector, difference vector axis position, surgically induced astigmatism, and correction index between real and generated corneal topography on the 3mm and 5mm rings(all P&#x003E;0.05).CONCLUSION:Based on the Self-Attention mechanism and Pix2Pix network, the postoperative corneal topography can be well predicted, which can provide reference for the surgical planning and postoperative effects of ophthalmic clinicians.

Study on the relationship between the age at natural menopause and postmenopausal metabolic syndrome / 中华预防医学杂志

To explore the relationship between the early or delayed age at natural menopause and metabolic syndrome (MS) in women. A total of 4 734 natural menopausal women who completed the baseline survey from November 2017 to January 2020 in the Guangzhou Middle-aged and Elderly Chronic Disease Prospective Cohort Study were selected in this cross-sectional study. Data on general demographic characteristics, disease history and female physiological health indicators were collected. Logistic regression model and restricted cubic spline curve were used to analyze the relationship between the age at natural menopause and MS. The results showed that the mean age of the subjects was (60±6) years old. The median (Q1,Q3) age at natural menopause was 50 (49, 52) years old, and the prevalence of MS was 14.8%(699/4 734). After adjusting for confounders, the age at natural menopause was closely related to MS in an approximate"U"shape. Compared with the group of normal age at natural menopause, the early age at menopause (OR=1.52, 95%CI: 1.12-2.06) and delayed age at menopause (OR=1.77, 95%CI: 1.36-2.30) had a higher risk of MS. In the group with time since menopause ≤6 years and 7-9 years, the risk of MS in the group with delayed age at menopause was 2.40 times (95%CI: 1.54-3.75) and 2.19 times (95%CI: 1.11-4.31) higher than that in the group with normal menopausal age, respectively. In conclusion, the early and delayed age at natural menopause increased the risk of MS. The increased risk of MS in delayed age at natural menopause mainly occurred within 10 years since menopause.

Effect of Qigongwan on Quality of Oocytes and Embryonic Development Potential in Patients with PCOS Infertility with Phlegm-dampness Syndrome / 中国实验方剂学杂志

ObjectiveTo observe the regulation of Qigongwan on the expression of proliferation and apoptosis-related factors programmed cell death 4 （PDCD4） and proliferating cell nuclear antigen （PCNA） in ovarian granulosa cells （GCs） in patients with polycystie ovarian syndrome （PCOS） infertility with phlegm-dampness syndrome， and to explore the effect of Qigongwan on the quality of oocytes and embryonic development potential. MethodSixty-six patients with PCOS with phlegm-dampness syndrome who underwent in vitro fertilization and embryo transfer （IVF-ET） were randomly selected and divided into an observation group （Qigongwan + western medicine） and a control group （western medicine）， with 33 patients in each group. Antagonist regimen was used to promote ovulation in the two groups. The observation group was given Qigongwan one cycle before IVF based on the treatment of conventional western medicine， while the control group was not given Chinese medicine. The improvement of phlegm and dampness syndrome， the dosage and the number of days of using gonadotropins （Gn）， the levels of luteinizing hormone （LH）， estradiol （E2）， and progesterone （P） on the day of human chorionic gonadotropin（HCG） injection， the 2PN fertilization rate， and the high-quality embryo rate of patients in the two groups were compared. Real-time polymerase chain reaction （Real-time PCR） and Western blot technology were used to detect the expression of PCNA and PDCD4 in GCs. ResultAs compared with groups before treatment， the score of phlegm-dampness syndrome in both groups was significantly lower （P<0.01）. The score of phlegm and dampness syndrome in the observation group was significantly lower than that of the control group （P<0.01）. As compared with the control group， the levels of LH， E2， and P in the observation group was higher， but only the difference in the level of E2 was statistically significant （P<0.01）. The 2PN fertilization rate ［82.25% （556/676） vs 69.92% （365/522）， χ2=25.172， P<0.01］ and high-quality embryo rate ［44.19% （190/430） vs 34.23% （102/298）， χ2=7.266， P<0.01］ in the observation group were significantly higher than that of the control group （P<0.01）. As compared with the control group， the mRNA and protein expression of PDCD4 in ovarian GCs was down-regulated in the observation group and that of PCNA was up-regulated （P<0.05）. ConclusionBy down-regulating the expression of PDCD4 and up-regulating the expression of PCNA， Qigongwan may interfere with follicle development， adjust hormone levels， improve the symptomatic manifestations of patients with PCOS with phlegm-dampness syndrome， inhibit the apoptosis of GCs， and promote growth， thus improving the quality of oocytes and embryonic development potential.

