Anatomical and histological investigation of the area anterior to the anorectum passing through the levator hiatus / 中华胃肠外科杂志

Objective: To document the anatomical structure of the area anterior to the anorectum passing through the levator hiatus between the levator ani slings bilaterally. Methods: Three male hemipelvises were examined at the Laboratory of Clinical Applied Anatomy, Fujian Medical University. (1) The anatomical assessment was performed in three ways; namely, by abdominal followed by perineal dissection, by examining serial cross-sections, and by examining median sagittal sections. (2) The series was stained with hematoxylin and eosin to enable identification of nerves, vessels, and smooth and striated muscles. Results: (1) It was found that the rectourethralis muscle is closest to the deep transverse perineal muscle where the longitudinal muscle of the rectum extends into the posteroinferior area of the membranous urethra. The communicating branches of the neurovascular bundle (NVB) were identified at the posterior edge of the rectourethralis muscle on both sides. The rectum was found to be fixed to the membranous urethra through the rectourethral muscle, contributing to the anorectal angle of the anterior rectal wall. (2) Serial cross-sections from the anal to the oral side were examined. At the level of the external anal sphincter, the longitudinal muscle of the rectum was found to extend caudally and divide into two muscle bundles on the oral side of the external anal sphincter. One of these muscle bundles angled dorsally and caudally, forming the conjoined longitudinal muscle, which was found to insert into the intersphincteric space (between the internal and external anal sphincters). The other muscle bundle angled ventrally and caudally, filling the gap between the external anal sphincter and the bulbocavernosus muscle, forming the perineal body. At the level of the superficial transverse perineal muscle, this small muscle bundle headed laterally and intertwined with the longitudinal muscle in the region of the perineal body. At the level of the rectourethralis and deep transverse perineal muscle, the external urethral sphincter was found to occupy an almost completely circular space along the membranous part of the urethra. The dorsal part of the external urethral sphincter was found to be thin at the point of attachment of the rectourethralis muscle, the ventral part of the longitudinal muscle of the rectum. We identified a venous plexus from the NVB located close to the oral and ventral side of the deep transverse perineal muscle. Many vascular branches from the NVB were found to be penetrating the longitudinal muscle and the ventral part of rectourethralis muscle at the level of the apex of the prostate. The rectourethral muscle was wrapped ventrally around the membranous urethra and apex of the prostate. The boundary between the longitudinal muscle and prostate gradually became more distinct, being located at the anterior end of the transabdominal dissection plane. (3) Histological examination showed that the dorsal part of the external urethral sphincter (striated muscle) is thin adjacent to the striated muscle fibers from the deep transverse perineal muscle and the NVB dorsally and close by. The rectourethral muscle was found to fill the space created by the internal anal sphincter, deep transverse perineal muscle, and both levator ani muscles. Many tortuous vessels and tiny nerve fibers from the NVB were identified penetrating the muscle fibers of the deep transverse perineal and rectourethral muscles. The structure of the superficial transverse perineal muscle was typical of striated muscle. These findings were reconstructed three-dimensionally. Conclusions: In intersphincteric resection or abdominoperineal resection for very low rectal cancer, the anterior dissection plane behind Denonvilliers' fascia disappears at the level of the apex of the prostate. The prostate and both NVBs should be used as landmarks during transanal dissection of the non-surgical plane. The rectourethralis muscle should be divided near the rectum side unless tumor involvement is suspected. The superficial and deep transverse perineal muscles, as well as their supplied vessels and nerve fibers from the NVB. In addition, the cutting direction should be adjusted according to the anorectal angle to minimize urethral injury.

Study on the relationship between secondhand smoke exposure and dyslipidemia in adult residents in Beijing / 中华流行病学杂志

Objective: To understand the relationship between secondhand smoke exposure and dyslipidemia among adults in Beijing and to provide a scientific basis for relevant intervention. Methods: Data were from Beijing Adult Non-communicable and Chronic Diseases and Risk Factors Surveillance Program in 2017. A total of 13 240 respondents were selected by multistage cluster stratified sampling method. The monitoring contents include a questionnaire survey, physical measurement, collection of fasting venous blood, and determination of related biochemical indicators. SPSS 20.0 software was used for the chi-square test and multivariate logistic regression analysis. Results: The prevalence of total dyslipidemia (39.27%), hypertriglyceridemia (22.61%), and high LDL-C (6.03%) were the highest among those exposed to daily secondhand smoke. Among the male respondents, the prevalence of total dyslipidemia (44.42%) and hypertriglyceridemia (26.12%) were the highest among those exposed to secondhand smoke daily. Multivariate logistic regression analysis after adjustment for confounding factors showed that compared with no exposure to secondhand smoke, the population with an average exposure frequency of 1-3 days per week had the highest risk of total dyslipidemia (OR=1.276, 95%CI: 1.023-1.591). Among the patients with hypertriglyceridemia, those exposed to secondhand smoke daily had the highest risk (OR=1.356, 95%CI: 1.107-1.661). Among the male respondents, those exposed to secondhand smoke for 1-3 days per week had a higher risk of total dyslipidemia (OR=1.366, 95%CI: 1.019-1.831), and the highest risk of hypertriglyceridemia (OR=1.377, 95%CI: 1.058-1.793). There was no significant correlation between the frequency of secondhand smoke exposure and the risk of dyslipidemia among female respondents. Conclusions: Secondhand smoke exposure in Beijing adults, especially men, will increase the risk of total dyslipidemia, especially hyperlipidemia. Improving personal health awareness and minimizing or avoiding exposure to secondhand smoke is necessary.

