Pathogenesis and treatment of non-alcoholic steatohepatitis and its fibrosis

The initial presentation of non-alcoholic steatohepatitis (NASH) is hepatic steatosis. The dysfunction of lipid metabolism within hepatocytes caused by genetic factors, diet, and insulin resistance causes lipid accumulation. Lipotoxicity, oxidative stress, mitochondrial dysfunction, and endoplasmic reticulum stress would further contribute to hepatocyte injury and death, leading to inflammation and immune dysfunction in the liver. During the healing process, the accumulation of an excessive amount of fibrosis might occur while healing. During the development of NASH and liver fibrosis, the gut-liver axis, adipose-liver axis, and renin-angiotensin system (RAS) may be dysregulated and impaired. Translocation of bacteria or its end-products entering the liver could activate hepatocytes, Kupffer cells, and hepatic stellate cells, exacerbating hepatic steatosis, inflammation, and fibrosis. Bile acids regulate glucose and lipid metabolism through Farnesoid X receptors in the liver and intestine. Increased adipose tissue-derived non-esterified fatty acids would aggravate hepatic steatosis. Increased leptin also plays a role in hepatic fibrogenesis, and decreased adiponectin may contribute to hepatic insulin resistance. Moreover, dysregulation of peroxisome proliferator-activated receptors in the liver, adipose, and muscle tissues may impair lipid metabolism. In addition, the RAS may contribute to hepatic fatty acid metabolism, inflammation, and fibrosis. The treatment includes lifestyle modification, pharmacological therapy, and non-pharmacological therapy. Currently, weight reduction by lifestyle modification or surgery is the most effective therapy. However, vitamin E, pioglitazone, and obeticholic acid have also been suggested. In this review, we will introduce some new clinical trials and experimental therapies for the treatment of NASH and related fibrosis.

The diagnostic value of active inflammatory changes of the symphysis pubis on magnetic resonance imaging scans in patients with axial spondyloarthritis and clinical factors analysis / 中华风湿病学杂志

Objective:To evaluate the correlation of active inflammatory changes of the symphysis pubis on magnetic resonance imaging (MRI) scans with clinical factors in patients with axial spondyloarthritis.Methods:We retrospectively evaluated 112 patients with axial spondyloarthritis (ax-SpA) in our hospital from February 2014 to November 2020. Patients were divided into 4 groups: symphysis pubis + sacroiliac arthritis, symphysis pubis + non-sacroiliac arthritis, non-symphysis pubis + sacroiliac arthritis, and non symphysis pubis + non-sacroiliac arthritis group. Intra-group correlation coefficient ( ICC) was used to analyze the correlation between MRI active inflammation of the symphysis pubis and the sacroilioarthritis. Age, sex, symptom duration, smoking, body mass index, human leukocyte antigen (HLA)-B27 positive rate, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) among the four groups were compared by one-way analysis of variance (ANOVA) and Chi-square test. Results:The proportion of active inflammation of the symphysis pubis was 35.7% (40/112). There was no correlation between active inflammation of the symphysis pubis and sacroilioarthritis ( r=-0.06, P=0.559). Twenty-four patients of the 69 patients with sacroilioarthritis had active inflammation of the symphysis pubis, 16 patients of the 43 patients without sacroilioarthritis had active inflammation of the symphysis pubis. In patients without active inflammation of the sacroiliac joint, the CRP and ESR of the active inflammation of the symphysis pubis group was (49±60) mg/L, (40±19) mm/1 h, statistically higher than that of the non-active inflammation group (19±22) mg/L, (22±37) mm/1 h ( t=2.36, P=0.023; t=2.88, P=0.006). In patients who had active inflammation of the symphysis pubis, the symptom duration of the non-active inflammation of the sacroiliac joint, was (14±9) years, which was significantly longer than that of the active inflammation group (5±4) years ( t=4.07, P=0.001). Conclusion:There is no correlation between active inflammatory changes of the symphysis pubis and bone marrow edema of the sacroiliac joint. Therefore, in ax-SpA patients with inflammatory low back pain and/or hip/groin pain, and also with high levels of CRP, ESR, but no active inflammatory changes of the sacroiliac joint on MRI scans, active inflammation of the symphysis pubis should be considered.

