Objective To investigate the causes of infant mortality and analyze the reasons of misdiagnosis and medical disputes,and to provide help for improving clinical diagnostic accuracy in future in order to decrease the infant mortality and prevent the occurrence of medical tangle.Methods To collect and reorganize the autopsy pathology reports of medical tangle of infant deaths in the autopsy files of the Pathology Department of Affiliated Hospital of Zunyi Medical College within 5 years from Jan.2008 to Dec.2012,and a total of 58 cases were collected,of whom 39 cases were male and 19 cases were female,and the ages of these cases ranged from 0 to 3 years old.Results In 5 years,the number of medical tangle of infant deaths were 8 cases,10 cases,10 cases,15 cases and 15 cases,respectively,which showed an increasing trend on the whole.Infant mortality showed a significant decrease with the increase of age,as the highest mortality was the baby,which accounted for 77.59％ (45/58 cases) of infant deaths.The most common cause of infant death was pneumonia,which accounted for 15.52％ (9/58 cases) of all diseases,and neonatal asphyxia was the top cause of newborn infant deaths (27.27％,6/22 cases).In the cases of misdiagnosis and missed diagnosis of infant deaths,the respiratory system disease was the most common disease (57.89％,22/38 cases).Conclusions Infant mortality decreased year by year in clinical medicine,but there was an upward trend of medical disputes in infant deaths.Various types of pneumonia was the most common cause of infant deaths,and it was also the main cause contributing to medical tangles of infant deaths.

For the treatment of primary dysmenorrhea, professor ZHAO Jiping focuses on meridian diagnosis and inspection, and uses pressing methods to locate the response points along the meridian, including acupoints and aishi points. During the stage of attack, it is essential to press along the spleen meridian, mainly Sanyinjiao (SP 6), Diji (SP 8) and Yinlingquan (SP 9); during the stage of remission, it is essential to press along the bladder meridian and stomach meridian, mainly Ganshu (BL 18), Pishu (BL 20), Weishu (BL 21), Shenshu (BL 23) and Zusanli (ST 36). The differences between deficiency syndrome and excess syndrome lead to the different feelings of doctors and patients. Combined with the results of meridian diagnosis and inspection, the aim of treatment can be achieved by different acupuncture methods. Professor ZHAO pays attention to the treatment of accompanied symptoms and timing of treatment, since the relief of accompanied syndromes and selection of timing are keys to relieving patient's pain.
Acupuncture Points ; Acupuncture Therapy ; Adult ; Diagnosis, Differential ; Dysmenorrhea ; diagnosis ; therapy ; Female ; Humans

Aim To investigate the effects of berberine combined with bone marrow mesenchymal stem cells ( BM-MSCs) on the energy metabolism of human um-bilical vein endothelial cells ( HUVECs ) under the condition of high glucose. Methods ①The state of cell reproduction and cell proliferating activity were de-termined by MTT assay. ②The cell cycle was detected by flow cytometry ( FCM ) . ③DNA damage of cells was measured by comet tail assay. ④The contents of ATP, ADP and AMP were determined by high perform-ance liquid chromatography ( HPLC ) and the level of energy charge ( EC) was calculated. ⑤The expression of CCR and COX mRNA was detected by reverse tran-scription-polymerase chain reaction ( RT-PCR) . ⑥The expressions of COX and CCR were detected by Western blot. Results ①The proliferating activity of HUVECs declined apparently and the proliferation decreased af-ter high glucose intervention. Meanwhile, the quantity of cells during S +G2 dropped dramatically and there was certain degree of damage to DNA. The berberine and BM-MSCs respectively improved the proliferating activity and the proliferation in different degrees, in-creased the quantity of cells during S+G2 and promo-ted the repair of DNA ( P <0 . 01 ) , and so did the combination of the two, with a better effect than each of them alone. ②After high glucose intervention and the damage caused, the content of both ATP and ADP of HUVECs was reduced, and EC level also declined significantly, while the content of AMP increased. The berberine and BM-MSCs respectively up-regulated the content of ATP and ADP ( P<0. 01 ) , and so did the combination of the two, with a better effect than each of them alone. ③After high glucose intervention and the damage caused, the expression of COX, CCR mR-NA and protein decreased obviously. Yet, all of the three gained a dramatic increase when the berberine, BM-MSCs or the combination of the two were added ( P<0. 01 or P <0. 05 ) , among which the combination worked more effectively. Conclusions The berber-ine, BM-MSCs and the joint use of the two could im-prove the energy metabolism of HUVECs, which had been damaged by high glucose, probably because the berberine and BM-MSCs could up-regulate the expres-sion of COX, CCR mRNA and protein, which leads to the hydrolyzation of glucose oxide and thus the im-provement of blood environment and the enhancement of glucose's supply and intake of HUVECs. Then, here comes the final result: the improvement of the energy metabolism of damaged vascular endothelial cells by high glucose.

