No Incidence of Liver Cancer Was Observed in A Retrospective Study of Patients with Aristolochic Acid Nephropathy / 中国结合医学杂志

OBJECTIVE@#To assess the risk of aristolochic acid (AA)-associated cancer in patients with AA nephropathy (AAN).@*METHODS@#A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014. Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer. The primary endpoint was the incidence of liver cancer, and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014.@*RESULTS@#A total of 337 patients diagnosed with AAN were included in this study. From the initiation of taking AA to the termination of follow-up, 39 patients were diagnosed with cancer. No cases of liver cancer were observed throughout the entire follow-up period, with urinary cancer being the predominant type (34/39, 87.17%). Logistic regression analysis showed that age, follow-up period, and diabetes were potential risk factors, however, the dosage of the drug was not significantly associated with urinary cancer.@*CONCLUSIONS@#No cases of liver cancer were observed at the end of follow-up. However, a high prevalence of urinary cancer was observed in AAN patients. Establishing a direct causality between AA and HCC is challenging.

Advances in the differential diagnosis of malignant bile duct stenosis / 临床肝胆病杂志

There are various etiologies for extrahepatic bile duct stenosis， and pharmacotherapy and endoscopic intervention can achieve a good clinical effect in benign stenosis. Early diagnosis and timely surgical treatment of malignant stenosis may prolong the survival time of patients. However， there are still difficulties in the differential diagnosis of malignant bile duct stenosis. This article reviews the application of serology， radiology， endoscopic techniques， and artificial intelligence in the differential diagnosis of malignant bile duct stenosis， so as to provide strategies and references for formulating clinical diagnosis and treatment regimens.

Effect of nerve growth factor on elderly degenerative knee osteoarthritis pain / 中国骨伤

OBJECTIVE@#To explore effect of nerve growth factor (NGF) antibody on knee osteoarthritis (KOA) pain model was evaluated by in vitro model.@*METHODS@#Thirty male SPF rats aged 28-week-old were divided into blank group (10 rats with anesthesia only). The other 20 rats were with monoiodoacetate (MIA) on the right knee joint to establish pain model of OA, and were randomly divided into control group (injected intraperitoneal injection of normal saline) and treatment group (injected anti-NGF) intraperitoneal after successful modeling, and 10 rats in each group. All rats were received retrograde injection of fluorogold (FG) into the right knee joint. Gait was assessed using catwalk gait analysis system before treatment, 1 and 2 weeks after treatment. Three weeks after treatment, right dorsal root ganglia (DRG) were excised on L4-L6 level, immunostained for calcitonin gene-related peptide (CGRP), and the number of DRGS was counted.@*RESULTS@#In terms of gait analysis using cat track system, duty cycle, swing speed and print area ratio in control and treatment group were significantly reduced compared with blank group (P<0.05). Compared with control group, duty cycle and swing speed of treatment group were significantly improved (P<0.05), and there was no significant difference in print area ratio between treatment group and blank group (P>0.05). The number of FG-labeled DRG neurons in control group was significantly higher than that in treatment group and blank group (P<0.05). The expression of CGRP in control group was up-regulated, and differences were statistically significant compared with treatment group (P<0.05).@*CONCLUSION@#Intraperitoneal injection of anti-NGF antibody inhibited gait injury and upregulation of CGRP in DRG neurons. The results suggest that anti-nerve growth factor therapy may be of value in treating knee pain. NGF may be an important target for the treatment of knee OA pain.

Analysis of WRKY transcription factor family based on full-length transcriptome sequencing in Polygonatum cyrtonema / 中国中药杂志

WRKY transcription factor family plays an important role in plant growth and development, secondary metabolite synthesis, and biotic and abiotic stress responses. The present study performed full-length transcriptome sequencing of Polygonatum cyrtonema by virtue of the PacBio SMRT high-throughput platform, identified the WRKY family by bioinformatics methods, and analyzed the physicochemical properties, subcellular localization, phylogeny, and conserved motifs. The results showed that 30.69 Gb nucleotide bases and 89 564 transcripts were obtained after redundancy removal. These transcripts had a mean length of 2 060 bp and an N50 value of 3 156 bp. Based on the full-length transcriptome sequencing data, 64 candidate proteins were selected from the WRKY transcription factor family, with the protein size of 92-1 027 aa, the relative molecular mass of 10 377.85-115 779.48 kDa, and the isoelectric point of 4.49-9.84. These WRKY family members were mostly located in the nucleus and belonged to the hydrophobic proteins. According to the phylogenetic analysis of WRKY family in P. cyrtonema and Arabidopsis thaliana, all WRKY family members were clustered into seven subfamilies and WRKY proteins from P. cyrtonema were distributed in different numbers in these seven subgroups. Expression pattern analysis confirmed that 40 WRKY family members had distinct expression patterns in the rhizomes of 1-and 3-year-old P. cyrtonema. Except for PcWRKY39, the expression of 39 WRKY family members was down-regulated in 3-year-old samples. In conclusion, this study provides abundant reference data for genetic research on P. cyrtonema and lays a foundation for the in-depth investigation of the biological functions of the WRKY family.

