Effects of individualized parenteral nutrition versus pre-mixed parenteral nutrition on liver function of patients with acute kidney injury / 中国药房

OBJECTIVE To compare the effects of individualized parenteral nutrition versus pre-mixed parenteral nutrition on liver function of patients with acute kidney injury （AKI）. METHODS Totally 97 AKI patients in the intensive care unit of our hospital from January 2021 to March 2022 were collected and randomly divided into pre-mixed multi-chamber bag （MCB） group （48 cases） and compounded parenteral nutrition （COM） group （49 cases）. The patients in both groups were given routine treatment to correct the reversible cause in time， and parenteral nutrition support treatment was started within 48 hours after the fluid resuscitation was successful or the hemodynamics of low-dose vasoactive drugs were stable. MCB group was given one bag of Fat emulsion amino acid （17） glucose （11%） injection， intravenous infusion， once a day； COM group was given Medium/long chain Fat emulsion injection （C8-24Ve） 0.5-0.8 g/kg+Compound amino acid 18AA-Ⅶ 1.0-1.2 g/kg+Glucose injection 1.5-2.5 g/kg+one Water soluble vitamin injection+Fat-soluble vitamin injection （Ⅱ） 10 mL+Multiple trace element injection （Ⅱ） 10 mL+ individualized supplement of sodium chloride and potassium chloride， with a ratio of glucose to lipid of 5∶5 and a ratio of heat to nitrogen of 100∶1. The treatment course of both groups lasted for 7 days. The percentage of abnormal liver function， the levels of liver function indexes [alanine aminotransferase （ALT）， total bilirubin （TBIL）， aspartate transaminase （AST）]， albumin （ALB）， interleukin-6 （IL-6） and C-reactive protein （CRP） were observed in 2 groups before and after treatment. RESULTS After treatment， the ratio of liver dysfunction， the levels of ALT， AST and CRP in MCB group were significantly higher than before treatment； the ratio of liver dysfunction， the levels of ALT and CRP in MCB group were significantly higher than COM group （P＜0.05）. There were no statistical significance in the ratio of liver dysfunction， the levels of ALT， AST， TBIL and CRP in COM group before and after treatment （P＞0.05）. CONCLUSIONS Individualized parenteral nutrition support treatment can reduce the occurrence of liver injury and improve the nutritional status of AKI patients.

The correlation between intraoperative temperature and postoperative neurological prognosis in aortic arch surgery: a single-center retrospective cohort study / 中华胸心血管外科杂志

Objective:To explore the correlation between intraoperative cooling temperature and postoperative neurological prognosis in aortic arch surgery.Methods:We observed and collected data from 118 patients who underwent open arch replacement surgery by a single surgeon with mild-to-moderate hypothermic circulatory arrest, from January 2017 to December 2020, in Beijing Anzhen Hospital. According to the bladder temperature during the circulation arrest, 118 patients were divided into 3 groups: T1 group[n=39, (25.58±0.64)℃]; T2 group[n=39, (28.21±0.77)℃]; T3 group[n=40, (30.95±0.97)℃]. Clinical data and operative data were analyzed to assess difference between these 3 groups. Analyze the risk factors of postoperative neurological complications, and explore further the correlation between intraoperative core temperature and postoperative neurological prognosis.Results:Among the 118 patients, the average operation, cardiopulmonary bypass (CPB), block, circulatory arrest, and selective cerebral perfusion (SCP) time were 6.64 h, 188.5 min, 104.19 min, 23.93 min, 28.81 min, respectively. The in-hospital death occurred in 8 patients(6.78%), and permanent neurological dysfunction (PND) in 13 patients(11.02%), transient neurological dysfunction (TND) in 25 patients(21.19%). There was no significant difference in the deaths among the three groups. The incidence of TND and PND in the T3 group was significantly reduced ( P=0.042; P=0.045). In addition, the volume of drainage during the first 24 h and the incidence of re-exploration for bleeding had a relatively obvious decreasing trend ( P=0.005; P=0.012). Through multiple regression analysis, under the adjusted model, the core temperature was independently correlated with the incidence of postoperative PND ( OR=0.51; 95% CI: 0.27-0.97; P=0.0389); in group comparison, the relatively higher core temperature was an independent protective factor for postoperative PND ( OR=0.04; 95% CI: 0.00-0.91; P=0.0434). Conclusion:Our research had preliminary proved that in the open arch replacement surgery, mild hypothermia can reduce the incidence of some complications of deep hypothermia, at the same time improve the prognosis of the neurological prognosis, reduce the incidence of postoperative PND.

