Establishment and Evaluation of Animal Model of Acute Myocardial Infarction with Syndrome of Qi and Yin Deficiency / 中国实验方剂学杂志

ObjectiveTo explore the establishment and evaluation methods of the rat model of acute myocardial infarction （AMI） in coronary heart disease with the syndrome of Qi and Yin deficiency by sleep deprivation （SD） combined with isoproterenol （ISO） and preliminarily explore its biological basis. MethodForty SD rats were assigned into normal （no treatment）， SD （treatment in modified multi-platform water environment for 96 h）， ISO （subcutaneous injection of ISO at 100 mg·kg-1 once every other day for a total of 2 times）， and SD+ISO （injection of 100 mg·kg-1 ISO after SD for 72 h and 96 h） groups. The cardiac function was detected by small animal echocardiography. The serum levels of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， and cardiac troponin T （cTnT） were measured by biochemical methods. The pathological changes of the myocardial tissue were observed by hematoxylin-eosin staining. The general state， body weight， grip strength， body temperature， behaviors in open field test， serum levels of cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， cAMP/cGMP ratio， red （R）， green （G）， blue （B） values of the tongue surface， and pulse amplitude were observed and measured to evaluate the modeling results. Enzyme-linked immunosorbent assay was employed to determine the serum levels of interleukin-18 （IL-18）， tumor necrosis factor-α （TNF-α）， superoxide dismutase （SOD）， malondialdehyde （MDA）， corticotropin-releasing factor （CRF）， adrenocorticotropic hormone （ACTH）， triiodothyronine （T3）， tetraiodothyronine （T4）， cluster of differentiation 4 （CD4）， and cluster of differentiation 8 （CD8）. ResultIn terms of disease indicators， the ISO and SD+ISO groups had lower cardiac function indicators than the normal group （P<0.01）. The levels of CK， CM-MB， LDH and cTnT elevated in each model group compared with the normal group （P<0.01）. The pathological changes of myocardial tissue were obvious in the ISO and SD+ISO groups. In terms of syndrome indicators， compared with the normal group， the SD and SD+ISO groups showed decreased body weight at each time point （P<0.01）， and the ISO group showed decreased body weight at the time points of 48 h and 72 h （P<0.05， P<0.01）. The paw temperature and rectal temperature increased in the SD group （P<0.01）. The model groups showed weakened grasp strength， lowered R， G， and B values of the tongue surface （P<0.01）， prolonged immobility time （P<0.01）， reduced total distance and number of entering the central area （P<0.01）， decreased average speed （P<0.05， P<0.01）， and increased cAMP and cGMP （P<0.05， P<0.01）. The cAMP/cGMP ratio was increased in the SD+ISO group （P<0.01）， and the pulse amplitude was decreased in the SD and SD+ISO groups （P<0.01）. In terms of serological indicators，compared with the normal group， the levels of IL-18， TNF-α， SOD and MDA were significantly increased in the ISO and SD+ISO groups （P<0.01）， the CRF， ACTH， CORT， T3， T4， CD4 and CD8 in the model groups were increased （P<0.05， P<0.01）. ConclusionSleep deprivation for 96 h combined with high-dose ISO can successfully establish a rat model of acute myocardial infarction in coronary heart disease with the syndrome of Qi and Yin deficiency. The model evaluation system can be built with disease indicators of western medicine， histopathological indicators， macroscopic indicators of traditional Chinese medicine， and serological indicators.

Protective Effect of Zingiberis Rhizoma Recens on LPS-induced Acute Lung Injury in Mice Through TLR4/NF-κB Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo explore the protective effect and mechanism of Zingiberis Rhizoma Recens alcohol extract on lipopolysaccharide （LPS）-induced acute lung injury in mice. MethodBalb/c mice were randomly divided into normal group， model group， dexamethasone group， and low- and high-dose Zingiberis Rhizoma Recens groups. Mice in the normal group were instilled with normal saline through the nose， and the other groups were instilled with normal saline containing LPS （50 μg）. After 30 minutes of modeling， the dexamethasone group was gavaged with 5 mg·kg-1 of dexamethasone acetate solution， the low- and high-dose Zingiberis Rhizoma Recens groups were gavaged with different doses of （7， 14 g·kg-1） of Zingiberis Rhizoma Recens alcohol extract， and the normal group and the model group were gavaged with the same volume of water. After 24 hours of modeling， the total number of white blood cells in bronchoalceolar lavage fluid （BALF） was detected by cell counter， and the levels of the inflammatory factors including tumor necrosis factor （TNF）-α， interleukin （IL）-1β， IL-6， and superoxide dismutase （SOD）， and myeloperoxidase （MPO） was detected by enzyme-linked immunosorbent assay （ELISA）. Haematoxylin-eosin （HE） staining method was used to observe the pathological changes of lung tissue in each group， and the Western blot was used to detect the protein expression of nuclear transcription factor （NF）-κB p65， phosphorylation （p）-NF-κB p65， and Toll-like receptor 4 （TLR4） in lung tissue. ResultCompared with the normal group， the white blood cell count in BALF and the levels of TNF-α， IL-1β， IL-6， and MPO in the model group was increased （P<0.01）， and the level of SOD was decreased （P<0.05）. Pathological damage of lung tissue was obvious， and the protein expression of NF-κB p65， p-NF-κB p65， and TLR4 in lung tissue was increased （P<0.01）. Compared with the model group， the white blood cell count in BALF and the levels of TNF-α， IL-1β， IL-6， and MPO in the treatment group was decreased （P<0.05，P<0.01）， and the level of SOD was increased （P<0.05，P<0.01）. Pathological damage of lung tissue was alleviated， and the protein expression of NF-κB p65， p-NF-κB p65， and TLR4 in lung tissue was decreased （P<0.01）. ConclusionZingiberis Rhizoma Recens alcohol extract may play a protective role in LPS-induced acute lung injury in mice by inhibiting the TLR4/NF-κB signaling pathway.

