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By organizing and studying on the original works of LI Wenrong, this paper aimed to explore his theories and methods for treating liver diseases. LI Wenrong believes that the liver is easily prone to physiological disturbances, difficult to pacify, and can be compared to a “chariot” that moves horizontally and vertically, acting as a “general” for both civil and military affairs. Pathologically, liver diseases tend to spread to other organs, resulting in ever-changing pathological changes, often affecting emotional health. In terms of therapeutic methods, LI Wenrong proposes ten methods including draining fire to calm the liver, nourishing water to moisten wood, clearing metal to calm the liver, calming gallbladder and harmonizing liver, subduing yang with shell-drug, treating liver diseases by supplementing spleen, soothing the liver with sweetness, astringing the liver with sourness, relieving the liver with spiciness, and draining the liver with excess-fire. These methods have great guidance and reference value for contemporary clinical practice in traditional Chinese medicine.
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Repulsive guidance molecule a (RGMa) is a glycosylphosphatidylinositol-anchored glycoprotein that has been demonstrated to influence neuroinflammatory-related diseases in addition to regulating neuronal differentiation and survival during brain development. However, any function or mechanism of RGMa in the polarization of microglia after ischemic stroke remains unclear. In the current study, RGMa was found to be expressed at reduced levels in microglia after oxygen-glucose deprivation-reoxygenation (OGD/R) in vitro. RGMa overexpression induced HAPI microglia to predominantly polarize to the M1 phenotype, promoting the release of proinflammatory cytokines and knockdown induced the M2 phenotype, promoting the release of anti-inflammatory cytokines. RGMa overexpression also regulated the polarization of HAPI microglia by inhibiting the transportation of peroxisome proliferator-activated receptor γ (PPARγ) from the nucleus to cytoplasm. The opposite effect resulted from RGMa-knockdown and was reversed by the PPARγ antagonist, GW9662. In addition, RGMa-knockdown HAPI microglial conditioned medium improved the survival of oligodendrocytes after OGD/R in vitro. Thus, inhibition of RGMa may constitute a therapeutic strategy for reducing neuroinflammation after ischemic stroke.
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ObjectiveTo evaluate the efficacy and influencing factors of Biejiajianwan in the treatment of primary liver cancer based on real-world data of traditional Chinese medicine (TCM). MethodClinical diagnosis and treatment data of patients with primary liver cancer admitted to five Grade-A tertiary hospitals in Henan Province from January 2015 to December 2020 were collected from the medical electronic database. The patients treated with Biejiajianwan for ≥30 days were assigned to the exposure group and those without treatment with Biejiajianwan or treated with Biejiajianwan for <30 days to the non-exposure group. The propensity score matching model was used to balance confounding factors between the two groups according to the 1∶1 genetic matching method. Kaplan-Meier method was used for survival analysis and survival curve plotting. Log-rank was used to test the difference in survival rate between the two groups. Univariate analysis of Biejiajianwan in the treatment of primary liver cancer was performed by Log-rank test combined with the Kaplan-Meier method. The factors with statistical significance (P<0.05) were combined with unbalanced factors by the propensity score matching model, and at the same time, clinical common sense and relevant prognostic factors by literature search were considered, which were subjected to multivariate analysis by Cox proportional hazards regression model. ResultA total of 2 207 electronic cases were collected,including 174 cases in the exposure group (Biejiajianwan group) and 2 033 cases in the non-exposure group. After propensity score matching, there were 174 cases in the exposure group and 174 cases in the non-exposure group. The Kaplan-Meier method was used for survival analysis on the matched data, and the Log-rank test results showed that the survival rate of patients with primary liver cancer in the Biejiajianwan group was higher than that in the control group (χ2=12.193, P<0.01). Cox proportional hazards regression model analysis showed that the regression coefficient of Biejiajianwan was -0.916 4 with the hazard ratio (HR) [95% confidence interval (CI)]=0.4 (0.239 5-0.668 0), P<0.01, and the regression coefficient of radiofrequency ablation treatment was -0.976 5 with HR (95% CI)=0.376 6 (0.172 8-0.821 1, P<0.05). Fibrinogen (FIB) abnormal regression coefficient was 0.481 4 with HR (95% CI)=1.618 4(1.022 0-2.562 9),P<0.05. ConclusionBiejiajianwan can prolong the survival period of patients with primary liver cancer. Radiofrequency ablation is an independent protective factor for Biejiajianwan in the treatment of primary liver cancer,while abnormal FIB are independent risk factors for Biejiajianwan in the treatment of primary liver cancer.
