BACKGROUND:Repeated hyperbaric oxygenation (HBO) preconditioning induces tolerance against ischemia in spinal cord. The confirmation of this phenomenon paves a new way in clinic to prevent and treat complications of spinal ischemia following thoracoepigastric aorta surgery. Probing into its mechanism of is chemic tolerance has provided basis for clinical application.OBJECTIVE: To investigate the changes of mitochondrial structure and ATPase activity during spinal cord ischemic tolerance induced by repeated HBO preconditioning in rabbits.DESIGN: Randomized and controlled trial.SETTING: Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University of Chinese PLA.MATERIALS: The experiment was conducted in the hyperbaric oxygen chamber of the Department of Air Medicine; Experimental Animal Center of the Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University of Chinese PLA, between March and June 2004. Totally 50 male New Zealand rabbits were selected.METHODS: Fifty male New Zealand rabbits were randomly divided into two groups: simple ischemia control group and HBO group with 25 rabbits in each group: 0.25 Mpa, 100% O2, one hour per day for 5 days. Spinal ischemia model was prepared 24 hours after the last preconditioning.Spinal cord ischemia (20 minutes)/reperfusion model was prepared by blocking the infrsrenal aorta. The motor function of hind-limbs was scored at 6 hours, 24 hours and 48 hours after reperfusion. The mitochondrial ATPase activity was measured and compared between two groups before ischemia, at 6 hours, 24 hours and 48 hours after reperfusion.MAIN OUTCOME MEASURES: ① The score of motor nerve function of the hind-limbs; ② The activity of mitochondrial ATPase; ③ Pathological evaluation.RESULTS: Totally 50 rabbits were involved for result analysis, and finally 25 rats in each group entered statistical analysis with no loss in the midway. ① The score of motor nerve function of the hind-limbs in HBO group at 6 hours, 24 hours and 48 hours after HBO preconditioning was significantly higher than that in control group (P ＜ 0.01). ② The activity of mitochondrial ATPase: the mitochondrial Na+, K+-ATPase activity and Ca2+, Mg2+-ATPase activity at each time point of the animals in the two groups after is chemia were significantly decreased; Na+, K+-ATPase activity in HBO preconditioning group at 6 hours, 24 hours and 48 hours of ischemia was significantly higher than that in control group (P ＜ 0.01); Ca2+, Mg2+-ATPase activity at 6 hours and 24 hours after ischemia was significantly higher than that in control group (P ＜ 0.01). ③ Pathological evaluation: The structure of mitochondria in control group was seriously damaged while it was found almost normal in spinal cord in HBO group animals at 48 hours after reperfusion.CONCLUSION: The mechanism of ischemic tolerance induced by hyperbaric oxygenation pretreatment may partly be related to the attenuation of mitochondria ATPase activity decrease after ischemia, thereby protecting the function of mitochondria.

Aiming at building research disciplines,Xijing hospital has initially achieved a strategic transformation into a hospital with research disciplines,with such measures as scientific layout of disciplines,making of advantageous disciplines with overseas benchmarks,encouragement of potential disciplines with advantageous disciplines,promotion of medical innovation with innovative ideas,and upgrading clinical service quality with technical innovation.

OBJECTIVE:To evaluate the clinical effects of urapidil on cardiovascular response induced by sympathetic stimulation during front approach cervical vertebra operation.METHODS:One hundred and twenty patients undergoing front approach cervical vertebra operation were randomly divided into three groups.Patients in URA group treated with0.5mg/kg urapidil and patients in NIC group treated with5?g/kg nicardipine when systolic blood pressure(SBP)and heart rate(HR)increased by sympathetic nerve stimulation during the operation.And patients in COM group only increased their anesthesia degree with isoflurane at the same situation.The patients’SBP and HR were observed and compared among three groups at the time before the sympathetic nerve stimulation,and5minutes and10minutes after the drugs treatment respective?ly.RESULTS:The patients’SBP and HR in URA group had no significantly increase after administration of urapidil.In NIC group,although the patients’SBP had no significantly increase,the patients’HR increased significantly after nicardipine was used.But the patients’SBP and HR increased significantly after improved anesthesia degree with isoflurane.CONCLUSION:Urapidil has better effect on sympathetic cardiovascular response during the front approach cervical vertebra operation com?pared with nicardipine.