Mechanism of active ingredients in Periploca forrestii compound against rheumatoid arthritis based on integrative metabolomics and network pharmacology / 中国中药杂志

In this study, an ultra-performance liquid chromatography-quadrupole time-of-flight high resolution mass spectrometer(UPLC-Q-TOF-HRMS) was used to investigate the effects of the active ingredients in Periploca forrestii compound on spleen metabolism in rats with collagen-induced arthritis(CIA), and its potential anti-inflammatory mechanism was analyzed by network pharmacology. After the model of CIA was successfully established, the spleen tissues of rats were taken 28 days after administration. UPLC-Q-TOF-HRMS chromatograms were collected and analyzed by principal component analysis(PCA), orthogonal partial least squares discriminant analysis(OPLS-DA), and MetPA. The results showed that as compared with the blank control group, 22 biomarkers in the spleen tissues such as inosine, citicoline, hypoxanthine, and taurine in the model group increased, while 9 biomarkers such as CDP-ethanolamine and phosphorylcholine decreased. As compared with the model group, 21 biomarkers such as inosine, citicoline, CDP-ethanolamine, and phosphorylcholine were reregulated by the active ingredients in P. forrestii. Seventeen metabolic pathways were significantly enriched, including purine metabolism, taurine and hypotaurine metabolism, glycerophospholipid metabolism, and cysteine and methionine metabolism. Network pharmacology analysis found that purine metabolism, glycerophospholipid metabolism, and cysteine and methionine metabolism played important roles in the pathological process of rheumatoid arthritis. This study suggests that active ingredients in P. forrestii compound can delay the occurrence and development of inflammatory reaction by improving the spleen metabolic disorder of rats with CIA. The P. forrestii compound has multi-target and multi-pathway anti-inflammatory mechanism. This study is expected to provide a new explanation for the mechanism of active ingredients in P. forrestii compound against rheumatoid arthritis.

Effects of Compound Danshen Dripping Pills on Ventricular Remodeling and Cardiac Function after Acute Anterior Wall ST-Segment Elevation Myocardial Infarction (CODE-AAMI): Protocol for a Randomized Placebo-Controlled Trial / 中国结合医学杂志

BACKGROUND@#Ventricular remodeling after acute anterior wall ST-segment elevation myocardial infarction (AAMI) is an important factor in occurrence of heart failure which additionally results in poor prognosis. Therefore, the treatment of ventricular remodeling needs to be further optimized. Compound Danshen Dripping Pills (CDDP), a traditional Chinese medicine, exerts a protective effect on microcirculatory disturbance caused by ischemia-reperfusion injury and attenuates ventricular remodeling after myocardial infarction.@*OBJECTIVE@#This study is designed to evaluate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function after AAMI on a larger scale.@*METHODS@#This study is a multi-center, randomized, double-blind, placebo-controlled, parallel-group clinical trial. The total of 268 patients with AAMI after primary percutaneous coronary intervention (pPCI) will be randomly assigned 1:1 to the CDDP group (n=134) and control group (n=134) with a follow-up of 48 weeks. Both groups will be treated with standard therapy of ST-segment elevation myocardial infarction (STEMI), with the CDDP group administrating 20 tablets of CDDP before pPCI and 10 tablets 3 times daily after pPCI, and the control group treated with a placebo simultaneously. The primary endpoint is 48-week echocardiographic outcomes including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). The secondary endpoint includes the change in N terminal pro-B-type natriuretic peptide (NT-proBNP) level, arrhythmias, and cardiovascular events (death, cardiac arrest, or cardiopulmonary resuscitation, rehospitalization due to heart failure or angina pectoris, deterioration of cardiac function, and stroke). Investigators and patients are both blinded to the allocated treatment.@*DISCUSSION@#This prospective study will investigate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function in patients undergoing pPCI for a first AAMI. Patients in the CDDP group will be compared with those in the control group. If certified to be effective, CDDP treatment in AAMI will probably be advised on a larger scale. (Trial registration No. NCT05000411).