Analysis of difficult-to-treat sites in patients with psoriasis who received biological therapy / 中华皮肤科杂志

Objective:To investigate difficult-to-treat sites in patients with psoriasis receiving biological therapy.Methods:Clinical data were retrospectively collected from 73 adult patients with psoriasis in the database of Psoriasis Center, National Clinical Research Center for Skin and Immune Diseases from June 2020 to September 2021, who had received sufficient and standardized treatment with biological agents for ≥ 24 weeks, and were still treated with biological agents at the time of enrolment into this study with the psoriasis area and severity index (PASI) score being 1 - 5 at the time of enrolment into the database of Psoriasis Center. Distribution of psoriatic lesions resistant to biological therapy were analyzed, and differences in refractory sites were compared between different biologics. Chi-square test or Fisher′s exact test was used to analyze differences in the anatomical distribution of residual skin lesions after treatment with different biologics, McNemar test to compare the anatomical distribution of skin lesions before and after biological therapy, and Kruskal-Wallis H test to analyze the association between PASI scores for residual skin lesions and dermatology life quality index (DLQI) scores. Results:After ≥ 24 weeks of sufficient and standardized biological therapy in the 73 patients, refractory skin lesions mostly involved the lower limbs (46 cases, 63.01%) , followed by the scalp (36 cases, 49.32%) and upper limbs (27 cases, 36.99%) ; proportions of patients with residual skin lesions on the face and neck, trunk, upper limbs, lower limbs, hands and feet significantly decreased after biological therapy compared with those before treatment (paired χ2 = 5.14, 7.69, 9.90, 4.17 and 6.13, P = 0.016, 0.003, 0.001, 0.031 and 0.008, respectively) , while there was no significant difference in the proportions of patients with skin lesions on the scalp and genital areas before and after treatment (both P > 0.05) . No significant difference in the anatomical distribution of residual skin lesions was observed between the 13 patients receiving treatment with tumor necrosis factor inhibitors (adalimumab, infliximab, or tumor necrosis factor receptor-antibody fusion protein) and 59 receiving treatment with interleukin-17 (IL-17) inhibitors (secukinumab or ixekizumab) (all P > 0.05) . There was no significant difference in the anatomical distribution of residual skin lesions in the 13 patients before and after the treatment with tumor necrosis factor inhibitors (all P > 0.05) ; in the 59 patients treated with IL-17 inhibitors, the proportions of patients with residual skin lesions on the trunk, upper limbs, hands and feet significantly decreased after treatment (paired χ2 = 4.90, 9.09 and 7.11, P = 0.021, 0.001 and 0.004, respectively) , while there was no significant difference in the distribution of skin lesions on the scalp, face and neck, lower limbs and genital area before and after treatment (all P > 0.05) . Among the 73 patients, the PASI scores for lesions on the upper and lower limbs and the total PASI scores were all associated with the DLQI scores ( H = 7.52, 12.61, 6.75, respectively, all P < 0.05) , and were significantly higher in the patients with DLQI scores of > 10 points than in those with DLQI scores of ≤ 5 points (all P < 0.05) . Conclusions:Biological therapy-resistant psoriatic lesions were mostly located on the scalp, and refractory skin lesions mostly involved the lower limbs, scalp and upper limbs. No significant difference in the anatomical distribution of residual skin lesions was observed between patients treated with tumor necrosis factor inhibitors and IL-17 inhibitors, but IL-17 inhibitors may result in lesion clearance at more anatomical sites compared with tumor necrosis factor inhibitors.

Health supervision of school based myopia prevention and control / 中国学校卫生

Objective@#To explore the associated factors in the implementation of the "random" sampling inspection of the lighting institutions in kindergartens, outofschool training institutions and primary and secondary schools in 2019 (Supervision Letter [2019] No. 314 of National Health Office) (hereinafter referred to as the "Plan"), and to provide reference for better implementation of the Plan.@*Methods@#A survey of schoolbased myopia prevention and control was conducted in 23 provincial, municipal and countylevel health supervision institutions in China. The main contents of the survey focused on the introduction, implementation and implementation of the program.@*Results@#The implementation of the "plan" was significantly associated with the specific work organized and coordinated by the health administrative department, clear responsibility of various departments, and collaboration with educational institutions[OR(95%CI)=1.57(1.05-2.36), 0.05(0.03-0.10), 0.31(0.19-0.52), 0.03(0.01-0.09), 0.12(0.04-0.37), P<0.05]. It was also associated with independent school health supervision department, one and two fulltime school health supervision staff equipment, onsite quick inspection of health supervision institutions, school selfexamination[OR=1.87(1.33-2.62), 0.62(0.40-0.97), 2.37(1.82-3.09), 1.62(1.09-2.40), P<0.05].@*Conclusion@#The program needs to be implemented through multiple departments and is associated with multiple factors. It is of great importance to strengthen multisector collaboration and clarify the responsibility of various departments for the health supervision of schoolbased myopia prevention and control.

