Chinese Medicine Intervention in Signaling Pathways Related to Diabetic Ulcer： A Review / 中国实验方剂学杂志

Diabetic ulcer （DU） wound is one of the chronic and serious complications of diabetes characterized by prolonged wound healing， and it is more common in foot and lower extremity ulcers. DU has brought great economic and psychological pressure to patients and seriously affected the quality of life of patients because of its great difficulty in treatment， long treatment process， and high morbidity and mortality. Therefore， how to help the rapid healing of DU wounds， reduce the disability rate and mortality rate， protect limb function， and improve the quality of life is an important topic and hot spot in the field of medical research. The pathogenesis of DU is complex， mainly including microcirculation disorder， peripheral neuropathy， inflammation and infection， and excessive apoptosis of cells， involving physiological processes such as wound inflammation， granulation tissue hyperplasia and re-epithelialization. A large number of previous studies have found that Chinese medicine can regulate phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， Wnt/β-catenin， nuclear factor-κB （NF-κB）， Notch， nuclear factor E2-related factor 2 （Nrf2）， transforming growth factor-β （TGF-β）/Smad， and other signaling pathways， regulate abnormal glucose metabolism， improve microcirculation， inhibit inflammation and oxidative stress， regulate cell proliferation and excessive apoptosis， and promote wound tissue growth to promote the rapid healing of DU wounds under the guidance of treatment based on traditional Chinese medicine （TCM） syndrome differentiation and internal and external treatment. Therefore， this paper reviewed Chinese medicinal monomers or Chinese medicinal compounds in recent years in regulating the above signaling pathways and the expression of key protein molecules and promoting the rapid healing of DU wounds， aiming to provide ideas and a theoretical basis for the in-depth study and clinical application of Chinese medicine in promoting the healing of DU wounds.

Clinical efficacy and application value of percutaneous interventional treatment for / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound. Methods    The clinical data of 1 010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2, 2015 to December 31, 2019 were retrospectively reviewed, including 360 males and 650 females, aged 1-50 years. There were 692 patients of atrial septal defect (603 with central type, 9 combined with arterial catheter, 80 with ethmoid type), 116 patent foramen ovale, 25 ventricular septal defects (3 combined with atrial septal defect), 132 patent ductus arteriosus, 32 pulmonary valve stenosis (3 combined with atrial defect), 1 main pulmonary artery window, and 3 aneurysm rupture of aortic sinus. All patients were diagnosed by transthoracic echocardiography (TTE) before operation. Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography (TEE) via the femoral artery or femoral vein. After operation, echocardiography, electrocardiogram and chest radiograph were reexamined. Results    Satisfactory results were obtained in 1 005 patients, and 1 patient failed to seal the ventricular defect and was repaired under direct vision, occluder detachment occurred in 5 patients after operation (3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired, 1 patient of atrial septal defects was closed after removing Amplatzer device, 1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured), mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis, a small amount  of residual shunt was found in 2 patients with ventricular defect, which disappeared after 3 months of follow-up, and 1 patient of right bundle branch block occurred and disappeared after 1 week. After follow-up of 1-24 months, 3 patients of ethmoidal atrial septal defect were reexamined with mild shunt. The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced. There was no complication such as hemolysis, arrhythmia, embolism or rupture of chordae tendinae. Conclusion    Percutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective, with little trauma, no radiation or contrast agent damage, and has significant clinical efficacy and application values.

Efficacy analysis of esophageal ultrasound-guided percutaneous femoral artery closure for ventricular septal defect / 中国胸心血管外科临床杂志

@#Objective    To investigate the effectiveness and safety of esophageal ultrasound-guided percutaneous femoral artery closure of ventricular septal defect (VSD). Methods    The clinical data of 24 patients with congenital VSD in our hospital from March 2017 to December 2019 were retrospectively analyzed, including 6 males and 18 females, with a median age of 12 (3-42) years, weight of 32 (12-91) kg, and VSD diameter of 4 (3-7) mm. There were 3 patients with VSD combined with atrial septal defect. Results    Twenty-four patients successfully underwent interventional closure of percutaneous femoral artery under esophageal ultrasound guidance, and the position and shape of the occluders were good. The operation time was 45 (39-54) min, and the waist size of the occluders was 7 (5-12) mm. Among the patients, 14 patients used symmetric ventricular occlusion devices, 8 patients used asymmetric ventricular occlusion devices, and 2 patients used ventricular occlusion muscle occluders. Small amount of residual shunt occurred in 2 patients after the operation and it disappeared 3 months after the operation. One patient with right bundle branch block, which disappeared after 1 week of observation. There were no complications such as occluder closure, pericardial effusion or valve regurgitation during the perioperative period. During the follow-up period [3-18 (9.25±5.04) months], no serious complication occurred. Conclusion    Transesophageal ultrasound-guided transfemoral artery occlusion for VSD is simple and safe, and it avoids the damage of radiation and contrast medium. It has advantages over traditional percutaneous interventional occlusion therapy.

