Objective To sum up our experience in the preoperative management for anticoagulated valve replacement patients undergoing selective biliary tract surgery Methods Thirty eight patients were divided into normal liver function group of 23 cases (group A) suspending anticoagulant 3 days before the surgery and group B of 15 cases with abnormal liver function suspending anticoagulant plus VitK 1 injection 12 hours before the surgery Prothrombin time was measured, and result was compared with 115 normal controls Results There were no significant difference in prothrombin time between the two groups Conclusion A biliary tract surgery could be safe if anticoagulated patients receive adequate preoperative management

Object To study the chemical constituents from the root of Rubus innominatus S. Moore (Rosaceae). Methods Twelve compounds were isolated from the methanol extract by repeated column chromatography over normal and reversed phase silica gels. Their structures were identified by analysis of their spectral data and comparing TLC with authentic samples. Results Ten triterpenic acids and two steroids were isolated and identified. The antibacterial test indicated some triterpenic acids had antibacterial activity. Conclusion All compounds were obtained from the plants of Rubus L. for the first time.

Objective To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI). Methods An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose>10 mmol/L) and known diagnosis of diabetes mellitus (DM) ,these patients were divided into four groups, Ⅰ :no DM and normal glucose group (control group) ; Ⅱ : DM but normal glucose group; Ⅲ : no DM and hyperglycemia group; and Ⅳ: DM and hyperglycemia group. Results Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group Ⅲ 17. 1% vs group I 8.6%, group Ⅳ 18.6% vs group Ⅰ 8. 6%, P<0.001) and also an increased incidence of MACE (group Ⅲ36. 3% vs group Ⅰ 21.6%, group Ⅳ 38. 8% vs group Ⅰ 21.6%, P<0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group Ⅱ 11.6% vs group Ⅰ 8. 6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group Ⅰ patients, group Ⅲ and group Ⅳ had a risk of death of 1.51 fold(OR 1.51,95% CI 1.22-1.87,P<0.001) and 1.83 fold(OR 1.83,95% CI 1.40-2. 39, P<0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05,95% CI 1.04-1.07,P<0.001), but DM without hyperglycemia was not so (OR 1.11,95% CI 0. 87-1.42, P =0. 412). Conclusions The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia isv not associated with the short-term mortality.

Objective To evaluate the effects of ischemic postconditioning (IPO) on c-fos protein expression during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-five adult male Sprague-Dawley rats,aged 8-12 weeks,weighing 200-250 g,were randomly allocated into 3 groups (n =25 each) using a random number table:sham operation group (group S),I/R group and IPO group.Renal I/R injury was induced by clamping the bilateral renal pedicles for 1 h followed by 24 h of reperfusion in I/R and IPO groups.Five animals were sacrificed at 1,3,6,12 and 24 h of reperfusion and the left kidneys were removed for microscopic examination and for determination of the expression of c-fos protein by immunohistochemistry.Results Compared with S group,the expression of c-fos protein was significantly up-regulated at each time point during reperfusion in I/R and IPO groups.Compared with I/R group,the expression of c-fos protein was significantly down-regulated at each time point during reperfusion in group IPO.The pathologic changes were significantly attenuated in group IPO as compared with group I/R.Conclusion The mechanism by which IPO attenuates renal I/R injury is related to down-regulation of c-fos protein expression in the renal tissues of rats.

Objective: To explore the relationship between serum sodium level and early prognosis in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 7461 STEMI patients within 12h of onset who matched the diagnostic standard of European society of cardiology and American college of cardiology were retrospectively studied. According to serum sodium levels within 24h of admission, the patients were categorized into 3 groups: Serum sodium≥135 mmol/L group, Serum sodium 130-134 mmol/L group and Serum sodium<130 mmol/L group. The baseline condition, 30-day mortality with other adverse events and the effect of neuroendocriology inhibitor treatment were compared among 3 groups; their relationships to serum sodium level were analyzed. Results: Serum sodium<130 mmol/L group had the higher 7-day and 30-day mortality than the other 2 groups, both P<0.001; compared with Serum sodium≥135 mmol/L group, Serum sodium<130 mmol/L group presented the higher occurrence rates of 30-day cardiac shock, heart failure (HF) and life-threatening arrhythmia, P<0.001. With adjusted affecting factors of age, diuretic and reperfusion treatments, serum sodium<130 mmol/L was still related to 7-day and 30-day mortality (OR=1.69 and OR=1.57). Both single and multivariable analysis indicated that serum sodium<130 mmol/L was related to cardiac shock (OR=1.75 and OR=1.64), HF (OR=1.42 and OR=1.30) and life-threatening arrhythmia (OR=1.53 and OR=1.34). In all 3 groups, the patients using ACE inhibitor, β-blocker or both medications had reduced 30-day mortality than those without such medication, allP<0.001; the reduction was more obvious in Serum sodium<130 mmol/L group than the other 2 groups,P<0.001. Conclusion: Serum sodium level<130 mmol/L within 24h of admission was the risk factor for the early stage main adverse events as mortality, cardiac shock, HF and life-threatening arrhythmia in acute STEMI patients.

