Search

Idiopathic pulmonary fibrosis (IPF) is a fibrotic interstitial lung disease in which collagen progressively deposits in the supporting framework of the lungs. The pathological collagen creates a recalcitrant barrier in mesenchyme for drug penetration, thus greatly restricting the therapeutical efficacy. On the other hand, this overloaded collagen is gradually exposed to the bloodstream at fibrotic sites because of the vascular hyperpermeability, thus serving as a potential target. Herein, pathological collagen targeting and penetrating liposomes (DP-CC) were constructed to deliver anti-fibrotic dual drugs including pirfenidone (PFD) and dexamethasone (DEX) deep into injured alveoli. The liposomes were co-decorated with collagen binding peptide (CBP) and collagenase (COL). CBP could help vehicle recognize the pathological collagen and target the fibrotic lungs efficiently because of its high affinity to collagen, and COL assisted in breaking through the collagen barrier and delivering vehicle to the center of injured sites. Then, the released dual drugs developed a synergistic anti-fibrotic effect to repair the damaged epithelium and remodel the extracellular matrix (ECM), thus rebuilding the lung architecture. This study provides a promising strategy to deliver drugs deep into pathological collagen accumulated sites for the enhanced treatment of IPF.

Cerebral ischemia-reperfusion (CI/R) injury is a serious complication when treating patients experiencing ischemic stroke. Although the microRNA miR-27a-3p reportedly participates in ischemia/reperfusion (I/R) injury, its actions in CI/R remain unclear. To mimic CI/R in vitro, HT22 cells were subjected to oxygen glucose deprivation/reoxygenation (OGD/R). The results indicate that OGD inhibited growth and induced apoptosis among HT22 cells. The apoptosis was accompanied by increases in activated caspases 3 and 9 and decreases in Bcl-2. Oxidative stress was also increased, as indicated by increases in ROS and malondialdehyde and decreases in glutathione and superoxide dismutase. In addition, OGD induced G1 arrest in HT22 cells with corresponding upregulation of FOXO1 and p27 Kip1, suggesting the cell cycle arrest was mediated by FOXO1/p27 Kip1 signaling. Notably, FOXO1 was found to be the direct target of miR-27a-3p in HT22 cells. MiR-27a-3p was downregulated in OGD/R-treated HT22 cells, and miR-27a-3p mimics partially or entirely reversed all of the in vitro effects of OGD. Moreover, miR-27a-3p agomir significantly alleviated the symptoms of CI/R in vivo in a rat model of CI/R. Thus, MiR-27a-3p appears to suppress CI/R injury by targeting FOXO1.

There is accumulating evidence suggesting that an autoimmune component is involved in esophageal achalasia. An increase in immune cells, cytokines, chemokines, and autoimmune antibodies in serum and infiltration of immune cells in tissues support the view that immune-mediated inflammation is a crucial pathogenesis of inhibitory neuron degeneration in the lower esophageal sphincter. Infection of viruses such as the herpes virus family has been suspected of provoking the autoimmune reaction. Meanwhile, previous reports on immunogenetics have proposed that specific risk alleles on the human leukocyte antigen complex define the susceptible population to achalasia. In this study we reviewed current knowledge regarding the immune-related factors of achalasia, including immunology, viral infection and immunogenetic variations.

Cisplatin, as one of the most effective chemotherapeutic agents, its clinical use is limited by serious side effect of nephrotoxicity. Cisplatin‐induced nephrotoxicity is closely related to apoptosis induction and activation of caspase. The present study aimed to explore the potential protective effect of ginsenoside Rk1 (Rk1), a rare ginsenoside generated during steaming ginseng, on cisplatin‐induced nephrotoxicity and the underlying mechanisms in human embryonic kidney 293 (HEK‐293) cells. Our results showed that the reduced cell viability induced by cisplatin could significantly recover by Rk1. Furthermore, glutathione (GSH) as an oxidative index, was elevated and the lipid peroxidation product malondialdehyde (MDA) was significantly decreased after Rk1 treatment compared to the cisplatin group. Additionally, Rk1 can also decrease the ROS fluorescence expression and increase the protein levels of nuclear factor erythroid 2‐related factor 2 (Nrf2) and heme oxygenase‐1 (HO‐1) compared to the cisplatin group, which suggested a suppression of oxidative response. More importantly, the cisplatin‐induced elevated protein levels of Bax, cleaved caspase‐3, cleaved caspase‐9, and decreased protein level of Bcl‐2 were reversed after treatment with Rk1. Our results elucidated the possible protective mechanism of Rk1 for the first time, which may involve in its anti‐oxidation and anti‐apoptosis effects.

Previous studies have suggested that pathogenic variants in interferon regulatoryse factor 6 (IRF6) can account for almost 70% of familial Van der Woude Syndrome (VWS) cases. However, gene modifiers that account for the phenotypic variability of IRF6 in the context of VWS remain poorly characterized. The aim of this study was to report a family with VWS with variable expressivity and to identify the genetic cause. A 4‑month‑old boy initially presented with cleft palate and bilateral lower lip pits. Examination of his family history identified similar, albeit milder, clinical features in another four family members, including bilateral lower lip pits and/or hypodontia. Peripheral blood samples of eight members in this three‑generation family were subsequently collected, and whole‑exome sequencing was performed to detect pathogenic variants. A heterozygous missense IRF6 variant with a c.1198C>T change in exon 9 (resulting in an R400W change at the amino acid level) was detected in five affected subjects, but not in the other three unaffected subjects. Moreover, subsequent structural analysis was indicative of damaged stability to the structure in the mutant IRF protein. Whole‑transcriptome sequencing, expression analysis and Gene Ontology enrichment analysis were conducted on two groups of patients with phenotypic diversity from the same family. These analyses identified significant differentially expressed genes and enriched pathways in these two groups. Altogether, these findings provide insight into the mechanism underlying the variable expressivity of VWS.

Deletion of mitochondrial DNA in eukaryotes is currently attributed to rare accidental events associated with mitochondrial replication or repair of double-strand breaks. We report the discovery that yeast cells arrest harmful intramitochondrial superoxide production by shutting down respiration through genetically controlled deletion of mitochondrial oxidative phosphorylation genes. We show that this process critically involves the antioxidant enzyme superoxide dismutase 2 and two-way mitochondrial-nuclear communication through Rtg2 and Rtg3. While mitochondrial DNA homeostasis is rapidly restored after cessation of a short-term superoxide stress, long-term stress causes maladaptive persistence of the deletion process, leading to complete annihilation of the cellular pool of intact mitochondrial genomes and irrevocable loss of respiratory ability. This shows that oxidative stress-induced mitochondrial impairment may be under strict regulatory control. If the results extend to human cells, the results may prove to be of etiological as well as therapeutic importance with regard to age-related mitochondrial impairment and disease.

