Feasibility study of chest ultra-low dose CT with deep learning reconstruction for lung cancer screening / 中华放射学杂志

Objective:To investigate the feasibility of chest ultra-low dose CT (ULDCT) using deep learning reconstruction (DLR) for lung cancer screening, and to compare its image quality and nodule detection rate with ULDCT iterative reconstruction (Hybrid IR) and conventional dose CT (RDCT) Hybrid IR.Methods:The patients who underwent chest CT examination for pulmonary nodules in Peking Union Medical College Hospital from October 2020 to March 2021 were prospectively included and underwent chest RDCT (120 kVp, automatic tube current), followed by ULDCT (100 kVp, 20 mA). The RDCT images were reconstructed with Hybrid IR (adaptive iterative dose reduction 3D,AIDR 3D), and ULDCT was reconstructed with AIDR3D and DLR. Radiation dose parameters and nodule numbers were recorded. Image quality was assessed using objective noise, signal-to-noise ratio (SNR) of the main trachea and left upper lobe, subjective image scores of the lung and nodules. Subjective scores were scored by 2 experienced radiologists on a Likert 5-point scale. The difference of radiation dose was compared with paired t-test between ULDCT and RDCT.The differences of quantitative indexes, objective image noise and subjective scores of the three reconstruction methods were compared with one-way analysis of variance or Friedman test. Results:Forty-five patients were enrolled, including 17 males and 28 females, aged from 32 to 74 (55±11) years. The radiation dose of ULDCT was (0.17±0.01) mSv, which was significantly lower than that of RDCT [(1.35±0.41) mSv, t=15.46, P<0.001]. There were significant differences in the image noise and SNR in the trachea and lung parenchyma and in the CT value of the trachea among ULDCT-AICE, ULDCT-AIDR 3D and RDCT-AIDR 3D images ( P<0.05). Image noise in the trachea and lung parenchyma and CT value in the trachea of ULDCT-AICE were significantly lower than those of ULDCT-AIDR 3D ( P<0.05) and comparable to RDCT-AIDR 3D ( P>0.05). There were significant differences in subjective image scores of the lung and nodules among ULDCT-AICE, ULDCT-AIDR 3D and RDCT-AIDR 3D images (χ2=50.57,117.20, P<0.001). Subjective image scores of the lung and nodules for ULDCT-AICE were significantly higher than those of ULDCT-AIDR 3D ( P<0.05), and non-inferior to RDCT-ADIR 3D ( P>0.05). All 72 clinically significant nodules detected on RDCT-ADIR 3D were also noted on ULDCT-AICE and ULDCT-AIDR 3D images. Conclusions:Chest ULDCT using DLR can significantly reduce the radiation dose, and compared with Hybrid IR, it can effectively reduce the image noise and improve SNR, and display the pulmonary nodules well. The image quality and nodule detection are not inferior to RDCT Hybrid IR routinely used in clinical practice.

The clinical value of deep learning reconstruction in low-dose CT pulmonary angiography / 中华放射学杂志