Anti-oxidant and Anti-inflammatory Effects of Ethanol Extract from Polygala sibirica L. var megalopha Fr. on Lipopolysaccharide-Stimulated RAW264.7 Cells / 中国结合医学杂志

OBJECTIVE@#To investigate the anti-oxidant and anti-inflammatory effects of ethanol extract of Polygala sibirica L. var megalopha Fr. (EEP) on RAW264.7 mouse macrophages.@*METHODS@#RAW264.7 cells were pretreated with 0-200 µg/mL EEP or vehicle for 2 h prior to exposure to 1 µg/mL lipopolysaccharide (LPS) for 24 h. Nitric oxide (NO) and prostaglandin (PGE2) production were determined by Griess reagent and enzyme-linked immunosorbent assay (ELISA), respectively. The mRNA levels of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), tumor necrosis factor α (TNF-α), interleukin-1beta (IL-1β), and IL-6 were determined using reverse transcription polymerase chain reaction (RT-PCR). Western blot assay was used to determine the protein expressions of iNOS, COX-2, phosphorylation of extracellular regulated protein kinases (ERK1/2), c-Jun N-terminal kinase (JNK), inhibitory subunit of nuclear factor Kappa B alpha (Iκ B-α) and p38. Immunofluorescence was used to observe the nuclear expression of nuclear factor-κ B p65 (NF-κ B p65). Additionally, the anti-oxidant potential of EEP was evaluated by reactive oxygen species (ROS) production and the activities of catalase (CAT) and superoxide dismutase (SOD). The 2,2-diphenyl-1-picrylhydrazyl (DPPH), hydroxyl (OH), superoxide anion (O2-) radical and nitrite scavenging activity were also measured.@*RESULTS@#The total polyphenol and flavonoid contents of EEP were 23.50±2.16 mg gallic acid equivalent/100 g and 43.78±3.81 mg rutin equivalent/100 g. With EEP treatment (100 and 150 µg/mL), there was a notable decrease in NO and PGE2 production induced by LPS in RAW264.7 cells by downregulation of iNOS and COX-2 mRNA and protein expressions (P<0.01 or P<0.05). Furthermore, with EEP treatment (150 µg/mL), there was a decrease in the mRNA expression levels of TNF-α, IL-1β and IL-6, as well as in the phosphorylation of ERK, JNK and p38 mitogen-activated protein kinase (MAPK, P<0.01 or P<0.05), by blocking the nuclear translocation of NF-κ B p65 in LPS-stimulated cells. In addition, EEP (100 and 150 µg/mL) led to an increase in the anti-oxidant enzymes activity of SOD and CAT, with a concomitant decrease in ROS production (P<0.01 or P<0.05). EEP also indicated the DPPH, OH, O2- radical and nitrite scavenging activity.@*CONCLUSION@#EEP inhibited inflammatory responses in activated macrophages through blocking MAPK/NF-κ B pathway and protected against oxidative stress.

Role of collagen membrane in modified guided bone regeneration surgery using buccal punch flap approach: A retrospective and radiographical cohort study / 北京大学学报(医学版)

OBJECTIVE@#To investigate whether the placement of absorbable collagen membrane increase the stability of alveolar ridge contour after guided bone regeneration (GBR) using buccal punch flap.@*METHODS@#From June 2019 to June 2023, patients who underwent GBR using buccal punch flap simultaneously with a single implant placement in posterior region (from first premolar to second molar) were divided into coverage group, in which particular bone graft was covered by collagen membrane and non-coverage group. Cone beam CT (CBCT) was taken before surgery (T0), immediately after surgery (T1), and 3-7 months after surgery (T2), and the thickness of the buccal bone plate at different levels (0, 2, 4, and 6 mm) below the smooth-rough interface of the implant (BBT-0, -2, -4, -6) was mea-sured after superimposition of CBCT models using Mimics software.@*RESULTS@#A total of 29 patients, including 15 patients in coverage group and 14 patients in non-coverage group, were investigated in this study. At T0, T1, and T2, there was no significant difference in BBT between the two groups (P>0.05). At T1, BBT-0 was (2.50±0.90) mm in the coverage group and (2.97±1.28) mm in the non-coverage group, with corresponding BBT-2 of (3.65±1.08) mm and (3.58±1.26) mm, respectively. At T2, BBT-0 was (1.22±0.55) mm in the coverage group and (1.70±0.97) mm in the non-coverage group, with corresponding BBT-2 of (2.32±0.94) mm and (2.57±1.26) mm, respectively. From T1 to T2, there were no statistically significant differences in the absolute values [(0.47±0.54)-(1.33±0.75) mm] and percentages [(10.04%±24.81%)-(48.43%±18.32%)] of BBT change between the two groups. The thickness of new bone formation in the buccal bone plate from T0 to T2 ranged from (1.27±1.09) mm to (2.75±2.15) mm with no statistical difference between the two groups at all levels.@*CONCLUSION@#In the short term, the GBR using buccal punch flap with or without collagen membrane coverage can effectively repair the buccal implant bone defect. But collagen membrane coverage showed no additional benefit on alveolar ridge contour stability compared with non-membrane coverage.

