Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging / 中国康复理论与实践

ObjectiveTo explore the effect of virtual reality on upper limb function in stroke patients through diffusion tensor imaging (DTI). MethodsFrom September, 2021 to March, 2023, 80 stroke patients in the Fuzhou Second General Hospital were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation, while the experimental group received virtual reality training additionally, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) before treatment, after treatment and after four-week follow-up; and they were scaned with DTI to measure the fractional anisotropy (FA) and relative anisotropy (RA) of cerebral peduncle and posterior limb of inner capsule of the affected side before and after treatment. ResultsTwo cases dropped in each group. The FMA-UE and ARAT scores increased in both groups after treatment and follow-up (F > 2.790, P < 0.001), and increased more in the experimental group than in the control group (t > 2.297, P < 0.05). FA and RA in the posterior limb of inner capsule increased in both groups after treatment (t > 21.013, P < 0.001), and increased more in the experimental group (t > 2.006, P < 0.05). The d-value of FA of the posterior limb of internal capsule before and after treatment (ΔFA) was positively correlated with the d-value of FMA-UE score (r > 0.362, P < 0.05) in both groups, the ΔFA of the posterior limb of internal capsule was positively correlated with the d-value of ARAT score (r = 0.459, P < 0.01). ConclusionVirtual reality training can promote the recovery of upper limb function in stroke patients, which may associate with the conductivity of posterior limb of inner capsule.

Effect of continuous blood purification on immunity and endothelial cell function in patients with sepsis / 中华危重病急救医学

Objective:To explore the effect of continuous blood purification (CBP) on the immunity and endothelial cell function of patients with sepsis.Methods:A prospective study was conducted. The patients aged ≥18 years old and meeting the diagnostic criteria of sepsis admitted to the department of critical care medicine of Binzhou Medical University Hospital from March 2019 to October 2020 were selected as the research subjects, and the patients were divided into standard treatment group and CBP treatment group according to random number table method. Both groups were given standard treatment including initial fluid resuscitation, infection source control and antibiotics according to the 2016 international guidelines for the management of sepsis and septic shock. CBP treatment group was additionally given continuous veno-venous hemofiltration (CVVH) at a dose of 25-30 mL·kg -1·h -1 and blood flow rate of 150-200 mL/min for more than 20 hours a day for 3 days. The clinical data of patients including blood lactic acid (Lac), procalcitonin (PCT), lymphocyte count (LYM), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score were recorded before treatment and 1 day and 3 days after treatment. At the same time, the venous blood was collected, and the immune function related indexes [interleukins (IL-4, IL-7), programmed death receptor-1 (PD-1), programmed death ligand-1 (PD-L1), interferon-γ (IFN-γ)] and endothelial cell injury related markers [soluble thrombomodulin (sTM), angiopoietin-2 (Ang-2), von Willebrand factor (vWF), heparan sulfate (HS), syndecan-1 (SDC-1)] levels in serum were determined by enzyme-linked immunosorbent assay (ELISA). The length of intensive care unit (ICU) stay of patients in the two groups was recorded, and the outcomes of patients in the two groups were followed up for 28 days. Results:Finally, 20 patients were enrolled in the standard treatment group, and 19 patients were enrolled in the CBP treatment group. There were no significant differences in gender, age and infection site between the two groups. The length of ICU stay in the standard treatment group was (10±5) days, and 5 patients died and 15 patients survived after 28 days. The length of ICU stay in the CBP treatment group was (9±4) days, and 8 patients died and 11 patients survived after 28 days. There were no significant differences in the length of ICU stay and number of patients who died within 28 days between the two groups (both P > 0.05). There were no significant differences in the Lac, PCT, LYM, APACHEⅡ score, SOFA score and immune function and endothelial cell injury related indexes before treatment and 1 day after treatment between the two groups. After 3 days of treatment, the Lac, PCT, APACHEⅡ score and SOFA score of the CBP treatment group were significantly lower than those before treatment, and pro-inflammatory and anti-inflammatory cytokines such as IFN-γ and IL-4, apoptosis-related indicators such as PD-1 and IL-7, and endothelial injury related factors such as sTM, SDC-1 and HS were significantly improved compared with the pre-treatment, the improvement degree of the above indicators was more obvious than that of the standard treatment group, and LYM was significantly higher than that of the standard treatment group (×10 9/L: 1.3±0.3 vs. 0.9±0.4, P < 0.05), IL-4, IFN-γ, IFN-γ/IL-4 ratio, IL-7, PD-1, sTM, SDC-1, HS, and Ang-2 were significantly lower than those of the standard treatment group [IL-4 (ng/L): 2.8 (1.5, 3.2) vs. 3.3 (2.7, 5.2), IFN-γ (ng/L): 6.3 (5.4, 106.5) vs. 217.9 (71.4, 517.1), IFN-γ/IL-4 ratio: 3.7 (1.8, 70.3) vs. 59.1 (18.3, 124.9), IL-7 (ng/L): 4.6 (3.2, 5.1) vs. 6.3 (5.2, 8.0), PD-1 (μg/L): 0.04 (0.03, 0.06) vs. 0.08 (0.05, 0.12), sTM (μg/L): 4.9 (4.3, 7.4) vs. 8.7 (6.0, 10.8), SDC-1 (μg/L): 0.6 (0.3, 1.1) vs. 0.9 (0.8, 2.5), HS (ng/L): 434.8 (256.2, 805.0) vs. 887.9 (620.1, 957.3), Ang-2 (ng/L): 934.0 (673.3, 1 502.1) vs. 2 233.9 (1 472.5, 3 808.4)], the differences were statistically significant (all P < 0.05). Conclusion:CBP treatment can eliminate the patient's immunosuppressive state, reduce a variety of endothelial injury markers and the degradation of glycocalyx, but cannot decrease the 28-day death risk or shorten the length of ICU stay.

Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.@*METHODS@#Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).@*RESULTS@#We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.@*CONCLUSION@#The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01597232.

Serum amyloid A 3 deficiency improves cognitive impairment and attenuates tau pathology in mouse model of Alzheimer′s disease / 中国药科大学学报

@#To explore the effects of serum amyloid A (SAA) on the cognitive function and tau phosphorylation in Alzheimer''s disease (AD), two mouse models of AD were constructed: one is the APP/PS1 double transgenic mice mated with the Saa3 knockout (Saa3-/-) mice, and the other involves intracerebroventricular (ICV) injection of streptozotocin (STZ) into WT and Saa3-/- mice.The expression of Saa3 in mouse brain was evaluated using immunofluorescence staining.The body weight of STZ injection mice during modeling was measured.The motor coordination and balance, spontaneous exploratory activity, and anxiety level of these mice were assessed by Rotarod test, open field, and elevated plus maze, respectively.Spatial reference learning and memory were evaluated by Morris water maze.Western blot was used to detect the phosphorylation level of tau protein in mouse brain tissue.The results showed that the expression of Saa3 was increased in the brain of AD mice.The Saa3 gene deletion had no significant effect on motor coordination, balance and spontaneous exploratory activity in these mice, yet with alleviated anxiety level of AD model mice.Saa3 deficiency improved the impairment of learning and memory function of intracerebroventricular STZ injection mice and APP/PS1 mice. Deletion of Saa3 relieved the hyperphosphorylation of tau protein at specific sites in the brain of AD mice. The difference between the groups was statistically significant (P < 0.05). These results suggest that Saa3 is associated with cognitive function and tau pathology in AD, and that the inhibition of SAA may be a new strategy for the treatment of AD.

Temporal dynamics in viral shedding and transmissibility of COVID-19

We report temporal patterns of viral shedding in 94 laboratory-confirmed COVID-19 patients and modelled COVID-19 infectiousness profile from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% of transmission could occur before first symptoms of the index. Disease control measures should be adjusted to account for probable substantial pre-symptomatic transmission.

