The distribution of blood pressure and associated factors of the elderly with type 2 diabetes in Jiangsu Province / 中华预防医学杂志

Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m2, fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m2, male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.

Pulmonary granular cell tumors: a clinicopathological analysis of five cases / 中华病理学杂志

Objective: To investigate the clinicopathological features of pulmonary granular cell tumors (pGCTs) and to improve the diagnostic accuracy of the tumor. Methods: A total of 5 pGCTs were diagnosed from February 2016 to January 2022 at Shanghai Pulmonary Hospital, Tongji University School of Medicine and Fudan University Shanghai Cancer Center, China. Immunohistochemical staining, and analysis of the clinicopathological characteristics were performed. Results: The average age of the pGCTs patients was 46 years (ranging from 24 to 54 years), with 3 females and 2 males. One case occurred in the bronchus with multiple nodules in the lung, 2 cases occurred in the bronchial opening, and 2 cases were solitary nodules in the lung. The maximum diameter of the tumors ranged from 12 to 15 mm (mean size 14 mm). Microscopically, the tumor showed infiltrative growth and consisted of round, oval or polygonal cells. Abundant eosinophilic cytoplasm was noted, and the nucleoli were prominent. None of the 5 cases showed any mitosis or necrosis. Immunohistochemical and histochemical study showed positive staining for S-100 (5/5), SOX10 (5/5), Vimentin (5/5), TFE3 (4/5), PAS (3/5), and amylase-digested-PAS (3/5), while 4 cases were negative for CD68. TFE3 FISH analyses on 2 cases showed that no signal abnormality was detected in these 2 cases. The average proliferation index of Ki-67 was 2.2% (range 0-5%). There was no recurrence in 4 cases of pGCTs with a follow-up time ranging from 2 months to 60 months. Conclusions: pGCTs are very rare tumors, most likely originating from Schwann cells. Immunohistochemical staining is the conventional diagnostic tool for pGCTs diagnosis. Recognition of this entity is essential for pathologists to avoid misdiagnosis and unnecessary treatments.

The Research Progress of Exosomes in Osteoarthritis, With Particular Emphasis on the Therapeutic Effect.

Exosomes participate in many physiological and pathological processes by regulating cell-to-cell communication. This affects the etiology and development of diseases, such as osteoarthritis (OA). Although exosomes in the OA tissue microenvironment are involved in the progression of OA, exosomes derived from therapeutic cells represent a new therapeutic strategy for OA treatment. Recent studies have shown that exosomes participate in OA treatment by regulating the proliferation, apoptosis, inflammation, and extracellular matrix synthesis of chondrocytes. However, studies in this field are scant. This review summarizes the therapeutic properties of exosomes on chondrocytes in OA and their underlying molecular mechanisms. We also discuss the challenges and prospects of exosome-based OA treatment.

Activation of the STING-IRF3 pathway involved in psoriasis with diabetes mellitus.

Psoriasis and type 2 diabetes mellitus (T2DM) share similar inflammatory pathways in their pathogenesis. The stimulator of interferon genes (STING)-interferon regulatory factor 3 (IRF3) pathway has recently been shown to play an important role in immune and metabolic diseases. In this study, we investigated the activation of the STING-IRF3 pathway in human immortalized keratinocytes (HaCaT) cells treated with palmitic acid (PA) and imiquimod (IMQ). Additionally, we detected the STING-IRF3 pathway in diabetic mice with imiquimod (IMQ)-induced psoriasis and assessed the potential of STING inhibitor C-176. Furthermore, skin samples from patients with psoriasis and diabetes were collected for immunohistochemical analysis. The results indicated that the STING-IRF3 pathway was activated in HaCaT cells. Moreover, the STING pathway was also found to be induced in the skin tissue of diabetic mice with psoriasis; the inflammatory responses were ameliorated by treatment with C-176. In the skin tissue samples of patients with psoriasis and diabetes, immunohistochemistry showed that the expression levels of STING and phosphorylated IRF3 were also significantly increased. Thus, we conclude that the STING-IRF3 pathway is involved in the inflammatory response in the manifestation of psoriasis with T2DM. Inhibition of the activation of the STING pathway can ameliorate the development of psoriasis in diabetes and could be targeted for the development of therapeutic agents for these conditions.

