Hemodynamic study of personalized Stanford type B aortic dissection based on computational fluid dynamics / 中国胸心血管外科临床杂志

@#Objective To establish a personalized Stanford type B aortic dissection numerical simulation model, and using computational fluid dynamics (CFD) numerical simulation to obtain the hemodynamic behavior and law of the type B aortic dissection at different stages of development. Methods Based on the theory of three-dimensional model reconstruction, we used CT images of a patient with type B aortic dissection in the Xiamen Cardiovascular Hospital of Xiamen University, relevant medical image processing software to reconstruct a personalized aortic three-dimensional model, and CFD to reconstruct the model which was simulated in fluid mechanics. Results The three-dimensional reconstruction model could intuitively observe the changing trend of the false cavity at different stages of the dissection development. Through fluid mechanics simulation, the blood flow rate, pressure, wall shear stress, vascular wall Von Mises stress and other parameters at different stages of the dissection development were obtained. Conclusion The hemodynamic behavior and law of relevant parameters in the development stage of aortic dissection are analyzed. The combination of the values of relevant parameters and clinical medical detection and diagnosis can well predict the development of the disease, and finally provide more theories and methods for the scientific diagnosis of aortic dissection.

Finding quarrel in a straw and making utmost effort to cultivate new seedings: record of clinical research training course organized by Lau Wanyee / 中华消化外科杂志

Professor Lau Wanyee, a member of the Chinese Academy of Sciences and a pro-fessor at the Chinese University of Hong Kong, actively advocates conducting clinical researches through "planting fruit trees" and "growing orchards", aiming to cultivate a team of dual-skilled talents in clinical practice and research, effectively improve the scientific and technological level of clinical medicine in China, make voice heard in the international medical science field, and better serve human health. He organized a clinical research training course in scholars′ forum for Hepatobiliary Young Expert Working Group of Chinese College of Surgeons. Throughout three sessions of the training course, a distinct theme was focused on how to enhance the level of clinical research in China and make voice heard by the international scholars. A group of multi-dimensional experts were gathered, including experts from surgery, methodology, and management, as well as both renowned experts and young talents. A lively teaching model was adopted, combining guided presentations with interactive discussion and debate sessions. A clean and upright academic spirit was strongly advocated, in which international rules were adopted to conduct in-depth analysis and sharp criticism of seven proposed clinical research projects and four published papers with high international influence to find quarrel in a straw. This clinical research training course provides a new model of guidance for young physicians in conducting clinical research. As a result, all attendees felt deeply educated and benefited greatly from the training session. This training activity not only laid a solid foundation for the development of scientization, standardization, and internationali-zation of clinical research in digestive surgery in China, but also demonstrated a correct path for cultivating a group of young and middle-aged clinical medical scientists with scientific spirit.

Improving the understanding of PI-RADS in practice: characters of PI-RADS 4 and 5 lesions with negative biopsy / 亚洲男科学杂志(英文版)

The Prostate Imaging Reporting and Data System (PI-RADS) has good ability to identify the nature of lesions on prostate magnetic resonance imaging (MRI). However, some lesions are still reported as PI-RADS 4 and 5 but are biopsy-proven benign. Herein, we aimed to summarize the reasons for the negative prostate biopsy of patients who were assessed as PI-RADS 4 and 5 by biparameter MRI. We retrospectively sorted out the prostate MRI, treatment, and follow-up results of patients who underwent a biparameter MRI examination of the prostate in The First Affiliated Hospital of Nanjing Medical University (Nanjing, China) from August 2019 to June 2021 with PI-RADS 4 and 5 but a negative biopsy. We focused on reviewing the MRI characteristics. A total of 467 patients underwent transperineal prostate biopsy. Among them, biopsy pathology of 93 cases were negative. After follow-up, 90 patients were ruled out of prostate cancer. Among the 90 cases, 40 were considered to be overestimated PI-RADS after review. A total of 22 cases were transition zone (TZ) lesions with regular appearance and clear boundaries, and 3 cases were symmetrical lesions. Among 15 cases, the TZ nodules penetrated the peripheral zone (PZ) and were mistaken for the origin of PZ. A total of 17 cases of lesions were difficult to distinguish from prostate cancer. Among them, 5 cases were granulomatous inflammation (1 case of prostate tuberculosis). A total of 33 cases were ambiguous lesions, whose performance was between PI-RADS 3 and 4. In summary, the reasons for "false-positive MRI diagnosis" included PI-RADS overestimation, ambiguous images giving higher PI-RADS, diseases that were really difficult to distinguish, and missed lesion in the initial biopsy; and the first two accounted for the most.

