The experience on the construction of the cluster prevention and control system for COVID-19 infection in designated hospitals during the period of "Category B infectious disease treated as Category A" / 中华危重病急救医学

The COVID-19 epidemic has spread to the whole world for three years and has had a serious impact on human life, health and economic activities. China's epidemic prevention and control has gone through the following stages: emergency unconventional stage, emergency normalization stage, and the transitional stage from the emergency normalization to the "Category B infectious disease treated as Category B" normalization, and achieved a major and decisive victory. The designated hospitals for prevention and control of COVID-19 epidemic in Tianjin has successfully completed its tasks in all stages of epidemic prevention and control, and has accumulated valuable experience. This article summarizes the experience of constructing a hospital infection prevention and control system during the "Category B infectious disease treated as Category A" period in designated hospital. The experience is summarized as the "Cluster" hospital infection prevention and control system, namely "three rings" outside, middle and inside, "three districts" of green, orange and red, "three things" before, during and after the event, "two-day pre-purification" and "two-director system", and "one zone" management. In emergency situations, we adopt a simplified version of the cluster hospital infection prevention and control system. In emergency situations, a simplified version of the "Cluster" hospital infection prevention and control system can be adopted. This system has the following characteristics: firstly, the system emphasizes the characteristics of "cluster" and the overall management of key measures to avoid any shortcomings. The second, it emphasizes the transformation of infection control concepts to maximize the safety of medical services through infection control. The third, it emphasizes the optimization of the process. The prevention and control measures should be comprehensive and focused, while also preventing excessive use. The measures emphasize the use of the least resources to achieve the best infection control effect. The fourth, it emphasizes the quality control work of infection control, pays attention to the importance of the process, and advocates the concept of "system slimming, process fattening". Fifthly, it emphasizes that the future development depends on artificial intelligence, in order to improve the quality and efficiency of prevention and control to the greatest extent. Sixth, hospitals need to strengthen continuous training and retraining. We utilize diverse training methods, including artificial intelligence, to ensure that infection control policies and procedures are simple. We have established an evaluation and feedback mechanism to ensure that medical personnel are in an emergency state at all times.

The effects of aerobic exercise on endothelial nitric oxide synthase uncoupling in the myocardium of spontaneously hypertensive rats / 中华物理医学与康复杂志

Objective:To observe any effect of regular aerobic exercise on cardiac remodeling in spontaneously hypertensive rats (SHR) and explore the mechanism of endothelial nitric oxide synthase (eNOS) uncoupling.Methods:Thirty 6-week-old healthy male SHR were divided into a sedentary group and an exercise group, each of 15. Another ten age- and sex-matched Wistar-Kyoto rats were set as a normal control group. The animals in the normal control and sedentary groups were fed quietly in their cages, and those in the exercise group performed moderate intensity treadmill exercise for 8 weeks (5 times per week). Forty-eight hours after the last training, echocardiography was applied to document cardiac structure and function in both groups. Wheat germ agglutinin staining and Picrosirius Red staining were used to obtain the cardiomyocyte cross sectional areas (CSAs) and interstitial collagen volume fractions (CVFs) of all of the mice. The rates of cardiomyocyte apoptosis were measured using TUNEL staining, and myocardial tetrahydrobiopterin (BH4) content was measured using high-performance liquid chromatography. Total eNOS, eNOS dimer and eNOS monomer protein expression in the myocardia were detected using western blotting.Results:Compared with the normal control group, the left ventricular wall thickness (LVWT), myocardial CSA, CVF, apoptosis of cardiomyocytes and eNOS monomer levels were significantly higher in the sedentary group, on average. But the end-diastolic diameter (LVEDD) and ejection fraction (LVEF) of the left ventricle and the levels of eNOS dimer and myocardial BH4 and the eNOS dimer/monomer ratio tended to be lower. Comparing the exercise group with the sedentary group, the average LVEDD, LVEF, eNOS dimer, eNOS dimer/monomer ratio and myocardial BH4 content were significantly higher in the exercise group, but the myocardial CVF, cardiomyocyte apoptosis and eNOS monomer levels were significantly lower. LVWT and CSA were not significantly different. There were no significant differences in the total eNOS protein levels among the three groups.Conclusion:Regular aerobic exercise might improve cardiac remodeling in cases of spontaneous hypertension regulating eNOS uncoupling, at least in rats.

