Analysis on Components Absorbed into Blood and Cerebrospinal Fluid of Schisandrae Chinensis Fructus Based on Sequential Metabolism / 中国实验方剂学杂志

ObjectiveTo identify the prototypical components and metabolites absorbed into blood and cerebrospinal fluid of Schisandrae Chinensis Fructus（SCF） based on sequential metabolism combined with liquid chromatography-mass spectrometry. MethodBlood and cerebrospinal fluid samples of integrated metabolism， intestinal metabolism and hepatic metabolism were collected from male SD rats after gavage and in situ intestinal perfusion administration， and ultra-performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry（UPLC Q-Exactive Orbitrap MS） was used to analyze and compare the differences in the spectra of SCF extract， blank plasma， administered plasma， blank cerebrospinal fluid and administered cerebrospinal fluid with ACQUITY UPLC BEH Shield RP18 column（2.1 mm×100 mm， 1.7 µm）， the mobile phase was acetonitrile（A）-0.1% formic acid aqueous solution（B） for gradient elution（0-7 min， 95%B； 7-12 min， 95%-35%B； 12-17 min， 35%-15%B； 17-20 min， 15%-12%B； 20-22 min， 12%-5%B； 22-23 min， 5%B； 23-25 min， 5%-95%B； 25-28 min， 95%B）. And heated electrospray ionization（HESI） was used with positive and negative ion modes， the scanning range was m/z 100-1 500. The prototypical constituents and their metabolites absorbed into blood and cerebrospinal fluid of SCF were identified according to the retention time， characteristic fragments， molecular formulae and the information of reference substances. ResultA total of 42 chemical components were identified in the extract of SCF， including lignans， flavonoids， amino acids， tannins， and others， of which lignans were the main ones. A total of 27 prototypical components and 14 metabolites were identified in plasma samples from different sites. A total of 15 prototypical components and 9 metabolites were identified in cerebrospinal fluid. The main metabolic reactions involved in the formation of metabolites were mainly demethylation， methylation， demethoxylation and hydroxylation. ConclusionThrough the systematic identification of the prototypical components and metabolites of SCF in rats， it provides data support for further better exploring the material basis of SCF in the treatment of central nervous system diseases.

Repair Mechanism of Jianpi Huogu Prescription on Vascular Injury in Alcohol-induced Osteonecrosis of Femoral Head Based on VEGF/VEGFR2/PI3K/Akt Signaling Pathway / 中国实验方剂学杂志

MethodIn the experiment， 46% vol Red Star Erguotou （10 mL·kg·d-1） was used to establish the AONFH rat model， and the intervention effect of JPHGP at different doses （2.5， 5.0， 10.0 g·kg-1） was observed. Jiangusheng pill （JGS， 1.53 g·kg-1） was selected as the positive control. After 8 weeks of administration， the bone histomorphometry of the femoral head was analyzed by Micro-CT imaging， and the area of medullary microvessels in the femoral head was detected by ink perfusion. The pathological change was observed by hematoxylin and eosin （HE） staining. The protein expressions of Platelet endothelial cell adhesion molecule-1 （CD31）， VEGF， VEGFR2， PI3K， phosphor-Akt （p-Akt） and phosphatase and Tensin homologue deleted on chromosome 10 （PTEN） in the femoral head were determined by immunohistochemistry and Western blot. ResultCompared with normal group， the model group presented the fracture and thinning of trabeculae in the femoral head， increased empty bone lacunae， and elevated number and diameter of adipocytes （P<0.01）. Micro-CT imaging revealed a decrease in bone mineral density （BMD）， bone volume fraction （BV/TV）， trabecular thickness （Tb.Th） and trabecular number （Tb.N） （P<0.05， P<0.01） while an increase in bone surface-to-volume ratio （BS/BV） and trabecular separation （Tb.Sp） （P<0.01）. The results of ink perfusion showed that the area of medullary microvessels in the femoral head was reduced （P<0.01）. Compared with model group， JPHGP lowered the empty bone lacunae rate as well as the number and diameter of adipocytes in the femoral head of AONFH rats. Micro-CT imaging indicated that JPHGP low-dose group had elevated BV/TV， Tb.Th and Tb.N （P<0.05， P<0.01） while decreased BS/BV （P<0.01）， and there was an upward trend in BMD while a downward trend in Tb.Sp， but without statistical difference. In addition， JPHGP medium- and high-dose groups had a rise in BMD， BV/TV， Tb.Th and Tb.N （P<0.05， P<0.01）， a decrease in BS/BV and Tb.Sp （P<0.05， P<0.01） and enlarged area of medullary microvessels in the femoral head （P<0.05， P<0.01）. The expressions of CD31， VEGF， VEGFR2， PI3K， p-Akt in the model group were lower than those in the normal group （P<0.01）， and after medium and high doses of JPHGP treatment， the expressions of CD31， PI3K and p-Akt in the femoral head of rats were up-regulated （P<0.01） while the protein expression of PTEN was down-regulated （P<0.01）. Moreover， JPHGP up-regulated the expressions of VEGF and VEGFR2 （P<0.05， P<0.01）. ConclusionJPHGP can repair the vascular injury in AONFH， and its mechanism may be related to the activation of VEGF/VEGFR2/PI3K/Akt signaling pathway. This study provides certain scientific basis and reference for the clinical application of JPHGP. ObjecctiveTo observe the repair effect of Jianpi Huogu prescription （JPHGP） on vascular injury in experimental alcohol-induced osteonecrosis of femoral head （AONFH）， and to explore its mechanism based on vascular endothelial growth factor （VEGF）/VEGFR2/phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway.

