The application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital / 中华医学教育探索杂志

Objective:To explore the application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital.Methods:A total of 84 newly recruited nurses from Beijing Shijitan Hospital Affiliated to Capital Medical University from August 2017 to August 2018 were selected as the control group, and routine teaching was used. In addition, 116 new nurses from August 2019 to August 2020 were selected as the observation group, and on-demand teaching was adopted. The results of theory and practical operation, comprehensive ability and teaching satisfaction of the two groups were compared. The software SPSS 22.0 was used for t-test. Results:The nurses in the observation group had higher scores than the control group in theory [(96.38±2.14) vs. (91.56±3.75)] and practice [(95.49±2.23) vs. (90.91±4.02)]. The scores of nurses in the observation group were higher than those in the control group in accurate implementation of doctor's orders, emergency response ability, ability to observe illness, operation level, communication ability, professional image of nurses, cooperation satisfaction with doctors and harmony with nurses ( P<0.05). The nurses in the observation group scored higher than those in the control group in teaching content, teaching method, teaching attitude, and teaching effect satisfaction ( P<0.05). Conclusion:The application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital can significantly improve their theoretical and practical skills, and improve their comprehensive ability and teaching satisfaction.

The observation on the effect of prospective intervention on emergence agitation and postoperative recovery in patients with chronic sinusitis during preoperative visits / 中国医师进修杂志

Objective:To investigate the effect of prospective intervention on emergence agitation and postoperative recovery in patients with chronic sinusitis during preoperative visits.Methods:A total of 80 patients with chronic sinusitis who underwent general anesthesia in Dayi County People′s Hospital of Chengdu City from December 2019 to October 2020 were selected and randomly divided into group D and group G, with 40 patients in each group. Group D received preoperative visit with conventional methods and group G received preoperative visit with prospective intervention methods. The hemodynamic changes of patients in the two groups at 30 min before the operation (T 1) and 1 (T 2), 5 (T 3), 10 (T 4) and 30 min (T 5) after tracheal tube extraction were recorded. The anxiety and depression scores of patients before the intervention and 1 d after the operation were compared between the two groups. The incidence of emergence agitation after the operation and complications during anesthesia awakening period were observed in the two groups, sino-nasal outcome test-20 (SNOT-20) was used to assess the postoperative recovery. Results:The incidence of emergence agitation in group G was lower than that in group D: 7.5%(3/40) vs. 25.0%(10/40), the difference was statistically significant ( χ2 = 4.50, P<0.05). There was no significant difference in systolic blood pressure, diastolic blood pressure and heart rate between the two groups at T 1 and T 5 ( P>0.05), but the level of above indicators in group G at T 2, T 3 and T 4 were significantly higher than those in group D ( P<0.05). The scores of State-Trait Anxiety Inventory(S-AI) and Self-Rating Depression Scale (SDS) in group G at the first day after the operation were significantly lower than those in group D: (35.45 ± 5.32) scores vs. (39.35 ± 4.91) scores, (35.42 ± 7.82) scores vs. (38.76 ± 5.21) scores, the differences were statistically significant ( P<0.05). The incidence of complications during anesthesia awakening period in group G was slightly lower than that in group D ( P>0.05). After the operation, the scores of sinusitis symptoms and nasal symptoms in the two groups were significantly decreased compared with those before the operation, and the scores of group G were significantly lower than those in group D ( P<0.05). Conclusions:Prospective intervention before anesthesia in patients with chronic sinusitis surgery can reduce stress response, improve bad mood, reduce the incidence of emergence agitation, and promote the postoperative recovery.

Long term prognosis of fulminant myocarditis and predictors related to impaired cardiac function post discharge / 中华心血管病杂志