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OBJECTIVE To evaluate the cost-effectiveness of sintilimab combined with chemotherapy than single-use chemotherapy in the first-line treatment of advanced, recurrent or metastatic esophageal squamous cell carcinoma (ESCC) from the perspective of health system of our country, and provide reference for rational use of drug in clinic. METHODS Based on ORIENT-15 study data, TreeAge Pro 2011 software was used to establish a three-state Markov model of non-progressive survival (PFS), disease progression and death for cost-utility analysis. The model period was 3 weeks, the research time limit was 10 years, and the discount rate was 5%. The main outputs of the model were total cost, quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER). The 1-3 times of China’s GDP per capita in 2021 was taken as the threshold of willing- ness to pay (WTP). The uncertainty of the parameters was analyzed by single factor sensitivity analysis and probability sensitivity analysis, and the cost-effectiveness of the two schemes was discussed under three situations: different discount rates, comparison with other similar treatment schemes and charitable drug donation schemes. RESULTS The results of basic analysis showed that compared with chemotherapy plan alone, the ICER of sintilimab combined with chemotherapy was 64 208.75 yuan/QALY, which was less than WTP threshold. The results of single factor sensitivity analysis show that PFS state utility value, cycle cost of sintilimab and discount rate had relatively great influence on the results. Probability sensitivity analysis showed that when WTP≥120 000 yuan, the economic probability of sintilimab combined with chemotherapy plan was 100%. The results of situational analysis showed that sintilimab combined chemotherapy was more cost- effective than single-use chemotherapy. CONCLUSIONS Sintilimab combined with chemotherapy is more cost-effective than single-use chemotherapy in the first-line treatment of advanced, recurrent or metastatic ESCC.
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Objective To establish a prediction model for tuberculosis incidence in Nantong area by multivariate regression analysis, and to provide theoretical support for the implementation of combined prevention work in this area. Methods A total of 37 338 registered patients with pulmonary tuberculosis in Nantong City from 2010 to 2021 were enrolled in the observation group. A total of 28,721 healthy people who underwent physical examination during the same period were selected as the control group. Results From 2010 to 2021, there were a total of 37 338 cases of pulmonary tuberculosis in central Nantong. From 2010 to 2015, more than 3,000 cases were reported annually, with the largest number (4 142 cases) in 2011, accounting for 11.09% of the total. The number of cases reported from 2016 to 2021 was all less than 3 000, and the number of cases reported from 2021 was the least , 1 803 cases, accounting for 4.83% of the total. The number of cases decreased each year in the past 12 years. The incidence of pulmonary tuberculosis in males was 70.97% (26 497 cases) and that in females was 29.03% (10 841 cases). In terms of age, the lowest incidence rate was 0.06% (23 cases) in the age group of 0-9 years old, and the highest incidence rate was 19.56% (7 304 cases) in the age group of 60-69 years old. Logistics regression analysis showed that male, age ≥60 years old, occupation as a farmer and smoking history were the risk factors for pulmonary tuberculosis (P < 0.05). ROC curve results showed that the AUC value of the risk prediction model for pulmonary tuberculosis in the Nantong area was 0.872, with a predictive sensitivity of 86.32% and a specificity of 89.21%. Conclusion There are many risk factors for pulmonary tuberculosis in Nantong area, and different factors interact and influence each other. The construction of a risk prediction model for pulmonary tuberculosis can better predict the clinical incidence, which is helpful to guide clinical diagnosis and treatment.