Exploration of making removable partial denture by digital technology / 中华口腔医学杂志

To explore the digital manufacturing process of distal extension removable partial denture. From November 2021 to December 2022, 12 patients (7 males and 5 females) with free-ending situation were selected from the Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University. Three-dimensional model of the relationship between alveolar ridge and jaw position was obtained by intraoral scanning technique. After routine design, manufacturing and try-in of metal framework for removable partial denture, the metal framework was located in the mouth and scanned again to obtain the composite model of dentition, alveolar ridge and metal framework. The free-end modified model is obtained by merging the digital model of free-end alveolar ridge with the virtual model with the metal framework. The three-dimensional model of artificial dentition, and base plate was designed on the free-end modified model, and the resin model were made by digital milling technology. The removable partial denture was made by accurately positioning the artificial dentition and base plate, bonding metal framework with injection resin, grinding and polishing the artificial dentition and resin base. Compared with the design data after clinical trial, the results showed that there was an error of 0.4-1.0 mm and an error of 0.03-0.10 mm in the connection between the resin base of artificial dentition and the connecting rod of the in-place bolt and the connection between artificial dentition and resin base. After denturen delivery, only 2 patients needed grinding adjustment in follow-up visit due to tenderness, and the rest patients did not find any discomfort. The digital fabrication process of removable partial denture used in this study can basically solve the problems of digital fabrication of free-end modified model and assembly of artificial dentition with resin base and metal framework.

Maresin1 inhibits the NF-κB/caspase-3/GSDME signaling pathway to alleviate hepatic ischemia-reperfusion injury / 中华肝脏病杂志

Objective: To investigate the role of Maresin1 (MaR1) in hepatic ischemia-reperfusion injury (HIRI). Methods: The HIRI model was established and randomly divided into a sham operation group (Sham group), an ischemia-reperfusion group (IR group), and a MaR1 ischemia-reperfusion group (MaR1+IR group). MaR1 80ng was intravenously injected into each mouse's tail veins 0.5h before anesthesia. The left and middle hepatic lobe arteries and portal veins were opened and clamped. The blood supply was restored after 1h of ischemia. After 6h of reperfusion, the mice were sacrificed to collect blood and liver tissue samples. The Sham's group abdominal wall was only opened and closed. RAW267.4 macrophages were administered with MaR1 50ng/ml 0.5h before hypoxia, followed by hypoxia for 8h and reoxygenation for 2h, and were divided into the control group, the hypoxia-reoxygenation group (HR group), the MaR1 hypoxia-reoxygenation group (MaR1 + HR group), the Z-DEVD-FMK hypoxia-reoxygenation group (HR+Z group), the MaR1 + Z-DEVD-FMK hypoxia-reoxygenation group (MaR1 + HR + Z group), and the Con group without any treatment. Cells and the supernatant above them were collected. One-way analysis of variance was used for inter-group comparisons, and the LSD-t test was used for pairwise comparisons. Results: Compared with the Sham group, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), interleukin (IL)-1β, and IL-18 in the IR group were significantly higher (P < 0.05), with remarkable pathological changes, while the level in the MaR1 + IR group was lower than before (P < 0.05), and the pathological changes were alleviated. Compared with the Con group, the HR group had higher levels of IL-1β and IL-18 (P < 0.05), while the MaR1 + HR group had lower levels of IL-1β and IL-18 (P < 0.05). Western blot showed that the expressions of caspase-3, GSDME, and GSDME-N were significantly higher in the HR group and IR group than in the other groups; however, the expression was lower following MaR1 pretreatment. The Z-DEVD-FMK exploration mechanism was inhibited by the expression of caspase-3 in HIRI when using MaR1. Compared with the HR group, the IL-1β and IL-18 levels and the expressions of caspase-3, GSDME, and GSDME-N in the HR + Z group were decreased (P < 0.05), while the expression of nuclear factor κB was increased, but following MaR1 pretreatment, nuclear factor κB was decreased. There was no significant difference in the results between the MaR1 + H/R group and the MaR1 + H/R + Z group (P > 0.05). Conclusion: MaR1 alleviates HIRI by inhibiting NF-κB activation and caspase-3/GSDME-mediated inflammatory responses.

