Research on Material Basis of Homologous and Heterogeneous Effect of Aurantii Fructus Immaturus and Aurantii Fructus Based on Total Statistical Moment Analysis and Molecular Connectivity Index / 中国实验方剂学杂志

ObjectiveTo investigate the material basis of homologous and heterogeneous effect of Aurantii Fructus Immaturus（AFI） and Aurantii Fructus（AF） based on the total statistical moment analysis and molecular connectivity index（MCI）. MethodRelevant literature at home and abroad and Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） were consulted to establish the chemical composition database of AFI and AF， and set up their fingerprints by ultra-high performance liquid chromatography（UPLC）， and the total statistical moments and similarity parameters of the fingerprint were calculated. According to MCI， all components of AFI and AF were divided into different component groups， the average values of 0-8th order（0χ-8χ） MCI of the common component groups of AFI and AF were calculated. ResultThe values of total zero-order moment（AUCT） of AFI and AF were （10.57±2.45）×106， （5.09±0.89）×106 μV·s， the values of total first-order moment（MCRTT） were （11.57±1.58）， （12.10±1.29） min， the values of total second-order moments（VCRTT） were（24.49±2.30）， （26.49±2.54） min2， respectively. It showed that qualitative and quantitative parameters of AFI and AF were significantly different. The components with high similarity such as neohesperidin， hesperidin and narirutin were screened as the common potential pharmacodynamic components of AFI and AF. The non-common components of AFI， such as alysifolinone and imperatorin， and the non-common components of AF， such as neoeriocitrin and isosakuranin， with high similarity were screened out as potential heterogeneous components of AFI and AF. The composition groups of AFI and AF were classified into six categories， and the similarities between the composition groups of AFI and AF and the total constituents were 0.872-0.979 and 0.918-0.997， the average values of 0χ-8χ MCI of alkaloids in AFI and AF were 3.65 and 3.14， the average values of 0χ-8χ MCI of flavonoids were 8.47 and 8.47， the average values of 0χ-8χ MCI of volatile oils were 2.71 and 3.48， respectively. It showed that there were some differences in MCI of chemical constituents（groups） between AFI and AF. ConclusionThe chemical constituents（groups） of AFI and AF not only differ in content and species， but also in structural characteristics and structure-activity relationship， which can provide a basis for further explaining the scientific connotation of homologous and heterogeneous effect of AFI and AF.

Clinical characteristics of eosinophilic esophagitis in children / 中华实用儿科临床杂志

Objective:To summarize the clinical characteristics of eosinophilic esophagitis (EoE) in children.Methods:Clinical data of children with EoE who were hospitalized in the Department of Gastroenterology, Beijing Children′s Hospital, Capital Medical University from January 1, 2017, to December 31, 2022, were retrospectively analyzed.Results:A total of 18 children with EoE were included in the study, including 13 males and 5 females, with the age of 11.96 (4.96, 12.81) years.Vomiting was more common in preschool children (4/5), while abdominal pain was the main symptom in school-age and adolescent children (11/13). There were 22.22% (4/18) of the children with EoE had an increased white blood cell count, and 33.33%(6/18) had an increased eosinophil count.Allergic history in the first-degree relatives was detected in 55.56%(10/18) of the children with EoE.Total immunoglobulin E (IgE) level was elevated in 68.75% (11/16) of the children.Food-specific IgE was positive in 66.67% (12/18) of the children with EoE.Milk, eggs, and wheat were the most common allergens.Esophageal mucosal hyperemia and erythema, rough, erosion, linear ulcers, annular changes, furrow or wrinkled paper changes, granular changes, polypoid or relaxation of the cardia were seen under endoscopy, whereas 27.78% (5/18) of the children showed normal esophageal mucosa.The histopathology showed chronic inflammation of the esophagus and increased eosinophil count.Three patients were lost of follow-up, and the remaining 15 were followed up for 6-24 months.All children with EoE were treated with the elimination diet.Nine children treated with glucocorticoids experienced clinical remission in a short period of time, involving 1 case with recurrence after withdrawal and being effectively treated by hormone therapy, and 2 cases of repeated digestive system symptoms or increased eosinophil count after withdrawal and being effectively relieved by the elimination diet.Conclusions:EoE is more common in elderly children and boys.Vomiting is the main symptom in pre-school aged children, whereas abdominal pain is the main symptom in school-aged children and adolescents.Increased peripheral white blood cell count and eosinophil count can be detected in some cases, and most of them are positive for food allergen tests.Gastrointestinal endoscopy and histopathology are important in the diagnosis of EoE.Elimination diet may be effective in some patients.Glucocorticoids are of great significance in the treatment of EoE, but a few children are steroid-dependent.