The occurrence of cancer metastasis may be related to stem cells in normal tissues. We searched for patient IDs with both normal tissue stem cell values and TCGA (The Cancer Genome Atlas) clinical data for pairing and obtained 639 sets of data (stemness index of normal tissue, stemness index of tumor tissue, cancer stage, distant metastasis, tumor size) and invasion, and lymph node involvement). However, clinical data on cancer metastasis are of only four stages (e.g., Stage I, II, III, and IV), which cannot show subtle changes continuously. We need to find an effective data mining method to transform this four-valued clinical description into a numerical curve. We data-mine this data through numericalization, sorting, and noise reduction filtering. The results showed that: as the normal tissue stemness value (NS) increased, the tumor tissue stemness value (TS) increased proportionally (1.26 times NS). When NS >0.5, the rate of change in TS decelerated (0.43 times NS), and tumor metastasis began to occur. Clinical indicators, such as cancer stage, distant metastasis, tumor size and invasion, and lymph node involvement, showed that tumor metastasis became more and more severe with the increase of NS. This study suggests that tumor metastasis is triggered when the NS in the patient’s body is more significant than 0.5.

Background: In our previous study, Hibiscus syriacus leaf tissue was successfully cultivated in an optimized callus culture system, and subsequently extracted with 70% ethanol to prepare H. syriacus callus extract (HCE). The previous study suggested that the callus culture is useful method for obtaining the anti-inflammatory ingredients from H. syriacus. Purpose: In the present study, we aimed to investigate the effect of HCE on the colorectal cancer (CRC) and its underlying mechanism of action using HT-29 cells and thymus-deficient mice bearing HT-29 xenografts. Methods: The cytotoxicity of HCE was investigated by MTT and colonies formation. The underling mechanism by which HCE regulates specific proteins in HT-29 cells was evaluated by the proteomic analysis. These putative proteins were validated using qRT-PCR and immunoblotting analyses. Subsequently, oral administration of HCE for 15 days further evaluating the anti-tumor activity by mRNA and protein expressions levels and tumor histopathology. Results: Results of cell viability and colony formation assays revealed a significant cytotoxic effect of HCE at doses below 100 μg/mL against HT-29 cells, but not against normal cells. Through differential protein expression analysis, signaling pathways underlying anti-CRC activity were predicted in HCE-treated HT-29 cells: Notch signaling, cholesterol biosynthesis, and AMPK signaling pathways. qRT-PCR and immunoblotting analyses indicated that the cytotoxic effect of HCE against HT-29 cells might be associated with the suppression of Notch signaling, which positively contributes to cholesterol biosynthesis. To our knowledge, this can be presented as the first study to demonstrate the detailed relationship between Notch signaling and cholesterol-AMPK signaling. Our in vivo result further corroborated the in vitro finding that 100 and 200 mg/kg HCE for 15 days exerts its anti-cancer effect via Notch signaling-mediated suppression of cholesterol synthesis without systemic toxicity. Conclusion: Our findings can serve as a starting point for developing the novel anti-CRC agent using HCE, as a targeted medicine acting on regulating Notch signaling and cholesterol synthesis.

Dental pulp stem cells (DPSCs) play a vital role in tooth restoration, regeneration, and homeostasis. The link between DPSC senescence and tooth aging has been well‐recognized. ROR2 plays an important role in aging‐related gene expression. However, the expression and function of ROR2 in DPSC aging remain largely unknown. In this study, we found that ROR2 expression was significantly decreased in aged pulp tissues and DPSCs. The depletion of ROR2 in young DPSCs inhibits their self‐renewal capacity, while its overexpression in aged DPSCs restores their self‐renewal capacity. Interestingly, we found that sphingomyelin (SM) is involved in the senescence of DPSCs regulated by ROR2. Mechanistically, we confirmed that ROR2 inhibited the phosphorylation of STK4, which promoted the translocation of Forkhead Box O1 (FOXO1) to the nucleus. STK4 inhibition or knockdown of FOXO1 markedly increased the proliferation of DPSCs and upregulated the expression of SMS1, which catalyzed SM biogenesis. Moreover, FOXO1 directly bound to the SMS1 promoter, repressing its transcription. Our findings demonstrated the critical role of the ROR2/STK4‐FOXO1/SMS1 axis in the regulation of SM biogenesis and DPSC senescence, providing a novel target for antagonizing tooth aging., Proposed hypothesis for ROR2 suppressing ageing process by promoting sphingomyelin synthesis through inactivating STK4/FOXO1 signallingin in DPSCs. ROR2 decreases with age, and overexpression of ROR2 restores the differentiation and regeneration of senescent DPSC. ROR2 prevents the translocation of FOXO1 to the nucleus by inhibiting STK4 phosphorylation. FOXO1 binds to the promoter of SMS1, which catalyzes SM biogenesis, and represses its transcription. The ROR2/STK4‐FOXO1/SMS1 axis regulated SM biogenesis and DPSC senescence.

Background:. Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome. Methods:. A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11–34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision. Results:. A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = −1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = −1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = −1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = −55.23, P

Dye sensitization achieving photoelectrochemical (PEC) signal amplification for ultrasensitive bioanalysis has undergone a major breakthrough. In this proposal, an innovative PEC sensing platform is developed by combining Z-scheme WO3@SnS2 photoactive materials and a G-wire superstructure as well as a dye sensitization enhancement strategy. The newly synthesized WO3@SnS2 heterojunction with outstanding PEC performance is employed as a photoelectrode matrix. Due to the formation of the Z-scheme heterojunction between WO3 and SnS2, the migration dynamics of the photogenerated carrier is evidently augmented. To improve sensitivity, the target excision-driven dual-cycle signal amplification strategy is introduced to output exponential c-myc fragments. Crystal violet is then conjugated into the G-quadruplex to amplify the PEC signal, where crystal violet generates excited electrons by capturing visible light and rapidly injects electrons into the conduction band of SnS2, suppressing the recombination of the photo-induced carrier. Moreover, the G-wire superstructure acts as a universal amplification pathway, ensuring adequate crystal violet loads. Specifically, the biosensor for uracil-DNA glycosylase quantification displays a wide detection range (0.0005-1.0 U/mL) and a lower detection limit (0.00025 U/mL). Furthermore, the Z-scheme electron migration mechanism and the crystal violet sensitization effect are discussed in detail. The construction of the PEC sensor provides a new consideration for signal amplification and material design.

