Therapeutic potential of alkaloid extract from Codonopsis Radix in alleviating hepatic lipid accumulation: insights into mitochondrial energy metabolism and endoplasmic reticulum stress regulation in NAFLD mice / 中国天然药物

Alkaloids are a class of naturally occurring bioactive compounds that are widely distributed in various food sources and Traditional Chinese Medicine. This study aimed to investigate the therapeutic effects and underlying mechanisms of alkaloid extract from Codonopsis Radix (ACR) in ameliorating hepatic lipid accumulation in a mouse model of non-alcoholic fatty liver disease (NAFLD) induced by a high-fat diet (HFD). The results revealed that ACR treatment effectively mitigated the abnormal weight gain and hepatic injury associated with HFD. Furthermore, ACR ameliorated the dysregulated lipid metabolism in NAFLD mice, as evidenced by reductions in serum triglyceride, total cholesterol, and low-density lipoprotein levels, accompanied by a concomitant increase in the high-density lipoprotein level. ACR treatment also demonstrated a profound anti-oxidative effect, effectively alleviating HFD-induced oxidative stress and promoting ATP production. These effects were achieved through the up-regulation of the activities of mitochondrial electron transfer chain complexes I, II, IV, and V, in addition to the activation of the AMPK/PGC-1α pathway, suggesting that ACR exhibits therapeutic potential in alleviating the HFD-induced dysregulation of mitochondrial energy metabolism. Moreover, ACR administration mitigated HFD-induced endoplasmic reticulum (ER) stress and suppressed the overexpression of ubiquitin-specific protease 14 (USP14) in NAFLD mice. In summary, the present study provides compelling evidence supporting the hepatoprotective role of ACR in alleviating lipid deposition in NAFLD by improving energy metabolism and reducing oxidative stress and ER stress. These findings warrant further investigation and merit the development of ACR as a potential therapeutic agent for NAFLD.

Application of artificial intelligence intestinal sound monitoring in the decision of postoperative feeding time in Crohn's patients / 中华普通外科杂志

Objective:To evaluate the impact of artificial intelligence continuous bowel sound auscultation recorder on enhanced recovery after surgery for patients with Crohn's disease.Methods:60 patients with Crohn's disease who underwent surgery in Sir Run Run Shaw Hospital , Zhejiang University School of Medicine in 2021 were enrolled in this trial prospectively. They were rendered to oral nutritional supplements (ONS) after surgery according to the hint given by artificial intelligence continuous bowel sound auscultation recorder or doctor's experience. In order to investigate the clinical value of artificial intelligence continuous bowel sound auscultation recorder.Results:the first postoperative flatus was earlier in the intervention group compared with control group [(58.3±1.5) h vs. (63.5±1.2) h, t=3.025, P=0.036], and the first ONS time was (18.3±0.3) h vs. (22.1±0.7) h, t=3.521, P=0.026; the incidence of postoperative complications in the intervention group was lower than that in the control group (3% vs. 7%, t=1.954, P=0.048) and the postoperative hospital stay was shorter [(7.2±0.4) d vs. (8.5±0.4) d, t=2.954, P=0.030]. The incidence of postoperative abdominal pain, abdominal distension, nausea, vomiting and fatigue in the intervention group was slightly lower than that in the control group, without statistically significant difference. Conclusion:In patient with Crohn's disease, the artificial intelligence continuous bowel sound auscultation recorder picks up accurate postoperative exhaust time, indicates the time of fist ONS after surgery, and shorten the postoperative hospital stay, without increase postoperative complication such as abdominal pain distension, accelerates postoperative recovery.

Qili Qiangxin, a compound herbal medicine formula, alleviates hypoxia-reoxygenation-induced apoptotic and autophagic cell death via suppression of ROS/AMPK/mTOR pathway in vitro / 中西医结合学报

OBJECTIVE@#Qili Qiangxin (QLQX), a compound herbal medicine formula, is used effectively to treat congestive heart failure in China. However, the molecular mechanisms of the cardioprotective effect are still unclear. This study explores the cardioprotective effect and mechanism of QLQX using the hypoxia-reoxygenation (H/R)-induced myocardial injury model.@*METHODS@#The main chemical constituents of QLQX were analyzed using high-performance liquid chromatography-evaporative light-scattering detection. The model of H/R-induced myocardial injury in H9c2 cells was developed to simulate myocardial ischemia-reperfusion injury. Apoptosis, autophagy, and generation of reactive oxygen species (ROS) were measured to assess the protective effect of QLQX. Proteins related to autophagy, apoptosis and signalling pathways were detected using Western blotting.@*RESULTS@#Apoptosis, autophagy and the excessive production of ROS induced by H/R were significantly reduced after treating the H9c2 cells with QLQX. QLQX treatment at concentrations of 50 and 250 μg/mL caused significant reduction in the levels of LC3II and p62 degradation (P < 0.05), and also suppressed the AMPK/mTOR signalling pathway. Furthermore, the AMPK inhibitor Compound C (at 0.5 μmol/L), and QLQX (250 μg/mL) significantly inhibited H/R-induced autophagy and apoptosis (P < 0.01), while AICAR (an AMPK activator, at 0.5 mmol/L) increased cardiomyocyte apoptosis and autophagy and abolished the anti-apoptotic effect of QLQX. Similar phenomena were also observed on the expressions of apoptotic and autophagic proteins, demonstrating that QLQX reduced the apoptosis and autophagy in the H/R-induced injury model via inhibiting the AMPK/mTOR pathway. Moreover, ROS scavenger, N-Acetyl-L-cysteine (NAC, at 2.5 mmol/L), significantly reduced H/R-triggered cell apoptosis and autophagy (P < 0.01). Meanwhile, NAC treatment down-regulated the ratio of phosphorylation of AMPK/AMPK (P < 0.01), which showed a similar effect to QLQX.@*CONCLUSION@#QLQX plays a cardioprotective role by alleviating apoptotic and autophagic cell death through inhibition of the ROS/AMPK/mTOR signalling pathway.