Effect of optimizing gastrointestinal reconstruction on reducing gastric emptying disorder after pancreaticoduodenectomy / 中华普通外科杂志

Objective:To investigate the effect of optimizing perioperative measures on reducing postoperative gastric emptying disorder in gastrointestinal reconstruction after pancreaticoduodenectomy.Methods:The clinical data of 146 patients who underwent pancreaticoduodenectomy from Jan 2019 to Dec 2020 at the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital ,Anhui Medical University were analyzed retrospectively. Among them, 78 cases underwent traditional Billroth Ⅱ gastrojejunal anastomosis for gastrointestinal reconstruction, and 68 cases in the improvement group took optimization measures. The time to first postoperative flatus, time to oral intake, postoperative hospital stay and complications were observed.Results:The operation time in the control group was (351.4±71.6) min, less than that in the improved group (368.8±97.6) min, while the time [(9.9±6.5)d vs. (7.6±6.0)d] to first oral take and postoperative hospital stay [(20.7±8.6)d vs. (17.9±7.0)d] were significantly longer than those in the improved group. The incidence of postoperative gastric emptying disorder (19.2% vs. 7.4%) was significantly higher than that in the improved group ( P<0.05). There was no significant difference in postoperative time to first flatus and postoperative gastrointestinal bleeding between the two groups (all P>0.05). Conclusions:The measures of optimizing gastrointestinal reconstruction in the perioperative period of pancreaticoduodenectomy have obvious advantages in reducing gastric emptying disorder, promoting the recovery of gastrointestinal function and shortening the length of hospital stay.

Involvement of AMP-activated Protein Kinase α/ Nuclear Factor (Erythroid-derived 2) Like 2-iniatived Signaling Pathway in Cytoprotective Effects of Wasabi 6-(Methylsulfinyl) Hexyl Isothiocyanate

6-(Methylsulfinyl) hexyl isothiocyanate (6-MSITC) is an active ingredient present in Wasabi, which is a popular pungent spice used in Japanese cuisine. Our previous studies suggested that the primary antioxidant activity of 6-MSITC may link to other biological activity. This study aimed to clarify how the antioxidant activity of 6-MSITC contributes to preventing overloaded lipid stress in he-patic cell model. HepG2 cells were treated with 6-MSITC at defined concentrations and times in normal medium or in combined fatty acids (CFA) medium, and the targeted proteins were detected by Western blotting. The kinetic data revealed that 6-MSITC activated AMP-activated protein kinase α (AMPKα) and nuclear factor (erythroid-derived 2) like 2 (Nrf2), and then enhanced the protein expression of Forkhead box protein O1 (FOXO1) and Sirtuin1 as well as that of the Nrf2 target proteins, NAD(P)H:quinone oxidoreductase 1 (NQO1) and heme oxygenase (HO-1). Furthermore, lipid metabolic stress was mimicked in HepG2 cells by overloading CFA. 6-MSITC significantly alleviated CFA-induced formation of thiobarbituric acid reactive substances and fat ac-cumulation. Signaling analysis data revealed that 6-MSITC enhanced phosphorylation of AMPKα, upregulated the expression of Nrf2, NQO1, heme oxygenase 1, FOXO1, and Siruin1, and downregulated the expression of PPARα. Taken together, our results suggested that the AMPKα/Nrf2-mediated signaling pathways might be involved in the cytoprotective effects of Wasabi 6-MSITC against metabolic lipid stress.

Risk factors for delayed gastrointestinal hemorrhage after pancreaticoduodenectomy / 中华消化外科杂志