The role of respiratory microbiota and mucosal immunity in the pathogenesis of asthma / 国际儿科学杂志

Bronchial asthma is a common chronic respiratory disease in children.With the development of high-throughput sequencing technology, it has been found that the occurrence and development of asthma is closely related to the dysbiosis of human microbiome.Studies have shown that the changes of respiratory microbiota can significantly affect the mucosal immune system of the host.Respiratory microbiota may be involved in pathophysiological processes such as airway inflammation, airway hyperresponsiveness and airway remodeling through specific mechanisms in asthma.This review focuses on the relationships between the respiratory microbiota and mucosal immunity, as well as their effects on the pathogenesis of asthma.

Liver fibrosis inhibits lethal injury through D-galactosamine/lipopolysaccharide-induced necroptosis / 中华肝脏病杂志

Objective: To explore the new mechanism of liver fibrosis through D-galactosamine/lipopolysaccharide (D-GalN/LPS)-induced necroptosis as an entry point to inhibit lethal injury. Methods: The carbon tetrachloride (CCl4)-induced mouse model of liver fibrosis was established. At 6 weeks of fibrosis, the mice were challenged with a lethal dose of D-GalN/LPS, and the normal mice treated with the same treatment were used as the control. The experiment was divided into four groups: control group (Control), acute injury group (D-GalN/LPS), liver fibrosis group (Fib), and liver fibrosis + acute challenge group (Fib + D-GalN/LPS). Quantitative PCR and immunofluorescence were used to analyze the expression of necroptosis key signal molecules RIPK1, RIPK3, MLKL and/or P-MLKL in each group. Normal mice were treated with inhibitors targeting key signaling molecules of necroptosis, and then given an acute challenge. The inhibitory effect of D-GalN/LPS-induced-necroptosis on acute liver injury was evaluated according to the changes in transaminase levels and liver histology. Liver fibrosis spontaneous ablation model was established, and then acute challenge was given. Necroptosis key signal molecules expression was analyzed in liver tissue of mice in each group and compared by immunohistochemistry. The differences between groups were compared with t-test or analysis of variance. Results: Quantitative PCR and immunofluorescence assays result showed that D-GalN/LPS-induced significant upregulation of RIPK1, RIPK3, MLKL and/or P-MLKL. Necroptosis key signal molecules inhibition had significantly reduced D-GalN/LPS-induced liver injury, as manifested by markedly reduced serum ALT and AST levels with improvement in liver histology. Necroptosis signaling molecules expression was significantly inhibited in fibrotic livers even under acute challenge conditions. Additionally, liver fibrosis with gradual attenuation of fibrotic ablation had inhibited D-GalN/LPS-induced necroptosis. Conclusion: Liver fibrosis may protect mice from acute lethal challenge injury by inhibiting D-GalN/LPS-induced necroptosis.

Interpretation of the 2022 edition guidelines for hepatolenticular degeneration diagnosis and treatment / 中华肝脏病杂志

In order to help liver disease-related clinicians make rational decisions, the Inherited and Metabolic Liver Disease Cooperative Group of Hepatology Branch of Chinese Medical Association released the 2022 edition guidelines for hepatolenticular degeneration diagnosis and treatment. This article introduces the ten highlights of this guideline from the aspects of epidemiology, pathogenesis, clinical characteristics, laboratory tests, diagnosis, treatment, monitoring, and so forth, with practicality and operability as prominent features.

Management of hepatolenticular degeneration during pregnancy / 中华肝脏病杂志

Hepatolenticular degeneration (Wilson's disease, WD) is a kind of autosomal recessive genetic disease characterized by disorders of copper metabolism. It is caused by mutations in the ATP7B gene, resulting in impaired excretion of copper into the bile, and then pathological deposition in the liver, brain, and other organs. Early diagnosis and treatment can significantly improve the prognosis of patients with WD. However, there is still no clear consensus on the treatment and management of WD during pregnancy. Herein, the clinical management of WD during pregnancy is summarized for clinicians' reference.