Curcumin alleviates nuclear factor-κB/NOD-like receptor protein 3 mediated renal injury caused by acute respiratory distress syndrome through reducing mitochondrial oxidative stress / 中华危重病急救医学

OBJECTIVE@#To evaluate the effect of curcumin on renal mitochondrial oxidative stress, nuclear factor-κB/NOD-like receptor protein 3 (NF-κB/NLRP3) inflammatory body signaling pathway and tissue cell injury in rats with acute respiratory distress syndrome (ARDS).@*METHODS@#A total of 24 specific pathogen free (SPF)-grade healthy male Sprague-Dawley (SD) rats were randomly divided into control group, ARDS model group, and low-dose and high-dose curcumin groups, with 6 rats in each group. The ARDS rat model was reproduced by intratracheal administration of lipopolysaccharide (LPS) at 4 mg/kg via aerosol inhalation. The control group was given 2 mL/kg of normal saline. The low-dose and high-dose curcumin groups were administered 100 mg/kg or 200 mg/kg curcumin by gavage 24 hours after model reproduction, once a day. The control group and ARDS model group were given an equivalent amount of normal saline. After 7 days, blood samples were collected from the inferior vena cava, and the levels of neutrophil gelatinase-associated lipocalin (NGAL) in serum were determined by enzyme-linked immunosorbent assay (ELISA). The rats were sacrificed, and kidney tissues were collected. Reactive oxygen species (ROS) levels were determined by ELISA, superoxide dismutase (SOD) activity was detected using the xanthine oxidase method, and malondialdehyde (MDA) levels were determined by colorimetric method. The protein expressions of hypoxia-inducible factor-1α (HIF-1α), caspase-3, NF-κB p65, and Toll-like receptor 4 (TLR4) were detected by Western blotting. The mRNA expressions of HIF-1α, NLRP3, and interleukin-1β (IL-1β) were detected by reverse transcription-polymerase chain reaction (RT-PCR). Renal cell apoptosis was detected by TdT-mediated dUTP nick end labeling (TUNEL). The morphological changes in renal tubular epithelial cells and mitochondria were observed under a transmission electron microscope.@*RESULTS@#Compared with the control group, the ARDS model group exhibited kidney oxidative stress and inflammatory response, significantly elevated serum levels of kidney injury biomarker NGAL, activated NF-κB/NLRP3 inflammasome signaling pathway, increased kidney tissue cell apoptosis rate, and renal tubular epithelial cell damage and mitochondrial integrity destruction under transmission electron microscopy, indicating successful induction of kidney injury. Following curcumin intervention, the injury to renal tubular epithelial cells and mitochondria in the rats was significantly mitigated, along with a noticeable reduction in oxidative stress, inhibition of the NF-κB/NLRP3 inflammasome signaling pathway, and a significant decrease in kidney tissue cell apoptosis rate, demonstrating a certain dose-dependency. Compared with the ARDS model group, the high-dose curcumin group exhibited significantly reduced serum NGAL levels and kidney tissue MDA and ROS levels [NGAL (μg/L): 13.8±1.7 vs. 29.6±2.7, MDA (nmol/g): 115±18 vs. 300±47, ROS (kU/L): 75±19 vs. 260±15, all P < 0.05], significantly down-regulated protein expressions of HIF-1α, caspase-3, NF-κB p65, and TLR4 in the kidney tissue [HIF-1α protein (HIF-1α/β-actin): 0.515±0.064 vs. 0.888±0.055, caspase-3 protein (caspase-3/β-actin): 0.549±0.105 vs. 0.958±0.054, NF-κB p65 protein (NF-κB p65/β-actin): 0.428±0.166 vs. 0.900±0.059, TLR4 protein (TLR4/β-actin): 0.683±0.048 vs. 1.093±0.097, all P < 0.05], and significantly down-regulated mRNA expressions of HIF-1α, NLRP3, and IL-1β [HIF-1α mRNA (2-ΔΔCt): 2.90±0.39 vs. 9.49±1.87, NLRP3 mRNA (2-ΔΔCt): 2.07±0.21 vs. 6.13±1.32, IL-1β mRNA (2-ΔΔCt): 1.43±0.24 vs. 3.95±0.51, all P < 0.05], and significantly decreased kidney tissue cell apoptosis rate [(4.36±0.92)% vs. (27.75±8.31)%, P < 0.05], and significantly increased SOD activity (kU/g: 648±34 vs. 430±47, P < 0.05).@*CONCLUSIONS@#Curcumin can alleviate kidney injury in ARDS rats, and its mechanism may be related to the increasing in SOD activity, reduction of oxidative stress, and inhibition of the activation of the NF-κB/NLRP3 inflammasome signaling pathway.

The effects of aerobic exercise on renal fibrosis and apoptosis in spontaneously hypertensive rats / 中华物理医学与康复杂志

Objective:To explore any effect of regular aerobic exercise on renal fibrosis and apoptosis in rats with spontaneous hypertension.Methods:Thirty 6-week-old male spontaneously hypertensive rats were randomly divided into a sedentary group (group HS) and an exercise group (group HE). Ten age- and sex-matched Wistar-Kyoto rats formed a control group. The rats in group HE underwent 12 weeks of swimming exercise lasting 60 minutes, five times a week, while the other two groups were kept quiet in their cages. Before and after the training, the tail artery blood pressure of each rat was measured. Renal function was evaluated after the experiment by measuring 24h urine protein, blood urea nitrogen and serum creatinine levels, while the degree of renal interstitial fibrosis was measured using Masson staining and the collagen volume fraction was calculated. The number of apoptotic cells in the renal tubular epithelial tissue was recorded by TUNEL staining and the apoptosis rate was calculated. The expression of renal transforming growth factor β1 (TGF-β1), Smad2/3, Smad7, Bax and Bcl-2 protein were detected using western blotting.Results:After the intervention, the average systolic and diastolic blood pressure and mean arterial pressure of group HS had increased significantly, while those of group HE had decreased significantly, with no significant changes in those measurements among the control group. Compared with the control group, after the intervention, the average blood pressure, 24h urinary protein, blood urea nitrogen and serum creatinine, as well as the cell apoptosis rate and expression of TGF-β1, Smad2/3 and Bax had increased significantly, and that of Smad7 and Bcl-2 had decreased significantly in group HS. And compared with group HS, in group HE the average blood pressure, 24h urinary protein, blood urea nitrogen, serum creatinine and the cell apoptosis rate had decreased significantly, together with the expression of TGF-β1, Smad2/3 and Bax, but the average expression of Smad7 and Bcl-2 had increased significantly.Conclusion:Regular aerobic exercise can relieve the renal dysfunction seen in spontaneous hypertension, at least in rats, by inhibiting renal fibrosis and apoptosis.

