Object To determine the baicalin content in skullcap polyploid by MEKC and HPLC, and to provide the reliable method used to determine a large number of samples. Methods On the basis of methodology of MEKC and HPLC, the baicalin in Scutellaria baicalensis Georgi. was determined, the data and relevant analysis were compared. Results The data of the content determined by HPLC was similar to that by MEKC, but the former showed slightly higher 1%-3%. There was no significant variation between the two methods with higher correlation coefficient. Conclusion Both the above two methods could be accurately used to determine the baicalin in S. baicalensis. The MEKC has some advantages, such as quick, save time with lower solvent cost, and is suitable for the large number of samples in the determination of baicalin of S. baicalensis.

Objective To test the mutation locus of uridine diphospho-glucuronosyltransferase gene (UGT1A1) in a Chinese patient with Crigler-Najjar syndrome type Ⅰ and her family members,analyzing the genetic characteristics of the pedigree.Methods Genomic DNA was extracted from the patient and her family members and other 50 full-term infants with normal serum bilirubin as a healthy control group.Fifty cases of full-term newborn whose serum bilirubin level were nomal were study as controls.The promoter and all exons of UGT1A1 gene were amplified by the method of polymerase chain reactions (PCR),and mutations were identified by direct sequencing.Results The propositus and her miscarriage sister were homozygous for a nonsense mutation at nucleotide number 715 (715C ＞ T) in exon 1 of gene UGT1A1,substituting of stop codon (TAG) for glutamine (CAG) at position 239 (Q239X).The other 5 members were heterozygous in the same mutation locus.A TA insertion mutation and a G71R mutation in exon 1 were observed in the family members.The patient and her sister were homozygous of A(TA)7TAA mutation while other four were heterozygous.Propositus,grandmother,mother and her younger brother were heterozygous of G71 R mutation.No mutation was found in exons 2-5.No mutation was found in other fifty healthy cases in the healthy control group.Conclusions Q239X homozygous mutations is considered to be the lethal gene in this Crigler-Najjar syndrome family.Collaborative G71 R and A(TA)7TAA mutations may further reduce the enzyme activity of UGT1A1,causing varying degrees of bilirubin disorder.

Surgical shunt is still an effective method in managing portal hypertension related gastrointestinal bleeding.To minimize the invasive trauma and adverse effect on transplantation remains to be the unsolved problem.Herein we present the use of a newly designed surgical shunt to cure massive refractory gastrointestinal tract hemorrhage in a patient,who was critically ill because of the extensive thrombus in portal venous system.The procedure is named gastrojugular shunt.For the sake of its simple operation and effective outcome,the procedure was performed on four other patients.All the patients were well treated and recovered uneventfully with good follow up results.

Objective The anti-tumor effect by sequential treatment with Newcastle disease virus (NDV) strain 7793 and 5-FU in liver-metastases mice model was evaluated and immune-active response stimulated by sequential therapy was investigated. Methods Liver metastasis mice model was established by intra-peritoneal injection. The model mice were randomly divided into 3 groups, being given PBS (0.1 mL/d,10 d), NDV7793 [512 HU/(kg·d),5 d] and NDV7793[512 HU/(kg·d),5 d] + fluorouracil [5-FU,10 mg/(kg·d),5 d]. The effect on survival time,body weight,liver weight change and the formation of liver metastasis in tumor-bearing mice model were detected after different treatments in evaluating the regression of mice liver metastasis by sequential therapy. The detection of thymus index and IFN-γ concentrations in liver tissue of tumor-bearing mice model may indicate the stimulation of immune-active response by sequential therapy. Results The mean survival time of tumor-bearing mice treated with NDV7793 and 5-Fu sequentially was 32 d , which was significantly higher than those of tumor-bearing mice treated with NDV7793(30 d) or PBS injections (17 d), respectively (P< 0.05); The metastatic foci of tumor-bearing mice treated with NDV and 5-FU sequentially (30.60 ± 9.32) which was significantly less than those of tumor-bearing mice treated with PBS injection (273.30 ± 30.73), (P <0.05), seem quite similar to those treated with NDV (24.83 ± 6.90),(P > 0.05), and the liver weight was lighter than PBS (P < 0.05); Compared with NDV treatment, the decreased thymus index and increased amount of the effector IFN γ were observed in tumor-bearing mice treated with NDV 7793 and 5-FU sequentially (P <0.05). Conclusions The sequential therapy with Newcastle disease virus 7793 strain and 5-FU was observed to co-exert a significant suppressive effect in liver metastases of colon cancer cells in tumor-bearing mice model. Compared with NDV treatment , the survival time of mice model and the induction of antitumor effector molecules were significantly improved after sequential therapy.