Effects of Onodera′s prognostic nutritional index on the prognosis of locally advanced oropharyngeal squamous cell carcinoma after induction chemotherapy followed by sequential chemoradiotherapy / 中华放射医学与防护杂志

Objective:To explore the effects of Onodera′s prognostic nutritional index (PNI) on the prognosis of locally advanced oropharyngeal squamous cell carcinoma (LA-OPSCC) after induction chemotherapy followed by sequential chemoradiotherapy.Methods:A retrospective analysis was conducted on the clinical data of 52 LA-OPSCC patients receiving induction chemotherapy followed by sequential chemoradiotherapy in The Affiliated Cancer Hospital of Guizhou Medical University during 2014-2018. The PNI values of all the patients at different treatment phases were statistically analyzed, and the ROC curve was employed to determine the optimal critical value of PNI. The patients in this study were divided into a well-nourished group ( n = 27) and a poorly-nourished group ( n = 25). The Kaplan-Meier method was used for survival analysis. The Cox proportional hazards model was utilized to analyze the relationships between different nutritional status and prognosis. Clinical features and adverse reactions were compared between the two groups. Results:The PNI values decreased significantly after radiotherapy, with an optimal critical value of 42.4. The 5-year overall survival (OS) and progression-free survival (PFS) of the well-nourished group (PNI ≥ 42.4) were 62.6% and 60.9%, respectively, which were significantly higher than those (30.1% and 29.7%) of the poorly-nourished group (PNI < 42.4, χ2 = 11.12, 5.74, P < 0.05). The multivariate analysis showed that PNI was an independent prognostic factor for the OS after radiotherapy ( HR = 2.752, 95% CI: 1.095-6.917, P = 0.031). The LA-OPSCC patients aged over 60 years or those who did not respond to induction chemotherapy accounted for a higher proportion of malnutrition after chemoradiotherapy ( χ2 = 4.89, 5.05, P < 0.05). Conclusions:PNI after radiotherapy can be used as a prognostic factor in the evaluation of LA-OPSCC patients receiving induction chemotherapy followed by sequential chemoradiotherapy. The LA-OPSCC patients aged over 60 years or those who do not respond to induction chemotherapy should receive more nutritional support during the chemoradiotherapy.

Changes in HIV prevalence and intervention service utilization among MSM under sentinel monitoring in Taizhou of Zhejiang Province / 上海预防医学

ObjectiveTo analyze the changes in HIV， syphilis and hepatitis C prevalence among men who have sex with men （MSM） in Taizhou City， Zhejiang Province from 2017 to 2022， and the utilization of HIV intervention services and its influencing factors. MethodsMSM participants were recruited from HIV sentinel surveillance in Taizhou through snowball sampling method. Participants’ socio-demographic characteristics， sexual behavior characteristics， knowledge of HIV and utilization of HIV intervention services were collected and statistically described by questionnaire survey. Blood samples from MSM sentinel population were also collected for HIV， syphilis， and HCV antibody testing. Multivariate logistic regression analysis was used to analyze the influencing factors for utilizing HIV intervention services among MSM. ResultsA total of 2 499 MSM were included in the analysis from 2017 to 2022， with HIV prevalence of 5.8%， syphilis prevalence of 4.0%， and HCV prevalence of 0.6%. The infection rate， proportion of homosexual anal sex and heterosexual sex showed a decreasing trend， while the proportion of condom use during homosexual anal sex， condom publicity and distribution， AIDS consultation and testing， acceptance of peer education， and online temporary homosexual sex showed an increasing trend. All these differences were statistically significant. Multivariate logistic regression analysis showed that COVID-19 epidemic （aOR=1.66， 95%CI：1.04‒2.64） and HIV knowledge awareness （aOR=2.57， 95%CI：1.22‒5.40） were positively correlated with increased acceptance of condom publicity and distribution， and utilization of AIDS counseling and testing. Those who sought male sexual partners through offline route （aOR=3.44， 95%CI： 1.16‒10.21）， and had a history of sexually transmitted diseases within one year （aOR=5.47， 95%CI： 1.04‒28.76） were positively correlated with community-based methadone maintenance therapy， clean needle provision and exchange services， while COVID-19 epidemic （aOR=0.35， 95%CI： 0.14‒0.88） was negatively correlated with the utilization of these services. COVID-19 epidemic （aOR=2.11， 95%CI： 1.54‒2.89）， HIV knowledge awareness （aOR=2.09， 95%CI： 1.08‒4.02）， offline search for male sexual partners （aOR=1.47， 95%CI： 1.03‒2.11）， and awareness of HIV infection of sexual partners （aOR=2.09， 95%CI： 1.62‒2.69） were positively correlated with the increased use of peer education service， while married or cohabited （aOR=0.73， 95%CI： 0.55‒0.98） and VCT （aOR=0.61， 95%CI： 0.46‒0.82） were negatively correlated with utilization of peer education service. ConclusionHIV infection rate of sentinel MSM population in Taizhou decreases， while the utilization of HIV intervention services increases in general. Targeted measures should be developed according to the changes in sexual behavior and HIV intervention services among MSM populations in Taizhou to improve the HIV intervention services for the MSM population.