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Objective To explore the classification and characteristics of common syndromes of primary liver cancer and provide reference for clinical treatment.Methods Collect the four diagnostic information of patients with primary liver cancer from two top three TCM hospitals in Henan Province,and build a database.Using Lantern 5.0 software,based on two-step hidden tree analysis,a hidden structure model was constructed,and common syndromes of primary liver cancer were extracted through comprehensive clustering.SPSS 23.0 software was used for factor analysis and systematic cluster analysis to infer the potential syndromes.Combined with the results of different methods and professional knowledge,the syndrome classification of primary liver cancer was determined.Results A total of 1353 patients with 105 symptoms of primary liver cancer were included.59 symptoms with an analysis frequency≥40 were included to construct a hidden structure model,24 hidden variables were obtained,and 5 common syndromes were obtained by comprehensive clustering,namely,qi deficiency syndrome,liver depression and qi stagnation syndrome,blood stasis syndrome,water dampness stagnation syndrome,liver and gallbladder damp heat syndrome.20 common factors were obtained by factor analysis for symptoms with frequency>3%,and 8 common syndromes were inferred by cluster analysis with common factors.7 common syndromes and characteristics were finally determined by combining different methods and expertise.Conclusion The common syndromes of primary liver cancer are qi deficiency syndrome,liver depression and qi stagnation syndrome,blood stasis syndrome,water dampness stagnation syndrome,yin deficiency syndrome,liver and gallbladder damp heat syndrome,spleen deficiency and dampness stagnation syndrome.The results objectively reflect the actual situation of patients with primary liver cancer,and can provide reference for the treatment of primary liver cancer based on syndrome differentiation.
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A 77-years-old female patient presented gross hematuria for one week, and CT showed a mass in the left kidney. Ureteroscopy detected a left renal mass. Laparoscopic nephroureterectomy was performed and pathology showed the tumor was mainly located in the renal parenchyma, with glomeruli around the tumor cells. Urothelium showed no obvious dysplasia or clear migration of tumor cells. Considering both the clinical symptoms, and squamous cell carcinoma not detecting in other locations of the patient, primary renal parenchyma was confirmed. Three months after surgery, CT detected recurrence in the operating area, with metastasis to the adjacent abdominal cavity and aorta lymph node.
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【Objective】 To investigate the status of blood donation of pregnant women's family members, so as to recruit their family members and establish potential blood donation team. 【Methods】 Questionnaire survey was carried out among family members of pregnant women who participated in blood preparation plan by random sampling. 【Results】 The motivations of self-efficacy, internal reward, severity and stress of blood donors were significantly higher than those of non-donors, but non-donors concerned more about negative feelings of phlebotomy(P<0.05). People with rare blood type, low age, high income, weak negative motivation and strong positive motivation had stronger blood donation intention and higher probability of blood donation behavior(P<0.05). 【Conclusion】 It is necessary to expand blood sources through multiple channels by organizing publicity activities around targeted groups, such as establishing channels for blood donation reservation, taking the lead role of the donated crowd, so as to build up a recruitment team for voluntary blood donation.
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Objective:To translate the Pediatric Respiratory Assessment Measure into Chinese, and to test its reliability and validity.Methods:According to the Brislin translation model, the English version of Pediatric Respiratory Assessment Measure was translated into Chinese, and then was back-translated and modified for cultural adaptation. From June 2019 to December 2020, convenience sampling method was used to evaluate the severity of 50 children with acute attack of bronchial asthma aged 2-14 years in the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University, in order to evaluate its reliability and validity.Results:The Cronbach α of the Chinese version of Pediatric Respiratory Assessment Measure was 0.838, the inter-rater reliability was 0.984; the average scale-content validity index was 0.97. One common factor was extracted, the cumulative variance contribution rate of superior sternal fossa depression was 61.83%. The criterion related validity between the evaluation results of doctors, nurses, respiratory therapists and the grading standard of bronchial asthma severity in the " Guidelines for the diagnosis, prevention and treatment of bronchial asthma in children ( 2016 edition)" were 0.903, 0.884 and 0.889, the ROC curve of the scale was 0.867 (95% CI 0.754-0.980). Conclusions:The Chinese version of Pediatric Respiratory Assessment Measure has good reliability and validity, which can be used to evaluate the severity of acute attack of bronchial asthma in children aged 2-14 in China, and provide a basis for further diagnosis and treatment.
