Mechanism of Dahuang Zhechongwan in Inhibiting Renal Fibrosis in Rats by Regulating Intestinal Flora Based on 16S rDNA Sequencing / 中国实验方剂学杂志

ObjectiveTo investigate the effect and mechanism of Dahuang Zhechongwan （DHZCW） on adenine-induced renal fibrosis in rats from the perspective of intestinal flora. MethodThirty-six SD rats were randomly divided into a blank group， a model group， and high-， medium- and low-dose DHZCW groups （0.168， 0.084， 0.042 g·kg-1）， and a pirfenidone group （200 mg·kg-1）， with 6 rats in each group. Except for those in the blank group， rats in other groups were treated with adenine suspension （250 mg·kg-1） by gavage for 28 days for renal fibrosis model induction. Subsequently， they received drug intervention for 4 weeks. Urine samples were collected from rats in metabolic cages， and renal function indicators including blood urea nitrogen （BUN）， urea， creatinine （Crea）， cystatin C （Cys C）， and 24-hour urine protein （24 h TP） were measured. Kidney samples were collected and subjected to hematoxylin-eosin （HE） staining and Masson's trichrome staining to observe the pathological changes in rat renal tissues. Western blot was used to detect the expression levels of key effector proteins α-smooth muscle actin （α-SMA）， type Ⅰ collagen （ColⅠ）， and type Ⅲ collagen （ColⅢ） in the kidneys. High-throughput sequencing of 16S rDNA was used to analyze the species diversity of rat intestinal flora. ResultCompared with the blank group， the model group showed increased BUN， urea， Crea， Cys C， and 24 h TP levels （P<0.01）. Compared with the model group， the high-， medium-， and low-dose DHZCW groups， as well as the pirfenidone group， showed significant reductions in BUN， urea， Crea， Cys C， and 24 h TP levels （P<0.01）， indicating that DHZCW intervention significantly improved renal function. In the model group， renal tissues exhibited significant fibrotic changes， and the protein levels of α-SMA， ColⅠ， and ColⅢ were significantly increased （P<0.01） compared to those in the blank group. Compared with the model group， the high-dose DHZCW group and the pirfenidone group had relatively normal tissue structure， with no significant pathological damage observed. However， fibrotic changes were observed in the medium- and low-dose DHZCW groups， with the changes being more significant in the low-dose group. The protein levels of α-SMA， ColⅠ， and ColⅢ were significantly decreased in the high-， medium-， and low-dose DHZCW groups， as well as the pirfenidone group （P<0.01）， indicating that DHZCW effectively reduced abnormal collagen deposition and inhibited renal fibrosis. From the perspective of intestinal flora， at the phylum level， compared with the blank group， the model group showed a significant increase in the abundance of Firmicutes and a decrease in Bacteroidetes， leading to a significant imbalance in their ratio. At the family level， the model group decreased the abundance of Lachnospiraceae， Prevotellaceae， and Bacteroidota_unclassified， and increased the abundance of Ruminococcaceae， Lactobacillaceae， and Oscillospiraceae. At the genus level， the model group showed significantly reduced abundance of Firmicutes_unclassified， Bacteroidota_unclassified， and Prevotellaceae_UCG-001， etc.， and increased abundance of UCG-005， Clostridia_UCG-014_unclassified， etc. Compared with the model group， DHZCW effectively reduced the abundance of potential pathogenic bacteria and increased the abundance of beneficial bacteria， regulating the intestinal flora. ConclusionDHZCW can effectively improve renal function and inhibit renal fibrosis， and its mechanism of action may be related to the regulation of intestinal flora.

Mechanism of Dahuang Zhechongwan in Treating Myocardial Fibrosis of Rats via TGF-β1/Smads/miR29 Pathway / 中国实验方剂学杂志