Spinal Muscular Atrophy: History, Current Status and Future / 罕见病研究

It has been a hundred years since the first case of spinal muscular atrophy(SMA) was reported in the medical literature. In its 100 years of history, medical development for the cure of SMA has gone through many stages, from clinical manifestation description, accumulation of cases, disease classification exploration to pathogenic gene mapping and cloning, clinical application of gene diagnosis, animal model establishment then to R&D of disease modifying drugs and clinical use of novel therapies. The future of the development lies in breakthrough in pathophysiological mechanism, carrier screening and precise prevention, as well as new therapies. As a representative of monogenic rare diseases, review the history of the progress in diagnosis and treatment and R&D in medications and discuss the prospect of further development in the future is instrumental in leading the continued advancement of the whole cause of rare disease.

Chemical screen identifies shikonin as a broad DNA damage response inhibitor that enhances chemotherapy through inhibiting ATM and ATR

DNA damage response (DDR) is a highly conserved genome surveillance mechanism that preserves cell viability in the presence of chemotherapeutic drugs. Hence, small molecules that inhibit DDR are expected to enhance the anti-cancer effect of chemotherapy. Through a recent chemical library screen, we identified shikonin as an inhibitor that strongly suppressed DDR activated by various chemotherapeutic drugs in cancer cell lines derived from different origins. Mechanistically, shikonin inhibited the activation of ataxia telangiectasia mutated (ATM), and to a lesser degree ATM and RAD3-related (ATR), two master upstream regulators of the DDR signal, through inducing degradation of ATM and ATR-interacting protein (ATRIP), an obligate associating protein of ATR, respectively. As a result of DDR inhibition, shikonin enhanced the anti-cancer effect of chemotherapeutic drugs in both cell cultures and in mouse models. While degradation of ATRIP is proteasome dependent, that of ATM depends on caspase- and lysosome-, but not proteasome. Overexpression of ATM significantly mitigated DDR inhibition and cell death induced by shikonin and chemotherapeutic drugs. These novel findings reveal shikonin as a pan DDR inhibitor and identify ATM as a primary factor in determining the chemo sensitizing effect of shikonin. Our data may facilitate the development of shikonin and its derivatives as potential chemotherapy sensitizers through inducing ATM degradation.

Yokukansan Suppresses Gastric Hypersensitivity and Eosinophil-associated Microinflammation in Rats With Functional Dyspepsia

Background/Aims@#Herbal medicine is an important complementary therapy for functional dyspepsia (FD). However, its effect against gastric hypersensitivity in patients with FD has rarely been evaluated. Yokukansan (YKS), a traditional Japanese herbal medicine, is effective against neuropathic and inflammatory pain. This study aims to use a maternal separation (MS) stress-induced FD model to investigate the effects of YKS against gastric hypersensitivity, gastric motility, and duodenal micro-inflammation. @*Methods@#The MS stress model was established by separating newborn Sprague-Dawley rats from their mothers for 2 hours a day from postnatal days 1 to 10. At the age of 7-8 weeks, the rats were treated with YKS at a dose of 5 mL/kg (1 g/kg) for 7 consecutive days. AfterYKS treatment, electromyographic activity in the acromiotrapezius muscle by gastric distention and the gastric-emptying rate were assessed. Immunohistochemical analysis of eosinophils in the duodenum and phosphorylated extracellular signal-regulated kinase(p-ERK) 1/2 in the spinal cord was performed. @*Results@#YKS treatment suppressed MS stress-induced gastric hypersensitivity and decreased the elevated levels of p-ERK1/2 in the spinal cord.In the gastroduodenal tract, YKS inhibited eosinophil-associated micro-inflammation but did not improve gastric dysmotility. @*Conclusions@#YKS treatment improved gastric hypersensitivity by alleviating eosinophil-associated micro-inflammation in the gastroduodenal tract.This treatment may be considered an effective therapeutic option for epigastric pain and micro-inflammation in patients with FD.

Exploration and practice of integrated governance system in hospital with multi-branches / 中华医院管理杂志

Aiming at the problems of resource allocation, cost control, homogenization management of medical and nursing quality and so on in a hospital with multi-campuses, People′s Hospital of Ningxia Hui Autonomous Region explored an integrated governance system. It incorporated a series of aspects, such as the establishment of Internet hospital platform using payment and settlement as the link, the construction of operation and management mode for integrating information of multiple branches, the completion of " one hospital, multiple branches" organizational structure and integrated operation system, the innovation of personnel and post compensation system in line with features of medical industry, the implementation of new service mode of diagnosis teams and inpatient wards, the execution of budget management and cost accounting control, and the establishment of integrated online and offline epidemic prevention and control system for the joint prevention and control. These practices achieved good effects that quality and efficiency of medical services were greatly improved, cost of medical services was effectively controlled, and the efficiency of hospital operation and management were enhanced. It provided valuable experience for the integrated management of public hospitals with multi-campuses.