Clinical characteristics of eosinophilic gastroenteritis in children under six years old / 中国小儿急救医学

Objective:To analyze the clinical characteristics of eosinophilic gastroenteritis in children under 6 years old.Methods:The clinical data，laboratory examinations，imaging examinations，gastrointestinal endoscopy，histopathology，treatment，and prognosis of patients under 6 years old with eosinophilic gastroenteritis who were hospitalized in the Department of Gastroenterology，Beijing Children's Hospital from January 1，2016 to December 31，2022 were collected and analyzed.Results:A total of 31 children under 6 years of age with eosinophilic gastroenteritis were enrolled in the study,including 14 cases≤3 years old and 17 cases>3 years old, and 38.71% (12/31) of them had multiple sites involved. The main clinical manifestations were abdominal pain（20/31，64.52%），vomiting（11/31，35.48%），hematochezia（7/31，22.58%），and diarrhea（7/31，22.58%）.The children with eosinophilic duodenitis and eosinophilic colitis were more likely to have abdominal pain, with an incidence of 83.33%(10/12)（ P<0.05）. Eosinophilia increased in 70.97%（22/31）of children，which was more common in children >3 years of age（88.24% vs. 50.00%， P<0.05）.Anemia was seen in 29.03%（9/31）of the patients，and it was more common in children under 3 years of age（50.00% vs. 11.76%， P<0.05）.Hypoalbuminemia was found in 22.58%（7/31）of patients. Specific IgE（sIgE）was positive in 73.33%（22/30）of children. Milk，egg，and wheat were the most common allergens. Gastrointestinal endoscopy showed mucosal edema（29/31，93.55%），erythema（26/31，83.87%），roughness（12/31，38.71%），ulcer（10/31，32.26%），et al.All children were treated with the elimination diet. Besides,10 cases were treated with omeprazole, 16 cases were treated with montelukast, and 17 cases were treated with glucocorticoid. The incidence of relapse or steroid resistance was 32.26%（10/31），and 70.00%（7/10）of them occurred within one year of treatment. Conclusion:Eosinophilic gastroenteritis in children under 6 years of age may involve single or multiple sites.Abdominal pain is the most common clinical manifestation. Children may have elevated peripheral blood eosinophils，anemia，or hypoalbuminemia.Most children have food allergens. Nearly one-third of children experience relapse or steroid resistance.

Changes in cerebrospinal fluid leukocytes and 24-hour intrathecal IgG synthesis rate in the patients with positive intrathecal IgG synthesis / 中华检验医学杂志

Objective:Laboratory evaluation of the relationship between cerebrospinal fluid and plasma indicators and intrathecal immunoglobulin G(IgG) synthesis in patients with neurological diseases, and establishment of a new diagnostic method for intrathecal IgG synthesis.Methods:This study retrospectively analyzed the content of IgG in cerebrospinal fluid samples and blood albumin in blood samples, and other test results of 410 patients with neurological diseases who visited Beijing Tiantan Hospital from 2019 to 2022. According to the results of oligoclonal bands in cerebrospinal fluid, patients were divided into intrathecal IgG synthesis group and non-intrathecal IgG synthesis group. The Mann Whitney U test was used for inter group comparison, and a bilateral test with P<0.05 indicates a statistically significant difference. Include indicators with differences between groups in logistic regression analysis, construct a predictive model, and compare it with the established quantitative formula IgG index. Results:There were significant differences in 10 indicators, including cerebrospinal fluid leukocyte count and 24-hour intrathecal IgG synthesis rate, between the intrathecal IgG synthesis group and the non-intrathecal IgG synthesis group, with P<0.05. The area under the curve (AUC) of intrathecal IgG synthesis was higher than the IgG index (AUC=0.920, 0.809, Z=31.178, P<0.001), the sensitivity was higher than the IgG index (0.825, 0.618), and the specificity was lower than the IgG index (0.876, 0.908). Conclusion:The combination of 10 indicators such as cerebrospinal fluid white blood cell count and 24-hour intrathecal IgG synthesis rate can improve the diagnostic efficacy and sensitivity of intrathecal IgG synthesis.

Analysis on Quality Attribute of Substance Benchmarks of Shentong Zhuyutang Based on Supramolecular "Imprinting Template" Theory / 中国实验方剂学杂志

