Research progress in control strategies of biological clock disorder / 生理学报

Circadian clock is an internal mechanism evolved to adapt to cyclic environmental changes, especially diurnal changes. Keeping the internal clock in synchronization with the external clock is essential for health. Mismatch of the clocks due to phase shift or disruption of molecular clocks may lead to circadian disorders, including abnormal sleep-wake cycles, as well as disrupted rhythms in hormone secretion, blood pressure, heart rate, body temperature, etc. Long-term circadian disorders are risk factors for various common critical diseases such as metabolic diseases, cardiovascular diseases, and tumor. To prevent or treat the circadian disorders, scientists have conducted extensive research on the function of circadian clocks and their roles in the development of diseases, and screened hundreds of thousands of compounds to find candidates to regulate circadian rhythms. In addition, melatonin, light therapy, exercise therapy, timing and composition of food also play a certain role in relieving associated symptoms. Here, we summarized the progress of both drug- and non-drug-based approaches to prevent and treat circadian clock disorders.

Validation of the Pollard' s classification criteria (2010) for rheumatoid arthritis patients with fibromyalgia / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the sensitivity and specificity of Pollard' s classification criteria(2010) for the diagnosis of rheumatoid arthritis (RA) patients withfibromyalgia (FM) in Chinese patients, and to assess the clinical features and psychological status of RA-FM patients in a real-world observational setting.@*METHODS@#Two hundred and two patients with rheumatoid arthritis were enrolled from the outpatients in Rheumatology and Immunology Department in Peking University People' s Hospital. All the patients were evaluated whether incorporating fibromyalgia translation occured using the 1990 American College of Rheumatolgy (ACR)-FM classification criteria. Forty two RA patients were concomitant with FM, while the other one hundred and sixty RA patients without FM were set as the control group.@*RESULTS@#There was no significant difference in general demography between the two groups (P>0.05). In this study, the Pollard' s classification criteria (2010) for RA-FM in Chinese patients had a high sensitivity of 95.2% and relatively low specificity of 52.6%. Compared with those patients without FM, RA patients with FM (RA-FM patients) had higher Disease Activity Scale in 28 joints (DAS-28) score (5.95 vs. 4.38, P=0.011) and much more 28-tender joint counts (TJC) (16.5 vs.4.5, P < 0.001).RA-FM patients had worse Health Assessment Questionnaire (HAQ) score (1.24 vs. 0.66, P < 0.001) and lower SF-36 (28.63 vs. 58.22, P < 0.001). Fatigue was more common in RA-FM patients (88. 1% vs. 50.6%, P < 0.001) and the degree of fatigue was significantly increased in RA-FM patients (fatigue VAS 5.55 vs. 3.55, P < 0.001). RA-FM patients also had higher anxiety (10 vs.4, P < 0.001) and depression scores (12 vs.6, P < 0.001). erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), morning stiffness time and 28-swollen joint counts (SJC) showed no difference between these two groups.@*CONCLUSION@#The Pollard' s classification criteria (2010) for RA-FM are feasible in Chinese rheumatoid arthritis patients. The Pollard' s classification criteria is highly sensitive in clinical application, while the relativelylow specificity indicates that various factors need to be considered in combination. RA patients with FM result in higher disease activity, worse function aland psychological status. RA patients with FM also have poorer quality of life. DAS-28 scores may be overestimated in RA patients with FM. In a RA patient thatdoes not reach remission, the possibility of fibromyalgia should be con-sidered.

