Characterization of the cellular immune response induced by Mycobacterium tuberculosis Rv2626c / 生物工程学报

Nearly a quarter of the world's population is infected with Mycobacterium tuberculosis and remains long-term asymptomatic infection. Rv2626c is a latent infection-related protein regulated by DosR of M. tuberculosis. In this study, the Rv2626c protein was prokaryotically expressed and purified, and its immunobiological characteristics were analyzed using RAW264.7 cells and mice as infection models. SDS-PAGE and Western blotting analysis showed that the Rv2626c-His fusion protein was mainly expressed in soluble form and specifically reacted with the rabbit anti-H37RV polyclonal serum. In addition, we found that the Rv2626c protein bound to the surface of RAW264.7 macrophages and up-regulated the production of NO. Moreover, the Rv2626c protein significantly induced the production of pro-inflammatory cytokines IFN-γ, TNF-α, IL-6 and MCP-1, and induced strong Th1-tendency immune response. These results may help to reveal the pathogenic mechanism of M. tuberculosis and facilitate the development of new tuberculosis vaccine.

Comparison between the 2020 international guidelines for the management of sepsis and septic shock and the Japanese guidelines for the management of sepsis / 中华危重病急救医学

In 2021, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) jointly released the Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2020 with 93 recommendations. In the same year, the Japanese Society of Intensive Care Medicine (JSICM) and the Japanese Association for Acute Medicine (JAAM) also cooperated to publish the Japanese clinical practice guidelines for management of sepsis and septic shock 2020, covering 118 clinical issues in 22 areas. In this paper, 50 items in the contents of the two guidelines are compared in accordance with the order of international guidelines, including screening, initial resuscitation, mean arterial pressure, transfer to intensive care unit (ICU), diagnosis of infection, timing of antimicrobial administration, biomarkers for initiation of antimicrobial therapy, selection of antibiotic, antifungal therapy, antiviral therapy, infusion of antibiotic, pharmacokinetics and pharmacodynamics, source of infection control, antimicrobial de-escalation strategy, course of antimicrobial administration, biomarkers for discontinuation of antibiotic, fluid management, vasoactive agents, positive inotropic agents, monitoring and intravenous access, fluid balance, oxygenation targets, high-flow nasal cannula oxygen therapy, noninvasive ventilation, protective ventilation in acute respiratory distress syndrome (ARDS), low tidal volume in respiratory failure patients with non-ARDS, lung recruitment maneuvers, prone position ventilation, muscle relaxants, extracorporeal membrane oxygenation (ECMO), glucocorticoids, blood purification, red blood cell (RBC) transfusion, immunoglobulin, stress ulcer prevention, prevention of venous thromboembolism (VTE), renal replacement therapy, glycemic management, vitamin C, sodium bicarbonate therapy, nutrition, treatment goals, palliative care, peer support groups, transition of care, screening economic and social support, education for the knowledge about sepsis to the patients and their families, common decision-making, discharge planning, cognitive therapy and follow-up after discharge. It is convenient for everyone to understand some views in the field of sepsis and septic shock, and deepen their understanding.

Development of a flow cytometry method for detection of bovine multi-cytokines / 生物工程学报

This study aims to develop a method to detect bovine multi-cytokines based on flow cytometry. Previously we have prepared and screened monoclonal antibodies against bovine cytokines IFN-γ, IL-2, TNF-α, IP-10 and MCP-1. These bovine cytokine monoclonal antibodies were fluorescently labeled, and the combination of antibody and cell surface molecules were used to develop the method for detecting bovine multi-cytokines. Subsequently, the developed method was used to determine the cytokine expression profile of Mycobacterium bovis BCG infected bovine peripheral blood mononuclear cells in vitro, and evaluate the cytokine expression level of peripheral blood CD4+ T cells of tuberculosis-positive cattle. The bovine multi-cytokine flow cytometry detection method can effectively determine the cytokine expression of BCG-infected bovine peripheral blood T lymphocytes. Among them, the expression levels of IFN-γ, IL-2, and TNF-α continue to increase after 40 hours of infection, while the expression levels of IP-10 and MCP-1 decreased. The combined detection of IFN-γ, IL-2, and TNF-α on CD4+ T lymphocytes in peripheral blood of cattle can effectively distinguish tuberculosis-positive and tuberculosis-negative samples. This method may facilitate evaluating the level of cellular immune response after bovine pathogen infection and vaccine injection.

