Objective To investigate the association between serum cytokines and depression and understand the effect of sertraline on serum leveI of interleukin 2(IL-2),interleukin 6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP).Methods A total of 50 depressive patients(study group) and 25 healthy controls(control group)were included in this study.The levels of serum IL-2,IL-6 and TNF-α were measured by enzymatic-linked immunosorbent assay(ELISA)on baseline and after treatment,CRP were measured by scatter rate nephelometry.Depressive patients were assessed by Hamilton depression sere(HAMD)on baseline and after treatment.Results The levels of IL-2(41.4±15.7)pg/ml,IL-6(63.4±17.2)pg/ml,TNF-α(81.4±19.3)pg/ml and CRP(8.2±2.9)mg/L in study group were significantly higher than those in control group(13.2±4.6)pg/ml,(21.3±7.7)ps/ml,(35.1±7.8)ps/ml,(2.9±0.5)mg/L,(P<0.01).Compared with baseline,the levels of serum IL-2(20.1±9.1)ps/ml,IL-6(38.5±11.6)pg/ml,TNF-a(49.5±12.6)pg/ml and CRP(4.2±1.6)mg/L after treatment by sertraline decreased significantly(P<0.01).In study group,there were significant positive correlations between the serum level of IL-2,IL-6,TNF-α and present age,the total score of HAMD(P<0.05,P<0.01).There were significant positive correlations between variation rates of serum IL-2,IL-6,TNF-αand reduction rate of HAMD(P<0.05,P<0.01).Conclusion The serum levels of IL-2,IL-6,TNF-α and CRP increased in patients with depression.Sertraline may affect depressive patients'serum levels of IL-2,IL-6,TNF-αand CRP.

OBJECTIVE:To explore the role of clinical pharmacists participating in the individualized treatment for purulent meningitis. METHODS:Clinical pharmacists participated in the therapy for a patient with purulent meningitis complicated with Staphylococcus aureus infection. According to patient's condition,clinical pharmacists assisted physicians to formulate preliminary therapeutic plan. Reviewing relevant guidelines,domestic and foreign literatures,clinical pharmacists suggested to combine with dexamethasone so as to relieve inflammatory reaction. According to the results of drug sensitivity test,based on vancomycin plasma concentration monitoring and population pharmacokinetics model fitting,clinical pharmacists suggested to reduce the dose of vanco-mycin to 0.5 g,ivgtt,q12 h. The pharmaceutical care were conducted throughout the therapy,including efficacy evaluation of an-ti-infective therapy,ADR monitoring,renal function monitoring,etc. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The disease condition of the patient was recovred,and no ADR related to vancomycin was found. On the 16th day, the patient was discharged from the hospital. CONCLUSIONS:Clinical pharmacists participate in treatment of purulent meningitis, assist physicians to optimize therapy plan based on relevant guideline,literature,etiological examination,blood concentration moni-toring and pharmacokinetics model fitting results. It not only guarantee therapeutic efficacy of anti-infective therapy,but also pre-vent and reduce the occurrence of ADR.

Objective To observe the influence of highflux hemodialysis(HFD)on homocysteine(Hcy) level and major cardiovascular events of maintenance hemodialysis (MHD) patients. Methods Patients eligible for inclusion were randomly divided into HFD group and low flux hemodialysis(HD)group with 30 cases in each group. Patient′s serum homocysteine (Hcy),major cardiovascular events and various clinical indicators were observed for 12 months then the data were analyzed. Results Hcy baseline levels in 2 groups(21.02 ± 11.79 mmol/L vs. 19.86 ± 6.97 mmol/L)indicated no significant difference(P = 0.162)before hemodialysis but Hcy levels had significant difference(20.29 ± 11.45 mmol/L vs. 24.57 ± 13.23 mmol/L),(P=0.045)after 12-month observation. There was lower incidence of major cardiovascular events in HFD when compared to that in HD group (10.0% vs. 33.3%) which showed significantly statistical difference (P=0.034),and there was no mortality in HFD group but 1 case of death in HD group. All-cause mortality in 2 groups showed no significant difference (P > 0.05). Conclusion Long-term HFD treatment significantly reduces Hcy levels and the incidence of major cardiovascular events of MHD patients

