Detection of meningeal carcinomatosis by metagenomic next-generation sequencing and copy number variation analysis of cerebrospinal fluid / 中华神经科杂志

Objective:To evaluate the significance of copy number variation (CNV) and metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) in the diagnosis of meningeal carcinomatosis (MC).Methods:Ten patients with MC diagnosed in the Department of Neurology of Peking Union Medical College Hospital from March 2022 to June 2022 were consecutively enrolled in this study. The patients were diagnosed according to the criteria of the Chinese expert consensus on the diagnosis of MC by the Chinese Society of Infectious Diseases and Cerebrospinal Fluid Cytology, and the diagnosis of MC was confirmed by CSF cytology. The control group included 10 patients who were diagnosed as autoimmune encephalitis or viral encephalitis. CSF mNGS and CNV analysis were performed simultaneously in all the patients.Results:Of the 10 patients with MC, 6 had lung adenocarcinoma, 4 had breast cancer. CSF mNGS and CNV analysis detected large CNV in 8 of 10 patients with MC, including 4 patients with breast cancer and 4 patients with lung cancer. The results of pathogenic microorganism analysis of CSF mNGS in all the patients were negative. Meanwhile, large CNV was not detected in the control group.Conclusions:CSF CNV can serve as a diagnostic marker for MC. The combination of mNGS and CNV analysis has demonstrated a high positive rate in the diagnosis of MC. The dual-omics analysis of pathogenic microorganisms and CNV has been proposed as a potential strategy to further expand the clinical utility of CSF mNGS in the realm of auxiliary diagnosis.

Health status of elderly residents in Beijing city: a survey and analysis based on the Health Criteria for Older Adults in China(2022) / 中华老年医学杂志

Objective:To evaluate and analyze the health status of elderly people from the physical, psychological and social aspects using the Health Criteria for Older Adults in China(2022), and to understand the impact of social demographic characteristics on the overall health status of the elderly.Methods:159 elderly people aged 60 years and over in the Lanyuan community of Malianwa Subdistrict, Haidian District, Beijing were selected by the stratified sampling method, with a mean age of(70.7±7.9)years, including 74 men and 85 women.The physical, psychological, social and overall health status of the elderly were comprehensively evaluated and analyzed from data collected through a self-designed questionnaire with face-to-face interviews at respondents' homes.Results:The percentage of participants in this community who were considered overall healthy was 30.2%(n=48). The proportions of those meeting the criteria for physical, mental and social health were 79.2%(n=126), 90.6%(n=144)and 32.1%(n=51), respectively.For participants of 3 age groups(60-69, n=89; 70-79, n=44; ≥80, n=26), differences in percentages of people who were considered not healthy, largely healthy and healthy, measured using the overall, physical, mental and social health criteria, were statistically significant( χ2=24.683, 57.096, 12.801, 11.802, all P<0.05), and results of the χ2test for trend showed that the frequency distribution of people with overall, physical, mental and social health decreased with age( χ2=16.878, 31.600, 9.626, 9.626, all P<0.05). Multivariate Logistic regression analysis showed that education level( OR=2.142, 95% CI: 1.053-4.538, P=0.035)was an influencing factor for overall health status of the elderly. Conclusions:The overall health status of community-dwelling elderly people in Beijing is relatively poor and deteriorates with age.Education level is a factor affecting their health status.Health assessment for the elderly should be strongly advocated, and targeted health education should be provided for the elderly in disease prevention and mental health care.

Disease-modifying therapy for spinal muscular atrophy / 中华实用儿科临床杂志

Spinal muscular atrophy (SMA) was a severe inherited neuromuscular disease caused by the deficiency of the survival motor neuron (SMN) protein encoded by SMN1 gene with pathogenic variants.According to the age of onset and maximal achievement of motor function, SMA was classified into 4 subtypes.The most common and severe subtype was SMA type 1.During the natural course, most of patients with SMA type 1 die of respiratory failure within 2 years of age if not treated.Patients with other subtypes have progressive muscle weakness and atrophy at varying degrees.Before the emergence of disease-modifying therapy, a multidisciplinary management, including physical therapy, respiratory and nutritional support, has been the only approach to delay the disease progression and enhance the survival rate of SMA.However, motor milestone progress is unable to achieve by SMA patients, because the lack of SMN protein has not been solved.In the past 5 years, 3 drugs have been approved for the treatment of SMA.Clinical trials and a growing number of real-world study data have shown that medications of disease-modifying agents contribute to effectively improve motor function in SMA patients with different subtypes, and promote the motor milestone progress in some patients, which significantly reduce the mortality.However, treatment response of disease-modifying agents to SMA varies with the subtypes of SMA, individualized conditions and courses of disease.Therefore, it is particularly important to choose an optimal treatment to ensure the quality of life of patients.This review focuses on recent advances and emerging challenges in the treatment of SMA.

