Historical Evolution and Herbal Textual Research of Jupi Zhurutang / 中国实验方剂学杂志

Jupi Zhurutang originated from Synopsis of the Golden Chamber （《金匮要略》）， which consists of Pericarpium Citri Reticulatae， Caulis Bambusae in Taenia， Ginseng Radix et Rhizoma， Zingiberis Rhizoma Recens， Jujubae Fructus， and Glycyrrhizae Radix et Rhizoma and is used to treat retching. It has been put on the list of Catalogue of Ancient Classical Prescription （First Batch） released by National Administration of Traditional Chinese Medicine. With the bibliometric method， we searched the medical classics containing Jupi Zhurutang and systematically examined the information on the origin of the prescription， the indications， compatibility rule， medicinals in the prescription， dosage and usage， processing method， and decocting method. It was found that there are many versions of Jupi Zhurutang， and there are common grounds of main symptoms， pathogenesis， composition and dosage between the same prescription with different names and different prescriptions with the same name. The prescription which is closest to the original version in Synopsis of the Golden Chamber is mainly used for the treatment of stomach deficiency and qi counterflow without obvious cold or heat. According to the weights and measures， ratio of Pericarpium Citri Reticulatae， Caulis Bambusae in Taenia， Radix Ginseng， Rhizoma Zingiberis Recens， and Radix Ginseng in Synopsis of the Golden Chamber is approximately 6∶2∶8∶5∶1. The Jupi Zhurutang derived from other ancient classics such as Yanshi Jisheng Fang（《严氏济生方》） is a different prescription for hiccups caused by the stomach heat， and the ratio of Pericarpium Citri Reticulatae to Caulis Bambusae in Taenia in this prescription is about 1∶1. It is also found that cold herbs such as Red Poria， Eriobotryae Folium and Ophiopogon Japonicus are added to the formula in later generations. Therefore， the Jupi Zhurutang used in modern times is mostly modified and different from that in Synopsis of the Golden Chamber. This study summarizes the historical evolution of Jupi Zhurutang and identifies the key information， with a view to providing a reference for the rational modification of this prescription in clinical settings and further research.

Application of noninvasive prenatal DNA screening combined with nuchal translucency thickness measurement in the diagnosis of fetal chromosomal aneuploidy / 中国基层医药

Objective:To investigate the application value of noninvasive prenatal DNA screening combined with nuchal translucency thickness measurement in the diagnosis of fetal chromosome aneuploidy.Methods:A total of 5 730 pregnant women who were screened for fetal chromosomal diseases in the Quzhou Maternal and Child Health Hospital from January 2017 to March 2019 were included in this study. All of them underwent noninvasive prenatal DNA screening and nuchal translucency thickness measurement. The results of amniocentesis were used as the gold standard to evaluate the diagnostic efficacy of noninvasive prenatal DNA screening, nuchal translucency thickness measurement and their combination.Results:Noninvasive prenatal DNA screening revealed that 64 (1.12%) women out of 5 730 pregnant women had high risk of developing chromosomal abnormalities. Ultrasound examination results showed that nuchal translucency was thickened in 140 (2.44%) women. The outcome of adverse pregnancy increased with the increase of nuchal translucency thickness. Among the 68 pregnant women who underwent amniocentesis, 51 women developed chromosomal abnormalities, with trisomy 21 syndrome being the majority (23/51,45.10%). The diagnostic efficacy of noninvasive prenatal DNA screening combined with nuchal translucency thickness measurement in the diagnosis of fetal chromosomal aneuploidy reached the ideal level.Conclusion:Noninvasive prenatal DNA screening combined with nuchal translucency thickness measurement has a high clinical application value. The combined method can be used as the main prenatal DNA screening method for pregnant women and it can effectively avoid the birth of children with chromosomal abnormalities.

Evaluation of psychological pain for cancer patients and analysis of contributory factors / 中国胸心血管外科临床杂志

@#Objective    To evaluate the degree of psychological pain for cancer patients undergoing surgical treatment and analyze the contributory factors to provide the theoretical basis for psychological intervention for cancer patients with surgical treatment. Methods    The clinical data of 455 cancer patients who received surgeries in our hospital from November 2020 to January 2021 were retrospectively analyzed, including 225 males and 230 females aged 53.80±13.50 years. By applying the method of convenient sampling, a cross-sectional survey was carried out by gathering the general information of the patients and evaluating their mental condition with the distress thermometer. The contributory factors were discussed by logistic regression analysis. Results    The score for the psychological pain of the patients was 4.11±2.49 points. The main factors contributing to the psychological pain were physical problems, emotional problems and family matters. The logistic regression analysis showed that the main factors related to the degree of psychological pain were cancer types (P=0.023), religious belief (P=0.046), number of niduses (P=0.016), respiratory status (P=0.004), medical expense (P=0.007), grief (P=0.001) and anxiety (P=0.040). Conclusion    Nearly half of the patients have been subjected to apparent psychological pain, and emotion and physical problems are the main factors. It is crucial to pay attention to the patients’ mental problems, seek convenient tools for psychological evaluation, and take actions to deal with the psychological problems and physical symptoms.

