Gut microbiota regulation of T lymphocyte subsets during systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by disturbance of pro-inflammatory and anti-inflammatory lymphocytes. Growing evidence shown that gut microbiota participated in the occurrence and development of SLE by affecting the differentiation and function of intestinal immune cells. The purpose of this study was to investigate the changes of gut microbiota in SLE and judge its associations with peripheral T lymphocytes. METHODS: A total of 19 SLE patients and 16 HCs were enrolled in this study. Flow cytometry was used to detect the number of peripheral T lymphocyte subsets, and 16 s rRNA was used to detect the relative abundance of gut microbiota. Analyzed the correlation between gut microbiota with SLEDAI, ESR, ds-DNA and complement. SPSS26.0 software was used to analyze the experimental data. Mann-Whitney U test was applied to compare T lymphocyte subsets. Spearman analysis was used for calculating correlation. RESULTS: Compared with HCs, the proportions of Tregs (P = 0.001), Tfh cells (P = 0.018) and Naïve CD4 + T cells (P = 0.004) significantly decreased in SLE patients, and proportions of Th17 cells (P = 0.020) and γδT cells (P = 0.018) increased in SLE. The diversity of SLE patients were significantly decreased. Addition, there were 11 species of flora were discovered to be distinctly different in SLE group (P < 0.05). In the correlation analysis of SLE, Tregs were positively correlated with Ruminococcus2 (P = 0.042), Th17 cells were positively correlated with Megamonas (P = 0.009), γδT cells were positively correlated with Megamonas (P = 0.003) and Streptococcus (P = 0.004), Tfh cells were positively correlated with Bacteroides (P = 0.040), and Th1 cells were negatively correlated with Bifidobacterium (P = 0.005). As for clinical indicators, the level of Tregs was negatively correlated with ESR (P = 0.031), but not with C3 and C4, and the remaining cells were not significantly correlated with ESR, C3 and C4. CONCLUSION: Gut microbiota and T lymphocyte subsets of SLE changed and related to each other, which may break the immune balance and affect the occurrence and development of SLE. Therefore, it is necessary to pay attention to the changes of gut microbiota and provide new ideas for the treatment of SLE.

Gastroesophageal reflux disease and non-alcoholic fatty liver disease: a two-sample Mendelian randomization combined with meta-analysis.

Accumulating evidence from observational studies have suggested an association between gastroesophageal reflux disease (GERD) and non-alcoholic fatty liver disease (NAFLD). However, due to that such studies are prone to biases, we imported Mendelian randomization (MR) to explore whether the causal association between two diseases exsit. Hence, we aimed to analysis the potential association with MR. The single nucleotide polymorphisms (SNPs) of GERD were retrieved from the genome-wide association study dataset as the exposure. The SNPs of NAFLD were taken from the FinnGen dataset as the outcome. The relationship was analyzed with the assistance of inverse variance weighted, MR-Egger, and weighted median. We also uitilized the MR-Egger intercept, Cochran's Q test, leave-one-out analysis, MR-PRESSO, and Steiger directionality test to evaluate the robustness of the causal association. The meta-analysis were also implemented to give an overall evaluation. Finally, our analysis showed a causal relationship between GERD and NAFLD with aid of MR and meta-analysis (OR 1.71 95% CI 1.40-2.09; P < 0.0001).

Correlation between serum phosphorus levels and outcomes of weaning from mechanical ventilation in elderly chronic obstructive pulmonary disease patients with type Ⅱ respiratory failure / 中华老年医学杂志