Significance of high mobility group box 1, von Willebrand factor and other cytokines in the evaluation of severity and prognosis of sepsis patients / 中华危重病急救医学

Objective:To explore the value of high mobility group box 1 (HMGB1), von Willebrand factor (vWF) and other cytokines in predicting the severity and prognosis of sepsis patients.Methods:Patients with sepsis and septic shock who ≥18 years old and met the Sepsis-3 diagnostic criteria admitted to the department of critical care medicine of Binzhou Medical University Hospital from January to June 2019 were taken as the research objects. The healthy individuals for regular health examination in the same period were taken as the control. The basic information, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) scores were recorded. The venous blood was taken within 24 hours after the patients were diagnosed. The levels of HMGB1, vWF, tumour necrosis factor-α (TNF-α), interleukin-10 (IL-10), soluble thrombomodulin (sTM), vascular endothelial growth factor receptor 2 (VEGFR-2), angiopoetin-2 (Ang-2) and other cytokines in serum were determined by enzyme linked immunosorbent assay (ELISA). Differences among patients with sepsis, septic shock, healthy physical examinees, and patients who died in 28-day and those who survived, were compared. Spearman rank correlation method was used to analyze the correlation among each cytokine and APACHEⅡ, SOFA scores. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of cytokines on the prognosis of patients with sepsis/septic shock. Logistic regression was used to analyze the risk factors of 28-day death.Results:Eleven patients with sepsis, 25 patients with septic shock and 30 healthy individuals were enrolled. Among the patients with sepsis/septic shock, 15 died in 28-day and 21 survived. The serum levels of TNF-α, IL-10, HMGB1, vWF, sTM and VEGFR-2 in patients with sepsis were significantly higher than those in the healthy control group. The levels of TNF-α, IL-10, HMGB1, vWF, sTM in septic shock group were higher than those in the sepsis group, while the Ang-2 level decreased significantly. The serum levels of TNF-α, IL-10, HMGB1, vWF and sTM in the death group were higher than those in the survival group, while Ang-2 was lower than the survival group. Spearman correlation analysis showed that HMGB1, TNF-α, sTM, IL-10, vWF were positively correlated with APACHEⅡ score when patients with sepsis/septic shock were enrolled ( r values were 0.652, 0.666, 0.445, 0.430 and 0.355, respectively, all P < 0.05), and HMGB1, TNF-α also positively correlated with SOFA score ( r values were 0.433, 0.479, both P < 0.05). Ang-2 was negatively correlated with APACHEⅡ and SOFA scores ( r values were -0.519, -0.440, both P < 0.05). ROC curve analysis showed that the predictive value of HMGB1, vWF, IL-10, sTM for 28-day death in patients with sepsis/septic shock were higher than the APACHEⅡ score [the area under ROC curve (AUC) and 95% confidence interval (95% CI): 0.946 (0.870-1.000), 0.902 (0.790-1.000), 0.877 (0.745-1.000), 0.868 (0.734-1.000) vs. 0.846 (0.700-0.991)]. Logistic regression analysis showed that APACHEⅡ score, vWF, sTM, and IL-10 were independent risk factors for 28-day death in patients with sepsis/septic shock (β values were 4.731, 0.407, -7.058, -0.887, all P < 0.05). Conclusion:HMGB1, vWF, IL-10, sTM and other cytokines all can be used to evaluate the severity and prognosis of sepsis patients.

Effect of serum amyloid A on microglial migration and its mechanism / 中国药科大学学报

@#To investigate the effect of serum amyloid A (SAA) on microglial migration and its mechanism,the migration ability of SAA-induced primary microglia and murine N9 microglia,and the effect of formyl peptide receptor 2 (FPR2) antagonist and TLR2 neutralizing antibody on SAA-induced migration of N9 microglia were all examined by Transwell assay. The expression changes of FPR2 and Toll-like receptor 2 (TLR2) in N9 microglia after SAA stimulation were detected by real-time PCR. The effect of SAA on the expression of downstream signaling pathway kinases in N9 microglia was detected by Western blot. The effect of signaling pathway inhibitors on SAA-induced N9 microglial migration was examined by Transwell assay. The results showed that SAA promoted the migration of primary microglia and N9 microglia in a concentration-dependent manner. FPR2 antagonist and TLR2 neutralizing antibody inhibited SAA-induced N9 cell migration. SAA promoted increased mRNA transcript levels of FPR2 and TLR2 in N9 microglia,and stimulated the activation of mitogen-activated protein kinases (MAPKs) and nuclear factor κB (NF-κB) signaling pathways in N9 microglia,as shown by increased extracellular regulated protein kinase (ERK),p38 and c-Jun N-terminal kinase (JNK) phosphorylation levels and decreased IκBα expression levels. Inhibitors of p38,JNK,and NF-κB signaling pathways inhibited SAA-induced migration of N9 microglia. The difference between the groups was statistically significant (P<0.05). These results indicate that SAA activates downstream p38,JNK,and NF-κB signaling pathways by acting on FPR2 and TLR2,thereby inducing microglia migration.

