The protective effect and mechanism of N-acetylcysteine on acute kidney injury by up-regulating Sirtuin3 protein expression in septic mice / 中华急诊医学杂志

Objective:To explore the protective effect and mechanism of the antioxidant N-acetylcysteine (NAC) regulating silent information regulator 3 (Sirt3) on acute kidney injury (AKI) in septic mice.Methods:Male C57BL/6 mice were randomly ( random number) divided into the sham operation group (sham), cecal ligation and perforation group (CLP), CLP + NAC (50 mg/kg) and CLP + NAC (100 mg/kg) groups, with 10 mice in each group. The mice were sacrificed 24 h after CLP, and blood and kidney tissue samples were collected. HE staining was used to evaluate the pathological damage of the kidney tissue of mice in each group. ELISA was used to detect serum creatinine (Scr), urea nitrogen (BUN), kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated apolipoprotein (NGAL) levels. Immunohistochemistry was used to detect the expression of Sirt3 protein in kidney tissue. RT-qPCR was used to detect the level of Sirt3 mRNA. Mitochondrial damage of renal tubular epithelial cells was observed under transmission electron microscope, and the mitochondrial density was calculated. Meanwhile, the levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and malondialdehyde (MDA) in the renal cortex were also detected. Results:Compared with the sham group, in the CLP group, the pathological damage of renal tissue was significantly aggravated ( P<0.001), and the levels of renal function indicators (Scr, BUN, KIM-1 and NGAL) were all increased significantly (all P<0.001). The protein and mRNA expression of Sirt3 were all significantly decreased (all P<0.001), the mitochondrial structure damage of renal tubular epithelial cells was increased, and the mitochondrial density was significantly decreased ( P<0.001). The levels of antioxidant enzymes (SOD, GSH-Px and CAT) in the renal cortex were all significantly decreased (all P<0.001), while the lipid peroxide MDA was significantly increased ( P<0.001). Compared with the CLP group, the renal injury score and renal function indexes (Scr, BUN, KIM-1 and NGAL levels) in the 50 mg/kg NAC pretreatment group were decreased, and the levels of SOD, GSH-Px and CAT in renal tissue were increased, but the differences were not significant. However, pretreatment with 100 mg/kg NAC significantly reduced the pathological damage of kidney tissue caused by CLP ( P<0.001), and significantly decreased the levels of Scr, BUN, KIM-1 and NGAL (all P<0.001). The expression of Sirt3 protein [(50.20±2.79) vs.(20.00±0.75), P<0.001] and mRNA [(0.57±0.07) vs. (0.41±0.07), P<0.001] were all significantly increased. The mitochondrial structure of renal tubular epithelial cells was more stable, and the mitochondrial density was significantly increased [(0.60±0.05) vs. (0.43±0.06), P<0.001]. The levels of SOD [(67.37±3.79) U/mg vs. (21.09±0.89) U/mg, P<0.001], GSH-Px [(265.61±9.61) U/mg vs. (180.00±3.31) U/mg, P<0.001] and CAT [(8.58±0.65) U/mg vs. (5.19±0.58) U/mg, P<0.001] were all significantly increased, while the expression level of MDA was significantly reduced [(40.36 ±1.79) vs. (83.81 ±1.70), P<0.001]. Conclusions:NAC can significantly reduce renal pathological damage, improve renal function, maintain mitochondrial structure stability and reduce oxidative stress levels in septic mice by up-regulating Sirt3 protein expression, and has a significant protective effect on CLP-induced AKI.

Analysis of refractive status of preschool children in Suzhou High tech Zone / 中国学校卫生

Objective@#To observe the refractive status of preschool children, and to explore the prevalence and development trend of ametropia in preschool children, so as to provide support for controlling adolescent ametropia and improving children s health care service.@*Methods@#This cross sectional survey was conducted among 27 561 preschool children (55 122 eyes) aged 3-6 years old in the High tech Zone of Suzhou from September to December 2020. The refractive status was screened by the US Weilun binocular optometry.@*Results@#The total detection rate of ametropia was 9.5%, including 8.6% of astigmatism, 1.3% of hyperopia and 0.5% of myopia. The detection rates of myopia (1.1%) and hyperopia (2.2%) were the highest in the 6-year-old group, and the older the age was, the lower the spherical diopter was, and the higher the cylindrical diopter was. The abnormal rate of colposcopy in girls ( 1.3% ) was higher than that in boys (0.9%), and the abnormal rate of total anisometropia in women (2.3%) was also higher than that in men (1.9%). The main astigmatism was mixed astigmatism (49.1%) and compound hyperopia astigmatism (39.2%); The older the age, the lower the detection rate of compound hyperopia astigmatism. And it is dominated by regular astigmatism( 97.5% ); The higher the age, the higher the detection rate of astigmatism with the rule, while the lower the detection rates of astigmatism against the rule and oblique axis astigmatism.@*Conclusion@#The detection rate of myopia and hyperopia increased significantly at the age of 6, and anisometropia and axial astigmatism also reached the highest at the age of 6. Local health care departments should pay attention to children s astigmatism, especially astigmatism with the rule.