Effect of incentive spouse cooperative psychological intervention on the delivery outcome of primipara / 上海预防医学

ObjectiveTo explore the effect of incentive spouse collaborative psychological intervention on delivery outcomes of primipara. MethodsFrom July 2019 to July 2020， 300 primiparas with an uneventful pregnancy were recruited and divided into the control group and the intervention group， with 150 cases in each group. The control group was managed by routine nursing care， and the intervention group was managed by incentive spouse collaborative psychological intervention. The delivery outcomes in two groups， including delivery route， postpartum blood loss， and perineal laceration were compared. ResultsAfter intervention， the cesarean section rate， the 2-hour postpartum blood loss and perineal laceration in the intervention group were less common than those in the control group and the difference was statistically significant （P<0.05）. The first， second and total stages of labor duration in the intervention group were shorter than those in the control group and the difference was statistically significant （P<0.05）. There was no significant difference in the incidence of neonatal asphyxia between these two groups （P>0.05）. In terms of vaginal delivery experience scores of the two groups， the intervention group was better than the control group and the difference was statistically significant （P<0.05）. ConclusionThe mode of incentive spouse collaborative psychological intervention can reduce the rate of cesarean section， the amount of bleeding 2 hours after delivery， and perineum injury. It can shorten the labor process， and effectively improve the delivery outcome of primiparas.

Effect of incentive spouse cooperative psychological intervention on the delivery outcome of primipara / 上海预防医学

ObjectiveTo explore the effect of incentive spouse collaborative psychological intervention on delivery outcomes of primipara. MethodsFrom July 2019 to July 2020， 300 primiparas with an uneventful pregnancy were recruited and divided into the control group and the intervention group， with 150 cases in each group. The control group was managed by routine nursing care， and the intervention group was managed by incentive spouse collaborative psychological intervention. The delivery outcomes in two groups， including delivery route， postpartum blood loss， and perineal laceration were compared. ResultsAfter intervention， the cesarean section rate， the 2-hour postpartum blood loss and perineal laceration in the intervention group were less common than those in the control group and the difference was statistically significant （P<0.05）. The first， second and total stages of labor duration in the intervention group were shorter than those in the control group and the difference was statistically significant （P<0.05）. There was no significant difference in the incidence of neonatal asphyxia between these two groups （P>0.05）. In terms of vaginal delivery experience scores of the two groups， the intervention group was better than the control group and the difference was statistically significant （P<0.05）. ConclusionThe mode of incentive spouse collaborative psychological intervention can reduce the rate of cesarean section， the amount of bleeding 2 hours after delivery， and perineum injury. It can shorten the labor process， and effectively improve the delivery outcome of primiparas.

Heat-sensitive moxibustion combined with western medication for low back pain of osteoporosis with kidney- / 中国针灸

OBJECTIVE@#To compare the clinical therapeutic effect between heat-sensitive moxibustion combined with western medication and simple western medication for low back pain of osteoporosis with kidney-@*METHODS@#A total of 60 patients with osteoporosis were randomized into an observation group (32 cases, 2 cases dropped off) and a control group (32 cases, 3 cases dropped off). In the control group, alendronate sodium tablet and calcium carbonate and vitamin D@*RESULTS@#The VAS scores, ODI scores and TCM clinical symptom scores after treatment were reduced in the two groups (@*CONCLUSION@#Heat-sensitive moxibustion combined with western medication could relieve low back pain, improve BMD in patients of osteoporosis with kidney-

Chemical constituents of triterpenoid saponins from Glycyrrhiza glabra / 药学学报

Ten triterpenoid saponins were isolated and purified from the water extract of Glycyrrhiza glabra by polyamide resin combined with macroporous resin column chromatography, ODS medium pressure column chromatography and semi-preparative RP-HPLC. Their structures were elucidated by physicochemical properties, NMR and MS spectra, and determined as 3β-O-[β-D-glucuronpyranosyl-(1→2)-β-D-glucuronpyranosyl]-30β-O-β-D-glucuronpyranosyl-oleanane-11-oxo-12(13)-ene (1), 3β-O-[β-D-glucuronpyranosyl-(1→2)-β-D-glucuronpyranosyl]-30β-O-α-L-rhamnopyranosyl-oleanane-11-oxo-12(13)-en-22β,30-diol (2), uralsaponin C (3), licorice-saponin A3 (4), licorice-saponin P2 (5), 22β-acetoxyl-glycyrrhizin (6), macedonoside A (7), 29-hydroxyl-glycyrrhizin (8), licorice-saponin G2 (9), glycyrrhizin (10). Compounds 1 and 2 are two new compounds and named as licorice-saponin R3 and licorice-saponin S3.