Clinical features and long-term outcomes after laparoscopic surgery in patients co-existing with ovarian endometrioma and deep infiltrating endometriosis / 中华妇产科杂志

Objective:To investigate the clinical features and long-term prognosis of patients co-existing with ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE).Methods:Totally 358 OMA patients were retrospectively analyzed, who had a minimum of 8 years follow-up after laparoscopic cystectomy, which was performed by one professional endometriosis surgery team at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into DIE group and non-DIE group, and analysis was performed in preoperative characteristics, surgical findings and postoperative outcomes during follow-up.Results:A total of 358 OMA patients were included, of which 190 patients (53.1%, 190/358) were in the DIE group, while other 168 patients (46.9%, 168/358) in the non-DIE group. The average ages between the two groups were (33.7±5.4), (32.5±5.3) years ( P=0.047), the average parity was (0.4±0.6) times vs (0.3±0.5) times ( P=0.079). There were significant differences in the proportions of moderate to severe dysmenorrhea [67.4% (128/190) vs 56.5% (95/168)], chronic pelvic pain [24.2% (46/190) vs 7.7% (13/168)], and the increase in CA 125 [79.9% (139/190) vs 65.2% (101/168)] between the two groups (all P<0.05). The average operation time in the DIE and non-DIE groups was (75±21) vs (39±36) minutes ( P<0.01). There was a significant difference in adenomyosis presence between the two groups [41.6% (79/190) vs 22.0% (37/168); P=0.001]. All patients were followed up for at least 8 years. At the end of the follow-up, though the DIE group was with higher total rate of disease relapse, yet no significant difference was found between the two groups in statistical comparison [21.6% (41/190) vs 16.1% (27/168); P=0.185]. A total of 41 cases in the DIE group recurred, the recurrence rate of pain was 15.8% (30/190), and the recurrence rate of cyst was 8.4% (16/190); 27 cases had recurrence after operation in the non-DIE group, the recurrence rate of pain was 8.9% (15/168), and the recurrence rate of cyst was 10.7% (18/168). There were no significant differences in the pain recurrence rate ( P=0.067) and cyst recurrence rate ( P=0.460) between the two groups. As for the successfully pregnant patients, live birth rates were 100.0% (65/65) vs 94.4% (68/72) between DIE group and non-DIE groups ( P=0.120). Conclusions:Compared with the non-DIE group, OMA patients with concurrent DIE might have severe pain symptoms, higher probability of abnormal CA 125 levels and more severe pelvic adhesions. Although there are no significant differences in the total recurrence rate and the recurrence rate of various types between the two groups, the proportion of pain recurrence in the DIE group is higher than that in the non-DIE group. In terms of fertility outcomes, patients in the DIE group are with lower likelihood of pregnancy after surgery during the long-time follow-up. DIE has no significant influence on the fertility outcome.

Effects of mental model based on relaxation training and 5E rehabilitation model on the perioperative rehabilitation of patients with osteosarcoma / 中国实用护理杂志

Objective:To explore the effect of mental model based on relaxation training and 5E rehabilitation model on the perioperative rehabilitation of patients with osteosarcoma, in order to provide the reference for rehabilitation nursing of patients with osteosarcoma.Methods:A total of 142 osteosarcoma patients were selected from January 2018 to December 2019 in the Affiliated Union Hospital of Tongji Medical College of Huazhong University of Science and Technology. According to the random method of digital table, the patients were divided into observation group and control group, 71 cases respectively. The control group took routine nursing, and the observation group patients took the mental model based on relaxation training and 5E rehabilitation mode. The quality of life, the levels of depression and anxiety before and after intervention were evaluated by Karuafsky Functional State Score, Generalized Anxiety Scale (GAD-7) and Health Questionnaire Depression Symptom Group Scale (PHQ-9). The recovery of the affected limb was evaluated by the Musculoskeletal Tumor Society (MSTS).The adverse reactions were observed.Results:There was no significant difference in the quality of life between the two groups before nursing ( P>0.05). After nursing, the quality of life score was (91.10±12.38) points in the observation group and (82.20±12.51) points in the control group. The difference was statistically significant ( t value was 10.441, P<0.001). There was no significant difference in GAD-7 and PHQ-9 scores between the two groups before nursing ( P>0.05). After nursing, the GAD-7 and QPH-9 score were (5.21±3.12), (4.41±3.43) points in the observation group and (6.82±3.34) , (6.43±3.13) points in the control group. The differences were statistically significant ( t values were 9.531, 10.592, P<0.001). The excellent and good recovery rate of the affected limb in the observation group was 71.9%(51/71) in the observation group and 54.9%(39/71) in the control group, the difference was statistically significant ( χ2 value was 10.468, P<0.001). The incidence of adverse reactions was 5.6%(4/71) in the observation group and 12.7%(9/71) in the control group, the difference was statistically significant ( χ2 value was 12.543, P<0.001). Conclusions:The mental model based on relaxation training combined with 5E rehabilitation model can improve the postoperative rehabilitation effect of patients with osteosarcoma limb salvage treatment, so that patients can establish confidence, actively cooperate with treatment and participate in postoperative rehabilitation training. Through intervention, patients can actively adjust their mentality, lay the foundation for further adjuvant treatment, improve the quality of life of patients, and ultimately improve the prognosis.