Prenatal echocardiographic features and outcomes of congenital ventricular outpouching in ten fetuses / 中华围产医学杂志

Objective:To summarize the echocardiographic features and outcomes in fetuses with congenital ventricular outpouching (CVO).Methods:This retrospective study enrolled ten fetuses diagnosed with CVO by fetal echocardiography in the Affiliated Hospital of Qingdao University and Qingdao Women and Children's Hospital from January 2015 to April 2022. Clinical data were analyzed, including echocardiographic features, other intracardiac and extracardiac malformations, karyotypes, and pregnancy outcomes. Data were analyzed by descriptive statistics.Results:All ten cases were single, including eight ventricular diverticula and two ventricular aneurysms. Five cases had the anomaly in the left ventricular and the other five in the right. Five cases were isolated malformations, and the other five were complicated by other intra- or extracardiac malformations. A pathogenic copy number variation was detected in one case. Three pregnancies were terminated, and one was lost to follow-up. The other six fetuses were born alive and showed no obvious clinical symptoms or abnormalities in growth and development during 3-70 months of follow-up. The right ventricular diverticulum spontaneously disappeared in one case. One case with the right ventricular aneurysm was also diagnosed with noncompaction of the left ventricular myocardium by echocardiography at six months.Conclusions:Fetal CVO presents with typical echocardiographic features and can be diagnosed prenatally. Regular follow-up during pregnancy is recommended to observe the sizes of outpouchings and the occurrence of complications in fetuses with CVO after excluding other structural and chromosomal abnormalities to avoid unnecessary termination. Attention should also be paid to postnatal follow-up.

Correlation between the changing trajectories of serum uric acid and new onset nonalcoholic fatty liver disease / 中华健康管理学杂志

Objective:To explore the correlation between changing trajectories of serum uric acid and the onset of nonalcoholic fatty liver disease (NAFLD).Methods:A longitudinal cohort study. Total of 3 353 subjects who had routine health examination every year from January 2017 to December 2019 in the Health Management Center of the Second Affiliated Hospital of Dalian Medical University and met the inclusion criteria were selected as the research subjects. Four different serum uric acid trajectory groups were determined by using the group-based trajectory model: the low stability group, medium stability group, medium-high stability group and high stability group. During the follow-up to December 2021, the differences in cumulative incidence of NAFLD in different serum uric acid trajectory groups were calculated and compared. Cox proportional hazard regression model was used to evaluate the hazard ratio ( HR) and 95% confidence interval ( CI) of the NAFLD onset in different serum uric acid trajectory groups. The dose-response relationship between baseline serum uric acid and NAFLD was evaluated by a restricted cubic spline regression model. Results:The cumulative incidence of NAFLD in two years was 10.77%, and the cumulative incidence increased with the rising trajectory of serum uric acid, it was the highestin the high stability group ( P<0.05). Compared that in the low stability group, the risk of NAFLD in the other three groups was as follows: 2.24 (95% CI: 1.59-3.14) in the medium stability group, 2.89 (95% CI: 1.92-4.33) in the medium-high stability group and 4.55 (95% CI:2.83-7.31) in the high stability group (all P<0.05). The risk of NAFLD gradually increased with the rising of serum uric acid level, and the cut-off value of serum uric acid for women and men was 260.32 μmol/L and 365.09 μmol/L, respectively. Conclusions:Long-term moderate and high levels of serum uric acid are independent risk factors for the occurrence of NAFLD. With the rising of serum uric acid trajectory, the risk of NAFLD increases. Attention should be paid to the longitudinal change trend of serum uric acid level in the prevention of NAFLD, and it should be controlled within lower level of the normal range.

Research on the improvement of physical examination service quality based on KANO model and quality function deployment / 中华健康管理学杂志

Objective:To establish an integrated model with KANO model and quality function deployment theory to determine the priority of measures in improving the quality of physical examination service.Methods:It was a cross-sectional study. A total of 196 physical examinees from the Health Management Center of the second affiliated Hospital of Dalian Medical University were selected by simple random sampling. Reliability test was used to analyze the reliability and validity of the questionnaire. KANO model was used to determine the importance of physical examination needs in health examination population. The quality function deployment model was used to create the house of quality and determine the priority of the importance of various service measures.Results:In the high important attribute requirements of physical examination, the final importance of emergency ability, outpatient time, professional and advanced equipment are 0.054, 0.052, 0.047 and 0.046 respectively. The measures that needed to be given priority to improve the quality of physical examination services were to improve the quality of medical services (absolute importance=107.5), strengthen skill assessment (absolute importance=70.1), define guidance, consultation and clinic identification (absolute importance=56.2), introduce advanced equipment and facilities (absolute importance=53.7), timely and accurate physical examination report (absolute importance=51.9) and interpretation of physical examination report (absolute importance=50.9).Conclusions:The physical examination center should give priority to the measures such as improving the medical level, strengthening the skill examination, introducing advanced equipment and facilities, defining the guidance of examination, consultation and consultation room identification, and strengthening service management.