COVID-19 vaccination-related attendance at a pediatric emergency department in Singapore among 12- to 18-year old adolescents.

BACKGROUND: Singapore was one of the first countries to begin COVID-19 vaccination with the BNT162b2 vaccine for adolescents aged 12-18 years. This study evaluates the incidence of COVID-19 vaccine related attendances to a Pediatric Emergency Department (PED) to understand post-vaccination health behaviors among adolescents. METHODS: This was a retrospective review of electronic medical records over a 4 month period, from the start of the adolescent vaccination drive to when more than 85% of this group had been fully vaccinated. RESULTS: The incidence of COVID-19 vaccination-related presentations to our PED was 3.1% over 4 months (291 of 9387 PED attendances), with a peak daily incidence of 15.4% (14 of 91 attendances). Presentations were characterized by severity into: severe (3.4%), moderate (7.9%) or mild (88.7%) based on predefined criteria. The most common presenting complaints were chest pain (58.8%), dyspnea (28.2%) and palpitations (22.6%). Hospitalization was required in only 6.2% of attendances. Patients with moderate-severe presentations were 0.7 years older (p = 0.030), more likely to have underlying drug allergies (p = 0.048) and had higher rates of hospitalization (p < 0.005) compared to mild presentations. Despite concerns of cardiac inflammation, chest pain related attendances were less likely to be severe (p < 0.005) with reduced hospitalization need (p = 0.043) compared to other presentations. Investigations beyond clinical assessment comprised 91% of attendances, but abnormalities were only found in 6.4% cases. CONCLUSION: Our study supports current evidence that COVID-19 vaccination is safe amongst adolescents. We highlight the health behaviors among adolescents post-vaccination, which is partly driven by media reports on vaccine side effects and an element of anxiety. While most of the presentations were mild, these can have implications on health resource utilization, particularly in an ongoing pandemic. As healthcare workers, we have an ongoing role to ensure accurate information on vaccine safety is communicated effectively to the public.

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery.

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

[Study on molecular target of Taohong Siwu Decoction in delaying growth of fibroblasts based on network pharmacology].

As a prescription for promoting blood circulation and removing blood stasis, Taohong Siwu Decoction(THSWD) has certain effects in delaying the progression of renal fibrosis. However, as a traditional Chinese medicine compound containing many monomer components, it has been a research hotspot in the field of exploring the research methods and targets for the complex pathological process. The method of activating blood circulation and removing blood stasis has certain clinical effect in retarding the process of IgA nephropathy(IgAN) fibrosis, but the mechanism of action is still unclear. In this study, the network pharmacology method was used to investigate the active ingredients, targets and molecular mechanisms of THSWD in the intervention of IgAN fibrosis. On this basis, in vitro experiments were conducted to verify the effect of THSWD on the expression of ERK factor in BALB/c 3 T3 cells. The active ingredients and targets in THSWD were collected through the TCMSP. Sixty-one active ingredients and 240 targets including luteolin and quercetin were screened, and 185 targets were obtained by intersecting with CTD database to search IgAN related targets. Cytoscape software and STRING database were used to construct "THSWD-active ingredients-targets" network and protein-protein interaction network, and 69 core targets were screened. In DAVID's GO enrichment analysis and KEGG pathway analysis of the core targets and cell experiments, the results showed that ERK was an important factor for THSWD to interfere with IgAN fibrosis, and THSWD intervention could significantly decrease cell activity, ERK1/2 mRNA expression, and p-ERK1/2 protein expression. This study preliminarily revealed that THSWD may delay the growth of fibroblasts by affecting ERK factor and its phosphorylation level.

Venous Thrombosis in Acquired Hemophilia: The Complex Management of Competing Pathologies.