Objective:To explore the effect of deep learning reconstruction (DLR) on radiation dosage reduction and image quality of CTPA compared with hybrid iterative reconstruction (HIR).Methods:A total of 100 patients with suspected pulmonary embolism (APE) or indications for CTPA due to other pulmonary artery diseases in Peking Union Medical College Hospital from December 2020 to April 2021 were prospectively enrolled and divided into HIR group and DLR group according to block randomization, with 50 cases in each group. The patient′s gender, age and body mass index (BMI) were recorded. HIR group and DLR group underwent standard deviation (SD)=8.8 and SD=15 CTPA protocols in combination with HIR and DLR algorithm respectively. Other scanning parameters and contrast medium injection plan were the same. The effective dose (ED) and size-specific dose estimate (SSDE) were calculated. Regions of interest (ROIs) were drawn in the lumen of Grade 1-3 pulmonary arteries and bilateral paravertebral muscles. The corresponding CT and SD values were recorded to acquire signal to noise ratio (SNR) and contrast noise ratio (CNR). Based on a double-blind method, two radiologists evaluated the subjective noise, visualization of pulmonary arteries, and diagnostic confidence of the two groups by 5-point Likert scales. The inconsistent results were judged comprehensively by the third radiologist. Independent samples t-test was used to compare the demographic data, radiation dosage and quantitative image quality of the two groups. Mann-Whitney U test was used to compare the subjective noise, visualization of pulmonary arteries and diagnostic confidence between the two groups. Linear weighted Kappa coefficient was calculated to analyze the consistency of the qualitative scores between the two radiologists. Results:There were no significant differences in gender, age and BMI between the two groups ( P>0.05). The CT values of Grade1-3 pulmonary arteries and paravertebral muscle had no significant differences ( P>0.05). Compared with HIR group, the ED and SSDE in DLR group decreased by about 35% to 1.3 mSv and 4.20 mGy respectively, while the SNR (30±5) and CNR (26±5) of CTPA images were higher in DLR group than those in HIR group (23±5 and 20±5, with t=-6.60 and -5.90, respectively, both P<0.001). The subjective noise score was higher in DLR group than that in HIR group ( Z=-7.34, P<0.001). In addition, two radiologists showed excellent interobserver agreement in DLR group (Kappa=0.847, 95%CI 0.553-1.000). No significant differences were found in visualization of pulmonary arteries and diagnostic confidence between the two groups ( P>0.05). Conclusion:DLR further reduced the radiation dosage and improved the image quality of CTPA, with no detriment to diagnostic confidence. Thus DLR is worthy of clinical promotion.

Application value of deep learning reconstruction to improve image quality of low-dose chest CT / 中华放射学杂志

Objective:To evaluate the effectiveness of deep learning reconstruction (DLR) compared with hybrid iterative reconstruction (Hybrid IR) in improving the image quality in chest low-dose CT (LDCT).Methods:Seventy-seven patients who underwent LDCT scan for physical examination or regular follow-up in Peking Union Medical College Hospital from October 2020 to March 2021 were retrospectively included. The LDCT images were reconstructed with Hybrid IR at standard level (Hybrid IR Stand) and DLR at standard and strong level (DLR Stand and DLR Strong). Regions of interest were placed on pulmonary lobe, aorta, subscapularis muscle and axillary fat to measure the CT value and image noise. The signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated. Subjective image quality was evaluated using Likert 5-score method by two experienced radiologists. The number and features of ground-glass nodule (GGN) were also assessed. If the scores of the two radiologists were inconsistent, the score was determined by the third radiologist. The objective and subjective image evaluation were compared using the Kruskal-Wallis test, and the Bonferroni test was used for multiple comparisons within the group.Results:Among Hybrid IR Stand, DLR Stand and DLR Strong images, the CT value of pulmonary lobe, aorta, subscapularis muscle and axillary fat had no significant differences (all P>0.05), but the image noise and SNR of pulmonary lobe, aorta, subscapularis muscle and axillary fat had significant differences(all P<0.05), and the CNR of images had significant difference( P<0.05), too. The CNR of Hybrid IR Stand images, DLR stand images and DLR strong images were 0.71 (0.49, 0.88), 1.06 (0.78, 1.32) and 1.14 (0.84, 1.48), respectively. Compared with Hybrid IR images, DLR images had lower objective and subjective image noise,higher SNR and CNR (all P<0.05). The scores of DLR images were superior to Hybrid IR images in identifying lung fissures, pulmonary vessels, trachea and bronchi, lymph nodes, pleura, pericardium and GGN (all P<0.05). Conclusions:DLR significantly reduced the image noise, and DLR images were superior to Hybrid IR images in identifying GGN in chest LDCT while maintaining superior image quality at relatively low radiation dose levels. Thus DLR images can improve the safety of lung cancer screening and pulmonary nodule follow-up by CT.