ObjectiveBased on the supramolecular "imprinting template" theory， the autonomous action law of the component groups of Shentong Zhuyutang in the preparation process of medicinal materials-decoction pieces-formulas was studied to clarify the quantitative transfer law of its quality attributes. MethodUltra performance liquid chromatography（UPLC） fingerprint of Shentong Zhuyutang was established with mobile phase of 0.4% phosphoric acid aqueous solution（A）-acetonitrile（B） for gradient elution（0-2.5 min， 100%A； 2.5-6 min， 100%-96%A； 6-15 min， 96%-92%A； 15-25 min， 92%-88%A； 25-35 min， 88%-75%A； 35-50 min， 75%-65%A； 50-60 min， 65%-50%A； 60-65 min， 50%-30%A； 65-70 min， 100%A） and detection wavelength of 235 nm， and the total statistical moments， information entropy and primary feeding amount of fingerprint of medicinal materials， decoction pieces and benchmark samples were calculated. Dry extract rate of the benchmark samples， the transfer rates and the addition parameters of medicinal materials-decoction pieces-formulas were calculated. ResultSimilarities of the total statistical moments of UPLC fingerprint of 15 batches of medicinal materials and decoction pieces were>0.89， the relative standard deviations（RSDs） of information entropy of UPLC fingerprint of 12 medicinal materials and decoction pieces were<10%. RSDs of total first-order moment（MCRTT） and information entropy of Shentong Zhuyutang（medicinal materials） were 5.5% and 2.3%， while the RSDs of MCRTT and information entropy of Shentong Zhuyutang（decoction pieces） were 4.8% and 2.6%， respectively. The dry extract rate of 45 batches of Shentong Zhuyutang was 17.2%-20.2%. The transfer rate of medicinal materials to decoction pieces was within the range of data fluctuation， which was 70%-130% of the average value. The overall transfer rates of medicinal materials to decoction pieces and decoction pieces to benchmark samples were 101.8% and 83.0%， respectively. ConclusionThe quality properties of Shentong Zhuyutang benchmark samples can be studied by total statistical moment analysis and primary feeding amount analysis， which can confirm the supramolecular "imprinting template" theory to a certain extent.

Preparation of Rubus parvifolius L.dispersible tablets and determination of its dissolution rate / 中国药师

Objective To optimize the preparation process of Rubus parvifolius L.dispersible tablets and determine its dissolution.Methods On the basis of single factor test,the formulation process of dispersible tablets was optimized by central composite design-response surface method with microcrystalline cellulose(MCC),polyvinyl polypyrrolidone(PVPP)and low substituted hydroxypropyl cellulose(L-HPC)as the influencing factors and disintegration time as the evaluation index.The total saponins of Rubus parvifolius L.was used as an indicator to determine the dissolution rate with reference to the method of Chinese Pharmacopoeia.Results The optimal prescription was 36.9％total saponin extract powder,42％MCC,13％PVPP,8％L-HPC and 0.1％microsilica gel,which showed a high correlation coefficient of the model.The disintegration time of the prepared dispersive tablets was less than 3 min,and the cumulative dissolution rate reached more than 88％at 50 min.Conclusion The optimized process is stable and reliable,and can be used for the preparation of Rubus parvifolius L.dispersible tablets.

Application of endoscopic retrograde cholangiopancreatography on diagnosis and treatment of pediatric chronic pancreatitis / 中国小儿急救医学

Objective:To investigate the value of endoscopic retrograde cholangiopancreatography(ERCP)and related techniques in the diagnosis and treatment of chronic pancreatitis in children.Methods:The clinical data of 16 children with chronic pancreatitis diagnosed in the Department of Gastroenterology at Beijing Children′s Hospital from January 2021 to January 2022, who had ERCP indications were analyzed retrospectively, including age, sex, operation time, postoperative complications and follow-up data.Results:Thirty nine ERCP operations were performed in 16 children, with the age of (7.20±2.51) years old, and the minimum weight of 13 kg.There were 7 males and 9 females.The clinical manifestations were upper abdominal pain in all cases, 3 patients with dyspnea, 1 patient with gastrointestinal bleeding, and 1 patient with diabetes.In terms of etiology, 16 cases were diagnosed by ERCP including, 7 cases with pancreatic divisum, 1 case with abnormal pancreaticobile duct confluence.Among the 16 children, 11 had gene examination with 9 gene mutations (including 7 cases SPINK1 mutation, 1 case PRSS mutation, and 1 case CFTR mutation).The operation time was 30 to 65 minutes, and the median was 43 minutes.The operation time was negative correlation with age, while there was no correlation with the anatomical structure abnormality or the gene mutation.Among the 16 children, 15 were placed with pancreatic duct stents, with a success rate of 93.8%.Three children had postoperative pancreatitis, the rest had hyperamylasemia.Postoperative complications were not related with the age, the anatomical structure abnormality or the gene mutation.All children had been followed up for more than one year.All children have not suffered from pancreatitis again, and the body mass index had increased significantly after operation than before( P<0.05).The ERCP operation was performed 2 to 4 times in children after stent replacement, and the time of stent replacement ranged from 3 months to 12 months. Conclusion:The main causes of chronic pancreatitis in children are anatomical abnormalities or gene mutations.ERCP and related techniques are minimally invasive, safe and effective in the treatment of chronic pancreatitis.