Fingerprint analysis and Q-marker prediction of processed liquorice products / 中国中药杂志

Licorice has long been regarded as one of the most popular herbs, with a very wide clinical application range. Whether being used alone or as an ingredient in prescription, it has an important role which cannot be ignored. However, the efficacy and chemical constituents of licorice will change after honey-processing. Therefore, it is necessary to find quality markers before and after honey-processing to lay the foundation for a comprehensive evaluation of the differences between raw and processed licorice pieces. HPLC-DAD was employed to establish fingerprints of raw and processed licorice. Multivariate statistical analysis methods including principal component analysis(PCA) and orthogonal partial least squares discrimination analysis(OPLS-DA) were applied to screen out the differential components before and after processing of licorice. Based on network pharmacology, the targets and pathways corresponding to the differential components were analyzed with databases such as Swiss Target Prediction and Metascape, and the "component-target-pathway" diagram was constructed with Cytoscape 3.6.0 software to predict the potential quality markers. A total of 17 common peaks were successfully identified in the established fingerprint, and seven differential components were selected as potential quality markers(licoricesaponin G2, glycyrrhizic acid, liquiritigenin, liquiritin, isoliquiritin, liquiritin apioside and isoliquiritigenin). The HPLC fingerprint method proposed in this study was efficient and feasible. The above seven differential chemical components screened out as potential quality markers of licorice can help to improve and promote the overall quality. These researches offer more sufficient theoretical basis for scientific application of licorice and its corresponding products.

Comparative study of water characteristic components of Glycyrrhiza uralensis from three geographical regions by chemical pattern recognition combined with muti-component qualitative and quantitative analysis / 中国中药杂志

Thirty-two batches of cultivated and wild Glycyrrhiza uralensis were obtained from three geographical regions. Comparative study of water characteristic components of G. uralensis from three geographical origins was conducted by PCA,OPLS-DA chemical pattern recognition combined with LC-TOF/MS and muti-component analysis. The similarity of fingerprints of 32 batches of medicinal materials ranged from 0. 903 to 0. 999. Patterns recognition could be used to distinguish cultivated G. uralensis in Gansu and Xinjiang areas from cultivated and wild plants in Inner Mongolia. Then a total of thirty-one common constituents were identified by LC-TOF/MS analysis coupled with standard compounds information. The contents of four flavonoid glycosides and five saponins were determinated by HPLC and compared using One-way ANOVA. The results showed that there was no significant difference in the contents of 5 triterpenoid saponins among the three regions,but the contents of 4 flavonoid saponins showed the trend of Inner Mongolia >Gansu≈Xinjiang( P<0. 05). In the same Inner Mongolia region,the contents of 4 flavonoid glycosides and 5 triterpenoid saponins in wild plant was significantly higher than that in cultivated plants( P<0. 01). In addition,the contents of liquiritin,isoliquiritin,licorice-saponin A_3,22β-acetoxyl-glycyrrhizic acid and uralsaponin B in Gansu and Xinjiang were obviously lower than those in Inner Mongolia,but the contents of glycyrrhizic acid,the main component of G. uralensis,were not different in the three geographical regions. In Inner Mongolia,the contents of liquiritin,isoliquiritin,licorice-saponin A_3,licorice-saponin G_2 and glycyrrhizic acid in wild plants were significantly higher than those in cultivated plants. In conclusion,qualitative/quantitative analysis of multi-index components combined with pattern recognition could effectively evaluate the quality of cultivated and wild licorice in different regions. It was helpful for us to understand the reality of licorice in different regions,and provided scientific basis for the development and comprehensive utilization of licorice resources.