The biology, function, and applications of exosomes in cancer

Exosomes are cell-derived nanovesicles with diameters from 30 to 150 nm, released upon fusion of multivesicular bodies with the cell surface. They can transport nucleic acids, proteins, and lipids for intercellular communication and activate signaling pathways in target cells. In cancers, exosomes may participate in growth and metastasis of tumors by regulating the immune response, blocking the epithelial-mesenchymal transition, and promoting angiogenesis. They are also involved in the development of resistance to chemotherapeutic drugs. Exosomes in liquid biopsies can be used as non-invasive biomarkers for early detection and diagnosis of cancers. Because of their amphipathic structure, exosomes are natural drug delivery vehicles for cancer therapy.

Sinomenine ester derivative inhibits glioblastoma by inducing mitochondria-dependent apoptosis and autophagy by PI3K/AKT/mTOR and AMPK/mTOR pathway

Glioblastoma multiforme (GBM) in the central nervous system is the most lethal advanced glioma and currently there is no effective treatment for it. Studies of sinomenine, an alkaloid from the Chinese medicinal plant,

Analyses of human papillomavirus infection and genotype distribution status among cervical cancer patients in northern Jiangsu Province and southern Anhui Province / 肿瘤研究与临床

Objective:To investigate the characteristics of human papillomavirus (HPV) infection and genotype distribution among cervical cancer patients in northern Jiangsu Province and southern Anhui Province, so as to provide references for cervical cancer prevention and HPV vaccination.Methods:The clinical data of 505 cervical cancer patients who were admitted to Xuzhou Cancer Hospital of Jiangsu Province and Jiangsu Cancer Hospital from July 2016 to June 2019 were retrospectively analyzed. The patients were mainly from northern Jiangsu Province and southern Anhui Province, and among them, 347 patients (68.7%) were 41-60 years old. The patient's HPV infection and genotype distribution characteristics were analyzed.Results:The total infection rate of HPV among 505 patients was 96.6% (488/505), of which patients aged 41-60 years old accounted for 68.4% (334/488); the single infection rate was higher than the multiple infection rate [69.7% (352/505) vs. 26.9% (136/505)]. There was a statistical difference in the total HPV infection rate of patients with different clinical stage ( χ2 = 14.528, P < 0.05), but the infection rate did not increase with the increase of stage. Among 488 HPV-positive patients, single infection accounted for 72.1% (352/488), double infection accounted for 17.4% (85/488), triple infection accounted for 6.2% (30/488), and more than triple infection accounted for 4.3% (21/488). Among 352 patients with HPV single infection, low-risk type infection accounted for 8.0% (28/352), and high-risk type infection accounted for 92.1% (324/352). The top three high-risk HPV genotypes were type 16, type 52 and type 58, and there were 174 cases in total. Among 136 patients with multiple HPV infections, 115 cases (84.6%) were infected with at least one of type 16, type 52 and type 58. Among them, the infection of type 16 combined with other types accounted for 53.7% (73/136). Conclusions:The infection rates of high-risk HPV genotypes among cervical cancer patients in northern Jiangsu Province and southern Anhui Province are high, and type 16 is the most common. It is more valuable to inoculate the nine-valent vaccine to prevent cervical cancer in these areas; 41-60 years old is the age at which HPV infection and cervical cancer are highly prevalent, so the prevention and control should be strengthened.

3--Acetyl-11-keto- -boswellic acid ameliorated aberrant metabolic landscape and inhibited autophagy in glioblastoma

Glioblastoma is the most common and aggressive primary tumor in the central nervous system, accounting for 12%-15% of all brain tumors. 3--Acetyl-11-keto--boswellic acid (AKBA), one of the most active ingredients of gum resin from Birdw., was reported to inhibit the growth of glioblastoma cells and subcutaneous glioblastoma. However, whether AKBA has antitumor effects on orthotopic glioblastoma and the underlying mechanisms are still unclear. An orthotopic mouse model was used to evaluate the anti-glioblastoma effects of AKBA. The effects of AKBA on tumor growth were evaluated using MRI. The effects on the alteration of metabolic landscape were detected by MALDI-MSI. The underlying mechanisms of autophagy reducing by AKBA treatment were determined by immunoblotting and immunofluorescence, respectively. Transmission electron microscope was used to check morphology of cells treated by AKBA. Our results showed that AKBA (100 mg/kg) significantly inhibited the growth of orthotopic U87-MG gliomas. Results from MALDI-MSI showed that AKBA improved the metabolic profile of mice with glioblastoma, while immunoblot assays revealed that AKBA suppressed the expression of ATG5, p62, LC3B, p-ERK/ERK, and P53, and increased the ratio of p-mTOR/mTOR. Taken together, these results suggested that the antitumor effects of AKBA were related to the normalization of aberrant metabolism in the glioblastoma and the inhibition of autophagy. AKBA could be a promising chemotherapy drug for glioblastoma.

