AIM: To investigate the antiplatelet aggregation of naringenin and its possible mechanism . METHODS:The effects of naringenin at different concentrations on adenosine diphosphate ( ADP)-induced platelet aggre-gation and platelet spreading on immobilized fibrinogen were detected by aggregational detector and observed under fluores -cence microscope, respectively.The expression of phosphoinositide 3-kinase (PI3K) and the phosphorylation of Akt were analyzed by Western blot .RESULTS:Naringenin significantly inhibited ADP-induced platelet aggregation in a dose-de-pendent manner in vitro and in vivo, and inhibited platelet ' s spreading on immobilized fibrinogen in vitro.Further studies indicated that naringenin inhibited platelet activation accompanied by attenuating not only the activation of PI 3K, but also the phosphorylation of Akt .Moreover, naringenin combined with LY294002 additively inhibited the ADP-induced platelet aggregation.CONCLUSION:Naringenin may inhibit platelet activation by regulation of PI 3K/Akt signaling pathway.

AIM: To investigate effect of naringenin on ADP-induced platelet aggregation and its possible mechanism.METHODS: The levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) were measured in the platelets with ADP stimulation using ELISA in the presence or absence of different concentrations of naringenin.The effect of naringenin at different concentrations on the change of phosphodiesterase (PDE) activity was measured by high efficiency liquid chromatography.The effects of naringenin at different concentrations on phosphorylation of vasodilator-stimulated phosphoprotein (VASP) at positions Ser157 and Ser239 in washed platelets with ADP stimulation were analyzed by Western blot.The phosphorylation of VASP at Ser239 was also analyzed in the presence of protein kinase A (PKA), protein kinase G (PKG), or protein kinase C (PKC) inhibitors before incubation with naringenin.The platelet aggregation was measured in the presence of PKA or PKG inhibitors before incubation with naringenin.RESULTS: Naringenin elevated cGMP levels significantly but not cAMP levels in the platelets with ADP stimulation in a dose-dependent manner.Naringenin inhibited PDE activity.Naringenin increased the phosphorylation of VASP at Ser239 in a dose-dependent manner in the platelets with ADP stimulation but only modest changes in the phosphorylation at position Ser157.The phosphorylation level of VASP at Ser239 position was inhibited when the platelets were treated with PKA inhibitor before incubation with naringenin.Incubation of platelets with neither PKG nor PKC inhibitors before treatment with naringenin affect the phosphorylation of VASP at Ser239.Pretreatment with PKA inhibitor but not PKG inhibitor significantly reversed the antiplatelet aggregation by naringenin in ADP-stimulated platelets.CONCLUSION: Naringenin may inhibit platelet activation through the elevation of cGMP-and PKA-mediated VASP phosphorylation.

Objective To systematically assess the clinical efficacy and security of Wendan Decoction in the treatment of dyslipidemia. Methods Retrieved from CNKI, CBM, VIP database, Wanfang Database, and PubMed, articles of RCTs about Wendan Decoction in the treatment of dyslipidemia were included. The searching range was from the establishment of the database to April, 2016. NoteExpress3.2.0 was used to establish database. Two researchers independently screened the articles and extracted the data. Cochrane Systematic Review Manual 5.1.0 was used for quality evaluation. Meta-analysis was performed with RevMan5.3 software. Results 12 articles involving 848 patients were included. Results of Meta-analysis showed that compared with the western medicine treatment, Wendan Decoction group was more capable of significantly improving clinical effective rate of dyslipidemia [OR=2.46, 95%CI (1.41, 4.30), P=0.001], lowering the level of TG [WMD=-0.31, 95%CI (-0.46, -0.15), P=0.0001] and LDL-C [WMD=-0.25, 95%CI (-0.30, -0.20), P=0.00001], but there was no statistical significance in regulating TC [WMD=-0.14, 95%CI (-0.35, -0.08), P=0.49] and HDL-C [WMD=0.04, 95%CI (-0.01, -0.1), P=0.13] between the two groups; compared with the western medicine group, Wendan Decoction combined with western medicine group was more capable in the clinical effective rate of dyslipidemia (P<0.05), regulating the level of TG [WMD=0.30, 95%CI (-0.37, -0.23), P=0.00001], TC [WMD=0.65, 95%CI (-0.80, -0.69), P=0.00001], LDL-C (P<0.05, P<0.01) between the two groups; Wendan Decoction combined with western medicine group had low rate of adverse reactions. Conclusion Wedan Decoction can effectively regulate dyslipidemia, with good safety. High quality RCTs in large-scale and multi-center are necessary for further evidence due to the poor methodological quality of included trials with few samples and other limitations.