ObjectiveTraditional Chinese medicine， namely Dahuang Zhechongwan （DHZCW） was used to treat myocardial fibrosis in model rats， observe its effect on myocardial fibrosis in rats， and explore its action mechanism. MethodThirty-six SPF male Kunming rats were divided into blank group， model group， low-， medium-， high-dose groups of DHZCW （0.056， 0.084， 0.168 g·kg-1）， captopril group （10 mg·kg-1）， with six rats in each group. Except for the blank group， the other groups were intraperitoneally injected isoproterenol solution of 5 mg·kg-1 for 15 consecutive days to replicate the myocardial fibrosis model. At the beginning of modeling， the rats in each group took drugs， and they were sacrificed 28 days after administration. Serum and heart tissue were collected for the corresponding detection. Hematoxylin-eosin （HE） staining and Masson staining were used to observe tissue inflammation， cellular degeneration， necrosis， and fibrosis. The contents of hydroxyproline （HYP）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， hyaluronic acid （HA）， laminin （LN）， type-Ⅲ procollagen （PC Ⅲ） in serum of rats and rats were determined by enzyme-related immunosorbent assay （ELISA）. The expression levels of key pathway proteins transforming growth factor-β1 （TGF-β1）， α-smooth muscle actin （α-SMA）， Smad2， Smad3， and Smad7 were detected by Western blot. The expression levels of key pathway genes TGF-β1， α-SMA， Smad2， Smad3， Smad7， miR-29a-5p， miR-29b-2-5p， and miR-29c-5p were detected by Real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the blank group， the pathological changes of fibrosis in the model group were obvious， the contents of serum HYP， TNF-α， IL-1β， IL-6， HA， LN， and PCⅢ were increased （P<0.01）， the protein expression levels of TGF-β1， α-SMA， Smad2， and Smad3 were increased； the protein expression level of Smad7 was decreased （P<0.01）. The mRNA expression levels of TGF-β1， α-SMA， Smad2， and Smad3 were increased （P<0.05， P<0.01）， while those of Smad7， miR-29a-5p， miR-29b-2-5p， and miR-29c-5p were decreased （P<0.01）. Compared with the model group， after 28 days of administration， serum HYP， TNF-α， IL-1β， IL-6， HA， LN， and PCⅢ in high-， medium-， and low-dose groups of DHZCW and captopril groups were decreased （P<0.01）. Except for the low-dose group， the protein contents of TGF-β1， α-SMA， Smad2， and Smad3 were decreased， while the protein content of Smad7 was increased （P<0.01）. The mRNA expression levels of TGF-β1， Smad2， α-SMA， and Smad3 in high-dose group of DHZCW were decreased （P<0.05，P<0.01）， while those of Smad7， miR-29a-5p， miR-29b-2-5p， and miR-29c-5p were increased （P<0.05）. The mRNA expressions of TGF-β1， Smad2， and Smad3 in the medium-dose group of DHZCW were decreased （P<0.05， P<0.01）， while mRNA expression of Smad7 was increased （P<0.01）. The mRNA levels of TGF-β1 and Smad2 in the low-dose group of DHZCW were decreased （P<0.01）. ConclusionDHZCW can improve myocardial fibrosis in rats， and its action mechanism may be related to the regulation of the TGF-β1/Smads/miR-29 pathway. In addition， there is dose dependence in the range of 0.056-0.168 g·kg-1， and the effect of the high-dose group is more stable.

Protective Effect of Alcohol Extract of Phyllanthi Fructus on Silicosis Mice and Its Correlation with Nrf2/ARE Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo explore the effect and underlying mechanism of alcohol extract of Phyllanthi Fructus on silicosis mice induced by silicon dioxide （SiO2）. MethodThirty-six male Kunming mice of SPF grade were randomly divided into a blank group，a model group，high-， medium， and low-dose Phyllanthi Fructus groups （800， 400， 200 mg·kg-1），and a tetrandrine group （0.039 mg·kg-1），with six mice in each group. The silicosis model was induced by static SiO2 exposure in mice except for those in the blank group. After 28 days of administration by gavage，the lung tissues were collected and the organ coefficient was calculated. Hematoxylin-eosin（HE）staining and Masson staining were used to detect the morphology of lung tissues. The content of hydroxyproline （HYP），superoxide dismutase （SOD），malondialdehyde （MDA）， and catalase （CAT） in serum was detected by enzyme-linked immunosorbent assay （ELISA）. Western blot and Real-time polymerase chain reaction（Real-time PCR） were used to detect the protein and mRNA expression of nuclear factor E2-related factor 2 （Nrf2），heme oxygenase-1 （HO-1），NAD（P）H：quinone oxidoreductase 1 （NQO1），and Kelch-like ECH-associated protein 1 （Keap1）， respectively. ResultCompared with the blank group，the model group showed seriously damaged morphological structure of lung tissues with inflammatory cell infiltration and fibrous tissue proliferation， reduced serum content of SOD and CAT（P<0.01），increased content of HYP and MDA（P<0.01）， down-regulated protein and mRNA expression of Nrf2，HO-1， and NQO1（P<0.01），and up-regulated protein and mRNA expression of Keap1 （P<0.05，P<0.01）. Compared with the model group，the high- and medium-dose Phyllanthi Fructus groups showed significantly restored morphological structure of lung tissues with reduced collagen deposition， increased serum content of SOD and CAT（P<0.05，P<0.01），decreased content of HYP and MDA（P<0.01）， up-regulated protein and mRNA expression of Nrf2，HO-1， and NQO1 （P<0.05，P<0.01），and down-regulated protein and mRNA expression of Keap1（P<0.05，P<0.01）. ConclusionThe alcohol extract of Phyllanthi Fructus can inhibit pulmonary fibrosis in silicosis mice，and the underlying mechanism may be related to the regulation of the Nrf2/antioxidant response element （ARE） signaling pathway.

