Rheumatoid arthritis and mitochondrial homeostasis: The crossroads of metabolism and immunity.

Rheumatoid arthritis is an autoimmune disease characterized by chronic symmetric synovial inflammation and erosive bone destruction. Mitochondria are the main site of cellular energy supply and play a key role in the process of energy metabolism. They possess certain self-regulatory and repair capabilities. Mitochondria maintain relative stability in number, morphology, and spatial structure through biological processes, such as biogenesis, fission, fusion, and autophagy, which are collectively called mitochondrial homeostasis. An imbalance in the mitochondrial homeostatic environment will affect immune cell energy metabolism, synovial cell proliferation, apoptosis, and inflammatory signaling. These biological processes are involved in the onset and development of rheumatoid arthritis. In this review, we found that in rheumatoid arthritis, abnormal mitochondrial homeostasis can mediate various immune cell metabolic disorders, and the reprogramming of immune cell metabolism is closely related to their inflammatory activation. In turn, mitochondrial damage and homeostatic imbalance can lead to mtDNA leakage and increased mtROS production. mtDNA and mtROS are active substances mediating multiple inflammatory pathways. Several rheumatoid arthritis therapeutic agents regulate mitochondrial homeostasis and repair mitochondrial damage. Therefore, modulation of mitochondrial homeostasis would be one of the most attractive targets for the treatment of rheumatoid arthritis.

Effective Component Screening in Antioxidant Active Fraction of Pueraria lobata by Fingerprint Combined with Chemometrics / 中国药房

OBJECTIVE：To screen the effective compo nent in antioxi dant active fraction of Pueraria lobata . METHODS ：The antioxidant active fraction sample （S1-S20） of 20 batches of P. lobata were prepared. HPLC method was adopted. The determination was performed on SepaxBio-C 18 column with mobile phase consisted of methanol-water （gradient elution ）at the flow rate of 0.6 mL/min. The column temperature was set at 25 ℃，and detection wavelength was set at 250 nm. HPLC fingerprints of 20 batches of P. lobata were established by the Similarity Evaluation System of TCM Chromatographic Fingerprints （2012 edition），and common peaks were identified. Cluster analysis ，principal component analysis （PCA）and orthogonal partial least squares discriminant analysis （OPLS-DA）were used to screen the effective components in antioxidant active fraction of P. lobata . RESULTS：There were 18 common peaks in HPLC fingerprints of 20 batches of antioxidant active fraction in P. lobata ，and the similarity was more than 0.99. Eight common peaks were identified ，which were 3′-hydroxypuerarin（peak 2），puerarin（peak 3）， 3′-methoxypuerarin（peak 4），daidzein（peak 5），genistein（peak 7），formononetin（peak 11），daidzein（peak 13）and genistein （peak 16）. The results of cluster analysis and PCA analysis showed that samples S 1，S3，S4，S6，S8，S18 and S 19 were clustered into one category ，and samples S 2，S5，S7，S9-S17 and S 20 were clustered into one category ；peak 2，peak 3，peak 10，peak 11 and peak 13 had great influence on principal component 1；peak 8 and peak 9 had great influence on principal component 2. OPLS-DA analysis showed that peak 4，peak 3，peak 2，peak 16，peak 13 and peak 11 had great influence on the quality of antioxidant active fraction of P. lobata . CONCLUSIONS ： HPLC fingerprint for active fraction of P. lobata is established in the study and 8 components are identified ；among them ， com puerarin，3′-hydroxypuerarin，daidzein and formononetin maybe the material basis of antioxidant fraction of P. lobata .

Chinese consensus on surgical treatment of traumatic rib fractures (2021) / 中华创伤杂志

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Comparison of gastrointestinal adverse events with different doses of metformin in the treatment of elderly people with type 2 diabetes.