While retrotransposons must activate in developing gametes in order to survive and propagate, how a retrotransposon selectively activates in the context of meiosis is unclear. These mobile genetic elements can promote evolutionary innovations, but their unchecked proliferation is catastrophic for their host. Consequently, organisms have developed elegant mechanisms to counteract retrotransposon proliferation. In this manuscript, we demonstrate that both transcriptional activation of Ty3/Gypsy retrotransposons and host defense are controlled by master meiotic regulators. We show that Ty3 retrotransposons in budding yeast co-opt binding sites of the essential meiotic transcription factor Ndt80 upstream of the integration site, thereby tightly linking their transcriptional activation to meiotic progression. Our results raise the question of how yeast protects the genomes of its developing gametes from retrotransposon proliferation during meiosis. We elucidate how yeast cells thwart the Ty3/Gypsy retrotransposition life cycle by blocking translation of the retrotransposon mRNA using amyloid-like assemblies of the RNA-binding protein Rim4. In mammals, Gypsy elements have lost retrotransposition capacity. Building from our findings in yeast, we show that developing gametes in mammals also utilize essential meiotic transcription factors and assembly-forming RNA-binding proteins to regulate Gypsy-derived genes. Our findings inform how novel genes that are evolving from retrotransposons can build upon existing regulatory networks during domestication.

The aim of this review is to explore the effects of the seminar teaching method versus lecture-based learning (LBL) in the education of medical students by meta-analysis.Data and information available on PubMed, Cochrane Library, EMBASE, MEDLINE, China National Knowledge Infrastructure, WanFang Data, China Science Periodical Database, and Chinese BioMedical were searched and examined from the inception up to January 2020. Randomized controlled trials (RCTs) that investigated the effects of the seminar teaching method versus LBL in medical education were included.A total of 16 RCTs were included, with a total sample size of 1122 medical students. The seminar teaching method significantly improved knowledge scores (SMD = 1.38, 95%CI 0.92-1.84;This meta-analysis showed that the seminar teaching method is an effective method for improving knowledge scores, skill scores, active learning ability, student collaboration, classroom atmosphere, and interaction between teachers and students.

To assess the prevalence of calcification surrounding the odontoid process (odontoid calcification) with crowned dens syndrome (CDS) and without CDS (non-CDS) and investigate factors that may related to the onset of CDS.Retrospective review of consecutive patients visited Sir Run Run Shaw Hospital between 1 January 2018 and 5 November 2019 who were identified to have odontoid calcification on cervical computed tomography (CT) images. Those who presented with an acute or subacute episode of cervico-occipital pain were defined as CDS, others were non-CDS.We diagnosed 69 cases of odontoid calcification among 2902 cervical CTs of 2556 patients (69/2556, 2.70%), 19 (19/2556, 0.74%) cases of which were CDS, 50 (50/2556, 1.96%) cases were non-CDS. Mean age was 71 (54-86) years old in odontoid calcification patients. The male-to-female ratio of patients with odontoid calcification was 27:42 (0.64). The prevalence of odontoid calcification was 69/1497 (6.14%) in individuals over 50 years old, The prevalence was 0.59% (4/679), 5.05% (26/515), 11.49% (27/235) and 20% (12/60) in patients aged 50-59, 60-69, 70-79 and 80-89 years old, respectively. Age and female gender were predictive factors of odontoid calcification. Lower hemoglobin (Hgb), red blood cell count (RBC), higher C-reactive protein (CRP), pain scale score were found in CDS patients comparing with non-CDS group. No difference of age, gender, hypertension, diabetes mellitus, smoking, alcohol history, creatinine, white blood cell count, mean corpuscular volume, uric acid, calcium was found between the two groups.Odontoid calcification is a common radiological entity in patients older than 50 years. Lower Hgb, RBC, higher CRP, pain scale score were found in CDS patients comparing with non-CDS.

Objective Reversible splenial lesion syndrome (RESLES) is a clinical radiological syndrome characterized by a reversible lesion of the splenium of the corpus callosum with a decreased apparent diffusion coefficient (ADC) value. The clinical manifestations of RESLES are diverse. Methods Fifteen cases of adult RESLES patients (10 males and 5 females) were retrospectively selected from the radiology system using the key word "corpus callosum" at a university-affiliated tertiary care hospital between May 1, 2015 and December 31, 2019. The possible precipitating factors, clinicoradiological findings and modified Rankin Scale (mRS) on follow-up were then analyzed. Results The patient ages ranged from 22 to 53 years old. The mean age was 34 years old. The most common neurological symptoms included headache (3/15), dizziness (3/15), first onset of seizure (3/15), paroxysmal blurred vision (2/15), vertigo (2/15), amnesia (2/15), and confused consciousness without seizure (2/15), followed by drowsiness (1/15), paresthesia (1/15), dysmetria (1/15) and dysarthria (1/15). The precipitating factors included infection, seizure, anti-epileptic treatment with levetiracetam, carbamazepine, valproate, hyperglycemia, hypoglycemia, cerebral venous sinus thrombosis, and rabies vaccine injection prior to the onset of RESLES. All cases were carefully followed up and had excellent prognoses. Conclusion RESLES manifests as variety of symptoms with less specificity and precipitating factors. Paroxysmal blurred vision may be a relatively specific symptom of RESLES. Levetiracetam, carbamazepine or valproate could be the cause of RESLES, exposure to the rabies vaccine could be another predisposing factors for RESLES as well. RESLES type 1 was therefore found to be highly "reversible" with an excellent prognosis.

In

Background: Tetrahydrocurcumin (THC) is the major active metabolite of curcumin, which is a dietary factor derived from Curcuma species. Our previous study demonstrated a significant beneficial effect of THC in mice with allergic asthma. Glucocorticosteroids (GCs) are commonly used drugs in asthma. Whether THC supplementation could promote the beneficial effects of GC therapy on asthma has not yet been reported. The current study aimed to investigate the combined efficacy of GC and THC treatment in a mouse model of allergic asthma. Methods: BALB/c mice were randomly divided into 5 groups: the control group, ovalbumin (OVA)-induced group, and OVA-induced mice treated with dietary THC only, intraperitoneal injection of dexamethasone (DEX) only, or THC combined with DEX. The nasal symptoms, histopathological alterations of lung tissues, lung cytokine production, and Th cell subsets were assessed. Results: THC or DEX had beneficial effects on nasal symptoms and pathological lung changes, and the therapeutic effects between THC and DEX treatment were comparable. Importantly, compared to the monotherapy groups (THC or DEX only), the combination of THC and DEX showed a significantly reduced nasal rubbing frequency, lower mucus hyperproduction, lower Th2 and Th17 cell numbers as well as lower related cytokine levels (IL-4, IL-5, and IL-17A). Conclusions: Supplementation with THC can enhance the therapeutic effects of DEX to alleviate airway symptoms, lung inflammation, and the Th2 response. Our findings suggest that dietary administration of THC could act as an add-on therapy for asthma treated with GCs.