Predictive value of BMI combined with preoperative oxygenation index for postoperative hypoxemia in Stanford type A aortic dissection / 解放军医学杂志

Objectives To analyze the risk factors and their predictive value for postoperative hypoxemia in Type-A aortic dissection(TAAD).Methods A single-center retrospective study was conducted among 146 consecutive patients diagnosed as TAAD and undergone aortic arch surgery from January 2018 to June 2021 in Nanfang Hospital of Southern Medical University.According to the lowest postoperative PaO2/FiO2 ratio within 24 hours,the patients were classified into two groups:hypoxemia group(PaO2/FiO2≤200 mmHg)and non-hypoxemia group(PaO2/FiO2>200 mmHg).The difference of preoperative oxygen index,duration of mechanical ventilation and mortality in hospital were analyzed between the two groups.The independent risk factors for postoperative hypoxemia were evaluated by multivariate logistic regression and the predictive value was analyzed by receiver operator character(ROC)curves.Results For TAAD patients,the incidence of postoperative hypoxemia was 45.9%.Compared to non-hypoxemia group,hypoxemia group exhibited longer duration of mechanical ventilation(P<0.001)and longer intensive care unit(ICU)length of stay(P<0.05).Moreover,patients with hypoxemia presented higher mortality during hospital(P=0.011).Multivariate regression analysis identified BMI as independent risk factor(OR=1.701,P<0.001)and preoperation PaO2/FiO2 ratio as protective factors for postoperative hypoxemia in patients with TAAD(OR=0.987,P=0.004).Area under the ROC curve of BMI was 0.848,the optimal cut-off point of BMI was 25.8 kg/m2.Area under the ROC curve of pre-operation PaO2/FiO2 ratio was 0.808,the optimal cut-off point of preoperation PaO2/FiO2 ratio was 265 mmHg.Conclusions BMI higher than 25.8 kg/m2 is an independent risk factor and preoperation PaO2/FiO2 ratio higher than 265 mmHg is a protective factor for postoperative hypoxemia in patients with TAAD.Subjects with hypoxemia had longer duration of mechanical ventilation,ICU stay and higher mortality.

MTBSTFA derivatization-LC-MS/MS approach for the quantitative analysis of endogenous nucleotides in human colorectal carcinoma cells / 药物分析学报

Endogenous ribonucleotides(RNs)and deoxyribonucleotides(dRNs)are important metabolites related to the pathogenesis of many diseases.In light of their physiological and pathological significances,a novel and sensitive pre-column derivatization method with N-(t-butyldimethylsilyl)-N-methyltri-fluoroacetamide(MTBSTFA)was developed to determine RNs and dRNs in human cells using high-performance liquid chromatography tandem mass spectrometry(HPLC-MS/MS).A one-step extraction of cells with 85％methanol followed by a simple derivatization reaction within 5 min at room temper-ature contributed to shortened analysis time.The derivatives of 22 nucleoside mono-,di-and tri-phosphates were retained on the typical Cig column and eluted by ammonium acetate and acetonitrile in 9 min.Under these optimal conditions,good linearity was achieved in the tested calibration ranges.The lower limit of quantitation(LLOQ)was determined to be 0.1-0.4 μM for the tested RNs and 0.001-0.1 μM for dRNs.In addition,the precision(CV)was＜15％and the RSD of stability was lower than 10.4％.Furthermore,this method was applied to quantify the endogenous nucleotides in human colorectal carcinoma cell lines HCT116 exposed to 10-hydroxycamptothecin.In conclusion,our method has proven to be simple,rapid,sensitive,and reliable.It may be used for specific expanded studies on intracellular pharmacology in vitro.

Specific blockade of muscle acetylcholine receptor by α-conotoxin MIA and MIB / 药学学报

The α-conotoxins are peptide toxins that are identified from the venom of marine cone snails and they hold outstanding potency on various subtypes of nicotinic acetylcholine receptors (nAChRs). nAChRs have an important role in regulating transmitter release, cell excitability, and neuronal integration, so nAChR dysfunctions have been involved in a variety of severe pathologies. Four types of α-3/5 conotoxins MI, MIA, MIB and MIC have been found from Conus magus. Among them, the activity and selectivity of MIA and MIB have not been well studied. In this study, four α-3/5 conotoxins MI, MIA, MIB and MIC were synthesized by solid peptide synthesis method, and the bioactivities of them were screened by double electrode voltage clamp electrophysiology. The results showed that MIA and MIB selectively inhibited muscle type acetylcholine receptors with IC50 values of 14.45 and 72.78 nmol·L-1, respectively, which are slightly weaker than MI and MIC. Molecular docking results have shown MIA and MIB interact with muscle-type nAChRs with similar mechanism. The reasons for activity differences may relate to the size of the N-terminal amino acids. Together, the conotoxins MIA and MIB may have the potential to develop as a tool for detect the function of muscle type nAChRs, as well as the diagnosis or treat of related diseases.