Objective To explore the correlation between HbA1c level and carotid plaque stability in type 2 diabetes mellitus(T2DM)patients.Methods From October 2018 to October 2020,100 T2DM patients who visited our hospital and underwent carotid artery ultrasound examination with a plaque thickness greater than 1.5 mm were included in this study.According to HbA1c levels,they were divided into HbA1c≤7%group(n=21),7%9%group(n=51).Results The FPGs of the 7%9%groups were higher than that of the HbA1c≤7%group(P<0.01).The plaque thickness gradually increased from group HbA1c≤7%,7%9%groups(P<0.01),and the proportion of high-level enhancement in the overall,proximal,middle,and distal segments of the plaque increased in sequence(P<0.05 or P<0.01).Pearson correlation analysis showed that HbA1c,FPG,and 2 hPG were positively correlated with plaque thickness and length(P<0.05).Spearman correlation analysis showed that HbA1c was positively correlated with the smoothness of the plaque surface,the presence of extremely low echogenicity within the plaque,and the overall,proximal,central,and distal enhancement intensity of the plaque(P<0.05).Conclusion HbA1c can not only evaluate the blood glucose control of T2DM patients,but also has a certain correlation with the stability of carotid plaque,with a trend of poorer plaque stability as HbA1c increases.

There are trillions of bacteria in the human′s intestine, these bacteria constitute the largest human microbiota what are called intestinal flora , the intestinal flora participate in or affect the occurrence and development of a variety of diseases with the host as a whole .This review is focused on the relationship between intestinal microbiota and digestive diseases .It is helpful for clinicians to expand their understanding of the pathogenesis of related diseases and to broaden the diagnosis and treatment of diseases by understanding and studying the effects of intestinal microflora on the development of these diseases .

The European Congress for Integrative Medicine 2015 Global Summit on Integrative Medicine and Healthcare in Greater Copenhagen has successfully promoted integrative medicine to the public once again. Integrative medicine, which is called the art and science of healthcare by Nordic Integrative Medicine, has been widely used in the world. In Hong Kong, integrated traditional Chinese and Western medicine, which is also known as the Chinese version of integrative medicine, provides a valuable reference for the development of integrative medicine in the world. In this article, we introduce the development of traditional Chinese medicine in Hong Kong and an integrated traditional Chinese and Western medicine model in the University of Hong Kong-Shenzhen Hospital.
Delivery of Health Care ; Hong Kong ; Hospitals ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional

BackgroundThe pathogenesis of depression remains not fully understood， and previous studies have suggested that the kynurenine pathway （KP） plays an important role in the pathogenesis of major depressive disorder. ObjectiveTo study the difference in serum KP metabolites level between patients with first-episode and recurrent major depressive disorder， and to testify the correlation between KP metabolites level with the severity of depressive symptoms， so as to provide references for the prevention of recurrence. MethodsA total of 136 patients with major depressive disorder who attended the outpatient clinics of the Affiliated Brain Hospital of Guangzhou Medical University from November 2016 to December 2018 and met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria were included， including 62 patients in the first-episode group and 74 patients in the recurrent group. Meanwhile， 60 healthy subjects were included as control group. All patients were assessed by Hamilton Depression Scale-17 item （HAMD-17）， and serum concentrations of tryptophan （TRP）， kynurenine （KYN） and kynurenic acid （KYNA） were measured by liquid chromatography tandem mass spectrometry （LC-MS/MS）. Then the correlation of HAMD-17 total score and individual item scores with the levels of KP metabolites was tested using partial correlation coefficient. ResultsCompared with the control group， the first-episode group and recurrent group showed a marked decline in TRP concentration （t=-3.044， -4.477， P<0.05 or 0.01） and an increase in KYN/TRP ratio （t=2.343， 3.644， P<0.05 or 0.01）， with significant differences. The KYNA concentrations （t=2.490， 2.636， P<0.05 or 0.01） and KYNA/KYN ratio （t=2.894， 2.616， P<0.01） in first-episode group and control group were notably elevated compared to recurrent group， with statistical difference. Partial correlation analysis in patients with first-episode major depressive disorder demonstrated that KYN/TRP ratio was positively correlated with the HAMD-17 anxiety/somatization factor score （r=0.261， P<0.05）， and KYNA/KYN ratio was negatively correlated with HAMD-17 total score and block factor score （r=-0.286， -0.282， P<0.05）. In patients with recurrent major depressive disorder， KYN/TRP ratio was positively correlated with HAMD-17 anxiety/somatization factor score （r=0.280， P<0.05）. ConclusionKP metabolites in serum differ between first-episode and recurrent major depressive disorder patients， and patients with recurrent episodes experience severe KP metabolite abnormalities. Therefore， KP metabolites are considered to be potential biomarker candidates to assist clinicians in the diagnosis and recurrent prediction of major depressive disorder. ［Funded by National Key Research and Development Program Precision Medicine Research Project （number， 2016YFC0906300）］