BACKGROUND: At present, researches have been proved that nerve growth factor (NGF) plays an important role in repairing neural regeneration after spinal cord injuries. Poor ability of neural regeneration is related to lack of microenvironment for neuronal growth at local injured site. Whether electro-acupuncture can protect nerve after spinal cord injuries through increasing NGF level in injured spinal cord or not is lack of experimental data on the view of molecule.OBJECTIVE: To observe the effect of electro-acupuncture on motor function, morphology of spinal cord and mRNA expression of NGF in rats with experimental spinal cord injuries through morphology and hybridization in situ.DESIGN: Randomized controlled animal study.SETTING: Department of Acupuncture and Moxibustion, the Tenth People's Hospital Affiliated to Tongji University; Shanghai Institute of Acupuncture and Meridian.MATERIALS: The experiment was completed in the Shanghai Institute of Acupuncture and Meridian from January 1999 to February 2002. A total of 15 male SD rats weighing (260±9.52) g were randomly divided into sham operation group, injured control group and acupuncture group with 5 in each group.METHODS: Models of spinal cord injuries were established in injured control group and electro-acupuncture group, and rats in sham operation group were just treated with resection of lamina of vertebra. Two hours after operation, rats in electro-acupuncture group were treated with electroacupuncture at Daczhui (GV14) and Mingmen (GV4), L2 Jiaji (Ex-B2-L2)and Huantiao (GB30), alternatively. Then, G6805 electro-acupuncture apparatus was used with distant wave, 0.8 Hz, 0.3-0.6 mA, and slight shake on muscle was regarded as proper response. The electro-acupuncture was performed every 30 minutes a day for 30 days. Rats in injured control group and sham operation group were not treated with any way, and motor functions 2 hours and 30 days after operation were observed with modified Tarlov scale and Rivlin method. ① Modified Tarlov scale: Pamplegia and irresponsivity of lower limbs during electro-acupuncture were scored from 0 to 6 points. ② Modified Rivlin method: Tiltboard was consisted of two rectangular alloy boards which was connected to one end through hinge.Board turned around axis at the beginning of horizontal position (0°) and the angle of ram could be measured. Rats faced towards front were put vertically as longitudinal axis of body to longitudinal axis of tiltboard.Angle was increased gradually when rats were not able to keep the primary position for 5 seconds, and the critical angle was recorded. Hybridization in situ assay: Amount of positive NGF cells was recorded under light microscope and photographs were completed at the same time.MAIN OUTCOME MEASURES: Scale of motor function (modified Tarlov score), critical angle of ram test (modified Rivlin method) and changes of amount of positive NGF mRNA cells in rats with spinal cord injuries.RESULTS: A total of 15 experimental rats were involved in the final analysis. ① Two hours after spinal cord injuries of rats in injured control group and electro-acupuncture group, score of motor function and critical angle of ram which was measured with modified Rivlin method were decreased remarkably; 30 days later, score of motor function measured with modified Tarlov scale and critical angle of ram were increased at various degrees, especially those in electro-acupuncture group were increased remarkably, and there was significant difference from those in injured control group [35.40±6.62, 27.80±1.10; (35.40±6.62)°, (27.80±1.10)°, P ＜ 0.05]. ② Thirty days after injury, pathological lesion of rats in electroacupuncture group was milder than that in injured control group, and morphological injury of spinal cord and amount of positive NGF mRNA cells were obvious as compared with those in injured control group (28.13±1.64,12.63±1.41, P ＜ 0.01).CONCLUSION: Electro-acupuncture can improve mRNA expression of NGF in spinal cord, relieve morphological injury of spinal cord, accelerate recovery of motor function of rats with spinal cord injuries, and protect nerve through mRNA expression of NGF.

Purpose: To investigate the relationship between quantity of suppurative moxibustion and its effect on allergic asthma. Methods: The patients were randomly divided into suppurative moxibustion 9 cones group, 3 cones group and 6 cones group. The biggest area, scar-losing time, suppurating time and scarring time of post-moxibustion sore, and the clinical effects of each group were observed. Results: The biggest post-moxibustion sore area of 9 cones group was bigger than 3 cones group but had no difference with 6 cones group,and scar-losing time, suppurating time and scarring time of post-moxibustion sore of each group were of no difference. The clinical effects of 9 cones were better than 3 cones group but have no difference with 6 cones group. Conclusion: The quantity of suppurative moxibustion is in close association with the effects in the treatment of allergic asthma, and eventually becomes the key factor for good results.