Incidence of cervical squamous intraepithelial lesion in patients with repeated uterine prolapse and its influencing factors / 肿瘤研究与临床

Objective:To investigate the incidence and its related influencing factors of cervical squamous intraepithelial lesion in patients with repeated uterine prolapse.Methods:A total of 200 patients with grade Ⅲ-Ⅳ repeated uterine prolapse treated by surgery at Jintan Hospital Affiliated to Jiangsu University from January 2017 to June 2019. The patients received vaginal hysterectomy. The clinical data and postoperative pathological results of patients were collected to observe the incidence of cervical squamous intraepithelial lesion, and the influencing factors of cervical squamous intraepithelial lesion were analyzed.Results:Of the 200 patients with grade Ⅲ-Ⅳ repeated uterine prolapse, 20 cases (10.0%) had cervical squamous intraepithelial lesion, including 17 cases of low-grade squamous intraepithelial lesion and 3 cases of high-grade squamous intraepithelial lesion. The differences of age, disease course of uterine prolapse, birth times, proportion of family history of tumor, proportion of cervicitis, high-risk human papillomavirus (HPV) infection rate, classification of uterine prolapse, and the proportion of flushing before husband's sexual life between patients with cervical squamous intraepithelial lesion and patients without squamous intraepithelial lesion were statistically significant (all P < 0.05). The logistic analysis showed that disease course of uterine prolapse ( OR = 2.381, 95% CI 1.337-9.050, P = 0.002), cervicitis ( OR = 1.242, 95% CI 1.113-3.015, P = 0.032), high-risk HPV infection ( OR = 1.425, 95% CI 1.124-6.234, P = 0.020), and uterine prolapse classification ( OR = 1.632, 95% CI 1.204-7.624, P = 0.015) were independent influencing factors associated with cervical squamous intraepithelial lesion in patients with repeated uterine prolapse. Conclusion:The incidence of cervical squamous intraepithelial lesion in patients with repeated uterine prolapse is high, and the risk of cervical squamous intraepithelial lesion is increased in patients with disease course >10 years or grade Ⅳ uterine prolapse.

Inhibition of FOXO3a/BIM signaling pathway contributes to the protective effect of salvianolic acid A against cerebral ischemia/reperfusion injury

Salvianolic acid A (SalA) is an effective compound extracted from traditional Chinese medicine Bunge. The Forkhead box O3a (FOXO3a) signaling pathway plays crucial roles in the modulation of ischemia-induced cell apoptosis. However, no information about the regulatory effect of SalA on FoxO3a is available. To explore the anti-cerebral ischemia effect and clarify the therapeutic mechanism of SalA, SH-SY5Y cells and Sprague-Dawley rats were applied, which were exposed to oxygen glucose deprivation/reoxygenation (OGD/R) and middle cerebral artery occlusion/reperfusion (MCAO/R) injuries, respectively. The involved pathway was identified using the specific inhibitor LY294002. Results showed that SalA concentration-dependently inhibited OGD/R injury triggered cell viability loss. SalA reduced cerebral infarction, lowered brain edema, improved neurological function, and inhibited neuron apoptosis in MCAO/R rats, which were attenuated by the treatment of phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) specific inhibitor LY294002. SalA time- and concentration-dependently upregulated the phosphorylation levels of protein kinase B (AKT) and its downstream protein FOXO3a. Moreover, the nuclear translocation of FOXO3a was inhibited by SalA both and , which was also reversed by LY294002. The above results indicated that SalA fought against ischemia/reperfusion damage at least partially the AKT/FOXO3a/BIM pathway.

