Review and prospect of traditional Chinese medicine in treatment of hypertension / 中国中药杂志

Hypertension, a primary cause of cardiovascular and cerebrovascular events, has become a major global public health problem and caused a heavy burden of health economics on the society. In "the 20 Most Important and Most Preventable Health Problems" released by the Chinese Academy of Engineering, hypertension was ranked the second. Due to the disease complexity, many hypertension patients need to take antihypertensive drugs for life. Although significant progress has been achieved in blood pressure lowering by western medicines, the problems including adverse reactions, poor compliance due to long-term medication, and ineffective mitigation in clinical symptoms related to hypertension remain to be addressed. In the last decade, the research on traditional Chinese medicine(TCM) treatment of hypertension has received much attention and achieved remarkable progress. The TCM treatment of hypertension is the most active area of research with integrated Chinese and western medicine in China. In addition to lowering blood pressure smoothly, TCM can alleviate clinical symptoms, reverse risk factors, improve the quality of life, and protect target organs from the damage caused by hypertension. This article systematically reviews the research progress of TCM in treating hypertension in the last decade from the following four aspects: consensus on guideline, clinical trial, experimental study, and systematic review/Meta-analysis. It summarized the evidence of TCM in reducing blood pressure and clarified the mechanism of TCM in reducing blood pressure, aiming to provide a reference for the TCM diagnosis and treatment of hypertension and the development of new drugs.

Anti-mGluR5 encephalitis with mental disorders as the initial symptom： a case report / 四川精神卫生

This article reported the clinical features of a rare patient with anti-metabotropic glutamate receptor 5 （mGluR5） encephalitis with mental disorders as the initial symptom， so as to provide references for clinical diagnosis and treatment. The patient was a 38-year-old male， developed pharyngeal pain as prodromal symptoms， and the main clinical manifestations included rapidly progressive memory loss， anxiety and depression， and psychomotor excitement symptoms including irritability and impulsive behaviors. The disease had a progressive deterioration. In the most severe state， the patient became unconscious in a shallow coma， with further cognitive decline， hallucinations and delusions， and lack of self-awareness. Both cerebrospinal fluid and serum anti-mGluR5 antibody were strongly positive （1∶100）. After two sessions of hormone shock therapy， the patient showed significantly improvement in consciousness， cognitive， emotional and psychiatric dimensions.

Effect of autoflation on the prognosis of otitis media with effusion in children / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the effect of autoinflation on the prognosis of OME in children. Methods: Total of 325 pediatric patients, age ranged from 3 to 8 years, with OME(486 ears)diagnosed in our department from January 2019 to January 2020 were collected. Among them, 177 were males, 148 were females. Disease course ranged from 25 to 86 days. According to watchful waiting and autoinflation application during follow-up, these children were divided into two groups including 183 cases(271 ears) and 142 cases(215 ears), respectively. The average auditory threshold and tympanogram curve type in two groups were analyzed in the period of 3 months follow-up, and the recovery of OME was evaluated. Results: At the end of 1- and 2- month follow-up, the auditory threshold of patients in autoinflation group was significantly lower than that in watchful waiting group (t=2.139 5 and 2.680 6, P<0.05). However, at the end of 3- month follow-up, there was no significant difference between two groups (t=1.158 5, P>0.05). At the end of 1-, 2- and 3- month follow-up, 89 (33%, 89/271), 200 (74%, 200/271), 220 (81%, 220/271) and 176 (82%, 176/215), 178 (83%, 178/215), 183 (85%, 183/215) ears in watchful waiting group and autoinflation group had a hearing threshold <20 dB HL, respectively, in which ears with auditory threshold<20 dB HL in watchful waiting group were significantly less than those in autoinflation group at the end of 1 and 2 month follow-up (P<0.05), However, ears with auditory threshold<20 dB HL in watchful waiting group were not significantly different from that in the autoflation group at the end of 3- month follow-up (P>0.05). The proportion of ears with type A tympanogram curve was 74%(159/215), 79%(170/215), and 85%(183/215) at the end of 1-, 2- and 3- month follow-up in autoinflation group and 36%(98/271), 71%(192/271) and 76%(206/271) in watchful waiting group, respectively. Proportion of ears with type A tympanogram curve in autoflation group was significantly higher than that in watchful waiting group (P<0.05). Conclusion: Autoinflation can improve the hearing of children with OME in early stage, restore normal middle ear pressure, increase recovery rate, and reduce the choice of surgical treatment of OME.

