Meranzin Hydrate Improves Depression-Like Behaviors and Hypomotility via Ghrelin and Neurocircuitry / 中国结合医学杂志

OBJECTIVE@#To investigate whether meranzin hydrate (MH) can alleviate depression-like behavior and hypomotility similar to Chaihu Shugan Powder (CSP), and further explore the potential common mechanisms.@*METHODS@#Totally 120 Spraque-Dawley rats were randomly divided into 5-8 groups including sham, vehicle, fluoxetine (20 mg/kg), mosapride (10 mg/kg), CSP (30 g/kg), MH (9.18 mg/kg), [D-Lys3]-GHRP-6 (Dlys, 0.5 mg/kg), and MH+Dlys groups by a random number table, 8 rats in each group. And 32 mice were randomly divided into wild-type, MH (18 mg/kg), growth hormone secretagogue receptor-knockout (GHSR-KO), and GHSR+MH groups, 8 mice in each group. The forced swimming test (FST), open field test (OFT), tail suspension test (TST), gastric emptying (GE) test, and intestinal transit (IT) test were used to assess antidepressant and prokinetic (AP) effects after drug single administration for 30 min with absorbable identification in rats and mice, respectively. The protein expression levels of brain-derived neurotrophic factor (BDNF) and phosphorylated mammalian target of rapamycin (p-mTOR) in the hippocampus of rats were evaluated by Western blot. The differences in functional brain changes were determined via 7.0 T functional magnetic resonance imaging-blood oxygen level-dependent (fMRI-BOLD).@*RESULTS@#MH treatment improved depression-like behavior (FST, OFT) and hypomotility (GE, IT) in the acute forced swimming (FS) rats (all P<0.05), and the effects are similar to the parent formula CSP. The ghrelin antagonist [D-Lys3]-GHRP-6 inhibited the effect of MH on FST and GE (P<0.05). Similarly, MH treatment also alleviated depression-like behavior (FST, TST) in the wild-type mice, however, no effects were found in the GHSR KO mice. Additionally, administration of MH significantly stimulated BDNF and p-mTOR protein expressions in the hippocampus (both P<0.01), which were also prevented by [D-Lys3]-GHRP-6 (P<0.01). Besides, 3 main BOLD foci following acute FS rats implicated activity in hippocampus-thalamus-basal ganglia (HTB) circuits. The [D-Lys3]-GHRP-6 synchronously inhibited BOLD HTB foci. As expected, prokinetic mosapride only had effects on the thalamus and basal ganglia, but not on the hippocampus. Within the HTB, the hippocampus is implicated in depression and FD.@*CONCLUSIONS@#MH accounts for part of AP effects of parent formula CSP in acute FS rats, mainly via ghrelin-related shared regulation coupled to BOLD signals in brain areas. This novel functionally connection of HTB following acute stress, treatment, and regulation highlights anti-depression unified theory.

Guideline for clinical comprehensive evaluation of Chinese patent medicine (2022 version) / 中国中药杂志

Currently,the research or publications related to the clinical comprehensive evaluation of Chinese patent medicine are increasing,which attracts the broad attention of all circles. According to the completed clinical evaluation report on Chinese patent medicine,there are still practical problems and technical difficulties such as unclear responsibility of the evaluation organization,unclear evaluation subject,miscellaneous evaluation objects,and incomplete and nonstandard evaluation process. In terms of evaluation standards and specifications,there are different types of specifications or guidelines with different emphases issued by different academic groups or relevant institutions. The professional guideline is required to guide the standardized and efficient clinical comprehensive evaluation of Chinese patent medicine and further improve the authority and quality of evaluation. In combination with the characteristics of Chinese patent medicine and the latest research achievement at home and abroad,the detailed specifications were formulated from six aspects including design,theme selection,content and index,outcome,application and appraisal,and quality control. The guideline was developed based on the guideline development requirements of China Assoication of Chinese medicine. After several rounds of expert consensus and public consultation,the current version of the guideline has been developed.

