Clinical effect observation of Yangxue-Qingnao granule combined with ligustrazine injection in the treatment of wind-phlegm entering collaterals type of cerebral infarction / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of Yangxue-Qingnao granule combined with ligustrazine injection in the treatment of wind-phlegm entering collaterals syndrome of cerebral infarction. Methods:A total of 96 patients with cerebral infarction and wind-phlegm entering collaterals syndrome to Suixi County Hospital of Traditional Chinese Medicine from January 2019 to December 2019 were selected and randomly divided into two groups by random number table method, with 48 in each group. The control group was given intravenous ligustrazine injection, and the observation group was given Yangxue-Qingnao granule on the basis of the treatment of the control group. Both groups were treated continuously for 2 weeks. TCM syndrome scores were performed before and after treatment, the National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of neurological impairment, and the Activity of Daily Living Scale (ADL) was evaluated. To evaluate the patient's quality of life, to detect the high-shear viscosity, low-shear viscosity and plasma viscosity of whole blood with an automatic hemorheology instrument. Results:The total effective rate of the observation group was 95.8% (46/48) and that of the control group was 70.8% (34/48). The difference between the two groups was statistically significant ( χ2=9.08, P<0.01). After treatment, the TCM syndrome score of the observation group was significantly lower than that of the control group ( t=3.51, P<0.01), the NIHSS score was significantly lower than that of the control group ( t=34.41, P<0.001), and the ADL score was significantly higher than that of the control group ( t=57.88, P<0.01). After treatment, the observation group's whole blood high shear viscosity [(5.04 ± 0.93)mPa?s vs. (5.64 ± 1.13)mPa?s, t=2.84], whole blood low shear viscosity [(11.32 ± 1.74)mPa?s vs. (13.39 ± 2.23)mPa?s, t=5.07] and plasma viscosity [(1.51 ± 0.33)mPa?s vs. (1.73 ± 0.47)mPa?s, t=2.65] of the observation group were significantly lower than those in the control group ( P<0.05 or P<0.01). Conclusion:Yangxue-Qingnao granule combined with ligustrazine injection can improve the neurological status and quality of life of patients with cerebral infarction syndrome of wind-phlegm entering the collaterals, and improve the clinical efficacy.

Intraoperative IPC combined with 3M warming instrument to prevent lower extremity deep venous thrombosis in patients undergoing proximal femoral anti rotation intramedullary nailing / 中国骨伤

OBJECTIVE@#To explore the effect of intermittent pneumatic compression(IPC) combined with 3M thermometer on the prevention of deep venous thrombosis(DVT) in patients with femoral intertrochanteric fracture.@*METHODS@#From March 2016 to August 2019, 127 patients with femoral intertrochanteric fractures who underwent proximal femoral nail antirotation(PFNA) were retrospectively analyzed. They were divided into two groups according to different methods of thrombus prevention and treatment. Among them, 63 patients in group A did not use IPC and 3M thermometer;64 cases in group B were treated with IPC combined with 3M thermometer. Color Doppler ultrasound was used to dynamically monitor the DVT and changes of lower limbs during perioperative period. The venous thrombosis of lower limbs was monitored at 0, 24, 72 h and > 72 h after operation(recheck every 3 days until discharge).@*RESULTS@#Occurrence of DVT of lower limbs after PFNA operation in two groups:there were 5 cases (7.8%) in group B and 20 cases (31.7%) in group A, there was significant difference between two groups (P=0.001). There was no significant difference in lower limb DVT between two groups at 0, 72 and > 72 h after operation(P>0.05), but the formation rate of group A was significantly higher than that of group B at 24 h after operation (P=0.049). There was no significant difference in DVT formation between group A and group B(P>0.05). However, the formation of DVT in group A was significantly higher than that in group B(P=0.012).@*CONCLUSION@#Intraoperative IPC combined with 3M thermostat can effectively prevent DVT of lower limbs in patients undergoing PFNA surgery.

Regulation of Naoxin'an Capsule on Glial Cell Activation and Inflammatory Response in Rats with Chronic Cerebral Hypoperfusion-induced Vascular Cognitive Impairment / 中国实验方剂学杂志