Clinical significance and prognostic value of fibrinogen in the treatment of locally advanced head and neck squamous cell carcinoma treated with induction chemotherapy combined with radiotherapy / 中华放射医学与防护杂志

Objective:To explore the clinical significance and prognostic value of fibrinogen (FIB) in the treatment of locally advanced head and neck squamous cell carcinoma with induction chemotherapy combined with radiotherapy.Methods:A retrospective analysis was conducted for the clinical data of 114 patients with locally advanced head and neck squamous cell carcinoma receiving non-surgical treatment in the Department of Head and Neck Oncology, the Affiliated Cancer Hospital of Guizhou Medical University from May 2011 to May 2021. The FIB critical value was determined based on the median FIB level before induction chemotherapy, by which patients were divided into high-FIB and low-FIB groups. The ROC curves were used to determine the optimal cut-off value for other hematologic-related parameters such as neutrophils, lymphocytes, and platelets. Statistical methods were used to analyze the results. The enumeration data were analyzed by Chi-square test or Fisher exact probability method. Survival curves for OS and PFS were plotted by Kalplan-Meier method and tested by Log-rank method. Prognostic factors were evaluated by Cox proportional hazard regression model.Results:There were 59 cases in the high-FIB group (FIB > 3.6 g/L) and 55 cases in the low-FIB group (FIB ≤ 3.6 g/L). The high FIB group had higher neutrophils, platelets, NLR, and PLR ( χ2= 7.84, 12.80, 15.04, 9.14; P<0.05) than the low FIB group. The 3- and 5-year overall survival (OS) rates were significantly longer in the low FIB group than those in the high-FIB group (62.9% vs. 39.6%; 46.9% vs. 25.8%), and progression-free survival (PFS) rates of the low FIB group significantly longer than those of the high-FIB group (63.3% vs. 40.3%; 48.1% vs. 26.2%). The univariate analysis showed that the OS and PFS in patients with locally advanced head and neck squamous cell carcinoma were related to FIB, the application of concurrent chemoradiotherapy, and the efficacy of radiotherapy for lymph nodes. The multivariate analysis showed that FIB, the application of concurrent chemoradiotherapy, and the efficacy of radiotherapy for lymph nodes were independent prognostic factors of the OS [ HR (95% CI): 1.89 (1.08-3.31), 3.76 (1.12-12.65), 2.14 (1.09-4.21), P < 0.05]and PFS HR (95% CI): 1.92 (1.90-3.36), 3.93 (1.01-11.34), 2.15 (1.09-4.22), P < 0.05]of patients with locally advanced head and neck squamous cell carcinoma. Conclusions:Patients with low FIB receive high OS and PFS rates after induction chemotherapy combined with radiotherapy. Therefore, FIB can be used as a prognostic factor in the evaluation of non-surgical treatment of patients with locally advanced head and neck squamous cell carcinoma.

Analysis on mortality and premature death rates of four major chronic diseases in Taizhou， Zhejiang 2011‒2018 / 上海预防医学

ObjectiveTo analyze the characteristics of death and premature death of 4 major chronic diseases （cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes） in Taizhou City from 2011 to 2018，and provide data basis for the government to formulate chronic disease prevention planning. MethodsThe death data of household registration residents in Taizhou City from 2011 to 2018 were derived from the Chronic Disease Surveillance Information Management System in Zhejiang Province. The death toll ratio of chronic diseases， the mortality rate of chronic diseases， the probability of premature death of chronic diseases were analyzed. The standardization rate was calculated six times in 2010. Population composition of the census. The Joinpoint Regression Program 4.2 software was used for calculating annual percent change （APC） and its statistical test results. ResultsFrom 2011 to 2018， there were 231 724 chronic disease deaths in Taizhou City， with a mortality rate of 486.52/105 and a standardized mortality rate of 381.55/105. The proportion of chronic disease deaths to total deaths was 79.89%， of which males were higher than females and rural areas were higher than urban areas.From 2011 to 2018， the standardized mortality and early death probability of cardiovascular and cerebrovascular diseases， malignant tumors and chronic respiratory diseases in Taizhou showed a downward trend （P<0.05）， the standardized mortality of diabetes （P=0.46） and the early death probability （P=0.22） did not decline， and the mortality of all age groups of the above four types of chronic diseases in rural areas was higher than that in urban areas. The mortality of the four types of chronic diseases from high to low are cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes， and the mortality tends to increase with age. From 2011 to 2018， the probability of premature death from four types of chronic diseases in Taizhou City showed a downward trend， from 13.49% in 2011 to 10.49% in 2018， with an average annual decrease of 2.97%. The difference was statistically significant （t=‒5.83，P<0.05）. ConclusionChronic disease death is the main cause of death in Taizhou City. In order to reduce the mortality rate of chronic diseases， effective prevention and control measures for chronic diseases should be carried out， especially the prevention and control of diabetes and male chronic diseases.

