Moxibustion regulates T-regulatory/T-helper 17 cell balance by modulating the microRNA-221/suppressor of cytokine signaling 3 axis in a mouse model of rheumatoid arthritis / 中西医结合学报

OBJECTIVE@#Rheumatoid arthritis (RA) progression is associated with the balance of T-regulatory (Treg) and T-helper 17 (Th17) cells, while the role of microRNAs (miRs) in regulating Treg/Th17 cell balance has not been clarified. This study aimed to assess whether moxibustion could regulate Treg/Th17 cell balance by modulating the miR-221/suppressor of cytokine signaling 3 (SOCS3) axis in the RA mouse model.@*METHODS@#A mouse model of collagen-induced arthritis (CIA) was established in male DBA/1J mice. Twenty-two days after CIA induction, the mice received daily treatment with moxibustion for 12 times. Pathological scores were assessed according to the levels of synovial hyperplasia. The expression levels of cytokines interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IL-17 and IL-10 were analyzed in serum by enzyme-linked immunosorbent assay. The cluster of differentiation 4 (CD4+) splenocytes was analyzed by fluorescence-activated cell sorting. The expression levels of RA-related miRs and target genes were subsequently detected, and the target of miR-221 was confirmed by the dual-luciferase reporter assay.@*RESULTS@#It was revealed that moxibustion treatment decreased the pathological scores and downregulated the expression levels of IL-1β, IL-6, TNF-α, IFN-γ and IL-17, while upregulated the expression level of IL-10. The Treg/Th17 cell balance was regulated by moxibustion treatment. The expression level of miR-221 was suppressed by moxibustion treatment. Furthermore, SOCS3 was found as the direct target of miR-221, which mediated the function of moxibustion by regulating the Treg/Th17 cell balance.@*CONCLUSION@#Moxibustion therapy regulated the Treg/Th17 cell balance by modulating the miR-221/SOCS3 axis in the RA mouse model.

Treatment of double-column acetabular fractures with open reduction and internal fixation through a single lateral rectus abdominis approach / 中华创伤杂志

Objective:To investigate the clinical effect of open reduction and internal fixation for the treatment of double-column acetabular fractures by lateral rectus abdominis approach.Methods:A retrospective case series study was conducted to analyze the data of 44 patients with double-column acetabular fractures admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2015 to June 2019. There were 29 males and 15 females, with the age of 21-72 years [(41.3±8.4)years]. All patients were treated by open reduction and internal fixation through a single lateral rectus abdominis approach. Operation time, intraoperative blood loss and fracture healing time were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria, and hip function by the modified Merle D'Aubigne and Postel score at last follow-up. Postoperative complications were observed.Results:A total of 40 patients were followed up and 4 patients were lost to follow-up. The follow-up time was 12-46 months [(30.5±6.4)months]. The operation time ranged from 45 to 150 minutes[(111.2±20.6)minutes], and the intraoperative blood loss was 200-1 200 ml [(398.5±78.5)ml]. The fractures were healed, with the healing time of 10 to 16 weeks [(11.8±3.3)weeks]. At last follow-up, according to the Matta criteria, the results were excellent in 29 patients, good in 7, fair in 3, poor in 1, with the excellent and good rate of 90%. At last follow-up, according to the Merle D'Aubigne and Postel score, the results were excellent in 27 patients, good in 6, fair in 6, poor in 1, with the excellent and good rate of 83%. One patient had heterotopic ossification with no impact on hip function, and no special treatment was given. One patient with the reaction of foreign body was finally controlled by anti-infection treatment, and the internal fixation was removed again one year after operation. Three patients with mild osteoarthritis were relieved by oral anti-inflammatory and analgesic drugs. Two patients with deep venous thrombosis of lower extremities were cured by anti-coagulation therapy such as low molecular weight heparin.Conclusions:The single rectus abdominis approach for open reduction and internal fixation of double-column acetabular fractures can take into account the anterior column, quadrilateral body and posterior column. Meanwhile, this approach has advantages of satisfactory acetabular reduction and functional recovery, and less postoperative complications, suggesting an alternative procedure for treatment of double-column acetabular fractures.

