Neutrophil extracellular trap increase the risk of sepsis: a two-sample, one-way Mendelian randomization study / 中华危重病急救医学

OBJECTIVE@#To investigate the causal relationship between neutrophil extracellular trap (NET) and sepsis based on Mendelian randomization analysis.@*METHODS@#The genome wide association study (GWAS) dataset for the NET biomarker myeloperoxidase (MPO)-DNA complex based on Donkel et al. 's Rotterdam study (RS) and GWAS dataset for identifying sepsis from the UK biobank were selected to screen single nucleotide polymorphisms (SNPS) associated with MPO-DNA complex as instrumental variable (IV) for genetic variation, using MPO-DNA complex as exposure factor. Potential causal associations between MPO-DNA complex and the risk of occurrence of sepsis, 28-day death from sepsis, need for intensive care due to sepsis, and 28-day death from sepsis requiring intensive care were analyzed using a two-sample, one-way Mendelian randomization analysis primary analysis method of inverse analysis of variance (IVW). Potential pleiotropy was assessed using the MR Egger regression intercept test. Sensitivity analysis was performed using the "leave one out" test.@*RESULTS@#The GWAS data were obtained from a European population of both sexes, and the screening criteria was based on the three main assumptions of Mendelian randomization, resulting in 22 SNP entering the Mendelian randomization analysis. The results of the Mendelian randomization causal association effect analysis using the IVW method showed that for every standard deviation increase in the level of the MPO-DNA complex, the risk of sepsis increased by approximately 18% [odds ratio (OR) = 1.18, 95% confidence interval (95%CI) was 1.07-1.29, P < 0.001], the risk of 28-day death from sepsis increased by approximately 51% (OR = 1.51, 95%CI was 1.27-1.81, P < 0.001), an increase of approximately 38% in the risk of occurrence of needing intensive care due to sepsis (OR = 1.38, 95%CI was 1.12-1.70, P = 0.002), and an increase of approximately 125% in the risk of 28-day death from sepsis requiring intensive care (OR = 2.25, 95%CI was 1.21-4.18, P = 0.01). MR Egger regression intercept test suggested that there was no horizontal pleiotropy in the included SNP, and the MR-PRESSO test did not find outliers. Sensitivity analysis suggested that the results of Mendelian randomization were robust.@*CONCLUSIONS@#Rising NET can increase the risk of sepsis onset, progression and death as derived from Mendelian randomization analysis.

Effectiveness and safety of endovascular therapy for acute progressive stroke caused by large vessel occlusion / 国际脑血管病杂志

Objective:To investigate the effectiveness and safety of endovascular therapy for acute progressive stroke caused by large vessel occlusion (LVO).Methods:Patients with progressive stroke caused by LVO admitted to the Department of Neurology, Yueyang Central Hospital from January 2019 to February 2022 were retrospective included. Patients with an Alberta Stroke Program Early CT Score (ASPECTS) or posterior circulation ASPECTS (pc-ASPECTS) ≥6 after progression were selected for endovascular therapy, including mechanical thromboectomy, thrombus aspiration, balloon angioplasty, stenting, or a combination of the above methods. Patients in the time window (anterior circulation within 12 h and posterior circulation within 24 h) and outside the time window (anterior circulation >12 h, posterior circulation >24 h) as well as those in the anterior and posterior circulation were compared.Results:A total of 20 patients with progressive stroke caused by LVO received endovascular treatment were included. There were 17 males and 3 females, aged 59.45±12.06 years. Three patients (15%) developed asymptomatic intracranial hemorrhage, and 12 (60%) had a good outcome 3 months after procedure. There were no statistically significant differences in the rate of successful vascular recanalization, incidence of intracranial hemorrhage, and the rate of poor outcomes between patients within and outside the time window and between the patients with anterior and posterior circulation.Conclusion:Endovascular therapy may be safe and effective for patients with progressive stroke caused by LVO with ASPECTS or pc-ASPECTS scores ≥6.

Analysis of factors associated with the structure of the gut microbial community in HIV/AIDS patients in some areas of Henan province / 中华流行病学杂志