Objective:To investigate the correlation between serum phosphorus levels and outcomes of weaning from mechanical ventilation in elderly chronic obstructive pulmonary disease(COPD)patients with type Ⅱ respiratory failure.Methods:A total of 142 hospitalized elderly COPD patients with type Ⅱ respiratory failure receiving mechanical ventilation in our hospital from August 2016 to December 2018 were retrospectively enrolled.Patients were divided into the successful weaning group(n=101)and the unsuccessful weaning group(n=41)based on weaning outcomes.General data, blood phosphorus levels on admission and before spontaneous breathing trials(SBT)and the incidence of hypophosphatemia were compared between the two groups.The logistic regression equation was used to analyze the related factors for the unsuccessful weaning, and the receiver operating characteristics(ROC)curve was drawn to analyze the value of serum phosphorus levels in predicting the failure of weaning.Methods:Compared with the successful weaning group, Acute Physiology and Chronic Health evaluation Ⅱ(APACHEⅡ)scores, rapid shallow breathing index(RSBI), and serum creatinine(Cr), C-reactive protein(CRP)levels were higher, while the oxygenation index(PaO 2/FiO 2), serum albumin(ALB)and magnesium levels were lower in the unsuccessful weaning group than in the successful weaning group( P<0.05). The incidences of hypophosphatemia on admission and before SBT were higher in the unsuccessful weaning group than in the successful weaning group(34.2% or 34/41 vs.17.8% or 18/101, 46.3% or 19/41 vs.25.7% or 26/101, χ2=4.452 and 5.716, P<0.05). Serum phosphorus levels on admission and before SBT were lower in the unsuccessful weaning group than in the successful weaning group[(0.82±0.21) mmol/L vs.(1.05±0.23) mmol/L, (0.71±0.19) mmol/L vs.(1.02±0.22) mmol/L, t=5.171 and 7.646, P<0.05)]. Multivariate logistic regression analysis showed that hypophosphatemia on admission or before SBT was an independent risk factor for unsuccessful weaning in elderly COPD patients with type Ⅱ respiratory failure( P<0.05). The areas under the ROC curve(AUC)of hypophosphatemia on admission and before SBT for predicting the failure of weaning was 0.657 and 0.776, respectively, and with 0.84 mmol/L and 0.76 mmol/L as the respective optimal threshold values, the sensitivity and specificity were 67.3% and 68.3% for AUC on admission and 76.5% and 85.6% for AUC before SBT, respectively.AUC of the serum phosphorus level was higher before SBT than on admission( Z=3.142, P<0.05). Conclusions:The decrease of blood phosphorus levels is common in elderly COPD patients with type Ⅱ respiratory failure, and hypophosphatemia has a high incidence and may be an independent risk factor for the failure of weaning.Blood phosphorus levels should be closely monitored in order to guide clinical weaning.

Small cell lung cancer with panhypopituitarism due to ectopic adrenocorticotropic hormone syndrome: A case report.

BACKGROUND: Small cell lung cancer (SCLC) accounts for 15% of lung cancers, and it commonly expresses peptide and protein factors that are active as hormones. These secreting factors manifest as paraneoplastic disorders, such as ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS). The clinical features are abnormalities in carbohydrate metabolism, hypokalemia, peripheral edema, proximal myopathy, hypertension, hyperpigmentation, and severe systemic infection. However, it is uncommon that EAS has an influence on hypothalamus-pituitary function. CASE SUMMARY: A 62-year-old man presented with complaints of haemoptysis, polyuria, polydipsia, increased appetite, weight loss, and pigmentation. Following a series of laboratory and imaging examinations, he was diagnosed with SCLC, EAS, hypogonadism, hypothyroidism, and central diabetes insipidus. After three rounds of chemotherapy, levels of ACTH, cortisol, thyroid hormone, gonadal hormone, and urine volume had returned to normal levels. In addition, the pulmonary tumor was reduced in size. CONCLUSION: We report a rare case of SCLC complicated with panhypopituitarism due to EAS. We hypothesize that EAS induced high levels of serum glucocorticoid and negative feedback for the synthesis and secretion of antidiuretic hormone from the paraventricular nucleus, and trophic hormones from the anterior pituitary. Therefore, patients who present with symptoms of hypopituitarism, or even panhypopituitarism, with SCLC should be evaluated for EAS.

Antagonistic Effects of N-acetylcysteine on Mitogen-activated Protein Kinase Pathway Activation, Oxidative Stress and Inflammatory Responses in Rats with PM2.5 Induced Lung Injuries / 中国医学科学杂志(英文版)

