Traditional Chinese Medicine Intervention in Membranous Nephropathy Based on Podocyte Injury： A Review / 中国实验方剂学杂志

Membranous nephropathy， an autoimmune kidney disease with glomerular podocyte injury as the core mechanism， is a common pathological type of adult nephrotic syndrome and has become the main cause of end-stage renal disease in China. Podocytes are terminally differentiated cells that play an important role in maintaining the structural and functional stability of glomeruli and are molecular barriers for protein filtration. Glomerular filtration membrane injury induced by podocyte injury is an important cause of massive proteinuria. Persistent or aggravated proteinuria may prolong the course of membranous nephropathy. It is believed that podocyte destruction in membranous nephropathy is mainly related to oxidative stress， autophagy dysregulation， abnormal expression of podocyte marker proteins， chronic inflammation， epithelial-mesenchymal cell transdifferentiation， and so on. At present， western medicine mostly uses immunosuppressants and hormones for treatment according to its pathological stage， but there are certain adverse reactions. Traditional Chinese medicine （TCM） has made some achievements in the prevention and treatment of membranous nephropathy. In recent years， studies have found that many Chinese medicines can affect the occurrence and development of membranous nephropathy in different links by acting on multiple targets in the human body， with manifest advantages. This paper overviewed the podocyte injury mechanism in membranous nephropathy and summarized the treatment of membranous nephropathy with Chinese medicine monomers， compounds， and Chinese patent medicines in intervening related target pathways， aiming to provide a basis for the clinical treatment， basic research， and targeted drug development of TCM against membranous nephropathy.

Evaluation of Renal Impairment in Patients with Diabetic Kidney Disease by Integrated Chinese and Western Medicine / 中国结合医学杂志

OBJECTIVE@#To investigate the factors related to renal impairment in patients with diabetic kidney disease (DKD) from the perspective of integrated Chinese and Western medicine.@*METHODS@#Totally 492 patients with DKD in 8 Chinese hospitals from October 2017 to July 2019 were included. According to Kidney Disease Improving Global Outcomes (KDIGO) staging guidelines, patients were divided into a chronic kidney disease (CKD) 1-3 group and a CKD 4-5 group. Clinical data were collected, and logistic regression was used to analyze the factors related to different CKD stages in DKD patients.@*RESULTS@#Demographically, male was a factor related to increased CKD staging in patients with DKD (OR=3.100, P=0.002). In clinical characteristics, course of diabetes >60 months (OR=3.562, P=0.010), anemia (OR=4.176, P<0.001), hyperuricemia (OR=3.352, P<0.001), massive albuminuria (OR=4.058, P=0.002), atherosclerosis (OR=2.153, P=0.007) and blood deficiency syndrome (OR=1.945, P=0.020) were factors related to increased CKD staging in patients with DKD.@*CONCLUSIONS@#Male, course of diabetes >60 months, anemia, hyperuricemia, massive proteinuria, atherosclerosis, and blood deficiency syndrome might indicate more severe degree of renal function damage in patients with DKD. (Registration No. NCT03865914).

Research status on efficacy enhancement and toxicity reduction of Chinese medicine in treatment of malignant tumors: a review of projects supported by National Natural Science Foundation of China / 中国中药杂志

Through a retrospective analysis of the projects supported by the National Natural Science Foundation of China in the past ten years in the field of Chinese medicine for the treatment of malignant tumors, this article systematically summarized the main research contents and hotspots of Chinese medicine in efficacy enhancement and toxicity reduction. The efficacy enhancement of Chinese medicine mainly included the mitigation of molecule-targeted drug resistance, multidrug resistance, and chemotherapy resistance, synergistic efficacy enhancement, and radiotherapy sensitization. The toxicity reduction is mainly reflected in the alleviation of the side effects of radiotherapy and chemotherapy. In addition, Chinese medicine has advantages in reducing serious adverse reactions of malignant tumors, providing more options for the adjuvant treatment of tumors.