Clinical efficacy of demethylating drugs in treatment of patients with myelodysplastic syndromes / 白血病·淋巴瘤

Objective:To investigate the clinical efficacy and safety of demethylating drugs decitabine and azacitidine in treatment of myelodysplastic syndromes (MDS).Methods:The clinical data of 15 patients initially diagnosed with MDS in Fujian Provincial Hospital from May 2010 to May 2020 were retrospectively analyzed; 10 patients were treated with decitabine (10-30 mg·m -2·d -1, 3-5 d consecutively) and 5 patients were treated with azacitidine (75 mg·m -2·d -1 for 7 d consecutively). Gene mutation, risk stratification, efficacy and adverse reactions were observed. Results:Among 15 patients, 9 cases were males and 6 cases were females, with a median age of 64 years (51-84 years). The median follow-up time was 18 months (4-62 months). There were 3 cases in high-risk group, 10 cases in medium-risk group and 2 cases in low-risk group. SF3B1, TET2 and STAG2 mutations were more common in patients with low to moderate risk; DNMT3A, EZH2, U2AF1, RUNX1 and TP53 mutations were more common in patients with high-risk. All patients were evaluated for efficacy after 2-3 courses of treatment, and the total effective rate was 66.7% (10/15). Among them, 1 case (6.7%) achieved complete remission, 1 case (6.7%) achieved bone marrow complete remission (mCR), 2 cases (13.3%) achieved partial remission, and 6 cases (40%) achieved hematological improvement. During the treatment, 9 cases had grade 3-4 hematological toxicity and 6 cases had grade 3-4 infection. There was no grade 3-4 bleeding, nausea, vomiting and liver function damage. During the follow-up to May 2020, 9 patients survived and 6 patients died.Conclusions:Demethylating drugs decitabine and azacitidine have high rates of complete remission and partial remission and a low rate of adverse drug reactions in MDS patients.

Associations between indoor volatile organic compounds and nocturnal heart rate variability of young female adults: A panel study / 北京大学学报(医学版)

OBJECTIVE@#To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults.@*METHODS@#This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results.@*RESULTS@#The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m2. During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m3, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) μg/m3, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m3 increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m3. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter.@*CONCLUSION@#Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.

Progress in minimally invasive surgery for adjacent segment disease after lumbar fusion / 中华外科杂志

Adjacent segment disease (ASDis) is a common complication of posterior lumbar spine fusion and often requires surgical treatment. In the treatment of ASDis, percutaneous spinal endoscopy can be used for simple decompression without removal of the original internal fixation, or for posterior fixation and fusion under the scope or in combination with other access fixation and fusion techniques, with the advantages of less surgical trauma, less bleeding, and faster postoperative recovery. Traditional trajectory screw technique is one of the risk factors for adjacent segment degeneration because of its tendency to cause damage to the adjacent synovial joint during surgery. In contrast, the cortical tone trajectory (CBT) screw placement technique not only reduces the damage to the articular joint during the screw placement process, but also preserves the original internal fixation in the treatment of ASDis, which significantly reduces the surgical trauma. Secondly, the implantation of CBT screws with the aid of digital technologies such as three-dimentinal printed guides, CT navigation, and robotics allows for more precise "double nailing" of ASDis patients to complete the fusion of adjacent segments, and is a minimally invasive procedure to be considered for patients who meet the clinical indications for fusion. This article reviews the literature on the use of percutaneous spinal endoscopy and CBT in the surgical management of ASDis.

