Benralizumab efficacy and safety in severe asthma: A randomized trial in Asia.

BACKGROUND: Benralizumab is indicated as add-on therapy in patients with uncontrolled, severe eosinophilic asthma; it has not yet been evaluated in a large Asian population with asthma in a clinical trial. OBJECTIVE: To evaluate the efficacy and safety of benralizumab in patients with severe asthma in Asia. METHODS: MIRACLE (NCT03186209) was a randomized, Phase 3 study in China, South Korea, and the Philippines. Patients aged 12-75 years with severe asthma receiving medium-to-high-dose inhaled corticosteroid/long-acting ß2-agonists, stratified (2:1) by baseline blood eosinophil count (bEOS) (≥300/µL; <300/µL), were randomized (1:1) to benralizumab 30 mg or placebo. Endpoints included annual asthma exacerbation rate (AAER; primary endpoint), change from baseline at Week 48 in pre-bronchodilator (BD) forced expiratory volume in 1 second (pre-BD FEV1) and total asthma symptom score (TASS). Safety was evaluated ≤ Week 56. RESULTS: Of 695 patients randomized, 473 had baseline bEOS ≥300/µL (benralizumab n = 236; placebo n = 237). In this population, benralizumab significantly reduced AAER by 74% (rate ratio 0.26 [95% CI 0.19, 0.36], p < 0.0001) and significantly improved pre-BD FEV1 (least squares difference [LSD] 0.25 L [95% CI 0.17, 0.34], p < 0.0001) and TASS (LSD -0.25 [-0.45, -0.05], p = 0.0126) versus placebo. In patients with baseline bEOS <300/µL, there were numerical improvements in AAER, pre-BD FEV1, and TASS with benralizumab versus placebo. The frequency of adverse events was similar for benralizumab (76%) and placebo (80%) in the overall population. CONCLUSIONS: MIRACLE data reinforces the efficacy and safety of benralizumab for severe eosinophilic asthma in an Asian population, consistent with the global Phase 3 results.

Soluble microbial products in pilot-scale drinking water biofilters with acetate as sole carbon source.

A comprehensive study on formation and characteristics of soluble microbial products (SMP) during drinking water biofiltration was made in four parallel pilot-scale ceramic biofilters with acetate as the substrate. Excellent treatment performance was achieved while microbial biomass and acetate carbon both declined with the depth of filter. The SMP concentration was determined by calculating the difference between the concentration of dissolved organic carbon (DOC), biodegradable dissolved organic carbon (BDOC) and acetate carbon. The results revealed that SMP showed an obvious increase from 0 to 100 cm depth of the filter. A rising specific ultraviolet absorbance (SUVA) was also found, indicating that benzene or carbonyl might exist in these compounds. SMP produced during this drinking water biological process were proved to have weak mutagenicity and were not precursors of by-products of chlorination disinfection. The volatile parts of SMP were half-quantity analyzed and most of them were dicarboxyl acids, others were hydrocarbons or benzene with 16-17 carbon atoms.

Proteomic insights into protostane triterpene biosynthesis regulatory mechanism after MeJA treatment in Alisma orientale (Sam.) Juz.

Protostane triterpenes in Alisma orientale (Sam.) Juz. have unique structural features with distinct pharmacological activities. Previously we have demonstrated that protostane triterpene biosynthesis could be regulated by methyl jasmonate (MeJA) induction in A. orientale. Here, proteomic investigation reveals the MeJA mediated regulation of protostane triterpene biosynthesis. In our study, 281 differentially abundant proteins were identified from MeJA-treated compared to control groups, while they were mainly associated with triterpene biosynthesis, α-linolenic acid metabolism, carbohydrate metabolism and response to stress/defense. Key enzymes 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR), squalene epoxidase (SE), oxidosqualene cyclase (OSC) and cytochrome P450s which potentially involved in protostane triterpene biosynthesis were significantly enriched in MeJA-treated group. Basic Helix-loop-helix (bHLH), MYB, and GRAS transcription factors were enhanced after MeJA treatment, and they also improved the expressions of key enzymes in Mevalonate pathway and protostane triterpene. Then, MeJA also could increase the expression of α-galactosidase (α-GAL), thereby promoting carbohydrate decomposition, and providing energy and carbon skeletons for protostane triterpene precursor biosynthesis. As well, exogenous MeJA treatment upregulated 13-lipoxygenase (13-LOX), allene oxide synthase (AOS) and allene oxide cyclase (AOC) involved in α-linolenic acid metabolism, leading to the accumulation of endogenous MeJA and activation of the protostane triterpene biosynthesis transduction. Finally, MeJA upregulated stress/defence-related proteins, as to enhance the defence responses activity of plants. These results were further verified by quantitative real-time PCR analysis of 19 selected genes and content analysis of protostane triterpene. The results provide some new insights into the role of MeJA in protostane triterpene biosynthesis.