Objective: To compare the long-term prognosis of fulminant myocarditis (FM) and non-fulminant myocarditis (NFM) patients who survived and discharged from hospital, and to explore the factors associated with the long-term prognosis and impaired cardiac function. Methods: This study was a retrospective study. Consecutive patients with acute myocarditis hospitalized in Tongji Hospital from January 2017 to December 2020 were enrolled and divided into FM group and NFM group according to the type of myocarditis. Then, patients in the FM group were further divided into normal cardiac function group and impaired cardiac function group according the left ventricular ejection fraction (LVEF). All patients with acute myocarditis were treated with antiviral, immunomodulatory, immunosuppressive medications and symptomatic and supportive treatment, while FM patients were treated with comprehensive treatment plan. Clinical data at admission of enrolled patients were collected through the electronic medical record system. Patients were clinically followed-up at 1, 3, 6 and 12 months, then once a year after discharge by clinical visit. The primary endpoints included major cardiovascular events, impaired cardiac function was defined by LVEF<55%. Kaplan-Meier survival curve was used to analyze the occurrence of LVEF<55% and left ventricular enlargement during the follow-up of patients in FM group and NFM group, and Log-rank test was used for comparison between groups. Cox regression model was used to analyze the risk factors of impaired cardiac function in patients with FM during follow-up. Results: A total of 125 patients with acute myocarditis were enrolled (66 in FM group and 59 in NFM group). Compared with NFM group, the proportion of FM patients with the lowest LVEF<55% during hospitalization was higher (P<0.01), and the recovery time of normal LVEF during hospitalization was longer (P<0.01). The proportion of LVEF<55% at discharge was similar between the two groups (P=0.071). During the follow-up of 12 (6, 24) months, 1 patient (1.5%) died due to cardiac reasons in FM group after discharge, 16 patients (24.2%) had sustained LVEF<55% after discharge, and 8 patients (12.1%) had left ventricular enlargement. In NFM group, 3 patients (5.1%) had sustained LVEF<55%, and 1 patient (1.7%) had left ventricular enlargement. Kaplan-Meier survival curve analysis showed that the incidence of sustained LVEF<55% in FM group was higher than that in NFM group (P=0.003), and the incidence of left ventricular enlargement was also higher than that in NFM group (P=0.024). Subgroup analysis of patients in the FM group showed that, compared with the normal cardiac function group, the time from onset to admission was shorter (P=0.011), the proportion of LVEF<55% at discharge was higher (P=0.039), the proportion of coronary angiography was higher (P=0.014), and the LVEF recovery time during hospitalization was longer (P=0.036) in FM patients with impaired cardiac function. Multivariate Cox regression analysis showed that longer LVEF recovery time during hospitalization was an independent risk factor for cardiac function impairment after discharge of FM patients (HR=1.199, 95%CI 1.023-1.406, P=0.025). Conclusions: The incidence of reduced LVEF is significantly higher in FM patients than that in NFM patients. Longer LVEF recovery time during hospitalization is an independent risk factor for cardiac function impairment in FM patients after discharge.

Effects of ginger-partitioned moxibustion on the expression levels of PGF2α, E2, P, and mRNAs of PGF2αR and E2R in rats with primary dysmenorrhea due to cold-dampness stagnation / 针灸推拿医学（英文版）

Objective: To observe the effects of ginger-partitioned moxibustion at Shenque (CV8) and Guanyuan (CV4) on the expression levels of endocrine-related molecules and their receptors in rats with primary dysmenorrhea (PD) due to cold-dampness stagnation, thus to explore their analgesic mechanisms. Methods: Thirty-two female Wistar rats were divided into a normal group, a model group, a ginger-partitioned moxibustion group, and a Western medicine group according to the random number table method, with 8 rats in each group. Except for rats in the normal group, all other rats were treated with oxytocin combined with ice-water bath to establish the rat models of PD due to cold-dampness stagnation. After successful modeling, rats in the normal group and the model group did not receive treatment; rats in the ginger-partitioned moxibustion group received treatments with ginger-partitioned moxibustion at Shenque (CV8) and Guanyuan (CV4); rats in the Western medicine group received ibuprofen by intragastric administration. The writhing response of rats was compared among groups, and the serum levels of prostaglandin F2α (PGF2α), estrogen (estradiol, E2), progesterone (P), and the mRNA expression of PGF2α and E2 receptors in the uterine tissues were detected. Results: No writhing behavior was observed in the normal group; compared with the normal group, the serum PGF2α and E2 levels in the model group were increased (P<0.01), while the P level was decreased (P<0.01), and the mRNA expression levels of the uterine PGF2α and E2 receptors were increased (P<0.01, P<0.05). Compared with the model group, the writhing behavior latency was prolonged, and the writhing response score was decreased in the ginger-partitioned moxibustion group and the Western medicine group (P<0.01); the serum PGF2α and E2 levels in the ginger-partitioned moxibustion group and the Western medicine group were decreased, while the P level was increased (P<0.05 or P<0.01); the mRNA expression levels of the uterine PGF2α and E2 receptors in the ginger-partitioned moxibustion group and the Western medicine group were decreased (P<0.05). Compared with the Western medicine group, the ginger-partitioned moxibustion group showed a prolonged writhing behavior latency, reduced writhing response score (P<0.05), and decreased serum E2 level (P<0.05), while no statistical differences in the serum PGF2α and P levels, or the mRNA expression levels of uterine PGF2α and E2 receptors (P>0.05).Conclusion: The analgesic effect of ginger-partitioned moxibustion on PD due to cold-dampness stagnation may be related to regulating the mRNA expression levels of PGF2α and E2 receptors in the uterine tissues.