Objective: To investigate the related factors associated with the structure of the gut microbial community in HIV infection/AIDS cases (HIV/AIDS) in Henan province. Methods: The convenience sampling method was used to select 122 cases who were receiving Antiviral Treatment (ART) or ART-naive in Henan. Whole blood and stool specimens were collected. Genomic DNA of stool samples was extracted, and the V3-V4 hypervariable regions of the 16S rRNA gene were sequenced using Illumina NovaSeq 6000 high-throughput sequencing system. The analysis was performed mainly at the genus level, and the 30 genera with the highest abundance were selected as a measure of the gut microbial community structure. The correlation between community structure and related factors was analyzed using redundancy analysis and Envfit function. Results: 122 cases were finally completed sequencing and analysis, the average BMI was (23.62±2.78) kg/m2 and the average age was (47±13) years. Among them, male accounted for 66.39% (81/122), and heterosexual transmission route constituted the largest ratio, accounting for 51.64% (63/122). 36 cases were treatment naive (29.51%, 36/122). The top five dominant genera of the total population (122 cases) were Prevotella, Roseburia, Megamonas, Bacteroides and Faecalibacterium and the top five dominant genera of the ART population (86 cases) were Prevotella, Megamonas, Bacteroides, Roseburia and Faecalibacterium. The top five dominant genera of the ART-naive population (36 cases) appeared as Prevotella, Faecalibacterium, Roseburia, Bacteroides and Megamonas. In the total population, ART (P<0.001) was the most significant factors of community structure. Other significant factors were: duration of diagnosis (P=0.009), viral load (P=0.022) and anti-HCV (P=0.018). ART was positively correlated with Megamonas and negatively correlated with Prevotella, Roseburia and Faecalibacterium, while the other three factors of duration of diagnosis, viral load and anti-HCV were positively correlated with Prevotella, Roseburia and Faecalibacterium and negatively correlated with Megamonas. In the ART-naive population, duration of diagnosis (P=0.003) were the factors significantly associated with community structure. Duration of diagnosis was positively correlated with Roseburia, Faecalibacterium, Megamonas and Prevotella and negatively correlated with Bacteroides. Conclusion: ART and duration of diagnosis were factors significantly associated with gut microbial community structure and had a significant impact on multiple high-abundance genera.

Integrating magnetization transfer imaging and fat suppression T 2WI for predicting the clinical activity of Graves ophthalmopathy / 中华放射学杂志

Objective:To investigate the value of magnetization transfer imaging (MTI) and fat suppression T 2WI (FS-T 2WI) in predicting the clinical activity of Graves ophthalmopathy (GO). Methods:From October 2020 to July 2021, 64 GO patients were prospectively enrolled in the First Affiliated Hospital of Nanjing Medical University. According to the clinical activity score (CAS), the patients were divided into active group (CAS≥3, 39 patients and 78 eyes) and inactive group (CAS<3, 25 patients and 50 eyes). The coronal MTI and FS-T 2WI were scanned for pre-treatment assessment. Magnetization transfer ratio (MTR) of extraocular muscles, and signal intensity ratio (SIR) between extraocular muscles and temporalis were measured, respectively. The independent-sample t-test was used to compare the MTR and SIR between two groups. The correlations between MRI parameters and CAS were analyzed using Spearman correlation analysis. The receiver operating characteristic (ROC) curve was performed to evaluate the value of each and combined parameters for predicting the clinical activity of GO. The DeLong test was used to compare the area under the curve (AUC). Results:The MTR of active group and inactive group were 0.45±0.04 and 0.51±0.04, respectively, the difference was statistically significant ( t=7.62, P<0.001). The SIR were 3.4±0.6 and 2.6±0.5, respectively, and the difference was also statistically significant ( t=-8.20, P<0.001). MTR was negatively correlated with CAS ( r=-0.46, P<0.001), while SIR was positively correlated with CAS ( r=0.63, P<0.001). The AUC of MTR, SIR and the combination of MTR and SIR for predicting the clinical activity of GO were 0.840, 0.845 and 0.905, respectively. The combination of MTR and SIR showed higher performance than MTR or SIR alone, and the differences were statistically significant ( Z=2.61, P=0.009; Z=2.15, P=0.032). Conclusions:The quantitative parameters of MTI and FS-T 2WI, namely MTR and SIR, can be used to evaluate the clinical activity of GO. Integrating MTI and FS-T 2WI can improve the diagnostic efficiency.

Anatomy and imaging of abdominal aorta and its branches in Southwestern China population / 解剖学报