[Nuclear magnetic resonance-based metabolomics revealed metabolite profiles participate in intervention effect of refined moxibustion in gastric ulcer model rats].

OBJECTIVE: To investigate the effect of refined moxibustion on expression of gastric mucosal epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF), and changes of metabolite profiles in gastric ulcer (GU) rats, so as to analyze its mechanism underlying improvement of GU. METHODS: Male SD rats were randomized into control, model, acupoint moxibustion groups (n=6 per group). The GU model was induced by cold-restraint stress. The ignited refined moxa was applied to bilateral "Liangmen" (ST21) and "Zusanli" (ST36) for 3 cones/acupoint, once daily for 7 days. Then, we employed 1H NMR-based metabolomics approach to analyze the metabolic profiles of serum and stomach tissue samples. The conventional histopathological changes of the gastric mucosa were observed by H.E. stain and the expressions of EGFR and VEGF in the gastric mucosa were detected by immunohistochemistry. RESULTS: Compared to the control group, the expression levels of EGFR and VEGF were significantly increased in the model group (P<0.01, P<0.05), and further notably up-regulated in the acupoint moxibustion group (P<0.001, P<0.01). Results of H.E. staining showed damage of the folds of gastric mucosa, disordered arrangement of the glands, infiltration of inflammatory cells and unclear structure of gastric mucosa in the model group, which was relatively milder in the acupoint moxibustion group. 1H-NMR technical analysis showed that in comparison with the control group, 11 and 11 metabolites in the stomach extract and plasma were increased, 10 in the gastric tissue and 3 in the plasma were decreased in the GU model group; while in comparison with the model group, 17 differently expressed metabolites in the gastric extract and 10 metabolites in the plasma restored to their levels of control group after the acupoint moxibustion intervention. These metabolites participate in 12 metabolic pathways including glycine, serine and threonine metabolism, glutathione metabolism, glycine metabolism, alanine, aspartic acid and glutamic acid metabolism, purine metabolism, glyoxylic acid and digarboxylic acid metabolism, biosynthesis of aminoacyl-tRNA, amino sugar and nucleotide sugar metabolism, cysteine and methionine metabolism, citrate cycle, pyruvate metabolism, and the mutual conversion of pentose and glucuronate，suggesting their involvement in moxibustion-induced improvement of GU. CONCLUSION: Refined moxibustion at ST21 and ST36 can up-regulate the expression of EGFR and VEGF in the gastric mucosa and lessen gastric mucosal injury, which may be related to its effects in reducing GU-induced metabolic disorders, including sugar, purine, amino acid, and phospholipid metabolism and antioxidant defense system.

[Endogenous metabolites involving effects of moxibustion on injured gastric mucosal tissue in rats with stomach heat or cold syndrome based on nuclear magnetic resonance spectroscopy].