Objective: To investigate the effect of bilirubin on inflammatory signaling pathway mediated by NOD-like receptor 2(NOD2) in premature infants. Methods: Fifteen cases of premature infants hospitalized at the Department of Neonatology, Children′s Hospital of Soochow University from April 2016 to January 2017, were selected, and 2 mL peripheral blood were collected from 15 cases of premature infants, and the mononuclear cells were isolated and divided into 6 groups, including blank control group (group A), muramyl dipeptide(MDP) group (group B), 102 μmol/L bilirubin group(group C), 102 μmol/L bilirubin+ MDP group (group D), 153 μmol/L bilirubin+ MDP group (group E), 255 μmol/L bilirubin+ MDP group (group F). Group A and group B were stimulated by buffer, group C, group D, group E and group F were stimulated by 102 μmol/L, 102 μmol/L, 153 μmol/L, 255 μmol/L bilirubin, respectively.The supernatant was discarded after 1 h, then the medium was added to group A and group C, and the rest of the 4 groups were agonisted with MDP, the cells were stimulated for 24 h, and then the cells and supernatant fluids were collected respectively, the expression levels of NOD2 mRNA in the cells were determinated by real time-PCR, and the expression levels interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the supernatant was determinated by enzyme linked immunosorbent assay. Results: The expression levels of NOD2 mRNA had no obvious changes after being stimulated by MDP or by different concentrations of bilirubin(7.16±3.08, 6.19±1.99, 7.02±4.04, 6.84±1.81) compared to those of the blank control group(7.46±3.70)(all P>0.05). After being stimulated by MDP, the expression level of IL-6 (5.13±2.36)was significantly higher than that of the blank control group(3.84±1.44), and the difference was statistically significant(P<0.05), but TNF-α had no obvious changes(4.85±2.47 vs.4.04±2.26, P>0.05). The expression levels of IL-6 and TNF-α had no obvious changes compared to those of the blank control group after being stimulated by 102 μmol/L bilirubin(3.26±1.06 vs.3.84±1.44, 3.45±1.84 vs.4.04±2.26, all P>0.05); but the expression levels of IL-6 and TNF-α were significantly lower after 153 μmol/L and 255 μmol/L bilirubin stimulation (IL-6: 2.58±1.33, 2.16±0.94; TNF-α: 2.32±1.49, 2.42±1.42)compared to those of the blank control group(3.84±1.44, 4.04±2.26), and the differences were statistically significant(all P<0.05). Conclusions Bilirubin have no obvious inhibitory effect on NOD2, and low concentration of bilirubin had no obvious inhibitory effect on IL-6 or TNF-α in this study, but high concentration of bilirubin can inhibit the expression levels of IL-6 and TNF-α, hyperbilirubin may inhibit the ability of anti-infection immune response in body by inhibiting inflammatory signaling pathway mediated by NOD2.

Objective:To understand the real physical and mental experience of family caregivers for centenarians in the long-term care process and to provide a basis for alleviating the pressure of caregivers and reducing social burdens.Methods:Using the purposive sampling method, family caregivers of centenarians in Rugao City of Jiangsu Province from April to June 2020 were selected as the research objects.The phenomenological research method in qualitative research was used to conduct in-depth interviews with family caregivers of centenarians. The content analysis method was used to analyze the data, sort out and extract the theme.Results:After comparative analysis, the physical and mental experience of family caregivers of centenarians revealed three themes. including grateful heart, diversified care pressure and social support needs to be further improved.Conclusions:Long-term family care work has a negative effect on the life of the centenarian family caregivers. The government, community and social workers should take the initiative to intervene and provide multi-channel support to reduce the physical and mental stress of the family caregivers and improve the satisfaction and quality of life of both caregivers and centenarians.