Clinical application of serum Golgi protein 73 in patients with chronic liver diseases / 中华肝脏病杂志

Golgi protein 73 (GP73) is a transmembrane protein on the Golgi apparatus and can be cut and released into the blood. In recent years, an increasing number of clinical studies have shown that the elevated serum GP73 level is closely related to liver diseases. And thus GP73 is expected to be used as a new serum marker for assessing progress of chronic liver diseases. Herein, the clinical application of serum GP73 in chronic hepatitis, liver fibrosis, liver cirrhosis and hepatocellular carcinoma with different etiologies was reviewed based on available literatures; and a research outlook in this field is made.

Relationship between bullying victimization and perpetration, academic achievement and screen time among primary and secondary school students / 中国学校卫生

Objective@#The study aims to determine the latent class of roles in bullying victimization and perpetration among primary and secondary school students and to explore its relationship with academic achievement and screen use, to provide a reference for developing preventive measures and intervention plans.@*Methods@#A total of 29 099 students at grade 5,6,7,8,10, and 11 from Shenzhen were surveyed through convenient cluster sampling method by Olweus Bully/Victim Questionnaire. The latent class analysis was used for classifying bully/victim category.@*Results@#The latent class analysis revealed three classes, the noninvolvement group (low response rate at all items, 80.9%), the bullying victimization group (low response rate at bullying and high response rate at victimization items, 15.9%), and the bullying victimization and perpetration group (high response rate at all items,3.3%). Boys were more likely than girls to belong to the bullying victimization and perpetration at all study sections ( OR =0.83,0.74, 0.47 , P <0.05). Transfer students were at higher risk to be in the bullying victimization group in elementary and middle school ( OR = 1.21 ,1.21), while they were more likely to fall into the bullying victimization and perpetration group in high school ( OR =2.65)( P < 0.05). Students with poor academic performance were more likely to be in the bullying victimization group at all sections ( OR = 0.98 ,0.98,0.98) and in the bullying victimization and perpetration group at elementary and middle school ( OR =0.97, 0.98)( P < 0.05 ). Students spending longer time on screen had elevated risk in the bullying victimization group ( OR =1.06,1.04,1.08, P < 0.05 ).@*Conclusion@#Students with poor academic achievement and prolonged screen time are at higher risks to be involved in bullying victimization and perpetration. Collaboration between home and school are needed to preventing bullying victimization perpetration.

Incidence and risk factors of retinopathy of prematurity in extremely preterm infants / 中华眼底病杂志

Objective:To investigate the incidence and risk factors of retinopathy of prematurity (ROP) in extremely preterm infants (EPI) before 28 weeks of gestation during 8-years period.Methods:A retrospective study. From January 1, 2011 to December 31, 2018, 300 EPI infants with a gestational age of less than 28 weeks admitted to the neonatal intensive care unit (NICU) of Tianjin Central Hospital of Gynecology Obstetrics were included in the study. EPI birth gestational week (GA), birth weight (BW), gender and other basic information, as well as neonatal respiratory distress syndrome, oxygen (≥10 d), bronchopulmonary dysplasia (BPD) and other hospitalizations and complications were recorded. According to ROP international classification standards, ROP was staged. Severe ROP was defined as ROP that requires treatment. The screening start time, screening interval, and intervention time of all children tested were carried out in accordance with the requirements of the "Guidelines for Screening Retinopathy of Prematurity" until the end of follow-up. The most severe ROP during the follow-up of each examined child was recorded as the final screening result of the examined child, and those with asymmetric eyes with the screening results of the severe side of the diseas was recorded. A retrospective analysis of the overall incidence of EPI ROP showed the incidence of severe ROP, and the first and second stages of EPI ROP during the 8 years (from January 1 , 2011 to December 31, 2014, and January 1, 2015 to December 31, 2018), changes in the rate of severe illness. Logistic regression analysis was used to screen independent risk factors for severe ROP.Results:Among 300 EPI infants, the average GA was (26.7±1.8) weeks; the average BW was (993.3±178.7) g. Two hundred and five infants (68.3%) were diagnosed with ROP, 116 (56.6%), 57 (27.8%), and 32 (15.6%) infants of stage Ⅰ, Ⅱ, and Ⅲ disease, respectively. There were no infants of stage IV and V. There were 30 infants (14.6%) with additional lesions and 59 infants (19.7%) with severe ROP requiring treatment. With the increase of GA ( χ2=52.391, 44.521; P=0.000, 0.000) and BW ( χ2=43.772, 26.138; P=0.000, 0.000), the incidence of EPI ROP and the incidence of severe ROP decreased significantly. From 2011 to 2018, the number of people surviving EPI obviously increased, especially those with small GA (26 weeks) and low BW (750 g). The average GA of the second stage EPI was lower than that of the first stage, the difference was statistically significant ( t=2.243, P=0.026); the average BW of the second stage EPI was lower than the first stage, the difference was not statistically significant ( t=1.428, P=0.154). The incidence of ROP in the second stage EPI was slightly higher than that in the first stage, and the incidence of severe ROP was lower than that in the first stage, the difference was not statistically significant ( χ2=1.069, 1.723; P=0.301, 0.189). Multivariate logistic regression analysis showed that GA<27 weeks ( β=-2.584, P=0.032), maternal chorioamnionitis (CA) ( β=-0.935, P=0.038) and BPD ( β=-1.432, P=0.001) was an independent risk factor for severe ROP. Conclusions:The incidence of EPI ROP and severe ROP are 68.3% and 19.7%, respectively. From 2011 to 2018, the number of survivors of EPI obviously increase, and those with small GA and low BW increase significantly; however, the incidence of ROP and severe ROP remaine stable. GA, CA and BPD are independent risk factors for severe ROP.