Objective To evaluate the antagonistic effects of N-acetylcysteine (NAC) on mitogen-activated protein kinases (MAPK) pathway activation, oxidative stress and inflammatory responses in rats with lung injury induced by fine particulate matter (PM2.5). Methods Forty eight male Wistar rats were randomly divided into six groups: blank control group (C1), water drip control group (C2), PM2.5 exposed group (P), low-dose NAC treated and PM2.5 exposed group (L), middle-dose NAC treated and PM2.5 exposed group (M), and high-dose NAC treated and PM2.5 exposed group (H). PM2.5 suspension (7.5 mg/kg) was administered tracheally once a week for four times. NAC of 125 mg/kg, 250 mg/kg and 500 mg/kg was delivered intragastrically to L, M and H group respectively by gavage (10 ml/kg) for six days before PM2.5 exposure. The histopathological changes and human mucin 5 subtype AC (MUC5AC) content in lung tissue of rats were evaluated. We investigated IL-6 in serum and bronchoalveolar lavage fluid (BALF) by Enzyme-linked immunosorbent assay (ELISA), MUC5AC in lung tissue homogenate by ELISA, glutathione peroxidase (GSH-PX) in serum and BALF by spectrophotometry, and the expression of p-ERK1/2, p-JNK1/2 and p-p38 proteins by Western blot. All the measurements were analyzed and compared statistically. Results Lung tissue of rats exposed to PM2.5 showed histological destruction and increased mucus secretion of bronchial epithelial cells. Rats receiving NAC treatment showed less histological destruction and mucus secretion. Of P, L, M and H group, MUC5AC in lung tissue, IL-6 in serum and BALF were higher than controls (C1 and C2) (all P<0.05), with the highest levels found in the P group and a decreasing trend with increase of NAC dose. The activity of GSH-PX in serum and BALF of PM2.5 exposed rats (P, L, M and H) was lower than that of controls (all P<0.05), with higher activities found in NAC treated rats (L, M, and H), and an increasing trend with increase of NAC dose. The expressions of p-ERK1/2, p-JNK1/2 and p-p38 proteins in PM2.5 exposed lung tissue (P, L, M and H) was higher than controls (all P<0.05), with decreased levels and dose dependent downregulation found in NAC treated rats. Conclusion NAC can antagonize major MAPK pathway activation, lung oxidative stress and inflammatory injury induced by PM2.5 in rats.

Shengmai Injection combined with conventional treatment for acute myocardial infarction: A systematic review and Meta-analysis / 中草药

This Meta-analysis systematically assessed the efficacy and safety of Shengmai Injection (SMI) combined with conventional treatment for acute myocardial infarction (AMI). Seven online databases were investigated, then randomized clinical trials (RCTs) of treatment effects of AMI patients, for which SMI was used in combination with conventional therapy compared with conventional therapy alone, were included. The literatures selection, data extraction, and quality assessment were in accordance with the Cochrane standards. Data analysis was carried out using RevMan software (V.5.3). RCTs (enrolling 1 258 patients) from 18 literatures published in Chinese journals were included in the systermatic review. The additional SMI could significantly reduce the risk of mortality, arrhythmia, cardiogenic shock, heart failure and improve left ventricular ejection fraction (LVEF), stroke volume (SV), vascular patency rate. The adverse effects of mild bleeding, palpitation, shortness of breath, fatigue could occur both in the control group and the treatment group. Thus, it was difficult to evaluate the safety of SMI due to the limited data and low-guality RCTs. Therefore, high-quality and adequate sample of RCTs with low risk of bias are required to demonstrate its true effects.

A Highly Efficient and Reusable Palladium(II)/Cationic 2,2'-Bipyridyl-Catalyzed Stille Coupling in Water.

A water-soluble PdCl2(NH3)2/cationic 2,2'-bipyridyl system was found to be a highly efficient catalyst for Stille coupling of aryl iodides and bromides with organostannanes. The coupling reaction was conducted at 110 °C in water, under aerobic conditions, in the presence of NaHCO3 as a base to afford corresponding Stille coupling products in good to high yields. When aryltributylstannanes were employed, the reactions proceeded smoothly under a very low catalyst loading (as little as 0.0001 mol %). After simple extraction, the residual aqueous phase could be reused in subsequent runs, making this Stille coupling economical. In the case of tetramethylstannane, however, a greater catalyst loading (1 mol %) and the use of tetraethylammonium iodide as a phase-transfer agent were required in order to obtain satisfactory yields.

HIV-1 diversity in infected individuals in Suzhou and Suqian, China.