Research on regularity of traditional Chinese medicine in treatment of Alzheimer's disease based on data mining / 中国中药杂志

To explore prescription medication regularity in the treatment of Alzheimer's disease with traditional Chinese medicine(TCM). With Alzheimer's disease or senile dementia as the subject, collecting and sorting out the journal papers in CNKI were collected as the data source to establish the literature research database of Alzheimer's disease prescriptions, and then the association rule analysis, factor analysis and systematic cluster analysis on the included TCM were conducted. Among the 113 prescriptions included in the standard, the single herb Acori Tatarinowii Rhizoma was the most common. The herbs were mainly warm and flat among four pro-perties, mainly sweet, bitter and spicy among five flavors. The drugs were mainly distributed in five internal organs, and the most commonly used drugs were deficiency tonifying drugs as well as blood activating and stasis removing drugs. In the association rule analysis, it was found that there were 6 drug pairs with the highest association strength. Eight common factors were extracted from the factor analysis, and they were classified into 6 categories in the systematic cluster analysis. The results have shown that the overall principles in treating Alzheimer's disease with modern Chinese medicine are tonifying deficiency, invigorating circulation, activating blood and dispelling phlegm.

Construction of a drug screening model for miscarriage from induced pluripotent stem cells in vitro / 药学学报

Drug use during pregnancy is unavoidable. Therefore, it is vitally important for medical workers to help pregnant women take drugs correctly to reduce the incidence of spontaneous abortion, premature birth, and low birth weight. In our study, drug screening model with induced pluripotent stem cells (iPSCs) was used to find some improper drugs which will result in woman's abortion. With 3D culture in vitro, iPSCs can form embryoid bodies (EBs) and cerebral organoids, which simulated in vitro development of early embryos, from inner cell mass to germ-layer differentiation. In the experiment, EBs were exposed to mifepristone (RU486), and three experimental groups were divided randomly. They were control group (without RU486), low-dose group (L-RU486, 10 μg·mL-1), and high-dose group (H-RU486, 20 μg·mL-1). After mifepristone exposure, EBs were observed at days 5, 8, and 11, including size of EB, cell apoptosis, and differentiation of germ layers, by using inverted optical microscope, TUNEL assay, and immunofluorescent staining. The results showed that through 3D culture, iPSCs could develop into embryoid bodies, neural rosettes, and finally cerebral organoids. After mifepristone exposure, EBs' sizes were decreased (P < 0.01); the levels of cell apoptosis in EBs were increased after mifepristone exposure (P < 0.01); the development of EBs' germ layer was affected. Mifepristone exposure could inhibit the proliferation of embryonic stem cells, reduce the differentiation of ectoderm (P < 0.01) and promote the development of mesoderm (P < 0.05). In conclusion, iPSCs can be used as a screening model for abortion drug, and EBs’ diameter, cell apoptosis, and differentiation changes of the germ layers can serve as criteria of abortion drug screening.

Comparative effectiveness and safety of 32 pharmacological interventions recommended by guidelines for coronavirus disease 2019: a systematic review and network meta-analysis combining 66 trials / 中华医学杂志(英文版)

BACKGROUND@#The global pandemic coronavirus disease 2019 (COVID-19) has become a major public health problem and presents an unprecedented challenge. However, no specific drugs were currently proven. This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19.@*METHODS@#Medline, Embase, the Cochrane Library, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/SARS-CoV. Random-effects network meta-analysis within the Bayesian framework was performed, followed by the Grading of Recommendations Assessment, Development, and Evaluation system assessing the quality of evidence. The primary outcome of interest includes mortality, cure, viral negative conversion, and overall adverse events (OAEs). Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size.@*RESULTS@#Sixty-six RCTs with 19,095 patients were included, involving standard of care (SOC), eight different antiviral agents, six different antibiotics, high and low dose chloroquine (CQ_HD, CQ_LD), traditional Chinese medicine (TCM), corticosteroids (COR), and other treatments. Compared with SOC, a significant reduction of mortality was observed for TCM (OR = 0.34, 95% CI: 0.20-0.56, moderate quality) and COR (OR = 0.84, 95% CI: 0.75-0.96, low quality) with improved cure rate (OR = 2.16, 95% CI: 1.60-2.91, low quality for TCM; OR = 1.17, 95% CI: 1.05-1.30, low quality for COR). However, an increased risk of mortality was found for CQ_HD vs. SOC (OR = 3.20, 95% CI: 1.18-8.73, low quality). TCM was associated with decreased risk of OAE (OR = 0.52, 95% CI: 0.38-0.70, very low quality) but CQ_HD (OR = 2.51, 95% CI: 1.20-5.24) and interferons (IFN) (OR = 2.69, 95% CI: 1.02-7.08) vs. SOC with very low quality were associated with an increased risk.@*CONCLUSIONS@#COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care. CQ_HD might increase the risk of mortality. CQ, IFN, and other antiviral agents could increase the risk of OAEs. The current evidence is generally uncertain with low-quality and further high-quality trials are needed.