Pharmacodynamic Material Basis of Astragali Radix and Angelicae Sinensis Radix Drug Pair in Supplementing Qi and Activating Blood Circulation / 中国实验方剂学杂志

ObjectiveTo evaluate the effect of Astragali Radix （AR）-Angelicae Sinensis Radix （ASR） drug pair on supplementing Qi and activating blood circulation in rats with Qi deficiency and blood stasis and provide a theoretical basis for clinical rational medication and identification and quality control of compound pharmacodynamic substances from the three aspects of characteristic map， identification of pharmacodynamic substances， and comparison of blood components. MethodHigh-performance liquid chromatography （HPLC） was employed to establish the fingerprint of AR∶ASR （3∶1）， and ultra-high performance liquid chromatography-Q-Exactive Orbitrap-mass spectrometry （UPLC-Q-Exactive Orbitrap-MS） was employed to analyze the ingredients of the decoction. Adult male Wistar rats with SPF grades were selected and randomly divided into a blank group， a model group， a 3∶1 group， and a 5∶1 group. The rat model of Qi deficiency and blood stasis syndrome was prepared by controlling food intake and swimming in cold water every day. In parallel， each group was given medicine （or water） once a day. The dose of drug groups was 10.2 g∙kg-1， and the model group and blank group were given the same amount of distilled water for 15 d. Animal behavior， body weight， whole blood and plasma viscosity， thymus index， spleen index， the levels of adenosine triphosphate （ATP）， adenosine diphosphate（ADP）， von willebrand factor （vWF）， and ATP/ADP value in serum of rats were recorded. The morphology of vascular endothelium was observed by hematoxylin-eosin （HE） staining and scanning electron microscopy. UPLC-Q-Exactive Orbitrap-MS was used to analyze prototype and metabolic components in serum. ResultThe fingerprint of AR-ASR drug pair （AR-ASR 3∶1） was established. UPLC-Q-Exactive Orbitrap MS identified 49 chemical components in vitro and preliminarily identified 11 prototype components absorbed into blood in vivo. As compared with the blank group， the body mass decreased significantly （P<0.01）， the whole blood （high shear， middle shear， and low shear） viscosity and plasma viscosity were significantly increased （P<0.05， P<0.01）， the thymus index and spleen index decreased significantly （P<0.05， P<0.01）， serum ATP content decreased significantly （P<0.01）， ADP content increased significantly （P<0.01）， ATP/ADP value decreased significantly （P<0.01）， and vWF content increased significantly （P<0.01）. The results of HE staining and scanning electron microscopy showed that the vessels were partially damaged， showing the structural disorder of the intima， the bulge， defect， and roughness of the endothelium， and the obvious cell adhesion and migration in the model group. As compared with the model group， the body mass also increased significantly （P<0.01）. The results of whole blood and plasma viscosity showed that the whole blood low shear viscosity was significantly decreased in the 3∶1 group （P<0.05）. The results of thymus index and spleen index showed that 5∶1 group significantly increased the thymus index of rats （P<0.05）. The results of serum ATP and ADP levels showed that the 5∶1 group had more significant effects on ATP and ADP levels （P<0.05）， and both groups significantly reduced ATP/ADP values （P<0.01）. The results of serum vWF level showed that the vWF content in the 3∶1 group decreased significantly （P<0.05）. The results of HE staining and scanning electronic microscopy showed that the damage of vascular endothelium was improved in the treatment group and the structure of intima was neat. ConclusionAR-ASR drug pair can improve the macro and micro indexes of rats with qi deficiency and blood stasis in the 3∶1 and 5∶1 groups. Overall， the 5∶1 ratio has a better effect on supplementing Qi but 3∶1 ratio has a better effect on promoting blood circulation.

The Effect of SP1 on the Progression of T-cell Acute Lymphoblastic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To study the transcriptional regulation of SP1 on the scaffold protein ARRB1 and its influence on the progression of T-cell acute lymphoblastic leukemia (T-ALL).@*METHODS@#pGL3-ARRB1-luc, pCDNA3.1-SP1 and other transcription factor plasmids that might be combined were constructed, and the binding of transcription factors to the promoter of ARRB1 was identified by dual luciferase reporter gene assay. Stable cell lines with over-expressed SP1 (JK-SP1) was constructed by lentiviral transfection, and the expression correlation of SP1 with ARRB1 was demonstrated by RT-PCR and Western blot. Further, the apoptosis, cell cycle and reactive oxygen species (ROS) were detected by flow cytometry. The effect of SP1 on propagation of leukemic cells was observed on NCG leukemic mice.@*RESULTS@#The expression of fluorescein were enhanced by co-transfection with pCDNA3.1-SP1 and pGL3-ARRB1-luc plasmids in HEK293T cell line (P<0.001), meanwhile, compared with the control group, the expression of ARRB1 mRNA and protein were increased in JK-SP1 cells (both P<0.01). Further in vitro experiments showed that, compared with the control group, the apoptosis rate was higher (x=22.78%) , the cell cycle was mostly blocked in G1 phase (63.00%), and the content of reactive oxygen species increased in JK-SP1 cells. And in vivo experiments showed that the mice injected with JK-SP1 cells through tail vein had a favorable overall survival time (average 33.8 days), less infiltration in liver and spleen tissue.@*CONCLUSION@#Transcription factor SP1 promotes the transcription and expression of ARRB1 by binding the the promoter of ARRB1 directly, thus delays the progress of T-ALL in vitro and in vivo. The study improves the pathogenesis of ARRB1 regulating the initiation and development of T-ALL, and provides theoretical basis for the development of new possible targeted drugs.