Therapeutic effect of compound acid, alpha hydroxyl acid and salicylic acid on acne vulgaris: a comparative study / 中华医学美学美容杂志

Objective:To evaluate the curative effect and adverse reactions of compound acid, alpha hydroxyl acid (AHA), and salicylic acid (SA) in the treatment of mild to moderate acne.Methods:A total of 105 patients admitted in Suzhou Municipal Hospital from August 2019 to May 2020 were divided into three groups randomly and treated with compound acid, AHA and SA, once every 3 weeks, 4 times totally. The efficacy was evaluated before treatment, 3 weeks after 1 time, 2 times, 3 times, and 4 times. The number of non-inflammatory lesions (comedos) and inflammatory lesions (papules or pustules) were recorded. VISIA image was used to record the patient＇s facial characteristics before treatment and 3 weeks after 4 times. The occurrence of adverse reactions was recorded.Results:Three groups were all safe and effective. The efficiency of non-inflammatory lesions showed that there was no statistically significant difference between the 3 groups (χ 2= 4.58, P=0.101). The effective rate of inflammatory lesions in the compound acid and SA groups were higher than that of AHA group, and the difference was statistically significant (χ 2=6.45, P=0.040). After 4 times, the clinical data of purpurin, red area, and spot in compound acid and SA groups were higher than those before treatment, and the difference was statistically significant ( P<0.05). While in the AHA group, the purple matter was higher than that before treatment after 4 times, the difference was statistically significant ( t=3.506, P=0.010), and the change in the red area was not statistically significant ( P>0.05). Conclusions:The compound acid is safe and effective in treating mild and moderate acne. It is effective for acne inflammatory and non-inflammatory lesions. It has less adverse reactions and is worthy of clinical application.

Preliminary exploration of the relationship between the serum anti-Müllerian hormone and the related clinical factors / 中华核医学与分子影像杂志

Objective:To explore the relationship between serum anti-Müllerian hormone (AMH) level and related clinical factors in healthy females, and establish and validate equation of correlation between age and serum AMH level for healthy females.Methods:From March 2015 to December 2016, a total of 602 females who measured serum AMH level in Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University were retrospectively enrolled. All cases had relatively complete clinical data, and were divided into healthy group (484 cases, 20-52 years) and case group (118 cases, 20-42 years; patients with menstrual disorders). Relationships between serum AMH level and estradiol (E2), tesosterone (T), follicle stimulating hormone (FSH), luetinizing hormone (LH), body mass index (BMI) of healthy group were analyzed by Spearman rank correlation. Kruskal-Wallis rank sum test was used to analyze the relationship between history of gestation and serum AMH level. Serum AMH level of health group was processed to establish predictive equation for serum AMH level. Internal ( n=27) and external ( n=37) validation group were chosen from healthy females with serum AMH level measured to validate the equation, and signed rank test was used to analyze the data. Difference between serum AMH level in case group and healthy group with corresponding age was explored by independent-sample t test. Results:Serum AMH levels were positively correlated with E2 and T ( rs values: 0.263, 0.334, both P<0.001), and negatively correlated with FSH, LH, BMI ( rs values: from -0.515 to -0.110, all P<0.005). Predictive equation was established as LogAMH=-1.208+ 0.1×age-0.000 042×age 3 ( R2=0.735, P<0.001). No statistically significant difference was found between real serum AMH levels and calculated serum AMH levels in the internal and external validation groups ( z values: -1.62 and -1.52, both P>0.05). Females in case group ( n=118) and control group ( n=446) were divided into two sub-groups respectively (<35 years and ≥35 years), and serum AMH levels of case group were lower than those of control group with corresponding age ( t values: 18.64, 11.70, both P<0.001). Conclusions:In healthy females, serum AMH level is related to some clinical data. The equation between serum AMH level and age established in the study may provide reference for clinical diagnosis and treatment.

Meta analysis on the treatment of coronavirus disease 2019 by traditional Chinese and Western medicine / 中华危重病急救医学

Objective:To evaluate the clinical efficacy and safety of combination of traditional Chinese and Western medicine in the treatment of coronavirus disease 2019 (COVID-19) by Meta analysis.Methods:The clinical randomized controlled trials (RCT) and cohort studies on the treatment of COVID-19 with combination of Chinese traditional and Western medicine published on CNKI, Wanfang database, VIP database and PubMed were searched by computer from January 2020 to June 2020. Patients in the simple Western medicine treatment group were treated with routine treatment of Western medicine, and the patients in integrated traditional Chinese and Western medicine treatment group were treated with traditional Chinese medicine on the basis of routine treatment of Western medicine. The main outcome was the total effective rate of treatment. The secondary outcome were the antipyretic rate, chest CT recovery rate, lymphocyte count (LYM), C-reactive protein (CRP) level and safety. The Cochrane manual and the Newcastle Ottawa Scale (NOS) were used to evaluate the quality of the literature; the RevMan5.3 software was used to analyze the articles that meets the quality standards, and a funnel chart was drawn to evaluate the total effective publication bias.Results:Thirteen articles were analyzed, including 1 039 COVID-19 patients, 559 in integrated traditional Chinese and Western medicine treatment group and 480 in simple Western medicine treatment group. The results of Meta-analysis showed that compared with the simple Western medicine treatment group, the combination of routine treatment of Western medicine and traditional Chinese medicine Qingfei Paidu decoction, Lianhua Qingwen granule, Shufeng jiedu capsule, Xuebijing injection or Reyanning mixture could significantly improve the total effective rate, antipyretic rate and chest CT recovery rate [total effective rate: odds ratio ( OR) = 2.95, 95% confidence interval (95% CI) was 2.10-4.14, P < 0.000 01; antipyretic rate: OR =3.01, 95% CI was 1.64-5.53, P = 0.000 4; chest CT recovery rate: OR = 2.53, 95% CI was 1.83-3.51, P = 0.000 1], increase LYM levels [mean difference ( MD) = 0.26, 95% CI was 0.02-0.50, P = 0.03], and reduce of CRP content ( MD = -17.68, 95% CI was -33.14 to -2.22, P = 0.02). Based on the funnel chart analysis of 12 articles with total efficiency, the result showed that the funnel chart distribution was not completely symmetrical, indicating that there might be publication bias. Conclusions:On the basis of routine treatment with Western medicine, combined with traditional Chinese medicine can significantly improve the total effective rate of COVID-19 and improve the laboratory results and clinical symptoms of patients. Compared with the routine treatment of Western medicine alone, the combination of traditional Chinese and Western medicine has better clinical efficacy and safety.

