Effect of Buzhong Yiqitang on Th17/Treg Immune Imbalance and Notch1 Signaling Pathway in AIT Mice / 中国实验方剂学杂志

ObjectiveTo explore the effect of Buzhong Yiqitang on the immune imbalance of helper T cell 17 （Th17）/regulatory T cell （Treg） and Notch1 signaling pathway in mice with autoimmune thyroiditis （AIT）. MethodA total of 60 8-week-old NOD.H-2h4 mice were randomly divided into the normal group， model group， western medicine group （selenium yeast tablet， 32.5 mg·kg-1）， and low-dose （4.78 g·kg-1·d-1）， middle-dose （9.56 g·kg-1·d-1）， and high-dose （19 g·kg-1·d-1） Buzhong Yiqitang groups， with 10 mice in each group. The normal group was fed with distilled water， and the other groups were fed with water containing 0.05% sodium iodide for eight weeks. After the animal model of AIT was formed spontaneously， the mice were killed under anesthesia after intragastric administration for eight weeks. Serum anti-thyroglobulin antibodies （TGAb）， thyroid-stimulating hormone （TSH）， free triiodothyronine （FT3）， and free thyroid hormone （FT4） were detected by enzyme-linked immunosorbent assay （ELISA）， and thyroid tissue changes were observed by hematoxylin-eosin （HE） staining. The mRNA and protein expressions of retinoid-related orphan receptor-γt （RORγt）， interleukin （IL）-17， forkhead box P3 （FoxP3）， IL-10， Notch1， and hair division-related enhancer 1 （Hes1） in thyroid tissue were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultCompared with the normal group， the thyroid structure of the model group was severely damaged， and lymphocytes were infiltrated obviously. The levels of serum TGAb， FT3， and FT4 contents were significantly increased， and TSH content was significantly decreased （P<0.01）. The mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were significantly increased， while those of FoxP3 and IL10 were significantly decreased in the model group （P<0.01）. Compared with the model group， thyroid structural damage and lymphocyte infiltration were improved in the treatment groups， and serum TGAb， FT3， and FT4 contents were significantly decreased. TSH content was increased， and mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were decreased. mRNA and protein expression levels of FoxP3 and IL-10 were increased to different degrees （P<0.05， P<0.01）， and the middle-dose Buzhong Yiqitang group had the most significant intervention effect. ConclusionBuzhong Yiqitang can alleviate the thyroid structural damage in AIT mice， and its mechanism may be related to improving the abnormal differentiation of Th17/Treg immune cells and inhibiting the activation of the Notch1 signaling pathway.

Advances in post-operative prognostic models for hepatocellular carcinoma / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Hepatocellular carcinoma (HCC) is one of the most common malignancies and a leading cause of cancer-related death worldwide. Surgery remains the primary and most successful therapy option for the treatment of early- and mid-stage HCCs, but the high heterogeneity of HCC renders prognostic prediction challenging. The construction of relevant prognostic models helps to stratify the prognosis of surgically treated patients and guide personalized clinical decision-making, thereby improving patient survival rates. Currently, the prognostic assessment of HCC is based on several commonly used staging systems, such as Tumor-Node-Metastasis (TNM), Cancer of the Liver Italian Program (CLIP), and Barcelona Clinic Liver Cancer (BCLC). Given the insufficiency of these staging systems and the aim to improve the accuracy of prognostic prediction, researchers have incorporated further prognostic factors, such as microvascular infiltration, and proposed some new prognostic models for HCC. To provide insights into the prospects of clinical oncology research, this review describes the commonly used HCC staging systems and new models proposed in recent years.