Effects of methionine restriction on oral cancer cell proliferation, migration and invasion / 中国药理学通报

Aim To investigate the effect of methionine restriction on the proliferation, migration and invasion of human oral squamous carcinoma CAL-27 cells. Methods Cell proliferation and colony formation ability were detected by cell counting and colony forming assay. The changes in cell cycle and apoptosis were detected by propidium iodide (PI) staining flow cytometry and Annexin V/7-amino-actinomycin staining flow cytometry. The migration and invasion ability of CAL-27 was detected by scratch and Transwell assay. The expression levels of apoptosis proteins Bax and Bcl-2, cyclins CDK2 and CDK4 and migration and invasion proteins N-cadherin and E-cadherin were examined by Western blot. Results Methionine restriction significantly inhibited the proliferation and clone formation of oral squamous cancer cell CAL-27 (P < 0. 01), induced cell cycle arrest at G

Prevention and inhibition of nasopharyngeal carcinoma growth by attenuated salmonella SGN1 / 中国药理学通报

Aim To study the inhibitory effect of attenuated salmonella SGN1, overexpressing methioninase, on nasopharyngeal carcinoma (NPC) and the underlying mechanism. Methods The cell proliferation, cell cycle, cell apoptosis, clony formation and migration a-bility of 5-8F, HNE-2, CNE-2 cells were measured u-sing flow cytometry assay, clone formation assay, and wound assay after the methionine restriction treatment. 5-8F, HNE-2, CNE-2 cells were infected with SGN1 at the multiplicity of infection (MOI) of 1: 100 for 5 hours, followed with the measurement of cell growth. A xenograft model was constructed by subcutaneous injection of 5-8F cells in mice to observe the inhibitory effect of SGN1 on nasopharyngeal carcinoma. Results Compared with the control group, methionine restriction significantly inhibited the proliferation, migration ability, and clone formation of nasopharyngeal carcinoma cells and blocked the G

Pathological features and diagnostic significance of lung biopsy in occupational lung diseases / 中华病理学杂志

Objective: To investigate the clinicopathological characteristics of occupational lung diseases, to reduce the missed diagnoses and misdiagnoses of the diseases and to help standardize the diagnosis and treatment of these patients. Methods: A total of 4 813 lung biopsy specimens (including 1 935 consultation cases) collected at the Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, China from January 1st, 2017 to December 31th, 2019 were retrospectively analyzed. Among them, 126 cases of occupational lung diseases were confirmed with clinical-radiological-pathological diagnosis. Special staining, PCR and scanning electron microscopy were also used to rule out the major differential diagnoses. Results: The 126 patients with occupational lung diseases included 102 males and 24 females. All of them had a history of exposure to occupational risk factor(s). Morphologically, 68.3% (86/126) of the cases mainly showed pulmonary fibrotic nodules, dust plaque formation or carbon end deposition in pulmonary parenchyma. 16.7% (21/126) of the cases mainly showed welding smoke particle deposition in the alveolar cavity and lung interstitium while 15.1% (19/126) of the cases showed granulomas with fibrous tissue hyperplasia, alveolar protein deposition or giant cell interstitial pneumonia. The qualitative and semi-quantitative analyses of residual dust components in the lung under scanning electron microscope were helpful for the diagnosis of welder's pneumoconiosis and hard metal lung disease. Conclusions: The morphological characteristics of lung biopsy tissue are important reference basis for the clinicopathological diagnosis and differential diagnosis of occupational lung diseases. Recognizing the characteristic morphology and proper use of auxiliary examination are the key to an accurate diagnosis of occupational lung diseases on biopsy specimens.

Auto-HSCT bridging to CAR-T for follicular lymphoma transformed to B-lymphoblastic leukemia/lymphoma: report of 1 case and review of literature / 白血病·淋巴瘤

Objective:To investigate the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) bridging to chimeric antigen receptor T cell (CAR-T) immunotherapy for follicular lymphoma (FL) transformed to B-lymphoblastic leukemia/lymphoma (B-LBL).Methods:The diagnosis and treatment of 1 patient with FL transformed to B-LBL admitted to the First Hospital of Soochow University in August 2020 were retrospectively analyzed and the literature was reviewed.Results:The male patient was 65 years old, and was diagnosed as FL (stage Ⅳ group A, FL international prognostic index -1 score 3 points, high-risk group) in August 2020. And then he was given 6 courses of RB (rituximab combined with bendamustine) regimen, with complete remission (CR) at mid-term and end-stage PET-CT, followed by regular maintenance therapy with rituximab every 2 months, and disease progressed after 4 courses of maintenance therapy. According to the results of histopathology and bone marrow aspiration in December 2021, he was diagnosed B-LBL involving the bone marrow. Partial remission was achieved after induction therapy with zanubnulindb combined with hyper CVAD (cyclophosphamide + doxorubicin + vindesine + dexamethasone) regimen, followed by auto-HSCT bridging to CAR-T treatment targeting CD19 and CD22, which proceeded smoothly with cytokine release syndrome grade 0, immune effector cell-associated neurotoxicity syndrome grade 0. The patient successfully underwent hematopoietic reconstruction and orally taken ibrutinib after discharge. PET-CT indicated CR 2 months after transplantation and he was still in disease-free survival state.Conclusions:The prognosis of FL transformed to B-LBL is poor, and auto-HSCT bridging to CAR-T can improve the prognosis and prolong the survival time of patients who cannot undergo allogeneic hematopoietic stem cell transplantation.