Relationship between interpregnancy interval and neurodevelopment among 6-month-old infants / 预防医学

Objective@#To examine the relationship between interpregnancy interval (IPI) and neurodevelopment among 6-month-old infants, so as to provide insights into the prevention of neurodevelopmental abnormalities among infants.@*Methods@#Puerparas with full-term delivery at Anhui Province Maternity and Child Health Hospital from April 2017 to July 2018 and their babies were recruited. The demographic features, behaviors during pregnancy, IPI and birth outcomes were collected through questionnaires and medical records. The neurodevelopment was evaluated using the Ages and Stages Questionnaire (third edition) among infants at 6 months of age. The association between IPI and neurodevelopment was examined using multivariable logistic regression analysis.@*Results @#Totally 485 maternal-newborn pairs were investigated, and the puerparas had a mean age of ( 29.43±4.40 ) years. There were 330 puerparas ( 68.04% ) with normal pre-pregnancy body mass index, 325 puerparas ( 67.01% ) with eutocia, 233 puerparas (48.04%) with the first delivery, 44 puerparas ( 9.07% ) with IPI of less than one year and 208 puerparas ( 42.89% ) with IPI of one year and greater. There were 246 male babies ( 50.72% ) and 437 babies ( 90.10% ) with normal birth weight. A total of 148 newborns were diagnosed with neurodevelopmental abnormalities, with a detection rate of 30.52%. Of all newborns with neurodevelopmental abnormalities, there were 45 babies with communication abnormalities ( 9.28% ), 87 babies with gross motor abnormalities ( 17.94% ), 73 babies with fine motor abnormalities ( 15.05% ), 68 babies with abnormalities of solving problems ( 14.02% ) and 60 babies with personal-social abnormalities ( 12.37% ). Multivariable logistic regression analysis showed a reduced risk of infant's communication abnormalities ( OR=0.273, 95%CI: 0.090-0.833 ), gross motor abnormalities ( OR=0.340, 95%CI: 0.150-0.770 ), fine motor abnormalities ( OR=0.266, 95%CI: 0.106-0.670 ), personal-social abnormalities ( OR=0.321, 95%CI: 0.121-0.851 ) and neurodevelopmental abnormalities ( OR=0.353, 95%CI: 0.171-0.730 ) among puerparas with IPI of one year and greater as compared to those with IPI of less than one year, and no significant difference was seen in infant's neurodevelopmental abnormalities between puerparas with the first delivery and with IPI of less than one year.@*Conclusion@#IPI is associated with neurodevelopmental abnormalities among 6-month-old infants.

Research of the correlation between α1-antitrypsin and acute kidney injury after cardiopulmonary bypass / 中华胸心血管外科杂志

Objective:To figure out variety of the plasma level of Alpha-1-Antitrypsin(α1-AT) in patients who undergo AKI following cardiopulmonary bypass(CPB), and whether this biomarker serve as a competent predictor.Methods:We recruited 75 patients undergoing cardiac surgery with CPB from January 2018 to January 2019. Patients were categorized into two groups according to the development of AKI. The relationship between plasma concentration of α1-AT and renal injury in two groups was analyzed.Results:27 patients in the AKI group were aged (54.3±12.2)years old, including 15 males and 12 females, the time of cardiopulmonary bypass was(133.5±34.7)min. In the non-AKI group, 48 cases were aged(47.7±11.3)years old, including 26 males and 22 females, and the time of cardiopulmonary bypass was(133.5±34.7)min. α1-AT was significantly decreased in AKI group at 1 h after operation[(0.53±0.53)g/L vs. (1.46±0.91)g/L, P<0.05]compared with the non-AKI group. The sensitivity and specificity of α1-antitrypsin level at 1h after operation was the highest when α1-AT was 0.675 g/L. CPB time ( OR=5.890, 95% CI: 1.078-32.173) and age ( OR=4.427, 95% CI: 1.113-17.614) were independent risk factors for AKI after surgery, and α1-AT at 1h after CPB ( OR=0.084, 95% CI: 0.021-0.333) were protective factors after operation. Conclusion:Increased concentration of α1-AT after cardiopulmonary bypass at early time is a protective factor for AKI and the concentration of α1-AT in plasma could be used as an early biomarker of AKI after CPB.