WHAT IS KNOWN AND OBJECTIVE: Gastrointestinal discomfort is the most common adverse event of metformin treatment for type 2 diabetes, especially in elderly patients. The aim of this study was to compare gastrointestinal adverse events resulting from different doses of metformin used for the treatment of elderly people with type 2 diabetes. METHODS: A total of 361 elderly patients with newly diagnosed diabetes were randomly divided into three groups: metformin 1000 mg/d (N = 120), metformin 1500 mg/d (N = 121) and metformin 2000 mg/d (N = 120). Glycaemic control and gastrointestinal adverse events (abdominal pain, diarrhoea, nausea, vomiting, bloating and anorexia) were assessed and compared among the three groups after 12 weeks of treatment. RESULTS AND DISCUSSION: At baseline, there was no significant difference in gastrointestinal symptoms among the three groups. After 12 weeks of treatment with metformin, the change in HbA1c level was -0.7%, -0.9% and -1.0% for the 1000 mg/d, 1500 mg/d and 2000 mg/d groups, respectively (P < .0001). There was no significant difference in gastrointestinal adverse events among the three groups after treatment with metformin. In total, 62 people (17.2%) could not tolerate the adverse effects of metformin, and most of them stopped treatment in the first 4 weeks. Logistic regression analysis shows that female sex (OR = 2.660, 95%CI 1.692-4.183, P < .0001) and the concurrent use of organic cation transporter 1-inhibiting drugs (OR = 1.874, 95%CI 1.076-3.265, P = .027) are independent risk factors for adverse events. WHAT IS NEW AND CONCLUSIONS: Our data demonstrate that metformin doses of 1000 mg/d-2000 mg/d have similar adverse events but that 2000 mg/d of metformin yields the best glycaemic control in elderly people with diabetes. If elderly people can tolerate 1000 mg/d of metformin, we could gradually increase the dose to 2000 mg/d to achieve better glycaemic control.

Effect of Hypoxia on the Muscle Fiber Switching Signal Pathways CnA/NFATc1 and Myostatin in Mouse Myocytes.

This study investigated the effects of a CoCl2-simulated hypoxic environment on the muscle fiber switching signaling pathways calcineurin A/nuclear factor of activated T cells cytoplasmic 1 (CnA/NFATc1) and myostatin. In this study, C2C12 muscle cells were cultured in vitro under CoCl2-simulated chemical hypoxic conditions, the expression levels of CnA and myostatin were detected through qRT-PCR and Western blot analyses, and a positioning study of NFATc1 was carried out by immunofluorescence labeling. Results showed that CoCl2 treatment significantly increased the expression levels of CnA and myostatin. Moreover, the position of NFATc1 expression changed; actually, its expression in the nucleus considerably increased. Furthermore, CoCl2-induced hypoxia inhibited the differentiation of C2C12 cells and reduced the expression levels of many slow- and fast-twitch muscles marker genes, but immunofluorescence staining results showed that the proportion of MyHC I type muscle fiber increased after CoCl2 treatment. The hypoxic environment simulated by CoCl2 can activate the signaling pathways CnA/NFATc1 and myostatin and increases the proportion of MyHC I type muscle fibers.

Effects of Neck Restrain on Traumatic Brain Injury of Child Occupant During Airbag Inflation / 医用生物力学

Objective To study the effect of neck restrain on traumatic brain injury during airbag inflation in traffic accidents. Methods Based on the previously validated 3-year-old child head finite element (FE) model, the impact on out-of-position (OOP) child occupant during airbag inflation was simulated by FE method, so as to investigate the effects of neck restraint on intracranial response and injury mechanism in traffic accidents. Results The head kinematics with neck restrain was different from that without neck restrain under the impact of airbag inflation. The neck restraint would obviously decrease the maximum Von Mises stress of pediatric brain. When airbag-head distance was 20 cm or 25 cm, the neck restraint would obviously decrease the maximum intracranial pressure. Conclusions Neck restraint had a relatively large influence on pediatric intracranial response. When the FE method is used to predict pediatric craniocerebral injury, consideration of neck restrain on child brain response is necessary.