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An 85-year-old woman with gross hematuria for 10 days was presented to Wuxi No.2 People′s Hospital on Dec 10th, 2018.The images showed bladder mass. Pathological analysis of transurethrally resected tissue showed primary malignant melanoma with less pigmentations of urinary bladder. Without any following treatment, it grew again after 17 months. After the second surgery, she died of cachexia half a month later. Primary malignant melanoma with less pigmentations of urinary bladder is rare. It is vulnerable to misdiagnosis without immunohistochemical staining. The prognosis is poor.
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Myopia is the most common eye disease occurring in children and adolescents. As the prevalence rates of myopia and high myopia have increased yearly, the number of individuals with low vision and blindness caused by high myopia and its complications has gradually increased. However, the mechanisms underlying the occurrence and development of myopia are currently unclear. The existing intervention methods include optical and drug measures. This article summarizes the measures implemented for the prevention and control of myopia in recent years and discusses the research progress of drug interventions for myopia, considering the aspects of clinical and animal trials.
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【Objective】 To explore the feasibility and necessity of establishing a scheduled blood donation team focusing on pregnant women′s blood preparation by the comparative analysis between RhD positive and negative pregnant women′s family participation in the team, so as to provide basis for decision-making on fine management of key groups of voluntary blood donation. 【Methods】 A questionnaire survey was conducted between the families of RhD negative and positive pregnant women participating in the blood preparation program from January to September 2020 to compare the differences in incentive measures, blood donation cognition, motivation, intention and behavior between the two groups. 【Results】 For common incentive measures for blood donation, both families of RhD negative pregnant women(the former) and families of RhD positive pregnant women(the latter) preferred expectant mothers to use blood first, accounting for 98.02% (99/101) and 98.51% (132/134), respectively, with no significant difference.For other incentive measures, the preference of the former were significantly higher (P<0.05). For the cognition of voluntary blood donation, the awareness of the former was higher than that of the latter, with significant difference(P<0.05), except for clinical blood use expenses; the score of intention to donate blood of the former was higher than that of the latter(P<0.05); among the six factors of motivation to blood donation, the score of severity of the former(understanding of the status of blood supply) was higher than that of the latter, and the difference was statistically significant(P<0.05). Analysis of ROC curve showed that AUC of fitting model of the former and latter was 0.816 (95% CI: 0.731~0.902) and 0.924 (95% CI: 0.871~0.977). 【Conclusion】 Pregnant women families participated in the program are more interested in the incentive measures of health policies.The former has higher awareness of the current supply situation hence demonstrates higher intention to donate blood than the latter.Therefore, relevant policies should be formulated to improve the enthusiasm of pregnant women families to participate in voluntary blood donation, optimize the construction strategy of scheduled blood donation team and expand the donation team while ensuring blood use of pregnant women.
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Attention is an essential cognitive function which was use to perceive the external world, and it is the basis of all cognitive activities.Other cognitive functions such as working memory, executive function, information processing speed and so on, are also adversely affected in hypoprosexia or hyperfocusing state.Patients with schizophrenia have severe attention disorder, which makes patients unable to successfully complete the task of work or study, thus reduce the quality of life.Attention disorder exists throughout the whole course of this disease, and there is no specific drug for it.In recent years, antipsychotic medications have widespread application, but it has not shown up significantly improvement of attention disorder, worse still, its side effects will exacerbate the disease, which results in the impairment of the patients' ability to learn and explore the novelties.Neuroimaging markers of attention disorder in schizophrenia are the focus of current researches.White matter fibers are important pathways that connect attention networks and maintain the three-dimensional structure of the brain.Previous studies have suggested that attention disorder may be related to abnormalities of white matter fibers connecting various encephalic regions.In particular, abnormalities in the integrity of white matter, such as corpus callosum, cingulum bundle, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, have been reported to be significantly associated with attention disorder in patients with schizophrenia.In this study, the relationship between attention disorder and white matter structure in patients with schizophrenia is reviewed through diffusion tensor imaging (DTI) technique.