Repressor/activator protein 1 (RAP1) is a highly evolutionarily conserved protein found at telomeres. Although yeast Rap1 is a key telomere capping protein preventing non‐homologous end joining (NHEJ) and consequently telomere fusions, its role at mammalian telomeres in vivo is still controversial. Here, we demonstrate that RAP1 is required to protect telomeres in replicative senescent human cells. Downregulation of RAP1 in these cells, but not in young or dividing pre‐senescent cells, leads to telomere uncapping and fusions. The anti‐fusion effect of RAP1 was further explored in a HeLa cell line where RAP1 expression was depleted through an inducible CRISPR/Cas9 strategy. Depletion of RAP1 in these cells gives rise to telomere fusions only when telomerase is inhibited. We further show that the fusions triggered by RAP1 loss are dependent upon DNA ligase IV. We conclude that human RAP1 is specifically involved in protecting critically short telomeres. This has important implications for the functions of telomeres in senescent cells., Human RAP1 specifically protects critically short telomeres from DNA damage response activation and telomere fusions in replicative senescent fibroblasts and tumor cells upon telomerase inhibition.

BACKGROUND Achalasia is an esophageal motility disorder with unknown etiology. Previous findings indicate that immune-mediated inflammatory process causes inhibitory neuronal degeneration. This study was designed to evaluate levels of serological cytokines and chemokines in patients with achalasia. METHODS We collected information from forty-seven patients with achalasia who underwent peroral endoscopic myotomy. Control samples were collected from forty-seven age- and sex-matched healthy people. The concentrations of serological cytokines and chemokines were analyzed by Luminex xMAP immunoassay. Serological and clinical data were compared between groups. KEY RESULTS Compared with healthy controls, achalasia patients had significantly increased concentrations of eleven cytokines and chemokines, namely, TGF-s1 (P

Acute liver injury (ALI) induced by acetaminophen (APAP) is the main cause of drug-induced liver injury. Previous reports indicated liver failure could be alleviated by saponins (ginsenosides) from

Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, causes considerable distress and worsens outcomes in rehabilitation. Although they have received the treatments such as anti-inflammatory drugs or physical therapy, many of the individuals remain suffering from shoulder pain 6 months after acute stroke event. In this retrospective study, we evaluated the effectiveness of ultrasound guided subacromial-subdeltoid (SASD) bursa injections with botulinum toxin type A (BoNT/A) compared to steroids for refractory HSP. The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. In total, 38 patients who received ultrasound guided SASD bursa injection (BoNT/A group, n = 18; corticosteroid group, n = 20) were included. The pain visual analog scale (VAS) score at rest and during arm passive abduction, Fugl-Meyer score of upper limbs (F-M score) were evaluated before, 2, 4, 8, and 12 weeks after injection. Both 2 groups obtained a significant improvement of VAS score at rest or during arms passive abduction compared to baseline score (within group compare, P .05). There were also no differences in results of the post treatment F-M score between 2 groups (between 2 groups compare, P > .05). Similarly, during the follow-up period no collateral effects were reported after BoNT/A injection. SASD bursa BoNT/A injection can substantially reduce the pain as corticosteroid in patients with HSP. BoNT/A injection could be a useful strategy for replacing steroids as a treatment for refractory HSP especially in the patients who cannot tolerate the steroids injection.

Background For patients with COPD, physical activity (PA) is recommended as the core component of pulmonary rehabilitation, but there is lack of a validated questionnaire for assessing the PA effectively. Aim To evaluate the reliability and validity of the Chinese version of Physical Activity Scale for the Elderly (PASE-C) in patients with COPD. Methods A cross-sectional study was conducted with 167 outpatients aged 60 years or older with COPD. Test−retest reliability and internal consistency were calculated by intraclass correlation coefficient (ICC) and Cronbach’s coefficient α, respectively. Validity was evaluated by correlation with the International Physical Activity Questionnaire-Short (IPAQ-S), data of pedometer, Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), grip strength, and disease characteristics. Results The PASE-C had an excellent seven-day test−retest reliability (ICC=0.98) and an acceptable internal consistency (Cronbach’s α=0.71). The content validity was supported by an item-content validity index, a scale-content validity index/universal agreement, and a scale-content validity index/average value of 0.70–1, 0.70, and 0.93, respectively. Concurrent validity was tested by correlation with IPAQ-S (r=0.651). Criterion validity was confirmed by correlation with the walking steps (r=0.611) and energy expenditure (r=0.493). For construct validity, PASE-C had correlations with SES6 (r=0.396), HADS for depression (r=−0.234), seven subscales of SF-36 (r=0.182–0.525), grip strength (r=0.341), and disease characteristics including the duration of COPD (r=−0.215), modified British Medical Research Council scale (r=−0.354), forced expiratory volume in one second as percentage of predicted (r=0.307), and Global Initiative for Chronic Obstructive Lung Disease grade (r=−0.264), with a good construct validity (all P, Video abstract

To systematically review the current status of application of acupuncture in low back pain guidelines.The computer retrieval was conducted in PubMed, Cochrane Library, EMbase, China Journal Full Text Database (CNKI), China Biomedical Literature Database (CBM), VIP, Wanfang, guidelines databases, and the official websites of WHO and academic organizations (American Pain Society, American College of Physicians, etc.). After screening, the basic information and acupuncture-related issues in the guidelines that met the inclusion criteria were extracted and compared by using Excel software.A total of 35 low back pain guidelines were included. ① One guideline was published before 2000, 16 guidelines were published from 2000 to 2010, and 18 guidelines were published from 2011 to 2017; 17 guidelines were published by the United States, 4 by Canada and China, 2 by New Zealand, the United Kingdom, and Europe, and 1 by Netherlands, Philippines, Denmark and Italy. ② Twenty-three guidelines were evidence-based guidelines, which was developed mainly by system review, meta-analysis and expert consultation, involving diagnosis, treatment, primary care of low back pain. ③ Acupuncture was mentioned in 23 guidelines, of them, 7 guidelines recommended acupuncture, 6 guidelines indicated that acupuncture might be considered under certain conditions such as combined with other therapies or patients were interested in acupuncture, however, 10 guidelines did not recommended acupuncture for low back pain.The guidelines of low back pain are mainly developed by Europe countries and the United States, and the majority is published in the last 20 years. Among them, 20% of the guidelines have recommend acupuncture for low back pain.