Effect of P-coumaric Acid on Apoptosis of Multiple Myeloma Cells Based on Oxidative Stress / 中国实验血液学杂志

OBJECTIVE@#To investigate the effect of p-coumaric acid on apoptosis of multiple myeloma cells and its related mechanism.@*METHODS@#Multiple myeloma cell line MM.1s cells were selected and treated with different concentrations of p-coumaric acid (0, 0.4, 0.8, 1.6, 3.2 mmol/L), and the inhibition rate and half inhibition concentration (IC50) were detected by CCK-8 method. Then MM.1s cells were treated with 1/2 IC50, IC50, 2 IC50 and transfected with ov-Nrf-2 and ov-Nrf-2+IC50. The apoptosis, ROS fluorescence intensity and mitochondrial membrane potential of MM.1s cells were detected by flow cytometry, and the relative expressions of cellular Nrf-2 and HO-1 protein were detected by Western blot.@*RESULTS@#P-coumaric acid inhibited the proliferation of MM.1s cells in a dose-dependent manner(r =0.997) with an IC50 value of 2.754 mmol/L. Compared with the control group, apoptosis and ROS fluorescence intensity of MM.1s cells were significantly increased in the 1/2 IC50 group, IC50 group, 2 IC50 group and ov-Nrf-2+IC50 group (P <0.01), the expressions of Nrf-2, HO-1 protein in the IC50 group and 2 IC50 group were significantly decreased (P <0.05). Compared with the IC50 group, the cells apoptosis and ROS fluorescence intensity were significantly decreased (P <0.01), and the expressions of Nrf-2 and HO-1 protein were significantly increased in the ov-Nrf-2+IC50 group (P <0.01).@*CONCLUSION@#P-coumaric acid can inhibit the proliferation of MM.1s cells and may target the Nrf-2/HO-1 signaling pathway to affect oxidative stress in MM cells thereby inducing their apoptosis.

Functional connectivity changes during migraine treatment with electroacupuncture at Shuaigu (GB8) / 中西医结合学报

OBJECTIVE@#To investigate the changes in the functional connectivity (FC) in the right insula between migraine without aura (MWoA) and healthy controls by using resting-state functional magnetic resonance imaging (rs-fMRI), and to observe the instant alteration of FC in MWoA during electroacupuncture (EA) stimulation at Shuaigu (GB8).@*METHODS@#A total of 30 patients with MWoA (PM group) and 30 healthy controls (HC group) underwent rs-fMRI scans. The PM group underwent a second rs-fMRI scan while receiving EA at GB8. The right insula subregions, including the ventral anterior insula (vAI), dorsal anterior insula (dAI) and posterior insula (PI), were selected as the seed points for FC analysis.@*RESULTS@#Aberrant FC, including dAI with right postcentral gyrus, PI with left precuneus, was found among PM before EA (PMa), PM during EA (PMb) and HC. Meanwhile, decreased FC between dAI and the right postcentral gyrus was found in the PMa compared to the HC and PMb. Increased FC between the PI and left precuneus was found in the PMa compared to the HC and PMb. Correlation analysis showed that the FC value of the right postcentral gyrus in PMa was negatively correlated with the scores of Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety. The FC value of the left precuneus in PMa was positively correlated with the visual analogue scale score.@*CONCLUSION@#The alteration of FC between the right insula subregions and multiple brain regions may be an important index for MWoA. EA at GB8 was able to adjust the FC between the right insula subregions and parietal lobe, namely, the right dAI and right postcentral gyrus, and the right PI and left precuneus, thereby rendering an instant effect in the management of MWoA.