Objective To investigate the effect of miRNA-200b-specific inhibitor on hepatic stellate cells(HSCs) activation,proliferation,and extracellular matrix production.Methods The miRNA-200b-specific inhibitors were designed,synthesized,and transfected into HSCs with lipofectamine 2000.The supernatant and HSCs were collected after incubation for 48 h.The expression of miR-200b was detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR).The expression ofα-smooth muscle actin (oα-SMA) protein in HSCs was detected by Western blotting.The cell proliferation was assayed by methyl thiazolyl tetrazolium (MTT) method.Contents of type Ⅲ procollagen and hyaluronic acid in supernatant were determined by radioimmunoassay.Results Compared to the control group,miRNA-200b expression was decreased in the miRNA-200b inhibitor group by 82％ (P ＜ 0.01),α-SMA protein expression was reduced in the miRNA-200b inhibitor group by (19 ± 3) ％ (P ＜ 0.05),and the activity of HSCs proliferation was reduced by(33 ± 5)％ (P ＜0.01),and the contents of type Ⅲ procollagen and hyaluronic acid in supernatant were reduced in miRNA-200b inhibitor group by (35 ± 4)％ and (31 ± 2)％,respectively(P ＜0.01).Conclusions The miRNA-200b-specific inhibitor could significantly reduce the expression of miRNA-200b,and inhibit HSC proliferation,activation,and extracellular matrix production.

Objective To summarize the stomach via laparoscopic and natural orifice transluminal endoscopic surgery (NOTES) Clinical application of abdominal exploration and peritoneal biopsy unexplained ascites. Methods A retrospective analysis of our hospital clinical datum of unexplained ascites patients, 20 cases were undergone single port laparoscopic operation from January 2014 to October 2015 and 11 cases were undergone NOTES from May 2015 to July 2016. Operation time, hospitalization expenses, intraoperative bleeding, postoperative hospital stay, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were compared in tow groups. Results Laparoscopy group 20 cases, 11 cases diagnosed as tuberculous ascites, 8 cases malignant ascites, 1 case was still unknown;NOTES group 11 cases, 9 cases diagnosed as tuberculous ascites, 1 case malignant ascites and 1 case liver cirrhosis. In two groups, 30 cases were accurate diagnosed (96.8%), tuberculous ascites 20 cases (64.5%), malignant ascites nine cases (29.0%). Laparoscopy group compared with NOTES group, operation time was longer and hospitalization expenses was more, there were statistical signiifcant differences (P<0.05);postoperative hospital stays were higher (P < 0.05); intraoperative bleeding, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were no statistical difference (P>0.05). Conclusion The two methods were able to quickly and accurately diagnose ascites reason, in order to facilitate treatment and surgical trauma, less serious complications. Comparison of laparoscopy, NOTES may be more advantageous in ascites diagnosis.

OBJECTIVE: To investigate the correlation betwen varying degrees of non-acute tinnitus and anxiety and depression. METHOD: Seventy-seven outpatients with non-acute tinnitus as their in chief complaint were submitted to Tinnitus Handicap Inventory(THI), Self-Rating Anxiety Scale(SAS), and Self-Rating Depression Scale (SDS). RESULT: THI and its three subscales were found to have significant correlations with SAS and SDS. The group (THI ≥ 38) had more anxiety and depression than the mild (THI < 38). Significant correlations were also observed between THI, SAS and SDS in the group with THI ≥ 38, in contrast with the group of THI < 38. CONCLUSION Patients with THI ≥ 38 suffered from severe anxiety and depression than the mild. Doctors should pay more attention to these patients, especially their psychological disorders.
Anxiety ; complications ; Depression ; Depressive Disorder ; Humans ; Personality Inventory ; Stress, Psychological ; Surveys and Questionnaires ; Tinnitus ; complications ; psychology