Introduction Venous thrombosis is rare in the setting of factor VIII (FVIII) deficiency. Cases of deep vein thrombosis (DVT) have been described in hemophiliacs after recent major surgery, or in association with the administration of FVIII concentrate and activated prothrombin complex concentrates, but occurrence of spontaneous DVT is even more uncommon. Aim We describe the challenging management of extensive DVT in a patient with acquired hemophilia A with concurrent hemorrhagic manifestations and review similar published cases. Methods We summarize a series of 10 cases with the following demographics: 6 males and 4 females; median age at presentation of 65 (21-80); mean inhibitor titer of 68.5 Bethesda Units (BU 1.9 to BU 350). Results Four cases were idiopathic and six had associated conditions (cancer [two cases], recent pregnancy [two cases], and recent surgery [two cases]). Three cases had an inferior vena cava filter inserted for acute lower limb DVT/pulmonary embolism. Inhibitor eradication was achieved with high-dose steroids with or without cyclophosphamide, and adjunct Rituximab administration was used in three cases. One patient received concurrent therapeutic plasma exchange (TPE). Inhibitor eradication was fastest with concurrent TPE at 6 days (range: 6-733 days). The 30-day survival was 90%. Conclusions There was adequate response of inhibitors to immunosuppression with steroids and cyclophosphamide therapy. For more refractory disease, Rituximab is emerging as a beneficial and cost-effective adjunct with better rates of complete remission, and the threshold for its use may be lowered in this complex cohort with dual competing pathologies.

Construction of a set of informatics-based assessment indicators for hospital operation and management / 中华医院管理杂志

Objective To establish a set of operational status assessment indicators to meet the needs of informationized hospital management.Methods Assessment indicators were selected and weights were set respectively through literature review,field interview,and questionnaire survey.Six target dimensions were key performance indicators medical business,operational performance,cost control,medical insurance,balance and risk management,and development capability.Thus a set of operational status evaluation indicators was established in IT means,and based on the informationization level of a tertiary A general hospital in Zhejiang province.Results In the principle of public welfare,objectivity,effectiveness and prospectiveness,we analyzed and sorted out relevant data in the current hospital informationization,identifying six quantitative indicators,15 level-1 indicators,and 86 level-2 indicators.Conclusions It is feasible to build a set of assessment indicators for hospital operation and management in view of both technology and methodology.

Effect of venous-to-arterial carbon dioxide difference to arterial-to-venous oxygen content difference ratio combined with ultrasound on fluid resuscitation in critical patients with septic shock / 中国中西医结合急救杂志

Objective To observe the effect of venous-to-arterial carbon dioxide difference to arterial-to-venous oxygen content difference [(Pv-aCO2)/(Ca-vO2)] ratio combined with critical ultrasound during the phases of fluid resuscitation of critical patients with septic shock. Methods Ninety-two critical patients with septic shock admitted to department of intensive care unit (ICU) of Anji County People's Hospital from July 2016 to December 2017 were enrolled, and they were divided into study group (42 cases) and control group (50 cases) according to random number table method. Two groups of patients were given supportive treatment such as antibiotic therapy, vasoactive drugs to support blood pressure, mechanical ventilation (MV), transfusion and nutritional therapy. The fluid resuscitation in patients of control group was guided through monitoring central venous pressure (CVP) and lactic acid (Lac). Patients in study group were given (Pv-aCO2)/(Ca-vO2) ratio combined with critical ultrasound directed therapy on the basis of the monitoring method of the control group. The differences in heart rate (HR), mean arterial pressure (MAP), CVP, Lac, central venous oxygen saturation (ScvO2), (Pv-aCO2)/(Ca-vO2) ratio, dosage of noradrenalin (NE), fluid intake in 6 hours, sequential organ failure assessment (SOFA) of 24 hours, time of MV, length of ICU stay, 28-day mortality rate, and incidence of pulmonary edema were compared. The correlation between (Pv-aCO2)/(Ca-vO2) ratio and Lac in study group was analyzed by Spearman analysis. Results In two groups, the HR, Lac, and (Pv-aCO2)/(Ca-vO2) ratio were significantly lower after 6 hours of treatment than those at admission, and MAP, CVP and ScvO2 were significantly increased compared with those at admission (all P < 0.05). The Lac and (Pv-aCO2)/(Ca-vO2) ratio in study group were significantly lower than those in control group at 6 hours after fluid resuscitation [Lac (mmol/L): 4.1±2.2 vs. 4.6±2.3, (Pv-aCO2)/(Ca-vO2) ratio:0.7±0.2 vs. 0.8±0.3, both P < 0.05], and MAP, CVP and ScvO2 were higher than those in control group [MAP (mmHg, 1 mmHg = 0.133 kPa): 78.6±10.3 vs. 71.4±11.5, CVP (mmHg): 13.2±5.1 vs. 9.8±4.4, ScvO2: 0.73±0.08 vs. 0.70±0.08, all P < 0.05]. In study group, the dosage of NE, fluid intake in 6 hours, and incidence of pulmonary edema were less than those in control group [dosage of NE (μg·kg-1·min-1): 0.22±0.16 vs. 0.43±0.11, fluid intake in 6 hours (mL): 1 290±518 vs. 1 560±426, incidence of pulmonary edema: 19.05% (8/42) vs. 32.00% (16/50)], 24 hours SOFA declined (9.3±3.2 vs. 12.6±3.8), and time of MV and length of ICU stay were obviously shortened [time of MV (hours):70.48±8.65 vs. 88.35±10.37, length of ICU stay (days): 7.28±2.07 vs. 8.42±1.51, all P < 0.05]. The 28-day mortality in study group had a trend of decrease compared with that in control group [40.5 % (17/42) vs. 44% (22/50)], but there was no statistical significant difference between two groups (P > 0.05). There was a significant positive correlation between the (Pv-aCO2)/(Ca-vO2) ratio and Lac in study group (r = 0.532, P < 0.001). Conclusion (Pv-aCO2)/(Ca-vO2) ratio combined with critical ultrasound can better guide the volume management of critical patients with septic shock, reduce the usage of vasoactive drugs and incidence of pulmonary edema, and decrease the time of MV and length of ICU stay.

Impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation: a prospective randomized controlled study / 中华危重病急救医学

Objective To compare the impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation (MV). Methods A prospective randomized controlled study was conducted. Eighty-two patients requiring MV admitted to intensive care unit (ICU) of Anji People's Hospital from January 2015 to March 2017 were enrolled, and they were randomly divided into the permissive underfeeding group (n = 40, non-protein heat was 52.3-62.8 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1) and standard enteral feeding group (n = 42, non-protein heat was 104.6-125.5 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1). Permissive underfeeding group received 50% of their daily energy expenditure via enteral nutrition (EN) and standard enteral feeding group received 100% of their daily energy expenditure via EN in 24-48 hours after admitted to ICU. Nutritional status [pro-albumin (PA), serum albumin (ALB)], inflammation state [procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP)] were detected before treatment and 7 days after treatment. Duration of MV, length of ICU stay, daily insulin dosage, 28-day mortality, hospital acquired pneumonia (HAP), urinary tract infection, septic shock and other secondary infection, and the nutrition related complications were recorded. Results Compared with before treatment, the levels of serum PA (mg/L) and ALB (g/L) were significantly increased, the levels of PCT (ng/L) and hs-CRP (mg/L) were significantly decreased at 7 days after treatment in both groups [permissive underfeeding group: PA was 127.42±65.83 vs. 80.92±60.14, ALB was 30.16±4.32 vs. 25.36±6.21, PCT was 375.8±227.2 vs. 762.3±314.5, hs-CRP was 32.19±7.53 vs. 120.48±60.24; standard enteral feeding group: PA was 132.56±61.32 vs. 86.78±47.06, ALB was 31.25±4.63 vs. 26.71±5.48, PCT was 412.1±323.4 vs. 821.7±408.6, hs-CRP was 35.86±5.69 vs. 116.38±72.16, all 1 < 0.05], but there was no significant difference in PA, ALB, PCT or hs-CRP at 7 days after treatment between two groups (all 1 > 0.05). There was no significant difference in the duration of MV, length of ICU stay, 28-day mortality or ICU-associated infection between two groups [duration of MV (hours): 162.35±20.37 vs. 153.48±18.65, length of ICU stay (days): 7.52±1.61 vs. 6.34±1.87, 28-day mortality: 17.5% vs. 19.0%, ICU-associated infection: 45.0% vs. 47.6%, all 1 > 0.05]. Compared with standard enteral feeding, insulin demand was significantly decreased (U/d: 13.68±10.36 vs. 26.24±18.53), and gastrointestinal intolerance was less frequent (32.5% vs. 54.8%) in the permissive underfeeding group (both 1 < 0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference between the two groups (χ2= 3.216, 1 = 0.068). Conclusion The curative effect and prognosis of MV severe patients receiving permissive underfeeding are similar to those of standard enteral feeding, but it can reduce the dosage of insulin with better gastrointestinal tolerance.