Objective To investigate the relationship between serum omega-3 polyunsaturated fatty acid (ω-3PUFA) and insulin resistance(IR) in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease (NAFLD). Methods This trial involved 51 patients of type 2 diabetes mellitus with NAFLD (G4 group), 50 patients of type 2 diabetes alone(G3 group), 45 patients of NAFLD alone (G2 group) and 42 healthy control subjects (G1 group). Serum ω-3PUFA profile was analyzed with capillary gas chromatography. Insulin resistance was assessed by homeostasis model assessment (HOMA-IR). ALT, AST, γ-glutamyltransferase(GGT) and serum lipids were measured. Results The levels of HOMA-IR were higher in G4 group than those in G3, G2 and G1 group(4. 90 ± 2. 54 vs 2. 38 ± 1.23, 2. 20 ± 1.15, 1.13± 0.42;P<0.05). The level of ALT, AST, GGT, TC, TG, LDL-C were higher in G4 group than those in G3, G2 and G1 group(P < 0. 05). The level of ω-3PUFA was signifieantly lower in G4 group than those in G3, G2 and G1 group(5.68 ±2.02 vs 7. 17 ±2. 38, 6.97±2.32, 10.08±2.76;P <0.05). ω-3PUFA cocentration was negatively correlated with HOMA-IR, TC, TG and LDL-C (r = -0.491, -0. 376, - 0. 462, - 0. 408, P < 0. 05). Conclusions Serum ω-3 PUFA is significantly decreased in patients with type 2 diabetes mellitus and NAFLD. Serum ω-3PUFA is negatively correlated with insulin resistance. ω-3PUEA plays a very important role in the development of diabetes mellitus and NAFLD.

Objective:To investigate the relationship between fester capacity and clinical efficacy on allergic asthma treated by scarring moxibustion.Methods:The patients were randomly divided into scarring moxibustion 9-cone group,3-cone group and 6-cone group.The biggest area,scab-lost time,first-festering time and scarring time of moxibustion sore,and the clinical efficacy in each group was observed.Results:The biggest post-moxibustion sore area in 9-cone group was larger than that in 3-cone group,but had no difference in comparison with 6-cone group;the scab-lost time,first-festering time and scarring time of post-moxibustion sore in each group were of no difference.The clinical efficacy was better in 9-cone group than in 3-cone group,but had no difference in comparison with the 6-cone group.Conclusion:Fester capacity in treating allergic asthma by scarring moxibustion is related to the clinical efficacy and definite fester capacity is the key to good results on allergic asthma.

Objective:To investigate the clinical, pathological and genetic characteristics of neonatal alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV).Methods:The clinical manifestations, radiographic examinations, pathology and parental genetic analysis of a newborn with FOXF1 variation induced ACDMPV, who was hospitalized in the Department of Neonatology of Shenzhen Children′s Hospital in January 2020, were extracted and analyzed. Related literature up to March 2020 with the key words of “Alveolar capillaries dysplasia” “Alveolar capillary dysplasia with misalignment of the pulmonary veins” “FOXF1” in PubMed, CNKI, Wanfang, CQVIP database and Leiden Open Variation database (LOVD) were searched.Results:A full-term male newborn （1 hour of age） was admitted due to anal atresia. Surgical repair of anal atresia and omphalocele was performed on the first day of life, and gallbladder absence and Meckel′s diverticulum were identified during the operation. Respiratory distress with hypoxemia developed at about 6 hours of life, and persistent pulmonary hypertension developed and progressed after surgery, with poor response to mechanical ventilation and pulmonary vasodilators. This infant passed away at 26 days of life. Lung biopsy showed decreased alveolar units and thickened interalveolar septa, reduced alveolar capillary density and thickened walls of peripheral pulmonary arteries, and misaligned pulmonary veins adjacent to the pulmonary arterioles, which were consistent with ACDMPV. The whole exome sequencing revealed a heterozygous novel frameshift of FOXF1 gene located in chromosome 16q24.1 c376_377insT; p.(Pro126fs). According to the bioinformatics analysis, this variation was likely to be pathogenic as it was associated with coding disorder of FOXF1 Pro126, resulting in truncation of the encoded protein. This novel variation had not been reported in the human gene mutation database (HGMD), ESP6500siv2_ALL, 1000g2015aug_ALL or dbSNP147 database. Previous 6 literatures reported 54 variants, including 28 missense, 10 nonsense, 11 frameshift, 2 deletion, 1 synonymous, and 2 extensions. Only three of the reported 45 cases （24 males, 21 females） were still alive as of the time of this study.Conclusions:Typically, ACDMPV is a catastrophic disease in neonatal period with high mortality. Lung biopsy and genetic testing should be considered in infants who present with persistent pulmonary hypertension and refractory hypoxemia, especially when combined with extrapulmonary abnormalities.

