Challenges in the study of self-assembled aggregates in decoction of traditional Chinese medicine: A preliminary review / 药学学报

Decoction is the most commonly used dosage form in the clinical treatment of traditional Chinese medicine (TCM). During boiling, the violent movement of various active ingredients in TCM creates molecular forces such as hydrogen bonding, π-π stacking, hydrophobic interactions and electrostatic interactions, which results in the formation of self-assembled aggregates in decoction (SADs), including particles, gels, fibers, etc. It was found that SADs widely existed in decoction with biological activities superior to both effective monomers and their physical mixtures, providing a new idea to reveal the pharmacodynamic material basis of Chinese herbal medicine from the perspective of component interactions-phase structure. Recently, SADs have become a novel focus of research in TCM. This paper reviewed their relevant studies in recent years and found some issues to be concerned in the research, such as the polydispersity of decoction system, instability of active ingredient interactions during boiling, uncertainty of the aggregates self-assembly rules, and stability, purity, yield of the products. In this regard, some solutions and new ideas were presented for the integrated development and clinical application of SADs.

Role of the synaptic plasticity in chronic pain comorbidity anxiety disorder / 中华行为医学与脑科学杂志

Chronic pain patients are often accompanied with anxiety disorder, which promote the development of each other's disease process to a certain extent and seriously affect the quality of life of patients.However, the mechanism regulating the comorbidity between the two has not been clarified.Synaptic remodeling is the alteration of synaptic structure and function, which affects the transmission of signals between neurons.Synaptic remodeling is a hot topic in the field of chronic pain and anxiety disorders, but only few studies have explored its pathological changes in chronic pain and anxiety disorders.By summarizing the relevant researches in recent years, the occurrence of chronic pain co-anxiety disorder is closely related to changes in synaptic structure, synaptic transmission efficiency and synaptic function in brain regions.Synaptic remodeling could lead to the decline of centra pain regulation ability and aggravate the progression of chronic pain accompanied by anxiety disorder through ionic amino acid receptors, neuronal transmission and interactions between neurons and glial cells.Understanding the latest research progress of the co-morbidity mechanism of chronic pain and anxiety disorder is helpful to provide theoretical basis and potential new targets for its treatment.

Clinical characteristics and risk factors of acute otitis media in infants under one-year-old / 上海交通大学学报（医学版）

Objective: To analyze the symptoms and signs of acute otitis media (AOM) in infants under one-year-old and the risk factors of AOM. Methods: Care information and clinical characteristics of a total of 304 full-term delivery infants with normal hearing who were examined in Shanghai Children's Hospital from January to December 2018 were included in the analysis. All infants were followed up to one-year-old and the clinical characteristics of AOM infants were collected. χ2 test was used to analyze whether there was a statistically significant difference between the AOM group (AOM infants) and the control group (infants without AOM) in terms of feeding status, daily care, going out, living environment, pneumococcal vaccination, and so on. Logistic regression model was used to explore the risk factors for AOM in infants under one-year-old. Results: In 304 infants, 177 developed AOM, and the age of AOM infants was (5.65±2.03) months. Compared with the control group, AOM group had higher rates of spitting up milk (P=0.000), frequent ears digging (P=0.021), participation in early education activities (P=0.000) and recurrent respiratory infection (P=0.000), and lower rate of pneumococcal vaccination (P=0.000). Logistic regression analysis showed that vomiting (OR=2.774, P=0.002), participation in early education activities (OR=3.785, P=0.000) and recurrent respiratory infection (OR=3.638, P=0.000) were risk factors for AOM in infants, and pneumococcal vaccination was a protective factor (OR=0.320, P=0.000). Conclusion: AOM is a high-incidence disease in infants under one-year-old in Shanghai. Insisting on scientific feeding position, reducing spitting and paying attention to the extra protection when participating in public activities such as early education may reduce the occurrence of AOM. Pneumococcal vaccination may help prevent AOM.