Objective To explore the clinical value of transgastric natural orifice transluminal endoscopic surgery(NOTES)in diagnosing unexplained ascites.Methods The clinical data in 12 cases of unexplained ascites diagnosed by adopting transgastric approach NOTES and performed abdominal exploration and peritoneal biopsy in our hospital from November 2015 to July 2016 were retrospectively analyzed.The operative risk and clinical application value were evaluated by statistically analyzing the postoperative complications occurrence and the diagnosis rate of disease.Results The definite diagnosis rate reached 100％ verified by pathology after abdominal exploration and peritoneal biopsy,in which 8 cases(66.7％)were tuberculous peritonitis,2 cases(16.7％)were liver cirrhosis,1 case(8.3％)was peritoneal mesothelioma,1 cases(8.3％)was peritoneal metastatic carcinoma;2 cases appeared abdominal pain after operation,including 1 case of neutrophil ratio increase,symptoms and persistent time of abnormal laboratory indexes did not exceed 24 h,the incidence rate was 8.3％;no complications of abdominal cavity infection,incision bleeding and puncture site fistula occurred.Conclusion The transgastric NOTES for conducting abdominal exploration and peritoneal biopsy in the diagnosis of unexplained ascites has the advantages of small trauma,less complications and rapid postoperative recovery,possesses an important clinical application value.

Clinical phenotype and gene characteristics of a patient diagnosed with Imerslund-Gr?sbeck syndrome (IGS) in Department of Neurology, Children′s Hospital of Soochow University in December 2018 were analyzed retrospectively, and literature review was conducted.The 16 years and 5 months old boy was admitted to the hospital with symptoms of weakness of lower limbs for 2 weeks.He had a history of megaloblastic anemia and isolated proteinuria.Genetic metabolism of hematuria showed methylmalonic academia.Genetic analysis revealed a compound heterozygous AMN gene mutation[c.742C>T(p.Q248 *) and c. 761G>A(p.G254E)]. These two mutations were derived from his parents respectively, which had been reported before.Symptoms of the patient improved after intramuscular administration of hydroxycobalamin and oral betaine.Review of the literature indicated that the clinical manifestations of AMN gene-related IGS were mostly megaloblastic anemia and isolated proteinuria, and the older children might suffer from neurological symptoms such as movement disorders, dementia, delirium or psychosis.The clinical phenotype of this disease was variable, which might easily lead to misdiagnosis.The patient presented with a special phenotype of mild reversible peripheral neuropathy, which expanded the clinical phenotype of pathogenic genes of AMN gene.In addition, peripheral neuropathy caused by vitamin B 12 metabolic disorders is reversible, and it is suggested to measure vitamin B 12, test related genes and treatment with vitamin B 12 in peripheral neuropathy of unknown etiology.