Long-term outcomes of definitive radiotherapy-based comprehensive treatment for inoperable stage I-III non-metastatic pancreatic cancer / 中华放射肿瘤学杂志

Objective:To analyze long-term outcomes of inoperable non-metastatic pancreatic cancer patients treated with definitive radiotherapy-based comprehensive treatment.Methods:Clinical data of 168 patients with medically unfit, refusal to surgery or inoperable non-metastatic pancreatic cancer treated with radiotherapy-based comprehensive treatment in PLA General Hospital between January 2016 and December 2020 were retrospectively analyzed. Survival outcomes,prognostic factors and patterns of treatment failure were analyzed in the radiotherapy ( n=95) and combined chemoradiotherapy ( n=73) groups. The survival analysis was conducted by Kaplan-Meier method. The survival curve was compared by log-rank test. Independent prognostic factors were identified by Cox proportional harzard model. Results:With a median follow-up of 20.2 months in the entire group, the median overall survival (OS) and median progression-free survival (PFS) were 18.0 and 12.3 months. The corresponding median OS and median PFS after receiving radiotherapy were 14.3 and 7.7 months. The 1-, 2-and 3-year OS rates were 72.1%, 36.6% and 21.5%, and the 1- and 2-year local control rates were 82.6% and 64.3%, respectively. The median OS for stage Ⅰ, stage Ⅱ and stage III were 27.1, 18.0 and 17.0 months, respectively. There was no significant difference in the median OS of patients with localized disease (stage Ⅰ-Ⅱ) between the radiotherapy and combined chemoradiotherapy groups (21.1 vs. 20.4 months, P=0.470). In patients with locally advanced disease (stage Ⅲ), combined chemoradiotherapy group showed better median OS compared with radiotherapy group (19.2 vs. 13.8 months, P=0.004). Clinical stage, CA19-9 before radiotherapy, comprehensive treatment and biological effective dose (BED 10) were identified as the independent prognostic factors for OS ( P=0.032, 0.011, 0.003 and 0.014). The cumulative 1- and 2-year actuarial rates of treatment failure, local-regional recurrence and distant metastasis were 48% and 74.4%, 15.0% and 27.4%, 23.6% and 33.1%, respectively. Liver metastasis (16.1%, 27/168) and local recurrence (11.9%, 20/168) were the primary patterns of treatment failure. Conclusions:Definitive radiotherapy-based comprehensive treatment effectively prolongs long-term survival in patients with inoperable non-metastatic pancreatic cancer. Definitive radiotherapy can be an alternative treatment option with curative intent for patients with localized pancreatic cancer who are medically unfit or refuse to undergo surgery. The combination of radiotherapy and chemotherapy remains an effective treatment choice for locally advanced unresectable pancreatic cancer.

Correlation between the expressions of serum microRNA-29c-3p, microRNA-378a-3p and serum inflammatory factors, myocardial injury indexes and echocardiographic indexes in sepsis patients with myocardial injury and the value of prognosis evaluation / 中国医师进修杂志

Objective:To investigate the correlation between the expressions of microRNA (miR)-29c-3p, miR-378a-3p and serum inflammatory factors, myocardial injury indexes and echocardiographic indexes in sepsis patients with myocardial injury, and analyze the value of prognosis evaluation.Methods:Prospective research methods were used. Two hundred and eighty-six patients with sepsis in Handan Central Hospital from February 2019 to October 2021 were selected. The serum levels of miR-29c-3p and miR-378a-3p were detected by polymerase chain reaction, and serum Troponin I (TnI), creatine kinase isoenzyme MB (CK-MB), myoglobin (Mb), B-type brain natriuretic peptide (BNP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β) and procalcitonin (PCT) were detected. The left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), stroke output (SV), cardiac output (CO) and the ratio of early diastolic maximum mitral valve velocity to atrial systolic maximum velocity (E/A) were measured by echocardiography. Serum TnI≥0.15 μg/L was defined as myocardial injury, the survival status within 28 d of hospitalization in patients with myocardial injury was recorded, and the acute physiology and chronic health Ⅱ evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were evaluated. Pearson method was used for correlation analysis; Multivariate Logistic regression was used to analyze the independent risk factors of death within 28 d of hospitalization in sepsis patients with myocardial injury; the receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of miR-29c-3p and miR-378a-3p in predicting the death within 28 d of hospitalization in septic patents with myocardial injury patients.Results:Among 286 patients with sepsis, 131 had myocardial injury (myocardial injury group), and 155 had no myocardial injury (non-myocardial injury group). The miR-29c-3p, Mb, CK-MB, BNP, TnI, TNF-α, IL-6, IL-1β, PCT, CRP, LVEDD and LVESD in myocardial injury group were significantly higher than those in non-myocardial injury group: 5.02 ± 1.69 vs. 2.01 ± 0.57, (102.35 ± 23.56) μg/L vs. (32.15 ± 9.12) μg/L, (25.01 ± 6.09) U/L vs. (13.02 ± 4.16) U/L, (905.23 ± 135.49) ng/L vs. (92.31 ± 26.35) ng/L, (0.23 ± 0.05) μg/L vs. (0.12 ± 0.02) μg/L, (13.41 ± 3.71) μg/L vs. (3.26 ± 0.95) μg/L, (9.02 ± 2.46) ng/L vs. (4.18 ± 1.03) ng/L, (71.45 ± 15.29) ng/L vs. (30.02 ± 6.39) ng/L, (1.05 ± 0.21) μg/L vs. (0.72 ± 0.13) μg/L, (21.35 ± 6.13) mg/L vs. (16.23 ± 4.57) mg/L, (37.45 ± 3.39) mm vs. (34.01 ± 2.15) mm and (50.12 ± 3.49) mm vs. (44.17 ± 3.02) mm, the miR-378a-3p, LVEF, SV, CO and E/A were significantly lower than those in non-myocardial injury group: 1.67 ± 0.36 vs. 3.02 ± 0.79, (46.32 ± 3.26)% vs. (56.24 ± 4.98)%, (48.21 ± 2.81) ml vs. (56.02 ± 3.49) ml, (3.11 ± 0.29) L/min vs. (4.15 ± 0.31) L/min and 0.98 ± 0.21 vs. 1.19 ± 0.32, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that miR-29c-3p was positive correlation with TNF-α, IL-6, IL-1β, PCT, CRP, Mb, CK-MB, BNP, TnI, LVEDD and LVESD in sepsis patients with myocardial injury ( P<0.01 or <0.05), and it was negative correlation with LVEF, SV, CO and E/A ( P<0.01); miR-378a-3p was negative correlation with TNF-α, IL-6, IL-1β, PCT, CRP, Mb, CK-MB, BNP, TnI, LVEDD and LVESD ( P<0.01 or <0.05), and it was positive correlation with LVEF, SV, CO and E/A P<0.01). Among 131 sepsis patients with myocardial injury, 55 patients died within 28 d of hospitalization (death subgroup), and 76 patients survived (survival subgroup). The mechanical ventilation rate, continuous renal replacement therapy rate, APACHE Ⅱ, SOFA, miR-29c-3p, Mb, CK-MB, TnI, BNP, TNF-α, IL-6, IL-1β, PCT, CRP, LVEDD and LVESD in death subgroup were significantly higher than those in survival subgroup, the miR-378a-3p, LVEF, SV, CO and E/A were significantly lower than those in survival subgroup, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that APACHE Ⅱ, TnI, miR-29c-3p were independent risk factors for death within 28 d of hospitalization in sepsis patients with myocardial injury ( OR = 1.203, 2.451 and 1.394; 95% CI 1.085 to 1.334, 1.498 to 4.008 and 1.141 to 1.702; P<0.01); and the miR-378a-3p an independent protective factor for death within 28 d of hospitalization in sepsis patients with myocardial injury ( OR = 0.367, 95% CI 0.217 to 0.622, P<0.01). ROC curve analysis result show that the best cut-off values of miR-29c-3p and miR-378a-3p for predicting the death within 28 d of hospitalization in sepsis patients with myocardial injury were 5.00 and 1.65; the area under the curve of miR-29c-3p combined with miR-378a-3p for predicting the death within 28 d of hospitalization in septic patients with myocardial injury was significantly larger than that of the two separate applications (0.890 vs. 0.695 and 0.732), with a sensitivity of 87.0%, a specificity of 87.3%, and an accuracy of 86.8%. Conclusions:The expression of serum miR-29c-3p is increased and the expression of miR-378a-3p is decreased in sepsis patients with myocardial injury. The expressions of miR-29c-3p and miR-378a-3p are related to the degree of myocardial injury, echocardiogram indexes, the levels of inflammatory factors and prognosis. The miR-29c-3p and miR-378a-3p can be used as potential prognostic indexes for sepsis patients with myocardial injury.