Research and development of medical record assistant management system / 医疗卫生装备

Objective To establish a basic information database of hospital medical records management and improve the management process.Methods The system was developed with C# programming language,basic information from Oracle 10g databases of HIS and electronic medical record system (EMRS),which stored corresponding information during the process into SQL 2005 database and generated early warning information based on statistical analysis on medical records.Results The system realized standardized filing of medical records,synchronized filing of electronic medical record and the first page of medical record,normalized lending of medical record,auto generation of statistical reports,auto alarming in case of standard-exceeded information and etc,which could be used as a platform for medical record management.Conclusion The system enhances the efficiency and management of medical record section,and thus is worthy promoting practically.

Hepatic Cyp1a2 Expression Reduction during Inflammation Elicited in a Rat Model of Intermittent Hypoxia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intermittent hypoxia (IH) is a key element of obstructive sleep apnea (OSA) that can lead to disorders in the liver. In this study, IH was established in a rat model to examine its effects on the expression of hepatic cytochrome P450 (CYP) and CYP regulators, including nuclear receptors.</p><p><b>METHODS</b>Hematoxylin and eosin staining was conducted to analyze the general pathology of the liver of rats exposed to IH. The messenger RNA (mRNA) expression levels of inflammatory cytokines, CYPs, nuclear factor-κB (NF-κB), and nuclear factors in the liver were measured by quantitative reverse transcription polymerase chain reaction.</p><p><b>RESULTS</b>We found inflammatory infiltrates in the liver of rats exposed to IH. The mRNA expression level of interleukin-1beta was increased in the liver of the IH-exposed rats (0.005 ± 0.001 vs. 0.038 ± 0.008, P = 0.042), whereas the mRNA expression level of Cyp1a2 was downregulated (0.022 ± 0.002 vs. 0.0050 ± 0.0002, P = 0.029). The hepatic level of transcription factor NF-κB was also reduced in the IH group relative to that in the control group, but the difference was not statistically significant and was parallel to the expression of the pregnane X receptor and constitutive androstane receptor. However, the decreased expression of the glucocorticoid receptor upon IH treatment was statistically significant (0.056 ± 0.012 vs. 0.032 ± 0.005, P = 0.035).</p><p><b>CONCLUSIONS</b>These results indicate a decrease in expression of hepatic CYPs and their regulator GR in rats exposed to IH. Therefore, this should be noted for patients on medication, especially those on drugs metabolized via the hepatic system, and close attention should be paid to the liver function of patients with OSA-associated IH.</p>

Design and implementation of inpatient's laboratory report self-printing program used in doctor station / 医疗卫生装备

Objective To explore a new mode for self-printing by a doctor station.Methods A self-printing program was developed with Delphi 6.0,which obtained the information on the hospitalized and discharged patients from oracle database of HIS first,then inquired the examination results and printing identification in SQL database of LIS and printed the laboratory report finally.Results The new mode saved the workload for laboratory report printing and distribution,shortened the time consumed for pasting the report,reduced the ratio for missed and false pasting,avoided the pathogen transmission due to the report and increased the report quality.Conclusion The new mode realizes data sharing and raises working efficiency,and thus is worthy promoting practically.

Design and implementation of inpatient's laboratory report self-printing program used in doctor station / 医疗卫生装备

Objective To explore a new mode for self-printing by a doctor station.Methods A self-printing program was developed with Delphi 6.0,which obtained the information on the hospitalized and discharged patients from oracle database of HIS first,then inquired the examination results and printing identification in SQL database of LIS and printed the laboratory report finally.Results The new mode saved the workload for laboratory report printing and distribution,shortened the time consumed for pasting the report,reduced the ratio for missed and false pasting,avoided the pathogen transmission due to the report and increased the report quality.Conclusion The new mode realizes data sharing and raises working efficiency,and thus is worthy promoting practically.

Primary adenosquamous carcinoma of liver: a clinical study of 2 patients / 中华肝胆外科杂志

Objective To study the diagnosis and treatment of primary adenosquamous carcinoma (ASC) of liver.Methods The clinical and histopathological data of 2 patients with ASC were analyzed retrospectively.The cases were confirmed by surgery and histopathological examination.Results The tumors were located in the left liver in these 2 patients.Both patients presented with abdominal pain and they underwent surgical resection.On gross pathological examination,the tumors were irregular in shape with unclear boundaries.Microscopically,the tumor cells were arranged in a nesting pattern with a tubular structure,which was an adenosquamous carcinoma structure.One patient survived 4 months after surgery and the other patient died of intrahepatic tumour recurrence 7 months after surgery.Conclusions The diagnosis of primary hepatic ASC relied on histopathological examination.Surgical resection was safe and feasible.