Jiangsu is one province with severe HIV-1 epidemic in China. However, the molecular epidemiological characterizations of HIV-1 in many cities of Jiangsu remain unclear. A molecular epidemiological investigation was performed based on 38 HIV-positive samples collected from Suzhou and Suqian during 2011-2013. Five HIV-1 genomic fragments, p17, pol, vif-vpr, vpr-env, and C2V3 were amplified and sequenced from these samples. HIV-1 group M subtype of each sample was determined by phylogenetic analyses with the standard reference sequences. Among these infected individuals, 81.6 % (31/38) self-reported to be infected via sexual contacts, including 50.0 % (19/38) via heterosexual contact and 31.6 % (12/38) via homosexual contact. Among 34 samples with available pol or vif-env sequence, 19 (55.9 %) CRF01_AE, 7 (20.6 %) CRF07_BC, 3 (8.8 %) CRF08_BC, and 5 (14.7 %) inter-subtype recombinants were identified. No pure B, B' and C subtypes were found in this cohort. The five recombinants contain one B/C, three CRF01/B and one CRF01/B/C recombinants. These results suggest that CRF01_AE was the most predominant HIV-1 group M subtype and CRF01_AE-involved recombinants were the major recombinant forms. Comparison showed that there was no obvious difference in HIV-1 group M subtype distribution between Jiangsu (including Suzhou and Suqian) and the surrounding provinces (e.g., Shanghai, Anhui, and Shandong). CRF01_AE and CRF07_BC were the top two predominant HIV-1 genotypes in Jiangsu, and less and/or no pure subtype B and C was currently circulating here. We predicted that more CRF01/CRF07 recombinants, but fewer B/C recombinants will be generated in Jiangsu in future.

[Aerosol Optical Properties in the Northern Suburb of Nanjing During Haze Days in January 2013].

In January 2013 large-scale, continuous and severe haze occurred in Nanjing. Three-wavelength photoacoustic soot spectrometer (PASS-3) was used for real-time, online and situ measurements of aerosol absorption and scattering coefficients in the northern suburb of Nanjing during January 2013. The results indicated that the average aerosol absorption and scattering coefficients were (83.20 ± 35.24) Mm⁻¹ and (670.16 ± 136.44) Mm⁻¹ during haze days, which were 3.85 and 3.45 times higher than those on clean days, respectively. The diurnal variation of absorption and scattering coefficients showed a bimodal distribution. The mean single scattering albedo and scattering Angstrom exponent were (0.89 ± 0.04) and (1.30 ± 0.27) respectively, indicating the predominance of scattering fine particles during haze days in Nanjing. Aerosols could be significantly removed by precipitation. The absorption and scattering coefficients showed negative correlations with surface wind speed, and the single scattering albedo and Angstrom exponent showed positive correlations with wind speed. Aerosol scattering coefficient was highest under southeasterly wind, whereas the absorption coefficient was highest under the southwesterly wind. In the three haze pollution events, Haze 1 and Haze 2 were mainly affected by long-range transportation of pollutants. Haze 1 was mainly affected by aging air mass from north Nanjing, Haze 2 was mainly affected by biomass burning air mass from southwest Nanjing, while Haze 3 was mainly caused by the high sulfate.

Xuezhikang () reduced renal cell apoptosis in streptozocin-induced diabetic rats through regulation of Bcl-2 family.

OBJECTIVE: To investigate the effect of Xuezhikang (, XZK) on renal cell apoptosis in diabetic rats and the possible mechanism. METHODS: Sixty-six rats were randomly divided into 3 groups: the normal, model and XZK groups. In each group, the rats were further randomly divided into 3-month and 6-month subgroups, respectively. Diabetes of rats was induced by a single intraperitoneal injection of 1% streptozocin at 60 mg/kg body weight. Rats in the XZK group received gastric perfusion of XZK (1200 mg/kg body weight) everyday for 3 or 6 months, while rats in the normal and model groups received equal volume of saline. Twenty-four hours' urine was collected for urinary albumin excretion (UAE) measurement. Periodic acid-Schiff (PAS) and Masson's trichrome staining were used for saccharides and collagen detection. Cell apoptosis of renal cortex was investigated by TdT-mediated dUTP nick end labeling (TUNEL) staining. Bax and Bcl-2 expressions were detected by immunohistochemistry and Western blot, respectively. Cytochrome C (Cyt C) and caspase-9 concentration were detected by Western blot. RESULTS: Compared with the model group, XZK treatment could significantly decrease the kidney hypertrophy index, 24 h UAE, renal cell apoptosis, cytoplasmic Cyt C level and active caspase-9 level, as well as suppress the increment of Bax and up-regulate the expression of Bcl-2, leading to the suppression of Bax/Bcl-2 ratio at 3 and 6 months (P<0.05 or P<0.01). Moreover, XZK treatment could alleviate the deposition of PAS-stained saccharides and Masson's trichromestained collagen to different extent. CONCLUSIONS: Renal cell apoptosis was observed in diabetic kidney, in which mitochondrial apoptotic pathway might be involved. XZK treatment could attenuate pathological changes in diabetic kidney and reduce renal cell apoptosis, probably via the suppression of Bax/Bcl-2 ratio, which lead to inhibition of Cyt C release and following caspase-9 activation.