Wutou Chishizhi Wan Regulates Autophagy and PI3K/Akt/GSK-3β Signaling Pathway in Rats with Myocardial Ischemia-reperfusion Injury / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Wutou Chishizhi Wan in regulating autophagy and phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/glycogen synthase kinase-3β （GSK-3β） signaling pathway in rats with myocardial ischemia-reperfusion injury （MIRI）. MethodSixty male SD rats were randomly assigned into the normal group （normal saline）， model group （normal saline）， positive control （trimetazidine， 5.4 mg·kg-1） group， and low-， medium-， and high-dose （1.63， 4.9， 14.7 g·kg-1， respectively） Wutou Chishizhi Wan groups， with 10 rats in each group. The rats in other groups except the normal group underwent left anterior descending coronary artery ligation for modeling. Electrocardiogram was employed to detect the ST-segment elevation to evaluate the modeling. Hematoxylin-eosin （HE） staining was performed to reveal the damage of myocardial tissue. The levels of aspartate aminotransferase （AST） and creatine kinase （CK） were determined by colorimetry， and those of cardiac troponin T （cTnT） and myoglobin （MYO） by enzyme-linked immunosorbent assay （ELISA）. Western blot was carried out to determine the protein levels of microtubule-associated proteins 1 light chain 3 （LC3）， autophagy-related gene Beclin-1， PI3K， Akt， GSK-3β， p-GSK-3β， and p-Akt. ResultCompared with the normal group， the modeling elevated the serum levels of AST， CK， cTnT， and MYO （P<0.01）， destroyed the arrangement of myocardial cells abd nucle， twisted and broken myocardial fibers， up-regulated the protein levels of LC3Ⅱ/Ⅰ and Beclin-1 （P<0.01）， and down-regulated the protein levels of PI3K， p-Akt， and p-GSK-3β （P<0.01）. Compared with the model group， trimetazidine and Wutou Chishizhi Wan （all the doses） lowered the levels of AST， CK， cTnT， and MYO in serum （P<0.01）， restored the arrangement of myocardial cells and muscle fibers， reduced necrosis， down-regulated the protein level of Beclin-1 （P<0.01）， and up-regulated the protein levels of PI3K， p-Akt， and p-GSK-3β （P<0.01）. Additionally， Wutou Chishizhi Wan （all the doses） down-regulated the protein level of LC3Ⅱ/Ⅰ （P<0.05， P<0.01）. Compared with those in the trimetazidine group， the serum AST level rose in the low-dose Wutou Chishizhi Wan group （P<0.05） and declined in the high-dose group （P<0.01）， and the protein level of Beclin-1 was down-regulated in the medium-dose group （P<0.01）. Additionally， the trimetazidine group had higher protein level of LC3Ⅱ/Ⅰ than medium- and high-dose Wutou Chishizhi Wan groups （P<0.05， P<0.01）， higher protein level of PI3K than low-， medium-， and high-dose groups （P<0.01）， lower protein level of p-Akt than low- and medium-dose groups （P<0.01）， and higher p-GSK-3β protein level than the medium-dose group （P<0.01）. ConclusionDifferent doses of Wutou Chishizhi Wan can ameliorate MIRI， and the high dose has the best effect. Wutou Chishizhi Wan can reduce the activity of myocardial injury markers AST， CK， cTnT， and MYO， and alleviate the pathological damage of myocardial tissue. It can down-regulate the protein levels of beclin-1， LC3Ⅱ/Ⅰ， and up-regulate those of PI3K， p-Akt， and p-GSK-3β. In summary， Wutou Chishizhi Wan may inhibit excessive autophagy and regulate the PI3K/Akt/GSK-3β signaling pathway to exert protective effect on MIRI rats.

Application of lumbar plexus-sciatic nerve block combined with low-dose Remimazolam anesthesia in elderly patients with intertrochanteric fractures / 中华老年医学杂志

Objective:To explore the value of lumbar plexus-sciatic nerve block combined with low-dose Remimazolam in elderly proximal femoral nail anti-rotation(PFNA)surgery.Methods:60 elderly patients with PFNA surgery were treated from September 2021 to March 2022 in our hospital.They were randomly divided into Propofol group receiving intravenous general anesthesia with laryngeal mask combined with Propofol(control group, n=30)and Remimazolam group with lumbar plexus-sciatic nerve block with laryngeal mask combined with low-dose Remimazolam anesthesia(experimental group, n=30). Mean arterial pressure(MAP)at different time points, heart rate, awakening quality[laryngeal mask removal time], vigilance / sedative observation(OAA / S)score at 15 min after surgery, observation time and various adverse reactions in anesthesia recovery room(in a postanaesthesia care unit, PACU), Montreal cognitive function scale(MoCA)1 day after operation, visual analog score(VAS)at different time points were compared between the two groups.Results:The levels of MAP and HR at the moments of T1, T2, T3, and T4 were lower in the observation group than in the control group(all P<0.05). The time of laryngeal mask removal was shorter in the observation group than in the control group[(8.7±1.3)min and(12.3±1.4)min, t=7.09, P<0.001]. The OAA/S scale value at 15 min after surgery was higher in the observation group than in the control group[(4.6±0.3)and(4.1±0.5), t=4.841, P<0.001]. The incidence of adverse reactions was lower in the observation group than in the control group(3.3% and 20%, χ2=4.043, P=0.044). Visual analogue scale(VAS)value at 3, 6 and 9 hour after surgery were lower in the observation group than in the control group(all P<0.05). The MoCA scores at 6 and 12 hours after operation were higher in the observation group than in the control group( P<0.05). Conclusions:Lumbar plexus-sciatic nerve block combined with low-dose Remimazolam in elderly PFNA surgery is effective and safe, which can reduce the intraoperative hemodynamic fluctuations, optimize the patient's recovery quality, facilitate the postoperative cognitive function recovery, reduce the various adverse reactions, and provide the good analgesic effect within 12 hours after operation.