Objective To investigate the normal reference values of abdominal aorta and its branches in Southwest China, so as to provide basis for clinical diagnosis and treatment of abdominal aortic aneurysm. Methods The length, diameter and angle of the abdominal aorta and its branches were measured in 20 cadavers. At the same time, 300 cases without obvious pathological changes in four urban populations were selected for abdominal CT angiography (CTA) to measure the length, diameter and angle of abdominal aorta and its branches. Results Display rate of abdominal aorta was 100%,the average length of abdominal aorta was (12.96±0.81) cm, the diameter of abdominal aorta was (1.93±0.28) cm, (1.55±0.23) cm, (1.61±0.19) cm in renal artery plane (Ⅰ), inferior mesenteric artery plane (Ⅱ) and lower edge plane of lumbar vertebrae (Ⅲ), and the average value on image was (2.17 ± 0.42) cm, (1.81 ± 0.40) cm, (1.99 ± 0.53) cm; Display rate of common iliac artery was 100%, the angle between left and right common iliac artery was (59.80± 4.66) ° and the diameter of the end was (1.16±0.33) cm and (1.12±0.11) cm; Display rate of celiac trunk on cadaver was 100%, the average length was (1.61±0.27) cm, the average diameter on cadaver was (0.78±0.71) cm, the image was (0.88± 0.31) cm; Display rate of renal artery was 100%, the average length of the left renal artery was (2.58 ± 0.50) cm, that of the right was (4.26±0.65) cm, the initial average diameter of the left renal artery was (0.55±0.24) cm, and the right renal artery was (0.62±0.20) cm; Display rate of the superior mesenteric artery was (100%), that of the on cadaver was (4.56 ± 0.29) cm, that of the image was (4.93 ± 0.84) cm, and that of the angle between the abdominal aorta was (38.05±5.99)°; Display rate of the inferior mesenteric artery was (100%),the average length of the inferior mesenteric artery was (6.57±0.79) cm on the cadaver, the image was (6.70±0.76) cm, and that of the angle between the abdominal aorta was (73.79 ± 9.62) ° and the initial diameter was (0.48 ± 0.29) cm. Conclusion The normal reference values of abdominal aorta and its visceral branches in Southwest China population were measured. CTA has a special advantage in showing the lesions of abdominal aorta and its branches in lumen, extraluminal and vascular wall, which can provide anatomical data of patients before operation.

Clinical characteristics of patients with black widow spider bites: A report of 59 patients and single-center experience / 世界急诊医学杂志（英文）

@#The black widow spider species, also known as the Latrodectus species by its biological nomenclature, is one of more than 40,000 different spider species and one of the most common poisonous species to humans.[1] It is reported to be responsible for most of the clinically significant envenomation among all species of spiders in the USA.[1] There are more than 30 different types of black widow spiders worldwide, and black widow spiders are easily identified by its characteristic shiny black body and strikingly red hourglass-shaped marking on the abdomen.[1] As a kind of world-famous highly toxic arachnid, their venom is highly toxic.[2] Casualties caused by black widow spider bites are reported all over the world in recent years.[3,4] In China, black widow spiders are mainly distributed in Xinjiang Uygur Autonomous Region, and have caused great harm to people’s lives.[5] Clinical characteristics of black widow spider bites are diverse. Except for local symptoms such as swelling, redness, and pain, many patients can develop systemic poisoning symptoms like hypotension, short of breath, and fever, which can lead to organ damage and even death.[6] The severity of poisoning depends on the type and the location of the bites, the level of toxicity, the amount of poison, and the health condition of the bitten individual.

Analysis on Evolution of Ancient Documents of Xiehuangsan / 中国实验方剂学杂志

Xiehuangsan， derived from QIAN Yi's Key to Therapeutics of Children's Diseases， consists of 5 medicines， namely Gypsum Fibrosum，Gardeniae Fructus，Saposhnikoviae Radix，Pogostemonis Herba and Glycyrrhizae Radix et Rhizoma. It is used to treat children with spleen heat and tongue scratching. With the clinical use of later generations of physicians，the scope of diseases and syndromes of this prescription was gradually expanded，including aphthous bad breath，dry lips，yellow eyes，and sweet mouth. Modern doctors used this prescription to treat children with anorexia，constipation，allergic purpura，tic disorder， and other diseases. At present，more and more attention has been paid to the research of classical famous prescriptions. At the same time，the application of classical famous prescriptions of traditional Chinese medicine（TCM） must be researched and verified in ancient literature. Therefore，it has become important contents in the study of classic prescriptions that researching the source of prescriptions from the ancient books，combing and analyzing literature，and studying the evolution rules of indications，preparations，methods of administration and taboos.The author searched a variety of ancient Chinese medicine databases and collected the relevant documents related to Xiehuangsan in ancient medical books. A total of 242 pieces of relevant ancient document data were obtained，involving 131 types of ancient Chinese medicine books. Through combing the relevant records of historical documents，this paper analyzes and researches the historical evolution of Xiehuangsan，the source and composition of the prescriptions，the indications，the dosage，the textual research of Chinese herbal medicine and the determination of the basis，and the method of prescription preparation and administration，etc. The historical changes of Xiehuangsan and its internal relations are expected to provide literature references and theoretical basis for the modern development and research of Xiehuangsan.

Research progress on natural products of fungi of Diaporthe sp / 中国中药杂志

Diaporthe sp. fungi is one of the important sources of active natural products. Polyketides, alkaloids, terpenes, anthraquinones and other types of novel metabolic products are found from this genus, and many of them have significant anti-tumor, antibacterial, anti-hyperlipidemia, inhibition of pulmonary fibrosis, antioxidant and other biological activities. This paper reviewed source, structure and biological activity of natural products from Diaporthe sp. in the past two decades, and provided a reference for in-depth study of natural product of this genus fungus and innovative drug development.

Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study / 世界急诊医学杂志（英文）

@#BACKGROUND:To evaluate the accuracy of National Early Warning Score (NEWS) in predicting clinical outcomes (28-day mortality, intensive care unit [ICU] admission, and mechanical ventilation use) for septic patients with community-acquired pneumonia (CAP) compared with other commonly used severity scores (CURB65, Pneumonia Severity Index [PSI], Sequential Organ Failure Assessment [SOFA], quick SOFA [qSOFA], and Mortality in Emergency Department Sepsis [MEDS]) and admission lactate level. METHODS: Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA ≥2 from baseline were enrolled. Demographic characteristics were collected. The primary outcome was the 28-day mortality after admission, and the secondary outcome included ICU admission and mechanical ventilation use. Outcome prediction value of parameters above was compared using receiver operating characteristics (ROC) curves. Cox regression analyses were carried out to determine the risk factors for the 28-day mortality. Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS. RESULTS: Among the 340 enrolled patients, 90 patients were dead after a 28-day follow-up, 62 patients were admitted to ICU, and 84 patients underwent mechanical ventilation. Among single predictors, NEWS achieved the largest area under the receiver operating characteristic (AUROC) curve in predicting the 28-day mortality (0.861), ICU admission (0.895), and use of mechanical ventilation (0.873). NEWS+lactate, similar to MEDS+lactate, outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality (AUROC 0.866) and ICU admission (AUROC 0.905), while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation (AUROC 0.886). Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission. CONCLUSIONS: NEWS could be a valuable predictor in septic patients with CAP in emergency departments. Admission lactate did not predict well the outcomes or improve the severity scores. A qSOFA ≥2 and a NEWS ≥9 were strongly associated with the 28-day mortality, ICU admission, and mechanical ventilation of septic patients with CAP in the emergency departments.

Diagnostic accuracy of artery peak velocity variation measured by bedside real-time ultrasound for prediction of fluid responsiveness: a Meta-analysis / 中华危重病急救医学

Objective:To evaluate the diagnostic value of ultrasonic measurement of artery peak velocity variation (ΔVpeak) on predicting fluid responsiveness in critically ill patients.Methods:Databases of PubMed, Embase, Cochrane Library, SinoMed, Wanfang, CNKI and VIP were retrieved from the establishment of the database to November 2019. The retrieval literatures were about the research of ΔVpeak used to judge fluid responsiveness. According to the inclusion and exclusion criteria, the relevant literatures were screened by two researchers, and the data of the included literatures were extracted. The quality of literatures was evaluated by quality assessment of diagnostic accuracy studies (QUADAS). Meta Dics 1.4 software was used to analyze the literatures that met the quality standard by Meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio ( DOR) were calculated. The summary receiver operating characteristic (SROC) curve was drawn and the area under SROC curve (AUC) was calculated. The χ 2 test and Spearman correlation coefficient were used to analyze heterogeneity, and Deek test was used to analyze publication bias. Results:A total of 1 854 patients were enrolled in 31 studies, including 11 domestic studies and 20 foreign studies. Using 14 items of QUADAS to evaluate the quality of literatures, it was found that the enrolled literatures were all in Grade A, indicating that the overall quality of literatures was high. The scattered distribution of SROC curve was not "shoulder arm shape", and Spearman correlation coefficient was 0.062 ( P = 0.710), so there was no threshold effect. The heterogeneity test showed that I2 = 57.2% ( P = 0.001), indicating that there was a certain degree of heterogeneity among the studies, and the source of heterogeneity was non threshold effect. Meta regression analysis showed that the reason for heterogeneity was the method of volume load test [ DOR = 3.87, 95% confidence interval (95% CI) was 1.56-9.57, P = 0.004 8]. According to the results of heterogeneity analysis, there was no significant heterogeneity ( I2 = 10.6, P = 0.288 5) among the studies after removing the samples of the passive leg raising (PLR) instead of the volume expansion. A meta-analysis was done with random effects model. The results showed that the pooled DOR was 23.85 (95% CI was 17.57 to 32.37), pooled sensitivity was 0.82 (95% CI was 0.80 to 0.85), pooled specificity was 0.83 (95% CI was 0.80 to 0.85), pooled PLR was 4.17 (95% CI was 3.58 to 4.86), and pooled NLR was 0.22 (95% CI was 0.18 to 0.28). The AUC was 0.901 2 (95% CI was 0.88 to 0.93), and Q index was 0.832 5. The results of Deek funnel plot showed that there was no published bias in all the studies ( P = 0.19). Conclusions:Ultrasonic measurement of ΔVpeak has a high value in predicting fluid responsiveness. It is a reliable parameter for the evaluation of shock, critical illness and surgical operation population who need to monitor the fluid responsiveness.