OBJECTIVETo study cycloartane triterpenoid of Cimicifuga foetida and their osteoclast inhibition activity.

METHODThe compounds were isolated and purified by normal and reversed phase column chromatographic methods. Structures were identified by spectroscopic analyses. Their osteoclast inhibition activity was then studied.

RESULTThirteen cycloartane triterpenoids were isolated from the rhizomes of C. foetida and were characterized as 25-O-acetyl-cimigenol (1), cimigenol (2), cimicidanol (3), 26-deoxyactein (4), asiaticoside A (5), 23-epi-26-deoxyactein (6), actein (7), 12beta-hydroxycimigenol (8), cimiside E (9), (23R, 24S) 25-O-acetyl-cimigenol-3-O-beta-D-xylopyranoside (10), (23R, 24S) cimigenol-3-O-beta-D-xylopyranoside (11), cimicifugoside H-1 (12) and cimicifugoside H-2 (13).

CONCLUSIONCompound 5 was isolated from this genus for the first time, compound 7 was isolated firstly from the plant and compound 2, 7, 10 and 11 exhibit osteoclast inhibition activity.

Animals ; Cells, Cultured ; Cimicifuga ; chemistry ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Mice ; Osteoclasts ; drug effects ; Triterpenes ; chemistry ; pharmacology

Objective To observe the effects of tetrandrine on the proliferation,migration,and invasion of melanoma cell B16,and to explore its effects on epithelial mesenchymal transition(EMT)and potential regulatory mechanisms.Methods(1)The proliferation of B16 cells was detected by CCK-8 assay after 0,2,4,6,8 and 10 μmol·L-1 of tetrandrine intervention for 24 and 48 hours.The colony formation ability of B16 cells was detected by plate clone formation assay after 1,2 and 4 μmol·L-1 of tetrandrine intervention;the migration and invasion ability of B16 cells was detected by cell scratch assay and Transwell invasion assay;the expressions of N-cadherin,Vimentin and E-cadherin related to EMT in B16 cells were detected by Western Blot assay.The mouse melanoma lung metastasis model was replicated by tail vein injection of B16 cells to observe the effects of tetrandrine(50 and 100 mg·kg-1)administered by gavage on the number of metastatic tumor nodules in the lungs of mice.(2)The CTD,SwissTargetPrediction and Similarity Ensemble Approach databases were used to predict the targets of tetrandrine;the GeneCards database was used to search for targets related to melanoma disease;the intersection of these two databases was taken as the potential target of tetrandrine for melanoma treatment.The intersected targets were imported into STRING database to construct protein-protein interaction(PPI)network and screen the core targets;the intersected targets were imported into DAVID database for GO function and KEGG pathway enrichment analysis;and molecular docking between tetrandrine and the core targets was verified by Autodock software.(3)In vivo experimental validation:after intervention of 1,2 and 4 μmol·L-1 tetrandrine,Western Blot method was used to detect the expression of the key pathway AKT/NF-κB/CREB pathway-related proteins;and AKT agonist SC79 was used to validate the replication experiments.Results(1)The IC50 of B16 cells intervened by tetrandrine was 4.273 and 4.085 μmol·L-1 at 24 and 48 hours.Compared with the control group,the colony forming ability,scratch healing rate and invasion rate of cells in the 1,2 and 4 μmol·L-1 tetrandrine group were all significantly reduced(P＜0.05,P＜0.01,P＜0.001);the expressions of cellular Vimentin and N-cadherin protein expressions were significantly down-regulated(P＜0.01,P＜0.001),and E-cadherin protein expression was significantly up-regulated(P＜0.01,P＜0.001).Compared with the model control group,the number of melanoma lung metastatic nodules was significantly reduced in the mice in the high-dose group of tetrandrine(P＜0.05).(2)A total of 60 potential targets were obtained for the treatment of melanoma with tetrandrine;core targets such as AKT1,TNF,CCND1,RELA,CASP9,CHUK,and CREBBP were further screened,among which AKT1 was the most strongly interacting target;the signaling pathways such as apoptosis,FoxO,TNF,PI3K-AKT,and NF-κB were mainly involved.The molecular docking showed that tetrandrine had strong binding activity with AKT1,TNF,RELA and other core targets.Compared with the control group,protein expressions of p-AKT/AKT,p-NF-κB p65/NF-κ B p65,and p-CREB/CREB were significantly down-regulated in the cells of the tetrandrine 1,2,and 4 μmol·L-1 groups(P＜0.05,P＜0.01);protein expressions of p-AKT and p-NF-κB p65 were significantly up-regulated in the cells of the SC79 group(P＜0.001).Compared with the SC79 group,protein expressions of p-AKT,p-NF-κB p65,and p-CREB were significantly down-regulated in the cells of the 2 μmol·L-1 tetrandrine+ SC79 group(P＜0.001).Conclusion Tetrandrine may inhibit the proliferation,migration,invasion and EMT of mouse melanoma by regulating the AKT/NF-κB/CREB pathway,and thus inhibit the lung metastasis of mouse melanoma.