The clinical characteristics and prognostic value of PSA dynamic features in patients with metastatic castration resistant prostate cancer received abiraterone acetate / 中华泌尿外科杂志

Objective:To analyze the clinical characteristics and prognostic value of prostate-specific antigen (PSA) dynamic features in patients with metastatic castration resistant prostate cancer (mCRPC) received abiraterone acetate (AA) therapy.Methods:The data of 89 patients with mCRPC who received AA therapy from January 2017 to June 2021 in Shanghai Tongji Hospital were retrospectively reviewed. The age of patients was (75.7 ± 8.3) years old, median PSA before AA was 56.88 (19.31, 143.75) ng/ml. The PSA dynamic features included PSA nadir (PSAN) and PSAN time. PSAN was defined as the lowest value of PSA after treatment, and PSAN time was defined as time to PSAN after AA treatment. PSAN was divided into 3 groups: PSAN1 (<0.1 ng/ml), PSAN2 (0.1- 4.0 ng/ml) and PSAN3 (>4.0 ng/ml) groups. PSA response was defined as a maximum PSA decline rate ≥50%, and no PSA decline after treatment was defined as primary resistance. Cox regressions adjusted to clinical factors were performed to evaluate the influence of PSA dynamic features on patients' radiographic progression-free survival (rPFS) and overall survival (OS). Log-rank test was used to evaluate the survival time of patients in different PSAN groups. Receiver operator characteristic (ROC) curve and area under the curve (AUC) were performed to analyze the predictive value of PSA dynamic features on survival outcomes of patients.Results:The follow-up time was 17 (12, 23) months, and 75 (84.3%) patients showed PSA responses. The median PSAN was 1.82 (0.01, 11.70) ng/ml, median PSAN time was 5.0(3.0, 9.5)months. Multivariate Cox regression indicated that PSAN was an independent risk factor for rPFS ( PSAN2: HR=5.308, P=0.017; PSAN3: HR=13.209, P<0.001), and PSAN time ≥ 5 months( HR=0.309, P<0.001)was an independent protective factor for rPFS. Also, the PSAN3 was an independent risk factor for OS( HR=9.459, P=0.048). Log-rank test indicated that the rPFS of PSAN1 group (median not reached) was significantly longer than PSAN2 [median 13.0(95% CI 8.2-17.8) months, P=0.001] and PSAN3 [8.0 (95% CI 4.1-11.9) months, P<0.001] groups. ROC curve and AUC showed that PSAN had a higher predictive value in rPFS outcomes compared with T stage, metastatic disease volume, and Eastern Cooperative Oncology Group (ECOG) score (0.82 vs. 0.69, 0.68, 0.53, P<0.05). PSAN had a higher predictive value in OS outcomes than metastatic disease volume and ECOG(0.83 vs. 0.63, 0.58, P<0.05). Conclusions:Lower PSAN needs longer PSAN time. PSAN is an independent risk factor for rPFS and OS, and PSAN time is an independent protective factor for rPFS.

Treatment of Schatzker type Ⅳ tibial plateau fracture involving the postero-lateral condyle with a medial support plate and a row of screws / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of a medial support plate and a row of screws in the treatment of Schatzker type Ⅳ tibial plateau fracture involving the postero-lateral condyle.Methods:A retrospective analysis was performed of the data of 26 patients who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University for Schatzker type Ⅳ tibial plateau fracture involving the postero-lateral condyle from December 2015 to December 2020. There were 17 males and 9 females, aged from 19 to 51 years (average, 36.1 years). All their fracture lines involved the postero-lateral condyle and all fractures were fixated with a medial support plate and a row of screws via one medial and one lateral incisions. Recorded were the operation time, hospital stay, blood loss, incision length, fracture healing, complications, quality of knee joint reduction and knee joint function at the last follow-up.Results:The length of hospital stay ranged from 8 to 16 days, averaging 10.4 days. The 26 patients were followed up for 8 to 18 months, with an average of 14.3 months. All the fractures got united after 11 to 17 weeks (average, 13.7 weeks). During the follow-up, no reduction loss, internal fixation failure or surgical complications were observed. Rasmussen radiographic scores at the last follow-up ranged from 11 to 18 points, averaging 16.1 points. The range of motion of the knee joint ranged from 0° to 140°, averaging 120.8°. The Rasmussen scores of the knee function ranged from 14 to 28 points, averaging 24.4 points.Conclusion:In the treatment of Schatzker type Ⅳ tibial plateau fracture involving the postero-lateral condyle, the use of a medial support plate and a row of screws can achieve satisfactory clinical results.