A descriptive analysis of hyperlipidemia in adult twins in China / 中华流行病学杂志

Objective: To describe the distribution characteristics of hyperlipidemia in adult twins in the Chinese National Twin Registry (CNTR) and explore the effect of genetic and environmental factors on hyperlipidemia. Methods: Twins recruited from the CNTR in 11 project areas across China were included in the study. A total of 69 130 (34 565 pairs) of adult twins with complete information on hyperlipidemia were selected for analysis. The random effect model was used to characterize the population and regional distribution of hyperlipidemia among twins. The concordance rates of hyperlipidemia were calculated in monozygotic twins (MZ) and dizygotic twins (DZ), respectively, to estimate the heritability. Results: The age of all participants was (34.2±12.4) years. This study's prevalence of hyperlipidemia was 1.3% (895/69 130). Twin pairs who were men, older, living in urban areas, married,had junior college degree or above, overweight, obese, insufficient physical activity, current smokers, ex-smokers, current drinkers, and ex-drinkers had a higher prevalence of hyperlipidemia (P<0.05). In within-pair analysis, the concordance rate of hyperlipidemia was 29.1% (118/405) in MZ and 18.1% (57/315) in DZ, and the difference was statistically significant (P<0.05). Stratified by gender, age, and region, the concordance rate of hyperlipidemia in MZ was still higher than that in DZ. Further, in within-same-sex twin pair analyses, the heritability of hyperlipidemia was 13.04% (95%CI: 2.61%-23.47%) in the northern group and 18.59% (95%CI: 4.43%-32.74%) in the female group, respectively. Conclusions: Adult twins were included in this study and were found to have a lower prevalence of hyperlipidemia than in the general population study, with population and regional differences. Genetic factors influence hyperlipidemia, but the genetic effect may vary with gender and area.

A descriptive analysis on hypertension in adult twins in China / 中华流行病学杂志

Objective: To describe the distribution characteristics of hypertension among adult twins in the Chinese National Twin Registry (CNTR) and to provide clues for exploring the role of genetic and environmental factors on hypertension. Methods: A total of 69 220 (34 610 pairs) of twins aged 18 and above with hypertension information were selected from CNTR registered from 2010 to 2018. Random effect models were used to describe the population and regional distribution of hypertension in twins. To estimate the heritability, the concordance rates of hypertension were calculated and compared between monozygotic twins (MZ) and dizygotic twins (DZ). Results: The age of all participants was (34.1±12.4) years. The overall self-reported prevalence of hypertension was 3.8%(2 610/69 220). Twin pairs who were older, living in urban areas, married, overweight or obese, current smokers or ex-smokers, and current drinkers or abstainers had a higher self-reported prevalence of hypertension (P<0.05). Analysis within the same-sex twin pairs found that the concordance rate of hypertension was 43.2% in MZ and 27.0% in DZ, and the difference was statistically significant (P<0.001). The heritability of hypertension was 22.1% (95%CI: 16.3%- 28.0%). Stratified by gender, age, and region, the concordance rate of hypertension in MZ was still higher than that in DZ. The heritability of hypertension was higher in female participants. Conclusions: There were differences in the distribution of hypertension among twins with different demographic and regional characteristics. It is indicated that genetic factors play a crucial role in hypertension in different genders, ages, and regions, while the magnitude of genetic effects may vary.

Diagnosis and treatment of incomplete Kawasaki disease in children / 中国当代儿科杂志

Kawasaki disease (KD) is a febrile disease mainly observed in children aged <5 years, with medium- and small-vessel vasculitis as the main lesion. Although KD has been reported for more than 50 years and great progress has been made in the etiology and pathology of KD in recent years, there is still a lack of specific indicators for the early diagnosis of KD, especially with more difficulties in the diagnosis of incomplete Kawasaki disease (IKD). At present, there are no clear diagnostic criteria for IKD, which leads to the failure of the timely identification and standardized treatment of IKD in clinical practice and even induce the development of coronary artery lesion. This article reviews the concept, epidemiological features, diagnosis, treatment, and follow-up management of IKD, in order to deepen the understanding of IKD among clinical workers and help to improve the clinical diagnosis and treatment of KD in China.