Neuroprotective effects of electroacupuncture on hypoxic-ischemic encephalopathy in newborn rats are associated with increased expression of GDNF-RET and protein kinase B / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the neuroprotective effects of electroacupuncture (EA) on hypoxic-ischemic encephalopathy (HIE) and to further investigate the role of glial cell line-derived neurotrophic factor (GDNF) family receptor member RET (rearranged during transfection) and its key downstream phosphatidylinositol 3 kinase (PI-3K)/protein kinase B (Akt) pathway in the process.</p><p><b>METHODS</b>A total of 220 seven-day-old SD rats (of either sex, from 22 broods) were randomly divided into two groups, one (30 rats) for sham-surgery group and the other (190 rats) for HIE model group. The HIE model was established using the left common carotid artery ligation method in combination with hypoxic treatment. The successfully established rats were randomly divided into five groups, including control model group, EA group, sham-EA group, antagonist group and antagonist plus electroacupuncture group, with 35 rats in each group. Baihui (GV 20), Dazhui (GV 14), Quchi (LI 11) and Yongquan (KI 1) acupoints were chosen for acupuncture. EA was performed at Baihui and Quchi for 10 min once a day for continuous 1, 3, 7 and 21 days, respectively. The rats were then killed after the operation and injured cerebral cortex was taken for the measurement of neurologic damage by hematoxylin-eosin (HE) staining and the degenerative changes of cortical ultrastructure by transmission electron microscopy. RET mRNA level and Akt protein level were detected by real-time reverse-transcription polymerase chain reaction (RT-PCR) and western blot analysis, respectively.</p><p><b>RESULTS</b>EA could ameliorate neurologic damage of the first somatic sensory area (S1Tr) and alleviate the degenerative changes of ultrastructure of cortical neurons in rats subjected to HIE. And the longer acupuncture treatment lasted, the better its therapeutic effect would be. This was accompanied by gradually increased expression of GDNF family receptor RET at the mRNA level and its downstream signaling Akt at the protein level in the ischemic cortex.</p><p><b>CONCLUSION</b>EA has neuroprotective effects on HIE and could be a potential therapeutic strategy for HIE in the neonate. Activation of RET/Akt signaling pathway might be involved in this process.</p>

Epidemiologic study of primary aldosteronism in northern Jiangsu / 心血管康复医学杂志

Objective:To explore epidemiologic features of primary aldosteronism (PA) in northern Jiangsu and using plasma aldosterone/renin activity ratio (ARR) combined plasma aldosterone level to screen PA patients among pa-tients with hypertension .Methods:A total of 2014 inpatients and outpatients with hypertension were collected from our hospital .Radioimmunoassay was used to measure plasma levels of renin and aldosterone and blood biochemical indexes ,then ARR was calculated .PA was diagnosed when ARR>240 and aldosterone>150 pg/ml .Results:A to-tal of 239 patients (11. 87% ) were complicated with PA among the 2014 patients with hypertension ,and it occupied 23.69% (145/612) among patients with refractory hypertension .Compared with pure hypertension group ,there were significant reductions in renin activity [ (2.18 ± 2.54) ng?ml-1 ?h-1 vs .(0.68 ± 0.49) ng?ml-1 ?h-1 ] and serum potassium level [ (3.96 ± 0.45) mmol/L vs .(3.54 ± 0.45) mmol/L] ,significant rise in aldosterone level [ (132.99 ± 104.25) pg/ml vs .(272.55 ± 154.68) pg/ml] and ARR [ (118.40 ± 109.4) vs .(463.19 ± 251.85)] ,P<0.05 or <0.01 ,and significant reduction in onset age of hypertension [ (49.37 ± 9.31) years vs .(39.69 ± 7.59) years] ,P<0.01. Patients complicated with hypokalemia occupied 33.47% among PA patients ,linear correlation a-nalysis indicated that serum potassium level was correlated with aldosterone level (r= -0.706 , P=0.001) .Conclu-sion:In northern Jiangsu ,PA occupies 11.87% among patients with hypertension and it occupies 23.69% among pa-tients with refractory hypertension .Therefore ,plasma ARR should be regularly detected to screen PA patients in patients with hypertension ,especially those with refractory hypertension .