Differential diagnosis of gallbladder polypoid lesions by micro-flow imaging / 南方医科大学学报

OBJECTIVE@#To explore the value of micro-flow imaging (MFI) in evaluating blood flow characteristics and differential diagnosis of gallbladder polypoid lesions.@*METHODS@#We retrospectively analyzed the clinical data and ultrasound images of 73 patients with gallbladder polypoid lesions, including 24 patients with pathologically confirmed neoplastic polyps (n=24) and 49 with non-neoplastic polyps (n=49). All the patients underwent conventional ultrasound, MFI and contrast enhanced ultrasound (CEUS) before cholecystectomy. The blood flow characteristics of the lesions in color Doppler flow imaging (CDFI) and MFI were compared, and the consistency of the findings by these two modalities with those of CEUS were evaluated by weighted Kappa consistency test. The diagnostic performance of MFI for gallbladder polypoid lesions was assessed.@*RESULTS@#There were significant differences between MFI and CDFI in the evaluation of blood flow characteristics of gallbladder polypoid lesions (χ2=37.684, P < 0.001). MFI showed better performance than CDFI in displaying the blood flow characteristics of the polyps. The consistency in the findings was 0.118 between CDFI and CEUS and 0.816 between MFI and CEUS. The sensitivity, specificity and accuracy of MFI in distinguishing neoplastic polyps from non-neoplastic polyps were 75.00%, 93.88% and 87.67%, respectively.@*CONCLUSION@#MFI has a good consistency with CEUS in displaying the blood flow characteristics of gallbladder polypoid lesions and can accurately distinguish neoplastic polyps from non-neoplastic polyps, thus providing new ultrasound diagnostic evidence to support clinical decisions on optimal treatments of gallbladder polypoid lesions.

Carotid intraplaque neovascularization is correlated with the risk of revascularization following percutaneous coronary intervention / 南方医科大学学报

OBJECTIVE@#To investigate the correlation of intraplaque neovascularization (IPN) detected by carotid contrast-enhanced ultrasound (CEUS) with revascularization in patients following percutaneous coronary intervention (PCI).@*METHODS@#This study was conducted among 105 patients who were followed up for more than 12 months after PCI. All the patients received CEUS examination for assessment of carotid plaque formation and IPN, which were compared between patients with revascularization (REV group, n=27) and those without revascularization (N-REV group, n=78). ROC curve was used to analyze the diagnostic efficacy of CEUS for predicting revascularization. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with revascularization.@*RESULTS@#In the REV group, the IPN score was 0 in 1 (3.7%) patient, 1 in 8 (29.6%) patients, 2 in 15 (55.6%) patients and 3 in 3 (11.1%) patients. Significant differences were noted between REV and N-REV groups in plaque length (15.70±6.93 vs 12.10±6.64, P < 0.05), maximum plaque thickness (3.69±1.12 vs 3.14±1.18, P < 0.05) and IPN (1.74±0.71 vs 0.87±0.63, P < 0.001). IPN score was identified as an independent risk factor for revascularization in patients following PCI, and at the cutoff value of 1.5, its sensitivity, specificity, positive predictive value, and negative predictive value for predicting the occurrence of revascularization were 74%, 89%, 69%, and 91%, respectively, with an AUC of 0.848 (95% CI: 0.703-0.905, P < 0.001).@*CONCLUSION@#CEUS allows noninvasive and semi-quantitative assessment of neovascularization in carotid artery plaques, and IPN detected by CEUS is correlated with the risk of revascularization in patients following PCI.

Interpretation of Technical Specifications for Revision of Safety Information in Marketed Chinese Patent Medicine Instructions / 中国中药杂志

Technical Specifications for Revision of Safety Information in Marketed Chinese Patent Medicine Instructions,a series of group standards,were proposed by Professor ZHANG Bing from Research Center for Pharmacovigilance and Rational Use of Traditional Chinese Medicine,and underwent centralized management by Chinese Association of Chinese Medicine. They were officially released on July 23 and implemented on July 31,2021. The series of group standards consist of six sections,including general principles,adverse drug events,contraindications,precautions,application for special populations,and warnings. The section of general principles is comprised of holistic and programmatic expressions,which explain the general technical requirements for revising the marketed Chinese patent medicine instructions. The other five sections focus on information collection,screening,transformation,and illustration of specific items,forming a standardized revision technical process. This series of standards is the result of multiple rounds of research and the suggestions of more than 200 experts in different professional fields of " medicine-pharmacy-management-law-enterprise" have been gathered therein to reach a consensus. With the purposes of establishing standardized technical specifications for the revision of safety information in the marketed Chinese patent medicine instructions,guiding marketing authorization holders in revising the instructions,filling the gaps in the research of Chinese patent medicine instructions,promoting the deve-lopment of pharmaceutical care and academic research,and encouraging the rational and safe medication of Chinese patent medicine,the series of group standards is of great significance.