Effect of epidural labor analgesia on hyperalgesia in early postpartum period / 中华麻醉学杂志

Objective:To evaluate the effect of epidural labor analgesia on hyperalgesia in the early postpartum period.Methods:Ninety nulliparas of primigravid, of American Society of Anesthesiologists physical statusⅠor Ⅱ, aged 20-35 yr, who were at full term with a singleton fetus, at 38-41 weeks of gestation, were assigned to labor analgesia group (group LA, n=38) and labor group (group L, n=52) according to whether the patient requested epidural labor analgesia or not.Epidural labor analgesia was performed when the cervical dilatation was 3-4 cm in LA group.The mechanical pain threshold was measured on admission to the delivery room and at days 1, 2 and 3 after delivery.Visual analog scale scores were assessed and recorded when cervical dilatation was 3 cm (T 1), at complete cervical dilatation (T 2), and at 12, 24 and 48 h after delivery (T 3-5). The duration of the first and second stage of labor and amount of intrauterine bleeding 2 h after delivery were recorded.Apger scores at 1, 5 and 10 min after birth were recorded. Results:Fifty-one cases completed surgery in group L and 37 cases in group LA.Compared with group L, the mechanical pain threshold was significantly increased, and visual analog scale score at T 2-4 was decreased, the first and second stages of labor were prolonged( P<0.05), and no statistically significant change was found in intrauterine bleeding volume or Apgar score at 2 h after delivery in group LA( P >0.05). Conclusion:Epidural labor analgesia can reduce hyperalgesia in the early postpartum period.

Effect of stellate ganglion block on nighttime sleep quality in patient with primary sleep disorder / 中华麻醉学杂志

Objective:To evaluate the effect of stellate ganglion block on nighttime sleep quality in the patients with primary sleep disorders.Methods:Sixty patients of both sexes with primary sleep disorders, of American Society of Anesthesiology physical status Ⅰ or Ⅱ, aged 18-64 yr, weighing 40-75 kg, were randomized to 2 groups ( n=30 each): control group (group C) and stellate ganglion block group (group S). In group S, 0.2% ropivacaine 5 ml was injected into the surface of the right longus colli muscle where the the stellate ganglion was located under ultrasound guidance once a day for 7 consecutive days starting from 1 h before bedtime.While the equal volume of normal saline was given instead in group C. Patients′ Subjective Sleep Quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire before treatment (T 0) and 1-7 days after treatment.The objective sleep quality was evaluated with polysomnography.A bispectral index(BIS)monitor and a cerebral and regional blood oxygen monitoring system were used to monitor the BIS value and regional cerebral oxygen saturation (rSO 2) during sleep, which were recorded once every 30 min, and the 7-day average was calculated.The patients′ daytime advanced cognitive function was assessed for 3 consecutive days after the end of treatment (T 8-10), including the Continuous Attention Test and the Behavioral Test for Performing Defect Syndrome, and the 3-day average value was calculated.Venous blood samples were collected at T 0 and T 8 to measure the plasma noradrenaline, cortisol, and serotonin concentrations by high-performance liquid chromatography. Results:Compared with group C, the individual and total scores of Pittsburgh Sleep Quality Index were significantly decreased, the sleep latency, awakening time and fast wave sleep latency were shortened, the number of awakening was increased, the total sleep time was prolonged, the sleep efficiency and proportion of fast wave sleep were increased, S 1-S 2 ratio in slow-wave sleep was decreased, S 3-S 4 ratio was increased, BIS value was decreased, rSO 2 was increased, each parameter of Continuous Attention Test was decreased and each parameter of Behavioral Test for Performing Defect Syndrome was increased after treatment, and plasma noradrenaline level was decreased at T 8 in group S ( P<0.05). Conclusion:Stellate ganglion block can improve nighttime sleep quality in patients with primary sleep disorders.