A convenience sampling questionnaire survey of the current status of diagnosis and treatment of endometriosis in China in 2018 / 中华妇产科杂志

Objective:To further understand the current status of diagnosis and treatment of endometriosis in China, the implementation of guideline in different levels of hospitals, and the need for continuing education in endometriosis among primary doctors.Methods:The survey was conducted in the form of convenience sampling questionnaire among the Wechat public platform. The doctors were free to participate in the investigation without any reward. All questions answered were assessed as valid questionnaire. The datas were collected on the questionnaire network platform and analyzed by SPSS 19.0.Results:Totally 1 494 valid questionnaires were collected in this survey. 60.17% (899/1 494) of them were from tertiary hospital, and 32.60% (487/1 494) were from grade two hospital. Only the hospitals where 9.97% (149/1 494) participants based opened the specialist clinic for endometriosis. 70.35% (1 051/1 494) of participants said they had read the second edition of guideline for the diagnosis and treatment of endometriosis which published in 2015. The American Society for Reproductive Medicine (ASRM) staging system was adopted in the clinical practices of only 25.03% (374/1 494) participants. And 18.74% (280/1 494) participants used the endometriosis fertility index (EFI) scoring during the laparoscopic surgery for endometriosis with infertility. 45.18% (675/1 494) of participants said they had not attended any academic conference on endometriosis in the past six months. 64.46% (963/1 494) of the participants believed their diagnosis and treatment in practice should be improved and standardized. 87.15% (1 302/1 494) of the participants expressed the hope that more conferences or workshops on endometriosis would be held.Conclusions:At presents, the diagnosis and treatment of endometriosis in China has been greatly improved, but the implementation of guidelines and the new concept is still a long-term job. The specialist clinic are held only in a few hospitals. It’s the expectation and voice of primary doctors to the association to organize the more academic congresses on endometriosis.

Relationship between C-reactive protein level and incidence of left atrial spontaneous echocardiographic contrast in patients with nonvalvular atrial fibrillation / 中华心血管病杂志

Objective: To investigate the relationship between high sensitivity C-reactive protein (hs-CRP) level and incidence of left atrial spontaneous echocardiographic contrast (LASEC) in the patients with nonvalvular atrial fibrillation (AF). Methods: Four hundred and ninety consecutive patients with nonvalvular atrial fibrillation who underwent radiofrequency ablation for the first time from January 1, 2018 to June 30, 2018 in the Department of Cardiology, Beijing Anzhen Hospital were enrolled. According to the results of transesophageal echocardiography before radiofrequency ablation, patients were divided into the group without LASEC (n=338) and the group with LASEC (n=152). hs-CRP was determined by latex enhanced immunoturbidimetry. The relationship between hs-CRP and LASEC in patients with nonvalvular atrial fibrillation was investigated by univariate and multivariate logistic analysis. Results: LASEC was detected in 152 (31%) of 490 patients. Significant differences in age, type of atrial fibrillation, previous embolic events, fibrinogen, D-dimer, the left atrial anteroposterior diameter and CHA(2)DS(2)-VASc scores were found between patients with and without LASEC (all P<0.05). Compared with the group without LASEC, the serum hs-CRP level was significantly higher in the group with LASEC (3.16 (1.30, 5.23) mg/L vs. 0.67 (0.37, 1.48) mg/L, P<0.001). Multivariate logistic regression analysis showed that hs-CRP (OR=1.136, 95%CI 1.060 - 1.217, P<0.001) and D-dimer (OR=1.040, 95%CI 1.011 - 1.070, P=0.007) were independent determinants for LASEC in this patient cohort. Conclusions: hs-CRP is an independent determinant for LASEC in patients with nonvalvular atrial fibrillation. Inflammation may thus be involved in the formation of prethrombotic state in patients with nonvalvular atrial fibrillation.

Clinical efficacy of one-stage repair and reconstruction of multiple ligament injury of the knee joint under an arthroscope / 解放军医学杂志