Xuezhikang () reduced renal cell apoptosis in streptozocin-induced diabetic rats through regulation of Bcl-2 family / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of Xuezhikang (, XZK) on renal cell apoptosis in diabetic rats and the possible mechanism.</p><p><b>METHODS</b>Sixty-six rats were randomly divided into 3 groups: the normal, model and XZK groups. In each group, the rats were further randomly divided into 3-month and 6-month subgroups, respectively. Diabetes of rats was induced by a single intraperitoneal injection of 1% streptozocin at 60 mg/kg body weight. Rats in the XZK group received gastric perfusion of XZK (1200 mg/kg body weight) everyday for 3 or 6 months, while rats in the normal and model groups received equal volume of saline. Twenty-four hours' urine was collected for urinary albumin excretion (UAE) measurement. Periodic acid-Schiff (PAS) and Masson's trichrome staining were used for saccharides and collagen detection. Cell apoptosis of renal cortex was investigated by TdT-mediated dUTP nick end labeling (TUNEL) staining. Bax and Bcl-2 expressions were detected by immunohistochemistry and Western blot, respectively. Cytochrome C (Cyt C) and caspase-9 concentration were detected by Western blot.</p><p><b>RESULTS</b>Compared with the model group, XZK treatment could significantly decrease the kidney hypertrophy index, 24 h UAE, renal cell apoptosis, cytoplasmic Cyt C level and active caspase-9 level, as well as suppress the increment of Bax and up-regulate the expression of Bcl-2, leading to the suppression of Bax/Bcl-2 ratio at 3 and 6 months (P<0.05 or P<0.01). Moreover, XZK treatment could alleviate the deposition of PAS-stained saccharides and Masson's trichromestained collagen to different extent.</p><p><b>CONCLUSIONS</b>Renal cell apoptosis was observed in diabetic kidney, in which mitochondrial apoptotic pathway might be involved. XZK treatment could attenuate pathological changes in diabetic kidney and reduce renal cell apoptosis, probably via the suppression of Bax/Bcl-2 ratio, which lead to inhibition of Cyt C release and following caspase-9 activation.</p>

Effects of Lianhua Qingwen on Pulmonary Oxidative Lesions Induced by Fine Particulates (PM2.5) in Rats / 中国医学科学杂志(英文版)

Objective To investigate the antagonistic effects of different doses of Lianhua Qingwen on pulmonary injury induced by fine particulates PM2.5 in rats. Methods Fine particulates suspended in the environment were collected. Forty-eight healthy adult wistar rats were randomly divided into 6 groups with 8 rats in each group. Four groups of rats were exposed to PM2.5 by intratracheally dripping suspensions of fine particulates PM2.5 (7.5 mg/kg) as dust-exposed model rats. Among them 24 rats in three groups received Lianhua Qingwen treatment (crude drug) at a dose of 2 g/kg, 4 g/kg, 8 g/kg per day for 3 days before dust exposure and were defined as low-dose, middle-dose and high-dose Lianhua Qingwen treatment groups respectively. The other dust-exposed model rats without treatment were assigned as PM2.5 control group. The un-exposed rats were set as saline control group (1.5 ml/kg saline) and blank control group. All rats were killed after 24 hours of the exposure. Lung tissue, serum and bronchoalveolar lavage fluid (BALF) were collected. The levels of malonaldehyde (MDA), lactate dehydrogenase (LDH), and glutathione peroxidase (GSH-PX) in blood serum and BALF, and superoxide dismutase (SOD) in blood surum were measured using fluorescent quantitation PCR; Expression of NF-E2-related factor 2(NRF-2), heme oxygenase 1 (HO-1) and quinone oxidoreductase 1 (NQO1) in lung tissues were measured using Western blot. Pathological changes of lung tissues in each group were also examined. Results Pathology revealed thickened alveolar septum, congestion of capillary, interstitial edema and infiltration of lymphocyte and neutrophil surrounding bronchiole in the PM2.5 control group, which were significantly relieved in the Lianhua Qingwen treatment groups. Compared to the blank and saline control groups, the PM2.5 control group had significantly higher levels of LDH and MDA (p<0.01) and lower level of GSH-PS (p<0.01) in BALF, significantly higher levels of LDH and MDA (p<0.05) and lower level of GSH-PS (p<0.05) in rat serum. The levels of MDA in blood serum and BALF were significantly lower in each treatment group than that in PM2.5 control group (all P<0.05). In both middle-dose and high-dose treatment group the measurements of LDH in serum and BALF as well as GSH-PX in serum were significant difference from those of PM2.5 control group (all P<0.05). Expressions of NRF-2, HO-1 and NQO1 in lung tissues were significantly different among middle-dose and high-dose treatment group compared with those in PM2.5 control group (all P<0.05). Conclusion Fine particulates PM2.5 in environment may induce pulmonary oxidative lesions in rats. Middle-dose and high-dose Lianhua Qingwen has antagonist effece on the injuries induced by fine particulates.