Nocturnal hypertension and riser pattern are associated with heart failure rehospitalization in patients with heart failure with preserved ejection fraction / 老年心脏病学杂志（英文版）

BACKGROUND@#Nocturnal hypertension is reported as a risk factor for cardiovascular disease. This study aimed to explore the potential association between nocturnal hypertension and heart failure (HF) rehospitalization in patients with HF with preserved ejection fraction (HFpEF).@*METHODS@#A total of 538 patients with HFpEF from May 2018 to December 2021 were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study. Cox regression analysis was used to reveal the potential association between nighttime blood pressure (BP) levels, nocturnal hypertension and nocturnal BP patterns and HF rehospitalization. Kaplan-Meier curve was used to assess the cumulative event-free survival rate between groups.@*RESULTS@#There were 537 patients with HFpEF were included in the final analysis. The mean age of the study population was 77.14 ± 8.68 years, and 41.2% of patients were men. After a median follow-up duration of 10.93 (4.19-21.13) months, 176 patients (32.7%) with HFpEF were readmitted for HF. Cox regression analysis had revealed that nighttime systolic BP level [hazards ratio (HR) = 1.018, 95% CI: 1.008-1.028, P = 0.001], nighttime diastolic BP level (HR = 1.024, 95% CI: 1.007-1.042, P = 0.007), nocturnal hypertension (HR = 1.688, 95% CI: 1.229-2.317, P = 0.001) were associated with HF rehospitalization. Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower event-free survival rate (log-rank P < 0.001). Furthermore, patients with a riser pattern had a higher risk of HF rehospitalization (HR = 1.828, 95% CI: 1.055-3.166, P = 0.031) and lower event-free survival rate (log-rank P = 0.003) than those with a dipper pattern. These findings were also confirmed in patients with HFpEF and hyperuricemia.@*CONCLUSIONS@#Nighttime BP levels, nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF, and prominently in patients with HFpEF and hyperuricemia. Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.

Veno-venous extracorporeal membrane oxygenation for a Stanford type A aortic dissection patient combined with postoperative respiratory failure and COVID-19: A case report / 中国胸心血管外科临床杂志

@#During the new coronavirus disease 2019 (COVID-19) pandemic, there has been controversy over whether emergency surgical management should be performed or not in the patients with COVID-19. Stanford type A aortic dissection is a very urgent life-threatening disease, and guidelines recommend surgical treatment for patients with type A aortic dissection in the first instance. However, intraoperative extracorporeal circulation can be fatal to patients recovering from COVID-19. During the pandemic, extracorporeal membrane oxygenation (ECMO) has played an important role in supporting COVID-19 patients with acute respiratory failure. This article reports a successful V-V ECMO treatment for a Stanford type A aortic dissection patient, who suffered respiratory failure caused by COVID-19 after emergency surgery.

Upper limb swing training with rhythmic auditory stimulation can improve the balance and walking ability of stroke survivors / 中华物理医学与康复杂志

Objective:To explore any effect of upper limb swing training guided by rhythmic auditory stimulation (RAS) on the walking ability of stroke survivors.Methods:Eighty stroke survivors were randomly divided into an observation group and a control group. Both groups received conventional rehabilitation treatment, including neuromuscular facilitation, muscle strength training, balance training and gait training, but the observation group was additionally provided with RAS-guided upper limb swing training for 20min once a day, 5d per week for 6 weeks. Before and after the intervention, balance and lower limb function were quantified in both groups using Holden′s walking function classification, the Fugl-Meyer lower extremity motor function scale (FMA-LE), the Berg Balance Scale (BBS) and the 10m walk test (10MWT). Limits of stability were also quantified.Results:After the treatment, the average Holden, FMA-LE and BBS scores, as well as the average 10MWT time were significantly better in the observation group than in the control group. The average stability limits and their maintenance were also superior.Conclusion:RAS-guided upper limb swing training can improve the gait, walking ability, walking stability, walking speed and balance of stroke survivors.