Effect of curcumin on renal fibrosis induced by acute respiratory distress syndrome in rats / 中华急诊医学杂志

Objective:To investigate the effect of curcumin on renal fibrosis in lipopolysaccharide (LPS) induced acute respiratory distress syndrome (ARDS) in adult SD rats.Methods:Twenty-four male SD rats were randomly (random number) divided into four groups: control group, ARDS group, low dose group, and high dose group ( n=6 per group). In the control group, the rats were given atomization intratracheal of standard saline 2 mL/kg; in the ARDS group, low-dose group, and high-dose group, the rats were given atomization intratracheal of 4 mg/kg LPS; in the low-dose group, the rats were given curcumin 100 mg/d by the oral administration, and in the high-dose group, the rats were given curcumin or 200 mg/d respectively. After seven days, the rats were sacrificed. The superoxide dismutase (SOD) activity and the content of malondialdehyde (MDA) and glutathione (GSH) in renal tissue were detected by colorimetric assay. Nuclear factor kappa-B p65 (NF-κB p65) and transforming growth factor-β1 (TGF-β1) were detected by Western blot. The expression of interleukin-6 (IL-6) mRNA, proline hydroxylase 3 (PHD3) mRNA, vascular endothelial growth factor (VEGF) mRNA and erythropoietin receptor (EPOR) mRNA were detected by quantitative real-time PCR (qRT-PCR). HE staining and Masson staining were used to assess pathological damage. One-way analysis of variance was used for comparison among multiple groups and SNK method was used for comparison between two groups. Results:Compared with the control group, the SOD activity and GSH content in the ARDS group, low-dose group, and high-dose group were significantly decreased (all P<0.05); the protein expression levels of MDA, NF-κB p65, and TGF-β1 were increased significantly, and IL-6 mRNA, PHD3 mRNA, VEGF mRNA, and EPOR mRNA were significantly upregulated (all P<0.05). HE staining showed inflammatory cell infiltration, and fibrogenesis in kidney tissue, and Masson staining showed deposition of collangen-like substance. Compared with the ARDS group, SOD activity and GSH content were increased, while the protein expression of NF-κB p65 and TGF-β1, IL-6 mRNA, PHD3 mRNA, VEGF mRNA, and EPOR mRNA were decreased significantly in the low-dose group and high-dose group (all P<0.05). Curcumin therapy reduced inflammatory cellular infiltration, and the deposition of collagen-like substance in kidney tissue. Compared with the low-dose group, SOD activity and GSH content were increased in the high-dose group (all P<0.05), and the protein expression of NF-κB p65 and TGF-β1, IL-6 mRNA, PHD3 mRNA, VEGF mRNA, and EPOR mRNA were decreased significantly in the high-dose group (all P<0.05). The high-dose group exhibited a significant reduction in edema, and a decrease of the deposition of collagen-like substance in kidney tissue. Conclusions:Curcumin can inhibit the development of renal fibrosis induced by acute respiratory distress syndrome in rats, and its mechanism may be related to inhibiting the expression of inflammatory factors and enhancing hypoxia tolerance.