Objective To summarize the clinical features of patients with diffuse coronary artey diseases,and evaluate the clinical efficacy of off-pump coronary artery bypass grafting(OPCABG) combined with selective coronary venous bypass grafting (SCVBG).Methods Retrospectively analyzed the clinical data of 61 patients with diffuse right coronary stenosis undergoing operation of OPCABG + SCVBG from January 2007 to December 2013,and couducted the comparative study of the patients who underwent OPCABG during the same period based on propensity score.Patients were divided into SCVBG group(61 cases,underwent OPCABG + SCVBG) and control group(60 cases,matched by propensity score and underwent OPCABG without SCVBG).Results Compared with control group,the rate of myocardial infarction in SCVBG group was higher (67.2％ vs.46.7c％,P ＜0.05),the heart rate was faster[(69.92 ± 15.82) bpm vs.(64.48 ± 13.72) bpm,P ＜ 0.05],the low density lipoprotcin and triglyceride were higher[(2.67 ± 0.78) mmol/L vs.(2.37 ± 0.78) mmol/L (1.84 ± 0.79) mmol/L vs.(1.36 ± 0.60) mmol/L,both P ＜ 0.05] and the troponin I was higher in the first postoperative day [0.85 (0.29,3.15)μg/L vs.5.09 (2.02,13.03)μg/L,P ＜ 0.05].The perioperative(postoperative) mortality(1.6％ vs.0) and the long-term survival curve difference had no statistically significance(P ＞0.05).Conclusion Patients with coronary artery disease should pay more attention to the control of heart rate and blood lipids,poorly controlled heart rate and high blood lipids are the important factors for the development of coronary heart disease.The exact efficacv of selective coronary vein arterialization for diffuse coronary artery disease is confirmed through the small sample comparative study.

ObjectiveTo investigate the risk factors for tumor recurrence and death after liver transplantation in patients with hepatocellular carcinoma (HCC) and their survival. MethodsThe patients with HCC who underwent liver transplantation in The Fifth Medical Center of Chinese PLA General Hospital from January 2005 to February 2019 were enrolled, and according to the presence or absence of HCC recurrence after liver transplantation, they were divided into recurrence group and non-recurrence group. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to determine the risk factors for HCC recurrence and death after liver transplantation. The Kaplan-Meier method was used for survival analysis, and the receiver operating characteristic (ROC) curve was used to investigate the predictive value of death-related risk factors after liver transplantation. ResultsA total of 391 HCC patients who underwent liver transplantation were enrolled, with a median follow-up time of 2 years, among whom 78(19.95%) experienced HCC recurrence. Preoperative alpha-fetoprotein (AFP) level＞200 ng/ml (recurrence: hazard ratio ［HR］=252, 95% confidence interval ［CI］: 1.58-4.03, P＜0.001; death: HR=2.99, 95%CI: 1.59-5.62, P＜0.001］, total tumor diameter (recurrence: HR=1.20, 95%CI: 1.12-1.28, P＜0.001; death: HR=1.10, 95%CI: 1.02-1.17, P=0.002), and vascular invasion (recurrence: HR=1.15, 95%CI: 1.04-1.26, P=0.016; death: HR=1.10, 95%CI: 1.03-1.18, P=0.004) were independent risk factors for tumor recurrence and death after liver transplantation. The 1-, 5-, and 10-year overall survival rates after liver transplantation were 94.8%, 84.2%, and 83.5%, respectively, and the 1-, 5-, and 10-year disease-free survival rates were 840%, 75.1%, and 75.1%, respectively. AFP, involvement of major blood vessels, body mass index, and total tumor diameter had a certain value in predicting the death of HCC patients with recurrence, with an area under the ROC curve of 0.789 (95% CI: 0.719-0858). ConclusionTumor biological features before transplantation are the key factors for tumor recurrence after transplantation.