Physical activity and primary prevention of stroke / 国际脑血管病杂志

With the change of lifestyle, lack of physical activity has become a serious public health problem. As an active intervention, physical activity can reduce the risk of stroke and play an important role in the primary prevention of stroke. This article reviews the research progress of physical activity and primary prevention of stroke in recent years, including the research progress of the relationship between physical activity and risk factors for stroke.

Application of flipped classroom combined with online interactive teaching in clinical clerkship of cardiology / 中华医学教育探索杂志

Objective:To explore the application effect of flipped classroom combined with online interactive teaching in clinical clerkship of cardiology.Methods:The study collected 56 students from Batch 2017 five-year clinical medicine undergraduate class of Medical College of China Three Gorges University and they were randomly divided into experimental group and control group in average. The control group adopted the traditional teaching method while the experimental group adopted the combined teaching method. The differences of test scores after teaching were compared between the two groups and the feedback of students on the two methods was also analyzed. SPSS 12.0 was used for t test and chi-square test. Results:The final score of clinical thinking in the experimental group (84.38±3.18) was significantly higher than in the control group (75.43±5.85) ( P<0.05), and the satisfaction of the experimental group to the teaching mode was [86% (24/28)], which was significantly higher than that of the control group [50% (14/28)]. More than 80% of the students in the experimental group regarded that the combined teaching method was helpful to promote the interaction between teachers and students, master relevant knowledge, and improve learning interest and learning efficiency. Conclusion:This combined teaching method can enhance students' clinical thinking ability, learning enthusiasm and efficiency, and finally effectively improve the effect of clerkship.

The effects of weight-bearing area compression injury of the femoral head on the outcomes of elderly acetabular fractures after open reduction and internal fixation / 中华骨科杂志

Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.

Perioperative transcutaneous electrical acupoint stimulation for improving postoperative gastrointestinal function: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Postoperative gastrointestinal dysfunction (PGD) is one of the most common complications in patients undergoing major abdominal surgery. Acupuncture has been used widely in gastrointestinal diseases due to its effectiveness and minimally invasive nature.@*OBJECTIVE@#This study evaluated the efficacy of using transcutaneous electrical acupoint stimulation (TEAS) during the surgery and postoperative recovery in patients with gastric and colorectal surgery for improving postoperative gastrointestinal function.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS@#A total of 280 patients undergoing abdominal surgery were stratified by type of surgery (i.e., gastric or colorectal surgery) and randomly allocated into the TEAS group (group T) or the sham group (group S). Patients in group T received TEAS at LI4, PC6, ST36 and ST37. Patients in group S received pseudo-TEAS at sham acupoints. The stimulation was given from 30 min before anesthesia until the end of surgery. The same treatment was performed at 9 am on the 1st, 2nd and 3rd days after surgery, until the recovery of flatus in patients.@*MAIN OUTCOME MEASURES@#The primary outcome was the time to the first bowel motion, as detected by auscultation. The secondary outcomes included the first flatus and ambulation time, changes of perioperative substance P (SP), incidence of PGD, postoperative pain, postoperative nausea and vomiting (PONV) and some economic indicators.@*RESULTS@#The time to first bowel motion, first flatus and first ambulation in group T was much shorter than that in group S (P < 0.01). In patients undergoing colorectal surgery, the concentration of SP was lower in group T than in group S on the third day after the operation (P < 0.05). The average incidence of PGD in all patients was 25%, and the frequency of PGD was significantly lower in group T than in group S (18.6% vs. 31.4%, respectively; P < 0.05). TEAS treatment (odds ratio = 0.498; 95% confidence interval: 0.232-0.786) and type of surgery were relevant factors for the development of PGD. Postoperative pain score and PONV occurrence were significantly lower in group T (P < 0.01). Postoperative hospitalization days and the resulting cost to patients were greatly reduced in the TEAS group (P < 0.01).@*CONCLUSION@#Perioperative TEAS was able to promote the recovery of postoperative gastrointestinal function, reduce the incidence of PGD and PONV. The concentration of SP was decreased by TEAS treatment, which indicates that the brain-gut axis may play a role in how TEAS regulates gastrointestinal function.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry, ChiCTR1900023263.

