Analysis of the pathogenesis and risk factors of gallstone / 中华外科杂志

Objective: To explore the pathogenesis and risk factors of gallstone formation. Methods: The findings of hepatobiliary ultrasound and related data were collected from healthy subjects who underwent a physical examination at Xuanwu Hospital of Capital Medical University from January 2012 to December 2021. A total of 98 344 healthy subjects were included in the study,including 48 241 males and 50 103 females,with a ratio of 1∶1.03,aged (42.0±15.6)years(range:14 to 97 years). The gender,age,body mass index,waist circumference,systolic pressure,diastolic pressure,ALT,AST,total bilirubin,fasting blood glucose,triglyceride,total cholesterol,low-density lipoprotein,high-density lipoprotein were collected.Healthy subjects were required to sit for at least 10 minutes before blood pressure was measured.Rresults of fasting venous blood were collected after 8 to 12 hours on an empty stomach.According to the presence of gallstones by ultrasound results, healthy subjects were divided into study group and control group. Data were analyzed by rank-sum tests and χ2 test, and risk factors for gallstone formation were explored by Logistic regression analysis. Results: The incidence of gallstones in this group was 5.42%(5 333/98 344). Among them,the incidence of gallstones in people aged 60 years and above was significantly higher than that in people under 60 years old(15.31%(2 348/15 334) vs. 3.60%(2 985/83 010), χ2=3 473.46,P<0.05).The healthy subjects were divided by age for every 10 years,and the results showed that the incidence of gallstones increased with age. The incidence of gallstones in females was 5.68%(2 844/50 103),greater than 5.16%(2 489/48 241) in males(χ2=11.81,P<0.05). Among them,1 478 cases underwent gallbladder surgical resection due to gallstones,and the operation rate was 27.71%. The operation rate reached the peak between 60 and <70 years old,and decreased after 70 years old. The results of the multivariate analysis showed that,female(OR=1.38, P<0.01),age(OR=1.58, P<0.01),body mass index≥24 kg/m2(OR=1.31, P<0.01),waist circumference≥85 cm(OR=1.24, P<0.01),fasting blood glucose>6.1 mmol/L(OR=1.18,P<0.01),total cholesterol≥5.18 mmol/L(OR=0.87, P=0.019),low-density lipoprotein≥3.37 mmol/L(OR=1.15,P=0.001) were the risk factors for gallstone formation;high-density lipoprotein≥1.55 mmol/L(OR=0.87, P<0.01) was a protective factor for gallstone formation. Conclusions: The incidence of gallstones increases with age in male and female. Gender,age,body mass index,waist circumferenc,fasting blood glucose,total cholesterol,LDL,and HDL are related factors with gallstone formation.

The effect of weight loss on endothelial function and cerebrovascular risk factors in obese and overweight people / 中华健康管理学杂志

Objective:To explore the effect of weight loss on endothelial function and cerebrovascular risk factors in obese and overweight people.Methods:A total of 127 obese or overweight subjects received 6-month body weight management. Subjects who lost 3 kg or more than 5% of their body weight prior to the 6-month intervention were defined as achievement group. Endothelial function (FMD) and other cerebrovascular risk factors were measured before and after intensified lifestyle management.Results:The achievement group comprised 57 (44.9%) cases and the non-achievement group 70 (55.1%) cases. After 6-month intervention, FMD (6.98±2.88% vs 7.90±2.96%, P<0.05) and HDL-C increased in the achievement group. Significant decreases were observed in the achievement group in BMI, SBP, DBP, FPG, TC, LDL-C, TG and uric acid. However, only DBP and FPG decreased in the non-achievement group. Conclusion:Weight loss can reverse endothelial dysfunction and metabolic dysfunction. Decrease of body fat ratio contributes to the improvement of endothelial function.

Role of anion exchanger 2 in the pathogenesis of primary biliary cholangitis / 临床肝胆病杂志

The etiology and pathogenesis of primary biliary cholangitis (PBC) remain unclear at present, and it is believed that the change in bile duct microenvironment and autoimmune response are the main factors for the onset of this disease. Anion exchanger 2 (AE2) is an HCO3-/Cl- exchange protein located on the membrane of epithelial cells and has been taken seriously by scholars since studies have shown that it can induce and aggravate PBC. This article summarizes the role of AE2 in bile duct microenvironment and autoimmune response from the aspects of AE2 and related regulatory mechanisms and further analyzes the pathogenesis of PBC, so as to find new therapies and diagnostic and prognostic indicators for PBC by exploring the regulatory mechanism of AE2 in PBC.