Simultaneous surgical treatment for pectus excavatum combined with congenital cardiothoracic diseases / 中南大学学报(医学版)

To study the methods and principles for simultaneous treatment in the children with pectus excavatum (PE) combined with congenital cardiothoracic diseases.
 Methods: The medical records of all children, who underwent simultaneous repair of PE combined with congenital cardiothoracic diseases, were retrospectively reviewed in Hunan Children's Hospital from January 2007 to September 2018. The patients were divided into a PE combined with congenital heart disease (CHD) group (n=17) and a PE combined with thoracic disease group (n=10). The repair with a custom-made sternal lifting device, a Nuss repair, were performed in the treatment of PE, and the correction of the CHD was performed by heart open surgery using cardiopulmonary bypass (through sternotomy or right infra-axillary thoracotomy) or by transcatheter closure under echocardiography or X-ray-guided percutaneous intervention in the PE combined with CHD group. The children in the PE combined with thoracic disease group underwent thoracic surgery plus Nuss procedure concurrently.
 Results: All 27 pediatric patients underwent simultaneous repair of the PE combined with congenital cardiothoracic diseases. In the PE combined with CHD group, the duration of hospital stay ranged from 8.0 to 25.0 (13.2±4.8) days. Two patients had delayed healing of the surgical wound and 1 patient developed a small left pleural effusion postoperatively. In the PE combined with thoracic disease group, the duration of hospital stay ranged from 10.0 to 34.0 (19.9±7.5) days. One patient was complicated with chylothorax and 2 patients were complicated with pleural effusionin. The treatment for the patients in the 2 groups was satisfactory. No severe complications like surgical death, severe bleeding, chest organ injuries, and implant rejections were observed.
 Conclusion: According to the characteristics of patients, individualized programs should be selected in order to correct children's PE combined with congenital cardiothoracic diseases in the same period, which are safe, effective and can avoid the risk of multiple operations and anesthesia, and can reduce the financial burden of family.

Application and clinical significance of human papilloma virus E6/E7 mRNA detection in cervical atypical glandular cells / 中国医师进修杂志

Objective To investigate the application and clinical significance of human papilloma virus (HPV) E6/E7 mRNA detection in cervical atypical glandular cells (AGC). Methods Four hundred and forty-five cervical AGC patients diagnosed by thin-layer liquid-based cytology in the Maternity Affiliated Hospital of Dalian Medical University from January 2014 to March 2018 were collected. Histological follow-up data and HPV E6/E7 mRNA detection results were analyzed, and histological differences in HPV E6/E7 mRNA positive and negative patients were compared. Results The histological result of 445 patients with cervical AGC showed that negative was in 306 cases (68.76%), and clinical significant lesion was in 129 cases (28.99%). In 445 patients with cervical AGC, HPV E6/E7 mRNA result was positive in 121 cases (27.19%), among whom the positive rate of HPV 16 and 18/45 type was 54.55% (66/121); HPV E6/E7 mRNA result was negative in 324 cases (72.81% ), including 13 non-cervical lesions. The negative rate of histological results in HPV E6/E7 mRNA negative patients was significantly higher than that in HPV E6/E7 mRNA positive patients: 91.05% (295/324) vs. 9.09% (11/121), and there was statistical difference (P＜0.01); the rates of adenocarcinoma in situ (AIS), high-grade squamous intraepithelial lesion (HSIL) and cervical adenocarcinoma of histological result in HPV E6/E7 mRNA positive patients were significantly higher than those in HPV E6/E7 mRNA negative patients: 40.50% (49/121) vs. 1.23% (4/324), 44.63% (54/121) vs. 1.23% (4/324), 3.31% (4/121) vs. 0.31% (1/324), and there were statistical differences (P＜0.01). The sensitivity of HPV E6/E7 mRNA in detecting clinical significant lesion of cervical AGC patients was 82.95% (107/129), the specificity was 95.57% (302/316), positive predictive value was 88.43% (107/121), and negative predictive value was 93.21% (302/324). Conclusions The histological result of cervical AGC shows that the amount of negative patients is significantly higher than clinical significant lesion. For cervical AGC patients with HPV E6/E7 mRNA negative results, conservative follow-up can be adopted after excluding extracervical lesions and fully assessing the risk of cervical lesions. However, the cervical AGC patients with HPV E6/E7 mRNA positive results need further examination to detect lesion and choose treatment earlier.