A Standard Method for Performance Detection of Fluorescence Imaging System / 中国医疗器械杂志

Fluorescence imaging now becomes an intraoperative navigation technique that gaining popularity in surgery and clinical research. However, at present, there is no mature and reliable method or other related guidance documents for the detection of fluorescence imaging performance. The performance analysis and quality supervision of products on the market could not be performed, which affects their clinical use and image quality. In this paper, a standard method of fluorescence imaging performance testing for fluorescence imaging system is proposed. Several kinds of fluorescence imaging performance parameters affecting fluorescence images are defined strictly. We also recommend scientific and feasible methods for their detections and analyses, which are verified by practical examples. This paper aims to provide a feasible reference standard for fluorescence performance evaluation.

Long-term high altitude exposure influence the processing stage of conflict inhibition / 中华行为医学与脑科学杂志

Objective:To explore the neutral mechanism of influence of long-term exposure to high altitude hypoxia environment on the processing stage of conflict inhibition.Methods:Differences in the electroencephalogram during a 2-1 mapping Stroop task were compared between a high-altitude (HA) group ( n=20) who lived in a high-altitude area (3 650 m) for two years, and a low-altitude (LA) group ( n=20) who had never visited high-altitude areas. Results:The HA group had a higher pulse rate ((82.0±9.7)/min vs (74.0±11.3)/min) and lower oxygen saturation level ((90.7±2.8)% vs (97.4±1.1)%) compared with LA group.Behavior data showed that the reaction time (RT) in congruent (CO) condition was shorter than that in stimulus incogruent (SI) condition, and the RT in SI condition was shorter than that in RI condition ((707.91±70.33)ms vs (753.76±72.96)ms vs (803.88±73.21)ms); accuracy(ACC) rate in SI condition was higher than CO condition, and the ACC in CO condition was higher than RI condition((96.35±2.91)% vs (95.90±2.83)% vs (91.55±5.22)%). And the response conflict effect was larger than the stimulus conflict effect((49.76±33.90) vs (23.60±30.20)). The differences were all statistically significant (all P<0.01). In SI condition, the RT of HA group was longer than LA group((730.43±60.50)ms vs (777.09±78.23)ms) ( P<0.05). As for the EEG, the amplitude of P2((6.18±0.62)μV vs (3.21±0.62)μV) and N450((1.39±1.48)μV vs (5.91±1.48)μV) component of the HA group were higher those that of the LA group.The amplitude of N450 at P4 electrode site was larger than that at P3 electrode site in HA group((2.26±1.34)μV vs (0.62±1.43)μV). The differences were all statistically significant (all P<0.05). Conclusion:Long-term exposure to high altitude hypoxia environment affects the early stage of stimulus perception and task retrieval, as well as the conflict monitoring in later stage of stimulus and response conflict.The HA group need compensation of right parietal to complete the conflict monitoring of stimulus and response conflict.

Automated Breast Ultrasound: Interobserver Agreement,Diagnostic Value, and Associated Clinical Factors ofCoronal-Plane Image Features

Objective@#To evaluate the interobserver agreement, diagnostic value, and associated clinical factors of automated breastultrasound (ABUS) coronal features in differentiating breast lesions. @*Materials and Methods@#This study enrolled 457 pathologically confirmed lesions in 387 female (age, 46.4 ± 10.3 years),including 377 masses and 80 non-mass lesions (NMLs). The unique coronal features, including retraction phenomenon,hyper- or hypoechoic rim (continuous or discontinuous), skipping sign, and white wall sign, were defined and recorded. Theinterobserver agreement on image type and coronal features was evaluated. Furthermore, clinical factors, including the lesionsize, distance to the nipple or skin, palpability, and the histological grade were analyzed. @*Results@#Among the 457 lesions, 296 were malignant and 161 were benign. The overall interobserver agreement for imagetype and all coronal features was moderate to good. For masses, the retraction phenomenon was significantly associated withmalignancies (p < 0.001) and more frequently presented in small and superficial invasive carcinomas with a low histologicalgrade (p = 0.027, 0.002, and < 0.001, respectively). Furthermore, continuous hyper- or hypoechoic rims were predictive ofbenign masses (p < 0.001), whereas discontinuous rims were predictive of malignancies (p < 0.001). A hyperechoic rim wasmore commonly detected in masses more distant from the nipple (p = 0.027), and a hypoechoic rim was more frequently foundin large superficial masses (p < 0.001 for both). For NMLs, the skipping sign was a predictor of malignancies (p = 0.040). @*Conclusion@#The coronal plane of ABUS may provide useful diagnostic value for breast lesions.