Clinical efficacy analysis of percutaneous balloon pulmonary valvuloplasty for pulmonary valve stenosis guided by ultrasound / 中国胸心血管外科临床杂志

@#Objective    To analyze the efficacy and safety of percutaneous balloon pulmonary valvuloplasty (PBPV) for pulmonary valve stenosis guided by ultrasound. Methods    From March 2016 to July 2019, 32 patients with pulmonary valve stenosis were treated in our hospital. There were 19 males and 13 females with an average age of 1-12 (6.2±3.1) years and weight of 7-45 (22.7±9.2) kg. The clinical efficacy of PBPV guided by transthoracic echocardiography (TTE) was evaluated. Results    The transvalvular pressure gradient (PG) of the patients before PBPV was 65.4±11.9 mm Hg. All patients successfully received PBPV under TTE guidance. The PG was 19.7±4.0 mm Hg immediately after operation, which was significantly decreased (P<0.001). All patients survived without any serious complications. The PG values at 3 months, 6 months and 12 months after operation were 18.4±4.0 mm Hg, 16.4±3.9 mm Hg, 15.2±3.3 mm Hg, respectively, which were significantly lower than that before the operation (P<0.001). Conclusion    PBPV guided by echocardiography is safe and effective in the treatment of pulmonary valve stenosis with low complications rate.

Correlation between nonalcoholic fatty liver disease and right bundle branch block in type 2 diabetes patients / 中国医师杂志

Objective:To investigate whether there is a correlation between right bundle branch block (RBBB) and nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus.Methods:A retrospective analysis of 226 patients with type 2 diabetes mellitus who were admitted to the Fifth Affiliated Hospital of Zhengzhou University from March 2018 to July 2019 was performed. According to the results of electrocardiogram examination, they were divided into RBBB group ( n=58 patients) and non-RBBB group ( n=168 patients). The general clinical data of the two groups of patients were collected, blood lipids, liver function, renal function, coagulation function and other related indicators were measured on the fasting of the next morning. The diagnosis of NAFLD is based on ultrasound. Logistic regression analysis was performed on factors that may affect RBBB. Results:Of the 226 patients with type 2 diabetes mellitus, 127 (56.2%) were male and 99 (43.8%) were female. The composition of male, age, diabetes duration, hypertension, fibrinogen (FIB), serum creatinine (SCr), alanine aminotransferase (ALT), and NAFLD in the RBBB group was higher than that in the non-RBBB group ( P<0.05). The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and albumin (ALB) in the RBBB group were lower than those in the non-RBBB group ( P<0.05). Logistic regression analysis showed that male ( OR=2.736, 95% CI: 1.075-5.251, P=0.032), advanced age ( OR=1.049, 95% CI: 1.009-1.090, P=0.016), higher serum creatinine levels ( OR=1.045, 95% CI: 1.021-1.070, P<0.001), and NAFLD ( OR=2.834, 95% CI: 1.166-6.891, P=0.022) were independent risk factors of RBBB in patients with type 2 diabetes mellitus. Conclusions:NAFLD may be associated with an increased risk of right bundle branch block in patients with type 2 diabetes.