Series of group standards of Technical Specifications for Revision of Safety Information in Marketed Chinese Patent Medicine Instructions / 中国中药杂志

Drug instructions,the statutory and technical documents recording effectiveness and safety information,are an important basis for guiding doctors,pharmacists,and patients to use drugs rationally,and their scientificity,standardization,and accuracy directly affect the medication safety of the public. The sections of adverse drug events,contraindications,precautions,warnings,and application for specific populations in drug instructions directly express safety information and measures for rational use of drugs. In the drug life cycle,marketing authorization holders( MAHs) need to update safety information in the instructions promptly to ensure the safety and effectiveness of clinical drug medication. At present,revising instructions is an important measure to control drug risks. In the drug life cycle,in order to standardize the revision of safety information in the instructions by MAHs and eliminate inexact terms such as " unclear",the Technical Specifications for Revision of Safety Information in Marketed Chinese Patent Medicine Instructions,a series of group standards,have been established under the guidance of Standardization Department,China Association of Chinese Medicine. Therefore,on the basis of the existing rules and regulations,the standardized technical procedures for revising instructions came into being to help clinical safe and rational medication of drugs,and implement the strategy of " Healthy China".

Core prescriptions in treatment of edema by traditional Chinese medicine masters and mechanism prediction / 中国中药杂志

The core prescriptions and formulation characteristics in the treatment of edema by traditional Chinese medicine(TCM) masters were analyzed through data mining and their mechanisms were explored by network pharmacology. We collected journal reports on the treatment of edema by TCM masters in three sessions from China National Knowledge Infrastructure(CNKI) and constructed a database by Traditional Chinese Medicine Inheritance Support System 3.0. The prescriptions in the case studies were analyzed by association rules and k-means clustering. The chemical components and targets of Chinese medicines in core prescriptions were collected through TCMSP and TCMID. Edema-related targets were collected from DrugBank and GeneCards. The protein-protein interaction(PPI) network was constructed by STRING and the core targets were screened out. FunRich 3.1.3 was used to enrich the expression sites of core prescriptions. Metascape was used to perform Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analysis of intersection targets. Cytoscape 3.6.0 was used to visualize the "Chinese medicine-active ingredient-core target-pathway" network. The results showed that 315 pieces of medical records in the treatment of edema by TCM masters were obtained and five core prescriptions were analyzed by association rules and k-means clustering. Core prescription 1 contained Poria, Atractylodis Macrocephalae Rhizoma, Astragali Radix, Alismatis Rhizoma, Glycyrrhizae Radix et Rhizoma, and Codonopsis Radix, involving 166 chemical components and 1 125 targets. Core prescription 2 contained Astragali Radix, Salviae Miltiorrhizae Radix et Rhizoma, Poria, Chuanxiong Rhizoma, Paeoniae Radix Rubra, and Angelicae Sinensis Radix, involving 138 chemical components and 1 112 targets. Core prescription 3 contained Poria, Salviae Miltiorrhizae Radix et Rhizoma, Astragali Radix, Atractylodis Macrocephalae Rhizoma, Alismatis Rhizoma, and Coicis Semen, involving 126 chemical components and 1 121 targets. Core prescription 4 contained Poria, Forsythiae Fructus, Atractylodis Macrocephalae Rhizoma, Imperatae Rhizoma, Cicadae Periostracum, and Coicis Semen, involving 58 chemical components and 820 targets. Core prescription 5 contained Poria, Atractylodis Macrocephalae Rhizoma, Astragali Radix, Alismatis Rhizoma, Trionycis Carapax, and Dioscoreae Rhizoma, involving 68 chemical components and 919 targets. The core targets of core prescriptions included AKT1, ALB, CASP3, MAPK3, EGFR, SRC, MAPK1, and TNF. The potential targets of core prescriptions in the treatment were highly expressed in the stomach, bladder, lung, and kidney. KEGG pathways were enriched in inflammation and cell cycle pathways, especially the inflammation-relation pathways. The therapeutic effect of core prescriptions on edema is presumedly achieved by tonifying the spleen, draining water, activating blood, and benefiting Qi to resist inflammation and regulate the immune system. This study is expected to provide references for the summary of TCM masters' experience and new drug development.