Study on the relationship between indexes of different abnormal weight and dyslipidemia in adults in Beijing City / 中华预防医学杂志

Objective: To analyze the relationship and consistency between indexes of different abnormal weight and dyslipidemia in adults in Beijing City. Methods: From August to December of 2017, 4 975 residents aged 18 to 79 years old in 5 districts of Beijing were randomly selected as subjects by using a multi-stage stratified cluster sampling method. Questionnaire, physical examination and laboratory tests were conducted. The prevalence of overweight/obesity, high body fat rate, central obesity, and high waist-to-height ratio was calculated. Partial correlation was used to analyze the correlation of blood lipid with body mass index (BMI), body fat rate, waist circumference and waist-height ratio. Logistic regression analysis for complex sampling was used to analyze the relationship between indexes of different abnormal weight and dyslipidemia after controlling for relevant risk factors, including age, sex, smoking status, drinking, insufficiency intake of vegetable and fruit, physical inactivity. Kappa value was computed to analyze the consistency between indexes of different abnormal weight. Results: The weighted prevalence of dyslipidemia was 30.48%, and it was higher in men than that in women (40.16% vs. 20.52%, P<0.01). The weighted rate of overweight/obesity, high body fat rate, central obesity, and high waist-to-height ratio was 56.65%, 47.52%, 42.48% and 59.45%, respectively. BMI, body fat rate, waist circumference and waist-to-height ratio were positively correlated with the level of total cholesterol, triglyceride, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol, and negatively correlated with high-density lipoprotein cholesterol. Logistic regression analysis for complex sampling showed that the high body fat rate (OR=1.67, 95%CI: 1.35-2.07), overweight/obesity (OR=1.65, 95%CI: 1.26-2.14) and high waist-to-height ratio (OR=1.46, 95%CI: 1.09-1.96) were associated with dyslipidemias. Kappa values of high body fat rate with overweight/obesity, high waist-to-height ratio and central obesity were 0.65, 0.53 and 0.58, respectively (P<0.05). Conclusion: In 2017, the prevalence of dyslipidemia in adults in Beijing City is high, especially in men. Overweight/obesity, high body fat rate and high waist-to-height ratio are associated with dyslipidemia. The high body fat rate is most associated with dyslipidemia.

Gene-lifestyle interaction on coronary heart disease in adult twins of China / 中华流行病学杂志

Objective: To explore the gene-lifestyle interaction on coronary heart disease (CHD) in adult twins of China. Methods: Participants were selected from twin pairs registered in the Chinese National Twin Registry (CNTR). Univariate interaction model was used to estimate the interaction, via exploring the moderation effect of lifestyle on the genetic variance of CHD. Results: A total of 20 477 same-sex twin pairs aged ≥25 years were recruited, including 395 CHD cases, and 66 twin pairs both had CHD. After adjustment for age and sex, no moderation effects of lifestyles, including current smoking, current drinking, physical activity, intake of vegetable and fruit, on the genetic variance of CHD were found (P>0.05), suggesting no significant interactions. Conclusion: There was no evidence suggesting statistically significant gene-lifestyle interaction on CHD in adult twins of China.

A descriptive analysis on coronary heart disease in adult twins in China / 中华流行病学杂志

Objective: To describe the distribution characteristics of coronary heart disease in adult twins recruited from Chinese Twin Registry (CNTR), and provide clues and evidence for the effect of genetic and environmental influences on coronary heart disease. Methods: By using the data of CNTR during 2010-2018, a total of 34 583 twin pairs aged ≥18 years who completed questionnaire survey and had related information were included in the current study to analyze the population and area distribution characteristics of coronary heart disease. Random effect models were used to compare the differences between groups. The concordane rate of coronary heart disease were calculated respectively in monozygotic (MZ) twin pairs and dizygotic (DZ) twin pairs to estimate the heritability. Results: The twin pairs included in this analysis were aged (34.2±12.4) years. The overall prevalence rate of coronary heart disease in twin pairs was 0.7%. Twin pairs who were women, older, obese and lived in northern China had higher prevalence of coronary heart disease (P<0.05). Intra-pair analysis in the same-sex twin pairs found that the concordane rate of coronary heart disease was higher in MZ twin pairs (25.3%) than in DZ twins (7.4%), and the difference was statistically significant (P<0.001). The overall heritability of coronary heart disease was 19.3% (95%CI: 11.8%-26.8%). Stratified by gender, age and area, the concordane rate was still higher in MZ twin pairs than in DZ pairs. Participants who were women, aged 18-30 years or ≥60 years and lived in northern China had a higher heritability of coronary heart disease. Conclusion: The distribution of coronary heart disease in twin pairs differed in populations and areas. The prevalence of coronary heart disease was affected by genetic factors, but the effect varied with age, gender and area.