Prognostic significance of the hemoglobin A1c level in non-diabetic patients undergoing percutaneous coronary intervention: a meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#The predictive value of hemoglobin A1c (HbA1c) levels in non-diabetic patients with myocardial infarction undergoing percutaneous coronary intervention (PCI) is still controversial. This study aimed to evaluate whether HbA1c levels were independently associated with adverse clinical outcomes in non-diabetic patients with coronary artery disease (CAD) who had undergone PCI by performing a meta-analysis of cohort studies.@*METHODS@#This meta-analysis included non-diabetic patients with CAD who had undergone PCI. A systematic search for publications listed in the PubMed, Embase, and Cochrane Library databases from commencement to December 2018 was conducted. Studies evaluating the adverse clinical outcomes according to abnormal HbA1c levels in non-diabetic patients diagnosed with CAD who had undergone PCI were eligible. The primary outcomes were long-term all-cause deaths and long-term major adverse cardiac events, and the secondary outcome was short-term all-cause deaths. The meta-analysis was conducted with RevMan 5.3 and Stata software 14.0. Odds ratios (ORs) were pooled using a random or fixed-effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.@*RESULTS@#Six prospective cohort studies involving 10,721 patients met the inclusion criteria. From the pooled analysis, abnormal HbA1c levels were associated with increased risk for long-term all-cause death (OR 1.39, 95% confidence interval [CI] 1.16-1.68, P = 0.001, I = 45%). Sub-group analysis suggested that abnormal HbA1c levels between 6.0% and 6.5% predicted higher long-term major adverse cardiac event (including all-cause deaths, non-fatal myocardial infarction, target lesion revascularization, target vessel revascularization, recurrent acute myocardial infarction, heart failure requiring hospitalization, and stent thrombosis) risk (OR 2.05, 95% CI 1.46-2.87, P < 0.001, I = 0). Contrarily, elevated HbA1c levels were not associated with increased risk of short-term all-cause death (OR 1.16, 95% CI 0.88-1.54, P = 0.300, I = 0).@*CONCLUSIONS@#An abnormal HbA1c level is an independent risk factor for long-term adverse clinical events in non-diabetic patients with CAD after PCI. Strict control of HbA1c levels may improve patient survival. Further studies in different countries and prospective cohort studies with a large sample size are required to verify the association.

Whole-Brain Mapping of Direct Inputs to and Axonal Projections from GABAergic Neurons in the Parafacial Zone / 神经科学通报·英文版

The GABAergic neurons in the parafacial zone (PZ) play an important role in sleep-wake regulation and have been identified as part of a sleep-promoting center in the brainstem, but the long-range connections mediating this function remain poorly characterized. Here, we performed whole-brain mapping of both the inputs and outputs of the GABAergic neurons in the PZ of the mouse brain. We used the modified rabies virus EnvA-ΔG-DsRed combined with a Cre/loxP gene-expression strategy to map the direct monosynaptic inputs to the GABAergic neurons in the PZ, and found that they receive inputs mainly from the hypothalamic area, zona incerta, and parasubthalamic nucleus in the hypothalamus; the substantia nigra, pars reticulata and deep mesencephalic nucleus in the midbrain; and the intermediate reticular nucleus and medial vestibular nucleus (parvocellular part) in the pons and medulla. We also mapped the axonal projections of the PZ GABAergic neurons with adeno-associated virus, and defined the reciprocal connections of the PZ GABAergic neurons with their input and output nuclei. The newly-found inputs and outputs of the PZ were also listed compared with the literature. This cell-type-specific neuronal whole-brain mapping of the PZ GABAergic neurons may reveal the circuits underlying various functions such as sleep-wake regulation.

Effect of warm joint needling plus rehabilitation on the balance function and quality of life of patients with spastic hemiplegia after ischemic cerebral stroke / 针灸推拿医学（英文版）