Clinical effects of multipoint tiny incision with continuous buried suture in double eyelidplasty for patients with mild or moderate dermatolysis / 中华医学美学美容杂志

Objective:To analyze the effect of the multipoint tiny incision with continuous buried suture method in double eyelidplasty for patients with mild or moderate dermatolysis.Methods:Totally, 1 161 patients from May 2008 to February 2019 underwent the double-eyelid surgical procedure with the multipoint tiny incision with continuous buried suture method. 1 148 patients were female and 13 patients were male, ranging from 25 to 50 years old. All the patients had normal single-eyelid or inborn narrow double-eyelid without blepharoptosis and they were performed double eyelidplasty for the first time. During the operation, moderate orbicularis oculi muscle and orbital septum fat were cut down from the four or five tiny incisions which were all 2 mm long. Skin levator fixation was performed through continuous buring suture between subcutaneous and the levator aponeurosis. Postoperative follow-up time points were 3 months, 1 year and 5 years.Results:There were 10 patients that showed slight asymmetry, 8 patients' eyes showed shallow creases and 5 patients' double eyelids narrowed. These 23 patients were operated for the second time. Besides that, all the creases were symmetry, parallel and natural. Notched scars did not occur, and patients' satisfaction was achieved in the rest of the cases.Conclusions:Our double eyelid procedure creates natural and beautiful double eyelids without depressed scars. The blepharoplasty of multipoint tiny incision with continuous buried suture method can produce a desired aesthetic effect and it lasts for a long time.

Rapid identification of common medicinal snakes and their adulterants using the Bar-HRM analysis method.

Effective identification methods for snake species are lacking, exacerbating the extermination of medicinal and commercially valuable snake species. Hence, it is imperative to find fast and reliable methods to distinguish snake samples available on the market. Seventy-three samples from four families belonging to 13 genera were collected in China and found to contain common medicinal snakes and their adulterants. Cytochrome oxidase I (COI) was utilized as a DNA barcode to analyse these common snakes, and a DNA mini-barcode was employed for fast detection. Then, the DNA mini-barcode assays were coupled with a high-resolution melting (HRM) analysis (Bar-HRM) to realize the rapid discrimination of these snake species. The results showed the power of DNA barcoding with COI, which was capable of distinguishing all collected snake samples, and the combined Bar-HRM method can successfully identify the adulterants and different snake species. In particular, Bar-HRM revealed Bungarus fasciatus adulterants in B. multicinctus at concentrations as low as 1.6%. Moreover, the results of the study confirmed the effectiveness of the technique in terms of the rapid identification of snakes, which has great potential for ensuring the safety of commercially valuable snake species.

Correlation between CT-feature of lobulation and epidermal growth factor receptor gene mutations in advanced pulmonary adenocarcinoma / 中华放射学杂志

