Role of T lymphocytes in primary sclerosing cholangitis / 临床肝胆病杂志

Primary sclerosing cholangitis （PSC） is an immune-mediated chronic cholestatic liver disease and can progress to end-stage liver diseases such as liver cirrhosis and liver failure， and there are still no effective treatment methods at present. Studies have found that T lymphocytes are closely associated with the development and progression of PSC. This article reviews the role of T lymphocytes in PSC， so as to provide new ideas for research on the pathogenesis of PSC and the clinical diagnosis and treatment of PSC.

Effect of motor imagery on knee function after unicompartmental knee arthroplasty / 中国康复理论与实践

ObjectiveTo explore the effect of motor imagery (MI) on knee function after unicompartmental knee arthroplasty (UKA). MethodsFrom January to September, 2022, 32 patients underwent UKA for the first time in Xuanwu Hospital were randomly divided into control group (n = 16) and experimental group (n = 16). All the patients accepted routine rehabilitation, and the experimental group accepted MI in addition, until four weeks after discharge. They were assessed with Oxford Knee Score (OKS), Visual Analogue Scale for pain (VAS), range of motion (ROM) of knee, and Timed Up and Go Test (TUGT) before and after treatment. ResultsAll the indexes improved after treatment (|t| > 2.517, P < 0.05), except ROM in the control group; and they improved more in the experimental group than in the control group (F > 7.999, P < 0.01), except the VAS score. ConclusionMI can further improve the knee function after UKA, but do less for pain.

Effects of lead and manganese combined exposure on neurodevelopmental toxicity and JNK expression in zebrafish / 环境与职业医学

Background Lead and manganese are heavy metal pollutants widely existing in the environment, which can accumulate in the human body through the food chain, exert neurotoxicity, and cause neurodegenerative disorders. Especially in early childhood, the developing blood-brain barrier and nervous system are highly susceptible to environmental chemical pollutants. Most of the previous studies focused on the toxic effects of single heavy metal such as lead or manganese, while the studies on combined toxic effect are still scarce, and involved mechanisms are still unclear. c-Jun N-terminal kinase (JNK) is involved in neuronal development and regeneration, and some studies have found that JNK is involved in lead or manganese induced neurotoxicity. Its role in the toxicity of combined lead and manganese is unknown. Objective To understand the neurodevelopmental toxicity mechanism and to observe changes of JNK expression in zebrafish induced by combined lead and manganese exposure at environmentlly low concentrations. Methods Zebrafish embryos within 2 h post fertilization (hpf) were divided into four groups: control group, lead exposure group (0.1 mg·L−1 lead acetate), manganese exposure group (0.3 mg·L−1 manganous chloride), and lead-manganese combined exposure group (0.1 mg·L−1 lead acetate +0.3 mg·L−1 manganous chloride) and exposed to lead or/and manganese at designed levels for 7 d. Spontaneous movements and motor locomotion were observed, and mortality rate were calculated. The changes of JNK mRNA expression in zebrafish were evaluated. Results The experimental results showed that no significant effect of lead or/and manganese on spontaneous movements and mortality rate was found in zebrafish compared with the control group (P＞0.05). The results of locomotion analysis showed that compared with the control group, the activity counts and activity distance of zebrafish in the manganese exposure group were slightly increased (P＜0.01); the activity counts and activity distance of zebrafish in the lead exposure group were reduced by 50% and those in the lead-manganese exposure group were reduced by 80% (P＜0.01). Compared with the lead exposure group, the activity counts and activity distance of zebrafish in the lead-manganese combined exposure group decreased significantly by 60% (P＜0.05). The real-time quantitative PCR results showed that the JNK mRNA expression level was significantly increased in the lead-manganese combined exposure group compared with the control group(P＜0.01). Conclusion Lead exposure combined with manganese exposure at environmentlly low concentration can induce neurodevelopmental toxicity to zebrafish. JNK may be involved in neurodevelopmental toxicity induced by the combined exposure to lead and manganese.