Correlation between serum adiponectin levels and post-stroke cognitive impairment / 国际脑血管病杂志

Objective To investigate the correlation between serum adiponectin levels and post-stroke cognitive impairment (PSCI). Methods From January 2018 to December 2018, consecutive patients with ischemic stroke admitted to the Departments of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Dongguan Changping Hospital, and Jiangsu Provincial Second Chinese Medicine Hospital were enrolled. Serum adiponectin concentration was detected by radioimmunoassay. The cognitive function assessment was performed 1 month after the onset of stroke using the Montreal Cognitive Assessment (MoCA). The total score of MoCA <22 was defined as PSCI. Univariate analysis was used to compare the baseline data between groups, and multivariate logistic regression analysis was used to determine the association between serum adiponectin levels and PSCI. Results A total of 257 patients with acute ischemic stroke were enrolled, with age 66.5 ± 9.9 years, 139 (54.1% ) males, and 91 (35.4% ) with PSCI. Age (68.2 ± 8.1 years vs. 65.6 ± 10.8 years; t=2.007, P=0.046 ), homocysteine (16.0 ± 6.2 μmol/L vs. 14.5 ± 4.5 μmol/L; t= 2.208, P= 0.028 ), and high-sensitivity C-reactive protein ( 7.0 [3.3-9.9] mg/L vs. 4.7 [2.2-9.6] mg/L; Z=2.346, P=0.019 ) as well as the proportion of hypertension (64.8% vs. 50.6% ; χ2 =4.824, P=0.028), diabetes (33.0% vs. 21.1% ; χ2 =4.392, P=0.036), leuko-araiosis (47.2% vs. 32.5% ; χ2 =5.422, P=0.020) and diffusion weighting imaging-Alberta Stroke Project early CT score 0-7 (59.3% vs. 41.4% ; χ2 =6.942, P=0.008) in the PSCI group was significantly higher than that of the non-PSCI group, while the adiponectin level was significantly lower than that of the non-PS-CI group (5.4 [3.5-8.4] mg/L vs. 7.0 [5.3-9.3] mg/L; Z=3.624, P=0.001 ). Multivariate logistic regression analysis showed that after adjusting for the confounding factors, the lower serum adiponectin level was an independent risk factors for PSCI (the 1st quartile group vs. the 4th quartile group: odds ratio 2.152, 95% confidence interval 1.119-5.039; P=0.047). Conclusions Low serum adiponectin level might be an independent risk factor for PSCI in patients with ischemic stroke.

Clinical Characteristics and Gene Mutation Types of 11 Cases of RASopathies in Childhood / 中山大学学报(医学科学版)

@#【Objective】Through summarizing the clinical manifestations and gene mutations of 5 types of RASopathies in childhood including Neurofibromatosis type1（NF1），Noonan syndrome（NS），Noonan syndrome with multiple lentigines（NSML），Costello syndrome（CS）and cardio-facio-cutaneous syndrome（CFC）and analyzing their commonalities and characteristics，to deepen the clinician′s understanding of the RASopathies and improve the domestic doctors′ diagnosis and treatment level of RASopathies.【Methods】The clinical data and gene mutation types of 11 patients of RASopathies who were diagnosed in Sun Yat- Sen Memorial Hospital from January 2015 to May 2018 were retrospectively analyzed. 【Results】The age of onset ranged from 6 months to 12 years and the main clinical manifestations of 11 patients included： short stature，craniofacial features，congenital heart defect，café-au-lait macules，developmental delay，thrombocytopenia， seizures and dystonia，cryptorchidism，etc. Five gene mutations were detected including NF1 gene，PTPN11 gene， RAF1 gene ，BRAF gene and HRAS gene.【Conclusions】The RASopathies are a clinically defined group of medical genetic syndromes caused by germline mutations in genes that encode components or regulators of the Ras/MAPK pathway. The RAS/MAPK pathway plays an important role in regulating growth development，promoting cell proliferation，differentiation，metabolism，and signal transduction of various hormones. Therefore，they share many overlapping characteristics，including craniofacial features，growth retardation，cardiac malformations，cutaneous and musculoskeletal abnormalities，neurocognitive impairment and tumor susceptibility. However ，each RASopathy exhibits different degree phenotypes because of mutations at different points in the pathway. In addition ，tumor susceptibility is one of the typical clinical features of RASopathies. Therefore，tumor monitoring is one of the most important contents in the follow-up process.