Objective To investigate the clinical features of multiple ligament injuries of the knee joint, and evaluate the clinical efficacy of one-stage repair and reconstruction under an arthroscope of multiple ligament injured knee joint. Methods The clinical data were analyzed retrospectively of 22 patients receiving treatment and follow-up for multiple ligament injuries of the knee joint from March 2015 to June 2017 in the Henan Orthopedic Hospital. 13 males and 9 females aged from 24 to 64 years; and left knee injury occurred in 7 cases, right knee in 5 cases, all injuries were close with knee subluxation or dislocation. Imaging, clinical and arthroscopical examination showed anterior and posterior cruciate ligament ruptures in all the patients. The time from injury to operation was from 4 to 16 days, all the patients were treated by single tunnel and single beam reconstruction of anterior and posterior cruciate ligament under an arthroscope, limited incision and reconstruction of PMC (posterior medial complex) and PLC (posterior lateral complex); and the concurrent injuries were treated at that same time. Postoperative X-Ray and MRI were performed to determine the healing of bone tunnel, internal fixation, remodeling of reconstructed tendon and tendon healing. The knee function was assessed on the basis of the range-of-motion of the knee, IKDC score and Lysholm Knee Function score. Results All the patients were followed up from 6 to 14 months with an average of (11.0±1.5) months. The torn inner and outer meniscus and fracture were all healed and the deep venous thrombus was dissolved. Last follow up found varus and valgus stress test was normal or close to normal in 22 patients by Lachman test, anterior and posterior drawer tests were negative, and the tibial shift distance forward or backward was smaller than 5mm. The patients had no subjective symptoms. X-Ray and MRI showed that the tibial femoral tunnel had healed, and the position of internal fixation had no change, and the ligament had been reconstructed and the tendon had healed. In 2 cases, one year later, sensory and motor recovery was observed after common peroneal nerve injury. Range of motion of the knee joint, and Lysholm and IKDC scores were significantly superior at the last following up to at the preoperation (P<0.01); and IKDC comprehensive assessment revealed a normal result (A) in 4 cases, close to normal (B) in 16, abnormal (C) in 2, whereas they are significantly abnormal (D) at admission. Conclusion One-stage arthroscopical repair and reconstruction for multiple ligament injuries of the knee can obviously stabilize the knee joint, improve the knee joint function early, prevent postoperative complications, shorten the hospitalization time, reduce the cost, improve the quality of life, and have the advantages of safety, reliability and less trauma, and the clinical efficacy is satisfactory.

The value of the spondyloarthritis research consortium of ceanada magnetic resonance imaging sacroiliac joint inflammation score and structural score in evaluating the activity of axial spondyloarthritis / 中华风湿病学杂志

Objective To analyze the correlation between the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) sacroiliac joint inflammation score (SPARCC score)/structural score (SSS) and the disease activity as well as the functional indexs.The correlation between the MRI score and inflammatory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] in patients with active axial spotdyloarthritis (axSpA) before and after treatment was explored.In addition,the contribution of the two MRI scoring method in evaluating conditions was also explored.Methods According to the inclusion criteria,24 patients with active axial SpA were recruited and received the recombinant hauman tumor necrosis factor (TNF)-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc),sulfasalazine and thalidomide for 12 weeks.Subjects were scored at week 0 and 12 by SPARCC/SSS scores.Bath ankylosing spondylitis disease activity index (BASDAI),Assessment of Spondyloarthritis Intemational Society (ASAS)-endorsed disease activity score (ASDAS)-CRP,bath ankylosing spondylitis functional index (BASFI).Bath ankylosing spondylitis metrology index (BASMI),ESR and CRP.The correlation between the SPARCC/SSS scores and that of clinical indicators were analyzed.Paired sample t test,Wilcoxon signedrank test,Spearman correlation analysis and Pearson correlation analysis were used for statistical analysis,and receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of SPARCC score decline as a response to treatment.Results ① Compared with baseline,after 12 weeks treatment,SPARCC scores [(15±4) and (33±10)],BASDAI [(3.2±0.9) and (5.2±1.1)],BASFI [(2.3±0.6) and (4.6±1.0)],BASMI [(2.3±0.7) and (4.1±1.1)],ASDAS-CRP scores [(2.0±0.8) and (3.7±0.9)],ESR [(16±12) mm/1 h and (49±26) mm/1 h],CRP [(7.2t2.8) mg/Land (30.4±19.3) mg/L] were significantly decreased (t values were 7.822,6.950,10.707,7.204,6.281,-4.015 and-4.257,respectively),and the differences were statistically significant (P=0.000).There was no significant difference in SSS scores between baseline [(20±6) and (19±7)] and after 12 weeks treatment (t=-0.761,P=0.455).② Before treatment,SPARCC score showed positive linear correlation with BASDAI (r=0.630,P=0.001),ASDAS-CRP (r=0.646,P=0.001),CRP (r=0.574,P=0.003) and ESR (r=0.559,P=0.004),and the correlation of the above indexes disappeared after treatment (P＞0.05).The association between SPARCC structral scores and the above indicators was not significant before and after treatment.③ Areas under curve(AUC) of ROC for assessing treatment response by reduced SPARCC scores was 0.809.The cut-off value for response to treatment was 20.5,with the sensitivity of 68.8％ and specificity of 75.0％.Conclusion The SPARCC MRI SIJ inflammation score has certain value in evaluating disease activity and efficacy,while the SPARCC SSS is not.