Intrathecal injection of AG-490 reduces bone-cancer-induced spinal cord astrocyte reaction and thermal hyperalgesia in a mouse model / 中南大学学报(医学版)

To investigate the role of spinal interleukin-6-Janus kinase 2 (IL-6-JAK2) signaling transduction pathway in regulating astrocytes activation during the maintenance of bone cancer pain (BCP).
 Methods: NCTC 2472 fibrosarcoma cells were injected into the femur marrow cavity in C3H/HeNCrlVr male mice to establish BCP model and they were replaced by the equal volume of α-MEM in the sham model. The paw withdrawal latency (PWL) was measured after inoculation of tumor cells. The lumbar enlargement of spinal cord (L3-L5) was isolated, and Real-time RT-PCR and Western blot were used to detect the expression of spinal glial fibrillary acidic protein (GFAP) and JAK2 mRNA and protein, respectively. The expression level of spinal GFAP mRNA indirectly reflect astrocytes activation level. Pain behaviors and spinal cord GFAP mRNA and protein expression were observed at the given time points after intrathecal administration of JAK2 antagonist AG-490.
 Results: The PWL at 10, 14, 21 d after operation in BCP model group were significantly shorter than that in the sham group (P<0.05); the spinal GFAP and JAK2 mRNA and protein levels were higher in the BCP model group in comparison to mice in the sham group (P<0.05); intrathecal injection of JAK2 agonist AG-490 (30 or 90 nmol) significantly alleviated PWL, and downregulated the expression of spinal GFAP mRNA and protein (P<0.05).
 Conclusion: The IL-6-JAK2 signaling pathway plays an important role in maintaining the BCP by regulating the expression of GFAP in the spinal cord. Intrathecal injection of AG-490 can reduce the BCP, and inhibit the activation of IL-6-JAK2 signaling pathway, which may be one of the mechanisms for spinal astrocyte activation.

Study on Value of Blockchain Technology in Medical Field / 医学信息学杂志

The paper expatiates on the concept,principle and characteristics of the blockchain technology,introduces the blockchain + medical treatment mode and its application,including the building of personal health database,the shaping of intelligent medical assistance platform,and the structuring of an open mutual-aid and sharing center of medical health resources,and analyzes challenges confronting application of the blockchain technology in the medical treatment field.

Risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following lower ex-tremity fracture surgery in elderly patients / 中华麻醉学杂志

Objective To identify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following lower extremity fracture surgery in elderly patients. Methods Four hundred and thirty patients, aged ≥ 65 yr, undergoing elective lower extremity fracture surgery from January 2010 to December 2014, were selected. Age, gender, American Society of Anesthesiologists (ASA) physical sta-tus, preoperative comorbidities (diabetes mellitus, cardio-cerebrovascular events and hemiplegia), preop-erative anemia, surgical site (hip and femur, knee joint and the site below the knee), anesthesia method (general anesthesia, neuraxial anesthesia), surgery time, intraoperative hypertension and hypotension, intraoperative blood loss, postoperative Hb≤90 g∕L in hospital and volume of postoperative drainage, post-operative pneumonia and admission to the intensive care unit after operation were recorded. The patients were divided into either cardio-cerebrovascular event group or non-cardio-cerebrovascular event group ac-cording to whether the patients developed cardio-cerebrovascular events after surgery in hospital. The pa-tients were divided into either survival group or dead group according to the living status 1 yr after surgery. The risk factors of which P values were less than 0. 05 would enter the multi-factor logistic regression analy-sis to stratify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following low-er extremity fracture surgery. Results Three hundred and seventy-two patients completed the study. A-mong the 372 patients, 35 patients developed postoperative cardio-cerebrovascular events in hospital, and the incidence was 9. 4％, logistic regression analysis showed that the preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ were risk factors for in-hospital postoperative cardio-cerebrovascular events. Thirty-three patients died within 1 yr after surgery, the mortality rate was 8. 9％, and logistic re-gression analysis showed that age≥75 yr, preoperative hemiplegia and development of cardio-cerebrovascu-lar events after surgery in hospital were postoperative 1-year mortality-related risk factors. Conclusion Preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ are the independent risk factors for in-hospital cardio-cerebrovascular events following lower extremity fracture surgery in elderly patients;age≥75 yr, preoperative hemiplegia and in-hospital postoperative cardio-cerebrovascular events are the in-dependent risk factors for 1-year mortality after surgery.