Four-stitch cholangiojejunostomy / 中华肝胆外科杂志

Objective:To evaluate the clinical application efficacy of four-stitch cholangiojejunostomy.Methods:Of 38 patients who received four-needle biliary and enterointestinal anastomosis in the Department of Hepatobiliary Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College from November 2016 to April 2020 were included, and the diseases, surgical methods and postoperative complications of four-needle biliary and enterointestinal anastomosis were analyzed.Results:There were 26 males and 12 females with an average of 57.3(44-77) years. Among 38 patients, there were 12 hilar cholangiocarcinoma patients, 10 pancreatic head cancer, 9 duodenal papillary cancer, 4 intrahepatic and extrahepatic bile duct stones, 1 pancreatic cystic adenoma, 1 gastric cancer invading pancreatic head and 1 gallbladder carcinoma. The procedure included pancreatoduodenectomy in 20, radical resection of hilar cholangiocarcinoma in 12, hepatectomy with biliary-enteric anastomosis in 4, radical resection of gastric cancer combined with pancreaticoduodenectomy in 1, radical resection of gallbladder carcinoma in 1. One, two and three ductal openings were anastomosed in 27, 7 and 4 patients, respectively. 10 patients have bile duct diameter <6 mm. Postoperative anastomotic leakage occurred in 1, and all patients were received followed-up visit for 2 months to 4 years without anastomotic stenosis.Conclusion:Four-stitch cholangiojejunostomy is simple, safe, effective, and convenient for small biliary ductal surgeries.

Protective effect and mechanism of Baicalin on acute kidney injury in septic mice / 中华危重病急救医学

Objective:To observe the protective effect and mechanism of different doses of Baicalin (BAI) on acute kidney injury (AKI) in septic mice.Methods:According to the random number table, 100 mice were divided into sham operation group (Sham group), cecal ligation and perforation (CLP) induced sepsis model group (CLP group) and BAI pretreatment groups. The mice in BAI pretreatment groups were divided into low-, medium- and high-dose groups (BAI-L+CLP, BAI-M+CLP, BAI-H+CLP groups), with 20 mice in each group. A murine sepsis associated-acute kidney injury (SA-AKI) model was reproduced using CLP. The mice in the Sham group were only opened and closed the abdomen, without ligating or perforating the cecum. The mice in the BAI pretreatment groups were given BAI 25, 50 and 100 mg/kg daily for 3 days, and CLP was performed at 6 hours after administration of BAI at the 3rd day to reproduce sepsis model. The mice in the Sham group and CLP group were given the same amount of distilled water as control. Ten mice were sacrificed at 24 hours after operation to collect orbital blood for renal function determination [serum creatinine (SCr), blood urea nitrogen (BUN), plasma neutrophil gelatinase-associated lipocalin (pNGAL) and plasma kidney injury molecule-1 (pKIM-1)] by enzyme linked immunosorbent assay (ELISA). The kidney tissue was collected to observe the kidney tissue injury under light microscope after hematoxylin-eosin (HE) staining. The TdT-mediated dUTP nick-end labeling (TUNEL) was used to detect the apoptosis of renal tubular epithelial cells. Western blotting was used to detect the expression of cell FLICE like inhibitory protein (c-FLIP) in renal tissue. The remaining 10 mice in each group were used to calculate the survival rate of 7 days after operation.Results:The renal tubular epithelial cells in the CLP group were massively degenerated with necrosis, the renal tubular lumen was significantly expanded, and inflammatory cells were widely infiltrated in the renal interstitium. Furthermore, the renal function deteriorated rapidly. Compared with the CLP group, the renal function of mice pretreated with low dose of BAI was improved, but the difference was not significant. Compared with the CLP group, the renal function in the mice pretreated with medium and high doses of BAI was significantly improved, the SCr, BUN, pNGAL and pKIM-1 were significantly reduced [SCr (μmol/L): 135.16±5.18, 125.70±5.26 vs. 170.42±5.42; BUN (mmol/L): 33.59±1.77, 27.29±1.61 vs. 45.68±1.39; pNGAL (μg/L): 91.29±4.68, 73.40±3.77 vs. 131.50±6.55; pKIM-1 (μg/L): 6.34±0.30, 5.51±0.35 vs. 8.03±0.29; all P < 0.01], the pathological injury of renal tissue was significantly decreased, the apoptotic number of renal tubular epithelial cells was significantly reduced (cells/HP: 16.20±0.49, 13.10±0.66 vs. 29.60±0.49, both P < 0.01), and the expression of c-FLIP protein in renal tissue was significantly increased [c-FLIP protein (c-FLIP/GAPDH): 0.35±0.02, 0.46±0.02 vs. 0.21±0.01, both P < 0.01]. No mouse in the Sham group died within 7 days. Compared with the CLP group, the average survival time of the mice within 7 days in the BAI-L+CLP, BAI-M+CLP and BAI-H+CLP groups was significantly prolonged with a dose-dependent manner (days: 3.5±2.5, 5.4±2.2, 5.9±1.9 vs. 2.1±1.2; Log-Rank test: χ2 = 73.410, P < 0.001). Conclusion:Pretreatment with medium and high doses of BAI can significantly improve the renal function in mice with SA-AKI, decrease the pathological damage and increase the survival of mice, and its mechanism may be related to promoting the increase of c-FLIP protein expression and inhibiting cell apoptosis.