A case of mitochondrial membrane protein-associated neurodegeneration caused by C19orf12 p.Gly58Ser mutation / 中华神经科杂志

Neurodegeneration with brain iron accumulation (NBIA) is a group of rare genetic diseases of nervous system. NBIA is characterized by varying degrees of abnormal iron metabolism and excessive iron deposition in brain tissue. The most common symptoms of NBIA are extrapyramidal symptoms. NBIA can also be associated with varying degrees of dysfunction of the pyramidal tract, cerebellum, peripheral nervous system, autonomic nervous system, mental cognition and vision functions. A patient with NBIA admitted to the Department of Neurology of Xijing Hospital in December 2020 was collected and analyzed for clinical features. Whole exome sequencing (WES) was employed to gene mutation screening, and pathogenicity analysis was performed according to the American College of Medical Genetics and Genomics (ACMG) guideline. The patient was a 13-year-old male with a chronic course of disease that began at the age of 4. The first symptom was spastic gait. With the progress of the disease, the patient developed mental retardation, arrhythmia, coughing from drinking water and loss of vision. Magnetic resonance imaging of the head showed atrophy of the optic nerve and hypointensity signal in bilateral substantia nigra and globus pallidus on T 2WI, fluid attenuated inversion recovery sequency, diffusion weighted imaging and susceptibility weighted imaging without "tiger eye sign" which was commonly found in pantothenate kinase associated neurodegeneration. The homozygous mutation c.172G>A (p.Gly58Ser) was found through WES. The proband′s father and mother are cousins (inbreeding), carried heterozygous variation of this locus. This novel mutation was not reported in mutation database. According to ACMG guideline, C19orf12 gene c.172G>A (p.Gly58Ser) was identified for possible pathogenic mutations. The conservative prediction of this locus suggests high conservatism. The final diagnosis of the patient was mitochondrial membrane protein-associated neurodegeneration (MPAN,NBIA type 4). This finding enriched the known mutation database of MPAN and provided a basis for further study of the disease.

Connotation and Clinical Application of Tong （Dredging） Method in Treatment of Coronary Heart Disease / 中国实验方剂学杂志

Tong （dredging） method in traditional Chinese medicine （TCM） emphasizes soothing the stagnated Qi， blood， and body fluid in zang-fu organs， meridians， and collaterals to remove pathogens， reinforce vital Qi， and balance Yin and Yang of the human body. Tong method can be adopted to disperse sweat pore， attack pathogenic Qi， harmonize Yin and Yang， as well as tonify deficiency， and resolve stagnation. It has been proved effective in treating coronary heart disease （CHD）， which falls into the category of "chest impediment and heart pain" in TCM， with the key pathogenesis lying in blood vessel obstruction. Therefore， dredging blood vessels is the primary therapeutic principle for CHD. Specifically， there are four aspects. The first is dispersing and dredging the sweat pore of the heart. If the sweat pore is occluded by pathogenic cold， which makes Yang-qi undissipated， Cinnamomi Ramulus， Piperis Longi Fructus， Alpiniae Officinarum Rhizoma， and Asari Radix et Rhizoma can be prescribed for warming and dredging heart Yang. If the Yang-qi of the heart and chest stagnated in the body， which hinders Qi and blood to nourish the myocardium， resulting in chest pain， Poria and Alismatis Rhizoma can be prescribed. For CHD due to atherosclerosis and inflammation， heat-clearing， toxin-removing， and inflammation-resisting Chinese medicinal herbs such as Coptidis Rhizoma and Rhei Radix et Rhizoma are recommended. The second is attacking and dredging the collaterals of the heart. Salviae Miltiorrhizae Radix et Rhizoma， Chuanxiong Rhizoma， Notoginseng Radix et Rhizoma， etc. can be prescribed for blood stasis， Trichosanthis Fructus， Allii Macrostemonis Bulbus， Pinelliae Rhizoma， etc. for phlegm， and Aquilariae Lignum Resinatum， Euodiae Fructus， etc. for pathogenic cold. Since the chronic disease can affect collaterals， Moschus and Santali Albi Lignum can be added to promote blood circulation and remove the obstruction of collaterals of the heart. The third is harmonizing and dredging the mind. Cinnamomi Ramulus， Coptidis Rhizoma， Cinnamomi Cortex， etc. are selected for restoring the coordination between the heart and the kidney. According to the specific syndrome， the methods of nourishing the mind and calming the nerves through tranquilizing the mind， calming down the mind， and inducing resuscitation can be selected using such Chinese medicines as Ziziphi Spinosae Semen， Polygalae Radix， and Draconis Ossa. The fourth is tonifying and dredging the Qi and blood of the heart. The deficiency syndrome of CHD is divided into Qi deficiency and kidney deficiency. Invigorating Qi and strengthening the heart are the first essentials for the treatment of CHD. In Qi invigoration， Qi and blood must be strengthened simultaneously to strengthen the heart and clear the pulse. Hence， Bazhentang modified by Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos can be chosen. In kidney Qi tonifying， kidney and heart must be strengthened simultaneously， and the methods of tonifying kidney and activating blood can be used. Ginseng Radix et Rhizoma and Astragali Radix are considered as the first choice for tonifying heart Qi， and Epimedii Folium and Morindae Officinalis Radix for tonifying kidney Qi， which are added with Salviae Miltiorrhizae Radix et Rhizoma and Rehmanniae Radix Praeparata to obtain the kidney-tonifying and blood-activating prescription. It is suitable for treating CHD due to kidney deficiency and blood stasis. Simultaneous treatment of heart and kidney is more suitable for middle-aged and elderly patients and chronically ill patients. Tong method can be used in various clinical diseases as well as CHD.