Analysis of risk factors for massive bleeding in patients with acute Stanford type A aortic dissection undergoing moderate hypothermic circulatory arrest repair / 中华胸心血管外科杂志

Objective:To study the risk factors of massive bleeding in patients with acute Stanford type A aortic dissection undergoing moderate hypothermic circulatory arrest repair.Methods:From January 2016 to October 2017, 486 consecutive patients with acute type A aortic dissection were included in the study. All operations were performed with moderate hypothermic circulatory arrest. The basic clinical data of patients were collected retrospectively. Massive bleeding was defined according to definition of Universal Definition of Perioperative Bleeding(UDPB) 4 class and the Blood Conservation Using Antifibrinolytics in a Randomized Trial(BART). Significant variables in univariate analysis were included in multivariate logistic regression analysis. Results:Thirty-four patients(7.00%) died in hospital. A total of one hundred and eighty-seven patients(38.48%) fulfilled criteria of the definition of BART massive bleeding. Forty-five patients(9.26%), 8 patients(1.65%), 114 patients(23.46%), 147 patients(30.25%) and 172 patients(35.39%) were in grade 0, grade 1, grade 2 and grade 4, respectively. With BART as the end point, the result of multivariate logistic regression showed that female gender( OR=3.32, P<0.001), anemia( OR=2.24, P=0.04), clearance creatine≤85 ml/min( OR=1.93, P=0.01), D-dimer level(every 500 ng/ml increase, OR=1.02, P=0.003), cardiopulmonary bypass(CPB) time( OR=1.01, P<0.001), total arch replacement(TAR, OR=2.40, P=0.02) were independent risk factors for massive bleeding, and the time from onset to operation( OR=0.86, P=0.01) was protective factor. With UDPB 4 class as the end point, multivariate logistic regression showed that creatinine clearance≤85 ml/min( OR=2.05, P=0.001), CPB time( OR=1.01, P=0.04) were independent risk factors for massive bleeding. The time from anset to operation( OR=0.85, P=0.002) and Bentall procedure( OR=0.65, P=0.04) were the protective factors. Conclusion:Massive bleeding was more common in acute Stanford type A aortic dissection. Female gender, poor preoperative renal function, high D-dimer level, early time accepting surgical operation and long CPB were independent risk factors. For high-risk patients, simple and effective surgical methods should be taken to reduce the risk of bleeding.