Evaluation and optimization of content determination method of Chrysanthemi Flos in Chinese Pharmacopoeia / 中国中药杂志

This study discovered that the resolution of 3,5-O-dicaffeoylquinic acid(isochlorogenic acid A) in the content determination method of Chrysanthemi Flos in Chinese Pharmacopoeia(ChP)(2020 edition) was poor, which affected accurate quantification. We tested the method in ChP with chromatographic columns of seven brands to clarify the problems in the existing method, optimized the chromatographic conditions by adjusting the mobile phase composition and elution ratio and replacing the chromatographic column packing, and carried out the reproducibility assay for the new method. The two methods were compared for the content determination results of Chrysanthemi Flos prepared from six different varieties. As evaluated by the resolution based on different chromatographic columns of seven brands, the existing method failed to separate isochlorogenic acid A and isochlorogenic acid D well. The peaks of the two components were not completely separated on three chromatographic columns, and isochlorogenic acid A and isochlorogenic acid D generated a co-effluent peak in the other four columns. Isochlorogenic acid A and isochlorogenic acid D could be completely separated under the optimized chromatographic conditions. The difference in the peak areas of isochlorogenic acid A+isochlorogenic acid D obtained by the optimized method and the method in ChP was not significant, with deviation less than 3.0%, which further proved that the result measured by the method in ChP was the co-effluent of isochlorogenic acid A and isochlorogenic acid D. The optimized method can ensure the accurate quantification of isochlorogenic acid A. The existing content determination method of Chrysanthemi Flos has the problem of poor resolution. It is recommended to revise the chromatographic conditions for the content determination method of Chrysanthemi Flos to improve the resolution of isochlorogenic acid A and ensure its accurate quantification.

Comparison of chemical components between aerial and underground parts of Coptis chinensis based on UPLC-Q-TOF-MS~E technology / 中国中药杂志

The ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS~E) technology was employed to compare the chemical components between the aerial and underground parts of Coptis chinensis samples from different batches. According to the retention time, molecular ion peak, and LC-MS~E fragment information of the reference substances and available literature, we identified a total of 40 components. Thirty-three and 31 compounds were respectively identified in the underground part(taproots) and the aerial part(stems and leaves) of C. chinensis. Among them, 24 compounds, including alkaloids(e.g., berberine and jatrorrhizine) and phenolic acids(e.g., chlorogenic acid, quinic acid, and tanshinol), were common in the two parts. In addition, differential components were also identified, such as magnoline glucoside in the underground part and(±) lariciresionol-4-β-D-glucopyranoside in the aerial part. The analysis of fragmentation pathways based on spectra of reference substances indicated the differences among samples of different batches. Furthermore, we performed the principal component analysis(PCA) for the peak areas of C. chinensis in different batches. The results showed that the underground part and the aerial part were clearly clustered into two groups, indicating that the chemical components contained in the two parts were different. Furthermore, the results of partial least squares discriminant analysis(PLS-DA) identified 31 differential compounds(VIP value>1) between the underground part and the aerial part, mainly including alkaloids, phenolic acids, lignans, and flavonoids. This study proves that C. chinensis possesses great development potential with multiple available compounds in stems and leaves. Moreover, it sheds light on for the development and utilization of non-medicinal organs of C. chinensis and other Chinese medicinal herbs.

Association between the Neutrophil-to-lymphocyte Ratio and New-onset Subclinical Macrovascular and Microvascular Diseases in the Chinese Population / 生物医学与环境科学（英文）

OBJECTIVE@#The association between neutrophil-to-lymphocyte ratio (NLR) with subclinical macrovascular and microvascular diseases has been less investigated. We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.@*METHODS@#From a community cohort, we included 6,430 adults aged ≥ 40 years without subclinical macrovascular and microvascular diseases at baseline. We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and albuminuria.@*RESULTS@#During a mean follow-up of 4.3 years, 110 participants developed incident abnormal ABI, 746 participants developed incident elevated baPWV, and 503 participants developed incident albuminuria. Poisson regression analysis indicated that NLR was significantly associated with an increased risk of new-onset abnormal ABI, elevated baPWV, and albuminuria. Compared to overweight/obese participants, we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight. Furthermore, we found an interaction between the NLR and body mass index (BMI) on the risk of new-onset abnormal ABI ( P for interaction: 0.01).@*CONCLUSION@#NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population. Furthermore, in participants with normal weight, the association between NLR and subclinical vascular abnormalities was much stronger.