Effect of pediatric obstructive sleep spnea hypopnea syndrome with attention deficit hyperactivity disorder on sleep and quality of life / 临床儿科杂志

Objective Related factors of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) combined with attention deficit hyperactivity disorder (ADHD) were retrospectively analyzed in OSAHS children. Methods The research included 437 cases of children hospitalized for OSAHS from January, 2014 to December, 2014. All the cases were divided into OSAHS group and OSAHS combined with ADHD group, according to the presence or absence of ADHD. Patient's general conditions (gender, age, height, weight, allergic rhinitis history, tonsil grade and adenoid grade), OSA-18 quality of life score, intention-hyperactivity score, polysomnography parameter (apnea hypopnea index, lowest oxygen) were collected as variables. SPSS20.0 was used to perform statistical analyses.Results There were 437 cases in this research, 298 of them were males, and 139 of them were females. Of 437 patients, 147 had OSAHS combined with ADHD (33.64%). Higher apnea hypopnea index (P <0.01) and severer oxygen deflciency (P < 0.01) were found in OSAHS combined with ADHD group than those in OSAHA group. Five projects of OSA - 18 score of in OSAHS combined with ADHD group were all higher than those in OSAHS group (P <0.01).Conclusions The incidence of pediatric OSAHS combined with ADHD in this research was more than 30%. More OSAHS combined with ADHD were found in male children. The quality of life was lower in pediatric OSAHS combined with ADHD. Oxygen deflciency was suggested to be the most important risk factor of ADHD in pediatric OSAHS.

Effect of verapamil on expression of K+·Cl-cotransporter 2 in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain / 中华麻醉学杂志

Objective To evaluate the effect of verapamil on the expression of K+-Cl-cotransporter 2 (KCC2) in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,aged 6-7 weeks,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:control group (group C),incisional pain group (group Ⅰ),incisional pain plus remifentanil plus verapamil group (group I+R+ V) and incisional pain plus remifentanil group (group I+R).Normal saline was subcutaneously infused in group C.A 1 cm long incision was made in the plantar surface of the right hindpaw in anesthetized rats in group Ⅰ.Verapamil 5 mg/kg was intraperitoneally injected at 10 min before establishment of the incisional pain model in group I+R+V.In I+R and I+R+V groups,the model of incisional pain was established,and remifentanil was subcutaneously infused for 30 min at a rate of 80 μg · kg-1 · h-1 simultaneously.The mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured at 1 day before establishment of the model (T0) and 2,6,24 and 48 h after establishment of the model (T1-4).The rats were sacrificed after measurement of MWT at T4,and the lumbar enlargement segments of the spinal cord were harvested for determination of the expression of KCC2 by immunofluorescence.Results Compared with group C,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in the other groups (P＜0.05).Compared with group Ⅰ,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in group I+R (P＜0.05).Compared with group I+R,the MWT was significantly increased at T1-4,and the expression of KCC2 was up-regulated in group I+R+V (P＜0.05).Conclusion The mechanism by which verapamil reduces remifentanil-induced hyperalgesia is related to up-regulation of the expression of KCC2 in spinal dorsal horns in a rat mnodel of incisional pain.