Clinical characteristics and influencing factors for mortality of patients with intra-abdominal candidiasis: a multicenter retrospective study / 中华消化外科杂志

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

The efficacy and safety of recombinant activated factor Ⅶ on uncontrolled perioperative hemorrhage in elderly patients / 中华老年医学杂志

Objective:To investigate the efficacy and safety of recombinant activated factor Ⅶ(rFⅦa)on uncontrolled perioperative hemorrhage in elderly patients in surgical intensive care unit(SICU).Methods:Clinical data of 27 elderly patients with uncontrolled perioperative hemorrhage treated successfully with rFⅦa in surgery-ICU of our hospital from May 2004 to December 2018 were retrospectively analyzed.And the application method and experience were summarized.Results:Of the 27 patients, 16 cases were cured, 11 cases died, and the total fatality rate was 40.74%(11/27). The bleeding stopped in 23 cases, four cases died of uncontrolled peri-operative hemorrhage, and the hemorrhage-caused fatality rate was 14.81%(4/27). Seven patients died of primary diseases after the control of bleeding, with a fatality rate of 25.93%(7/27 ). The thrombin time(TT), prothrombin time(PT), activated partial thromboplastin time(APTT)and international normalized ratio(INR)were reduced and the prothrombin activity(AT)was increased after versus before the application of rFⅦa( Z=-2.197, -3.180, -2.271, -2.803 and 2.756, P=0.028, 0.001, 0.023, 0.005 and 0.006, respectively). Conclusions:rFⅦa has a better effect on uncontrolled peri-operative hemorrhage in elderly patients, when traditional treatments are ineffective.

A genotyping study of 13 cases of early-onset Charcot-Marie-Tooth disease / 中国当代儿科杂志

OBJECTIVE@#To study the clinical characteristics and genetic variation of early-onset Charcot-Marie-Tooth disease (CMT).@*METHODS@#Children with a clinical diagnosis of early-onset CMT were selected for the study. Relevant clinical data were collected, and electromyogram and CMT-related gene detection were performed and analyzed.@*RESULTS@#A total of 13 cases of early-onset CMT were enrolled, including 9 males (69%) and 4 females (31%). The mean age at consultation was 4.0±2.1 years. Among them, 12 children (92%) had an age of onset less than 2 years, 9 children (69%) were diagnosed with CMT type 1 (including 6 cases of Dejerine-Sottas syndrome), 1 child (8%) with intermediate form of CMT, and 3 children (23%) with CMT type 2. The genetic test results of these 13 children showed 6 cases (46%) of PMP22 duplication mutation, 3 cases (23%) of MPZ gene insertion mutation and point mutation, 3 cases (23%) of MFN2 gene point mutation, and 1 case (8%) of NEFL gene point mutation. Eleven cases (85%) carried known pathogenic mutations and 2 cases (15%) had novel mutations. The new variant c.394C>G (p.P132A) of the MPZ gene was rated as "possibly pathogenic" and the new variant c.326A>G (p.K109R) of the MFN2 gene was rated as "pathogenic".@*CONCLUSIONS@#Early-onset CMT is mainly caused by PMP22 gene duplication mutation and MPZ gene mutations. The clinical phenotype is mainly CMT type 1, among which Dejerine-Sottas syndrome accounts for a considerable proportion.

Prevention and treatment of biotoxin-induced acute renal injury / 解放军医学杂志

With the increase of human activities, biotoxin poisoning has gradually become a serious health problem. Biotoxins are usually classified into bacterial toxins, mycotoxins, marine toxins, animal venoms, enterotoxins, exotoxins, etc. A variety of toxins can cause impaired renal function and even lead to acute renal failure. The biotoxin-induced kidney injury is a dangerous clinical condition involving a variety of pathophysiological mechanisms. Failure to treat properly in time often leads to higher mortality. Blood purification therapy plays a central role in the treatment of patients with biotoxin-induced renal injury. The present paper reviews the current status of prevention and treatment of acute renal injury caused by common biotoxins in China, including poisonous mushrooms, fish gall, snake venom and bee stings. The purpose of this review is to make Chinese nephrologists and specialists clear the prevention and treatment of biotoxin-induced renal injury, and standardize the prevention and treatment strategy of biotoxin-induced kidney injury.