Objective@#To investigate the correlation between the feature of lobulation, degree of lobulation on CT images and epidermal growth factor receptor gene (EGFR) mutations in advanced pulmonary adenocarcinoma.@*Methods@#Two hundred and one patients who were diagnosed with advanced pulmonary adenocarcinoma between January and December 2017 and had undergone a chest CT and EGFR mutation testing at Shanghai Pulmonary Hospital were enrolled in this retrospective study. The clinical and imaging data of the patients were analyzed. The patients were classified into EGFR mutations group (107 cases) and wild type group (94 cases) according to whether EGFR gene mutation occurred. The feature of lobulation (described as presence of lobulation, absence of lobulation, or obscured margin), degree of lobulation (including deep lobulation, shallow lobulation, no lobulation, and obscured) on CT images were statistically compared between the two groups.@*Results@#Based on the presence or absence of lobulation sign, there were 99, 0, 8 cases with lobulation, no lobulation, obscured margin in the EGFR mutations group and 80, 1, 13 cases in the wild type group, respectively. There was no significant difference in lobulation sign between the EGFR mutations group and wild type group (P=0.152). According to the degree of lobulation, there were 32, 67, 0, 8 cases of deep lobulation, shallow lobulation, no lobulation, obscured margin in EGFR mutations group and 60, 20, 1, 13 cases in wild type group. Significant differences of frequency were found regarding deep lobulation and shallow lobulation between the two groups (P<0.001). However, there was no significant difference between the two groups in the presence of no lobulation, and obscured margin (P>0.05).@*Conclusions@#EGFR mutations are significantly associated with shallow lobulation in advanced pulmonary adenocarcinoma. Conversely, deep lobulation is more likely to appear in advanced pulmonary adenocarcinoma with wild-type EGFR. However, there is no association between EGFR mutation status and the presence of lobulation.

Correlation between CT?feature of lobulation and epidermal growth factor receptor gene mutations in advanced pulmonary adenocarcinoma / 中华放射学杂志

Objective To investigate the correlation between the feature of lobulation, degree of lobulation on CT images and epidermal growth factor receptor gene (EGFR) mutations in advanced pulmonary adenocarcinoma. Methods Two hundred and one patients who were diagnosed with advanced pulmonary adenocarcinoma between January and December 2017 and had undergone a chest CT and EGFR mutation testing at Shanghai Pulmonary Hospital were enrolled in this retrospective study. The clinical and imaging data of the patients were analyzed. The patients were classified into EGFR mutations group (107 cases) and wild type group (94 cases) according to whether EGFR gene mutation occurred. The feature of lobulation (described as presence of lobulation, absence of lobulation, or obscured margin), degree of lobulation (including deep lobulation, shallow lobulation, no lobulation, and obscured) on CT images were statistically compared between the two groups. Results Based on the presence or absence of lobulation sign, there were 99, 0, 8 cases with lobulation, no lobulation, obscured margin in the EGFR mutations group and 80, 1, 13 cases in the wild type group, respectively. There was no significant difference in lobulation sign between the EGFR mutations group and wild type group (P=0.152). According to the degree of lobulation, there were 32, 67, 0, 8 cases of deep lobulation, shallow lobulation, no lobulation, obscured margin in EGFR mutations group and 60, 20, 1, 13 cases in wild type group. Significant differences of frequency were found regarding deep lobulation and shallow lobulation between the two groups (P<0.001). However, there was no significant difference between the two groups in the presence of no lobulation, and obscured margin (P>0.05). Conclusions EGFR mutations are significantly associated with shallow lobulation in advanced pulmonary adenocarcinoma. Conversely, deep lobulation is more likely to appear in advanced pulmonary adenocarcinoma with wild?type EGFR. However, there is no association between EGFR mutation status and the presence of lobulation.

Cutaneous tuberculosis / 中华皮肤科杂志

Cutaneous tuberculosis is an infectious disease caused by Mycobacterium tuberculosis complex.Its clinical manifestations vary with infection route,host immunity,etc.Traditional laboratory examinations,including acid-fast staining followed by direct microscopy,cultivation,histopathological examination and so on,still play important roles in the diagnosis and treatment of cutaneous tuberculosis.Development of a series of laboratory techniques represented by nucleic acid amplification tests provides significant support for accurate clinical diagnosis and treatment in recent years.This review summarizes advances in the etiology,pathogenesis,clinical manifestations,laboratory examinations and treatment of cutaneous tuberculosis.