Background Serum triiodothyronine (T3) concentration was reported to be associated with the prognosis after acute ischemic stroke. The aim of this study was to evaluate the effect of age on the prognostic value of thyroid-related hormones after an acute ischemic stroke. Methods This was a retrospective study involving the review of 1072 ischemic stroke patients who had been consecutively admitted to the hospital within 72 h of symptom onset. Total triiodothyronine (T3), total thyroxine (T4), free T3, free T4, and thyroid-stimulating hormone (TSH) were assessed to determine their values for predicting functional outcome at the first follow-up clinic visits, which usually occurred 2 to 4 weeks after discharge from the hospital. Results A total of 768 patients were finally included in the study and divided into two age groups: a younger group (age

Background Clarithromycin-resistance is becoming a global health concern in the treatment of Helicobacter pylori (H. pylori). The mutant prevention concentration (MPC) represent the propensities of antimicrobial agents to select resistant mutants. The concentration range between the minimum inhibitory concentration (MIC) and the MPC is defined as mutant selection window (MSW). In this study, we aimed to determine the cause of increasing clarithromycin resistance by investigating the MSW for clinical isolates of H. pylori. Results A retrospective subgroup, which included 68 clarithromycin-sensitive H. pylori strains, was selected from a double-blind trial. The MICs and MPCs were determined using agar plate assays. Genotypic tests were performed using Sanger sequencing. All isolates were wild-type, and 33.82% (23/68) had a 0.016 mg/L MIC, 45.59% (31/68) had a 0.031 mg/L MIC, 16.18% (11/68) had a 0.062 ≤ MIC ≤ 0.125 mg/L, and 4.41% (3/68) had a 0.25 mg/L MIC. The MPC50/90 (mg/L) of the isolates were: 0.062/0.125, 0.125/0.5, 0.25/0.25 and 1/2, respectively. The MPCs showed a moderate correlation with the MICs (r s = 0.65, P

To assess the prevalence and related factors of benign paroxysmal positional vertigo (BPPV) in patients with spontaneous intracranial hypotension (SIH).We retrospectively reviewed 156 consecutive inpatients with SIH, and collected the clinical and radiological data. These patients were divided into BPPV group and non-BPPV group according to the clinical manifestation and the results of Dix-Hallpike or supine roll tests during hospitalization period. We performed a univariate analysis and a further multiple logistic regression analysis to identify the related factors of the development of BPPV in SIH patients.BPPV was detected in 18 patients among the total 156 SIH patients (11.54%). The univariate analysis showed a low cerebrospinal fluid (CSF) pressure (P = 0.018), a small pontomesencephalic angle (P = 0.012) and a positive venous distension sign (VDS) (P = 0.045) were associated with the presence of BPPV. But the multivariate analysis only demonstrated a low CSF pressure was related to the presence of BPPV (OR = 1.022, 95% CI: 1.001-1.043, P = 0.044).BPPV is common in SIH patients. SIH patients with low CSF pressure may be prone to develop BPPV.

To investigate the effectiveness and safety of Xingnaojing Injection (XNJ, ) compared with naloxone for the treatment of acute alcohol intoxication (AAI), and provide the latest evidence through evidence-based approach.Seven electro-databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure Databases, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database (VIP) and Wanfang Database were searched from the inception to January 2018. Randomized controlled trials (RCTs) comparing XNJ with naloxone for patients with AAI and reporting at least one of the below outcomes were included: patients' conscious recovery time, stay length in emergency department, disappearance time of the ataxia symptom, the severity of the symptoms, the blood alcohol content as well as the adverse events. Methodological quality of included trials was assessed using the risk of bias tool which recommended by the Cochrane Collaboration. Meta-analysis was conducted by Review Manager 5.3 software.Totally 141 trials with 13,901 patients were included in this review, all of them were assessed as unclear or high risk of bias. Results showed that on the basis of routine therapy, standard dose XNJ (10-20 mL) may have similar results with naloxone on the recovery time of consciousness (MD 12 min, 95% CI 7.2-17.4 min) and disappearance time of symptoms (MD 6 min, 95% CI-13.8-25.8 min) for patients with AAI. Larger dose of XNJ Injection (21-40 mL) may speed up the time (almost 1 h earlier). Combination of XNJ and naloxone seemed superior to the naloxone alone for all the relevant outcomes. The average difference of time in consciousness recovery was 2 h and the number of AAI patients whose consciousness recovery within 1 h was above 50% the combination group than in the control group (RR 1.42, 95% CI 1.29 to 1.56). No severe adverse events or adverse reactions of XNJ were reported in the included trials.Low quality of evidence showed XNJ may have equal effect as naloxone and may achieve better effect as add-on intervention with naloxone for patients with AAI. We failed to evaluate the safety of XNJ Injection due to the insufficient evidence in this review. Registration number. in PROSPERO (No. CRD42018087804).

OBJECTIVE: To study the effect of Bifidobacterium on the expression of β-defensin-2(BD-2) in intestinal tissue of neonatal rats with necrotizing enterocolitis(NEC). METHODS: A total of 40 rats were randomly divided into four groups:normal control, Bifidobacterium control, NEC model, and Bifidobacterium treatment, with 10 rats in each group.A rat model of NEC was induced by hypoxia, cold stimulation, and artificial feeding.The rats in the Bifidobacterium control and Bifidobacterium treatment groups were given Bifidobacterium via the gastric tube after cold stimulation once a day for three consecutive days.The morphological changes of the terminal ileum were observed under a light microscope and the intestinal injury score was determined.Immunohistochemistry and qRT-PCR were used to measure the protein and mRNA expression of BD-2 in the ileal mucosal tissue. RESULTS: The NEC model group had a significantly higher intestinal injury score than the normal control, Bifidobacterium control, and Bifidobacterium treatment groups(P < 0.05).The Bifidobacterium treatment group had a significantly higher intestinal injury score than the normal control and Bifidobacterium control groups(P < 0.05).The mRNA and protein expression of BD-2 in the normal control group was significantly lower than in the Bifidobacterium control, NEC model, and Bifidobacterium treatment groups(P < 0.05).The Bifidobacterium control group had significantly higher mRNA and protein expression of BD-2 than the NEC model and Bifidobacterium treatment groups(P < 0.05).The Bifidobacterium treatment group had significantly higher mRNA and protein expression of BD-2 than the NEC model group(P < 0.05). CONCLUSIONS: Bifidobacterium can induce the expression of BD-2 in intestinal tissue of rats and reduce inflammatory response by increasing the expression of BD-2.This provides a protective effect on neonatal rats with NEC.

Supplemental Digital Content is available in the text

The differential diagnosis of Parkinson's diseases (PD) is challenging, especially in the early stages of the disease. We developed a microRNA profiling strategy for exosomal miRNAs isolated from cerebrospinal fluid (CSF) in PD and AD. Sixteen exosomal miRNAs were up regulated and 11 miRNAs were under regulated significantly in PD CSF when compared with those in healthy controls (relative fold > 2, p < 0.05). MiR-1 and miR-19b-3p were validated and significantly reduced in independent samples. While miR-153, miR-409-3p, miR-10a-5p, and let-7g-3p were significantly over expressed in PD CSF exosome. Bioinformatic analysis by DIANA-mirPath demonstrated that Neurotrophin signaling, mTOR signaling, Ubiquitin mediated proteolysis, Dopaminergic synapse, and Glutamatergic synapse were the most prominent pathways enriched in quantiles with PD miRNA patterns. Messenger RNA (mRNA) transcripts [amyloid precursor protein, APP), α-synuclein (α-syn), Tau, neurofilament, light gene (NF-L), DJ-1/PARK7, Fractalkine and Neurosin] and long non-coding RNAs (RP11-462G22.1 and PCA3) were differentially expressed in CSF exosomes in PD and AD patients. These data demonstrated that CSF exosomal RNA molecules are reliable biomarkers with fair robustness in regard to specificity and sensitivity in differentiating PD from healthy and diseased (AD) controls.