Effects of cholesterol-lowering probiotics on intestinal barrier and gut microbiota in mice with non-alcoholic fatty liver disease and the possible mechanisms / 中华微生物学和免疫学杂志

Objective To investigate the effects of cholesterol-lowering probiotics, DM9054 com-bined with 86066, on the intestinal mucosal barrier and gut microbiota in mice with nonalcoholic fatty liver disease ( NAFLD) induced by high-fat diet and the possible mechanisms. Methods Twenty-four male mice deficient in the low-density lipoprotein receptor gene ( Ldlr- / - mice ) were randomly divided into three groups including control, NAFLD model and probiotic intervention groups. Mice in the three groups were given normal chow diet+normal saline, high-fat diet ( HFD)+normal saline, and HFD+cholesterol-lowering probiotics, respectively. The mouse model of NAFLD was established by feeding mice with high-fat diet (45％ of calories derived from fat diet) for 12 weeks. qPCR was performed to measure the expression of liv-er and intestinal inflammatory genes and liver cholesterol synthesis genes. Western blot assay was used to de-tect the expression of intestinal tight junction proteins and HMG-CoA reductase ( HMGCR ) . Pathological changes in tissues were evaluated by HE staining. Features of gut microbiota were analyzed by 16S rRNA gene sequencing. Results Cholesterol-lowering probiotics intervention attenuated HFD-induced hepatic steatosis, inflammatory responses and obesity and decreased the synthesis of liver cholesterol (P<0. 05). Moreover, inhibited gut inflammatory responses and improved intestinal barrier function were detected in the probiotic intervention group (P<0. 05). The composition of gut microbiota in mice of the probiotic intervention group was different from that of the model group, but similar to that of the control group. Con-clusions Cholesterol-lowering probiotics might attenuate NAFLD in mice through reducing liver cholesterol synthesis, alleviating liver and intestinal inflammation, improving intestinal mucosal barrier function and reg-ulating intestinal microbiota.

Clinical study of transcervical occlusion of patent ductus arteriosus via femoral artery guided by ultrasound / 中国医师杂志

Objective To evaluate the efficacy and safety of transthoracic echocardiography (TTE) guided by transcatheter closure of patent ductus arteriosus (PDA) through the femoral artery.Methods From February 2016 to December 2017,53 patients with simple PDA were selected,the funnel type in 30 cases,cast type in 23 cases.All patients were guided by TTE and transcatheter closure of PDA through the femoral artery.The femoral artery was guided by TTE by establishing the orbit of the femoral artery-catheter-pulmonary artery to the right ventricle.The right ventricular septal defect was placed under the femoral artery approach,and the therapeutic effect was evaluated by echocardiography after occlusion.The outpatient visits were made at 1,3,and 6 months after operation.Results PDA closure was successfully completed under TTE guidance in 53 patients.In one adult PDA,the ultrasonic diagnosis of the inner diameter of the catheter was incorrect due to the image quality,which resulted in the replacement of the occluded device several times,but the occlusion was successful.The operative time was (30 ± 10)min.And the back diameter of the transcatheter closure device was (12 ± 6) mm and the murmur of the transmission sheath disappeared.There was no shunt between the main pulmonary artery and the main pulmonary artery,and the length of hospitalization was 3-4 days.No shunt signal was found at 1,3 and 6 months follow-up.Left atrial diameter (LAD) [(25.8 ± 6.1) mm vs (30.6 ± 8.4) mm] and left ventricular end diastolic diameter (LVEDD) [(38.5 ±9.1)mm vs (45.2 ± 11.5)mm],were decreased significantly (P ＜0.05).Conclusions It is safe and effective to block PDA by using femoral artery approach under the guidance of TTE,which avoids the damage of X-ray and contrast agent,and its prospect of clinical application is promising.

ism1 regulates convergence and extension movements during zebrafish gastrulation / 中国比较医学杂志

Objective During zebrafish embryo gastrulation, the embryonic body plan is established by coordinated movements,including epiboly,involution,and convergence and extension(CE)movements. The aim of this study was to examine the expression patterns and the developmental functions of isthmin 1(ism1)during zebrafish gastrulation. Methods First, the expression of ism1 was examined using whole mount in situ hybridization during zebrafish embryonic development. Next,antisense morpholino oligonucleotide against ism1 and ism1 mRNA were injected into zebrafish embryos,respectively,to investigate its role in CE movements. Results ism1 is an early zygotic gene that is expressed in the dorsal side at 30% epiboly stage and in the blastoderm margin with the highest level in the dorsal organizer at shield stage as revealed by whole-mount in situ hybridization experiments. Compared with the wild-type embryos,either gain-or loss-of-function of ism1 leads to severe defects of CE movements. Conclusions Ism1 plays an essential role in CE movements during zebrafish embryo gastrulation.