Association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes / 中华全科医师杂志

Objective To investigate the association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes mellitus (T2DM).Methods Three hundred and ninety-six T2DM patients aged 60-80 years were recruited from Department of Endocrinology,Huadong Hospital from January 2014 to January 2017.All cases used oral hypoglycemic drug more than 3 months,their glycosylated hemoglobin (HbA1c) was lower than 8.5％ and underwent continuous glucose monitoring for 72 h.The Pittsburgh sleep quality index (PSQI) scale was applied to evaluate sleep quality,and the PSQI＞7 was defined as the sleep disorder.There was dawn phenomenon in 165 cases (group Ⅰ) and no dawn phenomenon in 231 cases(group Ⅱ).The clinical data,blood glucose related indicators,homeostasis model assessment of insulin resistance (HOMA-IR) and PSQI scores were compared between two groups.The correlation between dawn phenomenon and sleep disorder was analyzed with Logistic regression.Results There were no significant differences in age,BMI,blood lipids,liver and kidney function,hypersensitive CRP(hCRP),serum cystatin and serum cortisol between the two groups (all P＞0.05).Patients in group Ⅰ presented a higher ratio of urinary protein/creatinine [1.3 (0.7,5.4) mg/mmol vs.1.1 (0.5,3.4) mg/mmol,t=-2.105,P=0.04],PSQI scores [(7.3±3.3) vs.(5.4±2.7),t=3.587,P＜0.01] and the incidence of sleep disorders [57.0％ (94/165) vs.25.1％ (58/231),x2=3.765,P＜0.01] than those in group Ⅱ.The HbA1c [(7.4±0.9)％ vs.(7.0±1.0)％,t=3.384,P＜0.01] and fasting glucose [(8.3±1.6) mmol/L vs.(7.0± 1.4) mmol/L,t=8.778,P＜0.01] were significantly higher in group Ⅰ than those in group Ⅱ;while the fasting insulin [(8.2±7.2) mU/L vs.(10.3±10.2) mU/L,t=-2.286,P=0.02] and nocturnal nadir [(5.7± 1.3) mmol/L vs.(6.6± 1.4) mmol/L,t =-6.331,P＜0.01] were lower than those in group Ⅱ.Pearson correlation analysis showed that dawn phenomenon was positively correlated with sleep disorders (r=0.323,P＜0.01).Logistic regression analysis showed that sleep disorders were associated with increased risk of dawn phenomenon (OR=4.143,95％CI:1.69-10.16,P＜0.0 1).Conclusion Sleep disorders may play a relevant pathological role in the occurrence of dawn phenomenon in elderly T2DM patients.

Transferring fascicles of obturator nerve restoring vesical branch of pelvic nerve to treat the micturition function of patients caused by sacral plexus injury / 中华骨科杂志

Objective To explore the feasibility of transferring of the obturator nerve onto the vesical branch of pelvic nerve with direct anastomosis,in order to restore the automatic micturition function of patients with bilateral lower sacral plexus injury (S2-S4).Methods Data of five patients (4 males and 1 female) with bilateral lower sacral plexus injury who had surgery from May to July 2018 were retrospectively analyzed.The average age was 26 years old (range,23-30 years old) and the average delay from injury to operation was 10.2 months (range,7-14 months).Three patients suffered with fell off injury and two patients had car accident injury.All patients presented with continence and the urodynamics revealed flaccid neuropathic bladder with neurogenic adynamia of detrusor muscle.The vesical branch of pelvic nerve was dissected between the bladder and the ureter where it entered the bladder neck from backward to forward almost vertically.The obturator nerve was dissected along the pelvic sidewall,and the comparable bundle branch of obturator nerve was transferred onto the vesical branch of pelvic nerve with direct anastomosis.The diameter and freed length of pelvic nerve and the fascicles of the obturator nerve were measured intraoperatively,and the cutaneous sensation of medial thigh and the muscle strength of hip adduction were evaluated postoperatively.Results The surgery was performed through the traditional abdominal paramedian approach in 3 patients and through the pararectus approach in 2 patients.The vesical branch of pelvic nerve in all five patients could be revealed clearly and there was enough operative space for nerve transferring.The surgery was successful in all five patients without any complication.The donor nerves were anterior branch of obturator nerve in 2 patients,posterior branch of obturator nerve in 1 patient,2/3 fascicles of anterior branch of obturator nerve in 1 patient and 2/3 fascicles of posterior branch of obturator nerve in 1 patient.The average length and diameter of freed fascicles of obturator nerve were 2.28 cm (range,1.9-2.6 cm) and 1.36 mm (range,1.2-1.5 mm).The average length and diameter of pelvic nerve were 2.46 cm (range,2.2-2.7 cm) and 1.2 mm (range,1.1-1.3 mm).The vesical branch of pelvic nerve and the bundle branch of the obturator never were comparable and anastomosed free of tension.The sensation of medial aspect of thigh was almost normal and the muscle strength of hip adduction was M4 postoperatively.Conclusion The vesical branch of pelvic nerve can be well exposed via pararectus approach.Transferring of the fascicles of obturator nerve onto the vesical branch of pelvic nerve is feasible and safe.