Clinical value of heparin binding protein level in BALF for diagnosis and differential diagnosis of bacterial pneumonia / 中华临床感染病杂志

Objective:To explore the clinical value of heparin binding protein (HBP) in bronchoalveolar lavage fluid (BALF) for diagnosis and differential diagnosis of bacterial pneumonia.Methods:Eighty eight patients with pulmonary infection from the respiratory department of the Fourth Affiliated Hospital of Anhui Medical University from January 2019 to January 2021 were enrolled in the study, including 48 cases of bacterial pneumonia and 40 cases of non-bacterial pneumonia; meanwhile, 40 non-pulmonary infection patients were also enrolled as the control group. The BALF levels of HBP, procalcitonin (PCT), interleukin-6 (IL-6) were measured, and the clinical values of the above indexes in differential diagnosis of bacterial and non-bacterial pneumonia were analyzed.Results:The BALF levels of HBP and IL-6 in bacterial pneumonia group were significantly higher than those of the non-bacterial pneumonia group and the control group ( P<0.05). ROC curve showed that the areas under the curve (AUC) of HBP and IL-6 were 0.930 and 0.893 for the early diagnosis of bacterial pneumonia; and the sensitivity was 88.5% and 82.7%, the specificity was 92.5% and 92.5%, respectively. Combined detection of HBP and IL-6, the AUC was 0.942 and the sensitivity was 94.2% and the specificity was 95.0%. When they were used to distinguish bacterial pneumonia, the AUC of HBP and IL-6 were 0.890 and 0.777, and the sensitivities were 80.8% and 71.2%, and the specificity were 91.7% and 75.0%, respectively. Combined detection of HBP and IL-6, the AUC was 0.902, and the sensitivity was 96.2% and the specificity was 79.2%. Conclusions:BALF HBP and IL-6 have good clinical value in the early diagnosis and distinguishing bacterial pulmonary infection and the joint value of the two is better.

Bibliometrics and visualization analysis of quality control research of health checkup / 中华健康管理学杂志

Objective:To understand the research status, research hotspots and research frontiers of quality control of health checkup in the past 15 years.Methods:Journal literatures with the theme of "Health checkup and Quality control" from China National Knowledge Infrastructure (CNKI) database from 2006 to 2020 were retrieved and analyzed. Excel was used to analyze the time and sequence and discipline distribution of literatures. CiteSpace V software was used for visual analysis of institutions and keywords.Results:A total of 306 literatures were obtained, and the number of literatures published in the past 15 years showed an overall growth trend, with the highest number of literatures published in 2019 (36). They mainly focused on the research of medical and health policies and laws and regulations, clinical medicine, preventive medicine and hygiene and other disciplines, with a few literatures belonging to interdisciplinary disciplines. The top three institutions were Physical Examination Center of Naval General Hospital, Health Management Center of the General Hospital of Tianjin Medical University, Health Management Research Institute of PLA General Hospital. The institutions with high centrality were Physical Examination Center of Naval General Hospital, Editorial Board of Chinese Journal of Health Management, and Chinese Health Management Association and so on. There were fewer cooperative links between institutions. The high-frequency keywords found in 306 literatures were"quality control","health checkup","quality management","health management","physical examination center","Deming Cycle (Plan-Do-Check-Action Cycle, PDCA Cycle)","quality of health checkup", etc."Health management"was the key emergence word in the recent three years.Conclusions:In the past 15 years, the attention on the quality control of health checkup in China has gradually increased, but there is less cross-connection between disciplines and institutions. The research focuses on the internal quality control and the application of advanced management theories in health examination institutions. The transformation from simple health checkup to health management service is the research frontier.