Safety and efficacy of retrograde intrarenal surgery and percutaneous nephrolithotomy in the treatment of incarcerated upper ureteral calculi / 中华泌尿外科杂志

Objective:To compare the clinical efficacy of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of incarcerated upper ureteral calculi.Methods:The clinical data of 202 patients with incarcerated upper ureteral calculi treated in our hospital from January 2018 to April 2020 were analyzed retrospectively, including RIRS group treated with RIRS and PCNL group treated with PCNL.There was no significant difference in age [(54.40±11.17) years vs. (52.82±12.58) years], sex [male / female: 86/54 vs. 45/17], body mass index [24.0(21.0, 27.0)kg/m 2 vs. 23.5(20.8, 26.3)kg/m 2], creatinine [75.45 (61.6, 93.3) μmol/L vs. 73.70 (62.4, 93.0) μmol/L], stone stay time [1.0 (0.5, 3.8) months vs. 1.0 (0.5, 6.0) months], stone hardness [(783.60 ±243.55) HU vs. (960.66 ±225.01) HU], stone diameter [(8.65 ±2.95) mm vs. (960.66 ±225.01) mm], stone location (65/75 vs. 34/28), proportion of infection before operation (40/140 vs. 25/62) and history of ESWL treatment (35/140 vs. 13/62) between the two groups. The operation time, hospital stay, perioperative complication rate, hospitalization cost and stone clearance rate were compared between the two groups. The high risk factors of preoperative stone characteristics (stone diameter, stone hardness, previous lithotripsy history, stone incarceration time, degree of hydronephrosis, infection) were scored (yes = 1, no = 0). Cases of complex stones were defined as ≥ 3 points. Simple stone cases were defined as < 3 points. Group analysis was carried out according to the score of stones in order to determine the influence of the choice of surgical methods on the results of operation. Results:All 202 operations were successfully done, and there was no transfer to open surgery or other surgical methods. Compared with the RIRS group, the operation time of the PCNL group was significantly shorter [48.5 (32.0, 62.5) min vs. 63.0 (48.0, 86.0) min, P<0.05], and the stone removal rate was significantly increased [98.4% (61/62) vs. 72.10% (101/ 140), P<0.05], the treatment cost was lower [1.16 (0.80, 1.40) ten thousand yuan vs. 2.73 (2.14, 3.32) ten thousand yuan, P<0.05]. The length of hospital stay in the RIRS group was shorter than that in the PCNL group [3.0 (2.0, 4.0) days vs. 8.0 (6.0, 9.0) days, P<0.05)]. There was no statistical difference in postoperative complications between the two groups [10.7% (15/140)) vs. 12.9% (8/62), P>0.05]. A comparative analysis of high-risk factors affecting stone removal revealed that for simple stone cases, the operation time was lower in the PCNL group than that in RIRS group [50.0(30.0, 64.0)min vs. 62.0(44.5, 86.0)min, P<0.05], the cost was lower [1.18 (0.80, 1.35) ten thousand yuan vs. 2.69 (2.22, 3.32) ten thousand yuan, P<0.05], and the stone removal rate was higher [100% (35/35)vs.78.3% (94/120), P <0.05], but the hospital stay was longer [ 7.0(6.0, 9.0) days vs.3.0(2.0, 4.0) days, P<0.05]. For complex stone cases, the operation time [46.0 (39.0, 61.0) min vs. 65.5 (51.0, 89.8) min, P<0.05] and hospitalization expenses [1.21 (0.98, 1.43) ten thousand yuan vs. 2.73 (2.13, 2.73) ten thousand yuan, P<0.05] in PCNL group were still lower than that in RIRS group, and the stone removal rate [96.3% (26/27)vs. 35% (7/20) , P<0.05] was also significantly higher than the latter. Conclusions:For simple stone cases, PCNL has a higher stone clearance rate, shorter operation time, lower treatment cost, and longer hospital stay than RIRS. For complex stone cases, the PCNL group has a higher stone clearance rate, shorter operation time, lower cost than RIRS group, but the length of hospital stay is no longer statistically different. Therefore, PCNL is more advantageous for the treatment of complex incarcerated upper ureteral calculi.