Analysis on the Implementation of Comprehensive School Health Evaluation in Liaoning Province / 中国学校卫生

Objective@#To understand the Implementation of Comprehensive Evaluation of School Health (GB/T 18205-2012) and associated factors, so as to provide rationalization proposals for future revision of standards.@*Methods@#A questionnaire survey was conducted on 436 schools, 56 health supervision agencies and 55 disease control agencies in Liaoning Province, and the main contents include the investigation of awareness rate, training, application, rationality and application of evaluation items and indicators.@*Results@#Totally 44 supervision agencies and 29 CDCs had independent school health departments, with significant differences in faculty equipment ( t =8.53， P <0.05). The standard was trained in 100% of municipal supervision agencies, 22.50% of district and county level, 46.15% of municipal CDC ,50.00% of district county CDC; 61.54% of municipal and 45.00% of district and county supervision agencies conducted evaluations in accordance with this standard, 53.85% of the municipal CDC, 60.00% of county CDC jointly completed the standard; 30.77% of municipal and 52.50% of district and county supervisory bodies informed the educational administration of the results of the comprehensive evaluation.@*Conclusion@#The establishment of school health professional departments and the training of management objects affect the implementation of comprehensive evaluation of school health, so it is necessary to combine the actual work to modify some of the important indicators, and strengthen the application of comprehensive evaluation results.

Analysis of clinical and biological characteristics of relapsed childhood low-risk acute B lymphoblastic leukemia / 白血病·淋巴瘤

Objective:To investigate the clinical and biological characteristics of relapsed childhood low-risk acute B lymphoblastic leukemia (B-ALL).Methods:The clinical and laboratory data of 34 children who admitted in Beijing Boren Hospital from July 2017 to July 2018 were retrospectively analyzed, and 127-339 mutations of hematological malignancy related genes were analyzed.Results:The median time from the diagnosis to the recurrence was 871 d (87-1 446 d). The recurrence at early stage and late stage had 26 cases (76%) and 8 cases (24%), respectively. The recurrence before maintenance treatment, during maintenance therapy and after withdrawal of chemotherapy had 3 cases (9%), 12 cases (35%) and 19 cases (56%) (13 cases relapsed within 1 year after withdrawal, 6 cases relapsed after withdrawal 1-2 years and no one relapsed after withdrawal 2 years). The sites of recurrence included bone marrow alone accounting for 26 cases (76%), both intramedullary and extramedullary disease (EMD) accounting for 6 cases (18%), EMD alone accounting for 2 cases (6%). Flow cytometry showed that 9 patients presented minimal residual disease (MRD)-positive (6 cases with one positive, 2 cases with twice positive and 1 case with 3 times positive), including 8 cases occurred at early stage and 1 case occurred at late stage; and the level of MRD was 0.02%-3.82%. Complex chromosomal karyotype appeared in 6 relapsed children with normal or hyperdiploid karyotype at first diagnosis. Hematological malignancy related gene mutation detection was made in 28 cases, and the results showed that each patient had at least one gene mutation, and 2 or more gene mutations were detected in 25 cases (89%). The high frequency of gene mutations were as follows: CREBBP (7 cases, 25%), NRAS (7 cases, 25%), KRAS(7 cases, 25%), TP53 (4 cases, 14%), and NT5C2 (4 cases, 14%).Conclusions:The recurrence of childhood low-risk B-ALL occurs mostly in the maintenance treatment or in two years of withdrawal of chemotherapy. Positive MRD after complete remission is likely to show the risk of early recurrence. The gene mutations after the poor prognosis in cancer cells may be related to the recurrence of childhood low-risk B-ALL, and the common gene mutations include CREBBP, RAS signaling pathways genes and TP53, NT5C2.