A descriptive analysis on type 2 diabetes in twins in China / 中华流行病学杂志

Objective: To describe the distribution characteristics of type 2 diabetes in twins in Chinese National Twin Registry (CNTR), provide clues and evidence for revealing the influence of genetic and environmental factors for type 2 diabetes. Methods: Of all twins registered in the CNTR during 2010-2018, a total 18 855 twin pairs aged ≥30 years with complete registration information were included in the analysis. The random effect model was used to describe the population and area distribution characteristics and concordance of type 2 diabetes in twin pairs. Results: The mean age of the subjects was (42.8±10.2) years, the study subjects included 10 339 monozygotic (MZ) twin pairs and 8 516 dizygotic (DZ) twin pairs. The self-reported prevalence rate of type 2 diabetes was 2.2% in total population and there was no sighificant difference between MZ and DZ. Intra-twin pairs analysis showed that the concordance rate of type 2 diabetes was 38.2% in MZ twin pairs, and 16.0% in DZ twin pairs, the difference was statistically significant (P<0.001). The concordance rate of type 2 diabetes in MZ twin parts was higher than that in DZ twin pairs in both men and women, in different age groups and in different areas (P<0.05). Further stratified analysis showed that in northern China, only MZ twin pairs less than 60 years old were found to have a higher concordance rate of type 2 diabetes compared with DZ twin pairs (P<0.05). In southern China, the co-prevalence rate in male MZ twin pairs aged ≥60 years was still higher than that in DZ twin pairs (P<0.05). Conclusion: The twin pairs in this study had a lower self-reported prevalence of type 2 diabetes than the general population. The study results suggested that genetic factors play a role in type 2 diabetes prevalence in both men and women, in different age groups and in different areas, however, the effect might vary.

Current status of regular exercise and influencing factors in 18-64 year old labor force population in Beijing / 中华流行病学杂志

Objective: To understand the regular exercise status and influencing factors in 18-64 year-old labor force population in Beijing, and provide evidences for behavioral intervention. Methods: Data were collected from Beijing Adult Non-communicable and Chronic Diseases and Risk Factors Surveillance Program from August to December, 2017. The stratified cluster sampling method was used to select 13 240 survey subjects throughout the city. The valid sample size included in this study were 11 604 persons aged 18 to 64 years. Questionnaire was used to collection the information about basic demographic characteristics, chronic disease history and physical activity prevalence of the study subjects. The body height and weight were measured by standard methods. Fasting venous blood samples were collected for the detection of fasting blood glucose, blood lipids and other biochemical indicators. Software SPSS 20.0 was used fort complex sampling sample weighting and data analysis. Results: The proportions of the study subjects who did regular exercise and never had leisure-time activity in 18-64 year-old labor force population in Beijing were 23.74% (95%CI: 21.51%-26.12%) and 64.34% (95%CI: 61.66%-66.94%) respectively; The average daily physical activity time was 23.44 min (95%CI: 21.16-25.71), and the total daily sedentary behavior time was 6.96 hours (95%CI: 6.80-7.13). With the increase of age, the proportions of the study subjects who did regular exercise and never had leisure-time activity increased (P=0.006, P<0.001). With the increase of educational level, the proportion of those who did regular exercise increased (P<0.001), and the proportion of those who never had leisure-time activity decreased (P<0.001); the higher the level of physical activity, the higher the regular exercise proportion (P<0.001); the proportions of employed people who did regular exercise was lower than those in unemployed people (P<0.001); the proportions of women never had leisure-time activity was higher than those in men (P=0.024). The results of multivariate analysis showed that older age and higher education level were positive factors for regular exercise (35- years old: OR=0.653, 95%CI: 0.530-0.804, P<0.001; 50-64 years old: OR=0.695, 95%CI: 0.560-0.864, P=0.001; high school/technical secondary school/technical School: OR=0.679, 95%CI: 0.593-0.777, P<0.001; college graduation: OR=0.478, 95%CI: 0.387-0.590, P<0.001; bachelor degree and above: OR=0.435, 95%CI: 0.347-0.546, P<0.001), while employment (OR=1.631, 95%CI: 1.330-2.000, P<0.001) and married/cohabitation (OR=1.340, 95%CI: 1.093-1.644, P=0.038) were negative factors for regular exercise. Conclusions: The rate of regular exercise in 18-64 year-old labor force population in Beijing needs to be improved. Older age and high educational level were positive factors for regular exercise, while being married and employed were negative factors for it.