Effects of high-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after surgery / 中国医师杂志

Objective To prospectively investigate the effects of high-flow nasal oxygen on hypoxemic patients after surgery.Methods A total of 108 postoperation hypoxemic patients (150 mmHg ≤ PaO2/FiO2 ＜300 mmHg, PaCO2 ≤50 mmHg) in Beijing Hospital Surgical Intensive Critical Unit was in cluded and assigned randomly to two groups from June 2016 to April 2017.Fifty four patients (study group) who received high-flow nasal oxygen therapy were compared with 54 patients (control group) who received noninvasive ventilation therapy.The data of reintubation and mortality in 28 days after extubation were collected and analyzed.Results No significant differences were found for reintubation rate (11.1％ vs 13.0％,P =0.767) and mortality (5.6％ vs 7.4％, P =0.696) in 28 days after extubation between two groups.In subgroup analysis, no significant differences were found for different hypoxima level (250 mmHg ≤ PaO2/FiO2 ＜ 300 mmHg,200 mmHg ≤ PaO2/FiO2 ＜ 250 mmHg and 150 mmHg≤ PaO2/FiO2 ＜ 200 mmHg) between two groups, for reintubation rate (0 vs 3.7％,P =0.296;20％ vs 14.3％,P =0.684;30％ vs 30.8％,P =0.968, respectively) and mortality (0 vs 3.7％,P =0.296;6.7％ vs 7.1％,P =0.960;20％ vs 15.4％,P =0.772, respectively).Face skin breakdown were significantly more common in control group (1 1.1％ vs 0,P =0.012).Conclusions High-flow nasal oxygen therapy was not inferior to noninvasive ventilation for mild and moderate hypoxemic patients after surgery.High-flow nasal oxygen therapy is safe and effective for these patients.

Efficacy and safety of aspirin for venous thromboembolism after total knee arthroplasty / 中国组织工程研究

BACKGROUND: The best prevention strategy for venous thrombosis (VTE) is currently controversial, especially for patients with high risk of total knee arthroplasty. There are no fully safe, effective and inexpensive thrombus prevention drugs. OBJECTIVE: To study the efficacy and safety of aspirin in preventing venous thrombosis after total knee arthroplasty. METHODS: 300 patients undergoing primary unilateral total knee arthroplasty from September 2014 to December 2016 were randomly divided into two groups: conventional anticoagulation group and risk stratification group (n=150 per group), including 88 males and 212 females at the age of 49-85 years old. The conventional anticoagulation group received low molecular weight heparin for prevention and treatment. Risk stratification group was stratified according to the risk of venous thrombosis. 64 patients with low risk were treated with aspirin and 86 patients with high risk were treated with low molecular weight heparin. Complications were analyzed within 90 days after surgery, including deep venous thrombosis, pulmonary embolism, wound infection, bleeding and death. RESULTS AND CONCLUSION: (1) Complications occurred in 39 cases (13%) within 90 days after follow-up. The total incidence of symptomatic deep vein thrombosis complications was 2% in 6 cases, and 19 cases (6.33%) had wound complications. There were 3 cases (2%) of symptomatic deep vein thrombosis in conventional anticoagulation group and 3 cases (2%) in risk stratification group. (2) The incidence of symptomatic deep vein thrombosis, proximal deep vein thrombosis and distal deep vein thrombosis and pulmonary embolism were 1.56% (1 case), 1.56% (1 case), 4.68% (3 cases), and 0% respectively in patients treated with aspirin. The incidence of symptomatic deep vein thrombosis, proximal deep vein thrombosis and distal deep vein thrombosis and pulmonary embolism in patients receiving low molecular weight heparin were 2.12% (5 cases), 0.85% (2 cases), 5.08% (12 cases) and 0.42% (1 case), respectively. There was no significant difference between the two groups (P > 0.05). (3) There were 11 cases of wound complications in the conventional anticoagulation group and 8 cases in the risk stratification group (χ2 = 506, P = 0.318). (4) The incidences of wound-related complications (wound delayed healing, superficial wound infection and deep wound infection) were 1.56% (1 case), 0% and 1.56% (1 case) respectively in patients receiving aspirin, and 5.51% (13 cases), 1.27% (3 cases) and 0.42% (1 case) in patients receiving low molecular weight heparin. (5) Results suggested that aspirin and low molecular weight heparin can effectively prevent the occurrence of deep vein thrombosis. For low-risk patients, aspirin multi-mode thrombosis prevention is safe and effective.