Effects of electroacupuncture on gastric emptying in patients undergoing hepatobiliary surgery with preoperative fasting and drinking under enhanced recovery after surgery protocol / 中华麻醉学杂志

Objective:To evaluate the effect of electroacupuncture (EA) on gastric emptying in patients undergoing hepatobiliary surgery with preoperative fasting and drinking under the enhanced recover after surgery (ERAS) protocol.Methods:Seventy-six patients of both sexes, aged 18-75 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, who underwent elective laparoscopic hepatectomy or cholecystectomy from January 2019 to December 2020, were divided into 2 groups ( n=38 each) using a random number table method: control group (group C) and EA group.Both groups used the ERAS strategy of fasting and drinking before operation.Solid food was forbidden after 20: 00 the night before surgery, and 12.5% preoperative oral carbohydrate drinks 800 ml was taken orally from 20: 00 to 22: 00, and preoperative oral carbohydrate drinks 400 ml was taken orally from 5: 30 to 6: 00 on the morning of surgery.The bilateral Zusanli, Zhongwan, Neiguan, and Taichong were stimulated at 7: 30 in group EA, while sham acupoints were stimulated in group C. All the patients underwent ultrasonography of the gastric antrum at 8: 00 for measurement of the cross-sectional area (CSA) in the supine and right lateral decubitus positions (right-lat CSA), gastric volume (GV), ratio of gastric volume to weight (GV/W), and ratio of right-lat CSA to weight (CSA/W) were measured, and Perlas A semi-quantitative grating was performed.After induction of anesthesia, the level of mucous pepsin at the esophageal entrance was quantitatively determined by enzyme-linked immunosorbent assay, and positive expression was recorded.The adverse reactions such as nausea, vomiting and aspiration during induction of anesthesia were recorded. Results:Compared with group C, the supine CSA, right-lat CSA, GV, right-lat CSA/W, GV/W, Perlas A semi-quantitative grading, positive rate of pepsin and incidence of nausea were significantly decreased in group EA ( P<0.05). Conclusions:EA can promote gastric emptying in the patients undergoing hepatobiliary surgery with preoperative fasting and drinking under ERAS protocol.

A case report of bladder malakoplakia in systemic sclerosis patient / 中华泌尿外科杂志

Systemic sclerosis is a rare and complex autoimmune disease, and malakoplakia is a rare chronic granulomatous inflammatory disease. Systemic sclerosis combined with malakoplakia is extremely rare. Diagnosis is difficult before surgery. It is easy to misdiagnose bladder malakoplakia as bladder tumor. This paper reports a middle-aged female patient with systemic sclerosis complicated with bladder malakoplakia. The main clinical manifestations were hematuria and bladder irritation, accompanied by severe diarrhea. Transurethral resection of bladder tumor was performed. Postoperative pathology proved that it was bladder malakoplakia. After the surgery, she continued to take low-dose prednisolone and methotrexate in the treatment of systemic sclerosis. The patient was followed up for 6 months.Transurethral cystoscopy was performed twice, and there was no recurrence.

Effects of short-term forest therapy on selected physical and mental health indicators of young healthy individuals / 环境与职业医学