Objective:To investigate the protective effect of Naoxin'an capsule （NC） against glial cell activation and inflammatory damage in brain of rats with chronic cerebral hypoperfusion-induced vascular cognitive impairment （VCI）. Method:One hundred and fifty rats were randomly divided into a sham operation group （<italic>n</italic>=20） and a modeling group （<italic>n</italic>=130）. Following the modeling with the two vessels occlusion （2-VO） technique， 87 successfully modeled rats were randomly divided into the model group， positive drug group （aricept， 0.5 mg·kg^-1）， and low-， medium-， and high-dose （0.18， 0.36， 0.72 g·kg^-1） NC groups， with 17-18 rats in each group. After intragastric administration of NC for eight weeks， the Morris water maze test and passive avoidance test were conducted to detect the effects of NC on learning and memory ability of VCI rats. Changes in neuronal structure of rat hippocampal CA1 area were observed by hematoxylin-eosin （HE） staining， and the neuronal apoptosis in hippocampus by terminal deoxynucleotidyl transferase （TdT）-mediated dUTP nick end labeling （TUNEL） staining. Western blot assay was used to detect the expression levels of glial fibrillary acidic protein （GFAP）， ionized calcium-binding adapter molecule 1 （Iba-1）， phosphorylated p38 mitogen-activated protein kinase （p38 MAPK）， and phosphorylated nuclear factor <italic>κ</italic>B （NF-<italic>κ</italic>B）， followed by the measurement of interleukin-1<italic>β</italic> （IL-1<italic>β</italic>） and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） in the brain by enzyme-linked immunosorbent assay （ELISA）. Result:Compared with the sham operation group， the model group displayed obviously decreased spatial learning and memory ability and memory retention ability （<italic>P</italic><0.05， <italic>P</italic><0.01）， neuronal damage in hippocampal CA1 area， enhanced neuronal apoptosis （<italic>P</italic><0.01）， up-regulated GFAP and Iba-1 （<italic>P</italic><0.01）， elevated phosphorylation of p38 MAPK and NF-<italic>κ</italic>B （<italic>P</italic><0.01）， and increased IL-1<italic>β</italic> and TNF-<italic>α</italic> （<italic>P</italic><0.01）. Compared with the model group， NC at each dose significantly improved the spatial learning and memory ability and memory retention ability of VCI rats （<italic>P</italic><0.05， <italic>P</italic><0.01）， ameliorated the neuronal damage in hippocampus CA1 area， reduced the apoptosis rate of nerve cells （<italic>P</italic><0.05， <italic>P</italic><0.01）， down-regulated the expression of GFAP and Iba-1 （<italic>P</italic><0.01）， decreased the phosphorylation levels of p38 MAPK and NF-<italic>κ</italic>B （<italic>P</italic><0.05， <italic>P</italic><0.01）， and lowered TNF-<italic>α</italic> and IL-1<italic>β</italic> levels （<italic>P</italic><0.01）. Conclusion:NC alleviates the inflammatory damage of the central nervous system caused by activated p38 MAPK and NF-<italic>κ</italic>B and improves chronic cerebral hypoperfusion-induced VCI in rats by inhibiting the activation of microglia and astrocytes.

Baseline left ventricular ejection fraction associated with symptom improvements in both children and adolescents with postural tachycardia syndrome under metoprolol therapy / 中华医学杂志(英文版)

BACKGROUND@#Postural tachycardia syndrome (POTS) is a common childhood disease that seriously affects the patient's physical and mental health. This study aimed to investigate whether pre-treatment baseline left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) values were associated with symptom improvement after metoprolol therapy for children and adolescents with POTS.@*METHODS@#This retrospective study evaluated 51 children and adolescents with POTS who received metoprolol therapy at the Peking University First Hospital between November 2010 and July 2019. All patients had completed a standing test or basic head-up tilt test and cardiac echocardiography before treatment. Treatment response was evaluated 3 months after starting metoprolol therapy. The pre-treatment baseline LVEF and LVFS values were evaluated for correlations with decreases in the symptom score after treatment (ΔSS). Multivariable analysis was performed using factors with a P value of  0.050). However, responders had significantly higher baseline LVEF (71.09% ± 4.44% vs. 67.17% ± 4.88%, t = -2.789, P = 0.008) and LVFS values (40.00 [38.00, 42.00]% vs. 36.79% ± 4.11%, Z = -2.542, P = 0.010) than the non-responders. The baseline LVEF and LVFS were positively correlated with ΔSS (r = 0.378, P = 0.006; r = 0.363, P = 0.009), respectively. Logistic regression analysis revealed that LVEF was independently associated with the response to metoprolol therapy in children and adolescents with POTS (odds ratio: 1.201, 95% confidence interval: 1.039-1.387, P = 0.013).@*CONCLUSIONS@#Pre-treatment baseline LVEF was associated with symptom improvement after metoprolol treatment for children and adolescents with POTS.