Safety and influencing factors of coronavirus disease 2019 vaccines in maintenance hemodialysis patients / 中华肾脏病杂志

Objective:To explore the status of coronavirus disease 2019 (COVID-19) vaccines, safety and the influencing factors of adverse reactions in maintenance hemodialysis (MHD) patients.Methods:The study was a retrospective study. The MHD patients vaccinated with COVID-19 vaccines in Tianjin city from January 2020 to July 2022 were enrolled in the study. The data of general information, vaccination situation, adverse reactions, and laboratory tests before and after vaccination were collected. Logistic regression analysis was used to analyze the risk factors of adverse reactions after vaccination.Results:A total of 7 375 patients were registered to receive hemodialysis treatment in Tianjin city, of whom 1 036 patients (14.05%) vaccinated with COVID-19 vaccines were enrolled from 53 hemodialysis centers in the study, with age of (54.00±13.27) years old (17-88 years old), and 676 males (65.25%). There were 171 patients (16.51%) receiving the first dose of vaccines only, 464 patients (44.79%) receiving two doses of vaccines, 401 patients (38.71%) receiving three doses of vaccines, and 67 patients (6.47%) had adverse reactions. No serious adverse reaction occurred. The number of neutrophils after vaccination was lower than that before vaccination ( P < 0.05), while the number of lymphocytes, alanine aminotransferase, glutamic oxaloacetic aminotransferase, and serum albumin after vaccination were higher than those before vaccination (all P < 0.05). Logistic regression analysis showed that age ( OR=0.967, 95% CI 0.946-0.990, P=0.005), previous allergic history ( OR=0.013, 95% CI 0.001-0.151, P < 0.001), serum uric acid ( OR=1.004, 95% CI 1.001-1.008, P=0.020), numbers of vaccinations administered ( OR=0.505, 95% CI 0.330-0.774, P=0.002), leukocytes ( OR=0.766, 95% CI 0.628-0.935, P=0.009) and lymphocytes ( OR=0.082, 95% CI 0.045-0.148, P < 0.001) were independently correlated with the incidence of adverse reactions. Conclusions:The proportion of MHD patients vaccinated with COVID-19 vaccines is 14.05%. The incidence of adverse reactions is 6.47%, and there is no serious adverse reaction. Age, previous allergic history, serum uric acid, and numbers of vaccinations administered, leukocytes and lymphocytes are independently correlated with the incidence of adverse reactions in MHD patients.

Progress on evaluation of dysphagia in patients with Parkinson′s disease / 中华神经科杂志

Parkinson′s disease (PD) is a common neurodegenerative disease. The prevalence of dysphagia in patients with PD is 16%-87%. Dysphagic patients show abnormalities in the oral, pharyngeal and esophageal phases of swallowing. The evaluation tools of dysphagia in patients with PD include instrumental assessment tools, non-instrumental objective assessment tools and subjective assessment tools. Videofluoroscopic study of swallowing and flexible endoscopic examination of swallowing are the gold standards for swallowing assessment in patients with PD; high-resolution manometry, tongue pressure measurement, surface electromyography and ultrasonography can be used as supplementary tests; the Swallowing Disturbance Questionnaire Scale, which is sensitive, specific, reliable and valid, is recommended as a screening tool.

Median effective dose of alfentanil combined with propofol inhibiting responses to laryngeal mask airway insertion in children / 中华麻醉学杂志

Objective:To determine the median effective dose(ED 50) of alfentanil combined with propofol inhibiting responses to the laryngeal mask airway(LMA) insertion in children. Methods:American Society of Anesthesiologists Physical Status classification Ⅰ children, aged 6-10 yr, with body mass index of 18-24 kg/m 2, undergoing facial skin pigmented nevus resection, were selected. Propofol(target plasma concentration 3 μg/ml) was given by the target-controlled infusion, alfentanil was intravenously injected, 2 min later LMA was inserted, and anesthesia was maintained with 2%-3% sevoflurane until the end of surgery. The dose of alfentanil was determined by the up-and-down sequential method, the initial dose of alfentanil was 15 μg/kg, when the response to LMA insertion was positive/negative, the dose of alfentanil increased/decreased by 1 μg/kg in the next case. The LMA insertion response was defined as swallowing, bucking, body movement occurred during insertion of the LMA, and this process was repeated until 7th turning points appeared. The ED 50 and 95% confidence interval of alfentanil combined with propofol inhibiting responses to LMA insertion in children were calculated using probit method. Results:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion was 13.18(95% confidence interval 12.43-13.79) μg/kg in children. Conclusions:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion is 13.18 μg/kg in children.