Clinical features and factors related to extraintestinal manifestations in children with ulcerative colitis / 国际儿科学杂志

Objective:To investigate the clinical features and risk factors of the extraintestinal manifestations(EIM)in children with ulcerative colitis(UC).Methods:A retrospective case-control study was conducted.The clinical data of 99 children with UC diagnosed in Department of Gastroenterology, Beijing Children′s Hospital, Capital Medical University from January 2016 to December 2021 were analyzed.According to whether the patients had EIM or not, they were divided into EIM-positive group and EIM-negative group.Rank sum test, χ2test or Fisher′s exact test were used to compare the variables between the 2 groups, including the clinical features, laboratory examination results and treatments.The Logistic regression was used to analyze the risk factors of EIM in children with UC. Results:A total of 99 children with UC were enrolled, including 57 males and 42 females; the age of onset was 10.3(6.4, 12.6)years, and the course of disease was 4.2(1.6, 10.1)months.The patients were mainly characterized by extensive disease(E3)and pancolitis(E4)(69/99, 69.7%), moderate to severe activity(63/99, 63.6%)and moderate to severe inflammation of colonic mucosa(89/99, 89.9%). There were 77 patients(77.8%)in the EIM-negative group and 22 patients(22.2%)in the EIM-positive group, of which 5 patients had two types of EIMs; the most common EIMs were oral ulcers(9 cases), joint lesions(7 cases), and skin lesions(6 cases). Compared with the EIM-negative group, those in the EIM-positive group, such as the E4 type(77.3% vs 44.2%, χ2=7.513, P=0.006), moderate to severe activity(81.8% vs 58.4%, χ2=4.041, P=0.044), pediatric ulcerative colitis activity index score[47.5(35.0, 57.5)score vs 35.0(25.0, 50.0)score, Z=-2.260, P=0.024], the proportion of C-reactive protein≥8mg/L at diagnosis(54.5% vs 19.5%, χ2=10.607, P=0.001), erythrocyte sedimentation rate[30.0(13.8, 47.8)mm/h vs 10.0(4.0, 19.5)mm/h, Z=-3.918, P<0.001], the proportion of glucocorticoid treatment within one year after diagnosis(77.3% vs 49.4%, χ2=5.403, P=0.020)and the proportion of biological agents treatment(45.5% vs 23.4%, χ2=4.112, P=0.043)were significantly higher; the E3 type were significantly lower than those in the EIM-negative group(0 vs 23.4%, χ2=4.813, P=0.028), and the differences were statistically significant.Multivariate Logistic regression analysis showed that erythrocyte sedimentation rate at diagnosis was an independent risk factor of EIM in children with UC( OR=1.063, 95% CI: 1.025~1.103, P=0.001). Conclusion:The UC patients with EIM had more extensive lesions, more severe disease activity, significantly increased inflammatory indicators, and more commom glucocorticoid and biologic therapy.Increased erythrocyte sedimentation rate was an high risk factor of EIM in children with UC.

High-resolution MRI combined with nomogram model predicts the risk factors of positive circumferential resection margin in rectal cancer / 实用放射学杂志

Objective To investigate the clinical value of high-resolution magnetic resonance imaging(HR-MRI)combined with nomogram model in predicting the risk factors of positive circumferential resection margin(CMR)in rectal cancer surgery.Methods A retrospective analysis was conducted on preoperative data from 107 rectal cancer patients who underwent surgery and were confirmed by pathology.SPSS 2 5.0 software was used for univariate statistical analysis of potential risk factors for positive CRM,and after independent risk factors were selected,multivariate logistic regression analysis was performed to classify the risk factor categories.R software(4.2.0 version)was used to establish the nomogram model,and a curve was drawn to evaluate the model.The receiver operating characteristic(ROC)curve was used to show specificity and sensitivity,the area under the curve(AUC)was used to evaluate discriminative ability,the calibration curve was used to evaluate calibration,the decision curve analysis(DCA)was used to evaluate clinical benefit,and the model was internally validated using the Bootstrap method.Results Tumor located in the lower rectum[P=0.01,odds ratio(OR)=8.71],maximum diameter of tumor perpendicular to the intestinal tube(≥18.86 mm±5.32 mm)(P=0.01,OR=1.24),extramural vascular invasion(EMVI)(P＜0.01,OR=0.03),and mesorectal lymph node metastasis(P=0.01,OR=0.15)were independent risk factors for positive CRM in rectal cancer.The nomogram model established based on these factors had a training set AUC of 0.921(sensitivity 0.83,specificity 0.93),a validation set AUC of 0.912(sensitivity 0.87,specificity 0.82),a Bootstrap internal validation corrected AUC of 0.92,and a consistency index(C-index)of 0.92,indicating good discriminative ability,calibration,and clinical benefit value.Conclusion HR-MRI combined with nomogram model predicted that tumor located in the lower rectum,maximum diameter of tumor perpendicular to the intestinal tube ≥(18.86±5.32)mm,EMVI,and mesorectal lymph node metastasis are closely related to positive CRM in rectal cancer.