Pollution， human exposure and harmful effects of neonicotinoid pesticides / 上海预防医学

Neonicotinoid is a kind of neuroactive pesticide， and it has become the most widely used pesticide in the world. In recent years， neonicotinoid has been detected in the environment and food， suggesting that human can be exposed to this kind of pesticide through drinking water， ingestion and respiration， which poses potential health hazards to human. However， there is no comprehensive report on the pollution level of neonicotinoid pesticides in the environment and food and the impact on human health. In this paper， the pollution status， population exposure level and potential health risks of neonicotinoid pesticides in water， air and food were reviewed. We found that neonicotinoid residues are widespread in fruits and vegetables， of which imidacloprid has the highest detection rate. Except for a few samples with excessive neonicotinoid detection， the detection level in most samples did not exceed national food safety standards. A variety of neonicotinoid pesticides have been detected in the air， surface water， tap water and drinking water. External exposure studies in the population have shown that ingestion is the main route of exposure to neonicotinoid， and the external exposure level is much lower than its chronic reference dose. The internal exposure study mainly detected the concentration of neonicotinoid pesticides and their metabolites in urine. A variety of neonicotinoid pesticides and their metabolites are detected in urine， and the concentration range is ng/ml level. Internal exposure studies found that the detection rate of thiamethoxam and dinotefuran in urine is higher， and the detection rate of neonicotinoid in Asian countries is higher than that in European and American countries. Occupational exposure studies found that neonicotinoid exposure levels increased after pesticide spraying， and the exposure levels in rural areas where pesticides were commonly used were higher than those in neighboring urban areas. Animal experiments have found that neonicotinoid pesticides have reproductive toxicity， genetic toxicity， neurotoxicity， immunotoxicity， liver toxicity and nephrotoxicity to non-target organisms. Cell experiments suggest that neonicotinoid is an endocrine disruptor. The symptoms of acute exposure in humans are related to the exposure dose， route and physical condition of the exposed person， which ranges from mild symptoms （nausea， vomiting， headache and diarrhea） to death. Population epidemiological studies have shown that chronic exposure to neonicotinoid pesticides is associated with adverse health effects in humans such as neonatal tetralogy of Fallot， anencephaly， and adverse mental symptoms.

Effect of early acupuncture on cognitive function in patients with vascular dementia after cerebral infarction / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of early acupuncture for vascular dementia (VD) after cerebral infarction, and explore its possible mechanism.@*METHODS@#A total of 120 patients with VD after cerebral infarction were randomized into an acupuncture combined with medication group (60 cases, 1 case dropped off) and a western medication group (60 cases, 1 case dropped off). In the western medication group, oxiracetam capsules were given orally, 2 capsules each time, 3 times a day. On the basis of the treatment as the western medication group, @*RESULTS@#The total effective rate was 89.8% (53/59) in the acupuncture combined with medication group, which was superior to 76.3% (45/59) in the western medication group (@*CONCLUSION@#Early acupuncture could improve cognitive function and activities of daily living in patients with VD after cerebral infarction, its mechanism may be related to improving the blood flow velocity of MCA, promoting blood circulation, and improving cerebral perfusion.

Multi-disciplinary management for metastatic renal cell carcinoma in the ear of targeted therapy: a single center experience / 中华泌尿外科杂志

Objective@#To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.@*Methods@#Data of 168 mRCC patients treated by multi-disciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified, including 76 patients with 55 males and 21 females, received anti-angiogenic agents alone (Group A), 66 patients with 55 males and 11 males, received anti-angiogenic agents plus local therapy (Group B)and 26 patients, with 19 males and 7 females, received anti-angiogenic agents plus immunotherapy and local therapy (Group C). The Sunitinib, Sorafenib, Axitinib were chosen for the TKI. The Pembrolizumab was used for immunotherapy. The stereotactic body radiation therapy and surgical excision were considered as the local therapy. The study aims to compare the age, gender, IMDC score, pathology, nbephrectomy, adverse events, progression-free survival and overall survival (OS).@*Results@#Of all patients, the median follow-up duration was 23 months (ranging 6-117 cmonths). The PFS was 18.3 months and median OS was 33.5 months. The 2 years and 5 years survival rate was 66% and 35%, respectively. The median OS of Group A, B and C were 29.8 months, 44.6 months and not reached. 2y-OS was 58%, 67% and 89%, while 5y-OS 12%, 46% and 57%.There was no difference in age, gender, IMDC score, pathology, synchronous metastases or nephterectomy between the three groups. The prognostic result in TKI based combination therapy was superior to TKI therapy alone, which the 5y-OS was 51% and 11%, respectively. The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B. The median OS in TKI+ DC and CIK+ Pembrolizumab was 49.1 months and 53.1 months. On univariate analyses, IMDC score, nephrectomy and treatment group was associated with OS (P<0.05). On multivariate analyses, treatment group, nephrectomy was associated with OS (P<0.05). The risk of death of Group C decreased about 60% [HR 0.39 (0.17, 0.89), P=0.026]. 78 (46.4%) patients on TKI alone and 16 (61.5%) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events. 16 (20.3%) patients had Clavien Ⅲ-Ⅳ toxicity after surgical procedures. 6 (5.7%) patients had Grade 3 toxiciy after SBRT.@*Conclusions@#Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone. MDT approach could bring survival benefit to mRCC patients.