Clinical study of retrograde intrarenal surgery and miniaturized percutaneous nephrolithotomy in the treatment of lower pole kidney stones with a diameter <1.5 cm / 中华泌尿外科杂志

Objective:To evaluate the clinical efficacy and safety of retrograde intrarenal surgery(RIRS) and miniaturized percutaneous nephrolithotomy(mini-PCNL) in the treatment of lower pole kidney stones with a diameter <1.5 cm.Methods:The data of 95 patients with lower pole kidney stones with a diameter <1.5 cm treated in Renmin Hospital of Wuhan University from June 2017 to October 2020 were retrospectively analyzed. According to different surgical methods, the patients were divided into RIRS group and mini-PCNL group. There were 51 cases in RIRS group and 44 cases in mini-PCNL group. There was no significant difference in age [(48.2±11.4) years vs. (46.4±14.1) years], body mass index [(21.9±2.4) kg/m 2 vs. (20.7±3.2) kg/m 2], gender [male/female: 37/14 vs. 24/20], stone CT [(746.42±164.24)HU vs. (858.62±148.72)HU], creatinine [(71.3±21.6)μmol/L vs. (63.5±20.3)μmol/L], stone location (left/right: 26/25 vs. 23/21), stone diameter [(10.5±2.1) mm vs. (12.5±2.4) mm], infundibulopelvic angle [(43.32±9.42) degrees vs. (43.82±10.34) degrees], infundibular length [(24.92±4.85)mm vs. (24.37±5.26)mm] and infundibular [(9.26±3.04)mm vs.(9.46±2.94)mm] between the two groups ( P>0.05). The operation time, stone-free rate, hospital stay and postoperative complications between the two groups were compared. Results:Compared with the mini-PCNL group, the RIRS group had significantly smaller decrease in postoperative hemoglobin [(1.53±0.92) g/L vs. (4.54±2.46) g/L, P<0.05], the postoperative hospital stay was shorter [(2.52±0.94) d vs. (4.51±1.25)d, P<0.05], and postoperative visual analogue score was lower [(2.43±0.92) vs. (3.24±0.76), P<0.05]. The operation time of the mini-PCNL group was shorter than that of the RIRS group [(42.32±13.28) min vs. (54.24±14.43)min, P<0.05]. There was no significant difference in postoperative complications [5.9% (3/51) vs. 11.4% (5/44), P>0.05], postoperative cveatinine [(71.3±21.6) μmol/L vs. (63.5±20.3) μmol/L, P>0.05], postoperative intestinal function recovery time [(25.46±10.28)h vs. (32.43±9.25)h, P>0.05] and stone-free rate [92.2% (47/51) vs. 97.7% (43/ 44), P>0.05] between the two groups. Conclusions:Both RIRS and mini-PCNL are effective and safe minimally invasive treatments for lower pole kidney stones with a diameter < 1.5 cm. RIRS has shorter operation time, less blood loss, lower pain score and faster postoperative recovery.