A systematic review and Meta-analysis of Tongfu Xiefei method in the treatment of acute respiratory distress syndrome / 中华危重病急救医学

Objective:To systematically review the effect of Tongfu Xiefei method on prognosis and respiratory mechanics parameters in patients with acute respiratory distress syndrome (ARDS).Methods:The randomized controlled trials (RCT) of Tongfu Xiefei method for ARDS published on PubMed, Web of Science, Embase, CNKI and Wanfang database from January 1st 2001 to June 30th 2019 were searched. Conventional treatment for ARDS that included mechanical ventilation, prone ventilation, anti-infection, organ function maintenance and nutritional therapy were used in the control group. While the Tongfu Xiefei method was applied in the experimental group based on the conventional treatment. The main outcome was in-hospital mortality, and the secondary outcomes included mechanic ventilation time, length of intensive care unit (ICU) stay and respiratory mechanics parameters. Two researchers independently searched the literature, collected data and assessed the risk of bias. The bias risk assessment was completed by RevMan 5.3 software. The Meta-analysis was completed by R software. The potential publication bias of main outcome was evaluation.Results:A total of 27 RCTs were included. There were 1 763 patients, including 899 in the experimental group and 864 in the control group. Meta-analysis showed that, compared with the control group, the in-hospital mortality of the experimental group significantly decreased [relative risk ( RR) = 0.46, 95% confidence interval (95% CI) was 0.36 to 0.59, P < 0.000 1], the mechanic ventilation time and the length of ICU stay were significantly shortened [mechanical ventilation time: standard mean difference ( SMD) = -1.92, 95% CI was -2.56 to -1.29, P < 0.000 1; length of ICU stay: SMD = -1.84, 95% CI was -2.49 to -1.18, P < 0.000 1], oxygenation index was significantly improved ( SMD = 2.26, 95% CI was 1.56 to 2.96, P < 0.000 1), airway peak pressure, airway platform pressure, mean airway pressure and airway resistance significantly decreased (airway peak pressure: SMD = -1.26, 95% CI was -2.35 to -0.18, P = 0.021 8; airway platform pressure: SMD = -0.61, 95% CI was -1.08 to -0.14, P = 0.010 7; mean airway pressure: SMD = - 1.67, 95% CI was - 2.93 to -0.42, P = 0.009 1; airway resistance: SMD = -0.88, 95% CI was -1.09 to -0.67, P < 0.000 1), while lung compliance increased ( SMD = 1.57, 95% CI was 0.78 to 2.36, P < 0.000 1). The results of publication bias assessment showed that there was no potential publication bias ( P = 0.499). Conclusion:Tongfu Xiefei method is capable of reducing the in-hospital mortality, shortening the mechanical ventilation time and the length of ICU stay, and improving respiratory mechanics parameters for patients with ARDS.

Gastrointestinal involvement of COVID-19 and potential faecal transmission of SARS-CoV-2 / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was found initially in Wuhan, China in early December 2019. The pandemic has spread to 216 countries and regions, infecting more than 23310 000 people and causing over 800 000 deaths globally by Aug. 24, 2020, according to World Health Organization (https://www.who.int/emergencies/diseases/ novel-coronavirus-2019). Fever, cough, and dyspnea are the three common symptoms of the condition, whereas the conventional transmission route for SARS-CoV-2 is through droplets entering the respiratory tract. To date, infection control measures for COVID-19 have been focusing on the involvement of the respiratory system. However, ignoring potential faecal transmission and the gastrointestinal involvement of SARS-CoV-2 may result in mistakes in attempts to control the pandemic.

Research progress on sesquiterpenes and its pharmacological activities in genus Carpesium / 中国中药杂志

The genus Carpesium plants contain many kinds of sesquiterpenes. Up to now, more than 201 sesquiterpene compounds have been isolated and identified, including 86 germacranolides, 30 eudesmanolides, 29 guaianolides, 23 sesquiterpene dimers, 9 pseudoguaianes, 9 carabranolides, 7 xanthanolides, 6 sesquiterpenes without lactone, 1 eremophilane and 1 tricyclo dodecane sesquiterpene. The reported sesquiterpenes possess a series of pharmacological properties, such as anti-tumor, anti-inflammatory, antibacterial, antiparasitic, insecticidal, and antiviral activities. This paper summarizes the 201 chemical structures and biological activities of sesquiterpenes in genus Carpesium, and provides the scientific basis for the further development and utilization.