Clinical analysis of TKIs combined with SBRT in the treatment of renal cell carcinoma with bone metastasis / 中华泌尿外科杂志

Objective:To evaluate the efficacy and safety of Tyrosine Kinase Inhibitors (TKIs) combined with stereotactic body radiation therapy(SBRT) in the treatment of renal cell carcinoma (RCC) patients with bone metastasis.Methods:The clinical data of 80 RCC patients with bone metastasis in Sun Yat-sen University Cancer Center from April 2010 to April 2020 were analyzed retrospectively. Among them, 64 patients were medium or high risk according to the International Metastatic Renal Cell Carcinoma Database Consortium(IMDC) score. Twenty-four patients received TKI therapy alone(Group A), and the other 56 cases received TKIs combined with SBRT to bone metastastic lesions (Group B).Results:The median follow-up period was 20.7 months (4.8-115.6 months), 70 patients received second or third-line targeted drug therapy, and 4 patients in group A and 15 patients in group B received TKI plus immunotherapy. Fifty-four patients had symptoms of bone pain before radiotherapy, 46 patients were satisfied with the analgesic effect after SBRT treatment. Twelve patients got complete response (CR) after bone lesions, and 32 patients achieved partial response (PR). Forty patients died of disease progression during follow-up. The median OS was: 20.7 months vs not reached(Group A vs. Group B), and the 2-y OS and 5-y OS were 50% vs. 62%, and 19% vs. 56%, respectively ( P=0.006). There were only 2 patients (3.6%) had grade 3 SBRT related adverse events. Conclusions:SBRT combined with TKIs improved the quality of life and prolonged the overall survival of RCC patients with bone metastasis.

Application of holographic image navigation in urological laparoscopic and robotic surgery / 中华泌尿外科杂志

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

Multi-disciplinary management for metastatic renal cell carcinoma in the ear of targeted therapy: a single center experience / 中华泌尿外科杂志

Objective To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.Methods Data of 168 mRCC patients treated by multidisciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified,including 76 patients with 55 males and 21 females,received anti-angiogenic agents alone (Group A),66 patients with 55 males and 11 males,received anti-angiogenic agents plus local therapy (Group B)and 26 patients,with 19 males and 7 females,received anti-angiogenic agents plus immunotherapy and local therapy (Group C).The Sunitinib,Sorafenib,Axitinib were chosen for the TKI.The Pembrolizumab was used for immunotherapy.The stereotactic body radiation therapy and surgical excision were considered as the local therapy.The study aims to compare the age,gender,IMDC score,pathology,nbephrectomy,adverse events,progression-free survival and overall survival (OS).Results Of all patients,the median follow-up duration was 23 months (ranging 6-117 cmonths).The PFS was 18.3 months and median OS was 33.5 months.The 2 years and 5 years survival rate was 66％ and 35％,respectively.The median OS of Group A,B and C were 29.8 months,44.6 months and not reached.2y-OS was 58％,67％ and 89％,while 5y-OS 12％,46％ and 57％.There was no difference in age,gender,IMDC score,pathology,synchronous metastases or nephterectomy between the three groups.The prognostic result in TKI based combination therapy was superior to TKI therapy alone,which the 5y-OS was 51％ and 11％,respectively.The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B.The median OS in TKI + DC and CIK + Pembrolizumab was 49.1 months and 53.1 months.On univariate analyses,IMDC score,nephrectomy and treatment group was associated with OS (P ＜ O.05).On multivariate analyses,treatment group,nephrectomy was associated with OS (P ＜ O.05).The risk of death of Group C decreased about 60％ [HR O.39 (0.17,0.89),P =O.026].78 (46.4％)patients on TKI alone and 16 (61.5％) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events.16 (20.3％) patients had Clavien IⅢ-V toxicity after surgical procedures.6 (5.7％) patients had Grade 3 toxiciy after SBRT.Conclusions Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone.MDT approach could bring survival benefit to mRCC patients.

Preliminary clinical observation of efficacy and safety of stereotactic body radiation therapy in combination with targeted therapy for metastatic renal cell carcinoma / 中华放射肿瘤学杂志

Objective:To evaluate the preliminary clinical efficacy and safety of stereotactic body radiation therapy (SBRT) in combination with targeted therapy for metastatic renal cell carcinoma (mRCC).Methods:Clinical data of 58 patients with mRCC who were treated with SBRT in combination with targeted therapy in Sun Yat-sen University Cancer Center from June 2013 to December 2018 were retrospectively analyzed. Among them, 79.3% patients were classified as intermediate or high risk according to International Metastatic Renal Cell Carcinoma Database Consortium Criteria. The median biologically equivalent dose (BED) was 147 Gy (67 to 238 Gy).Results:Overall, 32, 13, 7, 5 and 1 patients received SBRT for 1, 2, 3, 4 and 6 metastatic sites (105 lesions) and 71.4% of them were bone lesions. Targeted therapy was continued during SBRT. With a median follow-up of 9.4 months (range 2.7 to 40.1 months), 18 patients died. The 1-year local control rate was 97.4%. The 1-year progression-free survival was 50.3%. The 1-and 2-year overall survival was 72% and 53%. Approximately 85% patients experienced pain relief after SBRT. Patients who achieved complete or partial response after SBRT obtained better overall survival than those with stable disease or disease progression (1-year overall survival: 83% vs. 48%, P=0.021). In the whole cohort, 6 cases developed Grade Ⅲ adverse events, 4 of which were Grade Ⅲ myelosuppression, 1 case of Grade Ⅲ neuropathy and 1 case of radiation-induced skin injury. Conclusion:Preliminary study reveals that combined use of targeted therapy and SBRT is an efficacious and safe treatment of advanced mRCC.