Trends in cancer mortality in Wuyi County from 2015 to 2019 / 预防医学

Objective@#To investigate the trends in cancer mortality among residents in Wuyi County, so as to provide insights into the development of the cancer control strategy.@*Methods@#The deaths due to cancer among residents in Wuyi County from 2015 to 2019 were collected from Zhejiang Provincial Information Management System for Surveillance of Chronic Diseases. The crude mortality and standardized mortality of cancer and annual percent change (APC) of were calculated to analyze the trends in cancer mortality and causes of death.@*Results@#A total of 3 424 deaths occurred due to cancer in Wuyi County from 2015 to 2019, and the crude and standardized mortality rates of cancer were 199.65/105 and 185.87/105, respectively. The crude mortality of cancer was significantly higher in men than in women (271.53/105 vs. 125.40/105;χ2=459.374, P<0.001). The standardized mortality of cancer showed a tendency towards a reduction among all study subjects, men and residents at ages of 45 to 59 years (APC=-3.87%, -4.44%,-11.46%, all P<0.05), and the crude mortality of cancer appeared a tendency towards a rise with age in all study subjects, men and women (χ2=7 063.842, 2 155.609, 5 492.128, all P<0.001). Lung cancer, liver cancer, gastric cancer, bowel cancer and esophageal cancer were the five leading causes of cancer-related mortality, which accounted for 71.41% of all cancer mortality. The crude mortality of central nervous system cancer (2.07/105) and leukemia (1.66/105) was high among residents at ages of 0 to 14 years, and the crude mortality of liver cancer (3.02/105) and lung cancer (2.01/105) was high among residents at ages of 15 to 44 years, while the crude mortality of lung cancer (51.57/105) and liver cancer (36.22/105)was high among residents at ages of 45 to 59 years, and the crude mortality of lung cancer (305.48/105) and gastric cancer (114.65/105) was high among residents at ages of 60 years and older.@*Conclusions@#The standardized mortality of cancer appeared a tendency towards a reduction in Wuyi County from 2015 to 2019, and men and the elderly were high-risk populations for cancer. Screening, early diagnosis and treatment of lung cancer, gastrointestinal cancer and cervical cancer should be given a high priority.

Effects of scutellaria on the proliferation and migration of cervical cancer cells through miRNA-496 and stromal cell-derived factor 1 / 肿瘤研究与临床

Objective:To explore the effects of scutellarein on the cell proliferation and migration of cervical cancer cell line HCC94 through miRNA-496 (miR-496) and stromal cell-derived factor 1 (SDF-1).Methods:HCC94 cells in the logarithmic growth phase were taken as objects, and 20 μmol/L scutellarin solution (scutellarin group) and dimethyl sulfoxide (DMSO) (control group) were added respectively. The CCK-8 method and Transwell experiment were used to detect the proliferation and migration ability of the two groups of HCC94 cells. The relative expression levels of miR-496 and SDF-1 mRNA were detected by real-time quantitative polymerase chain reaction (qRT-PCR). The target gene of miR-496 was predicted by the bioinformatics software TarBase and verified by the dual-luciferase reporter gene assay. Western blot was used to detect the expression of related proteins.Results:Compared with the control group, the proliferation ability of HCC94 cells in the scutellarin group was decreased on the 3rd, 4th and 5th day of culture (all P < 0.05). The number of HCC94 cells in the scutellarin group and the control group were 25±5 and 134±19, respectively, and the cell migration ability of the scutellarin group was lower than that of the control group ( t = 5.61, P < 0.01). The relative expressions of miR-496 in the control group and the scutellarin group were 1.07±0.12 and 11.24±2.75, respectively, and the difference was statistically significant ( t = 3.68, P < 0.01). The dual-luciferase reporter gene assay confirmed that SDF-1 was the downstream targeted gene of miR-496. The relative expressions of SDF-1 mRNA in the scutellarin group and the control group were 0.29±0.05 and 1.01±0.07, respectively, and the difference was statistically significant ( t = 7.22, P < 0.01). Compared with the control group, after scutellarin promoted the expression of miR-496, the expressions of SDF-1 protein, the cell proliferation protein cyclin-dependent kinase 3 (CDK3) and the cell migration proteins Slug and Zeb-2 were decreased. Conclusions:Scutellarin could inhibit the proliferation and migration of cervical cancer HCC94 cells through the miR-496-SDF-1 axis.

Clinical analysis of 30 cases of asymptomatic primary hyperparathyroidism / 中华内分泌外科杂志

Objective:To analyze the clinical and pathological features of asymptomatic primary hyperparathyroidism (PHPT) .Methods:A retrospective analysis was carried out in terms of the clinical characteristics and pathological data in 30 patients with asymptomatic PHPT and 86 patients with typical PHPT hospitalized in the Department of Endocrinology and General Surgery of Beijing Jishuitan Hospital from Jan. 2013 to Dec. 2018. There were 7 males (23.3%) and 23 females (76.7%) , with a male to female ratio of 1:3.3. The average age was 56.9±13.3 years. In typical PHPT group, there were 32 males (37.2%) and 54 females (62.8%) , with the average age of 46.4±17.0 years. Bone metabolism indicators included bone density and bone biochemical markers (parathyroid hormone, 25-hydroxyvitamin D and alkaline phosphatase) . The t test was used to compare normally distributed variables, the Mann-Whitney rank sum test was used to compare skewed distributed variables, and the χ 2 test was used to compare enumeration data. Results:The median serum parathyroid hormone and alkaline phosphatase were 144.2 (108.1, 207.0) pg/ml and 80.0 (53.7, 105.5) IU/L respectively, the average serum concentration of calcium was 2.80±0.20 mmol/L, which were significantly lower than those of the classic group ( P<0.05) . The median serum 25-hydroxyvitamin D was 12.14 (7.87, 14.38) ng/ml, which was higher than that of the classic group ( P<0.001) . Ten patients (33.3%) developed osteoporosis, and the incidence was lower than that of the classic group ( P< 0.001) . The median tumor weight was 0.80 (0.25, 1.98) g, significantly smaller than that in the classical group ( P=0.003) . There were 26 cases (86.7%, including 2 atypical parathyroid adenomas) of parathyroid adenomas and 4 cases (13.3%) of hyperplasia. Conclusions:The asymptomatic PHPT has the same sex ratio as the classic type, mainly female, but the average age is significantly higher than that in the classic type. Although asymptomatic PHPT in this study are all benign lesions, abnormal bone biochemical indicators, especially vitamin D deficiency, are common, which also lead to osteoporosis.