Objective:To observe the effect of warm joint needling plus rehabilitation techniques on the balance function and quality of life (QOL) of patients with spastic hemiplegia after ischemic cerebral stroke.Methods:Ninety patients with spastic hemiplegia after ischemic cerebral stroke were randomized into a rehabilitation group,a warm joint needling group and an observation group,with 30 cases in each group.The rehabilitation group was intervened by Bobath therapy,the warm joint needling group was treated with joint needling on the affected side plus warm needling,and the observation group was given the same rehabilitation treatment as the rehabilitation group together with the same warm joint needling as the warm joint needling group.The three groups were treated once another day,1 month as a treatment course for 6 months.Before the treatment,and respectively after 2-week,1-month,3-month,and 6-month treatment,the modified Ashworth scale (MAS) was used to measure the anti-spasm ability of the lower limb,the Berg balance scale (BBS) was adopted to evaluate the balance function,and the stroke-specific quality of life scale (SS-QOL)was employed to estimate the QOL.Results:After 3-month and 6-month treatment,the lower-limb MAS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 1-month,3-month and 6-month treatment,the BBS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 2-week,1-month,3-month and 6-month treatment,the SS-QOL scores in the observation group were markedly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).Conclusion:Warm joint needling plus rehabilitation can effectively improve the lower-limb spasticity state,balance function and QOL in patients with spastic hemiplegia after ischemic cerebral stroke.

Impact of overweight and obesity on flow mediated dilation in adult / 中国基层医药

Objective To explore the impact of overweight and obesity on flow mediated dilation (FMD) in adult people.Methods Intact clinical data of 183 healthy people, aged 30~65 in our hosipital were analyzed.According to BMI, all people were divided into obesity group (48 cases), overweight group(75 cases) and normal group (60 cases).FMD was detected by E tracing of ultrasonic.Weight, WC, BFP, baPWV, BP,FPG,CHO,HDL-C,LDL-C,TG and UC were observed at the same time.FMD of three groups were compared and the risk factors of FMD were analyzed.Results The level of FMD in the obesity group and overweight group was significantly higher than that in the normal group[(5.63±2.76)%,(6.45±2.54)% vs.(8.31±3.04)%](F=13.77,P0.05).Age(β=0.078,95%CI: 1.004,1.164),BMI(β=0.465,95%CI 1.148,2.208),LDL-C(β=2.294,95%CI: 9.918,1.612) and UC(β=0.007,95%CI 0.986,1.000) were independent risk factors of decreased FMD(P<0.05).Conclusion Age, BMI, LDL-C and UC are independent risk factors of decreased FMD.

Association between N-glycans of immunoglobulin G and central obesity / 中华健康管理学杂志

Objective To explore the association between immunoglobulin G (IgG) glycosylation and central obesity in a Chinese population. Methods We recruited 517 Chinese individuals from a community-based cohort in the Xicheng District, Beijing, China. The height, weight, waist circumference, and hip circumference were measured, and blood samples were collected. Plasma IgG N-glycome was determined using hydrophilic interaction liquid chromatography (HILIC). Central obesity was determined using the waist-to-hip ratio (WHR). Men and women with a WHR>0.90 and >0.80, respectively were assigned to the central obese group,and those with a WHR≤0.90(men)and≤0.80(women)were assigned to the normal group.The correlation between WHR and glycosylation was determined using the standardized regression coefficient,and P<0.05 was considered statistically significant.Results The study included 517 participants,with an average age of(47.81±5.58)years(range:27-68 years),and 164(31.70%)of them were men. The central obese and normal groups included 205 (39.65%) and 312 (60.35%) participants, respectively. The average age for the central obese group (49.21 ± 5.70) years was higher than that for the normal group (46.89 ± 5.30) years, and the difference was statistically significant (t=-4.73, P=0.001). The two groups showed no significant differences in the sex of the participants(χ2=0.34,P=0.558).Twenty-four N-glycan traits(GP1-GP24)were directly measured,and because of the high variability among the repeated measurements and the unknown structures, GP3 and GP20 were excluded from the analysis. The peak contents for GP4,GP8,GP14,and GP18 were higher than the others and accounted for about 50% of all the peak contents. IgG GP10 (b'=0.076, P=0.024) positively correlated with WHR, whereas IgG GP12, GP17, GP22 negatively correlated with WHR(b'=-0.076,-0.081,-0.080,all P<0.05).Additionally,the IgG GP12, GP17,and GP22(P=0.001,0.004 and 0.033,respectively)were significantly lower in the participants of the central obese group,compared to those of the normal group. Conclusion The loss of galactose and sialic acid,as well as the addition of fucose to IgG N-glycan,correlate with increased WHR.