Effect of Chinese reading aloud training on cognitive function in patients with vascular cognitive impairment no dementia / 中华行为医学与脑科学杂志

Objective:To investigate the effect of Chinese reading aloud training (c-RAT) on cognitive function and activities of daily living in patients with vascular cognitive impairment no dementia (VCIND).Methods:From January 2018 to January 2019, totally 80 patients with VCIND in the General Hospital of Xingtai Mining Group were enrolled.Subjects were randomized grouped into c-RAT group ( n=43) and control group ( n=37). The c-RAT group was asked to read aloud the Chinese paper for 5 days a week for 12 weeks.At the time of enrollment and 12 weeks after the intervention, the Montreal cognitive assessment (MoCA), trail making test (TMT), auditory verb learn test (AVLT), digit symbol substitution test (DSST) and modified Barthel index (MBI) were filled out. Results:Compared with control group, the difference of D-value in c-RAT group was statistically significant in MoCA total scores(4.00(2.00), 1.50(0.50), Z=3.012, P=0.003), scores of MoCA-Visual space execution (2.00(1.00), 0.00(2.00), Z=2.787, P=0.008), MoCA-attention (1.00(1.00), 0.00(0.50), Z=2.369, P=0.022), MoCA-language (1.00(1.00), 0.00(0.75), Z=3.049, P=0.000)and MoCA-delayed recall(2.00(2.00), 0.00(1.00), Z=2.043, P=0.014), TMT-A scores (-8.00(23.00), 10.50(30.25), Z=2.120, P=0.039), AVLT scores (1earning)(3.00(2.00), 0.50(0.75), Z=2.266, P=0.039) , AVLT scores (recall)(2.00(1.00), 0.00(1.00), Z=2.974, P=0.003)、AVLT scores (recognition) (2.00(0.00), 0.50(1.50), Z=3.054, P=0.000)and DSST scores ((4.96±0.71), (2.39±0.78), t=2.572, P=0.014), while there were no significant differences in the rest parts of MoCA, TMT-B and MBI( P>0.05). The increased scores in DSST were positively correlated ( r=0.205, P=0.006) with the number of reading aloud tasks finished. Conclusion:C-RAT can improve general cognition, especially in information processing speed, executive function, attention and auditory memory.

Application of dysphagia rehabilitation pathway nursing in patients with dysphagia after stroke / 中国实用护理杂志

Objective:To explore the application effect of dysphagia rehabilitation pathway nursing in patients with dysphagia after stroke.Methods:Eighty patients with dysphagia after stroke who were admitted to the hospital from October 2019 to April 2020 were enrolled as the research objects. They were divided into observation group and control group by random number table method, 40 cases in each group. The control group was given routine nursing intervention, while observation group was given dysphagia rehabilitation pathway nursing on basis of control group. The swallowing function, serum ALBumin (ALB), subcutaneous fat, weight, incidence of aspiration pneumonia and nutrition deficiency were compared between the two groups at admission, after 2 weeks and 4 weeks of intervention.Results:After 2 weeks of intervention, the number of cases with normal swallowing function in observation group was significantly more than that in control group (15, 30 vs 7, 21) ( χ2 value was 4.013, 4.381, P<0.05). After 4 weeks of intervention, number of cases with abnormal swallowing function in observation group was less than that in control group (2 vs 9) ( χ2 value was 5.165, P<0.05). After 4 weeks of intervention, level of plasma ALB and TSF, and weight in the observation group were significantly higher than those in the control group [(39.46±2.84)g/L, (19.28±2.20)mm, (19.28±2.20) kg vs (31.71±2.59)g/L, (17.06±2.35)mm, (62.48±4.29)kg]( t value was 12.752, 4.362, 2.317, P<0.05), while incidence rates of aspiration pneumonia and nutrition deficiency were significantly lower than those in control group [12.50% (5/40), 2.50% (1/40) vs 32.50% (13/40), 32.50% (13/40)] ( χ2 value was 4.588, 12.468, P<0.05). Conclusion:Application of dysphagia rehabilitation pathway nursing in patients with dysphagia after stroke can significantly promote the recovery of swallowing function, improve their nutrition status, and reduce incidence of aspiration pneumonia and nutrition deficiency.