Applications of stem cell disease models in liver metabolic research and drug development / 生理学报

The high failure rate of the new drug development has been well recognized. Relying on the pre-clinical data obtained from animal experiments will inevitably cause a low concordance with human clinical trials, which will eventually lead to new drug development failure. Employing human induced pluripotent stem cells (iPSCs) or adult stem cells to simulate disease models can not only provide an unlimited cell materials, but also faithfully represent the genetic background of a certain disease, when iPSCs or adult stem cells derived from patients with a specific disease genetic variation are applied. In addition, gene editing methods can be used to introduce genetic variants of interest into stem cells to generate disease models. Furthermore, by establishing a cell bank with a population of iPSCs in petri dish, in vitro human genetic studies can be carried out in these cells, with GWAS and QTL studies applied to identify genetic variants that are associated with drug sensitivity or cytotoxicity. These efforts may offer valuable information for the recruitment of suitable patients for clinical trials. Therefore, stem cell-derived disease models can provide valuable resources for the pathophysiological studies of diseases as well as the drug development. In this review, we will briefly introduce the development of the liver disease models derived from stem cells and their applications in disease study and drug development.

Expression and clinical significance of long non-coding RNA antisense non-coding RNA in the INK4 locus and microRNA-125a in plasma of children with bronchial asthma / 第二军医大学学报

Objective To evaluate the correlation of long non-coding RNA (lncRNA) antisense non-coding RNA in the INK4 locus (ANRIL) with disease risk and severity of bronchial asthma as well as plasma microRNA (miRNA)-125a expression in child patients. Methods Seventy children with asthma exacerbation, 70 children with asthma remission and 70 matched healthy controls were consecutively enrolled in this study. Laboratory parameters and lung function indexes of the participants were recorded. LncRNA ANRIL and miRNA-125a expression levels in plasma were determined using qRT-PCR. Tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-6 and IL-17 levels in plasma were determined using enzyme-linked immunosorbent assay (ELISA). Results LncRNA ANRIL expression was the highest in the asthma exacerbation children, followed by asthma remission children and healthy controls. There were significant differences in the expression of lncRNA ANRIL among the three groups (all P<0.01). Receiver operating characteristic curves revealed that lncRNA ANRIL could well differentiate the participants in the three groups. In the children with asthma exacerbation, lncRNA ANRIL expression was associated with disease severity (P=0.001), positively associated with the levels of TNF-α, IL-1β, IL-6 and IL-17 (all P<0.05), while negatively associated with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and FEV1 as percentage of predicted (FEV1%Pred) value (both P<0.05). LncRNA ANRIL expression was also positively associated with the levels of TNF-α, IL-1β and IL-17 in the asthma remission children and IL-6 level in healthy controls (all P<0.05). LncRNA ANRIL expression was negatively associated with miRNA-125a expression in all the participants (all P<0.05). Besides, miRNA-125a expression was positively correlated with FEV1/FVC and FEV1%Pred value in the children with asthma exacerbetion (both P<0.001). Conclusion LncRNA ANRIL may serve as a novel biomarker for predicting asthma, asthma acute exacerbation and severity, and inflammation level. It may participate in the development and progression of asthma in children via targeting miRNA-125a..

Study on effects of different habitat processing methods of Salviae Miltiorrhizae Radix et Rhizoma in rats with acute myocardial ischemia / 中国中药杂志