OBJECTIVE: To investigate the profile of metabolites of gastric mucosa involving the effectiveness of moxibustion in the treatment of syndromes of stomach heat (SH) and stomach cold (SC) by 1H-nuclear magnetic resonance (1H-NMR) spectroscopy in rats, so as to reveal its mechanisms underlying improvement of gastric disorders. METHODS: Male SD rats were randomly divided into control, SH-model, SC-model, SH-moxibustion and SC-moxibustion groups (n＝6 rats/group). The SH-model and SC-model were established by gavage of pepper liquid plus ethanol, and ice water plus NaOH, respectively. Moxibustion was applied to bilateral "Zusanli" (ST36) and "Liangmen"(ST21) for 20 min, once daily for 7days. Histopathological changes of the gastric tissue were observed by H．E. staining. Differential metabolites in the gastric mucosal tissue were detected and the relevant metabolic pathways analyzed by using 1H-NMR, pattern recognition method，and online MetPA (http: //www.metaboanalyst.ca). RESULTS: Compared with the control group, the body mass was decreased significantly from the 4th to 14th day after modeling (P<0.05，P<0.01). After the treatment, the body mass was obviously increased from the 10th day on in both SH-EA and SC-EA groups relevant to the SH and SC model group, respectively (P<0.05，P<0.01). H．E. staining showed severe damage of the columnar epithelial structure of the gastric mucosa and inflammatory cell infiltration in the SH group, and inflammatory cell infiltration in the SC model group, which were relatively milder in both moxibustion groups. 1H-NMR analysis displayed a total of 16 potential biomarkers in the injured gastric mucosa of SH syndrome and 14 biomarkers for the SC syndrome after mode-ling, and 13 metabolites related to SH moxibustion and 8 metabolites related to SC moxibustion after moxibustion interventions, respectively. After moxibustion, among the 13 differential metabolites of the SH syndrome, the effectively up-regulated candidates were isoleucine, creatinine, choline and lactate (P<0.05), and the down-regulated ones were choline phosphate, glycine, alanine, urine pyrimidine, tyrosine, phenylalanine, hypoxanthine, adenosine and nicotinamide (P<0.05). Among the 8 metabolites related to the SC syndrome, creatinine, ethanolamine, choline, adenosine and nicotinamide were markedly increased (P<0.05), and glycine, creatine phosphate and tyrosine remarkably decreased in their levels after moxibustion (P<0.05). MetPA showed that moxibustion could regulate 10 metabolic pathways for SH syndrome and 7 metabolic pathways for SC syndrome. Metabolites and metabolic pathways are mainly involved in functions of amino acid metabolism, energy metabolism and inflammatory response. CONCLUSION: The idea of "moxibustion could be used for heat syndrome" has metabolic substance basis, and its efficacy in repairing the injured gastric mucosa involves regulation of amino acid metabolism, energy balance and inflammation response, and moxibustion for SH and SC syndromes has both generality and specificity in regulating metabolic activities.

Lymphocyte subpopulations and interleukin-6 levels in patients with viral pneumonia and their relationship with prognosis / 中国医师杂志

Objective:To explore the relationship between peripheral blood lymphocyte subsets, interleukin-6 (IL-6) levels, and prognosis in patients with viral pneumonia.Methods:A total of 100 patients with viral pneumonia admitted to the Emergency Department of the Chuiyangliu Hospital Affiliated to Tsinghua University from December 2021 to November 2023 were selected and divided into a survival group and a death group. 20 healthy individuals who underwent physical examinations during the same period were selected as the control group. General information of the patients was collected, and peripheral blood lymphocyte subsets and related cytokine IL-6 were detected. Differences in peripheral blood lymphocyte subsets and IL-6 levels among different groups were analyzed, And multiple logistic regression was used to analyze the influencing factors of viral pneumonia disease and death.Results:The proportion of death group with diabetes was significantly higher than that of survival group ( P<0.05). The mortality of patients with diabetes was higher than that of patients without diabetes [60.7%(17/28) vs 12.5%(9/72), P<0.05]. The total number of peripheral blood T lymphocytes, helper/inducible T lymphocytes (Th), CD4 + /CD8 + ratio, B lymphocyte count, and natural killer (NK) cells in patients with viral pneumonia were significantly lower than those in the healthy control group (all P<0.05), and the level of IL-6 was significantly higher than that in the healthy control group ( P<0.05); The total number of peripheral blood T lymphocytes, Th cells, CD4 + /CD8 + ratio, B lymphocyte count, and NK cells in the death group were significantly lower than those in the survival group (all P<0.05), and the level of IL-6 was significantly higher than that in the survival group ( P<0.05). The results of multivariate logistic regression analysis showed that T lymphocyte subsets and IL-6 were all influencing factors for the disease and death of viral pneumonia (all P<0.05). Conclusions:The mortality of viral pneumonia patients with diabetes increased; The absolute number of lymphocyte subsets decreases and the level of IL6 increases in patients with viral pneumonia; The difference in changes between the death group and the survival group is more significant; Early detection of peripheral blood lymphocyte subsets and IL6 levels is beneficial for evaluating the prognosis of patients with viral pneumonia and has certain guiding value for clinical practice.