Effects of heat stroke on CD4+CD25+Foxp3+ regulatory T cells in rats / 解放军医学杂志

Objective To better understand the immune status in the rats after heatstroke. Methods Adult male SD rats were randomized into 3 groups: control group (n=20), classic heatstroke group (CHS, n=60) and exertional heatstroke group (EHS, n=60). Flow cytometry was employed to detect the percentage of CD4+CD25+Foxp3+ regulatory T cells (Tregs) in arterial blood and spleen as well as the apoptosis rate of Tregs in the spleen. To trace the dynamic changes on Treg cells, samples were collected at specific time points after heatstroke modeling (0, 6, 12, 24, 48, 72 hours post heatstroke). Results The proportion of Tregs in artery blood and spleen in CHS group increased gradually with a percentage lower than those in control group at first 24 h but higher than those in control group after 24 h. Interestingly, the proportion of Tregs in artery blood and spleen in EHS group was gradually reduced over time. The Tregs in the artery blood slightly higher than that in control group at 0 h followed by less than that in control group afterward; while Tregs in the spleen were higher than that in control group within 12 h, followed by less than that in control group after 24 h. The proportion of apoptotic Tregs in the spleen in CHS group was gradual decline over time, in the first 12 h they were higher than that in control group but lower than that in control group after 24 h. On the contrary, the proportion of apoptotic Tregs in the spleen in EHS group was gradually increased over time and was higher than that in control group at all time points. Conclusions The proportion of Tregs in peripheral blood and spleen in CHS group showed a rising trend during the early period. This is consistent with the trend in the spleen Tregs apoptosis rate, indicated that immunosuppression may have appeared in the early onset of CHS rats. However, the proportion of Tregs in peripheral blood and spleen in EHS group showed a trend of gradual reduction which is consistent with the spleen Tregs apoptosis rate. The opposite phenotype detected from CHS and EHS rats may due to the excessive inflammatory reaction promoted the apoptosis of Tregs in EHS rats.

Clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy / 中华消化外科杂志

Objective To explore the clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods The retrospective cohort study was conducted.The clinicopathological data of 39 patients who underwent PD in the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to December 2017 were collected.There were 26 males and 13 females,aged (60±7)years,with a range of 41-75 years.All the 39 patients underwent PD,using Child method to reconstruct digestive tract.Of 39 patients,19 undergoing modified invagination for pancreaticojejunostomy and 20 undergoing mucosa-to-mucosa end-to-side pancreaticojejunostomy were allocated to innovative group and traditional group,respectively.Observation indicators:(1)surgical situations;(2) postoperative complications;(3) follow-up.Follow-up was performed by outpatient examination and telephone interview to detect postoperative tumor recurrence,main pancreatic duct dilatation,survival,and discomfort (abdominal pain,bloating,indigestion,etc.) of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by t test.Measurement data with skewed distribution were represented as M (P25,P75) or M (range),and comparison between groups was analyzed by Mann Whitney U test.Count data were expressed as absolute numbers,and comparison between groups was analyzed by chi-square test or Fisher exact probability.Results (1) Surgical situations:operation time,volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay of the innovative group were (342±47) minutes,400 mL (300 mL,400 mL),10,9,3.1 cm (2.9 cm,3.4 cm),37 days (32 days,63 days),17,18 days (15 days,22 days),respectively,versus (392±95)minutes,400 mL (300 mL,525 mL),6,14,3.6 cm (2.6 cm,4.2 cm),43 days (34 days,49 days),18,and 24 days (15 days,27days) of the traditional group;there was no significant difference in the volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay between the two groups (Z=-0.775,x2 =2.063,Z=-1.155,Z=-0.295,x2 =0.003,Z=-1.286,P＞0.05);but a significant difference in operation time between the two groups (t =-2.114,P＜0.05).(2) Postoperative complications:6 patients in the innovative group had complications,including 1 of delayed gastric emptying,1 of wound infection,1 of pulmonary infection,1 of acute respiratory failure,1 of perihepatic effusion,and 3 of grade A pancreatic leakage;11 patients in the traditional group had postoperative complications,including 1 of bile leakage,2 of delayed gastric emptying,4 of abdominal infection,4 of wound infection,2 of pulmonary infection,1 of ascites,1 of abdominal hemorrhage,1 of pleural effusion,2 of grade A pancreatic leakage,5 of grade B and C pancreatic leakage;the same patient had multiple complications.There was no significant difference in postoperative complications between the two groups (x2=2.174,P＞0.05),but there was a significant difference in postoperative grade B and C pancreatic leakage between the two groups (P＜O.05).Patients with postoperative complications were improved after symptomatic support treatment,and no patient died during the perioperative period.(3) Follow-up:of the 39 patients,33 (18 in the innovation group and 15 in the traditional group) were followed up for 3-57 months,with a median follow-up time of 17 months.Of the 18 patients receiving follow-up in the innovative group,5 died of tumor recurrence and metastasis,with a survival time of 5-24 months,1 had tumor recurrence at 34 months after operation,1 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,5 had indigestion,1 had back pain,and 5 had good recovery.Of 15 patients receiving follow-up in the traditional group,10 died of tumor recurrence and metastasis,with a survival time of 3-57 months,2 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,2 had indigestion,1 had good recovery.Conclusion Compared with the traditional mucosa-to-mucosa end-to-side pancreaticojejunostomy,modified invagination for pancreaticojejunostomy in the PD is safe and feasible,which can simplify the operation,reduce the requirements for the operator's operation skills,shorten the operation time,and reduce incidence of postoperative grade B and C pancreatic leakage.