Application of modified laryngeal mask airway combining fiberoptic bronchoscopy intubation in difficult airways / 临床麻醉学杂志

Objective To observe the clinical effect of modified laryngeal mask airway combining fiberoptic bronchoscope intubation in difficult airways.Methods Forty patients,21 males and 1 9 females,aged 30-55 years,ASA physical status Ⅰ or Ⅱ,scheduled for elective general anes-thesia surgery after failure to direct laryngoscope two attempts were randomly divided into two groups,20 cases in each group.Patients in group LMA-FOB underwent intubation with modified la-ryngeal mask airway combining fiberoptic bronchoscope,and patients in group FOB underwent intu-bation with fiberoptic bronchoscope.The fiberoptic bronchoscope score,the intubation time and the rate of successful intubation at first attempt were recorded.All the patients were followed up postop-eratively for adverse effects.Results The fiberoptic bronchoscope scores (Ⅰ/Ⅱ/Ⅲ/Ⅳ:1 5/4/1/0 vs. 8/4/5/3,P <0.05)and the rate of once successful intubation (90% vs.60%,P <0.05)was signifi-cantly higher,and the intubation time [(75 ± 20)s vs.(105 ± 25 )s,P < 0.05 ]was significantly shorter in group LMA-FOB than that in group FOB.In group LMA-FOB,one patient had blood stain in the LMA and one patient felt slight sore throat.There were no significant adverse effects in the two groups.Conclusion Modified Laryngeal mask airway combining fiberoptic bronchoscope intubation in difficult airways was effective to improve the grade of the view of the larynn and the success rate of intubation and shorten the intubation time.No significant adverse effect postoperatively was reported. It is relatively safe,effective and promising in patients with difficult airway.

Effects of different load distribution modes on human physiological parameters during walking / 医用生物力学

Objective To investigate the effects of unevenly-distributed backpack loads on human physiological parameters as compared to the traditional centrally-placed load at the backpack bottom. Methods For the unevenly-distributed load mode, the backpack was divided into four spaces including top right, top left, bottom right and bottom left. The loads were divided into two parts proportionally (1/2∶1/2, 1/4∶3/4 and 3/4∶1/4) and placed at the bottom left and top right of the backpack, respectively. The remaining two spaces were filled with the plastic foam. Ten healthy volunteers performed 30-min walking trials on the treadmill at the speed of 1.1 m/s with the backpack load equal to 10% body weight (BW). The changes of subjects’ body posture, muscle fatigue, heart rate, blood pressure before and after the trial, as well as the electromyography (EMG) changes at 0, 5, 10, 15 min after the trial were measured by the Bortec AMT-8 and the NDI Optotrak Certus. Results The muscle fatigue of right upper trapezius and forward-leaning angle increased as the loads at top right of the backpack increased. However, the muscle fatigue in the new mode of backpack load distribution showed no significant differences as compared to the traditional mode under the same backpack loads. The new mode with the load ratio of 3/4∶1/4 had no significant effects on posture. The new mode with the load ratio of 1/2∶1/2 could contribute to the decrease of heart rate and blood pressure as compared to the traditional mode. Conclusions Adopting a new and more reasonable load distribution mode can guarantee the body posture unaffected by the backpack loads, and decrease heart rate and blood pressure. Therefore, the cross and evenly distributed load mode is recommended for the backpack design.

Effect of passive motion of from lower extremity on muscle fatigue when the back under head-down tilting / 医用生物力学

Objective To study the effect of passive motion from lower extremity on electromyography (EMG) activity of major muscles when the back under head down tilting state. Methods Thirty healthy subjects were selected. The EMGs of erector spinal and trapezius muscles were recorded and analyzed when human body was under head-down tilting at angel of 0°, 10°, 20° and 27° in static mode, respectively, in sway mode (along the axis of Z with frequencies of 120 and 140/min， respectively) and in vibration mode (along the axis of Y with frequency of 680/min) with the help of multifunctional test bed. Results In the static mode, the median frequency (MF) decreased with the increase of head-down titling angle; in the sway mode, the MF at each of 4 head-down tilting angles was smaller than that in the static mode. When the frequency was 120/min, the MF decreased with head-down tilting angle increasing, but when the frequency reached 140/min, the variation of MF became irregular. In the vibration mode, the MF increased with the increase of head-down tilting angle and was larger than that in the static mode. Conclusions In the static mode, the muscle fatigue increased with the head down tilting angle increasing; in the vibration mode, smaller head-down tilting angle should be selected to achieve better treatment effect; but in the sway mode, larger head-down tilting angle would be better, and the sway frequency should be set lower than 120/min to avoid potential damage due to excessive muscle fatigue.