Clinical analysis of empyema in 49 children / 临床儿科杂志

Objective To explore the diagnosis and treatment of empyema in children. Method The clinical data of empyema in 49 children were reviewed and analyzed. Results In the 49 cases (25 males and 24 females) aged 4.7±3.4 years, the common symptoms were fever, shortness of breath and coughing. There were 11 cases of positive blood culture, 17 cases of positive pleural fluid culture, 3 cases of positive blood and pleural fluid culture. Streptococcus pneumoniae was the most common pathogenic bacteria. All 49 patients were given systemic antibiotics and closed thoracic drainage. In addition, 26 cases were treated with urokinase and intrapleural fibrinolytic therapy and 6 cases were treated surgically. The prognosis was good and there was no death. Conclusion Pneumococcal infection is most common in children with empyema. Systemic antibiotics plus closed thoracic drainage and urokinase are effective, and some require surgical treatment.

Treating vascular cognitive impairment using hyperbaric oxygen combined with repeated transcranial magnetic stimulation / 中华物理医学与康复杂志

Objective To observe the clinical effect of combining hyperbaric oxygen (HBO) with repeated transcranial magnetic stimulation (rTMS) in the treatment of vascular cognitive impairment (VCI).Methods A total of 56 hospitalized VCI patients were randomly divided into an HBO+rTMS group (n =25) and an rTMS group (n =27).The patients of both groups were given routine medication,rehabilitation and rTMS treatment,while the HBO+rTMS group was additionally provided with HBO.The mini mental state examination (MMSE),the Montreal cognitive assessment (MoCA),the Lo Winston occupational therapy cognitive assessment (LOTCA) and the modified Barthel index (MBI) were used to evaluate the cognitive function of both groups before and after 4 weeks of treatment.Results Before the treatment there were no significant differences between the two groups in any of the average measurements.After the treatment,significant improvement was observed in the average MMSE and MBI scores in both groups,with significantly greater improvement in the HBO+rTMS group.After the treatment,all the average subscores except that of naming and the total MMSE score of the rTMS group had improved significantly,together with all the average sub-scores and total scores of the HBO+rTMS group.After the treatment the average visual space and execution,abstraction,delayed recall,orientation and the total MoCA score of the HBO+rTMS group were all significantly higher than those of the control group.Conclusion HBO combined with rTMS can improve cognitive function and the life quality of VCI patients.

Comparative Stndy on Concentration Determination of Valproic Acid in Human Serum by LC-MS/MS and EMIT / 中国药房