Correlation between hypersomnia and anhedonia in patients with major depressive disorder / 中华行为医学与脑科学杂志

Objective:To explore the correlation between hypersomnia and anhedonia in patients with major depressive disorder.Methods:From November 2018 to May 2019, patients hospitalized with major depressive disorder who met the ICD-10 diagnostic criteria were selected.According to the Epworth Sleepiness Scale (ESS), 46 patients were divided into daytime sleepiness group with ESS ≥ 7, and 171 patients were divided into non-sleepiness group with ESS < 7.The Chinese Revised Social Anhedonia Scale (RSAS) and the Chinese Revised Physical Anhedonia Scale (RPAS) were used to evaluate the patients' anhedonia symptoms.Two-way ANOVA and Pearson correlation analysis were used for data processing.Results:(1)There was no interaction between the hypersomnia and gender on the score of physical anhedonia ( F=0.274, P=0.601). The main effect analysis showed that there was significant difference in the influence of gender on physical anhedonia ( F=10.948, P<0.05). (2)There was interaction between the hypersomnia and age on the score of physical anhedonia ( F=4.396, P=0.013). Further simple effect analysis showed that the score of physical anhedonia in 40-49 age(21.54±12.37) was lower than that in 50-64 age(34.13±12.53) in daytime sleepiness group( P<0.05). (3) There was interaction between hypersomnia and sitting and lying on the score of social anhedonia ( F=4.247, P=0.041). Further simple effect analysis showed that the score of social anhedonia in patients with sitting and lying time less than 2 hours (13.71±5.18) was lower than that in patients with sitting and lying time more than 2 hours (19.75±6.39) in daytime sleepiness group( P<0.05). (4)Pearson correlation analysis showed that the total sleepiness score of depression patients was positively correlated with the social anhedonia score ( r=0.206, P<0.01). After adjusting for gender, age and sitting and lying time, the total sleepiness score was still positively correlated with the social anhedonia score( r=0.225, P<0.01). Conclusion:Hypersomnia may be associated with anhedonia in patients with major depressive disorder.

Design, synthesis, and activity study of α-conotoxin A10LPnIA fluorescent probe / 药学学报

italic>α7 nicotinic acetylcholine receptor (nAChR) is widely distributed in the central and peripheral nervous systems, and is closely related to a variety of neurological diseases and inflammation response. α-Conotoxin [A10L]PnIA, as an antagonist targeting α7 nAChR, plays an important role in studying the physiological and pathological processes involved in α7 nAChR. [A10L]PnIA was labeled with fluorescein 5-carboxytetramethylrhodamine, and the active peptide ([A10L]PnIA-F) was obtained by a two-step oxidative folding procedure in vitro. The Xenopus oocyte expression system and the two-electrode voltage clamp technique were used to identify the potency of [A10L]PnIA-F fluorescent peptide, and its cytotoxicity was detected by mouse macrophages and CCK8 method. The molecular weight of [A10L]PnIA-F fluorescent peptide was identified by mass spectrometry as 2 077.28 Da, which was consistent with the theoretical value. Electrophysiological determination of its half-maximal inhibitory concentration (IC50) for α7 nAChR is 17.32 nmol·L-1, which is consistent with [A10L]PnIA (IC50, 13.84 nmol·L-1). The cytotoxicity test results showed that within the concentration range of 5 nmol·L-1 to 10 μmol·L-1, there was no significant inhibition on the growth of mouse macrophages. The results showed that the α-conotoxin fluorescent probe [A10L]PnIA could provide pharmacological tools for the research of α7 nAChR-related neurophysiological and pathological mechanisms.

Animal Model of Cystitis Based on Clinical Characteristics of Traditional Chinese and Western Medicine / 中国实验方剂学杂志

Cystitis， one of the most common diseases in the urinary system， is manifested by urinary frequency， urinary urgency， and bladder pain， which are known as the classic symptom triad of bladder irritation， especially in women. In recent years， with the change of the lifestyle， the prevalence of bladder diseases in China is increasing year by year. According to the characteristics of etiology， pathogenesis， and clinical symptoms of cystitis， this paper listed the clinical diagnostic criteria in traditional Chinese medicine （TCM） and western medicine after consulting the relevant literature. Through the analysis of the existing animal model of cystitis， the fit between the model and clinical manifestations was evaluated， and the advantages and disadvantages were summarized. The models induced by "intraperitoneal injection of cyclophosphamide" and "Freund's complete adjuvant combined with bladder catheterization" were proved highly matched with manifestations despite some shortcomings such as long time and high cost. At present， the diagnostic criteria of cystitis are mainly based on western medicine， and the definitive diagnosis of the relevant types still depends on cystoscopy and tissue biopsy. The lack of TCM syndrome model limits the TCM research. Additionally， four diagnostic methods in TCM cannot be well applied to animal models because of the susceptibility to subjective factors. Behavioral tests can be used to determine the model index and develop the relevant behavior rating scale. Therefore， it is necessary to establish an animal model of cystitis in line with the clinical characteristics of western medicine and TCM syndrome differentiation， so as to better promote the study of cystitis.