Background The health effects of forest therapy have been widely recognized, while the previous studies mostly focused on a single activity mode of forest walks. The effects of different types of forest therapy activities remain unclear. Objective To explore the effects of short-term forest therapy on cardiopulmonary health, psychological health, and sleep quality, and the health effects of different types of forest therapy activities, aiming to provide population empirical study data for the development of forest therapy. Methods A self-control study was conducted in a national forest park in suburb of Beijing from August to September 2018. A total of 31 healthy college students were recruited as the study subjects, with a total forest stay for 3 days and 2 nights. During the period of study, each subject practiced walking therapy, sitting therapy with five senses experience (sitting therapy thereafter), and handmade work therapy, successively. Each type of forest therapy lasted about 2 h. Changes of blood pressure, oxygen saturation (SpO2), lung function, and fractional exhaled nitric oxide (FeNO) were estimated by measuring corresponding indicators before and after the forest therapy. Psychological health and sleep quality were assessed by Profile of Mood States and Pittsburgh Sleep Quality Index respectively at the same time. Mixed effects models were used to analyze the changes of these health indicators. The health effects of different types of forest therapy activities were further analyzed. Results The average age and body mass index of subjects in this study were (24.5±2.6) years and (20.7±1.7) kg·m−2, respectively. After a short-term forest therapy, the selected indicators of cardiopulmonary health, psychological health, and sleep quality of subjects were all improved. In particular, the pulse pressure (PP) and FeNO decreased by 3.02 mmHg and 1.10 ppb, respectively, while the SpO2 and peak expiratory flow (PEF) increased by 0.65% and 0.50 L·s−1, respectively, and the negative emotion and global sleep quality also presented significant positive changes (all P<0.05). Furthermore, different therapy activities presented differential effects in the health indicators. Walking therapy significantly improved pulmonary function, SpO2, and confusion (CON) emotion, in which the SpO2, forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC) increased by 0.48%, 0.14 L, and 0.12 L, respectively, and the score of CON decreased by 0.97 (all P<0.05). Sitting therapy significantly reduced blood pressure and tension (TEN) emotion of subjects, including a decrease of the systolic blood pressure (4.45 mmHg), PP (4.19 mmHg), and the score of TEN (0.84) (all P<0.05). The diastolic blood pressure (DBP) increased slightly after handmade work therapy (ΔDBP=2.44 mmHg, P=0.016), but there were no significant changes in other indicators. Conclusion Short-term forest therapy could significantly improve cardiopulmonary health, psychological health, and sleep quality of young healthy individuals, and different types of forest therapy activities may have differential health effects.

Saponins in Treatment of Alzheimer's Disease and Their Mechanism of Action： A Review / 中国实验方剂学杂志

Alzheimer's disease（AD） is an irreversible neurodegenerative disease with clinical manifestations such as memory impairment， aphasia， impaired visuospatial skills， executive function impairment， and personality changes. AD has brought a heavy burden to the family and society due to its unrevealed pathogenesis and the lack of therapeutic approaches. Saponins， a group of oligoglycosides whose aglycones are triterpenes or spirosteroids， are divided into triterpene saponins and steroidal saponins， which have a variety of biological activities. At present， there is no systematic review on the anti-AD effect of saponins. According to the literature published in recent years， the authors summarized the studies of saponins in improving AD based on animal experiments. The results indicated that saponins enhanced learning ability and improved cognitive impairment by inhibiting amyloid β-protein （Aβ） cascade activity， suppressing microtubule-associated protein （tau） hyperphosphorylation， inhibiting neuronal oxidative stress， inhibiting inflammatory factors， regulating apoptosis， inhibiting cholinergic neuronal degeneration， promoting mitochondrial autophagy， regulating intestinal flora， and enhancing energy metabolism， which in turn improved the pathological state of AD animal models. The therapeutic effects of different saponins on AD are different. The present study discussed the effect of different aglycones and sugar chains on the anti-AD activity based on saponins and anti-AD effect to provide new ideas and a theoretical basis for the development and utilization of saponins.

Prediction of Short- and Long-term Death in Patients with Acute Ischemic Stroke Using Various Scoring Systems / 中国康复理论与实践

Objective:To compare the prediction of Ischemic Stroke Predictive Risk Score (iScore), Preadmission Comorbidities, Level of Consciousness, Age, and Neurologic Deficit (PLAN), Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and Totaled Health Risks in Vascular Events (THRIVE) for short- and long-term death for patients with acute ischemic stroke (AIS). Methods:From August, 2015 to June, 2018, 323 AIS patients in emergency ward were included, and followed up 30 days, three months and a year after including. Receiver operating characteristic (ROC) curve was used to analyze the predictive effects of iScore, PLAN, ASTRAL and THRIVE. Results:The all-cause mortality 30 days, three months and a year after including was 12.4% (40/323), 17.3% (56/323) and 25.7% (83/323), respectively. The area under curve (AUC) from more to less arranged as iScore, PLAN, ASTRAL and THRIVES. There was significant difference of AUC between iScore and THRIVE (Z > 1.990, P < 0.05), but not among the others (Z < 1.943, P > 0.05). Conclusion:iScore, PLAN, ASTRAL and THRIVE may predict short- and long-term death of AIS patients in the emergency well, and iScore is the best. However, the procedure of iScore is complex, it is recommended to use PLAN and ASTRAL for emergency.