Ganglioside GD3 synthase (GD3S), a novel cancer drug target

Gangliosides are a class of important glycosphingolipids containing sialic acid that are widely distributed on the outer surface of cells and are abundantly distributed in brain tissue. Disialoganglioside with three glycosyl groups (GD3) and disialoganglioside with two glycosyl groups (GD2) are markedly increased in pathological conditions such as cancers and neurodegenerative diseases. GD3 and GD2 were found to play important roles in cancers by mediating cell proliferation, migration, invasion, adhesion, angiogenesis and in preventing immunosuppression of tumors. GD3 synthase (GD3S) is the regulatory enzyme of GD3 and GD2 synthesis, and is important in tumorigenesis and the development of cancers. The study of GD3S as a drug target may be of great significance for the discovery of new drugs for cancer treatment. This review will describe the gangliosides and their roles in physiological and pathological conditions; the roles of GD3 and GD2 in cancers; the expression, functions and mechanisms of GD3S, and its potential as a drug target in cancers.

Progress of pathogenesis and molecular targeted therapy of ovarian cancer / 肿瘤研究与临床

Ovarian neoplasm has various histological types, and its main treatment is cytoreductive surgery combined with auxiliary chemotherapy. However, it has a high recurrence rate and effective control of disease is far from satisfaction owing to drug resistance of cancer cells to chemotherapeutics. With the development of molecular biology, genetics and clinical medicine including molecular classification, accurate screening and large epidemiological investigation, the pathogenesis and molecular targeted therapy for ovarian cancer has become a hot topic. This paper reviews the pathogenesis and molecular target therapy of ovarian cancer to provide data for clinical diagnosis and treatment.

The current situation of intellectual property right management department in public hospitals in Shanghai and the demand analysis of medical staff in medical translation / 中华医学科研管理杂志

Objective The basic feature of translational medicine is collaborative innovation by multiple disciplines.The essence of translational medicine is the management innovation.Public hospitals have the advantages of disciplines and talents,which is one of the main forces for translational medicine research.Study on the current situation of intellectual property right (IPR) management department in public hospitals and the demand analysis of medical staff in the medical translation will improve the management system of innovational medical technology and support the government policymaking.Methods Questionnaire survey was carried out in the part of Shanghai secondary and tertiary public hospitals.Results A total of 150 questionnaires were surveyed with a responding rate of 98％.Nearly 65 ％ of inventors do not know the basic situation of the administrative staff,which is in charge of the IPR management.The main work focuses on the patent application (accounting for 70.9％ of the responders).The medical staff want be supported in four areas including professional team(accounting for 62.5％ of the responders),special funds(accounting for 80.3％ of the responders),public research platform(accounting for 55.7％ of the responders) and talent policy(accounting for 43.6％ of the responders).Conclusions Full time management of IPR is proposed,active awareness of the administrative staff needs to be strengthened and government should support in these four areas.

Xingnaojing injection improves brain mitochondrial oxidative stress in rats with lipopolysaccharide-induced sepsis / 医学研究生学报