Surgical repair of acute Stanford type A aortic dissection with lower extremity ischemia / 中华胸心血管外科杂志

Objective:To explore the application of cannulating the ischemic femoral and right axillary artery in Sun’s procedure for acute type A aortic dissection with lower extremity ischemia.Methods:Twelve patients of acute Stanford type A aortic dissection complicated by lower extremity ischemia were analyzed retrospectively between July 2017 and May 2019, and the right axillary and ischemic femoral artery were used for cardiopulmonary bypass. All the 12 patients were male and categorized as the complicated Stanford type A aortic dissection. The mean age was(48.4±8.4)years, and the median time from symptom onset to emergency operation was 24.00(18.50, 43.25)hours. Eleven patients presented with unilateral extremity ischemia, while bilateral extremity ischemia occurred in one. The prosthetic vessel, with a diameter of 8 mm, was anastomosed to the ischemic femoral artery via an end-to-side way. Both the right axillary artery and the prosthetic vessel were cannulated for CPB. For the proximal dissection in this cohort of patients, we performed Bentall procedure in 5 cases, ascending aortic replacement in 3, and the aortic valve commissure reconstruction with ascending aortic replacement in 4. Total arch replacement with stented elephant trunk implantation were carried out for arch and descending aortic lesion in 12 cases.Results:Early mortality was 8.3%(1/12). The time of CPB, aortic clamp, circulatory arrest, and selective cerebral perfusion averaged(204.6±26.3) min, (114.6±16.6) min, (23.4±8.5) min, and(33.5±11.0) min, respectively. Five patients underwent concomitant bypass procedures, including: ascending aorta-bilateral femoral artery bypass in 1, ascending aorta-right femoral artery bypass in 3, ascending aorta-left femoral artery bypass in 1. Acute renal failure with continuous renal replacement therapy occurred in 4 cases, re-thoratomy for hemaostsis in 1, and re-intubation in 1. One patient developed osteofascial compartment syndrome after aortic repair, and consequent left lower extremity compartment fasciotomy was performed. The mean follow-up time was(17.2±7.6)months, and no aortic-related adverse event was detected during follow up.Conclusion:To acute Stanford type A aortic dissection with lower extremity ischemia, cannulating the ischemic femoral and right axillary artery in Sun’s procedure were associated with lower perioperative mortality and better prognosis.

Mortality of extremely preterm infants born at 22 +0-25 +6 gestational weeks in a single center and comparison with data from other countries / 中华围产医学杂志

Objective:To analyze the mortality of extremely preterm infants(EPIs) born at 22 +0-25 +6 weeks of gestation in Tianjin Central Hospital of Obstetrics and Gynecology and then compare it with data from other countries to provide evidence for better healthcare for this population. Methods:Clinical data of EPIs born at 22 +0-25 +6 gestational weeks in our center from January 2011 to December 2017 were retrospectively collected. The enrolled patients were grouped based on their gestational age, birth weight, and admission time in order to analyze the mortality in different groups. According to the inclusion and exclusion criteria, five sets of data regarding the mortality of EPIs born at 22 +0-25 +6 gestational weeks during the same period were retrieved from a multicenter survey involving 15 centers in China, the National Institute of Child Health and Human Development Neonatal Research Network (NICHD-NRN) in the United States, Canadian Neonatal Network TM, Australian and New Zealand Neonatal Network (ANZNN) and Korean Neonatal Network (KNN). The mortality rate among data from different sources was compared using Chi-square test on the condition that the definition of death was the same. Besides, the causes of neonatal death were analyzed. Results:A total of 64 EPIs were enrolled in our center. The total mortality rate was 42.2% (27/64), and were 1/1, 8/10, 50.0%(10/20) and 24.2%(8/33) in EPIs of gestational age of 22 +0-22 +6, 23 +0-23 +6, 24 +0-24 +6 and 25 +0-25 +6 weeks, 5/6, 50.0%(16/32), 25.0%(6/24) and 0/2 in those with birth weight of ≤600 g, >600-≤800 g, >800-≤1 000 g and >1 000 g, respectively. In the 27 death cases in our center, the causes of death were as follows: neonatal respiratory distress syndrome (16 cases, 59.3%), sepsis (two cases, 7.4%), necrotizing enterocolitis (three cases, 11.1%), severe intraventricular hemorrhage (three cases, 11.1%) and others (three cases, 11.1%). The mortality rate was 57.1%(12/21) before 2016(2011-2015), 45.0%(9/20) in 2016 and 26.1%(6/23) in 2017. The total mortality of EPIs in our center was higher than that in Canada [42.2% vs 26.6%(165/621), χ2=7.015, P=0.008], as well as in Australia and New Zealand [42.2% vs 28.2%(140/497), χ2=5.330, P=0.021], while there was no statistically significant difference when compared with that in South Korea [42.2% vs 42.1%(218/518), χ2<0.001, P=0.988]. Conclusions:The mortality of EPIs born at 22 +0-25 +6 gestational weeks is higher in our center when compared with that in some developed countries such as Canada and Australia. Therefore, we should pay more efforts to reduce the mortality of EPIs through quality improvement.