Prognostic analysis of patients with Ⅳ B stage hematogenous metastatic cervical squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To evaluate the prognostic factors and the value of definitive pelvic radiotherapy in patients with stage Ⅳ B hematogenous metastatic cervical squamous cell carcinoma. Methods:Clinical data of 80 patients with Ⅳ B stage squamous cell carcinoma admitted to Zhejiang Cancer Hospital from 2006 to 2016 were retrospectively analyzed. The survival analysis was conducted by Kaplan- Meier method. Prognostic factors were analyzed by Cox models. Results:The 1-, 2-and 5-year overall survival (OS) and progression-free survival (PFS) rates were 52.5%, 26.3%, 16.8% and 25%, 13.8%, 8.8%, with a median OS of 13.8 months and a median PFS of 5.6 months, respectively. The most common site of metastasis was bone (51.3%), followed by lung (36.3%) and liver (26.3%). Univariate analysis revealed that chemotherapy combined with definitive pelvic radiotherapy and ≥6 cycles of chemotherapy were positively correlated with OS and PFS, whereas ECOG performance status score of 3-4 and liver metastasis were negatively correlated with OS and PFS. In multivariate analysis, liver metastasis ( HR=2.23, 95% CI: 1.01-4.91, P=0.048) and ECOG performance status score of 3-4( HR=2.01, 95% CI: 1.03-3.91, P=0 0.040) were significantly correlated with poor OS. Subgroup multivariate analysis showed that compared with chemotherapy±palliative radiotherapy, systemic chemotherapy combined with definitive pelvic radiotherapy significantly improved OS ( HR=0.39, 95% CI: 0.18-0.84, P=0.016). Compared with double drugs combined with<4 cycles of chemotherapy, double drugs in combination with ≥4 cycles of chemotherapy significantly improved OS ( HR=0.32, 95% CI: 0.15-0.68, P=0.003). Conclusions:Patients with low ECOG performance status score or liver metastasis obtain poor prognosis. Definitive pelvic radiotherapy combined with chemotherapy can enhance clinical prognosis of patients with Ⅳ B stage hematogenous metastatic cervical squamous cell carcinoma.

Clinical characteristics and diagnostic models of latent autoimmune diabetes in adults with newly diagnosed type 2 diabetes mellitus / 中国医师杂志

Objective:To analyze the clinical features of latent autoimmune diabetes (LADA) in adults among newly diagnosed type 2 diabetes mellitus (T2DM), and to explore whether LADA diagnostic models can be established based on this.Methods:From May 2016 to January 2017, 302 patients with newly diagnosed T2DM in the outpatient and inpatient department of metabolism and endocrinology of Yueyang Central Hospital were analyzed. All of them were tested for glutamic acid decarboxylase antibody (GADA). According to the consensus of the Chinese Medical Association Diabetes Association (CDS) LADA diagnosis and treatment, they were divided into LADA group (18 cases) and T2DM group (284 cases). The general clinical data and clinical biochemical indexes of the two groups were analyzed; Multiple linear regression method was used to evaluate the feasibility of establishing LADA diagnostic model.Results:⑴ Compared with patients in the T2DM group, the patients in the LADA group had a younger age of onset, and " three more and one less" symptoms were more common ( P<0.05); the weight, body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), triglycerides (TG), fasting C peptide (FCP), postprandial 2 h C peptide (2 h-CP), modified islet function index HOMA-islet (CP-DM), and modified insulin resistance index HOMA-IR (CP) in the LADA group were all lower, while high-density lipoprotein cholesterol (HDL-C) and HbA1c were higher ( P<0.05). ⑵ the linear regression method was used to analyze the multicollinearity of patients in LADA group and T2DM group. The biochemical indexes with statistically significant difference were selected as independent variables through correlation analysis, and the GADA value was used as dependent variable. The statistical results showed that the independent variables could not fully meet the conditions of multicollinearity regression analysis. Conclusions:⑴ Related clinical features and glucose metabolism indicators have differential diagnosis significance for LADA, but this study cannot be used for multiple linear regression analysis, and it is difficult to establish a diagnostic model for LADA. ⑵ LADA diagnosis is a comprehensive diagnosis, which should be combined with the results of islet autoantibody and clinical features.