[ABSTRACT]OBJECTIVETo investigate the relationships between the characteristics of the upper airway anatomy, including the basis nasi, and the severity of obstructive sleep apnea hypopnea syndrome(OSAHS). METHODSFifty OSAHS patients and 40 normal subjects received three-dimensional CT scan and poly somnography(PSG). Variables between the two groups were compared. The association between the PSG parameters and the upper airway anatomic features were analyzed. RESULTSThere were significant differences in several CT variables between OSAHS patients and normal subjects(P<0.05), including the minimal lateral airway dimension and the minimal cross-sectional airway area of both velopharynx and glossopharynx, the minimal anterior-posterior airway dimension of velopharynx, and the airway width of basis nasi. The result of logistic regression analysis suggested that the minimal cross-sectional airway area of velopharynx and the airway width of basis nasi were significant predictors of the OSAHS(P<0.05, the values of the odds ratio were 0.978 and 0.589). The correlation analysis suggested that the airway width and the airway area of basis nasi both correlated significantly with several CT variables of pharynx(P<0.05), among these results, the correlation coefficents between these two variables and the mCSA of velopharynx were 0.536 and 0.425 respectively. CONCLUSIONNarrowed basis nasi and velopharynx might be important anatomical features in OSAHS patients. There are correlations between the characteristics of basis nasi and the anatomy of pharyngeal airway.

Objective:To evaluate the clinical efficacy of modified Qiwei Baizhu Powder combined with conventional therapy in the treatment of type 2 diabetes mellitus (T2DM) with abnormal lipid metabolism.Methods:A total of 96 patients with T2DM and abnormal lipid metabolism from March 2018 to March 2021 in Anhui Integrated Traditional Chinese and Western Medicine Hospital who met the inclusion criteria were divided into 2 groups according to the random number table method, with 48 in each group. The control group was treated with conventional western medicine, while the observation group was treated with modified Qiwei Baizhu Powder and treatment of the control group. Both groups were treated for 3 months. TCM syndrome scores were performed before and after treatment. Fasting blood glucose (FPG) and 2 hPG were detected by glucose oxidase method, HbA1c was detected by HPLC, TC, TG, HDL-C and LDL-C were detected by cholesterol peroxidase method, glycerophosphate oxidase method, direct inhibition method and direct surfactant clearance method. Adverse events during treatment were recorded and clinical efficacy was evaluated.Results:The total effective rate was 93.8% (45/48) in the observation group and 79.2% (38/48) in the control group, with a statistically significant difference between the two groups ( χ2=4.36, P=0.037). After treatment, the scores of dry mouth, fatigue, anorexia, dizziness, tongue, pulse and total scores in the observation group were significantly lower than those in the control group ( t values were 3.58, 3.17, 3.24, 3.59, 3.58, 2.76 and 8.44, respectively, all Ps<0.05); the levels of FPG, 2 hPG and HbA1c in the observation group were significantly lower than those in the control group ( t values were 3.37, 2.05 and 3.73 respectively, all Ps<0.05). After treatment, the levels of TC [(4.30±0.85) mmol/L vs. (4.78±0.94) mmol/L, t=2.62], TG [(3.00±0.37) mmol/L vs. (3.19±0.54) mmol/L, t=2.01], LDL-C [(2.60±0.71) mmol/L vs. (2.95±0.44) mmol/L, t=2.90] were significantly lower than those in the control group ( P<0.05). After treatment, the HDL-C [(2.07±0.63) mmol/L vs. (1.82±0.55) mmol/L, t=2.01] level was significantly higher than that of the control group ( P<0.05). Conclusion:Modified Qiwei Baizhu Powder combined with conventional therapy can improve blood glucose and blood lipid levels in T2DM patients with abnormal lipid metabolism, relieve clinical symptoms and improve curative effect.

Objective To search for new biomarkers to predict prognosis in colorectal cancer (CRC) patients.Methods A prognostic model was developed for colorectal cancer with immune-related genes from the cancer ge-nome atlas (TCGA) database using one-way Cox regression analysis and least absolute shrinkage and selection op-erator (LASSO) regression analysis.Moreover, the immune infiltration characteristics of patients in high and low risk groups was compared by sstimation of stromal and immune cells in malignant tumor tissues using expression da-ta (ESTIMATE) and cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT) .In addition, the expression levels of immune checkpoints were analyzed in patients from different risk groups.The sen-sitivity of patients in the two risk groups to chemotherapeutic agents was also compared based on genomics of drug sensitivity in cancer (GDSC).Results It was found that the prognostic model constructed based on immune genes could better predict the overall survival (OS) of CRC patients,and the results showed area under curve (AUC) values of 0.764 (95％ CI:0.751-0.793), 0.773 (95％ CI:0.761 -0.779), and 0.760 (95％ CI:0.742 -0.774) for 1-, 3-, and 5-year OS, respectively.Patients in the low-risk group had higher expression levels of im-mune checkpoints and more abundant immune cells such as T cells (P<0.001) , dendritic cells (P<0.001) , macrophages (P<0.001) , neutrophils (P<0.001) .Patients in the high-risk group might be more sensitive to some chemotherapeutic agents such as axitinib, imatinib, methotrexate, pazopanib, rapamycin, sunitinib and tasig-arnib.Conclusion A prognostic model based on 19 immune genes was effective in predicting the prognosis of CRC patients.The number and activity of immune cells in the immune microenvironment in different patients may be an important factor influencing their response to immunocheck inhibitors and chemotherapeutic agents.