Mangiferin attenuates IL / 中南大学学报(医学版)

OBJECTIVES@#Chondrocyte apoptosis is an important process in the pathogenesis of osteoarthritis. Mangiferin exerts multiple pharmacological effects such as anti-inflammatory and anti-apoptosis. However, the role of mangiferin in chondrocyte apoptosis is not clear. In this study, we aimed to explore the role of mangiferin in IL-1β-induced chondrocyte apoptosis.@*METHODS@#ATDC5 cells were randomly divided into a control group, a IL-1β group, a MFN-L group, a MFN-M group, a MFN-H group and a MFN+LY294002 group. Cells in the control group were treated with IL-1β (10 ng/mL) for 24 h; cells in the MFN-L group, the MFN-M group and the MFN-H group were pretreated with 5, 10 and 20 μmol/L mangiferin for 1 h respectively, and then they were treated with IL-1β (10 ng/mL) for 24 h; cells in the MFN+LY294002 group were treated with LY294002 (25 μmol/L) for 1 h, then mangiferin (20 μmol/L) and IL-1β (10 ng/mL) for 1 h and 24 h, respectively. Cell viability was detected by CCK-8 assay and cell apoptosis was measured by flow cytometry. Colorimetric assay was conducted to measure the caspase-3 activity. The protein levels of Bcl-2, Bax, and phosphoinositide 3-kinase (PI3K)/Akt signaling pathway related proteins were detected by Western blotting.@*RESULTS@#Compared to the control group, cell viability was significantly decreased; cell apoptosis, caspase-3 activity and Bax protein expression were significantly increased; the protein levels of Bcl-2, p-PI3K, and p-Akt were significantly decreased in the IL-1β group (all @*CONCLUSIONS@#Mangiferin could attenuate IL-1β-induced apoptosis of the mice chondrocytes, which is mediated by the activation of PI3K/Akt signaling pathway.

Study of quantitative flow ratio-guided surgical coronary revascularization / 上海交通大学学报（医学版）

Objective: To analyze the feasibility, safety and preliminary clinical results of quantitative flow ratio (QFR)-guided surgical coronary revascularization. Methods: From Jan 2018 to June 2019 at the Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, patients undergoing elective cardiac surgery with any coronary stenosis ≥ 50%, evaluated by preoperative coronary angiography visualization, were enrolled consecutively. There were 82 patients with 174 coronary artery vessels. Coronary artery bypass grafting (CABG) was recommended with a QFR value ≤ 0.8. The data of baseline characteristics, surgical procedure and perioperative outcomes were collected and analyzed. Results: QFR analysis was successfully carried out in 82 patients and 174 coronary artery vessels. QFR was detected positive ( ≤ 0.8) in 53 vessels (30.5%) and negative (>0.8) in the remaining 121 vessels (69.5%). As guided with QFR, 39 patients (47.6%) with 62 vessels (35.6%) proceeded to surgery for primary heart disease with concomitant CABG as planned, while the remaining 43 patients (52.4%) with 112 vessels (64.4%) changed revascularization strategy or spared CABG. Fifteen patients with simple coronary artery disease avoided CABG and discharged. Among the remaining 67 patients operated on, there were 2 deaths, 4 hemodialysis for new renal failure, 1 perioperative myocardial infarction and 1 stroke within 30 d. No unplanned revascularization was observed. The composite adverse events occurred in 6 cases (9.0%). Conclusion: QFR-guided surgical coronary revascularization is feasible and safe. This strategy could reduce the unnecessary bypass grafting. Further follow-up and prospective clinical trials are warranted to evaluate the effectiveness.

Recommendations for general surgery clinical practice in novel coronavirus pneumonia situation / 中华外科杂志

Novel coronavirus pneumonia (NCP) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the NCP as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight NCP.

Recommendations for general surgery clinical practice in novel coronavirus pneumonia situation / 中华外科杂志

Novel coronavirus pneumonia (NCP) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the NCP as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight NCP.