Department of Clinicopathological analysis of papillary thyroid carcinoma with Hashimoto’s thyroiditis / 中华内分泌外科杂志

Objective:To discuss the effect of Hashimoto’s thyroiditis (HT) on papillary thyroid carcinoma (РТС) .Methods:The clinical features and pathological characteristics of 682 patients who underwent surgical treatment for the first time from Sep. 1st,2019 to May. 1st, 2021 in Department of Thyroid, Breast and Hernia Surgery, and confirmed by postoperative pathology as papillary thyroid carcinoma were retrospectively analyzed. There were 189 male patients, and 493 female patients, 529 patients < 55 years old and 153 patients ≥55 years old. 476 patients were classified as PTC group and 206 patients as PTC combined with HT group. Chi square test was used to compare the difference between two groups in gender, age, thyroglobulin antibody, thyroid stimulating hormone, thyroid peroxidase antibodies, thyroid peroxidase, number of lesions, metastasis lymph node in central region, thyroid stimulating hormone receptor antibody, carcinoembryonic antigen, whether microcarcinoma, vascular invasion, glandular outside violation, capsule and lateral transfer analysis, ultrasonic calcification, etc. At the same time, all patients were divided into the group without central lymph node metastasis (345 cases) and the group with central lymph node metastasis (337 cases) . The χ 2 test was used to compare the differences between the two groups in terms of sex, age, number of lesions, microcarcinoma, vascular invasion, extradular invasion, capsular invasion, lateral cervical lymph node metastasis, ultrasonic calcification and so on, so as to analyze the differences in clinical characteristics between the two groups. Results:There were 206 cases (30.21%) in PTC combined with HT group and 476 cases (69.79%) in PTC without HT group. There were significant differences in gender (12/194 vs 177/299) ( P=0.000) , age (175/31 vs 354/122) ( P=0.002) , TgAb (115/91 vs 455/21) ( P=0.000) ,TSH (13/175/18 vs 33/429/14) ( P=0.004) , TPOAb (90/116 vs 422/54) ( P=0.000) , number of lesions (114/92 vs 325/151) ( P=0.001) and lymph node metastasis in central area (87/119 vs 250/226) ( P=0.014) between the two groups ( P < 0.05) , but there were no significant differences in TRAb (196/10 vs 461/15) ( P=0.171) , CEA (205/1 vs 469/7) ( P=0.478) , microcarcinoma (136/70 vs 309/167) ( P=0.781) , vascular invasion (4/202 vs 16/460) ( P=0.446) , extraglandular invasion (52/154 vs 108/368) ( P=0.470) , capsule invasion (149/57 vs 358/118) ( P=0.429) , lateral neck lymph node metastasis (31/175 vs 72/404) ( P=0.979) or ultrasonic calcification (157/49 vs 392/84) ( P=0.063) . Compared with PTC group, PTC combined with HT group had the characteristics of more women, younger age, high TgAb, high TSH, high TPOAb, multiple lesions and high proportion of non central lymph node metastasis. There were 345 cases (50.59%) without central lymph node metastasis and 337 cases (49.41%) with central lymph node metastasis. Gender (71/274 vs 118/219) ( P=0.000) , age (246/99 vs 283/54) ( P=0.000) , exadular invasion (66/279 vs 94/243) ( P=0.007) , number of lesions (240/105 vs 199/138) ( P=0.004) , microcarcinoma (259/86 vs 186/151) ( P=0.000) , calcification on ultrasound (250/95 vs 299/38) ( P=0.000) , and HT (119/226 vs 87/250) ) ( P=0.014) had statistical significance ( P<0.05) but had no statistical significance in capsule invasion (250/95 vs 257/80) ( P=0.256) or vascular invasion (10/335 vs 10/327) ( P=0.958) . In addition, patients in the group with central lymph node metastasis were more male, younger, with multiple lesions, exadenocarcinoma, less microcarcinoma, and calcification on ultrasound without hashimoto. Univariate analysis showed that gender, age, number of lesions, extraglandular invasion, calcification, microcarcinoma and Hashimoto had significant effects on lymph node metastasis in the central region; Multivariate analysis showed that the presence of microcarcinoma, ultrasonic calcification, Hashimoto and the number of lesions were independent risk factors for central lymph node metastasis. Conclusion:HT may promote the occurrence of PTC, but at the same time inhibit its development, so that PC patients with HT have a better prognosis.