Clinical characteristics of patients with COPD and obstructive sleep apnea or other comorbidities / 中华健康管理学杂志

Objective:To assess the clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) or other comorbidities.Methods:In this cross sectional study, a total of 2 090 patients with confirmed COPD which came from Renmin Hospital of Wuhan University from August 2017 to October 2021 were included to investigate the prevalence of comorbidities (hypertension, diabetes, cardiovascular disease, cerebrovascular disease, metabolic diseases and osteoporosis) and clinical characteristics. All subjects underwent overnight polysomnography, clinical symptom questionnaire and sleep questionnaire. The data of baseline, blood biochemistry, arterial blood gas, lung function, sleep questionnaire, sleep monitoring and other indicators were compared between group with COPD only and with COPD and OSA.Results:55.84% of COPD patients (1 167/2 090) with OSA were included in the study. By analyzing the prevalence of comorbidities (hypertension, diabetes, cardiovascular disease, cerebrovascular disease, metabolic diseases and osteoporosis), this study found that only the prevalence of hypertension was significantly higher in the group with COPD and OSA ( P<0.01) when compared with the COPD only group (35.2%). As the severity of OSA increased in COPD patients, the incidence of hypertension increased. The prevalence of hypertension was 35.2%, 37.5%, 44.9%, 53.2% in non-OSA, mild, moderate, and severe OSA patients, respectively. By binary logistic regression analysis, the BMI ( OR=1.067, 95% CI: 1.043-1.091, P<0.01) , neck circumference ( OR=1.019, 95% CI: 1.002-1.036, P<0.05), smoking history ( OR=1.345, 95% CI: 1.028-1.760, P<0.05), hypertension ( OR=1.249, 95% CI: 1.024-1.522, P<0.05) were regarded as independent risk factors for patients with COPD and OSA. Conclusions:COPD patients have a high rate of OSA. In clinical practice, greater emphasis on primary/secondary prevention should be paid to COPD patients with OSA and hypertension. The management and intervention of OSA and hypertension may improve the prognosis of CODP patients.

Research progress on prognostic factors of Legg-Calvé-Perthes disease in children / 中华骨科杂志

Legg-Calvé-Perthes disease (LCPD) is an idiopathic necrosis of the femoral head in childhood, the deformities of the femoral head occurring in the progress of disease could result in osteoarthritis. Treatment can be surgical or nonsurgical, but the timing and indications remain unclear. Understanding of the prognostic factors of LCPD is helpful to predict the outcome and guide the clinical management. This study reviewed the literatures about the prognosis of LCPD since 2000, the prognostic factors were summarized from three categoriesas general factors, disease factors and intervention factors. The general factors were the characteristic information of patient that can be obtained at the first time clinically. The age of onset is the most definite prognostic factor, the younger the age, the better the prognosis, and 6-8 years is an important watershed. Disease factors refer to the disease characteristic information obtained through evaluation. The modified Waldenstr?m stage of the disease needs to be confirmed first, early treatment can ensure better prognosis. Then the severity was evaluated, including the involvement of necrosis, morphological changes and extrusion of the femoral head. The more severe the disease, the worse the prognosis. Most predicters, such as Catterall grading and Herring lateral column typing, have to be used in late-stage of LCPD. The degree of femoral head perfusion evaluated in enhanced MRI or DWI-MRI is an early predictor of LCPD, but it is still in the preliminary exploratory. Intervention factors are the effects of different methods of treatment on prognosis, including the comparison of surgery or non-surgery, different non-surgical and different surgical methods. The determination of surgical or non-surgical treatment mainly depends on the age of onset and severity of disease, and the younger and milder cases tend to be non-surgical treatment, but the specific indications are still controversial.

Screening results and analysis of risk factors of developmental dysplasia of hip in infants in Tianjin / 中华骨科杂志

Objective:To investigate the Graf classification results and risk factors of infants for developmental dysplasia of the hip (DDH) by B-ultrasound screening in Tianjin.Methods:A retrospective analysis was conducted from January 2013 to December 2020 using the three-tier maternal and child health care management and the Tianjin maternal and child health information system for the early B-ultrasound screening data of 6-8 weeks old infants. The "2+1" screening model of "primary screening-re-screening-diagnostic treatment" was applied. The positive screening rate and age of infants at the time of referral for treatment in different years and different Graf classifications were analyzed, and the differences in positive infants with different sex, parity, fetal position, mode of production, gestational age, birth weight, and family history were compared. Binary logistic regression was used to analyze risk factors for DDH.Results:A total of 807 889 babies were screened, and 2 039 children (2 841 hips) were detected with B-ultrasound Graf classification count IIa and above, with the positive rate was 2.52‰ (2 039/807 889). Among the abnormal hips, 685 were type IIa(+) hips, 959 were type IIa(-) hips, 367 were type IIb hips, 262 were type IIc hips, 227 were type D hips, 265 were type III hips, and 76 were type IV hips. Type IIa(-) was the most common, accounting for 33.76% (959/2 841), type IIa(+) accounted for 24.11% (685/2 841), type D and above was 19.99%(568/2 841). The abnormality rate of the left hip was 2.02‰ (1 632/807 889), which was greater than 1.50‰ (1 209/807 889) of the right side, and the difference is statistically significant (χ 2=63.09, P<0.001). The rate of hip abnormalities in female infants was 3.27‰ (2 541/777 272), greater than 0.36‰ (300/838 506) in male infants, which the difference between the sexes had statistically significant (χ 2=1 947.871, P<0.001). The positive rate of DDH in male infants was 0.50‰ (209/419 253), and that in female infants was 4.71‰ (1 830/388 636). The detection ratio of male to female infants was 1∶8.76, and the difference in the positive rate of DDH between the sexes was statistically significant (χ 2=1 420.102, P<0.001). Different fetal position (cephalic position/breech presentation), delivery method (normal delivery/cesarean section), birth weight (normal/low weight), family history (with DDH/without DDH) showed statistically significant differences in the positive rate of DDH ( P<0.05), whereas there was no significant difference in the positive rate of DDH at different parity (first/second and above) and gestational age (term/premature) ( P>0.05). Logistic regression analysis showed that gender ( OR=10.50, P<0.001) and fetal position ( OR=3.40, P<0.001) were independent risk factors for DDH, and gestational age ( OR=0.91, P<0.001) was a protective factor for DDH. Differences in referral age of infants with different B-ultrasound Graf classification from year to year were statistically significant ( P<0.05). Conclusion:Through the "2+1" screening model of "primary screening-re-screening-diagnostic treatment", the DDH positive rate in 6-8 weeks old infants in Tianjin was 2.52‰, and the positive rate of DDH in female infants and left hip was higher. The more severe the Graf classification of B-ultrasound was, the younger the age of referral was. Women and infants with breech presentation had a higher risk of developing DDH, and the risk of DDH in preterm infants was lower.