[Pollution Characteristics and Light Extinction Effects of Water-soluble Ions in PM2.5 During Winter Hazy Days at North Suburban Nanjing].

To investigate the characteristics of water-soluble ions in PM2.5 and their contribution to light extinction in haze days, on-line monitoring of PM2.5. was conducted at North Suburban Nanjing from 25 January through 3 February, 2013. Water-soluble components were collected with a particle-into-liquid sampler (PILS), and analyzed by ion chromatography (IC) for the contents of SO4(2-), NO3-, NH4+, Cl-, Na+, K+, Mg2+ and Ca2+ Simultaneously particle size distributions were measured using scanning mobility particle sizer (SMPS) and Aerodynamic Particle Sizer (APS). The absorption and scattering coefficients were measured by three-wavelength photoacoustic soot spectrometer (PASS-3). Trace gases (SO2, NO2 etc.) were also monitored. The results showed that the average concentrations of total water-soluble ions were 70.3 and 22.9 microg x m(-3) in haze and normal days, respectively. Secondary hygroscopic components including SO4(2-), NO3- and NH4+ were the major ionic pollutants. Hazy days favored the conversion of SO2 and NOx, to SO4(2-) and NO3-, respectively, and in particular the oxidation of NOx. Using multiple linear regression statistical method, the empirical relationship between the dry aerosol extinction coefficient and the chemical composition was established. NH4NO3 was found to be the largest contributor to aerosol extinction in winter in Nanjing, followed by (NH4)2SO4, OC and EC. In two heavy pollution events, the increase of ion concentrations was influenced by the increase of primary emissions and secondary transformation.

[Efficacy observation on navel-warming therapy combined with western medication for yang-deficiency tympanites].

OBJECTIVE: To observe the effects of navel-warming therapy on clinical efficacy in patients with yang-deficiency tympanites based on regular treatment of western medication. METHODS: One hundred and twenty cases of yang-deficiency tympanites were randomly divided into a navel-warming therapy group and a western medication group, sixty cases in each one. The regular treatment of western medicine was applied in the western medication group, including oral administration of antiviral drug and diuretics as well as intravenous drip of hepatic protector. Based on western medicine treatment, the navel-warming therapy was applied in the navel-warming group. A medical cake was laid on Shenque (CV 8), and then a medical cylinder was placed above the medical cake and ignited. The treatment was given once daily. One month was considered as a treatment session in both groups and totally one session was required. The TCM symptom score, B-ultrasound ascites and temporary use of diuretics before and after treatment were observed in both groups; also the efficacy was evaluated. RESULTS: The total effective rate was 81.7% (49/60) in the navel-warming therapy group, which was superior to 56.7% (34/60) in the western medication group (P < 0.05). After the treatment, the TCM symptom score and ascites were improved in both groups (all P < 0.05), which was more significant in the navel-warming therapy group (all P < 0.05). The temporary use of diuretics was statistically different between the two groups (P < 0.05), indicating the navel-warming therapy group could obviously reduce or stop the use of diuretics. CONCLUSION: Based on regular treatment of western medication, the navel-warming therapy could significantly improve therapeutic efficacy, effectively relieve clinical symptoms and ease ascites.

Central obesity and metabolic risk factors in middle-aged Chinese.