Quality research of Puerariae Lobatae Radix from different habitats with UPLC fingerprint and determination of multi-component content / 中国中药杂志

To establish ultra performance liquid chromatography( UPLC) fingerprint of Puerariae Lobatae Radix from different habitats and simultaneously determine the contents of six isoflavonoids. The UPLC fingerprint analysis and content determination were performed on a Waters ACQUITY UPLC BEH C_(18)( 2. 1 mm×50 mm,1. 7 μm) chromatographic column,with acetonitrile-0. 05% formic acid as mobile phase for gradient elution. The detection wavelength was set at 250 nm; the flow rate was 0. 2 mL·min~(-1); the column temperature was 30 ℃ and the injection volume was 2 μL. Similarity evaluation system for chromatographic fingerprint of traditional Chinese medicine( TCM) was adopted; principal component analysis( PCA) and discriminant analysis by partial least square method( PLS-DA) in Simca-P software were used to identify the differential components in samples from three habitats. The similarity was over 0. 90 in 29 batches of samples,indicating good consistency of the samples. The samples were clustered into 3 categories by PCA and PLS-DA,and six differential components such as puerarin apioside,daidzin,and isoflavoues aglycone were found. The determination results of 6 isoflavones,including 3'-hydroxy puerarin,puerarin,3'-methoxy puerarin,puerarin apioside,daidzin,and isoflavoues aglycone,showed that the content of the same component and the fluctuation range between different components were all different among different habitats. The total content of 6 isoflavones from different regions was Anhui 11. 21% >Henan 10. 97% >Shannxi 9. 38%. The establishment of UPLC fingerprint combined with simultaneous determination of 6 active components provides a more comprehensive reference for quality control and quality evaluation of Puerariae Lobatae Radix.

Research advances in relationship between biological clock and cardiovascular diseases / 生理学报

Circadian rhythms widely exist in living organisms, and they are regulated by the biological clock. Growing evidence has shown that circadian rhythms are tightly related to the physiological function of the cardiovascular system, including blood pressure, heart rate, metabolism of cardiomyocytes, function of endothelial cells, and vasoconstriction and vasodilation. In addition, disruption of circadian rhythms has been considered as one of the important risk factors for cardiovascular diseases, such as myocardial infarction. This review summarizes the recent research advances in the relationship between circadian clock and cardiovascular diseases, hoping to improve treatment strategies for patients with cardiovascular diseases according to the theory of biological clock.

Acceleration of wound healing by a porous collagen/silk fibroin scaffold carrying zinc oxide nanoparticles / 中国组织工程研究

BACKGROUND:Anti-infective ability determine the success or failure of skin grafting. It is one of the commonly used methods to enhance the anti-infective ability of implants by compounding antibacterial materials with scaffolds. OBJECTIVE:To investigate the effect of porous collagen/silk fibroin scaffolds carrying zinc oxide nanoparticles against infection and inflammation, and to evaluate its effect on wound healing. METHODS:Thirty-two Sprague-Dawley rats with a full-thickness wound on the back skin were randomly divided into two groups. In experimental groiup, porous collagen/silk fibroin scaffolds containing zinc oxide nanoparticles were implanted, while only collagen/silk fibroin scaffolds were implanted in control group. Wound healing was compared between the two groups by measuring residual wound area at 1, 2, 4, 8 weeks post implantation. Hematoxylin-eosin and interleukin 6 immumohistochemical staining were performed at 1, 2, 4 weeks post implantation to observe wound morphology and inflammatory reactions. Meanwhile, expression of interleukin 6 and interleukin 1β was detected by real-time PCR. RESULTS AND CONCLUSION:(1) At 2, 4, 8 weeks post implantation, significantly increased healing rate was observed in the experiment group compared with the control group (P<0.05). (2) Findings from the hematoxylin-eosin staining showed that obvious inflammatory cell infiltration was observed in the control group, but less inflammation with vigorous growth of granulation tissues on the wound surface occurred in the experimental group at 1 week after implantation. Then, the wound repair was basically completed in the experimental group presenting with complete and compact epidermal tissue structure, while scar formation with no skin cover was found in the control group at 4 weeks after implantation. (3) Findings from the interleukin 6 immumohistochemical staining showed that there was interleukin 6 positive expression in both two groups to different extents; at 4 weeks after implantation, the expression of interleukin 6 was remarkably reduced in the control group, but it was still a strong positive expression, while week positive expression of interleukin 6 was observed in the experimental group. (4) Compared with the control group, the mRNA expression of interleukin 6 and interleukin 1β was both lower in the experimental group at 1, 2, 4 weeks after implantation, but there was a significant difference between the two groups at 1 and 2 weeks after implantation (P<0.05). Overall, the porous collagen/silk fibroin scaffold carrying zinc oxide nanoparticles can effectively reduce inflammations following skin injury, and accelerate skin wound healing.