Application of magnetic resonance neurography in the treatment of pelvic fracture with lumbosacral plexus injury / 中华骨科杂志

Objective:To investigate the application value of magnetic resonance neurography (MRN) in pelvic fractures with lumbosacral plexus injury.Methods:From January 2014 to June 2020, data of 9 patients with pelvic fractures combined with lumbosacral plexus injury who were diagnosed with MRN and were performed surgical treatment were analyzed retrospectively. Among them, there were 8 males and 1 female, aged from 18 to 54 years, with an average age of 40.6±11.0 years. There were 2 fresh fractures within 3 weeks and 7 old pelvic fractures in 9 patients. According to AO classification, there were 6 cases of C1.3 type, 3 cases of C3 type. According to Denis classification of sacral fracture, there were 8 cases of Denis II type, 1 case of Denis III. Gibbons classification of nerve injury: 2 cases of grade II, 4 cases of grade III, 3 cases of grade IV; According to the criteria by the Nervous Injury Committee of British Medical Research Council (BMRC): 2 cases of M1, 3 cases of M2, 2 cases of M3, 2 cases of M4. Before the operation, the MRN technology was used to accurately locate the location and extent of the lumbosacral nerve injury, and nerve exploration release or internal fixation combined with nerve exploration release was employed for treatment.Results:All 9 patients underwent surgery successfully. The operation time ranged from 150 to 360 min, with an average of 217.8±63.8 min; intraoperative blood loss ranged from 200 to 1 100 ml, with an average of 388.9±293.4 ml. All patients were followed up for 21.6±19.3 months. All the fractures were healed, and the healing time was 12.7±2.2 months (range, 10-18 months). At the last follow-up, Gibbons classification of nerve injury: 3 cases of grade I, 5 cases of grade II, and 1 case of grade III. According to the criteria of BMRC: the muscle strength achieved M5 in 6 cases, M4 in 2 cases, M3 in 1 case. One patient developed a urinary system infection 2 months after discharge and recovered after treatment.Conclusion:MRN technique can assist the surgeon to fully understand the compression and traction damage of the lumbosacral nerve by the fracture before the operation, and make clear qualitative and localized diagnosis of the nerve damage, making the operation more precise and minimally invasive, which is a supplement to the traditional diagnosis method of lumbosacral plexus injury.

Clinical treatment of pelvic fracture complicated with anterior sacroiliac joint dislocation / 中华骨科杂志

Objective:To explore the clinical diagnosis and treatment experience of pelvic fracture complicated with anterior sacroiliac joint dislocation.Methods:The data of 19 patients with pelvic fracture and anterior sacroiliac joint dislocation admitted from June 2013 to September 2019 were retrospectively analyzed. There were 12 males and 7 females; aged 9-67 years, with an average of 28.0 years. There were 11 cases of traffic accident injury, 6 of falling injury and 2 of crashing injury caused by machine extrusion. According to the Tile classification, there were 8 cases of type C1, 2 of type C2, and 9 of type C3; 6 cases of modified mangled extremity severity score (MESS) were greater than or equal to 7, of which 2 cases underwent hip amputation, 4 cases underwent king-steelquis semipelvectomy. 13 cases underwent limb-salvage surgery, of which 3 cases underwent external fixation surgery, and the remaining 10 cases underwent open reduction and internal fixation with steel plate. The reduction quality was evaluated according to the Matta imaging criteria of pelvis, the pain was evaluated according to the visual analogue scale (VAS), and the pelvic function was evaluated according to the Majeed score.Results:The operation time was 2 to 4 hours, with an average of 3.2 hours; the intraoperative blood loss was 400 to 1 200 ml, with an average of 768.4 ml. The 18 surviving patients were followed up for 6 to 24 months, with an average of 11.6 months. One of the 6 amputation patients died one week after the operation due to septic shock and multiple organ failure. The overall survival rate of the patients was 94.7% (18/19), and the amputation rate was 31.6% (6/19). The pelvic fractures of the 18 surviving patients were all healed, and the fracture healing time was 3 to 6 months, with an average of 4.2 months. No delayed union or nonunion occurred. At the last follow-up of the 18 surviving patients, the VAS was 2.4±1.9 points (range, 0-6 points). Among them, there were no pain in 3 cases, mild pain in 9 cases and moderate pain in 6 cases. At the last follow-up, 13 patients undergoing limb salvage treatment evaluated the quality of reduction according to Matta imaging criteria. Among them, 6 cases were excellent, 4 were good, 2 were fair, and 1 was poor. The excellent and good rate was 76.9% (10/13). The Majeed functional score was 81.8±11.9 points (range, 53-95 points). Among them, 6 cases were excellent, 5 were good, 1 was fair, and 1 was poor. The excellent and good rate was 84.6% (11/13). In the limb salvage treatment group, 4 patients with lumbosacral nerve injury caused limited hip joint movement function, and unilateral lower limb sensation and movement were weakened. After neurolysis and nutritional support treatment, the patient's sensorimotor function was significantly improved.Conclusion:The mortality and disability rate of pelvic fractures combined with anterior sacroiliac joint dislocation is high. In order to save the patient's life, early diagnosis of limb injury and early surgical intervention should be performed. If necessary, hip disarticulation or king-steelquis should be selected.