The value of the spondyloarthritis research consortium of ceanada magnetic resonance imaging sacr-oiliac joint inflammation score and structural score in evaluating the activity of axial spondyloarthritis / 中华风湿病学杂志

Objective@#To analyze the correlation between the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) sacroiliac joint inflammation score (SPARCC score)/structural score (SSS) and the disease activity as well as the functional indexs. The correlation between the MRI score and inflammatory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] in patients with active axial spondyloarthritis (axSpA) before and after treatment was explored. In addition, the contribution of the two MRI scoring method in evaluating conditions was also explored.@*Methods@#According to the inclusion criteria, 24 patients with active axial SpA were recruited and received the recombinant hauman tumor necrosis factor (TNF)-α receptor Ⅱ: IgG Fc fusion protein(rhTNFR:Fc), sulfasalazine and thalidomide for 12 weeks. Subjects were scored at week 0 and 12 by SPARCC/SSS scores. Bath ankylosing spondylitis disease activity index (BASDAI), Assessment of Spondyloarthritis Intemational Society (ASAS)-endorsed disease activity score(ASDAS)-CRP, bath ankylosing spondylitis functional index (BASFI). Bath ankylosing spondylitis metrology index(BASMI), ESR and CRP. The correlation between the SPARCC/SSS scores and that of clinical indicators were analyzed. Paired sample t test, Wilcoxon signedrank test, Spearman correlation analysis and Pearson correlation analysis were used for statistical analysis, and receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of SPARCC score decline as a response to treatment.@*Results@#① Compared with baseline, after 12 weeks treatment, SPARCC scores [(15±4) and(33±10)], BASDAI [(3.2±0.9) and (5.2±1.1)], BASFI [(2.3±0.6) and (4.6±1.0)], BASMI [(2.3±0.7) and (4.1±1.1)], ASDAS-CRP scores [(2.0±0.8) and (3.7±0.9)], ESR [(16±12) mm/1 h and (49±26) mm/1 h], CRP [(7.2±2.8) mg/L and (30.4±19.3) mg/L] were significantly decreased (t values were 7.822, 6.950, 10.707, 7.204, 6.281,-4.015 and-4.257, respectively), and the differences were statistically significant (P=0.000). There was no significant difference in SSS scores between baseline [(20±6) and (19±7)] and after 12 weeks treatment (t=-0.761, P=0.455). ② Before treatment, SPARCC score showed positive linear correlation with BASDAI (r=0.630, P=0.001), ASDAS-CRP (r=0.646, P=0.001), CRP (r=0.574, P=0.003) and ESR (r=0.559, P=0.004), and the correlation of the above indexes disappeared after treatment (P>0.05). The association between SPARCC structral scores and the above indicators was not significant before and after treatment. ③ Areas under curve(AUC) of ROC for assessing treatment response by reduced SPARCC scores was 0.809. The cut-off value for response to treatment was 20.5, with the sensitivity of 68.8% and specificity of 75.0%.@*Conclusion@#The SPARCC MRI SIJ inflamm-ation score has certain value in evaluating disease activity and efficacy, while the SPARCC SSS is not.

GSK923295 as a potential antihepatocellular carcinoma agent causing delay on liver regeneration after partial hepatectomy / 中华医学杂志(英文版)

BACKGROUND@#The clinical trials emerged centromere protein E inhibitor GSK923295 as a promising anticancer drug, but its function in hepatocellular carcinoma (HCC) remain needs to be fully elucidated, especially as chemotherapy after hepatectomy for liver tumors. We aimed to describe anti-HCC activities of GSK923295 and compare its antiproliferative effects on liver regeneration after partial hepatectomy (PH).@*METHODS@#All subjects were randomized to treatment with either vehicle or GSK923295. Antitumor activity of GSK923295 was assessed by xenograft growth assays. The C57BL/6 mice were subjected to 70% PH and the proliferation was calculated by liver coefficient, further confirmed by immunohistochemistry. The proliferation and cell cycle analysis of liver cell AML12 and HCC cells LM3, HUH7, and HepG2 were investigated using the cell counting kit-8 assay and Flow Cytometry. The chromosome misalignment and segregation in AML12 cells were visualized by immunofluorescence.@*RESULTS@#Treatment with GSK923295 induced antiproliferation in HCC cell lines. It also caused delay on HCC tumor growth instead of regression both in a HCC cell line xenograft model and patient-derived tumor xenograft model. With microarray analysis, CENtromere Protein E was gradually increased in mouse liver after PH. Exposure of liver cells to GSK923295 resulted in delay on a cell cycle in mitosis with a phenotype of misaligned chromosomes and chromosomes clustered. In 70% PH mouse model, GSK923295 treatment also remarkably reduced liver regeneration in later stage, in parallel with the mitotic marker phospho-histone H3 elevation.@*CONCLUSION@#The anticancer drug GSK923295 causes a significant delay on HCC tumor growth and liver regeneration after PH in later stage.

Clinical characteristics of psoriatic arthritis with positive rheumatoid factor or anti-cyclic citrullinated peptide antibody / 北京大学学报(医学版)