Meta analysis about the influence of physical therapy and respiratory muscle training on rehabilitation of patients with chronic obstructive pulmonary disease / 中国实用护理杂志

Objective:The purpose of this study was to conduct a Meta-analysis to assess the influence of physical therapy and respiratory muscle training on rehabilitation of patients with stable chronic obstructive pulmonary disease. To provide a basis for better rehabilitation exercise for patients, families, communities and hospitals.Methods:According to the literature search strategy, the relative literatures of randomized controlled trials (RCTS) of physical therapy and respiratory muscle training on rehabilitation of patients with chronic obstructive pulmonary disease were searched in Cochrane Library、MEDLINE、Embase、CINAHL、CBM、Wan Fang、CNKI and VIP from January 1990 to October 2017. Languages are limited to Chinese and English.The literatures were screened according to the predefined inclusion and exclusion criteria by two people . Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 were used to assess the quality of articles. The data were analyzed by Revman5.3.Results:A total of 7 articles were finally included, among of these 5 of which were written in English , Others were written in Chinese .They included 7 studies of randomized controlled trial and 267 patients with chronic obstructive pulmonary disease .7 studies show that treadmill exercise and respiratory muscle exercise are the most common rehabilitation methods.7 articles result of Meta-analysis showed that there were statistical differences between physical therapy and respiratory muscle training and other therapies in 6MWD、mMRC and FEV 1%;More research is needed on the impact of other outcome measures. Conclusions:Physical therapy and respiratory muscle training is a reliable way of rehabilitation, it to the stabilization of COPD patients FEV 1 % of expected value, activity ability, the influence of the degree of difficulty in breathing has a positive role.It is not stable for the positive effect of FVC and FEV 1 .However, the effects of other outcome measures were not determined.

miRNA-135b up-regulates the methylation of APC gene in the occurrence and development of type 2 diabetes mellitus / 中华内分泌外科杂志

Objective:To investigate the relationship between the DNA methylation of APC gene and the occurrence and development of diabetic nephropathy (DN) in peripheral blood, and to analyze its effect on gene transcription and protein expression levels.Methods:From Mar. 2018 to Mar. 2020, 96 patients with DN and 100 healthy examinees in Department of Nephrology, Hangzhou First people’s Hospital Affiliated to Zhejiang University were selected as the research objects, and the methylation level, mRNA level and protein expression level of CpG island of APC gene in the two groups were detected.Results:The methylation level of APC-1 island in DN patients was 3.05%±0.65%, which was significantly higher than that in healthy controls 2.34%±0.56% ( t=5.231, P<0.001) ; The methylation level of APC-2 island was 1.65%±0.37%, which was significantly higher than that of the healthy control group 1.17%±0.29% ( t=4.381, P<0.001) ; Pearson correlation analysis showed that the methylation level of APC-1 island was significantly positively correlated with the ration of serum creatinine and uric acid (all P<0.05) , and the methylation level of APC-2 island was significantly positively correlated with uric acid ( P<0.05 ) ; The methylation level of APC-1 island in DN patients was negatively correlated with the relative expression of mRNA ( r=-0.426, P=0.019) and the level of APC protein ( r=-0.569, P=0.004) . The expression of miRNA-135b in rats in the overexpression lentivirus group was significantly higher than that in the no-virus group ( t=5.432, P<0.001) and DN group ( t=5.812, P<0.001) ; The APC methylation level of rats in the miRNA-135b overexpression lentivirus group was also significantly higher than that in DN group ( t=6.217, P<0.001) and the rats in the no-virus group ( t=6.446, P<0.001) . Conclusion:miRNA-135b may participate in the occurrence and development of DN by up-regulating DNA methylation of APC gene and reducing mRNA and protein expression levels.

Mechanisms of resistance to immune checkpoint inhibitors and strategies to reverse drug resistance in lung cancer / 中华医学杂志(英文版)

In recent years, the research of immune checkpoint inhibitors has made a great breakthrough in lung cancer treatment. Currently, a variety of immune checkpoint inhibitors have been applied into clinical practice, including antibodies targeting the programmed cell death-1, programmed cell death-ligand 1, and cytotoxic T-lymphocyte antigen 4, and so on. However, not all patients can benefit from the treatment. Abnormal antigen presentation, functional gene mutation, tumor microenvironment, and other factors can lead to primary or secondary resistance. In this paper, we reviewed the molecular mechanism of immune checkpoint inhibitor resistance and various combination strategies to overcome resistance, in order to expand the beneficial population and enable precision medicine.