Visual analysis of influenza treated by traditional Chinese medicine based on CiteSpace / 中华危重病急救医学

Objective:To analyze the research status, research hotspots and frontier trends of traditional Chinese medicine (TCM) in the treatment of influenza in the past 20 years through the knowledge graph, so as to provide reference basis for further research.Methods:The related literatures of TCM in the treatment of influenza were collected in China National Knowledge Infrastructure (CNKI) from 2000 to 2019. The relevant graphs of authors, research institutions and key words were drawn by CiteSpace 5.6, the distribution and cooperation of main research forces in this field were analyzed, and the research frontiers and hot spot information in this field were discussed.Results:A total of 3 048 related literatures were obtained, involving 949 authors and 242 research institutions. The analysis of the number of articles showed that the volume of articles related to the treatment of influenza with TCM fluctuated greatly in the past 20 years, which was obviously affected by the sudden hot spots around 2010, but showed an overall upward trend, with an average annual volume of about 152 articles. The analysis of the author's cooperation map showed that a total of 77 core authors had published more than 5 articles, accounting for only 8.1% of all authors, and 5 authors had published more than 30 articles. Five major teams had been formed with Gu Ligang, Liu Qingquan, Lu Fangguo, Cui Xiaolan and Zhang Fengxue as the core. The analysis of the cooperation map of research institutions showed that the cooperation among institutions was not good, and only the scientific research institutes in Beijing and Guangzhou had formed a closely related cooperation network. The keyword co-occurrence map showed that 8 keywords appeared more than 100 times, especially ultra-high-frequency keywords, influenza virus ranked first ( n = 518). There were 14 key nodes, such as influenza virus, TCM treatment, viral pneumonia and so on, which supported the current research field of TCM in the treatment of influenza. Fourteen clusters were formed to classify the current research hotspots, including the nomenclature of influenza, virus type, TCM treatment, western medicine knowledge, etc., and the map showed that the clustering was reasonable and the structure was significant. Timeline graph showed that parainfluenza virus, virus disease, pharmacodynamics, heat-clearing and detoxifying drugs, bacteriostasis and experimental research had all been studied for more than 8 years, revealing the research hotspots and trends of TCM in the treatment of influenza. Conclusions:The overall research related to the treatment of influenza with TCM is relatively perfect. In the future, the close cooperation among authors and institutions should be strengthened. The molecular mechanism research, clinical and animal trials of TCM should be further studied, so as to improve the research system of TCM treatment of influenza.

Isolation characteristics and antibiotic resistance analysis of Streptococcus pneumoniae from the hospitalized children in Bao′an district of Shenzhen from 2012 to 2018 / 中华实用儿科临床杂志

Objective:To investigate the isolation characteristics and the antibiotic resistance of Streptococcus pneumoniae in hospitalized children from the Bao′an District of Shenzhen for many consecutive years, and to provide evidence for the assessment as well as clinical prevention and treatment of Streptococcus pneumoniae infection. Methods:The isolation rate and sample source of Streptococcus pneumoniae isolates as well as age composition of hospitalized children in Bao′an Maternal and Child Health Hospital of Shenzhen city from January 2012 to December 2018 were retrospectively analyzed.The susceptibility of the isolates to antibiotics was tested by disk diffusion method and E-test method. Results:(1) From 2012 to 2018, a total of 90 807 specimens were retrospectively summarized, 9 193 strains of Streptococcus pneumoniae were isolated, with an isolation rate of 10.1%, which was the first pathogen; 98.68% (9 072/9 193 cases) from respiratory tract samples and 97.20% from sputum samples.Among 107 strains isolated from aseptic body fluid specimens, 97 strains were blood specimens. Streptococcus pneumoniae was the most common bacteria with positive culture in aseptic body fluids.(2) The isolation rate of Streptococcus pneumoniae was 10.7% in children under 2 years old, 10.2% in children between 2 and 5 years old and 4.1% in children over 5 years old.About 97% of Streptococcus pneumoniae isolates came from children under 5 years old.(3) According to breakpoints of non-meningitis strains, the sensitivity rate of parenteral Penicillin was 93.18%, the mediation rate was 6.79%, the resistance rate was only 0.03%, the lowest drug concentration to inhibit the growth of 50% bacteria(MIC 50) value was 0.50 and the lowest drug concentration to inhibit the growth of 90% bacteria(MIC 90) value was 2.00; the sensitivity rate of Ceftria-xone was 76.55%, the mediation rate was 20.18%, the resistance rate was 3.26%, the MIC 50 value was 1.00 and the MIC 90 value was 2.00; when interpreted by the breakpoint of meningitis strains, the resistance rate of extra-gastrointestinal Penicillin reached 77.22%, and the mediation rate of Ceftriaxone increased to 30.48% and the drug resistance rate reached 18.45%.The drug resistance rates of Erythromycin, Clindamycin, Tetracycline and Compound neomycin were all over 85.00%.The resistance rates against Levofloxacin and Chloramphenicol were 0.16% and 7.85% respectively.No Vancomycin-resistant Streptococcus pneumoniae was found. Conclusions:Streptococcus pneumoniae is the first bacterial pathogen causing respiratory tract and invasive infection in hospitalized children under 5 years old in this area.Penicillin is still the preferred drug for non-meningitis pneumococcal infection, but the drug resistance rate is high in meningitis patients.