New path exploration of public hospitals party brand building to promote the deep integration of party and medical services / 现代医院

Objective To explore the path and methods of deeply integrating party building with professional routine work in public hospitals through the creating of party building brands.Methods Taking the establishment of grassroots party brand in a hospital in shanghai as an example,using the brand creation as a starting point,we build a carrier,in order to explore the positive effect of Party building brand's creating on the integration and development of grass-roots Party building and profes-sional routine work in public hospitals.Results Through brand creation,the party building alliance was formed.The core unit was created to play a radiating role of the regional medical center,and a system disease was used as a breakthrough for the inte-gration of party building and professional routine work,where party building pays a great role in promoting business development.Conclusion As a carrier,Party building brand can play a leading role in Party building,deeply integrating Party building of governmental hospitals and medical work,thereby,improving the effectiveness of Party building and promoting high-quality devel-opment of public hospitals under the guidance of Party building.

Feasibility of undergoing day surgery at 3rd week after infection with SARS-CoV-2 in children / 中华麻醉学杂志

Objective:To retrospectively analyze the feasibility of undergoing day surgery at 3rd week after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children.Methods:The clinical data from children who underwent day surgery from November 1, 2022 to February 28, 2023, with operation time ≤1 h, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, regardless of gender, aged≤14 yr, with body mass index of 10-30 kg/m 2, were divided into SARS-CoV-2 group and control group according to whether the children had been infected with the SARS-CoV-2. The main outcome measure was the incidence of respiratory system-related complications within 30 days after surgery. Secondary outcome measures included the rate of unplanned ventilation, delayed discharge and secondary admission within 30 days after surgery. Preoperative creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), hemoglobin (Hb), white blood cell count, C-reactive protein (CRP) level, grade of oropharyngeal mucosa inflammation, operation time, emergence time, intraoperative respiratory depression, laryngeal spasm, hypoxemia, hypotension, incidence of sinus bradycardia and rate of additional rescue drugs were recorded. Results:There were 337 cases in SARS-CoV-2 group and 1 396 cases in control group. Compared with control group, CK-MB concentrations were significantly increased, and the Hb concentration was decreased before surgery in SARS-CoV-2 group ( P<0.05). There were no statistically significant differences in the incidence of respiratory system-related complications, unplanned ventilation, delayed discharge and rate of postoperative secondary admission, preoperative AST and ALT concentrations, white blood cell count, CRP concentrations, grade of oropharyngeal mucosa inflammation, operation time, intraoperative respiratory depression, laryngeal spasm, hypoxemia, hypotension, incidence of sinus bradycardia, rate of additional rescue drugs and emergence time between the two groups ( P>0.05). Conclusions:Feasibility of undergoing day surgery is good at the third week after being infected with the SARS-CoV-2 in children.

Regulation effects of naringin on diesel particulate matter-induced abnormal airway surface liquid secretion.

BACKGROUND: PM2.5 is closely related to the incidence and mortality of respiratory diseases. Diesel particulate matter (DPM) is the main component of particulate air pollution and an important source of PM2.5. HYPOTHESIS/PURPOSE: This study mainly explored the effect of DPM on airway surface liquid (ASL) secretion and the regulation of naringin in this process, to evaluate therapeutic potentials of naringin for the treatment of abnormal secretion of the respiratory tract caused by PM2.5. METHODS: The concentration of lysozyme was measured by Lysozyme Assay Kit. Total protein content was determined by the BCA Protein Assay Kit. The concentration of cAMP and MUC5AC, expressions of CFTR, AQP1, and AQP5 proteins were measured by ELISA. Expressions of CFTR, AQP1 and AQP5 mRNA were determined by qPCR. Amount of CFTR on the cell membrane was determined by immunofluorescence. RESULTS: The in vitro and in vivo studies had indicated that DPM could inhibit ASL secretion and increased the viscosity of the liquid. Naringin had the functions to attenuate DPM-induced injury, reduce liquid viscosity by reducing MUC5AC and total protein secretion, increase DPM-induced CFTR, AQP1, and AQP5 mRNA and protein expression, positively regulate apical CFTR insertion and promote CFTR activation by increasing intracellular cAMP. CONCLUSION: These results demonstrated that naringin had regulating effects on the DPM-induced abnormal secretion of the respiratory tract.