To investigate the effects of different habitat processing methods of Salviae Miltiorrhizae Radix et Rhizoma on acute myocardial ischemia induced by pituitrin in rats. In this experiment, the tail vein injection of pituitrin was used to induce acute myocardial ischemia in rats. Electrocardiograph(ECG) heart rate and ΔST changes were recorded, and the levels of creatine kinase isoenzyme(CK-MB), lactate dehydrogenase(LDH), superoxide dismutase(SOD) and malondialdehyde(MDA) in serum of rats were detected to comprehensively evaluate the effects of six processing methods of Salviae Miltiorrhizae Radix et Rhizoma on serum biochemical indexes of rats with acute myocardial injury. The ECG results showed that the Salviae Miltiorrhizae Radix et Rhizoma dried in a drying oven had a good effect on the improvement of heart rate and ΔST of electrocardiogram after ischemia, and all the other groups had some protective effects to different degrees. The results of biochemical indexes in serum of each group after ischemia showed that the activity of CK-MB decreased most significantly in Salviae Miltiorrhizae Radix et Rhizoma high-dose group with drying in a drying oven after sweating and losing weight in a drying oven, high-dose group with drying in the shade and low-dose group with drying in the shade. The activity of LDH decreased most significantly in Salviae Miltiorrhizae Radix et Rhizoma high-dose group with drying in the shade and low-dose group of drying in the shade. The activity of SOD increased most significantly in Salviae Miltiorrhizae Radix et Rhizoma low-dose group with drying in sun, low-dose group with drying in sun after sweating and losing weight in sun, and low-dose group with drying in a drying oven. The activity of MDA decreased most significantly in Salviae Miltiorrhizae Radix et Rhizoma low-dose group with drying in sun. The comprehensive scoring results showed that the highest score was obtained in Salviae Miltiorrhizae Radix et Rhizoma high-dose group with drying in the shade while the scores of other treatment groups were higher than that of the model group. It could be seen that the Salviae Miltiorrhizae Radix et Rhizoma dried in a drying oven had a good improvement effect on electrocardiograph indexes after acute myocardial injury, the Salviae Miltiorrhizae Radix et Rhizoma dried in the shade had a good improvement effect on serum myocardial enzymes after acute myocardial injury, and the other processing methods had a certain protective effect on myocardial injury. The six processing methods evaluated by pharmacodynamics showed that the Salviae Miltiorrhizae Radix et Rhizoma dried in the shade and dried in a drying oven had good efficacy.

Dexmedetomidine Receptor Dependently Enhanced Macrophage Phagocytosis / 中山大学学报(医学科学版)

@#【Objective】To investigate the effect of dexmedetomidine on the phagocytosis of macrophages.【Methods】 RAW264.7 cells were divided into control group，DEX group，and BRL44408 + DEX group. Expression of α2A adrenergic receptor，p-Akt and Akt were detected by Western Blotting；Phagocytosis Assay Kit（IgG PE）was used to measure the phagocytosis of macrophages. 【Results】 α2A adrenergic receptor was detected in RAW264.7 cells；Dexmedetomidine could enhance the phagocytosis of macrophages（P < 0.001），and BRL44408 reversed the enhancement of phagocytic ability of macrophages（P < 0.001）；Dexmedetomidine upregulated the expression of Akt in RAW264.7 cells，while the use of BRL44408 inhibited the activation of the Akt pathway（P < 0.01）.【Conclusion】Dexmedetomidine could enhance phagocytosis of RAW264.7 by activating the Akt pathway through the α2A adrenergic receptor.

Effect of Modified Dihuang Yinzi on Learning and Memory Ability and Neuron Damage in Hippocampal CA1 Area in Rats with Vascular Dementia / 中国实验方剂学杂志

Objective::To observe the effect of modified Dihuang Yinzi on the learning and memory ability and on the neurons in CA1 area of hippocampus of rats suffering from vascular dementia. Method::The 84 male SD rats were randomly selected to form the sham operation group of 12 rats, and the other 72 rats were chosen for the vascular dementia model by means of Bivascular occlusion, and among which 60 were chosen randomly into 6 groups of 12 rats, namely, the model group, the nimodipine group (0.011 g·kg-1), and the high, medium and low dose modified Dihuang Yinzi (4.54, 2.27, 1.14 g·kg-1) respectively. After 30 days of continuous gavage, Morris water maze was used to detect the learning and memory ability of rats, hematoxylin eosin (HE) was used to observe the morphological changes of hippocampal CA1 neurons, transmission electron microscopy was used to observe the ultrastructural changes of hippocampal CA1 neurons, TUNEL was used to detect the apoptosis level of hippocampal CA1 neurons, immunohistochemical(IHC) was used to detect the expression level of phosphatidylinositol-3(PI3K), protein kinase B (Akt), Caspase-3 in hippocampal CA1 tissues. Result::Compared with sham operation group, the escape latency of the model group was significantly prolonged, the number of times of crossing the original platform was significantly reduced (P<0.01), the neuronal morphology of hippocampal CA1 area was damaged to varying degrees, the apoptosis rate was significantly increased (P<0.01), the integral optical density and average optical density of PI3K, Akt were significantly reduced (P<0.01), and the integral optical density and average optical density of Caspase-3 were significantly reduced (P<0.01). Compared with model group, the escape latency was shortened (P<0.05, P<0.01), the number of crossing the original platform was increased (P<0.05, P<0.01), the integrated optical density and average optical density of PI3K and Akt were significantly increased (P<0.01), and the integrated optical density and average optical density of Caspase-3 were decreased in different degrees (P<0.05, P<0.01). Conclusion::Modified Dihuang Yinzi can improve the learning and memory ability of vascular dementia model rats and the damaged neurons in the hippocampal CA1 area. The potential mechanism may be related to the activation of PI3K/Akt signal transduction pathway and the inhibition of apoptosis of neurons in hippocampal CA1 area of rats.