One case of recurrent parathyroid carcinoma complicated with lung metastasis after parathyroid adenoma operation and literature review / 中华内分泌外科杂志

This paper reports the clinical data of a patient with recurrent metastatic parathyroid carcinoma. The causes, clinical manifestation, diagnose, treatment and prognosis of parathyroid carcinoma were discussed in order to perfect the experience of diagnosis and treatment and improve the survival rate of such patients.

Potential Mechanism of Buzhong Yiqitang for Autoimmune Thyroiditis Based on miRNA Sequencing / 中国实验方剂学杂志

ObjectiveTo determine the influence of Buzhong Yiqitang on miRNA expression in thyroid tissues of mice with autoimmune thyroiditis （AIT）. MethodThirty female 8-week-old NOD.H-2h4 mice were randomly assigned into normal control group， model group， and Buzhong Yiqitang group （BG）， 10 in each group. Mice were subjected to a diet containing 0.05% sodium iodide for 8 weeks to build the AIT mouse model. After 8 weeks of administration （ig）， samples were collected. A thyroid biopsy was performed on each group of mice， and differential miRNAs in thyroid tissues from each group of mice were analyzed based on experimental validation and bioinformatics. ResultCompared with the conditions of normal control group， thyroid lymphocytes had significant inflammatory infiltration， and there was an increase in serum TgAb level and interleukin（IL）-6 and IL-17 expression and a decrease in IL-1β expression in mice of the model group （P<0.05， P<0.01）. In addition， 154 differentially expressed miRNAs were found. Compared with the conditions of model group， the degree of thyroid tissue inflammation was alleviated， and serum TgAb level， and IL-1β， IL-6 and IL-17 expression of mice treated with the Buzhong Yiqitang were reduced （P<0.05， P<0.01）. Additionally， 112 differentially expressed miRNAs were identified in the BG group. Validation using real-time polymerase chain reaction（Real-time PCR） showed the same trend for miR-326-3p， miR-128-3p， miR-223-5p， miR-141-3p， miR-871-3p， and miR-204-3p as that obtained from miRNA sequencing. In particular， gene ontology（GO） functions were enriched for regulation of T cell activation， oxidative stress， and miRNA binding. Pathways identified by Kyoto encyclopedia of genes and genomes（KEGG）database tended to be enriched in phosphatidylinositol 3-kinases（PI3K）/protein kinase B（Akt）， mitogen-activated protein kinase（MAPK）， and cyclic adenosine monophosphate（cAMP） signaling pathways. Based on miRNA prediction differences， three key genes were identified： SMAD3， JAK2， and STAT3. ConclusionBushong Yiqitang might treat autoimmune thyroiditis by regulating 6 miRNAs.

Analysis of the risk factors for severe hyperlipidemic acute pancreatitis / 中华胰腺病杂志

Objective:To explore the risk factors for hyperlipidemic acute pancreatitis (HTGP).Methods:The clincial data of 169 HTGP cases admitted in Capital Medical University Attached Xuanwu Hospital from September 2012 to December 2018 were retrospectively analyzed. Patients were divided into severe HTGP group ( n=63) and mild or moderately severe HTGP group ( n=106). Clinical data were compared between two groups and variables with statistically significance and clinical values were chosen and included for binary logistic regression to explore the independent risk factors for severe HTGP. Results:Severe HTGP patients′ heart beat and respiratory rate were significantly higher than moderately severe or mild HTGP cases, while the percentage of patients with previous AP history in severe HTGP group was obviously lower than moderately severe or mild HTGP cases. There were no statistically significant differences on other baseline data and previous history. Severe HTGP patients had significantly higher white blood cell, mean platelet volume, erythrocyte sedimentation rate, total protein, C-reaction protein on first day, C-reaction protein on third day, amylase, lipase, triacylglycerol, prothrombin time, D-dimer, fibrinogen, CTSI, APACHEⅡ score and Ranson score than those in moderately severe or mild HTGP cases; the lymphocyte count, albumin-globulin ratio, uric acid, apolipoprotein-A1, blood calcium, prothrombin activity were obviously lower than those in moderately severe or mild HTGP cases; and all the differences were statistically significant. Triglyceride and CRP on the first and third day, CTSI, APACHEⅡ score and Ranson score were included for binary logistic regression model, and the results showed that triglyceride on the first day ( OR=1.08, 95% CI 1.02-1.14, P=0.01), C-reaction protein on the third day ( OR=1.01, 95% CI 1.00-1.01, P<0.01), CTSI score( OR=1.51, 95% CI 1.06-2.13, P=0.02), APACHEⅡ score( OR=1.22, 95% CI 1.07-1.40, P<0.01)were the risk factors of severe HTGP, while triglyceride on the third day ( OR=0.8, 95% CI 0.69-0.91, P=0.00)was the protective factor of severe HTGP. Conclusions:Triglyceride on the first day, C-reaction protein on the third day, CTSI score and APACHEⅡ score were the risk factors of severe HTGP, which deserve special attention.