Naringin and Naringenin Relax Rat Tracheal Smooth by Regulating BKCa Activation.

Naringin and its aglycone, naringenin, occur naturally in our regular diet and traditional Chinese medicines. This study aimed to detect an effective therapeutic approach for cough variant asthma (CVA) through evaluating the relaxant effect of these two bioactive herbal monomers as antitussive and antiasthmatic on rat tracheal smooth muscle. The relaxant effect was determined by measuring muscular tension with a mechanical recording system in rat tracheal rings. Cytosolic Ca2+ concentration was measured using a confocal imaging system in primary cultured tracheal smooth muscle cells. In rat tracheal rings, addition of both naringin and naringenin could concentration dependently relax carbachol (CCh)-evoked tonic contraction. This epithelium-independent relaxation could be suppressed by BaCl2, tetraethylammonium, and iberiotoxin (IbTX), but not by glibenclamide. After stimulating primary cultured tracheal smooth muscle cells by CCh or high KCl, the intracellular Ca2+ increase could be inhibited by both naringin and naringenin, respectively. This reaction was also suppressed by IbTX. These results demonstrate that both naringin and naringenin can relax tracheal smooth muscle through opening big conductance Ca2+-activated K+ channel, which mediates plasma membrane hyperpolarization and reduces Ca2+ influx. Our data indicate a potentially effective therapeutic approach of naringin and naringenin for CVA.

Research on Life Cycle Management of Medical Consumables Based on Hospital Resource Planning System / 中国医疗器械杂志

OBJECTIVE@#In order to improve the compatibility of the hospital resource planning (HRP) system for the whole life cycle of medical consumables, and to improve the management and control capabilities of hospital institutions on medical consumables.@*METHODS@#Based on the traditional HRP system, a secondary development and design of a medical consumables whole life-cycle artificial intelligence module was conducted, and a neural network machine learning algorithm module was introduced to enhance its big data integration and analysis capabilities.@*RESULTS@#The simulation analysis found that after adding this module, the proportion of minimum inventory, the proportion of procurement cost difference and the expiration rate of consumables all decreased significantly, and the differences were statistically significant (P<0.05).@*CONCLUSIONS@#The whole life cycle module of medical consumables based on HRP system can effectively improve the management efficiency of hospital medical consumables, adjust the warehouse inventory management ability, and improve the overall management level of medical consumables.

Effect of site of placentation on pregnancy outcomes in patients with placenta previa.

INTRODUCTION: We aimed to evaluate the site of placentation on the pregnancy outcomes of patients with placenta previa. METHODS: This retrospective study included 678 cases of placenta previa. Basic information and pregnancy outcome data were collected. Differences between the different placenta previa positions and pregnancy outcomes were compared using the chi-square and independent t tests. Logistic and multiple regression analyses were used to calculate the odds ratios (ORs) to determine the risk factors for PAS disorders and postpartum hemorrhage and evaluate the effect of placental attachment site on pregnancy outcomes. RESULTS: There was no significant difference between the PAS disorders rate and the incidence of complete placenta previa depending on the type of placentation; however, placental attachment site influenced the pregnancy outcome. Placental attachment to the anterior wall was associated with shorter gestational age, low birth weight, lower Apgar score, higher prenatal bleeding rate, increased postpartum hemorrhage, longer duration of hospitalization, and higher blood transfusion and hysterectomy rates compared to cases with lateral/posterior wall placenta. Placental attachment at the incision site of a previous cesarean section significantly increased the incidence of complete placenta previa and PAS disorders compared with placental attachment at a site without incision, but did not significantly influence pregnancy outcomes. Placental attachment to the anterior wall was an independent risk factor for postpartum hemorrhage in patients with placenta previa. Placental attachment to a previous incision site was an independent risk factor for PAS disorders. CONCLUSION: The site of placental attachment in patients with placenta previa has an important influence on the pregnancy outcome. When the placenta is located on the anterior wall, clinicians should pay attention to the adverse pregnancy outcomes and the possibility of massive postpartum hemorrhage. In cases of placental attachment to the uterine incision site, physicians should be highly vigilant regarding the occurrence of PAS disorders.