Objective:To investigate the risk factors for delayed gastrointestinal hemorrhage after pancreaticoduodenectomy (PD).Methods:The retrospective case-control study was conducted. The clinicopathological data of 173 patients who underwent PD in the First Affiliated Hospital of Anhui Medical University from November 2017 to May 2020 were collected. There were 107 males and 66 females, aged (61±11)years. All patients underwent PD and patients with gastrointestinal hemorrhage after surgery were treated with non-surgical or surgical treatments. Observation indicators: (1) gastrointestinal hemorrhage after PD and treatment situations; (2) influencing factors for delayed gastrointestinal hemorrhage after PD. Measurement data with normal distribution were expressed by Mean±SD, and count data were expressed by absolute numbers or percentages. Univariate analysis was performed using the chi-square test, and multivariate analysis was performed using the Logistic regression model. Results:(1) Gastrointestinal hemorrhage after PD and treatment situations: of 173 patients, 15 cases had gastrointestinal hemorrhage after PD, including 2 cases with early gastrointestinal hemorrhage and 13 cases with delayed gastrointestinal hemorrhage. Among the 13 cases with delayed gastrointestinal hemorrhage, 3 cases were mild hemorrhage, 10 cases were severe hemorrhage, 4 cases were gastric mucosal hemorrhage, 3 cases were gastric ulcer hemorrhage, 3 cases were gastrointestinal anastomotic hemorrhage, 2 cases were cholangio-jejunal anastomotic hemorrhage, 1 case was biliary arteriovenous fistula hemorrhage. Of the 13 patients with delayed gastrointestinal hemorrhage, 4 cases were treated only with conservative treatment, 4 cases were treated with interventional treatment, 3 cases were treated with endoscopic treatment and 2 cases were treated with surgical treatment. Of the 13 patients with delayed gastrointestinal hemorrhage, 12 were cured and 1 died. (2) Influencing factors for delayed gastrointestinal hemorrhage after PD: results of univariate analysis showed that albumin, total bilirubin, pancreatic fistula and history of gastric ulcer were the influencing factors for delayed gastrointestinal hemorrhage after PD ( χ2=7.888, 6.555, 4.252, 6.253, P<0.05). Results of multivariate analysis showed that total bilirubin >200 μmol/ L, pancreatic fistula and history of gastric ulcer were independent risk factors for delayed gastrointestinal hemorrhage after PD ( odds ratio=4.122, 4.290, 5.267, 95% confidence interval as 1.009-16.844, 1.149-16.022, 1.195-23.221, P<0.05). Conclusion:Total bilirubin >200 μmol/L, pancreatic fistula and history of gastric ulcer are independent risk factors for delayed gastrointestinal hemorrhage after PD.

Inokosterone Is A Potential Drug Target of Estrogen Receptor 1 in Rheumatoid Arthritis Patients: Analysis from Active Ingredient of Cyathula Officinalis / 中国结合医学杂志

OBJECTIVE@#To elucidate the active compounds and the molecular mechanism of Cyathula Officinalis as a drug treatment for rheumatoid arthritis (RA).@*METHODS@#The target genes of active ingredients from Cyathula Officinalis were obtained from bioinformatics analysis tool for the molecular mechanism of traditional Chinese medicine. The protein-protein interaction between the target genes were analyzed using STRING and Genemania. The transcriptome of RA patients compared to healthy people (GSE121894) were analyzed using R program package Limma. The relative expression of the target genes was obtained from the RNA-seq datasets. The molecular docking analyses were processed based on the molecular model of estrogen receptor 1 (ESR1) binding with estradiol (PDB ID:1A52). The binding details were analyzed by SYBYL.@*RESULTS@#Inokosterone, ecdysterone, and cyaterone were the 3 active ingredients from Cyathula Officinalis that bind to target genes. Of all the significantly changed genes from RA patients, ESR1, ADORA1, and ANXA1 were significantly increased in mRNA samples of RA patients.@*CONCLUSION@#ESR1, the transcription factor that binds inokosterone in the molecular binding analysis, is the target protein of Cyathula Officinalis.

Infective characteristics of Fournier gangrene and evaluation of effect of negative pressure wound therapy / 中华创伤杂志