Value of Charlson comorbidity index in predicting the prognosis of patients with acute-on-chronic liver failure / 临床肝胆病杂志

Objective To investigate the value of Charlson comorbidity index (CCI) in predicting the short- and long-term risks of death in patients with acute-on-chronic liver failure (ACLF). Methods A total of 317 patients with ACLF who attended The First Hospital of Lanzhou University from December 1, 2016 to December 1, 2021 were enrolled, and according to their prognosis, they were divided into death group with 169 patients and survival group with 148 patients. The two groups were analyzed in terms of clinical data and follow-up data. The group t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the prognosis of ACLF patients. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison of survival time between patients with different CCI scores. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CCI and other indices in assessing the prognosis of ACLF patients. Results Among the 317 patients, there were 225 (71.0%) male patients. There were significant differences between the death group and the survival group in age, hemoglobin, white blood cell count, total bilirubin, albumin, Model for End-Stage Liver Disease (MELD) score, prothrombin time activity, CCI, age-adjusted Charlson co-morbidity index (ACCI), and follow-up time (all P < 0.05). The multivariate Cox regression analysis showed that the CCI (hazard ratio [ HR ]=1.351, 95% confidence interval [ CI ]: 1.112-1.641, P =0.002), ACCI ( HR =1.200, 95% CI : 1.011-1.423, P =0.037), and MELD score ( HR =1.076, 95% CI : 1.054-1.099, P < 0.001) were independent risk factors for the prognosis of ACLF patients. Based on CCI score, the patients were divided into CCI ≤4 group with 167 patients, CCI=5 group with 64 patients, and CCI ≥6 group with 86 patients, with a 3-year mortality rate of 26.5%, 83.2%, and 96.9%, respectively, and there was a significant difference in survival time between any two groups after 3 years of follow-up and at the time of follow-up till September 2022 (all P < 0.001). CCI, ACCI, and MELD scores had an area under the ROC curve of 0.845, 0.811, and 0.790, respectively, in predicting the prognosis of ACLF patients. Conclusion As commonly used comorbidity assessment indices, CCI and ACCI scores have certain value in evaluating the short- and long-term prognosis of ACLF patients.

Effects of integrated orthopedic rehabilitation pathway on motor function after total knee arthroplasty / 中国康复理论与实践

@#Objective To study the effects of integrated orthopedic rehabilitation pathway on motor function in six months after total knee arthroplasty (TKA), including pain, stiffness, range of motion and muscle strength, etc. Methods From March, 2016 to March, 2019, 180 patients who underwent TKA and treated with integrated orthopedic rehabilitation pathway were enrolled. Age, gender, operation time, time of follow-up, the scores of Hospital for Special Surgery-Knee Scale (HSS-KS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at preoperative/postoperative/one-month after operation/three-month after operation/six-month after operation time points were collected. The sub items, such as muscle strength, range of motion, flexion deformity, pain, stiffness, functional difficulty were primarily focused on. Results A total of 42 patients were followed up for three months and 22 patients were followed up for six months. There was no significant difference in the scores of HSS-KS and WOMAC before and after operation (P > 0.05). Within three months after operation, the HSS-KS scores gradually increased (P < 0.05) and the WOMAC scores gradually decreased (P < 0.05). The active knee flexion range of motion and knee extensor muscle strength scores of HSS-KS significantly decreased after operation (P < 0.05), and gradually recovered one month and three months after operation (P < 0.05). The flexion deformity scores of HSS-KS increased after operation (P < 0.05), decreased one month after operation (P < 0.05), and got a trend of incensement again three months after operation. The pain score of WOMAC decreased continuously within three months after operation (P < 0.05); the stiffness score of WOMAC did not change after operation (P > 0.05), decreased significantly one month after operation (P < 0.05), and did not change three months after operation (P > 0.05). The degree of functional difficulty of WOMAC decreased after operation (P < 0.05), and improved continuously within six months after operation (P < 0.05). Conclusion The overall function after TKA shows a trend of improvement within three months, and there is no obvious improvement from three to six months after operation. The flexion deformity score showed a downward trend in one month after operation, and it could be improved again after strengthening rehabilitation, which needs more attention in the postoperative rehabilitation.