Objective:To investigate the protective mechanism of resveratrol in reducing cardiac ischemia‐reperfusion injury (I/R) of diabetic rats and its effect on autophagy of cardiomyocytes .Methods:Streptozotocin(STZ)‐induced diabetic rat model was constructed and 35 diabetic model rats were randomly divided into five groups ,the sham group ,the resveratrol non‐surgery group ,the I/R group ,the resveratrol treatment group ,and the resveratrol+insulin group ,with 7 rats in each .Then I/R model was built by ligating‐relaxing the left coronary .The change of myocardial infarction size was observed by methylene blue stalning . Autophagic vacuoles were observed with transmission electron microscope (TEM ) . The expression of microtubule‐associated protein 1 light chaln 3(LC3)‐Ⅰ and Ⅱ ,autophagy related gene 5(Atg5) ,Beclin‐1 ,as well as the expression and phosphorylation levels of AMP‐activated protein kinase(AMPK) and mammalian target of rapamycin(mTOR) , were detected by Western blotting .Results:The infarction size in resveratrol treatment group and resveratrol+ insulin group was significantly smaller than that in I/R group(P<0 .05) .TEM showed that in resveratrol treatment group and resveratrol+insulin group ,autophagy of cardiomyocytes could be promoted and the structure of cardiomyocytes could be improved ,when I/R of occurred .The expression levels of LC3‐Ⅱ ,Atg5 ,Beclin‐1 in I/R group were significantly lower than those in sham group (P<0 .05) ,whereas the change of expression levels of LC3‐Ⅰ had no significant difference(P> 0 .05) .Meanwhile ,the expression levels of Atg5 and Beclin‐1 in resveratrol treatment group and resveratrol+ insulin group were significantly higher than those in I/R group ,and the expression level of Beclin‐1 in resveratrol+insulin group was higher than that in resveratrol treatment group(P< 0 .05) .There was no significant difference in the expression level of AMPK and mTOR among the 5 groups(P> 0 .05) .However ,the expression level of p‐AMPK was significantly higher in resveratrol treatment group and resveratrol+insulin group than that in I/R group ,and the expression level of p‐mTOR was significantly lower in resveratrol treatment group and resveratrol+ insulin group than that in I/R group ( P< 0 .05 ) .Conclusions:Resveratrol may protect cardiomyocytes of diabetic rats by activating AMPK pathway ,inhibiting mTOR pathway ,increasing the expression of LC3‐Ⅱ , Atg5 and Beclin‐1 ,promoting autophagy ,suppressing I/R ,and reducing infarction size .

Objective To investigate the gut microbial characteristics and risk factors in people with mild cognitive impairment. Methods Twenty-eight people with mild cognitive impairment and 65 age-, gender- as well as education-matched controls were recruited. Carotid artery ultrasonography was conducted and fasting anticoagulant blood and fresh fecal samples were collected on all subjects. Total bacterial DNA was extracted from the stool samples and amplified through real-time quantitative polymerase chain reaction (qPCR). Next generation analysis of 16S rRNA was performed to achieve genomic sequences using the Illumina Hiseq 2500 platform. Results Compared with the control group, mild cognitive impairment group exhibited greater microbial diversity (Bray Curtis distance, Adonis test, P<0.05), which were characterized by enrichment of proteobacteria, Synergistetes, lactobacillus, and depletion of Epulopiscium. Age, creatinine, average CCAIMT, Crouse score, and plaque numbers were associated with cognitive impairment. Multiple logistic regression analysis revealed that the number of hyperechoic plaques (OR=11.511, 95%CI:1.406~94.226, P=0.023) and the abundance of lactobacillus (OR=4.894, 95%CI: 1.090~21.966, P=0.038) were the important risk factors for mild cognitive impairment. Conclusion Higher abundance of lactobacillus in the gut holds potential as novel risk factor of people with mild cognitive impairment.