Non-osteotomy total hip arthroplasty in the treatment of Crowe IV DDH / 中华骨科杂志

Objective:To evaluate the efficacy and safety of non-osteotomy total hip arthroplasty (THA) in the treatment of Crowe IV developmental dysplasia of the hip (DDH).Methods:From Jan 2013 to Sep 2021, 46 patients (46 hips) in our department who underwent total hip arthroplasty without osteotomy for unilateral Crowe IV DDH were retrospectively analyzed, including 6 males and 40 females, with an average age of 41.2±7.2 years (25-61 years). The reduction of the femoral head was achieved successfully through moderate upward-posterior displacement of the movement center, gradual osteotomy of the calcar femorale, proper sinking of the femoral prosthesis and sufficient soft tissue release. The evaluation indexes included the basic condition of the operation (operation time, blood loss, blood transfusion, volume), clinical evaluation (Harris score of hip joint function, patient satisfaction, Trendelenburg sign), imaging evaluation (measurement of limb length and pelvic inclination) and incidence of complications.Results:The mean follow-up time was 72.2±8.8 months (8-101 months). The operation time was 97.2±12 min (84-112 min). The average intraoperative bleeding volume was 550±60 ml (350-850 ml). No patient had periprosthetic infection or fracture, no periprosthetic osteolysis or prosthesis loosening, and no patient needed revision surgery at the last follow-up of all cases. The average HHS score of patients increased from 42.5±12.3 points before surgery to 89.2±10.8 points at the last follow-up, and the difference was statistically significant ( t=19.35, P<0.001). Patient self-rated satisfaction: none was very dissatisfied, 1 patient were less satisfied (2%, 1/46), 4 patients were average (9%, 4/46), 19 patients were relatively satisfied (41%, 19/46), and 22 patients were very satisfied (48%, 22/46). The Trendelenburg sign of 46 cases was positive before operation, and all were negative at the last follow-up. The patients' true leg length discrepancy (LLD) measurement was -2.5±0.6 mm before surgery and 11.5±3.2 mm at the last follow-up ( t=29.17, P<0.05). Patients' perceived LLD was 28.2±5.1 mm before surgery and 3.4±1.4 mm at the last follow-up ( t=32.18, P<0.05). The length of the residual calcar femorale was 3.2±0.4 mm after THA. The limb extended distance of affected limb was 45.2±4.6 mm. The preoperative iliolumbar angle was -6.5°±2.3°, which returned to -0.5°±1.3° at the last follow-up ( F=651.97, P<0.05). Conclusion:For patients with unilateral type IV DDH, non-osteotomy THA is a safe and effective surgical method with simple operation and few complications. It can quickly correct pelvic tilt and lumbar compensatory scoliosis postoperatively.

Efficacy of liraglutide combined with metformin in the treatment of type 2 diabetes mellitus in 60 overweight or obese patients / 中国基层医药

Objective:To investigate the clinical efficacy of liraglutide combined with metformin in the treatment of type 2 diabetes mellitus in overweight or obese patients.Methods:The clinical data of 120 overweight or obese patients with type 2 diabetes mellitus admitted to Bayannur Hospital from January 2020 to June 2021 was retrospectively analyzed. They were divided into study and control groups ( n = 60/group) according to different treatments. The study group was treated with liraglutide combined with metformin, and the control group was treated with metformin alone. All patients were treated for 12 weeks. Clinical efficacy was compared between the two groups. Results:After treatment, body mass, body mass index, fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, visceral fat area, and insulin resistance index in the study group were (71.51 ± 10.12) kg, (25.98 ± 2.63) kg/m 2, (6.09 ± 0.99) mmol/L, (9.08 ± 2.39) mmol/L, (6.75 ± 1.13)%, (4.43 ± 0.88) mmol/L, (1.76 ± 0.68) mmol/L, (2.29 ± 0.90) mmol/L, (108.21 ± 26.46) cm 2 and (3.57 ± 1.45), respectively, which were significantly lower than (75.57 ± 7.11) kg, (27.91 ± 2.46) kg/m 2, (7.02 ± 0.95) mmol/L, (11.26 ± 2.86) mmol/L, (7.28 ± 1.04)%, (5.24 ± 1.11) mmol/L, (2.19 ± 0.70) mmol/L, (2.86 ± 0.97) mmol/L, (118.32 ± 28.63) cm 2, and (4.28 ± 2.07) respectively in the control group ( t = 2.54, 4.15, 5.23, 4.53, 2.66, 4.45, 3.43, 3.39, 2.01, 2.19, all P < 0.05). High-density lipoprotein cholesterol in the study group was significantly higher than that in the control group [(1.55 ± 0.28) mmol/L vs. (1.20 ± 0.32) mmol/L, t = -6.38, P < 0.05]. The grade of nonalcoholic fatty liver disease in the study group was significantly superior to that in the control group ( Z =-2.16, P < 0.05). Conclusion:Liraglutide combined with metformin can effectively improve blood glucose and lipid levels, and reduce insulin resistance, body weight, visceral adipose tissue and liver hepatocellular fatty deposits in overweight or obese patients with type 2 diabetes mellitus.

Triaging patients in the outbreak of COVID-2019 / 中国感染控制杂志

In the outbreak of COVID-19,triage procedures based on epidemiology were implemented in a local hospital in Changsha to control the transmission of SARS-CoV-2 and avoid healthcare-associated infection.This re-trospective study analyzed the data collected during the triage period and found that COVID-19 patients were en-riched 7 folds into the Section A designated for patients with obvious epidemiological history.On the other side,nearly triple amounts of visits were received at the Section B for patients without obvious epidemiological history.8 COVID-19 cases were spotted out of 247 suspected patients.More than 50％of the suspected patients were submi-tted to multiple rounds of nucleic acid analysis for SARS-CoV-2 infection.Of the 239 patients who were diagnosed as negative of the virus infection,188 were successfully revisited and none was reported as COVID-19 case.Of the 8 COVID-19 patients,3 were confirmed only after multiple rounds of nucleic acid analysis.Besides comorbidities,delayed sharing of epidemiological history added complexity to the diagnosis in practice.The triaging experience and strategy will be helpful for the control of infectious diseases in the future.