Clinical features of DRESS， AOSD， HLH with liver injury: An analysis of 58 cases / 临床肝胆病杂志

ObjectiveTo investigate the clinical features of adult liver injury patients with drug reaction with eosinophilia and systemic symptoms (DRESS), adult-onset Still’s disease (AOSD) or hemophagocytic lymphohistiocytosis (HLH) and the correlation of the degree of liver injury with inflammatory indices and immune indices. MethodsRelated clinical data were collected from 58 patients with liver injury caused by the above three systemic inflammatory diseases who were admitted to Peking University First Hospital from January 2008 to April 2019, among whom 7 had DRESS, 29 had AOSD, and 22 had HLH. General information, liver biochemical parameters, inflammatory indices, and immune indices were collected before treatment. The t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Bonferroni method was used for further comparison between two groups. Four inflammatory indices were compared between the groups with different alanine aminotransferase (ALT) levels (≤200 U/L or ＞200 U/L), and a Spearman correlation analysis was used to investigate the correlation of ferritin and immune indices with ALT level. ResultsThe median age of the patients with DRESS or AOSD was 38 years, and the median age of the patients with HLH was 34 years. DRESS patients were mostly male (5/7, 71%), while most of AOSD patients (20/29, 69%) and HLH patients (12/22, 55%) were female. For liver injury indices, there were no significant differences between the three groups in ALT peak, aspartate aminotransferase level, and alkaline phosphatase level (all P＞0.05). For the indices for the synthetic function of the liver, there were no significant differences in blood glucose, albumin, and prothrombin activity between the three groups (all P＞0.05). For inflammatory indicators, there were significant differences between the three groups in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (all P＜0.001), while there were no significant differences between the three groups in lactate dehydrogenase, ferritin, and procalcitonin (all P＞0.05); the AOSD group had significantly higher median CRP and ESR than the other two groups (all P＜0.05). For the patients with the three diseases, there were no significant differences in the four inflammatory indices between any two the groups with different ALT levels (all P＞0.05), and the level of ferritin was positively correlated with ALT level (R2=0.702 1, P＜0000 1). As for immune indices, there were no significant differences in IgG, IgA, C4, and the counts of NK and B cells between the three groups (P＞0.05), and CD8+ T cells were positively correlated with ALT level in HLH patients (R2=0.969 6, P＜0.000 1). ConclusionVarying degrees of liver injury are observed in patients with DRESS, AOSD or HLH. Ferritin and CD8+ T cells are well correlated with ALT level and can reflect liver injury, systemic inflammation, and immune status in patients with the three diseases, and therefore, they may become important indices for evaluating disease condition, guiding treatment, and judging treatment outcome and prognosis.

Critical pharmaceutical process identification considering chemical composition, biological activity, and batch-to-batch consistency: A case study of notoginseng total saponins / 中草药·英文版

Objective: Critical pharmaceutical process identification (CPPI) is an important step in the implementation of quality by design concept to traditional Chinese medicines (TCMs). Risk assessment methods are usually used in CPPI. However, risk evaluation is usually subjective. The purpose of this work is to present a more objective CPPI method. Methods: A CPPI method considering chemical composition, biological activity, and batch-to-batch consistency was presented in this work. The manufacturing process of notoginseng total saponins (NTS) was investigated as an example. The changes of chemical composition, biological activity, and chemical composition consistency after main processes were measured and compared. A significant change of them indicated a critical process. Results: After extraction process and chromatography process, saponin purity and chemical composition similarity remarkably increased, and saponin content variations decreased. Thrombin inhibitory activity was remarkably decreased after chromatography process. Because of the large influences on NTS quality, extraction process and chromatography process were identified to be critical processes of NTS. Conclusion: Based on a comprehensive and objective examination of the role of each process, critical pharmaceutical processes can be identified. A similar method can also be applied to other TCM processes.

Effect of Addition and Subtraction Adjuvant Therapy of Bufeitang on Immune Inflammation After Tracheotomy in Stroke Patients with Syndrome of Deficiency of Spleen and Lung Qi / 中国实验方剂学杂志