Efficacy of basiliximab in the treatment of 87 cases of steroid-refractory or steroid-dependent acute graft-versus-host disease / 中华血液学杂志

Objective: To evaluate the efficacy and prognosis of basiliximab in the treatment of steroid-refractory or steroid-dependent acute graft-versus-host disease (SR/SD-aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Clinical data of 87 patients with SR/SD-aGVHD in the skin, intestine, and liver after allo-HSCT at the Institute of Hematology & Blood Diseases Hospital Transplantation Center from January 2015 to December 2018 were retrospectively analyzed. The administration plan of basiliximab was as follows: 20 mg for adults and children weighing ≥35 kg and 10 mg for children weighing<35 kg. The drug was administered once on the 1st, 4th, and 8th days, respectively, and then once weekly. The efficacy was evaluated on the 7th, 14th, 21st, and 28th days after basiliximab treatment. Results: ①There were 51 males (58.6%) and 36 females (41.4%) , with a median (range) age of 34 (4-63) years. There were 54 cases of classic aGVHD, 33 of late aGVHD, 49 of steroid-refractory aGVHD, and 38 of steroid-dependent aGVHD. ②Thirty-five patients (40.2%) achieved complete remission (CR) , 23 (26.4%) achieved partial remission (PR) , and 29 had no remission (NR) . The total effective rate[overall response rate (ORR) ] was 66.7% (58/87) . ③The ORR of the classic and late aGVHD groups was 77.8% (42/54) and 48.5% (16/33) , respectively. ④The median (range) follow-up time was 154 (4-1813) days, the 6-month overall survival (OS) rate of the 87 patients was 44.8% (95% CI 39.5%-50.1%) and the 1-year OS was 39.4% (95%CI 34.2%-44.3%) . ⑤After treatment with basiliximab, the 6-month OS in the CR (35 cases) , PR (23 cases) , and NR (29 cases) groups was 80.0% (95%CI 73.2%-86.8%) , 39.1% (95%CI 28.9%-49.3%) , and 6.9% (95%CI 2.2%-11.6%) , respectively (χ(2)=34.679, P<0.001) , and the 1-year OS was 74.3% (95%CI 66.9%-81.7%) , 30.4% (95%CI 20.8%-40.0%) , and 3.4% (95%CI 0%-6.8%) , respectively (χ(2)=43.339, P<0.001) . The OS of the classic and late aGVHD groups was 57.4% (95%CI 50.7%-64.1%) and 24.2% (95%CI 16.7%-31.7%) , respectively (χ(2)=9.109, P=0.004) , and the 1-year OS was 51.9% (95%CI 45.1%-58.7%) and 18.2% (95%CI 11.5%-24.9%) , respectively (χ(2)=9.753, P=0.003) . ⑥Univariate and multivariate analyses showed that late aGVHD (OR=3.121, 95%CI 1.770-5.503, P<0.001) , Minnesota score high-risk group before medication (OR=3.591, 95%CI 1.931-6.679, P<0.001) , active infection before medication (OR=1.881, 95%CI 1.029-3.438, P=0.040) , and impairment of important organ function caused by non-GVHD (OR=3.100, 95%CI 1.570-6.121, P=0.001) were independent risk factors affecting the efficacy of basiliximab. Conclusion: Basiliximab has good efficacy and safety for SR/SD-aGVHD, but not in patients with late aGVHD, high-risk group of Minnesota score, and infection or impaired function of important organs.

Role of DNMT3a in Hydroquinone-Induced Hematopoietic Stem Cell Toxicity / 中国实验血液学杂志

OBJECTIVE@#To investigate the regulatory effect and mechanism of DNA methyltransferase 3A (DNMT3a) in hydroquinone-induced hematopoietic stem cell toxicity.@*METHODS@#Cells (HSPC-1) were divided into 4 groups, that is A: normal HSPC-1; B: HQ-intervented HSPC-1; C: group B + pcDNA3 empty vector; D: group B + pcDNA3- DNMT3a. RT-qPCR and Western blot were used to detect the expression levels of DNMT3a and PARP-1 mRNA and protein, respectively. Cell morphology was observe; Cell viability and apoptosis rate of HSPC-1 were detected by MTT and flow cytometry, respectively.@*RESULTS@#Compared with group A, the expression levels of DNMT3a mRNA and protein in HSPC-1 of group B were decreased, while PARP-1 mRNA and protein were increased (P<0.05); there was no significant difference in the above indexes between group C and group B; compared with group B, the expression levels of DNMT3a mRNA and protein showed increased, while PARP-1 mRNA and protein were decreased significantly in cells of group D transfected with DNMT3a (P<0.05). Cells in each group were transfected with DNMT3a and cultured for 24 h, HSPC-1 in group A showed high density growth and mononuclear fusion growth, while the number of HSPC-1 in group B and C decreased and grew slowly. Compared with group B and C, the cell growth rate of group D was accelerated. The MTT analysis showed that cell viability of HSPC-1 in group B were lower than that of group A at 24 h, 48 h and 72 h (P<0.05); after transfected with DNMT3a, the cell viability of HSPC-1 in group D were higher than that of group B at 24 h, 48 h and 72 h (P<0.05). The apoptosis rate of cells in group B was significantly higher than that of group A (P<0.001), while the apoptosis rate in group D was lower than that of group B (P<0.001).@*CONCLUSION@#DNMT3a may be involved in the damage of hematopoietic stem cells induced by hydroquinone, which may be related to the regulation of PARP-1 activity by hydroquinone-inhibited DNMT3a.