Cx43 silencing inhibits mechanical stress-induced apoptosis in mouse articular chondrocyte / 中南大学学报(医学版)

To explore the effect of connexin 43 (Cx43) silence on the apoptosis in mouse chondrocyte under mechanical stress.
 Methods: Mouse chondrocyte ATDC5 cells were divided into a control group, a mechanical stress group, a Cx43 siRNA transfection group, a scramble siRNA transfection group, a mechanical stress+scramble group, and a mechanical stress+siCx43 group. Flexcell FX-5000 system was used to produce mechanical stress on ATDC5 cells cultured in vitro. The mRNA and protein level of Cx43 was detected by quantitative RT-PCR (RT-qPCR) and Western blot. The cell activity and cell apoptosis was detected by cell counting kit-8 (CCK-8) method and flow cytometry, respectively. Caspase-3 activity was detected by colorimetric assay. The protein expression of Bcl-2, Bax, p-JNK and JNK was detected by Western blot.
 Results: Mechanical stress upregulated the mRNA and protein expression of Cx43 (both P<0.05). Transfection of Cx43 siRNA significantly decreased Cx43 mRNA and protein level (both P<0.05). After stimulation with mechanical stress, chondrocyte viability was significantly decreased, whereas cell apoptosis and caspase-3 activity were increased (both P<0.05). Mechanical stress obviously upregulated Bax protein level, and downregulated Bcl-2 protein expression and Bcl-2/Bax (both P<0.05). Cx43 siRNA transfection significantly increased cell viability, inhibited cell apoptosis and caspase-3 activity (both P<0.05). Cx43 siRNA also inhibited Bax expression, and increased the Bcl-2 protein expression and Bcl-2/Bax (both P<0.05). Furthermore, Cx43 siRNA significantly suppressed the p-JNK expression induced by mechanical stress (P<0.05).
 Conclusion: Cx43 silence inhibits mechanical stress-induced apoptosis in chondrocyte, which might be mediated by JNK signaling pathway.

Association of vitamin D and parathyroid hormone levels with glucose metabolism during pregnancy / 中华内分泌代谢杂志

Objective To explore the relationship between different statuses of vitamin D and parathyroid hormone (PTH) during pregnancy with glucose metabolism and the risk of gestational diabetes mellitus (GDM). Methods A total of 4138 pregnant women who had antenatal care in 3 hospitals of Hefei from March 2015 to December 2017 were recruited during 21-24 weeks. Baseline questionnaires were performed and serum 25-hydroxyvitamin D [25(OH) D] and PTH levels were measured in fasting venous blood. Glucose tolerance tests were performed during 24 to 28 weeks. Multivariate linear regression model and multivariate logistic regression model were applied to analyze the differences of glucose metabolism index and GDM risk among pregnant women at different statusesof25(OH)DandPTH.Results Theaveragelevelof25(OH)Dinthesecondtrimesterwas(39.8±16.6) nmol/L, with the median PTH 10.7 (6.9, 16.7) ng/L and the detection rate of GDM 20.4％. Covariance analysis showed no statistically significant association of vitamin D and PTH levels with glucose metabolism indexes. Pregnant women with high PTH and vitamin D deficiency had higher 1h postprandial plasma glucose ( 1hPG) , the area under the glucose curve ( AUCglu ) levels, and GDM risk compared with pregnant women with middle/lower PTH and vitamin D deficiency ( control group, all P<0.05) , and higher PTH accompanied with vitamin D non-deficiency ( Group 2, all P<0.05) . However, significant changes in glucose metabolism indicators and GDM risk were not observed in low-level PTH-pregnant women with vitamin D deficiency ( group 1) and group 2 pregnant women compared with control group. Conclusion There is an interaction between vitamin D/PTH levels and glucose metabolism during pregnancy. Vitamin D deficiency with elevated PTH level is associated with abnormal glucose metabolism.