Correlations between physical activity, sedentary behavior and physical posture disorders in primary school students / 中国学校卫生

Objective@#To explore correlations between physical activity (PA), sedentary behavior (SB) and physical posture disorders in primary school students, and to provide reference for the prevention and correction of adverse body posture in this group.@*Methods@#From September to December 2020, 206 children from 4 primary schools in Chaoyang District of Beijing were selected by multistage stratified cluster random sampling method. Body posture and PA were assessed using a body posture tester and a triaxial accelerometer. Children s Leisure Activity Questionnaire was used to investigate SB.@*Results@#The detection rate of abnormal body posture in primary school students was 76.70%. PA showed positive assocation with high and low shoulder, X/O leg, pelvis forward, spine curvature and comprehensive evaluation ( β =0.17, 0.21, 0.19, 0.24, 0.19, P <0.05). SB had significant negative linear correlation with high and low shoulder, X/O leg,pelvis forward, spine curvature and comprehensive evaluation ( β = -0.24 , -0.22, -0.36, -0.24, -0.27, P <0.05). In the combination analysis, children with high PA plus low SB ( OR=2.12, 95%CI= 1.46-3.37, P <0.05) and children with low PA plus high SB had the highest and lowest advantages of qualified rate of body posture assessment,respectively. Compare with low SB and low PA( OR=1.71, 95%CI=1.41-2.74, P <0.05), high PA and high SB ( OR=1.85, 95%CI=1.38-2.86, P <0.05) had higher qualified rate of body posture assessment.@*Conclusion@#Physical activity shows positive effects on physical posture while sedentary behavior shows negative effects on physical posture. The combination of PA and SB has a counteracting or synergistic interaction effect.

Analysis of high-risk behaviors related to HIV infection in men who have sex with men recruited by different methods / 中华皮肤科杂志

Objective:To analyze high-risk behaviors related to HIV infection in men who have sex with men (MSM) recruited by different methods in Zhenjiang city, and to provide a reference for precise prevention and control of acquired immunodeficiency syndrome (AIDS) .Methods:From April to June in 2020, MSM in Zhenjiang city were recruited as research subjects through the center for disease control and prevention (CDC) voluntary counseling and testing (VCT) clinic and community-based organizations (CBOs) . Information such as demographic characteristics, drug abuse, HIV testing history and high-risk sexual behavior were collected through a unified questionnaire survey. Chi-square test or Fisher′s exact test was used to analyze differences in relevant characteristics of MSM recruited by different methods.Results:A total of 641 MSM were recruited by the two methods, including 442 (68.95%) recruited from CBOs and 199 (31.05%) from CDC; the proportion of MSM aged under 20 years was significantly higher in the CBO group (6.56%) than in the CDC group (1.01%, χ2 = 9.20, P = 0.002) ; the proportions of MSM receiving health education information on potential hazards of drug use from professional health institutions and new network media were significantly higher in the CDC group (7.54% [15/199], 16.58% [33/199], respectively) than in the CBO group (3.39% [15/442], χ2 = 5.28, P = 0.022; 9.50% [42/442], χ2 = 6.66, P = 0.010) . In terms of characteristics of sexual behavior, the CBO group showed significantly increased proportions of individuals having group sex (25.21%, 30 cases) and those having unprotected sexual intercourse with women (47.51%, 210 cases) compared with the CDC group (7.50% [6 cases], χ2 = 10.13, P = 0.001; 27.64% [55 cases], χ2 = 22.35, P < 0.001, respectively) , but significantly decreased proportions of heterosexuals (2.04%, 9 cases) , individuals unknowing about the HIV status of sexual partners (22.40%, 99 cases) and those having unprotected anal sex with men (39.82%, 176 cases) compared with the CDC group (6.53% [13 cases], χ2 = 8.37, P = 0.004; 39.70% [79 cases], χ2 = 20.48, P < 0.001; 57.29% [114 cases], χ2 = 16.90, P < 0.001, respectively) . Compared with the CDC group, the CBO group showed significantly decreased proportions of individuals ever having an HIV test (74.43% [329 cases] vs. 80.90% [161 cases], χ2 = 3.19, P = 0.074) and those getting the latest HIV test from CDC (23.10% [76 cases] vs. 57.14% [92 cases], χ2 = 99.41, P < 0.001) , as well as decreased prevalence of HIV infection (5.20% [23 cases] vs. 13.07% [26 cases], χ2 = 21.85, P < 0.001) . Conclusions:The MSM recruited from CBO and CDC are complementary in terms of demographics and behaviors, and can represent the general MSM population. Specific prevention and control measures for AIDS should be taken according to different characteristics of the MSM population.