Spindle cell hemangioma: a clinicopathological and molecular analysis of eight cases / 中华病理学杂志

Objective: To investigate the clinicopathological and genetic characteristics of spindle cell hemangioma (SCH). Methods: The clinical, morphological and immunohistochemical features of 8 SCHs diagnosed from January 2013 to September 2021 in West China Hospital, Sichuan University, Chengdu, China were retrospectively analyzed. Hotspot mutations for IDH1 codon 132 and IDH2 codon 172 were tested in 4 SCHs and 29 other non-SCH lesions using Sanger sequencing. Results: The 8 cases occurred in patients with a wide age range, from neonate to 46 years (mean 28 years, median 32 years). Both genders were equally affected. The course of the disease spanned from half a year to 31 years. Two SCHs were recurrent tumors. All tumors involved the distal extremities (4 of foot, 2 of ankle and 2 of hand). Six cases were presented as a single lesion and 2 cases as multiple lesions. The tumor diameters were 1-5 cm. All the 8 SCHs were typically composed of cavernous vascular space and solid components consisting of slit-like vessels, spindle cells and epithelioid endothelial cells which often exhibited cytoplasmic vacuolation. These two alternating components and the vacuolated epithelioid endothelial cells were the distinctive diagnostic clues for SCH. Vascular endothelial cells including epithelioid cells in the solid areas expressed CD31 (8/8), ERG (4/4), CD34 (5/8) and D2-40 (2/3). The spindle cells expressed SMA (8/8). Neither endothelial cells nor spindle cells expressed HHV8 (0/7), Desmin (0/5) or S-100 (0/3). Mutations were revealed in 2 SCHs, with IDH1 mutation (p.R132C) and IDH2 mutation (p.R172G), respectively. The IDH1/2 gene hotspot mutations were not found in the remaining 2 SCHs or the other 29 non-SCH lesions. Simple excisions were performed for 7 cases, and partial resection for 1 case. Follow-up information was obtained in 6 cases, with follow-up time ranging from 5 to 90 months (average, 46 months). No metastasis occurred in the 6 cases. No recurrence occurred in cases treated with simple excision. The residual lesions of the patient who received partial resection were stable. Conclusions: SCH is rare and should be differentiated from a variety of benign and malignant vascular lesions. An accurate diagnosis of SCH is clinically important and can be achieved by combining clinical information and typical pathological presentation. IDH1/2 gene hotspot mutations are specific to SCH in vascular lesions. Genetic detection is helpful in the diagnosis of challenging cases.

Diagnostic value of MDM2 RNA in situ hybridization in atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma / 中华病理学杂志

Objective: To investigate the value of MDM2 RNA in situ hybridization (RNA-ISH) in diagnosing atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and dedifferentiated liposarcoma (DDL). Methods: A total of 26 ALT/WDL/DDLs diagnosed from March 2017 to May 2019 in West China Hospital, Sichuan University, Chengdu, China and 18 control cases were included. MDM2 RNA-ISH was performed on all samples and compared with the fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) regarding their performance in detecting MDM2. Results: All samples were detected successfully using the three methods. Among 26 ALT/WDL/DDLs, all cases showed MDM2 amplification and positivity for MDM2 RNA-ISH (26/26, 100%). Twenty-four (24/26, 92.3%) of the 26 tested cases were positive for MDM2 IHC while two of them were negative. Eighteen control cases were all negative for MDM2 FISH and RNA-ISH, and 15 (15/18) cases were negative for MDM2 IHC. The sensitivity and specificity of RNA-ISH were both 100%, and those of MDM2 IHC were 92.3% and 83.3%, respectively. Diffuse staining was identified in all MDM2 RNA-ISH positive ALT/WDL/DDLs, but identified in only 8/24 (33.3%) of the MDM2 IHC positive cases. Among the 11 ALT/WDL/DDL samples evaluated on tissue microarray, the positive rate of MDM2 RNA-ISH was 100% with diffuse staining in all cases. The positive rate of MDM2 IHC was 9/11 while only 1 of the 9 cases showed diffuse staining. The result of MDM2 RNA-ISH was identical to that of MDM2 FISH and was overall consistent with that of MDM2 IHC (Kappa=0.763, P<0.001). Conclusions: In ALT/WDL/DDLs, results of MDM2 RNA-ISH are highly consistent with those of FISH. MDM2 RNA-ISH is more sensitive and more specific and has more diffuse positive signals than the IHC. The findings indicate that MDM2 RNA-ISH is highly valuable for the diagnosis and differential diagnosis of ALT/WDL/DDLs.