Effect of functional exercises on patients with rheumatoid arthritis: a meta-analysis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effect of functional exercises on disease activity, joint function and quality of life of patients with rheumatoid arthritis (RA).@*METHODS@#Randomized controlled trials were searched in Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), VIP database and Wanfang database with keywords being "rheumatoid arthritis/RA", "function exercise (training)/joint exercise (training)/physical exercise (training)/resistance movement (exercise)/isotonic and isometric/stretching exercise/muscle exercise", and "trials/clinical trials". Then literature selection, extraction and literature quality evaluation were carried out by two of the authors independently following the including and excluding standards. Then the outcome indicators were analyzed with Review Manager 5.3 software.@*RESULTS@#In the study, 2 173 articles were achieved by searching in databases, including 1 522 English papers and 651 Chinese papers. Then 913 duplicated papers were identified and removed using EndNote software. After reading the titles and abstracts, 1 194 papers were excluded that did not satisfy the including standards. Finally, the full texts of these papers were read and papers with insufficient data were excluded, resulting in 13 included papers for systematic review, including 8 English and 5 Chinese papers. A total of 812 cases were studied in these papers, including 426 in the experimental groups and 386 in the conventional groups. For the outcome index in these articles, disease activity score 28 (DAS28) was used in 5 of them, health assessment questionnaire (HAQ) was used in 8 articles, visual analogue scale (VAS) for pain was used in 6 articles, and morning stiffness duration was used in 3 articles. The meta-analysis showed that functional exercises could delay the development of the disease activity of RA patients (mean difference=-0.76; 95%CI: -1.13, -0.38; P<0.001), improve the joint function (mean difference=-0.36; 95%CI: -0.47, -0.24; P<0.001), alleviate the pain of joints (mean difference=-1.75; 95%CI: -1.98, -1.53; P<0.001), and reduce the duration of morning stiffness (mean difference=-17.65; 95%CI: -22.09, -13.21; P<0.001).@*CONCLUSION@#This study showed the positive effects of functional exercises on alleviating the pain of joints, reducing the morning stiffness duration, and delaying the disease exacerbation of RA patients. It has a positive effect on improving the joint function and improving the quality of life in patients with RA.