Endotracheal suction following intubation during resuscitation in neonates born through meconium-stained amniotic fluid / 中华围产医学杂志

Meconium-stained amniotic fluid is one of the main risk factors for neonatal meconium aspiration syndrome, and can even cause death, which is a dangerous emergency to handle during neonatal resuscitation. Routine intubation and endotracheal suction are not recommended for non-vigorous newborns born through meconium-stained amniotic fluid in the latest international neonatal resuscitation guideline. But it is controversial due to lacking high-level evidence. We review the recent evidence for the rationale for endotracheal suction in non-vigorous neonates born through meconium-stained amniotic fluid.

Effect of moderate exercise therapy and fracture liaison service on osteoporotic hip fracture / 中国实用护理杂志

Objective:To explore the clinical effect of moderate exercise therapy and fracture liaison service in osteoporotic hip fracture.Methods:From June 2018 to June 2020, 120 patients with osteoporotic hip fracture admitted to Nanjing Hospital Affiliated to Nanjing Medical University were selected. The patients were divided into study group and control group by random number table method, 60 cases in each group. The control group was treated with routine nursing and moderate exercise therapy, and the control group was treated with fracture liaison service, clinical observation and comparison of treatment compliance, bone mineral density (BMD), Numerical Rating Scale (NRS) score and nursing satisfaction before and after intervention.Results:The BMD and NRS scores in the study group were (0.90±0.25) g/cm 2, (1.0±0.3) points, higher than those in the control group (0.80±0.18) g/cm 2, (1.0±0.25) points. The difference was statistically significant ( t values were 2.514, 2.547, P<0.05). The total compliance rate and nursing satisfaction of the study group were 93.30% (56/60) and 95.00% (57/60) respectively, which were significantly higher than 80.00% (48/60) and 83.33% (50/60) of the control group. The difference was statistically significant ( χ 2 values were 4.615, 4.227, P<0.05). Conclusion:Moderate exercise therapy and fracture contact service intervention can effectively improve bone mineral density and total compliance rate, relieve pain and improve nursing satisfaction.

Baicalein Regulates Colony Formation of Triple-negative Breast Cancer Cells by Inhibiting YAP Entry into Nucleus / 中国实验方剂学杂志

Objective:This study aims to observe the effect of baicalein on the clonal formation of triple negative breast cancer MDA-MB-231 and MDA-MB-468 cells， and to explore the mediation role of Yes- related protein （YAP） in it. Method:MDA-MB-231 and MDA-MB-468 cells were treated with baicalein. Thiazole blue （MTT） colorimetric method was used to detect cell proliferation ability. Plate cloning experiments was used to detect the colony forming ability. Immunofluorescence method was used to detect the nuclear distribution of YAP， and Western blot test was used to detect the protein expression levels of YAP large tumor suppressor factor 1 （LATS1）， YAP， phosphorylated Yes- related protein（p-YAP） and phosphorylated YAP large tumor suppressor factor 1 （p-LATS1）. Result:Compared with the blank group， baicalein （40， 80， 160 μmol·L^-1） significantly inhibited the proliferation ability of MDA-MB-468 and MDA-MB-231 cells （<italic>P</italic><0.05， <italic>P</italic><0.01）， and the inhibitory effect was dose-dependent. The half inhibit concentration（IC₅₀） of baicalein against MDA-MB-468 and MDA-MB-231 cells were （80.3±7.2），（70.4±6.5） μmol·L^-1， respectively. Compared with blank group， baicalein （5， 10， 20 μmol·L^-1） had no significant effect on the proliferation of MDA-MB-468 and MDA-MB-231 cells， and the difference was not statistically significant. Compared with the blank group， baicalein （5， 10， 20 μmol·L^-1） significantly dose-dependently reduced the cell colony formation rates of MDA-MB-468 and MDA-MB-231 cells （<italic>P</italic><0.05， <italic>P</italic><0.01）， and baicalein （10， 20 μmol·L^-1） significantly inhibited the nuclear expression of YAP in MDA-MB-468 and MDA-MB-231 cells in a dose-dependent manner（<italic>P</italic><0.01）. Also， baicalin （5， 10， 20 μmol·L^-1） significantly up-regulated p-YAP and p-LATS1 protein expressions in MDA-MB-468 cells in a dose-dependent manner （<italic>P</italic><0.05， <italic>P</italic><0.01）. Baicalein （10， 20 μmol·L^-1） significantly up-regulated p-YAP and p-LATS1 protein expressions in MDA-MB-231 cells in a dose-dependent manner （<italic>P</italic><0.01）. Conclusion:Baicalein can inhibit colony formation of triple negative breast cancer MDA-MB-468 and MDA-MB-231 cells by mediating the reduction of YAP entry into the nucleus.