Overcoming chemoresistance in non-angiogenic colorectal cancer by metformin via inhibiting endothelial apoptosis and vascular immaturity / 药物分析学报

The development of chemoresistance which results in a poor prognosis often renders current treatments for colorectal cancer(CRC).In this study,we identified reduced microvessel density(MVD)and vascular immaturity resulting from endothelial apoptosis as therapeutic targets for overcoming chemoresistance.We focused on the effect of metformin on MVD,vascular maturity,and endothelial apoptosis of CRCs with a non-angiogenic phenotype,and further investigated its effect in overcoming chemoresistance.In situ transplanted cancer models were established to compare MVD,endothelial apoptosis and vascular maturity,and function in tumors from metformin-and vehicle-treated mice.An in vitro co-culture system was used to observe the effects of metformin on tumor cell-induced endothelial apoptosis.Transcriptome sequencing was performed for genetic screening.Non-angiogenic CRC developed inde-pendently of angiogenesis and was characterized by vascular leakage,immaturity,reduced MVD,and non-hypoxia.This phenomenon had also been observed in human CRC.Furthermore,non-angiogenic CRCs showed a worse response to chemotherapeutic drugs in vivo than in vitro.By suppressing endo-thelial apoptosis,metformin sensitized non-angiogenic CRCs to chemo-drugs via elevation of MVD and improvement of vascular maturity.Further results showed that endothelial apoptosis was induced by tumor cells via activation of caspase signaling,which was abrogated by metformin administration.These findings provide pre-clinical evidence for the involvement of endothelial apoptosis and subsequent vascular immaturity in the chemoresistance of non-angiogenic CRC.By suppressing endothelial apoptosis,metformin restores vascular maturity and function and sensitizes CRC to chemotherapeutic drugs via a vascular mechanism.

Retrospective study on the treatment of phalanx fractures with absorbable materials / 中国医师进修杂志

Objective:To investigate the effect of absorbable material internal fixation in the treatment of phalanx fracture and its effect on the complications related to hypersensitive C-reactive protein (hs-CRP), interleukin-10 (IL-10), adrenocorticotropic hormone (ACTH) and foreign body reaction.Methods:The clinical data of 98 patients with phalangeal fracture in Huishan District People′s Hospital of Wuxi City from January 2018 to January 2020 were divided into absorbable group (49 cases, treated with absorbable material internal fixation) and microplate group (49 cases, treated with minimally invasive plate internal fixation). The rates of excellent and good treatment, operation conditions, serum inflammatory stress response indexes levels before and 1 d and 1 week after surgery were compared, and recovery at 3 and 6 months after surgery, the incidence of complications and the degree of treatment satisfaction were counted.Results:The rates of excellent and good treatmentin the absorbable group were higher than that in the micro plate group: 95.92%(47/49) vs. 81.63%(40/49), χ2 = 5.02, P<0.05. The duration of operation in the absorbable group was longer than that in the microplate group: (43.28 ± 12.18) min vs. (31.29 ± 11.69) min; and the duration of hospital stay, fracture healing time and recovery time were shorter than those in the microplate group: (4.09 ± 1.18) d vs. (6.89 ± 2.12) d, (4.35 ± 1.05) weeks vs. (5.69 ± 1.38) weeks, (4.89 ± 1.10) d vs. (6.20 ± 2.01) d; the differences were statistically significant ( P<0.05). The levels of serum hs-CRP, IL-10 and ACTH in absorbable group were lower than those in microplate group at 1 d and 1 week after surgery ( P<0.05). At 3 and 6 months after surgery, the range of motion of metacarpophalangeal joint in the absorbable group was greater than that in the microplate group, and the loss of grip strength of the healthy side was less than that in the microplate group ( P<0.05). The incidence of complications in absorbable group was lower than that in microplate group: 6.12%(3/49) vs. 20.41%(10/49), χ2 = 4.35, P<0.05. Conclusions:The absorbable material internal fixation can achieve good results in the treatment of phalanx fracture, the postoperative recovery is fast, the incidence of complications is lower.