Efficacy of Acupuncture Combined with Local Anesthesia in Ischemic Stroke Patients with Carotid Artery Stenting: A Prospective Randomized Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the efficacy of electro-acupuncture (EA) or transcutaneous electrical acupoint stimulation (TEAS) on perioperative cerebral blood flow (CBF) and neurological function in ischemic stroke (IS) patients undergoing carotid artery stenting (CAS).@*METHODS@#In total, 124 consecutive IS patients were randomly allocated to the EA, TEAS, and sham groups (groups A, T, and S; 41, 42, and 41 cases, respectively) by software-derived random-number sequence. Groups A and T received EA and TEAS, respectively, at the Shuigou (GV 26) and Baihui (GV 20), Hegu (LI4) and Waiguan (TE 5) acupoints. Group S received sham EA. The stimulation was started from 30 min before surgery until the end of the operation. The primary outcome was the CBF at 30 min after surgery, which was measured by transcranial Doppler sonography. The secondary outcomes included hyperperfusion incidence and neurological function. National Institutes of Health Stroke Scale (NIHSS) and General Evaluation Scale (GES) scores were recorded at 1 week, 1 month, and 3 months postoperatively.@*RESULTS@#Mean CBF velocity at 30 min after surgery in groups A and T was much lower than that in Group S (P < 0.05); the incidence of hyperperfusion in Groups A and T was also lower than that in group S (P <0.05). Acupuncture was an independent factor associated with reduced incidence of hyperperfusion (OR=0.042; 95% CI: 0.002-0.785; =0.034). NIHSS and GES scores improved significantly at 1 week postoperatively in Groups A and T than in Group S (P < 0.05). Relative to Group S, groups A and T exhibited significantly lower incidences of moderate pain, as well as higher incidences of satisfaction with anesthesia, at 1 day postoperatively (P < 0.05).@*CONCLUSIONS@#EA or TEAS administered in combination with local anesthesia during CAS can inhibit transient increases in CBF, reduce the incidence of postoperative hyperperfusion, and improve neurological function. (Registration No. ChiCTR-IOR-15007447).

ISA 61 VG adjuvant enhances protective immune response of Listeria monocytogenes inactivated vaccine / 生物工程学报

Listeria monocytogenes (Lm) is zoonotic pathogen that can cause listeriosis, and vaccine is one of the effective methods to prevent this pathogen infection. In this study, we developed a novel vaccine that is a mixture of inactivated bacteria and Montanide™ ISA 61 VG, a mineral oil adjuvant, and evaluated the safety and immune response characteristics of this vaccine. The mice immunized with the ISA 61 VG adjuvant had high safety, and it could induce significantly higher titer of anti-listeriolysin O (LLO) antibody and higher value of IgG2a/IgG1 ratio compared with the group without the adjuvant. In particular, it could provide 100% immune protection against lethal doses of Lm challenge in mice. In summary, ISA 61VG adjuvant significantly enhanced the ability of inactivated listeria vaccine to induce humoral and cellular immune responses, thereby enhanced the protective immune response in the host, and it is a potential vaccine candidate for the prevention of Lm infection in humans and animals.

Effect of cooperation between transporters and metabolic enzymes on drug disposition by intestine and liver / 药学学报

Drug transporters and metabolic enzymes are the key proteins in the disposition of drugs in the body. In recent years it has been found that there is a cooperative relationship between drug transporters and metabolizing enzymes. Functional changes in drug transporters or metabolizing enzyme can affect the ability to eliminate drugs. Therefore, it is important to clarify this cooperative relationship, which is directly related to the pharmacokinetics, pharmacodynamics and adverse effects of drugs. Intestine and liver are the main organs of drug metabolism. There are abundant drug transporters and metabolizing enzymes in the tissues. This paper reviews the influence of the cooperative relationship between drug transporters and metabolizing enzymes on drug disposition by intestine and liver.