Predictive value of lipid accumulation product and visceral fat index for metabolic syndrome among middle-aged and elderly populations / 预防医学

Objective@#To investigate the value of lipid accumulation product (LAP) and visceral fat index (VAI) for prediction of metabolic syndrome (MS). @*Methods@#Based on the 2018 Survey on Chronic Diseases and Risk Factors in Yantai City of Shandong Province, residents at ages of 45 years and older were sampled, and subjects' age, disease history, waist circumstance (WC), body mass index (BMI), blood pressure and blood lipid were collected to calculate LAP and VAI. MS was diagnosed with the a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity (JIS definition) and the recommended criteria proposed by the Chinese Diabetes Society (CDS) of Chinese Medical Association (CDS criteria), and the values of LAP and VAI for MS screening were evaluated using the receiver operating characteristic (ROC) curve analysis.@*Results@#Totally 9 366 subjects were enrolled, including 4 340 men (46.34%) and 5 026 women (53.66%), and had a mean age of (54.49±9.73) years. According to the CDS criteria, the prevalence of MS was 24.58%, and LAP and VAI showed areas under the ROC curve (AUC) of 0.837 (95%CI: 0.828-0.846) and 0.751 (95%CI: 0.739-0.762), sensitivities of 78.82% and 63.31% and optimal cut-off values of 44.64 and 1.86 for screening of MS. According to the JIS definition, the prevalence of MS was 35.26%, and LAP and VAI showed AUC values of 0.842 (95%CI: 0.834-0.850) and 0.790 (95%CI: 0.780-0.800), sensitivities of 75.73% and 68.42% and optimal cut-off values of 42.01 and 1.67 for screening of MS.@*Conclusions@#Both LAP and VAI are effective for screening MS among middle-aged and elderly residents, and LAP presents a higher accuracy than VAI.

Clinical observation of supracondylar fracture of humerus requiring surgical nerve exploration / 中国综合临床

Objective:To investigate the clinical effect of minimally invasive treatment of supracondylar fracture of humerus with nerve injury and the need for surgical exploration of nerve.Methods:From August 2017 to September 2020, 34 cases of children with supracondylar fracture of humerus with nerve injury in the Department of orthopedics of Shanxi Children′s Hospital were selected for retrospective analysis.Closed reduction, Kirschner wire fixation and small incision surgery were used to explore the injured nerve.The follow-up period ranged from 6 months to 3 years, with a follow-up time of (2.15±0.49) years.The elbow function, radial nerve, median nerve and ulnar nerve function were evaluated according to the trial standard of upper limb peripheral nerve function evaluation of Hand Surgery Society of Chinese Medical Association.Results:The elbow function of children in this group: excellent 31 cases, good 2 cases, fair 1 cases, poor 0 cases, excellent 33 cases.Three patients failed to take early functional rehabilitation exercise.Two patients recovered after 2.5 months of treatment by professional orthopedic rehabilitation therapists and physical therapy.One of them did not cooperate with functional rehabilitation training.After 3.5 months of treatment by orthopedic rehabilitation therapists, elbow and finger functions were not affected.Two weeks after nerve injury: radial nerve function evaluation: excellent in 15 cases, good in 3 cases, fair in 4 cases, poor in 0 cases, excellent in 18 cases.Median nerve function evaluation: excellent in 5 cases, good in 2 cases, fair in 6 cases, poor in 0 cases, excellent in 7 cases.Ulnar nerve function evaluation: excellent 5 cases, good 0 cases, fair 1 cases, poor 0 cases, excellent 5 cases.At 3 months after injury, the excellent and good rate of radial nerve, median nerve and ulnar nerve was 100%.Conclusion:The supracondylar fracture of humerus with nerve injury is treated by minimally invasive surgery, and the nerve exploration is still a few.The recovery of nerve injury after surgery is smooth, and the clinical effect is good.

Analysis of the quality of humanistic care for nursing students and its influencing factors / 中华医学教育探索杂志

Objective:To investigate the quality of humanistic care for nursing students in Hebei province and to analyze its influencing factors.Methods:The humanistic care quality assessment scale of nursing students was designed and used as the research tool. A questionnaire survey was conducted among 2 693 nursing students from 11 medical colleges and universities in Hebei province and the results were analyzed. SPSS 21.0 was used for statistical analysis. Measurement data were expressed by (mean±standard deviation). The single factor analysis of variance and independent sample t-test were used for comparative study, and the multiple linear regression method was used to analyze the influencing factors. Results:The total Cronbach's coefficient of the scale was 0.966, and the Cronbach's coefficient of each dimension was 0.780-0.959, proving that the scale could be used. The data showed that the overall quality of humanistic care of nursing students in Hebei province was (119.70 ± 15.35), and the overall score rate was 85.50%. Among them, the comparison results of education background, grade, participation in volunteer activities, personality, the degree of concern of surrounding people, family atmosphere, and whether the teacher mentioned humanistic care were statistically significant ( P<0.05). Conclusion:The quality of humanistic care for nursing students in Hebei province is at a relatively high level. Colleges and universities can provide targeted education according to the current situation and influencing factors, create a good humanistic classroom atmosphere for nursing students, encourage nursing students to actively participate in humanistic practice, and improve the quality of humanistic care for nursing students.