Characteristics of high-risk cardiovascular disease among residents aged 35-75 in 8 districts of Beijing / 中华流行病学杂志

Objective: To understand the characteristics and current situation of high risks related to cardiovascular disease among residents aged 35-75 in Beijing and to provide scientific reference for the formulation and improvement of cardiovascular disease prevention and control strategies and measures. Methods: According to the data of the Cardiovascular Disease Screening and Management Program in Beijing, 93 520 participants aged 35-75 in 8 districts of Beijing were selected for analysis. We used the χ2 test to compare the high-risk prevalence of cardiovascular disease in different population characteristics. The multivariate logistic regression model was used to analyze the relationship between population characteristics and the high risks of cardiovascular disease. Results: The prevalence of high-risk cardiovascular disease was 20.82% (19 471/93 520). The prevalence of high-risk population in the 65-75 years-old was significantly higher than those of other age groups [29.05% (5 151/17 733), χ2=3 359.37, P<0.001], and the prevalence increased with age (trend χ2=3 121.75, P<0.05). The prevalence of high risk in males was significantly higher than that of women (31.19%, 10 752/34 476 vs. 14.77%, 8 719/59 044, χ2=3 559.87, P<0.05). The most common clustered risk factors appeared as hypertension and diabetes (29.80%, 5 802/19 471), hypertension with smoking (37.84%, 4 069/10 752) in males, and hypertension with diabetes mellitus in females (49.32%, 4 300/8 719), in urban areas (33.62%, 2 571/7 647) and in suburbs (27.33%, 3 231/11 824). Lower education [high school (OR=1.56,95%CI:1.46-1.66), middle school (OR=1.99,95%CI:1.88-2.12), primary school and below (OR=2.28,95%CI:2.12-2.45)], non-Han ethnicity (OR=1.19, 95%CI: 1.07-1.33), unmarried (OR=1.16, 95%CI: 1.08-1.24), drinking alcohol (OR=3.06, 95%CI: 2.94-3.19), obesity (OR=1.85, 95%CI: 1.77-1.93), overweight (OR=1.41, 95%CI: 1.36-1.47), etc., were positively correlated with the high risk of cardiovascular disease. Conclusions: We noticed that the prevalence of high-risk groups of cardiovascular disease aged 35-75 years was around 20% in Beijing, and the proportion in males was higher than females. Low education, drinking, overweight, and obesity were positively correlated with the risks of cardiovascular disease.

Analysis of the current status and related factors of oral nutritional supplements intake among 18-79 years old in Beijing in 2017 / 中华流行病学杂志

Objective: To understand the current status of taking nutrient supplements for residents aged 18 to 79 years old in Beijing and its related factors. Methods: Data were gathered from the 2017 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified cluster sampling method was used, and participants aged 18-79 were sampled from 16 districts. The questionnaire included chronic diseases and related risk factors, health knowledge, and oral nutritional supplements within 12 months. Multivariate logistic regression models were established to analyze associated factors that affect the intake of nutrient supplements. Results: The weighted prevalence of supplements use was 13.1% among 12 696 subjects within the past 12 months. The proportions of multivitamins (4.7%), B vitamins (4.5%), and folic acid (3.2%) were higher. The prevalence of supplement use of young people (18-39 years old) and the elderly (60-79 years old) was higher than middle-aged people (40-59 years old) (χ2=54.09, P<0.001). Except for the age group of 70-79 years old, the consumption rate of women was significantly higher than that of men (P<0.05). After adjusting age and sex, among patients with hypertension, diabetes, or dyslipidemia, the control rates of blood pressure, glucose and lipids of patients who take nutrient supplements were higher than those who do not (P<0.05). And participants who took nutrient supplements had a more heightened awareness rate of health knowledge, such as the hazards of smoking and second-hand smoke, and recommended amount of salt per day (P<0.001). The multi-factor logistic analysis found that nutrient supplement-related factors include women, old age, higher education level, living in urban, insufficient physical activity, sleeping problems, active physical examination, blood pressure control among patients, and health knowledge (P<0.05). Conclusions: The factors of nutrient supplements use were related to sex, age, education level, health status, and health literacy. We should pay attention to key populations and guide them to establish the correct concept of taking nutrient supplements.

Investigation on knowledge, attitude and behavior of salt reduction in adults of Beijing in 2017 / 中华预防医学杂志

Objective: To explore the knowledge, attitude and behavior of salt reduction in adults of Beijing in 2017. Methods: Based on the monitoring data of chronic diseases and corresponding risk factors in adults of Beijing in 2017, the indicators of salt reduction knowledge, attitude and behavior of 13 240 participants aged 18-79 years old were analyzed. The awareness rate, attitude support rate and behavior rate were calculated by complex weighting method, and compared among different age groups, genders, residential areas, and history of hypertension. The proportion of people taking various salt reduction measures to the total number of people was compared. Results: The awareness rate of recommended daily salt intake, the awareness of hypertension caused or aggravated by more salt intake, the attitude support rate and behavior rate of adults were 31.77%, 88.56%, 90.27% and 53.86%, respectively. After weighted adjustment, the awareness rate of recommended daily salt intake was 31.08%, which increased with age (χ2trend=431.56, P<0.001) and education level (χ2trend=95.44, P<0.001). The awareness rate of women was higher than that of men (χ²=118.89, P<0.001), and the awareness rate of population in urban areas was higher than that of population in suburban areas (χ²=34.09, P=0.001). The awareness rate of hypertension caused or aggravated by eating more salt was 86.73%. The support rate of salt reduction attitude was 90.45%. The rate of salt-reducing behavior was 54.05%. Among different salt reduction measures, reducing salt when cooking was the most common measure (52.41%), while the least common one (35.22%) was using low sodium salt. Logistic regression model analysis showed that the gender, age, education level, self-reported history of hypertension, awareness of salt recommendation, awareness of hypertension caused or aggravated by eating more salt, and salt reduction attitude were significantly associated with salt reduction behavior. Conclusion: In 2017, adults in Beijing have a basic understanding of the impact of high-salt diet on health and support salt reduction, but the rate of salt reduction behavior is still relatively low. There are obvious gender and age differences, and the salt reduction measure is simple. Targeted measures should be taken to promote the formation of salt reduction behavior.