Protective effect of mitochondria-targeted antioxidant peptide SS-31 in sepsis-induced acute kidney injury / 中华危重病急救医学

Objective:To study the effect and mechanism of mitochondria-targeted antioxidant peptide SS-31 on sepsis-induced acute kidney injury (AKI).Methods:Sixty adult male C57BL/6 mice were randomly divided into four groups according to the random number table method: sham group (10 mice), positive control group (10 mice), sepsis model group (20 mice), and SS-31 peptide group (20 mice). The sepsis-induced AKI mouse model was reproduced by cecal ligation and puncture (CLP). The sham group only received laparotomy. SS-31 peptide (5 mg/kg) was intraperitoneally injected in SS-31 peptide group and positive control group 30 minutes after the operation, while an equivalent amount of normal saline was given in sham group and sepsis model group for 7 days. The blood samples were collected 24 hours after the operation from orbit, and the serum was collected to test the serum creatinine (SCr) and blood urea nitrogen (BUN). The mice were sacrificed 7 days after surgery. The kidney tissues were collected to observe the pathologic structure changes under the hematoxylin-eosin (HE) staining by light microscope. And the mitochondrial ultrastructure was checked under the transmission electron microscope. Cell apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method (TUNEL). The expression level of peroxisome proliferator-activated receptorγ coactivator-1α (PGC-1α), adenosine monophosphate-activated protein kinase (AMPK), and cleaved caspase-3 protein were tested by Western blotting.Results:Compared with sham group, the levels of SCr and BUN were significantly increased in sepsis model group [SCr (μmol/L): 93.12±11.80 vs. 32.94±3.37, BUN (mmol/L): 41.36±6.48 vs. 9.49±3.58, both P<0.05]. The expression levels of AMPK, PGC-1α and cleaved caspase-3 protein increased (AMPK/β-actin: 0.30±0.02 vs. 0.12±0.01, PGC-1α/β-actin: 0.38±0.03 vs. 0.16±0.02, cleaved caspase-3/β-actin: 0.20±0.01 vs. 0.11±0.02, all P<0.05). HE staining showed that inflammatory cell was infiltrated, glomerular basement membrane was exposed and vacuole-like transparent casts were found in the lumen. Mitochondria were damaged under electron microscope with swelling, ridge disappearance and ruptured membranes, with increasing of apoptotic cells [cells: 24.00 (18.75, 31.00) vs. 2.00 (0.72, 3.25) , P<0.05]. Meanwhile, compared with sepsis model group, the levels of SCr, BUN and the expressions of AMPK, PGC-1α, cleaved caspase-3 protein were significantly decreased in the SS-31 peptide group [SCr (μmol/L): 71.33±10.14 vs. 93.12±11.80, BUN (mmol/L): 27.00±5.52 vs. 41.36±6.48, AMPK/β-actin: 0.23±0.01 vs. 0.30±0.02, PGC-1α/β-actin: 0.27±0.02 vs. 0.38±0.03, cleaved caspase-3/β-actin: 0.13±0.01 vs. 0.20±0.01, all P < 0.05]. HE staining showed that cell swelling reduced, the mitochondrial structure was intact, the ridge swelling was also reduced, and the membrane structure was relatively intact, the number of apoptotic cells was significantly reduced [cells: 13.00 (9.00, 16.50) vs. 24.00 (18.75, 31.00) , P<0.05]. Conclusion:The protective effect of SS-31 peptide on organ dysfunction induced by sepsis-induced AKI is related to maintaining mitochondrial homeostasis and inhibiting cell apoptosis.

Application study of the evaluation index system of Hunan Medical Science and Technology Award / 中华医学科研管理杂志

Objective:To test the practicality and effectiveness of Evaluation system of Hunan Medical Science and Technology Awards by empirical data.Methods:The empirical data of this paper is based on the 48 award-winning projects of the 2018 Hunan Medical Science and Technology Award. The actual evaluation process was simulated and peer experts were invited to grade the researching samples by index system to collect measured data. Use AMOS and SPSS as tools to test the reliability, validity and the correlation of the Evaluation system.Results:The internal consistency reliability of Cronbach α is 0.820, which shows this evaluation system with good reliability; sample data of confirmatory factor analysis matches the theoretical model, which shows this evaluation system with good validity; The results of analysis of variance showed that the differences among the three winning groups were statistically significant( P<0.05); The correlation coefficient of spearman rank correlation analysis is 0.335( P<0.05), which shows the positive correlation between the theoretical results and the actual evaluation results. Conclusions:The evaluation system of Hunan Medical Science and Technology Awards performs well and possesses strong applicability and practicality. The higher the score of the project measured by this indicator, the higher the quality of the project, and the higher the order of rewards that can actually be obtained. It could be used as an objective reference for the evaluation of Hunan Medical Science and Technology Award.