OBJECTIVE@#To analyze the clinical and laboratory features of psoriatic arthritis (PsA) patients with positive rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP) antibody.@*METHODS@#In the study, 77 PsA patients who were hospitalized in the Department of Rheumatology and Immunology of Peking University Third Hospital from January 2007 to June 2019 were enrolled. All the patients met Classification Criteria for Psoriatic Arthritis or Moll or Wright Criteria. Rheumatoid factor (RF) and anti-cyclic-citrullinated peptide (CCP) antibody were tested in these patients. According to whether anti-CCP antibody or RF was detected in serum, all the patients were divided into anti-CCP antibody or RF positive group (15 cases), anti-CCP antibody or RF negative group (62 cases). According to the detection of anti-CCP antibody in serum, all the patients were divided into anti-CCP antibody positive group (7 cases) and anti-CCP antibody negative group (70 cases). Clinical and laboratory data were collected. The differences of clinical and laboratory indicators between the RF or anti-CCP antibody positive and negative PsA patients were compared. Clinical and laboratory indicators between the anti-CCP antibody positive and negative patients were also compared.@*RESULTS@#Among the 77 patients, 15 were RF or anti-CCP antibody positive, of whom 8 were only RF positive and 2 were only anti-CCP antibody positive, and both of RF and anti-CCP antibody were positive in 5 cases. The RF or anti-CCP antibody positive PsA patients were older than those in the negative group [(58.2±14.8) years vs. (46.69±12.27) years, P=0.002]. And metacarpophalangeal joints, elbow joints and shoulder joints were more likely to be involved in RF or anti-CCP antibody positive PsA patients. PsA patients in the anti-CCP antibody positive group were older than those in the negative group [(62.43±14.34) years vs. (47.59±12.75) years old, P=0.005]. The positive rate of RF and serum level of fibrinogen in the anti-CCP antibody positive group were higher than those in the negative group. The PsA patients in the anti-CCP antibody positive group were all polyarthritis, while 68.6% patients in the negative group were polyarthritis, but there was no statistical difference between the two groups. There was no statistical difference in sausage fingers/toes, changes in nails and enthesitis, and bone erosion on radiographs between the RF or anti-CCP antibody positive and negative PsA patients. There was also no statistical difference in sausage fingers/toes, bone erosion on radiographs, and changes in nails and enthesitis between the anti-CCP antibody positive and negative patients.@*CONCLUSION@#RF and anti-CCP antibodies can be detected in the serum of some PsA patients. RF or anti-CCP antibody positive PsA patients were older than those in negative PsA patients. Metacarpophalangeal joints, elbow joints and shoulder joints were more likely to be involved in RF or anti-CCP antibody positive PsA patients. Anti-CCP antibody positive PsA patients were older and had higher levels of RF positive rate and fibrinogen level.

Real-world research on cervical cancer screening program and effect evaluation for Chinese population / 中华肿瘤杂志

Objective@#To evaluate the actual efficacy of cervical cancer and precancerous lesions screening approaches in real-world regions with different economic levels in China.@*Methods@#The demonstrative application and effect evaluation of cervical cancer screening program were conducted in 21 hospitals nationwide from 2015 to 2018. Multi-stage sampling method was adopted to divide the country into 7 large areas according to geographical location. Two to four screening sites of two types of cancer (cervical cancer and breast cancer) were selected in each area, and the grassroots screening sites were implemented under the guidance of superior hospitals. In rural areas, women were initially screened using cytology, human papillomavirus (HPV) testing and visual inspection. The women with positive cytology or visual inspection were referred for colposcopy, and the women with positive HPV infection were randomly referred for reflex cytology or visual inspection, or direct colposcopy examination. In urban areas, women were primarily randomized into cytology or HPV testing groups. The women with abnormal cytology or positive HPV 16/18 infection were directly referred for colposcopy examination, whereas the women with positive infection of the other 12 high-risk subtypes of HPV were referred for reflex cytology or colposcopy. All of recruited women would be follow-up and screened by the baseline screening techniques in the third year while the positive women underwent colposcopy examination. The positive rates, referral rates, the detection rates of grade 2 and above of cervical intraepithelial neoplasia (CIN 2+ ) were compared.@*Results@#A total of 63 931 women were recruited at the baseline. Among them, 11 rural sites included 33 823 women: 15 577, 11 157 and 7 089 women were screened by HPV testing, visual inspection via acetic acid or Lugol′s iodine (VIA/VILI) and cytology, respectively. Additionally, 30 108 women were from 10 urban sites: 9 907 and 20 201 women were screened by cytology and HPV subtyping, respectively. The HPV positive rate for urban women was 9.34%, whereas that for rural women was 12.53%. The abnormal rate of cytology for urban women was 5.63%, and that for rural women was 4.24%. The positive rate of VIA/VILI in the rural women was 12.25% Furthermore, the detection rate of CIN2+ at the baseline was 0.56%, and that was statistically higher in HPV-positive group than cytology-positive group (P<0.05).@*Conclusions@#All of screening sites completed the baseline screening tasks as expected. The prevalence of HPV infection is higher in rural women than urban women. The performance of HPV testing is better than cytology for detecting CIN2+ cases. This real-world demonstration study provides evidences for cervical cancer prevention and control in different regions.

Effect of curcumin on JAK2/STAT3 signaling pathway after cerebral ischemia in rats / 中华老年心脑血管病杂志