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Chlamydia, a gram-negative obligate intracellular pathogen, is a major cause of human reproductive tract, eye and respiratory tract infections. It replicates in a special membrane-binding chamber called inclusion and survives in the host′s hostile intracellular environment through secreting effectors, but requires host-derived lipids to grow and develop in the cells. Emerging evidences suggest that Chlamydia has evolved a variety of strategies to meet its lipid needs by interacting with host cell compartments and redirecting the transport pathway to its intracellular niche. This paper briefly described the pathway for obtaining host lipids and the mechanism of lipid metabolic during Chlamydia infection.
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Objective@#Resting state functional magnetic resonance imaging (rsfMRI) provides a lot of evidence for local abnormal brain activity in schizophrenia, but the results are not consistent. Our aim is to find out the consistent abnormal brain regions of the patients with schizophrenia by using regional homogeneity (ReHo), and indirectly understand the degree of brain damage of the patients with drug-naive first episode schizophrenia (Dn-FES) and chronic schizophrenia. @*Methods@#We performed the experiment by activation likelihood estimation (ALE) software to analysis the differences between people with schizophrenia group (all schizophrenia group and chronic schizophrenia group) and healthy controls. @*Results@#Thirteen functional imaging studies were included in quantitative meta-analysis. All schizophrenia group showed decreased ReHo in bilateral precentral gyrus (PreCG) and left middle occipital gyrus (MOG), and increased ReHo in bilateral superior frontal gyrus (SFG) and right insula. Chronic schizophrenia group showed decreased ReHo in bilateral MOG, right fusiform gyrus, left PreCG, left cerebellum, right precuneus, left medial frontal gyrus and left anterior cingulate cortex (ACC). No significant increased brain areas were found in patients with chronic schizophrenia. @*Conclusion@#Our findings suggest that patients with chronic schizophrenia have more extensive brain damage than FES, which may contribute to our understanding of the progressive pathophysiology of schizophrenia.
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Objective@#Resting state functional magnetic resonance imaging (rsfMRI) provides a lot of evidence for local abnormal brain activity in schizophrenia, but the results are not consistent. Our aim is to find out the consistent abnormal brain regions of the patients with schizophrenia by using regional homogeneity (ReHo), and indirectly understand the degree of brain damage of the patients with drug-naive first episode schizophrenia (Dn-FES) and chronic schizophrenia. @*Methods@#We performed the experiment by activation likelihood estimation (ALE) software to analysis the differences between people with schizophrenia group (all schizophrenia group and chronic schizophrenia group) and healthy controls. @*Results@#Thirteen functional imaging studies were included in quantitative meta-analysis. All schizophrenia group showed decreased ReHo in bilateral precentral gyrus (PreCG) and left middle occipital gyrus (MOG), and increased ReHo in bilateral superior frontal gyrus (SFG) and right insula. Chronic schizophrenia group showed decreased ReHo in bilateral MOG, right fusiform gyrus, left PreCG, left cerebellum, right precuneus, left medial frontal gyrus and left anterior cingulate cortex (ACC). No significant increased brain areas were found in patients with chronic schizophrenia. @*Conclusion@#Our findings suggest that patients with chronic schizophrenia have more extensive brain damage than FES, which may contribute to our understanding of the progressive pathophysiology of schizophrenia.