Effect of Jiangtang Xiaozhi Tablet on Liver Circadian Clock-related Genes CLOCK， BMAL1， REV-ERBα， and REV-ERBβ in Mice with Metabolic Dysfunction-associated Fatty Liver Disease / 中国实验方剂学杂志

ObjectiveTo explore the effect of Jiangtang Xiaozhi tablet （JTXZT） on metabolic dysfunction-associated fatty liver disease and to study the mechanism from the perspective of circadian clock-related genes such as circadian locomotor output cycles kaput （CLOCK）， brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein 1 （BMAL1）， reverse-eritroblastosis receptor （REV-ERB）α and β. MethodA total of 50 male SPF C57BL/6J mice were randomized into normal group （n=10） and modeling group （n=40）. The normal group was fed with normal diet， and the modeling group with high-fat diet for 4 weeks. Then the model mice were randomly classified into model group， high-dose （12.5 g·kg-1） and low-dose （6.25 g·kg-1） Jiangtang Xiaozhi tablet groups， and orlistat group （70 mg·kg-1）， with 10 mice in each group. The normal group and model group received equivalent volume of distilled water （8 weeks）. Then， the body weight of mice was measured， and the content of serum triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， aspartate aminotransferase （AST）， and alanine aminotransferase （ALT） was determined with biochemical method. Serum content of free fatty acid （FFA） and leptin was detected by enzyme-linked immunosorbent assay （ELISA）. Pathological changes of liver tissue and epididymal adipose tissue were observed based on hematoxylin-eosin （HE） staining. Liver fibrosis was examined based on Masson's trichrome staining， and changes of lipids based on oil red O staining. The expression of CLOCK， BMAL1， REV-ERBα， and REV-ERBβ was detected by Western blot and immunohistochemistry assay. ResultCompared with the normal group， the model group had high content of TG， TC， LDL-C， HDL-C， AST， ALT， FFA， and leptin （P<0.05， P<0.01）， showed ballooning degeneration and focal microvesicular steatosis of liver cells， enlarged adipocytes， and inflammatory cell clusters and fibrous tissue hyperplasia， and displayed increased protein expression of sterol regulatory element binding protein （SREBP） 1 and peroxisome proliferators-activated receptor （PPAR）γ （P<0.01） and decreased protein expression of PPARα （P<0.05）， CLOCK， BMAL1， REV-ERBα and β （P<0.05， P<0.01）. Compared with the model group， JTXZT-H group down-regulated the content of TG， TC， LDL-C， HDL-C， AST， ALT， FFA， and leptin in mice （P<0.05， P<0.01）， and the JTXZT groups demonstrated reduction in the degree and range of ballooning degeneration of liver tissue， alleviation of the compression of hepatic sinusoidal tissue， unobvious inflammatory cell infiltration and fibrous tissue proliferation， reduction in the expression of SREBP1 and PPARγ （P<0.05， P<0.01）， and rise of the protein expression of PPARα （P<0.01）， CLOCK， BMAL1， REV-ERBα， and REV-ERBβ （P<0.05， P<0.01）. ConclusionJTXZT can significantly alleviate the metabolic dysfunction-associated fatty liver disease in mice caused by high-fat diet. The mechanism is the likelihood that it regulates downstream related lipid metabolism proteins （such as SREBP1， PPARγ， and PPARα）.

Effect of Jiangtang Xiaozhi Tablet on Liver Circadian Clock-related Genes CLOCK， BMAL1， REV-ERBα， and REV-ERBβ in Mice with Metabolic Dysfunction-associated Fatty Liver Disease / 中国实验方剂学杂志

ObjectiveTo explore the effect of Jiangtang Xiaozhi tablet （JTXZT） on metabolic dysfunction-associated fatty liver disease and to study the mechanism from the perspective of circadian clock-related genes such as circadian locomotor output cycles kaput （CLOCK）， brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein 1 （BMAL1）， reverse-eritroblastosis receptor （REV-ERB）α and β. MethodA total of 50 male SPF C57BL/6J mice were randomized into normal group （n=10） and modeling group （n=40）. The normal group was fed with normal diet， and the modeling group with high-fat diet for 4 weeks. Then the model mice were randomly classified into model group， high-dose （12.5 g·kg-1） and low-dose （6.25 g·kg-1） Jiangtang Xiaozhi tablet groups， and orlistat group （70 mg·kg-1）， with 10 mice in each group. The normal group and model group received equivalent volume of distilled water （8 weeks）. Then， the body weight of mice was measured， and the content of serum triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， aspartate aminotransferase （AST）， and alanine aminotransferase （ALT） was determined with biochemical method. Serum content of free fatty acid （FFA） and leptin was detected by enzyme-linked immunosorbent assay （ELISA）. Pathological changes of liver tissue and epididymal adipose tissue were observed based on hematoxylin-eosin （HE） staining. Liver fibrosis was examined based on Masson's trichrome staining， and changes of lipids based on oil red O staining. The expression of CLOCK， BMAL1， REV-ERBα， and REV-ERBβ was detected by Western blot and immunohistochemistry assay. ResultCompared with the normal group， the model group had high content of TG， TC， LDL-C， HDL-C， AST， ALT， FFA， and leptin （P<0.05， P<0.01）， showed ballooning degeneration and focal microvesicular steatosis of liver cells， enlarged adipocytes， and inflammatory cell clusters and fibrous tissue hyperplasia， and displayed increased protein expression of sterol regulatory element binding protein （SREBP） 1 and peroxisome proliferators-activated receptor （PPAR）γ （P<0.01） and decreased protein expression of PPARα （P<0.05）， CLOCK， BMAL1， REV-ERBα and β （P<0.05， P<0.01）. Compared with the model group， JTXZT-H group down-regulated the content of TG， TC， LDL-C， HDL-C， AST， ALT， FFA， and leptin in mice （P<0.05， P<0.01）， and the JTXZT groups demonstrated reduction in the degree and range of ballooning degeneration of liver tissue， alleviation of the compression of hepatic sinusoidal tissue， unobvious inflammatory cell infiltration and fibrous tissue proliferation， reduction in the expression of SREBP1 and PPARγ （P<0.05， P<0.01）， and rise of the protein expression of PPARα （P<0.01）， CLOCK， BMAL1， REV-ERBα， and REV-ERBβ （P<0.05， P<0.01）. ConclusionJTXZT can significantly alleviate the metabolic dysfunction-associated fatty liver disease in mice caused by high-fat diet. The mechanism is the likelihood that it regulates downstream related lipid metabolism proteins （such as SREBP1， PPARγ， and PPARα）.