Analysis of screening strategy of group B streptococcus in the third trimester and its influence on pregnancy outcome / 中华妇产科杂志

Objective To investigate the screening strategy of group B streptococcus (GBS) in the reproductive tract of women in the third trimester and analyze its impact on pregnancy outcome. Methods A total of 85 461 pregnant women in 35-37 weeks of gestation from Bao′an Maternity and Child Health Hospital, Jinan University from January 2011 to June 2018 were enrolled. They were divided into 3 periods according to different GBS screening strategies, the unscreened period included 31 384 cases (36.72%), 33 267 cases (38.93%) were included in partial screening period, 20 810 cases (24.35%) were included in screening period. All GBS screening positive pregnant women were given intrapartum antibiotic prophylaxis (IAP). The impact on pregnancy outcomes, and the impact of different GBS collection transport and culture methods on the positive rate of GBS screening were analyzed. Results (1) The incidence of neonatal early onset GBS disease (EOGBSD) in unscreened period was 0.03% (11/31 773), in partial screening period was 0.02%(6/33 887), and in screening period, the incidence of neonatal EOGBSD decreased to 0, the difference was statistically significant (χ2=7.86, P=0.02).(2) The incidence of hematogenous infection of GBS in pregnant women was 0.02%(6/33 887) in partial screening period, and there was none in screening period, there was no significant difference (adjusted χ2=3.75, P=0.05). (3) In the screening period, the positive rate of GBS was 14.08%(2 719/19 306), which was significantly higher than the positive rate of GBS in the partial screening period (11.48%, 2 058/17 920; χ2=56.12, P=0.00). (4) Antibiotic sensitivity tests of 4 777 GBS strains showed that the antibiotics with higher resistance rate were tetracycline (81.52%, 3 896/4 777), erythromycin (66.59%, 3 181/4 777), and clindamycin (64.31%, 3 072/4 777). The combination of erythromycin, clindamycin and tetracycline was the most common resistant pattern, accounting for 48.80% (2 331/4 777). No penicillin, ceftriaxone or vancomycin resistant strains was found. Conclusions GBS screening strategy in different regions could combine the local neonatal EOGBSD incidence rate, maternal GBS colonization rate, and the socioeconomic factors to determine whether universal GBS screening or screening for high-risk maternal women. GBS screening positive rate is related to the population, scope of the investigation, the sample collection, delivery and culture methods. The multi-drug resistance rate of GBS is high.[Key words] Streptococcus agalactiae; Streptococcal infections; Neonatal sepsis; Prenatal diagnosis; Pregnancy trimester, third; Pregnancy outcome

Correlation betw een serum 25-hydroxyvitamin D level and enlarged perivascular spaces in patients w ith lacunar infarction / 国际脑血管病杂志

Objective To investigate the correlation betw een serum 25-hydroxyvitamin D (25(OH) D) level and enlarged perivascular spaces (EPVS) in patients w ith lacunar infarction. Methods Consecutive inpatients w ith acute lacunar infarction w ere enrolled. Chemiluminescence immunoassay w as used to measure the serum 25(OH)D. Head MRI w as used to assess the severity of EPVS in the centrum ovale and the basal ganglia region (grade 1, 0-10; grade 2, 11-25; grade 3, >25). Univariate analysis w as used to analyze the differences in baseline data among the three groups. Multivariate ordinal logistic regression analysis w as used to investigate the independent correlation betw een the 25(OH)D levels and the severity of EPVS. Results A total of 194 patients w ere enrolled,96 w ere males.Their mean age w as 63.4 ±9.3 years. The mean baseline National Institutes of Health Stroke Scale (NIHSS) score w as 2.0 ±1.7. The mean 25(OH)D level w as(50.25 ±15.50)nmol/L. There w ere 112 patients (57.7%), 45 (23.2%) and 37 (19.1%) w ith EPVS grade 1,grade 2 and grade 3 in the centrum ovale,and 109 (56.2%),53(27.3%) and 32 (16.5%) w ith EPVS grade 1, grade 2 and grade 3 in basal ganglia region, respectively. Multivariate ordinal logistic regression analysis show ed that serum 25(OH)D levels w ere independently associated w ith the severity of EPVS in the centrum ovale (odds ratio 2.898,95% confidence interval 1.345-9.612; P=0.028) and basal ganglia region (odds ratio 2.688, 95% confidence interval 1.182-10.281; P=0.039). Conclusion The low serum 25 (OH) D levels are independently associated w ith the severity of EPVS in patients w ith lacunar infarction.