Preliminary study on serum differential expression of microRNA and its target gene function in patients with severe Alzheimer disease / 中国神经精神疾病杂志

Objective To conduct an in-depth analysis on the correlation of miRNA and Alzheimer disease (AD) pathogenesis and provide an experimental basis for AD potential biomarkers by analysis of serum miRNA expression profiles in AD patients. Methods The miRNA expression profiles were exmined in 7 severe AD patients and 5 normal controls using high-throughput sequencing and bioinformatic analysis. Results Compared with the normal controls, there were serum differential expression of 112 miRNAs (DEmiRNAs) including 57 being up-regulated and 55 being down-regulated in patients with severe AD (P<0.05). GO-term function enrichment analysis showed that DEmiRNAs participated in the protein binding, ion binding, transcription metal binding, and biological metabolism and regulation process of organelle and cell membrane, etc. KEGG pathway enrichment analysis found that PI3K-Akt signal pathway was an important pathway of target genes. Conclusion The differential expression of serum miRNAs may be potential biomarkers of AD and the target genes of DEmiRNAs are related to the pathological changes of AD.

The application of cost-benefit analysis on the management of large medical equipment / 中国医学装备

Objective: To forecast, analyze and evaluate the cost-benefit of large medical equipment in the three stages of whole life cycle included of investment decision-making stage, operation and use stage and update decision-making stage so as to achieve the aim that reasonably allocated diagnosis device resource. Methods: The breakeven point analysis, residual quantity analysis, method of return on investment per year and business income analysis of fixed assets per hundred RMB were applied to combined with cruor assembly line, high-end B-mode ultrasound scanner, PET-CT and other actual cases, and then the cost-benefit analysis of different stages in the whole life circle of large medical equipment was researched based on above data. Results: In the investment decision-making stage, the calculation shows that the break-even workload of testing cruor assembly line was 11317 person time, and the purchase wouldn't be suggested if projected workload was less than break-even workload. In the operation and use stage, the rate of return on investment per year in the operation period of computer B-mode ultrasound (12.5%) achieved better earnings. In the equipment replacement stage, the business income (242RMB) of fixed asset per hundred RMB of new equipment was higher than that of old equipment. Conclusion: The application of cost-benefit analysis in the whole life circle of large medical equipment and the establishment of efficiency evaluation system of corresponding equipment can play important role for realizing the unify of social benefit and cost-benefit of hospital.

Serum adiponectin predicts post-stroke depression in patients with ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of serum adiponectin (APN) for post-stroke depression (PSD) in patients with ischemic stroke. Methods Patients with acute ischemic stroke admitted to the Departments of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, and Dongguan Changping Hospital were enrolled prospectively from September 2016 to January 2018. Serum APN levels were measured by radioimmunoassay the next day after admission. PSD was diagnosed by using the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) at one month after discharge. The baseline clinical features in the PSD group and the non-PSD group were compared. Multivariable logistic regression analysis was used to determine the risk factors for PSD. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of APN for PSD. Results A total of 220 patients were enrolled, including 57 (25.9%) in the PSD group and 163 (74.1%) in the non-PSD group. The proportion of patients with diabetes (P=0.020) and living alone (P=0.012), as well as age (P=0.17), homocysteine (P=0.009), C-reactive protein ( P=0.001), and National Institutes of Health Stroke Scale score ( P=0.007) in the PSD group were significantly higher than those in the non-PSD group, while the APN level was significantly lower than that in the non-PSD group (P=0.003). Multivariate logistic regression analysis showed that the 4th quartile of serum APN level was used as a reference, the 1st quartile of APN level was an independent risk factor for PSD (odds ratio, 4 .202, 95% confidence interval 1.401-12.067; P=0.013). ROC curve analysis showed that the area under the curve of serum APN level for predicting PSD was 0.642 (95% confidence interval 0.564-0.721; P=0.001). The optimal cutoff value was 6.4 mg/L, and its sensitivity of predicting PSD was 63.2%, the specificity was 63.8%, the positive predictive value was 83.3%, and the negative predictive value was 57 .7%. Conclusion Serum APN has a certain predictive value for PSD in patients with ischemic stroke.