Objective:To summarize the infective characteristics of Fournier's gangrene (FG) and evaluate the effect of negative pressure wound therapy (NPWT).Methods:A retrospective case control study was conducted to analyze the clinical data of 31 patients with FG admitted to Peking University First Hospital from May 2010 to September 2020, including 29 males and 2 females, aged 21-78 years [(55.2±2.0)years]. A total of 29 patients were caused by infectious diseases of the perianal and urinary system, and the rest two patients were caused by vulvar infection and retroperitoneal abscess. A total of 23 patients were treated with NPWT (Group A) and 8 patients were treated with conventional dressing (Group B). Characteristics of pathogen, drug-resistance rate, medical treatment and prognosis for all patients were summarized. The hospitalization duration, numbers of operation and wound healing time were compared between two groups.Results:Monomicrobial infection was identified in 14 patients, while polymicrobial infection in 15 patients, fungal infection in 1 and culture-negative in 1. Escherichia coli, Enterococcus faecalis, Enterococcus faecium, Klebsiella pneumoniae and Staphylococcus haemolyticus were the most common pathogenic bacteria. The resistance rate of gram-negative bacilli to third-generation cephalosporins was 37%. Staphylococcus haemolyticus were methicillin-resistant Staphylococcus. The carbapenem antibiotics combined with vancomycin antibiotics were used for all patients as the empirical anti-infection treatment. Three patients died, and the rest 28 patients were followed up for 3 to 12 months [(10.8±2.6)months] after discharge. All the wounds were healed well without recurrence. In Group A and Group B, the hospitalization duration was (37.4±15.0)days and (47.0±16.0)days, respectively ( P>0.05); the number of operation was 3(3, 6) times and 13(4, 17)times, respectively ( P<0.05); the wound healing time was (38.9±17.8)days and (61.8±14.2)days, respectively ( P<0.05). Conclusions:Enterobacteriaceae, Enterococcus and Staphylococcus haemolyticus are the most common pathogenic bacteria for FG, among which the proportion of drug-resistant bacteria is relatively high. NPWT is an effective adjuvant therapy for wound management with reduced operation times and short wound healing time compared to conrentional method.

Primary hepatic adenosquamous carcinoma: report of 5 cases / 中华普通外科杂志

Objective:To explore the clinicopathological characteristics of the primary hepatic adenosquamous carcinoma(ASC).Methods:A retrospective analysis was performed on the clinical data of 5 ASC patients admitted to the First Affiliated Hospital of Anhui Medical University from 2006 to 2019 who underwent surgical resection and were pathologically confirmed.Results:Among the 5 ASC cases, there were 4 males and 1 female. The age ranged from 48 to 73 years. As for the initial symptoms, there were 5 cases complaining upper abdominal pain, 2 cases presenting fever, 1 case presenting weight loss and 1 case presenting jaundice. CA19-9 was significantly higher than normal in 4 cases, while AFP was normal in all. None had definite preoperative diagnosis.All the 5 patients underwent surgical resection with pathology proved primary hepatic ASC. Lymph node metastasis was found in 4 cases and nerve invasion in 2 cases. There were 4 cases at TNM stage ⅣA, one at stage ⅠB. The median disease-free survival (DFS) was 5 months and the overall survival (OS) was 9 months.Conclusions:Primary hepatic adenosquamous carcinoma is a rare type of liver malignant tumor with an extremely poor prognosis. Surgical resection helps little in improving the prognosis.

Using internal fixator combined with hollow nail in the treatment of anterior pelvic ring injury with symphyseolysis / 中华骨科杂志

Objective:To investigate the clinical efficacy of using INFIX combined with hollow nail in the treatment of anterior pelvic ring injury with symphyseolysis.Methods:Data of 12 patients with anterior pelvic ring injury and symphyseolysis who were treated from January 2016 to December 2018 were retrospectively analyzed. They were 8 males and 4 females with an average age of 39.5 years (range, 23-64 years). There were 4 cases of traffic injury, 3 cases of falling injury and 5 cases of crush injury; all the cases were combined with front and rear crush injury. According to Tile classification for pelvic fractures, there were 6 cases of type B1 , 3 cases of type B3, 1 case of type C1 and 2 cases of type C2. Six cases of B1 and 3 cases of B3 patients used percutaneous inter fixation with sacroiliac joint cannulated screw in posterior ring; 1 case of C1 and 2 cases of C2 used spinal-pelvic fixation. Every patients' operating time of INFIX combined with the pubic symphysis hollow nail , amount of hemorrhage, length of incisions and number of X-ray projections were recorded. Pelvic X-ray and CT scan were taken postoperatively to observe the reduction and screw position. Postoperative reduction quality was assessed using Matta radiological criteria and Majeed criteria was used at the final follow-up to evaluate the pelvic function.Results:The average operating time for 12 patients was 42 min (range, 35-56 min) ; the average amount of hemorrhage was 28 ml (range, 15-40 ml); the average length of incision at INFIX nail placement on both sides were 2.7 cm (range, 2.2-3.5 cm); the average length of incisions at the pubic symphysis hollow nail placement was 0.8 cm (range, 0.6-1.2 cm) and the average number of X-ray projections was 38 times (range, 26-55 times). Postoperative X-ray and CT scan showed that all the hollow screws are located accurately and firmly, and pubic symphysis had good reduction and no infection occurred in the surgical incision at the screw placement site. Postoperative reduction quality was evaluated according to Matta radiological criteria, and there were excellent in 10 and good in 2, giving an excellent to good rate of 100% (12/12). The average follow-up time for the 12 patients was 12 months (range, 6-15 months). At the final follow-up, all patients showed fine fracture union and no looseness of pubic symphysis occurred according to imaging test. According to the Majeed criteria, the pelvic function was excellent in 8 cases, good in 3 cases and fair in 1 case, giving a good to excellent rate of 91.7% (11/12). One case developed symptoms of femoral nerve compression after surgery and returned to normal after removal of the INFIX. Another case had damage to the lateral femoral cutaneous nerve and the symptoms disappeared after three months.Conclusion:Using INFIX combined with hollow nail in the treatment of symphyseolysis can lead to more minimally invasive with excellent postoperative efficacy and markedly reduced the morbidity of complication.