Theclinicopathologicalfeaturesand MRImanifestationsofuterinespecialleiomyoma / 实用放射学杂志

Objective ToexploretheclinicopathologicalfeaturesandMRImanifestationsofseveralspecialtypesofuterineleiomyomato improvethediagnosticlevelofit.Methods TheclinicopathologicalfeaturesandMRImanifestationsof18caseswithuterineleiomyomathatwere verifiedbypathologicanalysiswereanalyzedretrospectively.Results Amongthe18cases,therewere11casesofcellularleiomyoma,5casesof fattyleiomyomaand2casesofintravenousleiomyoma.Thetumorswereroundorirregular,withaclearmarginandamaximumdiameterof3.2cm to12.5cm.CellularleiomyomashowedisointensityonT1WI,homogeneouslyorslightlyhyperintensityonT2WI,and mostofthem werehyperintenseonDWI,whileafewisointense.Thelesionshowedearlyobviousenhancementandcontinuedtostrengthen,higher thanthemyometriumofthesameperiod.Fattyleiomyomaconsistsofsmooth musclecellsandadipocytesindifferentproportions, smoothmuscletissueshowedisointensityonT1WI,andisointensityorslightlyhyperintensityonT2WI,whileadiposetissueshowed hyperintensityonT1WIandT2WI,hypointensityonfatsequence,lighttomoderateenhancementforsmooth muscletissueandadiposetissue ntravenousleiomyomashowedirregularcircuity,shuttlesolidlumpin myometriumorneartheuterus,whichshowedisointenseon T1WI,andunevenorhyperintensityonT2WI,moderateheterogeneousenhancement,multiplecircuityvesselswithinoraroundthelesions.Allthe threetypesofuterineleiomyomaabovehavecertainMRIfeaturesandareassociatedwithpathology.Conclusion TheMRIfindingsof thecell-richleiomyomashowthattheedgeofthetumorisclear,ofwhichshowhyperintensityonDWI,andearlyandcontinuousenhancement, whilethedegreeofenhancementishigherthanthatinthemyometriumofuterusatthesameperiod.MRIofuterineadiposeleiomyomashows"whirlpool"or "braided"distributionoffatsignalinthetumor,andnoenhancementinadiposetissue;MRIofvenousleiomyoma showsirregulartwistsandturnsbetweenthewallofuterusorbesidetheuterus,andmoderateorunevenintensificationafterenhancement. withoutI.

Screening for potential bioactive components of Yin-zhi-huang using high bilirubin HepaRG cells incubating with serum from animals / 药学学报

A hyper-bilirubin cell model was established for its relevance to the pathological state of jaundice in human. This model was used to screen for the pharmacological components of Yin-Zhi-huang (YZH). Total bilirubin, indirect bilirubin in cells, and direct bilirubin in extracellular fluid were quantified after HepaRG cells were incubated with serum from rats injected with multiple components of YZH. Cellular uptake was determined by dynamic multiple reaction monitoring (DMRM) using LC-MS/MS. We found that the stable hyper-bilirubin HepaRG cell model could be established by incubating cells with 40 μg·mL-1 bilirubin and 50 μg·mL-1 probenecid. When the hyper-bilirubin cell model was incubated with serum from rats of YZH injection, there were 52.4% and 60.1% decrease in intercellular total bilirubin and indirect bilirubin, respectively, and 52.5% increase in extracellular direct bilirubin. Using DMRM mode, 53 components could be determined, and 8 potential bioactive candidates were identified from the serum. This method could be used to screen for bioactive metabolites of YZH. This strategy is simple, highly active, sensitive and specific, providing a new method for high throughput screening of therapeutic or toxic metabolites from traditional Chinese medicine. The regulations of Ethics Committee in the First Hospital of Lanzhou University were abided in the rat experiment of this study.