Objective To investigate the risk factors of perioperative complications of laparoscopic radical distal gastrectomy and influence of body shape on the short-term therapeutic effects.Methods The retrospective case-control study was conducted.The clinicopathological data of 506 patients (328 males and 178 females,average age 60 years with the range of 24-85 years) who underwent laparoscopic radical distal gastrectomy+D2 lymph nodes dissection in the 8 clinical centers between March 2016 and November 2018 were collected,including 143 in the First Affiliated Hospital of Xiamen University,66 in the Affiliated Hospital of Qinghai University,66 in the Second Affiliated Hospital of Wenzhou Medical University,64 in the Zhongshan Hospital of Xiamen University,54 in the Affiliated Hangzhou First people's Hospital of Zhejiang University School of Medicine,48 in the Zhangzhou Affiliated Hospital of Fujian Medical University,35 in the Affiliated Quanzhou First Hospital of Fujian Medical University,30 in the Second Affiliated Hospital of Xiamen Medical College.The maximum thickness of subcutaneous fat at the level of umbilicus (USCF),the maximum vertical distance between the anterior abdominal skin and the back skin at the level of the umbilicus (UAPD),the maximum horizontal distance between the anterior abdominal skin and the back skin at the level of the umbilicus (UTD),the maximum verticaldistance between the anterior abdominal skin and the back skin at the level of the xiphoid bone (XAPD),the maximum horizontal distance between the.anterior abdominal skin and the back skin at the level of the xiphoid bone (XTD),the distance between the anterior abdominal skin and the root of celiac artery (CAD) and the maximum horizontal distance at a right angle to CAD (CATD) were measured using preoperative imaging examinations.Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up situations;(3) risk factors analysis of perioperative complications;(4) influence of body shape related indexes on intraoperative situations and postoperative recovery:① Pearson univariate correlation analysis,② liner regression model analysis.Followup using outpatient examination and telephone interview was performed to detect the postoperative survival and tumor recurrence or metastasis up to December 2018.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Comparisons of count data were analyzed using the chi-square test.Comparisons of ordinal data were analyzed by Mann-Whitney U nonparametric test.Risk factors of perioperative complications of laparoscopic distal gastrectomy were analyzed by Logistic regression model.Influence of body shape related indexes on intraoperative situations and postoperative recovery was analyzed by Pearson univariate correlation analysis and liner regression model.Results (1) Intraoperative and postoperative situations:all the 506 patients underwent successful laparoscopic distal gastrectomy,including 103 with Billroth Ⅰ anastomosis,140 with Billroth Ⅱ anastomosis,201 with Billroth Ⅱ + Braun anastomosis,62 with Roux-en-Y anastomosis.The operation time,volume of intraoperative blood loss,number of lymph nodes dissected,time to postoperative anal exsufflation,time for initial fluid diet intake,time for initial semi-fluid diet intake and duration of postoperative hospital stay were (233±44)minutes,(102±86)mL,34±13,(3.6±1.5)days,(5.8±3.3)days,(8.3±3.8)days,(12.2±5.7)days respectively in the 506 patients.Of 506 patients,196 were defined as pathological stage Ⅰ,122 were defined as pathological stage Ⅱ and 188 were defined as pathological stage Ⅲ postoperatively.Of 506 patients,93 had 106 times of perioperative complications,including 33 times of pulmonary and upper respiratory infection,12 times of incisional infection,11 times of anastomotic leakage,11 times of abdominal infection,8 times of intestinal obstruction,8 times of gastroplegia,6 times of abdominal hemorrhage,5 times of bacteremia,3 times of anastomotic hemorrhage,3 times of lymph fluid leakage,2 times of pancreatic leakage,1 time of urinary infection,1 time of anatomotic stenosis,1 time of deep venous thrombosis and 1 time of pulmonary embolism;the same patient can merge multiple complications.Eleven patients were in the Clavien-Dindo classification ≥ Ⅲ.(2) Follow-up situations:465 of 506 patients were followed up for 1-32 months with a median time of 12 months.During the follow-up,451 had postoperative survival and 38 had tumor recurrence or metastasis.(3) Risk factors analysis of perioperative complications.① Results of univariate analysis showed that age,body mass index (BMI),preoperative hemoglobin,preoperative serum albumin and XAPD were related factors affecting perioperative complications of laparoscopic distal gastrectomy (x2 =10.289,7.427,5.269,5.481,4.285,P＜ 0.05).② Results of multivariate analysis showed that age,BMI,preoperative serum albumin were independent related factors affecting perioperative complications of laparoscopic distal gastrectomy (odds ratio =1.033,1.118,0.937,95％ interval confidence:1.011-1.057,1.025-1.219,0.887-0.990,P＜0.05).(4) Influence of body shape related indexes on intraoperative situations and postoperative recovery.① Results of Pearson univariate correlation analysis showed correlations between UAPD,XAPD,CAD,CATD and volume of intraoperative blood loss (r=0.107,0.169,0.179,0.106,P＜0.05),between UAPD,XAPD,CAD and the number of lymph nodes dissected (r=-0.137,-0.143,-0.173,P＜0.05),between USCF,XAPD and time to postoperative anal exsufflation (r =0.122,0.109,P＜0.05),between USCF,XAPD,CAD and time for initial fluid diet intake (r=0.132,0.108,0.132,P＜0.05),between USCF,XAPD and duration of postoperative hospital stay (r=0.116,0.100,P＜0.05).② Results of liner regression model analysis showed a positive correlation between CAD and volume of intraoperative blood loss (r =6.776),a negative correlation between CAD and the number of lymph nodes dissected (r =-0.841),with statistically significant differences (t =2.410,-1.992,P＜ 0.05);a positive correlation between USCF and time to postoperative anal exsufflation (r=0.170),between USCF and time for initial fluid diet intake (r=0.365),between USCF and duration of postoperative hospital stay (r=0.636) respectively,with statisticallysignificant differences (t =2.188,1.981,2.107,P＜ 0.05).Conclusions Abdominal shape can influence intraoperative situations and postoperative recovery of laparoscopic distal gastrectomy,but cannot increase risks ofperioperative complications.Age,BMI and preoperative serum albumin are independent related factors affecting perioperative complications of laparoscopic distal gastrectomy.