Mechanism of Cancer Drug Resistance and Reversal Effect of Chinese Medicine： A Review / 中国实验方剂学杂志

Malignant tumor is a serious threat to human life and health. The prevalence and mortality of malignancies in China are increasing year by year. Conquering cancer has become a difficult problem for human beings. Chemical drug therapy combined with molecular targeted therapy is a general and preferred anti-tumor clinical scheme， but the side effects and the drug resistance of cancer cells often hinder the efficacy. Therefore， it is of great significance to study the mechanism of drug resistance and the methods to reverse drug resistance. Chinese medicine has the characteristics of complex components， multiple targets， low toxicity， etc. A large number of experimental studies have demonstrated that the effective components or extracts of Chinese medicine can inhibit the proliferation， migration， and invasion of cancer cells， and induce apoptosis， autophagy， differentiation， and senescence. In clinical practice， Chinese medicine has been applied to the protection against ttumor， adjuvant treatment， and later consolidation. The research on Chinese medicine is expected to promote drug resistance reversal and cancer therapy. Studies have shown that the combination of Chinese medicine and chemotherapy can reverse drug resistance and increase efficacy， which has become the mainstream trend of cancer treatment. This study reviewed the mechanisms of the drug resistance of cancer cells induced by self-protective autophagy， gene mutation， high expression of enzymes， abnormal signaling pathways， and abnormal expression of RNA and protein， and summarized how compounds isolated from Chinese medicine， single drug and its extract， and classic anti-cancer prescription reversed the drug resistance to lay a solid foundation for the further investigation of the anti-tumor effect of Chinese medicine.

Anti-tumor Effect of Draconis Sanguis Petroleum Ether Fraction on Human Gastric Cancer HGC-27 and MGC-803 Cells / 中国实验方剂学杂志

ObjectiveTo investigate the effect of Draconis Sanguis petroleum ether fraction （DSPEF） on the proliferation， apoptosis， migration， and autophagy of human gastric cancer HGC-27 and MGC-803 cells， and preliminarily elucidate its molecular mechanism. MethodCell counting kit-8 （CCK-8） assay was used to detect the effect of DSPEF at different concentrations （0， 20， 40， 60， 80 mg·L-1） on the proliferation of HGC-27 and MGC-803 cells after 24， 48， 72 h. Hoechst staining and flow cytometry were used to explore the effects of DSPEF at different concentrations on the apoptosis and apoptosis rate of HGC-27 and MGC-803 cells after 48 h treatment， respectively. The wound healing assay and acridine orange staining were used to investigate the effects of DSPEF on the migration and autophagy of HGC-27 and MGC-803 cells， respectively. Western blot was used to detect the expression levels of signaling pathway-related proteins in HGC-27 and MGC-803 cells treated with DSPEF for 48 h. ResultCompared with the control group， DSPEF（30 mg·L-1） inhibited the proliferation and migration of HGC-27 and MGC-803 cells in a concentration- and time-dependent manner （P<0.05）， and induced the apoptosis （P<0.01） and autophagy of HGC-27 and MGC-803 cells. DSPEF （60 mg·L-1） down-regulated the protein levels of phosphorylated mammalian target of rapamycin （p-mTOR） （P<0.05， P<0.01） and down-regulated phospho-signal transducer and activator of transcription 3 （p-STAT3） in HGC-27 and MGC-803 cells （P<0.01）， suggesting that DSPEF presumedly inhibited the proliferation and migration of human gastric cancer HGC-27 and MGC-803 cells and induced their apoptosis and autophagy by inhibiting the mTOR/STAT3 signaling pathway. ConclusionThe down-regulation of the mTOR/STAT3 signaling pathway may be involved in the anti-gastric cancer effect of DSPEF. This study is expected to provide a reference for the investigation of the anti-tumor effect of Draconis Sanguis.