Familial glucocorticoid deficiency caused by the NNT gene mutation: a case report and literature review / 中华实用儿科临床杂志

The clinical data, diagnose and treatment of a child with familial glucocorticoid deficiency (FGD) caused by the NNT gene mutation who was treated in the Department of Endocrinology, Children′s Hospital Affiliated to Nanjing Medical University in November 2014 were retrospectively analyzed.The female child with 1 year and 5 months old presented with 6 months of skin pigmentation.Laboratory examinations showed decreased cortisol and increased adrenocorticotropic hormone.During the follow-up period, she developed convulsions and precocious puberty.Whole exome sequencing revealed that the patient carried a homozygous mutation c. 1054G > A (p.G352R) in exon 8 of the NNT gene, which was a newly reported gene mutation.Domestic cases of FGD caused by the NNT gene mutation has never been reported yet.Through literature review of a total of 40 reported children with FGD caused by the NNT gene mutation, typical manifestations included skin pigmentation, hypoglycemia and seizures, alongside mineralocorticoid deficiency, precious puberty, abnormal male gonadal development, thyroid diseases and heart diseases.

Diagnostic value of soluble interleukin 7 receptor in combination with other biomarkers for emergency sepsis / 中国医师杂志

Objective:To investigate the diagnostic value of soluble interleukin 7 receptors (sIL-7R) in combination with other biomarkers for emergency sepsis.Methods:A prospective study method was used to select 102 emergency patients from the Chuiyangliu Hospital affiliated to Tsinghua University and Baoding First Central Hospital from December 2020 to June 2022. They were divided into sepsis group (80 cases) and non-sepsis group (22 cases), and 20 healthy people in the same period were selected as the control group. The patient data were collected, the relevant biomarker examination was improved and the values were recorded. Using statistical methods, the significance of sIL-7R for the diagnosis of sepsis was assessed, and important indicators related to the presence of sepsis were also screened to construct a model for the early diagnosis of sepsis.Results:The levels of interleukin-6 (IL-6), C-reactive protein (CRP), age and sIL-7R in sepsis group were significantly higher than those in non-sepsis group and control group (all P<0.01). Further, the sIL-7R, age, CRP, and IL-6 were selected as important diagnostic indicators of sepsis by comparing the sepsis and non-sepsis groups using R-language statistical software. Receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) for diagnosing sepsis of the four indexes were calculated as 0.759, 0.622, 0.716 and 0.640, respectively. The diagnostic model based on the four indexes performed better than other indexes, and the AUC value reached 0.869. The AUC of sIL-7R in the diagnosis of sepsis was higher than that of the other three indexes, and the detection of SIL-7R in combination with other inflammatory indexes was significantly higher than that of the four indexes, which had obvious advantages for the early diagnosis of sepsis. Conclusions:sIL-7R is a good biological marker for the early diagnosis of sepsis, and its combination with age, CRP, and IL-6 can better improve the early diagnosis of sepsis.

Clinical diagnosis and prognosis analysis in patients with emergency septic encephalopathy / 中国医师杂志

Objective:To investigate the clinical diagnosis and prognosis in patients with emergency septic encephalopathy.Methods:Case data of 131 patients with septic encephalopathy admitted to the emergency department of Chuiyangliu Hospital Affiliated to Tsinghua University from January 2020 to December 2021 were selected and divided into survival group and death group. Logistic regression was used to analyze the risk factors affecting diagnosis, treatment and prognosis in patients with septic encephalopathy. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of each indicator in patients with septic encephalopathy.Results:The mean arterial pressure (MAP) and pH level in the death group were lower than those in the survival group, while the C reactive protein (CRP), troponin T (TNI), D-dimer, lactic acid, creatinine, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Sequential Organ Failure Assessment (SOFA), proportion of ventilator support, proportion of vasoactive drug use in the death group were higher than those in the survival group, with statistically significant difference (all P<0.05). Multivariate logistic regression analysis showed that APACHEⅡ score ( OR=1.290, 95% CI: 1.121-1.485, P<0.001), SOFA score ( OR=1.447, 95% CI: 1.183-1.796, P<0.001), the proportion of vasoactive drug use ( OR=18.720, 95% CI: 4.486-78.108, P<0.001) could predict the prognosis of patients with septic encephalopathy, and the area under the curve (AUC) was 0.823, 0886, 0.787. Conclusions:Elderly age and underlying brain diseases are important factors in the occurrence of septic encephalopathy. APACHE Ⅱ score, SOFA score, and the proportion of vasoactive drug use can predict the prognosis of patients with septic encephalopathy.