Clinical application of three-dimensional printing in the treatment of knee varus with high tibial osteotomy / 中华创伤骨科杂志

Objective To evaluate the clinical application of a three-dimensional (3D) printing personalized guide for medial open wedge high tibial osteotomy(MOWHTO) in the treatment of knee varus osteoarthritis.Methods A retrospective study was conducted of the 16 patients with knee varus osteoarthritis who had been treated at Department of Orthopaedics,Zhengzhou Central Hospital of Zhengzhou University from January 2016 to January 2017.They were 6 men and 10 women,aged from 49 to 65 years (mean,55.8 years).Bilateral knees were involved in 2 cases and a unilateral knee was involved in 14 cases.Their disease duration ranged from one to 12 years (mean,5.3 years).A personalized guide for MOWHTO was designed and manufactured by 3D printing for every patient preoperatively.All the patients underwent knee arthroscopy before osteotomy which was assisted by the personalized guide.The femorotibial angle (FTA),medial proximal tibial angle (MPTA),weight bearing line (WBL),posterior tibial slope (PTSA) and the patellofemoral height Insall-Salvati index (IS index) were measured on their X-ray radiographs preoperatively and 6 months postoperatively.The Hospital for Special Surgery (HSS) score and visual analogue scale (VAS) were used to evaluate the outcomes at the final follow-ups.Results All surgeries were successful.The 16 patients were followed up for 6 to 12 months (mean,9.1 months).The FTA,MPTA,WBL and IS index at postoperative 6 months were significantly improved than the preoperative values (P ＜ 0.05).There was no significant difference between postoperative PTSA and preoperative PTSA (P =0.990).The mean VAS scores for the 16 patients at the final follow-ups were 0.8 ± 0.7 peints,significantly better than the preoperative ones (4.2 ± 0.9 points) (P ＜ 0.05);their mean postoperative HSS scores (89.3 ± 6.7 points) were also significantly improved than the preoperative ones (61.9 ± 10.5 points) (P ＜ 0.05).According to the HSS scores at the final follow-ups,the surgical outcomes were excellent in 14 knees,good in 3 and fair in one.Conclusion A 3D printed osteotomy guide can be used to perform precise osteotomy in MOWHTO for knee varus osteoarthritis,leading to effective correction of the alignment of the lower limb and good short-term surgical outcomes.

Effect of Baduanjin on Cognition and Mood Disorders for Patients Recovering from Traumatic Brain Injury / 中国康复理论与实践

Objective:To explore the effects of Baduanjin on cognitive function, anxiety and depression in patients in recovery stage after traumatic brain injury. Methods:From January to July, 2018, 64 patients in recovery stage after traumatic brain injury were included. Finally, there were 31 patients in control group and 29 in experimental group. The experimental group received Baduanjin exercise, while the control group did not receive any regular exercise. They were assessed with Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before intervention, and six weeks, twelve weeks and 24 weeks after intervention. Results:The scores of HAMA and HAMD decreased in the experimental group after intervention (P < 0.05), but there was no significance in the control group (P > 0.05). The scores of orientation, visual and spatial perception, and visuomotor organization increased in the experimental group twelve weeks after intervention (P < 0.05), but there was no significance in the control group (P > 0.05). The scores of all the areas of LOTCA and total scores increased in the experimental group 24 weeks after intervention (P < 0.05), but there was no significance in the control group (P > 0.05). LOTCA total scores negtively correlated with HAMA and HAMD scores (P < 0.05). Conclusion:Regular Baduanjin exercise can improve the cognition and mood of patients after traumatic brain injury.

Efficacy and safety comparison of everolimus and fulvestrant in patients with estrogen receptor-positive advanced breast cancer progressed after endocrine therapy / 实用医学杂志

Objective To compare the efficacy and safety of everolimus combined with endocrine therapy and fulvestrant in patients with estrogen receptor-positive advanced breast cancer progressed after endocrine thera-py. Methods Ninety-three breast cancer patients were selected from January 2014 to February 2017. The primary end points were progression-free survival and clinical benefit rate and the secondary end points was tolerability. Re-sults The progression-free survival in fulvestrant group was slightly higher than that in the everolimus group(13.4 months vs 12.2 months,P = 0.297). The clinical benefit rates were 46.15% and 31.71% in fulvestrant group and everolimus group,respectively. Patients treated with fewer than 2 lines and endocrine resistant patients benefited more from fulvestrant but without statistical difference. The main adverse events related to everolimus were stomati-tis,with a prevalence rate of about 26% and a localized pneumonia with a prevalence rate of about 10%. The main adverse reaction of fulvestrant was the injection site reaction. Conclusions The efficacy of everolimus in combina-tion with endocrine therapy is not superior to that of fulvestrant for the treatment of advanced breast cancer pro-gressed after endocrine therapy. After weighing the clinical benefits and quality of life,fulvestrant may be better for patients treated with fewer than 2 lines and endocrine resistance.