Characteristics of gene variants among patients with hyperphenylalaninemia from Quanzhou region of Fujian province / 中华医学遗传学杂志

Objective@#To explore the spectrum of genetic variants among patients with hyperphenylalaninemia (HPA) from Quanzhou area of Fujian province.@*Methods@#For 63 children affected with HPA, next generation sequencing was used to identify potential variants in PAH, PTS, PCBD1, QDPR, SPR and GCH1 genes.@*Results@#Fifty two variants underlying phenylalanine hydroxylase deficiency (PAHD) and 13 variants underlying 6-pyruvoyl tetrahydropterin synthase deficiency (PTPSD) were identified. Two patients carried variants of both PAH and PTS genes. The most common variants of the PAH gene were R53H (21.69%), R241C (18.07%), R243Q (12.05%) and EX6-96A>G (7.23%), which were mainly located in exons 7 (32.53%), 2 (21.69%), 6 (9.64%) and 12 (9.64%). The L227M variant of the PAH gene was unreported previously. N52S (35.00%), P87S (25.00%), IVS1-291A>G (10.00%) and T67M (10.00%) variants were the most common variants for the PTS gene and were mainly located in exons 2 (35.00%) and 5 (35.00%).@*Conclusion@#The variant spectrum underlying HPA in Quanzhou area showed a geographical specificity. A novel variant of the PAH gene (L227M) has been detected.

Characteristics of gene variants among patients with hyperphenylalaninemia from Quanzhou region of Fujian province / 中华医学遗传学杂志

OBJECTIVE@#To explore the spectrum of genetic variants among patients with hyperphenylalaninemia (HPA) from Quanzhou area of Fujian province.@*METHODS@#For 63 children affected with HPA, next generation sequencing was used to identify potential variants in PAH, PTS, PCBD1, QDPR, SPR and GCH1 genes.@*RESULTS@#Fifty two variants underlying phenylalanine hydroxylase deficiency (PAHD) and 13 variants underlying 6-pyruvoyl tetrahydropterin synthase deficiency (PTPSD) were identified. Two patients carried variants of both PAH and PTS genes. The most common variants of the PAH gene were R53H (21.69%), R241C(18.07%), R243Q(12.05%) and EX6-96A to G (7.23%), which were mainly located in exons 7 (32.53%), 2 (21.69%), 6 (9.64%) and 12 (9.64%). The L227M variant of the PAH gene was unreported previously. N52S (35.00%), P87S (25.00%), IVS1-291A to G (10.00%) and T67M (10.00%) variants were the most common variants for the PTS gene and were mainly located in exons 2 (35.00%) and 5 (35.00%).@*CONCLUSION@#The variant spectrum underlying HPA in Quanzhou area showed a geographical specificity. A novel variant of the PAH gene (L227M) has been detected.

Protective effects of Klotho protein on acute kidney injury in septic mice and its mechanism / 中华危重病急救医学

Objective? To? investigate? the? protective? effects? of? Klotho? protein,? a? kind? of? single-pass?transmembrane?protein,?on?acute?kidney?injury?(AKI)?in?septic?mice?and?its?mechanism.? Methods? Sixty?SPF?healthy?male?C57BL/6?mice?(6-8?weeks)?were?randomly?divided?into?sham?operation?group?(Sham?group),?sepsis?model?group?(CLP?group)?and?Klotho?protein?injection?group?(CLP+KL?group),?with?20?in?each?group.?The?septic?AKI?mice?model?was?established?by?cecal?ligation?and?puncture?(CLP);?Sham?group?had?the?same?procedure?except?that?the?cecal?was?not?ligated.?The?CLP+KL?group?was?received?Klotho?protein?(0.02?mg/kg)?by?intraperitoneal?consecutive?injection?for?4?days?after?operation;?Sham?group?and?CLP?group?were?injected?with?the?same?amount?of?saline.?Blood?samples?were?obtained?at?24?hours?after?operation,?the?levels?of?serum?creatinine?(SCr)?and?urea?nitrogen?(BUN)?were?measured?by?sarcosine?oxidase?and?urease?method.?The?mice?were?sacrificed?under?anesthesia?at?5?days?after?operation?to?harvest?renal?tissues,?and?the?pathological?damage?of?the?kidney?was?evaluated?by?hematoxylin-eosin?(HE)?staining.?The?ultrastructure?of?mitochondria?in?mouse?renal?tubular?epithelial?cells?was?observed?under?transmission?electron?microscope.?The?levels?of?reduced? glutathione?hormone?(GSH),?malondialdehyde?(MDA)?and?nitric?oxide?synthase?(NOS)?in?mitochondrion?were?determined?by?micro-enzyme?method,?thiobarbituric?acid?method,?colorimetry?method,?respectively.?The?protein?expressions?of?Klotho,?Bcl-2?and?cytochrome?C?(Cyt?C)?were?detected?by?Western?Blot.? Results? The?pathological?structure?of?the?kidneys?in?the?Sham?group?was?clear?and?intact.?Compared?with?the?Sham?group,?the?renal?tissue?edema?of?the?mice?in?the?CLP?group?was?significant,?and?the?transparent?tube?type?was?observed?in?the?small?lumen,?and?the?interstitial?inflammatory?cells?infiltrated;?the?levels?of?SCr?and?BUN?were?significantly?increased?[SCr?(μmol/L):?182.60±6.97?vs.?47.20±5.37,?BUN?(mmol/L):?53.70±5.12?vs.?18.70±2.62,?both?P?<?0.01];?the?mitochondria?were?swollen?and?deformed,?the?sputum?structure?was?destroyed,?the?matrix?density?was?decreased,?the?outer?membrane?was?lost,?and?the?levels?of?MDA,?GSH?and?NOS?were?significantly?increased?[MDA?(μmol/g):?1.172±0.046?vs.?0.746±0.094,?GSH?(μmol/g):?5.765±0.059?vs.?4.223±0.072,?NOS?(kU/g):?0.91±0.05?vs.?0.68±0.03,?all?P?<?0.01];?the?protein?expressions?of?Klotho?and?Bcl-2??in?renal?tissue?were?decreased,?and?the?protein?expression?of?Cyt?C?was?increased?(Klotho/β-actin:?0.188±0.020?vs.?0.538±0.024,?Bcl-2/β-actin:?0.311±0.010?vs.?0.391±0.015,?Cyt?C/β-actin:?0.226±0.010?vs.?0.135±0.006,?all??P?<?0.01).?Comparing?with?the?CLP?group,?the?glomerular?and?tubular?tissue?epithelial?edema?and?the?small?lumen?in?the?CLP+KL?group?were?reduced;?the?levels?of?SCr?and?BUN?were?significantly?decreased?[SCr?(μmol/L):?85.70±7.23?vs.?182.60±6.97,?BUN?(mmol/L):?35.30±3.50?vs.?53.70±5.12,?both?P?<?0.01];?the?mitochondrial?structure?was?relatively?intact;?the?levels?of?MDA,?GSH?and?NOS?were?significantly?decreased?[MDA?(μmol/g):?0.958±0.072?vs.?1.172±0.046,?GSH?(μmol/g):?4.756±0.107?vs.?5.765±0.059,?NOS?(kU/g):?0.79±0.02?vs.?0.91±0.05,?all?P?<?0.01];?the?protein?expressions?of?Klotho,?Bcl-2?were?significantly?increased,?but?the?protein?expression?of?Cyt?C?was?significantly?decreased?(Klotho/β-actin:?0.336±0.011?vs.?0.188±0.020,?Bcl-2/β-actin:?0.474±0.017?vs.?0.311±0.010,?Cyt?C/β-actin:??0.168±0.006?vs.?0.226±0.010,?all?P?<?0.01).? Conclusion? Klotho?protein?has?significant?protective?effects?on?AKI?in?septic?mice,?and?its?mechanism?is?related?to?maintaining?mitochondrial?structural?integrity?and?oxidative?stress?response.