Efficacy and safety of rituximab alone or combined with glucocorticoid in the treatment of Graves′ ophthalmopathy / 中华内分泌代谢杂志

Objective:To compare the efficacy and safety of glucocorticoids (GCs), rituximab (RTX), and GCs combined with RTX in the treatment of active moderate-to-severe Graves′ ophthalmopathy (GO).Methods:A total of 42 patients with GO who were hospitalized in the Endocrinology Department of Jiangsu Integrated Traditional Chinese and Western Medicine Hospital from August 2017 to July 2019 were included and divided into GCs group (18 cases), RTX group (7 cases), GCs combined with RTX group (17 cases). Patients in the GCs group were received 500 mg intravenous methylprednisolone once a week for 6 weeks, followed by 250 mg intravenous methylprednisolone once a week for 6 weeks. In RTX group, patients were given intravenous RTX 100 mg every 2 weeks for 2 times. GCs combined with RTX group, i. e. RTX combined with methylprednisolone pulse therapy. At 12 and 24 weeks after treatment, CAS and NOSPECS classes were evaluated in each group. The altered course of thyroid stimulating receptor antibody were compared among the three groups. All adverse events were recorded.Results:The proportion of CAS decreased≥2 or total scores<3 points in the GCs, RTX and combined groups were 88.9%, 85.7% and 100%, with no statistical difference among the three groups ( P=0.321). At 24 weeks, CAS and NOSPECS classes decreased significantly in all three groups compared with those before treatment ( P<0.05). The reduction of CAS in the combined group was greater than in the GCs group (-3.12±1.02 vs -2.39±1.02, P=0.036) and RTX group (-3.12±1.02 vs -2.14±0.90, P=0.034). One patient in the combined group developed optic neuropathy at 24 weeks after treatment, all other patients had no severe adverse events. Conclusion:Low-dose RTX alone is not inferior to intravenous GCs in the treatment of active moderate to severe GO. GCs combined with RTX is more effective in improving patients′ CAS than either drugs alone.

Identification of a novel bombesin bioactive peptide QUB2995 and its insulin secreting activity / 中华内分泌代谢杂志

Objective:To identify a novel bombesin bioactive peptide from the skin secretion of Hylarana Latouchii, and to explore its effect on insulin secretion in islet cells.Methods:The skin secretion from Hylarana Latouchii was extracted by electrical stimulation, and the single chain of bombesin peptide was cloned and sequenced. The peptide QUB2995 was synthesized via solid-phase synthesis, then purified using reversed-phase high performance liquid chromatography (HPLC). Matrix assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF) was applied to validate. QPCR and ELISA were used to probe the effect of QUB2995 on insulin secretion in MIN6 and INS-1 cells.Results:A novel bombesin peptide named QUB2995 (GAFGDFLKGAAKA GALKILSIAQCKLSGTC) was found in the skin secretion of Hylarana Latouchii through molecular cloning. The bioactive peptide could significantly promote the proliferation and insulin secretion from mouse islet MIN6 cells and rat islet INS-1 cells. The effect reached a climax at the concentration of 10 -5 mol/L. Conclusion:A novel bombesin bioactive peptide named QUB2995 was found from Hylarana Latouchii. It could significantly promote insulin secretion in MIN6 cells of mouse islets and INS-1 cells of rat islets, indicating its potential in the treatment of diabetes.