Clinical application of perforator flap in defects after wide resection of tumor in perineal region / 中华整形外科杂志

Objective@#Reconstruction of defects after wide resection of tumor in perineal region is challenging because the defects are extensive and complex. In this report, we retrospectively analyzed the clinical experience of perineal reconstruction in last 6 years, to evaluate the value of clinical application of perforator flaps in defects of perineal region.@*Methods@#From January 2011 to December 2016, 32 cases of perineal cancer were treated by radical extensive excision, with defects repaired with perforator flaps. The size of perineal defects was between 8 cm×4 cm-20 cm× 20 cm, 52 perforator flaps were used for perineum reconstruction.@*Results@#All of the defects achieved tension-free closure. All the flaps were survived and healed with first intention except two infection and minor wound dehiscence cases. Both cases healing after dressing and secondary suture. There were no donor-site complications. During an average follow-up of 11.1 months (range, 10-12 months), the reconstructed areas achieved good functional and cosmetic outcomes.@*Conclusions@#Perineum reconstruction with perforator flaps following total radical extensive excision leads to good result in patients with perineal cancer. It can achieve tension-free closure and produces almost normal appearance and function of the perineum.

An Analysis of Stimulating Occlusal Trauma on Condyle Using Three-Dimensional Finite Element Model / 昆明医科大学学报

Objective To provide evidence for the relationship between TMD and occlusal trauma by studying the mechanics influence and displacement of condyle by building the three dimensional finite element analysis model andstimulating the abnormal bite force leading occlusal trauma.Methods We collected DICOM date of healthy male volunteers with normal occlusal relationship using CBCT scan with constraint on condylar top and formed the finite model with divide mesh.Two conditions were built: (1) We operated different vertical load on the left mandibular molar occlusal surface; (2) We operated different buccal direction load on the same modelto study the mechanic change on left condylar.Results When the three dimensional finite model of mandible was built, the mechanic region of condyle stayed the same but the stress and tension increased accordingly as the loda duplicate rose. As the same buccal operation load was operated,the stress and tension became larger and the displacement became longer.Conclusion The abnormal bite force causing occlusal trauma can change mechanic conduct on condyle and lead to the pathological change of condyle.

Research progress on autophagy-related protein 5 and BECLIN-1 regulate autophagy and apoptosis / 中国人兽共患病学报

ATG5 and BECLIN-1 belong to two kind of crucial autophagy-related proteins included the formation of autoph-agosomes,in addition to the promotion of autophagy,enhances susceptibility towards apoptotic stimuli,therefore,ATG5 and BECLIN-1 are considered to be a molecular link between autophagy and apoptosis.Preliminary data revealed that ATG5 media-ted the formation of autophagosomes by ATG5-ATG12-ATG16L ubiquitination system,while BECLIN-1 induces autophagy by phosphatidylino3-kinase (PtdIns3KC3)complex.But now it is believed that truncated ATG5(tATG5-N)and truncated BEC-LIN-1(BECLIN-1-C),an amino-terminal cleavage product of ATG5 and carboxyl-terminal cleavage product of BECLIN-1, could induce apoptosis.The research summarize the progress on ATG5 and BECLIN-1 regulated autophagy and apoptosis,so as to further reveal the molecular mechanism of they regulate autophagy and apoptosis.