Nutritional support in children with pneumonia on mechanical ventilation by short-peptide enteral nutrition formula / 中国当代儿科杂志

OBJECTIVE@#To observe the incidence of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation in the pediatric intensive care unit (PICU), and to explore the nutritional support effect of short-peptide enteral nutrition formula.@*METHODS@#A total of 68 children with severe pneumonia who were hospitalized in the PICU from October 2017 to October 2018 and required mechanical ventilation were enrolled for a prospective randomized controlled study. The children were randomly divided into a control group and an experimental group. Through the nasogastric feeding tube, the experimental group received the short-peptide enteral nutrition formula, and the control group received the intact-protein enteral nutrition formula. The weight-for-age Z score, STRONGkids nutritional risk score, and pediatric critical illness score of the two groups were evaluated. The serum levels of total protein, albumin, and prealbumin (PA) on admission and before discharge were measured. The gastrointestinal tolerance and clinical outcome indicators of the two groups were observed.@*RESULTS@#Among the 68 mechanically ventilated children, 26 (38%) had malnutrition, including moderate malnutrition (10 cases, 15%) and severe malnutrition (16 cases, 24%); 10 cases (15%) had malnutrition at discharge. Sixty-three children (93%) had nutritional risk, including moderate nutritional risk in 21 cases and high nutritional risk in 42 cases. The moderate and high nutritional risk rates of the critical and extreme critical groups were significantly higher than those of the non-critical group (P0.05).@*CONCLUSIONS@#The detection rates of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation are relatively high. Short-peptide enteral nutrition formula can help improve their treatment outcome and are more suitable for nutritional support in critically ill children on mechanical ventilation.

Effects of moxibustion on Treg/Th17 cell and its signal pathway in mice with rheumatoid arthritis / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of moxibustion on Treg/Th17 imbalance and related signal pathway in mice with rheumatoid arthritis (RA), so as to explore the action mechanism of moxibustion on RA.</p><p><b>METHODS</b>Twenty-four DBA/1J male mice were randomly divided into a normal group, a model group, a sham moxibustion group and a moxibustion group, 6 mice in each one. RA model was induced by subcutaneous injection of typeⅡcollagen and adjuvant at tail in mice other than the normal group. The mice in the moxibustion group were treated with moxibustion at"Zusanli" (ST 36) and "Shenshu" (BL 23), 1 mg per cone, 6 cones per acupoint. The consecutive 6-day treatment was taken as one course, and totally 2 courses were given with an interval of 2 d between courses. The mice in the sham moxibustion group were treated with immobilization as the moxibustion group. The effects of moxibustion on joint swelling was evaluated by RA scale of collagen induced arthritis (CIA); the pathological changes of joint inflammation were observed by HE staining; the cell count of Th17 and Treg in spleen was analyzed by flow cytometry; the content of cytokine IL-1β, IL-6, IL-10, IL-17, IL-23, TGF-β and Galectin-9 were analyzed by ELISA; the mRNA and protein expression of Foxp3, Galectin-9, RORγt, CARMA1, NF-κB were analyzed by Real-time PCR and Western Blotting method.</p><p><b>RESULTS</b>Ten to 12 d after the secondary immune, red and swelling of ankle joint, feet and toe joint were observed, indicating successful establishment of RA model. 15 d into moxibustion treatment, the joint swelling was improved in the moxibustion group and the sham moxibustion group, which was superior in the moxibustion group (<0.05). As for pathological changes, compare with the normal group, the articular surface was rougher and synovial layer thinner in the model group, which was recovered to a certain extent in the sham moxibustion group; the articular surface was smooth and synovial layer was thicker in the moxibustion group, which was similar to the normal group. The results of flow cytometry test indicated the cell count of Treg in the model group was reduced but that of Th17 was increased than the normal group (both<0.01); the moxibustion could increase significantly the cell count of Treg (<0.05), but no effect was observed on Th17 (>0.05). The results of ELISA test indicated the differences of increasing of IL-1β, IL-6, IL-17, IL-23, TGF-βas well as the reducing of IL-10 were not significant between the sham moxibustion group and the moxibustion group (all>0.05); moxibustion treatment could increase the content of Galectin-9 which was reduced in RA mice (<0.05). The results of RT-PCR and Western blotting test indicated the mRNA and protein expression of Foxp3, Galectin-9 were reduced in the model group (all<0.01), which could be up-regulated by moxibustion treatment (<0.05,<0.01); the mRNA and protein expression of RORγt, CARMA1, NF-κB was increased (all<0.01), which could be down-regulated by moxibustion treatment (<0.05,<0.01).</p><p><b>CONCLUSION</b>Moxibustion could improve the swelling of joint and inflammatory reaction of joint synovial in RA mice; the mechanism may be related to the regulation of Treg cells number in spleen and the expression of Foxp3, Galectin-9, RORγt, CARMA1, NF-κB, mRNA and protein expression.</p>