Hepatic perivascular epithelioid cell tumors-not otherwise specified: a case report / 南方医科大学学报

Neoplasms of perivascular epithelioid cells (PEComas) are characterized by epithelioid to spindle cells with eosinophilic to clear cytoplasm, an intimate relationship with blood vessels, and coexpression of myoid and melanocytic immunohistochemical markers. While most reported hepatic PEComas, such as angiomyolipoma (AML), behave in a benign fashion, emerging PEComas cases without typical characteristics require further clarification. We report a case of primary hepatic perivascular epithelioid cell tumors-not otherwise specified (HPEComas-NOS) with untypical pathological and immunohistochemical features compared to those of the benign hepatic AML cases. HPEComas-NOS may represent a special type of PEComas classified as having "malignant potential" or at "high risk of aggressive behavior", suggesting the need for further clarification of hepatic PEComas and long-term follow-up of patients with HPEComas-NOS.

The beneficial effect of Icariin on bone is diminished in osteoprotegerin-deficient mice.

BACKGROUND: Osteoprogeterin (OPG) plays an important role in regulating bone homeostasis by inhibiting osteoclastogenesis and bone resorption. Icariin is the major ingredient of Herba Epimedii, which exerts anabolic and anti-resorptive effects on bone, but the mechanism remains unknown. In this study, we evaluated the role of OPG in Icariin-mediated beneficial effects on bone. MATERIALS AND METHODS: Twelve-week-old Opg knockout (KO) male mice and their wild type (WT) littermates were orally administered with Icariin (0.3 mg/g) everyday for 8 weeks. Bone mass and microstructure in the right proximal tibiae were analyzed with micro-computed tomography (µCT). Bone remodeling was evaluated with serum biochemical analyses and bone histomorphometry. The colonies of fibroblast and osteoblast from bone marrow derived cells were quantified. The mRNA expressions of osteoblast and osteoclast related genes in trabecular bone from the femora were analyzed by real-time PCR. RESULTS: Icariin treatment led to greater trabecular bone volume and trabecular number compared with vehicle treatment in WT mice. Icariin treatment increased bone formation parameters while it decreased bone resorption parameters in WT mice; however, the anabolic response of trabecular bone to Icariin treatment was diminished in KO mice. At cellular and molecular levels, Icariin significantly increased the formation of osteoblast colonies from bone marrow derived cells and the Opg gene expression in trabecular bone of WT mice. CONCLUSIONS: These data suggest that Icariin treatment exerted anabolic and anti-resorptive effects on trabecular bone of WT mice, in which the effects were diminished in KO mice. The effects of Icariin treatment on bone are dependent on up-regulation of Opg, therefore, OPG plays an essential role in Icariin-mediated beneficial effects on trabecular bone.

Role of rennin-angiotensin system in cholinergic agonist carbachol-induced cardiovascular responses in ovine fetus / 生理学报

To investigate the mechanisms underlying the cholinergic agonist carbachol-induced cardiovascular responses, changes of renin-angiotensin system were examined in fetal hormonal systems. In the ovine fetal model under stressless condition, the cardiovascular function was recorded. Blood samples were collected before (during baseline period) and after the intravenous administration of carbachol. Simultaneously, the levels of angiotensin I (Ang I), angiotensin II (Ang II) and vasopressin in the fetal plasma were detected by immunoradiological method. Also, blood gas, plasma osmolality and electrolyte concentrations were analyzed in blood samples. Results showed that in chronically prepared ovine fetus, intravenous infusion of carbachol led to a significant decrease of heart rate (P < 0.05), and a transient decrease followed by an increase of blood pressure (P < 0.05) within 30 min. After the intravenous infusion of carbachol, blood concentrations of Ang I and Ang II in near-term ovine fetus were both significantly increased (P < 0.05); however, blood concentration of vasopressin, values of blood gas, electrolytes and plasma osmolality in near-term ovine fetus were not significantly changed (P > 0.05). Blood levels of Ang I and Ang II in the atropine (M receptor antagonist) + carbachol intravenous administration group was lower than those in the carbachol group without atropine administration (P < 0.05). In conclusion, this study indicates that the near-term changes of cardiovascular system induced by intravenous administration of carbachol in ovine fetus, such as blood pressure and heart rate, are associated with the changes of hormones of circulatory renin-angiotensin system.