Case report of type Ⅱ Bruck syndrome caused by PLOD2 gene mutation combined with loss of heterozygosity / 中华实用儿科临床杂志

To analyze the clinical characteristics and genetic data of a child with type Ⅱ Bruce syndrome (type Ⅱ BS) admitted to the Department of Orthopedics, Shanxi Children′s Hospital at May 2020.A 3-day-old boy was admitted due to the pain and swelling of the right lower limb 3 days after birth.Due to the patient had multiple fractures, callus formation after clavicle and rib fracture, greendstick fracture of the humerus, right femur fracture, left tibia and fibula fracture, congenital clubfoot, and congenital contracture of wrist, elbow, hip and knee joint, and therefore, chromosome diseases were considered.Gene sequencing data showed gene mutation in PLOD2 with compound heterozygosity deletion of the child (proband), and mutation and heterozygosity deletion came from their parents, respectively.The patient was diagnosed as type Ⅱ BS.This case report alarms clinicians to identify a missense mutation of PLOD2 and loss of heterozygosity, so as to reduce the misdiagnosis rate and achieve early diagnosis and treatment.

Investigation on infection status of key human parasites in Yantai City, Shandong Province from 2015 to 2019 / 中华地方病学杂志

Objective:To understand the infection status of key human parasites in Yantai City, Shandong Province, and to provide scientific basis for establishing strategy for prevention and control of the disease.Methods:According to the "National Investigation Plan of Human Parasitic Infection Status" and implementation rules, stratified cluster random sampling method was adopted to select 39 survey sites in 10 counties (cities, districts) of Yantai City from 2015 to 2019. The respondents were residents in each survey site, with no less than 200 people in each survey site. The modified garten thick smear method (one fecal two test) and the direct smear method were respectively used to detect the eggs of intestinal worms and the trophozoites or cysts of intestinal protozoa. Besides, the transparent adhesive paper anal swab was used to detect pinworms in children aged 3 - 9 years. SPSS 18.0 software was used for statistical analysis. Comparison between infection rates was analyzed by χ 2 test or Fisher's exact probability test with 0.05 of test level. Results:A total of 8 507 people were investigated from 2015 to 2019. The total infection rate of intestinal parasites was 1.75% (149/8 507), and no protozoa was detected. A total of 4 species of intestinal worms were detected, including 1.41% (120/8 507) of whipworm, 0.16% (14/8 507) of ascaris, 0.14% (12/8 507) of pinworm and 0.07% (6/8 507) of hookworm. Among 149 cases of worm infection, 3 cases were ascaris and whipworm mixed infection, accounting for 2.01%. The infection rate of pinworm was 1.90% (11/578) in 578 children aged 3 - 9 years detected by transparent adhesive paper anal swab. From 2015 to 2019, the incidence of intestinal parasites infection first increased and then decreased, the difference was statistically significant (χ 2 = 469.38, P < 0.05). The infection rates of male and female were 1.72% (70/4 071) and 1.78% (79/4 436), respectively, with no significant difference between them (χ 2 = 0.05, P > 0.05). There was a significant difference of intestinal parasites infection rate in different age groups (χ 2 = 23.34, P < 0.05). The infection rate of intestinal parasites in ≥80 years old group was the highest with 2.84% (8/282). There was a significant difference of intestinal parasites infection rate among different professionals (χ 2 = 41.71, P < 0.05). Intestinal parasites infection rate of farmers was the highest with 2.58% (113/4 388). There was a significant difference of intestinal parasites infection rate among people with different cultural degree(χ 2 = 51.91, P < 0.05). Infection rate of illiterate people was the highest with 4.98% (16/321). Parasitic infection was detected in 10 counties (cities, districts), except Laishan District. The highest infection rate was Haiyang City (10.18%, 102/1 002), and the results of other counties (cities, districts) were lower than 1.20%. There was significant difference in infection rate in different regions (χ 2 = 433.87, P < 0.05). The infection rate in urban area was 0.51% (22/4 281), and the infection rate in rural area was 3.01% (127/4 226). The difference between urban and rural areas was statistically significant (χ 2 = 76.70, P < 0.05). Conclusion:The infection rate of intestinal parasites has been reduced to a lower level in rural area of Yantai City, and farmers are the key prevention and control population of intestinal parasites infection, so attention should be paid to strengthen the publicity of parasitic disease prevention and control.

Portable Pulse Detection System Based on IoT / 中国医疗器械杂志

Aiming at the current situation of high cost, huge volume, complex operation and difficulty in real application of pulse analyzer, this study designs and implements a portable pulse detection system based on IoT. The design utilizes Raspberry Pi 3B+, STM32 series MCU and cloud server to collect, store, display and recognize pulse signals at CUN, GUAN and CHI. The system is small in size and low in cost, which can be connected with cloud server through network to make full use of resources. The experimental results show that the recognition accuracy of the main feature points of the pulse signal by the portable pulse analyzer is higher than 97%, which has a broad prospect of development and application.

Advances on molecular mechanism of hepatitis B virus-induced hepatocellular carcinoma / 浙江大学学报·医学版

The pathogenesis of hepatitis B virus （HBV）-associated hepatocellular carcinoma （HCC） is complicated with the crosstalk of multiple factors and the multi-step processes. The main mechanisms underlying the HBV-induced HCC include:①integration of HBV DNA into the host hepatocyte genome to alter gene function at the insertion site，resulting in host genome instability and expression of carcinogenic truncated proteins;②HBV gene mutations at S，C，and X coding regions in the genome;③HBV X gene-encoded HBx protein activates proto-oncogenes and inhibits tumor suppressor genes，leading to the HCC occurrence. In this article，the recent research progress on the molecular mechanism of HBV-induced HCC is comprehensively reviewed，so as to provide insights into the prevention，early prediction and postoperative adjuvant therapy of HCC.