Survey on the use of glucocorticoids in severe community-acquired pneumonia in intensive care unit of forty-five hospitals in Zhejiang Province / 中华危重病急救医学

Objective To investigate the use of glucocorticoids in patients with severe community-acquired pneumonia (SCAP) in the intensive care unit (ICU) of Hospitals in Zhejiang Province and to provide a reference for guiding clinical use of SCAP patients. Methods To draw up a questionnaire with reference to the Chinese and international guidelines, and to investigate the knowledge of community-acquired pneumonia (CAP) related guidelines and the use of glucocorticoids in patients with SCAP by doctors in hospitals above secondary level in Zhejiang Province by Email. Then the valid questionnaire was analyzed. Results In June 2016, 340 questionnaires were distributed, and all were returned after 2 months, with 333 of valid; 333 doctors from 45 ICUs in Zhejiang Province participated in the survey. ① The knowledge of CAP-related guidelines in ICU doctors: 79.58% (265/333) of the doctors had read the CAP guidelines, and those who work over 10 years had a higher reading rate than those with 1-5 years and 6-10 years [93.07% (94/101) vs. 74.00% (111/150), 73.17% (60/82), both P < 0.05]. Post-graduates and above had higher reading rates than undergraduates [85.35% (134/157) vs. 74.43% (131/176), P < 0.05]. Senior doctors had higher reading rates than the junior and intermediate doctors [93.07% (94/101) vs. 71.43% (80/112), 75.83% (91/120), both P < 0.05]. The rate of understanding the clinical application of glucocorticoids was 13.81% (46/333). The doctors who work over 10 years and the seniorshad a relatively high awareness rate, 23.76% (24/101) and 20.79% (21/101) respectively. However, there was no significant difference in the awareness rate between doctors with different degrees and different levels of hospitals. ② For the use of glucocorticoids in different causes of pneumonia, 44.74% (149/333) of doctors routinely used glucocorticoids in severe viral pneumonia. The proportion of glucocorticoids used in severe bacterial pneumonia, severe fungal pneumonia, severe pneumocystis pneumonia, chronic obstructive pulmonary disease (COPD) and severe pneumonia were 22.82% (76/333), 9.31% (31/333), 22.52% (75/333) and 18.32% (61/333), respectively. ③ The way of glucocorticoid usage: 79.58% (265/333) of doctors chose methylprednisolone, 4.20% (14/333) chose hydrocortisone, 1.20% (4/333) chose dexamethasone, and 15.02% (50/333) had not use glucocorticoids. The proportion of physicians who chose to use glucocorticoids within 24 hours of admission and 1-7 days after admission were 52.65% (149/283) and 47.35% (134/283), respectively. Glucocorticoids were used more in doctors with lower academic qualifications and hospitals within 24 hours. The undergraduate degree was 61.39% (97/158), and the second-grade class hospital was 67.50% (27/40). Among the doctors who chose methylprednisolone, 60.75% (161/265) prescribe the dose ≤80 mg/d;79.15% (224/283) chose the course of ≤7 days. The number of years of work, education, professional title and hospital grade had no significant effect on the choice of methylprednisolone and the course of treatment. Conclusions ICU doctors of 45 hospitals in Zhejiang Province have a high degree of heterogeneity in the understanding of the use and guidelines of glucocorticoids in SCAP. It is necessary to strengthen the ICU doctor's study of clinical guidelines at home and abroad and to develop a glucocorticoid use plan according to the specific conditions of patients, so that SCAP patients can benefit more.