Objective To observe the clinical effect of dynamic blood glucose monitoring combined with intensive insulin therapy in critically ill patients with hyperglycemia in intensive care unit (ICU).Methods A total of 135 cases of critically ill patients with severe hyperglycemia were randomly divided into control group (n =67) and treatment group (n =68).Control group was given fingertip blood glucose monitoring,3 times a day combined with syringe pump continuous intravenous 2-4 U · h-1 insulin.Treatment group was given dynamic blood glucose monitoring (every 6 h on blood glucose changes recorded) combined with insulin intensive treatment (when patients' initial blood glucose ＞ 12.1 mmol · L-1,the patients were intravenous infusion 4 U · h-1 insulin,if the blood glucose did not decline,the appropriate increase in 1.5-2.0 U · h-1 insulin).Two groups were treated continuously for 2 weeks.The fasting blood glucose (FBG),ICU hospitalization time,mean mechanical ventilation time,mortality and hypoglycemia were observed in two groups.Results After 3,5,7 d treatment,the FBG in treatment group were (6.34 ± 1.48),(5.73 ± 1.23),(5.24 ± 0.86) mmol· L-1,had significant difference with those in control group,which were (8.76 ±2.36),(8.46 ±2.19),(7.59 ±2.19) mmol · L-1(P ＜0.05).The ICU hospitalization time,mean mechanical ventilation time in treatment group were (8.63 ±5.72),(6.25 ±4.61) d,had no significant difference with those in control group,which were (9.78 ±6.34) and (6.75 ±4.78) d (P ＞0.05).There were 7 cases (10.29％) of mortality in treatment group and 11 cases (16.41％) in control group,with no significant difference (P ＞ 0.05).There were 6 cases (8.82％) of hypoglycemia in treatment group and 14 cases (20.89％) in control group,with no significant difference (P ＜ 0.05).Conclusion In the intensive care unit,hyperglycemia patients with dynamic blood glucose monitoring combined with insulin intensive treatment can more accurately grasp hyperglycemia critically ill patients' blood glucose changes,and then more scientific development of insulin use,can quickly reduce the patients' blood glucose and reduce the incidence of hypoglycemia,has a very good clinical efficacy.

Hepatocellular carcinoma (HCC) is one of leading causes of death in the world. Although various treatments have been developed, the therapeutic side effects are far from desirable. Chinese medicines (CMs, including plants, animal parts and minerals) have drawn a great deal of attention in recent years for their potential in the treatment of HCC. Most studies have shown that CMs may be able to retard HCC progression with multiple actions, either alone or in combination with other conventional therapies to improve quality of life in HCC patients. Additionally, CMs are used for preventing HCC occurrence. The aim of this study is to review the potential prophylactic and curative effects of CMs on human HCC and the possible mechanisms that underlie these pharmacological actions. Publications were collected and reviewed from PubMed and China National Knowledge Infrastructure from 2000 to 2014. Keywords for literature searches include "Chinese medicine", "Chinese herb", "traditional Chinese Medicine", "hepatocellular carcinoma" and "liver cancer". CMs in forms of pure compounds, isolated fractions, and composite formulas are included. Combination therapies are also considered. Both in vitro and in vivo efficacies of CMs are being discussed and the translational potential to bedside is to be discussed with clinical cases, which show the actions of CMs on HCC may include tumor growth inhibition, antimetastatic activities, anti-inflammation, anti-liver cancer stem cells, reversal on multi-drug resistance and induction/reduction of oxidative stress. Multiple types of molecules are found to contribute in the above actions. The review paper indicated that CMs might have potential to both prevent HCC occurrence and retard HCC progression with several molecular targets involved.
Carcinoma, Hepatocellular ; drug therapy ; prevention & control ; Drug Resistance, Multiple ; Humans ; Liver Neoplasms ; drug therapy ; prevention & control ; Medicine, Chinese Traditional ; NF-E2-Related Factor 2 ; physiology ; Neoplastic Stem Cells ; drug effects ; Reactive Oxygen Species ; metabolism

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ² test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ²=288.60,P<0.01),N stage(χ²=68.10, P<0.01), vascular invasion(χ²=128.70, P<0.01)and neural invasion(χ²=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ²=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.