CRISPR Screens Identify Essential Cell Growth Mediators in BRAF Inhibitor-resistant Melanoma / 基因组蛋白质组与生物信息学报·英文版

BRAF is a serine/threonine kinase that harbors activating mutations in ∼7% of human malignancies and ∼60% of melanomas. Despite initial clinical responses to BRAF inhibitors, patients frequently develop drug resistance. To identify candidate therapeutic targets for BRAF inhibitor resistant melanoma, we conduct CRISPR screens in melanoma cells harboring an activating BRAF mutation that had also acquired resistance to BRAF inhibitors. To investigate the mechanisms and pathways enabling resistance to BRAF inhibitors in melanomas, we integrate expression, ATAC-seq, and CRISPR screen data. We identify the JUN family transcription factors and the ETS family transcription factor ETV5 as key regulators of CDK6, which together enable resistance to BRAF inhibitors in melanoma cells. Our findings reveal genes contributing to resistance to a selective BRAF inhibitor PLX4720, providing new insights into gene regulation in BRAF inhibitor resistant melanoma cells.

Relationship between childhood sexual abuse and non suicidal self injury of female nursing students / 中国学校卫生

Objective@#To explore the relationships between the characteristics of childhood sexual abuse and non-suicidal self-injury in nursing female college students.@*Methods@#Two medical colleges and junior colleges were selected in Anhui province. A total of 2 549 female nursing students in grade 1 to 3 were asked to fill a questionnaire regarding sociodemographic information,childhood sexual abuse and non-suicidal self-injury.@*Results@#The reported rate of non-suicidal self-injury among female nursing students in the past six months was 8.2%. Sexual abuse at any time during childhood (primary school or earlier,middle school and high school) increased the risk of non-suicidal self-injury among female nursing students (P<0.05). Exposure to sexual abuse in all three periods was associated with 5.04(95%CI=1.73-14.62) times odds ratio than that of those who not exposed to sexual abuse (P<0.01). Only contact sexual abuse and both contact and non-contact sexual abuse in childhood were correlated with nonsuicidal selfinjury among female nursing students [OR(95%CI)=2.21(1.48-3.29), 3.56(2.13-5.96)] (P<0.05). Two patterns of sexual abuse experiences were identified,including persistent sexual abuse (3.1%) and the other group is occasional sexual (96.9%). Persistent sexual abuse in childhood was correlated to higher risk of non-suicidal self-injury compared with occasional sexual abuse (OR=2.61,95%CI=1.35-5.05,P<0.01).@*Conclusion@#The occurrence periods,types and patterns of sexual abuse in childhood are closely related to non-suicidal self-injury in female nursing students.

Preliminary study on the efficacy of sequential therapy with nucleotide analogues followed by interferon alpha in chronic hepatitis B patients with low HBsAg level / 中国感染与化疗杂志

Objective To investigate the efifcacy of interferon alpha (IFNα) followed by nucleotide analogues (NAs) treatment in patients with negative hepatitis B e antigen (HBeAg), undetectable serum HBV-DNA and low hepatitis B surface antigen (HBsAg) levels.Methods The enrolled HBeAg-negative chronic hepatitis B patients had undetectable HBV-DNA level (HBV-DNA<1000 copies/mL for at least 12 months) and low HBsAg level (HBsAg≤2000 U/mL) with long-term NAs treatment. These patients switched their therapy sequentially from NAs regimens to IFNα for 48 weeks. The treatment response was evaluated in terms of serum HBV DNA load, serological HBV markers, liver function tests and routine blood test before treatment and 12, 24 and 48 weeks of treatment. The patients were followed up for 24 weeks after treatment. The primary endpoint was HBsAg loss or seroconversion and HBsAg<10 U/mL. Logistic regression analysis was conducted to examine relevant predictive factors. Receiver operating characteristic curve was used to evaluate the value of prior HBeAg seroconversion and on-treatment HBsAg dynamics in predicting HBeAg seroconversion than in HBsAg persistence group (χ2=9.527,P=0.002). HBsAg loss was more likely in the patients who had HBsAg decline at least 0.5 log U/mL from baseline at week 12 of treatment (χ2=16.576,P<0.001). The area under the ROC curve for prediction of HBsAg loss was 0.810 (95 %CI, 0.686 to 0.935,P<0.001).Conclusions The HBeAg-negative chronic hepatitis B patients with positive virological response and low HBsAg level after NAs treatment are more likely to achieve HBsAg clearance when switched to IFNα treatment. Prior HBeAg seroconversion and on-treatment HBsAg dynamics are useful in predicting and guiding IFNα sequential therapy.