To analyse the rate of intraplaque hemorrhage in symptomatic vertebral artery stenosis by high-resolution MRI / 实用医学杂志

Objective To compare the rate of intraplaque hemorrhage between symptomatic and asymptom-atic vertebral artery stenosis groups using high-resolution magnetic resonance imaging(HR-MRI).Methods The patients diagnosed with PCI and with vertebral artery stenosis using HR-MRI were enrolled retrospectively. They were divided into symptomatic and asymptomatic groups according to whether they were detected with PCI by the re-sponsible vertebral artery stenosis before examination. All patients underwent 3D time of flight magnetic resonance angiography(3D TOF MRA)to detect the stenosis location of vertebral artery and the stenosis rate at the narrow-est. T1-weighted fat-suppressed images were positioned on the atherosclerotic plaque that the signal 150% higher than the surrounding muscle was confirmed to be intraplaque hemorrhage. Statistical significance was assessed by chi-square test or Student′s unpaired t test.Results A total of 60 patients were included in this study,28 patients in the symptomatic group and 32 patients in the asymptomatic group.The rate of vertebral artery stenosis in asymp-tomatic group was higher than symptomatic group,but there was no statistical significance[(72 ± 33)% vs.(65 ± 28)%,P=0.383];the number of intraplaque hemorrhage in symptomatic group was significantly higher than that in the asymptomatic group(9 vs.2,P=0.024).Conclusions There is a higher rate of intraplaque hemorrhage in symptomatic vertebral artery stenosis group than asymptomatic group.Intraplaque Hemorrhage could be one of risk factor of acute ischemic cerebral disease.

The miss rate analysis of anti-HLA antibodies detection for kidney transplantation preoperative recipients with sensitization history based on luminex xMAP / 中华器官移植杂志

Objective To interrogate the detection of anti-HLA antibodies using two methods of Luminex xMAP,and to compare their detection capacity and to analyze their misdetection rate for initial screening,providing more accurate results in clinical practice.Methods 214 serum samples from recipients with a history of sensitization before renal transplantation were collected and detected by LM (LABScreen Mixed) and LSA (LABScreen Single Antigen) respectively on the Luminex xMAP platform.Results For the LM detection,the positive rates of anti-HLA class Ⅰ and Ⅱ were 50.9％ and 23.4％ respectively,which were lower than those used by the LSA detection (58.9％ and 46.7％ respectively).The difference had statistical significance (P ＜ 0.05).The sensitivity,specificity,miss rate and mistake rate of anti-HLA class Ⅰ and Ⅱ[detection were 80.2％,90.9％,19.8％,9.1％ and 49.0％,99.1％,51.0％,0.9％ respectively.The missed detection gene with the highest rate was Cw * 17:01,B * 15:12,B * 45:01 for anti-HLA class Ⅰ and DPA1 * 01:03,DPB1 * 06:01,DPA1 * 01:03,DPB1 * 01:01 for anti-HLA class Ⅱ.The highest MFI value was 10603 and 3659.For the recipients with only blood transfusion history or pregnancy history,LM and LSA detection showed no statistically significant difference when detecting anti-HLA class Ⅰ antibodies,but had statistically significant difference when testing anti-HLA class Ⅱ antibodies.For the patients with history of both blood transfusion and pregnancy history,LM and LSA showed no significant difference in the detection of anti-HLA class Ⅰ antibodies and anti-HLA class Ⅱ antibodies.The miss rate of anti-HLA class Ⅰ antibody detection was lower than that of anti-HLA class Ⅱ antibody detection.Conclusion LSA detection has the higher sensivity and lower miss rate than LM detection.In the light of the disadvantage of LM detection as diagnostic preliminary screening,it is suggested that LSA detection should be used directly for the recipients with a history of sensitization.By this process optimization,it is more likely to cause missent inspection and the occurrence of rejection,as well as a poor long-term survival rate.

ABO-incompatible living donor kidney transplantation / 中华器官移植杂志

Objective To investigate the clinical efficacy and safety of individualized preconditioning in ABO-incompatible living donor kidney transplantation.Methods A series of 36 living donor kidney transplants across a wide range of ABO blood group incompatibilities using individualized preconditioning protocols were performed from September 2014 to June 2017.Preconditioning included oral immunosuppressants with or without the administration of rituximab,PE or DFPP.Medical records and electronic databases were reviewed for isoagglutinin titers,patient and graft survivals,graft function,rejections,infections as well as surgical complications.Results Of 30 ABO blood group incompatibilities,there were 6 cases of AB to A,2 cases of AB to B,4 cases of A to B,3 cases of B to A,13 cases of A to O (13),and 8 cases of B to O.Median initial ABO antibody titers were 1∶32 (1∶2-1∶256) (IgM) and 1 ∶ 8 (0-1∶64) (IgG),respectively.Individualized preconditioning included oral immunosuppressants alone (10 cases),oral immunosuppressants + PE (4 cases),oral immunosuppressants + PE + DFPP (1 case),oral immunosuppressants + rituximab + PE (16 cases),oral immunosuppressants + rituximab + DFPP (2 cases),and oral immunosuppressants + rituximab + PE+ DFPP (3 cases).After individualized preconditioning,an acceptable ABO antibody titer (≤1 ∶ 16) was obtained on the day of transplantation.Median follow-up duration was 12 months (1-33).Graft and patient survival rate was 94.4％ (34/36) and 100％ (36/36) respectively.Median value of serum creatinine at one year posttransplantation was 89 μmol/L,and eGFR was (81.07 mL/min/1.73 m2).In total,there was one episode of urinary tract infection and upper gastrointestinal tract hemorrhage,two cases of hyperacute rejection (leading to graft loss),acutecelluar-mediated rejection,delayed graft function,bone marrow suppression and pneumonia,and 3 cases of acute antibody-mediated rejection and wound fat liquefaction,respectively.Conclusion Our initial experience indicates that individualized preconditioning protocol based on initial ABO antibody titers is safe and technically feasible,and leads to excellent short-term survival of ABOi living donor kidney transplantation.