Objective Mitochondrial dysfunction, cell energy metabolism, and oxidative stress play important roles in sepsis-induced acute brain injury.This study was to investigate the effects of Xingnaojing Injection (XNJ) on brain mitochondrial oxidative stress in rats with lipopolysaccharide (LPS)-induced sepsis.Methods Totally, 252 male SD rats were randomly divided into a normal control group, 3 LPS-induced sepsis model groups (LPS 6, 24, and 48 h), and 3 XNJ treatment groups (XNJ 6, 24, and 48 h), with 36 in each group.After treatment, the mitochondrial membrane potential (MMP) was monitored by flow cytometry and the levels of manganese superoxide dismutase (Mn-SOD), malondialdehyde (MDA), nitric oxide (NO), and nitric oxide synthase (NOS) were determined by chromatometry.Results The MMP was significantly increased in the XNJ 6 h group as compared with the LPS 6 h group (0.80±0.11 vs 0.54±0.19, P<0.05).In the LPS and XNJ groups, the levels of MDA and NOS reached the peak at 6 hours and then dropped gradually, while those of NO and Mn-SOD rose to the peak at 24 hours followed by a gradual fall.Statistically significant differences were observed in the levels of MDA, NOS and NO between the LPS 6h and XNJ 6 h groups (P<0.05), as well as in those of NOS, NO and Mn-SOD between the LPS 24 h and XNJ 24 h groups (P<0.05).Conclusion Xingnaojing Injection can elevate the level of the brain mitochondrial membrane potential, improve anti-oxidation indexes in the mitochondria, and protect brain mitochondria in sepsis rats.

Study on main components of water extract in Xiefei-Pingchuanling using UPLC-MS / 国际中医中药杂志

Objective To establish a Ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS) chromatographic method for Xiefei-Pingchuanling extract, and to analyze the main components of its water extract. Methods The UPLC-MS was adopted with acetonitrile -0.2% formic acid aqueous solution (gradient elution) as mobile phase at a flow rate of 0.8 ml/min, detection wave length at 254 nm, and column temperature was 30 ℃. Results Eighteen components were separated from Xiefei-Pingchuanling extract, and eight ingredients were identified, such as the ephedrine, pseudoephedrine hydrochloride, salvianolic acidB, rhein, aloeemodin, chrysophanol, physcionwere. Conclusions The UPLC-MS chromatographic method has the specialty of stability and repeatability, and it is suitable for analysis of Xiefei-Pingchuanling extract.

BMP9 Regulates Osteogenic/Odontogenic Differentiation of Immortalized Stem Cells from the Apical Papilla via the ERK5 Pathway / 中国医科大学学报

Objective The aim of this study was to investigate the effects of the ERK5 pathway on bone morphogenetic protein?9(BMP9)?regu?lated osteogenic/odontogenic differentiation of immortalized stern cells from the apical papilla(iSCAP). Methods BMP9 was introduced into the iSCAP by using recombinant adenoviruses,and the P?ERK5 protein expression was measured via western blotting. Then,the osteogenic/odontoblas?tic changes were analyzed by alkaline phosphatase(ALP)staining and Alizarin red staining,and the expression of osteogenic/odontoblast?associat?ed genes,such as Runx2,OCN,OPN,and DMP1 was measured by RT?PCR. Results BMP9 could up?regulate the phosphorylation of ERK5 in iSCAP. After using BIX02189,which was an inhibitor of ERK5,the phosphorylation of ERK5;the activity of ALP;the expression of Runx2, OCN,OPN,and DMP1;and the calcium deposition were all significantly inhibited. Conclusion The ERK5 signaling pathway plays an important role in BMP9?regulated osteogenic/odontogenic differentiation of iSCAP.

Clinical research of Xingnaojing injection combined with naloxone in the treatment of hypoxic ischemic encephalopathy / 中国基层医药

Objective To observe the clinical effect of Xingnaojing injection combined with naloxone in the treatment of hypoxic ischemic encephalopathy.Methods 62 patients with hypoxia ischemia encephalopathy were randomly assigned into the control group(31 cases)and the treatment group(31 cases).The control group used naloxone treatment on the basis of the conventional treatment.The treatment group received Xingnaojing injection combined with naloxone treatment on the basis of routine treatment.The changes in different time of Glasgow Coma Scale(GCS) scores of the two groups after treatment were compared.Results After treatment for 1 ,5,1 0,1 5d,the GCS scores in the control group were (5.27 ±0.87)points,(9.03 ±0.72)points,(1 0.03 ±0.72)points,(1 3.03 ±0.72)points respectively,which in the treatment group were (5.1 4 ±1 .03)points,(9.24 ±1 .06)points,(1 3.31 ±2.83)points, (15.31 ±0.93)points.The differences of GCS scores after treatment for 15,10d between the two groups were statistically significant(t =1 5.1 1 3,1 0.501 ,P =0.00,0.00).In the control group,the total effective rate was 50.0%,which of the treatment group was 82.7%,the total effective rate between the two groups had statistically significant difference (χ2 =6.437,P <0.05).Conclusion On the basis of routine treatment,Xingnaojing injection combined with naloxone in the treatment of hypoxic ischemic encephalopathy has better effect than the single use of naloxone treatment.