Role and Mechanism of Chinese Medicinal Materials and Their Compound Formulas with Effects of Replenishing Qi， Activating Blood， and Dispelling Stasis in Prevention and Treatment of Heart Failure / 中国实验方剂学杂志

Heart failure with high prevalence is the endpoint of many cardiovascular diseases. Once diagnosed， patients usually need lifelong medication， which seriously affects their quality of life. The drugs commonly used to treat heart failure include angiotensin-converting enzyme inhibitors， beta-blockers， aldosterone receptor antagonists， and diuretics. However， the long-term use of those drugs can lead to side effects such as hypotension， depletion of body fluid， and electrolyte imbalance and even increase mortality. According to the theory of traditional Chinese medicine （TCM）， Qi deficiency and blood stagnation is the major cause of heart failure and when Qi is not moving， blood is not flowing. Therefore， the TCM clinical treatment of heart failure uses the Chinese medicinal materials which replenish Qi， activate blood， and dispell stasis to treat both internal cause and external symptoms. Recent studies have demonstrated that Chinese herbal medicines such as Astragali Radix， Ginseng Radix et Rhizoma， Notoginseng Radix et Rhizoma， Salviae Miltiorrhizae Radix et Rhizoma， Angelicae Sinensis Radix， as well as the compound formulas such as Buyang Huanwutang， Simiao Yongantang， Qili Qiangxin capsules， and Qishen Yiqi drops， play a significant role in the prevention and treatment of heart failure via replenishing Qi， activating blood， and dispelling stasis. Inhibition of oxidative stress and inflammatory responses， mitigation of myocardial fibrosis， improvement of calcium cycling， and protection of mitochondrial function represent the key mechanisms for the treatment of heart failure with Chinese medicinal materials. Focusing on the pathogenic mechanisms and signaling pathways of heart failure， this paper systematically describes the pharmacological effects， molecular mechanisms， and research progress in the clinical application of Chinese medicinal herbs with effects of replenishing Qi， activating blood， and dispelling stasis and their compound formulas in the prevention and treatment of heart failure， aiming to provide scientific evidence for the development and clinical use of anti-heart failure Chinese medicinal materials.

Treatment and prognosis of severe hyperbilirubinemia in full-term infants meeting exchange transfusion criteria: a multicenter retrospective study / 中华围产医学杂志

Objective:To investigate the prognosis of severe hyperbilirubinemia in full-term infants who met the exchange transfusion criteria and were treated by blood exchange transfusion and phototherapy.Methods:A total of 168 full-term infants with severe hyperbilirubinemia who met the criteria for exchange transfusion and were hospitalized in the Neonatology Department of seven tertiary hospitals in Hebei Province from June 2017 to December 2018 were retrospectively included. According to the treatment protocol, they were divided into two groups: exchange transfusion group (38 cases) and phototherapy group (130 cases). Two independent sample t-test and Chi-square test were used to compare the clinical manifestations and follow-up results between the two groups. Multivariate logistic regression was used to analyze the risk factors for poor prognosis. Results:Neonatal severe hyperbilirubinemia in the exchange transfusion and phototherapy group were both mainly caused by hemolytic disease [42.1%(16/38) and 29.2%(38/130)], sepsis [28.9%(11/38) and 11.5%(15/130)] and early-onset breastfeeding jaundice [15.8%(6/38) and 11.5%(15/130)]. Total serum bilirubin level on admission in the exchange transfusion group was significantly higher than that in the phototherapy group [(531.7±141.3) vs (440.0±67.4) μmol/L, t=3.870, P<0.001]. Moreover, the percentage of patients with mild, moderate and severe acute bilirubin encephalopathy in the exchange transfusion group were higher than those in the phototherapy group [15.8%(6/38) vs 3.8%(5/130), 7.9%(3/38) vs 0.8%(1/130), 13.2%(5/38) vs 0.0%(0/130); χ2=29.119, P<0.001]. Among the 168 patients, 135 were followed up to 18-36 months of age and 12 showed poor prognosis (developmental retardation or hearing impairment) with four in the exchange transfusion group (12.9%, 4/31) and eight in the phototherapy group (7.7%, 8/104). Multivariate logistic regression analysis showed that for full-term infants with severe hyperbilirubinemia who met the exchange transfusion criteria, phototherapy alone without blood exchange transfusion as well as severe ABE were risk factors for poor prognosis ( OR=14.407, 95% CI: 1.101-88.528, P=0.042; OR=16.561, 95% CI: 4.042-67.850, P<0.001). Conclusions:Full-term infants who have severe hyperbilirubinemia and meet the exchange transfusion criteria should be actively treated with blood exchange transfusion, especially for those with severe ABE, so as to improve the prognosis.

Risk factors of obstructive sleep apnea in women with polycystic ovary syndrome and its adverse effects on the body / 中华全科医师杂志

Polycystic ovary syndrome is a common endocrine disorder characterized by hyperandrogenemia and menstrual disorders. Patients not only have a high incidence of insulin resistance and metabolic syndrome, but also a high incidence of sleep disorders, especially obstructive sleep apnea. Obesity, hyperandrogenemia, insulin resistance,and other factors are responsible for the high prevalence of sleep apnea in women with polycystic ovary syndrome.