Construction and evaluation of recurrence risk model of Graves′ disease treated with antithyroid drugs / 中华内分泌代谢杂志

Objective:To establish and evaluate a predictive model for recurrence risk of Graves′ disease after antithyroid drugs(ATD) withdrawal.Methods:Among 308 patients with newly onset Graves′ disease taking ATD from 2012 to 2019, 170 patients who completed follow-up were enrolled and divided into relapse and remission groups according to whether hyperthyroidism reoccurred within 2 years after ATD withdrawal to establish the discovery cohort. An internal validation cohort was constructed by repeating the sampling with bootstrap. Cox regression analysis was used to screen risk factors and establish a predictive model, named Graves′ Recurrence Evaluation System(GRES). The differentiation and accuracy of GRES model were evaluated and compared with the GREAT score.Results:Of 170 patients, 90 Graves′ disease cases relapsed within 2 years after ATD withdrawal. According to Cox regression analysis, family history of Graves′ disease, younger age(<30 years), grade Ⅱ-Ⅲ goiter, high level of TRAb(≥13 IU/L), large thyroid volume(≥26.4 cm 3) and low 25(OH) D(<14.7 ng/mL) were included in the predictive model: PI=0.672×family history+ 0.405×age+ 0.491×severity of goiter+ 0.808×TRAb+ 1.423×thyroid volume+ 0.579×25(OH) D. PI≥1.449 was associated with a higher risk of recurrence after drug withdrawal. The GRES model has good prediction in assessing Graves′ disease relapse within 2 years after ATD withdrawal and better than GREAT score. Conclusion:GRES model can be used to evaluate the recurrence risk within 2 years for patients with newly onset Graves′ disease after ATD withdrawal, and facilitate clinicians to reasonably select treatment modalities in order to improve the remission rate.

Late-onset hypogonadism in males: Guidelines and controversies / 中华内分泌代谢杂志

Late-onset hypogonadism (LOH) is an age-related testosterone deficiency syndrome. With the increasing aging of society, LOH results in impaired quality of life of middle-aged and elderly men. Although domestic and international guidelines have been issued in recent years, and the management of LOH became more standardized, numerous controversies still remained in the diagnosis of LOH, the benefits of testosterone replacement therapy (TRT) and therapeutic targets. Based on comparison of different guidelines, this review focuses on age cut-off , specific signs and symptoms of LOH, diagnostic cut-off level of testosterone, the advantages and disadvantages of TRT treatment, and non-testosterone therapy.

Difficulties and prospects in the treatment of Graves′ disease / 中华内分泌代谢杂志

Although traditional treatment for Graves′ disease(GD) displays some effects, it is imperative to explore new treatment methods. Based on the pathogenesis of GD, biologic agents developed by consumption of B lymphocytes and acting on thyroid stimulating hormone receptor(TSHR), such as monoclonal antibodies, TSHR antagonists and epitopes, can provide more options for patients with GD, and some new drugs are expected to be put into clinical practice. By restoring the damaged immune system and maintaining normal thyroid function continuously, it can avoid the disadvantages of conventional therapies such as long-term treatment, induction or aggravation of Graves ophthalmopathy, permanent hypothyroidism, and other complications. Preliminary experience suggests that thermotherapy is effective and safe for patients with refractory GD. In addition, the traditional Chinese medicine improves the symptoms and thyroid function of GD patients.The emergence of new therapeutic modalities and techniques will provide new approaches for the future treatment of GD and help clinicians to make the best decision.

Ketogenic diet improves pancreatic β-cell dedifferentiation in db/db mice / 中华内分泌代谢杂志