Prevalence of hepatitis C virus and risk factors among drug users in Taizhou City of Zhejiang Province， 2009‒2020 / 上海预防医学

ObjectiveTo determine the prevalence of hepatitis C virus （HCV） infection and identify the underlying risk factors among drug users in Taizhou City of Zhejiang Province during 2009‒2020. MethodsA consecutive cross-sectional survey was conducted. A total of 400 drug users in correctional settings were randomly selected from April to August. The drug users were interviewed with a questionnaire to collect demographic characteristics， AIDS-related knowledge， detoxification service， drug use， and sexual behavior. Blood samples were then collected for anti-HCV antibody testing. Chi-square test and multivariate conditional logistic regression were used. ResultsA total of 5 042 drug users were included in this study. Seroprevalence of HCV was determined to be 22.7%. From 2009 to 2019， the seroprevalence showed a significant downward trend， from 34.9% to 8.8% （χ2=221.025， P<0.001）. However， in 2020， the seroprevalence was 12.7%. The multivariate logistic regression analysis showed that senior age （≥25 years old）， cohabitation， taking traditional or mixed drugs， injection drug use， and needle sharing were risk factors associated with HCV seroprevalence. ConclusionSince 2009， HCV seroprevalence among drug users in Taizhou City has shown a downward trend， however， it has increased slightly in 2020. It warrants strengthening prevention and treatment measures in response to risk factors related to HCV infection among drug users.

lncRNA in hepatic glucose and lipid metabolism: a review / 生物工程学报

In recent years, long non-coding RNA (lncRNA) has been proved to be involved in the regulation of biological processes at various levels, attracting research interests in life science. LncRNA possesses the unique capability and exert discrete effects on transcription, translation and post-translational modification of the target genes through interacting with DNA, RNA and protein. Current studies have revealed that lncRNA plays an important role in hepatic metabolism via diverse pathways. This review focuses on the function of lncRNA and its relationship with hepatic energy metabolism and the correlated diseases, to elucidate the underlying mechanisms and prospects of lncRNA researches.

Effect and safety of fourth arm robot assisted partial nephrectomy via retroperitoneal approach / 中华泌尿外科杂志

Objective:To investigate the effect and safety of using the fourth arm in robot assisted partial nephrectomy via retroperitoneal approach.Methods:The clinical data of 480 patients with newly diagnosed renal tumors treated in the First Affiliated Hospital of Medical College of Zhejiang University from January 2016 to December 2018 were analyzed retrospectively. All patients underwent robot assisted partial nephrectomy with the fourth arm and were divided into two groups according to the surgical approaches. There were 312 cases in the retroperitoneal group, 198 males and 114 females, aged 18-82 years, with an average of 54.0 years. The tumors were located in the right kidney in 152 cases (48.7%), left kidney in 155 cases(49.7%), double kidney in 5 cases (1.6%), with tumor size of (3.5±2.7) cm, R.E.N.A.L. score of 4-5 in 105 cases (33.7%), 6-8 in 143 cases(45.8%), and 9-12 in 64 cases (20.5%). There were 168 cases in the transperitoneal group, 105 males and 63 females, the age ranged from 21 to 79 years, with an average of 53.2 years. The tumors were located in the right kidney in 85 cases (50.6%), left kidney in 78 cases (46.4%), double kidney in 3 cases (1.8%), with tumor size of (3.8±2.9) cm, R.E.N.A.L. score of 4-5 in 52 cases (31.0%), 6-8 in 81 cases (48.2%), and 9-12 in 35 cases (20.8%). In the retroperitoneal group, the patients were placed in the 90 ° lateral position on the healthy side, the lens hole cannula was placed 2-3 cm above the iliac crest, and one operation hole cannula was placed 8 cm away from the lens hole cannula on the ventral and dorsal sides respectively. The included angle between the two operation holes and the lens hole was 150°-180°. The fourth arm operation hole was established 8 cm away from the ventral operation hole, and the included angle between the connecting line and the horizontal line is ≤15°. The fourth arm operating hole was placed with ProGrasp forceps, which can be used to push away fat, peritoneum, traction and lift kidney, etc., so as to obtain satisfactory operating space and position. The perioperative conditions and surgical complications of the two groups were compared.Results:The operations were successfully completed in both groups, and there was no conversion to open surgery. The installation time of retroperitoneal group and transperitoneal group were (12.3±5.3)min and (7.8±3.8)min respectively, the console time was (70.5±17.1)min and (89.4±23.9)min respectively, the warm ischemia time was (17.3±8.2)min and (19.2±9.1)min respectively, the intraoperative bleeding volume was (115.2±47.3)ml and (125.8±52.1)ml respectively, and the intestinal recovery time was (1.5±1.8)d and (2.7±2.4)d respectively.The postoperative hospital stay was(6.3±1.8)d and (7.4±2.8)d, respectively ( P<0.05). The positive rates of incision margin in retroperitoneal group and transperitoneal group were 0(0 cases) and 0.6% (1 case). The time of indwelling drainage tube was (4.6±2.5)d and (4.9±2.8)d, respectively, and there was no significant difference ( P>0.05). The incidence of postoperative complications in the retroperitoneal group was lower than that in the transperitoneal group (67 cases, 21.5% vs. 51 cases, 30.3%, P=0.031). There was significant difference in the incidence of Clavien grade Ⅰ-Ⅱ complications (62 cases, 19.8% vs. 48 cases, 28.6%, P=0.030). There was no significant difference in the incidence of Clavien grade Ⅲ-Ⅳ complications (5 cases, 1.6% vs. 3 cases, 1.9%, P>0.05). Conclusions:Compared with the transperitoneal approach, the retroperitoneal approach with the fourth arm robot assisted partial nephrectomy is safe and effective, with shorter operation time, warm ischemia time, postoperative recovery time and fewer complications.