Preliminary study on double-balloon enteroscopy in the treatment of Peutz-Jeghers syndrome polyp with intussusception in children / 中国小儿急救医学

Objective:To assess the value of double-balloon enteroscopy(DBE)in the treatment of Peutz-Jeghers syndrome(PJS)polyp with intussusception in children.Methods:A total of 14 cases with PJS polyp with intussusception were collected in Gastroenterology Department of Beijing Children′s Hospital Affiliated to Capital Medical University from July 2019 to January 2023.The general information, clinical manifestations, history of surgeries, abdominal ultrasound, enteroscopy and postoperative outcomes were retrospectively analyzed.Results:Fourteen cases with intussusception of PJS(including nine boys and five girls) were enrolled, and the average age was(10.25±2.52)years.There were 21 small intestinal intussusceptions in 14 cases, including eight cases of single intussusception and six cases of multiple intussusceptions.All the patients underwent DBE examination and treatment.A total of 215 small intestinal polyps were removed, no direct complications such as bleeding or perforation were found during the operation.Twelve cases were confirmed intussusception relieved by DBE, and the average maximum diameter of polyps causing intussusception was(4.38±1.43)cm.In addition, DBE did not reach the site of intussusception polyp in one case, and another case developed intestinal obstruction after DBE operation, which were treated by surgery.Conclusion:DBE provides a relatively effective method for the treatment of PJS polyps with intussusception without complete ileus in children.

Analysis of influencing factors of medical insurance fund settlement in neonatology under DIP payment method / 中国卫生政策研究

Objective:To analyze the DIP medical insurance settlement situation of neonatology and its influencing factors,to optimize the medical insurance settlement rules of neonatology,and to promote the fine management of payment method reform.Methods:City Y,the pilot city of national DIP payment method,was selected as the case area,and the data of the whole sample of patients in neonatology department of City Y were analyzed by descriptive analysis,four-quadrant bubble chart,and multivariate linear regression methods,combined with qualitative data analysis and interview study.Results:There were 1 372 neonates in City Y in 2022,with a health insurance billing rate of 84.82%and 81.10%in tertiary care facilities.There were 718 unenrolled cases.Tertiary care institutions,not enrolled,low-birth-weight babies,higher days of hospitalization,lower days of birth,and lower settlement scores were the influencing factors for the low rate of health insurance settlement in neonatology(P<0.05).Conclusion:Neonatology medical insurance settlement rate was significantly lower than that of the city,and tertiary care institutions had higher deficits,which may lead to the risk of shirking critically ill neonatal patients.There were problems of insufficient grouping refinement and score distortion in neonatology.Recommendation:We should improve the management and adjustment mechanism of core elements,optimize the DIP grouping of neonatology,comprehensively consider the resource consumption characteristics of neonates,rationally and dynamically adjust the price of neonatal medical services,and scientifically set the neonatology markup coefficients,so as to achieve synergistic improvement in the development of neonatology and health insurance,and to push forward the connotative and refined development of the reform of the payment method of health insurance.

Impact of global budget on the medical care flow and fund allocation of non-compact medical communities from the perspective of symbiosis / 中华医院管理杂志