Objective:To evaluate the effects of ketogenic diet(KD) on pancreatic β-cell dedifferentiation in db/db mice.Methods:In animal study, 8-week-old db/db male mice with type 2 diabetes mellitus(T2DM) were randomly divided into 3 groups: T2DM model group(ND), KD group, 75% caloric restriction(CR) group, and male C57BL/6 mice of the same age as normal control group(C) fed with standard diet. Both C and ND groups were on ad lititum feeding of chow, the KD group was free to eat the ketogenic diet, and the CR group was the positive control group, consuming 75% of the calories of the ND group every day. Four weeks after different diet intervention, body weight, fasting blood glucose, fasting insulin, glucose tolerance and blood β-hydroxybutyric acid(BHB) were measured. Morphology and structure of pancreatic islet was observed by hematoxylin-eosin staining(HE). Immunofluorescence co-staining was used to observe the expression of mouse pancreatic β-cell specific transcription factors.Results:After 4 weeks diet intervention, the fasting blood glucose, insulin and the area under the curve of blood glucose in KD group was significantly decreased( P<0.05); When compared with ND group, the morphology and structure of the islets in the KD group were more regular, and the number of islet cells increased as revealed with HE staining. Pancreatic immunofluorescence co-assay showed that KD not only restored the number and arrangement of β-cells and the ratio of β/α-cell in the pancreatic islets, but also reversed the expression of specific β-cell transcription factors such as pancreatic duodenal homeobox factor-1(PDX1). Conclusion:KD can reduce fasting blood glucose, fasting insulin and improve glucose tolerance in db/db mice, which may be related to its ability to restore the expression of specific β-cell transcription factors and reverse the dedifferentiation of pancreatic β-cells.

Effects of short-term very low-calorie restriction on gut microbiota in overweight/obese patients with type 2 diabetes / 中华内分泌代谢杂志

Objective:To evaluate the effect of short-term very low-calorie restriction(VLCR) on glycemic control in overweight/obese patients with type 2 diabetes, and to explore mechanisms through identifying markers of gut microbiota.Methods:This trial was conducted in 14 adult overweight/obese patients with type 2 diabetes. They received VLCR for 9 days in the hospital(calorie intake 300-600 kcal/d). Before and after VLCR, body weight(BW), waist circumference(WC), blood pressure(BP), and heart rate(HR) were measured, and body mass index(BMI) was calculated according to their height and weight. Fasting blood glucose(FBG), 2 h postprandial blood glucose(2hPBG), fasting insulin(FINS), triglycerides(TG), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), and low-density lipoprotein-cholesterol(LDL-C) were determined, and yielded the homeostasis model assessment for insulin resistance(HOMA-IR). Additional lab tests such as liver and kidney function and electrolytes were performed. The estimated glomerular filtration rate(eGFR) was calculated to evaluate renal function. All data were analyzed using the SPSS Sample Power software. Feces samples were collected before and after VLCR. Fecal samples were tested for microbial diversity using 16S rDNA technology. Professional software was used to analyze the differences of gut microbiota in feces before and after VLCR.Results:After 9 days of VLCR, BW, BMI, WC, BP, HR, FBG, 2hPBG, FINS, HOMA-IR, alkaline phosphatase, TG, and blood urea nitrogen of 14 overweight/obese patients with type 2 diabetes were significantly reduced( P<0.05). No effect was seen on serum alanine aminotransferase, aspartate amino transferase, gamma glutamyl transferase, TC, HDL-C, LDL-C, creatinine, eGFR, uric acid, albumin, calcium, and phosphorus( P>0.05). The gut microbiota diversity did not differ before and after VLCR. The abundance of Bacteroidetes increased significantly, and the Firmicutes/Bacteroidetes ratio decreased from 11.79 to 4.20. Between groups analysis showed the abundance of Parabacteroides distasonis increased significantly after VLCR. Conclusion:VLCR can improve body weight and glucose and lipid metabolism in overweight/obese patients with type 2 diabetes, with no serious adverse events. Parabacteroides distasonis may be a marker of VLCR.

Correlation between serum osteopontin and osteopontin and type 2 diabetes mellitus with coronary heart disease / 中国综合临床

Objective:To study the relationship between serum osteopontin and osteopontin and type 2 diabetes mellitus (T2DM) complicated with coronary heart disease, and to evaluate the correlation between the levels of serum osteopontin and osteopontin with the severity of coronary artery lesions in T2DM patients.Methods:A total of 100 T2DM patients who were suspected to have stable coronary heart disease and underwent coronary angiography from November 2019 to December 2020 were selected from the Affiliated Hospital of Chengde Medical College, according to coronary angiography results, 60 patients with confirmed coronary heart disease were classified as the case group and 40 patients with non-coronary heart disease were classified as the control group for retrospective analysis. The clinical data and biochemical indicators of all patients were recorded, and Gensini score was calculated. The concentration of osteopontin and osteopontin in serum was quantitatively determined by double-antibody enzyme linked immunosorbent assay method. Independent sample t-test was used to compare the mean of normal distribution measurement data between the two groups. The non normal distribution data are represented by M ( Q1, Q3), and Mann Whitney U test is used for comparison between groups. Composition comparison between count data groups χ 2 inspection. Spearman correlation analysis was used to analyze the correlation between serum osteopontin and osteopontin and Gensini score in patients with T2DM. Results:Univariate analysis showed that serum osteopontin and osteopontin were (13.076(8.433, 23.552) μg/L) and (0.437(0.300, 0.630) μg/L) significantly higher in the case group than in the control group (6.367(4.605, 9.048) μg/L) and (0.299(0.196, 0.399) μg/L) respectively, with statistically significant differences ( Z=5.12, 3.28, all P<0.001). Multi-factor logistic regression analysis showed that osteoprotegerin ( OR=2.887, 95% CI:1.850-8.515, P=0.024) and osteopontin ( OR=13.109, 95%CI: 2.557-67.204, P=0.002) were associated with T2DM combined with coronary heart disease, and the risk of T2DM combined with coronary heart disease increased with higher levels of osteoprotegerin and osteopontin. Spearman correlation analysis showed that serum osteopontin and osteoprotegerin were positively correlated with Gensini score in T2DM patients ( r=0.591, 0.467; all P<0.05). Conclusion:Serum osteopontin and osteoprotegerin are associated with T2DM combined with coronary heart disease, and high serum osteopontin and osteoprotegerin are risk factors for T2DM combined with coronary heart disease; serum osteopontin and osteoprotegerin are positively correlated with the degree of coronary artery disease in T2DM patients.