Effect of Aqueous Extract of Trametes robiniophila on Proliferation of Human Prostate Cancer VCaP Cells / 中国实验方剂学杂志

ObjectiveTo investigate effect of aqueous extract of Trametes robiniophila （TRM，Huaier） on autophagy of human prostate cancer VCaP cells and Lamin B1 expression， so as to uncover its role in the proliferation of VCaP cells. MethodThe inhibitory effect of 0， 2， 4， 6， 8， 10 g·L-1 TRM aqueous extract on the proliferation of human prostate cancer VCaP cells at different time points were determined by cell counting kit-8 （CCK-8） assay. Acridine orange staining was conducted for analyzing the effect of TRM aqueous extract on the formation of autolysosomes in VCaP cells. After medication， the expression of microtubule-associated protein Ⅰ light chain 3 （LC3）， autophagy-related protein 3 （Atg3）， autophagy-related protein 5 （Atg5）， and autophagy-related protein 7 （Atg7） in VCaP cells were detected by Western blot. The effect of TRM aqueous extract alone and its combination with autophagy inhibitor bafilomycin A1 on the proliferation of VCaP cells were assayed by CCK-8 assay. RNA interference technology was used to explore the role of Lamin B1 in anti-proliferation of VCaP cells by TRM. ResultCompared with the blank group， TRM aqueous extract inhibited the proliferation of human prostate cancer VCaP cells in a time- and concentration-dependent manner （P<0.01）. Acridine orange staining showed that TRM aqueous extract promoted the formation of autolysosomes in VCaP cells. As revealed by Western blotting， TRM aqueous extract up-regulated the expression levels of LC3-Ⅱ， Atg3， Atg5， and Atg7 in contrast to those in the blank group （P<0.05）. All these indicated that TRM aqueous extract induced the autophagy of VCaP cells. In addition， autophagy inhibition impaired the sensitivity of VCaP cells to TRM aqueous extract （P<0.05）. The comparison with the blank group showed that TRM aqueous extract inhibited Lamin B1 protein expression in VCaP cells （P<0.01）， which in turns weakened the sensitivity of VCaP cells to TRM aqueous extract. ConclusionTRM aqueous extract inhibited the proliferation of human prostate cancer VCaP cells possibly by inducing autography and down-regulating Lamin B1 expression. This study has provided a theoretical basis for the clinical application of TRM.

Mechanism of Proteoglycan TPG-1 from Trametes robiniophila Inhibiting Growth of Human Hepatoma SK-HEP-1 Cells / 中国实验方剂学杂志

ObjectiveProteoglycan TPG-1 isolated from Trametes robiniophila（Huaier） has proved to have anti-hepatoma activity， and this paper aims to explore the molecular mechanism. MethodHuman hepatoma SK-HEP-1 cells were treated with TPG-1 （0， 0.05， 0.1， 0.25， 0.5， 1 g·L-1）. Then cell survival was detected by methyl thiazolyl tetrazolium （MTT） and apoptosis by flow cytometry. In addition， expression of genes in SK-HEP-1 cells treated with or without TPG-1 was examined by DNA microarray to preliminarily explore the anti-hepatoma molecular mechanism of TPG-1. ResultTPG-1 inhibited the proliferation of SK-HEP-1 cells as compared with the blank group （P<0.01）. After treatment with 1 g·L-1 TPG-1 for 48 h， the apoptosis rate of SK-HEP-1 cells increased （P<0.01）， and TPG-1 promoted the cleavage of cysteinyl aspartate specific proteinase （Caspase）-3 and Caspase-7， the key mediators of apoptosis （P<0.01）. Additionally， TPG-1 （1 g·L-1） suppressed the migration of SK-HEP-1 cells （P<0.05）. A total of 971 differentially expressed genes （DEGs） were identified in SK-HEP-1 cells after treatment with TPG-1， with 486 up-regulated and 485 down-regulated. These DEGs were mainly involved in the Gene Ontology （GO） terms of interleukin-6 （IL-6） biosynthesis， antigen processing and presentation， superoxide dismutase activity， positive regulation of mitogen-activated protein kinase kinase kinase （MAPKKK） cascade， nature killer （NK） cell chemotaxis， and chemokine biosynthesis， and the Kyoto Encyclopedia of Genes and Genomes （KEGG） pathways of nucleotide-binding oligomerization domain （NOD）-like receptor signaling pathway， apoptosis， Toll-like receptor signaling pathway， retinoic acid-inducible gene-Ⅰ （RIG-Ⅰ）-like receptor signaling pathway， T-cell receptor signaling pathway， and chemokine signaling pathway. Western blot results showed that TPG-1 （1 g·L-1） activated mitogen-activated protein kinase （MAPK） signaling pathway in SK-HEP-1 cells （P<0.01）. ConclusionProteoglycan TPG-1 inhibited the proliferation and migration， and induced apoptosis of human hepatoma SK-HEP-1 cells. Up-regulation of MAPK signaling pathway may be responsible for the growth inhibition of human hepatoma SK-HEP-1 cells by TPG-1.