Analysis of follow-up results of chrono-chemotherapy or conventional chemotherapy combined with intensity modulated radiotherapy in locally advanced nasopharyngeal carcinoma / 中华肿瘤杂志

Objective@#To evaluate the long-term effect and safety of chrono-chemotherapy combined with intensity modulated radiotherapy (IMRT) in locally advanced nasopharyngeal carcinoma (NPC).@*Methods@#160 patients with locally advanced NPC were randomly divided into a chrono group and conventional group according to random number table. In the first stage, all patients underwent two cycles of induced chemotherapy, consisting of docetaxel, cisplatin and 5-Fu every 21 days. Notably, patients received chrono-moduated chemotherapy according to circadian rhythm in the chrono group, and conventional chemotherapy in the conventional group. Then, 21 days after the completion of first stage, three cycles of concurrent cisplatin chemotherapy every 21 days were given to all patients during IMRT. The median follow-up after the completion of radiotherapy was 31 months. Long-term side effects and the survival of patients were observed.@*Results@#Patients in the chrono group had significantly lower rates of hearing loss (22.72%), dysphagia (0) and neck fibrosis (4.54%) compared with those in the conventional group (39.13%、8.69%, 15.94%, respectively, all P<0.05). Meanwhile, the 1- year overall survival rates (97.0% vs 92.8%), 3-year overall survival rates (80.3% vs 81.2%), 1-year progression free survival rates (95.5% vs 87.0%), 3-year progression free survival rates (71.2% vs 73.9%), 1-year locoregional relapse-free survival rates (97.0% vs 95.7%), 1-year locoregional relapse-free survival rates (92.4% vs 92.8%), 1-year distant metastasis-free survival rates (97.0% vs 98.6%) and 3-year distant metastasis-free survival rates (90.9% vs 91.3%) between the chrono group and the conventional group were not statistically significant (all P>0.05).@*Conclusions@#Compared with conventional chemotherapy, chrono-chemotherapy combined with IMRT didn′t affect long-term survival, but reducing the incidence of adverse events in patients with locally advanced NPC.

Homoharringtonine is a safe and effective substitute for anthracyclines in children younger than 2 years old with acute myeloid leukemia / 医学前沿

Homoharringtonine (HHT), a plant alkaloid from Cephalotaxus harringtonia, exhibits a unique anticancer mechanism and has been widely used in China to treat patients with acute myeloid leukemia (AML) since the 1970s. Trial SCMC-AML-2009 presented herein was a randomized clinical study designed based on our previous findings that pediatric AML patients younger than two years old may benefit from HHT-containing chemotherapy regimens. Patients randomized to arm A were treated with a standard chemotherapy regimen comprising mainly of anthracyclines and cytarabine (Ara-C), whereas patients in arm B were treated with HHT-containing regimens in which anthracyclines in all but the initial induction therapy were replaced by HHT. From February 2009 to November 2015, 59 patients less than 2 years old with de novo AML (other than acute promyelocytic leukemia) were recruited. A total of 42 patients achieved a morphologic complete remission (CR) after the first course, with similar rates in both arms (70.6% vs.72.0%). At the end of the follow-up period, 40 patients remained in CR and 5 patients underwent hematopoietic stem cell transplantation in CR, which could not be considered as events but censors. The 5-year event-free survival (EFS) was 60.2%±9.6% for arm A and 88.0%±6.5% for arm B (P= 0.024). Patients in arm B experienced shorter durations of leukopenia, neutropenia, and thrombocytopenia and had a lower risk of infection during consolidation chemotherapy with high-dosage Ara-C. Consequently, the homoharringtonine-based regimen achieved excellent EFS and alleviated hematologic toxicity for children aged younger than 2 years with de novo AML compared with the anthracycline-based regimen.

Association between mitochondrial haplogroups and neurocognitive disorder in HIV positive individuals / 中华流行病学杂志

Objective@#To investigate the distribution of mitochondrial haplogroups and their correlation with neurocognitive disorder (NCD) in HIV positive individuals.@*Methods@#Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. A cross-sectional survey was performed in 448 HIV positive individuals. Sanger method was used for the sequencing and genotyping of whole mitochondrial genome of HIV positive individuals. NCD prevalence in the HIV positive individuals was assessed by Mini-mental State Examination (MMSE) in questionnaire interviews. Multivariable logistic regression analysis was performed to assess the associations between mtDNA haplogroups and NCD.@*Results@#In this sample, mitochondrial haplogroups D (19.6%, 88/448), B (19.4%, 87/448) and F(17.0%, 76/448) were the most predominant haplogroups. The overall prevalence rate of NCD was 20.3% (91/448), and was high in haplogroups A (23.1%, 9/39), D (21.6%, 19/88), F (26.3%, 20/76) and M7 groups (26.1%, 12/46), respectively. In multivariable logistic regression analysis after adjusting confounding factors, such as age and gender, compared with haplogroup A, there were no differences in the prevalence rate of NCD among HIV positive individuals with haplogroup B, D, F, M7, M8, N9, and others.@*Conclusion@#The study explored primarily correlation between mitochondrial haplogroups and NCD among HIV positive individuals and suggested that there is no significant association between mitochondrial haplogroups and NCD, but further longitudinal investigation with large sample size of HIV positive population is needed to confirm this finding.