Therapeutic Effect and Mechanism of Taohong Siwu Granule on Rats with Dysmenorrhea Due to Cold Coagulation and Blood Stasis / 中国实验方剂学杂志

Objective:To observe the effect of Taohong Siwu granule on dysmenorrhea rats. Method:Forty-eight healthy SD female rats were randomly divided into six groups: control group, model group, Taohong Siwu granule groups (18, 9, 4.5 g·kg-1) and Fuke Qianjin tablet group (0.08 g·kg-1). The rats were given Bugaorer (0.35 mg·kg-1) every day and ice-water bath for 8 minutes for 10 consecutive days. Oxytocin was injected intraperitoneally on the 11th day. The writhing reaction of rats was observed, and the effect of Taohong Siwu granules on hemorheology was measured. The levels of 6-ketoprostacyclin F1α(6-keto-PGF1α), thromboxane B2(TXB2), prostaglandinF2α（PGF2α）, PGE2 of rats were detected by enzyme-linked immunosorbent assay (ELISA). Ca2+ in uterine tissues was scanned by laser confocal microscopy. Result:Each dose of Taohong Siwu granule group reduced the number of writhing, the time of writhing and the incidence of writhing in dysmenorrhea rats, which were significantly lower than those in model group (P<0.05，P<0.01). Compared with the model group, high, medium and low-dose Taohong Siwu granules groups could reduce blood viscosity and plasma viscosity, and Taohong Siwu granules can significantly reduce the content of TXB2, Ca2+，PGF2α, and significantly increase the content of 6-keto-PGF1α，PGE2 (P<0.05，P<0.01). Conclusion:Taohong Siwu granule can significantly alleviate dysmenorrhea symptoms in rats. The mechanism may be correlated with the contents of 6-keto-PGF1α, TXB2 and PGF2α, PGE2 and Ca2+.

Current situation on the global distribution of hepatitis B virus subtypes / 中华疾病控制杂志

Hepatitis B virus (HBV) infection is an important global public health concern and a major cause of chronic hepatitis, cirrhosis and liver cancer. Many studies have shown that different genotypes and subtypes have significant differences in pathogenicity, thus affecting the disease progression and prognosis of infected individuals. So far, a total of 10 HBV genotypes and more than 40 subtypes have been reported across the world, and these subtypes have shown distinct distribution characteristics. In the present review, we systematically summarized the current situation on the global distribution of HBV genotypes.

Effects of Incretin-based Therapies on Weight-related Indicators among Patients with Type 2 Diabetes: A Network Meta-analysis / 生物医学与环境科学（英文）

Objective@#To evaluate the effects of incretin-based therapies on body weight as the primary outcome, as well as on body mass index (BMI) and waist circumference (WC) as secondary outcomes.@*Methods@#Databases including Medline, Embase, the Cochrane Library, and clinicaltrials.gov (www.clinicaltrials.gov) were searched for randomized controlled trials (RCTs). Standard pairwise meta-analysis and network meta-analysis (NMA) were both carried out. The risk of bias (ROB) tool recommended by the Cochrane handbook was used to assess the quality of studies. Subgroup analysis, sensitivity analysis, meta-regression, and quality evaluation based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were also performed.@*Results@#A total of 292 trials were included in this study. Compared with placebo, dipeptidyl-peptidase IV inhibitors (DPP-4Is) increased weight slightly by 0.31 kg [95% confidence interval ( ): 0.05, 0.58] and had negligible effects on BMI and WC. Compared with placebo, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) lowered weight, BMI, and WC by -1.34 kg (95% : -1.60, -1.09), -1.10 kg/m (95% : -1.42, -0.78), and -1.28 cm (95% : -1.69, -0.86), respectively.@*Conclusion@#GLP-1 RAs were more effective than DPP-4Is in lowering the three indicators. Overall, the effects of GLP-1 RAs on weight, BMI, and WC were favorable.