Objective:To discuss the efficacy of addition and subtraction adjuvant therapy of Bufei decoction for pulmonary infection after tracheotomy in stroke patients (syndrome of deficiency of spleen and lung Qi) and investigate its effect on immune inflammation. Method:One hundred patients were randomly divided into control group (50 cases) and observation group (50 cases) by random number table. The patients in both groups got cefepime hydrochloride for injection, once every 12 hours, 2 g/time， at the same time, symptomatic and supportive comprehensive treatment was given. Patients in control group additionally got compound glycyrrhiza oral solution via gastric tube, 10 mL/time, 3 times/day. Patients in observation group got addition and subtraction adjuvant therapy of Bufeitang every morning and night via gastric tube, 1 dose/day. The treatment course was 14 days in both groups. At the 1st, 7th and 14th day after treatment, scores of clinical pulmonary infection scale (CPIS) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) were graded. The time to control pulmonary infection and the antibiotics use time were recorded. Before and after treatment, levels of T lymphocyte subsets (CD3+, CD4+，CD8+ and CD4+/CD8+), regulatory T cells of (Treg cells), immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M(IgM), procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-1β, IL-6 and IL-10 were detected, and safety was evaluated. Result:At the 7th and 14th day after treatment, scores of CPIS and APACHE Ⅱ in observation group were lower than those in control group (P<0.01). The time to control pulmonary infection and antibiotics use time were shorter than those in control group (P<0.01). Levels of Treg cells, CD4+ and CD4+/CD8+ were higher than those in control group (P<0.05). Levels of CD8+, PCT, TNF-α, IL-1β, IL-6 and IL-10 were lower than that in control group (P<0.01), while levels of IgA and IgM were higher than those in control group (P<0.01). There was no adverse reaction related to Bufeitang. Conclusion:Based on comprehensive treatment of western medicine for anti-infection and symptomatic support, addition and subtraction adjuvant therapy of Bufeitang can effectively control the severity of pulmonary infection caused by tracheotomy in stroke, reduce coughing and expectoration, shorten the course of pulmonary infection and the use time of antibiotics, regulate immune function and inhibit inflammatory reaction.

Valproic acid concentration and biochemical indexes in epilepsy outpatients during monotherapy or combination therapy / 中南大学学报(医学版)

OBJECTIVES@#Due to the narrow therapeutic window of valproic acid (VPA), grievous adverse reactions such as hepatotoxicity, nephrotoxicity may occur in patients with epilepsy for a long time. This study aimed to explore the effect of VPA concentration on biochemical and routine blood test related to liver, renal, and hematology in epileptic outpatients treated with VPA alone or combined with other antiepileptic drugs.@*METHODS@#A total of 3 194 Chinese epileptic outpatients from Xiangya Hospital, were analyzed in a crude analysis after stratifying through dosage regimens. The plasma VPA concentration was detected by gas chromatography method and then standardized through dosage and body weight. Ten biochemical indexes related to liver, renal, and hematology were evaluated.@*RESULTS@#Of all patients, blood urea nitrogen (BUN), serum creatinine (SCr) level, and erythrocyte count (RBC) showed positive correlations with standardized VPA concentration (=0.494, =0.157, =0.596, respectively), while platelet specific volume (PCT) and blood platelet (PLT) showed negative correlations with standardized VPA concentration (=-5.500, =-0.086, respectively). After stratifying through dosage regimens, significantly positive associations between SCr and standardized VPA concentration were found in the juvenile patients from the monotherapy group and combination therapy group (=1.800, =0.352, respectively). In addition, PLT and leukocyte count (WBC) in the juvenile patients from the combination therapy group were negatively correlated with standardized VPA concentration (=-1.463, =-0.079, respectively), while RBC showed a positive association with standardized VPA concentration in the juvenile patients from the monotherapy group (=0.068).@*CONCLUSIONS@#SCr level is significantly associated with plasma VPA concentration. Drug combination and age are important factors leading to hematological disorders. The finding provides potential theoretical guidance for the rational and safe clinical use of VPA.

Measurement of residual radioactivity in postoperative inpatients with differentiated thyroid carcinoma after 131I treatment using robot / 中华核医学与分子影像杂志

Objective@#To evaluate the residual radioactivity after 131I treatment in postoperative inpatients with differentiated thyroid carcinoma (DTC) using service robot in nuclear medicine ward, and assess the time for patients to be released from isolation.@*Methods@#From September 2017 to June 2018, 297 patients (94 males, 203 females, age: 19-80 years) with DTC who underwent 131I treatment after surgery were included. According to the purpose of treatment and the prescription dosage of 131I, patients were divided into 8 groups: 4 groups accepted 131I remnant ablation therapy (RAT) with different dosages, which were 3 700 MBq (RAT1, n=34), 4 440 MBq (RAT2, n=122), 5 550 MBq (RAT3, n=81) and 7 400 MBq (RAT4, n=27), respectively; 4 groups had 131I treatment for recurrent/metastatic lesions (RMLT), and the dosages were 3 700 MBq (n=1), 4 440 MBq (n=2), 5 550 MBq (n=14) and 7 400 MBq (n=16). At 4, 24, 48 and 72 h after 131I administration, the dose equivalent rates at 2 cm away from the patient′s neck and at 1 m away from the body were measured by the robot designed for nuclear medicine ward. Kruskal-Wallis rank sum test and Mann-Whitney U test were used to analyze the data.@*Results@#Neck dose equivalent rates for patients with RAT at different time points (4, 24, 48 and 72 h) after 131I administration were significantly different among 4 groups (H values: 20.889-46.410, all P<0.05), as well as the body dose equivalent rates (H values: 27.181-35.497, all P<0.05). The neck dose equivalent rates at 24, 48 and 72 h after 131I administration were statistically different between group 3 and 4 for patients with RMLT (z values: 2.328-3.076, all P<0.05; data in group 1 and 2 were too limited to be compared), while there was no statistical difference for the body dose equivalent rates (z values: 0.333-1.621, all P>0.05). The radioactivity retention in patients decreased rapidly within 24 h, then slowed down gradually and became extremely low at 72 h. At 72 h after 131I administration, 96.6%(255/264) patients with RAT and 100%(33/33) patients with RMLT were lower than 23.3 μSv/h, which meant the patients could be discharged from hospitalization.@*Conclusions@#Nuclear medicine ward service robots may dynamically measure residual radioactivity in DTC patients who take 131I treatment, providing individualized isolation solutions.