Characteristics of sleep disorder in HIV positive and HIV negative individuals: a cluster analysis / 中华流行病学杂志

Objective@#To understand the characteristics of sleep disorder in HIV positive and negative individuals, and compare the distributions and epidemiologic characteristic of different subtypes of sleep disorder between two groups.@*Methods@#Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. A total of 459 HIV positive patients and 798 HIV negative controls with sleep disorders (Pittsburg Sleep Quality Index >5 or at least one question with answers of "most nights" or "every night" for Jenkins Sleep Scale) were included in the analysis. Cluster analysis was conducted to identify the different subtypes of sleep disorder based on 15 sleep-related questions.@*Results@#A total of 1 257 participants were divided into three groups (clusters), i.e. difficulty falling asleep and sleep keeping group (cluster 1), the mild symptoms group (cluster 2), and restless night and daytime dysfunction group (cluster 3), accounting for 19.4% (89/459), 63.8% (293/459) and 16.8% (77/459) in HIV positive group and 13.8% (110/798), 60.5% (483/798) and 25.7% (205/798) in HIV negative group (χ2=16.62, P<0.001). In HIV positive group, the patients in cluster 1 and 3 were older and had higher frailty score, the patients in cluster 1 had highest level of depression, and the more patients in cluster 3 had low body weight or overweight (χ2=13.29, P=0.039; χ2=23.33, P<0.001; χ2=25.71, P<0.001; χ2=15.37, P=0.004). In HIV-negative group, similar findings were found for age, depressive symptoms and frailty score. In addition, the proportion of those who were illiteracy or with primary school education level was significantly high in cluster 1, and the proportion of abnormal waist-to-hip ratio was significantly higher in cluster 1 and 3 (χ2=30.59, P<0.001; χ2=11.61, P=0.003).@*Conclusions@#The proportion of every subtype of sleep disorder in HIV positive individuals were different to those in HIV negative individuals. Mental and physical health status were the main factors affecting the prevalence of sleep disorder. It is necessary to conduct targeted interventions to improve sleep quality.

Prevalence of alcohol use and related factors in HIV positive and HIV negative males / 中华流行病学杂志

Objective@#To understand the prevalence of alcohol use and related factors in HIV positive and HIV negative males.@*Methods@#Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. The information about alcohol use in the last month was collected through a face-to-face questionnaire interview. Participants were categorized into non-current drinkers, light/moderate drinkers and heavy drinkers according to the US National Institute on Alcoholism and Alcohol Abuse (NIAAA) standard.@*Results@#A total of 1 367 HIV positive males and 2 418 HIV negative males were included. Current alcohol use rate (35.2%, 481/1 367) and heavy alcohol use rate (5.0%, 24/481) were significantly lower in HIV positive males than in HIV negative males (48.0%, 1 161/2 418; 23.5%, 273/1 161), but the proportion of drinking wine and yellow rice wine were significantly higher (21.8%, 105/481; 9.1%, 44/481) in HIV positive males than in HIV negative males (13.5%, 157/1 161; 5.8%, 67/1 161). The multivariate multinomial logistic regression analysis results showed that larger waist circumference, current smoking and regular physical exercise were associated with heavy alcohol use behavior in HIV positive males, and age ≥30 years, current smoking, regular physical exercise, higher score of depressive symptoms, heterosexual transmission route and baseline CD4+T cells counts of 200-499 cells/μl were significantly associated with mild/moderate alcohol use behavior in HIV positive males.@*Conclusions@#The alcohol use rate was significantly lower in HIV positive males than in HIV negative males in Taizhou. It is important to strengthen intervention on alcohol drinking behavior and chronic disease risk factors, such as larger waist circumference, smoking and so on.

Short-term efficacy and adverse events of intensity-modulated radiotherapy combined with chronomodulated chemotherapy for locally advanced nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective@#To compare the adverse events, immune status, and short-term efficacy between chronomodulated chemotherapy (CCR) and routine chemotherapy (RCR) combined with intensity modulated radiotherapy (IMRT)in the treatment of patients with locally advanced nasopharyngeal carcinoma.@*Methods@#A total of 159 patients with newly diagnosed locally advanced nasopharyngeal carcinoma were randomized into the CCR group and the RCR group to evaluate the short-term efficacy and adverse events.@*Results@#No significant difference was found in CR, PR, SD, and PD between the CCR group and the RCR group (P>0.05), and no significant difference was observed in the response rate (CR+ PR) between the two groups (P>0.05). The incidence of leukopenia(Z=-2.222, P<0.05), neutropenia(Z=-1.999, P<0.05), vomiting(Z=-2.298, P<0.05), and oral mucositis(Z=-3.571, P<0.05)of the CCR group was lower than those of the RCR group with statistical significance. The CD16+ 56+ lymphocyte cell count was higher in the CCR group than that in the RCR group(Z=-2.332, P<0.05).@*Conclusions@#As a novel invention, CCR combined with IMRT can reduce the incidence and severity of treatment-related adverse events and improve immune status without diminishing clinical efficacy, therefore deserving clinical application.