Application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients / 中华消化外科杂志

Objective@#To evaluate the application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 52 obese patients who underwent laparoscopic Roux-en-Y gastric bypass in the Third Medical Center of Chinese PLA General Hospital from March 2011 to February 2012 were collected. There were 24 males and 28 females, aged (43±9)years, with the range of 23-62 years. All the 52 patients underwent laparoscopic Roux-en-Y gastric bypass. Observation indicators: (1) surgical and postoperative conditions; (2) changes in anthropometric indices; (3) follow-up. Follow-up using outpatient examination was performed to detect complications of patients at 1, 3, 6, 12 months after surgery up to February 2013. Measurement data with normal distribution were represented as Mean±SD, repeated measurement data were analyzed using repeated ANOVA. Count data were represented as absolute numbers.@*Results@#(1) Surgical and postoperative conditions: all the patients underwent laparoscopic Roux-en-Y gastric bypass successfully, without conversion to open surgery. The volume of intraoperative blood loss, operation time, and duration of hospital stay were (25±11)mL, (78±14)minutes, and (11±2)days. (2) Changes in anthropometric indices: the body mass index (BMI), fat mass, free fat mass, total abdominal fat volume (TAFV), total subcutaneous fat volume (TSFV), and total visceral fat volume (TVFV) of all the 52 patients were (31.8±1.8)kg/m2, (39.4±4.1)kg, (50.2±6.0)kg, (11 703±3 899)cm3, (7 418±2 969)cm3, and (4 314±1 692)cm3 before surgery, (28.5±1.4)kg/m2, (33.0±1.1)kg, (49.7±4.6)kg, (11 016±3 713)cm3, (7 044±2 970)cm3, (3 969±1 443)cm3 at 3 months after surgery, (27.1±1.7)kg/m2, (30.2±1.3)kg, (45.4±3.1)kg, (9 406±4 452)cm3, (6 442±3 307)cm3, and (2 964±1 694)cm3 at 6 months after surgery, (24.4±2.4)kg/m2, (32.6±1.1)kg, (48.6±2.7)kg, (7 612±3 029)cm3, (5 623±2 650)cm3, and (1 826±360)cm3 at 12 months after surgery, respectively, there were significant differences in the changes of these indices (F=130.2, 30.3, 4.9, 25.6, 11.9, 16.5, P<0.05). The BMI, fat mass, and TAFV at 3 months after surgery had significant differences compared with those before surgery (P<0.05), but free fat mass, TSFV, and TVFV had no significant difference (P>0.05). The BMI, fat mass, TAFV, and TVFV at 6 months after surgery had significant differences compared with those before surgery (P<0.05), but free fat mass and TSFV had no significant difference (P>0.05). The BMI, fat mass, TAFV, TSFV, and TVFV at 12 months after surgery had significant differences compared with those before surgery (P<0.05), but free fat mass had no significant difference (P>0.05). (3) Follow-up: all the 52 patients have completed the follow-up after surgery and the remission number of obesity was 35. No complications such as anastomotic hemorrhage, obstruction, or anastomotic leakage occured in all the 52 patients.@*Conclusion@#Laparoscopic Roux-en-Y gastric bypass can reduce abdominal visceral fat significantly, while quantitative computed tomography can help to evaluate the distribution of abdominal visceral fat accurately.

Application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients / 中华消化外科杂志

Objective To evaluate the application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients.Methods The retrospective and descriptive study was conducted.The clinical data of 52 obese patients who underwent laparoscopic Roux-en-Y gastric bypass in the Third Medical Center of Chinese PLA General Hospital from March 2011 to February 2012 were collected.There were 24 males and 28 females,aged (43±9)years,with the range of 23-62 years.All the 52 patients underwent laparoscopic Roux-en-Y gastric bypass.Observation indicators:(1) surgical and postoperative conditions;(2) changes in anthropometric indices;(3) follow-up.Follow-up using outpatient examination was performed to detect complications of patients at 1,3,6,12 months after surgery up to February 2013.Measurement data with normal distribution were represented as Mean±SD,repeated measurement data were analyzed using repeated ANOVA.Count data were represented as absolute numbers.Results (1) Surgical and postoperative conditions:all the patients underwent laparoscopic Roux-en-Y gastric bypass successfully,without conversion to open surgery.The volume of intraoperative blood loss,operation time,and duration of hospital stay were (25± 11) mL,(78± 14) minutes,and (11±2) days.(2) Changes in anthropometric indices:the body mass index (BMI),fat mass,free fat mass,total abdominal fat volume (TAFV),total subcutaneous fat volume (TSFV),and total visceral fat volume (TVFV) of all the 52 patients were (31.8 ± 1.8)kg/m2,(39.4±4.1)kg,(50.2±6.0)kg,(l1 703±3 899)cm3,(7 418±2 969)cm3,and (4 314± 1 692)cm3 before surgery,(28.5±1.4)kg/m2,(33.0±1.1)kg,(49.7±4.6)kg,(11 016±3 713) cm3,(7 044± 2970)cm3,(3969±1 443)cm3 at 3 months after surgery,(27.1±1.7)kg/m2,(30.2±1.3)kg,(45.4± 3.1)kg,(9 406±4 452)cm3,(6 442±3 307)cm3,and (2 964±1 694) cm3 at 6 months after surgery,(24.4± 2.4)kg/m2,(32.6±1.1)kg,(48.6±2.7)kg,(7 612±3 029)cm3,(5 623±2 650)cm3,and (1 826±360) cm3 at 12 months after surgery,respectively,there were significant differences in the changes of these indices (F=130.2,30.3,4.9,25.6,11.9,16.5,P＜0.05).The BMI,fat mass,and TAFV at 3 months after surgery had significant differences compared with those before surgery (P＜0.05),but free fat mass,TSFV,and TVFV had no significant difference (P＞0.05).The BMI,fat mass,TAFV,and TVFV at 6 months after surgery had significant differences compared with those before surgery (P ＜ 0.05),but free fat mass and TSFV had no significant difference (P＞0.05).The BMI,fat mass,TAFV,TSFV,and TVFV at 12 months after surgery had significant differences compared with those before surgery (P＜0.05),but free fat mass had no significant difference (P＞ 0.05).(3) Follow-up:all the 52 patients have completed the follow-up after surgery and the remission number of obesity was 35.No complications such as anastomotic hemorrhage,obstruction,or anastomotic leakage occured in all the 52 patients.Conclusion Laparoscopic Roux-en-Y gastric bypass can reduce abdominal visceral fat significantly,while quantitative computed tomography can help to evaluate the distribution of abdominal visceral fat accurately.