Analysis of the risk factors for severe hyperlipidemic acute pancreatitis / 中华胰腺病杂志

Objective@#To explore the risk factors for hyperlipidemic acute pancreatitis (HTGP).@*Methods@#The clincial data of 169 HTGP cases admitted in Capital Medical University Attached Xuanwu Hospital from September 2012 to December 2018 were retrospectively analyzed. Patients were divided into severe HTGP group (n=63) and mild or moderately severe HTGP group (n=106). Clinical data were compared between two groups and variables with statistically significance and clinical values were chosen and included for binary logistic regression to explore the independent risk factors for severe HTGP.@*Results@#Severe HTGP patients′ heart beat and respiratory rate were significantly higher than moderately severe or mild HTGP cases, while the percentage of patients with previous AP history in severe HTGP group was obviously lower than moderately severe or mild HTGP cases. There were no statistically significant differences on other baseline data and previous history. Severe HTGP patients had significantly higher white blood cell, mean platelet volume, erythrocyte sedimentation rate, total protein, C-reaction protein on first day, C-reaction protein on third day, amylase, lipase, triacylglycerol, prothrombin time, D-dimer, fibrinogen, CTSI, APACHEⅡ score and Ranson score than those in moderately severe or mild HTGP cases; the lymphocyte count, albumin-globulin ratio, uric acid, apolipoprotein-A1, blood calcium, prothrombin activity were obviously lower than those in moderately severe or mild HTGP cases; and all the differences were statistically significant. Triglyceride and CRP on the first and third day, CTSI, APACHEⅡ score and Ranson score were included for binary logistic regression model, and the results showed that triglyceride on the first day (OR=1.08, 95% CI 1.02-1.14, P=0.01), C-reaction protein on the third day (OR=1.01, 95% CI 1.00-1.01, P<0.01), CTSI score(OR=1.51, 95% CI 1.06-2.13, P=0.02), APACHEⅡ score(OR=1.22, 95% CI 1.07-1.40, P<0.01)were the risk factors of severe HTGP, while triglyceride on the third day (OR=0.8, 95% CI 0.69-0.91, P=0.00)was the protective factor of severe HTGP.@*Conclusions@#Triglyceride on the first day, C-reaction protein on the third day, CTSI score and APACHEⅡ score were the risk factors of severe HTGP, which deserve special attention.

Correlation of apolipoprotein levels with the severity of hyperlipidemic acute pancreatitis / 中华全科医师杂志