Mechanisms involved in the effect of aerobic exercise on knee osteoarthritis / 中国骨伤

With the aging of the population, the incidence of knee osteoarthritis (KOA) is increasing year by year. Exercise is one of the none medicine therapies in KOA rehabilitation. When making proper KOA exercise prescription, it's necessary to consider about the mechanisms involved in the interaction between exercise and articular cartilage, and obey the principle of choosing right programs, moderate frequency and intensity avoiding the injury of articular cartilage. The standard of KOA sport prescription is still controversial, so the mechanisms involved in the effect of aerobic exercise on protecting and damaging the articular cartilage need further research.

Chemical constituents from active fraction in roots and rhizomes of Cynanchum paniculatum with reversal activity of multidrug resistance / 中草药

Objective: To investigate the chemical consituents from the active fraction in the roots and rhizomes of Cynanchum paniculatum with reversal activity of multidrug resistance. Methods: The active fraction was evaluated for reversing activities toward three human drug-resistance cell lines to clininally common used anticancer chemotherapeutic drugs. The compounds were isolated and purified by chromatography on ODS and preparative HPLC. Their structures were elucidated on the basis of chemical and spectroscopic methods, including MS, 1D, and 2D NMR spectral techniques. Results: The active fraction exhibited the significant effects in sensitization of human drug-resistance on gastric carcinoma cell line SGC-7901/VCR and human drug-resistance on colonic carcinoma cell line HCT-8/VCR to fluorouracil (5-FU). Nine compounds were isolated and identified as hancogenin B 3-O-β-D- oleandropyranoside (1), 3β,14-dihydroxy-14β-pregn-5-en-20-one (2), neocynapanogenin F (3), glaucogenin A (4), glaucogenin C (5), neocynapanogenin F 3-O-β-D-oleandropyranoside (6), glaucogenin C 3-O-β-D-thevetoside (7), glaucogenin A 3-O-β-D- oleandropyranoside (8), and 20-hydroxypregna-4,6-dien-3-one (9). Conclusion: Compound 1 is a new steroidal saponin named paniculatumoside D. C21 Steroids isolated from the active fraction in the roots and rhizomes of C. paniculatum have the potential value as multidrug resistance reversing agents.

Program optimization in the stage treatment of periarthritis of shoulder with acupuncture, moxibustion and positive functional exercise / 中国针灸

<p><b>OBJECTIVE</b>To optimize the therapeutic programs for periarthritis of shoulder treated with acupuncture, moxibustion and kinetohterapy with orthogonal design method adopted.</p><p><b>METHODS</b>The orthogonal design table of L8 (2(7)) hierarchical principle was used to randomly divide 192 patients of periarthritis of shoulder into 8 groups, 24 cases in each one. Separately, 4 factors and each different 2 levels were adopted in treatment, named acupuncture timing (factor A: A, acute stage, A2 adhesion stage), acupoint combination (factor B: B, local acupoints, B2 local acupoints and distal acupoints along meridians), filiform needling and warm needling therapy (factor C: C1 acupuncture with filiform needle, CZ acupuncture with filiform needle and warm needling therapy) and positive functional exercise (factor D: D1 without positive functional exercise, D2 with positive functional exercise). The treatment was given once a day, 10 treatments made one session and 2 sessions were required totally. The time points of observation were the point after 1 session of treatment and after 2 sessions of treatment. The short-form McGill pain questionnaire (MPQ) and shoulder joint motor disturbance score were adopted for evaluation.</p><p><b>RESULTS</b>In the orthogonal design analysis, taking the hierarchical factors into consideration, the age was considered as the main factor in the evaluation of shoulder pain and shoulder motor disturbance (P<0.01), and the shoulder function grade apparently impacted pain evaluation and the efficacy on shoulder motor disturbance (P<0.01). The best combination of 4 factors and 2 levels were A1B1CzD2 and A2BC2D2. SAS statistical analysis showed that at acute stage and adhesion stage, CZ Dz , meaning acupuncture with fifiform needling and warm needling therapy combined with positive functional exercise, is the main factor of the improvements of shoulder motor function (P<0.05).</p><p><b>CONCLUSION</b>For periarthritis of shoulder at acute stage, the combined therapy of acupuncture at local acupoints, warm needling and positive functional exercise is adopted. At chronic stage, the combined therapy of acupuncture at local acupoints and distal acupoints, acupuncture with filiform needle and warm needling and positive functional exercise is the best program. Additionally, in clinical treatment, the patients' age, sex, shoulder joint function and duration of treatment should be considered comprehensively for the impacts on the efficacy.</p>