OBJECTIVE:To compare the difference in the concentration determination of valproie acid (VPA) in human serum by LC-MS/MS and EMIT.METHODS:Both LC-MS/MS and EMIT methods were applied to determine the serum concentration of VPA in 144 inpatients or outpatients.The paired t-test,Pearson correlation analysis,Bland-Altman deviation chart and other methods were used to evaluate the difference in the results of concentration determination.RESULTS:The results of LC-MS/MS method was pos itively correlated with that of EMIT method (r=0.924,P＜0.05);the regression equation of them was cEMIT=0.920 7cLC.MS/MS-1.114 4 (r=0.924).Average serum concentrations of VPA determined by LC-MS/MS and EMIT were (49.9 ± 21.2) and (54.9 ± 21.3) μg/mL,with statistical significance (P＜0.05).The serum concentration of VPA determined by EMIT was higher than that by LC-MS/MS 8.3 μg/mL,95％ confidence interval was (-13.6,18.7).CONCLUSIONS:The serum concentration of VPA determined by LC-MS/MS and EMIT have high correlation.But the determination results still have certain difference,it is suggested to use same method for long term monitering.

Systematic review and meta-analysis of epidemiological investigation of Helicobacter pylori infection in children and adolescents in China / 临床儿科杂志

more likely to have H.pylori infection than those without digestive symptoms.Conclusions The total infection rate of H.pylori in Chinese children and adolescents is 29% and there is significant difference in geographical distribution. The infection rate of H.pylori in the higher incidence area of gastric cancer is 2.8 times higher than that in the low incidence area of gastric cancer. However,high quality epidemiological investigation with large sample size is needed,in order to further clarify the details of H.pylori infection in children and adolescents in China.

Systematic review and meta-analysis of epidemiological investigation of Helicobacter pylori infection in children and adolescents in China / 临床儿科杂志

more likely to have H.pylori infection than those without digestive symptoms.Conclusions The total infection rate of H.pylori in Chinese children and adolescents is 29% and there is significant difference in geographical distribution. The infection rate of H.pylori in the higher incidence area of gastric cancer is 2.8 times higher than that in the low incidence area of gastric cancer. However,high quality epidemiological investigation with large sample size is needed,in order to further clarify the details of H.pylori infection in children and adolescents in China.

Comprehensive evaluation on disease burden of injury and improvement of the related evidence system on injury prevention / 中华流行病学杂志

With rapid social and economic development in this country,injury has become one of the three major health issues with public concern.To reduce the burden of diseases as disability and medical treatment that caused by injury also became important in public health.Programs related to comprehensive evaluation on disease burden caused by injury and evidence-based strategies on injury-related prevention became substantially important.Our article-“The Disease Burden caused by Injury”,we involved a series of papers based on the systematic databases which focusing on the current status and the change of types of injuries in the Chinese population.Hopefully,it could provide key clues for the development of injury prevention and control programs in the future.

Comprehensive evaluation on disease burden of injury and improvement of the related evidence system on injury prevention / 中华流行病学杂志

With rapid social and economic development in this country,injury has become one of the three major health issues with public concern.To reduce the burden of diseases as disability and medical treatment that caused by injury also became important in public health.Programs related to comprehensive evaluation on disease burden caused by injury and evidence-based strategies on injury-related prevention became substantially important.Our article-“The Disease Burden caused by Injury”,we involved a series of papers based on the systematic databases which focusing on the current status and the change of types of injuries in the Chinese population.Hopefully,it could provide key clues for the development of injury prevention and control programs in the future.

Clinical experience of ECMO cannulation and vein intubation / 局解手术学杂志

Objective To analyze and summarize the skills and complications of extracorporeal membrane oxygenation( ECMO) cannu-lation and vein intubation. Methods The clinical data of 21 patients of V-A or V-V ECMO in our hospital from January 2009 to July 2014 were analyzed retrospectively. And the techniques of different catheter sites were summarized. Results Three cases were successfully insert-ed catheter by jugular vein puncture with one time. Four patients with ascending aorta intubation died from uncontrolled severe hemorrhage. Eight peripheral catheter site had a small amount of bleeding,with no more bleeding after pressurized bandage. There were no complications like bleeding, hematoma, hemothorax and pneumothorax in the period of ECMO. Conclusion In the process of the ECMO catheter, the standardized operation could reduce the incidence of serious complicaions including bleeding.