Nursing of a case of goal-directed pulmonary rehabilitation after spinal cord surgery for type Ⅱ spinal muscular atrophy / 中国实用护理杂志

Objective:To summarize the nursing care measures of a patient after spinal orthopedic surgery for spinal muscular atrophy type Ⅱ.Methods:The patient was provided with a goal-directed pulmonary rehabilitation nursing program during ICU resuscitation by exercise pulmonary function, monitor difficult airway extubation and alleviating anxiety.Results:The patient postoperative pulmonary function recovered well, the difficult airway was extubated smoothly and the anxiety was relieved. The patient was discharged from the hospital on the 17th day after the operation.Conclusions:Goal-directed pulmonary care can help promote pulmonary rehabilitation and improve the quality of patient survival after orthopedic surgery for spinal muscular atrophy typeⅡ.

Analysis of three patients with KBG syndrome and epileptic seizures due to variants of ANKRD11 gene / 中华医学遗传学杂志

OBJECTIVE@#To summarize the clinical phenotype and genotypic characteristics of 3 patients with KBG syndrome and epileptic seizure.@*METHODS@#Clinical data of the patients were collected. Family-trio whole exon sequencing (WES) was carried out. Candidate variants were verified by Sanger sequencing.@*RESULTS@#Patients 1 and 2 were boys, and patient 3 was an adult woman. All patients had epileptic seizures and mental deficiency. Their facial features included triangular face, low hair line, hypertelorism, large forward leaning auricles, broad nasal bridge, upturned nostrils, long philtrum, arched upper lip, and macrodontia. The two boys also had bilateral Simian creases. WES revealed that the three patients all harbored heterozygous de novo frameshift variants in exon 9 of the ANKRD11 gene including c.2948delG (p.Ser983Metfs*335), c.5397_c.5398insC (p.Glu1800Argfs*150) and c.1180_c.1184delAATAA (p.Asn394Hisfs*42). So far 291 patients with ANKRD11 gene variants or 16q24.3 microdeletions were reported, with over 75% being de novo mutations.@*CONCLUSION@#Above findings have enriched the spectrum of ANKRD11 gene mutations underlying KBG syndrome. WES is helpful for the early diagnosis of KBG, and provided reference for genetic counseling of this disease.

Effects of whole body vibration combined with extracorporeal shock wave therapy on spasticity and balance gait parameters in hemiplegic patients with stroke / 中南大学学报(医学版)

OBJECTIVES@#Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.@*METHODS@#From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.@*RESULTS@#After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001).@*CONCLUSIONS@#WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.

Research advances of small molecule inhibitors in the treatment of mixed lineage leukemia / 药学学报

Acute leukemia (AL) is a kind of malignant clonal disease of hematopoietic stem cells. Rearrangement of mixed lineage leukemia (MLL) gene can be observed in about 5%-10% of AL patients. Currently, AL patients with MLL-rearrangements (MLL-r) lack effective treatment and are usually associated with poor prognoses. Recent studies have shown that many epigenetic regulators are directly or indirectly involved in the occurrence and development of AL carrying MLL-r (MLL), which provides a biological basis for the use of epigenetic regulation strategies to treat MLL. In this review, we start from the epigenetic regulation mechanism of MLL, and select representative drug targets to briefly analyze the relationship between each target and MLL and summarize the development progress of their inhibitors, hoping to provide reference for the subsequent research and development of drugs for the treatment of MLL.