Cardiac metallothionein overexpression improves cardiac contractile function and attenuates oxidative stress in lipopolysaccharide-treated mice / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study was designed to examine the impact of the antioxidant metallothionein (MT) on cardiac contractile, intracellular Ca(2+) function and oxidative stress in lipopolysaccharide (LPS)-treated mice.</p><p><b>METHODS</b>Weight and age matched adult male FVB and cardiac-specific MT-overexpressing transgenic mice were injected intraperitoneally with 4 mg/kg Escherichia Coli LPS dissolved in sterile saline or an equivalent volume of pathogen-free saline (control groups). Six hours following LPS or saline injection, cardiac geometry and function were evaluated in anesthetized mice using the 2-D guided M-mode echocardiography. Mechanical and intracellular Ca(2+) properties were examined in hearts. Cell shortening and relengthening were assessed using the following indices: peak shortening (PS)-indicative of the amplitude a cell can shorten during contraction; maximal velocities of cell shortening and relengthening (± dl/dt)-indicative of peak ventricular contractility; time-to-PS (TPS)-indicative of systolic duration; time-to-90% relengthening (TR(90))-indicative of diastolic duration (90% rather 100% relengthening was used to avoid noisy signal at baseline concentration). The 360 nm excitation scan was repeated at the end of the protocol and qualitative changes in intracellular Ca(2+) concentration were inferred from the ratio of fura-2 fluorescence intensity (FFI) at two wavelengths (360/380). Fluorescence decay time was measured as an indicator of the intracellular Ca(2+) clearing rate. Glutathione/glutathione disulfide ratio and ROS generation were detected as the markers of oxidative stress.</p><p><b>RESULTS</b>Heart rate was increased while EF was reduced in LPS-FVB mice and heart rate was reduced and EF increased in MT-LPS transgenic mice [(528 ± 72) beats/min vs (557 ± 69) beats/min, (66 ± 14)% vs (42 ± 10)%, P < 0.05]. Cardiomyocytes from the LPS treated FVB mice displayed significantly reduced peak shortening (PS) and maximal velocity of shortening/relengthening (±dl/dt) associated with prolonged time-to-90% relengthening (TR(90)), these effects were attenuated in cardiomyocytes from the MT-LPS mice [PS(5 ± 1.1)% vs (7.2 ± 0.8)%, dl/dt(160 ± 15) µm/s vs (212 ± 36) µm/s, -dl/dt (175 ± 32) µm/s vs (208 ± 29) µm/s, TR(90) (0.24 ± 0.03)s vs (0.19 ± 0.02)s, P < 0.05]. LPS treated mice showed significantly reduced peak intracellular Ca(2+) and electrically-stimulated rise in intracellular Ca(2+) as well as prolonged intracellular Ca(2+) decay rate without affecting the basal intracellular Ca(2+) levels, again, these effects were significantly attenuated in MT-LPS transgenic mice. Metallothionein overexpression also ablated oxidative stress [reduced ROS generation and increased glutathione/glutathione disulfide ratio, ROS (0.35 ± 0.08) A/µg protein vs (0.24 ± 0.03) A/µg protein]. GSH/GSSG 2.1 ± 0.2 vs 2.6 ± 0.4, P < 0.05.</p><p><b>CONCLUSION</b>MT overexpression improved cardiac function and ablated oxidative stress in LPS treated mice.</p>

Effects of mechanical stimulation on expression of integrin subunits in chondrocyte / 中国骨伤

Osteoarthritis (OA) is a kind of degenerative disease characterized by hyperosteogeny at the joint margins and articular cartilage degeneration. Mechanical stress can regulate the multiple functions of cells. The integrin as one of the mechanoreceptors on the surface of cells, mainly mediated adhesion between cells and extracellular matrix, which plays an important role in the mechanical signal transmission to regulate the physiological functions of cell. Therefore, it is very important to select proper mechanical stimulation (such as naprapathy) in the early and middle stage of osteoarthritis, which regulate the expression of integrins to affect the function of chondrocytes, repair the damaged chondrocyte and delay the articular cartilage degeneration.

The present situation and analysis of acupuncture anesthesia / 中国针灸

Acupuncture anesthesia (AA) appeared in 1950s. It originates with Chinese TCM researchers and is one of important achievements of modern medicine. AA was developed vigorously and applied widely between 1960s-1970s. Due to the objective and subjective reasons, clinical application and research of AA in recent 20 years have developed very little. The paper reviews the formation and development processes of AA, analyzes the advantages and mechanisms of AA and its problems, then provides the feasible advice for the development of AA.