Objective To study the effect of curcumin on JAK2/STAT3 signaling pathway following ischemic cerebral injury in rats.Methods Sixty-eight SD rats were divided into sham opera tion group,cerebral ischemia group,curcumin treatment group and control group (17 in each group).After a rat focal cerebral hemmorrahge model was established,the changes of neurological behaviors in rats were recorded,expressions of TNF-α,IL-1β and IL-6 were detected by ELISA and those of JAK2,p-JAK2,STAT3,p-STAT3 and HMGB1 were detected by Western blot.Results The neurological behavior score was lower in curcumin treatment group than in cerebral ischemia group (1.53±0.62 vs 2.94±0.87,P＜0.05).No significant difference was found in expression levels of TNF-α,IL-1β and IL 6 between cerebral ischemia group and control group (P＞0.05).The expression levels of TNF α,IL 1β and IL 6 were lower in curcumin treatment group than in cerebral ischemia group (57.63±10.27 ng/L vs 99.35±8.97 ng/L,33.67 ± 9.10 ng/L vs58.43±7.22 ng/L,31.97±6.91 ng/L vs 49.23±6.28 ng/L,P＜0.01).The relative volume of p-JAK2/JAK2 and p-STAT3/STAT3 and the expression level of HMGB1 were lower in curcumin treatment group than in cerebral ischemia group (P＜0.05).Conclusion Curcumin can protect rats against cerebral injury following ischemia by inhibiting the JAK2/STAT3 signaling pathway and downregulating the HMGB1 expression,and can thus alleviate inflammatory reactions.

Changes of mitochondrial dynamics related genes expression in a glaucoma rat model / 中华实验眼科杂志

Objective To investigate the ultrastructural changes of mitochondria and dynamic changes of mitochondrial dynamics related genes in chronic ocular hypertension rat models.Methods Forty Sprague-Dawley (SD) rats were randomized into normal control group,modeling 3 day-group,modeling 7 day-group and modeling 14 day-group.Glaucoma models were induced by translimbal laser photocoagulation of trabecular meshwork in rats.The number of survival retinal ganglion cells was evaluated by retrogradely labeling of FluoroGold.The morphological change of mitochondria in optical nerve was observed under the transmission microscope.The dynamic changes of mitochondrial dynamic-related gene expression in the retina in gene and protein levels were detected by real-time fluorescence quantitative PCR and Western blot assay,respectively.The experiment complied ARVO Statement for the Use of Animals in Ophthalmic and Vision Research and approved by the Animal Experimentation Ethics Committee of the Eye and ENT Hospital of Fudan University.Results The intraocular pressure was significantly higher in the modeling 3-day group,modeling 7-day group and modeling 14-day group than that in the normal control group (all at P＜0.01).Compared with the normal control group,the immunoreactivity of glial fibrillary acidic protein (GFAP) was increased in the Müller cells in all modeling retinas,and the relative expressing levels of GFAP protein were significantly mcreased in all modeling groups (F =91.47,17.58,both at P＜0.01).Compared to the normal control group,the number of mitochondria was increased,and the mitochondrial health degree in the optic nerve and the nearest neighbor distance between adjacent mitochondria were decreased in the modeling 3-day group and 14-day group (all at P＜0.05).The expression levels of dynamics-related protein 1 (Drp1),parkin protein,PINK1,KIF5B and Miro1 mRNA in the retina were significantly elevated in the modeling 3-day group (all at P＜0.05).In addition,the expression levels of optineurin,parkin and OPA1 proteins were higher in the modeling 3-,7-and 14-day groups than those in the normal control group (all at P＜0.05).Conclusions Dysfunction of mitochondria and changes of mitochondrial dynamics exist in RGCs of glaucomatous rats,including increased mitochondrial fission and fusion as well as the activation of mitophagy pathway,which probably are the mechanism of RGC damage in glaucoma.

Application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion / 中华消化外科杂志

Objective To explore the application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion.Methods The retrospectively cross-sectional study was conducted.The clinicopathological data of 27 patients who received laparoscopic right-posterior lobe hepatectomy in the Sir Run Run Shaw Hospital of Zhejiang University from May 2007 to June 2017 were collected.The hepatocellular carcinoma,intrahepatic bile duct stone,hepatic hemangioma,focal nodular hyperplasia,cholangiocarcinoma and metastatic hepatic carcinoma were respectively detected in 13,4,4,4,1 and 1 patients.The laparoscopic right-posterior lobe hepatectomy were performed after regional blood flow occlusion.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative recurrence of patients with benign liver diseases and survival of patients with malignant liver tumors up to August 2017.Measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative recovery situations:27 patients underwent successful laparoscopic right-posterior lobe hepatectomy after regional blood flow occlusion,including 24 undergoing laparoscopic surgery and 3 undergoing conversion to open surgery due to difficult exposure under laparoscopy.Operation time,volume of intraoperative blood loss,recovery time of postoperative gastrointestinal function and time of postoperative abdominal drainage-tube removal were respectively 205 minutes (range,125-455 minutes),400 mL (range,50-2 000 mL),1 day (range,1-3 days) and 3 days (range,2-24 days).There was no postoperative hepatic failure,bile leakage and bleeding-induced reoperation.Of 4 patients with postoperative complications,1 with wound infection was improved by regular dressing,1 with deep venous thrombosis of the lower extremity was improved by anticoagulant therapy and 2 with pulmonary infection were improved by anti-infective supporting treatment.The duration of postoperative hospital stay in 27 patients was 9 days (range,5-26 days).(2) Follow-up situations:26 of 27 patients were followed up for 2-121 months,with a median time of 17 months,and 1 patient with benign liver disease lost to follow-up.During the follow-up,11 patients with benign liver disease had no recurrence,the tumor-free and overall survival times of 15 patients with malignant liver tumors were respectively 13 months (range,5-57 months) and 14 months (range,5-57 months).Conclusion Laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion is safe and feasible,with a lower risk of liver failure and better clinical efficacies.