Clinical value of preoperative perfluorobutane contrast-enhanced ultrasound in the evaluation of microvascular invasion and recurrence of hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the use of perfluorobutane contrast-enhanced ultrasound (CEUS) in preoperative detection of microvascular invasion (MVI), and postoperative short-term recurrence of hepatocellular carcinoma (HCC).Methods:Patients who underwent hepatectomy with curative intent at the Chinese PLA General Hospital from January 2021 to April 2021 were prospectively enrolled into this study. Of 42 patients in this study, there were 36 males and 6 females, with age of (56.51±11.95) years old. All patients underwent preoperative perfluorobutane CEUS, and the characteristics of ultrasound, the vascular phase and Kupffer phase of perfluorobutane CEUS were recorded. Based on the pathological results, these patients were divided into the MVI and non-MVI groups. These patients underwent liver MRI once every 3 months postoperatively to diagnose tumor recurrence. According to the recurrence of HCC 6 months after operation, these patients were divided into the non-recurrence and the recurrence groups. Independent risk factors for MVI and short-term recurrence were analyzed by univariate and multivariate analyses.Results:Two patients had two lesions, and the remaining 40 patients had a single lesion. The pathological diagnosis of all the lesions were HCC (14 patients in the MVI group and 28 patients in the non-MVI group). The median follow-up was 6 (3, 6) months, and there were 8 patients in the recurrence group and 34 patients in the non-recurrence group. On logistic analysis, independent risk factors for MVI included the number of vessels detected on color Doppler flow imaging (CDFI) ( OR=5.762, 95% CI: 1.597-20.785, P=0.007), increased tumor size by more than 10% after CEUS arterial enhancement ( OR=10.186, 95% CI: 3.647-28.447, P=0.037), and thickness of corona enhancement at Kupffer phase of greater than 5 mm ( OR=17.340, 95% CI: 6.124-49.095, P=0.040). Cox regression showed the independent risk factors for short-term recurrence to include the number of vessels in CDFI ( RR=7.519, 95% CI: 1.086-52.051, P=0.041) and thickness of corona enhancement at Kupffer phase of greater than 5 mm ( RR=10.623, 95% CI: 1.265-89.218, P=0.030). Conclusion:Preoperative perfluorobutane CEUS had potential values in detecting MVI and in predicting postoperative short-term recurrence of HCC.

Value of Contrast-enhanced Ultrasound in Differential Diagnosis between Cholesterol Polyp and Gallbladder Adenoma / 中国医学科学院学报

Objective To compare the performance of contrast-enhanced ultrasound(CEUS)and ultrasound(US)in the differential diagnosis between cholesterol polyps and gallbladder adenomas. Methods A total of 136 patients with gallbladder polyp lesions(GPLs)and undergoing cholecystectomy in the First Medical Center of Chinese PLA General Hospital from January 2019 to October 2020 were retrospectively analyzed.All the patients underwent US and CEUS examinations before cholecystectomy.US and CEUS images of cholesterol polyps and gallbladder adenomas were compared for the evaluation of the performance of CEUS in the diagnosis of gallbladder adenomas. Results The 136 cases of GPLs included 95 cases of cholesterol polyps and 41 cases of gallbladder adenomas.Cholesterol polyps and gallbladder adenomas showed significant differences in the maximum size of GPLs(

Analysis of the efficacy of three different methods of ureteroscopic surgery in the treatment of upper ureteral calculi / 中国综合临床