Objective:To analyze the clinical features of MDA5 antibody positive dermatomyositis (MDA5-DM) and to provide evidence for early diagnosis and treatment.Methods:From March 2019 to June 2021, 272 patients with anti-MDA5-DM from the Nanjing Medical University myositis-associated interstitial lung disease cohort were enrolled, with 76 patients with anti-synthetase syndrome (ASS) as the control group. The clinical characteristics and the occurrence of interstitial lung disease were analyzed. T-test was used for normally distributed and variance-homogeneous independent samples, Mann-Whitney U test for non-normally distributed data, and chi-square test or Fisher′s exact test for dichotomous variables. Results:Among the 272 anti-MDA5-DM patients, 88.6% (241/272) developed interstitial lung disease (ILD), and 33.8% (92/272) developed rapidly progressive ILD (RP-ILD). The six-month all-cause mortality rate of anti-MDA5-DM patients was 16.9% (46/272), and it was as high as 47.8% (44/92) for those with RP-ILD. Compared with ASS patients, anti-MDA5-DM patients had a significantly higher proportion of males, arthritis, Gottron's sign, heliotrope rash, V-sign, periungual erythema, and skin ulcers ( P<0.05). The levels of ALT, AST, and ferritin were significantly increased ( P<0.05). Compared with non-RP-ILD patients, RP-ILD patients had a significantly higher proportion of males [35.9%(33/92) vs. 23.3%(42/180), χ2=4.79, P=0.029], higher levels of LDH [387 (276, 547) U/L vs. 310 (245, 400) U/L, Z=-3.67, P<0.001], ESR [45.5 (29.25, 63.25) mm/1 h vs. 31.2 (20, 51) mm/1 h, Z=-3.71, P<0.001], CRP [10.9 (4.1, 25.2) mg/L vs. 4.54 (2.58, 9.08) mg/L, Z=-4.97, P<0.001], ferritin [1 340 (650, 2 000) ng/ml vs. 556 (203, 1 186) ng/ml, Z=-4.40, P<0.001], and a higher proportion of anti-Ro52 antibody and anti-MDA5 antibody co-positivity [87.0%(80/92) vs. 52.2%(94/180), χ2=31.87, P<0.001]. Conclusion:Anti-MDA5-DM patients are prone to develop RP-ILD and have poor prognosis.

Objective:To investigate the efficacy of continuous intravenous injection of hyaluronidase (HAase) combined with urokinase (UK) in the treatment of ischemia of hyaluronic acid (HA) arterial embolized skin flap.Methods:(1)Establish an animal model of superficial abdominal artery embolization with HA: 24 SD rats were used to make a square island flap (2 cm×2 cm, the width of the pedicle is 2 mm) on the left and right sides of the abdominal white line with superficial epigastric artery as feeding artery. The left and right flaps of rats were used as experimental group and control group. After the preparation of the experimental skin flap, HA 10 μl was injected into the superficial abdominal artery, while the self-control flap was only made and the vessels were peeled off without embolization.(2)The rats were randomly divided into A, B, C and D groups by drawing lots with 6 rats in each group, After the successful establishment of embolic animal model of 45 min, HAase(2 000 IU/kg)+ UK(50 000 IU/kg), HAase(2 000 IU/kg), UK(50 000 IU/kg) and normal saline were continuously infused through caudal vein with microinjection pump. The volume of solution in each group was 6 ml in 12 minutes. The general condition of rats and the skin color, edema, congestion and skin necrosis in the operation area of rats were observed, which were photographed and compared immediately, and at 3 days, 5 days and 7 days after embolization. The images were analyzed by Photoshop software, and the percentage of survival area of the flap after operation 7 days, was measured by pixel method. The percentage of survival area was compared by single factor analysis of variance (ANOVA) and head-to-head comparison by LSD- t test. Results:Immediately after operation, all the flaps in the four groups were pale and there was no obvious swelling. All the flaps showed different degrees of swelling within 3 days after operation, and the swelling basically disappeared within 3-5 days after operation, and gradually changed from dark red ecchymosis to dark purple or black. Seven days after operation, the necrotic area flap gradually hardened and its boundary was obvious. The skin flaps of the 4 groups showed different degrees of necrosis. The postoperative reaction of the flap was the slightest in group A, the performance of group B and C was similar, which were both between group A and group D, and there was the heaviest postoperative reaction in group D. At 7 days after operation, the percentage of survival area of flaps in groups A, B, C and D was 90.30%±5.95%, 52.63%±6.90%, 51.14%±5.95% and 7.70%±2.18%, respectively. The percentage of survival area of skin flap in group A was significantly higher than that in groups B, C and D (analysis of ANOVA: P<0.01; LSD- t test: P<0.01). Conclusions:Continuous intravenous infusion of HAase combined with UK can effectively alleviate the flap ischemia caused by HA artery embolism, increase tissue perfusion and increase the survival area of the flap.