Tissue-engineered cartilage implantation for the treatment of full-thickness knee cartilage defects / 中国组织工程研究

BACKGROUND:The use of normal hyaline cartilage to repair large areas of full-thickness knee cartilage defect has been a hot topic recently; however, a follow-up study with a relative large number of patients is required. OBJECTIVE:To make a preliminary study concerning the methods and therapeutic effects of tissue-engineered cartilage (TEC) implantation for treating large-area full-thickness knee cartilage defects. METHODS:Twenty-one patients (23 knees) diagnosed with cartilage defect of the knee joint (Outbridge III-IV) were enrolled. The area of the cartilage defect was 3.5-11.2 cm2. All of the patients were given TEC treatment. Postoperative functional exercise of the knee joint was carried out in these patients as planned. We regularly reviewed the knee MRI and calculated visual analog scale score, International Knee Documentation Committee (IKDC) score, and Lysholm score. RESULTS AND CONCLUSION:All the patients were followed up for 3 to 12 months. Postoperatively knee pain relieved obviously, and the visual analog scale score was significantly declined compared with the preoperation (P<0.05). All the patients manifested painless 1 year after surgery. The 1-year postoperative MRI showed that the injured cartilage grew well. The thickness and MRI signal of the graft was the same as the normal cartilage, and the bone healed completely. The IKDC and Lysholm scores were significantly improved at 3, 6, 12 months after the surgery, and the difference was statistically significant before and after the surgery (P<0.05). Overall, TEC is an improved technique of chondrocyte implantation, which is an effective and safe method for cartilage defect repair.

Effects of Levosimendan on haemodynamics in heart failure patients with low cardiac output / 中华老年医学杂志

Objective To investigate effects of Levosimendan on hemodynamics in heart failure patients with low cardiac output. Methods A total of 27 heart failure patients with low cardiac output were recruited in the surgical intensive care unit (SICU)of Beijing Hospital from July 2009 to May 2016. All patients were treated with continuous intravenous infusion of Levosimendan 12.5 mg within 24 h at a rate of 0.1~0.2 μg· kg -1·min-1. Hemodynamic variables were monitored by pulse-indicated continuous cardiac output(PICCO)at baseline ,24 h ,4 d and 7 d after infusion. Results There were no significant differences in systolic blood pressure(SBP) ,diastolic blood pressure(DBP) ,heart rate(HR)and global end diastolic volume index (GEDI)as comparing baseline with 24 h ,4 d and 7 d after infusion of levosimendan. The significant differences were found in central venous pressure (CVP) ,systemic vessel resistance index (SVRI) , extravascular lung water index (EVLWI ) among baseline versus 24 h ,4 d and 7 d after infusion of levosimendan[(8.34± 2.87)mmHg vs.(6.35± 2.31),(6.81± 2.03),(5.92± 2.23)mmHgforCVP ,(2 682.0 ± 388.9)dyn·s-1·cm -5·m-2vs. (2 170.0 ± 410.9) ,(2 062.0 ± 340.6 ) ,(1 960.0 ± 380.2 )dyn ·s-1·cm-5·m-2for SVRI ,(8.90 ± 2.45)ml/kg vs. (6.60 ± 2.66) ,(5.92 ± 2.88) ,(5.46 ± 2.52) ml/kg for EVLWI ,P=0.001 ,0.003 or＜0.01 ,respectively].As compared with hemodynamic variables at baseline ,brain natriuretic peptide levels were decreased ,and cardiac index ,cardiac function index and stroke volume index were increased at 24 h ,4 d and 7 d after infusion of Levosimendan (P＜0.01 ,0.05 or 0.01 , respectively ). Conclusions A single-dose intravenous infusion of Levosimendan can increase cardiac output and decrease systemic vascular resistance in heart failure patients with low cardiac output ,which maintain quite a long time.