Simultaneous Determination of Clopidogrel and Its Metabolites in Human Plasma by UPLC-MS/MS / 中国药房

OBJECTIVE:To establish the method for the simultaneous determination of clopidogrel (CLO) and its active metabolites (CATM) and inactive metabolites (CCAM),and to conduct pharmacokinetic study. METHODS:The plasma sam-ple had been derivatized by 2-bromine-3′-methoxy acetophenone(MPB),and was precipitated by acetonitrile. Using carbam-azepine as internal standard,UPLC-MS/MS was adopted. The separation was performed on Waters ACQUITY UPLC HSS T3 column with mobile phase consisted of water(containing 0.1% formic acid)-acetonitrile(containing 0.1% formic acid)using a gradient elution program at the flow rate of 0.50 ml/min. The ESI was equipped and quantitative analysis was operated in posi-tive ion and MRM mode. The mass transition ion-pairs were followed as m/z 322.1→211.8(CLO),m/z 504.1→155.0(the alkyl-ation derivatives of CATM,CATMD),m/z 308.3→198.0(CCAM),m/z 273.2→194.3(internal standard). RESULTS:The lin-ear calibration curves for CLO,CATMD and CCAM were obtained in the concentration range of 0.03-20.00 ng/ml,0.30-200.00 ng/ml and 10.00-10 000.00 ng/ml in plasma,respectively;intra-day and inter-day RSD for them were all less than 15%,and relative error(RE)ranged from -3.5% to 5.7%. Main pharmacokinetic parameters of CLO,CATMD and CCAM in 5 healthy volunteers after oral administration of CLO 300 mg were as follows:cmax were(7.89±5.46),(15.58±8.08),(8 023.33± 1 047.39)ng/ml;tmax were(1.25 ± 0.43),(1.25 ± 0.43),(1.67 ± 0.29)h;t1/2 were (2.31 ± 0.61),(0.64 ± 0.08),(6.53 ± 2.55)h;AUC0-t were(17.19±14.59),(21.39±9.58),(30 648.85±8 026.63)ng·h/ml. CONCLUSIONS:The established method is sensi-tive,rapid and convenient,which is suitable for pharmacokinetic study and plasma concentration determination of CLO and its metabolites.

Automation of hyperbaric oxygen chamber / 医疗卫生装备

The structure of the hyperbaric oxygen chamber was introduced, and the application of automatic control system to the chamber was discussed from the aspects of the function and information system. The automatic control system can be used for monitoring and control of equipment condition, operation flow and performance data during hyperbaric oxygen therapy, which enhances the efficiency and safety of hyperbaric oxygen chamber.

Ampullary tumor caused by metastatic renal cell carcinoma and literature review.

We present a case of a 50-year-old man with a metastasis to the ampulla of vater that led to the discovery of renal cell carcinomas.The man was referred to us because of jaundice.Computed tomography (CT) scan of the abdomen showed irregular masses in the right kidney. Magnetic resonance imaging (MRI) revealed dilatation of the bile duct. The patient underwent right nephrectomy and pancreatoduodenectomy. Postoperative histopathologic examination revealed clear cell carcinoma in both the renal and ampullary lesions. After a 5-year follow-up ,the patient was alive with no evidence of recurrent disease.

Effects of Extracorporeal Shock Wave Therapy Combined with Hyperbaric Oxygen on Nonunion of Long Bone Fractures / 中国康复理论与实践

@#Objective To explore the effect of extracorporeal shock wave therapy (ESWT) combined with hyperbaric oxygen on nonunion after surgery. Methods 83 patients with nonunion were treated with ESWT combined with hyperbaric oxygen (treatment group), and 32 cases served as control group. ESWT application was conducted using a protocol totaling 3000 shocks per treatment. The treatment group received 3~5 times of treatment, at the same time hyperbaric oxygen therapy was performed. The control group received no treatment and was followed up at least 3 months after treatment. Results The overall success rate was 78.31% in the treatment group, while only 12.50% recovered in the control group (P<0.01). The complications of treatment group were less and negligible. Conclusion Treatment of nonunion by extracorporeal shock wave combined with hyperbaric oxygen is safe and effective.