Objective:To analyze the impact of global budget on the medical flow treatment and fund allocation in a non-compact medical community based on the symbiosis theory, so as to provide references for relevant authorities to formulate policies for the medical community.Methods:Data on outpatient and emergency visits, discharges, and medical insurance fund usage of the leading hospital and primary medical and health institutions in a non-compact medical community were collected from the health information system of a certain city. The time range of the data spanned from January 2017 to December 2019. The total budget was implemented in April 2018. The symbiotic system of the non-compact medical community was analyzed based on the theory of symbiosis. Descriptive analysis and intermittent time series segmented regression model were used to analyze the changes in indexes related to the flow of medical treatment and fund allocation between the leading hospital and primary institutions under the global budget.Results:The non-compact medical community′s symbiotic system had developed a continuous symbiotic model in organization and an asymmetric reciprocal symbiotic model in behavior. From the perspective of medical treatment flow, the number of outpatient and emergency visits of leading hospital and primary institutions in the medical community showed an upward trend, with little change in the number of discharged patients from 2017 to 2019; The number of patients transferred by the leading hospital increased from 32 in 2017 to 87 in 2019. According to the analysis of the intermittent time series segmented regression model, after the implementation of global budget, the proportion of outpatient and emergency visits in leading hospital was decreased ( β3=-0.43, P<0.05), the proportion of outpatient and emergency visits in primary institutions was on the rise ( β3= 0.02, P<0.05). In terms of fund allocation, the share of health insurance fund of the leading hospital increased from 45.98% in 2017 to 46.51% in 2019, and the primary medical and health institutions decreased from 23.44% to 18.06%, as well as the ratio of per capita income of primary medical and health institutions to that of leading hospitals was decreased from 72.62% to 60.79%. Conclusions:Under the global budget, the outpatient and emergency medical treatment flow in a non-compact medical community had been optimized. However, there was an uneven distribution of funds among medical institutions at all levels. Thus it was recommended to continue to give full play to the positive incentive effect of the global budget, establish a scientific mechanism for distributing benefits, and strengthen supervision and management.

Evaluation of Renal Impairment in Patients with Diabetic Kidney Disease by Integrated Chinese and Western Medicine / 中国结合医学杂志

OBJECTIVE@#To investigate the factors related to renal impairment in patients with diabetic kidney disease (DKD) from the perspective of integrated Chinese and Western medicine.@*METHODS@#Totally 492 patients with DKD in 8 Chinese hospitals from October 2017 to July 2019 were included. According to Kidney Disease Improving Global Outcomes (KDIGO) staging guidelines, patients were divided into a chronic kidney disease (CKD) 1-3 group and a CKD 4-5 group. Clinical data were collected, and logistic regression was used to analyze the factors related to different CKD stages in DKD patients.@*RESULTS@#Demographically, male was a factor related to increased CKD staging in patients with DKD (OR=3.100, P=0.002). In clinical characteristics, course of diabetes >60 months (OR=3.562, P=0.010), anemia (OR=4.176, P<0.001), hyperuricemia (OR=3.352, P<0.001), massive albuminuria (OR=4.058, P=0.002), atherosclerosis (OR=2.153, P=0.007) and blood deficiency syndrome (OR=1.945, P=0.020) were factors related to increased CKD staging in patients with DKD.@*CONCLUSIONS@#Male, course of diabetes >60 months, anemia, hyperuricemia, massive proteinuria, atherosclerosis, and blood deficiency syndrome might indicate more severe degree of renal function damage in patients with DKD. (Registration No. NCT03865914).

Effects of Methionine Restriction on Proliferation, Cell Cycle, and Apoptosis of Human Acute Leukemia Cells / 中国实验血液学杂志

OBJECTIVE@#To investigate the effects of methionine restriction on proliferation, cell cycle and apoptosis of human acute leukemia cells.@*METHODS@#Cell Counting Kit-8 (CCK-8) assay was used to detect the effect of methionine restriction on HL-60 and Jurkat cells proliferation. The effect of methionine restriction on cell cycle of HL-60 and Jurkat cells was examined by PI staining. Annexin V-FITC / PI double staining was applied to detect apoptosis of HL-60 and Jurkat cells following methionine restriction. The expression of cell cycle-related proteins cyclin B1, CDC2 and apoptosis-related protein Bcl-2 was evaluated by Western blot assay.@*RESULTS@#Methionine restriction significantly inhibited the proliferation of HL-60 and Jurkat cells in a time-dependent manner (HL-60: r =0.7773, Jurkat: r =0.8725), arrested the cells at G2/M phase (P < 0.001), and significantly induced apoptosis of HL-60 and Jurkat cells (HL-60: P < 0.001; Jurkat: P < 0.05). Furthermore, Western blot analysis demonstrated that methionine restriction significantly reduced the proteins expression of Cyclin B1 (P < 0.05), CDC2 (P < 0.01) and Bcl-2 (P < 0.001) in HL-60 and Jurkat cells.@*CONCLUSION@#Acute leukemia cells HL-60 and Jurkat exhibit methionine dependence. Methionine restriction can significantly inhibit the proliferation, promote cell cycle arrest and induce apoptosis of HL-60 and Jurkat cells, which suggests that methionine restriction may be a potential therapeutic strategy for acute leukemia.