Research progress of single nucleotide polymorphism and development of high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#At present, myopia has become a public health disease worldwide, and its occurrence is mostly caused by genetic and environmental factors. Single nucleotide polymorphisms(SNPs)are the changes in single base at the genomic level caused by DNA sequence polymorphisms. In recent years, it is reported that the change of SNPs in myopic related gene loci is closely related to the occurrence and development of myopia. The present paper reviewed the current status of the association between SNPs of myopia-related genes and the development of myopia, providing a new insight into the future research of pathogenesis of myopia.

Retrospective Analysis of Gestational Adverse Drug Reactions from Sichuan Center for Adverse Drug Reaction Monitoring from Nov. 2016 to Nov. 2017 / 中国药房

OBJECTIVE： To investigate the characteristics and regularity of gestational （including perinatal period） adverse drug reactions （ADR） in Sichuan province， and to provide evidence for ensuring the safety and effectiveness of drug use in clinic. METHODS： Gestational ADR reported to Sichuan provincial ADR monitoring center from Nov. 2016 to Nov. 2017 were statistically analyzed in respects of report source， personnel distribution， general information of patients， route of administration， drug types and main drugs， involved system/organ， grading and outcome， etc. RESULTS： A total of 1 309 gestational ADR cases   （1 340 case time） were collected， in which 1 305 were from medical institutions， 3 from enterprises and 1 from manufacturer. There were 986 physicians， 188 nurses， 133 pharmacists and 2 commissioners for drug safety. 859 cases （65.62％） were 21-30 years old， accounting for the largest proportion. 867 case time were caused by intravenous administration （64.70％）. ADR-inducing drug types mainly included reproductive system drugs （491 case time， 36.64％）， antimicrobial drugs （479 case time， 35.75％） and blood system drugs （110 case time， 8.21％）. Main of them were Carboprost tromethamine injection （187 case time， 13.96％）， Cefazolin sodium for injection （122 case time， 9.10％） and Oxytocin injection （105 case time， 7.84％）. ADR mainly involved skin and its appendants （517 case time， 33.95％）， gastrointestinal system （387 case time， 25.41％）， whole body （175 case time， 11.49％）.  In 1 309 gestational ADR， 1 251 cases （95.57％） were general ADR； 58 cases （4.43％） were severe ADR， including 14 life-threatening cases， 7 extended hospital stay and 37 others； 592 （45.22％） patients improved， 716 （54.70％） recovered and 1 （0.08％） did not improve. CONCLUSIONS： In clinical practice， it is necessary to strengthen the monitoring of drug use in patients during gestational， especially monitor ADR of uterine contraction drugs and antimicrobial drugs during gestational， use drug cautiously and promote clinical medication safety in gestational patients.

Investigation and Reason Analysis of Drug Shortage in 78 Medical Institutions from Sichuan Province / 中国药房

OBJECTIVE： To investigate the situation and reasons of drug shortage in some medical institutions from Sichuan province. METHODS： A questionnaire survey was conducted among 78 medical institutions in Sichuan province by stratified random sampling. The situation of drug shortage were collected from Jan. 2015 to Jun. 2017， mainly including the basic information of medical institutions， drug shortage situation， specific drug shortage information and the reasons for drug shortage. Descriptive analysis of the information collected by the questionnaire was carried out， and Logistic regression analysis of the data by SPSS 20.0 software was adopted to find out the key factors affecting drug shortage. RESULTS & CONCLUSIONS： Totally 78 medical institutions include 13 third-level hospitals， 22 second-level hospitals and 43 primary medical institutions （10 community health service centers， 33 township health centers）. A total of 78 questionnaires were sent out， and the recovery rate and effective rate both were 100％. Among them， 68 medical institutions reported 206 shortage drugs totally， involving 240 specifications. The prices of more than 88.34％ of the shortage drug were less than 50 yuan. Main types of shortage drugs included anti-infective drugs， central nervous system drugs and cardiovascular system drugs， and most of them were purchased directly through internet. The proportion of temporary shortage （shortage time＜3 months） and long-term shortage （shortage time＞12 months） was relatively high （more than 68％ in total）. Drug supply and medical institutions’own factors were two main causes of drug shortage. Logistic regression analysis showed that main factors affecting the time of drug shortage were hospital drug purchase process， location of medical institution and drug purchase price. The main factors affecting the specifications of drug shortage in medical institutions were the process of drug purchase， the limitation of hospital purchase catalogue， primary or non-primary medical institution， comprehensive or specialized hospitals. It is suggested that medical institutions in this region can reduce the drug shortage caused by their own reasons by building a platform for drug information management， optimizing drug purchase catalogues and plans， strengthening the management of pharmacy inventory and establishing a regulatory system for distribution enterprises.