Effect of intraoperative warming on delirium during emergence from general anesthesia in elderly patients / 中华麻醉学杂志

Objective To evaluate the effect of intraoperative warming on delirium during emergence from general anesthesia in elderly patients.Methods Eighty elderly patients of both sexes,aged ≥ 65 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective total hip replacement,were assigned to routine group (group R,n=40) and warming group (group W,n=40).The non-operated site was covered using the sterile cloth,and no other active warming measurements were given in group C.Fluid was infused and warmed to 37 ℃,the non-operated site was covered using the forced-air warming system,and the temperature of the forced-air warming system was maintained at 38-42 ℃ in group W.The tympanic membrane temperatures was recorded at 5 min after anesthesia induction,at 30,60 and 90 min after beginning of surgery,at the end of surgery and at 30 min after emergence from anesthesia,and the difference between monitored values and monitored values on admission to operating room (△ T) was recorded at each time point.The intraoperative volume of fluid infused,operation time,extubation time,duration of postanesthesia care unit stay and development of delirium during emergence and shivering were recorded.Results Compared with group R,△T was significantly decreased at 60 and 90 min after beginning of surgery,the incidence of delirium during emergence and shivering was decreased,the extubation time and duration of postanesthesia care unit stay were shortened in group W (P＜0.05).Conclusion Intraoperative warming can decrease the development of delirium during emergence from general anesthesia and is helpful in improving the quality of recovery from anesthesia in elderly patients.

Effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder in female patients / 中华麻醉学杂志

Objective To evaluate the effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder (PTSD) in female patients with lower limb fracture.Methods Ninety female patients with lower limb fractures caused by traffic accident,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 20-35 yr,weighing 40-72 kg,scheduled for elective internal fixation,were divided into 3 groups (n =30 each) using a random number table:control group (group C),low-dose dexmedetomidine group (group D1) and high-dose dexmedetomidine group (group D2).Ropivacaine (0.75％) 10-15 ml was injected into the epidural space,and operation was started after pain disappeared at the plane T8-10.Two percent lidocaine 5-10 ml was intermittently injected to maintain the anesthetic plane at T10.After successful epidural anesthesia,dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused over 30 min in D1 and D2 groups,respectively,while the equal volume of normal saline was given in group C.Patient-controlled epidural analgesia was performed with 0.15％ ropivacaine after operation and lasted until 48 h postoperatively,maintaining visual analogue scale score ≤ 3 (baseline).Morphine 3 mg was intravenously injected for rescue analgesia when visual analogue scale score＞3.The requirement for rescue analgesia within 48 h after operation was recorded.Acute Stress Disorder Scale (ASDS),Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were assessed at 1 h before operation and on 1,3 and 7 days after operation.The patients were followed up for 3 months by telephone,and the PTSD Checklist-Civilian Version score was evaluated.The occurrence of acute PTSD (PTSD Checklist-Civilian Version score ＞ 38) was recorded.Results Compared with group C,the ASDS,SAS and SDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased in D1 and D2 groups (P＜0.05).Compared with group D1,the ASDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased (P＜0.05),and no significant change was found in SAS or SDS scores at each time point in group D2 (P＞ 0.05).There was no significant difference in the requirement for rescue analgesia between the three groups (P＞0.05).Conclusion Intraoperative application of dexmedetomidine can reduce the occurrence of acute PTSD and it is dose-related in female patients.

Association of AdipoQ single-nucleotide polymorphisms and smoking interaction with the risk of coronary heart disease in Chinese Han population.

AIMS: To investigate the impact of AdipoQ polymorphisms, and their additional interactions with smoking and drinking on coronary heart disease (CHD) risk based on Chinese population. METHODS: Hardy‒Weinberg equilibrium (HWE) was performed using SNPStats (available online at http://bioinfo.iconcologia.net/SNPstats ). Generalized multifactor dimensionality reduction (GMDR) model was used to screen the best gene‒gene and gene‒environment interaction combinations. Logistic regression was performed to investigate association between four single-nucleotide polymorphisms (SNPs) and CHD and the interaction effect between rs1501299 and smoking. RESULTS: Logistic analysis showed that CHD risks were higher in carriers with homozygous mutant of rs1501299 and rs2241766 than those with wild-type homozygotes, odds ratio (ORs) (95%CI) were 1.49 (1.19-1.95) and 1.71 (1.33-2.24), respectively, but CHD risks were lower in carriers with homozygous mutant of rs7649121 than those with wild-type homozygotes, OR (95%CI) was 0.72 (0.51-0.96). GMDR model indicated that there was a significant two-locus model (p = 0.0107) involving rs1501299 and current smoking, indicating a potential gene-environment interaction between rs1501299 and current smoking. Overall, the cross-validation consistency of this model was 9/10, and the testing accuracy was 60.11% (p = 0.0010). T-allele carriage had 42% prevalence, and one-quarter of them were current smokers. Smokers with rs1501299-GT or TT genotype have the highest CHD risk, compared to never-smokers with rs1501299-GG genotype, OR (95%CI) was 3.56 (1.91-5.42), after adjustment for gender, age, alcohol status, and body mass index. But we did not find any significant gene-gene and gene-drinking interaction combinations in GMDR models. CONCLUSIONS: Polymorphisms in rs1501299 and rs2241766, and their additional interactions between rs1501299 and smoking were associated with increased CHD risks: polymorphism in rs7649121 was associated with decreased CHD risks.