Objective:To explore the clinical value of one-step CT angiography from deep vein of lower limbs to pulmonary artery in the direction of head and foot.Methods:Twenty-eight patients who presented Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from January 2017 to June 2019 were collected. All patients who underwent one-step CT angiography of the deep veins of the lower extremities to the pulmonary artery were randomly divided into two groups, A or B, and scanned from the entrance of the thorax to 10 cm below the knee joint. Group A was foot-head direction group with delayed time scanning according to empirical method. Group B was the head-foot direction group with a single point triggered automatic tracing scan at the level of the main pulmonary artery trunk. The independent sample t-test was used to compare the scan time, dose length product (DLP), and mean CT value of enhancement of the pulmonary artery opening between the two groups. Results:The average scanning time of the foot-head scanning group was (36.4±1.2)s, the average DLP was (684.4±37.8) mGy·cm, and the average enhanced CT value of pulmonary artery image was (181.3±15.5) HU. The average scanning time of the head foot scanning group was (16.4±0.3) s, the average DLP was (441.8±34.4) mGy·cm, and the average enhanced CT value of the pulmonary artery image was (257.9±24.5) HU. Scanning time, mean DLP, and pulmonary artery level enhancement values were significantly different between the two groups ( t=17.92, 4.71, 2.44, P<0.05). Conclusions:The clinical value of one-step CT angiography from deep vein of lower limbs to pulmonary artery in the head-foot direction is significantly better than that in the head-foot direction. It can significantly shorten the scanning time, reduce the radiation dose, and increase the enhancement value of pulmonary artery to improve the detection of pulmonary embolism.

Objective:To analyze the clinical manifestations, pathology, and gene variant characteristics in children with progressive familial intrahepatic cholestasis type 3 (PFIC3).Methods:This retrospective study assessed the clinical manifestations, pathological features, gene variants, and prognosis data of 11 children with PFIC3 hospitalized in the Department of Hepatology, Fifth Medical Center, PLA General Hospital, from January 2015 to December 2022. Panel or whole exome sequencing was performed on the probands, followed by Sanger sequencing for verification within the family. Detected pathogenic variants were compared with known disease databases. Additionally, the new variants were predicted the deleteriousness and protein structure using relevant software to evaluate their pathogenicity.Results:Among the 11 PFIC3 children, 8 were boys and 3 were girls. The age of onset was 3.1 (0.2, 15.6) years. The main complaint of onset was different in the 11 patients;5 of them were abnormal liver function, 3 of them were liver and spleen enlargement, 2 of them were abdominal distension, and 1 of them was jaundice. Alanine aminotransferase, asparate aminotransferase and γ-glutamyltransferase increased in all the patients, which were(113±40), (150±44) and (270±156) U/L respectively. Moreover, direct bilirubin increased in 9 patients, and cholestasis was showed in 8 patients. All patients showed liver fibrosis on imaging, and 8 patients had cirrhosis. The pathological features of 8 cases by liver biopsy were as follows: 8 cases of fibrosis in the portal area, 7 cases of small bile duct hyperplasia, 4 cases of positive copper staining, and 5 cases of cirrhosis. A total of 17 ABCB4 gene variants were detected, including 9 new variants: c.589C>T(p.Q197X), c.1230+1G>A(Splicing), c.2914G>A(P.D972N), c.1058G>A(p.C353Y), c.956G>T(p.G319V), c.473T>A(p.L158Q), c.164T>C(p.L55S), c.2493G>C(p.R831S), and c.1150G>C(p.G384R). All 11 patients were treated with ursodeoxycholic acid and followed up for 5.1(0.6, 7.4) years. Among them, 4 cases of cirrhosis progressed continuously, 3 cases had liver transplantations, and the remaining 4 cases were stable after medical treatment.Conclusions:Children with PFIC3 have early onset, diverse clinical manifestations, rapid progression of fibrotic and cholestasis, as well as poor prognosis. Genetic testing helps to confirm the diagnosis.