Self-protection against triptolide-induced toxicity in human hepatic cells via Nrf2-ARE-NQO1 pathway / 中国结合医学杂志

<p><b>OBJECTIVE</b>To find the signaling pathway of triptolide (TP)-induced liver injury and to reveal whether NF-E2-related factor 2 (Nrf2) plays an important role in cellular self-protection.</p><p><b>METHODS</b>The L-02 and HepG2 cells were cultured and treated with various concentrations of TP. The cell viability was observed, and the cell medium was collected for detecting the aspartate aminotransferase (ALT), alanine aminotransferase (AST), lactate dehydrogenase (LDH), superoxide dismutase (SOD) and L-glutathione production (GSH) levels. Nrf2 and its downstream target NAD(P)H: quinine oxidoreductase 1 (NQO1) and heme oxygenase-1 (HO-1) expression, the nuclear translocation of Nrf2, and the binding ability of Nrf2 and antioxidant response element (ARE) were also identified. Meanwhile, shRNA was used to silence Nrf2 in L-02 cells to find out whether Nrf2 plays a protective role.</p><p><b>RESULTS</b>The viability of the L-02 and HepG2 cells treated with TP decreased in a doseand time-dependent manner, and TP (20-80 μg/mL) markedly induced the release of ALT, AST and LDH (P<0.05 or P<0.01), reduced the levels of SOD and GSH (P<0.01), and increased the intracellular reactive oxygen species. Meanwhile, TP augmented the Nrf2 expression in L-02 and HepG2 cells (P<0.05 or P<0.01), induced Nrf2 nuclear translocation, increased the Nrf2 ARE binding activity, and increased HO-1 and NQO1 expressions. Nrf2 knockdown revealed a more severe toxic effect of TP (P<0.05 or P<0.01).</p><p><b>CONCLUSIONS</b>Human hepatic cells treated with TP induced oxidative stress, and led to cytotoxicity. Self-protection against TP-induced toxicity in human hepatic cells might be via Nrf2-ARE-NQO1 transcriptional pathway.</p>

The influence of STK31 on osteosarcoma's malignant biological behavior / 重庆医学

Objective To observe the expression of serine/threonine kinase 31 (STK31) in osteosarcoma and its effect on the malignant biological behavior of osteosarcoma.Methods Fifteen cases of osteosarcoma specimens and adjacent normal tissue were collected.The expression of STK31 in tumor tissues and normal tissue were detected by immunohistochemistry,real-time quantitative PCR and Western blot.The STK31 knockout plasmids PGenesil-STK31-shRNA or control plasmid pGenesil-1 were transfected into osteosarcoma cell line MG63 cells.The effect of STK31 on the proliferation of MG63 cells was detected by CCK8 cell activity assay.Tanswell experiment was used to observed the effect of STK31 on the migration ability of osteosarcoma cells.Results Immunohistochemical showed that STK31 expressed in the tumor tissue,and it was significantly higher than the adjacent normal tissues;Real time quantitative PCR[(3.65±0.83)vs.(1.05±0.14),P＜0.05] and Western blot also revealed that STK31 expression in tumor tissue were significantly higher than adjacent normal tissues(P＜0.05);CCK8 experiments showed that knockdown STK31 inhibited proliferation of MG63 cell when compared with the control group after 36 h[(1.71±0.17)vs.(1.39±0.11),P＜0.05],72 h[(2.15±0.21)vs.(1.54±0.14),P＜0.05];Tansewell experiments showed that transfection of pGenesil-STK31-shRNA could suppress MG63 cell's migration[(13±4)vs.(55±8),P＜0.05].Conclusion STK31 is overexpression in osteosarcoma with increased biological activity of osteosarcoma cells.