The study of plasma levels of sCD40 and sCD40L in Alzheimer’s disease and mild cognitive impairment / 中国神经精神疾病杂志

Objective To explore the plasma levels of soluble CD40 (sCD40) and soluble CD40 ligand (sCD40L) in the patients with Alzheimer’s disease (AD) and those with amnestic mild cognitive impairment (aMCI). Methods The levels of plasma sCD40 and sCD40L were measured in 20 patients with AD, 35 patients with aMCI, and 32 cognitively normal controls (NC) using commercially available ELISAs. The cognitive function of AD and aMCI patients was mea?sured by mini-mental state examination (MMSE). Results There were significant differences in plasma sCD40 among AD, aMCI and NC groups (P<0.05) as the medians (the upper and lower quartiles) of plasma levels were 123.3 (97.4, 149.5) pg/mL, 102.9 (63.6, 124.0) pg/mL and 70.66 (51.0, 90.8) pg/mL, respectively. There were significant differences in plasma sCD40L among AD, aMCI and NC groups (P<0.05) as plasma levels were 537.0 (316.0, 1134.0) pg/mL, 316.0 (190.0,546.0) pg/mL and 167.0 (107.5,478.0) pg/mL. A negative correlation between the plasma concentrations of sCD40L and the MMSE scores was found in aMCI patients (r=-0.736, P<0.001). Conclusions There are relevant chang?es of plasma sCD40 and sCD40L levels in patients with AD and aMCI. The present results suggest that plasma levels of sCD40 and sCD40L may be appropriate biomarkers for AD patients and indicate that CD40-CD40L signaling may be in?volved in AD pathophysiology.

The study on the relationship between the 1h-proton magnetic resonance spectroscopy and cognitive im-pairment in patients with general paresis of the insane / 中国神经精神疾病杂志

Objective We aimed to use 1H-MRS to characterize metabolite concentrations in the bilateral hippo?campus in GPI patient. Methods Metabolite ratios in the bilateral hippocampus were compared between patients with GPI (n=52) and Normal Control (NC) (n=38). Clinical neurological tests were measured in all subjects and were correlat?ed to the metabolite concentrations. Results The GPI patients showed significantly lower concentrations of N-acetylas?partate(NAA)/creatine(Cr) ratios in the bilateral hippocampus region compared to the NC subjects. There was significant?ly difference in the NAA/Cr ratios between the mild GPI dementia and the severe GPI dementia groups on the left hippo?campus region. We found that the NAA/Cr ratios concentrations were positively correlated with Mini Mental state Exami?nation (MMSE) and Montreal Cognitive Assessment scale (MoCA) scores in the left hippocampus region and the mI/Cr ra?tios concentrations were positively correlated. Conclusions GPI Patients have neuronal dysfunction in the bilateral hippo?campus. The severity of cognitive impairments is associated with the severity of the damage in the left side.

Interaction of SNP in non-coding region between estrogen receptor alpha gene and brain-derived neurotrophic factor (BDNF) gene in late-onset Alzheimer's disease in southern Chinese Han population / 中国神经精神疾病杂志

Objective To study the interaction of BDNF gene C270T polymorphism and estrogen receptor alpha (ERα)gene Xba Ⅰ loci and Pvu Ⅱ loci polymorphism in late-onset Alzheimer's disease(LOAD)pathogenesis in southern Chinese Han population.Methods BNDF gene C270T locus,ERα gene Xba Ⅰ site and Pvu Ⅱ site polymorphisms were examined in 203 LOAD patients and normal controls using PCR-RFLP technique.Results There was an interaction be-tween BDNF gene and ERα gene,and BDNF gene C270T locus CC genotype and the ERa gene Xba Ⅰ locus xx genotype increased the LOAD incidance risk(OR=2.38,95%CI:1.02～5.53).Conclusions BDNF gene and ERα gene are in-teracted each other in the pathogenesis of LOAD.Patients carrying both BDNF gene C270T locus CC genotype and the ERα gene Xba Ⅰ locus xx genotypes might have an increased risk for LOAD.