Objective:To introduce the experience and clinical efficacy of a new type of negative pressure suction ureteroscope in the treatment of upper ureteral calculi, and compare it with traditional rigid ureteroscope and flexible ureteroscope lithotripsy.Methods:From January 2018 to January 2020, 160 patients with upper ureteral incarcerated calculi who were treated in Shengjing Hospital Affiliated to China Medical University were included in this study, and their clinical data were retrospectively analyzed.There were 50 cases in the rigid ureteroscope group, 54 cases in the flexible ureteroscope group and 56 cases in the new negative pressure combined ureteroscope group.The differences of operation time, hospital stay, stone free rate and postoperative complications were observed and compared among the three groups.According to whether the maximum diameter of the stone is more than 1.5 cm, the subgroups were analyzed to further compare the curative effect of the three groups.Results:All the 160 operations were completed successfully and none of them were converted to open surgery.The stone free rate of the new negative pressure suction ureteroscope Group (90.0% (18/20))was higher than that of the flexible ureteroscope Group (61.9% (13/21)) and the rigid ureteroscope Group (55.6% (10/18)), χ 2=8.49, P<0.001). The stone free rate in the first month after operation was also superior (96.4% (54/56), 77.7% (42/54), 74.0% (37/50), χ 2=5.48, P=0.01). The stone subgroup analysis showed that when the stone diameter increased (>1.5 cm), the net stone rate of the new negative pressure suction ureteroscope Group [91.6% (22 / 24)] was better than that of the flexible ureteroscope Group (62.5% (15/24)) and the rigid ureteroscope Group (50.0 (8/16))(χ 2=6.480, P=0.001). Conclusion:Compared with the traditional ureteroscopic lithotripsy, the new negative pressure suction ureteroscopic lithotripsy has higher initial and overall stone free rate, and higher safety factor.For the patients with stone diameter>1.5 cm, the new negative pressure suction ureteroscope lithotripsy has more advantages.

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure / 中华医学杂志(英文版)

BACKGROUND@#Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.@*METHODS@#Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.@*RESULTS@#A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.@*CONCLUSION@#Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.

Update in immune regulatory dysfunction of dendritic cells in sepsis / 中华烧伤杂志

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Further development of sepsis usually leads to septic shock or even death. Many previous studies have focused on the abnormal reactions of monocytes/macrophages, neutrophils, complement system, or cytokine inflammation in sepsis. Many evidences in recent years suggest that dendritic cells, as the most powerful antigen-presenting cells in innate immune system of body, play important role during the process of immune disorders of sepsis. In this article, I review the main classification, immune function, monitoring method, regulatory pathways of dendritic cells and their clinical significance in immune disorders of sepsis, so as to find new strategies for immune regulation of sepsis.

Analysis of Programs and Guidelines on Traditional Chinese Medicine (TCM) for COVID-19 to Provide Suggestions for Future Development of TCM Clinical Practice Guidelines / 中国实验方剂学杂志

Objective:To comprehensively analyze the diagnosis and treatment programs and prevention and treatment programs on tratidional Chinese medicine (TCM) for coronavirus disease-2019 (COVID-19), and to provide suggestions for further development of TCM clinical guidelines. Method:Diagnosis and treatment programs on TCM for COVID-19 pneumonia, as well as prevention and treatment programs, clinical practice guidelines and expert consensus, were retrieved till Feb 19, 2020. The information about TCM syndrome differentiation, state of disease, and TCM treatments (decoction and Chinese patent medicines) were extracted and analyzed. Result:A total of 24 TCM programs/guidelines were included containing 23 diagnosis and treatment programs or prevention and treatment programs and one rapid advice guideline. Of the 23 TCM programs, 14 programs described the classification of TCM syndromes and the stages of disease，22 programs described the composition of the TCM decoction; seven programs described how to add and subtract the herbs according to different TCM syndromes,17 programs described the weight/volume of the herbs of TCM decoctions, three programs described the decoction method，six programs described the usage and dosage of TCM decoction， two programs clarified the course of treatment; none of the 23 programs indicated the source of evidence. The TCM treatment within the rapid advice guideline was in reference to the fourth edition of the COVID-19 pneumonia TCM diagnosis and treatment program issued by the National Health Commission. A total of 41 Chinese patent medicines were recommended in 23 programs, of which 12 Chinese patent medicines were off-label recommended. Conclusion:In most TCM programs, TCM decoction and Chinese patent medicines are recommended based on TCM syndrome differentiation in combination with the state of disease, and the dosage of the TCM decoctions are clearly described. Some Chinese patent medicines in the TCM programs are off-label recommended. Expert experience and opinions are valued when developing TCM programs/ guidelines. All of these provide reference for developing TCM programs/guidelines in future.