Microvascular decompression for glossopharyngeal neuralgia with posterior inferior cerebellar artery as offending artery / 中国脑血管病杂志

Objective To investigate the key technical points of microvascular decompression (MVD)for the treatment of primary glossopharyngeal neuralgia (GPN)and its efficacy. Methods From July 2011 to October 2016,18 consecutive patients with primary GPN treated with MVD at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. All patients received magnetic resonance angiography (MRA)examination before procedure. The anatomical relationship between glossopharyngeal nerve / vagus nerve and peripheral blood vessels were identified. Seventeen of them were treated via suboccipital retrosigmoid approach,one were treated via far lateral approach. None of the patients were treated with nerve root rhizotomy. Results Eighteen patients had paroxysmal severe pain in tongue,pharynx,tonsil or deep ear canal and other parts before procedure. Preoperative MRA indicated and confirmed in the surgery that the offending vessels were the trunks or their branches of the posterior inferior cerebellar artery in this group of patients. During the operation,the offending vessels were removed from the out brainstem areas of the glossopharyngeal nerves and vagus nerves under the direct vision in order to ensure that the blood vessels and nerves no longer contacted with each other. There were no complications, such as disability and death,cerebrospinal fluid leakage,and intracranial infection. All the patients were followed up after procedure;the mean follow-up period was 1-62 months. The symptom of pain disappeared completely in 17 of them. The Numberical Rating Scale (NRS)score for pain were 0. The pain in one patient was not relieved. The NRS score was 8 at discharge;it was the same as before procedure. Three patients had mild hoarseness,throat discomfort after procedure. They were relieved gradually in the follow-up period. Conclusion MVD is a safe and effective method for the treatment of GPN. Posterior inferior cerebellar artery is the most common offending artery. Preoperative imaging examination and clear decompression during the procedure are very important. The cutting off of glossopharyngeal nerves and vagus nerves needs to be handled with care.

Assessment of accuracy of parents’ perception of their 4-36 months old children’ s picky eating behavior / 北京大学学报(医学版)

Objective:To evaluate the accuracy of parents ’ perception of whether their child is a picky eater and the specific food category the children avoideating according to the food frequency question-naire.Methods:This research selected 1 663 infants aged 4-36 months receiving non-diary complimen-tary food from maternal, infants, nutrition and growth study (MING Study) in 8 Chinese cities in which a combination of systematic cluster random sampling and purposive sampling was used .The general infor-mation, dietary status and picky eating status were collected through a self-designed questionnaire from the caregiver of the children .According to the parents ’ perception , the children were classified into picky/non-picky groups or avoid/non-avoid to a specific food category groups .Mann-Whitney U test was used to compare between the groups .Results: The reported percentage of picky eaters increased from 7.37%in 4-6 months old infants to 36.20%in 25-36 months old infants .Most picky infants in 4-6 months and 7-12 months old infants avoided eating dairy food ( 25% and 24%); while most picky toddlers aged 13-24 months and 25-36 months avoided eating vegetables (26.92% and 47.46%). The infants aged 4-6 months and 7-12 months who were perceived as picky by their parents took more kinds of food (8 and 19.5 kinds) than those who were not (6 and 18 kinds), while the picky toddlers aged 13-24 months and 25-36 months took fewer kinds of food (28.5 and 34 kinds for picky eaters, 31 and 37 kinds for non-picky eaters ) .The parents of infants aged 4-6 months judged correctly in every category of food without any statistical significance;the parents of 7-12 months old infants judged cor-rectly only in dairy food and eggs with statistical significance;those of 13-24 months old infants judged correctly in every food category except for vegetables with statistically significant difference in the category of eggs;those of 25-36 months old toddlers misjudged in dairy , beans and grains with no statistically significant difference in every category .Conclusion: Parents tend to misjudge their children ’ s picky eating behavior before the first 12 months of the child , and tend to make a more accurate perception after the 12th month.