Clinical effect of intervention with Gandouling tablets in the perioperative period of splenectomy in patients with Wilson’s disease accompanied by splenomegaly and hypersplenism / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of perioperative Gandouling intervention in patients with Wilson’s disease (WD) complicated by splenomegaly and hypersplenism and the changes in related indices. MethodsA total of 60 WD patients with splenomegaly and hypersplenism who were hospitalized in Encephalopathy Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, from July 2016 to July 2018 were enrolled and randomly divided into control group and treatment group, with 30 patients in each group. The patients in the control group were given conventional Western medicine treatment including decoppering for 4 courses (each course of treatment was 8 days), followed by splenectomy and conventional decoppering at the end of week 1 after surgery for 2 courses; the patients in the treatment group were given Gandouling in addition to the treatment in the control group. Clinical outcome and changes in 24-hour urinary copper, peripheral hemogram, liver function parameters, and portal venous flow indices were observed. The two independent samples t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsThe treatment group had a significantly higher overall response rate than the control group ［90% (27/30) vs 60% (18/30), χ2=443, P=0.03］. Compared with the control group at the end of two courses of treatment after surgery, the treatment group had significantly lower 24-hour urinary copper (t=41.07, P＜0.05) and levels of alanine aminotransferase and aspartate aminotransferase (t=7.29 and 6.13, both P＜0.01) and significantly higher levels of red blood cell count, platelet count, and hemoglobin (t=-5.49, -3.43, and -3.53, all P＜0.01). At the end of two courses of treatment after surgery, both groups had a reduction in portal venous flow, and the treatment group had a significantly greater improvement in portal venous flow than the control group (t=12.05, P＜0.01). ConclusionGandouling can improve the clinical outcome of WD patients with splenomegaly and hypersplenism after splenectomy.

Clinical effect of intervention with Gandouling tablets in the perioperative period of splenectomy in patients with Wilson’s disease accompanied by splenomegaly and hypersplenism / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of perioperative Gandouling intervention in patients with Wilson’s disease (WD) complicated by splenomegaly and hypersplenism and the changes in related indices. MethodsA total of 60 WD patients with splenomegaly and hypersplenism who were hospitalized in Encephalopathy Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, from July 2016 to July 2018 were enrolled and randomly divided into control group and treatment group, with 30 patients in each group. The patients in the control group were given conventional Western medicine treatment including decoppering for 4 courses (each course of treatment was 8 days), followed by splenectomy and conventional decoppering at the end of week 1 after surgery for 2 courses; the patients in the treatment group were given Gandouling in addition to the treatment in the control group. Clinical outcome and changes in 24-hour urinary copper, peripheral hemogram, liver function parameters, and portal venous flow indices were observed. The two independent samples t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsThe treatment group had a significantly higher overall response rate than the control group ［90% (27/30) vs 60% (18/30), χ2=443, P=0.03］. Compared with the control group at the end of two courses of treatment after surgery, the treatment group had significantly lower 24-hour urinary copper (t=41.07, P＜0.05) and levels of alanine aminotransferase and aspartate aminotransferase (t=7.29 and 6.13, both P＜0.01) and significantly higher levels of red blood cell count, platelet count, and hemoglobin (t=-5.49, -3.43, and -3.53, all P＜0.01). At the end of two courses of treatment after surgery, both groups had a reduction in portal venous flow, and the treatment group had a significantly greater improvement in portal venous flow than the control group (t=12.05, P＜0.01). ConclusionGandouling can improve the clinical outcome of WD patients with splenomegaly and hypersplenism after splenectomy.