Retrograde catheterization via superficial femoral artery for the treatment of ipsilateral superficial femoral artery occlusive disease:its clinical application / 中国医师进修杂志

Objective To investigate the clinical application and value of retrograde catheterization via superficial femoral artery for the treatment of limb chronic total occlusive disease (CTO). Methods Fifty-nine patients with proximal and middle occlusive lesions of superficial femoral artery from Jan. 2013 to Jan. 2015 in department of emergency surgery were retrospectively analyzed. Percutaneous transluminal angioplasty (PTA) together with stent implantation was performed to reopen the all narrowed or obstructed superficial femoral artery.Seventeen patients received ipsilateral retrograde catheterization via superficial femoral artery together. The length of the diseased artery ranged from 6.5 to 13.4 cm, with a mean of (8.3 ± 2.9) cm, including right (11 cases)and left (8 cases) femoral arteries. After the interventional therapy patients were followed up for 1- 24 months. Results All patients were treated successfully. The proximal and middle occlusive lesions of superficial femoral artery were reopened.No serious complications were found including nerve and vessel damage+After the treatment, the ischemic symptoms were markedly improved or even disappeared. In 14/19 of patients the superficial femoral arteries remained patent during the follow-up period. The ankle preoperative brachial index (ABI) was 0.20 to 0.51 (0.39 ± 0.06), while the postoperative ABI was 0.65 to 1.15 (0.74 ± 0.13). The difference in ABI between pre-operation and post-operation was statistically significant (P<0.05). Conclusions Retrograde catheterization via superficial femoral artery is an effective alternative to treat proximal and middle occlusion of ipsilateral superficial femoral artery. It has high successful rate and safety.

Apoptosis of HepG2 cells after transfection with LIGHT gene and interferon-γ / 中华消化外科杂志

Objective To investigate apoptosis of HepG2 ceils after transfecfion with LIGHT gene and interferon-γ. Methods LIGHT gene and interferon-γ were transfected into HepG2 cells by liposome mediated method. The HepG2 cells were divided into group A (transfected with LIGHT gene or interferon-γ), group B (transfeeted with LIGHT gene and interferon-γ) and group C (non-transfection group). The apoptosis rate of the HepG2 cells and the expression of Bcl-2 and Caspase-8 were detected 12, 24, 48 hours after transfeetion. Results (1) The apoptosis rates of HepG2 cells at hour 12, 24 and 48 after transfeetion were 18.8% ± 3.5%, 25.7%± 2.8% and 36.4% ±3.6% in group A, 23.8% ±2.4%, 31.1% ±2.1% and42.5% ±4.5% in group B, and 8.7% ± 2.1%, 9.3% ± 1.6% and 10.9% ± 1.2% in group C. There was a significant difference in apoptosis rate among the 3 groups (F = 15.69, 53.33, 48.28, P < 0.01). (2) The expression of Bcl-2 in HepG2 cells at hour 12, 24 and 48 after transfection was 16.4% ± 5.0%, 13.4% ± 3.5% and 8.6% ± 2.3% in group A, 14.7%±3.8%, 9.1% ±2.0% and 4.6% ±2.0% in group B, and 25.3% ±6. 3%, 19.8% ±4.4% and 10.1% ±3.8% in group C. There was a significant difference in the expression of Bcl-2 among the 3 groups (F = 6.19, 12.29, 5.81, P <0.05). (3) The expression of Caspase-8 at hour 12, 24 and48 after transfection were 19.3% ±2.4%, 27.2% ±1.9% and 33.7% ±3.0% in group A, 22.7% ±2.2%, 30.9% ±3.1% and 38.2% ±3.2% in group B, and 1.2% ±0.8%, 1.8% ±0.6% and 3.2% ±1.5% in group C. There was a significant difference in the expression of Caspase-8 among the 3 groups (F =71.54, 112. 78, I01.61, P < 0.01). Condusions LIGHT gene can signiticanfly promote cell apoptosis through regulating the expression of Bcl-2 and Caspase-8. Interferon-γ enhanced the effect of LIGHT gene on the apoptosis of HepG2 cells.

Teachers' Quality is the Key to Enhance the Effectiveness of "Two Courses" Teaching / 中华医学教育探索杂志

The quality of teachers is the key to enhance the effectiveness of "Two Courses" teaching.This paper mainly talks about the basic qualities of "Two Courses"teachers,such as the ideology and politics,professional ethics,theory,business technology,capacity and so on.