Alteration of IFN-γ, IL-4, IL-17 and TGF-β levels in Serum of Patients with Chronic Lymphocytic Leukemia Treated with FCR / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the alteration and clinical significance of IFN-γ, IL-4, IL-17 and TGF-β levels in serum of patients with chronic lymphocytic leukemia treated with FCR.</p><p><b>METHODS</b>Forty-seven CLL patients treated with FCR regimen were enrolled in CLL group, meanwhile 30 healthy persons were selected in control group. The serum levels of IFN-γ, IL-4, IL-17 and TGF-β were detected by ELISA in CLL group before and after treatment and in control group, then the differences of IFN-γ, IL-4, IL-17 and TGF-β levels as well as IFN-γ/IL-4 ratio and TGF-β/IL-17 ratio were compared between 2 groups.</p><p><b>RESULTS</b>Before treatment with PCR regimen, the IL-4, IL-17 and TGF-β levels as well as TGF-β/IL-17 in CLL group were higher than those in control group (P<0.05), while the IFN-γ level and IFN-γ/IL-4 ratio in CLL group were lower than those in control group (P<0.05); after treatment with PCR regimen, the IL-4, IL-17 and TGF-β levels as well as TGF-β/IL-17 ratio all significantly decreased (P<0.05), while IFN-γ level and IFN-γ/IL-4 ratio significantly increased (P<0.05) as compared with those before treatment, moreover, the IL-4 and IL-17 levels as well as TGF-β/ IL-17 and IFN-γ /IL-4 ratio were no significantly different from those in control group (P>0.05), only the IFN-γ and TGF-β levels were significantly diffrent from control group (P<0.05). The analysis of Binet staging (stage A, B, C) showed that along with pregression of Binet stages, the TGF-γ/IL-17 levels as well as the IFN-γ/IL-4 ratio in CLL group negatively correlated with Binet staging (r=-0.53), while the TGF-β/IL-17 ratio positively correlated with Binet staging (r=0.46). The analysis of grouping accoraing to therapentic efficacy fonnd that the IL-4 and IL-17 levels and IFN-γ/IL-4 and TGF-β/IL-17 ratios in CR and PR groups were significantly different before and after treatment (P<0.05), while those in SD and PD groups did not showed statistical difference before and after treatment (P>0.05).</p><p><b>CONCLUSION</b>Along with the progression of disease, the IFN-γ/ IL-4 ratio gradually decreases, and the TGF-β / L-17 ratio gradually increases. The treatment with FCR regimen can overcome this tread, therefore dynamically monitoring the chages of IFN-γ/ IL-4 and TGF-β / L-17 ratios may contribute to guide the clinical treatment.</p>

Application of titrated target-controlled infusion anesthesia in laparoscopic colorectal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of titrated target-controlled infusion with propofol and remifentanil on anesthetics consumption and anesthesia depth in patients undergoing elective laparoscopic colorectal surgery.</p><p><b>METHODS</b>Sixty ASA I-III patients for elective laparoscopic colorectal surgery were enrolled. Titrated target-controlled infusion (TCI) with propofol and remifentanil was performed. Plasma concentration of the drugs was administered by titrated method to maintain bispectral index (BIS) in the range of 40-60 with systolic blood pressure (SBP) fluctuation within 20% of the basic value. BIS, SBP, plasma concentration of propofol and remifentanil were recorded at different time points. Awareness during operation was inquired postoperatively.</p><p><b>RESULTS</b>During the entire anesthesia period, the blood pressure was stable and BIS was maintained less than 60. There was no awareness during operation. The plasma concentrations (95% confidence interval) for TCI of propofol and remifentanil were 2.55-2.65 mg/L and 4.09-4.26 μg/L respectively when existing surgical stimulation during anesthesia, and the plasma target concentration of propofol was lower than the recommended dosages.</p><p><b>CONCLUSION</b>Titrated target-controlled infusions with propofol and remifentanil for elective laparoscopic colorectal surgery can maintain proper anesthesia depth and reduce the drug consumption.</p>

Interference of octamer-binding transcription factor 4A and its effect on the proliferation and multiple differentiation of human dental pulp cells / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the expression of octamer-binding transcription factor 4A(Oct4A) in human dental pulp cells(DPC)and the effect of Oct4A on the proliferation and multiple differentiation ability of DPC.</p><p><b>METHODS</b>Expression of Oct4A in DPC was detected by realtime quantitative PCR(RT-qPCR). siRNA-Oct4A was constructed and transfected (50 nmol/L) into DPC with Lipofectamine(TM) RNAiMAX for 24, 48, 72, 96 and 120 h. The proliferation rate of DPC was examined using cell counting kit 8 (CCK-8) assay. The alizarin red staining was used to observe the formation of calcification nodules in DPC with 14 d of osteogenic induction, and oil red O staining to observe the formation of lipid droplet in DPC with 14 d of adipogenic induction. The expression of osteogenesis-related genes dentin sialophosphoprotein (DSPP) and adipogenesis-related genes lipoprotein lipase (LPL) was detected using RT-qPCR and Western blotting.</p><p><b>RESULTS</b>The expression of Oct4A reached the peak in P3 DPC (2.10 ± 0.10), which was 2.10 times as much as that in P1 (P = 0.000 vs. P1 and P7), and decreased along passages. The interference efficiency of DPC transfection peaked at 72 h (69.7%). Compared with control group and negative control group (IR-siRNA), the proliferation rate and multiple differentiation ability of DPC in interference group (Oct4A-siRNA) were downregulated (P = 0.000), and DSPP and LPL in DPC from interference group significantly decreased (P = 0.000).</p><p><b>CONCLUSIONS</b>The interference of Oct4A significantly downregulated the cell proliferation rate and multilineage differentiation capability of DPC.</p>