Accuracy analysis of robotic assistant needle placement for lateral skull base biopsy / 中华口腔医学杂志

Objective@#To evaluate the accuracy and feasibility of a custom robot system guided by navigation for lateral skull base tumor biopsy.@*Methods@#Two cadaver heads were used, with iopamidol injected into different areas in the skull base and infratemporal region to imitate the tumor. Cone beam CT (CBCT) scanning was performed before operation. With image data transferred to the graphical user interface of the computer workstation, the "tumor" was segmented as the target. The needle trajectory was determined by selecting the skin entry point and the target point on the surgical planning software. Following point-based registration, the data was sent to the robot control unit. The needle was automatically inserted into the intended target by the robot guided by optical navigation. After the procedure was performed, the instantaneous data of needle tip position acquired by navigation system was sent back to the computer workstation for accuracy verification. Subsequently, after the needle was released, CBCT scanning was performed again, and the pre-and post-operative skull were superimposed. The position data of needle tip was acquired on the postoperative image and the accuracy was re-verified. The paired t-test was used to compare the differences in the accuracy calculated by intraoperative navigation and postoperative image fusion. The independent samples t-test was used to compare the accuracy between the cadavers. The Pearson correlation coefficients (r) was used to analyze correlation between the needle intervention accuracy and insertion depth.@*Results@#All 20 interventions were successfully performed. The mean deviation of the needle tip was (0.67±0.28) mm (measured by the navigation system) and (3.19±0.39) mm (measured by image fusion) respectively (t=-23.238, P<0.001). The comparison of accuracy test showed no significant difference between the cadavers (t=-1.116, P=0.279). Pearson correlation coefficients (r=0.714, P<0.001) showed the close correlation between the needle intervention accuracy and insertion depth. The mean insertion depth was (5.14±0.21) cm.@*Conclusions@#The experimental results show that the robot system is efficient and reliable. The navigation accuracy and the needle deflection are the most significant factors affecting robotic puncture procedures.

Meta-analysis of SGLT2 inhibitors and stroke risk in type 2 diabetic patients / 中华内分泌代谢杂志

Objective To evaluate the effects of sodium-glucose cotransporter 2 ( SGLT2) inhibitors on the stroke risk for patients with type 2 diabetes mellitus (T2DM). Methods A systemic meta-analysis including 30 random control trails ( RCTs) was performed to compare the risk of stroke between type 2 diabetic patients treated with SGLT2 inhibitors and control drugs. Then their bias risk and quality were assessed and meta-analysis was conducted using Stata12.0 software. Results Thirty RCTs enrolling 74456 participants were selected for meta-analysis. The stroke incidence in the group receiving SGLT2 inhibitor monotherapy or combination therapy did not significantly differ from that in control group, with relative risk (RR) 1.01 (95％CI 0.93-1.10, P=0.978) and 1.00 (95％CI 0.92-1.09, P=0. 874 ) , respectively. Three SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin did not increase the risk of stroke, with similar RR values ( RR=0.91, 0.99, 1.13, respectively) . Subgroup analyses showed that there was no correlation between SGLT2 inhibitors and stroke risk in different gender, age, diabetes duration, body mass index, or HbA1C levels. Conclusions Whether administered as monotherapy or add-on therapy, SGLT2 inhibitors did not increase stroke incidence, and there were no significant within-class differences.

Expression and significance of c-FLIP protein in sepsis mice with acute kidney injury / 中华危重病急救医学

Objective To observe the expression of cellular Fas-associated death domain-like interleukin-1β converting enzyme inhibit protein (c-FLIP) in sepsis mice with acute kidney injury (SAKI) and explore its significance. Methods Thirty male ICR mice were divided into the normal control group (Normal group), sham operation group (Sham group) and SAKI group by random number table method, with 10 mice in each group. The SAKI model of mice was established by cecal ligation and puncture (CLP); the Sham group was not ligated and the cecum was not punctured, and other surgical procedures were the same as the SAKI group; the Normal group did not experience any treatment. The serum and renal tissues of mice in each group were harvested 24 hours after CLP model establishment. The levels of serum creatinine (SCr) and blood urea nitrogen (BUN) were detected by enzyme linked immunosorbent assay (ELISA). The renal tissues were stained with hematoxylin-eosin (HE), and the pathological changes of renal tissues were observed under light microscope and the severity of injury was determined. The expression of c-FLIP in renal tissues was detected by immunohistochemistry. The expression of c-FLIP, Bax and caspase-3 protein in renal tissue was detected by Western Blot. The correlation between c-FLIP expression and Bax, caspase-3 protein expressions in renal tissues were analyzed by Pearson test. Results In the Normal group and the Sham group, the renal tubular epithelial cells were regular and intact, and no interstitial inflammatory cell infiltration was observed; the renal injury score was both 1.30±0.48; immunohistochemistry showed a large amount of c-FLIP positive expression in renal tubular epithelial cells (IA: 120.20±3.87, 116.70±3.46); Western Blot showed high expression of c-FLIP in renal tissues (c-FLIP/GAPDH: 0.99±0.01, 0.98±0.02), and low expressions of Bax and caspase-3 (Bax/GAPDH: 0.16±0.04, 0.19±0.03, caspase-3/GAPDH: 0.24±0.04, 0.23±0.05). Compared with the Sham group, in the SAKI group, renal tubular epithelial cells were degenerated and necrosis, and a large number of interstitial inflammatory cells infiltrated, the renal injury score was significantly increased (4.60±0.52 vs. 1.30±0.48, P < 0.01); the levels of SCr and BUN were significantly increased [SCr (μmol/L): 193.90±13.54 vs. 24.50±3.78, BUN (mmol/L): 81.60±7.26 vs. 5.20±0.92, both P < 0.01]; the c-FLIP positive cells in renal tissues was significantly reduced (IA: 17.11±0.82 vs. 116.70±3.46, P < 0.01); the expression of c-FLIP protein in renal tissues was significantly decreased (c-FLIP/GAPDH: 0.29±0.03 vs. 0.98±0.02, P < 0.01), while the expressions of Bax and caspase-3 protein were significantly increased (Bax/GAPDH: 0.87±0.06 vs. 0.19±0.03, caspase-3/GAPDH: 0.88±0.07 vs. 0.23±0.05, both P < 0.01]. The correlation analysis showed that the c-FLIP protein was significantly negatively correlated with Bax (r = -0.468, P = 0.029) and caspase-3 protein expressions (r = -0.663, P = 0.004). Conclusions The expression level of c-FLIP protein was significantly down-regulated in renal tissue of SAKI, and its down-regulation mechanism was associated with increased apoptosis of renal tubular epithelial cells, which could be an effective target for the treatment of SAKI.