Objective: Spontaneous intracranial hypotension (SIH) is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid (CSF) pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure (CSF OP) and explore the factors affecting CSF OP in SIH patients. Methods: We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables (including demographic data, body mass index (BMI), duration of symptoms, and brain imaging findings). Univariate and multivariate analyses were performed to identify the potential factors affecting CSF OP. Results: In a total of 114 (55.3%) cases the CSF OP was ≤60 mmH2O (1 mmH2O=9.806 65 Pa), in 90 (43.7%) cases it was between 60 and 200 mmH2O, and in 2 (1.0%) cases it was >200 mmH2O. Univariate analysis showed that the duration of symptoms (P

Background. Oxidative stress could induce cell injury in vascular endothelial cells, which is the initial event in the development of atherosclerosis. Although quantitative real-time polymerase chain reaction (qRT-PCR) has been widely used in gene expression studies in oxidative stress injuries, using carefully validated reference genes has not cause sufficient attention in related researches. The objective of this study, therefore, was to select a set of stably expressed reference genes for use in qRT-PCR normalization in oxidative stress injuries in human umbilical vein endothelial cells (HUVECs) induced by hydrogen peroxide (H2O2). Methods. HUVECs were treated with different concentrations of H2O2, geNorm and NormFinder software were conducted to evaluate the expression stabilities of 15 candidate reference genes. The optimal number of reference genes needed for qRT-PCR was determined using geNorm. Results. Using geNorm analysis, we found that five stably expressed reference genes were sufficient for normalization in qRT-PCR analysis in HUVECs treated with H2O2. Genes with the most stable expression according to geNorm were U6 and TFRC, RPLP0, GAPDH and ACTB, and were ALAS1, TFRC, U6, GAPDH, and ACTB according to NormFinder. Discussion. Taken together, our study demonstrated that the expression stability of reference genes may differ according to the statistical program used. U6, TFRC, RPLP0, GAPDH, and ACTB was the optimal set of reference genes for studies on gene expression with qRT-PCR assays in HUVECs under oxidative stress study.

Real-world tolerability and effectiveness of nebivolol as first add-on therapy were compared with hydrochlorothiazide, metoprolol, and amlodipine. Medical records of hypertensive adults initiating nebivolol, hydrochlorothiazide, metoprolol, or amlodipine as first add-on therapy between December 16, 2010 and July 21, 2011 were retrospectively abstracted (N = 1600; 400/treatment). Outcomes included medication-related side-effect rates and blood pressure (BP) reduction and control. Compared with nebivolol, metoprolol and amlodipine had significantly higher side-effect rates (incidence rate ratio [95% CI]: 1.82 [1.14-2.92] and 2.67 [1.69-4.21]), respectively); the hydrochlorothiazide-nebivolol rate ratio was not significant (1.61 [0.95-2.71]). All treatments reduced BP at 2 months. Metoprolol, amlodipine, and hydrochlorothiazide were associated with significantly lower odds of achieving 2-month BP control than nebivolol (odds ratios [95% CI]: 0.34 [0.23-0.51], 0.51 [0.35-0.75] and 0.66 [0.44-0.99], respectively). In a real-world setting, nebivolol as first add-on therapy was associated with fewer side effects than metoprolol or amlodipine and with a higher BP control rate than hydrochlorothiazide, metoprolol, or amlodipine.

PTENP1, a pseudogene of PTEN, was previously reported to be a tumour suppressor in some cancer types. However, there was no evidence for the biological function and expression of PTENP1 in head and neck squamous cell carcinoma (HNSCC). Here, we evaluated the function and clinical implications of PTENP1 in HNSCC. Using RT-PCR and quantitative real-time PCR (qRT-PCR), we found that the level of PTENP1 was reduced in HNSCC specimens compared with adjacent tissues. A decrease in the PTENP1 copy number, but not in the PTEN copy number, was frequently observed in tumour cell lines (4 of 5 cell lines) by genomic real-time PCR. Decreased PTENP1 expression was significantly associated with a history of alcohol use (P = 0.034). Univariate and multivariate Cox regression analyses revealed that low expression of PTENP1 correlated with worse overall survival (OS, P = 0.005; HR:0.170; Cl:0.049 to 0.590) and disease-free survival (DFS, P = 0.009; HR:0.195; Cl:0.057 to 0.664) rates of HNSCC patients. Furthermore, ectopic PTENP1 expression inhibited the proliferation, colony formation and migration of HNSCC cells and the growth of xenograft HNSCC tumours. These results demonstrate that PTENP1 might play an important role in the initiation and progression of HNSCC.

Histone lysine-to-methionine (K-to-M) mutations are associated with multiple cancers, and they function in a dominant fashion to block the methylation of corresponding lysines on wild type histones. However, their mechanisms of function are controversial. Here we show that in fission yeast, introducing the K9M mutation into one of the three histone H3 genes dominantly blocks H3K9 methylation on wild type H3 across the genome. In addition, H3K9M enhances the interaction of histone H3 tail with the H3K9 methyltransferase Clr4 in a SAM (S-adenosyl-methionine)-dependent manner, and Clr4 is trapped at nucleation sites to prevent its spreading and the formation of large heterochromatin domains. We further determined the crystal structure of an H3K9M peptide in complex with human H3K9 methyltransferase G9a and SAM, which reveales that the methionine side chain had enhanced van der Waals interactions with G9a. Therefore, our results provide a detailed mechanism by which H3K9M regulates H3K9 methylation. DOI: http://dx.doi.org/10.7554/eLife.17903.001, eLife digest Cells switch their genes on or off in order to respond to changes in their environment. A group of proteins called histones are partly responsible for regulating gene activity. Like all proteins, histones are made from smaller building blocks called amino acids. Enzymes can chemically modify specific amino acids in histone proteins, which allows the histones to switch nearby genes on or off. One of these modifications is called methylation, and the methylation of specific “lysine” amino acids in histone proteins regulates gene activity in different ways. Previous research has shown that, in certain types of cancer cells, lysines that can be methylated are often replaced with another amino acid, a methionine. These substitutions stop the histones from correctly controlling the activity of nearby genes because methionine cannot be methylated like lysine. Additionally, even if only a small number of histones have methionine in place of lysine, this change can have a widespread effect because the few histones with the methionine can block other histones from being methylated too. However, previous studies did not provide a clear mechanism for why this is the case. In the fission yeast Schizosaccharomyces pombe an enzyme called Clr4 methylates a histone protein at a lysine named H3K9. Now, Shan, Wang, Xu et al. show that substituting this lysine with a methionine (referred to as H3K9M) stops the widespread methylation of histones by trapping the Clr4 enzyme. Specifically, Clr4 becomes stuck to the H3K9M histones, and is therefore unable to modify any other histones. Shan et al. went on to carry out a more detailed study of the structure of H3K9M attached to another enzyme called G9a. This enzyme is found in human cells and is similarly inhibited by H3K9M. This investigation identified additional chemical interactions that explain why Clr4 and G9a become trapped by the H3K9M histone but not by normal histones. Future studies are needed to explore whether other altered histones are able to trap enzymes in the way that H3K9M traps Clr4 and G9a. In addition, this work could eventually lead to new cancer therapies. DOI: http://dx.doi.org/10.7554/eLife.17903.002