Analysis on shielding,retention and reentry situation of reactive blood donors in Jiangsu Province / 国际检验医学杂志

Objective To summarize and analyze the shielding,retention and reentry works of blood donors,and to investigate the feasibility of retention and reentry strategy.Methods The samples of ELISA single reagent reactive/NAT non-reactive and ELISA non-reactive/ NAT reactive were negative by confirmatory tests.Then the blood was weeded out and the donation qualification was reserved.The donors of shielding more than 6 months could propose the reentry application at any blood station in the province,and were allowed to return to the ranks after qualified by routine detection and re-detection by Jiangsu Provincial Blood Center.The unqualified rates were compared between the donors of again blood donation after retention and reentry with the common donors by χ2 test.Results From October 2014 to June 2016,1 615 cases were ELISA single reagent reactive/NAT non-reactive,among which 67 cases were confirmed as positive,42 cases were undetermined and 1 506 cases were negative;831 cases were ELISA non-reactive/ NAT reactive,in which 809 cases were positive by confirmation and 22 cases were negative.A total of 1 528 donors were confirmed as negative and their donation qualifications were reserved,89 donors conducted blood donation again and 79 were qualified in blood detection.The unqualified rate was 11.24%,compared with that of common donors,the difference was statistically significant(P<0.001).Meanwhile,596 donors applied for reentry,among them 218 persons were weeded out by the reentry blood station.In remaining 378 samples sent to Jiangsu Provincial Blood Center,359 samples were qualified and confirmed to the reentry condition.Among them,332 donors conducted blood donation and all were qualified by blood detection.Conclusion The reentry strategy in Jiangsu Province is reasonable and feasible,but the donors retention strategy needs to be further optimized and perfected.

The Association Between Fasting C-peptide and Gastrointestinal Symptoms of Gastroparesis in Type 2 Diabetic Patients

BACKGROUND/AIMS: The relationship between C-peptide levels and gastrointestinal (GI) symptoms in type 2 diabetic patients is not clear. The purpose of this study is to examine the association between fasting C-peptide and GI symptoms of gastroparesis in type 2 diabetic patients. METHODS: We recruited 333 type 2 diabetic patients into the present study. All patients filled out questionnaires of gastroparesis cardinal symptom index (GCSI) to evaluate GI symptoms. Hospital anxiety and depression scale were adopted to define anxiety and depression. Patients with GCSI scores ≥ 1.9 were regarded as having symptoms of gastroparesis. RESULTS: In our study, 71 (21.3%) type 2 diabetic patients had GCSI scores ≥ 1.9. In comparison to patients with scores < 1.9, those with scores ≥ 1.9 had significantly lower fasting c-peptide levels (1.49 ng/mL vs 1.94 ng/mL, P < 0.001), higher prevalence of depression (40.9% vs 18.3%, P < 0.001) and anxiety (28.2% vs 13.0%, P = 0.002). Multivariate logistic regression revealed that fasting C-peptide was still significantly associated with symptoms of gastroparesis (odds ratio, 0.67; 95% confidence intervals, 0.48–0.94; P = 0.021), even after adjustments for age, sex, body mass index, HbA1c, current smoking and drinking status, anxiety, and depression. Furthermore, linear regressions showed that fasting C-peptide was independently and negatively related to GCSI scores (standardized regression coefficient, −0.29; P < 0.001) in patients with at least one GI symptom. CONCLUSION: GI symptoms of diabetic gastroparesis affect approximately 20% of type 2 diabetes patients and are associated with lower fasting C-peptide levels independent of depression and anxiety status.