Study on the late stage of autophagy in primary gouty arthritis / 中华风湿病学杂志

Objective:To explore the expression and clinical significance of late autophagy in per-ipheral blood mononuclear cells (PBMCs) of patients with primary gouty arthritis (GA).Methods:Peripheral blood, clinical data, and laboratory tests were collected from 30 patients with acute gout (AG), 30 patients with intermittent gout (IG), and 50 healthy controls (HC). Quantitative polymerase chain reaction (RT-qPCR) was used to detect mRNA expression levels of autophagy-related genes (ATG5, ATG12, ATG16, ATG3, ATG7, ATG10, ATG4B, LC3-2/LC3B). Measurement data conformed to normal distribution were tested using t test or analysis of variance (ANOVA), and non-normal distribution data were tested using Mann-Whitney test or Kruskal-Wallis H test. SNK was used for pairwise comparison among the three groups. Correlation between variables was tested by Spearman correlation analysis. Results:① The expression level of ATG5 mRNA,ATG12 mRNA, ATG16 mRNA, ATG10 mRNA and LC3-2 mRNA in the AG group was lower than that of the IG group and the HC group, and the expression level of the IG group was lower than that of the HC group[9.16×10 -3(6.04×10 -3, 15.00×10 -3) vs 14.48×10 -3(9.95×10 -3, 21.38×10 -3) vs 0.08×10 -3(12.21×10 -3, 42.79×10 -3), H=19.377, P<0.001; 18.89×10 -3(13.85×10 -3, 24.92×10 -3) vs 21.13×10 -3(12.11×10 -3, 28.06×10 -3) vs 33.57×10 -3(13.11×10 -3, 49.89×10 -3), H=7.545, P=0.023; 8.72×10 -3(4.96×10 -3, 13.74×10 -3) vs 10.62×10 -3(7.48×10 -3, 24.71×10 -3) vs 20.07×10 -3(11.99×10 -3, 39.56×10 -3), H=20.962, P<0.001; 1.05×10 -3(0.73×10 -3, 1.84×10 -3) vs 1.60×10 -3(0.93×10 -3, 2.58×10 -3) vs 1.69×10 -3(1.05×10 -3, 3.54×10 -3), H=8.193, P=0.017; 2.31×10 -3(1.22×10 -3, 3.53×10 -3) vs 2.78×10 -3(1.68×10 -3, 5.96×10 -3) vs 3.68×10 -3(2.00×10 -3, 5.67×10 -3) , H=7.135, P=0.028]. The expression level of ATG4B mRNA in the AG and IG group was higher than that in HC group, and there was significant difference between IG group and AG group, IG group and HC group[9.95×10 -3(6.32×10 -3, 12.23×10 -3) vs 10.86×10 -3 (8.80×10 -3, 17.03×10 -3) vs 8.07×10 -3(5.52×10 -3, 11.63×10 -3), H=8.531, P=0.014]. There was no significant difference between the ATG3 mRNA and ATG7 mRNA groups ( H=0.539, 3.739, bothall P values >0.05). ② The results of Spearman correlation analysis suggested that in patients with acute gout, ATG3 was negatively correlated with PDW and MPV ( r=-0.499, P=0.006; r=-0.463, P=0.011); ATG4B was positively correlated with HDL-C ( r=0.408, P=0.048); ATG7 was negatively correlated with GLOB ( r=-0.554, P=0.001); ATG10 was positively correlated with ALB ( r=0.412, P=0.024) and negatively correlated with Crea and hsCRP ( r=-0.459, P=0.011; r=-0.375, P=0.045); ATG12 was negatively correlated with MO ( r=-0.434, P=0.017); ATG16 was negatively correlated with ALT and AST ( r=-0.389, P=0.034; r=-0.366, P=0.047); LC3-2 was positively correlated with UA ( r=0.381, P=0.041) and negatively correlated with MPV and PDW ( r=-0.413, P=0.026; r=-0.449, P=0.015). In patients with intermittent gout, ATG3 and ATG4B were negatively correlated with apoB100 ( r=-0.555, P=0.011; r=-0.462, P=0.040); ATG5 was negatively correlated with Crea ( r=-0.456, P=0.011); ATG10 was negatively correlated with TC, LDL-C, and apoB100 ( r=-0.526, P=0.017; r=-0.556, P=0.011; r=-0.515, P=0.020). Conclusion:Autophagy is involved in the development of gout, and is correlated with ibflammatory and metabolic indicators, suggesting that autophagy is an important feature in the pathogenesis of GA.

Clinical study on serum 25-hydroxy vitamin D and retinol binding protein 4 in type 2 diabetic nephropathy / 中华临床营养杂志

Objective:This was a retrospective study to compare the serum 25-hydroxy vitamin D [25(OH)D], retinol binding protein 4(RBP-4) and other clinical data in type 2 diabetes mellitus (T2DM) patients with or without diabetic nephropathy (DN) and to explore the clinical significance of these indicators in DN.Methods:1946 T2DM patients were enrolled in this study. The T2DM patients were divided to group with diabetic nephropathy (DN group) and without diabetic nephropathy (NDN group). According to the urine albumin to creatinine ratio (UACR), DN patients were further divided into microalbuminuria subgroup (UACR 30~300 mg/g) and massive proteinuria subgroup (UACR> /g). Clinical characteristics including serum 25(OH)D, RBP-4 and other biochemical indicators were collected.Results:Compared with NDN group, DN group showed longer disease duration, older age and higher levels of HbA1c, RBP-4, hs-CRP, TC and TG; 25(OH)D and HDL-C in DN group were lower than those in NDN group ( P<0.05). Within DN group, massive proteinuria subgroup showed higher RBP-4, younger age and lower 25(OH)D and HDL-C than microalbuminuria subgroup ( P<0.05). After adjusted for age, gender and disease duration in DN, partial correlation analysis showed that 25(OH)D is positively correlated with eGFR, and negatively correlated with RBP-4 and UACR ( P<0.05). UACR is positively correlated with RBP-4 and TC, and negatively correlated with eGFR (all P<0.05). eGFR is negatively correlated with RBP-4, TC and UACR (all P<0.05). Multivariate logistic regression showed that disease duration, HbA1c, RBP-4 and hs-CRP are risk factors for DN, and 25(OH)D is the protective factor for DN. Conclusions:Decreased 25(OH)D and increased RBP-4 are associated with increased DN risk in T2DM patients, and also associated with exacerbated albuminuria and deteriorated renal function in DN patients. There is a negative correlation between 25(OH)D and RBP-4 in DN. Therefore, it is necessary to strengthen the monitoring of serum 25(OH)D and RBP-4 and enhance vitamin D supplementation in T2DM patients to prevent the occurrence and delay the progression of diabetic nephropathy.