Clinical value of Fluorine-18-fluorodeoxyglucose PET-CT examination in intrahepatic cholangiocarcinoma staging / 中华消化外科杂志

Objective To evaluate the clinical value of Fluorine-18-fluorodeoxyglucose (18F-FDG) positron-emission temography-computed tomography (PET-CT) examination in intrahepatic cholangiocarcinoma (ICC) staging.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 190 patients with ICC who were admitted to the Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Military Medical University from September 2013 to June 2016 were collected.There were 107 males and 83 females,aged from 37 to 79 years,with an average age of 57 years.There were 90 cases without distant metastasis undergoing surgery treatment and 100 with distant metastasis undergoing non-surgical treatment.Patients underwent preoperative CT,magnetic resonance imaging (MRI),and PET-CT examination,and then received surgery or non-surgery according to preference of patients and their family members.Observation indicators:(1) imaging features on preoperative CT,MRI,PET-CT examination;(2) treatment;(3) evaluation of tumor diameter,multiple tumors,macrovascular invasion,and bile duct invasion by three examinations in ICC staging of patients undergoing operation;(4) evaluation of regional lymph node metastasis by three tests in ICC staging of patients undergoing operation;(5) evaluation of distant metastasis in ICC staging by three tests.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by single factor ANOVA and paired comparison was analyzed by SNK method.Measurement data with skewed distribution were described as M (range).Count data were described as absolute number or percentage,and comparison between groups was analyzed using the chi square test.Results (1) Imaging features on preoperative CT,MRI,PET-CT examination:all the 190 patients received routine upper abdominal CT,MRI,and systemic PET-CT examination before treatment.CT imaging of ICC showed inhomogeneous low density on plain scan,peripheral enhancement in arterial phase,persistent enhancement of tumor margin in portal phase,and sometimes mild to moderate centripetal enhancement.MRI imaging showed heterogeneous low signal on T1-weighted imaging,uneven high,and slightly high signal on T2-weighted imaging.Reinforcement on MRI is the same as CT.Transverse images,fusion transverse images and maximum intensity projection images of PET-CT imaging showed abnormal high FDG uptake around the tumor.(2) Treatment:81 out of the 90 ICC patients with surgery treatment underwent hepatectomy and lymphadenectomy,and 9 underwent only tumor tissue biopsy and lymph node biopsy due to intraoperative finding of abdominal metastasis.Of the 100 non-operated patients,30 received systemic chemotherapy,23 received local radiotherapy,and 47 gave up treatment.(3) Evaluation of tumor diameter,multiple tumors,macrovascular invasion,and bile duct invasion by three examinations in ICC staging of patients undergoing operation:the tumor diameters of ICC on CT,MRI and PET-CT were (6.8±2.8)cm,(6.9±2.9)cm,(7.2±2.8)cm,respectively.There was no significant difference among the three methods (F=0.085,P＞0.05).CT,MRI,PET-CT had similar accuracy of 80.0％ (72/90),78.9％ (71/90),72.2％ (65/90) on diagnosing multiple tumors,87.8％(79/90),92.2％ (83/90),94.4％ (85/90) for macrovascular invasion,and 93.3％ (84/90),95.6％ (86/90),96.7％ (87/90) for vascular and bile duct invasion,respectively,there was no significant difference in the above indicators between the three groups (x2 =1.801,2.662,1.131,P＞0.05).(4) Evaluation of regional lymph node metastasis by three examinations in ICC staging of patients undergoing operation:the accuracy of CT,MRI and PET-CT examination for lymph node metastasis was 62.2％ (56/90),68.9％(62/90),86.7％ (78/90) and sensitivity was 40.0％ (16/40),47.5％ (19/40),80.0％ (32/40),respectively,showing significant differences between the three groups (x2 =14.446,14.666,P＜0.05),showing a significant difference between CT and PET-CT examination (x2=14.134,13.333,P＜0.05),showing a significant difference between MRI and PET-CT examination (x2=8.229,9.141,P＜0.05).The sensitivity of CT,MRI and PET-CT examination for lymph node metastasis was 80.0％ (40/50),86.0％ (43/50),92.0％ (46/50),showing no significant difference between the three groups (x2=2.990,P＞0.05).(5) Evaluation of distant metastasis in ICC staging by three tests:there were 27,34 and 100 cases with distant metastasis evaluated by CT,MRI and PET-CT examination,including 40 with supraclavicular lymph node metastasis,32 with bone metastasis,30 with mediastinal lymph node metastasis,20 with hilar lymph node metastasis,17 with pulmonary metastasis;77 patients had more than 2 sites of metastasis.The accuracy of CT,MRI and PET-CT examination for distal metastasis in 190 ICC patients was 61.58％ (117/190),65.26％ (124/190),98.42％ (187/190),respectively,with a significant difference between the three groups (x2=83.639,P＜0.05),with a significant difference between CT and PET-CT examination (x2=80.592,P＜0.05),between MRI and PET-CT examination (x2=70.284,P＜ 0.05).Conclusion PET-CT examination makes up for the deficiency of CT and MRI in judging regional lymph node metastasis and distant metastasis,and contributes to the clinical staging of ICC.