Influence of visceral fat area on the prognosis of laparoscopic radical resection in patients with colorectal cancer / 医学研究生学报

Objective The factors influencing the prognosis of laparoscopic radical resection of colorectal cancer remain controversial. This study was to investigate the effect of visceral fat area (VFA) on the prognosis of laparoscopic radical resection of colorectal cancer and provide evidence for evaluating the prognosis of patients with colorectal cancer. Methods A retrospective analysis was made on the clinical data of 218 patients undergoing laparoscopic radical resection of colorectal cancer in the Department of Gastrointestinal Surgery of Affiliated Hospital of Southwest Medical University from March 2013 to June 2014. The patients were divided into VFA-S group (VFA<100cm2, n=106) and VFA-L group (VFA≥100m2, n=112) according to the measured VFA values. The basic clinical data of the two groups were compared and the short-term and long-term prognosis of VFA were evaluated by logistic regression and Cox regression models. Results The incidence of complication and the incidence of minor complications (13.2%, 9.4%) in VFA group were significantly lower than those in control group (27.7%, 19.6%), and the difference was statistically significant (P<0.05). The overall survival rate of patients in VFA group at 1 year, 3 years, and 5 years (98.1%, 87.7%, 70.8%) was significantly greater than that of control group (93.8%, 67.9%, 58.0%), and the difference was statistically significant (P< 0.05). The disease-free survival rate (98.1%, 84.0%, 70.8%) at 1 year, 3 years, and 5 years after surgery was significantly higher in VFA group than that in control group (92.0%, 67.9%, 58.0%), and the difference was statistically significant (P <0.05). The Kaplan-Meier curve showed that the overall survival and disease-free survival (58.91 months, 57.82 months) in VFA group were significantly greater than those in control group (51.61 months, 50.60 months), and the difference was statistically significant (P<0.05). The overall survival and disease-free survival were associated with ASA classification, differentiation, TNM stage, and VFA (P<0.05). Conclusion VFA has an impact on short-term and long-term prognosis after laparoscopic radical resection of colorectal cancer. VFA≥100cm2 indicates that patients have a high possibility of postoperative complications and poor prognosis.

Survival analysis of 198 patients with pancreatic cancer in Hainan, China: A multi-institution prospective study

Objective: To explore the survival status and prognostic factors of patients with pancreatic cancer in Hainan. Methods: Clinical data of patients who were diagnosed as pancreatic cancer and visited the First and Second Affiliated Hospital of Hainan Medical University and Haikou People's Hospital from 2013 to 2017 were collected based on electronic medical records. Basic information was collected by a self-designed questionnaire. Data about admission examinations including blood routine examination, blood biochemistry tests, tumour markers tests, imaging examination and other clinical tests were also collected. The date of follow-up via telephone was 30 June 2018. The survival rate was analyzed by the Kaplan-Meier method and the logrank test. Univariate and multivariate analyses were performed with COX regression model. Results: A total of 198 patients were included in the study. Kaplan-Meier results showed that the overall survival (OS) in 6 months and 1, 2, 3 and 5 years was 47.4%, 26.8%, 16.4%, 13.2%, and 8.7%, respectively. The median OS was 5.8 months. Log-rank test analysis found that there were significant differences in OS among patients with different age, surgery status, distant metastasis or absolute number of neutrophils, percentage of neutrophils, absolute number of lymphocytes, neutrophil-to-lymphocyte ratio (NLR), CA199 and carcino-embryonic antigen (P<0.1). COX multivariate analysis showed that age, surgical presence, presence or absence of distant metastasis and NLR were significantly associated OS (P<0.05). Conclusions: Older age, higher NLR and liver or lung metastasis are independent risk factors, while surgical treatment is an independent protective factor for patients with pancreatic cancer.