Measurement of residual radioactivity in postoperative inpatients with differentiated thyroid carcinoma after 131 I treatment using robot / 中华核医学与分子影像杂志

Objective To evaluate the residual radioactivity after 131 I treatment in postoperative in-patients with differentiated thyroid carcinoma ( DTC) using service robot in nuclear medicine ward, and as-sess the time for patients to be released from isolation. Methods From September 2017 to June 2018, 297 patients ( 94 males, 203 females, age:19-80 years) with DTC who underwent 131 I treatment after surgery were included. According to the purpose of treatment and the prescription dosage of 131 I, patients were divid-ed into 8 groups:4 groups accepted 131 I remnant ablation therapy ( RAT) with different dosages, which were 3700 MBq ( RAT1, n=34) , 4440 MBq ( RAT2, n=122) , 5550 MBq ( RAT3, n=81) and 7400 MBq ( RAT4, n=27) , respectively;4 groups had 131 I treatment for recurrent/metastatic lesions ( RMLT) , and the dosages were 3700 MBq ( n=1) , 4440 MBq ( n=2) , 5550 MBq ( n=14) and 7400 MBq ( n=16) . At 4, 24, 48 and 72 h after 131 I administration, the dose equivalent rates at 2 cm away from the patient's neck and at 1 m away from the body were measured by the robot designed for nuclear medicine ward. Kruskal-Wallis rank sum test and Mann-Whitney U test were used to analyze the data. Results Neck dose equivalent rates for patients with RAT at different time points ( 4, 24, 48 and 72 h) after 131 I administration were significantly different among 4 groups (H values:20.889-46.410, all P<0.05), as well as the body dose equivalent rates (H values:27.181-35.497, all P<0.05). The neck dose equivalent rates at 24, 48 and 72 h after 131 I administration were statistically different between group 3 and 4 for patients with RMLT ( z values:2.328-3.076, all P<0.05;data in group 1 and 2 were too limited to be compared) , while there was no statistical difference for the body dose equivalent rates (z values:0.333-1.621, all P>0.05). The radioactivity retention in patients decreased rapidly within 24 h, then slowed down gradually and became ex-tremely low at 72 h. At 72 h after 131I administration, 96.6％(255/264) patients with RAT and 100％(33/33) patients with RMLT were lower than 23.3 μSv/h, which meant the patients could be discharged from hospitalization. Conclusions Nuclear medicine ward service robots may dynamically measure residual radi-oactivity in DTC patients who take 131 I treatment, providing individualized isolation solutions.

Photoacoustic imaging and photoacoustic spectrum analysis in mouse models of cutaneous squamous cell carcinoma / 中华皮肤科杂志