Association of liver damage with coronary artery lesion and no response to intravenous immunoglobulin in the acute stage of Kawasaki disease / 中国当代儿科杂志

OBJECTIVES@#To summarize the clinical features of liver damage in children in the acute stage of Kawasaki disease (KD), and to investigate the clinical value of liver damage in predicting coronary artery lesion and no response to intravenous immunoglobulin (IVIG) in children with KD.@*METHODS@#The medical data were collected from 925 children who were diagnosed with KD for the first time in Beijing Children's Hospital from January 1, 2016 to December 31, 2017. According to the presence or absence of abnormal alanine aminotransferase (ALT) level on admission, the children were divided into a liver damage group (n=284) and a non-liver damage group (n=641). A logistic regression analysis was used to investigate the clinical value of the indicators including liver damage in predicting coronary artery lesion and no response to IVIG in children with KD.@*RESULTS@#Compared with the non-liver damage group, the liver damage group had a significantly earlier admission time and significantly higher serum levels of inflammatory indicators (P<0.05). The liver damage group had a significantly higher incidence rate of coronary artery lesion on admission than the non-liver damage group (P=0.034). After initial IVIG therapy, the liver damage group had a significantly higher proportion of children with no response to IVIG than the non-liver damage group (P<0.001). In children with KD, coronary artery lesion was associated with the reduction in the hemoglobin level and the increases in platelet count, C-reactive protein, and ALT (P<0.05), and no response to IVIG was associated with limb changes, the reduction in the hemoglobin level, the increases in platelet count, C-reactive protein, and ALT, and coronary artery lesion (P<0.05).@*CONCLUSIONS@#Compared with those without liver damage, the children in the early stage of KD with liver damage tend to develop clinical symptoms early and have higher levels of inflammatory indicators, and they are more likely to have coronary artery lesion and show no response to IVIG treatment.

Research progress on anti-tumor effect of Chinese dragon's blood / 中国中药杂志

As a traditional Chinese medicine, Chinese dragon's blood has multiple effects, such as activating blood to remove blood stasis, softening and dispelling stagnation, astringent and hemostasis, clearing swelling and relieving pain, regulating menstruation and rectifying the blood, so it is called "an effective medicine of promoting blood circulation". It has been widely used clinically to treat a variety of diseases. With the further research on Chinese dragon's blood, its anti-tumor medicinal value is gradually emerging. Modern pharmacological studies have shown that Chinese dragon's blood exerts anti-tumor effects mainly by inhibiting cell proliferation, inducing apoptosis, inducing DNA damage and cell cycle arrest, inducing senescence and autophagy of tumor cells, inhibiting metastasis and angiogenesis, as well as reversing multidrug resistance. This article focuses on the research progress on anti-tumor effects of Chinese dragon's blood extract and its chemical components, with a view to provide new references for the in-depth research and reasonable utilization of Chinese dragon's blood.

Protective Effect of Longxue Tongluo Capsule on H2O2-induced Injury of PC12 Cells / 中国实验方剂学杂志

Objective::To investigate the protective effect of Longxue Tongluo capsule (LTC) on H2O2-induced injury of PC12 cells and its potential mechanism. Method::An in vitro injury model in PC12 cells was established with 500 μmol·L-1 H2O2.The experiment was divided into control group, injury model group (H2O2 500 μmol·L-1), and Longxuetongluo capsule group (LTC, 1, 2, 4 mg·L-1). Cell counting kit-8 (CCK-8) assay, intracellular reactive oxygen species (ROS), mitochondrial membrane potential, apoptosis of PC12 cells, and Western blot were used to evaluate the protective effect of LTC on PC12 cells induced by H2O2. Result::Compared with the control group, the cell viability was significantly decreased in the injury model group (P<0.01), intracellular ROS level was significantly increased (P<0.01), mitochondrial membrane potential was decreased, while apoptosis of PC12 cells was significantly increased (P<0.01), and the expression of cleaved poly adenosine diphospho ribose polymerase (PARP) was also increased significantly (P<0.01). Compared with the injury model group, pretreatment with LTC at the concentrations of 2 and 4 mg·L for 6 h significantly increased cell viability in PC12 cells exposed to H2O2 (P<0.01). Moreover, pretreatment with LTC reduced intracellular ROS level (P<0.05), maintained mitochondrial membrane potential, and inhibited apoptosis of PC12 cells induced by H2O2 in a dose-dependent manner (P<0.01). The results of western blotting showed that pretreatment with LTC significantly reduced the expression of cleaved PARP (P<0.01). Conclusion::LTC exerts a significant protective effect against H2O2-induced PC12 cells injury through inhibition of neuronal apoptosis by suppressing intracellular oxidative stress, maintaining mitochondrial function, and promoting DNA repair.