Structures and functions of tripartite-motif proteins / 中华微生物学和免疫学杂志

Members of the tripartite-motif (TRIM) protein family share a highly conserved domain architecture known as RBCC motif,which is composed of a RING finger domain,one or two B-box domains,a coiled-coil domain as well as diverse types of C-terminal regions.TRIM proteins can not only maintain the normal physiological functions of the body,but also regulate the development of various diseases.In the current review,we focus on recent advances in the structures of TRIM proteins and their functions in the development of viral infection,cancer and neurodegenerative disease.

Diagnosis and treatment strategies on vascular disease in abdominal surgery / 中华消化外科杂志

Although the incidence of vascular disease in abdominal surgery is low,there are speedy development,critical condition and high lethal rate when it happens.Moreover,the onset is usually latent and difficult in early diagnosis due to atypical clinical performance or non-specific signs at the early stage,with a high misdiagnosis rate.The aforementioned issues impose an urgent need to enhance the understanding of this type of disease.

Effects of Anisodine Hydrobromide on Cell Apoptosis and ERK1/2 Phosphorylation Level in Brain Tissue of Model Rats with Acute Cerebral Ischemia-reperfusion Injury / 中国药房

OBJECTIVE:To study the effects of anisodine hydrobromide on cell apoptosis and extracellular signal-regulated pro-tein kinase 1/2 (ERK1/2) phosphorylation (p-ERK1/2) level in brain tissue of model rats with acute cerebral ischemia-reperfusion injury. METHODS:Rats were randomly divided into sham operation group,model group,positive control group(nimodipine 1.0 mg/kg),anisodine hydrobromide high-dose,medium-dose,low-dose,extreme low-dose groups(1.2,0.6,0.3,0.15 mg/kg),8 in each group. Suture method was used to establish the rat models with acute cerebral ischemia-reperfusion injury. Rats were intrave-nously injected once in tail at 2nd of ischemia and 6th of reperfusion. Then adenosine triphosphate (ATP) enzyme activity,Ca2+content,cell apoptosis in brain tissue,p-ERK1/2 protein expression in brain tissue,and p-ERK1/2/total ERK1/2 (t-ERK1/2) pro-portion in brain tissue of rats were detected after 22 h of reperfusion. RESULTS:Compared with sham operation group,ATP en-zyme activity in brain tissue of rats in model group was obviously decreased,Ca2+ content was obviously increased,density of cell apoptosis in brain tissue was obviously increased,with statistical significances(P<0.01). Compared with model group,density of cell apoptosis in brain tissue was obviously decreased in each administration group;Ca2+ contents in brain tissue of rats in positive control group,anisodine hydrobromide high-dose,low-dose groups were obviously decreased;and p-ERK1/2/t-ERK1/2 proportion in brain tissue of rats in anisodine hydrobromide high-dose,low-dose,extreme low-dose groups were obviously increased,with sta-tistical significances(P<0.05 or P<0.01);the other differences were not statistically significant(P>0.05). CONCLUSIONS:An-isodine hydrobromide can inhibit the cell apoptosis in brain tissue of model rats with acute cerebral ischemia-reperfusion injury,andthe mechanism may be related with activating ERK1/2 signal pathway and regulating ATP enzyme activity to decrease the Ca2+content in the brain tissue.