Relation between HBsAg levels during the immune clearance phase of hepatitis B virus infection and liver pathological stages of chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate whether the level of hepatitis B surface antigen (HBsAg) represents the status of inflammation and stages of fibrosis in livers of patients with chronic hepatitis B (CHB) during the immune clearance phase (IC).</p><p><b>METHODS</b>Liver biopsy samples and sera were collected from 165 consecutive patients (136 males; 29 females) with CHB in IC who were treated in our hospital between March 2009 and June 2011. Routine biochemical tests were carried out to measure indicators of liver function. The relation between HBsAg level and liver pathological stages were determined by Spearman's rank correlation analysis. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of HBsAg level for liver pathological stages. Binary logistic regression was used to analyze potentially relevant indicators, and liver pathology-predicting models were built and analyzed by the ROC method.</p><p><b>RESULTS</b>The mean values of HBsAg (IU/mL) were significantly different at the different liver inflammation stages: G1, 27 716.07+/-32 870.69; G2, 34 478.75+/-40 899.55; G3, 19 408.09+/-24 881.07; G4, 14 286.31+/-28 610.14. Likewise, the mean values of HBsAg (IU/mL) were significantly different at the different liver fibrosis stages: S1, 41 337.23+/-43 236.39; S2, 27 264.32+/-32 517.29; S3, 111 541.77+/-11 538.93; S4, 11 447.37+/-22215.44. Spearman's rank correlation analysis indicated a significant correlation between HBsAg level and liver inflammation stage (rs = -0.244) and fibrosis stage (rs = -0.365). ROC curve analysis of the diagnostic value of HBsAg for inflammation stages S more than or equal to 4 revealed that the area under the curve (AUC) was 0.70. The specificity of diagnosing S more than or equal to 4 was > 95.16% when HBsAg was less than or equal to 32995 IU/mL. Binary logistic regression analysis identified age, serum albumin, cholinesterase, and HBsAg as independent predictors of liver fibrosis.</p><p><b>CONCLUSION</b>HBsAg level is negatively correlated with liver inflammation and fibrosis stages for patients with CHB in the IC phase, and might represent a useful noninvasive marker of the degree of hepatic fibrosis.</p>

Genetic diversity of adenoviruses in bats of China / 病毒学报

Adenovirus remains a significant threat to public health. Recent studies showed that bats can harbor diverse adenoviruses. To further investigate the distribution and genetic diversity of bat adenoviruses in China, we collected throat and anal swab samples of 11 bat species from 6 provinces of China, including Beijing, Hunan, Jiangxi, Yunnan, Guizhou and Hainan. Nested PCR was used to identify potential bat adenoviruses from the samples, and positive results were cloned and sequenced for genetic diversity study. In addition, nucleotide sequence alignments based on corresponding amino acid sequence similarities were used for phylogenetic analyses. Our results showed that about 20% of bat species in China are positive to adenoviruses, and Myotis ricketti is likely to be the most important host of bat adenoviruses in all locations. Moreover, we identified two diverse sequences of bat adenoviruses from the same sample of Ia io in Guizhou province of China. In general, the average nucleotide and amino acid sequence similarities of the conserved region of DNA polymerases of bat adenoviruses are 66.6% and 74.7%, respectively. The differences between bat species and their residences environments may have driven the adaptive evolution of the viruses, leading to the genetic diversity of the bat adenoviruses.