Facial cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis: a case report / 中华皮肤科杂志

A 55-year-old male patient presented with plaques on the face for more than 20 years,and no immunodeficiency diseases were diagnosed.Skin examination showed large areas of pink plaques on the nose,bilateral cheeks and upper oral lips with slight desquamation,verrucous hyperplasia on the dorsal area of the nose,and a bean-sized verrucous protuberance on the tip of the nose.Histopathological examination of the skin lesions revealed pseudoepitheliomatous hyperplasia in the epidermis and hyphae-like structures in the stratum corneum.Moreover,there was diffuse infiltration of inflammatory cells in the dermis,which mainly included neutrophils,lymphocytes,histiocytes and multinucleated giant cells.Periodic acid-Schiff (PAS)-positive spore-like structures were observed in the multinucleated giant cells.Culture of the lesional tissues on Sabouraud dextrose agar (SDA) medium showed grey-brown villous colonies.Microculture on the potato dextrose agar (PDA) medium yielded dark septate hyphae and pycnidia filled with a large number of spores.Microsphaeropsis arundinis was identified by fungal molecular biological techniques.The patient was diagnosed with cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis.The patient was treated with CO2 laser for the removal of verrucous protuberance on the tip of the nose,and oral itraconazole capsules at a dose of 200 mg twice a day.After 3-month treatment,the skin lesions subsided and the drug was withdrew.During 6-month follow-up,no relapse occurred.

Clinical observation of hepatitis B virus carriers after renal transplantation / 器官移植

Objective To observe the changes of liver and kidney function in hepatitis B virus(HBV)carriers after renal transplantation. Methods A total of 116 patients with HBV infection undergoing renal transplantation and 348 counterparts without HBV infection were recruited in this clinical trial. The liver function parameters including alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels and renal function parameter including serum creatinine(Scr)level were measured before and at 1, 3, 6, 12, 18, 24, 36 and 60 months after renal transplantation. Preoperative and postoperative changes of liver and kidney function were statistical y compared between the hepatitis B surface antigen(HBsAg)(+)and HBsAg(–)groups. According to the results of preoperative HBV serology, preoperative quantitative detection of HBV DNA and preoperative liver function test, 116 HBsAg(+)patients undergoing renal transplantation were divided into(HBsAg, HBeAg and anti-HBc all positive)and(HBsAg, anti-HBe and anti-HBc all positive)groups, HBV DNA(+)and HBV DNA(–)groups, and normal and abnormal liver function groups.Preoperativeandpostoperativechangesofliverandkidneyfunctionwerestatisticalycomparedbetweendifferentsubgroups. Results(1)Preoperative ALT and AST levels in HBsAg(+)patients were significantly higher compared with those in their HBsAg(–)counterparts. In 36 months after renal transplantation, liver function parameters significantly differed between two groups(al P<0.05), whereas no statistical significance was noted at postoperative 60 months(al P>0.05). Before and in 60 months after renal transplantation, no statistical significance was observed in the Scr levels between the HBsAg(+)and HBsAg(–)groups(all P>0.05).(2)Before and in 60 months after renal transplantation, no statistical significance was observed in the liver and kidney function parameters between the(HBsAg, HBeAg and anti-HBc all positive)and(HBsAg, anti-HBe and anti-HBc all positive)groups, and HBV DNA(+)and HBV DNA(–)groups(all P>0.05).(3)The ALT levels before and at 1, 3, 6 and 12 months after renal transplantation significantly differed between the normal and abnormal liver function groups(al P<0.05), whereas no statistical significance was observed at other time points(all P>0.05). The AST levels before and at 1 month after renal transplantation significantly differed between two groups(both P<0.05), whereas did not significantly differ at alternative postoperative time points(all P>0.05). No statisticalsignificancewasobservedinthekidneyfunctionparametersbeforeandat60monthsfolowingrenaltransplantation between two groups(al P>0.05). Conclusions HBV infection cannot exert significant effect upon kidney function within 5 years after renal transplantation, whereas it can affect short-term postoperative liver function.

The Role of Gut Microbiota in the Pathogenesis of Obesity / 世界科学技术-中医药现代化

Obesity has became a threat to the public health problem in the world.As a complex diseases with genetic factor,environmental factor and gut microbiota,gut microbiota plays an important role in the occurrence and development of obesity.This paper focuses on the study of the relationship between gut microbiota and obesity,and the effect of Chinese medicine on gut microbiota in obesity.