Feasibility and perioperative safety of the combined procedure of catheter ablation and watchman left atrial appendage closure / 中华心血管病杂志

Objective: We aimed to explore the feasibility and perioperative safety of performing catheter ablation and left atrial appendage closure (LAAC) in a single (one-stop) session in patients with atrial fibrillation (AF). Methods: This study is an observational study. Consecutive AF patients who underwent the combined procedure of catheter ablation and LAAC with Watchman device of Xinhua Hospital in Shanghai between March 2017 and May 2019 were prospectively enrolled. Baseline, intra-and peri-procedural parameters were evaluated. Results: A total of 358 AF patients (189 males, (69.0±8.0) years) underwent the one-stop procedure. The CHA2DS2-VASc score was 3.2±1.5 and HAS-BLED score was 2.4±1.1, respectively in this patient cohort. Pulmonary vein isolation was achieved in all patients, while additional linear ablation was applied in 180 (50.3%) patients, yielding immediate success rate of 99.7%. Successful Watchman implantation was achieved in all patients. The perioperative serious adverse event occurred in 14 cases (3.9%). including 6 pericardial effusions (1.7%), 1 stroke (0.3%) and 5 vascular complications (1.4%), yielding procedure-related complication rate of 3.4%. In addition, 2 (0.6%) new-onset heart failures occurred postoperatively. There was no major bleeding or death during the perioperative period. Conclusions: Combined catheter ablation and LAAC can be successfully and safely performed in AF patients with high stroke risk. Follow-up data are needed to evaluate the outcome of this one-stop procedure.

Three-dimensional finite element analysis of Kirschner wire fixation configuration for supracondylar fracture of humerus fracture in children / 中国骨伤

OBJECTIVE@#To establish a new mechanical model of distal humerus in children with epiphysial cartilage, stimulate supracondylar humerus fracture and perform three dimensional finite elements, and study effect of pins numbers, pin tract, outlet height and pin configurations on stability of fixation.@*METHODS@#Three dimensional computed tomography (CT) data of 6-year-old boy with distal humerus was downloaded from picture archiving and communications systems software (PACS), the data of picture was imported into Simpleware and SolidWorks 2016 software to establish distal humerus fracture in children contained ossific nucleus of the capitellum (ONC) and distal cartilage. Normal extense supracondylar humerus fracture model was established to stimulate configurations of crossed and lateral pinning fixation, 30 N was added on the direction of flexion extension and varus valgus, while 50 N was added on the direction of internal and external turning. Stability was analyzed by displacement degree of distal fracture.@*RESULTS@#Among 2-pin configurations, 2-crossed pins were more stable against rotation forces which could resist rotation stress over 2 585 Nmm/ °, while low position through ONC of 2-divergent lateral pins were more stable, which could resist stress of 45 N /mm and 190 N /mm during the test of resistant strains and varus-valgus stress. The third pins was added into the more stable lateral 2-pins, the stability in all directions were increased obviously, and 3 crossed pins is the most stable, stress of flexion-extension, varus-valgus and internal-external turning were 198 N /mm, 395 N /mm and 6 251 Nmm/ °.@*CONCLUSION@#Two-divergent lateral pins could provide enough stability for supracondylar humerus fracture in children. In two-crossed pins, the upper border of MDJ could provide the best stability. Three-crossed pins could offer the best stability against both translation and rotation forces.

HIV infection rate in people aged 50 years and older in China: a Meta-analysis / 中华流行病学杂志

The prevalence of HIV/AIDS in people aged ≥50 years is increasing in China, resulting in another focus for AIDS prevention and control. A Meta-analysis was conducted to evaluate the HIV infection, its area and time distributions in people aged ≥50 years in China to provide evidence for the prevention and control of HIV/AIDS. Information on HIV infection rate in people aged ≥50 years in China were collected from Wanfang digital database, China National Knowledge Infrastructure (CNKI), PubMed and Embase. The R Studio1.1.456 software was used to calculate the pooled infection rate, and assessed the publication bias. A total of 30 studies which covered 13 provinces were selected. From 2010 to 2018, the pooled HIV infection rate in people aged ≥50 years was 1.68 (95:1.00-2.79). The HIV infection rate (2.60) was higher in eastern China than in central and western China (0.16 2.13). The overall HIV infection rate in people aged ≥50 years is generally high in China. It is important to control the HIV infection in this population to facilitate the AIDS prevention and control in China.