Negative pressure wound therapy combined with reversed latissimus dorsi muscle flap for postoperative deep infection after spinal instrumentation / 中华创伤骨科杂志

Objective To explore a potentially effective treatment of postoperative deep infection after spinal instrumentation without removal of implants. Methods A total of 4 patients with postoperative deep infection after spinal instrumentation were treated at our hospital between January 2015 and May 2016. They were 2 men and 2 women, aged from 62 to 75 years (mean, 69.2 years). They were treated with ag-gressive surgical debridement under the guidance of methylene blue and negative pressure wound therapy. Reversed latissimus dorsi muscle flap was used to obturate the wound when the bacterial culture of the wound was negative and the relevant inflammatory indicators returned to normal. Negative pressure treatment con-tinued over the closed incision. Results The devices for negative pressure wound therapy were removed in the 4 patients one week after surgery. All the wounds were healed well by first intention 2 weeks after surgery without removal of their implants. The patients were discharged after their examinations for blood routine, CRP, ESR and PCT turned to be normal. Follow-ups for more than one year revealed no re-infection, implants loosening or other adverse effects. Conclusions Negative pressure wound therapy combined with reversed latissimus dorsi muscle flap is a new attempt to treat postoperative deep infection after spinal instru-mentation without implant removal. It may increase the rate of implants reserved, accelerate wound healing and raise the curative rate of deep infection.

Effect mechanism study of butylphthalide on renal interstitial fibrosis / 重庆医学

Objective To explore the rule of the Nrf2-ARE in renal interstitial fibrosis and the mechanism of butylphthalide on renal protective effect.Methods Seventy-two male CD-1 mice were divided into 4 groups,Sham group,UUO group,NBP group,ACEI group.The Sham group and UUO group were gavaged with physiological saline.The NBP group was gavaged with butylphthalide.The ACEI group was gavaged with benazepril.After 3,7,14 days,6 mice were executed and collection of kidney tissue.The expression of Nrf2,γ-GCS and type Ⅰ collagen were detected by immunohistochemisty,RT-PCR and Western blot.The correlation of Nrf2 and γ-GCS was assessmented by linear regression.Results The expression of type Ⅰ collagen in UUO group was increased compared with the Sham group,However,the expression of Type Ⅰ collagen in NBP group or ACEI group were reduced compared with the UUO group.Compared with Sham group,the expression of Nrf2mRNA,γ-GCSmRNA and type Ⅰ collagen mRNA in uuogroup were increased in 3,7,14 days after surgery.Compared with UUO group at 7th,14u day,the lelve of Nrf2 mRNA were apparently increased in NBP group (P＜0.05).It was a positive correlation between the Nrf2 and γ-GCS and negative correlation between the γ-GCS and Type Ⅰ collagen.Conclusion The renal protective effect of butylphthalide in the renal interstitial fibrosis was more predominant than benazepril.The roles maybe occurred through increased the expression of Nrf2 and γ-GCS and alleviated the expression of Type Ⅰ collagen in nephridial tissue.

Phosphoryaltion levels of ERK5 in acute myocardial infarction patients and its role in platelet activation in vitro / 复旦学报（医学版）

Objective To observe the phosphorylation levels of extracellular signal-regulated kinase 5 (ERK5) in acute myocardial infarction (AMI) patients and the effects of ERK5 selective inhibitor XMD8-92 on human platelet activation in vitro,and to explore its mechanism.Methods Western blot was applied to detect the phosphorylation levels of ERK5,Akt473 and Akt308 in AMI patients (n =34) and stable angina patients (n =33,control).The effects of different concentration of XMD8-92 on human platelet aggregation induced by collagen was tested by aggregometer in vitro.The release of ATP was measured simultaneously by luciferase detection.The effects of XMD8-92 on integrin aIIbβ3 were detected by platelet spreading on immobilized fibrinogen and clot retraction.The effects of XMD8-92 on phosphorylation levels of Akt473,Akt308 PTEN370 and ERK5 were detected by Western blot.Results The levels of phosphor-Akt473,Akt308 and phosphor-ERK5 were significantly higher in AMI patients than that in control group (P＜0.05).ERK5 inhibitor XMD8-92 diminished collagen-induced platelet aggregation,ATP secretion,the average area of platelet spreading on immobilized fibrinogen and the clot retraction extent.The levels of phosphor-Akt (Ser-473/Thr-308) and phosphor-PTEN (Ser370) were significantly down-regulated in the presence of XMD8-92.Conclusions ERK5 plays a role in platelet activation in AMI process.It regulates platelet activation by regulating PTEN and Akt phosphorylation.Its specific inhibitor is hoped to be new antithrombotic drug.