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OBJECTIVE:To optimi ze the optimal composition proportion of 4 ingredients (Panax ginseng ,Astragalus membranaceus,Polygonatum sibiricum ,Lycium chinensis )in Compound ginseng immune-enhancing formula (CGIF),and to study immune activity and acute toxicity of the extracts with the optimal ratio. METHODS :The cell activity test was used to screen the crude drug concentration range of 4 ingredients. After treated with different crude drug concentrations of each medicinal material,using the contents of NO ,IL-6 and TNF-α as indexes,uniform design was used to determine the optimal ratio of each ingredient in CGIF. Totally 240 mice were taken and randomly divided into 4 batches,with 60 mice in each batch. Each batch of mice was randomly divided into blank group (normal saline ),model group (normal saline ),positive drug group [levamisole ,4 mg/(kg·d)],and optimal proportion extract of CGIF low-dose ,medium-dose and high-dose groups [ 0.952 8,1.905 6,3.811 2 g/(kg·d)],with 10 mice in each group ;they were given medicine intragastrically ,qd,for consecutive 30 d. Except for blank group,mice in the other groups were intraperitoneally injected with cyclophosphamide [ 40 mg/(kg·d)] on the 24th day after first administration,qd,for consecutive 3 d to induce immunocompromised model. The immune activity of the optimal proportion extract was evaluated by determining visceral coefficients ,spleen lymphocyte transformation capacity ,serum contents of hemolysin,IL-2,IgM,IgG and IgA ,phagocytosis function of peritoneal macrophages. Another 20 mice were collected and given the optimal proportion extract 20 mL/kg intragastrically ,twice;acute toxicity of the formula was investigated with oral maximum tolerated dose (MTD). RESULTS :The optimal ratio of CGIF was that crude drug mass ratio of P. ginseng , membranaceus,P. sibiricum ,L. chinensis was 1 ∶ 2 ∶ 2 ∶ 4. The immunological activity experiment showed that theoptimal proportion extract can significantly improve visceral indexes of mice , spleen lymphocyte proliferation ability serum contents of hemolysin ,IL-2,IgM,IgG and IgA as well as macrophage phagocy tosis ability (P<0.05 or P< 0.01). The acute toxicity test indicated that oral MTD was over 15 g/kg,which was non-toxic. CONCLUSIONS :The optimal proportion extract of CGIF can significantly enhance the immune function of mice and are non-toxic.
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The mucosal surfaces of the human body are typically colonized by polymicrobial communities, they exist in the gastrointestinal tract, skin, oral cavity, and genitourinary tract, as well as in anatomical sites previously considered sterile, including the lung. These communities interact with the mucosal immune system to maintain homeostasis in health, emphasizing the important role of " second genome" , which is very important to human health. The human lower respiratory tract also harbor many microbes, the imbalance of microbiome composition maybe critically related with many lung disease. Up to date, researches on microbiome of lung caner is still on the first step. Our review mainly describes the characteristic composition of lung microbiome, and the relationship with diseases, especially with lung cancer. We attempts to provide the basis information for further researches about the relationship between human lung microbiome and lung cancer.
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Objective:To compare CT with MRI on the accuracy in TNM staging of pancreatic ductal adenocarcinoma (PDAC) based on the 8th American Joint Committee on Cancer System and Pathological Staging.Methods:From October 2013 to October 2019, 105 patients who had pathologically confirmed PDAC treated at the Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University were retrospectively studied. Of 52 patients who met the inclusion criteria, there were 32 males and 20 females, with age ranging from 45 to 84 years (mean 66.1 years). Based on the 8th American Joint Committee on Cancer System and Pathological Staging, CT was compared with MRI in their accuracies in categorizing TNM and staging of PDAC.Results:Forty-three of 52 patients who underwent curative resection had a mean tumor size of (3.4±1.2) cm, compared with tumor sizes of (3.3±1.2) cm and (3.3±1.4) cm on CT and MRI, respectively. No significant differences were observed between gross pathological examination and CT ( P>0.05) or MRI ( P>0.05). The accuracy of T, N, and M categories on CT versus (vs) MRI was 97.7% (42/43) vs 97.7% (42/43), 79.1% (34/43) vs 76.7% (33/43), and 100% (9/9) vs 88.9% (8/9), respectively. No significant differences were observed between the two modalities ( P>0.05). The overall accuracy of PDAC staging on CT vs MRI was 82.7% (43/52) vs 76.9% (40/52), respectively. There was also no significant difference between the two modalities ( P>0.05). Conclusion:Both CT and MRI had similar accuracies in categorizing TNM and staging of PDAC. However, the accuracies of T and M stages were higher than that of the N stage for these two imaging modalities.
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Cutaneous metastasis of renal cell carcinoma (RCC) is rare. Particularly, it is even more rare that multiple subcutaneous nodules become the first symptom of RCC. On January 19, 2018, a RCC patient with first symptom of multiple subcutaneous nodules was admitted to Wuxi No.2 People’s Hospital. The patient's right renal cancer stage was cT 4N 2M 1, stage Ⅳ. He has no surgical indication and medical treatment was the main strategy. Sunitinib was administered orally five days after the biopsy. He died of multiple brain metastases seven months after the operation. The overall survival was 7 months.