Macrophage exosomes transfer angiotensin II type 1 receptor to lung fibroblasts mediating bleomycin-induced pulmonary fibrosis / 中华医学杂志(英文版)

BACKGROUND@#Macrophages are involved in the pathogenesis of idiopathic pulmonary fibrosis, partially by activating lung fibroblasts. However, how macrophages communicate with lung fibroblasts is largely unexplored. Exosomes can mediate intercellular communication, whereas its role in lung fibrogenesis is unclear. Here we aim to investigate whether exosomes can mediate the crosstalk between macrophages and lung fibroblasts and subsequently induce fibrosis.@*METHODS@#In vivo, bleomycin (BLM)-induced lung fibrosis model was established and macrophages infiltration was examined. The effects of GW4869, an exosomes inhibitor, on lung fibrosis were assessed. Moreover, macrophage exosomes were injected into mice to observe its pro-fibrotic effects. In vitro, exosomes derived from angiotensin II (Ang II)-stimulated macrophages were collected. Then, lung fibroblasts were treated with the exosomes. Twenty-four hours later, protein levels of α-collagen I, angiotensin II type 1 receptor (AT1R), transforming growth factor-β (TGF-β), and phospho-Smad2/3 (p-Smad2/3) in lung fibroblasts were examined. The Student's t test or analysis of variance were used for statistical analysis.@*RESULTS@#In vivo, BLM-treated mice showed enhanced infiltration of macrophages, increased fibrotic alterations, and higher levels of Ang II and AT1R. GW4869 attenuated BLM-induced pulmonary fibrosis. Mice with exosomes injection showed fibrotic features with higher levels of Ang II and AT1R, which was reversed by irbesartan. In vitro, we found that macrophages secreted a great number of exosomes. The exosomes were taken by fibroblasts and resulted in higher levels of AT1R (0.22 ± 0.02 vs. 0.07 ± 0.02, t = 8.66, P = 0.001), TGF-β (0.54 ± 0.05 vs. 0.09 ± 0.06, t = 10.00, P < 0.001), p-Smad2/3 (0.58 ± 0.06 vs. 0.07 ± 0.03, t = 12.86, P < 0.001) and α-collagen I (0.27 ± 0.02 vs. 0.16 ± 0.01, t = 7.01, P = 0.002), and increased Ang II secretion (62.27 ± 7.32 vs. 9.56 ± 1.68, t = 12.16, P < 0.001). Interestingly, Ang II increased the number of macrophage exosomes, and the protein levels of Alix (1.45 ± 0.15 vs. 1.00 ± 0.10, t = 4.32, P = 0.012), AT1R (4.05 ± 0.64 vs. 1.00 ± 0.09, t = 8.17, P = 0.001), and glyceraldehyde-3-phosphate dehydrogenase (2.13 ± 0.36 vs. 1.00 ± 0.10, t = 5.28, P = 0.006) were increased in exosomes secreted by the same number of macrophages, indicating a positive loop between Ang II and exosomes production.@*CONCLUSIONS@#Exosomes mediate intercellular communication between macrophages and fibroblasts plays an important role in BLM-induced pulmonary fibrosis.

Construction practice of Internet of things platform in emergency for critical care medicine information / 中华医院管理杂志

Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.