The effects of different doses of butylphthalide on Nrf-2 expression in mouse model with unilateral ureteral obstruction / 天津医药

Objective To explore the impact of different doses of butylphthalide on renal interstitial fibrosis in mice with obstructive nephropathy, and to discuss the correlation between Nrf-2 expression level and renal interstitial fibrosis. Methods Totally 72 male CD-1 mice of clean grade were selected and randomly assigned into 4 groups:sham operation group (Sham), model group (UUO), low dose of butylphthalide group (NBPL) and high dose of butylphthalide group (NBPH). In addition to the control group, UUO model was established in other three groups. NBPL group was given NBP 150 mg/(kg· d) by gavage since postoperative day 1,NBPH group was given NBP 220 mg/(kg·d) by gavage. Sham group and UUO group were given equal volume of saline by gavage. Six mice were sacrificed at the third, 7th, 14th day, respectively. The obstructive renal tissue was selected for immunohistochemical staining and Western blot assay. The expression levels of Nrf- 2 and type Ⅰ collagen were detected by Western blot assay. Results The IOD value of type Ⅰ collagen was increased with time in UUO group, and which showed a gradual decreasing trend in Sham group, NBPL group and NBPH group (P<0.05). The IOD values at different time points were significantly higher in UUO group, NBPL group and NBPH group compared to those of Sham group. The IOD values were significantly decreased in NBPL and NBPH groups than that of UUO group, and IOD value was lower in NBPH group than that of NBPL group (P<0.05). Western blot assay showed that IOD values of Nrf-2 and type Ⅰ collagen at 7 d and 14 d were increased in UUO group, NBPL group and NBPH group compared with those of Sham group. The IOD values of Nrf-2 protein were increased, and IOD values of type Ⅰcollagen were decreased, in NBPL group and NBPH group than those of UUO group. The IOD value of Nrf-2 protein was decreased in NBPL group than that of NBPH group, but the IOD value of type Ⅰcollagen was increased in NBPL group than that of NBPH group (P<0.05). Conclusion NBP can improve renal interstitial fibrosis in UUO mice, which may be related with the increased expression of Nrf-2 and the down-regulated expression of type I collagen.

Reasons and prognosis of multiple-operations for intra-and extrahepatic cholangiolithiasis / 中华消化外科杂志