Limonoids from seeds of A. Juss. and their cytotoxic activity

Four new limonoid-type nortriterpenoids, 1-detigloyl-1--methacryloylsalannin (), 28-deoxo-2,3-dihydronimbolide (), 12-acetoxy-3--acetyl-7--tigloylvilasinin () and 12-acetoxy-3--acetyl-7--methacryloylvilasinin (), along with five known ones, were isolated from seeds of A. Juss. Their structures were elucidated by various spectroscopic methods, including UV, IR, MS, NMR, X-ray crystallography, quantum chemical calculation, as well as by comparison of their spectroscopic data with those reported. In the cytotoxic assay, showed inhibitory activity against human breast cancer MDA-MB-231 cell line with IC value of 7.68±1.74 μmol/L, and inhibited growth of human cervical cancer Hela cell line, melanoma A375 cell line and promyelocytic leukemia HL-60 cell line, with IC 12.00±2.08, 17.44±2.11, and 13.95±5.74 μmol/L, respectively.

Comparison of limus-eluting stent with paclitaxel-eluting stent for patients with coronary small vessel disease:a systematic review and meta-analysis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To compare the efficacy of limus-eluting stent (LES) with paclitaxel-eluting stent (PES) for patients with coronary small vessel disease.</p><p><b>METHODS</b>The studies of LES and PES used for patients with coronary small vessel disease were searched in PubMed, Web of Science, ClinicalTrials, SinoMed, CNKI, Wanfang data and CQVIP. The relative risk (RR) estimates with 95% confidence intervals and other statistical variables were calculated with Stata 14.0, and the meta analysis was performed with RevMan 5.2.</p><p><b>RESULTS</b>Eight studies involving 4738 patients were included in the meta-analysis. Compared with PES, LES implantation was associated with significant reduction in major adverse cardiovascular events (=0.64, 95%:0.53-0.77,=4.59,<0.01), myocardial infarction (=0.61, 95%:0.45-0.82;=3.24,<0.01), stent thrombosis (=0.22, 95%:0.13-0.37,=5.71,<0.01), and target lesion revascularization (=0.56, 95%:0.44-0.71,=4.72,<0.01), while no difference was observed in cardiac death (=1.08, 95%:0.62-1.88,=0.26,>0.05) and target vessel revascularization(=0.80, 95%:0.45-1.44,=0.74,>0.05).</p><p><b>CONCLUSIONS</b>LES has better efficacy than PES for patients with coronary small vessel disease, which may be the preferred stents for these patients.</p>

Effect of self-made atractylodes and spleen decoction combined with quadruple therapy on Hp-positive peptic ulcer and Its effect on wound healing, gastric secretion and recurrence / 中国生化药物杂志

Objective To observe the effect of self-assembling Atractylodes Rhizome Decoction combined with quadruple therapy on Helicobacter pylori (Hp)-positive peptic ulcer and its effect on wound healing, gastric acid secretion and recurrence.MethodsThis study was based on 70 patients with Hp-positive peptic ulcer treated in our hospital from March 2012 to May 2014.The patients were divided into study group and control group according to the order of admission.(BAO), the maximum gastric acid secretion (MAO), the peak gastric acid secretion (P<0.05).The treatment group is divided into two groups according to the treatment group.(PAO), Hp eradication and recurrence were observed and compared.ResultsAfter treatment, the total effective rate of wound healing study group was 80.00% higher than that 57.14% of the control group (χ2=4.242, P<0.05).The levels of BAO, MAO and PAO in the two groups were significantly lower than those before treatment (P<0.05).The eradication rates of Hp in the study group were significantly higher than those in the control group at 6 months and 1 year follow-up.The recurrence rate was significantly lower in the study group than in the control group (P<0.05),There was no significant difference between the two groups.ConclusionThe clinical effect of self-made Baishui Yipi Decoction combined with quadruple therapy on Hp-positive peptic ulcer patients is effective in promoting wound healing and Hp eradication, and inhibiting gastric acid secretion and reducing the recurrence rate.It is a kind of medicine worthy of clinical application Program.