OBJECTIVE：To study the mechanism of enhancement effects of Astragalus complanatus polysaccharides（ACP） on the proliferation of meniscal fibrochondrocytes cells in rabbits. METHODS ：The meniscal fibrochondrocytes cells were isolated from 1-month-old New Zealand white rabbits. The meniscal fibrochondrocytes cells were divided into normal control group （PBS）， positive control group （glucosamine sulfate ，10 mg/mL）and ACP high-dose，medium-dose and low-dose groups （40，20，10 mg/mL）. The morphology of meniscal fibrochondrocytes cells were observed under microscope. Cell proliferation rate was detected by MTT assay. Cell cycle was observed with flow cytometry. ELISA assay was used to detect relative expression of medium collagen type Ⅱ（Col Ⅱ）and alkaline phosphatase protein （ALP）in meniscal fibrochondrocytes cells. RT-qPCR and Western blotting assay were adopted to detect mRNA and protein expression of transforming growth factor β 1 （TGF-β 1） and bone morphogenetic protein 2（BMP-2）. RESULTS ：After cultured for 72 h，meniscal fibrochondrocytes cells were fused into a single layer，and most of them were slender type in appearance. Compared with normal control group ，the proliferation rate of meniscal fibrochondrocytes cells and the percentage of cells at G 1/G0 phase were decreased significantly in positive control group and ACP high-dose，medium-dose and low-dose groups （P＜0.05）；the percentage of cells at S phase ，protein expression of Col Ⅱ and ALP，mRNA and protein expression of TGF-β1 and BMP- 2 were increased significantly （P＜0.05）. Compared with positive control group，inhibitory rate of meniscal fibrochondrocytes cells proliferation and the percentage of cells at G 1/G0 phase were decreased significantly in ACP high-dose group （P＜0.05），while the percentage of cells at S phase ，protein expression of Col Ⅱ and ALP ， mRNA and protein expression of TGF-β1 and BMP- 2 were increased significantly （P＜0.05）. The inhibitory proliferation rate of meniscal fibrochondrocytes cells and the percentage of cells at G 1/G0 phase were increased significantly in ACP low-dose group （P＜ 0.05），while the percentage of cells at S phase ，protein expression of Col Ⅱ and ALP ，mRNA and protein expression of TGF-β1 and BMP- 2 were decreased significantly （P＜0.05）. There was no statistical significance in above indexes of ACP medium-dose group. CONCLUSIONS ：ACP can promote the proliferation of meniscal fibrochondrocytes cells ，reduce the percentage of cells at G1/G0 phase，promote cell transformation to S phase ；the mechanism of which may be related to up-regulating TGF-β1，BMP-2 mRNA and protein expression ，promoting Col Ⅱ and ALP protein expression enhancement.