A Review about h type indices / 中华医学科研管理杂志

This review firstly introduces sixty h type indices which are categorized in order to overcome the drawbacks of the Hirsch index,especially the advantages and limits of the h type indices when comparing with h index.Moreover,the review gives a list to show the main characteristics of h type indices.Lastly,some illustrative researches are shown to present the applicability of some h type indices.

Analgesic effect of acupuncture compound anesthesia in functionality nasal endoscopic sinus surgery / 中国针灸

<p><b>OBJECTIVE</b>To verify the analgesic effect of acupuncture compound anesthesia in functionality nasal endoscopic sinus surgery (FNES).</p><p><b>METHODS</b>Ninety patients undergoing FNES were randomly divided into three groups. Group A was treated with routine local anesthesia, and group B and C were treated with electroacupuncture at Yintang (EX-HN 3) and Yingxiang (LI 20) for 30 min before local anesthesia. Group B received routine local anesthesia, and group C received decrement local anesthesia. The dosage of narcotic, modified fingers pain scores and postoperative satisfaction scores were observed in three groups.</p><p><b>RESULTS</b>The operative dosage of decicaine was (118.33 +/- 26.21) mg in group A, (100.83 +/- 4.56) mg in group B, and (71.33 +/- 8.90) mg in group C, with significant differences among the three groups (all P < 0.01), the lowest dosage was used in group C and the highest dosage in group A. The fingers pain scores of group B and C were both lower than that of group A (both P < 0.01), and the postoperative satisfaction scores of group B and C were both higher than that of group A (both P < 0.01).</p><p><b>CONCLUSION</b>Acupuncture compound anesthesia can effectively alleviate the pain, decrease the dosage of local anesthetic, lower the discomfortableness and be helpful for safety of the patients during sinus surgery.</p>

Influence of acupuncture-drug compound anesthesia with different frequency electroacupuncture on immune function in patients undergoing pneumonectomy / 中国针灸