Study progress on antitumor activities of artemisinin and its derivatives / 中国生化药物杂志

The antitumor activities of artemisinin and its derivatives has become a hot topic in recent years.Artemisinin and its derivatives have been reported to exert antitumor effects mainly by blocking the cell cycle, promoting tumor cell apoptosis, inhibiting angiogenesis and so on.Also, their influence on signaling pathways has attracted considerable interest of many scholars.Currently, in order to discover some compounds with better therapeutic potentials, many studies dedicated to the synthesis and development of new artemisinin derivatives.In addition, the effects of artemisinin and its derivatives on multi-drug resistantace in tumor cells also become a trend of the future research.In this paper, we review the research advances in the antitumor activities of artemisinin and its derivatives during the past five years to provide a reference for future study .

Application and development of surgical robot systems in craniomaxillofacial surgery / 华西口腔医学杂志

Traditional craniomaxillofacial surgery significantly affects aesthetic appreciation. In contrast to traditional methods, robot-assisted surgery has been extensively investigated because it is microinvasive, precise, and safe. With robot-assisted surgery, operational vision and manipulation space become extended. As a result, operational quality and patient's postoperative life are improved. This article reviewed the development of surgical robot systems and their applications in craniomaxillofacial surgery.

Changes of coagulation and fibrinolysis function and PLT in patients with lung cancer before and after ;chemotherapy / 中国基层医药

Objective To investigate the changes of blood coagulation and fibrinolytic function and PLT in patients with lung cancer before and after chemotherapy,and to investigate the changes of the patients with lung cancer and the influence of the changes with lung cancer and the prognosis.Methods 40 patients with lung cancer(observation group)treated in our department from March 2012 to May 2014 were selected as the research subjects.The changes of coagulation and fibrinolytic activity,PT(PTINR),APTT,thrombin time(Fib),thrombin time(D -D),thrombin time (TT),D -D,and PLT were analyzed.The relationship between the parameters and the lung cancer staging was analyzed. Results Before chemotherapy,the levels of Fib,PLT,D -D,PT,PTNR,APTT,TT,PLT were (11.34 ±1.14)s, (1.01 ±0.07),(24.34 ±4.53)s,(2.54 ±0.45)g/L,(184.31 ±10.88)×109 /L,(143.35 ±23.45)ng/mL, (14.55 ±4.56)s.After chemotherapy,the levels of Fib,PLT,D -D,PT,PTNR,APTT,TT,PLT were (11.57 ± 1.36)s,(1.03 ±0.05),(24.52 ±5.32)s,(3.63 ±0.65)g/L,(210.45 ±11.24)×109 /L,(126.56 ±26.55)ng/mL, (14.34 ±4.17)s.The contents of Fib and PLT after chemotherapy were higher than before chemotherapy(t =0.024, 0.025,all P 0.05).Compared with patients with stage Ⅰ ~Ⅱ lung cancer,Fib level in stage Ⅲ ~Ⅳ lung cancer was higher (t =0.01,P 0.05).Conclusion PLT and Fib were increased,but D -D decreased after chemotherapy,the tumor remission rate was higher in D -D group,which indica-ted that the levels of Fib and D -D should be changed in the course of clinical chemotherapy.

Interferon-gamma and interleukin-10 levels in serum and saliva are related to different types of oral lichen planus / 中国组织工程研究

Abstract BACKGROUND: Many cytokines can be detected in saliva and serum, and have more clinical significance in the diagnosis, prognosis and treatment of oral mucosa disease. OBJECTIVE: To compare the interferon-γ and interleukin-10 levels in serum and saliva of patients with different types of oral lichen planus and to explore the feasibility of saliva samples as a substitute of blood samples to study the interferon-γ and interleukin-10 levels in serum and saliva. METHODS:Totaly 45 patients with oral lichen planus admitted at the Department of Periodontology, the Stomatological Hospital of Jiamusi University from January to July 2014 were enroled, including 15 cases of erosion type (erosion group), 15 cases of congestive erythema (congestive erythema group) and 15 cases of reticulate type (reticulate group). Another 15 healthy controls admitted for physical examination at the Department of Physical Examination, the Stomatological Hospital of Jiamusi University were enroled as controls. ELISA method was used to detect the interferon-γ and interleukin-10 levels in serum and saliva in the four groups. RESULTS AND CONCLUSION: Compared with the control group, the interferon-γ levels in serum and saliva were lower in the other three groups (P < 0.01), while there were significant differences in the interferon-γ level among the patients with different types of oral lichen planus (P < 0.01). The interleukin-10 levels in serum and saliva were significantly higher in the erosion group and congestive erythema group than those in the control group (P < 0.01 orP < 0.05) and reticulate groupP < 0.01 orP < 0.05). Experimental findings suggest that the levels of interferon-γ and interleukin-10 in serum and saliva are highly correlated in patients with different types of oral lichen planus, and saliva samples can be instead of blood samples to detect the levels of interferon-γ and interleukin-10 in patients with oral lichen planus.