Objective To establish a photoacoustic detection system and data processing methods for skin tumors,and to explore photoacoustic imaging and photoacoustic spectrum in mouse models of cutaneous squamous cell carcinoma (CSCC).Methods A total of 60 healthy specific pathogen-free (SPF) female BALB/C nude mice aged 6-8 weeks were randomly and equally divided into 2 groups to be inoculated with a murine CSCC cell line XL50 and a human CSCC cell line A431 respectively on the right back near the upper limbs,and mouse models of murine CSCC (n =20) and human CSCC (n =20) were successfully established.The 850-nm photoacoustic detection system was applied in the above 2 kinds of mouse models,and photoacoustic imaging and photoacoustic spectrum data were collected.The fitted slope of acoustic power spectrum curves was compared between squamous cell carcinoma tissues and normal skin on the left back of the mouse model.After the photoacoustic detection,tumor tissues and normal skin at the opposite side were excised from the 2 kinds of mouse models,and subjected to histopathological examination.The fitted slope of different tissues was compared by using t test.Results Photoacoustic imaging showed higher photoacoustic signals of hemoglobin in squamous cell carcinoma tissues compared with the normal skin tissues.In the model of murine CSCC,the fitted slope of acoustic power spectrum curve was significantly lower in the tumor tissues (-1.827 ± 0.153 1) than in the normal skin tissues (-1.059 ± 0.117 8,t =3.973,P ＜ 0.001).In the model of human CSCC,the fitted slope of acoustic power spectrum curve was also significantly lower in the tumor tissues (-1.537 ± 0.125 5) than in the normal skin tissues (-0.960 ± 0.259 7,t =2.166,P =0.043).Histopathological examination showed that the number of vessels increased in the tumor tissues compared with the normal skin tissues.Conclusion CSCC tissues are different from normal skin tissues in photoacoustic imaging signals and the fitted slope of acoustic power spectrum,which may lay a foundation for non-invasive photoacoustic diagnosis of CSCC.

Low molecular weight heparin modified injection method in patients with acute myocardial infarction application / 中国实用护理杂志

Objective To investigate the application of low molecular weight heparin modified injection in the nursing of patients with acute myocardial infarction. Methods A total of 90 patients with myocardial infarction who underwent subcutaneous injection of low molecular weight heparin from May 2017 to May 2018 were enrolled in the study. The patients were divided into the control group and the observation group according to the different injection and treatment methods. The control group used the traditional injection method of low molecular weight heparin, and the observation group used the low molecular weight heparin modified injection method. Forty-five patients were observed and compared for the degree of subcutaneous hemorrhage, incidence of induration and pain. Results The incidence of subcutaneous induration and subcutaneous hemorrhage in the observation group were 10.16% (64/630) and 19.84% (125/630), respectively. The control group was 16.19% (102/630) and 31.11% (196/630), respectively. The difference between the groups was statistically significant (χ2 =10.019, 21.073, both P<0.05). The pain score of the observation group was 1.29±0.21, and the control group was 1.86±0.28. The difference between the two groups was statistically significant (t=40.877, P<0.05); the subcutaneous mild, moderate, and severe bleeding in the observation group were 17.30% (109/630), 2.54% (16/630), and 0, respectively, and the control group was 21.90% (138/). 630), 8.41% (53/630), 0.79% (5/630), the difference between the two groups was statistically significant (χ2=4.235, 20.990, 4.019, all P<0.05). Conclusions Low molecular weight heparin modified injection method for myocardial infarction patients can effectively reduce the incidence of subcutaneous hemorrhage and induration, reduce the degree of subcutaneous hemorrhage and pain, suitable for clinical promotion.

The mechanism of overeXpression of retinoic acid receptor alpha in attenuating renal interstitial fibrosis in rats / 中华实用儿科临床杂志