Objective@#To explore the correlation of apolipoprotein levels with the severity of hyperlipidemic acute pancreatitis.@*Methods@#Clinical date of 169 patients with hyperlipidemic acute pancreatitis (AP) admitted in our hospital from September 2012 to December 2018 were retrospectively analyzed. Apolipoprotein (Apo) AⅠ, Apo B, Apo B/Apo AⅠ ratio were compared among hyperlipidemic AP patients with different severity. Pearson correlation analysis was conducted to explore the correlation of Apo AⅠ, Apo B, Apo B/Apo AⅠ with Atlanta classification, CTSI score, APACHE-Ⅱscore, RANSON score and C-reaction protein level. The optimal cut-off point of apolipoproteins for predict the severe hyperlipidemic AP was determined by ROC curve. The local and systemic complications of pancreatitis patients with different Apo levels were compared with chi-square test.@*Results@#There were no significant differences in general conditions among patients with severe AP (SAP), median-severe AP (MSAP) and mild AP (MAP). The Apo AⅠ levels of SAP [ (0.89±0.36) g/L] were lower than those of MSAP [(1.07±0.40)g/L, t=2.07, P=0.04] and MAP [(1.14±0.70) g/L, t=2.55, P=0.01]. Apo AⅠ was negatively correlated with Atlanta classification (r=-0.24, P<0.01). The optimal cut-off point of Apo A Ⅰ to predict SAP was 0.8 g/L, with the sensitivity of 0.877, specificity of 0.674 and Youden index of 0.55. The area under curve (AUC) was 0.623 (P<0.01). The proportions of SAP patients [52.94% (27/51) vs. 30.51%(36/118), χ2=7.66, P<0.01] and the patients of APACHE-Ⅱscore>8 [70.59%(36/51) vs. 55.08%(65/118), χ2=3.56, P=0.04] in patients with Apo AⅠ≤0.8 g/L were higher than those in patients with Apo AⅠ>0.8 g/L.@*Conclusion@#Apolipoprotein AⅠ level is negatively correlated with Atlanta classification and Apo AⅠ level can be used to predict severity of hyperlipidemic acute pancreatitis.

The effect of mobile application based interactive peer support on glycemic control in patients with type 1 diabetes mellitus / 中华内科杂志

Objective@#To evaluate the effect of mobile application (APP) based interactive peer support on glycemic control in patients with type 1 diabetes mellitus (T1DM).@*Methods@#The data of the present study were from the largest mobile APP platform for patients with T1DM in China, Tangtangquan. Patients with T1DM who has registered in the APP for at least 1 year and had completed data entry were recruited. According to the monthly interaction index during the first year of APP registration (including four indicators: praise, comment, posting and collection), the eligible patients were divided into the high-interaction group and the low-interaction group. The changes from baseline of self-blood glucose monitoring frequency (SMBG), glycosylated hemoglobin (HbA1c), incidence of hyperglycemia and incidence of hypoglycemia were compared between the two groups after one year of using the APP.@*Results@#A total of 238 patients with T1DM with an age of (27±8) years were included. Among them, 77.3% (184/238) were female. The baseline SMBG [the low-interaction group (1.71±1.14) times/day vs. the high-interaction group (1.82±1.15) times/day] and HbA1c [the low-interaction group (6.72±0.99)% vs. the high-interaction group (6.76±1.04)%] were comparable between the two groups. After one year use of the APP, the frequency of SMBG in the high-interaction group was significantly higher than that in the low-interaction group [ΔSMBG (0.59+2.06) times/d vs. (0.08+1.69) times/d, t=4.280, P=0.04), and the reduction of HbA1c was more obvious in the high-interaction group [ΔHbA1c (-0.40+1.10)% vs. (-0.06+1.13)%, t=5.651, P=0.018] than in the lower-interaction group. The incidence of hyperglycemia in the high-interaction group was significantly lower than that in the low-interaction group [13.19(6.22,23.19)% vs. 17.69(10.56,30.49)%, Z=2.850, P=0.005]. There was no significant difference in the incidence of hypoglycemia between the two groups [4.62(2.14, 8.03)% vs. 4.83(2.06, 8.87)%, Z=1.276, P=0.204]. The correlation analysis showed that interaction index was significantly associated with the reduction of HbA1c and incidence of hyperglycemia.@*Conclusion@#Participation in interactive peer education via mobile APP may be beneficent for glycemic control in patients with T1DM.