OBJECTIVE: Central obesity is considered to be a central component of metabolic syndrome. Waist circumference (WC) has been widely used as a simple indicator of central obesity. This study is aimed to evaluate the sensitivity of WC cut-off values for predicting metabolic risk factors in middle-aged Chinese. METHODS: The study involved 923 subjects aged 40-65 years. The metabolic risk factors were defined according to the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. WC cut-off 85-90 cm and ⋝90 cm were used as cut-off values of central pre-obesity and central obesity in males, respectively, while WC 80-85 cm and ⋝85 cm were used as cut-off values of central pre-obesity and central obesity in females. RESULTS: First, WC values corresponding to body mass index (BMI) 24 kg/m2 and visceral fat area (VFA) 80 cm2 were 88.55 cm and 88.51 cm in males, and 81.46 cm and 82.51 cm in females respectively. Second, receiver operating characteristic curves showed that the optimal WC cut-off of value was 88.75 cm in males, higher than that in females (81.75 cm). Third, the subjects with higher WC values were more likely to have accumulating metabolic risk factors. The prevalence of metabolic risk factors increased linearly and significantly in relation to WC levels. CONCLUSION: WC cut-off values of central pre-/central obesity are optimal to predict multiple metabolic risk factors.

Efficacy observation on navel-warming therapy combined with western medication for yang-deficiency tympanites / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of navel-warming therapy on clinical efficacy in patients with yang-deficiency tympanites based on regular treatment of western medication.</p><p><b>METHODS</b>One hundred and twenty cases of yang-deficiency tympanites were randomly divided into a navel-warming therapy group and a western medication group, sixty cases in each one. The regular treatment of western medicine was applied in the western medication group, including oral administration of antiviral drug and diuretics as well as intravenous drip of hepatic protector. Based on western medicine treatment, the navel-warming therapy was applied in the navel-warming group. A medical cake was laid on Shenque (CV 8), and then a medical cylinder was placed above the medical cake and ignited. The treatment was given once daily. One month was considered as a treatment session in both groups and totally one session was required. The TCM symptom score, B-ultrasound ascites and temporary use of diuretics before and after treatment were observed in both groups; also the efficacy was evaluated.</p><p><b>RESULTS</b>The total effective rate was 81.7% (49/60) in the navel-warming therapy group, which was superior to 56.7% (34/60) in the western medication group (P < 0.05). After the treatment, the TCM symptom score and ascites were improved in both groups (all P < 0.05), which was more significant in the navel-warming therapy group (all P < 0.05). The temporary use of diuretics was statistically different between the two groups (P < 0.05), indicating the navel-warming therapy group could obviously reduce or stop the use of diuretics.</p><p><b>CONCLUSION</b>Based on regular treatment of western medication, the navel-warming therapy could significantly improve therapeutic efficacy, effectively relieve clinical symptoms and ease ascites.</p>

Central obesity and metabolic risk factors in middle-aged Chinese / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Central obesity is considered to be a central component of metabolic syndrome. Waist circumference (WC) has been widely used as a simple indicator of central obesity. This study is aimed to evaluate the sensitivity of WC cut-off values for predicting metabolic risk factors in middle-aged Chinese.</p><p><b>METHODS</b>The study involved 923 subjects aged 40-65 years. The metabolic risk factors were defined according to the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. WC cut-off 85-90 cm and ⋝90 cm were used as cut-off values of central pre-obesity and central obesity in males, respectively, while WC 80-85 cm and ⋝85 cm were used as cut-off values of central pre-obesity and central obesity in females.</p><p><b>RESULTS</b>First, WC values corresponding to body mass index (BMI) 24 kg/m2 and visceral fat area (VFA) 80 cm2 were 88.55 cm and 88.51 cm in males, and 81.46 cm and 82.51 cm in females respectively. Second, receiver operating characteristic curves showed that the optimal WC cut-off of value was 88.75 cm in males, higher than that in females (81.75 cm). Third, the subjects with higher WC values were more likely to have accumulating metabolic risk factors. The prevalence of metabolic risk factors increased linearly and significantly in relation to WC levels.</p><p><b>CONCLUSION</b>WC cut-off values of central pre-/central obesity are optimal to predict multiple metabolic risk factors.</p>

[A comparison of clinical effectiveness of different neuropathy scoring systems in screening asymptomatic diabetic peripheral neuropathy].