Metabolomics analysis of Tripterygium wilfordii formulation based on theory of detoxicity compatibility / 中国中药杂志

Tripterygium wilfordii Hook. f. induced-hepatotoxicity was the main limitation for its usage in clinic. Qingluo Tongbi formulation showed obvious attenuation for hepatotoxicity in clinic and fundamental research in vivo. To explore the potential mechanism of the attenuation, we conducted a study on the plasma metabolomic profiles of T. wilfordii and Qingluo Tongbi formulation in rats by a sensitive gas chromatography-mass spectrometry (GC-MS/MS) method. In plasma samples, a total of 72 compounds were analyzed by EI source MS, and were successfully identified by matching NIST database. The semi-quantification results were then calculated by OPLS-DA model with SIMCA-P 13.0 software. The three groups were clearly distinguished in OPLS-DA score plot. In addition, the observation values of Qingluo Tongbi formulation showed the obvious trend towards the control levels, suggesting the detoxicity effect of the formulation. Variation metabolites were further analyzed by VIP and One Way ANOVAs, and the results showed a significant increase in compounds of glycogenic amino acids, such as alanine, proline, serine and glutamine after the administration of T. wilfordii, indicated that the tissue proteins were decomposed and amino acids were leakage into blood. Qingluo Tongbi formulation could reverse the amino acids into normal level. On the contrary, the levels of glucose, lactic acid and hydroxy butyrate decrease, and the formulation can relieve the disorder in the levels of lactic acid, suggesting the regulation of the energy metabolism. Additionally, the level of branched chain amino acid was decreased, suggested the toxicity was induced, but the formulation cannot increase it into the normal levels. Nevertheless, all the above results suggested that the classical Qingluo Tongbi formulation displayed the liver protection effect by adjusting the amino acid levels and regulating the energy metabolism. Qingluo Tongbi formulation was developed based on traditional Chinese medicine theory "detoxicity compatibility", and contained Panax notoginseng (Burk.) F. H. Chen to nourish blood and absorb clots. Modern pharmacology suggested that its liver protection effect was correlated with the promotion of protein synthesis. Another important herb is Rehmannia glutinosa Libosch., which can regulate the energy metabolism. Both were consistent with the metabolomic results in this study, which explained the potential mechanism of "detoxicity compatibility" theory. Therefore, the currently developed metabolomic approach and the obtained results would be highly useful for the comprehensive toxicity studies for other herbal medicines and various complex deoxicity formulations.

Researching in doctor-patient communication courses for internship of medical students / 中华医学教育探索杂志

Currently medical students are short in ability of doctor-patient communication and lack of professional training in doctor-patient communication.It is essential to explore ways and means of teaching clinical doctor-patient communication for medical students.Clinical doctor-patient communication training courses were carried out with internships by way of explaining the establishment of a good doctordoctor-patient communication relationship,preparation and investigation analysis of doctor-patient communication information,doctor-patient communication skills,evaluation and adjustment of doctor-doctor-patient commu-nication,doctor-doctor-patient communication in the legal and regulatory issues.Medical students were trained in the good doctor-doctor-patient communication relationship building,information collection,infor-mation giving,respect and understanding,ending doctor-patient communication skills.And after the training medical students' doctor-patient communication ability obtained a certain improvement,which means this curriculum of clinical doctor-patient communication training courses is worthy of further promotion.