Efficacy of ultrasound-guided modified anterior approach to sciatic nerve block for orthopedic sur-gery with general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided modified anterior approach to sciatic nerve block ( SNB) for orthopedic surgery with general anesthesia. Methods Ninety American So-ciety of Anesthesiology physical status Ⅰ or Ⅱpatients of both sexes, aged 18-64 yr, weighing 19-28 kg∕m2 , scheduled for elective knee joint or distal orthopedic surgery, were divided into 3 groups ( n=30 each) using a random number table method: modified anterior approach ( the puncture needle was almost perpendicular to the ultrasound beam) group, anterior approach group and posterior approach group. SNB ( injecting 0. 5％ ropivacaine 20 ml) combined with femoral nerve block ( injecting 0. 5％ ropivacaine 15-20 ml) was performed under ultrasound guidance. Surgery was completed under combination of the laryngeal mask and combined intravenous-inhalational anesthesia. When the respiratory rate ≥20 beats∕min and∕or the increase in heart rate was more than 20％ of the baseline value, sufentanil 1μg∕time was intravenously injected. When visual analog scale ( VAS) score ≥4 within 24 h after surgery, celecoxib capsules 0. 2 g was taken orally for analgesia. The depth of sciatic nerve, needling depth, sharpness score of needle ima-ging under ultrasound, and operation time and duration of SNB were recorded. VAS scores at rest and dur-ing activity were recorded at 6, 8, 10, 12 and 24 h after surgery. The amount of sufentanil consumed dur-ing surgery and use of celecoxib capsules within 24 h after surgery were recorded. The development of ad-verse reactions such as hematoma at the puncture site, nausea and vomiting was also recorded after surgery. Results Compared with posterior approach group, the depth of sciatic nerve and needling depth were sig-nificantly increased, the operation time of SNB was prolonged, the duration of SNB was shortened, the in-traoperative consumption of sufentanil was increased, VAS scores at rest and during activity were increased at 10 h after surgery, and the sharpness score of needle imaging was increased in modified anterior approach and anterior approach groups (P<0. 05). Compared with anterior approach group, the sharpness score of needle imaging was significantly increased, and VAS scores during activity were decreased at 24 h after sur-gery in modified anterior approach group ( P<0. 05) . There was no significant difference in the requirement for celecoxib capsules within 24 h after surgery or occurrence of adverse reactions among the three groups ( P>0. 05) . Conclusion Although ultrasound-guided modified anterior approach to SNB provides compara-ble efficacy with anterior approach to SNB and is not as good as posterior approach to SNB when used for or-thopedic surgery with general anesthesia, modified anterior approach to SNB is easy to operate, with clear images under ultrasound.

Dose-Response Relationship between Alanine Aminotransferase Levels within the Reference Interval and Metabolic Syndrome in Chinese Adults

PURPOSE: Elevation in serum alanine aminotransferase (ALT) levels is a biomarker for metabolic syndrome (MS); however, the relationship has not been fully investigated within the reference interval of ALT levels. Our objective was to explore the relationship between serum ALT levels within the reference interval and MS in Chinese adults. MATERIALS AND METHODS: This cross-sectional study included 16028 adults, who attended routine health check-ups at Shengli Oilfield Central Hospital from January 2006 to March 2012. The reference interval of serum ALT level was defined as less than 40 U/L. Logistic regression models and restricted cubic spline were used to evaluate the association of ALT with MS. RESULTS: The prevalence of MS in the total population was 13.7% (6.4% for females and 18.4% for males). Multiple logistic regression showed that ALT levels were positively associated with MS after adjustment for potential confounding factors. The odds ratio of MS in the top quartile was 4.830 [95% confidence interval (CI): 2.980–7.829] in females and 3.168 (95% CI: 2.649–3.790) in males, compared with the ALT levels in the bottom quartile. The restricted cubic spline models revealed a positive non-linear dose-response relationship between ALT levels and the risk of MS in women (p for nonlinearity was 0.0327), but a positive linear dose-response relationship in men (p for nonlinearity was 0.0659). CONCLUSION: Serum ALT levels within the reference interval are positively associated with MS in a dose-response manner. Elevated ALT levels, even within the reference interval, may reflect early dysmetabolic changes.

A clinical study of perfusion weighted magnetic resonance imaging in recombinant human endostatin combined with chemotherapy and radiotherapy for locally advanced nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective To assess the antiangiogenic role of recombinant human endostatin combined with chemoradiotherapy and the capacity,and to explore the early tumor response as measured by comparing the change of MRI perfusion parameter.Methods From May 2012 to March 2013,22 locally advanced nasopharyngeal carcinoma patients who received recombinant human endostatin combined with chemoradiotherapy following induction chemotherapy,were included in the prospective study group.The other 25 patients,who received chemoradiotherapy following induction chemotherapy alone in the same period,were included in the control group.The perfusion parameters including blood volume(BV),blood flux(BF),mean transit time (MTT) were obtained by carrying out MR perfusion scanning at 3 time points:before induction chemotherapy,after induction chemotherapy,the end of concurrent chemoradiotherapy.Results Compared with before induction chemotherapy,the perfusion parameters including BV and BF obviously decreased in the study group (F =3.05,3.85,P ＜ 0.05).The parameter of MTT had no obviously change in the study group(P ＞0.05).In the control group,the change of BV,BF and MTT of nasopharyngeal lesions area during the treatment showed no significant difference (P ＞ 0.05).To make comparison between the two groups,at the end of concurrent chemoradiotherapy,BF of nasopharyngeal lesions area in the study group was 0.72 ± 0.56 and 1.92 ± 1.26 in the control group,the former showing significantly declined results (t =-3.056,P =0.012).Conclusions Recombinant human endostatin might be a good indicator of local tumor microvascular changes and the treatment-related toxicity could be tolerated.Magnetic resonance perfusion imaging maybe assessed the capacity of anti-angiogenesis therapy to induce early tumor response.Clinical trial registration Chinese clinical trial registry,ChiCRTONRC-12002394.