BACKGROUNDNicotine may improve schizophrenia patient's cognitive deficit symptoms. This study was to explore the chronic effects of smoking on prepulse inhibition of the startle reflex (PPI) and P50 in the patients with first-episode schizophrenia (FES).

METHODSThe event-related potentials (ERP) recording and analysis instrument made by Brain Products, Germany, was used to detect PPI and P50 in 49 male FES patients (FES group, n = 21 for smokers and n = 28 for non-smokers) and 43 normal male controls (control group, n = 19 for smokers and n = 24 for non-smokers).

RESULTSCompared with normal controls, the FES group had prolonged PPI latency when elicited by single stronger stimulus (P < 0.05); the FES group had prolonged PPI latency and increased PPI amplitude (P < 0.05, 0.01) when elicited by weak and strong stimuli. The FES group had lower PPI inhibition rate than normal controls (P < 0.05). Compared with normal controls, the FES group had increased P50-S2 amplitude and increased amplitude ratio S2/S1 (both P <0.05). In the control group, the smokers had a tendency of increase in P50-S2 amplitude (P > 0.05) and shorter P50-S2 latency (P < 0.05) than the non-smokers. The smokers had higher PPI amplitude than the non-smokers (P < 0.05). In the FES group, the smokers had higher P50-S1 amplitude, shorter P50-S2 latency, and higher amplitude ratio S2/S1 than the non-smokers (P < 0.05, 0.01). The smokers had higher PPI amplitude than the non-smokers (P < 0.05).

CONCLUSIONSThere is obvious PPI and P50 deficits in schizophrenic patients. However, these deficits are relatively preserved in the smokers compared with the non-smokers, which suggests that long-term smoking might partially improve the sensory gating in schizophrenic patients. Whether this conclusion can be deduced to female patients requires further follow-ups.

Adult ; Case-Control Studies ; Evoked Potentials ; drug effects ; physiology ; Humans ; Male ; Reflex, Startle ; physiology ; Schizophrenia ; physiopathology ; Smoking ; adverse effects ; Young Adult