Acupoint Catgut Embedding Alleviates Insomnia in Different Chinese Medicine Syndrome Types: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To investigate the effects and safety of catgut embedding on alleviating insomnia.@*METHODS@#Totally 510 patients with insomnia were divided into 5 Chinese medicine (CM) syndrome types: Xin (Heart) and Pi (Spleen) deficiency, yin deficiency with excess fire, Xin and gut qi deficiency, Wei (Stomach) disorder, and qi and blood deficiency, respectively. These 5 types of patients were randomly assigned to a catgut embedding group, an acupuncture group or a medication group (30 cases in Xin and Pi deficiency type, Wei disorder type, Xin and gut qi deficiency type, respectively; 40 cases in yin deficiency with excess fire type and qi and blood deficiency type, respectively). In the catgut embedding group, patients were treated by implanting catgut into acupoints once every 10 days for a total of 30 days. In the acupuncture group, patients were treated with acupuncture once per day over 30 days (excluding weekends); and patients in the medication group took 1 mg Eurodin Tablet orally every night for 30 days. Pittsburgh Sleep Quality Index (PSQI) was evaluated before treatment, on 30 and 60 days after the first treatment, respectively. The International Unified Sleep Efficiency Value (IUSEV) was measured at 30 and 60 days. The safety was evaluated after treatment and adverse events were analyzed.@*RESULTS@#The objective PSQI scores including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, daytime dysfunction, and total scores at 30 days were significantly improved compared with pre-treatment in the catgut embedding and acupuncture groups (P<0.01 or P<0.05). At 30 days, the PSQI scores in catgut embedding group were superior to the medication group in the patients with each type of insomnia, with the exception of sleep duration (P<0.01 or P<0.05). At 60 days, significant differences were found between the catgut embedding group and the medication group (P<0.01 for all indices). The IUSEV scores in the catgut embedding group were significantly higher than the acupuncture group at 60 days, and the scores in acupuncture group were higher than the medication group at 30 days (P<0.05 for all types). No severe adverse events were found in this study.@*CONCLUSIONS@#Acupoint catgut embedding and acupuncture were more effective than medication in alleviating insomnia syndrome in different Chinese medicine syndrome type. However, the sustained effects of acupoint catgut embedding were superior to acupuncture.

Personality and depression: A review of theory model and behavior and neural mechanism / 生理学报

The analysis of the relationship between personality and depression can facilitate the development of subclinical preventive measures and clinical treatment schemes. Moreover, the personality is associated with a variety of mental diseases, and there is substantial comorbidity between depression and some other mental diseases. So, to reveal pathological relationships between personality and depression is helpful to understand the etiology of the comorbidity between depression and multiple mental disorders. In this review, we first summarize the empirical researches on the relationship between personality and depression from the aspects of behavior and neural mechanisms, and then discuss the hypothetical model to explain the relationship between personality and depression. In a word, high neuroticism, low extroversion and conscientiousness, and other related traits (rumination, self-criticism, dependency, etc.) have a moderate to strong correlation with depression. Among them, neuroticism is the most concerned. To a certain extent, it can predict the onset of depression and affect the duration and treatment outcome of depression. Other traits, such as positive emotionality/ extroversion and effortful control/responsibility, can moderate the relationship between negative emotionality/neuroticism and depression. And after the onset of depression, the neuroticism may change, but the extroversion does not seem to change.

Clinical characteristics of patients with Haff disease after eating crayfish / 世界急诊医学杂志（英文）

BACKGROUND@# The study aimed to explore the clinical presentations, laboratory findings, treatments and prognosis of patients with Haff disease after eating crayfish.@*METHODS@#Sixteen patients with Haff disease after eating crayfish were admitted to the Emergency Department of Beijing Chao-yang Hospital between June 2013 and August 2017. Clinical data was retrospectively analyzed.@*RESULTS@#Alcohol consumption and exercise were found to be most commonly associated with the onset of rhabdomyolysis after consuming crayfish. Most patients were young adults and the symptoms mostly occurred within 24 hours of consumption of crayfish. Clinical symptoms included myalgia (100%), fatigue (87.5%), nausea (43.8%), dizziness (62.5%), chest distress (37.5%) and fever (18.8%). Also found after laboratory testing was elevations in the levels of creatine kinase (11,376±5,535 U/L), myoglobin (350±158 ng/mL), lactate dehydrogenase (6,539±3,180 U/L), alanine transaminase (174±71 U/L) and aspartate aminase (348±100 U/L). The incidence of renal dysfunction was low (6.25%), and all 16 patients had a good prognosis.@*CONCLUSION@#Patients with Haff disease exhibited typical symptoms after consuming crayfish, and laboratory findings gave highly accurate diagnostic results. The development of rhabdomyolysis was considered to be associated with alcohol consumption and exercise, but further studies are needed to demonstrate its relationship with crayfish consumption. Compared with other causes of rhabdomyolysis, rhabdomyolysis after crayfish consumption has fewer complications and better prognosis.