Analysis on the refined management of drugs from the perspective of value chain in a hospital / 中国药房

In recent years， in order to meet the needs of high-quality development， more and more hospitals have begun to carry out refined drug management. Based on the theory of value chain management， this study analyzed and practiced the refined drug management. First of all， the value chain model of drug management was constructed to clarify the drug management process and classification. Secondly， the current situation and demand of drug management were analyzed to clarify the management needs of procurement， logistics， inventory， distribution and use in the management process. Then， based on the value chain theory， the basic activities and auxiliary activities of drug management were reconstructed and optimized. The performance evaluation suggested that refined drug management based on the value chain theory could improve the efficiency of drug management， provide better services for patients， and help the hospital develop with high quality.

Knockdown of ACC1 promotes migration of esophageal cancer cell / 中华肿瘤杂志

Objective: To investigate the effect of acetyl-CoA carboxylase 1 (ACC1) knockdown on the migration of esophageal squamous cell carcinoma (ESCC) KYSE-450 cell and underlying mechanism. Methods: Lentiviral transfection was conducted to establish sh-NC control cell and ACC1 knocking down cell (sh-ACC1). Human siRNA HSP27 and control were transfected by Lipo2000 to get si-HSP27 and si-NC. The selective acetyltransferase P300/CBP inhibitor C646 was used to inhibit histone acetylation and DMSO was used as vehicle control. Transwell assay was performed to detect cell migration. The expression of HSP27 mRNA was examined by reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) and the expressions of ACC1, H3K9ac, HSP27 and epithelial-mesenchymal transition-related proteins E-cadherin and Vimentin were detected by western blot. Results: The expression level of ACC1 in sh-NC group was higher than that in sh-ACC1 group (P<0.01). The number of cell migration in sh-NC group was (159.00±24.38), lower than (361.80±26.81) in sh-ACC1 group (P<0.01). The protein expression levels of E-cadherin and Vimentin in sh-NC group were statistically significant compared with sh-AAC1 group (P<0.05). The migrated cell number in sh-NC+ si-NC group was (189.20±16.02), lower than (371.60±38.40) in sh-ACC1+ si-NC group (P<0.01). The migrated cell number in sh-NC+ si-NC group was higher than that in sh-NC+ si-HSP27 group (152.40±24.30, P<0.01), and the migrated cell number in sh-ACC1+ si-NC group was higher than that in sh-ACC1+ si-HSP27 group (P<0.01). The protein expression levels of E-cadherin and Vimentin in sh-NC+ si-NC group were significantly different from those in sh-ACC1+ si-NC and sh-NC+ si-HSP27 groups (P<0.01). The protein expression levels of E-cadherin and Vimentin in sh-ACC1+ si-NC group were significantly different from those in sh-ACC1+ si-HSP27 group (P<0.01). After 24 h treatment with C646 at 20 μmmo/L, the migrated cell number in sh-NC+ DMSO group was (190.80±11.95), lower than (395.80±17.10) in sh-ACC1+ DMSO group (P<0.01). The migrated cell number in sh-NC+ DMSO group was lower than that in sh-NC+ C646 group (256.20±23.32, P<0.01). The migrated cell number in sh-ACC1+ DMSO group was higher than that in sh-ACC1+ C646 group (87.80±11.23, P<0.01). The protein expressions of H3K9ac, HSP27, E-cadherin and Vimentin in sh-NC+ DMSO group were significantly different from those in sh-ACC1+ DMSO group and sh-NC+ C646 group (P<0.01). The protein expression levels of H3K9ac, HSP27, E-cadherin and Vimentin in sh-ACC1+ DMSO group were significantly different from those in sh-ACC1+ C646 group (P<0.01). Conclusion: Knockdown of ACC1 promotes the migration of KYSE-450 cell by up-regulating HSP27 and increasing histone acetylation.