<p><b>OBJECTIVE</b>To explore different frequency electroacupuncture in acupuncture-drug compound anesthesia on analgesic effect and immune function in the pulmonary resection patients in order to recommend the best electroacupuncture frequency in acupuncture-drug compound anesthesia.</p><p><b>METHODS</b>One hundred and sixty-three patients scheduled for pneumonectomy were randomly divided into group A (n = 31), B (n = 34), C (n = 32), D (n = 34) and E (n = 32). Houxi (SI 3), Zhigou (TE 6), Neiguan (PC 6) and Hegu (LI 4) were selected in the five groups. Group A was treated with sham acupuncture by pasting needles without needle bodies at acupoints and electroacupuncture at the needle handle, and group B with 2 Hz electroacupuncture, and group C with 2 Hz/ 100 Hz electroacupuncture, and group D with 100 Hz electroacupuncture, and group E with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation, and general anesthesia was produced in all the groups followed by 30 min electrical stimulation and the stimulation was lasted till the end of operation. The dosages of the anesthetics and the changes of surface antigen of leukomonocyte (CD3+ , CD4+ , CD8+ and CD4+/CD8+) and natural killer (NK) cell were observed at 1 day before surgery, intraoperative and 1 day after surgery.</p><p><b>RESULTS</b>In comparison with group A, the dosages of Propofol in group B and D were decreased, Fentanyl in group B, D and E were decreased. CD3+ and CD4+ in 5 groups increased at first and then decreased over time (all P < 0.01), and group E and C could inhibit the decrease of CD3+ and CD4+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and D could inhibit the decrease of CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD4+/CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and C could inhibit the decrease of CD4+/CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). NK cells of 5 groups were increased gradually in different times (all P < 0.01), with the similar regulation of NK cells (all P > 0.05).</p><p><b>CONCLUSION</b>Acupuncture-drug compound anesthesia with 2 Hz and 100 Hz electroacupuncture together with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation have the best analgesic effect, and 2 Hz/100 Hz transcetaneous acupoints electrical stimulation and 2 Hz/100 Hz electroacupuncture have the best regulation of immune function. Acupuncture-drug compound anesthesia with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation is recommended for that it can not only decrease the dosages of the anesthetics, but also significantly improve the immunosuppression in patients undergoing pneumonectomy.</p>

Effect of exogenous interleukin-10 on liver regeneration in rats with biliary obstruction / 中华肝胆外科杂志

Objective To investigate the effect of exogenous interleukin-10 (IL-10) on liver regeneration in rats with biliary obstruction.Methods Male Wistar rats were divided randomly into either a sham operation (SO) group,obstructive jaundice (OJ) group,or IL-10 treated group.Rats in OJ and IL-10 treated groups underwent ligation and division of the common bile duct,while only the SO group had division of the common bile duct.Rats in the IL-10 treated group received daily intraperitoneal injection of IL-10 at a dose of 4 μg/kg after the operation.Quantitative fluorescence real-time PCR was performed to detect hepatic TGF-β1 mRNA expression.Immunohistochemistry for hepatic proliferating cell nuclear antigen (PCNA) labeling index was used to evaluate and epitope of IL-10.The serum levels of total bilirubin (T Bil),direct bilirubin (D Bil),alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also measured.Results Hepatic TGF-β1 mRNA,PCNA labeling index and serum levels of ALT and AST in OJ group rats were significantly higher than SO group rats at days 3 and 7 after the operation (P＜0.05).Compared to the OJ group,the IL-10 group had significantly lower hepatic TGF-β1 mRNA and serum levels of ALT and AST.Conversely the IL10 group's hepatic PCNA labeling index was significantly increased as compared with those in OJ group 7 days after operation (P＜0.05).Conclusion Exogenous IL-10 could enhance liver regeneration and alleviate hepatic dysfunction by down-regulating hepatic TGF-β1 expression in rats with biliary obstruction.

Patterns of hepatic cells death during hepatic ischemia/reperfusion injury in cirrhotic rats / 中国医学科学院学报

<p><b>OBJECTIVE</b>To research on the main pattern of hepatic cells death during hepatic ischemia/ reperfusion (I/R) injury in cirrhotic rat.</p><p><b>METHODS</b>Cirrhotic rat model was established by carbon tetrachloride replication. These rats were randomly divided into sham operation group and I/R group. In the I/R group, 70% i/R injury model was established and then the liver samples were taken 0, 1, 6, 24, and 48 hours after reperfusion. Serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels, Na+ - K+ ATPase, and Ca2+ ATPase were compared. the percentage of apoptotic/oncotic hepatic cells was measured with flow cytometry, and the changes in hepatic cellular structures were observed under transmission electron microscope.</p><p><b>RESULTS</b>Compared with the sham operation group, the levels of serum AST and ALT significantly increased in the I/R group (P < 0.05), reaching their peak levels at the 6th hour. The activities of Na+ - K+ ATPase and Ca2+ ATPase dramatically decreased one hour after reperfusion and then gradually recovered (P < 0.05). Hepatic cells mainly suffered oncosis at the early stage after reperfusion (within 6 hours); at the late stage (around 24 hours after reperfusion), apoptosis became the main death pattern.</p><p><b>CONCLUSION</b>Oncosis is the main pattern of hepatic cells death during I/R injury in cirrhotic rat, and the severity of hepatic injury correlates with the oncosis.</p>