Analysis of the Reasons for Drug Shortage and Countermeasure Study in Medical Institutions of Sichuan Province from the Perspective of Manufacturers and Distribution Enterprises / 中国药房

OBJECTIVE： To investigate the reasons for drug shortage in medical institutions of Sichuan province and put forward relevant countermeasures， and to provide reference for establishing supply security mechanism of drug shortage. METHODS： Questionnaire survey was conducted to investigate drug shortage in 78 medical institutions of the province during Jan. 2015-Jun. 2017. Traceability investigation was conducted from manufacturers and distribution enterprises involved in drug shortage. Questionnaire survey and field investigation were combined to analyze the reasons for drug shortage in Sichuan province and put forward countermeasures. RESULTS： Totally 78 questionnaires were sent out to medical institutions with recovery rate and effective rate of 100％. A total of 206 drugs were reported by 78 medical institutions， involving 240 specifications for shortage in total. Totally 140 questionnaires and 68 questionnaires were distributed to the manufacturers and distribution enterprises involved in drug shortage， and the recovery rate and effective rate were all 100％. Combined with the field survey， survey results of shortage drugs of 212 specifications were obtained. From the perspective of manufacturers， the most important factors causing drug shortage were the increase of production cost （66.51％） and circulation cost（26.88％）. From the perspective of distribution enterprises，the main factors causing drug shortage were insufficient supply of drugs（75.47％），inventory management（16.51％） and price inversion（11.32％）. CONCLUSIONS： Main reasons of drug shortage from manufacturers and distribution enterprises include the increase of production cost and circulation cost， drug price inversion， inventory management and bidding procurement. It is suggested that measures should be taken to improve the bidding and pricing system of drugs， mobilize the enthusiasm of enterprises； improve the early warning mechanism of drug shortage on the enterprises， strengthen information communication； establish the mechanism of drug shortage reserve， organize the emergency production of drug for shortage； strengthen the management of drug shortage supply chain， purify the unhealthy atmosphere in the market； improve the emergency disposal methods of drug shortage， and improve the supply guarantee ability of drug shortage. Departments cooperate to reduce the emergence of drug shortage and ensure the continuous access to safe and effective drugs in clinic.

Analysis of the Literature Quality of Systematic Evaluation/Meta-analysis of Oral Administration of Traditional Chinese Medicine in the Treatment of Lumbar Disc Herniation Based on Radar Plot / 中国药房

OBJECTIVE： To evaluate the literature quality of systematic reviews/Meta-analysis of oral administration of traditional Chinese medicine （TCM） in the treatment of lumbar disc herniation （LDH） using radar plot， and to provide scientific and effective evidence for clinical use of medicine. METHODS： Retrieving CNKI， VIP， Wanfang database， CBM， PubMed， Cochrane library and Embase during the establishement of database to Oct. 1st， 2018， the literatures about systematic reviews/Meta-analysis of oral administration of TCM in the treatment of LDH were collected. After data extraction of literatures met inclusion criteria， the quality literatures were evaluated from 6 aspects of radar plot （year of publication， design type， AMSTAR methodological quality evaluation， PRISMA reprot quality evaluation， homogeneous， publication bias risk）. The average score of rank number was calculated. Moreover， Excel 2010， Adobe Illustrator CC and other software were used to draw and optimize the radar plot. RESULTS： A total of 6 qualified literatures were included； average score of rank number of 6 aspects were 3.83， 4.67， 3.83， 3.67， 6.00， 4.67， scoring 4.56 in average. Multivariate evaluation of radar plot showed that 2 studies had higher qualities and only 1 study had lower qualities relatively. However， problems could be found such as information selection bias， inclusion and exclusion criteria， publication situation， limitations， project registration. CONCLUSIONS： The literature quality of systematic review/Meta-analysis of oral administration of TCM in the treatment of LDH need to be improved， starting with strengthening methodological quality and reporting quality. Radar plot is a visual and effective method of graphic evaluation， which is worth popularizing and applying in the future.