Objective To study the effcts of total parathyroidectomy with autotransplantation (tPTX+AT) on fibroblast growth factor-23 (FGF-23) in maintenance hemodialysis (MHD) patients with severe secondary hyperparathyroidism (SPTH). Methods Maintenance hemodialysis patients with severe SPTH treated in our hospital from 2014 to 2016 were enrolled and divided into two groups:tPTX+AT group and non-surgical group. Two groups' biochemical indexes and FGF-23 level before and after 6 months treatment were compared. Results A total of 48 patients were included in the study, including 22 in the tPTX+AT group and 26 in the non-surgical group. Age, duration of dialysis, primary disease, rate of hypertension, parathyroid hormone (iPTH), FGF - 23, cholesterol (TCH), triglyceride (TG), albumin (ALB), and hemoglobin (HGB) level showed no significant difference between the two groups (P>0.05); but serum calcium and alkaline phosphatase (ALP) of that tPTX+AT group were significantly higher than those of the non-surgical group (P<0.01). After 6 months the blood iPTH, calcium, phosphorus and the calcium-phosphorus product level of tPTX+AT group were significantly lower than those of non-surgical group (P<0.05). Blood lipids, propagated, HGB, and ALP level had no statistical differences in the two groups (P>0.05); serum FGF-23 progressive declined after 1 week, 1 month, 3 month and 6 month in tPTX+AT patients, and after 6 months, the level of FGF-23 was significantly lower than that of non-surgical patients[1462.9(903.7, 5826.9) ng/L vs 12627.9(5488.9, 16844.4) ng/L, P<0.01]. Conclusion tPTX+AT can significantly alleviate calcium and phosphorus metabolism disorders and in 6 months gradually reduce FGF-23 level in patients receiving MHD.

Objective:To analyze the trend and hot spots of research on multimorbidity.Methods:The Chinese and English literature in databases of CNKI, Wanfang data and Web of science from inception to July 2022 were retrieved using "multimorbidity" and "multiple chronic conditions" as the search terms. The scientific knowledge mapping software VOSviewer was used to analyze the co-occurrence network of scientific knowledge from the aspects of countries, Chinese and English keywords,burst terms and existing research results; and the status quo and hot trends of studies on multimorbidity at home and abroad were summarized and compared.Results:A total of 251 Chinese publications and 6 351 English publications were included. From the perspective of research trends, the overall trend of domestic and international publications showed a fluctuating upward trend in general, but the pace of development was different. The cooperation network represented by the United States, England, Canada, China, Japan, Australia and other countries was the largest regional cooperation network. Germany, the Netherlands, the United States, Australia and other countries were the first regions to carry out studies on multimorbidity. Studies on multimorbidity in China mainly focused on three topics: diagnosis, treatment and care of multimorbidity, common disease management of multimorbidity, and research methods of multimorbidity. The English literature mainly focused on the clustering of three topics: multi-disease co-diagnosis and care research, multi-disease co-management model research, and multimorbidity related research. The analysis of burst terms indicated the research focus and trend change in different time periods. The results of the outburst word analysis showed that the recent research hotspots of multimorbidity were public health, machine learning, geriatric medicine and so on.Conclusions:The number of studies on the multimorbidity is rapidly increasing both domestically and internationally, and related research in China is still in the early stages of development. In terms of research hotspots, the research of multimorbidity has gradually shifted from phenomenon description to topics such as medical services and research methods of multimorbidity.