Research Progress of Intervention in Autoimmune Thyroid Diseases Based on Th17/ Treg Signal Axis with Traditional Chinese Medicine / 中国实验方剂学杂志

Autoimmune thyroid disease （AITD） is a complex organ-specific autoimmune disease， associated with many factors such as genetic susceptibility， environmental factors， immune system disorders， and intestinal microbiota imbalance， which seriously affect the quality of life. At present， oral medicine， iodine 131 treatment and surgical treatment are mainly adopted in clinical parctice of western medicine. Although they can exert a certain curative effect， they still have surgical risks and side effect. Modern research shows that， traditional Chinese medicine（TCM） has the characteristics of stable curative effect， multi-targeted regulation and less side effect. It has definite efficacy and unique advantages in the prevention and treatment of AITD. Helper T lymphocyte cell 17 （Th17） mediate inflammation to induce immune promotion， while regulatory T lymphocyte cell （Treg） mediate immunosuppression， Th17 and Treg cooperate to maintain the balance of the immune microenvironment. During AITD progress， Inflammatory Th17 can be high， and the levels of mediated immunosuppressive Treg are relatively decreased. The restoration of balance between the two plays a key role in the inflammatory and immune processes of AITD. In recent years， based on Th17/Treg cell axis， a large number of clinical and experimental studies on the intervention of TCM on Th17/Treg balance in AITD have been carried out in the field of TCM， and some results have been achieved. Studies have shown that intervention in the Th17/Treg signaling axis is an important mechanism for the treatment of autoimmune thyroid diseases. This paper summarizes and analyzes the previous studies on the intervention effect of Chinese medicine monomer， Chinese medicine composition and Chinese medicine compound on Th17/Treg cell axis in AITD， mainly from the aspects of intervention related inflammatory factor secretion， regulation of antibody titer and the expression of related genes of related genes. These studies will help people to understand the mechanism of TCM in interfering with the Th17/Treg balance in AITD more accurately and comprehensively， and provide references for the rational application of TCM in the prevention and treatment of autoimmune thyroid diseases in clinical practice.

Therapeutic Effect and Mechanism of Modified Da Chengqitang in Treating Hyperlipidemic Acute Pancreatitis with Damp Heat Accumulation Syndrome / 中国实验方剂学杂志

Objective:To explore the efficacy and mechanism of modified Da Chengqitang in treating hyperlipidemic acute pancreatitis （HLAP） with damp heat accumulation syndrome. Method:A total of 110 patients with HLAP with damp heat accumulation syndrome treated at our hospital were randomly divided into control group and observation group， with 55 cases in each group， both groups were treated with low molecular weight heparin calcium， insulin and alprostadil injection. Control group was given Huazhironggan granules in addition to the basic therapy， while observation group was given modified Da Chengqitang in addition to the basic therapy. After 7 days， the clinical efficacy， traditional Chinese medicine (TCM） syndrome score， gastrointestinal function recovery， acute pancreatitis bedside index （BISAP）， acute physiology and chronic health status Ⅱ （APACHE Ⅱ）， inflammatory factors， such as tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， interleukin-6 （IL-6） and C-reactive protein （CRP）， oxidative stress， such as malondialdehyde （MDA）， oxidized glutathione （GSSG）， total antioxidant capacity （T-AOC）， total cholesterol （TC）， triglyceride （TG）， high and low density lipoprotein （HDL-C， LDL-C） blood lipid indicators and safety were evaluated. Result:The clinical efficacy of observation group was significantly better than that of control group （<italic>Z</italic>=3.353， <italic>P</italic><0.05）， and the total effective rate of observation group was 94.55%， which was higher than 74.55% of control group （<italic>χ²</italic>=8.419， <italic>P</italic><0.01）. After treatment， the scores of abdominal pain， stool obstruction， chest tightness and fever in observation group were significantly lower than those of control group （<italic>P</italic><0.05）. The gastric tube indwelling exhaust time， defecation time and recovery time of bowel sounds in observation group were significantly lower than those of control group （<italic>P</italic><0.05）. The scores of BISAP and APACHE Ⅱ in two groups were significantly decreased， and the BISAP and APACHE Ⅱ scores of observation group were lower than control group （<italic>P</italic><0.05）. After treatment， the serum levels of TNF-<italic>α</italic>， IL-6 and CRP in observation group were significantly lower than those in control group. The levels of serum MDA， GSSG in two groups were significantly decreased， whereas the T-AOC level was significantly increased； and the level of serum MDA， GSSG observation group was lower than control group， while the T-AOC level was higher than control group （<italic>P</italic><0.05）. After treatment， the levels of TC， TG and LDL-C in two groups were decreased， while the level of HDL-C was increased， the levels of TC， TG and LDL-C in observation group were lower than those in control group， and the HDL-C was higher than that control group （<italic>P</italic><0.05）. Conclusion:modified Da Chengqitang has a definite clinical efficady in treating HLAP with damp heat accumulation syndrome， and can alleviate TCM syndrome and patient symptoms， reduce inflammatory factors， inhibit oxidative stress of the body. It has a good safety， and is worthy of clinical application.

Multiple organ dysfunction due to a rare complication of Nuss procedure for pectus excavatum: A case report / 中华创伤杂志(英文版)

A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department. With organ function supportive treatment, the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib, which damaged the heart repeatedly and induced the consequent acute cardiac tamponade. After operation, the patient was successfully managed and discharged. Follow-ups till three years indicated a good recovery.