Objective To summarize the CT characteristics of tumor deposition adjacent to colorectal cancer (CRC),and provide the evidences for differential diagnosis.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 26 CRC patients who were admitted to the Wuxi Second People's Hospital of Nanjing Medical University from May 2015 to April 2017 were collected.Patients underwent preoperative multi-slice spiral CT scan and double-phase enhanced scan,and then received open surgery.Observation indicators:(1) characteristics of multi-slice spiral CT scan;(2) differential comparisons;(3) follow-up.Follow-up using telephone interview was performed to detect patients' prognosis once every 3 months up to May 2017.Measurement data with normal distribution were represented as (x)±s.Comparisons between groups and among groups were respectively analyzed using the t test and the one-way ANOVA.Pairwise comparison was done using the SNK method.Results (1) Characteristics of multi-slice spiral CT scan:of 26 patients,17 underwent double contrast enhanced scans of chest,abdomen and pelvic and 9 underwent double contrast scans of abdomen and pelvic.Primary tumors of 18 and 8 patients respectively located in the colon and rectum.Forty-one tumor deposits of 26 patients were collected,with number of tumor deposits of 1.6±0.9 per case,and number of tumor deposits ＜ 3 and ≥3 respectively were found in 20 and 6 patients.Tumor deposits were often isolated in the fat spaces around the rectum or colon and unconnected with the surrounding primary tumor or lymph node.Distance to the center of primary tumor was (2.6±l.0)cm (range,0.2-5.0 cm),the distance ＜2.6 cm and ≥2.6 cm were respectively detected in 22 and 19 patients.Thirty-three tumors showed signs of lobulation,22 showed signs of burr and 7 showed liquefaction necrosis,and there was a combination of multiple imaging characteristics in the same tumor deposit.The maximum width,minimum width,maximum diameter,plain scan value of CT,CT enhancement values in the arterial phase and venous phase in 41 tumor deposits were respectively (1.15 ± 0.60)cm,(1.11±0.44)cm,(1.13±0.49)cm,(27±13)HU,(28±14)HU and (49±19)HU.Of 41 tumor deposits,34 demonstrated homogeneous density in the plain scan,and obviously enhancement in early enhanced scan,with homogeneous enhancement;7 demonstrated heterogeneous density in the plain scan,with internal liquefaction necrosis,and enhanced scans showed no enhancement in the areas of necrosis and obviously early enhancement in the areas of non-necrosis.(2) Differential comparisons:26 patients underwent open surgery,including 8 with right hemectomy,2 with transverse colon resection,4 with left semicolon resection,2 with simple sigmoid resection,2 with abdominoperineal resection of rectal cancer and 8 with low anterior rectal resection,and all patients received postoperatively individualized treatment.Fifty-two lymph nodes with distance to center of primary tumor ＜ 5.0 cm that were confirmed by pathological examination were collected,including 19 metastatic lymph nodes.Of 41 tumor deposits,33 were irregular,and 8 were regular and round-like or oval-like shape.Of 19 metastatic lymph nodes,16 were regularly round-like shape,1 showed irregular shape and edge blur,and 2 were irregular with a mutual integration.The maximum width,minimum width and maximum diameter of 19 metastatic lymph nodes were respectively (1.09± 0.33) cm,(1.01 ± 0.23) cm and (1.05 ± 0.20) cm,with statistically significant differences in the above indicators between metastatic lymph nodes and tumor deposits (t =5.48,4.80,7.75,P＜0.05).The plain scan value of CT,CT enhancement values in the arterial phase and venous phase were respectively (12±7) HU,(18± 12) HU,(42± 15) HU in 19 metastatic lymph nodes and (33±6) HU,(31 ±15) HU,(53± 14)HU in 26 primary tumors,showing statistically significant differences in the plain scan value of CT and CT enhancement values in the arterial phase among tumor deposits,metastatic lymph nodes and primary tumors (F=24.43,4.46,P＜0.05),and no statistically significant difference in CT enhancement value in the venous phase (F=2.41,P＞0.05).There were statistically significant differences in the plain scan value of CT and CT enhancement values in the arterial phase between tumor deposits and metastatic lymph nodes (q =5.48,2.50,P＜0.05) and between metastatic lymph nodes and primary tumors (q =6.82,2.84,P＜0.05),and no statistically significant difference between tumor deposits and primary tumors (q =2.15,0.65,P＞0.05).Of 19 metastatic lymph nodes,11 demonstrated homogeneous density in plain scan,with a lower density compared with tumor deposits and primary tumors,and relatively homogeneous enhancement in the arterial phase of enhanced scan;8 demonstrated heterogeneous density with internal liquefaction necrosis,and ring-shaped enhancement in enhanced scan with no enhancement in the areas of necrosis.The density and enhancement range in the arterial phase and venous phase of tumor deposits were similar to primary tumors.(3) Follow-up:24 patients were followed up for 1-25 months,with a follow-up rate of 92.3％(24/26) and a median time of 17 months.Of 24 patients,2 were dead,and survival time were respectively 9 months and 21 months;22 had good survival.Conclusions Multislice spiral CT examination of tumor deposits demonstrates larger and irregular shape,with the signs of lobulation and burr,and the density in plain scan is similar to the primary tumor,with obviously enhancement in early enhanced scan.The metastatic lymph nodes are mostly round-like shape,diameter is smaller than that of tumor deposits,density in the plain scan and CT enhancement values in the arterial phase are lower than that of tumor deposits.