Mesenchymal stem cells attenuate acute kidney injury via regulation of natural immune system / 中华危重病急救医学

Objective To explore the potential mechanisms of mesenchymal stem cell (MSC) therapy in ischemia/reperfusion injury (IRI)-induced acute kidney injury (AKI). Methods Forty-five C57/BL6 male mice were randomly divided into three groups: sham group, IRI group, and IRI+MSCs group, with 15 mice in each group. The IRI-induced AKI model in mice was reproduced by clamping both renal pedicles for 35 minutes. In the sham group, both kidneys were exposed, but their pedicles were not clamped. Six hours after reperfusion, mice in IRI+MSCs group received 100 μL of MSCs (1×104 /μL) isolated from the bone marrow from C57/BL6 mice via tail vein, while the mice in the IRI group received same amount of normal saline. Blood samples were harvested at 48 hours after reperfusion, and levels of serum creatinine (SCr) and blood urea nitrogen (BUN) were determined. The changes in renal pathology were observed by microscopy with PAS staining, and the tubular injury and acute tubular necrosis (ATN) scores were calculated. The number of leukocytes (CD45+) infiltrated in kidney at 24 hours and 72 hours after reperfusion was measured with flow cytometry. The number of neutrophils (Ly-6G+) and macrophages (F4/80+) infiltrated in kidneys at 24 hours and 72 hours after reperfusion was determined by immunofluorescence. Results There was significant increase in the related parameters in IRI group compared with those of sham group. The levels of SCr (μmol/L) and BUN (mmol/L) were 180.3±8.8 vs. 9.7±3.5, and 1 121.1±8.3 vs. 9.4±2.3, both P < 0.01. The score of tubular injury was 4.80±0.55 vs. 0 at 48 hours after reperfusion. The quantity of leukocyte (CD45+) infiltration in kidney at 24 hours and 72 hours after reperfusion was increased (×105 cells/g: 60.50±2.56 vs. 19.46±4.83, 42.00±1.87 vs. 14.70±3.74, both P < 0.01), and the number of neutrophils (Ly-6G+) and macrophages (F4/80+) infiltrated in kidney at 24 hours and 72 hours after reperfusion was also increase although the number of leukocytes infiltrated in kidney was significantly lower at 72 hours after reperfusion than that at 24 hours. There was significant lowering of the levels of SCr and BUN [SCr (μmol/L): 99.0±8.0 vs. 180.3±8.8, BUN (mmol/L): 84.5±7.6 vs. 112.1±8.3, both P < 0.01] in IRI+MSCs group, compared to IRI group. For the degree of tubular necrosis in two groups, the tubular injury scores were 2.60±0.55 vs. 4.80±0.55 (P < 0.05). The number of leukocytes infiltrated in kidney at 24 hours and 72 hours after reperfusion (×105 cells/g) were 24.20±4.53 vs. 60.50±2.56, 31.70±3.15 vs. 42.00±1.87 (both P < 0.01). The number of neutrophils was lowered despite (the number of macrophages was increased). However, the number of infiltrated leukocytes was significantly more in IRI+MSCs group at 72 hours than that at 24 hours (×105 cells/g: 31.70±3.15 vs. 24.20±4.53, P < 0.05). Conclusion MSCs could protect against IRI induced AKI by reducing the total number of leuckocytes, especially that of the neutrophils infiltrating into ischemic kidney and by recruiting macrophages into ischemic kidney.

Performance and colonoscopic observation in macaques / 中国比较医学杂志

Diarrhea is a common intestinal symptom in macaque.The corresponding intestinal lesions of macaque are mainly described at autopsy but less observed by colonoscopy.The aim of this study was to develop a colonoscopic technique and to obtain endoscopic images of the entire colon in macaques.Eight healthy adult macaques ( 5 males and 3 females) without diarrhea for 2 months, were fed Glauber’ s salt through nasogastric tubes.The colon cleanliness was well matched to the endoscopic observation of macaque colon.The procedure took 10-20 min for each animal.There was no obvious abnormality in the colon of four animals except some slight differences of mucosal structure from that of human beings.Small pieces of erosion and ulcer in the colons were observed in four macaques which presented mild diarrhea for less than 1 day, while a severe stenosis was observed in one of those four macaques.No animal died during and one week after the endoscopic procedure.Colonoscopy may safely performed in macaques.The images taken by colonoscopy may be important to establish diagnosis and treatment of colitis in macaques in time and to evaluate the efficacy of drug intervention as well.This technique is also helpful to provide qualified macaques for scientific researches.