Background and aims: The aim of this study was to investigate superoxide dismutase (SOD) activity together with malondialdehyde (MDA) levels in a group of Chinese patients with age-related macular degeneration (AMD). Methods: Serum SOD activity and MDA levels were analysed in 56 AMD patients with subtypes (early dry, geographic atrophy, and wet) and 34 healthy controls matched with age and sex. Results: Serum MDA levels were significantly higher in AMD (3.68±1.06 nmol/mL) than in controls (2.83±0.43 nmol/mL; p=0.000), and was significantly higher in wet AMD (3.79±0.79 nmol/mL) than in early dry AMD (3.26±0.99 nmol/mL; p=0.038). Serum SOD activity was significantly higher in AMD (87.12±13.22 U/mL) than in controls (79.91±11.80 U/mL; p=0.012), and slightly higher in wet AMD (89.52±16.25 U/mL) than in GA (83.62+_9.75 U/mL; p=0.275) and early dry AMD (81.64±18.90 U/mL; p=0.093). There was a positive correlation between serum MDA levels and SOD activities in AMD patients and controls (r=0.320, p=0.002). Conclusions: The observed increase in SOD activity in our study may be related to increased MDA levels, as a compensatory regulation in response to oxidative stress in AMD patients. The present data also demonstrate that oxido-reduction disturbance may be hypothesized in the pathogenesis of AMD.

To increase opportunities for advanced clinical training, a few medical schools in China have created U.S.-style, temporary-contract residency programs for medical graduates, but nearly nothing is known about what proportion of residents successfully complete these programs or what factors affect attrition.By directly surveying and interviewing residents who withdrew voluntarily, the authors examined attrition from 16 medical specialties in the residency program of West China Hospital, Sichuan University, from the start of the program in 2003 through 2008.During the study period, 562 trainees matriculated into the program, and 127 (22.6%) withdrew before completing it; 106 (18.9%) withdrew voluntarily. Those who left voluntarily most frequently cited three reasons: (1) permanent employment in other hospitals, (2) pursuit of a higher academic degree, and (3) personal reasons. Nearly 90% (n = 92) of the residents who left voluntarily did so within two years of obtaining their medical license. Women were 1.82-fold more likely than men to leave (95% CI 1.20-2.76, P = .005). Attrition by specialty ranged from 3.7% to 42.9% over the study period. Surgery had one of the lowest attrition rates.Attrition is a challenge for the West China residency program just as it is for U.S. residency programs, but the factors behind attrition in each country differ significantly. To reduce attrition from temporary-contract residency programs in China, the programs themselves and government policies may need to change so that completing such residencies is as competitive an option as taking permanent hospital positions immediately after graduation.

Background: The aim of this study was to evaluate the utility of computed tomography (CT) vascular reconstruction in the localization diagnosis of perigastric mass. Methods: Fifty-eight patients with pathologically detected perigastric mass underwent abdominal dynamic contrast-enhanced CT. CT vascular reconstructions were produced from arterial phase data using volume rendering (VR), multiplanar reconstruction (MPR), and maximal intensity projection (MIP). Image analysis was focused on the relationship between the mass, perigastric arteries, and the gastric wall. Localization diagnosis values were compared between CT vascular reconstruction and dynamic-enhanced CT images. Results: Among the 58 cases of perigastric mass, 41 cases originated from the stomach, 7 cases from the left liver lobe, 6 from the pancreas, 2 from lessor omental bursa, 1 from transverse mesocolon, and 1 from left adrenal gland. The accuracy of CT vascular reconstruction images in the localization diagnosis of perigastric mass was higher than that of dynamic-enhanced CT images (98.3% and 86.2%, respectively, P = .04). On the reference level, 35 (35/41) patients with stomach-originated masses showed the mass adjacent perigastric arteries pushed away from the stomach (arterial displacement sign), and 15 (15/17) patients with nonstomach-originated masses showed perigastric arteries between the mass and the stomach (arterial entrapment sign). The sensitivity, specificity, positive predictive value, and negative predictive value of the localization diagnosis of perigastric mass with arterial displacement sign were 85.4%, 100%, 100%, and 73.9%, respectively, and with arterial entrapment sign, 88.2%, 100%, 100%, and 95.3%, respectively. Conclusion: CT vascular reconstruction can clearly depict the relationship between perigastric mass and adjacent perigastric arteries, which may help us more accurately differentiate between stomach-originated and nonstomach-originated masses compared with original dynamic-enhanced CT images.

Objective.The Medical Expenditure Panel Survey (MEPS) was used to estimate the national influence of rheumatoid arthritis (RA) on employment, limitations in work or housework, inability to work or do housework, missed work days, days spent sick in bed, and annual wages.Methods.MEPS is a nationally representative survey of the US population. Multiple logistic, negative binomial, and Heckman selection regression methods were used, controlling for age, sex, race, ethnicity, smoking status, income, education, and chronic comorbidity. RA was identified using International Classification of Diseases-9 code 714.Results.In unadjusted descriptive statistics, individuals with RA were older, had more chronic conditions, missed more work days, spent more days sick in bed, had lower employment rates, had higher rates of limitations and inability to work, and received disability benefits at higher rates. After adjustment, multiple regression analyses showed individuals with RA were 53% less likely to be employed [OR 0.47, 95% CI 0.34–0.65], 3.3 times more likely to have limitations in work or housework (95% CI 2.35–4.64), 2.3 times more likely to be unable to work or do housework (95% CI 1.55–3.53), and spent 3.6 times as many days sick in bed as those without RA (95% CI 2.32–5.53). RA was associated with an expected loss of $8957 in annual earnings (95% CI $1881–$15,937). There was no statistically significant difference in missed work days or the level of wages.Conclusion.In the most recent available national data for adults, RA was associated with reductions in employment, productivity, and function.

Two new cassane-type diterpenes, phangininoxys D and E (1 and 2), together with five known compounds were isolated from the seeds of Caesalpinia crista Linn. The structures of these compounds were elucidated by means of various spectroscopic analyses. All the isolated compounds were evaluated for cytotoxicity activities against HeLa, HT-29 and KB cell lines, and compound 7 showed moderate selective activities against KB cell line with an IC50 value of 17.1 μM.