Correlation analysis between the otitis media with effusion and allergic rhinitis in children with adenoidal hypertrophy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analysis the correlation between the otitis media with effusion and allergic rhinitis in children with adenoidal hypertrophy groups.@*METHOD@#Retrospective analysis of cases of adenoidal hypertrophy in children associated with the incidence of otitis media with effusion, with or without allergic rhinitis history, with or without nasal steroid hormone use history information.@*RESULT@#In the 287 cases of adenoidal hypertrophy in children cases, does not consider the role of nasal steroid hormones, the incidence of merger cases of allergic rhinitis and otitis media with effusion is 25.56%, compared to the incidence of control group is 32.47%, there is no significant difference (X=1.643, P>0.05). Not use a nasal steroid hormone therapy cases are grouped analysis, the combined incidence of allergic rhinitis group of otitis media with effusion 51.11%, higher than that in the control group to 32. 26% (2=5.019, P<0.05). Merger cases of allergic rhinitis, nasal steroid hormone group OME incidence of 12.50%, significantly below the 51.11% of the OME incidence of nasal steroid therapy group (2=23.32, P<0.01).@*CONCLUSION@#In children with adenoidal hypertrophy groups associated with a higher prevalence of otitis media with effusion, allergic rhinitis is an important factor in secretory otitis media. The use of nasal steroid hormones can reduce the incidence of secretory otitis media and may have some effect on the treatment of otitis media. Specific efficacy assessment and treatment mechanism needs further study.

Analgesic efficacy of intrathecal injection of competitive kinesin superfamily protein 17 antagonist in a mouse model of bone cancer pain / 中华麻醉学杂志

Objective To investigate the analgesic efficacy of intrathecal injection of RC-13,a competitive kinesin superfamily protein 17 antagonist,in a mouse model of bone cancer pain.Methods Forty male C3H/HeJ mice,aged 6-8 weeks,weighing 20-25 g,were randomly divided into 5 groups (n=8 each): sham operation group (group S); bone cancer pain + 5 μl dimethyl sulfoxide (DMSO) group (group R0); bone cancer pain + 2.5 μg RC-13 group (group R1); bone cancer pain + 5 μg RC-13 group (group R2) and bone cancer pain + 10 μg RC-13 group (group R3).In groups R0-3,bone cancer pain was induced by implantation of α-min-imal essence medium (α-MEM) containing osteosarcomaNCTC 2472 cells into the intramedullary space of right femur.In group S,culture medium α-MEM containing no cancer cell was injected instead.10％ DMSO 5 μl and RC-13 2.5 μg/5 μl,5μg/5μ1 and 10 μg/5 μ1 dissolved in 10％ DMSO were injected intrathecally in groups R0-3,respectively,once a day for 3 consecutive days starting from 14th day after inoculation of the tumor cells.Pain behavior was assessed by the paw withdrawal mechanical threshold (PWMT) and spontaneous lifting times (SLTs) measured at 1 day before inoculation and at 3,5,7,10,14 days after inoculation.The same tests were also performed at 1,3,5 and 7 days after administration in groups R0-3.Results Compared with group S,PWMT was significantly decreased and SLTs were increased at 7-14 days after inoculation in the other groups (P ＜ 0.05).Compared with group R0,PWMT was significantly increased and SLTs were reduced at 1 day after administration in group R1,at 1and 3 days after administration in group R2,and at 1,3 and 5 days after administration in group R3 (P ＜ 0.05).Compared with group R1,PWMT was significantly increased and SLTs were reduced at 3 days after administration in group R2,and at 1,3 and 5 days after administration in group R3 (P ＜ 0.05).Compared with group R2,PWMT was significantly increased and SLTs were reduced at 1 and 3 days after administration in group Rs (P ＜ 0.05).Conclusion Intrathecal RC-13,a competitive kinesin superfamily protein 17 antagonist,has a good analgesic efficacy in a mouse model of bone cancer pain and the efficacy is dose-dependent.