Objective:To investigate the application value of 3D printing technology in preoperative evaluation of laparoscopic radical resection of right colon cancer.Methods:The prospective study was conducted. The clinical data of 60 patients with right colon cancer who were admitted to the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from January to November of 2019 were collected. Patients were randomly divided into two groups by random number method. All the 60 patients were examined by plain scan and enhanced X-ray computed tomography (CT) preoperatively. Patients with vascular images printed into a 1∶1 full simulation entity using the 3D printing technology were divided into 3D printing group, and patients who only completed the plain scan and enhanced CT examination were divided into control group. All the 60 patients underwent laparoscopic complete mesocolic excision for right colon cancer. Observation indicators: (1) anatomic courses of Henle trunk of the 3D printing group in the preoperative 3D printing models and their consistency with intraoperative anatomic courses; (2) intraoperative and postoperative situations of two groups. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent-sample t test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results:A total of 60 patients were selected for eligibility, including 42 males and 18 females, aged (64±7)years, with a range from 44 to 78 years. Of the 60 patients, 30 were in the 3D printing group and 30 were in the control group. (1) Anatomic courses of Henle trunk of the 3D printing group in the preoperative 3D printing models and their consistency with intraoperative anatomic courses: Henle trunk was observed in 28 of the 30 patients in the 3D printing group. Of the 28 patients, 7 had the gastropancreatic trunk of 2 branches formed with the right gastroepiploic vein and the superior anterior pancreaticoduodenal vein, 13 had the gastrocolonic trunk of 2 or 3 branches formed with the right gastroepiploic vein, the middle colonic vein and (or) the right colonic vein (including 4 cases with gastrocolonic trunk of 2 branches formed with the right gastroepiploic vein and the middle colonic vein, 6 cases with gastrocolonic trunk of 2 branches formed with the right gastroepiploic vein and the right colonic vein, 3 cases with gastrocolonic trunk of 3 branches formed with the right gastroepiploic vein, the middle colonic vein and the right colonic vein), 8 had the gastropancreaticocolonic trunk of 3 or 4 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein, the right colonic vein and (or) the middle colonic vein (including 4 cases with gastropancreaticocolonic trunk of 3 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein and the middle colonic vein, 2 cases with gastropancreaticocolonic trunk of 3 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein and the right colonic vein, 2 cases with gastropancreaticocolonic trunk of 4 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein, the right colonic vein and the middle colonic vein). The consistency of anatomic courses of Henle trunk of the 28 patients in the preoperative 3D printing models with intraoperative anatomic courses of bared Henle trunk was 100%(28/28). (2) Intraoperative and postoperative situations of two groups: the operation time, volume of intraoperative blood loss, the numbers of lymph node dissected, cases with postoperative complications (cases with incision infection, cases with intestinal obstruction, cases with anastomotic leakage, cases with pulmonary infection), postoperative duration of hospital of the 3D printing group were (147±18)minutes, (79±29)mL, 19.1±2.8, 3 (1, 1, 0, 1), (9.0±2.5)days, respectively. The above indicators of the control group were (172±16)minutes, (118±17)mL, 15.6±2.6, 4(1, 1, 1, 1), (9.1±2.6)days, respectively. There were significant differences in the operation time, volume of intraoperative blood loss, the numbers of lymph node dissected between the two groups ( t=-5.630, -18.400, 3.318, P<0.05), and there was no significant difference in the cases with postoperative complications and postoperative duration of hospital between the two groups ( χ2=0.875, t=0.103, P>0.05). Conclusion:For laparoscopic right colon cancer radical resection, 3D printing technology can effectively evaluate the preoperative vascular anatomic courses, which can shorten operation time, reduce volume of intraoperative blood loss and improve the number of lymph node dissected. Trial Registration: This study was registrated at Chinese Clinical Trail Registry with the registration number of ChiCTR1800017161.