Characteristic prenatal MRI signs in diagnosis of placenta accreta / 中国医学影像技术

Objective To explore the value of prenatal MRI signs in diagnosis of placenta accreta.Methods MRI data of 163 pregnant women with suspected placenta accreta were retrospectively reviewed.According to the results of cesarean section,they were divided into placenta accreta group (n =136) or without placenta accreta group (n =27).The differencesof MRI signs between the two groups were compared.Taking cesarean section results as the gold standard,the sensitivity,specificity,positive and negative predictive value of MRI signs were calculated,respectively.Results Uterine bulging,abnormal vessels and hypointense T2WI bands at junction of placental and myometrium,as well as uterine recess had statistical differences between the two groups (all P＜0.05).No statistical difference of placental heterogeneity,focal interruptions in myometrial wall,uterine penetration and parametrium implantation nor protrusion of placenta into cervix was found between the two groups (all P＞0.05).The MRI signs of uterine penetration and parametrium implantation,uterine recess,protrusion of placenta into cervix yielded a specificity and positive predictive value of 100％,respectively.Conclusion Prenatal MRI has high efficacy in the diagnosis of placenta accrete.Placenta accrete should be highly suspected especially in the presence of uterine penetration and parametrium implantation,uterine recess and protrusion of placenta into the cervix.

Diagnostic value of fast imaging employing steady state acquisition and single shot fast spin echo sequences in diagnosis of normal fetal thymuses: Comparative study / 中国医学影像技术

Objective To compare the diagnostic value of MR examination with fast imaging employing steady state acquisition (FIESTA) and single shot fast spin echo (SSFSE) sequences for normal fetal thymuses.Methods Totally 366 normal fetuses were examined using MRI with FIESTA and SSFSE sequences,and the anatomy and MR manifestations of thymuses were observed.Kappa analysis and x2 test were performed.The transverse area (TA) and transverse diameter (TD) were measured on the "three vessel" level,while the superoinferior diameter (SID) was measured on the sagittal level.The mean value of these parameters at different gestational were calculated,and the regression equations of each parameter and gestational age were fitted.Results Two doctors had good agreements with the images of FIESTA and SSFSE sequences (Kappa=0.745,0.802,both P＜0.01).The clear rate of FIESTA and SSFSE sequences was 86.34％ (632/732) and 37.70％ (276/732) respectively,and the differences were significant (x2 =367.520,P＜0.001).The thymic size increased with the gestational age,and the regression equations and correlation coefficients were:TA =-5.80 + 0.35 ×gestational (r=0.820,P＜0.01),TD=-14.59+1.63×gestational (r=0.817,P＜0.01),and SID=-9.63+1.44×gestational (r=0.778,P＜0.01).Conclusion The subtle structure and contour of fetal thymus showed with FIESTA sequence are clearer than those of SSFSE sequence.MRI can clearly show fetal thymus after 22 weeks of pregnancy.

Diagnostic value of fast imaging employing steady state acquisition and single shot fast spin echo sequences in diagnosis of normal fetal thymuses: Comparative study / 中国医学影像技术

Objective To compare the diagnostic value of MR examination with fast imaging employing steady state acquisition (FIESTA) and single shot fast spin echo (SSFSE) sequences for normal fetal thymuses.Methods Totally 366 normal fetuses were examined using MRI with FIESTA and SSFSE sequences,and the anatomy and MR manifestations of thymuses were observed.Kappa analysis and x2 test were performed.The transverse area (TA) and transverse diameter (TD) were measured on the "three vessel" level,while the superoinferior diameter (SID) was measured on the sagittal level.The mean value of these parameters at different gestational were calculated,and the regression equations of each parameter and gestational age were fitted.Results Two doctors had good agreements with the images of FIESTA and SSFSE sequences (Kappa=0.745,0.802,both P＜0.01).The clear rate of FIESTA and SSFSE sequences was 86.34％ (632/732) and 37.70％ (276/732) respectively,and the differences were significant (x2 =367.520,P＜0.001).The thymic size increased with the gestational age,and the regression equations and correlation coefficients were:TA =-5.80 + 0.35 ×gestational (r=0.820,P＜0.01),TD=-14.59+1.63×gestational (r=0.817,P＜0.01),and SID=-9.63+1.44×gestational (r=0.778,P＜0.01).Conclusion The subtle structure and contour of fetal thymus showed with FIESTA sequence are clearer than those of SSFSE sequence.MRI can clearly show fetal thymus after 22 weeks of pregnancy.