Isoflavones from Sojae Semen Praeparatum Regulate Lipid Metabolism in Atherosclerotic Mice Through PPARγ/LXRα/ABCA1 Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo study the effect of isoflavones from Sojae Semen Praeparatum （ISSP） on lipid metabolism in atherosclerotic mice， and decipher the underlying mechanism via the peroxisome proliferator-activated receptor gamma/liver X receptor alpha/ATP-binding cassette transporter A1 （PPARγ/LXRα/ABCA1） signaling pathway. MethodFifty ApoE-/- mice were randomly assigned into the model group， western medicine （atorvastatin calcium， 3.03 mg·kg-1） group， and low-， medium-， and high-dose ISSP （2.5， 5， 10 mg·kg-1， respectively） groups， with 10 rats in each group. Atherosclerosis model mice were established by bilateral ovariectomy and feeding high-fat diet. Another 10 ApoE-/- mice receiving ovariectomy and high-fat diet were taken as the sham group. Some mice died of postoperative infection， and finally 6 mice were included in each group. One week after operation， each group was administrated with corresponding drugs or equivalent amount of normal saline. After 12 weeks， the levels of triglyceride （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， and non-esterified fatty acids （NEFAs） in serum and liver tissue were measured. The levels of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in serum were detected by enzyme-linked immunosorbent assay （ELISA）. Hematoxylin-eosin （HE） staining and oil red O staining were used for observation of aortic plaque formation and liver lipid deposition. The mRNA and protein levels of PPARγ， LXRα， ABCA1， and ATP-binding cassette transporter G1 （ABCG1） in liver were determined by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot. ResultCompared with the sham group， the modeling of atherosclerosis increased the aortic plaque area （P<0.01）， elevated the serum TC， TG， LDL-C， TNF-α， and IL-6 levels （P<0.01）， decreased the level of HDL-C （P<0.01）， increased the liver index （P<0.05） and the levels of TC， TG， and NEFAs in liver （P<0.01）， and caused obvious hepatic fat vacuoles and lipid deposition. In addition， the modeling down-regulated the mRNA levels of PPARγ， LXRα， ABCA1 in liver （P<0.05， P<0.01），and regulated the mRNA and protein levels of ABCG1（P<0.05， P<0.01）. Compared with the model group， atorvastatin calcium and middle-， high-dose ISSP reduced the serum TC， TG， LDL-C， TNF-α， and IL-6 levels （P<0.01）， decreased the liver index （P<0.01）， alleviated the liver fat vacuoles and lipid deposition， and increased the levels of TC， TG， and NEFAs in the liver （P<0.05， P<0.01）. Furthermore， they up-regulated the mRNA and protein levels of PPARγ， LXRα， ABCA1， and ABCG1 in the liver （P<0.05， P<0.01）. ConclusionISSP may regulate lipid metabolism through PPARγ/LXRα/ABCA1 signaling pathway to down-regulate the expression of inflammatory cytokines in serum and alleviate liver lipid deposition， thereby suppressing the formation of atherosclerotic plaque.

Discussion on Material Basis of Different Parts of Mulberry with Different Effects Based on Molecular Connectivity Index / 中国实验方剂学杂志

ObjectiveTo explore the material basis for the difference in the efficacy of different parts of mulberry based on molecular connectivity index （MCI）. MethodBy referring to the relevant literature at home and abroad and traditional Chinese medicine systems pharmacology database and analysis platform （TCMSP） database， the chemical composition database of mulberry-source medicinal materials was established. Venn analysis was carried out on the components among mulberry-source medicinal materials. The components in the database were divided into 10 categories， and the composition information was analyzed. According to MCI value， all components of mulberry-source medicinal materials were divided into different groups. The angle cosine method was used to calculate the MCI similarity. The average MCI values of the common component group from 0-8 orders and CI of mulberry-source medicinal materials were calculated. ResultThe components with high similarity such as （+）-cycloolivil， 1′-methoxy-2′-hydroxydihydromollugin， kuwanon， morusin and 1-deoxynojirimycin were selected as potential pharmacodynamic components. Mulberry-source medicinal materials could be divided into five component groups. The similarity between component groups and total components was 0.760-0.999， and the similarity between component groups was 0.248-0.999. In Mori Ramulus， Mori Folium， Mori Cortex and Mori Fructus， the average MCI values of their flavonoids from 0-8 orders were 4.57， 4.59， 6.41， 4.24， respectively. The average MCI values of alkaloids from 0-8 orders were 2.65， 4.55， 2.58， 2.78， respectively. The average CI values from 0-8 orders were 5.51， 5.49， 5.44 and 2.88， respectively. ConclusionIt is preliminarily concluded that there are differences in the flavonoids and pathways of hypoglycemic effects between Mori Cortex and the other three mulberry-source medicinal materials. The MCI values of alkaloids from 0-8 orders in Mori Folium and Mori Fructus were higher， but their inhibitory activity of α-glucosidase were lower than those of Mori Ramulus and Mori Cortex. The structural characteristics of the total components of Mori Fructus represented by CI were quite different from the other three mulberry-source medicinal materials.