Analysis of risk factors for lymph node metastasis and prognosis in T1-stage esophageal squamous cell carcinoma / 中国胸心血管外科临床杂志

@#Objective    To investigate the risk factors for lymph node metastasis (LNM) and prognosis of T1-stage esophageal squamous carcinoma (ESC). Methods    Clinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected. There were 281 males and 106 females aged 60 (41-80) years. The patients were divided into a lymph node metastasis group (n=77) and a non-metastasis group (n=310). The risk factors for LNM and prognosis were analyzed. Results    Among 387 patients with T1-stage ESC, 77 (19.9%) patients had LNM. The incidence of LNM was 8.4% (8/95) in T1a-stage patients and 23.6% (69/292) in T1b-stage patients. Univariate analysis showed that tumor size, differentiation degree, depth of invasion and vascular tumor thrombus were associated with LNM (P<0.05). Multivariate logistic regression analysis showed that invasion depth of tumor [OR=2.456, 95%CI (1.104, 5.463), P<0.05] and vascular tumor thrombus [OR=15.766, 95%CI (4.880, 50.938), P<0.05] were independent risk factors for LNM. The follow-up time was 41 (12, 66) months. The 1-year, 3-year and 5-year survival rates were 98.71%, 89.67% and 86.82%, respectively. Univariate analysis showed statistically significant differences in tumor invasion depth, vascular tumor thrombus and LNM between the survival group and the death group. Cox analysis showed that LNM [OR=3.794, 95%CI (2.109, 6.824), P<0.05] was an independent risk factor for prognosis. Conclusion    T1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM. The prognosis of T1-stage ESC with LNM is relatively poor.

Update in immune regulatory pathway of tumor necrosis factor-α-induced protein 8-like 2 / 中华危重病急救医学

The tumor necrosis factor-α-induced protein 8-like (TNFAIP8, TIPE) family is recently identified proteins consisting of four highly homologous mammalian proteins: TIPE, TIPE1, TIPE2, and TIPE3. Although the four members share similar molecular structure and function, involving effects in pathophysiological processes of inflammation, immunity, tumors, stroke, angiogenesis, and other diseases, they have individual characteristics. Many studies have shown that TIPE2 is an essential negative regulator of both innate and adaptive immunity. Up-regulation of TIPE2 expression can alleviate excessive inflammation during septic shock and maintain hemostasis of macrophages, neutrophils, dendritic cells, T cells, and B cells. In this review, we summarize the current literature for structure feature, immune function, and regulatory mechanism of TIPE2, together with its clinical significance in the pathogenesis of immune disorders of a wide array of human diseases. Understanding the basic biology of this new molecule might help us to seek novel strategies for the immunomodulation of human diseases.

Study on the status and influencing factors of hypertension in civil aviation pilots / 中国职业医学

OBJECTIVE: To investigate the incidence and influencing factors of hypertension among civil aviation pilots. METHODS: A total of 1 169 civil aviation pilots in Northern China were selected into the study by the method of convenient sampling. Physical examination, laboratory test and questionnaire survey were conducted. RESULTS: The prevalence of hypertension in Northern China was 4.7%(55/1 169). Multivariate regression analysis showed that the relative risk factors ranking from high to low were, age over 30 years [odds ratio(OR)=6.81, 95% confidence interval(95%CI) 3.57-12.98)], total flight hours over 1 000 hours(OR=4.24, 95%CI 2.14-8.41), flight hours over 500 hours in the past year(OR=2.91, 95%CI 1.57-5.40), obesity(OR=2.50, 95%CI 1.08-5.81), fasting blood glucose(OR=2.24, 95%CI 1.21-4.13), and frequent long-distance flight(OR=2.38, 95%CI 1.24-4.58). These factors were the risk factors of hypertension in civil aviation pilots(P<0.05). CONCLUSION: Age, total flight hours, flight hours in the past year, obesity, fasting blood glucose, frequent long-distance flight are related to the prevalence of hypertension in civil aviation pilots.