Objective To discuss the reasons,surgical procedures and prognosis of multiple-operations for intra-and extrahepatic cholangiolithiasis.Methods The retrospective cohort study was adopted.The clinical data of 85 patients with intra-and extrahepatic cholangiolithiasis who underwent multiple-operations at the Second Affiliated Hospital of Anhui Medical University from January 2006 to January 2015 were collected.Individualized operations were determined according to the distribution of stones and liver functional reserve,including stones removal by incising bile duct and external biliary drainage,Roux-en-Y hepaticojejunostomy and hepatolobectomy or segmental hepatectomy.The treatment followed the principles as complete removal of stones,complete resection of lesions,correction of stenosis and adequate drainage.Bile was extracted during operation for bacilli culture.Patients received the postoperative symptomatic treatments,including anti-inflammation,hemostasis,liver protection,acid inhibition and nutritional support.The observation indicators included reoperation reasons,operation method,operation time,volume of intraoperative blood loss and transfusion,hepatic inflow occlusion,stone clearance rate,postoperative complications and treatments,bacilli culture of bile,results of pathological examination and duration of hospital stay,results of follow-up.The follow-up using outpatient examination and telephone interview was performed to detect postoperative living conditions and results of abdominal ultrasound once every 3 or 6 months in patients without stone residue and once every 1 month in patients with stone residue from postoperative week 6 to December 2015.Measurement data with normal distribution and with skewed distribution were represented as x ± s and M (range),respectively.Results (1) Reasons of reoperation:85 patients had stone residue or recurrence,including 7 combined with stenosis of bilioenteric anastomosis,5 with secondary malignant biliary tumors and 2 with gastrointestinal stromal tumor invading intrahepatic bile duct.(2) Intraoperative status of reoperation:of 85 patients,25 received partial hepatectomy + stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage,21 received partial hepatectomy + stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,13 received stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage,8 received stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,5 received partial hepatectomy + removal of former bilioenteric anastomosis + choledochoscopy exploration + T-tube drainage,4 received former intestinal Y-loop resection + stones removal by choledochoscopy + Roux-en-Y hepaticojejunostomy,3 received stones removal by incising intrahepatic bile duct + choledochoscopy exploration + T-tube drainage,3 received partial hepatectomy + residual gallbladder resection + stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,2 received partial hepatectomy + residual gallbladder resection + stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage and 1 received residual gallbladder resection + removal of former bilioenteric anastomosis + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy.Operation time and volume of intraoperative blood loss of the 85 patients were (259 ± 66) minutes and (180 ± 142) mL,respectively.Seven patients underwent intraoperative blood transfusion and 17 underwent first hepatic hilum occlusion.ALl the 85 patients received intraoperative choledochoscopy exploration.The immediate and final stone clearance rates were 62.4％ (53/85) and 87.0％ (67/77).(3) Postoperative status of reoperations:of 85 patients,45 had postoperative complications.Sixteen patients with incision infection were improved by wound drainage and dressing,anti-infection and supporting treatments without other treatments.Ten patients with pleural effusion were out of hospital after effective anti-infection and nutritional support treatments.Eight patients with biliary fistula were discharged from hospital after abdominal drainage.Six patients with incision infection combined with pleural effusion were discharged from hospital after wound drainage and dressing,anti-infection and nutritional support treatments.Among 5 patients with bile duct bleeding,1 was self-healing,1 underwent reoperation and 3 were improved by conservative treatment.The bacilli culture of bile in 68 patients was positive,and bacteria mainly consisted of Escherichia coli,Enterobacter cloacae,Pseudomonas aeruginosa and Klebsiella pneumoniae.Of 85 patients,78,5 and 2 patients were respectively confirmed with hepatolithiasis,bile duct cell adenocarcinoma combined with stone recurrence and choledocholithiasis combined with interstitialoma by pathological examination.Duration of hospital stay was (21 ±8)days.(4) Results of follow-up:77 patients were followed up for a median time of 32 months (range,6-108 months) with an overall follow-up rate of 90.6％ (77/85).During follow-up,50 patients had good survival,27 had poor survival including 11 with stone residue,9 with stone recurrence and 7 with bile duct canceration,and 7 died of no operation of secondary tumors.Conclusions Stone residue and recurrence are the main reasons for reoperation.The individualized surgical methods are determined according to preoperative stone distribution,with or without atrophy of liver lobe,with or without canceration and condition of liver function,which can increase the stone clerance rate,reduce the stone residue and recurrence rates and avoid reoperation.

Expression of Total Vascular Endothelial Growth Factor and the Anti-angiogenic VEGF 165 b Isoform in the Vitreous of Patients with Retinopathy of Prematurity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study was to examine the expression of total vascular endothelial growth factor (VEGF) and the anti-angiogenic VEGF 165 b isoform in the vitreous body of retinopathy of prematurity (ROP) patients, and to further study the role of the VEGF splicing in the development of ROP.</p><p><b>METHODS</b>This was a prospective clinical laboratory investigation study. All patients enrolled received standard ophthalmic examination with stage 4 ROP that required vitrectomy to collect the vitreous samples. The control samples were from congenital cataract patients. The expression of total VEGF and the anti-angiogenic VEGF 165 b were measured by enzyme-linked immunosorbent assay. Results were analyzed statistically using nonparametric tests.</p><p><b>RESULTS</b>The total VEGF level was markedly elevated in ROP samples while VEGF 165 b was markedly decreased compared to control group. The relative protein expression level of VEGF 165 b isoform was significantly decreased in ROP patients which were correlated with the ischemia-induced neovascularization.</p><p><b>CONCLUSIONS</b>There was a switch of VEGF splicing from anti-angiogenic to pro-angiogenic family in ROP patients. A specific inhibitor that more selectively targets VEGF 165 and controls the VEGF splicing between pro- and anti-angiogenic families might be a more effective therapy for ROP.</p>