Meta-analysis and systematic review of efficacy and safety of Lianhua Qingwen in adjuvant treatment of adult pneumonia / 中国中药杂志

To systematically evaluate the clinical efficacy and safety of Lianhua Qingwen in the treatment of adult pneumonia. The randomized controlled trial of Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia were retrieved from PubMed, EMbase, Wanfang database, VIP database, and CNKI from the establishment of database to March 2020. Two researchers independently conducted literature screening and data extraction, and the third researcher was in charge of arbitration in case of any disagreement. Outcome indicators included total clinical effective rate, symptom improvement time, and incidence of adverse events. R 3.6.1 was used for Meta-analysis, and RevMan 5.3 was used for quality evaluation. Twenty-two studies were included, with a total of 2 007 patients, including 1 017 patients in the experimental group and 990 patients in the control group. The results showed that the total clinical effective rate of the experimental group was higher than that of the control group(RR=1.11, 95%CI[1.08, 1.15], P<0.001), and the antifebrile time(MD=-1.81, 95%CI[-2.42,-1.21], P<0.001), cough duration(MD=-2.32, 95%CI[-2.89,-1.76], P<0.001), rale duration(MD=-2.19, 95%CI[-2.74,-1.63], P<0.001), imaging recovery time(MD=-2.17, 95%CI[-2.76,-1.58], P<0.001) and post-treatment CRP(MD=-4.07, 95%CI[-6.39,-1.75], P<0.001] were all significantly lower than those of the control group. However, it did not proved that the experimental group was safer than the control group(RR=0.84, 95%CI[0.57, 1.24], P=0.382). The results confirmed that Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia could improve the clinical treatment efficiency, shorten the time of fever, cough, rale disappearance and imaging recovery, improve CRP index and accelerate the recovery of pneumonia patients. However, the literatures included in this study had a low quality, and the conclusions still need to be further confirmed by more high-quality, multi-center, rigorously designed randomized controlled trial.

Application of PBL teaching combined with flipped classroom in standardized residency training of orthopedics / 中华医学教育探索杂志

Objective:To explore the application of self-teaching model based on PBL teaching combined with flipped classroom in standardized residency training of orthopedics.Methods:There were 102 cases of residents who received standardized residency training from March 2017 to February 2018 in orthopedics department of Yueyang Hospital of Traditional Chinese and Western Medicine, among whom 55 were randomized into the observation group and 47 were divided into the control group. Traditional teaching was applied in the control group and self-teaching model was applied additionally in the observation group. At the end of the month, the teaching effect was evaluated by the department graduation examinations and questionnaire survey. SPSS 19.0 was used for t test. Results:The ability of history inquiry, diagnosis and physical examination of the residents in the observation group were higher than those in the control group. The self-study and data access ability, confidence in presenting, and satisfaction with teaching in the observation group were better than those in the control group.Conclusion:The self-teaching mode can arouse the learning initiative of residents, and increase residents' literature retrieval ability and their learning satisfaction.

Surgical treatment for type Stanford A aortic dissection with Kommerell′s diverticulum / 中华外科杂志

Objective@#To examine the outcomes of surgical treatment in patients of type Stanford A aortic dissection with Kommerell′s diverticulum.@*Methods@#From January 2009 to August 2017, patients of type Stanford A aortic dissection with Kommerell′s diverticulum who underwent the Sun procedure were enrolled. Patient demographic, preoperative, intraoperative, early morbidity and mortality data were collected from medical and electronic patient records. Clinical follow-up data, including late morbidity and mortality, were obtained by telephone interview with the patient.@*Results@#A total of 13 patients (11 males and 2 females; mean age 47 years) were included. The mean maximum diameter of Kommerell′s diverticulum was (21.8±7.7) mm. The Kommerell′s diverticulum was repaired by direct suture of the orifice in 3 patients, ligation of the aberrant right subclavian artery in 9 patients, and suture and ligation in 1 patient, respectively. No perioperative death occurred. One patient underwent a reexploration for bleeding. There were 2 late deaths: unknown reason in 1 patient and septic shock secondary to renal abscess in 1 patient. Reintervention was performed in one patient for a persistent type Ⅱ endoleak.@*Conclusions@#The Sun procedure with femoral artery cannulation for cardiopulmonary bypass, unilateral carotid artery cannulation for selective cerebral perfusion and ligation of aberrant right subclavian artery on the right side of the trachea is an appropriate therapeutic strategy for patients of type Stanford A aortic dissection with Kommerell′s diverticulum.