Inhibition mechanism of Qingluo Tongbi Granule () on osteoclast differentiation induced by synovial fibroblast and monocytes co-culture in adjuvant-induced arthritic rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the mechanism underlying the inhibitory effect of Qingluo Tongbi Granule (, QTG) on osteoclast differentiation in rheumatoid arthritis in rats.</p><p><b>METHODS</b>Fibroblast and monocyte co-culture were used to induce osteoclast differentiation in adjuvant-induced arthritic (AIA) rats. Serum containing QTG was prepared and added to the osteoclasts, and activation of the tumor necrosis factor receptor-associated factor 6/mitogen-activated protein kinase/nuclear factor of activated T cells, cytoplasmic1 (TRAF6/MAPK/NFATc1) pathways was examined.</p><p><b>RESULTS</b>The induced osteoclasts were multinucleated and stained positive for tartrate-resistant acid phosphatase (TRAP) staining. Serum containing QTG at 14.4, 7.2 or 3.6 g/kg inhibited the activation of TRAF6, extracellular regulated protein kinase (ERK)1/2, c-Jun N-terminal kinase (JNK) and p38 and decreased the percentage of cells with nuclear NFATc1 in a dose-dependent manner, the high and middle doses exhibited clear inhibitory activity (P<0.01 and P<0.05, respectively). After the addition of MAPK inhibitors, the NFATc1 expression showed no significant difference compared with the control group (P>0.05).</p><p><b>CONCLUSIONS</b>Serum containing QTG could generally inhibit the TRAF6/MAPK pathways and possibly inhibit the NFATc1 pathway. In addition, QTG may regulate other signaling pathways that are related to osteoclast differentiation and maturation.</p>

Guidelines and strategy of the International Conference of Harmonization (ICH) and its member states to overcome existing impurity control problems for antibiotics in China / 中国天然药物

In the present report, we review the technical guidelines and principles on impurity research and control for antibiotics established by various agencies, including the International Conference of Harmonization (ICH), the US Food and Drug Administration (FDA), the European Medicines Agency (EMA) and the China Food and Drug Administration (CFDA). Progresses with the US Pharmacopoeia (USP), the European Pharmacopoeia (EP) and the Chinese Pharmacopoeia (ChP) to control impurities in antibiotics are also presented. Next, our discussion is focused on analyzing the CFDA's requirements on impurity research and control for antibiotics, and the implementation of ICH, FDA and other technical guidelines for generic drugs impurity control in China. Existing problems are further reviewed, in order to improve the overall process for the control of antibiotic purity.

Diagnosis and treatment of pseudomyxoma peritonei in accidental discovery: a report of 8 cases / 国际外科学杂志

Objective To investigate the diagnosis and treatment of pseudomyxoma peritonei (PMP) and provide a reference for diagnosis and treatment of PMP.Methods The clinical features,laboratory examinations,treatment and outcomes of 8 PMP misdiagnosed cases were analyzed with recent relevant reference.Results Ultrasonography,CT,peritoneal cytological examination,tumor markers results are helpful for diagnosis of PMP.PMP will be confirmed and classified by pathological examination after operation.Complete cytoreductive surgery (CRS)or major debulking surgery (MDS) of the tumor combined intraperitoneal chemotherapy and systemic chemotherapy,eight patients in seven cases survived 4-71 month range,one patient died of respiratory failure of pulmonary infection after the third operation.Conclusions Ultrasonography,CT,peritoneal cytological examination,tumor markers tests help avoid misdiagnosis of PMP before operations.Intraoperative findings follow after PMP,CRS or MDS should be executed in the operation or the next time.Intraperitoneal chemotherapy and conventional chemotherapy can improve survival in patients with PMP and prolong their survival time.