Determinants for inadequate glycaemic control in Chinese patients with mild-to-moderate type 2 diabetes on oral antidiabetic drugs alone / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Prevalence of inadequate glycaemic control among patients with type 2 diabetes mellitus (T2DM) remains high. We assessed glycaemic control in the real-life practice among people with T2DM in metropolises in China who were treated with oral antidiabetic drugs (OAD) alone and to determine factors associated with inadequate glycaemic control in this population.</p><p><b>METHODS</b>An observational, cross-sectional multicentre study was conducted in 16 metropolitan medical centers. People with T2DM who had been followed-up before the index visit which occurred from January to September 2007 were included in the study. All subjects were ≥ 30 years of age at the time of T2DM diagnosis and had received monotherapy or combination therapy of OAD for at least 6 months. Demographic and clinical data were collected from medical records. The main study outcome was the inadequate glucose control rate, which was calculated by the proportion of patients with haemoglobin A(1C) (HbA(1C)) ≥ 6.5% detected on the index visit.</p><p><b>RESULTS</b>In this cohort of 455 patients with T2DM whose mean age was 60.6 years and mean disease duration was 6.1 years, 45.5% had inadequate glycaemic control. The mean (SD) HbA(1C) was 6.7% (1.3). Multivariate Logistic regression showed that physical inactivity, disease duration > 10 years, body mass index (BMI) ≥ 24 kg/m(2), low homeostasis model assessment of β-cell function (HOMA-β) index, less frequency of medical visit and hypertriglyceridaemia were independent determinants of inadequate glycaemic control. Higher incidence of self-reported hypoglycemia experience (47.1% vs. 34.8%, P = 0.008) and more fear of hypoglycemia quantified by Worry subscale of the Hypoglycaemia Fear Survey (HFS) II were happened in subjects with good glycemic control.</p><p><b>CONCLUSION</b>Approximately one half of these outpatients with T2DM from the metropolitan medical centers in China had inadequate glycaemic control treated with OAD alone, which raises the need for more effective educational and therapeutic approaches on management of hypertriglycemia, enhancing physical exercise and weight control, and at the same time, lowering the hypoglycemic risk and diminishing the hypoglycemic fear of patients.</p>

A pilot study of the effect of pressure-driven lidocaine spray on airway topical anesthesia for conscious sedation intubation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Difficult airway remains not only a challenge to the anesthesiologists, but also a life-threatening event to the patients. Awake intubation is the principal choice to deal with difficult airway, and a key point for awake intubation is airway topical anesthesia. Yet, so far there is no ideal topical anesthesia approach for awake intubation. This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.</p><p><b>METHODS</b>Thirty adult patients referred for elective surgery under general anesthesia, aged 18 - C60 years and Mallampati class I or II, were recruited for the study. Before topical anesthesia, the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg), propofol (2 mg×kg(-1)×h(-1)) and remifentanil (0.05 µg×kg(-1)×min(-1)). Ten minutes after sedation, topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min. After topical anesthesia, tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist, and a score of less than 10 was considered to be satisfactory. Attempts to intubate the patient were recorded, and the complications such as local anesthetic toxicity, mucosa injury, and respiration depression were also recorded. The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation. Patients were asked 24 hours after the operation whether they could recall the events during intubation.</p><p><b>RESULTS</b>All patients were intubated at the first attempt, the average intubation condition score was 7.0 ± 1.1, from 6 to 10, satisfied intubation condition. MAP and HR increased significantly but mildly immediately after the tracheal intubation (P < 0.05), and decreased to the pre-intubation level soon after intubation. There were no related complications and patients had no recall of the intubation procedures.</p><p><b>CONCLUSIONS</b>Topical anesthesia with pressure driven 2% lidocaine spray, where pressure is achieved by 10 L/min oxygen flow, can offer satisfactory intubation conditions for conscious sedation intubation.</p>