To investigate the nutritional status in acute stage ischemic stroke and its relation to disease severity and prognosis of patients.Fifty patients with ischemic stroke were admitted in hospital within 48 h after onset. National Institute of Health stroke scale (NIHSS) was used to assess the severity of stroke. Physical index and laboratory index were measured on d1, d7 and d14 after admission. Physical index included body weight, body mass index, triceps skin folds, upper arm circumference and arm muscle circumference. Laboratory index included prealbumin, high sensitivity C-reactive protein (hs-CRP), complement C3 and cortisol. The severity of metabolic disturbance was expressed as the difference of biochemical indexes between the d7 and d1. All cases were followed up for 6 months. The prognosis of stroke was evaluated with modified Rankin (mRankin) scores.No significant changes of physical indexes were found between d7 and d1. The levels of prealbumin and complement C3 on d7 after admission were significantly decreased compared to d1 (198.8 mg/L±20.3 mg/L vs 286.7 mg/L±23.8 mg/L and 0.6 g/L±0.1 g/L vs 1.0 g/L±0.1 g/L, respectively, both P0.05). The levels of hs-CRP and cortisol at d7 were significantly increased compared to d1 (495.2 nmol/L±39.5 nmol/L vs 24.1 mg/L±5.2 mg/L and 396.4 nmol/L±41.3 nmol/L vs 5.1 mg/L±1.2 mg/L, respectively, both P0.05). On d14 after admission hs-CRP (13.2 mg/L±4.5 mg/L) and cortisol levels (463.4 nmol/L±32.1 nmol/L) were still significantly higher than d1 (both P0.05). However, there were no difference in prealbumin (259.2 mg/L±22.8 mg/L) and complement C3 (0.8 g/L±0.2 g/L) levels between d1 and d14 after admission. Correlation analysis revealed that the NIHSS scores and mRankin scores were correlated with nutrition metabolism disturbances (P0.05).Nutrition metabolism disturbances in patients with acute ischemic stroke are related to the disease duration, the severity and prognosis of stroke.

To further explore the clinical effect of massage therapy on navel,the related ancient literatures were arranged and analyzed,and several methods in ancient clinical were introduced, including stroking navel, rubbing navel, pushing navel, tapping navel and puffing navel. In addition, the theoretical basis of massage therapy on navel were discussed. The results revealed ancient literatures offered abundant theoretical basis to modern clinical practice, and there were evidences of treating gastroenteric and gynecological diseases with this therapy. Comprehensively, through the study of ancient literatures and modern research, therapy of massage on navel is believed to be promising and will gain popularity in the future.

A healthy spleen has density stable on computed tomographic (CT) scan; in some patients, spleen infarction can be associated with acute pancreatitis. Here, we report 2 patients with acute pancreatitis associated with transient reduction of spleen density that were confirmed in our hospital. The clinical data of the 2 patients were retrospectively analyzed, and the relevant literature was reviewed. Acute pancreatitis with transient reduction of splenic density has certain characteristics in clinical and radiological aspects. After clinical treatment, the spleen density can be restored. Its mechanism may be related to glucose and lipid metabolism, transient thrombosis formation in splenic vessels, and so on.

To review the clinical characteristics of spontaneous intracranial hypotension (SIH) with cerebrospinal fluid (CSF) leakage.Clinical data of 42 SIH patients with cerebrospinal leakage, whose diagnosis met the criteria of the International Headache Classification, were retrospectively reviewed. The patients were divided into short (n=27) and long (n=15) course groups. The clinical data and imaging features were compared between two groups.Thirty-nine patients (92.9%) had orthostatic headache. Compared with the short course group, the frequency of headache were significantly lower in patients with long disease duration (80% vs 100%, P =0.040); the ratio of high CSF opening pressure (=60.0 mm H2O), the average CSF opening pressure, and the frequencies of subdural hematoma were higher in long course group than those in short course group [60.0% vs 20.8%, (64.7±42.1) vs (40.0±33.8)mm H2O, and 50.0% vs 11.6%; P=0.019, 0.038 and 0.018, respectively]. Forty-two patients underwent CT myelography;definite focal CSF leakage sites were found in all patients and multiple sites of CSF leakage in 38 patients.All SIH do not necessarily show the typical clinical manifestations, and cranial MRI and CT myelography are helpful in the diagnosis. Because of higher risk of subdural hemorrhage, patients with long disease duration require active intervention.

To investigate the migration of fluorescent dye PKH26-labeled BM-MSC in the Alzheimer's model rats.Normal human bone marrow extracted for isolation of BM-MSC was cultured in vitro. The 5th passaged BM-MSC was labeled with PKH26, and observed under a fluorescence microscope for PKH26 labeling efficiency, and using flow cytometry BM-MSC surface markers was checked. The PKH26 labeled BM-MSC injected into the tail vein of the normal control group and AD animal model group, 14 days after finding the PKH26-labeled BM-MSC cells in the rat hippocampus using fluorescence microscopy. Using the Morris water maze experiment comparison of AD model and BM-MSC transplantation group of spatial learning and memory ability.TFlow cytometry showed BM-MSC surface markers CD73 and CD105 were positive. In vitro, PKH26-labeled rate of BM-MSC was 100 %. The Morris water maze experiment comparison of BM-MSC transplantation group and AD group of animals, BM-MSC transplantation group at 13, 14 days of spatial learning and memory ability than AD animal group had significantly improved. 14 days after BM-MSCs in rat hippocampus could be found which were PKH26-positive, consistent with DAPI staining. PKH26-positive cells in animal models of AD were significantly more than those in the normal control group.BM-MSC in AD rats not only migrates through the blood-brain barrier, but also mainly survives in the hippocampus of AD rats, and it can improve AD rat model of learning disabilities.

To investigate the characteristics of the confined space accident and its medical rescue strategy.Thirty-six patients with emergency rescue in the five confined space accident during June 2009 to July 2012 were retrospectively analyzed.Twenty-nine people were caught in four confined space accidents caused by building collapse and 7 people were caught in one confined space accident caused by a tower of babel blast furnace damage which caused severe gas and hydrogen sulfide poisoning. For the 36 wounded, the shortest rescue time was 1.5 hours and the longest was 10.5 hours. Fourteen people were killed (mortality rate 38.89%). Characteristics of the confined space accident: the wounded activity environment was very harsh, the wounded were restricted particularly, the wounded injuries were diverse, the psychological depression was very common. The confined space environment and the complexity of wounded disease determined its medical rescue specificity and were very different from the usual trauma emergency.Confined space accident caused very painful casualties. The key reason is that the relevant personnel failed to clearly recognize the potential risks in the confined space or nearby, making the confined space into another "quiet killer". This problem needs to be paid highly attention.