Mechanical effects of needle texture on acupoint tissue / 中西医结合学报

OBJECTIVE@#This study aims to clarify how the stimulation of acupuncture points is achieved by needles with different surface texture during acupuncture; it also seeks to lessen injury at the insertion site and increase the therapeutic efficacy of acupuncture, by simulating the mechanical effects of various needle surface patterns on Zusanli (ST36) without changing the radius of acupuncture needles.@*METHODS@#Five acupuncture needle models with different surface patterns, including the smooth needle, the lined needle, the ringed needle, the left-hand threaded needle and the right-hand threaded needle, and a layered model of the Zusanli acupoint were used to investigate how to reduce tissue damage and increase stimulation during acupuncture treatment. Puncturing of the skin as well as lifting-inserting and twisting needle manipulations were simulated using these models, and the degree of damage and force of stimulation caused by the acupuncture needles with different surface patterns during acupuncture were compared.@*RESULTS@#The smooth needle and the lined needle caused the least tissue damage during insertion, while the left-hand threaded and the right-hand threaded needles caused the most damage. The ringed needle, the left-hand threaded needle and the right-hand threaded needle stimulated the acupoint tissue more during lifting-inserting manipulations, while the lined needle and the smooth needle produced less stimulation. The stimulation of the lined needle on the acupoint tissue was the largest during twisting manipulation, whereas the left-hand threaded needle and the right-hand threaded needle had smaller effects. In lifting-inserting and twisting manipulations, both the left-hand threaded needle and right-hand threaded needle provided more stimulation, but the torsion direction in which they produced better stimulation was the opposite.@*CONCLUSION@#According to the simulation results, the ringed pattern enhances stimulation best in the lifting-inserting manipulation, whereas the lined pattern enhances stimulation best in the twisting manipulation. Both the right-hand and left-hand thread patterns have certain enhancing effects in these two operations. Taking the geometric properties of the pattern into account, the left-hand thread pattern and the right-hand thread pattern have the geometric characteristics of both the lined pattern and the ringed pattern. To conclude, a pattern perpendicular to the movement direction during the acupuncture manipulation creates more stimulation. These results have significance for future needle design. Please cite this article as: Sun MZ, Wang X, Li YC, Yao W, Gu W. Mechanical effects of needle texture on acupoint tissue. J Integr Med. 2023; 21(3): 254-267.

Effect of proximal fibula osteotomy on tension of lateral knee soft tissue in patients with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To evaluate the short-term efficacy of proximal fibula osteotomy in the treatment of knee osteoarthritis, and to analyze the effect of osteotomy on the tension of the lateral knee soft tissue of patients and verify the reliability of the Arch string theory.@*METHODS@#A total of 71 patients with varus knee osteoarthritis from December 2019 to March 2022 were included, 3 patients dropped out, and 68 patients completed all trials, collected 27 males and 41 females, aged from 51 to 79 years old, with an average of (68.0±7.0 ) years old. The follow-up time ranged from 4 to 12 weeks, with an average of (3.76±1.94) weeks. After admission, the patient underwent Proximal fibula osteotomy, and the tension of lateral knee soft tissue, visual analogue scale (VAS) of pain, the western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and other indicators were recorded before surgery and 1 month after surgery in the weight-bearing state.@*RESULTS@#According to the VAS, the curative effect of a single index was evaluated by referring to the score before and after treatment by Bao Zongzhao. Thirty seven cases were markedly effective, 27 cases were effective, and 4 cases were ineffective. After surgery, 3 patients presented with weakness of dorsalis pedis extension and 1 presented with paresthesia of dorsalis pedis, which disappeared after symptomatic treatment . The VAS and WOMAC score at 1 month after operation were lower than those before operation, and the differences were statistically significant(P<0.001). The tension of lateral knee soft tissue 1 month after operation was lower than that before operation, and the difference had statistical significance(P<0.001).@*CONCLUSION@#Proximal fibula osteotomy is safe and effective in the treatment of varus knee osteoarthritis in the short term. One month after osteotomy, the tension of lateral knee soft tissue increases under weight-bearing state, but the long-term changes still need further observation and follow-up.