The experimental research of the SD rats exposed to the high-temperature and high-humidity environment / 重庆医学

Objective To investigate the effect of extremely high temperature and high humidity exposure on the survival and blood biochemical indexes of SD rats and the to the major organs .Methods Twenty-six SD rats were divided into the normal tem-perature and humidity group and the extremely high-temperature and high-humidity group .The mortality of SD rats in extremely high-temperature and high humidity environment was observed ,and at the median lethal time ,the living rats were undergoing the tests of serum biochemical indicators and the pathological examination of the heart ,lung ,kidney ,brain ,muscles and intestinal tis-sues .Results The exposure to the extremely high-temperature and high-humidity environment could lead to the death of SD rats , the median lethal time was 48 h .The serum creatinine(Scr) increased significantly(P<0 .05) ,and the serum alkaline phosphatase (ALP) and ischemia modified albumin (IMA) decreased significantly (P<0 .05) when compared with the normal temperature and humidity group ,and there was no significant difference in other biochemical indicators .The inflammatory cell infiltration was ob-served in heart ,lung ,kidney and intestines ,and there were no obvious pathological changes in brain and muscle .Conclusion The exposure to the extremely high-temperature and high-humidity environment has obvious lesion on SD rats ,it can lead to the abnor-mality of some biochemical indicators ,the inflammatory changes in heart ,lung ,kidney and intestines ,and even death .

Tripotolide ameliorates inflammation and apoptosis induced by focal cerebral ischemia/reperfusion in rats / 浙江大学学报·医学版

To investigate the effects of triptolide on inflammation and apoptosis induced by focal cerebral ischemia/reperfusion in rats.The rat model of focal cerebral ischemia/reperfusion injury was established according to Longa's method. A total of 80 SD rats were randomly divided into 5 groups:normal control, sham group, DMSO group, middle cerebral artery occlusion (MCAO) group, and MCAO with tripolide treatment group. TTC staining was used to examine the site and volume of cerebral infarction, and Longa score was employed for neurological disorders measurement. Number of astrocytes was measured by fluorescence staining, and neuronal apoptosis was determined by TUNEL staining. The expressions of inducible nitric oxide synthase(iNOS), cyclooxygenase 2(COX-2) and NF-κB proteins were detected by immunohistochemistry, and the expression of iNOS, COX-2 mRNA was detected by real-time PCR.Compared with DMSO group and MCAO group, brain edema was improved (80.03±0.46)% (<0.05), infarct volume was reduced (8.3±1.4)% (<0.01), Longa score was decreased (1.38±0.20,<0.05) in triptolide treatment group. Meanwhile triptolide also dramatically reduced the number of GFAP-positive astrocytes (<0.05), alleviated protein expression of COX-2 (91.67±1.31), iNOS (95.24±5.07) and NF-κB (75.03±2.06) triggered by MCAO (all<0.05), and induced a down-regulation of cell apoptosis as showed by TUNEL assay (64.15±3.52,<0.05).Triptolide can reduce the cerebral infarction volume, attenuate brain edema and ameliorate the neurological deficits induced by cerebral ischemia-reperfusion injury rats, indicating that it might be used as a potential anti-inflammatory agent.

Efficacy and Safety of Deproteinised Calf Blood Serum Injection in the Treatment of Cerebral Infarction:A Meta-analysis / 中国药房

OBJECTIVE:To systematically review the efficacy and safety of Deproteinised calf blood serum injection in the treatment of cerebral infarction,and to provide evidence-based reference for clinical treatment.METHODS:Retrieved from Co-chrane Library,EMBase,Medline,CBM,CJFD,VIP and Wanfan database,randomized controlled trials(RCT)about theeffica-cy and safety ofDeproteinised calf blood serum injection(test group)based on basic treatment(control group)in the treatment of cerebral infarction were collected.Meta-analysis was performed by using Rev Man 5.2 software after data extraction and quality eval-uation with Cochrane system evaluation manual 5.1.0.RESULTS:A total of 18 RCTs were included,involving 2 111 patients.Re-sults of Meta-analysis showed the total effective rate [OR=3.30,95%CI(2.48,4.39),P<0.001],National Institutes of Health Stroke Scale (NIHSS) score[MD=-1.47,95%CI(-2.06,-0.88),P<0.001] and activities of daily living(ADL) score[MD=9.09,95%CI(6.46,11.72),P<0.001] in test group were significantly better than control group,there were significant differences be-tween the 2 groups;and there was no obvious adverse reactions during treatment. CONCLUSIONS:Both efficacy and safety of De-proteinised calf blood serum injectionin the treatment of cerebral infarction are good.

Characteristics of domestic master and doctorial papers on rheumatoid arthritis:A visualization analysis / 中华医学图书情报杂志

The external and internal characteristics of domestic master and doctorial papers on rheumatoid arthritis were analyzed by visualization analysis, which revealed the publication of and hotspots and frontiers in domestic master and doctorial papers on rheumatoid arthritis, and can thus provide reference for the development of medical information resources and recent advances in rheumatoid arthritis for the broad masses of scientific workers.