Objective To study the mechanism of overexpression of retinoic acid receptor alpha( RARα)in attenuating renal interstitial fibrosis(RIP)in rats. Methods Porty 6_week_old male SD rats were randomly divided into 4 groups:sham operation group,model group,negative control group and transfection group,with 10 rats in each group. Rats in model group were separated and double ligated with left ureter;rats in sham operation group were not li_gated with ureter;rats in transfection group and negative control group were transfected with adeno_associated virus and negative control virus carrying RARα gene on the basis of model group,respectively. All rats were sacrificed 2 weeks later. Left kidney tissues were taken for pathological examination and RIP index was calculated. The expression of colla_genⅣ(Col_Ⅳ)and fibronectin(PN)in renal tissue was detected by using immunohistochemistry. The expressions of RARα,prohibitin(DHB)and transforming growth factor_beta 1(TGP_β1)in renal tissue were detected by using real_time fluorescence quantitative polymerase chain reaction( RT _qDCR)and Western blot. Results (1)Com_pared with sham operation group,the RIP index was significantly increased in model group(22. 81 ± 2. 43 vs. 2. 34 ± 0. 55,q﹦24. 94,P〈0. 05);compared with model group,the RIP index was not of significant difference in negative control group(22. 81 ± 0. 43 vs. 22. 26 ± 3. 43,q﹦0. 67,P〉0. 05),however it significantly decreased in transfection group(14. 06 ± 2. 99 vs. 22. 81 ± 2. 43,q﹦10. 66,P〈0. 05).(2)Compared with sham operation group,the mRNA and protein expressions of RARα,DHB significantly decreased in model group,but TGP_β1 mRNA and protein,Col_Ⅳand PN protein expression significantly increased in model group( mRNA:0. 43 ± 0. 17 vs. 1. 00 ± 0. 00,0. 34 ± 0. 08 vs. 1. 00 ± 0. 00,2. 97 ± 0. 54 vs. 1. 00 ± 0. 00,all P〈0. 05;protein:0. 25 ± 0. 10 vs. 0. 51 ± 0. 06,0. 24 ± 0. 07 vs. 0. 58 ± 0. 04,0. 59 ± 0. 09 vs. 0. 33 ± 0. 06,16. 01 ± 0. 87 vs. 8. 79 ± 0. 39,14. 64 ± 0. 32 vs. 9. 36 ± 0. 59,all P〈0. 05);com_pared with model group,the mRNA and protein expressions of RARα,DHB,TGP_β1 and Col_Ⅳand PN protein ex_pression had no significant difference in negative control group(all P〉0. 05);compared with model group,the mRNA and protein expression of RARα,DHB mRNA and protein expression significantly increased,but the TGP_β1 mRNA and protein,Col_Ⅳ and PN protein expression significantly decreased in transfected group( mRNA:0. 86 ± 0. 07 vs. 0. 43 ± 0. 17,0. 89 ± 0. 11 vs. 0. 34 ± 0. 08,1. 65 ± 0. 28 vs. 2. 97 ± 0. 54,all P〈0. 05;protein:0. 40 ± 0. 07 vs. 0. 25 ± 0. 10,0. 45 ± 0. 10 vs. 0. 24 ± 0. 07,0. 43 ± 0. 08 vs. 0. 59 ± 0. 09,11. 57 ± 0. 33 vs. 16. 01 ± 0. 87,11. 67 ± 0. 53 vs. 14. 64 ± 0. 32,all P〈0. 05).(3)Correlation analysis revealed that RARα protein expression was negatively correlated with RIP index,Col_Ⅳ,PN,TGP_β1(r﹦ _0. 78,_0. 78,_0. 76,_0. 76,all P〈0. 05);DHB protein expression was negatively correlated with RIP index,Col_Ⅳ,PN,TGP _β1( r ﹦ _0. 87,_0. 87,_0. 88,_0. 75,all P 〈0. 05);RARα protein was positively correlated with DHB(r﹦0. 85,P〈0. 05). Conclusion Overexpression of RARα could attenuate RIP by enhancing DHB expression in rats subjected to unilateral ureteral obstruction.

Association of valproic acid and 2-propyl-4-pentenoic acid concentrations with adverse reaction in 254 Chinese patients with epilepsy / 中南大学学报(医学版)

Objective:To investigate the correlation of the concentrations of valproic acid (VPA) and 2-propyl-4-pentenoic acid (4-ene-VPA) with their adverse reactions,and to guide the clinical safety and rational use of VPA.Methods:We collected 254 epilepsy outpatients who took long-term use of sodium valproate oral solution single or combined with other antiepileptic drugs from Xiangya Hospital.The plasma concentrations of VPA and 4-ene-VPA in patients were determined by gas chromatography-mass spectrometry (GC-MS).The double variable correlation analysis was performed to analyze the effect of plasma 4-ene-VPA and VPA concentrations on adverse reactions.Results:The correlations between the PLT level and the dosage ofVPA (P＜0.01 and P＜0.05,respectively),and the RBC level and the concentration of VPA (All P＜0.01) were significant negatively.The concentrations of 4-ene-VPA,VPA,ALT,and AST in the polytherapy group were much higher than those in the monotherapy group (All P＜0.05).In the monotherapy group,the ALT and AST levels in patients younger than or equal to 2 years old were significantly higher than those over 2 years old (P＜0.001).In the polytherapy group,the levels of AST,WBC,and PLT in patients younger than or equal to 2 years old were higher than those over 2 years old (P＜0.05).The levels of AST did not show positive correlation with the concentrations of 4-ene-VPA and VPA (r=0.031,r=0.035,all P＞0.05),and the levels of ALT also did not show positive correlation with the concentrations of 4-ene-VPA and VPA (r=-0.064,r=-0.089,all P＞0.05).Conclusion:VPA may affect blood routine indexes.Age and combination therapy with the non-enzyme-induced anti-epileptic drugs are risk factors for VPA-related liver dysfunctions and renal impairment.The determination of VPA and 4-ene VPA is not a suitable tool for early warning of the VPA-induced liver dysfunction.