OBJECTIVE: To evaluate the clinical effectiveness in screening asymptomatic diabetic peripheral neuropathy (ADPN) by the Michigan neuropathy screening instrument (MNSI) and the Toronto clinical scoring system (TCSS). METHODS: MNSI, TCSS and neural electrophysiological test (NET) were conducted in 232 neurologically asymptomatic type 2 diabetes patients. By using the results of NET as the golden criteria for diagnosis of ADPN, we evaluated the effectiveness of the two different scoring system by the receiver operator characteristic curve. The sensitivity, specificity, positive and negative predictive values, accuracy, Youden indexes and kappa values on different diagnostic cut-off points of MNSI and TCSS were analyzed. The correlation between the two different scoring system and the risk factors of diabetic peripheral neuropathy (DPN) were also analyzed. RESULTS: The area under the ROC curve of MNSI and TCSS were 0.792, 0.704, respectively. The sensitivity, specificity, accuracy, Youden indexes and kappa values of MNSI over 2 and TCSS over 2 were 66.2%vs 73.3%, 90.4% vs 63.7%, 78.3% vs 68.5%, 0.566 vs 0.370, and 0.588 vs 0.345, respectively. MNSI was better than TCSS in the effectiveness of diagnosing ADPN and consistence with the result of NET. Moreover, MNSI was associated with the most related risk factors of DPN including age, glycosylated hemoglobin (HbA1c), HbA1c × disease duration, islet function and HDL-C. CONCLUSIONS: MNSI could be used as a relatively simple and reliable method for clinical and epidemiological screening and assessment of ADPN.

Recurrent Hashimoto's encephalopathy, showing spontaneous remission: a case report.

Hashimoto's encephalopathy (HE) is a rare condition associated with Hashimoto's thyroiditis (HT). It is characterized by neurological/psychiatric symptoms, high levels of anti-thyroid antibodies, non-specific radiological examinations or electroencephalogram abnormalities, and responsiveness to corticosteroid treatment. We describe the case of a man with HE who showed decreased mentality, cognitive impairment, dysarthria, and gait disturbance. The initial attack was improved rapidly by corticosteroid treatment. When the symptoms recurred in 7 months, the patient achieved spontaneous remission without corticosteroid treatment. The recognition of the condition was essential for the prognosis and treatment of this rare disease.

[Clinical features and risk factors of renal damage in elderly and non-elderly patients with type 2 diabetes mellitus].

OBJECTIVE: To investigate the clinical features and risk factors of renal damage in the elderly and non-elderly patients with type 2 diabetes mellitus. METHODS: The data were collected from a survey of 10-year retrospective study of chronic complications of hospitalized type 2 diabetics organized by Chinese Diabetes Society. A total of 1351 patients of type 2 diabetes were selected and divided into an elderly group (>or=60 year) and a non-elderly group (<60 year). The patients were also divided into three groups according to urinary albumin excretion rate (AER): normoalbuminuria group (AER<30 mg/24 h), microalbuminuria group (30or=300 mg/24 h). eGFR was estimated by the equation from the MDRD study. Clinical and laboratory parameters of all patients were analyzed. RESULTS: (1) The proportions of renal insufficiency in both normoalbuminuria and microalbuminuria groups of type 2 diabetes in the elderly patients were significantly higher than those in the non-elderly patients (26.7% vs 15.8%, P<0.01; 30.5% vs 21.3%, P<0.05 respectively); (2) in type 2 diabetic patients with renal insufficiency and normoalbuminuria, the diabetes duration (7.7 vs 3.8 years), systolic blood pressure [(146+/-24) mm Hg vs (134+/-23) mm Hg], diastolic blood pressure [(84+/-13) mm Hg vs (80+/-11) mm Hg], proportion of hypertension (37.8% vs 21.1%), diabetic retinopathy (34.1% vs 23.9%), cardiovascular diseases (31.6% vs 11.3%) and cerebrovascular disease (24.4% vs 9.9%) were significantly higher in the elderly group than in the non-elderly group (P<0.05 or 0.01); (3) multiple logistic regression analysis revealed that the duration of diabetes (OR=1.046, P=0.013) and systolic blood pressure (OR=1.014, P=0.002) were independently associated with renal insufficiency in the elderly type 2 diabetic patients with normoalbuminuria, whereas systolic blood pressure (OR=1.042, P=0.000) and 2-hour postprandial blood glucose (OR=1.048, P=0.002) were independent risk factors for renal insufficiency of non-elderly patients. CONCLUSION: The elderly type 2 diabetic patients are likely to suffer renal insufficiency initially from a lower glomerular filtration rate than the non-elderly patients. Systolic blood pressure is the main risk factor in both elderly and non-elderly type 2 diabetes with normoalbuminuria and a decreased renal function. Controlling blood pressure may delay the decline of renal function.